Problematic Internet Use and Associated High-Risk Behavior in an Adolescent Clinical Sample: Results from a Survey of Psychiatrically Hospitalized Youth

Associations between internet addiction and suicidal ideation in depressed adolescents: the mediating effect of insomnia as well as sex differences

BACKGROUND

Insomnia may mediate the association between internet addiction (IA) and suicidal ideation (SI). However, such association has not been thoroughly investigated in adolescents with major depressive disorder (MDD). Thus, our study aimed to explore whether insomnia significantly affects the association between IA and SI in adolescents with MDD, as well as any sex differences.

METHODS

From January 2021 to September 2023, this cross-sectional study included 502 adolescents with MDD and 123 healthy controls (HCs). The Clinical Global Impression-Severity (CGI-S), the Internet Addiction Test (IAT), the Insomnia Severity Index Scale (ISI) and the Positive and Negative Suicidal Ideation Scale (PANSI) were used to assess subjects' severity of depression, IA, insomnia and SI. And we employed the PROCESS macro program to examine the mediating role of insomnia between IA and SI.

RESULTS

Compared to HCs, adolescents with MDD had significantly higher levels of SI and their prevalence of IA and insomnia were 50.0% and 35.7%. In patients, PANSI scores correlated negatively with age and age of onset, and positively with disease duration as well as the scores of the CGI-S, IAT, and ISI (all p < 0.01). Moreover, above-mentioned correlations were more significant in girls. Mediation analyses showed that insomnia mediated the effect of IA on SI, and the total, direct, and indirect effects were 0.197 (95% CI: 0.132-0.262), 0.157 (95% CI: 0.096-0.218) and 0.040 (95% CI: 0.014-0.068), respectively. In female patients, the total, direct, and indirect effects were 0.224 (95% CI: 0.151-0.296), 0.191 (95% CI: 0.124-0.257) and 0.033 (95% CI: 0.002-0.068), respectively. In male patients, insomnia acted as a fully mediated effect between IA and SI, with an effect value of 0.045 (95% CI: 0.008-0.093).

CONCLUSION

Depressed adolescents have higher suicide risk, and SI is significantly associated with IA and insomnia, especially in girls. Moreover, insomnia may mediate the association between IA and SI. However, given the small sample size of this study and the limitations of assessment tools used, the results need to be viewed with caution. Regardless, clinical interventions should be strengthened for IA and insomnia in adolescents with MDD to reduce suicide risk.

Correlations between problematic internet use and suicidal behavior among Chinese adolescents: a systematic review and meta-analysis

Background

Problematic Internet Use (PIU) has been increasingly linked to suicidal behavior among adolescents, raising significant public health concerns, particularly in Chinese youth. This study aimed to systematically review and meta-analyze the correlation between PIU and suicidal behavior in Chinese adolescents to provide a clearer understanding of this association.

Methods

A comprehensive search was conducted across seven databases up to July 1, 2024. Studies investigating the relationship between PIU and suicidal behavior among Chinese adolescents were included. A random-effects meta-analysis was employed to assess pooled effect sizes, with subgroup analyses conducted to explore potential moderators, such as geographic region, age, gender, assessment tools for PIU and suicidal ideation, and the presence of depression. Data analysis was performed using STATA software (version 16).

Results

This meta-analysis, comprising 23 studies with 353,904 participants, identified significant associations between PIU and suicidal behavior among Chinese adolescents. PIU was associated with increased risks of suicidal ideation (OR = 1.72, 95% CI: 1.45, 2.03), suicidal plans (OR = 1.50, 95% CI: 1.02, 2.20), and suicidal attempts (OR = 1.48, 95% CI: 1.16, 1.89). Subgroup analyses indicated higher risks in specific groups: adolescents from Central China (OR = 1.84, 95% CI: 1.46, 2.32), college students (OR = 2.09, 95% CI: 1.66, 2.62). The risk of suicidal ideation was particularly elevated when depression was not controlled (OR = 1.86, 95% CI: 1.53, 2.25). These findings underscore the need for targeted interventions in vulnerable populations.

