Pathological Internet Use-An Important Comorbidity in Child and Adolescent Psychiatry: Prevalence and Correlation Patterns in a Naturalistic Sample of Adolescent Inpatients

Risk-taking and self-harm behaviors as markers of adolescent borderline personality disorder

Adolescence is a critical period for early identification and intervention of borderline personality disorder (BPD). Risk-taking and self-harm behaviors (RSB) have been identified as promising early markers of BPD and correlates of depression in school-based samples. The present study aimed, first, to examine the association between RSB and BPD in a clinical sample of adolescents and, second, to examine whether RSB are also linked to depression. N = 405 participants (82.7% female) were recruited from an outpatient clinic for adolescents with RSB. RSB assessed included truancy, excessive media use, alcohol, tobacco, and illicit drug use, sexual risk-taking, and self-harm behavior. Regression analyses and generalized linear models were performed to examine the associations between individual RSB or patterns of RSB (identified using latent class analysis, LCA) and a diagnosis and severity of BPD or depression. All RSB (except excessive media use) were positively associated with BPD diagnosis and severity. In contrast, only non-suicidal self-injury (NSSI) and suicide attempts were positively associated with depression diagnosis and severity, while illicit drug use was negatively associated with depression severity. The LCA yielded two classes differing in the occurrence of RSB. The high RSB class was more likely to have a BPD diagnosis and greater BPD severity than the low RSB class. Classes did not differ regarding depression diagnosis or severity. As NSSI and suicide attempts were associated with both BPD and depression, the presence of additional RSB, besides self-harm behavior, may represent a specific risk marker for BPD in adolescents.

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

Background

Non-Suicidal Self-Injury (NSSI) has continued to be a major issue for public health worldwide, especially among teenagers. Studies have found a certain correlation between NSSI and Problematic Internet Use (PIU). However, this relationship is still unclear among Chinese adolescents, a specific population. Hence, a meta-analysis was carried out on observational studies to explore the connection between NSSI and PIU in Chinese teenagers, aiming to provide more clarity on the correlation.

Methods

To identify the link between NSSI and PIU, we scoured seven digital repositories until November 16, 2023. Employing a random-effects meta-analysis framework, we delved into the association between NSSI and PIU. Additionally, we carried out subgroup evaluations to scrutinize variables including geographical location, age demographics, research methodology, diagnostic instruments, gender, and variables controlled for confounding, like symptoms of depression. For amalgamating data, STATA software (version 16) was deployed.

Results

In this analysis, we included 15 research papers encompassing a collective sample of 137,166 individuals. Our findings revealed a significant positive association between NSSI and PIU within the adolescent population in China, with an Odds Ratio (OR) of 2.02 and a 95% Confidence Interval (CI) ranging from 1.73 to 2.37. Notably, this correlation was markedly stronger in specific subgroups: adolescents from China's Western regions exhibited an OR of 4.22 (95% CI: 3.44, 5.18); middle school attendees had an OR of 2.09 (95% CI: 1.92, 2.28); those diagnosed with concurrent depression disorders showed an OR of 2.32 (95% CI: 1.98, 2.73); and female adolescents demonstrated an OR of 2.49 (95% CI: 2.26, 2.75), highlighting the nuanced dynamics of this relationship.

Conclusion

This meta-analysis indicates that PIU among adolescents is associated with an increased risk of NSSI. Our findings underscore the importance of targeting specific populations, including those in the western region of China, middle school students, adolescents with comorbid depression disorders, and female adolescents, who may be at higher risk of PIU and subsequently NSSI. These results emphasize the need for tailored interventions and preventive strategies to address these intertwined issues effectively.

Systematic review registration

PROSPERO, identifier CRD42024496579.

Problematic Internet Use Among Adolescent Male and Female Psychiatric Inpatients: A Gender Perspective

Problematic internet use (PIU) is of treatment interest in adolescent clinical samples. Gender specific differences in terms of personality traits and psychopathological symptoms remain unclear. In an adolescent clinical sample (n = 104; 69 girls) PIU, psychopathology, temperament and character traits as well as emotional and behavioral problems were assessed. 62% of the sample showed subthreshold PIU and 34% full PIU (fPIU). Boys reported more gaming whereas girls social networking. Sex specific analyses revealed gender differences: Girls with fPIU scored significantly higher on internalizing/externalizing problems/behavior, novelty seeking and transcendence, and lower on persistence, self-directedness, and cooperativeness than girls without fPIU. Boys with fPIU scored significantly higher on internalizing problems and self-transcendence and lower on harm avoidance than boys without fPIU. Gender plays an important role in PIU. Gender specific differences in both application use as well as symptomatic, temperament and character traits call for a gender specific approach in prevention and treatment integration.

