The internet has become an integral part of modern education, transforming how students learn, communicate, and interact with the world. For health professional students, it serves as a crucial academic resource, providing access to up-to-date medical information, e-learning modules, research databases, and virtual simulations that enhance clinical understanding and self-directed learning. However, with these benefits comes the challenge of excessive or maladaptive internet use, which has emerged as a growing concern among young adults in higher education, particularly in the demanding environment of medical training (1,2). The increasing dependence on the internet among students has been linked to changes in lifestyle, study habits, and mental health. Studies across countries have shown a significant association between problematic internet use and symptoms of depression, anxiety, and stress (3,4). Health professional students are a particularly vulnerable group due to their heavy academic workload, long study hours, and pressure to achieve high academic performance. The competitive academic environment, coupled with easy internet access in hostels and campuses, may lead to unregulated online activity, resulting in academic procrastination, sleep disturbance, and reduced concentration (5). A growing body of research has examined the relationship between internet use and psychological well-being among university students. A study conducted by Kuss and Griffiths (6) highlighted that excessive online engagement often correlates with social isolation, low mood, and academic decline. Similarly, Young (7) introduced the concept of “Internet Addiction Disorder,” describing its parallels with behavioral addictions, such as compulsive use despite negative consequences. Among medical students, high internet use has been associated with elevated stress and anxiety levels, as shown by Sharma et al. (8) in India and by Salehi et al. (9) in Iran. Several studies have explored how internet usage patterns influence academic outcomes. For instance, Chen and Peng (10) found that moderate internet use enhances learning efficiency, while excessive non-academic browsing negatively affects grades. Another study among medical students in Nepal reported that around 35% exhibited problematic internet use, which was significantly associated with poor sleep quality and lower academic achievement (11). Additionally, the COVID-19 pandemic amplified internet reliance due to the shift toward online education, blurring boundaries between productive and recreational screen time (12). Despite these insights, the findings across studies are inconsistent. While some researchers report that internet use enhances academic performance through access to online learning platforms (13), others note its detrimental effects on concentration and motivation (14). Cultural and contextual factors—such as availability of resources, academic environment, and socio-economic background—play an important role in shaping internet use behavior. In India, where digital penetration has rapidly increased among youth, there is limited literature examining how this shift affects the well-being and performance of health professional students, especially in semi-urban and institutional settings (15). Although global research indicates a strong connection between internet use and student well-being, few studies have specifically focused on medical and dental students in the Indian context. Most existing studies employ quantitative designs, providing prevalence estimates of internet addiction or associated psychological symptoms but lacking qualitative insights into students’ lived experiences. There is also limited exploration of how students perceive the impact of internet use on their academic productivity, emotional health, and coping mechanisms. Moreover, while the internet is often studied as a risk factor, its potential role as a coping tool for stress and academic enhancement remains underexplored. These gaps highlight the need for a more comprehensive approach that integrates both quantitative and qualitative data to understand the dual nature of internet use—its benefits and risks—within the educational environment of health professional students. Understanding the interplay between internet use, mental health, and academic outcomes is particularly relevant for medical education, where students often face high stress levels, long hours of study, and limited leisure time. The availability of the internet can provide both relief and risk—it can serve as a learning aid or a means of escapism. Given the high prevalence of depression, anxiety, and stress among medical students in India (16), examining how internet use contributes to or alleviates these issues is vital for developing targeted interventions. This study aims to fill the existing knowledge gap by employing a mixed-methods approach that captures both statistical trends and personal narratives. Quantitatively, it assesses levels of depression, anxiety, and stress among students using the DASS-21 scale and compares self-reported academic performance with actual exam scores. Qualitatively, it explores students’ perceptions of internet use, emotional responses, academic impact, and coping strategies. Together, these insights will inform the design of digital wellness programs and institutional policies promoting responsible internet use among health professional students. Hence the objectives of the study are to assess the patterns of internet use among health professional students, to determine the association between internet use and psychological well-being (depression, anxiety, and stress), to evaluate the relationship between internet use and academic performance and to explore students’ perceptions of the positive and negative impacts of internet use on their academic and emotional life.

