INTERNET ADDICTION STUDIES: SUMMARIES

This page contains short internet addiction summaries of the latest research on Internet Addiction (As of 2020 we are no longer adding studies to this current page: see this page for all Internet addiction studies). Other studies involving Internet Gaming Addiction (IGD) can be found here. Internet addiction brain studies have already confirmed the presence of the same brain changes as seen in drug addiction.

• Current list of all the neurological studies on porn users and sex addicts (CSBD)
• Integrating psychological and neurobiological considerations regarding the development and maintenance of specific Internet-use disorders: An Interaction of Person-Affect-Cognition-Execution model (2016) – A review of the mechanisms underlying the development and maintenance of specific Internet-use disorders, including “Internet-pornography-viewing disorder”. The authors suggest that pornography addiction (and cybersex addiction) be classified as internet use disorders and placed with other behavioral addictions under substance-use disorders as addictive behaviors.
• For a thorough review of the neuroscience literature related to Internet addiction subtypes, with special focus on internet porn addiction, see –Neuroscience of Internet Pornography Addiction: A Review and Update (2015). The review also critiques two recent headline-grabbing EEG studies which purport to have “debunked” porn addiction.

Cognitive deficits in problematic internet use: meta-analysis of 40 studies (2019)

Br J Psychiatry. 2019 Feb 20:1-8. doi: 10.1192/bjp.2019.3.

Excessive use of the internet is increasingly recognised as a global public health concern. Individual studies have reported cognitive impairment in problematic internet use (PIU), but have suffered from various methodological limitations. Confirmation of cognitive deficits in PIU would support the neurobiological plausibility of this disorder.AimsTo conduct a rigorous meta-analysis of cognitive performance in PIU from case-control studies; and to assess the impact of study quality, the main type of online behaviour (for example gaming) and other parameters on the findings.

A systematic literature review was conducted of peer-reviewed case-controlled studies comparing cognition in people with PIU (broadly defined) with that of healthy controls. Findings were extracted and subjected to a meta-analysis where at least four publications existed for a given cognitive domain of interest.

RESULTS: The meta-analysis comprised 2922 participants across 40 studies. Compared with controls, PIU was associated with significant impairment in inhibitory control (Stroop task Hedge’s g = 0.53 (s.e. = 0.19-0.87), stop-signal task g = 0.42 (s.e. = 0.17-0.66), go/no-go task g = 0.51 (s.e. = 0.26-0.75)), decision-making (g = 0.49 (s.e. = 0.28-0.70)) and working memory (g = 0.40 (s.e. = 0.20-0.82)). Whether or not gaming was the predominant type of online behaviour did not significantly moderate the observed cognitive effects; nor did age, gender, geographical area of reporting or the presence of comorbidities.

 CONCLUSIONS: PIU is associated with decrements across a range of neuropsychological domains, irrespective of geographical location, supporting its cross-cultural and biological validity. These findings also suggest a common neurobiological vulnerability across PIU behaviours, including gaming, rather than a dissimilar neurocognitive profile for internet gaming disorder.

Mobile Phone Addiction Among Children and Adolescents: A Systematic Review (2019_)

J Addict Nurs. 2019 Oct/Dec;30(4):261-268. doi: 10.1097/JAN.0000000000000309.

Mobile phone addiction among children and adolescents has become a concern for all. To date, focuses have been given to Internet addiction, but comprehensive overview of mobile phone addiction is lacking. The review aimed to provide a comprehensive overview of mobile phone addiction among children and adolescents.

Electronic databases search included Medline, Proquest, Pubmed, EBSCO host, EMBASE, CINAHL, PsycINFO, OVID, Springer, Wiley online library, and Science Direct. Inclusion criteria were studies including children and adolescents, studies published in peer-reviewed journals, and studies focusing on mobile phone addiction or problematic use of mobile phone. A systematic search identified 12 descriptive studies, which met inclusion criteria, but no interventional study met the criteria.

The prevalence of problematic mobile phone use was found to be 6.3% in the overall population (6.1% among boys and 6.5% among girls), whereas another study found 16% among the adolescents. The review finds that excessive or overuse of mobile phone was associated with feeling insecurity; staying up late at night; impaired parent-child relationship; impaired school relationships; psychological problems such as behavioral addiction like compulsive buying and pathological gambling, low mood, tension and anxiety, leisure boredom, and behavioral problems, among which most pronounced association was observed for hyperactivity followed by conduct problems and emotional symptoms.

Though mobile phone use helps in maintaining social relationship, mobile phone addiction among children and adolescents needs urgent attention. Interventional studies are needed to address these emerging issues.

Cognitive functions in Internet addiction – a review (2019)

Psychiatr Pol. 2019 Feb 28;53(1):61-79. doi: 10.12740/PP/82194.

The Internet, being generally available, is used by all age groups for professional purposes and also as a form of education and entertainment. It is, however, possible to use the Internet excessively, resulting in an addiction. Internet addiction can be classified as one of the so-called ‘behavioral addictions’, and until recently it has rarely been addressed in scientific publications. It is therefore important to differentiate between normal and pathological Internet use. This paper presents data on the incidence of Internet addiction and reviews the relevant theoretical models. It also discusses the identification of Internet addiction based on diagnostic criteria suggested by the scientific community. The focus of the article is on executive functioning in this type of addiction. Until recently researchers have put it in the context of a personal, social or emotional area, yet it would seem that cognitive functions play a significant role in explaining the development of addiction, with cognitive control and executive functions being particularly important. In addition, knowledge of these mechanisms can contribute to the development of more adequate forms of prevention and treatment.

The “online brain”: how the Internet may be changing our cognition (2019)

World Psychiatry. 2019 Jun;18(2):119-129. doi: 10.1002/wps.20617.

The impact of the Internet across multiple aspects of modern society is clear. However, the influence that it may have on our brain structure and functioning remains a central topic of investigation. Here we draw on recent psychological, psychiatric and neuroimaging findings to examine several key hypotheses on how the Internet may be changing our cognition. Specifically, we explore how unique features of the online world may be influencing: a) attentional capacities, as the constantly evolving stream of online information encourages our divided attention across multiple media sources, at the expense of sustained concentration; b) memory processes, as this vast and ubiquitous source of online information begins to shift the way we retrieve, store, and even value knowledge; and c) social cognition, as the ability for online social settings to resemble and evoke real-world social processes creates a new interplay between the Internet and our social lives, including our self-concepts and self-esteem. Overall, the available evidence indicates that the Internet can produce both acute and sustained alterations in each of these areas of cognition, which may be reflected in changes in the brain. However, an emerging priority for future research is to determine the effects of extensive online media usage on cognitive development in youth, and examine how this may differ from cognitive outcomes and brain impact of uses of Internet in the elderly. We conclude by proposing how Internet research could be integrated into broader research settings to study how this unprecedented new facet of society can affect our cognition and the brain across the life course.

Pornographic Picture Processing Interferes with Working Memory Performance (2012)

J Sex Res. 2012 Nov 20.

Some individuals report problems during and after Internet sex engagement, such as missing sleep and forgetting appointments, which are associated with negative life consequences. One mechanism potentially leading to these kinds of problems is that sexual arousal during Internet sex might interfere with working memory (WM) capacity, resulting in a neglect of relevant environmental information and therefore disadvantageous decision making. Results revealed worse WM performance in the pornographic picture condition of the 4-back task compared with the three remaining picture conditions.

Furthermore, hierarchical regression analysis indicated an explanation of variance of the sensitivity in the pornographic picture condition by the subjective rating of the pornographic pictures as well as by a moderation effect of masturbation urges. Results contribute to the view that indicators of sexual arousal due to pornographic picture processing interfere with WM performance. Findings are discussed with respect to Internet addiction because WM interference by addiction-related cues is well known from substance dependencies.

Comments: Internet porn interferes with working memory, just as addiction-related cues interfere with working memory in addicts. First study to assess the effects of porn on the brain

Sexual Picture Processing Interferes with Decision-Making Under Ambiguity. (2013)

Arch Sex Behav. 2013 Jun 4.

Decision-making performance was worse when sexual pictures were associated with disadvantageous card decks compared to performance when the sexual pictures were linked to the advantageous decks. Subjective sexual arousal moderated the relationship between task condition and decision-making performance. This study emphasized that sexual arousal interfered with decision-making, which may explain why some individuals experience negative consequences in the context of cybersex use.

Impulsivity traits and addiction-related behaviors in youth (2018)

J Behav Addict. 2018 Apr 12:1-14. doi: 10.1556/2006.7.2018.22.

Background and aims

Impulsivity is a risk factor for addictive behaviors. The UPPS-P impulsivity model has been associated with substance addiction and gambling disorder, but its role in other non-substance addiction-related behaviors is less understood. We sought to examine associations between UPPS-P impulsivity traits and indicators of multiple substance and non-substance addiction-related behaviors in youth with varying involvement in these behaviors.

Methods

Participants (N = 109, aged 16-26 years, 69% males) were selected from a national survey based on their level of externalizing problems to achieve a broad distribution of involvement in addiction-related behaviors. Participants completed the UPPS-P Questionnaire and standardized questionnaires assessing problematic use of substances (alcohol, cannabis, and other drugs) and non-substances (Internet gaming, pornography, and food). Regression analyses were used to assess associations between impulsivity traits and indicators of addiction-related behaviors.

Results

The UPPS-P model was positively associated with indicators of all addiction-related behaviors except problematic Internet gaming. In the fully adjusted models, sensation seeking and lack of perseverance were associated with problematic use of alcohol, urgency was associated with problematic use of cannabis, and lack of perseverance was associated with problematic use of other drugs than cannabis. Furthermore, urgency and lack of perseverance were associated with binge eating and lack of perseverance was associated with problematic use of pornography.

We emphasize the role of trait impulsivity across multiple addiction-related behaviors. Our findings in at-risk youth highlight urgency and lack of perseverance as potential predictors for the development of addictions and as potential preventative therapeutic targets.

Cybersex addiction: Experienced sexual arousal when watching pornography and not real-life sexual contacts makes the difference (2013)

Journal of Behavioral Addictions. Volume 2, Number 2/June 2013

The results show that indicators of sexual arousal and craving to Internet pornographic cues predicted tendencies towards cybersex in the first study. Moreover, it was shown that problematic cybersex users report greater sexual arousal and craving reactions resulting from pornographic cue presentation. In both studies, the number and the quality with real-life sexual contacts were not associated to cybersex addiction. The results support the gratification hypothesis, which assumes reinforcement, learning mechanisms, and craving to be relevant processes in the development and maintenance of cybersex addiction. Poor or unsatisfying sexual reallife contacts cannot sufficiently explain cybersex addiction.

COMMENTS: Wow – an actual study about Internet porn addiction. Study found cue-induced cravings, similar to drug addicts, predicted porn addiction. Contrary to popular belief, unsatisfying sexual life had no correlation to porn addiction. Supporting the gratification hypothesis means addiction-like behaviors in response to ones chosen addiction.

Watching Pornographic Pictures on the Internet: Role of Sexual Arousal Ratings and Psychological-Psychiatric Symptoms for Using Internet Sex Sites Excessively (2011)

Cyberpsychol Behav Soc Netw. 2011 Jun;14(6):371-7. doi: 10.1089/cyber.2010.0222.

We found a positive relationship between subjective sexual arousal when watching Internet pornographic pictures and the self-reported problems in daily life due to the excessiveness of cybersex as measured by the IATsex. Subjective arousal ratings, the global severity of psychological symptoms, and the number of sex applications used were significant predictors of the IATsex score, while the time spent on Internet sex sites did not significantly contribute to explanation of variance in the IATsex score.

The finding that subjective sexual arousal ratings while watching Internet pornographic pictures is related to self-reported problems in daily life due to excessive use of cybersex sites may be interpreted in the light of previous studies on cue reactivity in individuals with substance dependency or behavioral addictions. As outlined in the introduction, cue reactivity as a mechanism potentially contributing to the maintenance of addicted behavior has been demonstrated in several patient groups with either substance dependence or behavioral addiction.

These studies converge to the view that craving reactions on watching addiction-related stimuli are important correlates of the addictive behavior. Although we did not examine brain correlates of watching Internet pornographic pictures in our study, we found the first experimental evidence for the potential link between subjective reactivity on Internet pornographic stimuli and a tendency toward cybersex addiction.

This means that for problems in daily life (e.g., reduced control over online sexual activities, problems with the own partner or in other interpersonal relationships, as well as problems in academic or work life), the time spent on cybersex sites is not predictive. Our results indeed emphasize that higher sexual arousal is linked to a tendency toward being addicted to cybersex and related problems in everyday life.

Cybersex addiction in heterosexual female users of internet pornography can be explained by gratification hypothesis (2014)

Cyberpsychol Behav Soc Netw. 2014 Aug;17(8):505-11.

Symptoms of cybersex addiction can be linked to both approaching and avoiding pornographic stimuli: results from an analog sample of regular cybersex users (2015)

Pathological Internet use – It is a multidimensional and not a unidimensional construct

May 15, 2013 ADDICTION RESEARCH &THEORY

It is still a topic of debate whether pathological Internet use (PIU) is a distinct entity or whether it should be differentiated between pathological use of specific Internet activities like playing Internet games and spending time on Internet sex sites. The aim of the current study was to contribute to a better understanding of common and differential aspects of PIU in relation to different specific Internet activities. Three groups of individuals were examined which differed with respect to their use of specific Internet activities: one group of 69 subjects used exclusively Internet games (IG) (but not Internet pornography (IP)), 134 subjects used IP (but not IG), and 116 subjects used both IG and IP (i.e., unspecific Internet use).

The results indicate that shyness and life satisfaction are significant predictors for a tendency towards pathological use of IG, but not pathological use of IP. Time spent online was a significant predictor for problematic use of both IG and IP. Additionally, no correlation was found between symptoms of pathological use of IG and IP. We conclude that games may be used to compensate social deficits (e.g., shyness) and life satisfaction in real life, whereas IP is primarily used for gratification in terms of achieving stimulation and sexual arousal.

WIRED: The impact of media and technology use on stress (cortisol) and inflammation (interleukin IL-6) in fast paced families (2018)

Volume 81, April 2018, Pages 265–273

• Despite being digital natives, technology most affects adolescents’ biomarkers of stress.
• Fathers and adolescents experienced rises in their CAR and higher IL-6 due to technology use.
• Bedtime and general use were related to an increase in CAR for adolescents, but a decrease for fathers.
• Technology use did not affect cortisol diurnal rhythm for any family member.
• Technology use also had no effect on mothers’ biosocial markers.

This study examined how technology and media use affect stress (cortisol) and inflammation (interleukin IL-6) in dual earning parents and their adolescents. Sixty-two families reflected on their technology use the past week and collected saliva on two consecutive days that week. Technology use had the greatest effect on adolescents. Adolescents with greater phone use, general media exposure, and larger social networks via Facebook had a greater rise in their cortisol awakening response (CAR) and higher IL-6. Fathers’ phone use and email were also associated with an increase in their CAR and IL-6. When bedtime technology use was high, greater general media use was associated with an increase in CAR for adolescents, but a decrease for fathers. Technology use did not significantly affect cortisol diurnal rhythm or mothers’ biosocial markers.

Information and Communications Technologies (ICT): Problematic use of Internet, video games, mobile phones, instant messaging and social networks using MULTICAGE-TIC (2018)

Adicciones. 2018 Jan 1;30(1):19-32. doi: 10.20882/adicciones.806.

This study aims to understand the problems that affect people of all ages in controlling the use of these ICTs and whether they are related to mental health problems, stress and difficulties in executive control of behaviour. A survey was administered through social networks and email, using the MULTICAGE-ICT, a questionnaire that explores problems in the use of Internet, mobile phones, video games, instant messaging and social networks. Additionally, the Prefrontal Symptom Inventory, General Health Questionnaire and Perceived Stress Scale were administered. The sample was comprised of 1,276 individuals of all ages from different Spanish-speaking countries.

The results indicate that about 50% of the sample, regardless of age or other variables, presents significant problems with the use of these technologies, and that these problems are directly related to symptoms of poor prefrontal functioning, stress and mental health problems. The results reveal the need for reconsidering whether we are facing an addictive behaviour or a new problem demanding environmental, psychological, sociological and sociopolitical explanations; therefore, it is necessary to reformulate actions to be implemented to address and refocus our understanding of the problem.

Problematic internet use: an exploration of associations between cognition and COMT rs4818, rs4680 haplotypes (2019)

CNS Spectr. 2019 Jun 4:1-10. doi: 10.1017/S1092852919001019.

We recruited 206 non-treatment seeking participants with heightened impulsive traits and obtained cross-sectional demographic, clinical, and cognitive data as well as the genetic haplotypes of COMT rs4680 and rs4818. We identified 24 participants who presented with problematic internet use (PIU) and compared PIU and non-PIU participants using one-way analysis of variance (ANOVA) and chi square as appropriate.

PIU was associated with worse performance on decision making, rapid visual processing, and spatial working memory tasks. Genetic variants were associated with altered cognitive performance, but rates of PIU did not statistically differ for particular haplotypes of COMT.

This study indicates that PIU is characterized by deficits in decision making and working memory domains; it also provides evidence for elevated impulsive responses and impaired target detection on a sustained attention task, which is a novel area worth exploring further in future work. The effects observed in the genetic influences on cognition of PIU subjects imply that the genetic heritable components of PIU may not lie within the genetic loci influencing COMT function and cognitive performance; or that the genetic component in PIU involves many genetic polymorphisms each conferring only a small effect.

Impaired orienting in youth with Internet Addiction: Evidence from the Attention Network Task (2018).

Psychiatry Res. 2018 Jun;264:54-57. doi: 10.1016/j.psychres.2017.11.071.

An important theory of attention suggests that there are three separate networks that execute discrete cognitive functions: alerting, orienting and conflict networks. Recent studies showed that there was a dysfunction of attention in Internet Addiction. In order to investigate the underlying mechanism of attention dysfunction in Internet Addiction, we recorded performance related to the Attentional Network Test (ANT) in youth.

The ANT, a behavioral assay of the functional integrity of attention networks, was used to examine the performance in Internet Addiction and healthy controls.

Performance on the ANT clearly differentiated the participants with and without Internet Addiction in terms of mean reaction times (RTs). Compared with control group, the Internet Addiction group detected targets more slowly and this effect was evident only for spatial cue condition. The Internet Addiction group demonstrated deficits in the orienting network in terms of slower RT. There was no demonstration of a deficit in both the alerting and conflict network in Internet Addiction on this task.

Effect of electro-acupuncture combined with psychological intervention on mental symptoms and P50 of auditory evoked potential in patients with internet addiction disorder (2017)

http://dx.doi.org/10.1016/S0254-6272(17)30025-0

To observe the therapeutic effects of electro-acupuncture (EA) combined with psychological intervention on the symptom of somzatization or obsession and mental symptom of depression or anxiety and P50 of Auditory Evoked Potential (AEP) on internet addiction disorder (IAD).

One hundred and twenty cases of IAD were randomly divided into an EA group, a psycho-intervention (PI) group and a comprehensive therapy (EA plus PI) group. Patients in the EA group were treated with EA. Patients in the PI group were treated with cognition and behavior therapy. Patients in the EA plus PI group were treated with electro-acupuncture plus psychological intervention. Scores of IAD, scores of the symptom checklist 90 (SCL-90), latency and amplitude of P50 of AEP were measured before and after treatment.

The scores of IAD after treatment significantly decreased in all groups (P < 0.05), and the scores of IAD in the EA plus PI group were significantly lower than those in the other two groups (P < 0.05). The scores of SCL-90 assembled and each factor after treatment in the EA plus PI group significantly decreased (P < 0.05). After treatment in the EA plus PI group, the amplitude distance of S1P50 and S2P50 (S1-S2) significantly increased (P < 0.05).

EA combined with PI could relieve the mental symptoms of IAD patients, and the mechanism is possibly related to the increase of cerebrum sense perception gating function.

Interference with Processing Negative Stimuli in Problematic Internet Users: Preliminary Evidence from an Emotional Stroop Task (2018)

J Clin Med. 2018 Jul 18;7(7). pii: E177. doi: 10.3390/jcm7070177.

Although it has been proposed that problematic Internet use (PIU) may represent a dysfunctional coping strategy in response to negative emotional states, there is a lack of experimental studies that directly test how individuals with PIU process emotional stimuli. In this study, we used an emotional Stroop task to examine the implicit bias toward positive and negative words in a sample of 100 individuals (54 females) who also completed questionnaires assessing PIU and current affect states. A significant interaction was observed between PIU and emotional Stroop effects (ESEs), with participants who displayed prominent PIU symptoms showing higher ESEs for negative words compared to other participants. No significant differences were found on the ESEs for positive words among participants. These findings suggest that PIU may be linked to a specific emotional interference with processing negative stimuli, thus supporting the view that PIU is a dysfunctional strategy to cope with negative affect.

Internet addiction and functional brain networks: task-related fMRI study (2019)

Sci Rep. 2019 Oct 31;9(1):15777. doi: 10.1038/s41598-019-52296-1.

A common brain-related feature of addictions is the altered function of higher-order brain networks. Growing evidence suggests that Internet-related addictions are also associated with breakdown of functional brain networks. Taking into consideration the limited number of studies used in previous studies in Internet addiction (IA), our aim was to investigate the functional correlates of IA in the default mode network (DMN) and in the inhibitory control network (ICN). To observe these relationships, task-related fMRI responses to verbal Stroop and non-verbal Stroop-like tasks were measured in 60 healthy university students. The Problematic Internet Use Questionnaire (PIUQ) was used to assess IA. We found significant deactivations in areas related to the DMN (precuneus, posterior cingulate gyrus) and these areas were negatively correlated with PIUQ during incongruent stimuli. In Stroop task the incongruent_minus_congruent contrast showed positive correlation with PIUQ in areas related to the ICN (left inferior frontal gyrus, left frontal pole, left central opercular, left frontal opercular, left frontal orbital and left insular cortex). Altered DMN might explain some comorbid symptoms and might predict treatment outcomes, while altered ICN may be the reason for having difficulties in stopping and controlling overuse.

The utility of combining respiratory sinus arrhythmia indices in association with internet addiction (2020)

Int J Psychophysiol. 2020 Feb 19. pii: S0167-8760(20)30041-6. doi: 10.1016/j.ijpsycho.2020.02.011.

The aim of this study is to examine the association of the combined indices of respiratory sinus arrhythmia at rest (basal RSA) and in response to a mental arithmetic task (RSA reactivity) to internet addiction. Participants included 99 young adults (61 men and 38 women) who reported on their levels of internet addiction. The results indicated that RSA reactivity moderated the association between basal RSA and self-reported internet addiction. This showcased that basal RSA had a negative association with internet addiction for individuals with higher RSA reactivity but had no significant association with internet addiction for those with lower RSA reactivity. These findings help to extend our understanding of the link between the parasympathetic nervous systems activity and internet addiction. Additionally, it underscores the need for the simultaneous consideration of basal RSA and RSA reactivity in future studies.

Automatic detection advantage of problematic Internet users for Wi-Fi signal cues and the moderating effect of negative affect: An event-related potential study (2019)

Addict Behav. 2019 Aug 8;99:106084. doi: 10.1016/j.addbeh.2019.106084.

Cognitive bias toward Internet-related cues is an important factor of the formation and maintenance of the addictive behavior of problematic Internet users (PIUs). The development of fiber-optic communication and smartphones has ushered human society into the era of wireless networks. The Wi-Fi signal, the symbol of wireless network connection, represents not only network access but also a channel for communication with others anywhere at any time. Therefore, the Wi-Fi signal cues should be an effective inducer of the addictive behaviors of PIUs. We used images of Wi-Fi signal as Internet-related cues to explore the automatic detection advantage of PIUs for these cues and to determine whether negative affect, another predisposing factor for addiction, can enhance this advantage. We utilized an intergroup design in this study. The PIU and control groups each comprised 30 participants and were randomly assigned to negative or neutral affect priming group. Mismatch negativity (MMN) was induced through the deviant-standard reverse oddball paradigm. Wi-Fi signal cues and neutral cues were used as standard and deviant stimuli, respectively. Results show that the MMN induced by Wi-Fi signal cues in the PIU group was larger than that in the control group. Meanwhile, the MMN induced by Wi-Fi signal cues was considerably enhanced in the PIU group under negative affect priming relative to that in the PIU group under neutral affect priming. Overall, PIUs have an automatic detection advantage for Wi-Fi signal cues, and negative affect can enhance this advantage. Our results suggest that the MMN elicited by Wi-Fi signal cues function as a sensitive neurobiological marker tracing the change of addiction motivation for PIUs.

Microstructural changes and internet addiction behaviour: A preliminary diffusion MRI study (2019)

Addict Behav. 2019 Jun 27;98:106039. doi: 10.1016/j.addbeh.2019.106039.

Internet addiction (IA) is a major health problem and is associated with comorbidities like insomnia and depression. These consequences frequently confound neuroanatomical correlates of IA in those suffering from it. We enrolled a number of 123 healthy native German-speaking adults (53 male, mean age: 36.8 ± 18.86) from the Leipzig Study for Mind-Body-Emotion Interactions (LEMON) database, for whom diffusion MRI data, internet addiction test, brief self-control scale (SCS), coping orientations to problems experienced (COPE), and depression scores were available. DMRI connectometry was used to investigate white matter microstructural correlates of the severity of internet addiction identified through IAT, in a group of healty young individuals. A multiple regression model was adopted with age, gender, SCS total score, COPE total score, and BDI-sum as covariates to track white matter fibers in which connectivity was associated with IAT. The connectometry analysis identified a direct correlation between connectivity in the splenium of corpus callosum (CC), parts of bilateral corticospinal tracts (CST), and bilateral arcuate fasciculi (AF) (FDR = 0.0023001), and an inverse correlation of the connectivity in the genu of CC and right fornix (FDR = 0.047138), with the IAT score in healthy adults. We suggest connectivity in the CC and CST as well as fornix and AF to be considered as microstructural biomarkers of predisposition to IA in healthy population.

Altered topological connectivity of internet addiction in resting-state EEG through network analysis (2019)

Addict Behav. 2019 Feb 26;95:49-57. doi: 10.1016/j.addbeh.2019.02.015.

The results of some neuroimaging studies have revealed that people with internet addiction (IA) exhibit structural and functional changes in specific brain areas and connections. However, the understanding about global topological organization of IA may also require a more integrative and holistic view of brain function. In the present study, we used synchronization likelihood combined with graph theory analysis to investigate the functional connectivity (FC) and topological differences between 25 participants with IA and 27 healthy controls (HCs) based on their spontaneous EEG activities in the eye-closed resting state.  Correlation analysis demonstrated that the observed regional alterations were significantly correlated with the severity of IA. Collectively, our findings showed that IA group demonstrated altered topological organization, shifting towards a more random state. Moreover, this study revealed the important role of altered brain areas in the neuropathological mechanism of IA and provided further supportive evidence for the diagnosis of IA.

Electro-acupuncture treatment for internet addiction: Evidence of normalization of impulse control disorder in adolescents (2017)

Chin J Integr Med. 2017 Sep 1. doi: 10.1007/s11655-017-2765-5.

To observe the impacts of electro-acupuncture (EA) and psychological intervention (PI) on impulsive behavior among internet addiction (IA) adolescents.

Thirty-two IA adolescents were allocated to either EA (16 cases) or PI (16 cases) group by a randomized digital table. Subjects in the EA group received EA treatment and subjects in the PI group received cognition and behavior therapy. All adolescents underwent 45-d intervention. Sixteen healthy volunteers were recruited into a control group. Barratt Impulsiveness Scale (BIS-11) scores, Young’s Internet Addiction Test (IAT) as well as the ratio of brain N-acetyl aspartate (NAA) to creatine (NAA/Cr) and choline (Cho) to creatine (Cho/Cr) were recorded by magnetic resonance spectroscopy before and after intervention respectively.

The IAT scores and BIS-11 total scores in both EA and PI group were remarkably decreased after treatment (P<0.05), while EA group showed more signifificant decrease in certain BIS-11 sub-factors (P<0.05). Both NAA/Cr and Cho/Cr were signifificantly improved in EA group after treatment (P<0.05); however, there were no signifificant changes of NAA/Cr or Cho/Cr in PI group after treatment (P>0.05).

Both EA and PI had signifificantly positive effect on IA adolescents, especially in the aspects of psychological experiences and behavioral expressions, EA might have an advantage over PI in terms of impulsivity control and brain neuron protection. The mechanism underlying this advantage might be related to the increased NAA and Cho levels in prefrontal and anterior cingulate cortices.

Neurophysiological and clinico-biological features of internet addiction (2019)

Zh Nevrol Psikhiatr Im S S Korsakova. 2019;119(12):51-56. doi: 10.17116/jnevro201911912151.

in English, Russian

AIM: To analyse neurophysiological and some physiological characteristics of people with Internet addiction.

MATERIAL AND METHODS: Two groups of subjects were studied: with Internet-addiction lasted no more than two years and the control group. Spectral-correlation parameters of EEG, functional asymmetry of EEG parameters, and heart rate variability were recorded. The comparison was performed in three states: eyes-closed, eyes-open conditions and after a 15-minute Internet session.

RESULTS AND CONCLUSION: The shift in the balance of the regulation of the heart rate towards the predominance of the sympathetic nervous system is accompanied by a functional state of increased activation, anxiety as indicated by the parameters of the electric activity of the brain and the shift in the functional asymmetry of the brain in the spectral power of the fast EEG rhythms in the right hemisphere.

Brains online structural and functional correlates of habitual Internet use (2014)

Addict Biol. 2014 Feb 24. doi: 10.1111/adb.12128.

Excessive use is a growing concern of health practitioners. Based on the assumption that excessive Internet use bears resemblance with addictive behaviour, we hypothesized alterations of the fronto-striatal network in frequent users.

We found a significant negative association between the IAT score and right frontal pole GM volume (P < 0.001, family wise error corrected). Functional connectivity of right frontal pole to left ventral striatum was positively associated with higher IAT scores. Furthermore, the IAT score was positively correlated to ALFF in bilateral ventral striatum.

The alterations in the fronto-striatal circuitry associated with growing IAT scores could reflect a reduction of top-down modulation of prefrontal areas, in particular, the ability to maintain long-term goals in face of distraction. The higher activation of ventral striatum at rest may indicate a constant activation in the context of a diminished prefrontal control. The results demonstrate that excessive Internet use may be driven by neuronal circuits relevant for addictive behaviour.

Attentional bias in Internet users with problematic use of social networking sites (2019)

J Behav Addict. 2019 Dec 2:1-10. doi: 10.1556/2006.8.2019.60.

Evidence from the field of addictive disorders suggests that attentional bias for stimuli related to a substance or activity of abuse (e.g., gambling) exacerbates the addictive behavior. However, evidence regarding attentional bias in PIU is sparse. This study aims to investigate whether individuals who express problematic tendencies toward social networking sites (SNS), a subtype of PIU, show attentional bias for stimuli associated with social media.

Sixty-five participants performed Visual Dot-Probe and Pleasantness Rating Tasks containing SNS-related and matched control images during eye movements were recorded, providing a direct measure of attention. Participants were assessed on their levels of SNS Internet use (ranging from problematic to non-problematic) and their levels of urges to be online (high vs. low).

Problematic SNS users and, in particular, a subgroup expressing higher levels of urges to be online showed an attentional bias for SNS-related images compared to control images. These results suggest that attentional bias is a common mechanism associated with problematic Internet use as well as other addictive disorders.

Measuring facets of reward sensitivity, inhibition, and impulse control in individuals with problematic Internet use (2019)

Psychiatry Res. 2019 Mar 19;275:351-358. doi: 10.1016/j.psychres.2019.03.032.

Problematic Internet Use (PIU) is the inability to control the amount of time spent on the Internet. Research indicates that abnormalities in reward sensitivity, sensitivity to punishment, and impulse control drive addictive behaviors such as substance abuse and gambling disorders, but it is unclear whether this is also the case in PIU.

Behavioral tasks and scales were completed by 62 participants (32 PIU individuals and 30 no-PIU individuals) to assess reward sensitivity, sensitivity to punishment, as well as inhibitory function and impulse control. Measures administered included Go/No-Go, delay discounting, Behavioral Inhibition/Activation (BIS/BAS) scales and the Sensitivity to Punishment and Sensitivity to Reward Questionnaire (SPSRQ).

The PIU group endorsed greater reward sensitivity and punishment sensitivity as indexed by the SPSRQ. However, there were no group differences with regards to delay discounting, performance in the Go/No-Go task, or endorsement in the BIS/BAS scales.

The present study found increased reward sensitivity and sensitivity to punishment in PIU individuals, though impulse control was not observably affected. Future experimental studies are needed to inform our conceptualization of the etiology of addictive behavior as it pertains to PIU. Further investigation will aid in informing prevention and intervention efforts.

Impaired Empathy Processing in Individuals with Internet Addiction Disorder: An Event-Related Potential Study (2017)

Front. Hum. Neurosci., 10 October 2017 | https://doi.org/10.3389/fnhum.2017.00498

Internet addiction disorder (IAD) is associated with deficits in social communication and avoidance of social contact. It has been hypothesized that people with IAD may have an impaired capacity for empathy. The purpose of the current study was to examine the processing of empathy for others’ pain in IADs. Event-related potentials produced in response to pictures showing others in painful and non-painful situations were recorded in 16 IAD subjects and 16 healthy controls (HCs). The N1, P2, N2, P3, and late positive potential components were compared between the two groups. Robust picture × group interactions were observed for N2 and P3. The painful pictures elicited larger N2 and P3 amplitudes than the non-painful pictures did only in the HC group but not in the IAD group. The results of this study suggest that both of the early automatic and of the later cognitive processes of pain empathy may be impaired in IADs. This study provides psychophysical evidence of empathy deficits in association with IAD.

Differentiation between young adult Internet addicts, smokers, and healthy controls by the interaction between impulsivity and temporal lobe thickness (2019)

J Behav Addict. 2019 Feb 11:1-13. doi: 10.1556/2006.8.2019.03.

Internet addiction is a non-substance-related addiction disorder with progressively growing prevalence. Internet addiction, like substance-related addictions, has been linked with high impulsivity, low inhibitory control, and poor decision-making abilities. Cortical thickness measurements and trait impulsivity have been shown to have a distinct relationship in addicts compared to healthy controls. Thus, we test whether the cortical correlates of trait impulsivity are different in Internet addicts and healthy controls, using an impulsive control group (smokers).

Thirty Internet addicts (15 females) and 60 age- and gender-matched controls (30 smokers, all young adults aged 19-28 years) were scanned using a 3T MRI scanner and completed the Barratt Impulsiveness Scale.

Internet addicts had a thinner left superior temporal cortex than controls. Impulsivity had a significant main effect on the left pars orbitalis and bilateral insula, regardless of group membership. We identified divergent relationships between trait impulsivity and thicknesses of the bilateral middle temporal, right superior temporal, left inferior temporal, and left transverse temporal cortices between Internet addicts and healthy controls. Further analysis with smokers revealed that the left middle temporal and left transverse temporal cortical thickness change might be exclusive to Internet addiction.

The effects of impulsivity, combined with a long-term exposure to some specific substance or stimuli, might result in different natures of relationships between impulsivity and brain structure when compared to healthy controls. These results may indicate that Internet addiction is similar to substance-related addictions, such that inefficient self-control could result in maladaptive behavior and inability to resist Internet use.

Neurobiological findings related to Internet use disorders (2016)

Psychiatry Clin Neurosci. 2016 Jul 23. doi: 10.1111/pcn.12422.

In the last ten years, numerous neurobiological studies have been conducted on Internet addiction or Internet use disorder. Various neurobiological research methods-such as magnetic resonance imaging; nuclear imaging modalities, including positron emission tomography and single photon emission computed tomography; molecular genetics; and neurophysiologic methods-have made it possible to discover structural or functional impairments in the brains of individuals with Internet use disorder. Specifically, Internet use disorder is associated with structural or functional impairment in the orbitofrontal cortex, dorsolateral prefrontal cortex, anterior cingulate cortex, and posterior cingulate cortex. These regions are associated with the processing of reward, motivation, memory, and cognitive control. Early neurobiological research results in this area indicated that Internet use disorder shares many similarities with substance use disorders, including, to a certain extent, a shared pathophysiology. However, recent studies suggest that differences in biological and psychological markers exist between Internet use disorder and substance use disorders. Further research is required for a better understanding of the pathophysiology of Internet use disorder.

Internet addiction associated with right pars opercularis in females (2019)

Structural differences in higher-order brain areas are common features of behavioral addictions, including Internet addiction (IA) as well. Taking into consideration the limited number of studies and methods used in previous studies on IA, our aim was to investigate the correlates of IA and the morphometry of the frontal lobes.

To observe these relationships, the high-resolution T1-weighted MR images of 144 healthy, Caucasian, university students were analyzed with volumetry and voxel-based morphometry. The Problematic Internet Use Questionnaire (PIUQ) was used to assess IA.

We found significant correlations between PIUQ subscales and the volume of the right pars opercularis volume and gray matter mass in women.

The increased gray matter measures of this structure might be explained with the extended effort to control for the impulsive behavior in addiction, and with the increased number of social interactions via the Internet.

Internet addiction and its facets: The role of genetics and the relation to self-directedness (2017)

Addict Behav. 2017 Feb;65:137-146. doi: 10.1016/j.addbeh.2016.10.018.

A growing body of research focuses on problematic behavior patterns related to the use of the Internet to identify contextual as well as individual risk factors of this new phenomenon called Internet addiction (IA). IA can be described as a multidimensional syndrome comprising aspects such as craving, development of tolerance, loss of control and negative consequences. Given that previous research on other addictive behaviors showed substantial heritability, it can be expected that the vulnerability to IA may also be due to a person’s genetic predisposition. However, it is questionable whether distinct components of IA have different etiologies.

For specific facets of IA and private Internet use in hours per week, heritability estimates ranged between 21% and 44%. Bivariate analysis indicated that Self-Directedness accounted for 20% to 65% of the genetic variance in specific IA facets through overlapping genetic pathways. Implications for future research are discussed.

Internet and Gaming Addiction: A Systematic Literature Review of Neuroimaging Studies (2012)

Brain Sci. 2012, 2(3), 347-374; doi:10.3390/brainsci2030347

In the past decade, research has accumulated suggesting that excessive Internet use can lead to the development of a behavioral addiction. Internet addiction has been considered as a serious threat to mental health and the excessive use of the Internet has been linked to a variety of negative psychosocial consequences. The aim of this review is to identify all empirical studies to date that used neuroimaging techniques to shed light upon the emerging mental health problem of Internet and gaming addiction from a neuroscientific perspective. A systematic literature search was conducted, identifying 18 studies.

These studies provide compelling evidence for the similarities between different types of addictions, notably substance-related addictions and Internet and gaming addiction, on a variety of levels. On the molecular level, Internet addiction is characterized by an overall reward deficiency that entails decreased dopaminergic activity. On the level of neural circuitry, Internet and gaming addiction led to neuroadaptation and structural changes that occur as a consequence of prolonged increased activity in brain areas associated with addiction. On a behavioral level, Internet and gaming addicts appear to be constricted with regards to their cognitive functioning in various domains.

Comments: Real simple – all brain studies done so far have pointed in one direction: Internet addiction is a real as substance addiction and involves the same fundamental brain changes.

New developments on the neurobiological and pharmaco-genetic mechanisms underlying internet and videogame addiction.

Am J Addict. 2015 Mar;24(2):117-25.

There is emerging evidence that the psychobiological mechanisms underlying behavioral addictions such as internet and videogame addiction resemble those of addiction for substances of abuse.

Literature search of published articles between 2009 and 2013 in Pubmed using “internet addiction” and “videogame addiction” as the search word. Twenty-nine studies have been selected and evaluated under the criteria of brain imaging, treatment, and genetics.

Brain imaging studies of the resting state have shown that long-term internet game playing affected brain regions responsible for reward, impulse control and sensory-motor coordination. Brain activation studies have shown that videogame playing involved changes in reward and loss of control and that gaming pictures have activated regions similarly to those activated by cue-exposure to drugs. Structural studies have shown alterations in the volume of the ventral striatum possible as result of changes in reward. Furthermore, videogame playing was associated with dopamine release similar in magnitude to those of drugs of abuse and that there were faulty inhibitory control and reward mechanisms videogame addicted individuals. Finally, treatment studies using fMRI have shown reduction in craving for videogames and reduced associated brain activity.

Videogame playing may be supported by similar neural mechanisms underlying drug abuse. Similar to drug and alcohol abuse, internet addiction results in sub-sensitivity of dopamine reward mechanisms.

Reduced Striatal Dopamine Transporters in People with Internet Addiction Disorder (2012)

Journal of Biomedicine and Biotechnology Volume 2012 (2012), Article ID 854524,

In recent years, IAD has become more prevalent worldwide; the recognition of its devastating impact on the users and society has rapidly increased [7]. Importantly, recent studies have found dysfunctions of IAD are similar to other types of addictive disorders, such as substance abuse disorders and pathological gambling [7-10]. People experiencing IAD showed clinical features such as craving, withdrawal and tolerance [7, 8], increased impulsiveness [9], and impaired cognitive performance in tasks involving risky decision-making [10].

The IAD subjects used the internet almost everyday, and spend more than 8 hours everyday in front of the monitor, mostly for chatting with cyber friends, playing online games, and watching online pornographies or adult movies. These subjects were initially familiar with internet mostly at the early stage of their adolescence  and had the indications of IAD for more than 6 years

Conclusion: The results from this study provide evidence that IAD may induce significant DAT losses in the brain and these findings suggest that IAD is associated with dysfunctions in the dopaminergic brain systems and are consistent with previous reports in various types of addictions either with or without substances [21-23, 37]. Our findings support the claim that IAD may share similar neurobiological abnormalities with other addictive disorders [15].

COMMENTS: Study examined reward circuitry dopamine transporter levels in Internet addicts. Levels were compared to a control group whose members also used the Internet. Levels of dopamine transporters were comparable to those with drug addiction. A decline in dopamine transporters is a hallmark of addictions. It indicates a loss of nerve endings that release dopamine.

