Internet gaming as a coping method among schizophrenic patients facing psychological distress

A three-wave longitudinal study on the underlying metacognitive mechanism between depression and Internet gaming disorder

BACKGROUND AND AIMS

Internet Gaming Disorder (IGD) and depression have negative consequences on individuals' mental health, but their relationships are complex. This three-wave longitudinal study aimed to detect the metacognitive mechanisms underlying the association between IGD tendency and depression based on the self-regulatory executive function model.

METHODS

A total of 1,243 Chinese undergraduate student gamers (57% female, M = 19.77, SD = 1.29) were recruited at the baseline survey (Wave 1 [W1]), with 622 and 574 of them taking part in the two follow-up surveys (Wave 2 [W2] at 6 and Wave 3 [W3] at 12 months later), respectively.

RESULTS

The three-wave path model demonstrated, after controlling for the autoregressive effect of each variable, that depression consistently predicted IGD tendency but not vice versa, while negative but not positive metacognitions about online gaming (MOG) significantly predicted both depression and IGD tendency. Moreover, two statistically significant mediation paths: (i) negative MOG [W1] → depression [W2] → IGD tendency [W3]; and (ii) depression [W1] → negative MOG [W2] → IGD tendency [W3] were identified.

DISCUSSION AND CONCLUSIONS

These findings extend the understanding of the associations among depression, IGD tendency, and MOG, highlighting how negative MOG has a stronger prospective effect than positive MOG on depression and IGD tendency, and also reveal the mutual mediation effects of depression and negative MOG on IGD tendency. Integrated programmes with both emotional regulation training and Metacognitive Therapy are recommended for IGD treatment.

A Network Model of Health-Related Changes after a Lifestyle-Enhancing Treatment in Patients with Severe Mental Illness: the MULTI Study VI

Background/Objective

The effects of lifestyle interventions on physical and mental health in people with severe mental illness (SMI) are promising, but its underlying mechanisms remain unsolved. This study aims to examine changes in health-related outcomes after a lifestyle intervention, distinguishing between direct and indirect effects.

Method

We applied network intervention analysis on data from the 18-month cohort Multidisciplinary Lifestyle enhancing Treatment for Inpatients with SMI (MULTI) study in 106 subjects (62% male, mean age=54.7 (SD=10.8)) that evaluated changes in actigraphy-measured physical activity, metabolic health, psychopathology, psychosocial functioning, quality of life and medication use after MULTI (n=65) compared to treatment as usual (n=41).

Results

MULTI is directly connected to decreased negative symptoms and psychotropic medication dosage, and improved physical activity and psychosocial functioning, suggesting a unique and direct association between MULTI and the different outcome domains. Secondly, we identified associations between outcomes within the same domain (e.g., metabolic health) and between the domains (e.g., metabolic health and social functioning), suggesting potential indirect effects of MULTI.

Conclusions

This novel network approach shows that MULTI has direct and indirect associations with various health-related outcomes. These insights contribute to the development of effective treatment strategies in people with severe mental illness.

Problematic Use of Internet Among Indonesia University Students: Psychometric Evaluation of Bergen Social Media Addiction Scale and Internet Gaming Disorder Scale-Short Form

OBJECTIVE

Social media addiction and internet gaming disorder may cause mental health problems among a minority of university students. The Bergen Social Media Addiction Scale (BSMAS) and the 9-item Internet Gaming Disorder Scale-Short Form (IGDS9-SF) are commonly used worldwide. However, they have not been translated or validated into Indonesian. The present study aimed to translate and validate the BSMAS and IGDS9-SF in an Indonesian context among young adults.

METHODS

A multi-center, web-based cross-sectional study was conducted among 458 university students (74% female; mean age 22.5 years) in Indonesia from June to December 2021. The BSMAS and IGDS9-SF were translated into Indonesian. Internal consistency (using Cronbach's α and McDonald's ω) and factor structure (using confirmatory factor analysis) of the two instruments were examined. Concurrent validity of BSMAS and IGDS9-SF was examined using their correlations with two external concepts: nomophobia and psychological distress.

RESULTS

Internal consistency of the Indonesian BSMAS and IGDS9-SF were both acceptable (Cronbach's α=0.80 and 0.90; McDonald's ω=0.86 and 0.92). Both instruments were unidimensional with good factor loadings (0.54-0.78 for BSMAS; 0.63-0.79 for IGDS9-SF). Moreover, BSMAS and IGDS9-SF had stronger associations with nomophobia (r=0.58 and 0.12; p<0.001) than with psychological distress (r=0.43 and 0.15; p<0.001).

