for this study , a 31-item self - rated questionnaire was designed . for the same , all the available internet addiction questionnaires were reviewed .
in addition , items were generated keeping the icd-10 criteria of substance dependence in mind .
this questionnaire was reviewed by a panel of six qualified psychiatrists , including those with a specialist experience of dealing with addictive disorders .
in addition , the questionnaire was reviewed by a clinical psychologist and a psychiatric social worker working in this field .
all the panelists were requested to critically review the questionnaire for completeness of addiction criteria as per substance dependence syndrome criteria of icd-10 , for completeness of excessive behaviors that could be associated with internet use , and for overlapping questions , if any . after receiving the feedback ,
a 42-item questionnaire was generated , which was again reviewed by all the panelists for its completeness .
no. the questionnaire covered all the icd-10 criteria ( which were covered by 1 - 14 questions of the questionnaire ) and young 's criteria for internet addiction . later , basic demographics ( age , gender , level of education , and occupation ) , basic internet use pattern ( duration of internet use in years , for how long are you using internet daily , number of internet use hours per day , and various purposes for which you use internet ) , and one question tapping family history of substance dependence were added .
the questionnaire was sent to 284 persons through e - mail and was given to 38 internet users in person over a period of 2 months by one of the authors ( k.c . ) . of the 284 persons approached through e - mail , 11 e - mails met with failure notice generated by the system ( due to nonexistent / wrong e - mail addresses ) .
the subjects were informed about the purpose of the study and were given freedom of choice to respond or not to respond .
they were also assured about maintenance of confidentiality and anonymity so that no individual responder could be identified from the collective data .
the questionnaire was sent to the subjects one to four times ( those who responded back were not sent reminder mails ) at a weekly interval .
it was presumed that the persons who would respond would provide implied consent to participate in the study .
the responses on the questionnaire were evaluated on the icd-10 substance dependence criteria and young 's iadq .
the data were analyzed by using spss version 14.0 for windows ( spss , chicago , il ) .
mean and standard deviation were calculated for the continuous variables and frequencies , and percentages were computed for the discontinuous variables .
comparisons were done by using unpaired student 's t test and chi - square test .
spearman 's rank order correlation analysis was used to study the relationship between parametric variables ( age , total duration of internet use , duration of daily internet use , time spent in internet use everyday ) and internet addiction .
the data were analyzed by using spss version 14.0 for windows ( spss , chicago , il ) .
mean and standard deviation were calculated for the continuous variables and frequencies , and percentages were computed for the discontinuous variables .
comparisons were done by using unpaired student 's t test and chi - square test .
spearman 's rank order correlation analysis was used to study the relationship between parametric variables ( age , total duration of internet use , duration of daily internet use , time spent in internet use everyday ) and internet addiction .
of the total 312 persons contacted , 104 ( 33.4% ) responded to the survey .
males ( 58.7% ) outnumbered females ( 41.3% ) , and most of them had completed their graduation ( n=101 ; 97.1% ) .
half of the sample comprised of doctors , about a fifth ( 20.2% ) of sample comprised other professionals ( nurses , engineers , and scientists ) , and the rest were students ( 29.8% ) .
the mean age of the sample was 27.73 years ( sd 5.14 ; range 20 - 49 ) , with females ( mean 24.79 ; sd 4.64 ) being significantly younger ( t - test value 5.56 , p<0.001 ) than males ( mean 29.80 ; sd 4.44 ) .
the mean duration of internet use was 73.43 months ( sd 44.51 ) , and this was significantly longer ( t - test value 3.00 ; p<0.001 ) for males ( mean 84.03 , sd 43.75 ) compared to females ( mean 58.39 , sd 41.58 ) .
two - thirds ( 65.38% ) of them were using internet on a regular basis for a period of more than a year , and the mean duration of daily internet use was 39.13 months ( sd 35.97 ) and this was significantly longer ( t - test value 3.43 ; p=0.001 ) for males ( mean 48.80 , sd 36.48 ) than for females ( mean 25.41,sd 30.73 ) . the average time spent in internet use was 2.13 h everyday ( sd 1.98 ) , with no significant difference between males ( mean 2.44 , sd 2.17 ) and females ( mean 1.69 , sd 1.60 ) .
more than half ( 56.73% ) of the sample was using internet at least for 2 h / day , and the daily internet use of more than half of the sample ( 58.6% ) was in the range of 1 - 3 h. nine ( 8.65% ) subjects had a first - degree relative who was currently using or had used alcohol or any other drug of abuse , leading to marked dysfunction in social and occupational functioning . when the respondents were asked to rank the purposes of their internet use on a scale of 1 ( i.e. , most common purpose for use ) to 5 ( i.e. , least common purpose for use ) , the most common purpose of use was educational for two - thirds ( 62.5% ) of the sample .
other common purposes of use were chatting ( 50.9% ) , recreational ( 37.5% ) , and e - mailing ( 33.6% ) .
