Policy and Prevention Approaches for Disordered and Hazardous Gaming and Internet Use: an International Perspective

Relationship between loneliness and internet addiction: a meta-analysis

BACKGROUND

In the digital age, the Internet has become integrated into all aspects of people's work, study, entertainment, and other activities, leading to a dramatic increase in the frequency of Internet use. However, excessive Internet use has negative effects on the body, psychology, and many other aspects. This study aims to systematically analyze the research findings on the relationship between loneliness and Internet addiction to obtain a more objective, comprehensive effect size.

METHODS

This study employed a comprehensive meta-analysis of empirical research conducted over the past two decades to investigate the relationship between loneliness and Internet addiction, with a focus on the moderating variables influencing this relationship. This meta-analysis adopted a unique approach by categorizing moderating variables into two distinct groups: the objective characteristics of research subjects and the subjective characteristics of researchers. It sheds light on the multifaceted factors that influence the relationship between loneliness and Internet addiction.

RESULTS

A literature search in web of science yielded 32 independent effect sizes involving 35,623 subjects. Heterogeneity testing indicated that a random effects model was appropriate. A funnel plot and Begg and Mazumdar's rank correlation test revealed no publication bias in this meta-analysis. Following the effect size test, it was evident that loneliness was significantly and positively correlated with Internet addiction (r = 0.291, p < 0.001). The moderating effect analysis showed that objective characteristics significantly affected the relationship. However, subjective characteristics did not affect the relationship.

CONCLUSIONS

The study revealed a moderately positive correlation between loneliness and Internet addiction. Moreover, this correlation's strength was found to be influenced by various factors, including gender, age, grade, and the region of the subjects. However, it was not affected by variables such as the measurement tool, research design, or research year (whether before or after COVID-19).

Internet Use Behavior and Adolescent Mental Health: The Mediating Effects of Self-Education Expectations and Parental Support

Purpose

This study focuses on how Internet use behavior affects adolescents' mental health and whether self-education expectations and parental support mediate the relationship between Internet use behavior and adolescents' mental health.

Methods

The data for this paper came from the results of the student questionnaire of the 2018 Programme for International Student Assessment (PISA 2018), which was a structured questionnaire that asked students about their family situation, school life, studies, internet use, and mental health, among other things. A sample of 336,600 children in grades 7-13 was selected for this study. The data were analyzed using STATA version 16 and the theoretical framework was tested using a mediated effects model.

Results

The results of the study showed that Internet use behavior made a positive contribution to mental health and the mediating effects of self-education expectations and parental support on the relationship between Internet use behavior and adolescent mental health were all significant.

Conclusion

It is recommended that appropriate policies should be formulated to help adolescents use the Internet rationally, and the positive effects of parental support and self-education expectations should be utilized.

Bidirectional associations between loneliness and problematic internet use: A meta-analytic review of longitudinal studies

BACKGROUND

Loneliness and problematic Internet use (PIU) are both major public health concerns around the world. These two constructs have long been linked, but there is conflicting evidence regarding the temporal nature of the loneliness-PIU relationship.

METHOD

We searched 8 databases to identify studies examining longitudinal associations between loneliness and PIU published on or before August 2023. From the 316 articles identified, 26 studies were included with a total of 23,382 participants.

RESULTS

Moderate, positive, and significant prospective pathways were found from loneliness to PIU (r = 0.287, p < 0.001, 95 % CI [0.241, 0.331]), and from PIU to loneliness (r = 0.255, p < 0.001, 95 % CI [0.205, 0.303]). Moderator analyses suggested that the association of loneliness with PIU was stronger in samples from Eastern countries, with more males, more young adults, less time passed, and in more recent years. The association of PIU with loneliness was stronger in samples from Eastern countries, with more males, more young adults, and in more recent years.

CONCLUSIONS

This meta-analytic review provided the first estimation for the overall bidirectional longitudinal associations between loneliness and PIU. A deeper comprehension of the relations has implications for loneliness and PIU intervention programs, where interventions targeting both constructs might be fruitfully applied.

Familial context influences media usage in 0- to 4-year old children

Background

The use of digital media (e.g., smartphones, tablets, etc.) and the Internet have become omnipresent for every age group and are part of children's and parents' everyday life. Focusing on young children, the availability of media devices, their use as well as associated problems (e.g., in social, emotional and motor development) have increased in recent years. Of particular interest for prevention of these problems in early childhood is the relationship between the familial context (parental digital media use, Problematic Internet Use, school graduation, presence of siblings) and the digital media use of infants and toddlers. The present study's goal was to describe media usage in 0-4-year-old children and to identify the potential relationship between familial context factors and child media usage.

Methods

The sample included N = 3,035 children aged 0 to 3;11 years (M = 17.37 months, SD = 13.68; 49.13% female). Recruitment took place within the framework of a restandardization study for a German developmental test. The parents of the participants answered a questionnaire on socio-demographics, on child media use, and on parental media use. Questions on parental media use included the full version of the Short Compulsive Internet Use Scale (S-CIUS).

Results

Significant increases in media usage times with child age were identified, but no significant gender differences. A multiple regression analysis revealed that increasing maternal total media usage time, a higher parental S-CIUS score, lower school leaving certificate of both mother and father, and increasing child's age led to higher child media usage time. Having siblings diminished young children's media usage in this study. Having more than one child and having children aged over a year was associated with a higher parental S-CIUS score.

Conclusion

Family factors such as maternal media use time, Problematic Internet Use and lower school graduation are significantly associated with young children's digital media use. Parents should be aware of their personal influence on their children's media use which might be due their role in terms of model learning.

Risk and protective factors for (internet) gaming disorder: A meta-analysis of pre-COVID studies

This large-scale meta-analysis aimed to provide the most comprehensive synthesis to date of the available evidence from the pre-COVID period on risk and protective factors for (internet) gaming disorder (as defined in the DSM-5 or ICD-11) across all studied populations. The risk/protective factors included demographic characteristics, psychological, psychopathological, social, and gaming-related factors. In total, we have included 1,586 effects from 253 different studies, summarizing data from 210,557 participants. Apart from estimating these predictive associations and relevant moderating effects, we implemented state-of-the-art adjustments for publication bias, psychometric artifacts, and other forms of bias arising from the publication process. Additionally, we carried out an in-depth assessment of the quality of underlying evidence by examining indications of selective reporting, statistical inconsistencies, the typical power of utilized study designs to detect theoretically relevant effects, and performed various sensitivity analyses. The available evidence suggests the existence of numerous moderately strong and highly heterogeneous risk factors (e.g., male gender, depression, impulsivity, anxiety, stress, gaming time, escape motivation, or excessive use of social networks) but only a few empirically robust protective factors (self-esteem, intelligence, life satisfaction, and education; all having markedly smaller effect sizes). We discuss the theoretical implications of our results for prominent theoretical models of gaming disorder and for the existing and future prevention strategies. The impact of various examined biasing factors on the available evidence seemed to be modest, yet we identified shortcomings in the measurement and reporting practices.

