Misophonia and Internet Addiction Among Nursing, Midwifery, and Emergency Medical Services Students: A Cross-sectional Study

Misophonia and Internet Addiction Among Nursing, Midwifery, and Emergency Medical Services Students: A Cross-sectional Study | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Misophonia and Internet Addiction Among Nursing, Midwifery, and Emergency Medical Services Students: A Cross-sectional Study Amir hosein Moradi pakro, Maryam Hoshmand, Hossein Hosseinefard, and 2 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-8748692/v1 This work is licensed under a CC BY 4.0 License Status: Under Revision Version 1 posted 10 You are reading this latest preprint version Abstract Background Misophonia is a sensory sensitivity condition characterized by intense emotional reactions (such as anger, anxiety, and avoidance) to everyday sounds, often impairing psychological well-being and social functioning. Internet addiction, a growing behavioral health concern among university students, has been linked to emotional dysregulation and various mental health problems. However, limited research has examined the association between misophonia and internet addiction, particularly in non-Western student populations. Objective This study aimed to examine the association between misophonia and internet addiction among nursing, midwifery, and emergency medical services students in Iran. Methods This cross-sectional study was conducted in 2024 among 277 students at the Faculty of Nursing and Midwifery, Hamadan University of Medical Sciences, using stratified random sampling. Data were collected using the Misophonia Questionnaire (Wu et al., 2014) and the Internet Addiction Test (Young, 1998). Descriptive statistics, Pearson’s correlation coefficients, independent t-tests, and ANOVA were performed using SPSS. Results The mean internet addiction score was 41.45 ± 12.13, with 25.6% of participants classified as at risk of internet addiction. The mean misophonia score was 26.00 ± 12.59. Internet addiction showed a significant positive correlation with total misophonia scores (r = 0.377, p < 0.001), with a stronger association observed for the emotions/behaviors subscale (r = 0.410, p < 0.001) than for misophonia symptoms (r = 0.259, p < 0.001). Higher internet addiction scores were reported among male students, nursing students, and those in higher academic years. Conclusions These findings suggest that problematic internet use may be associated with heightened emotional reactivity to sensory stimuli among university students. The results highlight the importance of psychological screening and preventive interventions targeting both behavioral addictions and sensory sensitivities to support student mental health. Longitudinal studies are recommended to clarify causal pathways and underlying psychological mechanisms. Misophonia Sound aversion Internet addiction University students Mental health Behavioral addiction Introduction Misophonia, also known as sound aversion, is a condition in which individuals exhibit excessive reactions to sounds that are often ordinary and repetitive [ 1 , 2 ]. Examples include throat clearing, slurping, chewing [ 2 ], coughing, finger tapping on a table, nail clipping, pacing, or kissing [ 3 ], as well as the clicking of a pen or the ticking of a clock [ 2 ]. According to individuals with misophonia, these sounds elicit intensified responses when produced by family members, friends, or colleagues [ 4 ]. The most common reaction is anger [ 5 ], with other responses including muscle tension, increased heart rate, anxiety, panic, disgust [ 1 ], frustration, and thoughts of harming others [ 5 ]. Consequently, affected individuals tend to avoid these triggers. While this avoidance initially prevents exposure to the sounds and associated distress, it gradually leads to social isolation over time, significantly and adversely impacting daily functioning [ 6 ], well-being, education, and social relationships [ 4 ]. One of the key populations experiencing misophonia is students, who play a vital role in managing and shaping the future of their countries. Thus, their physical and mental health directly influences their academic performance, well-being, professional activities, and, more importantly, society as a whole [ 4 , 5 ]. A study on the prevalence of misophonia revealed that one-fifth of students worldwide experience its symptoms [ 7 ]. On the other hand, internet addiction, defined as excessive and uncontrollable use of the internet, leads to psychological disorders and physical discomfort [ 8 ]. This phenomenon has become a growing challenge among students, particularly due to the widespread use of the internet for educational purposes. A study in China showed that the prevalence of internet addiction among students increased from 15.2% in 2016 to 23.7% following the COVID-19 pandemic [ 9 ], highlighting the exacerbation of this issue. According to Zuckerman (2020), approximately 59% of the global population (nearly 4.75 billion people) are active internet users, with 61% of them exhibiting addiction [ 10 ]. Additionally, studies indicate that the prevalence of internet addiction is higher in males than females [ 11 ]. In Iran, with about 56.7 million internet users (69.1% of the population), the country ranks among the top 20 globally in terms of user numbers [ 12 ]. However, limited research has been conducted on internet addiction in Iran. A review of 33 studies in Iran found that 5.7% to 67.1% of Iranian students suffer from internet addiction, with a higher prevalence (78.3%) among medical students compared to non-medical students (21.7%) [ 12 ]. Internet addiction is associated with mental health issues such as depression, anxiety, social isolation, and sleep disorders, as well as negative consequences like academic decline and occupational problems [ 11 , 13 ]. These findings underscore the need for prevention and management of this disorder in student populations. Although direct research on the association between misophonia and internet addiction is limited, indirect evidence supports significant correlations between these two disorders through mediating factors such as comorbid psychological issues and neurological mechanisms. Systematic studies show that misophonia has positive correlations with anxiety disorders, depression, and obsessive-compulsive disorder, which are themselves linked to internet addiction. Both misophonia and internet addiction involve heightened emotional reactivity, impaired emotion regulation, and avoidance-based coping strategies. Given the limitations of previous studies in this area, such as single-discipline sampling [ 14 , 15 ] and varying reported rates of internet addiction among Iranian students [ 8 , 15 – 19 ], this study aimed to investigate the association between misophonia and internet addiction among students from various academic levels in the Faculty of Nursing and Midwifery at Hamadan University of Medical Sciences. Materials and Methods This analytical cross-sectional study was conducted in 2024 on students of the Faculty of Nursing and Midwifery at Hamadan University of Medical Sciences. After obtaining approval from the Ethics Committee and necessary permissions from Hamadan University of Medical Sciences, and coordinating with faculty officials, the researchers individually approached the students to collect data. Since no similar study was found in previous research, proportional stratified sampling was employed. Following estimation of the total student population (850 students) and stratification by discipline, degree level, and academic year, participants were randomly selected from each subgroup proportional to its size using Demorgan’s table. A total of 277 students were included. Participants were enrolled if they met the inclusion criteria (willingness to participate and being a student at the Faculty of Nursing and Midwifery at Hamadan University of Medical Sciences during the study period) and had no exclusion criteria (unwillingness to participate or self-reported acute/chronic severe physical or mental illness). After providing detailed explanations about the study procedure, privacy protection, and obtaining informed consent in a private setting, questionnaires were distributed for self-completion. Statistical Analysis Descriptive statistics were used to report qualitative variables as frequency and percentage, and quantitative variables as mean and standard deviation. Inferential statistics included chi-square or Fisher’s exact test for qualitative variables, independent t-test or ANOVA for comparing quantitative variables across qualitative categories, and Pearson’s or nonparametric correlation coefficients for examining relationships between quantitative variables. Data Collection Tools Data were collected via a three-part paper-and-pencil self-report questionnaire: Part 1: Demographic Checklist This included age, gender, marital status, discipline, degree level, academic year, place of residence, and history of physical/mental illness. Content and face validity were confirmed by 10 faculty members of the Faculty of Nursing and Midwifery at Hamadan University of Medical Sciences. Part 2: Misophonia Questionnaire (Wu et al., 2014) 1 This 17-item questionnaire assesses the presence of misophonia symptoms, associated emotions and behaviors, and overall severity of auditory sensitivity using a Likert scale. It consists of two subscales: misophonia symptoms and misophonia emotions/behaviors. Wu et al. reported excellent reliability (Cronbach’s α = 0.86 for symptoms, 0.86 for emotions/behaviors, and 0.89 for the total scale) [ 20 ]. The Persian version was validated by Mehrabizadeh Honarmand and Roushani (2019), who confirmed adequate content, face, and criterion validity, with Cronbach’s α > 0.70 [ 21 ]. Part 3: Internet Addiction Test (IAT; Young, 1998) 2 This standardized 20-item questionnaire measures the degree of internet addiction on a 5-point Likert scale (5 = always, 1 = rarely). Total scores range from 20 to 100, classified as normal (20–49), at-risk (50–79), and addicted (80–100). Young reported high reliability (Cronbach’s α = 0.90). The Persian version has also shown good reliability (Cronbach’s α = 0.81–0.88) [ 22 ]. Ethical Considerations Participants were assured of confidentiality and anonymity. The study imposed no financial or physical burden, and any potential harm would be compensated. Participants could withdraw at any time without consequence. They were offered access to results upon request (contact details provided). The study adhered to the Helsinki Declaration and Iran’s national ethical guidelines and was approved by the Ethics Committee of Hamadan University of Medical Sciences (Code: IR.UMSHA.REC.1403.883). Results A total of 277 students from the Faculty of Nursing and Midwifery at Hamadan University of Medical Sciences participated in the study. The mean age was 22.95 ± 4.39 years, and the median daily internet use was 4 hours (IQR: 3–6). Of the participants, 48% (n = 133) were male and 52% (n = 144) were female. Nursing students comprised 65% (n = 180), midwifery students 17.3% (n = 48), and emergency medical services students 17.7% (n = 49). Most participants (84.5%, n = 234) were undergraduate students. Detailed demographic characteristics are presented in Table 1 . Table 1 Demographic Characteristics of the Participants (N = 277) Variable Category Frequency Percentage (%) Gender Male 133 48.0 Female 144 52.0 Marital Status Single 247 89.2 Married 30 10.8 Discipline Nursing 180 65.0 Midwifery 48 17.3 Emergency Medical Services 49 17.7 Degree Level Undergraduate 234 84.5 Master’s 37 13.4 Doctoral 6 2.2 Academic Year First 90 32.5 Second 84 30.3 Third 63 22.7 Fourth 40 14.4 Residence Private home 150 54.2 Dormitory 127 45.8 History of Illness No 256 92.4 Yes 21 7.6 Native Status Local 150 54.2 Non-local 127 45.8 Internet Addiction The mean total Internet Addiction Test (IAT) score was 41.45 ± 12.13. According to the IAT classification, 74.4% (n = 206) of students were in the normal range, 25.6% (n = 71) were at risk of addiction, and none met criteria for addiction. Mean IAT scores by demographic variables are shown in Table 2 . Significant differences were observed by gender (higher in males, p = 0.004), discipline (highest in nursing, lowest in midwifery, p = 0.013), and academic year (lowest in first-year and highest in fourth-year students, p = 0.015). Table 2 Mean Internet Addiction Scores by Demographic Characteristics Variable Category n Mean ± SD p-value Gender Male 133 43.65 ± 12.98 0.004 Female 144 39.43 ± 10.96 Marital Status Single 247 41.90 ± 12.00 0.078 Married 30 37.77 ± 12.80 Discipline Nursing 180 42.61 ± 12.41 0.013 Midwifery 48 36.81 ± 9.36 Emergency Medical Services 49 41.78 ± 12.67 Degree Level Undergraduate 234 42.12 ± 12.18 0.107 Master’s 37 37.86 ± 10.51 Doctoral 6 37.83 ± 16.93 Academic Year First 90 38.24 ± 10.26 0.015 Second 84 42.31 ± 11.71 Third 63 42.89 ± 13.44 Fourth 40 44.63 ± 13.56 Residence Private home 150 42.19 ± 12.41 0.272 Dormitory 127 40.58 ± 11.79 History of Illness No 256 41.46 ± 11.88 0.977 Yes 21 41.38 ± 15.25 Native Status Local 150 41.29 ± 11.46 0.803 Non-local 127 41.65 ± 12.93 Misophonia The mean total misophonia score was 26.00 ± 12.59, with subscale scores of 12.22 ± 6.03 for symptoms and 13.77 ± 7.76 for emotions/behaviors. Mean misophonia scores by demographic variables are presented in Table 3 . The emotions/behaviors subscale score differed significantly by academic year (p = 0.041), with the lowest scores in first-year and highest in fourth-year students. No other demographic variables showed statistically significant differences. Table 3 Mean Misophonia Scores (Total and Subscales) by Demographic Characteristics Variable Category n Symptoms Mean ± SD p Emotions/Behaviors Mean ± SD p Total Score Mean ± SD p Gender Male 133 11.55 ± 5.80 0.073 13.24 ± 7.42 0.268 24.79 ± 12.05 0.123 Female 144 12.85 ± 6.20 14.28 ± 8.07 27.13 ± 13.02 Academic Year First 90 11.54 ± 6.24 0.487 11.96 ± 8.08 0.041 23.50 ± 13.49 0.110 Second 84 12.86 ± 6.12 14.51 ± 7.35 27.37 ± 11.81 Third 63 12.02 ± 5.88 14.22 ± 7.73 26.24 ± 12.64 Fourth 40 12.75 ± 5.62 15.65 ± 7.43 28.40 ± 11.50 (Only variables with p < 0.1 shown in detail for brevity; full table available upon request) Correlation Between Internet Addiction and Misophonia Pearson correlation analysis revealed a significant positive correlation between IAT scores and total misophonia scores (r = 0.377, p < 0.001). Stronger correlations were observed with the emotions/behaviors subscale (r = 0.41, p < 0.001) than the symptoms subscale (r = 0.259, p < 0.001) (Table 4 ). Table 4 Pearson Correlations Between Internet Addiction and Misophonia Scores Variable Symptoms Emotions/Behaviors Total Misophonia Internet Addiction Score 0.259** 0.410** 0.377** **p < 0.001 Discussion The present study aimed to examine the association between misophonia and internet addiction among students in nursing, midwifery, and emergency medical services at Hamadan University of Medical Sciences. According to the IAT classification, 74.4% of students were in the normal range and 25.6% were at risk of internet addiction, with no participants meeting criteria for full addiction. Internet addiction scores were significantly higher in males than females, consistent with previous findings [ 24 ]. However, Sadeghi Bimorgh et al. (2022) found no significant gender difference in medical students [ 23 ], while a 2024 review of 15 studies by Tahvildarzadeh and Nemati reported higher rates among male and single students, aligning with our results [ 24 ]. Internet addiction scores were highest among nursing students and lowest among midwifery students, and increased progressively from first- to fourth-year students. The emotions/behaviors subscale of misophonia also showed a significant increase across academic years (p = 0.041), with the highest scores in fourth-year students. These findings are consistent with Sadeghi Bimorgh et al. (2022), who reported higher internet addiction during the medical internship phase compared to basic sciences [ 23 ]. This pattern may reflect the cumulative impact of academic stress over time. A significant positive correlation was observed between internet addiction and total misophonia scores (r = 0.377, p < 0.001), with a stronger association for the emotions/behaviors subscale (r = 0.41, p < 0.001) than the symptoms subscale (r = 0.259, p < 0.001). These results align with Melca et al. (2023), who found moderate associations between internet addiction and anxiety (p=.022), depression (p=.0002), and stress (p=.0322) in medical students [ 25 ]. Similarly, our findings support the link between internet addiction and emotional aspects of misophonia (e.g., anger, disgust, anxiety, emotional distress, guilt, and avoidance tendencies). Perez-Oyola et al. (2023) reported that severe internet addiction was associated with a 196% increase in anxiety symptoms [ 26 ], consistent with our observed correlation involving anxiety within the misophonia emotions subscale. Zhao et al. (2023) further demonstrated that anxiety mediates the relationship between internet addiction and depression in adolescents, with social support moderating both direct and indirect effects [ 27 ]. Although social support was not assessed in the current study, the observed association with anxiety-related emotions in misophonia supports these findings. Tayhan Kartal and Yabancı Ayhan (2021) found higher internet addiction in males and a positive relationship with prolonged internet use duration, aligning with our gender and academic year differences [ 28 ]. Sayed et al. (2022) reported strong correlations between internet addiction and symptoms of depression, anxiety, and stress among pharmacy students in Egypt, further supporting our results [ 29 ]. Li et al. (2020) also identified positive correlations between mobile phone addiction and anxiety, depression, impulsivity, and poor sleep quality [ 30 ]. More recently, Gu et al. (2025) highlighted that excessive internet use and addictive behaviors significantly increase the risk of multiple physical and mental health problems in adolescents, mediated in part by poor nutrition, sleep disturbances, and substance use [ 31 ]. Collectively, these findings, along with our results showing a significant positive correlation between internet addiction and misophonia (particularly its emotional components), underscore the need for preventive and supportive interventions to address these interconnected issues and promote mental health among students. Conclusion The findings of this study demonstrate a significant positive correlation between internet addiction and misophonia among nursing, midwifery, and emergency medical services students at Hamadan University of Medical Sciences. Internet addiction scores were significantly associated with the emotional components of misophonia (anger, disgust, anxiety, emotional distress, guilt, and avoidance tendencies). Additionally, higher internet addiction scores were observed among male students, nursing students, and those in higher academic years, with the lowest scores in first-year students. These results highlight the need for greater attention to sensory sensitivities and psychological vulnerabilities in university mental health programs, particularly as students progress through their academic training. Recommendations Based on the findings, the following programs are recommended for implementation at Hamadan University of Medical Sciences and other institutions: Educational and awareness programs: Conducting workshops and training courses on balanced internet use and the negative effects of internet addiction and sensory sensitivities such as misophonia, aimed at reducing psychological vulnerability and enhancing mental health. Psychological monitoring and support: Providing specialized counseling and psychotherapy services for students exhibiting higher levels of internet addiction and sensory sensitivities, particularly in senior years and in nursing and medical disciplines. Policies to reduce excessive use: Establishing reasonable restrictions on internet use duration within universities and promoting interactive, sports, and social activities to decrease dependency. Support for new students: Initial assessment and supportive interventions for first-year students to alleviate concerns, stress, and sensory sensitivities at the beginning of their studies and prevent the establishment of addictive patterns. Further research: Conducting longitudinal studies to examine trends in internet addiction and sensory sensitivities over time and evaluate the impact of interventions on reducing these issues. Limitations Sampling and population limitations: The study was limited to students in nursing, midwifery, and emergency medical services at Hamadan University of Medical Sciences, restricting generalizability to other disciplines, universities, or non-student populations. Study design limitations: The cross-sectional design precludes causal inferences; only correlations can be established. Failure to control for potential confounding variables (e.g., stress levels, socioeconomic status, or other psychological disorders) may influence interpretation of the associations. Self-report limitations: Response bias (e.g., social desirability or lack of honesty in reporting symptoms) may affect data accuracy. Abbreviations EMS Emergency Medical Services IAT Internet Addiction Test Declarations Ethics approval and consent to participate This study was approved by the Ethics Committee of Hamadan University of Medical Sciences (Approval Number: IR.UMSHA.REC.1403.883). All participants provided written informed consent prior to participation, and the study was conducted in accordance with the Declaration of Helsinki . Clinical trial number: not applicable Consent for publication Not Applicable . Availability of data and materials The datasets used and/or analyzed during the current study are available from the corresponding author on reasonable request . Competing Interests The authors declare no competing interests . Funding This study did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors . Authors' contributions S.Y. and A.M.P. conceived and designed the study. S.Y. coordinated the research process and served as the corresponding author. H.H. performed the statistical analysis and contributed to data interpretation. M.H. and Z.Z. contributed to data collection and initial manuscript drafting. S.Y., A.M.P., and M.H. wrote the first draft of the manuscript. All authors contributed to manuscript revision, read, and approved the final version . Acknowledgements We express our sincere gratitude to the administrators of Hamadan University of Medical Sciences, particularly the Faculty of Nursing and Midwifery, and to all students who participated in this study. References Holohan D, Marfilius K, Smith CJ. Misophonia: A Review of the Literature and Its Implications for the Social Work Profession. Social Work. 2023;68(4):341-348. doi:10.1093/sw/swac045 Guetta RE, Cassiello-Robbins C, Trumbull J, Anand D, Rosenthal MZ. Examining emotional functioning in misophonia: The role of affective instability and difficulties with emotion regulation. PLoS One. 2022;17(2):e0263230. doi:10.1371/journal.pone.0263230 Paunovic K, Milenković SM. The proposed criteria for high perceived misophonia in young healthy adults and the association between Misophonia symptoms and noise sensitivity. Noise Health. 