Challenges in Internet Addiction Disorder: Is a Diagnosis Feasible or Not?

Prevalence of internet addiction and associated factors among university students in Ethiopia: systematic review and meta-analysis

Introduction

Internet addiction refers to the excessive and uncontrolled utilization of the Internet, which disrupts one's daily activities. The current state of knowledge regarding internet addiction in Ethiopia is limited. Consequently, the objective of this study is to ascertain the combined prevalence of Internet addiction and its correlated factors among university students in Ethiopia.

Methods

To identify potential research findings, an extensive literature search was conducted using electronic databases such as PubMed/MEDLINE, Web of Science, and Google Scholar. The presence of heterogeneity between studies was assessed using Cochrane Q test statistics and I2 test statistics, while the effects of small studies were examined using Eggers statistical tests at a 5% significance level. Additionally, a sensitivity analysis was carried out. A random effects model was used to estimate the pooled prevalence and associated factors of Internet addiction among students. The primary focus of this research was to determine the prevalence of Internet addiction, while the secondary aim was to identify the factors associated with Internet addiction.

Results

To determine the overall prevalence of Internet addiction among university students in Ethiopia, a comprehensive analysis of 11 studies was conducted. The results of this study show that the pooled prevalence of Internet addiction was 43.42% (95% CI: 28.54, 58.31). The results also suggest that certain factors such as online gaming, depression, and current khat chewing are significantly associated with internet addiction among university students.

Conclusions

In Ethiopia, about one-third of university students suffer from internet addiction. The prevalence of Internet addiction among Ethiopian students is associated with online gaming, depression, and concurrent khat consumption. Therefore, we strongly recommend that health planners and policymakers prioritize monitoring and addressing Internet use and addiction in the Ethiopian context.

Maladaptive daydreaming and problematic online behaviors: A network analysis approach

Previous evidence showed that Maladaptive Daydreaming (MD) is positively associated with different Problematic Online Behaviors (POBs). This study aimed to investigate the mutual relationship between MD and several POBs. Data were collected from 1209 participants, aged 18-73 (M = 30.59, SD = 12.26), through self-report questionnaires assessing MD and POBs, including problematic online gambling, problematic online gaming, problematic cybersex, Problematic Social Media Use (PSMU), problematic online shopping, and cyberchondria. Two psychometric network analyses were performed to examine the associations between all POBs at item levels, and between MD and POBs at construct levels. Results revealed six distinct communities, supporting the specificity of each POB. Furthermore, MD was found to be more strongly associated with PSMU and cyberchondria, and weakly associated with problematic online gaming, problematic cybersex, and problematic online shopping. The mutual relationships between MD and POBs might have relevant implications for the assessment and treatment of these clinical conditions.

Personality Traits and Internet Addiction among Adolescent Students: The Moderating Role of Family Functioning

Objectives: Internet addiction is a behavioral addiction characterized by excessive and compulsive use of the internet. The risk of internet addiction among adolescents has risen recently due to an increase in technological advancement and globalization. However, previous studies have focused on the precipitating factors triggering the internet addiction without looking at the exogenous factors and boundary conditions, such as family functioning, that can either sustain or weaken such behavior. Thus, the present study aimed to examine the moderating role of family functioning in the relationship between personality traits and internet addiction among adolescents. Methods: This study is a cross-sectional study consisting of 3150 adolescent students in the grade/class level of JSS1-SS3 who were assessed with standardized measures of the Big-Five Personality Inventory, Internet Addictive Test, and Family APGAR Index. Pearson correlation was used to explore the bivariate relationships between the demographic variable and other variables of interest, while Hayes regression-based PROCESS macro for SPSS was used to test the Hypotheses. Results: (1) Openness to experience, conscientiousness, extraversion, and neuroticism positively correlated with internet addiction, whereas agreeableness was negatively associated with internet addiction. (2) Positive family functioning correlated negatively with internet addiction. (3) Positive family functioning moderated the relationships of extraversion and agreeableness with internet addiction but not on openness to experience, conscientiousness, and neuroticism with internet addiction. Conclusions: Positive family functioning correlated negatively with internet addiction among adolescents, suggesting that improving family functioning would be a valuable tactic for reducing adolescents' susceptibility to personality-related internet addiction.

Depression, stress, and anxiety versus internet addiction in early and middle adolescent groups: the mediating roles of family and school environments

BACKGROUND

Family and school environment play a crucial role across the different developmental stages of adolescence. This paper investigates the potential mediating role of family and school environments in the relationship between the three psychosocial predictors of depression, anxiety, stress, and Internet addiction (IA). Specifically, it focuses on the two stages of early and middle adolescence.

METHODS

The study involved a survey of 407 adolescents from Qatar, comprising 250 early adolescents and 157 middle adolescents. Inclusion criteria for the study included adolescents between the ages of 10 to 17 years old, residents of Qatar and studying in a Qatar-based school. To assess the constructs of the three psychosocial predictors, IA, family environment, the study utilized the Depression, Stress, and Anxiety Scale (DASS), the Internet Addiction Diagnostic Questionnaire (IADQ), and the Brief Family Relationship Scale, respectively. School environment was measured using questions from the "Health Behavior in School-aged Children: WHO Collaborative Cross-National survey/study (HBSC) 2013-2014. The study applied standard mediation analysis between the DASS components and IA with family and school environment as the mediators.

RESULTS

Results from the mediation analysis reveal insights into the relationships between psychosocial predictors and IA. The findings indicate that family and school environments partially mediated the relationship with regards to depression, stress, and anxiety in early adolescents. In middle adolescents, family environment partially mediated the relationship with depression and stress and fully mediating the relationship with anxiety. Meanwhile, school environment only exhibited partial mediation in the relationship with anxiety in middle adolescence.

CONCLUSIONS

These results highlight the crucial role parents and schools play in addressing problematic technology usage that develops as a response to depression, anxiety, and stress among adolescents. Moreover, the study reveals nuances in the mediating role of family and school environment in early and middle adolescence. This highlights the evolving nature of these influences across the different stages of development. Notably, this study contributes to the literature by moving beyond the conventional focus on the so-called WEIRD population, and offering valuable insights from a region that is underrepresented in current research.

Gambling and internet addiction: a pilot study among a Population of Italian Healthcare : Gambling and Internet Addition in a Healthcare Group

AIM

Measuring the phenomenon of gambling and Internet addiction, with analysis of attitudes and psychophysical consequences among nurses working in different care settings.

METHODS

An observational, cross sectional, multicenter study was conducted from April to September 2020. Participants' socio-demographic information, the "Internet Addiction Test" (IAT) scale, and the "South Oaks Gambling Screen" (SOGS) were collected in order to assess the overuse of and whether an individual has a problematic relationship with gambling, respectively.

RESULTS

502 nurses were enrolled in the study. Significant correlations were found (p < .001) between the IAT score and gender, number of years of work experience, job role, educational qualification; and between the SOGS and gender, number of years of work experience, job role and regions of Italy.

CONCLUSIONS

The study highlighted an emerging social problem, and the results may be just the tip of the iceberg. Given the lack of knowledge of these phenomena and a high percentage of people who suffer from them but are afraid to admit it and get help, this study could also be useful in expanding knowledge and allow more professionals to get help and learn about possible treatments and cures for the resolution of these addictions.

Pattern and predictors of internet addiction among secondary school adolescents in Enugu, Nigeria

Background

Internet addiction has negative effects on adolescents. These range from psychological and social impediments to school absenteeism.

