Internet addiction: a systematic review of epidemiological research for the last decade.

"A person who never made a mistake never tried anything new." -Albert Einstein THE BEGINNING In 1995, when the New York based psychiatrist Dr. Ivan Goldberg posted a sincere-looking but satirical note on the online psychiatric bulletin board PsyCom.net (no longer available now) taking a dig at the rigid diagnostic criteria of the newly released 4th edition of the Diagnostic and Statistical Manual (DSM-IV) of the American Psychiatric Association (APA) by "creating" a fictitious disorder called Internet addiction disorder (IAD) and cooking up its "diagnostic criteria" as per DSM style for substance dependence, little did he know that he had opened the proverbial Pandora's box.[1] He and his bulletin board were flooded with people narrating their tales of woe of "remaining caught in the Net" and seeking help for their condition. This was one condition he did not intend to create (he himself did not believe that there could be a true "addiction" to Internet but rather excessive or pathological use), but there it was whatever name you gave it! In 1995, a clinical psychology student Ms Kimberly Young, then in Rochester, USA, got interested in the psychological factors behind computer use and independently conceived of "addictive use of the Internet" as a pathological condition.[2] It is interesting to hear of this story from the author herself 20 years later: "Internet addiction began as a pet project in a young researcher's one bedroom apartment in Rochester, New York. I was that young researcher. It was in 1995, and a friend of mine's husband was seemingly addicted to AOL Chat Rooms spending 40, 50, and 60 h online at a time when it was still $2.95/h to dial into the Internet. Not only did they suffer financial burdens but also their marriage ended in divorce when he met women in online chat rooms."[3] The rest, as they say, is history, with her first illustrative case report published in 1996 having been cited 755 times, and her first definitive research article titled, "Internet addiction: Emergence of a new clinical disorder," published in 1998, having been cited a phenomenal 3144 times as on December 15, 2015![4] In 1995, a clinical psychologist Mark Griffiths, working at Nottingham Trent University, Nottingham, UK, who had been interested in research on gambling, computer use, and use of various machines or technology by humans in general for a few years at that time, published an article named, "Technological addictions."[5] The next year, in 1996, he published on Internet addiction, conceptualized by him as a subset of the broader term technology addiction.[6] This was the beginning, 20 years ago. As the freelance writer Michael OReilly, reporting in Canadian Medical Association Journal in 1996, (who, himself, interestingly, declared that "he may be at risk for developing IAD") titled his article as "Internet addiction: A new disorder enters the medical lexicon," where he mentioned Young's still unpublished research on Internet addiction.[7] Truly, a PubMed search on "Internet addiction" pegs this short report as the very first article included in PubMed on the topic. THE ACCOLADES… Now, in 2015/6, as on December 15, 2015, there are 1561 articles cited in PubMed on "Internet addiction." What is more interesting is a look at the acceleration rate of publication. While there were only three articles in 1996, there were 32 in 2005, 275 in 2014, and 296 (and still counting) in 2015! Thus, while the growth rate of publications was not hugely impressive in the first decade of its life, Internet addiction is now a robust young adult in its postteen year with a sizeable growth spurt in its second decade. Not many "new" terms can boast of such growth in just 20 years in the PubMed! As an aside, it is to be noted that the term "Internet addiction" has many competing contenders; some of the important ones are pathological Internet use, problematic Internet use (PIU), compulsive Internet use, Internet use disorder (IUD), and pathological use of electronic media among others. Pathological Internet use or PIU is often a favored term these days, but we have stuck to the original term because it is still very popular certainly with the social media but also in medical/psychological scientific research, and especially because we wanted to place this editorial in a historical perspective. Hence, what kinds of articles are being published on Internet addiction over the past decade or so? This is no place (and space) for a comprehensive review on the topic. Suffice it to say that, in addition to individual research articles from America, Europe, Asia, and Oceania, there are now a number of published narrative and even a few systematic reviews on almost every aspect of Internet addiction, including its concept and historical perspective,[89] diagnostic criteria,[10] epidemiology,[11] psychosocial and neuropsychological aspects,[1213] neurobiological aspects,[1314151617] and management, both pharmacological and nonpharmacological.