Internet use and electronic gaming by children and adolescents with emotional and behavioural problems in Australia - results from the second Child and Adolescent Survey of Mental Health and Wellbeing

Prevalence, Correlates, and Comorbidities Among Young Adults Who Screened Positive for ADHD in South Korea During the COVID-19 Pandemic

OBJECTIVE

This study examined the prevalence, associated factors, and psychiatric comorbidities of adult ADHD during the COVID-19 pandemic by analyzing nationally representative data.

METHODS

Among the 5,511 respondents of the 2021 National Mental Health Survey, South Korea, 2,764 (18-49 years) were selected. The Korean versions of the Adult ADHD Self-Report Scale, Composite International Diagnostic Interview, and Structured Clinical Interview for Internet Gaming Disorder were used as diagnostic assessments.

RESULTS

The 6-month prevalence of positive screens for adult ADHD was 3.1%. In individuals aged 18 to 29 years exhibiting adult ADHD symptoms, high prevalence rates of alcohol use, depression, and Internet gaming disorders were observed in the last 12 months. Adults who screened positive for ADHD reported significantly lower life satisfaction and resilience, and higher loneliness and social isolation (vs. non-ADHD group).

CONCLUSION

Adult ADHD symptoms significantly influenced mental well-being, highlighting the need for an appropriate treatment/prevention system, particularly for individuals aged 18 to 29 years.

Adolescents with emotional and behavioural problems are at higher risk to become excessive or addicted Internet users: is this association moderated by gender?

BACKGROUND

The Internet offers many opportunities for adolescents to facilitate their lives. However, its everyday use may lead to excessive behaviour, including addiction. Our aim was to assess the association between emotional and behavioural problems (EBP) and level of internet use, and whether gender moderates this association.

METHODS

We used data from a representative sample of 5,433 Slovak adolescents (mean age: 13.51, 48.8% boys) from the Health Behaviour in School-aged Children-study conducted in 2018, collected through online self-report questionnaires. EBP was measured by the Strengths and Difficulties Questionnaire and excessive internet use (EIU) and internet addiction (IA) by the Excessive internet use scale. We analysed using multinomial logistic regression.

RESULTS

More than 25% of the adolescents reported EIU; almost 4% reported being addicted to Internet. EIU was more prevalent in girls, but IA was more prevalent in boys. Adolescents with borderline or increased levels of EBP were more likely to report EIU (odds ratio, OR/95% confidence interval, CI: 1.85/1.60-2.14; 3.16/2.67-3.75, respectively) and IA (OR/95% CI: 2.23/1.57-3.18; 4.89/3.41-7.03, respectively). Adjustment for gender, age or perceived family wealth hardly changed the findings. Moreover, gender did not modify the associations between EBP with EIU.

CONCLUSION

Adolescents with higher levels of EBP are more likely to become excessive Internet users or Internet addicts. This shows a need of early identification of adolescents with EBP as they seem to be relatively vulnerable to develop EIU or IA.

Two Sides of the Same Virtual Coin: Investigating Psychosocial Effects of Video Game Play, including Stress Relief Motivations as a Gateway to Problematic Video Game Usage

Video gamers can play to negate the psychological impact of stress, which may become problematic when users over-rely on the stress relief potential of gaming. This study used a repeated measures experimental design to investigate the relationships between stress, video gaming, and problematic video gaming behaviours in a convenience sample of 40 students at a UK university. The results indicated that positive affect increased and negative affect decreased, whilst a biological stress measure (instantaneous pulse rate) also decreased after a short video gaming session (t(36) = 4.82, p < 0.001, d = 0.79). The results also suggested that video gaming can act as a short-term buffer against the physiological impact of stress. Further research should focus on testing individuals who have been tested for gaming disorder, as opposed to the general population. Research could also utilise variations of the methodological framework used in this study to examine the intensity of a stress relief effect under different social situations. The study's findings in relation to published works are also discussed.

Effect of the peripartum depressive symptoms on the Internet use disorder of their offspring in late childhood: retrospective longitudinal study

Internet use disorder (IUD) is an emerging social and mental health concern. This study aimed to analyze the relative risk of IUD in late childhood among children whose mothers experienced peripartum depressive symptoms. This study included 762 participants (397 boys and 365 girls) and was conducted in 2017 (aged 9) and 2019 (aged 11). We analyzed the adjusted relative risk of being at high risk for IUD based on whether the mother experienced depressive symptoms during pregnancy or one month after delivery. We also considered the persistence of depressed mood for 4 months after delivery and the severity of peripartum depressive symptoms. From 2017, 20.7% of boys and 14.0% of girls were at high risk of developing IUD. Compared to the non-peripartum depressive group, girls whose mothers experienced peripartum depressive symptoms and those that persisted for 4 months were 1.084 and 1.124 times more likely to be at high risk of IUD (95% confidence interval = 1.005-1.170 and 1.013-1.248), respectively. There were no statistically significant differences among boys. Peripartum depressed mood could be one of risk factors of IUD. IUD needs to be monitored in children whose mothers experienced peripartum depressive symptoms.

How does parents' psychological distress relate to adolescents' problematic gaming? The roles of parent-adolescent relationship and adolescents' emotion regulation

Background and Aims

Emerging research has identified parents' psychological distress as a potential risk factor that increases adolescents' vulnerability to problematic gaming. This study attempted to address "why" from a relational perspective. We hypothesized that parents' psychological distress may link to adolescents' problematic gaming through the mediation of parent-child relationship quality, while the mediating effects of parent-child relationship quality may vary depending on adolescents' emotion regulation.

Methods

We collected data from 4,835 parent-child dyads in China (parental age = 41.45 ± 4.53 years; adolescent age = 13.50 ± 1.00 years). Structural Equation Modeling (SEM) was utilized to analyze the relationships among the variables under study.

Results

Parent-reported parental depression/anxiety was related to worse adolescent-reported parent-child relationship, which in turn related to more severe adolescent-reported problematic gaming. Moreover, the mediating effects of parent-child relationship quality were weaker when adolescents used more expressive suppression (but not cognitive reappraisal).

Discussion and Conclusions

The findings of this study highlight the need to consider both parent-child relationships and adolescents' active role in their own emotion regulation in order to understand parental influence on adolescent problematic gaming.

Video game playing and oral health in school-age children: A cross-sectional study in Turkey

AIM

The aim of this study is to evaluate the relationship of video game playing with oral/dental health and harmful oral habits in school-age children.

METHODS

The daily video gamer (n = 77) and occasional video gamer (n = 77) children between 6 and 12 years old were included in the study. A questionnaire inquiring socio-demographic characteristics, video gaming and abnormal oral habits of the children was filled by parents. The children were examined intraorally and decayed-missing-filled tooth, the International Caries Detection and the Assessment-II System scores, dental plaque and gingival indices were recorded.

RESULTS

Of the children; 42.9% daily video gamers played video games for between 1 and 2 h and 57.1% played for ≥2 h while all of the occasional video gamers spent for between 1 and 2 h on video game per day. The daily video gamer and occasional video gamer children were not different in terms of socio-demographic characteristics, frequency of having daily tooth brushing habit, using children's toothpaste and having regular dental checkup (P > 0.05). No statistically significant difference was present between the groups in terms of frequencies of abnormal oral habits and having at least one abnormal oral habit (P > 0.05). Severe gingivitis and advanced caries lesions were more common in daily video gamer group (14.2% vs. 3.9%, P = 0.025 and 90.9% vs. 70.9%, P = 0.026, respectively). Daily video gaming time was weakly correlated with plaque index (r = 0.26, n = 77, P = 0.024). Daily video gaming for ≥2 h increased the risk for severe gingivitis (odds (95% confidence interval) = 4.53 (1.07-19.23), P = 0.041) while daily video gaming for between 1 and 2 h decreased the risk for having abnormal oral habit (odds (95% confidence interval) = 0.39 (0.16-0.93), P = 0.034).

CONCLUSION

In school age, daily video gaming may worsen oral and dental health compared with occasional video gaming. Particularly, an excessive video gaming time seems to be associated with poor oral health in school children.

