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This page contains short summaries of the latest research on Internet Addiction. Other studies involving Internet gaming addiction can be found here. Internet addiction brain studies have already confirmed the presence of the same brain changes as seen in drug addiction.

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 coattachmentsndition 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.


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.


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.

In the context of Internet addiction, cybersex is considered to be an Internet application in which users are at risk for developing addictive usage behavior. Regarding males, experimental research has shown that indicators of sexual arousal and craving in response to Internet pornographic cues are related to severity of cybersex addiction in Internet pornography users (IPU). Since comparable investigations on females do not exist, the aim of this study is to investigate predictors of cybersex addiction in heterosexual women.

We examined 51 female IPU and 51 female non-Internet pornography users (NIPU).

Results indicated that IPU rated pornographic pictures as more arousing and reported greater craving due to pornographic picture presentation compared with NIPU. Moreover, craving, sexual arousal rating of pictures, sensitivity to sexual excitation, problematic sexual behavior, and severity of psychological symptoms predicted tendencies toward cybersex addiction in IPU. Being in a relationship, number of sexual contacts, satisfaction with sexual contacts, and use of interactive cybersex were not associated with cybersex addiction. These results are in line with those reported for heterosexual males in previous studies.

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

Front Psychol. 2015 May 22;6:653.

There is no consensus regarding the phenomenology, classification, and diagnostic criteria of cybersex addiction. Some approaches point toward similarities to substance dependencies for which approach/avoidance tendencies are crucial mechanisms. Several researchers have argued that within an addiction-related decision situation, individuals might either show tendencies to approach or avoid addiction-related stimuli.

Analogous to substance dependencies, results suggest that both approach and avoidance tendencies might play a role in cybersex addiction. Moreover, an interaction with sensitivity toward sexual excitation and problematic sexual behavior could have an accumulating effect on the severity of subjective complaints in everyday life due to cybersex use. The findings provide further empirical evidence for similarities between cybersex addiction and substance dependencies. Such similarities could be retraced to a comparable neural processing of cybersex- and drug-related cues.

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


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.

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. Epub 2017 Dec 2.

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)

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.

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.

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.

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

Front. Hum. Neurosci., 10 October 2017 |

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.

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 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 overuse[17] 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.

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.

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)

Front Hum Neurosci. 2015 Jun 16;9:356.

Abnormal structure and function in the striatum and prefrontal cortex (PFC) have been revealed in Internet addiction disorder (IAD).  The aim of this study was to investigate the integrity of corticostriatal functional circuits and their relations to neuropsychological measures in IAD by resting-state functional connectivity (FC). Fourteen IAD adolescents and 15 healthy controls underwent resting-state fMRI scans.

Compared to controls, IAD subjects exhibited reduced connectivity between the inferior ventral striatum and bilateral caudate head, subgenual anterior cingulate cortex (ACC), and posterior cingulate cortex, and between the superior ventral striatum and bilateral dorsal/rostral ACC, ventral anterior thalamus, and putamen/pallidum/insula/inferior frontal gyrus (IFG), and between the dorsal caudate and dorsal/rostral ACC, thalamus, and IFG, and between the left ventral rostral putamen and right IFG. IAD subjects also showed increased connectivity between the left dorsal caudal putamen and bilateral caudal cigulate motor area. Moreover, altered cotricostriatal functional circuits were significantly correlated with neuropsychological measures. This study directly provides evidence that IAD is associated with alterations of corticostriatal functional circuits involved in the affective and motivation processing, and cognitive control.

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.

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.

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 2x2 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.

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.

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.


  • 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.

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.

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

Because addictive behaviors typically result from violated homeostasis of the impulsive (amygdala-striatal) and inhibitory (prefrontal cortex) brain systems, this study examined whether these systems sub-serve a specific case of technology-related addiction, namely Facebook "addiction." Using a go/no-go paradigm in functional MRI settings, the study examined how these brain systems in 20 Facebook users (M age = 20.3 yr., SD = 1.3, range = 18-23) who completed a Facebook addiction questionnaire, responded to Facebook and less potent (traffic sign) stimuli. The findings indicated that at least at the examined levels of addiction-like symptoms, technology-related "addictions" share some neural features with substance and gambling addictions, but more importantly they also differ from such addictions in their brain etiology and possibly pathogenesis, as related to abnormal functioning of the inhibitory-control brain system.

Facebook usage on smartphones and gray matter volume of the nucleus accumbens (2017)

Behavioural Brain Research SreeTestContent1

A recent study has implicated the nucleus accumbens of the ventral striatum in explaining why online-users spend time on the social network platform Facebook. Here, higher activity of the nucleus accumbens was associated with gaining reputation on social media. In the present study, we touched a related research field. We recorded the actual Facebook usage of N = 62 participants on their smartphones over the course of five weeks and correlated summary measures of Facebook use with gray matter volume of the nucleus accumbens. It appeared, that in particular higher daily frequency of checking Facebook on the smartphone was robustly linked with smaller gray matter volumes of the nucleus accumbens. The present study gives additional support for the rewarding aspects of Facebook usage.

Internet Addiction and Excessive Social Networks Use: What About Facebook? (2016)

Clin Pract Epidemiol Ment Health. 2016 Jun 28;12:43-8. doi: 10.2174/1745017901612010043. eCollection 2016.

However, healthy and conscience Facebook use is contrasted by excessive use and lack of control, creating an addiction with severely impacts the everyday life of many users, mainly youths. If Facebook use seems to be related to the need to belong, affiliate with others and for self-presentation, the beginning of excessive Facebook use and addiction could be associated to reward and gratification mechanisms as well as some personality traits. Studies from several countries indicate different Facebook addiction prevalence rates, mainly due to the use of a wide-range of evaluation instruments and to the lack of a clear and valid definition of this construct. Further investigations are needed to establish if excessive Facebook use can be considered as a specific online addiction disorder or an Internet addiction subtype.

Internet-Communication Disorder: It's a Matter of Social Aspects, Coping, and Internet-Use Expectancies (2016)

Front Psychol. 2016 Nov 10;7:1747.

Online communication applications such as Facebook, WhatsApp, and Twitter are some of the most frequently used Internet applications. There is a growing amount of individuals suffering diminished control over their use of online communication applications which leads to diverse negative consequences in offline life. This could be referred to as Internet-communication disorder (ICD). The current study investigates the role of individual characteristics (e.g., psychopathological symptoms, feelings of loneliness) and specific cognitions. In a sample of 485 participants a structural equation model was tested to investigate predictors and mediators which may predict an excessive use. The results emphasize that a higher level of social loneliness and less perceived social support enhance the risk of a pathological use. The effects of psychopathological symptoms (depression and social anxiety) as well as individual characteristics (self-esteem, self-efficacy, and stress vulnerability) on ICD symptoms are mediated by Internet-use expectancies and dysfunctional coping mechanisms.

The Dimensions of Facebook Addiction as Measured by Facebook Addiction Italian Questionnaire and Their Relationships with Individual Differences (2017)

Cyberpsychol Behav Soc Netw. 2017 Apr;20(4):251-258. doi: 10.1089/cyber.2016.0073.

The studies reported analyze the factorial structure of Facebook Addiction Italian Questionnaire (FAIQ), a variant of 20-item Young's Internet Addiction Test (IAT). In Study 1, we tested FAIQ psychometric properties using exploratory factor analysis (EFA). In Study 2, we performed a confirmatory factor analysis (CFA) to verify the FAIQ factorial structure identified through EFA. Results from CFA confirm the presence of a four-factor model accounting for 58 percent of total variance, plus a general higher order factor that best fits the data. Further relationships between FAIQ factor scores, personality, and Facebook usage have been explored.

Under the influence of Facebook? Excess use of social networking sites and drinking motives, consequences, and attitudes in college students (2017)

J Behav Addict. 2016 Mar;5(1):122-129. doi: 10.1556/2006.5.2016.007.

Excessive use of social networking sites (SNS) has recently been conceptualized as a behavioral addiction (i.e., "disordered SNS use") using key criteria for the diagnosis of substance dependence and shown to be associated with a variety of impairments in psychosocial functioning, including an increased risk of problem drinking. This study sought to characterize associations between "disordered SNS use" and attitudes towards alcohol, drinking motives, and adverse consequences resulting from alcohol use in young adults.Undergraduate students (n = 537, 64.0% female, mean age = 19.63 years, SD = 4.24) reported on their use of SNSs and completed the Alcohol Use Disorders Identification Test, Temptation and Restraint Inventory, Approach and Avoidance of Alcohol and Drinking Motives Questionnaires, and Drinker Inventory of Consequences.

Respondents meeting previously established criteria for "disordered SNS use" were significantly more likely to use alcohol to cope with negative affect and to conform to perceived social norms, reported significantly more conflicting (i.e., simultaneous positive and negative) attitudes towards alcohol, and had experienced significantly more, and more frequent adverse consequences from drinking in their inter- and intrapersonal, physical, and social functioning, compared to individuals without problems related to SNS use.

Findings add to an emerging body of literature suggesting a link between excess or maladaptive SNS use and problems related to alcohol in young adults and point to emotion dysregulation and coping motives as potential shared risk factors for substance and behavioral addictions in this demographic.



Psychological Well-Being and Adolescents’ Internet Addiction: A School-Based Cross-Sectional Study in Hong Kong (2018)

Child and Adolescent Social Work Journal (2018): 1-11.

This study examines the correlations of adolescents’ self-esteem, loneliness and depression with their internet use behaviors with a sample of 665 adolescents from seven secondary schools in Hong Kong. The results suggest that frequent online gaming is more strongly correlated to internet addiction and such correlation is higher than other predictors of internet addiction in online behaviors including social interactions or viewing of pornographic materials. Male adolescents tend to spend more time on online gaming than female counterparts. In terms of the effect of internet addiction on adolescents’ psychological well-being, self-esteem is negatively correlated with internet addiction, whereas depression and loneliness are positively correlated with internet addiction. Comparatively, depression had stronger correlation with internet addiction than loneliness or self-esteem.

Adolescent Internet Use, Social Integration, and Depressive Symptoms: Analysis from a Longitudinal Cohort Survey (2018)

J Dev Behav Pediatr. 2018 Feb 13. doi: 10.1097/DBP.0000000000000553.

To examine the association between adolescent leisure-time Internet use and social integration in the school context and how this association affects later depressive symptoms among adolescents in Taiwan, using a large nationwide cohort study and the latent growth model (LGM) method.

Data of 3795 students followed from the year 2001 to 2006 in the Taiwan Education Panel Survey were analyzed. Leisure-time Internet use was defined by the hours per week spent on (1) online chatting and (2) online games. School social integration and depressive symptoms were self-reported. We first used an unconditional LGM to estimate the baseline (intercept) and growth (slope) of Internet use. Next, another LGM conditioned with school social integration and depression was conducted.

The trend of Internet use was positively related to depressive symptoms (coefficient = 0.31, p < 0.05) at Wave 4. School social integration was initially associated with decreased leisure-time Internet use among adolescents. The growth of Internet use with time was not explainable by school social integration but had adverse impacts on depression. Reinforcing adolescents' bonding to school may prevent initial leisure-time Internet use. When advising on adolescent Internet use, health care providers should consider their patients' social networks and mental well-being.

Parent-adolescent relationship and adolescent internet addiction: A moderated mediation model (2018)

Addict Behav. 2018 Sep;84:171-177. doi: 10.1016/j.addbeh.2018.04.015.

Substantial research has found that positive parent-adolescent relationship is associated with low levels of adolescent Internet addiction (IA). However, little is known about the mediating and moderating mechanisms underlying this relation. The present study examined a moderated mediation model that included the parent-adolescent relationship (predictor variable), emotion regulation ability (mediator), stressful life events (moderator), and IA (outcome variable) simultaneously. A total of 998 (Mage = 15.15 years, SD = 1.57) Chinese adolescents completed the Parent-Adolescent Relationship Scale, Emotion Regulation Ability Scale, Adolescent Stressful Life Events Scale, and Internet Addiction Diagnostic Questionnaire. After controlling for adolescent gender, age, and family socioeconomic status, results revealed that good parent-adolescent relationship was positively associated with adolescent emotion regulation ability, which in turn was negatively associated with their IA. Moreover, stressful life events moderated the second part of the mediation process. In accordance with the reverse stress-buffering model, the relation between emotion regulation ability and adolescent IA was stronger for adolescents who experienced lower levels of stressful life events.

Socio-emotional ability, temperament and coping strategies associated with different use of Internet in Internet addiction (2018)

Eur Rev Med Pharmacol Sci. 2018 Jun;22(11):3461-3466. doi: 10.26355/eurrev_201806_15171.

The aim of the present study was to compare socio-emotional patterns, temperamental traits, and coping strategies, between a group of Internet addiction (IA) patients and a control group.Twenty-five IA patients and twenty-six healthy matched subjects were tested on IA, temperament, coping strategies, alexithymia and attachment dimensions. Participants reported their prevalent Internet use (online pornography, social networks, online games).

The IA patients using Internet for gaming online showed a greater attitude to novelty seeking and a lower tendency to use socio-emotional support and self-distraction compared to patients using Internet for social networking. Moreover, they showed a lower level of acceptance than patients using Internet for pornography. In the control group, the participants using Internet for online gaming showed higher levels of IA, emotional impairments and social alienation compared to social-networks and pornography users.

Findings showed a higher psychological impairment in gaming online users compared to social networking and online pornography users.

Problematic social media use and depressive symptoms among U.S. young adults: A nationally-representative study (2017)

Soc Sci Med. 2017 Apr 6. pii: S0277-9536(17)30223-X. doi: 10.1016/j.socscimed.2017.03.061.

The suggested association between social media use (SMU) and depression may be explained by the emerging maladaptive use pattern known as problematic social media use (PSMU), characterized by addictive components. We aimed to assess the association between PSMU and depressive symptoms-controlling for overall time and frequency of SMU-among a large sample of U.S. young adults.

In October 2014, participants aged 19-32 (N = 1749) were randomly selected from a nationally-representative U.S. probability-based panel and subsequently invited to participate in an online survey. We assessed depressive symptoms using the validated Patient-Reported Outcomes Measurement Information System (PROMIS) brief depression scale. We measured PSMU using an adapted version of the Bergen Facebook Addiction Scale to encompass broader SMU. Using logistic regression models, we tested the association between PSMU and depressive symptoms, controlling for time and frequency of SMU as well as a comprehensive set of socio-demographic covariates.

In the multivariable model, PSMU was significantly associated with a 9% increase in odds of depressive symptoms. Increased frequency of SMU was also significantly associated with increased depressive symptoms, whereas SMU time was not.

PSMU was strongly and independently associated with increased depressive symptoms in this nationally-representative sample of young adults. PSMU largely explained the association between SMU and depressive symptom, suggesting that it may be how we use social media, not how much, that poses a risk. Intervention efforts aimed at reducing depressive symptoms, such as screenings for maladaptive SMU, may be most successful if they address addictive components and frequency-rather than time-of SMU.

The Relationship Between Resilience and Internet Addiction: A Multiple Mediation Model Through Peer Relationship and Depression (2017)

Cyberpsychol Behav Soc Netw. 2017 Oct;20(10):634-639.

Heavy use of the Internet may lead to profound academic problems in elementary students, such as poor grades, academic probation, and even expulsion from school. It is of great concern that Internet addiction problems in elementary school students have increased sharply in recent years. In this study, 58,756 elementary school students from the Henan province of China completed four questionnaires to explore the mechanisms of Internet addiction. The results showed that resilience was negatively correlated with Internet addiction.

The theoretical underpinnings of Internet addiction and its association with psychopathology in adolescence (2017)

International Journal of Adolescent Medicine and Health (2017).

This paper reviews the psychological and theoretical underpinnings that might help to explain the reported relationship between Internet addiction (IA) and psychopathology in both children and adolescents. Drawing on cognitive-behavioural models and social-skills theory, IA shows a strong relationship with depression, attention deficit hyperactivity disorder (ADHD) and time spent using the Internet use. Mixed findings are reported for social anxiety. Loneliness and hostility were also found to be associated with IA. Gender and age moderated these relationships with greater psychopathology generally reported among males and younger Internet users. This paper adds to the growing body of literature showing an association between IA and a range of mental health problems in both children and adolescents. A dependence on the Internet can potentially result in significant harm both socially and psychologically. While research has identified a potential pathway commencing with mental health problems and concluding with IA, few studies have examined the alternative direction and this may provide the impetus for future research endeavours.

Internet Addiction and Its Relationship With Suicidal Behaviors: A Meta-Analysis of Multinational Observational Studies (2018)

J Clin Psychiatry. 2018 Jun 5;79(4). pii: 17r11761. doi: 10.4088/JCP.17r11761.

To perform a systematic review and meta-analysis of observational studies that investigated the putative association between internet addiction and suicidality.

We included 23 cross-sectional studies (n = 270,596) and 2 prospective studies (n = 1,180) that investigated the relationship between suicide and internet addiction.

We extracted the rates of suicidal ideation, planning, and attempts in individuals with internet addiction and controls.

The individuals with internet addiction had significantly higher rates of suicidal ideation (odds ratio [OR] = 2.952), planning (OR = 3.172), and attempts (OR = 2.811) and higher severity of suicidal ideation (Hedges g = 0.723). When restricted to adjusted ORs for demographic data and depression, the odds of suicidal ideation and attempts were still significantly higher in the individuals with internet addiction (ideation: pooled adjusted OR = 1.490; attempts: pooled adjusted OR = 1.559). In subgroup analysis, there was a significantly higher prevalence rate of suicidal ideation in children (age less than 18 years) than in adults (OR = 3.771 and OR = 1.955, respectively).

This meta-analysis provides evidence that internet addiction is associated with increased suicidality even after adjusting for potential confounding variables including depression. However, the evidence was derived mostly from cross-sectional studies. Future prospective studies are necessary to confirm these findings.

Technology-mediated addictive behaviors constitute a spectrum of related yet distinct conditions: A network perspective (2018)

Psychol Addict Behav. 2018 Jul 19. doi: 10.1037/adb0000379.

An important ongoing debate in the addiction field is whether certain technology-mediated behaviors constitute tenable and independent constructs. This study investigated whether problematic technology-mediated behaviors could be conceptualized as a spectrum of related, yet distinct disorders (spectrum hypothesis), using the network approach, which considers disorders as networks of symptoms. We used data from the Cohort Study on Substance Use and Risk Factors (C-SURF; Swiss National Science Foundation), with a representative sample of young Swiss men (subsample of participants engaged in technology-mediated behaviors, n = 3,404). Four technology-mediated addictive behaviors were investigated using symptoms derived from the Diagnostic and Statistical Manual of Mental Disorders (5th ed.) and the component model of addiction: Internet, smartphone, gaming, and cybersex. Network analyses included network estimation and visualization, community detection tests, and centrality indices. The network analysis identified four distinct clusters corresponding to each condition, but only Internet addiction had numerous relationships with the other behaviors. This finding, along with the finding that there were few relationships between the other behaviors, suggests that smartphone addiction, gaming addiction, and cybersex addiction are relatively independent constructs. Internet Addiction was often connected with other conditions through the same symptoms, suggesting that it could be conceptualized as an "umbrella construct," that is, a common vector that mediates specific online behaviors.

Adverse physiological and psychological effects of screen time on children and adolescents: Literature review and case study (2018)

Environ Res. 2018 Feb 27;164:149-157. doi: 10.1016/j.envres.2018.01.015.

A growing body of literature is associating excessive and addictive use of digital media with physical, psychological, social and neurological adverse consequences. Research is focusing more on mobile devices use, and studies suggest that duration, content, after-dark-use, media type and the number of devices are key components determining screen time effects. Physical health effects: excessive screen time is associated with poor sleep and risk factors for cardiovascular diseases such as high blood pressure, obesity, low HDL cholesterol, poor stress regulation (high sympathetic arousal and cortisol dysregulation), and Insulin Resistance. Other physical health consequences include impaired vision and reduced bone density. Psychological effects: internalizing and externalizing behavior is related to poor sleep. Depressive symptoms and suicidal are associated to screen time induced poor sleep, digital device night use, and mobile phone dependency. ADHD-related behavior was linked to sleep problems, overall screen time, and violent and fast-paced content which activates dopamine and the reward pathways. Early and prolonged exposure to violent content is also linked to risk for antisocial behavior and decreased prosocial behavior. Psychoneurological effects: addictive screen time use decreases social coping and involves craving behavior which resembles substance dependence behavior. Brain structural changes related to cognitive control and emotional regulation are associated with digital media addictive behavior. A case study of a treatment of an ADHD diagnosed 9-year-old boy suggests screen time induced ADHD-related behavior could be inaccurately diagnosed as ADHD. Screen time reduction is effective in decreasing ADHD-related behavior.

Components crucial for psychophysiological resilience are none-wandering mind (typical of ADHD-related behavior), good social coping and attachment, and good physical health. Excessive digital media use by children and adolescents appears as a major factor which may hamper the formation of sound psychophysiological resilience.

Comments: Demonstrates causation of ADHD by internet use

Gender Differences in and the Relationships Between Social Anxiety and Problematic Internet Use: Canonical Analysis (2018)

J Med Internet Res. 2018 Jan 24;20(1):e33. doi: 10.2196/jmir.8947.

Given the proposal of gender schema theory and social role theory, men and women are predisposed to experience social anxiety and engage in Internet use differently. Thus, an investigation of gender differences in these areas is warranted.

Participants included 505 college students, of whom 241 (47.7%) were women and 264 (52.3%) were men. Participants' ages ranged from 18 to 22 years, with a mean age of 20.34 (SD=1.16). The Social Anxiety Scale and Problematic Internet Use Scale were used in data collection. Multivariate analysis of variance (MANOVA) and canonical correlation analysis were used.

On the basis of the findings, we conclude that enhanced educational opportunities for women and their increasing role in the society have led women to become more active and thus closed the gap in social anxiety levels between men and women. We found that men showed more difficulties than women in terms of running away from personal problems (ie, social benefit), used the Internet more excessively, and experienced more interpersonal problems with significant others due to Internet use. We conclude that men are under a greater risk of social impairments due to PIU. Our overall conclusion is that there is a substantial amount of association between social anxiety and PIU and the association is stronger for men than it is for women. We advise that future research continue to investigate PIU and social anxiety as multidimensional constructs.

Distinct patterns of Internet and smartphone-related problems among adolescents by gender: Latent class analysis (2018)

J Behav Addict. 2018 May 23:1-12. doi: 10.1556/2006.7.2018.28.

The ubiquitous Internet connections by smartphones weakened the traditional boundaries between computers and mobile phones. We sought to explore whether smartphone-related problems differ from those of computer use according to gender using latent class analysis (LCA). Methods After informed consents, 555 Korean middle-school students completed surveys on gaming, Internet use, and smartphone usage patterns. They also completed various psychosocial instruments. LCA was performed for the whole group and by gender. In addition to ANOVA and χ2 tests, post-hoc tests were conducted to examine differences among the LCA subgroups. In the whole group (n = 555), four subtypes were identified: dual-problem users (49.5%), problematic Internet users (7.7%), problematic smartphone users (32.1%), and "healthy" users (10.6%). Dual-problem users scored highest for addictive behaviors and other psychopathologies. The gender-stratified LCA revealed three subtypes for each gender. With dual-problem and healthy subgroup as common, problematic Internet subgroup was classified in the males, whereas problematic smartphone subgroup was classified in the females in the gender-stratified LCA. Thus, distinct patterns were observed according to gender with higher proportion of dual-problem present in males. While gaming was associated with problematic Internet use in males, aggression and impulsivity demonstrated associations with problematic smartphone use in females. An increase in the number of digital media-related problems was associated with worse outcomes in various psychosocial scales. Gaming may play a crucial role in males solely displaying Internet-related problems. The heightened impulsivity and aggression seen in our female problematic smartphone users requires further research.

Peer relationship and adolescent smartphone addiction: The mediating role of self-esteem and the moderating role of the need to belong.

J Behav Addict. 2017 Dec 1;6(4):708-717. doi: 10.1556/2006.6.2017.079. Epub 2017 Dec 19.

Adolescent smartphone addiction has received increased attention in recent years, and peer relationship has been found to be a protective factor in adolescent smartphone. However, little is known about the mediating and moderating mechanisms underlying this relation. The aim of this study was to investigate (a) the mediating role of self-esteem in the association between student-student relationship and smartphone addiction, and (b) the moderating role of the need to belong in the indirect relationship between student-student relationship and adolescent smartphone addiction. This model was examined with 768 Chinese adolescents (mean age = 16.81 years, SD = 0.73); the participants completed measurements regarding student-student relationship, self-esteem, the need to belong, and smartphone addiction.

The correlation analyses indicated that student-student relationship was significantly negatively associated with adolescent smartphone addiction, and the need to belong was significantly positively associated with adolescent smartphone addiction. Mediation analyses revealed that self-esteem partially mediated the link between student-student relationship and adolescent smartphone addiction. Moderated mediation further indicated that the mediated path was weaker for adolescents with lower levels of the need to belong. High self-esteem could be a protective factor against smartphone addiction for adolescents with a strong need to belong as these students appeared to be at elevated risk of developing smartphone addiction.

Measurement Invariance of the Short Version of the Problematic Mobile Phone Use Questionnaire (PMPUQ-SV) across Eight Languages (2018)

Int J Environ Res Public Health. 2018 Jun 8;15(6). pii: E1213. doi: 10.3390/ijerph15061213.

The prevalence of mobile phone use across the world has increased greatly over the past two decades. Problematic Mobile Phone Use (PMPU) has been studied in relation to public health and comprises various behaviours, including dangerous, prohibited, and dependent use. These types of problematic mobile phone behaviours are typically assessed with the short version of the Problematic Mobile Phone Use Questionnaire (PMPUQ⁻SV).

The whole study sample comprised 3038 participants. Descriptive statistics, correlations, and Cronbach's alpha coefficients were extracted from the demographic and PMPUQ-SV items. Individual and multigroup confirmatory factor analyses alongside MI analyses were conducted. Results showed a similar pattern of PMPU across the translated scales. A three-factor model of the PMPUQ-SV fitted the data well and presented with good psychometric properties. Six languages were validated independently, and five were compared via measurement invariance for future cross-cultural comparisons.

Social implications of children's smartphone addiction: The role of support networks and social engagement (2018)

J Behav Addict. 2018 Jun 5:1-9. doi: 10.1556/2006.7.2018.48.

Most studies have regarded smartphone addiction as a condition stemming from individuals' psychological issues, so research has rarely examined it in relation to a lack of social resources and its social impacts. However, this study reinterprets smartphone addiction as a social problem stemming from a lack of offline social networks and resulting in a decline of social engagement. This study drew on a survey of 2,000 children in Korea consisting of 991 males and 1,009 females with an average age of 12 years old. Using the STATA 14 structural equation modeling program, this study examined the relationships between children's lack of social networks, smartphone addiction, and social engagement. Results - Social network variables, such as formal organizational membership, quality of relationship with parents, size of the peer group, and peer support, decrease smartphone addiction. Simply having good relationships and reciprocal feelings with peers do not have any influence on the smartphone addiction. The more the children become addicted to smartphones, the less they participate in social engagement.

This study provides a new understanding of smartphone addiction by focusing on its social aspects, augmenting prior studies that have addressed psychological factors. Findings suggest that children's lack of social networks may inhibit comfortable social interactions and feelings of support in the offline environment, which can heighten their desire to escape to smartphones. These children, unlike non-addicts, may not take advantage of the media to enrich their social lives and increase their level of social engagement.

The relationship between addiction to smartphone usage and depression among adults: a cross sectional study (2018)

BMC Psychiatry. 2018 May 25;18(1):148. doi: 10.1186/s12888-018-1745-4.

Addiction to smartphone usage is a common worldwide problem among adults, which might negatively affect their wellbeing. This study investigated the prevalence and factors associated with smartphone addiction and depression among a Middle Eastern population.This cross-sectional study was conducted in 2017 using a web-based questionnaire distributed via social media. Responses to the Smartphone Addiction Scale - Short version (10-items) were rated on a 6-point Likert scale, and their percentage mean score (PMS) was commuted. Responses to Beck's Depression Inventory (20-items) were summated (range 0-60); their mean score (MS) was commuted and categorized. Higher scores indicated higher levels of addiction and depression. Factors associated with these outcomes were identified using descriptive and regression analyses.

Complete questionnaires were 935/1120 (83.5%), of which 619 (66.2%) were females and 316 (33.8%) were males. The mean ± standard deviation of their age was 31.7 ± 11  years. Majority of participants obtained university education 766 (81.9%), while 169 (18.1%) had school education. The PMS of addiction was 50.2 ± 20.3, and MS of depression was 13.6 ± 10.0. A significant positive linear relationship was present between smart phone addiction and depression. Significantly higher smartphone addiction scores were associated with younger age users. Factors associated with higher depression scores were school educated users compared to the university educated group and users with higher smart phone addiction scores .

The positive correlation between smartphone addiction and depression is alarming. Reasonable usage of smart phones is advised, especially among younger adults and less educated users who could be at higher risk of depression.

Indicators of smartphone addiction and stress score in university students (2018)

Wien Klin Wochenschr. 2018 Aug 6. doi: 10.1007/s00508-018-1373-5.

Smartphone addiction is one of the most common non-drug addictions, accompanied by negative effects, such as depression, anxiety, self-disclosure, impaired academic performance, family life and human relationships. The aim of the present study was to assess the prevalence of a predisposition to smartphone use disorder in university students and to investigate the associations between the intensity of mobile phone use and several variables. A total of 150 students, from 2 universities from Timisoara, were included in the study. Students were requested to answer two questionnaires: Mobile Phone Dependence Questionnaire (MPDQ) and International Stress Management Association Questionnaire (ISMA). The study revealed a relative high number of students with a predisposition to smartphone use disorder, with significant correlations between indicators of smartphone addiction and stress scores. Also, significant correlations were obtained between MPDQ scores and students age, period of mobile phone use and ISMA.

Smartphone Restriction and Its Effect on Subjective Withdrawal Related Scores (2018)

Front Psychol. 2018 Aug 13;9:1444. doi: 10.3389/fpsyg.2018.01444.

Excessive smartphone use has been associated with a number of negative consequences for the individual and the environment. Some similarities can be observed between excessive smartphone usage and several behavioural addictions, and continual usage constitutes one of several characteristics included in addiction. In the extreme high end of the distribution of smartphone usage, smartphone restriction might be expected to elicit negative effects for individuals. These negative effects may be regarded as withdrawal symptoms traditionally associated with substance-related addictions. To address this timely issue, the present study examined scores on the Smartphone Withdrawal Scale (SWS), the Fear of Missing Out Scale (FoMOS) and the Positive and Negative Affect Schedule (PANAS) during 72 h of smartphone restriction. A sample of 127 participants (72.4% women), aged 18-48 years (M = 25.0, SD = 4.5), were randomly assigned into one of two conditions: a restricted condition (experimental group, n = 67) or a control condition (control group, n = 60). During the restriction period participants completed the aforementioned scales three times a day. The results revealed significantly higher scores on the SWS and FoMOS for participants allocated to the restricted condition than those assigned to the control condition. Overall the results suggest that smartphone restriction could cause withdrawal symptoms.

Prevalence and factors associated with smartphone addiction among medical students at King Abdulaziz University, Jeddah (2018)

Pak J Med Sci. 2018 Jul-Aug;34(4):984-988. doi: 10.12669/pjms.344.15294. 

To investigate smartphone addiction among medical students and to determine factors associated with smartphone addiction among sixth-year medical students at King Abdulaziz University, Jeddah.

This cross-sectional study was conducted on 203 sixth-year medical students at the Faculty of Medicine, King Abdulaziz University, Jeddah, Saudi Arabia, during July 2017. Data analysis was done using SPSS-20.

The number of completed questionnaires received was181 out of 203, making a response rate of 89%. There were 87 male respondents (48.1%) and 94 female respondents (51.9%). The overall prevalence of smartphone addiction was 66 (36.5%). There is a statistically significant relationship between daily hours of smartphone usage and smartphone addiction (p<0.02). Out of 66 addicted students, 24 (55.8%) students reported using their smartphone more than five hours daily, 17(34.7%) students were using it 4 to 5 hours daily, 13 (27.7%) students were using it 2 to 3 hours daily and 12(28.6%) students were using it less than two hours daily. The study showed no statistically significant relationship between smartphone addiction and smoking statusor degree of obesity. There was a significant association between the total score on the smartphone addiction scale and daily usage hours (p-value<0.005).

Differences of Self-Control, Daily Life Stress, and Communication Skills between Smartphone Addiction Risk Group and General Group in Korean Nursing Students (2018)

Psychiatr Q. 2018 Sep 3. doi: 10.1007/s11126-018-9596-1.

Concerns about smartphone addiction have been raised as the use time of and dependence on the smartphone is increasing. This study were to examine the differences of self-control, daily life stress, and communication skills between smartphone addiction risk group and general group in nursing students, South Korea. A cross-sectional descriptive design was adopted. Samples were total 139 nursing students (addictive risk: n = 40, general: n = 99) at G and B cities in South Korea. Measures were general characteristics form, self-control scale in Korean version, daily life stress scale for college students, and Global Interpersonal Communication Competence Scale (GICC). There were significant differences on self-control (t = 3.02, p = 0.003) and daily life stress (t = 3.56, p < 0.001), but there was no significant difference on communication skills (t = 1.72, p = 0.088) between two groups. Nursing students in smart phone addiction risk group had worse self-control and higher daily life stress than nursing students in general group. The preventive education programs for healthy smartphone use of Korean nursing students are needed.

Does Parental Control Work With Smartphone Addiction?: A Cross-Sectional Study of Children in South Korea (2018)

J Addict Nurs. 2018 Apr/Jun;29(2):128-138. doi: 10.1097/JAN.0000000000000222.

The purposes of this study were to (a) examine the relationship between personal characteristics (age, gender), psychological factors (depression), and physical factors (sleep time) on smartphone addiction in children and (b) determine whether parental control is associated with a lower incidence of smartphone addiction. Data were collected from children aged 10-12 years (N = 208) by a self-report questionnaire in two elementary schools and were analyzed using t test, one-way analysis of variance, correlation, and multiple linear regression. Most of the participants (73.3%) owned a smartphone, and the percentage of risky smartphone users was 12%. The multiple linear regression model explained 25.4% (adjusted R = .239) of the variance in the smartphone addiction score (SAS). Three variables were significantly associated with the SAS (age, depression, and parental control), and three variables were excluded (gender, geographic region, and parental control software). Teens, aged 10-12 years, with higher depression scores had higher SASs. The more parental control perceived by the student, the higher the SAS. There was no significant relationship between parental control software and smartphone addiction. This is one of the first studies to examine smartphone addiction in teens. Control-oriented managing by parents of children's smartphone use is not very effective and may exacerbate smartphone addiction.

Technological Addictions and Social Connectedness: Predictor Effect of Internet Addiction, Social Media Addiction, Digital Game Addiction and Smartphone Addiction on Social Connectedness. (2017)

Dusunen Adam: Journal of Psychiatry & Neurological Sciences. Sep2017, Vol. 30 Issue 3, p202-216. 15p.

Objective: This study examined the predictor effects of four technological addictions, including Internet addiction, social media addiction, digital game addiction and smartphone addiction on social connectedness.

Method: The study was conducted on 201 adolescents (101 girls, 100 boys) who have been using Internet, playing digital games, and using social media for at least one year, and have at least one social media account and a smartphone. The Young's Internet Addiction Test-Short Form, Social Media Disorder Scale, Digital Game Addiction Scale, Smartphone Addiction Scale-Short Version, Social Connectedness Scale, and Personal Information Form were used as data collection tools.

Results: The analysis showed that Internet addiction, social media addiction, digital game addiction and smartphone addiction significantly predicted 25% of social connectedness. In addition, it has been determined that the strongest effect on social connectedness is from Internet addiction followed by social media addiction, digital game addiction, and smartphone addiction respectively.

Conclusion: Four technological addictions including Internet addiction, social media addiction, digital game addiction and smartphone addiction significantly affect social connectedness.

Internet Addiction and Mental Health Status of Adolescents in Croatia and Germany (2017)

Psychiatr Danub. 2017 Sep;29(3):313-321. doi: 10.24869/psyd.2017.313.

The research examines the influence of internet addiction of adolescents in Croatia and Germany and its impact on the subjective feeling of health status. The purpose of this paper is also to give insight into how the Internet addiction which is a risky health behavior affects the health status of adolescents. The excessive use of Internet is linked with the lower health status of Croatian adolescents as well as of the adolescents in Germany.

Respondents are defined as students who attend school regularly ages 11-18.

There is a strong correlation between adolescents' mental health and quality of life and the level of their Internet addiction. Out of the total number of adolescents in ill-health, 39% of them are moderately or severely addicted to the Internet. 20% out of the total number of adolescents in medium health is moderate of severely addicted to the Internet. Finally, out of the total number of adolescents in good health 13% has been moderate of highly addicted to the Internet. Therefore, the better the adolescents' health, the fewer the Internet addicts. And vice versa, the worse the health, the more the Internet addicts.

Internet addiction and its relationship with anxiety, stress, depression and insomnia in nursing and midwifery (2017)

Health_Based Research, 3 (1).

Internet addiction is one of the problems associated with the advancement of technology that affects people's mental health. The purpose of this study was to investigate the relationship between addiction to the Internet and insomnia, anxiety, depression and stress in nursing and midwifery students of Bojnourd Islamic Azad University in 2017.

The mean of Internet addiction score in students was 31.14 and 6.7% of them had Internet addiction. Also, the mean score of anxiety, stress, depression and insomnia was 12.54, 23.37, 17.12 and 14.56. There was a significant relationship between addiction to the Internet with anxiety, stress, depression and insomnia . Conclusion: Considering the prevalence of Internet addiction among students, and its significant relationship with depression, anxiety, stress and insomnia in them, plans must be made to prevent this health problem.

Problematic Internet use and associated mental health issues in South Korean Internet users (2017)

European Psychiatry 41 (2017): S868

The Internet is commonly used in modern society; however, Internet use may become a problematic behaviour. There is an increasing need for research on problematic Internet use (PIU) and its’ associated risk factors.This study aims to explore the prevalence and health correlates of problematic Internet use among South Korean adults.

We recruited the participants aged between 18 and 84 years old among the online panel of an online research service. The sample size of the survey was 500. Of these 500 participants, 51.4% (n = 257) were men and 48.6% (n = 243) were women. A participant was classified as a problematic Internet use (PIU) if his/her total score of Young's Internet Addiction Scale (YIA) was above 50. Stress Response Index (SRI), Fagerstrom test for nicotine dependence, lifetime average caffeine consumption, and sociodemographic query form were used in the collection of data. The t test and chi-square test were used for data analysis.

One hundred ninety-seven (39.4%) of the participants was classified into the PIU group. There was no difference of gender and education between PIU and normal users. However, PIU group was younger (mean 39.5 years) than normal users (mean 45.8 years). PIU group was more likely to have high levels of perceived stress, nicotine dependence, and drink more often caffeinated beverages.

These data indicate that problematic Internet use is associated with perceived stress level, nicotine and caffeine use in South Korean Internet users. More research is needed to better understand the relationship between Internet use and mental health issues.

Metacognitions or distress intolerance: The mediating role in the relationship between emotional dysregulation and problematic internet use (2017)

Addictive Behaviors Reports rights and content


•This is the first study to explore the mediation role of distress intolerance in the relationship between emotional dysregulation and Problematic Internet Use (PIU).

•Relationships between distress intolerance and PIU were supported.

•The finding of this study indicate that distress intolerance plays a more significant mediating role than metacognition in the relationship between emotional dysregulation and PIU.

•Targeting distress intolerance may help reduce PIU.

Given the relevance of problematic Internet use (PIU) to everyday life, its relationship to emotional dysregulation and the importance of metacognitions and distress intolerance in process and intermediaries research, this study examined which of metacognitions and distress intolerance acts as an intermediary between emotional dysregulation and PIU.

In the current study, 413 undergraduate students from the University of Tehran, Iran (202 females; mean age = 20.13) voluntarily completed a questionnaire package which included the Internet Addiction Test (IAT), Difficulties in Emotion Regulation Scale (DERS), Metacognitions Questionnaire 30 (MCQ-30(, and Distress Tolerance Scale (DTS). The data were then analyzed using structural equation modeling by LISREL software.

The results of this study provide evidence for the impact of emotional dysregulation on PIU through metacognitions and distress intolerance. Also, these findings emphasize that distress intolerance has a more significant mediating role than metacognition in the relationship between emotional dysregulation and PIU.

Psychological problems of young people resorting to the Internet communication (2017)

International Journal Of Professional Science 1 (2017).

The analysis of foreign and Russian psychological researches on the issue of Internet communication has allowed to identify the main personal problems of young people. The article presents the results of an experimental study of the psychological problems of young people resorting to the Internet communication.

The study involved 45 students from different universities in Russia at the age of 18 to 22 years. The general hypothesis of the study was in the statement that the Internet as a modern communicative medium contributes to the emergence psychological problems of young people, in particular: the manifestation of negative emotional states (the experience of depression); reduce the level of self-confidence and self-esteem; formation of uncertainty feeling the manifestation Internet addiction symptoms.

Online social networking addiction among college students in Singapore: Comorbidity with behavioral addiction and affective disorder (2017)

Asian J Psychiatr. 2017 Feb;25:175-178. doi: 10.1016/j.ajp.2016.10.027.

This study aimed to determine the prevalence of addiction to social networking sites/platforms (SNS) and its comorbidity with other behavioral addiction and affective disorder among college students in Singapore. 1110 college students (age: M=21.46, SD=1.80) in Singapore completed measures assessing online social networking, unhealthy food intake and shopping addiction as well as depression, anxiety and mania.

The prevalence rates of SNS, food and shopping addiction were 29.5%, 4.7% and 9.3% respectively for the total sample. SNS addiction was found to co-occur with food addiction (3%), shopping addiction (5%), and both food and shopping addiction (1%). The comorbidity rates of SNS addiction and affective disorder were 21% for depression, 27.7% for anxiety, and 26.1% for mania. Compared with the total sample, students with SNS addiction reported higher comorbidity rates with other behavioral addiction and affective disorder. In general, females as compared to males reported higher comorbidity rates of SNS addiction and affective disorder.

Media use and Internet addiction in adult depression: A case-control study (2017)

Computers in Human Behavior Volume 68, March 2017, Pages 96–103

The present case-control study explored tendencies of Internet addiction in a group of depressive patients compared with a control group of healthy persons. Standardized questionnaires were used to assess the extent of Internet addiction (ISS), depression symptoms (BDI), impulsivity (BIS) and global psychological stress (SCL-90R).

The results presented significantly higher tendencies for Internet addiction in the group of depressive patients. The prevalence of Internet addiction in this group was considerably high (36%). In addition, depressive patients with Internet addiction showed consistently but insignificantly higher symptom severity and psychological stress compared with patients without Internet addiction. Both groups of depressive patients were significantly higher burdened with depressive symptoms and psychological stress than the healthy controls. Low age and male sex were particularly important predictors of Internet addiction in the group of depressive patients. The results are in accordance with previously published findings in other fields of addiction disorders.

Sleep quality, internet addiction and depressive symptoms among undergraduate students in Nepal (2017)

BMC Psychiatry. 2017 Mar 21;17(1):106. doi: 10.1186/s12888-017-1275-5. 

Evidence on the burden of depression, internet addiction and poor sleep quality in undergraduate students from Nepal is virtually non-existent. While the interaction between sleep quality, internet addiction and depressive symptoms is frequently assessed in studies, it is not well explored if sleep quality or internet addiction statistically mediates the association between the other two variables.

We enrolled 984 students from 27 undergraduate campuses of Chitwan and Kathmandu, Nepal. We assessed sleep quality, internet addiction and depressive symptoms in these students using Pittsburgh Sleep Quality Index, Young's Internet Addiction Test and Patient Health Questionnaire-9 respectively.

Overall, 35.4%, 35.4% and 21.2% of students scored above validated cutoff scores for poor sleep quality, internet addiction and depression respectively. Higher internet addiction was associated with having lower age, being sexually inactive and having failed in previous year's board examination. Depressive symptoms were higher for students having higher age, being sexually inactive, having failed in previous year's board examination and lower years of study. Internet addiction statistically mediated 16.5% of the indirect effect of sleep quality on depressive symptoms. Sleep quality, on the other hand, statistically mediated 30.9% of the indirect effect of internet addiction on depressive symptoms.

In the current study, a great proportion of students met criteria for poor sleep quality, internet addiction and depression. Internet addiction and sleep quality both mediated a significant proportion of the indirect effect on depressive symptoms. However, the cross-sectional nature of this study limits causal interpretation of the findings. Future longitudinal study, where the measurement of internet addiction or sleep quality precedes that of depressive symptoms, are necessary to build upon our understanding of the development of depressive symptoms in students.

Epidemiology of Internet Use by an Adolescent Population and its Relation with Sleep Habits (2017)

Acta Med Port. 2017 Aug 31;30(7-8):524-533. doi: 10.20344/amp.8205.

It was performed an observational, cross sectional and community-based study. The target were students attending 7th and 8th grades, to whom was applied an online self-report questionnaire to assess sociodemographic features, Internet use, Internet dependence, sleep characteristics and excessive daytime sleepiness.

A total of 727 adolescents were included with a mean age 13 ± 0.9 years. Three-quarters of teenagers use Internet daily and 41% do it for three or more hours/day, mainly at home. The phone and laptop were the main devices used. Online games and social networks use were the main activities performed. Internet dependence was observed in 19% of adolescents, and it was associated with male gender, social networks use, mainly Twitter and Instagram use, self-perceived sleep problems, initial and middle insomnia and excessive daytime sleepiness (p < 0.05).

The results confirm the highlight that Internet has in adolescents routine, who prioritize in their use access to social networks and online games, using single devices, less subject to parental control. The Internet addiction rate observed and its association with sleep alterations and daytime sleepiness emphasizes the importance of this issue.

The Relationship of Sexual Abuse with Self-Esteem, Depression, and Problematic Internet Use in Korean Adolescents (2017)

Psychiatry Investig. 2017 May;14(3):372-375. doi: 10.4306/pi.2017.14.3.372.

The association of sexual victimization with self-esteem, depression, and problematic internet use was examined in Korean adolescents. A total of 695 middle and high school students were recruited (413 boys, 282 girls, mean age, 14.06±1.37 years). The participants were administered the Early Trauma Inventory Self Report-Short Form (ETISR-SF), Rosenberg's Self-Esteem Scale (RSES), the Children's Depression Inventory (CDI), and Young's Internet Addiction Test (IAT). The associations between sexual abuse and the level of self-esteem, depressive symptoms, and problematic internet use were analyzed. Adolescents who had experienced sexual abuse showed lower self-esteem, more depressive symptoms, and greater problematic internet use compared with adolescents who had not experienced sexual abuse. Depressive symptoms predicted problematic internet use in a positive way. Sexual abuse also predicted problematic internet use directly. The results of the present study indicate that sexually abused adolescents had a higher risk of depression and problematic internet use. For sexually abused adolescents, programs aimed at raising self-esteem and preventing internet addiction, as well as mental health screening, are needed.

Relationship Between Internet Addiction and Self-Esteem: Cross-Cultural Study in Portugal and Brazil (2017))

Interacting with Computers (2017): 1-12.

As more people are connected to the Internet, researchers have been growingly concerned with Internet addiction and the psychological attributes connected to it. The aim of this study is to examine the relationship between Internet addiction and self-esteem. The sample included 1399 Portuguese and Brazilian Internet users, from 14 to 83 years old, who responded to the Internet Addiction Test (IAT) (Young, K. (1998b).

Using a Pearson correlation, we found a negative correlation between Internet addiction and self-esteem. Linear regression indicated that low self-esteem explained 11% of Internet addiction, and that negative feelings caused by Internet addiction (withdrawal & concealment) explained 13% of self-esteem. In the analysis of the IAT, we found that the groups exhibiting elevated levels of Internet addiction included men, Brazilians, and youths (14–25 years old).

Online sexual activities: An exploratory study of problematic and non-problematic usage patterns in a sample of men (2016)

Computers in Human Behavior

Volume 29, Issue 3, May 2013, Pages 1243–1254

This study systematically tested whether the use of specific technologies or media (including certain types of Facebook use), technology-related anxieties, and technology-related attitudes (including multitasking preference) would predict clinical symptoms of six personality disorders (schizoid, narcissistic, antisocial, compulsive, paranoid and histrionic) and three mood disorders (major depression, dysthymia and bipolar-mania)

  • Technology use, anxiety, and attitudes predict symptoms of nine psychiatric disorders.
  • Facebook general use and impression formation were the best predictors.
  • More friends predict more symptoms of some disorders but fewer symptoms of others.
  • Multitasking preference predicts more clinical symptoms of nearly all disorders.

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 - 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.

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.

Results: Compared to HC, IAD subjects showed increased activation in the anterior cingulate cortex (ACC) and decreased activation in the orbitofrontal cortex following error responses. Significant correlation was found between ACC activation and the Internet addiction test scores.

Conclusions: IAD subjects show an impaired error-monitoring ability compared to HC, which can be detected by the hyperactivation in ACC in error responses.

COMMENTS: Indicates hypofrontality

Differential resting-state EEG patterns associated with comorbid depression in Internet addiction (2014)

Prog Neuropsychopharmacol Biol Psychiatry. 2014 Apr 3;50:21-6.

Many researchers have reported a relationship between Internet addiction and depression. In the present study, we compared the resting-state quantitative electroencephalography (QEEG) activity of treatment-seeking patients with comorbid Internet addiction and depression with those of treatment-seeking patients with Internet addiction without depression, and healthy controls to investigate the neurobiological markers that differentiate pure Internet addiction from Internet addiction with comorbid depression.The Internet addiction group without depression had decreased absolute delta and beta powers in all brain regions, whereas the Internet addiction group with depression had increased relative theta and decreased relative alpha power in all regions. These neurophysiological changes were not related to clinical variables. The current findings reflect differential resting-state QEEG patterns between both groups of participants with Internet addiction and healthy controls and also suggest that decreased absolute delta and beta powers are neurobiological markers of Internet addiction.          

