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

Smartphone use, wellbeing, and their association in children

BACKGROUND

This study assessed changes in the duration of smartphone use, problematic smartphone use (PSU), quality of life, and their association from 2018 to 2024 in children and adolescents.

METHODS

Data were collected between 2018 and 2024 within the LIFE Child cohort study (Germany). We used a repeated cross-sectional dataset containing 2576 data points of 1113 10- to 17-year-old children and adolescents (51% male) who had reported on their quality of life, PSU, and their smartphone use duration. Hierarchical regression analyses were applied to assess associations of PSU, smartphone use duration, and quality of life with the year of assessment and associations of PSU and smartphone use duration with quality of life.

RESULTS

From 2021 onwards, symptoms of PSU and smartphone use durations >3 h/day were significantly more frequent than in 2018. For PSU, these changes were significantly stronger in girls and younger children. Concurrently, quality of life was significantly poorer than in 2018. Both PSU and long smartphone usage durations were significantly associated with lower quality of life.

CONCLUSIONS

This study shows the increasingly problematic use of smartphones and its negative association with the overall declining quality of life of children over the last seven years.

IMPACT

Problematic smartphone use in children and adolescents has increased in the last seven years, while quality of life has decreased. Problematic smartphone use is associated with decreased quality of life, and this association was especially strong in 2022 and 2023. In contrast to previous studies, the present time trend analysis covers time periods before and within the Covid-19 pandemic and suggests that the pandemic has reinforced the observed changes in smartphone use and quality of life. Restricting children's smartphone use might help to improve or maintain a higher quality of life.

Stigma in substance-based and behavioural addictions: A systematic review

Background and Aims

The study of stigma contributes greatly to our understanding of individuals' experiences of mental disorders. Addictive disorders are often associated with public misconceptions of the disorder, which can contribute to shame, discrimination, and reticence to seek help. This review aimed to: (1) evaluate the nature, frequency, and prevalence of addiction stigma; (2) identify the correlates of addiction stigma; and (3) examine the psychometric qualities of addiction stigma measures.

Methods

A search of Web of Science, PubMed, Scopus, PsycINFO, and PsycNet, had 5,515 results which were screened for eligibility using Covidence. Eligible papers were quantitative, peer-reviewed studies, which reported an outcome variable of stigma related to an addiction.

Results

A total of 99 studies were included in the review, including 70 studies of substance-based addictions, 19 studies of behavioral addictions, and 10 studies which examined both. Thirteen of the 20 studies examining the impact of familiarity with addiction reported that greater familiarity was associated with lower public stigma. Studies comparing substance and behavioral addictions (n = 5) typically reported greater public stigma towards vignettes depicting substance-based addictions than for behavioral addictions. Between 22% and 40% of individuals with an addictive disorder identified stigma as a significant barrier to seeking help; however, the relative importance of stigma among other barriers was unclear.

Discussion and Conclusions

Evidence for countermeasures to prevent and/or reduce stigma is currently limited. Further research on the nature and prevalence of addiction stigma is needed to inform the development of effective clinical and public health countermeasures.

Internalized weight stigma and psychological distress mediate the association of perceived weight stigma with food addiction among young adults: A cross-sectional study

BACKGROUND

Perceived weight stigma (PWS) and internalized weight stigma (IWS) are both associated with psychological distress and food addiction (FA). Using the previously proposed 'cyclic obesity/weight-based stigma' (COBWEBS) model, the present study extended the framework to investigate the mediating effects of IWS and psychological distress in the association between PWS and FA among young adults. Given that individuals who are overweight/have obesity have different vulnerabilities, this population was separately analyzed alongside the total study population.

METHODS

An online survey comprising the Perceived Weight Stigma Scale, Weight Bias Internalization Scale (WBIS), Depression, Anxiety and Stress Scale-21 (DASS-21), and modified Yale Food Addiction Scale Version 2 was completed by 601 participants (59.6% females; mean age 29.3 years [SD = 6.07]). A total of 219 participants were categorized as being overweight/having obesity.

RESULTS

A direct correlation was found between PWS and FA (standardized coefficient [β] = 0.28, p < 0.001) among both populations, and was mediated by IWS and psychological distress (β [95% CI] = 0.03 [0.01, 0.05] for WBIS score and 0.10 [0.06, 0.14] for DASS-21 score) among the total participants, but only mediated by psychological distress among participants who were overweight/had obesity (β [95% CI] = 0.14 [0.06, 0.24]).

CONCLUSIONS

The results demonstrated novel perspectives by showing the direct association between PWS and FA and the mediating roles of IWS and psychological distress. Treatment strategies such as psychological acceptance and psychoeducation could be used to reduce weight stigma, which could have positive downstream benefits of ameliorating FA. Future research may seek to study strategies for reducing weight stigma and psychological distress, to investigate their efficacy in improving disordered eating.

A longitudinal study of child adjustment during the COVID-19 pandemic: the protective role of the parent-child relationship in middle childhood

This longitudinal study assessed how parent-child relationship quality during the first COVID-19 lockdown was related to changes in internalizing, externalizing, and sleep problems during the first months of the pandemic: during lockdown, partial deconfinement, and total deconfinement. Participants included 167 children (9-12 year) and their parents recruited in the province of Quebec, Canada. Child behavior problems decreased between lockdown and the two deconfinement assessments, but more sleep and behavior problems were associated with lower levels of relationship quality (more conflict, less closeness, and more insecure attachment). Significant interaction effects showed that changes in externalizing and sleep problems varied as a function of parent-child relationship. Results support the critical importance of the parent-child relationship with regard to child adjustment in middle childhood in times of crisis such as a pandemic. They also highlight resilience in children aged 9 to 12, with a decrease in problems over time.

Chinese version of the Tendency to Avoid Physical Activity and Sport (TAPAS) scale: testing unidimensionality, measurement invariance, concurrent validity, and known-group validity among Taiwanese youths

BACKGROUND AND OBJECTIVES

Psychosocial factors affect individuals' desire for physical activity. A newly developed instrument (Tendency to Avoid Physical Activity and Sport; TAPAS) has been designed to assess the avoidance of physical activity. Considering cultural differences could be decisive factors, the present study aimed to translate and validate the TAPAS into Chinese (Mandarin) for Taiwanese youths, and further cultural comparisons are expected.

METHODS

Standard translation procedure (i.e., forward translation, back translation, and reconciliation) was used to translate the English TAPAS into the Chinese TAPAS. Following translation, 608 youths (mean [SD] age 29.10 [6.36] years; 333 [54.8%] women) participated in the study via a snowballing sampling method with an online survey. All participants completed the Chinese TAPAS and additional instruments assessing weight stigma and psychological distress. Confirmatory factor analysis (CFA) was used to examine the factor structure of the Chinese TAPAS and multigroup CFA to examine measurement invariance across gender (men vs. women) and weight status (overweight vs. non-overweight). Pearson correlations were used to examine the concurrent validity; independent t-tests between gender groups and weight status groups were used to examine the known-group validity.

RESULTS

Consistent with the English version, the Chinese TAPAS was found to have a one-factor structure evidenced by CFA results. The structure was invariant across gender and weight status groups evidenced by multigroup CFA results. Concurrent validity was supported by significant associations with the related constructs assessed (r = 0.326 to 0.676; p < 0.001). Known-group validity was supported by the significant differences in TAPAS total scores between gender and weight status groups (p = 0.004 and < 0.001; Cohen's d = 0.24 and 0.48).

CONCLUSION

The Chinese version of the TAPAS is a valid and reliable instrument assessing individuals' avoidance of physical activity and sports due to underlying psychosocial issues among Taiwanese youths. It is anticipated to be applied within a large Asian population, as well as cross-cultural comparisons, for further explorations in health, behavioral and epidemiological research and practice.

