Association of Stress Coping Strategies With Internet Addiction in College
Students: The Moderating Effect of Depression

Wei-Po Chou, Chih-Hung Ko, Erin A. Kaufman, Sheila E. Crowell,

Ray C. Hsiao, Peng-Wei Wang, Jin-Jia Lin, Cheng-Fang Yen

PII: S0010-440X(15)00095-4
DOI: doi: 10.1016/j.comppsych.2015.06.004
Reference: YCOMP 51532

To appear in: Comprehensive Psychiatry

Received date: 14 November 2014

Revised date: 12 May 2015
Accepted date: 3 June 2015

Please cite this article as: Chou Wei-Po, Ko Chih-Hung, Kaufman Erin A., Crowell Sheila
E., Hsiao Ray C., Wang Peng-Wei, Lin Jin-Jia, Yen Cheng-Fang, Association of Stress
Coping Strategies With Internet Addiction in College Students: The Moderating Effect
of Depression, Comprehensive Psychiatry (2015), doi: 10.1016/j.comppsych.2015.06.004

This is a PDF file of an unedited manuscript that has been accepted for publication.
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Association of Stress Coping Strategies With Internet Addiction in College

Students: The Moderating Effect of Depression

Wei-Po Chou,a,b,1 Chih-Hung Ko,a,b,c,1 Erin A. Kaufman,d Sheila E. Crowell,d

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Ray C. Hsiao,e Peng-Wei Wang,a,b Jin-Jia Lin,f,g,h,* Cheng-Fang Yena,b,*

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a
Department of Psychiatry, Kaohsiung Medical University Hospital, Kaohsiung,
Taiwan; bDepartment of Psychiatry, School of Medicine, and Graduate Institute

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of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung,
Taiwan; cDepartment of Psychiatry, Kaohsiung Municipal Hsiao-Kang Hospital,

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Kaohsiung, Taiwan; dDepartment of Psychology, University of Utah, Salt Lake
City, UT; eDepartment of Psychiatry and Behavioral Sciences, University of
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Washington School of Medicine, Seattle, WA; fDepartment of Psychiatry,
Chi-Mei Medical Center, Tainan, Taiwan; gDepartment of Psychiatry, Chi-Mei
Hospital, Liuying Campus, Tainan, Taiwan; hDepartment of Psychiatry, School of
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Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan

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1
Dr. W-P Chou and Dr. C-H Ko contributed equally to this study.
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Running title: Stress Coping Strategies and Internet Addiction

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Corresponding authors:
Cheng-Fang Yen, MD., PhD
Department of Psychiatry, Kaohsiung Medical University Hospital, 100 Tzyou 1st Road,
Kaohsiung, Taiwan 807; E-mail: chfaye@kmu.edu.tw
Tel: (+886) 7-312-4941; FAX: (+886) 7-3134761

Jin-Jia Lin, MD.

Department of Psychiatry, Chimei Medical Center
No. 442, Shulin Street, Section 2, South District, Tainan 702, Taiwan
Telephone: (+886) 6-2228116 ext 58100; Fax: (+886) 6-2203702
E-mail: jinjialin5483@gmail.com
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Abstract

Background: This study examined the association between stress-related coping

strategies and Internet addiction and the moderating effect of depression in a sample of

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Taiwanese college students.

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Method: A total of 500 college students (238 men and 262 women) participated in this

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study. Internet addiction was assessed using the Chen Internet Addiction Scale.

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Participants’ stress coping strategies and depressive symptoms were measured using the

Coping Orientation to Problems Experienced and the Beck Depression Inventory-II,

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respectively. We used t and chi-square tests to examine differences in demographic

characteristics, depression, and stress coping strategies between participants with and
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without Internet addiction. Significant variables were used in a logistic regression model

to examine the association between stress coping strategies and Internet addiction and the
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moderating effect of depression on the association.