Glow up: does a professional photoshoot intervention affect self-esteem and emotions among adolescent psychiatric patients?-A longitudinal intervention study

Background

Today, online communication is shaped by a billion-dollar social media (SM) and social networking site (SNS) industry. Visual content consumed by children and adolescents has been shown to influence behavioral patterns, state emotions, and self-esteem (SE). In this study, we introduced a novel intervention creating visual content through a professional photoshoot and investigated its impact on state emotions and SE in child and adolescent psychiatric (CAP) patients.

Methods

Standardized and validated self-rating questionnaires were used to assess SE, state emotions, coping mechanisms, psychopathological symptoms, and internet use behavior at baseline. SE and state emotions were monitored at different time points around a professional photoshoot within 45 CAP patients (30 female patients; mean age, 15.1 years) using a longitudinal design.

Results

Within-subject repeated-measures ANOVA and bootstrapped paired-sample t-tests showed a significant fluctuation in state emotions and SE throughout the intervention. Spearman correlations and univariate logistic regressions revealed that internalizing symptomatology and maladaptive coping significantly worsened the outcome of the intervention on state emotions and SE in girls. Internet-related variables heightened the positive effect of the intervention in boys and lowered SE in girls during the intervention.

Conclusion

The photo intervention had various gender-specific effects. Boys did benefit from the intervention in terms of longitudinal outcome on positive state emotions (PE) and SE, even positively influenced by SNS and SM. Thus, it might be concluded that online social comparison was processed more beneficial in boys. In contrast, when working with visual content in girls, psychopathology and coping must be considered. Internet consumption in general, especially SM and SNS, was related to low SE in girls. Nevertheless, when therapeutically accompanied, the "glow up moment" during the shoot (high on PE and SE; low on negative state emotions) could be used as an index moment for therapeutic reflection.

Compulsive digital use among school-age children and association with escapism and feeling of loneliness: A call for action

PURPOSE

This study aimed to investigate the relationship between Compulsive Digital Use (CDU), escapism, and loneliness among school-age children.

DESIGN AND METHODS

A quantitative, non-experimental, descriptive correlational study was conducted at 16 governmental preparatory schools affiliated with the Ministry of Education in Alexandria, Egypt. A simple random sampling of 300 school-age children participated in the study after obtaining the informed consent from the parents/guardians and assent from children.

RESULTS

The main study findings showed that 74% of school-age children had a subthreshold level of CDU, and 21.7% demonstrated a pathological/ addictive level. Compulsive digital use showed a significant positive correlation with both total escapism and loneliness scores (r = 0.689, p < 0.001 and r = 0.329, p = 0.005, respectively).

CONCLUSION

Children spend more than the recommended daily duration online. They reported having sleeping problems, especially insomnia, and poor academic achievement due to internet overuse. Most children had subthreshold level of CDU and one-quarter of them reached the addictive level. They reported that internet use helped them escape from the world of reality, unpleasant and worrisome things, as well as problems and pressures. Children reported loneliness and felt that people were around but not with them. Female gender and the employment of both parents were significantly associated with developing CDU. Escapism and loneliness among children were positively correlated with CDU.

PRACTICAL IMPLICATIONS

Awareness-raising campaigns regarding internet usage should be launched for school-age children and their parents to address its emerging psychosocial risks and challenges.

Emotional face expression recognition in problematic Internet use and excessive smartphone use: task-based fMRI study

Growing literature indicates that problematic Internet use (PIU) and excessive smartphone use (ESU) are associated with breakdown of functional brain networks. The effects of PIU&ESU on emotional face expression (EFE) recognition are not well understood, however behavioural investigations and fMRI studies of different addiction forms indicated the impairment of this function. The Facial Emotion Recognition Paradigm was used to probe cortico-limbic responses during EFE recognition. Combined fMRI and psychophysiological analysis were implemented to measure EFE-related functional brain changes in PIU&ESU. Self-reported questionnaires were used to assess PIU&ESU. Positive associations were found between the extent of PIU&ESU and functional connections related to emotional cognitive control and social brain networks. Our findings highlight the involvement of social functioning, especially EFE recognition in PIU&ESU. Therefore, we emphasize that besides the brain's executive and reward systems, the social brain network might be the next candidate to be involved in the pathogenesis of PIU&ESU.

