The Effect of Frequency and Type of Internet Use on Perceived Social Support and Sense of Well-Being in Individuals With Spinal Cord Injury

By Miller, Susan M

This article examines the effect of frequency and type of Internet use on perceived social support and sense of well-being in persons with spinal cord injury. The results show that Internet use is not significantly related to perceived social support. Bivariate analysis indicates that there is a significant negative association between total Internet use and overall sense of well-being. Simultaneous regression further investigated the nature of this relationship by examining the contribution of 10 online activities to four scales measuring sense of well-being. Frequency of online gaming was negatively associated with each scale. Disability- related information seeking was also negatively associated with psychological and financial well-being, as well as perceived social support. These results suggest that Internet use as a whole should not be overlooked by rehabilitation counselors for its practical uses to increase independence and social connectedness in persons with disabilities; however, care should be used, particularly with online gaming. Keywords: Internet use; psychosocial aspects of disabilities; perceived social support; sense of well-being; spinal cord injury

The Internet has the potential to greatly affect the independence and social connectedness of people with disabilities. It has improved access to and expanded opportunities for conducting business, interacting with others, obtaining information, and pursuing leisure activities. A Harris poll conducted in 2000 provided some initial support for the positive effects of Internet use in people with disabilities (Taylor, 2000). The results showed that although people with disabilities were less likely to be online than people without disabilities (43% versus 57%), those who did use the Internet spent twice as much time online than people without disabilities (20 hr per week versus 10 hr per week). People with disabilities were also more likely to report that the Internet significantly improved their quality of life (48% versus 27%). They reported that the Internet helped them better connect to the world and reach out to people with similar interests and life experiences.

This result is potentially important because one of the major consequences of the mobility limitations and lack of transportation common among people with disabilities is social isolation (Chan, Pruett, Miller, Frain, & Blalock, 2006). Individuals with spinal cord injury may experience barriers to mobility that make establishing social connections and participating in community activities difficult. In addition, negative attitudes and stigma may be barriers to social participation and relationship development within local communities. Research has attempted to identify ways to minimize circumstances contributing to social isolation. For example, people with chronic illness, especially those with stigmatizing dis eases (e.g., AIDS, alcoholism), have gained many psychological and physical health benefits from participation in social support groups (Davison, Pennebaker, & Dickerson, 2000). Given that the Internet may help decrease physical barriers that prevent people with disabilities from having meaningful social interactions, online social support may be a useful means of reducing social isolation (Chan et al., 2006). E-mail, chat rooms, instant messaging, and online dating services may provide easier ways for persons with mobility limitations to make connections with others.

It is also important to consider the potential negative effects of Internet use on social support and quality of life. Internet use may, being a solitary activity, detract from the time that the individual spends interacting with loved ones (Sanders, Field, Diego, & Kaplan, 2000). Excessive time spent online might also take time and energy away from other meaningful work and leisure pursuits. In this light, Internet use may be similar to television viewing. According to Csikszentmihalyi (1990; Kubey & Csikszentmihalyi, 1990), certain leisure activities, such as watching television, involve not much more than the passive absorption of information, requiring very little memory, thinking, and volition. Considerable participation in such activities has been found to be associated with decreased levels of subjective well- being (Kubey & Csikszentmihalyi, 1990). It is possible that Internet use may also have this negative effect on well-being, depending on the online activities that are performed.

General Research Findings

Although relatively little research has been done related to Internet usage patterns and people with disabilities, a body of literature on the impact of Internet use in the general public has begun to emerge. These results have been quite mixed. Several studies have found little relationship between time spent online and well-being (Gross, Juvonen, & Gable, 2002) and social support (Hlebec, Manfreda, & Vehovar, 2006; Swickert, Hittner, Harris, & Herring, 2002). However, other studies have found either negative (Nie & Erbring, 2000; Sanders et al., 2000; Waestlund, Norlander, & Archer, 2001) or positive (Cody, Dunn, Hoppin, & Wendt, 1999; Kraut, Mukhopadhyay, Szczpula, Kiesler, & Scherlis, 1999; McKenna & Bargh, 1998; McKenna & Bargh, 2000; McKenna, Green, & Gleason, 2002; Shaw & Gant, 2002) psychosocial outcomes related to Internet use.

A well-known study performed by Kraut et al. (1998) addressed what has come to be referred to as the Internet paradox. In their longitudinal study (12 to 18 months in 1995-1996) that followed 93 families in the Pittsburgh area, they assessed the relationship between Internet use and social involvement and psychological well- being of new Internet users. The authors had predicted that Internet use would increase users’ social networks and their amount of functional social support. However, they found that frequent Internet users had decreased rates of family communication, greater loneliness, a greater number of life stressors, increased depression, and decreased social network size. The authors reasoned that the superficial relationships formed online displaced meaningful relationships in the real world.

