Prevalence and risk factors of problematic Internet use: A cross-national comparison of Japanese and Chinese university students

Abstract

The aim of the present study was to compare risk factors for problematic Internet use (PIU) among Japanese and Chinese university students. A sample of 267 Japanese and 236 Chinese first year university students responded to questionnaires on the severity of PIU, depression, self-image/image of others, and perceived parental child-rearing styles. The results indicated that Japanese participants were more likely to demonstrate PIU than their Chinese counterparts. Compared to Chinese students, Japanese students reported more negative self-image, lower parental care, greater overcontrol, and higher depression scores. The PIU group had a higher depression score compared to the normal Internet use group. Compared with the non-PIU group, the PIU group consisted of more male and Japanese participants. Further, they tended to have more negative self-images, saw their mothers to be less caring, and perceived their mothers and fathers as more overcontrolling. PIU is strongly associated with depression, negative self-image, and parental relations. Finally, mediation analysis revealed that such national differences in PIU between Japanese and Chinese were clarified in depression and perceived mother’s care. This cross-national study indicated that depression and perceived mother’s care were both significant risk factors that were associated with the national difference in PIU between Japanese and Chinese participants.

Keywords

Chinese depression Japanese perceived parental styles problematic Internet use relationship

Introduction

The history of the Internet starts in the 1950s and 1960s with the development of computers and it was born from a military communication strategy. Decades later, Internet use is widespread by professionals and an essential tool in university education (Marson, 1997). In recent years, the use of the Internet has increased dramatically in both Japan and China, and with this has come great concern about Internet addiction (Sato, 2010). Golub and Lingley (2008) argue that the Chinese preoccupation with so-called “Internet addiction” is actually a “moral panic” and thus potentially not an actual problem or phenomenon. Many scholars propose problematic Internet use (PIU) as a better alternative to addiction, as they believe the addiction framework suggests underlying neurobiological processes that are not yet established. Yellowlees and Marks (2007) reported that individuals who were premorbidly vulnerable, especially with a history of impulse control and addictive disorders, were at risk of using the Internet in a problematic way. Moreover, Seay and Kraut (2007) reported that an individual’s level of self-regulatory activity was shown to be very important in allowing them to avoid negative outcomes like PIU. Since the consequences of having PIU are similar to those of Internet addiction, we examined PIU that may be commonly seen in the college population.

PIU, which has been described in the psychological literature as “Internet addiction” (Holden, 2001) encompasses the following characteristics (Ko et al., 2009; Shapira, Goldsmith, Keck, Khosla, & McElroy, 2000): (a) an uncontrollable use of the Internet; (b) Internet use which is markedly distressing, time-consuming or results in social, occupational, or financial difficulties; and (c) Internet use not solely present during hypomanic or manic clinical episodes. PIU can negatively affect academic performance, family relationships, and mood status (Lin & Tsai, 2002; K. S. Young & Rodgers, 1998).

PIU has been reported in both Japanese (Sato, 2004) and Chinese (Wu & Zhu, 2004) societies. Data from the China Network Information Center (as of June 30, 2010) showed that 420 million people had gone online, 58% of whom are between 10 and 29 years old (Dong, Lu, Zhou, & Zhao, 2011). The top 10 Internet applications in China are: online music, online news, instant messages, online video, search engines, email, online games, blog/personal spaces, forum/BBS and online shopping. Among the top 10 applications, three basic Internet applications are instant message, search engine, and email. Similarly, in Japan, one study found that 88.5% of young Japanese under the age of 30 used Internet services, including instant messaging, email, blog/personal spaces, online shopping, online music/video, forum/BBS, and online banking (B. Young, 2004). With this soaring number of Internet users, PIU has attracted much attention from psychiatrists, psychologists, educators, and the public. Given the apparent increase in PIU among college students in both Japan and China, there is a need for studies identifying risk factors and mediating variables.