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Results: Results indicated that use of restraint coping was negatively associated with

Internet addiction (odds ratio [OR] = 0.886, 95% confidence interval [CI]: 0.802−0.977),
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whereas denial (OR = 1.177, 95% CI: 1.029−1.346) and mental disengagement (OR =

2.673, 95% CI: 1.499−4.767) were positively associated with Internet addiction.
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Depression had a moderating effect on the association between denial and Internet

addiction (OR = 0.701, 95% CI: 0.530−0.927).

Conclusions: Stress coping strategies and depression are important factors to evaluate

when developing intervention programs targeting college undergraduate students with

Internet addiction.

Keywords: stress coping strategies, Internet addiction, college students, depression.

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1. Introduction

The Internet, which has grown rapidly since its development in the 1990s, has

become a major part of modern daily life. However, Internet usage can become

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excessive and uncontrolled. The American Psychiatric Association (APA) has

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included Internet gaming disorder as a preliminary diagnosis in Section III of the

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Diagnostic and Statistical Manual of Mental Disorders, 5th Edition (DSM-5) [1].

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Internet addiction, also described as pathological Internet use, is marked by an

inability to control Internet use that eventually leads to psychological, social, and/or

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work difficulties. International epidemiological studies have demonstrated that
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Internet addiction is a public health concern with prevalence rates ranging from 8% to

13% among college students [2] and 1.4% to 17.9% among adolescents [3-7]. People
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with Internet addiction often develop a range of comorbid psychological symptoms

[8], such as depression [9], attention deficit and hyperactivity disorder [9, 10], social
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isolation, and low self-esteem [7,11-12]. Moreover, they may exhibit a range of

problematic behaviors [13], such as impulsivity [14], sensation- and novelty-seeking

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behavior [15, 16], and high levels of aggression [15].

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The Internet can provide various entertainment and social networking

opportunities. However, the prevalence of Internet addiction, which mean those

people engaged in extended Internet use for work, entertainment, and social

networking, was increasing. Therefore, whether people with Internet addiction have

different stress coping strategies warrants investigation. A recent study that used the

Coping Orientation to Problems Experienced (COPE) found that those with Internet

addiction scored significantly higher on measures of mental disengagement, denial,

and behavioral disengagement compared to those without Internet addition; further,

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they scored significantly lower on positive reinterpretation and growth, use of

instrumental social support, restraint, use of emotional social support, suppression of

competing activities, and planning [17]. Previous studies have shown poor coping

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strategies may contribute to additional stress among certain people, leading to a

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negative pattern of behavior, the development of psychosomatic symptoms, and a

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decrease in academic performance [18]. In addition, problematic Internet use may

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compromise functioning and increase people’s difficulty of coping with stress [19].

Developing effective coping behavior can reduce stress, help people solve personal

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problems, and maintain psychological balance and health [20]. Thus, examining stress
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coping strategies among those with Internet addiction could guide future

interventions.
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The present study examined two problems that prior research [17] did not

resolve. First, Internet addiction is prevalent among college students [2]. College
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students constitute a high risk population since many have multiple sources of stress,

including academic demands, financial strain, time pressure, health concerns, troubled
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interpersonal relationships, and other self-imposed stressors [18]. The previous study
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had investigated the influence of online motive and coping strategy on perceived

stress [21]. The issue of coping strategies of the people with Internet addiction has not

been examined. Second, people with Internet addiction have a higher level of

depression than do those without Internet addiction [9]. There are differences in

coping strategies between those with and without depression [22]. Depression may

change the individuals’ behavioral patterns and confidence in themselves [23, 24], and

thus it is reasonable to hypothesized that there are differences in the associations

between stress coping strategies and Internet addiction between college students with

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and without significant depression. Yet no one has examined whether depression

plays a moderating role in the association between Internet addiction and stress coping

strategies. Research on these topics may inform the development of intervention

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programs for college students targeting more effective stress coping strategies,

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depression, and Internet addiction.

