Internet Addiction and Its Relationship With Suicidal Behaviors: A Meta-Analysis of Multinational Observational Studies

The relationship between chronotype, psychological pain, problematic social media use, and suicidality among university students in Turkey

Chronotype has been extensively linked to various psychological outcomes, including suicide, which significantly impacts the mortality rate among young adults worldwide. Research on the extent of these links is still ongoing. This cross-sectional study aimed to explore the complex relationships between chronotype, internet addiction, problematic social media use (PSMU), psychological pain, and suicidality in a student population. A total of 571 Turkish students (65.3% female, mean age 20.3 ± 1.63 years) completed the following scales: the Suicide Probability Scale (SPS), the Mee-Bunney Psychological Pain Assessment Scale (MBPPAS), the Social Media Disorder Scale (SMDS), the Internet Addiction Test (IAT), the Morningness - Eveningness Questionnaire (MEQ), and the Hospital Anxiety and Depression Scale (HADS). The results showed that the relationship between chronotype and suicidality was partially mediated by SMDS and MBPPAS but not by anxiety, depression, or IAT. These findings suggest that psychological pain and PSMU may be important factors that contribute to suicidality in evening-type individuals. These findings have significant implications for the development of interventions aimed at reducing suicidality among evening-type individuals. By addressing the underlying factors of psychological pain and PSMU, it may be possible to mitigate the increased risk of suicidality among this population.

Impaired control and gaming-related harm in relation to gaming Disorder

The concept of impaired control (IC) over gaming is an important element of assessment and interventions for problem gaming and gaming-related harm. Past studies have reported that gaming disorder (GD) is associated with various negative consequences, but there is limited research on the relationship between IC over gaming and negative outcomes. To address this gap, the study investigated the relationship between impaired control and gaming-related harm among individuals with self-identified gaming disorder. It was hypothesized that IC would be positively associated with gaming-related harm and harm severity. In addition, it was predicted that IC would be a significant predictor of harm when controlling for age, gender, psychological distress, and gaming urges. The current study recruited 513 participants through an online survey platform. The Impaired Control Over Gaming Scale (ICOGS) was used to measure IC, and modified items from Browne et al.'s taxonomy of gambling harms were used to assess gaming harm severity. The logistic regression results showed that IC was positively related to all forms of harm, after controlling for other variables. The predictive value of IC was similar across financial, psychological, relationship, social and work/school domains. These results supported the importance of IC as a mechanism that contributes to the experience of gaming-related harm, and the need to target IC in interventions for GD.

Stress and suicide risk among adolescents: the role of problematic internet use, gaming disorder and emotional regulation

BACKGROUND

Previous studies have associated videogame playing and social media use with suicidal behaviors together with lower stress coping or poor emotion regulation strategies. Due to the inconclusive evidence regarding the factors associated with suicidal behavior, the present study aimed to overcome the limitations of previous research and explored the relationship between adolescent stress, problematic internet use (PIU), gaming disorder (GD), and emotional regulation (ER) in a cross-section design. It was hypothesized that stress would have a direct effect on suicide risk (SR) as well as being mediated by PIU, GD, and ER.

METHODS

The participants comprised 430 adolescents (58.4% male) aged between 16 and 19 years. They completed an online survey including the Mobile-Related Experiences Questionnaire, Internet Gaming Disorder Scale-Short Form, Meta-Mood Trait Repair Scale, and Spanish version of the Suicidal Behaviors Questionnaire.

RESULTS

A total of 34.2% of the adolescents (N = 147) were at risk for SR. Results also indicated that 30,7% had experienced suicidal ideation at some point in their life, 12.1% had at least one plan to die by suicide, and 5.1% had attempted suicide. Results of path analysis confirmed that stress appeared to be a risk factor for suicide, but that its effects were not mediated by PIU. However, ER and GD mediated the effect of stress on SR. The results suggest that stress is a main risk factor for suicide, especially among adolescents with poor emotional regulation or problematic gaming.

CONCLUSIONS

Considering the prevalence of suicide among adolescents, the results of the present study suggest that suicide prevention programs should include emotional regulation strategies, stress coping, and videogaming management skills in the early stages of high school. Providing these protective resources to adolescents will help them face the stressful and changing situations typical of adolescence and will help them to attain greater well-being and satisfaction with life.

The effects of self-esteem and parental phubbing on adolescent internet addiction and the moderating role of the classroom environment: a hierarchical linear model analysis

BACKGROUND

With the advent of the new media era, the understanding of adolescent internet addiction needs to be enriched. It is also necessary to distinguish the related factors of adolescent internet addiction at different levels to clarify the mechanisms of this phenomenon.

METHODS

This study used hierarchical linear model analysis to explore the effects of student-level factors and school-level factors on adolescent internet addiction, along with cross-level moderating effects. A total of 1,912 students between the 4th and 8th grades in China participated in the study. Participants completed the Self-Esteem Scale, Parents Phubbing Scale, Classroom Environment Scale, and the Diagnostic Questionnaire of Internet Addiction.

RESULTS

Correlational analyses revealed that internet addiction was found to be negatively correlated with both self-esteem and the teacher-student relationship (p < 0.01), while father phubbing, mother phubbing, and learning burden were shown to positively correlate with internet addiction (p < 0.01). Hierarchical linear model analysis suggested that student-level variables, including self-esteem, and mother phubbing, were significant predictors of internet addiction (β = -0.077, p < 0.001 and β = 0.028, p < 0.01, respectively). At the school level, learning burden significantly and negatively predicted internet addiction (β = 0.073, p < 0.05). Furthermore, the relationship between self-esteem and internet addiction was significantly moderated by learning burden (β = -0.007, p < 0.05). Meanwhile, the teacher-student relationship also had a significant moderating effect on the association between mother phubbing and internet addiction (β = -0.005, p < 0.01).

CONCLUSIONS

This study revealed the relationships between self-esteem, parental phubbing, and classroom environment with adolescent internet addiction, and these findings could provide insights into reducing adolescent internet addiction from the perspective of individuals, families, and schools.

Network analysis of suicidality and internet addiction symptoms among Chinese primary and secondary school students

BACKGROUND

The COVID-19 pandemic has increased the risk of both Internet addiction and suicide across various populations, especially among children and adolescents. This study aimed to assess the inter-relationships between Internet addiction symptoms and suicidality among primary and secondary school students from the perspective of network analysis.

METHODS

This was a cross-sectional, multicenter study. The Internet Addiction Test (IAT) was used to assess internet addiction symptoms. Participants were also asked about having any suicidal ideation and suicide plan. Univariate analyses and network analysis were subsequently conducted.

RESULTS

Altogether, 5380 primary and secondary school students participated in the study. Among them, 3161 (58.8 %, 95 % CI = 57.4 %-60.1 %) students reported having Internet addiction symptoms and 798 (14.8 %, 95 % CI = 13.9 %-15.8 %) reported having suicidal ideation or suicide plan in the past two weeks. Network analysis revealed that IAT16 ('Request an extension for longer time spent online'; node strength = 1.223) was the most central symptom in the Suicidality-Internet addiction network model, while the edge suicidality-IAT4 ('Form new relationship with online users'; edge weight = 0.055) was the strongest edge linking both communities.

CONCLUSIONS

Internet addiction symptoms were common among primary and secondary school students during the COVID-19 school closure period in China and were significantly associated with suicidality. Targeted strategies such as strengthening self-control, sense of belonging and connectedness may be important in reducing the risk of both suicidality and Internet addiction among primary and secondary school students.

Internet addiction and suicidal ideation among Chinese college students: the mediating role of psychotic-like experiences

Background

Individuals with Internet addiction (IA) are at significant risk of suicide-related behaviors. This study aimed to investigate the relationships among IA, psychotic-like experiences (PLEs), and suicidal ideation (SI) among college students.

Methods

A total of 5,366 college students (34.4% male, mean age 20.02 years) were assessed using the self-compiled sociodemographic questionnaires, Revised Chinese Internet Addiction Scale (CIAS-R), 15-item Positive subscale of the Community Assessment of Psychic Experiences (CAPE-P15), Self-rating Idea of Suicide Scale (SIOSS), and 2-item Patient Health Questionnaire (PHQ-2).

Results

The prevalence of IA and SI were 9.3 and 12.1% among Chinese college students, respectively. There were direct effects of IA and PLEs on SI. The total effect of IA on SI was 0.18 (p < 0.001). PLEs mediated the relationship between IA and SI (Indirect effect = 0.07).

