Psychiatry and Clinical Neurosciences 2014; 68: 197–205
12124
Regular Article
Internet abusers associate with a depressive state but not a
depressive trait
Andrew Chih Wei Huang, PhD,1* Huai-En Chen,
Le-Min Wang, PhD3
1
Department of Psychology, Fo Guang University, Yi-Lan, 2Department of Clinical Psychology, Fu Jen Catholic University,
New Taipei City, and 3Women and Children Protection Brigade of Tainan City Police Department, Tainan, Taiwan
Aim: The present study investigated three issues: (i)
whether Internet abusers display a depressive state
without a depressive trait; (ii) which symptoms are
shared between Internet abuse and depression; and
(iii) which personality characteristics were shown in
Internet abusers.
Methods: Ninety-nine male and 58 female partici-
pants aged 18–24 years were screened with the Chen
Internet Addiction Scale. After screening, subjects
were separated into the high- (n = 73) and low-risk
(n = 84) Internet abuser groups. Participants were
respectively administered the Chinese version of the
Beck Depression Inventory-II to assess a depressive
state and the Minnesota Multiphasic Personality
Inventory-2 to assess a depressive trait.
Results: The present results showed that high-risk
Internet abusers exhibited a stronger depressive state
than low-risk Internet abusers in the Beck Depression
Inventory-II. However, high-risk Internet abusers did
NTERNET MISUSE HAS spread throughout many
I countries and across different cultures for more than
the past decade.1 Past studies of Internet abuse have
shown that abusers can elicit various symptoms
similar to those observed with substance misuse, such
as impulsive behaviors,2 withdrawal symptoms, toler-
ance,3 aggressive behavior, loss of interest in social,
occupational, and recreational activities, depressed
*Correspondence: Andrew Chih Wei Huang, PhD, Department of
Psychology, Fo Guang University, No. 160, Linwei Rd, Jiaosi Shiang,
Yilan County 26247, Taiwan. Email: chweihuang@mail.fgu.edu.tw
Received 17 July 2012; revised 3 September 2013; accepted 9
September 2013.
© 2013 The Authors
Psychiatry and Clinical Neurosciences © 2013 Japanese Society of Psychiatry and Neurology
doi:10.1111/pcn.
BS,1 Ying-Chou Wang, PhD2 and
not show a depressive trait in the Minnesota Multi-
phasic Personality Inventory-2 compared to low-risk
Internet abusers. Therefore, high-risk Internet abuse
participants exhibited a depressive state without a
depressive trait.
Conclusions: In a comparison of the symptoms of
depression and Internet abuse, it was found that
high-risk Internet abuse participants shared some
common behavioral mechanisms with depression,
including the psychiatric symptoms of loss of inter-
est, aggressive behavior, depressive mood, and guilty
feelings. High-risk Internet abuse participants may be
more susceptible to a temporal depressive state but
not a permanent depressive trait. The present findings
have clinical implications for the prevention and
treatment of Internet abuse.
Key words: depressive state, depressive trait, Internet
abuse.
mood, and guilty feelings.4 Recent data demonstrated
that numerous psychiatric disorders could be associ-
ated with Internet abuse, including major depressive
disorder,5 aggressive behavior,6 attention-deficit/
hyperactivity disorder, social phobia, and substance
use.7 Interestingly, most Internet abuse individuals
indicate that they have experienced some negative
emotional responses after ‘surfing the net’.8,9 There-
fore, a depressive state might be an important compo-
nent of Internet abuse’s psychiatric symptoms.
Growing studies reported that Internet abuse
correlated with the pathologic symptoms of
depression.7,10–18 For example, some studies have
shown that Internet abuse subjects could be classified
197
198 A. C. W. Huang et al.
as moderately-to-severely depressed, but non-Internet
abuse subjects could be classified as non-depressed14
when undergoing Young’s Internet Abuse and the
Beck Depression Inventory (BDI) tests. Furthermore,
it was reported that Internet addicts had higher scores
of depression and anxiety.15 A recent study indicated
that Internet abuse subjects displayed higher depres-
sion, anxiety, obsessive–compulsive behavior, and
hostility than subjects without Internet abuse, based
on self-report. Moreover, this pattern of psychiatric
symptoms was similar to substance abusers.7 Some
psychiatric comorbidity studies of Internet abuse and
psychiatry have shown that depression,11 attention-
deficit/hyperactivity disorder,10,12 social phobia, and
hostility could predict the occurrence of Internet
abuse.13,18
However, other studies have demonstrated some
opposing evidence to suggest that Internet abuse was
not related to depression.19–21 A recent Chinese Inter-
net abuse report has shown that being male, alcohol
consumption, family dissatisfaction, and the experi-
ence of a recent stressful event, but not depression
levels, affected the susceptibility to Internet abuse.21
Additionally, an Internet abuse study with samplings
from Korean high school students has demonstrated
that Internet abuse scores were not significantly cor-
related with depression scores, but Internet abuse
scores were associated with suicidal ideation scores.20
Another study showed that the time spent online in
subjects with Internet abuse did not correlate with
depression, anxiety, or social fearfulness.19
The issues of whether Internet addicts were associ-
ated with depression and whether clinical personality
characteristics occurred in Internet abusers were
explored further in the present study. Furthermore,
no study of which we are aware has examined
whether Internet abusers not only have a temporal
depressive state associated with Internet use, but
also a permanent depressive personality trait. There-
fore, the present study used the BDI-II to assess a
depressive state22 and the Minnesota Multiphasic Per-
sonality Inventory-2 (MMPI-2) to assess a depressive
trait.23
Altogether, the present study investigated three
specific items. The study was concerned with whether
Internet abusers exhibited a higher depressive state
but not a depressive trait in personality. Second, the
