Discordance between self-report and clinical diagnosis of Internet gaming disorder in adolescents

Aligning categories of mental health conditions with intervention types in high-performance sports: A narrative cornerstone review and classification framework

Epidemiological studies suggest that psychiatric disorders are as prevalent amongst high-performance athletes as in general populations, challenging the myth of invulnerability. Despite efforts of sport organisations to highlight the significance of athletes' mental health, it is still many times tough to combine the sport performance ethos with a discourse on mental health. This narrative cornerstone review examines challenges related to definitions and classifications of athlete mental health in high-performance sports and how these influence assessments and the implementation of interventions. We discuss challenges with concept creep and psychiatrisation and outline their consequences for sport healthcare professionals. Based on this, we present a framework that aligns different categories of athlete mental health conditions (from the reduction of wellbeing to psychiatric disorders) with intervention types (from the provision of supporting environments to pharmacotherapy). We conclude that researchers and sport practitioners need to carefully consider conceptual creep and the risk of pathologising normal and healthy, albeit emotionally aversive, reactions to athlete lifeworld events when assessing athlete mental health. A clear separation of terminology denoting the athlete's resources to handle the lifeworld (including salutogenic factors) and terms describing psychiatric conditions and their management is necessary to avoid misguidance in intervention planning.

Metabolic Profile and Long-Term Risk of Depression, Anxiety, and Stress-Related Disorders

Importance

Biomarkers of lipid, apolipoprotein, and carbohydrate metabolism have been previously suggested to be associated with the risk for depression, anxiety, and stress-related disorders, but results are inconsistent.

Objective

To examine whether the biomarkers of carbohydrate, lipid, and apolipoprotein metabolism are associated with the risk of depression, anxiety, and stress-related disorders.

Design, Setting, and Participants

This population-based cohort study with longitudinal data collection assessed 211 200 participants from the Apolipoprotein-Related Mortality Risk (AMORIS) cohort who underwent occupational health screening between January 1, 1985, and December 31, 1996, mainly in the Stockholm region in Sweden. Statistical analysis was performed during 2022 to 2023.

Exposures

Lipid, apolipoprotein, and carbohydrate biomarkers measured in blood.

Main Outcomes and Measures

The associations between biomarker levels and the risk of developing depression, anxiety, and stress-related disorders through the end of 2020 were examined using Cox proportional hazards regression models. In addition, nested case-control analyses were conducted within the cohort, including all incident cases of depression, anxiety, and stress-related disorders, and up to 10 control individuals per case who were individually matched to the case by year of birth, sex, and year of enrollment to the AMORIS cohort, using incidence density sampling. Population trajectories were used to illustrate the temporal trends in biomarker levels for cases and controls.

Results

A total of 211 200 individuals (mean [SD] age at first biomarker measurement, 42.1 [12.6] years; 122 535 [58.0%] male; 188 895 [89.4%] born in Sweden) participated in the study. During a mean (SD) follow-up of 21.0 (6.7) years, a total of 16 256 individuals were diagnosed with depression, anxiety, or stress-related disorders. High levels of glucose (hazard ratio [HR], 1.30; 95% CI, 1.20-1.41) and triglycerides (HR, 1.15; 95% CI, 1.10-1.20) were associated with an increased subsequent risk of all tested psychiatric disorders, whereas high levels of high-density lipoprotein (HR, 0.88; 95% CI, 0.80-0.97) were associated with a reduced risk. These results were similar for male and female participants as well as for all tested disorders. The nested case-control analyses demonstrated that patients with depression, anxiety, or stress-related disorders had higher levels of glucose, triglycerides, and total cholesterol during the 20 years preceding diagnosis, as well as higher levels of apolipoprotein A-I and apolipoprotein B during the 10 years preceding diagnosis, compared with control participants.

Conclusions and Relevance

In this cohort study of more than 200 000 participants, high levels of glucose and triglycerides and low levels of high-density lipoprotein were associated with future risk of depression, anxiety, and stress-related disorders. These findings may support closer follow-up of individuals with metabolic dysregulations for the prevention and diagnosis of psychiatric disorders.

Multilingual Framework for Risk Assessment and Symptom Tracking (MRAST)

The importance and value of real-world data in healthcare cannot be overstated because it offers a valuable source of insights into patient experiences. Traditional patient-reported experience and outcomes measures (PREMs/PROMs) often fall short in addressing the complexities of these experiences due to subjectivity and their inability to precisely target the questions asked. In contrast, diary recordings offer a promising solution. They can provide a comprehensive picture of psychological well-being, encompassing both psychological and physiological symptoms. This study explores how using advanced digital technologies, i.e., automatic speech recognition and natural language processing, can efficiently capture patient insights in oncology settings. We introduce the MRAST framework, a simplified way to collect, structure, and understand patient data using questionnaires and diary recordings. The framework was validated in a prospective study with 81 colorectal and 85 breast cancer survivors, of whom 37 were male and 129 were female. Overall, the patients evaluated the solution as well made; they found it easy to use and integrate into their daily routine. The majority (75.3%) of the cancer survivors participating in the study were willing to engage in health monitoring activities using digital wearable devices daily for an extended period. Throughout the study, there was a noticeable increase in the number of participants who perceived the system as having excellent usability. Despite some negative feedback, 44.44% of patients still rated the app's usability as above satisfactory (i.e., 7.9 on 1-10 scale) and the experience with diary recording as above satisfactory (i.e., 7.0 on 1-10 scale). Overall, these findings also underscore the significance of user testing and continuous improvement in enhancing the usability and user acceptance of solutions like the MRAST framework. Overall, the automated extraction of information from diaries represents a pivotal step toward a more patient-centered approach, where healthcare decisions are based on real-world experiences and tailored to individual needs. The potential usefulness of such data is enormous, as it enables better measurement of everyday experiences and opens new avenues for patient-centered care.

Korean adolescents' coping strategies on self-harm, ADHD, insomnia during COVID-19: text mining of social media big data

Introduction

Since the Coronavirus disease 2019 (COVID-19), public safety measures, including social distancing and school closures, have been implemented, precipitating psychological difficulties and heightened online activities for adolescents. However, studies examining the impact of the pandemic on adolescent mental health and their coping strategies in Asian countries are limited. Further, most studies have used survey measures to capture mental health challenges so far. Accordingly, this study aimed to examine the psychological challenges South Korean adolescents experienced and their coping strategies during the pandemic using the Natural Language Processing (NLP) and Text mining (TM) technique on adolescents' social media texts/posts.

Methods

The data were gathered from social media texts/posts such as online communities, Twitter, and personal blogs from January 1, 2019, to October 31, 2021. The 12,520,250 texts containing keywords related to adolescents' common psychological difficulties reported during the pandemic, including self-harm, Attention-Deficit/Hyperactivity Disorders (ADHD), and insomnia, were analyzed by TM, NLP using information extraction, co-occurrence and sentiment analysis. The monthly frequency of the keywords and their associated words was also analyzed to understand the time trend.

Results

Adolescents used the word "self-harm" in their social media texts more frequently during the second wave of COVID-19 (August to September 2020). "Friends" was the most associated word with "self-harm." While the frequency of texts with "Insomnia" stayed constant throughout the pandemic, the word "ADHD" was increasingly mentioned in social media. ADHD and insomnia were most frequently associated with ADHD medications and sleeping pills, respectively. Friends were generally associated with positive words, while parents were associated with negative words.

Conclusion

During COVID-19, Korean adolescents often expressed their psychological challenges on social media platforms. However, their coping strategies seemed less efficient to help with their difficulties, warranting strategies to support them in the prolonged pandemic era. For example, Korean adolescents shared psychological challenges such as self-harm with friends rather than their parents. They considered using medicine (e.g., sleeping pills and ADHD medication) as coping strategies for sleep and attention problems.

Effects of Online Game and Short Video Behavior on Academic Delay of Gratification - Mediating Effects of Anxiety, Depression and Retrospective Memory

Objective

Learner dependence on short videos has many pitfalls for learning outcomes, but the negative effects of excessive short video use have been little discussed in the learning psychology literature. Therefore, this study investigated the effects of excessive short video use on anxiety, depression, prospective memory, and academically delayed gratification (ADOG) in relation to online gaming-related behaviours, and explored the possible mechanisms by which excessive online gaming and short video use may lead to decreased ADOG, to expand our understanding of excessive short video use.

