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

Research progress and debates on gaming disorder

Gaming disorder has become a significant issue in mental healthcare. While gaming is an important form of entertainment, excessive gaming may cause serious consequences for players. At present, there are still controversies in the academic community concerning the public health problems related to gaming disorder. This article attempts to expound the definition, epidemiology, aetiology, diagnosis, treatment and prevention of gaming disorder, in order to contribute to future conceptualization of gaming disorder.

Neurobiological Risk Factors for the Development of Internet Addiction in Adolescents

The sudden appearance and spread of Internet addiction in adolescent populations, in association with the rapid escalation of consumed Internet content and the broad availability of smartphones and tablets with Internet access, is posing a new challenge for classical addictology which requires urgent solutions. Like the majority of other psychopathological conditions, pathological Internet addiction depends upon a group of multifactor polygenic conditions. For each specific case, there is a unique combination of inherited characteristics (nervous tissue structure, secretion, degradation, and reception of neuromediators), and many are extra-environment factors (family-related, social, and ethnic-cultural). One of the main challenges in the development of the bio-psychosocial model of Internet addiction is to determine which genes and neuromediators are responsible for increased addiction susceptibility. This information will herald the start of a search for new therapeutic targets and the development of early prevention strategies, including the assessment of genetic risk levels. This review summarizes the literature and currently available knowledge related to neurobiological risk factors regarding Internet addiction in adolescents. Genetic, neurochemical and neuroimaging data are presented with links to actual pathogenetic hypotheses according to the bio-psychosocial model of IA forming.

Test-Retest Reliability and Walk Score® Neighbourhood Walkability Comparison of an Online Perceived Neighbourhood-Specific Adaptation of the International Physical Activity Questionnaire (IPAQ)

There is a growing public health interest in the contributions of the built environment in enabling and supporting physical activity. However, few tools measuring neighbourhood-specific physical activity exist. This study assessed the reliability of an established physical activity tool (International Physical Activity Questionnaire: IPAQ) adapted to capture perceived neighbourhood-specific physical activity (N-IPAQ) administered via the internet and compared N-IPAQ outcomes to differences in neighbourhood Walk Score^®. A sample of n = 261 adults completed an online questionnaire on two occasions at least seven days apart. Questionnaire items captured walking, cycling, moderate-intensity, and vigorous-intensity physical activity, undertaken inside the participant's perceived neighbourhood in the past week. Intraclass correlations, Spearman's rank correlation, and Cohen's Kappa coefficients estimated item test-retest reliability. Regression estimated the associations between self-reported perceived neighbourhood-specific physical activity and Walk Score^®. With the exception of moderate physical activity duration, participation and duration for all physical activities demonstrated moderate reliability. Transportation walking participation and duration was higher (p < 0.05) in more walkable neighbourhoods. The N-IPAQ administered online found differences in neighbourhoods that vary in their walkability. Future studies investigating built environments and self-reported physical activity may consider using the online version of the N-IPAQ.

Policy and Prevention Approaches for Disordered and Hazardous Gaming and Internet Use: an International Perspective

Problems related to high levels of gaming and Internet usage are increasingly recognized as a potential public health burden across the developed world. The aim of this review was to present an international perspective on prevention strategies for Internet gaming disorder and related health conditions (e.g., Internet addiction), as well as hazardous gaming and Internet use. A systematic review of quantitative research evidence was conducted, followed by a search of governmental reports, policy and position statements, and health guidelines in the last decade. The regional scope included the USA, UK, Australia, China, Germany, Japan, and South Korea. Prevention studies have mainly involved school-based programs to train healthier Internet use habits in adolescents. The efficacy of selective prevention is promising but warrants further empirical attention. On an international scale, the formal recognition of gaming or Internet use as a disorder or as having quantifiable harms at certain levels of usage has been foundational to developing structured prevention responses. The South Korean model, in particular, is an exemplar of a coordinated response to a public health threat, with extensive government initiatives and long-term strategic plans at all three levels of prevention (i.e., universal, selective, and indicated). Western regions, by comparison, are dominated by prevention approaches led by non-profit organizations and private enterprise. The future of prevention of gaming and Internet problems ultimately relies upon all stakeholders working collaboratively in the public interest, confronting the reality of the evidence base and developing practical, ethical, and sustainable countermeasures.

Measuring facets of reward sensitivity, inhibition, and impulse control in individuals with problematic Internet use

INTRODUCTION

Problematic Internet Use (PIU) is the inability to control the amount of time spent on the Internet. Research indicates that abnormalities in reward sensitivity, sensitivity to punishment, and impulse control drive addictive behaviors such as substance abuse and gambling disorders, but it is unclear whether this is also the case in PIU.

METHODS

Behavioral tasks and scales were completed by 62 participants (32 PIU individuals and 30 no-PIU individuals) to assess reward sensitivity, sensitivity to punishment, as well as inhibitory function and impulse control. Measures administered included Go/No-Go, delay discounting, Behavioral Inhibition/Activation (BIS/BAS) scales and the Sensitivity to Punishment and Sensitivity to Reward Questionnaire (SPSRQ).

RESULTS

The PIU group endorsed greater reward sensitivity and punishment sensitivity as indexed by the SPSRQ. However, there were no group differences with regards to delay discounting, performance in the Go/No-Go task, or endorsement in the BIS/BAS scales.

DISCUSSION

The present study found increased reward sensitivity and sensitivity to punishment in PIU individuals, though impulse control was not observably affected. Future experimental studies are needed to inform our conceptualization of the etiology of addictive behavior as it pertains to PIU. Further investigation will aid in informing prevention and intervention efforts.

