Problematic Social Media Use and Depression among Addis Ababa University Students, Ethiopia: Institutional based Cross Sectional Study

doi:10.21203/rs.3.rs-5191222/v1

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Research Article

Problematic Social Media Use and Depression among Addis Ababa University Students, Ethiopia: Institutional based Cross Sectional Study

https://doi.org/10.21203/rs.3.rs-5191222/v1

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Background

Problematic social media use (PSMU) and its potential link to depression among university students have become significant areas of concern. This study aims to explore the prevalence of PSMU and its relationship with depression symptoms and identify demographic factors associated with level of depression among undergraduate students at Addis Ababa University's main campus.

Methods

An institutional-based cross-sectional study was conducted among 316 students using a stratified random sampling method from March to April 2024. Data were collected using standardized questionnaires, including the Bergen Social Media Addiction Scale (BSMAS) and the Patient Health Questionnaire-9 (PHQ-9). Descriptive statistics and logistic regression analysis were employed to analyze the data.

Results

The study found that 17.1% of the respondents exhibited problematic social media use. Additionally, the prevalence of depression was found to be 77 (24.3%:95% CI :19.7-29.5) with 4.4% of the participant found to have severe depression.

The odds of depression are 1.6 times higher in those compared to non-problematic social media users (AOR = 1.62; 95% CI: 1.4-1.8; p < 0.0001). Moreover, individuals who frequently use social media to watch pornography have a 14 times greater likelihood of experiencing depression compared to those who do not watch pornography at all. Compared to men, female students report greater levels of depression.

Conclusions

The findings indicate a high prevalence of PSMU among undergraduate students at Addis Ababa University and a significant association with depression symptoms. These results highlight the need for targeted interventions to address PSMU and its mental health implications among university students.

Psychiatry

Problematic social media use (PSMU)

Depression

TikTok

Social media addiction

Addis Ababa University

Social media is a way of communication that is an electronic communication platform, such as websites for social networking, where individuals create virtual communities to share information, ideas, and personal messages (1). It is a global phenomenon, connecting people worldwide and creating a sense of a smaller, interconnected village.

In recent years, the ubiquitous presence of social media platforms has profoundly influenced the lives of young adults worldwide, including university students. Social media platforms such as Facebook, Instagram, and Twitter offer unprecedented opportunities for connectivity, information sharing, and social interaction (2). However, alongside these benefits, concerns have arisen regarding the potential adverse effects of excessive social media use on mental health, particularly its association with depression among young adults.

Studies have demonstrated that increased engagement with social media can lead to declines in subjective well-being and heightened levels of depressive symptoms among young adults in various cultural contexts(3, 4). A Meta-analytic findings further shows the consistent association between problematic social media use and increased risk of depression across diverse populations(5).

Additionally, a study explored social media patterns among pharmaceutical undergraduates at Kenyatta University, emphasizing WhatsApp and YouTube as primary platforms for leisure and academic information sharing(6). These findings emphasize the high social media usage among university students and warrant an examination of its potential correlation with depression levels.

Depression is a global mental health concern that affects over three million individuals worldwide, with major depressive disorder (MDD) contributing significantly to disability. In the U.S., approximately 16.1 million aged 15 to 44 experience major depressive disorder annually. Africa, including Ethiopia, faces substantial challenges, with millions affected by depressive disorders (7).

Among university students, Numerous studies highlight the alarming rates of depression among university students(8). The effects of depression extend beyond mental and academic performance(9, 10). To address this issue, understanding the causes of depression is crucial, making the proposed study on the relationship between social media use and depression among university students at Addis Ababa University.

In Ethiopia, the rapid expansion of social media usage has paralleled the country's increasing access to the internet, particularly among young adults and university students. A Study done on the prevalence and factors associated with problematic internet use among Dilla university students found that a high prevalence of problematic Internet use and there were various factors associated with increased prevalence of problematic Internet use(11). Although this study tried to highlight the prevalence of internet use among university students, it didn't show problematic social media use which is different from the general problematic internet use.

There are few literatures that showed the prevalence of social media use and associated factors among different university students. However, on manual and different journal searches, there is scarce literature that reveals the relationship between problematic social media use and depression rate among Ethiopian university students, including the current study area.

Furthermore, this study addressed important interconnected factors that could be managed by stakeholders. It aimed in providing students with information on safe, beneficial, and healthy Internet practices and to help control psychological issues among them. Therefore, this study aimed at evaluating how widespread problematic social media use is and its relationship with depression among undergraduate students at Addis Ababa University.