Abnormal White Matter Integrity in Adolescents with Internet Addiction Disorder: A Tract-Based Spatial Statistics Study (2012)

 PLoS ONE 7(1): e30253. doi:10.1371/journal.pone.0030253

Compared with the age, gender and education matched controls, IAD subjects had significantly reduced FA in the orbito-frontal white matter, together with cingulum, commissural fibers of the corpus callosum, association fibers including the inferior front-occipital fasciculus, and projection fibers comprising the corona radiation, internal capsule and external capsule. These results provide evidences of widespread deficits in white matter integrity and reflect a disruption in the organization of white matter tracts in IAD. The orbito-frontal cortex has extensive connections with prefrontal, visceromotor, and limbic regions, as well as the association areas of each sensory modality 33. It plays a critical role in emotional processing and addiction-related phenomena, such as craving, compulsive-repetitive behaviors, and maladaptive decision-making 34, 35.

Previous studies found that abnormal white matter integrity in the orbito-frontal cortex has been frequently observed in the subjects exposed to addictive substances, such as alcohol 36, cocaine 37, 38, marijuana 39, methamphetamine 40, and ketamine 41. Our finding that IAD is associated with impaired white matter integrity in the orbito-frontal regions is consistent with these previous results. Anterior cingulate cortex (ACC) connects to the frontal lobes and the limbic system, playing an essential role in cognitive control, emotional processing and craving 42. Abnormal white matter integrity in the anterior cingulum has also been consistently observed in other forms of addiction, such as alcoholism 36, heroin dependence 43, and cocaine addiction 38. The observation of decreased FA within the anterior cingulum of IAD subjects is consistent with these previous results and with the report that heavy Internet overuse17 is associated with impaired cognitive control. More interestingly, the same group of IAD subjects had been shown to have significantly decreased gray matter density in the left ACC, compared to control 12. Similar results have also been reported by another group 13.

COMMENTS: Another brain study on the white matter differences between control groups and those with Internet addiction. Those with Internet addiction have white matter changes that mimic those with substance addictions. White matter, also called myelin, wraps the axons of nerve cells.  The myelin covered axons function as the communication pathways connecting different parts of the brain.

A Week Without Using Social Media: Results from an Ecological Momentary Intervention Study Using Smartphones (2018)

Cyberpsychol Behav Soc Netw. 2018 Oct;21(10):618-624. doi: 10.1089/cyber.2018.0070.

Online social media is now omnipresent in many people’s daily lives. Much research has been conducted on how and why we use social media, but little is known about the impact of social media abstinence. Therefore, we designed an ecological momentary intervention study using smartphones. Participants were instructed not to use social media for 7 days (4 days baseline, 7 days intervention, and 4 days postintervention; N = 152). We assessed affect (positive and negative), boredom, and craving thrice a day (time-contingent sampling), as well as social media usage frequency, usage duration, and social pressure to be on social media at the end of each day (7,000+ single assessments). We found withdrawal symptoms, such as significantly heightened craving (β = 0.10) and boredom (β = 0.12), as well as reduced positive and negative affect (only descriptively). Social pressure to be on social media was significantly heightened during social media abstinence (β = 0.19) and a substantial number of participants (59 percent) relapsed at least once during the intervention phase. We could not find any substantial rebound effect after the end of the intervention. Taken together, communicating through online social media is evidently such an integral part of everyday life that being without it leads to withdrawal symptoms (craving, boredom), relapses, and social pressure to get back on social media.

Mobile phone addiction in Tibetan and Han Chinese adolescents (2018)

Perspect Psychiatr Care. 2018 Dec 4. doi: 10.1111/ppc.12336.

To compare mobile phone addiction (MPA) patterns between Tibetan and Han adolescents in China. The study was carried out in two provinces of China. The Mobile Phone Addiction Scale (MPAS) was used to assess MPA.

Seven hundred and five Tibetan and 606 Han students participated in the study. The MPAS total score was 24.4 ± 11.4 in the whole sample; 27.3 ± 10.8 and 20.9 ± 11.2 in Tibetan and Han students, respectively. Quality of life (QOL) in the physical, psychological, social, and environmental domains was negatively associated with MPA.

Compared with Han students, Tibetan students were found to have more severe MPA. Given its negative impact on QOL, appropriate measures for the prevention of MPA should be developed, particularly for Tibetan middle school students.

Altered Plasma Levels of Glial Cell Line-Derived Neurotrophic Factor in Patients with Internet Gaming Disorder: A Case-Control, Pilot Study (2019)

Psychiatry Investig. 2019 Jun;16(6):469-474. doi: 10.30773/pi.2019.04.02.2.

Glial cell line-derived neurotrophic factor (GDNF) has been reported to be involved in negatively regulating the effects of addictive disorders. The objective of this study was to investigate alterations in the levels of GDNF in patients with Internet gaming disorder (IGD) and to assess the relationship between GDNF levels and the severity of IGD indices. Nineteen male patients with IGD and 19 sexmatched control subjects were evaluated for alteration of plasma GDNF levels and for relationship between GDNF levels and clinical characteristics of Internet gaming, including the Young’s Internet Addiction Test (Y-IAT). The GDNF levels were found to be significantly low in patients with IGD (103.2±62.0 pg/mL) compared with the levels of controls (245.2±101.6 pg/mL, p<0.001). GDNF levels were negatively correlated with Y-IAT scores (Spearman’s rho=-0.645, p=<0.001) and this negative correlation remained even after controlling for multiple variables (r=-0.370, p=0.048). These findings support the assumed role of GDNF in the regulation of IGD.

Short abstinence from online social networking sites reduces perceived stress, especially in excessive users (2018)

Psychiatry Res. 2018 Dec;270:947-953. doi: 10.1016/j.psychres.2018.11.017.

Online social networking sites (SNSs), such as Facebook, provide frequent and copious social reinforcers (e.g., “likes”) delivered at variable time intervals. As a result, some SNS users display excessive, maladaptive behaviors on these platforms. Excessive SNS users, and typical users alike, are often aware of their intense use and psychological dependence on these sites, which may lead to elevated stress. In fact, research has demonstrated that use of SNSs alone induces elevated stress. Other research has begun to investigate the effects of short periods of SNS abstinence, revealing beneficial effects on subjective wellbeing. We aligned these two lines of research and hypothesized that a short period of SNS abstinence would induce a reduction in perceived stress, especially in excessive users. The results confirmed our hypothesis and revealed that both typical and excessive SNS users experienced reduction in perceived stress following SNS abstinence of several days. The effects were particularly pronounced in excessive SNS users. The reduction in stress was not associated with academic performance increases. These results indicate a benefit-at least temporarily-of abstinence from SNSs and provide important information for therapists treating patients who struggle with excessive SNS use.

Social networking site addiction and undergraduate students’ irrational procrastination: The mediating role of social networking site fatigue and the moderating role of effortful control (2018)

PLoS One. 2018 Dec 11;13(12):e0208162. doi: 10.1371/journal.pone.0208162.

With the popularity of social networking sites (SNSs), the problems of SNS addiction have been increasing. Research has revealed the association between SNS addiction and irrational procrastination. However, the mechanism underlying this relation is still unclear. The present study aimed to examine the mediating role of social networking site fatigue and the moderating role of effortful control in this link among Chinese undergraduate students. The Social Networking Site Addiction Scale, Social Networking Service Fatigue Scale, Effortful Control Scale and Irrational Procrastination Scale were completed by 1,085 Chinese undergraduate students. Results indicated that SNS addiction, SNS fatigue and irrational procrastination were positively correlated with each other, and negatively correlated with effortful control. Further analyses revealed that, SNS addiction has a direct effect on irrational procrastination. SNS fatigue mediated the relationship between SNS addiction and irrational procrastination. Both direct and indirect effects of SNS addiction on irrational procrastination were moderated by effortful control. Specifically, this effect was stronger for people with lower effortful control. These findings help clarify the mechanism underlying the association between SNS addiction and irrational procrastination, which have potential implications for intervention.

Loneliness, Individualism, and Smartphone Addiction Among International Students in China (2018)

Cyberpsychol Behav Soc Netw. 2018 Oct 17. doi: 10.1089/cyber.2018.0115.

Rapidly adopted globally, smartphones may help international students adjust their life abroad and cope with bad feelings, while negative influence of smartphone addiction becomes a recent concern. To fill the gap, this study explores the levels of loneliness of international students in China. Integrating cultural dimensions theory and relevant research on smartphone addiction, the present study adopted online survey as main research method to examine the relationship between individualism, loneliness, smartphone use, and smartphone addiction. In total, 438 international students voluntarily participated in the survey. The participants were from 67 countries and have been studying in China for months. The results show international students in China as a high-risk population for both severe loneliness and smartphone addiction, with 5.3 percent of the participants experiencing severe loneliness and more than half of the participants exhibiting smartphone addiction symptoms. This study reveals predicting power of cultural individualism in explaining loneliness and significant mediation effects of loneliness and smartphone use. Those international students with lower degree of individualism showed higher degree of loneliness, which led to higher degree of smartphone use and smartphone addiction. Loneliness was found to be the strongest predictor for smartphone addiction.

Cross-cultural validation of the Social Media Disorder scale (2019)

Psychol Res Behav Manag. 2019 Aug 19;12:683-690. doi: 10.2147/PRBM.S216788.

With the popularity of social networking sites, there is an urgency to devise instruments to evaluate social media addiction in different cultural context. This paper evaluates the psychometric properties and validation of the Social Media Disorder (SMD) scale in People’s Republic of China.

A total of 903 Chinese university students were recruited to participate in this cross-sectional study. The internal consistency, criterion validity and construct validity of the SMD scale were examined.

The results suggested that the 9-item SMD scale had good psychometric properties. Its internal consistency was good, with a Cronbach’s alpha of 0.753. The results showed weak and moderate correlations with other validation constructs, such as self-efficacy and other disorder symptoms suggested in the original scale. The Chinese version of SMD demonstrated a good model fit for a two-factor structure in confirmatory factor analysis, with χ² (44.085)/26=1.700, SRMR=0.059, CFI=0.995, TLI=0.993 and RMSEA=0.028.

Impaired frontal-Basal Ganglia connectivity in adolescents with internet addiction (2014)

Sci Rep. 2014 May 22;4:5027. doi: 10.1038/srep05027.

Understanding the neural basis of poor impulse control in Internet addiction (IA) is important for understanding the neurobiological mechanisms of this syndrome. The current study investigated how neuronal pathways implicated in response inhibition were affected in IA using a Go-Stop paradigm and functional magnetic resonance imaging (fMRI).  The results showed that the indirect frontal-basal ganglia pathway was engaged by response inhibition in healthy subjects. However, we did not detect any equivalent effective connectivity in the IA group. This suggests the IA subjects fail to recruit this pathway and inhibit unwanted actions. This study provides a clear link between Internet addiction as a behavioral disorder and aberrant connectivity in the response inhibition network.

COMMENTS; Clear demonstration of hypofrontality in those with Internet addiction.

Enhanced Reward Sensitivity and Decreased Loss Sensitivity in Internet Addicts: An fMRI Study During a Guessing Task (2011)

J Psychiatr Res. 2011 Jul 16.

As the world’s fastest growing “addiction”, Internet addiction should be studied to unravel the potential heterogeneity. The present study is set to examine reward and punishment processing in Internet addicts as compared to healthy controls.The results showed that Internet addicts associated with increased activation in orbitofrontal cortex in gain trials and decreased anterior cingulate activation in loss trials than normal controls. The results suggested that Internet addicts have enhanced reward sensitivity and decreased loss sensitivity than normal comparisons.

COMMENTS: Both enhanced reward sensitivity (sensitization) and decreased loss sensitivity (lessened aversion) are markers of an addiction process

The dysfunction of face processing in patients with internet addiction disorders: an event-related potential study (2016)

Neuroreport. 2016 Aug 25.

To investigate face processing in patients with internet addiction disorders (IAD), an event-related brain potential experiment was conducted in IAD patients and healthy age-matched controls in which participants were instructed to classify each stimulus (face vs. nonface object) as quickly and accurately as possible. Although we did not find a significant difference in the performance between two groups, both the N110 and the P2 components in response to faces were larger in the IAD group than in the control group, whereas the N170 to faces decreased in the IAD group than in the control group. In addition, the source analysis of event-related potential components showed different generators between two groups. These data indicated that there was a dysfunction of face processing in IAD patients and the underlying mechanism of processing faces could be different from healthy individuals.

Random topology organization and decreased visual processing of internet addiction: Evidence from a minimum spanning tree analysis (2019)

Brain Behav. 2019 Jan 31:e01218. doi: 10.1002/brb3.1218.

Internet addiction (IA) has been associated with widespread brain alterations. Functional connectivity (FC) and network analysis results related to IA are inconsistent between studies, and how network hubs change is not known. The aim of this study was to evaluate functional and topological networks using an unbiased minimum spanning tree (MST) analysis on electroencephalography (EEG) data in IA and healthy control (HC) college students.

In this study, Young’s internet addiction test was used as an IA severity measure. EEG recordings were obtained in IA (n = 30) and HC participants (n = 30), matched for age and sex, during rest. The phase lag index (PLI) and MST were applied to analyze FC and network topology. We expected to obtain evidence of underlying alterations in functional and topological networks related to IA.

IA participants showed higher delta FC between left-side frontal and parieto-occipital areas compared to the HC group (p < 0.001), global MST measures revealed a more star-like network in IA participants in the upper alpha and beta bands, and the occipital brain region was relatively less important in the IA relative to the HC group in the lower band. The correlation results were consistent with the MST results: higher IA severity correlated with higher Max degree and kappa, and lower eccentricity and diameter.

Functional networks of the IA group were characterized by increased FC, a more random organization, and a decrease of relative functional importance of the visual processing area. Taken together, these alterations can help us understand the influence of IA to brain mechanism.

Electrophysiological activity is associated with vulnerability of Internet addiction in non-clinical population (2018)

Addictive behaviors 84 (2018): 33-39.

•Vulnerability of Internet addiction is associated with frontal alpha power.

•People with Internet addiction may exhibit altered frontal functional activity.

•There is a positive correlation between depression and frontal alpha asymmetry.

This study investigated the electrophysiological activity associated with vulnerability of problematic Internet use in non-clinical population. The resting EEG spectrum of alpha (8–13 Hz) rhythm was measured in 22 healthy subjects who have used the Internet for recreational purpose. The vulnerability of Internet addiction was assessed using Young’s Internet Addiction Test (IAT) and Assessment for Computer and Internet Addiction-Screener (AICA-S) respectively. Depression and impulsivity were also measured with Beck Depression Inventory (BDI) and Barratt Impulsiveness Scale 11(BIS-11) respectively. The IAT was positively correlated with alpha power obtained during eyes closed (EC, r = 0.50, p = 0.02) but not during eyes open (EO). This was further supported by a negative correlation (r = −0.48, p = 0.02) between IAT scores and alpha desynchronization (EO-EC). These relationships remained significant following correction for multiple comparisons. Furthermore, The BDI score showed positive correlation with alpha asymmetry at mid-lateral (r = 0.54, p = 0.01) and mid-frontal (r = 0.46, p = 0.03) regions during EC, and at mid-frontal (r = 0.53, p = 0.01) region during EO. The current findings suggest that there are associations between neural activity and the vulnerability of problematic Internet use. Understanding of the neurobiological mechanisms underlying problematic Internet use would contribute to improved early intervention and treatment.

Brain oscillations, inhibitory control mechanisms and rewarding bias in internet addiction (2016)

Journal Of The International Neuropsychological Society

Internet Addiction (IA) is considered a subtype of impulse control disorder, and a behavior related to rewarding system deficits. The present research aims to examine the neural correlates of deficits in inhibitory control and the rewarding mechanisms in IA. Internet Addiction Inventory (IAT) was applied to a sub-clinical sample.

Results: BAS, BAS-R (BAS-Reward subscale), BIS and IAT predicted the low-frequency band variations, although in an opposite direction: reduced delta and theta and RTs values were found for higher BAS, BAS-R and IAT, in the case of NoGo for gambling and videogames stimuli; in contrast increased delta and theta and RTs values were ob-served for higher BIS. Two potential different subjects’ clusters were suggested: with low inhibitory impulse control and rewarding bias (higher BAS and IAT); and with impulse hyper-control (higher BIS).

Web addiction in the brain: Cortical oscillations, autonomic activity, and behavioral measures (2017)

J Behav Addict. 2017 Jul 18:1-11. doi: 10.1556/2006.6.2017.041.

Internet addiction (IA) was recently defined as a disorder tagging both the impulse control and the reward systems. Specifically, inhibitory deficits and reward bias were considered highly relevant in IA. This research aims to examine the electrophysiological correlates and autonomic activity [skin conductance response (SCR) and heart rate] in two groups of young subjects (N = 25), with high or low IA profile [tested by the Internet Addiction Test (IAT)], with specific reference to gambling behavior.

Results: A better performance (reduced ERs and reduced RTs) was revealed for high IAT in the case of NoGo trials representing rewarding cues (inhibitory control condition), probably due to a “gain effect” induced by the rewarding condition. In addition, we also observed for NoGo trials related to gambling and video games stimuli that (a) increased low-frequency band (delta and theta) and SCR and (b) a specific lateralization effect (more left-side activity) delta and theta in high IAT. Both inhibitory control deficits and reward bias effect were considered to explain IA.

Internet Communication Disorder and the structure of the human brain: initial insights on WeChat addiction (2018)

Sci Rep. 2018 Feb 1;8(1):2155. doi: 10.1038/s41598-018-19904-y.

WeChat represents one of the most popular smartphone-based applications for communication. Although the application provides several useful features that simplify daily life, a growing number of users spend excessive amounts of time on the application. This may lead to interferences with everyday life and even to addictive patterns of use. In the context of the ongoing discussion on Internet Communication Disorder (ICD), the present study aimed to better characterize the addictive potential of communication applications, using WeChat as an example, by examining associations between individual variations in tendencies towards WeChat addiction and brain structural variations in fronto-striatal-limbic brain regions. To this end levels of addictive tendencies, frequency of use and structural MRI data were assessed in n = 61 healthy participants. Higher tendencies towards WeChat addiction were associated with smaller gray matter volumes of the subgenual anterior cingulate cortex, a key region for monitoring and regulatory control in neural networks underlying addictive behaviors. Moreover, a higher frequency of the paying function was associated with smaller nucleus accumbens volumes. Findings were robust after controlling for levels of anxiety and depression. The present results are in line with previous findings in substance and behavioral addictions, and suggest a similar neurobiological basis in ICD.

Brain anatomy alterations associated with Social Networking Site addiction (2017)

Sci Rep. 2017 Mar 23;7:45064. doi: 10.1038/srep45064.

This study relies on knowledge regarding the neuroplasticity of dual-system components that govern addiction and excessive behavior and suggests that alterations in the grey matter volumes, i.e., brain morphology, of specific regions of interest are associated with technology-related addictions. Using voxel based morphometry (VBM) applied to structural Magnetic Resonance Imaging (MRI) scans of twenty social network site (SNS) users with varying degrees of SNS addiction, we show that SNS addiction is associated with a presumably more efficient impulsive brain system, manifested through reduced grey matter volumes in the amygdala bilaterally (but not with structural differences in the Nucleus Accumbens). In this regard, SNS addiction is similar in terms of brain anatomy alterations to other (substance, gambling etc.) addictions. We also show that in contrast to other addictions in which the anterior-/ mid- cingulate cortex is impaired and fails to support the needed inhibition, which manifests through reduced grey matter volumes, this region is presumed to be healthy in our sample and its grey matter volume is positively correlated with one’s level of SNS addiction. These findings portray an anatomical morphology model of SNS addiction and point to brain morphology similarities and differences between technology addictions and substance and gambling addictions.

Aberrant corticostriatal functional circuits in adolescents with Internet addiction disorder (2015)

Male Internet addicts show impaired executive control ability evidence from a color-word: Stroop task (2011).

Neurosci Lett. 2011 Jul 20;499(2):114-8. PR China

This study investigated the executive control ability of male students with Internet addiction disorder (IAD) by recording event-related brain potentials (ERP) during a color-word Stroop task. Behavior results showed that IAD students were associated with longer reaction time and more response errors in incongruent conditions than the control group. ERP results revealed that participants with IAD showed reduced medial frontal negativity (MFN) deflection in incongruent conditions than the control group. Both of the behavioral performance and ERP results indicate that people with IAD show impaired executive control ability than the normal group.

COMMENTS: This study, like other recent fMRI studies on Internet addicts, showed reductions in executive control. Reductions in executive control in addicts indicate a decline in frontal cortex activity. this decline parallels loss of impulse control, and is found in all addictions.

Microstructure Abnormalities in Adolescents with Internet Addiction Disorder. (2011).

PLoS ONE 6(6): e20708. doi:10.1371/journal.pone.0020708

Recent studies suggest that internet addiction disorder (IAD) is associated with structural abnormalities in brain gray matter. However, few studies have investigated the effects of internet addiction on the microstructural integrity of major neuronal fiber pathways, and almost no studies have assessed the microstructural changes with the duration of internet addiction. As one of the common mental health problems amongst Chinese adolescents, internet addiction disorder (IAD) is currently becoming more and more serious. Data from the China Youth Internet Association (announcement on February 2, 2010) demonstrated that the incidence rate of internet addiction among Chinese urban youths is about 14%. It is worth noting that the total number is 24 million

Conclusions: We provided evidences indicating that IAD subjects had multiple structural changes in the brain. The gray matter atrophy and white matter FA changes of some brain regions were significantly correlated with the duration of internet addiction. These results may be interpreted, at least partially, as the functional impairment of cognitive control in IAD. The prefrontal cortex abnormalities were consistent with previous substance abuse studies hence we suggested that there may exist partially overlapping mechanisms in IAD and substance use.

COMMENTS: This study clearly shows that those with Internet addiction develop brain abnormalities that parallel those found in substance abusers. Researchers found a 10-20% reduction in frontal cortex gray matter in adolescents with Internet addiction. Hypofrontality is the common term for these frontal cortex changes caused by addiction. It is a key marker for all addiction processes.

Reduced Striatal Dopamine D2 Receptors in People With Internet Addiction (2011).

Neuroreport. 2011 Jun 11;22(8):407-11. Department of Brain and Cognitive Engineering, Korea University, Seoul, Korea.

An increasing amount of research has suggested that Internet addiction is associated with abnormalities in the dopaminergic brain system. Consistent with our prediction, individuals with Internet addiction showed reduced levels of dopamine D2 receptor availability in subdivisions of the striatum including the bilateral dorsal caudate and right putamen. This finding contributes to the understanding of neurobiological mechanism of Internet addiction.

COMMENTS: More evidence that Internet addiction exists. A reduction of striatal D2 dopamine receptors is the primary marker for desensitization of the reward circuitry, which is one the major changes that occurs with addictions,

Gray Matter Abnormalities In Internet Addiction: A Voxel-Based Morphometry Study (2009).

Eur J Radiol. 2009 Nov 17.. Jiao Tong University Medical School, Shanghai 200127, PR China.

This study aims to investigate brain gray matter density (GMD) changes in adolescents with Internet addiction (IA) using voxel-based morphometry (VBM) analysis on high-resolution T1-weighted structural magnetic resonance images. Compared with healthy controls, IA adolescents had lower GMD in the left anterior cingulate cortex, left posterior cingulate cortex, left insula, and left lingual gyrus. CONCLUSIONS: Our findings suggested that brain structural changes were present in IA adolescents, and this finding may provide a new insight into the pathogenesis of IA.

COMMENT: Adolescents with Internet addiction have decreased gray matter in portions of the frontal cortex. Decreases in size and functioning the frontal cortex (hypofrontality) are found in all addiction processes, and is related to declining D2 receptors. Another example of a non-drug addiction causing brain changes similar to substance abuse disorders.

Autonomic stress reactivity and craving in individuals with problematic Internet use (2018)

PLoS One. 2018 Jan 16;13(1):e0190951. doi: 10.1371/journal.pone.0190951.

The link between autonomic stress reactivity and subjective urge/craving has been less systematically examined in behavioral addictions (i.e. problematic Internet use) than in substance use disorders. The present study investigated whether problematic Internet users (PU) show enhanced autonomic stress reactivity than non-PU, indexed by lower Heart Rate Variability (HRV) and higher Skin Conductance Level (SCL) reactivity during the Trier Social Stress Test (TSST), whether greater reactivity is related to stronger Internet craving, and whether problematic Internet usage is associated with some dysfunctional psychological features. Based on their Internet Addiction Test scores, participants were divided into PU (N = 24) and non-PU (N = 21). Their heart rate and skin conductance were continuously recorded during baseline, social stressors, and recovery. Craving for Internet usage were collected using a Likert scale before and after the TSST. The SDNN, an overall measure of HRV, was significantly lower in PU than non-PU during baseline, but not during and after stressful task. Furthermore, only among PU a significant negative correlation emerged between SDNN during recovery and craving ratings after the test. No group differences emerged for SCL. Lastly, PU endorsed more mood, obsessive-compulsive, and alcohol-related problems. Our findings suggest that problems in controlling one’s use of the Internet may be related to reduced autonomic balance at rest. Moreover, our results provide new insights into the characterization of craving in PIU, indicating the existence of a relationship between craving for Internet usage and reduced autonomic flexibility.

Structural Brain Network Abnormalities In Subjects With Internet Addiction (2017)

Journal Of Mechanics In Medicine And Biology (2017): 1740031.

The present study included 17 subjects with IA and 20 healthy subjects. We constructed the structural brain network from diffusion tensor imaging data and investigated alteration of structural connections in subjects with IA using the network analysis on the global and local levels. The subjects with IA showed increase of regional efficiency (RE) in bilateral orbitofrontal cortex (OFC) and decrease in right middle cingulate and middle temporal gyri (P<0.05), whereas the global properties did not show significant changes. Young’s internet addiction test (IAT) scores and RE in left OFC showed positive correlation, and average time spent on internet per day was positively correlated with the RE in right OFC. This is the first study examining alterations of the structural brain connectivity in IA. We found that subjects with IA showed alterations of RE in some brain regions and RE was positively associated with the severity of IA and average time spent on internet per day. Therefore, RE may be a good property for IA assessment.

Effect of excessive Internet use on the time–frequency characteristic of EEG (2009)

Progress in Natural Science: Materials International > 2009 > 19 > 10 > 1383-1387

The event-related potentials (ERP) of normal subjects and excessive Internet users were acquired using the oddball paradigm experiment. We applied the wavelet transformed and event-related spectral perturbation to ERP in order to extract the time–frequency values. Excessive Internet use resulted in a significant decrease in the P300 amplitudes and a significant increase in the P300 latency in all electrodes. Thus, these data suggest that excessive Internet use affects information coding and integration in the brain.

Lateral orbitofrontal gray matter abnormalities in subjects with problematic smartphone use (2019)

J Behav Addict. 2019 Sep 23:1-8. doi: 10.1556/2006.8.2019.50.

Smartphone use is becoming commonplace and exerting adequate control over smartphone use has become an important mental health issue. Little is known about the neurobiology underlying problematic smartphone use. We hypothesized that structural abnormalities in the fronto-cingulate brain region could be implicated in problematic smartphone use, similar to that has been reported for Internet gaming disorder and Internet addiction. This study investigated fronto-cingulate gray matter abnormalities in problematic smartphone users, particularly those who spend time on social networking platforms.

The study included 39 problematic smartphone users with excessive use of social networking platforms via smartphone and 49 normal control male and female smartphone users. We conducted voxel-based morphometric analysis with diffeomorphic anatomical registration using an exponentiated Lie algebra algorithm. Region of interest analysis was performed on the fronto-cingulate region to identify whether gray matter volume (GMV) differed between the two groups.

Problematic smartphone users had significantly smaller GMV in the right lateral orbitofrontal cortex (OFC) than healthy controls, and there were significant negative correlations between GMV in the right lateral OFC and the Smartphone Addiction Proneness Scale (SAPS) score, including the SAPS tolerance subscale.

These results suggest that lateral orbitofrontal gray matter abnormalities are implicated in problematic smartphone use, especially in social networking platform overuse. Small GMV in the lateral OFC was correlated with an increasing tendency to be immersed in smartphone use. Our results suggest that orbitofrontal gray matter abnormalities affect regulatory control over previously reinforced behaviors and may underlie problematic smartphone use.

The research of event-related potentials in working memory of the juvenile internet addiction (2010)

 E-Health Networking, Digital Ecosystems and Technologies (EDT), 2010 International Conference on

Internet addiction disorder, as a form of technological addiction, will cause neurological complications, psychological disturbances, and relational chaos. Teenagers are in the most vulnerable age group, who will develop more serious complications than other age groups when addicted to the Internet. The objective of this study was to analyze the damage in working memory of the juvenile Internet addiction (IAD). The Chinese words Recognition is used as the experimental paradigms of event-related potentials (ERP). 13 normal teenagers and 10 internet addiction received recognition task which use the old/new effects during Chinese words and the behavior data and electroencephalogram signals were recorded by the experiment equipment. After the data disposed, compared with the normal, both the ERP and the behavior data of the IAD have some obvious characteristics. The difference reveals the damage of the working memory from the neurophysiology.

Deficits in Early-Stage Face Perception in Excessive Internet Users (2011)

Cyberpsychology, Behavior, and Social Networking. May 2011, 14(5): 303-308.

Excessive Internet use is associated with a limited ability to communicate effectively socially, which depends largely on the capacity for perception of the human face. We used a passive visual detection paradigm to compare the early stages of the processing of face-related information in young excessive Internet users (EIUs) and healthy normal subjects by analyzing event-related potentials (ERPs) elicited by faces and by nonface stimuli (tables), each presented in the upright and inverted position.

These data indicate that EIUs have deficits in the early stage of face-perception processing but may have intact holistic/configural processing of faces. Whether some deeper processes of face perception, such as face memory and face identification, are affected in EIUs needs to be investigated further with more specific procedures.

Electroencephalogram Feature Detection and Classification in People with Internet Addiction Disorder with Visual Oddball Paradigm (2015)

Journal of Medical Imaging and Health Informatics, Volume 5, Number 7, November 2015, pp. 1499-1503(5)

In this paper, the electroencephalogram (EEG) signals were recorded from ten healthy and ten Internet Addiction (IA)-afflicted university students during a visual oddball paradigm. It showed significant difference in P300 amplitudes between healthy subjects and Internet Addition subjects. The amplitudes of Internet Addition were lower (p < 0.05). The classification accuracy could reach above 93% using Bayesian-based method in active areas, while it was lower than 90% in central areas. The results show that there are negative influences on the brain response and memory abilities of IA-afflicted university students.

Bidirectional relationships of psychiatric symptoms with internet addiction in college students: A prospective study (2019)

J Formos Med Assoc. 2019 Oct 22. pii: S0929-6646(19)30007-5. doi: 10.1016/j.jfma.2019.10.006.

This prospective study evaluated the predictive ability of psychiatric symptoms at initial consultation for the occurrence and remission of Internet addiction during a 1-year follow-up period among college students. Furthermore, it evaluated the predictive ability of changes in psychiatric symptoms for Internet addiction at the initial consultation during the 1-year follow-up period among college students.

Five hundred college students (262 women and 238 men) were recruited. The baseline and follow-up consultations measured the levels of Internet addiction and psychiatric symptoms using the Chen Internet Addiction Scale and Symptom Checklist-90 Revised, respectively.

The results indicated that severe interpersonal sensitivity and paranoia symptoms might predict the incidence of Internet addiction at 1-year follow-up. The college students with internet addiction did not have significant improvement in the severities of psychopathology, whereas those without internet addiction had significant improvement in obsession-compulsion, interpersonal sensitivity, paranoid and psychoticism during the same period.

Psychiatric symptoms and Internet addiction exhibited bidirectional relationships in college students during the 1-year follow-up period.

Evidences from Rewarding System, FRN and P300 Effect in Internet-Addiction in Young People (2017)

Brain Sci. 2017 Jul 12;7(7). pii: E81. doi: 10.3390/brainsci7070081.

The present research explored rewarding bias and attentional deficits in Internet addiction (IA) based on the IAT (Internet Addiction Test) construct, during an attentional inhibitory task (Go/NoGo task). Event-related Potentials (ERPs) effects (Feedback Related Negativity (FRN) and P300) were monitored in concomitance with Behavioral Activation System (BAS) modulation. High-IAT young participants showed specific responses to IA-related cues (videos representing online gambling and videogames) in terms of cognitive performance (decreased Response Times, RTs; and Error Rates, ERs) and ERPs modulation (decreased FRN and increased P300). Consistent reward and attentional biases was adduced to explain the cognitive “gain” effect and the anomalous response in terms of both feedback behavior (FRN) and attentional (P300) mechanisms in high-IAT. In addition, BAS and BAS-Reward subscales measures were correlated with both IAT and ERPs variations. Therefore, high sensitivity to IAT may be considered as a marker of dysfunctional reward processing (reduction of monitoring) and cognitive control (higher attentional values) for specific IA-related cues. More generally, a direct relationship among reward-related behavior, Internet addiction and BAS attitude was suggested.

Cue-induced craving in Internet-communication disorder using visual and auditory cues in a cue-reactivity paradigm (2017)

Addiction Research & Theory (2017): 1-9.

Internet-communication disorder (ICD) signifies the excessive, uncontrolled use of online-communication applications such as social networking sites, instant messaging services, or blogs. Despite the ongoing debate about classification and phenomenology, there is an increasing number of individuals suffering from negative consequences due to their uncontrolled use of these applications. Moreover, there is growing evidence for similarities between behavioral addictions and even substance-use disorders. Cue-reactivity and craving are considered as key concepts of the development and maintenance of addictive behavior. Based on the assumption that certain visual symbols, as well as auditory ringtones are associated with online-communication applications, this study investigates the effect of visual and auditory cues compared to neutral cues on subjective craving for communication application use in addiction-related behavior. In a 2×2 between-subjects design, 86 participants were confronted with cues of one of four conditions (visual addiction-related, visual neutral, auditory addiction-related, auditory neutral). Baseline and post-craving measurements and tendencies towards ICD were assessed. The results reveal increased craving reactions after the presentation of addiction-related cues while craving reactions decrease after neutral cues. The craving measurements were also correlated with tendencies towards ICD. The results emphasize that cue-reactivity and craving are relevant mechanisms of the development and maintenance of an ICD. Moreover, they show parallels with further specific Internet-use disorders, such as Internet-gaming disorder, and even substance-use disorder, so that a classification as behavioral addiction should be considered.

Electrophysiological studies in Internet addiction: A review within the dual-process framework (2017)

Addictive Behaviors

• EEG studies in Internet addiction are reviewed within a dual-process framework.
• Internet addiction is associated with hypo-activated reflective-control system.
• Internet addicts also appear to present an hyper-activated affective system.
• Internet addiction may thus be characterized by an imbalance between systems.
• Future works should explore Internet addiction subtypes and the role of comorbiditie

The 14 articles finally selected show that Internet addiction shares essential features with other addictive states, mainly a joint hypo-activation of the reflective system (decreased executive control abilities) and hyper-activation of the automatic-affective one (excessive affective processing of addiction-related cues). Despite the currently limited data, dual-process models thus appear useful to conceptualize the imbalance between cerebral systems in Internet addiction. We finally propose that future electrophysiological studies should better characterize this disequilibrium between controlled-deliberate and automatic-affective networks, notably by using event-related potentials paradigms focusing on each system separately and on their interactions, but also by better specifying the potential differences between sub-categories of Internet addiction.

Functional magnetic resonance imaging of brain of college students with Internet addiction (2011)

Zhong Nan Da Xue Xue Bao Yi Xue Ban. 2011 Aug;36(8):744-9. [Article in Chinese]

Objective:To explore the functional locations of brain regions related to Internet addiction (IA)with task-functional magnetic resonance imaging (fMRI).

Conclusions: Compared with the control group, the IA group showed increased activation in the right superior parietal lobule, right insular lobe, right precuneus, right cingulated gyrus, and right superior temporal gyrus. Abnormal brain function and lateral activation of the right brain may exist in Internet Addiction.

COMMENTS: Those with Internet Addiction had markedly different brain activation patterns than controls.

Decreased frontal lobe function in people with Internet addiction disorder (2013)

Neural Regen Res. 2013 Dec 5;8(34)

In our previous studies, we showed that frontal lobe and brainstem functions were abnormal in on-line game addicts. In this study, 14 students with Internet addiction disorder and 14 matched healthy controls underwent proton-magnetic resonance spectroscopy to measure cerebral function. Results demonstrated that the ratio of N-acetylaspartate to creatine decreased, but the ratio of choline-containing compounds to creatine increased in the bilateral frontal lobe white matter in people with Internet addiction disorder. However, these ratios were mostly unaltered in the brainstem, suggesting that frontal lobe function decreases in people with Internet addiction disorder.

Higher Media Multi-Tasking Activity Is Associated with Smaller Gray-Matter Density in the Anterior Cingulate Cortex (2014)

September 24, 2014.  DOI: 10.1371/journal.pone.0106698

.Individuals who engage in heavier media-multitasking are found to perform worse on cognitive control tasks and exhibit more socio-emotional difficulties. Research has demonstrated that brain structure can be altered upon prolonged exposure to novel environments and experience.  This was confirmed via Voxel-Based Morphometry (VBM) analyses: Individuals with higher Media Multitasking Index (MMI) scores had smaller gray matter density in the anterior cingulate cortex (ACC). Functional connectivity between this ACC region and the precuneus was negatively associated with MMI. Our findings suggest a possible structural correlate for the observed decreased cognitive control performance and socio-emotional regulation in heavy media-multitaskers.

A Smartphone Attention Bias Intervention for Individuals With Addictive Disorders: Protocol for a Feasibility Study (2018)

JMIR Res Protoc. 2018 Nov 19;7(11):e11822. doi: 10.2196/11822.

Substance use disorders are highly prevalent globally. Relapse rates following conventional psychological interventions for substance use disorders remain high. Recent reviews have highlighted attentional and approach or avoidance biases to be responsible for multiple relapses. Other studies have reported the efficacy of interventions to modify biases. With advances in technologies, there are now mobile versions of conventional bias modification interventions. However, to date, no study has evaluated bias modification in a substance-using, non-Western sample. Existing evaluations of mobile technologies for the delivery of bias interventions are also limited to alcohol or tobacco use disorders.

This study aims to examine the feasibility of mobile-based attention bias modification intervention among treatment-seeking individuals with substance use and alcohol use disorders.

This is a feasibility study, in which inpatients who are in their rehabilitation phase of clinical management will be recruited. On each day that they are in the study, they will be required to complete a craving visual analogue scale and undertake both a visual probe-based assessment and and modification task in a smartphone app . Reaction time data will be collated for the computation of baseline attentional biases and to determine whether there is a reduction of attentional bias across the interventions. Feasibility will be determined by the number of participants recruited and participants’ adherence to the planned interventions up until the completion of their rehabilitation program and by the ability of the app in detecting baseline biases and changes in biases. Acceptability of the intervention will be assessed by a short questionnaire of users’ perceptions of the intervention. Statistical analyses will be performed using SPSS version 22.0, while qualitative analysis of the perspectives will be performed using NVivo version 10.0.

To the best of our knowledge, this is the first study to evaluate the feasibility and acceptability of a mobile attention bias modification intervention for individuals with substance use disorders. The data pertaining to the feasibility and acceptability are undoubtedly crucial because they imply the potential use of mobile technologies in retraining attentional biases among inpatients admitted for medical-assisted detoxification and rehabilitation. Participants’ feedback pertaining to the ease of use, interactivity, and motivation to continue using the app is crucial because it will determine whether a codesign approach might be warranted to design an app that is acceptable for participants and that participants themselves would be motivated to use.

Extracting the Values of Resting-state Functional Connectivity that Correlate with a Tendency of Internet Addiction (2017)

Transactions of Japanese Society for Medical and Biological Engineering Vol. 55 (2017) No. 1 p. 39-44

The number of patients with internet addiction disorder (IAD), especially among school-age children, is on the rise. Development of objective examination technique to assist the current diagnostic methods using medical interview and inquiry tests is desirable for detection of IAD at its early stage. In this study, we extracted the values of functional connectivity (FC) that correlated with a tendency of IAD, using resting-state functional magnetic resonance imaging (rs-fMRI) data. We recruited 40 males [mean age (SD): 21.9 (0.9) years] with no neurological disorders.

The results suggested that the functional connectivity between specific brain regions was significantly degraded already at the stage prior to the onset of IAD. We expect that our connectivity method can be an objective tool for detecting a tendency of IAD to assist the present diagnostic methods.

Disrupted Brain Functional Network in Internet Addiction Disorder: A Resting-State Functional Magnetic Resonance Imaging Study (2014)

PLoS ONE 9(9): e107306. doi:10.1371/journal.pone.0107306

Our results demonstrate that there is significant disruption in the functional connectome of IAD patients, particularly between regions located in the frontal, occipital, and parietal lobes. The affected connections are long-range and inter-hemispheric connections.  Our findings, which are relatively consistent between anatomically and functionally defined atlases, suggest that IAD causes disruptions of functional connectivity and, importantly, that such disruptions might link to behavioral impairments.

Young adults’ internet addiction: Prediction by the interaction of parental marital conflict and respiratory sinus arrhythmia (2017)

Int J Psychophysiol. 2017 Aug 8. pii: S0167-8760(17)30287-8. doi: 10.1016/j.ijpsycho.2017.08.002.

The aim of the current study was to address the potential moderating roles of respiratory sinus arrhythmia (RSA; baseline and suppression) and participant sex in the relation between parents’ marital conflict and young adults’ internet addiction. Participants included 105 (65 men) Chinese young adults who reported on their internet addiction and their parents’ marital conflict. Marital conflict interacted with RSA suppression to predict internet addiction. Specifically, high RSA suppression was associated with low internet addiction, regardless of parental marital conflict; however, for participants with low RSA suppression, a positive relation between marital conflict and internet addiction was found. Internet addiction also was predicted by a significant three-way interaction among baseline RSA, marital conflict, and participant sex.

Increased regional homogeneity in Internet addiction disorder a resting state functional magnetic resonance imaging study (2009).

Chin Med J (Engl). 2010 Jul;123(14):1904-8.

Background: Internet addition disorder (IAD) is currently becoming a serious mental health problem among Chinese adolescents. The pathogenesis of IAD, however, remains unclear. The purpose of this study applied regional homogeneity (ReHo) method to analyze encephalic functional characteristic of IAD college students under resting state

Conclusions: There are abnormalities in regional homogeneity in IAD college students compared with the controls and enhancement of synchronization in most encephalic regions can be found. The results reflect the functional change of brain in IAD college students. The connections between the enhancement of synchronization among cerebellum, brainstem, limbic lobe, frontal lobe and apical lobe may be relative to reward pathways.

COMMENTS: Brain alteration found in Internet addicts that do not exist in controls. Synchronization of brain regions leading to reward activation.

