Internet addiction and problematic Internet use: A systematic review of clinical research

Problematic internet use and suicide ideation among Chinese adolescents: The indirect effects of insomnia, nightmares, and social jetlag

BACKGROUND

Problematic Internet use (PIU) is related to suicide ideation (SI) in adolescents, but little is known about the potential mechanisms between them. This study aimed to examine the mediation roles of insomnia, nightmares, and social jetlag in the association of PIU with SI in adolescents.

METHODS

A total of 39,731 adolescents (mean age = 13.49 ± 0.76 years, 54.4 % males) from Shenzhen, China, participated in a cross-sectional survey. SI was assessed using the ninth item of the Patient Health Questionnaire-9. PIU was measured by the Revised Chinese Internet Addiction Scale. A self-administered questionnaire was used to assess insomnia symptoms, nightmare frequency, social jetlag, sleep duration, psychological distress, and social-demographical characteristics. Logistic regression and path analyses were performed to examine the associations between PIU, insomnia symptoms, nightmares, social jetlag, and SI.

RESULTS

The prevalence of PIU and SI were 14.9 % and 18.6 %, respectively. PIU, insomnia symptoms, frequent nightmares, and social jetlag were significantly associated with SI. Path analyses showed that the indirect effects of PIU on SI through insomnia symptoms, frequent nightmares, and social jetlag were significant. Conversely, social jetlag significantly mediated the pathway from SI to PIU. The mediation effect sizes of these sleep and circadian problems were slightly larger in females than in males.

LIMITATIONS

Cross-sectional design limited the capacity to infer causal relationships.

CONCLUSIONS

The associations between PIU and SI were mediated by sleep and circadian problems. These findings underscore the importance of assessing and intervening in sleep and circadian problems among adolescents with PIU or SI.

Problematic Social Media Use and Lifestyle Behaviors in Adolescents: Cross-Sectional Questionnaire Study

Background

The use of social media by adolescents has increased considerably in the past decade. With this increase in social media use in our daily lives, there has been a rapidly expanding awareness of the potential unhealthy lifestyle-related health effects arising from excessive, maladaptive, or addictive social media use.

Objective

This study aims to assess the association between adolescents' social media use and health-related behaviors.

Methods

We used a cross-sectional research approach and analyzed data from 96,919 adolescents at high schools throughout the Netherlands. A structured 43-item questionnaire was used to gather data on sociodemographics, dietary and lifestyle factors, and the degree of social media use based on the Compulsive Internet Use Scale. Logistic regression analyses were performed to assess the association between problematic social media use (PSMU) and lifestyle behaviors while adjusting for sociodemographic factors.

Results

Of the 96,919 included adolescents, 7.4% (n=7022) were identified as at risk for PSMU. Furthermore, logistic regression results showed that adolescents who are at risk for PSMU were more likely to report alcohol consumption and smoking while simultaneously having significantly lower levels of health-promoting behavior such as healthy eating habits (eating fruits, vegetables, and breakfast regularly) and physical activity.

Conclusions

This study confirms that adolescents at risk of PSMU were more likely to exhibit an unhealthy lifestyle. Being at risk for PSMU was a determinant of soft drug use, alcohol consumption, smoking, poor eating habits, and lower physical activity independent of the additional adjusted covariates including demographic variables and remaining lifestyle variables. Future research is needed to confirm this observation in an experimental setting.

Differences in Screen Addiction in the Past 15 Years

The use of information and communication technologies (ICTs) has become widespread in recent years, leading to an increase in addiction cases. A total of 118 patients who attended the Behavioral Addictions Unit of Consorci Sanitari de Terrassa (Barcelona, Spain) between October 2005 and December 2021 were included in the study. The sample was divided into three groups according to the time period in which they started treatment: between 2005 and 2010 (before the rise in new technologies, named the pre-ICT period), between 2011 and 2019 (a time of major ICT development, named the ICT period) and between 2020 and 2021 (with massive use of the internet due to effects of the pandemic, named the COVID-19 period). We found an increase in the incidence of screen addiction cases related to the development of technology throughout the study years, and this increase was accentuated during the COVID-19 period. This increase was not equal for all types of content consumed via the internet, with patients with video game addiction increasing to a greater extent than patients with internet/social network addiction. In addition, patients with video game addiction were younger and had started gaming at a younger age than those with internet/social network addiction. These results contribute to a better understanding of the phenomenon of technology addiction and to the design of appropriate treatment protocols and preventive programs.

Prevalence of Internet Addiction and Impact of Internet Socialization on Professional, Academic, Social Lives and Sleep Pattern Among Students and Professionals from Various Fields Across India

BACKGROUND

Internet addiction was found to be associated with a variety of psychosocial problems, including academic failure, low self-esteem, poor diet, mental disorders like depression and anxiety, sleep deprivation, and social withdrawal.

OBJECTIVE

To determine the prevalence and risk factors of internet addiction and evaluate the impact of internet socialization on professional, academic, social lives and sleep pattern among students and professionals from various fields across India.

METHODOLOGY

This cross-sectional, descriptive study was conducted from January 2022 to July 2023 among 772 participants who were aged ≥18 years. The study tool consisted of a questionnaire with four parts comprising questions related to demographic characteristics, pattern of use and impact of internet over academic, professional, social life, sleep pattern, and Kimberley Young's Internet Addiction Test (IAT) questionnaire.

RESULTS

The prevalence of Internet addiction was 53.6% among the participants. Participants aged above 30 years demonstrated a decreased risk of internet addiction compared to those aged below 30 years (AOR = 0.35). Participants who reported becoming restless without internet access (AOR = 4.88) and going to bed late because of the use of internet or social media (AOR = 3.01) had a significantly higher risk of internet addiction.

CONCLUSION

Internet addiction is very common among professionals, and students and there is a high risk of internet addiction in persons who get restless when they cannot log in, spend too much time online, stay up late using the internet, and share personal information soon after meeting others on social media sites.

The relationship between problematic internet use and attention deficit, hyperactivity and impulsivity: A meta-analysis

OBJECTIVE

This study aimed to investigate the relationship between problematic internet use (PIU) and ADHD-related symptoms of attention deficit, impulsivity and hyperactivity.

METHODS

We chose a meta-analytical approach and searched for relevant studies in different databases (Pubmed, PsycInfo, Google scholar). We identified 24 studies with 18 859 participants (mean age = 18.40 (SD = 5.51)) published between 2004 and 2021 which were applicable for our research. We calculated 21, 7, and 9 effect sizes for attention deficit, hyperactivity and impulsivity, respectively.

RESULTS

We found significant associations between PIU and attention deficit (r = 0.36, 95% confidence interval = [0.28 to 0.43]), hyperactivity (r = 0.44, 95% confidence interval = [0.33 to 0.53]), and impulsivity (r = 0.41, 95% confidence interval = [0.30 to 0.51]), p < .001 for all three. The effect sizes of attention deficit and hyperactivity were significantly higher in male compared to female participants. Additionally, higher attention deficit effects were found in adults compared to children/adolescents.

CONCLUSIONS

Our meta-analysis indicates that ADHD-related symptoms are associated with PIU. Although cross-sectional analyses cannot explain cause-and-effect relationships, we hypothesize that attention deficit, hyperactivity and impulsivity constitute a vulnerability towards PIU.