Measuring Female Gaming: Gamer Profile, Predictors, Prevalence, and Characteristics From Psychological and Gender Perspectives

Research investigating female gaming is relatively scarce, and past research has demonstrated that men are more likely to be problematic gamers. Few studies have focused on female gamers in community samples, and those that have been published have mainly collected qualitative data in Europe. There is case study evidence suggesting clinicians are increasingly treating problem female gamers. The aim of this study is threefold: (i) to establish an international female gamer profile, (ii) to determine predictors associated with perceived internet gaming disorder (IGD), and (iii) to identify those who are potentially at risk of developing gaming addiction and its characteristics by applying a quantitative approach. A cross-sectional online survey was applied through international gaming forums recruiting 625 female gamers, assessing sociodemographics, gaming devices used and play genres, and a set of questionnaires on gaming [e.g., problem online gaming (e.g., the nine-item short-form scale to assess IGD: IGDS9-SF), female stereotypes (e.g., sex role stereotyping scale), and psychological symptoms (e.g., Symptom CheckList-27-plus)]. Female gamers from all continents reported the use of all videogames, especially popular online games using computers and consoles. The proportion of gamers with potential IGD was one per cent. Regression analyses identified several risk factors for increased scores on the IGDS9-SF, namely having achievement and social motivations, embodied presence and identification with the avatar, hostility and social phobia together with negative body image, playing Multiplayer Online Battle Arena games, Massively Multiplayer Online Role-Playing Games, and First-Person-Shooter games. Findings contribute to filling the gap in knowledge on female gaming, to aid in the applicability of problematic gaming measurements in female gamers, especially those who are at risk of problematic gaming. The purpose of this study is to enhance the validity of the current measures to diagnose problem gaming appropriately in both genders.

The Current Status of Psychological Intervention Research for Internet Addiction and Internet Gaming Disorder

This integrative review assesses the effectiveness of psychological interventions for reducing the severity of Internet addiction and/or Internet gaming disorder. We searched five databases, and both a narrative synthesis and meta-analyses were conducted. Five randomized controlled trials (RCTs) and six quasi-experimental studies met the inclusion criteria. The included interventions were categorized as cognitive-behavioral therapy, family-based intervention, and counseling program. A meta-analysis showed significant effects of psychological interventions, whereas a narrative synthesis showed some evidence that they could reduce addiction severity. Psychological interventions may help to reduce addiction severity, but further RCTs are needed to identify the most effective type.

Role of social anxiety on high engagement and addictive behavior in the context of social networking sites

Purpose

The purpose of this paper is to tackle the problem of technology addiction by investigating the differences between the antecedences of addictive (problematic technology usage) and high-engagement behavior (non-problematic technology usage). The case of social networking site usage (SNS, e.g. Facebook, Instagram or Twitter) is taken as the case out of the reason of prevalent user population.

Design/methodology/approach

It is revealed that people tend to use SNS not only for building a relationship, but also for communicating. In other words, there are inner needs of adopting the SNS technology. However, no clear definitions can be followed for determining the problematic SNS usage, addictive behavior and the high-engagement behavior. Therefore, this study adopts the notion of uses and gratification theory (U&G theory) for investigating the SNS usage behavior. Also, the social anxiety is also first introduced to integrate into the research for an empirical study.

Findings

Results reveal that gratification sought and relationship maintenance are associated with the addictive behavior, whereas the relationship maintenance is significantly related to high-engagement behavior.

Research limitations/implications

First, the selected data represents a sample of SNW users in the Asian Pacific region and mainly from the group of young college users. Therefore, caution must be taken when generalizing the findings to other SNW users or groups. Second, the time aspect related to social media dependence may need to be considered in future studies. Third, the authors found marginal support for the influence of intentions of high engagement¸ and future studies may consider applying other theories that could better explain these types of behavior.

Practical implications

The results of this study provide strong evidence that inner anxiety perceived by users should not be neglected while tackling the problematic internet use due to SNW addiction because it can strengthen the force for depending on SNW for seeking social support. Apart from the value of perceived enjoyment as asserted in previous studies, this study opens up a new opportunity to tackle SNW dependence.

Social implications

The key implication of this research is that the impact of the mental health of users on SNW problematic should not be overlooked . The higher the level of anxiety perceived, the more likely is the SNW dependence. Therefore, the online behavior depending on psychological health should be addressed because it may be a critical point for assisting users to adopt SNW wisely.

Originality/value

This study confirms that social anxiety people experience in real (offline) life has impacts on online behavior of SNS usage (online). It suggests that the difference between users as the perceived level of social anxiety can trigger different levels of SNS usage. Second, U&G theory is proven valid in understanding SNS addiction. Third, relationship maintenance through the use of SNS reveals its dissimilar effects on SNS addiction and high engagement.

Current diagnostic procedures and interventions for Gaming Disorders: A Systematic Review

Background: Despite the growth in the number of studies on Gaming Disorders (GD), assessing the characteristics of clinical subjects is still limited. Driven by the need to overcome this limitation, a broad systematic review is essential to cover the studies that have already assessed the clinical characteristics of individuals diagnosed with GD.

Objectives: The aim of this systematic review is to provide a broad cross-cultural picture of the current diagnostic procedures and interventions used for GDs in clinical practice.

Methods: A total of 28 studies met the inclusion criteria, and data were synthesized in these categories: (1) the cultural background of the country where the research took place; (2) the instruments used to measure GD; (3) the diagnostic criteria for GD; (4) the diagnostic procedures used; and (5) the treatment protocol applied.

Results: Results of this systematic review suggest that in GD clinical practice, there is a great deal of heterogeneity in the choice of instruments, the diagnostic and intervention processes for GD.

Conclusions: This systematic review indicates that a validation process of standard procedures in clinical populations with GD is necessary to create clear shared guidelines for practitioners.

Differentiation between young adult Internet addicts, smokers, and healthy controls by the interaction between impulsivity and temporal lobe thickness

BACKGROUND AND AIMS

Internet addiction is a non-substance-related addiction disorder with progressively growing prevalence. Internet addiction, like substance-related addictions, has been linked with high impulsivity, low inhibitory control, and poor decision-making abilities. Cortical thickness measurements and trait impulsivity have been shown to have a distinct relationship in addicts compared to healthy controls. Thus, we test whether the cortical correlates of trait impulsivity are different in Internet addicts and healthy controls, using an impulsive control group (smokers).

METHODS

Thirty Internet addicts (15 females) and 60 age- and gender-matched controls (30 smokers, all young adults aged 19-28 years) were scanned using a 3T MRI scanner and completed the Barratt Impulsiveness Scale.