Internet addictive individuals share impulsivity and executive dysfunction with alcohol-dependent patients (2014)

Internet addiction disorder (IAD) should belong to a kind of behavioral addiction. Previous studies indicated that there are many similarities in the neurobiology of behavior and substance addictions.

Results showed that Barratt impulsiveness scale 11 scores, false alarm rate, the total response errors, perseverative errors, failure to maintain set of IAD and AD group were significantly higher than that of NC group, and hit rate, percentage of conceptual level responses, the number of categories completed, forwards scores, and backwards scores of IAD and AD group were significantly lower than that of NC group, however, no differences in above variables between IAD group and AD group were observed. These results revealed that the existence of impulsivity, deficiencies in executive function and working memory in an IAD and an AD sample, namely, Internet addictive individuals share impulsivity and executive dysfunction with alcohol-dependent patients.

Neural responses to various rewards and feedback in the brains of adolescent Internet addicts detected by functional magnetic resonance imaging (2014)

Psychiatry Clin Neurosci. 2014 Jun;68(6):463-70. doi: 10.1111/pcn.12154.

These findings suggest that AIA show reduced levels of self-related brain activation and decreased reward sensitivity irrespective of the type of reward and feedback. AIA may be only sensitive to error monitoring regardless of positive feelings, such as sense of satisfaction or achievement.

Blunted feedback processing during risk-taking in adolescents with features of problematic Internet use (2015)

Addict Behav. 2015 Jan 20;45C:156-163.

While the conceptualization of problematic Internet use (PIU) as a "behavioral addiction" resembling substance-use disorders is debated, the neurobiological underpinnings of PIU remain understudied. This study examined whether adolescents displaying features of PIU (at-risk PIU; ARPIU) are more impulsive and exhibit blunted responding in the neural mechanisms underlying feedback processing and outcome evaluation during risk-taking.

Compared to non-ARPIU, ARPIU adolescents displayed higher levels of urgency and lack of perseverance on the UPPS Impulsive Behavior Scale. Although no between-group difference in BART performance was observed, ERPs demonstrated overall decreased sensitivity to feedback in ARPIU compared to non-ARPIU adolescents, as indexed by blunted feedback-related negativity (FRN) and P300 amplitudes to both negative and positive feedback. The present study provides evidence for feedback processing during risk-taking as a neural correlate of ARPIU.

An Error-Related Negativity Potential Investigation of Response Monitoring Function in Individuals with Internet Addiction Disorder (2013)

Front Behav Neurosci. 2013 Sep 25;7:131.

Internet addiction disorder (IAD) is an impulse disorder or at least related to impulse control disorder. Deficits in executive functioning, including response monitoring, have been proposed as a hallmark feature of impulse control disorders.The error-related negativity (ERN) reflects individual's ability to monitor behavior. Since IAD belongs to a compulsive-impulsive spectrum disorder, theoretically, it should present response monitoring functional deficit characteristics of some disorders, such as substance dependence, ADHD, or alcohol abuse, testing with an Erikson flanker task. Up to now, no studies on response monitoring functional deficit in IAD were reported.

IAD group made more total error rates than did controls; Reactive times for total error responses in IAD group were shorter than did controls. The mean ERN amplitudes of total error response conditions at frontal electrode sites and at central electrode sites of IAD group were reduced compared with control group. These results revealed that IAD displays response monitoring functional deficit characteristics and shares ERN characteristics of compulsive-impulsive spectrum disorder.

Differences in Resting-state Quantitative Electroencephalography Patterns in Attention Deficit/Hyperactivity Disorder with or without Comorbid Symptoms (2017)

Clin Psychopharmacol Neurosci. 2017 May 31;15(2):138-145. doi: 10.9758/cpn.2017.15.2.138.

The aim of the present study was to evaluate the role of comorbid psychiatric symptoms on quantitative electroencephalogram (QEEG) activities in boys with the attention deficit/hyperactivity disorder (ADHD).

All participants were male students in the second, third or fourth grade in elementary school. Therefore, there were no significant differences in age or sex. Participants with ADHD were assigned to one of three groups: pure ADHD (n=22), ADHD with depressive symptoms (n=11), or ADHD with problematic internet use (n=19). The Korean version of the Children's Depression Inventory and the Korean Internet Addiction Self-scale were used to assess depressive symptoms and problematic internet use, respectively. Resting-state EEG during eyes closed was recorded, and the absolute power of five frequency bands was analyzed: delta (1-4 Hz), theta (4-8 Hz), alpha (8-12 Hz), beta (12-30 Hz), and gamma (30-50 Hz).

The ADHD with problematic internet use group showed decreased absolute theta power at the central and posterior region compared with the pure ADHD group. However, The ADHD with depressive symptoms group showed no significant differences compared with the other groups.

The links between healthy, problematic, and addicted Internet use regarding comorbidities and self-concept-related characteristics (2018)

Comments: Another unique study examining subjects with recently developed ADHD-like symptoms. The authors strongly believe that internet use is causing ADHD like symptoms. An excerpt from the discussion.

To our knowledge, this was the first study to attempt at including the assessment of the impact of recently developed ADHD symptoms in addition to the ADHD diagnosis in Internet addicts. Participants with ADHD as well as those with only recently developed ADHD-like symptoms showed significantly higher lifetime and current Internet use severity compared with those who did not fulfill these conditions. Furthermore, addicted participants with recently developed ADHD symptoms (30% of the addicted group) exhibited increased lifetime Internet use severity compared with those addicted participants without ADHD symptoms. Our results indicate that recently developed ADHD symptoms (without fulfilling the diagnostic criteria for ADHD) are associated with Internet addiction. This may lead to a first indication that the excessive Internet use has an impact on the development of cognitive deficits similar to those found in ADHD. A recent study of Nie, Zhang, Chen, and Li (2016) reported that adolescent Internet addicts with and without ADHD as well as participants with ADHD alone showed comparable deficits in inhibitory control and working memory functions.

This assumption seems to also be supported by certain studies reporting reduced gray matter density in the anterior cingulate cortex in addictive Internet users as well as in ADHD patients (Frodl & Skokauskas, 2012; Moreno-Alcazar et al., 2016; Wang et al., 2015; Yuan et al., 2011). Nevertheless, to confirm our assumptions, further studies assessing the relationship between the onset of excessive Internet use and ADHD in Internet addicts are needed. In addition, longitudinal studies should be applied to clarify causality. If our findings are confirmed by further studies, this will have clinical relevance for the diagnostic process of ADHD. It is conceivable that the clinicians would be required to carry out a detailed assessment of possible addictive Internet usage in patients with suspected ADHD.

The relationship between internet addiction, attention deficit hyperactivity symptoms and online activities in adults (2018)

Compr Psychiatry. 2018 Aug 9;87:7-11. doi: 10.1016/j.comppsych.2018.08.004.

The objective of this study was to examine the relationship between Internet Addiction (IA), Attention Deficit Hyperactivity Disorder (ADHD) symptoms and online activities in an adult population.

A sample of 400 individuals aged 18 to 70 completed the Adult ADHD Self-Report Scale (ASRS), Young's Internet Addiction Test, and their preferred online activities.

A moderate association was found between higher levels of ADHD symptoms and IA. The best predictors of IA scores were ADHD symptoms, age, playing online games and spending more time online.

Our findings further support a positive relationship between ADHD symptoms and excessive internet use.

Relationship of internet addiction severity with probable ADHD and difficulties in emotion regulation among young adults (2018)

Psychiatry Res. 2018 Aug 29;269:494-500. doi: 10.1016/j.psychres.2018.08.112.

The aim of the present study was to evaluate relationship of Internet addiction (IA) symptom severity with probable attention deficit/hyperactivity disorder (ADHD) and difficulties in emotion regulation, while controlling the effects of depression, anxiety and neuroticism. The study was conducted with online survey among 1010 volunteered participants of university students and/or amateur or professional gamers. Scale scores were higher among the group with high probability of ADHD (n = 190, 18.8%). In linear regression analysis, both Inattentiveness and hyperactivity/impulsivity dimensions of ADHD were related with the severity of IA symptoms, together with depression and non-accept dimension of the Difficulties in Emotion Regulation Scale (DERS). Similarly, presence of probable ADHD was related with the severity of IA symptoms in ANCOVA, together with depression, neuroticism and non-accept dimension of DERS. Participants were two different groups of non-clinical samples and all scales were self-rated. Also common comorbidities were not screened. Finally, since this study is cross-sectional the findings of this study cannot address the causal relationships among the primary constructs of interest. These findings suggest that the presence of probable ADHD is related with the severity of IA symptoms, together with the difficulties in emotion regulation, particularly non-accept dimension, depression and neuroticism among young adults.

Prefrontal Control and Internet Addiction A Theoretical Model and Review of Neuropsychological and Neuroimaging Findings (2014)

Front Hum Neurosci. 2014 May 27;8:375. eCollection 2014.

Some individuals suffer from a loss of control over their Internet use resulting in personal distress, symptoms of psychological dependence, and diverse negative consequences. This phenomenon is often referred to as Internet addiction. Only Internet Gaming Disorder has been included in the appendix of the DSM-5, but it has already been argued that Internet addiction could also comprise problematic use of other applications with cybersex, online relations, shopping, and information search being Internet facets at risk for developing an addictive behavior.

Neuropsychological investigations have pointed out that certain prefrontal functions in particular executive control functions are related to symptoms of Internet addiction, which is in line with recent theoretical models on the development and maintenance of the addictive use of the Internet. Control processes are particularly reduced when individuals with Internet addiction are confronted with Internet-related cues representing their first choice use. For example, processing Internet-related cues interferes with working memory performance and decision making. Consistent with this, results from functional neuroimaging and other neuropsychological studies demonstrate that cue-reactivity, craving, and decision making are important concepts for understanding Internet addiction. The findings on reductions in executive control are consistent with other behavioral addictions, such as pathological gambling.

The Internet Process Addiction Test: Screening for Addictions to Processes Facilitated by the Internet (2015)

Behav Sci (Basel). 2015 Jul 28;5(3):341-352.

The Internet Process Addiction Test (IPAT) was created to screen for potential addictive behaviors that could be facilitated by the internet. The IPAT was created with the mindset that the term "Internet addiction" is structurally problematic, as the Internet is simply the medium that one uses to access various addictive processes. The role of the internet in facilitating addictions, however, cannot be minimized. A new screening tool that effectively directed researchers and clinicians to the specific processes facilitated by the internet would therefore be useful. This study shows that the Internet Process Addiction Test (IPAT) demonstrates good validity and reliability. Four addictive processes were effectively screened for with the IPAT: Online video game playing, online social networking, online sexual activity, and web surfing. Implications for further research and limitations of the study are discussed.

Problematic internet use as an age-related multifaceted problem: Evidence from a two-site survey (2018)

Addict Behav. 2018 Feb 12;81:157-166. doi: 10.1016/j.addbeh.2018.02.017.

Problematic internet use (PIU; otherwise known as Internet Addiction) is a growing problem in modern societies.  Our aim was to identify specific internet activities associated with PIU and explore the moderating role of age and gender in those associations.We recruited 1749 participants aged 18 and above via media advertisements in an Internet-based survey at two sites, one in the US, and one in South Africa; we utilized Lasso regression for the analysis.

Specific internet activities were associated with higher problematic internet use scores, including general surfing (lasso β: 2.1), internet gaming (β: 0.6), online shopping (β: 1.4), use of online auction websites (β: 0.027), social networking (β: 0.46) and use of online pornography (β: 1.0). Age moderated the relationship between PIU and role-playing-games (β: 0.33), online gambling (β: 0.15), use of auction websites (β: 0.35) and streaming media (β: 0.35), with older age associated with higher levels of PIU. There was inconclusive evidence for gender and gender × internet activities being associated with problematic internet use scores. Attention-deficit hyperactivity disorder (ADHD) and social anxiety disorder were associated with high PIU scores in young participants (age ≤ 25, β: 0.35 and 0.65 respectively), whereas generalized anxiety disorder (GAD) and obsessive-compulsive disorder (OCD) were associated with high PIU scores in the older participants (age > 55, β: 6.4 and 4.3 respectively).

Many types of online behavior (e.g. shopping, pornography, general surfing) bear a stronger relationship with maladaptive use of the internet than gaming supporting the diagnostic classification of problematic internet use as a multifaceted disorder. Furthermore, internet activities and psychiatric diagnoses associated with problematic internet use vary with age, with public health implications.

Influence of excessive internet use on auditory event-related potential (2008)

Sheng Wu Yi Xue Gong Cheng Xue Za Zhi. 2008 Dec;25(6):1289-93.

At present, young people's internet addiction has become a serious social problem and on important concern in China. Comparison studies of auditory event-related potential (ERP) between 9 excessive internet users and 9 common internet users were carried out. The obvious influences of excessive internet use on the users were observed. The result suggests that excessive internet use may have some influences on cerebral cognitive function.

Problematic internet use is associated with structural alterations in the brain reward system in females. (2015)

2015 Sep 23.

Neuroimaging findings suggest that excessive Internet use shows functional and structural brain changes similar to substance addiction. Even though it is still under debate whether there are gender differences in case of problematic use, previous studies by-passed this question by focusing on males only or by using gender matched approach without controlling for potential gender effects. We designed our study to find out whether there are structural correlates in the brain reward system of problematic Internet use in habitual Internet user females.

According to MR volumetry, problematic Internet use was associated with increased grey matter volume of bilateral putamen and right nucleus accumbens while decreased grey matter volume of orbitofrontal cortex (OFC). Similarly, VBM analysis revealed a significant negative association between the absolute amount of grey matter OFC and problematic Internet use. Our findings suggest structural brain alterations in the reward system usually related to addictions are present in problematic Internet use.

The cognitive dysregulation of Internet addiction and its neurobiological correlates (2017)

Front Biosci (Elite Ed). 2017 Jun 1;9:307-320.

Individuals with Internet addiction (IA) show loss of control and recurring maladaptive Internet use. This condition has negative consequences and causes significant psychosocial distress. Here, we review neurobiological changes in four key paradigms in cognitive domain in IA including reward processing, impulsivity, cue reactivity, and decision-making. IA is associated with alterations in prefrontal-cingulate region activation during the inhibition of inappropriate responses. Such patterns are also observed in cue-reactivity paradigm tasks, suggesting a relationship with loss of control and deficits in the control of cue-eliciting behavior. Individuals with IA exhibit heightened reward prediction, devalue negative outcomes and have a higher risk-taking propensity under ambiguous situations. In conclusion, addictive use of the Internet is associated with deficits in cognitive-emotional processing, aberrant sensitivity to rewards and Internet-related cues, poor impulse control, and impaired decision-making. There is a need to examine neural underpinnings of these aberrant behaviors and neurobiological-cognitive perspective in IA.

Working memory, executive function and impulsivity in Internet-addictive disorders: a comparison with pathological gambling (2015)

2015 Sep 24:1-9.

The purpose of the present study was to test whether individuals with Internet addiction disorder (IAD) presented analogous characteristics of working memory, executive function and impulsivity compared with pathological gambling (PG) patients. The subjects included 23 individuals with IAD, 23 PG patients and 23 controls.

The results of this study showed that the false alarm rate, total response errors, perseverative errors, failure to maintain set and BIS-11 scores of both the IAD and PG groups were significantly higher than that of the control group. In addition, the forward scores and backwards scores, percentage of conceptual level responses, number of categories completed and hit rate of the IAD and PG groups were significantly lower than that of the control group. Furthermore, the false alarm rate and BIS-11 scores of the IAD group were significantly higher than those of PG patients, and the hit rate was significantly lower than that of the PG patients.

Individuals with IAD and PG patients present deficiencies in working memory, executive dysfunction and impulsivity, and individuals with IAD are more impulsive than PG patients.

Respiratory sinus arrhythmia reactivity of internet addiction abusers in negative and positive emotional states using film clips stimulation (2016)

Biomed Eng Online. 2016 Jul 4;15(1):69.

People with internet addiction (IA) suffer from mental, physical, social, and occupational problems. IA includes psychological and physiological syndromes, and among the syndromes, emotion was suggested important mental and physiological expressions of IA. However, few physiologically emotional characters of IA were investigated. Autonomic nervous system (ANS) activity was a good link between IA and emotion, and respiratory sinus arrhythmia (RSA) gained from ANS was hypothesized related to IA.

The results revealed that the changes in RSA values were biologically significantly different between HIA and LIA, especially when sadness, happiness, or surprise was induced. HIA people exhibited stronger RSA reactivity following negative emotion than LIA people, but the RSA reactivity following positive emotion was weaker. This study provides more physiological information about IA and assists further investigation on the regulation of the ANS for IA abusers. The results will benefit the further application, early detection, therapy, and even early prevention.

Decision-making and prepotent response inhibition functions in excessive internet users (2009)

CNS Spectr. 2009 Feb;14(2):75-81.

Excessive Internet use (EIU), also described as Internet addiction or pathological Internet use, has already become a serious social problem around the world. Some researchers consider EIU as a kind of behavioral addiction. However, there are few experimental studies on the cognitive functions of excessive Internet users (EIUers) and limited data are available to compare EIU with other addictive behaviors, such as drug abuse and pathological gambling.

These results showed some similarities and dissimilarities between EIU and other addictive behaviors such as drug abuse and pathological gambling. The findings from the Gambling Task indicated that EIUers have deficits in decision-making function, which are characterized by a strategy learning lag rather than an inability to learn from task contingencies.

EIUers' better performance in the Go/no-go Task suggested some dissociation between mechanisms of decision-making and those of prepotent response inhibition. However, EIUers could hardly suppress their excessive online behaviors in real life. Their ability of inhibition still needs to be further studied with more specific assessments.

COMMENTS: Using cognitive tests, researchers found similarities between Internet addicts and gambling addicts.

The theoretical underpinnings of Internet addiction and its association with psychopathology in adolescence (2017)

Int J Adolesc Med Health. 2017 Jul 6. pii: /j/ijamh.ahead-of-print/ijamh-2017-0046/ijamh-2017-0046.xml.

This paper reviews the psychological and theoretical underpinnings that might help to explain the reported relationship between Internet addiction (IA) and psychopathology in both children and adolescents. Drawing on cognitive-behavioural models and social-skills theory, IA shows a strong relationship with depression, attention deficit hyperactivity disorder (ADHD) and time spent using the Internet use. Mixed findings are reported for social anxiety. Loneliness and hostility were also found to be associated with IA. Gender and age moderated these relationships with greater psychopathology generally reported among males and younger Internet users. This paper adds to the growing body of literature showing an association between IA and a range of mental health problems in both children and adolescents. A dependence on the Internet can potentially result in significant harm both socially and psychologically. While research has identified a potential pathway commencing with mental health problems and concluding with IA, few studies have examined the alternative direction and this may provide the impetus for future research endeavours.

Exploring Associations between Problematic Internet Use Depressive Symptoms and Sleep Disturbance among Southern Chinese Adolescents (2016)

Int J Environ Res Public Health. 2016 Mar 14;13(3). pii: E313.

The primary aim of this study was to examine associations between problematic Internet use, depression and sleep disturbance, and explore whether there were differential effects of problematic Internet use and depression on sleep disturbance. A total of 1772 adolescents who participated in the Shantou Adolescent Mental Health Survey were recruited in 2012 in Shantou, China. Among the participants, 17.2% of adolescents met the criteria for problematic Internet use, 40.0% were also classified as suffering from sleep disturbance, and 54.4% of students had depressive symptoms. Problematic Internet use was significantly associated with depressive symptoms and sleep disturbance. There is a high prevalence of problematic Internet use, depression and sleep disturbance among high school students in southern China, and problematic Internet use and depressive symptoms are strongly associated with sleep disturbance. This study provides evidence that problematic Internet use and depression have partially mediating effects on sleep disturbance. These results are important for clinicians and policy makers with useful information for prevention and intervention efforts.

Loneliness as the Cause and the Effect of Problematic Internet Use: The Relationship between Internet Use and Psychological Well-Being (2009)

CyberPsychology & Behavior. July 2009, 12(4): 451-455. doi:10.1089/cpb.2008.0327.

The current research started from the assumption that one of the major motives driving individuals' Internet use is to relieve psychosocial problems (e.g., loneliness, depression). This study showed that individuals who were lonely or did not have good social skills could develop strong compulsive Internet use behaviors resulting in negative life outcomes (e.g., harming other significant activities such as work, school, or significant relationships) instead of relieving their original problems. Such augmented negative outcomes were expected to isolate individuals from healthy social activities and lead them into more loneliness. Even though previous research suggests that social use of the Internet (e.g., social networking sites, instant messaging) could be more problematic than entertainment use (e.g., downloading files), the current study showed that the former did not show stronger associations than the latter in the key paths leading to compulsive Internet use.

Anxiety and depression among school students in Jordan: Prevalence, risk factors, and predictors (2017)

Perspect Psychiatr Care. 2017 Jun 15. doi: 10.1111/ppc.12229.

This study aimed to assess the prevalence of anxiety and depression, examine their relationships with sociodemographic factors and Internet addiction, and identify their main predictors among Jordanian school students aged 12-18 years.

Overall, 42.1 and 73.8% of the students were experiencing anxiety and depression. Risk factors for both problems were school class and Internet addiction, with the latter being the main predictor.

Increasing students' and stakeholders' awareness of mental illnesses and health programs and developing counseling centers to meet the students' needs are necessary.

Internet Addiction or Psychopathology in Disguise? Results From a Survey of College-Aged Internet Users (2018)

European Neuropsychopharmacology 28, no. 6 (2018): 762.

Internet addiction, is a term describing pathological, compulsive internet use and has an estimated prevalence of 6% among the general population and higher in students[1]. Extreme internet use may have significant public health importance as it has been attributed to several cardio-pulmonary deaths and at least one murder. While the pathological use of alcohol or drugs has been historically accepted as an addiction, questions remain concerning whether extreme internet use should be conceptualized as an addiction. The Internet Addiction Test (IAT) was developed in 1998, prior to the wide-spread use of Smartphone and other mobile devices, to detect internet addiction [2]. It is unclear whether this instrument is capable of capturing problematic modern internet use. The purpose of this study was to examine the construct of “internet addiction” in a sample of college aged internet users.

A survey was administered to first year undergraduate students at McMaster University and posted to our centre website

Two hundred and fifty-four participants completed all assessments. They had a mean age of 18.5±1.6 years and 74.5% were female. In total 12.5% (n = 33) met screening criteria for internet addition according to the IAT, while 107 (42%) met addiction criteria according to the DPIU.

A high proportion of the sample met criteria for internet addiction. Participants meeting criteria for internet addiction had greater levels of psychopathology and functional impairment. With the exception of instant messaging tools, none of the dimensions of internet use differed between individuals who did and did not meet internet addiction criteria on the IAT. This study highlights that problematic internet use may be more widespread than once thought. Further studies are needed to understand the relationship between problematic internet use and psychopathology.

Deficits in recognizing disgust facial expressions and Internet addiction: Perceived stress as a mediator (2017).

Psychiatry Research.



  • Deficit in recognizing disgust expressions is related to Internet addiction.
  • Deficit in recognizing disgust expressions is related to perceived stress.
  • Perceived stress is an underlying psychological mechanism.

The present study filled these gaps by (a) establishing a relationship between deficits in facial expression recognition and Internet addiction, and (b) examining the mediating role of perceived stress that explains this hypothesized relationship. Ninety-seven participants completed validated questionnaires that assessed their levels of Internet addiction and perceived stress, and performed a computer-based task that measured their facial expression recognition. The results revealed a positive relationship between deficits in recognizing disgust facial expression and Internet addiction, and this relationship was mediated by perceived stress. However, the same findings did not apply to other facial expressions.

Prevalence of Internet Addiction in Medical Students: a Meta-analysis (2017)

Acad Psychiatry. 2017 Aug 28. doi: 10.1007/s40596-017-0794-1.

The objective of this meta-analysis was to establish precise estimates of the prevalence of IA among medical students in different countries. The pooled prevalence of IA among medical students was determined by the random-effects model. Meta-regression and subgroup analysis were performed to identify potential factors that could contribute to heterogeneity.

The pooled prevalence of IA among 3651 medical students is 30.1%  with significant heterogeneity. Subgroup analysis shows the pooled prevalence of IA diagnosed by the Chen's Internet Addiction Scale (CIAS) is significantly lower than Young's Internet Addiction Test (YIAT). Meta-regression analyses show that the mean age of medical students, gender proportion and the severity of IA are not significant moderators.

Internet Addiction in Tibetan and Han Chinese middle school students: prevalence, demographics and quality of life (2018)

Internet addiction (IA) is common amongst young people, but no data on IA are available in Tibetan middle school students in China. This study compared the prevalence of IA between Tibetan and Han Chinese middle school students, and examined its association with quality of life. The study was conducted in two middle schools in the Tibetan area of Qinghai province and two, Han Chinese middle schools in Anhui province, China. IA, depressive symptoms and quality of life were measured using standardized instruments. Totally, 1,385 students completed the assessments. The overall prevalence of IA was 14.1%; 15.9% in Tibetan students and 12.0% in Han students.

Prevalence, associated factors and impact of loneliness and interpersonal problems on internet addiction: A study in Chiang Mai medical students (2017)

Asian J Psychiatr. 2017 Dec 28;31:2-7. doi: 10.1016/j.ajp.2017.12.017.

Internet addiction is common among medical students, and the prevalence is higher than the general population. Identifying and creating solutions for this problem is important. The aim of this study was to examine the prevalence and associated factors, particularly loneliness and interpersonal problems among Chiang Mai medical students.

Of 324 first to sixth year medical students, 56.8% comprised females with a mean age of 20.88 (SD 1.8). All completed questionnaires related to the objectives and activities of internet use, the Young Internet Addiction Test, the UCLA loneliness scale, and the Interpersonal Problems Inventory were employed to identify internet addiction.

In all, 36.7% of the subjects exhibited internet addiction, mostly at mild level. Amount of time used daily, loneliness and interpersonal problems were strong predictors, whereas age and sex were not. All objectives of using internet contributed to the variance of internet addiction score.

Effects of a prevention program for internet addiction among middle school students in South Korea (2018)

Public Health Nurs. 2018 Feb 21. doi: 10.1111/phn.12394. [Epub ahead of print]

This study explored the effects of a self-regulatory efficacy improvement program on self-control, self-efficacy, internet addiction, and time spent on the internet among middle school students in South Korea. The program was led by school nurses, and it is integrated self-efficacy and self-regulation promotion strategies based on Bandura's social cognitive theory.

A quasi-experimental, nonequivalent, control group, pre-posttest design was used. The participants were 79 middle school students.

Measurements included the Self-Control Scale, Self-Efficacy Scale, Internet Addiction Proneness Scale, and an assessment of internet addiction.

Self-control and self-efficacy significantly increased and internet addiction and time spent on the internet significantly decreased in the intervention group compared with the control group.

A program led by school nurses that integrated and applied self-efficacy and self-regulation intervention strategies proved effective for prevention of students' internet addiction.

Relationship with Parents, Emotion Regulation, and Callous-Unemotional Traits in Adolescents' Internet Addiction (2018)

Biomed Res Int. 2018 May 23;2018:7914261. doi: 10.1155/2018/7914261.

The aim of this study was to investigate the associations of relationship with parents, emotion regulation, and callous-unemotional traits with Internet addiction in a community sample of adolescents. Self-report measures of relationship with parents (both mothers and fathers), emotion regulation (in its two dimensions: cognitive reappraisal and expressive suppression), callous- unemotional traits (in its three dimensions: callousness, uncaring, and unemotional), and Internet addiction were completed by 743 adolescents aged 10 to 21 years. Results showed that a low perceived maternal availability, high cognitive reappraisal, and high callousness appeared to be predictors of Internet addiction. The implications of these findings are then discussed.

Adolescent Internet Abuse: A Study on the Role of Attachment to Parents and Peers in a Large Community Sample (2018)

Biomed Res Int. 2018 Mar 8;2018:5769250. doi: 10.1155/2018/5769250.

Adolescents are the main users of new technologies and their main purpose of use is social interaction. Although new technologies are useful to teenagers, in addressing their developmental tasks, recent studies have shown that they may be an obstacle in their growth. Research shows that teenagers with Internet addiction experience lower quality in their relationships with parents and more individual difficulties. However, limited research is available on the role played by adolescents' attachment to parents and peers, considering their psychological profiles. We evaluated in a large community sample of adolescents (N = 1105) the Internet use/abuse, the adolescents' attachment to parents and peers, and their psychological profiles. Hierarchical regression analyses were conducted to verify the influence of parental and peer attachment on Internet use/abuse, considering the moderating effect of adolescents' psychopathological risk. Results showed that adolescents' attachment to parents had a significant effect on Internet use. Adolescents' psychopathological risk had a moderating effect on the relationship between attachment to mothers and Internet use. Our study shows that further research is needed, taking into account both individual and family variables.

Prevalence and Predictors of Internet Addiction among College Students in Sousse, Tunisia (2018)

J Res Health Sci. 2018 Jan 2;18(1):e00403.

The current study was conducted in the colleges of Sousse, Tunisia in 2012-2013. A self-administrated questionnaire was used to collect data from 556 students in 5 randomly selected colleges from the region. Collected data concerned socio-demographic characteristics, substances use and internet addiction using the Young Internet Addiction Test.

The response rate was 96%. The mean age of participants was 21.8±2.2 yr. Females represented 51.8% of them. Poor control of internet use was found among 280 (54.0%; CI95%: 49.7, 58.3%) participants. Low education levels among parents, the young age, lifetime tobacco use and lifetime illicit drugs use were significantly associated with poor control of internet use among students. While, the most influential factor on internet use among them was under-graduation with an adjusted odds ratio of 2.4.

Poor control of internet use is highly prevalent among the college students of Sousse especially those under graduate. A national intervention program is required to reduce this problem among youth. A national study among both in-school and out-of-school adolescents and young people would identify at-risk groups and determine the most efficient time to intervene and prevent internet addiction.

Internet addiction detection rate among college students in the People's Republic of China: a meta-analysis (2018)

Child Adolesc Psychiatry Ment Health. 2018 May 25;12:25. doi: 10.1186/s13034-018-0231-6.

In this meta-analysis, we attempted to estimate the prevalence of Internet addiction among College Students in the People's Republic of China in order to improve the mental health level of college students and provide evidence for the prevention of Internet addiction.

Eligible articles about the prevalence of Internet addiction among college students in China published between 2006 and 2017 were retrieved from online Chinese periodicals, the full-text databases of Wan Fang, VIP, and the Chinese National Knowledge Infrastructure, as well as PubMed. Stata 11.0 was used to perform the analyses.

A total of 26 papers were included in the analyses. The overall sample size was 38,245, with 4573 diagnosed with Internet addiction. The pooled detection rate of Internet addiction was 11% (95% confidence interval [CI] 9-13%) among college students in China. The detection rate was higher in male students (16%) than female students (8%). The Internet addiction detection rate was 11% (95% CI 8-14%) in southern areas, 11% (95% CI 7-14%) in northern areas, 13% (95% CI 8-18%) in eastern areas and 9% (95% CI 8-11%) in the mid-western areas. According to different scales, the Internet addiction detection rate was 11% (95% CI 8-15%) using the Young scale and 9% (95% CI 6-11%) using the Chen scale respectively. Cumulative meta analysis showed that the detection rate had a slight upward trend and gradually stabilized in the last 3 years.

The pooled Internet addiction detection rate of Chinese college students in out study was 11%, which is higher than in some other countries and strongly demonstrates a worrisome situation. Effective measures should be taken to prevent further Internet addiction and improve the current situation.

Prevalence and pattern of internet addiction among medical students, Bengaluru (2017)

International Journal Of Community Medicine And Public Health 4, no. 12 (2017): 4680-4684.

A Cross sectional study was conducted among the first year medical students of Rajarajeswari Medical College and Hospital, Bengaluru. The sample size calculated was 125 as per the prevalence of internet addiction among medical students as 58.87% found in the study by Chaudhari et al. A total of 140 students present in the class at the time of data collection, who consented were considered for the study. Semi structured questionnaire with Young’s 8-item questionnaire and 20-item internet addiction scale was administered to the students. The data was analyzed using SPSS version 21.0. Pearson’s chi-square test was applied to know the association between two variables.
Out of 140 study subjects, majority (73.57%) were 18 yrs of age, 62.14% were females. 81 (57.86%) were hostilities. 77 (55%) of students were using internet for 4-6 hrs per day. 80 (57.14%) students have been using internet for more than 5 yrs. The prevalence of internet addiction according to Young’s 8-item questionnaire was 66 (47.14%) out of 140. Out of the 66, most common gadget used was mobile and most common purpose was social networking. The most common pattern of internet addiction according to Young’s 20-item scale was possible addict (49.29%). Internet addiction among localities was observed to be more than hostelites, this association was found to be statistically significant.

Internet Addiction among Junior Doctors: A Cross-sectional Study (2017)

Indian J Psychol Med. 2017 Jul-Aug;39(4):422-425. doi: 10.4103/0253-7176.211746.

Excessive internet use has been attributed to socio-occupational dysfunction, and this study is targeting the junior doctors on whom not many studies have been done till date.The objective of this study was to analyze the proportion of junior doctors with internet addiction and whether there is any relation between increased internet use and psychological distress, assessed using General Health Questionnaire (GHQ).

One hundred postgraduate students and house surgeons were requested to fill out the specially prepared pro forma, Internet Addiction Test Questionnaire and GHQ, and the data were analyzed.  Among the 100 study participants, 13% were found to have moderate addiction and none were in severe addiction range.

Internet addiction at workplace and it implication for workers life style: Exploration from Southern India (2017)

Asian J Psychiatr. 2017 Dec 9;32:151-155. doi: 10.1016/j.ajp.2017.11.014.

 The present study was undertaken to explore internet use in Information technology (IT) industry and non IT industry, to see its consequence and effect on lifestyle and functioning. 250 employees of various Government/Private sector organizations(using internet for more than a year and education level of graduation and above) were approached for the assessment using cross sectional research design.

The average age of participants was 30.4 years. 9.2% participants falling in category of occasional problems/'at risk' for developing addiction in functioning/moderate impairment due to internet use. Statistically more participants falling in 'at risk category' had reported postponement of work and change in productivity. Sleep, meals, personal hygiene and family time were postponed more by participants who were at risk for developing internet addiction.

Internet Addiction and Relationships with Insomnia, Anxiety, Depression, Stress and Self-Esteem in University Students: A Cross-Sectional Designed Study (2016)

PLoS One. 2016 Sep 12;11(9):e0161126. doi: 10.1371/journal.pone.0161126.

Internet addiction (IA) could be a major concern in university medical students aiming to develop into health professionals. The implications of this addiction as well as its association with sleep, mood disorders and self-esteem can hinder their studies, impact their long-term career goals and have wide and detrimental consequences for society as a whole. The objectives of this study were to: 1) Assess potential IA in university medical students, as well as factors associated with it; 2) Assess the relationships between potential IA, insomnia, depression, anxiety, stress and self-esteem.

Our study was a cross-sectional questionnaire-based survey conducted among 600 students of three faculties: medicine, dentistry and pharmacy at Saint-Joseph University. Four validated and reliable questionnaires were used: the Young Internet Addiction Test, the Insomnia Severity Index, the Depression Anxiety Stress Scales (DASS 21), and the Rosenberg Self Esteem Scale (RSES).

 Potential IA prevalence rate was 16.8% and it was significantly different between males and females, with a higher prevalence in males (23.6% versus 13.9%). Significant correlations were found between potential IA and insomnia, stress, anxiety, depression and self-esteem; ISI and DASS sub-scores were higher and self-esteem lower in students with potential IA.

The Status of Internet Addiction Disorder and its Relationship with the Mental Health; a Case Study among Medical Sciences Students of Khalkhal University (2017)

The present study aimed to evaluate the relationship between internet addiction disorder and mental health among University students of Medical Sciences in Khalkhal. As a descriptive-analytical research, this study conducted on 428 university students in Khalkhal who were studying the Medical Sciences in 2015. The instrument used in this study was a three-part questionnaire; the first part included the demographic characteristics of the participants; the second part was Young Internet Addiction Test and the third part consisted of General Health Questionnaire (GHQ-28).

Findings: 77.3 of the participants had no internet addiction, 21.7 were at the risk of internet addiction and 0.9 suffered from internet addiction. Moreover, there was a significant relationship between the mental health and internet addiction disorder.

Conclusion: There is a relationship between the internet addiction and mental health of students.

Digital Addiction: Increased Loneliness, Anxiety, and Depression (2018)

NeuroRegulation 5, no. 1 (2018): 3.

Digital addiction is defined by the American Society for Addiction Medicine (ASAM) as well as the American Psychiatric Association (APA) as “… a primary, chronic disease of brain reward, motivation, memory, and related circuitry.  Dysfunction in these circuits leads to characteristic biological, psychological, social, and spiritual manifestations. This is reflected in an individual pathologically pursuing reward and/or relief by substance use and other behaviors…” with examples such a such as internet gaming or similar behaviors. Symptoms of digital addiction such as increased loneliness (also called “phoneliness”), anxiety, and depression were observed in a sample of university undergraduates who completed a survey about smartphone use during and outside of class. Other observations included observations of “iNeck” (poor) posture as well as how multitasking/semitasking was prevalent in the sample. Implications of continued digital addition are discussed.

The Relationship Between Internet Addiction and Depression in the Iranian Users: A Systematic Review and Meta-analysis (2017)

Article 8, Volume 4, Issue 4 - Issue Serial Number 13, Autumn 2017, Page 270-275
Internet is one of the new technologies whose users are increasing, and internet addiction is defined as the excessive use of internet. One of the factors that influence internet addiction is depression. The purpose of our study was to investigate the relationship between internet addiction and depression in Iranian users using meta-analysis.

Results: There were significant correlations between internet addiction and depression (P < 0.05). Hence the mean risk differentiating criteria were estimated to be 0.55 (95% CI: 0.14 to 0.96). Subgroup analysis showed that the value of a university student was 0.46 (95% CI: 0.04 to 0.88) and of a high school student was 1.12 (95% CI: 0.90 to 1.34).

Conclusion: Our results indicated positive significant correlation between internet addiction and depression in adolescents and young adults in Iranian users. There was a positive correlation between internet addiction and depression as one of the most important psychological disorders.

A 2-year longitudinal psychological intervention study on the prevention of internet addiction in junior high school students of Jinan city (2018)

Biomedical Research 28, no. 22 (2018): 10033-10038.

Objective: To investigate the effect of psychological intervention on the prevention of internet addiction in junior high school students of Jinan.

Methods: A total number of 888 junior high school students in Jinan City were assessed by Internet Addiction Disorder Diagnostic Scale (IADDS). 57 cases students were diagnosed with internet addiction according to the scores of IADDS, while the rest 831 students were required to fill the self-designed general questionnaire, such as demographic questionnaire and Symptom Checklist 90 (SCL-90) and randomly divided into the intervention and the control groups. The psychological intervention was given in 4 states during two years, one stage in each semester, and there were 4 classes in each stage.

Results: In the intervention group, the IADDS and SCL-90 scores were significantly lower compared with those in the control students at different time points of T2 and T3 (all Ps<0.01). In the intervention group, the different factors of SCL-90 were decreased after each intervention (all Ps<0.01). These results showed that the intervention has positive effects on the mental health of students. The positive rate of internet addiction screened by IADDS in the intervention group was considerably lower compared with that in the controls at T2 and T3 time points (all P<0.05).

Conclusion: Longitudinal prospective and preventive psychological intervention can effectively improve the mental health of junior middle school students of Jinan city and reduce the incidence of internet addiction.2018

Internet addiction: Associated with lower health-related quality of life among college students in Taiwan, and in what aspects? (2018)

Computers in Human Behavior 84 (2018): 460-466.

•Internet addiction was negatively related to every aspect of health-related quality of life in college students.

•Various Internet addiction manifestations were differentially related to different domains of quality of life.

•Internet addiction should be tackled together with depression for synergistic harmful effects.

Internet use has been integrated into college students’ daily lives for learning and social purposes. However, little is known about whether those with Internet addiction (IA) had lower health-related quality of life (HRQOL) in physical, psychological, social, and environment domains. Survey data from 1452 college students in Taiwan were collected using proportional stratified sampling (response rate = 84.2%). IA, including 5 IA manifestations, and HRQOL were assessed by Chen Internet Addiction Scale and World Health Organization Quality of Life (WHOQOL-BREF) Taiwan version, respectively. College students with IA reported significantly lower HRQOL in all 4 domains (B = −0.130, −0.147, −0.103, and −0.085, respectively). Furthermore, 3 IA manifestations, namely compulsivity (B = −0.096), interpersonal and health problems (B = −0.100), and time management problems (B = −0.083), were significantly associated with lower physical HRQOL; compulsivity was also associated with decreased psychological (B = −0.166) and environment (B = −0.088) HRQOL; lastly, interpersonal and health problems owing to Internet use was associated with lower social HRQOL (B = −0.163). These findings warrant further research into the mechanisms through which IA relates to HRQOL in youths. Multi-faceted tailored interventions are needed to target early IA manifestations, thereby preventing IA and associated health consequences.

Boredom proneness and its correlation with Internet addiction and Internet activities in adolescents with attention-deficit/hyperactivity disorder (2018)

Kaohsiung J Med Sci. 2018 Aug;34(8):467-474. doi: 10.1016/j.kjms.2018.01.016.

This study examined the associations of boredom proneness with Internet addiction and activities as well as the moderators for such associations in adolescents with attention-deficit/hyperactivity disorder (ADHD). In total, 300 adolescents with ADHD participated in this study. Their Internet addiction, the scores for lack of external and internal stimulation on the Boredom Proneness Scale-short form (BPS-SF), ADHD, parental characteristics, and the types of Internet activities were examined. The associations of boredom proneness with Internet addiction and Internet activities and the moderators of the associations were examined using logistic regression analyses. Higher scores for lack of external stimulation on the BPS-SF were significantly associated with a higher risk of Internet addiction. Maternal occupational socioeconomic status moderated the association of lack of external stimulation with Internet addiction. Higher scores for lack of external stimulation were significantly associated with a high tendency to engage in online gaming, whereas higher scores for lack of internal stimulation were significantly associated with a low tendency to engage in online studies. Lack of external stimulation on the BPS-SF should be considered a target in prevention and intervention programs for Internet addiction among adolescents with ADHD.

The effects of technology use on working young loneliness and social relationships (2018)

Perspect Psychiatr Care. 2018 Jul 25. doi: 10.1111/ppc.12318.

This study was conducted to investigate the effects of technology use on working young loneliness and social relationships.

The relational descriptive study was conducted with 1,312 young using a young information form, the Internet Addiction Scale, the Peer Relationship Scale, and the Smart Phone Addiction Scale.

It was determined that young, who are exposed to violence, smoke, and work as unskilled labor force have a high dependence on the Internet and smartphones. Young with the Internet and smartphone addiction were found to have high levels of loneliness and poor social relations.

It has been determined that young who are weak in the social aspect fill these deficiencies by using the Internet and telephone.

Association between parental marital conflict and Internet addiction: A moderated mediation analysis (2018)

J Affect Disord. 2018 Nov;240:27-32. doi: 10.1016/j.jad.2018.07.005.

The effect of parental marital conflict on Internet addiction has been well-established; however, little is known regarding the underlying mechanism of this effect. The aim of this study was to explore the mediating effect of depression and anxiety, as well as the role of peer attachment as a moderator in this relation between parental marital conflict and Internet addiction.

The moderated mediation analysis was tested using data from a cross-sectional sample of 2259 high school students who completed questionnaires regarding marital conflict, depression, anxiety, peer attachment and Internet addiction.

The results indicated that the effect of parental marital conflict on Internet addiction was mediated by depression and anxiety. In addition, peer attachment moderated the association between parental marital conflict and depression/anxiety.

Avoidant romantic attachment in adolescence: Gender, excessive internet use and romantic relationship engagement effects (2018)

PLoS One. 2018 Jul 27;13(7):e0201176. doi: 10.1371/journal.pone.0201176.

Romantic development is a distinctive characteristic of puberty. However, a significant proportion of adolescents present with avoidant romantic attachment (ARA) tendencies, which have significant impact on their general adaptation. ARA variations have been suggested in relation to age, gender, engagement with a romantic partner and Excessive Internet Use (EIU) behaviours. In this longitudinal, two-wave study of a normative sample of 515 Greek adolescents at 16 and 18 years, ARA was assessed with the relevant subscale of the Experiences in Close Relationships-Revised and EIU with the Internet Addiction Test. A three-level hierarchical linear model found ARA tendencies to decrease between 16 and 18 while engagement in a romantic relationship and EIU were associated with lower and higher ARA tendencies respectively. Gender did not differentiate ARA severity either at the age of 16 or its changes over time. Results highlight the need of adopting a longitudinal-contextualized approach and provide implications for prevention and intervention initiatives in relation to the romantic development of adolescents.

Personal and social factors involved in internet addiction among adolescents: A meta-analysis (2018)

Computers in Human Behavior 86 (2018): 387-400.


• Internet addiction (IA) was associated with psychosocial factors in adolescents.

• The risk factors had a greater effect on IA than protective factors.

• Personal factors showed a greater association with IA than social factors.

• Hostility, depression and anxiety showed the greatest link with IA.

The growing popularity and frequency of Internet use has resulted in a large number of studies reporting various clinical problems associated with its abuse. The main purpose of this study is to conduct a meta-analysis of the association between Internet addiction (IA) and a number of personal and social psychological factors in adolescents.

The search included cross-sectional, case-control and cohort studies which analyzed the relationship between IA and at least one of the following personal variables: (i) psychopathology, (ii) personality features and (iii) social difficulties, as well as (iv) self-esteem, (v) social skills and (vi) positive family functioning. These variables were classified as protective and promoting factors of the risk of developing IA.

A total of 28 studies with adequate methodological quality were identified in the primary medical, health and psychological literature databases up to November 2017. Of the 48,090 students included in the analysis, 6548 (13.62%) were identified as excessive Internet users. The results highlight that risk factors had a greater effect on IA than protective factors. Also, personal factors showed a greater link with IA than social factors.

Association between Internet addiction and depression in Thai medical students at Faculty of Medicine, Ramathibodi Hospital (2017)

PLoS One. 2017 Mar 20;12(3):e0174209. doi: 10.1371/journal.pone.0174209.

A cross-sectional study was conducted at Faculty of Medicine, Ramathibodi Hospital. Participants were first- to fifth-year medical students who agreed to participate in this study. Demographic characteristics and stress-related factors were derived from self-rated questionnaires. Depression was assessed using the Thai version of Patient Health Questionnaire (PHQ-9). A total score of five or greater derived from the Thai version of Young Diagnostic Questionnaire for Internet Addiction was classified as "possible IA".

From 705 participants, 24.4% had possible IA and 28.8% had depression. There was statistically significant association between possible IA and depressio. Logistic regression analysis illustrated that the odds of depression in possible IA group was 1.58 times of the group of normal Internet use. Academic problems were found to be a significant predictor of both possible IA and depression.

IA was likely to be a common psychiatric problem among Thai medical students. The research has also shown that possible IA was associated with depression and academic problems. We suggest that surveillance of IA should be considered in medical schools.

Quality of Life in Medical Students With Internet Addiction (2016)

Acta Med Iran. 2016 Oct;54(10):662-666.

The aim of this study was to examine the quality of life in medical students who suffer from internet addiction. This cross-sectional survey was carried out in Tehran University of Medical Sciences, and a total of 174 fourth-to seventh-year undergraduate medical students were enrolled. 

Mean GPA was significantly lower in the addicted group. It seems that quality of life is lower in the internet addicted medical students; moreover, such students academically perform poorer in comparison with non-addicts. Since internet addiction is increasing at a rapid pace which may provoke considerable academic, psychological and social implications; as a result, it may require screening programs to the immediate finding of such problem to give consultations to prevent unwanted complications.

Factors associated with Internet addiction: Cross-sectional study of Turkish adolescents (2016)

Pediatr Int. 2016 Aug 10. doi: 10.1111/ped.13117.

The aim of this study was to investigate the prevalence of Internet addiction (IA), and the relationship between sociodemographic characteristics, depression, anxiety, attention-deficit-hyperactivity disorder (ADHD) symptoms and IA in adolescents.

This was a cross-sectional school-based study with a representative sample of 468 students aged 12-17 years at the first trimester of the 2013-2014 academic year. Approximately 1.6% of students were identified as having IA, whereas 16.2% had possible IA. There were significant correlations between IA and depression, anxiety, attention disorder and hyperactivity symptoms in adolescents. Smoking was also related to IA. There was no significant relationship between IA and age, sex, body mass index, school type, and SES. Depression, anxiety, ADHD and smoking addiction are associated with PIU in adolescent students. Preventive public health policies targeting the psychological wellbeing of young people are needed.

The Mediational Role of Coping Strategies in the Relationship Between Self-Esteem and Risk of Internet Addiction (2018)

Eur J Psychol. 2018 Mar 12;14(1):176-187. doi: 10.5964/ejop.v14i1.1449

The aim of the present study is to explore, through a mediation model, the relationship among self-esteem, coping strategies, and the risk of Internet addiction in a sample of 300 Italian university students. We submitted the data to a descriptive, mediational comparison between variables (t-test), and correlational statistical analyses. The results confirmed the effect of self-esteem on the risk of Internet addiction. However, we found that the introduction of coping strategies as a mediator gives rise to partial mediation. A low level of self-esteem is a predictor of avoidance-oriented coping that, in turn, affects the risk of Internet addiction.

Internet addiction and psychological well-being among college students: A cross-sectional study from Central India (2018)

J Family Med Prim Care. 2018 Jan-Feb;7(1):147-151. doi: 10.4103/jfmpc.jfmpc_189_17.

