Internet usage has increased greatly. It is expected to be more than 4 billion by the end of this year. About 80% of them spend most of their internet time on social media, and are expected by 2026 to be about 50% of the total population to use social media at least once a month. The internet is mainly used to connect with friends, relatives, learn new skills, or for entertainment, such as video gaming. However, with this increasing usage, internet addiction can easily increase.

Internet addiction or pathological internet use is defined as uncontrolled, excessive use of it, with uncontrolled time consuming that can cause distress and impairment. The prevalence of internet addiction varied between regions. A study in the seven countries in Europe reported a prevalence of addiction among adolescents to be 1%, and an additional 12.7% at risk of having addiction. In Turkey, a recent cross-sectional study found a prevalence of 18.3%. In the Middle East, the prevalence varied greatly from 0.9% to 33% among adolescents.

Additionally, internet video gaming is another addictive problem that can affect adolescents. A previous meta-analysis showed that gaming addiction prevalence ranged from 0.9% to 19.9%, with males being higher than females. Also, another study showed a prevalence of about 8.4% among Thailand medical students.

On the other hand, overuse of the internet can lead to an increase in problematic pornography use. Another study found a significant association between increased usage of the internet and pornography addiction (P value: <0.001). Additionally, previous studies showed a prevalence of porn addiction ranging from 3.2% to 16.6%. Also, a negative correlation between education level and porn addiction was observed.

All these behavioral addictions increase depression, anxiety, and stress for addicts. Several cross-sectional studies have assessed the positive correlation between either internet, gaming, or porn addiction, and an increase in anxiety and depression. However, to our knowledge, no single study has assessed these three addictive behaviors together with depression, anxiety, and stress in Arab countries.

Rational Medical students, in particular, use the internet frequently. Students use it in training, faculty assignments, research projects, and so on, which can make them depend greatly on the internet. This potentially can increase their addiction to the internet, subsequently increasing their addiction to video gaming and porn addiction. In the Middle East, few studies have tried to assess the prevalence of internet addiction and its association with increased depression, anxiety, and stress among medical students. Despite that, there is a lack of studies on gaming addiction and porn addiction.

The study aimed to assess the prevalence of internet addiction alongside video gaming and porn addiction among medical students and interns in the Middle East (MENA region). Also, the study aimed to assess the relationship of these three addictive behaviors with each other and their relationship with increased stress, anxiety, and depression among this population.

Inclusion Criteria:

• Arabic Medical students and interns
• Studying medicine in the Middle East countries
• Have access to online platforms
• Agree to participate in the study

Exclusion Criteria:

• • Students or interns who refused to participate

Medical students and interns in the Middle East countries are allowed in the study