Pornography use in the setting of the COVID-19 pandemic

Impact of COVID-19 on pornography use: Evidence from big data analyses

INTRODUCTION

Coronavirus disease 2019 (COVID-19) has led to radical changes in social distancing awareness and affected social relationships. Owing to large-scale lockdown, home quarantine and social distancing requirements, it was anticipated that sexual activities would be severely impacted. However, retrospective self-report studies showed that pornography use and autoerotism increased during the pandemic.

AIM

This study used big-data databases available on the Internet to investigate factors that modulated pornography use during the pandemic.

METHODS

Daily relative search volume (RSV) data from Google Trends for the period from 24 February 2020 to 13 July 2020 were extracted. Pornhub traffic data were extracted from the Pornhub Insights website, for the period from 24 February 2020 to 13 July 2020. The parameter was defined as 'percent change in traffic compared to an average day in 2019'. The number of daily new cases of COVID-19 was extracted from the database on Our World in Data.

OUTCOME MEASURES

The normality of the data was examined using the Shapiro-Wilk test. All variables included in this study were non-normally distributed. Therefore, non-parametric tests or parametric tests with bootstrapping were adopted where appropriate.

RESULTS

According to Google Trends, the RSV for 'pornography' increased after late March 2020, which is close to the date when the World Health Organization declared COVID-19 a global pandemic. The number of daily new cases of COVID-19 was positively correlated with the traffic of Pornhub, a popular pornography website, and the RSV for 'pornography'. Moderation analysis demonstrated a significant main effect of daily new cases of COVID-19 and the RSV for 'social distancing' in predicting Pornhub traffic/RSV for 'pornography'. Furthermore, the RSV for 'social distancing' significantly moderated the relationship between daily new cases and Pornhub traffic/RSV for 'pornography'. A stronger COVID-pornography use association was observed with increased social distancing awareness.

CONCLUSION

Increased pornography consumption during the pandemic was observed, and it was associated with the severity of the pandemic. Social distancing awareness could be a key factor influencing interest in and use of pornography. Further studies on the changes in sexual desire and birth-rate control are worthwhile because long-term public health may be affected by the changes in sexual behaviour during the pandemic.

Potentially addictive behaviours increase during the first six months of the Covid-19 pandemic

BACKGROUND AND AIMS

In this study we aimed to assess multiple potentially addictive behaviours simultaneously for an extended period of time during the Covid-19 pandemic and their relation to distress.

METHODS

Data were collected every three days from Amazon's MTurk between 26.03.2020 and 02.10.2020 in repeated cross-sectional samples of 25 participants resulting in a total sample of 1430 US adults (60% men, mean age 36.6 years, SD = 11). General distress and Covid-19 related fear were assessed as well as self-reported frequency of eight potentially addictive behaviours: shopping (compulsive buying), alcohol, smoking, legal substances, illegal substances, gambling, gaming and overeating.

RESULTS

We found a positive relationship between time and the frequency of each self-reported potentially addictive behaviour ( τ = 0.15-0.23, all P < 0.001), and their frequency is linearly related to the intensity of (Covid-19-related and general) distress ( τ = 0.12-0.28, all P < 0.001). Most popular activities were gaming and compulsive buying, and the relative frequency of the behaviours remained about the same during the data collection period.

DISCUSSION

It is possible that people seek other maladaptive substitutes when other coping mechanisms (e.g. social recreation) are hindered depending on their level of distress.

CONCLUSION

Given the evidence for the increasing frequency of potentially addictive behaviours and their relevance to distress, special attention needs to be paid to reduce potential harmful effects of maladaptive coping during and after this demanding period.

Assessing online gaming and pornography consumption patterns during COVID-19 isolation using an online survey: Highlighting distinct avenues of problematic internet behavior

Background and aim

The Coronavirus (COVID-19) pandemic has required drastic safety precautions to contain virus spread, involving a protracted self-isolation period. Those with greater perceived or actual life stress are vulnerable to develop problematic internet behaviors. Thus, we assessed how COVID-19 social isolation affected online gaming (OG) and pornography viewing (PV) in the general population.

Methods

We developed an online cross-sectional survey, Habit Tracker (HabiT), completed by 1,344 adults (≥18 years). HabiT was released internationally with individuals from 80 countries participating; a majority residing in the United States and United Kingdom. We measured changes in OG (IGDS9-SF) and PV (CYPAT) behaviors before and during the COVID-19 quarantine period. We also assessed psychiatric factors such as anxiety, depression (HADS), and impulsivity (SUPPS-P). The primary outcome measures were change in amount of, and current OG and PV severity during quarantine. These measures were related to ten COVID-19-related stress factors.

Results

Overall, we observed a large increase in OG and a minor increase in PV. Those who increased OG (63%) and PV (43%) during quarantine were younger individuals, males, those who left the quarantine household infrequently, those who reported low frequency or poor quality social interactions, and those with higher depression, anxiety, and urgency impulsivity.

Discussion

Our findings highlight similarities between forms of problematic internet behaviors driven by stress, depression, anxiety; while highlighting distinct avenues which these behaviors can manifest.

Conclusion

We emphasize the relevance of identifying those in need of emotional regulation interventions, to mitigate problematic internet behaviors in the context of COVID-19 isolation.

Partnership status, living arrangements, and changes in sexual behaviour and satisfaction during the COVID-19 lockdown: insights from an observational, cross-sectional online survey in Singapore

Background The SARS-CoV-2 (coronavirus disease 2019; COVID-19) pandemic and its concomitant movement control measures have had a profound impact on the world. In spite of its potential impact on sexual health, there is a lack of research on how the pandemic and its movement control measures have impacted sexual wellbeing among Singaporeans. Methods This observational, cross-sectional study was conducted from August to September 2020. Participants were recruited through an online survey instrument promoted through social media. Respondents self-reported their sexual behaviours and levels of sexual satisfaction prior to and during the COVID-19 pandemic movement control measures. Results We recruited a total of 562 participants, of whom 338 (60.1%) ever had a sexual experience. Singles (n=106, 31.4%) and those not living with their partners (n=115, 34.0%) reported a greater decrease in partnered sexual activities but a greater increase in individual sexual activities such as masturbation, sending and receiving nudes and watching pornography, relative to those who were living with their partners (n=117, 34.6%). Multivariable analyses indicated that relative to singles, those who were not living with their partners were more likely to experience a decrease in sexual satisfaction (adjusted prevalence ratio [aPR]=1.42, 95% CI [1.07, 1.90]), whereas those who were living with their partners were less likely to experience a decrease in sexual satisfaction (aPR=0.45, 95% CI [0.25, 0.81]). Conclusions Interventions may focus on enhancing sexual wellness by educating on and supporting individual or partnered sexual activities that may vary along the lines of partnership status and living arrangements during the implementation of movement control measures.

Partner number and use of COVID-19 risk reduction strategies during initial phases of the pandemic in British Columbia, Canada: a survey of sexual health service clients

Objectives

Initial public health guidance related to sex and COVID-19 infection focused on reducing partner number. We characterized individuals having a higher partner number during the initial phases of the pandemic.

Methods

In British Columbia, the initial wave of COVID-19 cases was from March 14 to May 19, 2020, followed by gradual lifting of public health restrictions. We conducted an e-mail survey of existing sexual health service clients during the period of July 23 to August 4, 2020. We used bivariate logistic regression to examine the association between the reported number of sexual partners since the start of the pandemic and key variables (level of significance p < 0.01).

Results

Of the 1196 clients in our final sample, 42% reported 2+ partners since the start of the pandemic, with higher odds among participants who were men who have sex with men, and single or in open relationships prior to the pandemic. This group was more likely to perceive stigma associated with having sex during the pandemic, and had the highest use of strategies to reduce risk of COVID-19 infection during sexual encounters (mainly focused on reducing/avoiding partners, such as masturbation, limiting sex to a “bubble”, and not having sex).

Conclusion

Sexual health service clients in BC with 2+ partners during the initial phases of BC’s pandemic used strategies to reduce their risk of COVID-19 infection during sex. Our study provides support for a harm reduction approach to guidance on COVID-19 risk during sex, and highlights the need for further research on stigma related to having sex during the COVID-19 pandemic.

Supplementary Information

The online version contains supplementary material available at 10.17269/s41997-021-00566-9.

Changes in substance use and other reinforcing behaviours during the COVID-19 crisis in a general population cohort study of young Swiss men

BACKGROUND AND AIMS

There are concerns about the potential impact of the coronavirus disease (COVID-19) pandemic on substance use (SU) and other reinforcing behaviours (ORB). This paper investigates changes in SU and ORB among young men during the COVID-19 crisis (i.e. March-June 2020).