[1819] It appears that the issue is, at least partly, resolved, and that we have sufficient power in our knowledge base to conceptualize, detect, diagnose, characterize, treat, and prognosticate something called Internet addiction. Twenty years … and we are quite there. Well, not quite, yet. …AND THE BRICKBATS The first jolt came from APA in their widely publicized 5th edition of the DSM (DSM-5) published in May 2013.[20] Although the much-awaited and much-hyped category of "behavioral addictions" was indeed kept in its re-formulated category, "Substance-related and addictive disorders," the sole diagnostic category kept in its final version under behavioral addictions was gambling disorder, which was a slightly tweaked version of the earlier pathological gambling, shifting its parental home from impulse control disorders of DSM-IV (there is no broad category of impulse control disorders any more in DSM-5) to addictive disorders in DSM-5. Despite early speculations and expectations, Internet addiction did not find a home under behavioral addictions. Instead, and almost as a consolation prize, one particular subtype of Internet addiction, called Internet Gaming Disorder, has been entertained in the DSM-5, but only as a tentative "Condition for Further Study" that "requires further research before they might be considered formal disorders," in its Section III called Emerging Measures and Models. The second jolt, and the one more important from an international perspective including India, comes from the forthcoming 11th revision of the International Classification of Diseases (ICD-11) by the World Health Organization (WHO). A recent article from the WHO Working Group on Classification of Obsessive-Compulsive and Related Disorders, while deliberating on this area as a "key controversy," concluded that, "based on the limited, current data, it would therefore seem premature to include it in the ICD-11."[21] Consequent to this stand, the very recently released Beta Draft of the entire ICD-11 (where Mental and Behavioral Disorders is coded as 07) sticks to its previous model of separate groups for "disorders due to substance use" (which has, by definition, no mention of any behavioral addictions but only substance use related disorders), and "impulse control disorders," which continues to house pathological gambling but has also added "compulsive sexual behavior disorder," a contender for the behavioral addictions, under impulse control disorders. Internet addiction, in any of its avatars, is nowhere in sight.[22] This is certainly a big disappointment for the advocates and champions of behavioral addictions, technological addictions, including Internet addictions. Let alone classifying it as an addictive disorder, ICD-11 Beta Draft refuses to recognize Internet addiction as a disorder in the first place! Why is it so? And, what can be done? To our mind, there is a hierarchical series of questions that need to be answered to get a grasp on the issue. Each successive question builds on its predecessor, assuming that the question hierarchically one step above is answered in the affirmative. THE FOUR CARDINAL QUESTIONS The first and foremost question: Is Internet addiction better conceptualized as a "disorder" or as a continuum of normal behavior (after all, Internet use is an essential part of everyday life of a vast proportion of people worldwide, and steadily increasing – we all are Internet "dependent" in much the same way we are dependent on so many basic things in life)? Although heavily debated already, the simple answer to this question can be borrowed from ICD-11 Working Group: "Where there is a continuum between normal and pathological behavior, associated impairment may become a key determinant of whether or not behavior is disordered. An additional important consideration, from a public health perspective, is whether efficacious treatments are available."[21] As abundantly documented in the literature over the past 20 years, excessive, uncontrolled, and inflexible Internet use behavior can indeed lead to severe functional impairment in some persons. Further, consider the definition of a mental and behavioral disorder as espoused in the Beta Draft of ICD-11: "Mental and behavioral disorders are recognizable and clinically significant behavioral or psychological syndromes that are associated with distress or interference with personal functions."