Unravelling the web of addictions: A network analysis approach

Protective and risk factors in problematic mobile phone use among adolescents: A three-wave longitude study

Adolescents' problematic mobile phone use (PMPU) has become increasingly severe. This study examined the changes in relationships between dimensions of PMPU, protective (positive psychological capital, i.e., optimism, hope, resilience, core self-evaluation) and risk (psychological distress, i.e., anxiety, depression, loneliness, and stress) factors within the network, aiming to identify the most influential factors over time and find the longitudinal predictive relationships between the factors and PMPU. A total of 1,170 Chinese adolescents participated over three waves (T1: January 2023, T2: August 2023, T3: February 2024). Cross-section network analysis showed that "core self-evaluation", "depression", "hope", "loss of control", and "stress_P" were the central nodes. "Stress_N" (sense of losing control and negative affective reactions) in risk factors and "affect control" (ability to regulate emotions) in protective factors were the bridge symptoms in the network across three timepoints. As shown in network comparison, the global strength of the network remained stable from T1 to T2 but increased from T2 to T3. The edge strength between "family support", "anxiety" and the nodes of PMPU weakened across the time. While, correlations between "loneliness", "goal planning", "positive thinking", "affect control" and PMPU nodes strengthened. The relationship between "Stress_N" and PMPU initially increasing before decreasing. Longitudinal cross-lagged network analysis revealed that "negative life consequence" and "craving" in PMPU strongly predicted protective/risk factors, while "hope," "affect control," and "core self-evaluation" were most susceptible to prediction. The findings highlight the significant role of "core self-evaluation" and "stress_N" in the development of adolescents' PMPU and the negative results of PMPU. Additionally, the changes in the network over time suggest that the factors influencing PMPU evolve, with various protective/risk factors gaining or losing significance at different stages. The results of CLPN emphasize the negative outcome of PMPU. Therefore, targeting interventions on the internalized symptoms may help alleviate the severity of PMPU among adolescents.

Patterns of Addiction in Chronic Skin Diseases: A Comparative Analysis of Addictions and Influencing Factors in Atopic Dermatitis and Psoriasis

Addictions seem to be more frequent in atopic dermatitis and psoriasis patients than in the general population. This cross-sectional observational study comparatively evaluated substance-related and behavioural addictions in atopic dermatitis and psoriasis patients and analysed possible addiction patterns. From October 2023 to April 2024, 100 atopic dermatitis and 104 psoriasis patients at a German university hospital completed an anonymous questionnaire, including sociodemographic and health-related parameters, along with validated assessment tools for common addictions (smoking, gambling, alcohol, drugs, food, and internet). More psoriasis patients had at least 1 addiction (50.0% vs 39.0%), were more frequent daily smokers (34.6% vs 15.0%) and reported gambling more frequently than atopic dermatitis patients. No differences emerged regarding gambling addiction. Psoriasis patients showed higher body mass index, with 1.9% addicted to food. Atopic dermatitis patients were more vulnerable to pathological internet use (9.0% vs 2.9%). Low happiness was a risk factor for smoking in atopic dermatitis and for gambling and drug consumption in psoriasis patients. Low disease severity was associated with pathological alcohol in-take in psoriasis. Younger age emerged as a ubiquitous risk factor for drug consumption. Distinct addiction patterns in atopic dermatitis and psoriasis patients, influenced by age, happiness, and disease severity, should guide the development of education and screening strategies.

Problematic pornography use and novel patterns of escalating use: A cross-sectional network analysis with two independent samples

Modern internet pornography allows users to harness sexual novelty in numerous ways, which can be used to overcome desensitisation through increasing volume of use (quantitative tolerance), progressing to more stimulating genres (qualitative escalation), skipping between stimuli (tab-jumping), delaying orgasm ('edging'), and engaging in pornographic binges. However, existing research has not yet evaluated how these potentially reciprocal consumption patterns relate to problematic pornography use (PPU). To this end, we recruited two independent samples of male pornography users (N1 = 1,356, Mage = 36.86, SD = 11.26; N2 = 944, Mage = 38.69, SD = 12.26) and examined the relationships between these behavioural dimensions and self-reported difficulties in controlling one's pornography use. Data were analysed through the network analysis approach (using Gaussian graphical models). As hypothesised, i) quantitative tolerance was centrally placed within the overall network, and ii) acted as a statistical bridge node between other patterns of pornography use (e.g., pornographic binges), and all measured facets of PPU. Our results are consistent with other emerging literature suggesting that tolerance, pornographic binges, tab-jumping, and edging behaviours as relevant features ofPPU, and that upscaling overall usage may connect broader patterns of use with problematic engagement. Clinical and theoretical implications, as well as future research directions, are discussed.

