Adolescent Internet Addiction in Hong Kong: Prevalence, Psychosocial Correlates, and Prevention

A comprehensive measure assessing different types of problematic use of the internet among Chinese adolescents: The Assessment of Criteria for Specific Internet-use Disorders (ACSID-11)

BACKGROUND

Problematic use of the internet (PUI) is prevalent, particularly among adolescents and young adults. Given the limited measures to assess specific types of PUI, which encompasses a broad spectrum of activities such as online gaming, social media use, pornography use, shopping, gambling, and web-streaming, Muller et al. (2022) developed the Assessment of Criteria for Specific Internet-use Disorders (ACSID-11) to comprehensively assess different types of PUI (i.e., gaming, shopping, social media use, gambling, and pornography use). The present study aimed to validate the Chinese ACSID-11 among adolescents incorporating cross-cultural adaptations.

METHODS

Using forward-backward translation method, a culturally adapted version of the ACSID-11 was prepared. Then, a cross-sectional online survey was administered between September 8 and September 26, 2023. Adolescents, using a convenience sample (N = 11,492; mean age = 16.42 years [SD ± 0.91]; 59.1% male), were recruited from six schools to complete the translated ACSID-11, Internet Gaming Disorder Scale-Short Form (IGDS9-SF), Bergen Social Media Addiction Scale (BSMAS), and Smartphone Application Based Addiction Scale (SABAS) via an online platform. Pearson correlation coefficients assessed convergent/discriminant validity. Factor structure and measurement invariance were examined through confirmatory factor analysis (CFA) and multi-group CFA. Cronbach's alpha and McDonald's omega tested internal consistency.

RESULTS

Associations between the ACSID-11 components and other scales supported convergent validity (i.e., ACSID-11 gaming scale with IGDS9-SF [0.37 ≤ r ≤ 0.41]; social networks use scale with BSMAS [0.24 ≤ r ≤ 0.31]) and discriminant validity (i.e., online gambling scale with BSMAS [0.16 ≤ r ≤ 0.19] and with SABAS [0.11 ≤ r ≤ 0.13]). A four-factor solution indicated good fit with comparative fit index (CFI) ranging from 0.982 to 0.958. The ACSID-11 was measurement invariant across sexes (∆CFI = -0.001 to 0.000) and different levels of related addictive behaviors (∆CFI = -0.001 to 0.000). Both Cronbach's alpha and McDonald's omega (0.63 to 0.97) were acceptable for both frequency and intensity of responses.

CONCLUSIONS

The ACSID-11 is an appropriate scale to assess different kinds of PUI among Chinese adolescents and students. Psychometric assessment of the measure in other cultures and among clinical samples is recommended.

Family factors related to adolescent screen media use and mental health outcomes: A systematic review and recommendation for practices

INTRODUCTION

Screen media serves an essential role in adolescents' lives, posing growth opportunities and mental health challenges. Family plays a crucial role in mitigating these challenges. This systematic review offers a comprehensive analysis of the family factors related to adolescent screen media use and mental health.

METHODS

A systematic search was conducted in PubMed, CINAHL, PsycINFO, Scopus, and Embase, adhering to Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines using the following inclusion criteria: English, peer-reviewed, observational design, and published since 2013; adolescent samples aged 10-17 years; and examining screen media use, family factors, and internalizing problems. The role of family factors as predictors, moderators, and mediators was also examined.

RESULTS

Of the 3587 records, 32 met the inclusion criteria. These studies, primarily cross-sectional, presented a global perspective of 14 countries. A heterogeneous range of family factors, screen media use, and mental health outcomes were examined, revealing significant associations between elevated screen media use and internalizing problems. Positive family processes and democratic media-specific parenting mitigate such association. A few studies underscored family socioeconomic status (SES), noting elevated screen media use and mental health risks among adolescents in families of low SES.

CONCLUSIONS

Accumulating evidence supports the important role of positive family contexts in fostering balanced screen media use and mental health in adolescents, accentuating the need for professional screening and education to promote positive screen media use among adolescents and families. Further research requires refinement in measurement and methodology to better capture the intricate relationship between family dynamics, screen media use, and adolescent mental health.

Predicting Smartphone Addiction Trajectories in Korean Adolescents: A Longitudinal Analysis of Protective and Risk Factors Based on a National Survey from 2018 to 2020

This longitudinal study aimed to identify the role of psychosocial factors affecting smartphone addiction (SA) among Korean adolescents and predict the trajectory of SA based on the Korean Children and Youth Panel Survey (KCYPS) 2018 to 2020. The dependent variable is SA score as measured by the Korean Smartphone Addiction Propensity Scale (SAPS), and the independent variables are psychosocial factors (attention, grit, life satisfaction, self-esteem, aggression, depression, social withdrawal and physical symptom). Generalized estimating equation (GEE) analysis (adjusted for covariates) results indicated that attention (B = -0.346, P < .001), grit (B = -0.402, P < .001), life satisfaction (B = -0.150, P < .001), and self-esteem (B = -0.099, P < .001) were protective factors for reducing SA score. Conversely, aggression (B = 0.222, P < .001) and depression (B = 0.067, P = .005) were predicted to be risk factors for increasing SA score. A better understanding of the relationship between behavioral addiction and psychosocial development factors in adolescence will assist in the development of more effective prevention and treatment strategies.

Internet addiction and depressive symptoms in adolescents: joint trajectories and predictors

Objective

Internet addiction and depressive symptoms are common mental health problems in adolescents. Due to the comorbidity of Internet addiction and depressive symptoms, their mutual relationship influences their developmental trajectories over time. Thus, this study aimed to identify the joint trajectories of Internet addiction and depressive symptoms, and examined the individual, family, and school antecedents of these trajectories among Chinese adolescents.

Methods

Using a battery of self-report scales, three waves of data collection were conducted in a Chinese adolescent sample (N = 1,301). The co-developmental trajectories of Internet addiction and depressive symptoms were extracted by adopting parallel-process latent class growth modeling (PPLCGM). Multinomial logistic regression was performed to assess predictive factors.

Results

Four unique joint trajectory classes were detected: the Health Group (n = 912, 70.1%), Comorbidity-Worsening Group (n = 85, 6.5%), Asymptomatic-Comorbid Risk Group (n = 148, 11.4%), and Prominent Depressive Symptoms-Remission Group (n = 156, 12.0%). Individual, family, and school factors (e.g., gender, positive youth development, family function, academic performance) significantly predicted the membership in these distinct co-developmental trajectories.

Conclusion

Our findings illustrate that the joint development of Internet addiction and depressive symptoms among adolescents presents a heterogeneous distribution, which could better inform prevention and intervention strategies since each co-developmental trajectory may represent unique experience for adolescents who need targeted treatment. Various individual, family, and school factors are important predictors that play different roles in distinguishing the joint trajectories of Internet addiction and depressive symptoms during this critical developmental transition period.