CONCLUSION

The Indonesian versions of the BSMAS and IGDS9-SF had good psychometric properties in terms of linguistic validity, unidimensionality, and reliability. The findings indicate the tools are appropriate for assessing the risk of social media addiction and internet gaming disorder among university students in Indonesia.

The relationship between internet gaming disorder and psychotic experiences: cyberbullying and insomnia severity as mediators

BACKGROUND

The nature of the relationship between Internet Gaming Disorder (IGD) and psychosis is unclear so far. There is evidence that greater time spent in playing video games may expose players to both insomnia and a toxic online environment with widespread cyberbullying. These two possible consequences of IGD may, in turn, be associated with greater psychotic experiences (PE). Based on this theoretical framework, the present study proposed to contribute the body of the knowledge in this area, by testing the possible indirect effects of insomnia severity, cyber-victimization and cyberbullying in the cross-sectional association between IGD and PE in a sample of Tunisian university students.

METHOD

We conducted a cross-sectional study over 4 months (February-May 2022). The Arabic versions of the Brief Symptom Inventory, the Internet Gaming disorder-20 Test, the Insomnia Severity Index, and the Revised Cyber Bullying Inventory-II were administered to a total of 851 students (mean age = 21.26 ± 1.68 years, 53.7% females).

RESULTS

We found that 25% of students were at risk of IGD, and 1.8% had an IGD. The results of the mediation analysis showed that insomnia severity fully mediated the association between IGD and paranoid ideation. Higher IGD was significantly associated with more insomnia severity, which was, in turn, significantly associated with more paranoid ideation. Cyberbullying partly mediated the association between IGD and psychoticism. Higher IGD scores were significantly associated with more cyberbullying, which was, in turn, significantly associated with more psychoticism. Finally, greater IGD was significantly and directly associated with higher psychoticism.

CONCLUSION

Our findings suggest that insomnia and cyberbullying may be regarded as potential targets for youth mental health promotion, as well as community-focused prevention and early intervention in psychosis. More particular attention should be devoted to the huge potential for engaging in cyberbullying among online gamers. Sleep deprivation should be prevented, assessed and treated in heavy gamers.

Sleep Quality and Self-Stigma Mediate the Association Between Problematic Use of Social Media and Quality of Life Among People With Schizophrenia in Taiwan: A Longitudinal Study

OBJECTIVE

Problematic use of social media (PUSM) may affect sleep quality and self-stigma in people with schizophrenia and consequently reduce their quality of life (QoL). This longitudinal study investigated if sleep quality and self-stigma mediated relationships between PUSM and QoL.

METHODS

One-hundred-and-ninety-three outpatients with schizophrenia were recruited from a psychiatric center in Taiwan from April 2019 to August 2021 and participated in a longitudinal study at intervals of three months between measurements. QoL was assessed using the World Health Organization Quality of Life Questionnaire Brief Version; sleep quality using the Pittsburgh Sleep Quality Index; self-stigma using the Self-Stigma Scale-Short; and PUSM using the Bergen Social Media Addiction Scale. Via SPSS 20.0, general estimating equation models assessed temporal associations between variables. Via R software, mediating effects of self-stigma and sleep quality were examined through Monte Carlo simulations with 20,000 repetitions.

RESULTS

Mean scores of physical, psychological, social and environmental QoL ranged from 11.86 to 13.02. Mean scores of sleep quality and self-stigma were 9.1±4.5 and 2.2±0.8, respectively. Sleep quality and self-stigma were directly related to QoL (p<0.001) and mediated indirect relationships between PUSM and all components of QoL with a range of 95% confidence intervals spanning from -0.0591 to -0.0107 for physical QoL; -0.0564 to -0.0095 for psychological QoL; -0.0292 to -0.0035 for social QoL; and -0.0357 to -0.0052 for environmental QoL.

CONCLUSION

Sleep quality and self-stigma mediated relationships between PUSM and QoL in people with schizophrenia. Developing interventions targeting PUSM, sleep, and self-stigma may help improve QoL in people with schizophrenia.

