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

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

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

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

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

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

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

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

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

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

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

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

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

Cognitive functions in Internet addiction – a review (2019)

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

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

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

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

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

Pornographic Picture Processing Interferes with Working Memory Performance (2012)

J Sex Res. 2012 Nov 20.

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

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

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

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

Arch Sex Behav. 2013 Jun 4.

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

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

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

Background and aims

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


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.

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

in English, Russian

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Front. Hum. Neurosci., 10 October 2017 |

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

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

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

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

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

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

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

Neurobiological findings related to Internet use disorders (2016)

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

J Psychiatr Res. 2011 Jul 16.

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

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

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

Neuroreport. 2016 Aug 25.

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

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

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

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

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

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

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

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

Addictive behaviors 84 (2018): 33-39.

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

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

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

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

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

Journal Of The International Neuropsychological Society

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

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

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

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

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

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

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

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

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

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

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

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

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

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.

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Addictive Behaviors

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Psychiatry Res. 2012 Aug 11.

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Journal of Social and Clinical Psychology.

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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


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

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

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

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

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

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

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

Spontaneous Hedonic Reactions to Social Media Cues (2017)

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

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

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

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

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

Facebook Addiction Disorder in Germany (2018)

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Facebook Addiction: Onset Predictors (2018)

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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.

Structural and functional correlates of smartphone addiction (2020)

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

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

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.

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

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

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

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

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

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

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

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

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

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

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

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

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

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.

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

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

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

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

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

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

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

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

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.

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

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

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

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

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

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

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

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 (2017)

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

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.

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

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

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

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.

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

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

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

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

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

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

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

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

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.

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

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

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

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

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

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

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

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

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

Influence of dopaminergic system on internet addiction (2011)

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

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

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

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

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

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

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

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

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

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

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

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

Prog Neuropsychopharmacol Biol Psychiatry. 2012 Jun 9.

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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.

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

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

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

The 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.

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Internet addiction and poor quality of life are significantly associated with suicidal ideation of senior high school students in Chongqing, China (2019)

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.

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

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

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

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

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

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

2018 Sep 28:1-11. doi: 10.1556/2006.7.2018.87.

The aim of the study is to investigate (a) whether probable depression status assessed at baseline prospectively predicted new incidence of Internet addiction (IA) at the 12-month follow-up and (b) whether IA status assessed at baseline prospectively predicted new incidence of probable depression at follow-up.

We conducted a 12-month cohort study (n = 8,286) among Hong Kong secondary students, and derived two subsamples. The first subsample (n = 6,954) included students who were non-IA at baseline, using the Chen Internet Addiction Scale (≤63), and another included non-depressed cases at baseline (n = 3,589), using the Center for Epidemiological Studies Depression Scale (<16).

In the first subsample, 11.5% of the non-IA cases developed IA during follow-up, and probable depression status at baseline significantly predicted new incidence of IA [severe depression: adjusted odds ratio (ORa) = 2.50, 95% CI = 2.07, 3.01; moderate: ORa = 1.82, 95% CI = 1.45, 2.28; mild: ORa = 1.65, 95% CI = 1.32, 2.05; reference: non-depressed], after adjusting for sociodemographic factors. In the second subsample, 38.9% of those non-depressed participants developed probable depression during follow-up. Adjusted analysis showed that baseline IA status also significantly predicted new incidence of probable depression (ORa = 1.57, 95% CI = 1.18, 2.09).

The high incidence of probable depression is a concern that warrants interventions, as depression has lasting harmful effects in adolescents. Baseline probable depression predicted IA at follow-up and vice versa, among those who were free from IA/probable depression at baseline.

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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


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

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

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

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.

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

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

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

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.

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

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

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

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

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

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.

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

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

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

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

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

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

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

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

Zhang J1,2, Zhang Y1, Xu F1.



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


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


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


PMID: 31568011

DOI:  10.1097/MD.0000000000017283

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

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

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

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

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

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

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.

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

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

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

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

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

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

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

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

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

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 (2015)

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.

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

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

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

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

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

A Healthy Mind for Problematic Internet Use (2018)

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

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

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

The internet and children’s psychological wellbeing (2020)

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

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

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.

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

Front Psychiatry. 2019; 10: 268.

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Smartphone Nonusers: Associated Sociodemographic and Health Variables (2019)

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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.

Factors associated with Internet addiction among Tunisian adolescents (2019)

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

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

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

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

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

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

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

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

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

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

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

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.

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Problematic internet use and feelings of loneliness (2018)

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

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

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

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

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

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.

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

Computers in Human Behavior

Volume 90, January 2019, Pages 246-258


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

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

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

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

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.

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

Can J Psychiatry. 2018 Oct 2:706743718800698. doi: 10.1177/0706743718800698.

This study highlights the clinical profile of adolescents having consulted with an addiction treatment center (ATC) in Québec for a problematic internet use (PIU) to develop knowledge about these specific clients and precisely target their needs relative to treatment

The study was conducted with 80 adolescents between ages 14 and 17 (M = 15.59) who had consulted with an ACT for a PIU. Adolescents have participated in an interview documenting internet use patterns and their consequences, mental health disorder co-occurrence, and family and social relationships.

The sample was constituted of 75 boys (93.8%) and 5 girls (6.3%), who spent an average of 55.8 hours (SD = 27.22) per week on internet for non-school or professional activities. Almost all of these youths (97.5%) presented a co-occurring mental health disorder, and more than 70% had seeked help last year for a psychological problem. Results show that 92.6% feel their internet use significantly hinders their family relationships, and 50% feel it impedes their social relationships.

Contribution of stress and coping strategies to problematic Internet use in patients with schizophrenia spectrum disorders (2018)

Compr Psychiatry. 2018 Sep 26;87:89-94. doi: 10.1016/j.comppsych.2018.09.007.

Internet use is already high and increasing rapidly among people with psychotic disorders, but there have been few studies on problematic Internet use (PIU) among patients with schizophrenia spectrum disorders. This study aimed to measure the prevalence of PIU and identify the factors associated with PIU among patients with schizophrenia spectrum disorders.

A cross-sectional survey was performed that included 368 outpatients with schizophrenia spectrum disorders: 317 with schizophrenia, 22 with schizoaffective disorder, 9 with schizophreniform disorder, and 20 with other schizophrenia spectrum and psychotic disorders. The severity of psychotic symptoms and levels of personal and social functioning were assessed by the Clinician-rated Dimensions of Psychosis Symptom Severity (CRDPSS) scale and the Personal and Social Performance (PSP) scale, respectively. PIU was evaluated using Young’s Internet Addiction Test (IAT). Additionally, the Hospital Anxiety and Depression Scale (HADS), Perceived Stress Scale (PSS), Rosenberg Selfesteem Scale (RSES), and Brief Coping Orientation to Problems Experienced (COPE) Inventory were administered.

PIU was identified in 81 (22.0%) of the 368 patients with schizophrenia spectrum disorders. Subjects with PIU were significantly younger and more likely to be male. Scores on the HADS, PSS, and dysfunctional coping dimension of the Brief COPE Inventory were significantly higher, and RSES scores were significantly lower, in the PIU group. Logistic regression analysis indicated that PIU in patients was significantly associated with scores on the PSS and dysfunctional coping dimension of the Brief COPE Inventory.

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.

Investigation the relationship between internet dependence with anxiety and educational performance of high school students (2019)

J Educ Health Promot. 2019 Nov 29;8:213. doi: 10.4103/jehp.jehp_84_19.

Internet is one of the most advanced modern communication technologies. Despite the positive uses of internet, the existence of extreme behaviors and its harmful consequences has attracted the attention of all. The aim of this study was to determine the relationship between internet addiction with anxiety and educational performance.

This research is a descriptive correlative study. The statistical population of the study includes a total number of 4401 female students in the high school in the city of Ilam-Iran in the academic year of 2017-2018. The sample size includes353 students estimated using Cochran’s formula. They were selected by random cluster sampling. For data collection, the Young’s Internet Dependency Questionnaire, Academic Performance Inventory, and Marc et al., anxiety Scale were used. Data were analyzed at the significant level of α = 0.05.

The results showed a positive and significant correlation between internet dependency and students’ anxiety (P < 0.01). There is also a negative and significant correlation between internet dependency and academic performance of students (P < 0.01), and also a negative and significant correlation between anxiety and educational performance of students (P < 0.01).

On the one hand, the results indicate a high prevalence of internet dependency and its significant relationship with anxiety and academic performance in students, and on the other hand, the negative effect of internet dependency on the students’ educational performance. Therefore, it is necessary to design some intervention programs to prevent harm to students who are increasingly interacting with internet. In addition, raising the level of the students’ awareness on the complications of internet addiction and the proper use of the internet seems to be necessary.

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.

Prevalence of Internet Addiction in Iran: A Systematic Review and Meta-analysis (2018)

Addict Health. 2017 Fall;9(4):243-252.

The internet has unique properties that include ease of access, ease of use, low cost, anonymity, and its attractiveness which resulted in problems such as internet addiction. Different statistics has been reported about internet addiction rate, but there is not a suitable estimation about the growth of Internet addiction in Iran. The aim of this study is to analyze the growth of Internet addiction in Iran using meta-analysis method.

At the first stage, by searching in scientific databases such as Magiran, SID, Scopus, ISI, Embase and use of keywords like Internet addiction, 30 articles were chosen. The outcomes of the study combined together with using meta-analysis method (random effects model). The analysis of the data was performed using R and Stata software.

Based on 30 studies and sample size of 130531, the growth rate of internet addiction based on the random effects model was 20% [16-25 confidence interval (CI) of 95%]. The meta regression model showed t-hat the trend of Internet addiction growth rate in Iran increased from 2006 to 2015.

Worry and anger are associated with latent classes of problematic smartphone use severity among college students (2018)

J Affect Disord. 2018 Dec 18;246:209-216. doi: 10.1016/j.jad.2018.12.047.

Problematic smartphone use (PSU) is associated with depression and anxiety symptom severity throughout the literature. However, many important psychopathology constructs have not been examined for associations with PSU severity. Worry and anger are two psychopathology constructs receiving little empirical scrutiny in relation to PSU, but theoretically should demonstrate significant relationships. Furthermore, few studies have used person-centered analyses, such as mixture modeling, to analyze possible latent subgroups of individuals based on PSU symptom ratings.

We conducted a web survey of 300 American college students, using the Smartphone Addiction Scale-Short Version, Penn State Worry Questionnaire-Abbreviated Version, and Dimensions of Anger Reactions-5 Scale.

Conducting mixture modeling using latent profile analysis, we found most support for a three-class model of latent groups of individuals based on their PSU item ratings. Adjusting for age and sex, worry and anger scores were significantly higher in the more severe PSU classes.

Results are discussed in the context of uses and gratifications theory, as well as compensatory internet use theory, in terms of individual differences explaining excessive technology use. Limitations include the non-clinical nature of the sample.

Worry and anger may be helpful constructs in understanding the phenomenology of PSU, and psychological interventions for worry and anger may offset PSU.

Problematic Use of Mobile Phones in Australia…Is It Getting Worse? (2019)

Front Psychiatry. 2019 Mar 12;10:105. doi: 10.3389/fpsyt.2019.00105.

Rapid technological innovations over the past few years have led to dramatic changes in today’s mobile phone technology. While such changes can improve the quality of life of its users, problematic mobile phone use can result in its users experiencing a range of negative outcomes such as anxiety or, in some cases, engagement in unsafe behaviors with serious health and safety implications such as mobile phone distracted driving. The aims of the present study are two-fold. First, this study investigated the current problem mobile phone use in Australia and its potential implications for road safety. Second, based on the changing nature and pervasiveness of mobile phones in Australian society, this study compared data from 2005 with data collected in 2018 to identify trends in problem mobile phone use in Australia. As predicted, the results demonstrated that problem mobile phone use in Australia increased from the first data collected in 2005. In addition, meaningful differences were found between gender and age groups in this study, with females and users in the 18-25 year-old age group showing higher mean Mobile Phone Problem Use Scale (MPPUS) scores. Additionally, problematic mobile phone use was linked with mobile phone use while driving. Specifically, participants who reported high levels of problem mobile phone use, also reported handheld and hands-free mobile phone use while driving.

The Use of Social Media by Dental Students for Communication and Learning: Two Viewpoints: Viewpoint 1: Social Media Use Can Benefit Dental Students’ Communication and Learning and Viewpoint 2: Potential Problems with Social Media Outweigh Their Benefits for Dental Education (2019)

J Dent Educ. 2019 Mar 25. pii: JDE.019.072. doi: 10.21815/JDE.019.072.

Social media have become a major part of an interconnected society, impacting personal and professional lives. This Point/Counterpoint presents two opposing viewpoints on the question of whether social media should be used in dental education as a learning and communication tool for dental students. Viewpoint 1 argues that social media benefit student learning and should be used as a tool in dental education. This argument is based on evidence concerning use of social media and improved learning across health professions, improved peer-peer communication in clinical education, improved engagement in interprofessional education (IPE), and provision of a mechanism for safe and improved communication between practitioners and patients, as well as faculty and students. Viewpoint 2 argues that potential problems and risks in using social media outweigh any benefits found in learning and therefore social media should not be used as a tool in dental education. This viewpoint is supported by evidence of negative effects on learning, the establishment of a negative digital footprint in the public’s view, risk of privacy violations when using social media, and the new phenomenon of Internet addiction with its negative physiological effects on social media users.

Problematic Internet Use and Associated High-Risk Behavior in an Adolescent Clinical Sample: Results from a Survey of Psychiatrically Hospitalized Youth (2019)

Cyberpsychol Behav Soc Netw. 2019 Mar 21. doi: 10.1089/cyber.2018.0329.

Problematic Internet use (PIU) is a growing clinical concern to clinicians working in adolescent mental health, with significant potential comorbidities like depression and substance use. No prior study has examined associations between PIU, high-risk behavior, and psychiatric diagnoses specifically in psychiatrically hospitalized adolescents. Here, we analyzed how PIU severity correlated with preadmission Internet habits, psychiatric symptoms, and high-risk behavior in this unique population. We hypothesized that as the severity of PIU increased, so would endorsement of mood symptoms, engagement in risky behaviors, and chances of having comorbid mood and aggression-related diagnoses. We performed a cross-sectional survey on an adolescent psychiatric inpatient unit in an urban community hospital in Massachusetts. Participants were 12-20 years old (n = 205), 62.0 percent female, and of diverse racial/ethnic backgrounds. Relationships between PIU, high-risk symptoms, diagnoses, and behaviors were performed both using chi-square tests and determining Pearson correlation coefficients. Two hundred five adolescents participated in the study. PIU severity was associated with being female (p < 0.005), sexting (p < 0.05), cyberbullying (p < 0.005), and increased suicidality within the last year (p < 0.05). Adolescents with aggressive and developmental disorders, but not depressive disorders, also had significantly higher PIU scores (p ≤ 0.05). In our sample of psychiatrically hospitalized adolescents, PIU severity was significantly associated with both serious psychiatric symptoms and high-risk behaviors, including those related to suicide.

Exploring the Differences between Adolescents’ and Parents’ Ratings on Adolescents’ Smartphone Addiction (2018)

J Korean Med Sci. 2018 Dec 19;33(52):e347. doi: 10.3346/jkms.2018.33.e347

Smartphone addiction has recently been highlighted as a major health issue among adolescents. In this study, we assessed the degree of agreement between adolescents’ and parents’ ratings of adolescents’ smartphone addiction. Additionally, we evaluated the psychosocial factors associated with adolescents’ and parents’ ratings of adolescents’ smartphone addiction.