In their 3-year follow-up, however, the authors (Kraut et al., 2002) found that most of the negative effects found in the initial study had dissipated. They offered several possible explanations for the results, including the maturation of participants (such that the Internet was no longer a novelty) and the changes made in the Internet. For example, as time went on, more information became available online that could be better integrated with the rest of the participants’ lives (such as news, financial, hobby, and work- related information).

LaRose and colleagues (LaRose, Eastin, & Gregg, 2001; LaRose, Mastro, & Eastin, 2001), however, utilized social-cognitive theory to explain Internet use and the Internet paradox. In this view, expectations about the positive outcomes from using the Internet (e.g., discovering useful information) should increase usage and decrease stress, whereas expectations about negative outcomes (e.g., encountering technical problems) should decrease usage and increase stress (LaRose et al., 2001). In addition, Internet self-efficacy, or an individual’s belief in his or her ability to use the Internet to achieve desired outcomes, also influences usage patterns. According to LaRose and colleagues, because the initial Kraut et al. study (1998) utilized novice Internet users, they may have experienced high stress and low Internet self-efficacy, which may have contributed to depression and negated any benefits of social support received online. It is likely that between the first study and the second (Kraut et al., 2002), the participants’ familiarity with and capability to use the Internet increased, thereby leading to increased Internet self-efficacy, decreased stress and depression, and increased social support.

Health and Disability Research Findings

With respect to health and disability, research related to chronic illness (e.g., HIV/AIDS, breast cancer, diabetes) is generally positive, suggesting that the use of the Internet for health care information and support significantly improves perceived psychosocial well-being and reduces hospitalizations and clinic visits (Barrera, Glasgow, McKay, Boles, & Feil, 2002; Fogel, Albert, Schnabel, Ditkoff, & Neugut, 2002; Gustafson et al., 1999; Kalichman et al., 2002; Kalichman et al., 2003; Kalichman et al., 2005; McKay, Glasgow, Feil, Boles, & Barrera, 2002; Rodgers & Chen, 2005). This evidence provides support for the use of the Internet for health and disability-related information and social support within rehabilitation settings.

A multimethod pilot study performed by Houlihan et al. (2003) provided an initial analysis of the effect of the Internet in persons with spinal cord injury. In their study, Internet access was provided to 33 individuals with spinal cord injury who had no prior Internet experience. Quantitatively, at a follow-up that took place between 6 and 19 months after installation, the results showed trends toward improved emotional health, although the number of friends and relatives whom the participants contacted during previous month declined. There were increases in romantic relationships and sexual activity in the participants, despite an average of doing 3 fewer hours of recreational activity per week. Qualitatively, over half the study participants thought the most important impact of the Internet on their lives was improved quality of life. The follow-up to this pilot study investigated the relationship between frequency of Internet use and a variety of health-related quality-of-life indicators in persons with spinal cord injury (Drainoni et al., 2004). The researchers found that frequency of Internet use was marginally related to increases in satisfaction with life and decreases in severity of depression and strongly related to improvements in health status, health compared to 1 year ago, number and type of social contacts, and occupational situation. Considerations Related to Prior Research

As mentioned, research into Internet use and wellbeing has been mixed, and the contradictory findings may be partially explained by differing designs and methods. For example, the Kraut and Houlihan studies (Houlihan et al., 2003; Kraut et al., 1998; Kraut et al., 2002) longitudinally followed participants with no prior Internet experience, whereas many other studies have utilized survey design (e.g., Hlebec et al., 2006; Nie & Erbring, 2000). In addition, qualitative results, such as those found by Houlihan et al. (2003) and Taylor (2000), tend to show more positive results than what quantitative analyses suggest. Another important consideration to mention related to synthesizing prior research is that the well- being outcome variables measured have been so varied that direct comparison of individual studies is difficult. For example, Drainoni et al. (2004) measured a variety of health-related quality-of-life indicators (e.g., health status, depression), whereas Waestlund et al. (2001) measured a variety of psychological well-being indicators (e.g., optimism, loneliness). Clearly, the direct comparison of outcomes in these studies must be done with caution.

