Assessment of Sel ie addiction, and Sel itis among Allied Health Sciences students of a tertiary care hospital in Chennai, Tamil Nadu

A sel ie is a self-portrait photograph typically taken with a camera phone held in hand or supported by a sel ie stick. Studies suggest that the level of sel ie addiction among youngsters has been increasing over the years. Sel itis is the term that is being widely used to denote sel ie addiction. This study aims at assessing the level of sel ie addiction and various factors associated with it, and to evaluate the relationship between sel ie addiction and addictive sel ie habits. A cross-sectional study was conducted among the Allied Health Science students of a tertiary care hospital in Chennai. Two hundred seventythree students were studied by convenient sampling method. A pre-tested, validated, structured and self-administered questionnaire was given, and the desired information was elicited. Chi-square test was used to test the signi icance (p <0.05)A total of 287 studentswere studied, ofwhich 65 (22.6%)were males, and 222 (77.4%) were females. It is observed that age, year of study, the place from which they come, place of stay and father’s occupation have a statistically signi icant relationship with sel ie addiction. Most of the sel ie addictive behaviours have a female preponderance. A signi icant portion of the youth is in the early stage of sel ie addiction. Hence it is highly essential to spread awareness about the ill effects of sel ie addiction among the youngsters to curb this addiction earlier.


INTRODUCTION
A recent development in the ield of technology is the 'Sel ie', which is a self-portrait photograph typically taken with a digital camera or camera phone held in hand or supported by a sel ie stick (Saroshe, 2016). In recent times, rather than to treasure memories, sel ies have led to a type of behavioural addiction called 'SELFITIS'. The APA has stated that Sel itis is an 'obsessive-compulsive desire to take photos of one's self and post them on social media as a way to make up the lack of self-esteem and to ill a gap in intimacy (Singh, 2016).
Clicking sel ies initially start with a fun, and as time passes, it becomes a habit and later an addiction (Nagaraju and Chikkegowda, 2019). Posting sel ies on social media for likes and comments have increased the level of addiction. They develop mental, physical and social dependency on the internet and sel ies (Gaddala et al., 2017). They use social media to mediate interpersonal interaction to ful ill their self-esteem needs (Varnali and Toker, 2015). Sel itis on a later basis leads to decreased concentration and productivity of the youth. It also has paved the way for many other medical complications like frozen shoulders, back pain, cervical spondylitis (Kela et al., 2017).
We have also come across cases of fatality of individuals trying to take dangerous sel ies. The irst  (Domlur et al., 2018). Since then, there have been 259 deaths reported all over the world (Singh, 2016). Since there is a gap in the literature in this fast-growing problem, this study was intended to explore more about it to identify, assess the level of addiction and to curb the ill effects and provide them with support to come out of it.

Aims and Objectives:
To assess the level of Sel ie addiction and various factors associated with it, to evaluate the relationship between sel itis behaviour and addictive sel ie habits and to determine the magnitude of the association between level of sel ie behaviour and sel itis

MATERIALS AND METHODS
A cross-sectional study was conducted in an Allied Health Science College among Physiotherapy stu-dents in Chennai, Tamil Nadu. Based on a review done by Singh v et al. (Singh and Yadav, 2018), it was seen that 20.5% of subjects had acute selfitis. Using the formula 4pq/d 2 and considering 5% allowable error, the sample size was calculated as 261, taking 5% non-respondent rate, the inal estimated sample size is 273. All the subjects who were willing to participate in the study were included in the study by convenient sampling method. Informed written consent was obtained from all the study participants before eliciting the desired information. A Pre-tested, validated, structured and self -administered questionnaire, consisting of their socio-demographic details, Sel itis behaviour scale (Singh and Yadav, 2018) which consists of 10 points Likert scale questionnaire, where the scores are 0-33: Mild sel itis behaviour, 34-67: Moderate sel itis behaviour, and 68-100: Severe sel itis behaviour, and a structured questionnaire on types of sel itis were used as study tools for the study. The APA has classi ied Sel ie addiction (Singh and Yadav, 2018) into three stages: "Borderline-Up to 3 sel ies per day but not sharing on social media, Acute Sel itis-3 sel ies per day and sharing it on social media and Chronic Sel itis-At least six sel ies per day and sharing them in social media". The data was then entered into the excel sheet and analyzed by using SPSS Software version 22. The frequencies and percentages were calculated. Chi-square test was used to ind the association, and p-value <0.05 was considered signi icant. This study had obtained the ethical clearance approval from the Institutional Ethical Committee of Saveetha Medical College and Hospital, Chennai.