In total, 158 adolescents aged 12-19 years and their parents participated in this study. The adolescents completed the Smartphone Addiction Scale (SAS) and the Isolated Peer Relationship Inventory (IPRI). Their parents also completed the SAS (about their adolescents), SAS-Short Version (SAS-SV; about themselves), Generalized Anxiety Disorder-7 (GAD-7), and Patient Health Questionnaire-9 (PHQ-9). We used the paired t-test, McNemar test, and Pearson’s correlation analyses.

Percentage of risk users was higher in parents’ ratings of adolescents’ smartphone addiction than ratings of adolescents themselves. There was disagreement between the SAS and SAS-parent report total scores and subscale scores on positive anticipation, withdrawal, and cyberspace-oriented relationship. SAS scores were positively associated with average minutes of weekday/holiday smartphone use and scores on the IPRI and father’s GAD-7 and PHQ-9 scores. Additionally, SAS-parent report scores showed positive associations with average minutes of weekday/holiday smartphone use and each parent’s SAS-SV, GAD-7, and PHQ-9 scores.

The results suggest that clinicians need to consider both adolescents’ and parents’ reports when assessing adolescents’ smartphone addiction, and be aware of the possibility of under- or overestimation. Our results cannot only be a reference in assessing adolescents’ smartphone addiction, but also provide inspiration for future studies.

Survey of the effects of internet usage on the happiness of Japanese university students (2019)

Health Qual Life Outcomes. 2019 Oct 11;17(1):151. doi: 10.1186/s12955-019-1227-5.

Besides research on psychiatric diseases related to problematic Internet use (PIU), a growing number of studies focus on the impact of Internet on subjective well-being (SWB). However, in previous studies on the relationship between PIU and SWB, there is little data for Japanese people specifically, and there is a lack of consideration for differences in perception of happiness due to cultural differences. Therefore, we aimed to clarify how happiness is interdependent on PIU measures, with a focus on how the concept of happiness is interpreted among Japanese people, and specifically among Japanese university students.

A paper-based survey was conducted with 1258 Japanese university students. Respondents were asked to fill out self-report scales regarding their happiness using the Interdependent Happiness Scale (IHS). The relationship between IHS and Internet use (Japanese version of the Internet addiction test, JIAT), use of social networking services, as well as social function and sleep quality (Pittsburgh Sleep Quality Index, PSQI) were sought using multiple regression analyses.

Based on multiple regression analyses, the following factors related positively to IHS: female gender and the number of Twitter followers. Conversely, the following factors related negatively to IHS: poor sleep, high- PIU, and the number of times the subject skipped a whole day of school.

It was shown that there was a significant negative correlation between Japanese youths’ happiness and PIU. Since epidemiological research on happiness that reflects the cultural background is still scarce, we believe future studies shall accumulate similar evidence in this regard.


The role of self-esteem in Internet addiction within the context of comorbid mental disorders: Findings from a general population-based sample (2018)

J Behav Addict. 2018 Dec 26:1-9. doi: 10.1556/2006.7.2018.130.

Internet Addiction (IA) has consistently been related to comorbid psychiatric disorders and lowered self-esteem. However, most studies relied on self-report questionnaires using non-representative samples. This study aims to analyze the relative impact of self-esteem and comorbid psychopathology with lifetime IA in a population-based sample of excessive Internet users using clinical diagnoses assessed in a personal interview.

The sample of this study is based on a general population survey. Using the Compulsive Internet Use Scale, all participants with elevated Internet use scores were selected and invited to a follow-up interview. Current DSM-5 criteria for Internet gaming disorder were rephrased to apply to all Internet activities. Out of 196 participants, 82 fulfilled the criteria for IA. Self-esteem was measured with the Rosenberg’s Self-Esteem Scale.

Self-esteem is significantly associated with IA. For every unit increase in self-esteem, the chance of having IA decreased by 11%. By comparison, comorbidities such as substance-use disorder (excluding tobacco), mood disorder, and eating disorder were significantly more likely among Internet-addicted than in the non-addicted group. This could not be reported for anxiety disorders. A logistic regression showed that by adding self-esteem and psychopathology into the same model, self-esteem maintains its strong influence on IA.

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.

Associations between emotion recognition and social networking site addiction (2019)

Psychiatry Res. 2019 Nov 1:112673. doi: 10.1016/j.psychres.2019.112673

With the widespread use of the internet today, many studies have been conducted regarding the use of social networking sites (SNS). Despite the growing literature on the effects of SNS on human life, there are limited successful therapeutic interventions for SNS addiction. Our study aimed to elucidate the potential role of emotion recognition in the development of SNS addiction and to propose novel strategies for alleviating problems emerging from SNS addiction. A total of 337 individuals participated in the study. A sociodemographic data form, the Reading the Mind in the Eyes Test (RMET), and the Social Media Addiction Scale (SMAS) were administered. The results revealed the presence of emotion recognition deficits among individuals with SNS addiction, relative to non-addicts. RMET positive and negative scores were associated with SNS addiction in a negative direction. Additionally, RMET negative scores predicted.

The Digital Addiction Scale for Children: Development and Validation (2019)

Cyberpsychol Behav Soc Netw. 2019 Nov 22. doi: 10.1089/cyber.2019.0132.

Researchers worldwide have developed and validated several scales to assess various forms of adults’ digital addiction. The urge for some of these scales found support in World Health Organization’s inclusion of gaming disorder as a mental health condition in its eleventh revision of the International Classification of Diseases in June 2018. Additionally, several studies have shown that children are starting to use digital devices (DDs) (e.g., tablets and smartphones) at a very young age, including playing video games and engaging in social media. Consequently, the need for early detection of the risk of digital addiction among children is becoming more of a necessity. In the present study, the Digital Addiction Scale for Children (DASC)-a 25-item self-report instrument-was developed and validated to assess the behavior of children 9 to 12 years old in association with DD usage, including video gaming, social media, and texting. The sample comprised 822 participants (54.2 percent males), from grade 4 to grade 7. The DASC showed excellent internal consistency reliability (α = 0.936) and adequate concurrent and criterion-related validities. The results of the confirmatory factor analysis showed that the DASC fitted the data very well. The DASC paves the way to (a) help in early identification of children at risk of problematic use of DDs and/or becoming addicted to DDs and (b) stimulate further research concerning children from different cultural and contextual settings.

Personal Factors, Internet Characteristics, and Environmental Factors Contributing to Adolescent Internet Addiction: A Public Health Perspective (2019)

Int J Environ Res Public Health. 2019 Nov 21;16(23). pii: E4635. doi: 10.3390/ijerph16234635.

Individual characteristics, family- and school-related variables, and environmental variables have equal importance in understanding Internet addiction. Most previous studies on Internet addiction have focused on individual factors; those that considered environmental influence typically only examined the proximal environment. Effective prevention and intervention of Internet addiction require a framework that integrates individual- and environmental-level factors. This study examined the relationships between personal factors, family/school factors, perceived Internet characteristics, and environmental variables as they contribute to Internet addiction among adolescents based on the public health model. A representative sample of 1628 junior high school students from 56 regions in Seoul and Gyeonggi-do participated in the study via questionnaires with the cooperation of the Ministry of Health and Welfare and the district office of education. The study analyzed psychological factors, family cohesion, attitudes toward academic activities, Internet characteristics, accessibility to PC cafés, and exposure to Internet game advertising. About 6% of the adolescents were categorized as being in the severely addicted group. Between-group comparisons showed that the addicted group had started using the Internet earlier; had higher levels of depression, compulsivity, and aggressiveness as well as lower family cohesion; and reported higher accessibility to PC cafés and exposure to Internet game advertising. Multiple logistic regression indicated that for adolescents, environmental factors had a greater influence than family or school-related factors.

The impacts of internet addiction on depression, physical activity level and trigger point sensitivity in Turkish university students (2019)

J Back Musculoskelet Rehabil. 2019 Nov 15. doi: 10.3233/BMR-171045.

Internet addiction (IA), defined as excessive, time consuming, uncontrollable use of the internet, has become a widespread problem. In this study, we investigated the impact of internet addiction on depression, physical activity level, and latent trigger point sensitivity in Turkish university students.

A total of 215 university students (155 females and 60 males) who were between 18-25 years of age participated in the study. Using the Addiction Profile Index Internet Addiction Form (APIINT), we identified 51 people as non-internet-addicted (non-IA) (Group 1: 10 male/41 female) and 51 as internet-addicted (IA) (Group 2: 7 male/44 female). APIINT, International Physical Activity Questionnaire-Short-Form (IPAQ), Beck Depression Inventory (BDI), and Neck Disability Index (NDI) were administered to both groups, and the pressure-pain threshold (PPT) in upper/middle trapezius latent trigger points area was measured.

The internet addiction rate was 24.3% in our students. Compared with the non-IA group, the daily internet use time and BDI and NDI scores were higher (all p< 0.05), while the IPAQ walking (p< 0.01), IPAQ total (p< 0.05), and PPT values (p< 0.05) were lower in the IA group.

IA is a growing problem. This addiction may lead to musculoskeletal problems and can have consequences involving the level of physical activity, depression, and musculoskeletal disorders, particularly in the neck.

New age technology and social media: adolescent psychosocial implications and the need for protective measures (2019)

Current Opinion in Pediatrics: February 2019 – Volume 31 – Issue 1 – p 148–156

doi: 10.1097/MOP.0000000000000714

Purpose of review In recent years, breakthroughs and advancements in new age technology have revolutionized the way children communicate and interact with the world around them. As social media platforms such as Facebook, Instagram, and Snapchat continue to grow in popularity, their usage has raised concerns about their role and impact on adolescent development and behavior. This review examines the psychosocial implications of social media usage on youth outcomes related to body image, socialization, and adolescent development. It discusses ways that clinicians and parents can effectively safeguard their children from the potential threats posed by digital media while providing a fact sheet for parents that addresses these concerns and summarizes recommended strategies to combat them.

Recent findings While social media platforms continue to experience surges in popularity, mounting evidence suggests significant correlations between their usage and adolescent mental health and behavioral issues. Increased social media usage has been linked to diminished self-esteem and body satisfaction, elevated risk of cyber-bullying, heightened exposure to pornographic material, and risky sexual behaviors.

Summary Given how new age technology is steadily permeating everyday life, greater efforts are needed to inform adolescent users and their families about the negative consequences of social media usage. Pediatricians and parents must take cautionary measures to reduce psychosocial risks and ensure the online safety of children.

Effects of screentime on the health and well-being of children and adolescents: a systematic review of reviews (2019)

Objectives To systematically examine the evidence of harms and benefits relating to time spent on screens for children and young people’s (CYP) health and well-being, to inform policy.

Methods Systematic review of reviews undertaken to answer the question ‘What is the evidence for health and well-being effects of screentime in children and adolescents (CYP)?’ Electronic databases were searched for systematic reviews in February 2018. Eligible reviews reported associations between time on screens (screentime; any type) and any health/well-being outcome in CYP. Quality of reviews was assessed and strength of evidence across reviews evaluated.

Results 13 reviews were identified (1 high quality, 9 medium and 3 low quality). 6 addressed body composition; 3 diet/energy intake; 7 mental health; 4 cardiovascular risk; 4 for fitness; 3 for sleep; 1 pain; 1 asthma. We found moderately strong evidence for associations between screentime and greater obesity/adiposity and higher depressive symptoms; moderate evidence for an association between screentime and higher energy intake, less healthy diet quality and poorer quality of life. There was weak evidence for associations of screentime with behaviour problems, anxiety, hyperactivity and inattention, poorer self-esteem, poorer well-being and poorer psychosocial health, metabolic syndrome, poorer cardiorespiratory fitness, poorer cognitive development and lower educational attainments and poor sleep outcomes. There was no or insufficient evidence for an association of screentime with eating disorders or suicidal ideation, individual cardiovascular risk factors, asthma prevalence or pain. Evidence for threshold effects was weak. We found weak evidence that small amounts of daily screen use is not harmful and may have some benefits.

Conclusions There is evidence that higher levels of screentime is associated with a variety of health harms for CYP, with evidence strongest for adiposity, unhealthy diet, depressive symptoms and quality of life. Evidence to guide policy on safe CYP screentime exposure is limited.

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).

Internet Addiction and Depression in Chinese Adolescents: A Moderated Mediation Model (2019)

Front Psychiatry. 2019 Nov 13;10:816. doi: 10.3389/fpsyt.2019.00816.

Research has revealed that Internet addiction is a risk factor for adolescents’ development of depressive symptoms, although the underlying mechanisms are largely unknown. The present study examines the mediating role of positive youth development and the moderating role of mindfulness to determine the association between Internet addiction and depression. A sample of 522 Chinese adolescents completed measures related to Internet addiction, positive youth development, mindfulness, depression, and their background information, for which the results reveal that positive youth development mediates the relation between Internet addiction and depression. Moreover, the associations between both Internet addiction and depression as well as positive youth development and depression are moderated by mindfulness. These two effects were stronger for adolescents with low mindfulness than for those with high mindfulness. The present study contributes to a more thorough understanding of how and when Internet addiction increases the risk of depression in adolescents, suggesting that Internet addiction may affect adolescent depression through positive youth development and that mindfulness can alleviate the negative effect of Internet addiction or a low level of psychological resources on depression. The implications for research and practice are finally discussed.

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.

Association Between Internet Addiction and the Risk of Musculoskeletal Pain in Chinese College Freshmen – A Cross-Sectional Study (2019)

Front Psychol. 2019 Sep 3;10:1959. doi: 10.3389/fpsyg.2019.01959.

It is well established that increased internet use is related to an increased risk of musculoskeletal pain among adolescents. The relationship between internet addiction (IA), a unique condition involving severe internet overuse, and musculoskeletal pain has, however, not been reported. This study aimed to investigate the association between IA and the risk of musculoskeletal pain among Chinese college students.

A cross-sectional study was conducted among 4211 Chinese college freshmen. IA status was evaluated using the 20-item Young’s Internet Addiction Test (IAT). IA was defined as internet addiction score ≥50 points. Musculoskeletal pain was assessed using a self-reported questionnaire. Multiple logistic regression analysis was performed to determine association between IA categories (normal, mild, and moderate-to-severe) and musculoskeletal pain.

This cross-sectional study showed that severe IA was associated with a higher risk of musculoskeletal pain in Chinese college freshmen. In future research, it will be necessary to explore causality regarding this relationship using interventional studies.

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.

Prevalence of excessive internet use and its association with psychological distress among university students in South India (2018)

Objectives: This study was set up to examine the internet use behaviors, internet addiction (IA), and its association with psychological distress primarily depression among a large group of university students from South India.

Methods: Totally 2776 university students aged 18–21 years; pursuing undergraduate studies from a recognized university in South India participated in the study. The patterns of internet use and socioeducational data were collected through the internet use behaviors and demographic data sheet, IA test (IAT) was utilized to assess IA and psychological distress primarily depressive symptoms were evaluated with Self-Report Questionnaire-20.

Results: Among the total n = 2776, 29.9% (n = 831) of university students met criterion on IAT for mild IA, 16.4% (n = 455) for moderate addictive use, and 0.5% (n = 13) for severe IA. IA was higher among university students who were male, staying in rented accommodations, accessed internet several times a day, spent more than 3 h per day on the Internet and had psychological distress. Male gender, duration of use, time spent per day, frequency of internet use, and psychological distress (depressive symptoms) predicted IA.