2022;24(113):40-48. doi:10.4103/nah.nah_81_21 Savard MA, Sares AG, Coffey EBJ, Deroche MLD. Specificity of Affective Responses in Misophonia Depends on Trigger Identification. Front Neurosci. 2022;16:879583. doi:10.3389/fnins.2022.879583 Yektatalab S, Mohammadi A, Zarshenas L. The Prevalence of Misophonia and Its Relationship with Obsessive-compulsive Disorder, Anxiety, and Depression in Undergraduate Students of Shiraz University of Medical Sciences: A Cross-Sectional Study. Int J Community Based Nurs Midwifery. 2022;10(4):259-268. doi:10.30476/IJCBNM.2022.94491.1994 Bagrowska P, Pionke-Ubych R, Gawęda Ł. Do they make these sounds to hurt me? The mediating role of emotion regulation, anxiety and hostile attributions in the relationship between misophonia and paranoia-like thoughts. Schizophrenia Research. 2022;250:137-142. doi:10.1016/j.schres.2022.11.003 Patel NM, Fameen R, Shafeek N, Prabhu P. Prevalence of Misophonia in College Going Students of India: A Preliminary Survey. Indian J Otolaryngol Head Neck Surg. 2023;75(2):374-378. doi:10.1007/s12070-022-03270-5 Khazaie H, Lebni JY, Abbas J, et al. Internet Addiction Status and Related Factors among Medical Students: A Cross-Sectional Study in Western Iran. Community Health Equity Res Policy. 2023;43(4):347-356. doi:10.1177/0272684X221119634 Pan L, Li J, Hu Z, Wu H. The Effect of COVID-19 Perceived Risk on Internet Addiction among College Students in China: An Empirical Study Based on the Structural Equation Model. Int J Environ Res Public Health. 2022;19(20):13377. doi:10.3390/ijerph192013377 Parmar JS, Kumbhakar S. Prevalence of internet addiction and its impact on selected psychological parameters among UG nursing students. J Educ Health Promot. 2022;11:407. doi:10.4103/jehp.jehp_1702_21 Arzani-Birgani A, Zarei J, Favaregh L, Ghanaatiyan E. Internet addiction, mental health, and sleep quality in students of medical sciences, Iran: a cross-sectional study. J Educ Health Promot. 2021;10:409. doi:10.4103/jehp.jehp_1565_20 Khatony A, Azizi SM, Janatolmakan M, Jafari F, Mohammadi MM. Explanation of the internet addiction model based on academic performance, academic experience, and clinical self-efficacy in nursing students: a path analysis. J Educ Health Promot. 2023;12:459. doi:10.4103/jehp.jehp_459_23 Hammad MA, Alyami MHF, Awed HS. The association between internet addiction and sleep quality among medical students in Saudi Arabia. Ann Med. 2024;56(1):2307502. doi:10.1080/07853890.2024.2307502 Ballad CAC, Labrague LJ, Cayaban ARR, Turingan OM, Al Balushi SM. Self-directed learning readiness and learning styles among Omani nursing students: Implications for online learning during the COVID-19 pandemic. Nurs Forum. 2022;57(1):94-103. doi:10.1111/nuf.12656 Khatony A, Azizi SM, Janatolmakan M, Jafari F, Mohammadi MM. Explanation of the internet addiction model based on academic performance, academic experience, and clinical self-efficacy in nursing students: a path analysis. J Educ Health Promot. 2023;12:459. doi:10.4103/jehp.jehp_459_23 Zenebe Y, Kunno K, Mekonnen M, et al. Prevalence and associated factors of internet addiction among undergraduate university students in Ethiopia: a community university-based cross-sectional study. BMC Psychol. 2021;9(1):4. doi:10.1186/s40359-020-00508-z Feizy F, Sadeghian E, Shamsaei F, Tapak L. The relationship between internet addiction and psychosomatic disorders in Iranian undergraduate nursing students: a cross-sectional study. J Addict Dis. 2020;38(2):164-169. doi:10.1080/10550887.2020.1730749 Najafi F, Kerman Saravi F, Navidian A, Malek Raeisi S. The Relationship Between Internet Addiction, Loneliness and Sleep Quality Among Students of Nursing and Midwifery Faculty. Zahedan J Res Med Sci. 2018;20(12):e68394. doi:10.5812/zjrms.68394 Salarvand S, N A, Dalvand S, Baghban Karimi E, Ghanei Gheshlagh R. Prevalence of Internet Addiction Among Iranian University Students: A Systematic Review and Meta-analysis. Cyberpsychol Behav Soc Netw. 2022;25(4):213-222. doi:10.1089/cyber.2021.0120 Wu MS, Lewin AB, Murphy TK, Storch EA. Misophonia: incidence, phenomenology, and clinical correlates in an undergraduate student sample. J Clin Psychol. 2014;70(10):994-1007. doi:10.1002/jclp.22098 Mehrabizadeh Honarmand M, Roushani K. Investigation of Psychometric Properties of Misophonia Questionnaire. The Neuroscience Journal of Shefaye Khatam. 2019;7(2):13-22. doi:10.29252/shefa.7.2.13 Bahri N, Sadeghmoghadam L, Khodadost L, Mohammadzade J, Banafsheh E. Internet addiction status and its relation with student's general health at Gonabad Medical University. Modern Care Journal. 2011;8(3):166-173. (DOI not available BenchMark: http://moderncare.bums.ac.ir/article-1-166-en.html) Sadeghi Bimorgh M, Akbarzadeh F, Moharreri F, Akbari A, Porghafar H, Ebrahimi A. The relationship between the internet addiction and cell phone addiction with academic burnout in medical students of Mashhad University of Medical Sciences. Journal of Fundamentals of Mental Health. 2023;25(1):3-9. doi:10.22038/jfmh.2023.21407 Tahvildarzadeh M, Nemati M. Internet Addiction in Students of Medical Universities in Iran. Conference Article; 2024. (DOI not available) Melca IA, Teixeira EK, Nardi AE, Spear AL. Association of Internet Addiction and Mental Disorders in Medical Students: A Systematic Review. Prim Care Companion CNS Disord. 2023;25(3):22r03444. doi:10.4088/PCC.22r03444 Perez-Oyola JC, Walter-Chavez DM, Zila-Velasque JP, et al. Internet addiction and mental health disorders in high school students in a Peruvian region: a cross-sectional study. BMC Psychiatry. 2023;23(1):408. doi:10.1186/s12888-023-04889-3 Zhao M, Huang Y, Wang J, Feng J, Zhou B. Internet addiction and depression among Chinese adolescents: anxiety as a mediator and social support as a moderator. Psychol Health Med. 2023;28(8):2315-2328. doi:10.1080/13548506.2022.2159893 Tayhan Kartal F, Yabancı Ayhan N. Relationship between eating disorders and internet and smartphone addiction in college students. Eat Weight Disord. 2021;26(6):1853-1862. doi:10.1007/s40519-020-01027-7 Sayed M, Naiim CM, Aboelsaad M, Ibrahim MK. Internet addiction and relationships with depression, anxiety, stress and academic performance among Egypt pharmacy students: a cross-sectional designed study. BMC Public Health. 2022;22(1):1826. doi:10.1186/s12889-022-14140-6 Li Y, Li G, Liu L, Wu H. Correlations between mobile phone addiction and anxiety, depression, impulsivity, and poor sleep quality among college students: A systematic review and meta-analysis. J Behav Addict. 2020;9(3):551-571. doi:10.1556/2006.2020.00057 Gu H, Shi B, He H, Yuan S, Cai J, Chen X, Wan Z. Association Between Excessive Internet Use Time, Internet Addiction, and Physical-Mental Multimorbidity Among Chinese Adolescents: Cross-Sectional Study. J Med Internet Res. 2025;27:e69210. doi:10.2196/69210 Additional Declarations No competing interests reported. Cite Share Download PDF Status: Under Revision Version 1 posted Editorial decision: Revision requested 30 Mar, 2026 Reviews received at journal 29 Mar, 2026 Reviews received at journal 19 Mar, 2026 Reviewers agreed at journal 16 Mar, 2026 Reviewers agreed at journal 15 Mar, 2026 Reviewers invited by journal 12 Mar, 2026 Editor invited by journal 22 Feb, 2026 Editor assigned by journal 16 Feb, 2026 Submission checks completed at journal 16 Feb, 2026 First submitted to journal 31 Jan, 2026 You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. Our growing team is made up of researchers and industry professionals working together to solve the most critical problems facing scientific publishing. Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-8748692","acceptedTermsAndConditions":true,"allowDirectSubmit":false,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":604939952,"identity":"ef47077c-b211-4076-a3c8-0f36fa1dcd46","order_by":0,"name":"Amir hosein Moradi pakro","email":"","orcid":"","institution":"Hamedan University of Medical Sciences","correspondingAuthor":false,"prefix":"","firstName":"Amir","middleName":"hosein Moradi","lastName":"pakro","suffix":""},{"id":604939953,"identity":"728e44be-0db0-4a84-bb57-3e9153a2d615","order_by":1,"name":"Maryam Hoshmand","email":"","orcid":"","institution":"Hamedan University of Medical Sciences","correspondingAuthor":false,"prefix":"","firstName":"Maryam","middleName":"","lastName":"Hoshmand","suffix":""},{"id":604939954,"identity":"ed972fa8-a356-471c-85b2-ecbcf418d738","order_by":2,"name":"Hossein Hosseinefard","email":"","orcid":"","institution":"Hamedan University of Medical Sciences","correspondingAuthor":false,"prefix":"","firstName":"Hossein","middleName":"","lastName":"Hosseinefard","suffix":""},{"id":604939955,"identity":"58f0ac46-4362-4f08-9db2-12f7b9331e87","order_by":3,"name":"Zahra Zareei","email":"","orcid":"","institution":"Hamedan University of Medical Sciences","correspondingAuthor":false,"prefix":"","firstName":"Zahra","middleName":"","lastName":"Zareei","suffix":""},{"id":604939956,"identity":"49e19aaf-c852-4927-8848-2662ada49c1d","order_by":4,"name":"Safura Yaghmaei","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAABCElEQVRIiWNgGAWjYFACxgcQWgJEGNiARBoP4NfCbICsJQ2kpYEULQyHwSReLfLth9mkK2oOy8tHdyd++FBw3m5t+2GgLTU20bi0GJxJZpM8c+yw4cY7ZzdLzjC4nbztTCJQy7G03AZcWhjyj0k2sB1m3Dgjd4M0D1CL2QGgFsaGwzi1yPc/ZpNs+HfYHqhl8+8/BueSzc4/xK+F4QbQYY1thxPnS+Ruk2YwOGBndoOALQY3HjNbNvalJ28AarHsMUhOMLsBtCUBj1/k+5MZbzZ8s7adD3TYjR9/7OzNzqc/fPChxga3wyCgGegkCCsRrDIBv3IQqGOQhxpqT1jxKBgFo2AUjDQAADnlaGKxr68lAAAAAElFTkSuQmCC","orcid":"","institution":"Hamedan University of Medical Sciences","correspondingAuthor":true,"prefix":"","firstName":"Safura","middleName":"","lastName":"Yaghmaei","suffix":""}],"badges":[],"createdAt":"2026-01-31 09:54:09","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-8748692/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-8748692/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":104782890,"identity":"ab23ddc7-6931-44b9-aa9e-041f52dd81c5","added_by":"auto","created_at":"2026-03-17 07:57:55","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":831866,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-8748692/v1/12f661f0-7e4c-4ea3-a6ba-0910a7686c4b.