Statement of the Problem

With the continuous evolution of technology, the increase in internet coverage, and the regular emergence of social media applications, young people have increasingly shifted towards online interactions rather than traditional face-to-face communication. Various activities are now predominantly conducted through diverse online social media platforms.

As of April 2024, globally social media users reached 5.07 billion, with an additional 2259 million users in the last 12 months, resulting in 62.9% worldwide social media usage (12). This data shows the rapid increase in the social media users with a significant proportion being young people.

In the United States of America (U.S.A), digital consumers spend approximately 2.5 hours daily on online socializing, with 69% of adults using more than one social media platform. On average, an American internet user has 7.1 social media accounts, and 88% of U.S. citizens' social media users aged 18 to 29 find it challenging to function without social media. These statistics highlight the prevalent use of social media, especially among young adults and university students (12).

Existing literature highlights the heightened use of social media among young individuals, particularly those enrolled in universities. A study conducted which revealed that university students are among the most active users of social media, utilizing these platforms for both academic and social purposes(13). Similarly, another study found that a significant proportion of university students spend multiple hours daily on social media(14).

A systematic review revealed that the prevalence of problematic social media use among university students ranges from 13–31%(15). In the United States, a study found that approximately 29% of university students reported experiencing problematic social media use(4).

Meta-analytic findings further showed the consistent association between problematic social media use and negative mental health outcomes among university students. Another meta-analysis found an average prevalence of 24.5% for problematic social media use among this demographic(5). The analysis confirmed consistent associations between problematic use and increased risk of depression. Additionally, a study in China noted that 22.3% of Chinese university students met the criteria for problematic social media use, with female students more likely to report such behaviors compared to male students(16).

Concurrently, a literature review has revealed varying levels of depression among university students on a global scale. A reported that a substantial percentage of university students experience depressive symptoms(8). A study in Saudi Arabia found that the prevalence of depression among university students was notably high, highlighting the mental health challenges faced by this demographic(17). A study that determine the associations between depression, sociodemographic, social and health variables among undergraduate students of Obafemi Awolowo University in Nigeria identified high levels of depressive symptoms among university students(18). Another study further illustrated the severity of this problem in Kenya, where a significant proportion of university students were found to suffer from moderate to severe depression(19).

The relationship between problematic social media use and depression among university students is a significant concern globally, with research highlighting consistent patterns across different areas. A meta-analytical study have demonstrated a robust positive correlation between social media addiction and depressive symptoms among college students, showed the widespread nature of this issue(20).

These findings collectively suggest that while social media provides valuable benefits for university students, such as enhanced communication and information sharing, it also poses risks to their mental health, particularly in the form of increased depressive symptoms.

Given the observable surge in social media utilization and the concurrent rise in depression levels among undergraduates, it becomes imperative to investigate the potential correlation between social media use and depression in this population.

Despite the global and regional recognition of these issues, there is a lack of comprehensive research focused on Ethiopian university students, particularly those at Addis Ababa University. This gap in knowledge suggests the need for this study to assess the prevalence and impact of problematic social media use on depression among regular undergraduate students at Addis Ababa University.

Objective of the study

General objective

The major objective of the study is to examine the relationship between problematic social media use and depression levels among Addis Ababa University’s main campus undergraduates.

Specific Objectives

1. To determine the prevalence of problematic social media use among students at Addis Ababa University’s main campus.

2. To examine the relationship between problematic social media use and the presence of depression symptoms among students at Addis Ababa University’s main campus.

3. To determine the association between demographic factors and the level of depression among students at Addis Ababa University’s main campus.

Significance of the study

The rise of social media has revolutionized the way individuals communicate, interact, and share information. This transformation is particularly pronounced among university students.

This study, focusing on Addis Ababa University main campus regular undergraduate students, aims to explore the prevalence and relationship of problematic social media use (PSMU) and depression. The significance of this study lies in its potential to fill critical research gaps, inform policy and intervention strategies, and contribute to the broader understanding of social media's impact on mental health within an Ethiopian context.

One of the primary significance of this study is its potential to address a notable research gap. While numerous studies have explored the relationship between social media use and mental health in Western contexts, there is a scarcity of research focusing on African populations, particularly Ethiopian university students. This study will provide much-needed empirical data on the prevalence of PSMU and its correlation with depression among Addis Ababa University students, offering insights that are directly relevant to the Ethiopian context.

Depression are often under-recognized and under-treated in many developing countries, including Ethiopia. This study aims to raise awareness about the potential mental health risks associated with excessive social media use. By highlighting the prevalence of PSMU and its association with depression, the study can contribute to a broader understanding of these issues among students, faculty, and administrators at Addis Ababa University. Increased awareness can lead to more proactive measures to identify and support students struggling with mental health issues, ultimately fostering a healthier university environment.

