{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,23]],"date-time":"2026-10-23T20:28:55Z","timestamp":1792787335260,"version":"4.5.0"},"reference-count":51,"publisher":"BMJ","issue":"1","license":[{"start":{"date-parts":[[2026,1,5]],"date-time":"2026-01-05T00:00:00Z","timestamp":1767571200000},"content-version":"unspecified","delay-in-days":4,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"}],"funder":[{"name":"Non-Communicable Disease (NCD) Section (Mental Study), Ministry of Health (MOH), Malaysia","award":["NMRR ID 22-00965-YZW"],"award-info":[{"award-number":["NMRR ID 22-00965-YZW"]}]}],"content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["BMJ Open"],"accepted":{"date-parts":[[2025,12,9]]},"published-print":{"date-parts":[[2026,1]]},"abstract":"<jats:sec>\n                    <jats:title>Objective<\/jats:title>\n                    <jats:p>To determine the prevalence of internet addiction and examine its association with psychological factors specifically depression, anxiety and loneliness among Malaysian public university students.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Design<\/jats:title>\n                    <jats:p>Cross-sectional study.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Setting<\/jats:title>\n                    <jats:p>All public universities in Malaysia, 20 universities.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Participants<\/jats:title>\n                    <jats:p>The study included 7278 students from 20 public universities in Malaysia.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Main outcome measures<\/jats:title>\n                    <jats:p>Statistical analyses were performed usingSTATA V.17 software. Descriptive statistics summarised participants\u2019 demographic characteristics, prevalence of internet addiction and psychological distress (depression, anxiety and loneliness). Pearson\u2019s correlation was used to assess bivariate relationships between internet addiction and psychological variables, while multiple logistic regression identified independent factors associated with internet addiction after adjusting for significant confounders.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>The study found that 38.6% of the students showed signs of internet addiction, along with a high level of psychological distress; 24.8% had depressive symptoms, 32.4% experienced anxiety and 35.5% reported loneliness. Moderate positive correlations were observed between internet addiction and depression, anxiety and loneliness (p&lt;0.00). Multivariate analyses adjusted for field of study, gender and ethnicity confirmed these associations.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>The findings indicate significant associations between internet addiction and psychological factors such as depression, anxiety and loneliness. A comprehensive, multifaceted approach is essential to address psychological distress among university students and reduce the risk of internet addiction.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1136\/bmjopen-2025-108315","type":"journal-article","created":{"date-parts":[[2026,1,5]],"date-time":"2026-01-05T12:55:24Z","timestamp":1767617724000},"page":"e108315","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":3,"title":["Association between depression, anxiety and loneliness with internet addictions among public university students in Malaysia"],"prefix":"10.1136","volume":"16","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-7772-2103","authenticated-orcid":false,"given":"Nor Asiah","family":"Muhamad","sequence":"first","affiliation":[{"name":"Sector for Evidence-Based Healthcare, National Institutes of Health, Ministry of Health, Shah Alam, Selangor, Malaysia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nur Hasnah","family":"Maamor","sequence":"additional","affiliation":[{"name":"Sector for Evidence-Based Healthcare, National Institutes of Health, Ministry of Health, Shah Alam, Selangor, Malaysia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tengku Puteri Nadiah","family":"Tengku Baharudin Shah","sequence":"additional","affiliation":[{"name":"Sector for Evidence-Based Healthcare, National Institutes of Health, Ministry of Health, Shah