Unpacking the relation between children's use of digital technologies and children's well-being: A scoping review

Over the last decade, a substantial number of studies have addressed children's use of technologies and their impact on well-being. Nonetheless, there is still a lack of clarity on the operationalisation of technology use, well-being, and the relation between the two. This scoping review intended to shed lights on Digital Technologies Use, its operationalisation, and the relation between Digital Technologies Negative Use (DTNU) and children's well-being. For the scope of the special issue we focused on negative use. Results showed two conceptualisations of DTNU: compulsive/addictive use of devices and the Internet (e.g., Internet addiction) and negative online experiences/risky behaviours (e.g., cyberbullying). Well-being in relation to DTNU was mainly studied in terms of psycho/social dimensions (e.g., depression), and a gap in cognitive well-being studies was identified. Study designs were largely quantitative, and, in most studies, well-being was considered as a predictor of DTNU. Also, research with children under 12 years was lacking. Future research on DTNU should look at: how dimensions of addiction and negative online experiences relate; provide more evidence on cognitive well-being; explore the interplay of well-being multiple components relying on integrative conceptual frameworks. The recent notion of digital well-being should also be explored considering the results of this review.

Gender-Specific Significance of Peer Abuse during Childhood and Adolescence on Physical and Mental Health in Adulthood-Results from a Cross-Sectional Study in a Sample of Hospital Patients

Peer abuse (PA) is a widespread and gender-sensitive form of Adverse Childhood Experiences (ACEs). However, research on its influence on physical and mental health in adulthood remains scarce. The aim of this study was to investigate gender-specific associations between PA and physical and mental health in adulthood in a sample of general hospital patients. A cross-sectional study at the University Hospital of Innsbruck was conducted. Data on ACEs, physical and mental health were collected using self-report questionnaires. We compared patients with no ACEs, PA only, ACEs without PA, and ACEs with PA using gender-specific binary logistic regressions to investigate the association of PA with physical and mental health. A total of 2,392 patients were included in the analyses. Women reported more emotional PA (13.1% vs. 9.4%; p = 0.006), while men reported more physical PA (8.3% vs. 5.2%; p = 0.003). PA was associated with a higher likelihood for depression (OR = 2.6), somatization (OR = 2.1), as well as worse physical health (OR = 2.1) in women but not in men. This study is the first to present data on the gender-specific detrimental effect of PA on physical and mental health in adulthood. Especially for women, PA poses a significant health risk. Thus, we should be aware of these effects and offer adequate support for affected individuals.

The prevalence of internet addiction and its association with quality of life among clinically stable patients with major depressive disorder

BACKGROUND

Internet addiction (IA) is associated with mental health problems but its impact on quality of life (QOL) is understudied. We examined the prevalence of IA and its association with QOL in clinically stable patients with major depressive disorder (MDD).

METHODS

In a cross-sectional survey between September 2020 and July 2021, the Young's Internet Addiction Test (IAT), the Patient Health Questionnaire-2 (PHQ-2) and the World Health Organization Quality of Life Brief version scale (WHOQOL-BREF) were administered to 1267 patients with MDD. Logistic regression was used to examine the correlates of IA, while analysis of covariance (ANCOVA) was used to examine the association between IA and QOL."

RESULTS

The prevalence of IA (IAT total scores ≥50) was 27.2 % (95 % CI: 24.7 %-29.6 %) in MDD patients. Compared to patients without IA, those with IA had lower QOL (F_{(1, 1267)} = 19.1, P < 0.001). Logistic regression revealed that higher education (senior high school and above; OR = 1.85, 95 % CI: 1.13-3.03), family history of psychiatric disorders (OR = 1.72, 95 % CI: 1.08-2.73), and higher PHQ-2 total score (OR = 1.23, 95 % CI: 1.14-1.32) were positively associated with IA while older age (OR = 0.93, 95 % CI: 0.91-0.96) was inversely related to IA.