Conclusions: IA was present among a substantial proportion of university students which can inhibit their academic progress and impact their psychological health. Early identification of risk factors of IA can facilitate the effective prevention and timely initiation of treatment strategies for IA and psychological distress among university students.

Gender Differences in Smartphone Addiction Behaviors Associated With Parent-Child Bonding, Parent-Child Communication, and Parental Mediation Among Korean Elementary School Students.

J Addict Nurs. 2018 Oct/Dec;29(4):244-254. doi: 10.1097/JAN.0000000000000254.

This study investigated the gender differences in smartphone addiction (SA) behaviors associated with parent-child bonding, parent-child communication, and parental mediation among Korean elementary school students aged 11-13 years.

A sample of 224 smartphone users (112 boys and 112 girls) was surveyed in a cross-sectional study. Descriptive statistics and multiple regression analysis were conducted to investigate the predictors of SA behaviors based on gender differences using SPSS Win 23.0 software.

Of the participants, 14.3% (15.18% boys and 13.39% girls) were in the SA behaviors risk group, and the prevalence of SA behaviors was not significantly different between gender groups. In multiple stepwise regression analysis, less active safety mediation; longer duration of smartphone use; more use of smartphones for games, videos, or music; and less restrictive mediation were linked to higher SA behaviors in boys, and these indicators accounted for 22.1% of the variance in SA behaviors. Longer duration of smartphone use, less active use mediation, worse parent-child communication, and more use of smartphones for text, chatting, or social network sites were linked to higher SA behaviors in girls, and these indicators accounted for 38.2% of the variance in SA behaviors.



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.

Problematic Social Networking Site Use and Comorbid Psychiatric Disorders: A Systematic Review of Recent Large-Scale Studies (2018)

Front Psychiatry. 2018 Dec 14;9:686. doi: 10.3389/fpsyt.2018.00686.


Background and Aims: Research has shown a potential association between problematic social networking site (SNS) use and psychiatric disorders. The primary objective of this systematic review was to identify and evaluate studies examining the association between problematic SNS use and comorbid psychiatric disorders.

Sampling and Methods: A literature search was conducted using the following databases: PsychInfo, PsycArticles, Medline, Web of Science, and Google Scholar. Problematic SNS use (PSNSU) and its synonyms were included in the search. Information was extracted based on problematic SNS use and psychiatric disorders, including attention deficit and hyperactivity disorder (ADHD), obsessive compulsive disorder (OCD), depression, anxiety, and stress. The inclusion criteria for papers to be reviewed were (i) being published since 2014 onwards, (ii) being published in English, (iii) having population-based studies with sample sizes >500 participants, (iv) having specific criteria for problematic SNS use (typically validated psychometric scales), and (v) containing empirical primary data reporting on the correlation between PSNSU and psychiatric variables. A total of nine studies met the predetermined inclusion and exclusion criteria.

Results: The findings of the systematic review demonstrated that most research has been conducted in Europe and all comprised cross-sectional survey designs. In eight (of the nine) studies, problematic SNS use was correlated with psychiatric disorder symptoms. Of the nine studies (some of which examined more than one psychiatric symptom), there was a positive association between PSNSU and depression (seven studies), anxiety (six studies), stress (two studies), ADHD (one study), and OCD (one study).

Conclusions: Overall, the studies reviewed showed associations between PSNSU and psychiatric disorder symptoms, particularly in adolescents. Most associations were found between PSNSU, depression, and anxiety.

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.

Susceptibility and perceptions of excessive internet use impact on health among Vietnamese youths (2019)

Addict Behav. 2019 Jan 31. pii: S0306-4603(18)31238-3. doi: 10.1016/j.addbeh.2019.01.043.

Studies performed worldwide show excessive Internet use could have a negative impact on health. However, Internet use studies in Vietnam are limited. In this study, we reported a high prevalence of frequent Internet usage among Vietnamese youth between 16 and 30 years old. Of 1200 participants, almost 65% reported using the Internet daily. Moreover, 34.3% of the participants reported feeling anxious or uncomfortable after not using the Internet for one day irrespective of their gender, and 40% believed using the Internet frequently did not affect their health. Of those, there was a higher proportion of women than men that held this belief (42.1% vs. 35.9%, respectively, p = .03). In this cohort, undergraduate students were more likely than blue-collar workers to believe that frequent Internet use could affect health. Yet, undergraduate [OR = 1.50, 95%CI = (1.08, 2.09), p < .05)] and high school students (OR = 1.54, 95%CI = 1.00, 2.37), p < .1) were more likely than blue collar workers to feel anxious or uncomfortable after a day without the Internet. Participants in urban areas were more than twice as likely than those from rural areas to believe the Internet did not affect their health [(OR = 0.60, 95%CI = (0.41,0.89), p < .01)]. Lastly, participants between 16 and 18 years old were less likely to believe in the negative impact of the Internet on health than older participants.

The Relation Between Emotional Intelligence and Internet Addiction in Katowice High School Students (2019)

Psychiatr Danub. 2019 Sep;31(Suppl 3):568-573.

1450 high school students from Katowice, at the age from 18 to 21 years took part in an anonymous survey consisting of three parts: The Trait Emotional Intelligence Questionnaire – Short Form (TEIQue-SF), Internet Addiction Test and authorial test giving information about the way of spending time online. The questionnaires were collected from May 2018 to January 2019.

1.03% of the respondents fulfilled the Internet addiction criteria. Students at risk for addiction (33.5%) turned out to be a larger group. A statistically significant correlation between TEIQue-SF and Internet Addiction Test score (P<0.0001, r=-0.3308) was observed. Another significant correlation was found between TEIQue-SF score and amount of time spend on the Internet (p<0.0001, r=-0.162).

A significant part of high school students used Internet excessively. Such behaviours were positively correlated with lower EI test results.

Relationship between Self-Identity Confusion and Internet Addiction among College Students: The Mediating Effects of Psychological Inflexibility and Experiential Avoidance (2019)

Int J Environ Res Public Health. 2019 Sep 3;16(17). pii: E3225. doi: 10.3390/ijerph16173225.

Internet addiction (IA) has become a major public health problem among college students. The aim of this study was to examine the relationship between self-identity confusion and IA and the mediating effects of psychological inflexibility and experiential avoidance (PI/EA) indicators in college students. A total of 500 college students (262 women and 238 men) were recruited. Their levels of self-identity were evaluated using the Self-Concept and Identity Measure. Their levels of PI/EA were examined using the Acceptance and Action Questionnaire-II. The severity of IA was assessed using the Chen Internet Addiction Scale. The relationships among self- identity, PI/EA, and IA were examined using structural equation modeling. The severity of self-identity confusion was positively associated with both the severity of PI/EA and the severity of IA. In addition, the severity of PI/EA indicators was positively associated with the severity of IA. These results demonstrated that the severity of self-identity confusion was related to the severity of IA, either directly or indirectly. The indirect relationship was mediated by the severity of PI/EA. Self-identity confusion and PI/EA should be taken into consideration by the community of professionals working on IA. Early detection and intervention of self-identity confusion and PI/EA should be the objectives for programs aiming to lower the risk of IA.

Associations Among Resilience, Stress, Depression, and Internet Gaming Disorder in Young Adults (2019)

Int J Environ Res Public Health. 2019 Aug 31;16(17). pii: E3181. doi: 10.3390/ijerph16173181.

Background and Aims: Using gaming to escape emotional difficulty has been suggested to be a candidate mechanism contributing to Internet gaming disorder (IGD). This study evaluated the associations among resilience, perceived stress, depression, and IGD.

Methods: A total of 87 participants in an IGD group and 87 participants in a control group were recruited into this study. IGD was diagnosed using the Diagnostic and Statistical Manual of Mental Disorders. Stress levels, resilience, and depression were measured by a self-reported questionnaire.

Results: The IGD group had a lower resilience, higher perceived stress, and depression than the control group. Hierarchical regression analysis demonstrated that resilience was associated with IGD when perceived stress was controlled. After depression was controlled, resilience and perceived stress were not associated with IGD. Among the IGD group, those with low resilience had higher depression. Furthermore, discipline was the resilience characteristic associated with IGD.

Conclusions: Low resilience was associated with a higher risk of IGD. IGD individuals with low resilience had higher depression. Depression was more associated with IGD than resilience. Depression assessments and stress coping interventions should be provided for individuals with IGD who exhibit low resilience or high stress.

Cognitive mechanism of intimate interpersonal relationships and loneliness in internet-addicts: An ERP study (2019)

2019 Jul 24;10:100209. doi: 10.1016/j.abrep.2019.100209.

Interpersonal relationship and loneliness are important factors affecting internet addictive behavior of individuals. In the present study, we investigated intimate interpersonal relationships and loneliness in internet-addicts. We recorded event-related potentials (ERPs) of 32 internet addicts and 32 non internet-addicts. Participants viewed intimate-/conflict-relationship, happy/lonely, and neutral images. Results concerning attention probes showed that the accuracy rate of attention probes of internet-addicts was significantly lower than that of non internet-addicts; whereas, there was no significant difference in the reaction time of attention probes. Moreover, the differences in the mean amplitude and latency of P1, N1, N2P3, and LPP between internet-addicts and non internet-addicts were insignificant. Then, we found that the P1 amplitude of conflict images was significantly higher than that of intimate images among non internet-addicts; whereas internet-addicts indicated an insignificant difference between the two types of images. The P1 amplitude of lonely images was significantly higher than that of happy images among internet-addicts, but non internet-addicts were insignificant. The questionnaire data also obtained similar conclusions based on the EEG data. Finally, internet-addicts reported significantly higher loneliness scores than those of non internet-addicts. These results suggested that the social cognitive function of internet-addicts was probably impaired, especially in the cognition of interpersonal conflict. Furthermore, internet-addicts are likely to keep poor interpersonal relationships, which may induce more loneliness.

Data on the relationship between internet addiction and stress among Lebanese medical students in Lebanon (2019)

Data Brief. 2019 Aug 6;25:104198. doi: 10.1016/j.dib.2019.104198.

Stress and behavioral addiction are becoming major health problems growing in strength and prevalence. They are often associated with a large array of debilitating diseases and conditions including psychosocial impairments. Medical students remain a vulnerable territory for developing stress and addiction mainly relating to Internet use. Data was gathered from medical students around Lebanon on the relationship between stress and internet addiction. The data in this article provides demographic data about medical students in Lebanon, their stress levels, sources of stress as well as the level of internet addiction recorded in relation to their stress levels. The analyzed data is provided in the tables included in this article.

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.

Problematic internet use among students in South-East Asia: Current state of evidence (2018)

Indian J Public Health. 2018 Jul-Sep;62(3):197-210. doi: 10.4103/ijph.IJPH_288_17.

Problematic Internet use (PIU) among students has become a significant mental health concern. Our goals were to review the existing studies on problematic Internet from Southeast Asian Region and examine: the prevalence for PIU among students; explore for sociodemographic and clinical correlates; and assess the physical, mental, and psychosocial impact of PIU in this population. All studies conducted among population of the Southeast Asia, involving students (school students to postgraduate students) of any age which explored etiological factors and/or the prevalence or any other factor associated with PIU/Internet addiction were considered eligible for the present review. The electronic databases of PubMed and Google Scholar were systematically searched for the relevant published studies up to and including October 2016. Our search strategy yielded 549 articles, 295 of which were eligible for screening based on their publication in English language in a peer-reviewed journal. Of these, a total of 38 studies met the inclusion criteria and were included in the review. The prevalence of severe PIU/Internet addiction ranged from 0 to 47.4%, whereas the prevalence of Internet overuse/possible Internet addiction ranged from 7.4% to 46.4% among students from Southeast Asia. Physical impairments in the form of insomnia (26.8%), daytime sleepiness (20%), and eye strain (19%) were also reported among problem users. There is a need to conduct further research in this area to explore the protective and risk factors associated with it and also longitudinally assess the trajectories of the outcome.

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.

Exercise as an Alternative Approach for Treating Smartphone Addiction: A Systematic Review and Meta-Analysis of Random Controlled Trials (2019)

Int J Environ Res Public Health. 2019 Oct 15;16(20). pii: E3912. doi: 10.3390/ijerph16203912.

With the emergence of electronic products, smartphones have become an indispensable tool in our daily life. On the other hand, smartphone addiction has become a public health issue. To help reduce smartphone addiction, cost-effective interventions such as exercise are encouraged.

We therefore performed a systematic review and meta-analysis evaluating existing literature on the rehabilitative effects of exercise interventions for individuals with a smartphone addiction.

We searched PubMed, Web of Science, Scopus, CNKI, and Wanfang from inception to September 2019. Nine eligible randomized controlled trials (RCT) were finally included for meta-analysis (SMD represents the magnitude of effect of exercise) and their methodological quality were assessed using the PEDro scale.

We found significant positive effects of exercise interventions (Taichi, basketball, badminton, dance, run, and bicycle) on reducing the total score (SMD = -1.30, 95% CI -1.53 to -1.07, p < 0.005, I2 = 62%) of smartphone addiction level and its four subscales (withdrawal symptom: SMD = -1.40, 95% CI -1.73 to -1.07, p < 0.001, I2 = 81%; highlight behavior: SMD = -1.95, 95% CI -2.99 to -1.66, p < 0.001, I2 = 79%; social comfort: SMD = -0.99, 95% CI -1.18 to -0.81, p = 0.27, I2 = 21%; mood change: SMD = -0.50, 95% CI 0.31 to 0.69, p = 0.25, I2 = 25%). Furthermore, we found that individuals with severe addiction level (SMD = -1.19, I2 = 0%, 95%CI:-1.19 to -0.98) benefited more from exercise engagement, as compared to those with mild to moderate addiction levels (SMD = – 0.98, I2 = 50%, 95%CI:-1.31 to -0.66); individuals with smartphone addiction who participated in exercise programs of 12 weeks and above showed significantly greater reduction on the total score (SMD = -1.70, I2 = 31.2%, 95% CI -2.04 to -1.36, p = 0.03), as compared to those who participated in less than 12 weeks of exercise intervention (SMD = -1.18, I2 = 0%, 95% CI-1.35 to -1.02, p < 0.00001). In addition, individuals with smartphone addiction who participated in exercise of closed motor skills showed significantly greater reduction on the total score (SMD = -1.22, I2 = 0 %, 95% CI -1.41 to -1.02, p = 0.56), as compared to those who participated in exercise of open motor skills (SMD = -1.17, I2 = 44%, 95% CI-1.47 to -0.0.87, p = 0.03).

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%).

End-user frustrations and failures in digital technology: exploring the role of Fear of Missing Out, Internet addiction and personality (2018)

Heliyon. 2018 Nov 1;4(11):e00872. doi: 10.1016/j.heliyon.2018.e00872.

The present study aimed to explore the potential relationship between individual differences in responses to failures with digital technology. In total, 630 participants (50% male) aged between 18-68 years (M = 41.41, SD = 14.18) completed an online questionnaire. This included a self-report, response to failures in digital technology scale, a measure of Fear of Missing Out, Internet addiction, and the BIG-5 personality traits. Fear of Missing Out, Internet addiction, extraversion, and neuroticism all served as significant positive predictors for maladaptive responses to failures in digital technology. Agreeableness, conscientiousness, and openness acted as significant negative predictors for maladaptive responses to failures in digital technology. The responses to failures in digital technology scale presented good internal reliability, with items loading onto four key factors, these being; ‘maladaptive responses’, ‘adaptive responses’, ‘external support and venting frustrations’, and ‘anger and resignation’.

