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Adiksi Internet (AI) merupakan masalah kesehatan jiwa yang sering terjadi pada remaja yang dapat menimbulkan konsekuensi negatif berupa dampak fisik, psikologi, dan sosial. Diagnosis dan tata laksana yang tepat diperlukan untuk intervensi segera tetapi  kuesioner skrining AI bagi remaja di Indonesia sampai saat ini belum ada. Tujuan penelitian ini adalah mengembangkan kuesioner AI (KDAI) yang andal dan sahih bagi remaja Indonesia, memperoleh gambaran konektivitas fungsional otak pada remaja dengan AI, mendapatkan prevalensi AI, faktor risiko dan proteksi.

Domain dan butir pernyataan KDAI dikembangkan dari kepustakaan, focus group discussion (FGD) remaja, dan level of agreement para pakar melalui teknik Delphi. Uji reliabilitas dan validitas KDAI mengikutsertakan 643 subjek yang dipilih secara acak dari 4 SMP dan 5 SMA di Jakarta. Data diambil pada bulan Juli 2018–Juli 2019. Uji validitas konstruk KDAI menggunakan exploratory analysis factor (EFA) dan confirmatory analysis factor (CFA). Penentuan titik potong KDAI melalui metode receiver operating characteristics (ROC) yang dibandingkan dengan internet addiction test (IAT) versi Indonesia. Pemeriksaan rs-fMRI BOLD dilakukan pada 60 subjek untuk mendapatkan validitas prediktif KDAI dan gambaran konektivitas fungsional otak pada remaja dengan AI dan tidak AI. Faktor risiko dan proteksi AI dianalisis dengan uji regresi logistik multivariat.

Kuesioner diagnostik adiksi internet terdiri atas 7 domain dan 44 butir pernyataan dengan validitas isi dan konstruk yang baik. Nilai reliabilitas KDAI 0,942 dengan nilai titik potong 108 (sensitivitas 91,8% dan spesifisitas 77,8%). Terdapat korelasi positif antara skor KDAI dengan konektivitas fungsional lateral prefrontal cortex kiri dan lateral parietal kanan pada kelompok adiksi (p = 0,018; r = 0,437). Korelasi negatif juga didapatkan antara skor KDAI dengan konektivitas fungsional lateral prefrontal cortex kiri dan lateral parietal kanan pada kelompok adiksi (p = 0,049; r = -0,375). Diperoleh prevalensi AI 31,4% dengan faktor risiko berupa durasi penggunaan internet  >  20 jam / minggu (p <  0,001; OR = 2,889) dan masalah perilaku (p <  0,001; OR = 2,539). Faktor risiko lainnya adalah tujuan penggunaan internet untuk media sosial dan permainan daring (p = 0,005; OR = 1,826), masalah emosi (p = 0,001;

OR = 1,918), usia awitan penggunaan internet ≤ 8 tahun (p = 0,008; OR = 1,821), dan masalah perilaku prososial (p = 0,008; OR = 1,758). Faktor proteksi AI adalah pola asuh non-exposure (p = 0,012; OR = 0,518).

Reliabilitas dan validitas KDAI baik untuk digunakan sebagai alat skrining AI pada remaja di Indonesia. Skor KDAI dapat menggambarkan perbedaan konektivitas fungsional otak pada remaja AI dan tidak AI. Durasi penggunaan internet dan masalah perilaku menjadi faktor risiko utama, sedangkan pola asuh non-exposure menjadi faktor proteksi AI. Pencegahan AI dapat dilakukan dengan deteksi dini dan intervensi faktor risiko serta proteksi.