Association between problematic social networking use and anxiety symptoms: a systematic review and meta-analysis

A growing number of studies have reported that problematic social networking use (PSNU) is strongly associated with anxiety symptoms. However, due to the presence of multiple anxiety subtypes, existing research findings on the extent of this association vary widely, leading to a lack of consensus. The current meta-analysis aimed to summarize studies exploring the relationship between PSNU levels and anxiety symptoms, including generalized anxiety, social anxiety, attachment anxiety, and fear of missing out. 209 studies with a total of 172 articles were included in the meta-analysis, involving 252,337 participants from 28 countries. The results showed a moderately positive association between PSNU and generalized anxiety (GA), social anxiety (SA), attachment anxiety (AA), and fear of missing out (FoMO) respectively (GA: r = 0.388, 95% CI [0.362, 0.413]; SA: r = 0.437, 95% CI [0.395, 0.478]; AA: r = 0.345, 95% CI [0.286, 0.402]; FoMO: r = 0.496, 95% CI [0.461, 0.529]), and there were different regulatory factors between PSNU and different anxiety subtypes. This study provides the first comprehensive estimate of the association of PSNU with multiple anxiety subtypes, which vary by time of measurement, region, gender, and measurement tool.

Scoping review: longitudinal effects of the COVID-19 pandemic on child and adolescent mental health

The COVID-19 pandemic and associated containment measures have massively changed the daily lives of billions of children and adolescents worldwide. To investigate the global longitudinal effects on various mental health outcomes over a period of 1.5 years, we conducted a scoping review in accordance with the guidelines of the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews (PRISMA-ScR). We included the peer-reviewed articles from PubMed, Web of Science, and APA PsycInfo that were published between December 2019 and December 2021, followed a longitudinal or repeated cross-sectional design, and quantitatively assessed with clinical questionnaires the effect of the COVID-19 pandemic or a related stressor on mental health indicators in community samples of children and adolescents.The results of our qualitative analysis of 69 studies indicate a general trend of less psychological well-being and more mental health problems, such as heightened stress, and depressive and anxiety symptoms during the pandemic. Data suggest that both protection measure intensity and infection dynamics were positively associated with severity of the psychopathology. The most reported influencing factors were age, gender, socio-economic status, previous state of mental and physical health, self-regulation abilities, parental mental health, parenting quality, family functioning, social support, isolation and loneliness, health-related worries, and consistent routines and structure. Our results demonstrate that children and adolescents worldwide have experienced more mental health problems due to the COVID-19 pandemic. They call for improved access to child and adolescent mental health care and prioritisation of child and adolescent welfare in political decision making.

Effects of Long COVID on Psycho-Physical Conditions in the Italian Population: A Statistical and Large Language Model Combined Description

BACKGROUND

Long COVID refers to the persistence or development of signs and symptoms well after the acute phase of COVID-19.

OBJECTIVE OF THE STUDY

To investigate the long-term outcomes of the SARS-CoV-2 infection in terms of psychological, social, and relational consequences within the Italian population.

MATERIALS AND METHODS

We conducted an observational, cross-sectional, and multicenter study using an online questionnaire distributed to a sample of the Italian population. By utilizing the Short Form 12 Health Survey (SF-12) and the Hikikomori scale, we assessed perceived quality of life and social isolation, respectively. The questionnaire also included an open-answer question: "What will you remember about the pandemic period?". We used generative artificial intelligence to analyze and summarize the corresponding answers.

RESULTS

A total of 1097 people participated in this study. A total of 79.3% (n = 870) of participants declared that they had been hospitalized and 62.8% (n = 689) received home care. Physical symptoms included headaches (43%, n = 472) and asthma (30.4%, n = 334). Additionally, 29.2% (n = 320) developed an addiction during the pandemic and, among these, 224 claimed internet addiction while 73 declared an emotional addiction. Furthermore, 51.8% (n = 568) experienced limitations in carrying out daily life activities. According to the Hikikomori scale, participants with positive SARS-CoV-2 infection exhibited higher levels of isolation compared to the others (p < 0.001). Participants without COVID-19 showed higher levels of emotional support (p < 0.001). Our semiautomatic analysis of the open-ended responses, obtained by a procedure based on a free large language model, allowed us to deduce and summarize the main feelings expressed by the interviewees regarding the pandemic.

CONCLUSIONS

The data collected emphasize the urgent need to investigate the consequences of long COVID in order to implement interventions to support psychological well-being.

The "bubbles"-study: Validation of ultra-short scales for the assessment of depression, anxiety and stress symptoms

Depression, anxiety and stress symptoms cause substantial psychological and economic burdens around the globe. To mitigate the negative consequences, the negative symptoms should be identified at an early stage. Therefore, the implementation of very brief valid screening tools in mental health prevention programs and in therapeutic settings is advantageous. In two studies on representative German population samples, we developed and validated three ultra-short scales-the "bubbles"-that consist of only one item based on the Depression Anxiety Stress 21 subscales (DASS-21) for the assessment of depression, anxiety and stress symptoms. The results of Study 1 (N = 1,001) and Study 2 (N = 894) revealed that the bubbles are valid instruments that fit the DASS-21 subscales on the factor level. Moreover, the bubbles replicated the association pattern of the DASS-21 subscales with demographic variables, and with variables that belong to the negative and the positive dimension of mental health. Thus, due to their time- and cost-efficiency, the bubbles can be used as brief screening tools in research (e.g., large-scale studies, longitudinal studies, experience sampling paradigms) and in praxis. Their shortness can prevent fatigue, motivation decrease, and participants' drop-out.

Problematic Use of Internet Associates with Poor Quality of Life via Psychological Distress in Invididuals with ADHD

BACKGROUND

Problematic use of internet (PUI) may have negative impacts on psychological distress and quality of life (QoL). This situation might be more profound in people with attention-deficit/hyperactivity disorder (ADHD) due to poorer behavioral control and regulatory capacity. However, there is little evidence regarding mediated effects in the associations between PUI, psychological distress, and QoL in people with ADHD.

AIMS

To investigate mediating effects of psychological distress in the associations of problematic smartphone use (PSPU), problematic use of social media (PUSM), and problematic gaming (PG) with QoL in individuals with ADHD.

METHODS AND PROCEDURES

PUI behaviors of participants with ADHD (n = 99) were assessed using the Smartphone Application-Based Addiction Scale, Bergen Social Media Addiction Scale, and Internet Gaming Disorder-Short Form. Psychological distress was assessed using the Depression, Anxiety, Stress Scale and QoL using the Kid-KINDL.

OUTCOMES AND RESULTS

Psychological distress mediated the associations between PUI and different domains of QoL, except for self-esteem QoL. There were also positively direct effects between PG and physical QoL, PUSM and friends' QoL, and PSPU and physical QoL.

CONCLUSIONS AND IMPLICATIONS

PUI may associate with poor QoL in people with ADHD via psychological distress. Programs on reducing PUI for people with ADHD are needed.

Conventional weight loss therapy in morbid obesity during COVID-19 pandemic: degree of burdens at baseline and treatment efficacy

Introduction

COVID-19 affected global physical and psychological health. The purpose of this study was to explore the pandemics impact on health-related quality of life (HRQoL), mental health (anxiety, depression, and perceived stress) and eating behavior in people with severe obesity participating in a multimodal conservative behavioral weight loss (BWL) program conducted via videoconferencing. Additionally, the efficacy of the six-month BWL program in a virtual video-based setting during the pandemic was examined.