In Japan, the U.S. Diagnostic and Statistical Manual for Mental Disorders (DSM; American Psychiatric Association, 2000) is used mainly for research purposes rather than in daily practice (Someya & Takahashi, 2001). The Chinese Classification of Mental Disorders Version 3 (CCMD-III) is the most commonly used diagnostic system in China (63.8%), followed by the ICD-10 (28.5%) and DSM-IV (7.7%) (Zou et al., 2008). PIU, such as Internet addiction, is currently not classified as a psychiatric disorder in the DSM (Block, 2008). Some researchers do not think it is useful to speak of “Internet addiction” as general phenomenon but instead advise speaking of problematic behavior in relation to specific domains of Internet activity. Yellowlees and Marks (2007) reported that individuals who are premorbidly vulnerable (i.e., with a history of impulse control and addictive disorders) are especially at risk of using the Internet in a problematic way. PIU has been found to be associated with psychiatric disorders including depression (Lin & Tsai, 2002; K. S. Young & Rodgers, 1998), psychosis (Dong et al., 2011), and personality traits of introversion and compulsive personality (Huang et al., 2010).

In the last two decades, culture has emerged in population health as a common explanation for health outcomes and disparities (Hruschka, 2009). The Chinese government put into place the “One Child” policy in 1979, restricting all Chinese families to giving birth to and/or raising only one child. This policy allows parents no room for failure. This is significant for the Chinese style of parenting because parents are often motivated by the fact that they have just one chance to produce a highly educated child. Therefore, for the majority of Chinese, child-rearing practices are characterized by authoritarian parenting, with high levels of care, control, and overprotection. Japanese child-rearing styles, in contrast, are very different from Chinese parenting styles. Although there are also declining birthrates in Japan, Japanese children tend to have siblings. Further, it is said that parents encourage their children to understand others’ ideas first and their own ideas second. Japanese children spend more time with their friends than with their families. Married Japanese women think that they should take care of their children, but they do not need to work outside the home. In both Japan and China, fathers who work full-time generally spend less time with their children than do mothers. Therefore, compared with the father–child relationship, we might get more significant results from the mother–child relationship. According to some social scientists, the mother–child relationship may be so dominant that it causes a child to become excessively dependent.

Previous research has identified parenting style as a potential risk factor for PIU. A study in Beijing found that adolescents with Internet addiction consistently rated their parents’ child-rearing styles as being overintrusive, punitive, and lacking in responsiveness (Huang et al., 2010). Huang and colleagues (2010) also found that adolescents with Internet addiction generally rated both maternal and paternal rearing practices as lacking in emotional warmth, being over-involved, rejecting, and punitive (mothers only). Matthew, Bradley, and Linda (2006) reported that parenting style influences the mediation techniques parents used to try to control their adolescents’ Internet use. These findings suggest that the influences of parenting style and family function may be important factors in the development of Internet dependency. Further, adolescents who were compulsive Internet users tended to utilize dysfunctional coping strategies and show poor self-image compared to adolescents who did not show signs of PIU (Milani, Osualdella, & Di Blasio, 2009). People who are overly reliant on the cyberworld may tend to ignore relationships in the real world (e.g., to demonstrate a lack of communication with friends and/or parents). Chan and Cheng (2004) compared offline and online friendship qualities at different stages of relationship development. Offline friendships involved more interdependence, breadth, depth, code change, understanding, commitment, and network convergence than online friendships. These results suggest that the influence of the structural and normative constraints typically found in face-to-face interaction may be different in the online setting.

To date, there has not been an investigation of the mediating roles of the selected variables on PIU in a cross-cultural setting. This study explored three questions among Japanese and Chinese university students: (a) the possibility of differing rates and patterns in PIU; (b) the relationships among depression, parental child-rearing style, and self-image/image of others with PIU; (c) whether any national differences in PIU between Japanese and Chinese are mediated by differences in depression, self-image, and perceived parental styles.

Methods

Participants and procedure

Japanese participants included 267 first year students from two universities in the Kyushu area: 215 students were enrolled in the Faculty of Agriculture of Saga University, and 52 were from the Faculty of Education of Fukuoka University of Education. For Chinese participants, 236 students participated from Northeast China: 105 students were from the Clinical Medicine Program at Dalian Medical University, and 131 students were from a Japanese course at Dalian University of Foreign Languages. All participants in this study were first year students at public universities. The socioeconomic status of the Kyushu area in Japan is similar to that of the Northeast area in China (Ogawa & Dong, 2011). Those studying agriculture and clinical medicine were considered science majors, and those studying education and in the Japanese course were considered liberal arts majors.