The findings of this study have significant implications for policy and intervention strategies at Addis Ababa University and potentially other educational institutions in Ethiopia. Understanding the relationship between social media use and depression can inform the development of targeted interventions aimed at promoting healthy social media habits and improving mental health support services. Additionally, mental health services could be tailored to address the specific needs of students who exhibit signs of PSMU and depression, ensuring timely and effective support.

This study can serve as a foundation for future research in the area of social media use and mental health among Ethiopian students. By providing empirical data and insights, it can stimulate further investigations into the causal mechanisms underlying the relationship between PSMU and depression.

While this study is localized to Addis Ababa University, its findings will contribute to the global literature on social media use and mental health. By providing data from a non-Western context, the study can enhance the diversity and comprehensiveness of existing research.

For educators and administrators, the study provides evidence-based insights that can inform the development of curricula and programs aimed at promoting digital literacy and mental well-being. Health professionals, including counselors and psychologists, can use the findings to enhance their understanding of the digital behaviors of university students and tailor their interventions accordingly.

By addressing a critical research gap, enhancing mental health awareness, informing policy and intervention strategies, guiding future research, and contributing to global literature, the study holds the potential to make a substantial impact on the understanding and management of mental health issues related to social media use. The practical applications of the study's findings can lead to improved mental health and academic performance, promoting the holistic development of students and encouraging responsible social media use.

Ultimately, this study aims to contribute to the well-being of university students and foster a healthier, more supportive educational environment.

Problematic Social Media Use Prevalence

Problematic Social Media Use(PSMU) has been defined as the excessive, compulsive, or dysfunctional use of social media platforms, leading to negative consequences such as impaired daily functioning, psychological distress, or interference with real-life relationships(21).

Problematic social media use among university students varies widely, with reported rates ranging from 0.8–47.7% in different studies(22, 23). The majority of research indicates that excessive internet usage negatively impacts physical health, family relationships, and academic achievement.

Studies conducted in various countries have showed significantly different estimates. For instance, the prevalence of problematic Internet use among college students was very low in Italy 0.8% (22). Whereas in the UK, the prevalence rate has been reported as high as 18%(24).

A study in Japan investigated the prevalence and assessment of Internet addiction (IA) among college students through cross-sectional surveys conducted in 2014 and 2016, involving 1005 respondents with a mean age of 18.9 years. The findings revealed that 21.6% of students found to have internet addicted which is highly prevalent among college students(25).

A pilot study conducted at Ugandan public university among medical students examined the association between problematic internet, social media, and smartphone use with depression symptoms. The study found that 16.73% of the students reported moderate to severe depression symptoms. Prevalence rates for being at risk of smartphone addiction were 45.72%, social media addiction 74.34%, and internet addiction 8.55%(26).

A study conducted at Dilla University, Ethiopia, found a high prevalence of problematic Internet use among undergraduate students, with 19.4% exhibiting symptoms according to Young's internet Addiction Test(11). Significant factors associated with this behavior included male gender, depression, and the consumption of khat or caffeinated drinks. This finding is comparable with the global studies.

Even though problematic Internet use is becoming a serious problem and highly prevalent across the world, there is no much study done among ethiopian university students.

Prevalence of Depression Among University Students

Depression among university students has been extensively studied due to its significant impact on mental health and academic performance. Various studies have highlighted the prevalence and associated factors contributing to depression in this population.
A systematic review and meta-analysis aimed to assess the prevalence of depression among Chinese university students, compiling data from 113 studies retrieved through electronic databases revealed the overall prevalence of depression 28.4%. The findings underscored a persistently high prevalence of depression among Chinese university students(27).
Another systematic review done on the prevalence of depressive symptoms among university students in low- and middle-income countries based on data extracted from 37 studies published between 2009 and 2018 found that the overall prevalence of depressive symptoms among university students was estimated to be 24.4%, highlighting a substantial burden of depression in this population(28).
A meta-analysis and comprehensive review conducted to observe the prevalence of depression among university students in Ethiopia found a pooled prevalence of depression of 28.13% where significant factors associated with depression included being female, being a first-year student, and having a family history of mental illness(29). This study revealed that more than one-fourth of students at Ethiopian universities experienced depression.
A study done to determine the prevalence of depression and its associated factors among Ambo University students,Ethiopia indicated that 32.2% of the participants were experiencing depression. Factors significantly associated with depression included being female, with females being four times more likely to experience depression compared to males(30).
The collective findings from various studies examining the prevalence of depression among university students across the globe reveal a significant mental health challenge affecting this population. Across different universities and regions, prevalence rates vary but consistently highlight a substantial burden of depression. Studies consistently identify being female, being a first-year student, having a family history of mental illness, and engaging in substance use as common factors associated with higher rates of depression. The prevalence ranges from 4.4% to as high as 35.52%, showing the variability across different settings and demographic factors.