Conclusion

This meta-analysis demonstrated significant associations between PIU and suicidal behaviors among Chinese adolescents. The findings emphasize the need for targeted interventions, particularly for adolescents from Central and Western China, college students, and those with untreated depression. Focused strategies are required to mitigate the risks associated with PIU and to effectively address suicidal behaviors in these high-risk populations.

Systematic review registration

https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42024577593, identifier CRD42024577593.

A meta-review of screening and treatment of electronic "addictions"

Concerns surrounding electronic addictions, an umbrella term including any clinically significant technology-based addictive problem, have increased as technology has advanced. Although researchers and clinicians have observed detrimental effects associated with excessive technology use, there is no agreed-on definition or set of criteria for these problems. The lack of a consistent understanding of electronic addictions has led to a lack of consistency in both assessment and treatment studies, precluding strong recommendations for effective screening and clinical intervention. This meta-review integrates findings from 22 systematic reviews and meta-analyses of electronic addictions to determine which measures and interventions may effectively measure and treat electronic addictions. We conducted a meta-review using Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Findings suggest that although some measures may have good internal consistency and reliability among college students, there was a general lack of consistency in how measures were used across studies, making comparison difficult. Psychological and exercise-based interventions were shown to reduce symptoms of electronic addictions short-term, but no treatment was superior to others in overall symptom reduction. Most included reviews raise serious concerns about the lack of consensus on what constitutes an electronic addiction. Consequently, it was not possible to draw conclusions about the overall efficacy of any measurement tools or interventions. We provide suggestions for next steps to establish the phenomenology of electronic addictions before additional research on assessment and intervention is conducted.

Fun in a Box? Loneliness and Adolescents' Problematic Smartphone Use: A Moderated Mediation Analysis of the Underlying Mechanisms

Addictive smartphone use is one of the most concerning behaviors among adolescents. The present study investigated the indirect effects of self-esteem and boredom proneness and the moderating role of the need to belong on the link between loneliness and addictive smartphone use (ASU). Our sample included 357 adolescents aged 12 to 19 (Mage = 15.56, SD = 1.01, 57.42% males) from ten public schools in Romania. We used a moderated mediation approach, with moderation of the both second mediation paths and the direct effect path. Results suggested that the influence of loneliness on ASU was statistically significant and partially mediated both by self-esteem and boredom proneness. Adolescents' need to belong significantly moderated the positive association between boredom proneness and ASU, and the direct negative association between loneliness and ASU; however, it did not moderate the negative association between self-esteem and ASU. Thus, high levels of the need to belong also increased the influence of boredom proneness on AUS and had a marginally significant effect on the relation between loneliness and ASU. These results suggested that adolescents' need to belong, self-esteem, and boredom proneness might contribute to developing ASU. Interventions centered around countering the adverse effects of excessive technology use ought to consider group activities that facilitate social bonding to satisfy the participants' need to belong, reduce their levels of boredom, and, thus, reduce the risk of developing ASU symptoms.

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

BACKGROUND

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

METHODS

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

RESULTS

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

LIMITATIONS

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

CONCLUSIONS

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

Korean adolescent suicide and search volume for "self-injury" on internet search engines

Introduction

Many adolescents with suicidal ideation receive support through the Internet. However, they also find ways to attempt suicide or strengthen their suicidal ideation through this medium. This study analyzed the association between the search volume of suicide-related terms and the number of suicides among Korean adolescents. We also analyzed the correlations between the search volumes of suicide-related terms.

Methods

We selected seven words (suicide, self-injury, depression, academic score, school violence, outcasts, and family trouble) related to adolescent suicide. A dataset was constructed by combining data from the most commonly used search engine in Korea (Naver Datalab) and the daily number of adolescent suicides in school settings (n = 347) from January 1, 2016 to December 31, 2018, collected from the Ministry of Education. Poisson regression and Pearson correlation analyses were performed.

Results

Significant associations were found between suicide attempts and search term volumes, which differed according to sex and time interval. Among the search terms, "self-injury" was most strongly associated with suicide, and this association was significant at all time intervals (daily, weekly, and monthly) in female adolescents and in the total population. Further, the association was strongest in the daily suicide data. More search term volumes were related to suicide in the daily and weekly data than in the monthly data. There were positive correlations between "suicide," "self-injury," and "depression" search volumes.