Methods

Based on the whole class random sampling method, a questionnaire survey was conducted among college students in Northern Anhui, China from May 7 to July 27, 2022. The questionnaires included the Generalized Anxiety Disorder Scale (GAD-7), Patient Health Questionnaire Scale (PHQ-9), Prospective and Retrospective Memory (PRM) Questionnaire, and ADOG Scale.

Results

A total of 1016 participants completed the survey. The study found that of all the internet behaviors, 20.8% of the college students mainly played online games, 43.9% mainly played short videos, and 35.3% conducted other online behaviors. When compared with other internet behaviors, online gaming and short video behaviors can cause more serious anxiety/depression and worse PRM and ADOG scores. As time spent playing online games and short videos increased, anxiety and depression became worse, and the scores for PRM and ADOG also declined. Anxiety, depression, and PRM mediate the relationship between time spent on online gaming/short videos and ADOG.

Conclusion

Excessive short videos behaviour may produce the same psychological problems and learning problems as online gaming disorder. Excessive short video and online gaming behaviors may affect ADOG performance through anxiety, depression, and prospective memory. These findings could be used as a basis for future studies on the improvement of ADOG.

Multifractal test for nonlinearity of interactions across scales in time series

The creativity and emergence of biological and psychological behavior tend to be nonlinear, and correspondingly, biological and psychological measures contain degrees of irregularity. The linear model might fail to reduce these measurements to a sum of independent random factors (yielding a stable mean for the measurement), implying nonlinear changes over time. The present work reviews some of the concepts implicated in nonlinear changes over time and details the mathematical steps involved in their identification. It introduces multifractality as a mathematical framework helpful in determining whether and to what degree the measured series exhibits nonlinear changes over time. These mathematical steps include multifractal analysis and surrogate data production for resolving when multifractality entails nonlinear changes over time. Ultimately, when measurements fail to fit the structures of the traditional linear model, multifractal modeling allows for making those nonlinear excursions explicit, that is, to come up with a quantitative estimate of how strongly events may interact across timescales. This estimate may serve some interests as merely a potentially statistically significant indicator of independence failing to hold, but we suspect that this estimate might serve more generally as a predictor of perceptuomotor or cognitive performance.

Experimental drugs in randomized controlled trials for long-COVID: what's in the pipeline? A systematic and critical review

INTRODUCTION

Over three years have passed since the emergence of coronavirus disease 2019 (COVID-19), and yet the treatment for long-COVID, a post-COVID-19 syndrome, remains long overdue. Currently, there is no standardized treatment available for long-COVID, primarily due to the lack of funding for post-acute infection syndromes (PAIS). Nevertheless, the past few years have seen a renewed interest in long-COVID research, with billions of dollars allocated for this purpose. As a result, multiple randomized controlled trials (RCTs) have been funded in the quest to find an effective treatment for long-COVID.

AREAS COVERED

This systematic review identified and evaluated the potential of current drug treatments for long-COVID, examining both completed and ongoing RCTs.

EXPERT OPINION

We identified four completed and 22 ongoing RCTs, investigating 22 unique drugs. However, most drugs were deemed to not have high potential for treating long-COVID, according to three pre-specified domains, a testament to the ordeal of treating long-COVID. Given that long-COVID is highly multifaceted with several proposed subtypes, treatments likely need to be tailored accordingly. Currently, rintatolimod appears to have modest to high potential for treating the myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS) subtype, LTY-100 and Treamid for pulmonary fibrosis subtype, and metformin for general long-COVID prevention.

The mediating role of sleep quality on the relationship between internet gaming disorder and perceived stress and suicidal behaviour among Indian medical students

Background

In the recent digital era, individuals with internet gaming disorder (IGD) have reported a much higher prevalence of poor sleep quality, perceived stress and suicidal behaviour. However, the underlying mechanisms for these psychological problems remain unknown.

Aims

The primary aims of this study were to explore the mediating role of sleep quality on the relationship between IGD and the health outcomes of perceived stress and suicidal behaviour and to assess the prevalence and risk factors for IGD among medical students.

Methods

A cross-sectional study enrolling 795 medical students from two medical colleges in a rural area of North India was conducted from April to May 2022. The study participants were chosen using a stratified random sampling approach. A self-administered questionnaire was used to collect data, including sociodemographic and personal information and gaming characteristics. The study also included the Gaming Disorder and Hazardous Gaming Scale, the Pittsburgh Sleep Quality Index, the Perceived Stress Scale-10 and the Suicide Behaviors Questionnaire-Revised to measure IGD, sleep quality, perceived stress and suicidal behaviour, respectively. Multiple logistic regression for the risk factors and Pearson's correlation test for the relationship between variables were used. Hayes' PROCESS macro for SPSS was employed to carry out mediation analysis.

Results

Among the 348 gamers with a mean age of 21.03 (SD 3.27) years, the prevalence of IGD was 15.23% (95% confidence interval: 11.6% to 19.4%). In the correlational analysis, small to large (r: 0.32-0.72) significant relationships between scores of IGD and other health outcomes were established. The indirect effect (B=0.300) via sleep quality accounted for 30.62% of the total effect (B=0.982) of IGD on perceived stress (partially mediated), while sleep quality (B=0.174) accounted for 27.93% of the total effect (B=0.623) of IGD on suicidal behaviour (partially mediated). The factors of being male, living in a single-parent family, using the internet for other than academic purposes (1-3 hours and more than 3 hours/day), playing games for more than 3 hours/day and playing games with violent content were associated with IGD symptoms.

Conclusions

Using a dimensional measure, the results specified the relationship between IGD and perceived stress and suicidal behaviour by demonstrating that sleep quality meditated them. This modifiable mediating factor can be addressed by psychotherapy to mitigate the risk of perceived stress and suicidal behaviour among the future medical workforce.

Development and initial validation of a short form of the Memories of Home and Family Scale

The Memories of Home and Family Scale (MHFS; Shevlin et al., 2022) was developed as a multidimensional measure of subjective memories of experiences at home and with family during childhood. Due to the length of the scale, a short version of the MHFS (MHFS-SF) has been developed. Data were from Wave 7 of the COVID-19 Psychological Research Consortium Study (C19PRC-UK), a population based UK survey (N = 1405). Two items with the highest factor loadings from each of the six dimensions of the original MHFS were selected for inclusion. Confirmatory factor analytic (CFA) models were estimated to test the dimensionality of the scale. Convergent and discriminant validity were tested by examining associations with criterion variables. CFA results supported the multidimensionality of the scale. MHFS-SF total and sub-scale scores were negatively correlated with measures of depression, anxiety, loneliness, and paranoia, and were positively correlated with wellbeing. Regression analyses revealed that MHFS-SF total and sub-scale scores significantly predicted loneliness, paranoia, and wellbeing, even after accounting for age, gender, and current internalising symptoms. Results from this study suggest that the MHFS-SF scores retain the excellent psychometric properties of the original scale while improving efficiency. The MHFS-SF demonstrated high levels of convergent and discriminant validity with mental health and wellbeing measures. Future research should seek to validate the MHFS-SF in different populations and assess its usefulness in clinical settings.

Supplementary Information

The online version contains supplementary material available at 10.1007/s42844-023-00097-x.

Gender differences in symptom structure of adolescent problematic internet use: A network analysis

BACKGROUND

Gender differences in problematic Internet use (PIU) have long been discussed. However, whether and how female and male adolescents differ in central symptoms and symptom associations are not fully understood.

METHODS

As a national survey in the Chinese mainland, 4884 adolescents (51.6% females; M_age = 13.83 ± 2.41) participated in the present study. This study applies network analysis to identify central symptoms of PIU networks in female and male adolescents and compares whether and how global and local connectivity of PIU networks differ by gender.