Aim

To ascertain the pattern of Internet addiction and the factors that predict Internet addiction among secondary school adolescents in southeast Nigeria.

Subjects and Methods

This was a cross-sectional study that involved 796 secondary school adolescents drawn from six secondary schools in Enugu, Nigeria. The data were analyzed using IBM Statistical Package for Social Sciences (SPSS) software.

Results

The highest proportion of the respondents (36.3%) had a moderate level of Internet addiction, while the least proportion (2.1%) had severe dependence on the Internet. Adolescents who were less than 15 years of age have 1.1 odds of having Internet addiction when compared to those who were 20 years and above (AOR = 1.1; 95% CI: 0.4-2.8). The respondents who were of the low socioeconomic class were 1.2 times more likely to have Internet addiction when compared with those in the high socioeconomic class (AOR = 1.2; 95% CI: 0.9-1.7). About 20.1% of adolescents were always depressed when they are not using the Internet, while 16.3% of adolescents who were addicted to the Internet developed insomnia.

Conclusion

There is a rising prevalence of Internet addiction among secondary school adolescents. Younger adolescents tend to be more addicted to the Internet than their older counterparts. A small number of them had severe Internet addiction. A subpopulation of adolescents who were addicted to the Internet presents with depression and sleep disorders.

E-sports playing and its relation to lifestyle behaviors and psychological well-being: A large-scale study of collegiate e-sports players in China

BACKGROUND

The research on e-sports mainly concerns the relationship between game playing behavior and Internet addiction, especially among college students. It remained a question of how college students' e-sports playing was associated with their lifestyle behaviors and psychological well-being in China.

OBJECTIVES

Our study aimed to explore whether collegiate e-sports players' e-sports participation behaviors differ across demographic backgrounds and how their e-sports playing relates to their lifestyle behaviors and psychological well-being.

METHODS

A cross-sectional survey was conducted on 1441 collegiate e-sports players in China. The demographic characteristics of collegiate e-sports players were explored. The Bivariate Person correlation, linear and Tobit regression analyses were used to examine how students' e-sports playing was related to their lifestyle behaviors (i.e., sleep quality and physical activity) and psychological well-being (mobile phone addiction, online game addiction, satisfaction with life, and perceived stress).

RESULTS

The results of independent t-test and ANOVA analyses revealed that students from different grades, majors, family residences, and family structures differed in their e-sports participation behaviors. The results of linear regression and Tobit regression analyses also revealed that students' e-sports participation behaviors were related to their lifestyle behaviors and psychological well-being, except for sleep quality and mobile phone addiction. It is noteworthy that the length of time in playing e-sports and e-sports consumption was related to different lifestyle behaviors and psychological well-being.

CONCLUSION

The findings demonstrated that e-sports playing had penetrated college students' daily life. Appropriate time arrangement and rational e-sports consumption are crucial in promoting a healthy lifestyle and psychological well-being among college students.

Flow Experience Is a Key Factor in the Likelihood of Adolescents' Problematic TikTok Use: The Moderating Role of Active Parental Mediation

TikTok use and overuse have grown rapidly in recent years among adolescents. However, risk factors for problematic TikTok use are still largely unknown. In addition, drawing on the flow theory and parental mediation theory, this study aims to examine how adolescents' perceptions of enjoyment, concentration, and time distortion affect their problematic TikTok use behavior. Further, we examined the moderating effect of active parental mediation. An online survey in China received responses from a sample of 633 adolescents between the ages of 10 and 19 (males: 51.2%; M_age = 15.00; DS = 0.975). Our findings showed that enjoyment was positively associated with concentration and, in turn, with time distortion. We also found significant positive effects of concentration and time distortion on problematic TikTok use. The effect of enjoyment, however, was non-significant, indicating that hedonic mood was not associated with problematic TikTok use. Out of the three moderated relationships examined in this study, only active parental control was found to be a significant moderator for the relationship between concentration and problematic TikTok use. The significant negative moderation result showed that as active parental mediation grows, the impact of adolescents' concentration on problematic TikTok use is reduced. Future research directions and implications are discussed.

Opposing associations of Internet Use Disorder symptom domains with structural and functional organization of the striatum: A dimensional neuroimaging approach

BACKGROUND

Accumulating evidence suggests brain structural and functional alterations in Internet Use Disorder (IUD). However, conclusions are strongly limited due to the retrospective case-control design of the studies, small samples, and the focus on general rather than symptom-specific approaches.

METHODS

We here employed a dimensional multi-methodical MRI-neuroimaging design in a final sample of n = 203 subjects to examine associations between levels of IUD and its symptom-dimensions (loss of control/time management, craving/social problems) with brain structure, resting state and task-based (pain empathy, affective go/no-go) brain function.

RESULTS

Although the present sample covered the entire range of IUD, including normal, problematic as well as pathological levels, general IUD symptom load was not associated with brain structural or functional alterations. However, the symptom-dimensions exhibited opposing associations with the intrinsic and structural organization of the brain, such that loss of control/time management exhibited negative associations with intrinsic striatal networks and hippocampal volume, while craving/social problems exhibited a positive association with intrinsic striatal networks and caudate volume.

CONCLUSIONS

Our findings provided the first evidence for IUD symptom-domain specific associations with progressive alterations in the intrinsic structural and functional organization of the brain, particularly of striatal systems involved in reward, habitual and cognitive control processes.

Gender differences in psychiatric comorbidity and personality characteristics among adults seeking treatment for problematic internet use

In the present study, we investigated gender differences in personality and psychiatric correlates among adults (N = 115) seeking treatment for problematic internet use (PIU) at a specialized clinic in São Paulo, Brazil. All participants were assessed at the beginning of their treatment for co-occurring psychiatric conditions, other addictive behaviors, and personality characteristics. Women (n = 20) were more likely to present with greater rates of psychiatric comorbidity compared to men (n = 95), including mood disorders, anxiety disorders, obsessive-compulsive disorder, post-traumatic stress disorder, and bulimia nervosa. Women also had a greater severity of certain behavioral addictions, such as compulsive buying and disordered eating. Gender differences were also found across personality characteristics, with women scoring higher on impulsivity, novelty seeking, and self-transcendence compared to men. To our knowledge, the present study is the first to investigate gender differences for PIU in a clinical sample. The results suggest that there are notable gender differences in individuals seeking treatment for PIU which underscores the importance of assessing for co-occurring conditions, especially in women. Understanding the characteristics associated with PIU can help serve to inform the most appropriate interventions to bolster treatment outcomes.

Investigating the Association Between Adolescent Internet Addiction and Parental Attitudes

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

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

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

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

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.

Prevalence of internet addiction in Africa: A systematic review and meta-analysis

BACKGROUND AND AIM

In the last two decades, the proportion of internet users has greatly increased worldwide. Data regarding internet addiction (IA) are lacking in Africa compared to other continents. This systematic review and meta-analysis aimed to estimate the pooled prevalence of IA in African countries.

METHODS

We systematically sought relevant articles in PubMed/MEDLINE, EMBASE, PsycINFO and Cochrane database published before September 25, 2021. The risk of bias was assessed using the Joanna Briggs Institute tool, and we estimated the pooled prevalence of IA using a random-effects meta-analytic model. We followed the Preferred Reporting Items for Systematic Reviews and Meta-analyses guidelines.