Methods

297 participants of a face-to-face multimodal behavioral weight loss program prior to the pandemic (PrePAN, May 2014-September 2019) and 146 participants of the in terms of content same intervention in a videoconference-based setting during the pandemic (PAN, July 2020-April 2022) were questioned and compared using standardized questionnaires for HRQoL, symptoms of depressive and anxiety disorders, perceived stress, and eating behavior at baseline and at the end of treatment.

Results

Symptoms for anxiety, depression and perceived stress were similar between PrePAN and PAN at baseline. In addition, PAN tended to show lower disinhibition of eating behavior and feelings of hunger than PrePAN. During the pandemic, the BWL intervention resulted in body weight loss (67%) or stabilization (16%) in most of the participants. It also contributed by improving physical HRQoL, lower worries, and improved eating behaviors compared to baseline.

Conclusion

During the COVID-19 pandemic, baseline mental health of people with morbid obesity was not worse than before the pandemic. Additionally, the BWL intervention in the virtual video-based setting stabilized and improved physical and mental health during the COVID-19 pandemic.

A phubbing scale tested in Bangladesh, Iran, and Pakistan: confirmatory factor, network, and Rasch analyses

BACKGROUND

Phubbing, a phenomenon of ignoring others in face-to-face conversations due to mobile phone use, can be assessed using a Phubbing Scale (PS). Recently, the PS has been shortened into an eight-item version, the PS-8. However, psychometric properties of the PS-8 among Iranian, Bangladeshi and Pakistani individuals remain understudied, especially using advanced psychometric testing, such as Rasch and network analyses.

METHODS

Participants residing in Iran, Bangladesh, and Pakistan (n = 1902; 50.4% females; mean age = 26.3 years) completed the PS-8 and the Internet Disorder Scale-Short Form (IDS9-SF) via an online survey. Network analysis was used to examine if PS-8 items were differentiated from IDS9-SF items; confirmatory factor analysis (CFA) was used to examine the factor structure and measurement invariance of the PS-8; Rasch modeling was used to examine the dimensionality of the PS-8 and differential item functioning (DIF).

RESULTS

Network analysis showed that PS-8 items were clustered together with a distance to the IDS9-SF items. The CFA results supported a two-factor structure of the PS-8, and the two-factor structure was found to be invariant across countries and women and men. Rasch model results indicated that the two PS-8 subscales were both unidimensional and did not display DIF across countries and gender/sex.

CONCLUSION

The PS-8 is a feasible and robust instrument for healthcare providers, especially mental health professionals, to quickly assess and evaluate individuals' phubbing behaviors.

Psychometric properties of the Persian Gaming Disorder Test and relationships with psychological distress and insomnia in adolescents

BACKGROUND

Gaming Disorder (GD) was recently included by the World Health Organization (WHO) as a psychiatric condition in the eleventh revision of the International Classification of Diseases (ICD-11) and is a concern worldwide, including in Iran. Thus, based on the ICD-11 criteria, a Persian version of the Gaming Disorder Test (GDT) was developed to facilitate assessment of GD.

METHODS

The present study used classical test theory and Rasch analysis to examine the psychometric properties of the Persian GDT. Iranian adolescents (n = 3837; 2171 [56.6%] males; mean [SD] age = 16.02 [1.4] years) completed the GDT and other instruments assessing disordered gaming, psychological distress, and insomnia.

RESULTS

Overall, the psychometric properties of the Persian GDT were satisfactory based on classical test theory (i.e., confirmatory factor analysis corroborated the unidimensional structure of GDT) and Rasch analysis (i.e., fit statistics suggested that all items were embedded in the concept of GD). Moreover, the Persian GDT was found to be sex-invariant, displaying no items with substantial differential item functioning across sexes. Additionally, it was found that GD mediated associations between time spent gaming and measures of psychological distress and insomnia.

CONCLUSION

The Persian GDT is a convenient and short instrument for assessing GD among Iranian adolescents. The mediating roles of GD in the associations between time spent gaming and psychological distress and between time spent gaming and insomnia suggest that targeting features of GD may reduce psychological distress and improve sleep for Iranian adolescents.

The relationship between loneliness and problematic smartphone use among adolescents during the COVID-19 pandemic: The mediating role of negative emotions and maladaptive coping

INTRODUCTION

Given the observed increased feelings of loneliness and problematic smartphone use among adolescents during the COVID-19 pandemic, further research was needed to determine whether and how the increased loneliness of adolescents during such major public health crisis events affects the risk of problematic smartphone use among adolescents. This study aimed to examine the relationship between loneliness and problematic smartphone use among Chinese adolescents (aged 10-16 years) during the COVID-19 pandemic and to investigate the possible mediating role of negative emotions and maladaptive coping.

METHODS

A total of 672 Chinese adolescents (Mage  = 13.05, SD = 1.51, 50.4% boys, 93.8% from rural areas, 22.5% of whom were only children) took part in this cross-sectional study in April 2022 by completing the Chinese adolescent version of the Loneliness Scale, the Positive and Negative Affect Scale (subscale), the Ways of Coping Questionnaire, and the Mobile Phone Addiction Index Scale.

RESULTS

The serial mediation model revealed that negative emotions and maladaptive coping independently mediated the relationship between adolescents' loneliness and problematic smartphone use. In addition, the mediation effects of "negative emotions-maladaptive coping" could also mediate the relationship between loneliness and problematic smartphone use.

CONCLUSIONS

Loneliness may be positively related to problematic smartphone use through negative emotions and maladaptive coping among adolescents during major public health crisis events, such as the COVID-19 pandemic.

Problematic social media use and mental health risks among first-year Chinese undergraduates: a three-wave longitudinal study

Introduction

The association between social media use and mental health risks has been widely investigated over the past two decades with many cross-sectional studies reporting that problematic social media use (PSMU) is associated with higher mental health risk such as anxiety and depression. The present study examined the relationship between PSMU severity and mental health risks (depression, anxiety, stress, and loneliness) using a three-wave longitudinal design.

Methods

A total of 685 first-year Chinese undergraduate students (Mean age = 19.12 years, SD = 0.92) completed surveys at three times points with intervals of 3 to 4 months. Results revealed that PSMU was positively correlated with all the mental health risk variables over the three time points.

Results

The prevalence of PSMU increased over the three research waves. Cross-lagged models identified bi-directional relationships between PSMU and mental health risks, while such links were not consistent between different mental health risk variables and can change over different research intervals.

Discussion

This study indicates that PSMU and mental health risks could predict each other in a vicious loop, but the differences between specific mental health risks and the research context (e.g., different term times and experiences in university) should not be ignored. Further research attention should be paid to the prevalence of PSMU and mental health conditions among Chinese first-year undergraduates who appear to have difficulties in adapting to university life.

COVID-19 Restrictions Resulted in Both Positive and Negative Effects on Digital Media Use, Mental Health, and Lifestyle Habits

While studies have reported effects on digital media during the COVID-19 restrictions, few have included data prior to the pandemic, and most have only measured screen time. We therefore investigated changes in specific digital media activities, as well as mental health and lifestyle habits, in a longitudinal study of adolescents spanning from before the pandemic (T1) to one month into restrictions (T2) and one year later when schools had reopened (T3). Adolescents (16-19 years) rated smartphone use, problematic/addictive media use, negative experiences (e.g., victimization), mental health (i.e., irritability, stress, and closeness), and protective lifestyle habits (i.e., sleep and exercise). Results showed initial decreases in irritability and negative digital experiences, increases in sleep and exercise, as well as a decrease in closeness during remote learning (T2). However, these changes returned to, or superseded, their initial levels at follow-up (T3). There were also increases in digital media use and stress at T3. Conclusively, by investigating specific digital media activities and collecting data both prior to and during different phases of the pandemic, we were able to find both positive and negative effects.