Conclusion

Further studies with larger sample sizes, more search terms, and analysis of time intervals between suicide-related term search and suicide death are required. These studies can contribute to the establishment of an online suicide prevention system to detect suicide risk in adolescents and provide interventions.

Problematic Smartphone Use Mediates the Pathway from Suicidal Ideation to Positive Psychotic Experiences: a Large Cross-Sectional, Population-Based Study

The present study followed the newly hypothesized "suicidal drive for psychosis" suggesting that psychosis may be consequential to suicidal ideation (SI) and behavior and attempted to explain parts of the pathway between these variables. To this end, we aimed to test whether problematic smartphone use (PSU) has an indirect mediating effect in the cross-sectional relationship between SI and positive psychotic experiences (PEs). Lebanese community young adults (N=4158; 64.4% females; mean age 21.91±3.79) have been invited to participate to a cross-sectional, web-based study in the period from June to September 2022. After adjusting for potential confounders (i.e., the living situation, marital status, household crowding index, economic pressure, cannabis use, other drugs use, and past history of mental illness other than psychosis), we found that higher levels of suicidal ideation was significantly associated with greater PSU, which was also positively and significantly associated with more positive PEs. Finally, greater suicidal ideation was significantly and directly associated with more positive PEs. Our findings suggest that SPU may be regarded as a potential target for prevention and intervention in psychosis. Clinicians, educators, and school administrators ought to give greater attention to PSU among vulnerable young people who present with SI.

Review: Digital experiences and their impact on the lives of adolescents with pre-existing anxiety, depression, eating and nonsuicidal self-injury conditions - a systematic review

BACKGROUND

Published systematic reviews provide evidence linking positive and negative digital experiences to adolescent mental health. However, these reviews focus on the general public rather than the digital experiences of adolescents with different pre-existing mental health conditions and so may be limited in their clinical relevance. We review publications relating to anxiety, depression, eating disorders and nonsuicidal self-injury to identify common and condition-specific digital experiences and how these may be implicated in the origins and maintenance of these mental health conditions.

METHODS

A systematic literature search using a combination of mental health, digital experience (including social media use), and age of the target population terms was conducted on four databases. Detailed findings from the included studies were summarised using a combination of thematic and narrative methods.

RESULTS

Five qualitative and 21 quantitative studies met the eligibility criteria for inclusion (n = 5021). Nine studies included adolescents with depression, one with eating problems, two with nonsuicidal self-injury and 14 with multiple emotional health conditions. The review identified six themes related to the target populations' digital experiences: (a) social connectivity and peer support; (b) escape and/or distraction; (c) social validation and social comparison; (d) accessing/creation of potentially harmful content; (e) cyberbullying; and (f) difficulties with self-regulation during engagement with digital media.

CONCLUSIONS

Digital practices of adolescents with pre-existing clinical vulnerabilities are complex and encompass a range of positive and negative experiences, which appear to have common elements across different clinical populations. The literature is currently too limited to identify disorder-specific practices, with too few direct or indirect comparisons between conditions.

Mental Health Among Sexual and Gender Minority Youth Incarcerated in Juvenile Corrections

OBJECTIVES

This study examined differences by sexual and gender minority (SGM) and incarceration statuses in mental health indicators among youth.

METHODS

Population-based, cross-sectional data are from the 2019 Minnesota Student Survey (N = 72 324) and includes public school students (Mage = 15.49) and youth incarcerated in juvenile correctional facilities (Mage = 15.48). We categorized youth into 4 groups: (1) non-SGM youth in public schools, (2) non-SGM youth in correctional facilities, (3) SGM youth in public schools, and (4) SGM youth in correctional facilities. Multivariable regression models assessed associations among SGM and incarceration statuses and mental health indicators after controlling for sociodemographic characteristics and exposure to adverse childhood experiences.

