Internet addiction and poor quality of life are significantly associated with suicidal ideation of senior high school students in Chongqing, China

Is Problematic Internet and Smartphone Use Related to Poorer Quality of Life? A Systematic Review of Available Evidence and Assessment Strategies

Purpose of Review

Previous studies have explored the links between problematic Internet use (PIU) or problematic smartphone use (PSU) and quality of life (QOL). In this systematic review, we (i) describe the instruments used to assess QOL or health-related quality of life (HRQOL) in these studies, (ii) critically examine the content validity of the instruments used, and (iii) examine the relationships between PIU, PSU, QOL, and HRQOL.

Recent Findings

We identified 17 PIU and 11 PSU studies in a systematic search. Evidence suggests that PIU and PSU negatively correlate with either QOL or HQOL and most of their domains (especially mental and physical health). Multiple instruments were used to assess QOL or HRQOL in these studies. Our analysis showed an important heterogeneity in the domains covered by these instruments.

Summary

Because of the widespread prevalence of PIU and PSU, which tend to be linked with lower QOL or HRQOL, in particular poor mental and physical health, a more systematic public health campaign is required to target the healthy use of these communication devices. Prevention programs should also target vulnerable individuals, focusing on the most affected domains of QOL and HRQOL (i.e., physical and psychological health). Among the existing instruments, the World Health Organization Quality of Life for adults and the Pediatric Quality of Life Inventory for adolescents (aged 13-18 years) proved to be the most relevant, although new measurement instruments are needed to target domains that are specifically relevant in the context of PIU and PSU (e.g., physical and psychological health domains such as sleep, loneliness, and quality of familial relations).

Suicide Risk and Association With the Different Trauma During the COVID-19 Pandemic Period: A Cross-Sectional Study on Adolescent With Different Learning Stage in Chongqing, China

This study aimed to examine the current suicidal risk and whether the suicidal risk was associated with a wide range of trauma. The self-administered online questionnaire was adopted to collect suicide risk (SR) such as suicidal ideation, self-harm, suicide attempts, and different trauma information of the adolescents by cluster sampling in Chongqing, China. Multivariable linear regression was presented to assess the association between different risks of trauma and SR scores. Approximately 14.7% of adolescents enrolled reported suicide ideation and more than 10% of adolescents have experienced one kind of trauma during the Coronavirus disease 2019 (COVID-19) pandemic period. After adjusting for confounding variables, adolescents who suffered family hurt had a higher risk score of SR (beta coefficients (β) = 0.289, 95% confidence interval (CI) = 0.115-0.463). A positive association was found among participants from junior and senior school (β = 0.415, 95% CI = 0.152, 0.768), and the SR score was positively associated with sexism among participants from the university/college (β = 0.238, 95% CI = 0.042, 0.434). The most potentially obvious trauma that contributed to SR in junior and senior school adolescents might be cyberbullying. Family neglect or abuse might be a detrimental factor in SR for adolescents whether those in junior school or those in university school in China. More interventions, like education related to cyberbullying and family abuse, should be prioritized to reduce the risk of suicide.

Is there a gradient in the association between internet addiction and health?

Background

Internet Addiction (IA) is often shown to be associated with health issues, but no study explicitly examined a possible gradient in the association between different levels of IA and health. This study aimed to examine if the levels of IA had a graded relationship with poor sleep quality, psychological distress, and self-rated health among university students in Bangladesh.

Methods

In this cross-sectional study, a sample of 625 students from six universities/colleges responded to an online survey that contained measures of internet addiction test (IAT), general health questionnaire (GHQ-12), sleep quality, and self-rated health. Modified Poisson regression models were fitted to estimate the adjusted risk ratios (RR) and confidence intervals (CI) of the associations between IA and health outcomes.