Conclusion

IA had both direct and indirect effects on SI. These findings enable us to elucidate the mechanism of how IA influences individual SI, which can provide vital information for developing and implementing targeted interventions and strategies to alleviate SI among Chinese college students.

Prevalence and associated factors of internet addiction among Chinese adolescents: association with childhood trauma

Introduction

Internet addiction (IA) is common among adolescents and may have severe consequences. This study aimed to investigate the prevalence and factors associated with IA among middle school students of Hunan Province, China. Relevance between IA and childhood trauma was also explored.

Methods

One thousand six hundred ten students were enrolled in this cross-sectional study. Data collected included demographics; internet addiction (revised-Chen internet addiction scale); childhood trauma (CTQ-SF); depression, anxiety, and stress symptoms (DASS-21); suicidal behaviors, as well as non-suicidal self-injury (NSSI). Cramer's V analysis, univariable logistic regression and multivariable logistic regression were used for associations and identifying independent relevance of IA, respectively.

Results

The prevalence of IA was 12.8%. Cramer's V analysis showed that IA was associated with emotional abuse, emotional and physical neglect, NSSI, suicidal behaviors, stress, anxiety and depressive symptoms, physical disorder history. Regression analysis showed that IA was independently associated with emotional neglect (OR = 3.062, 95% CI: 2.083, 4.501, p < 0.001); physical neglect (OR = 2.328; 95% CI: 1.590, 3.409, p < 0.001); depressive symptoms (OR = 2.218, 95% CI: 1.467, 3.353, p < 0.001) nationality (OR = 1.888, 95% CI: 1.034, 3.447, p = 0.006) and age (OR = 1.253, 95% CI: 1.066, 1.471, p = 0.006).

Discussion

IA is common among middle school students. Attention should be paid to students with childhood trauma since they have a higher risk for IA, which may increase the risk for suicidal behaviors.

The association of problematic usage of the internet with burnout, depression, insomnia, and quality of life among Hungarian high school students

Introduction

The extensive availability of the internet has led to the recognition of problematic usage of the internet (PUI) or so called internet addiction (IA), probably mostly involving adolescents.

Aim

Here we present a study focusing on the incidence and consequences (including burnout, which is relatively rarely studied) of internet addiction among high school students using a questionnaire-based non-random sampling cross-sectional survey. Included questionnaires were the Problematic Internet Use Questionnaire, the Maslach Burnout Inventory General Survey for Students MBI-GS (S), the 9-item short version of Beck Depression Inventory (BDI-SF), the Athens Insomnia Questionnaire and the EQ-5D (quality of life) questionnaire. Data were evaluated the exertion of Student's t-test, chi square test and Pearson's rank-order correlation. Logistic regression analysis was used to determine the significance of the different parameters as independently associated with PUI.

Results

Overall 3,000 paper-based questionnaires were successfully delivered and 2,540 responses received (response rate of 84.6%). 1,309 males (mean age 17.6 ± 1.43 years) (51.5%) and 1,231 females (mean age 17.5 ± 1.4 years) (48.5%) took part in our study. Problematic usage of the internet was detected in 486 (19.1%) students (232 males, mean age 17.6 ± 1.35 years and 254 females, mean age 17.34 ± 1.37 years). In a logistic regression analysis sleep disturbance (OR: 1.84, 95% CI: 1.83-2.03), depression (OR: 1.97, 95% CI: 1.77-2.02) and burnout (OR: 1.8, 95% CI: 1.16-1.94) were significantly associated with PUI.

Conclusion

Nearly one fifth of our study population suffered from PUI, which was strongly associated with school burnout, insomnia and depression, which underlines the importance of this phenomenon.

Suicide and Non-Suicidal Self-Injury From Internet Addiction Among Korean Adolescents

Objectives

This study examined the associations between Internet addiction and suicide and non-suicidal self-injury (NSSI) among South Korean adolescents.

Methods

We conducted a cross-sectional study of 1694 Korean adolescents. The suicidal Ideation Questionnaire and Deliberate Self- Harm Inventories were used to identify high-risk suicide and NSSI groups, respectively. Internet addiction was assessed using the Internet Addiction Scale. Other questionnaires included sociodemographic data, perceived academic stress, and daily life-related factors. We also performed a logistic regression analysis using the high suicide risk and NSSI groups as dependent variables.

Results

The high suicide risk and NSSI prevalence rates among participants were 11.8% and 28.3%, respectively. A multivariable logistic regression analysis revealed that Internet addiction is associated with higher suicide risk and NSSI. Additionally, being female and academic stress were significant suicide risk factors, while male participants had a higher NSSI prevalence.

Conclusion

Our results suggest that monitoring adolescents' Internet use and providing education to prevent Internet addiction would lower high suicide and NSSI risk. Moreover, suicide and NSSI risk screening in adolescents with Internet addiction and providing suitable interventions will be essential for the preventing suicide and NSSI.

The Relationship of Internet Gaming Addiction and Suicidal Ideation among Adolescents: The Mediating Role of Negative Emotion and the Moderating Role of Hope

Recently, internet gaming addiction and suicide have been global public health issues among adolescents. This study used convenience sampling and surveyed 1906 Chinese adolescents to investigate the relationship between internet gaming addiction and suicidal ideation and the role of negative emotion and hope in the relationship between the two. The results showed that the detection rate of internet gaming addiction among adolescents was 17.16% and the detection rate of suicidal ideation was 16.37%. Moreover, there was a significant positive correlation between internet gaming addiction and suicidal ideation. Negative emotion partially mediated the relationship between internet gaming addiction and suicidal ideation. In addition, hope moderated the relationship between negative emotion and suicidal ideation. The effect of negative emotion on suicidal ideation decreased as hope increased. These findings suggest that the role of emotion and hope in coping with adolescent internet gaming addiction and suicidal ideation should be emphasized.

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

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

Internet Addiction of Older Women and Its Relationship With Social Influence and Social Networks Use as a Mediator

The aim is to analyse the relationship between social influence for Internet use and Internet addiction (IA) in older women, considering the use of Internet-based social networks as a mediator. The participants were 480 older women Internet users. Social influence, frequency of use of social networks and IA (including loss of control and emotional dysregulation) were evaluated. Structural Equation Modeling (SEM) was conducted to analyse the proposed model. The use of social networks was a significant mediator in the relationship between social influence for Internet use and the dimension of loss of control of IA. On the contrary, social network use was not a significant mediator. Older women with more social influence reported more frequency of social networking and, in turn, more loss of control in Internet use. Public policy and clinicians should address addictive behaviours about Internet use in older women, preventing the negative consequences.

Relationship between behavioral inhibition/activation system and Internet addiction among Chinese college students: The mediating effects of intolerance of uncertainty and self-control and gender differences

Background

Internet addiction is a global public health issue among college students that is associated with a range of negative outcomes. Especially the COVID-19 pandemic has forced them to shift most of their studies and life activities from offline to online, leading to a growing problem of Internet dependence and even Internet addiction. Although previous studies have indicated that the Behavioral Inhibition/Activation System (BIS/BAS) have important effects on college students' Internet addiction, the mechanisms underlying these associations and gender differences are still unclear.

Aims

The present study investigated the mediating roles of intolerance of uncertainty and self-control in the association between BIS/BAS and Internet addiction following the Interaction of Person-Affect-Cognition-Execution model. Gender differences in such associations between variables were also tested.

Method

A total of 747 Chinese college students were surveyed by using Young's Diagnostic Questionnaire for Internet Addiction, BIS/BAS Scales, the Intolerance of Uncertainty Scale and the Brief Self-Control Scale.

Results

The results from the structural equation modeling analysis showed that BIS was positively related to Internet addiction and that BAS had a negative association with Internet addiction. Moreover, intolerance of uncertainty and self-control mediated the relationships between BIS/BAS and Internet addiction. Multi-group analysis further revealed that the associations between BAS and Internet addiction and between intolerance of uncertainty and Internet addiction were stronger among the male students than among female students. The relationship between self-control and Internet addiction was greater in the female sample than in the male sample.

Conclusions

These findings extend our understanding of how BIS/BAS influence Internet addiction among college students and suggest that not only should training approaches based on intolerance of uncertainty and self-control be fully considered, but different intervention programs should be focused on gender sensitivity to maximize the intervention effect.