The effect of time spent sitting and excessive gaming on the weight status, and perceived weight stigma among Taiwanese young adults

BACKGROUND

During the COVID-19 pandemic, physical inactivity and sedentary behaviors (i.e., longer sitting time and excessive gaming) increased because governments across the globe adopted stringent mitigation strategies such as social distancing and lockdowns to curb the spread of the virus. Excessive gaming was one of the coping mechanisms used to deal with the pressure associated with the pandemic. Moreover, perceived weight stigma (PWS) and weight status became more salient concerns among young adults during the COVID-19 pandemic. The current study sought to investigate the relationship between time spent sitting, excessive gaming, weight status, and PWS of Taiwanese Young adults. Additionally, weight status and PWS were examined as mediators between both sedentary behaviors.

METHODS

This cross-sectional study involved 600 participants who were recruited through Taiwan universities. All participants completed a demographic questionnaire (including weight and height) and self-report measures including the International Physical Activity Questionnaire short form (IPAQ-SF), the Perceived Weight Stigma Scale (PWSS), and the Internet Gaming Disorder Scale-short form (IGDS9-SF). PROCESS model was performed to test the potential mediation roles of weight status and PWS. Moreover, we categorized participants into two groups based on the sitting-time item in the IPAQ-SF: students whose sitting time was less than 8 h daily, and those more than 8 h daily.

RESULTS

The group that had less than 8 h had significantly higher PWS and IGDS9-SF scores than the other group. Sitting time was negatively associated with weight status, PWS, and IGDS9-SF. Additionally, we found a significantly direct effect between time spent sitting and excessive gaming. Both weight status and PWS were significant mediators in the association between time spent sitting and excessive gaming.Conclusions: The present study demonstrated important negative correlates of excessive sedentary behaviors. Prevention efforts should focus on promoting physical activity and providing information to decrease sedentary behavior among university students.

Factors Associated with Psychosocial Symptoms Experienced by Students in Response to COVID-19 Pandemic: A Multivariate Analysis

The COVID-19 pandemic has significantly impacted many sectors, including the education sector. After in-person school activities were suspended due to the pandemic, a number of educational institutions in Indonesia reported concerns in implementing online learning due to the institutions' unpreparedness. This issue may potentially induce mental health disorders among students and triggers long-term stress. This study aimed to examine factors linked to the psychosocial symptoms of anxiety, stress, and depression in response to the early stage of the COVID-19 pandemic. An online cross-sectional study in Indonesia was conducted with 433 undergraduate and senior high school students aged 15 to 26 years old, both female and male. The self-reported symptoms were analyzed using both bivariate and multivariate linear regression methods. It was found that the percentage of participants with depression symptoms was 66%, while 61% and 43% participants experienced stress and anxiety respectively. The bivariate analysis presented strong correlations between anxiety and gender, learning duration and use of gadgets, internet expenses, and highly-interrupted learning. Furthermore, the multivariate regression revealed that only anxiety was significantly linked to internet expenses. This study indicates that many students are affected by COVID-19, the impacts of which manifest in psychosocial issues in the form of anxiety. We suggest that creating a supportive and positive family environment would help to alleviate some of these issues.

A bidirectional association between smartphone addiction and depression among college students: A cross-lagged panel model

Background

Smartphone addiction (SA) is associated with adverse consequences, especially for freshmen. Evidence indicates that SA is associated with depression, and it is necessary to conduct a longitudinal study to explore the association further.

Methods

SA (measured by the Smartphone Addiction Scale-Short Version) and depression (measured by the Zung's Self-Rating Depression Scale) among 1,186 freshmen were surveyed at baseline and a respective 12-month follow-up for each participant. The application of a cross-lagged panel model approach (CLPM) revealed an association between SA and depression after adjusting for demographic variables.

Results

The CLPM results showed a significant path from baseline SA to follow-up depression (β = 0.08, P < 0.001) and a significant path from baseline depression to follow-up SA (β = 0.08, P < 0.001). Compared with the overall cross-lagged model, the cross-lagged coefficient of the path from baseline SA to follow-up depression increased in the female group (β = 0.10, P = 0.015), and the cross-lagged coefficient of the path from baseline depression to follow-up SA also increased significantly (β = 0.15, P < 0.001). In contrast, the cross-lagged model in the male group showed no predictive effect between SA and depression (P > 0.05).

Conclusions

The current study showed a significant bidirectional association between smartphone addiction and depression among freshmen, but only in the female population.

A Systematic Overview of Adolescents’ Smartphone Habits and Internet Addiction During the COVID-19 Era

In order to prevent the spread of the virus during the Covid-19 epidemic period, measures such as maintaining social distance, quarantine practices, and keeping schools closed have been taken in many countries. In this process, individuals' internet use has also increased in order to restore interpersonal relationships that have decreased with staying at home. In addition, the transfer of educational activities, which are risky to be carried out face-to-face during the epidemic period, to online platforms, as in many countries, brought about an increase in the time spent on devices with internet providers in adolescents. For this reason, it is important to evaluate the results of studies examining the concepts of internet and smartphone addiction in relation to the use of the internet in the Covid-19 period. In this context, in this systematic review, "What is the status of adolescents' smartphone and internet addictions in the Covid-19 Era?" The question has been tried to be answered. As a result of the searches made in the databases, fourteen studies were reached and these studies were examined in depth. The findings showed that adolescents’ internet/smartphone addictions were higher than before the epidemic, the prevalence of internet/smartphone addictions increased in general, and internet/smartphone addictions were associated with adolescents' mental disorders and problems.

Distance learning during the COVID-19 pandemic for children with ADHD and/or ASD: a European multi-center study examining the role of executive function deficits and age

BACKGROUND

One of the COVID-19 pandemic consequences that has affected families the most is school lockdowns. Some studies have shown that distance learning has been especially challenging for families with a child with neurodevelopmental disorders such as ADHD or ASD. However, previous studies have not taken the heterogeneity of these disorders into account. The aim of the present study was therefore to investigate differences between families with a child with ADHD, ASD, or both conditions, and to examine the role of underlying deficits in executive functioning (EF) in both children and parents in relation to negative and positive effects of distance learning.

METHODS

Survey data assessing both negative and positive experiences of distance learning were collected from parents with a child aged 5-19 years in seven Western European countries: the UK, Germany, Spain, Sweden, the Netherlands, Italy, and Belgium. Altogether, the study included 1010 families with a child with ADHD and/or ASD and an equally large comparison group of families with a child without mental health problems. We included measures of three different types of negative effects (i.e., effects on the child, effects on the parent, and lack of support from school) and positive effects on the family.

RESULTS

Results confirmed that families with a child with ADHD, ASD or a combination of ADHD and ASD showed higher levels of both negative and positive effects of distance learning than the comparison group. However, few differences were found between the clinical groups. Group differences were more pronounced for older compared to younger children. Regarding the role of both ADHD/ASD diagnosis and EF deficits, primarily children's EF deficits contributed to high levels of negative effects. Parent EF deficits did not contribute significantly beyond the influence of child EF deficits. Families of children with ADHD/ASD without EF deficits experienced the highest levels of positive effects.

CONCLUSIONS

School closings during COVID-19 have a major impact on children with EF problems, including children with neurodevelopmental disorders. The present study emphasizes that schools should not focus primarily on whether a student has a neurodevelopmental disorder, but rather provide support based on the student's individual profile of underlying neuropsychological deficits.