A pilot study of a group mindfulness-based cognitive-behavioral intervention for smartphone addiction among university students (2018)

J Behav Addict. 2018 Nov 12:1-6. doi: 10.1556/2006.7.2018.103.

Mindfulness-based intervention (MBI) has been applied in behavioral addiction studies in recent years. However, few empirical studies using MBI have been conducted for smartphone addiction, which is prevalent among Chinese university students. The aim of this study was to investigate the effectiveness of a group mindfulness-based cognitive-behavioral intervention (GMCI) on smartphone addiction in a sample of Chinese university students.

Students with smartphone addiction were divided into a control group (n = 29) and an intervention group (n = 41). The students in the intervention group received an 8-week GMCI. Smartphone addiction was evaluated using scores from the Mobile Phone Internet Addiction Scale (MPIAS) and self-reported smartphone use time, which were measured at the baseline (1st week, T1), post-intervention (8th week, T2), the first follow-up (14th week, T3), and the second follow-up (20th week, T4).

Twenty-seven students in each group completed the intervention and the follow-up. Smartphone use time and MPIAS scores significantly decreased from T1 to T3 in the intervention group. Compared with the control group, the intervention group had significantly less smartphone use time at T2, T3, and T4 and significantly lower MPIAS scores at T3.

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.

Prevalence and Correlates of Excessive Smartphone Use among Medical Students: A Cross-sectional Study (2019)

Indian J Psychol Med. 2019 Nov 11;41(6):549-555. doi: 10.4103/IJPSYM.IJPSYM_75_19.

Increasing smartphone use has led to the introduction of smartphone addiction as a behavioral addiction with detrimental effects on health. This phenomenon has not been widely studied in the Indian context. This study assessed the rate of smartphone addiction in a sample of medical students, with a focus on its correlation with sleep quality and stress levels.

A cross-sectional study was conducted between November 2016 and January 2017 in 195 medical students. Their smartphone use, level of smartphone addiction, sleep quality, and perceived stress levels were measured using the Smartphone Addiction Scale-Short Version (SAS-SV), the Pittsburgh Sleep Quality Index (PSQI), and the Perceived Stress Scale (PSS-10), respectively.

Of the 195 students, 90 (46.15%) had smartphone addiction as per the scale. A self-reported feeling of having smartphone addiction, use of the smartphone right before sleeping, PSS scores, and PSQI scores were found to be significantly associated with the SAS-SV scores. Significant positive correlations were observed between the SAS-SV and PSS-10 scores, and the SAS-SV and PSQI scores.

There is a high magnitude of smartphone addiction in medical students of a college in Western Maharashtra. The significant association of this addiction with poorer sleep quality and higher perceived stress is a cause for concern. The high self-awareness among students about having smartphone addiction is promising. However, further studies are required to determine whether this self-awareness leads to treatment seeking. Further studies are required to explore our finding of the association of smartphone addiction with using the smartphone before sleeping.

Patterns, influencing factors and mediating effects of smartphone use and problematic smartphone use among migrant workers in Shanghai, China (2019)

Int Health. 2019 Oct 31;11(S1):S33-S44. doi: 10.1093/inthealth/ihz086.

With the popularization of smartphones in China, the conditions of smartphone use (SU) and problematic smartphone use (PSU) among migrant workers are unknown. This study explored the patterns and influencing factors of SU and PSU in migrant workers in Shanghai, China. Furthermore, the mediation effects of PSU in the link between SU and some psychological factors were also examined.

Questionnaires containing the Mobile Phone Addiction Index, Patient Health Questionnaire, World Health Organization Five-item Well-being Index and other items, including demographics, sleep quality, job stress and SU, were distributed to 2330 migrant workers by trained investigators in six districts of Shanghai from June to September 2018.

Of the 2129 returned questionnaires, 2115 were valid. SU and PSU varied according to certain demographics. Many demographics, psychological factors, sleep quality and main smartphone applications were influencing factors for SU and PSU. PSU played a mediating role in the link between daily SU time and psychological factors, including depression, mental health and job stress.

Relative risks of Internet-related addictions and mood disturbances among college students: a 7-country/region comparison (2018)

Public Health. 2018 Oct 19;165:16-25. doi: 10.1016/j.puhe.2018.09.010.

This study aimed to determine the relative risks of addiction to the Internet, online gaming and online social networking of college students in six Asian countries/regions (Singapore, Hong Kong [HK]/Macau, China, South Korea, Taiwan and Japan) compared with students in the United States (US). It also explored the relative risks of depression and anxiety symptoms among students with Internet-related addictions from these countries/regions.

A convenience sample of 8067 college students aged between 18 and 30 years was recruited from seven countries/regions. Students completed a survey about their use of the Internet, online gaming and online social networking as well as the presence of depression and anxiety symptoms.

For all students, the overall prevalence rates were 8.9% for Internet use addiction, 19.0% for online gaming addiction and 33.1% for online social networking addiction. Compared with the US students, Asian students showed higher risks of online social networking addiction but displayed lower risks of online gaming addiction (with the exception of students from HK/Macau). Chinese and Japanese students also showed higher risks of Internet addiction compared with the US students. In general, addicted Asian students were at higher risks of depression than the addicted US students, especially among Asian students who were addicted to online gaming. Addicted Asian students were at lower risks of anxiety than the addicted US students, especially among Asian students who were addicted to online social networking, and addicted students from HK/Macau and Japan were more likely to have higher relative risks of depression.

There are country/regional differences in the risks of Internet-related addictions and psychiatric symptoms. It is suggested that country/region-specific health education programmes regarding Internet-related addictions are warranted to maximise the efficiency of prevention and intervention. These programmes should attempt to tackle not only problematic Internet-related behaviours but also mood disturbances among college students.

Short version of the Smartphone Addiction Scale in Chinese adults: Psychometric properties, sociodemographic, and health behavioral correlates (2018)

J Behav Addict. 2018 Nov 12:1-9. doi: 10.1556/2006.7.2018.105

Problematic smartphone use (PSU) is an emerging but understudied public health issue. Little is known about the epidemiology of PSU at the population level. We evaluated the psychometric properties of the Smartphone Addiction Scale – Short Version (SAS-SV) and examined its associated sociodemographic factors and health behaviors in Chinese adults in Hong Kong.

A random sample of 3,211 adults aged ≥18 years (mean ± SD: 43.3 ± 15.7, 45.3% men) participated in a population-based telephone survey in Hong Kong and completed the Chinese SAS-SV. Multivariable linear regressions examined the associations of sociodemographic factors, health behaviors, and chronic disease status with SAS-SV score. Data were weighted by age, sex, and education attainment distributions of the Hong Kong general population.

The Chinese SAS-SV is internally consistent (Cronbach’s α = .844) and stable over 1 week (intraclass correlation coefficient = .76, p < .001). Confirmatory factor analysis supported a unidimensional structure established by previous studies. The weighted prevalence of PSU was 38.5% (95% confidence interval: 36.9%, 40.2%). Female sex, younger age, being married/cohabitated or divorced/separated (vs. unmarried), and lower education level were associated with a higher SAS-SV score (all ps <.05). Current smoking, weekly to daily alcohol drinking, and physical inactivity predict greater PSU after controlling for sociodemographic factors and mutual adjustment.

The Chinese SAS-SV was found valid and reliable for assessing PSU in Hong Kong adults. Several sociodemographic and health behavioral factors were associated with PSU at the population level, which may have implication for prevention of PSU and future research.

Adolescents’ smartphone use at night, sleep disturbance and depressive symptoms (2018)

Int J Adolesc Med Health. 2018 Nov 17.

Nowadays smartphones are used anywhere and at any time, day or night, by adolescents. Smartphone use, especially at night, is a risk factor for sleep disturbance and depression in adolescents. The purpose of this study was to analyse the correlation between smartphone use at night, sleep disturbance and depression symptoms in adolescents. This cross-sectional study analysed the data from 714 students in Surabaya, who were selected by using a simple random sampling technique. The independent variable was smartphone usage at night while the dependent variable was sleep disturbance and depressive symptoms. The data was collected using three questionnaires: the smartphone usage at night questionnaire, the Insomnia Severity Index questionnaire and the Kutcher Adolescent Depression Scale questionnaire. The data was then analysed using Spearman’s rho analysis (α < 0.05). The results indicated that there was a relationship between the use of smartphones at night and sleep disturbance in adolescents with a positive correlation (r = 0.374), and that there was a relationship between the use of smartphones at night and depression symptoms in adolescents with a positive correlation (r = 0.360). This study highlights that the excessive use of smartphones during the night may play a significant role in sleep problems and depressive symptoms among teenagers. Adolescents with sleep disturbance and depressive symptoms should be carefully monitored for signs of smartphone addiction. Nurses should improve health education for adolescents to inform them about the positive use of smartphones to prevent sleep disturbance and to minimise depressive symptoms.

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.

Internet Use Patterns, Internet Addiction, and Psychological Distress Among Engineering University Students: A Study from India (2018)

Indian J Psychol Med. 2018 Sep-Oct;40(5):458-467. doi: 10.4103/IJPSYM.IJPSYM_135_18.

This study was a first such attempt to explore internet use behaviors, IA, among a large group of engineering students from India, and its association with psychological distress primarily depressive symptoms.

One thousand eighty six engineering students aged 18-21 years pursuing bachelors in engineering from the south Indian city of Mangalore participated in the study. The socio-educational and internet use behaviors data sheet was used to gather demographic information and patterns of internet use, Internet Addiction Test (IAT) was utilized to assess IA, and Self-Report Questionnaire (SRQ-20) assessed psychological distress primarily depressive symptoms.

Among the total N = 1086, 27.1% of engineering students met criterion for mild addictive internet use, 9.7% for moderate addictive internet use, and 0.4% for severe addiction to internet. IA was higher among engineering 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. Gender, duration of use, time spent per day, frequency of internet use, and psychological distress (depressive symptoms) predicted IA.

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 study motivation in higher education (2020)

Journal of Computer Assisted Learning, 2019; DOI: 10.1111/jcal.12414

The current study explored the relationship between problematic internet use (PIU) and motivation to learn, and examined psychological and social factors mediating this relationship. Two hundred and eighty‐five students in an Italian University were recruited for the current study. There was a negative relationship between PIU and motivation to study: a negative impact on learning strategies, meaning that the students found it harder to organize their learning productively; and PIU also positively associated with test anxiety. The current results also demonstrated that there was partial mediation of this effect of PIU on learning strategies in terms of loneliness. This suggest at those with high levels of PIU may be particularly at risk from lower motivations to study, and, hence, lower actual generalized academic performance due to a number of consequences of PIU.

Lay Description

  • The current study explored the relationship between problematic internet use (PIU) and motivation to learn.
  • There was a negative relationship between PIU and motivation to study.
  • PIU was positively associated with test anxiety.
  • Loneliness partially mediated the effect of PIU on learning strategies
  • Those with high levels of PIU are at risk from lower motivation to study.

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.

The Smartphone Addiction Levels and the Association With Communication Skills in Nursing and Medical School Students (2020)

J Nurs Res. 2020 Jan 16. doi: 10.1097/jnr.0000000000000370.

The use of smartphones among young people is quite common. However, smartphones are associated with negative effects when used excessively. It has been reported that smartphone use may adversely affect learning in the classroom, cause safety issues, and negatively affect interpersonal communications.

The aims of this study were to determine the level of smartphone addiction among nursing and medical school students and to examine the effect of smartphone addiction level on communication skills.

This cross-sectional study was conducted with medical school and nursing students at a public university (502 participants). Data were collected using a personal information form, the Smartphone Addiction Scale-Short Version (SAS-SV), and the Communication Skills Assessment Scale.

All of the participants in the study owned smartphones. Most (70.9%) were female, and 58.2% were in the nursing program. The participants used smartphones for a mean time of 5.07 ± 3.32 hours a day, primarily for messaging. The mean total SAS-SV score for the participants was 31.89 ± 9.90, and a significant difference in SAS-SV mean scores was found with regard to the variables of department, gender, daily smartphone use duration, academic success, status regarding smartphone use in the classroom, participation in sports, easy communication with patients and relatives, preferred mode of communication, health problems tied to phone use, and injury status (p < .05). In addition, a positive weak-to-moderate relationship was found between SAS-SV mean scores and the variables of daily smartphone use duration and years of smartphone use, whereas a negative weak relationship was found between SAS-SV mean scores and Communication Skills Assessment Scale scores. Daily smartphone use duration was found to be the most important predictor of smartphone addiction.

Facebook addiction and personality (2020)

Heliyon. 2020 Jan 14;6(1):e03184. doi: 10.1016/j.heliyon.2020.e03184.

This study explored the associations between Facebook addiction and personality factors. A total of 114 participants (age range of participants is 18-30 and males were 68.4% and females were 31.6 %) have participated through an online survey. The results showed that 14.91 % of the participants had reached the critical polythetic cutoff score, and 1.75 % has reached the monothetic cutoff score. The personality traits, such as extraversion, openness to experience, neuroticism, agreeableness, conscientiousness, and narcissism, are not related to Facebook addiction and Facebook intensity. Loneliness was positively related to Facebook addiction, and it significantly predicted Facebook addiction by accounting to 14% of the variation in Facebook addiction. The limitations and suggestions for further research have been discussed.

Smartphone and Facebook addictions share common risk and prognostic factors in a sample of undergraduate students (2019)

Trends Psychiatry Psychother. 2019 Oct-Dec;41(4):358-368. doi: 10.1590/2237-6089-2018-0069.

To improve the comprehension of the interface between smartphone addiction (SA) and Facebook addiction (FA), we hypothesize that the occurrence of both technological addictions correlate, with higher levels of negative consequences. Moreover, we hypothesize that SA is associated with lower levels of social support satisfaction.

We recruited a convenience sample of undergraduate students from Universidade Federal de Minas Gerais, with age ranging between 18 and 35 years. All subjects completed a self-fulfilled questionnaire comprising sociodemographic data, the Brazilian Smartphone Addiction Inventory (SPAI-BR), the Bergen Scale for Facebook Addiction, the Barrat Impulsivity Scale 11 (BIS-11), the Social Support Satisfaction Scale (SSSS), and the Brief Sensation Seeking Scale (BSSS-8). After completing the questionnaire, the interviewer conducted a Mini-International Neuropsychiatric Interview (MINI).

In the univariate analysis, SA associated with female gender, with ages 18 to 25 years, FA, substance abuse disorders, major depressive disorder, anxiety disorders, low scores in SSSS, high scores in BSSS-8, and high scores in BIS. The group with SA and FA presented a higher prevalence of substance abuse disorders, depression, and anxiety disorders when compared to the group with SA only.

In our sample, co-occurrence of SA and FA correlated with higher levels of negative consequences and lower levels of social support satisfaction. These results strongly suggest that SA and FA share some elements of vulnerability. Further studies are warranted to clarify the directions of these associations.

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.