Results

The IA levels were associated with each of the three health outcomes in a linear fashion. Compared to the lowest IA quintile, the highest quintile remained associated with an increased risk of poor-quality sleeping (RR: 1.77; 95% CI: 1.26, 2.48), psychological distress (RR: 2.09; 95% CI: 1.55, 2.82), and worse self-rated health (RR: 1.46; 95% CI: 1.09, 1.96) after adjusting for socio-demographic covariates. There were also dose-response associations between IAT z-scores and health outcomes. The association between IAT z-scores and psychological distress was significantly stronger in males compared to females (p-value for interaction<0.05).

Conclusions

The study found strong gradients between levels of addiction to internet and health outcomes, suggesting that increased health risks may exist even at lower levels of internet addiction. The findings highlight the need for departure of current research from a focus on the classic dichotomy of problematic versus not problematic internet use and a move toward recognizing the potential hierarchical effects of IA on health.

Prevalence, correlates, and network analysis of Internet addiction symptoms among Chinese pregnant and postpartum women

OBJECTIVE

Excessive Internet use is a common health problem globally. This study aimed to assess the prevalence, correlates, and network structure of Internet addiction symptoms (Internet addiction hereafter) among Chinese pregnant and postpartum women.

METHODS

This was a multicenter cross-sectional study using Internet Addiction Test (IAT) and the World Health Organization Quality of Life Questionnaire (WHOQOL-BREF) to evaluate Internet addiction and quality of life (QOL), respectively. Univariate analyses, multivariate logistic regression analyses, and network analyses were performed.

RESULTS

Of a total of 1,060 women who completed the study, 320 (30.19%, 95% CI=27.42%-32.96%) women reported Internet addiction during or after pregnancy. Women with previous adverse pregnancy experiences (OR=1.831, P=0.001) and physical comorbidities (OR=1.724, P=0.004) had a higher likelihood of developing Internet addiction. Internet addiction was significantly associated with poor QOL in all domains. Network analyses revealed that IAT item 16 (request an extension for longer time spent online) was the most central symptom in the analyses, and also one of the strongest bridging symptoms linking the Internet addiction and QOL communities.

LIMITATIONS

This was a cross-sectional study, all study findings were based on self-reported data, and possible recall bias and selection bias may exist.

CONCLUSION

Internet addiction is common among Chinese pregnant and postpartum women, and is significantly associated with lower QOL. Effective strategies, especially focusing on central symptoms, are needed to reduce the impact of Internet addiction and improve QOL in pregnant and postpartum women.

The prevalence of and factors associated with antenatal depression among all pregnant women first attending antenatal care: a cross-sectional study in a comprehensive teaching hospital

BACKGROUND

Antenatal depression has become a common and serious problem, significantly affecting maternal and fetal health. However, evaluation and intervention methods for pregnant women in obstetric clinics are inadequate. This study aimed to determine the prevalence of and risk factors for depression among all pregnant women at their first attending antenatal care in the obstetrics clinic, a comprehensive teaching hospital, southwest of China.

METHODS

From June to December 2019, 5780 pregnant women completed online psychological assessments, and data from 5728 of the women were analyzed. The women were categorized into two groups according to the presence or absence of depression. Depression was assessed by the Patient Health Questionnaire-9 (PHQ-9), with a cutoff point of 10 for depression. Anxiety and somatic symptoms were measured by the Generalized Anxiety Disorder-7 (GAD-7) and Patient Health Questionnaire-15 (PHQ-15), respectively. Univariate analysis and binary logistic regression analysis were used to determine the association among antenatal depression, anxiety, somatic symptoms and participants' characteristics.

RESULTS

The prevalence of antenatal depression among all the pregnant women at their first attending antenatal care was 16.3%, higher in the first trimester (18.1%). Anxiety symptoms (Mild anxiety AOR = 2.937; 95% CI: 2.448-3.524) and somatic symptoms (Mild somatic symptoms AOR = 3.938; 95% CI: 2.888-3.368) were major risk factors for antenatal depression among women and the risk increased more with the anxiety level or somatic symptoms level. Gestational weeks (second trimester AOR = 0.611; 95% CI: 0.483-0.773; third trimester AOR = 0.337; 95% CI: 0.228-0.498) and urban residence (AOR = 0.786; 95% CI: 0.652-0.947) were protective factors for antenatal depression among women.