 

Kata kunci: adiksi internet, KDAI, remaja, konektivitas fungsional, faktor risiko

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Internet addiction (IA) is a common mental health problem in adolescents alongside the rapid rise of digital technology that results in negative physical, psychological, and social consequences. IA screening in adolescence is required to provide accurate diagnosis and treatment, however, to date an IA screening questionnaire for Indonesian adolescents does not exist. The purpose of this study is to develop a valid and reliable IA questionnaire for Indonesian adolescents titled Kuesioner Diagnosis Adiksi Internet – KDAI, evaluate brain functional connectivity in adolescents with IA, and find the prevalence of IA along with its risk and protective factors.

The domains and items in KDAI were developed from literatures, adolescent focus group discussions (FGD), and level of agreements of experts through the Delphi technique. The reliability and validity testing of KDAI involved randomly selected adolescents from 9 schools (4 junior high schools and 5 high schools) in Jakarta. Data collection was done from July 2018–July2019. Exploratory analysis factor (EFA) and confirmatory analysis factor (CFA) was performed to find the construct validity. The cut-off for KDAI was determined through the receiver operating characteristic (ROC) method using the Indonesian version of the internet addiction test (IAT) as a comparison. Rs-fMRI examinations were performed on 60 subjects to attain predictive validity of KDAI and evaluate brain functional connectivity in adolescents with internet addiction. The risk and protective factors of IA were assessed using a multivariate logistic regression test.

The KDAI is comprised of 7 domains and 44 statement items with good content and construct validity. The reliability score of KDAI is 0.942. The cut-off for KDAI is 108 (sensitivity 91.8 and % specificity 77.8%). A positive correlation was found in non-addiction group (p = 0.018; r = 0.437). In contrast, a negative correlation between KDAI score with the functional connectivity of the left LPFC and right LP in the addiction group (p = 0.049; r = -0.375) was found. The prevalence of IA among adolescents in Jakarta is 31.4%. Risk factors associated with IA include duration of internet use > 20 hours/week (p < 0.001; OR = 2.889), conduct disorders (p < 0.001; OR = 2.539), purpose of internet use for social media and playing online games

(p = 0.005; OR = 1.826), emotional problems (p = 0.001; OR = 1.918), onset of internet use ≤ 8 years old (p = 0.008; OR = 1.821), and prosocial problems (p = 0.008; OR = 1.758). The protective factor of IA was found to be a non-exposure parenting style (p = 0.012; OR = 0.518).

The good reliability and validity properties of KDAI functions it as an IA screening tool for adolescents in Indonesia. KDAI scores were able to portray changes in brain functional connectivity in the IA group. The duration of internet use and conduct disorders are the main risk factors for IA and a non-exposure parenting style is a protective factor. Prevention programs for IA can be implemented by focusing on early detection and providing intervention to risk and protective factors.  

Keywords: Internet addiction, KDAI, adolescents, functional connectivity

 

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Adiksi Internet (AI) merupakan masalah kesehatan jiwa yang sering terjadi pada remaja yang dapat menimbulkan konsekuensi negatif berupa dampak fisik, psikologi, dan sosial. Diagnosis dan tata laksana yang tepat diperlukan untuk intervensi segera tetapi  kuesioner skrining AI bagi remaja di Indonesia sampai saat ini belum ada. Tujuan penelitian ini adalah mengembangkan kuesioner AI (KDAI) yang andal dan sahih bagi remaja Indonesia, memperoleh gambaran konektivitas fungsional otak pada remaja dengan AI, mendapatkan prevalensi AI, faktor risiko dan proteksi.

Domain dan butir pernyataan KDAI dikembangkan dari kepustakaan, focus group discussion (FGD) remaja, dan level of agreement para pakar melalui teknik Delphi. Uji reliabilitas dan validitas KDAI mengikutsertakan 643 subjek yang dipilih secara acak dari 4 SMP dan 5 SMA di Jakarta. Data diambil pada bulan Juli 2018–Juli 2019. Uji validitas konstruk KDAI menggunakan exploratory analysis factor (EFA) dan confirmatory analysis factor (CFA). Penentuan titik potong KDAI melalui metode receiver operating characteristics (ROC) yang dibandingkan dengan internet addiction test (IAT) versi Indonesia. Pemeriksaan rs-fMRI BOLD dilakukan pada 60 subjek untuk mendapatkan validitas prediktif KDAI dan gambaran konektivitas fungsional otak pada remaja dengan AI dan tidak AI. Faktor risiko dan proteksi AI dianalisis dengan uji regresi logistik multivariat.