Alam, Selangor, Malaysia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nurul Hidayah","family":"Jamalluddin","sequence":"additional","affiliation":[{"name":"Sector for Evidence-Based Healthcare, National Institutes of Health, Ministry of Health, Shah Alam, Selangor, Malaysia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Fatin Norhasny","family":"Leman","sequence":"additional","affiliation":[{"name":"Sector for Evidence-Based Healthcare, National Institutes of Health, Ministry of Health, Shah Alam, Selangor, Malaysia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"\u2018Izzah \u2018Athirah","family":"Rosli","sequence":"additional","affiliation":[{"name":"Sector for Evidence-Based Healthcare, National Institutes of Health, Ministry of Health, Shah Alam, Selangor, Malaysia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nik Athirah Farhana","family":"Nik Azhan","sequence":"additional","affiliation":[{"name":"Sector for Evidence-Based Healthcare, National Institutes of Health, Ministry of Health, Shah Alam, Selangor, Malaysia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Norliza","family":"Chemi","sequence":"additional","affiliation":[{"name":"Department of Psychiatry and Mental Health, Tengku Permaisuri Norashikin Hospital, Kajang, Selangor, Malaysia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Muhammad Arif","family":"Muhamad Rasat","sequence":"additional","affiliation":[{"name":"Department of Psychiatric and Mental Health, Sultanah Bahiyah Hospital, Alor Setar, Kedah, Malaysia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Norni","family":"Abdullah","sequence":"additional","affiliation":[{"name":"Department of Psychiatry and Mental Health, Tengku Ampuan Rahimah Hospital, Klang, Selangor, Malaysia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Norli","family":"Abdul Jabbar","sequence":"additional","affiliation":[{"name":"National Centre of Excellence Mental Health (NCEMH), Ministry of Health, Cyberjaya, Selangor, Malaysia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nurashikin","family":"Ibrahim","sequence":"additional","affiliation":[{"name":"National Centre of Excellence Mental Health (NCEMH), Ministry of Health, Cyberjaya, Selangor, Malaysia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mohd Fadzli","family":"Mohamad Isa","sequence":"additional","affiliation":[{"name":"Department of Psychiatry and Mental Health, Kuala Lumpur Hospital, Federal Territory of Kuala Lumpur, Malaysia"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"239","published-online":{"date-parts":[[2026,1,5]]},"reference":[{"key":"2026062609052128000_16.1.e108315.1","unstructured":"International Telecommunication Union (ITU) . Measuring digital development: facts and figures 2022. Geneva: ITU, 2022."},{"key":"2026062609052128000_16.1.e108315.2","doi-asserted-by":"crossref","first-page":"107201","DOI":"10.1016\/j.chb.2022.107201","article-title":"Internet addiction in young adults: A meta-analysis and systematic review","volume":"130","author":"Lozano-Blasco","year":"2022","journal-title":"Comput Human Behav"},{"key":"2026062609052128000_16.1.e108315.3","unstructured":"GSMA Intelligence . The mobile economy 2023. London: GSMA, 2023."},{"key":"2026062609052128000_16.1.e108315.4","unstructured":"Malaysian Communications and Multimedia Commission (MCMC) . Internet users survey 2020. Cyberjaya: MCMC, 2020."},{"key":"2026062609052128000_16.1.e108315.5","doi-asserted-by":"publisher","DOI":"10.1089\/cpb.1998.1.237"},{"key":"2026062609052128000_16.1.e108315.6","doi-asserted-by":"crossref","first-page":"292","DOI":"10.2174\/157340012803520513","article-title":"Internet Addiction: A Brief Summary of Research and Practice","volume":"8","author":"Cash","year":"2012","journal-title":"Curr Psychiatry Rev"},{"key":"2026062609052128000_16.1.e108315.7","doi-asserted-by":"publisher","DOI":"10.2165\/00023210-200822050-00001"},{"key":"2026062609052128000_16.1.e108315.8","doi-asserted-by":"crossref","first-page":"143","DOI":"10.5498\/wjp.v6.i1.143","article-title":"Internet addiction and problematic Internet use: A systematic review of clinical research","volume":"6","author":"Kuss","year":"2016","journal-title":"World J Psychiatry"},{"key":"2026062609052128000_16.1.e108315.9","doi-asserted-by":"crossref","unstructured":"Mishra