Children's mobile-gaming preferences, online risks, and mental health

This study examined the relationships between children's mobile gaming preferences, online risks, and mental health. Data were obtained from a sample of 2,702 third and fourth grade students from 16 elementary schools in Taiwan and 9 schools in China. A self-administered questionnaire was used. The mental state of the children who participated in the study was assessed using the Strengths and Difficulties Questionnaire (SDQ), while mobile gaming addiction was assessed using the short form of the Internet Gaming Disorders Scale (IGDS9-SF). The results showed that about 54% of children played mobile games with others (multi-player), while 31% played mobile games alone, and 15% did not play mobile games. Multiple logistic regression results indicated that behaviors such as participating in multi-player games, playing violent games, a poor parent-child relationship, and living in a rural area were associated with a greater risk of mobile gaming addiction. Involvement in multi-player games, playing violent games, mobile gaming addiction, and exposure to mobile violence/pornography were associated with greater risks of cyber aggression/victimization. Multiple regression results showed that being a multi-player, playing violent games, mobile gaming addiction, exposure to violence/pornography, exposure to cyber aggression/victimization, and having a poor parent-child relationship were associated with emotional and behavioral problems.

Problematic use of the Internet in low- and middle-income countries before and during the COVID-19 pandemic: a scoping review

People from low- and middle-income countries (LMICs) represent large portions of the world population, often occupy less favorable living conditions, and typically suffer greater health risks, yet frequently receive little research and global health attention. The present study reviews emerging evidence on problematic use of the Internet (PUI) in LMICs prior/during the COVID-19 pandemic. Analyzed studies mainly focused on general properties of PUI in university students, problematic gaming in youth, or problematic use of social media in adults, registering higher prevalence estimates, as compared with earlier reports. Research mainly focused on initially affected regions and COVID-exposed populations. Overall, unfavorable circumstances, including poor social support, family relationships, and lifestyle tendencies/habits, may present potential risk for PUI in LMICs, likely exacerbated during the pandemic.

Problematic Internet Use among Adolescents 18 Months after the Onset of the COVID-19 Pandemic

Studies in recent years and especially since the beginning of the COVID-19 pandemic have shown a significant increase in the problematic use of computer games and social media. Adolescents having difficulties in regulating their unpleasant emotions are especially prone to Problematic Internet Use (PIU), which is why emotion dysregulation has been considered a risk factor for PIU. The aim of the present study was to assess problematic internet use (PIU) in adolescents after the third wave (nearly 1.5 years after the onset in Europe) of the COVID-19 pandemic. In the German region of Siegen-Wittgenstein, all students 12 years and older from secondary-level schools, vocational schools and universities were offered a prioritized vaccination in August 2021 with an approved vaccine against COVID-19. In this context, the participants filled out the Short Compulsive Internet Use Scale (SCIUS) and two additional items to capture a possible change in digital media usage time and regulation of negative affect due to the COVID-19 pandemic. A multiple regression analysis was performed to identify predictors of PIU. The original sample consisted of 1477 participants, and after excluding invalid cases the final sample size amounted to 1268 adolescents aged 12-17 (x = 14.37 years, SD = 1.64). The average prevalence of PIU was 43.69%. Gender, age, digital media usage time and the intensity of negative emotions during the COVID-19 pandemic were all found to be significant predictors of PIU: female gender, increasing age, longer digital media usage time and higher intensity of negative emotions during the COVID-19 pandemic were associated with higher SCIUS total scores. This study found a very high prevalence of PIU among 12- to 17-year-olds for the period after the third wave of the COVID-19 pandemic, which has increased significantly compared to pre-pandemic prevalence rates. PIU is emerging as a serious problem among young people in the pandemic. Besides gender and age, pandemic-associated time of digital media use and emotion regulation have an impact on PIU, which provides starting points for preventive interventions.

The social and mental impact on healthcare workers: A comparative and cross-sectional study during two waves of the COVID-19 pandemic in Taiwan

The coronavirus disease 2019 (COVID-19) pandemic has caused a heavily burden on healthcare workers (HCWs) worldwide. The aim of this study was to compare differences in psychological and social impact between two waves of the pandemic among first- and second-line HCWs in Taiwan. The current study derived data from two cross-sectional surveys conducted in 2020 and 2021. Levels of depression, sleep disturbance, psychological distress, social impact, and demographic variables were collected through self-reported questionnaires. The independent t test was used to compare differences in scores between the first and second wave of the pandemic. Differences between first- and second-line HCWs were also analyzed. A total of 711 HCWs in the first wave and 560 HCWs in the second wave were recruited. For the first- and second-line HCWs, the social impact during the second wave was higher than during the first wave, and they expressed a higher intention to maintain social distancing and were more aware of the pandemic overseas in the second wave. The first-line HCWs had a trend of worse sleep quality during the second wave. In addition, sleep quality was worse in the first-line HCWs than in the second-line HCWs during both waves. The second-line HCWs expressed a greater desire to seek COVID-19-related information than the first-line HCWs during the first wave, and more intended to maintain social distancing during the second wave. Our results show the importance of evaluating the social and mental health burden of HCWs, and especially first-line workers.

COVID-19 related information seeking: The impact of media on parental concerns

The expansion of information sources and their use has accelerated since the beginning of the COVID-19 pandemic, sometimes provoking significant concern in the daily lives of parents. The objective of this study was to investigate the association between COVID-19 related information sources and the level of concern about COVID-19 among parents of school-aged children. Using factor analysis and hierarchical ascending classification, we constructed groups according to the information sources they used. We performed ANOVA analysis and then binomial logistic regression to compare concern levels among the groups created. Overall, the 3,459 participants were mainly women (79.2%) and 59.5% reported being between 35 and 44 years old. The mean concern score in our sample was 9.5/15 (s.d. = 3.87). The whole sample fell into three groups: (1) Traditional Media (n = 1,610), who mainly used newspapers; (2) Online Social Networks and Entourage (n = 776), who mostly consulted online social media as well as friends and family; and (3) the Unplugged (n = 1,073), who consulted few or no information sources. Compared to the Unplugged, individuals in the other two groups had a higher risk of being concerned (Traditional Media, OR = 2.2; p < 0.001; Social Networks and Entourage, OR = 3.1; p < 0.001). Communication about pandemic risk should be conveyed based on reliable information and at moderate intervals to safeguard the mental health of individuals.

Associations of Problematic Internet Use, Weight-Related Self-Stigma, and Nomophobia with Physical Activity: Findings from Mainland China, Taiwan, and Malaysia

Insufficient physical activity is a common problem for university students because they may engage in sedentary lifestyle owing to excessive time spent on their smartphones and social media use. This may result in problematic internet use (PIU) and nomophobia (fear of not having a mobile phone). Moreover, prior evidence shows that weight-related self-stigma is an important factor contributing to low physical activity. Therefore, the present study examined the associations between PIU, nomophobia, and physical activity among university students across mainland China, Taiwan, and Malaysia. Participants (3135 mainland Chinese, 600 Taiwanese, and 622 Malaysian) completed the Bergen Social Media Addiction Scale (BSMAS), Smartphone Application-Based Addiction Scale (SABAS), Nomophobia Questionnaire (NMPQ), Weight Self-Stigma Questionnaire (WSSQ), and International Physical Activity Questionnaire Short Form (IPAQ-SF). The measurement invariance of the assessed questionnaires was supported across the three regions. The present findings analyzed using partial least squares structural equation modeling showed that (i) greater nomophobia was associated with higher levels of physical activity, (ii) greater weight-related self-stigma was associated with higher levels of physical activity, and (iii) greater nomophobia was associated with greater weight-related self-stigma. Although the present findings suggest the possibility that experiencing some level of nomophobia or weight-related self-stigma appears to help improve physical activity, it is not recommended that these be encouraged, but reducing PIU should be targeted as a means to improve physical activity.