Impulse inhibition in people with Internet addiction disorder: electrophysiological evidence from a Go/NoGo study. (2010)

Neurosci Lett. 2010 Nov 19;485(2):138-42. Epub 2010 Sep 15.

We investigated response inhibition in people with Internet addiction disorder (IAD) by recording event-related brain potentials during a Go/NoGo task. Results show that the IAD group exhibited lower NoGo-N2 amplitude, higher NoGo-P3 amplitude, and longer NoGo-P3 peak latency than the normal group. The results also suggest that the IAD students had lower activation in the conflict detection stage than the normal group; thus, they had to engage in more cognitive endeavors to complete the inhibition task in the late stage. In addition, the IAD students showed less efficiency in information processing and lower impulse control than their normal peers.

COMMENTS: Subjects with Internet addiction needed to “engage in more cognitive endeavors” to complete the inhibition task, and demonstrated lower impulse control – which can be related to hypofrontality

Impaired inhibitory control in internet addiction disorder: A functional magnetic resonance imaging study (2012)

Psychiatry Res. 2012 Aug 11.

‘Internet addiction disorder’ (IAD) is rapidly becoming a prevalent mental health concern in many countries around the world.  The present study examines the neural correlates of response inhibition in males with and without IAD using an event-related functional magnetic resonance imaging (fMRI) Stroop task. The IAD group demonstrated significantly greater ‘Stroop effect’-related activity in the anterior and posterior cingulate cortices compared with their healthy peers. These results may suggest diminished efficiency of response-inhibition processes in the IAD group relative to healthy controls.

COMMENTS: Stroop effect is a measure of executive function (frontal cortex). Study found diminished frontal cortex functioning (hypofrontality)

Brain structures and functional connectivity associated with individual differences in Internet tendency in healthy young adults (2015)

Neuropsychologia. 2015 Feb 16. pii: S0028-3932(15)00080-9.

Internet addiction (IA) incurs significant social and financial costs in the form of physical side-effects, academic and occupational impairment, and serious relationship problems. The majority of previous studies on Internet addiction disorders (IAD) have focused on structural and functional abnormalities, while few studies have simultaneously investigated the structural and functional brain alterations underlying individual differences in IA tendencies measured by questionnaires in a healthy sample. Here we combined structural (regional gray matter volume, rGMV) and functional (resting-state functional connectivity, rsFC) information to explore the neural mechanisms underlying IAT in a large sample of 260 healthy young adults. These findings suggest the combination of structural and functional information can provide a valuable basis for further understanding of the mechanisms and pathogenesis of IA.

Physiological markers of biased decision making in problematic Internet users (2016)

J Behav Addict. 2016 Aug 24:1-8.

Problematic Internet use (PIU) is a relatively new concept and its classification as an addiction is debated. Implicit emotional responses were measured in individuals expressing nonproblematic and problematic Internet behaviors while they made risky/ambiguous decisions to explore whether they showed similar responses to those found in agreed-upon addictions.

The design of the study was cross sectional. Participants were adult Internet users (N = 72). All testing took place in the Psychophysics Laboratory at the University of Bath, UK. Participants were given the Iowa Gambling Task (IGT) which provides an index of an individual’s ability to process and learn probabilities of reward and loss. Integration of emotions into current decision-making frameworks is vital for optimal performance on the IGT and thus, skin conductance responses (SCRs) to reward, punishment, and in anticipation of both were measured to assess emotional function.

Performance on the IGT did not differ between the groups of Internet users. However, problematic Internet users expressed increased sensitivity to punishment as revealed by stronger SCRs to trials with higher punishment magnitude.

PIU seems to differ on behavioral and physiological levels with other addictions. However, our data imply that problematic Internet users were more risk-sensitive, which is a suggestion that needs to be incorporated into in any measure and, potentially, any intervention for PIU.

Functional changes in patients with internet addiction disclosed by adenosine stressed cerebral blood flow perfusion imaging 99mTc-ECD SPET.

Hell J Nucl Med. 2016 Jun 22. pii: s002449910361.

To investigate the abnormal cerebral blood flow (CBF) perfusion in patients with internet addiction (IA) and its possible association with IA severity.Thirty-five adolescents who met the criteria for IA and 12 matched healthy volunteers were recruited for ^99mTc-ethylcysteinate dimer based CBF perfusion imaging with single photon emission tomography (SPET) both at rest and in adenosine-stressed state. Regional CBF (rCBF) was measured and compared between IA subjects and the controls. Correlation analysis between those abnormal rCBF in adenosine-stressed state and the duration of IA was performed.

At the resting state, the IA individuals showed significantly increased rCBF in the left mid-frontal gyrus and left angular gyrus, but significantly decreased in the left paracentral lobule, compared to the controls. In adenosine-stressed state, more cerebral regions with abnormal rCBF were identified. Specifically, increased rCBF was identified in the right paracentral lobule, right mid-frontal gyrus and left superior temporal gyrus, while decreased rCBF were demonstrated in right transverse temporal gyrus, left inferior frontal gyrus and left precuneus. Those rCBF in rCBF-increased regions in stress state were positively correlated with the duration of IA, while those in rCBF-decreased regions were negatively correlated with the duration of IA.

Influence of internet addiction on executive function and learning attention in Taiwanese school-aged children (2018)

Perspect Psychiatr Care. 2018 Jan 31. doi: 10.1111/ppc.12254.

This study aims to evaluate the executive function and learning attention in children with internet addiction (IA). Children aged 10-12 were screened by Chinese Internet Addiction Scale to compose the IA group and internet nonaddiction group. Their executive functions were evaluated by Stroop color and word test, Wisconsin card sorting test, and Wechsler digit span test. Learning attention was evaluated by Chinese concentration questionnaire.

Executive function and learning attention were lower in the IA group than in the internet nonaddiction group.Executive function and learning attention are compromised by IA in children. Early interventions into the IA should be planned to maintain the normal development of executive function and learning attention in childhood.

Recognition of Facial Expressions by Urban Internet-Addicted Left-Behind Children in China (2017)

Psychol Rep. 2017 Jun;120(3):391-407. doi: 10.1177/0033294117697083.

Internet addition affects facial expression recognition of individuals. However, evidences of facial expression recognition from different types of addicts are insufficient. The present study addressed the question by adopting eye-movement analytical method and focusing on the difference in facial expression recognition between internet-addicted and non-internet-addicted urban left-behind children in China. Sixty 14-year-old Chinese participants performed tasks requiring absolute recognition judgment and relative recognition judgment. The results show that the information processing mode adopted by the internet-addicted involved earlier gaze acceleration, longer fixation durations, lower fixation counts, and uniform extraction of pictorial information. The information processing mode of the non-addicted showed the opposite pattern. Moreover, recognition and processing of negative emotion pictures were relatively complex, and it was especially difficult for urban internet-addicted left-behind children to process negative emotion pictures in fine judgment and processing stage of recognition on differences as demonstrated by longer fixation duration and inadequate fixation counts.

The Facebook Experiment: Quitting Facebook Leads to Higher Levels of Well-Being (2016)

Cyberpsychology, Behavior, and Social Networking. November 2016, 19(11): 661-666. doi:10.1089/cyber.2016.0259.

Most people use Facebook on a daily basis; few are aware of the consequences. Based on a 1-week experiment with 1,095 participants in late 2015 in Denmark, this study provides causal evidence that Facebook use affects our well-being negatively. By comparing the treatment group (participants who took a break from Facebook) with the control group (participants who kept using Facebook), it was demonstrated that taking a break from Facebook has positive effects on the two dimensions of well-being: our life satisfaction increases and our emotions become more positive. Furthermore, it was demonstrated that these effects were significantly greater for heavy Facebook users, passive Facebook users, and users who tend to envy others on Facebook.

No More FOMO: Limiting Social Media Decreases Loneliness and Depression (2018)

Journal of Social and Clinical Psychology.

Introduction: Given the breadth of correlational research linking social media use to worse well-being, we undertook an experimental study to investigate the potential causal role that social media plays in this relationship.

Method: After a week of baseline monitoring, 143 undergraduates at the University of Pennsylvania were randomly assigned to either limit Facebook, Instagram and Snapchat use to 10 minutes, per platform, per day, or to use social media as usual for three weeks.

Results: The limited use group showed significant reductions in loneliness and depression over three weeks compared to the control group. Both groups showed significant decreases in anxiety and fear of missing out over baseline, suggesting a benefit of increased self-monitoring.

Discussion: Our findings strongly suggest that limiting social media use to approximately 30 minutes per day may lead to significant improvement in well-being

Facebook Addiction Disorder (FAD) among German students—A longitudinal approach (2017)

PLoS One. 2017; 12(12): e0189719.

The present study aimed to investigate Facebook Addiction Disorder (FAD) in a German student sample over a period of one year. While mean FAD level did not increase during the investigation period, a significant increase was shown in the number of participants reaching the critical cutoff score. FAD was significantly positively related to the personality trait narcissism and to negative mental health variables (depression, anxiety, and stress symptoms). Furthermore, FAD fully mediated the significant positive relationship between narcissism and stress symptoms, which demonstrates that narcissistic people can be specifically at risk to develop FAD. Present results give a first overview of FAD in Germany. Practical applications for future studies and limitations of present results are discussed.

Investigating the differential effects of social networking site addiction and Internet gaming disorder on psychological health (2017)

J Behav Addict. 2017 Nov 13:1-10. doi: 10.1556/2006.6.2017.075.

Previous studies focused on examining the interrelationships between social networking site (SNS) addiction and Internet gaming disorder (IGD) in isolation. Moreover, little is known about the potential simultaneous differential effects of SNS addiction and IGD on psychological health. This study investigated the interplay between these two technological addictions and ascertained how they can uniquely and distinctively contribute to increasing psychiatric distress when accounting for potential effects stemming from sociodemographic and technology-related variables.

A sample of 509 adolescents (53.5% males) aged 10-18 years (mean = 13.02, SD = 1.64) were recruited.  It was found that key demographic variables can play a distinct role in explaining SNS addiction and IGD. Furthermore, it was found that SNS addiction and IGD can augment the symptoms of each other, and simultaneously contribute to deterioration of overall psychological health in a similar fashion, further highlighting potentially common etiological and clinical course between these two phenomena. Finally, the detrimental effects of IGD on psychological health were found to be slightly more pronounced than those produced by SNS addiction, a finding that warrants additional scientific scrutiny.

Neuroticism Magnifies the Detrimental Association between Social Media Addiction Symptoms and Wellbeing in Women, but Not in Men: a three-Way Moderation Model (2018)

Psychiatr Q. 2018 Feb 3. doi: 10.1007/s11126-018-9563-x.

Addiction symptoms in relation to the use of social networking sites (SNS) can be associated with reduced wellbeing. However, the mechanisms that can control this association have not been fully characterized, despite their relevance to effective treatment of individuals presenting SNS addiction symptoms. In this study we hypothesize that sex and neuroticism, which are important determinants of how people evaluate and respond to addiction symptoms, moderate this association. To examine these assertions, we employed hierarchical linear and logistic regression techniques to analyze data collected with a cross-sectional survey of 215 Israeli college students who use SNS. Results lend support to the hypothesized negative association between SNS addiction symptoms and wellbeing (as well as potentially being at-risk for low mood/ mild depression), and the ideas that (1) this association is augmented by neuroticism, and (2) that the augmentation is stronger for women than for men. They demonstrated that the sexes may differ in their SNS addiction-wellbeing associations: while men had similar addiction symptoms -wellbeing associations across neuroticism levels, women with high levels of neuroticism presented much steeper associations compared to women with low neuroticism. This provides an interesting account of possible “telescoping effect”, the idea that addicted women present a more severe clinical profile compared to men, in the case of technology-“addictions”.

Unveiling the dark side of social networking sites: Personal and work-related consequences of social networking site addiction (2018)

Information & Management 55, no. 1 (2018): 109-119.

Highlights

• Social networking site (SNS) addiction impacts personal and work environments.
• Addiction to SNSs indirectly impairs performance.
• Addiction to SNSs increases task distraction that reduces performance.
• Addiction to SNSs reduces positive emotions.
• Positive emotions improve health and performance.

The results, based on 276 questionnaires completed by employees in a large information technology corporation, show that addiction to SNSs has negative consequences on the personal and work environments. SNS addiction reduces positive emotions that augment performance and enhance health. SNS addiction fosters task distraction, which inhibits performance. Theoretical and practical implications are discussed.

Facebook addiction and loneliness in the post-graduate students of a university in southern India (2017)

Int J Soc Psychiatry. 2017 Jun;63(4):325-329. doi: 10.1177/0020764017705895.

Recent research has shown that excessive use of Facebook can result in addictive behavior in some individuals. To assess the patterns of Facebook use in post-graduate students of Yenepoya University and evaluate its association with loneliness.

A cross-sectional study was done to evaluate 100 post-graduate students of Yenepoya University using Bergen Facebook Addiction Scale (BFAS) and University of California and Los Angeles (UCLA) loneliness scale version 3. Descriptive statistics were applied. Pearson’s bivariate correlation was done to see the relationship between severity of Facebook addiction and the experience of loneliness.

More than one-fourth (26%) of the study participants had Facebook addiction and 33% had a possibility of Facebook addiction. There was a significant positive correlation between severity of Facebook addiction and extent of experience of loneliness.

Spontaneous Hedonic Reactions to Social Media Cues (2017)

Cyberpsychology, Behavior, and Social Networking. May 2017, 20(5): 334-340. doi:10.1089/cyber.2016.0530.

Why is it so difficult to resist the desire to use social media? One possibility is that frequent social media users possess strong and spontaneous hedonic reactions to social media cues, which, in turn, makes it difficult to resist social media temptations. In two studies (total N = 200), we investigated less-frequent and frequent social media users’ spontaneous hedonic reactions to social media cues using the Affect Misattribution Procedure–an implicit measure of affective reactions. Results demonstrated that frequent social media users showed more favorable affective reactions in response to social media (vs. control) cues, whereas less-frequent social media users’ affective reactions did not differ between social media and control cues (Studies 1 and 2). Moreover, the spontaneous hedonic reactions to social media (vs. control) cues were related to self-reported cravings to use social media and partially accounted for the link between social media use and social media cravings (Study 2). These findings suggest that frequent social media users’ spontaneous hedonic reactions in response to social media cues might contribute to their difficulties in resisting desires to use social media.

Why narcissists are at risk for developing Facebook addiction: The need to be admired and the need to belong (2018)

Addict Behav. 2018 Jan;76:312-318. doi: 10.1016/j.addbeh.2017.08.038. Epub 2017 Sep 1.

Building upon previous research establishing a positive association between grandiose and vulnerable narcissism and problematic social networking use, the present study tests a model that explains how grandiose and vulnerable narcissists might develop Facebook (Fb) addiction symptoms through the need for admiration and the need to belong. A sample of 535 undergraduates (50.08% F; mean age 22.70±2.76years) completed measures of grandiose narcissism, vulnerable narcissism, Fb addiction symptoms, and two brief scales measuring the need for admiration and the need to belong. Results from structural equation modelling show that the association between grandiose narcissism and Fb addiction levels was completely mediated by the need for admiration and the need to belong. On the other hand, vulnerable narcissism was not found to be associated either directly or indirectly with Fb addiction levels.

Facebook Addiction Disorder in Germany (2018)

Cyberpsychol Behav Soc Netw. 2018 Jul;21(7):450-456. doi: 10.1089/cyber.2018.0140.

This study explored the Facebook addiction disorder (FAD) in Germany. Of the 520 participants, 6.2 percent reached the critical polythetic cutoff score and 2.5 percent reached the critical monothetic cutoff score. FAD was significantly positively related to Facebook use frequency, the personality trait narcissism, as well as depression and anxiety symptoms, but also to subjective happiness. Its association with resilience was significantly negative. Furthermore, Facebook use frequency partly mediated the positive relationship between narcissism and FAD. Current results provide a first overview of FAD in Germany. They demonstrate that FAD is not only the consequence of excessive Facebook use. The positive relationship between FAD and happiness contributes to the understanding of the mechanisms that are involved in the development and maintenance of FAD, and partly explains earlier inconsistencies. Practical applications for future studies and limitations of present results are discussed.

Relationship between internet addiction and academic performance of undergraduate medical students of Azad Kashmir (2020)

Pak J Med Sci. 2020 Jan-Feb;36(2):229-233. doi: 10.12669/pjms.36.2.1061.

A cross-sectional study was done involving 316 medical students of Poonch Medical College, Azad Kashmir, Pakistan from May 2018 to November 2018. Dr. Young’s Internet Addiction Test questionnaire was used as the tool of data collection. The questionnaire contained twenty 5-points Likert scale questions to assess internet addiction. IA score was calculated and the association between IA and academic performance was observed by Spearman Rank Correlation test. Relationship between baseline characteristics of the medical students and IA was also seen.

Eighty-nine (28.2%) medical students fell under the category of ‘severe addiction’ and most importantly only 3 (0.9%) were not internet addicted according to Dr. Young’s questionnaire. Internet addicted medical students scored significantly poor in their exams (p. <.001). One hundred thirty one (41.4%) students with a median IA score of 45 scored in the range of 61-70% marks as compared to 3 (0.9%) students with a median IA score of 5, secured greater than 80% marks.

This study and many other previous studies have revealed that internet addiction affects academic performance. The number of internet users is ever increasing therefore, the number of internet misusers will also increase. If no step is taken to control internet addiction, it may cause a serious impact in the future.

Urban and rural pattern of Internet use among youth and its association with mood state (2019)

J Family Med Prim Care. 2019 Aug 28;8(8):2602-2606. doi: 10.4103/jfmpc.jfmpc_428_19.

The problematic use of internet is associated with dysfunction life style. The emerging evidence do also suggest its impact on user’s mood profile. There is need to establish the urban and rural difference in relation to internet use as well as its association with mood states and its implications for primary care setting.

The present work explored the pattern of internet use in Urban and Rural area and its impact on mood states. 731 individuals (403 males and 328 females) in the age group of 18-25 years from urban and rural areas were approached for the study. The internet addiction test and Depression Anxiety Stress Scale were administered in group setting. Results indicated no significant difference in term of internet use as well as in term for gender. Significant difference was seen for internet use and mood states.

The results indicate no significant difference in terms of internet use pattern and gender in relation to urban and rural areas. However, a significant difference exists with respect to Internet use and its relation to depression, anxiety and stress.

It implies the development of early brief intervention for Primary Physicians to enable them to screening psychological conditions along with internet use as well as help users to have healthy use of technology.

Predictors of problematic Internet use in school going adolescents of Bhavnagar, India (2019)

Int J Soc Psychiatry. 2019 Feb 11:20764019827985. doi: 10.1177/0020764019827985.

We assessed the frequency of PIU and predictors of PIU, including social anxiety disorder (SAD), quality of sleep, quality of life and Internet-related demographic variables among school going adolescents.

This was an observational, single-centered, cross-sectional, questionnaire-based study of 1,312 school going adolescents studying in Grades 10, 11 and 12 in Bhavnagar, India. Every participant was assessed by a pro forma containing demographic details, questionnaires of Internet Addiction Test (IAT), Social Phobia Inventory (SPIN), Pittsburgh Sleep Quality Index (PSQI) and Satisfaction With Life Scale (SWLS) for PIU severity, SAD severity, Quality of Sleep assessment and Quality of Life assessment, respectively. The statistical analysis was done with SPSS Version 23 (IBM Corporation) using chi-square test, Student’s t test and Pearson’s correlation. Multiple linear regression analysis was applied to find the predictors of PIU.

We found frequency of PIUs as 16.7% and Internet addiction as 3.0% among school going adolescents. Participants with PIU are more likely to experience SAD ( p < .0001), poor quality of sleep ( p < .0001) and poor quality of life ( p < .0001). There is positive correlation between severity of PIU and SAD ( r = .411, p < .0001). Linear regression analysis shows PIU can be predicted by SAD, sleep quality, quality of life, English medium, male gender, total duration of Internet use, monthly cost of Internet use, education, social networking, gaming, online shopping and entertainment as purpose of Internet use. Participants with PIU are more likely to experience SAD, poor quality of sleep and poor quality of life.

Impact of nomophobia: A nondrug addiction among students of physiotherapy course using an online cross-sectional survey (2019)

Indian J Psychiatry. 2019 Jan-Feb;61(1):77-80. doi: 10.4103/psychiatry.IndianJPsychiatry_361_18.

Smartphone addiction is known as nomophobia (NMP) which is a fear of not using mobile phone. More researches are available regarding NMP among the students of various professions. However, till date, to the best of our knowledge, there is no literature available on the impact of NMP on the academic performance among students pursuing physiotherapy course (SPPC).

An online cross-sectional survey was conducted by using Google Form platform utilizing validated NMP questionnaires (NMP-Q). A self-reported questionnaire regarding demographic data, information regarding smartphone use, last academic performance, and presence of musculoskeletal disorders was collected. A total of 157 students participated in this survey. Google Form automatically analyzed the collected data.

The mean age of students was 22.2 ± 3.2 years; among them, 42.9% were male and 57.1% were female. Nearly 45% of students have been using smartphone for >5 years and 54% students have musculoskeletal disorders during their prolonged smartphone use. The mean NMP score with 95% confidence interval was 77.6 (72.96-82.15). There exists an inverse relation between the NMP scores (NMPS) and student’s academic performance and no significant difference between NMP scores, P = 0.152.

Internet addiction and attention-deficit / hyperactivity disorder symptoms in adolescents with autism spectrum disorder (2019)

Res Dev Disabil. 2019 Mar 13;89:22-28. doi: 10.1016/j.ridd.2019.03.002.

Several studies have reported that internet addiction (IA) is more prevalent in adolescents with autism spectrum disorder (ASD). However, the characteristics of ASD adolescents with IA are unclear. The objective of this study was to investigate the prevalence of IA in ASD adolescents, and compare the characteristics between the IA and the non-IA groups in adolescents with ASD.

The study included 55 participants who were outpatients at Ehime University Hospital and Ehime Rehabilitation Center for Children in Japan, aged 10-19 years, diagnosed with ASD. Patients and their parents answered several questionnaires including the Young’s Internet Addiction Test (IAT), Strengths and Difficulties Questionnaire (SDQ), Autism Spectrum Quotient (AQ), and Attention Deficit Hyperactivity Disorder Rating Scale-IV (ADHD-RS).

Based on the total IAT score, 25 out of 55 participants were classified as having IA. Although there were no significant differences in AQ and Intelligence Quotient, the higher scores of ADHD symptoms in SDQ and ADHD-RS were observed in the IA group than the non-IA group. The IA group used portable games more often than the non-IA group.

The ADHD symptoms were strongly associated with IA in ASD adolescents. More intensive prevention and intervention for IA are needed especially for the ASD adolescents with ADHD symptoms.

Correlation between smartphone addiction and dysfunctional attitudes in nursing/midwifery students (2019)

Perspect Psychiatr Care. 2019 Jun 6. doi: 10.1111/ppc.12406

The aim of this study is to determine the correlation between smartphone addiction and dysfunctional attitudes.

This descriptive study was conducted with the students of Nursing/Midwifery Department of a state university from March 01 to April 01, 2018.

Participant students had a mean score of 27.25 ± 11.41 in smartphone addiction scale and a mean score of 27.96 ± 14.74 in dysfunctional attitudes scale. The number of students’ friends was found to affect their problem solving skills. Loneliness levels of participant students affected their dysfunctional attitude scores.

Problematic use of the Internet is a unidimensional quasi-trait with impulsive and compulsive subtypes (2019)

BMC Psychiatry. 2019 Nov 8;19(1):348. doi: 10.1186/s12888-019-2352-8.

Problematic use of the Internet as measured by the Internet Addiction Test reflects a quasi-trait – a unipolar dimension in which most variance is restricted to a subset of people with problems regulating Internet use. There was no evidence for subtypes based on the type of online activities engaged in, which increased similarly with overall severity of Internet use problems. Measures of comorbid psychiatric symptoms, along with impulsivity, and compulsivity, appear valuable for differentiating clinical subtypes and could be included in the development of new instruments for assessing the presence and severity of Internet use problems.

Cross-cultural validation of the Social Media Disorder scale (2019)

Psychol Res Behav Manag. 2019 Aug 19;12:683-690. doi: 10.2147/PRBM.S216788.

With the popularity of social networking sites, there is an urgency to devise instruments to evaluate social media addiction in different cultural context. This paper evaluates the psychometric properties and validation of the Social Media Disorder (SMD) scale in People’s Republic of China.

A total of 903 Chinese university students were recruited to participate in this cross-sectional study. The internal consistency, criterion validity and construct validity of the SMD scale were examined.

The results suggested that the 9-item SMD scale had good psychometric properties. Its internal consistency was good, with a Cronbach’s alpha of 0.753. The results showed weak and moderate correlations with other validation constructs, such as self-efficacy and other disorder symptoms suggested in the original scale. The Chinese version of SMD demonstrated a good model fit for a two-factor structure in confirmatory factor analysis, with χ² (44.085)/26=1.700, SRMR=0.059, CFI=0.995, TLI=0.993 and RMSEA=0.028.

Prevalence of excessive internet use and its correlation with associated psychopathology in 11th and 12th grade students (2019)

Gen Psychiatr. 2019 Apr 20;32(2):e100001. doi: 10.1136/gpsych-2018-1000019.

Globally, the number of internet users has crossed the three-billion mark, while in India users grew over 17% in the first 6 months of 2015 to 354 million. This study presented a background on internet use and the existence of excessive internet use.

To study the extent of internet use in 11th and 12 grade students and the psychopathology, if any, associated with excessive internet use.

426 students who met the inclusion criteria were recruited from 11th and 12th grade classes from Kendriya Vidyalaya, New Delhi, India, and were assessed by Young’s Internet Addiction Test and the Strength and Difficulties Questionnaire.

Among the 426 students, the mean internet addiction total score was 36.63 (20.78), which indicated mild level of internet addiction. 1.41% (six students) was diagnosed as excessive internet users, while 30.28% and 23.94% were classified as moderate and mild internet users, respectively. The prevalence of internet addiction between gender was 58.22% in males and 41.78% in females. While both positive (prosocial) and negative (hyperactivity, emotional, conduct and peer problem) impacts of internet use were reported by students, in the current study excessive use of internet had a negative impact on students’ lives as compared with positive impact, which was statistically significant (p<0.0001).

Excessive internet use led to abnormal behaviours which cause negative consequences to users. Early diagnosis of risk factors related to excessive internet use, provides education about responsible use and supervision of students by family members.

Disentangling the role of users’ preferences and impulsivity traits in problematic Facebook use (2018)

PLoS One. 2018 Sep 5;13(9):e0201971. doi: 10.1371/journal.pone.0201971..

The use of social network sites (SNSs) has grown dramatically. Numerous studies have shown that SNS users may suffer from excessive use, associated with addictive-like symptoms. With a focus on the popular SNS Facebook (FB), our aims in the current study were twofold: First, to explore the heterogeneity of FB usage and determine which kind of FB activity predicts problematic usage; second, to test whether specific impulsivity facets predict problematic use of FB. To this end, a sample of FB users (N = 676) completed an online survey assessing usage preferences (e.g., types of activities performed), symptoms of problematic FB use and impulsivity traits. Results indicated that specific usage preferences (updating one’s status, gaming via FB, and using notifications) and impulsive traits (positive and negative urgency, lack of perseverance) are associated to problematic FB use. This study underscores that labels such as FB “addiction” are misleading and that focusing on the actual activities performed on SNSs is crucial when considering dysfunctional usage. Furthermore, this study clarified the role of impulsivity in problematic FB use by building on a theoretically driven model of impulsivity that assumes its multidimensional nature. The current findings have identifiable theoretical and public health implications.

The impact of motives for Facebook use on Facebook addiction among ordinary users in Jordan (2018)

Int J Soc Psychiatry. 2018 Sep;64(6):528-535. doi: 10.1177/0020764018784616.

Facebook has become the most popular social networking site with more than 2.07 billion monthly active users. However, this popularity has its pains too reflected by some addictive behavior among its users. Although researchers have recently started to examine the factors that influence Facebook addiction, little research examined the links between motives for Facebook use and Facebook addiction. These studies mainly concentrate on students too. Also, little research has explored this issue among general public in general and among people in Jordan in particular.

This study therefore examined the impact of motives for Facebook use on Facebook addiction among ordinary users in Jordan.

A sample of 397 ordinary users is employed to achieve the study objective.

Results showed that 38.5% of the participants were addicted to Facebook. Facebook addiction was significantly associated with six motives, namely exhibitionism and companionship, entertainment, escapism and passing time, social curiosity, relationships formation and relationships maintenance.

Among these six motives, escapism and passing time, exhibitionism and companionship, and relationships maintenance were the strong predictors of Facebook addiction.

Facebook Addiction: Onset Predictors (2018)

J Clin Med. 2018 May 23;7(6). pii: E118. doi: 10.3390/jcm7060118.

Worldwide, Facebook is becoming increasingly widespread as a communication platform. Young people especially use this social networking site daily to maintain and establish relationships. Despite the Facebook expansion in the last few years and the widespread acceptance of this social network, research into Facebook Addiction (FA) is still in its infancy. Hence, the potential predictors of Facebook overuse represent an important matter for investigation. This study aimed to deepen the understanding of the relationship between personality traits, social and emotional loneliness, life satisfaction, and Facebook addiction. A total of 755 participants (80.3% female; n = 606) aged between 18 and 40 (mean = 25.17; SD = 4.18) completed the questionnaire packet including the Bergen Facebook Addiction Scale, the Big Five, the short version of Social and Emotional Loneliness Scale for Adults, and the Satisfaction with Life Scale. A regression analysis was used with personality traits, social, family, romantic loneliness, and life satisfaction as independent variables to explain variance in Facebook addiction. The findings showed that Conscientiousness, Extraversion, Neuroticism, and Loneliness (Social, Family, and Romantic) were strong significant predictors of FA. Age, Openness, Agreeableness, and Life Satisfaction, although FA-related variables, were not significant in predicting Facebook overuse. The risk profile of this peculiar behavioral addiction is also discussed.

Online-specific fear of missing out and Internet-use expectancies contribute to symptoms of Internet-communication disorder (2018)

Addict Behav Rep. 2017 Apr 14;5:33-42. doi: 10.1016/j.abrep.2017.04.001

Some of the most frequently used online applications are Facebook, WhatsApp, and Twitter. These applications allow individuals to communicate with other users, to share information or pictures, and to stay in contact with friends all over the world. However, a growing number of users suffer from negative consequences due to their excessive use of these applications, which can be referred to as Internet-communication disorder. The frequent use and easy access of these applications may also trigger the individual’s fear of missing out on content when not accessing these applications. Using a sample of 270 participants, a structural equation model was analyzed to investigate the role of psychopathological symptoms and the fear of missing out on expectancies towards Internet-communication applications in the development of symptoms of an Internet-communication disorder. The results suggest that psychopathological symptoms predict higher fear of missing out on the individual’s Internet-communication applications and higher expectancies to use these applications as a helpful tool to escape from negative feelings. These specific cognitions mediate the effect of psychopathological symptoms on Internet-communication disorder. Our results are in line with the theoretical model by Brand et al. (2016) as they show how Internet-related cognitive bias mediates the relationship between a person’s core characteristics (e.g., psychopathological symptoms) and Internet-communication disorder. However, further studies should investigate the role of the fear of missing out as a specific predisposition, as well as specific cognition in the online context.

Development and Validation of the Problematic Media Use Measure: A Parent Report Measure of Screen Media “Addiction” in Children (2019)

Psychol Pop Media Cult. 2019 Jan;8(1):2-11. doi: 10.1037/ppm0000163.

Although problematic media use among adolescents is of wide interest, less is known regarding problematic media use among younger children. The current study reports on the development and validation of a parent-report measure of one potential aspect of children’s problematic use-screen media addiction-via the Problematic Media Use Measure (PMUM). Items were based on the nine criteria for Internet Gaming Disorder in the DSM-5. The first study describes the development and preliminary validation of the PMUM in a sample of 291 mothers. Mothers (80.8% identified as White) of children 4 through 11 years of age completed the PMUM and measures of child screen time and child psychosocial functioning. EFA indicated a unidimensional construct of screen media addiction. The final versions of the PMUM (27 items) and PMUM Short Form (PMUM-SF, 9 items) evidenced high internal consistency (Cronbach α = .97 and α = .93, respectively). Regression analyses were conducted to examine convergent validity of the PMUM with indicators of child psychosocial functioning. Convergent validity was supported and the PMUM scales also independently predicted children’s total difficulties in functioning, over and above hours of screen time, indicating incremental validity. The second study sought to confirm the factor structure of the PMUM-SF and test for measurement invariance across gender. In a sample of 632 parents, we confirmed the factor structure of the PMUM-SF and found measurement invariance for boys and girls. These studies support the use of the PMUM-SF as a measure of screen media addiction in children ages 4 through 11 years old.

Epidemiology of technology addiction among school students in rural India (2019)

Asian J Psychiatr. 2019 Jan 24;40:30-38. doi: 10.1016/j.ajp.2019.01.009.

Penetration of mobile technology is rapidly rising. Excessive use leads to Technology addiction, which often start early in adolescence. The purpose of the present study was to assess Technology addiction and its correlates among school students in rural India.

This cross sectional study was conducted among 885 school students in north India. Four schools were selected and participants aged 13-18 years, were enrolled randomly. A self-designed 45 item questionnaire was used to evaluate dependence syndrome (intense desire, impaired control, tolerance, withdrawal, persistence despite harm, neglect of alternate pleasure) as used for substance dependence in ICD-10. Screening for depression and anxiety was done by using patient health questionnaire (PHQ-9) and generalized anxiety disorder scale (GAD-7) respectively. Descriptive and logistic regression analyses were done.

The mean age of the study participants was 15.1 years. Among the participants, 30.3% (95% Confidence Interval = 27.2%-33.3%) met the dependence criteria. One-third (33%) of the students stated that their grades had gone down due to gadget use. Technology addiction was more among male students (odds ratio = 2.82, 95% CI = 1.43, 5.59), those having a personal mobile phone (2.98, (1.52-5.83), use smart phone (2.77, 1.46-5.26), use one additional gadget (2.12, 1.14-3.94) and those who were depressed (3.64, 2.04-6.49).

Increased mobile phone access in rural India is leading to technology addiction among school students. Certain demographic and gadget specific factors predict addiction. The technology addiction possibly contributes to poor academic performance and depression.

Mobile gaming and problematic smartphone use: A comparative study between Belgium and Finland (2018)

J Behav Addict. 2018 Mar 1;7(1):88-99. doi: 10.1556/2006.6.2017.080.

Background and aims Gaming applications have become one of the main entertainment features on smartphones, and this could be potentially problematic in terms of dangerous, prohibited, and dependent use among a minority of individuals. A cross-national study was conducted in Belgium and Finland. The aim was to examine the relationship between gaming on smartphones and self-perceived problematic smartphone use via an online survey to ascertain potential predictors. Methods The Short Version of the Problematic Mobile Phone Use Questionnaire (PMPUQ-SV) was administered to a sample comprising 899 participants (30% male; age range: 18-67 years). Results Good validity and adequate reliability were confirmed regarding the PMPUQ-SV, especially the dependence subscale, but low prevalence rates were reported in both countries using the scale. Regression analysis showed that downloading, using Facebook, and being stressed contributed to problematic smartphone use. Anxiety emerged as predictor for dependence. Mobile games were used by one-third of the respective populations, but their use did not predict problematic smartphone use. Very few cross-cultural differences were found in relation to gaming through smartphones. Conclusion Findings suggest mobile gaming does not appear to be problematic in Belgium and Finland.

Examination of neural systems sub-serving facebook “addiction” (2014)

Psychol Rep. 2014 Dec;115(3):675-95

Structural and functional correlates of smartphone addiction (2020)

Addict Behav. 2020 Feb 1;105:106334. doi: 10.1016/j.addbeh.2020.106334.

Popularity and availability of smartphones have dramatically increased in the past years. This trend is accompanied by increased concerns regarding potentially adverse effects of excessive smartphone use, particularly with respect to physical and mental health. Recently, the term “smartphone addiction” (SPA) has been introduced to describe smartphone-related addictive behavior and associated physical and psychosocial impairment. Here, we used structural and functional magnetic resonance imaging (MRI) at 3 T to investigate gray matter volume (GMV) and intrinsic neural activity in individuals with SPA (n = 22) compared to a control group (n = 26). SPA was assessed using the Smartphone Addiction Inventory (SPAI), GMV was investigated by means of voxel-based morphometry, and intrinsic neural activity was measured by the amplitude of low frequency fluctuations (ALFF). Compared to controls, individuals with SPA showed lower GMV in left anterior insula, inferior temporal and parahippocampal cortex (p < 0.001, uncorrected for height, followed by correction for spatial extent). Lower intrinsic activity in SPA was found in the right anterior cingulate cortex (ACC). A significant negative association was found between SPAI and both ACC volume and activity. In addition, a significant negative association between SPAI scores and left orbitofrontal GMV was found. This study provides first evidence for distinct structural and functional correlates of behavioral addiction in individuals meeting psychometric criteria for SPA. Given their widespread use and increasing popularity, the present study questions the harmlessness of smartphones, at least in individuals that may be at increased risk for developing smartphone-related addictive behaviors.

Problematic internet use and mental health among British children and adolescents (2018)

Addict Behav. 2018 Sep 11;90:428-436. doi: 10.1016/j.addbeh.2018.09.007.

Despite concerns about the effects of internet use, little is known about how problematic internet use impacts on British children and adolescents. By adapting the Problematic Internet Use Questionnaire (PIUQ, Demetrovics, Szeredi, & Rózsa, 2008), this study seeks its validation while studying its association with psychopathological and health problems. A sample of 1,814 children and adolescents (aged 10-16 years old) from UK schools completed questionnaires about PIU, behavioural problems, depression, anxiety and health problems. Confirmatory Factor Analysis identified three independent factors: Neglect, Obsession and Control Disorder. Using path analysis, PIU was significantly predicted by conduct problems, hyperactivity, impact on daily life activities, depression and poorer physical health. Males were more likely than females to score higher on PIU. The study shows for the first time that the adapted PIU questionnaire constitutes a valid tool for the assessment of problematic internet use among children/adolescents.

Relationship Between (Pathological) Internet Use and Sleep Problems in a Longitudinal Study (2019)

Prax Kinderpsychol Kinderpsychiatr. 2019 Feb;68(2):146-159. doi: 10.13109/prkk.2019.68.2.146.

Relationship Between (Pathological) Internet Use and Sleep Problems in a Longitudinal Study Excessive or pathological Internet use has already been associated with sleep disorders, but the direction of the connection remains still uncertain. The relationship between (pathological) Internet use and sleep problems in adolescence was investigated by a representative longitudinal survey of data from a sample of 1,060 students from Heidelberg and the surrounding area (SEYLE study). The students, on average 15 years old, responded at a baseline and after one year to a survey on sleep and Internet use. In addition to the number of hours of Internet use, pathological Internet use was assessed using the Young Diagnostic Questionnaire (YDQ). Sleep duration and sleep problems were surveyed by self-assessment. The prevalence of adolescents with pathological Internet use was 3.71 % in the follow-up survey. Furthermore, 20.48 % of adolescents reported sleep problems. Pathological and excessive Internet use were predictors of sleep problems over the course of one year. Adolescents who met the criteria for Internet addiction to the baseline had a 3.6 times greater risk of developing sleep problems in the course of one year. Whereas sleep problems to the baseline increased the YDQ symptoms only by 0.22. Sleep problems often occur as a result of pathological Internet use and could have an addiction-enhancing effect as well as mediating further psychiatric comorbidities. Thus, sleep problems should be targeted for early intervention and therapeutic measures.

Prevalence of smartphone addiction and its effects on sleep quality: A cross-sectional study among medical students (2019)

Ind Psychiatry J. 2019 Jan-Jun;28(1):82-85. doi: 10.4103/ipj.ipj_56_19.

The study aims to assess the prevalence of smartphone addiction and its effects on sleep quality among medical students.

A cross-sectional study was carried out by convenience sampling of medical students at a tertiary care hospital in South India.

Structured Clinical Interview for Diagnostic and Statistical Manual of Mental Disorders, 4^th Edition, Text Revision axis I disorders research version was used for screening past and current psychiatric illness. A semi-structured pro forma was used to obtain demographic details. Smartphone Addiction Scale-Short Version was used to assess smartphone addiction in the participants. Sleep quality was assessed using Pittsburgh’s Sleep Quality Index (PSQI).

Among 150 medical students, 67 (44.7%) were addicted to smartphone usage. Despite the preponderance of male students (31 [50%]) being addicted, there was no statistically significant gender difference in smartphone addiction (P = 0.270). The PSQI revealed poor sleep quality in 77 (51.3%) which amounts to half of the participants. Smartphone addiction was found to be statistically significantly associated with poor sleep quality (odds ratio: 2.34 with P < 0.046).

The prevalence of smartphone addiction among younger population is higher compared to those of contemporary studies. No gender difference in smartphone addiction could be made out in the current study. Smartphone addiction was found to be associated with poor sleep quality. The findings support screening for smartphone addiction which will be helpful in early identification and prompt management.

Evaluating the Effects of Social Networking Sites Addiction, Task Distraction and Self-Management on Nurses’ Performance (2019)

J Adv Nurs. 2019 Aug 5. doi: 10.1111/jan.14167.

The purpose of this study is to explore the relationship of social networking sites (SNSs) addiction on nurses’ performance and how this relationship is mediated by task distraction and moderated by self-management.

This cross-sectional study is design to empirically test the relationship of SNSs addiction, task distraction and self-management with the nurses’ performance.

Data were collected by conducting an online-survey on nurses across the world using a web-based questionnaire developed through ‘Google Docs’ and distributed through ‘Facebook’ from 13 August, 2018 – 17 November, 2018. The Facebook groups were searched using the selected key terms. In total, 45 groups were found to have relevance to this research; therefore, request was made to the admins of these groups to participate in this research and to post a link in their groups. Only 19 group admins responded positively by uploading a link of the research instrument on their respective group pages and 461 members of these groups participated in the research.

Results of the data collected from fifty-three different countries indicated that SNSs addiction results in lowering the nurses’ performance. This relationship is further strengthened by task distraction introduced as a mediating variable. The results show that self-management mediates the relationship between SNSs addiction and employees’ performance. Moreover, the results of the study confirm that self-management reduces the negative impact of SNSs addiction on nurses’ performance.