[22] Many (but not all) cases of Internet addiction would satisfy this definition. As in many other psychiatric disorders, there would be a large "gray area," but that only proves that there is indeed a "white" ("normal") and a "black" (pathological or disordered) area as well. From a public health perspective, this is an important question because of its policy implications. There is also some evidence that at least nonpharmacological interventions (especially cognitive behavioral therapy for Internet addiction) can be useful though much more research is needed. And that would only be feasible, once we initially and tentatively agree that indeed there can be a disorder for which we are seeking a treatment! The second important question we ask is, assuming that some cases of these excessive, uncontrolled, and inflexible Internet use behavior indeed is a mental and behavioral disorder: Is this pattern of behavior an addictive disorder? There are actually three sublevels of criticism or question in this: How can there be an addiction to something which is not as tangible a thing as drugs? Why is it not better explained by simply as a manifestation of other underlying disorders such as depression, anxiety, or social phobia? Why is it not better conceived as, say, an impulse control disorder (as done for pathological gambling or the new category of compulsive sexual behavior disorder), or an obsessive-compulsive spectrum disorder? As to the response to the first sublevel of this question/critique, our take is: Epistemologically, "addiction" to psychoactive substances was a later development in history. The Latin root of the word "addiction" – addicere – simply meant "to adjudge, sentence, doom, assign, confiscate, or – importantly – enslave."[23] Thus, "addicted" would simply mean "being sentenced, doomed, or enslaved." The object of this transitive verb could be theoretically anything, from drugs to playing poker. On a neurobiological note, it is the brain learning or memory of a rewarding experience that is the basis of dopaminergic-based positive reinforcement which defines the early stages of addiction, rather than which specific stimulus (whether cocaine or social networking online) triggered that experience.[24] Once continued for a while, this early mechanism paves the way for a delayed-onset recruitment of nondopaminergic anti-reward mechanisms that provides negative reinforcement for a particular behavior which perpetuates that behavior in a compulsive manner.[24] Finally, at a behavioral level, addiction (as opposed to pharmacological dependence on a substance) is always with regard to a core behavior. Even in case of substances, what characterizes substance dependence is the pathological pattern of "use" of the substance (please note: Use refers to a particular behavior). For example, take the definition of alcohol dependence as in the ICD-11 Beta Draft: "Alcohol dependence is a disorder of the regulation of alcohol use, arising from repeated or continuous use of alcohol. Characteristic features are a strong drive to use alcohol, impaired ability to control its use, and giving increasing priority to alcohol use over other activities. Often individuals develop tolerance and experience withdrawal symptoms when cutting down or stopping, or use alcohol to prevent or alleviate withdrawal symptoms. Use of alcohol increasingly becomes a central focus of the person's life and relegates other interests, activities, and responsibilities to the periphery. Continuation of alcohol use despite adverse consequences is a common feature."[22] Now, let us do a little fun experiment. Try substituting the word "alcohol" with "Internet" in this definition and see what comes out of it! The second level of this second question/criticism is partly true. There is a documented large comorbidity between the putative behavioral addictions (including Internet addiction) and other psychiatric disorders, particularly depressive and anxiety and bipolar disorders.[25] However, that is true for many psychiatric disorders and certainly true for substance use disorders in general. The fact that alcohol dependence is heavily comorbid with depression does not make the former identical with the latter! If at all, such a pattern lends credence to the similarity of these behavioral disorders with addictive disorders.[26] Of course, Internet addiction should not be diagnosed if such behavior is exclusively contained within the boundaries of a bipolar, depressive, or anxiety episode and spontaneously resolves after the resolution of such conditions. Coming to the third level, the very nature of these behavioral disorders, we land in a debate that goes to the very heart of concept and nosology of psychiatric disorders. Substance use disorders too, from time to time, have been conceptualized as impulse control disorders, obsessive spectrum disorders, compulsive spectrum disorders, or combinations of these.[27] Impulsivity in decision making and behavior, obsession-like repeated preoccupation, and a compulsion-like quality in repeated use of substances, all are important components of the process of addiction, but addiction as a gestalt has characteristics beyond each of these individual phenomena; otherwise, all substance use disorders would have been consumed under any of these too. Thus, we take on this matter at the moment (admittedly incomplete and one that will require a lot more research to settle) is that pathological or PIU, after a certain threshold of severity and functional impairment, can be conceptualized as an addictive disorder. However, we suggest that the name of the condition be changed to "Internet Use Disorder (IUD)." This term retains the three cardinal characteristics:First, it is a disorder; second, it is concerned with a particular core behavior of using the Internet as a medium (for whatever purpose); and