For Japanese participants, the average age was 18.8 years, ranging from 17 to 24 years, and for Chinese participants, the average age was 19.4 years, ranging from 17 to 22 years. In the Japanese sample, there were 91 males and 176 females, and in the Chinese sample, there were 60 males and 176 females.

The study protocol was approved by the Ethics Committee of Saga University Medical School. University approval was obtained before participants entered the study. Investigators visited each university and explained the purpose of the study in Japanese to the students in Japan and in Chinese to the students in China. All students were assured that they were free to refuse if they did not agree with the objective of the study. A total of 551 questionnaires were distributed and 503 were collected (a response rate of 91.3%).

Instruments

We used the Internet Addiction Test (IAT; K. S. Young, 1996, 1998) to screen for PIU, the Beck Depression Inventory (BDI; Beck, 1967; Beck, Ward, Mendelson, Mock, & Erbaugh, 1961) to determine the participants’ depressive states, the Relationship Questionnaire (RQ; Bartholomew & Horowitz, 1991) to assess how respondents perceive their self-image and image of others, and the Parental Bonding Instrument (PBI; Parker, 1979, 1990) to measure perceived parental child-rearing styles.

Internet Addiction Test (IAT)

The IAT (K. S. Young, 1996, 1998) assesses the occurrence of PIU. It consists of 20 items rated on scales from 1 to 5, where a score of 1 is defined as “rarely” and 5 as “always.” The total IAT score ranges from 20 to 100, and a higher score reflects a greater tendency for PIU. Previous research has used different cut-off scores for PIU (e.g., Sato, 2004; Tsitsika, Critselis, Janikian, Kormas, & Kafetzis, 2010; Wu & Zhu, 2004). However, the majority of studies have used a score of 49 points and below as indicating average Internet user, 50-79 points as problematic Internet use, and 80 points and above as Internet dependence. We therefore used a cut-off score of 50 in the present study to define caseness in order examine the national difference in PIU (Sato, 2004; The Center for Internet Addiction, 1995; Wu & Zhu, 2004). The IAT is comprised of five subscales: preoccupation, compulsive use, behavioral problems, emotional changes, and impact upon functionality consequent to Internet utilization. The Japanese and Chinese versions of the IAT have been widely used in previous reports (Fan et al., 2008; Sato, 2006). In the present study, the Cronbach’s alphas of the IAT for the Japanese and the Chinese versions were both 0.73.

Beck Depression Inventory (BDI)

The BDI (Beck, 1967; Beck, Ward, Mendelson, Mock, & Erbaugh, 1961) is a 21-item self-report scale measuring manifestations of depression. Participants rate each item on a 0-3 point scale. The BDI has been widely used among culturally diverse samples, including Japanese (Habukawa et al., 2010) and Chinese (Lai, Tang, Lee, Yip, & Chung, 2010). The Japanese version of BDI was translated by Hayashi (1988), and the reliability and validity were demonstrated by Hazama (1989). The Chinese version of the BDI possesses acceptable psychometric properties, and the factor analytic data tend to support Beck’s multidimensional view of depression as a construct (Shek, 1990). However, several studies have reported different cut-off scores for BDI across cultures. For example, in China, the cut-off score for depression was 14 (Lee et al., 2008), while it was 11 in Japan (Arnault, Sakamoto, & Moriwaki, 2006). In the present study, the internal consistencies of the BDI were 0.79 for both Japan and China.

Relationship Questionnaire

Bartholomew and Horowitz (1991) developed the Relationship Questionnaire (RQ) which assigns respondents to four categories or styles of adult attachment: secure (comfortable with intimacy and autonomy); fearful (fearful of intimacy and socially avoidant); preoccupied (preoccupied with relationships); and dismissive (dismissing of intimacy and strongly independent).The RQ was based on the idea that attachment styles depend on whether or not people perceive their partners as accessible and responsive to their requests for support, and whether they perceive themselves to be the kind of individuals to whom others want to respond and lend help. Regarding self-image, Bartholomew and Horowitz described respondents categorized as secure or dismissive as having a positive self-image, while respondents who are categorized as fearful or preoccupied have a negative self-image. Regarding image of others, respondents who are classified as secure or preoccupied have a positive image of others, while respondents who are classified as fearful or dismissive as have a negative image of others. These types only provide a profile of an individual’s attachment feelings and behavior. The Japanese adaptation of the RQ was reported by Kato (1998) to be reliable and to have good validity. The Chinese version has also demonstrated good reliability and validity (Li & Du, 2005).