METHODS

Before and during the COVID-19 crisis, 2,344 young Swiss men completed questionnaires covering SU (i.e. alcohol, cigarettes, illegal cannabis), ORB (i.e. gaming, watching TV series, internet pornography) and sociodemographic and work-related characteristics (i.e. deterioration in the work situation, change in working hours, change in working hours from home, healthcare workers' and other professionals' contacts with potentially infected people, linguistic region, call up to military or civil protection unit, living situation, age).

RESULTS

Latent-change score models showed significant decreases of 17% for drinking volume and frequency of heavy episodic drinking, and a significant increase of 75% for time spent gaming and watching TV series. Subgroups showed greater relative increases. French-speaking participants, those who experienced a deterioration in their work situation and healthcare workers in contact with potentially infected people reported increased cigarette use. Those without children increased gaming, whereas those who worked fewer hours, experienced a deterioration in their work situation or were French-speaking did more gaming and watched more TV series. Those who lived alone or were German-speaking watched more internet pornography.

CONCLUSION

During the COVID-19 crisis, young Swiss men drank less alcohol and spent more time gaming and watching TV series. Changes in SU and ORB were not homogenous in the young Swiss men population.

"Making Peace" with Bodies and Sexual Selves: Changes during COVID-19 among Adults in the United States

The COVID-19 pandemic has negatively impacted the physical and mental health of many and has necessitated widespread societal shifts, including changes to work and family activities. These changes have impacted individuals’ identity, including their sexual self-image and body image, yet research on perceptions of these changes is missing. This study reports on quantitative and qualitative data from an electronic survey with adults in the United States (N = 326) to examine these perceptions. Body appreciation did not significantly differ between demographic groups. Themes emerging from the qualitative results included changes in general self-image (becoming more restricted or disempowered), changes in sexual self-image (deepening, becoming more sexy/sexual, or less sexy/sexual), and changes in body image (positive, negative, and neutral). Our findings point to positive, negative, and neutral effects on sexual self-image and body image, implying that nuanced approaches are needed to understand how identity has transformed as a result of the COVID-19 pandemic.

Young people's romantic relationships and sexual activity before and during the COVID-19 pandemic

BACKGROUND

Social distancing measures to reduce the spread of COVID-19 may profoundly impact young people's relationships. This study compared adolescent and young adults' romantic relationships and sexual activity before and after social distancing policies were enacted.

METHODS

In June 2020, 351 youth participating in an ongoing intervention study in Fresno County, California completed an online survey about their experiences related to COVID-19. The survey included open and closed-ended questions about their romantic relationships, sexual activity, and online romantic or sexual interactions before and during social distancing restrictions. We used the chi-square test of independence to compare adolescent (ages 13-17) and young adults' (ages 18-21) responses. Results were also compared to responses in the intervention study's baseline survey.

RESULTS

One-third (37%) of youth were dating or in a romantic relationship and 28% spent time in person with a partner early in the COVID-19 pandemic. Among those dating or in a relationship, 34% physically distanced from their partner due to parental restrictions related to COVID-19. Youth also spent less time in person with their partners during the pandemic than before. Although most youth (69%) were not sexually active before or during the pandemic, 22% had sex during the social distancing period. Young adults were more likely to spend time with their partners and have sex during the restrictions than adolescents. Most youth were not involved in sexting or online dating, before or during the pandemic.

CONCLUSIONS

Adolescents and young adults have continued to engage in sexual and romantic relationships during the COVID-19 pandemic, although many reported physical distancing from their partners. Results suggest that youth continue to need access to sexual health education and services during emergencies such as the COVID-19 pandemic.

Stress, internet use, substance use and coping among adolescents, young-adults and middle-age adults amid the 'new normal' pandemic era

Background

Globally, there is a constant state of flux amid the 'new normal' period of the COVID-19 pandemic. People try to accommodate to uncertainty, stress, and the threat of facing subsequent waves. It is crucial to explore and compare the psychological and behavioral processes of adolescents, young adults, and middle-aged adults amid such an era in a developing country like India.

Aim

The present study compared the stress, internet use, substance use, and coping among adolescents, young adults, and middle-aged adults amid India's 'new normal' era.

Methods

A cross-sectional design was used on an online platform. The sample included 1027 participants [ 456 adolescents; 347 young adults, and 224 middle age-adults] using PerceivedStress Scale, Internet Gaming Disorders-9, DSM-5 Self-Rated Level-1, and Brief-COPE scale.

Results

Results showed moderate stress among all participants across all ages. Adolescent females perceived the highest stress (20.91, SD = 8.65); Adolescents reported higher internet use (Females: M = 3.59, S.D. = 2.44; Males: M = 3.40, S.D. = 2.30); Young and middle-aged adults Males reported significantly higher substance use (M = 1.60, S.D. = 2.96; M = 1.17, S.D. = 2.21). Maladaptive coping was used more by Young Adult Males (M = 10.83, S.D. = 4.66). Internet use was positively correlated with perceived stress (0.40) and maladaptive coping (0.40). Substance Use was also moderately positively correlated with maladaptive coping (0.38).

Discussion

The study reveals significant variations in perceived stress, internet use, substance use, and coping based on gender and age variations. Adolescent females were the most affected and reported high perceived stress, whereas middle-aged adults were the least affected.

Conclusion

The study provides further avenues to understand the stress and coping in different sections of society amid the 'new normal' era. It also gives an idea about resilience and identifies the sections of society which require focused interventions.

Gambling and the COVID-19 pandemic in the province of Quebec (Canada): protocol for a mixed-methods study

INTRODUCTION

The COVID-19 pandemic has major collateral impacts on mental health. Gambling is among the major public health issues that seems to have been transformed by the pandemic. In the province of Quebec in Canada, gambling is an important leisure activity. About two out of three adults are in Quebec gamble. The objective of this study is to draw a portrait of the impacts of the COVID-19 pandemic on gamblers and to learn more about their experiences during the pandemic in the province of Quebec.

METHOD AND ANALYSIS

This study has a sequential explanatory mixed-method design in two phases. The first phase is a cross-sectional online survey with Quebec residents who are 18 years of age or older and have gambled at least once in the previous 12 months. The second phase will be a qualitative study. Semistructured interviews will be conducted with gamblers, family members, addiction counsellors and state representatives selected through purposing sampling.

ETHICS AND DISSEMINATION

This study is one of the first mixed-methods studies on the impacts of the COVID-19 pandemic on gambling. This study will generate new scientific knowledge on a worrisome public health issue, that is, gambling, and provide a better understanding of the experiences and gambling behaviours of gamblers during the pandemic. This study is funded by the Ministry of Health and Social Services of the Government of Quebec and was approved on 27 October 2020 by the Scientific and Research Ethics Committee of the CIUSSS de l'Estrie-CHUS. This is a 2-year study that will be completed in June 2022.

Problematic Pornography Use: Legal and Health Policy Considerations

Purpose of Review

Reports of sexual violence, especially towards women and children, are rapidly increasing. At the same time, rates of problematic pornography use (PPU) are accelerating across the world too. The purpose of this review is to consider the recent research on PPU and its contribution to sexual violence. The article offers guidance to governments on possible health policy interventions and legal actions to prevent the development of PPU and to reduce the incidence of sexual violence in society.

Recent Findings

Working from the consumer’s point of view, we identify PPU and ask how much pornography is needed to cause PPU. We examine how PPU drives sexual offending in children, adolescents and adults. The impact of PPU on some consumers’ behaviour suggests significant links to domestic violence. Sexual strangulation is highlighted as an example. Artificial intelligence algorithms play a key role in the pornography industry and appear to be driving escalation to more violent material, inducing high levels of sexual dysfunction in consumers and creating appetites for viewing child sexual abuse material (CSAM).

Summary

Easy access to internet pornography has led to an increase in PPU and sexual violence. Diagnoses and treatments for PPU are examined, as are legal transgressions of a civil and criminal nature arising from PPU. Legal remedies and government policy implications are discussed from the point of view of the precautionary principle. Strategies covered include age verification for pornography, public health campaigns and embedded health and legal warnings for users at the start of pornography sessions along with lessons for pupils about pornography’s impact on the brain.

Sexual Behavior Change Among Gay and Bisexual Men During the First COVID-19 Pandemic Wave in the United States

Background

After decades of navigating HIV and other sexually transmitted infections, gay and bisexual men are responding to new and uncertain risks presented by the coronavirus (COVID-19) pandemic by adapting their sexual behavior.

Methods

This paper uses data from a national sample of 728 gay and bisexual men collected from April 10 to May 10, 2020, to examine changes to sexual behavior in response to the first wave of the pandemic in the USA. We also assess whether behavior modifications are associated with exposure to statewide public health measures, including Stay-at-Home orders.