Kuesioner diagnostik adiksi internet terdiri atas 7 domain dan 44 butir pernyataan dengan validitas isi dan konstruk yang baik. Nilai reliabilitas KDAI 0,942 dengan nilai titik potong 108 (sensitivitas 91,8% dan spesifisitas 77,8%). Terdapat korelasi positif antara skor KDAI dengan konektivitas fungsional lateral prefrontal cortex kiri dan lateral parietal kanan pada kelompok adiksi (p = 0,018; r = 0,437). Korelasi negatif juga didapatkan antara skor KDAI dengan konektivitas fungsional lateral prefrontal cortex kiri dan lateral parietal kanan pada kelompok adiksi (p = 0,049; r = -0,375). Diperoleh prevalensi AI 31,4% dengan faktor risiko berupa durasi penggunaan internet  >  20 jam / minggu (p <  0,001; OR = 2,889) dan masalah perilaku (p <  0,001; OR = 2,539). Faktor risiko lainnya adalah tujuan penggunaan internet untuk media sosial dan permainan daring (p = 0,005; OR = 1,826), masalah emosi (p = 0,001;

OR = 1,918), usia awitan penggunaan internet ≤ 8 tahun (p = 0,008; OR = 1,821), dan masalah perilaku prososial (p = 0,008; OR = 1,758). Faktor proteksi AI adalah pola asuh non-exposure (p = 0,012; OR = 0,518).

Reliabilitas dan validitas KDAI baik untuk digunakan sebagai alat skrining AI pada remaja di Indonesia. Skor KDAI dapat menggambarkan perbedaan konektivitas fungsional otak pada remaja AI dan tidak AI. Durasi penggunaan internet dan masalah perilaku menjadi faktor risiko utama, sedangkan pola asuh non-exposure menjadi faktor proteksi AI. Pencegahan AI dapat dilakukan dengan deteksi dini dan intervensi faktor risiko serta proteksi.

 

Kata kunci: adiksi internet, KDAI, remaja, konektivitas fungsional, faktor risiko

 

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Internet addiction (IA) is a common mental health problem in adolescents alongside the rapid rise of digital technology that results in negative physical, psychological, and social consequences. IA screening in adolescence is required to provide accurate diagnosis and treatment, however, to date an IA screening questionnaire for Indonesian adolescents does not exist. The purpose of this study is to develop a valid and reliable IA questionnaire for Indonesian adolescents titled Kuesioner Diagnosis Adiksi Internet – KDAI, evaluate brain functional connectivity in adolescents with IA, and find the prevalence of IA along with its risk and protective factors.

The domains and items in KDAI were developed from literatures, adolescent focus group discussions (FGD), and level of agreements of experts through the Delphi technique. The reliability and validity testing of KDAI involved randomly selected adolescents from 9 schools (4 junior high schools and 5 high schools) in Jakarta. Data collection was done from July 2018–July2019. Exploratory analysis factor (EFA) and confirmatory analysis factor (CFA) was performed to find the construct validity. The cut-off for KDAI was determined through the receiver operating characteristic (ROC) method using the Indonesian version of the internet addiction test (IAT) as a comparison. Rs-fMRI examinations were performed on 60 subjects to attain predictive validity of KDAI and evaluate brain functional connectivity in adolescents with internet addiction. The risk and protective factors of IA were assessed using a multivariate logistic regression test.