Prediction of suicidal ideation among Chinese college students based on radial basis function neural network

Background

Suicide is one of the leading causes of death for college students. The predictors of suicidal ideation among college students are inconsistent and few studies have systematically investigated psychological symptoms of college students to predict suicide. Therefore, this study aims to develop a suicidal ideation prediction model and explore important predictors of suicidal ideation among college students in China.

Methods

We recruited 1,500 college students of Sichuan University and followed up for 4 years. Demographic information, behavioral and psychological information of the participants were collected using computer-based questionnaires. The Radial Basis Function Neural Network (RBFNN) method was used to develop three suicidal ideation risk prediction models and to identify important predictive factors for suicidal ideation among college students.

Results

The incidence of suicidal ideation among college students in the last 12 months ranged from 3.00 to 4.07%. The prediction accuracies of all the three models were over 91.7%. The area under curve scores were up to 0.96. Previous suicidal ideation and poor subjective sleep quality were the most robust predictors. Poor self-rated mental health has also been identified to be an important predictor. Paranoid symptom, internet addiction, poor self-rated physical health, poor self-rated overall health, emotional abuse, low average annual household income per person and heavy study pressure were potential predictors for suicidal ideation.

Conclusions

The study suggested that the RBFNN method was accurate in predicting suicidal ideation. And students who have ever had previous suicidal ideation and poor sleep quality should be paid consistent attention to.

Association between adolescents' problematic online behaviors and self-harm risk

INTRODUCTION

Problematic online behaviors, including sexting, cyberbullying, and Internet gaming disorder (IGD), were associated with a higher risk of self-harm among adolescents. However, the independent effect on self-harm brought by each problematic online behavior remains unknown.

METHODS

This cross-sectional nationwide survey investigated a representative sample of 8446 Taiwanese adolescents (49.7 % female, mean age = 15.4 ± 1.8, ranging from 10 to 18) in the summer of 2021. We used self-reported questionnaires to assess adolescents' problematic online behaviors. 18-item Risk-Taking and Self-Harm Inventory was applied to evaluate their self-harm risks. Adolescents with score ≥ 7 were considered self-harm identified. Multivariate regression analyses were performed to investigate the association between problematic online behaviors and self-harm risks.

RESULTS

The prevalence of sexting, cyberbullying victimization, cyberbullying perpetration, and IGD was 1.3 %, 1.1 %, 0.9 %, and 0.7 %, respectively. Adolescents with sexting were associated with higher self-harm scores (β = 4.30, 95 % CI [3.35, 5.25]), so did adolescents with IGD (β = 3.33, 95 % CI [1.96, 4.71]), cyberbullying perpetration (β = 2.61, 95 % CI [1.03, 4.20]), and cyberbullying victimization (β = 1.40, 95 % CI [0.04, 2.76]). Also, sexting (OR = 5.16, 95 % CI [3.26, 8.07]) and IGD (OR = 3.11, 95 % CI [1.50, 6.15]) were associated with increased odds of identified self-harm behaviors.

CONCLUSIONS

Sexting, cyberbullying victimization, cyberbullying perpetration, and IGD were all independently associated with an increased self-harm risk among adolescents. Among them, sexting was shown to be the most robust risk factor of identified self-harm behaviors. To prevent self-harm among adolescents, it is important to identify youth involved in problematic online behaviors, especially sexting.

Association between Smartphone Addiction and Suicide

OBJECTIVE

This study aimed to explore the associations between smartphone overdependence (smartphone addiction) and suicidal ideation and attempts among Korean adolescents to acknowledge the risk of smartphone overuse.

METHODS

Data were obtained from the results of the 2020 Korea Youth Risk Behavior Web-based Survey. Smartphone addiction was categorized into three groups: adolescents who scored less than 23 were categorized as the general user group and formed the reference, those with scores of 23-30 were categorized as the potential-risk user group, and those with scores higher than 31 were categorized under the high-risk user group. Suicidal ideation and suicide attempt were identified as dependent variables in the present study. Multiple logistic regression was used to analyze the relationship between SA and suicidal ideation and suicide attempt status among Korean adolescents.

RESULTS

This study included 41,173 general users of smartphones, 12,142 potential-risk users, and 1633 high-risk users from among 54,948 adolescents who were middle- and high-school students. Adolescents with potentially risky smartphone use showed a higher likelihood of suicidal ideation (OR: 1.50, CI: 1.42-1.60). Similarly, adolescents with high-risk smartphone use showed a significant risk of suicidal ideation (OR: 2.49, CI: 2.21-2.81) and suicide attempt (OR: 1.87, CI: 1.48-2.37) compared to the adolescents who were general users.

CONCLUSION

Our study results encourage parents and social workers to acknowledge that adolescents' smartphone addiction leads to a higher risk to their mental health, wherein they may engage in suicidal ideation and even resort to a suicide attempt.

Suicidal Depression in Ancient Egypt

OBJECTIVE

To evaluate the oldest record of a depressed individual contemplating suicide.

METHOD

A directed review of ancient Egyptology literature of translations and discussion regarding a papyrus that is approximately 4,000 years old.

RESULTS

The content of the document is consistent with a man going through a severe depression and is contemplating suicide. However, this does not appear to be a suicide note, but more of an ancient example of 'journaling' or working through the thoughts of suicide and its possible consequences to the man's eternal life in the afterworld.

CONCLUSIONS

Presentation of depression, the reasons for considering suicide, and the process by which an individual works through those thoughts have not varied significantly over the past 4,000 years.

Effects of changes in physical and sedentary behaviors on mental health and life satisfaction during the COVID-19 pandemic: Evidence from China

Background

While restriction measures are critical in containing the COVID-19 outbreak, limited studies have investigated the behavioral and psychological impact of these measures. This study aimed to investigate the effects of physical and sedentary behavioral changes and online behavior during the COVID-19 pandemic on mental health and life satisfaction among the Chinese population.

Methods

The data were obtained from a cross-sectional survey of 2145 residents aged between 18 and 80 in Hubei province, China between March 23, 2020, and April 9, 2020.

Results

Participants who had high frequencies of physical activities before or during the COVID-19 outbreak exhibited higher levels of life satisfaction. Participants who increased their sitting time during the pandemic or kept sitting for more than eight hours before and during the pandemic reported worse mental health than those who maintained less sedentary behavior. Besides, participants who used the Internet for information seeking, communication, and entertainment more frequently reported better mental health and life satisfaction. In contrast, there was a positive association between commercial use of the Internet and symptoms of mental disorders.

Conclusion

Given the link between physical and sedentary behavioral changes with worse mental wellbeing, strategies to reduce sedentariness and increase physical activity during the COVID-19 pandemic are needed.

Problematic Use of the Internet Mediates the Association between Reduced Mentalization and Suicidal Ideation: A Cross-Sectional Study in Young Adults

Suicide is a major public health problem, and it is urgent to investigate its underlying clinical and psychological concomitants. It has been suggested that low mentalization skills and problematic use of the internet (PUI) are factors that can play a role in suicidal behaviors. It is possible that poor mentalization skills contribute to leading to forms of PUI, which, in turn, can represent triggers for suicidal ideation (SI). We tested this hypothesis through a quantitative and cross-sectional study on a sample (n = 623) of young adults (age range: 18−34). Self-report measures investigating symptoms related to Social Media Addiction (SMA), Internet Gaming Disorder (IGD), mentalization capacity, and SI were used. A single mediation analysis with two mediators was carried out to evaluate the direct and indirect effects of mentalization on SI through the mediating role of SMA- and IGD-related symptoms, controlling for potential confounding factors (e.g., socio-demographic and addiction-related variables). The four explored variables were significantly associated with each other (all p < 0.001) across all subjects; the mediational model showed that the total effect of mentalization on SI was significant (B = −0.821, SE = 0.092 (95% CI: −1.001; −0.641)) and that both SMA- (B = −0.073, SE = 0.034 (95% CI: −0.145; −0.008)) and IGD-related symptoms (B = 0.046, SE = 0.027 (95% CI: −0.107; −0.001)) were significant mediators of such association. Our findings support the possibility that PUI severity plays a relevant role in mediating the association between low mentalization skills and levels of SI.