Problematic Social media Use and Depression

Over the past decade, problematic social media use has been identified as a major contributor to the development of depression among university students and existing data indicate a correlation between problematic social media use and depression(31).
A meta-analysis aimed to explore the relationship between depression and Internet addiction (IA) among adolescents aged 10 to 24, synthesizing data from 42 studies involving 102,769 participants. The analysis confirmed a positive correlation between depression and IA, with adolescents experiencing depressive disorders showing a higher risk of IA, and those with IA exhibiting a higher risk of depressive disorders. Furthermore, IA was found to have a stronger effect on increasing the risk of depression. The findings underscore the bidirectional nature of the relationship between depression and IA in adolescents(32).
A cross-sectional study assessed Facebook addiction among 422 Ethiopian university students alongside measures of self-esteem, anxiety, depression, and study habits and results indicated a high prevalence of Facebook addiction among participants, with significant associations found between Facebook addiction and lower academic performance, as well as symptoms of anxiety and depression(33). This study also shows similarity with the global findings.
Another cross-sectional study conducted among undergraduate students at Dilla University aimed to assess the prevalence of problematic Internet use and its associated factors found a high prevalence of problematic Internet use and depression being significantly associated with problematic Internet use(11).
The reviewed studies consistently demonstrate a significant association between problematic social media use (PSMU) and depression. However, there is a scarcity of data on the relationship of problematic social media use and depression among Ethiopian university students. Consequently, this study investigates the relationship between depression and problematic social media use in this population. Additionally, it assesses factor that are associated with problematic social media use and depression .

Theoretical Framework

Theory of Planned Behavior (TPB)

TPB serves as a fundamental approach for predicting and elucidating diverse behaviors. It aims to discern individuals' intentions to engage in specific actions, focusing on behaviors subject to self-control (34). The key construct is behavioral intent, shaped by perceptions of the likelihood of desired outcomes and subjective assessments of risks and benefits associated with the behavior. The TPB, consisting of six components—attitudes, behavioral intention, subjective norms, perceived behavioral control, perceived power, and social norms—has effectively explained various health-related actions. Given its emphasis on intention, motivation, and anticipated outcomes, this model proves pertinent to understanding intentional social media use among university students and forms the foundation for grasping the motivations behind their engagement.

Study design

The research employed an institutional based cross sectional study method to explore the relationship between the use of social media and depression among undergraduate regular students at Addis Ababa University’s main campus.

Sampling Procedure

This study targeted 1837 students undertaking their studies at AAU’s main campus, as per the document from the registrar, (2024). The final sample size become 350. In this study, the stratified random sampling technique was used to ensure a representative sample of the student population across different departments and academic years.

The total student population of 1837 was divided into strata based on the 16 departments and the four academic years (second, third, fourth, and fifth year). A proportional sample size was determined for each stratum, aiming to select a total of 350 students. After determining the distribution for each stratum, simple random sampling was applied within each subgroup.

Research instruments

A self-reported questionnaire was used to collect the data. The social networking usage scale was adopted to capture data on the function of social media utilization(35).

The presence of problematic social media use was evaluated using the Bergen Social Media Addiction Scale (BSMAS). The Bergen Social Media Addiction Scale (BSMAS) consists of six measures that assess the fundamental components of addiction (i.e., salience, mood modification, conflict, withdrawal, tolerance, and relapse). Each question is answered on a 5-point Likert scale resulting in a score ranging from 6 to 30. The BSMAS has been translated into several languages and has shown acceptable psychometric properties across studies (36). In this study Bergen Social Media Addiction Scale (BSMAS) was adopted to measure problematic social media use.

PHQ 9 scale was adopted to collect data on assessing the level of depression among university students (37). This instrument has nine questions that evaluate the frequency with which patients have had depressed symptoms during the last two weeks. The nine questions closely align with the DSM-V's nine criteria for major depressive disorders. Participants choose from four options: not at all, several days, more than half the days and nearly every day and each question scored from 0 (not at all) to 3 (nearly every day), and the total score ranges from 0 to 27.

Data Collection Procedures

Approval to proceed with data collection was given from the supervisor, then a support letter was taken from the department and submitted to AAU registrar office and each department. The questionnaire was prepared in soft copy to be filled online. Informed consent forms were given to read and sign before agreeing to participate in it.