Prevalence and Predictors of Internet Addiction Among Adolescents Before the First Wave of COVID-19 Lockdown in India

Background Internet dependency behavior was found to be prevalent among adolescents even before the first wave of COVID-19 lockdowns across the world including India. Adolescent users develop Internet addiction due to various risk factors. Aim The aim is to measure the prevalence and psychosocial predictors of internet addiction among adolescents before the first wave of the COVID-19 lockdown in India. Methods A cross-sectional, descriptive study before the first wave of the COVID-19 lockdown, included 1199 adolescents of both genders, aged 11 to 19 years, at selected educational settings from a city in south India, by using Young's Internet addiction test (IAT)-20 and structured questioner. Results The study found almost all the participants (100%) were using the internet in a day and the highest number of subjects started using the internet during their 6th standard of education (13%). Before the first wave of COVID-19 lockdown, the prevalence of a total of mild, moderate, and severe forms of internet addiction among adolescents was 65%. Individual, family, and community-related risk factors were found significant association with Internet addiction. The age of 14-16 years (OR 2.050, p= 0.000), duration of internet use in a day (OR 0.740, p= 0.064), financial matters (OR 0.981, p=0.016), total internet addiction score (OR 1.03, p=0.035) and timings of internet use (OR 1.161, p=0.004), were significant predictors of Internet addiction. Conclusion Internet addiction was prevalent and a notable behavior addiction among adolescents during the margin time of pre-pandemic and the first wave of the COVID-19 lockdown in India. The study highlighted many significant psychosocial risk factors and predictors of Internet Addiction in adolescents, thus the need for a panoramic approach to identify internet addiction in adolescents, to bring the modest behavior of healthy use of the internet in adolescents.

Genetic polymorphism in HTR2A rs6313 is associated with internet addiction disorder

Introduction

Internet addiction disorder (IAD) has grown into public health concern of global proportions. Previous studies have indicated that individuals with IAD may exhibit altered levels of serotonin and dopamine, which are known to play crucial roles in depression, anxiety, impulsivity, and addiction. Therefore, polymorphisms in the receptors that mediate the effects of serotonin and dopamine and affect their functional states as well as their activities are suspect. In this study, we aimed to investigate the association between IAD and rs6313 (T102C) polymorphism in the serotonin 2A receptor (5-HT2A) gene, (HTR2A).

Methods

Twenty patients with IAD and twenty healthy controls (HCs) were included in this study. Young's Internet Addiction Test (IAT), Self-Rating Anxiety Scale, Self-Rating Depression Scale, Yale-Brown Obsessive-Compulsive Scale (Y-BOCS), Barratt Impulse Scale, Pittsburgh Sleep Quality Index (PSQI), and Social Support Rating Scale (SSRS) were used to assess the severity of internet addiction, mental status, impulsive traits, sleep quality, and social support. Genotyping was performed to identify rs6313 polymorphisms in the HTR2A gene of all participants.

Results

The frequencies of the C and T alleles of HTR2A T102C were 28% and 72% in the IAD group and 53% and 47% in the HCs group, respectively, indicating that the differences between these two groups were significant. No significant difference was observed in the distribution of the CC, CT, and TT genotypes of HTR2A gene T102C between the IAD and the HCs groups. Additionally, there was no difference in the distribution of the frequencies of the HTR2A gene T102C CC and CT+TT genotypes between the two groups. However, the distribution between the TT and CC+CT genotypes showed an apparent statistical difference in the HTR2A gene T102C between the two groups. Correlation analysis indicated that the IAT score was positively correlated with the Y-BOCS and BIS scores for the CC+CT genotype in patients with IAD. Moreover, the IAT score was positively correlated with the PSQI score in patients with IAD carrying the TT genotype.

Conclusion

The present study demonstrates that rs6313 in HTR2A is associated with IAD, and that the T allele of rs6313 in HTR2A may be a risk factor for IAD.

Internet addiction among MBBS students at a New Delhi medical college: Prevalence and determinants of a silent pandemic

Background and Objective

The 21st century has witnessed a surge in global internet usage, particularly in developing nations like India. Internet addiction, also known as pathological internet use (PIU) or internet addiction (IA), has emerged as a mental health concern, especially among university students. This study aimed to investigate the prevalence of IA among MBBS students in a medical college in Delhi, India, and explore the association of IA with sociodemographic and internet usage patterns.

Materials and Methods

A cross-sectional observational study was conducted among 300 undergraduate medical students. Data was collected using a self-administered questionnaire, which included the Internet Addiction Test (IAT) developed by Dr. Kimberley Young. The IAT measures various aspects of internet use, and scores are categorized as normal user, mild addiction, moderate addiction, and severe addiction. Descriptive statistics and chi-square tests were used for data analysis.

Results

The mean age of onset of internet use was 14.4 ± 1.6 years. Smartphones were the most common devices used for internet access (96.3%), and the mean daily internet usage was 2.9 h ± 0.9 (standard deviation [SD]). The study found that 70.7% of students maintained a permanent login status. The majority of subjects used the Internet for coursework (89.7%) and information searches (88.7%). The prevalence of IA was significant, with 90% of participants being addicted to varying degrees. The grading of IA revealed 10% with no addiction, 54.6% with mild addiction, 32% with moderate addiction, and 3.3% with severe addiction.

Conclusion

IA is a prevalent public health concern among medical students in Delhi, with a majority of participants being addicted to some extent. Females showed a higher proportion of addiction compared to males. Certain internet activities, such as social networking and watching online videos, were significantly associated with IA. The study highlights the need for recognizing IA as a public health concern and further research to understand its impact on the youth. Longitudinal studies are recommended to observe the development and progression of IA over time.

The influence of adolescents essential and non-essential use of technology and Internet addiction on their physical and mental fatigues

This study explores the impact of Internet addiction (IA), age, and essential and non-essential technology usage time on the physical and mental fatigue of adolescents. The research surveyed 477 adolescents from Qatar and employed the Internet Addiction Diagnostic Questionnaire (IADQ) and Chalder's Fatigue Scale for data collection. Multiple linear regression and Mann-Whitney U tests were utilized for analysis. The findings indicate that IA, non-essential usage time, and age are positively associated with overall fatigue among adolescents. IA and non-essential usage time are positively linked to physical fatigue, while IA, non-essential usage time, and age are positive predictors of mental fatigue. However, essential usage time is negatively associated with mental fatigue. These results highlight the importance of distinguishing technology usage based on intent and necessity, as well as differentiating between physical and mental fatigue when examining problematic technology usage. This study is among the few conducted in the Middle Eastern context.

Prevalence of internet addiction and anxiety, and factors associated with the high level of anxiety among adolescents in Hanoi, Vietnam during the COVID-19 pandemic

BACKGROUND

The COVID-19 pandemic and the resulting isolation measures created an increase in the usage of smart devices and internet among adolescents. This study aims to estimate the prevalence of internet addiction, the prevalence of high level of anxiety as well as to examine factors associated with the high level of anxiety among adolescents in Hanoi, Vietnam during the COVID-19 pandemic.

METHOD

Data was collected using respondent-driven sampling and Google online survey forms from a sample of 5,325 school students aged 11-17 in Hanoi between October and December 2021. A short scale consisting of 5 items was used to measure internet addiction and the GAD-7 was used to measure adolescent anxiety level.

RESULTS

The findings revealed that 22.8% and 7.32% of adolescents experienced moderate and severe anxiety. About 32.7% of the study sample exhibited at least three internet addiction indicators. Logistic regression analysis identified significant predictors for high levels of adolescent anxiety. Being female, family experiencing economic difficulties, and exposure to domestic violence were associated with higher risk of anxiety disorder (OR 1.78, 1.45, and 2.89, respectively). Both average daily online time and internet addiction demonstrated gradient association with high level of anxiety.

CONCLUSION

The prevalence of internet addiction and high level of anxiety were high among adolescents in Hanoi, Vietnam during the COVID-19 pandemic. The study highlights the importance of implementing measures at the family and school levels to promote a balanced and healthy approach to smart device use among adolescents.