Problematic internet use in emerging adulthood to escape from maternal helicopter parenting: defensive functioning as a mediating mechanism

The increasing use of the Internet has raised concerns about its problematic use, particularly among emerging adults who grew up in a highly digitalized world. Helicopter parenting, characterized by excessive involvement, overcontrol, and developmentally inappropriate behavior, has been identified as a potential factor contributing to problematic Internet use (PIU). Under these circumstances, considering that emerging adults navigate their adult lives and strive to reduce their sense of being in-between, implicit emotion regulation strategies, such as defense mechanisms, may help comprehend PIU. The present questionnaire-based study investigated the associations between maternal and paternal helicopter parenting and PIU through defensive functioning among a community sample of 401 cisgender emerging adults (71.82% females; 82.04% heterosexuals; Mage=24.85, SD=2.52) living in Italy. About one-fourth (25.19%) reported PIU. Greater maternal, B=0.904, SE=0.235, p<.001, but not paternal, B=0.343, SE=0.188, p=.068, helicopter parenting was significantly associated with PIU through a less mature defensive functioning. Conversely, neither maternal, B=1.158, SE=0.722, p=.109, nor paternal, B=0.355, SE=0.731, p=.628, helicopter parenting had a direct association with PIU. The results suggest the importance for psychotherapists to incorporate individuals' defense mechanisms and parent-child relationship history when designing tailored interventions for effective treatment of PIU. This emphasis is crucial because, in the context of a developmentally appropriate parenting style, relying on more mature defenses after psychotherapeutic intervention can lead to healthier adjustment among emerging adults.

A Holistic Investigation of the Relationship between Digital Addiction and Academic Achievement among Students

Digital addiction (DA), an umbrella term referring to addiction to any type of digital media, such as the internet, smartphone, digital games, and social media, is a significant factor influencing students' academic achievement (AA). Many scholars have contributed to this line of research from around the world. Nevertheless, the literature lacks a holistic investigation of how the DA-AA research field evolved, which could guide future studies. The current study aims to address this void and conducts a combined bibliometric and science mapping analysis of research addressing the relationship between DA and AA. Data were retrieved from the WoS database, considered one of the optimal databases for such studies with its comprehensive coverage of quality journals. One hundred eighteen articles were included in the final dataset and were analyzed using the SciMAT software, which allowed analysis over three consecutive periods and yielded comparable results regarding the conceptual and thematic evolution of the DA-AA domain. The results indicated an increased research interest in the topic, especially during the last five years. The science mapping analysis showed that the most-studied types of addiction were smartphone addiction for the first two periods and social media addiction for the last. Research in the DA-AA domain which focused on understanding the addictive use of smartphones during the first period, evolved to address factors such as self-efficacy or life satisfaction leading to smartphone addiction and lower grades. During the third period, the number of factors addressed gained significant variety and covered family-related and personal factors.

Digital Dependency: How Parenting and Social Intelligence Shape Internet Addiction

The global pandemic forced young adults and their parents to be together. This situation has equally exposed the weaknesses in the child-parent relationship. This study aimed to investigate the role of social intelligence in the relationship between parenting style and Internet addiction during the global COVID-19 pandemic. Seven hundred and seventy-four were sampled from a public university in southeast Nigeria. They comprised 373 females and 401 males aged 17-28 years, with a mean age of 21.61. The students responded to validated measures of parenting style inventory-II, the Tromsø social intelligence scale, and Young's Internet addiction test. The moderated multiple regression analysis results indicated that permissive parenting and social intelligence significantly predicted Internet addiction. Social intelligence moderated the relationship between authoritarian parenting style and Internet addiction. The moderation was that Internet addiction is significantly higher for individuals with low social intelligence and authoritarian parenting style than individuals with low social intelligence and higher authoritarian parenting style. Some implications of the findings include engaging parenting styles to encourage more physical interactions and enabling an environment for growth. Also, adopting techniques to increase social intelligence will help students adjust to any parenting style that may influence their psychological well-being.

Investigating links between Internet literacy, Internet use, and Internet addiction among Chinese youth and adolescents in the digital age

Introduction

In current digital era, adolescents' Internet use has increased exponentially, with the Internet playing a more and more important role in their education and entertainment. However, due to the ongoing cognitive, emotion, and social development processes, youth and adolescents are more vulnerable to Internet addiction. Attention has been paid to the increased use of Internet during the COVID-19 pandemic and the influence of Internet literacy in prevention and intervention of Internet addiction.

Methods

The present study proposes a conceptual model to investigate the links between Internet literacy, Internet use of different purpose and duration, and Internet addiction among Chinese youth and adolescents. In this study, N = 2,276 adolescents studying in primary and secondary schools in East China were recruited, and they completed self-reports on sociodemographic characteristics, Internet literacy scale, Internet use, and Internet addiction scale.

Results

The results showed a significant relationship between Internet use and Internet addiction. To be specific, the duration of Internet use significantly and positively affected Internet addiction. With different dimensions of Internet literacy required, entertainment-oriented Internet use had positive impact on Internet addiction, while education-oriented Internet use exerted negative effects on Internet addiction. As for Internet literacy, knowledge and skills for Internet (positively) and Internet self-management (negatively) significantly influenced the likelihood of Internet addiction.

Discussion

The findings suggest that Internet overuse increases the risk of Internet addiction in youth and adolescents, while entertainment-oriented rather than education-oriented Internet use is addictive. The role of Internet literacy is complicated, with critical Internet literacy preventing the development of Internet addiction among youth and adolescents, while functional Internet literacy increasing the risk.

Internet Addiction and Depression among Syrian College Students: A Cross-Sectional Study

Background: Problematic internet use (PIU) or internet addiction has become increasingly prevalent, and concerns about its impact on mental health and social functioning have grown. This study aimed to investigate the prevalence of PIU among Syrian university students and its relationship with their demographics, internet user behavior, and mental health. Methods: A cross-sectional study was conducted among undergraduate medical students in Syrian government universities between 12 April and 29 May 2022. The survey included the Beck Depression Inventory and the Internet Addiction Scale. Results: Out of 2891 participants, 75.2% were female, with an average age of 21.87. The average Internet Addiction Test (IAT) score was 49.4, and the overall prevalence of PIU was 89%. Furthermore, 93.0% of participants displayed possible signs and symptoms of depression. PIU was significantly linked with physical abuse (p = 0.001) and mental stress (p = 0.0001). Internet addiction is (AOR:1.723, COR:2.289) fold more likely to occur in those with more than 8 h of sleep per night than in those who sleep for less than 6 h (p-value < 0.05). Unadjusted regression analysis showed that 13 predictors of the independent variables were statistically significant in predicting the presence of internet addiction, such as participants who suffered from a breakup (COR:2.039), domestic violence (COR:2.136), physical abuse (COR:2.190), or mental stress (COR:2.621) were more likely to be affected by internet addiction than those who did not (p-value < 0.05). Conclusions: The study found a high rate of internet addiction among Syrian medical students, with those experiencing mental health problems and depression symptoms more likely to be internet addicts. To prevent PIU, students should be encouraged to participate in extracurricular activities, such as sports, and awareness programs should be enhanced to highlight the negative effects of internet addiction.

Dissociative Trait as a Mediator of Problematic Internet Use in Children with attention-deficit/hyperactivity Disorder and Learning Disabilities

PURPOSE

This study used data from a national birth cohort study to investigate the duration of internet use at the age of 12 years among children diagnosed with attention-deficit/hyperactivity disorder (ADHD), autism spectrum disorder (ASD), intellectual disabilities (IDs) and learning disabilities (LDs) at the age of five and a half years (66 months) to understand whether an ADHD, ASD, ID and LD diagnosis in childhood increases the risk of problematic internet use (PIU) in adolescence. Furthermore, the pathway relationship of dissociative absorptive trait with PIU and these diagnoses was also investigated.

METHODS

The 5.5- and 12-year-old Taiwan Birth Cohort Study dataset was used (N = 17,694).

RESULTS

More boys were diagnosed with LDs, IDs, ADHD and ASD; however, girls were at increased likelihood of PIU. ID and ASD diagnoses were not associated with increasing PIU likelihood. However, children who had been diagnosed with LDs and ADHD, along with higher dissociative absorptive trait, had an indirectly increased likelihood of PIU in adolescence.

CONCLUSIONS

Dissociative absorption was found to be a mediating factor between childhood diagnosis and PIU and can be used as a screening indicator in prevention programs to reduce the duration and severity of PIU in children diagnosed with ADHD and LDs. Furthermore, with the increased prevalence of smartphone usage in adolescents, education policy-makers should pay greater attention to the issue of PIU in female adolescents.