Association Between Comorbid Anxiety and Depression and Health Risk Behaviors Among Chinese Adolescents: Cross-Sectional Questionnaire Study

BACKGROUND

Comorbidity of psychiatric disorders such as depression and anxiety is very common among children and adolescents. Few studies have examined how comorbid anxiety and depression are associated with health risk behaviors (HRBs) in adolescents, which could inform preventative approaches for mental health.

OBJECTIVE

We evaluated the association between HRBs and comorbid anxiety and depression in a large adolescent cohort.

METHODS

We used data from 22,868 adolescents in the National Youth Cohort (China). Anxiety and depression symptoms were assessed using the 9-item Patient Health Questionnaire scale and the 7-item Generalized Anxiety Disorder scale, respectively. Comorbidity was determined by the coexistence of anxiety and depression. HRBs including poor diet, smoking, physical inactivity, and poor sleep, as well as the above HRB scores, were added to obtain the total HRB score (HRB risk index). Based on single and total HRB scores, we divided participants into low-, medium-, and high-risk groups. Potential confounders included gender, presence of siblings, regional economic level, educational status, self-rated health, parental education level, self-reported family income, number of friends, learning burden, and family history of psychosis. Correlation analysis was used to explore associations between single risk behaviors. Binary logistic regression estimated the association between HRBs and anxiety-depression comorbidity before and after adjusting for potential confounders.

RESULTS

The comorbidity rate of anxiety and depression among Chinese adolescents was 31.6% (7236/22,868). There was a statistically significant association between each HRB (P<.05), and HRBs were positively associated with comorbid anxiety and depression in the above population. For single HRBs, adolescents with poor diet, smoking, and poor sleep (medium-risk) were more prone to anxiety-depression comorbidity after adjusting for confounders compared to low-risk adolescents. However, adolescents with all high-risk HRBs were more likely to have comorbid anxiety and depression after adjusting for confounders (poor diet odds ratio [OR] 1.50, 95% CI 1.39-1.62; smoking OR 2.17, 95% CI 1.67-2.81; physical inactivity OR 1.16, 95% CI 1.06-1.28; poor sleep OR 1.84, 95% CI 1.70-2.01). Moreover, in both unadjusted (medium risk OR 1.79, 95% CI 1.56-2.05; high risk OR 3.09, 95% CI 2.72-3.52) and adjusted (medium risk OR 1.57, 95% CI 1.37-1.80; high risk OR 2.33, 95% CI 2.03-2.68) models, HRB risk index, like clustered HRBs, was positively associated with anxiety-depression comorbidity, and the strength of the association was stronger than for any single HRB. In addition, we found that compared to girls, the association between clustered HRBs and anxiety-depression comorbidity was stronger in boys after adjustment.

CONCLUSIONS

We provide evidence that HRBs are related to comorbid anxiety and depression. Interventions that decrease HRBs may support mental health development in adolescence, with the potential to improve health and well-being through to adulthood.

Compulsive Internet Use Scale for assessment of self-reported problematic internet use in primary school-aged children

Introduction

The tremendous growth of internet use during past few decades has been primarily led by young people. Despite a plenitude of studies reporting the pros and cons of excessive internet use by adolescents, the internet use of primary school-aged children is under-researched. First, there is lack of reliable and valid cultural invariant self-report instruments for children younger than 11-years-old. Secondly, there is no consensus on whether primary school-aged children can reliably report on their internet use. This study aimed to examine the psychometric properties of the Compulsive Internet Use Scale (CIUS) as reported by primary school-aged children in three different countries/regions.

Methods

Paper-pencil format CIUS questionnaires were completed by a total of 691 children aged 8 to 10 years old, 236 of them Latvian, 207 Lithuanian, and 248 Taiwanese, as well as by one of their parents, at two-time points, separated by a one-year interval. The parents also reported on the child's emotional and behavioral difficulties.

Methods

Confirmatory factor analysis indicated that for the child self-report, a 10-item CIUS showed the best fit and good psychometric properties: solid structural validity; very good internal consistency; appropriate stability and predictive validity after 1 year; as well as sound sensitivity and specificity when compared to the 14-item CIUS parent-report form. Child self-report CIUS ratings correlated with time online reported by the child and parent and with emotional and behavioral problems reported by the parent.

Discussion

This study indicates that children as young as 8-10 years old can reliably and consistently provide valuable information on their problematic use of the internet.

Time Use and Cognitive Achievement among Adolescents in China: Depression Symptoms as Mediators

Everyone's time is limited, and there is competition between different aspects of time use; this requires comprehensive consideration of the effects of different aspects of time use on cognitive achievement in adolescents. This study uses a dataset of 11,717 students from a nationally representative large-scale survey project conducted in 2013 to 2014 to clarify the relationship between time use (including working on homework, playing sports, surfing the Internet, watching TV, and sleeping) and cognitive achievement among Chinese adolescents, and explores the mediating role of depression symptoms in the relationship between time use and cognitive achievement. The results of the correlation analysis show that the average daily time spent on homework, playing sports, and sleeping is significantly positively correlated with cognitive achievement (p < 0.01), while time spent surfing the Internet and watching TV are significantly negatively correlated with cognitive achievement (p < 0.01). The results of the mediating effect model show that depression symptoms play a mediating role in the relationship between time use and cognitive achievement among Chinese adolescents. Specifically, time spent playing sports (indirect effect = 0.008, p < 0.001) and sleeping (indirect effect = 0.015, p < 0.001) have a positive effect on cognitive achievement when using depression symptoms as mediators; time spent on homework (indirect effect = -0.004, p < 0.001), surfing the Internet (indirect effect = -0.002, p = 0.046), and watching TV (indirect effect = -0.005, p < 0.001) have a negative effect on cognitive achievement when using depression symptoms as mediators. This study contributes to the understanding of the relationship between time use and cognitive achievement among Chinese adolescents.

Is internet gaming disorder associated with suicidal behaviors among the younger generation? Multiple logistic regressions on a large-scale purposive sampling survey

The ubiquity of Internet gaming as part of the younger generation's (11-35 year-olds) lifestyle to-day warrants a deeper understanding of its impact on their mental health. In particular, there has been scant research investigating the link between Internet Gaming Disorder (IGD) and suicidal behaviors in this demographic group, even though several mental health symptoms of the former are known risk factors for the latter. This paper aims to establish the presence or absence of association between IGD and each of suicidal ideation, self-harm, and suicide attempt among the younger generation. A large-scale online survey on Internet gamers in Hong Kong was conducted in February 2019. 3430 respondents were recruited through purposive sampling. Study samples were stratified into distinct age groups and multiple logistic regression was conducted for each measured suicidal behavior in each age group. After controlling for sociodemographics, Internet usage, self-reported bullying perpetration and bullying victimization, social withdrawal, and self-reported psychiatric diagnoses such as depression and psychosis, analyses revealed that adolescent (11-17 year-old) gamers with IGD were more likely than their peers who had no IGD to have had suicidal ideation, self-harm, and suicide attempt in their lifetime. These associations did not hold for 18-35 year-old gamers. Findings suggest that it may be prudent to recognize IGD as a growing public mental health priority for the young populace, particularly adolescents. Existing suicide prevention efforts can be complemented through screening adolescents for IGD, and could be expanded to online gaming platforms to reach more hidden at-risk individuals.

Youths' attitudes toward open discussion of suicide, preferred contexts, and the impact of Internet use: An exploratory sequential mixed-methods study in Hong Kong

BACKGROUND

Although the necessity and benefits of having the open and public discussion about suicide have been recognized, youths' opinions regarding such discussion remain unknown.

AIMS

To explore youths' attitudes toward open suicide discussion, particularly concerning their preference of discussion contexts and impacts of Internet use.

METHOD

This exploratory sequential mixed-methods study targeted Hong Kong youths aged 15 to 19. A total of six focus groups and 12 individual interviews were held (N = 40). Topics included adolescents' views of open suicide discussion, concerns, perceived benefits, and preferred contexts. The questionnaire survey (N = 1,676) was conducted subsequently to investigate the prevalence of youths' perspectives on public discussion of suicide and relationships with discussion contexts, use of social media platforms, and motivations of online expression.