RESULTS

We included 22 studies (13,365 participants), and collected data from Egypt, Ethiopia, Morocco, Nigeria, South Africa, Tanzania and Tunisia between 2013 and 2021. The mean age of participants ranged from 14.8 to 26.1 years, and the most used tool for IA screening was the Young's 20-item Internet Addiction Test. The pooled prevalence rate of IA was 40.3% (95% CI: 32.2%-48.7%), with substantial heterogeneity. The pooled prevalence for Northern Africa was 44.6% (95% CI: 32.9%-56.7%), significantly higher than the prevalence in sub-Saharan Africa, which was 31.0% (95% CI: 25.2%-37.1%). The risk of bias was moderate for most studies, the certainty was very low, and we found no publication bias.

DISCUSSION AND CONCLUSIONS

Four in every ten individuals was considered to have IA in Africa. Further research with methodological optimization seems needed, especially for IA screening tools and the representativity of some subregions.

Internet Addiction among Brazilian Students: Prevalence and Association with Emotional Problems

The objective of this study was to evaluate the prevalence of Internet addiction (I.A.) among students and its association with emotional problems. A total of 2,214 students (M = 21.9; SD = 1.86) from all Brazilian regions responded to an online questionnaire and were classified according to the IAT instrument score in NRU= No-risk Users, LRU= Low-risk Users, and RHU= Risk and High-risk Users. DASS-21 measured emotional problems, and the data were analyzed using descriptive and inferential statistics. It was observed that 12.5% were classified as URAR and presented higher levels of depression (p< 0.001), anxiety (p< 0.001), and stress (p< 0.001). The main predictors for I.A. were depression (aOR = 3.2), anxiety (aOR = 2.5), and stress (aOR = 2.6). These results confirm an association between DI and emotional problems, as indicated in the literature.

A network analysis of the Internet Disorder Scale-Short Form (IDS9-SF): A large-scale cross-cultural study in Iran, Pakistan, and Bangladesh

The Internet Disorder Scale-Short Form (IDS9-SF) is a validated instrument assessing internet disorder which modified the internet gaming disorder criteria proposed in the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5). However, the relationships between the nine items in the IDS9-SF are rarely investigated. The present study used network analysis to investigate the features of the IDS9-SF among three populations in Bangladesh, Iran, and Pakistan. Data were collected (N = 1901; 957 [50.3%] females; 666 [35.0%] Pakistani, 533 [28.1%] Bangladesh, and 702 [36.9%] Iranians) using an online survey platform (e.g., Google Forms). All the participants completed the IDS9-SF. The central-stability-coefficients of the nine IDS9-SF items were 0.71, 0.89, 0.96, 0.98, 0.98, 1.00, 0.67, 0.79, and 0.91, respectively. The node centrality was stable and interpretable in the network. The Network Comparison Test (NCT) showed that the network structure had no significant differences among Pakistani, Bangladeshi, and Iranian participants (p-values = 0.172 to 0.371). Researchers may also use the IDS9-SF to estimate underlying internet addiction for their target participants and further explore and investigate the phenomenon related to internet addiction.

Supplementary Information

The online version contains supplementary material available at 10.1007/s12144-022-03284-8.

Internet Addiction and Its Associated Factors Among African High School and University Students: Systematic Review and Meta-Analysis

Introduction

Internet addiction is characterized by excessive and uncontrolled use of the internet affecting everyday life. Adolescents are the primary risk group for internet addiction. Data on internet addiction is lacking in Africa. Thus, this review aimed to determine the pooled prevalence of internet addiction and its associated factors among high school and university students in Africa.

Methods

A comprehensive literature search was conducted using electronic databases (PubMed/MEDLINE, Web of science, Hinari, and Google scholar) to locate potential studies. Heterogeneity between studies was checked using Cochrane Q test statistics and I2 test statistics and small-study effects were checked using Egger's statistical test at a 5% significance level. A sensitivity analysis was performed. A random-effects model was employed to estimate the pooled prevalence and associated factors of internet addiction among students. The primary outcome of measure of this review was the prevalence of internet addiction and the secondary outcome of measures are the factors associated with internet addiction.

Results

A total of 5,562 studies were identified among the five databases. Of these, 28 studies from 10 countries with 14,946 high school and university students were included in this review. The overall pooled prevalence of internet addiction among the students was 34.53% [95% Confidence Interval (CI): 26.83, 42.23, I2 = 99.20%]. Male sex [Pooled Odds Ratio (POR) = 1.92, 95% CI:1.43, 2.57 I2 = 0.00], urban residence (POR = 2.32, 95% CI:1.19, 4.53, I2 = 59.39%), and duration of daily internet use for more than 4 h (POR = 2.25, 95% CI:1.20, 4.21, I2 = 0.00%, were significantly associated with internet addiction among adolescents.

Conclusion

Almost one-third of university and high school students in Africa are addicted to the internet. Male students, those from urban areas, and those who use the internet for more than 4 h per day have higher odds of internet addiction. Thus, we recommend that health planners and policymakers pay attention to the use of the internet and internet addiction in Africa.

The Mediating Role of Emotion Dysregulation and Problematic Internet Use in the Relationship Between Negative Affect and Excessive Daytime Sleepiness: A Structural Equation Model

PURPOSE

The present study aimed to explore the mediating role of emotion dysregulation and problematic Internet use in the relationship between negative affect and excessive daytime sleepiness.

METHODS

This cross-sectional study included 664 Italian adults aged between 18 and 70 years (M = 32.13; SD = 11.71). Participants were asked to complete the Depression Anxiety Stress Scale, the Difficulties in Emotion Regulation Scale, the Compulsive Internet Use Scale-7, and the Epworth Sleepiness Scale to assess negative affect, emotion dysregulation, problematic internet use, and excessive daytime sleepiness, respectively.

RESULTS

According to our results there are significant associations between negative affect, emotion dysregulation, problematic Internet use, and daytime sleepiness. Moreover, the structural equation model showed good fit indices. Emotion dysregulation and problematic Internet use partially mediated the relationship between negative mood and excessive daytime sleepiness.

CONCLUSION

By exploring the role of emotion dysregulation on the association between excessive daytime sleepiness and its possible predictors, our study might represent an important step toward the implementation of psychological intervention for reducing excessive daytime sleepiness. Emotion dysregulation appears to play a significant role in explaining the relationship between negative affect, problematic Internet use, and excessive daytime sleepiness. Thus, it should be considered a treatment target for reducing excessive daytime sleepiness.

Self-Control and Problematic Internet Use in College Students: The Chain Mediating Effect of Rejection Sensitivity and Loneliness

Purpose

To explore the relationship between self-control, rejection sensitivity, loneliness, and problematic internet use in college students.

Patients and Methods

A total of 725 college students were investigated using Self-control Scale, Rejection Sensitivity Questionnaire, Loneliness Scale, and Internet Addiction Scale.

Results

① Correlation analysis showed that self-control was negatively related to rejection sensitivity, loneliness, and problematic internet use; rejection sensitivity was positively related to loneliness and problematic internet use; loneliness was positively related to problematic internet use. ② Chain mediating effect analysis showed that self-control can not only affect problematic internet use in college students, but also through three indirect paths, as follows: the mediating role of rejection sensitivity and loneliness, the chain mediating roles of rejection sensitivity and loneliness, and the mediating effect size, accounting for 9.76%, 20.73%, and 4.88% of the total effect, respectively.

Conclusion

Rejection sensitivity and loneliness played a chain mediating role in the relationship between self-control and problematic internet use in college students.

