Altered Resting-State Network in Adolescents with Problematic Internet Use

Problematic internet use (PIU) is increasingly recognized as a mental health concern, particularly among adolescents. The resting-state functional connectivity (rsFC) of the triple-network model has been described inconsistently in PIU. Using resting-state fMRI (rsFMRI) and hypothesizing a lower rsFC between default mode (DMN) and central executive networks (CEN) but a higher rsFC within the salience network (SN), this study scrutinized the neural substrates of PIU adolescents. A total of 30 adolescents with PIU and 30 control subjects underwent rsFMRI. The severity of PIU was evaluated by the Internet Addiction Test. Additionally, personality traits as well as emotional and behavioral problems were evaluated by the Temperament and Character Inventory (TCI) and the Strength and Difficulties Questionnaire (SDQ), respectively. Focusing on the DMN, SN, and CEN, we compared rsFC values between PIU and the control. Subsequently, within the combined group of subjects, TCI and SDQ correlation and mediation effects were investigated. Higher rsFC values of the left lateral prefrontal cortex (LPFC(L)) with the left anterior insula (aIns(L)) were observed for PIU than for the control, while rsFCs of the LPFC(L) with the medial PFC (MPFC), LPFC(L), as well as with the right lateral parietal cortex (LP(R)) were lower for PIU. Among these significant group differences, the rsFC between the LPFC(L) and MPFC was mediated by emotional symptoms (standardized β = −0.12, 95% CI −0.29, −0.0052). The dysfunctional attention switching and incentive salience regulated by the SN were implicated as being a neural correlate of PIU, and this relationship would in part be explained by the emotional dysregulation associated with PIU in adolescents.

Psychometric properties of the Indonesian Ten-item Internet Gaming Disorder Test and a latent class analysis of gamer population among youths

Internet gaming disorder (IGD) is a rising health concern. Indonesia has yet to have any validated instrument specifically designed to screen for this disorder. This study aims to validate the Indonesian version of the Ten-item Internet Gaming Disorder Test (IGDT-10) and conduct a latent class analysis of gamers among the youth. An online survey was conducted between October and December 2020 at two universities in Depok and Jakarta, Indonesia. In total, 1233 respondents (62.6% female and 20.3±1.90 years old) gave valid responses and played video games. Confirmatory factor analysis (CFA) confirmed the unidimensional structure of the scale. Cronbach’s alpha was 0.72 and composite reliability was 0.92. The latent class analysis yielded three distinct classes of gamers. The continuation and negative consequences were highly distinctive for the group at high risk of IGD (class 3). Deception had the lowest endorsement rate (41.7%); while, the continuation domain had the highest endorsement, 91.2%. The IGD prevalence estimate was 1.90% among the respondents. Approximately 70.2% of the gamers did not show IGD symptoms. The adapted Indonesian IGDT-10 was demonstrated as valid and reliable among Indonesian youths. Consistent with previous studies, the deception domain had a low endorsement rate. The detected IGD rates were comparable to the global range. The majority of the current sample disclosed no symptoms; however, a considerable proportion would benefit from early preventive measures.

Potential Correlates of Internet Gaming Disorder Among Indonesian Medical Students: Cross-sectional Study

BACKGROUND

Internet gaming disorder has been a controversial topic for nearly a decade. Although internet addiction has been studied in medical students, there is a paucity of evidence regarding internet gaming disorder. Previous studies in Indonesia explored only the prevalence rate and characteristics.

OBJECTIVE

This study aimed to determine the prevalence rate of internet gaming disorder and correlations between internet gaming disorder, temperament, and psychopathology among Indonesian medical students.

METHODS

A cross-sectional study was performed from August 2019 to September 2019 using total and convenience sampling at a private university and a public university, respectively. The study variables were measured using the Indonesian version of the 10-item Internet Gaming Disorder Test, the Temperament and Character Inventory, and the Symptoms Checklist 90. Chi-square and logistic regression analyses were conducted to examine the relationships between demographic factors, temperament, psychopathology, and the presence of internet gaming disorder.

RESULTS

Among the 639 respondents, the prevalence rate of internet gaming disorder was 2.03% (n=13), with a mean age of 20.23 (SD 0.13) years and an average gaming duration of 19.0 (SD 0.96) hours/week. Up to 71.2% respondents played using their mobile phones, and respondents with internet gaming disorder reported experiencing all psychopathologies assessed, except phobic anxiety. Bivariate analysis demonstrated that internet gaming disorder was associated with gender, gaming duration, gaming community affiliation, and 9 out of 10 domains of psychopathology. In a logistic regression model, internet gaming disorder was correlated with weekly gaming hours ≥20 hours (odds ratio [OR] 4.21, 95% CI 1.08-16.38, P=.04).

CONCLUSIONS

These findings suggest that the prevalence of internet gaming disorder among medical students in Jakarta, Indonesia is similar to that in other populations of Asian countries. The predisposing factor for internet gaming disorder was weekly gaming duration, while other demographic, temperament, and psychopathology variables acted as probable moderators. Strategies should, therefore, be developed and integrated into medical curriculum to screen and aid individuals with these predisposing factors.