RESULTS

Qualitative findings revealed three types of attitudes toward open suicide discussion: reluctance, support, and indifference. Major barriers included cultural norms, topic sensitivity, privacy concerns, contagion effect, fear of embarrassment, and unpleasant experiences in school programs. Results of quantitative analyses showed that reluctance was the dominant attitude among adolescents, and taboo was the top concern. Variations in youths' attitudes were related to gender, school academic banding, and suicide-related experiences. Notably, adolescents who had been exposed to suicide messages in contexts of peer networks and online platforms were more likely to endorse open suicide discussion. In addition, an increased likelihood of engaging in public suicide discussion was associated with the use of Instagram, WhatsApp, and Snapchat, and the motive of 'expressing emotions and opinions' online.

CONCLUSIONS

Our results indicated a prevalent rejection among adolescents toward open suicide discussion, suggesting the issue of stigma, the need for tailored programs, the value of appropriate contexts, and the impact of Internet use. These findings may facilitate the development of school-based suicide prevention initiatives and the efficacy of online services for suicide-related communication.

Relationship between time spent playing internet gaming apps and behavioral problems, sleep problems, alexithymia, and emotion dysregulations in children: a multicentre study

BACKGROUND

Internet gaming addiction (IGA) is a serious condition that can significantly impact personal and social functioning. Many studies of IGA have been conducted in adolescents and young adults, but there are limited data available in children. We investigated the time spent using internet gaming apps in children and its association with behavioral problems, sleep problems, alexithymia, and emotional regulation.

METHODS

The research populations (N = 564) were categorized based on the number of hours spent using online gaming applications. The Strengths and Difficulties Questionnaire, the Children's Sleep Habits Questionnaire Abbreviated, the Children's Alexithymia Measure (CAM), and the Clinical Evaluation of Emotional Regulation-9 were used to assess all participants.

RESULTS

Compared to other groups, children who used internet gaming applications for more than 6 h had a higher proportion of abnormal responses on the emotional symptoms and hyperactivity scales. Children who used internet gaming applications for more than 6 h had the poorest sleep quality (75%), while children who used internet gaming applications for 1-2 h had the best (36.7%). Participants who used internet gaming apps for 1-2 h had significantly lower mean total scores on the emotional regulation scale and total CAM, whereas those using internet gaming apps for more than 6 h had the highest mean scores in the CAM.

CONCLUSIONS

Excessive use of internet gaming apps during childhood may be associated with hyperactivity, peer problems, high socioeconomic level, alexithymia concerns, shorter daytime sleep duration, and a delayed morning wake-up.

Problematic gaming risk among European adolescents: a cross-national evaluation of individual and socio-economic factors

BACKGROUND AND AIMS

Previous research has identified numerous risk and protective factors of adolescent problematic gaming (PG) at the individual and social levels; however, the influence of socio-economic indicators on PG is less known. This study aimed to measure the contribution of individual and socio-economic factors involved in PG risk among adolescents from 30 European countries.

DESIGN

Multi-level logistic regression analysis of survey data from the 2019 European School Survey Project on Alcohol and Other Drugs (ESPAD) cross-sectional study using self-administered anonymous questionnaires.

SETTING

Thirty European countries.

PARTICIPANTS

A representative cohort of 15-16-year-old students (n = 88 998 students; males = 49.2%).

MEASUREMENTS

The primary outcome measure was adolescents' (low and high) risk of PG. Individual key predictors included self-report assessments of socio-demographic characteristics, time spent gaming and family variables (parental regulation and monitoring, family support). Main country-level predictors comprised Gini coefficient for economic inequalities and benefits for families and children (% gross domestic product), retrieved from international public data sets and national thematic reports. The data analysis plan involved multi-level logistic regression.

FINDINGS

Participants who reported stronger parental regulation [odds ratio (OR) = 0.81, 95% confidence interval (CI) = 0.79-0.83] and higher family support (OR = 0.93, 95% CI = 0.91-0.95) reported lower risk of PG. At the country-level, economic inequalities (OR = 1.05, 95% CI = 1.03-1.07) were positively associated with the risk of PG, while benefits for families and children (OR = 0.78, 95% CI = 0.70-0.89) were negatively correlated with the risk of PG.

CONCLUSIONS

Supportive family environments, lower country-level economic inequalities and higher government expenditures on benefits for families and children appear to be associated with a lower risk of problematic gaming among European adolescents.

Relationship between depressive symptoms and internet usage time among adolescents: Results from a nationwide survey

Adolescent depression is becoming a public health problem. In this study the association between depressive symptoms and internet usage time in adolescents was examined, with data collected from the China Education Tracking Survey (CEPS). The survey is publicly available and carried out nationwide. A logistic regression analysis was conducted with odds ratios (OR) and 95% confidence intervals (CI), the subgroup analysis examined the relationships between internet usage time and depressive symptoms. A total of 10,705 adolescents were involved, where 46.4% of them are caught by the internet for more than two hours per day. Adolescents keeping on the internet for 6-8 h per day were reported to have higher odds of depressive symptoms than adolescents who were free from it with the confounders of individual, family, and school adjusted, which were observed among groups with a medium family economic status without living with their father and with a sleep time less than nine hours. The results revealed that adolescents spending more time online had a higher risk of experiencing depression symptoms. This study suggested that it is helpful for mental health professionals to evaluate and develop prevention interventions for depressive symptoms in adolescents promptly through monitoring and managing online time.

Generalized structural equation modeling: Symptom heterogeneity in attention-deficit/hyperactivity disorder leading to poor treatment efficacy

BACKGROUND

Treatment efficacy for attention-deficit/hyperactivity disorder (ADHD) is reported to be poor, possibly due to heterogeneity of ADHD symptoms. Little is known about poor treatment efficacy owing to ADHD heterogeneity.

AIM

To use generalized structural equation modeling (GSEM) to show how the heterogeneous nature of hyperactivity/impulsivity (H/I) symptoms in ADHD, irritable oppositional defiant disorder (ODD), and the presentation of aggression in children interferes with treatment responses in ADHD.

METHODS

A total of 231 children and adolescents completed ADHD inattention and H/I tests. ODD scores from the Swanson, Nolan, and Pelham, version IV scale were obtained. The child behavior checklist (CBCL) and parent’s satisfaction questionnaire were completed. The relationships were analyzed by GSEM.

RESULTS

GSEM revealed that the chance of ADHD remission was lower in children with a combination of H/I symptoms of ADHD, ODD symptoms, and childhood aggressive behavior. ODD directly mediated ADHD symptom severity. The chance of reaching remission based on H/I symptoms of ADHD was reduced by 13.494% [= exp (2.602)] in children with comorbid ADHD and ODD [odds ratio (OR) = 2.602, 95% confidence interval (CI): 1.832-3.373, P = 0.000] after adjusting for the effects of other factors. Childhood aggression mediated ODD symptom severity. The chance of reaching remission based on ODD symptoms was lowered by 11.000% [= 1 - exp (-0.117)] in children with more severe baseline symptoms of aggression based on the CBCL score at study entry [OR = -0.117, 95%CI: (-0.190)-(-0.044), P = 0.002].

CONCLUSION

Mediation through ODD symptoms and aggression may influence treatment effects in ADHD after adjusting for the effects of baseline ADHD symptom severity. More attention could be directed to the early recognition of risks leading to ineffective ADHD treatment, e.g., symptoms of ODD and the presentation of aggressive or delinquent behaviors and thought problems in children with ADHD.

Parental Depression and Leisure Activity Engagement on Children's Gaming Disorder: A Dyadic Study

Nowadays, playing both online and offline video games is a popular leisure activity among youngsters, but excessive gaming activity engagement may lead to gaming disorder that disrupts daily functioning. Identifying risk and protective factors of this emerging problem is thus essential for devising prevention and intervention strategies. This mixed-method, cross-sectional study aimed to examine the roles of parental depressive symptoms and children’s leisure activity engagement on children’s gaming disorder symptoms. Furthermore, the moderating roles of risky and protective leisure activity engagement were investigated. The sample comprised 104 parent-child dyads recruited from a population-based survey (parents: M_age = 45.59 years, SD = 6.70; children: M_age = 11.26 years; SD = 4.12). As predicted, parental depressive symptoms and children’s gaming activity engagement were positively associated with children’s gaming disorder symptoms, whereas children’s literacy activity engagement was negatively associated with these symptoms. Moreover, engagement in these two types of leisure activity moderated the association between parental depressive symptoms and children’s gaming disorder symptoms in distinct manners, further indicating literacy activities as beneficial and gaming activities as risk-enhancing. These new findings imply that parental depressive symptoms and children’s leisure activity engagement should be considered when designing parent-based programs for gaming disorder prevention and intervention.