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"Misophonia and Internet Addiction Among Nursing, Midwifery, and Emergency Medical Services Students: A Cross-sectional Study","fulltext":[{"header":"Introduction","content":"\u003cp\u003eMisophonia, also known as sound aversion, is a condition in which individuals exhibit excessive reactions to sounds that are often ordinary and repetitive [\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e, \u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e]. Examples include throat clearing, slurping, chewing [\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e], coughing, finger tapping on a table, nail clipping, pacing, or kissing [\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e], as well as the clicking of a pen or the ticking of a clock [\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e]. According to individuals with misophonia, these sounds elicit intensified responses when produced by family members, friends, or colleagues [\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e]. The most common reaction is anger [\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e], with other responses including muscle tension, increased heart rate, anxiety, panic, disgust [\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e], frustration, and thoughts of harming others [\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e]. Consequently, affected individuals tend to avoid these triggers. While this avoidance initially prevents exposure to the sounds and associated distress, it gradually leads to social isolation over time, significantly and adversely impacting daily functioning [\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e], well-being, education, and social relationships [\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eOne of the key populations experiencing misophonia is students, who play a vital role in managing and shaping the future of their countries. Thus, their physical and mental health directly influences their academic performance, well-being, professional activities, and, more importantly, society as a whole [\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e, \u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e]. A study on the prevalence of misophonia revealed that one-fifth of students worldwide experience its symptoms [\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eOn the other hand, internet addiction, defined as excessive and uncontrollable use of the internet, leads to psychological disorders and physical discomfort [\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e]. This phenomenon has become a growing challenge among students, particularly due to the widespread use of the internet for educational purposes. A study in China showed that the prevalence of internet addiction among students increased from 15.2% in 2016 to 23.7% following the COVID-19 pandemic [\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e], highlighting the exacerbation of this issue.\u003c/p\u003e \u003cp\u003eAccording to Zuckerman (2020), approximately 59% of the global population (nearly 4.75\u0026nbsp;billion people) are active internet users, with 61% of them exhibiting addiction [\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e]. Additionally, studies indicate that the prevalence of internet addiction is higher in males than females [\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e]. In Iran, with about 56.7\u0026nbsp;million internet users (69.1% of the population), the country ranks among the top 20 globally in terms of user numbers [\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e]. However, limited research has been conducted on internet addiction in Iran. A review of 33 studies in Iran found that 5.7% to 67.1% of Iranian students suffer from internet addiction, with a higher prevalence (78.3%) among medical students compared to non-medical students (21.7%) [\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eInternet addiction is associated with mental health issues such as depression, anxiety, social isolation, and sleep disorders, as well as negative consequences like academic decline and occupational problems [\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e, \u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e]. These findings underscore the need for prevention and management of this disorder in student populations.\u003c/p\u003e \u003cp\u003eAlthough direct research on the association between misophonia and internet addiction is limited, indirect evidence supports significant correlations between these two disorders through mediating factors such as comorbid psychological issues and neurological mechanisms. Systematic studies show that misophonia has positive correlations with anxiety disorders, depression, and obsessive-compulsive disorder, which are themselves linked to internet addiction. Both misophonia and internet addiction involve heightened emotional reactivity, impaired emotion regulation, and avoidance-based coping strategies. Given the limitations of previous studies in this area, such as single-discipline sampling [\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e, \u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e] and varying reported rates of internet addiction among Iranian students [\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e, \u003cspan additionalcitationids=\"CR16 CR17 CR18\" citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e], this study aimed to investigate the association between misophonia and internet addiction among students from various academic levels in the Faculty of Nursing and Midwifery at Hamadan University of Medical Sciences.\u003c/p\u003e"},{"header":"Materials and Methods","content":"\u003cp\u003eThis analytical cross-sectional study was conducted in 2024 on students of the Faculty of Nursing and Midwifery at Hamadan University of Medical Sciences. After obtaining approval from the Ethics Committee and necessary permissions from Hamadan University of Medical Sciences, and coordinating with faculty officials, the researchers individually approached the students to collect data. Since no similar study was found in previous research, proportional stratified sampling was employed. Following estimation of the total student population (850 students) and stratification by discipline, degree level, and academic year, participants were randomly selected from each subgroup proportional to its size using Demorgan\u0026rsquo;s table. A total of 277 students were included.\u003c/p\u003e \u003cp\u003eParticipants were enrolled if they met the inclusion criteria (willingness to participate and being a student at the Faculty of Nursing and Midwifery at Hamadan University of Medical Sciences during the study period) and had no exclusion criteria (unwillingness to participate or self-reported acute/chronic severe physical or mental illness). After providing detailed explanations about the study procedure, privacy protection, and obtaining informed consent in a private setting, questionnaires were distributed for self-completion.\u003c/p\u003e \u003cp\u003e \u003cb\u003eStatistical Analysis\u003c/b\u003e Descriptive statistics were used to report qualitative variables as frequency and percentage, and quantitative variables as mean and standard deviation. Inferential statistics included chi-square or Fisher\u0026rsquo;s exact test for qualitative variables, independent t-test or ANOVA for comparing quantitative variables across qualitative categories, and Pearson\u0026rsquo;s or nonparametric correlation coefficients for examining relationships between quantitative variables.\u003c/p\u003e \u003cp\u003e \u003cb\u003eData Collection Tools\u003c/b\u003e Data were collected via a three-part paper-and-pencil self-report questionnaire:\u003c/p\u003e \u003cp\u003e \u003cb\u003ePart 1: Demographic Checklist\u003c/b\u003e This included age, gender, marital status, discipline, degree level, academic year, place of residence, and history of physical/mental illness. Content and face validity were confirmed by 10 faculty members of the Faculty of Nursing and Midwifery at Hamadan University of Medical Sciences.\u003c/p\u003e \u003cp\u003e \u003cb\u003ePart 2: Misophonia Questionnaire (Wu et al., 2014)\u003c/b\u003e \u003csup\u003e1\u003c/sup\u003e This 17-item questionnaire assesses the presence of misophonia symptoms, associated emotions and behaviors, and overall severity of auditory sensitivity using a Likert scale. It consists of two subscales: misophonia symptoms and misophonia emotions/behaviors. Wu et al. reported excellent reliability (Cronbach\u0026rsquo;s α\u0026thinsp;=\u0026thinsp;0.86 for symptoms, 0.86 for emotions/behaviors, and 0.89 for the total scale) [\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e]. The Persian version was validated by Mehrabizadeh Honarmand and Roushani (2019), who confirmed adequate content, face, and criterion validity, with Cronbach\u0026rsquo;s α\u0026thinsp;\u0026gt;\u0026thinsp;0.70 [\u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e].\u003c/p\u003e \u003cp\u003e \u003cb\u003ePart 3: Internet Addiction Test (IAT; Young, 1998)\u003c/b\u003e \u003csup\u003e2\u003c/sup\u003e This standardized 20-item questionnaire measures the degree of internet addiction on a 5-point Likert scale (5\u0026thinsp;=\u0026thinsp;always, 1\u0026thinsp;=\u0026thinsp;rarely). Total scores range from 20 to 100, classified as normal (20\u0026ndash;49), at-risk (50\u0026ndash;79), and addicted (80\u0026ndash;100). Young reported high reliability (Cronbach\u0026rsquo;s α\u0026thinsp;=\u0026thinsp;0.90). The Persian version has also shown good reliability (Cronbach\u0026rsquo;s α\u0026thinsp;=\u0026thinsp;0.81\u0026ndash;0.88) [\u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e].\u003c/p\u003e \u003cp\u003e\u003cb\u003eEthical Considerations\u003c/b\u003e Participants were assured of confidentiality and anonymity. The study imposed no financial or physical burden, and any potential harm would be compensated. Participants could withdraw at any time without consequence. They were offered access to results upon request (contact details provided). The study adhered to the Helsinki Declaration and Iran\u0026rsquo;s national ethical guidelines and was approved by the Ethics Committee of Hamadan University of Medical Sciences (Code: IR.UMSHA.REC.1403.883).\u003c/p\u003e"},{"header":"Results","content":"\u003cp\u003e A total of 277 students from the Faculty of Nursing and Midwifery at Hamadan University of Medical Sciences participated in the study. The mean age was 22.95\u0026thinsp;\u0026plusmn;\u0026thinsp;4.39 years, and the median daily internet use was 4 hours (IQR: 3\u0026ndash;6). Of the participants, 48% (n\u0026thinsp;=\u0026thinsp;133) were male and 52% (n\u0026thinsp;=\u0026thinsp;144) were female. Nursing students comprised 65% (n\u0026thinsp;=\u0026thinsp;180), midwifery students 17.3% (n\u0026thinsp;=\u0026thinsp;48), and emergency medical services students 17.7% (n\u0026thinsp;=\u0026thinsp;49). Most participants (84.5%, n\u0026thinsp;=\u0026thinsp;234) were undergraduate students. Detailed demographic characteristics are presented in Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e.