CONCLUSION

IA is much more common in clinically stable patients with MDD compared to the reported figures in the general population. It would be prudent to screen and monitor internet use in MDD patients and treat those with IA.

Screening for media use in the ED among young Australians: a cross-sectional study (Preprint)

BACKGROUND

Research on problematic internet use has largely adhered to addiction paradigms, possibly impeding the identification of specific internet behaviors related to psychopathology. This study presents a novel approach to screening for specific problematic internet behaviors by using a new measure, the emergency department media use screener (EDMUS).

OBJECTIVE

The purpose of this study was to identify patterns of internet use in young people presenting with mental health concerns to the emergency department (ED), ascertain associations with their mental health, and evaluate whether the EDMUS can be used to predict subsequent ED presentations within 3 months.

METHODS

This cross-sectional retrospective study of Australian young people (N=149, aged 11-25 years; female: n=92, 61.7%) sought to use the EDMUS, a 24-item questionnaire, to identify problematic internet behaviors, including accessing or posting prosuicidal or proeating disorder content, cyberbullying, and inappropriate digital content. Data on each person's mental health were extracted from electronic medical records to look for associations with EDMUS responses and ED re-presentation over 3 months. EDMUS items were grouped into clusters for analysis using chi-square tests, binary logistic regression, and path analyses.

RESULTS

Sharing suicidal digital content was the most common problematic internet use pattern identified by the EDMUS. However, this did not correlate with having a prior mental health diagnosis or predict readmission. Most participants had families with a concern for their internet use; however, this was less likely in participants with a diagnosis of personality disorder. Diagnoses of personality disorder or posttraumatic stress disorder were independent predictors of readmission (P=.003; P=.048).

CONCLUSIONS

Although a history of complex psychopathology increases the likelihood of subsequent ED presentations, its links to internet use-related behaviors are still unclear. The EDMUS has potential for identifying young people who are most vulnerable to problematic internet behaviors and offers the opportunity for early intervention and potential prevention of more entrenched difficulties.

The prevalence of gaming and gambling in a child and adolescent psychiatry unit

Background:

Gaming and gambling are frequently reported from child and adolescent psychiatry and school health care. Swedish epidemiological data show that 1.3% of the population meet the criteria for gambling disorder. Risk factors are male gender, young age, single status and being born outside Sweden. Both problem gaming and gambling are associated with compulsion, psychiatric and physical symptoms, impaired cognitive development and school performance. Based on the limited knowledge and the need for more research into these behaviours among young individuals, the present study aimed to look at the prevalence of gaming and gambling in patients at the child and adolescent psychiatry department (CAP) in Skåne, a region in the south of Sweden.

Design and methods:

The overall aim is to explore gaming and gambling in a child and youth population. Children aged 8–18 years ( N = 144) from CAP in Skåne were assessed with two self-screening instruments: GASA (Game Addiction Scale for Adolescents) and NODS-CLiP (NORC Diagnostic Screen for Gambling Problems). Information were collected regarding type of care, housing situation and diagnosis.

Results:

Thirty-three percent of the study participants showed problem/addictive gaming. Fifty-two percent of the males in the study showed problem/addictive gaming. Forty-four percent of the subjects with ADHD showed problem/addictive gaming. Eleven percent of the study participants showed problem gambling.

Conclusions:

The present study reports hitherto unreported figures of problem gaming and gambling. Our results show the importance of screening children and adolescents for these conditions when admitting subjects to CAP in/outpatient care.

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.

Psychometric Properties of a Cultural Adapted Version of the Assessment of Identity Development in Adolescence in Panama