Internet provides tremendous educational benefits for college students and also provided better opportunities for communication, information, and social interaction for young adults; however, excessive internet use can lead to negative psychological well-being (PWB).

The present study was conducted with the objective to find out the relationship between internet addiction and PWB of college students.

A multicenter cross-sectional study was carried out in college students of Jabalpur city of Madhya Pradesh, India. A total of 461 college students, using internet for at least past 6 months were included in this study. Young's Internet addiction scale, consisting of 20-item, based on five-point Likert scale was used to calculate internet addiction scores and 42-item version of the Ryff's PWB scale based on six-point scale was used in this study.

A total of 440 questionnaire forms were analyzed. The mean age of students was 19.11 (±1.540) years, and 62.3% were male. Internet addiction was significantly negatively correlated to PWB (r = -0.572, P < 0.01) and subdimensions of PWB. Students with higher levels of internet addiction are more likely to be low in PWB. Simple linear regression showed that internet addiction was a significant negative predictor of PWB.

Psychological Factors Including Demographic Features, Mental Illnesses, and Personality Disorders as Predictors in Internet Addiction Disorder (2018)

Iran J Psychiatry. 2018 Apr;13(2):103-110.

Objective: Problematic internet use is an important social problem among adolescents and has become a global health issue. This study identified predictors and patterns of problematic internet use among adult students.

Method: In this study, 401 students were recruited using stratified sampling technique. Participants were selected among students from 4 universities in Tehran and Karaj, Iran, during 2016 and 2017. Internet Addiction Test (IAT), Millon Clinical Multiaxial Inventory - Third Edition (MCMI-III), Structured Clinical Interview for DSM (SCID-I), and semi-structured interview were used to diagnose internet addiction. Then, the association between main psychiatric disorders and internet addiction was surveyed. Data were analyzed using SPSS18 software by performing descriptive statistics and multiple logistic regression analysis methods. P- Values less than 0.05 were considered statistically significant.

Results: After controlling the demographic variables, it was found that narcissistic personality disorder, obsessive- compulsive personality disorder, anxiety, bipolar disorders, depression, and phobia could increase the odds ratio (OR) of internet addiction by 2.1, 1.1, 2.6, 1.1, 2.2 and 2.5-folds, respectively (p-value<0.05), however, other psychiatric or personality disorders did not have a significant effect on the equation.

Conclusion: The findings of this study revealed that some mental disorders affect internet addiction. Considering the sensitivity and importance of the cyberspace, it is necessary to evaluate mental disorders that correlate with internet addiction.

Smartphone Addiction and Interpersonal Competence of Nursing Students (2018)

Iran J Public Health. 2018 Mar;47(3):342-349.

Interpersonal competence is an important capacity for nurses. Recently, the advent of smartphones has instigated considerable changes in daily life. Because smartphone has multiple functions, people tend to use them for numerous activities, often leading to addictive behavior.

This cross-sectional study performed a detailed analysis of smartphone addiction subscales and social support related to interpersonal competence of nursing students. Overall, 324 college students were recruited at Catholic University in Seoul, Korea from Feb 2013 to Mar 2013. Participants completed a self-reported questionnaire, which included scales that measured smartphone addiction, social support, interpersonal competence, and general characteristics. Path analysis was used to evaluate structural relations between subscales of smartphone addictions, social support, and interpersonal competence.

The effect of cyberspace-oriented relationships and social support on interpersonal competence were 1.360 (P=.004) and 0.555 (P<.001), respectively.

Cyberspace-oriented relationship, which is a smartphone addiction subscale, and social support were positively correlated with interpersonal competence of nursing students, while other smartphone addiction subscales were not related to nursing student interpersonal competence. Therefore, effective smartphone teaching methods be developed to enhance nursing student motivation.

Potential impact of internet addiction and protective psychosocial factors onto depression among Hong Kong Chinese adolescents - direct, mediation and moderation effects (2016)

Compr Psychiatry. 2016 Oct;70:41-52. doi: 10.1016/j.comppsych.2016.06.011.

Internet addiction (IA) is a risk factor while some psychosocial factors can be protective against depression among adolescents. Mechanisms of IA onto depression in terms of mediations and moderations involving protective factors are unknown and were investigated in this study. A representative cross-sectional study was conducted among Hong Kong Chinese secondary school students (n=9518).

Among males and females, prevalence of depression at moderate or severe level  was 38.36% and 46.13%, and that of IA  was 17.64% and 14.01%, respectively. The high IA prevalence contributes to increased risk of prevalent depression through its direct effect, mediation (reduced level of protective factors) and moderation (reduced magnitude of protective effects) effects. Understanding to mechanisms between IA and depression through protective factors is enhanced. Screening and interventions for IA and depression are warranted, and should cultivate protective factors, and unlink negative impact of IA onto levels and effects of protective factors.

Internet Addiction: Impact on Academic Performance of Premedical Post-Baccalaureate Students (2017)

Medical Science Educator (2017): 1-4.

The study identified Internet addicts in a population of post-baccalaureate students (n = 153) enrolled in a USA-based medical school preparatory program, using a standard Internet Addiction Test (IAT). Independent sample t tests, chi-square tests, and multiple regression analyses were used to compare outcomes and measure the contributions made by different predictors toward different outcomes. Of the total number of subjects, 17% met the criteria for Internet addicts. Students’ age and time spent on the Internet per day were significant predictors underlying their addictive Internet usage. Internet addiction and students’ academic performance also exhibited a significant negative association. A preliminary positive association between Internet addiction and students’ self-reported depression was noted.

Incidence and predictive factors of Internet addiction among Chinese secondary school students in Hong Kong: a longitudinal study (2017)

Soc Psychiatry Psychiatr Epidemiol. 2017 Apr 17. doi: 10.1007/s00127-017-1356-2.

We investigated incidence and predictors of IA conversion among secondary school students. A 12-month longitudinal study was conducted among Hong Kong Chinese Secondary 1-4 students (N = 8286). Using the 26-item Chen Internet Addiction Scale (CIAS; cut-off >63), non-IA cases were identified at baseline. Conversion to IA during the follow-up period was detected, with incidence and predictors derived using multi-level models.
Prevalence of IA was 16.0% at baseline and incidence of IA was 11.81 per 100 person-years (13.74 for males and 9.78 for females). Risk background factors were male sex, higher school forms, and living with only one parent, while protective background factors were having a mother/father with university education. Adjusted for all background factors, higher baseline CIAS score (ORa = 1.07), longer hours spent online for entertainment and social communication (ORa = 1.92 and 1.63 respectively), and Health Belief Model (HBM) constructs (except perceived severity of IA and perceived self-efficacy to reduce use) were significant predictors of conversion to IA (ORa = 1.07-1.45).

Prevalence and factors of self-corrective intention among Hong Kong secondary school students who are self-assessed Internet addiction cases (2017)

Child and Adolescent Mental Health.

This cross-sectional study surveyed 9,618 Chinese secondary school students in Hong Kong; 4,111 (42.7%) self-assessed that they had IA (self-assessed IA cases); 1,145 of these self-assessed IA cases (27.9%) were also classified as IA cases (concordant IA cases), as their Chen Internet Addiction Scale score exceeded 63.

The prevalence of self-corrective intention among these two subsamples was only 28.2% and 34.1%, respectively. In the self-assessed IA subsample, the HBM constructs including perceived susceptibility to IA, perceived severity of IA perceived benefits for reducing Internet use, self-efficacy to reduce Internet use, and cues to action to reduce Internet use were positively, while perceived barriers for reducing Internet use were negatively, associated with self-corrective intention. Similar factors were identified in the concordant IA subsample.

A large proportion of the students perceived that they had IA but only about one-third intended to correct the problem. Future interventions may consider altering students’ HBM constructs, and focus on the segment of concordant IA with self-corrective intention, as they show readiness for changes.

Effect of internet addiction on psychological wellbeing among adolescents (2017)

International Journal of Psychology and Psychiatry  10.5958/2320-6233.2017.00012.8

The present study aims to find out the effect of internet addiction on psychological wellbeing of adolescents studying in and around Mysuru city. A total of 720 adolescents were included in the present study, having equal number of male and female students studying in 10, 11 and 12th standards. They were administered Internet addiction scale (Young, 1998) and Psychological wellbeing scale (Ryff, 1989). One way ANOVA was employed to find out the difference between normal, problematic and addict levels of internet on psychological wellbeing scores. Results revealed that as the levels of internet addiction increased, total psychological wellbeing scores decreased linearly and significantly. As the levels of internet addiction increased, wellbeing also decreased in specific components of autonomy, environmental mastery, and purpose in life.

The Dark Side of Internet Use: Two Longitudinal Studies of Excessive Internet Use, Depressive Symptoms, School Burnout and Engagement Among Finnish Early and Late Adolescents (2016)

J Youth Adolesc. 2016 May 2.

Using two longitudinal data waves gathered among 1702 (53 % female) early (age 12-14) and 1636 (64 % female) late (age 16-18) Finnish adolescents, we examined cross-lagged paths between excessive internet use, school engagement and burnout, and depressive symptoms. Structural equation modeling revealed reciprocal cross-lagged paths between excessive internet use and school burnout among both adolescent groups: school burnout predicted later excessive internet use and excessive internet use predicted later school burnout.

Reciprocal paths between school burnout and depressive symptoms were also found. Girls typically suffered more than boys from depressive symptoms and, in late adolescence, school burnout. Boys, in turn, more typically suffered from excessive internet use. These results show that, among adolescents, excessive internet use can be a cause of school burnout that can later spill over to depressive symptoms.



Evidence for an internet addiction disorder: internet exposure reinforces color preference in withdrawn problem users (2016)

J Clin Psychiatry. 2016 Feb;77(2):269-274.

This study examined whether exposure to the Internet could create a preference for colors associated with visited Web sites and explored the possible relationship with self-reported problematic Internet use and Internet deprivation.

100 adult participants were divided into 2 groups; one was deprived access to the Internet for 4 hours, and the other was not. After this period, they were asked to choose a color and complete a series of psychometric questionnaires concerning mood (Positive and Negative Affect Schedule), anxiety (Spielberger State-Trait Anxiety Inventory), and depression (Beck Depression Inventory). They were then given a 15-minute exposure to the Internet, and the Web sites they visited were recorded. They were then asked to again choose a color, complete the same psychometric questionnaires, and complete the Internet Addiction Test.

For Internet-deprived, but not nondeprived, subjects, a reduction of mood and increased anxiety was noted in the higher problematic Internet users following Web cessation. There was also a shift toward choosing the color most prominent on the visited Web sites in these participants. No shift in mood, or toward choosing the dominant Web site color, was seen in the lower problem users.

These findings suggest that the Internet can serve as a negative reinforcer for behavior in higher problem users and that the reinforcement obtained from the alleviation of withdrawal symptoms becomes conditioned, with the color and appearance of the visited Web sites giving them a more positive value.

Problematic Internet Use and Problematic Online Gaming Are Not the Same: Findings from a Large Nationally Representative Adolescent Sample (2014)

Cyberpsychol Behav Soc Netw. 2014 Nov 21.

There is an ongoing debate in the literature whether problematic Internet use (PIU) and problematic online gaming (POG) are two distinct conceptual and nosological entities or whether they are the same. The present study contributes to this question by examining the interrelationship and the overlap between PIU and POG in terms of sex, school achievement, time spent using the Internet and/or online gaming, psychological well-being, and preferred online activities.

Questionnaires assessing these variables were administered to a nationally representative sample of adolescent gamers  Data showed that Internet use was a common activity among adolescents, while online gaming was engaged in by a considerably smaller group. Similarly, more adolescents met the criteria for PIU than for POG, and a small group of adolescents showed symptoms of both problem behaviors.

The most notable difference between the two problem behaviors was in terms of sex. POG was much more strongly associated with being male. Self-esteem had low effect sizes on both behaviors, while depressive symptoms were associated with both PIU and POG, affecting PIU slightly more. POG appears to be a conceptually different behavior from PIU, and therefore the data support the notion that Internet Addiction Disorder and Internet Gaming Disorder are separate nosological entities.

The exacerbation of depression, hostility, and social anxiety in the course of Internet addiction among adolescents: A prospective study (2014)

Compr Psychiatry. 2014 May 17. pii:

In adolescent populations worldwide, Internet addiction is prevalent and is often comorbid with depression, hostility, and social anxiety of adolescents. This study aimed at evaluating the exacerbation of depression, hostility, and social anxiety in the course of getting addiction to Internet or remitting from Internet addiction among adolescents.

This study recruited 2293 adolescents in grade 7 to assess their depression, hostility, social anxiety and Internet addiction. The same assessments were repeated one year later. The incidence group was defined as subjects classified as non-addicted in the first assessment and as addicted in the second assessment. The remission group was defined as subjects classified as addicted in the first assessment and as non-addicted in the second assessment.

Depression and hostility worsen in the addiction process for the Internet among adolescents. Intervention of Internet addiction should be provided to prevent its negative effect on mental health. Depression, hostility, and social anxiety decreased in the process of remission. It suggested that the negative consequences could be reversed if Internet addiction could be remitted within a short duration.                                            

COMMENTS: Study followed students for one year assessing internet addiction and evaluating depression, hostility, and social anxiety. They found internet addiction exacerbates depression, hostility, and social anxiety, while remission from addiction decreases depression, hostility, and social anxiety

Examination of the Correlation Between Internet Addiction and Social Phobia in Adolescents (2016)

West J Nurs Res. 2016 Aug 25. pii: 0193945916665820

This was a descriptive and cross-sectional study conducted with adolescents to examine the correlation between Internet addiction and social phobia. The population of the study consisted of 24,260 students aged between 11 and 15 years.

In this study, 13.7% of the adolescents had an Internet addiction, and 4.2% spent more than 5 hr on the computer every day. There was a positive correlation between Internet addiction and social phobia. The form of time spent on Internet was examined in terms of addiction and social phobia; although Internet addiction was related to games, dating sites, and web surfing, social phobia was related to homework, games, and web surfing.

Longitudinal Associations between Anhedonia and Internet-Related Addictive Behaviors in Emerging Adults (2016)

Comput Human Behav. 2016 Sep;62:475-479.

Internet addiction (including online gaming) has been associated with depression. The purpose of the current study was to examine potential longitudinal associations between anhedonia (i.e., difficulty experiencing pleasure, a key facet of depression) and internet-related addictive behaviors in 503 at-risk emerging adults (former attendees of alternative high schools). Participants completed surveys at baseline and approximately one year later (9-18 months later). Results indicated that trait anhedonia prospectively predicted greater levels of compulsive internet use and addiction to online activities as well as a greater likelihood of addiction to online/offline video games. These findings suggest that anhedonia may contribute to the development of internet-related addictive behaviors in the emerging adult population.

A Longitudinal Study for the Empirical Validation of an Etiopathogenetic Model of Internet Addiction in Adolescence Based on Early Emotion Regulation (2018)

Biomed Res Int. 2018 Mar 7;2018:4038541. doi: 10.1155/2018/4038541.

Several etiopathogenetic models have been conceptualized for the onset of Internet Addiction (IA). However, no study had evaluated the possible predictive effect of early emotion regulation strategies on the development of IA in adolescence. In a sample of N = 142 adolescents with Internet Addiction, this twelve-year longitudinal study aimed at verifying whether and how emotion regulation strategies (self-focused versus other-focused) at two years of age were predictive of school-age children's internalizing/externalizing symptoms, which in turn fostered Internet Addiction (compulsive use of the Web versus distressed use) in adolescence. Our results confirmed our hypotheses demonstrating that early emotion regulation has an impact on the emotional-behavioral functioning in middle childhood (8 years of age), which in turn has an influence on the onset of IA in adolescence. Moreover, our results showed a strong, direct statistical link between the characteristics of emotion regulation strategies in infancy and IA in adolescence. These results indicate that a common root of unbalanced emotion regulation could lead to two different manifestations of Internet Addiction in youths and could be useful in the assessment and treatment of adolescents with IA.

Low empathy is associated with problematic use of the Internet: Empirical evidence from China and Germany (2015)

Asian J Psychiatr. 2015 Jul 6.

As empathy has not been investigated in the context of problematic use of the Internet, we conducted a study to test for a potential link. In samples from China (N=438) and Germany (N=202), two self-report measures for empathic behavior and one self-report measure for problematic Internet use (PIU) were administered in adolescents/students. Across both cultures lower empathy was associated with more PIU. The present study underlines the importance to take into account empathy related questionnaires for a better understanding of Internet overuse in the future.

Health-related quality of life among female university students in Dammam district: Is Internet use related? (2018)

J Family Community Med. 2018 Jan-Apr;25(1):20-28. doi: 10.4103/jfcm.JFCM_66_17.

Quality of life (QOL) is defined by the World Health Organization as the individual's perception of his/her position in life, within the context of culture and system of values in which the individual lives, and as relates to his/her objectives, expectations, standards, and concerns. Life in university is so stressful; it can affect health-related QOL (HRQOL). There are many factors that affect HRQOL of university students. The aim of this study was to assess the QOL of female university students in Dammam, Saudi Arabia, and identify factors related to it, with special emphasis on Internet use.

This cross-sectional study surveyed 2516 female students at Imam Abdulrahman Bin Faisal University in Dammam, using a self-administered questionnaire with sections on sociodemographics, score for Internet use/addiction (IA), and an assessment of HRQOL. Two latent factors were extracted: physical component summaries (PCSs) and mental component summaries (MCSs). Bivariate analyses and MANOVA were then performed.

The overall PCS and MCS were 69% ± 19.6 and 62% ± 19.9, respectively. Almost two-thirds of the students were found to have IA or possible IA. Students whose parents had lower education reported less PCS. Students with high family income reported higher PCS and MCS than those with a lower income. MANOVA model has shown that the higher the IA score, the lower the score of both the PCS and MCS.HRQOL in female students was found to be affected by parental educational level, family income, and problematic Internet use.

Insomnia partially mediated the association between problematic Internet use and depression among secondary school students in China (2017)

J Behav Addict. 2017 Dec 1;6(4):554-563. doi: 10.1556/2006.6.2017.085.

This study aims to examine the mediating effects of insomnia on the associations between problematic Internet use, including Internet addiction (IA) and online social networking addiction (OSNA), and depression among adolescents.

A total of 1,015 secondary school students from Guangzhou in China participated in a cross-sectional survey. Levels of depression, insomnia, IA, and OSNA were assessed using the Center for Epidemiological Studies-Depression Scale, Pittsburgh Sleep Quality Index, Young's Diagnostic Questionnaire, and Online Social Networking Addiction Scale, respectively.

The prevalence of depression at moderate level or above, insomnia, IA, and OSNA were 23.5%, 37.2%, 8.1%, and 25.5%, respectively. IA and OSNA were significantly associated with depression and insomnia after adjusting for significant background factors. The high prevalence of IA and OSNA may be associated with increased risk of developing depression among adolescents, both through direct and indirect effects (via insomnia). Findings from this study indicated that it may be effective to develop and implement interventions that jointly consider the problematic Internet use, insomnia, and depression.

Screen time is associated with depressive symptomatology among obese adolescents: a HEARTY study (2016)

Eur J Pediatr. 2016 Apr 13.

Obese adolescents spend a disproportionate time in screen-based activities and are at higher risk for clinical depression compared to their normal-weight peers. While screen time is associated with obesity and cardiometabolic risk factors, little is known about the relationship between screen time and mental health. This cross-sectional study examines the association between duration and types of screen time and depressive symptomatology (subclinical symptoms) in a sample of 358 (261 female; 97 male) overweight and obese adolescents aged 14-18 years. . After controlling for age, ethnicity, sex, parental education, body mass index (BMI), physical activity, caloric intake, carbohydrate intake, and intake of sugar-sweetened beverages, total screen time was significantly associated with more severe depressive symptomatology. After adjustment, time spent playing video games and recreational computer time was associated with depressive symptoms, but TV viewing was not.


Screen time may represent a risk factor or marker of depressive symptomatology in obese adolescents. Future intervention research should evaluate whether reducing screen exposure reduces depressive symptoms in obese youth, a population at increased risk for psychological disorders.

What is Known:

  • Screen time is associated with an increased risk of obesity in youth.
  • Screen time is associated with an adverse cardio-metabolic profile in youth.

What is New:

  • Screen time is associated with more severe depressive symptoms in overweight and obese adolescents.
  • Time spent in recreational computer use and playing video games, but not TV viewing, was associated with more severe depressive symptoms in overweight and obese adolescents.

Internet use patterns and Internet addiction in children and adolescents with obesity (2017)

Pediatr Obes. 2017 Mar 28. doi: 10.1111/ijpo.12216.

This study aimed to explore the prevalence and patterns of IA in children and adolescents with obesity. The relationship between IA and body mass index (BMI) was also investigated.

Study includes 437 children and adolescents with age ranging from 8 to 17 years: 268 with obesity and 169 with healthy controls. The Internet addiction scale (IAS) form was administered to all participants. The obesity group also completed a personal information form including Internet usage habits and goals.

A total of 24.6% of the obese children and adolescents were diagnosed with IA according to IAS, while 11.2% of healthy peers had IA (p < 0.05). The mean IAS scores for the obesity group and the control group were 53.71 ± 25.04 and 43.42 ± 17.36, respectively (p < 0.05). The IAS scores (t = 3.105) and spending time more than 21 h week-1 on the Internet (t = 3.262) were significantly associated with increased BMI in the obesity group (p < 0.05). Other Internet habits and goals were not associated with BMI (p > 0.05). The IAS scores (t = 8.719) were also found to be associated with increased BMI in the control group (p < 0.05).

The present study suggests that obese children and adolescents were found to have higher IA rates than their healthy peers, and the results indicate an association between IA and BMI.

Prevalence of internet addiction and its risk and protective factors in a representative sample of senior high school students in Taiwan (2017)

J Adolesc. 2017 Nov 14;62:38-46. doi: 10.1016/j.adolescence.2017.11.004.

The aim of this study investigated the prevalence of Internet addiction (IA) in a large representative sample of secondary school students and identified the risk and protective factors. Using a crosssectional design, 2170 participants were recruited from senior high schools throughout Taiwan using both stratified and cluster sampling. The prevalence of IA was 17.4%. High impulsivity, low refusal self-efficacy of Internet use, high positive outcome expectancy of Internet use, high disapproving attitude of Internet use by others, depressive symptoms, low subjective well-being, high frequency of others' invitation to Internet use, and high virtual social support was all independently predictive in the logistic regression analysis.

Internet Addiction in High School Students in Turkey and Multivariate Analyses of the Underlying Factors (2016)

J Addict Nurs. 2016 Jan-Mar;27(1):39-46.

The aim of this study is to examine the Internet addiction among adolescents in relation to their sociodemographic characteristics, communication skills, and perceived familial social support. This cross-sectional research is conducted in the high schools in some city centers, in Turkey, in 2013. One thousand seven hundred forty-two students aged between 14 and 20 years were included in the sample.The mean Internet Addiction Scale (IAS) score of the students was found to be 27.9 ± 21.2. According to the scores obtained from IAS, 81.8% of the students were found to display no symptoms (<50 points), 16.9% were found to display borderline symptoms (50-79 points), and 1.3% were found to be Internet addicts (≥80 points).

Factors associated with internet addiction: A cross-sectional study among Turkish adolescents (2016)

Pediatr Int. 2016 Aug 10. doi: 10.1111/ped.13117.

To investigate the prevalence of internet addiction and relationship between socio-demographic characteristics, depression, anxiety, attention-deficit/hyperactivity disorder symptoms, and internet addiction in adolescents.

This was a cross-sectional school-based study with a representative sample of 468 students aged 12-17 years at the first trimester of education year in 2013. About 1.6% were determined as addictive, whereas 16.2% were possible addictive. There were significant correlations between Internet Addiction and depression, anxiety, attention disorder and hyperactivity symptoms in adolescents. Smoking cigarette was also related with internet addiction. There was no significant relationship between IA and the students' age, sex, body-mass index, school type, socio-economic status.

Comparison of the personality and other psychological factors of students with internet addiction who do and do not have associated social dysfunction (2015)

Shanghai Arch Psychiatry. 2015 Feb 25;27(1):36-41.

Compared to persons with internet addiction without accompanying social dysfunction, those with social dysfunction had higher levels of interpersonal sensitivity, hostility, and paranoia; lower levels of social responsibility, anxiety, self-control, and family social support; and they were more likely to employ negative coping strategies. There were however, no differences in perceived parenting styles between the two groups.

A relatively small proportion of individuals who meet the physiological markers of internet addiction simultaneously report significant internet-related social dysfunction. There are several psychosocial measures that distinguish persons with internet addiction who do or do not have concurrent social dysfunction.

COMMENTS: It seems as though a lot of internet addicts do not have social dysfunction.

Moderating effects of depressive symptoms on the relationship between problematic use of the Internet and sleep problems in Korean adolescents (2018)

BMC Psychiatry. 2018 Sep 4;18(1):280. doi: 10.1186/s12888-018-1865-x.

Data for a total of 766 students' between 7th and 11th grades were analyzed. We assessed various variables related sleep to problems and depression and compared those variables between an adolescent group with problematic Internet use (PIUG) and an adolescent group with normal Internet use (NIUG).

One hundred fifty two participants were classified as PIUG, and 614 were classified as NIUG. Compared with the NIUG, the members of the PIUG were more prone to insomnia, excessive daytime sleepiness and sleep-wake behavior problems. The PIUG also tended to include more evening types than the NIUG. Interestingly, the effect of Internet use problems on sleep problems appeared to be different according to the presence or absence of the moderating effect of depression. When we considered the moderating effect of depression, the effect of Internet use problems on sleep-wake behavior problems, insomnia and excessive daytime sleepiness increased with increasing Young's Internet Addiction Scale (IAS) scores in the non-depressed group. However, in the depressed group, the effects of Internet use problems on sleep-wake behavior problems and insomnia did not change with increasing Internet use problems, and the effect of Internet use problems on excessive daytime sleepiness was relatively decreased with increasing Internet use problems in the depressed group.

This study demonstrated that the effect of PIU on sleep presented differently between the depressed and non-depressed groups. PIU is associated with poorer sleep in non-depressed adolescents but not in depressed adolescents. This finding might be observed because PIU may be the biggest contributor to sleep problems in the problematic Internet user without depression, but in the problematic Internet user with depression, depression might be a more important contributor to sleep problems; thus, the influence of PIU on sleep effect might be diluted.

Predicting Effects of Psychological Inflexibility/Experiential Avoidance and Stress Coping Strategies for Internet Addiction, Significant Depression, and Suicidality in College Students: A Prospective Study (2018)

Int J Environ Res Public Health. 2018 Apr 18;15(4). pii: E788. doi: 10.3390/ijerph15040788.

The aims of this study were to evaluate the predicting effects of psychological inflexibility/experiential avoidance (PI/EA) and stress coping strategies for Internet addiction, significant depression and suicidality among college students during the follow-up period of one year. A total of 500 college students participated in this study. The level of PI/EA and stress coping strategies were evaluated initially. One year later, 324 participants were invited to complete the Chen Internet Addiction Scale, Beck Depression Inventory-II and the questionnaire for suicidality to evaluate depression symptoms and internet addiction and suicidality. The predicting effects of PI/EA and stress coping strategies were examined by using logistic regression analysis controlling for the effects of gender and age. The results indicated that PI/EA at the initial assessment increased the risk of Internet addiction, significant depression, and suicidality at the follow-up assessment. Less effective coping at the initial assessment also increased the risk of Internet addiction, significant depression, and suicidality at the follow-up assessment. Problem focused and emotion-focus coping at the initial assessment was not significantly associated with the risks of Internet addiction, significant depression, and suicidality at the follow-up assessment. College students who have high PI/EA or are accustomed to using less effective stress coping strategies should be the target of prevention programs for IA (internet addiction), depression, and suicidality.

The role of social support on emotion dysregulation and Internet addiction among Chinese adolescents: A structural equation model (2018)

Addict Behav. 2018 Jul;82:86-93. doi: 10.1016/j.addbeh.2018.01.027

Relatively few studies examined the role of emotion dysregulation and social support on Internet addiction in this population. The present examined the association between emotion dysregulation, social support, and Internet addiction among junior secondary school students in Hong Kong. The mediating role of emotion dysregulation and Internet use on the relationship between social support and Internet addiction and the gender difference in such association were also tested.

A total of 862 junior secondary school students (grade 7 to 8) from 4 schools completed a cross-sectional survey.

10.9% scored above the cut-off for Internet addiction based on the Chen Internet Addiction Scale. Results from structural equation modeling revealed that social support was negatively related to emotion dysregulation and Internet usage, which in turn, were positively related to Internet addiction. Results from multi-group analysis by gender showed that the relationship between social support and emotion dysregulation, Internet usage, and Internet addiction, and those between emotion dysregulation and Internet addiction and between Internet usage and Internet addiction were stronger among female participants.

Emotion dysregulation is a potential risk factor while social support is a potential protective factor for Internet addiction. The role of social support on emotion dysregulation and Internet addiction were stronger among female students. Gender-sensitive interventions on Internet Addiction for adolescents are warranted, such interventions should increase social support and improve emotion regulation.

Exploring Individual Differences in Online Addictions: the Role of Identity and Attachment (2017)

Int J Ment Health Addict. 2017;15(4):853-868. doi: 10.1007/s11469-017-9768-5.

Research examining the development of online addictions has grown greatly over the last decade with many studies suggesting both risk factors and protective factors. In an attempt to integrate the theories of attachment and identity formation, the present study investigated the extent to which identity styles and attachment orientations account for three types of online addiction (i.e., internet addiction, online gaming addiction, and social media addiction). The sample comprised 712 Italian students (381 males and 331 females) recruited from schools and universities who completed an offline self-report questionnaire. The findings showed that addictions to the internet, online gaming, and social media were interrelated and were predicted by common underlying risk and protective factors. Among identity styles, 'informational' and 'diffuse-avoidant' styles were risk factors, whereas 'normative' style was a protective factor. Among attachment dimensions, the 'secure' attachment orientation negatively predicted the three online addictions, and a different pattern of causal relationships were observed between the styles underlying 'anxious' and 'avoidant' attachment orientations. Hierarchical multiple regressions demonstrated that identity styles explained between 21.2 and 30% of the variance in online addictions, whereas attachment styles incrementally explained between 9.2 and 14% of the variance in the scores on the three addiction scales. These findings highlight the important role played by identity formation in the development of online addictions.

Pathological Internet Use and Risk-Behaviors among European Adolescents (2016)

Int J Environ Res Public Health. 2016 Mar 8;13(3). pii: E294.

The main objective of this study is to investigate the association between risk-behaviors and PIU in European adolescents.  Data on adolescents were collected from randomized schools within study sites across eleven European countries. Adolescents reporting poor sleeping habits and risk-taking actions showed the strongest associations with PIU, followed by tobacco use, poor nutrition and physical inactivity. Among adolescents in the PIU group, 89.9% were characterized as having multiple risk-behaviors. The significant association observed between PIU and risk-behaviors, combined with a high rate of co-occurrence, underlines the importance of considering PIU when screening, treating or preventing high-risk behaviors among adolescents.

Problem Internet Use and Internet Gaming Disorder: a survey of health literacy among psychiatrists from Australia and New Zealand (2017)

Australas Psychiatry. 2017 Jan 1:1039856216684714.

Research is limited on psychiatrists' opinions on the concepts of Internet Gaming Disorder (IGD) and Problematic Internet Use (PIU). We aimed to assess health literacy among psychiatrists on IGD/PIU. A self-report survey was administered online to members of the Royal Australia and New Zealand College of Psychiatrists (RANZCP) ( n=289).

The majority (93.7%) were familiar with the concepts of IGD/PIU. The majority (78.86%) thought it is possible to be 'addicted' to non-gaming internet content, and 76.12% thought non-gaming addictions could possibly be included in classificatory systems. Forty-eight (35.6%) felt that IGD maybe common in their practice. Only 22 (16.3%) felt they were confident in managing IGD. Child psychiatrists were more likely to screen routinely for IGD and were more likely to elicit specific symptoms of addiction.

Dependência de internet em adolescentes do IFSUL-RS/Campus Pelotas: prevalência e fatores associados (2017)

The present study aimed at evaluating the prevalence of internet addiction in adolescent students of the Pelotas Campus of the Instituto Federal Sul-Riograndense. This is a cross-sectional study, with a sample of students aged 14 to 20 years as the target population. The sample selection was performed in a random way, in order to be representative of the 4083 students enrolled in the institution.

Internet addiction was assessed through the Internet Addiction Test (IAT). Presence of anxiety and / or depressive disorders was studied with the Well-Being Index (WHO-5). Results: The prevalence of internet addiction was 50.6%, being higher among individuals who presented positive screening for depressive or anxious disorders than among those who did not. There was an association between internet addiction and use of games. There was a tendency for the association between work / study-related access content and the presence of internet dependence.

Prevalence of Internet Addiction among Schoolchildren in Novi Sad (2015)

Srp Arh Celok Lek. 2015 Nov-Dec;143(11-12):719-25.

The aim of this study was an assessment of the prevalence of Internet use and Internet addiction among school children aged 14-18 years in the Municipality of Novi Sad, Serbia, and influence of sociodemographic variables on Internet use. A cross-sectional study was conducted in Novi Sad among final-year students from elementary and first- and second-year students from high schools.The prevalence of Internet addiction was assessed by using Young's Diagnostic Questionnaire.

Out of 553 participants, 62.7% were females, and the average age was 15.6 years. The sample consisted of 153 elementary school students and 400 high school students. Majority of respondents had a computer in their household. Our study showed widespread Internet use among adolescents. Facebook and YouTube were among most visited web-sites. The main purpose of Internet use was entertainment. Estimated prevalence of Internet addiction was high (18.7%).

A Phenotype Classification of Internet Use Disorder in a Large-Scale High-School Study (2018)

Int J Environ Res Public Health. 2018 Apr 12;15(4). pii: E733. doi: 10.3390/ijerph15040733.

Internet Use Disorder (IUD) affects numerous adolescents worldwide, and (Internet) Gaming Disorder, a specific subtype of IUD, has recently been included in DSM-5 and ICD-11. Epidemiological studies have identified prevalence rates up to 5.7% among adolescents in Germany. However, little is known about the risk development during adolescence and its association to education. The aim of this study was to: (a) identify a clinically relevant latent profile in a large-scale high-school sample; (b) estimate prevalence rates of IUD for distinct age groups and (c) investigate associations to gender and education. N = 5387 adolescents out of 41 schools in Germany aged 11-21 were assessed using the Compulsive Internet Use Scale (CIUS). Latent profile analyses showed five profile groups with differences in CIUS response pattern, age and school type. IUD was found in 6.1% and high-risk Internet use in 13.9% of the total sample. Two peaks were found in prevalence rates indicating the highest risk of IUD in age groups 15-16 and 19-21. Prevalence did not differ significantly between boys and girls.


A study on the influence of internet addiction and online interpersonal influences on health-related quality of life in young Vietnamese (2017)

BMC Public Health. 2017 Jan 31;17(1):138. doi: 10.1186/s12889-016-3983-z.

Internet addiction (IA) is a common problem found in young Asians. This study aimed to study the influence of IA and online activities on health-related quality of life (HRQOL) in young Vietnamese. This study also compared the frequencies of anxiety, depression and other addiction of young Vietnamese with and without IA.

This study recruited 566 young Vietnamese (56.7% female, 43.3% male) ranging from 15 to 25 years of age via the respondent-driven sampling technique. Results from this cross-sectional study showed that 21.2% of participants suffered from IA. Online relationship demonstrated significantly higher influences on behaviors and lifestyles in participants with IA than those without IA. Participants with IA were more likely to have problems with self-care, difficulty in performing daily routine, suffer from pain and discomfort, anxiety and depression. Contrary to previous studies, we found that there were no differences in gender, sociodemographic, the number of participants with cigarette smoking, water-pipe smoking and alcohol dependence between the IA and non-IA groups. IA was significantly associated with poor HRQOL in young Vietnamese.

IA is a common problem among young Vietnamese and the prevalence of IA is the highest as compared to other Asian countries. Our findings suggest that gender may not play a key role in IA. This can be an emerging trend when both genders have equal access to the internet. By studying the impact of IA on HRQOL, healthcare professionals can design effective intervention to alleviate the negative consequences of IA in Vietnam.

Internet addiction and sleep quality among Vietnamese youths (2017)

Asian J Psychiatr. 2017 Aug;28:15-20. doi: 10.1016/j.ajp.2017.03.025.

Internet addiction has been a major behavioral disorder over the past decade. Prior meta-analytic review has demonstrated the association between Internet addiction and psychiatric disorders, as well as sleep related disorders.

An online cross-sectional study was conducted between August through to October 2015. 21.2% Of the participants were diagnosed with Internet addiction. 26.7% of those with Internet addiction also reported that they have had sleep related difficulties. 77.2% of these participants were receptive towards seeking medical treatment. Our current study also highlighted that being single and those who were using tobacco products were not at heightened risk of developing associated sleep related issues.

Facebook Role Play Addiction - A Comorbidity with Multiple Compulsive-Impulsive Spectrum Disorders (2016)

J Behav Addict. 2016 May 9:1-5.

 Problematic Internet use (PIU) is an emerging entity with varied contents. Behavioral addictions have high comorbidity of attention deficit hyperactivity disorder and obsessive-compulsive spectrum disorders. Social networking site (SNS) addiction and role playing game (RPG) addiction are traditionally studied as separate entities. We present a case with excessive Internet use, with a particular focus on phenomenology and psychiatric comorbidities.

Fifteen-year-old girl with childhood onset attention deficit disorder, obsessive-compulsive disorder, adolescent onset trichotillomania, and disturbed family environment presented with excessive Facebook use. Main online activity was creating profiles in names of mainstream fictional characters and assuming their identity (background, linguistic attributes, etc.). This was a group activity with significant socialization in the virtual world. Craving, salience, withdrawal, mood modification, and conflict were clearly elucidated and significant social and occupational dysfunction was evident.

This case highlights various vulnerability and sociofamilial factors contributing to behavioral addiction. It also highlights the presence of untreated comorbidities in such cases.

The Association Between Muslim Religiosity and Internet Addiction Among Young Adult College Students (2018)

J Relig Health. 2018 Sep 7. doi: 10.1007/s10943-018-0697-9.

The major focus of this research was to investigate the effects of religiosity factor on internet addiction among young adults enrolled at college level. We adopted two instruments to gather the information including OK-religious attitude scale for Muslims developed and used by Ok, Uzeyir, and Internet Addiction Test prepared by Widyanto and McMurran. In total, 800 Muslim college students enrolled in four colleges at graduate level of southern Punjab Pakistan were chosen through multi-phase sampling. 

The outcomes expressed positive role in case of DE conversion in world faith toward internet indications, whereas intrinsic religious orientations remained beneficial in decreasing internet usage. Students' anti-religion subscale demonstrates higher increase in becoming of internet addict; however, intrinsic religious orientations show significant decrease in using internet. Similarly, DE conversion in world faith view and Anti-Religion Scale indicate students' significant contributions in expecting them being internet addict.

Internet addiction is associated with social anxiety in young adults (2015)

Ann Clin Psychiatry. 2015 Feb;27(1):4-9.

Problematic Internet use or excessive Internet use is characterized by excessive or poorly controlled preoccupations, urges, or behaviors regarding computer use, and Internet access that leads to impairment or distress. Cross-sectional studies on samples of patients reported high comorbidity of Internet addiction with psychiatric disorders, especially affective disorders (including depression), anxiety disorders (generalized anxiety disorder, social anxiety disorder), and attention-deficit/hyperactivity disorder.

We have investigated the association between Internet addiction and social anxiety in 2 samples of 120 university students (60 males and 60 females in each sample).

We found a correlation between Internet addiction and social anxiety in the 2 samples respectively. Secondly, we found no difference between males and females on the level of Internet addiction. Thirdly, we did not find a preference for social networks among participants with high levels of social anxiety. The results of the study support previous evidence for co-occurrence of Internet addiction and social anxiety, but further studies need to clarify this association.

The effect of psychiatric symptoms on the internet addiction disorder in Isfahan’s University students (2011) 

Res Med Sci. 2011 Jun;16(6):793-800.

Internet addiction is a problem of modern societies and many studies have considered this issue. The prevalent use of Internet is increasing markedly during these years. Internet addiction disorder is an interdisciplinary phenomenon and various sciences such as medicine, computer, sociology, law, ethics and psychology have surveyed it from different viewpoints. Two hundred and fifty students participated in this cross-sectional study. Their age ranged from 19 to 30 years with average of of 22.5 ± 2.6 years. IAT is a 20-item self-report with a 5-point scale, based on the DSM-IV diagnostic criteria for compulsive gambling and alcoholism. It includes questions that reflect typical behaviors of addiction.

The growing number of researches on Internet addiction indicates that Internet addiction is a psychosocial disorder and its characteristics are as follows: tolerance, withdrawal symptoms, affective disorders, and problems in social relations. Internet usage creates psychological, social, school and/or work difficulties in a person's life.

Eighteen percent of a study participants were considered to be pathological Internet users, whose excessive use of the Internet was causing academic, social, and interpersonal problems. Excessive Internet use may create a heightened level of psychological arousal, resulting in little sleep, failure to eat for long periods, and limited physical activity, possibly leading to the user experiencing physical and mental health problems such as depression, OCD, low family relationships and anxiety.

We found that Internet addicts had various co-morbid psychiatric disorders. It means that Internet addiction brings with it various dimensions of psychiatric symptoms, which suggests that the addiction could have a negative effect on the mental health status of youth. These findings are consistent with other studies and support previous findings. Since it has yet to be established whether psychiatric symptoms are the cause or the outcome of Internet addiction, researchers need to conduct longitudinal research on the Internet and its users.

COMMENTS: Study found that 23% of male college students had developed Internet addiction. Researchers state that excessive use of the Internet can lead to "heightened level of psychological arousal, resulting in little sleep, failure to eat for long periods, and limited physical activity, possibly leading to the user experiencing physical and mental health problems such as depression, OCD, low family relationships and anxiety."

Pathological Internet use, cyberbullying and mobile phone use in adolescence: a school-based study in Greece (2017)

Int J Adolesc Med Health. 2017 Apr 22. pii: /j/ijamh.ahead-of-print/ijamh-2016-0115/ijamh-2016-0115.xml.

In this cross-sectional, school-based study, 8053 students of 30 middle and 21 high schools (12-18 years old) were invited to participate, based on a multistage stratified random sampling technique. The Internet aiddiction test (IAT) was used along with information on socio-demographics, Internet activities and cyberbullying experience. Results Five thousand five hundred and ninety students participated (response rate 69.4%). Pathological Internet use (IAT ≥50) was found in 526 (10.1%), while 403 (7.3%) experienced cyberbullying as victims and 367 (6.6%) as perpetrators during the last year. In multivariable models, the odds of IA increased with online hours on mobile phones and Internet use during weekends, Internet café visits, chatrooms usage and engagement in cyberbullying. Cyberbullying victims were more likely to be older, female, Facebook and chatrooms users, while perpetrators were more likely to be male, older Internet users and fans of pornographic sites. A perpetrator was significantly more likely to have also been a victim [odds ratio (OR) = 5.51, confidence interval (CI): 3.92-7.74]. Hours of daily Internet use on a mobile phone was independently associated with IA and cyberbullying (OR) 1.41, 95% CI 1.30, 1.53 and OR 1.11, 95% CI 1.01, 1.21, respectively

Internet Addiction among Adolescents May Predict Self-Harm/Suicidal Behavior - A Prospective Study (2018)

J Pediatr. 2018 Mar 15. pii: S0022-3476(18)30070-2. doi: 10.1016/j.jpeds.2018.01.046.

To explore the role of Internet addiction in the development of self-harm/suicidal behavior among adolescents after 1-year of follow-up. We conducted this 1-year, prospective cohort study of 1861 adolescents (mean age 15.93 years) attending a senior high school in Taiwan; 1735 respondents (93.2%) were classified as having no history of self-harm/suicidal attempts in the initial assessment and were referred to as the "noncase" cohort.
The prevalence rate of Internet addiction at baseline was 23.0%. There were 59 students (3.9%) who were identified as having developed new self-harm/suicidal behaviors on follow-up assessments. After controlling for the effects of potential confounders, the relative risk of newly emerging self-harm/suicidal behavior for participants who were classified as Internet addicted was 2.41 (95% CI 1.16-4.99, P = .018) when compared with those without Internet addiction. Our findings indicate that Internet addiction is prospectively associated with the incidence of self-harm/suicidal behavior in adolescents.

Problematic Internet Use and Its Correlates Among Students from Three Medical Schools Across Three Countries (2015)

Acad Psychiatry. 2015 Jul 1.

The authors aimed to assess and compare problematic internet use among medical students enrolled in a graduate degree course in one school each from Croatia, India, and Nigeria and to assess correlates of problematic use among these students. The questionnaire included a sociodemographic profile of participants and Young's Internet Addiction Test.

The final analysis included 842 subjects. Overall, 38.7 and 10.5 % of respondents scored in the mild and moderate categories. Only a small fraction (0.5 %) of students scored in the severe category. Moreover, a significantly higher proportion of participants who scored above the cutoff used the Internet for browsing, social networking, chatting, gaming, shopping, and viewing pornography. However, there was no difference between the two groups with regard to using the internet for e-mailing or academic activities.

Internet Addiction, Psychological Distress, and Coping Responses Among Adolescents and Adults (2017)

Cyberpsychol Behav Soc Netw. 2017 Apr 17. doi: 10.1089/cyber.2016.0669.

In the present study, 449 participants aged from 16 to 71 years of age were sourced from a wide range of English-speaking Internet forums, including social media and self-help groups. Of these, 68.9% were classified as nonproblematic users, 24.4% as problematic users, and 6.7% as addictive Internet users. High use of discussion forums, high rumination levels, and low levels of self-care were the main contributing factors to Internet addiction (IA) among adolescents. For adults IA was mainly predicted through engagement in online video gaming and sexual activity, low email use, as well as high anxiety and high avoidant coping. Problematic Internet users scored higher on emotion and avoidance coping responses in adults and higher on rumination and lower on self-care in adolescents. Avoidance coping responses mediated the relationship between psychological distress and IA.

Problematic internet use among high school students: Prevalence, associated factors and gender differences (2017)

Psychiatry Res. 2017 Jul 24;257:163-171. doi: 10.1016/j.psychres.2017.07.039.

This study aimed to measure the prevalence of Problematic Internet Use (PIU) among high school students and to identify factors associated with PIU underlining gender differences. The students filled a self-administered, anonymous questionnaire collecting information on demographic characteristics and patterns of Internet use. Multiple logistic regression analysis was performed to identify factors associated with PIU in the overall sample and by gender.

Twenty-five schools and 2022 students participated in the survey. Prevalence of PIU was 14.2% among males and 10.1% among females. Males 15-year-olds and females 14-year-olds had the highest PIU prevalence that progressively lowered with age among females. Only 13.5% of pupils declared parents controlled their Internet use. The sensation of feeling lonely, the frequency of use, the number of hours of connection, and visiting pornographic websites were associated with the risk of PIU in both genders. Attending vocational schools, the activities of chatting and file downloading, and the location of use at Internet point among males, and younger age among females were associated with PIU, whilst information searching was protective among females. PIU could become a public health problem in the next years.

Shyness and Locus of Control as Predictors of Internet Addiction and Internet Use (2004)

CyberPsychology & BehaviorVol. 7, No. 5

Past studies have indicated that some patterns of Internet use are associated with loneliness, shyness, anxiety, depression, and self-consciousness, but there appears to be little consensus about Internet addiction disorder. This exploratory study attempted to examine the potential influences of personality variables, such as shyness and locus of control, online experiences, and demographics on Internet addiction. Data were gathered from a convenient sample using a combination of online and offline methods. The respondents comprised 722 Internet users mostly from the Net-generation. Results indicated that the higher the tendency of one being addicted to the Internet, the shyer the person is, the less faith the person has, the firmer belief the person holds in the irresistible power of others, and the higher trust the person places on chance in determining his or her own course of life. People who are addicted to the Internet make intense and frequent use of it both in terms of days per week and in length of each session, especially for online communication via e-mail, ICQ, chat rooms, newsgroups, and online games.

Relationship between psychological inflexibility and experiential avoidance and internet addiction: Mediating effects of mental health problems (2017)

Psychiatry Res. 2017 Jul 11;257:40-44. doi: 10.1016/j.psychres.2017.07.021.

Internet addiction became a major mental health problem in college student. Our objective was to examine the relationship between psychological inflexibility and experiential avoidance (PIEA) and Internet addiction (IA) and the mediating effects of mental health problem indicators. 500 college students (238 men and 262 women) participated in this study.

The relationship among PIEA, mental health problems, and IA was examined using structural equation modeling. The severity of PIEA was positively associated with the severity of IA as well as positively associated with the severity of mental health problems. In addition, the severity of mental health problem indicators was positively associated with the severity of IA. These results provide the severity of PIEA is directly related to the severity of IA and indirectly related to the severity of IA through increasing the severity of mental health problems.

Internet use and addiction among medical students of Universiti Sultan Zainal Abidin, Malaysia (2016)

Psychol Res Behav Manag. 2016 Nov 14;9:297-307

Internet addiction is a widespread phenomenon among students and academicians at universities in Malaysia. Students use the Internet for recreational purpose and personal and professional development. The Internet has become an integral part of day-to-day life of the university students, including medical students. The aim of the present study was to examine the Internet use and addiction among students of Universiti Sultan Zainal Abidin, Malaysia. This was a cross-sectional study in which a questionnaire, Internet Addiction Diagnostic Questionnaire, developed by the Center for Internet Addiction, USA, was used. One hundred forty-nine medical students of Universiti Sultan Zainal Abidin participated in this study.

The mean scores were 44.9±14.05 and 41.4±13.05 for male and female participants, respectively, which indicated that both the genders were suffering from mild Internet addiction.

Prevalence and factors associated with internet addiction among medical students - A cross-sectional study in Malaysia (2017)

Med J Malaysia. 2017 Feb;72(1):7-11.