RESULTS

Female and male network structures of PIU were different and global strength was stronger in males than females, indicating a higher risk of chronicity of PIU among male adolescents. Specifically, "Reluctant to turn off Internet" exerted the largest effect on both genders. "Increase time online to achieve satisfaction" and "Feel depressed once not online for a while" were particularly critical to female and male adolescents, respectively. Moreover, females scored higher centralities in social withdrawal symptoms and males did so in interpersonal conflicts owing to PIU.

CONCLUSIONS

These findings provide novel insights into gender differential risks and features of adolescent PIU. Differences in the core symptoms of PIU suggest that gender-specific interventions focusing on core symptoms might effectively relieve PIU and maximize treatment effects.

Internet Gaming Disorders and Early Onset Psychosis in Young People: A Case Study and Clinical Observations

BACKGROUND

Over the last ten years, the video game industry has grown exponentially, involving about 2.5 billion young adults in the world. The estimated global prevalence of gaming addiction has been reported to be 3.5% ranging from 0.21% to 57.5% in the general population. Moreover, during the recent COVID-19 pandemic period, school closures and stay-at-home measures have also further increased the opportunities for prolonged and intensified playing of video games. Little is known about the relationship between IGD and psychosis, and the literature is still scarce. Some characteristics of patients with psychosis, particularly those with a first-episode psychosis (FEP), may suggest that these individuals would be particularly liable to develop IGD.

CASE PRESENTATION

We report two cases of young patients with to Internet gaming disorder, experiencing early onset psychosis treated with antipsychotic therapy.

CONCLUSION

Although it is difficult to show the specific mechanisms underlying the psychopathological alterations in IGD, it is clear that excessive exposure to video games could be a risk factor for precipitating psychosis especially in a vulnerable age group such as adolescence. Clinicians should be aware of the possibility of a higher risk of psychotic onset associated specifically with gaming disorders in very young people.

Psychiatric Disorders and Obesity in Childhood and Adolescence-A Systematic Review of Cross-Sectional Studies

Obesity and psychiatric disorders have high prevalence and are both considered major health problems. Within the last decades, the rates of obesity have risen over 6%, while the prevalence of psychiatric disorders is over 12% for children and adolescents. The aim of this study was to systematically review the evidence regarding the relation of obesity and psychiatric disorders in childhood and adolescence. This review, based on the PRISMA guidelines, included cross-sectional studies published within the last decade, pertaining to the relation between psychiatric disorders and obesity in children and adolescents up to the age of 19 years. Studies on eating disorders were excluded. A total of 14 studies of 23,442 children and adolescents that investigated the relation of obesity with anxiety, mood disorders, and psychosis were included in this systematic review. Nine of the included studies reported a significant relationship between the psychiatric disorder under investigation and obesity. Understanding the nexus between obesity and psychiatric disorders in children and adolescents is of great importance, given the alarming increase in both conditions in youth. Such findings could facilitate the development and implementation of targeted interventions.

Associations between digital media use and lack of physical exercise among middle-school adolescents in Korea

OBJECTIVES

The reported effects of digital media overuse on physical activity among adolescents are inconsistent. This study examined the association between hours of digital media use and lack of moderate-intensity physical exercise (mPE) according to the type of digital media.

METHODS

This study included 1,837 middle school students from the iCURE (Internet user Cohort for Unbiased Recognition of gaming disorder in Early Adolescence) study conducted in Korea. Hours spent using digital media were measured by self-reported daily usage time for Internet games, messengers, social media, and watching game streaming on weekdays. Lack of mPE was defined as performing a minimum of 30 minutes at a time less than twice weekly. Multivariable logistic regression analysis stratified by sex was performed.

RESULTS

Among male students, the group with the highest hours of using either Internet games or watching game streaming was more likely to lack mPE than each non-user group. In contrast, among male students, the group using either messengers or social media had a higher rate of mPE compared to each non-user group. Female students showed no association between hours spent using Internet games, messengers, social media, or watching game streaming and a lack of mPE.

CONCLUSIONS

Among male middle school students in Korea, the excessive use of Internet games or watching game streaming was associated with a lack of mPE. Thus, guidelines should be established regarding adolescent use of internet games and watching game streaming.

Leveraging Patient Preference Information in Medical Device Clinical Trial Design

Use of robust, quantitative tools to measure patient perspectives within product development and regulatory review processes offers the opportunity for medical device researchers, regulators, and other stakeholders to evaluate what matters most to patients and support the development of products that can best meet patient needs. The medical device innovation consortium (MDIC) undertook a series of projects, including multiple case studies and expert consultations, to identify approaches for utilizing patient preference information (PPI) to inform clinical trial design in the US regulatory context. Based on these activities, this paper offers a cogent review of considerations and opportunities for researchers seeking to leverage PPI within their clinical trial development programs and highlights future directions to enhance this field. This paper also discusses various approaches for maximizing stakeholder engagement in the process of incorporating PPI into the study design, including identifying novel endpoints and statistical considerations, crosswalking between attributes and endpoints, and applying findings to the population under study. These strategies can help researchers ensure that clinical trials are designed to generate evidence that is useful to decision makers and captures what matters most to patients.

Agreement for diagnosis of depression and anxiety between self-assessment with e-questionnaire and psychiatric telephone interview among post-COVID-19 patients

BACKGROUND

Psychological disorders, such as depression and anxiety, are common among individuals who have experienced coronavirus disease 2019 (COVID-19); however, diagnosis may be challenging and subjected to invalidity. This study aimed to examine agreement between online self-assessment and psychiatric telephone interview among COVID-19 survivors.

MATERIALS AND METHODS

This cross-sectional descriptive study was carried out from March to June 2021 in Afzalipour Hospital, Kerman, Iran. The inpatients confirmed with COVID-19 were contacted within the first week after discharge and were asked to fill the Hospital Anxiety and Depression scale (HADS) and socio-demography questionnaire. They were later interviewed using Hamilton Depression Rating Scale (HAM-D) and Hamilton Anxiety Rating Scale (HAM-A). Agreement between the data extracted from self-report and telephone interview was analyzed using Cohen's kappa coefficient, sensitivity, and specificity.

RESULTS

Out of 200 post-COVID patients, 60 participants completed all assessments. Prevalence of depression was observed to be 88% via telephone interview and 45% via self-assessment. Moreover, 83% of the participants were diagnosed with anxiety according to the telephone interview, in comparison to 31% diagnosed with anxiety using self-report questionnaire. The agreement between online self-assessment and telephone interview for depression and anxiety was not significant (κ = 0.08 and κ = 0.1, respectively).

CONCLUSION

The discordance between online self-report and clinician's assessment via phone contact interview indicates that using self-report evaluations is not sufficient as the single assessment tool for mental health monitoring and reflects the need to employ multiple assessments for diagnosis of psychiatric problems in pandemics.

Identification of Major Cognitive Disorders in Self-Reported versus Administrative Health Data: A Cohort Study in Quebec

BACKGROUND

The first imperative in producing the relevant and needed knowledge about major neurocognitive disorder (MNCD) is to identify people presenting with the condition adequately. To document potential disparities between administrative health databases and population-based surveys could help identify specific challenges in this population and methodological shortfalls.

OBJECTIVE

To describe and compare the characteristics of community-dwelling older adults according to four groups: 1) No MNCD; 2) Self-reported MNCD only; 3) MNCD in administrative health data only; 4) MNCD in both self-reported and administrative health data.

METHODS

This retrospective cohort study used the Care Trajectories-Enriched Data (TorSaDE) cohort, a linkage between five waves of the Canadian Community Health Survey (CCHS) and health administrative health data. We included older adults living in the community who participated in at least one cycle of the CCHS. We reported on positive and negative MNCD in self-reported versus administrative health data. We then compared groups' characteristics using chi-square tests and ANOVA.

RESULTS

The study cohort was composed of 25,125 older adults, of which 784 (3.12%) had MNCD. About 70% of people with an MNCD identified in administrative health data did not report it in the CCHS. The four groups present specific challenges related to the importance of perception, timely diagnosis, and the caregivers' roles in reporting health information.

CONCLUSION

To a certain degree, both data sources fail to consider subgroups experiencing issues related to MNCD; studies like ours provide insight to understand their characteristics and needs better.