RESULTS

Internet addicts had a thinner left superior temporal cortex than controls. Impulsivity had a significant main effect on the left pars orbitalis and bilateral insula, regardless of group membership. We identified divergent relationships between trait impulsivity and thicknesses of the bilateral middle temporal, right superior temporal, left inferior temporal, and left transverse temporal cortices between Internet addicts and healthy controls. Further analysis with smokers revealed that the left middle temporal and left transverse temporal cortical thickness change might be exclusive to Internet addiction.

DISCUSSION

The effects of impulsivity, combined with a long-term exposure to some specific substance or stimuli, might result in different natures of relationships between impulsivity and brain structure when compared to healthy controls.

CONCLUSION

These results may indicate that Internet addiction is similar to substance-related addictions, such that inefficient self-control could result in maladaptive behavior and inability to resist Internet use.

The role of family and personality traits in Internet gaming disorder: A mediation model combining cognitive and attachment perspectives

BACKGROUND AND AIMS

Gaming disorder was recently recognized as a mental health disorder by the World Health Organization and included in the International Classification of Diseases. Extensive research has been conducted with regard to psychosocial correlates and comorbidity, less so for the developmental mechanisms and the processes leading to the disorder. The association between family factors, personality traits, and gaming has been studied independently but not in combination. To fill this gap in knowledge, this study examined (a) the association between parental acceptance-rejection theory and Internet gaming disorder (IGD) and (b) the mediating and moderating effect of core self-evaluations (CSE), a personality construct, on the aforementioned variables.

METHODS

The study was quantitative and involved young adults members of online gaming communities (N = 225).

RESULTS

The results showed that parental rejection is associated with the occurrence of IGD, only through the mediating effect of CSE. The moderation model was not confirmed.

DISCUSSION

Findings bridge early emotional deficits with CSE personality traits and IGD, based on two widely acknowledged theoretical frameworks. In addition, they highlight the importance of the father's role in upbringing.

CONCLUSIONS

These frameworks combine cognitive and attachment perspectives and a process-oriented approach to the development and maintenance of IGD. The implications of these findings are discussed in relation to (a) the mechanisms leading to the disorder and (b) providing an evidence base for therapeutic interventions for IGD to go beyond abstinence and include self-esteem enhancement and efficacy contingencies. Directions for future research are also provided in this study.

Internet addiction associated with right pars opercularis in females

BACKGROUND AND AIMS

Structural differences in higher-order brain areas are common features of behavioral addictions, including Internet addiction (IA) as well. Taking into consideration the limited number of studies and methods used in previous studies on IA, our aim was to investigate the correlates of IA and the morphometry of the frontal lobes.

METHODS

To observe these relationships, the high-resolution T1-weighted MR images of 144 healthy, Caucasian, university students were analyzed with volumetry and voxel-based morphometry. The Problematic Internet Use Questionnaire (PIUQ) was used to assess IA.

RESULTS

We found significant correlations between PIUQ subscales and the volume of the right pars opercularis volume and gray matter mass in women.

DISCUSSION AND CONCLUSION

The increased gray matter measures of this structure might be explained with the extended effort to control for the impulsive behavior in addiction, and with the increased number of social interactions via the Internet.

Cognitive-behavioral therapy for Internet gaming disorder: A systematic review and meta-analysis

OBJECTIVE

Although there is sufficient research and clinical evidence to support the inclusion of gaming disorder in the latest revision of the International Classification of Diseases, relatively little is known about the effectiveness of first-line psychological treatment for gaming disorder or internet gaming disorder (IGD) as it is listed in the Diagnostic and Statistical Manual. This systematic review employed meta-analytic techniques to determine the effectiveness of cognitive-behavioural therapy (CBT) for IGD on four key outcomes: IGD symptoms, anxiety, depression, and time spent gaming.

METHOD

A database search identified 12 independent CBT studies. Effect size estimates (Hedges' g) with associated confidence intervals, prediction intervals, and p values for each pre-post treatment outcome, were calculated. Study reporting quality was evaluated in accordance with the Consolidated Standards of Reporting Trials guidelines. Subgroup and moderator analyses were undertaken to investigate potential sources of heterogeneity.

RESULTS

CBT demonstrated high efficacy in reducing IGD symptoms (g = 0.92; [0.50, 1.34]) and depression (g = 0.80, [0.21, 1.38]), and showed moderate efficacy in reducing anxiety (g = 0.55, [0.17, 0.93]) at post-test. There was insufficient power to determine whether CBT was capable of reducing time spent gaming. Treatment gains at follow-up were nonsignificant across the four treatment outcomes.

CONCLUSIONS

The pooled findings suggest that CBT for IGD is an effective short-term intervention for reducing IGD and depressive symptoms. However, the effectiveness of CBT for reducing actual time spent gaming was unclear. Given the limitations of this evidence base, there is a need for more rigorous studies to determine the potential long-term benefits of CBT for IGD.

PUBLIC HEALTH SIGNIFICANCE STATEMENT

Given the rise in treatment demand for internet gaming disorder (IGD) and problematic gaming, it is necessary to determine which treatments are most effective for whom and under which conditions. This review shows that cognitive-behavioural therapy for IGD, which is often considered the first-line therapy, can improve IGD symptoms and comorbid depression. However, treatment gains tend to be short-term and their effect in reducing time spent gaming is unclear. Programs that target problematic gaming may be improved by additional support beyond the standard program of therapy sessions. More funding and resources are needed to support the development of a more rigorous evidence base on IGD and its treatment.

Urbanization and Internet addiction in a nationally representative sample of adult community residents in Japan: A cross-sectional, multilevel study

This study examines the relationship between urbanization and Internet addiction (IA) and association with other psychopathology and social support, in a nationally representative sample in Japan. Data from the World Mental Health Japan Second Survey were used. There were 2450 survey respondents, with an average response rate of 43.4%. Respondents' living areas were divided into three groups on the basis of urbanization (operationalized as city size). IA was measured using the Compulsive Internet Use Scale (CIUS). Three variables - psychological distress, past-12-month mental disorder, and social support - were measured using established instruments. A multilevel model was conducted to clarify the association between urbanization and IA (continuous scores and prevalence), before and after adjusting for possible individual-level and area-level variables and demographic variables. CIUS scores were significantly higher in large cities than in small municipalities before adjusting for psychological distress, social support, and past-12-month mental disorder. After adjustment, these associations attenuated substantially: urbanization was no longer significantly associated with odds of mild/severe IA, while the relationship held for continuous CIUS scores. Thus, residence in large cities is associated with higher odds of IA in Japan; psychological distress, social support, and past-12-month mental disorder partly explain this association.