This study aims to determine the prevalence and factors associated with internet usage among medical students in a public university in Malaysia. This cross-sectional study was performed among all the medical students (Year 1-5). Students were assessed on their internet activities using the internet addiction questionnaires (IAT).

The study was conducted among 426 students. The study population consisted of 156 males (36.6%) and 270 females (63.4%). The mean age was 21.6 ±1.5 years. Ethnicity distribution among the students was: Malays (55.6%), Chinese (34.7%), Indians (7.3%) and others (2.3%). According to the IAT, 36.9% of the study sample was addicted to the internet. Internet addiction is a relatively frequent phenomenon among medical students. The predictors of internet addiction were male students using it for surfing and entertainment purposes.

Internet use behaviors, internet addiction and psychological distress among medical college students: A multi centre study from South India (2018)

Asian J Psychiatr. 2018 Jul 30;37:71-77. doi: 10.1016/j.ajp.2018.07.020.

This study was a first such attempt to explore internet use behavior's, IA, among a large group of medical students across multiple centers and its association with psychological distress primarily depression.
1763 medical students aged 18 to 21 years, pursuing Bachelor of Medicine; Bachelor of Surgery (MBBS) from three south Indian cities of Bangalore, Mangalore and Trissur participated in the study. The socio-educational and internet use behaviors data sheet was used to gather demographic information and patterns of internet use, IA Test (IAT) was utilized to assess IA and Self-Report Questionnaire (SRQ-20) assessed psychological distress primarily depression.

Among the total N = 1763, 27% of medical students met criterion for mild addictive internet use, 10.4% for moderate addictive internet use, and 0.8% for severe addiction to internet. IA was higher among medical students who were male, staying in rented accommodations, accessed internet several times a day, spent more than 3 h per day on internet and had psychological distress. Age, gender, duration of use, time spent per day, frequency of internet use and psychological distress (depression) predicted IA.

A substantial proportion of medical students have IA which can be detrimental for their medical education progress and long term career goals. Early identification and management of IA and psychological distress among medical students is crucial.

The Role of Resilience in Internet Addiction among Adolescents between Sexes: A Moderated Mediation Model (2018)

J Clin Med. 2018 Aug 19;7(8). pii: E222. doi: 10.3390/jcm7080222.

The behavioral inhibition/activation systems (BIS/BAS) have been considered to be predictors of Internet addiction, mediated by clinical variables such as anxiety and depression. However, resilience has been suggested as a protective factor toward Internet addiction, and certain sex differences in resilience buffering the effects of vulnerability have been reported. Thus, the aim of this study was to identify any role of resilience that might moderate the effects of BIS/BAS on Internet addiction through multiple clinical variables in boys and girls. A total of 519 middle-school students (268 boys and 251 girls, all 14 years old) were administered a questionnaire battery that measures Internet addiction, BIS/BAS, depression, anxiety, impulsivity, anger, and resilience. We used the PROCESS macro in SPSS to perform moderation and mediation analysis. Findings revealed that although a somewhat similar mediation model was supported in both sexes, moderating effects of resilience only emerged in girls. The results showed a protective role of resilience differing between sexes. These results suggest that clinicians should consider sex in the way resilience works as a protective factor against Internet addiction and focus on mitigating the effects of vulnerability by enhancing resilience in female Internet addicts.

The relationship of internet addiction with anxiety and depressive symptomatology (2018)

Psychiatriki. 2018 Apr-Jun;29(2):160-171. doi: 10.22365/jpsych.2018.292.160.

The purpose of the present study was to investigate the relationship between internet addiction and anxiety and depressive symptomatology of the user. Participants were 203 internet users aged between 17 and 58 years (Mean=26.03, SD=7.92) who approached the Department For Problematic Use Of Internet, Addiction Unit "18ANO" in Psychiatric Hospital Of Attica to receive specialized help for their pathological internet use. Internet Addiction Test (IAT) was used for the assessment of internet addiction and Symptom Checklist- 90-R (SCL-90-R) was administered for the evaluation of anxiety and depressive symptomatology. The analysis of the survey data showed that gender difference is not observed as to the intensity internet dependence. Younger users are more likely to develop addictive behaviour (in relation to internet use). At this point it should be noted that although positive, this association does not present to be statistically significant. Finally, regarding the relationship between psychopathology and internet addiction, anxiety symptomatology, which was moderately correlated with the overall score at IAT, was found to predict in regression analysis the internet addiction. There was no statistically significant association between internet addiction and depressive symptomatology, with women however, who presented with depressive symptoms to appear more vulnerable than men (who requested therapy from the department). Exploration of the effects of sex and age on internet addiction is expected contribute to the design of the appropriate preventive and therapeutic programs, whereas the study of the relationship between internet addiction and other psychiatric disorders would contribute the understanding of the mechanisms underpinning the development and onset of the addiction.

School-based Prevention for Adolescent Internet Addiction: Prevention is the Key. A Systematic Literature Review (2018)

Curr Neuropharmacol. 2018 Aug 13. doi: 10.2174/1570159X16666180813153806.

Adolescents' media use represents a normative need for information, communication, recreation and functionality, yet problematic Internet use has increased. Given the arguably alarming prevalence rates worldwide and the increasingly problematic use of gaming and social media, the need for an integration of prevention efforts appears to be timely. The aim of this systematic literature review is (i) to identify school-based prevention programmes or protocols for Internet Addiction targeting adolescents within the school context and to examine the programmes' effectiveness, and (ii) to highlight strengths, limitations, and best practices to inform the design of new initiatives, by capitalizing on these studies' recommendations. The findings of the reviewed studies to date presented mixed outcomes and are in need of further empirical evidence. The current review identified the following needs to be addressed in future designs to: (i) define the clinical status of Internet Addiction more precisely, (ii) use more current psychometrically robust assessment tools for the measurement of effectiveness (based on the most recent empirical developments), (iii) reconsider the main outcome of Internet time reduction as it appears to be problematic, (iv) build methodologically sound evidence-based prevention programmes, (v) focus on skill enhancement and the use of protective and harm-reducing factors, and (vi) include IA as one of the risk behaviours in multi-risk behaviour interventions. These appear to be crucial factors in addressing

Relationship of internet addiction with depression and academic performance in Indian dental students (2018)

Clujul Med. 2018 Jul;91(3):300-306. doi: 10.15386/cjmed-796.

Internet addiction (IA) has negative consequences on the mental health and affects daily activities. This study was conducted with the aim to assess the prevalence of Internet addiction among dental university students and to determine if there is any relationship of excessive Internet use with depression and academic performance among students.

This was a cross sectional study which included 384 dental students from different academic years. A questionnaire was prepared that collected information on demographic characteristics, pattern of Internet use, duration of use, and most common mode of Internet access. Internet addiction was assessed using Youngs Internet Addiction test. Depression was assessed using Becks depression inventory [BDI-1].

The prevalence of Internet addiction and depression was found to be 6% and 21.5% respectively. The first year students showed the highest mean Internet addiction (17.42±12.40) score. Chatting was the main purpose for Internet use. Logistic regression analysis showed that individuals who were depressed (Odds Ratio=6.00, p value<0.0001*) and scored less than 60% marks (Odds Ratio=6.71, p value<0.0001*) were more likely to be addicted to Internet.

The addiction to internet has negative impact on mental health and academic performance. These high risk group students should be identified and psychological counseling should be provided.

Factors Statistically Predicting At-Risk/Problematic Internet Use in a Sample of Young Adolescent Boys and Girls in South Korea (2018)

Front Psychiatry. 2018 Aug 7;9:351. doi: 10.3389/fpsyt.2018.00351. eCollection 2018.

Aims: This study aimed to investigate in a gender-sensitive manner factors related to at-risk/problematic Internet use (ARPIU) in a sample of young Korean adolescents. Given prior findings, we hypothesized we would observe specific temperamental, social and biological measures that would statistically predict ARPIU in boys and girls, respectively.

Method: Subjects included 653 middle-school students from Chuncheon, Korea who completed measures assessing Internet addiction, mood, temperament, and social interactions. Finger digit (2D:4D) ratios were also assessed. Chi-square and logistic regression models were conducted.

Results: Among boys and girls, the ARPIU and non-ARPIU groups showed differences in temperament, mood, social tendencies, and gaming behaviors. In boys, IAT correlated inversely with the 2D:4D digit ratio and novelty-seeking and positively with reward-dependence scores when controlling for BDI scores; these relationships were not found in girls. Multivariate analyses showed that among boys, novelty-seeking, harm avoidance, self-transcendence, and daily time spent gaming statistically predicted ARPIU. Among girls, daily time spent gaming, number of best friends, self-directedness, and cooperation statistically predicted ARPIU.

Conclusion: ARPIU was linked to specific temperamental, behavioral and biological characteristics, with specific relationships observed in boys and girls. Specific risk factors may exist for boys and girls with respect to their propensities to developing ARPIU, suggesting the need for gender-sensitive approaches to prevent ARPIU in youth.

Self-rated Health and Internet Addiction in Iranian Medical Sciences Students; Prevalence, Risk Factors and Complications (2016)

Int J Biomed Sci. 2016 Jun;12(2):65-70.

Self-rated health is a brief measure for general health. It is a comprehensive and sensitive index for prediction of health in future. Due to the high internet usage in medical students, the current study designed to evaluate the self-rated health (SRH) in relationship with internet addiction risk factors in medical students.

This cross sectional study conducted on 254 students of Qom University of Medical Sciences 2014. More than 79.9% of students reported their general health good and very good. The student's mean score of general health was higher than the average. In addition, the prevalence of internet addiction was 28.7%. An inverse significant correlation observed between SRH and internet addiction score. Using internet for Entertainment, using private Email and chat rooms were the most important predictors of affecting to internet addiction. Moreover, internet addiction is the most predictors of SRH and increased the odds of bad SRH.

Cross-cultural study of Problematic Internet Use in nine European countries (2018)

Computers in Human Behavior 84 (2018): 430-440.


  • The prevalence of Problematic Internet Use (PIU) ranged from 14% to 55%.
  • PIU was more frequent among women in all samples.
  • Time online and psychopathological variables explained PIU in the total sample.
  • PIU was explained by different variables depending on countries and gender.

The main objective of the present study was to investigate the relationships between Problematic Internet Use (PIU) and time spent online, online activities and psychopathology, by taking cross-cultural and gender differences into account. The second objective was to provide the prevalence estimate of PIU among European Internet users. Our total sample consisted of 5593 Internet users (2129 men and 3464 women) of nine European countries, aged between 18 and 87 years old (M = 25.81; SD = 8.61). Recruited online, they completed several scales about their Internet use and psychopathology. PIU was related to time spent online at weekends, obsessive-compulsive symptoms, hostility and paranoid ideation among the total sample of women; among men phobic anxiety was also significant. Regression analyses performed in each sample also suggest the importance of obsessive-compulsive symptoms (in seven samples), somatization (four samples) and hostility (three samples). Many cross-cultural and gender differences have been observed in terms of relationships with psychopathology and online activities. Prevalence estimates of PIU ranged between 14.3% and 54.9%. PIU was more prevalent among women in the respective samples, including the total sample. This European research highlights relevant relationships between PIU, psychopathology and time spent online, as important differences with regards to these variables in respective samples.

Internet addiction among Croatian university students (2017)

European Journal of Public Health, Volume 27, Issue suppl_3, 1 November 2017, ckx187.352,

The Internet has become an indispensable part of current modern living; however, excessive self-indulgence and pathological use of this medium has led to development of internet addiction (IA). IA is defined as inability to control one’s use of the Internet which leads to negative consequences in daily life. Prevalence for IA in young people varies between 2% and 18% worldwide. The aim of this study was to examine the prevalence of IA among Croatian university students and its interconnections with gender and main reason for Internet usage.

As part of this cross-sectional study a validated, anonymous questionnaire that contained questions regarding demographic data as well as Young’s Internet Addiction Test was self-administered to cross-faculty representative student sample of University of Osijek, Croatia during April and May 2016.

The study sample included 730 students, the average age being 21 (range 19-44), 34.4% males and 75.6% females. The main reasons for Internet usage were learning and faculty assignments (26.4%), social networking and entertainment (71.7%) and online gaming (1.9%). There were 41.9% of the students who had IA; 79.8% had mild, 19.9% moderate and 0.3% severe IA. IA was more frequent among males (51.1%) than among females (38.9%). IA was determined among 17.3% of students whose main reason for Internet usage was learning and faculty assignments, among 79.4% of students whose main reason for Internet usage was social networking and entertainment and among 3.3% of students whose main reason for Internet usage was online gaming.

IA is highly prevalent among Croatian university students and as such represents an important public health challenge within this population. Social networking and entertainment as reasons for Internet usage represent significant risk factors for the development of IA in the studied population.

Internet addiction prevalence in last-year medical students and related factors (2017)

European Journal of Public Health, Volume 27, Issue suppl_3, 1 November 2017, ckx186.050,

Internet addiction is becoming increasingly recognized as a mental health concern and it causes personal, familial, financial and occupational problems like other addictions. This study aimed to determine the internet addiction prevalence and related factors among last-year medical students.

This cross-sectional study was conducted among last-year medical students at Akdeniz University Faculty of Medicine in March 2017. 259 medical students who were at their last year make up the population. 216 (83.4%) students participated in the study.

Data was collected with a questionnaire consisting of sociodemographic questions and 20 questions of the Internet Addiction Test developed by Young. Chi Square was performed.

Of the students participated in the study 48.1% were female, 51.9% were male and average of age was 24.65±1.09. According to Internet Addiction Test, the mean score was 42.19±20.51. 65.7% of the students were classified as “normal users”, 30.6% were “risky users” and 3.7% were “addicted users”.

Relationship Between Problematic Internet Use and Time Management Among Nursing Students (2018)

Comput Inform Nurs. 2018 Jan;36(1):55-61. doi: 10.1097/CIN.0000000000000391.

The aims of this study were to evaluate nursing students' problematic Internet use and time management skills and to assess relationship between Internet use and time management. This descriptive study was conducted with 311 nursing students in Ankara, Turkey, from February to April 2016. The data were collected using the Problematic Internet Use Scale and Time Management Inventory. The Problematic Internet Use Scale and Time Management Inventory median scores were 59.58 ± 20.69 and 89.18 ± 11.28, respectively. There were statistically significant differences between both nursing students' Problematic Internet Use Scale and Time Management Inventory median scores and some variables (school grade, the time spent on the Internet). Fourth-year students were more prone to excessive use of the Internet and the resulting negative consequences than students from other year levels (P < .05). A significant negative relationship was also found between problematic Internet use and time management.

A Cross Cultural Study of Mental Health among Internet Addicted and Non-Internet Addicted: Iranian and Indian Students (2016)

Glob J Health Sci. 2016 May 19;9(1):58269.

This cross-sectional study was conducted on 400 students in various colleges from Pune and Mumbai cities of Maharashtra. Internet Addiction Test and Symptom Check List (SCL) 90-R were used. Data were analyzed using SPSS 16.

Internet addicted students were higher on Somatization, Obsessive-compulsive, Interpersonal sensitivity, Depression, Anxiety, Hostility, Phobic anxiety, Paranoid ideation, Psychoticism than Non-internet addicted students (P<0.05). Indian students had higher score on mental health domains compared to Iranian students (P<0.05). Female students had higher scores on Somatization, Obsessive-compulsive, Anxiety, Hostility, Phobic anxiety and Psychoticism than male students (P<0.05).

Psychiatrists and psychologists who are active in the field of mental hygiene must be aware of mental problems associated with Internet addiction such as depression, anxiety, obsession, hypochondria, paranoia, interpersonal sensitivity, and job and educational dissatisfaction among Internet addicts.

Prevalence and risk factors of problematic internet use and the associated psychological distress among graduate students of Bangladesh (2016)

Asian J Gambl Issues Public Health. 2016;6(1):11.

This study aimed to explore socio-demographic and behavioural correlates of PIU and examine its association with psychological distress. A total of 573 graduate students from Dhaka University of Bangladesh responded to a self-administered questionnaire that included internet addiction test (IAT), 12-items General Health Questionnaire and a set of socio-demographic and behavioural factors. The study found that nearly 24% of the participants displayed PIU on the IAT scale. The multiple regression analyses suggested that PIU is strongly associated with psychological distress regardless of all other explanatory variables.

The effect of sleep disturbances and internet addiction on suicidal ideation among adolescents in the presence of depressive symptoms (2018)

Psychiatry Res. 2018 Mar 28;267:327-332. doi: 10.1016/j.psychres.2018.03.067.

Maladaptive use of internet and sleep problems is a significant health concern among adolescents. We aimed to understand better how sleep problems are related to suicidal ideation taking into account the presence of depression and internet addiction. 631 adolescents aged between 12 and 18 randomly recruited from different middle and high schools to complete self-report questionnaires assessing sleep disturbances, addictive use of the internet, depressive symptoms, and suicidal ideation. 22.9% of the sample reported on suicidal ideation during the month before the study, 42% of the sample suffer from sleep disturbances, 30.2% reported on the addictive use of the internet, and 26.5% exhibited severe symptoms of depression. Adolescents with suicidal ideation had higher rates of sleep disturbances, addictive use of internet and depressive symptoms. A confirmatory path analysis suggests that the effect of sleep disturbances on suicidal ideation moderated by the impact of internet addiction and mediated by the sleep effects on depressive symptoms.

Is Internet Addiction a Clinical Symptom or a Psychiatric Disorder? A Comparison With Bipolar Disorder (2018)

J Nerv Ment Dis. 2018 Aug;206(8):644-656. doi: 10.1097/NMD.0000000000000861.

The general purpose of this review is to present an updated literature overview of neurobiological/clinical aspects of Internet addiction (IA), particularly of overlaps and differences with bipolar affective disorder (BPAD). Articles with clinical/neurobiological aspects of IA or similarities/differences with BPAD as main topics, from 1990 to present and written in English language, were included. Comorbidity between IA and other psychiatric disorders, including BPAD, is common. Dysfunctions in dopaminergic pathways have been found both in IA and in mood disorders. Most of investigations in IA support a chronic hypodopaminergic dysfunctional state in brain reward circuit and an excessive reward experience during mood elevation. Neuroimaging studies show prefrontal cortex abnormalities shared between addictive and bipolar patients. BPAD and IA present numerous overlaps, such as polymorphisms in nicotinic receptors genes, anterior cingulate/prefrontal cortex abnormalities, serotonin/dopamine dysfunctions, and good response to mood stabilizers. The future is to clarify diagnostic criteria to better define the IA/BPAD relationship.

Insights Into Aspects Behind Internet-Related Disorders in Adolescents: The Interplay of Personality and Symptoms of Adjustment Disorders (2017)

J Adolesc Health. 2017 Nov 22. pii: S1054-139X(17)30476-7.

Problematic Internet use (PIU) that has recently been referred to as Internet-related disorder is a growing health concern. Yet, it is unclear why some adolescents are developing problematic use, whereas others sustain control. Based on previous research, we hypothesize that personality traits (low conscientiousness and high neuroticism) act as predispositions for PIU. We further hypothesize that PIU can be understood as a maladaptive reaction toward critical life events and that these maladaptive reactions are exacerbated by dysfunctional personality traits.

The study investigates the prevalence of distinct subtypes of PIU among a sample of adolescents (n = 1,489; 10-17 years). Personality traits (Big Five Inventory-10 [BFI-10]), perceived stress (Perceived Stress Scale 4 [PSS-4]), and their relations to PIU (Scale for the Assessment of Internet and Computer Game Addiction [AICA-S]) were examined. As novel research questions, associations between PIU and adjustment disorders (Adjustment Disorder-New Module [ADNM]-6) and the mediating role of personality were investigated.

The prevalence of PIU was 2.5%; girls (3.0%) were more often affected than boys (1.9%). Social networking sites in girls and online games in boys were most often associated with PIU. Low conscientiousness and high neuroticism generally predicted PIU. Significantly more adolescents with PIU (70%) reported critical life events compared with those without PIU (42%). PIU was related to heightened stress and higher adjustment disorder symptoms. These associations were exacerbated by conscientiousness and neuroticism.

The effect of the internet addiction on the information-seeking behavior of the postgraduate students (2016)

Mater Sociomed. 2016 Jun;28(3):191-5. doi: 10.5455/msm.2016.28.191-195.

This study aims to investigate the effect of the internet addiction on the information-seeking behavior of the postgraduate students. The research population composed of 1149 postgraduate students of Isfahan University of Medical Sciences, of which 284 were selected using the stratified random sampling as the sample. Yang's internet addiction questionnaire and the researcher-developed questionnaire of the information-seeking behavior were used as the data collection instruments.

Based on the findings, there was no sign of internet addiction among the 86.6% of the students. However, 13% of the students were exposed to the internet addiction and only 0.4% of internet addiction was observed among the students. There was no significant difference between the information-seeking behavior of the male and female respondents. There was no sign of the internet addiction in any dimension of the information-seeking behavior of the students.

Prevalence of Internet addiction disorder in Chinese university students: A comprehensive meta-analysis of observational studies (2018)

J Behav Addict. 2018 Jul 16:1-14. doi: 10.1556/2006.7.2018.53.

This is a meta-analysis of the prevalence of IAD and its associated factors in Chinese university students. Methods Both English (PubMed, PsycINFO, and Embase) and Chinese (Wan Fang Database and Chinese National Knowledge Infrastructure) databases were systematically and independently searched from their inception until January 16, 2017. Altogether 70 studies covering 122,454 university students were included in the meta-analysis. Using the random-effects model, the pooled overall prevalence of IAD was 11.3% (95% CI: 10.1%-12.5%). When using the 8-item Young Diagnostic Questionnaire, the 10-item modified Young Diagnostic Questionnaire, the 20-item Internet Addiction Test, and the 26-item Chen Internet Addiction Scale, the pooled prevalence of IAD was 8.4% (95% CI: 6.7%-10.4%), 9.3% (95% CI: 7.6%-11.4%), 11.2% (95% CI: 8.8%-14.3%), and 14.0% (95% CI: 10.6%-18.4%), respectively. Subgroup analyses revealed that the pooled prevalence of IAD was significantly associated with the measurement instrument (Q = 9.41, p = .024). Male gender, higher grade, and urban abode were also significantly associated with IAD. The prevalence of IAD was also higher in eastern and central of China than in its northern and western regions (10.7% vs. 8.1%, Q = 4.90, p = .027).

Internet Addiction Through the Phase of Adolescence: A Questionnaire Study (2017)

JMIR Ment Health. 2017 Apr 3;4(2):e11. doi: 10.2196/mental.5537.

The study included a simple random sample of 1078 adolescents-534 boys and 525 girls-aged 11-18 years attending elementary and grammar schools in Croatia, Finland, and Poland. Adolescents were asked to complete an anonymous questionnaire and provide data on age, gender, country of residence, and purpose of Internet use (ie, school/work or entertainment). Collected data were analyzed with the chi-square test for correlations.

Adolescents mostly used the Internet for entertainment (905/1078, 84.00%). More female than male adolescents used it for school/work (105/525, 20.0% vs 64/534, 12.0%, respectively). Internet for the purpose of school/work was mostly used by Polish adolescents (71/296, 24.0%), followed by Croatian (78/486, 16.0%) and Finnish (24/296, 8.0%) adolescents. The level of Internet addiction was the highest among the 15-16-year-old age subgroup and was lowest in the 11-12-year-old age subgroup. There was a weak but positive correlation between Internet addiction and age subgroup (P=.004). Male adolescents mostly contributed to the correlation between the age subgroup and level of addiction to the Internet (P=.001).

Adolescents aged 15-16 years, especially male adolescents, are the most prone to the development of Internet addiction, whereas adolescents aged 11-12 years show the lowest level of Internet addiction

Exploring the association of ego defense mechanisms with problematic internet use in a Pakistani medical school (2016)

Psychiatry Res. 2016 Jul 11;243:463-468.

The present study was designed to analyze association between problematic internet use and use of ego defense mechanisms in medical students. This cross-sectional study was undertaken at CMH Lahore Medical College (CMH LMC) in Lahore, Pakistan from 1st March, 2015 to 30th May, 2015. 522 medical and dental students were included in the study.

Multiple regression analysis was used to delineate ego defenses as predictors of problematic internet use. A total of 32 (6.1%) students reported severe problems with internet usage. Males had higher scores on IAT i.e had more problematic use of internet. Scores on internet addiction test (IAT) were negatively associated with sublimation and positively associated with projection, denial, autistic fantasy, passive aggression and displacement.

Correlation between the Family Function Based on Circumplex Model and Students' Internet Addiction in Shahid Beheshti University of Medical Sciences in 2015 (2016)

Glob J Health Sci. 2016 Mar 31;8(11):56314. doi: 10.5539/gjhs.v8n11p223.

So, this study was conducted aimed to investigate the correlation between the family function based on Circumplex Model and students' Internet addiction in ShahidBeheshti University of Medical Sciences in 2015.

In this correlational study, 664 students were selected by stratified random sampling method. Findings showed, 79.2 percent of students did not have Internet addiction, 20.2 percent were at risk of addiction and 0.6 percent was addicted to the Internet. Female students were the most frequent users of the Internet among students (41.47% and p < 0.01) with the purpose of recreation and entertainment (79.5 percent). A significant negative correlation was seen between Internet addiction and cohesion (a family function aspect) (p<0.01), also a positive and significant relationship was seen between average time of using Internet every time, average weekly hours of Internet use and Internet addiction (p>0.01).

Maybe you should blame your parents: Parental attachment, gender, and problematic Internet use (2016)

J Behav Addict. 2016 Aug 24:1-5.

Prior research has generally established parental attachment as a predictor of problematic Internet use (PIU). An anonymous survey was completed by 243 undergraduate students in a public university in the U.S. Midwest. In addition to demographic information, the survey contained measurement scales to assess PIU and parental attachment (both maternal and paternal). Survey data show that (a) attachment anxiety, but not attachment avoidance, is significantly related to PIU and (b) gender significantly moderates this relationship, where paternal attachment anxiety leads to PIU in female students while maternal attachment anxiety contributes to PIU in male students.

Attachment Style and Internet Addiction: An Online Survey (2017)

J Med Internet Res. 2017 May 17;19(5):e170. doi: 10.2196/jmir.6694.

The aim of this study was to examine people's tendency toward pathological Internet usage in relation to their attachment style. An online survey was conducted. Sociodemographic data, attachment style (Bielefeld questionnaire partnership expectations), symptoms of Internet addiction (scale for online addiction for adults), used Web-based services, and online relationship motives (Cyber Relationship Motive Scale, CRMS-D) were assessed. In order to confirm the findings, a study using the Rorschach test was also conducted.

In total, 245 subjects were recruited. Participants with insecure attachment style showed a higher tendency to pathological Internet usage compared with securely attached participants. An ambivalent attachment style was particularly associated with pathological Internet usage. Escapist and social-compensatory motives played an important role for insecurely attached subjects. However, there were no significant effects with respect to Web-based services and apps used. Results of the analysis of the Rorschach protocol with 16 subjects corroborated these results. Users with pathological Internet use frequently showed signs of infantile relationship structures in the context of social groups. This refers to the results of the Web-based survey, in which interpersonal relationships were the result of an insecure attachment style. Pathological Internet use was a function of insecure attachment and limited interpersonal relationships.

Parenting approaches family functionality and internet addiction among Hong Kong adolescents (2016)

BMC Pediatr. 2016 Aug 18;16:130. doi: 10.1186/s12887-016-0666-y.

Internet addiction (IA) among adolescents has become a global health problem, and public awareness of it is increasing. Many IA risk factors relate to parents and the family environment. This study examined the relationship between IA and parenting approaches and family functionality.

A cross-sectional study was conducted with 2021 secondary students to identify the prevalence of IA and to explore the association between adolescent IA and familial variables, including parents' marital status, family income, family conflict, family functionality, and parenting approaches.

The results revealed that 25.3 % of the adolescent respondents exhibited IA, and logistic regression positively predicted the IA of adolescents from divorced families, low-income families, families in which family conflict existed, and severely dysfunctional families. Interestingly, adolescents with restricted Internet use were almost 1.9 times more likely to have IA than those whose use was not restricted.

No site unseen: predicting the failure to control problematic Internet use among young adults (2016)

Cogn Behav Ther. 2016 Jul 18:1-5.

Problematic Internet use has been associated with the neglect of valued activities such as work, exercise, social activities, and relationships. In the present study, we expanded the understanding of problematic Internet use by identifying an important predictor of the inability to curb Internet use despite the desire to do so. Specifically, in a college student sample reporting a mean of 27.8 h of recreational Internet use in the past week, we investigated the role of distress intolerance (DI)-an individual difference variable that refers to the inability of an individual to tolerate emotional discomfort and to engage in goal-directed behavior when distressed-to predict the failure to meet personal restrictions on Internet use. Consistent with hypotheses, DI emerged as a significant predictor of the failure to meet self-control goals in both bivariate and multivariate models, indicating that DI offers unique prediction of self-control failure with problematic Internet use. Given that DI is a modifiable trait, these results encourage consideration of DI-focused early intervention strategies.

Internet addiction and its determinants among medical students (2015)

Ind Psychiatry J. 2015 Jul-Dec;24(2):158-62. doi: 10.4103/0972-6748.181729.

The study was designed to evaluate the prevalence of internet addiction and its determinants among medical students.

We found prevalence of internet addiction among medical students to be 58.87% (mild - 51.42%, moderate -7.45%) and significantly associated factors with internet addiction being male gender, staying in private accommodation, lesser age of first internet use, using mobile for internet access, higher expenditure on internet, staying online for longer time, and using internet for social networking, online videos, and watching website with sexual content.

Internet Addiction among Iranian Adolescents: a Nationwide Study. (2014)

Acta Med Iran. 2014 Jun;52(6):467-72.

In Iran, despite the very high speed rate of Internet spread, there is not enough data on the rate of Internet addiction among the adolescents. This study is the first nationwide study that addresses this issue. Overall 4500 students of high school or pre-college schools were recruited. Two self-rated questionnaires (one demographics and one Young's Internet addiction scale) were filled b the participants.

962 (22.2%) of the study participants were labeled as having "internet addiction." Males were significantly more likely to be an internet addict. Students whose father and/or mother had a doctorate degree were most likely to have Internet addiction. Job engagement of mothers was significantly associated with students' internet addiction, and the least rate of addiction was observed when the mother was a housewife; having no exercise was associated with the highest rate of Internet addiction.

Adolescent Internet Addiction in Hong Kong: Prevalence, Change, and Correlates (2015)

J Pediatr Adolesc Gynecol. 2015 Oct 9. pii:

The prevalence rates of Internet addiction in Hong Kong adolescents ranged from 17% to 26.8% during the high school years. Male students consistently showed a higher prevalence rate of Internet addiction and more Internet addictive behaviors than did female students.

Longitudinal data suggested that while family economic disadvantage served as a risk factor for youth Internet addiction, the effects of family intactness and family functioning were not significant. Students' overall positive youth development and general positive youth development qualities were negatively related to Internet addictive behaviors whereas prosocial attributes had a positive relationship with youth Internet addiction.

Prevalence of internet addiction and associated factors among medical students from mashhad, iran in 2013.

Iran Red Crescent Med J. 2014 May;16(5):e17256.

Problematic internet use is on the increase and has caused serious problems in many areas. This issue seems to be more important for medical students.This study was designed to explore the prevalence of internet addiction and its related factors among the students of Mashhad University of Medical Sciences.

It was found that 2.1% of the studied population were at risk and 5.2% were addicted users. Chatting with new people, communicating with friends and families, and playing games were the most popular activities in these groups.

The relationship between internet addiction, social anxiety, impulsivity, self-esteem, and depression in a sample of Turkish undergraduate medical students (2018)

Psychiatry Res. 2018 Jun 14;267:313-318. doi: 10.1016/j.psychres.2018.06.033.

Internet addiction (IA) is currently becoming a serious mental health problem. The aim of this study was to estimate the prevalence of IA among undergraduate medical students and evaluate the relationship of IA with social anxiety, impulsivity, self-esteem, and depression. The study included 392 undergraduate medical students. Evaluations were made with the sociodemographic data form, the Internet Addiction Test (IAT), the Liebowitz Social Anxiety Scale (LSAS), the Barratt Impulsivity Scale-11 (BIS-11), the Rosenberg Self-Esteem Scale (RSES), the Beck Depression Inventory (BDI), and the Beck Anxiety Inventory (BAI). The IA group had significantly higher scores on LSAS, BDI, BAI and lower scores on RSES than the control group but the BIS-11 scores were similar among groups. IAT severity was positively correlated with LSAS, BDI, and BAI and negatively with RSES. No correlation was observed between IAT severity and BIS-11. In the hierarchical linear regression analysis, the avoidance domain of social anxiety was the strongest predictor of the severity of IA. The present study suggests that undergraduate medical students with IA exhibit higher social anxiety, lower self-esteem and are more depressed than those without IA, thus, indicating that social anxiety, rather than impulsivity, seemed to play a prominent role in IA psychopathology.

Investigation on Internet addiction disorder in adolescents in Anhui, People's Republic of China (2016)

Neuropsychiatr Dis Treat. 2016 Aug 29;12:2233-6. doi: 10.2147/NDT.S110156.

The purpose of this study was to describe the characteristics and prevalence of Internet addiction (IA) in adolescents so as to provide a scientific basis for the communities, schools, and families.

We conducted a survey by randomized cluster sampling on 5,249 students, grades ranging from 7 to 12, in Anhui province, People's Republic of China. The questionnaire consisted of general information and IA test. Chi-square test was used to compare the status of IA disorder (IAD).

In our results, the overall detection rate of IAD and non-IAD in students was 8.7% (459/5,249) and 76.2% (4,000/5,249), respectively. The detection rate of IAD in males (12.3%) was higher than females (4.9%). The detection rate of IAD was statistically different between students from rural (8.2%) and urban (9.3%) areas, among students from different grades, between students from only-child families (9.5%) and non-only-child families (8.1%), and among students from different family types.

Problematic smartphone use, nature connectedness, and anxiety (2018)

J Behav Addict. 2018 Mar 1;7(1):109-116. doi: 10.1556/2006.7.2018.10.

Background Smartphone use has increased greatly at a time when concerns about society's disconnection from nature have also markedly increased. Recent research has also indicated that smartphone use can be problematic for a small minority of individuals. Methods In this study, associations between problematic smartphone use (PSU), nature connectedness, and anxiety were investigated using a cross-sectional design (n = 244). Results Associations between PSU and both nature connectedness and anxiety were confirmed. Receiver operating characteristic (ROC) curves were used to identify threshold values on the Problematic Smartphone Use Scale (PSUS) at which strong associations with anxiety and nature connectedness occur. The area under the curve was calculated and positive likelihood ratios used as a diagnostic parameter to identify optimal cut-off for PSU. These provided good diagnostic ability for nature connectedness, but poor and non-significant results for anxiety. ROC analysis showed the optimal PSUS threshold for high nature connectedness to be 15.5 (sensitivity: 58.3%; specificity: 78.6%) in response to an LR+ of 2.88. Conclusions The results demonstrate the potential utility for the PSUS as a diagnostic tool, with a level of smartphone use that users may perceive as non-problematic being a significant cut-off in terms of achieving beneficial levels of nature connectedness. Implications of these findings are discussed.

Effect of parental neglect on smartphone addiction in adolescents in South Korea (2018)

Child Abuse Negl. 2018 Mar;77:75-84. doi: 10.1016/j.chiabu.2017.12.008.

The purpose of this study was to investigate the importance of the relationships with parents, peers, and teachers as a cause of adolescents' smartphone addiction, and to examine the effect of parental neglect on smartphone addiction and the mediating effect of relational maladjustment in school, especially focusing on the relational maladjustment with peers and teachers. For this purpose, a survey was conducted of students from middle schools and high schools in four regions of South Korea. A total of 1170 middle-school students who reported using smartphone took part in this study. A multiple mediator model was analyzed using the bootstrapping mediation methods Parental neglect was significantly associated with adolescents' smartphone addiction. Furthermore, in the relationship between parental neglect and smartphone addiction, parental neglect was not significantly associated with the relational maladjustment with peers, whereas the relational maladjustment with peers negatively influenced smartphone addiction. On the other hand, the relational maladjustment with teachers had a partial mediation effect between parental neglect and smartphone addiction. Based on the results of this study, some implications are suggested that include the need for (1) a customized program for adolescents who use smartphones addictively, (2) a family therapy program to strengthen family function, (3) an integrated case-management system to prevent the reoccurrence of parental neglect, (4) a program to improve relationships with teachers, and (5) expanding the leisure activity infrastructure to improve relationships with friends off-line.

The Use of Smartphones in Different Phases of Medical School and its Relationship to Internet Addiction and Learning Approaches (2018)

J Med Syst. 2018 Apr 26;42(6):106. doi: 10.1007/s10916-018-0958-x.

The present study aims to evaluate smartphone use in the educational context as well as Internet addiction and its repercussions on surface and deep learning and to compare them during the different phases of medical students' education. This is a cross-sectional study involving medical students in all phases of education. Sociodemographic data, type and frequency of smartphone use, degree of digital addiction (Internet Addiction Test - IAT), and surface and deep approaches to learning (Biggs) were analyzed. A total of 710 students were included. Almost all students had a smartphone and a total of 96.8% used it during lectures, classes, and meetings. Less than half of the students (47.3%) reported using a smartphone for more than 10 min for educational purposes, a usage that is higher among clerkship students. At least 95% reported using a smartphone in the classroom for activities not related to medicine (social media and searching for general information) and 68.2% were considered problematic Internet users according to the IAT. The most common reasons for noneducational use were that the class was uninteresting, students needed to receive or make an important call, and the educational strategy was not stimulating. The "frequency of smartphone use" and higher "internet addiction" were correlated to both higher levels of surface learning and lower levels of deep learning.

Effects of Internet and Smartphone Addictions on Depression and Anxiety Based on Propensity Score Matching Analysis (2018)

Int J Environ Res Public Health. 2018 Apr 25;15(5). pii: E859. doi: 10.3390/ijerph15050859.

The associations of Internet addiction (IA) and smartphone addiction (SA) with mental health problems have been widely studied. We investigated the effects of IA and SA on depression and anxiety while adjusting for sociodemographic variables. In this study, 4854 participants completed a cross-sectional web-based survey including socio-demographic items, the Korean Scale for Internet Addiction, the Smartphone Addiction Proneness Scale, and the subscales of the Symptom Checklist 90 Items-Revised. The participants were classified into IA, SA, and normal use (NU) groups. To reduce sampling bias, we applied the propensity score matching method based on genetics matching. The IA group showed an increased risk of depression and anxiety compared to NUs. The SA group also showed an increased risk of depression and anxiety compared to NCs. These findings show that both, IA and SA, exerted significant effects on depression and anxiety. Moreover, our findings showed that SA has a stronger relationship with depression and anxiety, stronger than IA, and emphasized the need for prevention and management policy of the excessive smartphone use.

Smartphone addiction risk and daytime sleepiness in Korean adolescents (2018)

J Paediatr Child Health. 2018 Apr 6. doi: 10.1111/jpc.13901.

Smartphone overuse can cause not only mobility problems in the wrists, fingers and neck but also interference with sleep habits. However, research on smartphone addiction and sleep disturbances is scarce. Therefore, we aimed to investigate daytime sleepiness in association with smartphone addiction risk in Korean adolescents.

A cross-sectional survey method was used in this study. The Pediatric Daytime Sleepiness Scale was used to assess daytime sleepiness, and the Korean Smartphone Addiction Proneness Scale index was used to evaluate the degree of risk for smartphone addiction.

The analyses were performed in 1796 adolescents using smartphones, including 820 boys and 976 girls. The at-risk smartphone users made up 15.1% of boys and 23.9% of girls. Our multivariate analyses demonstrated that students who were female, consumed alcohol, had lower academic performance, did not feel refreshed in the morning and initiated sleep after 12 am were at a significantly higher risk of smartphone addiction. The at-risk smartphone user group was independently associated with the upper quartile Pediatric Daytime Sleepiness Scale score in students with the following factors: Female gender, alcohol consumption, poor self-perceived health level, initiating sleep after 12 am, longer time taken to fall asleep and duration of night sleep less than 6 h.

Problematic Use of the Internet and Smartphones in University Students: 2006-2017 (2018)

Int J Environ Res Public Health. 2018 Mar 8;15(3). pii: E475. doi: 10.3390/ijerph15030475.

It has been more than a decade since a concern about the addictive use of the Internet and mobile phones was first expressed, and its possible inclusion into the lists of mental disorders has recently become a popular topic of scientific discussion. Thus, it seems to be a fitting moment to investigate the prevalence of this issue over time. The aim of the present study was to analyze the prevalence of the perception of problematic Internet and smartphone use in young people over the period 2006-2017. To this end, a questionnaire on Internet use habits and two questionnaires on the negative consequences of Internet and smartphone use were administered to a sample of 792 university students. The scores were then compared with the results of former studies that had used these questionnaires. The perception of problematic Internet and mobile phone use has increased over the last decade, social networks are considered responsible for this increase, and females are perceived to be more affected than males. The current study shows how strong smartphone and Internet addiction and social media overlap. Participants from 2017 report higher negative consequences of both Internet and mobile phone use than those from 2006, but long-term observations show a decrease in problematic use after a sharp increase in 2013. We conclude that the diagnosis of technological addictions is influenced by both time and social and culture changes.

Emotion regulation's relationships with depression, anxiety and stress due to imagined smartphone and social media loss (2017)

Psychiatry Res. 2017 Dec 19;261:28-34. doi: 10.1016/j.psychres.2017.12.045.

A sample of 359 students participated in a web survey, administered the Emotion Regulation Questionnaire, and Depression Anxiety Stress Scale-21 (DASS-21) as a pre-test. We subsequently randomly assigned subjects to either 1) a smart phone loss group or 2) social media accounts loss group. We asked them to imagine losing two days' access to the technology in their respective group, and rate associated symptoms using the DASS-21. Compared to subjects in the smartphone loss group, social media loss subjects evidenced stronger relations between suppressive emotion regulation with depression, anxiety and stress from imagined loss. Controlling for age and gender, social media loss subjects' increased use of suppression, and decreased use of cognitive reappraisal in emotion regulation, were related to depression, stress and (for suppression only) anxiety due to imagined lost social media. Emotion regulation was not related to psychopathology for subjects in the smartphone loss scenario. Results suggest that emotion dysregulation may be associated with psychopathology from social media loss.

Impact of Smartphone Addiction on Business Students’ Academic Performance: A Case Study (2017)

e-ISSN......: 2236-269X

The development of telecom technology has a profound impact on the lives and activities of the people of the world. Smartphone usage became popular to young generation because of its educational and entertaining options by using the numerous apps. Among the young people, students are increasingly using Smartphone. But excessive Smartphone usage usually makes the students addicted to that subconsciously impacts on user’s academic performance, daily activities, physical and mental health and withdrawal tendency, and social relationships. This study aims at identifying the factors that affect the level of Smartphone addiction of the students and its impact on their academic performance. A structured questionnaire has been developed to gather data from the students. A total of 247 questionnaires were collected from the business students of a university of Bangladesh. Using Structural Equation Modeling (SEM) the data were analyzed. Results revealed five Smartphone addiction factors such as, positive anticipation, impatience and tolerance, withdrawal, daily-life disturbance, and cyber friendship. Tolerance and daily-life disturbance have significant impact on students’ academic performance. This study suggests that the students should minimize the usage of Smartphone for achieving good academic performance.

Comparison of smartphone addiction and loneliness in high school and university students (2018)

Perspect Psychiatr Care. 2018 Mar 30. doi: 10.1111/ppc.12277.

This study was conducted to compare the relationship between the smartphone addiction and loneliness in high school and university students.

A correlation and descriptive study from a convenience sample of 1156 high school and university students. Questionnaire, Smartphone Addiction scale, and Short Loneliness scale were used to collect the data of the study.

No relationship was found between the smartphone addiction and loneliness in high school and university students.

It is recommended to organize comprehensive training programs for the students and their families in the school health services.

Psychosocial Factors Affecting Smartphone Addiction in University Students (2017)

J Addict Nurs. 2017 Oct/Dec;28(4):215-219. doi: 10.1097/JAN.0000000000000197.

Smartphone addiction is a recent concern that has resulted from the dramatic increase in worldwide smartphone use. The purpose of this cross-sectional study was to evaluate psychosocial factors affecting smartphone addiction in university students. The study was performed among students at the Ondokuz Mayis University Samsun School of Health (Samsun, Turkey) on October-December 2015. Four hundred ninety-four students possessing smartphones and agreeing to participate were included. A sociodemographic data form produced by the authors and consisting of 10 questions was administered together with a questionnaire involving the Smartphone Addiction Scale-Short Version (SAS-SV), the Flourishing Scale, the General Health Questionnaire, and the Multidimensional Scale of Perceived Social Support. SAS-SV scores of 6.47% of students were "significantly higher" than the participating group mean SAS-SV score. Multiple regression analysis revealed that depression, anxiety and insomnia, and familial social support statistically, significantly predicted smartphone addiction.

Smartphone usage and increased risk of mobile phone addiction: A concurrent study (2017)

Int J Pharm Investig. 2017 Jul-Sep;7(3):125-131. doi: 10.4103/jphi.JPHI_56_17.

This study aimed to study the mobile phone addiction behavior and awareness on electromagnetic radiation (EMR) among a sample of Malaysian population. This online study was conducted between December 2015 and 2016. The study instrument comprised eight segments, namely, informed consent form, demographic details, habituation, mobile phone fact and EMR details, mobile phone awareness education, psychomotor (anxious behavior) analysis, and health issues.

Totally, 409 respondents participated in the study. The mean age of the study participants was 22.88 (standard error = 0.24) years. Most of the study participants developed dependency with smartphone usage and had awareness (level 6) on EMR. No significant changes were found on mobile phone addiction behavior between the participants having accommodation on home and hostel.

The study participants were aware about mobile phone/radiation hazards and many of them were extremely dependent on smartphones. One-fourth of the study population were found having feeling of wrist and hand pain because of smartphone use which may lead to further physiological and physiological complication.

The Effect of Adolescents' Internet Addiction on Smartphone Addiction (2017)

J Addict Nurs. 2017 Oct/Dec;28(4):210-214. doi: 10.1097/JAN.0000000000000196.

The purpose of this study was to evaluate the effect of adolescents' Internet addiction levels on smartphone addiction. This study included 609 students from three high schools that are located in western Turkey. Numbers, percentages, and averages were used to evaluate the sociodemographic data.

The average age of the participants was 12.3 ± 0.9 years. Of them, 52.3% were male, and 42.8% were 10th graders. All participants had smartphones, and 89.4% of them connected to the Internet continuously with their smartphones. The study found that there was a statistically significant correlation between Internet addiction and smartphone addiction. It was determined that male adolescents with high levels of Internet addiction also had high smartphone addiction levels.

An Analysis of Smartphone Overuse Recognition in Terms of Emotions using Brainwaves and Deep Learning (2017)

Kim, Seul-Kee, and Hang-Bong Kang. Neurocomputing (2017).

The overuse of smartphones is increasingly becoming a social problem. In this paper, we analyze smartphone overuse levels, according to emotion, by examining brainwaves and deep learning. We assessed the asymmetry power with respect to theta, alpha, beta, gamma, and total brainwave activity in 11 lobes. The deep belief network (DBN) was used as the deep learning method, along with k-nearest neighbor (kNN) and a support vector machine (SVM), to determine the smartphone addiction level. The risk group (13 subjects) and non-risk group (12 subjects) watched videos portraying the following concepts: relaxed, fear, joy, and sadness. We found that the risk group was more emotionally unstable than the non-risk group. In recognizing Fear, a clear difference appeared between the risk and non-risk group. The results showed that the gamma band was the most obviously different between the risk and non-risk groups. Moreover, we demonstrated that the measurements of activity in the frontal, parietal, and temporal lobes were indicators of emotion recognition. Through the DBN, we confirmed that these measurements were more accurate in the non-risk group than they were in the risk group. The risk group had higher accuracy in low valence and arousal; on the other hand, the non-risk group had higher accuracy in high valence and arousal.

Smartphone addiction: psychosocial correlates, risky attitudes, and smartphone harm (2017)

Journal of Risk Research (2017): 1-12.

Smartphone use has brought convenience to users, although its excessive use and addiction might also have negative consequences. Using a representative sample of 526 smartphone users in Spain, the present study analyzes smartphone extensive use and addiction as well as its relationship to smartphone harm. Self-reported and scanned data were obtained from users and their smartphones. Multivariate linear regression analyses showed that higher levels of smartphone extensive use were found for female respondents, those high on general propensity to risk, neuroticism, and low on conscientiousness, openness, or social support. Multivariate binary logistic results showed that general propensity to risk and low social support were predictive of smartphone addiction. The combination of high smartphone extensive use and low social support was positively and significantly related to the existence of smartphone harm as well as higher levels of risk attitudes toward smartphone use.

Smartphone use and smartphone addiction in middle school students in Korea: Prevalence, social networking service, and game use (2018)

Health Psychol Open. 2018 Feb 2;5(1):2055102918755046. doi: 10.1177/2055102918755046.

This study aimed to examine smartphone use patterns, smartphone addiction characteristics, and the predictive factors of the smartphone addiction in middle school students in South Korea. According to the Smartphone Addiction Proneness Scale scores, 563 (30.9%) were classified as a risk group for smartphone addiction and 1261 (69.1%) were identified as a normal user group. The adolescents used mobile messengers for the longest, followed by Internet surfing, gaming, and social networking service use. The two groups showed significant differences in smartphone use duration, awareness of game overuse, and purposes of playing games. The predictive factors of smartphone addiction were daily smartphone and social networking service use duration, and the awareness of game overuse.

Associations between smartphone addiction scale and sociopsychological aspects in medical school students (2017)

Yeungnam Univ J Med. 2017 Jun;34(1):55-61. Korean.

