Internet dependence as a predictor of mental health among medical students before and during the COVID-19 pandemic: a longitudinal cohort study in Brazil (2019–2021).

Purpose: This study aims to compare internet dependence (ID) and mental health outcomes among Brazilian medical students before the COVID-19 pandemic (2019) and during peak distancing (2021), and to assess whether baseline ID predicted mental health outcomes at follow-up. Design/methodology/approach...

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Publicado en:Journal of Mental Health Training, Education & Practice Vol. 21; no. 4; pp. 323 - 338
Autores principales: Vitorino, Maria Clara Candido, da Silva, Maria Clara Chaves, e Santos Soares, Renata de Castro, de Melo, Mayara Moreira, von Humboldt, Sofia Almeida, Vitorino, Luciano Magalhães
Formato: research tables/charts Journal Article
Publicado: Emerald Publishing Limited 2026
Acceso en línea:Ver este registro en EBSCOhost
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        atl: Internet dependence as a predictor of mental health among medical students before and during the COVID-19 pandemic: a longitudinal cohort study in Brazil (2019–2021).
      aug:
        au:
          Vitorino, Maria Clara Candido
          da Silva, Maria Clara Chaves
          e Santos Soares, Renata de Castro
          de Melo, Mayara Moreira
          von Humboldt, Sofia Almeida
          Vitorino, Luciano Magalhães
        affil: Department of Medicine, Faculdade de Medicina de Itajubá – Afya, Itajubá, Brazil
      sug:
        subj:
          COVID-19 Pandemic Psychosocial Factors
          Students, Medical Psychosocial Factors
          Internet Addiction
          Mental Health
          Mental Disorders Risk Factors
          Risk Assessment
          Human
          Male
          Female
          Adolescence
          Adult
          Brazil
          Schools, Medical
          Prospective Studies
          Depression
          Anxiety
          Optimism
          Pessimism
          Stress, Psychological
          Behavior, Addictive
          Digital Technology
          Psychological Well-Being
          Paired T-Tests
          McNemar's Test
          One-Way Analysis of Variance
          Pearson's Correlation Coefficient
          Spearman's Rank Correlation Coefficient
          Multivariate Analysis
          Multiple Linear Regression
          Confidence Intervals
          Post Hoc Analysis
          Data Analysis Software
          Descriptive Statistics
          Questionnaires
          Psychological Tests
          Adolescent: 13-18 years
          Adult: 19-44 years
          Male
          Female
      ab: Purpose: This study aims to compare internet dependence (ID) and mental health outcomes among Brazilian medical students before the COVID-19 pandemic (2019) and during peak distancing (2021), and to assess whether baseline ID predicted mental health outcomes at follow-up. Design/methodology/approach: This prospective longitudinal cohort study was conducted at a private medical school in Brazil with two waves (2019, in-person; 2021, online). Instruments included the Internet Addiction Test (IAT), PHQ-9, GAD-7 and the Life Orientation Test-Revised (LOT-R). Paired t-tests and McNemar tests compared within-person changes. Correlations and multivariable linear regression models adjusted for age, sex, family income and mental health service use assessed associations, including change scores (? = T1–T0). Statistical significance was set at p < 0.05. Findings: Ninety-four students completed both waves. Mean PHQ-9 scores increased from 10.56 to 14.80 (? = +4.24; p < 0.001), and mean GAD-7 scores increased from 9.74 to 13.08 (? = +3.34; p < 0.001). Optimism declined from 8.54 to 5.42 (p < 0.001), pessimism increased from 6.97 to 7.73 (p = 0.028) and ID increased from 40.59 to 47.43 on the IAT (p < 0.001). At baseline, ID correlated with higher depressive symptoms (r = 0.282; p = 0.038) and anxiety (r = 0.260; p = 0.042). In adjusted regression models, baseline ID predicted higher anxiety at follow-up (ß = 0.699; p = 0.042), but not depressive symptoms at follow-up (ß = 0.087; p = 0.148). Higher baseline ID also predicted greater increases in PHQ-9 (ß = 0.201; p = 0.022) and GAD-7 (ß = 0.398; p = 0.042) scores from 2019–2021. Originality/value: This study provides longitudinal evidence from a middle-income country tracking ID and mental health among medical students from a pre-pandemic baseline to the period of peak distancing. By examining both negative psychological symptoms and positive psychological markers such as optimism, the findings underscore digital hyperconnectivity as a salient, modifiable correlate of distress in medical training. The results support routine screening and the integration of digital literacy and self-regulation strategies into medical curricula to mitigate risk and promote well-being.
      pubtype: Academic Journal
      doctype:
        research
        tables/charts
        Journal Article
      ougenre: Article
    language: English
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