Data Analysis and Presentation

This investigation produced quantitative data. Each completed forms were checked for completeness and consistency. Data were entered to MS Excel then exported to SPSS version 29 for analysis. The data on demographic characteristics were analyzed via descriptive statistics. Data on social media utilization and the level of depression were also analyzed through descriptive statistics, explanatory variables such as: sex, department, year of study, frequency of social media use, function of social media use, form of social media us and problematic social media were analyzed first by bivariable analysis. Based on the p-value (< 0.25) of the bivariable analysis, the result of the multivariable analysis was revealed.

Data Management and Ethical Considerations

A letter was obtained from School of Psychology of Addis Ababa University. Then an official letter of support was submitted to the AAU registrar’s office and each department office of Addis Ababa University's main campus. Confidentiality was maintained at all levels of the study, and the collected information was kept in a secure place.

Sociodemographic characteristics

A total of three hundred sixteen (316) regular undergraduate students from AAU main campus participated. Out of 350 participants, ten (10) were not using any form of social media,14 participants refused to take part when they gave their consent and the remaining 10 participants had an incomplete response, leaving the final sample of 316 participants.

From the participants, 72 (22.8%) were from the Department of Law, followed by 40 (12.7%) from the Department of Social Work, and 7.9% from the Department of Psychology. More than half of the participants were male 181(57.3%) and 135(42.7%) were females.

The distribution of students across different years of study was 33.9% second year, 28.5% third year, 33.9% fourth year, and 3.8% fifth year.

From the social media platforms, telegram is mostly used 309(97.8%) followed by TikTok 224(70.9%) and YouTube 127(40.2%).

From the participants, 290(99.2%) use social media platforms to chat with friends, 98.3 percent use social media platforms to get updates on academic dates, 310(97.9%) participant use social media for social networking, 307(97%) participants use social media to watch movies and 65(20.5%) use social media to watch pornography.Table 1 shows the frequency and percentage of social media use purpose among the participants.

Table 1

*Purpose of Social media use*
Social media function	Frequency	Percent
1. Utilizing social media for dating	290	93.8
2. To communicate with relatives	298	94
3.To chat with friends	314	99.2
4.For social networking	310	97.9
5.To consult lectures	305	96.3
6.To prepare for exams	124	39.1
7. To get updates on academic’s dates	311	98.3
8.To watch music videos	300	94.8
9.To watch movies	307	97.0
10. To watch pornography	65	20.5
11. To publish online content	269	85.1

Prevalence of Problematic Social Media Use

As of now, there is no standard cutoff point for social media users to say it is problematic or not, but most of the researchers use a cutoff point of 19 and 24 based on the Bergen Social Media Addiction Scale (39). A study done in Hungary among a Large-Scale Nationally Representative Adolescent Sample tested different cut points to classify PSMU and a cut point of 19 gave a sensitivity of 83%, 99% specificity, 73% PPV, 99% NPV and 98% of accuracy, with this measurement they recommend 19 as an ideal cut point to classify as at risks of PSMU (39).

In this study using a cutoff point of 19 on the Bergen social media addiction scale [BSMAS], 54 participants (17.1%) were classified as problematic social media users. This shows that a substantial proportion of the student population exhibits signs of PSMU.

The distribution of Problematic Social Media Use (PSMU) among different demographic factors reveals significant variation. Among the participants, 19 males, representing 35.2% of the total male participants, exhibit signs of problematic social media use. In contrast, 35 females, which constitute 64.8% of the total female participants, are affected by PSMU. This indicates that a higher proportion of females are experiencing problematic social media use compared to males.

The prevalence of PSMU varies significantly across different departments. The Law department has the highest number of PSMU cases, with 12 students (22.2%) affected. Following closely are the Social Work department with 7 cases (13%), Journalism with 5 cases (9.3%), and both Science and Mathematics and Education & Planning departments, each with 5 cases (9.3%). This distribution suggests that certain fields of study may be more susceptible to problematic social media use, possibly due to varying academic pressures or social environments.

Considering the year of study, the 2nd-year students show a prevalence of 17 PSMU cases, which accounts for 31.5% of this group. The 3rd-year students have the highest number of cases, with 20 students affected, representing 37% of the total. In the category of 4th year and above, there are 17 PSMU cases, also making up 31.5% of the students in this category. This data indicates that PSMU is relatively evenly distributed across different years of study, though 3rd-year students exhibit a slightly higher tendency towards problematic use.

Prevalence of depression

A cutoff score of 5 was used to classify whether depression is present on the PHQ-9 depression scale (37). Of the participants, 77 (24.3%) were classified as having depression. Fourteen participants (4.4%) were found to have severe depression and 40 percent were classified as having mild depression. Table 2 shows the frequency and percentage of depression levels among participants.