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This cross-sectional study examined the association between stress coping

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strategies and Internet addiction in Taiwanese college students as well as the potential

moderating effect of depression on that association. Due to the dearth of previous

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research in this area, we hypothesized that the association between stress coping
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strategies and Internet addiction would vary among college students. We also

temporally hypothesized that the association between stress coping strategies and
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Internet addiction was more significant in college students with significant depression

than that in those without significant depression.

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2. Methods
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2.1.Participants
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Participants were recruited using an advertisement posted for college students

between 20 and 30 years old. A total of 500 college students (238 men and 262

women) participated in this study. Their mean age was 22.1 years (standard deviation

[SD]: 1.8 years). Informed consent was obtained for all participants prior to

assessment. The study was approved by the Institutional Review Board of Kaohsiung

Medical University Hospital.

2.2.Measures

2.2.1. Coping Orientation to Problems Experienced

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The 53-item self-administrated COPE [25] is composed of 13 scales; five

measure problem-focused coping (active coping, planning, suppression of competing

activities, restraint coping, and seeking of instrumental social support), five measure

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emotion-focused coping (seeking of emotional social support, positive reinterpretation,

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acceptance, denial, and turning to religion), and three scales measure coping responses

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that are generally less effective than the aforementioned responses (focus on and

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venting of emotions, behavioral disengagement, mental disengagement). The COPE

measures how people respond when they confront difficult or stressful events in their

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lives but not cope with a specific stressful event. Every item is rated on a 4-point
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Likert scale. Higher total scale scores indicate that participants are more likely to cope

with stress by using those strategies. Research indicates the COPE has high reliability

and validity [24]. The internal reliability (Cronbach’s α) of 13 scales on the COPE in
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the present study ranges from .73 to .92, indicating acceptable to excellent internal
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consistency reliability [26].

2.2.2. Chen Internet Addiction Scale

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We used the self-administrated Chen Internet Addiction Scale (CIAS) to assess

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participants’ severity of Internet addiction in the month preceding the study. The

CIAS contains 26 items rated on a 4-point Likert scale with scaled scores ranging

from 26 to 104 [27]. A higher total score indicates a more severe level of Internet

addiction. The internal reliability (Cronbach’s α) of the CIAS in the present study

was .93, indicating excellent internal consistency reliability [26]. A previous study

found that the 67/68 cutoff point of the CIAS is the optimal diagnostic cutoff point for

Internet addiction in college students [28]. Accordingly, participants whose total

CIAS score was 68 or higher were identified as having Internet addiction.

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2.2.3. Beck Depression Inventory-II

The 21-item Beck Depression Inventory-II (BDI-II) is a self-administered

instrument that assesses the severity of depressive symptoms in the preceding 2 weeks

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[29]. A higher total BDI-II score indicates more severe depression. The Cronbach’s α

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for the BDI-II in the present study was 0.88. Research found that a total BDI-II score

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of 14 or higher indicates clinically significant depression [29]. Accordingly,

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participants whose total BDI-II score was 14 or higher were identified as having

significant depression.

2.3.Procedure and statistical analysis

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Research assistants explained the procedures and methods of completing the

research questionnaires to the participants individually. The participants could

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propose any question when they had problems on completing the questionnaires, and

the research assistants would resolve the problems for them. Data analysis was
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performed using the SPSS 18.0 statistical software (SPSS Inc., Chicago, IL, USA).

The ratios of sex and significant depression were compared between those with and
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without Internet addiction by using the chi-square test. Group differences in age and
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scores on the COPE were examined by using an independent t test. The significant

variables were subsequently selected for a logistic regression analysis to examine the

association of stress coping strategies with Internet addiction. When depression was

significantly associated with Internet addiction, the moderating effect of depression on

the association between coping strategies and Internet addiction was examined

according to the standard criteria proposed by Baron and Kenny [29]. A p value of .05

was used to indicate significance in all statistical tests.