Internet Addiction and Physical Activity among Polish and Portuguese Students in the Final Year of the COVID-19 Pandemic

AIM

The purpose of this study was to analyze the level of Internet addiction and physical activity, as well as the relationship between internet addiction and physical activity, among Polish and Portuguese students in the final year of the COVID-19 pandemic.

METHODS

A web-based online survey was conducted among students in Poland and Portugal (398 respondents) aged between 17 and 26 in October 2022. The level of internet addiction was assessed by the Kimberly Young questionnaire in Polish and in Portuguese. The level of physical activity was measured by the international physical activity questionnaire in Polish and in Portuguese.

RESULTS

In the study population, the majority of the respondents were mildly addicted to the internet. The average level of addiction was reported by 9.3-23.5% of the respondents. The average level of internet addiction was higher among Portuguese students and among men. Those who had suffered from COVID-19 (especially more than once) and were more physically active showed a higher tendency towards internet addiction.

CONCLUSIONS

Internet addiction is a problem that has to be monitored and given more attention, particularly among male students. The results presented provide the first statistical insight into the problem of internet addiction among students in both countries and form the basis for further studies. They also highlight the severity of the problem and point to the need for early preventive and protective interventions against problematic internet use. It appears that effective strategies should include promoting the benefits of physical activity.

Association between problematic Internet use and specific Internet activities and COVID-19- and earthquake-related stress, anxiety, and depression symptoms among Croatian young adults

Background

During the COVID-19 pandemic and concomitant earthquakes in Croatia in 2020, increased Internet use (IU) and Internet-based addictive behaviors were associated with decreasing mental well-being. We determined the changes in IU, problematic IU (PIU), and problematic specific Internet activities in young adults during the prolonged stress caused by the pandemic and earthquakes, age differences in PIU and differences in perceived source of stress (pandemic or earthquakes), and association between PIU and increase in specific Internet activities and stress, anxiety, and depression symptoms in young adults.

Methods

A cross-sectional online survey conducted from September 30, 2021 to October 17, 2021 included 353 young adults aged 22.6 ± 2.1 years, 382 early adults aged 32.1 ± 4.4 years, and 371 middle-aged adults aged 49.0 ± 6.5 years. Data on sociodemographic characteristics, stressors (without perceived stressors, only pandemic-related stressor, only earthquake-related stressor, and both pandemic and earthquake-related stressors), PIU and IU were collected with a self-report questionnaire. The Impact of Event Scale and the Hospital Anxiety Depression Scale were used to evaluate mental symptoms. PIU and problematic specific Internet activities were assessed using Tao et al.'s criteria. Data were anaylzed with paired-sample Wilcoxon test, McNemar's and Pearson's chi-square tests, and structural equation modeling.

Results

In 17% of young adults, we found increased PIU (OR = 5.15, 95% CI [2.82, 10.18]), problematic social media use (OR = 2.77, 95% CI [1.56, 5.14]), and uncontrolled online shopping (OR = 5.75, 95% CI [1.97, 22.87]) (p < 0.001 for all). PIU and problematic social media use were more common among young adults (60.8%), as well as problematic online gaming (25.9%). Problematic social media use was more frequent among young adults reporting pandemic stress than among those without perceived stress (69.9% vs. 43.2%). Increased online gaming predicted more severe avoidance symptoms (p = 0.041), increased social media use predicted more severe depression symptoms (p = 0.017), increased online shopping predicted more severe intrusion (p = 0.013) and anxiety symptoms (p = 0.001). PIU predicted more severe intrusion (p = 0.008), avoidance (p = 0.01), anxiety (p < 0.001), and depression (p = 0.012) symptoms.

Conclusion

Different effects of the pandemic and earthquakes on IU could reflect a different effect of various stressors on Internet behavior of young adults. Type of problematic Internet behavior may predict for the type of mental health problem.

Internet addiction induced critical fusion frequency among young adults

Critical flicker fusion frequency (CFF) is the frequency at which flickering light can be perceived as continuous and it is used to assess the processing of temporal vision. It is of interest to compare critical fusion frequency (CFF) in mild, moderate & severe internet users. Cross sectional observation study was done among 350 professional students. Internet addictions for around 372 professional students & internet addiction was evaluated by Young's scale of Internet Addiction questionnaire in the age group 18-25 years. CFF was measured using an in-house built LED-based CFF M1 Model instrument. A total of 372 participants (in age group 19-22 years) were recruited. Of the participants 65 % of them were mild internet addictors, 48% were moderate and 7% were severe internet adductors. Among the internet usage, the Kruskal-Wallis test showed a significant difference in internet addiction score, duration of internet usage (hours) and average Critical fusion frequency (Hz) (P<0.001). For the average critical fusion frequency (Hz), the Dwass-Steel-Critchlow-Fligner test showed significant pairwise comparisons between the following: (1) mild internet addictor's vs moderate internet addictors and (2) Mild internet addictors versus severe internet addictors (p<0.001). Critical flicker fusion frequency(CFF) as it is an easy, quick, and non-invasive technique used as a general indicator of cortical processing, visual persistence for cognitive flexibility.

The association of problematic usage of the internet with burnout, depression, insomnia, and quality of life among Hungarian high school students

Introduction

The extensive availability of the internet has led to the recognition of problematic usage of the internet (PUI) or so called internet addiction (IA), probably mostly involving adolescents.

Aim

Here we present a study focusing on the incidence and consequences (including burnout, which is relatively rarely studied) of internet addiction among high school students using a questionnaire-based non-random sampling cross-sectional survey. Included questionnaires were the Problematic Internet Use Questionnaire, the Maslach Burnout Inventory General Survey for Students MBI-GS (S), the 9-item short version of Beck Depression Inventory (BDI-SF), the Athens Insomnia Questionnaire and the EQ-5D (quality of life) questionnaire. Data were evaluated the exertion of Student's t-test, chi square test and Pearson's rank-order correlation. Logistic regression analysis was used to determine the significance of the different parameters as independently associated with PUI.

Results

Overall 3,000 paper-based questionnaires were successfully delivered and 2,540 responses received (response rate of 84.6%). 1,309 males (mean age 17.6 ± 1.43 years) (51.5%) and 1,231 females (mean age 17.5 ± 1.4 years) (48.5%) took part in our study. Problematic usage of the internet was detected in 486 (19.1%) students (232 males, mean age 17.6 ± 1.35 years and 254 females, mean age 17.34 ± 1.37 years). In a logistic regression analysis sleep disturbance (OR: 1.84, 95% CI: 1.83-2.03), depression (OR: 1.97, 95% CI: 1.77-2.02) and burnout (OR: 1.8, 95% CI: 1.16-1.94) were significantly associated with PUI.

Conclusion

Nearly one fifth of our study population suffered from PUI, which was strongly associated with school burnout, insomnia and depression, which underlines the importance of this phenomenon.

Neurobiological risk factors for problematic social media use as a specific form of Internet addiction: A narrative review

Problematic social media use (PSMU) is a behavioral addiction, a specific form of problematic Internet use associated with the uncontrolled use of social networks. It is typical mostly for modern adolescents and young adults, which are the first generations fully grown up in the era of total digitalization of society. The modern biopsychosocial model of the formation of behavioral addictions, postulating the impact of a large number of biological, psychological, and social factors on addictive behavior formation, may be quite applicable to PSMU. In this narrative review, we discussed neurobiological risk factors for Internet addiction with a focus on current evidence on the association between PSMU and structural/ functional characteristics of the brain and autonomic nervous system, neurochemical correlations, and genetic features. A review of the literature shows that the vast majority of the mentioned neurobiological studies were focused on computer games addiction and generalized Internet addiction (without taking into account the consumed content). Even though a certain number of neuroimaging studies have been conducted for PSMU, there is practically no research on neuropeptide and genetic associations for PSMU to date. This fact points to the extremely high relevance of such studies.

