ORIGINAL ARTICLE

Alpha Psychiatry 2021;22(5):257-262

Alpha Psychiatry DOI: 10.5152/alphapsychiatry.2021.21242

Social Media Addiction in Young Adult Patients with

Anxiety Disorders and Depression

ABSTRACT

Objective: Although the relationship between social media addiction (SMA) and men-
tal health is bidirectional, there have been very few attempts to investigate patients with
depression or anxiety disorders in terms of SMA. The first aim of this study is to determine
whether young adult patients diagnosed with depression or anxiety disorders have a ten-
dency to become addicted to social media. The second aim of the study is to examine the
effects of 6 DSM-based personality traits (dependent, histrionic, narcissistic, obsessive-com-
pulsive, borderline, and paranoid) that commonly coexist with these disorders on SMA.

Methods: This study was carried out with 276 participants between the ages of 18 and
35 in the Psychiatry Outpatient Clinic in Gazi University Hospital, Turkey. Seventy-three
patients diagnosed with depression, 80 patients diagnosed with anxiety disorders, and
123 healthy controls were recruited for the study. The SMA Scale, Hospital Anxiety and
Depression Scale, and the Personality Belief Questionnaire-Short Form were administered
to the participants.

Results: Patients with anxiety disorders (PAD) and patients with depression (PD) were
more addicted to social media than healthy controls (HC) despite similar frequencies of
social media use. Dependent, histrionic, narcissistic, obsessive-compulsive, borderline,
and paranoid personality features in HC increased the susceptibility to SMA. Borderline
and dependent personality features comorbid with PAD increased the susceptibility to
SMA. None of the personality traits comorbid with PD had an effect on SMA.

Conclusion: The present study will serve as a base for future studies which explore factors
that can make PAD or PD more vulnerable to SMA.

Keywords: Anxiety disorders, depression, mental health, personality, social media

Erman Şentürk1
Introduction Bahadır Geniş2

Social media has become a part of the private and professional lives of many people all over Behcet Coşar3
the world. People have witnessed social network interactions adding a new social dimen- 1
Department of Psychiatry, University of
sion to daily life and relationships in platforms such as Facebook, Twitter, Instagram, and Health Sciences Bağcılar Training and
Whatsapp over the last decade. It is estimated that the number of social media users world- Research Hospital, İstanbul, Turkey
wide will increase and reach 3 billion in 2021.1
2
Department of Psychiatry, Kocaeli University
School of Medicine, Kocaeli, Turkey
3
Department of Psychiatry, Gazi University
Social media addiction (SMA) is defined as having a strong motivation toward excessive social School of Medicine, Ankara, Turkey
media use (SMU) and being overly concerned about social media, which impairs social and
This research article is derived from the
psychological well-being.2 Although SMA is not classified in the Diagnostic and Statistical specialty thesis in medicine written by
Manual of Mental Disorders (DSM-5), it has been identified as a potential behavioral addic- E.Ş.; Gazi University School of Medicine, 2017.
tion associated with impairments in academic performance, physical health, interpersonal
Corresponding author:
relationships, and occupational life.3 Erman Şentürk
✉ [Link]@[Link]
Young adulthood is a time of increased SMU among some users.2 Social media serves as an
Received: March 4, 2021
important socialization platform in which young adults put forward their developing auton- Accepted: May 6, 2021
omy, explore their identity, and maintain social relationships.4 Social media provides a sense Published Online Date: June 18, 2021

Cite this article as: Şentürk E, Geniş B,

Coşar B. Social media addiction in young
Copyright@Author(s) - Available online at [Link]. adult patients with anxiety disorders
Content of this journal is licensed under a Creative Commons Attribution-NonCommercial 4.0 and depression. Alpha Psychiatry.
International License. 2021;22(5):257-262.