\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab1\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eDemographic Characteristics of the Participants (N\u0026thinsp;=\u0026thinsp;277)\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"4\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eVariable\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eCategory\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eFrequency\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003ePercentage (%)\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eGender\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eMale\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e133\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e48.0\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eFemale\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e144\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e52.0\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMarital Status\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eSingle\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e247\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e89.2\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eMarried\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e30\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e10.8\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eDiscipline\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNursing\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e180\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e65.0\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eMidwifery\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e48\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e17.3\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eEmergency Medical Services\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e49\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e17.7\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eDegree Level\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eUndergraduate\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e234\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e84.5\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eMaster\u0026rsquo;s\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e37\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e13.4\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eDoctoral\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e6\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e2.2\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAcademic Year\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eFirst\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e90\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e32.5\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eSecond\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e84\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e30.3\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eThird\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e63\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e22.7\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eFourth\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e40\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e14.4\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eResidence\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003ePrivate home\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e150\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e54.2\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eDormitory\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e127\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e45.8\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eHistory of Illness\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e256\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e92.4\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e21\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e7.6\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNative Status\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eLocal\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e150\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e54.2\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNon-local\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e127\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e45.8\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003e \u003cb\u003eInternet Addiction\u003c/b\u003e The mean total Internet Addiction Test (IAT) score was 41.45\u0026thinsp;\u0026plusmn;\u0026thinsp;12.13. According to the IAT classification, 74.4% (n\u0026thinsp;=\u0026thinsp;206) of students were in the normal range, 25.6% (n\u0026thinsp;=\u0026thinsp;71) were at risk of addiction, and none met criteria for addiction. Mean IAT scores by demographic variables are shown in Table\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e.\u003c/p\u003e \u003cp\u003eSignificant differences were observed by gender (higher in males, p\u0026thinsp;=\u0026thinsp;0.004), discipline (highest in nursing, lowest in midwifery, p\u0026thinsp;=\u0026thinsp;0.013), and academic year (lowest in first-year and highest in fourth-year students, p\u0026thinsp;=\u0026thinsp;0.015).\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab2\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 2\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eMean Internet Addiction Scores by Demographic Characteristics\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"5\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\"\u0026plusmn;\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eVariable\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eCategory\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003en\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eMean\u0026thinsp;\u0026plusmn;\u0026thinsp;SD\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003ep-value\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eGender\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eMale\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e133\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c4\"\u003e \u003cp\u003e43.65\u0026thinsp;\u0026plusmn;\u0026thinsp;12.98\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.004\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eFemale\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e144\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c4\"\u003e \u003cp\u003e39.43\u0026thinsp;\u0026plusmn;\u0026thinsp;10.96\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMarital Status\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eSingle\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e247\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c4\"\u003e \u003cp\u003e41.90\u0026thinsp;\u0026plusmn;\u0026thinsp;12.00\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.078\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eMarried\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e30\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c4\"\u003e \u003cp\u003e37.77\u0026thinsp;\u0026plusmn;\u0026thinsp;12.80\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eDiscipline\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNursing\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e180\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c4\"\u003e \u003cp\u003e42.61\u0026thinsp;\u0026plusmn;\u0026thinsp;12.41\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.013\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eMidwifery\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e48\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c4\"\u003e \u003cp\u003e36.81\u0026thinsp;\u0026plusmn;\u0026thinsp;9.36\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eEmergency Medical Services\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e49\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c4\"\u003e \u003cp\u003e41.78\u0026thinsp;\u0026plusmn;\u0026thinsp;12.67\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eDegree Level\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eUndergraduate\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e234\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c4\"\u003e \u003cp\u003e42.12\u0026thinsp;\u0026plusmn;\u0026thinsp;12.18\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.107\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eMaster\u0026rsquo;s\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e37\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c4\"\u003e \u003cp\u003e37.86\u0026thinsp;\u0026plusmn;\u0026thinsp;10.51\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eDoctoral\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e6\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c4\"\u003e \u003cp\u003e37.83\u0026thinsp;\u0026plusmn;\u0026thinsp;16.93\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAcademic Year\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eFirst\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e90\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c4\"\u003e \u003cp\u003e38.24\u0026thinsp;\u0026plusmn;\u0026thinsp;10.26\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.015\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eSecond\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e84\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c4\"\u003e \u003cp\u003e42.31\u0026thinsp;\u0026plusmn;\u0026thinsp;11.71\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eThird\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e63\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c4\"\u003e \u003cp\u003e42.89\u0026thinsp;\u0026plusmn;\u0026thinsp;13.44\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eFourth\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e40\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c4\"\u003e \u003cp\u003e44.63\u0026thinsp;\u0026plusmn;\u0026thinsp;13.56\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eResidence\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003ePrivate home\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e150\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c4\"\u003e \u003cp\u003e42.19\u0026thinsp;\u0026plusmn;\u0026thinsp;12.41\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.272\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eDormitory\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e127\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c4\"\u003e \u003cp\u003e40.58\u0026thinsp;\u0026plusmn;\u0026thinsp;11.79\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eHistory of Illness\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e256\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c4\"\u003e \u003cp\u003e41.46\u0026thinsp;\u0026plusmn;\u0026thinsp;11.88\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.977\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e21\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c4\"\u003e \u003cp\u003e41.38\u0026thinsp;\u0026plusmn;\u0026thinsp;15.25\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNative Status\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eLocal\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e150\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c4\"\u003e \u003cp\u003e41.29\u0026thinsp;\u0026plusmn;\u0026thinsp;11.46\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.803\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNon-local\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e127\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c4\"\u003e \u003cp\u003e41.65\u0026thinsp;\u0026plusmn;\u0026thinsp;12.93\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003e \u003cb\u003eMisophonia\u003c/b\u003e The mean total misophonia score was 26.00\u0026thinsp;\u0026plusmn;\u0026thinsp;12.59, with subscale scores of 12.22\u0026thinsp;\u0026plusmn;\u0026thinsp;6.03 for symptoms and 13.77\u0026thinsp;\u0026plusmn;\u0026thinsp;7.76 for emotions/behaviors. Mean misophonia scores by demographic variables are presented in Table\u0026nbsp;\u003cspan refid=\"Tab3\" class=\"InternalRef\"\u003e3\u003c/span\u003e.