WhatsApp use and its impact on relationships among doctors: A cross-sectional pilot study
Abhijeet D Faye1, Sudhir H Bhave1, Sushil Gawande1, Rahul Tadke1, Vivek C Kirpekar1, Abhijit Pakhare2, Deepika Singh1
1 Department of Psychiatry, NKP Salve Institute of Medical Sciences and Lata Mangeshkar Hospital, Nagpur, Maharashtra, India
2 Department of Preventive and Social Medicine, All India Institute of Medical Sciences, Bhopal, Madhya Pradesh, India
|Date of Submission||20-Sep-2019|
|Date of Decision||24-Jan-2020|
|Date of Acceptance||17-Feb-2020|
|Date of Web Publication||30-May-2020|
Dr. Abhijeet D Faye
Department of Psychiatry, (OPD-10), 2nd Floor, OPD Building, NKP Salve Institute of Medical Sciences and Lata Mangeshkar Hospital, Digdoh Hills, Hingna Road, Nagpur - 440 019, Maharashtra
Source of Support: None, Conflict of Interest: None
Background: Social media like WhatsApp is known to affect relationships of an individual, and busy professionals like doctors appear no bar. The objectives of this study were to analyze the pattern of WhatsApp use in specialist-doctors and to study its effect on their relationships. Materials and Methods: This was a cross-sectional pilot study. Consecutively selected hundred married specialist doctors were assessed using self-reported validated questionnaire including questions related to demographics, WhatsApp use, and effects on relationships in a tertiary care center. Statistical analysis was performed using mean, standard deviation, t-test, and Chi-square test. A value of P < 0.05 was considered statistically significant. Results: Participants of various specialties, with a mean age of 41.5 years reported regular WhatsApp-use (89%) of mean duration 2.5 years with 19% spending >2 h/day. About 62% reported using WhatsApp during personal time, leading to reduction in time spent with spouse (37%), impairment in household responsibilities (24%), disturbances in social-activities (26%) and craving. About 36% reported negative effects on married life. 21% reported inability to spend quality-time with spouse, 24% had concern about spouse's WhatsApp-use, 25% reported reduced cohesion between them and 22% felt that excessive use can create doubts in spouse's mind. Those aged <40 years had significantly higher total duration and time spent/day on WhatsApp and reported more conflicts with spouse and reduced expression of love. Conclusion: Inappropriate WhatsApp use can affect many aspects of life of doctors including relationships though exact causal relation is not demonstrated and it should be used judiciously.
Internet addiction is a broad term conceptually included in compulsive-impulsive spectrum disorder that involves online and/or offline computer use  and consists of excessive gaming, sexual preoccupations, and e-mail/text messaging. These variants share the following four features: (1) excessive use, spending time at the cost of neglect to other important drives, (2) tolerance, leading to the need for better computer equipment, more time for use or more software, (3) withdrawal, including symptoms of anger, depression or tension when the computer is not accessible, and (4) negative consequences, including arguments, poor achievement, lying, social isolation, and fatigue.,
Similar effects can be expected to occur with excessive WhatsApp-use (as a component of internet addiction). In literature, there are multiple reports and studies on smartphones and Internet addiction, but very few are available on WhatsApp addiction., Some authors argued that Blackberry Messenger and WhatsApp, though produce noticeable improvements in user's lives, it may simultaneously cause serious social and personal problems, including the addiction of using these applications.
In the context of excessive use of WhatsApp, there are chances of the emergence of interpersonal problems along with social, occupational, and educational problems. WhatsApp use may cause the user to progressively spend more time being online. It may result in paying less attention or ignoring other important household or work responsibilities. Inability to spend quality time with the spouse and children, reduced communication between them, minimal romantic talks between them can lead to marital disputes. Online infidelity can also arise if the user falls in a loving relationship with someone through WhatsApp (by regular sharing of romantic messages, images or videos) which can be the reason for marital conflicts. Studies have highlighted the negative impact of online infidelity on marital relationships and its detrimental effect on the mental health of the offended spouse.
We decided to consider WhatsApp use (social media) for this study because research shows that social media addiction can have negative effects on the relationship of couples  and WhatsApp is most common social media used by people along with Facebook according to recent literature  and its use is increasing. Specialist doctors were considered as, for them, because of busy schedules of work, WhatsApp and other means of online communication can be the easy way to socialize and keep them updated along with its use for professional purposes. At the same time, in their professional course, they are exposed to high levels of stress which makes them susceptible to suffer burnout. Burnout, in turn, may lead to marital discord and other related problems among many other negative consequences. Hence, we decided to study the pattern of WhatsApp use in doctors and to assess whether it affects their relationship with spouse and others.
| Materials and Methods|| |
A cross-sectional pilot study was carried out among 100 specialist doctors in a medical college and tertiary care hospital. After institutional ethics committee approval, information about the study was given to the 107 consecutive specialist doctors (those working in medical college and tertiary care hospital after completing their postgraduate degree in the position ranging from senior resident to professor level). Of these, 7 were excluded as they were either not using WhatsApp or were not in marital relationship (unmarried, separated, divorced, or widowed). Selected 100 participants were assured confidentiality, and informed consent was taken.