Gamers' and non-gamers' perspectives on the development of problematic video game play

Gaming Disorder was recently included in the 11th Edition of the International Classification of Diseases and Internet Gaming Disorder may be introduced in the sixth edition of The Diagnostic and Statistical Manual. Much is not understood about how problems with video games develop. This qualitative study aimed to better understand the development of problematic gaming through focus groups. Eleven young adult "frequent gamers," twelve young adult "non-frequent or non-gamers," and five older adult "non-gamers" discussed vulnerabilities and risk factors of problematic gaming. Participants across all groups believed that problematic gaming developed when people used video games as a primary means of meeting basic psychological needs that were unsatisfied, thwarted, or blocked outside of video games. Frequent and non-frequent gamers, compared to older adult non-gamers, were more likely to view video games as a healthy way to meet basic psychological needs and less likely to stereotype gamers. Video games are equipped to meet basic psychological needs for autonomy, competence, and relatedness. That is, gamers often experience a sense of agency, skill, and connection to others when playing video games. However, problematic gaming may develop when people with unmet psychological needs rely exclusively on video games to meet them. Treatment and prevention approaches to problematic gaming can benefit from greater attention to helping at risk individuals meet needs for autonomy, competence, and relatedness outside of video games.

Not all games are created equal: Adolescents who play and spend money on simulated gambling games show greater risk for gaming disorder

Research reports positive associations between gaming disorder (GD) in adolescents and loot box purchasing but has not examined this relationship for other types of simulated gambling. This study examined whether greater engagement and expenditure in three types of simulated gambling were associated with meeting the criteria for GD in adolescents. A sample of Australians aged 12-17 years (N = 826) was recruited through an online panel aggregator. It included 646 gamers (57.7% male) with 89 being classified as having past-year GD, as defined and measured by the Internet Gaming Disorder Scale. Independent variables comprised past-month engagement in three simulated gambling activities (games with 'mini' gambling components, social casino games, and loot boxes), loot box purchasing, other microtransactions, impulsiveness, and demographics. Logistic regressions first examined whether engagement in each of the three simulated gambling activities was individually associated with GD, then with all three in the same model, and then controlling for demographic variables and impulsivity. Logistic regressions also examined whether microtransactions and purchasing loot boxes were individually associated with GD, then with both in the same model, and then controlling for demographic variables and impulsivity. Adolescents who had engaged in each simulated gambling activity in the past month were more likely to report meeting the criteria for GD. These relationships remained significant when controlling for common demographics and impulsiveness. Past-month engagement in social casino games increased the odds of GD 2.5 times (95% CI: 1.54; 4.02), 2.4 times for games with 'mini' gambling components (95% CI: 1.42; 3.90) and 2.0 times for engaging in loot boxes (95% CI: 1.22; 3.21), but only social casino games remained significant when controlling for engagement in all three activities. The likelihood of meeting the criteria for GD increased 3.8 times with expenditure on microtransactions (95% CI: 2.32; 6.27) and 4.6 times for buying loot boxes, and each remained significant when both were included in the model. Compared to digital games without simulated gambling elements, simulated gambling appears to attract adolescents who report GD. Implications of the results are discussed in detail.

Associations Between Problematic Internet Use and Mental Health Outcomes of Students: A Meta-analytic Review

The increasing prevalence of problematic internet use has heightened concerns about its adverse impact on internet users' mental health. Despite reviews investigating the associations between problematic internet use and mental health outcomes, there is a lack of understanding of various aspects of students' mental health. This study aimed to bridge this gap by providing a more comprehensive overall picture of this issue through a quantitative synthesis based on three-level random-effects meta-analytic models. In total, 223 studies with a cumulative total of 498,167 participants and 512 effect sizes were included in this synthesis. The results showed that problematic internet use was moderately and positively associated with depressive symptoms, anxiety, loneliness, and other mental health outcomes, and negatively related to subjective well-being. Moderator analyses revealed that several study features (i.e., school grade, region, measure of problematic internet use, publication year, and gender) could explain the variations in the findings across individual studies. These research results provide solid evidence for the link between problematic internet use and different mental health outcomes and have implications for future research and interventions on students' problematic internet use.

SUPPLEMENTARY INFORMATION

The online version contains supplementary material available at 10.1007/s40894-022-00201-9.

Public Health Approach to Problems Related to Excessive and Addictive Use of the Internet and Digital Media

Purpose of Review

Advances in digital technology and media have provided convenience and advantages in all areas of our daily lives. However, there is a risk of excessive and addictive use, which increases the risk of addiction as a disease and other related mental and physical problems. This article reviews the public health approach to problems related to excessive and addictive use of the Internet and digital media.

Recent Findings

The public health model views addiction as the result of interactions among individuals, digital media, and the environment; therefore, interventions should aim to reduce risk factors and increase protective factors in these three areas. This includes developing and providing evidence-based services according to each individual's problem type and severity. Regarding interventions for digital media and the environment, restricting accessibility and regulating content may be necessary. This calls for an integrative, comprehensive, and continuous intervention strategy, and to achieve such a framework, we need to establish an information system to monitor the magnitude and patterns of related problems.

Summary

This review suggests a surveillance system that provides a list of evidence-based policies from the public health perspective. Suggestions for an advanced international information, policy, and monitoring system are discussed.

Relationship of Gaming Disorder with parenting based on low affection-communication and personality trait of neuroticism in adolescents

Background

Gaming Disorder is increasingly common in adolescents. We aimed to evaluate the relationship between parenting, personality traits, and Gaming Disorder.

Methods

An observational and cross-sectional study in six secondary schools of Castelló, obtaining a final sample of 397 students.

Results

Adolescents with Gaming Disorder had lower scores in Adolescent Affection-Communication (F = 8.201; p < 0.001), Father's Warmth (F = 3.459; p = 0.028), and Father's Acceptance/Involvement (F = 5.467; p = 0.003), and higher scores in Mother's Revoking Privileges (F = 4.277; p = 0.034) and Father's Indifference (F = 7.868; p = 0.002) than healthy participants. Male sex was a risk factor for Gaming Disorder (OR = 12.221; p = 0.004), while Adolescent Affection-Communication (OR = 0.908; p = 0.001) and Agreeableness (OR = 0.903; p = 0.022) were protective factors. Data modeling described the protective effect that Adolescent Affection-Communication had on Gaming Disorder, which was both directly (B = -0.20; p < 0.001) and indirectly mediated by Neuroticism (B = -0.20; p < 0.001), while Neuroticism itself was a risk factor for Gaming Disorder (B = 0.50; p < 0.001).