This study employed a mixed-methods research (Explanatory sequential) design. The quantitative component followed a cross-sectional descriptive design using structured questionnaires and standardized scales to quantify patterns and associations, while the qualitative component utilized a semi-structured interview guide to explore students’ lived experiences and perceptions in depth. This approach facilitated triangulation of data, allowing both numerical trends and narrative insights to complement each other for a holistic understanding of the phenomenon. The study was conducted at SLN Medical College in Odisha, India, which offers undergraduate and postgraduate programs in various health sciences. The institution was selected because of its diverse student population, high internet accessibility, and relevance to the study objectives. Data collection for both quantitative and qualitative phases took place within the campus premises to ensure familiarity, convenience, and comfort for participants. The entire study was conducted over six months, from April to September 2025, encompassing tool development, data collection, data entry, and both statistical and thematic analyses. The study population included undergraduate and postgraduate health professional students, mainly from the MBBS and BDS programs. Participants were selected from different years of study to capture variation in exposure to academic stress, internet usage behavior, and coping mechanisms. For the quantitative phase, the sample size was calculated using the standard formula for cross-sectional studies, assuming a prevalence of problematic internet use of 20% among medical students, a 95% confidence interval, and a 5% allowable error. The minimum sample size required was 246, but to compensate for potential non-responses, 250 students were included in the final analysis. Stratified random sampling ensured proportional representation across different academic years. For the qualitative component, 15 participants were purposively selected from among survey respondents to represent diverse profiles in terms of gender, year of study, and internet use levels. Sampling continued until data saturation was achieved, meaning no new information or themes emerged from subsequent interviews. The study included students who were enrolled in MBBS or BDS programs, had been using the internet for at least one year, and provided informed consent to participate voluntarily. Students who were on long-term leave, those with major medical illnesses affecting participation, or those unwilling to participate were excluded. Incomplete questionnaires were also excluded from the final analysis. After obtaining approval from the Institutional Ethics Committee, the investigator explained the objectives and procedures of the study to students and invited voluntary participation. For the quantitative phase, data were collected using self-administered questionnaires distributed in group settings during class hours. The average completion time was 20 minutes. For the qualitative phase, semi-structured interviews were conducted in a private and quiet space within the campus to ensure confidentiality. Each interview lasted approximately 30 to 45 minutes and was audio-recorded with participants’ permission. Transcriptions were made verbatim for analysis. The study tools consisted of two main instruments. The quantitative tool included three sections: socio-demographic and academic details (such as age, gender, year of study, type of residence, and family income), patterns of internet use (duration, purpose, and self-reported academic performance), and psychological well-being assessed using the Depression, Anxiety, and Stress Scale-21 (DASS-21), a standardized and validated instrument widely used in student populations. The qualitative tool was a semi-structured interview guide developed by the researcher and validated by subject experts. It consisted of open-ended questions exploring internet use habits, emotional and psychological effects, academic influence, and coping mechanisms, allowing participants to share their experiences freely. Quantitative data were collected through self-administered paper-based questionnaires. Each participant was assigned a unique identification code to maintain anonymity. The researcher checked all responses daily for completeness and accuracy. For the qualitative phase, interviews were conducted face-to-face at scheduled times and recorded after obtaining consent. Transcripts were reviewed and verified to ensure accuracy before proceeding with analysis. The primary outcome measures included levels of depression, anxiety, and stress based on DASS-21 scores, while secondary outcomes were patterns of internet use (academic versus non-academic), self-reported and actual academic performance, and themes emerging from qualitative narratives concerning emotional and academic consequences of internet use. Quantitative data were entered into Microsoft Excel and analyzed using Jamovi version 2.6.44. Descriptive statistics such as mean, median, standard deviation, and frequency distribution were used to summarize the data. Inferential analyses, including the Chi-square test and t-test, were applied to identify associations between categorical and continuous variables. A paired-sample t-test was used to compare self-reported academic performance with actual examination scores. The level of statistical significance was set at p < 0.05. Qualitative data were analyzed using thematic analysis based on Braun and Clarke’s six-step framework, which involves familiarization with the data, generating initial codes, identifying themes, reviewing and refining themes, defining and naming them, and finally synthesizing the findings into a coherent narrative. NVivo software facilitated coding and organization of the qualitative data. Findings from both components were triangulated during interpretation to enhance the validity, depth, and comprehensiveness of conclusions. To ensure data quality and reliability, all research assistants underwent training on data collection, confidentiality, and handling of sensitive information. A pilot test of the questionnaire was conducted among 20 students not included in the final study to check clarity, comprehension, and reliability. The internal consistency of the DASS-21 scale was confirmed with a Cronbach’s alpha coefficient of 0.87. For qualitative data, methodological rigor was ensured through member checking, peer debriefing, and maintaining a detailed audit trail of analytical decisions to enhance credibility and trustworthiness. Ethical approval for the study was obtained from the Institutional Ethics Committee of SLN Medical College and Hospital, Koraput, Odisha prior to data collection. Written informed consent was obtained from all participants after providing detailed information about the study’s purpose, confidentiality, and voluntary nature. Participants were assured that their responses would remain anonymous and that they could withdraw at any point without any consequences. All digital recordings and transcripts were stored in password-protected files accessible only to the research team. To safeguard participants’ emotional well-being, information about available student counseling and mental health support services within the institution was provided at the end of each session.