Results

Sexual minority men report significant changes to their sexual behavior and partner selection during the first wave. Nine out of 10 men reported having either one sexual partner or no sexual partner in the last 30 days at the time of interview, a decrease compared to just before the pandemic for nearly half of men surveyed. Reporting no sexual partners in the last 30 days was significantly predicted by increased exposure to a Stay-at-Home order. Sexual minority men also reduced interactions with casual partners, increased no-contact sexual behaviors (e.g., masturbation and virtual sex), and engaged in new strategies to reduce their risks of infection from partners. HIV-positive men were particularly likely to adopt strategies including avoiding casual partners and avoiding public transportation to meet sexual partners.

Conclusion

Sexual minority men's behavior changes during the first wave may have reduced the impact of the coronavirus pandemic on their communities. Despite substantial changes in sexual behavior for most men in our sample during the initial first wave, we identify some concerns around the sustainability of certain behavioral changes over time and nondisclosure of COVID-19 symptoms to partners.

Addictions en temps de pandémie

L’Organisation mondiale de la santé a déclaré la maladie causée par le coronavirus 2 comme pandémie en mars 2020. Via les différentes mesures prises, un phénomène stressant psychosocial induit par cette épidémie a, dès lors, émergé en raison des difficultés financières, de l’isolement social et du caractère incertain du futur. L’ensemble des études nationales et internationales a mis en évidence une augmentation des usages de tabac, d’alcool et de substances illicites. Outre les comportements de consommation excessive, voire les décompensations addictives liées aux substances, il faut également prendre en considération l’usage excessif de la pornographie, des jeux de hasard et d’argent, des jeux vidéo essentiellement via Internet et l’exercice physique. La COVID-19 peut être à l’origine d’un certain nombre de conséquences et de complications chez les personnes souffrant de troubles liés à l’usage de substances licites ou illicites, population particulièrement vulnérable. Dans cette revue de la littérature narrative, nous analyserons les données concernant les comportements de consommation excessive et les addictions aux substances psychoactives licites et illicites et à certains types de comportements de la vie quotidienne. Nous avons, pour ce faire, utilisé les combinaisons de mots-clés pour sélectionner les articles scientifiques de langue anglaise et française publiés entre 2019 et 2021 en consultant les bases de données Medline, Embase, PsycInfo, Google Scholar.

Psychological distress in the context of the COVID-19 pandemic: the joint contribution of intolerance of uncertainty and cyberchondria

OBJECTIVE

To explore the direct and indirect associations between intolerance of uncertainty, health anxiety (HA), and psychological distress through problematic internet use (PIU) and cyberchondria, both before and during the first months of the COVID-19 pandemic.

DESIGN

Two Italian samples were enrolled via an online questionnaire. Sample 1 (N = 556; 69.3% females, M_age 29.6 years, SD = 13.2) was recruited in non-pandemic times, whereas Sample 2 (N = 575; 74% females, M_age 31.9 years, SD = 13.4) was recruited during the COVID-19 lockdown.

MAIN OUTCOME MEASURES

Self-report measures assessing HA and psychological distress.

RESULTS

Two distinct path analyses showed that intolerance of uncertainty was directly associated with HA and psychological distress in both samples. Moreover, cyberchondria partially mediated the relationship between intolerance of uncertainty and HA and PIU partially mediated the relationship between intolerance of uncertainty and psychological distress in both samples. The link between cyberchondria and psychological distress was significant in Sample 2 but non-significant in Sample 1. The model accounted for a substantial variance of HA and psychological distress in both samples.

CONCLUSION

Our findings suggest that problematic online behaviors might exacerbate the negative consequences of intolerance of uncertainty in terms of higher levels of HA and psychological distress both in pandemic and non-pandemic contexts.

Male Sexual Health and Sexual Behaviors during the First National COVID-19 Lockdown in a Western Country: A Real-Life, Web-Based Study

Restriction measures enacted during the COVID-19 pandemic had severe effects on male sexual and reproductive health. We aimed to investigate the real-life impact and perception of sexual function in 2020 in Italy, as the first Western country experiencing a national lockdown by measuring relative search volume for keywords pertaining to sexual health and behaviors provided by Google Trends and sales data for pro-erectile treatments. No significant change was observed for erectile dysfunction and premature ejaculation. Interest towards most phosphodiesterase type 5 inhibitors decreased significantly during lockdown (e.g., sildenafil, p = 0.0002; tadalafil p = 0.0016), then reverted to pre-lockdown levels (e.g., sildenafil, p < 0.0001; tadalafil p < 0.0001), mirroring a concomitant sales decrement (p = 0.0292). A subsequent recovery to previous levels at the end of the social confinement was also found (e.g., after vs. before lockdown, sildenafil, p = 0.8459; tadalafil p = 0.1166). During lockdown, interest towards pornography significantly increased during restrictions (p = 0.0053) and remained high (after vs. before lockdown, p = 0.0004), whereas interest towards paid and casual sex declined (p = 0.0015 and p = 0.049, respectively), then reverted to previous levels (after vs. before lockdown, p = 0.3969 and 0.8373, respectively). During the first Italian lockdown, we observed a transient but measurable decrease of sexual health-seeking behaviors and changes in sexual behaviors, with unknown impact for sexual medicine and public health.

Creativity and Leisure During COVID-19: Examining the Relationship Between Leisure Activities, Motivations, and Psychological Well-Being

Social distancing policies have been implemented around the world to reduce the spread of coronavirus disease 2019 (COVID-19). These measures have included temporary restrictions on mass gatherings and the closure of public facilities, limiting the pursuit of leisure activities such as travel while allowing more time for at-home pursuits, including creative activities such as gardening and painting. Previous research has demonstrated the benefits of physical activity for psychological well-being during COVID-19, but less attention has been given to the potential benefits of creative pursuits, such as arts and music. The present study investigated changes in the pursuit of creative, non-creative, and physical leisure activities and the relationship between engaging in leisure, the motivations for and barriers to pursuing these activities, and psychological well-being during COVID-19. A total of 3,827 participants from 74 countries completed an online leisure activities questionnaire and the World Health Organization Five Well-Being Index. Logistic regression indicated that gender, age, social distancing adherence, and employment status significantly predicted leisure engagement during COVID-19. Compared to sports and outdoor pursuits, participation in creative activities was generally more likely to increase during this period, while participation in non-creative activities was less likely to increase. Multiple linear regression indicated that maintaining or increasing time on leisure activities significantly predicted well-being during COVID-19, with increased time spent on home crafts and artisanship, fine arts, musical and performing arts engagement, sports and outdoor pursuits, niche and IT interests, and language activities each predicting higher well-being outcomes. Motivations such as seeking creative expression and mental stimulation, keeping fit, and maintaining social connections also predicted higher well-being. These findings suggest that participation in both physical and creative leisure activities may offer protective benefits for well-being during COVID-19, and that strategies to promote engagement in creative activities should also be considered in future guidance for mental health during periods of lockdown or isolation.

Who complies with coronavirus disease 2019 precautions and who does not?

PURPOSE OF REVIEW

Severe acute respiratory syndrome (SARS)-coronavirus disease 2019 (COVID-19) virus imposes a higher risk of complications and mortality among people with mental disorders. Until widely available vaccines, adherence to preventive behaviours remains the most crucial tool to prevent SARS/COVID-19 virus transmission. Our review focuses on the determinants of adherence behaviours.

RECENT FINDINGS

Adherence behaviours include the use of a face mask and protective gloves, personal hygienic behaviours (handwashing or using hand sanitiser), and keeping physical distance and avoiding social gatherings. In almost all studies, males and younger people show less adherence. Risk perception and health beliefs (especially perceived severity of COVID-19 related conditions) can explain the sex and age differences in adherence. Studies covering the impact of mental disorders on adherence are surprisingly missing, with the exception of smoking.

SUMMARY

Engaging men and young people in adopting preventive behaviours is crucial in protecting the whole community and specific vulnerable populations. There is a lack of studies investigating preventive behaviours among people living with mental disorders and addiction problems. Furthermore, descriptive and intervention studies are needed to understand and improve the adherence of this population to preventive behaviours.