Parental Bonding Instrument (PBI)

The PBI (Parker, 1979, 1990) includes two subscales termed Parental “Care” and “Control or Overprotection,” which aim to measure the respondent’s perceived parental child-rearing styles. The measure is “retrospective,” meaning that adults (over 16 years) complete the measure for how they remember their parents during their first 16 years. Respondents rate their mothers and fathers separately. For each parent there are 25 items consisting of 12 “Care” items and 13 “Control or Overprotection” items. Higher scores on the Care subscale reflect participants’ perceptions of their parents as warm and understanding, while higher scores on the Control subscale reflect parental overcontrol or intrusion (R. Young, Lennie, & Minnis, 2011). The PBI was translated into Japanese and has been used widely by Japanese researchers with adequate validity and reliability (Kitamura & Suzuki, 1993). Appropriate reliability and validity of the Chinese version has also been demonstrated (Yang et al., 2009). Various studies have demonstrated acceptable test–retest reliability (e.g., Favaretto, Torresani, & Zimmermann, 2001). In the present study, the internal reliabilities for the PBI were acceptable: with Cronbach’s alphas of .74 and .72 for the Japanese versions for mother and for father, respectively and .79 for the Chinese versions for both mother and father.

Statistical analyses

Data were analyzed using SPSS Statistics 17.0 (SPSS Inc., Chicago, IL). Categorical variables were compared using a chi-square test. Student’s t test was computed for fundamental parental styles and depression of Japanese and Chinese participants. Further, path-analytic mediation analyses were performed according to guidelines developed by Baron and Kenny (1986) to examine the mediating roles of risk factors on PIU.

Results

Bivariate comparison of groups with student’s t test showed that the mean IAT score of Japanese students was significantly higher than that of Chinese students (39.0 ± 13.6 vs. 34.0 ± 10.1; t = −4.0; p < .0001). A chi-square test demonstrated that 18.7% of Japanese and 10.2% of Chinese students were categorized as having PIU. Japanese participants were significantly more likely to turn to PIU than were Chinese participants (see Table 1). Compared to Chinese students, Japanese presented higher depression scores, more negative self-image, but also more positive image of others, and lower perceived mother-care scores, but higher parental control/overprotection scores.

Table 1.

Comparison of characteristics of Japanese and Chinese students (N = 503)

Japanese (N = 267)		Chinese (N = 236)
n	%	n	%	Statistical test	p-value
IAT
Problematic Internet use	50	18.7	24	10.2	χ² = 7.3 (df = 1)	.0069
Normal Internet use	217	81.3	212	89.8
Gender
Male	91	34.1	60	25.4	χ² = 4.5 (df = 1)	.03
Female	176	65.9	176	74.6
RQ
Self-image
Positive	102	38.2	204	86.4	χ² = 122.4 (df = 1)	<.0001
Negative	165	61.8	32	13.6
Image of others
Positive	161	60.3	219	92.8	χ² = 71.6 (df = 1)	<.0001
Negative	106	39.7	17	7.2
mean ± SD		mean ± SD
Age	18.8 ± 0.1		19.3 ± 0.1		t = −.3	.073
BDI Depression	10.3 ± 7.5		8.4 ± 7.6		t = 2.8	.006
PBI
Mother Care	23.5 ± 7.3		25.6 ± 6.5		t = 3.3	.0011
Control/Overprotection	10.2 ± 5.5		11.7 ± 5.0		t = 3.1	.0018
Father Care	27.4 ± 6.4		27.7 ± 5.3		t = 0.6	.136
Control/Overprotection	11.8 ± 6.5		13.1 ± 5.6		t = 2.4	.016

BDI: Beck Depression Inventory.

Positive self-image: secure type; dismissive type.