Impact of Internet usage time on mental health in adolescents: Using the 14th Korea Youth Risk Behavior Web-Based Survey 2018

Dependency on the Internet in daily life is increasing, and the negative consequences this dependence may have on mental health are not sufficiently understood. The aim of this study was to investigate the relationship between Korean adolescents' Internet usage time and their mental health. This cross-sectional study included 29,811 high school students ages 16-18 from the 2018 Korea Youth Risk Behavior Web-Based Survey. Participants' mean Internet usage time was 193.4±1.6 min/day. Internet usage time was associated with sex, grade level, type of school, living arrangement, economic status, academic achievement, and experience of school violence. With regard to mental health, subjective health status, stress, feelings of sadness, and suicidal ideation were also related to Internet usage time. The group with more than average Internet usage had poorer subjective health, higher level of stress, and had feelings of sadness and suicidal ideation compared to the group with less than average Internet usage. To effectively manage Internet usage time, interventions to lower Internet usage and leisure programs that could replace Internet usage need to be developed.

Sexual Differences in Internet Gaming Disorder (IGD): From Psychological Features to Neuroanatomical Networks

Internet gaming disorder (IGD) has been included in the 2013 Diagnostic and Statistical Manual of Mental Disorders (DSM-5) as a condition in need of further study, and gaming disorder was recognized by the World Health Organization as a mental disorder in the International Classification of Disease (ICD-11) of 2018. IGD has different characteristics in the two sexes and is more prevalent in males than females. However, even if the female gamer population is constantly growing, the majority of available studies analyzed only males, or the data were not analyzed by sex. To better elucidate sex differences in IGD, we selectively reviewed research publications that evaluated IGD separately for males and females collected in approximately one hundred publications over the past 20 years. The available data in this narrative review indicate that IGD is strongly dimorphic by sex for both its psychological features and the involvement of different brain areas. Impulsivity, low self-control, anxiety, emotion dysregulation, and depression are some of the psychological features associated with IGD that show a sex dimorphism. At the same time, IGD and its psychological alterations are strongly correlated to dimorphic functional characteristics in relevant brain areas, as evidenced by fMRI. More research is needed to better understand sex differences in IGD. Animal models could help to elucidate the neurological basis of this disorder.

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.

Hierarchical Analysis of Disparities in Suicidal Outcomes With Intersection of Sexual Minority and Gender Among U.S. Youth, 2017

Sexual minority youth have a higher risk of suicidal behaviors than their straight peers. Despite this alarming trend, there is limited information on how health-risk factors are systematically associated with suicidal outcomes in relation to the intersection of sex and sexual orientation identity. Data from the 2017 Youth Risk Behavior Survey (Grades 9-12, N = 14,108) were analyzed to examine three distinct suicidal outcomes (i.e., suicidal ideation, suicide planning, and suicide attempt). Separate hierarchical logistic regression models were performed to gradually adjust for influencing factors in examining the association between suicidal outcomes and sexual orientation identity (i.e., heterosexual, gay/lesbian, bisexual, and unsure), stratified by self-reported sex. There exist significant differences in youth suicidal behaviors based on sexual orientation identity and sex: lesbians (adjusted odds ratio [AOR] = 2.7, 95% CI [1.5, 5.0]), bisexual girls (AOR = 1.9, 95% CI [1.3, 2.6]) and bisexual boys (AOR = 2.6, 95% CI [1.3, 5.2]) had higher odds of suicide attempts than their straight peers. Unsure boys and girls also reported higher risks of suicidal ideation and suicide plan as compared with their straight peers. Having a very short sleep duration, reporting ever use of illicit drugs, being bullied, and feeling sad/hopeless were associated with elevated risks of suicidality across males and females. This study identified potential disparities in suicidal outcomes by sexual orientation identity as well as factors that attenuate or strengthen this relationship in a representative sample of adolescents across the United States. An improved understanding of the differences in suicidal outcomes will serve as an opportunity to ameliorate any potential inequalities and improve sexual minority youth' health outcomes.

[Parental factors in internet and computer game addiction in adolescence: An overview]

Parental factors in internet and computer game addiction in adolescence: An overview Abstract. Objective: Internet-related disorders (IRD) in adolescents and young adults are closely linked to family factors. However, few research and review articles include the family. To this end, N = 87 scientific papers were integrated into the literature review. Method: The present work gives an overview of parental factors that can be involved in the development, maintenance, and reduction of symptoms. Results: The literature provides clear connections between the parent-child relationship and IRD in adolescents and young adults. The quality of parent-child communication appears to be a promising approach for influencing IRD symptoms. There are indications that, at least for some families, encouraging the time spent together could be helpful. Regarding educational aspects, a distinction should be made between different areas. Parental knowledge and control of internet use seem to be protective factors. The effect of rules and restrictions, however, is unclear. Conclusions: To change IRD symptoms, it makes sense to improve the parent-child relationship. However, the ways to achieve that have hardly been explored. Recommendations regarding parenting strategies (e. g., rules and restrictions) should be formulated very carefully, as the effects are still unclear. The integration of parents in prevention and intervention efforts is advocated by many researchers, but there only individual studies have considered parents in the context of interventions.

Biofeedback Applied to Interactive Serious Games to Monitor Frailty in an Elderly Population

This article proposes an example of a multiplatform interactive serious game, which is an additional tool and assistant used in the rehabilitation of patients with musculoskeletal system problems. In medicine, any actions and procedures aimed at helping the rehabilitation of patients should entail the most comfortable, but at the same time, effective approach. Regardless of how these actions are orientated, whether for rehabilitation following surgery, fractures, any problems with the musculoskeletal system, or just support for the elderly, rehabilitation methods undoubtedly have good goals, although often the process itself can cause all kinds of discomfort and aversion among patients. This paper presents an interactive platform which enables a slightly different approach to be applied in terms of routine rehabilitation activities and this will help make the process more exciting. The main feature of the system is that it works in several ways: for normal everyday use at home, or for more in-depth observation of various biological parameters, such as heart rate, temperature, and so on. The basic component of the system is the real-time tracking system of the body position, which constitutes both a way to control the game (controller) and a means to analyze the player’s activity. As for the closer control of rehabilitation, the platform also provides the opportunity for medical personnel to monitor the player in real time, with all the data obtained from the game being used for subsequent analysis and comparison. Following several laboratory tests and feedback analysis, the progress indicators are quite encouraging in terms of greater patient interest in this kind of interaction, and effectiveness of the developed platform is also on average about 30–50% compared to conventional exercises, which makes it more attractive in terms of patient support.

Problematic social media use and mental health (depression, anxiety, and insomnia) among Lebanese adults: Any mediating effect of stress?

PURPOSE

To examine the association between problematic social media use with depression, anxiety, insomnia, and stress in a sample of young Lebanese adults.

METHODS

This cross-sectional study was achieved between January and May 2019; 466 out of 600 adults completed the questionnaire.

RESULTS

Higher problematic social media use was significantly associated with higher depression, anxiety, and insomnia, but not stress. Stress mediated the relation between depression, anxiety, insomnia, and problematic social media use.

PRACTICAL IMPLICATIONS

This study showed that problematic social media use was associated with psychological disorders. Additional research is needed to identify and describe the potential causality between the use of social media and various mental health issues and the interplay between the social media network and other mental health factors.

