Brief ReportBRIEF

Problematic Use of Social Media Platforms and Its Association With Depression in Pharmacy Students

Rend Al Saigh, Reem Herzallah and Ahmed Alhusban
American Journal of Pharmaceutical Education June 2022, 86 (5) 8625; DOI: https://doi.org/10.5688/ajpe8625

Abstract

Objectives. The objective of this investigation is to examine the association between depression and problematic use of social media among university students with a focus on the differential effect of studying pharmacy as compared to other disciplines.

Methods. A cross sectional study was conducted using an online survey that recruited students from different disciplines at one university. Problematic use of social media was measured using the Bergen Social Media Addiction Scale. Depression was assessed using the patient health questionnaire-9 (PHQ-9).

Results. Responses from 105 respondents out of 140 invited were analyzed. The average age of participants was 19.9 years (SD=2.1 years). Forty-seven participants (44.8%) reported depression. Depression was less prevalent in pharmacy students than in students of other disciplines (35.7% vs 62.9%, respectively). Social media addiction score (OR: 1.07; 95% CI: 1.01-1.12) and pharmacy discipline (OR: 0.2; 95%: 0.02-0.66) were identified as independent predictors of depression. The extent of problematic use of social media was similar between pharmacy and non-pharmacy students (49.8 and 52.7, respectively).

Conclusion. Studying pharmacy may have a differential effect on the association between problematic use of social media and the development of depression among undergraduate university students.

Keywords:

INTRODUCTION

Mental health disorders such as depression and anxiety are a recognized public health problem among university students. 1 Available data show an alarmingly high prevalence of depression among university students. 1-6 Data from a survey conducted by the American College Health Association reported that 3075 (20%) of the college students surveyed had been diagnosed with depression. 1 Comparable numbers have been reported from other parts of the world. 7-10 Rotenstein and colleagues reported a pooled estimate of depression of about 27% among medical students. 2 The significance of depression among university students is more pronounced among health care students because of the long-term consequences of depression on their college performance and future productivity. 11 These consequences will negatively affect the quality of care that these future health professionals will provide to the general population, which will impair the efficiency of the health care system.

Several factors were suggested to explain the development of depression among university students. 7-10 These factors included poor academic performance, perceived stress, financial challenges, and problematic social media use. During the last decade, problematic social media use was recognized as a significant factor in the development of depression in this group. 12-16 Available data show a correlation between depression and problematic social media use. 2, 3, 8, 13, 15, 17 This correlation was consistent in studies that assessed students from a specific discipline 3, 12, 18 or university students form different disciplines assessed collectively. 3, 5, 7-9, 19 There is a lack of data regarding the differential effect of university discipline on the association between social media addiction and depression. Furthermore, data regarding the characteristics of problematic social media use and depression among pharmacy student are lacking. Accordingly, this investigation examines the association of depression and among university students. Furthermore, an assessment of whether studying pharmacy alters the aforementioned association was made.

METHODS

This was a cross-sectional study to assess the association between problematic social media use and depression among university students. A special focus of the study was assessing the differential effect of studying pharmacy on the association between problematic social media use and depression.

Participants were recruited through an online invitation that was circulated using the mailing lists and social media groups across different colleges in Al Ain University, Abu Dhabi, UAE. Al Ain University is a private university with six colleges, including Engineering, Pharmacy, Education, Media, Law, and Business. All potential participants were offered a description of the study, and their ability to leave the study at any time was stressed. The study protocol was approved by the human research committee in the university.

Demographic data, including age, gender, discipline, and university level, were collected from each participant. The university level was categorized into junior for first year students and advanced for other years. This categorization was based on published literature. 7, 12, 15, 17, 20 The assessment of problematic social media use was conducted using the Bergen Social Media Addiction Scale (BSMAS), which is a modified version of the Arabic version of the Bergen Facebook Addiction Scale (BFAS) created after obtaining permission from the author. 21 The Arabic version was modified by replacing the word “Facebook” with “social media” as suggested and validated by Andreessen and colleagues. 14 The tool is composed of 18 items measured on a five-point Likert scale ranging from never=1 to very often=5. The scale is calculated by summing the score (1-5) given for each item. Scores on the scale range from 18-90, with higher values indicating higher levels of problematic social media use.