Mental Health Support in the Time of Crisis: Are We Prepared? Experiences With the COVID-19 Counselling Programme in Hungary

The Coronavirus disease 2019 (COVID-19) posed unexpected global economic and societal challenges. These include a heavy impact on mental health due to fast changing lockdown and quarantine measures, uncertainty about health and safety and the prospect of new waves of infections. To provide crisis mental health support during the pandemic, Eötvös Loránd University in Hungary launched a specialist online counselling programme, consisting of one to three sessions. The programme was available to all university members between 4th March and 25th May 2020. Overall, 47 clients received support. In this paper we discuss challenges reported by clients, key features of providing a brief mental health intervention online, reflect on counsellor experiences and give recommendations on how mental health services could be developed in the time of crisis. Most clients had challenges with developing a daily routine under quarantine; and many had hardship related to finances, housing, and distance learning. Common mental health consequences included fear from the virus and stress, anxiety, and fatigue due to the interruption to everyday life. In some cases, more complex conditions were triggered by the pandemic. Examples include addictive behaviours and symptoms of depression or psychosis. However, referring cases beyond the competency of counselling proved to be a challenge due to the closure of specialist services. Counsellors observed three key features to the online delivery of a brief crisis mental health intervention: [1] an explicit problem-oriented approach to counselling; [2] challenges of building rapport online; and [3] frames of online counselling. Counsellor experiences often overlapped with those of clients and included challenges of working from home and adjusting to online counselling methods. The possibility of online counselling allowed that mental health care could take place at all during the pandemic. Client experiences reflect findings from previous literature. Like other mental health initiatives launched to tackle COVID-19, the intervention's effectiveness was not measured given the unexpected context and short time frame for programme development. We recommend the use of impact measurement tools to develop mental health services in crises. Meanwhile, the pandemic brought to attention the need to better understand online delivery models. Counsellors should have access to training opportunities on online counselling and managing work-life balance in a remote setting. The COVID-19 counselling programme in Eötvös Loránd University, Hungary is an example of providing online mental health counselling in the time of crisis. Clearly, more studies are needed discussing delivery models and effectiveness of mental health interventions during the pandemic. Experience and knowledge sharing across practitioners should be encouraged to improve how the field reacts to unexpected, high risk events and crises.

Non-pharmaceutical interventions during the COVID-19 pandemic: A review

Infectious diseases and human behavior are intertwined. On one side, our movements and interactions are the engines of transmission. On the other, the unfolding of viruses might induce changes to our daily activities. While intuitive, our understanding of such feedback loop is still limited. Before COVID-19 the literature on the subject was mainly theoretical and largely missed validation. The main issue was the lack of empirical data capturing behavioral change induced by diseases. Things have dramatically changed in 2020. Non-pharmaceutical interventions (NPIs) have been the key weapon against the SARS-CoV-2 virus and affected virtually any societal process. Travel bans, events cancellation, social distancing, curfews, and lockdowns have become unfortunately very familiar. The scale of the emergency, the ease of survey as well as crowdsourcing deployment guaranteed by the latest technology, several Data for Good programs developed by tech giants, major mobile phone providers, and other companies have allowed unprecedented access to data describing behavioral changes induced by the pandemic. Here, I review some of the vast literature written on the subject of NPIs during the COVID-19 pandemic. In doing so, I analyze 348 articles written by more than 2518 authors in the first 12 months of the emergency. While the large majority of the sample was obtained by querying PubMed, it includes also a hand-curated list. Considering the focus, and methodology I have classified the sample into seven main categories: epidemic models, surveys, comments/perspectives, papers aiming to quantify the effects of NPIs, reviews, articles using data proxies to measure NPIs, and publicly available datasets describing NPIs. I summarize the methodology, data used, findings of the articles in each category and provide an outlook highlighting future challenges as well as opportunities.

Phubbing and temperaments among young Lebanese adults: the mediating effect of self-esteem and emotional intelligence

Background

The rapid increasing rate of mobile and internet users in Lebanon, predisposes us to a high dependency on smartphones, leading to more phubbing. Phubbing has been found associated with many psychological factors. Thus, the main objectives of this study was (1) to evaluate the association between phubbing and temperaments, and (2) assess the mediating effect of self-esteem and emotional intelligence in the association between phubbing and temperaments among a sample of Lebanese adults.

Methods

A cross-sectional study, carried out between August and September 2020, enrolled 461 participants aged between 18 and 29 years old. Participants were recruited from all districts/governorates of Lebanon (Beirut, Mount Lebanon, North Lebanon, South Lebanon, and Bekaa) using the snowball technique. The Generic Scale of Phubbing, Rosenberg Self‐Esteem Scale, Schutte Self Report Emotional Intelligence Test and TEMPS-M were used to assess phubbing, self-esteem, emotional intelligence and temperaments respectively.

Results

Our results showed that higher depressive temperament (B = 1.21) was significantly associated with more phubbing, whereas higher self-esteem (B = − 0.32) was significantly associated with less phubbing. Regarding the mediating effect, self-esteem partially mediated the association between depressive temperament and phubbing (21.02%), whereas emotional intelligence had no mediating effect on the association between temperaments and phubbing.

Conclusion

A strong correlation between phubbing and temperaments has been found in our study with a partial mediating effect of self-esteem in this association. Our findings might be a first step for raising awareness to develop the etiquette of using smartphones by providing media education to families, and good media usage habits.

Problematic consumption of online pornography during the COVID-19 pandemic: clinical recommendations

The coronavirus disease (COVID-19) pandemic is one of the greatest contemporary challenges. Feelings of fear and uncertainty triggered by this pandemic have had noxious effects on people's mental health. This seems to have increased during quarantine and there is evidence of an intensification of rewarddirected behavior. Nevertheless, there are few studies dealing with pornography consumption during this period. The aim of this manuscript is to contextualize this phenomenon during the pandemic and suggest some clinical recommendations on the matter.

Problematic Internet use among residential college students during the COVID-19 lockdown: A social network analysis approach

BACKGROUND AND AIMS

During the COVID-19 lockdown, problematic Internet use (PIU) has become a serious issue among residential college students, who remain physically isolated from off-campus society. This study constructs an integrated model to investigate the influencing mechanisms of internal locus of control (LOC) and objective peer effects.

METHODS

Residential college students (n = 494) were surveyed from a single department of a Chinese university. An item from the World Value Survey was employed to measure internal LOC, while objective peer effects were assessed via friends' mutual nominations. Finally, PIU was measured using Young's Internet Addiction Tests, while a social network analysis and logit regression were combined to estimate various factors' effects on PIU.

RESULTS

In our sample, the prevalence rate of PIU was 30.6%, and while internal LOC was a protective factor for PIU, its protective role was diluted when exposed to a peer environment with high PIU prevalence. Furthermore, indegree performed contrasting roles on PIU under various network conditions. It acted as a protective factor when exposed to a low prevalence of PIU in a peer environment; however, it became a risk factor when PIU peers were prevalent. Lastly, the protective efficacy of betweenness was activated when individuals had more than one PIU friend.

DISCUSSION AND CONCLUSIONS

Further intervention studies focusing on individuals with a weak internal LOC are recommended during the lockdown. Additionally, interventions that consider the network structures carefully, may enhance the prevention of PIU.

Internet pornography exposures amongst young people in Malaysia: A cross-sectional study looking into the role of gender and perceived realism versus the actual sexual activities

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High prevalence of pornography exposure among participants and mostly through internet.

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Easy accessibility to free internet especially at home facilitate pornography use among young people.

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Further evidence is needed on perceived realism as a protective factor of pornography exposure.

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Male participants had earlier exposure on pornography during early adolescence.

Despite the wide accessibility to internet, pornography activities among youths are not well described in conservative countries like Malaysia. This study aimed to determine the prevalence, elicit gender differences and identify associated factors of pornographic exposure including perceived realism among college students. This cross-sectional study was conducted among students aged 18 to 25 years from seven colleges in Penang, Malaysia. A self-administered questionnaire was used to obtain data on socio-demographic characteristics, pornography exposure, pattern of use, sexual exposure and perceived realism. Among 986 participants, the prevalence of lifetime pornography exposure was 74.5%. More males (71.7%) were exposed to pornography, had started at earlier age, were frequent users and using the internet alone at home (p < 0.001). Males had higher odds of having exposure (Adjusted odds ratio, AOR = 20.44, 95% CI: 12.50 – 33.42, p < 0.001), whilst those who perceived pornography as real had lower odds of having pornographic exposure (AOR = 0.64, 95% CI: 0.43–0.94, p = 0.02). There is a high prevalence of pornography exposure among Malaysian college students, especially involving males. Easy access to pornographic materials at home facilitates this activity. Gender and perceived realism determined their pornographic exposure. Thus, parental monitoring of online access and planning structured activities to occupy free time are recommended at an early age.