Symptoms of Internet Gaming Disorder, Inattention, and Impulsivity: a Cross-Sectional Study Conducted in the United Arab Emirates

The addictive use of internet video games is now recognized as a valid diagnostic construct by both the World Health Organization and the American Psychiatric Association. A burgeoning body of preliminary evidence points to a relationship between attention deficit and hyperactivity disorder (ADHD) symptoms as being a risk factor for behaviors indicative of internet gaming disorder (IGD), however, studies have rarely examined ADHD's two diagnostic constructs, inattention and impulsivity, separately. Moreover, IGD research is non-existent in Middle Eastern contexts. Therefore, this study examined, separately, the association of IGD with inattention and impulsivity in a sample of gamers from the United Arab Emirates. A cross-sectional survey was completed by 214 participants aged 18-33 years (m_age = 20.64, SD = 4.34) who completed measures of IGD and ADHD, and self-reported daily duration of gameplay as well as a number of demographic characteristics. The pair of hierarchical linear regressions indicated that both the examined constructs, increased symptoms of inattention and impulsivity, were separately associated with elevated risk for engagement in IGD behaviors. However, these associations were not moderated by gender. These results confirm that symptoms of ADHD are indeed associated with IGD and is the first to confirm the presence of this relationship in a Middle Eastern sample.

Gaming Behaviors among Polish Students with Visual Impairment

The access of people with disabilities to digital solutions promotes their inclusion and participation in many aspects of life. Computer games based on hearing or haptic devices have been gaining popularity among persons with visual impairment (VI), and players tend to display improved spatial and abstract reasoning skills, as well as better social interaction and self-confidence, after playing these games. However, a recent survey suggested that excessive gaming could represent a public health concern as a harmful form of behavior in young people associated with risk factors of negative psychosomatic and physical complaints. Young persons with VI are regular users of various technologies, but little is still known about their media patterns. This study aimed to determine the characteristics of the variables associated with gaming for adolescents with VI. The participants were 490 students, aged 13-24 years, from special schools for students with VI. Data was collected using a self-administered questionnaire. The current survey indicated a tendency towards excessive gaming in a significant proportion of young persons with VI. Sociodemographic variables are important in predicting gaming prevalence or screen time, but further research focused on establishing possible mediators (such as parental attitudes towards media) are necessary for identifying problematic gaming behaviors among students with VI.

High cellphone use associated with greater risk of depression among young women aged 15-24 years in Soweto and Durban, South Africa

BACKGROUND

The ubiquity of cellular phone (cellphone) use in young people's daily lives has emerged as a priority area of concern for youth mental health.

OBJECTIVE

This study measured the prevalence of depression and its association with high cellphone use among youth in Soweto and Durban, South Africa.

METHODS

We analysed cross-sectional, baseline survey data among youth aged 16-24 who participated in a dual-site cohort study, 'AYAZAZI', conducted from 2014 to 2017. The primary outcome was depression using the 10-item Center for Epidemiologic Studies Depression Scale, with a score of ≥ 10 indicating probable depression. Cellphone use was measured via self-reported average number of hours of active use, with 'high cellphone use' defined as daily usage of ≥ 8. Multivariable logistic regression models assessed the independent relationship between high cellphone use and probable depression, adjusting for potential confounders.

RESULTS

Of 425 participants with a median age of 19 years (IQR = 18-21), 59.5% were young women. Overall, 43.3% had probable depression, with a higher prevalence among women (49.0% vs. 34.9%, P = .004). Nearly all (94.6%) owned a cellphone. About one-third (29.5%) reported spending ≥ 8 hours per day using their cellphone (39.3% of women vs. 14.9% of men, P < .001). In the overall adjusted model, youth reporting high daily cellphone use had higher odds of probable depression (aOR: 1.83, 95% CI: 1.16-2.90). In gender-stratified models, high daily cellphone use was associated with probable depression among women (aOR: 2.51, 95% CI: 1.47-4.31), but not among men (aOR: 0.87, 95% CI: 0.35-2.16).

CONCLUSIONS

Among a cohort of South African youth, we found a high prevalence of probable depression and high cellphone use (30%). The findings indicate a need for intersectoral initiatives focused on meaningful mental health support for South African youth to support positive growth and development.

Effect of internet use and electronic game-play on academic performance of Australian children

This study examined the association of internet use, and electronic game-play with academic performance respectively on weekdays and weekends in Australian children. It also assessed whether addiction tendency to internet and game-play is associated with academic performance. Overall, 1704 children of 11–17-year-olds from young minds matter (YMM), a cross-sectional nationwide survey, were analysed. The generalized linear regression models adjusted for survey weights were applied to investigate the association between internet use, and electronic-gaming with academic performance (measured by NAPLAN–National standard score). About 70% of the sample spent > 2 h/day using the internet and nearly 30% played electronic-games for > 2 h/day. Internet users during weekdays (> 4 h/day) were less likely to get higher scores in reading and numeracy, and internet use on weekends (> 2–4 h/day) was positively associated with academic performance. In contrast, 16% of electronic gamers were more likely to get better reading scores on weekdays compared to those who did not. Addiction tendency to internet and electronic-gaming is found to be adversely associated with academic achievement. Further, results indicated the need for parental monitoring and/or self-regulation to limit the timing and duration of internet use/electronic-gaming to overcome the detrimental effects of internet use and electronic game-play on academic achievement.

Screen media activity does not displace other recreational activities among 9-10 year-old youth: a cross-sectional ABCD study®

Background

Screen media is among the most common recreational activities engaged in by children. The displacement hypothesis predicts that increased time spent on screen media activity (SMA) may be at the expense of engagement with other recreational activities, such as sport, music, and art. This study examined associations between non-educational SMA and recreational activity endorsement in 9–10-year-olds, when accounting for other individual (i.e., cognition, psychopathology), interpersonal (i.e., social environment), and sociodemographic characteristics.

Methods

Participants were 9254 youth from the Adolescent Brain Cognitive Development Study®. Latent factors reflecting SMA, cognition, psychopathology, and social environment were entered as independent variables into logistic mixed models. Sociodemographic covariates included age, sex, race/ethnicity, education, marital status, and household income. Outcome variables included any recreational activity endorsement (of 19 assessed), and specific sport (swimming, soccer, baseball) and hobby (music, art) endorsements.

Results

In unadjusted groupwise comparisons, youth who spent more time engaging with SMA were less likely to engage with other recreational activities (ps < .001). However, when variance in cognition, psychopathology, social environment, and sociodemographic covariates were accounted for, most forms of SMA were no longer significantly associated with recreational activity engagement (p > .05). Some marginal effects were observed: for every one SD increase in time spent on games and movies over more social forms of media, youth were at lower odds of engaging in recreational activities (adjusted odds ratio = 0·83, 95% CI 0·76–0·89). Likewise, greater general SMA was associated with lower odds of endorsing group-based sports, including soccer (0·93, 0·88–0·98) and baseball (0·92, 0·86–0·98). Model fit comparisons indicated that sociodemographic characteristics, particularly socio-economic status, explained more variance in rates of recreational activity engagement than SMA and other latent factors. Notably, youth from higher socio-economic families were up to 5·63 (3·83–8·29) times more likely to engage in recreational activities than youth from lower socio-economic backgrounds.

Conclusions

Results did not suggest that SMA largely displaces engagement in other recreational activities among 9–10-year-olds. Instead, socio-economic factors greatly contribute to rates of engagement. These findings are important considering recent shifts in time spent on SMA in childhood.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12889-020-09894-w.

Parent-Child Discrepancies in Reports of Exposure to Violence/Pornography on Mobile Devices and the Impact on Children's Psychosocial Adjustment

This study assessed the discrepancies between reports from parents and children concerning children's exposure to violence/pornography on mobile devices and the impact on the psychosocial adjustment of children. Data were obtained from a sample of 2,230 parent-child dyads recruited from 16 elementary schools (1,140 dyads) in Taiwan and 9 schools (1,090 dyads) in China. A self-administered questionnaire was used. The results showed that about 30 percent of children reported being exposed to violence on mobile devices. Approximately 70 percent of their parents were unaware of their child's exposure to violence on mobile devices. About 16 percent of children reported exposure to pornography on mobile devices, and 80 percent of their parents were unaware of this exposure. Multinomial logistic regression results showed that after controlling for parent and child sociodemographic variables, factors related to parental unawareness of child exposure to violence on mobile devices included a child's ownership of mobile devices, smartphone/tablet use time, a lower level of parental understanding, and a residence in China or in a rural area, whereas the parent-child relationship and a child's smartphone/tablet use time were associated with parents who were unaware of their child's exposure to pornography. Multiple regression results showed that children who were living with household poverty, had a poor parent-child relationship, spent much time using a smartphone/tablet, and with parents who were unaware of their exposure to violence/pornography on mobile devices were more likely to have emotional and behavioral problems.