Network analysis of DSM-5 criteria for gambling disorder: considering sex differences in a large clinical sample

BACKGROUND

The fifth version of the Diagnostic and Statistical Manual for Mental Disorders (DSM-5) and its revised version (DSM-5-TR) propose severity levels for gambling disorder (GD) based on the number of criteria met. However, this taxonomy has some limitations. We aimed to assess the centrality of each criterion and its relationship by conducting a network analysis while considering sex differences.

METHODS

We performed a network analysis with the DSM-5 criteria for GD with data from 4,203 treatment-seeking patients (3,836 men and 367 women) diagnosed with GD who sought for treatment in a general tertiary hospital which has a unit specialized in behavioral addictions.

RESULTS

The withdrawal criterion ("Restless or irritable when attempting to cut down or stop gambling") showed the highest centrality values in both sexes. In men, the second most central criterion was the tolerance criterion ("Needs to gamble with increasing amounts of money in order to achieve the desired excitement"); while among women, the second was the chasing losses criterion ("After losing money gambling, often returns another day to get even").

CONCLUSIONS

The most central criteria identified are associated with compulsivity-driven behaviors of the addictive process. Taking into account the high relevance and transitive capacity of withdrawal in both men and women, as well as tolerance in men, and chasing losses in women, the recognition and understanding of these symptoms are fundamental for the accurate diagnosis and severity assessment of GD.

Depressive symptoms and loneliness among early adolescents: a psychometric network analysis approach

BACKGROUND

Previous studies demonstrate a high prevalence of depression and loneliness among adolescents. Although they often co-occur, the relationship between symptoms of depression and loneliness remains poorly understood. This study investigates: (a) the symptoms of depression that are connected to loneliness; (b) the role played by loneliness in the network of depression symptoms; and (c) whether the method used to measure loneliness (single-item direct or multi-item indirect) affects the relationship of loneliness with depressive symptoms.

METHODS

Participants were 496 Polish adolescents (50.8% girls) aged 11 to 13, who completed: (a) the 10-item Major Depressive Disorder subscale of the Revised Child Anxiety and Depression Scale; (b) the 11-item De Jong Gierveld Loneliness Scale (indirect loneliness), and (c) a single direct question evaluating loneliness: 'I'm lonely'. Networks were estimated using a Gaussian Graphical Model.

RESULTS

Loneliness shows a direct relationship with three affective symptoms of depression: sadness, worthlessness, and anhedonia, which mediate relationships with somatic symptoms. In contrast to previous studies, loneliness has the lowest level of centrality among all elements of the network. The method used to assess loneliness did not significantly affect the connections between loneliness and depressive symptoms.

CONCLUSIONS

Loneliness and depression overlap since they are formed by the same cognitive biases and deficits in emotion regulation but differ in the level of generality. In loneliness, they have an interpersonal context, while symptoms of depression can be intrapersonal. This helps us to understand why cognitive interventions, as compared to those which are social, are more effective in reducing loneliness.

The Predictive Role of Tolerance and Health Problems in Problem Gambling: A Cross-Sectional and Cross-Lagged Network Analyses

The existing symptomatic networks of problem gambling are all based on cross-sectional data. Thus, there is a need to explore longitudinal symptom networks of problem gambling. Moreover, the replicability of cross-sectional symptom networks can be limited; therefore, further research should assess the convergence between cross-sectional networks of problem gambling symptoms. The present study aimed (i) to examine cross-sectional networks of problem gambling symptoms and evaluate their replicability and (ii) to examine a longitudinal cross-lagged network of problem gambling symptoms. The study included a representative sample of young adult gamblers (born between 1984 and 2000) from the first two waves of the Budapest Longitudinal Study (original sample: N = 2777; final sample: N = 335). The Problem Gambling Severity Index was used to assess symptoms of problem gambling. Cross-sectional symptom networks showed differences in the centrality of nodes. Correlations between the two cross-sectional networks were low in the presence vs. absence of edges, rank order of edge weights, and centrality estimates. However, network invariance tests indicated non-significant differences between them. The cross-lagged network revealed that the symptoms of tolerance and health problems could predict the subsequent presence of multiple problem gambling symptoms. Overall, limited evidence demonstrated the replicability of cross-sectional symptom networks of problem gambling. Future research needs to explore the utility of cross-sectional networks of problem gambling and assess more precisely causal relationships between problem gambling symptoms by distinguishing within- and between-subject effects.