SNSs addiction and task distraction reduces the nurses’ performance, whereas, self-management enhances nurses’ performance.

This study addresses the problem of using SNSs at the workplace and its potential effect on nurses’ performance. Results demonstrate that SNSs addiction reduces the performance which is further decreased by task distraction; however, self-management of nurses can enhance the nurses’ performance. The research has numerous theoretical and practical implications for hospital administration, doctors and nurses.

Bad Choices Make Good Stories: The Impaired Decision-Making Process and Skin Conductance Response in Subjects With Smartphone Addiction (2019)

Front Psychiatry. 2019 Feb 22;10:73. doi: 10.3389/fpsyt.2019.00073.

Introduction: Smartphone Addiction (SA) has caused negative consequences and functional impairments in college students, such as reduction of academic performance and impairment in sleep quality. Studies have shown that individuals with chemical and behavioral dependencies have a bias in decision-making process, which leads to short-term advantageous choices even if they cause long-term harm. This bias in decision-making process is accompanied by a change in somatic markers and is associated with the development and maintenance of addictive behavior. The decision-making process and the measurement of physiological parameters have not yet been analyzed in SA. The neuropsychological and physiological characterization of the SA can contribute to its approach with the other dependency syndromes and to its recognition as a disease.

Objective: we aimed to evaluate the decision-making process under risk and under ambiguity in individuals with SA and to measure the physiological parameters that accompany this process.

Method: We compared the performance in the Iowa Gambling Task (IGT), Game of Dice Task (GDT) and skin conductance response (SCR) between 50 individuals with SA and 50 controls.

Results: Smartphone dependents presented a profile of impairment in decision-making under ambiguity, without impairment in decision-making under risk. They demonstrated lower SCR before disadvantageous choices, higher SCR after rewards and lower SCR after punishments during decision-making, which suggests difficulty in recognizing disadvantageous alternatives, high sensitivity to rewards, and low sensitivity to punishments.

Conclusion: The impairment in the decision-making process in smartphone dependents is similar to that found in other chemical and behavioral addictions, such as alcohol addiction, gambling disorders and pathological buy. The impairment in decision under ambiguity with preservation of decision under risk may reflect dysfunction of implicit emotional processes without dysfunction of explicit cognitive process. This profile can contribute to the recognition of SA as a behavioral dependence and to guide specific preventive and therapeutic strategies.

Temperament profile and its association with the vulnerability to smartphone addiction of medical students in Indonesia (2019)

PLoS One. 2019 Jul 11;14(7):e0212244. doi: 10.1371/journal.pone.0212244.

Two dimensions of temperament, namely, (high levels of) novelty seeking and (low levels of) harm avoidance are related to substance addictions. However, their implications for smartphone addiction remain unexplored. Medical students are heavy smartphone users. Accordingly, screening for the risk of smartphone addiction based on individual differences in temperament can facilitate the identification of the best possible prevention strategy. Therefore, the present study aimed to examine the relationship between temperament and the vulnerability to smartphone addiction among medical students in Jakarta, Indonesia. The research study adopted a cross-sectional research design and used a simple random sampling technique. The Indonesian versions of the Temperament and Character Inventory and the Smartphone Addiction Scale were used to measure the study variables. Logistic regression analysis was conducted to examine the relationships between demographic factors, patterns of smartphone use, temperament, and vulnerability to smartphone addiction. A majority of the 185 participants were found to have the following temperament profile: low levels of novelty seeking and high levels of reward dependence and harm avoidance. The average duration of daily smartphone use was 7.83 hours (SD = 4.03) and the age at first smartphone use was 7.62 years (SD = 2.60). The respondents used smartphone to communicate with other people and access social media. A high level of harm avoidance was significantly associated with the risk of smartphone addiction (Odds Ratio [OR] = 2.04, 95% Confidence Interval [CI] = 1.12, 3.70). The findings suggest that smartphone addiction is comparable to other addictive behaviors.

Personality Associations With Smartphone and Internet Use Disorder: A Comparison Study Including Links to Impulsivity and Social Anxiety (2019)

Front Public Health. 2019 Jun 11;7:127. doi: 10.3389/fpubh.2019.00127.

The present work aims to replicate findings linking specific personality traits with Internet and Smartphone Use Disorder (IUD/SUD). Specifically, earlier research demonstrated that tendencies toward IUD and SUD are associated with high Neuroticism and both low Conscientiousness and low Agreeableness, while IUD (but not SUD) tendencies are negatively related to Extraversion and SUD (but not IUD) tendencies are negatively associated with Openness (1). In the aftermath of the replication crisis in psychology and related disciplines, it has become increasingly important to replicate findings in psychological research. Therefore, we revisited this earlier study by investigating (i) a sample from different countries and (ii) using different questionnaires to assess IUD, SUD and the Five Factor Model of Personality than the earlier work by Lachmann et al. (1). By applying such a design, we believe that replicating results from this earlier study hints toward generalizable associations being (largely) independent from that sample’s specific cultural background and instrumentation. Importantly (iii) we used a larger sample consisting of N = 773 in the present study to have higher statistical power to observe the initially reported associations. Additionally, we investigated the role of impulsivity and social anxiety on IUD/SUD, further illuminating the nature of these potential new disorders. Indeed, we were able to reaffirm the aforementioned correlation patterns between personality and IUD/SUD in the present work to a large extent, with low Conscientiousness and high Neuroticism being most robustly associated with higher IUD/SUD. Furthermore, social anxiety and impulsivity showed positive correlations with IUD and SUD, as expected.

Transitions in Problematic Internet Use: A One-Year Longitudinal Study of Boys (2019)

Psychiatry Investig. 2019 Jun;16(6):433-442. doi: 10.30773/pi.2019.04.02.1.

Longitudinal studies may help elucidate the factors associated with Problematic Internet Use (PIU); however, little prospective research has been conducted on the subject. The aim of the current study was to prospectively examine PIU in children/adolescents and identify the possible risk factors associated with transitions in PIU severity.

650 middle-school boys were surveyed at two points one year apart and assessed for PIU using the Internet Addiction Proneness Scale for Youth (KS-II) and on other psychological characteristics.

We found that 15.3% at baseline and 12.4% at one year met the criteria for at-risk/high-risk PIU (ARHRPIU). Both the persistent-ARHRPIU and emerging-ARHRPIU groups revealed greater depressive, motor impulsive, and smart-phone-addiction tendencies than the remitting-ARHRPIU group or the persistent low-risk group. In addition, we found that individuals exhibiting higher hyperkinetic attention-deficit/hyperactivity disorder (ADHD) scores were less likely to remit from ARHRPIU, and that individuals exhibiting more ADHD-related cognitive dysfunction and reporting fewer Internet-game-free days were more likely to demonstrate an emergence of ARHRPIU.

Relationships between depression, health‑related behaviors, and internet addiction in female junior college students (2019)

PLoS One. 2019 Aug 9;14(8):e0220784. doi: 10.1371/journal.pone.0220784.

Depressive emotions can lead to subsequent unhealthy behaviors such as Internet addiction, especially in female adolescents; therefore, studies that examine the relationships among depression, health‑related behaviors, and Internet addiction in female adolescents are warranted.

To examine (1) the relationship between depression and health-related behaviors and (2) the relationship between depression and Internet addiction.

A cross-sectional study design was adopted using a structured questionnaire to measure depression, health-related behaviors, and Internet addiction in female adolescents. The data were collected from students of a junior college in southern Taiwan using convenience sampling to select the participants. The questionnaire was divided into four sections: demographics, the Center for Epidemiologic Studies Depression Scale (CES-D), the Health Promoting Lifestyle Profile (HPLP), and the Internet Addiction Test (IAT).

The final sample comprised 503 female junior college students, with the participants mainly aged between 15 to 22 years (mean age = 17.30 years, SD = 1.34). Regarding the HPLP scores, the overall score, nutrition subscale score, and self-actualization subscale score were significantly and negatively associated with the CES-D depression score (p < 0.05-0.01). In other words, depression level was lower in students who exhibited more healthy behaviors, put more emphasis on dietary health, and had higher levels of self-admiration and confidence toward life. Regarding the IAT scores, the overall score and six domain scores were all positively associated (p < 0.01) to the CES-D depression score. In other words, the higher an individual’s Internet addiction score was, the higher her depression level was.

The results confirmed the relationship between depression, health-related behaviors, and Internet addiction. The cultivation of health-related behaviors may help in lowering depressive symptoms. Teenagers with depression have higher risks of developing Internet addiction, and such addiction is likely to affect their daily functioning.

Cognitive flexibility in internet addicts: fMRI evidence from difficult-to-easy and easy-to-difficult switching situations (2013)

Addict Behav. 2013 Dec 11.

Behavioral and imaging data were collected from 15 IAD subjects (21.2±3.2years) and 15 healthy controls (HC, 22.1±3.6years).

Correlations were also performed between behavioral performances and brain activities in relevant brain regions. Taken together, we concluded that IAD subjects engaged more endeavors in executive control and attention in the switching task. From another perspective, IAD subjects show impaired cognitive flexibilities.

Effects of Internet Addiction on Heart Rate Variability in School-Aged Children (2013).

J Cardiovasc Nurs. 2013 Oct 1

This study explored the effects of Internet addiction on autonomic nervous system function through heart rate variability (HRV) analysis.Data were collected from 240 school-aged children who completed the Chinese Internet Addiction Scale and Pittsburgh Sleep Quality Index questionnaires.

Internet addicts had significantly lower high frequency (HF) percentage, logarithmically transformed HF, and logarithmically transformed total power and significantly higher low frequency percentage than did nonaddicts. Internet addiction is associated with higher sympathetic activity and lower parasympathetic activity. The autonomic dysregulation associated with Internet addiction might partly result from insomnia, but the mechanism still needs to be further studied.

COMMENTS: Heart rate variability is a measure of autonomic nervous system function and dysfunction. Those with IAD demonstrated autonomic dysfunction.

FULL STUDY may be available- P300 change and cognitive behavioral therapy in subjects with Internet addiction disorder: A 3 month follow-up study (2011)

CONCLUSION The results of the current investigation of ERPs in individuals suffering from IAD were in accordance with the findings of previous studies of other addictions[17-20]. Specifically, we found reduced P300 amplitude and longer P300 latency in individuals exhibiting addictive behaviors compared with healthy controls. These results support the hypothesis that similar pathological mechanisms are involved in different addiction behaviors.

Influence of dopaminergic system on internet addiction (2011)

Acta Medica Medianae 2011;50(1):60-66.

Subtypes of Internet Addiction Generalized Internet addiction is not as common and it includes a multidimensional, excessive usage of Internet service and content, commonly without a specific goal of this usage. However, it is more common that people grow addicted to the specific online content and activities rather than general Internet usage. There is no consensus with regards to the exact number of assumptions of the subtypes of Internet abuse. However, four or five types are most commonly defined, and, in his work, Hinić accentuates concept 6+1 subtypes:

1. Cyber-Relational Addiction
2. Cybersexual Addiction
3. Information Overload
4. Net Gaming
5. Compulsive Online Shopping
6. Computer and IT Addiction
7. Mixed type of addiction

Comparison of Psychological Symptoms and Serum Levels of Neurotransmitters in Shanghai Adolescents with and without Internet Addiction Disorder: A Case-Control Study (2013)

PLoS ONE 8(5): e63089. doi:10.1371/journal.pone.0063089

Peripheral blood dopamine, serotonin and norepinephrine were assayed. The mean level of norepinephrine was lower in the IAD group than that in the typically developing participants, while dopamine and serotonin levels did not differ. The SDS, SAS and SCARED symptom scores were increased in the adolescents with IAD. A logistic regression analysis revealed that a higher SAS score and lower level of norepinephrine independently predicted IAD group membership. There was no significant correlation between hours spent online and scores of SAS/SDS in IAD group.

Effects of electroacupuncture combined psycho-intervention on cognitive function and event related potentials P300 and mismatch negativity in patients with internet addiction. (2012)

Chin J Integr Med. 2012 Feb;18(2):146-51. Epub 2012 Feb 5.

RESULTS: After treatment, in all groups, the IA score was lowered significantly (P <0.05) and scores of short-term memory capacity and short-term memory span increased significantly (P <0.05), while the decreased IA score in the CT group was more significant than that in the other two groups (P <0.05). ERP measurements showed that P300 latency was depressed and its amplitude raised in the EA group; MMN amplitude increased in the CT group (all P<0.05).

CONCLUSION:The EA in combination with PI could improve the cognitive function of IA patients, and its mechanism might be related to the speedup of cerebral discrimination on external stimulus and the enhancement of effective resource mobilization during information processing of the brain.

COMMENTS: Study compared 3 treatment protocols for Internet addiction. Interesting findings: 1) after 40 days of treatment all groups significantly improved in cognitive function; 2) Internet addiction scores were significantly lowered. If pre-existing condition were the cause, changes would not have occurred with treatment.

Abnormal brain activation of adolescent internet addict in a ball-throwing animation task: Possible neural correlates of disembodiment revealed by fMRI (2012)

Prog Neuropsychopharmacol Biol Psychiatry. 2012 Jun 9.

While adolescent internet addicts are immersed in cyberspace, they are easily able to experience ‘disembodied state’. The purposes of this study were to investigate the difference of brain activity between adolescent internet addicts and normal adolescents in a state of disembodiment, and to find the correlation between the activities of disembodiment-related areas and the behavioral characteristics related to internet addiction. The fMRI images were taken while the addiction group (N=17) and the control group (N=17) were asked to perform the task composed with ball-throwing animations.

These results show that the disembodiment-related activation of the brain is easily manifested in adolescent internet addicts. Internet addiction of adolescents could be significantly unfavorable for their brain development related with identity formation.

Excessive social media users demonstrate impaired decision making in the Iowa Gambling Task (2019)

J Behav Addict. 2019 Jan 9:1-5. doi: 10.1556/2006.7.2018.138.

Online social networking sites (SNSs) like Facebook provide users with myriad social rewards. These social rewards bring users back to SNSs repeatedly, with some users displaying maladaptive, excessive SNS use. Symptoms of this excessive SNS use are similar to symptoms of substance use and behavioral addictive disorders. Importantly, individuals with substance use and behavioral addictive disorders have difficulty making value-based decisions, as demonstrated with paradigms like the Iowa Gambling Task (IGT); however, it is currently unknown if excessive SNS users display the same decision-making deficits. Therefore, in this study, we aimed to investigate the relationship between excessive SNS use and IGT performance.

We administered the Bergen Facebook Addiction Scale (BFAS) to 71 participants to assess their maladaptive use of the Facebook SNS. We next had them perform 100 trials of the IGT to assess their value-based decision making.

We found a negative correlation between BFAS score and performance in the IGT across participants, specifically over the last block of 20 trials. There were no correlations between BFAS score and IGT performance in earlier blocks of trials.

Our results demonstrate that more severe, excessive SNS use is associated with more deficient value-based decision making. In particular, our results indicate that excessive SNS users may make more risky decisions during the IGT task.

This result further supports a parallel between individuals with problematic, excessive SNS use, and individuals with substance use and behavioral addictive disorders.

Resting-state beta and gamma activity in Internet addiction (2013)

Int J Psychophysiol. 2013 Jun 13. pii: S0167-8760(13)00178-5. doi: 10.1016/j.ijpsycho.2013.06.007.

Internet addiction is the inability to control one’s use of the Internet and is related to impulsivity. Although a few studies have examined neurophysiological activity as individuals with Internet addiction engage in cognitive processing, no information on spontaneous EEG activity in the eyes-closed resting-state is available. The Internet addiction group showed high impulsivity and impaired inhibitory control. These EEG activities were significantly associated with the severity of Internet addiction as well as with the extent of impulsivity.

The present study suggests that resting-state fast-wave brain activity is related to the impulsivity characterizing Internet addiction. These differences may be neurobiological markers for the pathophysiology of Internet addiction.

Automatic detection advantage of network information among Internet addicts: behavioral and ERP evidence (2018)

Sci Rep. 2018 Jun 12;8(1):8937. doi: 10.1038/s41598-018-25442-4.

Converging evidence has proved the attentional bias of Internet addicts (IAs) on network information. However, previous studies have neither explained how characteristics of network information are detected by IAs with priority nor proved whether this advantage is in line with the unconscious and automatic process. To answer the two questions, this study aims to investigate whether IAs prioritize automatic detection of network information from the behavior and cognitive neuroscience aspects. 15 severe IAs and 15 matching healthy controls were selected using Internet Addiction Test (IAT). Dot-probe task with mask was used in the behavioral experiment, while deviant-standard reverse oddball paradigm was used in the event-related potential (ERP) experiment to induce mismatch negativity (MMN). In the dot-probe task, when the probe location appeared on the Internet-related picture’s position, the IAs had significantly shorter reaction time than do the controls; in the ERP experiment, when Internet-related picture appeared, MMN was significantly induced in the IAs relative to the controls. Both experiments show that IAs can automatically detect network information.

Differentiation of Internet addiction risk level based on autonomic nervous responses: the Internet-addiction hypothesis of autonomic activity (2010)

Cyberpsychol Behav Soc Netw. 2010 Aug;13(4):371-8.

How high-risk Internet addiction (IA) abusers respond to different autonomic nervous activities compared with low-risk subjects may be a critical research goal with prevention and treatment implications. The aim of the present study was to address this issue by observing differences between high- and low-risk IA abusers in four physiological assessments when surfing the Internet: blood volume pulse (BVP), skin conductance (SC), peripheral temperature (PTEMP), and respiratory response (RESPR). Forty-two male and ten female participants aged 18-24 years were screened with the Chen Internet Addiction Scale (CIAS, 2003), and then separated into high- and low-risk IA groups.

Thus we suggest that four autonomic responses may be differentially sensitive to abusers’ potency in terms of the IA hypothesis of autonomic activity. The stronger BVP and RESPR responses and the weaker PTEMP reactions of the high-risk IA abusers indicate the sympathetic nervous system was heavily activated in these individuals. However, SC activates parasympathetic responses at the same time in the high-risk IA abusers.

COMMENTS: Those classified as having an Internet addiction had much stronger sympathetic nervous system activation when surfing the Internet.

Impaired Error-Monitoring Function in People with Internet Addiction Disorder: An Event-Related fMRI Study (2013)

Eur Addict Res. 2013 Mar 23;19(5):269-275.

This study was set to investigate the error-monitoring ability in IAD subjects. Participants were asked to perform a fast Stroop task that may show error responses. Behavioral and neurobiological results in relation to error responses were compared between IAD subjects and HC.

Internet Addiction Among Lebanese Adolescents: The Role of Self-Esteem, Anger, Depression, Anxiety, Social Anxiety and Fear, Impulsivity, and Aggression-A Cross-Sectional Study (2019)

J Nerv Ment Dis. 2019 Sep 9. doi: 10.1097/NMD.0000000000001034.

The study objective was to evaluate the association between depression, anxiety, social anxiety and fear, impulsivity, and aggression and Internet addiction (IA) among Lebanese adolescents. This cross-sectional study, conducted between October 2017 and April 2018, enrolled 1103 young adolescents aged between 13 and 17 years. The Internet Addiction Test (IAT) was used to screen for IA. The results also showed that 56.4% of the participants were average Internet users (IAT score ≤49), 40.0% had occasional/frequent problems (IAT scores between 50 and 79), and 3.6% had significant problems (IAT scores ≥80) because of Internet use. The results of a stepwise regression showed that higher levels of aggression (β = 0.185), depression (Multiscore Depression Inventory for Children) (β = 0.219), impulsivity (β = 0.344), and social fear (β = 0.084) were associated with higher IA, whereas an increased number of siblings (β = -0.779) and a higher socioeconomic status (β = -1.707) were associated with lower IA. Uncontrolled use of the Internet can be associated with addiction and other psychological comorbidities.

The Prevalence of Internet Addiction in Turkish Adolescents with Psychiatric Disorders (2019)

Noro Psikiyatr Ars. 2019 Jul 16;56(3):200-204. doi: 10.29399/npa.23045.

A total of 310 adolescents, aged from 12 to 18, participated in the study. The psychiatric sample group included 162 participants who had applied to the child psychiatry outpatients service. The psychiatric disorders among those in this group were assessed through clinical interviews based on the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition Text Revision (DSM-IV-TR). The control group was chosen from adolescents of families who had never sought psychiatric help. The demographics of the participants and the features of their Internet usage habits were gathered through a questionnaire prepared by researchers. Young’s Internet Addiction Test was used to assess internet addiction.

The frequency of IA was found to be significantly higher in the psychiatric sample group than in the control group (24.1% vs. 8.8%, respectively). A total of 23.9% of the subjects had one, and 12.6% had two or more co-morbid psychiatric diagnoses. The frequencies of the diagnostic groups were as follows: attention deficit hyperactivity disorder 55.6%, anxiety disorder 29.0%, mood disorder 21.0%.

IA was found to be significantly more common among adolescents in the child psychiatry outpatient department than among the adolescents who had no psychiatric history, even after confounding variables had been controlled. Further studies are needed to define IA more precisely and to improve prevention approaches.

The Association of Internet Addiction and Perceived Parental Protective Factors Among Malaysian Adolescents (2019)

Asia Pac J Public Health. 2019 Sep 15:1010539519872642. doi: 10.1177/1010539519872642.

Parental protective factors do play an important role in preventing Internet addiction. A self-administered questionnaire was used to measure health risk behaviors among Malaysian adolescents. The prevalence of Internet addiction was significantly higher among adolescents with perceived lack of parental supervision (30.1% [95% confidence interval (CI) = 28.7-31.4]) and lack of parental connectedness (30.1% [95% CI = 28.5-31.7]), compared with their counterparts. Adolescents who perceived a lack of parental supervision, respect for privacy, connectedness, and bonding were more likely to have Internet addiction: (adjusted odds ratio [aOR] = 1.39; 95% CI = 1.27-1.52), (aOR = 1.23; 95% CI = 1.16-1.31), (aOR = 1.09; 95% CI = 1.02-1.16), (aOR = 1.06; 95% CI = 1.00-1.12), respectively. Among girls, Internet addiction was associated with those who perceived lack in all 4 parental factors, while among boys, those who perceived lack of parental supervision and respect for privacy were more prone to Internet addiction.

Adult Attachment Orientations and Social Networking Site Addiction: The Mediating Effects of Online Social Support and the Fear of Missing Out (2020)

Front Psychol. 2019 Nov 26;10:2629. doi: 10.3389/fpsyg.2019.02629.

Evidence supports predictive roles of adult attachment orientations for the maintenance of social networking site (SNS) addiction, but the underlying mechanisms are mostly unknown. Based on attachment theory, this study explored whether online social support and the fear of missing out mediated the relationship between insecure attachment and social networking site addiction among 463 college students in China. A questionnaire was used to collect data using the Experience in Close Relationship Scale-Short Form, online social support scale, fear of missing out scale, and Chinese Social Media Addiction Scale. The results showed that online social support and fear of missing out mediated the relationship between anxious attachment and social networking site addiction in parallel paths and serially, and online social support negatively mediated the relationship between avoidant attachment and social networking site addiction. Theoretically, the present study contributes to the field by showing how insecure attachment is linked to SNS addiction.

Motivational but not executive dysfunction in attention deficit/hyperactivity disorder predicts internet addiction: Evidence from a longitudinal study (2020)

Psychiatry Res. 2020 Jan 25;285:112814. doi: 10.1016/j.psychres.2020.112814.

This study tested the causal link between Attention Deficit/Hyperactivity Disorder (ADHD) and Internet addiction (IA) and investigated motivational and executive dysfunction as explanatory mechanisms in this association. A sample of 682 young adults completed self-report measures both at Time1 and Time2, six-months apart, including 54 ADHD participants diagnosed by the Conners’ Adult ADHD Rating Scale and the Continuous Performance Test. According to the performance in four cognitive tasks, ADHD participants were classified into three groups based on the dual pathway model of ADHD: executive dysfunction (ED), motivational dysfunction (MD) and combined dysfunction (CD). Participants’ severity of IA symptoms was assessed using the self-report Chen IA Scale. Results indicated that ADHD scores at Time1 predicted IA scores at Time2 but not vice versa. ADHD participants were easier to be IA than controls, while the severity of IA among the three ADHD groups changed differently. The MD and CD groups became more excessively engaged in Internet use over the course of the six-months while the ED group was unchanged. These findings identify ADHD as a potential risk factor for IA and suggest that motivational dysfunction, characterized by an excessive preference for immediate reward over delayed rewards, is a better predictor of IA than executive dysfunction.

Problematic Smartphone Use and Mental Health in Chinese Adults: A Population-Based Study (2020)

Int J Environ Res Public Health. 2020 Jan 29;17(3). pii: E844. doi: 10.3390/ijerph17030844.

Problematic smartphone use (PSU) has been associated with anxiety and depression, but few explored its mental well-being correlates that could co-occur with or be independent of mental symptoms. We studied the associations of PSU with anxiety, depression, and mental well-being in Hong Kong Chinese adults in a probability-based survey (N = 4054; 55.0% females; mean age ± SD 48.3 ± 18.3 years). PSU was measured using Smartphone Addiction Scale-Short Version. Anxiety and depression symptoms were evaluated using General Anxiety Disorder screener-2 (GAD-2) and Patient Health Questionnaire-2 (PHQ-2). Mental well-being was measured using Subjective Happiness Scale (SHS) and Short Warwick-Edinburgh Mental Well-Being Scale (SWEMWBS). Multivariable regression analyzed associations adjusting for sociodemographic and lifestyle-related variables. Associations of PSU with mental well-being were stratified by symptom severity of anxiety (GAD-2 cutoff of 3) and depression (PHQ-2 cutoff of 3). We found that PSU was associated with higher odds of anxiety and depression symptom severity and lower scores of SHS and SWEMWBS. Associations of PSU with lower SHS and SWEMWBS scores remained in respondents who screened negative for anxiety or depression symptoms. To conclude, PSU was associated with anxiety, depression, and impaired mental well-being. Associations of PSU with impaired mental well-being could be independent of anxiety or depression symptoms.

Internet Use and Addiction Among Medical Students in Qassim University, Saudi Arabia (2019)

Sultan Qaboos Univ Med J. 2019 May;19(2):e142-e147. doi: 10.18295/squmj.2019.19.02.010.

This study aimed to measure the prevalence of Internet use and addiction and determine its association with gender, academic performance and health among medical students.

This cross-sectional study was conducted between December 2017 and April 2018 at the College of Medicine, Qassim University, Buraydah, Saudi Arabia. The validated Internet Addiction Test questionnaire was distributed by simple random methods to medical students (N = 216) in the pre-clinical phase (first-, second- and third-years). A chi-square test was used to determine significant relationships between Internet use and addiction and gender, academic performance and health.

A total of 209 student completed the questionnaire (response rate: 96.8%) and the majority (57.9%) were male. In total, 12.4% were addicted to the Internet and 57.9 had the potential to become addicted. Females were more frequent Internet users than males (w = 0.006). Academic performance was affected in 63.1% of students and 71.8% lost sleep due to late-night Internet use, which affected their attendance to morning activities. The majority (59.7%) expressed feeling depressed, moody or nervous when they were offline.

Internet addiction among medical students at Qassim University was very high, with addiction affecting academic performance and psychological well-being. Suitable interventional and preventive measures are needed for proper Internet use to protect students’ mental and physical health.

Prevalence of Internet addiction in Japan: Comparison of two cross-sectional surveys (2020)

Pediatr Int. 2020 Apr 16. doi: 10.1111/ped.14250.

Internet addiction is a serious problem, and the incidence has increased significantly in recent years. In two cross-sectional studies over a 4-year period, we investigated Internet addiction in adolescents and evaluated the resulting changes in their lives.

Junior high school students (aged 12 to 15 years) were assessed in 2014 (survey I) and in 2018 (survey II). They filled out Young’s Internet Addiction Test (IAT), the Japanese version of the General Health Questionnaire (GHQ), and a questionnaire on sleep habits and usage of electric devices.

A total of 1382 students were recruited for the two surveys. The mean IAT score was significantly higher in survey II (36.0 ± 15.2) than in survey I (32.4 ± 13.6) (p < 0.001). The increase in total IAT score indicates that the rate of Internet addiction was significantly higher in 2018 than in 2014. For each subscale of the GHQ, social dysfunction scores were significantly lower in survey II than in survey I (p = 0.022). During the weekend, mean total sleep time was 504.8 ± 110.1 min, and the time of awakening was 08:02 h in survey II; the total sleep time and wake time were significantly longer and later, respectively, in survey II than in survey I (p < 0.001, p = 0.004, respectively). Smartphone usage was also significantly higher in survey II than in survey I (p < 0.001).

Bidirectional predictions between Internet addiction and probable depression among Chinese adolescents (2018)

Behaviors Associated with Internet Use in Military Medical Students and Residents (2019)

Mil Med. 2019 Apr 2. pii: usz043. doi: 10.1093/milmed/usz043.

Problematic use of video games, social media, and Internet-related activities may be associated with sleep deprivation and poor work performance. The Internet Addiction Test was given to military medical and nursing students and housestaff to assess problematic Internet use.

Medical and nursing students at the Uniformed Services University of the Health Sciences and residents from Naval Medical Center San Diego were contacted via email (n = 1,000) and given a survey that included the Internet Addiction Test (IAT) and questions asking about other specific lifestyle variables. Individuals who received an Internet Addiction Score (IAS) ≥50 were identified as likely experiencing harmful effects of Internet addiction (IA).

Of 399 surveys submitted, 68 were omitted due to gross incompletion or failing to finish the entirety of the IAT. Of the participants included, 205 (61.1%) were male and 125 (37.9%) were female. The mean age was 28.6 years old (S.D. = 5.1 years). In regards to training status, completed surveys were assessed for 94 medical residents, 221 School of Medicine students, and 16 Graduate School of Nursing students. Our survey showed 5.5% of the participants (n = 18) indicated problems with Internet use that are concerning for IA. The study results indicated that our population showed problematic Internet use in the lower range of global estimates of IA.

To Each Stress Its Own Screen: A Cross-Sectional Survey of the Patterns of Stress and Various Screen Uses in Relation to Self-Admitted Screen Addiction (2019)

J Med Internet Res. 2019 Apr 2;21(4):e11485. doi: 10.2196/11485.

The relationship between stress and screen addiction is often studied by exploring a single aspect of screen-related behavior in terms of maladaptive dependency or the risks associated with the content. Generally, little attention is given to the pattern of using different screens for different types of stressors, and variations arising from the subjective perception of stress and screen addiction are often neglected. Given that both addiction and stress are complex and multidimensional factors, we performed a multivariate analysis of the link between individual’s subjective perceptions of screen addiction, various types of stress, and the pattern of screen usage.

Using the media-repertoires framework to study usage patterns, we explored (1) the relation between subjective and quantitative assessments of stress and screen addiction; and (2) differences in stress types in relation to subjective screen addiction and different types of needs for screens. We hypothesized that interindividual heterogeneity in screen-related behavior would reflect coping differences in dealing with different stressors.

A multifactorial Web-based survey was conducted to gather data about screen-related behaviors (such as screen time, internet addiction, and salience of different types of screens and related activities), and different sources of stress (emotional states, perceptual risks, health problems, and general life domain satisfaction). We performed group comparisons based on whether participants reported themselves as addicted to internet and games (A1) or not (A0), and whether they had experienced a major life stress (S1) or not (S0).

Complete responses were obtained in 459 out of 654 survey responders, with the majority in the S1A0 (44.6%, 205/459) group, followed by S0A0 (25.9%, 119/459), S1A1 (19.8%, 91/459), and S0A1 (9.5%, 44/459). The S1A1 group was significantly different from S0A0 in all types of stress, internet overuse, and screen time (P<.001). Groups did not differ in rating screens important for short message service (SMS) or mail, searching information, shopping, and following the news, but a greater majority of A1 depended on screens for entertainment (χ²₃=20.5; P<.001), gaming (χ²₃=35.6; P<.001), and social networking (χ²₃=26.5; P<.001). Those who depended on screens for entertainment and social networking had up to 19% more emotional stress and up to 14% more perceptual stress. In contrast, those who relied on screens for work and professional networking had up to 10% higher levels of life satisfaction. Regression models including age, gender, and 4 stress types explained less than 30% of variation in internet use and less than 24% of the likelihood of being screen addicted.

We showed a robust but heterogeneous link between screen dependency and emotional and perceptual stressors that shift the pattern of screen usage toward entertainment and social networking. Our findings underline the potential of using ludic and interactive apps for intervention against stress.

A meta-analysis of psychological interventions for Internet/smartphone addiction among adolescents (2020)

J Behav Addict. 2019 Dec 1;8(4):613-624. doi: 10.1556/2006.8.2019.72.

Although the peculiarities of problematic Internet use and Internet addiction have been analyzed previously by researchers, there is still no general agreement in the literature as to the effectiveness of psychological interventions for Internet addiction deployed among adolescents. This study sought to investigate the effects of intervention programs for Internet/smartphone addiction among adolescents through a meta-analysis.

We searched MEDLINE (PubMed), EbscoHost Academic Search Complete, ProQuest, and PsycARTICLES using a combination of “Internet addiction or phone addiction” AND “intervention or treatment” OR “therapy” OR “program” AND “adolescents,” and a combination of the following search terms: “patholog_,” “problem_,” “addict_,” “compulsive,” “dependen_,” “video,” “computer,” “Internet,” “online,” “intervention,” “treat_,” and “therap_.” The studies identified during the search were reviewed according to the criteria and a meta-analysis was conducted on the six selected papers published from 2000 to 2019. Only studies with a control/comparison group that performed preintervention and postintervention assessments were included.

Included studies showed a trend toward a beneficial effect of intervention on the severity of Internet addictions. The meta-analysis suggested significant effects of all included randomized controlled trials (RCTs) and their educational programs.

Psychological interventions may help to reduce addiction severity, but further RCTs are needed to identify the effectiveness of cognitive behavioral therapy. This study provides a basis for developing future programs addressing addiction problems among adolescents.

The Role of Perceived Loneliness in Youth Addictive Behaviors: Cross-National Survey Study (2020)

JMIR Ment Health. 2020 Jan 2;7(1):e14035. doi: 10.2196/14035.

In the ever-growing and technologically advancing world, an increasing amount of social interaction takes place through the Web. With this change, loneliness is becoming an unprecedented societal issue, making youth more susceptible to various physical and mental health problems. This societal change also influences the dynamics of addiction.

Employing the cognitive discrepancy loneliness model, this study aimed to provide a social psychological perspective on youth addictions.

A comprehensive survey was used to collect data from American (N=1212; mean 20.05, SD 3.19; 608/1212, 50.17% women), South Korean (N=1192; mean 20.61, SD 3.24; 601/1192, 50.42% women), and Finnish (N=1200; mean 21.29, SD 2.85; 600/1200, 50.00% women) youths aged 15 to 25 years. Perceived loneliness was assessed with the 3-item Loneliness Scale. A total of 3 addictive behaviors were measured, including excessive alcohol use, compulsive internet use, and problem gambling. A total of 2 separate models using linear regression analyses were estimated for each country to examine the association between perceived loneliness and addiction.

Loneliness was significantly related to only compulsive internet use among the youth in all 3 countries (P<.001 in the United States, South Korea, and Finland). In the South Korean sample, the association remained significant with excessive alcohol use (P<.001) and problem gambling (P<.001), even after controlling for potentially confounding psychological variables.

The findings reveal existing differences between youths who spend excessive amounts of time online and those who engage in other types of addictive behaviors. Experiencing loneliness is consistently linked to compulsive internet use across countries, although different underlying factors may explain other forms of addiction. These findings provide a deeper understanding in the mechanisms of youth addiction and can help improve prevention and intervention work, especially in terms of compulsive internet use.

Prevalence and pattern of problematic internet use among engineering students from different colleges in India (2020)

Indian J Psychiatry. 2019 Nov-Dec;61(6):578-583. doi: 10.4103/psychiatry.IndianJPsychiatry_85_19.

The college students are prone to use internet in a manner that could negatively affect several aspects of their life. The present study is one of the largest studies to be undertaken in India, aimed at understanding the existing pattern of internet use and estimating the prevalence of problematic internet use (PIU) among college students.

The Generalized Problematic Internet Use Scale 2 (GPIUS-2) was used to assess the PIU. Multiple linear regression analysis was conducted to ascertain the relationship between GPIUS-2 total score and demographic and internet use-related variables.

Of 3973 respondents from 23 engineering colleges located in the different parts of the country, about one-fourth (25.4%) had GPIUS-2 scores suggestive of PIU. Among the variables studied, older age, greater time spent online per day, and use of internet mainly for social networking were associated with greater GPIUS-2 scores, indicating higher risk for PIU. Students who used internet mainly for academic activities and during evening hours of the day were less likely to have PIU.

A Scoping Review of Cognitive Bias in Internet Addiction and Internet Gaming Disorders (2020)

Int J Environ Res Public Health. 2020 Jan 6;17(1). pii: E373. doi: 10.3390/ijerph17010373.

Internet addiction and Internet gaming disorders are increasingly prevalent. Whilst there has been much focus on the use of conventional psychological approaches in the treatment of individuals with these addictive disorders, there has also been ongoing research exploring the potential of cognitive bias modification amongst individuals with Internet and gaming addiction. Some studies have documented the presence of cognitive biases and the effectiveness of bias modification for Internet addiction and gaming disorders. However, there have not been any reviews that have synthesized the findings related to cognitive biases for Internet addiction and Internet gaming disorders. It is important for us to undertake a scoping review as an attempt to map out the literature for cognitive biases in Internet addiction and gaming disorders. A scoping review was undertaken, and articles were identified using a search through the following databases: PubMed, MEDLINE, and PsycINFO. Six articles were identified. There were differences in the methods of ascertaining whether an individual has an underlying Internet or gaming addiction, as several different instruments have been used. With regards to the characteristics of the cognitive bias assessment task utilized, the most common task used was that of the Stroop task. Of the six identified studies, five have provided evidence documenting the presence of cognitive biases in these disorders. Only one study has examined cognitive bias modification and provided support for its effectiveness. Whilst several studies have provided preliminary findings documenting the presence of cognitive biases in these disorders, there remains a need for further research evaluating the effectiveness of bias modification, as well as the standardization of the diagnostic tools and the task paradigms used in the assessment.

Does Smartphone Addiction Fall on a Continuum of Addictive Behaviors? (2020)

Int J Environ Res Public Health. 2020 Jan 8;17(2). pii: E422. doi: 10.3390/ijerph17020422.

Due to the high accessibility and mobility of smartphones, widespread and pervasive smartphone use has become the social norm, exposing users to various health and other risk factors. There is, however, a debate on whether addiction to smartphone use is a valid behavioral addiction that is distinct from similar conditions, such as Internet and gaming addiction. The goal of this review is to gather and integrate up-to-date research on measures of smartphone addiction (SA) and problematic smartphone use (PSU) to better understand (a) if they are distinct from other addictions that merely use the smartphone as a medium, and (b) how the disorder(s) may fall on a continuum of addictive behaviors that at some point could be considered an addiction. A systematic literature search adapted from the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) method was conducted to find all relevant articles on SA and PSU published between 2017 and 2019. A total of 108 articles were included in the current review. Most studies neither distinguished SA from other technological addictions nor clarified whether SA was an addiction to the actual smartphone device or to the features that the device offers. Most studies also did not directly base their research on a theory to explain the etiologic origins or causal pathways of SA and its associations. Suggestions are made regarding how to address SA as an emerging behavioral addiction.

Predictors of Spontaneous Remission of Problematic Internet Use in Adolescence: A One-Year Follow-Up Study (2010)

Int J Environ Res Public Health. 2020 Jan 9;17(2). pii: E448. doi: 10.3390/ijerph17020448.

Problematic use of the Internet is becoming increasingly important and especially for adolescents, high prevalence rates are reported in many countries. Despite the growing international research activities and the reported prevalence estimates, comparatively very few studies have focused on spontaneous remission and its possible causes. In a risk population of 272 adolescents, we used standardized diagnostic instruments to investigate which socio-demographic and psychosocial characteristics at baseline (at t1) predicted spontaneous remission of problematic Internet use one year later (at t2). The predictors were determined by bivariate and multivariate logistic regression analyses. In the bivariate regressions, we found male gender, higher self-efficacy (t1), a lower level of maladaptive emotion regulation strategies (t1), lower depression (t1), lower performance and school anxiety (t1), lower social-interaction anxiety (t1), and lower procrastination (t1) to predict spontaneous remission of problematic Internet use at t2. In the multivariable analysis, a lower level of maladaptive emotion regulation strategies (t1) was the sole statistically significant predictor for the remission one year later (t2). For the first time, the high relevance of emotion regulation for spontaneous remission of adolescent problematic Internet use was observed. Based on these findings, emotion regulation could be specifically trained and promoted in future prevention measures.

Prevalence of internet addiction among medical students: a study from Southwestern Iran (2019)

Cent Eur J Public Health. 2019 Dec;27(4):326-329. doi: 10.21101/cejph.a5171.

In today’s world, despite the numerous benefits, increasing demand for computer technology and the influence of widespread internet technology, many people, especially students, have faced impaired mental health and social relationships resulting from internet addiction; therefore, with regard to the contradictory results of preceding studies in the field of internet addiction, this study was designed to determine the prevalence of internet addiction in students of Ahvaz Jundishapur University of Medical Sciences.

This descriptive study was conducted on all students of Ahvaz Jundishapur University of Medical Sciences. For data collection questionnaire and demographic profile of internet addiction test was used.

The results showed that internet addiction is common among university students (t = 23.286, p < 0.001). Internet addiction is significantly different between males and females and more prevalent in the male users (t = 4.351, p = 0.001). The prevalence of internet addiction in various categories was 1.6% normal, 47.4% mild, 38.1% moderate, and 12.9% severe. Our analysis also showed a significantly higher proportion of senior students with severe internet addiction (16.4%) compared to junior students (χ² = 30.964; p < 0.001).

Based on the findings of this study it can be concluded that there is a considerable internet addiction in medical students, and to prevent risks and complications, health considerations and proper treatments seem to be necessary.

Politically Motivated Internet Addiction: Relationships among Online Information Exposure, Internet Addiction, FOMO, Psychological Well-being, and Radicalism in Massive Political Turbulence (2020)

Int J Environ Res Public Health. 2020 Jan 18;17(2). pii: E633. doi: 10.3390/ijerph17020633.