Children's Internet Use Profiles in Relation to Behavioral Problems in Lithuania, Latvia, and Taiwan

This study explored the profiles of elementary-school-aged children’s Internet use in relation to their emotional and behavioral problems. Participating in this cross-sectional study were 877 child–parent dyads from Latvia, Lithuania, and Taiwan. Children (8–10 years old) provided information on three variables: the amount of time they spent online, frequency of online activities, and knowledge of how to do things online. Latent profile analysis including these three variables provided a four-class solution for child Internet use. A comparison between Latvia, Lithuania, and Taiwan on the percentage of the sample distribution in each class showed that there was no difference between sites for the high class (high ratings on all three variables). The largest differences were for the low and average classes (low and average ratings on all three variables, namely, time online, frequency, and knowledge): the Lithuanian and Taiwanese samples were similar in that a higher percentage of each sample was in the low class, whereas the Latvian sample had children equally distributed between the low class and the average class. Analysis of the data from the entire sample for differences in parent-reported child behavioral difficulties suggested that children in the high class had an elevated level of behavioral problems and compulsive Internet use.

The Psychosocial Factors of Elementary School-Aged Children’s Compulsive Internet Use As Reported by Children and Parents

Children’s electronic media use in the form of Internet has increased over the past decades. The activities that children engage using the Internet can lead to experiencing positive as well as negative outcomes. Recent studies have found that excessive time devoted to the Internet use and behavioral narrowing can lead to Internet addiction (Enagandula et al., 2018) or compulsive Internet use (Meerkerk et al., 2009). This phenomenon can be described as a greater risk of developing excessive online habits, which may result in impairments of individual’s activities of daily living as well as relationships with others. Specific characteristics of these associations, however, have been examined only minimally in young children. The goal of this study was to examine the peculiarities of elementary school-aged children’s Internet use in relation to sociodemographic and relationships with others, as well as possible behavioral and emotional difficulties. The sample consisted of 304 parent-child dyads. All children in the study were second or third grade students (mean age 8.47 years, SD = 0.56), 50.3% were boys. Children and parents completed the Compulsive Internet Use Scale (CIUS; Meerkerk et al., 2009) and provided information about time spent on the Internet. Parents provided sociodemographic information and completed the Strengths and Difficulties Questionnaire (SDQ; Goodman, 1997), and children answered questions about their relationships with their parents and peers. The results of the study revealed significant gender differences in compulsivity of the Internet use, i.e. the estimates of boys CIUS – both provided by children and their parents – were significantly higher than girls. In overall, there was good agreement between parental and children’s reports on child’s CIUS, however parents reported higher CIUS scores and longer Internet use than children themselves. Regression analysis revealed that children’s CIUS is predicted (a) from the child’s perspective – by longer Internet time together with lower scores of child prosocial behavior, male gender, less advantaged financial situation in the family, and poorer parent-child relationships; (b) from the parent’s perspective – by longer Internet time, male gender, lower scores of child prosocial behavior, higher scores of behavioral and emotional difficulties together with less advantaged financial family status. The findings of the study are discussed in light of evidence-based practice and research.

Identifying individuals in need of help for their uncontrolled gaming: A narrative review of concerns and comments regarding gaming disorder diagnostic criteria

OBJECTIVE

In 2013, the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5) included the diagnostic criteria of Internet gaming disorder (IGD). Then, in 2019, the 11th Revision of the International Classification of Diseases (ICD-11) categorized gaming disorder (GD) as an addictive disorder. This review aimed to review the raised concerns, debate, and research of IGD or GD criteria and provide suggestions to resolve them.

METHODS

A narrative review was conducted, and PubMed was searched for articles mentioning concerns and research on the DSM-5 criteria for IGD, ICD-11 criteria for GD, or criteria for other synonyms, such as problematic gaming or gaming addiction. A total of 107 articles were identified.

RESULTS

Concerns were organized into three categories: conceptual framework, moral panic, and diagnostic validity. Most argumentations supported the proposition that GD and other substance use disorders have similar presentations. A clear definition of GD and adequate public education could prevent rather than exacerbate moral panic. Several researchers reported concerns regarding the nosology, diagnostic validity, and wording of each criterion. However, the threshold, five of the nine criteria with impaired function, demonstrated adequate validity in interview studies.

CONCLUSION

The current findings support the addiction framework, functional impairment, and validity of the GD criteria. However, further prospective, experimental, and clinical studies validating these findings are warranted. Moreover, an integrative review or debate conference could contribute to the organization of the available results and concept development. Aggregating adequate scientific information could allay or resolve concerns related to the diagnosis of GD.

Mental Health Problems and Associated Factors in Chinese High School Students in Henan Province: A Cross-Sectional Study

Approximately one in five adolescents experience mental health problems globally. However, studies on mental health problems in Chinese high school students are few. Therefore, this study examined the status and associated factors of mental health problems in high school students in China. A stratified two-stage cluster sampling procedure was adopted, leading to a final sample of 15,055 participants from 46 high schools in all 17 provincial cities of Henan province, China. Self-reported questionnaires were used to collect the data. A mental health problems variable was assessed using the Mental Health Inventory of Middle School Students. The positive rate of mental health problems among high school students was 41.8%, with a male predominance (43.3% versus 40.2% in females; p < 0.01). The most frequent mental health problem was academic stress (58.9%). Higher grades, physical disease, chronic constipation, alcohol consumption, engagement in sexual behavior, residence on campus, and living in nonurban areas and with single-parent families were significantly associated with higher odds of having mental health problems (p < 0.05). We suggest that the prevention of mental health problems in high school students be strengthened, especially in students with physical illnesses, unhealthy behaviors, and single-parent families.

Development and validation study of Game Overuse Screening Questionnaire

The aim of this study was to develop a screening questionnaire to distinguish high-risk individuals associated with game overuse from casual internet users. Reliability, validity, and diagnostic ability were evaluated for the newly developed Game Overuse Screening Questionnaire (GOS-Q). Preliminary items were assessed by 50 addiction experts online and 30 questions were selected. A total of 158 subjects recruited from six community centers for internet addiction participated in this study. Finally, 150 people were used in the analysis after excluding eight non-respondents. GOS-Q, Young's internet addiction scale, and Korean scale for internet addiction were used to assess concurrent validity. Internal consistency and item-total correlations were favorable (α= 0.96, r= 0.47-0.82). Test-retest reliability was moderate in size (r= 0.74). GOS-Q showed superior concurrent validity, and the highest correlation with Y-Scale (r= 0.77). The construct validity was marginally supported by a six-factor model using exploratory factor analysis. The area under the Receiver Operating Characteristic curve was 0.945. The high-risk addiction group was effectively characterized by a cut-off point of 38.5, with a sensitivity of 0.87 and a specificity of 0.88. Overall, the current study supports the use of GOS-Q as a reliable screening tool in a variety of settings.

Is Family Functioning Stable and Consistent over Time and Stakeholders? A Comparison of Adolescents' and Caregivers' Views

Family functioning is a key construct in research and practice involving children and youth. Given that multi-informant assessment of this construct is considered a best practice in research and clinical settings, ensuring measurement invariance of family functioning instruments is an important consideration for family science scholars and practitioners who increasingly use multiple groups or longitudinal designs in investigating family dynamics. Yet, studies involving family functioning provide limited reports of psychometric properties of key or contextual measures. This study used multigroup confirmatory factor analyses to examine measurement invariance of a short version of the McMaster Family Assessment device using data from caregivers (N = 479) and adolescents (N = 571) collected at two periods four years apart. Results revealed that configural and metric invariance of a short version of the family functioning measure hold both across groups (caregivers and adolescents) and time, thus providing the foundation for using this instrument to assess family functioning with different populations and at different time periods. However, evidence of only partial scalar invariance indicated that group comparisons might be biased. The article concludes with implications for family science scholars and practitioners, including caution in using mean scores to compare perceptions of family functioning across different populations, such as caregivers and adolescents.