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3. Results

In total, 85 (17%) participants were identified as having Internet addiction. Table

1 shows the results of comparing sex, age, COPE scores, and significant depression

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between college students with and without Internet addiction. Results indicated that

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students with Internet addiction had lower scores in active and restraint coping and

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higher scores in denial, behavioral disengagement, and mental disengagement

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compared to those without Internet addiction. There were 33 (38.8%) and 54 (13.0%)

participants who had significant depression in those with and without Internet

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addiction, respectively. Those with Internet addiction were more likely to have
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significant depression. No age or sex differences were observed between the two

groups.
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[Insert Table 1 here]

Significant variables were then employed in a logistic regression analysis (Table

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2). Results indicated that restraint coping was negatively associated with Internet

addiction, whereas denial and mental disengagement were positively associated with
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Internet addiction. Because depression was positively associated with Internet

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addiction, the interaction variables of depression × restraint coping, depression ×

denial, and depression × mental disengagement were used in the regression analysis

models. The depression × denial variable was significantly associated with Internet

addiction, indicating that depression had a moderating effect on the association

between denial and Internet addiction. The Nagelkerke R2 was 0.196. Further

examination revealed that the significant association between denial and Internet

addiction was present only among college students without significant depression (B

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= .297, p < .001, OR = 1.346, 95% CI: 1.1401.591) and not among college students

with significant depression (B = -.063, p = .621, OR = 0.939, 95% CI: 0.7321.204).

[Insert Table 2 here]

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4. Discussion

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This is the first study examined the association between stress-related coping

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strategies and Internet addiction and the moderating effect of depression. It indicated

that use of restraint coping was negatively associated with Internet addiction, whereas

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denial and mental disengagement were positively associated with Internet addiction.
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Depression had a moderating effect and may diminish the effects which denial coping

strategy put on Internet addiction.

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This study found that 17% of the participants were identified as having Internet

addiction. Research on the college students in Taiwan also found that the prevalence
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rate of Internet addiction ranged from 12% to 18% [30,31]. The prevalence rates of

Internet addiction among college students in the United States and Europe ranged
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between 1.5% and 8.2% [32]. Compared with the studies in the United States and
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Europe, the prevalence rate of Internet addiction in the present study is higher. A

previous study also found that compared with the students in the United States, more

Chinese students were identified with Internet addiction [33].

Addiction and stress are linked at multiple levels. Addictive behaviors are often

initiated as a maladaptive mechanism for coping with stress [34]. Meanwhile, stress

may enhance abstinent individuals’ recall of memories of addictive behaviors as stress

relievers and then increase the risk of relapse to addictive behaviors after abstinence

[35]. Previous researches have demonstrated that several stress-related hormones such

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as cortisol, dopamine and serotonin may account for the association between addiction

and stress coping or psychological comorbidity [35-38]. Coping styles reflect both

strategies used to cope with various stressors and people’s habitual preferences in

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coping with problems [39]. In this study, we evaluated the associations between three

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dimensions of coping (i.e., problem focused, emotion focused, and nonfunctional)

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with Internet addiction by controlling for the effect of depression in college students.

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This study showed that, among the problem-focused stress coping strategies,

restraint coping was negatively associated with Internet addiction. This indicates that

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college students with a higher tendency to use the restraint coping strategy were less
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likely to have Internet addiction. The restraint coping strategy involves waiting until

an appropriate opportunity to act arises, holding oneself back, and not acting
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prematurely [25]. The relationship between the restraint coping strategy and Internet

addiction may be bidirectional. College students who use this strategy may refrain
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from participating in activities that compete with their chances to resolve problems

and, consequently, allocate their time and effort to effectively managing stress.
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Internet use might be one activity that they refrain from, thus reducing the risk of
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Internet addiction. In contrast, college students with Internet addiction may experience

difficulty controlling their Internet use and may use the Internet as a means of

avoidance. Thus, they may particularly likely to use the Internet excessively when

they encounter stress. Although the Internet provides access to resources that may

facilitate resolving stressors, young people with Internet addiction spend a substantial

amount of time on websites with gaming and chat content [40], and these Internet

activities may compromise chances to manage stress effectively in real life. The

people who overuse of Internet may waste lots of time, lost control to cut down the

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use of Internet and avoid managing stress directly, which lead to manage stress

inefficiency and even worsening mental health problems.