Impact of Internet usage time on mental health in adolescents: Using the 14th Korea Youth Risk Behavior Web-Based Survey 2018

Dependency on the Internet in daily life is increasing, and the negative consequences this dependence may have on mental health are not sufficiently understood. The aim of this study was to investigate the relationship between Korean adolescents' Internet usage time and their mental health. This cross-sectional study included 29,811 high school students ages 16-18 from the 2018 Korea Youth Risk Behavior Web-Based Survey. Participants' mean Internet usage time was 193.4±1.6 min/day. Internet usage time was associated with sex, grade level, type of school, living arrangement, economic status, academic achievement, and experience of school violence. With regard to mental health, subjective health status, stress, feelings of sadness, and suicidal ideation were also related to Internet usage time. The group with more than average Internet usage had poorer subjective health, higher level of stress, and had feelings of sadness and suicidal ideation compared to the group with less than average Internet usage. To effectively manage Internet usage time, interventions to lower Internet usage and leisure programs that could replace Internet usage need to be developed.

The Association of Internet Addiction with Burnout, Depression, Insomnia, and Quality of Life among Hungarian High School Teachers

The extensive availability of Internet has led to the recognition of problematic Internet use (so called Internet addiction, IA) mostly involving adolescents. There are limited data about the prevalence and consequences of IA in adults especially among high school teachers. Here, we present a cross-sectional prospective study focusing on the association of Internet addiction with burnout, depression, insomnia, and lower quality of life among high school teachers taking many co-variates into account. Overall, 623 males (34.3%) and 1194 females (65.7%) participated in our study. Internet addiction was detected in 5.2% (95/1817) based on the Problematic Internet Use Questionnaire. Internet addiction was associated with severe burnout (10.5 vs. 2.7%, p < 0.001), moderate (36.8 vs. 1.7%, p < 0.001), and severe (6.3 vs. 0.1%, p < 0.001) depression, insomnia (23.1 vs. 11.4%, p < 0.001), and severe sleep disturbance (severe insomnia, 27.4 vs. 3.8%, p < 0.001) and lower quality of life in all domains (p < 0.001). There was also a significant correlation of the severity of the above-mentioned parameters and the severity of IA (overall scores, p < 0.001 in all cases). In a multivariate analysis including demographic criteria, risk factors medical conditions and the above-mentioned parameters as co-variates internet addiction was significantly associated with depression (OR = 3.836, CI: 2.92-5.44, p = 0.03), and insomnia (OR: 3.932, CI: 3.6-5.69, p = 0.002). This is the first study from Hungary and is one of the first studies showing the association of IA with mental issues, burnout, and lower quality of life among adults. It underlines the clinical importance of problematic Internet use among adults.

Prevalence of Suicidal Behavior and Associated Clinical Correlates in Patients with Behavioral Addictions

Addictive disorders are characterized by severe consequences, including suicidal events, but most studies investigating the association between addiction and suicidal risk have focused on substance use disorders and gambling disorder at the expense of the rest of behavioral addictions. This study examined the prevalence and the associated clinical correlates of suicidal ideation and suicide attempts in a sample of patients with a diagnosis of behavioral addiction. The total sample consisted of 4404 individuals: 4103 of these patients with gambling disorder, 99 with gaming disorder, 44 with sex addiction, and 158 with buying–shopping disorder. All of them were assessed consecutively at a specialized hospital unit for the treatment of behavioral addictions. Participants attended two clinical interviews and completed self-reported questionnaires to explore clinical features of behavioral addictions, personality traits, psychopathological symptomatology, suicidal behavior, and sociodemographic variables. The highest prevalence of suicidal ideation was found in patients with gambling disorder (22.9%), followed by buying–shopping disorder (18.4%), sex addiction (18.2%), and gaming disorder (6.1%). The highest prevalence of suicide attempts was registered for sex addiction (9.1%), followed by buying–shopping disorder (7.6%), gambling disorder (6.7%), and gaming disorder (3.0%). Female gender and unemployment constituted two relevant sociodemographic factors associated with suicidal risk in gambling disorder, gaming disorder, and buying–shopping disorder. Lack of family support appeared as a relevant risk factor, except for gaming disorder. These results pointed out that suicide is a prevalent behavior in behavioral addictions, and clinicians and researchers need to pay particular attention to the specificities of each behavioral addiction when assessing suicidal risk.

A Latent Profile Analysis of Problematic Media Device Use and Its Association With Executive Function and Behavioral Problem Among Children: A Population-Based Study

OBJECTIVE

Despite the rapid increase in problematic media device use, relatively little is known about specific characteristics and extent of problematic media device and how they relate to different psychological features.

METHODS

Data extracted from the Panel Korea Study for the Child Cohort Study were used. At the age of 9 years, media device addiction severity was assessed using the K-scale, and children's behavioral outcomes were assessed using the Child Behavior Checklist. Among children with problematic media device use (n=339), we performed latent profile analysis using the K-scale to identify subtypes of problematic media device use, and then compared the child behavioral problems and executive function according to the different subtypes of problematic media device use.

RESULTS

Children with problematic media device use were divided into class 1 (n=51), class 2 (n=138), and class 3 (n=150). Compared with classes 2 and 3, class 1 had more severe problematic media device use, including daily activity disturbance, withdrawal, and tolerance. Class 1 had the most serious behavioral problems and executive function difficulties among classes. Class 2 had greater daily activity disturbance and tolerance than those of class 3, but executive function showed no significant difference between the two classes. In logistic regression analysis, behavioral problems except for somatization were more common in class 1 than in the control group.

CONCLUSION

Results suggest that problematic media device use is associated with significant behavioral problem and executive function difficulties and underscore the need for further clinical and research attention for these specific subgroup members.

Internet gaming disorder and comorbidities among campus-dwelling U.S. university students

This study investigates the prevalence and associations of DSM-5 Internet Gaming Disorder (IGD) with sleep impairment, daytime functioning, psychiatric disorders, and health status among young adults living in student houses on the campus of an American university. A random sample of students living on the campus underwent phone interviews during the 2007 & 2015 academic years. The sample included 1,871 undergraduate and 1,113 graduate students (2,984 in total). Students were considered to have IGD if they recreationally spent ≥15 hours per week on an electronic device (39.4% of the students) and displayed ≥5 addiction-related symptoms; 5.3% of the sample met these 2 criteria. In bivariate analyses, IGD students had a greater proportion of suicidal thoughts (16.9% vs. 6.6%), suicide attempts (9.7% vs. 3.3%), major depressive disorder (9.7% vs. 3.0%), and social anxiety disorder (24.8% vs. 8.5%) than the no-IGD group. In multivariate analyses, IGD predicted non-restorative sleep, excessive fatigue, less close friends, depressive mood, bipolar disorder, social anxiety disorder, and a poor to fair health status. IGD is highly prevalent in this student population, affecting one in 20 students. IGD was associated with a variety of sleep, psychiatric, and health factors which may impact functioning and academic performance.

Depression and anxiety in recurrent giant cell tumor of bone

Giant cell tumor of bone (GCTB) is a benign neoplasia more frequently encountered in young females. The pathogenic and evolutionary dynamics of the disease is strongly influenced by the presence of depression and cellular mechanisms, especially proinflammatory and immune. Although it is not a malignant tumor, it is often recurrent, which determines a high level of depression, anxiety, and fear of the patients. Cytokine mechanisms, especially through increased tumor necrosis factor alpha (TNFα) and interleukin-6 (IL-6), as well as the involvement of the receptor activator of nuclear factor-kappa B (RANK)–RANK ligand (RANK-L) system, can be correlated with the risk of malignancy. Unfavorable evolution is associated with persistent pain, difficulties of movement and body dysmorphic symptoms. The diagnosis is based mainly on histopathological (HP) assessment. The patients can be treated with pharmacological agents (Denosumab), surgery with tumor excision, reconstruction or osteosynthesis, and radiotherapy. Patients with GCTB require HP and imaging evaluations, especially of relapses, to detect the risk of metastasis or malignancy, simultaneously with psychological and psychiatric monitoring to detect depression, addictive behaviors, and suicide risk. It is necessary to evaluate in a multidisciplinary team to avoid unfavorable oncological and psychiatric developments. Through its clinical, HP, and therapeutic features, GCTB has multiple connections with the psychological and psychopathological dimension.