Time spent gaming and psychiatric symptoms in childhood: cross-sectional associations and longitudinal effects

There is sparse knowledge on how the amount of gaming overlaps with-and is longitudinally related to-psychiatric symptoms of ADHD and emotional problems throughout early and middle childhood. In this prospective study of 791 Norwegian children, we investigated the amount of electronic gaming at ages 6, 8, and 10 while also measuring DSM symptoms of such disorders. Cross-lagged longitudinal analyses showed that more ADHD symptoms at age 8 predicted more gaming at age 10, whereas gaming did not predict more psychiatric symptoms, controlled for gender and socio-economic status. Cross-sectional overlaps between gaming and symptoms were marginal but nonetheless increased with each age level. Hence, time spent gaming did not forecast more psychiatric problems at these ages, but children with more ADHD symptoms were more likely to increase their amount of gaming throughout middle childhood. Results indicate that the sheer amount of gaming is not harmful to children's mental health, but that poorly regulated children become more attracted to games throughout childhood. Findings are discussed in light of the coexistence of problematic gaming and psychiatric problems reported among adolescents and adults, as well as the potential beneficial psychological outcomes from gaming.

Gaming addiction and perceived stress among Saudi adolescents

•

5% of Saudi adolescents (grade 7–12) were addicted to gaming.

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11% were suffering from a high level of stress.

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Gaming addiction was strongly associated with moderate- and high-level stress.

Introduction

Adolescents (age: 10–19 years) make up 15% of the Saudi population and have easy access to electronic gadgets and the Internet, yet data on gaming addiction among adolescents are negligible. We aimed to determine the prevalence of gaming addiction and its association with stress among Saudi school students.

Methods

In this cross-sectional survey, 2675 school students (grades 7–12) from 40 randomly selected schools in four main cities of Al-Qassim province in Saudi Arabia participated. The questionnaire inquired about demography, lifestyle, gaming addiction (7-item Game Addiction Scale), and stress (10-item Perceived Stress Scale). Multinomial logistic regression assessed the association between gaming addiction (yes, no) and stress (high, moderate, low).

Results

Participants’ mean age was 16.1 (SD = 1.6) years; 50% were female; 64% reported >3 h of daily screen time; 5% were addicted to gaming; 11.4% had high-level stress. Addiction to gaming was strongly associated with stress in the adjusted analysis (moderate OR = 6.7, 95% CI = 2.9–15.5; high OR = 11.9, 95% CI = 4.7–30.1). Additionally, those who were older, female, had poor grades, unhealthy dietary habits, an inactive lifestyle, and smoked were more likely to experience high stress.

Conclusions

Gaming addiction is strongly associated with stress among Saudi adolescents.

Prevalence and associated factors of internet gaming disorder among secondary school students in rural community, Thailand: a cross-sectional study

Objective

Internet gaming disorder (IGD) is an emerging mental problem for adolescent that has been increasingly piqued interest over the last decade. Although many studies have been conducted, very few studies have studied populations with low technological access. Therefore, this study aimed to estimate the prevalence and associated factors of internet gaming disorder among secondary school students in an area with a comparatively lower technological access in a large community sample. We used Chachoengsao province, Thailand as our sample area with a comparatively lower access to technology. This cross-sectional study was conducted during December 2017–January 2018 among 12 secondary schools in Chachoengsao province, Thailand.

Results

5.4% of the 5497 subjects were positive for IGD. The associated factors found were male gender (odds ratio (OR) = 1.4), not living with both parents (OR = 1.75), use of online dating (OR = 1.53), being bullied at school (OR = 1.51), depression (OR = 1.92), anxiety (OR = 1.62) and stress (OR = 3.57) after being adjusted for age, family composition, failure of an exam, limit of internet use, use of online dating, bully perpetration, bully victimization, cyber bully perpetration, cyber bully victimization, suicidal ideation, use of alcohol, depression, anxiety, and stress.

Clusters of health behaviours and their relation to body mass index among adolescents in Northern Finland

AIMS

To identify clusters of health behaviours among Finnish adolescents and examine whether these clusters are associated with body mass index (BMI).

METHODS

The data, drawn from the prospective population-based Northern Finland Birth Cohort 1986, comprised a total of 7182 adolescents who replied to a follow-up postal questionnaire at the age 15 to 16. The adolescents were asked about multiple health behaviours, such as physical activity, screen time, cigarette smoking, alcohol use and diet. Adolescents who answered the questions concerning all of these variables were included in the study, yielding a final sample of 4305 subjects. K-means cluster analysis was performed to identify group of adolescents with similar health behaviours. Chi-squared tests were performed to analyse the association between the clusters and BMI.

RESULTS

Two clusters - Healthy Lifestyle and Unhealthy Lifestyle - were identified for both genders. The values of all the studied variables differed significantly between the clusters identified for both boys and girls. No significant relationship between the identified clusters and BMI was found for either boys or girls.

CONCLUSIONS

It is important to consider multiple lifestyle-related behaviours and trying to identify groups that present probability for developing lifestyle diseases.

Social media, internet use and suicide attempts in adolescents

PURPOSE OF REVIEW

Suicide is the second leading cause of death in youth aged 10-24 years old globally, but detecting those at risk is challenging. Novel preventive strategies with wide influence across populations are required. Interest in the potential for both detrimental and supportive influences of social media/internet use on suicidal behaviour has been growing; however, the relationship remains unclear.

RECENT FINDINGS

A systematic search of articles from database inception up to 25 January 2019 across five databases: Medline, PsycINFO, EMBASE, HMIC and CINAHL revealed nine independent studies investigating social media/internet use and suicide attempts in young people less than 19 years old (n = 346 416). An independent direct association was found between heavy social media/internet use and increased suicide attempts in seven studies (adjusted ORs ranged from 1.03 to 5.10), although adjusting for cyberbullying victimization and sleep disturbance reduced the strength of this association. Two studies found that some social media/internet use, versus no use, may be associated with fewer suicide attempts. There were no studies investigating the relationship between social media/internet use and completed suicide.

SUMMARY

There is an independent association between problematic use of social media/internet and suicide attempts in young people. However, the direction of causality, if any, remains unclear. Further evaluation through longitudinal studies is needed.

Effects of prolonged continuous computer gaming on physical and ocular symptoms and binocular vision functions in young healthy individuals

Background and Objective

Addiction to computer gaming has become a social problem in Korea and elsewhere, and it has been enlisted as a mental health disorder by the World Health Organization. Most studies related to computer use and vision have individually assessed physical and ocular symptoms and binocular vision. Accordingly, the present study comprehensively assessed subjective physical and ocular symptoms and functions related to binocular vision after prolonged continuous computer gaming. This study aimed to investigate the effects of prolonged continuous computer gaming on physical and ocular health and visual functions in young healthy individuals.

Methods

Fifty healthy college students (35 male/15 female), aged 19-35 years old, were enrolled in this study. The inclusion criteria were no binocular vision problems and no reported history of ocular disease. Participants played continuously for 4 h from 6:00 to 10:00 p.m. Physical and ocular symptoms and visual functions such as convergence, accommodation, phoria, and the blink rate were assessed before and after continuous computer gaming for 4 h.

Results

Continuous computer gaming for 4 h resulted in convergence and accommodation disturbances and increased physical and ocular discomfort. Near phoria showed an exophoric shift, whereas distance phoria showed no change. Moreover, the accommodative and vergence facilities and blink rate were significantly decreased. All visual functions recovered to the baseline levels by the following morning.

Discussion

Our findings suggest that excessive and continuous computer gaming impairs visual functions and causes ocular and physical fatigue. Our findings further the understanding of the adverse effects of excessive computer use on physical and ocular health, and adequate breaks are necessary to reduce physical and visual discomfort during computer gaming.

Why and how to include parents in the treatment of adolescents presenting Internet gaming disorder?

BACKGROUND AND AIMS

Clinicians and researchers are increasingly interested in investigating excessive use of video gaming recently named Internet gaming disorder (IGD). As is the case with extensively researched adolescent problem behaviors such as substance use disorder, several studies associate IGD with the young person's family environment and the parent-adolescent relationship in particular. Evidence-based treatments for a range of adolescent clinical problems including behavioral addictions demonstrate efficacy, the capacity for transdiagnostic adaptation, and lasting impact. However, less attention has been paid to developing and testing science-based interventions for IGD, and at present most tested interventions for IGD have been individual treatments (cognitive behavioral therapy).