The Symptom Network Structure of Teachers' Burnout and Its Connection to Psychological Capital

Background

Teacher burnout is characterized by emotional and physical exhaustion resulting from excessive work-related stress. Previous research based on traditional latent variable theory has revealed a significant negative relationship between TB and psychological capital (PsyCap). This study explored the complex symptoms of TB and the contact points of PsyCap in reducing TB using psychometric network analysis.

Methods

A total of 3991 teachers completed the burnout subscale of the Professional Quality of Life and Psychological Capital Scale.

Results

The results showed that: (a) In the TB network, the core symptoms displayed by teachers due to burnout are difficulty feeling "I am a very caring person", "I am happy", and "I am the person I always wanted to be"; (b) The TB-PsyCap network was closely connected, and the symptoms affected each other. PsyCap affected the TB network through "I feel optimistic and happy almost every day" and "I often feel that there is a future as a teacher"; (c) PsyCap's bridge symptoms had a negative impact on TB, and PsyCap may reduce TB primarily through optimistic, hopeful dimensions.

Conclusion and Implications

Psychometric network analysis helps us understand the complex symptoms of TB and the contact points of PsyCap in reducing TB. This study offers valuable insights into the prevention of, and intervention in, burnout within the teaching community.

Conceptualising social media addiction: a longitudinal network analysis of social media addiction symptoms and their relationships with psychological distress in a community sample of adults

BACKGROUND

Problematic social media use has been identified as negatively impacting psychological and everyday functioning and has been identified as a possible behavioural addiction (social media addiction; SMA). Whether SMA can be classified as a distinct behavioural addiction has been debated within the literature, with some regarding SMA as a premature pathologisation of ordinary social media use behaviour and suggesting there is little evidence for its use as a category of clinical concern. This study aimed to understand the relationship between proposed symptoms of SMA and psychological distress and examine these over time in a longitudinal network analysis, in order better understand whether SMA warrants classification as a unique pathology unique from general distress.

METHOD

N = 462 adults (Mage = 30.8, SDage = 9.23, 69.3% males, 29% females, 1.9% other sex or gender) completed measures of social media addiction (Bergen Social Media Addiction Scale), and psychological distress (DASS-21) at two time points, twelve months apart. Data were analysed using network analysis (NA) to explore SMA symptoms and psychological distress. Specifically, NA allows to assess the 'influence' and pathways of influence of each symptom in the network both cross-sectionally at each time point, as well as over time.

RESULTS

SMA symptoms were found to be stable cross-sectionally over time, and were associated with, yet distinct, from, depression, anxiety and stress. The most central symptoms within the network were tolerance and mood-modification in terms of expected influence and closeness respectively. Depression symptoms appeared to have less of a formative effect on SMA symptoms than anxiety and stress.

CONCLUSIONS

Our findings support the conceptualisation of SMA as a distinct construct occurring based on an underpinning network cluster of behaviours and a distinct association between SMA symptoms and distress. Further replications of these findings, however, are needed to strengthen the evidence for SMA as a unique behavioural addiction.

Co-occurrence of Common Biological and Behavioral Addictions: Using Network Analysis to Identify Central Addictions and Their Associations with Each Other

The present study used network analysis to examine the network properties (network graph, centrality, and edge weights) comprising ten different types of common addictions (alcohol, cigarette smoking, drug, sex, social media, shopping, exercise, gambling, internet gaming, and internet use) controlling for age and gender effects. Participants (N = 968; males = 64.3%) were adults from the general community, with ages ranging from 18 to 64 years (mean = 29.54 years; SD = 9.36 years). All the participants completed well-standardized questionnaires that together covered the ten addictions. The network findings showed different clusters for substance use and behavioral addictions and exercise. In relation to centrality, the highest value was for internet usage, followed by gaming and then gambling addiction. Concerning edge weights, there was a large effect size association between internet gaming and internet usage; a medium effect size association between internet usage and social media and alcohol and drugs; and several small and negligible effect size associations. Also, only 48.88% of potential edges or associations between addictions were significant. Taken together, these findings must be prioritized in theoretical models of addictions and when planning treatment of co-occurring addictions. Relatedly, as this study is the first to use network analysis to explore the properties of co-occurring addictions, the findings can be considered as providing new contributions to our understanding of the co-occurrence of common addictions.