RESULTS

More youth in juvenile correctional facilities identified as SGM (28.8%) compared with youth in public schools (20.4%, P = .002). SGM youth in correctional facilities reported a higher prevalence of suicidal ideation (42.2%), suicide attempt (37.5%), and self-harm (57.8%) compared with all other groups. Depressive symptom severity was similarly elevated among SGM youth in correctional facilities and SGM youth in public schools. SGM youth in correctional facilities, compared with non-SGM youth in public schools, demonstrated elevated odds of suicide ideation (adjusted odds ratio [aOR] = 2.2, 95% confidence interval [95% CI] = 1.3-3.9), suicide attempt (aOR = 6.3, 95% CI = 3.6-10.9), and self-harm (aOR = 3.6, 95% CI = 2.1-6.3).

CONCLUSIONS

Incarcerated SGM youth disproportionately experience negative mental health indicators. Findings suggest that tailored, intersectional, and responsive mental health interventions are needed to support incarcerated SGM youth.

Association of Cyberbullying and Internet Use Disorder

Purpose of Review

The purpose of this review is to critically assess the published studies on the relationship between cyberbullying and internet use disorder (IUD), and propose directions for further study.

Recent Findings

There were only four prospective studies out of thirty-two reviewed studies conducted since 2004, with only one prospective study conducted during the past 5 years. The field of study has been stagnant during the past 5 years with the vast majority of studies conducted on primary or secondary education and failing to address cyberbullying and IUD in social media and online gaming.

Summary

Cyberbullying and IUD have been described since the nineties, yet there are still significant issues with their definition and research. Lately, both these problematic behaviors are sharing the same environments in social media and online gaming. This critical appraisal of published research examined thirty-two published peer-reviewed studies carried out since 2004. Findings indicate a number of significant issues including an overreliance on cross-sectional study design, near-exclusive focus on primary and secondary education students, widespread employment of unstandardized measures for cyberbullying and IUD, and lack of assessment for objective measures of psychological distress. Directions for future research are offered.

Assessing the Association Between Internet Addiction Disorder and Health Risk Behaviors Among Adolescents and Young Adults: A Systematic Review and Meta-Analysis

Background

Internet addiction disorder (IAD) is a global issue that has resulted in a slew of physical and emotional consequences. Studies have indicated that health risk behaviors might be the risk factors for IAD. The published literature on the correlation between the two is lacking. Therefore, we conducted a comprehensive analysis to understand better the link between IAD and health risk behaviors among adolescents and young adults.

Methods

We searched ten electronic databases for relevant articles. Data were extracted based on IAD and health risk behaviors ( alcohol, smoking, suicidal, gambling and drug abuse). We calculated odds ratios (ORs), a pooled correlation coefficient (r) and 95% confidence intervals (CIs). A fixed-effect model was applied to summarize the pooled effects. Heterogeneity was examined using I2 statistics and Cochran's Q statistics. All analyses were conducted by using Stata version 15.0.

Results

A total of 16 studies and 61,823 participants were included in this study. Meta-analysis showed that IAD was positively correlated with drinking (r = 0.35; 95% CI 0.32–0.37) and smoking (r = 0.12; 95%CI 0.10–0.15), and was associated with an increased risk of suicidal behavior (OR= 1.95; 95% CI 1.65–2.30), drinking (OR= 1.75; 95% CI 1.65–1.85), and smoking (OR= 1.63; 95% CI 1.54–1.72) among adolescents.

Conclusion

We found significantly increased risks of suicidal behavior, drinking, and smoking in adolescents and young adults with IAD. These findings are important to expand our understanding of IAD and have great guiding significance for preventing health risk behaviors of adolescents and young adults.

Systematic Review Registration

https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42021257729, identifier: PROSPERO CRD42021257729.

Are Youth Sexting Rates Still on the Rise? A Meta-analytic Update

A meta-analysis of 39 studies (110,380 participants) from 2009 to 2015 indicated that youth sexting increased over time. To inform current practice and policy initiatives, this meta-analytic update of studies since 2016 examined if rates of youth sexting have continued to rise and whether youth sexting differs by age, sex, sexting methods, and geographical location. Electronic searches were conducted in March 2020 in Embase, PsycINFO, MEDLINE, and Web of Science, yielding 1,101 nonduplicate records. Studies were included if they provided prevalence of youth sexting and data collection occurred ≥2016. Literature review and data extraction were conducted by following established PRISMA guidelines. All relevant data were extracted by two independent reviewers. To calculate mean prevalence rates, random-effects meta-analyses were conducted. Twenty-eight studies (N = 48,024) met inclusion criteria. The estimated pooled prevalence rates were as follows: (1) sending (19.3%), (2) receiving (34.8%), and (3) forwarding sexts without consent (14.5%). These prevalence rates are statistically similar to studies with data collected before 2016. In recent studies, females receive sexts at a higher rate than males, older youth are more likely to send sexts, and younger and older adolescents receive sexts at similar rates. Youth sexting rates have likely plateaued. Sexting education initiatives should begin early and encourage safe, ethical, and respectful online behavior.