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Alpha Psychiatry 2021;22(5):257-262 Şentürk et al. The Ignored Side of Social Media Addiction

of constant social connection with its rewarding and reinforcing side Methods
and this increases the frequency of use.5 Subrahmanyam et al6 have
reported that excessive Facebook use is beneficial for early adult Sample
users experiencing low self-esteem and low life-satisfaction. On This study was carried out with 281 participants between the ages
the other hand, excessive SMU may be a symptom of more serious of 18 and 35 in the Gazi University Psychiatric Outpatient Clinic.
underlying problems such as relationship or individual problems that Seventy-six PD, 82 PAD, and 123 HC participated in the study with a
induce addictive use of social media as a coping mechanism.7 It has convenience sampling method. Three patients from the depression
been found that there is a strong positive correlation between exces- group and 2 patients from the anxiety disorders group were excluded
sive SMU and young adults with depression and anxiety.8 due to incomplete or stereotyped responses to questions. Therefore,
our study group consisted of 73 PD, 80 PAD, and 123 HC. Depression
Social media users’ personality features may be a crucial factor lead- and anxiety disorders were diagnosed as an outcome of the clinical
ing them to engage in social media. Most studies on the relationship interview, in patients meeting the symptoms of these disorders in the
between personality and SMA have often been based on the Five- DSM-5. The HC comprised Gazi University students, employees, and
Factor Model of Personality. Correa et al9 have revealed that there is relatives of patients who agreed to participate in the study. The exclu-
a significant correlation between extraversion, openness to experi- sion criteria for HC were the existence any of psychiatric disorders,
ence personality traits, and SMU. So far, there has been little research psychiatric treatment history, and a diagnosis of mental retardation in
directly investigating the relationship between SMA and DSM-based the medical history. The criteria for selecting participants were as fol-
personality features.10 Moreover, it is a well-known fact that there is lows: (a) young adult; (b) have at least one social media account; and
a high comorbidity between depression, anxiety disorders, and per- (c) depression or anxiety disorders diagnosed without any comorbid
sonality disorders.11,12 However, there has been no study in the litera- psychiatric disorders based on the clinical interview (only for the
ture investigating the effects of personality features, which coexist patient group). After the clinical interview, the patient was informed
with depression or anxiety disorders on SMA. about the content and details of the study. Instruments of the study
were administered after obtaining consent from the volunteers who
There have been considerable limitations in the existing literature
accepted to participate in the study. All responses were anonymous
that investigate the relationship between SMA and mental health.
and no personally identifiable information was requested. In addi-
The sample of most studies consisted of the general population.
tion, a written informed consent form was signed by all participants.
Symptoms of depression or anxiety disorders were generally assessed
Ethical approval was obtained from the Institutional Review Board
with self-report measurements. Therefore, the results of studies may
of Gazi University (July 2017; E.108015). Data were collected from
fail to represent depression or anxiety disorders, which is actually a clin-
August 1 to October 1, 2017.
ical diagnosis. Previous studies have mainly focused on the influence
of SMA on mental health-related outcomes. However, the relationship Data Collection Tools
between SMA and mental health is bidirectional.13 Surprisingly, there
have been very few attempts to investigate patients with depression Sociodemographic Data Form (SDF): The Sociodemographic Data
(PD) or patients with anxiety disorders (PAD) in terms of SMA. In this Form (SDF) included the participants’ age, gender, marital status,
study, the first aim is to compare young adult PAD or PD and healthy educational level, and occupation. The participants’ ages were
controls (HC) in terms of SMA. The second aim is to reveal the possible classified into 2 categories as 18-24 and 25-34. Marital status was
effects of 6 DSM-based personality traits (dependent, histrionic, nar- classified as married or unmarried. Educational levels were classified
cissistic, obsessive-compulsive, borderline, and paranoid) that com- as high school, university, and postgraduate degrees. The working
monly coexist with these disorders on SMA. status was classified as employed, unemployed, and student.

Three questions were asked of the participants, to rate how fre-

quently they used social media. These questions were about average
MAIN POINTS daily time spent on social media (≤1 hour, 1-3 hours, ≥ 3 hours), the
• Despite a similar frequency of social media use, a significant dif- daily number of times they logged-in to social media accounts (≤10,
ference was found in patients with depression and patients with 11-20, ≥ 21), and the ratio of time spent on social media/internet on
anxiety disorders compared to healthy controls in total scores of an ordinary day (less than half, almost half, more than half, almost all
the Social Media Addiction Scale. the time).
• In this study, mood modification, conflict, and relapse aspects of
social media addiction were observed to be more predominant Social Media Addiction Scale (SMAS): The Social Media Addiction
in patients with depression and patients with anxiety disorders Scale (SMAS) was developed by Tutgun-Ünal and Deniz14 in the
than healthy controls. The salient aspect of social media addiction Turkish language, with a comprehensive pool of items created using
was its predominance only in patients with anxiety disorders than internet addiction, problematic internet use, and Facebook addiction
healthy controls. studies. SMAS has 41 items and 4 subdimensions (salience, mood
• It was found that dependent, histrionic, narcissistic, obsessive- modification, relapse, and conflict).14 The scale is scored as a 5-point
compulsive, borderline, and paranoid personality features in Likert scale (1 = never, 5 = always), and Cronbach’s α is 0.967. The
healthy controls, and borderline and dependent personality fea- lowest score is 41, and the highest score is 205. The higher scores on
tures in patients with anxiety disorders, increased the susceptibility the scale indicate that SMA has increased. Those with a total score of
to social media addiction. Surprisingly, it was found that none of 41-73 are grouped as not addicted to social media, 74 and above as
the personality features in patients with depression increased the those with low, moderate, high, and extreme addiction to social
susceptibility to social media addiction. media. In this study, a score of 73 and below were not classified as