Table 2

*Depression Level Among Addis Ababa University Main Campus Regular Students*
	Frequency	Percent	Valid Percent	Cumulative Percent
Depression level	No Depression	239	75.6	75.6
	Mild Depression	40	12.7	12.7
	Moderate Depression	17	5.4	5.4
	Moderate to severe	6	1.9	1.9
	Severe Depression	14	4.4	4.4
	Total	316	100.0	100.0

Regarding recommendations for social media strategies for reducing the level of depression,260 participants (82.3%) believe that there is a connection between the use of social media and depression.

Of the participants who believe there is a connection between the use of social media and depression,52 participants (20%) recommended social media-based strategies to decrease levels of depression.

Problematic Social Media Use and Depression

In this study, in order to see the relationship between problematic social media use and depression logistic regression analysis was used. Initially bivariant analysis was used and based on the p-value (< 0.25) of the analysis, the result of the multivariable analysis used to determine the presence of relationship between depression and problematic social media use.

The analysis reveals that individuals with problematic social media use have a significantly higher likelihood of experiencing depression, with an adjusted odds ratio of 1.62 (95% CI: 1.4–1.8: p-value 0.00001). This indicates that these individuals are 62% more likely to suffer from depression compared to non-problematic social media users. The association is highly statistically significant, as evidenced by the very low p-value (0.00001).Table 3 shows logistic regression analysis of depression and problematic social media use

Factors Associated With Depression

Explanatory variables such as sex, department, year of study, frequency of social media use, function of social media use and form of social media use were analyzed first by bivariable analysis. Based on the p-value (< 0.25) of the bivariable analysis, the result of the multivariable analysis revealed that sex and utilization of social media to watch pornography were significantly associated with depression. Table 3 shows lists of variables linked to depression among undergraduates on AAU main campus.

The logistic regression analysis indicates that females are significantly more likely to experience depression compared to males, with an adjusted odds ratio of 2.4 (95% CI: 1.328–4.35). The association is statistically significant, as evidenced by the p-value of 0.0001, which suggests a very low probability that this finding is due to chance. The confidence interval further supports this conclusion, as it does not include one and indicates a precise estimate of the increased risk.

The logistic regression analysis reveals high association between frequent use of social media for watching pornography and the likelihood of experiencing depression. Individuals who frequently use social media for this purpose are 14.05 times more likely to suffer from depression compared to those who never engage in such activities (AOR = 14.05; 95% CI: 5.9–32). The association is highly statistically significant with a p-value of 0.00001.

Table 3

*Factors Associated with Depression Level in AAU, Main Campus Undergraduates*
Explanatory Variable		Depression prevalence		Bivariate analysis (COR)	Multivariate analysis (AOR)	P value
Explanatory Variable		No	Yes	Bivariate analysis (COR)	Multivariate analysis (AOR)	P value
Sex of respondents	Male	148	33	1
Sex of respondents	Female	91	44	2.168(1.28–3.6)	2.4(1.328–4.35)	0.04
Frequency of TikTok users	Less than one hr.	120	25	1
	Above one hr.	119	52	2.097(1.22–3.6)	1.6(0.88–2.9)	0.12
Frequency of YouTube	Less than one hr.	51	28	1
	Above one hr.	188	49	0.47(0.272–0.829)		0.29
Utilize to watch pornography	Never	230	48	1
	Often	9	29	15.44(6.89–34.7)	14.05(5.9–32)	0.0001
Social media use	PSMU	4	50	1.65(1.4–1.8)	1.62(1.4–1.8)	0.0001
	No PSMU	235	27	1

Prevalence of Problematic Social Media Use

This study found that 17.1% of the participants show problematic social media use (PSMU), as measured by the Bergen Social Media Addiction Scale (BSMAS). Although the rates vary, this prevalence is consistent with other studies conducted in different regions. For instance, a survey done in the U.S. among young adults found that 44 percent of the adults were using social media problematically, which is significantly higher than this finding(38).

In contrast, a study done among Hungarian university students reported a problematic social media use prevalence of 4.5%, which is lower than this finding(39). Another study found a PSMU prevalence of 10% among Norwegian university students(21).

The higher prevalence observed in this study could be due to the increasing accessibility of smartphones, the majority of university students' widespread use of social media, as well as the university's constant access to WIFI, both of which may contribute to increased rates of problematic usage.

Due to a variety of methodological problems, including convenience sampling, focusing mostly on college students, and/or having small sample sizes, earlier research revealed a broad range of prevalence rates (40, 41, 42, 43). For example, among undergraduates of Nigerian universities, the proportion of problematic social media users was 1.6% (44). On the other hand, 47% of Malaysian college students reported PSMU (43).