This research examines the mediating role of the tendency for Internet addiction, fear of missing out (FOMO), and psychological well-being in the relationship between online exposure to movement-related information and support for radical actions. A questionnaire survey that targets tertiary students was conducted during the Anti-Extradition Law Amendment Bill (Anti-ELAB) Movement (N = 290). The findings reveal the mediating effect of Internet addiction and depression as the main relationship. These findings enrich the literature of political communication by addressing the political impact of Internet use beyond digital architecture. From the perspective of psychology, this research echoes the literature that concerns depression symptoms driven by a protest environment. Radical political attitudes driven by depression during protests should also be concerned based on the findings of this survey.

Psychopathological symptoms in individuals at risk of Internet addiction in the context of selected demographic factors (2019)

Ann Agric Environ Med. 2019 Mar 22;26(1):33-38. doi: 10.26444/aaem/81665.

Researchers who study the problems of Internet addiction point out that this dependence is often co-morbid with symptoms of a variety of pathological disorders, including anxiety, depressive, somatization, and obsessive-compulsive disorders. The goal of this study was to compare the severity of psychopathological symptoms in individuals at risk of Internet addiction (according to Young’s criteria) and those not at risk of developing this addiction with respect to gender and place of residence (urban vs. rural).

The study included a group of 692 respondents (485 females and 207 males). The average age of the participants was 20.8 years. 56.06% of them lived in urban areas and 43.94% in rural areas. The following instruments were used: a sociodemographic questionnaire designed by the authors, Young’s 20-item Internet Addiction Test (IAT, Polish translation by Majchrzak and Ogińska-Bulik), and the “O” Symptom Checklist (Kwestionariusz Objawowy “O”, in Polish) by Aleksandrowicz.

Individuals at risk of Internet addiction showed significantly more severe pathological symptoms than the individuals who were not at risk of this addiction. There were differences in the severity of psychopathological symptoms between people at risk of Internet dependence living in urban and rural areas.

Individuals at risk of Internet addiction were found to be characterized by a significantly higher severity of obsessive-compulsive, conversion, anxiety, and depressive symptoms. Persons at risk of Internet addiction who lived in rural areas had significantly more severe psychopathological symptoms, mainly obsessive-compulsive, hypochondriac and phobic, compared to their urban peers.

Internet addiction and daytime sleepiness among professionals in India: A web-based survey (2019)

Indian J Psychiatry. 2019 May-Jun;61(3):265-269. doi: 10.4103/psychiatry.IndianJPsychiatry_412_18.

The likelihood of the relation between Internet overuse and comorbid psychiatric conditions is on the rise. However, sleep disturbances are common psychiatric symptoms associated with internet overuse. Our objective was to examine the association of Internet overuse with excessive daytime sleepiness, sleep problems in professionals from India.

This was a web-based cross-sectional study through a predesigned questionnaire which included various professional groups. The information included in the questionnaire was sociodemographic details, Young’s internet addiction test (IAT) and Epworth sleepiness scale (ESS).

About 1.0% of total sample population had severe internet addiction whereas 13% were in the range of moderate internet addiction and the mean score on IAT was found to be 32 (standard deviation [SD] = 16.42). The mean duration of total night time sleep (5.61 ± 1.17) is significantly lower in participants with moderate and severe internet addiction (6.98 ± 1.12) compared to those with no and mild internet addiction. The mean scores of ESS were significantly higher in individuals with moderate and severe addiction (M = 10.64, SD = 4.79). We found that sleepiness while in 5 of the situations such as driving a car (χ² = 27.67; P < 0.001), sitting and reading (χ² = 13.6; P = 0.004), traveling in a car (χ² = 15.09; P = 0.002), afternoon rest time (χ² = 15.75; P = 0.001), and postlunch quiet time (χ² = 24.09; P < 0.001), predicted membership to moderate-to-severe internet addiction, even after controlling for the confounding effects of age and gender.

Internet Addiction, Smartphone Addiction, and Hikikomori Trait in Japanese Young Adult: Social Isolation and Social Network (2019)

Front Psychiatry. 2019 Jul 10;10:455. doi: 10.3389/fpsyt.2019.00455.

Background: As the number of internet users increases, problems related to internet overuse are becoming more and more serious. Adolescents and youth may be particularly attracted to and preoccupied with various online activities. In this study, we investigated the relationship of internet addiction, smartphone addiction, and the risk of hikikomori, severe social withdrawal, in Japanese young adult. Methods: The subjects were 478 college/university students in Japan. They were requested to complete the study questionnaire, which consisted of questions about demographics, internet use, the Internet Addiction Test (IAT), the Smartphone Addiction Scale (SAS)-Short Version (SV), the 25-item Hikikomori Questionnaire (HQ-25), etc. We investigated the difference and correlation of the results between two groups based on the purpose of internet use or the total score of each self-rating scale, such as screened positive or negative for the risk of internet addiction, smartphone addiction, or hikikomori. Results: There was a trend that males favored gaming in their internet use while females used the internet mainly for social networking via smartphone, and the mean SAS-SV score was higher in females. Two-group comparisons between gamers and social media users, according to the main purpose of internet use, showed that gamers used the internet longer and had significantly higher mean IAT and HQ-25 scores. Regarding hikikomori trait, the subjects at high risk for hikikomori on HQ-25 had longer internet usage time and higher scores on both IAT and SAS-SV. Correlation analyses revealed that HQ-25 and IAT scores had a relatively strong relationship, although HQ-25 and SAS-SV had a moderately weak one. Discussion: Internet technology has changed our daily lives dramatically and altered the way we communicate as well. As social media applications are becoming more popular, users are connected more tightly to the internet and their time spent with others in the real world continues to decrease. Males often isolate themselves from the social community in order to engage in online gaming while females use the internet as to not be excluded from their communications online. Mental health providers should be aware of the seriousness of internet addictions and hikikomori.

Prevalence of internet addiction, its association with psychological distress, coping strategies among undergraduate students (2019)

Nurse Educ Today. 2019 Jul 12;81:78-82. doi: 10.1016/j.nedt.2019.07.004.

This study aimed to describe the prevalence of Internet addiction (IA) among undergraduate students, and its impact on psychological distress and coping strategies.

Data were collected using a convenience sample of 163 student nurses.

The results showed that there was high prevalence rate of IA among students. In addition, the use of avoidance and problem-solving coping mechanism was statistically significant among the IA group compared with the non-IA group (p < 0.05). This was associated with a more negative impact on psychological distress and self-efficacy (p < 0.05).

IA is an increasing problem in the general population and among university students. It can affect many aspects of a student’s life and performance.

Problematic internet use in Bangladeshi students: The role of socio-demographic factors, depression, anxiety, and stress (2019)

Asian J Psychiatr. 2019 Jul 9;44:48-54. doi: 10.1016/j.ajp.2019.07.005.

Problematic Internet Use (PIU) has become a concern for public mental health across the globe. However, there are few studies assessing PIU in Bangladesh. The present cross-sectional study estimated the prevalence rate of PIU and its associated risk factors among 405 university students in Bangladesh between June and July 2018. The measures included sociodemographic questions, internet and health-related variables, the Internet Addiction Test (IAT) and the Depression, Anxiety and Stress Scale (DASS-21). The prevalence of PIU was 32.6% among the respondents (cut-off score of ≥50 on the IAT). The prevalence of PIU was higher in males in comparison to females, although the difference was not statistically significant. Internet-related variables and psychiatric comorbidities were positively associated with PIU. From the unadjusted model, more frequent use of the internet and more time spent on the internet were identified as strong predictors of PIU, whereas the adjusted model showed depressive symptoms and stress only as strong predictors of PIU.

Internet Addiction and its Relationships with Depression, Anxiety, and Stress in Urban Adolescents of Kamrup District, Assam (2019)

J Family Community Med. 2019 May-Aug;26(2):108-112. doi: 10.4103/jfcm.JFCM_93_18.

In these modern times of digitization, the use of Internet has become an integral part of everyday life, especially the lives of adolescents. At the same time, Internet addiction has emerged as a serious affliction. However, the impact of Internet addiction on these crucial years of life has not been well studied in India. The objective of this study was to determine the prevalence of Internet addiction in adolescents of the urban areas of Kamrup district and assess its association with depression, anxiety, and stress.

A cross-sectional study was conducted among students of higher secondary schools/colleges in the urban areas of Kamrup district in Assam. Out of 103 government and private higher secondary school/colleges of Kamrup district, Assam, 10 colleges were selected randomly, and a total of 440 students were enrolled in the study. A pretested, predesigned questionnaire, Young’s Internet Addiction Scale, and Depression Anxiety Stress Scales 21 (DASS21) were used in the study. Chi-square test and Fisher’s exact test were used to assess the association between Internet addiction and depression, stress, and anxiety.

Majority (73.1%) of the respondents were females, and mean age was 17.21 years. The prevalence of Internet addiction was 80.7%. The main purpose of using Internet was social networking (71.4%) followed by study (42.1%), and majority (42.1%) reported spending 3-6 hours a day on internet. There was a significant association between Internet addiction and stress (odds ratio=12), depression (odds ratio=14), and anxiety (odds ratio=3.3).

Influence of Family Processes on Internet Addiction Among Late Adolescents in Hong Kong (2019)

Front Psychiatry. 2019 Mar 12;10:113. doi: 10.3389/fpsyt.2019.00113.

The present study investigated how the quality of the parent-child subsystem (indexed by behavioral control, psychological control, and parent-child relationship) predicted Internet addiction (IA) levels and change rates among senior high school students. It also examined the concurrent and longitudinal influence of the father- and mother-related factors on adolescent IA. At the beginning of the 2009/2010 school year, we randomly selected 28 high schools in Hong Kong and invited Grade 7 students to complete a questionnaire annually across the high school years. The present study used data collected in the senior high school years (Wave 4-6), which included a matched sample of 3,074 students (aged 15.57 ± 0.74 years at Wave 4). Growth curve modeling analyses revealed a slight decreasing trend in adolescent IA in senior high school years. While higher paternal behavioral control predicted children’s lower initial level of and a slower drop in IA, maternal behavioral control was not a significant predictor of these measures. In contrast, higher maternal but not paternal psychological control showed a significant relationship with a higher initial level of and a faster drop in adolescent IA. Finally, better father-child and mother-child relationships predicted a lower initial level of IA among adolescents. However, while a poorer mother-child relationship predicted a faster decline in adolescent IA, father-child relationship quality did not. With the inclusion of all parent-child subsystem factors in the regression analyses, paternal behavioral control and maternal psychological control were identified as the two unique concurrent and longitudinal predictors of adolescent IA. The present findings delineate the essential role of parental control and the parent-child relationship in shaping children’s IA across senior high school years, which is inadequately covered in the scientific literature. The study also clarifies the relative contribution of different processes related to the father-child and mother-child subsystems. These findings highlight the need to differentiate the following: (a) levels of and

Internet Addiction, Cyberbullying, and Victimization Relationship in Adolescents: A Sample from Turkey (2019)

J Addict Nurs. 2019 Jul/Sep;30(3):201-210. doi: 10.1097/JAN.0000000000000296.

The study is a descriptive and relational study carried out with an aim to analyze the effects of Internet use and Internet addiction on cyber victimization and cyberbullying among adolescents.The universe of the study consists of the students (N = 3,978) studying at high schools in a city center located in the Black Sea Region. The students were determined by a stratified and simple random sampling method, whereas the sample of the study included 2,422 voluntary high school students. The data were collected through the Adolescent Information Form, Internet Addiction Scale, and Cyber Victim and Bullying Scale. In the analysis of the data, descriptive statistics such as number, percentage, average, and standard deviation were used, whereas independent samples t test, one-way analysis of variance, and correlation coefficients were used to compare the groups. The predictive effects of independent variables on cyber victimization and cyberbullying were investigated with multiple linear regression analysis. The average age of the adolescents participating in the study is 16.23 ± 1.11 years. The mean scores were calculated as 25.59 ± 15.88 for Internet addiction, 29.47 ± 12.65 for cyber victimization, and 28.58 ± 12.01 for cyberbullying. In our study, it was found that the Internet addiction, cyber victimization, and cyberbullying scores of the adolescents were low, but cyber victimization and cyberbullying were related to Internet usage characteristics and Internet addiction. Internet usage characteristics, cyber victimization, and bullying prevalence and relational studies should be done in adolescents. It is recommended to raise awareness of the harmful use of the Internet to families.

The Relationship Between Sleep Quality and Internet Addiction Among Female College Students (2019)

Front Neurosci. 2019 Jun 12;13:599. doi: 10.3389/fnins.2019.00599.

Over 40% of Taiwanese College students experience sleep problems that not only impair their quality of life but also contribute to psychosomatic disorders. Of all the factors affecting the sleep quality, internet surfing is among one of the most prevalent. Female college students are more vulnerable to internet-associated sleep disorders than their male counterparts. Therefore, this study aims to investigate (1) the relationship between internet addiction and sleep quality, and (2) whether significant variations in sleep quality exist among students with different degrees of internet use.

This structured questionnaire-based cross-sectional study enrolled students from a technical institute in southern Taiwan. The questionnaire collected information on the following three aspects: (1) demography, (2) sleep quality with Pittsburgh Sleep Quality Index (PSQI), and (3) severity of internet addiction using a 20-item Internet Addiction Test (IAT). Multiple regression analysis was performed to examine the correlation between PSQI and IAT scores among the participants. Logistic analysis was used to determine the significance of association between PSQI and IAT scores.

In total, 503 female students were recruited (mean age 17.05 ± 1.34). After controlling for age, body mass index, smoking and drinking habits, religion, and habitual use of smartphone before sleep, internet addiction was found to be significantly associated with subjective sleep quality, sleep latency, sleep duration, sleep disturbance, use of sleep medication, and daytime dysfunction. Worse quality of sleep as reflected by PSQI was noted in students with moderate and severe degrees of internet addiction compared to those with mild or no internet addiction. Logistic regression analysis of the association between scores on IAT and sleep quality, demonstrated significant correlations between quality of sleep and total IAT scores (odds ratio = 1.05:1.03 ∼ 1.06, p < 0.01).

The relationship between Internet addiction, psychological distress, and coping strategies in a sample of Saudi undergraduate students (2019)

Perspect Psychiatr Care. 2019 Sep 30. doi: 10.1111/ppc.12439.

This study aimed to investigate the relationship between Internet addiction (IA), psychological distress, and coping strategies.

Data were collected using a convenience sample of 163 student nurses.

The results showed that there was high prevalence rate of IA among students. In addition, the use of avoidance and problem-solving coping mechanism was statistically significant among the IA group compared with the non-IA group (P < .05). This was associated with a more negative impact on psychological distress and self-efficacy (P < .05).

IA is an increasing problem in the general population and among university students. It can affect many aspects of a student life.

Does cognitive-behavioral therapy reduce internet addiction? Protocol for a systematic review and meta-analysis (2019)

Medicine (Baltimore). 2019 Sep;98(38):e17283. doi: 10.1097/MD.0000000000017283.

Zhang J^1,2, Zhang Y¹, Xu F¹.

Abstract

BACKGROUND:

Cognitive-behavioral therapy has been considered as a means for internet addiction, but its long-term effect and the impact of internet addiction types and culture are still unclear.

OBJECTIVE:

This study aims to assess the efficacy of cognitive-behavior therapy for internet addiction symptoms and associated other psychopathological symptoms.

METHOD AND ANALYSIS:

We will search PubMed, Web of Knowledge, Ovid Medline, Chongqing Vip Database, Wanfang, and China National Knowledge Infrastructure database. Random-effects model in comprehensive meta-analysis software will be used to conduct main meta-analysis. Cochran Q and I are be used to assess heterogeneity while funnel plots and the Egger test are used to assess publication bias. Risk of bias for each study included is assessed by using the Cochrane risk of bias tool. The primary outcome is internet addiction symptom while secondary outcomes are psychopathological symptoms, time spent online, and dropout.

TRIALS REGISTRATION NUMBER: PROSPERO CRD42019125667.

PMID: 31568011

DOI:  10.1097/MD.0000000000017283

Correlates of Problematic Internet Use among college and university students in eight countries: An international cross-sectional study (2019)

Asian J Psychiatr. 2019 Sep 5;45:113-120. doi: 10.1016/j.ajp.2019.09.004.

Internet use has increased worldwide exponentially over the past two decades, with no up-to-date cross-country comparison of Problematic Internet Use (PIU) and its correlates available. The present study aimed to explore the pattern and correlates of PIU across different countries in the European and the Asian continent. Further, the stability of factors associated with PIU across different countries were assessed.

An international, cross-sectional study with a total of 2749 participants recruited from universities/colleges of eight countries: Bangladesh, Croatia, India, Nepal, Turkey, Serbia, Vietnam, and United Arab Emirates (UAE). Participants completed the Generalized Problematic Internet Use Scale -2 (GPIUS2) assessing PIU, and the Patient Health Questionnaire Anxiety-Depression Scale (PHQ-ADS) assessing the depressive and anxiety symptoms.

A total of 2643 participants (mean age 21.3 ± 2.6; 63% females) were included in the final analysis. The overall prevalence of PIU for the entire sample was 8.4% (range 1.6% to 12.6%). The mean GPIUS2 standardized scores were significantly higher among participants from the five Asian countries when compared to the three European countries. Depressive and anxiety symptoms were the most stable and strongest factors associated with PIU across different countries and cultures.

The PIU is an important emerging mental health condition among college/university going young adults, with psychological distress being the strongest and most stable correlate of PIU across different countries and cultures in this study. The present study highlighted the importance of screening university and college students for PIU.

Performance of the DSM-5-based criteria for Internet addiction: A factor analytical examination of three samples (2019)

J Behav Addict. 2019 May 23:1-7. doi: 10.1556/2006.8.2019.19

The diagnosis “Internet Gaming Disorder” (IGD) has been included in the fifth edition of Diagnostic and Statistical Manual of Mental Disorders. However, the nine criteria have not been sufficiently reviewed for their diagnostic value. This study focuses on a broader approach of Internet addiction (IA) including other Internet activities. It is not yet clear what the construct of IA is in terms of dimensionality and homogeneity and how the individual criteria contribute to explained variance.

Three separate exploratory factor analyses and multinomial logistic regression analyses were carried out based on information collected from a general population-based sample (n = 196), a sample of people recruited at job centers (n = 138), and a student sample (n = 188).

Both of the adult samples show a distinct single-factor solution. The analysis of the student sample suggests a two-factor solution. Only one item (criterion 8: escape from a negative mood) can be assigned to the second factor. Altogether, high endorsement rates of the eighth criterion in all three samples indicate low discriminatory power.

Overall, the analysis shows that the construct of IA is represented one dimensionally by the diagnostic criteria of the IGD. However, the student sample indicates evidence of age-specific performance of the criteria. The criterion “Escape from a negative mood” might be insufficient in discriminating between problematic and non-problematic Internet use. The findings deserve further examination, in particular with respect to the performance of the criteria in different age groups as well as in non-preselected samples.

Adolescent Internet Addiction in Hong Kong: Prevalence, Psychosocial Correlates, and Prevention (2019)

J Adolesc Health. 2019 Jun;64(6S):S34-S43. doi: 10.1016/j.jadohealth.2018.12.016.

The prevalence of Internet addiction (IA) and its correlates among Hong Kong adolescents and local prevention programs for adolescents’ IA were reviewed and analyzed, with a view to identifying service gaps and making suggestions on ways forward. From 8 papers identified from ProQuest and EBSCOhost, published from 2009 to 2018, the local prevalence rates of IA in adolescents were noted to range from 3.0% to 26.8%, which was higher than that in other regions of the world. The more recent the studies, the higher the prevalence rate. Seven papers provided the correlates of IA. Risk factors for IA included being male, higher school grade, poor academic performance, with depression, suicidal ideation, from disorganized family, with family members having IA, parents with lower education level, and using restrictive parenting style. Teens with self-confidence, higher school performance, having positive youth development qualities, with well-educated parents, were found to be protective against IA. IA adversely affects adolescents’ growth and physical, mental, and psychosocial development. Ten prevention programs were identified from these search engines as well as government departments and agencies’ Web sites. They all focused on education, skills training, behavior modification, and raising public awareness. Unlike tobacco and alcohol, the Internet is a tool, and media literacy has become an essential skill. Based on current evidence, modifiable protective factors should be strengthened to curb the problem.

Social media addiction and sexual dysfunction among Iranian women: The mediating role of intimacy and social support (2019)

J Behav Addict. 2019 May 23:1-8. doi: 10.1556/2006.8.2019.24.

Social media use has become increasingly popular among Internet users. Given the widespread use of social media on smartphones, there is an increasing need for research examining the impact of the use of such technologies on sexual relationships and their constructs such as intimacy, satisfaction, and sexual function. However, little is known about the underlying mechanism why social media addiction impacts on sexual distress. This study investigated whether two constructs (intimacy and perceived social support) were mediators in the association of social media addiction and sexual distress among married women.

A prospective study was conducted where all participants (N = 938; mean age = 36.5 years) completed the Bergen Social Media Addiction Scale to assess social media addiction, the Female Sexual Distress Scale – Revised to assess sexual distress, the Unidimensional Relationship Closeness Scale to assess intimacy, and the Multidimensional Scale of Perceived Social Support to assess perceived social support.

The results showed that social media addiction had direct and indirect (via intimacy and perceived social support) effects on sexual function and sexual distress.

A Healthy Mind for Problematic Internet Use (2018)

This article designed and tested a cognitive behavioral-based preventive intervention program for youths with problematic Internet use (PIU) behavior. The program is the Psychological Intervention Program-Internet Use for Youth (PIP-IU-Y). A cognitive-based therapy approach was adopted. A total of 45 secondary students from four schools completed the intervention program that was conducted in a group format by registered school counselors.

Three sets of self-reported data on Problematic Internet Use Questionnaire (PIUQ), Social Interaction Anxiety Scale (SIAS), and Depression Anxiety Stress Scale (DASS) were collected at three time points: 1 week before the intervention, immediately after the last intervention session, and 1 month after the intervention. Paired t-test results showed that the program was effective in preventing negative progression into more serious Internet addiction stages, and reducing anxiety and stress and interaction phobia of the participants. The effect was evident immediately at the end of the intervention session and was maintained 1 month after the intervention.

This study is among the first to develop and test a preventive intervention program for youths with PIU. The effectiveness of our program in preventing negative progression of PIU and its symptoms in problematic users has led us to postulate that the program will also prevent normal users from developing serious symptoms.

The internet and children’s psychological wellbeing (2020)

J Health Econ. 2019 Dec 13;69:102274. doi: 10.1016/j.jhealeco.2019.102274.

Late childhood and adolescence is a critical time for social and emotional development. Over the past two decades, this life stage has been hugely affected by the almost universal adoption of the internet as a source of information, communication, and entertainment. We use a large representative sample of over 6300 children in England over the period 2012-2017, to estimate the effect of neighbourhood broadband speed, as a proxy for internet use, on a number of wellbeing outcomes, which reflect how these children feel about different aspects of their life. We find that internet use is negatively associated with wellbeing across a number of domains. The strongest effect is for how children feel about their appearance, and the effects are worse for girls than boys. We test a number of potential causal mechanisms, and find support both for the ‘crowding out’ hypothesis, whereby internet use reduces the time spent on other beneficial activities, and for the adverse effect of social media use. Our evidence adds weight to the already strident calls for interventions that can reduce the adverse effects of internet use on children’s emotional health.

Correlations of Internet Addiction Severity With Reinforcement Sensitivity and Frustration Intolerance in Adolescents With Attention-Deficit/Hyperactivity Disorder: The Moderating Effect of Medications (2019)

Front Psychiatry. 2019; 10: 268.

Deviations in reinforcement sensitivity and frustration-related reactions have been proposed as components of the biopsychosocial mechanisms, which explained the high vulnerability to internet addiction (IA) among individuals with attention-deficit/hyperactivity disorder (ADHD). There is currently limited knowledge on the relationship of IA symptoms with reinforcement sensitivity and frustration intolerance, as well as factors moderating those correlations in this population.

The aims of this study were (1) to examine the associations of IA symptoms severity with reinforcement sensitivity and frustration intolerance and (2) identify the moderators of these associations among adolescents diagnosed with ADHD in Taiwan.

A total of 300 adolescents aged between 11 and 18 years who had been diagnosed with ADHD participated in this study. Their levels of IA severity, reinforcement sensitivity, and frustration intolerance were assessed using the Chen Internet Addiction Scale, behavioral inhibition system (BIS) and behavioral approach system (BAS), and Frustration Discomfort Scale, respectively. The associations of IA severity with reinforcement sensitivity and frustration intolerance were examined using multiple regression analysis. Possible moderators, including medications for ADHD, were tested using the standard criteria.

Higher fun seeking on the BAS (p = .003) and higher frustration intolerance (p = .003) were associated with more severe IA symptoms. Receiving medication for treating ADHD moderated the association between fun seeking on the BAS and severity of IA symptoms.

An exploration of the associations among positivity, general distress and internet addiction: The mediating effect of general distress (2018)

Psychiatry Res. 2018 Dec 29;272:628-637. doi: 10.1016/j.psychres.2018.12.147.

The aim of the present study was to examine the relationships between positivity and general distress (including depression, anxiety, stress) and internet addiction and the mediating effects of general distress. The theoretical model was examined with 392 volunteers who were university students. Participants filled out the Positivity Scale (POS), Depression, Anxiety, Stress Scale (DASS) and Short Form of Young’s Internet Addiction Test (YIAT-SF). The results revealed that there were significant associations among positivity, general distress and internet addiction. According to the results of mediation analysis using structural equation modelling and bootstrapping, depression fully mediated the positivity-internet addiction relationship, whilst anxiety and stress partially mediated it. Bootstrap analysis indicated that positivity exerted a significant indirect effect on internet addiction through depression. Overall, the results implied the potential therapeutic effect of positivity which leads to a direct decrease in general distress and an indirect decrease in internet addiction through general distress. In addition, internet addiction may be considered as a secondary problem rather than a primary disorder.

At-risk Internet addiction and related factors among junior high school teachers-based on a nationwide cross-sectional study in Japan (2019)

Environ Health Prev Med. 2019 Jan 5;24(1):3. doi: 10.1186/s12199-018-0759-3.

School teachers have a possibility toward at-risk Internet addiction (IA) due to increased opportunities to use the Internet, along with the spread of the Internet in recent years. Burnout syndrome (BOS) is found to be one of the symptoms related to unhealthy mental health, especially among teachers. This study aims to research the relationship between at-risk IA and the Internet usage or BOS by conducting a nationwide cross-sectional survey and examining the factors associated with IA.

This study was a cross-sectional survey by anonymous questionnaire. This survey was a random sampling survey of junior high schools across Japan in 2016. The participants were 1696 teachers at 73 schools (response rate in teachers 51.0%). We asked participants for details of their backgrounds, Internet usage, the Internet Addiction Test (IAT) by Young, and the Japanese Burnout Scale (JBS). We divided the participants into either the at-risk IA group (IAT score ≧ 40, n = 96) or the non-IA group (IAT score < 40, n = 1600). To compare the difference between at-risk IA and non-IA, we used nonparametric tests and t test according to variables. To analyze the relationship between the IAT score and the scores of three factors of the JBS (emotional exhaustion, depersonalization, and personal accomplishment), we used both ANOVA and ANCOVA, adjusted by relevant confounding factors. To clarify the contribution of each independent variable to IAT scores, we used multiple logistic regression analysis.

In our study, at-risk IA was associated with using the internet many hours privately, being on the Internet both on weekdays and weekends, playing games, and surfing the Internet. In the relationship between IAT score and BOS factor score, a higher score for “depersonalization” had a positive relationship with at-risk IA, and the highest quartile for “decline of personal accomplishment” had a lower odds ratio with at-risk IA by multiple logistic regression analysis.

We clarified there is a significant relationship between at-risk IA and BOS among junior high school teachers in a nationwide survey. Our results suggest that finding depersonalization at the early stage may lead to the prevention of at-risk IA among teachers.

Christian Spirituality and Smartphone Addiction in Adolescents: A Comparison of High-Risk, Potential-Risk, and Normal Control Groups (2019)

J Relig Health. 2019 Jan 4. doi: 10.1007/s10943-018-00751-0.

The goal of this study was to compare aspects of Christian spirituality such as God’s image and sense of spiritual well-being among three groups: the high-risk, potential-risk and normal control groups for smartphone addiction. Participants were: 11 adolescents in the high-risk group for smartphone addiction; 20 adolescents who were potentially at risk of smartphone addiction, and 254 adolescents who were in the normal control group. The results showed that the high-risk group for smartphone addiction adolescent group showed low levels of spiritual well-being and positive image of God comparing to those in the potential-risk and control groups. Each group had specific and distinctive features.

Smartphone addiction may be associated with adolescent hypertension: a cross-sectional study among junior school students in China (2019)

BMC Pediatr. 2019 Sep 4;19(1):310. doi: 10.1186/s12887-019-1699-9.

Hypertension in children and adolescents is on the rise worldwide, especially in China. The prevalence of hypertension is related to many factors, such as obesity. In the era of smart phones, it is important to study the negative health effects of mobile phones on blood pressure. The purpose of this study was to investigate the prevalence of hypertension and its association with smartphone addiction among junior school students in China.

A school-based cross-sectional study was conducted, including total 2639 junior school students (1218 boys and 1421 girls), aged 12-15 years old (13.18 ± 0.93 years), enrolled in the study by random cluster sampling. Height, weight, systolic blood pressure (SBP) and diastolic blood pressure (DBP) were measured following standard protocols, and the body mass index (BMI) was calculated. Overweight/obesity and hypertension were defined according to sex- and age-specific Chinese children reference data. The Smartphone Addiction Scale short version (SAS-SV) and the Pittsburgh Sleep Quality Index (PSQI) were used to assess smartphone addiction and sleep quality among the students, respectively. Multivariate logistic regression models were used to seek associations between smartphone addiction and hypertension.

The prevalence of hypertension and smartphone addiction among participants were 16.2% (13.1% for females and 18.9% for males) and 22.8% (22.3% for females and 23.2% for males), respectively. Obesity (OR = 4.028, 95% CI: 2.829-5.735), poor sleep quality (OR = 4.243, 95% CI: 2.429-7.411), smartphone addiction (OR = 2.205, 95% CI: 1.273-3.820) were significantly and independently associated with hypertension.

Among the junior school students surveyed in China, the prevalence of hypertension was high, which was related to obesity, poor sleep quality and smartphone addiction. These results suggested that smartphone addiction may be a new risk factor for high blood pressure in adolescents.

Prolonged Bedtime Smartphone Use is Associated With Altered Resting-State Functional Connectivity of the Insula in Adult Smartphone Users (2019)

Front Psychiatry. 2019 Jul 23;10:516. doi: 10.3389/fpsyt.2019.00516.

Prolonged bedtime smartphone use is often associated with poor sleep quality and daytime dysfunction. In addition, the unstructured nature of smartphones may lead to excessive and uncontrolled use, which can be a cardinal feature of problematic smartphone use. This study was designed to investigate functional connectivity of insula, which is implicated in salience processing, interoceptive processing, and cognitive control, in association with prolonged bedtime smartphone use. We examined resting-state functional connectivity (rsFC) of insula in 90 adults who used smartphones by functional magnetic resonance imaging (fMRI). Smartphone time in bed was measured by self-report. Prolonged bedtime smartphone use was associated with higher smartphone addiction proneness scale (SAPS) scores, but not with sleep quality. The strength of the rsFC between the left insula and right putamen, and between the right insula and left superior frontal, middle temporal, fusiform, inferior orbitofrontal gyrus and right superior temporal gyrus was positively correlated with smartphone time in bed. The findings imply that prolonged bedtime smartphone use can be an important behavioral measure of problematic smartphone use and altered insula-centered functional connectivity may be associated with it.

The Role of Cognitive Emotion Regulation Strategies on Problematic Smartphone Use: Comparison between Problematic and Non-Problematic Adolescent Users (2019)

Int J Environ Res Public Health. 2019 Aug 28;16(17). pii: E3142. doi: 10.3390/ijerph16173142.

Prior work has suggested that individuals with deficits in emotion regulation skills are prone to compulsive behaviour and to following maladaptive coping strategies, such as smartphone overuse, to manage negative moods. Adolescence is a vulnerable developmental stage for deficits in emotion regulation, and these are linked to excessive smartphone use. The present study is the first to examine the links between the use of specific cognitive emotion regulation (CER) strategies and problematic smartphone use in a sample of adolescents. A total of 845 Spanish adolescents (455 females) completed the Spanish versions of the Cognitive Emotion Regulation Questionnaire and the Smartphone Addiction Scale, along with a socio-demographic survey. The adolescents were divided into two groups: Non-problematic smartphone users (n = 491, 58.1%) and problematic smartphone users (n = 354, 41.9%). Significant group differences were found, with the problematic users reporting significantly higher scores for all maladaptive CER strategies, including higher self-blame, rumination, blaming of others and catastrophising. The results from logistic regression analyses show that rumination, catastrophising and blaming of others were the most important variables for distinguishing between the two groups, along with gender and parental control outside the home. In summary, these findings suggest the importance of specific maladaptive CER strategies in problematic smartphone use and provide insight for relevant targets for intervention designs.

Smartphone Nonusers: Associated Sociodemographic and Health Variables (2019)

Cyberpsychol Behav Soc Netw. 2019 Aug 29. doi: 10.1089/cyber.2019.0130.

Smartphone abuse and the associated consequences have been intensely studied. However, little attention has been given to the group of people who have a smartphone and yet barely use it. One might think that they are at the opposite end of abuse, both behaviorally and in relation to the consequences. This study aims to establish sociodemographic variables and health indicators for smartphone nonusers. A population survey through random stratified sampling in a large city (Madrid, Spain) obtained 6,820 people between 15 and 65 years who own a smartphone. About 7.5 percent (n = 511) stated they do not use their smartphone regularly. This group comprised more of men than of women with a higher mean age, underprivileged social class, residence in less-developed districts, and a lower education level. They showed worse mental health indicators, lower perceived quality of life relating to their health, more sedentarism, and greater tendency toward being overweight/obese and a higher feeling of loneliness. When looking at all these variables together, the regression model showed that in addition to sex, age, social class, and education level, the only significantly associated health indicator was a feeling of loneliness. Mobile phone abuse is associated with health problems, but nonregular use does not reflect the opposite. It is important to study the group of nonusers and explore the reasons and related consequences, particularly the role of perceived loneliness, which is paradoxical as a smartphone is a tool that can foster interpersonal contact.

Correlation among smartphone addiction, craniovertebral angle, scapular dyskinesis, and selected anthropometric variables in physiotherapy undergraduates (2019)

J Taibah Univ Med Sci. 2018 Oct 5;13(6):528-534. doi: 10.1016/j.jtumed.2018.09.001.

Smartphone addiction has been indicated to reduce the craniovertebral angle, thereby causing a forward head posture and increasing scapular dyskinesis. This study determined the correlation among smartphone addiction level, craniovertebral angle, scapular dyskinesis, and selected anthropometric variables in physiotherapy undergraduates.

Seventy-seven participants were recruited from the Department of Physiotherapy, College of Medicine, University of Lagos, through a purposive sampling technique. The smartphone addiction level was assessed with the short version Smartphone Addiction Scale (English version). Craniovertebral and scapular dyskinesis were assessed using the photographic method. Descriptive and inferential statistics were used to analyse the data at an alpha level of 0.05.

The analysis in this study revealed that many undergraduates are addicted to using smartphones. There was no significant difference in the addiction level (p = 0.367) and in scapular dyskinesis (p = 0.129) between male and female participants. However, there was a significant difference in craniovertebral angle (p = 0.032) between male and female participants. There was a significant relationship among smartphone addiction, craniovertebral angle (r = 0.306, p = 0.007), and scapular dyskinesis (r = 0.363, p = 0.007) in male and female participants.

A high level of smartphone addiction reduces the craniovertebral angle and increases scapular dyskinesis. Therefore, the smartphone addiction level should be assessed in all patients with neck and shoulder pain to plan appropriate management.

Factors Affecting User Acceptance in Overuse of Smartphones in Mobile Health Services: An Empirical Study Testing a Modified Integrated Model in South Korea (2018)

Front Psychiatry. 2018 Dec 12;9:658. doi: 10.3389/fpsyt.2018.00658.

Smartphones have become crucial in people’s everyday lives, including in the medical field. However, as people become close to their smartphones, this leads easily to overuse. Overuse leads to fatigue due to lack of sleep, depressive symptoms, and social relationship failure, and in the case of adolescents, it hinders academic achievement. Self-control solutions are needed, and effective tools can be developed through behavioral analysis. Therefore, the aim of this study was to investigate the determinants of users’ intentions to use m-Health for smartphone overuse interventions. A research model was based on TAM and UTAUT, which were modified to be applied to the case of smartphone overuse. The studied population consisted of 400 randomly selected smartphone users aged from 19 to 60 years in South Korea. Structural equation modeling was conducted between variables to test the hypotheses using a 95% confidence interval. Perceived ease of use had a very strong direct positive association with perceived usefulness, and perceived usefulness had a very strong direct positive association with behavioral intention to use. Resistance to change had a direct positive association with behavioral intention to use and, lastly, social norm had a very strong direct positive association with behavioral intention to use. The findings that perceived ease of use influenced perceived usefulness, that perceived usefulness influenced behavioral intention to use, and social norm influenced behavioral intention to use were in accordance with prior related research. Other results that were not consistent with previous research imply that these are unique behavioral findings regarding smartphone overuse.

Experiential avoidance and excessive smartphone use: a Bayesian approach (2018)

Adicciones. 2018 Dec 20;0(0):1151. doi: 10.20882/adicciones.1151.

[Article in English, Spanish; Abstract available in Spanish from the publisher]

The smartphone is a common tool in our everyday lives. However, recent research suggests that using the smartphone has both positive and negative consequences. Although there is no agreement on the concept or the term to label it, researchers and clinical practitioners are worried about the negative consequences derived from excessive smartphone usage. This study aims to analyse the relationship between smartphone addiction and experiential avoidance. A sample of 1176 participants (828 women) with ages ranging from 16 to 82 (M = 30.97; SD = 12.05) was used. The SAS-SV scale was used to measure smartphone addiction and the AAQ-II to assess experiential avoidance. To model the relationship between variables, Bayesian inference and Bayesian networks were used. The results show that experiential avoidance and social networks usage are directly related to smartphone addiction. Additionally, the data suggests that sex is playing a mediating role in the observed relationship between these variables. These results are useful for understanding healthy and pathological interaction with smartphones and could be helpful in orienting or planning future psychological interventions to treat smartphone addiction.

Association of excessive smartphone use with psychological well-being among university students in Chiang Mai, Thailand (2019)

PLoS One. 2019 Jan 7;14(1):e0210294. doi: 10.1371/journal.pone.0210294

The current study addresses this research gap by investigating the relationship between smartphone use and psychological well-being among university students in Thailand. This cross-sectional study was conducted from January to March 2018 among university students aged 18-24 years from the largest university in Chiang Mai, Thailand. The primary outcome was psychological well-being, and was assessed using the Flourishing Scale. Smartphone use, the primary independent variable, was measured by five items which had been adapted from the eight-item Young Diagnostic Questionnaire for Internet Addiction. All scores above the median value were defined as being indicative of excessive smartphone use.

Out of the 800 respondents, 405 (50.6%) were women. In all, 366 (45.8%) students were categorized as being excessive users of smartphones. Students with excessive use of smartphones had lower scores the psychological well-being than those who did not use smartphone excessively (B = -1.60; P < 0.001). Female students had scores for psychological well-being that were, on average, 1.24 points higher than the scores of male students (P < 0.001).

Factors associated with Internet addiction among Tunisian adolescents (2019)

Encephale. 2019 Aug 14. pii: S0013-7006(19)30208-8. doi: 10.1016/j.encep.2019.05.006.

Internet addiction, a relatively new phenomenon, is a field of recent research in mental health, particularly within young populations. It seems to interact with several individual and environmental factors.

We aim to spot internet addiction in a Tunisian adolescent population, and to study its relationship with personal and family factors, as well as with anxious and depressive comorbidities.

We conducted a cross-sectional study of 253 adolescents recruited in public places in the city of Sfax in the south of Tunisia. We collected biographical and personal data as well as data describing family dynamics. The internet addiction was assessed by Young’s questionnaire. Depressive and anxious co-morbidities were assessed using the HADS scale. The comparative study was based on the chi-square test and the Student’s test, with a significance level of 5 %.

The prevalence of internet addiction was 43.9 %. The average age of internet-addicts was 16.34 years, the male sex was the most represented (54.1 %) and increased the risk of internet addiction (OR a=2.805). The average duration of connection among Internet addicts was 4.6hours per day and was significantly related to internet addiction; P<0.001). Socializing activities were found in the majority of the internet-addicted adolescents (86.5 %). The type of online activity was significantly associated with internet addiction (P=0.03 and OR a=3.256). Other behavioral addictions were frequently reported: 35.13% for excessive use of video games and 43.25 % for pathological purchases. These two behaviors were significantly associated with internet addiction (with respectively P=0.001 and P=0.002 with OR=3.283). The internet-addicted adolescents lived with both parents in 91.9 % of cases. The mother’s regular professional activity was significantly associated with internet addiction risk (P=0.04) as was the use of the Internet by parents and siblings (with respectively P=0.002 and P<0.001 with OR=3.256). The restrictive attitude of the parents was significantly associated with internet addiction risk (P<0.001 OR=2.57). Family dynamics, particularly at the level of adolescent-parent interactions, were a determining factor in internet addiction. Anxiety was more frequently found than depression among our cyber-dependent adolescents with frequencies of 65.8 % and 18.9 %, respectively. Anxiety was significantly correlated with the risk of internet addiction (P=0.003, OR a=2.15). There was no significant correlation between depression and the risk of internet addiction.

The Tunisian adolescent seems at great risk of internet addiction. Targeted action on modifiable factors, especially those affecting family interactions, would be very useful in prevention.

Prevalence of pathological and maladaptive Internet use and the association with depression and health-related quality of life in Japanese elementary and junior high school-aged children (2018)

Soc Psychiatry Psychiatr Epidemiol. 2018 Sep 25. doi: 10.1007/s00127-018-1605-z.

The survey was conducted among children who attend national and public elementary and junior high schools in a medium-sized city in Japan; data were received from 3845 elementary school-aged and 4364 junior high school-aged children.