The Assessment of Identity Development in Adolescence (AIDA) is a self-report instrument to detect pathological development of Identity. In Panamá, psychometric instruments for assessment of psychopathology in adolescence are lacking. Our aim was to develop a valid and reliable version of the AIDA Inventory for Panamanian Population. AIDA was adapted to Spanish considering cultural aspects of Panamanian population. Two pilot tests were performed prior to main test to assess item-total correlation at subscale, primary scale and total scale levels and internal consistency at subscale level. A mixed sample of students and PD patients (N = 315) completed the AIDA inventory, the "Strength and Difficulties Questionnaire" and "Defense Style Questionnaire-40." AIDA was retested in a sub sample from school population (n = 98). The Structured Clinical Interview for Axis II Disorders was used for diagnosis of personality disorders in the patient sample (n = 25). Psychometric properties were tested to assess internal consistency, reliability, factorial validity, convergent validity, and criterion validity. AIDA Panama showed excellent internal consistency for the total scale Identity Diffusion with Cronbach's α:0.94 and a retest reliability of 0.84. A Bifactorial CFA was modeled to assess the dimensionality of the inventory. The proportion between OmegaH and Omega at total scales 96% of the variance is explained by a general factor. Furthermore, the Explained Common Variance for the General Factor is 73% supporting unidimensionality. In line with theory, AIDA total scale showed a high positive correlation (r = 0.67) with Total Difficulties scale and high positive correlation (r = 0.71) with Immature Defense scale. The AIDA total score differed highly significant (p = 0.000) between the patient sample and the students with a large effect size (d = 1.02).

CONCLUSION

The adaptation and validation of AIDA for Panamanian adolescent population was successful with good psychometric properties and significant correlations with related psychopathological constructs. AIDA showed high clinical validity by providing a valid discrimination between the school sample and a diagnosed PD sample, in line with the assumption that impaired identity functioning is at the core of personality disorders, especially in adolescence.

Compulsive Internet Pornography Use and Mental Health: A Cross-Sectional Study in a Sample of University Students in the United States

Background

The sustained rise in negative mental health reports among university students is a source of continued global concern, and investigation continues into potential contributors to this rise. This includes the increased prevalence of risky sexual behaviors. Related is the increased prevalence of pornography use. Our study sought to explore the potential relationship between compulsive use of pornography and mental health in university students.

Methods

Our sample consisted of university students (N = 1031; 34% male, 66% female) from Franciscan University of Steubenville, Steubenville, Ohio. An anonymous survey was sent to all students at the university over the age of 18. The survey was comprised of the following: (1) demographic questions, (2) questions on pornography use and perception, (3) a modified version of the Compulsive Internet Use Scale (mCIUS) assessing various factors associated with compulsive internet pornography use, (4) questions assessing emotional and sexual states relative to pornography use (EmSS), and (5) the 21-question version of the Depression, Anxiety and Stress Scale (DASS-21).

Results

Our results indicate that 56.6% of those surveyed reported lifetime pornography use, with a significantly higher proportion of males than females reporting such use. The majority of students reported accessing pornography through internet-related technologies. Additionally, 17.0, 20.4, and 13.5% of students reported severe or extremely severe levels of depression, anxiety and stress, respectively, with compulsive pornography use significantly affecting all three mental health parameters in both sexes. Exploratory Factor Analysis identified three factors suggesting emotional coping, dependence and preoccupation for the mCIUS items and three factors reflecting interoceptive, impotent, and extrinsic characteristics for the EmSS items. Regression analysis indicated that various demographics, items pertaining to reduced control and social impairment, and other variables pertaining to pornography use predicted mental health outcomes. Faith, morals and personal motivation were the primary variables reported to help reduce pornography use.

Conclusion

Our analyses indicate a significant relationship between mental health and pornography use, including behaviors reflecting behavioral addictions, highlighting the necessity for a better understanding and consideration of the potential contribution of internet pornography to negative mental health among university students.

Prevalence of Internet Addiction Disorder and Its Correlates Among Clinically Stable Adolescents With Psychiatric Disorders in China During the COVID-19 Outbreak

Background: Since the Coronavirus disease 2019 (COVID-19) pandemic emerged, Internet usage has increased among adolescents. Due to this trend, the prevalence of Internet addiction disorder (IAD) may have increased within this group. This study examined the prevalence of IAD and its correlates among clinically stable adolescents with psychiatric disorders in China during the COVID-19 outbreak. Method: A multi-center, cross-sectional study was carried out between April 29 and June 9, 2020 in three major tertiary mental health centers in China. IAD and depressive symptoms were assessed using the Internet Addiction Test (IAT) and the 9-item Patient Health Questionnaire (PHQ-9), respectively. Results: A total of 1,454 adolescent psychiatric patients were included in final analyses. The prevalence of IAD was 31.2% (95% CI: 28.8-33.6%) during the COVID-19 pandemic. A multiple logistic regression analysis revealed that poor relationships with parents (P < 0.001, OR = 2.34, 95%CI: 1.49-3.68) and elevated total PHQ-9 scores (P < 0.001, OR = 1.19, 95%CI: 1.16-1.21) were significantly associated with higher risk for IAD while longer daily physical exercise durations (P = 0.04, OR = 0.67, 95%CI: 0.46-0.98) and rural residence (P = 0.003, OR = 0.62, 95%CI: 0.46-0.85) were significant correlates of lower risk for IAD. Conclusions: IAD was common among adolescent patients with clinically stable psychiatric disorders during the COVID-19 pandemic; regular physical exercise, healthy relationships with parents and fewer symptoms of depression were associated with lower risk within this population.