Relationship Between Big Five Personality and Pathological Internet Use: Mediating Effects of Loneliness and Depression

Pathological Internet use will have a serious impact on normal individual study and work and has become one of the most important factors hindering the growth and development of contemporary college students. The purpose of this study was to examine the mechanisms of loneliness and depression in the relationship between the Big Five personality traits and pathological Internet use (PIU). A total of 1,179 college students were studied using the Chinese version of the Big Five Personality Scale, Loneliness Scale, Depression Scale, and Pathological Internet Use Scale. The results showed that loneliness partially mediated the relationship between extraversion and PIU and completely mediated the relationship between agreeableness and PIU and neuroticism and PIU. Depression completely mediated the relationship between agreeableness and PIU, neuroticism completely mediated the relationship with PIU, and sense of responsibility partially mediated the relationship with PIU. This study revealed the relationship between different personality traits and PIU and the mediating role of loneliness and depression, suggesting that we should carry out targeted interventions on PIU for college students with different personality traits.

Impulsivity and Depressive Brooding in Internet Addiction: A Study With a Sample of Italian Adolescents During COVID-19 Lockdown

This contribution presents a study conducted on a sample of Italian adolescents (n = 411) in the period of the first COVID-19 lockdown. The study investigated the role and predictive weight of the impulsivity and depressive brooding variables on Internet addiction, using a hierarchical regression analysis. The participants were administered the Uso-Abuso e Dipendenza da Internet [Internet Use-Abuse and Addiction] (UADI-2), the Barratt Impulsiveness Scale-11 (BIS-11), and the Ruminative Response Scale (RRS). In terms of percentage distribution, 28% of the participants were in the full dependency range, while 34.7% demonstrated Internet abuse behavior. The results highlighted not only the predictive value of impulsiveness (β = 0.323) and ruminative thinking (β = 0.258), but also the role of gender (β = -0.205) on Internet addiction. Thus, male participants showed higher levels of Internet addiction, with higher scores on impulsiveness and brooding way of thinking. The study shows that the issue in question is significantly present among adolescents; in addition, not only targeted awareness programmes but also psycho-educational and clinical interventions to promote greater emotional and cognitive control would be necessary as a preventive and mitigating measure. Psychological interventions can help increase self-awareness, develop emotional regulation and impulse control, and correct maladaptive cognitions which in adolescents are mostly driven by a ruminative cognitive style.

Factors related to the dual condition of gambling and gaming disorders: A path analysis model

BACKGROUND AND AIMS

Gaming disorder has experienced rapid growth in the last decade among youth and adult populations, in parallel to the expansion of the videogame industry. The objective of this study was to explore the underlying process to explain the dual diagnosis of gaming with gambling disorder.

METHODS

The sample included n = 117 patients who met clinical criteria for gaming disorder, recruited from a tertiary care unit specialized in the treatment of behavioral addictions. Path analysis (implemented through structural equation modeling) assessed the direct and mediational mechanisms between the dual condition of gaming + gambling disorder and sociodemographic variables and personality traits.

RESULTS

The comorbid gaming + gambling disorder was met for 14.5% of the participants (additionally, 6.0% of the sample also met criteria for problematic gambling). The dual diagnosis was directly related to an older age at onset of the addiction problems, a higher level of the novelty seeking trait and being in active work. Employment status also mediated the relationship between persistence levels and chronological age. Greater psychopathological distress was related to females, higher levels of harm avoidance and persistence and lower levels of self-directedness.

CONCLUSIONS

The results of this study provide empirical evidence for the specific factors that increase the likelihood of the dual gaming + gambling disorder. Clinical settings should consider these features to improve gaming diagnosis and treatment. Preventive programs should also be focused on the most vulnerable groups to prevent onset and progression of this comorbid condition.

Validation of the Romanian Version of the Toronto Empathy Questionnaire (TEQ) among Undergraduate Medical Students

Medical professionals require adequate abilities to identify others’ emotions and express personal emotions. We aimed to determine the validity and reliability of an empathy measuring tool in medical students for this study. We employed Spreng’s Toronto Empathy Questionnaire (TEQ) as a starting point for this validation. The process was performed in several steps, including an English-Romanian-English translation and a focus group meeting to establish each question’s degree of understandability and usability, with minor improvements of wording in each step. We checked internal and external consistency in a pilot group (n = 67). For construct and convergent validity, we used a sample of 649 students. The overall internal and external reliability performed well, with Cronbach’s alpha = 0.727 and respective ICC = 0.776. The principal component analysis resulted in 3 components: prosocial helping behavior, inappropriate sensitivity, dismissive attitude. Component 1 includes positively worded questions, and components 2 and 3 include negatively worded questions. Women had significantly higher scores than men in convergent validity, but we did not highlight any differences for other demographic factors. The Romanian version of the TEQ is a reliable and valid tool to measure empathy among undergraduate medical students that may be further used in subsequent research.

Subtyping treatment-seeking gaming disorder patients

BACKGROUND AND AIMS

Gaming Disorder (GD) is characterized by a pattern of persistent and uncontrolled gaming behavior that causes a marked impairment in important areas of functioning. The evolution of the worldwide incidence of this disorder warrants further studies focused on examining the existence of different subtypes within clinical samples, in order to tailor treatment. This study explored the existence of different profiles of patients seeking treatment for GD through a data-driven approach.

METHODS

The sample included n = 107 patients receiving treatment for GD (92% men and 8% women) ranging between 14 and 60 years old (mean age = 24.1, SD = 10). A two-step clustering analysis approach explored the existence of different underlying GD profiles based on a broad set of indicators, including sociodemographic features, clinical course of the condition (e.g., onset or evolution), psychopathological symptoms, and personality traits.

RESULTS

Two GD profiles emerged. The first cluster grouped together patients who presented with a lower psychological impact (n = 72, 66.1%), whereas the second cluster comprised patients with a higher psychological impact (n = 35, 32.7%). Cluster comparisons revealed that those patients presenting the higher impact were older, with a later onset of pathological gaming patterns, and more pronounced psychopathological symptoms and dysfunctional personality profiles.

CONCLUSIONS

GD severity is influenced by specific demographic, clinical, and psychopathological factors. The identification of two separate profiles provides empirical evidence that contributes to the conceptualization of this disorder, as well as to the development of reliable and valid screening tools and effective intervention plans focused on the precise characteristics of the treatment-seeking patients.

The role of loneliness in university students' pathological Internet use - a web survey study on the moderating effect of social web application use

The present study investigated the role of social web application use in the association between loneliness and pathological Internet use. A sample of university students (n = 445) completed an online survey of their loneliness and Internet use, including an assessment of pathological Internet use level. Based on existing theory and empirical findings, loneliness was expected to be indirectly associated with pathological Internet use through social-compensatory Internet use motives. The strength of this indirect effect was hypothesized to be moderated by levels of social web application use. Results pointed to the specificity of social-compensatory use motives in mediating loneliness effects on pathological Internet use, while the size of these effects was moderated by quantity of social web application use. Findings suggest that lonely people with higher levels of social web activity show a stronger social-compensatory use orientation, which translates to higher levels of pathological Internet use. Implications and limitations of these findings are discussed and several suggestions for future studies are made.

Childhood emotional abuse and problematic social networking sites use in a sample of Italian adolescents: The mediating role of deficiencies in self-other differentiation and uncertain reflective functioning

OBJECTIVE

Childhood emotional abuse (CEA) is associated with various negative mental health outcomes. This study aimed to investigate the association between CEA and problematic social networking site (SNS) use in a sample of Italian adolescents.