Based on the Young’s Diagnostic Questionnaire score, the prevalence of pathological and maladaptive Internet use was 3.6% and 9.4% and 7.1% and 15.8% in elementary and junior high school-aged children, respectively. The prevalence of problematic Internet use, including pathological and maladaptive Internet use, consistently increased from the 4th grade to the 8th grade. In addition, the prevalence sharply increased between the 7th grade and the 8th grade. Our study revealed that children with pathological and maladaptive Internet use exhibited more severe depression and decreased health-related quality of life than those with adaptive Internet use.

Our results demonstrated that pathological Internet use is not uncommon even in elementary school-aged children and that those with pathological and maladaptive Internet use have severe mental health problems and decreased health-related quality of life, supporting the importance of providing these children with educational and preventive interventions against problematic Internet use and associated risk factors.

Generalised Versus Specific Internet Use-Related Addiction Problems: A Mixed Methods Study on Internet, Gaming, and Social Networking Behaviours (2018)

Int J Environ Res Public Health. 2018 Dec 19;15(12). pii: E2913. doi: 10.3390/ijerph15122913.

The field of technological behavioural addictions is moving towards specific problems (i.e., gaming disorder). However, more evidence of generalised versus specific Internet use-related addiction problems (generalised pathological Internet use (GPIU) vs. specific pathological Internet use (SPIU)) is still needed. This mixed methods study aimed to disentangle GPIU from SPIU. A partially mixed sequential equal status study design (QUAN→QUAL) was undertaken. First, through an online survey, which adapted the compulsive Internet use scale (CIUS) for three types of problems (i.e., generalised Internet use, and specific online gaming and social networking). Second, potential problem users’ perceptions of the evolution of these problems (aetiology, development, consequences, and factors) were ascertained, through semi-structured interviews, together with their opinion on present Internet gaming disorder (IGD) criteria adapted to each problem studied. Findings showed the CIUS remains valid and reliable for GPIU and SPIUs examined; a prevalence between 10.8% and 37.4% was estimated for potential at-risk problem gamers and Internet users, respectively, who reported their preference for maintaining their virtual lives. Half of the sample had a risk of a unique or mixed profile of these problems. Moreover, device patterns, gender, and age issues emerged, such as problem gamers being proportionally equal male and female young or middle-aged adults. GPIU was highly associated with problem social networking use, and weakly with problematic gaming, but both SPIUs were independent. Concerning addictive symptoms, salience, deception, and tolerance required redefinition, especially for SPIUs, while better-valued IGD criteria applied to GPIU and SPIUs were: Risk relationships or opportunities, give up other activities, withdrawal, and continue despite problems. Thus, although problems studied are present as risk behaviours, SPIUs seem to cover the addictive symptomatology in those categorised as potential problem users, online gaming being the most severe behavioural addiction problem.

Associations of personality traits with internet addiction in Chinese medical students: the mediating role of attention-deficit/hyperactivity disorder symptoms (2019)

BMC Psychiatry. 2019 Jun 17;19(1):183. doi: 10.1186/s12888-019-2173-9.

Internet addiction (IA) has emerged as a public health concern, particularly among adolescents and young adults. However, few studies have been conducted in medical students. This multi-center study aimed to investigate the prevalence of IA in Chinese medical students, to examine the associations of big five personality traits with IA in the population, and to explore the possible mediating role of attention-deficit/hyperactivity disorder (ADHD) symptoms in the relationship.

Self-reported questionnaires, including Internet Addiction Test (IAT), Big Five Inventory (BFI), Adult ADHD Self-Report Scale-V1.1 (ASRS-V1.1) Screener, and socio-demographic section were distributed to clinical students at 3 medical schools in China. A total of 1264 students became the final subjects.

The overall prevalence of IA among Chinese medical students was 44.7% (IAT > 30), and 9.2% of the students demonstrated moderate or severe IA (IAT ≥ 50). After adjustment for covariates, while conscientiousness and agreeableness were negatively associated with IA, neuroticism was positively associated with it. ADHD symptoms mediated the associations of conscientiousness, agreeableness and neuroticism with IA. The prevalence of IA among Chinese medical students is high. Both personality traits and ADHD symptoms should be considered when tailored intervention strategies are designed to prevent and reduce IA in medical students.

Negative Life Events and Problematic Internet Use as Factors Associated With Psychotic-Like Experiences in Adolescents (2019)

Front Psychiatry. 2019 May 29;10:369. doi: 10.3389/fpsyt.2019.00369.

In total, 1,678 adolescents attending high school were recruited for a cross-sectional survey. They completed self-reported assessments of PLEs using the Prodromal Questionnaire-16 (PQ-16) and measures of depression, anxiety, self-esteem, internet use, and negative life events using the Center for Epidemiological Studies Depression Scale (CES-D), the State-Trait Anxiety Inventory (STAI), the Rosenberg Self-Esteem Scale (RSES), the Korean Scale for Internet Addiction (K-scale), and the Lifetime Incidence of Traumatic Events for Children (LITE-C), including cybersexual harassment and school violence.

A total of 1,239 subjects (73.8%) scored at least 1 on the PQ-16. The mean total and distress PQ-16 scores were significantly higher in students who used mental health services. The total and distress prodromal questionnaire-16 (PQ-16) scores were positively correlated with the CES-D, STAI-S, STAI-T, LITE-C, and K-scale scores but negatively correlated with the RSES score. Hierarchical linear regression analysis revealed that PLEs were significantly associated with a high K-scale score and the incidence of negative life events, such as LITE-C, cybersexual harassment, and bully-victims.

Our results demonstrate that PIU and negative life experiences were significantly associated with PLEs in adolescents. Assessment and therapeutic intervention with regard to internet use as a coping strategy for stress are needed to prevent the development of clinical psychotic symptoms.

Parenting styles, perceived social support and emotion regulation in adolescents with internet addiction (2019)

Compr Psychiatry. 2019 Apr 3. pii: S0010-440X(19)30019-7. doi: 10.1016/j.comppsych.2019.03.003.

The aim of this study is to investigate parental attitudes, perceived social support, emotion regulation and the accompanying psychiatric disorders seen in adolescents who, having been diagnosed with Internet Addiction (IA), were referred to an outpatient child and adolescent psychiatric clinic.

Of 176 adolescents aged 12-17, 40 were included in the study group. These scored 80 or higher on Young’s Internet Addiction Test (IAT) and met Young’s diagnostic criteria for IA based on psychiatric interviews. Forty adolescents who matched them in terms of age, gender and socio-economic level were included in the control group. The Schedule for Affective Disorders and Schizophrenia for School-Age Children (K-SADS-PL), the Parenting Style Scale (PSS), the Lum Emotional Availabilty of Parents (LEAP), the Social Support Appraisals Scale for Children (SSAS-C), the Difficulties in Emotion Regulation Scale (DERS) and the Toronto Alexithymia Scale-20 (TAS-20) were applied.

The results showed that the parents of adolescents with IA were more frequently inadequate in acceptance/involvement, supervision/monitoring and they had less emotional availability. The adolescents with IA had less perceived social support, greater difficulty in the identification and verbal expression of their feelings and emotion regulation. Lower parental strictness/supervision, higher alexithymia and the existence of an anxiety disorder were found to be significant predictors of IA. Internet addicted adolescents with comorbid major depressive disorder had higher levels of alexithymia and lower levels of emotional availability in their parents.

Transitions in smartphone addiction proneness among children: The effect of gender and use patterns (2019)

PLoS One. 2019 May 30;14(5):e0217235. doi: 10.1371/journal.pone.0217235.

This study assessed the incidence of transitions in smartphone addiction proneness (SAP) among children and examined the effects of gender, use patterns (social networking sites (SNSs) use and smartphone gaming) and depression on smartphone addiction transitions.

A representative sample of 2,155 children from Taipei completed longitudinal surveys in both 2015 (5th grade) and 2016 (6th grade). Latent transition analysis (LTA) was used to characterize transitions in SAP and to examine the effects of gender, use patterns and depression on SAP transitions.

LTA identified four latent statuses of SAP: about half of the children were in non-SAP status, one-fifth were in tolerance status, one-sixth were in withdrawal status, and one-seventh were in high-SAP status. Both boys and girls had a higher prevalence of high-SAP and tolerance in 6th grade than in 5th grade, whereas in both grades boys had a higher prevalence of high-SAP and withdrawal, and girls had a higher prevalence of non-SAP and tolerance. Controlling for parents’ education, family structure, and household income, higher use of SNSs by children, increasing use of mobile gaming and higher levels of depression were individually associated with increased odds of being in one of the three SAP statuses other than non-SAP. When all three covariates were jointly entered into the model, usage of SNSs and depression remained significant predictors.

Problematic smartphone use and related factors in young patients with schizophrenia (2019)

Asia Pac Psychiatry. 2019 May 1:e12357. doi: 10.1111/appy.12357.

A total of 148 schizophrenia patients aged 18 to 35 years completed self-administered questionnaires exploring sociodemographic characteristics; Smartphone Addiction Scale (SAS), the Big Five Inventory-10 (BFI-10), the Hospital Anxiety and Depression Scale (HADS), the Perceived Stress Scale (PSS), and the Rosenberg Self-Esteem Scale (RSES). All were also assessed using the Clinician-Rated Dimensions of Psychosis Symptom Severity (CRDPSS) Scale and the Personal and Social Performance (PSP) Scale.

The mean subject age was 27.5 ± 4.5 years. No significant differences in the SAS scores occurred between gender, jobs, and level of education. The Pearson r-correlation test showed that the SAS scores were significantly positively correlated with HADS anxiety, PSS, and BFI-10 neuroticism scores; it was negatively correlated with RSES, BFI-10 agreeableness, and conscientiousness scores. In the stepwise linear regression analysis, the severity of PSU was significantly associated with both high anxiety and low agreeableness.

Internet Interpersonal Connection Mediates the Association between Personality and Internet Addiction (2019)

Int J Environ Res Public Health. 2019 Sep 21;16(19). pii: E3537. doi: 10.3390/ijerph16193537.

The development of the Internet has changed interpersonal interactions, so that people no longer need to physically meet each other. However, some people are more vulnerable to becoming addicted to Internet activities, something to which the ease of Internet access and usage has contributed. In this study, we examined the association between personality traits and feelings about online interpersonal interactions to predict Internet addiction. This was accomplished using an online advertisement that asked participants to complete the questionnaires in the laboratory.

Two hundred and twenty-three participants with a mean age of 22.50 years were recruited for this study and asked to complete the following questionnaires: the Beck Depressive Inventory (BDI), the Beck Anxiety Inventory (BAI), the Chen Internet Addiction Scale (CIAS), the Eysenck Personality Questionnaire (EPQ), the Internet Usage Questionnaire (IUQ) and the Feelings of Internet Interpersonal Interaction Questionnaire (FIIIQ).

The results showed that people with a neurotic personality and anxious feelings about Internet interpersonal interactions are more likely to become addicted to the Internet. In addition, people with neuroticism and who are more anxious about Internet interpersonal relationships are more likely to develop Internet addiction.

People who tend to develop new interpersonal relationships via the Internet and be anxious about online interpersonal relationships are more vulnerable to becoming addicted to the Internet. The individuals who are more anxious about Internet interpersonal interaction and tend to develop new interpersonal relationships via the Internet are more likely to develop Internet addiction.

Internet addiction among social networking sites users: Emerging mental health concern among medical undergraduates of Karachi (2018)

Pak J Med Sci. 2018 Nov-Dec;34(6):1473-1477. doi: 10.12669/pjms.346.15809.

To determine the frequency and intensity of Internet Addiction (IA) among medical undergraduates, using Social Networking Sites (SNS), in Karachi.

A cross-sectional survey was conducted in March-June ’16 in a private and government medical college of Karachi. Self-administered, Young’s Internet Addiction Test was implemented by 340 medical students to assess the frequency and intensity of IA among SNS profile users for past three years. The structured questionnaire further enquired regarding the social and behaviour patterns relevant to IA and SNS use. Data was analyzed using SPSS 16.

Internet Addiction (IA) was found in 85% (n=289) of all study participants. Among them, 65.6% (n=223) were ‘minimally addicted’, 18.5% (n=63) were ‘moderately addicted’, whereas 0.9% (n=3) were found to be ‘severely addicted’. Burden of IA was relatively higher among female medical students as compared to male medical students (p=0.02). There was no significant difference between type of medical college attended and IA (p=0.45). However, statistically significant differences were observed in certain behavioural patterns among addicted and non-addicted medical students.

Predictive Effects of Sex, Age, Depression, and Problematic Behaviors on the Incidence and Remission of Internet Addiction in College Students: A Prospective Study (2018)

Int J Environ Res Public Health. 2018 Dec 14;15(12). pii: E2861. doi: 10.3390/ijerph15122861.

The aim of the study was to determine the predictive effects of sex, age, depression, and problematic behaviors on the incidence and remission of internet addiction (IA) in college students over a one-year follow-up. A total of 500 college students (262 women and 238 men) were recruited. The predictive effects of sex, age, severity of depression, self-harm/suicidal behaviors, eating problems, risk-taking behaviors, substance use, aggression, and uncontrollable sexual encounters on the incidence and remission of IA over a one-year follow-up were examined. The one-year incidence and remission rates for IA were 7.5% and 46.4%, respectively. Severity of depression, self-harm and suicidal behaviors, and uncontrollable sexual encounters at the initial investigation predicted the incidence of IA in a univariate analysis, whereas only severity of depression predicted the incidence of IA in a multivariable logistic regression (p = 0.015, odds ratio = 1.105, 95% confidence intervals: 1.021⁻1.196). A relatively young age predicted the remission of IA. Depression and young age predicted the incidence and remission, respectively, of IA in college students in the one-year follow-up.

Problematic internet use and feelings of loneliness (2018)

Int J Psychiatry Clin Pract. 2018 Dec 20:1-3. doi: 10.1080/13651501.2018.1539180.

Internet addiction or problematic internet use (PIU) has been related to feelings of loneliness and social networking. Research suggests that online communication may cause loneliness. We examined if the association between PIU and loneliness is independent of lack of social support, as indicated by lack of a committed romantic relationship, poor family functioning, and lack of time to interact face-to-face due to time online.

Portuguese adolescents and young adults (N = 548: 16-26 years) completed the Generalized Problematic Internet Use Scale-2, the UCLA Loneliness Scale, and the general functioning subscale of the McMaster Family Assessment Device. They also reported if they had a committed romantic relationship, and if being online did not leave them time to be with partner, spend with family and socialise face-to-face with friends.

Social networking was reported as among the main preferences by 90.6% of the females and 88.6% of the males. Perceived loneliness was associated with PIU independently of age and indicators of social support.

Evolution created neurophysiological mechanisms to recognize satisfying social relationships based on sensory information and bodily feedback present in face-to-face interactions. These are greatly absent in online communication. Hence, online communication likely engenders feelings of loneliness. Keypoints Problematic internet use (PIU) has been related to loneliness and social networking. Online communication was shown to increase loneliness. Lack of romantic relationships did not explain the association of PIU with loneliness. Poorer family environment did not explain the association of PIU with loneliness. Lack of face-to-face interactions due to time online also did not explain it. Lack of adequate sensory cues and bodily feedback in online contacts might facilitate it.

Mobile ubiquity: Understanding the relationship between cognitive absorption, smartphone addiction and social network services (2019)

Computers in Human Behavior

Volume 90, January 2019, Pages 246-258

Highlights

• Addiction to smartphone devices exceeds addiction to social network services (SNS).
• Smartphone addiction varies by educational attainment; SNS does not.
• Users addicted to smartphones and SNS experience higher cognitive absorption.
• The impact of cognitive absorption is greater for SNS than smartphones.
• Impact of cognitive absorption on smartphone addiction mediated by addiction to SNS.

Internet Addiction and Online Gaming: An Emerging Epidemic of the Twenty-First Century? (2019)

DOI: 10.4018/978-1-5225-4047-2.ch010

Internet addiction has gradually turned a medium of gaming and other leisure activities shifting from its original intention to fasten the communication and help in the researches. The excessive usage of internet and nature of its usage has been found to be similar with psycho-addictive substance addiction with similar neurobiological basis. Inclusion of gambling disorder into DSM 5 further strengthens the emerging concept of behavioral addiction. Various worldwide researches also support the upsurge of such problem. The clinical presentation and management options are mostly based on the behavioral principles learned from the substance abuse problems. However, large-scale randomized trails and epidemiological studies are definitely needed to understand this twenty-first century problem.

Clinical profile of adolescents being treated for problematic internet use (2018)

Can J Psychiatry. 2018 Oct 2:706743718800698. doi: 10.1177/0706743718800698.

This study highlights the clinical profile of adolescents having consulted with an addiction treatment center (ATC) in Québec for a problematic internet use (PIU) to develop knowledge about these specific clients and precisely target their needs relative to treatment

The study was conducted with 80 adolescents between ages 14 and 17 (M = 15.59) who had consulted with an ACT for a PIU. Adolescents have participated in an interview documenting internet use patterns and their consequences, mental health disorder co-occurrence, and family and social relationships.

The sample was constituted of 75 boys (93.8%) and 5 girls (6.3%), who spent an average of 55.8 hours (SD = 27.22) per week on internet for non-school or professional activities. Almost all of these youths (97.5%) presented a co-occurring mental health disorder, and more than 70% had seeked help last year for a psychological problem. Results show that 92.6% feel their internet use significantly hinders their family relationships, and 50% feel it impedes their social relationships.

Contribution of stress and coping strategies to problematic Internet use in patients with schizophrenia spectrum disorders (2018)

Compr Psychiatry. 2018 Sep 26;87:89-94. doi: 10.1016/j.comppsych.2018.09.007.

Internet use is already high and increasing rapidly among people with psychotic disorders, but there have been few studies on problematic Internet use (PIU) among patients with schizophrenia spectrum disorders. This study aimed to measure the prevalence of PIU and identify the factors associated with PIU among patients with schizophrenia spectrum disorders.

A cross-sectional survey was performed that included 368 outpatients with schizophrenia spectrum disorders: 317 with schizophrenia, 22 with schizoaffective disorder, 9 with schizophreniform disorder, and 20 with other schizophrenia spectrum and psychotic disorders. The severity of psychotic symptoms and levels of personal and social functioning were assessed by the Clinician-rated Dimensions of Psychosis Symptom Severity (CRDPSS) scale and the Personal and Social Performance (PSP) scale, respectively. PIU was evaluated using Young’s Internet Addiction Test (IAT). Additionally, the Hospital Anxiety and Depression Scale (HADS), Perceived Stress Scale (PSS), Rosenberg Selfesteem Scale (RSES), and Brief Coping Orientation to Problems Experienced (COPE) Inventory were administered.

PIU was identified in 81 (22.0%) of the 368 patients with schizophrenia spectrum disorders. Subjects with PIU were significantly younger and more likely to be male. Scores on the HADS, PSS, and dysfunctional coping dimension of the Brief COPE Inventory were significantly higher, and RSES scores were significantly lower, in the PIU group. Logistic regression analysis indicated that PIU in patients was significantly associated with scores on the PSS and dysfunctional coping dimension of the Brief COPE Inventory.

Investigation the relationship between internet dependence with anxiety and educational performance of high school students (2019)

J Educ Health Promot. 2019 Nov 29;8:213. doi: 10.4103/jehp.jehp_84_19.

Internet is one of the most advanced modern communication technologies. Despite the positive uses of internet, the existence of extreme behaviors and its harmful consequences has attracted the attention of all. The aim of this study was to determine the relationship between internet addiction with anxiety and educational performance.

This research is a descriptive correlative study. The statistical population of the study includes a total number of 4401 female students in the high school in the city of Ilam-Iran in the academic year of 2017-2018. The sample size includes353 students estimated using Cochran’s formula. They were selected by random cluster sampling. For data collection, the Young’s Internet Dependency Questionnaire, Academic Performance Inventory, and Marc et al., anxiety Scale were used. Data were analyzed at the significant level of α = 0.05.

The results showed a positive and significant correlation between internet dependency and students’ anxiety (P < 0.01). There is also a negative and significant correlation between internet dependency and academic performance of students (P < 0.01), and also a negative and significant correlation between anxiety and educational performance of students (P < 0.01).

On the one hand, the results indicate a high prevalence of internet dependency and its significant relationship with anxiety and academic performance in students, and on the other hand, the negative effect of internet dependency on the students’ educational performance. Therefore, it is necessary to design some intervention programs to prevent harm to students who are increasingly interacting with internet. In addition, raising the level of the students’ awareness on the complications of internet addiction and the proper use of the internet seems to be necessary.

Prevalence of Internet Addiction in Iran: A Systematic Review and Meta-analysis (2018)

Addict Health. 2017 Fall;9(4):243-252.

The internet has unique properties that include ease of access, ease of use, low cost, anonymity, and its attractiveness which resulted in problems such as internet addiction. Different statistics has been reported about internet addiction rate, but there is not a suitable estimation about the growth of Internet addiction in Iran. The aim of this study is to analyze the growth of Internet addiction in Iran using meta-analysis method.

At the first stage, by searching in scientific databases such as Magiran, SID, Scopus, ISI, Embase and use of keywords like Internet addiction, 30 articles were chosen. The outcomes of the study combined together with using meta-analysis method (random effects model). The analysis of the data was performed using R and Stata software.

Based on 30 studies and sample size of 130531, the growth rate of internet addiction based on the random effects model was 20% [16-25 confidence interval (CI) of 95%]. The meta regression model showed t-hat the trend of Internet addiction growth rate in Iran increased from 2006 to 2015.

Worry and anger are associated with latent classes of problematic smartphone use severity among college students (2018)

J Affect Disord. 2018 Dec 18;246:209-216. doi: 10.1016/j.jad.2018.12.047.

Problematic smartphone use (PSU) is associated with depression and anxiety symptom severity throughout the literature. However, many important psychopathology constructs have not been examined for associations with PSU severity. Worry and anger are two psychopathology constructs receiving little empirical scrutiny in relation to PSU, but theoretically should demonstrate significant relationships. Furthermore, few studies have used person-centered analyses, such as mixture modeling, to analyze possible latent subgroups of individuals based on PSU symptom ratings.

We conducted a web survey of 300 American college students, using the Smartphone Addiction Scale-Short Version, Penn State Worry Questionnaire-Abbreviated Version, and Dimensions of Anger Reactions-5 Scale.

Conducting mixture modeling using latent profile analysis, we found most support for a three-class model of latent groups of individuals based on their PSU item ratings. Adjusting for age and sex, worry and anger scores were significantly higher in the more severe PSU classes.

Results are discussed in the context of uses and gratifications theory, as well as compensatory internet use theory, in terms of individual differences explaining excessive technology use. Limitations include the non-clinical nature of the sample.

Worry and anger may be helpful constructs in understanding the phenomenology of PSU, and psychological interventions for worry and anger may offset PSU.

Problematic Use of Mobile Phones in Australia…Is It Getting Worse? (2019)

Front Psychiatry. 2019 Mar 12;10:105. doi: 10.3389/fpsyt.2019.00105.

Rapid technological innovations over the past few years have led to dramatic changes in today’s mobile phone technology. While such changes can improve the quality of life of its users, problematic mobile phone use can result in its users experiencing a range of negative outcomes such as anxiety or, in some cases, engagement in unsafe behaviors with serious health and safety implications such as mobile phone distracted driving. The aims of the present study are two-fold. First, this study investigated the current problem mobile phone use in Australia and its potential implications for road safety. Second, based on the changing nature and pervasiveness of mobile phones in Australian society, this study compared data from 2005 with data collected in 2018 to identify trends in problem mobile phone use in Australia. As predicted, the results demonstrated that problem mobile phone use in Australia increased from the first data collected in 2005. In addition, meaningful differences were found between gender and age groups in this study, with females and users in the 18-25 year-old age group showing higher mean Mobile Phone Problem Use Scale (MPPUS) scores. Additionally, problematic mobile phone use was linked with mobile phone use while driving. Specifically, participants who reported high levels of problem mobile phone use, also reported handheld and hands-free mobile phone use while driving.

The Use of Social Media by Dental Students for Communication and Learning: Two Viewpoints: Viewpoint 1: Social Media Use Can Benefit Dental Students’ Communication and Learning and Viewpoint 2: Potential Problems with Social Media Outweigh Their Benefits for Dental Education (2019)

J Dent Educ. 2019 Mar 25. pii: JDE.019.072. doi: 10.21815/JDE.019.072.

Social media have become a major part of an interconnected society, impacting personal and professional lives. This Point/Counterpoint presents two opposing viewpoints on the question of whether social media should be used in dental education as a learning and communication tool for dental students. Viewpoint 1 argues that social media benefit student learning and should be used as a tool in dental education. This argument is based on evidence concerning use of social media and improved learning across health professions, improved peer-peer communication in clinical education, improved engagement in interprofessional education (IPE), and provision of a mechanism for safe and improved communication between practitioners and patients, as well as faculty and students. Viewpoint 2 argues that potential problems and risks in using social media outweigh any benefits found in learning and therefore social media should not be used as a tool in dental education. This viewpoint is supported by evidence of negative effects on learning, the establishment of a negative digital footprint in the public’s view, risk of privacy violations when using social media, and the new phenomenon of Internet addiction with its negative physiological effects on social media users.

Problematic Internet Use and Associated High-Risk Behavior in an Adolescent Clinical Sample: Results from a Survey of Psychiatrically Hospitalized Youth (2019)

Cyberpsychol Behav Soc Netw. 2019 Mar 21. doi: 10.1089/cyber.2018.0329.

Problematic Internet use (PIU) is a growing clinical concern to clinicians working in adolescent mental health, with significant potential comorbidities like depression and substance use. No prior study has examined associations between PIU, high-risk behavior, and psychiatric diagnoses specifically in psychiatrically hospitalized adolescents. Here, we analyzed how PIU severity correlated with preadmission Internet habits, psychiatric symptoms, and high-risk behavior in this unique population. We hypothesized that as the severity of PIU increased, so would endorsement of mood symptoms, engagement in risky behaviors, and chances of having comorbid mood and aggression-related diagnoses. We performed a cross-sectional survey on an adolescent psychiatric inpatient unit in an urban community hospital in Massachusetts. Participants were 12-20 years old (n = 205), 62.0 percent female, and of diverse racial/ethnic backgrounds. Relationships between PIU, high-risk symptoms, diagnoses, and behaviors were performed both using chi-square tests and determining Pearson correlation coefficients. Two hundred five adolescents participated in the study. PIU severity was associated with being female (p < 0.005), sexting (p < 0.05), cyberbullying (p < 0.005), and increased suicidality within the last year (p < 0.05). Adolescents with aggressive and developmental disorders, but not depressive disorders, also had significantly higher PIU scores (p ≤ 0.05). In our sample of psychiatrically hospitalized adolescents, PIU severity was significantly associated with both serious psychiatric symptoms and high-risk behaviors, including those related to suicide.

Exploring the Differences between Adolescents’ and Parents’ Ratings on Adolescents’ Smartphone Addiction (2018)

J Korean Med Sci. 2018 Dec 19;33(52):e347. doi: 10.3346/jkms.2018.33.e347

Smartphone addiction has recently been highlighted as a major health issue among adolescents. In this study, we assessed the degree of agreement between adolescents’ and parents’ ratings of adolescents’ smartphone addiction. Additionally, we evaluated the psychosocial factors associated with adolescents’ and parents’ ratings of adolescents’ smartphone addiction.

In total, 158 adolescents aged 12-19 years and their parents participated in this study. The adolescents completed the Smartphone Addiction Scale (SAS) and the Isolated Peer Relationship Inventory (IPRI). Their parents also completed the SAS (about their adolescents), SAS-Short Version (SAS-SV; about themselves), Generalized Anxiety Disorder-7 (GAD-7), and Patient Health Questionnaire-9 (PHQ-9). We used the paired t-test, McNemar test, and Pearson’s correlation analyses.

Percentage of risk users was higher in parents’ ratings of adolescents’ smartphone addiction than ratings of adolescents themselves. There was disagreement between the SAS and SAS-parent report total scores and subscale scores on positive anticipation, withdrawal, and cyberspace-oriented relationship. SAS scores were positively associated with average minutes of weekday/holiday smartphone use and scores on the IPRI and father’s GAD-7 and PHQ-9 scores. Additionally, SAS-parent report scores showed positive associations with average minutes of weekday/holiday smartphone use and each parent’s SAS-SV, GAD-7, and PHQ-9 scores.

The results suggest that clinicians need to consider both adolescents’ and parents’ reports when assessing adolescents’ smartphone addiction, and be aware of the possibility of under- or overestimation. Our results cannot only be a reference in assessing adolescents’ smartphone addiction, but also provide inspiration for future studies.

Survey of the effects of internet usage on the happiness of Japanese university students (2019)

Health Qual Life Outcomes. 2019 Oct 11;17(1):151. doi: 10.1186/s12955-019-1227-5.

Besides research on psychiatric diseases related to problematic Internet use (PIU), a growing number of studies focus on the impact of Internet on subjective well-being (SWB). However, in previous studies on the relationship between PIU and SWB, there is little data for Japanese people specifically, and there is a lack of consideration for differences in perception of happiness due to cultural differences. Therefore, we aimed to clarify how happiness is interdependent on PIU measures, with a focus on how the concept of happiness is interpreted among Japanese people, and specifically among Japanese university students.

A paper-based survey was conducted with 1258 Japanese university students. Respondents were asked to fill out self-report scales regarding their happiness using the Interdependent Happiness Scale (IHS). The relationship between IHS and Internet use (Japanese version of the Internet addiction test, JIAT), use of social networking services, as well as social function and sleep quality (Pittsburgh Sleep Quality Index, PSQI) were sought using multiple regression analyses.

Based on multiple regression analyses, the following factors related positively to IHS: female gender and the number of Twitter followers. Conversely, the following factors related negatively to IHS: poor sleep, high- PIU, and the number of times the subject skipped a whole day of school.

It was shown that there was a significant negative correlation between Japanese youths’ happiness and PIU. Since epidemiological research on happiness that reflects the cultural background is still scarce, we believe future studies shall accumulate similar evidence in this regard.

The role of self-esteem in Internet addiction within the context of comorbid mental disorders: Findings from a general population-based sample (2018)

J Behav Addict. 2018 Dec 26:1-9. doi: 10.1556/2006.7.2018.130.

Internet Addiction (IA) has consistently been related to comorbid psychiatric disorders and lowered self-esteem. However, most studies relied on self-report questionnaires using non-representative samples. This study aims to analyze the relative impact of self-esteem and comorbid psychopathology with lifetime IA in a population-based sample of excessive Internet users using clinical diagnoses assessed in a personal interview.

The sample of this study is based on a general population survey. Using the Compulsive Internet Use Scale, all participants with elevated Internet use scores were selected and invited to a follow-up interview. Current DSM-5 criteria for Internet gaming disorder were rephrased to apply to all Internet activities. Out of 196 participants, 82 fulfilled the criteria for IA. Self-esteem was measured with the Rosenberg’s Self-Esteem Scale.

Self-esteem is significantly associated with IA. For every unit increase in self-esteem, the chance of having IA decreased by 11%. By comparison, comorbidities such as substance-use disorder (excluding tobacco), mood disorder, and eating disorder were significantly more likely among Internet-addicted than in the non-addicted group. This could not be reported for anxiety disorders. A logistic regression showed that by adding self-esteem and psychopathology into the same model, self-esteem maintains its strong influence on IA.

Associations between emotion recognition and social networking site addiction (2019)

Psychiatry Res. 2019 Nov 1:112673. doi: 10.1016/j.psychres.2019.112673

With the widespread use of the internet today, many studies have been conducted regarding the use of social networking sites (SNS). Despite the growing literature on the effects of SNS on human life, there are limited successful therapeutic interventions for SNS addiction. Our study aimed to elucidate the potential role of emotion recognition in the development of SNS addiction and to propose novel strategies for alleviating problems emerging from SNS addiction. A total of 337 individuals participated in the study. A sociodemographic data form, the Reading the Mind in the Eyes Test (RMET), and the Social Media Addiction Scale (SMAS) were administered. The results revealed the presence of emotion recognition deficits among individuals with SNS addiction, relative to non-addicts. RMET positive and negative scores were associated with SNS addiction in a negative direction. Additionally, RMET negative scores predicted.

The Digital Addiction Scale for Children: Development and Validation (2019)

Cyberpsychol Behav Soc Netw. 2019 Nov 22. doi: 10.1089/cyber.2019.0132.

Researchers worldwide have developed and validated several scales to assess various forms of adults’ digital addiction. The urge for some of these scales found support in World Health Organization’s inclusion of gaming disorder as a mental health condition in its eleventh revision of the International Classification of Diseases in June 2018. Additionally, several studies have shown that children are starting to use digital devices (DDs) (e.g., tablets and smartphones) at a very young age, including playing video games and engaging in social media. Consequently, the need for early detection of the risk of digital addiction among children is becoming more of a necessity. In the present study, the Digital Addiction Scale for Children (DASC)-a 25-item self-report instrument-was developed and validated to assess the behavior of children 9 to 12 years old in association with DD usage, including video gaming, social media, and texting. The sample comprised 822 participants (54.2 percent males), from grade 4 to grade 7. The DASC showed excellent internal consistency reliability (α = 0.936) and adequate concurrent and criterion-related validities. The results of the confirmatory factor analysis showed that the DASC fitted the data very well. The DASC paves the way to (a) help in early identification of children at risk of problematic use of DDs and/or becoming addicted to DDs and (b) stimulate further research concerning children from different cultural and contextual settings.

Personal Factors, Internet Characteristics, and Environmental Factors Contributing to Adolescent Internet Addiction: A Public Health Perspective (2019)

Int J Environ Res Public Health. 2019 Nov 21;16(23). pii: E4635. doi: 10.3390/ijerph16234635.

Individual characteristics, family- and school-related variables, and environmental variables have equal importance in understanding Internet addiction. Most previous studies on Internet addiction have focused on individual factors; those that considered environmental influence typically only examined the proximal environment. Effective prevention and intervention of Internet addiction require a framework that integrates individual- and environmental-level factors. This study examined the relationships between personal factors, family/school factors, perceived Internet characteristics, and environmental variables as they contribute to Internet addiction among adolescents based on the public health model. A representative sample of 1628 junior high school students from 56 regions in Seoul and Gyeonggi-do participated in the study via questionnaires with the cooperation of the Ministry of Health and Welfare and the district office of education. The study analyzed psychological factors, family cohesion, attitudes toward academic activities, Internet characteristics, accessibility to PC cafés, and exposure to Internet game advertising. About 6% of the adolescents were categorized as being in the severely addicted group. Between-group comparisons showed that the addicted group had started using the Internet earlier; had higher levels of depression, compulsivity, and aggressiveness as well as lower family cohesion; and reported higher accessibility to PC cafés and exposure to Internet game advertising. Multiple logistic regression indicated that for adolescents, environmental factors had a greater influence than family or school-related factors.

The impacts of internet addiction on depression, physical activity level and trigger point sensitivity in Turkish university students (2019)

J Back Musculoskelet Rehabil. 2019 Nov 15. doi: 10.3233/BMR-171045.

Internet addiction (IA), defined as excessive, time consuming, uncontrollable use of the internet, has become a widespread problem. In this study, we investigated the impact of internet addiction on depression, physical activity level, and latent trigger point sensitivity in Turkish university students.

A total of 215 university students (155 females and 60 males) who were between 18-25 years of age participated in the study. Using the Addiction Profile Index Internet Addiction Form (APIINT), we identified 51 people as non-internet-addicted (non-IA) (Group 1: 10 male/41 female) and 51 as internet-addicted (IA) (Group 2: 7 male/44 female). APIINT, International Physical Activity Questionnaire-Short-Form (IPAQ), Beck Depression Inventory (BDI), and Neck Disability Index (NDI) were administered to both groups, and the pressure-pain threshold (PPT) in upper/middle trapezius latent trigger points area was measured.

The internet addiction rate was 24.3% in our students. Compared with the non-IA group, the daily internet use time and BDI and NDI scores were higher (all p< 0.05), while the IPAQ walking (p< 0.01), IPAQ total (p< 0.05), and PPT values (p< 0.05) were lower in the IA group.

IA is a growing problem. This addiction may lead to musculoskeletal problems and can have consequences involving the level of physical activity, depression, and musculoskeletal disorders, particularly in the neck.

New age technology and social media: adolescent psychosocial implications and the need for protective measures (2019)

Current Opinion in Pediatrics: February 2019 – Volume 31 – Issue 1 – p 148–156

doi: 10.1097/MOP.0000000000000714

Purpose of review In recent years, breakthroughs and advancements in new age technology have revolutionized the way children communicate and interact with the world around them. As social media platforms such as Facebook, Instagram, and Snapchat continue to grow in popularity, their usage has raised concerns about their role and impact on adolescent development and behavior. This review examines the psychosocial implications of social media usage on youth outcomes related to body image, socialization, and adolescent development. It discusses ways that clinicians and parents can effectively safeguard their children from the potential threats posed by digital media while providing a fact sheet for parents that addresses these concerns and summarizes recommended strategies to combat them.

Recent findings While social media platforms continue to experience surges in popularity, mounting evidence suggests significant correlations between their usage and adolescent mental health and behavioral issues. Increased social media usage has been linked to diminished self-esteem and body satisfaction, elevated risk of cyber-bullying, heightened exposure to pornographic material, and risky sexual behaviors.

Summary Given how new age technology is steadily permeating everyday life, greater efforts are needed to inform adolescent users and their families about the negative consequences of social media usage. Pediatricians and parents must take cautionary measures to reduce psychosocial risks and ensure the online safety of children.

Effects of screentime on the health and well-being of children and adolescents: a systematic review of reviews (2019)

Objectives To systematically examine the evidence of harms and benefits relating to time spent on screens for children and young people’s (CYP) health and well-being, to inform policy.

Methods Systematic review of reviews undertaken to answer the question ‘What is the evidence for health and well-being effects of screentime in children and adolescents (CYP)?’ Electronic databases were searched for systematic reviews in February 2018. Eligible reviews reported associations between time on screens (screentime; any type) and any health/well-being outcome in CYP. Quality of reviews was assessed and strength of evidence across reviews evaluated.

Results 13 reviews were identified (1 high quality, 9 medium and 3 low quality). 6 addressed body composition; 3 diet/energy intake; 7 mental health; 4 cardiovascular risk; 4 for fitness; 3 for sleep; 1 pain; 1 asthma. We found moderately strong evidence for associations between screentime and greater obesity/adiposity and higher depressive symptoms; moderate evidence for an association between screentime and higher energy intake, less healthy diet quality and poorer quality of life. There was weak evidence for associations of screentime with behaviour problems, anxiety, hyperactivity and inattention, poorer self-esteem, poorer well-being and poorer psychosocial health, metabolic syndrome, poorer cardiorespiratory fitness, poorer cognitive development and lower educational attainments and poor sleep outcomes. There was no or insufficient evidence for an association of screentime with eating disorders or suicidal ideation, individual cardiovascular risk factors, asthma prevalence or pain. Evidence for threshold effects was weak. We found weak evidence that small amounts of daily screen use is not harmful and may have some benefits.

Conclusions There is evidence that higher levels of screentime is associated with a variety of health harms for CYP, with evidence strongest for adiposity, unhealthy diet, depressive symptoms and quality of life. Evidence to guide policy on safe CYP screentime exposure is limited.

Internet Addiction and Depression in Chinese Adolescents: A Moderated Mediation Model (2019)

Front Psychiatry. 2019 Nov 13;10:816. doi: 10.3389/fpsyt.2019.00816.

Research has revealed that Internet addiction is a risk factor for adolescents’ development of depressive symptoms, although the underlying mechanisms are largely unknown. The present study examines the mediating role of positive youth development and the moderating role of mindfulness to determine the association between Internet addiction and depression. A sample of 522 Chinese adolescents completed measures related to Internet addiction, positive youth development, mindfulness, depression, and their background information, for which the results reveal that positive youth development mediates the relation between Internet addiction and depression. Moreover, the associations between both Internet addiction and depression as well as positive youth development and depression are moderated by mindfulness. These two effects were stronger for adolescents with low mindfulness than for those with high mindfulness. The present study contributes to a more thorough understanding of how and when Internet addiction increases the risk of depression in adolescents, suggesting that Internet addiction may affect adolescent depression through positive youth development and that mindfulness can alleviate the negative effect of Internet addiction or a low level of psychological resources on depression. The implications for research and practice are finally discussed.

Association Between Internet Addiction and the Risk of Musculoskeletal Pain in Chinese College Freshmen – A Cross-Sectional Study (2019)

Front Psychol. 2019 Sep 3;10:1959. doi: 10.3389/fpsyg.2019.01959.

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

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

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

Prevalence of excessive internet use and its association with psychological distress among university students in South India (2018)

Objectives: This study was set up to examine the internet use behaviors, internet addiction (IA), and its association with psychological distress primarily depression among a large group of university students from South India.

Methods: Totally 2776 university students aged 18–21 years; pursuing undergraduate studies from a recognized university in South India participated in the study. The patterns of internet use and socioeducational data were collected through the internet use behaviors and demographic data sheet, IA test (IAT) was utilized to assess IA and psychological distress primarily depressive symptoms were evaluated with Self-Report Questionnaire-20.

Results: Among the total n = 2776, 29.9% (n = 831) of university students met criterion on IAT for mild IA, 16.4% (n = 455) for moderate addictive use, and 0.5% (n = 13) for severe IA. IA was higher among university students who were male, staying in rented accommodations, accessed internet several times a day, spent more than 3 h per day on the Internet and had psychological distress. Male gender, duration of use, time spent per day, frequency of internet use, and psychological distress (depressive symptoms) predicted IA.

Conclusions: IA was present among a substantial proportion of university students which can inhibit their academic progress and impact their psychological health. Early identification of risk factors of IA can facilitate the effective prevention and timely initiation of treatment strategies for IA and psychological distress among university students.

Gender Differences in Smartphone Addiction Behaviors Associated With Parent-Child Bonding, Parent-Child Communication, and Parental Mediation Among Korean Elementary School Students.

J Addict Nurs. 2018 Oct/Dec;29(4):244-254. doi: 10.1097/JAN.0000000000000254.

This study investigated the gender differences in smartphone addiction (SA) behaviors associated with parent-child bonding, parent-child communication, and parental mediation among Korean elementary school students aged 11-13 years.

A sample of 224 smartphone users (112 boys and 112 girls) was surveyed in a cross-sectional study. Descriptive statistics and multiple regression analysis were conducted to investigate the predictors of SA behaviors based on gender differences using SPSS Win 23.0 software.