Assessment was made using self-reported semi-structured pro forma which included questions regarding sociodemographic profile, marital details, pattern of WhatsApp use, questions related to the various disturbances that may occur due to excessive WhatsApp use, questions related to relationship with spouse and the effects of WhatsApp use on relationship (examples-effects on day-to-day communication, amount of time spent together with spouse, and ability to give quality time to partner), questions related to thoughts about getting separated or divorced and few questions related to infidelity in the context of WhatsApp use. The above details were collected across 36 items in the questionnaire, besides information about sociodemographic data. Some questions needed the factual answers (e.g., how much time do you spend on WhatsApp daily? The participants had to answer anyone out of four options provided to them i.e., (1) 1–2 h, (2) 2–5 h, (3) 5–10 h, (4) >10 h). Most of the questions needed responses in “Yes” or “No” and “Present” or “Absent” format. Each question was designed after studying the possible pattern of responses to increase the objectivity of the questions. It was a self-reported questionnaire and required approximately 20 min for each participant to complete the pro forma. Questions were framed by investigators (experts in psychiatry and community medicine) along with psychiatrists who are working in the field of addiction and relationship issues. Questions were decided by consensus. Cronbach's alpha measure of internal consistency for items exploring effects on marital life was 0.9 indicating high internal consistency.
We could not find any studies on this topic assessing relationship problems in doctors due to WhatsApp use. Hence, we have not performed any formal sample size calculations and decided to conduct this study as a pilot study.
The study was carried out over 6 months. A primary selection criterion was to include specialist doctors using WhatsApp for at least past 1-year and in the marital relationship since or before the participant started using WhatsApp.
All the collected data were tabulated and statistically analyzed using mean, standard deviation, t-test, and Chi-square test. A value of P < 0.05 was considered statistically significant.
Hundred specialist doctors included in the study were from both clinical and nonclinical branches. Sixty participants from clinical branches were distributed among general medicine-8, general surgery-10, gynecology-7, pediatrics-6, ophthalmology-7, orthopedics-6, pulmonologists-4, radiologists-3, dermatology-5, and ear, nose and throat-4. Among forty nonclinical branches, 6 were from physiology, 6-pathology, 4-microbiology, 2-forensic medicine, 4-pharmacology, 3-community medicine, 2-biochemistry, 5-anatomy, and 8 were from anesthesia department.
Socio demographic profile
Among 100 participants (51 males and 49 females), age distribution and other sociodemographic factors are tabulated as in [Table 1].
Of 100 participants, 89% reported regular use of WhatsApp with a mean duration of use as 2.5 years. About 19% were using WhatsApp for >2 h/day, 53% for 1–2 h and 28% for <1 h a day [Table 2].
Pattern of WhatsApp use
When the pattern of WhatsApp use was analyzed, 37% of the participants reported reduction in time spent with spouses and family since they started using WhatsApp. About 24% reported impairment in fulfilling their responsibilities (household, family, other) compared to before, 35% noticed that time spent by them on WhatsApp was increasing significantly day by day. About 62% responded positively to the use of WhatsApp while doing personal or household chores, 26% of the participants agreed having disturbances in work and social activities, 20% said that they have difficulty in bearing the absence of WhatsApp and few (13%) noticed irritability and restlessness when they are unable to use it [Table 3].
Effects of WhatsApp on relationship
When participants were assessed for the effects of WhatsApp use on relationships, it was found that 17% reported conflicts with their spouses, 21% agreed about inability to spend quality time with their spouses, 11% reported frequent altercations with spouse due to WhatsApp use, 24% reported concern about spouse's WhatsApp use, and 12% doubted that their spouses spend less time with them than before. About 16% reported reduced expression of love and agreed that things between them and their spouses are not going well. About 1/4th reported reduced sharing of thoughts and reduced marital (dyadic) cohesion (less engagement in outside interests together, reduction in exchanging ideas, laughing together, etc.) between them. About 22% thought that their spouses doubt them for spending more time or indulging in close relationships with someone through WhatsApp and 14% feared that their marriage was on stake. Out of those who reported the effects of WhatsApp use on their marital life in some or the other way, 21% tried to cut down WhatsApp use to fix or solve their marital problems [Table 4].