Correlation between Internet addiction, depression, anxiety and stress among undergraduate medical students in Azad Kashmir

Objective:

To find out the correlation between internet addiction and depression, anxiety, and stress among undergraduate medical students in Azad Kashmir.

Methods:

A cross-sectional study including 210 undergraduate medical students (first to the fifth year) was done in Poonch Medical College, Azad Kashmir. The data collection tools were DASS21 questionnaire and Young’s internet addiction questionnaire. Spearman rank correlation test was done to see the correlation between internet addiction and depression, anxiety, and stress. Data were analyzed by SPSS v23 at a 95% confidence interval.

Results:

A very high prevalence (52.4%) of moderate to extremely severe internet addiction was observed among the respondents. The mild positive correlation between internet addiction and depression was identified (p <.001) and similar type of correlation was observed between internet addiction and stress (p .003). However, anxiety and internet addiction were not significantly correlated. The prevalence of anxiety and depression among the males were higher than the females, whilst the stress level was almost the same across gender.

Conclusion:

Internet addiction has been found to be associated with various psychiatric diseases. In this study, we also observed such correlation. We have also observed a very high level of internet addiction among medical students. The prevalence of internet addiction may further increase in the coming years as the internet will become more cheap, available and include more high quality psychologically addictive contents.

[Clinical profile of adolescents being treated for problematic internet use]

OBJECTIVES

This study highlights the clinical profile of adolescents having consulted with an addiction treatment center (ATC) in Québec for a problematic internet use (PIU) to develop knowledge about these specific clients and precisely target their needs relative to treatment.

METHOD

The study was conducted with 80 adolescents between ages 14 and 17 (M = 15.59) who had consulted with an ACT for a PIU. Adolescents have participated in an interview documenting internet use patterns and their consequences, mental health disorder co-occurrence, and family and social relationships.

RESULTS

The sample was constituted of 75 boys (93.8%) and 5 girls (6.3%), who spent an average of 55.8 hours (SD = 27.22) per week on internet for non-school or professional activities. Almost all of these youths (97.5%) presented a co-occurring mental health disorder, and more than 70% had seeked help last year for a psychological problem. Results show that 92.6% feel their internet use significantly hinders their family relationships, and 50% feel it impedes their social relationships.

CONCLUSIONS

This study shows the multiple difficulties experienced by adolescents in need of a treatment for their PIU. The presence of co-occurring mental health disorders and relational difficulties among them underlines the need to develop and implement in ACTs integrated assessments and treatments that target not only online activities, but also all of life domains that can be affected by PIU.

CLINICAL IMPLICATIONS

- PIU adolescents are mainly boys who report problematic use of video games. - Almost all young people who consult for PIU have comorbid mental health problems and difficulties in their relation. - The study highlights the need to offer to this clientele an integrated assessment and treatment services that target all areas of their lives who are likely to be affected, to contribute or maintain the PIU.

LIMITATIONS

- This study was conducted with a convenience sample and the results are representative of young people who have visited a treatment center for addiction. The generalization of results to all adolescents with PIU is limited. - Considering that PIU are subject to cultural influence, the scope of this study is limited to populations living in a culture similar to that of Quebec and Canada.

Relationships between Internet addiction and clinicodemographic and behavioral factors

BACKGROUNDS AND AIMS

While the Internet became an indispensable component of our contemporary life, public and academic attention is also gathered to its negative impact, namely Internet addiction (IA). Although clinicodemographic and behavioral factors are hypothetically implicated in the mechanism of IA, it still remains largely unknown how such factors are linked to IA severity. Thus, this study sought to examine relationships among IA severity and factors potentially associated with IA in Japanese students in different educational stages.

METHODS

We conducted a questionnaire-based survey, which included questions about types of online activities and clinicodemographic information, the IA test for IA severity, and the K6 scale for psychological distress in 3,224 students at elementary, junior, and senior high schools, and universities. A multiple regression analysis was performed to predict IA severity with clinicodemographic and behavioral factors.

RESULTS

IA severity was significantly positively related to the following factors: e-messaging, social networking services (SNS), games, holiday Internet usage, and K6 scores, while IA severity had negative correlation with using Internet for educational purposes, age of first exposure to the Internet, and sleep duration. Age was not related to IA severity among participants using both SNS and e-messaging.

CONCLUSIONS

IA was linked to various online activities and the degree of psychological distress. This indicates the importance of comprehensive assessment of online behavior and psychological factors for further understanding of IA.

School-based Prevention for Adolescent Internet Addiction: Prevention is the Key. A Systematic Literature Review

Adolescents' media use represents a normative need for information, communication, recreation and functionality, yet problematic Internet use has increased. Given the arguably alarming prevalence rates worldwide and the increasingly problematic use of gaming and social media, the need for an integration of prevention efforts appears to be timely. The aim of this systematic literature review is (i) to identify school-based prevention programmes or protocols for Internet Addiction targeting adolescents within the school context and to examine the programmes' effectiveness, and (ii) to highlight strengths, limitations, and best practices to inform the design of new initiatives, by capitalizing on these studies' recommendations. The findings of the reviewed studies to date presented mixed outcomes and are in need of further empirical evidence. The current review identified the following needs to be addressed in future designs to: (i) define the clinical status of Internet Addiction (IA) more precisely, (ii) use more current psychometrically robust assessment tools for the measurement of effectiveness (based on the most recent empirical developments), (iii) reconsider the main outcome of Internet time reduction as it appears to be problematic, (iv) build methodologically sound evidence-based prevention programmes, (v) focus on skill enhancement and the use of protective and harm-reducing factors, and (vi) include IA as one of the risk behaviours in multi-risk behaviour interventions. These appear to be crucial factors in addressing future research designs and the formulation of new prevention initiatives. Validated findings could then inform promising strategies for IA and gaming prevention in public policy and education.