Conclusion

These results reflect that Parental style with low affection and communication was directly and indirectly related to the Gaming Disorder, as well as male sex and personality trait of Neuroticism.

Content and Effectiveness of Web-Based Treatments for Online Behavioral Addictions: Systematic Review

BACKGROUND

Very few people seek in-person treatment for online behavioral addictions including gaming and gambling or problems associated with shopping, pornography use, or social media use. Web-based treatments have the potential to address low rates of help seeking due to their convenience, accessibility, and capacity to address barriers to health care access (eg, shame, stigma, cost, and access to expert care). However, web-based treatments for online behavioral addictions have not been systematically evaluated.

OBJECTIVE

This review aimed to systematically describe the content of web-based treatments for online behavioral addictions and describe their therapeutic effectiveness on symptom severity and consumption behavior.

METHODS

A database search of MEDLINE, Embase, PsycInfo, Web of Science, Cochrane Central Register of Controlled Trials, and Google Scholar was conducted in June 2022. Studies were eligible if the study design was a randomized controlled trial or a pre-post study with at least 1 web-based intervention arm for an online behavioral addiction and if the study included the use of a validated measure of problem severity, frequency, or duration of online behavior. Data on change techniques were collected to analyze intervention content, using the Gambling Intervention System of CharacTerization. Quality assessment was conducted using the Effective Public Health Practice Project Quality Assessment Tool.

RESULTS

The review included 12 studies with 15 intervention arms, comprising 7 randomized controlled trials and 5 pre-post studies. The primary focus of interventions was gaming (n=4), followed by internet use inclusive of screen time and smartphone use (n=3), gambling (n=3), and pornography (n=2). A range of different technologies were used to deliver content, including websites (n=6), email (n=2), computer software (n=2), social media messaging (n=1), smartphone app (n=1), virtual reality (n=1), and videoconferencing (n=1). Interventions contained 15 different change techniques with an average of 4 per study. The techniques most frequently administered (>30% of intervention arms) were cognitive restructuring, relapse prevention, motivational enhancement, goal setting, and social support. Assessment of study quality indicated that 7 studies met the criteria for moderate or strong global ratings, but only 8 out of 12 studies evaluated change immediately following the treatment. Across included studies, two-thirds of participants completed after-treatment evaluation, and one-quarter completed follow-up evaluation. After-intervention evaluation indicated reduced severity (5/9, 56%), frequency (2/3, 67%), and duration (3/7, 43%). Follow-up evaluation indicated that 3 pre-post studies for gaming, gambling, and internet use demonstrated reduced severity, frequency, and duration of consumption. At 3-month evaluation, just 1 pre-post study indicated significant change to mental health symptoms.

CONCLUSIONS

Web-based treatments for online behavioral addictions use an array of mechanisms to deliver cognitive and behavioral change techniques. Web-based treatments demonstrate promise for short-term reduction in symptoms, duration, or frequency of online addictive behaviors. However, there is limited evidence on the effectiveness of web-based treatments over the longer term due to the absence of controlled trials.

What the grey literature can contribute to addictive behaviour disorder classification •

This commentary examines the proposal made by Brand et al. (2022) regarding a framework outlining relevant criteria for considering possible behavioural addictions within the current World Health Organisation's International Classification of Diseases (ICD-11) category of 'other specified disorders due to addictive behaviours'. We agree with the framework as it highlights the clinical perspective requiring agreed-upon classifications and criteria to produce effective diagnostic procedures and efficacious treatments. Additionally, we propose to add the need of recognising potential addictive behaviour through the inclusion of a fourth meta-level criterion: 'grey literature evidence'. Utilising non-academic evidence can provide validity in the social context where the behaviour takes place, and it can support authorities in taking action to prevent and treat the resultant behavioural problems. The inclusion of the proposed fourth criterion will aid comprehensibility of the current proposal and provide clarity, as indicated in the present commentary, which includes the fourth criterion analysis for problematic pornography use, shopping/buying and social networking site use.

Exploring Internet gaming disorder: an updated perspective of empirical evidence (from 2016 to 2021)

BACKGROUND AND AIMS

Since the acceptance of Internet gaming disorder (IGD) as a "disorder due to addictive behaviors", research has proliferated exponentially. The present review focuses on the conceptualization of IGD, its diagnosis and assessment, associated factors and existing prevention and treatment plans to address it.

RESULTS AND CONCLUSIONS

The discrepancies between the diagnostic criteria for IGD proposed by the two central diagnostic entities, as well as the questioning of their clinical validity, have generated multiple proposals for the diagnosis and psychometric evaluation of IGD. Likewise, there have been numerous suggestions to prevent this pathology, with the involvement of governments, the gaming industry and health institutions. Finally, multiple treatment plans have been proposed, both pharmacological and psychological, although only the efficacy of cognitive behavioral therapy has been tested. It is essential, therefore, to delve deeper into this disorder by addressing the central limitations of the current literature.

Emerging experience with selected new categories in the ICD-11: complex PTSD, prolonged grief disorder, gaming disorder, and compulsive sexual behaviour disorder

Among the important changes in the ICD-11 is the addition of 21 new mental disorders. New categories are typically proposed to: a) improve the usefulness of morbidity statistics; b) facilitate recognition of a clinically important but poorly classified mental disorder in order to provide appropriate management; and c) stimulate research into more effective treatments. Given the major implications for the field and for World Health Organization (WHO) member states, it is important to examine the impact of these new categories during the early phase of the ICD-11 implementation. This paper focuses on four disorders: complex post-traumatic stress disorder, prolonged grief disorder, gaming disorder, and compulsive sexual behaviour disorder. These categories were selected because they have been the focus of considerable activity and/or controversy and because their inclusion in the ICD-11 represents a different decision than was made for the DSM-5. The lead authors invited experts on each of these disorders to provide insight into why it was considered important to add it to the ICD-11, implications for care of not having that diagnostic category, important controversies about adding the disorder, and a review of the evidence generated and other developments related to the category since the WHO signaled its intention to include it in the ICD-11. Each of the four diagnostic categories appears to describe a population with clinically important and distinctive features that had previously gone unrecognized as well as specific treatment needs that would otherwise likely go unmet. The introduction of these categories in the ICD-11 has been followed by a substantial expansion of research in each area, which has generally supported their validity and utility, and by a significant increase in the availability of appropriate services.