table 1 shows the items of internet use questionnaire grouped under suitable criteria of icd-10 substance dependence .
the five most commonly endorsed items were as follows : the need to use the internet everyday ( 53.8% ) , internet use helping to overcome bad moods ( 50% ) , staying online longer than one originally intends to ( 43.3% ) , eating while surfing ( 24% ) , and physical activity going down since one has started using the internet ( 22.1% ) .
items of internet use questionnaire for assessing the icd-10 criteria , any subject who answered positively on any 1 item covering a particular criterion was considered to be fulfilling that criterion . accordingly
, the icd-10 dependence criteria that were fulfilled by about half of the sample were persistence despite harm ( 54.8% ) , craving ( 53.8% ) , preoccupation with use ( 51% ) , and dyscontrol ( 49% ) .
the icd-10 criteria of withdrawal ( 20.2% ) and tolerance ( 14.4% ) were fulfilled by only a few subjects .
overall , 51.9% of the sample met any 3 of the total 6 icd-10 criteria together , and hence could be considered as 
cases of internet addiction according to the definitional equivalent of the icd-10 diagnostic guidelines for substance dependence . from the 31 items of the internet use questionnaire ,
items similar to young 's iadq [ table 2 ] were chosen ; the prevalence of internet addiction as per iadq ( i.e. , had at least five criteria out of eight ) was only 3.8% .
young 's criteria for internet addiction significant association was seen between dependence as per icd-10 criteria and male gender ( spearman 's rank order correlation 0.325 ; p<0.01 ) , duration of daily internet use ( spearman 's rank order correlation 0.228 ; p<0.05 ) , and average time spent in internet use everyday ( spearman 's rank order correlation 0.273 ; p<0.01 ) .
significant association was seen between dependence as per icd-10 criteria and male gender ( spearman 's rank order correlation 0.325 ; p<0.01 ) , duration of daily internet use ( spearman 's rank order correlation 0.228 ; p<0.05 ) , and average time spent in internet use everyday ( spearman 's rank order correlation 0.273 ; p<0.01 ) .
this was a preliminary survey to evaluate the internet addiction and impact of internet use in a purposive indian sample . in the present study ,
available data from the community and online surveys as well as clinical samples[3338 ] suggest that internet addiction appears to have a male preponderance . in a finnish study , men had significantly higher mean score on the internet addiction test ( iat ) than did women .
a study that included adolescents revealed 50% increased odds for males to be addicted to the internet ( or=1.5 , 95% ci=1.12.2 ) when compared with females .
it is suggested that the gender distribution may be explained by the fact that men are more likely to express interest in games , pornography , and gambling activities that have all been associated with problematic internet use .
studies have found that the internet addiction usually manifests itself in the late 20s or early 30s . the mean age ( 27.735.14 years ) of the subjects in the index study also support the same .
black et al . reported a lag time of 11 years from the initial use to the problematic use .
other studies have also reported a 3-year history of problematic use at the time of interview .
subjects in the present study had a lag period of approximately 6 years ( 73.4344.51 months ) from the initial computer use to the index assessment for internet addiction , which is in the range of that reported in the other studies .
subjects in the present study used internet for 2.13 h / day , which translates into 14.91 h / week , which is lower compared with that reported by other studies . in the index study the most commonly endorsed items on internet use questionnaire were the need to use the internet everyday ( 53.8% ) , internet use helping to overcome bad moods ( 50% ) , staying online longer than one originally intends to ( 43.3% ) , eating while surfing ( 24% ) , physical activity going down since one has started using the internet ( 22.1% ) , using internet to escape from problems ( 18.3% ) , becoming upset on attempting to cut down internet use ( 17.3% ) , surfing being responsible for spending less time with family members ( 16.3% ) , surfing causing a change in sleep pattern ( 16.3% ) , and so on .
previous studies from other countries have also reported similar positive and negative impact of internet use as found by us .
a study from india too reported that those who were dependent on internet would delay their work to spend time online , lose sleep due to logging in till late night , feel lonelier , and feel life would be boring without the internet as compared with nondependent subjects .
the studies that have estimated the prevalence of internet addiction have come up with varying results ( 0.9 - 38% ) depending on the criteria used and the sample studied . in a methodologically rigorous study that involved a random telephone survey of 2513 adults aged 18 years and older and employed four criteria sets , prevalence rates varied from 0.3 to 0.7% .
the only published study from india , which evaluated internet addiction by using davis online cognition scale in school - going children aged 16 - 18 years , reported a prevalence of 18% .
the reasons for huge variation in the prevalence rates could be as follows : difficulty in conceptualizing internet addiction , heterogeneity of population studied , lack of availability of standard diagnostic criteria , studies failing to differentiate between essential and nonessential internet use , and nonconsideration of psychiatric comorbidity in some of the studies.[13163336384548 ] more surprisingly , the studies that have used young 's iat have also come up with varied prevalence rates .