present study compared the possible shared charac-
teristics of depression and Internet abuse. Finally,
the study examined which personality characteristics
Internet abusers exhibited.
© 2013 The Authors
Psychiatry and Clinical Neurosciences © 2013 Japanese Society of Psychiatry and Neurology
Psychiatry and Clinical Neurosciences 2014; 68: 197–205
METHODS
Participants
A sample of 157 students (99 men and 58 women),
aged 18–24 years, were recruited from Fo Guang Uni-
versity, National Yi-Lan University, and Lan Yang
Institute of Technology in Taiwan. All participants
were administered the Chen Internet Abuse Scale
(CIAS),24 the BDI-II, and the MMPI-2. All participants
were screened by the criteria of MMPI-2 Validity
scales, so the valid samples were 157 (99 male and 58
female) university students. The CIAS screened the
157 participants. A cut-off score of 58 (not including
58, ≧59) produced 84 low-risk and 73 high-risk
Internet abusers. A score of more than 58 was a
highly efficacious cut-off score for dissociating
Internet abusers from non-Internet abusers.25 All of
the participants provided informed written consent
before participating in the study. This study complied
with the Ethical Principles of Psychologists and the
Code of Conduct 2002.
Instruments
The CIAS score served as a screening tool to separate
the low- and high-risk Internet abuse groups.25 The
BDI-II22 and MMPI-223 scores served as dependent
variables to reveal the magnitude of depression (i.e.,
depressive states) and personality characteristics (i.e.,
depressive trait), respectively. Depressive states and
traits were analyzed with Pearson correlations to test
their relations for all participants. The high and low
depressive trait groups were separated by the mean
value of depression index D and DEP of MMPI-2,
respectively. BDI scores greater than 20 served as the
high-depressive state group.26
CIAS
We followed our previous report (2010) and used the
CIAS scale to measure participants’ Internet abuse.27
The present study used a cut-off of 58 points (not
including 58, ≧59) to screen participants into high-
and low-risk Internet abuse groups.25 The partici-
pants’ responses on the CIAS are based on a 4-point
Likert scale for each item. The CIAS may be viewed
as a reliable test because of its test–retest reliability
and internal consistency (between 0.79 and 0.93;
P < 0.05). The Cronbach’s α value for the CIAS is
0.93.24
Psychiatry and Clinical Neurosciences 2014; 68: 197–205
BDI-II
Like the CIAS, each item was scored on a 4-point
Likert scale, which reflected the degree of participant
agreement with each of the statements. Each item on
the questionnaire had possible scores between 0 and
3. The BDI-II is a reliable test, reflected by its internal
consistency and test–retest reliability between 0.92
and 0.93 (P < 0.01).28 The Cronbach’s α value of
the BDI-II is 0.92 and 0.93, respectively, for clinical
patients and college students.28
MMPI-2
The Traditional Chinese MMPI-2 in the ‘Hong Kong’
version has clinical scales and content scales. The
clinical scales assessed 10 clinical personality charac-
teristics, including hypochondriasis (Hs), depression
(D), conversion hysteria (Hy), psychopathic deviate
(Pd), masculinity–femininity (MF), paranoia (Pa),
psychasthenia (Pt), schizophrenia (Sc), hypomania
(Ma), and social introversion (Si). The content scales
measured 15 personality characteristics, including
anxiety (ANX), fears (FRS), obsessiveness (OBS),
depression (DEP), health concerns (HEA), bizarre
mentation (BIZ), anger (ANG), cynicism (CYN), anti-
social practices (ASP), type A personality (TPA), low
self-esteem (LSE), social discomfort (SOD), family
problems (FAM), work interference (WRK), and
negative treatment indicators (TRT). The assessments
of validity scales included Q (i.e., the ‘cannot say’
scale, which is the number of items left unanswered),
F (i.e., ‘faking good’ or ‘faking bad’), K (i.e., the
‘defensiveness scale’, which is a more effective and
less obvious way of detecting attempts to reveal
Table 1. Comparisons of demographic characteristics, Internet addiction, and a depressive state between low- and high-risk
Internet abuse groups
Internet abuse
Characteristics Low-risk Internet abusers (n = 84) High-risk Internet abusers (n = 73) t(155) P
Sex
Male participants 49
Female participants 35
Internet addiction, mean (SE) 49.76 (0.75)
Depressive state (BDI), mean (SE) 10.43 (1.09)
*P < 0.05, compared with low-risk Internet abusers.
BDI, Beck Depression Inventory.
Psychiatry and Clinical Neurosciences © 2013 Japanese Society of Psychiatry and Neurology
Internet abuse and depression 199
oneself in the best way), and L values (i.e., the ‘lie
scale’). The test–retest reliability of the Chinese
MMPI-2 for the clinical and content scales ranges
from 0.74 to 0.94 and 0.70 to 0.95, respectively.29
The average Cronbach’s α coefficient for the clinical
scales is 0.63 for men and 0.64 for women. The
average Cronbach’s α coefficient for the content
scales is 0.76 and 0.77 for men and women,
respectively.29
Procedure
All of the participants were asked to complete the
CIAS instrument and were then separated into low-
and high-risk Internet abuse groups. They were
administered the BDI-II to assess the depression state
and the MMPI-2 to assess various personality charac-
teristics, including the depressive trait.
Statistical analysis
All raw data were analyzed using the t-independent
test. Values of P < 0.05 were considered statistically
significant. The effect size was calculated by Hedge’s g
statistic, which was modified by Cohen’s d statistic:
the g-value is equal to 0.20 for a small effect, to 0.50
for a medium effect, and equal to and above 0.80 for
a large effect.30
RESULTS
Table 1 shows that 49 of the male participants could
be classified with low-risk Internet abuse and 50 of
the male participants could be classified with high-
risk Internet abuse, using 58 as the cut-off score.
50 – –
23 – –
68.42 (0.98) −15.14 0.00*
15.29 (1.54) 2.58 0.01*
© 2013 The Authors
200 A. C. W. Huang et al. Psychiatry and Clinical Neurosciences 2014; 68: 197–205