Internet addiction in adolescents: Development and validation of Internet Addiction Diagnostic Questionnaire (KDAI)

Internet addiction (IA) is an emerging behavioral problem that constitutes a major health threat to vulnerable populations, including adolescents. However, there is a paucity of IA screening tools specifically designed for adolescents, especially in Indonesia. Therefore, the current study developed and validated the IA Diagnostic Questionnaire (KDAI) in adolescents while acknowledging local cultural influences. The KDAI was conceived through extensive literature reviews, expert discussions based on Delphi methods, a face validity study, focus group discussion (N = 31) for initial reliability testing, and a recruited pilot study (N = 385) and main study (N = 643) for exploratory and confirmatory factor analyses, respectively. The multi-sample analyses demonstrated that the KDAI model with the best fit and reliability comprised a seven-factor structure, including withdrawal, loss of control, increase of priority, negative consequences, mood modification, salience, and impairment. These factors were scrutinized against domains of IA Test, and concurrent validity was ascertained. Subsequently, a receiver operating characteristic curve and area under the curve determined a cutoff score of 108 to discern adolescents with IA. Taken together, the KDAI displayed excellent psychometric indices and sensitivity as a screening tool for IA in adolescents.

Alcohol- and Cigarette-Use Related Behaviors During Quarantine and Physical Distancing Amid COVID-19 in Indonesia

Background: In light of the coronavirus disease 2019 (COVID-19) pandemic, Indonesia implemented large-scale social restrictions (pembatasan sosial berskala besar/PSBB) to combat the spread of COVID-19, which might influence addictive behaviors. The current study aimed to explore the fluctuation of substance use during the pandemic and association of physical distancing and related factors toward consumption of alcohol and cigarettes. Method: An online survey was conducted from April 28 to June 1, 2020. Data regarding sociodemographic information, physical distancing profile, alcohol and cigarette usages, Alcohol Use Disorders Identification Test (AUDIT), Cigarette Dependence Scale (CDS), Symptom Checklist-90, and Pittsburg Sleep Quality Index (PSQI) were collected. A total of 4,584 respondents from all 34 provinces in Indonesia completed the survey. Data were summarized descriptively and analyzed using chi-square, ANOVA, and multinomial regression on SPSS 23.0 for Windows. Results: This study found that during the COVID-19 pandemic in Indonesia alcohol consumption was 9.50% and daily cigarette smoking was 20.3%. Around 44.5% and 47.6% of respondents reported stable alcohol consumption and cigarette consumption, respectively. The mean AUDIT score was 3.52 ± 4.66 and the mean CDS score was 24.73 ± 8.86. Physical distancing was not correlated to any substance use changes. Increased alcohol consumption was negatively correlated with being unmarried and positively correlated with a higher PSQI score. Decreased alcohol use positively correlated with living in PSBB-implementing provinces and higher AUDIT scores when compared to stable alcohol drinking. Increased cigarette smoking was positively correlated with being male, unmarried, and higher CDS scores. Reduced cigarette smoking was negatively correlated with living in provinces implementing PSBB, higher CDS scores, and phobic anxiety, hostility, and psychoticism subscales of SCL-90. Discussion and Conclusion: The prevalence of alcohol and cigarette consumption changes showed a similar trend with other available studies in other countries. This study established that substance use was mainly sustained with a smaller proportion of respondents amplifying their substance usages. The changes were correlated with PSBB policy but not the practice of physical distancing. Psychiatry and addiction services in Indonesia should be strengthened to cope with the increased burden of psychological distress. Future studies should conduct more comparisons to determine whether the overall rising intensity of consumption was maintained post-pandemic and delineate acute psychopathologies' effects on substance use.

Implications of COVID-19 and Lockdown on Internet Addiction Among Adolescents: Data From a Developing Country

Introduction: Physical distancing policy during coronavirus disease 2019 (COVID-19) pandemic requires adolescents to spend most of their time at home, thus increasing Internet use duration. Limited social interaction with their peers may lead to loneliness and an increased risk of mental health among adolescents. This study aimed to assess the prevalence of Internet addiction (IA) among adolescents and analyze the influence of psychosocial factors toward the heightened risk of IA during the COVID-19 pandemic. Methods: An online survey comprising sociodemographic questionnaire, Internet Addiction Diagnostic Questionnaire (KDAI), Strengths and Difficulties Questionnaire (SDQ), and Pittsburgh Sleep Quality Index (PSQI) was distributed. Overall, a total of 2,932 adolescents (mean age, 17.38 ± 2.24 years old; female, 78.7%), originating from 33 of 34 provinces in Indonesia, completed the survey. Results: The point prevalence of IA among Indonesian adolescents during the COVID-19 outbreak was 19.3%. Increased Internet use duration, internalization, externalization, low prosocial behavior, and sleep disturbances were found as risk factors of IA, either directly or as mediating variables. Physical distancing, large-scale social restriction (PSBB), and health status were not correlated to IA. Discussion: Physical distancing was not established as a risk of IA. This could be due to other psychological factors such as internalization, externalization, prosocial, and sleep problems that had correlations to IA occurrence among adolescents in the COVID-19 pandemic. Sleep impairment might have resulted from the emotional and behavioral issues and directly contributed to IA development. Conclusion: The present study found the prevalence of IA among Indonesian adolescents to be higher than the adult during the COVID-19 pandemic. Several psychological measures were indicated to increase the risk of IA, while physical distancing did not elevate the risk. Thus, remote schooling is preferable in Indonesia along with proper parental supervision to minimize Internet use for entertainment purposes.