Smartphone addiction, academic stress and anxiety of university students are increasing gradually; however, few studies have investigated these factors in medical school students. Therefore, this study investigated associations between smartphone addiction scale and sociopsychological aspects in medical school students.

A total of 231 Yeungnam University College of Medicine students were enrolled in this study in March 2017. Gender, school grade, type of residence, and smartphone usage patterns of the students were surveyed. The Korean Smartphone Addiction Proneness Scale and each Korean version scale were used to assess sociopsychological aspects such as loneliness, stress and anxiety.

There was a direct statistical correlation between loneliness, stress of negative perception, anxiety and smartphone addiction scales. There was also a negative statistical correlation between stress of positive perception and smartphone addiction scales. There was a higher level of anxiety among female students than male students. Additionally, there was a higher level of stress associated with negative perception and anxiety among medical students in the first grade than other students. Moreover there was a higher level of loneliness, stress of negative perception and anxiety among students who live with friends than students who live with their own family.

Psychological Factors Associated With Smartphone Addiction in South Korean Adolescents (2018)

The Journal of Early Adolescence 38, no. 3 (2018): 288-302.

The smartphone has many attractive attributes and characteristics that could make it highly addictive, particularly in adolescents. The purpose of this study was to examine the prevalence of young adolescents in risk of smartphone addiction and the psychological factors associated with smartphone addiction. Four hundred ninety middle school students completed a self-questionnaire measuring levels of smartphone addiction, behavioral and emotional problems, self-esteem, anxiety, and adolescent-parent communication. One hundred twenty-eight (26.61%) adolescents were in high risk of smartphone addiction. This latter group showed significantly more severe levels of behavioral and emotional problems, lower self-esteem, and poorer quality of communication with their parents. Multiple regression analysis revealed that the severity of smartphone addiction is significantly associated with aggressive behavior and self-esteem.

Relationships among smartphone addiction, stress, academic performance, and satisfaction with life. (2016)

Computers in Human Behavior 57 (2016): 321-325.


• Stress mediates the relationship between smartphone addiction and satisfaction with life.

• Academic performance mediates the relationship b/w smartphone addiction & satisfaction with life.

• There is a zero order correlation between smartphone addiction and satisfaction with life.

Results of several studies have suggested that smartphone addiction has negative effects on mental health and well-being. A total of 300 university students completed an online survey questionnaire that was posted to the student information system. The survey questionnaire collected demographic information and responses to scales including the Smartphone Addiction Scale - Short Version, the Perceived Stress Scale, and the Satisfaction with Life Scale. Data analyses included Pearson correlations between the main variables and multivariate analysis of variances. The results showed that smartphone addiction risk was positively related to perceived stress, but the latter was negatively related to satisfaction with life. Additionally, a smartphone addiction risk was negatively related to academic performance, but the latter was positively related to satisfaction with life.

The Comparison of Cervical Repositioning Errors According to Smartphone Addiction Grades (2014)

Journal of physical therapy science 26, no. 4 (2014): 595-598.The purpose of this study was to compare cervical repositioning errors according to smartphone addiction grades of adults in their 20s. A survey of smartphone addiction was conducted of 200 adults. Based on the survey results, 30 subjects were chosen to participate in this study, and they were divided into three groups of 10; a Normal Group, a Moderate Addiction Group, and a Severe Addiction Group. After attaching a C-ROM, we measured the cervical repositioning errors of flexion, extension, right lateral flexion and left lateral flexion.

Significant differences in the cervical repositioning errors of flexion, extension, and right and left lateral flexion were found among the Normal Group, Moderate Addiction Group, and Severe Addiction Group. In particular, the Severe Addiction Group showed the largest errors. The result indicates that as smartphone addiction becomes more severe, a person is more likely to show impaired proprioception, as well as impaired ability to recognize the right posture. Thus, musculoskeletal problems due to smartphone addiction should be resolved through social cognition and intervention, and physical therapeutic education and intervention to educate people about correct postures.

Hypernatural Monitoring: A Social Rehearsal Account of Smartphone Addiction (2018)

Front Psychol. 2018 Feb 20;9:141. doi: 10.3389/fpsyg.2018.00141. eCollection 2018.

We present a deflationary account of smartphone addiction by situating this purportedly antisocial phenomenon within the fundamentally social dispositions of our species. While we agree with contemporary critics that the hyper-connectedness and unpredictable rewards of mobile technology can modulate negative affect, we propose to place the locus of addiction on an evolutionarily older mechanism: the human need to monitor and be monitored by others. Drawing from key findings in evolutionary anthropology and the cognitive science of religion, we articulate a hypernatural monitoring model of smartphone addiction grounded in a general social rehearsal theory of human cognition. Building on recent predictive-processing views of perception and addiction in cognitive neuroscience, we describe the role of social reward anticipation and prediction errors in mediating dysfunctional smartphone use. We conclude with insights from contemplative philosophies and harm-reduction models on finding the right rituals for honoring social connections and setting intentional protocols for the consumption of social information.

Children's Environmental Health in the Digital Era: Understanding Early Screen Exposure as a Preventable Risk Factor for Obesity and Sleep Disorders (2018)

Children (Basel). 2018 Feb 23;5(2). pii: E31. doi: 10.3390/children5020031.

The quantity, accessibility and focus on child-targeted programming has exponentially increased since it entered American households in the early 1900s. It may have started with the television (TV), but technology has evolved and now fits in our pockets; as of 2017, 95% of American families own a smartphone. Availability and child-tailored content has subsequently led to a decrease in the age at initial screen exposure. The negative effects that accompany the current culture of early screen exposure are extensive and need to be considered as technology continues to enter the home and inundate social interactions. Increased levels of early screen exposure have been associated with decreased cognitive abilities, decreased growth, addictive behavior, poor school performance, poor sleep patterns, and increased levels of obesity. Research on the adverse effects of early screen exposure is mounting, but further epidemiological studies are still needed to inform prevention and regulation policies.

Smartphone addiction in university students and its implication for learning (2015)

In Emerging issues in smart learning, pp. 297-305.  Springer, Berlin, Heidelberg

As smartphones are getting popular, a concern for smartphone learner’s addiction to their phones has been raised together with the possibility of Smart Learning. This research is focused on the level of university students’ addiction to their smartphones and to understand the difference between self-regulated learning, learning flow, based on smartphone addiction level. After 210 students of university students in Seoul were participated in this research, it has been found that the higher the addiction level is, the lower level of self -regulated learning the students have, as well as low level of flow when studying. Further interview for smartphone addiction group was conducted, it has been found that the smartphone addict—learners are constantly interrupted by the other applications on the phones when they are studying, and does not have enough control over their smartphone learning plan and its process.

Relationship among family environment, self-control, friendship quality, and adolescents' smartphone addiction in South Korea: Findings from nationwide data (2018)

PLoS One. 2018 Feb 5;13(2):e0190896. doi: 10.1371/journal.pone.0190896.

This study aimed to investigate the association of adolescents' smartphone addiction with family environment (specifically, domestic violence and parental addiction). We further investigated whether self-control and friendship quality, as predictors of smartphone addiction, may reduce the observed risk.

We used the 2013 national survey on internet usage and utilization data from the National Information Agency of Korea. Information on exposure and covariates included self-reported experience of domestic violence and parental addiction, sociodemographic variables, and other variables potentially related to smartphone addiction. Smartphone addiction was estimated using a smartphone addiction proneness scale, a standardized measure developed by national institutions in Korea.

Our findings suggest that family dysfunction was significantly associated with smartphone addiction. We also observed that self-control and friendship quality act as protective factors against adolescents' smartphone addiction.

Association of Internet addiction and alexithymia - A scoping review (2018)

Addict Behav. 2018 Feb 6. pii: S0306-4603(18)30067-4. doi: 10.1016/j.addbeh.2018.02.004.

It has been hypothesized that individuals with alexithymia who have difficulty in identifying, expressing, and communicating emotions may overuse Internet as a tool of social interaction to better regulate their emotions and to fulfill their unmet social needs. Similarly, an increasing body of evidence suggests that alexithymia may also play an essential role in the etiopathogenesis of addictive disorders. We conducted a scoping review of questionnaire-based studies of problematic Internet use/Internet addiction and alexithymia. From initial 51 studies, all of the final 12 included studies demonstrated a significant positive association between scores of alexithymia and severity of Internet addiction. However, the causal direction of the association is not clear because the interplay of numerous other variables that could affect the relation has not been studied. There are limitations in the methodology of the studies conducted. Hence, we emphasise the need for longitudinal studies with stronger methodologies.

Relationship of smartphone use severity with sleep quality, depression, and anxiety in university students (2015)

 Journal of behavioral addictions 4, no. 2 (2015): 85-92.

The aim of the current study was to investigate the relationship between smartphone use severity and sleep quality, depression, and anxiety in university students.In total, 319 university students (203 females and 116 males; mean age = 20.5 ± 2.45) were included in the study. The findings revealed that the Smartphone Addiction Scale scores of females were significantly higher than those of males. Depression, anxiety, and daytime dysfunction scores were higher in the high smartphone use group than in the low smartphone use group. Positive correlations were found between the Smartphone Addiction Scale scores and depression levels, anxiety levels, and some sleep quality scores.

The results indicate that depression, anxiety, and sleep quality may be associated with smartphone overuse. Such overuse may lead to depression and/or anxiety, which can in turn result in sleep problems. University students with high depression and anxiety scores should be carefully monitored for smartphone addiction.

The correlation between Smartphone Addiction and Psychiatric Symptoms in College Students (2013)

 Journal of the Korean Society of School Health

Volume 26, Issue 2,  2013, pp.124-131

This study was designed to identify the relationship between smartphone addiction and psychiatric symptoms and the difference in severity of psychiatric symptoms by the degree of smart phone addiction in order to raise awareness of mental health problem. related to smartphone addiction in college students. Methods: Two hundreds and thirteen university student survey data was collected from December 5th to 9th of 2011 in South Korea using smartphone Addiction Scale, and the Symptom Checklist-90-Revision that was translated with korean for the psychiatric symptoms.

Respondents were classified as upper addicted (25.3%) and lower addicted group (28.1%). Addicted scores were positively correlated with psychiatric symptom scores. Obsessive-compulsive score was the most highly correlated with addiction scores. There were significant different in psychiatric symptom scores by the groups. Upper groups was 1.76 times higher than lower in total psychiatric scores. The addicted group used smartphone significantly longer per day and more satisfied with than lower addicted group.

Although the smartphone was first introduced not so long ago, the addiction rate is exponentially increasing in students. The results proved that there is an inevitable correlation between the smartphone addiction and the severity of psychiatric symptoms.

To excel or not to excel: Strong evidence on the adverse effect of smartphone addiction on academic performance (2015)

Computers & Education 98 (2016): 81-89.


• Students who are at high risk of smartphone addiction are less likely to achieve high GPAs.

• Male and female university students are equally susceptible to smartphone addiction.

• Every other university student was identified as high risk for smartphone addiction.

• Males and females are equal in achieving high GPAs within same levels of smartphone addiction.

This study aimed to verify whether achieving a distinctive academic performance is unlikely for students at high risk of smartphone addiction. Additionally, it verified whether this phenomenon was equally applicable to male and female students. After implementing systematic random sampling, 293 university students participated by completing an online survey questionnaire posted on the university's student information system. The survey questionnaire collected demographic information and responses to the Smartphone Addiction Scale-Short Version (SAS-SV) items. The results showed that male and female university students were equally susceptible to smartphone addiction. Additionally, male and female university students were equal in achieving cumulative GPAs with distinction or higher within the same levels of smartphone addiction. Furthermore, undergraduate students who were at a high risk of smartphone addiction were less likely to achieve cumulative GPAs of distinction or higher.

Linking loneliness, shyness, smartphone addiction symptoms, and patterns of smartphone use to social capital (2015)

Social Science Computer Review 33, no. 1 (2015): 61-79.

The purpose of this study is to explore the roles of psychological attributes (such as shyness and loneliness) and smartphone usage patterns in predicting smartphone addiction symptoms and social capital. Data were gathered from a sample of 414 university students using online survey in Mainland China. Results from exploratory factor analysis identified five smartphone addiction symptoms: disregard of harmful consequences, preoccupation, inability to control craving, productivity loss, and feeling anxious and lost, which formed the Smartphone Addiction Scale. Results show that the higher one scored in loneliness and shyness, the higher the likelihood one would be addicted to smartphone. Furthermore, this study shows the most powerful predictor inversely affecting both bonding and bridging social capital was loneliness. Moreover, this study presents clear evidence that the use of smartphones for different purposes (especially for information seeking, sociability, and utility) and the exhibition of different addiction symptoms (such as preoccupation and feeling anxious and lost) significantly impacted social capital building. The significant links between smartphone addiction and smartphone usage, loneliness, and shyness have clear implications for treatment and intervention for parents, educators, and policy makers.

Latent-level relations between DSM-5 PTSD symptom clusters and problematic smartphone use (2017)

Comput Human Behav. 2017 Jul;72:170-177.

Common mental health consequences following the experience of potentially traumatic events include Posttraumatic Stress Disorder (PTSD) and addictive behaviors. Problematic smartphone use is a newer manifestation of addictive behaviors. People with anxiety severity (such as PTSD) may be at risk for problematic smartphone use as a means of coping with their symptoms. Unique to our knowledge, we assessed relations between PTSD symptom clusters and problematic smartphone use.

Results indicate that problematic smartphone use is most associated with negative affect and arousal among trauma-exposed individuals. Implications include the need to clinically assess problematic smartphone use among trauma-exposed individuals presenting with higher NACM and arousal severity; and targeting NACM and arousal symptoms to mitigate the effects of problematic smartphone use.

Time Is Money: The Decision Making of Smartphone High Users in Gain and Loss Intertemporal Choice (2017)

Front Psychol. 2017 Mar 10;8:363. doi: 10.3389/fpsyg.2017.00363.

Although a great number of studies have demonstrated that people affected by substance abuse, pathological gambling, and internet addiction disorder have lower self-control than average, scarcely any study has investigated the decision making of smartphone high users by using a behavioral paradigm. The present study employed an intertemporal task, the Smartphone Addiction Inventory (SPAI) and the Barratt Impulsiveness Scale 11th version (BIS-11) to explore the decision control of smartphone high users in a sample of 125 college students. Participants were divided into three groups according to their SPAI scores. The upper third (69 or higher), middle third (from 61 to 68) and lower third (60 or lower) of scores were defined as high smartphone users, medium users and low users, respectively. We compared the percentage of small immediate reward/penalty choices in different conditions between the three groups. Relative to the low users group, high users and medium users were more inclined to request an immediate monetary reward. These findings demonstrated that smartphone overuse was associated with problematic decision-making, a pattern similar to that seen in persons affected by a variety of addictions.

Neuroticism and quality of life: Multiple mediating effects of smartphone addiction and depression (2017)

Psychiatry Res. 2017 Aug 31. pii: S0165-1781(17)30240-8. doi: 10.1016/j.psychres.2017.08.074.

The purposes of this study were to investigate the mediating effect of smartphone addiction and depression on neuroticism and quality of life. Self-reported measures of neuroticism, smart-phone addiction, depression, and quality of life were administered to 722 Chinese university students. Results showed smartphone addiction and depression were both significantly affected neuroticism and quality of life. The direct effect of neuroticism on quality of life was significant, and the chain-mediating effect of smartphone addiction and depression was also significant. In conclusion, neuroticism, smartphone addiction, and depression are important variables that worsen quality of life.

Gender differences in factors associated with smartphone addiction: a cross-sectional study among medical college students (2017)

BMC Psychiatry. 2017 Oct 10;17(1):341. doi: 10.1186/s12888-017-1503-z.

This cross-sectional study was conducted in 2016 and included 1441 undergraduate students at Wannan Medical College, China. The Smartphone Addiction Scale short version (SAS-SV) was used to assess smartphone addiction among the students, using accepted cut-offs. Participants' demographic, smartphone usage, and psycho-behavioral data were collected. Multivariate logistic regression models were used to seek associations between smartphone addiction and independent variables among the males and females, separately.

The prevalence of smartphone addiction among participants was 29.8% (30.3% in males and 29.3% in females). Factors associated with smartphone addiction in male students were use of game apps, anxiety, and poor sleep quality. Significant factors for female undergraduates were use of multimedia applications, use of social networking services, depression, anxiety, and poor sleep quality.

Smartphone addiction was common among the medical college students investigated. This study identified associations between smartphone usage, psycho-behavioral factors, and smartphone addiction, and the associations differed between males and females. These results suggest the need for interventions to reduce smartphone addiction among undergraduate students.

Relationship between smartphone addiction of nursing department students and their communication skills (2018)

Contemp Nurse. 2018 Mar 14:1-11. doi: 10.1080/10376178.2018.1448291.

The use of technological devices today is widespread. One of these devices is the smartphone. It can be argued that when smartphones are thought of as a means of communication, they can influence communication skills.

The aim of this study is to determine the effect of nursing students' smartphone addiction on their communication skills.

A relational screening model was used for the study. The study's data were obtained from 214 students studying in the nursing department

Smartphone addiction levels of students are below average (86.43 ± 29.66). Students think that their communication skills are at a good level (98.81 ± 10.88). Correlation analysis results show that students have a negative, significant and very weak relationship between the smartphone addiction of students and communication skills (r = -.149). Smartphone addiction explains 2.2% of the variance in communication skills.

Communication skills of nursing students is affected negatively by smartphone addiction..

Timing rather than user traits mediates mood sampling on smartphones (2017)

BMC Res Notes. 2017 Sep 16;10(1):481. doi: 10.1186/s13104-017-2808-1.

Recent years have seen an increasing number of studies using smartphones to sample participants' mood states. Moods are usually collected by asking participants for their current mood or for a recollection of their mood states over a specific period of time. The current study investigates the reasons to favour collecting mood through current or daily mood surveys and outlines design recommendations for mood sampling using smartphones based on these findings. These recommendations are also relevant to more general smartphone sampling procedures.

N=64 participants completed a series of surveys at the beginning and end of the study providing information such as gender, personality, or smartphone addiction score. Through a smartphone application, they reported their current mood 3 times and daily mood once per day for 8 weeks. We found that none of the examined intrinsic individual qualities had an effect on matches of current and daily mood reports. However timing played a significant role: the last followed by the first reported current mood of the day were more likely to match the daily mood. Current mood surveys should be preferred for a higher sampling accuracy, while daily mood surveys are more suitable if compliance is more important.

Problematic smartphone use and relations with negative affect, fear of missing out, and fear of negative and positive evaluation (2017)

Psychiatry Res. 2017 Sep 25. pii: S0165-1781(17)30901-0. doi: 10.1016/j.psychres.2017.09.058.

For many individuals, excessive smartphone use interferes with everyday life. In the present study, we recruited a non-clinical sample of 296 participants for a cross-sectional survey of problematic smartphone use, social and non-social smartphone use, and psychopathology-related constructs including negative affect, fear of negative and positive evaluation, and fear of missing out (FoMO). Results demonstrated that FoMO was most strongly related to both problematic smartphone use and social smartphone use relative to negative affect and fears of negative and positive evaluation, and these relations held when controlling for age and gender. Furthermore, FoMO (cross-sectionally) mediated relations between both fear of negative and positive evaluation with both problematic and social smartphone use. Theoretical implications are considered with regard to developing problematic smartphone use.

Association between psychological and self-assessed health status and smartphone overuse among Korean college students (2017)

J Ment Health. 2017 Sep 4:1-6. doi: 10.1080/09638237.2017.1370641.

This study investigated the associations between psychological and subjective health conditions and smartphone overuse in Korean college students.
A total of 608 college students participated in this study. We investigated the perceived psychological factors, such as stress, depression symptoms and suicidal ideation. Overall health status was evaluated with self-assessed items, including usual health condition and EuroQol-visual analog scales score. Smartphone overuse was evaluated as the Korean Smartphone Addiction Proneness Scale.

Students with psychotic anxiety (i.e. stress, depression and suicidal ideation) showed significant associations with smartphone overuse, indicating an approximately twofold increased risk compared to those without psychological anxiety. Students who reported feeling that their usual health is not good were more likely to overuse smartphones than those who are in good health. The EQ-VAS score, which indicates current self-assessed health status, also showed a similar result with general health status. Negative conditions in self-perceived emotional or overall health condition are associated with the increased likelihood of smartphone overuse in Korean college students.

The influence of alexithymia on mobile phone addiction: The role of depression, anxiety and stress (2017)

J Affect Disord. 2017 Sep 1;225:761-766. doi: 10.1016/j.jad.2017.08.020

Alexithymia is an important predictor of mobile phone addiction. Enhancing and improving college students' mental health can reduce the rate of mobile phone addiction. However, it is not clear about the role of depression, anxiety and stress in the relationship between college students' alexithymia and mobile phone addiction.

A total of 1105 college students were tested with the Toronto Alexithymia Scale, the Depression Anxiety Stress Scale and the Mobile Phone Addiction Index.

An individual's level of alexithymia was significantly correlated with depression, anxiety, stress and mobile phone addiction. Alexithymia had a significantly positive prediction effect on mobile phone addiction, and depression, anxiety, and stress on mobile phone are positive predictors. Depression, anxiety or stress had partially mediating effects between alexithymia and mobile phone addiction. Alexithymia not only directly had a positively impact on mobile phone addiction, but both also had an indirect effect on mobile phone addiction through depression, anxiety or stress.

Depression, anxiety, and smartphone addiction in university students - A cross sectional study (2017)

PLoS One. 2017 Aug 4;12(8):e0182239. doi: 10.1371/journal.pone.0182239.

The study aims to assess prevalence of smartphone addiction symptoms, and to ascertain whether depression or anxiety, independently, contributes to smartphone addiction level among a sample of Lebanese university students, while adjusting simultaneously for important sociodemographic, academic, lifestyle, personality trait, and smartphone-related variables.

A random sample of 688 undergraduate university students (mean age = 20.64 ±1.88 years; 53% men). Prevalence rates of smartphone-related compulsive behavior, functional impairment, tolerance and withdrawal symptoms were substantial. 35.9% felt tired during daytime due to late-night smartphone use, 38.1% acknowledged decreased sleep quality, and 35.8% slept less than four hours due to smartphone use more than once. Whereas gender, residence, work hours per week, faculty, academic performance (GPA), lifestyle habits (smoking and alcohol drinking), and religious practice did not associate with smartphone addiction score; personality type A, class (year 2 vs. year 3), younger age at first smartphone use, excessive use during a weekday, using it for entertainment and not using it to call family members, and having depression or anxiety, showed statistically significant associations with smartphone addiction. Depression and anxiety scores emerged as independent positive predictors of smartphone addiction, after adjustment for confounders.

Several independent positive predictors of smartphone addiction emerged including depression and anxiety. It could be that young adults with personality type A experiencing high stress level and low mood may lack positive stress coping mechanisms and mood management techniques and are thus highly susceptible to smartphone addiction.

Fatal Attractions: Attachment to Smartphones Predicts Anthropomorphic Beliefs and Dangerous Behaviors (2017)

Cyberpsychology, Behavior, and Social Networking. May 2017, 20(5): 320-326. doi:10.1089/cyber.2016.0500.
As technology's presence grows increasingly concrete in global societies, so too do our relationships with the devices we keep close at hand from day to day. Whereas research has, in the past, framed smartphone addiction in terms of possessional attachment, the present research hypothesizes that anxious smartphone attachment stems from human attachment, in which Anxiously attached individuals may be more likely to generalize their anxious attachment style to communication devices. In the present study, we found support for this hypothesis and showed that anxious smartphone attachment predicts (1) anthropomorphic beliefs, (2) reliance on—or “clinginess” toward—smartphones, and (3) a seemingly compulsive urge to answer one's phone, even in dangerous situations (e.g., while driving). Taken together, we seek to provide a theoretical framework and methodological tools to identify the sources of technology attachment and those most at risk of engaging in dangerous or inappropriate behaviors as a result of attachment to ever-present mobile devices.

Smartphone dependence classification using tensor factorization (2017)

PLoS One. 2017 Jun 21;12(6):e0177629. doi: 10.1371/journal.pone.0177629.

Excessive smartphone use causes personal and social problems. To address this issue, we sought to derive usage patterns that were directly correlated with smartphone dependence based on usage data. This study attempted to classify smartphone dependence using a data-driven prediction algorithm. We developed a mobile application to collect smartphone usage data. A total of 41,683 logs of 48 smartphone users were collected from March 8, 2015, to January 8, 2016. The participants were classified into the control group (SUC) or the addiction group (SUD) using the Korean Smartphone Addiction Proneness Scale for Adults (S-Scale) and a face-to-face offline interview by a psychiatrist and a clinical psychologist (SUC = 23 and SUD = 25). We derived usage patterns using tensor factorization and found the following six optimal usage patterns: 1) social networking services (SNS) during daytime, 2) web surfing, 3) SNS at night, 4) mobile shopping, 5) entertainment, and 6) gaming at night. The membership vectors of the six patterns obtained a significantly better prediction performance than the raw data. For all patterns, the usage times of the SUD were much longer than those of the SUC.

The prevalence of phantom vibration/ringing syndromes and their related factors in Iranian' students of medical sciences (2017)

Asian J Psychiatr. 2017 Jun;27:76-80. doi: 10.1016/j.ajp.2017.02.012.

Mobile phone abuse can cause pathologic stress that may lead to addictive behavior such as Phantom Vibration Syndrome (PVS) and Phantom Ringing Syndrome (PRS). The current study aimed to determine the PVS and PRS due to mobile phone use in students of Qom University of medical Sciences in Iran.

The participants were 380 students selected by proportional stratified random sampling method in each stratum.

The prevalence of PVS and PRS due to mobile phones in students of medical sciences was estimated to be 54.3% and 49.3%, respectively. PVS was higher in female students than in males while the PRS was higher in male students. There was a significant relationship between PVS and using social networks such as Viber, WhatsApp, and Line. In addition, a significant association was observed between PVS and friend-finding, chatting and entertainment. Studies should be done in the future to assess the long-term complication of overusing mobile phones. In the current study, the prevalence of PVS and PRS in half of students is considerable.

Assessment of the accuracy of a new tool for the screening of smartphone addiction (2017)

PLoS One. 2017 May 17;12(5):e0176924. doi: 10.1371/journal.pone.0176924. eCollection 2017.

To translate, adapt and validate the Smartphone Addiction Inventory (SPAI) in a Brazilian population of young adults. We employed the translation and back-translation method for the adaptation of the Brazilian version SPAI (SPAI-BR). The sample consisted of 415 university students. Data was collected through an electronic questionnaire, which consisted of the SPAI-BR and the Goodman Criteria (gold standard). The retests were carried out 10-15 days after the initial tests with 130 individuals.The high correlation between SPAI-BR and the Goodman Criteria (rs = 0.750) established the convergent validity.

Relationship between family history of alcohol addiction, parents' education level, and smartphone problem use scale scores (2017)

J Behav Addict. 2017 Mar 1;6(1):84-91. doi: 10.1556/2006.6.2017.016.

As smartphones increased in popularity, researchers realized that people were becoming dependent on their smartphones. The purpose here was to provide a better understanding of the factors related to problematic smartphone use (PSPU). The participants were 100 undergraduates (25 males, 75 females) whose ages ranged from 18 to 23 (mean age = 20 years). The participants completed questionnaires to assess gender, ethnicity, year in college, father's education level, mother's education level, family income, age, family history of alcoholism, and PSPU.

Whereas the MPPUS measures tolerance, escape from other problems, withdrawal, craving, and negative life consequences, the ACPAT measures preoccupation (salience), excessive use, neglecting work, anticipation, lack of control, and neglecting social life.

Results: Family history of alcoholism and father's education level together explained 26% of the variance in the MPPUS scores and 25% of the variance in the ACPAT scores. The inclusion of mother's education level, ethnicity, family income, age, year in college, and gender did not significantly increase the proportion of variance explained for either MPPUS or ACPAT scores.


Structural Equation Model of Smartphone Addiction Based on Adult Attachment Theory: Mediating Effects of Loneliness and Depression (2017)

Asian Nurs Res (Korean Soc Nurs Sci). 2017 Jun;11(2):92-97. doi: 10.1016/j.anr.2017.05.002.

This study investigated the mediating effects of loneliness and depression on the relationship between adult attachment and smartphone addiction in university students.

A total of 200 university students participated in this study. The data was analysed using descriptive statistics, correlation analysis, and structural equation modeling.

There were significant positive relationships between attachment anxiety, loneliness, depression, and smartphone addiction. However, attachment anxiety was not significantly correlated with smartphone addiction. The results also showed that loneliness did not directly mediate between attachment anxiety and smartphone addiction. In addition, loneliness and depression serially mediated between attachment anxiety and smartphone addiction.The results suggest there are mediating effects of loneliness and depression in the relationship between attachment anxiety and smartphone addiction. The hypothesized model was found to be a suitable model for predicting smartphone addiction among university students. Future study is required to find a causal path to prevent smartphone addiction among university students.

Problematic smartphone use: A conceptual overview and systematic review of relations with anxiety and depression psychopathology (2016)

J Affect Disord. 2016 Oct 2;207:251-259.

Research literature on problematic smartphone use, or smartphone addiction, has proliferated. However, relationships with existing categories of psychopathology are not well defined. We discuss the concept of problematic smartphone use, including possible causal pathways to such use.
We conducted a systematic review of the relationship between problematic use with psychopathology. Using scholarly bibliographic databases, we screened 117 total citations, resulting in 23 peer-reviewer papers examining statistical relations between standardized measures of problematic smartphone use/use severity and the severity of psychopathology.

Most papers examined problematic use in relation to depression, anxiety, chronic stress and/or low self-esteem. Across this literature, without statistically adjusting for other relevant variables, depression severity was consistently related to problematic smartphone use, demonstrating at least medium effect sizes. Anxiety was also consistently related to problem use, but with small effect sizes. Stress was somewhat consistently related, with small to medium effects. Self-esteem was inconsistently related, with small to medium effects when found. Statistically adjusting for other relevant variables yielded similar but somewhat smaller effects.

Smart phone usage and addiction among dental students in Saudi Arabia: a cross sectional study (2017)

Int J Adolesc Med Health. 2017 Apr 6. pii: /j/ijamh.ahead-of-print/ijamh-2016-0133/ijamh-2016-0133.xml.

The main aim of this research is to explore measures of smart phone usage, smart phone addiction, and their associations with demographic and health behavior-related variables among dental students in Saudi Arabia.  Cross sectional study involving sample of 205 dental students from Qaseem Private College were surveyed for smart phone use and addiction using the short version of the Smartphone Addiction Scale for Adolescents (SAS-SV).

Smart phone addiction was seen in 136 (71.9%) of the 189 students. The findings from our study revealed that high stress levels, low physical activity, higher body mass index (BMI), longer duration of smart phone usage, higher frequency of usage, shorter time period until first smart phone use in the morning and social networking sites (SNS) were associated significantly with the smart phone addiction.

Stress and adult smartphone addiction: Mediation by self-control, neuroticism, and extraversion (2017)

Stress Health. 2017 Mar 23. doi: 10.1002/smi.2749.

This study employed descriptive statistics and correlation analysis to examine the influence of stress on smartphone addiction as well as the mediating effects of self-control, neuroticism, and extraversion using 400 men and women in their 20s to 40s followed by structural equation analysis. Our findings indicate that stress had a significant influence on smartphone addiction, and self-control mediates the influence of stress on smartphone addiction. As stress increases, self-control decreases, which subsequently leads to increased smartphone addiction. Self-control was confirmed as an important factor in the prevention of smartphone addiction. Finally, among personality factors, neuroticism, and extraversion mediate the influence of stress on smartphone addiction.

Relationship between Mobile Phone Addiction and the Incidence of Poor and Short Sleep among Korean Adolescents: a Longitudinal Study of the Korean Children & Youth Panel Survey (2017)

J Korean Med Sci. 2017 Jul;32(7):1166-1172. doi: 10.3346/jkms.2017.32.7.1166.

Three of ten teenagers in Korea are addicted to mobile phones. The aim of this study was to examine the relationship between mobile phone addiction and the incidence of poor sleep quality and short sleep duration in adolescents. We used longitudinal data from the Korean Children & Youth Panel Survey conducted by the National Youth Policy Institute in Korea (2011-2013). A total of 1,125 students at baseline were included in this study after excluding those who already had poor sleep quality or short sleep duration in the previous year. A generalized estimating equation was used to analyze the data. High mobile phone addiction (mobile phone addiction score > 20) increased the risk of poor sleep quality but not short sleep duration. We suggest that consistent monitoring and effective intervention programs are required to prevent mobile phone addiction and improve adolescents' sleep quality.

To use or not to use? Compulsive behavior and its role in smartphone addiction (2017)

Transl Psychiatry. 2017 Feb 14;7(2):e1030. doi: 10.1038/tp.2017.1.

Global smartphone penetration has led to unprecedented addictive behaviors. To develop a smartphone use/non-use pattern by mobile application (App) in order to identify problematic smartphone use, a total of 79 college students were monitored by the App for 1 month. The App-generated parameters included the daily use/non-use frequency, the total duration and the daily median of the duration per epoch. We introduced two other parameters, the root mean square of the successive differences (RMSSD) and the Similarity Index, in order to explore the similarity in use and non-use between participants. The non-use frequency, non-use duration and non-use-median parameters were able to significantly predict problematic smartphone use. A lower value for the RMSSD and Similarity Index, which represent a higher use/non-use similarity, were also associated with the problematic smartphone use. The use/non-use similarity is able to predict problematic smartphone use and reach beyond just determining whether a person shows excessive use.

Prevalence and correlates of problematic smartphone use in a large random sample of Chinese undergraduates (2016)

BMC Psychiatry. 2016 Nov 17;16(1):408.

Because the present scenario of problematic smartphone use (PSU) is largely unexplored, in the current study we aimed to estimate the prevalence of PSU and to screen suitable predictors for PSU among Chinese undergraduates in the framework of the stress-coping theory.

A sample of 1062 undergraduate smartphone users was recruited by means of the stratified cluster random sampling strategy between April and May 2015. The Problematic Cellular Phone Use Questionnaire was used to identify PSU. The prevalence of PSU among Chinese undergraduates was estimated to be 21.3%. The risk factors for PSU were majoring in the humanities, high monthly income from the family (≥1500 RMB), serious emotional symptoms, high perceived stress, and perfectionism-related factors (high doubts about actions, high parental expectations).

Comparison of risk and protective factors associated with smartphone addiction and Internet addiction (2015)

J Behav Addict. 2015 Dec;4(4):308-14.

Smartphone addiction is a recent concern that has resulted from the dramatic increase in worldwide smartphone use. This study assessed the risk and protective factors associated with smartphone addiction in college students and compared these factors to those linked to Internet addiction.

The risk factors for smartphone addiction were female gender, Internet use, alcohol use, and anxiety, while the protective factors were depression and temperance. In contrast, the risk factors for Internet addiction were male gender, smartphone use, anxiety, and wisdom/knowledge, while the protective factor was courage.

Incorporation of Mobile Application (App) Measures Into the Diagnosis of Smartphone Addiction.

J Clin Psychiatry. 2017 Jan 31. doi: 10.4088/JCP.15m10310.

Global smartphone expansion has brought about unprecedented addictive behaviors. The current diagnosis of smartphone addiction is based solely on information from clinical interview. This study aimed to incorporate application (app)-recorded data into psychiatric criteria for the diagnosis of smartphone addiction and to examine the predictive ability of the app-recorded data for the diagnosis of smartphone addiction.

The app-incorporated diagnosis, combining both psychiatric interview and app-recorded data, demonstrated substantial accuracy for smartphone addiction diagnosis. In addition, the app-recorded data performed as an accurate screening tool for app-incorporated diagnosis.

Is Smartphone Addiction Comparable between Adolescents and Adults? Examination of the Degree of Smartphone Use, Type of Smartphone Activities, and Addiction Levels Among Adolescents and Adults (2017)

International Telecommunications Policy Review, Vol. 24, No. 2, 2017

To identify the patterns of smartphone use in relation to addiction, this study classifies survey respondents into non-addicts, potential addicts, and addicts groups, and analyzes differences in the use of smartphones by the three groups. Adolescents are found to spend more time using smartphones than adults, and the rates of smartphone addiction are higher among adolescents than among adults. Multinominal regression models show that weekend use and average time per use are significant predictors of smartphone addiction. On the other hand, among the addicts groups, adolescents and adults are found to engage in different sets of activities. The adolescent addicts are more likely to use social networking sites (SNS) and mobile games, while the adult addicts engage in a more diverse set of activities such as SNS, gambling, mobile games, videos and pornography.

Smartphone addiction proneness in relation to sleep and morningness-eveningness in German adolescents (2016)

J Behav Addict. 2016 Aug 8:1-9.

 In this study, the relationships among smartphone addiction, age, gender, and chronotype of German adolescents were examined. Two studies focused on two different measures of smartphone addiction. The Smartphone Addiction Proneness Scale (SAPS) was applied to 342 younger adolescents (13.39 ± 1.77; 176 boys, 165 girls, and 1 not indicated) in Study 1 and the Smartphone Addiction Scale was applied to 208 older adolescents (17.07 ± 4.28; 146 girls and 62 boys) in Study 2, both samples in southwest Germany. In addition, a demographic questionnaire and the Composite Scale of Morningness (CSM) and sleep measures were implemented.

The most remarkable result of this study was that morningness-eveningness (as measured by CSM scores) is an important predictor for smartphone addiction; even stronger than sleep duration. Evening oriented adolescents scored higher on both smartphone addiction scales. In addition, gender is an important predictor for smartphone addiction and girls are more prone to become addicted. In addition, while sleep duration on weekdays negatively predicted SAPS, age, sleep duration on weekends, and midpoint of sleep on weekdays and weekends did not predicted smartphone addiction in both scales. T

Personality Factors Predicting Smartphone Addiction Predisposition Behavioral Inhibition and Activation Systems Impulsivity and Self Control (2016)

PLoS One. 2016 Aug 17;11(8):e0159788.

The purpose of this study was to identify personality factor-associated predictors of smartphone addiction predisposition (SAP). Participants were 2,573 men and 2,281 women (n = 4,854) aged 20-49 years (Mean ± SD: 33.47 ± 7.52); participants completed the following questionnaires: the Korean Smartphone Addiction Proneness Scale (K-SAPS) for adults, the Behavioral Inhibition System/Behavioral Activation System questionnaire (BIS/BAS), the Dickman Dysfunctional Impulsivity Instrument (DDII), and the Brief Self-Control Scale (BSCS).

We found that SAP was defined with maximal sensitivity as follows: weekend average usage hours > 4.45, BAS-Drive > 10.0, BAS-Reward Responsiveness > 13.8, DDII > 4.5, and BSCS > 37.4. This study raises the possibility that personality factors contribute to SAP. And, we calculated cut-off points for key predictors. These findings may assist clinicians screening for SAP using cut-off points, and further the understanding of SA risk factors.

Smartphone gaming and frequent use pattern associated with smartphone addiction (2016)

Medicine (Baltimore). 2016 Jul;95(28):e4068.

The aim of this study was to investigate the risk factors of smartphone addiction in high school students.A total of 880 adolescents were recruited from a vocational high school in Taiwan in January 2014 to complete a set of questionnaires, including the 10-item Smartphone Addiction Inventory, Chen Internet Addiction Scale, and a survey of content and patterns of personal smartphone use.

Of those recruited, 689 students (646 male) aged 14 to 21 and who owned a smartphone completed the questionnaire. Multiple linear regression models were used to determine the variables associated with smartphone addiction.Smartphone gaming and frequent smartphone use were associated with smartphone addiction. Furthermore, both the smartphone gaming-predominant and gaming with multiple-applications groups showed a similar association with smartphone addiction. Gender, duration of owning a smartphone, and substance use were not associated with smartphone addiction.Our findings suggest that smartphone use patterns should be part of specific measures to prevent and intervene in cases of excessive smartphone use.

Smartphone addiction among university students in Riyadh Saudi Arabia.

Saudi Med J. 2016 Jun;37(6):675-83.

This cross-sectional study was conducted in King Saud University, Riyadh, Kingdom of Saudi Arabia between September 2014 and March 2015. An electronic self administered questionnaire and the problematic use of mobile phones (PUMP) Scale were used. 
Out of 2367 study subjects, 27.2% stated that they spent more than 8 hours per day using their smartphones. Seventy-five percent used at least 4 applications per day, primarily for social networking and watching news. As a consequence of using the smartphones, at least 43% had decrease sleeping hours, and experienced a lack of energy the next day, 30% had a more unhealthy lifestyle  (ate more fast food, gained weight, and exercised less), and 25% reported that their academic achievement been adversely affected. There are statistically significant positive relationships among the 4 study variables, consequences of smartphone use (negative lifestyle, poor academic achievement), number of hours per day spent using smartphones, years of study, and number of applications used, and the outcome variable score on the PUMP. The mean values of the PUMP scale were 60.8 with a median of 60. 

Dependency on Smartphone Use and Its Association with Anxiety in Korea.

Public Health Rep. 2016 May-Jun;131(3):411-9.

South Korea has the highest rate of smartphone ownership worldwide, which is a potential concern given that smartphone dependency may have deleterious effects on health. We investigated the relationship between smartphone dependency and anxiety. Participants included 1,236 smartphone-using students (725 men and 511 women) from six universities in Suwon, South Korea.

On a scale from 25 to 100, with higher scores on the smartphone dependency test indicating greater dependency, women were significantly more dependent on smartphones than were men (mean smartphone dependency score: 50.7 vs. 56.0 for men and women, respectively, p<0.001). However, the amount of time spent using smartphones and the purpose of smartphone use affected smartphone dependency in both men and women. Particularly, when daily use time increased, smartphone dependency showed an increasing trend. Compared with times of use <2 hours vs. ≥6 hours, men scored 46.2 and 56.0 on the smartphone dependency test, while women scored 48.0 and 60.4, respectively (p<0.001). Finally, for both men and women, increases in smartphone dependency were associated with increased anxiety scores. With each one-point increase in smartphone dependency score, the risk of abnormal anxiety in men and women increased by 10.1% and 9.2%, respectively (p<0.001).

Smartphone use and smartphone addiction among young people in Switzerland (2015)

J Behav Addict. 2015 Dec;4(4):299-307.

This study investigated indicators of smartphone use, smartphone addiction, and their associations with demographic and health behaviour-related variables in young people. A convenience sample of 1,519 students from 127 Swiss vocational school classes participated in a survey assessing demographic and health-related characteristics as well as indicators of smartphone use and addiction.

Smartphone addiction occurred in 256 (16.9%) of the 1,519 students. Longer duration of smartphone use on a typical day, a shorter time period until first smartphone use in the morning, and reporting that social networking was the most personally relevant smartphone function were associated with smartphone addiction. Smartphone addiction was more prevalent in younger adolescents (15-16 years) compared with young adults (19 years and older), students with both parents born outside

Development and Validation Study of the Internet Overuse Screening Questionnaire (2018)

Psychiatry Investig. 2018 Apr;15(4):361-369. doi: 10.30773/pi.2017.09.27.2.

Participants (n=158) were recruited at six I-will-centers located in Seoul, South Korea. From the initial 36 questionnaire item pool, 28 preliminary items were selected through expert evaluation and panel discussions. The construct validity, internal consistency, and concurrent validity were examined. We also conducted Receiver Operating Curve (ROC) analysis to assess diagnostic ability of the Internet Overuse Screening-Questionnaire (IOS-Q).

The exploratory factor analysis yielded a five factor structure. Four factors with 17 items remained after items that had unclear factor loading were removed. The Cronbach's alpha for the IOS-Q total score was 0.91, and test-retest reliability was 0.72. The correlation between Young's internet addiction scale and K-scale supported concurrent validity. ROC analysis showed that the IOS-Q has superior diagnostic ability with the Area Under the Curve of 0.87. At the cut-off point of 25.5, the sensitivity was 0.93 and specificity was 0.86.

Overall, this study supports the use of IOS-Q for internet addiction research and for screening high-risk individuals.

Problematic internet use in Japan: current situation and future issues (2014)

Alcohol Alcohol. 2014 Sep;49 Suppl 1:i68.

The Internet was originally designed to facilitate communication and research activities. However, there has been a dramatic increase in the use of the Internet in recent years for commerce, education, and entertainment, including video games. Problematic Internet use is a significant behavioral problem.Behavioral addictions can induce symptoms similar to substance-related addictions such as excessive use, loss of control, craving, tolerance, and negative repercussions. These negative repercussions can range from poor achievement and social isolation to dysfunction in the family unit and even greater rates of intimate partner violence.                                                                                                                                                                                                                                                                                  

Though there has been relatively little research on the neurobiology of behavioral addictions, studies mostly involving pathological gambling have suggested parallels with substance-related addictions. Social isolation has increasingly become a problem in Japan and has been hypothesized to be related to internet addiction. Particularly amongst students, problematic internet use may be a major factor of social withdrawal.

Internet addiction: Prevalence and relationship with mental states in adolescents (2016)

Psychiatry Clin Neurosci. 2016 May 14. doi: 10.1111/pcn.12402.

Internet addiction disrupts the daily lives of adolescents. We investigated the prevalence of Internet addiction in junior high school students, elucidated the relationship between Internet addiction and mental states, and determined the factors associated with Internet addiction in adolescents.

Junior high school students (age, 12-15 years) were assessed using Young's Internet Addiction Test (IAT), the Japanese version of General Health Questionnaire (GHQ), and a questionnaire on access to electric devices.

Based on total IAT scores, 2.0% (male, 2.1%; female, 1.9%) and 21.7% (male, 19.8%; female, 23.6%) of the total 853 participants were classified as Addicted and Possibly-addicted, respectively. Total GHQ scores were significantly higher in the Addicted (12.9 ± 7.4) and Possibly-addicted groups (8.8 ± 6.0) than in the Non-addicted group (4.3  4.6; P < 0.001, both groups). Comparison of the percentage of students in the pathological range of GHQ scores revealed significantly higher scores in the Possibly-addicted group than in the Non-addicted group. Further, accessibility to smartphones was significantly associated with Internet addiction.

Reliability of the Arabic Smartphone Addiction Scale and Smartphone Addiction Scale-Short Version in Two Different Moroccan Samples (2018)

Cyberpsychol Behav Soc Netw. 2018 May;21(5):325-332. doi: 10.1089/cyber.2017.0411.

The extensive accessibility to smartphones in the last decade raises the concerns of addictive behavior patterns toward these technologies worldwide and in developing countries, and Arabic ones in particular. In an area of stigmatized behavior such as Internet and smartphone addiction, the hypothesis extends to whether there is a reliable instrument that can assess smartphone addiction. To our knowledge, no scale in Arabic language is available to assess maladaptive behavior associated with smartphone use. This study aims to assess the factorial validity and internal reliability of the Arabic Smartphone Addiction Scale (SAS) and Smartphone Addiction Scale-Short Version (SAS-SV) in a Moroccan surveyed population. Participants (N = 440 and N = 310) completed an online survey, including SAS, SAS-SV, and questions about sociodemographic status. Factor analysis results showed six factors with factor loading ranging from 0.25 to 0.99 for SAS. Reliability, based on Cronbach's alpha, was excellent (α = 0.94) for this instrument. The SAS-SV showed one factor (unidimensional construct), and internal reliability was in the good range with an alpha coefficient of (α = 0.87). The prevalence of excessive users was 55.8 percent with highest symptom prevalence reported for tolerance and preoccupation. This study proved factor validity of the Arabic SAS and SAS-SV instruments and confirmed their internal reliability.

Internet addiction, problematic internet use, nonproblematic internet use among Chinese adolescents: Individual, parental, peer, and sociodemographic correlates (2018)

Psychol Addict Behav. 2018 May;32(3):365-372. doi: 10.1037/adb0000358.

Internet addiction has been typically conceptualized as either a continuous construct or a dichotomous construct. Limited research has differentiated adolescents with problematic Internet use (PIU) from the Internet addiction group (IA) and/or nonproblematic Internet use group (NPIU) and examined the potential correlates. To fill this gap, based on data obtained from 956 Chinese adolescents (11-19 years, 47% male), this study examined if adolescents with PIU is a distinctive group from the IA and NPIU. This study also examined factors from different ecological levels that may differentiate among the three groups, including individual, parental, peer, and sociodemographic factors. Results indicated that IA, PIU, and NPIU differed significantly on scores of Young's Diagnostic Questionnaire (YDQ). Critical factors emerging from different ecological levels could differentiate between PIU and NPIU and between IA and NPIU. Such findings suggest that PIU may represent a distinct, intermediate group of Internet users. The potential theoretical and practical implications of identifying PIU were also discussed.

Validation of a Spanish Questionnaire on Mobile Phone Abuse (2018)

Front Psychol. 2018 Apr 30;9:621. doi: 10.3389/fpsyg.2018.00621. eCollection 2018.

Mobile phone addiction has attracted much attention recently and is showing similarity to other substance use disorders. Because no studies on mobile phone addiction had yet been conducted in Spain, we developed and validated a questionnaire (Cuestionario de Abuso del Teléfono Móvil, ATeMo) to measure mobile phone abuse among young adults in Spanish. The ATeMo questionnaire was designed based on relevant DSM-5 diagnostic criteria and included craving as a diagnostic symptom. Using stratified sampling, the ATeMo questionnaire was administered to 856 students (mean age 21, 62% women). The MULTICAGE questionnaire was administered to assess history of drug abuse and addiction. Using confirmatory factor analysis, we found evidence for the construct validity of the following factors: Craving, Loss of Control, Negative Life Consequences, and Withdrawal Syndrome, and their association with a second order factor related to mobile phone abuse. The four ATeMO factors were also associated with alcoholism, internet use, and compulsive buying. Important gender differences were found that should be considered when studying mobile phone addictions. The ATeMo is a valid and reliable instrument that can be used in further research on mobile phone abuse.

The Influence of Parental Control and Parent-Child Relational Qualities on Adolescent Internet Addiction: A 3-Year Longitudinal Study in Hong Kong (2018)

Front Psychol. 2018 May 1;9:642. doi: 10.3389/fpsyg.2018.00642.