Resting-state heart rate variability, level of stress and resilience in internet gaming disorder and alcohol use disorder

Stress and resilience are involved in the pathophysiology of addictive disorders, and heart rate variability (HRV) is an index of an individual's global capability to regulate psychological responses. In this study, we aimed to identify transdiagnostic and disorder-specific markers in people with addictive disorders by analyzing resting-state HRV and associations with the levels of stress and resilience. We compared relevant data between patients with internet gaming disorder (IGD) and/or alcohol use disorder (AUD) and healthy controls (HCs). In all, 163 adults aged 18-35 years (53 with IGD, 49 with AUD, 61 HCs) participated. The levels of stress and resilience were measured using the Psychosocial Wellbeing Index and the Connor-Davidson Resilience Scale, respectively. The HRV was obtained from each participant during a 5 min resting-state. The IGD and AUD patients exhibited increased levels of stress and decreased resilience compared to the HCs. Patients with either addictive disorder exhibited a lower standard deviation of the normal-to-normal beat interval (SDNN) index [SDNNi] compared to HCs even after adjusting for clinical variables such as depression, anxiety, and impulsivity. In multiple comparison tests among the three groups, the AUD group had lower HRV than HCs, but no differences were observed among the groups after adjusting for the clinical variables. The HRV indices were correlated with the levels of stress, resilience, and disease severity. In conclusion, IGD and AUD patients exhibit lower HRV as indicated by the SDNNi compared to HCs, revealing their vulnerability to stress as well as a common transdiagnostic marker of addiction.

Suicidal behaviors in the entertainment industry: a preliminary exploration of the interplay between work scheduling, social support, and wellbeing in Australia

OBJECTIVE

Workers of the Australian entertainment industry exhibit disproportionately high rates of impaired psychological wellbeing and suicidal behaviors, with such rates being exacerbated by the negative impact of working long and odd hours (Work Scheduling Impact; WSI). Nonetheless, stable and secure social support networks may buffer the risks associated with such systemic difficulties.

METHODS

The responses of 1302 Australian entertainment industry workers (50.3% females, Mage 38.39 years) on the Multidimensional Scale of Perceived Social Support, the Short Form Health Survey, WSI, and suicidal behaviors questions were examined via moderation analyses.

RESULTS

Higher social support and lower WSI appeared to reduce the suicidal ideation of those experiencing poorer mental health, while lower WSI further enhanced social support's positive effect.

CONCLUSIONS

Findings highlight the likely detrimental effect of WSI regarding the suicidal ideation reported by vulnerable Australian entertainment industry workers and stress the importance of the social support they experience.

PUBLIC HEALTH IMPLICATIONS

Interventions attempting to increase social support could improve inherent conditions associated with the Australian entertainment industry. Similarly, the negative effect of working long and odd hours on workers' mental health and suicidal behaviors indicates the need to regulate the industry appropriately.

The Online Flow Questionnaire: An Item Response Theory Examination

Online flow refers to the rate of an individual's absorbance in an Internet activity in which they are engaged. It has been implicated with both the effectiveness of cyberhealth and online education applications, as well as excessive Internet use. One way of assessing it is the Online Flow Questionnaire (OFQ). Consequently, this study investigated the optimum measurement of online flow, as well as OFQ cutoff points, using Item Response Theory (IRT). A large sample of high school students from Greece (N = 1579, M_age = 16.12, SD_age = 0.85; 50.5 percent females) completed the OFQ and the data were analyzed using IRT procedures. The analysis indicated that items in the OFQ possess differing levels of discrimination and difficulty, although all items were generally within acceptable ranges. An OFQ cutoff score of 5 represented an extremely high level of online flow experiences. The findings suggest that the OFQ generally functions as an acceptable marker of overall online flow. However, the current format of the OFQ appears to inhibit its ability to detect variability at the extreme low and high ends of the latent trait in the population assessed. Future revisions (potentially employing computerized adaptive tests) of the OFQ response format may enhance its utility.

Online Gambling Disorder Questionnaire (OGD-Q): An item r'esponse theory examination

Gambling disorder behaviours, such as one's preoccupation with gambling and/or mood modification due to gambling, have been proposed to differ in their diagnostic weight/importance, especially when informing diagnostic scales. Such potential differences are imperative to be considered to improve assessment accuracy. The latter is particularly important in the light of the rapidly increasing gambling opportunities offered online. To contribute to this area of knowledge, the current study assessed an online adult community sample (N = 968, Mage  = 29.5 years, SDage  = 9.36 years) regarding their responses on the Online Gambling Disorder Questionnaire (OGD-Q). Item response theory (IRT) procedures examined the psychometric properties of the instrument, at both the item and the scale level. Results indicated that the OGD-Q demonstrated good capacity to reliably assess problem gambling and differentiate between individuals at similar levels of the trait, particularly between 1 and 3 SDs above the mean. The findings also showed OGD-Q components/items possess varying discrimination capacities, whilst they also differ in reliability across respondents with different levels of disordered gambling behaviours. Thus, it is supported that consideration is required regarding the differential weighting of one's item responses in the assessment procedure, taking concurrently into account their severity of disordered gambling behaviours.