Digital Technology Use and Adolescent Mental Health Before and During the COVID-19 Pandemic: The Roles of Internet Addiction and Digital Competence

This study examined whether Internet addiction (IA) and digital competence (DC) mediated the association between digital technology use and mental health problems in adolescents before and during the COVID-19 pandemic, when digital device use increased dramatically. Repeated cross-sectional data from a 3-year cross-cohort study adopting stratified random sampling were analyzed. In 2019, 569 adolescents (female = 312) from 14 secondary schools completed a DC assessment and an online survey on their digital technology use, IA, and mental health. In 2021, 775 adolescents (female = 397) from 11 of those 14 schools completed both instruments. Results showed that adolescents in 2021 spent more time using digital devices, were more digitally competent, and reported more mental health problems than adolescents in 2019. The prevalence of IA was 8 percent in 2019 and 12.4 percent in 2021. In both years, more frequent digital technology use predicted a higher risk of IA, which was associated with more mental health problems (indirect β = 0.08, p < 0.001 for 2019 and β = 0.05, p < 0.001 for 2021). In addition, in 2021, DC was positively associated with digital technology use and negatively with IA, which indirectly related to fewer mental health problems (indirect β = -0.01, p = 0.03). In conclusion, DC is a protective factor alleviating the positive associations of digital technology use and IA with mental health problems in adolescents when the ecological context requires high levels of digital device use.

The Relationship between Anxious-Ambivalent Attachment and Social Appearance Anxiety in Adolescents: The Serial Mediation of Positive Youth Development and Instagram Addiction

The prevalence of social appearance anxiety among adolescents has increased in recent years. It can be said that one of the reasons for this situation is appearance-oriented social media applications. Attachment styles in adolescents may play a role in social appearance anxiety, as in many types of anxiety. However, adolescents' positive youth development levels may have a protective role against social appearance anxiety. Therefore, this study investigated the serial mediator roles of Instagram addiction and positive youth development in the relationship between anxious-avoidant attachment style and social appearance anxiety in adolescents. The research was carried out with 508 high school students. As a result of the research, it was determined that anxious-avoidant attachment and Instagram addiction predicted social appearance anxiety positively. It was determined that positive youth development predicted social appearance anxiety negatively. In addition, mediating roles in the relationship between positive youth development and Instagram addiction, anxious-avoidant attachment and social appearance anxiety were found significant in the study.

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.

Prevalence and associated factors of internet addiction among Chinese adolescents: association with childhood trauma

Introduction

Internet addiction (IA) is common among adolescents and may have severe consequences. This study aimed to investigate the prevalence and factors associated with IA among middle school students of Hunan Province, China. Relevance between IA and childhood trauma was also explored.

Methods

One thousand six hundred ten students were enrolled in this cross-sectional study. Data collected included demographics; internet addiction (revised-Chen internet addiction scale); childhood trauma (CTQ-SF); depression, anxiety, and stress symptoms (DASS-21); suicidal behaviors, as well as non-suicidal self-injury (NSSI). Cramer's V analysis, univariable logistic regression and multivariable logistic regression were used for associations and identifying independent relevance of IA, respectively.

Results

The prevalence of IA was 12.8%. Cramer's V analysis showed that IA was associated with emotional abuse, emotional and physical neglect, NSSI, suicidal behaviors, stress, anxiety and depressive symptoms, physical disorder history. Regression analysis showed that IA was independently associated with emotional neglect (OR = 3.062, 95% CI: 2.083, 4.501, p < 0.001); physical neglect (OR = 2.328; 95% CI: 1.590, 3.409, p < 0.001); depressive symptoms (OR = 2.218, 95% CI: 1.467, 3.353, p < 0.001) nationality (OR = 1.888, 95% CI: 1.034, 3.447, p = 0.006) and age (OR = 1.253, 95% CI: 1.066, 1.471, p = 0.006).

Discussion

IA is common among middle school students. Attention should be paid to students with childhood trauma since they have a higher risk for IA, which may increase the risk for suicidal behaviors.

Adolescents' Internet addiction: Does it all begin with their environment?

BACKGROUND

This is one of the few studies that examines adolescent Internet addiction (IA) among Middle Eastern population. The purpose of this study is to determine whether adolescents' family and school environments play a role in their Internet Addiction.

METHODS

We conduced a survey that included 479 adolescents in Qatar. The survey collected demographic data, the Internet Addiction Diagnostic Questionnaire (IADQ), the Brief Family Relationship Scale (BFRS) and questions from the WHO Health Behavior in School-aged Children (HBSC) survey that assess school environment, academic performance, teacher support, and peer support of the adolescents. Factorial analysis, multiple regression, and logistic regression were used for statistical analysis.

RESULTS

Family environment and school environment were negative and significant predictors of adolescent Internet addiction. The prevalence rate was 29.64%.

CONCLUSION

Results imply that interventions and digital parenting programs should not only target adolescents, but also include entities in the developmental environment of adolescents, i.e. their family and school.

Depression and internet addiction among adolescents:A meta-analysis

Depression and Internet addiction (IA) are both prevalent and burdensome in adolescents. Findings on the relationship between depression and IA remain equivocal, and we therefore conducted a meta-analysis to confirm their correlation. We searched for relevant studies, with the last search being conducted on November 10, 2022. Adolescents aged 10 to 24 reported objectively measured depression and IA using scales that have been used worldwide and are valid. Random effect models were used to produce combined odds ratios (OR) and coefficient of regression (β) We included 42 studies presenting data from 102,769 participants. The meta-analysis confirmed that depression is positively correlated with IA and vice versa. Adolescents with depressive disorders were found to have a higher risk of IA. Adolescents with IA were found to have a higher risk of depressive disorders. In addition, IA had a stronger effect on depression risk. Screening for Internet addiction in depressed adolescents is recommended at initial diagnosis and follow-up. Similarly, Internet addicts should be screened regularly for depression.

The association of childhood maltreatment with Internet addiction: the serial mediating effects of cognitive emotion regulation strategies and depression

OBJECTIVES

Childhood maltreatment, cognitive emotion regulation strategies (CERSs), and depression can be important in adolescents' Internet addiction. The current study aims to investigate the direct effect of childhood maltreatment on Internet addiction and its indirect effects via CERSs and depression.

PARTICIPANTS AND SETTING

4091 adolescents (age M = 13.64, SD = 1.59; 48.9 % males) were recruited from a public school in China.

METHODS

In a cross-sectional design, participants completed the Childhood Trauma Questionnaire-Short Form (CTQ-SF), the Cognitive Emotion Regulation Questionnaire-Short version (CERQ-Short), the Self-Rating Depression Scale (SDS), and the Internet Addiction Test (IAT). A latent structural equation model was used to test the hypotheses.

RESULTS

After controlling for age, childhood maltreatment was directly associated with adolescents' Internet addiction (β = 0.12, p < 0.001). Meanwhile, the serial mediating effect via maladaptive CERSs and depression was 0.02 (95 % CI [0.01, 0.04]), and via adaptive CERSs and depression was 0.001 (95 % CI [0.0004, 0.002]), demonstrating significant serial mediating role of CERSs and depression in this relationship. No gender difference was observed.

CONCLUSIONS

The findings suggest that maladaptive CERSs and depression can be potential mechanisms relating childhood maltreatment to adolescents' Internet addiction, while adaptive CERSs can be a less influential factor for reducing Internet addiction.

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.

Internet and depression in adolescents: Evidence from China

Despite growing attention to Internet activity as a social determinant of depression in adolescents, few studies have focused on its diverse effects on depressive symptoms. Using data from the 2020 China Family Panel Study, this study employed logistic regression analysis to examine how Internet activity affects depressive symptoms in adolescents in China. The results indicated that adolescents with longer online duration using mobile phones tended to have higher levels of depression. Adolescents who engaged in online activities related to games, shopping, and entertainment had more severe depressive symptoms, but their time spent on online learning was not significantly associated with their level of depression. These findings suggest a dynamic link between Internet activity and adolescent depression and offer policy implications for addressing depressive symptoms in adolescents. Specifically, Internet and youth development policies and public health programs during the COVID-19 pandemic should be designed based on a comprehensive account of all aspects of Internet activity.