Negative self-image: fearful type; preoccupied type.

PIU group: IAT score ≧50, normal Internet use group: IAT score ≦49.

RQ: Relationship Questionnaire.

PBI: Parental Bonding Instrument.

IAT: Internet Addiction Test.

Positive image of others: secure type; preoccupied type.

Negative image of others: fearful type; dismissive type.

Table 2 shows the comparison of PIU and normal Internet use groups. The results indicated that the PIU group consisted of more males, Japanese participants, and participants who had a negative self-image but positive image of others. Age was not related with the PIU group. Furthermore, the PIU group showed higher depression scores, and lower parents’ care scores, but higher parents’ control/overprotection scores than the normal Internet use group.

Table 2.

Comparison of characteristics of PIU and normal Internet use groups (N = 503)

Problematic internet use (N = 74)		Normal internet use (N = 429)
n	%	n	%	Statistical test	p-value
Gender
Male	40	54.1	111	25.9	χ² = 23.9 (df = 1)	<.0001
Female	34	45.9	318	74.1
Nation
Japanese	50	67.6	217	50.6	χ² = 7.3 (df = 1)	.0069
Chinese	24	32.4	212	49.4
RQ
Self-image
Positive	29	39.2	281	65.5	χ² = 18.5 (df = 1)	<.0001
Negative	45	60.8	148	34.5
Image of others
Positive	44	59.5	336	78.3	χ² = 12.2 (df = 1)	.0005
Negative	30	40.5	93	21.7
mean ± SD		mean ± SD
Age	18.9 ± 1.0		19.1 ± 1.1		t = 1.4	.174
BDI Depression	14.6 ± 10.7		8.5 ± 6.5		t = −6.6	<.0001
PBI
Mother Care	21.7 ± 8.2		25.0 ± 6.6		t = 3.7	.0002
Control/ Overprotection	12.2 ± 6.0		10.7 ± 5.2		t = −2.2	.0249
Father Care	24.7 ± 6.7		28.1 ± 5.6		t = 4.6	<.0001
Control/ Overprotection	14.5 ± 7.1		12.0 ± 5.9		t = −3.2	.0013

BDI: Beck Depression Inventory.

Positive self model: secure type; dismissive type.

Negative self model: fearful type; preoccupied type.

PIU group: IAT score ≧50, Normal Internet use group: IAT score ≦49.

RQ: Relationship Questionnaire.

PBI: Parental Bonding Instrument.

IAT: Internet Addiction Test.

Positive image of others: secure type; preoccupied type.

Negative image of others: fearful type; dismissive type.

The present study further investigated the mediating roles of parental child-rearing styles and depression on PIU. According to Baron and Kenny (1986), three requirements must be met to achieve mediating effect. That is, the predictor variable must show a significant relationship with both the hypothesized mediator and criterion variables; the mediator must show a significant relationship (after controlling for the relationship between the predictor and the criterion) with the criterion variable; and, finally, when the relationship between the mediator and the criterion is held constant, the previously significant relationship between the predictor variable and the criterion variable should be significantly reduced. This latter criterion would be manifested in a significant indirect effect of the predictor on the criterion via its influence on the mediator. To test the indirect effect, Sobel’s (1982) significance test was performed.

Depression correlated with PIU both in Japan and China (Japan: r = 0.27, p < .0001; China: r = 0.42, p < .0001). Figure 1a presents a mediation model with the predictor variable as country, depression as the mediator, and PIU as the criterion variable. The results showed that all three requirements were met. Further, Sobel’s test indicated that depression was a significant mediator (p < .01); that is, national differences in PIU between Japanese and Chinese participants were mediated by national differences in depression. We also performed mediation analysis with the predictor variable as country, mother-care as the mediator, and PIU as the criterion variable (Figure 1b). All three requirements were again met for this analysis, and Sobel’s test confirmed that mother-care was a significant mediator (p < .01). However, regarding mother-control and father-control, the relationship between the predictor variable and the criterion variable was not significantly decreased. Country (predictor variable) did not show a significant relationship with father-care (hypothesized mediator). These three parental styles could not be mediators. Thus, Sobel’s test was not performed. The summary of the mediation analyses that were not fully mediated is presented in Table 3.