The Mediating Role of Coping Styles on Impulsivity, Behavioral Inhibition/Approach System, and Internet Addiction in Adolescents From a Gender Perspective (2019)

Front Psychol. 2019 Oct 24;10:2402. doi: 10.3389/fpsyg.2019.02402

Previous findings have shown that impulsivity and Behavioral Inhibition/Approach System (BIS/BAS) have substantial effects on adolescents’ Internet addiction, but the mechanisms underlying these associations and gender differences in these effects have received little attention. We examined the mediating effects of coping styles from impulsivity, and BIS/BAS to Internet addiction as well as gender differences in these associations. A total of 416 Chinese adolescents were examined using a cross-sectional survey involving Young’s Diagnostic Questionnaire for Internet Addiction, Barratt Impulsiveness Scale, BIS/BAS scales, and Coping Style Scale for Middle School Students. The data were analyzed using the independent sample t-test, chi-square test, Pearson correlation, and structure equation modeling. The results from the multiple-group (by adolescent gender) structural model analysis revealed that both impulsivity (p < 0.001) and BIS (p = 0.001) directly predicted positive Internet addiction in girls, while both impulsivity (p = 0.011) and BAS (p = 0.048) directly predicted positive Internet addiction in boys. Furthermore, emotion-focused coping mediated the relationship between impulsivity and Internet addiction (β = 0.080, 95% CI: 0.023-0.168) and the relationship between BIS and Internet addiction (β = 0.064, 95% CI: 0.013-0.153) in girls, while in boys, problem-focused coping and emotion-focused coping mediated the association between impulsivity and Internet addiction (β = 0.118, 95% CI: 0.031-0.251; β = 0.065, 95% CI: 0.010-0.160, respectively) and problem-focused coping mediated the association between BAS and Internet addiction [β = -0.058, 95% CI: (-0.142)-(-0.003)]. These findings extend our insight into the mechanisms underlying the associations among impulsivity, BIS/BAS, and Internet addiction in adolescents and suggest that gender-sensitive training approaches to decrease adolescents’ Internet addiction are indispensable. These interventions should focus on the different gender predictors of adolescent Internet addiction and on the development of specific coping styles for boys and girls respectively.

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”.

Ethical Considerations for Mental Health Clinicians Working with Adolescents in the Digital Age. (2018)

Curr Psychiatry Rep. 2018 Oct 13;20(12):113. doi: 10.1007/s11920-018-0974-z.

Adolescents’ use of digital technologies is constantly changing and significantly influences and reflects their mental health and development. Technology has entered the clinical space and raises new ethical dilemmas for mental health clinicians. After an update on this shifting landscape, including a brief review of important literature since 2014, this article will demonstrate how core ethical principles may be applied to clinical situations with patients, using vignettes for illustration.

The vast majority of adolescents (95%) across all demographic groups can access smartphones (Anderson et al. 2018•). Technology use in mental health is also expanding, including a proliferation of “apps.” While qualitative data from technology experts reports overall positive effects of technology (Anderson and Rainie 2018), concern about its potential negative impact on youth mental health remains high, and an association between technology use and depression is strong. Internet addiction, online sexual exploitation, and accessing illicit substances through the “dark net” pose additional clinical and legal concerns. In this context, clinicians have an ethical responsibility to engage in education and advocacy, to explore technology use with teen patients and to be sensitive to ethical issues that may arise clinically, including confidentiality, autonomy, beneficence/nonmaleficence, and legal considerations such as mandated reporting. New media and digital technologies pose unique ethical challenges to mental health clinicians working with adolescents. Clinicians need to stay abreast of current trends and controversies about technology and their potential impact on youth and engage in advocacy and psychoeducation appropriately. With individual patients, clinicians should watch for potential ethical dilemmas stemming from technology use and think them through, with consultation as needed, by applying longstanding core ethical principles.

The Moderating Role of State Attachment Anxiety and Avoidance Between Social Anxiety and Social Networking Sites Addiction (2019)

Psychol Rep. 2019 Jan 6:33294118823178. doi: 10.1177/0033294118823178.

This study aims to explore the relationships among social anxiety, social networking sites (SNS) addiction, and SNS addiction tendency and further to examine the moderating role of state attachment anxiety and state attachment avoidance. A sample of Chinese young adults ( N = 437, Mage = 24.21 ± 3.25, 129 males) participated in this study, the data were collected through self-reports. Results revealed that participants’ social anxiety was positively associated with SNS addiction and SNS addiction tendency. State attachment anxiety moderated these two relationships after controlling gender, age, and state attachment avoidance, while state attachment avoidance showed no significant moderating effect. Specifically, the positive relationships between social anxiety and SNS addiction (tendency) were restricted to individuals with low state attachment anxiety. While for individuals with high state attachment anxiety, social anxiety was no longer associated with SNS addiction or SNS addiction tendency.

Applying behavioral economic theory to problematic Internet use: An initial investigation (2018)

Psychol Addict Behav. 2018 Nov;32(7):846-857. doi: 10.1037/adb0000404.

The current study seeks to apply a behavioral economic framework to Internet use, testing the hypothesis that, similar to other addictive behaviors, problematic Internet use is a reinforcer pathology, reflecting an overvaluation of an immediately acquirable reward relative to prosocial and delayed rewards. Data were collected through Amazon’s Mechanical Turk data collection platform. A total of 256 adults (Mage = 27.87, SD = 4.79; 58.2% White, 23% Asian; 65.2% had an associate degree or greater) completed the survey. Measures of delay discounting, consideration of future consequences, Internet demand, and alternative reinforcement all contributed unique variance in predicting both problematic Internet use and Internet craving. In aggregate models controlling for all significant predictors, alternative reinforcement and future valuation variables contributed unique variance. Individuals with elevated demand and discounting were at greatest risk for problematic Internet use. Consistent with behavioral economic research among substance abusing samples, individuals engaging in heavy Internet use report elevated motivation for the target behavior coupled with diminished motivation for other potentially rewarding activities, especially those associated with delayed reward.

Overlapping dimensional phenotypes of impulsivity and compulsivity explain co-occurrence of addictive and related behaviors (2018)

CNS Spectr. 2018 Nov 21:1-15. doi: 10.1017/S1092852918001244.

Impulsivity and compulsivity have been implicated as important transdiagnostic dimensional phenotypes with potential relevance to addiction. We aimed to develop a model that conceptualizes these constructs as overlapping dimensional phenotypes and test whether different components of this model explain the co-occurrence of addictive and related behaviors.

A large sample of adults (N=487) was recruited through Amazon’s Mechanical Turk and completed self-report questionnaires measuring impulsivity, intolerance of uncertainty, obsessive beliefs, and the severity of 6 addictive and related behaviors. Hierarchical clustering was used to organize addictive behaviors into homogenous groups reflecting their co-occurrence. Structural equation modeling was used to evaluate fit of the hypothesized bifactor model of impulsivity and compulsivity and determine the proportion of variance explained in the co-occurrence of addictive and related behaviors by each component of the model.

Addictive and related behaviors clustered into 2 distinct groups: Impulse-Control Problems, consisting of harmful alcohol use, pathological gambling, and compulsive buying, and Obsessive-Compulsive-Related Problems, consisting of obsessive-compulsive symptoms, binge eating, and internet addiction. The hypothesized bifactor model of impulsivity and compulsivity provided the best empirical fit, with 3 uncorrelated factors corresponding to a general Disinhibition dimension, and specific Impulsivity and Compulsivity dimensions. These dimensional phenotypes uniquely and additively explained 39.9% and 68.7% of the total variance in Impulse-Control Problems and Obsessive-Compulsive-Related Problems.

A model of impulsivity and compulsivity that represents these constructs as overlapping dimensional phenotypes has important implications for understanding addictive and related behaviors in terms of shared etiology, comorbidity, and potential transdiagnostic treatments.

Internet : abuse, addiction and benefits (2018)

Rev Med Brux. 2018;39(4):250-254.

In this article, we propose to review the recent literature on Internet addiction (AI) by addressing several themes : we will begin by detailing the various questions that have arisen over time as to the reality of the syndrome and the responses that have been provided by the clinical and neuroimaging studies ; we will then discuss comorbidity problems as well as factors favoring the emergence of the AI and its consequences on health ; we will then detail the different treatments proposed and in a dialectical spirit, we will discuss the advantages that a moderate use of the Internet can have on the cognitive functioning as well as different tracks for future researches.

The relationship between Internet Use Disorder, depression and burnout among Chinese and German college students (2018)

Addict Behav. 2018 Aug 27;89:188-199. doi: 10.1016/j.addbeh.2018.08.011.

In the present study, we investigated the relationship between depression and Internet Use Disorder (IUD) and between burnout and IUD among German as well as Chinese college students. Due to cultural differences and their implications for the individual’s psychological health, we expected Chinese college students to have in particular higher IUD than German college students. We further expected to find positive relationships between depression and IUD and between burnout and IUD. Furthermore, we believed these relationships to reflect global effects and thus to be present in both samples. The data showed that Chinese college students had higher average burnout scores in the subscales MBI Emotional Exhaustion and MBI Cynicism and also higher IUD scores, but not higher depression scores. As expected, the correlation analysis revealed significant, positive correlations between depression and IUD as well as between burnout and IUD. The results are consistent in both samples, implying that the effect is globally valid. Furthermore, we observed that the relationship between depression and IUD is stronger than the relationship between emotional exhaustion and IUD in both samples, although this effect was not significant. We conclude that burnout and depression are related to IUD and that this relationship is valid independently of the cultural background of an individual.

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.

Spanish version of the Phubbing Scale: Internet addiction, Facebook intrusion, and fear of missing out as correlates (2018)

Psicothema. 2018 Nov;30(4):449-454. doi: 10.7334/psicothema2018.153.

Phubbing is an increasingly common behavior that involves using a smartphone in a social setting of two or more people and interacting with the phone rather than with the other people. Research to date on phubbing has measured it using different scales or single questions, and therefore standard measures with appropriate psychometric properties are needed to improve its assessment. The aim of our study was to develop a Spanish version of the Phubbing Scale and to examine its psychometric properties: factor structure, reliability, and concurrent validity.

Participants were 759 Spanish adults between 18 and 68 years of age. They completed an online survey.

The results support a structure that is consistent with the original validation study, with two factors: Communication Disturbance and Phone Obsession. Internal consistency was found to be adequate. Evidence of concurrent validity was provided via a hierarchical regression model that showed positive associations with measures of internet addiction, Facebook intrusion, and fear of missing out.

Problematic Internet use and its associations with health-related symptoms and lifestyle habits among rural Japanese adolescents (2018)

Psychiatry Clin Neurosci. 2018 Oct 29. doi: 10.1111/pcn.12791.

There have been concerns about the increase in problematic Internet use (PIU) and its impact on lifestyle habits and health-related symptoms, given the rapid spread of smartphones. This study aimed to clarify PIU prevalence over 3 years in the same area and investigate lifestyle and health-related factors related to PIU among junior high-school students in Japan.

Each year during 2014-2016, a survey was conducted with junior high-school students from a rural area of Japan (2014, n = 979; 2015, n = 968; 2016, n = 940). Young’s Internet Addiction Test was used to assess participants’ PIU. Students scoring 40 or higher on the Internet Addiction Test were classified as showing PIU in this study. The associations between PIU and lifestyle factors (e.g., exercise habits, weekday study time, and sleep time) and health-related symptoms (depressive symptoms and orthostatic dysregulation (OD) symptoms) were studied by logistic regression analyses.

Over the 3 years, the prevalence of PIU was 19.9% in 2014, 15.9% in 2015 and 17.7% in 2016 without significant change. PIU was significantly associated with skipping breakfast, having a late bedtime (after midnight), and having OD symptoms among all grade students. Sleepiness after awakening in the morning, less studying time, and depressive symptoms had significant positive associations with PIU, except among 1st grade students.

Our results suggest that PIU is related to decreased time spent on sleep, study, and exercise and increased symptoms of depression and OD. Further investigations are needed to develop preventive measures for PIU.

Prevalence of Internet Addiction and Associated Psychological Co-morbidities among College Students in Bhutan (2018)

JNMA J Nepal Med Assoc. 2018 Mar-Apr;56(210):558-564.

This cross sectional study included 823 first year and final year students aged 18-24 from six colleges in Bhutan. A self-administered questionnaire consisting of three parts was utilized for data collection. The data was entered and validated in Epidata and analyzed using STATA/IC 14.

The prevalence of moderate and severe internet addiction was 282 (34.3%) and 10 (1%) respectively. Positive correlations between internet addiction and psychological well-being (r= 0.331 95% CI: 0.269, 0.390), between Internet Addiction score and years of internet usage (r=0.104 95% CI: 0.036, 0.171), age and years of using internet (r= 0.8 95% CI: 0.012, 0.148) were observed. The commonest mode of internet use was martphone 714 (86.8%). The use of computer laboratory (aPR 0.80, 95%CI: 0.66, 0.96) and internet use for news and educational purposes (aPR 0.76, 95%CI: 0.64, 0.9) showed protective effects.

Internet Addiction In Medical Students (2019)

J Ayub Med Coll Abbottabad. 2018 Oct-Dec;30(Suppl 1)(4):S659-S663.

It is a multi-dimensional behavioural disorder that manifest in various physical, psychological and social disorders and causes a number of functional and structural changes in brain with related various comorbidities. There is paucity of local researches on this topic but the access to internet and its use is enormous. This study was conducted to find the magnitude of internet addiction in medical students.

It was a descriptive crosssectional study carried out in Ayub Medical College, Abbottabad. One hundred & forty-eight students were selected in the survey using stratified random sampling. The data was collected using academic and school competence scale and internet addiction diagnostic criteria.

In this study, 11 (7.86%) fulfilled the criteria for internet addiction. Most of the students 93 (66.3%) used internet to visit social media applications. Majority of the students 10 (90.9%), showed tolerance as major non-essential symptom of internet addiction. Internet addicts showed significant p=0.01 below average academic performance when compared to non-addicts. Internet addiction showed a significant p=0.03 gender association with internet addiction more prevalent in females than males (12.5% Vs 2.9%).

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 InternetAddiction 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.

Comparison of Students With and Without Problematic Smartphone Use in Light of Attachment Style (2019)

Front Psychiatry. 2019 Sep 18;10:681. doi: 10.3389/fpsyt.2019.00681.

Background: Nowadays, media addictions are especially of high relevance to psychotherapeutic practice. More recently, this particularly includes excessive smartphone usage. Even though a growing number of scientific literature and also mainstream media highlight problematic smartphone use as a serious health problem, there is only little research on this issue. Objective: The aim of this study was to examine this phenomenon with a focus on attachment-specific differences between students with and without problematic smartphone use. Method: A survey was carried out on all enrolled students of the Sigmund Freud University Vienna. The Smartphone Addiction Scale (SPAS) was used to differentiate between students with and without problematic smartphone use. The attachment style was assessed using the Bielefeld Partnership Expectations Questionnaire (BFPE). Results: Of the total sample, 75 of the students (15.1%) showed a problematic smartphone use. A positive correlation between excessive smartphone usage and an insecure attachment style was found. Discussion: Therapy for problematic smartphone use should be carried out in light of patient’s attachment style. Further research into other factors of mental stress and personality is needed to better understand problematic smartphone use.

The Relationship Between Adolescents’ Stress and Internet Addiction: A Mediated-Moderation Model (2019)

Front Psychol. 2019 Oct 4;10:2248. doi: 10.3389/fpsyg.2019.02248.