Developing Personas of Gamers with Problematic Gaming Behavior among College Students Based on Qualitative Data of Gaming Motives and Push-Pull-Mooring

Gaming is a popular but possibly problematic activity among college students. To distinguish gamers with potential problematic gaming behaviors (PGB) is crucial to mental health staff. Two studies were conducted that aimed to explore portraits of gamers with PGB in college campuses. The first study selected 20 college students, diagnosed with problematic gaming behaviors, from a longitudinal dataset and semi-structured interviews were conducted for a systematic description of long-term PGB. The second study selected four personas with the richest coding data of internet addiction and depression from 20 gamers. The profiles and life experiences of the personas showed changing processes of gaming motives and push-pull-mooring effects across the years. "Loss of purpose in life" and "desperate to escape from stress or boredom in the real world" were the important push effects. Mooring effects revealed their addiction or depression symptoms and the process of developing the addiction. The dynamics of "push", "pull", and "mooring" effects were clearly indicated in the results suggesting PGB might be a long-term coping strategy and a consequence of depression and loneliness. Dealing with depression and finding real-life goals could help PGB gamers to change the dynamics of their gaming motives and push-pull-mooring effects. The results may help develop interventions for gamers with problematic gaming behaviors.

Associations Between Adolescent Problematic Internet Use and Relationship Problems in Chinese Families: Findings from a Large-scale Survey

BACKGROUND

Problematic internet use (PIU) is prevalent among Chinese adolescents. There is a need to better understand how the quality of parent-adolescent relationship is associated with adolescent PIU to guide the development of effective prevention and early intervention programs.

OBJECTIVE

This study aims to evaluate parent-adolescent conflict and parenting styles as potential risk factors associated with adolescent PIU.

METHODS

A sample of 6552 students (aged 10-19 years) from 22 schools in Guangdong, China, was recruited. The participants completed self-report questionnaires measuring their perceptions of conflict with their parents (involving verbal conflict, emotional abuse, and physical abuse) as well as their perceptions of their parents' parenting styles (including parental care and parental control as measured by the Parental Bonding Inventory), and PIU using the Adolescent Pathological Internet Use Scale. Grade level and gender were examined as moderators of these associations.

RESULTS

Using multiple regression analyses, we found that greater mother-adolescent conflict, father-adolescent conflict, and parental control, and lower levels of parental care, were associated with higher levels of adolescent PIU (P<.001). The association between mother-adolescent conflict and PIU was stronger in older students than in younger students (P=.04), whereas the association between father-adolescent conflict and PIU was stronger in male students than in female students (P=.02). Compared with those who reported no mother-adolescent conflict, participants who experienced verbal conflict and emotional abuse, but not physical abuse from their mothers, reported higher levels of PIU (P<.001). Compared with those who reported no father-adolescent conflict, participants who experienced verbal conflict, emotional abuse, and physical abuse from their fathers had significantly higher levels of PIU (P<.001, P<.001, and P=.02, respectively).

CONCLUSIONS

These findings point to the value of interventions to reduce parental verbal conflict, emotional abuse, and physical abuse, and to increase positive parenting styles, to lower the risk of PIU in Chinese adolescents.

Investigating the Association Between Adolescent Internet Addiction and Parental Attitudes

Objectives: In this study, the association between parents’ attitudes and internet addiction among adolescent high school students was investigated through some sociodemographic variables.

Methods: The research was carried out with 385 students studying in four high schools in western Turkey. Sociodemographic characteristics, parental attitude scale and internet addiction scale were used in the study. Descriptive statistics, logistic regression analysis and structural equation modeling analysis were applied.

Results: The results of multivariate logistic regression analysis demonstrated that there was a significant relationship between the combined mean score obtained from the Parental Attitude Scale and the mean score obtained from the Internet Addiction Scale, and that authoritarian parenting attitude increases the risk of internet addiction [OR = 1.70 (95% CI: 1.33–2.18)]. In the structural equation modeling analysis, the model summary fit values were determined to be at a good level (χ²/df = 2.86, GFI = 0.97, RMSEA = 0.073) regarding the relationship between parental attitude and internet addiction.

Conclusion: Adolescents’ internet addiction levels changes related to their parents’ democratic attitude evolve.

The relationship between Internet addiction and childhood trauma in adolescents: The mediating role of social support

Background

Adolescents are at high risk of Internet addiction (IA). Previous studies have shown that the occurrence of IA may be associated with childhood trauma and social support to varying degrees. This study aimed to investigate the pathogenesis of IA in adolescents. Further, to explore the potential mediating role of social support in childhood trauma and IA. This study provides theoretical support for future interventions targeting IA in adolescents.

Methods

This study used a descriptive cross-sectional design. The Childhood Trauma Questionnaire (CTQ), Social Support Rating Scale (SSRS), and Young’s Internet Addiction Test (IAT) were used to conduct an anonymous questionnaire survey among randomly selected adolescents aged less than 18 years old in two cities in southern Anhui Province. Descriptive statistics and correlation analysis were used to test the correlation between IA and other variables. A binary logistic regression model was used to explore the influencing factors of IA. Multiple regression models were examined with process macro and bootstrapping to confirm significant mediating effects.

Results

A total of 844 adolescents, equally divided between males and females, participated in this study, and the prevalence of IA in the region was 23.0%. Through the mediation test, the direct effect of childhood trauma on IA was 0.20 (95% CI [0.12, 0.27], p < 0.001), and the mediating effect of social support on childhood trauma and IA was 0.09 (95% CI [0.06, 0.14]).

Conclusion

The study showed that childhood trauma significantly affected the incidence of IA in adolescents. Social support had a significant mediating effect on childhood trauma and IA and attenuated its negative effects.

Exploring the links between alexithymia and cognitive emotion regulation strategies in internet addiction: A network analysis model

Alexithymia and emotion regulation are closely related to internet addiction. However, no research has examined how the different components of alexithymia are associated with cognitive emotion regulation in the context of multi-strategy use in internet addiction. The current study aimed to investigate the relation between alexithymia and cognitive emotion regulation in individuals with internet addiction via network analysis. Participants included 560 students with Young’s Internet Addiction Test scores greater than 50 points; they were also asked to complete the Toronto Alexithymia Scale (TAS-20) and the Cognitive Emotion Regulation Questionnaire (CERQ). The results revealed two bridge nodes emerging within the combined alexithymia and cognitive emotion regulation network model: “catastrophizing” and “externally oriented thoughts.” These findings indicate a more specific relation between alexithymia and cognitive emotion regulation and provide empirical evidence for targeted prevention and targeted interventions for internet addiction.

Family Factors Associated with Problematic Use of the Internet in Children: A Scoping Review

BACKGROUND

Problematic use of the internet (PUI) is a growing concern, particularly in the young population. Family factors influence internet use among children in negative ways. This study examined the existing literature on familial or parental factors related to PUI in children.

METHODS

A scoping review was conducted in EBSCOhost, PubMed, ScienceDirect, JSTOR, Biomed Central, VHL Regional Portal, Cochrane Library, Emerald Insight, and Oxford Academic Journal databases. Studies reporting data on family factors associated with PUI in children, published in English in the 10 years to July 2020 were included. The following data were extracted from each paper by two independent reviewers: methodology and demographic, familial, psychiatric, and behavioral correlates of PUI in children.