RESULTS AND DISCUSSION
A total of 287 students were studied, of which 65 (22.6%) were males, and 222 (77.4%) were females. A majority (79.8%) were between the age group 17-19 years. The majority (86.4%) were Hindus by religion. 53% were from 1 st year, 25.8% and 21.3% were from 2 nd and 3 rd years, respectively. The majority (85.7%) lived in a nuclear family. The family income of maximum students (45.6%) fell in the category of Rs.11,000-30,000. 65.2% of the students lived in urban areas. 69.0% of the students stayed in their homes, whereas 27.5%, 2.4%, 0.3% and 0.7% stayed in the hostel, relative's house, friend's house or alone in apartments respectively. The fathers of maximum students (25.8%) were occupied in professional work. The mothers of maximum students (80.5%) were home-makers.
From Table 1, it is observed that age, year of study, residence, place of stay and father's occupation have statistically signi icant relationship with sel ie addiction. Whereas gender, religion, type of family, total family income and mother's occupation was not statistically signi icant. 44.3% of students from urban areas and 51.2% of female students are moderately addicted. Students who lived in nuclear families had a maximum level of moderate (56.1%) and severe (12.5%) addiction. The level of moderate sel ie addiction is maximum (38.0%) among 1 st year students. Maximum number of moderate (46.0%) and severe (8.4%) addiction were found among students who lived with their parents.
From Table 2, it is observed that maximum female students (38.7%) took sel ies weekly, whereas maximum male students (11.1%) took sel ies monthly. A majority of students (96.9%) said that they take group sel ies. A maximum number of students (53.3%), with a female preponderance, said that they take sel ies for time pass. 32.8% of the students said that they get annoyed when interrupted while taking sel ies. 4.2%, 3.1%, 0.7% and 1.4% of the stu-dents felt sad, irritable, depressed and angry respectively when they were not able to take sel ies, with a female preponderance.
From Table 3 , it is observed that there is a signi icant relationship between all the variables of sel ie addictive behaviour and sel itis behaviour scale. 6.6% and 5.9% of the students who fell under the category of moderate and severe addiction felt themselves uncontrollable after they start taking sel ies. 15.0% of the students stated that they take selfies even in sad situations. 10.5% and 8.4% of the students who were moderate and severe addiction respectively had stated that they tried to cut down the number of sel ies taken, but failed. 5.2% of the students have said that they cannot survive without taking sel ies and 2.4% of the students wanted to take counseling to reduce their sel ie addiction.
From Table 4, it is observed that maximum number of students (35.5%) with borderline sel itis had moderate levels of addiction in the sel itis behavior scale, followed by 16.0%, 7.0% and 6.6% with acute, normal and chronic sel itis respectively. Among severely addicted students, most of them (6.3%) fell in the category of borderline sel itis, followed by 4.9% and 3.5% in chronic and acute levels of addiction respectively.
From Figure 1, it is observed that 11.8% and 17.8% of females fall under acute and chronic sel itis. It is also noted that at all the levels, there is a female preponderance. Finally, 5 students mentioned that they wanted counseling to come out of sel ie addiction.
In our study, 10.1% of the participants said they take sel ies to send it to their friends who were similar to studies done by Satish Saroshe et al. (Saroshe, 2016) and Nath Som et al. (Som et al., 2017) were 15% and 12% of the participants stated the same reason respectively. In our study, the gender difference was not noticed in sel ie-taking behavior similar to the study by Dom Joy et al., (Joy and Venkatachalam, 2019) From our study we ind that 33.8% of the students agree that they edit images using software to make themselves more appealing due to the lack of self-esteem as stated in the study done by Fox and Rooney (Fox and Rooney, 2015). The study done by Era Dutta et al. (Sousa et al., 2016) in 2016 among 11 th standard student shows a result that 10% of the students use similar software. Hence, we can understand that during these three years, with the advancement of various software, addiction to sel ies have also increased proportionally. In our study, 9.8% of participants said they took sel ies to mainly post it on social media which is slightly lesser than the inding of 14% of the participants in the research done by Satish Saroshe et    al. (Saroshe, 2016) done among medical students of MGM Medical College, Indore. These medical students from North India comparatively have a better reach to technology compared to AHS students in the South, due to which the values are slightly higher. In our study, 53% of the participants stated that they take sel ies for time pass. In contrast, in the survey by Raghavendra Nagaraju et al. (Nagaraju and Chikkegowda, 2019) done on medical students, it was 30% as medical students are occupied with academics and rarely ind time to relax.
In our study,78.8% of the participants said that they take sel ies for memories but only 9.8% among them post the pictures on social media. Similarly, the study done by Hari Kumar et al. (Gaddala et al., 2017) 80% of the participants said that they take sel ies for memories, but only 7% post it on social media. In our study, 11.1% are normal, and 12.9% are affected by chronic sel itis. On the contrary, the study was done by Hari Kumar et al. (Gaddala et al., 2017) in 2017 has observed that 24% were normal, and only 1% was affected by chronic sel itis. Our study shows that 53.3% are affected by borderline sel itis, and this is slightly higher than the results of a study done by Raghavendra Nagaraju et al. (Nagaraju and Chikkegowda, 2019) where 48.7% are affected by the same (Nagaraju and Chikkegowda, 2019).
The maximum number of moderate (56.1%) and severe (12.5%) addiction was found to be more among the students who lived in nuclear families, as they don't spend much time with the relatives. If both their parents are working, they are left with none to interact and hence engage in taking more sel ies. Students from urban areas were affected more, where 44.3% were moderately addicted due to the increased development and reach of technology in these areas compared to rural areas. It was found that a maximum number of moderate (46.0%) and severe (8.4%) addiction were found among students who lived with parents compared to those in the hostel who get to spend a lot of time with their friends and hence are rarely bored.
The entire students have not participated in the study, and only a small number of students were sampled, which is a limitation. Awareness about the harmful effects of sel itis and how to overcome it should be created among the youth. Creative and other extracurricular activities should be organized apart from the routine academics to channelize their boredom. Counseling sessions can be arranged in all the colleges.

CONCLUSIONS
An early stage of sel itis was seen in nearly half of the study participants, and there was an association between sel itis and sel itis behaviour scale. It is understood that if this addiction like any other addiction if curbed earlier can lead to a better and productive youth power. Awareness about the harmful effects of sel itis and how to come out of it should be created among the youth. Since many students stated that they took sel ies only because they were bored, creative and, other extracurricular activities should be organized apart from the routine academics to channelize their boredom. Counseling sessions can be arranged in all the colleges.
ACKNOWLEDGEMENT I want to thank the Director of Saveetha Medical College Dr.Saveetha Rajesh, Dean Dr.J.Damodharan, HOD of Community Medicine Dr.Timsi Jain for giving me this opportunity to conduct research. I would also like to thank the Principal of Saveetha College of Allied Health Sciences for permitting me to study the AHS Students. I would also like to thank all of the study participants who participated in my study.