Resource-Strengthening Training for Parents of Adolescents with Problematic Gaming (Res@t-P): A Clinical Pilot Study

Background: Problematic gaming (PG) has become an increasing mental health issue among adolescents during the preceding years. The role of parents and the family environment in the development of PG has been repeatedly emphasized. However, the structured involvement of parents in the therapy is still largely insufficient. Resource-strengthening training for parents of adolescents with PG (Res@t-P) is a new parent-centered 8-week group intervention to fill this substantial gap. The present pilot study aimed to collect first information on its potential effectiveness in improving parental and family factors. Methods: The study was conducted in a clinical setting with N = 43 parents of adolescents with PG, applying a pre- and post-follow-up design. Standardized questionnaires on psychological stress perception, family communication, family functioning, media rules, and adolescent PG symptoms were applied at three measurement points (before, at the end of, and 6 weeks after the training). Conditional growth models were estimated. Results: Over time, an improvement in parental and family aspects as well as a reduction in adolescent PG symptoms could be observed. Conclusions: The results of the present pilot study on the effectiveness of Res@t-P are promising. No causal inferences can be drawn at this stage. A randomized-controlled intervention study is highly warranted.

Validation of self-report measures of narcissism against a diagnostic interview

The Pathological Narcissism Inventory (PNI) and the Narcissistic Personality Inventory (NPI) are often used to screen for pathological narcissism but have rarely been validated against a clinician-administered diagnostic interview. Our study evaluated the convergent validity of the PNI and NPI against a diagnostic interview for narcissistic personality disorder (NPD) in a clinical population. We used data from a psychiatric outpatient center located in Switzerland (n = 123). Correlations between PNI/NPI and NPD ranged between .299 and .498 (common variance 9.0–24.8%). The PNI and NPI should be used carefully to screen for NPD. We highlight a need to increase the compatibility between the conceptual underpinnings of the PNI, NPI and NPD.

Factors Associated with Games Addiction among Internet Game Players Visiting Internet Gaming Cafes in Northern Sumatera

BACKGROUND: The prevalence of teenagers experiencing addiction game Indonesia continued to increase. AIM: Study aimed to investigate factors associated with game addiction among internet game players visiting internet gaming cafes using Indonesian version the Game Addiction Scale (GAS) score. METHODS: Cross-sectional was conducted from November to December 2020 at an internet gaming cafe in the Tanjung Sari village, Medan city. The study subjects were online game players at four internet gaming cafes. A structured interview was conducted on online game players before being assigned to fill out identity and answer the Indonesian version of the GAS questionnaire. RESULTS AND CONCLUSION: Age, number of playing game mates, daily duration of sleep, weekly duration of playing online games, online game group membership, and parental monthly income were found to be associated with gaming addiction as measured by GAS scores. Meanwhile, educational background and monthly cost of playing games were found to be not associated with game addiction as measured by the GAS score.

Who Benefits from Fermented Food Consumption? A Comparative Analysis between Psychiatrically Ill and Psychiatrically Healthy Medical Students

Probiotic therapies and fermented food diets hold promise for improving mental health. Although in this regard psychiatric patients appear to benefit more than healthy individuals, no research has been performed to directly evaluate this hypothesis. The present study examined a cohort of medical students facing a stressful event, and some of the students reported suffering from chronic psychiatric diseases. The amount of fermented food consumption was calculated with the use of seven-day dietary records, while depressive and anxiety symptoms were assessed with the use of the Patient Health Questionnaire-9 and Generalized Anxiety Disorder-7, respectively. In psychiatrically healthy medical students under psychological stress (n = 372), higher fermented food consumption was associated with more depressive and anxiety symptoms. In contrast, psychiatrically ill medical students (n = 25, 6.3% of all the participants) were found to present a negative association between the amount of fermented food consumed and the severity of depressive symptoms (adjusted β -0.52, 95% CI -0.85 to -0.19, p = 0.0042); however, this relationship was insignificant for anxiety symptoms (adjusted β -0.22, 95% CI -0.59 to 0.15, p = 0.22). A significant interaction was found between the consumption of fermented food and psychiatric diagnosis in predicting depressive symptoms (p = 0.0001), and a borderline significant interaction for anxiety symptoms (p = 0.053). In conclusion, psychiatrically ill people, but not healthy ones, may benefit from fermented food consumption in terms of alleviation of depressive symptoms. Our findings require cautious interpretation and further investigation.

Problem Gaming and Suicidality: A Systematic Literature Review

•

This is the first review on the association between problem gaming and suicidality.

•

12 studies were identified, all of which found a positive association.

•

Future studies should investigate the causality and mechanisms in the relationship.

Background

No studies have so far synthesised the current evidence concerning a possible relationship between problem gaming and suicidality. We therefore conducted a systematic review of the literature. Our objective was to investigate the relationship between problem gaming and suicidality. The review was funded by the Norwegian Competence Center for Gambling and Gaming Research.

Methods

The review was pre-registered in PROSPERO International prospective register of systematic reviews (CRD42021279774). Searches were conducted in Web of Science, PsycINFO, EMBASE, PubMed and Google Scholar, September 2021. Studies that reported data on the relationship between problem gaming and suicidality, published between 2000 and 2021, and written in any European language were included. Studies investigating internet addiction/problematic internet use and not problem gaming, specifically, and studies investigating mental health in general or mental health outcomes other than suicidality, were excluded. Data from the included studies were extracted independently by two coders who also evaluated for risk of bias using the Newcastle-Ottawa Quality Assessment Scale. The results from each included study were presented in a table.

Results

A total of 12 cross-sectional studies, with in total 88,732 participants, were included in the review. In total 10 studies investigated the association between problem gaming and suicidal ideation. One of these also investigated the association between problem gaming and suicide attempts. Two studies combined suicidal ideation and suicide attempts into one variable and investigated the association between that variable and problem gaming. In total 11 of the 12 included studies found positive, crude associations between problem gaming and suicidal ideation/attempts. Five studies adjusted for possible confounding variables. Three of these still found significant associations between problem gaming and suicidal ideation, one found a positive but not statistically significant association, and the fifth found an inverse, non-significant association.

Discussion

The current findings indicate that there is an association between problem gaming and suicidal ideation, and likely between problem gaming and suicide attempts. The most important limitation of the included studies is the lack of longitudinal designs. Future studies should aim to investigate the causality and mechanisms in the relationships using more stringent designs.

Prevalence of gaming disorder: A meta-analysis

BACKGROUND

Gaming disorder (GD) has been listed in the International Classification of Diseases 11th Revision. Studies on GD prevalence have been highly heterogeneous, and there are significant gaps in prevalence estimates. Few studies have examined what methodological and demographic factors could explain this phenomenon. Therefore, this meta-analytic study quantifies globally reported GD prevalence rates and explores their various moderating variables.

METHODS

Prevalence estimates were extracted from 61 studies conducted before December 3, 2020, which included 227,665 participants across 29 countries. Subgroup and moderator analyses were used to investigate the potential causes of heterogeneity, including region, sample size, year of data collection, age group, study design, sampling method, survey format, sample type, risk of bias, terminology, assessment tool, and male proportion.

RESULTS

The overall pooled prevalence of GD was 3.3% (95% confidence interval: 2.6-4.0) (8.5% in males and 3.5% in females). By selecting only 28 representative sample studies, the prevalence estimate was reduced to 2.4% (95% CI 1.7-3.2), and the adjusted prevalence estimate using the trim-and-fill method was 1.4% (95% CI 0.9-1.9). High heterogeneity in GD prevalence rates was influenced by various moderators, such as participant variables (e.g., region, sample size, and age) and study methodology (e.g., study design, sampling method, sample type, terminology, and instrument). The moderator analyses revealed that the sample size, mean age, and study quality were negatively associated with GD prevalence.

CONCLUSIONS

This study confirms that GD prevalence studies were highly heterogeneous based on participant demographics and research methodologies. Various confounding variables, such as sampling methods, sample types, assessment tools, age, region, and cultural factors have significantly influenced the GD prevalence rates. Prevalence estimates are likely to vary depending on study quality. Further epidemiological studies should be conducted using rigorous methodological standards to more accurately estimate GD prevalence.