Problematic Internet Use Before and During the COVID-19 Pandemic in Youth in Outpatient Mental Health Treatment: App-Based Ecological Momentary Assessment Study

BACKGROUND

Youth with existing psychiatric illness are more apt to use the internet as a coping skill. Because many "in-person" coping skills were not easily accessible during the COVID-19 pandemic, youth in outpatient mental health treatment may have been particularly vulnerable to the development of problematic internet use (PIU). The identification of a pandemic-associated worsening of PIU in this population is critical in order to guide clinical care; if these youth have become dependent upon the internet to regulate their negative emotions, PIU must be addressed as part of mental health treatment. However, many existing studies of youth digital media use in the pandemic do not include youth in psychiatric treatment or are reliant upon cross-sectional methodology and self-report measures of digital media use.

OBJECTIVE

This is a retrospective cohort study that used data collected from an app-based ecological momentary assessment protocol to examine potential pandemic-associated changes in digital media youth in outpatient mental health treatment. Secondary analyses assessed for differences in digital media use dependent upon personal and familial COVID-19 exposure and familial hospitalization, as well as factors associated with PIU in this population.

METHODS

The participants were aged 12-23 years and were receiving mental health treatment in an outpatient community hospital setting. All participants completed a 6-week daily ecological momentary assessment protocol on their personal smartphones. Questions were asked about depression (PHQ-8 [8-item Patient Health Questionnaire]), anxiety (GAD-7 [7-item General Anxiety Disorder]), PIU (PIU-SF-6 [Problematic Internet Use Short Form 6]), digital media use based on Apple's daily screen time reports, and personal and familial COVID-19 exposure. The analyses compared screen time, psychiatric symptoms, and PIU between cohorts, as well as between youth with personal or familial COVID-19 exposures and those without. The analyses also assessed for demographic and psychiatric factors associated with clinically significant PIU-SF-6 scores.

RESULTS

A total of 69 participants completed the study. The participants recruited during the pandemic were significantly more likely to meet the criteria for PIU based on their average PIU-SF-6 score (P=.02) and to spend more time using social media each day (P=.049). The overall amount of daily screen time did not differ between cohorts. Secondary analyses revealed a significant increase in average daily screen time among subjects who were exposed to COVID-19 (P=.01). Youth with clinically significant PIU-SF-6 scores were younger and more likely to have higher PHQ-8 (P=.003) and GAD-7 (P=.003) scores. No differences in scale scores or media use were found between subjects based on familial COVID-19 exposure or hospitalization.

CONCLUSIONS

Our findings support our hypothesis that PIU may have worsened for youth in mental health treatment during the pandemic, particularly the problematic use of social media. Mental health clinicians should incorporate screening for PIU into routine clinical care in order to prevent potential familial conflict and subsequent psychiatric crises that might stem from unrecognized PIU.

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.

An exploratory study of clinical and physiological correlates of problematic social media use in adolescents

Prior validation studies of the Bergen Social Media Addiction Scale (BSMAS) demonstrate its utility for identifying problematic social media use in adolescents. There are knowledge gaps regarding the potential clinical and physiological underpinnings of problematic social media use in adolescents. This cross-sectional, single-visit study examined a sample of depressed (n = 30) and healthy (n = 30) adolescents who underwent clinical assessments of depressive symptom severity, bullying, cyberbullying, self-esteem, salivary measures of stress (cortisol and α-amylase) to identify correlates with adolescent and parental reports of the BSMAS. LASSO-penalized multiple linear regression models were implemented. With respect to the adolescent BSMAS scores in all subjects, the risk of problematic social media increased as depressive symptom severity increased. Depressed female adolescents appeared to have a greater risk. Based on parental BSMAS scores, depression status, depressive symptom severity, cyberbullying score, and salivary cortisol significantly predicted problematic social media use. For the depressed sample, the risk of problematic social media use increased as salivary cortisol increased. No significant predictors of problematic social media usage emerged in the healthy control sample. These preliminary results provide novel insights into clinical and physiological characteristics of problematic social media use in adolescents.