Insights Into Adolescents' Substance Use in a Low-Middle-Income Country During the COVID-19 Pandemic

Introduction: The COVID-19 pandemic and its lockdown have been a significant life event for many individuals, particularly adolescents. The immense psychological pressure could drive risky behavior, e.g., substance use, while lockdown might lead to decreased use. This study aimed to observe the change in substance use among adolescents in Indonesia and the moderating variables to consumption during the COVID-19 lockdown period. Methods: This study utilized an online survey from April 28, 2020 to June 30, 2020. The hyperlink was disseminated to school administrators and parenting groups through social media and direct messages. A total of 2,932 adolescents (17.4 ± 2.24 and 78.7% females) submitted valid responses. The survey was comprised of a sociodemographic section, substance use details, and psychometric sections, including the Alcohol Use Disorders Identification Test (AUDIT), Cigarette Dependence Scale 12 (CDS-12), Pittsburgh Sleep Quality Index (PSQI), and Strength and Difficulties Questionnaire (SDQ). Results: Overall, adolescent alcohol use during the pandemic was 5.1%, cigarette smoking was 3.1%, and drug consumption was 0.4%. Over half (53.4%) of alcohol drinkers reported increased drinking, and 33.1% had harmful or dependence-like drinking behavior; in contrast, 44.4% of adolescent smokers disclosed reduced cigarette consumption. Around 37.8% of the drug users indicated increased use. During the pandemic, adolescent alcohol use was associated with higher education [adjusted odds ratio (AOR) = 2.67, 95% confidence interval (CI) 1.02-4.86, p = 0.04], higher AUDIT scores (AOR = 1.33, 95% CI 1.25-1.42, p < 0.001), and very low prosocial behavior (AOR = 2.46, 95% CI 1.52-3.88, p < 0.001). Cigarette smoking was correlated with male sex (AOR = 9.56, 95% CI 5.64-16.62, p < 0.001), age (AOR = 1.40, 95% CI 1.14-1.75, p < 0.001), and higher CDS score (AOR = 1.17, 95% CI 1.13-1.20, p < 0.001). Conclusions: Rates of adolescent substance use were significant, with sizeable proportions reporting higher usage. This appeared to occur predominantly in specific demographics and those with a lower protective psychosocial attribute, i.e., prosocial behavior, during the lockdown. These findings should urge the strengthening of adolescent addiction care during and after the pandemic.

The Impact of Physical Distancing and Associated Factors Towards Internet Addiction Among Adults in Indonesia During COVID-19 Pandemic: A Nationwide Web-Based Study

INTRODUCTION

Physical distancing has encouraged the public to utilize the Internet for virtually all daily activities during the COVID-19 pandemic. This study aimed to assess the impact of COVID-19 on Internet addiction (IA) prevalence and analyzed the correlated factors during quarantine and pandemic.

METHODS

An online survey was generated, comprising of a sociodemographic section, Internet Addiction Diagnostic Questionnaire (KDAI), Symptoms Checklist-90, and Pittsburgh Sleep Quality Index. The hyperlink was disseminated through social media, companies, and universities. Overall, 4,734 adults, (mean age 31.84 ± 7.73 years old and 55.2% males) representing all 34 provinces of Indonesia, gave valid responses.

RESULTS

Point prevalence of IA during the COVID-19 pandemic was 14.4% in Indonesian adults. Online duration increased by 52% compared to before the pandemic. Physical distancing was not established as a risk of IA. Increased daily online duration, specific motivations, types of application, and having confirmed/suspected COVID-19 cases within the household were predictive of IA. All subscales of SCL-90 and PSQI were higher in the group with positive/suspect cases of COVID-19 within households and were correlated to higher scores of IA.

DISCUSSION

Physical distancing alone was not associated with an increased risk of IA. The prevalence of IA during COVID-19 was higher than the previously proposed rate among Indonesian adults, which might be related to digital activities associated with COVID-19 and the popularity of virtual socializing. Furthermore, psychopathologies and sleep disruptions were related to IA occurrences and especially prevalent in groups with proximity to COVID-19. Fear of COVID-19 contraction and rampant misinformation of COVID-19 probably contributed to these factors, which potentially harbor long-term consequences.

CONCLUSION

The current study demonstrated a high point prevalence of IA and identified several preventable factors predictive of IA during home-quarantine and COVID-19, especially in adults with confirmed/suspected COVID-19 cases within the household. However, physical distancing did not increase the odds of IA. Public health agencies should maintain physical distancing advisory while providing adaptive psychiatric education and service.