this suggests that a single instrument can not reliably pick up the cases of internet addiction .
another fact that contributes to a wide variation in the prevalence rates is the fact that internet addiction has been viewed from different theoretical perspectives such as an impulse control disorder , obsessive compulsive disorder , and substance use disorder .
however , there is very little agreement between these on the crucial components and dimensions of internet addiction . in the present study , the prevalence rate of 51.9% as per icd-10 substance dependence criteria seems to be overinflated whereas the prevalence of 3.8% as per iadq is probably an underestimate , although both the figures are very near to range reported in the literature .
this wide variation suggests that some conceptual issues have to be addressed before we even plan to define internet addiction and estimate its prevalence .
for example , are we going to diagnose internet addiction in people who are compelled to use internet for prolonged periods of time because of the nature of their occupation ?
what about people who are logged on to internet all the time just checking their mails intermittently ?
should it be appropriate to diagnose internet addiction in a job seeker or a researcher who try to keep abreast of the recent developments by logging on to the internet ?
the internet , like mobile phones and other electronic gadgets , has become a part and parcel of modern life .
an in - depth interview of the subject , with corroboration of history from the family members , might be a more reasonable approach to diagnose internet addiction .
a diagnostic questionnaire at best can serve as a screening instrument to detect the population at risk of internet addiction rather than identifying the persons having full blown disorder .
no face - to - face interview was conducted to explore the phenomenology of internet addiction ; data were exclusively gathered by the self - reporting internet use questionnaire .
items were generated from various questionnaires developed to identify internet addiction and some items were constructed keeping the icd-10 criteria of substance dependence in mind .
it can be argued that icd-10 dependence criteria are developed for psychoactive substance dependence and hence can not be applied to those substance - neutral behaviors commonly performed in daily life .
thus , the item for assessing the criterion craving ( item 1 : do you feel the need to use the internet everyday ? ) would easily capture the work - related internet users for whom daily internet use is essential .
the questionnaire is self - administered and thus the authors can not clarify the meaning of such items .
yes. however , when the hardcore physical dependence features , i.e. , tolerance and withdrawal , are concerned , only about 15% of subjects fulfill such criteria . as mentioned earlier , this study did not differentiate between essential and nonessential internet use .
the issue of the presence of psychiatric comorbidity in the subjects was also not considered . nevertheless ,
in view of the current ongoing debate on internet addiction after its inclusion in the proposal draft of dsm - v , this study from india could provide some insights into the impact of internet use and , more importantly , the issues facing the delineation of a syndrome of  internet addiction. the sharp difference in the prevalence estimates of internet addiction depending on the type of criteria used shows the fragility of the construct of internet addiction .
this study should not be cited as a usual  prevalence study of a particular disorder , because of both sampling issues and methodological issues as mentioned . moreover , the issue of whom to treat and whom not to still remains open . before embarking on any kind of major manipulation to the diagnostic system , a through understanding of the concept of internet addiction is required .
this study brings into focus some of these conceptual and methodological issues that must be debated before any decisive action in this regard is taken .
 background : to study the pattern of internet use across people of various professions who have access to it ; the impact of internet use on their personal , social , and occupational life ; and to evaluate their internet use on the international classification of diseases  tenth revision ( icd-10 ) dependence criteria and young 's internet addiction diagnostic questionnaire ( iadq).materials and methods : hundred four respondents were assessed on a 31-items self - rated questionnaire covering all the icd-10 criteria and young 's criteria for internet addiction.results:the typical profile of an internet user was as follows : the mean duration of internet use was 73.43 months ( sd 44.51 ) , two - thirds ( 65.38% ) of them were using internet on a regular basis for a period of more than a year , the mean duration of daily internet use was 39.13 months ( sd 35.97 ) , the average time spent in internet use was 2.13 h ( sd 1.98 ) everyday , more than half ( 56.73% ) of the sample was using internet at least for 2 h / day , and the most common purpose of internet use was educational for two - thirds ( 62.5% ) of the sample . 
 the five most commonly endorsed items were as follows : the need to use the internet everyday ( 53.8% ) , internet use helping to overcome bad moods ( 50% ) , staying online longer than one originally intends to ( 43.3% ) , eating while surfing ( 24% ) , and physical activity going down since one has started using the internet ( 22.1% ) . 
 when evaluated on icd-10 substance dependence criteria and young 's iadq separately , the prevalence of the  cases of internet addiction came out to be 51.9 and 3.8% , respectively.conclusions:the internet affects the users life in multiple ways . 
 the sharp difference in the prevalence estimates of internet addiction depending on the type of criteria used shows the fragility of the construct of internet addiction . 
 a cautious approach should be adopted while revising the nosological system to differentiate users from those who are dependent . 
MATERIALS AND METHODS
Data analysis
RESULTS
Correlation analysis
DISCUSSION