This cross-sectional study explored the impact of stress, social anxiety, and social class on Internet addiction among adolescents. The subjects-1,634 middle school students-were investigated using the Chinese Perceived Stress Scale (CPSS), the Social Anxiety Scale for Adolescents (SAS-A) Chinese Short Form, the Chinese Internet Addiction Scale (CIAS), and the Questionnaire of Family Social-economic Status. The results show that 12% of the adolescents investigated showed signs of Internet addiction. With the increase of grade, the tendency of Internet addiction and the number of addicts gradually increased. It also showed that Internet addiction is positively correlated with stress and social anxiety and negatively correlated with social class. Social anxiety partially mediates the impact of stress on Internet addiction and social class indirectly influences Internet addiction by moderating the relationship between stress and social anxiety. In conclusion, there is a mediated-moderation effect between stress and adolescent Internet addiction This means that adolescents from different social classes have different types of anxiety when they feel the stress, which influences their choices concerning internet use.

Relationship between headache and Internet addiction in children (2019)

2019 Oct 24;49(5):1292-1297. doi: 10.3906/sag-1806-118.

We aimed to investigate Internet addiction in pediatric patients with migraine- and tension-type headache in this study.

Among our 200 subjects, 103 had migraine-type headache and 97 had tension-type headache.

Headache triggered by computer use was more common in the migraine-type headache group. There was no difference between the Internet addiction scale score of the two groups. The Internet addiction scale scores of the patients were found to differ depending on the aim and duration of computer use. Internet addiction was found in six (6%) patients. Internet addiction prevalence was 3.7% and 8.5% in the two groups, respectively.

The prevalence of Internet addiction in children with recurrent headache was lower than that found in their peers in Turkey, possibly due to avoidance of computer use as a headache trigger. This finding raises the question of whether migraine- or tension-type headaches actually prevent Internet addiction.

Anxiety-Related Coping Styles, Social Support, and Internet Use Disorder (2019)

Front Psychiatry. 2019 Sep 24;10:640. doi: 10.3389/fpsyt.2019.00640.

Objective: The Internet can offer a seemingly safe haven for those being disappointed by relationships in the “offline world”. Although the Internet can provide lonely people with opportunities to seek for help and support online, complete withdrawal from the offline world comes with costs. It is discussed if people can even become “addicted” to the Internet. Of note, meanwhile, many researchers prefer the term Internet use disorder (IUD) instead of using the term “Internet addiction”. To illustrate the importance of one’s own social network supporting a person in everyday life, we investigated, for the first time to our knowledge, how social resources in terms of quality and quantity might represent a buffer against the development of IUD. Furthermore, anxiety related coping styles are investigated as a further independent variable likely impacting on the development of an IUD. Method: In the present work, N = 567 participants (n = 164 males and n = 403 females; Mage = 23.236; SDage = 8.334) filled in a personality questionnaire assessing individual differences in cognitive avoidant and vigilant anxiety processing, ergo, traits describing individual differences in everyday coping styles/modes. Moreover, all participants provided information on individual differences in tendencies toward IUD, the perceived quality of social support received, and the size of their social network (hence a quantity measure). Results: Participants with larger social networks and higher scores in the received social support reported the lowest tendencies toward IUD in our data. A vigilant coping style was positively correlated with tendencies toward IUD, whereas no robust associations could be observed between a cognitive avoidant coping style and tendencies toward IUD. Hierarchical linear regression underlined an important predictive role of the interaction term of vigilance in ego-threat scenarios and perceived quality of social support. Conclusion: The current study not only yields support for the hypothesis that the size of one’s own social network as well as the perceived quality of social support received in everyday life present putative resilience factors against developing IUD. It also supports the approach that special coping styles are needed to make use of the social support offered.

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.

The Neuroscience of Smartphone/Social Media Usage and the Growing Need to Include Methods from ‘Psychoinformatics’ (2019)

Information Systems and Neuroscience pp 275-283

The present work gives a brief overview of the current state of affairs in the investigation of the neuroscientific underpinnings of social media use. Such an overview is of importance because individuals spend significant amounts of time on these ‘social’ online channels. Despite several positive aspects of social media use, such as the ability to easily communicate with others across long distances, it is clear that detrimental effects on our brains and minds are possible. Given that much of the neuroscientific and psychological research conducted up to now relies solely on self-report measures to assess social media usage, it is argued that neuroscientists/psychologists need to include more digital traces resulting from human-machine/computer interaction, and/or information shared by individuals on social media, in their scientific analyses. In this realm, digital phenotyping can be achieved via methods of ‘Psychoinformatics’, a merger of the disciplines psychology and computer science/informatics.

A Study of the Correlation Between Internet Addiction and Aggressive Behaviour Among the Namibian University Students (2019)

Data Science and Big Data Analytics pp 1-9

The explosion of online Social Networking Sites over time has its benefits as well as its risks. A potential risk is the fact that so many individuals have become victims of aggressive and cyber-bullying acts via Online Social Networking Sites. In the paper, the aim of this study is to analyse the correlation between Internet addiction and Aggressive Behavior Among the Namibian University Students. Based on statistical analysis the paper concluded that there is a worthwhile correlation between Internet addiction and Aggressive Behaviour and a sizable majority of the students who participated in the study suffer from moderate addiction problems due to their Internet usage. Also, the results indicate that the two most prevalent forms of aggression among the majority of the students are hostility and Physical Aggression.

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.

Profiles of Problematic Internet Use and Its Impact on Adolescents’ Health-Related Quality of Life (2019)

Int J Environ Res Public Health. 2019 Oct 13;16(20). pii: E3877. doi: 10.3390/ijerph16203877.

The internet has been a breakthrough for adolescents in many ways, but its use can also become dysfunctional and problematic, leading to consequences for personal well-being. The main objective is to analyze profiles related to problematic internet use and its relationship with health-related quality of life (HRQoL). An analytical and cross-sectional study was carried out in a region of northern Spain. The sample comprised 12,285 participants. Sampling was random and representative. Mean age and standard deviation was 14.69 ± 1.73 (11-18 years). The Spanish versions of the Problematic and Generalized Internet Use Scale (GPIUS2) and of the Health-Related Quality of Life (KIDSCREEN-27) were used. Four profiles were detected (non-problematic use, mood regulator, problematic internet use, and severe problematic use). The prevalence of these last two profiles was 18.5% and 4.9%, respectively. Problematic internet use correlated negatively and significantly with HRQoL. The severe problematic use profile presented a significant decrease in all dimensions of HRQoL. Analyses were carried out to extract a diagnostic cut-off point for GPIUS2 (52 points).

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 Relationship Between Parental Attachment and Mobile Phone Dependence Among Chinese Rural Adolescents: The Role of Alexithymia and Mindfulness (2019)

Front Psychol. 2019 Mar 20;10:598. doi: 10.3389/fpsyg.2019.00598.

Mobile phone has experienced a significant increase in popularity among adolescents in recent years. Findings indicate dependence on mobile phone is related to poor parent-child relationship. However, previous research on mobile phone dependence (MPD) is scant and mainly focus on adult samples. In this view, the present study investigated the association between parental attachment and MPD as well as its influence mechanism, in sample of adolescents in rural China. Data were collected from three middle schools in rural areas of Jiangxi and Hubei Province (N = 693, 46.46% female, M age = 14.88, SD = 1.77). Participants completed the Inventory of Parent and Peer Attachment (IPPA), the twenty-item Toronto alexithymia scale (TAS-20), the Mindful Attention Awareness Scale (MAAS) and the Mobile Phone Addiction Index Scale (MPAI). Among the results, parental attachment negatively predicted MPD and alexithymia were exerting partial mediation effect between parental attachment and MPD. Further, mindfulness acted as moderator of the relationship between alexithymia and MPD: The negative impact of alexithymia on MPD was weakened under the condition of high level of mindfulness. Knowledge of this mechanism could be useful for understanding adolescents’ MPD in terms of the interaction of multiple factors.

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.

Problematic internet use and its correlates among resident doctors of a tertiary care hospital of North India: A cross-sectional study (2018)

Asian J Psychiatr. 2018 Nov 26;39:42-47. doi: 10.1016/j.ajp.2018.11.018.

Problematic Internet use/ Internet addiction (IA) has gained the attention of mental health professionals recently and studies have found that medical professionals are not immune to IA with prevalence rate ranging from 2.8 to 8%. Few studies from India have also reported high rates of IA among medical students. The term ‘Problematic internet use’ is being increasing used nowadays in place of IA as it signifies a better terminology than the word ‘addiction’ per se. However, there is lack of information among resident doctors.

To evaluate the prevalence of problematic Internet use and its association with depressive symptoms, perceived stress, and health care outcomes among resident doctors working in a government funded tertiary care Institute.

An online e-mail survey was carried out among medical professionals (a total of 1721 doctors) in a tertiary care hospital located in Chandigarh, India out of whom 376 responded. The residents doctors were the postgraduate trainees (MBBS) and those residents who have complete post-graduation and working as senior residents/registrar (MBBS, MD/MS). They were in the age group ranging from 24 to 39 years. The survey included Young’s Internet addiction test (IAT), Patient Health Questionnaire-9 (PHQ-9), Cohen’s Perceived Stress Scale, Maslach Burnout Inventory and a self designed questionnaire to assess the health care related outcomes.

On IAT, 142 residents (37.8%) scored <20 i.e., normal users and 203 residents (54%) had mild addiction. Only 31 residents (8.24%) had moderate addiction category, none of the residents had severe IA (score>80). Those with IA reported higher level of depressive symptoms, perceived stress and burnout. There was positive association between ever use of alcohol and watching pornography (as a part of recreational activities) with IA. Significantly higher proportion of those with IA, reported having faced physical abuse and verbal abuse in the hands of the patients/caregivers.

The present study suggests that about 8.24% of resident doctors have Problematic internet use/IA. Problematic internet use/IA is associated with presence of higher level of depressive symptoms, perceived stress and burn out. Further, Problematic internet use/IA is also associated with higher likelihood of facing violence in the hands of patients and their caregivers.

Social and Psychological Effects of the Internet Use (2018)

2016 Feb;24(1):66-8. doi: 10.5455/aim.2016.24.66-68

Over the past two decades there was an upsurge of the use of Internet in human life. With this continuous development, Internet users are able to communicate with any part of the globe, to shop online, to use it as a mean of education, to work remotely and to conduct financial transactions. Unfortunately, this rapid development of the Internet has a detrimental impact in our life, which leads to various phenomena such as cyber bullying, cyber porn, cyber suicide, Internet addiction, social isolation, cyber racism etc. The main purpose of this paper is to record and analyze all these social and psychological effects that appears to users due to the extensive use of the Internet.

This review study was a thorough search of bibliography data conducted through Internet and library research studies. Key words were extracted from search engines and data bases including Google, Yahoo, Scholar Google, PubMed.

The findings of this study showed that the Internet offers a quick access to information and facilitates communication however; it is quite dangerous, especially for young users. For this reason, users should be aware of it and face critically any information that is handed from the website.

Relationship between anxiety, depression, sex, obesity, and internet addiction in Chinese adolescents: A short-term longitudinal study (2018)

Addict Behav. 2018 Dec 7;90:421-427. doi: 10.1016/j.addbeh.2018.12.009.

Associations between anxiety, depression and adolescent Internet addiction have been well documented in the literature; however, few published studies have examined these relationships considering the developmental trajectory courses of adolescent Internet addiction as well as the individual differences over time. Using a sample of 1545 Chinese adolescents and 3 waves of data over six months, we examined the longitudinal associations between anxiety and depression and Internet addiction, considering sex and obesity. We used latent growth curve modeling (LGCM) to examine the overall conditions of Internet addiction, and latent class growth modeling (LCGM) to determine adolescent developmental membership for Internet addiction. Both unconditional and conditional models were performed. Anxiety and depression were analyzed as time-varying variables, and sex and obesity as time-invariants in our conditional models. Overall, there was a linear decline in adolescent Internet addiction over the six months. Anxiety and depression positively predicted adolescent Internet addiction. Two developmental trajectory patterns for Internet addiction were determined (i.e., low/declining, high/declining). Anxiety was associated with adolescent Internet addiction for both groups of adolescents, but depression was associated with Internet addiction only for adolescents who followed a low/declining course of Internet addiction. Boys reported a higher mean score of Internet addiction at the initial status than girls, and boys also had a faster, declining rate of change over the six months than girls. Obesity was not a predictor of Internet addiction.

Unpacking the mechanisms underlying the relation between ostracism and Internet addiction (2018)

Psychiatry Res. 2018 Dec;270:724-730. doi: 10.1016/j.psychres.2018.10.056.

Prior studies have mainly focused on the psychological correlates of Internet addiction, but scant research has tested how actual interpersonal experience can influence people’s tendency to spend an excessive amount of time online. The present research aimed to fill the research gap by investigating the potential relationship between ostracism and Internet usage as well as the mechanisms underlying such a linkage. Participants completed a series of well-validated measures assessing their ostracism experience in school, solitude seeking, self-control, and Internet addiction. The results established a significant positive association between ostracism and Internet addiction and demonstrated this relation was mediated by enhanced solitude seeking and impaired self-control. These findings advanced our current knowledge by showing that adverse interpersonal experiences in school can predict Internet addiction and by unveiling the underlying psychological mechanisms that can account for such a relation.

The relationship between anxiety symptom severity and problematic smartphone use: A review of the literature and conceptual frameworks (2018)

J Anxiety Disord. 2018 Nov 30;62:45-52. doi: 10.1016/j.janxdis.2018.11.005.

In the present paper, we examine the literature studying relations between problematic smartphone use (PSU) and anxiety symptom severity. We first present background on the health advantages and disadvantages of using a smartphone. Next, we provide caveats in distinguishing healthy smartphone use from unhealthy PSU, and we discuss how PSU is measured. Additionally, we discuss theoretical frameworks explaining how some people develop PSU, including Uses and Gratifications Theory, and Compensatory Internet Use Theory. We present our own theoretical model of how PSU is specifically related to anxiety.

Addiction to the Internet and mobile phones and its relationship with loneliness in Iranian adolescents (2018)

Int J Adolesc Med Health. 2018 Dec 4. pii: /j/ijamh.ahead-of-print/ijamh-2018-0035/ijamh-2018-0035.xml. doi: 10.1515/ijamh-2018-0035.

Addiction to the Internet and mobile phones in adolescents could be related to loneliness. However, less research has been conducted on this topic in developing countries. This study aimed to examine addiction to the Internet and mobile phones and its relationship with loneliness in adolescents in Iran.

This was a cross-sectional and analytic study that was conducted between 2015 and 2016 in Rasht, in the north of Iran. Subjects were selected through cluster sampling from female and male teens who were studying in the public and private schools. The Kimberly’s Internet Addiction Test, Cell phone Overuse Scale (COS), and the University of California , Los Angeles (UCLA) Loneliness Scale were used for data collection.

The mean age of participants was 16.2 ± 1.1 year. The mean of addiction to the Internet was 42.2 ± 18.2. Overall, 46.3% of the subjects reported some degrees of addiction to the Internet. The mean of addiction to mobile phones was 55.10 ± 19.86. The results of this study showed that 77.6% (n = 451) of the subjects were at risk for addiction to mobile phones, and 17.7% (n = 103) of them were addicted to their use. The mean of loneliness was 39.13 ± 11.46 in the adolescents. Overall, 16.9% of the subjects obtained a score higher than mean in loneliness. A statistically significant direct relationship was found between addiction to the Internet and loneliness in the adolescents (r = 0.199, p = 0.0001). The results also showed a statistically significant direct relationship between addiction to mobile phones and loneliness in the adolescents (r = 0.172, p = 0.0001).