Thirty-six percent of the participants reported significant effects of WhatsApp use on their married life. The common marital problems reported were frequent altercations with the spouse, inability to give adequate time or spend quality time with the spouse, reduced interactions, and reduced overall quality of married life. About 56% reported no significant effects, whereas 8% reported positive effects of WhatsApp on their married life in the form of more sharing of emotions and thoughts.
Although 36% of the participants reported marital problems, only 2% expressed the thoughts of living away or divorcing the spouse [Table 5]. Of 36, 21 participants (58.33%) tried to avoid the marital conflicts by various means like restricting the internet use, keeping data cable off or uninstalling the WhatsApp application (this was a single question in the pro forma and participants mentioned that they tried multiple methods at different period therefore exact percentage of individual method of restricting the WhatsApp use could not be obtained).
WhatsApp and fidelity
About 93% of the participants had opposite gender friends on WhatsApp and 53% were exchanging messages with them once in 15 days or more. About 16% found hiding such messages from their spouses, whereas 20% reported deleting those messages immediately after sending them. Only 6% disclosed about sending messages with intimate content sometimes [Table 6] [questions that may suggest online infidelity on WhatsApp were included in the pro forma and are mentioned in [Table 6].
Regular use of WhatsApp was more in participants <40 years of age compared to those >40 years age group. The mean duration of WhatsApp use and daily time spent on it both were significantly greater in specialist doctors <40 years of age [Table 7].
On comparison between sociodemographic factors and effects of WhatsApp on relationship, it was found that married life was affected more in those <40 years of age and the difference was statistically significant. Those married at later age had significantly more marital problems than those with early age of marriage. Participants using WhatsApp regularly and spending more time on it had reported significant effects on marital life compared to those not using WhatsApp daily. Spending more time on work and less time with family were also the contributing factors for a significant negative impact on marriage [Table 8]. There was no statistically significant correlation between the pattern of WhatsApp use and effects on marital life with respect to gender and branch specialty of the participants.
In this study, 89% of the specialist doctors were using WhatsApp daily. This shows increasing popularity and “easy to use” characteristic of WhatsApp causing its widespread use among all the age or occupational groups to keep in touch with friends and relatives. Doctors use it for the same reason along with the purpose of discussing difficult/rare cases with their colleagues, sharing information/photographs of important clinical conditions and to conduct online group discussions/meetings when they have busy schedules and difficulty meeting in person. Some articles mention that Indian doctors use WhatsApp to instantly send electrocardiogram pictures of their patients who have suffered heart attacks and save valuable time and potentially lives. The mean duration of WhatsApp use was 2.5 years and it was statistically higher in participants <40 years of age compared to older ones. It is a known fact that the younger generation is more techno-savvy and use Internet more frequently for multiple purposes. This study found that 19% of the participants were spending >2 h a day on WhatsApp which was significantly more in participants of younger age (<40 years). This correlates well with the observations of a study done on 147 MBBS students which showed that average time spent on Facebook and WhatsApp was 3.09 h/day. Another study done on 436 married Saudi individuals, (309 males, 127 females) to assess the effects of social network with WhatsApp as a model, found that the largest percentage of the participants were using WhatsApp for 1–3 years. This study also found that the majority of respondents were using WhatsApp daily from 1 to 3 h.
Addiction (for substance or internet) is characterized by tolerance, withdrawal, inability to cut down use, loss of control over use, inability to bear its absence, craving, and impairment in social and occupational functioning. Internet addiction is comparatively a new disorder described by many authors.,, Although there is no category in the current diagnostic classification for internet addiction, Young proposed that this diagnosis should be made based on the pattern of Internet use that results in significant impairment or distress as indicated by the presence of five or more of the given criteria considering only the nonprofessional and non-academic use. It included preoccupation with the Internet, need for longer amount of time online to achieve satisfaction, repeated unsuccessful efforts to control, cut back or stop internet use, restlessness, depression or irritability on attempt to reduce or stop internet use, compromising or the loss of significant relationship, educational, job opportunities because of the Internet, staying online for longer time than intended, lying to family members or others to hide the extent of involvement with the internet and using the Internet as a way of escaping from problems or for relieving a dysphoric mood. In this study, more than one-third of the participants reported reduction in time spent with spouse and family due to WhatsApp and increase in time spent on it with every passing day. Around one-fourth of the specialist, doctors reported disturbances in work and social activities along with impairment in fulfilling the personal responsibilities. Few reported difficulty in bearing the absence of WhatsApp and irritability/restlessness when not using it. About 62% reported that they use WhatsApp during personal or household chores (while eating, cooking, in the washroom, and while playing with kids). These findings though do not clearly categorize or sufficient to call it a “WhatsApp addiction,” can be considered as factors of problematic WhatsApp use with the potential to result in consequences similar to those in other behavioral or technological addictions. Because of the scarcity of research on WhatsApp use in doctors, we could not directly compare the findings with that of other studies, but one study done on 150 MBBS students found that 12% of participants qualified for WhatsApp addiction. Another study on 100 junior doctors found that Internet addiction of moderate severity was found in 13% of the participants.