Many of the studies reviewed above, particularly those in which Internet access was provided to nonusers, also had considerably small sample sizes. For example, Houlihan et al.’s study (2003) had only 33 participants, 10 of whom dropped out within the first 6 months in the study. The Kraut studies (Kraut et al., 1998; Kraut et al., 2002) utilized a convenience sample of 93 families in Pittsburgh, and critics of these studies question the generalizability of their results. Another criticism of these studies is that they did not include a control group of Internet nonusers. It is important to note, however, that because the Internet has so permeated everyday life in recent years, practically speaking, larger samples of people that have never used the Internet may be difficult to obtain.

Research related to Internet use and disability is just now beginning to emerge in the literature, and much more work clearly needs to be done in this area. Although the work of Houlihan and colleagues (2003) and Drainoni and colleagues (2004) represents an important first step in investigating Internet use in persons with disabilities, the effect of different types of Internet use on social support and sense of well-being in persons with disabilities has not yet been studied. Therefore, this article addresses the following research question: What is the impact of type and amount of Internet use on social support and sense of well-being in individuals with spinal cord injury? This information is intended to inform rehabilitation counselors about which Internet activities may be beneficial or detrimental to the quality of life of their clients.



In sum, 137 people with spinal cord injury participated in this study. The mean age of the participants was 41.1 years (SD – 10.9), and the group was approximately 53% male and 47% female. Overall, 83.9% identified their ethnic background as European American, 6.6% identified as African American, 4.4% identified as Latino/Latina, 1.5% identified as Native American, and 3.6% identified as Asian American. Furthermore, 24.1% were single, 47.4% were married, 12.4% were in a committed relationship but unmarried, 4.4% were separated, and 11.7% were divorced. In addition, 45.3% reported that their injury was in the cervical spine; 38.7%, the thoracic spine; 13.1%, the lumbar spine; and 2.9%, the sacral spine. Participants worked an average of 12.2 hr (SD = 18.75) per week in paid employment; however, 62% reported being unemployed. Participants reported an average 10.6 years since injury (SD = 8.8).


The instruments included a demographic questionnaire, an Internet- use questionnaire, the Personal Resources Questionnaire-2000 (PRQ- 2000; Weinert, 2003), and the Sense of Well-Being Inventory (SWBI; Rubin, Chan, Bishop, & Miller, 2003). The demographic questionnaire consisted of 11 items, including age, gender, race, disability characteristics, employment status, and relationship status.

The Internet use questionnaire consisted of 10 items that asked participants to indicate the number of hours per week that they participate in online activities, including e-mail; information seeking, disability related (such as treatment and medical information); information seeking, nondisability related (such as online news and entertainment information); online chat and instant messaging; online support groups; bulletin boards; online dating; creating and updating a personal Web site; playing online games; and other Web activities. Table 1 presents Internet usage patterns for the sample.

The PRQ-2000 is a measure of perceived social support containing 15 positively worded items rated on a 7-point Likert-type scale, ranging from 1 (strongly disagree) to 7 (strongly agree)-for example, “There is someone I feel close to who makes me feel secure.” The total score is calculated by summing all items, with scores ranging from 15 to 105 and with higher scores indicating more support. Weinert (2003) reported Cronbach’s alphas ranging from .89 to .95. The alpha in the present study was .93.

The SWBI is a subjective well-being measure developed for people with disabilities. The original SWBI consists of 36 items that asks consumers to indicate the extent to which they agree that each item is descriptive of them, using a 4-point Likert-type rating scale, ranging from 1 (strongly disagree) to 4 (strongly agree)-for example, “I get frustrated about my disability.” The original SWBI consists of five subscales measuring the following constructs: physical well-being and associated feelings about self, psychological well-being, family and social well-being, financial well-being, and medical care. Cronbach’s alphas were reported by Rubin et al. (2003) to be .88, .83, .79, .72, and .62, respectively.

Chapin, Miller, Ferrin, Chan, and Rubin (2004) examined the factor validity of the SWBI using a sample of Canadians with spinal cord injuries. Their analysis yielded a 26-item instrument consisting of four factors (Psychological Well-Being, Financial Well- Being, Family and Social Well-Being, and Physical WellBeing). Alpha coefficients were reported to be .87, .88, .84, and .79, respectively. Because this validation was performed on individuals with spinal cord injury, this version of the SWBI was utilized in the present study, in which alpha coefficients were calculated to be .79, .86, .76, and .74, respectively.