The KDAI is comprised of 7 domains and 44 statement items with good content and construct validity. The reliability score of KDAI is 0.942. The cut-off for KDAI is 108 (sensitivity 91.8 and % specificity 77.8%). A positive correlation was found in non-addiction group (p = 0.018; r = 0.437). In contrast, a negative correlation between KDAI score with the functional connectivity of the left LPFC and right LP in the addiction group (p = 0.049; r = -0.375) was found. The prevalence of IA among adolescents in Jakarta is 31.4%. Risk factors associated with IA include duration of internet use > 20 hours/week (p < 0.001; OR = 2.889), conduct disorders (p < 0.001; OR = 2.539), purpose of internet use for social media and playing online games

(p = 0.005; OR = 1.826), emotional problems (p = 0.001; OR = 1.918), onset of internet use ≤ 8 years old (p = 0.008; OR = 1.821), and prosocial problems (p = 0.008; OR = 1.758). The protective factor of IA was found to be a non-exposure parenting style (p = 0.012; OR = 0.518).

The good reliability and validity properties of KDAI functions it as an IA screening tool for adolescents in Indonesia. KDAI scores were able to portray changes in brain functional connectivity in the IA group. The duration of internet use and conduct disorders are the main risk factors for IA and a non-exposure parenting style is a protective factor. Prevention programs for IA can be implemented by focusing on early detection and providing intervention to risk and protective factors.  