An Evaluation of Gaming-Related Harms in Relation to Gaming Disorder and Loot Box Involvement

The specific nature of harm and functional impairment in the context of gaming disorder (GD) has received limited attention. In this study, we present one of the first concerted attempts to measure the types and degree of harm experienced by people displaying signs of problem gaming. Attempts were made to assess the extent to which types of harm were attributable to gaming as opposed to other factors. The study also investigated potential behavioural indicators of harmful involvement, including exposure to loot boxes. A sample of 471 regular gamers (M = 380, F = 73), recruited through the online platform Prolific, completed a survey where problem gaming was identified using Petry et al.’s (2014) checklist. Individuals who met the cut-off for gaming disorder scored higher than the non-problem group on most dimensions of harm, with physical and psychological types being the most common issues. Loot box expenditure was low (M = $25 in 3 months, for the 10.8% of respondents who played loot boxes) but significantly positively associated with the degree of gaming-related financial harm. This study shows that problem gaming is most strongly associated with physical or psychological harm and that financial harms may manifest in gaming activities that facilitate continuous spending options.

Characterizing the building blocks of Problematic Use of the Internet (PUI): The role of obsessional impulses and impulsivity traits among Italian young adults

BACKGROUND

Problematic Use of the Internet (PUI) is a considerable issue of the modern era, but its risk factors are still poorly understood. Impulsivity and obsessive-compulsive symptoms have been associated with PUI, but this relationship is still debated. In this article we focus on the relationships of PUI with obsessive-compulsive and impulsive symptoms in a cohort of Italian young adults, in order to identify possible vulnerability factors for PUI.

METHODS

A sample of 772 Italian individuals aged 18-30 (mean age 23.3 ± 3.3 years old; 38% males and 62% females) was assessed via online survey using the Internet Addiction Test (IAT), the Mini International Neuropsychiatric Interview (MINI) Screen, the Padua Inventory-Washington State University Revision (PI-WSUR) and the Barratt Impulsiveness Scale (BIS-11).

RESULTS

Ninety-seven subjects (12.6% of the sample) reported IAT scores at risk for PUI. PUI participants reported higher levels of impulsivity, obsessive-compulsive symptoms and a higher burden of co-occurrent psychiatric symptoms. In a logistic regression model, obsessional impulses to harm (OR = 1.108, p < 0.001), attentional impulsivity (OR = 1.155, p < 0.001) and depressive symptomatology (OR = 1.246, p = 0.012) had significant association with PUI. Finally, higher severity of PUI has been associated with manic/psychotic symptoms and with attentional impulsivity.

CONCLUSIONS

Our findings confirmed the role of impulsivity in PUI, while also underling the association of obsessional impulses with this pathological behavior. We could hypothesize a trigger role of obsessive impulses for the engagement in PUI, together with factors as negative affective states. Further research is needed with respect to more severe forms of PUI, also for establishing tailored interventions.

Cross-sectional survey of depressive symptoms and suicide-related ideation at a Japanese national university during the COVID-19 stay-home order

Background

We aimed to estimate the prevalence of depressive symptoms as well as suicide-related ideation among Japanese university students during the stay-home order necessitated by the coronavirus disease 2019 pandemic in Japan, and offer evidence in support of future intervention to depression and suicide prevention strategies among college and university students.

Methods

The data for this cross-sectional study were derived from the Student Mental Health Survey conducted from May 20 to June 16, 2020 at a national university in Akita prefecture. Among the 5111 students recruited, 2712 participated in this study (response rate, 53%; mean age ± standard deviation, 20.5 ±3.5 years; men, 53.8%). Depressive symptoms were identified by using the Patient Health Questionnaire-9 (PHQ-9).

Results

The prevalence of moderate depressive symptoms based on a PHQ-9 score ≥10 and suicide-related ideation based on question 9 of PHQ-9 ≥1, which encompasses thoughts of both suicide and self-harm, was 11.7% and 6.7%, respectively. Multivariable logistic regression analyses showed that risk factors for depression included being a woman, smoking, alcohol consumption, and social network communication using either video or voice. For suicide-related ideation, alcohol consumption was the only risk factor. Exercise and having someone to consult about worries were associated with decreased risk of both depressive symptoms and suicide-related ideation.

Conclusions

Negative lifestyles of smoking and drinking, and being a woman, may be important risk factors for depressive symptoms, whereas exercise and having someone to consult about worries may be protective factors.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12199-021-00953-1.

Prevalence and Risk Factors of Internet Addiction among Hungarian High School Teachers

The extensive availability of internet has led to the the recognition of problematic internet use (so called internet addiction, IA) mostly involving adolescents. There is limited data about the prevalence of IA in adults. Here we present a study focusing on the prevalence and risk factors of internet addiction among high school teachers. Overall 2500 paper-based questionnaires were successfully delivered and 1817 responses received (response rate of 72.7%). In our study 1194 females (65.7%) and 623 males (34.3%) participated. In a multivariate analysis including of all factors (demographic data, internet habits, comorbidity etc.) age <35 years (OR: 6.098, CI: 5.09-7.08, p < 0.001), male gender (OR = 5.413, CI: 4.39-6.18, p = 0.002), surfing on the internet > 5 h daily (OR 2.568, CI: 2.03-3.39, p < 0.001), having no children (OR: 1.353, CI: 1.13-1.99, p = 0.0248), and having secondary employment (OR = 11.377, CI: 8.67-13.07, p = 0.001) were significantly associated with internet addiction. This is the first study from Hungary showing the prevalence and risk factors of internet addiction among high school teachers. A small, but significant proportion suffered from IA. Our study also draws attention to the risk factors of IA such as younger age, family status and working type.

Cybervictimization and Adolescent Internet Addiction: A Moderated Mediation Model

Previous research indicates that cybervictimization can lead to adolescent Internet addiction; however, there is a gap in the knowledge about the mediating and moderating variables facilitating this relationship. This study examines the role of rejection sensitivity as a mediator in this relationship and the role of parent–adolescent communication as a moderator for this mediation effect among Chinese adolescents. Participants were 1006 adolescents (M = 13.16 years, SD = 0.67), who completed the questionnaires anonymously. The questionnaires assessed the four variables of interest. Descriptive statistics and structural equation modeling were used for data analysis. The results show that the positive association between cybervictimization and adolescent Internet addiction is mediated by rejection sensitivity. Moreover, this indirect effect is stronger for adolescents with low parent–adolescent communication than for those with high parent–adolescent communication.

To What Extent is Internet Activity Predictive of Psychological Well-Being?

Background

Healthy internet activity (eg, making use of eHealth and online therapy) is positively associated with well-being. However, unhealthy internet activity (too much online time, problematic internet use/PIU, internet dependency/ID, etc.) is associated with reduced well-being, loneliness, and other related negative aspects. While most of the evidence is correlational, some research also shows that internet activity can be predictive for well-being.

Objective

The aim of this article is to elaborate on the question as to what extent internet activity is predictive of psychological well-being by means of (a) a scoping review and (b) theoretical understanding which model the interrelation of internet activity and psychological well-being.

Methodology

We searched different electronic databases such as Web of Science by using the search terms "Internet" OR "App" OR "digital" OR "online" OR "mobile application" AND "Use" OR "Activity" OR "Behavior" OR "Engagement" AND "Well-being" OR "Loneliness" for (a, the scoping review) or CCAM for (b, the theoretical understanding).

Results

The scoping review (a) summarizes recent findings: the extent to which internet activity is predictive for well-being depends on the internet activity itself: internet activity facilitating self-management is beneficial for well-being but too much internet activity, PIU and ID are detrimental to well-being. To understand (b) why, when and how internet activity is predictive for well-being, theoretical understanding and a model are required. While theories on either well-being or internet activity exist, not many theories take both aspects into account while also considering other behaviors. One such theory is the Compensatory Carry-Over Action Model (CCAM) which describes mechanisms on how internet use is related to other lifestyle behaviors and well-being, and that individuals are driven by the goal to adopt and maintain well-being - also called higher-level goals - in the CCAM. There are few studies testing the CCAM or selected aspects of it which include internet activity and well-being. Results demonstrate the potentials of such a multifactorial, sophisticated approach: it can help to improve health promotion in times of demographic change and in situations of lacking personnel resources in health care systems.

Conclusion and Recommendation

Suggestions for future research are to employ theoretical approaches like the CCAM and testing intervention effects, as well as supporting individuals in different settings. The main aim should be to perform healthy internet activities to support well-being, and to prevent unhealthy internet activity. Behavior management and learning should accordingly aim at preventing problematic internet use and internet dependency.

Internet Addiction and Burnout in A Single Hospital: Is There Any Association?