This study investigated how parental behavioral control, parental psychological control, and parent-child relational qualities predicted the initial level and rate of change in adolescent internet addiction (IA) across the junior high school years. The study also investigated the concurrent and longitudinal effects of different parenting factors on adolescent IA. Starting from the 2009/2010 academic year, 3,328 Grade 7 students (Mage = 12.59 ± 0.74 years) from 28 randomly selected secondary schools in Hong Kong responded on a yearly basis to a questionnaire measuring multiple constructs including socio-demographic characteristics, perceived parenting characteristics, and IA. Individual growth curve (IGC) analyses showed that adolescent IA slightly decreased during junior high school years. While behavioral control of both parents was negatively related to the initial level of adolescent IA, only paternal behavioral control showed a significant positive relationship with the rate of linear change in IA, suggesting that higher paternal behavioral control predicted a slower decrease in IA. In addition, fathers' and mothers' psychological control was positively associated with the initial level of adolescent IA, but increase in maternal psychological control predicted a faster drop in IA. Finally, parent-child relational qualities negatively and positively predicted the initial level and the rate of change in IA, respectively. When all parenting factors were considered simultaneously, multiple regression analyses revealed that paternal behavioral control and psychological control as well as maternal psychological control and mother-child relational quality were significant concurrent predictors of adolescent IA at Wave 2 and Wave 3. Regarding the longitudinal predicting effects, paternal psychological control and mother-child relational quality at Wave 1 were the two most robust predictors of later adolescent IA at Wave 2 and Wave 3. The above findings underscore the importance of the parent-child subsystem qualities in influencing adolescent IA in the junior high school years. In particular, these findings shed light on the different impacts of fathering and mothering which are neglected in the scientific literature. While the findings based on the levels of IA are consistent with the existing theoretical

The association between parental depression and adolescent's Internet addiction in South Korea (2018)

Ann Gen Psychiatry. 2018 May 4;17:15. doi: 10.1186/s12991-018-0187-1. eCollection 2018.

A number of risk factors for Internet addiction among adolescents have been identified to be associated with their behavior, familial, and parental factors. However, few studies have focused on the relationship between parental mental health and Internet addiction among adolescents. Therefore, we investigated the association between parental mental health and children's Internet addiction by controlling for several risk factors.

This study used panel data collected by the Korea Welfare Panel Study in 2012 and 2015. We focused primarily on the association between Internet addiction which was assessed by the Internet Addiction Scale (IAS) and parental depression which was measured with the 11-item version of the Center for Epidemiologic Studies Depression Scale. To analyze the association between parental depression and log-transformed IAS, we conducted multiple regression analysis after adjusting for covariates.

Among 587 children, depressed mothers and fathers comprised 4.75 and 4.19%, respectively. The mean IAS score of the adolescents was 23.62 ± 4.38. Only maternal depression (β = 0.0960, p = 0.0033) showed higher IAS among children compared to nonmaternal depression. Strongly positive associations between parental depression and children's Internet addiction were observed for high maternal education level, adolescents' gender, and adolescent's academic performance.

Maternal depression is related to children's Internet addiction; particularly, mothers who had graduated from the university level or above, male children, and children's normal or better academic performance show the strongest relationship with children's Internet addiction.

Risk and protective factors of internet addiction: a meta-analysis of empirical studies in Korea (2014)

Yonsei Med J. 2014 Nov 1;55(6):1691-711.

A meta-analysis of empirical studies performed in Korea was conducted to systematically investigate the associations between the indices of Internet addiction (IA) and psychosocial variables.

Specifically, IA demonstrated a medium to strong association with "escape from self" and "self-identity" as self-related variables. "Attention problem", "self-control", and "emotional regulation" as control and regulation-relation variables; "addiction and absorption traits" as temperament variables; "anger" and "aggression" as emotion and mood and variables; "negative stress coping" as coping variables were also associated with comparably larger effect sizes. Contrary to our expectation, the magnitude of the correlations between relational ability and quality, parental relationships and family functionality, and IA were found to be small. The strength of the association between IA and the risk and protective factors was found to be higher in younger age groups.

Comments: Unexpectedly, the correlations between quality of relationships and Internet addiction were small.

Prevalence, correlates, psychiatric comorbidities, and suicidality in a community population with problematic Internet use (2016)

Psychiatry Res. 2016 Jul 14;244:249-256. doi: 10.1016/j.psychres.2016.07.009.

We examined the prevalence, correlates, and psychiatric comorbidities of community-dwelling subjects with problematic Internet use (PIU). In an epidemiological survey of mental disorders among Korean adults conducted in 2006, 6510 subjects (aged 18-64 years)

The prevalence of PIU was 9.3% in the general population of South Korea. Being male, younger, never married, or unemployed were all associated with increased risks of PIU. Significant positive associations were observed between PIU and nicotine use disorders, alcohol use disorders, mood disorders, anxiety disorders, somatoform disorders, pathological gambling, adult type ADHD symptoms, sleep disturbances, suicide ideas and suicide plans compare to subjects without PIU, after controlling for socio-demographic variables.

Suicidal Ideation and Related Factors Among Korean High School Students: A Focus on Cyber Addiction and School Bullying (2017)

J Sch Nurs. 2017 Jan 1:1059840517734290. doi: 10.1177/1059840517734290.

The purpose of the study was to explore the association among suicidal ideation, cyber addiction, and school bullying of Korean high school students. This descriptive cross-sectional study included 416 students. The data were collected using structured questionnaires on suicidal ideation, Internet and smartphone addiction, experiences of school bullying, impulsiveness, and depression. Students who were bullied  and more depressed were more likely to have higher scores for suicidal ideation; however, when a lower stringency was used, female gender and addiction to smartphones were also statistically significant contributors to the presence of suicidal ideation. Students with suicidal ideation that is higher than average, but lower than the classical thresholds for risk group designation, should also be carefully assessed for early detection and intervention. Cyber addiction may be a particularly significant contributor to suicidal ideation, in addition to bullying and depressive mood, among Korean adolescents.

Relationships of Mental Health and Internet Use in Korean Adolescents (2017)

Arch Psychiatr Nurs. 2017 Dec;31(6):566-571. doi: 10.1016/j.apnu.2017.07.007.

The purpose of this study was to identify the relationships of mental health and internet use in Korean adolescents. Also, it was intended to provide guidelines for reducing internet overuse based on the influencing factors of internet use.Participants in this study were convenient sampling, and selected middle and high school students in Incheon metropolitan city, South Korea. Internet use and mental health of adolescents were measured by self-reported instruments. This study was carried out from June to July 2014. 1248 participants were collected overall except for insufficient data. The data were analyzed by descriptive statistics, t-test, ANOVA, Pearson's correlation coefficient, and multiple regression.

There were significant correlations between mental health and internet use. The significant influencing factors of internet use were normal internet use group, mental health, middle school, internet using time on weekends (3h or more), internet using time at a time (3h or more), and high school record. These six variables accounted for 38.1% of internet use.

Sleep problems and internet addiction among children and adolescents: a longitudinal study.

J Sleep Res. 2016 Feb 8. doi: 10.1111/jsr.12388.

Although the literature has documented associations between sleep problems and internet addiction, the temporal direction of these relationships has not been established. The purpose of this study is to evaluate the bidirectional relationships between sleep problems and internet addiction among children and adolescents longitudinally. A four-wave longitudinal study was conducted with 1253 children and adolescents in grades 3, 5 and 8 from March 2013 to January 2014.

 Based on the results of time-lag models, dyssomnias, especially early and middle insomnias, sequentially predicted internet addiction, and internet addiction sequentially predicted disturbed circadian rhythm regardless of adjustment for gender and age. This is the first study to demonstrate the temporal relationship of early and middle insomnia predicting internet addiction, which subsequently predicts disturbed circadian rhythm. These findings imply that treatment strategies for sleep problems and internet addiction should vary according to the order of their occurrence.

Psychosocial risk factors associated with internet addiction in Korea (2014)

Psychiatry Investig. 2014 Oct;11(4):380-6.

The aim of this study was to examine the prevalence of Internet addiction in middle school students and to identify associated psychosocial risk factors and depression.

The subjects consisted of addicted users (2.38%), over users (36.89%) and normal Internet users (60.72%). Attention problems, sex, delinquent problems, K-CDI scores, thought problems, age and aggressive behavior were predictable variables of internet addiction. Age of initial Internet use negatively predicted Internet addiction.

This result showed similar to other researches about sociodemographic, emotional or behavioral factors related to internet addiction. Generally, subjects with more severe internet addiction had more emotional or behavioral problems.

An analysis of integrated health care for Internet Use Disorders in adolescents and adults (2017)

J Behav Addict. 2017 Nov 24:1-14. doi: 10.1556/2006.6.2017.065.

Although first treatment approaches for Internet Use Disorders (IUDs) have proven to be effective, health care utilization remained low. New service models focus on integrated health care systems, which facilitate access and reduce burdens of health care utilization, and stepped-care interventions, which efficiently provide individualized therapy.

An integrated health care approach for IUD intended to (a) be easily accessible and comprehensive, (b) cover a variety of comorbid syndromes, and (c) take heterogeneous levels of impairment into account was investigated in a one-armed prospective intervention study on n = 81 patients, who were treated from 2012 to 2016. Results First, patients showed significant improvement in Compulsive Internet Use over time, as measured by hierarchical linear modeling. Second, differential effects were found depending on patients' compliance, demonstrating that high compliance resulted in significantly higher rates of change. Third, patients referred to minimal interventions did not differ significantly in amount of change from patients referred to intensive psychotherapy.

Exploring depression, self-esteem and verbal fluency with different degrees of internet addiction among Chinese college students (2016)

Compr Psychiatry. 2016 Oct 15;72:114-120. doi: 10.1016/j.comppsych.2016.10.006.

The aims of this study were to explore depression, self-esteem and verbal fluency functions among normal internet users, mild internet addictions and severe internet addictions.

The survey sample consisted of 316 college students, and their internet addiction symptoms, depression and self-esteem symptoms were assessed using the Revised Chen Internet Addiction Scale (CIAS-R), Zung Self-Rating Depression Scale (ZSDS), Rosenberg Self-Esteem Scale (RSES), respectively. From this sample, 16 students with non-addictions, 19 students with mild internet addiction (sub-MIA) and 15 students with severe internet addiction (sub-SIA) were recruited and subjected to the classical verbal fluency tests, including the semantic and phonemic fluency task. The results indicated that severe internet addiction in the survey sample showed the highest tendency towards depressive symptoms and lowest self-esteem scores, and sub-SIA showed poor performance on the semantic fluency task.

Frequency of Internet addiction and development of social skills in adolescents in an urban area of Lima (2017)

Medwave. 2017 Jan 30;17(1):e6857. doi: 10.5867/medwave.2017.01.6857.

The degree of social skills and level of internet use was evaluated in adolescents from 10 to 19 years of 5th to 11th grades in two secondary schools in the town of Condevilla. Classrooms were randomly selected, and the questionnaires were applied to all adolescents. Two questionnaires were applied: Scale for Internet Addiction of Lima to determine the extent of Internet use, and the Social Skills Test from the Ministry of Health of Peru, which evaluates self-esteem, assertiveness, communication and decision-making. The analyses by Chi2 test and Fisher's exact test, as well as a generalized linear model (GLM) were performed using the binomial family.

Both questionnaires were applied to 179 adolescents, of whom 49.2% were male. The main age was 13 years, 78.8% of which were in secondary school. Internet addiction was found in 12.9% of respondents, of whom the majority were male (78.3%) and had a higher prevalence of low social skills (21.7%). In adolescents, there is a relationship between internet addiction and low social skills, among which the area of communication is statistically significant.

Problematic Internet use was more common in Turkish adolescents with major depressive disorders than controls.

Acta Paediatr. 2016 Feb 5. doi: 10.1111/apa.13355.

This study compared problematic Internet use (PIU) rates in 12 to 18 year olds with major depressive disorder (MDD) and healthy controls and explored potential links between PIU and suicide among MDD patients.

The study sample consisted of 120 MDD patients (62.5% girls) and 100 controls (58% girls) with a mean age of 15. Suicide ideation and suicide attempts were evaluated and sociodemographic data were collected. In addition, the Children's Depression Inventory, Young Internet Addiction Test and Suicide Probability Scale were applied.

The results showed that PIU rates were significantly higher in the MDD cases than the controls  The analysis of covariance results showed that there was no relationship between potential suicide and the Young Internet Addiction Test score in MDD cases. However, the hopelessness subscale scores of the MDD patients with PIU were significantly higher than the scores of those without PIU.

Psychopathological factors associated with problematic alcohol and problematic Internet use in a sample of adolescents in Germany (2016).

Psychiatry Res. 2016 Apr 22;240:272-277. doi: 10.1016/j.psychres.2016.04.057.

o our knowledge, this is the first investigation assessing psychopathological factors for both problematic alcohol and problematic Internet use in the same sample of adolescents. We surveyed a sample of 1444 adolescents in Germany regarding problematic alcohol use, problematic Internet use, psychopathology and psychological well-being. We conducted binary logistic regression analyses. 5.6% of the sample showed problematic alcohol use, 4.8% problematic Internet use, and 0.8% both problematic alcohol and problematic Internet use. Problematic alcohol use was higher in adolescents with problematic Internet use compared to those without problematic Internet use. Conduct problems and depressive symptoms were statistically significant associated with both problematic alcohol and problematic Internet use.

Prevalence of problematic internet use in Slovenia (2016)

Zdr Varst. 2016 May 10;55(3):202-211.

Problematic Internet Use Questionnaire (PIUQ) was included in European Health Interview Study (EHIS) on representative Slovenian sample. The frequency of Internet use and problematic Internet use were both assessed.

3.1% of Slovenian adult population are at risk of becoming problematic Internet users, whereas 3 out of 20 Slovenian adolescents aged from 18 to 19 years are at risk (14.6%). Prevention programs and treatment for those affected are paramount, especially for the young generation.

Positive metacognitions about Internet use: The mediating role in the relationship between emotional dysregulation and problematic use.

Addict Behav. 2016 Apr 4;59:84-88.

The present study hypothesized that two specific positive metacognitions about Internet use (i.e. the belief that Internet use is useful in regulating negative emotions and the belief that it affords greater controllability) mediate the association between emotional dysregulation and problematic Internet use (PIU). Variables accounted for 46% of the variance in PIU levels. A partial mediation model in which emotional dysregulation predicted PIU levels through positive metacognitions associated with Internet use was found. The presence of a direct relationship between emotional dysregulation and PIU was also detected. Moreover, the study found that emotional dysregulation might drive symptoms of PIU to a greater extent than high negative emotionality.

Epidemiology of Internet Behaviors and Addiction Among Adolescents in Six Asian Countries (2014)

Cyberpsychol Behav Soc Netw. 2014 Nov;17(11):720-728.

A total of 5,366 adolescents aged 12-18 years were recruited from six Asian countries: China, Hong Kong, Japan, South Korea, Malaysia, and the Philippines. Participants completed a structured questionnaire on their Internet use in the 2012-2013 school year.

Internet addiction was assessed using the Internet Addiction Test (IAT) and the Revised Chen Internet Addiction Scale (CIAS-R). The variations in Internet behaviors and addiction across countries were examined.

  • The overall prevalence of smartphone ownership is 62%, ranging from 41% in China to 84% in South Korea.
  • Moreover, participation in online gaming ranges from 11% in China to 39% in Japan.
  • Hong Kong has the highest number of adolescents reporting daily or above Internet use (68%).
  • Internet addiction is highest in the Philippines, according to both the IAT (5%) and the CIAS-R (21%).

Factors associated with internet addiction among school-going adolescents in Vadodara (2017)

J Family Med Prim Care. 2016 Oct-Dec;5(4):765-769. doi: 10.4103/2249-4863.201149.

The aim was to assess the prevalence of IA among school-going adolescents and factors associated with IA. A cross-sectional study was designed to survey adolescents studying in 8th to 11th standard of five schools of Vadodara.
Seven hundred and twenty-four participants that completed IAT were analyzed. Internet use prevalence was 98.9%. Prevalence of IA was 8.7%. Male gender, owning a personal device, hours of internet use/day, use of smartphones, permanent login status, use of internet for chatting, making online friends, shopping, watching movies, online gaming, searching information online and instant messaging were found to be associated significantly with IA in univariate analysis. Internet use for online friendships was found to be a significant predictor of IA, and internet use for searching information was found to be protective against IA on logistic regression.

Multi-family group therapy for adolescent Internet addiction: Exploring the underlying mechanisms (2014)

Addict Behav. 2014 Oct 30;42C:1-8. doi: 10.1016/j.addbeh.2014.10.021.

Internet addiction is one of the most common problems among adolescents and effective treatment is needed. This research aims to test the effectiveness and underlying mechanism of multi-family group therapy (MFGT) to reduce Internet addiction among adolescents.

A total of 92 participants consisting of 46 adolescents with Internet addiction, aged 12-18years, and 46 their parents, aged 35-46years, were assigned to the experimental group (six-session MFGT intervention) or a waiting-list control.

The six-session multi-family group therapy was effective in reducing Internet addiction behaviors among adolescents and could be implemented as part of routine primary care clinic services in similar populations.

The impact of sensation seeking on the relationship between attention deficit/hyperactivity symptoms and severity of Internet addiction risk.

Psychiatry Res. 2015 May 1. pii: S0165-1781(15)00243-7.

The aim of this study was to investigate the relationship of attention deficit/hyperactivity symptoms (ADHS) with severity of Internet addiction risk (SIAR), while controlling the effects of variables such as depression, anxiety, anger, sensation seeking and lack of assertiveness among university students. The participants were classified into the two groups as those with high risk of Internet addiction (HRIA) (11%) and those with low risk of Internet addiction (IA) (89%).  Lastly, a hierarchical regression analysis suggested that severity of sensation seeking and ADHS, particularly attention deficiency, predicted SIAR.

Exploring personality characteristics of Chinese adolescents with internet-related addictive behaviors: Trait differences for gaming addiction and social networking addiction (2014)

Addict Behav. 2014 Nov 1;42C:32-35.

This study investigated the associations between personality traits, based on the Big Five model, and addictive behaviors to different online activities among adolescents. A sample of 920 participants was recruited from four secondary schools in different districts using random cluster sampling.

The results demonstrated a significant difference in personality traits for addictive behaviors related to different online activities. Specifically, higher neuroticism and less conscientiousness displayed significant associations with internet addiction in general; less conscientiousness and low openness were significantly associated with gaming addiction; and neuroticism and extraversion were significantly associated with social networking addiction.

Dysfunctional internet behaviour symptoms in association with personality traits (2017)

Psychiatriki. 2017 Jul-Sep;28(3):211-218. doi: 10.22365/jpsych.2017.283.211.

Internet addiction is a matter of great interest for researchers, taking into consideration Internet's rapid spread and its ever growing use in children, adolescents and adults. It has been associated with multiple psychological symptoms and social difficulties, therefore raising even greater concerns for its adverse consequences. The present study that consists part of a broader research, aims to investigate the association between excessive Internet use and personality traits in an adult population.

Our main hypotheses are that dysfunctional internet behaviour would be positively associated with neuroticism but negatively linked to extraversion. The 1211 participants aged over 18 years, completed the IAT (Internet Addiction Test) by Kimberly Young and the Eysenck Personality Questionnaire (EPQ) and some other questionnaires detecting psychopathology. Results showed that 7.7% showed dysfunctional internet behaviour that concerns both medium and severe degree of dependence by the use of Internet, as measured by the use of IAT. The univariate logistic regression analysis revealed that the individuals exhibiting symptoms of dysfunctional internet behaviour were more likely to suffer from a chronic mental health disorder, to use psychotropic medication and to score higher on neuroticism. In contrast, they were less likely to have children and be extraverted. Multiple logistic regression analysis confirmed that neuroticism and extraversion were independently associated with dysfunctional internet behaviour.

The relationships between problematic internet use, alexithymia levels and attachment characteristics in a sample of adolescents in a high school, Turkey (2017)

Psychol Health Med. 2017 Oct 25:1-8. doi: 10.1080/13548506.2017.1394474.

The aim of this study is to investigate the relationships between attachment characteristics, alexithymia and problematic internet use (PIU) in adolescents. The study was performed on 444 high school students (66% female and 34% male). Internet Addiction Test (IAT), Toronto Alexithymia Scale (TAS-20) and Short Form of the Inventory of Parent and Peer Attachment (s-IPPA) scales were used. The results indicate that alexithymia increases the risk of PIU and higher attachment quality is a protective factor for both alexithymia and PIU. These results suggest that it is important to focus on the insecure attachment patterns and alexithymic characteristics when studying adolescents with PIU.

Big five personality and adolescent Internet addiction: The mediating role of coping style (2016)

Addict Behav. 2016 Aug 12;64:42-48. doi: 10.1016/j.addbeh.2016.08.009.

This study examined the unique associations between big five personality traits and adolescent Internet addiction (IA), as well as the mediating role of coping style underlying these relations. Our theoretical model was tested with 998 adolescents. 

After controlling for demographic variables, it was found that agreeableness and conscientiousness were negatively associated with IA, whereas extraversion, neuroticism, and openness to experience were positively associated with IA. Mediation analyses further indicated that conscientiousness had an indirect impact on adolescent IA through decreased emotion-focused coping, whereas extraversion, neuroticism, openness to experience had indirect impacts on adolescent IA through increased emotion-focused coping. In contrast, problem-focused coping had no mediating role.

Experiential Avoidance and Technological Addictions in Adolescents (2016)

J Behav Addict. 2016 Jun;5(2):293-303.

The relationship of ICT use and experiential avoidance (EA), a construct that has emerged as underlying and transdiagnostic to a wide variety of psychological problems, including behavioral addictions, is examined. EA refers to a self-regulatory strategy involving efforts to control or escape from negative stimuli such as thoughts, feelings, or sensations that generate strong distress. This strategy, which may be adaptive in the short term, is problematic if it becomes an inflexible pattern. A total of 317 students of the Spanish southeast between 12 and 18 years old were recruited to complete a questionnaire that included questions about general use of each ICTs, an experiential avoidance questionnaire, a brief inventory of the Big Five personality traits, and specific questionnaires on problematic use of the Internet, mobile phones, and video games. Correlation analysis and linear regression showed that EA largely explained results regarding the addictive use of the Internet, mobile phones, and video games, but not in the same way. As regards gender, boys showed a more problematic use of video games than girls. Concerning personality factors, conscientiousness was related to all addictive behaviors.

Pathological Buying Online as a Specific Form of Internet Addiction: A Model-Based Experimental Investigation.

PLoS One. 2015 Oct 14;10(10):e0140296.

The study aimed to investigate different factors of vulnerability for pathological buying in the online context and to determine whether online pathological buying has parallels to a specific Internet addiction. According to a model of specific Internet addiction by Brand and colleagues, potential vulnerability factors may consist of a predisposing excitability from shopping and as mediating variable, specific Internet use expectancies. Additionally, in line with models on addiction behavior, cue-induced craving should also constitute an important factor for online pathological buying. The theoretical model was tested in this study by investigating 240 female participants with a cue-reactivity paradigm, which was composed of online shopping pictures, to assess excitability from shopping. Craving (before and after the cue-reactivity paradigm) and online shopping expectancies were measured. The tendency for pathological buying and online pathological buying were screened with the Compulsive Buying Scale (CBS) and the Short Internet Addiction Test modified for shopping (s-IATshopping). The results demonstrated that the relationship between individual's excitability from shopping and online pathological buying tendency was partially mediated by specific Internet use expectancies for online shopping. Furthermore, craving and online pathological buying tendencies were correlated and an increase in craving after the cue presentation was observed solely in individuals scoring high for online pathological buying  In line with the model for specific Internet addiction, the study identified potential vulnerability factors for online pathological buying and suggests potential parallels. The presence of craving in individuals with a propensity for online pathological buying emphasizes that this behavior merits potential consideration within the non-substance/behavioral addictions.

Heritability of compulsive Internet use in adolescents (2015)

Addict Biol. 2015 Jan 13. doi: 10.1111/adb.12218.

The participants form a sample that is informative for genetic analyses, allowing the investigation of the causes of individual differences in compulsive Internet use. The internal consistency of the instrument was high and the 1.6-year test-retest correlation in a subsample (n = 902) was 0.55. CIUS scores increased slightly with age. Remarkably, gender did not explain variation in CIUS scores, as mean scores on the CIUS were the same in boys and girls. However, the time spent on specific Internet activities differed: boys spent more time on gaming, whereas girls spent more time on social network sites and chatting.

The heritability estimates were the same for boys and girls: 48 percent of the individual differences in CIUS score were influenced by genetic factors. The remaining variance (52 percent) was due to environmental influences that were not shared between family members.

The association between attention deficit/hyperactivity disorder and internet addiction: a systematic review and meta-analysis (2017)

BMC Psychiatry. 2017 Jul 19;17(1):260. doi: 10.1186/s12888-017-1408-x.

This study aimed to analyze the association between Attention Deficit/Hyperactivity Disorder (ADHD) and Internet addiction (IA). A systematic literature search was performed in four online databases in total including CENTRAL, EMBASE, PubMed and PsychINFO. Observational studies (case-control, cross-sectional and cohort studies) measuring the correlation between IA and ADHD were screened for eligibility. Two independent reviewers screened each article according to the predetermined inclusion criteria. A total of 15 studies (2 cohort studies and 13 cross-sectional studies) met our inclusion criteria and were included in the quantitative synthesis. Meta-analysis was conducted using RevMan 5.3 software.

A moderate association between IA and ADHD was found. Individuals with IA were associated with more severe symptoms of ADHD, including the combined total symptom score, inattention score and hyperactivity/impulsivity score. Males were associated with IA, whereas there was no significant correlation between age and IA.

IA was positively associated with ADHD among adolescents and young adults. Clinicians and parents should pay more attention to the symptoms of ADHD in individuals with IA, and the monitoring of Internet use of patients suffering from ADHD is also necessary.

Comorbidity of Internet use disorder and attention deficit hyperactivity disorder: Two adult case-control studies (2017)

J Behav Addict. 2017 Dec 1;6(4):490-504. doi: 10.1556/2006.6.2017.073.

There is good scientific evidence that attention deficit hyperactivity disorder (ADHD) is both a predictor and a comorbidity of addictive disorders in adulthood. These associations not only focus on substance-related addictions but also on behavioral addictions like gambling disorder and Internet use disorder (IUD). For IUD, systematic reviews have identified ADHD as one of the most prevalent comorbidities besides depressive and anxiety disorders. Yet, there is a need to further understand the connections between both disorders to derive implications for specific treatment and prevention. This is especially the case in adult clinical populations where little is known about these relations so far. This study was meant to further investigate this issue in more detail based on the general hypothesis that there is a decisive intersection of psychopathology and etiology between IUD and ADHD.

Two case-control samples were examined at a university hospital. Adult ADHD and IUD patients ran through a comprehensive clinical and psychometrical workup. We found support for the hypothesis that ADHD and IUD share psychopathological features. Among patients of each group, we found substantial prevalence rates of a comorbid ADHD in IUD and vice versa. Furthermore, ADHD symptoms were positively associated with media use times and symptoms of Internet addiction in both samples.

Association between childhood and adult attention deficit hyperactivity disorder symptoms in Korean young adults with Internet addiction (2017)

J Behav Addict. 2017 Aug 8:1-9. doi: 10.1556/2006.6.2017.044.

This study aims to analyze these possible mechanisms by comparing the effect of IA severity and childhood ADHD on inattention, hyperactivity, and impulsivity in young adults with IA. We hypothesized that IA might have associations with ADHD-like cognitive and behavior symptoms aside from childhood ADHD.

Study participants consisted of 61 young male adults. Participants were administered a structured interview. The severity of IA, childhood and current ADHD symptoms, and psychiatry comorbid symptoms were assessed through self-rating scales. The associations between the severity of IA and ADHD symptoms were examined through hierarchical regression analyses.

Hierarchical regression analyses showed that the severity of IA significantly predicted most dimensions of ADHD symptoms. By contrast, childhood ADHD predicted only one dimension. The high comorbidity of inattention and hyperactivity symptoms in IA should not solely be accounted by an independent ADHD disorder but should consider the possibility of cognitive symptoms related to IA. Functional and structural brain abnormalities associated with excessive and pathologic Internet usage might be related to these ADHD-like symptoms. Inattention and hyperactivity in young adults with IA are more significantly associated with the severity of IA than that of childhood ADHD.

Internet Addiction and Attention Deficit Hyperactivity Disorder Among Schoolchildren (2015)

Isr Med Assoc J. 2015 Dec;17(12):731-4.

Use of the internet and videogames by children and adolescents has risen dramatically over the last decade. Increasing evidence of internet and videogame addiction among children is causing concern due to its harmful physical, emotional and social consequences. There is also emerging evidence for an association between computer and videogame addiction and attention deficit/hyperactivity disorder (ADHD).

We compared 50 male schoolchildren, mean age 13 years, diagnosed with ADHD to 50 male schoolchildren without ADHD on measures of internet addiction, internet use and sleep patterns.

Children with ADHD had higher scores on the Internet Addiction Test (IAT), used the internet for longer hours, and went to sleep later than those without ADHD. These findings indicate an association of ADHD, sleep disorders and internet/videogame addiction.

The Prevalence of Internet Addiction Among a Japanese Adolescent Psychiatric Clinic Sample With Autism Spectrum Disorder and/or Attention-Deficit Hyperactivity Disorder: A Cross-Sectional Study (2017)

Journal of Autism and Developmental Disorders

Extant literature suggests that autism spectrum disorder (ASD) and attention-deficit hyperactivity disorder (ADHD) are risk factors for internet addiction (IA). The present cross-sectional study explored the prevalence of IA among 132 adolescents with ASD and/or ADHD in a Japanese psychiatric clinic using Young’s Internet Addiction Test. The prevalence of IA among adolescents with ASD alone, with ADHD alone and with comorbid ASD and ADHD were 10.8, 12.5, and 20.0%, respectively. Our results emphasize the clinical importance of screening and intervention for IA when mental health professionals see adolescents with ASD and/or ADHD in psychiatric services.

Social skills deficits and their association with Internet addiction and activities in adolescents with attention-deficit/hyperactivity disorder (2017)

J Behav Addict. 2017 Mar 1:1-9. doi: 10.1556/2006.6.2017.005

The aims of this study were to examine the association between social skills deficits and Internet addiction and activities in adolescents with attention-deficit/hyperactivity disorder (ADHD) as well as the moderators for this association.  A total of 300 adolescents, aged between 11 and 18 years, who had been diagnosed with ADHD participated in this study. Their Internet addiction levels, social skills deficits, ADHD, parental characteristics, and comorbidities were assessed. The various Internet activities that the participants engaged in were also examined.

The associations between social skills deficits and Internet addiction and activities and the moderators of these associations were examined using logistic regression analyses. Social skills deficits were significantly associated with an increased risk of Internet addiction after adjustment for the effects of other factors. Social skills deficits were also significantly associated with Internet gaming and watching movies.

Internet addiction and self-evaluated attention-deficit hyperactivity disorder traits among Japanese college students (2016)

Psychiatry Clin Neurosci. 2016 Aug 30. doi: 10.1111/pcn.12454.

Internet addiction (IA), also referred to as Internet use disorder, is a serious problem all over the world, especially in Asian countries. Severe IA in students may be linked to academic failure, attention-deficit hyperactivity disorder (ADHD), and forms of social withdrawal, such as hikikomori. In this study, we performed a survey to investigate the relation between IA and ADHD symptoms among college students.

Out of 403 subjects, 165 were male. The mean age was 18.4 ± 1.2 years, and mean total IAT score was 45.2 ± 12.6. One hundred forty-eight respondents (36.7%) were average Internet users (IAT < 40), 240 (59.6%) had possible addiction (IAT 40-69), and 15 (3.7%) had severe addiction (IAT ≥ 70). Mean length of Internet use was 4.1 ± 2.8 h/day on weekdays and 5.9 ± 3.7 h/day on the weekend. Females used the Internet mainly for social networking services while males preferred online games. Students with a positive ADHD screen scored significantly higher on the IAT than those negative for ADHD screen (50.2 ± 12.9 vs 43.3 ± 12.0).

The association of Internet addiction symptoms with impulsiveness, loneliness, novelty seeking and behavioral inhibition system among adults with attention-deficit/hyperactivity disorder (ADHD). (2016)

Psychiatry Res. 2016 Mar 31;243:357-364. doi: 10.1016/j.psychres.2016.02.020.

The aims of this study were to test the associations of the Internet addiction symptoms with impulsiveness, loneliness, novelty seeking and behavioral inhibition systems among adults with attention-deficit/hyperactivity disorder (ADHD) and adults with non-ADHD. A total of 146 adults aged between 19 and 33 years involved in this study. The results of hierarchical regression analysis indicated that impulsiveness, loneliness, and behavioral inhibition system were significant predictors of Internet addition among adults with ADHD. Higher loneliness was significantly associated with more severe Internet addition symptoms among the non-ADHD group.

Internet addiction in young people (2014)

Ann Acad Med Singapore. 2014 Jul;43(7):378-82.

In our technology-savvy population, mental health professionals are seeing an increasing trend of excessive Internet use or Internet addiction. Researchers in China, Taiwan and Korea have done extensive research in the field of Internet addiction. Screening instruments are available to identify the presence of Internet addiction and its extent. Internet addiction is frequently associated with mental illnesses such as anxiety, depression, conduct disorder and attention deficit hyperactivity disorder (ADHD). future research in this area is needed to address its growing trend and to minimise its negative psychological and social impact on the individuals and their families.

The association of Internet addiction symptoms with anxiety, depression and self-esteem among adolescents with attention-deficit/hyperactivity disorder (2014)

Compr Psychiatry. 2014 Jun 12. pii: S0010-440X(14)00153-9.

The aims of this study were to examine the associations of the severity of Internet addiction symptoms with various dimensions of anxiety (physical anxiety symptoms, harm avoidance, social anxiety, and separation/panic) and depression symptoms (depressed affect, somatic symptoms, interpersonal problems, and positive affect) and self-esteem among adolescents diagnosed with attention-deficit/hyperactivity disorder (ADHD) in Taiwan.

A total of 287 adolescents aged between 11 and 18 years who had been diagnosed with ADHD participated in this study. The association between the severity of Internet addiction symptoms and anxiety and depression symptoms and self-esteem were examined using multiple regression analyses.

The results indicated that higher physical symptoms and lower harm avoidance scores on the MASC-T, higher somatic discomfort/retarded activity scores on the CES-D, and lower self-esteem scores on the RSES were significantly associated with more severe Internet addiction symptoms.

Multi-dimensional correlates of Internet addiction symptoms in adolescents with attention-deficit/hyperactivity disorder (2014)

Psychiatry Res. 2014 Nov 12. pii: S0165-1781(14)00855-5.

This study examined the associations of the severity of Internet addiction symptoms with reinforcement sensitivity, family factors, Internet activities, and attention-deficit/hyperactivity disorder (ADHD) symptoms among adolescents in Taiwan diagnosed with ADHD. A total of 287 adolescents diagnosed with ADHD and aged between 11 and 18 years participated in this study. Their levels of Internet addiction symptoms, ADHD symptoms, reinforcement sensitivity, family factors, and various Internet activities in which the participants engaged were assessed.

The results indicated that low satisfaction with family relationships was the strongest factor predicting severe Internet addiction symptoms, followed by using instant messaging, watching movies, high Behavioral Approach System (BAS) fun seeking, and high Behavioral Inhibition System scores.

Meanwhile, low paternal occupational SES, low BAS drive, and online gaming were also significantly associated with severe Internet addiction symptoms.

Impaired inhibition and working memory in response to internet-related words among adolescents with internet addiction: A comparison with attention-deficit/hyperactivity disorder (2016)

Psychiatry Res. 2016 Jan 5.

Impairments in response inhibition and working memory functions have been found to be closely associated with internet addiction (IA) symptoms and attention-deficit/hyperactivity disorder (ADHD) symptoms. In this study, we examined response inhibition and working memory processes with two different materials (internet-related and internet-unrelated stimuli) among adolescents with IA, ADHD and co-morbid IA/ADHD.

In comparison to the NC group, subjects with IA, ADHD and IA/ADHD demonstrated impaired inhibition and working memory. In addition, in comparison to internet-unrelated conditions, IA and co-morbid subjects performed worse on the internet-related condition in the Stop trials during the stop-signal task, and they showed better working memory on the internet-related condition in the 2-Back Task. The findings of our study suggest individuals with IA and IA/ADHD may be impaired in inhibition and working memory functions that might be linked to poor inhibition specifically

Internet Addiction Is Related to Attention Deficit but Not Hyperactivity in a Sample of High School Students (2014)

Int J Psychiatry Clin Pract. 2014 Oct 30:1-21.

To assess the effects of attention-deficit/hyperactivity disorder (ADHD) symptom dimensions on Internet addiction (IA) after controlling for Internet usage features among high school students. This study consisted of 640 students (331 females, 309 males) ranging from 14 to 19 years of age.

According to the logistic regression analysis, attention deficit and playing online games were significant predictors of IA in both sexes. Other predictors of IA included: behavioural problems for females, total weekly Internet usage time, and lifelong total Internet use for males. Hyperactivity and other Internet usage features did not predict IA.

Pathological Internet use among European adolescents: psychopathology and self-destructive behaviours (2014)

Eur Child Adolesc Psychiatry. 2014 Jun 3.

Rising global rates of pathological Internet use (PIU) and related psychological impairments have gained considerable attention in recent years. In an effort to acquire evidence-based knowledge of this relationship, the main objective of this study was to investigate the association between PIU, psychopathology and self-destructive behaviours among school-based adolescents in eleven European countries. mean age: 14.9.

Results showed that suicidal behaviours (suicidal ideation and suicide attempts), depression, anxiety, conduct problems and hyperactivity/inattention were significant and independent predictors of PIU.

Self-harm and its association with internet addiction and internet exposure to suicidal thought in adolescents (2016)

J Formos Med Assoc. 2016 May 1. pii: S0929-6646(16)30039-0. doi: 10.1016/j.jfma.2016.03.010.

This study was a cross-sectional survey of students who self-completed a series of online questionnaires including a sociodemographic information questionnaire, questionnaire for suicidality and SH, Chen Internet Addiction Scale (CIAS), Patient Health Questionnaire (PHQ-9), multi-dimensional support scale (MDSS), Rosenberg self-esteem scale (RSES), Alcohol Use Disorder Identification Test-Consumption (AUDIT-C), and questionnaire for substance abuse.

A total of 2479 students completed the questionnaires (response rate = 62.1%). They had a mean age of 15.44 years (range 14-19 years; standard deviation 0.61), and were mostly female (n = 1494; 60.3%). The prevalence of SH within the previous year was 10.1% (n = 250). Among the participants, 17.1% had internet addiction (n = 425) and 3.3% had been exposed to suicidal content on the internet (n = 82). In the hierarchical logistic regression analysis, internet addiction and internet exposure to suicidal thoughts were both significantly related to an increased risk of SH, after controlling for gender, family factors, exposure to suicidal thoughts in the real life, depression, alcohol/tobacco use, concurrent suicidality, and perceived social support.

Relationship of Internet addiction with cognitive style, personality, and depression in university students (2014)

Compr Psychiatry. 2014 May 6. pii: S0010-440X(14)00112-6. doi: 10.1016/j.comppsych.2014.04.025.

The results indicated that 52 (7.2%) of the students had Internet addiction. There were 37 (71.2%) men, 15 (28.8%) women in the addicted group. While the addicted groups' BDI, DAS-A perfectionistic attitude, need for approval,  According to the multiple binary logistic regression analysis, being male, duration of Internet usage, depression, and perfectionistic attitude have been found as predictors for Internet addiction. It has been found that perfectionistic attitude is a predictor for Internet addiction even when depression, sex, duration of Internet were controlled.

Treatment of Internet Addiction with Anxiety Disorders: Treatment Protocol and Preliminary Before After Results Involving Pharmacotherapy and Modified Cognitive Behavioral Therapy (2016)

JMIR Res Protoc. 2016 Mar 22;5(1):e46. doi: 10.2196/resprot.5278.

Individuals addicted to the Internet usually have comorbid psychiatric disorders. Panic disorder (PD) and generalized anxiety disorder (GAD) are prevalent mental disorders, involving a great deal of damage in the patient's life. This open trial study describes a treatment protocol among 39 patients with anxiety disorders and Internet addiction (IA) involving pharmacotherapy and modified cognitive behavioral therapy (CBT).
Before treatment, anxiety levels suggested severe anxiety, with an average score of 34.26 (SD 6.13); however, after treatment the mean score was 15.03 (SD 3.88) (P<.001). A significant improvement in mean Internet addiction scores was observed, from 67.67 (SD 7.69) before treatment, showing problematic internet use, to 37.56 (SD 9.32) after treatment (P<.001), indicating medium Internet use. With respect to the relationship between IA and anxiety, the correlation between scores was .724.

Prevalence of Internet Addiction and Its Association With Psychological Distress and Coping Strategies Among University Students in Jordan.

Perspect Psychiatr Care. 2015 Jan 30. doi: 10.1111/ppc.12102.

The purpose of this study was to measure the prevalence of Internet addiction (IA) and its association with psychological distress and coping strategies among university students in Jordan. A descriptive, cross-sectional, correlational design was used with a random sample of 587 university students in Jordan. The Perceived Stress Scale, Coping Behavior Inventory, and Internet Addiction Test were used.:

The prevalence of IA was 40%. IA was associated with high mental distress among the students. Students who used problem solving were more likely to experience a lower level of IA.

The relationship between addictive use of social media and video games and symptoms of psychiatric disorders A large scale cross sectional study.

Psychol Addict Behav. 2016 Mar;30(2):252-262.

Over the last decade, research into "addictive technological behaviors" has substantially increased. Research has also demonstrated strong associations between addictive use of technology and comorbid psychiatric disorders. In the present study, 23,533 adults (mean age 35.8 years, ranging from 16 to 88 years) participated in an online cross-sectional survey examining whether demographic variables, symptoms of attention-deficit/hyperactivity disorder (ADHD), obsessive-compulsive disorder (OCD), anxiety, and depression could explain variance in addictive use (i.e., compulsive and excessive use associated with negative outcomes) of two types of modern online technologies: social media and video games. Correlations between symptoms of addictive technology use and mental disorder symptoms were all positive and significant, including the weak interrelationship between the two addictive technological behaviors. Age appeared to be inversely related to the addictive use of these technologies. Being male was significantly associated with addictive use of video games, whereas being female was significantly associated with addictive use of social media. Being single was positively related to both addictive social networking and video gaming. Hierarchical regression analyses showed that demographic factors explained between 11 and 12% of the variance in addictive technology use. The mental health variables explained between 7 and 15% of the variance. The study significantly adds to our understanding of mental health symptoms and their role in addictive use of modern technology, and suggests that the concept of Internet use disorder (i.e., "Internet addiction") as a unified construct is not warranted.

The association between internet addiction and psychiatric co-morbidity: a meta-analysis (2014)

BMC Psychiatry 2014, 14:183  doi:10.1186/1471-244X-14-183

Meta-analyses were conducted on cross-sectional, case-control and cohort studies which examined the relationship between IA and psychiatric co-morbidity. Internet Addiction is significantly associated with alcohol abuse, attention deficit and hyperactivity, depression and anxiety.

Stress moderates the relationship between problematic internet use by parents and problematic internet use by adolescents (2015)

J Adolesc Health. 2015 Mar;56(3):300-6.

Based on the theoretical framework of Problem Behavior and Stress Reduction theories for problematic Internet use (PIU), this study aimed to investigate the relationship between parental PIU and the PIU among adolescents taking into consideration the stress levels of young people.

Of the total 1,098 parent and adolescent dyads with usable information, 263 adolescents (24.0%) and 62 parents (5.7%) could be classified as moderate and severe problematic users of the Internet. There was a significant parent and adolescent PIU relationship; however, this relationship is differentially affected by the stress status of the adolescent. The direct implication of the results is that parental Internet use should also be assessed and included as part of the treatment regime for adolescents.Adolescents; Dyad study; Internet addiction; Parent; Problematic Internet use; Stress

Is excessive online usage a function of medium or activity? An empirical pilot study (2014)

J Behav Addict. 2014 Mar;3

The purpose of the study was to seek a better insight into whether the online medium or the online activity was more important in relation to excessive online use. It is not clear whether those people who spend excessive amounts of time on the Internet are engaged in general Internet or whether excessive Internet use is linked to specific activities.

These results show that time spent with Internet activity is not random and/or generalized, but appears more focused. Attraction or addiction on Internet to one or more specific behavior(s) may be a better way forward in the quest for better understanding excessive human behavior in the online environment.

The impact of digital media on health: children's perspectives (2015)

Int J Public Health. 2015 Jan 20.

Focus groups and interviews were conducted with children between the ages of 9 and 16 in 9 European countries (N = 368).

In this study, children reported several physical and mental health problems without indicating internet addiction or overuse. Physical health symptoms included eye problems, headaches, not eating, and tiredness. For mental health symptoms, children reported cognitive salience of online events, aggression, and sleeping problems. Sometimes they reported these problems within 30 min of technology usage. This suggests that even shorter time usage can cause self-reported health problems for some children.

Parents and teachers should also be informed about the possible physical and mental health issues associated with children's average usage of technology.

Maladaptive and addictive Internet use in zagazig university students, Egypt (2017)

(2017). European Psychiatry, 41, S566-S567.

Internet use has increased broadly worldwide. There are growing concerns about problematic Internet use (PIU) among youth. Among undergraduate students, excessive Internet use can adversely affect their interpersonal relations and academic achievements.To estimate the prevalence of PIU among Zagazig university students, and to identify the possible associations between sociodemographic and Internet-related factors and PIU.

A cross-sectional study included a total of 732 undergraduate students, aged 17–34 years, from various colleges in Zagazig University. Participants were randomly selected and assessed for their internet use and abuse using the Internet Addiction Test (IAT), along with a semi-structured questionnaire for sociodemographic and Internet-related factors.

Maladaptive Internet use was found in 37.4% of respondents, and addictive Internet use was found in 4.1% of respondents. Logistic regression showed the predictors of PIU were: using the Internet throughout the day, the number of hours spent daily using the Internet, the number of days/week using the Internet, accessing the Internet using multiple devices, and accessing the Internet both indoors and outdoors.

This is the first prevalence study of PIU at an Egyptian university. PIU was common among university students. Addressing this issue and its predictors could eventually help to enhance academic performance and achievement among those students.

Pathological Internet Use Is on the Rise Among European Adolescents.

J Adolesc Health. 2016 Jun 3. pii: S1054-139X(16)30037-4.

Comparable data from two large cross-sectional multicentre, school-based studies conducted in 2009/2010 and 2011/2012 in five European countries (Estonia, Germany, Italy, Romania, and Spain) were used. The Young's Diagnostic Questionnaire was used to assess the prevalence of PIU.

The comparison of the two samples provides evidence that the prevalence of PIU is on the rise (4.01%-6.87%, odds ratio = 1.69, p < .001) except in Germany. Comparison with data on Internet accessibility suggests that the rise in prevalence of adolescent PIU may be a consequence of increased Internet accessibility.

Our findings are the first data to confirm the rise of PIU among European adolescents. They definitively warrant further efforts in the implementation and evaluation of preventive interventions.

The problematic use of Information and Communication Technologies in adolescents by the cross sectional JOITIC study (2016)

BMC Pediatr. 2016 Aug 22;16(1):140. doi: 10.1186/s12887-016-0674-y.

The objective is to determine the prevalence of the problematic use of ICT such as Internet, mobile phones and video games, among adolescents enrolled in mandatory Secondary Education (ESO in Spanish) and to examine associated factors. 5538 students enrolled in years one to four of ESO at 28 schools in the Vallès Occidental region (Barcelona, Spain).

Questionnaires were collected from 5,538 adolescents between the ages of 12 and 20 (77.3 % of the total response), 48.6 % were females. Problematic use of the Internet was observed in 13.6 % of the surveyed individuals; problematic use of mobile phones in 2.4 % and problematic use in video games in 6.2 %. Problematic Internet use was associated with female students, tobacco consumption, a background of binge drinking, the use of cannabis or other drugs, poor academic performance, poor family relationships and an intensive use of the computer. Factors associated with the problematic use of mobile phones were the consumption of other drugs and an intensive use of these devices. Frequent problems with video game use have been associated with male students, the consumption of other drugs, poor academic performance, poor family relationships and an intensive use of these games.

Psychological risk factors of addiction to social networking sites among Chinese smartphone users (2014)

J Behav Addict. 2013 Sep;2(3):

The findings revealed that those who spent more time on SNSs also reported higher addictive tendencies. The findings of this study suggest that, compared to demographics, psychological factors provide a better account for addictive tendencies towards SNSs among Chinese smartphone users in Macau. The three psychological risk factors were low Internet self-efficacy, favorable outcome expectancies, and high impulsivity trait.

The Impact of Internet and PC Addiction In School Performance of Cypriot Adolescents (2013)

Stud Health Technol Inform. 2013;191:90-4.

Data were collected from a representative sample of the adolescent student population of the first and fourth grades of high school. Total sample was 2684 students, 48.5% of them male and 51.5% female. Research material included extended demographics and an Internet security questionnaire, the Young's Diagnostic questionnaire (YDQ), the Adolescent Computer Addiction Test (ACAT). Results indicated that the Cypriot population had comparable addiction statistics with other Greek-speaking populations in Greece; 15.3% of the students were classified as Internet addicted by their YDQ scores and 16.3% as PC addicted by their ACAT scores.

Parental mental health and Internet Addiction in adolescents (2014)

Addict Behav. 2014 Nov 1;42C:20-23. doi: 10.1016/j.addbeh.2014.10.033.

This study aimed to investigate the relationship between parental mental health, particularly depression, and Internet Addiction (IA) among adolescents.