Piloting Smartphone Digital Phenotyping to Understand Problematic Internet Use in an Adolescent and Young Adult Sample

Problematic Internet use (PIU) preferentially affects youth development, particularly youth with psychiatric conditions. Studies attempting to understand PIU and its impact on adolescent mental health have been limited by cross-sectional design and self-report data. Even with a small sample size, digital phenotyping (DP) methodology can address these limitations through repeated sampling and collection of survey and sensor data through personal smartphones. This study pilots a 6-week DP protocol in 28 youth in mental health treatment in order to assess relationships between PIU, mood symptoms, and daily behaviors like smartphone engagement and daily travel in this high-risk population. Our results found shared associations between depression and PIU, where symptom severity of both worsened in the setting of decreased smartphone engagement. These clinically relevant findings indicate that, rather than uniformly worsening mental health, increased digital engagement may actually provide short-term relief from negative affect in youth with psychiatric comorbidities.

Psychometric evaluation of the Russian version of the Gaming Disorder Scale for Adolescents

Problematic gaming has become an emerging global health issue. Formal recognition of gaming disorder in the ICD-11 is a new opportunity for the discipline to conduct further investigation concerning the psychological consequences of problematic gaming. The present study investigated the psychometric properties and construct structure of the recently developed Gaming Disorder for Scale for Adolescents (GADIS-A), a multi-dimensional instrument that screens for gaming disorder symptoms, among Russian adolescent gamers. The sample comprised 933 adolescent gamers (547 boys and 386 girls) recruited via a web-based platform, using a multistage sampling method. Analysis showed the GADIS-A had very good internal consistency (Cronbach's alpha coefficient = .891; Composite reliability = .89) and adequate test-retest reliability after two weeks (intraclass coefficient  =0.68 with 95% CI [0.61, 0.77]. Exploratory structural equation modeling (ESEM) showed the data fitted well. Measurement invariance testing indicated the GADIS-A was invariant by gender and gaming medium (online vs. offline). As for criterion-related validity, high scores on the GADIS-A positively correlated with scales assessing depression, anxiety, impulsivity, and difficulties in emotion regulation, and negatively correlated with social connectedness and life satisfaction. Using latent profile analysis, four groups of gamers were identified, and problematic gaming was associated with greater mental health problems. The findings indicated that psychological comorbidity (e.g., depression and anxiety) was more prevalent among gamers with higher risk of GD. The findings indicate that GADIS-A is a reliable and valid instrument to assess the symptoms and severity of gaming disorder among Russian adolescents.

SUPPLEMENTARY INFORMATION

The online version contains supplementary material available at 10.1007/s12144-021-02575-w.

Reliability, and Convergent and Discriminant Validity of Gaming Disorder Scales: A Meta-Analysis

Background: An association between gaming disorder (GD) and the symptoms of common mental disorders is unraveled yet. In this preregistered study, we quantitatively synthesized reliability, convergent and discriminant validity of GD scales to examine association between GD and other constructs. Methods: Five representative GD instruments (GAS-7, AICA, IGDT-10, Lemmens IGD-9, and IGDS9-SF) were chosen based on recommendations by the previous systematic review study to conduct correlation meta-analyses and reliability generalization. A systematic literature search was conducted through Pubmed, Proquest, Embase, and Google Scholar to identify studies that reported information on either reliability or correlation with related variables. 2,124 studies were full-text assessed as of October 2020, and 184 were quantitatively synthesized. Conventional Hedges two-level meta-analytic method was utilized. Results: The result of reliability generalization reported a mean coefficient alpha of 0.86 (95% CI = 0.85-0.87) and a mean test-retest estimate of 0.86 (95% CI = 0.81-0.89). Estimated effect sizes of correlation between GD and the variables were as follows: 0.33 with depression (k = 45; number of effect sizes), 0.29 with anxiety (k = 37), 0.30 with aggression (k = 19), -0.22 with quality of life (k = 18), 0.29 with loneliness (k = 18), 0.56 with internet addiction (k = 20), and 0.40 with game playtime (k = 53), respectively. The result of moderator analyses, funnel and forest plots, and publication bias analyses were also presented. Discussion and Conclusion: All five GD instruments have good internal consistency and test-retest reliability. Relatively few studies reported the test-retest reliability. The result of correlation meta-analysis revealed that GD scores were only moderately associated with game playtime. Common psychological problems such as depression and anxiety were found to have a slightly smaller association with GD than the gaming behavior. GD scores were strongly correlated with internet addiction. Further studies should adopt a rigorous methodological procedure to unravel the bidirectional relationship between GD and other psychopathologies. Limitations: The current study did not include gray literature. The representativeness of the five tools included in the current study could be questioned. High heterogeneity is another limitation of the study. Systematic Review Registration: [https://www.crd.york.ac.uk/PROSPERO/], identifier [CRD42020219781].

Pathological gaming and its association with lifestyle, irritability, and school and family environments among Japanese elementary school children

BACKGROUND

Pathological gaming (PG) has emerged as one of the major public health concerns worldwide. We aimed to assess PG and its associated factors among elementary school children in Japan.

METHODS

We conducted a school-based observational study in Toyama, Japan in 2018. Totally, 13,413 children in the 4th-6th grades (mean age, 10.5 years) participated in the study. We distributed questionnaires and inquired about their lifestyle, irritability, and school and family environments. Referring to criteria of gaming disorder in the International Statistical Classification of Disease (ICD-11), we asked about three core symptoms: impaired control over gaming, increasing priority given to gaming over other activities, and continuation of gaming despite the negative consequences. Children who had all three criteria in the questionnaire were defined as PG.

RESULTS

The response rate was 97.6% and 11,826 children were included in our analyses (88.2%). The prevalence of PG was 5.6% (7.8% in boys, 3.2% in girls). Besides sex, PG was significantly associated with lifestyles including skipping breakfast (odds ratio, OR=1.33; 95% confidence interval, CI: 1.05-1.68), physical inactivity (OR=2.23; 95% CI: 1.63-3.05 for rare), late bed time (OR=2.52; 95% CI: 1.96-3.25 for ≥11 p.m), frequent irritability (OR=1.89; 95% CI: 1.47-2.43), frequent feeling of school avoidance (OR=1.92; 95% CI: 1.49-2.46), fewer close friends (OR=1.30; 95% CI: 1.08-1.56 for some), low academic performance (OR=1.53; 95% CI: 1.13-2.08), no child-parental interaction (OR=1.34; 95% CI: 1.02-1.75), and no rules at home (OR=1.21; 95% CI: 1.02-1.43).

CONCLUSION

Unhealthy lifestyles, irritability, and low functioning in school and family environments were associated with PG. Besides having a healthy lifestyle, parental involvement appears to be an essential countermeasure for PG in children.

Digital Phenotyping in Child and Adolescent Psychiatry: A Perspective

Digital phenotyping (DP) provides opportunities to study child and adolescent psychiatry from a novel perspective. DP combines objective data obtained from digital sensors with participant-generated "active data," in order to understand better an individual's behavior and environmental interactions. Although this new method has led to advances in adult psychiatry, its use in child psychiatry has been more limited. This review aims to demonstrate potential benefits of DP methodology and passive data collection by reviewing studies specifically in child and adolescent psychiatry. Twenty-six studies were identified that collected passive data from four different categories: accelerometer/actigraph data, physiological data, GPS data, and step count. Study topics ranged from the associations between manic symptomology and cardiac parameters to the role of daily emotions, sleep, and social interactions in treatment for pediatric anxiety. Reviewed studies highlighted the diverse ways in which objective data can augment naturalistic self-report methods in child and adolescent psychiatry to allow for more objective, ecologically valid, and temporally resolved conclusions. Though limitations exist-including a lack of participant adherence and device failure and misuse-DP technology may represent a new and effective method for understanding pediatric cognition, behavior, disease etiology, and treatment efficacy.