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Şentürk et al. The Ignored Side of Social Media Addiction Alpha Psychiatry 2021;22(5):257-262

addicted to social media, but 74 and above were classified as Table 1. Sociodemographic Characteristics of Groups
addicted to social media, regardless of addiction severity. In the Healthy Anxiety
current study, Cronbach’s α is 0.971. controls Depression disorders
(n = 123) (n = 73) (n = 80)
Personality Belief Questionnaire-Short Form (PBQ-SF): The Variables n (%) n (%) n (%) P
Personality Belief Questionnaire-Short Form (PBQ-SF) is a 65-item Gender
self-report questionnaire used to assess features of personality Female 68 (55.3) 35 (47.9) 48 (60.0) .332
beliefs according to DSM-IV.15 PBQ-SF includes 10 subscales indicating Male 55 (44.7) 38 (52.1) 32 (40.0)
DSM-5 personality disorders (dependent, histrionic, narcissistic, Marital status
obsessive-compulsive, borderline, avoidant, passive-aggressive, Married 9 (7.3) 8 (11.0) 6 (7.5) .638
schizoid, paranoid, antisocial). The reliability internal consistency Unmarried 114 (92.7) 65 (89.0) 74 (92.5)
coefficient was specified as 0.92 in the Turkish adaptation study by Age
Taymur et al.16 Questionnaire scoring is on a 6-point Likert scale (0 = I 18-24 85 (69.1) 46 (63.0) 64 (80.0) .062
do not believe at all, 5 = I totally believe). A total score for each
25-34 38 (30.9) 27 (37.0) 16 (20.0)
subscale is obtained by summing across relevant items. In the current
Educational levels
study, Cronbach’s α is 0.959.
High school 3 (2.4) 6 (8.2) 2 (2.5) .156
University 111 (90.2) 62 (84.9) 76 (95.0)
Hospital Anxiety and Depression Scale (HADS): The Hospital
Postgraduate 9 (7.3) 5 (6.8) 2 (2.5)
Anxiety and Depression Scale (HADS) was designed to measure both degree
anxiety and depression in outpatient populations.17 HADS is a self- Working status
report scale and consists of a total of 14 items, including 7 items for
Unemployed 21 (17.1) 15 (20.5) 13 (16.3) .902
anxiety symptoms, and 7 items for depression symptoms. The items
Employed 60 (48.8) 36 (49.3) 43 (53.8)
are assessed through a Likert scale, ranging from 0 to 3, with the
Student 42 (34.1) 22 (30.1) 24 (30.0)
higher scores indicating more severe anxiety and depression. Based
on a study with the Turkish version of HADS, cut-off points are 10 for
the anxiety subdimension and 7 for the depression subdimension.18 between the PD, PAD, and HC groups in terms of gender (P = .332),
In the current study, Cronbach’s α is 0.861. age (P = .062), marital status (P = .638), educational level (P = .156),
and working status (P = .902).
Statistical Analysis
The SPSS v23.0 (IBM Corp., Armonk, NY, USA) was used for data The frequency of the participants’ SMU is shown in Table 2. There
­analyses. The numbers, percentages, arithmetic mean, standard devi- was no significant difference between the PD, PAD, and HC groups in
ation, median, and interquartile range values distributions were used terms of average daily time spent on social media (P = .379), the daily
for descriptive statistics. The chi-square test was used to compare frequency of social media log-in (P=.184), and the ratio of time spent
qualitative data, and the Fisher–Freeman–Halton test was used when on social media/internet on an ordinary day (P = .577).
necessary. The Kolmogorov–Smirnov test was used to investigate
Total and subdimension scores of SMAS were compared between
the conformity of the data for normal distribution. However, non-
the PD, PAD, and HC groups. Significant differences were found
parametric tests were used in the analysis since the scales included
(P < .001 for each). Group comparison of SMAS subdimensions and
sequential variables. The Mann–Whitney U-test was used to compare
HADS subtests are shown in Table 3. Mood modification, conflict, and
the 2 groups, and the Kruskal–Wallis H test to compare the 3 groups.
relapse subdimensions and total scores of SMAS were significantly
If a significant difference was detected by Kruskal–Wallis variance
higher in the PD and PAD groups than HC. The salience subdimen-
analysis, the Mann–Whitney U-test was used to determine the
sion of SMAS was significantly higher in the PAD group only than HC.
groups between which the difference was significant. The Bonferroni
correction was used to reduce the likelihood of type 1 errors. The cor- Effects of personality features on SMA in groups are shown in
rected type 1 error rate was accepted as 0.0167 after the correction Figure 1. Consequently, dependent (Z = −3.582, P < .001), obses-
(type 1 error rate/number of analyses performed = 0.05/3 = 0.0167). sive-compulsive (Z = 3.664, P < .001), narcissistic (Z = −3.494,
This situation is specified as a footnote in Table 3. The type 1 error rate P < .001), histrionic (Z = −3.102, P = .002), borderline (Z = −3.395,
was taken as 0.05 in other analyses. P = .001), and paranoid (Z = −3.189, P = .001) personality features
in the HC group were found significantly higher in the presence of
Results SMA. Borderline (Z = −3.687, P < .001) and dependent (Z = −2.365,
P = .018) personality features in the PAD group were found signifi-
Participants’ sociodemographic characteristics, including age, gen-
cantly higher in the presence of SMA. However, none of the person-
der, marital status, educational level, and working status, are shown
ality features in the PD group showed significant differences in the
in Table 1. There were 151 (54.7%) female and 125 (45.3%) male par-
presence of SMA (P > .05 for each).
ticipants; 23 (8.3%) were married and 253 (91.7%) were unmarried;
195 (70.6%) were between the ages of 18 and 24, and 81 (29.4%) Discussion
were between the ages of 25 and 34; 11 (4%) were high school grad-
uates, 249 (90.2%) were university graduates, 16 (5.8%) were post- Our findings suggested that there were no statistically significant
graduate; 49 (17.7%) were unemployed, 139 (50.3%) were employed, differences in frequency of SMU in the PD, PAD, and HC groups
and 88 (32%) were students. There was no significant difference (average daily time spent on social media, the daily number of