Treatment Modalities for Internet Addiction in Children and Adolescents: A Systematic Review of Randomized Controlled Trials (RCTs)

BACKGROUND

In recent years, the use of the internet among children and adolescents has dramatically increased, leading to growing concerns regarding the potential risks of excessive internet use and addiction. Addressing these concerns, this systematic review aims to summarize current evidence on the effectiveness of treatment interventions for internet addiction among children and adolescents.

METHOD

We performed a systematic review using PubMed, Web of Science, PsycInfo, and Google Scholar with search terms including "internet addiction", "problematic internet use", "children" or "adolescents", "treatment" and "randomized controlled trial". We found 10 Randomized Controlled Trials (RCTs) meeting the criteria and included them in this systematic review.

RESULTS

This systematic review analyzed 10 randomized controlled trials focused on treatment interventions for internet addiction in adolescents and young adults. The interventions used were diverse, including cognitive-behavioral therapy (CBT), medication, electro-acupuncture (EA), and solution-focused approaches. The measures used to assess the effectiveness of the interventions also varied, but most studies reported moderate to large effect sizes for at least some outcomes. Overall, the studies suggest that interventions such as CBT and EA can be effective in reducing symptoms of internet addiction, internet gaming disorder, and unspecified internet use disorders. School-based programs and brief manualized CBT programs also show promise, though more research is needed to determine their long-term effectiveness.

CONCLUSION

Promising treatment approaches for internet addiction are emerging, but inconsistencies in conceptualization, language, and diagnostic criteria present some challenges. The growing recognition of problematic internet use, as shown by the DSM-5's recognition of Internet Gaming Disorder, highlights the need for a multidisciplinary approach and standardized criteria to facilitate accurate reporting across studies. Continued research is needed to identify effective treatments and diagnostic criteria for internet addiction, with the potential to offer practical insights into effective medications and therapies.

Internet, studying and daily rhythm: health symptoms among higher education students

OBJECTIVES

Excessive Internet use is a health concern among higher education students leading to reduced academic performance and problems in everyday life. This study aimed to explore the relationship between health and problems of studying and daily rhythm caused by time spent online among students (n=3,050).

METHODS

A cross-sectional survey was carried out. The data were analyzed using descriptive and chi-square tests and logistic regression analyses.

RESULTS

Findings indicated that one fifth of students reported having problems of studying and daily rhythm caused by time spent online. Psychological health symptoms such as anxiety (p<0.001) and physical health symptoms including lower back problems (p<0.001) were associated with these problems. According to the logistic regression analyses, problems of studying and daily rhythm caused by time spent online and higher amount of Internet use by time were associated with psychological and physical health symptoms.

CONCLUSIONS

The findings suggest that problems of studying and daily rhythm and spending more time online are related to health symptoms among the students. The study's findings can be used from a prevention standpoint for early identification and further to identify the need for seeking professional treatment.

Problematic internet use and suicidality and self-injurious behaviors in adolescents: Effects of negative affectivity and social support

BACKGROUND

Problematic internet use (PIU) has been shown to be closely associated with suicidality and self-injurious behavior (SSIB), but the mechanism to help explain this association is understudied. The aim of the present study is to test mediating effects of negative affectivity between PIU and SSIB and whether social support moderates this mediating effect.

METHODS

A sample of 2173 middle and high school students (M_age = 14.66, SD_age = 1.87) in central China were recruited. All participants completed a self-report questionnaire assessing PIU, SSIB, negative affectivity, and social support. Simple mediation analysis and moderated mediation analysis were conducted to examine the roles of negative affectivity and social support in the association between PIU and SSIB.

RESULTS

PIU was positively associated with SSIB, and negative affectivity mediated this association (β = 0.255, Boot 95 % CI: 0.219 to 0.296). The indirect effect of negative affectivity was moderated by social support, with a stronger association between PIU and SSIB for adolescents with lower social support (β = 0.228, Boot 95 % CI: 0.178 to 0.282) than their counterparts (β = 0.098, Boot 95 % CI: 0.068 to 0.133).

LIMITATION

Cross-sectional design with self-report measures.

CONCLUSIONS

PIU is a detrimental risk factor for SSIB, as it is associated with high negative affectivity and increased SSIB, which was more robust for adolescents with lower social support. These results highlight the importance of helping adolescents regulate negative affectivity and improving social support-based preventative interventions to reduce SSIB.

Digital Addiction Intervention for Children and Adolescents: A Scoping Review

Digital devices play a significant role in the learning and living of children and adolescents, whose overuse or addiction has become a global concern. This scoping review seeks to synthesize existing studies to investigate relevant interventions and their effects on digital addiction in children (ages 0-18). To understand the latest advances, we have identified 17 studies published in international peer-reviewed journals between 2018-2022. The findings revealed that, first, most interventions for digital addiction in children and adolescents were cognitive-behavioral therapies (CBT) or CBT-based interventions, which could improve anxiety, depression, and related symptoms of digital addiction. Second, rather than directly targeting addictive behaviors, some family-based interventions aim to strengthen family functions and relationships. Finally, digital-based interventions, such as website-based, application-based, and virtual reality interventions, are promising in adolescent digital addiction interventions. However, these studies shared the same limitations: small sample sizes, short intervention durations, no control group, and nonrandomized assignments. The small sample size problem is difficult to solve by offline intervention. Meanwhile, online digital-based intervention is still in its infancy, resulting in limited generalizability of the findings and the inability to popularize digital intervention. Accordingly, future intervention studies should integrate various assessments and interventions to form an integrated platform to provide interventions for addicted children and adolescents worldwide.

Can Heart Rate Variability be Viewed as a Biomarker of Problematic Internet Use? A Systematic Review and Meta-Analysis

Heart rate variability (HRV) has been used to explore the parasympathetic activity of individuals with problematic Internet use (PIU), but the results are controversial. We conducted a systematic review and meta-analysis of studies comparing HRV in PIU individuals and healthy participants from several databases. HRV was analyzed according to the parasympathetic activity in hierarchical order (primary analysis), and the total variability (secondary analysis). The baseline HRV and HRV reactivity were both considered. Of the 106 studies screened, 12 were included in the quantitative analysis. Significant differences were observed for baseline HRV in PIU individuals compared to the controls. Regarding HRV reactivity, PIU individuals did not have a significantly lower HRV value during pleasant or unpleasant stimuli. In summary, PIU individuals and healthy subjects had significantly different resting state parasympathetic activity. The finding of HRV reactivity in PIU individuals awaits further investigation.

Problematic Internet Use among Adults: A Cross-Cultural Study in 15 Countries

BACKGROUND

The present study compared adult usage patterns of online activities, the frequency rate of problematic internet use (PIU), and risk factors (including the psychopathology associated with PIU, i.e., distress and impulsivity) among adults in 15 countries from Europe, America, and Asia.

METHODS

A total of 5130 adults from Belgium, Finland, Germany, Italy, Spain, France, Switzerland, Hungary, Poland, UK, Norway, Peru, Canada, US, and Indonesia completed an online survey assessing PIU and a number of psychological variables (i.e., depression, anxiety, stress, and impulsivity). The sample included more females, with a mean age of 24.71 years (SD = 8.70).

RESULTS

PIU was slightly lower in European countries (rates ranged from 1.1% in Finland to 10.1% in the UK, compared to 2.9% in Canada and 10.4% in the US). There were differences in specific PIU rates (e.g., problematic gaming ranged from 0.4% in Poland to 4.7% in Indonesia). Regression analyses showed that PIU was predicted by problematic social networking and gaming, lack of perseverance, positive urgency, and depression.

CONCLUSIONS

The differences in PIU between countries were significant for those between continental regions (Europe versus non-European countries). One of the most interesting findings is that the specific PIU risks were generally low compared to contemporary literature. However, higher levels of PIU were present in countries outside of Europe, although intra-European differences existed.

Refractive errors and ocular findings in children and adolescents with mental disorders: a retrospective study

BACKGROUND

An increasing prevalence of mental disorders (MDs) has been reported among children and adolescents. However, only few studies have conducted ocular examinations, including those on refractive status, in these groups of patients. Thus, the purpose of this study was to evaluate the refractive status and ocular findings in children and adolescents with MDs compared with matched controls with similar socioeconomic backgrounds.