Positive youth development attributes and cyberbullying victimization among Chinese middle school students: A longitudinal moderated mediation model involving internet gaming disorder and depression

As an extension of traditional bullying, cyberbullying emerges with the increasing popularity of the internet, and seriously affects the health of students. However, fewer studies have explored the potential influencing mechanisms of cyberbullying victimization from a positive psychology perspective. Therefore, based on the positive youth development theory, this study will explore the potential mediator and moderator in the relationship between positive youth development (PYD) attributes and cyberbullying victimization through a longitudinal design. 719 students (Mage = 15.95 years, SD = 0.76, 45.2% boy) participated in the study and completed self-report questionnaires on relevant variables. The result found that students' level of PYD significantly and negatively predicted the level of cyberbullying victimization. Meanwhile, SEM analysis showed that PYD influenced individuals' cyberbullying victimization by affecting their internet gaming disorder (IGD), while depression levels moderated the relationship between PYD and IGD. This study examines cyberbullying victimization from a positive psychology orientation, with potential prevention and intervention value.

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.

Exploring mediational roles for self-stigma in associations between types of problematic use of internet and psychological distress in youth with ADHD

BACKGROUND

Several studies have linked the problematic use of the Internet (PUI) to psychological distress. Youth with attention deficit hyperactivity disorder (ADHD) are considered a particular disadvantaged population with a high risk of developing PUI, psychological distress, and self-stigma. Nonetheless, the interrelationships of PUI, self-stigma, and psychological distress in adolescents with ADHD are not well understood.

AIMS

This study investigated whether self-stigma mediates relationships between different forms of PUI, such as problematic gaming (PG), problematic social media use (PSMU), problematic smartphone use (PSPU), and psychological distress (i.e., depression, anxiety, and stress), in children with ADHD.

METHODS AND PROCEDURES

We recruited 100 youth with ADHD (mean age=10.80 [SD=3.07] years; 84 boys) from psychiatric outpatient clinics in Taiwan. All participants were assessed for PUI (via Internet Gaming Disorder-Short Form for PG, Bergan Social Medica Addiction Scale for PSMU, and Smartphone Application-Based Addiction Scale for PSPU), self-stigma (via Self-Stigma Short-Scale), and psychological distress (via Depression, Anxiety, Stress Scale).

OUTCOMES AND RESULTS

The results of path and bootstrapping analyses indicated that self-stigma mediated the associations between PSMU and PSPU, but not PG, and depression, anxiety, and stress.

CONCLUSIONS AND IMPLICATIONS

This study expands the extant literature by revealing that self-stigma mediates the association between specific forms of PUI and psychological distress in adolescents with ADHD. Interventions aimed at reducing self-stigma and PUI, particularly PSMU and PSPU, may help decrease psychological distress among adolescents with ADHD.

Temporal associations between physical activity and three types of problematic use of the internet: A six-month longitudinal study

Background and aims

Internet use has become an important part of daily living. However, for a minority it may become problematic. Moreover, problematic use of the Internet/smartphone (PUIS) has been associated with low physical activity. The present study investigated the temporal associations between three types of PUIS (i.e., problematic smartphone use [PSPU], problematic social media use [PSMU] and problematic gaming [PG]) and physical activity among Taiwanese university students.

Methods

A six-month longitudinal survey study comprising three time points for assessments was conducted. From the original 974 participants, a total of 452 completed all three waves of an online survey comprising the International Physical Activity Questionnaire Short Form (IPAQ-SF) assessing physical activity level, Smartphone Application-Based Addiction Scale (SABAS) assessing PSPU, Bergen Social Media Addiction Scale (BSMAS) assessing PSMU, and Internet Gaming Disorder Short Form (IGDS9-SF) assessing PG.

Results

The linear mixed effects model found positive temporal associations of PSMU and PG with physical activity level (PSMU: B = 85.88, SE = 26.24; P = 0.001; PG: B = 36.81, SE = 15.17; P = 0.02). PSPU was not associated with physical activity level (B = 40.54, SE = 22.99; P = 0.08). Additionally, the prevalence rates were 44.4% for at-risk/PSPU, 24.6% for at-risk/PSMU, and 12.3% for at-risk/PG.

Discussion and Conclusions

PSMU and PG unexpectedly demonstrated correlations with higher physical activity level. The nature of these relationships warrants additional investigation into the underlying mechanisms in order to promote healthy lifestyles among university students.

Comparisons of psychological distress and self-stigma among three types of substance use disorders receiving treatment-as-usual approaches: real-world data from a 9-month longitudinal study

BACKGROUND

Substance use is an important issue worldwide and people with substance use disorders (SUDs) have been reported to have high levels of psychological distress and self-stigma. Therefore, psychological distress and self-stigma in people with SUDs are considerable.