The data for this study were collected online. Links to the study were placed on the Web sites of the National Spinal Cord Injury Association, the Florida Spinal Cord Injury Resource Center, and the Florida Brain and Spinal Cord Injury Program. In addition, flyers for the study were distributed to clients with spinal cord injury by each regional manager of the Florida Brain and Spinal Cord Injury Program. The first page of the online survey contained institutional review board information, and participants were informed that proceeding with the survey implied giving informed consent to participate. A total of 143 respondents completed the survey. An additional 19 began the survey but did not complete it. To control for the validity of responses, participants were asked to indicate then” injury level and to describe their level of functional independence. Four cases were removed because of a lack of a functional independence description, and 2 were eliminated because of incongruence between reported injury level and functional independence, thereby resulting in the final sample of 137.

Data Analysis

SPSS 14.0 was utilized in all data analyses. Before the primary analyses took place, several diagnostics were performed to detect outliers and transform non-normal variables. Examination of Mahalanobis distances, which measure the distance between a case’s values on the predictor variables and the centroid of the independent variables (Cohen, Cohen, West, & Aiken, 2003), resulted in the identification of no outliers. Multicollinearity diagnostics revealed no significant multicollinearity. Each Internet variable was significantly positively skewed and therefore subjected to log transformation to increase normality. Finally, because so little is known about the relationships among different types of Internet use, perceived social support, and well-being in persons with spinal cord injury, the critical p value for all analyses was set at a liberal value of p = .10 to minimize the likelihood of overlooking potential associations among these variables. Furthermore, p values between .06 and. 10 are considered marginally significant. Pearson’s r values were computed to determine correlations among all variables, and simultaneous regression was used to measure the contribution of each of the Internet variables to perceived social support and each of the well-being variables. Results

The results of the bivariate analysis indicate that SWBI total scores are significantly negatively correlated with total hours of Internet use (r = -.18, p

Table 2 presents the results of the regression analysis performed with the criterion variable of perceived social support. The set of Internet variables did not contribute a significant amount of variance to PRQ-2000 scores, R^sup 2^ = .08, F(10, 126) = 1.10, ns. This indicates that Internet use does not have a significant impact on perceived social support in persons with spinal cord injury. Although the overall set was not significant, the examination of the standardized partial regression coefficients can provide some general insight into the relationships among variables. In this case, disability-related information seeking appears to influence perceived social support in a negative way.

Table 3 presents the results of the regression analyses performed with the four subscales of the SWBI. A layered Bonferroni method was used to control Type I error in these analyses (Darlington, 1990). In this method, the Bonferroni correction factor is lowered by 1 for each successive test. In the present analyses, the uncorrected ps in order of significance are .003 (Psychological WeIlBeing), .029 (Financial Well-Being), .128 (Physical Well-Being), and .290 (Family and Social Well-Being). A simple Bonferroni correction on Psychological WellBeing yielded a corrected p of .003 x 4 = .012. Financial Well-Being is the most significant of the remaining three, with .029 x 3 = .087. The final two are already nonsignificant so no further correction is necessary.

As mentioned, the set of Internet variables contributed a significant amount of variance to psychological well-being scores, R^sup 2^ = .43, F(10, 126) = 2.92, p

The set of Internet variables also contributed a marginally significant amount of variance to financial well-being scores, R^sup 2^ = .14, F(10, 126) = 2.10, p

The set of Internet variables did not contribute a significant amount of variance to either family and social well-being scores or physical well-being scores, R^sup 2^ = .09, F(10, 126) = 1.21, ns, and R^sup 2^ = .11, F(10, 126) = 1.56, ns, respectively. This indicates that Internet use does not significantly predict family and social well-being or physical well-being scores in persons with spinal cord injury. The examination of the standardized partial regression coefficients in these analyses indicates that online gaming appears to influence scores on both subscales in a negative way.


The purpose of this study was to investigate the relationship between frequency and type of Internet use and perceived social support and sense of well-being in persons with spinal cord injury. The results of the bivariate analyses indicate that level of perceived social support and Internet use are not significantly related in persons with spinal cord injury. In addition, overall sense of well-being was found to be significantly negatively correlated with total hours of Internet use per week. To further investigate the nature of these relationships, simultaneous regression was used to break down Internet use into specific activities and examine their effect on

perceived social support and the four constructs of the well- being subscales of the SWBI.