Estimation of Behavioral Addiction Prevalence During COVID-19 Pandemic: A Systematic Review and Meta-analysis

Purpose of Review

The COVID-19 pandemic changed people’s lifestyles and such changed lifestyles included the potential of increasing addictive behaviors. The present systematic review and meta-analysis aimed to estimate the prevalence of different behavioral addictions (i.e., internet addiction, smartphone addiction, gaming addiction, social media addiction, food addiction, exercise addiction, gambling addiction, and shopping addiction) both overall and separately.

Recent Findings

Four databases (PubMed, Scopus, ISI Web of Knowledge, and ProQuest) were searched. Peer-reviewed papers published in English between December 2019 and July 2022 were reviewed and analyzed. Search terms were selected using PECO-S criteria: population (no limitation in participants’ characteristics), exposure (COVID-19 pandemic), comparison (healthy populations), outcome (frequency or prevalence of behavioral addiction), and study design (observational study). A total of 94 studies with 237,657 participants from 40 different countries (mean age 25.02 years; 57.41% females). The overall prevalence of behavioral addiction irrespective of addiction type (after correcting for publication bias) was 11.1% (95% CI: 5.4 to 16.8%). The prevalence rates for each separate behavioral addiction (after correcting for publication bias) were 10.6% for internet addiction, 30.7% for smartphone addiction, 5.3% for gaming addiction, 15.1% for social media addiction, 21% for food addiction, 9.4% for sex addiction, 7% for exercise addiction, 7.2% for gambling addiction, and 7.2% for shopping addiction. In the lockdown periods, prevalence of food addiction, gaming addiction, and social media addiction was higher compared to non-lockdown periods. Smartphone and social media addiction was associated with methodological quality of studies (i.e., the higher the risk of boas, the higher the prevalence rate). Other associated factors of social media addiction were the percentage of female participants, mean age of participants, percentage of individuals using the internet in country, and developing status of country. The percentage of individuals in the population using the internet was associated with all the prevalence of behavioral addiction overall and the prevalence of sex addiction and gambling addiction. Gaming addiction prevalence was associated with data collection method (online vs. other methods) that is gaming addiction prevalence was much lower using online methods to collect the data.

Summary

Behavioral addictions appeared to be potential health issues during the COVID-19 pandemic. Healthcare providers and government authorities should foster some campaigns that assist people in coping with stress during COVID-19 pandemics to prevent them from developing behavioral addictions during COVID-19 and subsequent pandemics.

Supplementary Information

The online version contains supplementary material available at 10.1007/s40429-022-00435-6.

Game-related behaviors among children and adolescents after school closure during the COVID-19 pandemic: A cross-sectional study

Aim

Increased exposure to digital gaming content among youth in recent years has raised serious health concerns. Social restrictions such as school closures, imposed worldwide because of the ongoing COVID-19 pandemic, may increase exposure to gaming and lead to addictive gaming behavior in young people. In this study, we investigated gaming behaviors among Japanese students during COVID-19 school closures.

Methods

Students completed questionnaires regarding their living conditions, game-related behaviors, diagnosis of Internet addiction, psychological difficulties, and the impact of the COVID-19 pandemic. We compared differences between the responses of potentially at risk for gaming disorder (potentially at risk for gaming disorder; defined in this paper with reference to the ICD-11 MMS criteria for gaming disorder [PGD]) students who met the criteria for a diagnosis of gaming disorder in ICD-11 MMS and those of control students. Logistic regression analysis was performed to predict the extent of factors contributing to potential gaming disorder.

Results

Four thousand and forty-eight participants completed the survey. Compared with control students (93%), potentially at risk for gaming disorder (defined in this paper with reference to the ICD-11 MMS criteria for gaming disorder, PGD) students (7%) reported playing games for longer times, spending more money on in-game purchases, were of younger age at the start of game playing, showed a tendency toward Internet dependence, practised school avoidance or absenteeism, and demonstrated the need for psychological support. Moreover, participants in the PGD group reported more anxiety about COVID-19 than control participants, as well as an increase in game-playing time and amount of money spent on games during the COVID-19 pandemic.

Conclusion

These results indicate that young people classified as having a gaming disorder not only exhibit characteristic game-related behaviors but may be psychologically and socially vulnerable and need special support, especially during the ongoing COVID-19 pandemic.

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.

Does Smartphone Addiction, Social Media Addiction, and/or Internet Game Addiction Affect Adolescents' Interpersonal Interactions?

The purpose of this study is to investigate the correlations that levels of addiction to smartphones, social media, and online games have with levels of real-life and online interpersonal interactions among adolescents. In this cross-sectional study of adolescents in a college in Taiwan, structured questionnaire surveys were used to collect information. The questionnaire included the following: demographic background, Real Interpersonal Interaction Scale (RIIS), Internet Interpersonal Interaction Scale (IIIS), Smartphone Application-Based Addiction Scale (SABAS), Bergen Social Media Addiction Scale (BSMAS), and Internet Gaming Disorder Scale—Short Form (IGDS9-SF). Multiple regression analyses were carried out to investigate the correlations between SABAS, BSMAS, IGDS9-SF, and RIIS/IIIS. We recruited 998 students (413 boys). The average age was 17.18 ± 1.46. The study results show that adolescents with higher levels of addiction to smartphones and social media may have greater interpersonal interaction with friends in real life, but adolescents with high levels of addiction to online games may have less interpersonal interactions with friends in real life. Adolescents with high levels of addiction to smartphones, social media, and online games may have greater interpersonal interactions with friends online.

Reciprocal Relationships Between Problematic Social Media Use, Problematic Gaming, and Psychological Distress Among University Students: A 9-Month Longitudinal Study

BACKGROUND

The causal relationships between two specific types of problematic use in internet-related activities [i.e., problematic social media use (PSMU) and problematic gaming (PG)] and psychological distress remain controversial. The present study investigated the temporal relationships between PSMU, PG, and psychological distress (i.e., anxiety, depression) in university students.

METHODS

Hong Kong and Taiwan university students [N = 645; nmale = 266; mean = 20.95 years (SD = 5.63)] were recruited for a survey study, with follow-ups at 3, 6, and 9 months after baseline assessment. The Bergen Social Media Addiction Scale, Internet Gaming Disorder Scale-Short Form, and the Hospital Anxiety and Depression Scale were used to assess studied variables. Demographics including age, physical characteristics (i.e., height, weight, and body mass index), and cigarette use were compared between participants who completed all the follow-ups and those who dropped out. Random intercept cross-lagged models were constructed to understand the reciprocal relationships between PSMU, PG, and psychological distress.

RESULTS

No significant differences were found in age, physical characteristics, and cigarette use between participants who completed all the follow-ups and those who dropped out. Findings indicated that a high level of PSMU significantly increased the level of anxiety and a high level of anxiety significantly increased the level of PSMU. A high level of PSMU significantly increased the level of depression but the level of depression did not significantly affect the level of PSMU. A high level of PG significantly increased the level of anxiety, but the level of anxiety did not significantly affect the level of PG. A high level of depression significantly increased the level of PG, but the level of depression did not significantly affect the level of PG.

CONCLUSION

The patterns of the causal relationship between PIU and psychological distress variables differ. A reciprocal relationship was only found between the level of PSMU and the level of anxiety. Moreover, the longitudinal design found no differences in the waves in terms of gaming by the participants.

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.