Audio Described vs. Audiovisual Porn: Cortisol, Heart Rate and Engagement in Visually Impaired vs. Sighted Participants

Audio description remains the cornerstone of accessibility for visually impaired audiences to all sorts of audiovisual content, including porn. Existing work points to the efficacy of audio description to guarantee immersion and emotional engagement, but evidence on its role in sexual arousal and engagement in porn is still scant. The present study takes on this challenge by comparing sighted and visually impaired participants’ experiences with porn in terms of their physiological response [i.e., cortisol and heart rate (HR)] and self-report measures of affect [Positive and Negative Affect Schedule (PANAS); Watson et al., 1988], anxiety [State-Trait Anxiety Inventory (STAI); Spielberger et al., 1970], sexual reactivity and arousal [Sexual Inhibition/Sexual Excitation Scale (SIS/SES); Moyano and Sierra (2014); and the Ratings of Sexual Arousal (RSA); Mosher (2011)], and narrative engagement or transportation [The Transport Narrative Questionnaire, Green and Brock (2013)]. 69 Spanish participants were allocated into three different groups: 25 sighted participants who watched and heard the porn scenes in their audio-visual version (AV); 22 sighted participants who listened to the audio described version without images (AD); and 22 visually impaired participants who also listened to the audio described version without images (ONCE). Overall, results on physiological and self-report measures revealed no significant differences between groups or different versions of the clips. The analysis of cortisol reactivity to porn as the maximum increase or decrease in cortisol (t+12) with respect to baseline values (t−20) revealed no significant differences between the groups, but pointed to a higher percentage of non-responders than responders in the three groups, the highest being found in the ONCE group. As for participants’ cardiac response to the clips, no significant differences were found across the groups, with the highest HR levels being registered in the baseline phase. Self-report measures revealed significant between-group differences in negative affect. The ONCE group displayed the highest pre-task levels of negative affect and was the only group that showed a decrease in negative affect after exposure to the clips. Sighted and visually impaired participants reported to be moderately aroused and immersed in the films, regardless of exposure to AV or AD porn. In addition, correlations found between participants’ levels of self-report sexual arousal and transportation and post-task affect pointed to a positive relationship between exposure to porn and perceived levels of sexual arousal and affect. Results from the study reflected the efficacy of audio description in providing sighted and visually impaired audiences with a similar experience to that offered by original AV porn scenes. This study is exploratory but provides valid, initial groundwork for further research on the impact of audio description on porn reception.

Maladaptive Daydreaming in an Adult Italian Population During the COVID-19 Lockdown

During the COVID-19 outbreak, individuals with or without mental disorders may resort to dysfunctional psychological strategies that could trigger or heighten their emotional distress. The current study aims to explore the links between maladaptive daydreaming (MD, i.e., a compulsive fantasy activity associated with distress and psychological impairment), psychological symptoms of depression, anxiety, and negative stress, and COVID-19-related variables, such as changes in face-to-face and online relationships, during the COVID-19 lockdown in Italy. A total of 6,277 Italian adults completed an online survey, including socio-demographic variables, COVID-19 related information, the 16-item Maladaptive Daydreaming Scale (MDS-16), and Depression, Anxiety, and Stress Scales-21 Items (DASS-21). Based on an empirically derived cut-off score, 1,082 participants (17.2%) were identified as probable maladaptive daydreamers (MDers). A binary logistic regression revealed that compared to controls, probable MDers reported that during the COVID-19 lockdown they experienced higher levels of anxiety and depression, decreased online social relationships, and, surprisingly, stable or increased face-to-face social relationships. Given the peculiar characteristics of the pandemic context, these findings suggest that the exposure to the risk of contagion had probably exacerbated the tendency of probable MDers to lock themselves inside their mental fantasy worlds, which in turn may have contributed to further estrangement from online social relationships and support, thus worsening their emotional distress.

Prevalence of Internet-based addictive behaviors during COVID-19 pandemic: a systematic review

With the outbreak of the COVID-19 worldwide pandemic, many countries have imposed lockdowns which have caused an increase in Internet use. As large-scale disasters may have an impact on addictions, a review on Internet-based addictive behaviors seems necessary. The goals of this review are to find whether Internet-based addictive behaviors have increased during the pandemic and to define the main reasons for this increase. The systematic search was conducted in Google Scholar, Science Direct, PsycINFO, and PubMed in October of 2020, to determine the current evidence and observations concerning the Internet-based addictive behaviors amid COVID-19. Studies were included if they considered the Internet-based addictive behaviors during the current pandemic. We used all the names of the coronavirus 2 (SARS-CoV2 previously 2019 nCoV), the name of the coronavirus disease 2019 (COVID-19), and common Internet-based addictive behaviors, namely Internet addiction, online gaming disorder, online gambling disorder, pornography use, and smartphone use disorder. The study design is PEOs, finding if individuals' exposure to the COVID-19 pandemic has caused an increase in Internet-based addictive behaviors. The quality of the studies was assessed independently by two authors using the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) approach. The articles found in this review proved an increase in Internet-based addictive behaviors during the COVID-19 pandemic mostly due to financial hardships, isolation, problematic substance use, and mental health issues such as depression, anxiety, and stress. Effective interventions should be scaled up to prevent and reduce online addictive behaviors, as well as accessible guidelines, particularly for adolescents.

Internet and Pornography Use During the COVID-19 Pandemic: Presumed Impact and What Can Be Done

The COVID-19 pandemic continues to cause an immense psychosocial strain worldwide. Excessive use of the internet during these psychologically trying times, fueled by physical isolation as a result of lockdowns, has translated into dysfunctional behaviors. A growing body of evidence suggests an unprecedented increase in internet use and consumption of online pornography during the pandemic, and possibly even directly caused by it. In this review, the authors report data from relevant sources to show the rise in pornography use during lockdowns in different countries worldwide. In addition to a brief overview of the neurobiology of internet addiction broadly and problematic online pornography use specifically, similarities with substance use disorders are explained. Further, the current status of the debate about defining diagnostic criteria is discussed. Finally, the review sheds light on the potential detrimental outcomes during the future post-pandemic "re-adaptation," while simultaneously offering preventative and management strategies for harm reduction. The authors conclude that foresightedness with utilizing existing tools and therapies and exercising appropriate amounts of caution could go a long way in addressing the challenges that lie ahead in the post-pandemic era.

Compulsive Internet Pornography Use and Mental Health: A Cross-Sectional Study in a Sample of University Students in the United States

Background

The sustained rise in negative mental health reports among university students is a source of continued global concern, and investigation continues into potential contributors to this rise. This includes the increased prevalence of risky sexual behaviors. Related is the increased prevalence of pornography use. Our study sought to explore the potential relationship between compulsive use of pornography and mental health in university students.

Methods

Our sample consisted of university students (N = 1031; 34% male, 66% female) from Franciscan University of Steubenville, Steubenville, Ohio. An anonymous survey was sent to all students at the university over the age of 18. The survey was comprised of the following: (1) demographic questions, (2) questions on pornography use and perception, (3) a modified version of the Compulsive Internet Use Scale (mCIUS) assessing various factors associated with compulsive internet pornography use, (4) questions assessing emotional and sexual states relative to pornography use (EmSS), and (5) the 21-question version of the Depression, Anxiety and Stress Scale (DASS-21).

Results

Our results indicate that 56.6% of those surveyed reported lifetime pornography use, with a significantly higher proportion of males than females reporting such use. The majority of students reported accessing pornography through internet-related technologies. Additionally, 17.0, 20.4, and 13.5% of students reported severe or extremely severe levels of depression, anxiety and stress, respectively, with compulsive pornography use significantly affecting all three mental health parameters in both sexes. Exploratory Factor Analysis identified three factors suggesting emotional coping, dependence and preoccupation for the mCIUS items and three factors reflecting interoceptive, impotent, and extrinsic characteristics for the EmSS items. Regression analysis indicated that various demographics, items pertaining to reduced control and social impairment, and other variables pertaining to pornography use predicted mental health outcomes. Faith, morals and personal motivation were the primary variables reported to help reduce pornography use.

Conclusion

Our analyses indicate a significant relationship between mental health and pornography use, including behaviors reflecting behavioral addictions, highlighting the necessity for a better understanding and consideration of the potential contribution of internet pornography to negative mental health among university students.

How do Google searches for symptoms, news and unemployment interact during COVID-19? A Lotka-Volterra analysis of google trends data

In this paper I exploit Google searches for the topics "symptoms", "unemployment" and "news" as a proxy for how much attention people pay to the health and economic situation and the amount of news they consume, respectively. I then use an integrable nonautonomous Lotka-Volterra model to study the interactions among these searches in three U.S. States (Mississippi, Nevada and Utah), the District of Columbia and in the U.S. as a whole. I find that the results are very similar in all areas analyzed, and for different specifications of the model. Prior to the pandemic outbreak, the interactions among health searches, unemployment searches and news consumption are very weak, i.e. an increase in searches for one of these topics does not affect the amount of searches for the others. However, from around the beginning of the pandemic these interactions intensify greatly, suggesting that the pandemic has created a tight link between the health and economic situation and the amount of news people consume. I observe that from March 2020 unemployment predates searches for news and for symptoms. Consequently, whenever searches for unemployment increase, all the other searches decrease. Conversely, when searches for any of the other topics considered increase, searches for unemployment also increase. This underscores the importance of mitigating the impact of COVID-19 on unemployment to avoid that this issue swallows all others in the mind of the people.