\u003c/p\u003e \u003cp\u003eThe emotions/behaviors subscale score differed significantly by academic year (p\u0026thinsp;=\u0026thinsp;0.041), with the lowest scores in first-year and highest in fourth-year students. No other demographic variables showed statistically significant differences.\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab3\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 3\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eMean Misophonia Scores (Total and Subscales) by Demographic Characteristics\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"9\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\"\u0026plusmn;\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\"\u0026plusmn;\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c7\" colnum=\"7\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\"\u0026plusmn;\" class=\"colspec\" colname=\"c8\" colnum=\"8\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c9\" colnum=\"9\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eVariable\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eCategory\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003en\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eSymptoms Mean\u0026thinsp;\u0026plusmn;\u0026thinsp;SD\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003ep\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c6\"\u003e \u003cp\u003eEmotions/Behaviors Mean\u0026thinsp;\u0026plusmn;\u0026thinsp;SD\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c7\"\u003e \u003cp\u003ep\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c8\"\u003e \u003cp\u003eTotal Score Mean\u0026thinsp;\u0026plusmn;\u0026thinsp;SD\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c9\"\u003e \u003cp\u003ep\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eGender\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eMale\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e133\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c4\"\u003e \u003cp\u003e11.55\u0026thinsp;\u0026plusmn;\u0026thinsp;5.80\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.073\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c6\"\u003e \u003cp\u003e13.24\u0026thinsp;\u0026plusmn;\u0026thinsp;7.42\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e0.268\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c8\"\u003e \u003cp\u003e24.79\u0026thinsp;\u0026plusmn;\u0026thinsp;12.05\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c9\"\u003e \u003cp\u003e0.123\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eFemale\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e144\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c4\"\u003e \u003cp\u003e12.85\u0026thinsp;\u0026plusmn;\u0026thinsp;6.20\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c6\"\u003e \u003cp\u003e14.28\u0026thinsp;\u0026plusmn;\u0026thinsp;8.07\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c8\"\u003e \u003cp\u003e27.13\u0026thinsp;\u0026plusmn;\u0026thinsp;13.02\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAcademic Year\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eFirst\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e90\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c4\"\u003e \u003cp\u003e11.54\u0026thinsp;\u0026plusmn;\u0026thinsp;6.24\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.487\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c6\"\u003e \u003cp\u003e11.96\u0026thinsp;\u0026plusmn;\u0026thinsp;8.08\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e\u003cb\u003e0.041\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c8\"\u003e \u003cp\u003e23.50\u0026thinsp;\u0026plusmn;\u0026thinsp;13.49\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c9\"\u003e \u003cp\u003e0.110\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eSecond\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e84\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c4\"\u003e \u003cp\u003e12.86\u0026thinsp;\u0026plusmn;\u0026thinsp;6.12\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c6\"\u003e \u003cp\u003e14.51\u0026thinsp;\u0026plusmn;\u0026thinsp;7.35\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c8\"\u003e \u003cp\u003e27.37\u0026thinsp;\u0026plusmn;\u0026thinsp;11.81\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eThird\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e63\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c4\"\u003e \u003cp\u003e12.02\u0026thinsp;\u0026plusmn;\u0026thinsp;5.88\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c6\"\u003e \u003cp\u003e14.22\u0026thinsp;\u0026plusmn;\u0026thinsp;7.73\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c8\"\u003e \u003cp\u003e26.24\u0026thinsp;\u0026plusmn;\u0026thinsp;12.64\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eFourth\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e40\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c4\"\u003e \u003cp\u003e12.75\u0026thinsp;\u0026plusmn;\u0026thinsp;5.62\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c6\"\u003e \u003cp\u003e15.65\u0026thinsp;\u0026plusmn;\u0026thinsp;7.43\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c8\"\u003e \u003cp\u003e28.40\u0026thinsp;\u0026plusmn;\u0026thinsp;11.50\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cem\u003e(Only variables with p\u0026thinsp;\u0026lt;\u0026thinsp;0.1 shown in detail for brevity; full table available upon request)\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003e \u003cb\u003eCorrelation Between Internet Addiction and Misophonia\u003c/b\u003e Pearson correlation analysis revealed a significant positive correlation between IAT scores and total misophonia scores (r\u0026thinsp;=\u0026thinsp;0.377, p\u0026thinsp;\u0026lt;\u0026thinsp;0.001). Stronger correlations were observed with the emotions/behaviors subscale (r\u0026thinsp;=\u0026thinsp;0.41, p\u0026thinsp;\u0026lt;\u0026thinsp;0.001) than the symptoms subscale (r\u0026thinsp;=\u0026thinsp;0.259, p\u0026thinsp;\u0026lt;\u0026thinsp;0.001) (Table\u0026nbsp;\u003cspan refid=\"Tab4\" class=\"InternalRef\"\u003e4\u003c/span\u003e).\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab4\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 4\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003ePearson Correlations Between Internet Addiction and Misophonia Scores\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"4\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eVariable\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eSymptoms\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eEmotions/Behaviors\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eTotal Misophonia\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eInternet Addiction Score\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e0.259**\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.410**\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.377**\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e**p\u0026thinsp;\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e"},{"header":"Discussion","content":"\u003cp\u003eThe present study aimed to examine the association between misophonia and internet addiction among students in nursing, midwifery, and emergency medical services at Hamadan University of Medical Sciences. According to the IAT classification, 74.4% of students were in the normal range and 25.6% were at risk of internet addiction, with no participants meeting criteria for full addiction. Internet addiction scores were significantly higher in males than females, consistent with previous findings [\u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e]. However, Sadeghi Bimorgh et al. (2022) found no significant gender difference in medical students [\u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e], while a 2024 review of 15 studies by Tahvildarzadeh and Nemati reported higher rates among male and single students, aligning with our results [\u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eInternet addiction scores were highest among nursing students and lowest among midwifery students, and increased progressively from first- to fourth-year students. The emotions/behaviors subscale of misophonia also showed a significant increase across academic years (p\u0026thinsp;=\u0026thinsp;0.041), with the highest scores in fourth-year students. These findings are consistent with Sadeghi Bimorgh et al. (2022), who reported higher internet addiction during the medical internship phase compared to basic sciences [\u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e]. This pattern may reflect the cumulative impact of academic stress over time.\u003c/p\u003e \u003cp\u003eA significant positive correlation was observed between internet addiction and total misophonia scores (r\u0026thinsp;=\u0026thinsp;0.377, p\u0026thinsp;\u0026lt;\u0026thinsp;0.001), with a stronger association for the emotions/behaviors subscale (r\u0026thinsp;=\u0026thinsp;0.41, p\u0026thinsp;\u0026lt;\u0026thinsp;0.001) than the symptoms subscale (r\u0026thinsp;=\u0026thinsp;0.259, p\u0026thinsp;\u0026lt;\u0026thinsp;0.001). These results align with Melca et al. (2023), who found moderate associations between internet addiction and anxiety (p=.022), depression (p=.0002), and stress (p=.0322) in medical students [\u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e]. Similarly, our findings support the link between internet addiction and emotional aspects of misophonia (e.g., anger, disgust, anxiety, emotional distress, guilt, and avoidance tendencies).\u003c/p\u003e \u003cp\u003ePerez-Oyola et al. (2023) reported that severe internet addiction was associated with a 196% increase in anxiety symptoms [\u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e26\u003c/span\u003e], consistent with our observed correlation involving anxiety within the misophonia emotions subscale. Zhao et al. (2023) further demonstrated that anxiety mediates the relationship between internet addiction and depression in adolescents, with social support moderating both direct and indirect effects [\u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e27\u003c/span\u003e]. Although social support was not assessed in the current study, the observed association with anxiety-related emotions in misophonia supports these findings.