mRNA Levels of MAOA and 5-HT 2 A Receptor in Patients With Pathological Internet Use: Correlations With Comorbid Symptoms

Objective: Uncontrolled internet use may lead to the emergence of pathological internet use (PIU). PIU has become a global public health concern that can cause a range of psychotic symptoms, including anxiety, depression, and impulse control disorder. To date, we know very little about the principal biological factors related to PIU. Monoamine oxidase type A (MAOA) and serotonin (5-HT) 5-HT_2A receptor (5-HT_2AR) play critical roles in the development of behavioural and drug addictions. Thus, the aim of this study was to measure the relative expression of mRNA of MAOA and 5-HT_2AR in peripheral blood mononuclear cells (PBMCs) of patients with PIU and to determine the correlations between these biological indicators and the comorbid symptoms of patients with PIU. Methods: In this study, the mRNA of MAOA and 5-HT_2AR was detected using real-time PCR in PBMCs of the patients with PIU (n = 24) and healthy controls (HCs, n = 25). The relationship between the mRNA levels of MAOA and 5-HT_2AR and clinical symptoms in patients with PIU was further investigated. Results: MAOA mRNA in PBMCs was significantly upregulated in patients with PIU compared with that in HCs. mRNA levels of 5-HT_2AR were not found to differ significantly between HCs and patients with PIU. Correlation analyses further revealed a significant positive correlation between the relative expression of MAOA mRNA in PBMCs of patients with PIU and the Young's Internet Addiction Test and Self-Rating Depression Scale scores. Conclusion: The present study revealed upregulated expression of MAOA mRNA in patients with PIU and an association between the expression of MAOA mRNA and clinical symptoms of PIU, suggesting that the neurobiological changes may be similar between PIU and substance addiction. Additionally, this study demonstrated a potential association between comorbid symptoms and mRNA levels of MAOA.

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.

Prospective associations between internet use and poor mental health: A population-based study

OBJECTIVES

Most of the evidence on the effects of internet use on mental health derives from cross-sectional research. We set out to explore prospective associations between internet use (hours online and specific internet experiences) and future mental health problems.

METHODS

Participants were 1,431 respondents from the Avon Longitudinal Study of Parents and Children (ALSPAC), a UK birth cohort, who completed a questionnaire on internet use (time online and ten different internet experiences) when they were aged 18 years. Outcomes included past year self-harm, assessed at 21 years and high levels of depression and anxiety symptoms, assessed at 22 years. Associations were investigated using logistic regression models and analyses were conducted separately for males and females.

RESULTS

Females reporting high levels of internet use (number of hours online) were found to be at increased risk of depression at follow-up (highest tertile vs lowest tertile OR = 1.41, 95% CI 0.90 to 2.20), whereas males with high levels of internet use were at increased risk for self-harm (highest tertile vs lowest tertile OR = 2.53, 95%CI 0.93 to 6.90). There was no evidence to suggest an association between hours spent online and anxiety. With regards to the specific internet experiences, associations were found for females but not for males. In fully adjusted models, being bullied online (OR = 1.76, 95% CI 1.09 to 2.86) and meeting someone face to face (OR = 1.55, 95% CI 1.00 to 2.41) were associated with an increased risk of future depression. Being bullied online was also associated with an increased risk of future self-harm (OR = 2.42, 95% CI 1.41 to 4.15), along with receiving unwanted sexual comments or material, and coming across pornography and violent/gruesome material.

CONCLUSIONS

Our findings highlight the importance of digital citizenship training to help teach young people to use technology safely and responsibly.