Table 2. Comparisons of personality characteristics between low- and high-risk Internet abuse groups

Internet abuse
Personality characteristics Low-risk Internet abusers (n = 84) High-risk Internet abusers (n = 73) t(155) P
Clinical scale, mean (SE)
HS 22.59 (0.60) 21.54 (0.62) 1.21 0.23
D 23.10 (0.49) 23.05 (0.54) 0.06 0.96
Hy 27.70 (0.61) 26.30 (0.63) 1.58 0.11
Pd 26.22 (0.64) 25.40 (0.67) 0.88 0.38
Mff 28.96 (0.48) 27.37 (0.43) 2.46 0.02*
Mfm 25.69 (0.37) 26.14 (0.37) −0.85 0.40
Pa 17.75 (0.53) 17.11 (0.61) 0.80 0.43
Pt 34.08 (0.58) 35.78 (0.86) −1.63 0.11
Sc 44.24 (1.07) 45.95 (1.20) −1.06 0.29
Ma 23.18 (0.46) 23.12 (0.61) 0.08 0.93
Si 34.82 (0.59) 35.11 (0.84) −0.29 0.78
Content scale, mean (SE)
ANX 10.82 (0.55) 12.00 (0.56) −1.49 0.14
FRS 9.93 (0.59) 10.12 (0.57) −0.24 0.82
OBS 6.52 (0.29) 7.21 (0.32) −1.57 0.12
DEP 14.79 (0.55) 15.64 (0.57) −1.08 0.28
HEA 14.94 (0.63) 15.07 (0.69) −0.14 0.89
BIZ 8.79 (0.44) 8.16 (0.47) 0.96 0.34
ANG 6.92 (0.30) 7.71 (0.34) −1.75 0.08
CYN 11.62 (0.43) 11.88 (0.44) −0.42 0.68
ASP 9.42 (0.41) 9.84 (0.49) −0.66 0.51
TPA 8.07 (0.35) 9.22 (0.35) −2.30 0.02*
LSE 10.33 (0.34) 10.48 (0.44) −0.27 0.79
SOD 11.13 (0.45) 10.62 (0.51) 0.76 0.45
FAM 9.82 (0.45) 9.48 (0.43) 0.54 0.59
WRK 14.13 (0.58) 16.62 (0.68) −2.80 0.01*
TRT 10.72 (0.43) 11.90 (0.42) −1.94 0.05**
*P < 0.05, **P < 0.10 compared with low-risk Internet abusers.
ANG, anger; ANX, anxiety; ASP, antisocial practices; BIZ, bizarre mentation; CYN, cynicism; D, depression; DEP,
depression; FAM, family problems; FRS, fears; HEA, health concerns; HS, hypochondriasis; Hy, conversion hysteria;
LSE, low self-esteem; Ma, hypomania; MF, masculinity–femininity; OBS, obsessiveness; Pa, paranoia; Pd, psychopathic
deviate; Pt, psychasthenia; Sc, schizophrenia; Si, social introversion; SOD, social discomfort; TPA, type A personality;
TRT, negative treatment indicators; WRK, work interference.