METHODS

A total of 178 participants with MDs and 200 controls were recruited between April 2021 and May 2022. All the children and adolescents underwent cycloplegic or noncycloplegic autorefraction and retinoscopy, slit-lamp biomicroscopy, and dilated fundus examinations. Ocular alignment was assessed using Hirschberg, Krimsky, or prism cover tests. The prevalence of refractive errors and ocular findings was the main outcome.

RESULTS

Twenty-seven percent of patients with MDs and 8% of controls had ocular findings, the most common of which were conjunctivitis, keratitis, and trichiasis. For refractive status, 70% (124/178) of patients with MDs had myopia ≤-1.00 DS, and 2% (4/178) had hyperopia ≥+2.00 DS. In the control group, 70% (140/200) of patients had myopia ≤-1.00 DS, and 1% (2/200) had hyperopia ≥+2.00 DS. No differences were observed between the MD and control groups. However, the patients in the MD group (14.25±2.69 years) were significantly more susceptible to strabismus (P<0.05) and amblyopia (P<0.01) than those in the control group (13.65±3.04 years). There was a substantial difference between the two groups in the time spent on screen-based devices (P<0.001). Furthermore, mental retardation (OR=3.286, P<0.01), emotional disorders (OR=2.003, P<0.01), and adjustment disorders (OR=2.629, P<0.01) were associated with an increased risk of amblyopia. Depression (OR =1.362, P<0.01) and emotional disorders (OR=2.205, P<0.01) were associated with a higher prevalence of strabismus.

CONCLUSION

Ophthalmological examinations should be performed in children and adolescents with MDs because MDs are associated with a high prevalence of refractive errors and ocular diseases. Detection and intervention of ocular and refractive findings in children and adolescents with MDs are necessary and effective in alleviating the economic burden in healthcare and improving individuals' quality of life.

Systematic reviews and meta-analyses of treatment interventions for Internet use disorders: Critical analysis of the methodical quality according to the PRISMA guidelines

RATIONALE

As a result of concerns about predominantly online behavioral addictions, an increasing number of systematic reviews and meta-analyses (SRMA) of treatment interventions for internet use disorders (IUD) are being recorded. This review was designed to (a) systematically identify the evidence base of SRMA and to (b) critically appraise the quality of reporting according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines.

METHODS

Four databases were searched until August 2022 to systematically identify SRMA. PRISMA indicators were evaluated on a three-level response format to obtain an overall score operationalizing the quality of reporting (score range: 0-84). Additionally, the percentage of adherence to the PRISMA indicators was calculated.

RESULTS

Reporting quality of 23 SRMA, comprising 12 systematic reviews and 11 meta-analyses was evaluated. Quality scores ranged from 25 to 77 (M: 52.91; SD: 17.46). Results of the critical appraisal revealed deviations from the PRISMA indicators, including missing information on (a) registration of a study protocol, (b) statistical synthesis methods (c) evaluation of certainty of evidence, and (d) risk of bias assessment. Eleven (47.83%) of the SRMAs partially adhered, and twelve (52.17%) completely adhered to the PRISMA indicators.

CONCLUSION

This first critical appraisal on the reporting quality of SRMA on treatment interventions for IUD highlights limitations of the evidence base. Inadequate reporting compromises the practical utility and validity of SRMA and may complicate ongoing efforts of consensus on evidence-based interventions for IUD. Future research should focus on sufficient and transparent reporting of the methodological approach.

Internet addiction in adolescent psychiatric patient population: A hospital-based Study from China

BACKGROUND

Internet is gradually reshaping adolescents' behaviors in China. It is important to identify the prevalence and risk factors to predict Internet addiction among adolescent psychiatric patients.

METHODS

The survey was conducted among inpatient or outpatient adolescent patients with mental disorders. All participants were interviewed face-to-face and completed Young Internet Addiction Test and other relevant assessments. Binary logistic regression analysis was used to exam between-group differences of internet addiction.

RESULT

The prevalence for internet addiction (mild to severe) in adolescent psychiatric patients was 80.2%, where the prevalence for "medium and severe internet addiction was 25.5%. Logistic regression analysis identified two independent predictors for "medium and severe internet addiction" including the total score of Adolescent Non-suicidal-self-injury (NSSI) Behavior Function Assessment Scale (ANBFAS) and the diagnosis of generalized anxiety disorder (GAD) (R² =0.27, p = .02 for total ANBFAS score, p = .01 for GAD) in psychiatric adolescent patients.

CONCLUSION

The prevalence of internet addiction is notably high among adolescent psychiatric patients in China. Coping for Internet addiction in adolescent psychiatric patients should conclude the coping of NSSI and GAD.

Occurrence of problematic Internet use and its correlates among Egyptian adolescent students in international schools in Cairo

Background

Internet addiction is a global phenomenon that has been a topic of great interest to researchers, clinicians, teachers, parents, and community groups. The study aims in determination of the rate of problematic Internet use among a sample of Egyptian adolescent students, relations of problematic Internet use with socio-demographic data, risk factors, and comorbid psychiatric disorders. A sample of 248 Egyptian adolescent school students aged 11 to 18 years old were assessed using the Young’s Internet Addiction Test (IAT), Internet Gaming Disorder (IGD) Scale, Social Media Disorder (SMD) Scale, Youth Self-Report (YSR), and The Mini International Neuropsychiatric Interview for children and adolescents (Mini KID).

Results

Among the study sample, 42.3% of the students suffered from mild Internet addiction, 35.1% suffered from moderate Internet addiction, and 3.6% suffered from severe addiction. 31.5% were risky gamers and 10.5% were disordered gamers; 34.3% had problematic social media disorder and the highest observed psychiatric disorders were major depressive episodes 9.3%, generalized anxiety disorder 7.7%, alcohol dependence 4.4%, attention-deficit hyperactivity disorder 4.4%, social phobia 4%, and a higher percentage of psychiatric disorders among severe Internet addiction 88.9% and among moderate addiction 70.6%, disordered gamers 92.3%, problematic social media users 60%, and a higher mean of hours spent online per day of 6.8 h per day.

Conclusions

Problematic Internet use has a negative impact on Egyptian adolescent students in international schools in study sample and adds to the existing literature regarding the magnitude of Internet addiction and its relationship with different psychiatric disorders.

Problematic Internet Use, Anxiety, Depression, and Stress Symptoms in Adults with COVID-19 Pandemic and Earthquake Experience: Insights from Croatian Online Survey

In 2020, Croatia was hit by the COVID-19 pandemic and two earthquakes. As previous research showed that Internet use (IU) increased during the COVID-19 pandemic, we carried out an online survey to determine the levels of problematic Internet use (PIU) and problematic specific Internet activities before and during the prolonged stress caused by the COVID-19 pandemic as well as earthquakes. We also determined the correlation between the PIU and specific Internet activities and anxiety, depression, and stress symptoms. According to the responses of 1,118 participants from all Croatian regions, PIU increased by 14.1 percent (odds ratio [OR] 6.2), problematic social media use by 12.6 percent (OR 4.8), and uncontrolled online shopping by 5.3 percent (OR 5.8) in comparison with presurvey period. The PIU increase was significantly higher in participants reporting only pandemic-related stress than in those reporting both pandemic- and earthquake-related stress. Problematic social media use increased in those reporting only pandemic-related stress and both pandemic- and earthquake-related stress. The strongest correlation between PIU and problematic social media use and anxiety, depression, intrusion, and avoidance symptoms was found among those reporting both pandemic- and earthquake-related stress. The correlation between psychiatric measures and PIU and problematic specific Internet activities varied depending on the source of experienced or perceived stress. Our findings show the relationship between the problematic stress-related Internet behaviors, different types of stressors, and their impact on the overall PIU and problematic specific Internet activities in situations of prolonged stress.