The extensive availability of the internet has led to the recognition of problematic internet use, the so-called Internet Addiction (IA), mostly involving adolescents. Burnout can lead to substance abuse or addictive behaviour (such as internet addiction) as a coping method. There are insufficient data about internet addiction and its possible association with burnout in adults, especially among healthcare workers. The aim of our present study was to focus on prevalence and the risk factors of internet addiction and its possible association with burnout among healthcare workers in a single hospital applying a questionnaire-based survey. In total, 49 doctors (10.1%), 198 nurses (40.9%), 123 medical assistant (25.4%), 73 other healthcare workers (15.1%), and 42 (1.7%) healthcare associated workers (cleaning, laundry, etc.) have completed our survey. In a multivariate analysis, IA was associated with age between 18 and 25 (OR: 2.6, p = 0.024), surfing on the internet >5 h daily (OR 25.583, p < 0.001), being single (OR: 4.275, p = 0.006), being childless (OR: 3.81, p = 0.011), working less than five years (OR 2.135, p = 0.048) and job type (being healthcare associated worker, OR: 2.907, p = 0.009). Illicit drug intake (OR 52.494, p < 0.001), and diabetes (OR: 4.122, p = 0.043) were also significantly associated with internet addiction. No association of burnout and IA could be found. A small but significant proportion of our healthcare workers suffered from IA, which was associated with substance abuse and diabetes in multivariate analysis. Our study also draws attention to the risk factors of IA such as younger age, family status, working type and working hours internet use. The possible association of burnout and IA merits further investigation.

Validation and Psychometric Properties of the Persian Version of the 21-Item Game Addiction Scale With a Sample of Adolescents and Young Adults

Background: Excessive gaming has become a psychological health issue for both gamers and their social environments. This observation holds true for western but also non-western countries such as Iran. The aim of the present study was to translate and validate a Persian version of the Game Addiction Scale 21 (GAS 21) using a sample of adolescents and adults. Methods: A total of 412 participants (mean age: 22.16 years; 55.3% females) took part in the study. They completed questionnaires covering sociodemographic information and gaming-related information, as well as the Persian version of the GAS 21, the GAS 7, the Internet Addiction Test, and the Generalized Self-Efficacy Scale. Results: Of the initial 21 items of the Persian version of the GAS 21, five proved redundant and were eliminated. Factors analyses yielded four factors explaining 66.35% of the variance: 1. Withdrawal; 2. Feelings of guilt and addiction; 3. Mood modification; 4. Issues of time budget. Cronbach's alphas were satisfactory (alphas > 0.87). To validate the results, scores on the translated version were compared with the well-established Young Internet Addiction test. Factors correlated positively (rs between 0.21 and 0.31) with overall score on this latter test but, against expectations, positively with the generalized self-efficacy scale. Conclusions: A Persian version of the Game Addiction Scale-21 proved to be a useful tool for assessing the risk of game addiction behavior. Further, the solution with 16 items loading on four factors appears respond to the ecological need of parsimony.

Prevalence of Behavioral Addictions and Their Relationship With Stress and Anxiety Among Medical Students in Saudi Arabia: A Cross-Sectional Study

Behavioral addiction is identified as any compulsive, repeated, and persistent behavior that leads to significant and functionally impairing harm or distress. The aim of this study is to determine the prevalence of internet, video-gaming, and pornography addictions among medical students in Western region. In addition, we intend to investigate the relationship between these behavioral addictions with stress and anxiety. Our study was a cross-sectional study with a sample size of 225. The study participants were medical students in their 3rd, 4th, and 5th academic years from five different medical colleges in Western region. The questionnaire included demographics and adapted five different pre-validated scales: Young's Internet Addiction Test - Short Version (IAT-SV), Internet Gaming Disorder Scale 9 - Short Form (IGDS9-SF), (PPC scale), Perceived Stress Scale (PSS), and Generalized Anxiety Disorder 7-item scale (GAD-7). The IAT-SV scale showed: 71 (31.6%) of the participants had normal internet usage, 51 (22.7%) participants showed problematic usage, and 103 (45.8%) used the internet pathologically. The IGDS9-SF scale had observed the following values: 220 participants (97.8%) were non-disordered, and 5 participants (2.2%) were found to be disordered. Statistical analysis showed a highly significant association between stress and problematic pornography consumption (P < 0.01), and internet addiction (P <0.001). Moreover, there was a significant association between anxiety and internet gaming disorder (P < 0.01). This study showed high prevalence of internet addiction and low prevalence of internet gaming disorder. Also, it gave more understanding to a possible association between these behavioral addictions with stress and anxiety.

Internet addiction among adolescents in Macau and mainland China: prevalence, demographics and quality of life

Internet addiction (IA) is common among adolescents and significantly determined by sociocultural and economic factors. The aim of this study was to compare the prevalence of IA among adolescents between Macau and mainland China and also examine its association with quality of life. A total of 2892 secondary school students were included. Standardized instruments were used to measure IA, depressive symptoms and quality of life. The overall prevalence of IA was 23.7%, with 32.5% in Macau and 19.8% in mainland China. Students in Macau were more likely to suffer from IA than those in mainland China (OR = 2.15, p < 0.001). Correlates of IA included being in higher school grades, poor academic performance, and more severe depressive symptoms. Students with IA reported lower quality of life in physical, psychological, social, and environmental domains. IA is common among Chinese adolescents, particularly in Macau. Considering the negative impact of IA on health and quality of life, regular screening and effective interventions should be undertaken for young Internet users.

Cybervictimization, Depression, and Adolescent Internet Addiction: The Moderating Effect of Prosocial Peer Affiliation

Although vast research has shown that cybervictimization is a significant risk factor of adolescent’s internet addiction (IA), little is known about the mediating and moderating mechanisms behind this relationship. The current study examined whether depression mediated the relationship between cybervictimization and adolescent’s IA, and whether the direct and indirect effect was moderated by prosocial peer affiliation (PPA). A sample of 1,006 adolescents (Mean_age = 13.16; SD = 0.67) anonymously completed the questionnaires. The results revealed that the positive association between cybervictimization and adolescent’s IA was mediated by depression. Moderated mediation analysis further showed that PPA moderated the association between cybervictimization and adolescent’s IA. However, this indirect effect was stronger for adolescents with high PPA than for those with low PPA, which means that the protective effects of PPA are limited. These findings highlight the mediating and moderating mechanisms between cybervictimization and adolescent’s IA, and provide guidance for the prevention and intervention in adolescent’s IA.

Serial multiple mediation of the association between internet gaming disorder and suicidal ideation by insomnia and depression in adolescents in Shanghai, China

BACKGROUND

High prevalence and strong relationships among suicidal ideation, Internet gaming disorder (IGD), insomnia, and depression have been reported for adolescents worldwide, but the mechanism underlying these psychological problems remains unclear. This cross-sectional study explored the mediating effect of insomnia and depression on the association between IGD and suicidal ideation.

METHODS

Participants were 1066 adolescents (median age = 13.0 years) with Internet games exposure in the previous 12 months from junior high schools in Shanghai, China. Questionnaire measures of suicidal ideation, IGD, insomnia, depressive symptoms, and background characteristics were obtained. Path analysis was conducted to test the multiple mediating roles of insomnia and depression.

RESULTS

Suicidal ideation, IGD, insomnia, and depression prevalence was 27.2, 13.6, 9.2, and 17.0%, respectively. A serial multiple mediation model was generated. The mediation effect of insomnia and depression on the pathway from IGD to suicidal ideation was 45.5% (direct effect: standardized estimate [Std. estimate] = 0.186; total indirect effect: Std. estimate = 0.155). The association between IGD and depression was partially mediated by insomnia (direct effect: Std. estimate = 0.211; indirect effect: Std. estimate = 0.135). The proposed model fit the data well.

CONCLUSIONS

Insomnia and depression may serially mediate the association between IGD and suicidal ideation. IGD was positively associated with insomnia, then with depression, which in turn positively contributed to suicidal ideation. We suggest greater monitoring of Internet use and prevention of insomnia and depression to mitigate the risk of suicidal ideation among Chinese adolescents.

Editorial: Did Goldilocks Have It Right? How Do We Define Too Little, Too Much, or Just Right?

Clinicians, teachers, and parents alike have long lamented screen time and its developmental and psychological implications, particularly as access to digital devices, games, and online platforms has become ubiquitous. In 2018, 95% of US teens reported having access to a smartphone, and 45% reported being online "almost constantly."¹ Parental and expert concerns include displacement of important activities such as sleep and exercise, Internet or video game addiction, negative social experiences such as cyberbullying, and worry that excessive use may cause or worsen mental health symptoms such as depression.²³ Research on the subject is challenging, as associations between device use and psychological functioning are likely multifactorial and nonlinear and therefore difficult to elucidate from small samples or samples that are lacking in rich covariate data. In addition, the rapid pace of technological change makes studying and reporting on these phenomena challenging as studies may be out of date before they are even published.