Weight stigma in the COVID-19 pandemic: a scoping review

BACKGROUND

Weight stigma is a phenomenon associated with adverse behavioural and psychological consequences. Although experts suggest that its increase during the COVID-19 pandemic may be associated with worse health outcomes for people with obesity, a thorough analysis of the main findings and gaps is still needed when relating to this subject.

OBJECTIVE

We aim to answer three questions: (1) How does weight stigma manifest in the COVID-19 pandemic? (2) How can weight stigma affect people with overweight or obesity in times of COVID-19? (3) What are the perceptions and experiences of weight stigma during the pandemic in individuals who experience overweight or obesity?

METHODS

We conducted a scoping review of studies addressing weight stigma and the COVID-19 pandemic in electronic databases (Medline/PubMed, CINAHL, Embase, PsycInfo, BVS/Lilacs, Scopus, Web of Science, Google Scholar, and OpenGrey) published until 10th August 2021. All relevant studies were reviewed in full by two researchers. In addition, a narrative synthesis of the data was performed.

RESULTS

The results included 35 studies out of 8,090 records and identified 13 original research publications, 14 text and opinion papers, and 6 narrative reviews. The results revealed the presence of weight stigma in the media, healthcare settings, interpersonal relationships, and public campaigns during the COVID-19 pandemic. The evidence of increasing weight stigma in the COVID-19 outbreak is limited, though. Many weight discrimination consequences were described during this time, such as impairment in accessing healthcare, worst COVID-19 outcomes, and maladaptive eating. However, only maladaptive behaviours and decline in mental health outcomes were demonstrated empirically in all age groups. This effect occurred regardless of body mass index, but people with high body weight were more likely to experience weight stigma. For some people with obesity, weight stigma in the pandemic has made activities of daily routine difficult.

CONCLUSIONS

The results suggest that weight stigma in the COVID-19 pandemic occurs in several settings; moreover, although weight discrimination impacts mental health, whether before or during the pandemic, this influence between the pandemic and pre-pandemic scenario is still unclear. Therefore, more research is required in this field while the pandemic lasts, especially with people with obesity. Overall, people with overweight or obesity are more vulnerable to weight stigma than individuals without overweight. In addition, weight stigma refers to discrimination or prejudice based on a person's weight and relates to several consequences, for instance, poor healthcare treatment and mental health problems. In the COVID-19 outbreak, these weight stigma effects tend to become even more critical because they may be associated with unfavourable COVID-19 outcomes and eating disorder risks. Thus, it is crucial to investigate how weight stigma occurs during the pandemic and its impact on health, mainly for the most affected people. We investigated 35 studies published between 2019 and 2021 to map and explore how weight stigma was manifested and the related consequences for people with overweight or obesity in the COVID-19 pandemic. Only about a third of them were quantitative or qualitative, limiting the evidence of weight stigma in the COVID-19 context. The available evidence suggests that weight stigma manifests in several settings such as media, healthcare, public campaigns, and is more common in people with excess weight. However, weight discrimination experiences before or during the pandemic were associated with adverse psychological and behavioural consequences across all age groups, regardless of body weight. For some people with obesity, for instance, weight stigma made it difficult to accomplish their activities of daily routine. Nevertheless, it remains unclear whether weight stigma has increased in the pandemic, thus, more studies are required, especially about people with overweight or obesity.

Fear among Syrians: A Proposed Cutoff Score for the Arabic Fear of COVID-19 Scale

COVID-19 pandemic has led to psychological health issues one of which is fear. This study validates the Arabic version of the fear of COVID-19 scale and suggests a new cutoff score to measure fear of COVID-19 among the Syrian Population. A total of 3989 participants filled an online survey consisting of socio-demographic information, the fear of COVID-19 scale, the patient health questionnaire 9-item, and the generalized anxiety disorder 7-item. Receiver operating characteristic analysis was used to define cutoff scores for the fear of COVID-19 scale in relation to generalized anxiety disorder 7-item and the patient health questionnaire 9-item. The Cronbach α value of the Arabic fear of COVID-19 scale was 0.896, revealing good stability and internal consistency. The inter-item correlations were between [0.420–0.868] and the corrected item-total correlations were between [0.614–0.768]. A cutoff point of 17.5 was deduced from the analysis. According to the deduced cutoff point, 2111(52.9%) were categorized as extreme fear cases. This cutoff score deduced from this study can be used for screening purposes to distinguish community members that may be prone to developing extreme fear of COVID-19. Therefore, early preventive and supportive measures can then be delivered.

Digital Media Use and Adolescents' Mental Health During the Covid-19 Pandemic: A Systematic Review and Meta-Analysis

The Covid-19 physical distancing measures had a detrimental effect on adolescents' mental health. Adolescents worldwide alleviated the negative experiences of social distancing by spending more time on digital devices. Through a systematic literature search in eight academic databases (including Eric, Proquest Sociology, Communication & Mass Media Complete, Psychology and Behavioral Sciences Collection, PsycINFO, CINAHL, Pubmed, and Web of Science), the present systematic review and meta-analysis first summarized the existing evidence from 30 studies, published up to September 2021, on the link between mental health and digital media use in adolescents during Covid-19. Digital media use measures included social media, screen time, and digital media addiction. Mental health measures were grouped into conceptually similar dimensions, such as well-being, ill-being, social well-being, lifestyle habits, and Covid-19-related stress. Results showed that, although most studies reported a positive association between ill-being and social media use (r = 0.171, p = 0.011) and ill-being and media addiction (r = 0.434, p = 0.024), not all types of digital media use had adverse consequences on adolescents' mental health. In particular, one-to-one communication, self-disclosure in the context of mutual online friendship, as well as positive and funny online experiences mitigated feelings of loneliness and stress. Hence, these positive aspects of online activities should be promoted. At the same time, awareness of the detrimental effects of addictive digital media use should be raised: That would include making adolescents more aware of adverse mechanisms such as social comparison, fear of missing out, and exposure to negative contents, which were more likely to happen during social isolation and confinement due to the pandemic.

Community Outbreak Moderates the Association Between COVID-19-Related Behaviors and COVID-19 Fear Among Older People: A One-Year Longitudinal Study in Taiwan

Although health behavior theories indicate that fear is effective in activating preventive behaviors, the question of whether COVID-19 severity moderates the association between fear of COVID-19 and preventive behaviors remains unclear. The present study investigated the association between the fear of COVID-19 and preventive behaviors during the COVID-19 community outbreak of two severity levels in Taiwan. Data were obtained regarding the fear of COVID-19 and practice of preventive behaviors from 139 older people (mean age = 71.73 years; 30.2% men) through in-person interviews during a mild COVID-19 outbreak period (baseline assessment). Data from 126 of the 139 participants were obtained again through a telephone interview during a severe COVID-19 outbreak period (follow-up assessment). A significant increase in the fear of COVID-19 (d = 0.39, p < 0.001) and a decrease in preventive behaviors (d = 0.63, p < 0.001) were found in the follow-up assessment. The association between fear of COVID-19 and preventive behaviors was not significant at baseline (r = −0.07, p > 0.05) but became significant at the follow-up assessment (r = 0.32, p < 0.001). The severity of a COVID-19 outbreak may alter older people's psychological status and related behaviors.

Does cyberchondria predict Internet addiction among students during the COVID-19 pandemic? A web-based survey study

BACKGROUND

Previous literature has investigated the association of this phenomenon and Internet addiction. Nevertheless, little research has been conducted to elucidate the predictive associations among these concepts among students.

OBJECTIVE

This study reported students' cyberchondria and Internet addiction, and it examined whether cyberchondria predicts Internet addiction.