OBJECTIVE

The present study used a longitudinal design to examine whether treatment-as-usual approaches in Taiwan improve psychological distress and self-stigma among people with three types of SUDs (heroin, amphetamine, and alcohol use disorders).

DESIGN

A 9-month longitudinal design involving four assessments spaced 3 months apart.

METHODS

Convenience sampling was used to recruit people with heroin (n = 112), amphetamine (n = 151), and alcohol (n = 56) use disorders from outpatient psychiatric center in Southern Taiwan. Psychological distress was assessed using the Depression, Anxiety, Stress Scale (DASS-21), and self-stigma was assessed using the Self-Stigma Scale-Short (SSS-S). Generalized estimating equation (GEE) models were constructed to understand between-group differences in psychological distress and self-stigma over time.

RESULTS

Patients with heroin and amphetamine use disorders had lower levels of psychological distress as compared with those with alcohol use disorder. Levels of psychological distress were lower at Time 2 to Time 4 as compared with Time 1. Patients with heroin and amphetamine use disorders had higher levels of self-stigma as compared with those with alcohol use disorder. Self-stigma levels remained stable over time. The dropout rate of receiving treatment-as-usual approach in the 9-month study was 60%.

CONCLUSION

Treatment as usual for SUDs among outpatients in Taiwan may decrease psychological distress but not self-stigma. However, such effects need to be further examined given the high drop-out rates and absence of a control condition. The findings suggest that self-stigma may warrant additional treatment for patients with SUDs.

Temporal associations between problematic use of the internet and self-stigma among people with substance use disorders: A cross-lagged model across one year

Self-stigma is a common experience for people with substance use disorders (SUDs). Understanding factors associated with self-stigma may aid in intervention development. This study investigated the reciprocal relationship between three types of problematic use of the internet [PUI; i.e. problematic use of social media (PUSM), problematic smartphone use (PSPU), and problematic gaming (PG)] and self-stigma among people with SUDs. This longitudinal study involved five waves of a survey given to individuals with SUDs in Taiwan. A total of 319 participants (85% male), with a mean age of 42.2 years (SD = 8.9), were recruited. The Smartphone Application-Based Addiction Scale, Bergen Social Media Addiction Scale, Internet Gaming Disorder-Short Form, and Self-Stigma Scale-Short Form were used. No significant associations between PUI and self-stigma were found in early waves (i.e., Waves 1 and 2). The earliest significant finding was identified between Wave 2 PSPU (smartphone) and Wave 3 self-stigma. Additionally, Wave 3 PSPU (smartphone) and PG (gaming) were associated with Wave 4 self-stigma, and Wave 4 PSPU (smartphone), PG (gaming), and PUSM (social media) were associated with Wave 5 self-stigma. Therefore, all three types of PUI (internet) may elevate self-stigma at different time points for individuals with SUDs. However, the reciprocal effects between self-stigma and PUI (internet) only occurred in PUSM (social media) at a later stage (i.e., from Wave 4 to Wave 5). In conclusion, people with SUDs who have PUI (internet) are at increased likelihood of developing more self-stigma, which may then increase subsequent PUSM (social media), forming a vicious cycle.

Attentional biases and daily game craving dynamics: An ecological momentary assessment study

BACKGROUND AND AIMS

Theories posit that the combination of external (e.g. cue exposure) and internal (e.g. attention biases) factors contributes to the development of game craving. Nevertheless, whether different components of attentional biases (namely, engagement bias and disengagement bias) play separate roles on game craving has not been fully elucidated. We aimed to examine the associations between two facets of attentional biases and game craving dynamics under a daily life setting.

METHODS

Participants (110 regular internet game players) accomplished the modified attentional assessment task in the laboratory, after which they entered a 10-day ecological momentary assessment (EMA) to collect data on their momentary game craving and occurrence of game-related events at five different time points per day.

RESULTS

We found that occurrence of game-related events was significantly associated with increased game craving. Moreover, attentional disengagement bias, instead of engagement bias, bore on the occasional level variations of game craving as moderating variables. Specifically, attentional disengagement bias, not engagement bias, was associated with a greater increase in game craving immediately after encountering a game-related event; however, neither attentional engagement bias nor disengagement bias was associated with the craving maintenance after a relatively long period.

DISCUSSION AND CONCLUSIONS

The present study highlights the specific attentional processes involved in game craving dynamics, which could be crucial for designing interventions for attentional bias modification (ABM) in Internet Gaming Disorder (IGD) populations.