Internet and Social Support

The results of the regression on perceived social support indicate that the set of Internet use variables as a whole did not significantly predict PRQ-2000 scores. This is consistent with studies related to the general public that have shown that Internet use has a relatively limited impact on social support (Hlebec et al., 2006; Swickert et al., 2002). However, as research has been mixed, multiple studies have also shown either a positive relationship (e.g., Cody et al., 1999; Kraut et al., 2002) or a negative relationship (e.g., Kraut et al., 1998; Nie & Erbring, 2000). In addition, studies related to chronic illness have typically shown more positive results than were found in the present study (e.g., Barrera et al., 2002; Fogel et al., 2002). One potential explanation for this result is that the present study measured perceived level of social support, not the size of each individuals’ social network, as have many of the previous research studies. It is possible that with increased Internet use, the number of persons in each participant’s social network may change. However, the results of this study suggest that any potential network size change related to Internet use does not necessarily change the amount of social support individuals perceive.

Internet and Well-Being

The results of the regressions on the four subscales of the SWBI from Chapin and colleagues’ factor analysis (2004) found the set of Internet variables to be significantly related to psychological well- being scores and financial well-being scores. The set of Internet variables was not significantly related to family and social wellbeing or physical well-being. To fully appreciate these results, it is important to examine the individual contributions of each of the Internet activities to the overall models.

Online gaming in particular had a negative relationship with all four subscales, especially, psychological well-being. Prior research on Internet gaming has found that playing online games can become an addiction that may lead to sacrifices in other important life activities, including sleep, time with loved ones, work, and school (Griffiths, Davies, & Chappell, 2004; Ng & WiemerHastings, 2005; Petty, 2006). However, although the range of hours that participants played online games in the present study was O to 72 hr per week, only 2 participants played online games 40 hr a week or more. Griffiths and colleagues (2004) defined excessive playing as 80 hr a week or more. Furthermore, only 11 participants in this study played games online between 20 and 39 hr per week. This suggests that even a relatively small amount of online gaming may be detrimental to an individual’s sense of well-being. However, the results of the study did not show as strong a negative relationship between online gaming and perceived social support. Therefore, gaming may not affect actual perceived social support but may have other harmful consequences that influence well-being. This surprisingly robust result certainly warrants further research.

Disability-related information seeking was also found to be negatively associated with both psychological wellbeing and financial well-being, as well as perceived social support. This is an interesting result because many studies have demonstrated significant benefits of healthrelated Internet use in individuals with chronic illness (e.g., Barrera et al., 2002; Fogel et al., 2002). However, it is important to note that the negative association in the present study was only found related to disability information; nondisability-related information seeking did not have this negative effect. The difference in these outcomes may be related to the greater investment that participants with disabilities have in finding accurate and reliable disability and health information. Sillence and Briggs (2007) found that users with genuine health risks paid close attention to the content of selected sites and were careful and critical evaluators of the information provided. The use of the Internet to search for disabilityrelated information may consequently involve higher amounts of stress because of the stakes being so high.

A positive relationship to note is that creating and updating one’s own Web site marginally predicted higher psychological well- being scores. Persons with spinal cord injury may receive satisfaction from sharing their stories and providing advice to others in similar situations. In today’s era of the blog, people can share opinions, discuss activities, vent frustrations, and so on, to a like-minded audience who may provide positive reinforcement in return.


A body of literature exists related to subjective wellbeing and the impact that work and leisure activities have on quality of life. Such research may help to explain the mechanisms through which Internet use affects wellbeing. For example, Csikszentmihalyi (1990) describes the phenomenon of the optimal experience, by which people are able to achieve true happiness through controlling the inner consciousness. According to this model, also referred to as flow, the optimal experience is characterized by having a well-defined goal, feeling as if one’s skills are adequate to cope with the challenges at hand, measuring progress and receiving feedback with regard to one’s goal, being able to fully concentrate on the task and forget about the worries and frustrations of everyday life, having a strong intrinsic motivation to complete the task, losing self-consciousness, and experiencing an altered sense of time. During the state of flow, people are so involved in an activity that nothing else seems to matter and the experience is so enjoyable that people will do it simply for the sake of doing it. It may be possible to achieve an optimal experience while using the Internet; however, this ideal is likely bound to the type of activity that the user is performing. For example, completing a challenging online crossword puzzle may lead to conditions that make flow possible, but reading the latest celebrity gossip pages may not. As mentioned, television viewing cannot create an optimal experience, because the activity is neither goal directed nor challenging (Csikszentmihalyi, 1990; Kubey & Csikszentmihalyi, 1990). Excessive viewing may therefore lead to decreases in well-being. Although using the Internet is not entirely passive, as television is, certain activities (such as reading discussion boards) require little active participation.