Figure 1.

Mediation analyses of relationship between country, PIU, and depression. (a) Mediation analysis depression as a mediator *p < 0.01, **p < 0.001; (b) Mediation analysis mother care as a mediator PIU: Problematic Internet use; (c) Mediation analysis PIU as a mediator.

Table 3.

Unstandardized path coefficients for PIU as a function of mediators

	Mediators
	Mother-Contrl.	Father-Care	Father-Contrl.
JA/CH—MED	−1.48 (.47)*	−.32 (.53)	−1.32 (.55)*
MED—PIU	.28 (.10)*	−.46 (.09)**	.32 (.09)**
JA/CH—PIU	4.37 (1.08)**	4.37 (1.08)**	4.37 (1.08)**
JA/CH—PIU (MED)	4.87 (1.08)**	4.23 (1.06)**	4.85 (.09)**

Note. JA/CH = Difference between Japanese and Chinese. MED = Mediator. PIU = Internet.

Addiction Test. Mother-Contrl. = Parenting Bonding Instrument: Mother-Control subscale.

Father-Care = Parenting Bonding Instrument: Father-Care subscale. Father-Contrl. = Parenting.

Bonding Instrument: Father-Control subscale. (MED) = unstandardized correlation between nations and PIU after mediation was controlled.

p < .01, **p < .001. Inside of the parentheses represent standardized error.

Figure 1c presents the mediation model of Internet use as the mediator between the predictor variable (country) and the criterion variable (depression). The result showed that all three requirements were met. Further, Sobel’s test indicated that the PIU was a significant mediator (p < .01).

Discussion

This study examined differing patterns in PIU between Japanese and Chinese students as well as the effects of depression, relationship, and perceived parental child-rearing styles on PIU. We found that depression was significantly associated with PIU for both Japanese and Chinese college students. This result is consistent with studies by Morrison and Gore (2010) in the UK and Yen, Tang et al. (2009) in China, who investigated the relationship between depression and Internet addiction. As Young (2004) pointed out, students with Internet addiction may use the Internet to hide their vulnerable and negative feelings, such as depression, and to escape from negative or stressful events. Individuals with depression may be drawn to the electronic world because it offers anonymity through fictitious handles, which helps them overcome real-life interpersonal difficulties (K. S. Young & Rodgers, 1998). Some reports also confirm that Internet addiction often occurs concurrently with other psychiatric problems, such as obsessive-compulsive disorder, anxiety, hostility, and paranoid ideation (Huang et al., 2010). Other studies have found associations between Internet addiction and bipolar disorder (Kim, Grant, Eckert, Faris, & Hartman, 2006) as well as gambling problems (McIntyre et al., 2007). Because the comorbidity rate is great between PIU and other psychiatric disorders, further studies are vital to clarify the causal direction of the association.

Second, the present study indicated that students who turned to PIU tended to have a negative self-image. On the Internet, self-presentational styles can be altered, and users can present themselves with a more “ideal self” than they might otherwise have. Wu and Zhu (2004) also reported that self-image is one of the most crucial risk factors of PIU, such as Internet addiction. As Janet and Phyllis (2003) suggested, individuals with negative self-image may use the Internet to enhance their self-image or self-esteem by presenting an ideal self. Thus, we suggest that Japanese and Chinese students with negative self-image may feel better about themselves and their relationships in the online world, leading them to desire to escape into cyberspace. It is also plausible that Internet addiction, as with other addictions, may jeopardize self-image. Again, longitudinal studies are needed to resolve the causal direction of effects.

Third, the students in the PIU groups tended to perceive their mothers to be less caring and warm, and to see both of their parents to be more controlling. In an earlier study in China, Yen, Ko, Yen, Chang, and Chung (2009) found a similar result, i.e., low family monitoring and/or high family conflict were discriminative factors for PIU. Over the past few years, the use of the Internet has increased considerably. Adolescents can use the Internet in many places such as their schools, their bedrooms, and Internet cafes. Therefore, parents generally do not know how often their children use the Internet. Japanese and Chinese students may go to a cyberworld rather than dealing with less caring and over-controlling parents.