Thirty-five of the female participants could be classi-
fied with low-risk Internet abuse and 23 of the female
participants could be classified with high-risk Inter-
net abuse. Internet addiction was significantly stron-
ger in the high-risk Internet abuse group than in the
low-risk Internet abuse group. The BDI-II scores for
low- and high-risk Internet groups were shown to
be the medium effect size (Hedge’s g = 0.42). The
t-independent test indicated that the high-risk Inter-
net abusers had a stronger depressive state than the
low-risk Internet abusers (see Table 1).
Table 2 shows the MMPI-2 scores for the clinical
scale personality characteristics, including HS, D, Hy,
Pd, MF, Pa, Pt, Sc, Ma, and Si. However, with the
exception of Mff, none of the subscales were signifi-
cantly different between the low- and high-risk Inter-
net abuse groups. The present results indicated that
high-risk Internet abusers may have less female atti-
tude in clinical personality characteristics.
Additionally, Table 2 shows the MMPI-2 scores for
the content scale personality characteristics, includ-
ing ANX, FRS, OBS, DEP, HEA, BIZ, ANG, CYN, ASP,
TPA, LSE, SOD, FAM, WRK, and TRT. The present
results indicated significant differences in TPA and
WRK, and there was a tendency for a significant dif-
ference between the low- and high-risk Internet abuse

© 2013 The Authors

Psychiatry and Clinical Neurosciences © 2013 Japanese Society of Psychiatry and Neurology
Psychiatry and Clinical Neurosciences 2014; 68: 197–205 Internet abuse and depression 201

Table 3. Comparisons of validity scales of personality characteristics between low- and high-risk Internet abuse groups