Development and Validation of a Risk Assessment Tool for Gaming Disorder in China: The Gaming Hazard Assessment Scale

Despite the growing research interest in gaming disorder, risk screening tools developed specifically for the Chinese population are still lacking. This study aimed to construct a screening tool to evaluate the risk of gaming disorder (GD) development, by assessing the severity of GD symptoms among Chinese gamers, based on clinical expert interviews, structured interviews with GD patients, a background literature review, and IGD/GD criteria proposed by the DSM-5 and ICD-11. It introduced the Gaming Hazard Assessment Scale—a multidimensional GD risk screening tool—and evaluated the dimension structure, reliability, and validity of the scale among 959 Chinese gamers. A three-level structure, consisting of 18 items scored from 0 to 54, ultimately indicated satisfactory reliability, good validity, and acceptable model fit. The scale will help large-scale initial screening and early identification of patients with a high risk of GD. Further evaluation of the Gaming Hazard Assessment Scale in clinical settings is highly recommended.

Effects of Psychological Distress and Coping Resources on Internet Gaming Disorder: Comparison between Chinese and Japanese University Students

The high prevalence of Internet gaming disorder (IGD) among Asian youth indicates an urgent need to identify protective factors and examine their consistency across Asian cultures in order to facilitate cost-effective interventions. Based on the transactional theory of stress and coping, this study collected data of 1243 online gamers (45% males; 18-25 years) through an anonymous survey from universities in China and Japan and investigated whether three coping resources (i.e., mindfulness, coping flexibility, and social support) serve to protect Chinese and Japanese youth from the impact of psychological distress on IGD tendency. After adjusting for the measurement non-invariance across samples, we found that Japanese students reported higher levels of IGD tendency and psychological distress than Chinese students. The results of multiple-group SEM analyses showed that, after controlling for other predictors, mindfulness served as the strongest protective factor against IGD across samples. Moreover, the buffering effect of mindfulness on the association between psychological distress and IGD tendency of female (but not male) students was observed. Our findings highlighted the cross-cultural invariance of the impact of psychological distress and coping resources on IGD in Chinese and Japanese youth, which can be considered in future IGD prevention programs.

The Associations Between Gaming Motivation and Internet Gaming Disorder: Systematic Review and Meta-analysis

BACKGROUND

There has been a surge in interest in examining internet gaming disorder (IGD) and its associations with gaming motivation. Three broad components of gaming motivation have been proposed: achievement, immersion, and social. Achievement-oriented players are motivated by gaining in-game rewards, immersion-oriented players are motivated by the experience of immersion in the virtual world, and social-oriented players are motivated by the need to socialize with other players through gaming.

OBJECTIVE

This study aimed to (1) quantitatively synthesize the growing body of literature to systematically examine the discrepancies in the magnitude of associations between various components of gaming motivation and IGD and (2) examine the moderating role of cultural dimension on the association between escapism gaming motivation and IGD.

METHODS

We conducted a systematic search of multiple databases between 2002 and 2020. Studies were included if they (1) included quantitative data, (2) used measures assessing both gaming motivation and IGD, and (3) contained sufficient information for effect size calculation.

RESULTS

The findings revealed IGD to have a stronger association with achievement motivation (r=0.32) than with immersion (r=0.22) or social motivation (r=0.20), but the strongest such association was found to be with escapism motivation (r=0.40), a subcomponent of immersion motivation. Our cross-cultural comparison further showed a stronger association between escapism motivation and IGD in studies conducted in individualistic (vs collectivistic) regions.

CONCLUSIONS

This meta-analysis highlights the importance of acknowledging the discrepancies among different components of gaming motivation with respect to their role in the development of IGD, as well as the potential cultural variations in the strength of such associations.

Development and validation of the smartphone addiction risk children questionnaire (SARCQ)

Smartphone abuse interferes with all activities in daily life. Young people who tend to have a smartphone addiction (SA) also have social, familiar and academic problems. Furthermore, smartphone provides immediate access to communication as well as avoids experiencing social anxiety. This research aims to evaluate the factorial structure of Smartphone Addiction Risk Children Questionnaire (SARCQ), a specific questionnaire created to assess the risk of SA in primary school children (8–11 years). An exploratory factor analysis before and a confirmatory factor analysis after were performed in order to establish the factorial structure of the questionnaire. Results showed a two-factor structure explaining 49.30% of total variance. The outstanding dimensions are: “I'm not afraid with you” (INAWY) and “Linus blanket” (LB). SARCQ will be useful to assess the risk of SA in childhood in order to operate early effective therapeutic interventions.

Effectiveness of Cognitive Behavioral Therapy-Based Intervention in Preventing Gaming Disorder and Unspecified Internet Use Disorder in Adolescents: A Cluster Randomized Clinical Trial

IMPORTANCE

Behavioral addictions were introduced as novel mental disorders in the International Classification of Diseases, 11th Revision, based on evidence that human behavior itself can become addictive, similar to addiction to substances. However, previous studies on prevention of gaming disorder and unspecified internet use disorder lacked randomization, follow-up measurements, and diagnostic interviews that assessed incidence rates; this trial was intended to fill this gap.

OBJECTIVES

To investigate whether the PROTECT (Professioneller Umgang mit technischen Medien [Professional Use of Technical Media]) intervention can reduce the symptom severity and prevent full syndrome and subthreshold onset of gaming disorder and unspecified internet use disorder in at-risk adolescents.

DESIGN, SETTING, AND PARTICIPANTS

A multicenter cluster randomized clinical trial conducted recruitment, screening, intervention delivery, and data collection among at-risk adolescents aged 12 to 18 years in 33 high schools in Germany. Inclusion criteria for the study and symptom severity analyses were elevated symptoms of gaming disorder and unspecified internet use disorder. A subsample that met the inclusion criteria for incidence analyses (no full syndrome of gaming disorder or unspecified internet use disorder, depression, or anxiety at baseline) was analyzed for illness onset. Participants were randomized to either the PROTECT intervention group or the assessment-only control group. Participants were assessed at baseline, 1-month follow-up, 4-month follow-up, and 12-month follow-up between October 1, 2015, and September 30, 2018. Based on intent-to-treat principle, data analyses were conducted from February 8, 2019, to May 7, 2021.

INTERVENTIONS

PROTECT, a theory-driven, manualized, cognitive behavioral therapy-based indicated preventive group intervention that is delivered in 4 sessions by trained psychologists. It targets changes in addictive reward processing and pathological cognitive mechanisms.

MAIN OUTCOMES AND MEASURES

The primary outcome was symptom severity (measured by CSAS [Computerspielabhängigkeitsskala], a modified German video game dependency scale with a score range of 0-56 [higher scores indicating greater pathology]) along with incidence rates (assessed by a structured clinical interview) after 12 months. Secondary outcomes were comorbid psychopathology and problem behaviors.