CONCLUSIONS

About one in six pregnant women would experience depression, and special attention should be paid to some risk factors (i.e., early pregnancy, anxiety symptoms, somatic symptoms, rural residence). Online psychological assessments might be a time-saving and convenient screening method for pregnant women in obstetric clinics.

Trajectories of depression and anxiety in Chinese high school freshmen: Associations with Internet addiction

BACKGROUND

Most previous studies focused on the associations of depression and anxiety with Internet addiction (IA) have used variable-centered approaches. This study aims to explore the distinct developmental trajectories of depression and anxiety, and their association with IA based on person-centered approaches.

METHODS

A total of 437 Chinese high school freshmen at the baseline were followed across one year. Latent class growth analysis (LCGA) and growth mixture modeling (GMM) were used to identify the heterogeneity of individual trajectories of depression and anxiety.

RESULTS

For depression, there were three distinct trajectories identified, namely, the escalating group (n=60, 13.7%), recovery group (n=31, 7.1%), and the low-stable group (n=346, 79.2%). For anxiety, the subgroups consisted of the escalating group (n=50, 11.4%), the recovery group (n=34, 7.8%), and the low-stable group (n=353, 80.8%). The probability of IA in the depression low-stable group was significantly smaller compared to those in either the recovery group (χ²=10.794, P=0.001) or the escalating group (χ²=19.314, P<0.001). The probability of IA in the anxiety low-stable group was found to be significantly smaller than that in the recovery group (χ²=17.359, P<0.001) and the escalating group (χ²=7.752, P=0.005).

LIMITATIONS

The sample was limited to students from one specific high school and had a one-year follow-up.

CONCLUSIONS

The findings of the study suggest the necessity of early prevention and intervention strategies for those students with depression and anxiety, which are at elevated risk of developing IA.

How has Internet Addiction been Tracked Over the Last Decade? A Literature Review and 3C Paradigm for Future Research

Background:

The popularity of the internet aggravated by its excessive and uncontrolled use has resulted in psychological impairment or addiction. Internet addiction is hypothesized as an impulse-control disorder of internet use having detrimental impacts on daily life functions, family relationships, and emotional stability. The goal of this review is to provide an exhaustive overview of the empirical evidence on internet addiction and draw attention to future research themes.

Methods:

We performed a literature search on ScienceDirect and PubMed to review original research articles with empirical evidence published on peer-reviewed international journals from 2010 to 2019. Eight hundred and 26 articles were eligible for analysis. Frequency and descriptive statistics were calculated by Microsoft Excel.

Results:

A substantial contribution has been coming from researchers from China, Turkey, Korea, Germany, and Taiwan respectively. Despite controversies regarding its definition and diagnostic procedures, internet addiction has become the focal point of a myriad of studies that investigated this particular phenomenon from different exposures. Given observed literature review data regarding research design, data acquisition, and data analysis strategies, we proposed the 3C paradigm which emphasizes the necessity of research incorporating cross-disciplinary investigation conducted on cross-cultural settings with conscientious cross-validation considerations to gain a better comprehension of internet addiction.

Conclusions:

The findings of the present literature review will serve both academics and practitioners to develop new solutions for better characterize internet addiction.