The Impact of Online Game Addiction on Adolescent Mental Health: A Systematic Review and Meta-analysis

Abstract: Introduction: The World Health Organization (WHO) in 2019 determined that Internet Gaming Disorders (IGD) were included as mental health disorders. Among adolescents, excessive online gaming has become a lifestyle and is associated with psychological symptoms (psychopathological symptoms and life satisfaction), social health (social interactions) and physical health (general health and body mass index). The IGD has now become a problem all over the world.   AIM: This study aims to analyze the impact of online game addiction on adolescents using the Preferred Reporting Items for Systematic Reviews (PRISMA) approach.   MATERIALS AND METHODS: Subjects were searched extensively from the Pubmed, Sage, Science Direct, and Scopus databases. The search used the keywords "online game addiction", "mental health", and "youth". The inclusive criteria for the included  literature in this study  were as follow; the literature had to be sourced from journal article, written in English, available in full text, the published between  2011-2021, and the age of the adolescent subject should be 13-18 years. We identified 81 articles of which 20 were deemed relevant for this systematic review.   RESULTS: This review study shows that problematic online gaming behavior has a strong negative correlation with various subjective health outcomes.   CONCLUSION: Early relevant prevention for  adolescents from the IGD is the appropriate use of  internet/ gadgets as the only option to avoid or to reduce the symptoms of internet addiction and online games.   Keywords : Online game addiction; Mental health; Adolescents; Good Health and Wellbeing

Joint effects of children's emotional problems and parental depressive symptoms on the occurrence of internet gaming disorder among children and adolescents: A longitudinal study

BACKGROUND AND AIMS

Parental depressive symptoms may aggravate the effects of children's emotional problems on risks for Internet gaming disorder (IGD). Here we examined the joint effects of children's emotional problems and parents' depressive symptoms on the incidence of IGD.

METHODS

A large prospective, population-based cohort tested potential interactions between children's emotional problems, parents' depressive symptoms, and incidence of high risk of IGD (HRIGD). Family dyads (n=2,031) that included children who were non-HRIGD at baseline completed assessments of childhood and parental affective symptomatology. HRIGD was assessed at baseline and 12 months. Relative excess risk due to interaction (RERI) estimated the magnitudes of interactions.

RESULTS

In terms of risk for the development of IGD, parental depression was 1.8 times greater, children's emotional problems were 2.9 times greater, and both risk factors together were 6.1 times greater than the background risk, with the last two findings reaching statistical significance. The expected risk for the development of HRIGD was RR=3.7.

DISCUSSION AND CONCLUSIONS

Children's emotional problems demonstrated a particularly strong relationship with HRIGD. Joint effects of children's emotional problems and depressive symptoms in parents on the incidence of HRIGD were stronger than the sum of the independent effects of each factor. The findings suggest that combining interventions for the treatment of children's emotional problems and parents' depressive symptoms may have extra risk reduction effects on preventing IGD in children and adolescents.

Mental Health and Traumatization of Newly Arrived Asylum Seeker Adults in Finland: A Population-Based Study

Asylum seekers frequently experience potentially traumatic events (PTEs), but the type and frequency vary depending on the country of origin. The cumulative effect of multiple PTEs and other stressors expose asylum seekers to a significant risk of mental ill health. The aim of the study was to examine the prevalence of PTEs, depression and anxiety symptoms, risk for psychological trauma, psychotropic medication use and previous mental health diagnoses among adult asylum seekers in the Asylum Seekers Health and Wellbeing (TERTTU) Survey (n = 784 respondents, participation rate 78.6%). A substantial majority (88.7%, 95% CI 86.9–90.3) of asylum seekers reported one or more PTEs before arriving to Finland. PTEs during the asylum-seeking journey were reported at 12.0% (95% CI 10.7–13.4), however, when examined by region of origin, the proportion was 34.5% (95% CI 29.5–39.8) for asylum seekers from Africa (excluding North Africa). Significant symptoms of depression were reported by 41.7% (95% CI 39.6–43.9) of asylum seekers and symptoms of anxiety by 34.2% (95% CI 32.1–36.2). Half of the asylum seekers were assessed as having at least a medium-risk for psychological trauma. Prevalence rates were higher among females and asylum seekers from Africa. This study highlights the importance of using screening tools to identify asylum seekers with severe mental health problems that may need referral to further assessment and treatment. Asylum seekers from Africa (excluding North Africa) should be given additional attention in initial health screenings and examinations.

Factors associated with severity, incidence or persistence of internet gaming disorder in children and adolescents: a 2-year longitudinal study

AIM

This study examined factors associated with severity, incidence and/or persistence of internet gaming disorder (IGD) in children and adolescents.

DESIGN, SETTING, PARTICIPANTS

Prospective cohort study with 2-year follow-up study in South Korea. A total of 2319 3rd-, 4th- and 7th-graders enrolled into the internet user cohort for unbiased recognition of gaming disorder in early adolescence [intramural Continuing Umbrella of Research Experiences (iCURE)] and analyzed for the current study.

MEASUREMENTS

Severity of the IGD features was assessed by the Internet Game Use-Elicited Symptom Screen (IGUESS), a self-reported questionnaire based on the DSM-5 IGD criteria. Participants with IGUESS scores ≥ 10 were considered to be at high risk for IGD (HIGD). Time spent playing on-line games, game types, depressive symptoms, trait anxiety, attention deficit hyperactivity disorder (ADHD) symptoms, social support, openness of communication with parents, attachment to parents and potential confounders were assessed by self-report.

FINDINGS

A total of 175 (7.5%) students were classified as HIGD cases upon initial assessment. The independent risk factors of incidence of HIGD included playing on-line games for ≥ 240 minutes/day, playing multi-player games, depressive symptoms and ADHD symptoms [adjusted rate ratios (aRRs) = 2.03, 1.63, 2.04, 2.53, respectively; all P < 0.05]. Factors related to changing IGD severity scores were playing on-line games for 60-239 minutes/day, playing single-player on-line games, higher attachment and social support [adjusted incidence rate ratio (aIRRs) = 1.38, 1.22, 0.86, 0.87, respectively; all P < 0.05]. Independent predictors of persistence of HIGD were playing on-line games for ≥ 240 minutes/day and ADHD symptoms (aRRs = 2.63, 2.14, respectively; all P < 0.05).

CONCLUSIONS

Among adolescents in South Korea, the existence of ADHD symptoms and spending more than 4 hours per day playing on-line games were associated with the occurrence or persistence of high risk for internet gaming disorder.

Estimated Prevalence of Unreported IGD Cases in Routine Outpatient Children and Adolescent Psychotherapy

Internet Gaming Disorder (IGD) has been included in the DSM-5 as a diagnosis for further study, and Gaming Disorder as a new diagnosis in the ICD-11. Nonetheless, little is known about the clinical prevalence of IGD in children and adolescents. Additionally, it is unclear if patients with IGD are already identified in routine psychotherapy, using the ICD-10 diagnosis F 63.8 (recommended classification of IGD in ICD-10). This study investigated N = 358 children and adolescents (self and parental rating) of an outpatient psychotherapy centre in Germany using the Video Game Dependency Scale. According to self-report 4.0% of the 11- to 17-year-old patients met criteria for a tentative IGD diagnosis and 14.0% according to the parental report. Of the 5- to 10-year-old patients, 4.1% were diagnosed with tentative IGD according to parental report. Patients meeting IGD criteria were most frequently diagnosed with hyperkinetic disorders, followed by anxiety disorders, F 63.8, conduct disorders, mood disorders and obsessive-compulsive disorders (descending order) as primary clinical diagnoses. Consequently, this study indicates that a significant amount of the clinical population presents IGD. Meaning, appropriate diagnostics should be included in routine psychological diagnostics in order to avoid “hidden” cases of IGD in the future.