Internet abuse
Personality characteristics Low-risk Internet abusers (n = 84) High-risk Internet abusers (n = 73) t(155) P
Validity scale, mean (SE)
Q 1.21 (0.25) 0.60 (0.18) 1.98 0.05*
F 20.89 (0.88) 21.90 (1.06) −0.74 0.46
K 14.54 (0.42) 13.33 (0.45) 1.95 0.05*
L 6.24 (0.27) 5.71 (0.31) 1.28 0.20
*P < 0.10, compared with low-risk Internet abusers.
F, ‘faking good’ or ‘faking bad’; K, the ‘defensiveness scale’, which is a more effective and less obvious way of detecting
attempts to reveal oneself in the best way; L values, the ‘lie scale’; Q, the ‘cannot say’ scale, which is the number of items
left unanswered.

groups. The results showed that high-risk Internet
abusers might have higher scores in Type A person-
ality, work interference, and negative treatments than
low-risk Internet abusers.
Table 3 shows that the F and L values were non-
significant. The Q and K values tended to increase
significantly in low-risk Internet abusers.
Further analysis investigating the interaction
between state and trait depression appears in Figure 1.
The high depressive trait had significantly higher BDI
values than those of the low depressive trait for
the dissociation from the D values (t[155] = −3.12,
P < 0.05) (Fig. 1a). The DEP value dissociation also
showed a significant increase in BDI scores for the
high depressive trait compared with the low depres-
sive trait (t[155] = −2.30, P < 0.05) (Fig. 1b). There-
fore, the depression trait is correlated positively with
the depression state.
In contrast, the BDI scores indicated that the
depression state separated into low and high depres-
sive state groups. The results showed that the high
depressive state group significantly increased the

(a) D index (b) DEP index

20 20
*
Mean (±SEM) Beck

*
Mean (±SEM) Beck

Depression Score
Depression Score

15 15

10 10

5 5

0 0
Low depressive High depressive Low depressive High depressive
Figure 1. Assessments of a depression triat (n = 75) triat (n = 82) triat (n = 80) triat (n = 77)
state and a depression trait. Mean
(± SEM) Beck Depression Inventory
(c) (d)
(BDI) scores for low and high depressive
28
trait groups (a) using the mean value of
Mean (±SEM) DEP Score

20
Mean (±SEM) D Score

the D index and (b) using the mean of *

the DEP index of the Minnesota Multi- 18
26 *
phasic Personality Inventory-2 as cut-off 16
scores. Mean (± SEM) (c) D and (d) DEP
scores for low and high depressive 24 14
state groups using the BDI ascending 12
rank cut-off scores. Note: D represents
depression in the clinical scales. DEP 22 10
represents depression in the content Low depressive High depressive Low depressive High depressive
scales. *P < 0.05. state (n = 130) state (n = 27) state (n = 130) state (n = 27)