Of the participants, 14.3% (15.18% boys and 13.39% girls) were in the SA behaviors risk group, and the prevalence of SA behaviors was not significantly different between gender groups. In multiple stepwise regression analysis, less active safety mediation; longer duration of smartphone use; more use of smartphones for games, videos, or music; and less restrictive mediation were linked to higher SA behaviors in boys, and these indicators accounted for 22.1% of the variance in SA behaviors. Longer duration of smartphone use, less active use mediation, worse parent-child communication, and more use of smartphones for text, chatting, or social network sites were linked to higher SA behaviors in girls, and these indicators accounted for 38.2% of the variance in SA behaviors.

Problematic Social Networking Site Use and Comorbid Psychiatric Disorders: A Systematic Review of Recent Large-Scale Studies (2018)

Front Psychiatry. 2018 Dec 14;9:686. doi: 10.3389/fpsyt.2018.00686.

Background and Aims: Research has shown a potential association between problematic social networking site (SNS) use and psychiatric disorders. The primary objective of this systematic review was to identify and evaluate studies examining the association between problematic SNS use and comorbid psychiatric disorders.

Sampling and Methods: A literature search was conducted using the following databases: PsychInfo, PsycArticles, Medline, Web of Science, and Google Scholar. Problematic SNS use (PSNSU) and its synonyms were included in the search. Information was extracted based on problematic SNS use and psychiatric disorders, including attention deficit and hyperactivity disorder (ADHD), obsessive compulsive disorder (OCD), depression, anxiety, and stress. The inclusion criteria for papers to be reviewed were (i) being published since 2014 onwards, (ii) being published in English, (iii) having population-based studies with sample sizes >500 participants, (iv) having specific criteria for problematic SNS use (typically validated psychometric scales), and (v) containing empirical primary data reporting on the correlation between PSNSU and psychiatric variables. A total of nine studies met the predetermined inclusion and exclusion criteria.

Results: The findings of the systematic review demonstrated that most research has been conducted in Europe and all comprised cross-sectional survey designs. In eight (of the nine) studies, problematic SNS use was correlated with psychiatric disorder symptoms. Of the nine studies (some of which examined more than one psychiatric symptom), there was a positive association between PSNSU and depression (seven studies), anxiety (six studies), stress (two studies), ADHD (one study), and OCD (one study).

Conclusions: Overall, the studies reviewed showed associations between PSNSU and psychiatric disorder symptoms, particularly in adolescents. Most associations were found between PSNSU, depression, and anxiety.

Susceptibility and perceptions of excessive internet use impact on health among Vietnamese youths (2019)

Addict Behav. 2019 Jan 31. pii: S0306-4603(18)31238-3. doi: 10.1016/j.addbeh.2019.01.043.

Studies performed worldwide show excessive Internet use could have a negative impact on health. However, Internet use studies in Vietnam are limited. In this study, we reported a high prevalence of frequent Internet usage among Vietnamese youth between 16 and 30 years old. Of 1200 participants, almost 65% reported using the Internet daily. Moreover, 34.3% of the participants reported feeling anxious or uncomfortable after not using the Internet for one day irrespective of their gender, and 40% believed using the Internet frequently did not affect their health. Of those, there was a higher proportion of women than men that held this belief (42.1% vs. 35.9%, respectively, p = .03). In this cohort, undergraduate students were more likely than blue-collar workers to believe that frequent Internet use could affect health. Yet, undergraduate [OR = 1.50, 95%CI = (1.08, 2.09), p < .05)] and high school students (OR = 1.54, 95%CI = 1.00, 2.37), p < .1) were more likely than blue collar workers to feel anxious or uncomfortable after a day without the Internet. Participants in urban areas were more than twice as likely than those from rural areas to believe the Internet did not affect their health [(OR = 0.60, 95%CI = (0.41,0.89), p < .01)]. Lastly, participants between 16 and 18 years old were less likely to believe in the negative impact of the Internet on health than older participants.

The Relation Between Emotional Intelligence and Internet Addiction in Katowice High School Students (2019)

Psychiatr Danub. 2019 Sep;31(Suppl 3):568-573.

1450 high school students from Katowice, at the age from 18 to 21 years took part in an anonymous survey consisting of three parts: The Trait Emotional Intelligence Questionnaire – Short Form (TEIQue-SF), Internet Addiction Test and authorial test giving information about the way of spending time online. The questionnaires were collected from May 2018 to January 2019.

1.03% of the respondents fulfilled the Internet addiction criteria. Students at risk for addiction (33.5%) turned out to be a larger group. A statistically significant correlation between TEIQue-SF and Internet Addiction Test score (P<0.0001, r=-0.3308) was observed. Another significant correlation was found between TEIQue-SF score and amount of time spend on the Internet (p<0.0001, r=-0.162).

A significant part of high school students used Internet excessively. Such behaviours were positively correlated with lower EI test results.

Relationship between Self-Identity Confusion and Internet Addiction among College Students: The Mediating Effects of Psychological Inflexibility and Experiential Avoidance (2019)

Int J Environ Res Public Health. 2019 Sep 3;16(17). pii: E3225. doi: 10.3390/ijerph16173225.

Internet addiction (IA) has become a major public health problem among college students. The aim of this study was to examine the relationship between self-identity confusion and IA and the mediating effects of psychological inflexibility and experiential avoidance (PI/EA) indicators in college students. A total of 500 college students (262 women and 238 men) were recruited. Their levels of self-identity were evaluated using the Self-Concept and Identity Measure. Their levels of PI/EA were examined using the Acceptance and Action Questionnaire-II. The severity of IA was assessed using the Chen Internet Addiction Scale. The relationships among self- identity, PI/EA, and IA were examined using structural equation modeling. The severity of self-identity confusion was positively associated with both the severity of PI/EA and the severity of IA. In addition, the severity of PI/EA indicators was positively associated with the severity of IA. These results demonstrated that the severity of self-identity confusion was related to the severity of IA, either directly or indirectly. The indirect relationship was mediated by the severity of PI/EA. Self-identity confusion and PI/EA should be taken into consideration by the community of professionals working on IA. Early detection and intervention of self-identity confusion and PI/EA should be the objectives for programs aiming to lower the risk of IA.

Associations Among Resilience, Stress, Depression, and Internet Gaming Disorder in Young Adults (2019)

Int J Environ Res Public Health. 2019 Aug 31;16(17). pii: E3181. doi: 10.3390/ijerph16173181.

Background and Aims: Using gaming to escape emotional difficulty has been suggested to be a candidate mechanism contributing to Internet gaming disorder (IGD). This study evaluated the associations among resilience, perceived stress, depression, and IGD.

Methods: A total of 87 participants in an IGD group and 87 participants in a control group were recruited into this study. IGD was diagnosed using the Diagnostic and Statistical Manual of Mental Disorders. Stress levels, resilience, and depression were measured by a self-reported questionnaire.

Results: The IGD group had a lower resilience, higher perceived stress, and depression than the control group. Hierarchical regression analysis demonstrated that resilience was associated with IGD when perceived stress was controlled. After depression was controlled, resilience and perceived stress were not associated with IGD. Among the IGD group, those with low resilience had higher depression. Furthermore, discipline was the resilience characteristic associated with IGD.

Conclusions: Low resilience was associated with a higher risk of IGD. IGD individuals with low resilience had higher depression. Depression was more associated with IGD than resilience. Depression assessments and stress coping interventions should be provided for individuals with IGD who exhibit low resilience or high stress.

Cognitive mechanism of intimate interpersonal relationships and loneliness in internet-addicts: An ERP study (2019)

Data on the relationship between internet addiction and stress among Lebanese medical students in Lebanon (2019)

Data Brief. 2019 Aug 6;25:104198. doi: 10.1016/j.dib.2019.104198.

Stress and behavioral addiction are becoming major health problems growing in strength and prevalence. They are often associated with a large array of debilitating diseases and conditions including psychosocial impairments. Medical students remain a vulnerable territory for developing stress and addiction mainly relating to Internet use. Data was gathered from medical students around Lebanon on the relationship between stress and internet addiction. The data in this article provides demographic data about medical students in Lebanon, their stress levels, sources of stress as well as the level of internet addiction recorded in relation to their stress levels. The analyzed data is provided in the tables included in this article.

Problematic internet use among students in South-East Asia: Current state of evidence (2018)

Indian J Public Health. 2018 Jul-Sep;62(3):197-210. doi: 10.4103/ijph.IJPH_288_17.

Problematic Internet use (PIU) among students has become a significant mental health concern. Our goals were to review the existing studies on problematic Internet from Southeast Asian Region and examine: the prevalence for PIU among students; explore for sociodemographic and clinical correlates; and assess the physical, mental, and psychosocial impact of PIU in this population. All studies conducted among population of the Southeast Asia, involving students (school students to postgraduate students) of any age which explored etiological factors and/or the prevalence or any other factor associated with PIU/Internet addiction were considered eligible for the present review. The electronic databases of PubMed and Google Scholar were systematically searched for the relevant published studies up to and including October 2016. Our search strategy yielded 549 articles, 295 of which were eligible for screening based on their publication in English language in a peer-reviewed journal. Of these, a total of 38 studies met the inclusion criteria and were included in the review. The prevalence of severe PIU/Internet addiction ranged from 0 to 47.4%, whereas the prevalence of Internet overuse/possible Internet addiction ranged from 7.4% to 46.4% among students from Southeast Asia. Physical impairments in the form of insomnia (26.8%), daytime sleepiness (20%), and eye strain (19%) were also reported among problem users. There is a need to conduct further research in this area to explore the protective and risk factors associated with it and also longitudinally assess the trajectories of the outcome.

Exercise as an Alternative Approach for Treating Smartphone Addiction: A Systematic Review and Meta-Analysis of Random Controlled Trials (2019)

Int J Environ Res Public Health. 2019 Oct 15;16(20). pii: E3912. doi: 10.3390/ijerph16203912.

With the emergence of electronic products, smartphones have become an indispensable tool in our daily life. On the other hand, smartphone addiction has become a public health issue. To help reduce smartphone addiction, cost-effective interventions such as exercise are encouraged.

We therefore performed a systematic review and meta-analysis evaluating existing literature on the rehabilitative effects of exercise interventions for individuals with a smartphone addiction.

We searched PubMed, Web of Science, Scopus, CNKI, and Wanfang from inception to September 2019. Nine eligible randomized controlled trials (RCT) were finally included for meta-analysis (SMD represents the magnitude of effect of exercise) and their methodological quality were assessed using the PEDro scale.

We found significant positive effects of exercise interventions (Taichi, basketball, badminton, dance, run, and bicycle) on reducing the total score (SMD = -1.30, 95% CI -1.53 to -1.07, p < 0.005, I² = 62%) of smartphone addiction level and its four subscales (withdrawal symptom: SMD = -1.40, 95% CI -1.73 to -1.07, p < 0.001, I² = 81%; highlight behavior: SMD = -1.95, 95% CI -2.99 to -1.66, p < 0.001, I² = 79%; social comfort: SMD = -0.99, 95% CI -1.18 to -0.81, p = 0.27, I² = 21%; mood change: SMD = -0.50, 95% CI 0.31 to 0.69, p = 0.25, I² = 25%). Furthermore, we found that individuals with severe addiction level (SMD = -1.19, I² = 0%, 95%CI:-1.19 to -0.98) benefited more from exercise engagement, as compared to those with mild to moderate addiction levels (SMD = – 0.98, I² = 50%, 95%CI:-1.31 to -0.66); individuals with smartphone addiction who participated in exercise programs of 12 weeks and above showed significantly greater reduction on the total score (SMD = -1.70, I² = 31.2%, 95% CI -2.04 to -1.36, p = 0.03), as compared to those who participated in less than 12 weeks of exercise intervention (SMD = -1.18, I² = 0%, 95% CI-1.35 to -1.02, p < 0.00001). In addition, individuals with smartphone addiction who participated in exercise of closed motor skills showed significantly greater reduction on the total score (SMD = -1.22, I² = 0 %, 95% CI -1.41 to -1.02, p = 0.56), as compared to those who participated in exercise of open motor skills (SMD = -1.17, I² = 44%, 95% CI-1.47 to -0.0.87, p = 0.03).

End-user frustrations and failures in digital technology: exploring the role of Fear of Missing Out, Internet addiction and personality (2018)

Heliyon. 2018 Nov 1;4(11):e00872. doi: 10.1016/j.heliyon.2018.e00872.

The present study aimed to explore the potential relationship between individual differences in responses to failures with digital technology. In total, 630 participants (50% male) aged between 18-68 years (M = 41.41, SD = 14.18) completed an online questionnaire. This included a self-report, response to failures in digital technology scale, a measure of Fear of Missing Out, Internet addiction, and the BIG-5 personality traits. Fear of Missing Out, Internet addiction, extraversion, and neuroticism all served as significant positive predictors for maladaptive responses to failures in digital technology. Agreeableness, conscientiousness, and openness acted as significant negative predictors for maladaptive responses to failures in digital technology. The responses to failures in digital technology scale presented good internal reliability, with items loading onto four key factors, these being; ‘maladaptive responses’, ‘adaptive responses’, ‘external support and venting frustrations’, and ‘anger and resignation’.

A pilot study of a group mindfulness-based cognitive-behavioral intervention for smartphone addiction among university students (2018)

J Behav Addict. 2018 Nov 12:1-6. doi: 10.1556/2006.7.2018.103.

Mindfulness-based intervention (MBI) has been applied in behavioral addiction studies in recent years. However, few empirical studies using MBI have been conducted for smartphone addiction, which is prevalent among Chinese university students. The aim of this study was to investigate the effectiveness of a group mindfulness-based cognitive-behavioral intervention (GMCI) on smartphone addiction in a sample of Chinese university students.

Students with smartphone addiction were divided into a control group (n = 29) and an intervention group (n = 41). The students in the intervention group received an 8-week GMCI. Smartphone addiction was evaluated using scores from the Mobile Phone Internet Addiction Scale (MPIAS) and self-reported smartphone use time, which were measured at the baseline (1st week, T1), post-intervention (8th week, T2), the first follow-up (14th week, T3), and the second follow-up (20th week, T4).

Twenty-seven students in each group completed the intervention and the follow-up. Smartphone use time and MPIAS scores significantly decreased from T1 to T3 in the intervention group. Compared with the control group, the intervention group had significantly less smartphone use time at T2, T3, and T4 and significantly lower MPIAS scores at T3.

Prevalence and Correlates of Excessive Smartphone Use among Medical Students: A Cross-sectional Study (2019)

Indian J Psychol Med. 2019 Nov 11;41(6):549-555. doi: 10.4103/IJPSYM.IJPSYM_75_19.

Increasing smartphone use has led to the introduction of smartphone addiction as a behavioral addiction with detrimental effects on health. This phenomenon has not been widely studied in the Indian context. This study assessed the rate of smartphone addiction in a sample of medical students, with a focus on its correlation with sleep quality and stress levels.

A cross-sectional study was conducted between November 2016 and January 2017 in 195 medical students. Their smartphone use, level of smartphone addiction, sleep quality, and perceived stress levels were measured using the Smartphone Addiction Scale-Short Version (SAS-SV), the Pittsburgh Sleep Quality Index (PSQI), and the Perceived Stress Scale (PSS-10), respectively.

Of the 195 students, 90 (46.15%) had smartphone addiction as per the scale. A self-reported feeling of having smartphone addiction, use of the smartphone right before sleeping, PSS scores, and PSQI scores were found to be significantly associated with the SAS-SV scores. Significant positive correlations were observed between the SAS-SV and PSS-10 scores, and the SAS-SV and PSQI scores.

There is a high magnitude of smartphone addiction in medical students of a college in Western Maharashtra. The significant association of this addiction with poorer sleep quality and higher perceived stress is a cause for concern. The high self-awareness among students about having smartphone addiction is promising. However, further studies are required to determine whether this self-awareness leads to treatment seeking. Further studies are required to explore our finding of the association of smartphone addiction with using the smartphone before sleeping.

Patterns, influencing factors and mediating effects of smartphone use and problematic smartphone use among migrant workers in Shanghai, China (2019)

Int Health. 2019 Oct 31;11(S1):S33-S44. doi: 10.1093/inthealth/ihz086.

With the popularization of smartphones in China, the conditions of smartphone use (SU) and problematic smartphone use (PSU) among migrant workers are unknown. This study explored the patterns and influencing factors of SU and PSU in migrant workers in Shanghai, China. Furthermore, the mediation effects of PSU in the link between SU and some psychological factors were also examined.

Questionnaires containing the Mobile Phone Addiction Index, Patient Health Questionnaire, World Health Organization Five-item Well-being Index and other items, including demographics, sleep quality, job stress and SU, were distributed to 2330 migrant workers by trained investigators in six districts of Shanghai from June to September 2018.

Of the 2129 returned questionnaires, 2115 were valid. SU and PSU varied according to certain demographics. Many demographics, psychological factors, sleep quality and main smartphone applications were influencing factors for SU and PSU. PSU played a mediating role in the link between daily SU time and psychological factors, including depression, mental health and job stress.

Relative risks of Internet-related addictions and mood disturbances among college students: a 7-country/region comparison (2018)

Public Health. 2018 Oct 19;165:16-25. doi: 10.1016/j.puhe.2018.09.010.

This study aimed to determine the relative risks of addiction to the Internet, online gaming and online social networking of college students in six Asian countries/regions (Singapore, Hong Kong [HK]/Macau, China, South Korea, Taiwan and Japan) compared with students in the United States (US). It also explored the relative risks of depression and anxiety symptoms among students with Internet-related addictions from these countries/regions.

A convenience sample of 8067 college students aged between 18 and 30 years was recruited from seven countries/regions. Students completed a survey about their use of the Internet, online gaming and online social networking as well as the presence of depression and anxiety symptoms.

For all students, the overall prevalence rates were 8.9% for Internet use addiction, 19.0% for online gaming addiction and 33.1% for online social networking addiction. Compared with the US students, Asian students showed higher risks of online social networking addiction but displayed lower risks of online gaming addiction (with the exception of students from HK/Macau). Chinese and Japanese students also showed higher risks of Internet addiction compared with the US students. In general, addicted Asian students were at higher risks of depression than the addicted US students, especially among Asian students who were addicted to online gaming. Addicted Asian students were at lower risks of anxiety than the addicted US students, especially among Asian students who were addicted to online social networking, and addicted students from HK/Macau and Japan were more likely to have higher relative risks of depression.

There are country/regional differences in the risks of Internet-related addictions and psychiatric symptoms. It is suggested that country/region-specific health education programmes regarding Internet-related addictions are warranted to maximise the efficiency of prevention and intervention. These programmes should attempt to tackle not only problematic Internet-related behaviours but also mood disturbances among college students.

Short version of the Smartphone Addiction Scale in Chinese adults: Psychometric properties, sociodemographic, and health behavioral correlates (2018)

J Behav Addict. 2018 Nov 12:1-9. doi: 10.1556/2006.7.2018.105

Problematic smartphone use (PSU) is an emerging but understudied public health issue. Little is known about the epidemiology of PSU at the population level. We evaluated the psychometric properties of the Smartphone Addiction Scale – Short Version (SAS-SV) and examined its associated sociodemographic factors and health behaviors in Chinese adults in Hong Kong.

A random sample of 3,211 adults aged ≥18 years (mean ± SD: 43.3 ± 15.7, 45.3% men) participated in a population-based telephone survey in Hong Kong and completed the Chinese SAS-SV. Multivariable linear regressions examined the associations of sociodemographic factors, health behaviors, and chronic disease status with SAS-SV score. Data were weighted by age, sex, and education attainment distributions of the Hong Kong general population.

The Chinese SAS-SV is internally consistent (Cronbach’s α = .844) and stable over 1 week (intraclass correlation coefficient = .76, p < .001). Confirmatory factor analysis supported a unidimensional structure established by previous studies. The weighted prevalence of PSU was 38.5% (95% confidence interval: 36.9%, 40.2%). Female sex, younger age, being married/cohabitated or divorced/separated (vs. unmarried), and lower education level were associated with a higher SAS-SV score (all ps <.05). Current smoking, weekly to daily alcohol drinking, and physical inactivity predict greater PSU after controlling for sociodemographic factors and mutual adjustment.

The Chinese SAS-SV was found valid and reliable for assessing PSU in Hong Kong adults. Several sociodemographic and health behavioral factors were associated with PSU at the population level, which may have implication for prevention of PSU and future research.

Adolescents’ smartphone use at night, sleep disturbance and depressive symptoms (2018)

Int J Adolesc Med Health. 2018 Nov 17.

Nowadays smartphones are used anywhere and at any time, day or night, by adolescents. Smartphone use, especially at night, is a risk factor for sleep disturbance and depression in adolescents. The purpose of this study was to analyse the correlation between smartphone use at night, sleep disturbance and depression symptoms in adolescents. This cross-sectional study analysed the data from 714 students in Surabaya, who were selected by using a simple random sampling technique. The independent variable was smartphone usage at night while the dependent variable was sleep disturbance and depressive symptoms. The data was collected using three questionnaires: the smartphone usage at night questionnaire, the Insomnia Severity Index questionnaire and the Kutcher Adolescent Depression Scale questionnaire. The data was then analysed using Spearman’s rho analysis (α < 0.05). The results indicated that there was a relationship between the use of smartphones at night and sleep disturbance in adolescents with a positive correlation (r = 0.374), and that there was a relationship between the use of smartphones at night and depression symptoms in adolescents with a positive correlation (r = 0.360). This study highlights that the excessive use of smartphones during the night may play a significant role in sleep problems and depressive symptoms among teenagers. Adolescents with sleep disturbance and depressive symptoms should be carefully monitored for signs of smartphone addiction. Nurses should improve health education for adolescents to inform them about the positive use of smartphones to prevent sleep disturbance and to minimise depressive symptoms.

Problematic internet use and study motivation in higher education (2020)

Journal of Computer Assisted Learning, 2019; DOI: 10.1111/jcal.12414

The current study explored the relationship between problematic internet use (PIU) and motivation to learn, and examined psychological and social factors mediating this relationship. Two hundred and eighty‐five students in an Italian University were recruited for the current study. There was a negative relationship between PIU and motivation to study: a negative impact on learning strategies, meaning that the students found it harder to organize their learning productively; and PIU also positively associated with test anxiety. The current results also demonstrated that there was partial mediation of this effect of PIU on learning strategies in terms of loneliness. This suggest at those with high levels of PIU may be particularly at risk from lower motivations to study, and, hence, lower actual generalized academic performance due to a number of consequences of PIU.

Lay Description

• The current study explored the relationship between problematic internet use (PIU) and motivation to learn.
• There was a negative relationship between PIU and motivation to study.
• PIU was positively associated with test anxiety.
• Loneliness partially mediated the effect of PIU on learning strategies
• Those with high levels of PIU are at risk from lower motivation to study.

The Smartphone Addiction Levels and the Association With Communication Skills in Nursing and Medical School Students (2020)

J Nurs Res. 2020 Jan 16. doi: 10.1097/jnr.0000000000000370.

The use of smartphones among young people is quite common. However, smartphones are associated with negative effects when used excessively. It has been reported that smartphone use may adversely affect learning in the classroom, cause safety issues, and negatively affect interpersonal communications.

The aims of this study were to determine the level of smartphone addiction among nursing and medical school students and to examine the effect of smartphone addiction level on communication skills.

This cross-sectional study was conducted with medical school and nursing students at a public university (502 participants). Data were collected using a personal information form, the Smartphone Addiction Scale-Short Version (SAS-SV), and the Communication Skills Assessment Scale.

All of the participants in the study owned smartphones. Most (70.9%) were female, and 58.2% were in the nursing program. The participants used smartphones for a mean time of 5.07 ± 3.32 hours a day, primarily for messaging. The mean total SAS-SV score for the participants was 31.89 ± 9.90, and a significant difference in SAS-SV mean scores was found with regard to the variables of department, gender, daily smartphone use duration, academic success, status regarding smartphone use in the classroom, participation in sports, easy communication with patients and relatives, preferred mode of communication, health problems tied to phone use, and injury status (p < .05). In addition, a positive weak-to-moderate relationship was found between SAS-SV mean scores and the variables of daily smartphone use duration and years of smartphone use, whereas a negative weak relationship was found between SAS-SV mean scores and Communication Skills Assessment Scale scores. Daily smartphone use duration was found to be the most important predictor of smartphone addiction.

Facebook addiction and personality (2020)

Heliyon. 2020 Jan 14;6(1):e03184. doi: 10.1016/j.heliyon.2020.e03184.

This study explored the associations between Facebook addiction and personality factors. A total of 114 participants (age range of participants is 18-30 and males were 68.4% and females were 31.6 %) have participated through an online survey. The results showed that 14.91 % of the participants had reached the critical polythetic cutoff score, and 1.75 % has reached the monothetic cutoff score. The personality traits, such as extraversion, openness to experience, neuroticism, agreeableness, conscientiousness, and narcissism, are not related to Facebook addiction and Facebook intensity. Loneliness was positively related to Facebook addiction, and it significantly predicted Facebook addiction by accounting to 14% of the variation in Facebook addiction. The limitations and suggestions for further research have been discussed.

Smartphone and Facebook addictions share common risk and prognostic factors in a sample of undergraduate students (2019)

Trends Psychiatry Psychother. 2019 Oct-Dec;41(4):358-368. doi: 10.1590/2237-6089-2018-0069.

To improve the comprehension of the interface between smartphone addiction (SA) and Facebook addiction (FA), we hypothesize that the occurrence of both technological addictions correlate, with higher levels of negative consequences. Moreover, we hypothesize that SA is associated with lower levels of social support satisfaction.

We recruited a convenience sample of undergraduate students from Universidade Federal de Minas Gerais, with age ranging between 18 and 35 years. All subjects completed a self-fulfilled questionnaire comprising sociodemographic data, the Brazilian Smartphone Addiction Inventory (SPAI-BR), the Bergen Scale for Facebook Addiction, the Barrat Impulsivity Scale 11 (BIS-11), the Social Support Satisfaction Scale (SSSS), and the Brief Sensation Seeking Scale (BSSS-8). After completing the questionnaire, the interviewer conducted a Mini-International Neuropsychiatric Interview (MINI).

In the univariate analysis, SA associated with female gender, with ages 18 to 25 years, FA, substance abuse disorders, major depressive disorder, anxiety disorders, low scores in SSSS, high scores in BSSS-8, and high scores in BIS. The group with SA and FA presented a higher prevalence of substance abuse disorders, depression, and anxiety disorders when compared to the group with SA only.

In our sample, co-occurrence of SA and FA correlated with higher levels of negative consequences and lower levels of social support satisfaction. These results strongly suggest that SA and FA share some elements of vulnerability. Further studies are warranted to clarify the directions of these associations.

The Mediating Role of Coping Styles on Impulsivity, Behavioral Inhibition/Approach System, and Internet Addiction in Adolescents From a Gender Perspective (2019)

Front Psychol. 2019 Oct 24;10:2402. doi: 10.3389/fpsyg.2019.02402

Previous findings have shown that impulsivity and Behavioral Inhibition/Approach System (BIS/BAS) have substantial effects on adolescents’ Internet addiction, but the mechanisms underlying these associations and gender differences in these effects have received little attention. We examined the mediating effects of coping styles from impulsivity, and BIS/BAS to Internet addiction as well as gender differences in these associations. A total of 416 Chinese adolescents were examined using a cross-sectional survey involving Young’s Diagnostic Questionnaire for Internet Addiction, Barratt Impulsiveness Scale, BIS/BAS scales, and Coping Style Scale for Middle School Students. The data were analyzed using the independent sample t-test, chi-square test, Pearson correlation, and structure equation modeling. The results from the multiple-group (by adolescent gender) structural model analysis revealed that both impulsivity (p < 0.001) and BIS (p = 0.001) directly predicted positive Internet addiction in girls, while both impulsivity (p = 0.011) and BAS (p = 0.048) directly predicted positive Internet addiction in boys. Furthermore, emotion-focused coping mediated the relationship between impulsivity and Internet addiction (β = 0.080, 95% CI: 0.023-0.168) and the relationship between BIS and Internet addiction (β = 0.064, 95% CI: 0.013-0.153) in girls, while in boys, problem-focused coping and emotion-focused coping mediated the association between impulsivity and Internet addiction (β = 0.118, 95% CI: 0.031-0.251; β = 0.065, 95% CI: 0.010-0.160, respectively) and problem-focused coping mediated the association between BAS and Internet addiction [β = -0.058, 95% CI: (-0.142)-(-0.003)]. These findings extend our insight into the mechanisms underlying the associations among impulsivity, BIS/BAS, and Internet addiction in adolescents and suggest that gender-sensitive training approaches to decrease adolescents’ Internet addiction are indispensable. These interventions should focus on the different gender predictors of adolescent Internet addiction and on the development of specific coping styles for boys and girls respectively.

Ethical Considerations for Mental Health Clinicians Working with Adolescents in the Digital Age. (2018)

Curr Psychiatry Rep. 2018 Oct 13;20(12):113. doi: 10.1007/s11920-018-0974-z.

Adolescents’ use of digital technologies is constantly changing and significantly influences and reflects their mental health and development. Technology has entered the clinical space and raises new ethical dilemmas for mental health clinicians. After an update on this shifting landscape, including a brief review of important literature since 2014, this article will demonstrate how core ethical principles may be applied to clinical situations with patients, using vignettes for illustration.

The vast majority of adolescents (95%) across all demographic groups can access smartphones (Anderson et al. 2018•). Technology use in mental health is also expanding, including a proliferation of “apps.” While qualitative data from technology experts reports overall positive effects of technology (Anderson and Rainie 2018), concern about its potential negative impact on youth mental health remains high, and an association between technology use and depression is strong. Internet addiction, online sexual exploitation, and accessing illicit substances through the “dark net” pose additional clinical and legal concerns. In this context, clinicians have an ethical responsibility to engage in education and advocacy, to explore technology use with teen patients and to be sensitive to ethical issues that may arise clinically, including confidentiality, autonomy, beneficence/nonmaleficence, and legal considerations such as mandated reporting. New media and digital technologies pose unique ethical challenges to mental health clinicians working with adolescents. Clinicians need to stay abreast of current trends and controversies about technology and their potential impact on youth and engage in advocacy and psychoeducation appropriately. With individual patients, clinicians should watch for potential ethical dilemmas stemming from technology use and think them through, with consultation as needed, by applying longstanding core ethical principles.

The Moderating Role of State Attachment Anxiety and Avoidance Between Social Anxiety and Social Networking Sites Addiction (2019)

Psychol Rep. 2019 Jan 6:33294118823178. doi: 10.1177/0033294118823178.

This study aims to explore the relationships among social anxiety, social networking sites (SNS) addiction, and SNS addiction tendency and further to examine the moderating role of state attachment anxiety and state attachment avoidance. A sample of Chinese young adults ( N = 437, M_age = 24.21 ± 3.25, 129 males) participated in this study, the data were collected through self-reports. Results revealed that participants’ social anxiety was positively associated with SNS addiction and SNS addiction tendency. State attachment anxiety moderated these two relationships after controlling gender, age, and state attachment avoidance, while state attachment avoidance showed no significant moderating effect. Specifically, the positive relationships between social anxiety and SNS addiction (tendency) were restricted to individuals with low state attachment anxiety. While for individuals with high state attachment anxiety, social anxiety was no longer associated with SNS addiction or SNS addiction tendency.

Applying behavioral economic theory to problematic Internet use: An initial investigation (2018)

Psychol Addict Behav. 2018 Nov;32(7):846-857. doi: 10.1037/adb0000404.

The current study seeks to apply a behavioral economic framework to Internet use, testing the hypothesis that, similar to other addictive behaviors, problematic Internet use is a reinforcer pathology, reflecting an overvaluation of an immediately acquirable reward relative to prosocial and delayed rewards. Data were collected through Amazon’s Mechanical Turk data collection platform. A total of 256 adults (Mage = 27.87, SD = 4.79; 58.2% White, 23% Asian; 65.2% had an associate degree or greater) completed the survey. Measures of delay discounting, consideration of future consequences, Internet demand, and alternative reinforcement all contributed unique variance in predicting both problematic Internet use and Internet craving. In aggregate models controlling for all significant predictors, alternative reinforcement and future valuation variables contributed unique variance. Individuals with elevated demand and discounting were at greatest risk for problematic Internet use. Consistent with behavioral economic research among substance abusing samples, individuals engaging in heavy Internet use report elevated motivation for the target behavior coupled with diminished motivation for other potentially rewarding activities, especially those associated with delayed reward.

Overlapping dimensional phenotypes of impulsivity and compulsivity explain co-occurrence of addictive and related behaviors (2018)

CNS Spectr. 2018 Nov 21:1-15. doi: 10.1017/S1092852918001244.

Impulsivity and compulsivity have been implicated as important transdiagnostic dimensional phenotypes with potential relevance to addiction. We aimed to develop a model that conceptualizes these constructs as overlapping dimensional phenotypes and test whether different components of this model explain the co-occurrence of addictive and related behaviors.

A large sample of adults (N=487) was recruited through Amazon’s Mechanical Turk and completed self-report questionnaires measuring impulsivity, intolerance of uncertainty, obsessive beliefs, and the severity of 6 addictive and related behaviors. Hierarchical clustering was used to organize addictive behaviors into homogenous groups reflecting their co-occurrence. Structural equation modeling was used to evaluate fit of the hypothesized bifactor model of impulsivity and compulsivity and determine the proportion of variance explained in the co-occurrence of addictive and related behaviors by each component of the model.

Addictive and related behaviors clustered into 2 distinct groups: Impulse-Control Problems, consisting of harmful alcohol use, pathological gambling, and compulsive buying, and Obsessive-Compulsive-Related Problems, consisting of obsessive-compulsive symptoms, binge eating, and internet addiction. The hypothesized bifactor model of impulsivity and compulsivity provided the best empirical fit, with 3 uncorrelated factors corresponding to a general Disinhibition dimension, and specific Impulsivity and Compulsivity dimensions. These dimensional phenotypes uniquely and additively explained 39.9% and 68.7% of the total variance in Impulse-Control Problems and Obsessive-Compulsive-Related Problems.

A model of impulsivity and compulsivity that represents these constructs as overlapping dimensional phenotypes has important implications for understanding addictive and related behaviors in terms of shared etiology, comorbidity, and potential transdiagnostic treatments.

Internet : abuse, addiction and benefits (2018)

Rev Med Brux. 2018;39(4):250-254.

In this article, we propose to review the recent literature on Internet addiction (AI) by addressing several themes : we will begin by detailing the various questions that have arisen over time as to the reality of the syndrome and the responses that have been provided by the clinical and neuroimaging studies ; we will then discuss comorbidity problems as well as factors favoring the emergence of the AI and its consequences on health ; we will then detail the different treatments proposed and in a dialectical spirit, we will discuss the advantages that a moderate use of the Internet can have on the cognitive functioning as well as different tracks for future researches.

The relationship between Internet Use Disorder, depression and burnout among Chinese and German college students (2018)

Addict Behav. 2018 Aug 27;89:188-199. doi: 10.1016/j.addbeh.2018.08.011.

In the present study, we investigated the relationship between depression and Internet Use Disorder (IUD) and between burnout and IUD among German as well as Chinese college students. Due to cultural differences and their implications for the individual’s psychological health, we expected Chinese college students to have in particular higher IUD than German college students. We further expected to find positive relationships between depression and IUD and between burnout and IUD. Furthermore, we believed these relationships to reflect global effects and thus to be present in both samples. The data showed that Chinese college students had higher average burnout scores in the subscales MBI Emotional Exhaustion and MBI Cynicism and also higher IUD scores, but not higher depression scores. As expected, the correlation analysis revealed significant, positive correlations between depression and IUD as well as between burnout and IUD. The results are consistent in both samples, implying that the effect is globally valid. Furthermore, we observed that the relationship between depression and IUD is stronger than the relationship between emotional exhaustion and IUD in both samples, although this effect was not significant. We conclude that burnout and depression are related to IUD and that this relationship is valid independently of the cultural background of an individual.

Spanish version of the Phubbing Scale: Internet addiction, Facebook intrusion, and fear of missing out as correlates (2018)

Psicothema. 2018 Nov;30(4):449-454. doi: 10.7334/psicothema2018.153.

Phubbing is an increasingly common behavior that involves using a smartphone in a social setting of two or more people and interacting with the phone rather than with the other people. Research to date on phubbing has measured it using different scales or single questions, and therefore standard measures with appropriate psychometric properties are needed to improve its assessment. The aim of our study was to develop a Spanish version of the Phubbing Scale and to examine its psychometric properties: factor structure, reliability, and concurrent validity.

Participants were 759 Spanish adults between 18 and 68 years of age. They completed an online survey.

The results support a structure that is consistent with the original validation study, with two factors: Communication Disturbance and Phone Obsession. Internal consistency was found to be adequate. Evidence of concurrent validity was provided via a hierarchical regression model that showed positive associations with measures of internet addiction, Facebook intrusion, and fear of missing out.

Problematic Internet use and its associations with health-related symptoms and lifestyle habits among rural Japanese adolescents (2018)

Psychiatry Clin Neurosci. 2018 Oct 29. doi: 10.1111/pcn.12791.

There have been concerns about the increase in problematic Internet use (PIU) and its impact on lifestyle habits and health-related symptoms, given the rapid spread of smartphones. This study aimed to clarify PIU prevalence over 3 years in the same area and investigate lifestyle and health-related factors related to PIU among junior high-school students in Japan.

Each year during 2014-2016, a survey was conducted with junior high-school students from a rural area of Japan (2014, n = 979; 2015, n = 968; 2016, n = 940). Young’s Internet Addiction Test was used to assess participants’ PIU. Students scoring 40 or higher on the Internet Addiction Test were classified as showing PIU in this study. The associations between PIU and lifestyle factors (e.g., exercise habits, weekday study time, and sleep time) and health-related symptoms (depressive symptoms and orthostatic dysregulation (OD) symptoms) were studied by logistic regression analyses.

Over the 3 years, the prevalence of PIU was 19.9% in 2014, 15.9% in 2015 and 17.7% in 2016 without significant change. PIU was significantly associated with skipping breakfast, having a late bedtime (after midnight), and having OD symptoms among all grade students. Sleepiness after awakening in the morning, less studying time, and depressive symptoms had significant positive associations with PIU, except among 1^st grade students.

Our results suggest that PIU is related to decreased time spent on sleep, study, and exercise and increased symptoms of depression and OD. Further investigations are needed to develop preventive measures for PIU.

Prevalence of Internet Addiction and Associated Psychological Co-morbidities among College Students in Bhutan (2018)

JNMA J Nepal Med Assoc. 2018 Mar-Apr;56(210):558-564.

This cross sectional study included 823 first year and final year students aged 18-24 from six colleges in Bhutan. A self-administered questionnaire consisting of three parts was utilized for data collection. The data was entered and validated in Epidata and analyzed using STATA/IC 14.

The prevalence of moderate and severe internet addiction was 282 (34.3%) and 10 (1%) respectively. Positive correlations between internet addiction and psychological well-being (r= 0.331 95% CI: 0.269, 0.390), between Internet Addiction score and years of internet usage (r=0.104 95% CI: 0.036, 0.171), age and years of using internet (r= 0.8 95% CI: 0.012, 0.148) were observed. The commonest mode of internet use was martphone 714 (86.8%). The use of computer laboratory (aPR 0.80, 95%CI: 0.66, 0.96) and internet use for news and educational purposes (aPR 0.76, 95%CI: 0.64, 0.9) showed protective effects.

Internet Addiction In Medical Students (2019)

J Ayub Med Coll Abbottabad. 2018 Oct-Dec;30(Suppl 1)(4):S659-S663.

It is a multi-dimensional behavioural disorder that manifest in various physical, psychological and social disorders and causes a number of functional and structural changes in brain with related various comorbidities. There is paucity of local researches on this topic but the access to internet and its use is enormous. This study was conducted to find the magnitude of internet addiction in medical students.

It was a descriptive crosssectional study carried out in Ayub Medical College, Abbottabad. One hundred & forty-eight students were selected in the survey using stratified random sampling. The data was collected using academic and school competence scale and internet addiction diagnostic criteria.

In this study, 11 (7.86%) fulfilled the criteria for internet addiction. Most of the students 93 (66.3%) used internet to visit social media applications. Majority of the students 10 (90.9%), showed tolerance as major non-essential symptom of internet addiction. Internet addicts showed significant p=0.01 below average academic performance when compared to non-addicts. Internet addiction showed a significant p=0.03 gender association with internet addiction more prevalent in females than males (12.5% Vs 2.9%).

Comparison of Students With and Without Problematic Smartphone Use in Light of Attachment Style (2019)

Front Psychiatry. 2019 Sep 18;10:681. doi: 10.3389/fpsyt.2019.00681.

Background: Nowadays, media addictions are especially of high relevance to psychotherapeutic practice. More recently, this particularly includes excessive smartphone usage. Even though a growing number of scientific literature and also mainstream media highlight problematic smartphone use as a serious health problem, there is only little research on this issue. Objective: The aim of this study was to examine this phenomenon with a focus on attachment-specific differences between students with and without problematic smartphone use. Method: A survey was carried out on all enrolled students of the Sigmund Freud University Vienna. The Smartphone Addiction Scale (SPAS) was used to differentiate between students with and without problematic smartphone use. The attachment style was assessed using the Bielefeld Partnership Expectations Questionnaire (BFPE). Results: Of the total sample, 75 of the students (15.1%) showed a problematic smartphone use. A positive correlation between excessive smartphone usage and an insecure attachment style was found. Discussion: Therapy for problematic smartphone use should be carried out in light of patient’s attachment style. Further research into other factors of mental stress and personality is needed to better understand problematic smartphone use.

The Relationship Between Adolescents’ Stress and Internet Addiction: A Mediated-Moderation Model (2019)

Front Psychol. 2019 Oct 4;10:2248. doi: 10.3389/fpsyg.2019.02248.

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

Relationship between headache and Internet addiction in children (2019)

Anxiety-Related Coping Styles, Social Support, and Internet Use Disorder (2019)

Front Psychiatry. 2019 Sep 24;10:640. doi: 10.3389/fpsyt.2019.00640.