A total of 1098 parent-and-child dyads were recruited and responded to the survey providing usable information. For IA, 263 (24.0%) students could be classified as at risk of moderate to severe IA. About 6% (n=68), 4% (n=43), and 8% (n=87) of parents were categorised to be at risk of moderate to severe depression, anxiety, and stress respectively. Regression analysis results suggested a significant association between parental depression at the level of moderate to severe and IA in adolescents after adjusting for potential confounding factors. On the other hand, no associations between parental anxiety and stress and child's IA were observed.

The result suggested that there was a significant relationship between parental mental health, particularly depression, and the IA status of their children. These results have direct implications on the treatment and prevention of Internet Addiction among young people.

Clinical characteristics and diagnostic confirmation of Internet addiction in secondary school students in Wuhan, China (2014)

Psychiatry Clin Neurosci. 2014 Jun;68(6):471-8. doi: 10.1111/pcn.12153.

Of a total of 1076 respondents (mean age 15.4 ± 1.7 years; 54.1% boys), 12.6% (n = 136) met the YIAT criteria for IAD. Clinical interviews ascertained the Internet addiction of 136 pupils and also identified 20 students (14.7% of IAD group) with comorbid psychiatric disorders. Results from multinomial logistic regression indicated that being male, in grade 7-9, poor relationship between parents and higher self-reported depression scores were significantly associated with the diagnosis of IAD.

The association between suicidality and Internet addiction and activities in Taiwanese adolescents (2013

Compr Psychiatry. 2013 Nov 27

The aims of this cross-sectional study were to examine the associations of suicidal ideation and attempt with Internet addiction and Internet activities in a large representative Taiwanese adolescent population.9510 adolescent students aged 12-18 years were selected using a stratified random sampling strategy in southern Taiwan and completed the questionnaires.  After controlling for the effects of demographic characteristics, depression, family support and self-esteem, Internet addiction was significantly associated with suicidal ideation and suicidal attempt.   Online gaming, MSN, online searching for information, and online studying were associated with an increased risk of suicidal ideation. While online gaming, chatting, watching movies, shopping, and gambling were associated with an increased risk of suicidal attempt, watching online news was associated with a reduced risk of suicidal attempt.                                                                                                                                                                                                                                                                                                                               

COMMENTS: Even after controlling for depression, self esteem, family support, and demographics the study found a correlation between internet addiction and suicidal ideation and attempt.

Precursor or Sequela: Pathological Disorders in People with Internet Addiction Disorder (2011)

 PLoS ONE 6(2): e14703. doi:10.1371/journal.pone.0014703

This study aimed to evaluate the roles of pathological disorders in Internet addiction disorder and identify the pathological problems in IAD, as well as explore the mental status of Internet addicts prior to addiction, including the pathological traits that may trigger Internet addiction disorder. 59 students were measured by Symptom CheckList-90 before and after they became addicted to the Internet.

A comparison of collected data from Symptom Checklist-90 before Internet addiction and the data collected after Internet addiction illustrated the roles of pathological disorders among people with Internet addiction disorder. The obsessive-compulsive dimension was found abnormal before they became addicted to the Internet. After their addiction, significantly higher scores were observed for dimensions on depression, anxiety, hostility, interpersonal sensitivity, and psychoticism, suggesting that these were outcomes of Internet addiction disorder.

Dimensions on somatisation, paranoid ideation, and phobic anxiety did not change during the study period, signifying that these dimensions are not related to Internet addiction disorder. Conclusions: We can not find a solid pathological predictor for Internet addiction disorder. Internet addiction disorder may bring some pathological problems to the addicts in some ways.

COMMENTS: A unique study. It follows first year university students to ascertain what percentage develop Internet addiction, and what risk factors may be in play. The unique aspect is that the research subjects had not used the Internet prior to enrolling in college. Hard to believe. After only one year of school, a small percentage were classified as Internet addicts. Those who developed Internet addiction where higher on the obsessive scale, they were lower on scores for anxiety depression, and hostility. The key point is Internet addiction caused behavioral changes. From the study:

  • After their addiction, significantly higher scores were observed for dimensions on depression, anxiety, hostility, interpersonal sensitivity, and psychoticism, suggesting that these were outcomes of Internet addiction disorder.
  • We can not find a solid pathological predictor for Internet addiction disorder. Internet addiction disorder may bring some pathological problems to the addicts in some ways.

The relationship of Internet addiction severity with Attention Deficit Hyperactivity Disorder symptoms in Turkish University students; impact of personality traits, depression and anxiety (2014)

Compr Psychiatry. 2014 Apr;55(3):497-503. doi: 10.1016/j.comppsych.2013.11.01

The aim of this study was to investigate the relationship of Internet addiction (IA) with Attention Deficit Hyperactivity Disorder (ADHD) symptoms while controlling the effect of personality traits, depression and anxiety symptoms in Turkish university students.

According to IAS, participants were separated into three groups, namely, moderate/high, mild and without IA groups. The rates of groups were 19.9%, 38.7% and 41.3%, respectively.

The severity of ADHD symptoms has predicted the severity of IA even after controlling the effect of personality traits, depression and anxiety symptoms among Turkish university students. University students with severe ADHD symptoms, particularly hyperactivity/impulsivity symptoms may be considered as a risk group for IA.

Effects of electroacupuncture combined with psychologic interference on anxiety state and serum NE content in the patient of internet addiction disorder (2008)

Zhongguo Zhen Jiu. 2008 Aug;28(8):561-4.

To observe therapeutic effect of electroacupuncture (EA) on internet addiction disorder (lAD) and to preliminarily probe the mechanism.

Forty-seven cases of TAD were randomly divided into a psychotherapy group and an EA plus psychotherapy group. T Changes of score of lAD, score of anxiety self-rating scale (SAS), score of Hamilton anxiety scale (HAMA) and serum norepinephrine (NE) content before and after treatment were observed. The total effective rate was 91.3% in the EA plus psychotherapy group and 59.1% in the psychotherapy group,  Electroacupuncture combined with psychologic interference can significantly improve anxiety state and the mechanism is possibly related with the decrease of NE in the body.

The screens culture: impact on ADHD (2011)

Atten Defic Hyperact Disord. 2011 Dec;3(4):327-34.

Children's use of electronic media, including Internet and video gaming, has increased dramatically to an average in the general population of roughly 3 h per day. Some children cannot control their Internet use leading to increasing research on "internetaddiction." The objective of this article is to review the research on ADHD as a risk factor for Internetaddiction and gaming, its complications, and what research and methodological questions remain to be addressed. 

Previous research has demonstrated rates of Internet addiction as high as 25% in the population and that it is addiction more than time of use that is best correlated with psychopathology. Various studies confirm that psychiatric disorders, and ADHD in particular, are associated with overuse, with severity of ADHD specifically correlated with the amount of use. The time spent on these games may also exacerbate ADHD symptoms, if not directly then through the loss of time spent on more developmentally challenging tasks.

Comments: ADHD is associated with overuse, and may exacerbate symptoms

Personality Disorders in Female and Male College Students With Internet Addiction (2016)

J Nerv Ment Dis. 2016 Jan 5.

Males with IA showed a higher frequency of narcissistic PD, whereas females with IA showed a higher frequency of borderline, narcissistic, avoidant, or dependent PD when compared with those without IA. The high rate of PD among Internet addicts may be associated with the core features of specific PD psychopathology. Sex differences in the PD frequencies among IA individuals provide indications for understanding the psychopathological characteristics of PDs in Internet addicts.

Associations between Problematic Internet Use and Psychiatric Symptoms among University Students in Japan (2018)

Psychiatry Clin Neurosci. 2018 Apr 13. doi: 10.1111/pcn.12662.

Research on the adverse effects of internet use has gained importance recently. However, there is currently insufficient data on Japanese young adults' internet use, so we conducted a survey targeting Japanese university students to research Problematic Internet Use (PIU). We also investigated the relationship between PIU and multiple psychiatric symptoms.

A paper-based survey was conducted at five universities in Japan. Respondents were asked to fill out self-report scales regarding their internet dependency using the Internet Addiction Test (IAT). Sleep quality, ADHD tendency, depression, and anxiety symptom data were also collected based on respective self-reports.

There were 1336 responses and 1258 were included in the analysis. 38.2% of participants were classified as PIU, and 61.8% as non-PIU. We found a high PIU prevalence among Japanese young adults. The factors that predicted PIU were: female gender, older age, poor sleep quality, ADHD tendencies, depression, and anxiety.

Predictive factors and psychosocial effects of Internet addictive behaviors in Cypriot adolescents (2014)

Int J Adolesc Med Health. 2014 May 6.

A cross-sectional study design was applied among a random sample (n=805) of Cypriot adolescents (mean age: 14.7 years).

Among the study population, the prevalence rates of borderline addictive Internet use (BIU) and addictive Internet use (AIU) were 18.4% and 2%, respectively. Adolescents with BIU had an increased likelihood of concomitantly presenting with abnormal peer relations , conduct problems, hyperactivity and emotional symptoms. Adolescent AIU was significantly associated with abnormal conduct, peer problems, emotional symptoms, and hyperactivity. The determinants of BIU and AIU included accessing the Internet for the purposes of retrieving sexual information and participating in games with monetary awards.

Conclusions: Both BIU and AIU were adversely associated with notable behavioral and social maladjustment among adolescents.

Attention deficit hyperactivity symptoms and internet addiction (2004)

Psychiatry Clin Neurosci. 2004 Oct;58(5):487-94.

The objective of this study was to evaluate the relationship between attention deficit-hyperactivity/impulsivity symptoms and Internetaddiction. The ADHD group had higher Internet addiction scores compared with the non-ADHD group. Therefore, significant associations have been found between the level of ADHD symptoms and the severity of Internet addiction in children. In addition, current findings suggest that the presence of ADHD symptoms, both in inattention and hyperactivity-impulsivity domains, may be one of the important risk factors for Internet addiction.

Comments: Internet addiction is strongly associated with ADHD

Oppositional defiant disorder/conduct disorder co-occurrence increases the risk of Internet addiction in adolescents with attention-deficit hyperactivity disorder (2018)

J Behav Addict. 2018 Jun 5:1-8. doi: 10.1556/2006.7.2018.46.

Objectives The aims of this cross-sectional study were to assess the prevalence of Internet addiction (IA) in a clinical sample of adolescents with attention-deficit hyperactivity disorder (ADHD) and to detect the moderating effects of co-occurring oppositional defiant disorder/conduct disorder (ODD/CD) on the association between ADHD and IA.

Methods The study group comprised 119 adolescent subjects who were consecutively referred to our outpatient clinic with a diagnosis of ADHD. The Turgay DSM-IV-Based Child and Adolescent Disruptive Behavioral Disorders Screening and Rating Scale (T-DSM-IV-S) was completed by parents, and subjects were asked to complete the Internet Addiction Scale (IAS).

Results The IAS results indicated that 63.9% of the participants (n = 76) fell into the IA group. Degree of IA was correlated with hyperactivity/impulsivity symptoms but not with inattention symptoms. As compared to the ADHD-only group (without comorbid ODD/CD), ADHD + ODD/CD subjects returned significantly higher scores on the IAS.

Conclusions As adolescents with ADHD are at high risk of developing IA, early IA detection and intervention is of great importance for this group. In addition, adolescents with ADHD + ODD/CD may be more vulnerable to IA than those in the ADHD-only group and may need to be more carefully assessed for IA.

The relationship of Internet addiction severity with Attention Deficit Hyperactivity Disorder symptoms in Turkish University students; impact of personality traits, depression and anxiety (2013)

Compr Psychiatry. 2013 Nov 27. pii: S0010-440X(13)00350-7. doi: 10.1016/j.comppsych.2013.11.018.

The aim of this study was to investigate the relationship of Internet addiction (IA) with Attention Deficit Hyperactivity Disorder (ADHD) symptoms while controlling the effect of personality traits, depression and anxiety symptoms in Turkish university students.

The severity of ADHD symptoms has predicted the severity of IA even after controlling the effect of personality traits, depression and anxiety symptoms among Turkish university students. University students with severe ADHD symptoms, particularly hyperactivity/impulsivity symptoms may be considered as a risk group for IA.

The Difference in Comorbidities and Behavioral Aspects between Internet Abuse and Internet Dependence in Korean Male Adolescents (2014)

Psychiatry Investig. 2014 Oct;11(4):

This study examined the differences in psychiatric comorbidities and behavioral aspects in accordance with the severity of Internet addiction in male adolescents. One hundred and twenty-five adolescents from four middle and high schools in Seoul were enrolled in this study. The subjects were divided into non-addict, abuse, and dependence groups according to a diagnostic interview by psychiatrists.

The psychiatric comorbidity distributions were significantly different in the abuse and dependence groups, particularly in terms of attention-deficit hyperactivity disorder and mood disorder items. There were significant differences in seven items between the non-addict and abuse groups, but no differences between subjects in the abuse and dependence groups. Significant differences were observed in three items between the abuse and dependence groups, but there were no significant differences between the non-addict and abuse groups. In terms of behavioral aspects, scores for abusive, sexual, and decreased social interest behaviors were highest in the dependence group, and lowest in the non-addict group. However, the behavioral aspects of decreased interpersonal relationships did not show this difference between groups.

High risk of internet addiction and its relationship with lifetime substance use, psychological and behavioral problems among 10 (th) grade adolescents. (2014)

Psychiatr Danub. 2014 Dec;26(4):330-9.

Cross-sectional online self-report survey conducted in 45 schools from the 15 districts in Istanbul, Turkey. A representative sample of 4957 10(th) grade students was studied between October 2012 and December 2012.

The participants were classified into two groups as those with HRIA (15.96%) and those with lower risk of Internet addiction. The rate of HRIA was higher in the males. The findings indicated that HRIA is related with negative consequences in school, lifetime use of tobacco, alcohol and/or drug, suicidal thoughts, self-harming and delinquent behaviors.

Dysfunctional inhibitory control and impulsivity in Internet addiction (2013)

Psychiatry Res. 2013 Dec 11. pii: S0165-1781(13)00764-6.

The IA group exhibited more trait impulsivity than the healthy control group. They also scored higher for novelty seeking and harm avoidance. The IA group performed more poorly than the healthy control group in a computerized stop signal test, a test for inhibitory function and impulsivity; no group differences appeared for other neuropsychological tests.

The IA group also scored higher for depression and anxiety, and lower for self-directedness and cooperativeness. In conclusion, individuals with IA exhibited impulsivity as a core personality trait and in their neuropsychological functioning.

Is Internet addiction a psychopathological condition distinct from pathological gambling? (2014)

Addict Behav. 2014 Mar 3. pii: S0306-4603(14)00054-9. doi: 10.1016/j.addbeh.2014.02.016.

The behavioural-addiction perspective suggests that Internet addiction (IA) and pathological gambling (PG) could share similar characteristics with substance dependence.

.Despite IA and PG showing similar differences with the control group on the levels of depression, anxiety and global functioning, the two clinical groups showed different temperamental, coping and social patterns. Specifically IA patients compared with the PG patients showed a greater mental and behavioural disengagement associated with an important interpersonal impairment. The two clinical groups shared an impulsive coping strategy and socio-emotional impairments.

Despite IA and PG patients presenting similar clinical symptoms, IA condition was characterised by a more relevant mental, behavioural, and social disengagement compared to PG condition.

Differential psychological impact of internet exposure on internet addicts (2013)

PLoS One. 2013;8(2):e55162. doi: 10.1371/journal.pone.0055162.

The study explored the immediate impact of internet exposure on the mood and psychological states of internet addicts and low internet-users. Participants were given a battery of psychological tests to explore levels of internetaddiction, mood, anxiety, depression, schizotypy, and autism traits. They were then given exposure to the internet for 15 min, and re-tested for mood and current anxiety.

Internet addiction was associated with long-standing depression, impulsive nonconformity, and autism traits. High internet-users also showed a pronounced decrease in mood following internet use compared to the low internet-users.

The immediate negative impact of exposure to the internet on the mood of internet addicts may contribute to increased usage by those individuals attempting to reduce their low mood by re-engaging rapidly in internet use.

Similarly, exposure to the object of the problematic behaviours has been found to reduce mood [26], especially in individuals addicted to pornography [5], [27]. As both of these reasons (i.e. gambling and pornography) for use of the internet are strongly associated with problematic internet use [2], [3], [14], it may well be that these factors may also contribute to internet addiction [14].

Indeed, it has been suggested that such negative impacts of engagement in problematic behaviour may, in themselves, generate further engagement in these high probability problematic behaviours in an attempt to escape these negative feelings [28]. The results showed a striking negative impact of internet exposure on the positive mood of ‘internet addicts’.

This effect has been suggested in theoretical models of ‘internet addiction [14], [21], and a similar finding has also been noted in terms of the negative effect of exposure to pornography on internet sex addicts [5], which may suggest commonalities between these addictions. It is also worth suggesting that this negative impact on mood could be considered as akin to a withdrawal effect, suggested as needed for the classification of addictions

COMMENTS: Researchers found a significant drop in mood after use which parallells addiction withdrawal.

Are Adolescents with Internet Addiction Prone to Aggressive Behavior? The Mediating Effect of Clinical Comorbidities on the Predictability of Aggression in Adolescents with Internet Addiction (2015)

Cyberpsychol Behav Soc Netw. 2015 Apr 22.

Previous studies have reported associations between aggression and Internet addiction disorder (IAD), which has also been linked with anxiety, depression, and impulsiveness. However, the causal relationship between aggression and IAD has thus far not been clearly demonstrated. Three groups were identified based on the Y-IAT: the usual user group (n=487, 68.2%), the high-risk group (n=191, 26.8%), and the Internet addiction group (n=13, 1.8%). The data revealed a linear association between aggression and IAD such that one variable could be predicted by the other. The current findings suggest that adolescents with IAD seem to have more aggressive dispositions than do normal adolescents. If more aggressive individuals are clinically prone to Internet addiction, early psychiatric intervention may contribute to the prevention of IAD.

Effect of Pathological Use of the Internet on Adolescent Mental Health: A Prospective Study (2010)

Arch Pediatr Adolesc Med. 2010 Oct;164(10):901-6.

To examine the effect of pathological use of the Internet on the mental health, including anxiety and depression, of adolescents in China. It is hypothesized that pathological use of the Internet is detrimental to adolescents’ mental health.A prospective study with a randomly generated cohort from the population.

Adolescents aged between 13 and 18 years.

After adjusting for potential confounding factors, the relative risk of depression for those who used the Internet pathologically was about 21⁄2 times that of those who did not exhibit the targeted pathological internet use behaviors. No significant relationship between pathological use of the Internet and anxiety at follow-up was observed.

Results suggested that young people who are initially free of mental health problems but use the Internet pathologically could develop depression as a consequence. These results have direct implications for the prevention of mental illness in young people, particularly in developing countries.

It is hypothesized that pathological use of the Internet is detrimental to the mental health of adolescents such that young people who use the Internet extensively and pathologically would have an increased risk of anxiety and depression.

COMMENTS: One of the rare studies that tract Internet users over time.This study found that Internet use caused depression in adolescents.

Internet abusers associate with a depressive state but not a depressive trait (2013)

Psychiatry Clin Neurosci. 2013 Dec 8. doi: 10.1111/pcn.12124

The present study investigated three issues: (i) whether Internet abusers display a depressive state without a depressive trait; (ii) which symptoms are shared between Internet abuse and depression; and (iii) which personality characteristics were shown in Internet abusers.

Ninety-nine male and 58 female participants aged 18-24 years were screened with the Chen Internet Addiction Scale.

In a comparison of the symptoms of depression and Internet abuse, it was found that high-risk Internet abuse participants shared some common behavioral mechanisms with depression, including the psychiatric symptoms of loss of interest, aggressive behavior, depressive mood, and guilty feelings. High-risk Internet abuse participants may be more susceptible to a temporal depressive state but not a permanent depressive trait.

COMMENTS: Internet addiction was associated with depression states, but not with chronic depression. This means that Internet use is a likely cause of depression. This indicates that depression was not a pre-existing condition

Prevalence & determinants of Internet Addiction among Indian adolescents (2017)

Indian Journal of Community Health, 29(1), 89-96.

Objectives: To determine the prevalence of internet addiction in the school-going adolescents of Aligarh, and to measure the association of internet addiction with the socio-demographics of the study participants.

Material & Methods: This cross-sectional study was conducted in the schools of Aligarh. 1020 participants were selected through a multi-stage sampling technique proportional to the number of students in each class. Data Collection was done using a questionnaire that included Young’s 20-item Internet Addiction Test (IAT).

Results: About 35.6% of the students had internet addiction. Males (40.6%) were significantly (p=0.001) more addicted to the internet than females (30.6%). On bivariate analysis, a higher age group (17-19 years), male gender and internet access at home were found to have a significantly higher odds’ for internet addiction.

Internet addiction and its correlates among high school students: a preliminary study from Ahmedabad, India (2013)

Asian J Psychiatr. 2013 Dec;6(6):500-5. doi: 10.1016/j.ajp.2013.06.004.

Internet addiction (IA) is an upcoming and less researched entity in psychiatry, especially in low and middle income countries. This is the first such effort to study IA amongst Indian school students of class 11th and 12th and to find its correlation with socio-educational characteristics, internet use patterns and psychological variables, namely depression, anxiety and stress.

Six hundred and twenty one students of six English medium schools of Ahmedabad participated, of which 552 (88.9%) who completed forms were analyzed. Sixty-five (11.8%) students had IA; it was predicted by time spent online, usage of social networking sites and chat rooms, and also by presence of anxiety and stress. Age, gender and self-rated academic performance did not predict IA. There was a strong positive correlation between IA and depression, anxiety and stress.

IA may be a relevant clinical construct, and needs extensive research even in developing nations. All high school students suffering from depression, anxiety and stress must be screened for IA, and vice versa.

A Cross-Sectional Study on the Prevalence, Risk Factors, and Ill Effects of Internet Addiction Among Medical Students in Northeastern India.

Prim Care Companion CNS Disord. 2016 Mar 31;18(2). doi: 10.4088/PCC.15m01909.

The cross-sectional study sample comprised 188 medical students from Silchar Medical College and Hospital (Silchar, Assam, India). Students completed a sociodemographic form and an Internet use questionnaire, both created for this study, and the Young's 20-Item Internet Addiction Test after they received brief instructions. Data were collected during a10-day period in June 2015.

Of the 188 medical students, 46.8% were at increased risk of Internet addiction. Those who were found to be at increased risk had longer years of Internet exposure and always online status. Also, among this group, the men were more prone to develop an online relationship. Excessive Internet usage also led to poor performance in college  and feeling moody, anxious, and depressed.

The ill effects of Internet addiction include withdrawal from real-life relationships, deterioration in academic activities, and a depressed and nervous mood. Internet use for nonacademic purposes is increasing among students, thus there is an immediate need for strict supervision and monitoring at the institutional level. The possibility of becoming addicted to the Internet should be emphasized to students and their parents through awareness campaigns so that interventions and restrictions can be implemented at the individual and family levels.

The relationship of problematic internet use with dissociation among South Korean internet users (2016)

Psychiatry Res. 2016 Apr 30;241:66-71.

This study examined patterns of problematic internet use (PIU) among South Korean internet users to investigate the association between PIU and dissociative experiences. Five hundred and eight participants between 20 and 49 years old were recruited through an online panel survey. Using logistic regression analysis with PIU as the dependent variable, we observed that the participants with PIU were more likely to have alcohol-related behaviors or problems, higher levels of perceived stress, and dissociative experiences.

Participants' scores on the Korean version of the Dissociative Experiences Scale were positively correlated with the severity of PIU. Individuals with PIU and dissociation had more severe PIU and more severe mental-health problems than those with PIU but without dissociation.

Effect of Facebook on the life of Medical University students (2013)

Int Arch Med. 2013 Oct 17;6(1):40.

It was a cross sectional, observational and questionnaire based study conducted in Dow University OF Health Sciences during the period of January 2012 to November 2012. Participants were in the age group of 18--25 years with a mean age of 20.08 years.

Youngsters are willing to compromise their health, social life, studies for the sake of fun and entertainment or whatever satisfaction they get after using Facebook. What we observed in our study was that although majority of our subjects showed multiple signs of Facebook addiction, they don't realize it and if even they realize it they don't want to quit Facebook and even if they want to quit, they can't. Our observance concluded that majority of the users are highly addicted.

Craving Facebook? Behavioral addiction to online social networking and its association with emotion regulation deficits (2014)

Addiction. 2014 Aug 29. doi: 10.1111/add.12713.

Cross-sectional survey study targeting undergraduate students. Associations between disordered online social networking use, internet addiction, deficits in emotion regulation, and alcohol use problems were examined using univariate and multivariate analyses of covariance. Undergraduate students (n=253, 62.8% female, 60.9% white, age M=19.68, SD=2.85), largely representative of the target population. Response rate was 100%.

Disordered online social networking use was present in 9.7% of the sample surveyed, and significantly and positively associated with scores on the Young Internet Addiction Test  greater difficulties with emotion regulation and problem drinking. The use of online social networking sites is potentially addictive. Modified measures of substance abuse and dependence are suitable in assessing disordered online social networking use. Disordered online social networking use seems to arise as part of a cluster of symptoms of poor emotion regulation skills and heightened susceptibility to both substance and non-substance addiction.

Modeling Problematic Facebook Use: Highlighting the role of mood regulation and preference for online social interaction (2018)

Addict Behav. 2018 Dec;87:214-221. doi: 10.1016/j.addbeh.2018.07.014.

A validated theoretical model of Problematic Facebook Use (PFU) is currently lacking in the literature. The cognitive-behavioral model of generalized Problematic Internet Use (PIU) proposed by Caplan (2010) may provide a conceptual basis for understanding the problematic use of Social Networking Sites. The present study aimed at contributing to the discussion on the conceptualization of PFU by testing the feasibility of the model of generalized PIU in the context of PFU. The Italian version of the Problematic Facebook Use Scale (PFUS; including five subscales, i.e., preference for online social interaction - POSI, mood regulation, cognitive preoccupation, compulsive use, and negative outcomes) was administered to 815 young Italian adults. A Structural Equation Modeling analysis was used to test the theoretical model. POSI resulted to be a positive predictor of Facebook use for mood regulation and of deficient self-regulation; using Facebook for mood regulation was a positive predictor of deficient self-regulation; and deficient self-regulation was a positive predictor of negative outcomes of Facebook use. Of note, difficulties in self-regulating Facebook use was related more strongly to using Facebook for mood regulation than to preference for online social interaction. Similarly, using Facebook for mood regulation appears to have a greater impact than preference for online social interaction on negative outcomes of PFU. The obtained results support the feasibility of the model of generalized PIU in the context of PFU and suggest that mood regulation abilities may be a potential target for prevention and treatment of PFU.

Negative consequences from heavy social networking in adolescents: The mediating role of fear of missing out (2017)

J Adolesc. 2017 Feb;55:51-60. doi: 10.1016/j.adolescence.2016.12.008.

Social networking sites (SNS) are especially attractive for adolescents, but it has also been shown that these users can suffer from negative psychological consequences when using these sites excessively. We analyze the role of fear of missing out (FOMO) and intensity of SNS use for explaining the link between psychopathological symptoms and negative consequences of SNS use via mobile devices. In an online survey, 1468 Spanish-speaking Latin-American social media users between 16 and 18 years old completed the Hospital Anxiety and Depression Scale (HADS), the Social Networking Intensity scale (SNI), the FOMO scale (FOMOs), and a questionnaire on negative consequences of using SNS via mobile device (CERM). Using structural equation modeling, it was found that both FOMO and SNI mediate the link between psychopathology and CERM, but by different mechanisms. Additionally, for girls, feeling depressed seems to trigger higher SNS involvement. For boys, anxiety triggers higher SNS involvement.

Attention bias in social networking sites-addicted individuals (2014)

Alcohol Alcohol. 2014 Sep;49 Suppl 1:i50.

Numerous studies have revealed that addicted individuals have attention bias related to addictive subjects, however, little is known about the relationship between attention bias and internet addiction. In this study, we have investigated whether social networking sites (SNS)-addicted individuals show attention bias for SNS- related pictures.

Results of t-tests revealed that the SNS-addiction group showed attention bias for SNS stimuli in the 500 ms (t(45) = 2.77, p < .01) condition and not in the 5000 ms condition (t(45) = .22, n.s.), when compared with the non-SNS addiction group. This result suggested that SNS-addicted individuals have attention bias for SNS-related stimuli during attention capture as well as other addictive disorder or dependence (e.g. alcohol or nicotine dependence).

Longitudinal study shows that addictive Internet use during adolescence was associated with heavy drinking and smoking cigarettes in early adulthood (2016)

Acta Paediatr. 2016 Dec 15. doi: 10.1111/apa.13706.

This longitudinal study investigated the association between addictive Internet use during adolescence and heavy drinking and cigarette smoking in early adulthood. We focused on middle school students from the Korea Youth Panel Study who were 16 in 2003:1,804 who did not drink alcohol and 2,277 who did not smoke. Multivariate logistic analysis investigated the relationships between Internet use at the age of 16, with regard to location, time spent and reason for use, and drinking and smoking at the age of 20.

Using the Internet for chatting, games, and adult websites at the age of 16 had a significant association with heavy drinking at the age of 20. The Internet café as the location for Internet use at the age of 16 was associated with smoking behaviour at the age of 20. This study confirmed significant associations between addictive use of the Internet at the age of 16 and heavy drinking and cigarette smoking at the age of 20. The findings demonstrated the negative effects of addictive Internet use, one of the biggest problems with adolescents.

Association between Internet Overuse and Aggression in Korean Adolescents (2013)

Pediatr Int. 2013 Jun 30. doi: 10.1111/ped.12171.

A total of 2,336 (boys, 57.5%; girls, 42.5%) high school students in South Korea completed the structured questionnaire. The severity of Internet overuse was evaluated using Young's Internet Addiction Test. 

The proportions of boys who were classified as severe addicts and moderate addicts were 2.5% and 53.7%, respectively. For girls, the corresponding proportions were 1.9% and 38.9%, respectively. This study shows that Internet overuse is strongly associated with aggression in adolescents.

Development and Validation of the Smartphone Addiction Inventory (SPAI) (2014)

PLoS One. 2014 Jun 4;9(6):e98312. doi: 10.1371/journal.pone.0098312.

The aim of this study was to develop a self-administered scale based on the special features of smartphone. The reliability and validity of the Smartphone Addiction Inventory (SPAI) was demonstrated.

A total of 283 participants were recruited from Dec. 2012 to Jul. 2013 to complete a set of questionnaires. There were 260 males and 23 females, with ages 22.9±2.0 years. Exploratory factor analysis, internal-consistency test, test-retest, and correlation analysis were conducted to verify the reliability and validity of the SPAI.

In summary, the results from this study provide evidence that the SPAI is a valid and reliable self-administered screening tool to identify smartphone addiction. The consistent taxonomy with substance related and addictive disorder in DSM implies the property of “addiction” identical in smartphone addiction.

Overview of internet addiction (2014)

Alcohol Alcohol. 2014 Sep;49 Suppl 1:i19.

Problematic Internet Use or Internet addiction is generally considered as an inability to control the use of the Internet, which eventually involves psychological, social, academic, and/or professional problems in a person's life. Dysfunctional use of the Internet has been related to a variety of different activities such as cybersex, online gambling, online video game playing, or social network involvement, thereby emphasizing that this problematic behavior can take very different forms across individuals and should not be viewed as a homogeneous construct.

Prevalence of Pathological Internet Use in a Representative German Sample of Adolescents: Results of a Latent Profile Analysis (2014)

Psychopathology. 2014 Oct 22.

Background: Pathological internet use is of increasing significance in several industrial nations.Sampling and Methods: We surveyed a representative German quota sample of 1,723 adolescents (aged 14-17 years) and 1 caregiver each. We conducted a latent profile analysis to identify a high-risk group for pathological internet use.

Results: Overall, 3.2% of the sample formed a profile group with pathological internet use. In contrast to other published studies, the results of the latent profile analysis were verified not only by self-assessments of the youth's but also by external ratings of the caregivers. In addition to the pathological internet use, the high-risk group showed lower levels of family functioning and life satisfaction as well as more problems in family interactions.

Associations between overuse of the internet and mental health in adolescents (2013)

Nurs Health Sci. 2013 Aug 29. doi: 10.1111/nhs.12086.

This study examined the factors influencing internet addiction levels and mental health in a nationally-representative sample of 74,980 Korean middle- and high-school students who completed the 2010 Korea Youth Risk Behavior Web-Based Survey. The prevalence rates of potential internet addiction and internet addiction were 14.8% and 3%, respectively.

The odds ratios for potential internet addiction were higher in both boys and girls who reported suicidal ideation, depressive mood, moderate or higher subjective stress, moderate or more happiness, or ever having engaged in problematic substance use. Adolescents at high risk for internet addiction had poor mental health outcomes.

Internet use and addiction among Finnish Adolescents: 15-19years. (2014)

J Adolesc. 2014 Feb;37(2):123-31. doi: 10.1016/j.adolescence.2013.11.008.

This study investigates Internet use among Finnish adolescents (n = 475) combining qualitative and quantitative research. Internet use was evaluated using the Internet Addiction Test (Young, 1998a, 1998b). The data was divided into three parts according to the test scores: normal users (14.3%), mild over-users (61.5%), and moderate or serious over-users (24.2%).

As disadvantages of using the Internet, students reported that it is time-consuming and causes mental, social, and physical harm and poor school attendance. Four factors of Internet addiction were found, and for two of them, a statistical difference between females and males was found.

The presence of altered craniocervical posture and mobility in smartphone addicted teenagers with temporomandibular disorders.

J Phys Ther Sci. 2016 Jan;28(2):339-46.

Smartphones are widely used by teenagers and adults for various purposes. As teenagers use smartphones more actively than adults, they are more prone to be addicted to smartphones. Furthermore, excessive usage of smartphones can lead to various psychosocial and physical symptoms.

Cephalometric analysis showed no significant difference in the craniocervical angles of the resting positions of the two groups. However, measurement using an inclinometer revealed a significantly flexed cervical posture while using smartphones and decreased cervical range of motion in the smartphone-addicted teenagers. The clinical profile of temporomandibular disorders revealed that muscular problems were more frequently presented in the smartphone-addicted teenagers.

Internet addiction disorder and youth (2014)

The association between pathological internet use and comorbid psychopathology: a systematic review (2013)

Psychopathology. 2013;46(1):1-13. doi: 10.1159/000337971. Epub 2012 Jul 31.

The primary objective of this systematic review was to identify and evaluate studies performed on the correlation between PIU and comorbid psychopathology.

The majority of research was conducted in Asia and comprised cross-sectional designs. Twenty articles met the preset inclusion and exclusion criteria; 75% reported significant correlations of PIU with depression, 57% with anxiety, 100% with symptoms of ADHD, 60% with obsessive-compulsive symptoms, and 66% with hostility/aggression. No study reported associations between PIU and social phobia.

The majority of studies reported a higher rate of PIU among males than females. The strongest correlations were observed between PIU and depression; the weakest was hostility/aggression.

Depression and symptoms of ADHD appeared to have the most significant and consistent correlation with PIU. Associations were reported to be higher among males in all age groups.

The severity of Internet addiction risk and its relationship with the severity of borderline personality features, childhood traumas, dissociative experiences, depression and anxiety symptoms among Turkish University Students (2014)

Psychiatry Res. 2014 Mar 3.

The aim of this study was to investigate the relationship of Internet addiction (IA) risk with the severity of borderline personality features, childhood traumas, dissociative experiences, depression and anxiety symptoms among Turkish university students. A total of 271 Turkish university students participated in this study.

The rates of students were 19.9% (n=54) in the high IA risk group, 38.7% (n=105) in the mild IA risk group and 41.3% (n=112) in the group without IA risk.

Univariate covariance analysis indicated that the severity of borderline personality features, emotional abuse, depression and anxiety symptoms were the predictors of IAS score, while gender had no effect on IAS score. Among childhood trauma types, emotional abuse seems to be the main predictor of IA risk severity. Borderline personality features predicted the severity of IA risk together with emotional abuse, depression and anxiety symptoms among Turkish university students.

Relationship between borderline personality symptoms and Internet addiction: The mediating effects of mental health problems (2017)

J Behav Addict. 2017 Aug 29:1-8. doi: 10.1556/2006.6.2017.053.

Aim - To examine the relationship between borderline personality symptoms and Internet addiction as well as the mediating role of mental health problems between them. Methods -  A total of 500 college students from Taiwan were recruited and assessed for symptoms of Internet addiction using the Chen Internet Addiction Scale, borderline personality symptoms using the Taiwanese version of the Borderline Symptom List and mental health problems using four subscales from the Symptom Checklist-90-Revised Scale (interpersonal sensitivity, depression, anxiety, and hostility). SEM analysis revealed that all paths in the hypothesized model were significant, indicating that borderline personality symptoms were directly related to the severity of Internet addiction as well as indirectly related to the severity of Internet addiction by increasing the severity of mental health problems.

Association between problematic internet use, socio-demographic variables and obesity among European adolescents (2016)

Eur J Public Health. 2016 Apr 25. pii: ckw028.

Overweight of children and adolescents continues to be an important and alarming global public health problem. As the adolescent's time spent online has increased, problematic internet use (PIU) potentially leads to negative health consequences. This study aimed to examine the relation between PIU and overweight/obesity among adolescents in seven European countries and assess the effect of demographic and lifestyle factors recorded in the European Network for Adolescent Addictive Behaviour (EU NET ADB) survey (

A cross-sectional school-based survey of 14- to 17-year-old adolescents was conducted in seven European countries: Germany, Greece, Iceland, the Netherlands, Poland, Romania and Spain. Anonymous self-completed questionnaires included sociodemographic data, internet usage characteristics, school achievement, parental control and the Internet Addiction Test. Associations between overweight/obesity and potential risk factors were investigated by logistic regression analysis, allowing for the complex sample design.

The study sample consisted of 10 287 adolescents aged 14-17 years. 12.4% were overweight/obese, and 14.1% presented with dysfunctional internet behavior. Greece had the highest percentage of overweight/obese adolescents (19.8%) and the Netherlands the lowest (6.8%). Male sex [odds ratio (OR) = 2.89, 95%CI: 2.46-3.38], heavier use of social networking sites (OR = 1.26, 95%CI: 1.09-1.46) and residence in Greece (OR = 2.32, 95%CI: 1.79-2.99) or Germany (OR = 1.48, 95%CI: 1.12-1.96) were independently associated with higher risk of overweight/obesity. A greater number of siblings (OR = 0.79, 95%CI: 0.64-0.97), higher school grades (OR = 0.74, 95%CI: 0.63-0.88), higher parental education (OR = 0.89, 95%CI: 0.82-0.97) and residence in the Netherlands (OR = 0.49, 95%CI: 0.31-0.77) independently predicted lower risk of overweight/obesity.

Internet Addiction Among Elementary and Middle School Students in China: A Nationally Representative Sample Study. (2013)

Cyberpsychol Behav Soc Netw. 2013 Aug 24.

The data were from the National Children's Study of China (NCSC) in which 24,013 fourth- to ninth-grade students were recruited from 100 counties in 31 provinces in China.

the prevalence of Internet addiction in the total sample was 6.3%, and among Internet users was 11.7%. Among the Internet users, males (14.8%) and rural students (12.1%) reported Internet addiction more than females (7.0%) and urban students (10.6%)

When considering the location and purpose of Internet use, the percentage of Internet addicts was highest in adolescents typically surfing in Internet cafes (18.1%) and playing Internet games (22.5%).

Concurrent and predictive relationships between compulsive Internet use and substance: use findings from vocational high school students in china and the USA (2012)

Int J Environ Res Public Health. 2012 Mar;9(3):660-73. Epub 2012 Feb 23.

PURPOSE: Compulsive Internet Use (CIU) has increasingly become an area of research among process addictions. METHODS: . Path analyses were applied to detect the concurrent and predictive relationships between baseline and one-year follow-up measures of CIU level, 30-day cigarette smoking, and 30-day binge drinking. RESULTS:

(1) CIU was not positively related with substance use at baseline.

(2) There was a positive predictive relationship between baseline CIU and change in substance use among female, but not male students.

(3) Relationships between concurrent changes in CIU and substance use were also found among female, but not male students.

(4) Baseline substance use did not predict an increase in CIU from baseline to 1-year follow-up.

CONCLUSIONS: While CIU was found to be related to substance use, the relationship was not consistently positive.

COMMENTS: This study found no correlation between compulsive Internet use and substance use. This does not align with often stated theory that Internet addiction must be due to pre-existing conditions or only occurring in those with "addict brains".

Internet Addiction (2012) [Article in Finnish]

Duodecim. 2012;128(7):741-8.

Internet addiction is defined as uncontrolled and harmful use of Internet, which manifests in three forms:gaming, various sexual activities and excessive use of emails, chats or SMS messaging. Several studies have found that abuse of alcohol and other substances, depression and other health problems are associated with Internet addiction. In boys and men depression may be more a consequence of the addiction than a cause for it. ADHD seems to be a significant background factor for developing the condition.

COMMENTS: First, they conclude that Internet addiction manifests is 3 forms, one of which is sexual activities. Second, they found depression to be caused by Internet addiction, rather than it being the result of Internet addiction. As for ADHD, we have seen a it decline or remit in many guys who recovered from porn addiction.

Prevalence of internet addiction and its association with stressful life events and psychological symptoms among adolescent internet users (2014)

Addict Behav. 2014 Mar;39(3):744-7.

Internet addiction (IA) among adolescents is a serious public health problem around the world. The prevalence rate of internet addiction was 6.0% among adolescent internet users. Logistic regression analyses indicated that stressors from interpersonal problem and school related problem and anxiety symptoms were significantly associated with IA after controlling for demographic characteristics.

Changes of internet addiction among the adult population of Japan in five years: results of two major surveys (2014)

Alcohol Alcohol. 2014 Sep;49 Suppl 1:i51.

The number of people with Internet addiction (IA) in Japan is assumed to have rapidly increased, but the actual conditions have not been unknown.  Our first survey was conducted in 2008, and the subjects were 7,500 men and women. Our second survey was conducted in 2013, and the subjects were 7,052 people. Both of the two survey, the subjects were selected from the entire adult population of Japan by stratified two-stage random sampling.

In the first survey, 51% of the replied that they used the Internet, and 20% scored 40 or higher on the IAT. We estimated the number of adullts with IA tendency was 2.7 million in Japan. Problem users were more prevalent in the younger generation and tended to have a higher education level. The second survey revealed a much higher prevalence of IA than the first survey. We estimated the number of adullts with IA tendency was 4.21 million in Japan.

Depression, loneliness, anger behaviours and interpersonal relationship styles in male patients admitted to internet addiction outpatient clinic in Turkey (2014)

Psychiatr Danub. 2014 Mar;26(1):39-45.

'Internet addiction' is excessive computer use that interferes with daily life of a person. We designed this study in order to evaluate the predictor effect of depression, loneliness, anger and interpersonal relationship styles for internet addiction as well as develop a model.The results of this study showed that the 'duration of internet use' and STAXI  'anger in' subscale were the predictors of internet addiction. When the clinicians suspect for the internet overuse, regulation of internet usage might be helpful. Psychiatric treatments for expressing anger and therapies that focus on validation of the feelings may be useful.           

The association between Internet addiction and personality disorders in a general population-based sample (2016)

J Behav Addict. 2016 Dec;5(4):691-699. doi: 10.1556/2006.5.2016.086.

Cross-sectional analysis data are based on a German sub-sample (n = 168; 86 males; 71 meeting criteria for IA) with increased levels of excessive Internet use derived from a general population sample (n = 15,023). IA was assessed with a comprehensive standardized interview using the structure of the Composite International Diagnostic Interview and the criteria of Internet Gaming Disorder as suggested in DSM-5. Impulsivity, attention deficit hyperactivity disorder, and self-esteem were assessed with the widely used questionnaires. Participants with IA showed higher frequencies of personality disorders (29.6%) compared to those without IA (9.3%; p < .001).

Shared psychological characteristics that are linked to aggression between patients with Internet addiction and those with alcohol dependence (2014)

Ann Gen Psychiatry. 2014 Feb 21;13(1):6.

Internet addiction (IA) is considered as one of behavioral addictions. Although common neurobiological mechanisms have been suggested to underlie behavioral addiction and substance dependence, few studies have directly compared IA with substance dependence, such as alcohol dependence (AD).

We compared patients with IA, AD, and healthy controls (HC) in terms of the Five Factor Model of personality and with regard to impulsiveness, anger expression, and mood to explore psychological factors that are linked to aggression.

The IA and AD groups showed a lower level of agreeableness and higher levels of neuroticism, impulsivity, and anger expression compared with the HC group, which are characteristics related to aggression. The addiction groups showed lower levels of extraversion, openness to experience, and conscientiousness and were more depressive and anxious than the HCs, and the severity of IA and AD symptoms was positively correlated with these types of psychopathology.

IA and AD are similar in terms of personality, temperament, and emotion, and they share common characteristics that may lead to aggression.

Impact of addiction to Internet on a number of psychiatric symptoms in students of Isfahan universities, Iran, 2010. (2012)

Int J Prev Med. 2012 Feb;3(2):122-7.

 This study aimed to investigate the impact of Internet addiction on some psychiatric symptoms among university students. This cross-sectional study was conducted among 250 students selected via quota sampling from universities in Isfahan, Iran. CONCLUSION: Psychiatrists and psychologists involved in the field of mental health need to be well informed about mental problems due to internet addiction, such as anxiety, depression, aggression, and job and educational dissatisfaction.

COMMENTS: From the study: "problems due to Internet addiction, such as anxiety, depression, aggression, and job and educational dissatisfaction." Correlation does not equal causation, but we see symptoms such as depression and anxiety remit through recovery from porn addiction

The Relationship between Alexithymia, Anxiety, Depression, and Internet Addiction Severity in a Sample of Italian High School Students (2014)

ScientificWorldJournal. 2014;2014:504376.

We aimed to assess whether Internet addiction (IA) severity was related to alexithymia scores among high school students, taking into account the role of gender differences and the possible effect of anxiety, depression, and age. Participants in the study were 600 students (ages ranging from 13 to 22; 48.16% girls) recruited from three high schools in two cities from Southern Italy.

The findings of the study showed that IA scores were associated with alexithymia scores, over and above the effect of negative emotions and age. Students with pathological levels of alexithymia reported higher scores on IA severity. In particular, results showed that difficulty in identifying feelings was significantly associated with higher scores on IA severity.

Impulsivity in Internet Addiction: A Comparison with Pathological Gambling (2012)

Cyberpsychol Behav Soc Netw. 2012 Jun 4.

Internet addiction has been considered to be associated with poor impulse control. The aim of this study is to compare the trait impulsivity of those suffering from Internet addiction with that of individuals suffering from pathological gambling. Our results show that those suffering from Internet addiction showed increased levels of trait impulsivity which were comparable to those of patients diagnosed with pathological gambling.

Additionally, the severity of Internet addiction was positively correlated with the level of trait impulsivity in patients with Internet addiction. These results state that Internet addiction can be conceptualized as an impulse control disorder and that trait impulsivity is a marker for vulnerability to Internet addiction.

COMMENTS: In the new DSM5 pathological gambling will be categorized as an addiction. This study concludes that impulsivity of Internet addicts compares with those that have developed an "official addiction".

A case of withdrawal psychosis from internet addiction disorder (2014)

Psychiatry Investig. 2014 Apr;11(2):207-9. doi: 10.4306/pi.2014.11.2.207.

Similar to substance use disorder, patients with Internet addiction disorder (IAD) show excessive use, tolerance and withdrawal symptoms. We report a case of a patient with withdrawal psychosis who showed persecutory delusion and disorganized behaviors in addition to common withdrawal symptoms such as agitation and irritability.

With antipsychotic medication (quetiapine up to 800 mg), his psychotic symptoms rapidly subsided and after four days of treatment, he no longer showed any signs of psychosis. This case report suggests that brief psychosis can develop during withdrawal from long-term excessive use of an Internet and the central pathology beneath the IAD is more likely a form of addiction than impulse control.

Commonalities in the psychological factors associated with problem gambling and Internet dependence (2010)

Cyberpsychol Behav Soc Netw. 2010 Aug;13(4):437-41.

The most commonly applied conceptual approach for excessive Internet use has been as a behavioral addiction, similar to pathological or problem gambling. In order to contribute to the understanding of Internet dependence as a disorder resembling problem gambling, the current study aimed to examine the relationship between problem gambling and Internet dependence and the degree to which psychological factors associated with problem gambling are relevant to the study of Internet dependence.

The findings revealed that there is no overlap between the populations reporting problem gambling and Internet dependence, but that individuals with these disorders report similar psychological profiles. Although requiring replication with larger community samples and longitudinal designs, these preliminary findings suggest that problem gambling and Internet dependence may be separate disorders with common underlying etiologies or consequences.

COMMENTS: Study found "that problem gambling and Internet dependence may be separate disorders with common underlying etiologies or consequences."

Relationship between facebook use and problematic internet use among college students (2012)

Cyberpsychol Behav Soc Netw. 2012 Jun;15(6):324-7.

The popularity of Facebook and other online social-networking sites has led to research on the potential risks of use, including Internet addiction. Previous studies have reported that between 8 percent and 50 percent of college students report problems consistent with Internet addiction.  Undergraduate participants (N=281, 72 percent women) completed a battery of self-report measures, including the Internet Addiction Test. The results of the current study suggest that a sizable minority of students experience problems related to Internet use and that the use of Facebook may contribute to the severity of symptoms associated with Internet addiction

COMMENTS: Quite a claim that - "Previous studies have reported that between 8 percent and 50 percent of college students report problems consistent with Internet addiction" When it comes to Internet addiction is it facebook for women, gaming for guys, and porn for both?

Internet use, Facebook intrusion, and depression: Results of a cross-sectional study.

Eur Psychiatry. 2015 May 8. pii: S0924-9338(15)00088-7.