According to Drainoni and colleagues (2004), Internet access, if properly utilized, can empower persons with spinal cord injury by providing a means for enhanced participation in a variety of aspects of daily life. The Internet may provide important opportunities to people with disabilities by reducing physical barriers, facilitating communication, and providing an interactive conduit for the exchange of information (Drainoni et al., 2004). Individuals may feel great comfort in the anonymity of the Internet, where they may be evaluated more for the strength of their contributions than for their physical appearance or disability (Madara, 1997; McKenna & Seidman, 2005). The Internet also provides protection against self- consciousness and social anxiety, and active participation can lead to greater levels of self-acceptance, decreased feelings of isolation, and increased friendship formation (McKenna & Baugh, 2000; Morahan-Martin & Schumacher, 2003). Other favorable outcomes from Internet use may include improved participation in the marketplace, increased access to information, and heightened morale.

Limitations and Considerations

Several limitations to this study must be taken into consideration when interpreting the results. It is important to mention that because this study is correlational, no causality between variables can be determined. In addition, the impact of the Internet may not have been fully captured by the measure used. Variables such as shopping, banking, utilizing government services, taking online courses, and searching for jobs were not separately measured. Such activities are assumed to have been included in “other Web activities”; however, they were not delineated. Also, no distinction was made between Internet use for work and leisure. It is quite likely that many individuals in this study utilize the Internet at work, which could potentially confound the results. Furthermore, it is possible that some of the variables might have overlapped to some degree. For example, participating in online support groups might involve utilizing bulletin boards, and it is impossible to determine how participants might have divided this time within the measure.

Another potential limitation of the study lies in the fact that the data were collected online. Internet survey methodology provides many advantages over traditional paper-and-pencil tests, including access to an expanded participant pool and the convenience of automated data collection (Wright, 2005). In addition, multiple studies have found Web-based and paper-and-pencil test formats to be virtually equivalent in terms of reliability and factor structure (Herrero & Meneses, 2006; Query & Wright, 2003). However, significant disadvantages to online data collection do exist. For example, greater uncertainty may be present regarding the validity of the data (Wright, 2005). Little may be known about the characteristics of online participants, aside from demographic information collected in the survey, which itself may be questionable. As mentioned, a validity question was asked in this study to help ensure that only individuals with spinal cord injury completed the survey. Also, individuals who complete a particular survey may be inherently different from those who do not choose to complete the survey, which may lead to systematic bias (Wright, 2005).

The digital divide in computer use and Internet access rates is an important consideration in this study. In a recent compilation of nationally representative data regarding computer and Internet use, Dobransky and Hargittai (2006) found that individuals with disabilities are almost half as likely to use computers at home (30.2% versus 57.6%) and the Internet at home (26.4% versus 54.4%) than are people without disabilities. The researchers also found that people with disabilities are about half as likely to use the Internet anywhere (e.g., home, work, school, library) than are people without disabilities (30.8% versus 63.6%). This discrepancy may be due to cost of equipment and Internet subscriptions, as well as lack of access to appropriate assistive technology. Because data in the present study were collected exclusively online, only those with spinal cord injury who had computer and Internet access would have had the opportunity to participate.


The results of this study indicate that frequency and type of Internet use are not significantly related to perceived social support in persons with spinal cord injury. In addition, although the bivariate analysis revealed that there is a significant negative association between Internet use and overall sense of well-being, the simultaneous regressions shed light on this relationship. Frequency of online gaming was negatively related to all four components of sense of well-being studied here, with especially strong negative relationships with psychological and financial well- being. Disability-related information seeking was also negatively related to psychological and financial well-being, as well as level of perceived social support. Although care should be used with respect to online gaming in particular, Internet use as a whole should not be overlooked by rehabilitation counselors for its practical uses to increase independence and social connectedness in persons with disabilities.


Barrera, M. J., Glasgow, R. E., McKay, H. G., Boles, S. M., & Feil, E. G. (2002). Do Internet-based support interventions change perceptions of social support? An experimental trial of approaches for supporting diabetes self-management. American Journal of Community Psychology, 30, 637-654.

Chan, R, Pruett, S., Miller, S. M., Frain, M., & Blalock, K. (2006). Internet utilization by people with disabilities: Applications and research directions. In K. Hagglund & A. Heinemann (Eds.), Handbook of applied disability and rehabilitation research (pp. 263-278). New York: Springer.

Chapin, M., Miller, S. M., Ferrin, J. M., Chan, F., & Rubin, S. E. (2004). Psychometric validation of a subjective well-being measure for people with spinal cord injuries. Disability and Rehabilitation, 26, 1135-1142.

Cody, M. L, Dunn, D., Hoppin, S., & Wendt, P. (1999). Silver surfers: Training and evaluating Internet use among older adult learners. Communication Education, 48, 269-286.