Additionally, the prevalence variation might also have resulted from the scale used to assess social media use, the cutoff point used to classify participants as problematic and non-problematic can also contribute to the significant difference among studies.

Prevalence of Depression

According to the PHQ-9 scale, 24.3% of individuals met the criteria for depression, with 4.4% experiencing severe depression. This finding is comparable to other studies. In a study done among freshman at Addis Ababa university main campus students, the prevalence of depression was 27.7% which is similar to this finding, though the study was done among first-year students(45).

A study done across 23 countries found that a prevalence of 20.3% for major depressive disorder among university students, closely matches this finding(46).

The high prevalence of depression in this study could be due to academic pressures, and financial difficulties which can contribute to psychological distress. Furthermore, the socio-political condition (ongoing war in Ethiopia for those who came from war zone areas), and economic instability in Ethiopia may exacerbate these stressors, leading to higher levels of depression among students.

Relationship Between Problematic Social Media Use and Depression

This study revealed that a significant positive correlation between problematic social media use and depression. Those Students who were classified as problematic social media users were more likely to report higher levels of depression. This relationship is supported by previous research. For instance, a study found that excessive social media use is associated with increased depression, anxiety, and psychological distress among adolescents and young adults(15). A meta-analysis found that problematic social media use is positively associated with depression(47).

Another study done in USA among young adults found that individuals with higher social media use were significantly more likely to report depression symptoms(38). Exposure to idealized pictures and the pressure to uphold an online identity can exacerbate poor self-esteem and feelings of inadequacy, which are recognized previously as depression risk factors. (48).

In most reviewed studies problematic social media use was strongly associated with depression levels among university students.

Frequency and Forms of Social Media Use

In this study increased depression levels were linked to higher social media usage frequency, yet multivariate analysis could not find a statistically significant correlation. This shows that although using social media often may increase the risk of depression, other important variables also need to be considered. In contrast, a study done in U.S reported that excessive screen time, including social media use, is associated with higher levels of depression and anxiety among adolescents(49).

This study's finding suggests that the way students engage with social media is more important than the amount of time spent on it

Demographic Factor

This study identified gender and specific uses of social media (watching pornography) as significant predictors of depression. Female students and those students who frequently use social media to watch pornography had higher odds of experiencing depression. This finding shows a similarity with those of Norwegian university students that female students use social media problematically(21).

Additionally, a study found that female adolescents are more likely to experience depression related to social media use than males, supporting this finding of gender difference in the impact of social media use(4).

Regarding the association between watching pornography and depression, a research explored that frequent exposure to online pornography is associated with higher levels of psychological distress and depressive symptoms among young adults, which is similar to this study(50).

Limitations

This study specifically targeted undergraduates at AAU's main campus. Consequently, conclusions drawn from this study apply to university students with similar socio-demographic characteristics. The study is specifically designed to investigate the relationship between social media use and depression. As a result, the findings should not be used to generalize other psychiatric conditions like anxiety, and stress that are affected by social media use.

Conclusion

The current study identified significant problematic social media use among addis ababa university main campus students. There was strong evidence of association between problematic social media use and depression indicating that students with higher levels of problematic social media use are more likely to experience depression. Additionally, a significant association was observed between depression and female undergraduate students, and significant association was also found between depression and those who use social media to watch pornography.

Recommendations

Based on the result of this study, the following recommendations were forwarded to different stakeholders:

1. For University students

- Practice healthy Social Media Use: Establish specific time limits for social media usage and take regular breaks to prevent excessive use.

- Engage in Offline Activities: Balance online activities with offline pursuits such as physical exercise, joining clubs, and participating in face-to-face social interactions.

- Monitor Consumption:Students at universities should employ a variety of designs, such as setting screen time limits and utilizing apps to restrict internet access, to reduce their use of social media.

- Seek Support: Utilize university counseling services if experiencing overwhelming social media use or symptoms of depression.

2. For Student Clinic and Counselors

- Early Detection and Intervention: Implement screening tools to identify students at risk of problematic social media use and depression.

- Individual and Group Therapy: Offer both individual and group therapy sessions focused on managing social media use and coping with depression.

- Collaborate with Departments: Work closely with academic departments to identify students who may benefit from counseling services.

3.For Counseling Psychology Department

- Develop Targeted Programs: Create specialized counseling programs aimed at addressing problematic social media use and its psychological impacts.

- Awareness Campaigns: Conduct regular workshops and seminars to educate students about the potential mental health risks associated with excessive social media use.

4. For Universities and colleges

- Integrate Mental Health Education: Include mental health awareness and digital literacy in the curriculum to help students understand the impacts of social media.