Changes of Health Outcomes, Healthy Behaviors, Generalized Trust, and Accessibility to Health Promotion Resources in Taiwan Before and During COVID-19 Pandemic: Comparing 2011 and 2021 Taiwan Social Change Survey (TSCS) Cohorts

PURPOSE

The present study compared two nationally representative cohort datasets concerning Taiwan residents' healthy behaviors, subjective health outcomes, generalized trust, and accessibility to health promotion resources.

PATIENTS AND METHODS

The Taiwan Social Change Survey (TSCS) was conducted in two waves ten years apart: 2011 cohort (n = 1021; 48.4% males) and 2021 cohort (n = 1425; 47.4%) cohorts. Descriptive statistics were calculated to compare the two TSCS datasets. Then, multiple regression models were constructed with health outcome as the dependent variable, and demographics and other key components as independent variables.

RESULTS

The 2011 TSCS cohort showed higher prevalence for cigarette smoking (30.8% vs 25.2%; p=0.002), alcohol drinking (52.5% vs 24.3%; p<0.001), exercise habits (52.7% vs 48.0%; p=0.02), and better fruit and vegetable accessibility (Mean=3.91 vs 3.82; p=0.04). The 2021 TSCS cohort reported higher body mass index (Mean=24.20 vs 23.63; p<0.001), less residency in urban areas (22.4% vs 31.1%; p<0.001), better jogging accessibility (4.14 vs 4.05; p=0.006), higher generalized trust (2.26 vs 2.17; p=0.001), and greater internet usage (3.43 vs 2.89; p<0.001). The regression model showed that exercise habits (standardized coefficient=0.20 and 0.10; p<0.001) and generalized trust (standardized coefficient=0.11 and 0.11; p=0.004 and <0.001) were consistently associated with health outcomes in both cohorts. Additionally, internet use (standardized coefficient=-0.07; p=0.026) and alcohol drinking behaviors (standardized coefficient=-0.07; p=0.0022) were negatively associated with health outcomes in the 2021 cohort.

CONCLUSION

The present study demonstrated the trends and changes over 10 years regarding multiple health-related components among Taiwan residents. The study's findings provide insight into education promotion programs to reduce unhealthy behaviors as well as enhancing generalized trust building and developing healthy behaviors for Taiwan residents.

The prevalence and possible risk factors of internet gaming disorder among adolescents and young adults: Systematic reviews and meta-analyses

BACKGROUND

As a spreading addictive behaviour in recent years, internet gaming disorder (IGD) has been studied a lot and the overall research results indicate that IGD has a high prevalence among adolescents and young adults (AYAs). To update the status quo of prevalence, it is necessary to conduct comprehensive analyses.

METHODS

On the premise of following the PRISMA statement, the study conducted two systematic reviews and meta-analyses to assess the global prevalence of IGD among AYAs and identify its possible risk factors. To achieve the goals, PubMed and CNKI databases were used to select the concerned studies published up to May 31, 2021. Heterogeneity was assessed using a funnel plot, Begg's test, Egger's test, and trim-and-fil method, followed by sensitivity analysis, subgroup analysis, and meta-regression analysis.

RESULTS

For the meta-analysis of prevalence, 407,620 participants from 155 reports in 33 countries were included. The pooled prevalence of IGD among AYAs was 9.9% (95% CI: 8.6%-11.3%, P = 0.000, I² = 94.4%), including 8.8% (95% CI: 7.5%-10.0%) among adolescents and 10.4% (95% CI: 8.8%-11.9%) among young adults. The following 12 factors are the possible risk factors of IGD among AYAs, which are stress, long average game time, family dysfunction, poor academic performance, being bullied, bullying, interpersonal problems, hyperactivity/inattention, anxiety, depression, emotional distress and low self-esteem.

CONCLUSIONS

This study confirms the prevalence and possible risk factors for IGD among AYAs. It's valuable in understanding the threat of IGD and finding intervention strategies for IGD among AYAs.

Reliability and validity study of the Indonesian Smartphone Application-Based Addiction Scale (SABAS) among college students

Background/Objective

Smartphone addiction, smartphone dependence, and compulsive smartphone use all describe similar phenomena that can cause problems in everyday daily life in many countries worldwide. Most scholars agree that it is the applications on smartphones that individuals have problems with rather than the smartphone itself. For this reason, smartphone application-based addiction is an issue of concern and one instrument has been specifically developed to assess this risk, namely, the Smartphone Application-Based Addiction Scale (SABAS). Although the SABAS has been translated into a number of languages, it has not been translated or validated into Indonesian.