College students in our sample who endorsed using denial to cope with stress

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were more likely to have Internet addiction. Denial is an emotional coping strategy

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whereby an individual attempts to reject the reality of a stressful event [41]. When

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college students use denial, they may choose to escape into the Internet to avoid

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confronting the stresses of reality, increasing their risk of developing Internet

addiction. Continual use of the denial coping strategy may also increase the

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probability of developing depression later in life [42]. In addition, emotion-focused
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coping strategies are associated with mental health problems such as anxiety and

depression [43, 44]. Internet use may alleviate symptoms of anxiety and depression
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temporarily [45]. However, it may also lead to psychological, social, or work

difficulties in real life [8, 9].

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Interestingly, a significant association between denial and Internet addiction was

only observed among college students without significant depression. Research found
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that depressive symptoms and depressive disorders are prevalent among those who
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used to cope with stress by denial [39]. Meanwhile, depression was significantly

associated with Internet addiction [9]. The complicated relationships among the stress

coping strategy of denial, Internet addiction and depression may result in the

difference in the association between the stress coping strategy of denial and Internet

addiction between the college students with and without significant depression. The

actual mechanism of moderating effect of depression on association between denial

and Internet addiction needs further study. The result of this study supports that

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mental health and educational professionals need to take depression into consideration

when selecting intervention strategies for college students with Internet addiction.

We also found college students who tend to cope with stress through mental

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disengagement were more likely to have Internet addiction. Disengagement strategies

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include cognitive avoidance, psychological detachment, and cognitive distortion [46].

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Psychological disengagement refers to the process of mentally distancing oneself as a

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strategy of dealing with stressful situations [47]. The difference between

disengagement and avoidance was the construct of psychological disengagement from

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the work recovery side, and avoidance coping on the coping side [47]. Disengagement
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coping strategies like of self-blame and self-distraction were the most strongly

associated with distress [48]. These associations indicate disengagement is especially

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problematic with regard to mental health problems [48]. Because the Internet provides

people with entertainment, the feeling of achievement, and the pleasure of control [49],
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people may easily immerse themselves in a virtual world to escape from emotional

difficulties in the real world. The characteristics of the Internet may partially account
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for the association between mental disengagement and Internet addiction.

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The coping strategies of active coping and behavioral disengagement were not

significantly associated with Internet addiction in the final regression. Behavioral

disengagement involved reducing one's effort to deal with the stressor even giving up

the attempt to attain goals with which the stressor is interfering. It is most likely to

occur when people expect poor outcomes [25]. Research has found that behavioral

disengagement was associated with alcohol use [52] and increased level of depression

[52], but there has no previous research to clarify whether it has influence on other

addictive behaviors. Active coping is the process of taking active steps to try to

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remove or circumvent the stressor or to ameliorate its effects [26]. Active coping

includes initiating direct action, increasing one's efforts, and trying to execute a

coping attempt in stepwise fashion [26]. College students who use this strategy may

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deal with the stressor by searching information on Internet. Research has revealed that

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active coping was less related with substance use or addictive behavior such as

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gambling [53-54]. However, the final regression of the present study did not find the

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significant association of active coping and behavioral disengagement with Internet

addiction. Further study is necessary to clarify the relationship of active coping and

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behavior disengagement with Internet addiction.
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Several limitations of this study require acknowledgment. First, the

cross-sectional research design of this study limited our ability to draw conclusions
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regarding the causal relationships between Internet addiction and the stress coping

strategies examined in this study. Second, study data were exclusively self-report. The
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use of one data source could have influenced our findings and may have resulted in

shared-method variance. Third, the small moderating effect of depression may

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indicate factors other than depression may moderate relationship between stress
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coping and Internet addiction in college students. Fujita argued that the importance of

effect size should depend on the value of effect size and depends on factors such as

the severity of problems interested [55]. Therefore, even a small effect size was also

important to understanding what factors relate to Internet addiction in college student

because Internet addiction was an important health problem. Fourth, although we

measured depression, no further information regarding their psychiatric diagnoses was

collected.