The present study found that the national difference in PIU between Japanese and Chinese was mediated by the national difference in perceived mother’s care. Compared to Chinese students, Japanese students were likely to show more negative self-image, lower perceived parents’ care, and higher over-control. The findings from this study also indicated that individuals who perceived their mothers to be less caring and warm tended to evidence PIU. This may be due to lack of support from their parents, especially from their mothers, leading them to seek social support through relationships on the Internet. In addition, perceived fathers’ child-rearing style did not mediate the national difference on PIU. Our hypothesis was not supported, we believe, because fathers usually work full-time, and thus often spend less time with their children than do mothers in both countries. Moreover, this study also revealed that Chinese students perceived their parents as more warm or caring than did Japanese students. This may be related to the One Child policy that started in 1979, resulting in a rapid increase in the number of only children in China. Thus, although previous scholars have reported that children without brothers and/or sisters have more psychological problems (Liu, Munakata, & Onuoha 2005), Chinese students may have more interaction with their parents than do Japanese students.

This study also showed that the national difference in PIU between Japanese and Chinese was mediated by the national difference in depression. This finding was consistent with our hypothesis. However, the direction of the effect is unclear and mediation analysis also indicated that the national difference in depression was mediated by the national difference in PIU. Previous studies have reported a significant relationship between Internet addiction and depression (Whang, Lee, & Chang, 2003). McKenna and Bargh (2000) found that the level of depression actually decreased when depression was measured before and after Internet use. Furthermore, Kraut et al. (1998) used longitudinal data to show that engaging in PIU leads to significant increases in depression. These findings warrant further investigation to clarify the relationship between depression and PIU.

Several limitations of the present study should be noted. First, given that the data were collected from college students in two Japanese cities and one city in China, the results may not be representative of the general population. Second, the participants were from different majors (i.e., agriculture as compared to medicine, education and foreign languages), and science students may use computers more than liberal arts students. Third, the sample had an unequal number of male and female participants; a greater number of male participants would have improved the study. Fourth, the data were provided by the students themselves, which may have introduced self-report bias, and the validity of some data could not be easily quantified. Fifth, we only used the results of the questionnaire, but did not conduct interviews. Last, this was a cross-sectional study; longitudinal studies are necessary to resolve the causal direction of associations between PIU, depression, and other potential risk factors.

Conclusion

Our research supports the notion that PIU is significantly associated with depression, self-image, and parental relations. National differences in PIU between Japanese and Chinese participants were mediated by national differences in depression and perceived mother’s care. Japanese students had higher depression scores, more negative self-image, and lower mother’s care scores but higher parents’ control/overprotection scores than Chinese students.

Given that PIU is significantly associated with other psychiatric symptoms and disorders, such as anxiety (Tsai et al., 2009), attention deficit hyperactivity symptoms (Yoo et al., 2004), and impulsivity (Cao, Su, Liu, & Gao, 2007), further longitudinal studies are indispensable to reveal the mechanism of the relationship between PIU and psychiatric disorders. Such studies can be used to guide prevention and incorporated into treatment modalities for PIU.

Footnotes

Acknowledgment

This study was supported by Professor Sun from Dalian Medical University, China.

Funding

This research received no specific grant from any funding agency in the public, commercial, or not-for-profit sectors.

Chun Yan Yang graduated from the postgraduate doctor course at the Faculty of Medicine at Saga University, Japan. She is now working at the Dalian No. 7 People's Hospital and Dalian Mental Health Center in China.

Takeshi Sato is Professor and Director of the Health Care Center at Saga University in Japan. He provides medical/psychological services for college students and officers. His recent interests include college mental health and occupational mental health, particularly the relationships between mobile phones, social connectedness, and depression.

Niwako Yamawaki is an associate professor in the Department of Psychology at Brigham Young University, where she teaches in the area of applied social psychology and the psychology of gender. She conducts research on cultural factors that influence attitudes toward mental health services and violence against women in both Eastern and Western populations.

Masakazu Miyata is Professor and Deputy Director of the Center for Health and Sports Science at Fukuoka University of Education, where he teaches in the area of psychosomatic medicine and mental health. His research investigates the correlation between stress and allergic diseases, and the effect of stress on the function of autonomic nervous system.

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