RESULTS

Sixty-nine studies fulfilled the eligibility criteria. Three themes emerged: parenting, parental mental health, and intrafamilial demographic correlates of PUI in children. Parenting styles, parental mediation, and parent-child attachment were the major parenting correlates.

CONCLUSION

Literature on significant familial and parental factors associated with PUI in children is scarce. More research is required to identify the interactions of familial and parental factors with PUI in children, to develop informed management strategies to address this issue.

The More Internet Access, the More Mental Symptoms Students Got, the More Problematic Internet Use They Suffered: a Meta-analysis of Mainland Chinese Adolescents and Young Adults

The traditional view is that mental symptoms and problematic Internet use are positively related. Still, other researchers have questioned this view, and they believe that mental symptoms are negatively associated with problematic Internet use. Since then, this controversy has continued yet. The current study attempts to use meta-analysis to explore the relationship between mental symptoms and problematic Internet use in mainland Chinese students to provide a reliable basis for resolving this dispute. Sixty-three articles were included in this study, including 66 sample sizes and 47,968 subjects. It found that mental symptoms are positively correlated with problematic Internet use (r = .288, 95% confidence interval [.255, .320]). The correlation is affected by regions. Compared with coastal areas, problematic Internet users in the non-coastal areas are more likely to be affected by mental symptoms. In addition, gender differences also significantly affect the relationship between mental symptoms and problematic Internet use. The correlation coefficient between mental symptoms and problematic Internet use of girls is significantly higher than that of boys. Moreover, year also significantly affects the relationship between mental symptoms and problematic Internet use-the correlation increases by growing years.

How Does the Parent–Adolescent Relationship Affect Adolescent Internet Addiction? Parents’ Distinctive Influences

Although previous research has demonstrated that parent–adolescent relationships have a significant effect on adolescent Internet Addiction (IA), the mechanisms underlying these associations and parental differences in these effects have received insufficient attention. We investigated the mediating role of Perceived Social Support and Dual System of Self-Control (DSSC) in the relationship between Father-Adolescent Relationships/Mother-Adolescent Relationships (FAR/MAR) and adolescent IA, as well as the differences in the effects of FAR and MAR. A cross-sectional survey of 732 Chinese adolescents was conducted using the Adolescent Pathological Internet Use Scale, Parent–Adolescent Relationship Scale, Multidimensional Scale of Perceived Social Support, and Dual System of Self-Control Scale. Multiple linear regression analysis, Pearson correlation analysis and structural equation modeling were used. The results of structural modeling analysis showed that neither FAR nor MAR directly predicted adolescent IA. In contrast, FAR/MAR had an impact on adolescent IA mainly through the mediating effects of Perceived Social Support and Impulsive System. Furthermore, in the relationship between FAR/MAR and adolescent IA, the Impulsive System and Perceived Social Support both served as chain mediators, as did Perceived Social Support and the Reflective System. And more importantly, unlike FAR, MAR affects adolescent IA through the mediating effect of the Reflective System. Multiple linear regression showed that the regression coefficient of MAR on adolescent IA had stronger significance compared to FAR, MAR is deserving of more attention than FAR. These findings contribute to our understanding of the mechanisms underlying the association between FAR/MAR and adolescent IA and suggest that family relationship-focused training approaches are critical for suppressing adolescent IA. These interventions should be tailored to the unique circumstances of each family.

Effectiveness of a psychological growth camp without internet in the treatment of adolescents at risk of internet addiction: a pilot study

OBJECTIVE

This study aimed to investigate the effects of a psychological growth camp in the treatment of adolescents at risk of Internet addiction in Taiwan.

METHODS

We designed a psychological growth camp to treat adolescents at risk of Internet addiction. The CIAS (Chen Internet Addiction Scale) was used to assess the severity of Internet addiction at baseline, immediately after the camp, and at 1-month and 2-month follow-up visits.

RESULTS

A total of 16 participants were recruited, including 10 at risk of Internet addiction and 6 without the risk of Internet addiction. The results indicated that the participants not in a 2-parent family had significantly higher CIAS scores than those in a 2-parent family (p = .034). The participants at risk of Internet addiction exhibited significant improvements in total CIAS score at the time immediately after the camp (p = .033) and at 1-month (p = .001) and 2-month (p = .003) follow-up visits. Moreover, the incidence of possible Internet addiction was not significantly decreased immediately after the camp (p = .056) but was significantly decreased at 1- and 2-month follow-up visits (p < .05) compared with the baseline level. Otherwise, no significant improvements in total CIAS score or subscales were observed at the follow-up visits (p > .05) for the participants not at risk of Internet addiction.

CONCLUSION

The results indicate that the psychological growth camp without Internet might be effective in treating adolescents with Internet addiction.

Food Addiction and Emotional Eating Behaviors Co-Occurring with Problematic Smartphone Use in Adolescents?

Addiction in adolescence is increasing and has a significant impact on physical and mental health. Notably, addictions can be comorbid and affect each other. Despite the recent growing interest in food addiction (FA) and problematic smartphone use (PSU), few studies have investigated their association in adolescents. We investigated the relationship between FA and PSU in adolescents and the effects of eating behaviors. A total of 209 adolescents (44.5% male; mean age = 12.86 ± 0.7 years) participated in the current school-based community study. We found a positive correlation between the dimensional Yale Food Addiction Scale for Children 2.0 (dYFAS-C2.0) and the Smartphone Overdependence Scale after adjusting for age, sex, body mass index, and socioeconomic status. The high-risk PSU group accounted for 17.2% of participants. Furthermore, this group showed 2.3 times higher dYFAS-C2.0 scores than the general group. Emotional overeating and satiety responsiveness were correlated with PSU. A comprehensive evaluation of addiction symptoms is needed for proper intervention, especially in adolescents with symptoms of abnormal eating behaviors.

Understanding the relationship between distress intolerance and problematic Internet use: The mediating role of coping motives and the moderating role of need frustration

INTRODUCTION

There is emerging research interest in exploring the relationship between distress intolerance and problematic Internet use, yet most of the existing studies are limited by cross-sectional design, convenience sampling method, and poor understanding of the potential mediating and moderating factors involved. Based on the distress intolerance theory of addictive behavior and the theory of compensatory internet use, this study investigated a moderated mediation model to explain the impact of distress intolerance on problematic Internet use in adolescents.

METHODS

A three-wave longitudinal survey was conducted with 709 adolescents in Shanghai, China. The gender distribution was even, 50.2% were boys and 49.8% were girls. The mean age at T1 was 14.79 years (SD = 2.87).

RESULTS

Distress intolerance at Time 1 was found to positively predict problematic Internet use at Time 3. This prospective relation was mediated by adolescents' coping motives for Internet use at Time 2. Further, the mediation effect of coping motives for Internet use was moderated by need frustration at Time 2. The moderated mediation model was statistically equivalent for both genders.

CONCLUSIONS

Findings of this study contribute to new knowledge and have practical implications for prevention and intervention of adolescent problematic Internet use.

Feelings of Loneliness: Understanding the Risk of Suicidal Ideation in Adolescents with Internet Addiction. A Theoretical Model to Answer to a Systematic Literature Review, without Results

The Internet has become an essential tool for adolescents. It is part of their social integration within peers and supports their identity construction. The Internet can also become a source of addiction, especially when used as a coping strategy towards unpleasant life situations. Addiction to the Internet is often linked with an increase in the feeling of loneliness. The feeling of loneliness is an emotion present during adolescence. However, in excess, it can lead to suicidal ideation. Addiction to the Internet is also linked to an increased suicide risk. We questioned ourselves on the impact of the feeling of loneliness on the link between an excessive use of the Internet by adolescents and the risks of suicidal ideation. We attempted to find an answer to this question by performing a systematic review of the literature. We found no result matching our search criteria. We noted the absence of studies with regards to the interaction between the feeling of loneliness, addiction to the Internet and the risk of suicidal ideation amongst adolescents. We established a theoretical model which could be used as a lead for future research. We insist on the importance that studies need to be conducted in this domain, in order to enable us to establish efficient preventive measures for the risks of suicidal ideation amongst adolescents.