Loneliness and Problematic Internet Use during COVID-19 Lock-Down

(1) Background: During the COVID-19 pandemic, strict lock-down and quarantine were widely imposed by most governments to minimize the spread of the virus. Previous studies have investigated the consequences of the quarantine and social isolation on mental health and the present study examines loneliness and problematic internet use. (2) Methods: The current research used a cross-sectional survey during a lock-down phase of the COVID-19 pandemic. A sample of 593 participants from the Middle East region (Kuwait, Saudi Arabia) were tested using the short form of the Revised UCLA Loneliness Scale and the Internet Addiction Test. (3) Results: Results from regression analyses showed an association between loneliness and Problematic Internet Use (PIU), and an association between loneliness and the number of hours spent online. Younger participants reported greater loneliness. The quality of the relationship with the person(s) with whom they were spending their lock-down was also correlated with loneliness. Those who reported greater loneliness also obtained frequent news about the pandemic from social media. Problematic internet use was associated with loneliness and the predictors of loneliness. ANOVA analyses showed a dose-response between the predictors and PIU. (4) Conclusions: This study highlights the influence of the social characteristics of the local culture during the COVID-19 lock-down on feelings of loneliness and on PIU.

Emerging Health and Education Issues Related to Internet Technologies and Addictive Problems

This timely editorial paper outlines some of the main emerging research on technological topics on health and education approaches to Internet use-related problems before and during the beginning of coronavirus disease 2019 (COVID-19). Background: The aim is to provide a brief overview to facilitate a rapid comprehensive and practical approach to these new trends to promote research, interventions, education, and prevention. Methods: The rapid review includes an analysis of both health and education technologies studies on Internet use-related addiction problems included in the Special Issue “Internet and Smartphone Use-Related Addiction Health Problems: Treatment, Education and Research” to extract recent findings and a few reflections about the development of the field before and during the first wave of the COVID-19. Results: Main findings highlighted studies which tended to be empirical, with a relational type associating specific addictive problems with individual and a few contextual factors in adult populations. Psychometric studies about scales are prevalent, but predictive and mixed methods ones are starting to emerge, together with reviews about conceptualisation, measure, treatment, and prevention. Conclusions: From the arrival of Internet, our societies have converged in a global culture which has impacted health and educational domains. Internet use-related addiction problems have globally emerged and common knowledge, advances, and strategies exist to overcome challenges which are starting to be tested, and prevention interest has arisen in a pandemic situation with global health problems holistically tackled.

Gambling-Like Day Trading During the COVID-19 Pandemic - Need for Research on a Pandemic-Related Risk of Indebtedness and Mental Health Impact

Stock exchange trading increasingly has been highlighted as a possible cause of gambling disorder, typically in rapid and excessive "day trading" which may cause over-indebtedness and mental health problems. The COVID-19 pandemic has been suspected to increase online gambling and gambling problems. In a number of recent media reports, day trading has been reported to increase during COVID-19, possibly in relation to changes in everyday life, financial problems and job insecurity during the pandemic. Increasing day trading has thereby been suspected to cause addictive behavior, financial difficulties, and poor mental health. However, there is hitherto a lack of research in the area. The present paper addresses the potential for day trading to cause problem gambling, debts and mental health problems, and calls for research and clinical guidelines in problem gambling related to stock market behavior as a problematic gambling behavior. Screening tools, awareness among clinicians, and longitudinal research studies may be warranted, both during the COVID-19 pandemic and beyond.

"INSIDE" Project on Sexual Health in Spain: Sexual Life During the Lockdown Caused by COVID-19

INTRODUCTION

The COVID-19 pandemic is becoming a major hazard to public health worldwide. This is causing a significant impact on life and physical health, as well as on the psychological well-being of the general population. Since the emotional distress and the social restrictions caused by this epidemic, it must be expected that its impact will also extend to sexual health. The purpose of this study, the first including a large sample of the Spanish general population, was to analyze sexual behavior during the 99 days of confinement in Spain (INSIDE Project).

METHOD

One thousand four hundred forty-eight Spanish people, between 18 and 60 years old, were evaluated through an online survey during April 2020. The variables analyzed were the physical and social environment during confinement, sexual desire, type of sexual activity, masturbation, sexual intercourse, online sexual activity, general sexual frequency, sexual fantasies, degree of self-control over sexual drive, sexual abuse, general impact of confinement on sexuality, and emotional mood.

RESULTS

Confinement has affected the sexual life of half of the Spanish population (47.7%), especially women. Those who reported a worsening of their sexual life are almost three times more (37.9%) than those who reported an improvement (14.4%).

CONCLUSIONS

Different factors have been significant predictors of the positive or negative evaluation about the impact of this confinement on sexual life, such as gender, couple life, privacy, stress level, and the perception of confinement as unbearable.

POLICY IMPLICATIONS

These results have important implications for the public health and more especially sexual health of the Spanish population.

Sex in the Time of COVID-19: Results of an Online Survey of Gay, Bisexual and Other Men Who Have Sex with Men's Experience of Sex and HIV Prevention During the US COVID-19 Epidemic

This paper presents data from a recent cross-sectional survey of gay, bisexual and other men who have sex with men (GBMSM) in the US, to understand changes in sexual behavior and access to HIV prevention options (i.e. condoms and pre-exposure prophylaxis (PrEP)) during the COVID-19 lockdown period. The Love and Sex in the Time of COVID-19 survey was conducted online from April to May, 2020. GBMSM were recruited through advertisements featured on social networking platforms, recruiting a sample size of 518 GBMSM. Analysis considers changes three in self-reported measures of sexual behavior: number of sex partners, number of anal sex partners and number of anal sex partners not protected by pre-exposure prophylaxis (PrEP) or condoms. Approximately two-thirds of the sample reported that they believed it was possible to contract COVID-19 through sex, with anal sex reported as the least risky sex act. Men did not generally feel it was important to reduce their number of sex partners during COVID-19, but reported a moderate willingness to have sex during COVID-19. For the period between February and April-May 20,202, participants reported a mean increase of 2.3 sex partners during COVID-19, a mean increase of 2.1 anal sex partners (range - 40 to 70), but a very small increase in the number of unprotected anal sex partners. Increases in sexual behavior during COVID-19 were associated with increases in substance use during the same period. High levels of sexual activity continue to be reported during the COVID-19 lockdown period and these high levels of sexual activity are often paralleled by increases in substance use and binge drinking. There is a clear need to continue to provide comprehensive HIV prevention and care services during COVID-19, and telehealth and other eHealth platforms provide a safe, flexible mechanism for providing services.

COVID-19 lockdown impact on cognitions and emotions experienced during sexual intercourse

Objectives

To study the impact of COVID-19 lockdown on cognitions and emotions felt during sexual intercourse by analyzing the responses of 1079 French-speaking subjects (338 men, 741 women, median age: 31 years) who participated in an online survey between April 27 and May 11, 2020.

Method

Negative sexual cognitions (NSC), positive sexual emotions (PSE) and negative sexual emotions (NSE) are assessed using a tool inspired by the Sexual Mode Questionnaire. Data are crossed with sociodemographic indicators, information on lockdown modalities, indices on sex life, information on psychological functioning and sexual satisfaction.

Main results

One third of the participants saw a decrease in the frequency of their sexual activities or in their sexual satisfaction. Changes in NSCs were found in 74.4% of subjects (increase: 38.4%; decrease: 36%). Emotional changes are found in between 50.7% (NSC: increase: 20.2%; decrease: 30.5%) and 60.9% (PSE: increase: 24.6%; decrease: 36.3%) of participants. The effect of lockdown on NSC, NSE, and PSE depends on gender at birth, intensity of depressive symptoms, and attachment styles. Women appear to be more vulnerable to lockdown than men. Insecure or depressed subjects also appear more vulnerable. The lockdown impact also depends on changes in the frequency of physical/digital intercourse during lockdown and the modalities of confinement. Changes in NSC, NSE, and PSE had a significant effect on sexual satisfaction during lockdown.

Conclusion

The lockdown impact on sexual emotions and cognitions is non-negligible and greater than the impact on sexual behaviors. Whether it is positive or negative, it asks about the post-confinement repercussions: what becomes of a positive impact with deconfinement? Will the negative impacts be one-off or will vulnerabilities be expressed over the long-term?

"INSIDE" Project on Sexual Health in Spain: Sexual Life During the Lockdown Caused by COVID-19

INTRODUCTION

The COVID-19 pandemic is becoming a major hazard to public health worldwide. This is causing a significant impact on life and physical health, as well as on the psychological well-being of the general population. Since the emotional distress and the social restrictions caused by this epidemic, it must be expected that its impact will also extend to sexual health. The purpose of this study, the first including a large sample of the Spanish general population, was to analyze sexual behavior during the 99 days of confinement in Spain (INSIDE Project).

METHOD

One thousand four hundred forty-eight Spanish people, between 18 and 60 years old, were evaluated through an online survey during April 2020. The variables analyzed were the physical and social environment during confinement, sexual desire, type of sexual activity, masturbation, sexual intercourse, online sexual activity, general sexual frequency, sexual fantasies, degree of self-control over sexual drive, sexual abuse, general impact of confinement on sexuality, and emotional mood.