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Alpha Psychiatry 2021;22(5):257-262 Şentürk et al. The Ignored Side of Social Media Addiction

Table 2. Daily Social Media Use Characteristics

Healthy controls (n = 123) Depression (n = 73) Anxiety disorders (n = 80)
Variables n (%) n (%) n (%) P
Time spent on social media
≤ 1 hour 36 (29.3) 20 (27.4) 14 (17.5) .379
1-3 hours 59 (48.0) 34 (46.6) 45 (56.3)
≥ 3 hours 28 (22.8) 19 (26.0) 21 (26.3)
Number of times log-in to social media accounts
≤ 10 92 (74.8) 55 (75.3) 48 (60.0) .184
11-20 22 (17.9) 12 (16.4) 21 (26.3)
≥ 21 9 (7.3) 6 (8.2) 11 (13.8)
Ratio of time spent on social media/internet per
day
Less than half 31 (25.2) 18 (24.7) 14 (17.5) .577
Almost half 34 (27.6) 20 (27.4) 18 (22.5)
More than half 42 (34.1) 22 (30.1) 32 (40.0)
Almost all 16 (13.0) 13 (17.8) 16 (20.0)

times they logged-in to social media accounts and the ratio of time have suggested that more daily time on social media, and increased
spent on social media/internet on an ordinary day). There was a sig- volume or frequency of SMU are associated with both depression
nificant difference in total scores of SMAS in the PAD and PD groups and anxiety.20,21 For PD or PAD, SMA may depend on SMU patterns
compared to the HC group, despite a similar frequency of SMU. and personal experiences rather than time spent on social media.
This finding is consistent with a prior study demonstrating that the According to Xu and Tan,22 if social media is perceived as a crucial
association between excessive SMU and depression may be more mediator to alleviate the burden of an individual’s stress, loneliness,
indicative of personal experience than the volume or frequency of or depressed mood, the transition from normal to problematic SMU
SMU.19 However, this finding is contrary to previous studies, which occurs. SMU is associated with lower levels of loneliness, greater