A total of 250 health professional students participated in the study. The mean age was 22.1 ± 1.97 years, with ages ranging from 18 to 29 years. The majority were males (53.6%), while females constituted 46.4%. Most respondents were MBBS students (98.8%), with a small proportion from BDS and other allied courses. The largest group of participants were in the third year of study (45.2%), followed by first-year students (30.8%) (Table 1). Regarding residence, 88% of the students lived in hostels, 10% were day scholars, and the remaining resided in rented accommodation or with family. Most students belonged to families with a monthly income between ₹25,000 and ₹1,00,000 (48.4%), indicating a middle-income background. According to DASS-21 scores (Figure 1), 61.6% of participants had normal depression levels, 14% moderate, and 3.2% extremely severe. Anxiety levels were normal in 60%, but 17.2% reported moderate and 11.6% very severe anxiety. Most participants (77.9%) exhibited normal stress levels, with only 3.6% reporting severe or very severe stress. The mean self-reported academic performance (Table 2) was 74.1 ± 50.4, whereas the mean recent exam score was 70.1 ± 50.4. A paired-samples t-test indicated a statistically significant difference between the two means (t(249)=4.96, p<0.001), suggesting that students tend to overestimate their academic performance. Most students reported daily internet use exceeding 4 hours, primarily for academic purposes such as accessing notes, online classes, and research. However, a significant proportion also engaged in non-academic activities, including social media, entertainment, and gaming. Correlation analysis revealed a negative relationship between time spent on non-academic internet use and actual exam performance (r = –0.28, p<0.05). Table 1. Socio-demographic profile of participants (N=250) Variable Category Frequency (n) Percentage (%) Gender Male 134 53.6 Female 116 46.4 Course MBBS 247 98.8 BDS 1 0.4 Others 2 0.8 Year of study 1st 77 30.8 2nd 27 10.8 3rd 113 45.2 4th 7 2.8 Intern 25 10.0 PG 1 0.4 Type of residence Hostel 220 88.0 Day scholar 25 10.0 Others 5 2.0 Monthly family income < ₹25,000 39 15.6 ₹25,000–₹50,000 57 22.8 ₹50,000–₹1,00,000 64 25.6 > ₹1,00,000 69 27.6 Figure 1: Distribution of Depression, Anxiety, and Stress Levels (DASS-21) Table 2. Comparison of self-reported and actual academic performance Measure Mean ± SD t-value df p-value Self-reported performance (%) 74.1 ± 50.4 4.96 249 <0.001 Actual exam performance (%) 70.1 ± 50.4 A total of 15 in-depth interviews were conducted until thematic saturation was achieved. Four major themes and ten subthemes emerged from the analysis, supported by direct participant quotes (verbatims). Table 3: Summary of Themes and Subthemes from Qualitative Analysis Theme Subtheme Codes Quotations (Verbatims) Academic Utility of the Internet Access to online lectures and resources Use of YouTube, online lectures, e-learning platforms for academic understanding “I rely on YouTube and online lectures for topics that are difficult to understand in class.” — Participant 4, 2nd Year MBBS Digital collaboration and self-paced learning Group discussions via WhatsApp/Google Docs, collaborative learning, self-paced study “We discuss case studies over WhatsApp or Google Docs; it makes group study easier.” — Participant 9, 3rd Year MBBS Emotional and Psychological Impact Online engagement as stress relief Internet use for relaxation, social connection, mood improvement “Scrolling through Instagram helps me unwind after classes, but sometimes I lose track of time.” — Participant 5, 1st Year MBBS Anxiety and sleep disturbance due to overuse Restlessness, anxiety, sleep disruption, guilt “If I don’t have internet access, I feel restless, almost anxious.” — Participant 12, 4th Year MBBS Distraction and Academic Procrastination Academic procrastination Delayed assignments, postponing study tasks, distraction from academics “I open my phone for notes but