The Generalized Problematic Internet Use Scale 2 in a Polish sample: psychometric validation and relationship with specific Internet-related disorders and psychosocial functioning

BACKGROUND

The present study aimed to adapt and psychometrically validate the Generalized Problematic Internet Use Scale 2 (GPIUS2) based on the cognitive-behavioral model of problematic Internet use. Furthermore, the study aimed to examine the relationship between problematic Internet use and other specific Internet-related disorders (i.e., social networking sites addiction, Facebook addiction, and problematic pornography use), as well as the relationships with indicators of poor psychosocial functioning.

PARTICIPANTS AND PROCEDURE

GPIUS2 was administered to 1155 young Internet users. Participants completed a survey assessing problematic Internet use, specific Internet related-disorders, and indicators of poor psychosocial functioning (anxious and avoidant attachment, social anxiety, and loneliness) via two measuring contexts (online and offline).

RESULTS

The results support a four-factor internal structure of the GPIUS2, similar to that initially proposed and the results of the previous studies. GPIUS2 demonstrated good reliability as well as scalar invariance across online and offline measured contexts.

CONCLUSIONS

Problematic Internet use is a multidimensional construct rather than a one-dimensional construct with strong but not overlapping positive relations with the other specific Internet-related disorders. Those relationships are especially strong among problematic activities related to the social context of Internet use. Furthermore, our findings prove the theoretical assumptions that psychosocial problems and poor social skills are related to problematic Internet use.

Gender differences in psychiatric comorbidity and personality characteristics among adults seeking treatment for problematic internet use

In the present study, we investigated gender differences in personality and psychiatric correlates among adults (N = 115) seeking treatment for problematic internet use (PIU) at a specialized clinic in São Paulo, Brazil. All participants were assessed at the beginning of their treatment for co-occurring psychiatric conditions, other addictive behaviors, and personality characteristics. Women (n = 20) were more likely to present with greater rates of psychiatric comorbidity compared to men (n = 95), including mood disorders, anxiety disorders, obsessive-compulsive disorder, post-traumatic stress disorder, and bulimia nervosa. Women also had a greater severity of certain behavioral addictions, such as compulsive buying and disordered eating. Gender differences were also found across personality characteristics, with women scoring higher on impulsivity, novelty seeking, and self-transcendence compared to men. To our knowledge, the present study is the first to investigate gender differences for PIU in a clinical sample. The results suggest that there are notable gender differences in individuals seeking treatment for PIU which underscores the importance of assessing for co-occurring conditions, especially in women. Understanding the characteristics associated with PIU can help serve to inform the most appropriate interventions to bolster treatment outcomes.

Assessment of the Popularity and Perceived Effectiveness of Smartphone Tools That Track and Limit Smartphone Use: Survey Study and Machine Learning Analysis

Background

Problematic smartphone use, like problematic internet use, is a condition for which treatment is being sought on the web. In the absence of established treatments, smartphone-provided tools that monitor or control smartphone use have become increasingly popular, and their dissemination has largely occurred without oversight from the mental health field.

Objective

We aimed to assess the popularity and perceived effectiveness of smartphone tools that track and limit smartphone use. We also aimed to explore how a set of variables related to mental health, smartphone use, and smartphone addiction may influence the use of these tools.

Methods

First, we conducted a web-based survey in a representative sample of 1989 US-based adults using the crowdsourcing platform Prolific. Second, we used machine learning and other statistical tools to identify latent user classes; the association between latent class membership and demographic variables; and any predictors of latent class membership from covariates such as daily average smartphone use, social problems from smartphone use, smartphone addiction, and other psychiatric conditions.

Results

Smartphone tools that monitor and control smartphone use were popular among participants, including parents targeting their children; for example, over two-thirds of the participants used sleep-related tools. Among those who tried a tool, the highest rate of perceived effectiveness was 33.1% (58/175). Participants who experienced problematic smartphone use were more likely to be younger and more likely to be female. Finally, 3 latent user classes were uncovered: nonusers, effective users, and ineffective users. Android operating system users were more likely to be nonusers, whereas younger adults and females were more likely to be effective users. The presence of psychiatric symptoms did not discourage smartphone tool use.

Conclusions

If proven effective, tools that monitor and control smartphone use are likely to be broadly embraced. Our results portend well for the acceptability of mobile interventions in the treatment of smartphone-related psychopathologies and, potentially, non–smartphone-related psychopathologies. Better tools, targeted marketing, and inclusive design, as well as formal efficacy trials, are required to realize their potential.

The Effect of COVID-19 Perceived Risk on Internet Addiction among College Students in China: An Empirical Study Based on the Structural Equation Model

This study focused on COVID-19 perceived risk and Internet addiction among Chinese college students during the lockdown. On the basis of the Social Cognitive Theory, this study proposed a mediating model to evaluate the mediating role of difficulties in regulating emotion between the COVID-19 perceived risk and Internet addiction. A questionnaire survey was conducted among 690 college students during the COVID-19 lockdown in China. The results showed that the COVID-19 perceived risk was significantly positively associated with Internet addiction (r = 0.236, p < 0.001) and difficulties in emotion regulation (r = 0.220, p < 0.001), difficulties in emotion regulation was significantly positively associated with Internet addiction (r = 0.368, p < 0.001). The COVID-19 perceived risk had a significant and positive predictive effect on Internet addiction (β = 0.233, p < 0.001) among Chinese college students. The analysis of the mediation model showed that difficulties in emotion regulation partially mediated the relationship between COVID-19 perceived risk and Internet addiction (indirect effect value was 0.051 with 95% Confidence Interval ranging from 0.027 to 0.085). The findings not only enhanced our understanding of the internal influence mechanism of COVID-19 perceived risk on Internet addiction but also provided a practical basis for college education works. Finally, discussions and suggestions were provided on the basis of the results.

Internet addiction, depression, anxiety and stress among first year medical students after COVID-19 lockdown: A cross sectional study in West Bengal, India

Objectives

1. To assess the impact of COVID-19 lockdown on Internet addiction on first year medical students. 2. To evaluate the associations, if any, between internet addiction, anxiety, depression and stress.

Methods

Internet addiction, depression, anxiety and stress among medical students across West Bengal have been studied using Young's Internet Addiction Test (IAT) scale and the Depression, Anxiety and Stress Scale (DASS-21). A web-based questionnaire was made and circulated via different social media platforms. All interested candidates who gave consent were included in the study. All statistical analyses were done using SPSS version 25.0.

Results

The study population consisted of 37.2% of males and 63.8% of females. 80.23% of the participants showed moderate levels of internet addiction. Strong positive correlation was found between anxiety and stress (r = 0.83, P < 0.05), depression and anxiety (r = 0.92, P < 0.05) and between depression and stress (r = 0.86, P < 0.05).

Conclusion

The unprecedented ramifications of lockdown are incessant, with internet addiction, magnification in depression, anxiety and stress to name a few. Internet addiction coupled with psychological disorders still remains a matter of concern for medical students.

Does Internet Entertainment Reduce the Cognitive Ability of Children? Evidence from the China Education Panel Survey

Internet technology has been assimilated into children’s educational system on an in-depth level. In particular, the number of children who use the internet for entertainment has been rapidly increasing. However, there has been a debate as to whether internet entertainment can have a detrimental impact on children’s cognitive ability. This paper investigates the effect of internet entertainment on the cognitive ability of children in the Chinese context. The results show no evidence of associations between internet entertainment and children’s cognitive ability. However, the additional analysis provides preliminary evidence suggesting that internet entertainment can be beneficial to children who use it for entertainment only on weekends but detrimental for those who spend leisure time online daily. In addition, the findings are robust in a variety of sensitivity tests. We also examine whether the effects of internet entertainment on children’s cognitive ability in different family environments are heterogeneous. The findings suggest that parents’ internet habits, parents’ internet supervision, parental relationship, family education and living area play a moderating role in the relationship between internet entertainment and children’s cognitive ability. This study offers useful insights into the current global debate on the nexus between internet entertainment and children’s cognitive ability and also provides suggestions for parents, children, regulators and policymakers.