Cohen, J., Cohen, P., West, S. G., & Aiken, L. S. (2003). Applied multiple regression/correlational analysis for the behavioral sciences. Mahwah, NJ: Lawrence Erlbaum.

Csikszentmihalyi, M. (1990). Flow: The psychology of optimal experience. New York: HarperCollins.

Darlington, R. B. (1990). Regression and linear models. New York: McGraw-Hill.

Davison, K. P., Pennebaker, J. W., & Dickerson, S. S. (2000). The social psychology of illness support group. American Psychologist, 55, 205-217.

Dobransky, K., & Hargittai, E. (2006). The disability divide in Internet access and use. Information, Communication & Society, 9, 313-334.

Drainoni, M., Houlihan, B., Williams, S., Vedrani, M., Esch, D., LeeHood, E., et al. (2004). Patterns of Internet use by persons with spinal cord injuries and relationship to health-related quality of life. Archives Physical Medicine and Rehabilitation, 85, 1872-1879.

Fogel, J., Albert, S. M., Schnabel, R, Ditkoff, B. A., & Neugut, A. I. (2002). Internet use and social support in women with breast cancer. Health Psychology, 21, 398-404.

Griffiths, M. D., Davies, M. N. O., & Chappell, D. (2004). Demographic factors and playing variables in online computer gaming. CyberPsychology & Behavior, 7, 479-487.

Gross, E. E, Juvonen, J., & Gable, S. L. (2002). Internet use and wellbeing in adolescence. Journal of Social Issues, 58, 75-90.

Gustafson, D. H., Hawkins, R., Boberg, E., Pingree, S., Serlin, R. E., Graziano, R, et al. (1999). Impact of a patient-centered, computerbased health information/support system. American Journal of Preventive Medicine, 16, 1-9.

Herrero, J., & Meneses, J. (2006). Short Web-based versions of the Perceived Stress (PSS) and Center For Epidemiological StudiesDepression (CESD) scales: A comparison to pencil and paper responses among Internet users. Computers in Human Behavior, 22, 830- 846.

Hlebec, V., Manfreda, K. L., & Vehovar, V. (2006). The social support networks of Internet users. New Media & Society, 8, 9-32.

Houlihan, B. V., Drainoni, M., Warner, G., Nesathurai, S., Wierbicky, J., & Williams, S. (2003). The impact of Internet access for people with spinal cord injuries: A descriptive analysis of a pilot study. Disability and Rehabilitation: An International Multidisciplinary Journal, 25, 422-431. Kalichman, S. C., Benotsch, E. G., Weinhardt, L., Austin, J., Luke, W, & Cherry, C. (2003). Health-related Internet use, coping, social support, and health indicators in people living with HIV/AIDS: Preliminary results from a community survey. Health Psychology, 22, 111-116.

Kalichman, S. C., Cain, D., Cherry, C., Pope, H., Eaton, L., & Kalichman, M. O. (2005). Internet use among people living with HIV/ AIDS: Coping and health-related correlates. AIDS Patient Care and STDs, 19, 439-448.

Kalichman, S. C., Weinhardt, L., Benotsch, E., DiFonzo, K., Luke, W., & Austin, J. (2002). Internet access and Internet use for health information among people living with HIV-AIDS. Patient Education and Counseling, 46, 109-116.

Kraut, R., Kiesler, S., Boneva, B., Cummings, J. N., Helgeson, V., & Crawford, A. M. (2002). Internet paradox revisited. Journal of Social Issues, 58, 49-74.

Kraut, R., Mukhopadhyay, T., Szczypula, J., Kiesler, S., & Scherlis, B. (1999). Information and communication: Alternative uses of the Internet in households. Information Systems Research, 10, 287- 303.

Kraut, R., Patterson, M., Lundmark, V., Kessler, S., Mukopadhyay, T., & Scherlis, W. (1998). Internet paradox: A social technology that reduces social involvement and psychological well-being? American Psychologist, 53, 65-77.

Kubey, R., & Csikszentmihalyi, M. (1990). Television and the quality of life: How viewing shapes everyday experience. Hillsdale, NJ: Lawrence Erlbaum.

LaRose, R., Eastin, M. S., & Gregg, J. (2001). Reformulating the Internet paradox: Social cognitive explanations of Internet use and depression. Journal of Online Behavior, 1(2). Retrieved April 25, 2007, from paradox.html

LaRose, R., Mastro, D., & Eastin, M. S. (2001). Understanding Internet usage: A social-cognitive approach to uses and gratifications. Social Science Computer Review, 19, 395-413.