Any type of addiction is associated with a plethora of disturbances. These disturbances are well noted in drug/substance addiction, but the literature on these disturbances due to WhatsApp use is very limited. This may include physical (sleep deprivation, increased fatigue, etc.), social (social isolation, decreased one-to-one interaction and lack of real-life social relationships), occupational and relational problems (relationship problems with family, neglect of daily chores, reduced time spent with family, and increased family conflicts). Some other authors also found the effects of WhatsApp use on social relationships, family relationships, and marital relationships.
The ease of online relationship formation has led to increased interest in investigating how the Internet may harm couple relationships through various behaviors such as intrusion, addiction, and online infidelity. Problematic WhatsApp use, just like Internet addiction, can lead to disturbances in married life. In this study, 36% of the participants reported problems in married life due to excessive and inappropriate WhatsApp use. Some participants also experienced extreme feelings like their marriage is on the verge of separation, wishing to live separately or getting divorced. The reasons for this can be (1) being addicted or dependent on WhatsApp use leading to neglect of relationship and (2) in general, social networking may create the potential situations, thereby evoking the feelings of jealousy between partners, harming their relationship quality. It also facilitates users reconnecting with people with whom they have had relationship in the past. Although we could not find literature on WhatsApp use and effects on marriage, studies have shown marital problems and even marital breakdown arising out of Internet addiction. Some authors mentioned that excessive use of social media like Facebook affects the real world interaction abilities and communication. Internet Addiction is also commonly associated with depression, anger, and anxiety disorders. The same can be considered to exist with inappropriate WhatsApp use.
Although WhatsApp use is associated with many negative outcomes, there are studies that have shown its positive effects as well. In one study, around 52.4% of participants reported an increase in creativity with the use of Facebook and WhatsApp. It also showed that 91.8% of the participants expressed how Facebook and WhatsApp usage have increased their closeness with family members, friends, and relatives. The present study showed 8% of the participants describing positive effects of WhatsApp use on their married life in terms of increased sharing of emotions and information and increased opportunity to stay in touch with close family members or friends.
Cyber infidelity is defined as the use of the Internet for sexual, emotional, or romantic interaction while a person is already in a spousal relationship. This begins with an online contact and it is maintained mainly through the electronic conversations that occur through e-mail and chat. Easy access to the Internet has created new opportunities for extra-conjugal relationships. Being able to create a virtual identity on Internet without getting recognized by anyone has made a variety of online sexual behaviors easy. This has also made online infidelity anonymous, affordable and accessible. At present, there are many dating sites that make it easy for people to connect with anyone, outside the knowledge of the family. WhatsApp is no exception to this and sending romantic messages or messages with intimate content can be done outside the watchful eye of anyone. This may lead to conflicts between the partners and disturbances in marital life. Widespread Internet use has resulted in a rise in online infidelity. This study showed 12% of the participants sending romantic messages. Around 6% of the respondents reported sending messages with intimate (sexual) content through WhatsApp. Studies have shown 33.4% of the participants having emotional infidelity behaviors (exchanging emotional/romantic messages) and 17.3% exchanging messages with sexual content on Internet. Secrecy is an integral part of online infidelity and many attempts are made to keep discussion or chatting with the person on the Internet a “secret.” This includes hiding or deleting the chat and search histories. In our study, it was found that 93% of the participants had opposite gender friends on WhatsApp with a variable frequency of sending messages ranging from “once in 15 days” to “many messages per day.” The participants in this study are specialist doctors and it is expected that 100% of them would have friends of opposite gender considering the professional needs and culture. However, the study pro forma was self-reported and there is a possibility of hesitation in disclosing the details about online friends and communication with them. This might be one of the reasons that 7% of the participants did not reveal about friendship with opposite gender friends on WhatsApp. To prevent trouble in married life, 20% of the participants reported deleting the messages and 16% reported hiding the messages sent by them to friends of the opposite gender. Puri in her article published in 2015 mentioned that social media, particularly WhatsApp, is putting marriages and relationships on stake. Easy accessibility to the past or to the desirable, though in a virtual sense, has complicated real-life relationships. Option to delete the content and password-protection of chats has made people believe that their mobile activity is safe and not accessible to others.
For WhatsApp, the rules that define what is acceptable and what is not in virtual encounters are not clearly defined in couples. Furthermore, the literature available on WhatsApp use in specialist doctors is very less and its worth studying the impact of its inappropriate use on specialist doctors.
Conflicts of interest
There are no conflicts of interest.
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[Table 1], [Table 2], [Table 3], [Table 4], [Table 5], [Table 6], [Table 7], [Table 8]