DESIGN

Using structural equation modeling, the study examined whether the relationship between CEA and problematic SNS use was sequentially mediated by self-other differentiation and uncertain reflective functioning in 1308 Italian adolescents (628 males, age range 13-19 years).

RESULTS

A history of CEA was positively associated with problematic SNS use. Furthermore, deficiencies in self-other differentiation and uncertain reflective functioning partially mediated the relationship between CEA and problematic SNS use.

CONCLUSIONS

The present study provides additional insight into the psychological dynamics underpinning problematic SNS use among adolescents. The clinical implications of these findings are discussed.

Problematic Internet Use and Emotional Dysregulation Among Young People: A Literature Review

OBJECTIVE

In recent years scientific interest in Internet use disorders, especially among young people, has grown dramatically. Within this contemporary research field, difficulties in regulating emotions have been increasingly explored in association with problematic Internet use (PIU). Indeed, individuals who experience difficulties in emotion regulation might be more exposed to the risk of developing PIU. Therefore, the present study aimed to review the literature from the last ten years focused on the relationship between young people's emotional dysregulation and PIU, taking into account the main variables involved in this relationship and possible gender-related differences.

METHOD

This review included studies published between 2010 and 2020 that were indexed in major databases with the following keywords: emotion regulation, problematic Internet use, Internet addiction, social network addiction, and social media addiction. In the selection process of the studies, close attention was paid for the mean age of the involved samples that had to range between 13 and 25 years.

RESULTS

A total of 23 studies satisfied the initial inclusion criteria and were included in the present literature review. Several reviewed studies found a strong association between emotion dysregulation and both PIU and problematic social networking with controversial gender-based findings. Furthermore, the relationships among emotional dysregulation, PIU, attachment styles, and metacognitions were largely explored.

CONCLUSIONS

Overall, the present review showed that problematic Internet use might represent a coping strategy to compensate for emotional regulation deficits. The lack of social support and the lack of a good parent-adolescent relationship seem to negatively affect emotional regulation abilities, which in turn increase the risk of developing PIU. Moreover, good metacognitive abilities might represent a protective factor towards emotional dysregulation and PIU. Finally, males with emotional dysregulation are likely to be more problematically engaged in Internet use than females. These results might have important practical implications to implement health prevention/promotion programs, emotion regulation-based training programmes and therapies.

Involvement of DAT1 Gene on Internet Addiction: Cross-Correlations of Methylation Levels in 5'-UTR and 3'-UTR Genotypes, Interact with Impulsivity and Attachment-Driven Quality of Relationships

Internet influences our communication, social and work interactions, entertainment, and many other aspects of life. Even if the original purpose was to simplify our lives, an excessive and/or maladaptive use of it may have negative consequences. The dopamine transporter (DAT1) gene was studied in relation to addictions, including excessive use of the Internet. The crucial role of DAT1 was previously underlined in modulating emotional aspects, such as affiliative behaviors. The present research follows a new approach based on cross-correlation between (de)methylation levels in couples of CpG loci, as previously shown. We investigated the possible relationships between Internet addiction, impulsivity, quality of attachment, DAT1 genotypes (from the 3'-untranslated region (UTR) variable number of tandem repeats (VNTR) poly-morphism), and the dynamics of methylation within the 5'-UTR of the DAT1 gene. From a normative sample of 79 youths, we extrapolated three subgroups a posteriori, i.e., one "vulnerable" with high Internet Addiction Test (IAT) scores (and high Barrat Impulsivity Scale (BIS) scores; n = 9) and two "controls'' with low BIS scores and 10/10 vs. 9/x genotype (n = 12 each). Controls also had a "secure" attachment pattern, while genotypes and attachment styles were undistinguished in the vulnerable subgroup (none showed overt Internet addiction). We found a strongly positive correlation in all groups between CpG2 and CpG3. An unsuspected relationship between the 3'-UTR genotype and a 5'-UTR intra-motif link was revealed by CpG5-CpG6 comparison. The negative correlation between the CpG3-CpG5 positions was quite significant in the control groups (both with genotype 10/10 and with genotype 9/x), whereas a tendency toward positive correlation emerged within the high IAT group. In conclusion, future attention shall be focused on the intra- and inter-motif interactions of methylation on the CpG island at the 5'-UTR of DAT1.

Predictive utility of the brief Screener for Substance and Behavioral Addictions for identifying self-attributed problems

BACKGROUND AND AIMS

The Brief Screener for Substance and Behavioral Addictions (SSBAs) was developed to assess a common addiction construct across four substances (alcohol, tobacco, cannabis, and cocaine), and six behaviors (gambling, shopping, videogaming, eating, sexual activity, and working) using a lay epidemiology perspective. This paper extends our previous work by examining the predictive utility of the SSBA to identify self-attributed addiction problems.

METHOD

Participants (N = 6,000) were recruited in Canada using quota sampling methods. Receiver Operating Characteristics (ROCs) analyses were conducted, and thresholds established for each target behavior's subscale to predict self-attributed problems with these substances and behaviors. For each substance and behavior, regression models compared overall classification accuracy and model fit when lay epidemiologic indicators assessed using the SSBA were compared with validated screening measures to predict selfattributed problems.

RESULTS

ROC analyses indicted moderate to high diagnostic accuracy (Area under the curves (AUCs) 0.73-0.94) across SSBA subscales. Thresholds for identifying self-attributed problems were 3 for six of the subscales (alcohol, tobacco, cannabis, cocaine, shopping, and gaming), and 2 for the remaining four behaviors (gambling, eating, sexual activity, and working). Compared to other instruments assessing addiction problems, models using the SSBA provided equivalent or better model fit, and overall had higher classification accuracy in the prediction of self-attributed problems.

DISCUSSION AND CONCLUSIONS

The SSBA is a viable screening tool for problematic engagement across ten potentially addictive behaviors. Where longer screening tools are not appropriate, the SSBA may be used to identify individuals who would benefit from further assessment.

Internet Addiction, Oral Health Practices, Clinical Outcomes, and Self-Perceived Oral Health in Young Saudi Adults

The study assessed the relationship between Internet addiction and oral health practices and clinical outcomes and whether this was affected by oral health perception. In 2017, a cross-sectional study included university students in the Eastern Province of Saudi Arabia. Questionnaires assessed demographic background, oral health practices (consuming sugar, tobacco use, and oral hygiene), perceived oral health, and Internet addiction. Caries experience and gingivitis were assessed using the World Health Organization criteria. The multivariate general linear analysis assessed the relationship between dependent variables (oral health practices, DMFT, and gingivitis) and exposure (Internet addiction). Data were available for 919 participants, 75.4% females, mean age = 19.8 years, and 1.6% with significant Internet use problem. The mean percentage of teeth with gingivitis was 8.5% and mean DMFT was 2.9. Among those with good perception of oral health and compared with participants with significant Internet use problem, average Internet users had lower consumption of sugar and tobacco (B = -6.52, P = 0.03 and B = -2.04, P = 0.03), better oral hygiene practices (B = 2.07, P = 0.33), higher DMFT (B = 2.53, P = 0.10), and lesser gingivitis (B = -15.45, P = 0.06). Internet addiction was associated with negative oral health practices and poor clinical outcomes among young Saudis. Holistic health promotion approaches need to address the negative impact of Internet addiction on health and oral health status for this at-risk age group.