J , Behera MR , Mitra R , et al . Prevalence and impact of Internet Addiction Disorder among adolescents and young adults. Open Public Health J 2024. doi:10.2174\/0118749445345806241010081642","DOI":"10.2174\/0118749445345806241010081642"},{"key":"2026062609052128000_16.1.e108315.10","doi-asserted-by":"publisher","DOI":"10.1007\/s40596-017-0794-1"},{"key":"2026062609052128000_16.1.e108315.11","doi-asserted-by":"publisher","DOI":"10.1111\/j.1360-0443.2012.03946.x"},{"key":"2026062609052128000_16.1.e108315.12","doi-asserted-by":"crossref","first-page":"108","DOI":"10.4103\/jfcm.JFCM_93_18","article-title":"Internet Addiction and its Relationships with Depression, Anxiety, and Stress in Urban Adolescents of Kamrup District, Assam","volume":"26","author":"Saikia","year":"2019","journal-title":"J Family Community Med"},{"key":"2026062609052128000_16.1.e108315.13","doi-asserted-by":"crossref","first-page":"3","DOI":"10.1186\/s42506-019-0032-7","article-title":"Prevalence and associated factors of internet addiction among young adults in Bangladesh","volume":"95","author":"Hassan","year":"2020","journal-title":"J Egypt Public Health Assoc"},{"key":"2026062609052128000_16.1.e108315.14","unstructured":"Rajanna SH , Sharma MK . Exploration of technology use pattern among teenagers and its relationship with psychological variables. ASEAN J Psychiatry 2016;239\u201349."},{"key":"2026062609052128000_16.1.e108315.15","doi-asserted-by":"crossref","first-page":"115311","DOI":"10.1016\/j.psychres.2023.115311","article-title":"Depression and internet addiction among adolescents:A meta-analysis","volume":"326","author":"Ye","year":"2023","journal-title":"Psychiatry Res"},{"key":"2026062609052128000_16.1.e108315.16","doi-asserted-by":"crossref","first-page":"21","DOI":"10.1177\/09727531231171979","article-title":"Internet Addiction and Its Association with Demographic Variables, Depression, Anxiety, and Psychological Well-being in College Students","volume":"31","author":"Kumar","year":"2024","journal-title":"Ann Neurosci"},{"key":"2026062609052128000_16.1.e108315.17","doi-asserted-by":"publisher","DOI":"10.2174\/13816128113199990617"},{"key":"2026062609052128000_16.1.e108315.18","unstructured":"Kamel H . Malaysians are addicted to internet. The Malaysian Reserve; 2019."},{"key":"2026062609052128000_16.1.e108315.19","first-page":"3","article-title":"Psychological distress and internet addiction among medical students from a Malaysian public university: A comparison between gender","volume":"15","author":"Mooi","year":"2019","journal-title":"Malaysian J Med Health Sci"},{"key":"2026062609052128000_16.1.e108315.20","doi-asserted-by":"crossref","DOI":"10.1186\/s12889-024-18366-4","article-title":"Relationship between loneliness and internet addiction: a meta-analysis","volume":"24","author":"Wang","year":"2024","journal-title":"BMC Public Health"},{"key":"2026062609052128000_16.1.e108315.21","doi-asserted-by":"crossref","DOI":"10.1080\/21642850.2022.2158089","article-title":"Associations between social media use and loneliness in a cross-national population: do motives for social media use matter?","volume":"11","author":"Bonsaksen","year":"2023","journal-title":"Health Psychol Behav Med"},{"key":"2026062609052128000_16.1.e108315.22","first-page":"19","article-title":"The impact of Internet-based specific activities on the perceptions of Internet addiction, quality of life, and excessive usage: A cross-sectional study","volume":"1","author":"Pontes","year":"2015","journal-title":"Addict Behav Rep"},{"key":"2026062609052128000_16.1.e108315.23","unstructured":"Linden DJ . The compass of pleasure. New York: Penguin Books, 2012:211\u20136."},{"key":"2026062609052128000_16.1.e108315.24","doi-asserted-by":"crossref","first-page":"182","DOI":"10.1097\/YCO.0000000000000994","article-title":"Global prevalence of internet addiction among university students: a systematic review and meta-analysis","volume":"38","author":"Liu","year":"2025","journal-title":"Curr Opin Psychiatry"},{"key":"2026062609052128000_16.1.e108315.25","unstructured":"Breiner H , Stroud C , Bonnie RJ , eds. Investing in the health and well-being of young adults. 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