Brain Anatomy Alterations and Mental Health Challenges Correlate to Email Addiction Tendency

Despite the widespread use of email, our knowledge regarding the consequences of email addiction is lacking. The purpose of this study was to develop an email addiction tendency scale to evaluate its correlation to behavior and brain structure. Following this, the validity and reliability of the developed scale was investigated. We used voxel-based morphometry, correlation, and univariate regression analysis to assess the relationships between email addiction tendency scores and regional gray and white matter volumes, depression, and nonverbal reasoning abilities in a large sample of healthy young adults (n = 1152; mean age, 20.69 ± 1.84 years). The content validity ratio, content validity index, principal component analysis, and confirmatory factorial analysis all showed that the email addiction tendency scale (EATS) has high validity. Additionally, the Cronbach’s alpha internal consistency and split-half reliability coefficient showed that the EATS has high reliability. We found that email addiction tendency scores were significantly negatively correlated with nonverbal reasoning. We also observed that the email addiction tendency scores were significantly and positively correlated with depression symptom severity and gray matter volume of the left rostrolateral prefrontal cortex (RLPC) in subjects. These results indicate that email addiction tendency is associated with lower mental health outcomes and increased GMV in the left RLPC.

Motivational brief interventions for adolescents and young adults with Internet use disorders: A randomized-controlled trial

BACKGROUND

Adolescents and young adults (AYA) have an increased risk for Internet use disorders (IUD) compared to older individuals that may lead to functional impairments in daily life. To date, evidence-based brief interventions are lacking. This study aimed to test the efficacy of a low-threshold counseling approach based on Motivational Interviewing (MI) in a vocational school setting.

METHODS

Of 8.230 vocational students (age M=20.56, SD=4.68; 51.85% female) being proactively screened for IUD, 937 with positive screenings took part in telephone-based diagnostic interviews. IUD were assessed in line with the criteria of the Internet Gaming Disorder in the Diagnostic and Statistical Manual of Mental Disorders, 5th edition (DSM-5). Readiness to change, self-efficacy, and impairments in daily life were additionally assessed with standardized screening instruments. Participants fulfilling at least two IUD criteria were randomized to the intervention group (n=240, up to three MI-based counseling sessions via telephone) or the control group (n=257, information brochure on responsible Internet use). Follow-up interviews were conducted after five and ten months. The primary outcome was the reduction of IUD criteria. Secondary outcomes were improvements of readiness/ self-efficacy to change and the reduction of daily impairments. Data were analyzed with Intention-to-Treat (ITT) and complier average causal effect (CACE) analyses.

RESULTS

Overall, 153 (63.75%) individuals assigned to the intervention group participated at least in one counseling session (=compliers). Both groups reduced the number of IUD criteria over time. In ITT analyses, however, we did not find intervention effects for primary and secondary outcomes. Bayes statistics were inconclusive. Based on low participation rates in the intervention group, explorative CACE analyses were conducted to compare compliers in the intervention group to potential compliers in the control group. Again, we did not find intervention effects apart from improvements in self-efficacy after five months.

DISCUSSION

Telephone-based counseling seems not appropriate to address AYA at risk for IUD. Low participation rates in the intervention group caused underpowered analyses. Besides, dealing with the own Internet use during intensive assessments and receiving an information brochure led to behavioral changes also in the control group. Since the efficacy of brief interventions under the condition of higher participation rates cannot be fully ruled out, further research is required by taking the implications of this study into account.

Relationships between Social Networking Sites Use and Self-Esteem: The Moderating Role of Gender

With the prevalence of the internet, there is growing attention on the impacts of social networking sites use among adolescents. The purpose of this study was to explore the relationships between different types of online activities (i.e., information searching, social interaction and entertainment) and self-esteem. It examined whether the relationships vary across gender. One hundred and ninety-three students (57.5% males; M_age = 13.33, SD_age = 1.58) participated in the present study. Unexpectedly, the associations between online activities and self-esteem were not significant (p > 0.05). Path analysis showed gender moderated the relationships between social interaction activities and self-esteem. Females reported higher levels of engagement in social interaction activities and self-esteem than their male counterparts. The present study shows the importance of assessing different types of online activities as a predictor for understanding the impact of social media use among adolescents.

Content and Effectiveness of Web-Based Treatments for Online Behavioral Addictions: Systematic Review

BACKGROUND

Very few people seek in-person treatment for online behavioral addictions including gaming and gambling or problems associated with shopping, pornography use, or social media use. Web-based treatments have the potential to address low rates of help seeking due to their convenience, accessibility, and capacity to address barriers to health care access (eg, shame, stigma, cost, and access to expert care). However, web-based treatments for online behavioral addictions have not been systematically evaluated.

OBJECTIVE

This review aimed to systematically describe the content of web-based treatments for online behavioral addictions and describe their therapeutic effectiveness on symptom severity and consumption behavior.

METHODS

A database search of MEDLINE, Embase, PsycInfo, Web of Science, Cochrane Central Register of Controlled Trials, and Google Scholar was conducted in June 2022. Studies were eligible if the study design was a randomized controlled trial or a pre-post study with at least 1 web-based intervention arm for an online behavioral addiction and if the study included the use of a validated measure of problem severity, frequency, or duration of online behavior. Data on change techniques were collected to analyze intervention content, using the Gambling Intervention System of CharacTerization. Quality assessment was conducted using the Effective Public Health Practice Project Quality Assessment Tool.

RESULTS

The review included 12 studies with 15 intervention arms, comprising 7 randomized controlled trials and 5 pre-post studies. The primary focus of interventions was gaming (n=4), followed by internet use inclusive of screen time and smartphone use (n=3), gambling (n=3), and pornography (n=2). A range of different technologies were used to deliver content, including websites (n=6), email (n=2), computer software (n=2), social media messaging (n=1), smartphone app (n=1), virtual reality (n=1), and videoconferencing (n=1). Interventions contained 15 different change techniques with an average of 4 per study. The techniques most frequently administered (>30% of intervention arms) were cognitive restructuring, relapse prevention, motivational enhancement, goal setting, and social support. Assessment of study quality indicated that 7 studies met the criteria for moderate or strong global ratings, but only 8 out of 12 studies evaluated change immediately following the treatment. Across included studies, two-thirds of participants completed after-treatment evaluation, and one-quarter completed follow-up evaluation. After-intervention evaluation indicated reduced severity (5/9, 56%), frequency (2/3, 67%), and duration (3/7, 43%). Follow-up evaluation indicated that 3 pre-post studies for gaming, gambling, and internet use demonstrated reduced severity, frequency, and duration of consumption. At 3-month evaluation, just 1 pre-post study indicated significant change to mental health symptoms.

CONCLUSIONS

Web-based treatments for online behavioral addictions use an array of mechanisms to deliver cognitive and behavioral change techniques. Web-based treatments demonstrate promise for short-term reduction in symptoms, duration, or frequency of online addictive behaviors. However, there is limited evidence on the effectiveness of web-based treatments over the longer term due to the absence of controlled trials.

Behavioral Addictions Questionnaire (BAQ): Validation of a New Tool for the Screening of Multiple Addictive Behaviors in the Italian Population

This study deals with the uncertainty in defining behavioral addictions (BAs). BAs are characterized by specific compulsive behaviors, regardless of potential negative consequences. However, to differentiate a behavior from a leisure activity to an addictive one is still an object of debate in the literature. Accordingly, this study aimed to assess the psychometric properties of the Behavioral Addictions Questionnaire (BAQ) as a possible screening tool for multiple BAs (i.e., shopping, food addiction, gambling, sex, work, exercise, Internet, videogames, and smartphone). BAQ aims to give a dimensional and quantitative assessment of addictive behaviors in a continuum, including both the adaptive and maladaptive features of the behaviors. Five hundred and seventy-six healthy adults (age range: 18–88) participated in the study, completing a survey including the BAQ questionnaire. Considering both exploratory and confirmatory factor analyses, statistical examination suggested good psychometric properties, with adequate validity in all its subscales (i.e., the goodness of fit). Moreover, also higher reliability was confirmed for each dimension detected (i.e., all alpha over 0.65). The BAQ represents a comprehensive screening instrument that benefits from appropriate validity and reliability for assessing BAs. Therefore, it can be used in clinical fields and research. Moreover, the feature of BAs on a continuum, and the severity index adopted by the study, can help from a preventive perspective. However, further validation of the BAQ is needed in other countries and contexts.