Ghosts in the Machine?

In keeping with the theme of this special journal issue, the crosspollination discussed here includes technologies of cyberspace and the internet, psychological sub-disciplines concerned with personality and identity-formation, philosophy, and the neurosciences. Ordinarily, “crosspollination” connotes the emergence of something positive: a new birth, for instance, or an interesting hybrid. However, contrary to a rosy outlook, this article reflects concern about the effects of cyberspace technologies on personality and identity. “Progress” is an extremely powerful metaphor, or mental frame, and once new social media platforms, and virtual reality and augmented reality technologies are equated with progress, it is extremely difficult to contemplate their possible disadvantages. Nevertheless, glancing-backwards, one can readily concede that eager receptivity for the prospective benefits of new technologies should have been matched with sobriety about unforeseen or unintended consequences.

Treatment of Internet Addiction and Internet Gaming Disorder in Adolescence

Internet use is growing year after year and adolescents represent a large proportion of internet users. There is a scholarly interest in teen internet gaming disorder (IGD) and internet addiction (IA) is constantly increasing, but little is known about the treatments of IA and IGD. This study systematically reviews the literature of the last fifteen years, focusing on two main aspects: adolescence, and IA and IGD intervention programs. The inclusion criteria were (1) contain empirical data, (2) include an analysis relating to IA or IGD, (3) include teen samples aged between 13 and 19 years or with an average age within this range, and (4) provide a full-text article published in English. A total number of 17 papers were included, 7 focused on IA and 10 focused on IGD. Prevalence and different treatment-related outcomes are discussed.

Psychometric Evaluation of the Nine-Item Problematic Internet Use Questionnaire (PIUQ-9) in Nine European Samples of Internet Users

Objectives: The nine-item Problematic Internet Use Questionnaire (PIUQ-9) is a brief self-report screening instrument for problematic internet use. The main objective of the present study was to explore the psychometric properties of the PIUQ-9 among nine different language-based samples of European internet users (Italian, German, French, Polish, Turkish, Hungarian, English, and Greek). Methods: The total sample comprised 5,593 internet users (38.1% men), aged between 18 and 87 years (M = 25.81; SD = 8.61). Via online recruitment, participants completed the PIUQ-9, the Brief Symptom Inventory (BSI) and items about time spent online. Results: Confirmatory factor analysis demonstrated that the bifactor model with one general factor (i.e., general problem) and two-specific factors (i.e., obsession and neglect + control disorder) yielded acceptable or good fit indices in all subsamples except for one. The common variance index in the bifactor model indicated that the general problem factor explained from 57.0 to 76.5% of common variance, which supports the presence of a strong global factor. According to the multiple indicators multiple causes (MIMIC) model, psychiatric symptoms had a moderate-to-strong direct effect on the general problem factor in all subsamples, ranging from β = 0.28 to β = 0.52 supporting the construct validity of the scale. Furthermore, in a majority of the subsamples, time spent online during the weekend had considerably higher effect sizes on the general problem factor than time spent online during weekdays. Conclusion: The present study highlights the appropriate psychometric properties of the PIUQ-9 across a number of European languages and cultures.

The relationship between coping style and Internet addiction among mainland Chinese students: A meta-analysis

The matter of whether different coping styles are correlated with increased Internet addiction or not remains a topic of debate. Most researchers have argued that Internet addiction is linked to low positive coping and high negative coping; however, others have rejected this opinion. Consequently, this meta-analysis examined the link between coping style and Internet addiction to address this controversy. Seventy-seven studies comprising 46,025 Chinese adolescent students were analyzed. The results suggested a medium negative correlation between positive coping and Internet addiction and a medium positive correlation between negative coping and Internet addiction. Furthermore, coping style measures, Internet addiction, region, and gender moderated these links. The link between negative coping and Internet addiction was largest when positive coping was measured with the Coping Style Questionnaire (CSQ), smaller when using the Simplified Coping Style Questionnaire, and smallest when using other measures. The negative correlation between positive coping and Internet addiction was largest when Internet addiction was measured with the Internet Addiction Test, smaller when using revised Chinese Internet Addiction Scale, and smallest when using other measures. For both positive and negative coping and Internet addiction, the correlations were largest in Eastern China, smaller in Central China, and smallest in Western China.

Association between problematic Internet use, sleep disturbance, and suicidal behavior in Chinese adolescents

BACKGROUND AND AIMS

This large-scale study aimed to test (a) associations of problematic Internet use (PIU) and sleep disturbance with suicidal ideation and suicide attempts among Chinese adolescents and (b) whether sleep disturbance mediates the association between PIU and suicidal behavior.

METHODS

Data were drawn from the 2017 National School-based Chinese Adolescents Health Survey. A total of 20,895 students' questionnaires were qualified for analysis. The Young's Internet Addiction Test was used to assess PIU, and level of sleep disturbance was measured by the Pittsburgh Sleep Quality Index. Multilevel logistic regression models and path models were utilized in analyses.

RESULTS

Of the total sample, 2,864 (13.7%) reported having suicidal ideation, and 537 (2.6%) reported having suicide attempts. After adjusting for control variables and sleep disturbance, PIU was associated with an increased risk of suicidal ideation (AOR = 1.04, 95% CI = 1.03-1.04) and suicide attempts (AOR = 1.03, 95% CI = 1.02-1.04). Findings of the path models showed that the standardized indirect effects of PIU on suicidal ideation (standardized β estimate = 0.092, 95% CI = 0.082-0.102) and on suicide attempts (standardized β estimate = 0.082, 95% CI = 0.068-0.096) through sleep disturbance were significant. Conversely, sleep disturbance significantly mediated the association of suicidal behavior on PIU.

DISCUSSION AND CONCLUSIONS

There may be a complex transactional association between PIU, sleep disturbance, and suicidal behavior. The estimates of the mediator role of sleep disturbance provide evidence for the current understanding of the mechanism of the association between PIU and suicidal behavior. Possible concomitant treatment services for PIU, sleep disturbance, and suicidal behavior were recommended.