Children and adolescents' positive youth development qualities and internet addiction during the COVID-19 pandemic: A longitudinal study in China

BACKGROUNDS

Recent studies have shown that the qualities of children and adolescents' positive youth development (PYD) enable them to cope with developmental challenges in an adaptive manner and maintain healthy functioning. During the COVID-19 pandemic, there is still a lack of reporting on changes in children and adolescents' PYD qualities and Internet addiction and their relationship. This study investigated the association between PYD qualities and Internet addiction among the children and adolescents who have experienced the COVID-19 lockdown.

METHODS

A school-based cohort survey was launched in December 2019 (Wave 1, before COVID-19 lockdown) and followed up in June 2020 (Wave 2, after COVID-19 lockdown). The Chinese PYD scale (80 items, scoring 80-480) and Young's Internet addiction test (20 items, scoring 20-100) were used to evaluate the children and adolescents' PYD qualities and the degree of their Internet addiction, respectively. Cross-sectional regressions, longitudinal regressions, and cross-lagged panel model were used to examine the association between PYD qualities and Internet addiction.

RESULTS

7,985 children and adolescents completed both waves of surveys. Compared with children and adolescents before lockdown (Wave 1), their total PYD quality dropped from 4.99 to 4.96 after COVID-19 lockdown (Wave 2), and the mean score for Internet addiction rose from 35.56 to 36.16. Cross-sectional analysis showed that after controlling for basic characteristics such as age and gender, the total PYD quality of children and adolescents in two waves was negatively correlated with the degree of Internet addiction during the same period, with β of -6.10 and -6.95, respectively. Longitudinal analysis showed that after controlling for basic characteristics, children and adolescents' total PYD quality in Wave 1 was negatively correlated with the Wave 2 of Internet addiction and the change between the two waves of Internet addiction, with β of -3.35 and -0.26, respectively. Cross-lagged panel models showed a negative bilateral relationship between total PYD quality and Internet addiction.

CONCLUSION

During the COVID-19 pandemic, the qualities of children and adolescents' PYD declined, which makes children and adolescents more vulnerable to Internet addiction. Therefore, it is necessary to widely implement programs in China that can comprehensively improve the qualities of children and adolescents' positive development to prevent Internet addiction, especially after the blockade due to public health emergencies.

The modulation of mRNA levels of MAOA by electroacupuncture and psychotherapy in patients with pathological internet use

OBJECTIVE

The aim of this study was to observe the efficacy of electroacupuncture (EA) and psychotherapy (PT) effect on the mental status, sleep quality and impulsive trait in patients with pathological internet use, and to observe the changes of Monoamine oxidase type A (MAOA) messenger Ribonucleic acid (mRNA) levels in each group.

METHODS

A total of 60 PIU patients were included for the present study. These patients were randomly divided into two groups: EA group and PT group. Baihui, Sishencong, Hegu, Neiguan, Shenmen, Taichong, Sanyinjiao and Xuanzhong were selected for acupuncture in the EA group, while group psychotherapy combined with individual psychotherapy was used for intervention in patients in the PT group. Young's Internet addiction Test (IAT), Yale-Brown Obsessive-Compulsive Scale (Y-BOCS), Self-Rating Anxiety Scale (SAS), Self-Rating Depression Scale (SDS), Barratt Impulse Scale (BIS-11) and Pittsburgh Sleep Quality Index (PSQI) were used to observe the severity of Internet addiction, mental status, sleep quality and impulsive trait of all patients at baseline and 40th days of treatment; and MAOA mRNA data were collected at baseline and 40th days of treatment.

RESULTS

Electroacupuncture and psychological intervention effectively reduced IAT, SAS, SDS, Y-BOCS, BIS and PSQI scores of PIU patients. After 40 days treatment, the MAOA expression of the PT group was increased, and there was no significant change in EA group. The correlation analysis indicated that IAT scores were positively correlated with SAS, SDS, Y-BOCS, BIS and PSQI at baseline. In addition, after treatment the EA group showed that the change in IAT scores was positively correlated with the change in Y-BOCS and BIS scores, and the PT group showed that the change in IAT scores was positively correlated with the change in SDS, BIS and PSQI scores.

CONCLUSION

The present study showed that electroacupuncture and psychological intervention can improve severity of Internet addiction, mental status, sleep quality and impulsive trait of PIU patients. Simultaneously, neurobiological changes may be the underlying mechanisms of psychotherapy for internet additcion.

Internet addiction and psychosocial problems among adolescents during the COVID-19 pandemic: A cross-sectional study

PURPOSE

This research was conducted to investigate the prevalence of internet addiction and psychosocial problems and associated factors among adolescents during the COVID-19 pandemic.

DESIGN AND METHODS

A cross-sectional study was conducted in Turkey. The population was composed of 9th and 10th grade students. The sample consisted of 1572 participants. Data were collected from parents of the students through a questionnaire, the Pediatric Symptom Checklist, and the Parent-Child Internet Addiction Test.

RESULTS

The prevalence of psychosocial problems was 20.7%. A few (4.8%) of adolescents had limited internet addiction symptoms. The psychosocial problems risk was significantly higher in adolescents whose fathers did not work, whose family income was less than expense, and whose daily internet use time was more than 3 h and more (p < 0.05). The risk of problematic internet use was significantly higher in males, whose mother's education level was high school and lower, whose family income was less than expense, and whose duration of internet use was 5 years and more (p < 0.05). There was a positive correlation between internet addiction and psychosocial problem mean scores (p < 0.05).

CONCLUSION

Most of the adolescents were internet users and one in five adolescents was at risk of psychosocial problems. Internet addiction and psychosocial problems were associated with several sociodemographic factors.

PRACTICE IMPLICATIONS

This study emphasizes the need for the prevention of excessive internet use and psychosocial problems during COVID-19 pandemic among adolescents. Nurses should organize online trainings for internet addiction and psychosocial problems for adolescents and their parents during the quarantine process.

Internet Addiction and Emotional and Behavioral Maladjustment in Mainland Chinese Adolescents: Cross-Lagged Panel Analyses

Adolescence is a developmental stage when adolescents are vulnerable to addictive behaviors, such as Internet addiction (IA), which refers to pathological use of the Internet. Although there are views proposing that the links between IA and adolescent problem behavior may be bidirectional in nature, few studies have examined the reciprocal relationships between IA and other maladjustment indicators, and even fewer studies have simultaneously employed both emotional and behavioral maladjustment indicators in a single study. To address the above research gaps, the present study investigated how IA is associated with both depression and delinquency among Chinese adolescents. Two waves of data were collected at two consecutive years, respectively, with 1year apart, from 3,010 students (Mean age=13.16, SD=0.81; 57.48% boys) in four junior high schools in mainland China. These students completed the same questionnaire containing measures of IA, depression, and delinquency at each wave. The proposed cross-lagged panel model fitted the data very well, and there were significant positive reciprocal effects between IA and depression as well as delinquency after controlling for background socio-demographic factors. Gender differences were also observed in multi-group comparisons. Specifically, IA showed a stronger longitudinal impact on delinquency among boys than among girls. While depression significantly predicted IA in 1year among boys, such a prediction was not significant among girls. These findings delineate the bidirectionality of the associations between IA and emotional and behavioral maladjustment indexed by depression and delinquency, respectively. The findings also suggest that researchers and practitioners have to take gender differences as well as different developmental indicators in understanding the bidirectional influences between IA and adolescent behavioral and emotional development.