Effectiveness of a Nurse-Led Intervention for Adolescents With Problematic Internet Use

The current study assessed the effect of an intervention on problematic internet use (PIU), biopsychosocial functioning, and academic performance in 100 adolescents with PIU in grades 9 and 11 in Ernakulam District, Kerala, India. Students from four comparable schools were randomly assigned to experimental and wait-list control groups after being screened for PIU. The experimental group participated in a 10-week intervention and parents of these adolescents were provided with two sessions. The wait-list control group received the intervention after the posttest. A PIU questionnaire, sociodemographic data, internet usage pattern, a biopsychosocial functioning tool, and academic performance were used to assess participants at baseline and immediately after and 3 months postintervention. Findings revealed significant differences in PIU; physical, psychological, and social functioning; and academic performance immediately and 3 months postintervention (p < 0.05). Thus, the intervention was effective in reducing PIU among adolescents and improved their physical, psychological, and social functioning and academic performance. [Journal of Psychosocial Nursing and Mental Health Services, 58(7), 16-26.].

Prevalence and Interpersonal Correlates of Internet Gaming Disorders among Chinese Adolescents

This study investigated the prevalence and interpersonal correlates of Internet gaming disorders (IGD) among Chinese adolescents. A cross-sectional survey was conducted in two cities (Shanghai and Xi’an) in China. A total of 2666 (Mean_age = 12.77 ± 0.75) year-one students from eight middle schools completed a self-reported questionnaire. It tested their levels of IGD, parental psychological control, negative interpersonal events (physical/verbal abuse by parents, verbal abuse by teachers, peer/online bullying), social support from parents/peers, and positive relationships with parents/peers. Results showed that 346 participants (13.0%) were classified as having IGD. Gender, city, single-parent family, family socio-economic status, and mother’s education level were significantly associated with the risk of IGD. Logistic regression analyses with and without controlling for the significant background variables showed that the studied interpersonal variables were significantly associated with IGD, respectively. Forward stepwise logistic regression showed that the significant correlates of IGD included parental psychological control, physical/verbal abuse by parents, verbal abuse by teachers, and peer/online bullying. Results highlight the importance of addressing interpersonal risk factors to reduce adolescent IGD. Limitations and implications of this study are discussed.

Social media, internet use and suicide attempts in adolescents

PURPOSE OF REVIEW

Suicide is the second leading cause of death in youth aged 10-24 years old globally, but detecting those at risk is challenging. Novel preventive strategies with wide influence across populations are required. Interest in the potential for both detrimental and supportive influences of social media/internet use on suicidal behaviour has been growing; however, the relationship remains unclear.

RECENT FINDINGS

A systematic search of articles from database inception up to 25 January 2019 across five databases: Medline, PsycINFO, EMBASE, HMIC and CINAHL revealed nine independent studies investigating social media/internet use and suicide attempts in young people less than 19 years old (n = 346 416). An independent direct association was found between heavy social media/internet use and increased suicide attempts in seven studies (adjusted ORs ranged from 1.03 to 5.10), although adjusting for cyberbullying victimization and sleep disturbance reduced the strength of this association. Two studies found that some social media/internet use, versus no use, may be associated with fewer suicide attempts. There were no studies investigating the relationship between social media/internet use and completed suicide.

SUMMARY

There is an independent association between problematic use of social media/internet and suicide attempts in young people. However, the direction of causality, if any, remains unclear. Further evaluation through longitudinal studies is needed.

Relationship Between Shyness and Generalized Pathological Internet Use Among Chinese School Students: The Serial Mediating Roles of Loneliness, Depression, and Self-Esteem

The present study aimed to explore the mediating effects of loneliness, depression, and self-esteem on the association between shyness and generalized pathological Internet use (GPIU). A total of 5215 school students completed questionnaires regarding shyness, loneliness, depression, self-esteem, and GPIU (aged 11-23 years old, M = 16.19, SD = 3.10). The self-reported scores for GPIU, shyness, loneliness, depression, and self-esteem were tested in students from elementary schools to universities. The results of a variance analysis indicated that senior high school students had the greatest prevalence of GPIU of all the study stages. With the study stages resolved, the results of a structural equation model revealed that: (a) shyness positively predicted GPIU; (b) shyness/loneliness/depression predicted GPIU through self-esteem; (c) shyness predicted GPIU through loneliness/depression → self-esteem; and (d) shyness predicted GPIU through loneliness → depression → self-esteem. In conclusion, these results provided significant implications for preventing or reducing GPIU in Chinese school students.