The relationship between mental well-being and dysregulated gaming: a specification curve analysis of core and peripheral criteria in five gaming disorder scales

Gaming disorder (also known as dysregulated gaming) has received significant research and policy attention based on concerns that certain patterns of play are associated with decreased mental well-being and/or functional impairment. In this study, we use specification curve analysis to examine analytical flexibility and the strength of the relationship between dysregulated gaming and well-being in the form of general mental health, depressive mood and life satisfaction. Dutch and Flemish gamers (n = 424) completed an online survey containing five unique dysregulated gaming measures (covering nine scale variants) and three well-being measures. We find a consistent negative relationship; across 972 justifiable regression models, the median standardized regression coefficient was -0.39 (min: -0.54, max: -0.19). Data show that the majority of dysregulated gaming operationalizations converge upon highly similar estimates of well-being. However, variance is introduced by the choice of well-being measure; results indicate that dysregulated gaming is more strongly associated with depressive mood than with life satisfaction. Weekly game time accounted for little to no unique variance in well-being in the sample. We argue that research on this topic should compare a broad range of psychosocial well-being outcomes and explore possible simplifications of the DSM-5 gaming disorder criteria. Given somewhat minute differences between dysregulated gaming scales when used in survey-based studies and largely equivalent relationships with mental health indicators, harmonization of measurement should be a priority.

Anxiety and stress in women with suspected endometrial cancer: Survey and paired observational study

OBJECTIVE

To determine the anxiety and stress levels of women with suspected endometrial cancer and factors affecting this.

METHODS

Prospective survey and paired observational study of consecutive women with suspected endometrial cancer in a rapid access gynaecology clinic. Structured questionnaire including a GAD-7 anxiety test and a modified stress thermometer were used. Patients ranked their perception of a cancer diagnosis on 0-5 Likert scale (0 = confident not cancer and 5 = cancer). Patients requiring an endometrial tissue biopsy were asked to rank their pain on a visual analogue scale (VAS), this was paired with the survey results.

RESULTS

250 patients completed the study and 23 of which underwent an endometrial tissue biopsy. The median age was 50-59 years old and 59% of women spoke English as their first language. 32% of patients had significant levels of anxiety with GAD-7 score ≥10. The median stress score was three out of five on Likert scale. GAD-7 anxiety scores were higher in women who perceived that they received insufficient information prior to clinic (sufficient information 5 vs. insufficient information 9.5, P = 0.00036) or had a disability (disability 9 vs. no disability 5.5, P = 0.00374). The median VAS score from the biopsies was seven out of 10 (range 1-10). Patients with higher anxiety levels (GAD-7 scores) were more likely to believe they had cancer P <0.00001.

CONCLUSIONS

These findings confirm high levels of anxiety and stress in women with suspected endometrial cancer. Adequate pre-clinic information is essential, particularly for minority groups.

Internet Usage Habits and Experienced Levels of Psychopathology: A Pilot Study on Association with Spontaneous Eye Blinking Rate

Increasing availability of the internet has resulted in the increased prevalence of problematic online behaviors. Reliable and affordable neurobiological and psychological biomarkers that distinguish problematic internet use (PIU) from functional online activities are of utmost importance. Previous studies have shown a relationship between spontaneous eye blinking rate (sEBR) and changes in dopamine regulation in neurological and psychiatric disorders, including substance use disorders. In this study, we utilized sEBR to examine the potential link between individual differences in dopaminergic neurotransmission and PIU. In sum, 62 subjects participated in this study (median age 25, IQR 6 years, 34 females). The Problematic Internet Use Questionnaire (PIUQ-9), Beck Depression Inventory (BDI-II), Beck Anxiety Inventory (BAI), Clark-Beck Obsessive-Compulsive Inventory (CBOCI) and Barratt Impulsiveness Scale (BIS-11) were used for psychological assessment. The sEBRs were assessed with an electrooculogram recorded from above and below the left eye and from the right and left outer canthi. The group with PIU (PIUQ-9 > 20) expressed higher levels of impulsivity and compulsive behavior symptoms than the control group. In the group with PIU, impulsivity levels were inversely related to sEBR, and a trend of negative association of sEBR with compulsive behavior was observed. Future research should enroll subjects with high levels of PIU and strongly expressed psychopathology levels to further address the utility of sEBR as a potential biomarker.

Assessing Problematic Social Media Use in Adolescents by Parental Ratings: Development and Validation of the Social Media Disorder Scale for Parents (SMDS-P)

Background: The problematic use of social media (SM) is a rising phenomenon, especially in adolescents. It can be assessed by self-rating screeners such as the Social Media Disorder Scale (SMDS). However, young age or symptom denial might reduce adolescent assessment accuracy. Therefore, the development and validation of a parental scale (SMDS-P) is desirable. Method: A representative sample of 961 parents and corresponding frequently SM-using children aged 10 to 17 years participated in an online study. Factorial analyses were performed to determine item structure. Adolescents’ SMDS self-reports, SM usage time, emotional dysregulation, and academic performance were used to assess validity. The SMDS-P cut-off value was calculated by ROC-analysis. Results: A one-factorial structure of the SMDS-P could be confirmed. The internal consistency was good (Cronbach’s α = 0.85, McDonald’s ω = 0.88) and the accordance between parental and self-ratings moderate (kappa = 0.51). SMDS-P was positively associated with adolescents’ self-ratings (r = 0.68), SM usage time (r = 0.26) and frequency (ϱ = 0.16) as well as with emotional dysregulation (r = 0.35) in a highly significant manner. Conclusions: SMDS-P offers a promising new approach to assess problematic SM usage in adolescence. Further studies including clinical validations are required.

Adolescent gaming and social media usage before and during the COVID-19 pandemic

Abstract. Background: The COVID-19 pandemic has raised concerns about a potential increase of addictive behaviors. Adolescents are considered particularly vulnerable to a problematic usage of digital applications. For the first systematic investigation of screen time and problematic usage patterns over the course of the pandemic, a pre-pandemic survey on adolescent social media (SM) and gaming use was extended to a longitudinal study. Here we present the results of the first two measurements points (pre-pandemic/under lockdown). Methods: A representative sample of 1,221 adolescents (10–17 years) participated in an online survey in 09/2019, 824 of them in 04/2020. Prevalence rates were measured at baseline with standardized scales covering ICD-11 criteria for problematic usage patterns. These were statistically compared and related to pre- and under-lockdown screen time. Results: Pre-pandemic prevalence rates for pathological SM/gaming were about 3 % each, for at-risk usage 8–10 % including more boys than girls. Usage frequencies and screen times significantly increased under the lockdown. The predictive value of usage patterns for screen time decreased from before to during the lockdown. Changes in screen time could not be predicted by the usage pattern. Discussion: The stability of the observed rates and effects should be further examined over the course of the pandemic. This will lead to relevant implications for prevention measures and the allocation of intervention resources.

Validity and Psychometric Properties of the Internet Gaming Disorder Scale in Three Large Independent Samples of Children and Adolescents

Background: Problematic gaming has become a major health issue in children and adolescents resulting in the need for targeted valid and reliable screening instruments. This study aimed to explore the psychometric properties and criterion validity of the widely used 9-item Internet Gaming Disorder Scale (IGDS) in young gamers. Methods: Three independent samples were drawn from socio-demographically representative cross-sectional telephone surveys collected in the years 2016 (N = 762), 2017 (N = 777), and 2018 (N = 784) and analyzed separately. Results: The IGDS revealed psychometric properties suitable for screening in large samples. Cronbach’s alpha was 0.563, 0.724, and 0.778. The unidimensionality assumption was challenged. At-risk and pathological gamers compared to normal gamers reported longer digital media use and more emotional symptoms and hyperactivity/inattention with clinical relevance to medium effect sizes. The comparison of at-risk and pathological gamers indicated a partial distinction between the two problematic gaming groups. Conclusions: The IGDS could be shown to be an overall suitable and valid tool to identify pathological gamers in childhood and adolescence according to the DSM-5 criteria on a population level. However, the polythetic structure limits comparability with the recent ICD-11 criteria. At-risk gamers appeared as a heterogeneous group warranting more research.

Assessing ICD-11 gaming disorder in adolescent gamers by parental ratings: Development and validation of the Gaming Disorder Scale for Parents (GADIS-P)

BACKGROUND AND AIMS

The addiction to digital games is associated with substantial impairments in daily functioning and adolescents are particularly at risk. Screening instruments for the new ICD-11 diagnosis Gaming Disorder (GD) are rare and only include self-ratings thus far. Since adolescents' insight might be limited due to young age or symptom denial, external ratings are essential. We therefore aimed to develop and validate the Gaming Disorder Scale for Parents (GADIS-P) in a representative sample of parents and young gamers.