Association between Problematic Internet Use and Sleep Disturbance among Adolescents: The Role of the Child's Sex

Use of the Internet has become an integral part of daily life. Adolescents are especially at a higher risk of developing problematic Internet use (PIU). Although one of the most well-known comorbid conditions of PIU is sleep disturbance, little is known about the sex disparity in this association. This school-based survey in students of grades 7⁻9 was conducted to estimate the prevalence of PIU and sleep disturbance among Chinese adolescents, to test the association between PIU and sleep disturbance, and to investigate the role of the child's sex in this association. A two-stage stratified cluster sampling method was used to recruit participants, and two-level logistic regression models were fitted. The mean Internet addiction test score was 37.2 (SD: 13.2), and 15.5% (736) met the criteria for PIU. After adjusting for control variables, problematic Internet users were at a higher risk of sleep disturbance (adjusted odds ratio = 2.41, 95% confidence interval (CI) = 2.07⁻3.19). Sex-stratified analyses also demonstrated that association was greater in girls than boys. In this respect, paying more attention to the sleep patterns of adolescents who report excessive Internet use is recommended, and this early identification may be of practical importance for schools, parents, and adolescents themselves.

Psychometric Properties of the Internet Addiction Test: A Systematic Review and Meta-Analysis

This article performs a systemic review of psychometric properties of Internet Addiction Test (IAT)-the most widely used tool for assessing Internet addiction in clinic and research field. Studies measuring psychometric properties of IAT (original version) were searched through MEDLINE, The Cumulative Index to Nursing and Allied Health Literature (CINAHL), PsycINFO, and Embase. A total of 25 studies including 18,421 subjects were reviewed in our study. Based on meta-analysis for internal consistency, the pooled Cronbach's alpha coefficient from college/university students with a single department subgroup was 0.90 (95percent confidence interval [CI], 0.89-0.91), and that from middle-/high-school students (older than 15 years) subgroup was 0.93 (95 percent CI, 0.92-0.93). According to test-retest analysis, the pooled Spearman's correlation coefficient from college/university students with a single department subgroup was high at 0.83 (95 percent CI, 0.81-0.85), along with low publication bias. Convergent validity showed correlation coefficients of 0.62-0.84, as compared with major tools. For construct validity, the number of factors is believed to be 1-2, only considering studies that followed the guidelines. IAT appears to have acceptable internal consistency, test-retest reliability, and convergent validity in specific groups. To verify these values, well-designed evidence-based studies assessing psychometric properties of IAT across diverse populations are warranted.

Internet addiction in Tibetan and Han Chinese middle school students: prevalence, demographics and quality of life

Internet addiction (IA) is common amongst young people, but no data on IA are available in Tibetan middle school students in China. This study compared the prevalence of IA between Tibetan and Han Chinese middle school students, and examined its association with quality of life. The study was conducted in two middle schools in the Tibetan area of Qinghai province and two Han Chinese middle schools in Anhui province, China. Internet addiction, depressive symptoms and quality of life were measured using standardized instruments. Totally, 1,385 students completed the assessments. The overall prevalence of IA was 14.1%; 15.9% in Tibetan students and 12.0% in Han students. After controlling for the covariates, the prevalence of IA was significantly higher in Tibetan students than in Han students (OR = 3.5, p < 0.001). More severe depressive symptoms, religious beliefs and male gender were positively associated with IA, while good family relationship was negatively associated with IA. Internet addiction was also associated with significantly lower QOL in physical, psychological and environmental domains. Internet addiction appears to be common in Chinese middle school students, particularly amongst Tibetan Chinese students. Considering its negative impact on quality of life, appropriate educational programs and preventive measures for IA should be urgently developed.

Policy responses to problematic video game use: A systematic review of current measures and future possibilities

BACKGROUND AND AIMS

Empirical research into problematic video game playing suggests that overuse might cause functional and psychological impairments for a minority of gamers. Therefore, the need for regulation in the case of video games (whether governmental or self-imposed) has arisen but has only been implemented in a few countries around the world, and predominantly in Asia. This paper provides a systematic review of current and potential policies addressing problematic gaming.

METHODS

After conducting a systematic search in the areas of prevention, treatment, and policy measures relating to problematic Internet and video game use, papers were selected that targeted problematic gaming policies (N = 12; six in English and six in Korean). These papers served as the basis of this review.

RESULTS

Policies were classified into three major groups: (i) policy measures limiting availability of video games (e.g., shutdown policy, fatigue system, and parental controls), (ii) measures aiming to reduce risk and harm (e.g., warning messages), and (iii) measures taken to provide help services for gamers. Beyond the attempt to classify the current and potential policy measures, the authors also tried to evaluate their efficiency theoretically and (if data were available) empirically.

DISCUSSION AND CONCLUSIONS

Overall, it appears that although several steps have been taken to address problematic video game playing, most of these steps were not as effective as expected, or had not been evaluated empirically for efficacy. The reason for this may lie in the fact that the policies outlined only addressed or influenced specific aspects of the problem instead of using a more integrative approach.

The association between aggression and risk of Internet gaming disorder in Korean adolescents: the mediation effect of father-adolescent communication style

OBJECTIVES

Open and supportive communication between parents and children is known to reduce adolescents' delinquent behavior. Recently, the risk of Internet gaming disorder (IGD) has been increasing in adolescents. The purpose of this study was to investigate the mediating effects of parent-child communication styles on the relationship between adolescent aggressiveness and risk of IGD.

METHODS

Participants in this study were 402 first-year students from 4 middle schools in Seoul who enrolled in the Internet user Cohort for Unbiased Recognition of gaming disorder in Early adolescence (iCURE) and completed baseline assessment in 2016. The structural equation model was constructed based on an aggression questionnaire, the Internet game use-elicited symptom screen, a mother-child communication inventory, and a father-child communication inventory.

RESULTS

Adolescents' aggressiveness was found to be related to their risk of IGD. The father-child communication style mediated the relationship between aggression and risk of IGD. However, the mother-child communication style had no mediating effect.

CONCLUSIONS

Our findings suggest that fathers should make an effort to improve open and positive communication skills with their children, because the father-child communication style plays an important role in the relationship between adolescent aggressiveness and risk of IGD.