The association of smartphone screen time with sleep problems among adolescents and young adults: cross-sectional findings from India

Background

Although sleep problem is a growing public health issue with the advancement of technology, especially among adolescents and young adults, it received little attention. The study aimed to examine the association of screen time on smartphone with sleep problems among adolescents and young-adults in India.

Methods

We used data from the “Understanding the lives of adolescents and young-adults” (UDAYA, 2018). The effective sample size for the study was 16,292 adolescents and young adults (males-4428 and females-11,864). Descriptive statistics and bivariate analysis with percentages and chi-square test were used to report the preliminary results. Multivariable logistic regression analysis was conducted to examine the association between smartphone screen time and sleep problems, separately for adolescents and young adults.

Results

Nearly 15.6% of males and 23.5% of females had sleep problems in their adolescence in the last 15 days, while these percentage were high among young-adults (18.4% males and 33.24% females). Adolescents [AOR: 1.55; CI: 1.21-1.99] and young adults [AOR: 1.48; CI: 1.24-1.75], who spent more than 2 h on smartphone had higher odds of reporting sleep problems than those who did not use smartphone in the last 24 hours. Adolescent females who used smartphone for less or equal to 2 h and three or more hours respectively, had 2.11 [AOR: 2.11; CI: 1.63-2.73] and 2.94 times [AOR: 2.94; CI: 1.97-4.38] higher odds of reporting sleep problems than adolescent males who did not use smartphones. Additionally, among the young adult females, the odds of sleep problems were 1.66 times [AOR: 1.66; CI: 1.55-2.38] and 2.36 times [AOR: 2.36; CI: 1.59-3.51] greater than the non-users young adult males.

Conclusion

The increased time spent on mobile phones’s screen among adolescents and young-adults, particularly in females is associated with a higher likelihood of reporting sleeping problems. The current findings have important implications for adolescence and young-adults’ mental health programmes. The findings can also be used to further inform how different strategies need to be developed for better sleep outcome during adolescence and young-adults.

Prevalence of internet addiction in Africa: A systematic review and meta-analysis

BACKGROUND AND AIM

In the last two decades, the proportion of internet users has greatly increased worldwide. Data regarding internet addiction (IA) are lacking in Africa compared to other continents. This systematic review and meta-analysis aimed to estimate the pooled prevalence of IA in African countries.

METHODS

We systematically sought relevant articles in PubMed/MEDLINE, EMBASE, PsycINFO and Cochrane database published before September 25, 2021. The risk of bias was assessed using the Joanna Briggs Institute tool, and we estimated the pooled prevalence of IA using a random-effects meta-analytic model. We followed the Preferred Reporting Items for Systematic Reviews and Meta-analyses guidelines.

RESULTS

We included 22 studies (13,365 participants), and collected data from Egypt, Ethiopia, Morocco, Nigeria, South Africa, Tanzania and Tunisia between 2013 and 2021. The mean age of participants ranged from 14.8 to 26.1 years, and the most used tool for IA screening was the Young's 20-item Internet Addiction Test. The pooled prevalence rate of IA was 40.3% (95% CI: 32.2%-48.7%), with substantial heterogeneity. The pooled prevalence for Northern Africa was 44.6% (95% CI: 32.9%-56.7%), significantly higher than the prevalence in sub-Saharan Africa, which was 31.0% (95% CI: 25.2%-37.1%). The risk of bias was moderate for most studies, the certainty was very low, and we found no publication bias.

DISCUSSION AND CONCLUSIONS

Four in every ten individuals was considered to have IA in Africa. Further research with methodological optimization seems needed, especially for IA screening tools and the representativity of some subregions.

The relationship between perceptions of school climate and internet gaming disorder of teenage students: A moderated mediation model

Background

In recent years, teenage students' internet gaming disorder has raised widespread concern in the society. The current study aims to explore how perceptions of school climate, maladaptive cognition, and belief in a just world impact teenage students' internet gaming disorder and seek the suitable intervention to prevent teenage students' internet gaming disorder tendency.

Methods

A total of 1,164 teenage students (age: 19.62 ± 3.14 years) were evaluated using the Perceived School Climate Scale (PSCS), Maladaptive Cognition Scale (MCS), Belief in a Just World Scale (BJWS), and Internet Gaming Disorder Scale (IGDS).

Results

(1) Perceptions of school climate could predict teenage students' internet gaming disorder [β = -0.15, p < 0.001, 95% CI = (-0.20, -0.11)]. (2) Teenage students' maladaptive cognition exerts a partial mediating effect between their perceptions of school climate and internet gaming disorder [ab = -0.13, boot SE = 0.01, 95% CI = (-0.16, -0.11)]. (3) The direct effect of perceptions of school climate on internet gaming disorder [β = -0.07, p < 0.01, 95% CI = (-0.11, -0.02)], the first half of the mediation model "perceptions of school climate → maladaptive cognition" [β = -0.08, p < 0.01, 95% CI = (-0.12, -0.03)], and the second half of the mediation model "maladaptive cognition → internet gaming disorder" [β = 0.10, p < 0.001, 95% CI = (0.06, 0.14)] are all moderated reciprocally by teenage students' belief in a just world.

Conclusion

Schools should create a good climate and shape belief in a just world to reduce the maladaptive cognition of teenagers, to effectively prevent teenage students' internet gaming disorder tendency.

Emotion Regulation Choice in Internet Addiction: Less Reappraisal, Lower Frontal Alpha Asymmetry

Individuals with internet addiction (IA) show difficulties in emotion regulation. However, they could effectively employ emotion regulation strategies when instructed. We speculate that this discrepancy might be caused by maladaptive emotion regulation choices. Recent studies indicated that decreased activity of the left frontal cortex could be a neural marker of reappraisal use. To address this problem, individuals with IA (n = 17, IA group) and healthy individuals (n = 23, healthy control [HC] group) were required to choose an emotion regulation strategy between reappraisal and distraction to regulate their emotions varying in emotional intensity and valence. We also compared the resting state frontal alpha asymmetry (FAA) of these 2 groups. The results replicated more choices of reappraisal in low- versus high-intensity emotional contexts across groups. More importantly, the IA group chose reappraisal less frequently compared with the HC group, irrespective of emotional intensity. Furthermore, we found individuals with IA have lower FAA than healthy controls, and FAA shows a positive correlation with the use of reappraisal. These findings suggest that IA alters individuals' patterns of emotion regulation choice and impairs frontal activities, causing difficulties in emotion regulation.

Language processing in Internet use disorder: Task-based fMRI study

Internet use disorder (IUD) is generally conceptualized as a fast-growing behavioral addiction. Several structural and functional brain alterations have been revealed in this condition, but previous behavioral studies indicated that language systems may also be impaired. We used a silent word generation task to induce brain activation in Broca’s area and other parts of the language system. Blood-oxygen-level-dependent activation analysis and psychophysiological interaction analysis were applied to assess functional brain changes. IUD was measured by the Problematic Internet Use Questionnaire and two additional questions concerning usage time and subjective rating of addiction. According to our key findings, areas strongly related to the default mode network were altered in IUD during the task. Moreover, Broca’s area showed altered functional connectivity with other language network and occipital areas in IUD. These findings may address the neural background of decreased verbal fluency performance previously reported in the literature, and we emphasize that beside the brain’s reward and inhibitory control systems, the language system is the next candidate to be involved in the pathogenesis of IUD.