end up watching reels for hours.” — Participant 2, 3rd Year MBBS Multitasking and attention loss Frequent phone checking, loss of concentration, divided attention “During exams, I try to avoid the phone, but somehow I always check messages and lose focus.” — Participant 8, 2nd Year MBBS Awareness and Coping Strategies Self-regulation strategies Timer apps, scheduled study periods, digital detox “I started using a timer app to restrict my non-academic browsing.” — Participant 10, Intern Institutional and peer support College sessions on digital well-being, peer influence, awareness campaigns “It would help if colleges organized sessions on digital well-being. We often don’t realize how much time we waste online.” — Participant 6, 1st Year MBBS Theme 1: Academic Utility of the Internet Students viewed the internet as an indispensable academic resource. Most acknowledged that online materials enhanced their understanding of complex medical concepts and provided access to the latest information. Subthemes: • Access to online lectures and resources • Digital collaboration and self-paced learning Verbatims: “I rely on YouTube and online lectures for topics that are difficult to understand in class.” — Participant 4, 2nd Year MBBS “We discuss case studies over WhatsApp or Google Docs; it makes group study easier.” — Participant 9, 3rd Year MBBS Theme 2: Emotional and Psychological Impact Participants reported both positive and negative emotional consequences of internet use. While online engagement provided relaxation and social connection, excessive use often led to anxiety, sleep disruption, and guilt. Subthemes: • Online engagement as stress relief • Anxiety and sleep disturbance due to overuse • Verbatims: “Scrolling through Instagram helps me unwind after classes, but sometimes I lose track of time.” — Participant 5, 1st Year MBBS “If I don’t have internet access, I feel restless, almost anxious.” — Participant 12, 4th Year MBBS Theme 3: Distraction and Academic Procrastination Many students admitted that the same tools that supported learning also caused distraction. Social media notifications, streaming content, and gaming contributed to procrastination and poor time management. Subthemes: • Academic procrastination • Multitasking and attention loss Verbatims: “I open my phone for notes but end up watching reels for hours.” — Participant 2, 3rd Year MBBS “During exams, I try to avoid the phone, but somehow I always check messages and lose focus.” — Participant 8, 2nd Year MBBS Theme 4: Awareness and Coping Strategies Several participants were aware of their excessive use and consciously tried to limit screen time through apps, scheduled study periods, or digital detox efforts. Others emphasized the role of institutional support and peer influence in regulating online habits. Subthemes: • Self-regulation strategies • Institutional and peer support Verbatims: “I started using a timer app to restrict my non-academic browsing.” — Participant 10, Intern “It would help if colleges organized sessions on digital well-being. We often don’t realize how much time we waste online.” — Participant 6, 1st Year MBBS Below is a representation of the frequency of qualitative codes based on their frequency of use (Figure 2). Figure 2. Code cloud representing prominent themes in qualitative data The integration of quantitative and qualitative findings revealed that while internet use improved academic access, it also contributed to psychological strain and distraction when used excessively. Quantitative results indicated that over 25% of students had moderate-to-severe anxiety and that increased non-academic screen time negatively correlated with exam performance. Qualitative findings supported these trends, as students described difficulty managing time and maintaining focus. The overall insight suggests that internet use among medical students is a double-edged sword, simultaneously promoting academic enhancement and posing risks to mental health.