Objective: The Internet can offer a seemingly safe haven for those being disappointed by relationships in the “offline world”. Although the Internet can provide lonely people with opportunities to seek for help and support online, complete withdrawal from the offline world comes with costs. It is discussed if people can even become “addicted” to the Internet. Of note, meanwhile, many researchers prefer the term Internet use disorder (IUD) instead of using the term “Internet addiction”. To illustrate the importance of one’s own social network supporting a person in everyday life, we investigated, for the first time to our knowledge, how social resources in terms of quality and quantity might represent a buffer against the development of IUD. Furthermore, anxiety related coping styles are investigated as a further independent variable likely impacting on the development of an IUD. Method: In the present work, N = 567 participants (n = 164 males and n = 403 females; M_age = 23.236; SD_age = 8.334) filled in a personality questionnaire assessing individual differences in cognitive avoidant and vigilant anxiety processing, ergo, traits describing individual differences in everyday coping styles/modes. Moreover, all participants provided information on individual differences in tendencies toward IUD, the perceived quality of social support received, and the size of their social network (hence a quantity measure). Results: Participants with larger social networks and higher scores in the received social support reported the lowest tendencies toward IUD in our data. A vigilant coping style was positively correlated with tendencies toward IUD, whereas no robust associations could be observed between a cognitive avoidant coping style and tendencies toward IUD. Hierarchical linear regression underlined an important predictive role of the interaction term of vigilance in ego-threat scenarios and perceived quality of social support. Conclusion: The current study not only yields support for the hypothesis that the size of one’s own social network as well as the perceived quality of social support received in everyday life present putative resilience factors against developing IUD. It also supports the approach that special coping styles are needed to make use of the social support offered.

The Neuroscience of Smartphone/Social Media Usage and the Growing Need to Include Methods from ‘Psychoinformatics’ (2019)

Information Systems and Neuroscience pp 275-283

The present work gives a brief overview of the current state of affairs in the investigation of the neuroscientific underpinnings of social media use. Such an overview is of importance because individuals spend significant amounts of time on these ‘social’ online channels. Despite several positive aspects of social media use, such as the ability to easily communicate with others across long distances, it is clear that detrimental effects on our brains and minds are possible. Given that much of the neuroscientific and psychological research conducted up to now relies solely on self-report measures to assess social media usage, it is argued that neuroscientists/psychologists need to include more digital traces resulting from human-machine/computer interaction, and/or information shared by individuals on social media, in their scientific analyses. In this realm, digital phenotyping can be achieved via methods of ‘Psychoinformatics’, a merger of the disciplines psychology and computer science/informatics.

A Study of the Correlation Between Internet Addiction and Aggressive Behaviour Among the Namibian University Students (2019)

Data Science and Big Data Analytics pp 1-9

The explosion of online Social Networking Sites over time has its benefits as well as its risks. A potential risk is the fact that so many individuals have become victims of aggressive and cyber-bullying acts via Online Social Networking Sites. In the paper, the aim of this study is to analyse the correlation between Internet addiction and Aggressive Behavior Among the Namibian University Students. Based on statistical analysis the paper concluded that there is a worthwhile correlation between Internet addiction and Aggressive Behaviour and a sizable majority of the students who participated in the study suffer from moderate addiction problems due to their Internet usage. Also, the results indicate that the two most prevalent forms of aggression among the majority of the students are hostility and Physical Aggression.

Profiles of Problematic Internet Use and Its Impact on Adolescents’ Health-Related Quality of Life (2019)

Int J Environ Res Public Health. 2019 Oct 13;16(20). pii: E3877. doi: 10.3390/ijerph16203877.

The internet has been a breakthrough for adolescents in many ways, but its use can also become dysfunctional and problematic, leading to consequences for personal well-being. The main objective is to analyze profiles related to problematic internet use and its relationship with health-related quality of life (HRQoL). An analytical and cross-sectional study was carried out in a region of northern Spain. The sample comprised 12,285 participants. Sampling was random and representative. Mean age and standard deviation was 14.69 ± 1.73 (11-18 years). The Spanish versions of the Problematic and Generalized Internet Use Scale (GPIUS2) and of the Health-Related Quality of Life (KIDSCREEN-27) were used. Four profiles were detected (non-problematic use, mood regulator, problematic internet use, and severe problematic use). The prevalence of these last two profiles was 18.5% and 4.9%, respectively. Problematic internet use correlated negatively and significantly with HRQoL. The severe problematic use profile presented a significant decrease in all dimensions of HRQoL. Analyses were carried out to extract a diagnostic cut-off point for GPIUS2 (52 points).

The Relationship Between Parental Attachment and Mobile Phone Dependence Among Chinese Rural Adolescents: The Role of Alexithymia and Mindfulness (2019)

Front Psychol. 2019 Mar 20;10:598. doi: 10.3389/fpsyg.2019.00598.

Mobile phone has experienced a significant increase in popularity among adolescents in recent years. Findings indicate dependence on mobile phone is related to poor parent-child relationship. However, previous research on mobile phone dependence (MPD) is scant and mainly focus on adult samples. In this view, the present study investigated the association between parental attachment and MPD as well as its influence mechanism, in sample of adolescents in rural China. Data were collected from three middle schools in rural areas of Jiangxi and Hubei Province (N = 693, 46.46% female, M _age = 14.88, SD = 1.77). Participants completed the Inventory of Parent and Peer Attachment (IPPA), the twenty-item Toronto alexithymia scale (TAS-20), the Mindful Attention Awareness Scale (MAAS) and the Mobile Phone Addiction Index Scale (MPAI). Among the results, parental attachment negatively predicted MPD and alexithymia were exerting partial mediation effect between parental attachment and MPD. Further, mindfulness acted as moderator of the relationship between alexithymia and MPD: The negative impact of alexithymia on MPD was weakened under the condition of high level of mindfulness. Knowledge of this mechanism could be useful for understanding adolescents’ MPD in terms of the interaction of multiple factors.

Problematic internet use and its correlates among resident doctors of a tertiary care hospital of North India: A cross-sectional study (2018)

Asian J Psychiatr. 2018 Nov 26;39:42-47. doi: 10.1016/j.ajp.2018.11.018.

Problematic Internet use/ Internet addiction (IA) has gained the attention of mental health professionals recently and studies have found that medical professionals are not immune to IA with prevalence rate ranging from 2.8 to 8%. Few studies from India have also reported high rates of IA among medical students. The term ‘Problematic internet use’ is being increasing used nowadays in place of IA as it signifies a better terminology than the word ‘addiction’ per se. However, there is lack of information among resident doctors.

To evaluate the prevalence of problematic Internet use and its association with depressive symptoms, perceived stress, and health care outcomes among resident doctors working in a government funded tertiary care Institute.

An online e-mail survey was carried out among medical professionals (a total of 1721 doctors) in a tertiary care hospital located in Chandigarh, India out of whom 376 responded. The residents doctors were the postgraduate trainees (MBBS) and those residents who have complete post-graduation and working as senior residents/registrar (MBBS, MD/MS). They were in the age group ranging from 24 to 39 years. The survey included Young’s Internet addiction test (IAT), Patient Health Questionnaire-9 (PHQ-9), Cohen’s Perceived Stress Scale, Maslach Burnout Inventory and a self designed questionnaire to assess the health care related outcomes.

On IAT, 142 residents (37.8%) scored <20 i.e., normal users and 203 residents (54%) had mild addiction. Only 31 residents (8.24%) had moderate addiction category, none of the residents had severe IA (score>80). Those with IA reported higher level of depressive symptoms, perceived stress and burnout. There was positive association between ever use of alcohol and watching pornography (as a part of recreational activities) with IA. Significantly higher proportion of those with IA, reported having faced physical abuse and verbal abuse in the hands of the patients/caregivers.

The present study suggests that about 8.24% of resident doctors have Problematic internet use/IA. Problematic internet use/IA is associated with presence of higher level of depressive symptoms, perceived stress and burn out. Further, Problematic internet use/IA is also associated with higher likelihood of facing violence in the hands of patients and their caregivers.

Social and Psychological Effects of the Internet Use (2018)

Acta Inform Med. 2016 Feb;24(1):66-8. doi: 10.5455/aim.2016.24.66-68

Relationship between anxiety, depression, sex, obesity, and internet addiction in Chinese adolescents: A short-term longitudinal study (2018)

Addict Behav. 2018 Dec 7;90:421-427. doi: 10.1016/j.addbeh.2018.12.009.

Associations between anxiety, depression and adolescent Internet addiction have been well documented in the literature; however, few published studies have examined these relationships considering the developmental trajectory courses of adolescent Internet addiction as well as the individual differences over time. Using a sample of 1545 Chinese adolescents and 3 waves of data over six months, we examined the longitudinal associations between anxiety and depression and Internet addiction, considering sex and obesity. We used latent growth curve modeling (LGCM) to examine the overall conditions of Internet addiction, and latent class growth modeling (LCGM) to determine adolescent developmental membership for Internet addiction. Both unconditional and conditional models were performed. Anxiety and depression were analyzed as time-varying variables, and sex and obesity as time-invariants in our conditional models. Overall, there was a linear decline in adolescent Internet addiction over the six months. Anxiety and depression positively predicted adolescent Internet addiction. Two developmental trajectory patterns for Internet addiction were determined (i.e., low/declining, high/declining). Anxiety was associated with adolescent Internet addiction for both groups of adolescents, but depression was associated with Internet addiction only for adolescents who followed a low/declining course of Internet addiction. Boys reported a higher mean score of Internet addiction at the initial status than girls, and boys also had a faster, declining rate of change over the six months than girls. Obesity was not a predictor of Internet addiction.

Unpacking the mechanisms underlying the relation between ostracism and Internet addiction (2018)

Psychiatry Res. 2018 Dec;270:724-730. doi: 10.1016/j.psychres.2018.10.056.

Prior studies have mainly focused on the psychological correlates of Internet addiction, but scant research has tested how actual interpersonal experience can influence people’s tendency to spend an excessive amount of time online. The present research aimed to fill the research gap by investigating the potential relationship between ostracism and Internet usage as well as the mechanisms underlying such a linkage. Participants completed a series of well-validated measures assessing their ostracism experience in school, solitude seeking, self-control, and Internet addiction. The results established a significant positive association between ostracism and Internet addiction and demonstrated this relation was mediated by enhanced solitude seeking and impaired self-control. These findings advanced our current knowledge by showing that adverse interpersonal experiences in school can predict Internet addiction and by unveiling the underlying psychological mechanisms that can account for such a relation.

The relationship between anxiety symptom severity and problematic smartphone use: A review of the literature and conceptual frameworks (2018)

J Anxiety Disord. 2018 Nov 30;62:45-52. doi: 10.1016/j.janxdis.2018.11.005.

In the present paper, we examine the literature studying relations between problematic smartphone use (PSU) and anxiety symptom severity. We first present background on the health advantages and disadvantages of using a smartphone. Next, we provide caveats in distinguishing healthy smartphone use from unhealthy PSU, and we discuss how PSU is measured. Additionally, we discuss theoretical frameworks explaining how some people develop PSU, including Uses and Gratifications Theory, and Compensatory Internet Use Theory. We present our own theoretical model of how PSU is specifically related to anxiety.

Addiction to the Internet and mobile phones and its relationship with loneliness in Iranian adolescents (2018)

Int J Adolesc Med Health. 2018 Dec 4. pii: /j/ijamh.ahead-of-print/ijamh-2018-0035/ijamh-2018-0035.xml. doi: 10.1515/ijamh-2018-0035.

Addiction to the Internet and mobile phones in adolescents could be related to loneliness. However, less research has been conducted on this topic in developing countries. This study aimed to examine addiction to the Internet and mobile phones and its relationship with loneliness in adolescents in Iran.

This was a cross-sectional and analytic study that was conducted between 2015 and 2016 in Rasht, in the north of Iran. Subjects were selected through cluster sampling from female and male teens who were studying in the public and private schools. The Kimberly’s Internet Addiction Test, Cell phone Overuse Scale (COS), and the University of California , Los Angeles (UCLA) Loneliness Scale were used for data collection.

The mean age of participants was 16.2 ± 1.1 year. The mean of addiction to the Internet was 42.2 ± 18.2. Overall, 46.3% of the subjects reported some degrees of addiction to the Internet. The mean of addiction to mobile phones was 55.10 ± 19.86. The results of this study showed that 77.6% (n = 451) of the subjects were at risk for addiction to mobile phones, and 17.7% (n = 103) of them were addicted to their use. The mean of loneliness was 39.13 ± 11.46 in the adolescents. Overall, 16.9% of the subjects obtained a score higher than mean in loneliness. A statistically significant direct relationship was found between addiction to the Internet and loneliness in the adolescents (r = 0.199, p = 0.0001). The results also showed a statistically significant direct relationship between addiction to mobile phones and loneliness in the adolescents (r = 0.172, p = 0.0001).

The results of this study revealed that a high percentage of adolescents who have some degrees of addiction to the Internet and mobile phones experience loneliness, and there are relationships between these variables.

Association between problematic Internet use, sleep disturbance, and suicidal behavior in Chinese adolescents (2018)

J Behav Addict. 2018 Nov 26:1-11. doi: 10.1556/2006.7.2018.115.

This large-scale study aimed to test (a) associations of problematic Internet use (PIU) and sleep disturbance with suicidal ideation and suicide attempts among Chinese adolescents and (b) whether sleep disturbance mediates the association between PIU and suicidal behavior.

Data were drawn from the 2017 National School-based Chinese Adolescents Health Survey. A total of 20,895 students’ questionnaires were qualified for analysis. The Young’s Internet Addiction Test was used to assess PIU, and level of sleep disturbance was measured by the Pittsburgh Sleep Quality Index. Multilevel logistic regression models and path models were utilized in analyses.

Of the total sample, 2,864 (13.7%) reported having suicidal ideation, and 537 (2.6%) reported having suicide attempts. After adjusting for control variables and sleep disturbance, PIU was associated with an increased risk of suicidal ideation (AOR = 1.04, 95% CI = 1.03-1.04) and suicide attempts (AOR = 1.03, 95% CI = 1.02-1.04). Findings of the path models showed that the standardized indirect effects of PIU on suicidal ideation (standardized β estimate = 0.092, 95% CI = 0.082-0.102) and on suicide attempts (standardized β estimate = 0.082, 95% CI = 0.068-0.096) through sleep disturbance were significant. Conversely, sleep disturbance significantly mediated the association of suicidal behavior on PIU.

There may be a complex transactional association between PIU, sleep disturbance, and suicidal behavior. The estimates of the mediator role of sleep disturbance provide evidence for the current understanding of the mechanism of the association between PIU and suicidal behavior. Possible concomitant treatment services for PIU, sleep disturbance, and suicidal behavior were recommended.

Problematic Gaming and Internet Use but Not Gambling May Be Overrepresented in Sexual Minorities – A Pilot Population Web Survey Study.

Front Psychol. 2018 Nov 13;9:2184. doi: 10.3389/fpsyg.2018.02184.

Background: Substance-related addictive disorders are known to be overrepresented in non-heterosexual individuals, but it is largely unknown whether this is also the case for behavioral addictions such as problem gaming and gambling. This study aimed, in a pilot web survey design, to assess whether problematic gambling, gaming and internet use may be more common in individuals with a non-heterosexual orientation.

Methods: An online survey was distributed through media and social media, and answered by 605 individuals (51% women and 11% non-heterosexual). Problem gambling, problem gaming and problematic internet use were measured through structured screening instruments (the CLiP, the GAS and the PRIUSS, respectively).

Results: Problem gaming and problematic internet use were significantly more prevalent in non-heterosexual subjects. Instead, problem gambling did not differ between heterosexual and non-heterosexual respondents. Psychological distress and social media use for more than 3 h daily were significantly more common in non-heterosexual respondents. In the overall sample, gaming and gambling were associated statistically.

Association between social media use (Twitter, Instagram, Facebook) and depressive symptoms: Are Twitter users at higher risk? (2018)

Int J Soc Psychiatry. 2018 Nov 30:20764018814270. doi: 10.1177/0020764018814270.

The purpose of this study was to determine the association between social media dependence and depressive symptoms and also, to characterize the level of dependence. It was a transversal, analytical research.

The stratified sample was 212 students from a private university that used Facebook, Instagram and/or Twitter. To measure depressive symptoms, Beck Depression Inventory was used, and to measure the dependence to social media, the Social Media Addiction Test was used, adapted from the Internet Addiction Test of Echeburúa. The collected data were subjected for analysis by descriptive statistics where STATA12 was used

The results show that there is an association between social media dependence and depressive symptoms (PR [Prevalence Ratio] = 2.87, CI [Confidence Interval] 2.03-4.07). It was also shown that preferring the use of Twitter (PR = 1.84, CI 1.21-2.82) over Instagram (PR = 1.61, CI 1.13-2.28) is associated with depressive symptoms when compared to the use of Facebook.

Excessive social media use is associated with depressive symptoms in university students, being more prominent in those who prefer the use of Twitter over Facebook and Instagram.

Lifestyle Interventions and Prevention of Suicide (2018)

Front Psychiatry. 2018 Nov 6;9:567. doi: 10.3389/fpsyt.2018.00567.

Over the past years, there has been a growing interest in the association between lifestyle psychosocial interventions, severe mental illness, and suicide risk. Patients with severe mental disorders have higher mortality rates, poor health states, and higher suicide risk compared to the general population. Lifestyle behaviors are amenable to change through the adoption of specific psychosocial interventions, and several approaches have been promoted. The current article provides a comprehensive review of the literature on lifestyle interventions, mental health, and suicide risk in the general population and in patients with psychiatric disorders. For this purpose, we investigated lifestyle behaviors and lifestyle interventions in three different age groups: adolescents, young adults, and the elderly. Several lifestyle behaviors including cigarette smoking, alcohol use, and sedentary lifestyle are associated with suicide risk in all age groups. In adolescents, growing attention has emerged on the association between suicide risk and internet addiction, cyberbullying and scholastic and family difficulties. In adults, psychiatric symptoms, substance and alcohol abuse, weight, and occupational difficulties seems to have a significant role in suicide risk. Finally, in the elderly, the presence of an organic disease and poor social support are associated with an increased risk of suicide attempt. Several factors may explain the association between lifestyle behaviors and suicide. First, many studies have reported that some lifestyle behaviors and its consequences (sedentary lifestyle, cigarette smoking underweight, obesity) are associated with cardiometabolic risk factors and with poor mental health. Second, several lifestyle behaviors may encourage social isolation, limiting the development of social networks, and remove individuals from social interactions; increasing their risk of mental health problems and suicide.

General health of students of medical sciences and its relation to sleep quality, cell phone overuse, social networks and internet addiction (2019)

Biopsychosoc Med. 2019 May 14;13:12. doi: 10.1186/s13030-019-0150-7.

In recent years, the phenomena of access to the cell phone and addiction to the Internet have been developed among students due to their many applications and attractiveness. Therefore, the present study was conducted with the aim of evaluating general health status and also determining the predictive role of variables such as cell phone usage, sleep quality, internet addiction and social networks addiction in students.

This cross-sectional study was conducted on 321 students of Kermanshah University of Medical Sciences in an analytical approach. Data collection tools were: Goldberg’s General Health Questionnaire, Pittburgh Sleep Quality Index, Young Internet Addiction Test, Social Network Addiction Questionnaire, and Cell Phone Overuse Scale. Data analysis was done using SPSS version 21 and general linear model.

Based on the results, the mean (SD) score of the general health was 21.27 (9.49). Variables of gender, sleep quality, and levels of cell phone usage were independent predictors of student’s health. Male students (β (95% CI) = - 0.28 (- 0.49 to - 0.01) and students with favorable sleep quality (β (95% CI) = - 0.22 (- 0.44 to - 0.02) had lower total health score than the reference category (female students and students with unfavorable sleep quality, respectively). In addition, students with cell phone overuse (β (95% CI) = 0.39 (0.08 to 0.69) had a higher general health score than the reference category (students with cell phone little use).In general, this group of students had lower general health status (Low or high scores of general health indicate a higher and lower general health status for subjects, respectively).

Parent and peer attachment as predictors of facebook addiction symptoms in different developmental stages (early adolescents and adolescents) (2019)

Addict Behav. 2019 May 11. pii: S0306-4603(19)30008-5. doi: 10.1016/j.addbeh.2019.05.009.

Facebook Addiction (FA) is a problem that concerns minors all over the world. The attachment bond with peers and parents has been proven to be a risk factor for the onset of FA. However, the family and peer group can have a different importance depending on the developmental period of the minor. This study examined the influence of peer and parental attachment on the symptoms of FA in early adolescents and adolescents to verify whether attachment to peers and parents predicts FA symptoms in both categories respectively. The sample was composed of 598 participants (142 early adolescents) between the ages of 11 and 17 years (M age = 14.82, SD = 1.52) recruited in the school setting. Multivariate multiple regressions were performed. For early adolescents the relationships with their parents influenced the levels of FA the most (such as withdrawal, conflict, and relapse), whereas peer relationships (such as, peer alienation) were the most relevant for adolescents.

Correlation between Internet addiction, depression, anxiety and stress among undergraduate medical students in Azad Kashmir (2019)

Pak J Med Sci. 2019 Mar-Apr;35(2):506-509. doi: 10.12669/pjms.35.2.169.

A cross-sectional study including 210 undergraduate medical students (first to the fifth year) was done in Poonch Medical College, Azad Kashmir. The data collection tools were DASS21 questionnaire and Young’s internet addiction questionnaire. Spearman rank correlation test was done to see the correlation between internet addiction and depression, anxiety, and stress. Data were analyzed by SPSS v23 at a 95% confidence interval.

A very high prevalence (52.4%) of moderate to extremely severe internet addiction was observed among the respondents. The mild positive correlation between internet addiction and depression was identified (p <.001) and similar type of correlation was observed between internet addiction and stress (p .003). However, anxiety and internet addiction were not significantly correlated. The prevalence of anxiety and depression among the males were higher than the females, whilst the stress level was almost the same across gender.

Internet addiction has been found to be associated with various psychiatric diseases. In this study, we also observed such correlation. We have also observed a very high level of internet addiction among medical students. The prevalence of internet addiction may further increase in the coming years as the internet will become more cheap, available and include more high quality psychologically addictive contents.

Game of thorns: Modern day opium (2019)

Med J Armed Forces India. 2019 Apr;75(2):130-133. doi: 10.1016/j.mjafi.2018.12.006..

With the advent of internet and mobile communication the virtual space of world wide web has become a playground; people plugged in to it at distant horizon completely unfamiliar to each other are players; keyboard, touchpad and joysticks have become the tools of play; webmaster, app developer are self designated referees of the game; while the virtual media is the largest ever spectators in this amphitheatre of the web. More and more youth are getting hooked onto this and are gradually becoming dependent on these games. World Health Organization has recognized this as a diagnosable medical illness and included as Internet Gaming Disorder (IGD) in its International Classification of Diseases (ICD) -11 released in 2018. Various aspects of this problem are discussed in this article.

Predicting effects of borderline personality symptoms and self-concept and identity disturbances on internet addiction, depression, and suicidality in college students: A prospective study (2019)

Kaohsiung J Med Sci. 2019 May 7. doi: 10.1002/kjm2.12082.

The aims of this study were to evaluate the predicting effects of borderline personality symptoms and self-concept and identity disturbances on internet addiction, significant depression, and suicidality among college students at follow-up assessments conducted 1 year later. A sample of 500 college students aged between 20 and 30 years participated in this study. Their levels of borderline personality symptoms, self-concept and identity disturbances, internet addiction, depression, and suicidality at baseline and at follow-up interviews were assessed through the Borderline Symptoms List, Self-concept and Identity Measure, Chen Internet Addiction Scale, Beck Depression Inventory-II, and questions related to suicidality from the Epidemiological version of the Kiddie Schedule for Affective Disorders and Schizophrenia, respectively. A total of 324 college students received follow-up assessments 1 year later. Among them, 15.4%, 27.5%, and 17% had internet addiction, significant depression, and suicidality, respectively. Our result revealed the severity of borderline symptoms, disturbed identity, unconsolidated identity, and lack of identity at initial assessment increased the occurrence of internet addiction, significant depression, and suicidality at follow-up assessment except for the predictive effect of unconsolidated identity on internet addiction.

Relationships of Internet addiction and Internet gaming disorder symptom severities with probable attention deficit/hyperactivity disorder, aggression and negative affect among university students (2019)

Atten Defic Hyperact Disord. 2019 May 6. doi: 10.1007/s12402-019-00305-8.

The aim of the present study was to evaluate relationships of Internet addiction (IA) and Internet gaming disorder (IGD) symptom severities with probable attention deficit/hyperactivity disorder (ADHD) and aggression among university students, while controlling the effects of anxiety and depressive symptoms. The study was conducted with online survey among 1509 volunteered university students in Ankara who regularly use the Internet, among whom we conducted analyses related with IA. Among these students, 987 of them, who play video games, were included in the analyses related with IGD. Correlation analyses revealed that the severities of the scale scores were mildly correlated with each other both among students who regularly use the Internet and students who play video games. Probable ADHD was associated with the severity of IA symptoms, together with depression and aggression, particularly physical aggression and hostility, in ANCOVA analyses. Similarly probable ADHD was also associated with the severity of IGD symptoms, together with depression and aggression, particularly physical aggression, anger and hostility, in ANCOVA analyses. These findings suggest that the presence of probable ADHD is related with both severity of IA and IGD symptoms, together with aggression and depression.

Depression and anxiety symptoms are related to problematic smartphone use severity in Chinese young adults: Fear of missing out as a mediator (2019)

Addict Behav. 2019 Apr 20. pii: S0306-4603(19)30087-5. doi: 10.1016/j.addbeh.2019.04.020.

We recruited 1034 Chinese undergraduate students via a web-based survey that measured smartphone use frequency, PSU, depression, anxiety and FOMO.

Structural equation modeling demonstrated that FOMO was significantly related to smartphone use frequency and PSU severity. FOMO significantly mediated relations between anxiety and both smartphone use frequency and PSU severity. FOMO did not account for relations between depression and smartphone use/PSU.

The Relationship Between Personality Traits, Psychopathological Symptoms, and Problematic Internet Use: A Complex Mediation Model (2019)

J Med Internet Res. 2019 Apr 26;21(4):e11837. doi: 10.2196/11837.

The aim of this study was to build and test a mediation model based on problematic internet use, psychopathological symptoms, and personality traits.

Data were collected from a medical addiction center (43 internet addicts) and internet cafés (222 customers) in Beijing (mean age 22.45, SD 4.96 years; 239/265, 90.2% males). Path analysis was applied to test the mediation models using structural equation modeling.

Based on the preliminary analyses (correlations and linear regression), two different models were built. In the first model, low conscientiousness and depression had a direct significant influence on problematic internet use. The indirect effect of conscientiousness-via depression-was nonsignificant. Emotional stability only affected problematic internet use indirectly, via depressive symptoms. In the second model, low conscientiousness also had a direct influence on problematic internet use, whereas the indirect path via the Global Severity Index was again nonsignificant. Emotional stability impacted problematic internet use indirectly via the Global Severity Index, whereas it had no direct effect on it, as in the first model.

Relationship between nursing students’ levels of internet addiction, loneliness, and life satisfaction (2020)

Perspect Psychiatr Care. 2020 Jan 22. doi: 10.1111/ppc.12474.

This study examined nursing students’ levels of Internet addiction, loneliness, and satisfaction with life.

This descriptive, cross-sectional study was conducted in included university involving 160 nursing students who completed an information form and the Internet addiction, UCLA Loneliness, and Satisfaction with Life Scales.

No significant correlation was found between students’ Internet addiction, loneliness, and life satisfaction (P > .05). However, a significant positive correlation between loneliness and life satisfaction was observed (P < .05).

Internet Addiction in Adolescents: A Systematic Review of Nursing Studies (2020)

J Psychosoc Nurs Ment Health Serv. 2020 Jan 22:1-11. doi: 10.3928/02793695-20200115-01.

Nursing studies related to internet addiction in adolescents were assessed in the current systematic review. Six databases were searched, and 35 studies were included. Internet addiction was found to have negative effects on adolescents’ mental, psychosocial, and physical health, with 43.4%, 43.4%, and 8.8% of studies, respectively, examining these variables. Nursing practices to support adolescents’ mental, psychosocial, and physical health should be planned and implemented and outcomes researched. [Journal of Psychosocial Nursing and Mental Health Services, xx(x), xx-xx.].

Using Eye Tracking to Explore Facebook Use and Associations with Facebook Addiction, Mental Well-being, and Personality (2019)

Behav Sci (Basel). 2019 Feb 18;9(2). pii: E19. doi: 10.3390/bs9020019.

Social networking sites (SNSs) have become ubiquitous in our everyday lives, and for all its communicative benefits, excessive SNS use has been associated with a range of negative health implications. In the present study, the authors use eye-tracking methodology to explore the relationship between individual differences in personality, mental well-being, SNS usage, and the focus of Facebook users’ visual attention. Participants (n = 69, mean age = 23.09, SD = 7.54) completed questionnaire measures for personality and to examine changes in depression, anxiety, stress, and self-esteem. They then engaged in a Facebook session while their eye movements and fixations were recorded. These fixations were coded as being directed to social and update areas of interest (AOI) of the Facebook interface. An exploratory analysis of personality factors revealed a negative correlation between openness to experience and inspection times for the updates AOI and an unexpected negative relationship between extraversion and inspection times for social AOI. There were correlations between changes in depression score and inspection of updated AOI, with reduced depression scores associated with increased inspection of updates. Finally, self-reported duration of participants’ typical Facebook sessions did not correlate with eye-tracking measures but were associated with increased Facebook addiction scores and greater increases in depression scores. These initial findings indicate that there are differences in the outcomes of interacting with Facebook which can vary based on Facebook addiction, personality variables, and the Facebook features that individuals interact with.

The relationship between social networking addiction and academic performance in Iranian students of medical sciences: a cross-sectional study (2019)

BMC Psychol. 2019 May 3;7(1):28. doi: 10.1186/s40359-019-0305-0.

In this cross-sectional study, 360 students were enrolled by stratified random sampling. The study tools included personal information form and the Bergen Social Media Addiction Scale. Also, the students’ overall grade obtained in previous educational term was considered as the indicator of academic performance. Data were analyzed using SPSS-18.0 and descriptive and inferential statistics.

The mean social networking addiction was higher in male students (52.65 ± 11.50) than in female students (49.35 ± 13.96) and this difference was statistically significant (P < 0.01). There was a negative and significant relationship between students’ addiction to social networking and their academic performance (r = - 0.210, p < 0.01).

The social networking addiction of the students was at moderate level and the male students had a higher level of addiction compared to the female students. There was a negative and significant relationship between the overall use of social networks and academic performance of students. Therefore, it is imperative that the university authorities take interventional steps to help students who are dependent on these networks and, through workshops, inform them about the negative consequences of addiction to social networks.

The relationship between smartphone addiction and symptoms of depression, anxiety, and attention-deficit/hyperactivity in South Korean adolescents (201)

Ann Gen Psychiatry. 2019 Mar 9;18:1. doi: 10.1186/s12991-019-0224-8.

Excessive smartphone use has been associated with numerous psychiatric disorders. This study aimed to investigate the prevalence of smartphone addiction and its association with depression, anxiety, and attention-deficit hyperactivity disorder (ADHD) symptoms in a large sample of Korean adolescents.

A total of 4512 (2034 males and 2478 females) middle- and high-school students in South Korea were included in this study. Subjects were asked to complete a self-reported questionnaire, including measures of the Korean Smartphone Addiction Scale (SAS), Beck Depression Inventory (BDI), Beck Anxiety Inventory (BAI), and Conners-Wells’ Adolescent Self-Report Scale (CASS). Smartphone addiction and non-addiction groups were defined using SAS score of 42 as a cut-off. The data were analyzed using multivariate logistic regression analyses.

338 subjects (7.5%) were categorized to the addiction group. Total SAS score was positively correlated with total CASS score, BDI score, BAI score, female sex, smoking, and alcohol use. Using multivariate logistic regression analyses, the odds ratio of ADHD group compared to the non-ADHD group for smartphone addiction was 6.43, the highest among all variables (95% CI 4.60-9.00).

Our findings indicate that ADHD may be a significant risk factor for developing smartphone addiction. The neurobiological substrates subserving smartphone addiction may provide insights on to both shared and discrete mechanisms with other brain-based disorders.

Types of problematic smartphone use based on psychiatric symptoms (2019)

Psychiatry Res. 2019 Feb 28;275:46-52. doi: 10.1016/j.psychres.2019.02.071.

To provide appropriate solutions for problematic smartphone use, we need to first understand its types. This study aimed to identify types of problematic smartphone use based on psychiatric symptoms, using the decision tree method. We recruited 5,372 smartphone users from online surveys conducted between February 3 and February 22, 2016. Based on scores on the Korean Smartphone Addiction Proneness Scale for Adults (S-Scale), 974 smartphone users were assigned to the smartphone-dependent group and 4398 users were assigned to the normal group. The data-mining technique of C5.0 decision tree was applied. We used 15 input variables, including demographic and psychological factors. Four psychiatric variables emerged as the most important predictors: self-control (Sc; 66%), anxiety (Anx; 25%), depression (Dep; 7%), and dysfunctional impulsivities (Imp; 3%). We identified the following five types of problematic smartphone use: (1) non-comorbid, (2) self-control, (3) Sc + Anx, (4) Sc + Anx + Dep, and (5) Sc + Anx + Dep + Imp. We found that 74% of smartphone-dependent users had psychiatric symptoms. The ratio of participants belonging to the non-comorbid and self-control types was 64%. We proposed that these types of problematic smartphone use may be used for the development of an appropriate service for controlling and preventing such behaviors in adults.

A Study of Magnitude and Psychological Correlates of Smartphone Use in Medical Students: A Pilot Study with A Novel Telemetric Approach (2018)

Indian J Psychol Med. 2018 Sep-Oct;40(5):468-475. doi: 10.4103/IJPSYM.IJPSYM_133_18.

Smartphone use is being investigated as a potential behavioral addiction. Most of the studies opt for a subjective questionnaire-based method. This study evaluates the psychological correlates of excessive smartphone use. It uses a telemetric approach to quantitatively and objectively measure participants’ smartphone use.

One hundred forty consenting undergraduate and postgraduate students using an Android smartphone at a tertiary care teaching hospital were recruited by serial sampling. They were pre-tested with the Smartphone Addiction Scale-Short Version, Big five inventory, Levenson’s Locus of Control Scale, Ego Resiliency Scale, Perceived Stress Scale, and Materialism Values Scale. Participants’ smartphones were installed with tracker apps, which kept track of total smartphone usage and time spent on individual apps, number of lock-unlock cycles, and total screen time. Data from tracker apps were recorded after 7 days.

About 36 % of participants fulfilled smartphone addiction criteria. Smartphone Addiction Scale score significantly predicted time spent on a smartphone in the 7-day period (β = 0.234, t = 2.086, P = 0.039). Predictors for time spent on social networking sites were ego resiliency (β = 0.256, t = 2.278, P = 0.008), conscientiousness (β = -0.220, t = -2.307, P = 0.023), neuroticism (β = -0.196, t = -2.037, P = 0.044), and openness (β = -0.225, t = -2.349, P = 0.020). Time spent gaming was predicted by success domain of materialism (β =0.265, t = 2.723, P = 0.007) and shopping by ego resiliency and happiness domain of materialism.

Usage of Online Social Networking Sites among School Students of Siliguri, West Bengal, India (2018)

Indian J Psychol Med. 2018 Sep-Oct;40(5):452-457. doi: 10.4103/IJPSYM.IJPSYM_70_18.

Social networking sites (SNSs) are online platforms that provide individuals with an opportunity to manage their personal relationship and remain updated with the world. The primary objective of the present research was to find the pattern of school students’ SNS usage and its influence on their academic performance

The setting was an English medium school situated in the metropolitan city of Siliguri in West Bengal. A pretested and predesigned questionnaire was self-administered anonymously by 388 randomly selected students. The data were analyzed using appropriate statistics.

Three hundred thirty-eight (87.1%) students used SNS and spent an increased amount of time on these networks. Addiction was seen in 70.7% and was more common in the age group of 17 years and above.

Prevalence and Pattern of Phantom Ringing and Phantom Vibration among Medical Interns and their Relationship with Smartphone Use and Perceived Stress (2018)

Indian J Psychol Med. 2018 Sep-Oct;40(5):440-445. doi: 10.4103/IJPSYM.IJPSYM_141_18.

Phantom sensations like phantom vibration (PV) and phantom ringing (PR)- the sensations of vibration and ringing of the phone when they are not, respectively-are among the latest in the category of “techno-pathology” to receive global attention. This study was conducted with the aim to estimate the prevalence of such sensations among medical interns and their association with perceived stress levels and smartphone usage pattern.

Ninety-three medical interns using smartphone were recruited for the study. Data were collected anonymously using semi-structured questionnaire, perceived stress scale (PSS), and smartphone addiction scale-short version (SAS-SV). Data were analyzed using descriptive statistics, Chi-square test, independent t-test, ANOVA, and Pearson’s correlation coefficient.

Fifty-nine percent students had a high level of stress, whereas 40% had problematic smartphone use. Sixty percent students experienced PV, whereas 42% experienced PR and both were significantly associated with higher frequency of phone use and the use of vibration mode. Mean SAS-SV score was significantly lower in students who did not perceive PR/PV, whereas mean PSS score was significantly lower in students who did not perceive PV.

Mobile Phone Addiction and Its Relationship to Sleep Quality and Academic Achievement of Medical Students at King Abdulaziz University, Jeddah, Saudi Arabia (2018)

J Res Health Sci. 2018 Aug 4;18(3):e00420.

Adverse effects of Mobile Phone (MP) usage could lead to dependency problems, and medical students are not excluded from it. We aimed to determine the pattern of MP usage, and its relation to sleep quality and academic performance between medical students at King Abdulaziz University (KAU), Jeddah, Saudi Arabia.

A multistage stratified random sample was used for selection of 610 participants, during 2016-2017. A validated, anonymous data collection sheet was used. It inquired about the Grade Point Averages (GPA). It included the Problematic Mobile Phone Use Questionnaire (PMPU-Q) for assessing various aspects of cellphone addiction (dependency, financial problems, prohibited and dangerous use). The Pittsburgh Sleep Quality Index (PSQI) was also included. Descriptive and inferential statistics were done.

A high frequency of MP usage prevailed among participants (73.4% used it >5 h/day). About two-thirds of participants had poor sleep quality. Females, owners of smartphone for >1 yr, and increasing time spent on MP were associated with MP dependency. Lower academic achievers had significantly worse MP scores on financial problems, dangerous use, and total PUMP. MP dependency was correlated with subjective sleep quality score, and sleep latency. Global PSQI scale was correlated with prohibited MP use.

Lower achievers had significantly worse scores on MP financial problems, dangerous usage, and the total PMPU. MP dependency was correlated with poor subjective sleep quality, and sleep latency. Rationale MP usage is needed to decrease the dependency, improve sleep quality, and academic achievement of medical students.

Addiction-like Behavior Associated with Mobile Phone Usage among Medical Students in Delhi (2018)

Indian J Psychol Med. 2018 Sep-Oct;40(5):446-451. doi: 10.4103/IJPSYM.IJPSYM_59_18.

Mobile phone addiction is a type of technological addiction or nonsubstance addiction. The present study was conducted with the objectives of developing and validating a mobile phone addiction scale in medical students and to assess the burden and factors associated with mobile phone addiction-like behavior.

A cross-sectional study was conducted among undergraduate medical students aged ≥18 years studying in a medical college in New Delhi, India from December 2016 to May 2017. A pretested self-administered questionnaire was used for data collection. Mobile phone addiction was assessed using a self-designed 20-item Mobile Phone Addiction Scale (MPAS). Data were analyzed using IBM SPSS Version 17.

The study comprised of 233 (60.1%) male and 155 (39.9%) female medical students with a mean age of 20.48 years. MPAS had a high level of internal consistency (Cronbach’s alpha 0.90). Bartlett’s test of sphericity was statistically significant (P < 0.0001), indicating that the MPAS data were likely factorizable. A principal component analysis found strong loadings on items relating to four components: harmful use, intense desire, impaired control, and tolerance. A subsequent two-stage cluster analysis of all the 20-items of the MPAS classified 155 (39.9%) students with mobile phone addiction-like behavior that was lower in adolescent compared to older students, but there was no significant difference across gender.

Problematic social networking site usage and substance use by young adolescents (2018)

BMC Pediatr. 2018 Nov 23;18(1):367. doi: 10.1186/s12887-018-1316-3.

The present study was devised to examine whether substance use in early adolescence is associated with problematic social networking site usage (PSNSU).

In the academic year 2013-2014, secondary schools in Padua (north-eastern Italy) were involved in a survey called “Pinocchio”. A sample of 1325 pupils attending years 6 to 8 (i.e. aged from 11 to 13 years) completed self-administered questionnaires, in which PSNSU was measured by applying the DSM-IV criteria of dependence to identify any social network addiction disorder and its fallout on daily life. Multivariate analysis (ordered logistic regression) was performed to assess an adjusted association between young adolescents’ substance use and PSNSU.

The percentage of pupils classified as problematic social networking site users rose with age (from 14.6% in year 6 to 24.3% in year 7, and 37.2% in year 8), and it was higher in girls (27.1%) than in boys (23.6%). In a fully-adjusted model, PSNSU conferred a higher likelihood of being substance users (OR 2.93 95% CI 1.77-4.85)

This study identified an association between PSNSU and the likelihood of substance use (smoking, alcohol and energy drink consumption), providing further evidence of the need to pay more attention to PSNSU in early adolescence.

Study of Internet addiction in children with attention-deficit hyperactivity disorder and normal control (2018)

Ind Psychiatry J. 2018 Jan-Jun;27(1):110-114. doi: 10.4103/ipj.ipj_47_17.

The aim is to study and compare Internet addiction between ADHD and normal children and the relation of demographic profile to Internet addiction.

This was a cross-sectional study including 100 children (50 ADHD cases and 50 normal children without any psychiatric illness as controls) between the ages of 8 and 16 years. A semi-structured pro forma for demographic profile and Internet usage using Young’s Internet Addiction Test (YIAT) was used. Statistical analysis was done using SPSS 20.

Internet addiction among ADHD children was 56% (54% having “probable Internet addiction” and 2% having “definite Internet addiction”). This was statistically significant (P < 0.05) in comparison with normal children where only 12% had Internet addiction (all 12% had “probable Internet addiction”). ADHD children were 9.3 times more prone to the development of Internet addiction as compared to normal (odds ratio – 9.3). Significant increase in average duration of Internet usage in ADHD children with increasing score of YIAT (P < 0.05) was seen. The incidence of Internet addiction was more in male ADHD children as compared to normal (P < 0.05).