\u003c/p\u003e \u003cp\u003eTayhan Kartal and Yabancı Ayhan (2021) found higher internet addiction in males and a positive relationship with prolonged internet use duration, aligning with our gender and academic year differences [\u003cspan citationid=\"CR28\" class=\"CitationRef\"\u003e28\u003c/span\u003e]. Sayed et al. (2022) reported strong correlations between internet addiction and symptoms of depression, anxiety, and stress among pharmacy students in Egypt, further supporting our results [\u003cspan citationid=\"CR29\" class=\"CitationRef\"\u003e29\u003c/span\u003e]. Li et al. (2020) also identified positive correlations between mobile phone addiction and anxiety, depression, impulsivity, and poor sleep quality [\u003cspan citationid=\"CR30\" class=\"CitationRef\"\u003e30\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eMore recently, Gu et al. (2025) highlighted that excessive internet use and addictive behaviors significantly increase the risk of multiple physical and mental health problems in adolescents, mediated in part by poor nutrition, sleep disturbances, and substance use [\u003cspan citationid=\"CR31\" class=\"CitationRef\"\u003e31\u003c/span\u003e]. Collectively, these findings, along with our results showing a significant positive correlation between internet addiction and misophonia (particularly its emotional components), underscore the need for preventive and supportive interventions to address these interconnected issues and promote mental health among students.\u003c/p\u003e"},{"header":"Conclusion","content":"\u003cp\u003eThe findings of this study demonstrate a significant positive correlation between internet addiction and misophonia among nursing, midwifery, and emergency medical services students at Hamadan University of Medical Sciences. Internet addiction scores were significantly associated with the emotional components of misophonia (anger, disgust, anxiety, emotional distress, guilt, and avoidance tendencies). Additionally, higher internet addiction scores were observed among male students, nursing students, and those in higher academic years, with the lowest scores in first-year students.\u003c/p\u003e \u003cp\u003eThese results highlight the need for greater attention to sensory sensitivities and psychological vulnerabilities in university mental health programs, particularly as students progress through their academic training.\u003c/p\u003e\n\u003ch3\u003eRecommendations\u003c/h3\u003e\n\u003cp\u003eBased on the findings, the following programs are recommended for implementation at Hamadan University of Medical Sciences and other institutions:\u003c/p\u003e \u003cp\u003e \u003col\u003e \u003cspan\u003e \u003cli\u003e \u003cp\u003eEducational and awareness programs: Conducting workshops and training courses on balanced internet use and the negative effects of internet addiction and sensory sensitivities such as misophonia, aimed at reducing psychological vulnerability and enhancing mental health.\u003c/p\u003e \u003c/li\u003e \u003c/span\u003e \u003cspan\u003e \u003cli\u003e \u003cp\u003ePsychological monitoring and support: Providing specialized counseling and psychotherapy services for students exhibiting higher levels of internet addiction and sensory sensitivities, particularly in senior years and in nursing and medical disciplines.\u003c/p\u003e \u003c/li\u003e \u003c/span\u003e \u003cspan\u003e \u003cli\u003e \u003cp\u003ePolicies to reduce excessive use: Establishing reasonable restrictions on internet use duration within universities and promoting interactive, sports, and social activities to decrease dependency.\u003c/p\u003e \u003c/li\u003e \u003c/span\u003e \u003cspan\u003e \u003cli\u003e \u003cp\u003eSupport for new students: Initial assessment and supportive interventions for first-year students to alleviate concerns, stress, and sensory sensitivities at the beginning of their studies and prevent the establishment of addictive patterns.\u003c/p\u003e \u003c/li\u003e \u003c/span\u003e \u003cspan\u003e \u003cli\u003e \u003cp\u003eFurther research: Conducting longitudinal studies to examine trends in internet addiction and sensory sensitivities over time and evaluate the impact of interventions on reducing these issues.\u003c/p\u003e \u003c/li\u003e \u003c/span\u003e \u003c/ol\u003e \u003c/p\u003e \u003cp\u003e \u003cb\u003eLimitations\u003c/b\u003e \u003c/p\u003e \u003cp\u003e \u003col\u003e \u003cspan\u003e \u003cli\u003e \u003cp\u003eSampling and population limitations: The study was limited to students in nursing, midwifery, and emergency medical services at Hamadan University of Medical Sciences, restricting generalizability to other disciplines, universities, or non-student populations.\u003c/p\u003e \u003c/li\u003e \u003c/span\u003e \u003cspan\u003e \u003cli\u003e \u003cp\u003eStudy design limitations: The cross-sectional design precludes causal inferences; only correlations can be established. Failure to control for potential confounding variables (e.g., stress levels, socioeconomic status, or other psychological disorders) may influence interpretation of the associations.\u003c/p\u003e \u003c/li\u003e \u003c/span\u003e \u003cspan\u003e \u003cli\u003e \u003cp\u003eSelf-report limitations: Response bias (e.g., social desirability or lack of honesty in reporting symptoms) may affect data accuracy.\u003c/p\u003e \u003c/li\u003e \u003c/span\u003e \u003c/ol\u003e \u003c/p\u003e"},{"header":"Abbreviations","content":"\u003cdiv class=\"DefinitionList\"\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eEMS\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eEmergency Medical Services\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eIAT\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eInternet Addiction Test\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003c/div\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eEthics approval and consent to participate\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis study was approved by the Ethics Committee of Hamadan University of Medical Sciences (Approval Number: IR.UMSHA.REC.1403.883). All participants provided written informed consent prior to participation, and the study was conducted in accordance with the Declaration of Helsinki\u003cspan dir=\"RTL\"\u003e.\u003c/span\u003e Clinical trial number: not applicable\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConsent for publication\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNot Applicable\u003cspan dir=\"RTL\"\u003e.\u003c/span\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAvailability of data and materials\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe datasets used and/or analyzed during the current study are available from the corresponding author on reasonable request\u003cspan dir=\"RTL\"\u003e.\u003c/span\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eCompeting Interests\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe authors declare no competing interests\u003cspan dir=\"RTL\"\u003e.\u003c/span\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFunding\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis study did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors\u003cspan dir=\"RTL\"\u003e.\u003c/span\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthors\u0026apos; contributions\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eS.Y. and A.M.P. conceived and designed the study. S.Y. coordinated the research process and served as the corresponding author. H.H. performed the statistical analysis and contributed to data interpretation. M.H. and Z.Z. contributed to data collection and initial manuscript drafting. S.Y., A.M.P., and M.H. wrote the first draft of the manuscript. All authors contributed to manuscript revision, read, and approved the final version\u003cspan dir=\"RTL\"\u003e.\u003c/span\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAcknowledgements\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eWe express our sincere gratitude to the administrators of Hamadan University of Medical Sciences, particularly the Faculty of Nursing and Midwifery, and to all students who participated in this study.\u003c/p\u003e"},{"header":"References","content":"\u003col start=\"1\" type=\"1\"\u003e\n\u003cli\u003eHolohan D, Marfilius K, Smith CJ. Misophonia: A Review of the Literature and Its Implications for the Social Work Profession. Social Work. 2023;68(4):341-348. doi:10.1093/sw/swac045\u003c/li\u003e\n\u003cli\u003eGuetta RE, Cassiello-Robbins C, Trumbull J, Anand D, Rosenthal MZ. Examining emotional functioning in misophonia: The role of affective instability and difficulties with emotion regulation. PLoS One. 2022;17(2):e0263230. doi:10.1371/journal.pone.0263230\u003c/li\u003e\n\u003cli\u003ePaunovic K, Milenković SM. The proposed criteria for high perceived misophonia in young healthy adults and the association between Misophonia symptoms and noise sensitivity. Noise Health. 2022;24(113):40-48. doi:10.4103/nah.nah_81_21\u003c/li\u003e\n\u003cli\u003eSavard MA, Sares AG, Coffey EBJ, Deroche MLD. Specificity of Affective Responses in Misophonia Depends on Trigger Identification. Front Neurosci. 2022;16:879583. doi:10.3389/fnins.2022.879583\u003c/li\u003e\n\u003cli\u003eYektatalab S, Mohammadi A, Zarshenas L. The Prevalence of Misophonia and Its Relationship with Obsessive-compulsive Disorder, Anxiety, and Depression in Undergraduate Students of Shiraz University of Medical Sciences: A Cross-Sectional Study. Int J Community Based Nurs Midwifery. 2022;10(4):259-268. doi:10.30476/IJCBNM.2022.94491.1994\u003c/li\u003e\n\u003cli\u003eBagrowska P, Pionke-Ubych R, Gawęda Ł. Do they make these sounds to hurt me? The mediating role of emotion regulation, anxiety and hostile attributions in the relationship between misophonia and paranoia-like thoughts. Schizophrenia Research. 2022;250:137-142. doi:10.1016/j.schres.2022.11.003\u003c/li\u003e\n\u003cli\u003ePatel NM, Fameen R, Shafeek N, Prabhu P. Prevalence of Misophonia in College Going Students of India: A Preliminary Survey. Indian J Otolaryngol Head Neck Surg. 2023;75(2):374-378. doi:10.1007/s12070-022-03270-5\u003c/li\u003e\n\u003cli\u003eKhazaie H, Lebni JY, Abbas J, et al. Internet Addiction Status and Related Factors among Medical Students: A Cross-Sectional Study in Western Iran. Community Health Equity Res Policy. 2023;43(4):347-356. doi:10.1177/0272684X221119634\u003c/li\u003e\n\u003cli\u003ePan L, Li J, Hu Z, Wu H. The Effect of COVID-19 Perceived Risk on Internet Addiction among College Students in China: An Empirical Study Based on the Structural Equation Model. Int J Environ Res Public Health. 2022;19(20):13377. doi:10.3390/ijerph192013377\u003c/li\u003e\n\u003cli\u003eParmar JS, Kumbhakar S. Prevalence of internet addiction and its impact on selected psychological parameters among UG nursing students. J Educ Health Promot. 2022;11:407. doi:10.4103/jehp.jehp_1702_21\u003c/li\u003e\n\u003cli\u003eArzani-Birgani A, Zarei J, Favaregh L, Ghanaatiyan E. Internet addiction, mental health, and sleep quality in students of medical sciences, Iran: a cross-sectional study. J Educ Health Promot. 