Depression symptoms were assessed using the Arabic version of patient health questionnaire-9 (PHQ-9). The PHQ-9 is the self-reported version of the Primary Care Evaluation of Mental Disorders (PRIME-MD) diagnostic tool. 22 It has nine items measured on a four-point Likert scale, ranging from “not at all” to “nearly every day.” The scale score ranges from 0 to 27, and a cutoff point of more than nine has been suggested to identify students with depression.

Descriptive statistics were calculated for the demographic variables. The distribution of depression across the different demographic data variables was calculated using the chi square for categorial variables. Student t test or one-way analysis of variance (ANOVA), applying Bonferroni as a post hoc analysis as appropriate, were used to test continuous variables. Odds ratio and the corresponding 95% confidence intervals were calculated for the presence of depressive symptoms using a stepwise binary logistic regression analysis model. A liner regression model was used to calculate the extent of social media use using a forward least regression approach. All statistical analyses were performed using SPSS, version 24 (IBM)). A p value of less than .05 was considered significant.

RESULTS

One hundred five participants were recruited with an average age of 19.9 (SD=2.1) years. The majority of participants were female (73.3%). The study included 70 (66.7%) pharmacy students. Seventy-two participants (68.6%) were advanced. The average BSMAS score of participants was 50.8 (SD=11.8). Demographics of the participants are presented in Table 1.

View this table:
Table 1.

Characteristics of Participants in a Survey Conducted to Determine an Association Between Social Media Use and Depression in University Students

In this study, 47 (44.8%) participants had PHQ-9 scores consistent with depression (a score of 9 or higher in the PHQ-9). The average age of the participants with depression was similar to that of participants without depression, 19.8 (SD=1.4) vs 19.9 (SD=2.5); p=.58. Similarly, the gender distribution was similar in both groups (p=.49). Pharmacy students comprised a significantly smaller percentage of the subjects with depression as compared to non-pharmacy students (25 [35.7%]) vs 22 [62.9%]; p=.008). Furthermore, participants with depression scored significantly higher on the BSMAS scale (55.4 [SD=10.4]) vs 47 [SD=11.67]; p=.001). Detailed characteristics of the participants and their reported mood states are provided in Table 1.

A binary logistic regression analysis that corrected for age, gender, discipline, university level, the social media applications used, and BSMAS score, was used to identify the independent predictors of reporting depression. In this analysis, the university discipline and the BSMAS score were identified as independent predictors of depression.

Pharmacy students were less likely to report having depression (OR: 0.203, 0.062-0.664; p=.008). Furthermore, higher BSMAS scores increased the likelihood of reporting depression (OR: 1.07, 1.021-1.122; p=.005). A detailed description of the analysis is provided in Table 2.

View this table:
Table 2.

Predictors of Depression and Problematic Use of Social Media Among Students at a University in the United Arab Emirates (N=105)

To determine the predictors of social media addiction, a stepwise linear regression model that corrected for age, gender, discipline, university level, and PHQ-9 score was conducted. The final model was able to analyze 33.6% of the variability in the model (F=9.7; p=<.001). The PHQ-9 score was identified as the sole predictor of problematic social media use (standardized coefficients beta=0.512, 0.687-1.395; p<.001). A detailed description of the model is provided in Table 2.

To further the understanding of the effect of discipline on reporting the symptoms of depression, a comparison of the participants’ characteristics based on discipline was made (Table 3). The average age of pharmacy students was similar to that of participants in other disciplines (20.1[SD=2.3] vs 19.41[SD=1.6]; p=.11). Both groups had similar results on the social media addiction scale (49.8 [SD=12.5] vs 52.74 [SD=10.1]; p=.23). The percentage of female students was higher among the pharmacy student cohort than that in other disciplines (60 [85.7%] vs 17 [48.6%]; p<.001). Furthermore, a majority of pharmacy students were further advanced in the program (77.1% vs 51.4%; p=.007).

View this table:
Table 3.

Characteristics of Participants in a Survey to Determine an Association Between Social Media Use and Depression Stratified According to University Discipline (N=105)

DISCUSSION

The data suggest that there is a high prevalence of depressive symptoms among university students. The level of problematic social media use and the discipline were identified as independent predictors of depression. Pharmacy students were less likely to be depressed, while students with a high level of problematic social media use were more likely to report symptoms of depression.