RESULTS

Confinement has affected the sexual life of half of the Spanish population (47.7%), especially women. Those who reported a worsening of their sexual life are almost three times more (37.9%) than those who reported an improvement (14.4%).

CONCLUSIONS

Different factors have been significant predictors of the positive or negative evaluation about the impact of this confinement on sexual life, such as gender, couple life, privacy, stress level, and the perception of confinement as unbearable.

POLICY IMPLICATIONS

These results have important implications for the public health and more especially sexual health of the Spanish population.

Impact du confinement COVID19 sur les cognitions et émotions sexuelles

Objectifs

Etudier l’impact du confinement COVID19 sur les cognitions et émotions ressenties lors des rapports sexuels par l’analyse des réponses de 1079 sujets francophones (338 hommes, 741 femmes, âge médian : 31 ans) ayant participé à une enquête en ligne entre le 27 avril et le 11 mai 2020.

Méthode

Les cognitions sexuelles négatives (CSN) et les émotions sexuelles positives (ESP) et négatives (ESN) sont recensées à partir d’un outil inspiré du Sexual Mode Questionnaire de Nobre et Pinto-Gouveia (2003). Les données sont croisées avec des indicateurs sociodémographiques, des informations concernant les modalités de confinement, des indices sur la vie sexuelle, des informations relatives au fonctionnement psychologique et la satisfaction sexuelle.

Principaux résultats

Un tiers des participants ont vu la fréquence de leurs activités sexuelles ou leur satisfaction sexuelle diminuer. Les CSN ont augmenté chez 38,4 % des sujets et diminué pour 36 % des participants. L’augmentation des ESN concerne 20.2 % des sujets, leur diminution concerne 30,5 %. Les ESP ont augmenté pour 24,6 % des participants et diminué pour 36,3 % d’entre eux. Les femmes, les sujets insécures et ceux présentant des symptômes dépressif apparaissent plus particulièrement fragilisées par le confinement. L’impact du confinement dépend également des changements de fréquence des relations sexuelles physiques/digitales pendant le confinement et des modalités de confinement. Les changements des CSN, des ESN et des ESP ont eu un effet significatif sur la satisfaction sexuelle ressentie pendant le confinement.

Conclusion

L’impact du confinement sur les émotions et cognitions sexuelles est non-négligeable et plus important que l’impact sur les comportements sexuels. Qu’il soit positif ou négatif, il interroge concernant les répercussions post-confinement : quel devenir d’un impact positif avec le déconfinement ? Les répercussions négatives seront-elles ponctuelles ou les vulnérabilités s’exprimeront-elles au long cours ?

A Global Survey on Changes in the Supply, Price, and Use of Illicit Drugs and Alcohol, and Related Complications During the 2020 COVID-19 Pandemic

Background and Aims: COVID-19 has infected more than 77 million people worldwide and impacted the lives of many more, with a particularly devastating impact on vulnerable populations, including people with substance use disorders (SUDs). Quarantines, travel bans, regulatory changes, social distancing, and "lockdown" measures have affected drug and alcohol supply chains and subsequently their availability, price, and use patterns, with possible downstream effects on presentations of SUDs and demand for treatment. Given the lack of multicentric epidemiologic studies, we conducted a rapid global survey within the International Society of Addiction Medicine (ISAM) network in order to understand the status of substance-use patterns during the current pandemic. Design: Cross-sectional survey. Setting: Worldwide. Participants: Starting on April 4, 2020 during a 5-week period, the survey received 185 responses from 77 countries. Measurements: To assess addiction medicine professionals' perceived changes in drug and alcohol supply, price, use pattern, and related complications during the COVID-19 pandemic. Findings: Participants reported (among who answered "decreased" or "increased") a decrease in drug supply (69.0%) and at the same time an increase in price (95.3%) globally. With respect to changes in use patterns, an increase in alcohol (71.7%), cannabis (63.0%), prescription opioids (70.9%), and sedative/hypnotics (84.6%) use was reported, while the use of amphetamines (59.7%), cocaine (67.5%), and opiates (58.2%) was reported to decrease overall. Conclusions: The global report on changes in the availability, use patterns, and complications of alcohol and drugs during the COVID-19 pandemic should be considered in making new policies and in developing mitigating measures and guidelines during the current pandemic (and probable future ones) in order to minimize risks to people with SUD.

The Impact of COVID-19 Pandemic on Searching for Health-Related Information and Cyberchondria on the General Population in Italy

Objectives: The Internet has become one of the most common sources people use to search for health-related information, a behavior rapidly increased during the novel Coronavirus disease 2019 (COVID-19). The present study aimed to investigate behavioral patterns in the online health-related searches and Cyberchondria (CYB) during the COVID-19 pandemic time, in order to explore socio-demographic and psychopathological factors related to CYB. Methods: During the third wave of the COVID-19 pandemic in Italy, a cross-sectional online survey collected the main socio-demographic variables and habits related to Internet use of 572 participants. CYB was measured by the Cyberchondria Severity Scale-Short Version and different psychopathological factors were measured by specific questionnaires: the Coronavirus Anxiety Scale, the Hospital Anxiety and Depression Scale, the Short Health Anxiety Inventory, the Meta-Cognitions about Health Questionnaire, the Internet Addiction Test, the Maudsley Obsessional-Compulsive Questionnaire-Short Version, the Rosenberg's Self-Esteem Scale, and the WHO Quality of Life-BREF. Descriptives, non-parametric ANOVAs, and Spearman correlations were performed. Results: In the present sample, the Internet was the main source participants used to search for health-related information and nearly one-third increased this habit during the pandemic. Higher expression of CYB emerged in females, in younger participants, in students, and in those suffering from a physical/psychiatric illness. CYB showed a positive correlation with different phenomenology of anxiety (i.e., anxiety about COVID-19, health anxiety, general anxiety, metacognitive believes about anxiety) and with depression, obsessive-compulsive symptoms, and problematic usage of the Internet. Conversely, quality of life and self-esteem showed a negative correlation with CYB. Conclusion: During the COVID-19 pandemic, the use of the Internet for health-related information and CYB contribute to the psychological stress affecting individuals and society. Delineating subjects more vulnerable to CYB and associated psychopathological factors will help to elaborate operational indications for prevention and psychological support.

Cyberchondria in the time of the COVID-19 pandemic

Cyberchondria is an excessive or repeated online health information seeking that is associated with increasing levels of health anxiety or distress. This article presents a model of cyberchondria during public health crises such as the COVID‐19 pandemic. The factors that contribute to cyberchondria at this time include (a) a heightened perception of threat and fear of a newly identified and poorly understood disease; (b) difficulty in coping with uncertainty associated with the pandemic; (c) lack of authoritative and trustworthy sources of relevant health information; (d) difficulty in coping with abundance of information that is often confusing, conflicting, unverified and constantly updated, along with a decreased ability to filter out unnecessary information; and (e) inability of excessive online health information seeking to provide the necessary information and deliver reassurance. These factors amplify fear and distress, which increases the perception of threat and uncertainty and perpetuates further online health searches. Cyberchondria has significant public health implications because of the associated distress or functional impairment and effects on health behaviors. Cyberchondria should be addressed by targeting a heightened perception of threat, improving management of uncertainty and online health information and promoting an ability to critically appraise the results of online health searches. This should contribute to a better online health information literacy. The model of cyberchondria during the COVID‐19 pandemic explains the hypothesized rise in cyberchondria during public health emergencies and helps to formulate a framework for prevention of cyberchondria and its effective management.

Substitute addictions in the context of the COVID-19 pandemic

The global spread of COVID-19, subsequent stay-at-home requirements, spatial distancing measures, and long-term isolation present additional challenges for persons in recovery. Using an illustrative case from South Africa, we discuss COVID-19 related pornography use through the lens of relapse and substitute addiction. South Africa is the epicenter of the pandemic in Africa, and has issued an alcohol and cigarette ban. Historical examples suggest that responses to forced abstinence may include compliance and abstinence, but also seeking alternatives to the original addiction and substitution. Substitution of alternative activities/objects may provide similar appetitive effects to fill the void of the terminated addictive behavior, temporarily or in the long-term. While substitutes do not necessarily portend a relapse, coupled with isolation and reduced recovery support, they can potentiate relapse to the former or 'new' addictive behavior. Addiction professionals should be aware of the potential for such negative impacts during and after the COVID-19 pandemic.

COVID-19 and the Changes in the Sexual Behavior of Men Who Have Sex With Men: Results of an Online Survey

BACKGROUND

Social distancing in the wake of the coronavirus disease 2019 (COVID-19) pandemic may affect the sexual behavior of men who have sex with men (MSM). In early March 2020, Israel imposed travel restrictions and limited social contacts to household members only. The effects of these restrictions on the sexual behavior and mental health of MSM are unknown.