Madara, E. J. (1997). The mutual-aid self-help online revolution. Social Policy, 27, 20-26.

McKay, H. G., Glasgow, R. E., Feil, E., Boles, S. M., & Barrera, M. (2002). Internet-based diabetes self-management and support: Initial outcomes from the Diabetes Network Project. Rehabilitation Psychology, 47, 31-48.

McKenna, K. Y. A., & Bargh, J. A. (1998). Coming out in the age of the Internet: Identity “demarginalization” through virtual group participation. Journal of Personality and Social Psychology, 75, 681- 694.

McKenna, K. Y. A., & Bargh, J. A. (2000). Plan 9 from cyberspace: The implications of the Internet for personality and social psychology. Personality and Social Psychology Review, 4, 57-75.

McKenna, K. Y. A., Green, A. S., & Gleason, M. E. J. (2002). Relationship formation on the Internet: What’s the big attraction? Journal of Social Issues, 58, 9-31.

McKenna, K. Y. A., & Seidman, G. (2005). You, me, and we: Interpersonal processes in electronic groups. In Y. AmichaiHamburger (Ed.), The social net: Human behavior in cyberspace (pp. 191-217). Oxford, UK: Oxford University Press.

Morahan-Martin, J., & Schumacher, P. (2003). Loneliness and social uses of the Internet. Computers in Human Behavior, 19, 659- 671.

Ng, B. D., & Wiemer-Hastings, P. (2005). Addiction to the Internet and online gaming. CyberPsychology & Behavior, 8, 110-113.

Nie, N., & Erbring, L. (2000). Internet and mass media: A preliminary report. IT & Society, 1, 134-141.

Petty, N. M. (2006). Internet gambling: An emerging concern in family practice medicine? Family practice, 23, 421-426.

Query, J. L. J., & Wright, K. (2003). Assessing communication competence in an online study: Toward informing subsequent interventions among older adults with cancer, their lay caregivers, and peers. Health communication, 15, 203-218.

Rodgers, S., & Chen, Q. (2005). Internet community group participation: Psychosocial benefits for women with breast cancer. Journal of Computer-Mediated Communication, 10(4). Retrieved April 15, 2007, from

Rubin, S. E., Chan, R, Bishop, M., & Miller, S. M. (2003). Psychometric validation of the Sense of Well-Being Inventory for program evaluation in rehabilitation. The Rehabilitation Professional, 11(2), 54-59.

Sanders, C. E., Field, T. M., Diego, M., & Kaplan, M. (2000). The relationship of Internet use to depression and social isolation among adolescents. Adolescence, 35, 237-242.

Shaw, L. H., & Gant, L. M. (2002). In defense of the Internet: The relationship between Internet communication and depression, loneliness, self-esteem, and perceived social support. Cyber Psychology & Behavior, 5, 157-171.

Sillence, E., & Briggs, P. (2007). Please advise: Using the Internet for health and financial advice. Computers in Human Behavior, 23, 727-748.

Swickert, R. J., Hittner, J. B., Harris, J. L., & Herring, J. A. (2002). Relationships among Internet use, personality, and social support. Computers in Human Behavior, 18, 437-451.

Taylor, H. (2000, June 7). How the Internet is improving the lives of Americans with disabilities (Harris Poll No. 30). Washington, DC: Harris Poll.

Waestlund, E., Norlander, T., & Archer, T. (2001). Exploring crosscultural differences in self-concept: A meta-analysis of the SelfDescription Questionnaire 1. Cross-Cultural Research: The Journal of Comparative Social Science, 35, 280-302.

Weinert, C. (2003). Measuring social support: PRQ2000. In O. Strickland & C. Dilorio (Eds.), Measurement of nursing outcomes: Vol. 3. Self-care and coping (pp. 161-172). New York: Springer.

Wright, K. B. (2005). Researching Internet-based populations: Advantages and disadvantages of online survey research, online questionnaire authoring software packages, and Web survey services. Journal of Computer-Mediated Communication, 10(3). Retrieved April 15, 2007, from

Susan M. Miller

Florida State University, Tallahassee

Susan M. Miller, PhD, CRC, is an assistant professor of rehabilitation counseling and services in the Department of Childhood Education, Reading, and Disability Services at Florida State University. She received her doctorate from the University of Wisconsin-Madison in 2005 and has been a rehabilitation counselor educator for approximately 2.5 years. Dr. Miller’s research interests include psychosocial aspects of disability and evidence- based rehabilitation counseling practice.

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