Social Media Use and Deliberate Self-Harm Among Youth: A Systematized Narrative Review

BACKGROUND

Suicide is now the 2^nd leading cause of death among adolescents and young adults. Social media's influence on youth suicidal risk or attenuation of risk is a novel and rapidly expanding topic of research that requires attention from a broad range of mental health services professionals. We aimed to provide an updated review of social media-related risk and protective factors to youth deliberate-self harm (DSH) to guide mental health services professionals in offering care and support to youth vulnerable to suicide.

METHODS

Studies on which primary research was conducted that evaluated young people's use of social media platforms related to DSH were systematically searched via Scopus and identified through expert recommendation and the Association for Computing Machinery's digital library of conference materials. The search focused on the timeframe June 2014 to September 2019, to offer an update since the time the most recent systematic reviews on this topic concluded their literatures searches. Quality was reviewed using the Mixed Methods Appraisal Tool (MMAT).

RESULTS

A total of 38 articles were eligible, and 24 articles rated as high quality were included in a narrative review. Of the included articles, 19 explored DSH risk and 8 explored DSH protection. Most articles reported on cross-sectional quantitative or qualitative studies. Opportunities for both risks and benefits were explored, and potential influences of social media use were considered for subgroups of youth who may be especially vulnerable to suicide.

CONCLUSIONS

In the relatively short period of review, the association between social media use and youth DSH was tested in population-based studies, offering preliminary evidence for suicide prevention and treatment efforts. Further research is needed to understand the contribution of social media use to youth DSH, particularly among youth most vulnerable to suicidal risk.

Associations of Internet Addiction Severity With Psychopathology, Serious Mental Illness, and Suicidality: Large-Sample Cross-Sectional Study

Background

Internet addiction has become a major global concern and a burden on mental health. However, there is a lack of consensus on its link to mental health outcomes.

Objective

The aim of this study was to investigate the associations between internet addiction severity and adverse mental health outcomes.

Methods

First-year undergraduates enrolled at Sichuan University during September 2015, 2016, 2017, and 2018 were invited to participate in the current study survey, 85.13% (31,659/37,187) of whom fully responded. Young’s 20-item Internet Addiction Test, Patient Health Questionnaire-15, Patient Health Questionnaire-9, Symptom Checklist 90, Six-Item Kessler Psychological Distress Scale, and Suicidal Behaviors Questionnaire-Revised were used to evaluate internet addiction, four psychopathologies (high somatic symptom severity, clinically significant depression, psychoticism, and paranoia), serious mental illness, and lifetime suicidality.

Results

The prevalence of students with mild, moderate, and severe internet addiction was 37.93% (12,009/31,659), 6.33% (2003/31,659), and 0.20% (63/31,659), respectively. The prevalence rates of high somatic symptom severity, clinically significant depression, psychoticism, paranoid ideation, and serious mental illness were 6.54% (2072/31,659), 4.09% (1294/31,659), 0.51% (160/31,659), 0.52% (165/31,659), and 1.88% (594/31,659), respectively, and the lifetime prevalence rates of suicidal ideation, suicidal plan, and suicidal attempt were 36.31% (11,495/31,659), 5.13% (1624/31,659), and 1.00% (315/31,659), respectively. The prevalence rates and odds ratios (ORs) of the four psychopathologies and their comorbidities, screened serious mental illness, and suicidalities in the group without internet addiction were much lower than the average levels of the surveyed population. Most of these metrics in the group with mild internet addiction were similar to or slightly higher than the average rates; however, these rates sharply increased in the moderate and severe internet addiction groups. Among the four psychopathologies, clinically significant depression was most strongly associated with internet addiction after adjusting for the confounding effects of demographics and other psychopathologies, and its prevalence increased from 1.01% (178/17,584) in the students with no addiction to 4.85% (582/12,009), 24.81% (497/2,003), and 58.73% (37/63) in the students with mild, moderate, and severe internet addiction, respectively. The proportions of those with any of the four psychopathologies increased from 4.05% (713/17,584) to 11.72% (1408/12,009), 36.89% (739/2003), and 68.25% (43/63); those with lifetime suicidal ideation increased from 24.92% (4382/17,584) to 47.56% (5711/12,009), 67.70% (1356/2003), and 73.02% (46/63); those with a suicidal plan increased from 2.59% (456/17,584) to 6.77% (813/12,009), 16.72% (335/2003), and 31.75% (20/63); and those with a suicidal attempt increased from 0.50% (88/17,584) to 1.23% (148/12,009), 3.54% (71/2003), and 12.70% (8/63), respectively.

Conclusions

Moderate and severe internet addiction were strongly associated with a broad group of adverse mental health outcomes, including somatic symptoms that are the core features of many medical illnesses, although clinically significant depression showed the strongest association. This finding supports the illness validity of moderate and severe internet addiction in contrast to mild internet addiction. These results are important for informing health policymakers and service suppliers from the perspective of resolving the overall human health burden in the current era of “Internet Plus” and artificial intelligence.

The frequency of impairments in everyday activities due to the overuse of the internet, gaming, or smartphone, and its relationship to health-related quality of life in Korea

BACKGROUND

This study aimed to investigate the relationships between the frequency of impairments in daily activities due to the overuse of the Internet, gaming, or smartphones (IGS) and sociodemographic characteristics, social relationships (including family) & activities, psychosocial characteristics, health status, and health-related quality of life (HRQoL) of Korean adults.

METHODS

Secondary data from the 2017 Community Health Survey, a large-scale sample survey conducted yearly in South Korea, were analyzed for 190,066 adults over 19 years of age. Three categories were created for impairment groups due to IGS overuse: No Impairment, Mild Impairment, and Moderate-to-Severe groups. And between-group differences were examined using a one-way ANOVA for health status measured with the EQ-5D-3 L and chi-square tests for all categorical dependent variables, which included sociodemographic characteristics, social relationships & activities, and psychosocial factors. The association between frequencies of daily activity impairments due to IGS overuse and the dependent variables were examined using a multivariate logistic regression analysis and a linear regression model.

RESULTS

Approximately 21,345 (11.23%) of the 190,066 participants reported experiencing impairments in daily activities due to IGS overuse at least once in the previous year and the impairments were more severe in males than females. Participants experiencing impairments in daily activities contacted their friends a significantly higher number of times (4 times or more per month) and engaged in leisure activities more frequently (more than once per month) than those without impairments. There was also a significant positive relationship between IGS overuse and stress, depression, suicidal ideation, and suicide attempts. Among participants aged 19-64, impairments in daily activities due to IGS overuse were associated with a lower HRQoL. Conversely, for those aged 65 and over, mild and moderate-to-severe impairments due to IGS overuse were associated with a significantly higher HRQoL.

CONCLUSIONS

Increased impairments in daily activities due to IGS overuse may negatively affect mental health. However, among older adults, the frequency of such impairments was positively associated with HRQoL. This finding could be considered to apply interventions with Internet usage or ICT devices for older adults to enhance their quality of life.

College Student Problematic Internet Use and Digital Communication Medium Used With Parents: Cross-Sectional Study

BACKGROUND

Problematic internet use (PIU) is associated with mental health concerns such as depression and affects more than 12% of young adults. Few studies have explored potential influences of parent-college student digital communication on college students' risk of PIU.

OBJECTIVE

This study sought to understand the relationship between parent-college student digital communication frequency via phone calls, text messages, and Facebook contacts and PIU among college students.

METHODS

Incoming first-year students were randomly selected from registrar lists of a midwestern and northwestern university for a 5-year longitudinal study. Data from interviews conducted in summer 2014 were used. Measures included participants' daily Facebook visits, communication frequency with parents via phone call and text message, and 3 variables related to Facebook connection status and communication: (1) parent-college student Facebook friendship status, (2) college student blocking personal Facebook content from parent, and (3) Facebook communication frequency. PIU risk was assessed using the Problematic and Risky Internet Use Screening Scale. Analysis included participants who reported visiting Facebook at least once per day. Multiple linear regression was used, followed by a post hoc mediation with Hayes process macro to further investigate predictive relationships among significant variables.