Reactions to Problematic Internet Use Among Adolescents: Inappropriate Physical and Mental Health Perspectives

Although numerous studies have examined the factors influencing problematic Internet use (PIU), few studies have investigated the interactions between inappropriate physical and mental health (e.g., cyberbullying, Internet pornography, and Internet fraud) as factors facilitating PIU and examined the moderating effect of community bond. Thus, this study analyzed the moderating role of community bond in the relationship between cyberbullying, Internet pornography, Internet fraud, and PIU. Using a cross-sectional survey, adolescents were surveyed through self-report questionnaires. A total of 5,211 responses were received from participant students at 60 senior high schools in Taiwan. Statistical analyses were performed using structural equation modeling. The results indicated that cyberbullying, Internet pornography, Internet fraud, and community bond have significant positive effects on PIU. Community bond has a significant moderating effect in the relationship between cyberbullying, Internet fraud, and the PIU of adolescents. Parental Internet attitude and behavior were found to significantly moderate the relationship between inappropriate physical and mental health, community bond, and PIU. The results suggest that public health and education policies should focus more on adolescents who require additional assistance. Furthermore, school policies could be more informed in regard to relevant psychosocial variables and patterns of Internet use. Finally, this study may serve as a reference for parents, schools, and government education authorities.

Problematic Internet Use in Lonely Adolescents: The Mediating Role of Detachment from Parents

OBJECTIVE

The relationship between Problematic Internet Use (PIU) and loneliness in adolescence is a disputed issue. In the current study, we explored whether the relationship between loneliness and PIU in adolescence is mediated by detachment from parents.

METHOD

A community sample of 356 adolescents completed self-report questionnaires assessing Internet addiction symptoms, peer- and parent-related loneliness, and detachment from parents. Linear regression and mediation analyses were performed to explore the role of loneliness and detachment from parents in predicting PIU.

RESULTS

Peer-related loneliness positively predicted PIU, whereas detachment from parents fully mediated the association between parent-related loneliness and PIU.

CONCLUSIONS

Multidimensional assessment of subjective solitary experience is needed to explain the relationship between loneliness and PIU in adolescence. This is in line with previous research on adolescents' PIU, suggesting that peer-related loneliness is more strictly related with maladjustment, whereas parent-related loneliness is maladaptive in the context of a lack of parental support.

Psychological effects of cognitive behavioral therapy on internet addiction in adolescents: A systematic review protocol

BACKGROUND

In this study, we aim to assess the psychological effects of cognitive behavioral therapy (CBT) on internet addiction (IA) in adolescents.

METHODS

This study will search the following databases of Cochrane Library, PUBMED, EMBASE, Scopus, Web of Science, PsycINFO, Chinese Biomedical Literature Database, and China National Knowledge Infrastructure. All these electronic databases will be searched from inception to the September 30, 2019 without any language limitation. Two authors will conduct study selection, data extraction, and study quality assessment, respectively. Any disagreements between 2 authors will be solved by a third author through discussion. Statistical analysis will be performed using RevMan 5.3 software.

RESULTS

This study will investigate the psychological effects of CBT on IA in adolescents by measuring psychopathological symptoms, depression, anxiety, time spent on the internet (hours/day), and health-related quality of life.

CONCLUSION

This study summarizes current evidence of CBT on IA in adolescents and may provide guidance for both intervention and future researches.PROSPERO registration number: PROSPERO CRD42019153290.

Internet addiction disorder detection of Chinese college students using several personality questionnaire data and support vector machine

With the unprecedented development of the Internet, it also brings the challenge of Internet Addiction (IA), which is hard to diagnose and cure according to the state-of-art research. In this study, we explored the feasibility of machine learning methods to detect IA. We acquired a dataset consisting of 2397 Chinese college students from the University (Age: 19.17 ± 0.70, Male: 64.17%) who completed Brief Self Control Scale (BSCS), the 11th version of Barratt Impulsiveness Scale (BIS-11), Chinese Big Five Personality Inventory (CBF-PI) and Chen Internet Addiction Scale (CIAS), where CBF-PI includes five sub-features (Openness, Extraversion, Conscientiousness, Agreeableness, and Neuroticism) and BSCS includes three sub-features (Attention, Motor and Non-planning). We applied Student's t-test on the dataset for feature selection and Support Vector Machines (SVMs) including C-SVM and ν-SVM with grid search for the classification and parameters optimization. This work illustrates that SVM is a reliable method for the assessment of IA and questionnaire data analysis. The best detection performance of IA is 96.32% which was obtained by C-SVM in the 6-feature dataset without normalization. Finally, the BIS-11, BSCS, Motor, Neuroticism, Non-planning, and Conscientiousness are shown to be promising features for the detection of IA.

Maladaptive Personality Functioning and Psychopathological Symptoms in Problematic Video Game Players: A Person-Centered Approach

BACKGROUND

A need exists to increase our understanding of the association between maladaptive personality traits, psychopathological symptoms, game preference, and different types of video game use. In the present study, we used a person-centered approach to identify different subtypes of video game players and we explored how they differ in personality profiles, clinical symptoms, and video game usage.

METHODS

We assessed problematic gaming via the nine-item Internet Gaming Disorder Scale and self-reported screen time playing video games in a sample of 366 adolescents and young adult gamers. Participants also completed measures on maladaptive personality domains (Personality Inventory for DSM-5 Brief Form), alexithymia (Toronto Alexithymia Scale-20 items), and psychopathological symptoms (DSM-5 Self-Rated Level 1 Cross-Cutting Symptom Measure) and reported which genre of video games they preferred.

RESULTS

Using a person-centered, cluster-analytic approach, we identified four clusters of video game players (Occasional, Passionate, Preoccupied, and Disordered) presenting peculiar combinations of problematic gaming scores and time spent online playing video games. Non-problematic gamers (Occasional and Passionate) represented the majority of the sample (62.3% of the participants). Highly involved gamers who exhibited excessive screen time playing video games (Disordered gamers) presented the highest level of maladaptive personality traits and psychopathological symptoms, and were characterized by the greatest use of Multiplayer Online Battle Arena (MOBA) games.

CONCLUSION

These results have clinical implications on suggesting the importance to determining whether or not problematic gaming activities reflect a dysfunctional emotion-focused coping strategy to avoid inner unpleasant emotional or a more generally compromised emotional and social functioning.

The Relationship Between Adolescents' Stress and Internet Addiction: A Mediated-Moderation Model

This cross-sectional study explored the impact of stress, social anxiety, and social class on Internet addiction among adolescents. The subjects-1,634 middle school students-were investigated using the Chinese Perceived Stress Scale (CPSS), the Social Anxiety Scale for Adolescents (SAS-A) Chinese Short Form, the Chinese Internet Addiction Scale (CIAS), and the Questionnaire of Family Social-economic Status. The results show that 12% of the adolescents investigated showed signs of Internet addiction. With the increase of grade, the tendency of Internet addiction and the number of addicts gradually increased. It also showed that Internet addiction is positively correlated with stress and social anxiety and negatively correlated with social class. Social anxiety partially mediates the impact of stress on Internet addiction and social class indirectly influences Internet addiction by moderating the relationship between stress and social anxiety. In conclusion, there is a mediated-moderation effect between stress and adolescent Internet addiction This means that adolescents from different social classes have different types of anxiety when they feel the stress, which influences their choices concerning internet use.