The results of this study revealed that a high percentage of adolescents who have some degrees of addiction to the Internet and mobile phones experience loneliness, and there are relationships between these variables.

Association between problematic Internet use, sleep disturbance, and suicidal behavior in Chinese adolescents (2018)

J Behav Addict. 2018 Nov 26:1-11. doi: 10.1556/2006.7.2018.115.

This large-scale study aimed to test (a) associations of problematic Internet use (PIU) and sleep disturbance with suicidal ideation and suicide attempts among Chinese adolescents and (b) whether sleep disturbance mediates the association between PIU and suicidal behavior.

Data were drawn from the 2017 National School-based Chinese Adolescents Health Survey. A total of 20,895 students’ questionnaires were qualified for analysis. The Young’s Internet Addiction Test was used to assess PIU, and level of sleep disturbance was measured by the Pittsburgh Sleep Quality Index. Multilevel logistic regression models and path models were utilized in analyses.

Of the total sample, 2,864 (13.7%) reported having suicidal ideation, and 537 (2.6%) reported having suicide attempts. After adjusting for control variables and sleep disturbance, PIU was associated with an increased risk of suicidal ideation (AOR = 1.04, 95% CI = 1.03-1.04) and suicide attempts (AOR = 1.03, 95% CI = 1.02-1.04). Findings of the path models showed that the standardized indirect effects of PIU on suicidal ideation (standardized β estimate = 0.092, 95% CI = 0.082-0.102) and on suicide attempts (standardized β estimate = 0.082, 95% CI = 0.068-0.096) through sleep disturbance were significant. Conversely, sleep disturbance significantly mediated the association of suicidal behavior on PIU.

There may be a complex transactional association between PIU, sleep disturbance, and suicidal behavior. The estimates of the mediator role of sleep disturbance provide evidence for the current understanding of the mechanism of the association between PIU and suicidal behavior. Possible concomitant treatment services for PIU, sleep disturbance, and suicidal behavior were recommended.

Problematic Gaming and Internet Use but Not Gambling May Be Overrepresented in Sexual Minorities – A Pilot Population Web Survey Study.

Front Psychol. 2018 Nov 13;9:2184. doi: 10.3389/fpsyg.2018.02184.

Background: Substance-related addictive disorders are known to be overrepresented in non-heterosexual individuals, but it is largely unknown whether this is also the case for behavioral addictions such as problem gaming and gambling. This study aimed, in a pilot web survey design, to assess whether problematic gambling, gaming and internet use may be more common in individuals with a non-heterosexual orientation.

Methods: An online survey was distributed through media and social media, and answered by 605 individuals (51% women and 11% non-heterosexual). Problem gambling, problem gaming and problematic internet use were measured through structured screening instruments (the CLiP, the GAS and the PRIUSS, respectively).

Results: Problem gaming and problematic internet use were significantly more prevalent in non-heterosexual subjects. Instead, problem gambling did not differ between heterosexual and non-heterosexual respondents. Psychological distress and social media use for more than 3 h daily were significantly more common in non-heterosexual respondents. In the overall sample, gaming and gambling were associated statistically.

Association between social media use (Twitter, Instagram, Facebook) and depressive symptoms: Are Twitter users at higher risk? (2018)

Int J Soc Psychiatry. 2018 Nov 30:20764018814270. doi: 10.1177/0020764018814270.

The purpose of this study was to determine the association between social media dependence and depressive symptoms and also, to characterize the level of dependence. It was a transversal, analytical research.

The stratified sample was 212 students from a private university that used Facebook, Instagram and/or Twitter. To measure depressive symptoms, Beck Depression Inventory was used, and to measure the dependence to social media, the Social Media Addiction Test was used, adapted from the Internet Addiction Test of Echeburúa. The collected data were subjected for analysis by descriptive statistics where STATA12 was used

The results show that there is an association between social media dependence and depressive symptoms (PR [Prevalence Ratio] = 2.87, CI [Confidence Interval] 2.03-4.07). It was also shown that preferring the use of Twitter (PR = 1.84, CI 1.21-2.82) over Instagram (PR = 1.61, CI 1.13-2.28) is associated with depressive symptoms when compared to the use of Facebook.

Excessive social media use is associated with depressive symptoms in university students, being more prominent in those who prefer the use of Twitter over Facebook and Instagram.

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.

Lifestyle Interventions and Prevention of Suicide (2018)

Front Psychiatry. 2018 Nov 6;9:567. doi: 10.3389/fpsyt.2018.00567.

Over the past years, there has been a growing interest in the association between lifestyle psychosocial interventions, severe mental illness, and suicide risk. Patients with severe mental disorders have higher mortality rates, poor health states, and higher suicide risk compared to the general population. Lifestyle behaviors are amenable to change through the adoption of specific psychosocial interventions, and several approaches have been promoted. The current article provides a comprehensive review of the literature on lifestyle interventions, mental health, and suicide risk in the general population and in patients with psychiatric disorders. For this purpose, we investigated lifestyle behaviors and lifestyle interventions in three different age groups: adolescents, young adults, and the elderly. Several lifestyle behaviors including cigarette smoking, alcohol use, and sedentary lifestyle are associated with suicide risk in all age groups. In adolescents, growing attention has emerged on the association between suicide risk and internet addiction, cyberbullying and scholastic and family difficulties. In adults, psychiatric symptoms, substance and alcohol abuse, weight, and occupational difficulties seems to have a significant role in suicide risk. Finally, in the elderly, the presence of an organic disease and poor social support are associated with an increased risk of suicide attempt. Several factors may explain the association between lifestyle behaviors and suicide. First, many studies have reported that some lifestyle behaviors and its consequences (sedentary lifestyle, cigarette smoking underweight, obesity) are associated with cardiometabolic risk factors and with poor mental health. Second, several lifestyle behaviors may encourage social isolation, limiting the development of social networks, and remove individuals from social interactions; increasing their risk of mental health problems and suicide.

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.

General health of students of medical sciences and its relation to sleep quality, cell phone overuse, social networks and internet addiction (2019)

Biopsychosoc Med. 2019 May 14;13:12. doi: 10.1186/s13030-019-0150-7.

In recent years, the phenomena of access to the cell phone and addiction to the Internet have been developed among students due to their many applications and attractiveness. Therefore, the present study was conducted with the aim of evaluating general health status and also determining the predictive role of variables such as cell phone usage, sleep quality, internet addiction and social networks addiction in students.

This cross-sectional study was conducted on 321 students of Kermanshah University of Medical Sciences in an analytical approach. Data collection tools were: Goldberg’s General Health Questionnaire, Pittburgh Sleep Quality Index, Young Internet Addiction Test, Social Network Addiction Questionnaire, and Cell Phone Overuse Scale. Data analysis was done using SPSS version 21 and general linear model.

Based on the results, the mean (SD) score of the general health was 21.27 (9.49). Variables of gender, sleep quality, and levels of cell phone usage were independent predictors of student’s health. Male students (β (95% CI) = - 0.28 (- 0.49 to - 0.01) and students with favorable sleep quality (β (95% CI) = - 0.22 (- 0.44 to - 0.02) had lower total health score than the reference category (female students and students with unfavorable sleep quality, respectively). In addition, students with cell phone overuse (β (95% CI) = 0.39 (0.08 to 0.69) had a higher general health score than the reference category (students with cell phone little use).In general, this group of students had lower general health status (Low or high scores of general health indicate a higher and lower general health status for subjects, respectively).

Parent and peer attachment as predictors of facebook addiction symptoms in different developmental stages (early adolescents and adolescents) (2019)

Addict Behav. 2019 May 11. pii: S0306-4603(19)30008-5. doi: 10.1016/j.addbeh.2019.05.009.

Facebook Addiction (FA) is a problem that concerns minors all over the world. The attachment bond with peers and parents has been proven to be a risk factor for the onset of FA. However, the family and peer group can have a different importance depending on the developmental period of the minor. This study examined the influence of peer and parental attachment on the symptoms of FA in early adolescents and adolescents to verify whether attachment to peers and parents predicts FA symptoms in both categories respectively. The sample was composed of 598 participants (142 early adolescents) between the ages of 11 and 17 years (M age = 14.82, SD = 1.52) recruited in the school setting. Multivariate multiple regressions were performed. For early adolescents the relationships with their parents influenced the levels of FA the most (such as withdrawal, conflict, and relapse), whereas peer relationships (such as, peer alienation) were the most relevant for adolescents.

Correlation between Internet addiction, depression, anxiety and stress among undergraduate medical students in Azad Kashmir (2019)

Pak J Med Sci. 2019 Mar-Apr;35(2):506-509. doi: 10.12669/pjms.35.2.169.

A cross-sectional study including 210 undergraduate medical students (first to the fifth year) was done in Poonch Medical College, Azad Kashmir. The data collection tools were DASS21 questionnaire and Young’s internet addiction questionnaire. Spearman rank correlation test was done to see the correlation between internet addiction and depression, anxiety, and stress. Data were analyzed by SPSS v23 at a 95% confidence interval.

A very high prevalence (52.4%) of moderate to extremely severe internet addiction was observed among the respondents. The mild positive correlation between internet addiction and depression was identified (p <.001) and similar type of correlation was observed between internet addiction and stress (p .003). However, anxiety and internet addiction were not significantly correlated. The prevalence of anxiety and depression among the males were higher than the females, whilst the stress level was almost the same across gender.

Internet addiction has been found to be associated with various psychiatric diseases. In this study, we also observed such correlation. We have also observed a very high level of internet addiction among medical students. The prevalence of internet addiction may further increase in the coming years as the internet will become more cheap, available and include more high quality psychologically addictive contents.

Game of thorns: Modern day opium (2019)

Med J Armed Forces India. 2019 Apr;75(2):130-133. doi: 10.1016/j.mjafi.2018.12.006..

With the advent of internet and mobile communication the virtual space of world wide web has become a playground; people plugged in to it at distant horizon completely unfamiliar to each other are players; keyboard, touchpad and joysticks have become the tools of play; webmaster, app developer are self designated referees of the game; while the virtual media is the largest ever spectators in this amphitheatre of the web. More and more youth are getting hooked onto this and are gradually becoming dependent on these games. World Health Organization has recognized this as a diagnosable medical illness and included as Internet Gaming Disorder (IGD) in its International Classification of Diseases (ICD) -11 released in 2018. Various aspects of this problem are discussed in this article.

Predicting effects of borderline personality symptoms and self-concept and identity disturbances on internet addiction, depression, and suicidality in college students: A prospective study (2019)

Kaohsiung J Med Sci. 2019 May 7. doi: 10.1002/kjm2.12082.

The aims of this study were to evaluate the predicting effects of borderline personality symptoms and self-concept and identity disturbances on internet addiction, significant depression, and suicidality among college students at follow-up assessments conducted 1 year later. A sample of 500 college students aged between 20 and 30 years participated in this study. Their levels of borderline personality symptoms, self-concept and identity disturbances, internet addiction, depression, and suicidality at baseline and at follow-up interviews were assessed through the Borderline Symptoms List, Self-concept and Identity Measure, Chen Internet Addiction Scale, Beck Depression Inventory-II, and questions related to suicidality from the Epidemiological version of the Kiddie Schedule for Affective Disorders and Schizophrenia, respectively. A total of 324 college students received follow-up assessments 1 year later. Among them, 15.4%, 27.5%, and 17% had internet addiction, significant depression, and suicidality, respectively. Our result revealed the severity of borderline symptoms, disturbed identity, unconsolidated identity, and lack of identity at initial assessment increased the occurrence of internet addiction, significant depression, and suicidality at follow-up assessment except for the predictive effect of unconsolidated identity on internet addiction.

Relationships of Internet addiction and Internet gaming disorder symptom severities with probable attention deficit/hyperactivity disorder, aggression and negative affect among university students (2019)

Atten Defic Hyperact Disord. 2019 May 6. doi: 10.1007/s12402-019-00305-8.

The aim of the present study was to evaluate relationships of Internet addiction (IA) and Internet gaming disorder (IGD) symptom severities with probable attention deficit/hyperactivity disorder (ADHD) and aggression among university students, while controlling the effects of anxiety and depressive symptoms. The study was conducted with online survey among 1509 volunteered university students in Ankara who regularly use the Internet, among whom we conducted analyses related with IA. Among these students, 987 of them, who play video games, were included in the analyses related with IGD. Correlation analyses revealed that the severities of the scale scores were mildly correlated with each other both among students who regularly use the Internet and students who play video games. Probable ADHD was associated with the severity of IA symptoms, together with depression and aggression, particularly physical aggression and hostility, in ANCOVA analyses. Similarly probable ADHD was also associated with the severity of IGD symptoms, together with depression and aggression, particularly physical aggression, anger and hostility, in ANCOVA analyses. These findings suggest that the presence of probable ADHD is related with both severity of IA and IGD symptoms, together with aggression and depression.

Depression and anxiety symptoms are related to problematic smartphone use severity in Chinese young adults: Fear of missing out as a mediator (2019)

Addict Behav. 2019 Apr 20. pii: S0306-4603(19)30087-5. doi: 10.1016/j.addbeh.2019.04.020.

We recruited 1034 Chinese undergraduate students via a web-based survey that measured smartphone use frequency, PSU, depression, anxiety and FOMO.

Structural equation modeling demonstrated that FOMO was significantly related to smartphone use frequency and PSU severity. FOMO significantly mediated relations between anxiety and both smartphone use frequency and PSU severity. FOMO did not account for relations between depression and smartphone use/PSU.

The Relationship Between Personality Traits, Psychopathological Symptoms, and Problematic Internet Use: A Complex Mediation Model (2019)

J Med Internet Res. 2019 Apr 26;21(4):e11837. doi: 10.2196/11837.

The aim of this study was to build and test a mediation model based on problematic internet use, psychopathological symptoms, and personality traits.

Data were collected from a medical addiction center (43 internet addicts) and internet cafés (222 customers) in Beijing (mean age 22.45, SD 4.96 years; 239/265, 90.2% males). Path analysis was applied to test the mediation models using structural equation modeling.

Based on the preliminary analyses (correlations and linear regression), two different models were built. In the first model, low conscientiousness and depression had a direct significant influence on problematic internet use. The indirect effect of conscientiousness-via depression-was nonsignificant. Emotional stability only affected problematic internet use indirectly, via depressive symptoms. In the second model, low conscientiousness also had a direct influence on problematic internet use, whereas the indirect path via the Global Severity Index was again nonsignificant. Emotional stability impacted problematic internet use indirectly via the Global Severity Index, whereas it had no direct effect on it, as in the first model.

Relationship between nursing students’ levels of internet addiction, loneliness, and life satisfaction (2020)

Perspect Psychiatr Care. 2020 Jan 22. doi: 10.1111/ppc.12474.

This study examined nursing students’ levels of Internet addiction, loneliness, and satisfaction with life.

This descriptive, cross-sectional study was conducted in included university involving 160 nursing students who completed an information form and the Internet addiction, UCLA Loneliness, and Satisfaction with Life Scales.

No significant correlation was found between students’ Internet addiction, loneliness, and life satisfaction (P > .05). However, a significant positive correlation between loneliness and life satisfaction was observed (P < .05).