RESULTS

A total of 151 participants reported daily Facebook use and were included in analyses. Among these participants, 59.6% (90/151) were female, 62.3% (94/151) were from the midwestern university, and 78.8% (119/151) were white. Mean Facebook visits per day was 4.3 (SD 3.34). There was a collective significant effect between participant daily Facebook visits, college student-parent phone calls, texts, and all 3 Facebook connection variables (F6,144=2.60, P=.02, R2=.10). Phone calls, text messages, and Facebook contacts were not associated with PIU risk. However, two individual items were significant predictors for PIU: participant daily Facebook visits were positively associated with increased PIU risk (b=0.04, P=.006) and being friends with a parent on Facebook was negatively associated with PIU risk (b=-0.66, P=.008). Participant daily Facebook visits were not a significant mediator of the relationship between college student-parent Facebook friendship and PIU risk (b=-0.04; 95% CI -0.11 to 0.04).

CONCLUSIONS

This study did not find support for a relationship between parent-college student digital communication frequency and PIU among college students. Instead, results suggested Facebook friendship may be a protective factor. Future studies should examine how a parent-child Facebook friendship might protect against PIU among children at varying developmental stages.

Patologías asociadas al uso problemático de internet. Una revisión sistemática y metaanálisis en WOS y Scopus

El uso problemático de internet (UPI) ha empezado a vincularse con la predisposición a padecer ciertas patologías que afectan la salud del ser humano. Este trabajo se propuso determinar las patologías asociadas al uso problemático de internet a partir de una revisión sistemática en Web of Science y Scopus, y analizar la incidencia del UPI en cada una de las patologías a través del metaanálisis. Así pues, se empleó una metodología de revisión sistemática con metaanálisis y se estableció una muestra final de 62 documentos. Entre los resultados destacan, como principales patologías asociadas al uso problemático de internet, el trastorno obsesivo-compulsivo, el abuso del alcohol, la depresión, el estrés, los trastornos del sueño, el déficit de atención y la hiperactividad y los trastornos alimenticios. Además, en la mayoría de estas patologías se estableció una significación estadística entre los grupos de control y los grupos con UPI. Finalmente, se muestra una panorámica general sobre los riesgos que conlleva el abuso de internet y la incidencia que presentan en la salud tanto física como mental.

The association between sedentary behaviour and indicators of stress: a systematic review

BACKGROUND

Emerging evidence shows sedentary behaviour may be associated with mental health outcomes. Yet, the strength of the evidence linking sedentary behaviour and stress is still unclear. This study aimed to synthesise evidence regarding associations between time spent in sedentary behaviour and stress in adults.

METHODS

A systematic search was conducted (January 1990 - September 2019). Following PRISMA guidelines, an evaluation of methodological quality, and best-evidence synthesis of associations between time in sedentary behaviour (including sitting time, TV viewing, computer use) and stress were presented. Twenty-six studies reporting on data from n = 72,795 people (age 18-98y, 62.7% women) were included.

RESULTS

Across the studies (n = 2 strong-, n = 10 moderate- and n = 14 weak-quality), there was insufficient evidence that overall time spent in sedentary behaviour and sitting time were associated with stress, particularly when using self-report measures of sedentary behaviour or stress. There was strong evidence of no association between TV viewing, or computer use and stress. Amongst studies using objective measures of sedentary behaviour and/or stress there was also strong evidence of no association.

CONCLUSION

Although previous research suggested sedentary behaviour may be linked to mental health outcomes such as depression and anxiety, the evidence for an association between various types of sedentary behaviour and stress is limited in quality, and associations are either inconsistent or null. High-quality longitudinal/interventional research is required to confirm findings and determine the direction of associations between different contexts (i.e. purpose) and domains (i.e. leisure, occupational, transport) of sedentary behaviour and stress.

Problematic Internet Use as a Predictor of Eating Disorders in Students: A Systematic Review and Meta-Analysis Study

Problematic Internet use (PIU) has begun to be linked to the development of certain eating disorders. This uncontrolled use of the Internet is mainly found in the student population. The purposes of this paper were to determine PIU-related eating disorders in students from a systematic review of the literature and to analyze the incidence of PIU in eating disorders through a meta-analysis of the literature. We used two electronic databases (Web of Science and Scopus) from inception to June 2019. The systematic literature review was based on fixed inclusion and exclusion criteria. A total of 12 studies were identified (systematic review) and 10 studies for meta-analysis, which included 16,520 students. Different eating disorders were associated with PIU: anorexia nervosa, bulimia nervosa, binge-eating disorder, food preoccupation, loss of control eating, and dieting. Furthermore, meta-analysis confirmed that PIU is a predictor of eating disorders in students. The groups of students with PIU presented a higher rate in the presence of eating disorders, these differences being significant. Finally, this study showed empirical evidence on the link between PIU and eating disorders. The need for prevention in childhood and adolescence is highlighted.

Neural Correlates of Non-clinical Internet Use in the Motivation Network and Its Modulation by Subclinical Autistic Traits

Background: Increasing evidence regarding the neural correlates of excessive or pathological internet use (IU) has accumulated in recent years, and comorbidity with depression and autism has been reported in multiple studies. However, psychological and neural correlates of non-clinical IU in healthy individuals remain unclear.

Objectives: The aim of the current study was to investigate the relationships between non-clinical IU and functional connectivity (FC), focusing on the brain’s motivation network. We sought to clarify the influence of depression and autistic traits on these relationships in healthy individuals.

Methods: Resting-state functional magnetic resonance imaging (fMRI) was performed in 119 healthy volunteers. IU, depression, and autistic traits were assessed using the Generalized Problematic Internet Use Scale 2 (GPIUS2), Beck Depression Inventory-II (BDI-II), and the autism spectrum quotient (AQ) scale, respectively. Correlational analyses were performed using CONN-software within the motivation-related network, which consisted of 22 brain regions defined by a previous response-conflict task-based fMRI study with a reward cue. We also performed mediation analyses via the bootstrap method.

Results: Total GPIUS2 scores were positively correlated with FC between the (a) left middle frontal gyrus (MFG) and bilateral medial prefrontal cortex; (b) left MFG and right supplementary motor area (SMA); (c) left MFG and right anterior insula, and (d) right MFG and right insula. The “Mood Regulation” subscale of the GPIUS2 was positively correlated with FC between left MFG and right SMA. The “Deficient Self-Regulation” subscale was positively correlated with FC between right MFG and right anterior insula (statistical thresholds, FDR < 0.05). Among these significant correlations, those between GPIUS2 (total and “Mood Regulation” subscale) scores and FC became stronger after controlling for AQ scores (total and “Attention Switching” subscale), indicating significant mediation by AQ (95% CI < 0.05). In contrast, BDI-II had no mediating effect.

Conclusion: Positive correlations between IU and FC in the motivation network may indicate health-promoting effects of non-clinical IU. However, this favorable association is attenuated in individuals with subclinical autistic traits, suggesting the importance of a personalized educational approach for these individuals in terms of adequate IU.

Manifesto for a European research network into Problematic Usage of the Internet

The Internet is now all-pervasive across much of the globe. While it has positive uses (e.g. prompt access to information, rapid news dissemination), many individuals develop Problematic Use of the Internet (PUI), an umbrella term incorporating a range of repetitive impairing behaviours. The Internet can act as a conduit for, and may contribute to, functionally impairing behaviours including excessive and compulsive video gaming, compulsive sexual behaviour, buying, gambling, streaming or social networks use. There is growing public and National health authority concern about the health and societal costs of PUI across the lifespan. Gaming Disorder is being considered for inclusion as a mental disorder in diagnostic classification systems, and was listed in the ICD-11 version released for consideration by Member States (http://www.who.int/classifications/icd/revision/timeline/en/). More research is needed into disorder definitions, validation of clinical tools, prevalence, clinical parameters, brain-based biology, socio-health-economic impact, and empirically validated intervention and policy approaches. Potential cultural differences in the magnitudes and natures of types and patterns of PUI need to be better understood, to inform optimal health policy and service development. To this end, the EU under Horizon 2020 has launched a new four-year European Cooperation in Science and Technology (COST) Action Programme (CA 16207), bringing together scientists and clinicians from across the fields of impulsive, compulsive, and addictive disorders, to advance networked interdisciplinary research into PUI across Europe and beyond, ultimately seeking to inform regulatory policies and clinical practice. This paper describes nine critical and achievable research priorities identified by the Network, needed in order to advance understanding of PUI, with a view towards identifying vulnerable individuals for early intervention. The network shall enable collaborative research networks, shared multinational databases, multicentre studies and joint publications.