Methods

The SABAS was translated into Bahasa Indonesian utilizing a cross-cultural method to ensure its linguistic validity. The linguistic validity of the Indonesian SABAS was ensured using international standard translation guidelines. Moreover, reliability and validity testing of the translated Indonesian SABAS were carried out using Cronbach’s α, McDonald’s ω, confirmatory factor analysis (CFA), and correlations with psychometric scales assessing psychological distress and nomophobia.

Results

Using a sample of 458 participants (mean age = 22.46 years), reliability tests showed that the Indonesian SABAS was acceptable (Cronbach α = 0.74; McDonald’s ω = 0.79). Construct validity of the Indonesian SABAS was supported by satisfactory CFA fit indices; concurrent validity supported by good correlations with psychological distress (r = 0.50) and nomophobia (r = 0.61).

Conclusions

The Indonesian version of SABAS is valid and reliable to be used for assessing the risk of smartphone application-based addiction in college students.

Exploring the link between cognitive deficit, self-esteem, alexithymia, and depressive symptom of schizophrenia

OBJECTIVE

To the best of our knowledge, studies have been rarely conducted to assess the correlation between cognitive deficit, self-esteem, and alexithymia in the depressive symptoms of schizophrenia (SCZ). Therefore, this study aims to explore the risk factors associated with impairment of cognitive function, alexithymia, and self-esteem among a representative sample of first-episode schizophrenic patients.

METHOD

We recruited 107 first-episode schizophrenic patients (48.6% male, 51.4% female, 36.94 ± 10.73 years) into the research group, according to the Diagnostic and Statistical Manual of Mental Disorders (5th edition). A total of 45 healthy people (51.1% male, 48.9% female, 32.47 ± 10.94 years) were enlisted in the healthy control group. Psychotic symptoms were evaluated using the Positive and Negative Syndrome Scale (PANSS). Cognitive functions were estimated using the Montreal Cognitive Assessment Scale (MoCA). The feelings of respect and self-acceptance were tested using the Rosenberg Self-Esteem Scale (RSES). Emotion of identifying and describing were measured by self-report scale of Toronto Alexithymia Scale-20 (TAS-20).

RESULTS

Overall cognitive impairment and alexithymia were found more serious in the patients of SCZ than the healthy group (p < .001, respectively). The patients of SCZ have higher self-esteem than the healthy group (p = .013). Total score of MoCA, ability of visual space and executive function, and delayed recall were explored had negatively correlation with alexithymia (r = -.319, p = .001; r = -.248, p = .010; r = -0.263, p = .006). Total score of RSES and depressive symptoms of PANSS had a positive correlation with alexithymia (r = .394, p = .001; r = .208, p = .032). Stepwise regression analyses have shown a positive relationship between difficulty describing feelings and depression subscale of PANSS (β = .188, t = -2.007, p = .047) while a negative relationship between externally oriented thinking and depression subscale of PANSS (β = -.244, t = -2.603, p = .011). A positive link correlation also was found between the total scores of TAS and RSES (β = .372, t = 4.144, p = .001). A negative relevance was found between the total scores of TAS and scores of MoCA (β = -.305, t = -3.348, p = .001).

CONCLUSION

Overall impairment of cognitive function and alexithymia are commonly encountered in SCZ patients. Poor cognitive function, alexithymia, and high level self-esteem may be specific detective risk factors for the depressive symptoms of SCZ.

A longitudinal study of the effects of problematic smartphone use on social functioning among people with schizophrenia: Mediating roles for sleep quality and self-stigma

Background and aims

Individuals with schizophrenia may often experience poor sleep, self-stigma, impaired social functions, and problematic smartphone use. However, the temporal relationships between these factors have not been investigated. The present study used a longitudinal design to examine potential mediating roles of poor sleep and self-stigma in associations between problematic smartphone use and impaired social functions among individuals with schizophrenia.

Methods

From April 2019 to August 2021, 193 individuals with schizophrenia (mean [SD] age = 41.34 [9.01] years; 88 [45.6%] males) were recruited and asked to complete three psychometric scales: the Smartphone Application-Based Addiction Scale to assess problematic smartphone use; the Pittsburgh Sleep Quality Index to assess sleep quality; and the Self-Stigma Scale-Short Scale to assess self-stigma. Social functioning was evaluated by a psychiatrist using the Personal and Social Performance Scale. All measures were assessed five times (one baseline and four follow-ups) at three-month intervals between assessments.