Internet Addiction in Adolescents: A Systematic Review of Nursing Studies (2020)

J Psychosoc Nurs Ment Health Serv. 2020 Jan 22:1-11. doi: 10.3928/02793695-20200115-01.

Nursing studies related to internet addiction in adolescents were assessed in the current systematic review. Six databases were searched, and 35 studies were included. Internet addiction was found to have negative effects on adolescents’ mental, psychosocial, and physical health, with 43.4%, 43.4%, and 8.8% of studies, respectively, examining these variables. Nursing practices to support adolescents’ mental, psychosocial, and physical health should be planned and implemented and outcomes researched. [Journal of Psychosocial Nursing and Mental Health Services, xx(x), xx-xx.].


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.

Using Eye Tracking to Explore Facebook Use and Associations with Facebook Addiction, Mental Well-being, and Personality (2019)

Behav Sci (Basel). 2019 Feb 18;9(2). pii: E19. doi: 10.3390/bs9020019.

Social networking sites (SNSs) have become ubiquitous in our everyday lives, and for all its communicative benefits, excessive SNS use has been associated with a range of negative health implications. In the present study, the authors use eye-tracking methodology to explore the relationship between individual differences in personality, mental well-being, SNS usage, and the focus of Facebook users’ visual attention. Participants (n = 69, mean age = 23.09, SD = 7.54) completed questionnaire measures for personality and to examine changes in depression, anxiety, stress, and self-esteem. They then engaged in a Facebook session while their eye movements and fixations were recorded. These fixations were coded as being directed to social and update areas of interest (AOI) of the Facebook interface. An exploratory analysis of personality factors revealed a negative correlation between openness to experience and inspection times for the updates AOI and an unexpected negative relationship between extraversion and inspection times for social AOI. There were correlations between changes in depression score and inspection of updated AOI, with reduced depression scores associated with increased inspection of updates. Finally, self-reported duration of participants’ typical Facebook sessions did not correlate with eye-tracking measures but were associated with increased Facebook addiction scores and greater increases in depression scores. These initial findings indicate that there are differences in the outcomes of interacting with Facebook which can vary based on Facebook addiction, personality variables, and the Facebook features that individuals interact with.

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).

The relationship between social networking addiction and academic performance in Iranian students of medical sciences: a cross-sectional study (2019)

BMC Psychol. 2019 May 3;7(1):28. doi: 10.1186/s40359-019-0305-0.

In this cross-sectional study, 360 students were enrolled by stratified random sampling. The study tools included personal information form and the Bergen Social Media Addiction Scale. Also, the students’ overall grade obtained in previous educational term was considered as the indicator of academic performance. Data were analyzed using SPSS-18.0 and descriptive and inferential statistics.

The mean social networking addiction was higher in male students (52.65 ± 11.50) than in female students (49.35 ± 13.96) and this difference was statistically significant (P < 0.01). There was a negative and significant relationship between students’ addiction to social networking and their academic performance (r = - 0.210, p < 0.01).

The social networking addiction of the students was at moderate level and the male students had a higher level of addiction compared to the female students. There was a negative and significant relationship between the overall use of social networks and academic performance of students. Therefore, it is imperative that the university authorities take interventional steps to help students who are dependent on these networks and, through workshops, inform them about the negative consequences of addiction to social networks.

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.

The relationship between smartphone addiction and symptoms of depression, anxiety, and attention-deficit/hyperactivity in South Korean adolescents (201)

Ann Gen Psychiatry. 2019 Mar 9;18:1. doi: 10.1186/s12991-019-0224-8.

Excessive smartphone use has been associated with numerous psychiatric disorders. This study aimed to investigate the prevalence of smartphone addiction and its association with depression, anxiety, and attention-deficit hyperactivity disorder (ADHD) symptoms in a large sample of Korean adolescents.

A total of 4512 (2034 males and 2478 females) middle- and high-school students in South Korea were included in this study. Subjects were asked to complete a self-reported questionnaire, including measures of the Korean Smartphone Addiction Scale (SAS), Beck Depression Inventory (BDI), Beck Anxiety Inventory (BAI), and Conners-Wells’ Adolescent Self-Report Scale (CASS). Smartphone addiction and non-addiction groups were defined using SAS score of 42 as a cut-off. The data were analyzed using multivariate logistic regression analyses.

338 subjects (7.5%) were categorized to the addiction group. Total SAS score was positively correlated with total CASS score, BDI score, BAI score, female sex, smoking, and alcohol use. Using multivariate logistic regression analyses, the odds ratio of ADHD group compared to the non-ADHD group for smartphone addiction was 6.43, the highest among all variables (95% CI 4.60-9.00).

Our findings indicate that ADHD may be a significant risk factor for developing smartphone addiction. The neurobiological substrates subserving smartphone addiction may provide insights on to both shared and discrete mechanisms with other brain-based disorders.

Types of problematic smartphone use based on psychiatric symptoms (2019)

Psychiatry Res. 2019 Feb 28;275:46-52. doi: 10.1016/j.psychres.2019.02.071.

To provide appropriate solutions for problematic smartphone use, we need to first understand its types. This study aimed to identify types of problematic smartphone use based on psychiatric symptoms, using the decision tree method. We recruited 5,372 smartphone users from online surveys conducted between February 3 and February 22, 2016. Based on scores on the Korean Smartphone Addiction Proneness Scale for Adults (S-Scale), 974 smartphone users were assigned to the smartphone-dependent group and 4398 users were assigned to the normal group. The data-mining technique of C5.0 decision tree was applied. We used 15 input variables, including demographic and psychological factors. Four psychiatric variables emerged as the most important predictors: self-control (Sc; 66%), anxiety (Anx; 25%), depression (Dep; 7%), and dysfunctional impulsivities (Imp; 3%). We identified the following five types of problematic smartphone use: (1) non-comorbid, (2) self-control, (3) Sc + Anx, (4) Sc + Anx + Dep, and (5) Sc + Anx + Dep + Imp. We found that 74% of smartphone-dependent users had psychiatric symptoms. The ratio of participants belonging to the non-comorbid and self-control types was 64%. We proposed that these types of problematic smartphone use may be used for the development of an appropriate service for controlling and preventing such behaviors in adults.


A Study of Magnitude and Psychological Correlates of Smartphone Use in Medical Students: A Pilot Study with A Novel Telemetric Approach (2018)

Indian J Psychol Med. 2018 Sep-Oct;40(5):468-475. doi: 10.4103/IJPSYM.IJPSYM_133_18.

Smartphone use is being investigated as a potential behavioral addiction. Most of the studies opt for a subjective questionnaire-based method. This study evaluates the psychological correlates of excessive smartphone use. It uses a telemetric approach to quantitatively and objectively measure participants’ smartphone use.

One hundred forty consenting undergraduate and postgraduate students using an Android smartphone at a tertiary care teaching hospital were recruited by serial sampling. They were pre-tested with the Smartphone Addiction Scale-Short Version, Big five inventory, Levenson’s Locus of Control Scale, Ego Resiliency Scale, Perceived Stress Scale, and Materialism Values Scale. Participants’ smartphones were installed with tracker apps, which kept track of total smartphone usage and time spent on individual apps, number of lock-unlock cycles, and total screen time. Data from tracker apps were recorded after 7 days.

About 36 % of participants fulfilled smartphone addiction criteria. Smartphone Addiction Scale score significantly predicted time spent on a smartphone in the 7-day period (β = 0.234, t = 2.086, P = 0.039). Predictors for time spent on social networking sites were ego resiliency (β = 0.256, t = 2.278, P = 0.008), conscientiousness (β = -0.220, t = -2.307, P = 0.023), neuroticism (β = -0.196, t = -2.037, P = 0.044), and openness (β = -0.225, t = -2.349, P = 0.020). Time spent gaming was predicted by success domain of materialism (β =0.265, t = 2.723, P = 0.007) and shopping by ego resiliency and happiness domain of materialism.

Usage of Online Social Networking Sites among School Students of Siliguri, West Bengal, India (2018)

Indian J Psychol Med. 2018 Sep-Oct;40(5):452-457. doi: 10.4103/IJPSYM.IJPSYM_70_18.

Social networking sites (SNSs) are online platforms that provide individuals with an opportunity to manage their personal relationship and remain updated with the world. The primary objective of the present research was to find the pattern of school students’ SNS usage and its influence on their academic performance

The setting was an English medium school situated in the metropolitan city of Siliguri in West Bengal. A pretested and predesigned questionnaire was self-administered anonymously by 388 randomly selected students. The data were analyzed using appropriate statistics.

Three hundred thirty-eight (87.1%) students used SNS and spent an increased amount of time on these networks. Addiction was seen in 70.7% and was more common in the age group of 17 years and above.

Prevalence and Pattern of Phantom Ringing and Phantom Vibration among Medical Interns and their Relationship with Smartphone Use and Perceived Stress (2018)

Indian J Psychol Med. 2018 Sep-Oct;40(5):440-445. doi: 10.4103/IJPSYM.IJPSYM_141_18.

Phantom sensations like phantom vibration (PV) and phantom ringing (PR)- the sensations of vibration and ringing of the phone when they are not, respectively-are among the latest in the category of “techno-pathology” to receive global attention. This study was conducted with the aim to estimate the prevalence of such sensations among medical interns and their association with perceived stress levels and smartphone usage pattern.

Ninety-three medical interns using smartphone were recruited for the study. Data were collected anonymously using semi-structured questionnaire, perceived stress scale (PSS), and smartphone addiction scale-short version (SAS-SV). Data were analyzed using descriptive statistics, Chi-square test, independent t-test, ANOVA, and Pearson’s correlation coefficient.

Fifty-nine percent students had a high level of stress, whereas 40% had problematic smartphone use. Sixty percent students experienced PV, whereas 42% experienced PR and both were significantly associated with higher frequency of phone use and the use of vibration mode. Mean SAS-SV score was significantly lower in students who did not perceive PR/PV, whereas mean PSS score was significantly lower in students who did not perceive PV.

Mobile Phone Addiction and Its Relationship to Sleep Quality and Academic Achievement of Medical Students at King Abdulaziz University, Jeddah, Saudi Arabia (2018)

J Res Health Sci. 2018 Aug 4;18(3):e00420.

Adverse effects of Mobile Phone (MP) usage could lead to dependency problems, and medical students are not excluded from it. We aimed to determine the pattern of MP usage, and its relation to sleep quality and academic performance between medical students at King Abdulaziz University (KAU), Jeddah, Saudi Arabia.

A multistage stratified random sample was used for selection of 610 participants, during 2016-2017. A validated, anonymous data collection sheet was used. It inquired about the Grade Point Averages (GPA). It included the Problematic Mobile Phone Use Questionnaire (PMPU-Q) for assessing various aspects of cellphone addiction (dependency, financial problems, prohibited and dangerous use). The Pittsburgh Sleep Quality Index (PSQI) was also included. Descriptive and inferential statistics were done.

A high frequency of MP usage prevailed among participants (73.4% used it >5 h/day). About two-thirds of participants had poor sleep quality. Females, owners of smartphone for >1 yr, and increasing time spent on MP were associated with MP dependency. Lower academic achievers had significantly worse MP scores on financial problems, dangerous use, and total PUMP. MP dependency was correlated with subjective sleep quality score, and sleep latency. Global PSQI scale was correlated with prohibited MP use.

Lower achievers had significantly worse scores on MP financial problems, dangerous usage, and the total PMPU. MP dependency was correlated with poor subjective sleep quality, and sleep latency. Rationale MP usage is needed to decrease the dependency, improve sleep quality, and academic achievement of medical students.

Addiction-like Behavior Associated with Mobile Phone Usage among Medical Students in Delhi (2018)

Indian J Psychol Med. 2018 Sep-Oct;40(5):446-451. doi: 10.4103/IJPSYM.IJPSYM_59_18.

Mobile phone addiction is a type of technological addiction or nonsubstance addiction. The present study was conducted with the objectives of developing and validating a mobile phone addiction scale in medical students and to assess the burden and factors associated with mobile phone addiction-like behavior.

A cross-sectional study was conducted among undergraduate medical students aged ≥18 years studying in a medical college in New Delhi, India from December 2016 to May 2017. A pretested self-administered questionnaire was used for data collection. Mobile phone addiction was assessed using a self-designed 20-item Mobile Phone Addiction Scale (MPAS). Data were analyzed using IBM SPSS Version 17.

The study comprised of 233 (60.1%) male and 155 (39.9%) female medical students with a mean age of 20.48 years. MPAS had a high level of internal consistency (Cronbach’s alpha 0.90). Bartlett’s test of sphericity was statistically significant (P < 0.0001), indicating that the MPAS data were likely factorizable. A principal component analysis found strong loadings on items relating to four components: harmful use, intense desire, impaired control, and tolerance. A subsequent two-stage cluster analysis of all the 20-items of the MPAS classified 155 (39.9%) students with mobile phone addiction-like behavior that was lower in adolescent compared to older students, but there was no significant difference across gender.

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.

Problematic social networking site usage and substance use by young adolescents (2018)

BMC Pediatr. 2018 Nov 23;18(1):367. doi: 10.1186/s12887-018-1316-3.

The present study was devised to examine whether substance use in early adolescence is associated with problematic social networking site usage (PSNSU).

In the academic year 2013-2014, secondary schools in Padua (north-eastern Italy) were involved in a survey called “Pinocchio”. A sample of 1325 pupils attending years 6 to 8 (i.e. aged from 11 to 13 years) completed self-administered questionnaires, in which PSNSU was measured by applying the DSM-IV criteria of dependence to identify any social network addiction disorder and its fallout on daily life. Multivariate analysis (ordered logistic regression) was performed to assess an adjusted association between young adolescents’ substance use and PSNSU.

The percentage of pupils classified as problematic social networking site users rose with age (from 14.6% in year 6 to 24.3% in year 7, and 37.2% in year 8), and it was higher in girls (27.1%) than in boys (23.6%). In a fully-adjusted model, PSNSU conferred a higher likelihood of being substance users (OR 2.93 95% CI 1.77-4.85)

This study identified an association between PSNSU and the likelihood of substance use (smoking, alcohol and energy drink consumption), providing further evidence of the need to pay more attention to PSNSU in early adolescence.

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.

Study of Internet addiction in children with attention-deficit hyperactivity disorder and normal control (2018)

Ind Psychiatry J. 2018 Jan-Jun;27(1):110-114. doi: 10.4103/ipj.ipj_47_17.

The aim is to study and compare Internet addiction between ADHD and normal children and the relation of demographic profile to Internet addiction.

This was a cross-sectional study including 100 children (50 ADHD cases and 50 normal children without any psychiatric illness as controls) between the ages of 8 and 16 years. A semi-structured pro forma for demographic profile and Internet usage using Young’s Internet Addiction Test (YIAT) was used. Statistical analysis was done using SPSS 20.

Internet addiction among ADHD children was 56% (54% having “probable Internet addiction” and 2% having “definite Internet addiction”). This was statistically significant (P < 0.05) in comparison with normal children where only 12% had Internet addiction (all 12% had “probable Internet addiction”). ADHD children were 9.3 times more prone to the development of Internet addiction as compared to normal (odds ratio – 9.3). Significant increase in average duration of Internet usage in ADHD children with increasing score of YIAT (P < 0.05) was seen. The incidence of Internet addiction was more in male ADHD children as compared to normal (P < 0.05).

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 Withd