A Cross-Sectional Study on Internet Addiction Among Adolescent Children of Parents With Mental Illness

BACKGROUND

The internet can cause adverse psychological issues in children whose parents show less competence because of their mental illness. This study aims to find the level of internet addiction among adolescents who have a parent with psychiatric illness and its relationship to the type and duration of their parent's illness.

METHOD

This study was conducted among 283 adolescents whose parents suffered from mental illness. They were selected from the inpatient and outpatient services of a neuropsychiatric hospital in India. Informed written consent was obtained from the parent not suffering from psychiatric illness, and a semistructured interview accommodating various factors and statements from the internet addiction test was used to find the level of internet addiction.

RESULT

A total of 79.5% of adolescents showed scores indicative of internet addiction, with 14.5% of the participants having mild levels of addiction, 60.8% having moderate levels of addiction, and 4.2% having severe levels of addiction. There is a significant relationship between internet addiction scores and the type and duration of psychiatric illness in a parent.

CONCLUSION

The internet addiction scores in adolescents have a significant relationship to the various types of illnesses and the duration of illness of their parents.

How does Internet Addiction Affect Adolescent Lifestyles? Results from a School-Based Study in the Mediterranean Region of Turkey

PURPOSE

The habits acquired during adolescence may continue into adulthood. Therefore, the identification and prevention of Internet addiction is an important goal. The aim of this study was to investigate the effects of Internet addiction on the lifestyles of adolescents in a sample in the Mediterranean region of Turkey.

DESIGN AND METHODS

The sample consisted of 367 adolescents. Data were collected using a personal information form, the Internet Addiction Scale, and the Healthy Lifestyle Behaviours Scale-II between January and June 2018. This manuscript has been prepared according to Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) guidelines.

RESULTS

The mean Internet addiction score among the included adolescents was found to be moderate. Males aged 17 years with divorced parents and adolescents who have poor relationships with family members and friends had higher average Internet addiction scores. A negative and moderate relationship between Internet addiction and healthy lifestyle behaviours was identified among adolescents.

CONCLUSIONS

Internet addiction is negatively and moderately predictive of an adolescent's lifestyle.

PRACTICE IMPLICATIONS

Strengthening relationships with family and friends can prevent adolescents from developing Internet addictions and increase healthy lifestyle behaviours. Courses should be added to the curriculum that aim to improve the understanding of the risks and benefits (e.g. e-mail, Internet tools) associated with the Internet for both school staff and students. The results of the present study can be used to guide the development of a healthy Internet use program targeted at adolescents for use by school nurses.

Identifying Internet Addiction and Evaluating the Efficacy of Treatment Based on Functional Connectivity Density: A Machine Learning Study

Although mounting neuroimaging studies have greatly improved our understanding of the neurobiological mechanism underlying internet addiction (IA), the results based on traditional group-level comparisons are insufficient in guiding individual clinical practice directly. Specific neuroimaging biomarkers are urgently needed for IA diagnosis and the evaluation of therapy efficacy. Therefore, this study aimed to develop support vector machine (SVM) models to identify IA and assess the efficacy of cognitive behavior therapy (CBT) based on unbiased functional connectivity density (FCD). Resting-state fMRI data were acquired from 27 individuals with IA before and after 8-week CBT sessions and 30 demographically matched healthy controls (HCs). The discriminative FCDs were computed as the features of the support vector classification (SVC) model to identify individuals with IA from HCs, and the changes in these discriminative FCDs after treatment were further used as features of the support vector regression (SVR) model to evaluate the efficacy of CBT. Based on the informative FCDs, our SVC model successfully differentiated individuals with IA from HCs with an accuracy of 82.5% and an area under the curve (AUC) of 0.91. Our SVR model successfully evaluated the efficacy of CBT using the FCD change ratio with a correlation efficient of 0.59. The brain regions contributing to IA classification and CBT efficacy assessment were the left inferior frontal cortex (IFC), middle frontal cortex (MFC) and angular gyrus (AG), the right premotor cortex (PMC) and middle cingulate cortex (MCC), and the bilateral cerebellum, orbitofrontal cortex (OFC) and superior frontal cortex (SFC). These findings confirmed the FCDs of hyperactive impulsive habit system, hypoactive reflecting system and sensitive interoceptive reward awareness system as potential neuroimaging biomarkers for IA, which might provide objective indexes for the diagnosis and efficacy evaluation of IA.

Internet addiction and affected factors in primary school students: School-based study

The aim of the study was to determine the prevelance of internet addiction and effected factors in primary school students. This school-based study was a cross-sectional descriptive research design. This study was conducted with 277 students. Prevelans of IA among students was found 10.5%. Variables such as age (≥11 years), internet use in a day (≥3 h), not use internet for education, homework, research, use internet for communication, social network, gaming and mid academic grade accounted for 23% of the internet addiction. It is recommended that children with risk factors for internet addiction should be determined in the early stages, and that school-based intervention programs should be performed for students and their parents to prevent internet addiction.

Autism, Problematic Internet Use and Gaming Disorder: A Systematic Review

The present study investigated the association between autism and problematic internet use (PIU) and gaming disorder (GD). A systematic literature search was conducted in accordance with PRISMA guidelines. A total of 2286 publications were screened, and 21 were deemed eligible for inclusion in the review. The majority of the studies found positive associations between PIU and subclinical autistic-like traits with weak and moderate effect sizes and between PIU and Autism Spectrum Disorder (ASD) with varying effect sizes. Additionally, individuals with ASD were more likely to exhibit symptoms of GD with moderate and strong effect sizes. Future research would benefit from high-quality studies examining GD and PIU at a clinical level and their relationship with both clinical and subclinical autism.

School-based relationships and problematic internet use amongst Chinese students

The potential for adolescent mental health problems arising from heavy internet use is significant. There is a need to better understand the risk and protective factors related to problematic internet use (PIU) amongst adolescents. This study examined the role of adolescents’ perceptions of school-based relationships as potential contextual antecedents to problematic internet use. Specifically, 6552 adolescent students (55.9% boys, 13.51 ± 2. 93 years) from 22 primary and middle schools in southern China completed questionnaires to measure the degree of adolescent conflict with peers, teachers and other staff, school connectedness, perceived classroom atmosphere and problematic internet use. Self-reported data was collected using a two-level stratified sampling. Multiple regression analyses showed that conflict with peers and teachers was positively associated with higher levels of PIU, while school connectedness and perceived classroom atmosphere were negatively associated with PIU. An interaction effect was found for conflict with peers and grade level, such that the association between conflict with peers and PIU was stronger for secondary students compared to primary school students. The results support the need for school-based interventions for PIU to include a focus on conflict with peers and teachers, and for a focus on the enhancement of school connectedness and classroom atmosphere.

The recognition of gaming disorder in China: a case series of 223 patients

Background

Internet gaming disorder (IGD) was listed in the appendix of the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5) as a condition requiring further study in 2013, and gaming disorder (GD) was considered a mental disorder and listed in the 11th International Classification of Diseases Manual (ICD-11) in 2018. The study aims to obtain preliminary knowledge of the recognition of GD in China.

Methods

A total of 223 Chinese patients who met both the ICD-11 and DSM-5 criteria for GD participated in the study, and a self-administered questionnaire was used to collect demographic information, gaming use characteristics, and previous diagnoses.