Relationship Between Childhood Left-Behind Experience and Quality of Life Among Chinese University Freshmen: Place of Origin Matters

Background: Childhood left-behind experience (LBE) has a long-term detrimental effect on the mental health of Chinese University students, but it remains unclear whether childhood LBE negatively impacts the quality of life (QOL) of University students and whether the LBE-QOL association differs between students of rural origin and students of urban origin. This study examined the LBE-QOL relationship and the interactive effect between LBE and place of origin on QOL among Chinese University freshmen. Methods: By using a two-stage random cluster sampling approach, a total of 5,033 freshmen were recruited from two comprehensive universities. The students completed an online, self-administered questionnaire that included sociodemographic variables, a 2-week physical morbidity assessment, and assessments of depressive symptoms, academic stress, and QOL. The Chinese six-item QOL scale was used to assess QOL. Multiple linear regression was used to test the independent LBE-QOL association and the interaction between LBE and place of origin. Results: Students with childhood LBE had significantly lower QOL scores than those without LBE (60.1 ± 13.1 vs. 64.3 ± 11.7, p < 0.001). After adjusting for the potential confounding effects of other sociodemographic variables, 2-week physical morbidity, depressive symptoms, and academic stress, childhood LBE was significantly associated with a lower QOL score (β: -3.022, p < 0.001) and the LBE-place of origin interaction was still significantly associated with the QOL score (β: -2.413, p < 0.001). Overall, compared to non-LBE, LBE was associated with a QOL score decrease of 5.93 among freshmen of urban origin and of 3.01 among freshmen of rural origin. Conclusion: In Chinese University freshmen, childhood LBE is independently associated with poor QOL, and the LBE-QOL association is greater among freshmen from urban backgrounds than among freshmen from rural backgrounds.

Problematic Internet use and the risk of suicide ideation in Chinese adolescents: A cross-sectional analysis

To evaluate the relationships between problematic Internet use (PIU) and suicidal ideation (SI) among adolescents, we encompassed 12,507 participants (16.6 ± 0.8 years). The occurrence of mood disorders, quality of life (QOL), personality traits and SI were compared in adolescents with and without PIU. Multilevel logistic regression models, trend analysis and interaction analysis were employed. A total of 2,809 (22.46%) adolescents reported SI. PIU was assessed using Internet Addiction Test score (IATs), and 3,442 (27.52%) participants met the criteria for PIU (IATs ≥ 40). PIU was significantly and independently associated with SI [AOR for suicidal ideation (vs. IATs < 40): 1.00 for 40-59 points; 1.3 (CI, 1.2-1.5): 60-79 points; 1.7 (CI, 1.4-2.1): 80-100 points; and 2.2 (CI, 1.2-3.9)]. Trend analysis demonstrated that PIU increased the risk of SI in each of the subgroups (p for trend ≤ 0.001 for each). Interaction analysis showed an association of PIU and SI that were dependent on mood disorders, QOL, impulsivity and aggression (p-value for interaction < 0.05). These findings highlight the need for a range of cross disciplinary health interventions to afflicted families, students, and clinicians, to increase the awareness of adverse PIU effects.

Relationship between Internet addiction, susceptible personality traits, and suicidal and self-harm ideation in Chinese adolescent students

BACKGROUND AND AIMS

Internet addiction (IA) is common among young students. This study aimed to examine the influence and mechanisms of IA and susceptible personality traits on the impact of suicidal ideation in adolescent students in China.

METHODS

This cross-sectional study (09/2012-09/2015) used stratified cluster sampling with "school type" for stratification; 136,266 students from 63 schools completed the questionnaire. Logistic regression analysis was performed to estimate the effect of IA (Young's Internet Addiction Test) and susceptible personality (Barratt impulsiveness scale, Buss & Perry Aggression Questionnaire; and Eysenck Personality Questionnaire-R Short Scale) on suicidal ideation (Scale of Suicidal Ideation).

RESULTS

Suicidal ideation was observed in 20,218 (14.77%) of the students, and IA was detected in 28,836 (21.16%) subjects. Compared with those without IA, students with IA had a higher prevalence of suicidal ideation (P < 0.0001). No planning impulsiveness had a predictive effect on suicidal ideation in the impulsive personality trait, while in the aggressive personality trait, hostility and self-aggression had a predictive effect on suicidal ideation (all P < 0.0001). High psychoticism and neuroticism were impact factors for suicidal ideation, but extroversion was a protective factor (all P < 0.0001).