RESULTS

A total of 422 at-risk adolescents (mean [SD] age, 15.11 [2.01] years; 229 female participants [54.3%]) were randomized to either the PROTECT intervention group (n = 167; mean [SD] risk score, 29.05 [6.98]) or the assessment-only control group (n = 255; mean [SD] risk score, 26.21 [5.01]) and were included in the symptom severity analyses. Compared with the control group, the PROTECT group showed a significantly greater reduction in symptom severity of gaming disorder or unspecified internet use disorder (γ11 = -0.128; 95% CI, -0.246 to -0.011; P = .03), reflecting a 39.8% vs 27.7% reduction of symptoms with an effect size of Cohen d = 0.67 (baseline vs 12-month follow-up) for the PROTECT group. Differences in incidence rates did not reach statistical significance. The PROTECT group showed a significantly greater decrease in procrastination (γ11 = -0.458; 95% CI, -0.735 to -0.180; P < .001) over 12 months, but no significant differences were found for other secondary outcomes.

CONCLUSIONS AND RELEVANCE

Results of this trial showed that the PROTECT intervention effectively reduced symptoms of gaming disorder and unspecified internet use disorder over 12 months. The intervention did not change incidence rates of gaming disorder or unspecified internet use disorder.

TRIAL REGISTRATION

ClinicalTrials.gov Identifier: NCT02907658.

Measurement Invariance of the Questionnaire on the Internal Stigma of Internet Surfing Among Sino-Australian Undergraduates

BACKGROUND

The stigma of internet surfing is a relatively new area of study arising from the popularity of the internet. The Questionnaire on the Internal Stigma of Internet Surfing-9 (QISIS-9) was developed for the Chinese culture, so its suitability for use in other cultural contexts is uncertain. This paper examines the measurement invariance of the QISIS-9 among Sino-Australian undergraduates to verify the cross-cultural measurement invariance of QISIS-9 and promote cross-cultural (nationality) research regarding the internal stigma of internet surfing.

METHODS

The Internal Stigma of Internet Surfing-9 (QISIS-9) was used to assess 200 Chinese undergraduates (50% female, M_age = 19.78) and 204 Australian undergraduates (76% female, M_age = 21.10), respectively.

RESULTS

A confirmatory factor analysis (CFA) indicated that the single-factor model of QISIS-9 is acceptable with both Chinese and Australian undergraduates. However, the factor loading of Item 9, to which a reverse score is assigned, is not ideal for both samples. Thus, the item should be deleted. According to a multigroup confirmatory factor analysis (MCFA), QISIS-8, the revised version of QISIS-9, meets the strict measurement invariance among the Chinese and Australian participants. The QISIS-8 demonstrated appropriate internal consistency in the scores for both the Chinese and Australian undergraduates.

CONCLUSION

The new QISIS-8 can effectively assess the internal stigma of internet surfing among Chinese and Australian undergraduates, and it provides a frame of reference for further cross-cultural (border) comparisons.

Youth Internet Safety Education: Aligning Programs With the Evidence Base

BACKGROUND

This review critically examines the messages of youth internet safety education programs in the light of research about both the dynamics of internet dangers and the efficacy of youth prevention education.

METHODS

Using terms "internet safety education" and "digital citizenship," a Google search identified 12 multi-topic safety programs. Review articles were identified via Google Scholar for six forms of online harm to youth that have been targeted by many of these programs: cyberbullying (19 articles); online sexual exploitation (23 articles); sexting (19 articles); online fraud, hacking, and identity theft (6 articles); online suicide and self-harm promotion (18 articles); and internet overuse or addiction (15 articles).

FINDINGS

There appear to be mismatches between dynamics revealed in the research about internet harms and the messages emphasized in educational programs, particularly on the issues of sexual exploitation and sexting. Overall, the review literature also suggests major advantages to integrating internet safety into already well-established and evidence-based programs currently addressing related off-line harms, for example, programs focusing on general bullying, dating abuse, or sexual abuse prevention. The advantages stem from four factors: (1) the considerable overlap between online harms and similar off-line harms, (2) the apparent greater prevalence of off-line harms, (3) the evidence that the same risk factors lie behind both online and off-line harms, and most importantly, (4) the substantially superior evidence base for the longer standing programs developed originally around the off-line harms.

Draconian policy measures are unlikely to prevent disordered gaming

In August of 2021, China imposed severe restrictions on children's online gaming time. We argue that such a policy may seem useful on the surface but does not reflect the current evidence concerning prevention of disordered gaming. Videogame play is normal for children worldwide, and like other leisure activities can lead to benefits for the majority and problems for a minority. Problematic or disordered play results from the interaction of multiple risk factors that are not addressed by draconian policy measures. Identifying these factors through stakeholder-engaged research and current evidence will be much more likely to succeed in preventing disordered gaming and promoting youth wellbeing.

Time flies when chatting online: a social structure and social learning model to understand excessive use of mobile instant messaging

Purpose

Widespread concerns about excessive use of mobile instant messaging (MIM) have inspired research in different disciplines. However, the focus thus far tends to be on diagnostics and cognitive predictors. There is little understanding from the socio-technical perspective to capture the drivers of excessive use of MIM. To address this research gap, the authors aim to enrich existing literature by adopting a social structure and social learning model (SSSLM) to understand the excessive use of MIM. The authors argue that excessive MIM use is developed and reinforced in highly interactive online communication, through a social learning process.

Design/methodology/approach

The authors conduct a cross-sectional online survey to validate our proposed research model on excessive use of mobile instant messaging (MIM). 368 valid responses are obtained from active MIM users in China.

Findings

The results suggest that highly interactive MIM creates a technology-based social structure that facilitates the social learning process of excessive technology use. The influence of perceived interactivity of MIM on excessive MIM use is mediated by a series of contextualized social learning factors. Furthermore, the influences of perceived interactivity on social learning factors are moderated by MIM use experience.

Originality/value

The authors contribute to literature in related fields by highlighting the crucial role of social learning in facilitating excessive technology use. The authors contribute to the social structure and social learning model by contextualizing it into the context of excessive MIM use. Design guidelines are provided with a purpose to inhibit excessive use of MIM.

Development and Verification of an Internet Game Literacy Scale

BACKGROUND

Education on internet games for parents and internet game literacy are needed to prevent problematic internet game playing in Korea. We created an 18-item Internet Game Literacy Scale (IGLS). It is a valuable tool for assessing the positive and negative aspects of internet game play. We aimed to determine the validity of the IGLS and the cut-off for the tendency for internet gameplay.

METHODS

An online research company gathered data from 300 participants. Factor analysis, including Cronbach's α and consistency coefficient, exploratory factor analysis, and confirmatory factor analysis were conducted to verify the 18 items of the IGLS. Additionally, a K-means cluster analysis was performed to determine the cut-off values for positive and negative IGLS scores.