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Our study results pointed mental health and educational professionals to the

importance of helping college students develop effective stress coping strategies for

reducing the risk of Internet addiction. College students had multiple stressors during

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school. Educational and mental health professionals should supply recourses and

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educate the ways to manage stress effectively, as well as help college students reducing

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the risk of avoidance or disengagement by Internet use. Meanwhile, this study found

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that depression not only increased the risk of Internet addiction but also moderated the

association between stress coping strategies and Internet addiction. The results support

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that mental health and educational professionals need to take depression into
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consideration when selecting intervention strategies for college students with Internet

addiction. Further study on whether psychiatric disorders affect the association between
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Internet addiction and stress coping strategies is necessary.

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Acknowledge

This study was supported by a grant awarded by the Chi-Mei Medical Center
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and Kaohsiung Medical University Research Foundation (102CM-KMU-02).

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Table 1. Sex, age, stress coping strategies on the COPE, and significant depression in
college students with and without Internet addiction

Cronbach’s Have Internet No Internet t or χ2 p

α addiction addiction

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(n = 85) (n = 415)

P
Age (years), mean (SD) 22.0 (1.5) 22.1 (1.8) 0.552 .581

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Sex (female), n (%) 42 (49) 220 (53) 0.367 .545

COPE, mean (SD)

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Active coping .73 11.3 (2.5) 12.4 (2.2) 4.116 <.001

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Planning .83 12.4 (2.9) 12.9 (2.4) 1.911 .057

Suppression of competing activity .84 10.7 (2.8) 11.1 (2.7) 1.271 .204
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Restraint coping .85 9.8 (2.8) 10.9 (2.8) 3.537 <.001

Seeking social support for instrumental reason .87 12.7 (2.6) 13.2 (2.6) 1.706 .089
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Seeking social support for emotional reason .89 11.3 (3.2) 11.9 (3.0) 1.585 .114

Positive reinterpretation and grow .85 12.8 (2.6) 13.1 (2.2) 1.141 .254
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Acceptance .82 11.9 (2.2) 12.2 (2.5) 1.161 .246

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Turning to religion .92 7.8 (3.3) 7.7 (3.3) -0.411 .681

Focusing on and venting emotion .87 11.0 (3.1) 10.5 (2.7) -1.501 .134
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Denial .78 6.4 (2.2) 5.4 (1.7) -4.238 <.001

Behavioral disengagement .80 7.2 (2.3) 6.5 (2.0) -3.074 .002

Mental disengagement .79 9.7 (3.0) 8.1 (2.6) -4.794 <.001

Significant depression, n (%) 33 (38.8) 54 (13.0) 32.703 <.001

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Table 2. Association between stress coping strategies and Internet addiction and the

moderating effect of depression: Logistic regression analysis

B (Standard error) p OR (95% of CI)

T
Model I

P
Active coping -.077 (.064) .233 0.926 (0.816-1.051)

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Restraint coping -.122 (.050) .016 0.886 (0.802-0.977)

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Denial .163 (.069) .017 1.177 (1.029-1.346)

Behavioral disengagement -.039 (.068) .562 0.961 (0.841-1.098)

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Mental disengagement .117 (.057) .038 1.124 (1.006-1.256)

Significant depression .983 (.295) .001 2.673 (1.499-4.767)

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Model IIa

Depression x Restraint coping .099 (.103) .336 1.104 (0.903-1.349)

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Depression x Denial -.355 (.143) .013 0.701 (0.530-0.927)

Depression x Mental disengagement .145 (.116) .210 1.156 (0.921-1.451)

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a
: Only the interactive variables are shown
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