- Provide Resources: Allocate resources for mental health services and ensure students have easy access to counseling and support.

- Promote Healthy Social Media Use: Encourage the development of healthy social media habits through university-wide campaigns and initiatives.

5.For Mental Health Advocates

- Raise Awareness: Organize and participate in campaigns to educate students about the mental health risks associated with problematic social media use and promote healthy digital habits.

- Promote Digital Literacy: Advocate for the integration of digital literacy programs in educational institutions to help students understand the impact of social media on mental health.

- Facilitate Access to Resources: Ensure that students are aware of and have easy access to mental health resources and support services available on and off-campus.

- Advocate for Policy Changes: Work with policymakers to develop and implement policies that promote responsible social media use and support mental health initiatives in educational settings.

- Collaborate with Institutions: Partner with universities, colleges, and schools to design and implement mental health programs targeted to address issues related to social media use.

6. For Ministry of Health

- National Awareness Campaigns: Launch national campaigns to raise awareness about the mental health impacts of problematic social media use.

- Support Research and Training: Fund research on social media use and mental health, and provide training for healthcare professionals on how to address these issues.

- Mental Health Services in Universities: Ensure that all universities have access to adequate mental health services and support structures.

7. For Policy Makers

- Regulate Social Media Use: Develop policies that promote responsible social media use among young people.In this finding, pornography shows a strong association with depression in those who use social media to watch such content, so the country should restrict websites that generate pornographic content

- Support Mental Health Programs: Allocate funding for mental health programs in educational institutions.

Future Research Directions

To determine the causal linkages between problematic social media usage and depression, future researchers should focus on longitudinal studies. Additionally, exploring the effective interventions that reduce problematic social media use and its outcomes would be valuable.

Qualitative assessments may also help to enhance the directionality of problematic social media use and depression symptoms. Furthermore, assessment of other mental health conditions like anxiety, and stress would help to generalize and widen the scope of the study.

AAU

Addis Ababa University

AOR

Adjusted Odds Ratio

BSMAS

Bergen’s Social Media Addiction Scale

Confidence Interval

DSM

Diagnostic and statistical Manual of Mental Disorders

EDPM

Education and Planning Management

MDD

Major Depressive Disorder

NPV

Negative Predictive Value

Non response

PHQ-9

Patient Health Questionnaire 9

PPV

Positive Predictive Value

PSMU

Problematic social media use

SMU

Social media use

SPSS

Software Program for Social Science

TPB

Theory of Planned Behavior

WHO

World Health Organization

USA

United States of America

Ethics approval and consent to participate

This study was conducted with the support and approval of Addis Ababa University, School of Psychology, which provided a support letter allowing the research to proceed. The research was conducted in accordance with the ethical standards laid down in the 1964 Declaration of Helsinki and its later amendments.

All participants provided informed consent before taking part in the survey. Participants were fully informed about the purpose of the study, the procedures involved, and any potential risks or benefits. Participation was entirely voluntary, and participants were assured that their responses would remain confidential and used solely for research purposes.

Consent for publication

Not applicable

Availability of data and materials

The data and materials used in this study are available upon reasonable request. Due to privacy concerns and institutional policies, the data cannot be made publicly accessible. Interested parties may contact [email protected] to request access to the data and materials.

Competing interests

The authors declare that they have no competing interests.

Funding

This research did not receive any specific grant from funding agencies in the public, commercial, or not for profit sectors. All expenses related to the study, including data collection, analysis, and manuscript preparation, were self-funded.

Acknowledgement

Not applicable

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The authors declare no competing interests.

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Problematic Social Media Use and Depression among Addis Ababa University Students, Ethiopia: Institutional based Cross Sectional Study

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Abstract

Background to the Study

Statement of the Problem

Objective of the study

General objective

Significance of the study

Literature review

Problematic Social Media Use Prevalence

Prevalence of Depression Among University Students

Problematic Social media Use and Depression

Theoretical Framework

Theory of Planned Behavior (TPB)

Methods

Study design

Sampling Procedure

Research instruments

Data Collection Procedures

Data Analysis and Presentation

Data Management and Ethical Considerations

Results

Sociodemographic characteristics

Prevalence of Problematic Social Media Use

Prevalence of depression

Problematic Social Media Use and Depression

Factors Associated With Depression

Discussion

Prevalence of Problematic Social Media Use

Prevalence of Depression

Relationship Between Problematic Social Media Use and Depression

Frequency and Forms of Social Media Use

Demographic Factor

Limitations

Conclusion and Recommendations

Abbreviations

Declarations

References

Additional Declarations

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