Impulsivity Mediates Associations Between Problematic Internet Use, Anxiety, and Depressive Symptoms in Students: A Cross-Sectional COVID-19 Study

Background: Problematic internet use (PIU) is a serious global mental health issue that especially manifested during the Coronavirus disease (COVID-19) pandemic. Engagement in PIU as an impulsive coping with mental distress may pose a long-lasting threat to develop anxiety and depressive disorders. The first aim of our study was to investigate the prevalence of PIU and mental distress symptoms during the COVID-19 pandemic among university students in Lithuania. The second aim was to test the hypothesis that PIU affects anxiety and depressive symptoms through the mediating role of impulsivity. Methods: The cross-sectional study was comprised of 619 university students (92.9% females and 7.1% males) with a mean age of 22 ± 3 years who participated in an online survey from May to November, 2020. Participants completed the following scales: the Problematic Internet Use Questionnaire-9, the Generalized Anxiety Disorder Questionnaire-7, the Patient Health Questionnaire-9, and the Barratt Impulsiveness Scale-11. K-means cluster analysis and one-way multivariate analysis of variance were used for group comparison in terms of internet use time and habit change during COVID-19 pandemic. Structural equation modeling was applied to examine the mediating effect of impulsivity in association between PIU and mental distress, while controlling for age. Results: In sum, 45.1% of the participants reported PIU and 38.1% had markedly expressed symptoms of anxiety while 43.6% of the students reported moderate to severe depressive symptoms. During the COVID-19 pandemic 76% of the students reported at least moderate increase in their internet use time. Anxiety and depressive symptoms were significantly higher in the group of frequent internet users. The results of the structural equational modeling analysis showed a statistically significant effect of PIU on subjective anxiety symptoms and the statistically significant effect of PIU on subjective depression symptoms, both mediated via impulsivity. Conclusions: During COVID-19 pandemic, PIU, anxiety and depression symptoms are highly prevalent among students. Findings also suggest that relationships between PIU, anxiety and depressive symptoms are mediated via impulsivity. These results underscore the importance of the inclusion of impulsivity factor in the studies analyzing longitudinal effects of PIU on mental distress during COVID-19 pandemic.

How has Internet Addiction been Tracked Over the Last Decade? A Literature Review and 3C Paradigm for Future Research

Background:

The popularity of the internet aggravated by its excessive and uncontrolled use has resulted in psychological impairment or addiction. Internet addiction is hypothesized as an impulse-control disorder of internet use having detrimental impacts on daily life functions, family relationships, and emotional stability. The goal of this review is to provide an exhaustive overview of the empirical evidence on internet addiction and draw attention to future research themes.

Methods:

We performed a literature search on ScienceDirect and PubMed to review original research articles with empirical evidence published on peer-reviewed international journals from 2010 to 2019. Eight hundred and 26 articles were eligible for analysis. Frequency and descriptive statistics were calculated by Microsoft Excel.

Results:

A substantial contribution has been coming from researchers from China, Turkey, Korea, Germany, and Taiwan respectively. Despite controversies regarding its definition and diagnostic procedures, internet addiction has become the focal point of a myriad of studies that investigated this particular phenomenon from different exposures. Given observed literature review data regarding research design, data acquisition, and data analysis strategies, we proposed the 3C paradigm which emphasizes the necessity of research incorporating cross-disciplinary investigation conducted on cross-cultural settings with conscientious cross-validation considerations to gain a better comprehension of internet addiction.

Conclusions:

The findings of the present literature review will serve both academics and practitioners to develop new solutions for better characterize internet addiction.

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.