The present mixed-methods study examined the complex relationship between internet use, mental health, and academic performance among health professional students. Quantitative results revealed that a substantial proportion of students experienced mild-to-moderate symptoms of anxiety and depression, while qualitative narratives highlighted both the academic benefits and psychological risks of internet engagement. The findings align with prior studies indicating that medical students are particularly vulnerable to problematic internet use due to the academic demands and emotional pressures inherent in their training (2,3). The majority of participants in this study viewed the internet as an essential educational tool, corroborating previous research emphasizing its role in academic enrichment, accessibility, and self-directed learning (10,8). Students reported that online lectures, YouTube tutorials, and collaborative platforms like Google Docs enhanced their comprehension of complex medical topics and facilitated peer learning. This resonates with findings from Chen and Peng (10), who reported that moderate internet use improves learning efficiency and academic engagement. The growing dependence on digital resources in medical education reflects a global shift toward technology-integrated learning, as observed during the COVID-19 pandemic when online education became indispensable (17). However, this reliance also blurs the boundary between academic and non-academic use, leading to overexposure and reduced self-regulation. Emotional and psychological consequences emerged as a central concern. Nearly one-fourth of the respondents in the current study reported moderate-to-severe anxiety levels, and qualitative data revealed that excessive internet use was often associated with sleep disruption, restlessness, and guilt. Similar patterns were observed by Sharma et al. (8) among Indian medical students and by Salehi et al. (9) in Iran, where prolonged internet engagement was correlated with higher anxiety and stress scores. The psychological impact appears to stem from both content exposure and behavioral dependence, consistent with Young’s (7) conceptualization of Internet Addiction Disorder as a behavioral condition characterized by compulsive use despite negative outcomes. For many participants, social media served as a short-term coping mechanism for academic stress; however, excessive scrolling or online gaming became counterproductive, echoing findings from Kuss and Griffiths (6), who linked excessive online engagement to low mood and social withdrawal. The study also revealed a significant negative correlation between non-academic screen time and actual academic performance (r = –0.28, p<0.05). This finding supports the hypothesis that internet overuse, particularly for entertainment and social networking, undermines concentration and productivity. Similar results were reported by Hidalgo-Fuentes (18), who found that frequent multitasking and prolonged screen exposure impaired learning outcomes among students. The thematic analysis underscored this paradox: while the internet facilitated easy access to information, it also encouraged academic procrastination and attention loss. Students’ verbatims vividly captured this duality—using digital tools for study but often being sidetracked by distractions such as social media notifications or video streaming. This aligns with research suggesting that constant digital interruptions contribute to cognitive overload and reduced academic focus (19,20). Interestingly, several students demonstrated awareness of their excessive use and implemented self-regulation strategies such as timer apps, digital detox efforts, or scheduled study hours. These adaptive coping mechanisms mirror findings from a study by Bener and Bhugra (21), which emphasized self-control and peer support as protective factors against internet addiction. Participants also expressed the need for institutional initiatives promoting digital well-being, including workshops or counseling sessions—indicating that collective awareness and structured interventions could mitigate the adverse effects of excessive internet use. Integrating such programs into the medical curriculum may foster healthier online habits and enhance students’ mental resilience. The integrated analysis suggests that internet use among health professional students operates as a double-edged sword—serving as both a facilitator of academic success and a contributor to psychological strain. When used judiciously, the internet enhances medical education by broadening access to global knowledge and enabling flexible learning. However, excessive, unregulated, or emotionally driven use can lead to anxiety, sleep deprivation, and decreased academic efficiency. These findings underscore the importance of balance and digital literacy in modern medical training. As technology becomes increasingly embedded in education, institutions must prioritize digital wellness education, promoting not only academic competence but also psychological well-being. Limitations This study had several limitations. Being cross-sectional in design, it cannot establish causality between internet use and psychological outcomes. The sample was restricted to a single institution, which may limit the generalizability of findings to other regions or disciplines. Self-reported measures of internet use and academic performance may also be subject to recall or social desirability bias. Additionally, while qualitative insights provided depth, the relatively small number of interviews might not capture the full range of experiences among all health professional students. Future research should employ longitudinal and multi-institutional designs to explore causal pathways and evaluate the effectiveness of digital wellness interventions.

This study highlights the dual role of internet use among health professional students as both a facilitator of academic learning and a potential source of psychological strain. Quantitative findings indicated that while the majority of students maintained normal levels of depression, anxiety, and stress, a notable proportion experienced moderate-to-severe anxiety, with excessive non-academic internet use negatively affecting academic performance. Qualitative insights revealed that students rely heavily on online resources for understanding complex medical concepts, accessing lectures, and collaborating with peers, illustrating the internet’s integral role in modern medical education. Simultaneously, participants reported challenges such as academic procrastination, attention loss, sleep disruption, and feelings of guilt, particularly when online activity shifted from academic to recreational purposes. Students demonstrated awareness of the potential harms and adopted coping strategies, including self-regulation, scheduled study periods, and digital detox efforts, highlighting the value of personal and institutional interventions in promoting responsible internet use. These findings underscore the need for targeted digital wellness programs and structured guidance to balance academic benefits with psychological well-being. By fostering awareness, self-regulation, and institutional support, health professional students can leverage the advantages of internet use while mitigating its risks, ultimately enhancing both academic performance and mental health. Acknowledgement The authors would like to sincerely thank the Department of Community Medicine, SLN Medical College, for their invaluable guidance and support throughout the study. We are also grateful to the interns who assisted with data collection, ensuring accuracy and completeness of the information. Their cooperation and commitment were instrumental in the successful completion of this research. Funding Nil Conflict of Interest The authors declare no conflict of interest.

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