RESULTS

The 18 items of the IGLS were proven to be reliable, as evidenced by a high Cronbach's alpha (α = 0.892). The Kaiser-Meyer-Olkin measure of sampling adequacy was 0.903, and Bartlett's test of sphericity was good (χ² = 1,623.314, P < 0.001). All 18 items were segregated into two factors, with nine items each. The eigenvalue of all 18 items was significant at > 0.4. In the analysis of the validity of the 18-item IGLS with confirmatory factor analysis (CFA) (maximum likelihood estimation, with an oblique method), the fit indices of the standard three-factor model reached acceptable standards. The cut-off point of the total score between the low positive and average positive groups was 23, and the cut-off point of the total score between the average positive and high positive groups was 30. The cut-off point of the total score between the low negative and the average negative groups was 24. The cut-off point of the total score between the average negative group and the high negative group was 32.

CONCLUSION

The study assessed the reliability and validity of the IGLS and suggested a cut-off for low, average, and high Internet game literacy degree with 300 Korean adults aged 21-49 years. The current results suggest that the IGLS has good internal consistency and a proper cut-off for positive and negative internet game literacy degrees.

Managing Problematic Usage of the Internet and Related Disorders in an Era of Diagnostic Transition: An Updated Review

INTRODUCTION

Problematic Usage of the Internet (PUI) refers to a broad and likely heterogeneous group of Internet-related conditions associated with behavioural disturbances and functional impairment.

METHODS

Within PUI several conditions have been reported, including Gaming Disorder, Shopping Addiction, Cyberchondria, Gambling Disorder, Cyberpornography Addiction and Cyberbullying. While increasing reports in the field try to define the epidemiologic and clinical boundaries of these conditions, the rapid and continuous evolution of Internet related behaviours as well as their problematic/pathological expressions are often difficult to diagnose, assess, approach with treatment interventions and follow-up.

RESULTS

In addition, some of the PUI-related conditions show characteristics of addiction to the Internet as a preferential tool to engage in specific behaviours, while some others exclusively manifest on the Internet, making it necessary to find distinct assessment and treatment pathways.

CONCLUSION

The inclusion of Internet Gaming Disorder in Section III by the DSM-5 and the recognition of Gaming Disorder by the ICD-11 opened the way for a systematic clinical investigation of this and other PUI-related conditions, particularly in terms of preventive and therapeutic strategies. The present article is aimed at offering an updated clinical overview on the main expressions of PUI, focussing on the latest acquisitions in this evolving field.

[Examining the effects of dissonance-based primary prevention of Internet and computer-game addiction on attitudes toward gaming among grade 5 pupils: A pilot study]

Examining the effects of dissonance-based primary prevention of Internet and computer-game addiction on attitudes toward gaming among grade 5 pupils: A pilot study Abstract. Objective: To date, childhood has hardly been considered in the development of effective prevention and intervention programs for gaming disorder and Internet addiction. PROTECTdissonance was therefore designed as a 1-hour dissonance-based, universal primary prevention program for grade 5 high-school students. This pilot study examines the immediate effects of dissonance induction on attitudes toward gaming. Method: A single-arm A+B design with three measurement points (T0, T1, T2) assessed attitudes toward gaming using the Gaming Attitude Test (GAT). The baseline sequence (sequence A, T0 to T1, subsample) included N = 83 high-school students (age: M = 10.27; SD = 0.48) and the intervention sequence (sequence B, T1 to T2, total sample) included N = 200 pupils (age: M = 10.24; SD = 0.47). Acceptance and satisfaction were recorded after the intervention. Results: Hierarchical linear growth models showed a significant reduction of GAT symptoms through the intervention, both in the total GAT score and on the subscale "Trivialization of Negative Consequences." There were no changes in the natural course (baseline sequence A). Pupils correspondingly reported a high rate of satisfaction with PROTECTdissonance. Conclusions: A brief, targeted dissonance-induction exercise shows immediate effects on an attitudinal measure of gaming. To follow up on this promising approach, future studies should investigate whether reduced trivialization of negative consequences of gaming is actually reflected in behavioral change.

Global prevalence of gaming disorder: A systematic review and meta-analysis

BACKGROUND

Gaming disorder was included in the latest revision of the International Classification of Diseases (11th ed.). Worldwide, prevalence estimates of gaming disorder are considerably heterogeneous and often appear to be exceedingly high. However, few studies have examined the methodological, cultural and/or demographic factors that might explain this phenomenon. This review employed meta-analytic techniques to compute the worldwide-pooled prevalence of gaming disorder and evaluate the potential contributing factors for varied prevalence estimates.

METHOD

Prevalence estimates were extracted from 53 studies conducted between 2009 and 2019, which included 226,247 participants across 17 different countries. Study findings were meta-analyzed using a random-effects model. Subgroup and moderator analyses examined potential sources of heterogeneity, including assessment tool and cut-off, participant age and gender, sample size and type, study region, and year of data collection.

RESULTS

The worldwide prevalence of gaming disorder was 3.05% (confidence interval: [2.38, 3.91]); this figure was adjusted to 1.96% [0.19, 17.12] when considering only studies that met more stringent sampling criteria (e.g. stratified random sampling). However, these estimates were associated with significant variability. The choice of screening tool accounted for 77% of the variance, with the Lemmens Internet gaming disorder-9, Gaming Addiction Identification Test and Problematic Videogame Playing scales associated with the highest estimates. Adolescent samples, lower cut-off scores and smaller sample size were significant predictors of higher prevalence. Gaming disorder rates were approximately 2.5:1 in favor of males compared to females.

CONCLUSION

The worldwide prevalence of gaming disorder appears to be comparable to obsessive-compulsive disorder and some substance-related addictions, but lower than compulsive buying and higher than problem gambling. Gaming disorder prevalence rates appear to be inflated by methodological characteristics, particularly measurement and sampling issues.

Person-centred interventions for problem gaming: a stepped care approach

BACKGROUND

Problem gaming is reported by approximately 1-3% of the population and is associated with decreased health and wellbeing. Research on optimal health responses to problem gaming remains limited. This study aimed to identify and describe the key components of a person-centred approach to interventions for problem gaming for individuals who voluntary seek assistance.

METHODS

Online interviews were conducted with 20 adults (90% male; M_age = 23y) currently seeking help for problem gaming. The interview protocol was guided by a health care access framework which investigated participants' experiences and needs related to accessing professional support. Transcripts were analysed in NVivo using qualitative content analysis to systematically classify participant data into the themes informed by this framework.

RESULTS

Participants had mixed views on how the negative consequences of problem gaming could be best addressed. Some indicated problems could be addressed through self-help resources whereas others suggested in-person treatment with a health professional who had expertise in gaming. Participants described the essential components of an effective health service for problem gaming as including: valid and reliable screening tools; practitioners with specialist knowledge of gaming; and access to a multimodal system of intervention, including self-help, internet and in-person options that allow gamers to easily transition between types and intensity of support.