DISCUSSION

These results highlight the importance of assessing personality traits and reducing IA as a possible means of lessening suicidal ideation. Susceptible personality (such as high psychoticism, high neuroticism, and low extroversion) play a prominent role in influencing the probability of having suicidal behavior among those recently exposed to IA.

CONCLUSIONS

IA and susceptible personality traits were significantly correlated with suicidal and self-harm ideation among adolescent students.

Internet society, internet addiction, and pathological social withdrawal: the chicken and egg dilemma for internet addiction and hikikomori

PURPOSE OF REVIEW

Internet society has made our daily life more convenient, while its negative consequences especially internet, smartphone, and gaming addiction are emerging. At the same time, the phenomenon of pathological social withdrawal called 'hikikomori' has been increasingly highlighted as a problematic behavior in Japan. Now hikikomori is becoming a global mental health issue. The interaction between internet society, internet addiction, and hikikomori has not been well clarified.

RECENT FINDINGS

A case vignette survey among psychiatrists suggested that hikikomori cases could be comorbid with internet addiction. In reality, hikikomori cases with internet addiction have been reported internationally. A recent survey among college/university students in Japan has indicated positive interactions between internet addiction, smartphone addiction, gaming internet disorder, and hikikomori-tendencies.

SUMMARY

The cause of hikikomori has not been well understood, and the emergence of internet may be one of the important contributing factors for the occurrence of hikikomori. Whether pathological social withdrawal creates internet addiction, or internet overuse creates hikikomori remains unclear. Both possibilities exist, and we herein propose the conceptual model of these hypothetical interactions. Clarifying the mechanisms of both conditions will help to solve these crucial issues for contemporary urban societies.

The Potential Role of the Early Maladaptive Schema in Behavioral Addictions Among Late Adolescents and Young Adults

Background

Behavioral addiction (BA) is a recent concept in psychiatry. Few studies have investigated the relationship between BA and early maladaptive schemas (EMSs). EMS is the core of Schema Therapy (ST). According to the ST model, psychiatric disorders result from the development of EMSs in response to unmet emotional needs in childhood. Bach et al. (2018) grouped the 18 EMSs into four domains: (1) disconnection and rejection; (2) impaired autonomy and performance; (3) excessive responsibility and standards; and (4) impaired limits. This study aims to assess the possible association of the most frequent BAs with EMSs in a large group of late adolescents and young adults and to evaluate their self-perceived quality of life (QoL).

Methods

A battery of psychological tests assessing food addiction (FA), gambling disorder (GD), internet addiction (IA), and QoL was administered to 1,075 late adolescents and young adults (N = 637; 59.3% women). A forward-stepwise logistic regression model was run to identify which variables were associated with BAs.

Results

Food addiction was more frequent among women and GD among men, while IA was equally distributed. Regarding the EMSs, participants with FA or IA showed significantly higher scores on all four-schema domains, whereas those with GD exhibited higher scores on impaired autonomy and performance and impaired limits. Besides, average scores of all domains increased with the association of two or more comorbid BAs. Self-perceived QoL was lower for participants with FA and IA, but not for those with GD; the presence of comorbid BAs was associated with lower Physical Component Summary (PCS) and Mental Component Summary (MCS) scores. Finally, specific EMS domains and demographic variables were associated with each BA.

Conclusion

Late adolescents and young adults with FA or IA have a lower perception of their mental and physical health. The most striking result is that FA appears to be associated with the disconnection and rejection schema domain, IA with all the schema domains (except for impaired autonomy and performance), and GD with impaired autonomy and performance schema domain. In conclusion, our findings suggest that EMS should be systematically assessed during psychotherapy of patients with BAs.