Avoidant romantic attachment in adolescence: Gender, excessive internet use and romantic relationship engagement effects

Romantic development is a distinctive characteristic of puberty. However, a significant proportion of adolescents present with avoidant romantic attachment (ARA) tendencies, which have significant impact on their general adaptation. ARA variations have been suggested in relation to age, gender, engagement with a romantic partner and Excessive Internet Use (EIU) behaviours. In this longitudinal, two-wave study of a normative sample of 515 Greek adolescents at 16 and 18 years, ARA was assessed with the relevant subscale of the Experiences in Close Relationships-Revised and EIU with the Internet Addiction Test. A three-level hierarchical linear model found ARA tendencies to decrease between 16 and 18 while engagement in a romantic relationship and EIU were associated with lower and higher ARA tendencies respectively. Gender did not differentiate ARA severity either at the age of 16 or its changes over time. Results highlight the need of adopting a longitudinal-contextualized approach and provide implications for prevention and intervention initiatives in relation to the romantic development of adolescents.

Internet Addiction and Attention-Deficit/Hyperactivity Disorder Traits among Female College Students in Japan

Objectives:

Previous studies have reported that internet addiction (IA) is associated with attention-deficit/hyperactivity disorder (ADHD) consistently. However, in terms of gender, there are controversial findings. We aimed to investigate the relation between IA and self-acknowledged ADHD traits among female college students in Japan.

Methods:

The study questionnaire consisted of questions about demographics, Adult ADHD Self-Report Scale-V1.1 Part A (ADHD screener) and Young’s Internet Addiction Test (IAT). When four or more items are more frequent than the cut-off on ADHD screener, the subject was categorized into students with a positive ADHD screen. We defined students with total IAT score of 70 and higher as IA.

Results:

A total number of respondents was 369 (mean age: 19.0±0.7 years). Seventy-seven subjects were screened positive on ADHD screener (20.9%). Students with a positive ADHD screen scored significantly higher on the IAT (54.2±14.2 vs. 42.5±11.3). The rates of IA in students with and without a positive ADHD screen were 18.2% and 1.0%, respectively.

Conclusion:

Results of this study demonstrated the relation between IA and self-evaluated ADHD traits among female college students in Japan. Appropriate education for students on how to use the internet properly will be necessary to prevent IA.

Associations between problematic Internet use and psychiatric symptoms among university students in Japan

AIM

Research on the adverse effects of Internet use has gained importance recently. However, there is currently insufficient data on Japanese young adults' Internet use, so we conducted a survey targeting Japanese university students to research problematic Internet use (PIU). We also investigated the relationship between PIU and multiple psychiatric symptoms.

METHODS

A paper-based survey was conducted at five universities in Japan. Respondents were asked to fill out self-report scales regarding their Internet dependency using the Internet Addiction Test (IAT). Sleep quality, attention-deficit hyperactivity disorder (ADHD) tendency, depression, and anxiety symptom data were also collected based on respective self-reports.

RESULTS

There were 1336 responses and 1258 were included in the analysis. The mean IAT score (± SD) was 37.87 ± 12.59; and 38.2% of participants were classified as PIU, and 61.8% as non-PIU. The trend level for young women showed that they were more likely to be classified as PIU than young men (40.6% and 35.2% respectively, P = 0.05). Compared to the non-PIU group, the PIU group used the Internet longer (P < 0.001), had significantly lower sleep quality (P < 0.001), had stronger ADHD tendencies (P < 0.001), had higher Depression scores (P < 0.001), and had higher Trait-Anxiety scores (P < 0.001). Based on multiple logistic regression analyses, the factors that contributed to an increased risk of PIU were: being female (odds ratio [OR] = 1.52), being older (OR = 1.17), having poor sleep quality (OR = 1.52), having ADHD tendencies (OR = 2.70), having depression (OR = 2.24), and having anxiety tendencies (OR = 1.43).

CONCLUSION

We found a high PIU prevalence among Japanese young adults. The factors that predicted PIU were: female sex, older age, poor sleep quality, ADHD tendencies, depression, and anxiety.

Cortical thickness and volume abnormalities in Internet gaming disorder: Evidence from comparison of recreational Internet game users

Although online gaming may lead to Internet gaming disorder (IGD), most players are recreational game users (RGUs) who do not develop IGD. Thus far, little is known about brain structural abnormalities in IGD subjects relative to RGUs. The inclusion of RGUs as a control group could minimize the potential effects of gaming experience and gaming-related cue familiarity on the neural mechanism of IGD subjects. In this study, structural magnetic resonance imaging data were acquired from 38 IGD subjects and 66 RGUs with comparable age, gender, and educational level. Group differences in cortical thickness and volume were analyzed using the FreeSurfer software. Correlations between cortical changes and addiction severity were calculated for both groups. Compared with the RGU group, the IGD group showed significantly decreased cortical thickness in the left lateral orbitofrontal cortex, inferior parietal lobule, bilateral cuneus, precentral gyrus, and right middle temporal gyrus. Moreover, significantly reduced cortical volume was observed in the left superior temporal gyrus and right supramarginal gyrus in the IGD group. Whole-brain correlational analysis indicated different correlations between the two groups. The brain regions that showed group differences were considered to be involved in cognitive control, decision making, and reward/loss processing. These functions may serve as potential mechanisms that explain why IGD individuals experience negative outcomes in frequent game playing.

Problematic internet use as an age-related multifaceted problem: Evidence from a two-site survey

BACKGROUND AND AIMS

Problematic internet use (PIU; otherwise known as Internet Addiction) is a growing problem in modern societies. There is scarce knowledge of the demographic variables and specific internet activities associated with PIU and a limited understanding of how PIU should be conceptualized. Our aim was to identify specific internet activities associated with PIU and explore the moderating role of age and gender in those associations.

METHODS

We recruited 1749 participants aged 18 and above via media advertisements in an Internet-based survey at two sites, one in the US, and one in South Africa; we utilized Lasso regression for the analysis.