Keywords: Internet addiction, KDAI, adolescents, functional connectivity

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"Remaja usia transisi rentan mengalami masalah kesehatan jiwa dan sekitar 50–75% masalah kesehatan jiwa muncul pada usia 14–24 tahun. Pada usia tersebut terjadi perubahan biologis, psikologis dan lingkungan yang dapat menimbulkan stres sehingga remaja perlu beradaptasi. Mahasiswa merupakan remaja usia transisi yang rentan terhadap stres sehingga perlu dilatih untuk meningkatkan ketahanan mental (resiliensi). Namun, belum ada modul penguatan kesehatan jiwa bagi mahasiswa usia transisi sehingga diperlukan modul yang efektif memperkuat kesehatan jiwa berdasarkan aspek biospikososial. Desain penelitian ini adalah mixed method research, yaitu exploratory sequencial method dengan penelitian kualitatif untuk pengembangan modul yang diikuti penelitian kuantitatif untuk menilai efektivitas modul. Penelitian dilakukan di Fakultas Kedokteran Universitas Indonesia (FKUI) pada bulan September 2020 sampai Januari 2022. Subjek penelitian kualitatif adalah 20 mahasiswa FKUI serta 12 ahli yang terdiri atas psikiater, psikolog dan dosen. Mahasiswa dipilih secara random sedangkan para ahli dipilih dengan consecutive sampling. Data dari mahasiswa diambil dengan wawancara mendalam dan dari para ahli dilakukan metode delphi. Uji efektivitas terhadap resiliensi mahasiswa dilakukan secara kuasi eksperimental dengan pengukuran berulang pada minggu ke-4, ke-8, ke-12. Tema modul adalah “Transisi dan Adaptasi Menuju Resiliensi: Modul Kenali Stres dan Penguatan Kesehatan Jiwa dalam Proses Adaptasi Mahasiswa Baru di Fakultas Kedokteran”. Kepuasan mahasiswa terhadap modul diukur dengan instrumen CSQ-I dan diperoleh skor 37,4 (SB 3,81) dari skor maksimal 40. Uji validitas dan reliabilitas pada kuesioner pengetahuan, sikap terhadap kesehatan jiwa, dan perilaku mencari bantuan diperoleh rentang I-CVI 0,7–1,0, serta nilai S-CVI untuk masing-masing kuesioner 0,87; 0,90 dan 0,99. Reliabilitas kuesioner diuji dengan cronbach’s alpha dan diperoleh nilai 0,521; 0,780; dan 0,852. Pengukuran biomarker kortisol menurun bermakna pada kelompok perlakuan (uji Wilcoxon, p < 0,001), sedangkan kadar enzim alfa-amilase saliva tidak berbeda bermakna. Nilai resiliensi yang diukur dengan kuesioner CD-RISC meningkat bermakna pada kelompok perlakuan dibandingkan kontrol pada minggu ke-4, ke-8 dan ke-12 (Uji ANOVA two way, p < 0,001). Terdapat juga peningkatan bermakna pada pengetahuan (uji ANOVA two way, p < 0,001), sikap dan perilaku terhadap kesehatan jiwa (uji ANOVA two way, p < 0,001). Terdapat penurunan bermakna (uji ANOVA two way, p < 0,001) skor persepsi terhadap stres yang diukur dengan kuesioner PSS. Skor depresi pada kelompok perlakuan yang diukur dengan kuesioner DASS pada minggu ke-12 menunjukkan penurunan bermakna (uji Wilcoxon, p < 0,001), demikian juga dengan ansietas (uji Wilcoxon, p < 0,001) dan stres (uji Wilcoxon, p < 0,001). Disimpulkan modul penguatan kesehatan jiwa dapat diterima dan diterapkan pada mahasiswa tingkat pertama di FKUI karena efektif meningkatkan kekuatan menghadapi stres dari aspek biopsikososial......Adolescents of transitional age are vulnerable to mental health problems, and about 50–75% of mental health problems arise at the age of 14–24 years. At that age, biological, psychological and environmental changes can cause stress, so adolescents need to adapt. Students are teenagers of transition-age prone to stress, so they need to be trained to increase mental resilience. However, there is no module for strengthening mental health for transitional-aged students, so an effective module is needed based on biopsychosocial aspects. This research design is mixed-method research, namely exploratory sequential method with qualitative research for module development followed by quantitative research to assess the module’s effectiveness. The research was conducted at the Faculty of Medicine, University of Indonesia (FKUI) from September 2020–January 2022. The subjects of the qualitative research were 20 FKUI students and 12 experts consisting of psychiatrists, psychologists and lecturers. Students were selected randomly, while the experts were selected by consecutive sampling. Data from students were taken through in-depth interviews, and from the experts, the Delphi method was used. The effectiveness test on student resilience was conducted in a quasi-experimental manner with repeated measurements at the 4th, 8th, and 12th weeks. The module’s theme is “Transition and Adaptation Towards Resilience: Recognizing Stress and Strengthening Mental Health in the Adaptation Process of New Students at the Faculty of Medicine”. Student’s satisfaction with the module was measured using the CSQ-I instrument and a score of 37.4 (SB 3.81) out of a maximum score of 40. The validity and reliability test of the knowledge, attitudes toward mental health and help-seeking behaviour questionnaires obtained the I-CVI range of 0.7–1.0, while the S-CVI value for each questionnaire was 0.87; 0.90 and 0.99. The reliability of the questionnaire was tested with Cronbach’s alpha and obtained a value of 0.521; 0.780; and 0.852. Cortisol measurement decreased significantly in the treatment group (Wilcoxon test, p < 0.001), while salivary alpha-amylase enzyme levels were not significantly different. The value of resilience as measured by the CD-RISC questionnaire increased significantly in the treatment group compared to the control group at week 4, 8, 12 (ANOVA two way test, p < 0.001). There were significant improvement in knowledge (ANOVA two way test, p < 0.001) and in attitudes and behaviour toward mental health (ANOVA two way, p < 0.001). The PSS questionnaire measured a significant decrease (ANOVA two way, p < 0.001) in perceived stress scores. Depression scores as measured by the DASS questionnaire at week 12 showed significant differences (Wilcoxon test, p < 0.001), as did anxiety (Wilcoxon test, p < 0.001) and stress (Wilcoxon test, p < 0.001). It is concluded that the mental health strengthening module can be accepted and applied to first-year students at FKUI because it effectively increases the strength to deal with stress from a biopsychosocial aspect."