METHODS

GADIS-P was developed as an adaptation of a recently published self-rating scale. It was validated in 800 parents and their frequently gaming children between 10 and 17 years with standardized questionnaires in an online survey. Item structure was investigated by confirmatory factorial analysis. Gaming time, pathological gaming according to DSM-5, emotional dysregulation, and academic performance were used to derive criterion validity. Accordance with self-ratings was determined. ROC-Analyses were computed to determine cut-off values.

RESULTS

A presumed two-factorial structure of GADIS-P could be confirmed describing cognitive-behavioral symptoms and negative consequences. The instrument showed good to excellent internal consistency (Cronbach's α = 0.89-0.92, McDonald's ω = 0.92-0.95) and criterion validity with moderate to strong correlations regarding gaming behavior (r/ϱ = 0.35-0.76), excellent discriminatory power, and moderate accordance with the adolescents' self-ratings (kappa = 0.47-0.58).

DISCUSSION AND CONCLUSIONS

As the first successfully validated tool for the assessment of ICD-11 GD in adolescents by parental judgment, GADIS-P can make an important contribution to reliable GD screening in clinical and research settings.

Development and validation of gaming disorder and hazardous gaming scale (GDHGS) based on the WHO framework (ICD-11 criteria) of disordered gaming

This study aimed to develop and validate a brief psychometric scale for gaming disorder and hazardous gaming based on the WHO framework as defined in the ICD-11. The study was carried out among college students using face to face interview. A panel of mental health experts examined the face validity of the new Gaming Disorder and Hazardous Gaming Scale (GDHGS). An Exploratory Factor Analysis (EFA) using the principle component analysis (PCA) method with direct oblimin rotation on the five items of GDHGS was used for assessment of construct validity. The results of Kaiser Meyer Olkin (KMO) measure used for sampling adequacy and Bartlett's test (BT) of sphericity used to show the appropriateness of using factor analysis, confirmed the appropriateness of EFA for the present study sample. The factor analysis extracted single component with an eigenvalue of greater than one, which was further supported by the examination of scree plot. To examine the criterion related validity of the GDHGS, correlation between GDHGS and IGDS-SF scores was assessed. Spearman correlational analysis showed strong positive correlation of GDGHS score with IGDS-SF score (rs = 0.878, p < 0.01). Further, the sum of first four item score of GDHGS among participants diagnosed with GD (median: 15.00; IQR: 15.00-15.75) was significantly greater than those without GD (median: 4.00; IQR: 3.00-6.50) according to the diagnostic interview based on the ICD-11 criteria (U = 0.000, p < 0.001). The internal consistency of GDHGS as measured by the Cronbach's alpha was 0.914. Further, the GDHGS did not have its reliability increased by removal of any of the five items included in the scale. Also, the threshold for significant floor and ceiling effect was not reached. In conclusion, GDHGS is a valid measurement scale for disorders involving gaming behaviour based on the ICD- 11 construct.

A pilot study using ecological momentary assessment via smartphone application to identify adolescent problematic internet use

For some youth, pathologic Internet use can cause significant distress and dysfunction, a phenomenon known as Problematic Internet Use (PIU). PIU has been associated with poorer health outcomes in adolescents with existing psychiatric illness but understanding PIU has been challenging due to research methodologies using cross-sectional, self-report data. This study assessed the feasibility of using app-based ecological momentary assessment (EMA) to provide more ecologically-valid data to identify and characterize the relationship between mood symptoms and PIU in adolescents in active mental health treatment. 25 youth (aged 12-23) were recruited to use an EMA app for 6 weeks. 96% of participants completed the study and the majority of participants completed surveys at least once weekly. Youth with anxiety disorders endorsed significantly greater benefit from using the app to monitor PIU. While PIU severity was positively correlated with worsened anxiety and depression, analyses of the temporal relationships between PIU and mood symptoms showed that anxiety symptoms were significantly improved after episodes of PIU. Overall results suggest that app-based EMA may be both acceptable and feasible to understand PIU in this population. Follow-up studies should consider personalization of study protocols and use of digital phenotyping methodology to collect more objective measurements of behavior.

Identifying individuals in need of help for their uncontrolled gaming: A narrative review of concerns and comments regarding gaming disorder diagnostic criteria

OBJECTIVE

In 2013, the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5) included the diagnostic criteria of Internet gaming disorder (IGD). Then, in 2019, the 11th Revision of the International Classification of Diseases (ICD-11) categorized gaming disorder (GD) as an addictive disorder. This review aimed to review the raised concerns, debate, and research of IGD or GD criteria and provide suggestions to resolve them.

METHODS

A narrative review was conducted, and PubMed was searched for articles mentioning concerns and research on the DSM-5 criteria for IGD, ICD-11 criteria for GD, or criteria for other synonyms, such as problematic gaming or gaming addiction. A total of 107 articles were identified.

RESULTS

Concerns were organized into three categories: conceptual framework, moral panic, and diagnostic validity. Most argumentations supported the proposition that GD and other substance use disorders have similar presentations. A clear definition of GD and adequate public education could prevent rather than exacerbate moral panic. Several researchers reported concerns regarding the nosology, diagnostic validity, and wording of each criterion. However, the threshold, five of the nine criteria with impaired function, demonstrated adequate validity in interview studies.

CONCLUSION

The current findings support the addiction framework, functional impairment, and validity of the GD criteria. However, further prospective, experimental, and clinical studies validating these findings are warranted. Moreover, an integrative review or debate conference could contribute to the organization of the available results and concept development. Aggregating adequate scientific information could allay or resolve concerns related to the diagnosis of GD.

Psychometric Properties of the Nine-Item Korean Internet Gaming Disorder Scale: Short Form

The main objective of this study was to examine the psychometric properties of the Korean version of the Internet Gaming Disorder Scale-Short Form (K-IGDS9-SF), a brief self-report instrument developed to assess Internet gaming disorder (IGD) in accordance with the Diagnostic and Statistical Manual of Mental Disorders-5th edition criteria. A total of 594 Korean game users (average age = 23.5 years, 70.37 percent male) participated and completed questionnaires containing the K-IGDS9-SF and other measures for its validation. The K-IGDS9-SF showed good reliability (Cronbach's α = 0.86, composite reliability coefficient = 0.87). Consistent with previous studies, the K-IGDS9-SF demonstrated a single-factor structure in a confirmatory factor analysis. Moreover, the K-IGDS9-SF had significant associations with related variables (IGD, game playing variables, self-esteem, impulsivity, and loneliness) in the expected direction, supporting its concurrent, criterion, and convergent validity. Taken together, these results indicated that the K-IGDS9-SF has satisfactory psychometric properties, suggesting its utility as a unified robust instrument for studying IGD worldwide.

College campuses and COVID-19 mitigation: clinical and economic value

BACKGROUND

Decisions around US college and university operations will affect millions of students and faculty amidst the COVID-19 pandemic. We examined the clinical and economic value of different COVID-19 mitigation strategies on college campuses.

METHODS

We used the Clinical and Economic Analysis of COVID-19 interventions (CEACOV) model, a dynamic microsimulation that tracks infections accrued by students and faculty, accounting for community transmissions. Outcomes include infections, $/infection-prevented, and $/quality-adjusted-life-year ($/QALY). Strategies included extensive social distancing (ESD), masks, and routine laboratory tests (RLT). We report results per 5,000 students (1,000 faculty) over one semester (105 days).

RESULTS

Mitigation strategies reduced COVID-19 cases among students (faculty) from 3,746 (164) with no mitigation to 493 (28) with ESD and masks, and further to 151 (25) adding RLTq3 among asymptomatic students and faculty. ESD with masks cost $168/infection-prevented ($49,200/QALY) compared to masks alone. Adding RLTq3 ($10/test) cost $8,300/infection-prevented ($2,804,600/QALY). If tests cost $1, RLTq3 led to a favorable cost of $275/infection-prevented ($52,200/QALY). No strategies without masks were cost-effective.

CONCLUSION

Extensive social distancing with mandatory mask-wearing could prevent 87% of COVID-19 cases on college campuses and be very cost-effective. Routine laboratory testing would prevent 96% of infections and require low cost tests to be economically attractive.