The relationship between maladaptive personality functioning and problematic technology use in adolescence: A cluster analysis approach

In the last two decades, scientific research has explored the problematic use of internet, videogames and mobile phones. However, there is still little consistent knowledge regarding the co-occurrence of problematic technology use and the role of maladaptive personality characteristics in adolescence. The present study aimed to investigate adolescents' styles of technology use with a cluster analysis approach focusing on personality functioning. The sample comprised 408 Italian adolescents (46.3% males) aged 11 to 18 years (M _age  = 13.80; SD = 2.08). Data were collected using the Internet Addiction Test, the Videogame Dependency Scale, the Test of Mobile-Phone Dependence Brief Form and the Personality Inventory for DSM5 Brief Form. Results provided a four-cluster solution based on the co-occurrence of problematic technology use. The four clusters were labeled as follows: cluster 1: "Above average internet and mobile-phone use"; cluster 2: "Below average technology use"; cluster 3: "Above average videogame use"; and cluster 4: "Problematic technology use." Analyses on demographic variables (e.g., gender and age) demonstrated significant differences between the four groups. Adolescents with high levels of problematic technology use reported greater overall personality dysfunction than the other three groups. This finding supported our hypothesis on maladaptive personality functioning in adolescents at risk for addiction. Finally, the Antagonism domain played a specific role in differentiating the severity of adolescents' involvement in technology use. Further studies are needed to confirm our findings and to plan preventive interventions as well as therapeutic treatments.

Problematic Internet Use among Youths

Problematic Internet Use (PIU) has of late come to the major attention of researchers of risky behaviours. For parents and teachers in turn, the various pathological forms of Internet use have become more and more noticeable. In recent years, the operationalisation of the term PIU has also been discussed and attempts to measure its various phenomena have been made. In our study, we used the quantitative method—a diagnostic survey designed on the basis of a tool of the Supreme Audit Office and Scientific and Academic Computer Network (Naukowa i Akademicka Sieć Kompureowa NASK), The survey was conducted in the first half of 2017 in Poland, among 3569 adolescents (median 16, SD = 1.28). The purpose of the research was to investigate the scale of PIU among Polish youths. For most young people, PIU is a major social problem. The majority also declare that more than half of their friends have problems with using electronic media (smartphones and the Internet in particular). On the basis of the data collected, it is estimated that 60% of adolescents use media in a functional way, whereas 40% of young electronic media users show visible PIU symptoms, of which 5% do so at a destructive level (all symptoms). Gender does not co-occur with PIU; however, family structure (where both parents are present), the setting of rules for the use of electronic media, and the place of residence are all protective factors. There is a need for constantly improved tools for measuring PIU, as well as preventive programs focused on developing self-control and helping young people understand their own emotions.

Risky cyber behaviors in adolescents with depression: A case control study

OBJECTIVE

This study aimed to compare adolescents diagnosed with major depressive disorder (MDD) and healthy adolescents with regard to cyberbullying, cyber victimization, internet addiction, and digital game addiction.

MATERIALS AND METHODS

This cross-sectional study was performed in Selçuk University Hospital. The study sample consisted of 34 adolescents with MDD and 39 controls without any psychopathology. A socio-demographic data form, the Cyber bullying Scale (CBS), Cyber Victimization Scale (CVS), Cyber bullying Sensibility Scale (CBSS), Internet Addiction Scale (IAS), Digital Game Dependence Scale (DGA-7), and Children's Anxiety and Depression Scale-Refurbished (RCADS) were administered to all participants.

RESULTS

CBS, CVS, IAS and DGAS-7 scores of the MDD group were significantly higher than those of the control group. The significant differences persisted even after controlling for confounding factors such as age, gender, socio-economic level, and parental educational levels with MANCOVA. A strong positive correlation existed between CBS and CVS scores, and higher IAS scores were associated with higher CBS scores in the MDD group. CBSS scores negatively correlated with DGAS-7 scores in the MDD group.

LIMITATIONS

Due to the cross-sectional design of this study, conclusions about causality remain speculative.

CONCLUSION

This study demonstrated the importance of assessing problems related to the online environment in the presence of depression in adolescents. Our results suggested that evaluating the use of technology with a view to the potential for cyber bullying and cyber victimization as well as internet addiction and addiction to digital games may be necessary as a holistic approach in the follow-up of adolescent depression.