CONCLUSION

A comprehensive health care approach for interventions for problem gaming is in its infancy, with numerous service access and delivery issues still to be resolved. This study highlights the importance of involving individuals with gaming-related problems in developing solutions that are fit for purpose and address the spectrum of individual preferences and needs. These findings recommend a stepped healthcare system that adheres to evidence-based practice tailored to each individual and the implementation of standard assessment and routine outcome monitoring.

Policy Recommendations for Preventing Problematic Internet Use in Schools: A Qualitative Study of Parental Perspectives

Parenting in the digital age has been characterized as one of the most challenging tasks of the modern era. Parents are ambivalent about their mediating role. However, problematic aspects of adolescent online use have not been adequately addressed in education. The present study investigated parental perceptions of intervention needs within schools to prevent excessive/problematic use, enhance parent-child communication, and reduce family conflicts. Nine interviews with parents of adolescents residing in the UK were carried out and analyzed utilizing thematic analysis. Three main themes emerged as parental proposals: (i) schools as digital education providers and prevention hubs, (ii) provision of mental health literacy to raise awareness, resolve ambiguity regarding impacts and mitigate excessive use and impacts, and (iii) psychoeducation and upskilling. The third theme related to impacts from time spent on screens (time displacement), content-related impacts, and context-related impacts. The present study offers recommendations for media literacy during adolescence beyond e-safety (i.e., addressing interpersonal communication problems, privacy vs. disclosure issues), based on parents' views, and provides new insights for media and emotional health literacy collaboration efforts. Future work should investigate the feasibility and effectiveness of such interventions to support the emotional health of young people and prevent problematic internet use escalation.

Prevention Strategies to Address Problematic Gaming: An Evaluation of Strategy Support Among Habitual and Problem Gamers

Psychosocial problems arising from excessive gaming are a public health issue across the developed world. In its most serious form, problematic gaming is recognized as gaming disorder (GD) in the ICD-11. Research has tended to focus on the value of outpatient treatment for GD, but less attention has been paid to broader prevention strategies to address less serious but nevertheless harmful gaming behaviors. Another gap in this literature has been the lack of involvement of the gaming community as stakeholders to identify feasible prevention approaches. This study investigated: (1) regular and problematic gamers' level of support for different prevention strategies within primary, secondary, and tertiary approaches; and, (2) whether self-efficacy is associated with greater support for prevention strategies, as predicted by the Health Belief Model. A total of 992 participants completed an online survey that evaluated support for problem gaming prevention strategies and included measures of self-efficacy, gaming involvement, and GD symptoms, psychological distress, and mental health help-seeking behaviors. Participants reported stronger support for primary prevention strategies, including education, screening, and warning labels, than for other prevention approaches. Overall, 61% of participants expressed support for primary prevention as compared to secondary (39%) and tertiary (36%) approaches. There was stronger support for outpatient care (48%) than inpatient services (25%). In-game shutdown features received the lowest support (65% disapproval). Contrary to the Health Belief Model, self-efficacy was not associated with prevention support. Younger, female, and less frequent gamers were more likely to support primary and secondary prevention strategies. These findings suggest that gamers may be more favorable toward prevention measures aligned with informed decision-making, autonomy, and self-directed actions. Gamers may be strongly opposed to modifications to the structure of gaming activities (e.g., shutdown features). Future research should evaluate the efficacy and cost-effectiveness of problem gaming prevention measures in different populations and regions.

Perceived Challenges and Online Harms from Social Media Use on a Severity Continuum: A Qualitative Psychological Stakeholder Perspective

Evidence suggests that problematic use of gaming, the internet, and social media among adolescents is on the rise, affecting multiple psycho-emotional domains. However, research providing a comprehensive and triangulated stakeholder perspective of perceived harms is lacking. How are adolescent online harms experienced and conceptualized by students, parents, and teachers? The present study comprised part of a qualitative needs assessment investigation with the use of focus groups and individual interviews among key stakeholder groups assessing perceived impacts with a focus on the negative consequences and perceived harms. The study’s sample consisted of students (N = 42, M_age = 13.5, SD = 2.3), parents (N = 9, M_age = 37, SD = 5.6) and teachers (N = 9, M_age = 34, SD = 4.9) from the UK. Data were analysed with thematic analysis. Findings focused primarily on social media use impacts and indicated that processes underlying impacts experienced by adolescents may be conceptualized on a severity continuum. Stakeholder consensus on perceptions of challenges and perceived harms formed the second theme, with impacts further analysed as relating to time displacement, peer judgement, sensory overload and context of the adolescent with functional (performance, task switching, use of multiple devices), cognitive (loss or deterioration of attentional focus, attention deficit), and emotional consequences (stress, anxiety, obsessive-compulsive/checking behaviours). A third theme formed was individual vulnerabilities predisposing poor mental health outcomes. The final theme related to impacts dependent on context and meaning attached. Findings suggest a consideration of a spectrum approach encompassing a broader range of potential psychological challenges and perceived harms beyond safety concerns and addiction in understanding problematic adolescent online experiences. Understanding perceived harms can aid the objective setting of interventions and consideration of mental health literacy in school curricula.

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

Background:

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

Methods:

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

Results:

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

Conclusions:

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

Problematic risk-taking involving emerging technologies: A stakeholder framework to minimize harms

BACKGROUND AND AIMS

Despite the many benefits of technological advancements, problematic use of emerging technologies may lead to consumers experiencing harms. Substantial problems and behavioral addictions, such as gambling and gaming disorders, are recognized to be related to Internet-based technologies, including the myriad of new devices and platforms available. This review paper seeks to explore problematic risk-taking behaviors involving emerging technologies (e.g., online gambling and gaming, online sexual behaviors, and oversharing of personal information via social networking sites) that have the potential to lead to problematic outcomes for individuals.

RESULTS AND DISCUSSION

Previous research has focused on policy frameworks for responding to specific issues (e.g., online gambling), but a broader framework is needed to address issues as they emerge, given lags in governments and regulators responding to dynamically evolving technological environments. In this paper, key terms and issues involved are identified and discussed. We propose an initial framework for the relative roles and responsibilities of key stakeholder groups involved in addressing these issues (e.g., industry operators, governments and regulators, community groups, researchers, treatment providers, and individual consumers/end users).

CONCLUSION

Multidisciplinary collaboration can facilitate a comprehensive, unified response from all stakeholders that balances individual civil liberties with societal responsibilities and institutional duty of care.