The prevalence of depression has been identified as an alarming health issue worldwide. 1-3, 5, 10, 23 Available data reported different prevalence rates of depression among university students that ranged from 27% to 51%. 8, 10, 24, 27 These estimates are consistent with our estimates of about 45% of the sample. Furthermore, we identified the extent of problematic social media use and educational discipline as independent predictors of reporting depression.

In this study, special attention was placed on assessing the differential effect of studying pharmacy on the association between problematic social media use and depression. The prevalence of depression in our study was 35.7%, which is consistent with the range of previously reported rates among pharmacy students. Abbas and colleagues reported a 62% prevalence of depression in Pakistani pharmacy students, whereas Silva and colleagues reported a lower prevalence of depressive symptoms that was less than the cutoff point for depression among Portuguese pharmacy students. 25, 26 Similar studies in the United States reported a prevalence of 19.3%-29.5%. 27, 28 This variability was attributed to country-specific socioeconomic factors. Furthermore, our data demonstrated a lower rate of depression among pharmacy students as compared to non-pharmacy students. In contrast, Fischbein and colleagues, reported a similar prevalence of depression between pharmacy and medical students. 28 Sabourin and colleagues reported a similar prevalence of depression between pharmacy and non-pharmacy university students. 27 This discrepancy might be attributed to differences in the prevalence of depression in the three studies. In the aforementioned studies, the prevalence of depression was less than 20%, whereas our data reported a prevalence of more than 45% in the overall sample. This variability might be influenced by country specific factors and the small sample size of our study. Additionally, a significantly higher proportion of the pharmacy students in our study were female and in their senior year as compared to the proportion of non-pharmacy students who were female and in their senior year. The larger number of senior students may explain the lower prevalence of depression among pharmacy students as other studies have reported that freshman students face more issues with adaptation and are more likely to report depressive symptoms than students in other years. 12, 15 Counterintuitively, female students, who represented the majority of recruited pharmacy students, have consistently been more likely to report depression. 13, 14, 29, 30 This discrepancy requires further investigation. Furthermore, self-esteem and academic stress were linked to the development of depression among university students. There is a need to investigate the contribution of these factors to the lower prevalence of depression in our sample.

In a large study, Andreassen and colleagues reported a positive correlation between the extent of social media use and the prevalence of depression. 14 Similarly, there is a plethora of evidence supporting the association between problematic social media use and the development of depression among young adults, particularly university students. 12, 13, 18, 29, 31, 32 Available literature suggested female gender, depression, and anxiety as predictors of problematic social media use. 12-14, 29 Our findings did not show an increased risk of problematic social media use among female students. On the other hand, the presence of depression was the only independent predictor of social media addiction. This finding is consistent with reported data regarding the predictors of problematic social media use. 12, 15, 17, 29, 30 Furthermore, the extent of problematic social media use was similar between pharmacy and non-pharmacy students in our sample. This finding is consistent with identifying depression, which was lower in pharmacy students, as the only independent predictor of problematic use of social media applications.

The number of social media applications and their features is large and continuously increasing. Accordingly, it is prudent to assess the effect of the type of application used on depression and problematic social media use. The prevalence of depression and the extent of problematic social media use were not altered by the type of social media application used. Data regarding the effect of the type of most commonly used social media application on the development of depression is limited. One study that suggested an increased risk of depression and social media addiction among individuals who use twitter more than other applications. More research is needed in this specific area.

We acknowledge several limitations in this work. The study was performed in a single educational institution with a small number of participants, which might limit the generalizability of the results. Additionally, the use of self-reported questionnaires may introduce bias.

CONCLUSION

While social media addiction is a predictor of depression among university students, pharmacy students are less likely to have depression (35.7% vs 62.9%). The effect of university level (year) and gender on the development of depression may be impacted by the discipline the student has chosen to pursue.

ACKNOWLEDGMENTS

The author would like to thank Dr. Laila Alhusban for her assistance with language proofing and editing.

  • Received March 4, 2021.
  • Accepted July 26, 2021.

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Problematic Use of Social Media Platforms and Its Association With Depression in Pharmacy Students
Rend Al Saigh, Reem Herzallah, Ahmed Alhusban
American Journal of Pharmaceutical Education Jun 2022, 86 (5) 8625; DOI: 10.5688/ajpe8625
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