The main objective of our study was to examine the potential associations between Internet use, depression, and Facebook intrusion. A total of 672 Facebook users took part in the cross-sectional study.  Our results provides additional evidence that daily Internet use time in minutes, gender, and age are also predictors of Facebook intrusion: that Facebook intrusion can be predicted by being male, young age, and an extensive number of minutes spent online. On the basis of this study, it is possible to conclude that there are certain demographic - variables, such as age, gender, or time spent online - that may help in outlining the profile of a user who may be in danger of becoming addicted to Facebook.

Internet addiction: Prevalence and risk factors: A cross-sectional study among college students in Bengaluru, the Silicon Valley of India (2015)

Indian J Public Health. 2015 Apr-Jun;59(2):

The Internet is a widely used tool known to foster addictive behavior, and Internet addiction threatens to develop into a major public health issue in the near future in a rapidly developing country like India. This cross-sectional study intends to estimate prevalence, understand patterns, and evaluate risk factors for Internet addiction among college students in the city of Bengaluru, India.

This study of college students aged 16-26 years (mean ± SD 19.2 ± 2.4 years), with marginally high female representation (56%), identified 34% and 8%  as students with mild and moderate Internet addiction respectively.

Internet addiction in a group of medical students: a cross sectional study (2012)

Nepal Med Coll J. 2012 Mar;14(1):46-8.

The use of Internet for education, recreation and communication is increasing day by day. Nevertheless, the possibility of exploitation and addiction leading to impairment in academic performance and emotional balance cannot be denied, especially among young population.

The study was aimed to measure the degree of Internet addiction among a group of medical students. Internet addiction test questionnaire developed by Young was used to assess mild, moderate and severe addiction. Amongst the study population (n=130, age 19-23 years), 40% had mild addiction. Moderate and severe addiction was found in 41.53% and 3.07% of the participants respectively.

The study revealed that 24% often and 19.2% always found themselves using Internet longer than they had planned or thought.

Late night Internet surfing leading to sleep deprivation was found in 31.53% of the participants.

Almost one fourth of them (25.38%) occasionally tried to cut down the time they spent on the Internet but failed and 31.53% sometimes experienced restlessness when deprived of Internet access.

COMMENTS: Problematic Internet use was widpsread among medical students in Nepal

Effects of a manualized short-term treatment of Internet and computer game addiction (STICA): study protocol for a randomized controlled trial. (2012)

Trials. 2012 Apr 27;13(1):43.

In the last few years, excessive Internet use and computer gaming have increased dramatically. Salience, mood modification, tolerance, withdrawal symptoms, conflict, and relapse have been defined as diagnostic criteria for Internet addiction (IA) and computer addiction (CA) in the scientific community. Despite a growing number of individuals seeking help, there are no specific treatments of established efficacy. According to Block [6], three subtypes of IA/computer game addiction (CA) (excessive gaming, sexual preoccupations, and email/text messaging) have four components in common: (a) excessive use (along with a loss of sense of time or the ignorance of basic drives);

(b) withdrawal (for example tension, anger, agitation, and/or depression when access to a computer is blocked;

(c) tolerance (increasing use or sophistication of computer equipment); and

(d) negative repercussions (for example poor achievement/performance, fatigue, social isolation, or conflicts). Salience, mood modification, tolerance, withdrawal symptoms, conflict, and relapse are additional diagnostic criteria for IA and CA [7].

The addicted individual is increasingly attracted towards the excessive behavior and life is emotionally and cognitively preoccupied with the application (for example computer game), requiring more and more time in order to regulate his mood states. Empirical studies [4,8,9] have demonstrated that the symptom complex of IA/CA [10,11] matches the criteria of substance disorders.

Results of neurobiological studies have identified neurophysiological mechanisms in IA/CA equivalent to substance abuse (alcohol [12] and cannabis addiction [13]). Patients with CA and IA have increasingly sought help in addiction counseling [14], because of serious negative psychosocial consequences (social, work/education, health) which have been documented along with high mental co-morbidities [15-19].

COMMENTS: This study describes 3 categories of Internet addiction: excessive gaming, sexual preoccupations, and email/text messaging.

Evolution of Internet addiction in Greek adolescent students over a two-year period: the impact of parental bonding (2012)

Eur Child Adolesc Psychiatry. 2012 Feb 4.

We present results from a cross-sectional study of the entire adolescent student population aged 12-18 of the island of Kos and their parents, on Internet abuse, parental bonding and parental online security practices.  Our results indicate that Internet addiction is increased in this population where no preventive attempts were made to combat the phenomenon from the initial survey, 2 years ago.

This increase is parallel to an increase in Internet availability. Parents tend to underestimate the level of computer involvement when compared to their own children estimates. Parental safety measures on Internet browsing have only a small preventive role and cannot protect adolescents from Internet addiction. The three online activities most associated with Internet addiction were watching online pornography, online gambling and online gaming.

COMMENTS: Says that Internet addiction is growing and correlated to increased availability. The three online activities most associated with Internet addiction were watching online pornography, online gambling and online gaming.

The Relationship Between Personality, Defense Styles, Internet Addiction Disorder, and Psychopathology in College Students (2014)

Cyberpsychol Behav Soc Netw. 2014 Sep 16.

The purpose of this study is to assess any underlying links between personality, defense styles, Internet addiction disorder (IAD), and psychopathology in a college student sample. A path model that was tested using Partial Least Squares (PLS) methodology showed that the defense styles employed by the students and certain personality traits (Impulsivity, Sensation Seeking, Neuroticism/Anxiety, and Aggression-Hostility) contributed to the prediction of variability in IAD, with IAD in turn predicting variability in overt psychopathology.

Depressive Symptoms and Problematic Internet Use Among Adolescents: Analysis of the Longitudinal Relationships from the Cognitive-Behavioral Model (2014)

Cyberpsychol Behav Soc Netw. 2014 Nov;17(11):714-719.

The objective of this study was to analyze the temporal and reciprocal relations between the presence of depressive symptoms and various components of problematic Internet use (i.e., the preference for online relationships, use of the Internet for mood regulation, deficient self-regulation, and the manifestation of negative outcomes).

Consequently, a longitudinal design was employed with two times separated by a 1 year interval. The sample consisted of 699 adolescents (61.1% girls) between 13 and 17 years of age.

The results indicated that depressive symptoms at time 1 predicted an increase in preference for online relationships, mood regulation, and negative outcomes after 1 year. In turn, negative outcomes at time 1 predicted an increase in depressive symptoms at time 2.

Confirmation of the Three Factor Model of Problematic Internet Use on Off Line Adolescent and Adult Samples. (2011)

Cyberpsychol Behav Soc Netw. 2011 Jun 28. Budapest, Hungary .

Data were collected from 438 high-school students (44.5 percent boys; mean age: 16.0 years; and also from 963 adults (49.9 percent males; mean age: 33.6 years; standard deviation=11.8 years). The results of the analyses carried out inevitably support the original three-factor model over the possible one-factor solution. Using latent profile analysis, we identified 11 percent of adults and 18 percent of adolescent users characterized by problematic use.

COMMENTS: Study found problematic Internet use in 18% of adolescents - in a sample that was more than half girls! What would it have been had the sample been all male? 

Characteristics of online compulsive buying in Parisian students (2014)

Addict Behav. 2014 Aug 6;39(12):1827-1830.

To better understand its clinical aspects by focusing on (i) prevalence rate, (ii) correlation with other addictions, (iii) influence of means of access, (iv) motivations to shop to the internet and (v) financial and time-consuming consequences. Cross-sectional study. 200 students in two different centers of Paris Diderot University.                                                                                                                                                                                                                                                                                                                         

Prevalence of online compulsive buying was 16.0%, while prevalence of internet addiction was 26.0%. We found no significant relationship with cyberdependence, alcohol or tobacco use disorders. 

Online compulsive buying seems to be a distinctive behavioral disorder with specific factors of loss of control and motivations, and overall financial and time-consuming impacts. More research is needed to better characterize it.

Overlapping of different addictions including alcohol, tobacco, internet and gambling (2014)

Alcohol Alcohol. 2014 Sep;49 Suppl 1:i10.

Subjects were Japanese adults randomly selected from throughout Japan. The questionnaire included screening tests for alcohol dependence, nicotine dependence, internet addiction, gamble addiction. The results were compared with the results from 2008 nationwide survey.

The prevalence of addiction was higher among males than females across all addictive behaviors. For male, most prevalent situation was alcohol use disorder only, followed by gambling addiction only, nicotine dependence only, internet addiction only. For female, most prevalent situation was internet only, followed by gambling addiction only, alcohol use disorder only, nicotine dependence only. The patterns of associations among the four addictive behaviors were different for men and women. Significant associations among four additive behaviors were found among women, while among men, internet addiction was associated only with nicotine addiction, but not with other behaviors.

Exercise rehabilitation for smartphone addiction (2013)

J Exerc Rehabil. 2013 Dec 31;9(6):500-505.

Internet addiction after launching smartphone is becoming serious. Therefore this paper has attempted to sketch out the diverse addiction treatment and then check the feasibility of exercise rehabilitation. The reason to addict the internet or smartphone is personalized individual characters related personal psychological and emotional factors and social environmental factors around them. We have shown that 2 discernible approaches due to 2 different addiction causes: that is behavioral treatment and complementary treatment.

College students with Internet addiction decrease fewer Behavior Inhibition Scale and Behavior Approach Scale when getting online (2014)

Asia Pac Psychiatry. 2014 May 27. doi: 10.1111/appy.12135.

The aim of the study is to compare the reinforcement sensitivity between online and offline interaction. The effect of gender, Internet addiction, depression, and online gaming on the difference of reinforcement sensitivity between online and offline were also evaluated.

The results showed that reinforcement sensitivity was lower when interacting online than when interacting offline. College students with Internet addiction decrease fewer score on BIS and BAS after getting online than did others. The higher reward and aversion sensitivity are associated with the risk of Internet addiction.

The fun seeking online might contribute to the maintenance of Internet addiction. This suggests that reinforcement sensitivity would change after getting online and would contribute to the risk and maintenance of Internet addiction.

The bidirectional associations between the family factors and internet addiction among adolescents in a prospective investigation (2014)

Psychiatry Clin Neurosci. 2014 May 19. doi: 10.1111/pcn.12204.

A total of 2293 adolescents in grade 7 participated in the study. We assessed their Internet addiction, family function, and family factors with a 1-year follow-up.
In the prospective investigation, inter-parental conflict predicted the incidence of internet addiction one year later in forward regression analysis, followed by not living with mother and allowance to use internet more than 2 hours per day by parents or caregiver (AIU>2H). The inter-parental conflict and AIU>2H also predicted the incidence in girls. Not cared for by parents and family APGAR score predicted the incidence of internet addiction among boys.

Problematic Internet use, well-being, self-esteem and self-control: Data from a high-school survey in China (2016)

Addict Behav. 2016 May 12;61:74-79. doi: 10.1016/j.addbeh.2016.05.009.

The present study examines the association between problematic Internet use (PIU), demographic variables, and health-related measures among Chinese adolescents. Survey data from 1552 adolescents (male=653, mean age=15.43 years) from Jilin Province, China, were collected. According to the Young Diagnostic Questionnaire for Internet Addiction (YDQ), 77.8% (n=1207), 16.8% (n=260), and 5.5% (n=85) showed adaptive, maladaptive, and problematic Internet use, respectively. 

Well-being, self-esteem, and self-control were related to severity of problematic Internet use, with greater severity typically associated with poorer measures in each domain. The findings that severity of problematic Internet use is associated with specific socio-demographic features and temperamental and well-being measures suggest that specific groups of youth may be particularly vulnerable to developing problematic Internet use.

The characteristics of decision making, potential to take risks, and personality of college students with Internet addiction (2010)

Psychiatry Res. 2010 Jan 30;175(1-2):121-5. doi: 10.1016/j.psychres.2008.10.004.

This study aimed to identify risk factors involved in Internet addiction.

The results revealed the following: (a) 49% of males and 17% of females were addicted, (b) the addicted students tended to select more advantageous cards in the last 40 cards of the Iowa test, indicating better decision making, (c) no difference was found for the BART, indicating that addicted subjects were not more likely to engage in risk-taking behaviors and (d) TPQ scores showed lower reward dependence (RD) and higher novelty seeking (NS) for the addicts. Their higher performance on the Iowa gambling test differentiates the Internet addiction group from the substance use and pathologic gambling groups that have been shown to be deficient in decision making on the Iowa test.

Risk factors and psychosocial characteristics of potential problematic and problematic Internet use among adolescents: A cross-sectional study. (2011)

BMC Public Health. 2011; 11: 595.

The source population for the present study consisted of a random cluster sample of 20 public junior high and high schools, stratified according to their locality and surrounding population density, in Athens, Greece. All students enrolled in Grades 9 and 10 of the selected schools were invited to participate in the study (n = 937). No exclusion criteria, including demographic and/or socioeconomic characteristics, for study participation were applied. The source population of the study consisted of 438 (46.7%) boys and 499 (53.3%) girls (overall mean age: 14.7 years). Among the study population, the prevalence rates of potential PIU and PIU were 19.4% and 1.5%, respectively Overall maladaptive Internet use (MIU) Among the study population (n = 866), the prevalence rate of maladaptive Internet use (MIU) was 20.9% (n = 181).

Previous reports indicate that more than one quarter of frequent Internet users utilize the Internet for accessing sexual information and education. Both frequent Internet use and accessing the Internet for the purposes of sexual education have been found to be significant predictors of pornographic Internet site use. Hence, it is proposed that PIU may develop and/or manifest secondary to the specific content of Internet sites accessed, rather than to the Internet per se.

COMMENTS: Researchers found maladaptive Internet use use in 21% of 9th & 10th graders. What would the percentage have been if it was 100% male students?

Internet Addiction and Antisocial Internet Behavior of Adolescents (2011)

ScientificWorldJournal. 2011; 11: 2187–2196. 2011 November 3

In fact, there is no definition of Internet addiction that is universally accepted by psychologists and scholars in this field. While the investigation of the concept of Internet addiction is still a main agenda of many researchers the problems of excessive use of Internet, especially in school students, become more and more prevalent and disturbing Young classifies Internet addiction into five different types of behaviors. (1) Cybersexual addiction: the addicts spent a lot of time in adult websites for cybersex and cyberporn. (2) Cyber-relationship addiction: the addicts involved heavily in online relationships. (3) Net compulsions: the addicts exhibited obsessive online gambling and shopping. They are compulsive online gamblers and shopaholics. (4) Information overload: the addicts displayed compulsive web surfing and database searches. (5) Computer game addiction: the addicts were obsessive online game players.

COMMENTS: This study acknowledges that Internet pornography (cybersexual) is one of five categories of Internet addiction. It also states the problem is growing.

Is it meaningful to distinguish between generalized and specific Internet addiction? Evidence from a cross-cultural study from Germany, Sweden, Taiwan and China (2014)

Asia Pac Psychiatry. 2014 Feb 26. doi: 10.1111/appy.12122.

It has been hypothesized that two distinctive forms of Internet addiction exist. Here, generalized Internet addiction refers to the problematic use of the Internet covering a broad range of Internet-related activities. In contrast, specific forms of Internet addiction target the problematic use of distinct online activities such as excessive online video gaming or activities in social networks.

The present study investigates the relationship between generalized and specific Internet addiction in a cross-cultural study encompassing data from China, Taiwan, Sweden and Germany in n = 636 participants. In this study, we assessed - besides generalized Internet addiction - addictive behavior in the domains of online video gaming, online shopping, online social networks and online pornography.

The results confirm the existence of distinct forms of specific Internet addiction. One exception, however, was established in five of the six samples under investigation: online social network addiction correlates in large amounts with generalized Internet addiction. In general, it is of importance to distinguish between generalized and specific Internet addiction.

Internet addiction in Hong Kong adolescents: a three-year longitudinal study (2013)

J Pediatr Adolesc Gynecol. 2013 Jun;26(3 Suppl):S10-7. doi: 10.1016/j.jpag.2013.03.010.

Three waves of data were collected over 3 years from students in 28 secondary schools in Hong Kong (Wave 1: 3,325 students, age = 12.59 ± 0.74 y; Wave 2: 3,638 students, age = 13.64 ± 0.75 y; Wave 3: 4,106 students, age = 14.65 ± 0.80 y).

At Wave 3, 22.5% of the participants met the criterion of Internet addiction, which was lower than those observed at Wave 1 (26.4%) and Wave 2 (26.7%). Using different measures at Wave 1 to predict Internet addiction at Wave 3, it was found that male students showed more problematic Internet use behavior than did female students; good family functioning predicted lower probability of having Internet addiction; positive youth development indicators negatively predicted Internet addictive behaviors over time.

The comorbid psychiatric symptoms of Internet addiction: attention deficit and hyperactivity disorder (ADHD), depression, social phobia, and hostility (2007)

J Adolesc Health. 2007 Jul;41(1):93-8. Epub 2007 Apr 12.

To: (1) determine the association between Internet addiction and depression, self-reported symptoms of attention deficit and hyperactivity disorder (ADHD), social phobia, and hostility for adolescents; and (2) evaluate the sex differences of association between Internet addictionand the above-mentioned psychiatric symptoms among adolescents. 

The results demonstrated that adolescents with Internet addiction had higher ADHD symptoms, depression, social phobia, and hostility. Higher ADHD symptoms, depression, and hostility are associated with Internet addiction in male adolescents, and only higher ADHD symptoms and depression are associated with Internet addiction in female students. These results suggest that Internet addiction is associated with symptoms of ADHD and depressive disorders. However, hostility was associated with Internet addiction only in males.

Comments: Internet addiction associated with ADHD, depression, social phobia, and hostility.

Prevalence and Factors of Addictive Internet Use among Adolescents in Wuhan, China: Interactions of Parental Relationship with Age and Hyperactivity-Impulsivity (2013)

PLoS One. 2013 Apr 15;8(4):e61782.

This study examined the prevalence of addictive Internet use and analyzed the role of parental relationship in affecting this behavior among a random sample of adolescents in Wuhan, China. The prevalence rate of Internet addiction was 13.5% (16.5% for boys and 9.5% for girls. Compared to non-addictive users, addictive Internet users were scored significantly lower on parental relationships and significantly higher on hyperactivity-impulsivity. Interaction analysis indicated that better parental relationship was associated with more reductions in risk of addictive Internet use for younger students than for older students, and with more risk of Internet addiction among higher than among lower hyperactivity-impulsivity students.

Psychometric Properties of the Revised Chen Internet Addiction Scale (CIAS-R) in Chinese Adolescents (2014)

J Abnorm Child Psychol. 2014 Mar 2.

The Revised Chen Internet Addiction Scale (CIAS-R) was developed to assess Internet addiction in Chinese populations, but its psychometric properties in adolescents have not been examined. This study aimed to evaluate the factor structure and psychometric properties of CIAS-R in Hong Kong Chinese adolescents.                                                                                                                                                                                                                                                                                                                                                        

860 Grade 7 to 13 students (38 % boys) completed the CIAS-R, the Young's Internet Addiction Test (IAT), and the Health of the Nation Outcome Scales for Children and Adolescents (HoNOSCA) in a survey. The prevalence of Internet addiction as assessed by CIAS-R was 18 %. High internal consistency and inter-item correlations were reported for the CIAS-R. Results from the confirmatory factor analysis suggested a four-factor structure of Compulsive Use and Withdrawal, Tolerance, Interpersonal and Health-related Problems, and Time Management Problems.

Shyness, Loneliness Avoidance, and Internet Addiction: What are the Relationships? (2017)

The Journal of psychology (2017): 1-11.

Given that shyness has been consistently linked to Internet addiction in youth, an examination into the mediating effect of a desire to avoid loneliness on the shyness–Internet addiction link could offer potential insights into a possible explanatory mechanism as well as directions for Internet addiction prevention and intervention in young adulthood. Thus, the aim of this study is to investigate the mediating role of loneliness avoidance in the relationship between shyness and Internet addiction among 286 youth Internet users. Shyness was significantly and positively correlated with loneliness avoidance and Internet addiction. In addition, loneliness avoidance was significantly and positively correlated with Internet addiction. Most importantly, loneliness avoidance may predispose shy youth to become addicted to the Internet.

Prevalence and Psychosocial Risk Factors Associated with Internet Addiction in a Nationally Representative Sample of College Students in Taiwan. (2011)

Cyberpsychol Behav Soc Netw. 2011 Jun 8.

The aim of this study was to examine the prevalence of Internet addiction in a nationally representative sample of college students and to identify any associated psychosocial risk factors. The prevalence of Internet addiction was found to be 15.3 percent. The prevalence of Internet addiction among college students in Taiwan was high, and the variables mentioned were independently predictive.

COMMENTS: 15.3 with Internet addiction. What if the sample had been all male?

Psychosocial Profile of Iranian Adolescents' Internet Addiction (2013)

Cyberpsychol Behav Soc Netw. 2013 Apr 24.

In the present study, factors that could play an important role in Internet addiction (IA) in 4,177 Iranian high school and secondary school adolescents (age range: 14-19 years) were examined. Among the study participants, 21.1% of the students were in some way victims of IA, among whom 1.1% had significant problematic symptoms. Familial relationships was the most important factor related to IA; religious beliefs, moreover, was the second most important factor.

Internet Addiction Among Students of the Medical University of Białystok. (2011).

Comput Inform Nurs. 2011 Jun 21.

Internet addiction was confirmed among 24 (10.3%) nursing, 7 (9.9%) midwifery, and 5(9.1%) medical rescue students. The abstinence syndrome was noted among 11 (4.7%) nursing, 7(9.9%) obstetrics, and 7 (12.7%) medical rescue students. Several students had both an Internet addiction and the abstinence syndrome.

COMMENTS: Approximately 10% of students enrolled in a medical university were identified as Internet Addicts. Equal numbers developed withdrawal symptoms (abstinence syndrome) when they stopped using the Internet.

Prevalence of Internet Addiction and its Contributory Factors among Nursing Students (2017)

International Journal of Nursing Education, Year : 2017, Volume : 9, Issue : 1 Article DOI : 10.5958/0974-9357.2017.00003.4

An exploratory study was carried out among 300 nursing students in selected nursing colleges in city Ludhiana, Punjab. Systematic sampling technique was used to select the sample. Data was collected with standardized internet addiction scale (Dr. K. Young) and structured checklist to assess contributory factors of internet addiction by using self-report method.

The study results revealed that most of the students 97.7% had an easy access to internet. More than one fourth addicted to mild internet addiction. More than half 180 (60.0%) nursing students were in age group 16–20 years. Contributory factors “Unlimited access to internet”, “Use internet as a way to escape problems”, “Get more respect online than real life” had significant association with internet addiction. Student's age, mother's education, father's occupation, quality of your parent's relationship had significant association with internet addiction. Prevalence of internet addiction among nursing students was 70.3%.

Social Networking Addiction among Health Sciences Students in Oman (2015)

Sultan Qaboos Univ Med J. 2015 Aug;15(3):e357-63.

Addiction to social networking sites (SNSs) is an international issue with numerous methods of measurement. The impact of such addictions among health science students is of particular concern. This study aimed to measure SNS addiction rates among health sciences students at Sultan Qaboos University (SQU) in Muscat, Oman.

In April 2014, an anonymous English-language six-item electronic self-reporting survey based on the Bergen Facebook Addiction Scale was administered to a non-random cohort of 141 medical and laboratory science students at SQU. The survey was used to measure usage of three SNSs: Facebook (Facebook Inc., Menlo Park, California, USA), YouTube (YouTube, San Bruno, California, USA) and Twitter (Twitter Inc., San Francisco, California, USA). Two sets of criteria were used to calculate addiction rates (a score of 3 on at least four survey items or a score of 3 on all six items). Work-related SNS usage was also measured.

 Of the three SNSs, YouTube was most commonly used (100%), followed by Facebook (91.4%) and Twitter (70.4%). Usage and addiction rates varied significantly across the three SNSs. Addiction rates to Facebook, YouTube and Twitter, respectively, varied according to the criteria used (14.2%, 47.2% and 33.3% versus 6.3%, 13.8% and 12.8%). However, addiction rates decreased when work-related activity was taken into account.

Internet addiction: development and validation of an instrument in adolescent scholars in Lima Perú. (2011)

 Rev Peru Med Exp Salud Publica. 2011 Sep;28(3):462-9.

The mean age was 14 years old. The bi-dimensional data analysis revealed a significant association (p<0,001) between Dimension I (symptoms of IA) and the weekly time spent on the Internet, male sex, past history of bad behavior in school and plans for the future. Conclusions. The SIAL showed a good internal consistency, with moderate and significant inter-item correlations. The findings show that addiction has a dynamic role, which evidences a problem generated in family patterns and inadequate social networks.

COMMENTS: Another country studying Internet addiction.

The Relationship between Recent Stressful Life Events, Personality Traits, Perceived Family Functioning and Internet Addiction among College Students. (2013)

Stress Health. 2013 Apr 25. doi: 10.1002/smi.2490.

The results indicated that compared with non-addicted subjects, subjects with severe IA (9.98%) had lower family functioning, lower extraversion, higher neuroticism and psychoticism, and more stressful life events, and subjects with mild IA (11.21%) had higher neuroticism and more health and adaptation problems.

Alexithymia components in excessive internet users: A multi-factorial analysis (2014)

Psychiatry Res. 2014 Aug 6. pii: S0165-1781(14)00645-3.

The increasing use of computers and the internet - especially among young people - apart from its positive effects, sometimes leads to excessive and pathological use.  Excessive use of the internet among Greek university students was studied within a multi-factorial context and was associated with the alexithymia and demographic factors in nonlinear correlations, forming thus a personalized emotional and demographic profile of the excessive internet users.

Internet addiction: hours spent online, behaviors and psychological symptoms. (2011)

Gen Hosp Psychiatry. 2011 Oct 28. Rome, Italy.

The aim of this study was to investigate psychopathological symptoms, behaviors and hours spent online in patients with Internet addiction disorder (IAD) at a new psychiatric service for IAD inside a policlinic IAD patients showed significantly higher scores on the IAT compared to subjects of the control group. Findings suggest that a misuse of Internet, characterized by many hours spent online avoiding interpersonal relationships with real and known people, could be an important criterion in the clinical interview in order to diagnose the IAD. The association between the lost interest in communicating with real people and psychological symptoms such as anxiety and depression could be relevant to detect IAD patients.

Internet addiction and web mediated psychopathology (2011)

Recenti Prog Med. 2011 Nov;102(11):417-20. doi: 10.1701/975.10605.

In this context, emerged disorders related to a pathological use of the network, up to forms of real addiction (Internet Addiction Disorder), similar to the use of psychotropic substances. The abuse of the Internet can seriously aggravate pre-existing psychopathological traits, which are the basis of addiction, resulting in a continuous process of disconnection from reality. The loss of interpersonal relationships, the change of mood, cognition completely oriented to the use of the network and disruption of temporal experience are common features in patients addicted to the Internet. There are also clear signs of intoxication and abstinence. Teenagers are particularly at risk, maybe because born in the "new virtual world" and therefore less aware of the risks that may ensue.

COMMENTS:  The translation is rough, but "intoxication" and "abstinence" refer to addictive behaviors and withdrawal symptoms.

Recognizing internet addiction: Prevalence and relationship to academic achievement in adolescents enrolled in urban and rural Greek high schools (2013)

J Adolesc. 2013 Apr 19. pii: S0140-1971(13)00045-6. doi: 10.1016/j.adolescence.2013.03.008.

This study aims: a) to estimate the prevalence of internet addiction among adolescents of urban and rural areas in Greece, b) to examine whether the Internet Addiction Test cut-off point is applicable to them and c) to investigate the phenomenon's association with academic achievement. Participants were 2090 adolescents (mean age 16, 1036 males, 1050 females). Young's (1998) Internet Addiction Test and her Diagnostic Questionnaire were applied. School records' grades were retrieved. A 3.1% prevalence revealed, while boys , urban residents and academic track high school students  were at higher risk. Finally, findings illustrated the syndrome's relation to worse academic achievement.

Problematic Internet use in Chinese adolescents and its relation to psychosomatic symptoms and life satisfaction. (2011)

 BMC Public Health. 2011 Oct 14;11(1):802.

Problematic Internet use (PIU) is a growing problem in Chinese adolescents. Little is known about associations of PIU with physical and psychological health. Approximately 8.1% of subjects showed PIU. Adolescents with PIU were associated with males, high school students, urban, eastern and western areas, upper self-report family economy, service type mostly used for entertainment and relieving loneliness and more frequency of Internet use. Conclusions. PIU is common among Chinese students, and PIU was significantly associated with psychosomatic symptoms and life satisfaction.

 COMMENTS: Study found 8% addiction rate for adolescents.

Determinants of Problematic Internet Use Among El-Minia High School Students, Egypt (2013)

Int J Prev Med. 2013 Dec;4(12):1429-37.

Problematic Internet Use (PIU) is a growing problem in Egyptian adolescents. This study was designed to assess the prevalence of PIU among high school students in El-Minia Governorate and to determine the personal, clinical, and social characteristics of them.

Of the 605 students, 16 (2.6%) were Problematic Internet Users (PIUs), 110 (18.2%) were Potential (PIUs). Adolescents with PIU were associated with male gender, poor friends' relations, bad family relations, irregular bedtime, and bad personal hygiene. PIUs were more likely to suffer from physical symptoms; weight gain, joint stiffness, lack of physical energy, and emotional symptoms.

The prevalence of PIU reported in this study is low, however, the Potential PIUs was high and preventative measures are recommended.

Addictive Internet Use among Korean Adolescents: A National Survey (2014)

PLoS One. 2014 Feb 5;9(2):e87819. doi: 10.1371/journal.pone.0087819.

A psychological disorder called 'Internet addiction' has newly emerged along with a dramatic increase of worldwide Internet use. However, few studies have used population-level samples nor taken into account contextual factors on Internet addiction.

We identified 57,857 middle and high school students (13-18 year olds) from a Korean nationally representative survey, which was surveyed in 2009.

To identify associated factors with addictive Internet use, two-level multilevel regression models were fitted with individual-level responses (1st level) nested within schools (2nd level) to estimate associations of individual and school characteristics simultaneously. Gender differences of addictive Internet use were estimated with the regression model stratified by gender. Significant associations were found between addictive Internet use and school grade, parental education, alcohol use, tobacco use, and substance use. Female students in girls' schools were more likely to use Internet addictively than those in coeducational school

Internet use and pathological Internet engagement in a sample of college students. (2011)

Psychiatrike. 2011 Jul-Sep;22(3):221-30.

Recent studies indicate multiple consequences of pathologically excessive Internet use. This study investigated the correlate of Internet usage, with pathological Internet engagement. Participants were 514 college students from the University of Athens who completed a questionnaire covering various aspects of Internet use, Young's Internet Addiction Test, scales investigating online gambling addiction and cybersexual addiction and scales investigating suicidal ideation and the use of psychoactive substances. Subjects at risk for developing pathological Internet engagement had significantly higher levels of online gambling addiction, cybersexual addiction, suicidal ideation and alcohol abuse, compared with other groups.

COMMENTS: Specifically states that cybersexual addiction exists.

Prevalence and risk factors of Internet addiction in high school students (2013)

Eur J Public Health. 2013 May 30.

Our study population included 1156 students, among whom 609 (52.7%) were male. The mean age of the students was 16.1 ± 0.9 years. Seventy-nine percent of the students had a computer at home, and 64.0% had a home Internet connection. In this study, 175 (15.1%) students were defined as Internet addicts. Whereas the addiction rate was 9.3% in girls, it was 20.4% in boys (P < 0.001). In this study, Internet addiction was found to have an independent relationship with gender, grade level, having a hobby, duration of daily computer use, depression and negative self-perception.

The relationship of affective temperament and emotional-behavioral difficulties to internet addiction in Turkish teenagers (2013)

ISRN Psychiatry. 2013 Mar 28;2013:961734.

The purpose of this study was to investigate the association of affective temperament profiles and emotional and behavioural characteristics with Internet addiction among high school students. The study sample included 303 high school students.

Of the sample, 6.6% were found to be addicted to Internet. According to these findings, there is a relation between the Internet addiction and affective temperament profiles, especially with anxious temperament. Furthermore, emotional and behavioural problems are more frequent in adolescents who have problematic Internet use

Problematic Internet Use among Greek university students: an ordinal logistic regression with risk factors of negative psychological beliefs, pornographic sites, and online games (2011)

Cyberpsychol Behav Soc Netw. 2011 Jan-Feb;14(1-2):51-8.

The aim of this paper is to investigate the relationships between Problematic Internet Use (PIU) among university students in Greece. Data were gathered from 2,358 university students from across Greece. The prevalence of PIU was 34.7% in our sample. On average, problematic Internet users use MSN, forums, YouTube, pornographic sites, chat rooms, advertisement sites, Google, Yahoo!, their e-mail, ftp, games, and blogs more than non-problematic Internet users. Significant risk factors for PIU were being male, enrolment in unemployment programs, presence of negative beliefs, visiting pornographic sites, and playing online games. Thus PIU is prevalent among Greek university students and attention should be given to it by health officials.

COMMENTS: The prevalence of problematic Internet use was 35% among university students in Greece.

Adolescents Over-Use of The Cyber World: Internet Addiction or Identity Exploration? (2011)

J Adolesc. 2011 Jul 29.

Participants in the study were 278 adolescents (48.5% girls; 7th-9th graders) who completed questionnaires relating to their levels of Internet use, Internet addiction, ego development, self consciousness, self-concept clarity, and personal demographic data. The study results support the general notion that adolescents' level of self-clarity is negatively related to Internet addiction and over-use. Hence, it is suggested that future studies on adolescents' Internet over-use should use qualitative rather than quantitative conceptualization and measurements in order to properly explore such a behavior and its, either positive or negative, implications.

COMMENTS: Study acknowledges that Internet addiction exists and negatively correlates it to "self-clarity". Suggests future studies examine type of Internet use, rather than amount.

Preliminary study of Internet addiction and cognitive function in adolescents based on IQ tests (2011)

Psychiatry Res. 2011 Dec 30;190(2-3):275-81. Epub 2011 Sep 6.

The Internet-addicted group had comprehension sub-item scores that were significantly lower than those of the non-addicted group. As the comprehension item reflects ethical judgement and reality testing, there may be a relationship between Internet addiction and weak social intelligence. Earlier onset of Internet addiction and longer addiction duration were associated with lower participant performance in areas related to attention.

As this study is a cross-sectional study, it is not clear whether the persons who display weak cognitive functioning are susceptible to Internet addiction or if Internet addiction causes cognitive problems. However, as brain development remains active during adolescence, the possibility that Internet addiction adversely affects the cognitive functioning of adolescents cannot be ruled out.

COMMENTS: Weak cognitive function was correlated to Internet addiction

Predictive Values of Psychiatric Symptoms for Internet Addiction in Adolescents: A 2-Year Prospective Study. Taiwan (2009)

Arch Pediatr Adolesc Med. 2009;163(10):937-943.

Objectives: To evaluate the predictive values of psychiatric symptoms for the occurrence of Internet addiction and to determine the sex differences in the predictive value of psychiatric symptoms for the occurrence of Internet addiction in adolescents.

Design: Internet addiction, depression, attention-deficit/hyperactivity disorder, social phobia, and hostility were assessed by self-reported questionnaires. Participants were then invited to be assessed for Internet addiction 6, 12, and 24 months later (the second, third, and fourth assessments, respectively).

Results: Depression, attention-deficit/hyperactivity disorder, social phobia, and hostility were found to predict the occurrence of Internet addiction in the 2-year follow-up, and hostility and attention-deficit/hyperactivity disorder were the most significant predictors of Internet addiction in male and female adolescents, respectively.

COMMENTS: This study found correlation between depression, ADHD, social phobia, and Internet Addiction.

The association between Internet addiction and psychiatric disorder: A review of the literature. Taiwan (2011)

Eur Psychiatry. 2011 Dec 6.

Internet addiction is a newly emergent disorder. It has been found to be associated with a variety of psychiatric disorders. In this review, we have recruited articles mentioning coexisting psychiatric disorders of Internet addiction from the PubMed database as at November 3, 2009. We describe the updated results for such disorders of Internet addiction, which include substance use disorder, attention-deficit hyperactivity disorder, depression, hostility, and social anxiety disorder.

On the other hand, Internet addiction should be paid more attention to when treating people with these coexisting psychiatric disorders of Internet addiction. Additionally, we also suggest future necessary research directions that could provide further important information for the understanding of this issue.

The screens culture: impact on ADHD. Canada (2011)

Atten Defic Hyperact Disord. 2011 Dec;3(4):327-34. Epub 2011 Sep 24.

Children's use of electronic media, including Internet and video gaming, has increased dramatically to an average in the general population of roughly 3 h per day. Some children cannot control their Internet use leading to increasing research on "Internet addiction." The objective of this article is to review the research on ADHD as a risk factor for Internet addiction and gaming, its complications, and what research and methodological questions remain to be addressed. Previous research has demonstrated rates of Internet addiction as high as 25% in the population and that it is addiction more than time of use that is best correlated with psychopathology. Various studies confirm that psychiatric disorders, and ADHD in particular, are associated with overuse, with severity of ADHD specifically correlated with the amount of use.

COMMENTS: States - Internet addiction may be as high as 25% in the population, and is associated with ADHD.

Problematic Internet Use in High School Students in Guangdong Province China (2011)

PLoS One. 2011; 6(5): e19660. doi: 10.1371/journal.pone.0019660

Problematic Internet Use (PIU) is a growing problem in Chinese adolescents. There are many risk factors for PIU, which are found at school and at home. This study was designed to investigate the prevalence of PIU and to investigate the potential risk factors for PIU among high school students in China. A cross-sectional study was conducted. A total of 14,296 high school students were surveyed in four cities in Guangdong province.

Problematic Internet Use was assessed by the 20-item Young Internet Addiction Test (YIAT). Information was also collected on demographics, family and school-related factors and Internet usage patterns. Of the 14,296 students, 12,446 were Internet users. Of those, 12.2% (1,515) were identified as problematic Internet users (PIUs). Conclusions/Significance: PIU is common among high school students, and risk factors are found at home and at school. Teachers and parents should pay close attention to these risk factors. Effective measures are needed to prevent the spread of this problem.

Lifestyle and Depressive Risk Factors Associated With Problematic Internet Use in Adolescents in an Arabian Gulf Culture (2013)

J Addict Med. 2013 May 9.

A total of 3000 students (12-25 years of age) were selected through multistage stratified random sampling from public and private schools and university under the overall administration of Qatar Supreme Council of Education.

Among them, 2298 students (76.6%) consented to participate in the study during September 2009 to October 2010. Data were collected using a structured questionnaire including sociodemographic details, lifestyle, and dietary habits. Problematic Internet use and depressive tendencies were measured through validated Internet Addiction Test (IAT) and BDI

Of 2298, 71.6% were males and 28.4% were females. The overall prevalence of PIU was 17.6%. This study revealed that a significantly larger proportion of males (64.4%; P = 0.001) and Qatari students (62.9%; P < 0.001) had PIU.

Effect of social support on depression of internet addicts and the mediating role of loneliness (2014)

Int J Ment Health Syst. 2014 Aug 16;8:34.

Many studies have determined the existence of an extremely close association between Internet addiction and depression. However, the reasons for the depression of Internet addicts have not been fully investigated. A total of 162 male Internet addicts completed the Emotional and Social Loneliness Scale, Multidimensional Scale of Perceived Social Support, and Self-Rating Depression Scale.

Loneliness and lack of social support are significantly correlated with depression among Internet addicts. Structural Equation Modeling results indicate that social support partially mediates loneliness and depression.

Associations Between Problematic Internet Use and Adolescents' Physical and Psychological Symptoms: Possible Role of Sleep Quality (2014)

J Addict Med. 2014 Jul 14.

To evaluate the associations between problematic Internet use (PIU) and physical and psychological symptoms among Chinese adolescents, and to investigate the possible role of sleep quality in this association.

Prevalence rates of PIU, physical symptoms, psychological symptoms, and poor sleep quality were 11.7%, 24.9%, 19.8%, and 26.7%, respectively. Poor sleep quality was found to be an independent risk factor for both physical and psychological symptoms. The effects of PIU on the 2 health outcomes were partially mediated by sleep quality.

Problematic Internet use is becoming a significant public health issue among Chinese adolescents that requires urgent attention. Excessive Internet use may not only have direct adverse health consequences but also have indirect negative effects through sleep deprivation.

Internet Addiction: A Brief Summary of Research and Practice. (2012)

Curr Psychiatry Rev. 2012 Nov;8(4):292-298.

Problematic computer use is a growing social issue which is being debated worldwide. Internet Addiction Disorder (IAD) ruins lives by causing neurological complications, psychological disturbances, and social problems. Surveys in the United States and Europe have indicated alarming prevalence rates between 1.5 and 8.2%. There are several reviews addressing the definition, classification, assessment, epidemiology, and co-morbidity of IAD and some reviews addressing the treatment of IAD. 

Relationship of Internet Addiction Severity with Depression, Anxiety, and Alexithymia, Temperament and Character in University Students (2013)

Cyberpsychol Behav Soc Netw. 2013 Jan 30.

Of the university students enrolled in the study, 12.2 percent (n=39) were categorized into the moderate/high IA group (IA 7.2 percent, high risk 5.0 percent), 25.7 percent (n=82) were categorized into the mild IA group, and 62.1 percent (n=198) were categorized into the group without IA.

Results revealed that the rate of moderate/high IA group membership was higher in men (20.0 percent) than women (9.4 percent).

Alexithymia, depression, anxiety, and novelty seeking (NS) scores were higher; whereas self-directedness (SD) and cooperativeness (C) scores were lower in the moderate/high IA group.

COMMENTS: IAD was associated with depression, anxiety, and alexithymia

Usefulness of Young's Internet Addiction Test for clinical populations (2012)

Nord J Psychiatry. 2012 Dec 18.

Background: Young's Internet Addiction Test (IAT) is one of the most widely used scales for assessing Internet addiction. Aims: The purpose of the current study was to investigate the value of IAT for subjects clinically diagnosed with Internet addiction. Results: The mean IAT score of our clinical subjects was 62.8 ± 18.2, which was below 70, the cut-off point indicating significant problems. The IAT detected only 42% of the clinical subjects as having significant problems with Internet addiction.

No significant differences in IAT scores among those with mild, moderate and severe degrees of Internet addition were found, and no association between IAT scores and duration of illness was observed. Conclusions: IAT scores were not significant correlated with clinical severity and duration of illness in a clinical population. This instrument had limited clinical utility for evaluating the severity of Internet addiction. Considerable caution is required in interpretations of IAT scores

Comments: Young's Internet addiction test was developed as a way to assess Internet addiction. This study finds that it is not all that great and misses many users who do have significant issues. Young's test relies on time spent using. The test is poor assessment tool for Internet porn addiction or related problems as time spent using has been found to be less important than applications used or use related symptoms.

Standardization study of internet addiction improvement motivation scale (2012)

Psychiatry Investig. 2012 Dec;9(4):373-8. doi: 10.4306/pi.2012.9.4.373.

 The problem of Internet addiction has drawn the attention of researchers worldwide, and because the Internet industry continues to grow, the incident rate of the disorder is increasing. In the Netherlands, it has been reported that the incident rate of Internet addiction reaches as high as 1.5 to 3.0%, and those who have Internet addiction have a difficult time adjusting to their school or workplace.1 According to another research study in Norway, 1% of the population can be classified as Internet addicted and 5.2% of the population can be classified as a latent risk group for Internet addiction. In particular, young male adults with a high education but low socioeconomic status are vulnerable to the disorder.2

In the case of Hong-Kong, 17% of research participants showed symptoms of Internet addiction and half experienced severe insomnia.3 With Internet addiction appearing to spread worldwide, it is becoming a disorder that aggravates many psychosocial problems.

Discussions of the concept and diagnosis criteria for Internet addiction are active in research circles. Goldberg used the term "addictive disorder" based on the substance addiction of Diagnostic and Statistical Manual for mental disorder 4th edition (DSM-IV) for the first time, and he refers to Internet addiction as "pathological computer use."4 Young also suggested Internet addiction diagnosis criteria, including obsessions with the Internet, tolerance, withdrawal symptoms, excessive computer use, lack of interest in other activities. He based these diagnostic criteria on those developed for pathological gambling.5

In this study, three criteria are adopted-tolerance, withdrawal, and deterioration of functional level in everyday life-to conceptualize Internet addiction.

According to a study conducted in South Korea, Internet addiction was observed in more than 30% of people aged from 10 to more than 30 years old. In particular, 46.8% of those aged 10 to 19 years old showed signs of addiction.6 Another study reported that the prevalence of Internet addiction reached 9 to 40% among adolescent group in Korea.7

The prevalence rate of Internet addiction in South Korea is higher than any other country. Internet addiction, with such high prevalence, is associated with tolerance and withdrawal symptoms, much like other addictions. As such, more and more persons are exhibiting Internet addiction. Terminating the use of the Internet provokes various psychological symptoms, which eventually reduces the individual's functional level in daily life. It can thus be said that Internet addiction is a severe disorder.

Comments: IAD rates are much higher non-European studies due the population studied - the studies from Europe include much older subjects, and some use subjects who have never used the internet. Closer examination of the data show up to 20% of males, ages 13-30 have IAD in some European studies.

Problematic internet and cell phone use Psychological behavioral and health correlates (2007)

2007, Vol. 15, No. 3 , Pages 309-320 (doi:10.1080/16066350701350247)

This study aimed to assess pathological Internet and cell-phone use in college students, and to identify psychological, health, and behavioral correlates. Logistic regression analyses indicated that heavy Internet use is associated with high anxiety; high cell-phone use is associated to being female, and having high anxiety and insomnia. The developed measures seem to be promising tools for assessing these new behavioral addictions.

Comments: Study - "heavy Internet use is associated with high anxiety; high cell-phone use is associated to being female, and having high anxiety and insomnia."  This was before smartphones.

Prevalence of perceived stress symptoms of depression and sleep disturbances in relation to information and communication technology ICT use among young adults an explorative prospective study (2007)

Computers in Human Behavior Volume 23, Issue 3, May 2007, Pages 1300–1321

The aim of this study was to prospectively investigate whether high quantity of information and communication technology (ICT) use is a risk factor for developing psychological symptoms among young ICT users. A cohort of college students responded to a questionnaire at baseline and at 1-year follow-up (n = 1127).

Exposure variables, such as different types of ICT use, and effect variables, such as perceived stress, symptoms of depression and sleep disturbances, were assessed. Prevalence ratios were computed, based on symptom-free subjects at baseline and prevalence of symptoms at follow-up. For women, high combined use of computer and mobile phone at baseline was associated with increased risk of reporting prolonged stress and symptoms of depression at follow-up, and number of short message service (SMS) messages per day was associated with prolonged stress.

Also online chatting was associated with prolonged stress, and e-mailing and online chatting were associated with symptoms of depression, while Internet surfing increased the risk of developing sleep disturbances. For men, number of mobile phone calls and SMS messages per day were associated with sleep disturbances. SMS use was also associated with symptoms of depression.

Comments: High levels of cell phone and Internet use correlates with depression, anxiety, and sleep problems.

Depression and Internet addiction in adolescents. (2007)

Psychopathology. 2007;40(6):424-30. Epub 2007 Aug 20.

A total of 452 Korean adolescents were studied.

Internet addiction was significantly associated with depressive symptoms and obsessive-compulsive symptoms. Regarding biogenetic temperament and character patterns, high harm avoidance, low self-directedness, low cooperativeness and high self-transcendence were correlated with Internet addiction. In multivariate analysis, among clinical symptoms depression was most closely related to Internet addiction, even after controlling for differences in biogenetic temperament. This study reveals a significant association between Internet addiction and depressive symptoms in adolescents.

This association is supported by temperament profiles of the Internet addiction group. The data suggest the necessity of the evaluation of the potential underlying depression in the treatment of Internet-addicted adolescents.                    

Comments: High correlation with depression. More important, depression was correlated more closely with Internet addiction than with "biogenetic temperament". That means Internet addiction caused the depression rather than depression caused the addiction.

The prevalence of computer and Internet addiction among pupils (2009)

Postepy Hig Med Dosw (Online). 2009 Feb 2;63:8-12.

This study was based on a diagnostic survey in which 120 subjects participated. The participants were pupils of three kinds of schools: primary, middle, and secondary school (high school)

The results confirmed that every fourth pupil was addicted to the Internet. Internet addiction was very common among the youngest users of computers and the Internet, especially those who had no brothers and sisters or came from families with some kind of problems. Moreover, more frequent use of the computer and the Internet was connected with higher levels of aggression and anxiety.

COMMENTS: More frequent use was associated with anxiety and aggression.

Internet adiction: definition, assessment, epidemiology and clinical management (2008)

CNS Drugs. 2008;22(5):353-65.

Internet addiction is characterized by excessive or poorly controlled preoccupations, urges or behaviours regarding computer use and internet access that lead to impairment or distress. The condition has attracted increasing attention in the popular media and among researchers, and this attention has paralleled the growth in computer (and Internet) access. Clinical samples and a majority of relevant surveys report a male preponderance.

Onset is reported to occur in the late 20s or early 30s age group, and there is often a lag of a decade or more from initial to problematic computer usage. Internet addiction has been associated with dimensionally measured depression and indicators of social isolation. Psychiatric co-morbidity is common, particularly mood, anxiety, impulse control and substance use disorders.

COMMENTS: It takes about a decade for problematic computer usage to manifest. IAD associated with depression, anxiety and social isolation.

Internet use, abuse, and dependence among students at a southeastern regional university (2007)

J Am Coll Health. 2007 Sep-Oct;56(2):137-44.

 Approximately half of the sample met criteria for Internet abuse, and one-quarter met criteria for Internet dependence. Men and women did not differ on the mean amount of time accessing the Internet each day; however, the reasons for accessing the Internet differed between the 2 groups. In addition, individuals meeting criteria for Internet abuse and dependence endorsed more depressive symptoms, more time online, and less face-to-face socialization than did those not meeting the criteria.