Table 3. Group Comparison of SMAS Subdimensions and HADS Subtests

Variables Healthy controls1 (n=123) Depression2 (n=73) Anxiety disorders3 (n=80) Statistical analysis
Post-Hoc analysis
SMAS Median (IQR) Median (IQR) Median (IQR) P Duals P
SMAS-S 29 (22-35) 33 (22-41) 35 (28-40) <.001 1-2 .069
1-3 <.001a
2-3 .133
SMAS-MM 10 (7-14) 13 (9-16.5) 13 (10-16.5) <.001 1-2 .001a
1-3 <.001a
2-3 .767
SMAS-R 7(5-10) 10 (5-14) 10 (7-13) <.001 1-2 .001a
1-3 <.001a
2-3 .490
SMAS-C 23 (20-32) 38 (23.5-50.5) 32 (26-41.5) <.001 1-2 <.001a
1-3 <.001a
2-3 .580
SMAS-Total 72 (57-88) 96 (61.5-120) 91 (73-105.5) <.001 1-2 <.001a
1-3 <.001a
2-3 .943
HADS-A 5 (3-6) 8 (7-10) 10 (10-12) <.001 1-2 <.001a
1-3 <.001a
2-3 <.001a
HADS-D 3 (1-4) 9 (8-10) 5 (3-7) <.001 1-2 <.001a
1-3 <.001a
2-3 <.001a
IQR, interquartile ranges; SMAS, Social Media Addiction Scale; SMAS-S, Social Media Addiction Scale salience subdimension; SMAS-MM, Social Media Addiction Scale mood
modification subdimension; SMAS-R, Social Media Addiction Scale relapse subdimension; SMAS-C, Social Media Addiction Scale conflict subdimension; SMAS-Total, Social
Media Addiction Scale total scores; HADS-A, Hospital Anxiety and Depression Scale anxiety subtest; HADS-D, Hospital Anxiety and Depression Scale depression subtest.
a
Whose significance continues after the Bonferroni correction (corrected type 1 error rate = 0.0167).
The numbers 1, 2, and 3 were used for the group comparisons in the duals column of the table.

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Şentürk et al. The Ignored Side of Social Media Addiction Alpha Psychiatry 2021;22(5):257-262

Figure 1. The effect of personality features on social media addiction in groups of control, depression, and anxiety disorders. (A) Comparison
of personality traits in the control group according to the presence of social media addiction; (B) Comparison of personality traits in the
depression group according to the presence of social media addiction; (C) Comparison of personality traits in the anxiety disorders group
according to the presence of social media addiction. Since the median values are similar for histrionic and borderline personality traits in the
anxiety disorders group, these variables are located on the same line. The P values obtained from the comparisons of these variables are
expressed next to the line.