© 2013 The Authors

Psychiatry and Clinical Neurosciences © 2013 Japanese Society of Psychiatry and Neurology
202 A. C. W. Huang et al.
D index (t[155] = −2.44, P < 0.05) and DEP index
(t[155] = −2.28, P < 0.05) compared to the low
depressive state group (Fig. 1c,d). It means that the
depression state is correlated to the depression trait.
Taken together, the depression state is correlated
with the depression trait.
DISCUSSION
High-risk Internet abusers show significantly higher
rates of the depression state compared to the low-risk
Internet abusers. However, high-risk Internet abuse
participants did not exhibit any significant depressive
personality characteristics, such as the D index on the
clinical scales and the DEP index on the content
scales. High-risk Internet abuse participants may
present a significantly depressive state without dis-
playing a depressive trait. Internet abusers may natu-
rally display some personality characteristics, for
example, less female attitude, Type A personality,
work interference, and negative treatment. Further-
more, the Q and K values of the validity scales were
significantly higher in the low-risk Internet abuse
group when compared with the high-risk Internet
abuse group. It may be due to the social desirability
effect resulting in the low-risk Internet abusers to
prevent showing their real mental conditions.
Internet abuse and depression: Depressive
state versus depression trait
Previous studies have examined the possible relations
between Internet abuse and a depressive state to
show conflicting results. An important claim was that
Internet abuse positively correlated with a depressive
state.11,16,31 For example, a study of Taiwan college
students utilized a self-report questionnaire13 and
interview approach12 to show that Internet abuse was
associated with the psychiatric symptoms of
attention-deficit/hyperactivity disorder, depression,
and hostility (i.e., aggressive behavior).18 Some
studies reported that only men with Internet abuse
were more susceptible to depressive symptoms com-
pared with women.12–14 Recent studies reported that
Internet abuse was associated with not only depres-
sion, but also substance abuse7 and obsessive–
compulsive symptoms.11,17
Nevertheless, another line of research did not cor-
roborate the connection between Internet abuse and
depression.20,21 For example, a study regarding Inter-
net addiction and depression used a correlation
© 2013 The Authors
Psychiatry and Clinical Neurosciences © 2013 Japanese Society of Psychiatry and Neurology
Psychiatry and Clinical Neurosciences 2014; 68: 197–205
survey design in a sample of Korean adolescents and
found that depression significantly correlated with
suicidal ideation but not Internet abuse.20 Moreover,
a correlation test showed a non-significant relation
between Internet abuse and depression.21 The present
data support the hypothesis that Internet abuse and
depression are correlated positively.
However, our data extended this hypothesis
and further showed that high-risk Internet abusers
showed seemingly higher depression responses than
low-risk Internet abusers. This depression response
appears to be like a depression state. The present data
further indicated that high-risk Internet abuse partici-
pants had a depressive state, but did not show a
depressive trait in the personality assessment. There-
fore, we suggest that Internet games or related events
can cause Internet addiction and the associated
depressive state. The concept that depression can be
separated into a state and a trait was consistent with
the previous report.32 However, we discuss this
concept with Internet addiction.
On the other hand, the present data did not con-
flict with the previous investigations of Internet
addicts and their personality traits. Subjects with
Internet abuse presented a lower level of extraversion
and a higher degree of psychoticism compared with
controls, suggesting that Internet addicts often show
introversion and psychoticism in their personality
traits.33 A recent personality trait study indicated
that online gaming addiction highly correlated with
personality traits, such as neuroticism, sensation
seeking, trait anxiety, state anxiety, and aggression.34
Therefore, high-risk Internet abusers were not related
to a high depressive trait.
Clinical implications: Pharmacological and
psychosocial interventions
The present data indicated that Internet abuse might
produce the depressive state but not depressive traits.
The implications of the present study indicate that
some typical pharmacological treatments of major
depressive disorder might be able to treat the depres-
sive state of Internet addiction.35–37 First, monoamine
oxidase inhibitor drugs (such as moclobemide) were
shown to block the activation of monoamine oxidase,
protected active monoamines in the brain, and then
decrease the depressive state.38 Second, a tricyclic
antidepressant drug has been demonstrated to block
the reuptake of serotonin and norepinephrine to
reduce the depressive state.39 Finally, the selective
Psychiatry and Clinical Neurosciences 2014; 68: 197–205
serotonin reuptake inhibitors (such as fluoxetine40
and escitalopram41) was shown to specifically affiliate
and block the reuptake mechanism of serotonergic
neurons, and increased the amount of serotonin
released in the synapse to decrease the depressive
state. Therefore, Internet addiction can be treated with
any of the antidepressant drugs to decrease the depres-
sive symptoms of Internet addiction. By contrast,
these treatments cannot modify the depressive trait for
Internet abusers.
Psychosocial interventions might be an alternative
treatment to prevent the suffering of Internet
addiction.42–45 For example, a recent investigation has
proposed that cognitive-behavioral therapy could
help Internet abusers overcome the maladaptive cog-
nition for Internet misuse to modify their behavior to
re-construct adaptive cognition.42 A similar finding
was demonstrated in the previous evidence.45 More-