Magic Mirror on the Wall: Selfie-Related Behavior as Mediator of the Relationship Between Narcissism and Problematic Smartphone Use

OBJECTIVE

Recent research has suggested that problematic smartphone use is associated with several psychological factors and that mobile apps and smartphone-related behavior (i.e. selfie behavior) may encourage the development of problematic smartphone use. However, little is known about how the interplay between dysfunctional personality characteristics and selfie-related behavior can influence problematic smartphone use. The aim of this study was to examine the relationship between narcissism and problematic smartphone use, as well as the mediating role of selfie-related behavior in this relationship among young men and women.

METHOD

In the current study, a total of 627 undergraduate students (283 males and 344 females) completed a cross-sectional survey. A structural equation model was tested separately for males and females in order to evaluate the associations between narcissism, selfie-related behavior and problematic smartphone use.

RESULTS

The results showed that greater narcissism was related to increased selfie-related behavior, which in turn were positively associated with problematic smartphone use both for males and females. However, selfie-related behavior mediated the relationship between narcissism and problematic smartphone use only for females.

CONCLUSIONS

The study provides fresh insight into our understanding of the psychological mechanisms underlying problematic smartphone use, which may inform prevention and treatment interventions.

Association Between Internet Addiction and the Risk of Musculoskeletal Pain in Chinese College Freshmen - A Cross-Sectional Study

BACKGROUND

It is well established that increased internet use is related to an increased risk of musculoskeletal pain among adolescents. The relationship between internet addiction (IA), a unique condition involving severe internet overuse, and musculoskeletal pain has, however, not been reported. This study aimed to investigate the association between IA and the risk of musculoskeletal pain among Chinese college students.

METHODS

A cross-sectional study was conducted among 4211 Chinese college freshmen. IA status was evaluated using the 20-item Young's Internet Addiction Test (IAT). IA was defined as internet addiction score ≥50 points. Musculoskeletal pain was assessed using a self-reported questionnaire. Multiple logistic regression analysis was performed to determine association between IA categories (normal, mild, and moderate-to-severe) and musculoskeletal pain.

RESULTS

Among all participants; neck, shoulder, elbow, wrist/hand, and low back and waist pain was reported by 29.2, 33.9, 3.8, 7.9, and 27.9%, respectively. The prevalence of IA was 17.4%. After adjusting for potential confounders, the results showed significant differences in the risk of musculoskeletal pain among different IA categories. The odds ratios (ORs) and 95% confidence intervals (CI) for neck pain with IA categories were 1.000 (reference), 1.451 (1.221, 1.725), and 1.994 (1.608, 2.473), respectively (P for trends: < 0.001). For shoulder pain, these were 1.000 (reference), 1.520 (1.287, 1.795), and 2.057 (1.664, 2.542), respectively (P for trends: < 0.001). For elbow pain, ORs (95% CIs) were 1.000 (reference), 1.627 (1.016, 2.605), and 2.341 (1.382, 3.968), respectively (P for trends: 0.001). Those for wrist/hand pain were 1.000 (reference), 1.508 (1.104, 2.060), and 2.236 (1.561, 3.202), respectively (P for trends: < 0.001). For low back and waist pain with severe IA categories, these were 1.000 (reference), 1.635 (1.368, 1.955), and 2.261 (1.813, 2.819), respectively (P for trends: < 0.001).

CONCLUSION

This cross-sectional study showed that severe IA was associated with a higher risk of musculoskeletal pain in Chinese college freshmen. In future research, it will be necessary to explore causality regarding this relationship using interventional studies.

Neurobiological Risk Factors for the Development of Internet Addiction in Adolescents

The sudden appearance and spread of Internet addiction in adolescent populations, in association with the rapid escalation of consumed Internet content and the broad availability of smartphones and tablets with Internet access, is posing a new challenge for classical addictology which requires urgent solutions. Like the majority of other psychopathological conditions, pathological Internet addiction depends upon a group of multifactor polygenic conditions. For each specific case, there is a unique combination of inherited characteristics (nervous tissue structure, secretion, degradation, and reception of neuromediators), and many are extra-environment factors (family-related, social, and ethnic-cultural). One of the main challenges in the development of the bio-psychosocial model of Internet addiction is to determine which genes and neuromediators are responsible for increased addiction susceptibility. This information will herald the start of a search for new therapeutic targets and the development of early prevention strategies, including the assessment of genetic risk levels. This review summarizes the literature and currently available knowledge related to neurobiological risk factors regarding Internet addiction in adolescents. Genetic, neurochemical and neuroimaging data are presented with links to actual pathogenetic hypotheses according to the bio-psychosocial model of IA forming.

Attachment and behavioral addictions in adolescents: The mediating and moderating role of coping strategies

Gambling, video gaming, and Internet use are typically included as everyday activities that could potentially become behavioral addictions. There is growing evidence that views non-substance related addictions as coping mechanisms, and considers that attachment styles are likely to play a pivotal role on the development of such addictions, especially on young people. Therefore, the present study aimed to: (1) explore the association between attachment, coping, and behavioral addictions (i.e., gambling disorder, video game addiction, and problematic Internet use); and (2) to analyze the mediating/moderating effect that coping has in the relationship of attachment and these behavioral addictions. A sample consisting of 472 students from secondary education (Mean age = 15.6; SD = 1.33; 51.6% females) was recruited. The findings showed a negative association between attachment and behavioral addictions. Most coping strategies were found to be associated with attachment styles, except for self-critique and emotional avoidance. In particular, problem avoidance was significantly correlated to all behavioral addictions. In addition, self-blame and problem solving were significantly correlated to video game addiction and problematic Internet use. Finally, coping was found to act as a mediator and moderator between attachment and video game addiction and problematic Internet use.

Sensation Seeking, Deviant Peer Affiliation, and Internet Gaming Addiction Among Chinese Adolescents: The Moderating Effect of Parental Knowledge

Although there is abundant evidence that an association between sensation seeking and adolescent Internet gaming addiction (IGA) exists, research has provided little insight into why adolescents with high sensation seeking are more likely to be focused on Internet and video games. Grounded in the social development model and ecological systems theory, this study investigated whether deviant peer affiliation mediated the relationship between sensation seeking and adolescent IGA, and whether this indirect link was moderated by parental knowledge. Participants were 1293 Chinese adolescents (49.65% male, M_age = 12.89 ± 0.52 years) who completed questionnaires assessing sensation seeking, deviant peer affiliation, parental knowledge, and IGA. Structural equation models revealed that the positive association between sensation seeking and adolescent IGA was partially mediated by deviant peer affiliation. In addition, this indirect link was significantly moderated by parental knowledge. Specifically, the indirect path from sensation seeking to adolescent IGA was stronger for adolescents with low parental knowledge than for those with high parental knowledge. Identifying the role of peers and parents in the onset of adolescent IGA has key implications for prevention and intervention.

Is the Clinical Version of the Iowa Gambling Task Relevant for Assessing Choice Behavior in Cases of Internet Addiction?