Results

The average age of patients with GD was 20.5 years, and 71.3% were male. Most patients were diagnosed with emotion-related disorders at their first psychiatric visit: mood disorders (59.2%), bipolar affective disorder (18.4%), depressive episode (12.6%), and anxiety disorder (4.9%). Among the adolescent patients with a first diagnosis of mood disorders, 71.2% and 33.3% were diagnosed with bipolar affective disorder and personality disorders, respectively, at subsequent visits. Overall, after the first visit, the most common diagnosis was bipolar affective disorder (61.0%), followed by personality disorders (34.1%), mood disorders (17.0%), depressive episode (17.0%), and other disorders. Only three patients had Internet overuse.

Conclusion

The identification rate of GD is extremely low in routine psychiatric clinical practice in China. Most patients with GD were previously misdiagnosed with emotion-related disorders. Psychiatrists should be trained to improve their ability to recognize and manage GD.

Mediating effects of rumination and bedtime procrastination on the relationship between Internet addiction and poor sleep quality

BACKGROUND AND AIMS

Numerous studies have shown that people who have Internet addiction (IA) are more likely to experience poor sleep quality than people who do not. However, few studies have explored mechanisms underlying the relation between IA and poor sleep quality. As a first attempt to address this knowledge gap, a cross-sectional design was applied, and structural equation modeling was used to explore the direct relationship between IA and poor sleep quality, as well as the potential mediating roles of rumination and bedtime procrastination.

METHODS

A convenience sample, consisting of 1,104 Chinese University students (696 females or 63%), completed an online survey that included the following measures: Young's 8-item Internet Addiction Diagnosis Questionnaire, the Pittsburgh Sleep Quality Index, the Ruminative Responses Scale, and the Bedtime Procrastination Scale.

RESULTS

While the direct path between IA and poor sleep quality was not found to be significant, rumination and bedtime procrastination were each shown to separately mediate the predictive effect of IA on poor sleep quality. However, the greatest level of support was found for the sequential mediating effects of rumination and bedtime procrastination between IA and poor sleep quality.

CONCLUSION

While rumination and bedtime procrastination were both shown to be important independent mediators for the relation between IA and poor sleep quality, their combined effect was as great as either alone.

Ability to initiate relationships and sense of loneliness mediate the relationship between low self-esteem and excessive internet use

The purpose of the study was to identify possible mechanisms underlying the relationship between low self-esteem and excessive Internet use in a non-clinical sample of young adults. Basing on the theoretical framework and results of existing studies we hypothesized that the association between self-esteem and excessive Internet use will be serially mediated by the ability to initiate contact with others and sense of loneliness. The study sample consisted of 506 participants (60% women) aged between 18 and 35 years (mean = 19). The following questionnaires were administered: the Rosenberg Self-Esteem Scale, the UCLA Loneliness Scale, the Interpersonal Competence Questionnaire and the Excessive Internet Use Scale. The last measure was prepared by authors for the purpose of the study. Serial mediation analysis was conducted. In line with our hypotheses the link between low self-esteem and excessive Internet use was found to be sequentially mediated by the capability to initiate social contacts and chronic loneliness. Difficulty in engaging in social interaction leading to the sense of loneliness may explain the link between low self-esteem and excessive Internet use. These results may help to design early intervention programs.

Association between parental separation and addictions in adolescents: results of a National Lebanese Study

Background

Since divorce rates are on the rise in Lebanon (an increase of 101% between 2006 and 2017) and since previous international studies have shown a relationship between divorced parents and adolescents’ addiction to smoking, alcohol, and the internet, assessing the background of the Lebanese situation was deemed necessary. The study objective was to investigate the association between the divorce of parents and smoking, alcohol, and internet addiction among a representative sample of Lebanese adolescents.

Methods

This study was a cross-sectional, conducted between January and May 2019 using a proportionate random sample of schools from all Lebanese Mohafazat. Out of 2000 questionnaires distributed; 1810 (90.5%) were completed and collected back.

Results

The mean age was 15.42 ± 1.14 years, with 53.3% females and 74.1% smokers. In addition, 11.9% [95% CI 0.104–0.134] of the adolescents had separated/divorced parents. Divorce in parents was significantly associated with higher alcohol use disorder (Beta = 8.035), higher cigarette dependence (Beta = 2.767) and a higher waterpipe dependence (Beta = 5.263) in adolescents. However, divorce in parents was not associated with internet addiction in adolescents.

Conclusion

Parental divorce is correlated to higher alcohol and smoking, but not internet addiction among adolescents. Children whose parents are divorced should be subject to continuous follow-up by their parents and by a psychiatrist/psychologist in order not to develop an addiction that could potentially harm them.

Association between Internet Use Behavior and Palpitation among Adolescents: A Cross-Sectional Study of Middle School Children from Northwest Romania

PURPOSE

The use of the internet is a tool and media literacy has become an essential skill among adolescents. Related to this behavior, some adolescents evoke cardiovascular effects. The purpose of this study was to explore a possible correlation between internet use behavior and occurrence of palpitations and related symptoms among a representative cohort of adolescents from the north-west region of Romania.

METHOD

The study included students of seven middle schools from Northwest Romania. Participants completed an anonymous questionnaire consisting of 18 questions about internet use.

RESULTS

In total, 1147 students responded to the study. Mean duration of daily internet usage was 2.57 h during school time and 3.57 h during the holidays. A total of 77% of adolescents had more than one symptom related to internet use, and 11% of them reported palpitations and related symptoms. We found an independent relation between palpitation and urban background, palpitations and the internet usage time interval 20:00-24:00, and palpitations and tobacco smoking. Strong heartbeats were independently associated with the time interval 12:00-16:00, tobacco smoking, and energy drink consumption.

CONCLUSION

In our cohort, the most important factors associated with the occurrence of palpitations and related symptoms were the timeframe of internet usage and smoking.

The Modulation of Reward and Habit Systems by Acupuncture in Adolescents with Internet Addiction

Purpose

Acupuncture is an effective therapy for Internet addiction (IA). However, the underlying mechanisms of acupuncture in relieving compulsive Internet use remain unknown. Neuroimaging studies have demonstrated the role of the ventral striatum (VS) in the progress of IA; hence, the aim of this study was to explore the effects of acupuncture on the resting-state functional connectivity (rsFC) and relevant network of VS in IA.

Methods

Twenty-seven IA individuals and 30 demographically matched healthy control subjects (HCs) were recruited in this study. We acquired the functional magnetic resonance imaging (fMRI) data in IA subjects before and after 40 days of acupuncture treatment. Seed-to-voxel and ROI-to-ROI analyses were applied to detect the rsFC alterations of the VS and related network in IA subjects and to investigate the modulation effect of acupuncture on the rsFC.

Results

Compared with HCs, IA subjects exhibited enhanced rsFC of the right ventral rostral putamen (VRP) with the left orbitofrontal cortex (OFC), premotor cortex (PMC), cerebellum, and right ventromedial prefrontal cortex (vmPFC). In the network including these five ROIs, IA also showed increased ROI-to-ROI rsFC. Using a paired t-test in IA subjects before and after 40 days of acupuncture, the increased ROI-to-ROI rsFC was decreased (normalized to HC) with acupuncture, including the rsFC of the right VRP with the left OFC, PMC, and cerebellum, and the rsFC of the left cerebellum with the left OFC, PMC, and right vmPFC. Furthermore, the change in rsFC strength between the right VRP and left cerebellum in IA individuals was found positively correlated with the Internet craving alleviation after acupuncture.

Conclusions

These findings verified the modulation effect of acupuncture on functional connectivity of reward and habit systems related to the VS in IA individuals, which might partly represent the underlying mechanisms of acupuncture on IA.