2021;10:409. doi:10.4103/jehp.jehp_1565_20\u003c/li\u003e\n\u003cli\u003eKhatony A, Azizi SM, Janatolmakan M, Jafari F, Mohammadi MM. Explanation of the internet addiction model based on academic performance, academic experience, and clinical self-efficacy in nursing students: a path analysis. J Educ Health Promot. 2023;12:459. doi:10.4103/jehp.jehp_459_23\u003c/li\u003e\n\u003cli\u003eHammad MA, Alyami MHF, Awed HS. The association between internet addiction and sleep quality among medical students in Saudi Arabia. Ann Med. 2024;56(1):2307502. doi:10.1080/07853890.2024.2307502\u003c/li\u003e\n\u003cli\u003eBallad CAC, Labrague LJ, Cayaban ARR, Turingan OM, Al Balushi SM. Self-directed learning readiness and learning styles among Omani nursing students: Implications for online learning during the COVID-19 pandemic. Nurs Forum. 2022;57(1):94-103. doi:10.1111/nuf.12656\u003c/li\u003e\n\u003cli\u003eKhatony A, Azizi SM, Janatolmakan M, Jafari F, Mohammadi MM. Explanation of the internet addiction model based on academic performance, academic experience, and clinical self-efficacy in nursing students: a path analysis. J Educ Health Promot. 2023;12:459. doi:10.4103/jehp.jehp_459_23\u003c/li\u003e\n\u003cli\u003eZenebe Y, Kunno K, Mekonnen M, et al. Prevalence and associated factors of internet addiction among undergraduate university students in Ethiopia: a community university-based cross-sectional study. BMC Psychol. 2021;9(1):4. doi:10.1186/s40359-020-00508-z\u003c/li\u003e\n\u003cli\u003eFeizy F, Sadeghian E, Shamsaei F, Tapak L. The relationship between internet addiction and psychosomatic disorders in Iranian undergraduate nursing students: a cross-sectional study. J Addict Dis. 2020;38(2):164-169. doi:10.1080/10550887.2020.1730749\u003c/li\u003e\n\u003cli\u003eNajafi F, Kerman Saravi F, Navidian A, Malek Raeisi S. The Relationship Between Internet Addiction, Loneliness and Sleep Quality Among Students of Nursing and Midwifery Faculty. Zahedan J Res Med Sci. 2018;20(12):e68394. doi:10.5812/zjrms.68394\u003c/li\u003e\n\u003cli\u003eSalarvand S, N A, Dalvand S, Baghban Karimi E, Ghanei Gheshlagh R. Prevalence of Internet Addiction Among Iranian University Students: A Systematic Review and Meta-analysis. Cyberpsychol Behav Soc Netw. 2022;25(4):213-222. doi:10.1089/cyber.2021.0120\u003c/li\u003e\n\u003cli\u003eWu MS, Lewin AB, Murphy TK, Storch EA. Misophonia: incidence, phenomenology, and clinical correlates in an undergraduate student sample. J Clin Psychol. 2014;70(10):994-1007. doi:10.1002/jclp.22098\u003c/li\u003e\n\u003cli\u003eMehrabizadeh Honarmand M, Roushani K. Investigation of Psychometric Properties of Misophonia Questionnaire. The Neuroscience Journal of Shefaye Khatam. 2019;7(2):13-22. doi:10.29252/shefa.7.2.13\u003c/li\u003e\n\u003cli\u003eBahri N, Sadeghmoghadam L, Khodadost L, Mohammadzade J, Banafsheh E. Internet addiction status and its relation with student\u0026apos;s general health at Gonabad Medical University. Modern Care Journal. 2011;8(3):166-173. (DOI not available BenchMark: http://moderncare.bums.ac.ir/article-1-166-en.html)\u003c/li\u003e\n\u003cli\u003eSadeghi Bimorgh M, Akbarzadeh F, Moharreri F, Akbari A, Porghafar H, Ebrahimi A. The relationship between the internet addiction and cell phone addiction with academic burnout in medical students of Mashhad University of Medical Sciences. Journal of Fundamentals of Mental Health. 2023;25(1):3-9. doi:10.22038/jfmh.2023.21407\u003c/li\u003e\n\u003cli\u003eTahvildarzadeh M, Nemati M. Internet Addiction in Students of Medical Universities in Iran. Conference Article; 2024. (DOI not available)\u003c/li\u003e\n\u003cli\u003eMelca IA, Teixeira EK, Nardi AE, Spear AL. Association of Internet Addiction and Mental Disorders in Medical Students: A Systematic Review. Prim Care Companion CNS Disord. 2023;25(3):22r03444. doi:10.4088/PCC.22r03444\u003c/li\u003e\n\u003cli\u003ePerez-Oyola JC, Walter-Chavez DM, Zila-Velasque JP, et al. Internet addiction and mental health disorders in high school students in a Peruvian region: a cross-sectional study. BMC Psychiatry. 2023;23(1):408. doi:10.1186/s12888-023-04889-3\u003c/li\u003e\n\u003cli\u003eZhao M, Huang Y, Wang J, Feng J, Zhou B. Internet addiction and depression among Chinese adolescents: anxiety as a mediator and social support as a moderator. Psychol Health Med. 2023;28(8):2315-2328. doi:10.1080/13548506.2022.2159893\u003c/li\u003e\n\u003cli\u003eTayhan Kartal F, Yabancı Ayhan N. Relationship between eating disorders and internet and smartphone addiction in college students. Eat Weight Disord. 2021;26(6):1853-1862. doi:10.1007/s40519-020-01027-7\u003c/li\u003e\n\u003cli\u003eSayed M, Naiim CM, Aboelsaad M, Ibrahim MK. Internet addiction and relationships with depression, anxiety, stress and academic performance among Egypt pharmacy students: a cross-sectional designed study. BMC Public Health. 2022;22(1):1826. doi:10.1186/s12889-022-14140-6\u003c/li\u003e\n\u003cli\u003eLi Y, Li G, Liu L, Wu H. Correlations between mobile phone addiction and anxiety, depression, impulsivity, and poor sleep quality among college students: A systematic review and meta-analysis. J Behav Addict. 2020;9(3):551-571. doi:10.1556/2006.2020.00057\u003c/li\u003e\n\u003cli\u003eGu H, Shi B, He H, Yuan S, Cai J, Chen X, Wan Z. Association Between Excessive Internet Use Time, Internet Addiction, and Physical-Mental Multimorbidity Among Chinese Adolescents: Cross-Sectional Study. J Med Internet Res. 2025;27:e69210. doi:10.2196/69210\u003c/li\u003e\n\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"discover-mental-health","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"dimh","sideBox":"Learn more about [Discover Mental Health](https://www.springer.com/44192)","snPcode":"","submissionUrl":"","title":"Discover Mental Health","twitterHandle":"","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"stoa","reportingPortfolio":"Discover Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true},"keywords":"Misophonia, Sound aversion, Internet addiction, University students, Mental health, Behavioral addiction","lastPublishedDoi":"10.21203/rs.3.rs-8748692/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-8748692/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003ch2\u003eBackground\u003c/h2\u003e \u003cp\u003eMisophonia is a sensory sensitivity condition characterized by intense emotional reactions (such as anger, anxiety, and avoidance) to everyday sounds, often impairing psychological well-being and social functioning. Internet addiction, a growing behavioral health concern among university students, has been linked to emotional dysregulation and various mental health problems. However, limited research has examined the association between misophonia and internet addiction, particularly in non-Western student populations.\u003c/p\u003e\u003ch2\u003eObjective\u003c/h2\u003e \u003cp\u003eThis study aimed to examine the association between misophonia and internet addiction among nursing, midwifery, and emergency medical services students in Iran.\u003c/p\u003e\u003ch2\u003eMethods\u003c/h2\u003e \u003cp\u003eThis cross-sectional study was conducted in 2024 among 277 students at the Faculty of Nursing and Midwifery, Hamadan University of Medical Sciences, using stratified random sampling. Data were collected using the Misophonia Questionnaire (Wu et al., 2014) and the Internet Addiction Test (Young, 1998). Descriptive statistics, Pearson\u0026rsquo;s correlation coefficients, independent t-tests, and ANOVA were performed using SPSS.\u003c/p\u003e\u003ch2\u003eResults\u003c/h2\u003e \u003cp\u003eThe mean internet addiction score was 41.45\u0026thinsp;\u0026plusmn;\u0026thinsp;12.13, with 25.6% of participants classified as at risk of internet addiction. The mean misophonia score was 26.00\u0026thinsp;\u0026plusmn;\u0026thinsp;12.59. Internet addiction showed a significant positive correlation with total misophonia scores (r\u0026thinsp;=\u0026thinsp;0.377, p\u0026thinsp;\u0026lt;\u0026thinsp;0.001), with a stronger association observed for the emotions/behaviors subscale (r\u0026thinsp;=\u0026thinsp;0.410, p\u0026thinsp;\u0026lt;\u0026thinsp;0.001) than for misophonia symptoms (r\u0026thinsp;=\u0026thinsp;0.259, p\u0026thinsp;\u0026lt;\u0026thinsp;0.001). Higher internet addiction scores were reported among male students, nursing students, and those in higher academic years.\u003c/p\u003e\u003ch2\u003eConclusions\u003c/h2\u003e \u003cp\u003eThese findings suggest that problematic internet use may be associated with heightened emotional reactivity to sensory stimuli among university students. The results highlight the importance of psychological screening and preventive interventions targeting both behavioral addictions and sensory sensitivities to support student mental health. Longitudinal studies are recommended to clarify causal pathways and underlying psychological mechanisms.\u003c/p\u003e","manuscriptTitle":"Misophonia and Internet Addiction Among Nursing, Midwifery, and Emergency Medical Services Students: A Cross-sectional Study","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2026-03-16 09:51:23","doi":"10.21203/rs.3.rs-8748692/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"decision","content":"Revision requested","date":"2026-03-30T14:24:24+00:00","index":"","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2026-03-29T07:22:45+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2026-03-19T22:15:29+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"5926821501190183645720671852646606933","date":"2026-03-16T09:03:38+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"115225257132389777508510298637671190510","date":"2026-03-15T06:56:11+00:00","index":"hide","fulltext":""},{"type":"reviewersInvited","content":"","date":"2026-03-12T07:03:24+00:00","index":"","fulltext":""},{"type":"editorInvited","content":"","date":"2026-02-22T16:16:32+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2026-02-16T13:14:20+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2026-02-16T13:10:23+00:00","index":"","fulltext":""},{"type":"submitted","content":"Discover Mental Health","date":"2026-01-31T09:40:55+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"discover-mental-health","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"dimh","sideBox":"Learn more about [Discover Mental Health](https://www.springer.com/44192)","snPcode":"","submissionUrl":"","title":"Discover Mental Health","twitterHandle":"","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"stoa","reportingPortfolio":"Discover Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"7c8d0392-ec51-4e5e-a70e-4bb749c36a64","owner":[],"postedDate":"March 16th, 2026","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"in-revision","subjectAreas":[],"tags":[],"updatedAt":"2026-05-18T18:38:49+00:00","versionOfRecord":[],"versionCreatedAt":"2026-03-16 09:51:23","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-8748692","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-8748692","identity":"rs-8748692","version":["v1"]},"buildId":"XKTyCvWXoU3ODBz1xrDgd","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}