Objective: A critical issue in research related to the Iowa gambling task (IGT) is the use of the alternative factors expected value and gain-loss frequency to distinguish between clinical cases and control groups. When the IGT has been used to examine cases of Internet addiction (IA), the literature reveals inconsistencies in the results. However, few studies have utilized the clinical version of IGT (cIGT) to examine IA cases. The present study aims to resolve previous inconsistencies and to examine the validity of the cIGT by comparing performances of controls with cases of Internet gaming disorder (IGD), a subtype of IA defined by the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders. Methods: The study recruited 23 participants with clinically diagnosed IGD and 38 age-matched control participants. Based on the basic assumptions of IGT and the gain-loss frequency viewpoint, a dependent variables analysis was carried out. Results: The results showed no statistical difference between the two groups in most performance indices and therefore support the findings of most IGT-IA studies; in particular, expected value and gain-loss frequency did not distinguish between the IGD cases and controls. However, the participants in both groups were influenced by the gain-loss frequency, revealing the existence of the prominent deck B phenomenon. Conclusion: The findings provide two possible interpretations. The first is that choice behavior deficits do not constitute a characteristic feature of individuals who have been diagnosed with IGD/IA. The second is that, as the cIGT was unable to distinguish the choice behavior of the IGD/IA participants from that of controls, the cIGT may not be relevant for assessing IGD based on the indices provided by the expected value and gain-loss frequency perspectives in the standard administration of IGT.

ACTonHEALTH study protocol: promoting psychological flexibility with activity tracker and mHealth tools to foster healthful lifestyle for obesity and other chronic health conditions

Background

Obesity and the state of being overweight are increasing steadily and becoming a global epidemic. Recent research reports 64% of the adult population as overweight in Europe and the USA. The social and economic impacts are increasing, and most of the rehabilitation programs, while effective in the short term, do not produce long-lasting results. An explanatory model from a behavioral perspective can describe the phenomena with the lack of sources of reinforcement related to healthful habits in a daily life context.

Methods/design

A randomized clinical trial combining single-subject studies and a four-arm group design will be conducted to compare the effect of the current standard in obesity treatment to Acceptance and Commitment Therapy (ACT) and wearable technology at different times, before starting intervention, at the end, and at follow-up visits of 3, 6, and 12 months measuring changes over time of physical activity and psychological well-being.

Discussion

The goal of this project, combining ACT and wearable technology, is to develop an effective intervention, efficient and sustainable, which even after discharge can provide adequate contingencies of reinforcement in the natural environment, integrating systematic measurements, continuous feedback, and individualized, values-based objectives. The intervention is aimed to provide a contingent reinforcement for healthful behaviors instead of reinforcing only the achievement of a significant weight loss.

The aim of the project, combining Acceptance and Commitment Therapy and Wearable Technology, is to develop an effective, efficient and sustainable intervention able to provide a contingent reinforcement for healthy behaviors. The intervention is aimed to promote adequate healthy behaviors in the natural environment, integrating systematic measurements, continuous feedback and individualized values-based objectives, instead of reinforcing only the achievement of a significant weight loss.

Trial registration

ClinicalTrials.gov, NCT03351712. Registered on 24 November 2017.

Electronic supplementary material

The online version of this article (10.1186/s13063-018-2968-x) contains supplementary material, which is available to authorized users.

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.

Relationships Between Social Support, Loneliness, and Internet Addiction in Chinese Postsecondary Students: A Longitudinal Cross-Lagged Analysis

Using the Internet has become one of the most popular leisure activities among postsecondary students in China. Concern about the large number of students using the Internet has led to an increase in research on the influencing factors of Internet addiction and the negative consequences caused by it. This short-term longitudinal study examined the associations among three dimensions of social support [objective support (OS), subjective support (SS), and support utilization (SU)], loneliness, and the four dimensions of Internet addiction (compulsive Internet use [CIU] & withdrawal from Internet addiction [WIA], tolerance of Internet addiction [TIA], time-management problems [TMPs], and interpersonal and health problems [IHPs]) in a Chinese sample. A total of 169 postsecondary first-year students (88 girls and 81 boys; mean age = 18.31 years) participated in the study. The questionnaire measurements were taken at the beginning of the school year (T1), 6 months later (T2), and 1 year later (T3). Cross-lagged and structural equation modeling analyses indicated that (a) OS (T1) and SU (T1) negatively predicted loneliness (T2); and loneliness (T2) negatively predicted OS (T3) and SU(T3); (b) CIU & WIA (T1) and TMPs (T1) positively predicted loneliness (T2); and loneliness (T2) positively predicted CIU & WIA (T3), TIA (T3), TMP (T3), and IHP (T3); (c) SS (T1) directly affected TIA (T3) and TMP (T3); and (d) loneliness (T2) played a mediating role in the relationships between OS (T1) and CIU (T3), OS (T1) and TMP (T3), OS (T1) and IHP (T3), and SU (T1) and IHP (T3). Finally, interventions for Internet addiction and implications for future studies were discussed.

Personality and Cognition in Gamers: Avoidance Expectancies Mediate the Relationship Between Maladaptive Personality Traits and Symptoms of Internet-Gaming Disorder

Internet-gaming disorder (IGD) has become a clinically relevant phenomenon worth investigating with respect to its mechanisms of development and maintenance. Considering theoretical models of specific Internet-use disorders, we assumed an interaction of maladaptive personality traits as unspecific predisposing factors and experience-based, gaming-related Internet-use expectancies in predicting symptoms of IGD. Therefore, 103 male and female regular Internet gamers were investigated with questionnaires assessing maladaptive personality traits in accordance to DSM-5, gaming-related positive and avoidance Internet-use expectancies, and symptoms of IGD. The results demonstrated that negative affectivity, detachment, antagonism, disinhibition, psychoticism as well as gaming-related positive and avoidance expectancies were related to symptoms of IGD. Moreover, the relationship between maladaptive personality traits as represented by negative affectivity, detachment, and psychoticism with symptoms of IGD was mediated by avoidance expectancies. Positive gaming-related use expectancies were related to detachment, and were not a significant mediator in the hypothesized model. The findings give reason to assume that maladaptive personality traits in combination with gaming-related positive expectancies and avoidance expectancies are important factors for the development of IGD, but that positive expectancies and avoidance expectancies play a differential role regarding there mediating role between personality characteristics and symptoms of IGD.

Internet Addiction among Adolescents May Predict Self-Harm/Suicidal Behavior: A Prospective Study

OBJECTIVE

To explore the role of Internet addiction in the development of self-harm/suicidal behavior among adolescents after 1-year of follow-up.

STUDY DESIGN

We conducted this 1-year, prospective cohort study of 1861 adolescents (mean age 15.93 years) attending a senior high school in Taiwan; 1735 respondents (93.2%) were classified as having no history of self-harm/suicidal attempts in the initial assessment and were referred to as the "noncase" cohort. The Chen Internet Addiction Scale was used to identify individuals with Internet addiction. The participants were evaluated for self-harm/suicidal behavior again 1 year later and the "noncase" cohort was selected for statistical analysis. To examine the relationship between Internet addiction and self-harm/suicidal behavior, multivariate logistic regression analysis was performed using Internet addiction at baseline as the predictor for newly developed self-harm/suicidal behavior in the next year, after adjustment for potential confounding variables.

RESULTS

The prevalence rate of Internet addiction at baseline was 23.0%. There were 59 students (3.9%) who were identified as having developed new self-harm/suicidal behaviors on follow-up assessments. After controlling for the effects of potential confounders, the relative risk of newly emerging self-harm/suicidal behavior for participants who were classified as Internet addicted was 2.41 (95% CI 1.16-4.99, P = .018) when compared with those without Internet addiction.

CONCLUSIONS

Our findings indicate that Internet addiction is prospectively associated with the incidence of self-harm/suicidal behavior in adolescents.