AIM

To assess sexual behaviors and mental health of Israeli MSM during social distancing and to compare sexual behaviors before and during social distancing, due to the COVID-19 pandemic.

METHODS

Data were collected through anonymous web-based questionnaires in a popular geospatial application used by MSM between March and April 2020 during the social-distancing period.

OUTCOMES

The dependent variable was casual sex, in violation of social-distancing regulations. Independent variables were demographic characteristics, sexual behaviors before and during social-distancing restrictions, and mental health.

RESULTS

Of the 2,562 participants, 1,012 (39.5%) continued to meet new casual sex partners during this period. Being of a younger age, single, and with higher levels of mental distress predicted engagement in casual sex during the social-distancing period. MSM reduced their sexual risk and limited sexual repertoire-in particular, kissing with their sexual partners. Participants also spent more time in dating applications than in the pre-social-distancing period and increased their use of sex phone, webcams, and porn consumption. They perceived the threat of severe acute respiratory syndrome coronavirus to be greater than that of HIV: only 3.2% could imagine themselves having sex with a partner who is infected with SARS-CoV-2 compared with 30.1% in case of HIV, P < .01.

CLINICAL IMPLICATIONS

MSM reduced their risk behaviors during social distancing because of the threat of COVID-19. Casual sex during social distancing was associated with negative feelings of mental distress. Future public health response in the future waves of COVID-19 morbidity should strike a balance between containment measures and the need for social distancing with its possible mental and social burdens.

STRENGTHS AND LIMITATIONS

This is the first study in Israel and one of the few in the world to examine sexual behaviors among MSM during the COVID-19 social distancing period. It involved a relatively large sample, through convenience sampling, which limits causality. Findings should be interpreted cautiously, specifically because COVID-19-related behaviors and circumstances may change rapidly.

CONCLUSION

The negative feelings of distress due to social distancing should be considered as a potential barrier to adherence among vulnerable populations, such as MSM. Future public health response should strike a balance between containment measures and its possible mental, social, and financial burdens. Shilo G, Mor Z. COVID-19 and the Changes in the Sexual Behavior of Men Who Have Sex With Men: Results of an Online Survey. J Sex Med 2020;17:1827-1834.

Changes in Sexuality and Quality of Couple Relationship During the COVID-19 Lockdown

The COVID-19 pandemic is heavily influencing people's general well-being worldwide. Since its outbreak, many studies have explored the population's general psychological well-being, while only a few studies have addressed how the COVID-19 pandemic and the lockdown are affecting sexuality. Sexual health, an important aspect of general well-being, has relevant consequences on people's daily lives. Although it is well known that distress can affect sexuality, and it is possible to speculate that the outbreak's psychological outcomes are affecting the population's sexual life; recent literature does not explore couples' sexuality and their relationship quality during the lockdown. The present preliminary research aimed to understand if the Italian population's sexuality has changed, and if so, how it had changed since the spread of COVID-19, and which variables were influencing couples' relationship quality during the COVID-19 lockdown. A questionnaire reserved especially for cohabiting couples was designed and distributed online from April 11 to May 5, 2020, the 5th and 8th weeks, respectively, after the start of the lockdown. Of the 124 respondents who completed the online survey, 73% were females. Despite the pandemic's psychological consequences, when asked directly, most couples responded that they did not perceive any differences in their sexuality. However, some female participants did report a decrease in pleasure, satisfaction, desire, and arousal. The main reasons behind the changes in sexuality in women, therefore, appear to be worry, lack of privacy, and stress. Even when participants seemed to show high levels of resilience, the negative aspects of lockdown could affect their quality of sexual life. This study needs to be completed using qualitative data from online focus groups that have investigated how sexual life has changed and the main needs of couples. All the same, our results will serve to better address population needs and experiences, and provide ad hoc interventions during this unprecedented time of crisis.

COVID Isolation Eating Scale (CIES): Analysis of the impact of confinement in eating disorders and obesity-A collaborative international study

Confinement during the COVID‐19 pandemic is expected to have a serious and complex impact on the mental health of patients with an eating disorder (ED) and of patients with obesity. The present manuscript has the following aims: (1) to analyse the psychometric properties of the COVID Isolation Eating Scale (CIES), (2) to explore changes that occurred due to confinement in eating symptomatology; and (3) to explore the general acceptation of the use of telemedicine during confinement. The sample comprised 121 participants (87 ED patients and 34 patients with obesity) recruited from six different centres. Confirmatory Factor Analyses (CFA) tested the rational‐theoretical structure of the CIES. Adequate goodness‐of‐fit was obtained for the confirmatory factor analysis, and Cronbach alpha values ranged from good to excellent. Regarding the effects of confinement, positive and negative impacts of the confinement depends of the eating disorder subtype. Patients with anorexia nervosa (AN) and with obesity endorsed a positive response to treatment during confinement, no significant changes were found in bulimia nervosa (BN) patients, whereas Other Specified Feeding or Eating Disorder (OSFED) patients endorsed an increase in eating symptomatology and in psychopathology. Furthermore, AN patients expressed the greatest dissatisfaction and accommodation difficulty with remote therapy when compared with the previously provided face‐to‐face therapy. The present study provides empirical evidence on the psychometric robustness of the CIES tool and shows that a negative confinement impact was associated with ED subtype, whereas OSFED patients showed the highest impairment in eating symptomatology and in psychopathology.

Gambling During the COVID-19 Crisis - A Cause for Concern

: The COVID-19 pandemic has the potential to worsen mental health problems in the general population, including increasing engagement in addictive behaviors. Here, we describe observations suggesting that the current crisis and its sequelae may worsen problem gambling. The current pandemic may impact financial and psychological well-being due to social isolation during spatial distancing, and these stressors in conjunction with substantial changes in gambling markets (land-based, online) during the pandemic may significantly influence gambling behaviors. This situation calls for rapid research initiatives in this area and preventive and regulatory measures by multiple stakeholders.

Covid-19-Pandemie und Verhaltenssüchte

Zusammenfassung. Einführung und Zielsetzung: Die COVID-19 Pandemie und die entsprechenden Lockdown-Maßnahmen verdeutlichen, dass besondere Strategien der Verhaltens- und Verhältnisprävention für Online-Verhaltenssüchte notwendig sind. Begründung: Die Wahrscheinlichkeit ist hoch, dass die COVID-19 Krise und die begleitenden Maßnahmen zu deren Eindämmung die Risiken für die Entwicklung von Verhaltenssüchten erhöht haben. Dazu tragen Faktoren wie Fortfall von terrestrischen Angeboten, soziale Isolation und erzwungene Inaktivität sowie Bedeutungsgewinn von Online-Angeboten bei. Gleichzeitig können als Folge bei bereits bestehenden Störungen die Schwere zu- und Remissionschancen abgenommen haben. Auch von einem erhöhten Rückfallrisiko kann ausgegangen werden. Schlussfolgerung: Es sind epidemiologische Studien notwendig, um veränderte Prävalenzen, Versorgungsbedarfe und geänderte Risikofaktoren zu erfassen. Es besteht die Notwendigkeit, Maßnahmen der Verhältnis- und Verhaltensprävention zu entwickeln und umzusetzen. Die Identifizierung von Risikoverhalten wäre durch Tracking des Online-Verhaltens möglich und könnte Ausgangspunkt für Maßnahmen wie Spiel- oder Anwendungspausen, Warnhinweise und Verbraucherschutzinformationen sowie konkrete Angebote der Frühintervention oder weitergehende Hilfen sein. Die Anbieter stehen hier in der Pflicht, Verantwortung für ihre Produkte zu übernehmen, das Risiko von Verhaltenssüchten zu minimieren und Maßnahmen von Frühentdeckung und Intervention zu ermöglichen und bereitzustellen.

Preventing problematic internet use during the COVID-19 pandemic: Consensus guidance

As a response to the COVID-19 pandemic, many governments have introduced steps such as spatial distancing and "staying at home" to curb its spread and impact. The fear resulting from the disease, the 'lockdown' situation, high levels of uncertainty regarding the future, and financial insecurity raise the level of stress, anxiety, and depression experienced by people all around the world. Psychoactive substances and other reinforcing behaviors (e.g., gambling, video gaming, watching pornography) are often used to reduce stress and anxiety and/or to alleviate depressed mood. The tendency to use such substances and engage in such behaviors in an excessive manner as putative coping strategies in crises like the COVID-19 pandemic is considerable. Moreover, the importance of information and communications technology (ICT) is even higher in the present crisis than usual. ICT has been crucial in keeping parts of the economy going, allowing large groups of people to work and study from home, enhancing social connectedness, providing greatly needed entertainment, etc. Although for the vast majority ICT use is adaptive and should not be pathologized, a subgroup of vulnerable individuals are at risk of developing problematic usage patterns. The present consensus guidance discusses these risks and makes some practical recommendations that may help diminish them.