Results

General estimating equations found that problematic smartphone use (coefficient = -0.096, SE = 0.021; P < 0.001), sleep quality (coefficient = -0.134, SE = 0.038; P < 0.001), and self-stigma (coefficient = -0.612, SE = 0.192; P = 0.001) were significant statistical predictors for social functioning. Moreover, sleep quality and self-stigma mediated associations between problematic smartphone use and social functioning.

Conclusion

Problematic smartphone use appears to impact social functioning longitudinally among individuals with schizophrenia via poor sleep and self-stigma concerns. Interventions aimed at reducing problematic smartphone use, improving sleep, and addressing self-stigma may help improve social functioning among individuals with schizophrenia.

Investigating the Role of Health Factors and Psychological Well-Being in Gaming Disorder

The recent recognition of Gaming Disorder (GD) as a mental health issue has provided a unique opportunity for researchers to advance our current understanding of the intricate relationships between GD and specific health-related factors and well-being. This study sought to investigate the role of key physical and psychological health and well-being factors in GD. To achieve this, three goals were explored. First, we tested whether GD can be predicted by health and well-being factors such as depression, anxiety, loneliness, attention problems, physical health problems (PHP), and psychological well-being (PWB). Second, we assessed the role of distress tolerance (DT) as a moderator in the relationship between PWB and GD. Third, we examined whether PWB would mediate the relationship between PHP and GD. A sample of 474 participants (Mean_age = 28.86 years; SD = 9.23; range: 18-66 years; 47 percent female) were recruited. The results of the multiple linear regression analysis indicated that age, attention problems, and PHP significantly predicted GD (R² = 0.15). In addition, the mediation findings uncovered an important direct association between PHP and GD despite the lack of mediation effects through PWB and the absence of moderating effects from DT. The present findings signify important health-related implications related to GD that are further discussed here in terms diagnosis, treatment, and prevention efforts.

Demographic and Psychosocial Factors associated with Internet Addiction among the Pakistani Population during COVID-19: A Web-Based Survey

This study aims to determine the burden of COVID19-induced internet addiction and related psychosocial factors among the Pakistani sample. A web-based cross-sectional survey was conducted from January to March 2021. An analytical cross-sectional survey was broadcast on the internet via a Google form completed by 1145 Pakistanis. Individuals aged 13 years and above with competency to comprehend English or Urdu language, currently residing in any province of Pakistan, having access to the questionnaire, and willing to participate were eligible to participate. Overseas Pakistanis were excluded from the study. The outcome is COVID19-induced internet addiction was measured using the validated tool Young’s Internet Addiction Test (IAT). In addition, symptoms of depression, anxiety, stress, and other psychosocial factors were assessed using the validated tool Depression, Anxiety, and Stress Scale-21 (DASS-21). Adjusted odds ratios with a 95% confidence interval were reported using multinomial logistic regression. Most participants were females and youth (between 20 and 24 years). The prevalence of problematic internet users (PIU) and addictive internet users (AIU) was 27.3% and 11.3%, respectively. The odds of extremely severe anxiety among AIU were approximately three times (Adj OR: 2.6 (1.1-7.1), followed by the odds of having extremely severe stress being about five times higher among AIU (Adj OR: 5.4 (1.6-17.6)) as compared to normal internet users (NIU). Amid COVID-19, the burden of internet addiction has surged among the Pakistani populace. This study identified that gender, marital status, depression, stress, anxiety, work situation, and mood changes during the COVID-19 pandemic are significantly correlated with problematic and addictive internet use. Preventative measures against the addictive use of the internet are needed to avoid or mitigate any serious mental health problems.

Internet addiction and psychological distress among Chinese schoolchildren before and during the COVID-19 outbreak: A latent class analysis

BACKGROUND AND AIMS

The present longitudinal study examined the changes in problematic internet use (problematic smartphone use, problematic social media use, and problematic gaming) and changes in COVID-19-related psychological distress (fear of COVID-19 and worry concerning COVID-19) across three time-points (before the COVID-19 outbreak, during the initial stages of the COVID-19 outbreak, and during the COVID-19 outbreak recovery period).

METHODS

A total of 504 Chinese schoolchildren completed measures concerning problematic internet use and psychological distress across three time-points. Latent class analysis (LCA) was used to classify participants into three groups of problematic internet use comprising Group 1 (lowest level), Group 2 (moderate level), and Group 3 (highest level).