over, a previous study with regard to the treatment of
compulsive cybersex behavior used some psychoso-
cial treatments (e.g., relapse prevention, intimacy
enhancement, lovemap reconstruction, dissociative
states therapy, arousal reconditioning, and coping
skills training) to reduce the trauma, intimacy
dysfunction, depression, and additive behavior.43
Furthermore, the motivational interviewing, reality
therapy, Naikan cognitive psychotherapy, group
therapy, family therapy, and multimodal psycho-
therapy have been shown to have efficient treatments
for Internet addiction.42 Recently, some studies have
demonstrated that psychological interventions, par-
ticularly cognitive-behavioral therapy, were more
successful than the pharmacological treatment.44
Therefore, psychosocial interventions might be
another way to treat Internet abuse.
Internet abuse and depression: Some
common symptoms
A critical issue is whether Internet abuse patients
share behavioral symptoms with depressed subjects.
Moreover, the specific reasons why Internet abuse
participants present psychiatric symptoms of depres-
sion may be more important than simply the deter-
mination of a positive correlation between Internet
abuse and depression. To elucidate this issue, we
compared the definitions of the symptoms of Inter-
net abuse2–4 and depression.46 Three symptoms are
shared between Internet abuse and depression. First,
depressed patients may have depressed mood or a
loss of interest or pleasure in nearly all activities.
Psychiatry and Clinical Neurosciences © 2013 Japanese Society of Psychiatry and Neurology
Internet abuse and depression 203
Interestingly, a similar symptom of Internet abuse is
the loss of interest in other social, occupational, and
recreational activities. Moreover, a similar finding has
been shown by another recent study,47 which sug-
gested that the Internet misuse might result from
spending many hours on the Internet, thereby pre-
venting interpersonal communication, and losing
interest in interpersonal relationships.47 Second,
aggressive behavior might emerge in depression such
that individuals express thoughts of death or suicidal
ideations, plans, or attempts. Depressed patients do
not project their aggressive behavior outward, but
rather place the target on themselves. However, some
reports suggest that aggressive behavior may be a
critical behavioral characteristic when turning off an
online game.1,2,6 Third, Internet abuse and depression
share the symptoms of depressed mood and guilty
feelings. According to the DSM-IV-TR, depressed
patients may feel worthless or guilty. Data from a
website questionnaire indicated that 43% of subjects
reported having depressed mood and guilty feelings
after a long duration of Internet use.2
In summary, the relation between Internet abuse
and depression is hypothesized to result from a
common behavioral mechanism, including loss of
interest, aggressive behavior, and negative mood.
Discrepancy between Internet abuse and
depression: Psychoticism versus neuroticism
To elucidate the personality characteristics between
Internet abuse and depression, a previous study
has shown that only the significant effects of
neuroticism, but not psychoticism, occurred in
patients suffering from depression.48 A recent study
utilized the Eysenck Personality Questionnaire for
assessing the personality characteristics of Internet
abusers. Their results indicated that Internet abusers
showed significant differences in psychoticism and
neuroticism (but not extraversion/introversion and
lie) compared to the control group.49 Therefore,
psychoticism was observed only in Internet abusers,
but not depressed patients. Psychoticism is the dis-
crepancy between Internet abusers and depressed
patients. The discrepancy between Internet abuse
and depression should be investigated in further
studies.
Restriction of the present study
A possible restriction should be of concern. For
example, although the MMPI-2 personality test is
© 2013 The Authors
204 A. C. W. Huang et al.
designed to measure the personality trait, D and DEP
scales are probably different. To illustrate, the D scale
is characterized as a clinical scale since it was designed
originally to identify depression, characterized by
poor morale, lack of hope in the future, and a general
dissatisfaction with one’s own life situation. Very high
scores may indicate depression, while moderate scores
tend to reveal a general dissatisfaction with one’s life.
This scale was developed with a criterion group, most
of whom were in the depressed phase of a bipolar
disorder, showing a deeper level of psychopathology,
yet one that may not be easily characterized as a trait.
On the other hand, the DEP scale indicates feelings of
guilt, low self-esteem, pessimism, brooding, and with-
drawal. This is more entrenched and pathological
than the D scale and may be referred loosely as mea-
suring a depressive trait. Hence, the D scale and the
BDI-II may be considered similar measures, while the
DEP scale could be considered as loosely measuring a
trait. However, these possible differences between the
D and DEP values are not dissociated in the present
study.
Conclusion
High-risk Internet abusers had significantly stronger
depression states but not depressive traits in person-
ality. High-risk Internet abusers had less female
attitude, Type A personality, work interference, and
negative treatment in personality. Aggressive behav-
ior, loss of interest, and depressed mood are identical
symptoms between Internet abuse and depression.
The present findings have clinical implications for the
prevention and treatment of Internet abuse.
ACKNOWLEDGMENTS
This research was supported by funding from the
National Research Council of the Republic of China
(NSC 98-2410-H-431-005 and NSC 99-2410-H-431-
013) to A.C.W. Huang. The authors of this paper do
not have any commercial associations or financial
holdings that might pose a conflict of interest in con-
nection with the results or interpretations of this
study.
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