feelings of social connectedness, a higher level of life-satisfaction, use social media more frequently to manage their social media
self-esteem, and social support.23,24 and have more interactions on these platforms.27 It is known that
they worry so much about maintaining and losing popularity. The
SMA consists of common components as follows: salience (SMU possibility of reaching thousands of people even with a single post
becoming the most important activity that dominates thinking, makes social media indispensable in their life. It has been suggested
feeling, and behavior), mood modification (engaging in social that dependent personality features are associated with anxious
media leads to favorable mood swings), conflict (interpersonal attachment.28 Attachment theory indicates that anxious attachment
problems as a result of SMU), and relapse (unsuccessful attempts styles are associated with a risk of psychiatric disorders, especially
to control SMU).3 This study demonstrated that mood modifica- anxiety disorders.29 It has been stated that the anxious attachment
tion, conflict, and relapse aspects of SMA were more predominant style is an important predictor of SMA.30 Borderline personality
in the PAD and PD groups than the HC group. The salience aspect features are associated with high levels of excessive reassurance
of SMA was predominant only in PAD than HC. The predominance seeking.31 Anxiety leads to interpersonal reassurance-seeking
of the conflict subdimension in PD and PAD groups may be associ- behaviors so that individuals with anxiety may engage in extreme
ated with more interpersonal problems. These disorders limit active reassurance-seeking to endorse their self-worth or reduce feelings
participation in the social environment. Depressive and anxious of uncertainty/worry by posting more frequently to get more “favs”
moods lead PAD and PD to prefer online communication over in- and “likes.”32
person interaction to fulfill social needs. A review of SMU research
declares that there have been increased symptoms of depression Several limitations in this study should be noted. The research is lim-
associated with SMU, including negative social interactions and ited by the fact that it is cross-sectional in design. The cross-sectional
comparisons.13 The reason why the salience and mood modification design may preclude making a causal inference across significant asso-
subdimensions have dominance in the PAD group may be associ- ciations. Participants were classified as addicted or not addicted to
ated with less fear of being judged and negatively evaluated in social media, regardless of addiction severity. We evaluated the 6 per-
social media. Increased social media connectedness may correlate sonality belief dimensions (dependent, histrionic, narcissistic, obses-
with higher levels of subjective well-being and increased social cap- sive-compulsive, borderline, and paranoid), which had been found
ital for PD.25 The prominence of the relapse subdimension in both more associated with SMA in previous studies.10,27 The other 4 person-
PAD and PD groups may be related to the anxious or depressive ality belief dimensions (schizoid, schizotypal, avoidant, antisocial) from
mood that predisposes people who try to cope with addiction to the PBQ-SF were not included in the study. Further studies which take
repeat the addictive behavior.26 these variables into account can overcome these issues.

In this study, we also aimed to reveal the possible effects of 6 DSM- This study has been one of the first attempts to thoroughly exam-
based personality features (dependent, histrionic, narcissistic, ine the association between mental health, personality features,
obsessive-compulsive, borderline, and paranoid) on the relation- and SMA among PAD and PD. One of the most important conclu-
ship between mental health and SMA in young adulthood. It was sions from this study is that PAD or PD are more vulnerable to SMA
found that all 6 personality features in the HC group, and the bor- than HC, although there is no difference in the amount of SMU. We
derline and dependent personality features in the PAD group suggest that it will be useful to investigate the factors that make PAD
increased the susceptibility to SMA. Surprisingly, it was found that and PD more susceptible to SMA. We think that not only depression
none of the personality features in the PD group increased the sus- or anxiety disorders but also comorbid personality patterns affect
ceptibility to SMA. Individuals with histrionic personality features SMA and that future studies will further clarify these relationships.

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Alpha Psychiatry 2021;22(5):257-262 Şentürk et al. The Ignored Side of Social Media Addiction

Ethics Committee Approval: Ethics committee approval was received for this 14. Tutgun-Ünal A, Deniz L. Development of the social media addiction
study from the Institutional Review Board of Gazi University (Approval Date: July, scale. AJIT-e Online Academic Journal of Information Technology.
2017; Approval Number: E.108015). 2015;6:51-70. [CrossRef]
15. Butler AC, Beck AT, Cohen LH. The Personality Belief Questionnaire-Short
Informed Consent: Written informed consent was obtained from the individuals Form: development and preliminary findings. Cognit Ther Res.
who participated in this study. 2007;31(3):357-370. [CrossRef]
16. Taymur İ, Türkçapar H, Örsel S, et al. Validity and reliability of the Turkish
Peer-review: Externally peer-reviewed. version of the personality belief questionnaire- short form (PBQ-STF) in
the university students. Klin Psikiyatr Derg. 2011;14(4):199-209.
Author Contributions: Concept - E.Ş., B.G., B.C.; Design - E.Ş., B.G., B.C.; Supervision - 17. Zigmond AS, Snaith RP. The hospital anxiety and depression scale. Acta
B.C.; Materials - E.Ş.; Data Collection and/or Processing - E.Ş., B.G.; Analysis and/or Psychiatr Scand. 1983;67(6):361-370. [CrossRef]
Interpretation - B.G.; Literature Search - E.Ş., Writing - E.Ş.; Critical Review - E.Ş. 18. Aydemir Ö, Güvenir T, Küey L, Kültür S. Validity and reliability of Turkish
version of Hospital Anxiety and Depression Scale. Türk Psikiyatr Derg.
Conflict of Interest: The authors have no conflict of interest to declare. 1997;8(4):280-287.
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Financial Disclosure: The authors declared that this study has received no finan- social support, and depression among college students: a model of Face-
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