RESULTS

Specific internet activities were associated with higher problematic internet use scores, including general surfing (lasso β: 2.1), internet gaming (β: 0.6), online shopping (β: 1.4), use of online auction websites (β: 0.027), social networking (β: 0.46) and use of online pornography (β: 1.0). Age moderated the relationship between PIU and role-playing-games (β: 0.33), online gambling (β: 0.15), use of auction websites (β: 0.35) and streaming media (β: 0.35), with older age associated with higher levels of PIU. There was inconclusive evidence for gender and gender × internet activities being associated with problematic internet use scores. Attention-deficit hyperactivity disorder (ADHD) and social anxiety disorder were associated with high PIU scores in young participants (age ≤ 25, β: 0.35 and 0.65 respectively), whereas generalized anxiety disorder (GAD) and obsessive-compulsive disorder (OCD) were associated with high PIU scores in the older participants (age > 55, β: 6.4 and 4.3 respectively).

CONCLUSIONS

Many types of online behavior (e.g. shopping, pornography, general surfing) bear a stronger relationship with maladaptive use of the internet than gaming supporting the diagnostic classification of problematic internet use as a multifaceted disorder. Furthermore, internet activities and psychiatric diagnoses associated with problematic internet use vary with age, with public health implications.

Internet pornography viewing preference as a risk factor for adolescent Internet addiction: The moderating role of classroom personality factors

Background and aims Adolescent Internet pornography viewing has been significantly increased in the last decade with research highlighting its association with Internet addiction (IA). However, there is little longitudinal data on this topic, particularly in relation to peer context effects. This study aimed to examine age- and context-related variations in the Internet pornography-IA association. Methods A total of 648 adolescents, from 34 classrooms, were assessed at 16 years and then at 18 years to examine the effect of Internet pornography preference on IA in relation to the classroom context. IA was assessed using the Internet Addiction Test (Young, 1998), Internet pornography preference (over other Internet applications) was assessed with a binary (yes/no) question, and classroom introversion and openness to experience (OTE) with the synonymous subscales within the Five Factor Questionnaire (Asendorpf & Van Aken, 2003). Results Three-level hierarchical linear models were calculated. Findings showed that viewing Internet pornography exacerbates the risk of IA over time, while classroom factors, such as the average level of OTE and introversion, differentially moderate this relationship. Discussion and conclusion The study demonstrated that the contribution of Internet pornography preference (as an IA risk factor) might be increased in more extroverted classrooms and decreased in OTE classrooms.

Internet and Video Game Addictions: Diagnosis, Epidemiology, and Neurobiology

In the past 2 decades, there has been substantial increase in availability and use of digital technologies, including the Internet, computer games, smart phones, and social media. Behavioral addiction to use of technologies spawned a body of related research. The recent inclusion of Internet gaming disorder as a condition for further study in the DSM-V invigorated a new wave of researchers, thereby expanding our understanding of these conditions. This article reviews current research, theory, and practice regarding the diagnosis, epidemiology, and neurobiology of Internet and video game addictions.

The Role of Empathy and Life Satisfaction in Internet and Smartphone Use Disorder

Recent studies have yielded initial evidence for an association between Internet Use Disorder (IUD), empathy, and life satisfaction. In the present study we sought to replicate these previous findings, and then to extend this research by also examining the relationship between empathy, life satisfaction, and the related phenomenon of Smartphone Use Disorder (SUD). The present study included independent samples from China (N = 612, 162 females) and Germany (N = 304, 207 females), with the same set of questionnaires administered to both samples. IUD was measured with Pawlikowski's s-IAT and SUD was assessed with the short version of Kwon's Smartphone Addiction Scale. The Interpersonal Reactivity Index (IRI) was used to assess individual differences in empathy. Please note that for the German sample data on the empathy quotient (EQ) are also available. Life satisfaction data were collected using items from the SOEP-Questionnaire (Socio-Economic Panel, Germany). In both of our samples we replicated previous findings showing the association between higher IUD, lower empathy, and lower life satisfaction scores. In addition, individuals with higher SUD showed higher scores on the IRI Personal Distress scale in China and Germany, while further associations between IRI dimensions and SUD were only found in the Chinese sample. Personal Distress is known to be highly correlated with the personality trait of Neuroticism, hence higher stress/negative emotionality in tense social situations is related to SUD. In the present study we confirm earlier findings showing the relationship between empathy, life satisfaction, and IUD, and extend some of these findings to SUD. We also emphasize the importance of cross-cultural studies when investigating IUD/SUD in the context of empathy and life satisfaction.

The Mediational Role of Coping Strategies in the Relationship Between Self-Esteem and Risk of Internet Addiction

The aim of the present study is to explore, through a mediation model, the relationship among self-esteem, coping strategies, and the risk of Internet addiction in a sample of 300 Italian university students. We submitted the data to a descriptive, mediational comparison between variables (t-test), and correlational statistical analyses. The results confirmed the effect of self-esteem on the risk of Internet addiction. However, we found that the introduction of coping strategies as a mediator gives rise to partial mediation. A low level of self-esteem is a predictor of avoidance-oriented coping that, in turn, affects the risk of Internet addiction.

A Longitudinal Study for the Empirical Validation of an Etiopathogenetic Model of Internet Addiction in Adolescence Based on Early Emotion Regulation

Several etiopathogenetic models have been conceptualized for the onset of Internet Addiction (IA). However, no study had evaluated the possible predictive effect of early emotion regulation strategies on the development of IA in adolescence. In a sample of N = 142 adolescents with Internet Addiction, this twelve-year longitudinal study aimed at verifying whether and how emotion regulation strategies (self-focused versus other-focused) at two years of age were predictive of school-age children's internalizing/externalizing symptoms, which in turn fostered Internet Addiction (compulsive use of the Web versus distressed use) in adolescence. Our results confirmed our hypotheses demonstrating that early emotion regulation has an impact on the emotional-behavioral functioning in middle childhood (8 years of age), which in turn has an influence on the onset of IA in adolescence. Moreover, our results showed a strong, direct statistical link between the characteristics of emotion regulation strategies in infancy and IA in adolescence. These results indicate that a common root of unbalanced emotion regulation could lead to two different manifestations of Internet Addiction in youths and could be useful in the assessment and treatment of adolescents with IA.