METHODS

This article presents the rationale for a systemic conceptualization of IGD and a therapeutic approach that targets multiple units or subsystems. The IGD treatment program is based on the science-supported multidimensional family therapy approach (MDFT). Following treatment development work, the MDFT approach has been adapted for IGD.

RESULTS

The article discusses recurring individual and family-based clinical themes and therapeutic responses in the MDFT-IGD clinical model, which tailors interventions for individuals and subsystems within the young person's family.

DISCUSSION AND CONCLUSIONS

Basic science developmental research can inform conceptualization of IGD and a systemic logic model of intervention and change. This paper aims to expand treatment theorizing and intervention approaches for practitioners working with frequently life-altering behaviors of excessive Internet gaming. We operationalize this aim by addressing the question of why and how parents should be involved in youth IGD treatment.

Associations between attention deficit hyperactivity and internet gaming disorder symptoms: Is there consistency across types of symptoms, gender and countries?

BACKGROUND

Videogame addiction has been suggested as a tentative disorder in 2013 by the American Psychiatric Association (APA) and was recently officially recognized as a mental health disorder by the World Health Organization (WHO). Although a few studies have identified attention deficit and hyperactivity disorder (ADHD) as a key risk factor for Internet Gaming Disorder (IGD), the interplay between ADHD and IGD symptoms with gender differences across cultures remains to be further examined.

OBJECTIVE

This study examined the moderating effects of gender in the association between ADHD and IGD across two nations.

METHOD

A cross-sectional online survey was developed to recruit 164 Australian (Mage = 23.01, SD = 3.35, Minage = 18, Maxage = 31, Males n = 121, 73.80%) and 457 U.S.-North American (Mage = 25.25 years, SD = 2.76, Minage = 18 years, Maxage = 29 years, Males = 265, 57.98%) Massively Multiplayer Online (MMO) players aged between 18 and 29 years.

RESULTS

The hierarchical linear regression, moderation and moderated moderation analyses revealed that participants presenting greater inattention and hyperactivity symptoms exhibited higher levels of IGD-related behaviors in the two samples. Moreover, these associations differed across genders between the two countries. Specifically, more hyperactive-impulsive, as well as inattentive males in the USA presented higher levels of disordered gaming.

CONCLUSION

The results highlight the need for more cross-cultural and symptom-focused research in the broader IGD field.

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

OBJECTIVES

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

METHODS

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

RESULTS

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

CONCLUSION

Both boys and girls tended to transition to tolerance or high-SAP statuses, while children's depression and their usage of SNSs increased the risk of smartphone addiction.

Psychometric properties of the Internet Gaming Disorder Test (IGDT-10) and problematic gaming behavior among Finnish vocational school students

This study was conducted to investigate the psychometric properties of the Finnish version of the Internet Gaming Disorder Test (IGDT-10), identify the proportion displaying problematic gaming behavior (PGB) among Finnish vocational school students, and characterize the relationships between sociodemographic factors and gaming characteristics predicting PGB in this population. This cross-sectional study involving 773 students (mean age 17.5 years). Socio-demographic and gaming behavior characteristics were established using a web-based survey. A confirmatory factor analysis (CFA) showed that the IGDT-10 test has appropriate psychometric properties. The proportion of students exhibiting PGB based on the DSM-5 cut-off threshold was 1.3%. Regression analysis showed that male gender, preference for gaming on a personal computer, gaming time, poor self-perceived health status, and a preference for the solo and multiplayer online battle arenas (MOBA) game genres related positively to PGB scores. These findings demonstrate the appropriateness of the IGDT-10 test for the assessment of problematic gaming among adults, and support further research on PGB in Finland.

Association between psychological distress and elevated use of electronic devices among U.S. adolescents: Results from the youth risk behavior surveillance 2009-2017

OBJECTIVE

The purpose of this study was to provide updated information about the prevalence and temporal trends of elevated use of electronic devices (EUED) in leisure time (i.e., 3 h or more on an average school day) in nationally representative samples of U.S. adolescents in recent years and to determine whether there is a significant association between EUED and psychological distress.

METHODS

We used the national Youth Risk Behavior Survey (YRBS) data from 2009, 2011, 2013, 2015, and 2017 (N = 75,807). Propensity score matching was used to reduce selection bias due to potential confounding factors with EUED. Ordinal logistic regression analyses were performed for the matched samples to predict the association between EUED and psychological distress.

RESULTS

The prevalence of EUED in U.S. youth has substantially increased from 24.9% in 2009 to 43.1% in 2017 (p < .001). Boys had higher rates of EUED than girls only in 2009 and 2011 but not in 2013, 2015, and 2017. A significant association between EUED and psychological distress was identified throughout all the five survey years. The odds of having a higher level of psychological distress increased approximately 1.5 times among youth with EUED than those without.

CONCLUSIONS

The prevalence of U.S. youth with psychological distress and EUED has increased simultaneously in the past several years. Future longitudinal studies are warranted to examine causal and/or reciprocal relationship between the two.

Bio-psychosocial factors of children and adolescents with internet gaming disorder: a systematic review

Previous large-scale studies suggest that internet gaming disorder (IGD) among children and adolescents has become an important public concern. Minors are known to be particularly susceptible to problematic internet gaming use owing to age-related underdevelopment of cognitive control. It has been shown that precursors of addictions appear during adolescence; therefore, prevention efforts must be established targeting minors who have their first experience with addictive substances and behaviors during pubescence. Since the DSM-5 classification of IGD in 2013, studies on IGD have drastically increased in number. Thus, we performed an updated review of studies of IGD in children and adolescents to assess the clinical implications of IGD. The search included all publication years, using PubMed, MEDLINE, and PsycINFO. Across studies, the presence of IGD had a negative effect on sleep and schoolwork in minors. Additionally, family factors, including the quality of parent-child relationships, were important social factors in minors with IGD. Brain imaging studies indicate that impaired cognitive control in minors with IGD is associated with abnormal function in the prefrontal cortex and striatum. Persistent pathological online game use from childhood may aggravate abnormal brain function; therefore, preventive care and early intervention are increasingly important. Although extant research supports the effectiveness of cognitive behavioral therapy for minors with IGD, effective psychological intervention for minors with IGD is an urgent issue that requires further research. This review, which presents updated findings of IGD in minors, is expected to contribute to the development of future research and be useful in clinical practice in the field of child and adolescent psychiatry.

Screen media activity and brain structure in youth: Evidence for diverse structural correlation networks from the ABCD study

The adolescent brain undergoes profound structural changes which is influenced by many factors. Screen media activity (SMA; e.g., watching television or videos, playing video games, or using social media) is a common recreational activity in children and adolescents; however, its effect on brain structure is not well understood. A multivariate approach with the first cross-sectional data release from the Adolescent Brain Cognitive Development (ABCD) study was used to test the maturational coupling hypothesis, i.e. the notion that coordinated patterns of structural change related to specific behaviors. Moreover, the utility of this approach was tested by determining the association between these structural correlation networks and psychopathology or cognition. ABCD participants with usable structural imaging and SMA data (N = 4277 of 4524) were subjected to a Group Factor Analysis (GFA) to identify latent variables that relate SMA to cortical thickness, sulcal depth, and gray matter volume. Subject scores from these latent variables were used in generalized linear mixed-effect models to investigate associations between SMA and internalizing and externalizing psychopathology, as well as fluid and crystalized intelligence. Four SMA-related GFAs explained 37% of the variance between SMA and structural brain indices. SMA-related GFAs correlated with brain areas that support homologous functions. Some but not all SMA-related factors corresponded with higher externalizing (Cohen's d effect size (ES) 0.06-0.1) but not internalizing psychopathology and lower crystalized (ES: 0.08-0.1) and fluid intelligence (ES: 0.04-0.09). Taken together, these findings support the notion of SMA related maturational coupling or structural correlation networks in the brain and provides evidence that individual differences of these networks have mixed consequences for psychopathology and cognitive performance.