Considering existing classic and contemporary proposals for preventing online addiction problems: Some old recipes for new problems. •

This commentary examines the proposed framework in relation to current policy options and preventive strategies and adds classical prevention and ecological models to tackle internet use-related addiction problems. Specifically, it highlights the preventive developments regarding contributions to promote the healthy use of technologies, and the need of designing and testing prevention strategies targeting the incidence, prevalence and severity of these problems at all population levels. In summary, to start preventing and minimising harms due to the problematic and addictive use of emerging technologies, we already have old models we can apply to these new problems to ensure secure behaviours through the technologies, and enhance users' wellness and quality of life.

Gaming Disorder: How to Translate Behavioral Neuroscience Into Public Health Advances

Purpose of Review

Gaming disorder (GD), meanwhile classified as a mental disorder in both DSM-5 and ICD-11, is a current public health issue. Theoretical models assume core psychological processes, such as cue reactivity, craving, reward processing, decision-making, cognitive biases, inhibitory control, and stress relief, to be crucially involved in the development and maintenance of GD. This review summarizes neuroscientific findings on these processes in the context of GD as well as treatments and intervention programs addressing these processes.

Recent Findings

We identified overlaps regarding the involvement of neural structures and networks related to psychological processes which may be targeted by public health programs. Complex interactions between executive control, salience, reward, and habit networks are crucially linked to processes involved in GD and public health programs respectively.

Summary

We point at the difficulties of making one to one assignments of neural networks to psychological processes or interventions. Furthermore, new treatment and prevention programs of GD are discussed pointing at possible future directions for neuroscientific research and treatment programs for GD.

[Media-associated disorders in childhood and adolescence: Evidence paper of the joint addiction commision of the German societies and professional associations of child and adolescent psychiatry and psychotherapy]

Media-associated disorders in childhood and adolescence: Evidence paper of the joint addiction commision of the German societies and professional associations of child and adolescent psychiatry and psychotherapy Abstract. Media-associated disorders (MAD) describe the problematic use of the internet, certain electronic devices in general as well as digital applications. During childhood and adolescence, digital games and social media are the most commonly used applications. In May 2019, as first MAD "gaming disorder" was included as a clinical diagnosis in the ICD-11. The prevalence of MAD in German children and adolescents is estimated to lie between 3 % and 5 %. In most cases, MAD are accompanied by psychiatric comorbidities. MAD ensue because of dysfunctional learning processes in combination with general and specific risk factors. They are associated with neural changes like those of substance-associated addictions. Diagnostics can be based on validated questionnaires and clinical exploration, though a standardized diagnostic path is not yet common. Treatment depends on the level of severity and generally comprises outpatient, day-clinic, and inpatient therapy approaches with elements from cognitive-behavioral therapy and under parental involvement. Suitable treatments are not yet available in all German regions and have also not been sufficiently evaluated. Moreover, only a few studies exist on the efficacy of prevention measures addressing MAD in children and adolescents. Thus, further research is strongly required.

How have excessive electronics devices and Internet uses been concerned? Implications for global research agenda from a bibliometric analysis

BACKGROUND AND AIMS

Excessive use of electronic devices has become a major global problem. However, little is known about the development and current landscape of research concerning this field. This study aimed at exploring the overall publication trend and topics of research on the overuse of electronic devices and the Internet from 1971 to 2017.

METHODS

We systematically searched the Web of Science (WoS) and Scopus databases for published articles on the excessive use of electronic devices and the Internet. Data regarding the publication volume, international collaborations, and geographical locations were analyzed by bibliometrics analysis. Latent Dirichlet Allocation (LDA) was undertaken to categorize publications into different research topics.

RESULTS

A total of 2,276 papers from the WOS and 600 papers from the Scopus were included. We found a dramatic increase in the number of scientific papers towards addiction to electronic devices and the Internet. The United State led in all publication parameters including the total number of papers and total citations. China, Korea and Taiwan were among the most prolific countries/regions. Smartphone addiction was the main concern, and the relationship between the overuse of electronic devices and the Internet and mental health issues have been highlighted. On the other hand, our study found a limited appearance of discussion on effective treatment and intervention.

DISCUSSION AND CONCLUSION

The findings of this study call for more national and international cooperation in evaluating and intervening addiction to electronic devices and the Internet to gather more knowledge about this phenomenon and evaluate the effectiveness of treatment.

Preventing Harmful Internet Use-Related Addiction Problems in Europe: A Literature Review and Policy Options

Internet use-related addiction problems are increasingly being recognized on a European scale due to international health organizations considering gaming addiction. In April 2013, the American Psychiatric Association recognized Internet Gaming Disorder in the fifth Diagnostic and Statistical Manual of Mental Disorders, and in April 2018, the World Health Organization included Gaming Disorder in the eleventh International Classification of Diseases. However, findings on these problems within this period are lacking in Europe, and a preventive approach is missing globally. A detailed critical literature review was conducted using PsycINFO and Web of Science in this five-year period. A total of 19 studies were reviewed and problems identified were: generalized Internet addiction and online gaming and gambling addictions across seven European countries (i.e., Spain, Germany, France, Italy, Greece, The Netherlands, and Denmark). The individuals with problematic use were found to be educated adolescents, usually young males with comorbid disorders, and gaming and gambling disorders were implicated in the most severe cases. Cognitive behavioral therapy was the main treatment, sometimes combined with a systemic approach for adolescents. Prevalence, high-risk populations, and factors contributing to these addiction problems are discussed, and a set of policy options are developed for this region. The implications for early detection, diagnosis, treatment, and prevention in Europe are considered.

Fortnite microtransaction spending was associated with peers' purchasing behaviors but not gaming disorder symptoms

Monetized video games have received academic and regulatory scrutiny following concerns that these products may foster addiction-like behaviors, including compulsive spending. Previous studies have reported that individuals with markedly higher in-game financial expenditure are more likely to endorse symptoms of addictive behavior (i.e., gaming or gambling disorder). The present study recruited 428 adult Fortnite players from online forums and investigated gaming motivations and behaviors, as well as online social network influences, in relation to microtransaction spending and gaming disorder (GD) symptoms. The results showed that microtransaction spending was predicted by social influences (i.e., the frequency of spending by the participants' closest friend who spends money on Fortnite), greater accessibility to Fortnite across multiple devices, and having a higher in-game level. Spenders reported stronger motivation to acquire in-game rewards and were more likely to perceive game items as representing good value for money. Higher spenders were older and reported using more payment methods, having a close friend who pays for Fortnite more often, and spent more hours playing Fortnite. Problematic gaming was associated with trait impulsivity, weekly time spent playing the game, and the perception that reducing time spent playing would diminish one's sense of self-worth. Fortnite loot box spending was not associated with GD symptoms. These data suggest that different implementations of in-game monetization schemes may have different risk potential for consumers across games.