RESULTS

Statistical analyses showed that as problematic use of internet-related activities declined among Group 3 participants across the three time points, participants in Group 1 and Group 2 had increased problematic use of internet-related activities. Although there was no between-group difference in relation to worrying concerning COVID-19 infection, Groups 2 and 3 had significantly higher levels of fear of COVID-19 than Group 1 during the COVID-19 recovery period. Regression analysis showed that change in problematic internet use predicted fear of COVID-19 during the recovery period.

CONCLUSION

The varied levels of problematic internet use among schoolchildren reflect different changing trends of additive behaviors during COVID-19 outbreak and recovery periods.

Mediating role of positivity in the relationship between state anxiety and problematic social media use during the COVID-19 pandemic

This study investigated the mediating role of positivity in the relationship between state anxiety and problematic social media use during the COVID-19 pandemic. The Positivity Scale, State-Trait Anxiety Inventory, and Bergen Social Media Addiction Scale were used to collect data from 834 social media users. SEM-based mediation analysis was used to test hypothesized relationships. Results indicated that positivity has a direct negative effect on problematic social media use. Furthermore, the results indicated that state anxiety has a direct negative effect on positivity and state anxiety has a direct positive effect on problematic social media use. Positivity significantly mediates the relationship between state anxiety and problematic social media use.

Associations Between Attention Deficit/Hyperactivity Disorder and Internet Gaming Disorder Symptoms Mediated by Depressive Symptoms and Hopelessness Among College Students

PURPOSE

The mediating role of depressive symptoms and hopelessness on the relationship between attention deficit/hyperactivity disorder (ADHD) and internet gaming disorder (IGD) symptoms has not yet been elucidated. This study assessed this mediating effect in college students.

PARTICIPANTS AND METHODS

Participants consisted of 1236 freshmen recruited at a local university. Symptoms of ADHD, IGD, depression and hopelessness were measured using self-report scales. The effect of ADHD on IGD mediated by depression and hopelessness was analyzed by Haye's PROCESS macro for SPSS (Model 6) using the bias-corrected percentile bootstrap method with 5000 bootstrapped samples.

RESULTS

Symptoms of ADHD, depression and hopelessness were common in college students and were strongly associated with the appearance of IGD symptoms. ADHD symptoms of college students impacted their IGD symptoms directly and indirectly via depressive symptoms and hopelessness. The total effect of ADHD symptoms on IGD symptoms was 0.075 (standard error [SE]: 0.009, 95% confidence interval [CI] 0.057, 0.093), with a direct effect of 0.037 (SE: 0.010, 95% CI 0.018, 0.056, effect ratio: 49.3%), and total indirect effect was 0.038 (SE: 0.005, 95% CI 0.029, 0.050, effect ratio: 50.7%).

CONCLUSION

Depressive symptoms and hopelessness can mediate the relationship between ADHD and IGD symptoms among college students. These findings point to the importance of evaluating ADHD, depressive and hopelessness symptoms for the prevention and treatment of adult IGD.

Problematic Use of Internet-Related Activities and Perceived Weight Stigma in Schoolchildren: A Longitudinal Study Across Different Epidemic Periods of COVID-19 in China

Background: Social distancing and school suspension due to the coronavirus pandemic (COVID-19) may have a negative impact on children's behavior and well-being. Problematic smartphone use (PSU), problematic social media use (PSMU) and perceived weight stigma (PWS) are particularly important issues for children, yet we have a poor understanding of how these may have been affected by lockdowns and physical isolation resulting from COVID-19. This research aimed to understand how these psychosocial and behavioral variables may be associated with psychological distress, and how these associations may have changed during the COVID-19 pandemic. Methods: A total of 489 children completed a three-wave longitudinal study from January 2020 to June 2020. The first wave was conducted before the COVID-19 outbreak. The second wave was conducted during the outbreak. The third wave was conducted during post-COVID-19 lockdown. Questionnaires measured psychological distress, PSU, PSMU, and PWS. Results: PSU, PSMU, PWS and psychological distress were all significantly associated with each other. PSU was significantly higher during outbreak. PWS was significantly higher before outbreak. We found an increased association between PSMU and PWS across three waves in all three models. The association between PSU and depression/anxiety decreased across three waves; however, association between PSMU and depression/anxiety increased across three waves. Conclusions: COVID-19 initiated school suspension and associated lockdowns appear to have exacerbated PSU and depression among children. However, PWS was reduced during this period. Children should use smartphones and social media safely and cautiously, and be aware of the potential exposure to weight stigmatization.