Cross-Addiction Risk Profile Associations with COVID-19 Anxiety: a Preliminary Exploratory Study

"Cross-addiction" involves a person substituting one form of addictive behaviour for another. Indeed, cross-additive presentations have been frequently described (e.g. from drugs to alcohol, gambling to sex), and risk profiles have been assumed. Nevertheless, there has been a dearth of evidence considering the occurrence of cross-addiction risk profiles in the community. This research is imperative for informing effective prevention/intervention policies, especially under anxiety-provoking conditions, such as the current coronavirus pandemic. To address this need, a cross-sectional exploratory research design was utilized, with quantitative survey data obtained from 968 respondents (18-64; M age  = 29.5 years, SD = 9.36), who completed an online survey regarding a range of addictive behaviours (i.e. abuse of alcohol, drug, smoking, online gaming, shopping, internet, exercise, online gambling, sex, and social media) and their anxiety about the coronavirus. Latent class/profiling analyses were implemented to (a) explore profiles of cross-addiction risk, (b) describe the characteristics and the proportions of these profiles, and (c) identify their differential associations with the pandemic precipitated anxiety. Findings revealed two distinct profiles/types, the "cross-addiction low risk" (57.4%) and the "cross-addiction high risk" (42.6%). Those in the latter scored consistently higher across all behaviours assessed, were more likely to suffer from concurrent addictive problems, and reported significantly higher levels of pandemic-related anxiety. Implications for prevention, assessment, and treatment and future research are discussed.

Problematic Shopping Behavior: An Item Response Theory Examination of the Seven-Item Bergen Shopping Addiction Scale

There has been an increasing amount of research examining problematic shopping behavior (PSB), often referred to in the psychological literature as "compulsive buying" or "shopping addiction." A popular scale for assessing the risk of PSB is the seven-item Bergen Shopping Addiction Scale (BSAS). To expand our knowledge of the psychometric properties of this instrument, the present study employed Item Response Theory (IRT) and differential item functioning analyses (DIF) while concurrently attempting to determine a preliminary cut-off point. A relatively large community sample completed the BSAS online (N = 968, M age = 29.5 years, SD age = 9.36, 32.5% women). IRT analyses showed differences regarding the BSAS items' discrimination, difficulty, and precision, with a raw score exceeding 23 (out of 28) indicating a higher risk of shopping addiction. Finally, while most BSAS items operated equally among males and females, Item 2 (mood modification) required a higher level of shopping addiction behaviors to be endorsed by males. The BSAS functions as a reliable assessment of the risk of shopping addiction, particularly between average and high levels of the trait. Clinical implications are discussed in light of these findings.

Benefits, Risks and Gender Differences in Sport, and Exercise Dependence: Key Role of Alexithymia

The literature has long highlighted the benefits of sport, but too much sport could indicate a dependence without a substance, namely exercise dependence. The literature has only recently investigated this issue and therefore several questions are open, particularly with regard to psychopathological significance and gender differences. The aim of this paper is to investigate whether young subjects (M = 20 years) with a risk of exercise dependency and non-dependent symptomatic display other behavioural and psychological suffering and discomforts, or whether such an investment in physical activity is compatible with a framework of relative well-being; and if there are differences related to gender. A total of 396 subjects were involved in this study. Exercise Dependence Scale, Toronto Alexithymia Scale, Subjective Happiness Scale, Satisfaction with Life Scale and an ad hoc questionnaire with information relating to the consumption of alcohol, soft and hard drugs, quality of sleep and nutrition, affective and friendship relationships, hobbies, presence of psychological or physical disorders, motivations for sporting activity, and any traumatic experiences were used. With regard to the Exercise Dependence Scale (EDS), the prevalence of subjects at risk of exercise dependence was 1.5% and that of non-dependents symptomatic was 31.3%. Considering only men, the percentage of subjects at risk of exercise dependence rose to 3% and that of non-dependents symptomatic to 47.9%. Our data support the hypothesis that the risk of exercise dependence and the symptomatic condition without dependence can occur in situations of relative well-being (happiness, satisfaction, relationships) without significant associations with other problematic behaviours. Modest consumption of soft drugs is reported in non-dependent symptomatic subjects. The hypothesis of increased levels of alexithymia is confirmed but limited to the male gender. Gender differences are confirmed in the frequency and motivation to practice sport and in the risk of dependence. It is important that the assessment of addiction risk is integrated with the assessment of alexithymia and personal and social resources over time.