MATERIAL AND METHODS

During the COVID-19 pandemic, cross-sectional data were collected using a web survey from a convenience snowball sample of 143 students enrolled in e-learning courses at a governmental university.

RESULTS

A moderate level of cyberchondria and a mild level of Internet addiction was evident among students. A moderate level of cyberchondria and a mild level of Internet addiction was evident among students. Moderate to high significant correlations were reported among the studied concepts and with the sample's characteristics. Cyberchondria and unavailability of the Internet at school were predictors of Internet addiction.

IMPLICATIONS

Healthcare providers, including nurses, should provide information that preserves students' mental health during stressful periods such as the COVID-19 pandemic and should offer clear instructions on stress and anxiety management during such times. A longer scale, especially for cyberchondria, is warranted in future research with a random and larger sample.

CONCLUSIONS

Findings suggest that cyberchondria serves as a predictor of Internet addiction, contrary to findings of previous studies. Various psychosocial interventions should always be initiated to help students prevent or address cyberchondria and Internet addiction.

Development and evaluation of smartphone usage management system for preventing problematic smartphone use

Objective

The increased use of smartphones has led to several problems, including excessive smartphone use and the decreased self-ability to control smartphone use. To prevent these problems, the MindsCare app was developed as a method of self-management and intervention based on an evaluation of smartphone usage. We designed the MindsCare app to manage smartphone usage and prevent problematic smartphone use by providing personalized interventions.

Methods

We recruited 342 Korean participants over the age of 20 and asked them to use MindsCare for 13 weeks. Subsequently, we evaluated the changes in average smartphone usage time and the usability of the app. We designed a usability evaluation questionnaire based on the Technology Acceptance Model and conducted factor and reliability analyses on the participants’ responses. In the eighth week of the study, participants responded to a survey on the usability of the app. We ultimately collected data from 190 participants.

Results

The average score for the usability of the system was 3.61 on a five-point Likert scale, and approximately 58% of the participants responded positively to the evaluation items. In addition, our analysis of MindsCare data revealed a significant reduction in average smartphone use time in the eighth week compared to the baseline (t = 3.47, p = 0.001). Structural equation model analysis revealed that effort expectancy and performance expectancy had a positive relation with behavior intention for the app.

Conclusions

Through this study, we confirmed the MindsCare app's smartphone usage time reduction effect and proved its good usability. As a result, MindsCare may contribute to achieving users’ goals of reducing problematic smartphone use.

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.

Longitudinal association between smartphone ownership and depression among schoolchildren under COVID-19 pandemic

Under the COVID-19 pandemic, concerns regarding prolonged screen time and mental health effects in children have increased. We examined the association of depression with smartphone ownership in school children at four time points: September 2019, July 2020, December 2020, and March 2021. The analysis revealed an interaction between group and time, indicating that depressive symptoms among smartphone owners were significantly more severe than in the other group. These results were clearer for fourth-year students, pointing that smartphone possession at younger ages may be a risk factor for mental health in the new lifestyle caused by the COVID-19 pandemic.

Problematic Social Networking Site use-effects on mental health and the brain

The association between excessive use of Social Networking Sites (SNS) and mental health is raising serious concern among health and education professionals. Problematic SNS use has been associated with an increased rate of depression, anxiety, stress, obsessive-compulsive disorder (OCD), attention-deficit/hyperactivity disorder (ADHD), and propensity to excessive alcohol use. It may also lead to vulnerability to aggression, cyberbullying and fear of missing out (FOMO). There is little evidence for cognitive impairments, but there is some preliminary event-related potentials (ERPs) evidence for inefficiency in allocating and monitoring resources and inhibitory control. Problematic SNS has been associated with the personality traits of conscientiousness agreeableness and neuroticism, and with narcissism. There is evidence for reduced sleep quality and quantity, longer sleeping latency and more sleep disturbance. The few brain imaging studies show some similarity between problematic SNS use and other addictions related to inhibitory-control mechanism, reduced gray matter volumes in the nucleus accumbens, amygdala, and the insula, suggesting rewarding effects of SNS use on the brain. Finally, there is preliminary evidence that treatment with Cognitive Behavior Therapy (CBT) can assist in short-term abstinence intervention to treat problematic SNS use. We conclude that problematic SNS use may have deleterious effects on emotional and social relationships, and more research is required on its effects on cognitive and brain function.

Weight Stigma and Social Media: Evidence and Public Health Solutions

Weight stigma is a pressing issue that affects individuals across the weight distribution. The role of social media in both alleviating and exacerbating weight bias has received growing attention. On one hand, biased algorithms on social media platforms may filter out posts from individuals in stigmatized groups and concentrate exposure to content that perpetuates problematic norms about weight. Individuals may also be more likely to engage in attacks due to increased anonymity and lack of substantive consequences online. The critical influence of social media in shaping beliefs may also lead to the internalization of weight stigma. However, social media could also be used as a positive agent of change. Movements such as Body Positivity, the Fatosphere, and Health at Every Size have helped counter negative stereotypes and provide more inclusive spaces. To support these efforts, governments should continue to explore legislative solutions to enact anti-weight discrimination policies, and platforms should invest in diverse content moderation teams with dedicated weight bias training while interrogating bias in existing algorithms. Public health practitioners and clinicians should leverage social media as a tool in weight management interventions and increase awareness of stigmatizing online content among their patients. Finally, researchers must explore how experiences of stigma differ across in-person and virtual settings and critically evaluate existing research methodologies and terminology. Addressing weight stigma on social media will take a concerted effort across an expansive set of stakeholders, but the benefits to population health are consequential and well-worth our collective attention.

Smartphone Addiction and Depression among Low-Income Boys since COVID-19: The Moderating Effect of Being an Only Child

Even though boys' depression has become important, and their smartphone use has increased since COVID-19, little is known about low-income middle and high school boys' depression in the context of whether they have siblings. Thus, this study investigates the relationship between smartphone addiction and depression as well as the moderating effect of being an only child on the relationship. Participants were limited to middle and high school students whose families were regarded as having a low-income. A total of 129 low-income boys were selected for the final sample. The PROCESS macro 3.4 for Statistical Product and Service Solutions was used to identify the moderating effect. Smartphone addiction was positively related to depression among low-income male students. Being an only child significantly moderated the relationship between smartphone addiction and depression. This study contributes to understanding the importance of examining mental health problems among middle school boys since COVID-19, particularly among low-income boys. It is necessary to provide tailored mental health services for middle school boys in low-income families. Alternative activities and social programs should be provided for adolescent boys who are only children to safely socialize with friends and peers without a smartphone.

A Systematic Review of Prevention and Intervention Strategies for Smartphone Addiction in Students: Applicability During the COVID-19 Pandemic

"During this coronavirus (COVID-19) pandemic, smartphones play an important role in online classes, study, and entertainment. However, excessive use may lead to smartphone addiction (SPA). The incidence of SPA among students has increased with the spread of COVID-19 and threatens to impair home-based students’ learning efficiency and physical and mental health. This study aimed to provide a comprehensive overview of the latest achievements in SPA prevention and treatment, and a theoretical basis for future experimental research and clinical treatment, while considering their applicability during the current pandemic. We researched the core literature in Chinese, English, and Korean databases from 2000 to 2021; 3208 articles were identified. After reading the titles, abstracts, and full texts, 53 articles were selected. Research on SPA interventions was relatively limited; we identified six types of prevention and treatment measures: psychotherapies, cognitive training, behavioral intervention, application restriction, social intervention, and complementary and alternative medicine. They can be implemented by students, parents, or online experts. Future research should focus on developing early measures to identify and prevent SPA and enhance students’ change motivation."