third, Internet) the target "object" (in a metaphorical sense, not as a substance but as a vehicle or medium) of use. The third question, assuming that the two above have been answered, is: If PIU is indeed best conceptualized as an addictive disorder (i.e. IUD, as a behavioral addiction), what is the person addicted to? Is it the Internet as a medium, any of the many actions using the software applications of the Internet (e.g., online gambling, gaming, social networking, relating, watching a particular content such as pornography or scientific literature search, buying, etc.), or to a particular gadget of technology that hosts the Internet (e.g., smartphones, tablets, laptop, or desktop computers)? Many authors now contend that there are two distinct forms of IUD – one specific (where the addictive behavior is predominantly focused on a particular application of the Internet) and another generalized (where there is no such focus).[928] Some researchers even have theorized about the different psychological and neurobiological pathways of these two subtypes.[13] In this regard, we would reiterate that it is the pathological use of the Internet that is the main concern at hand, not what specific purpose it is used for. Much more commonly, users of the Internet (both "normal" and "pathological") use it for a narrow set of specific purposes. Indeed, normal users use the Internet for much more varied purposes, while pathological users tend to narrow down their focus on specific activities (gaming, gambling, sex, chat, buying, etc.) to the exclusion of others. This is reminiscent of the "narrowing of repertoire" characteristic originally espoused for a "dependence syndrome" by Edwards and Gross.[29] Only a handful of persons with IUD do not have any predominant focus; however, even in them, an apparently aimless surfing of the Internet itself is an activity which, however, "useless" in the value-laden sense it may be, is actually a use of the Internet! Thus, the conceptualization of IUD obviates the question of whether one is addicted to the Internet as a source for gratifying other needs or addicted to the Internet as a medium (or to a gadget that hosts that medium), so long as the use of the Internet is the object of the addictive behavior. This view suggests that there is one IUD, with varied subtypes or specifiers based on the specific applications or even lack of any specific one (which may be thought of as "not otherwise specified" in the standard nosological tradition). The fourth question, assuming that we conceptualize IUD as a unifying concept with varied "subtypes" based on specific applications of the Internet, is: How to diagnose such a condition? There is a plethora of screening and diagnostic instruments (21 instruments as mentioned in reference 11) based upon the authors' own theoretical understanding of the issue. Unfortunately, these instruments often provide very different estimates of Internet addiction or PIU, ranging from <1% to 27%.[11] Of course, sample nature and sample selection also play a significant role in explaining such wide intervals. However, coupled with such heterogeneous instruments, such figures undermine the confidence in the concept and diagnosability of the condition. The answer to this question has to build on at least partial resolution of the above questions. INDIAN SCENE: A SKETCHY VIEW There is a trickle of Indian research in this area. Although the first published article was published more than a decade ago,[30] not many published articles are available in peer-reviewed journals. It is beyond the scope and space of this article to critically review all these, but two characteristics are commonly seen:First, often the samples are self-selected or convenience samples, likely to be drawn from accessible college students; second, an almost exclusive use of Young's Internet Addiction Test. It is interesting to note that two Indian studies compared the prevalence of Internet addiction by using two different diagnostic questionnaires from different constructs of Internet addiction. One study compared questions derived from ICD-10 substance dependence criteria with Young's questionnaire;[31] another recent one compared a more conservative and validated diagnostic criteria set with the latter.[32] Both the studies found a wide disparity between prevalence figures for Internet addiction as estimated by different instruments. The prevalence figures varied widely, from 1.2% to more than 50%! This demonstrates the important point raised in the fourth question above. Why is this issue important for India? India is a country with rapidly increasing Internet connectivity. Starting from August 14, 1995, when Videsh Sanchar Nigam Limited first launched India's first full Internet service for public access,[33] interestingly, again 20 years later as of September 2015, there were 350 million active Internet users, fuelled by the rapid spread of smartphones and other In by India is to become the second the and second only to this and growth even a conservative of just prevalence of PIU, IUD, or Internet addiction, by whatever name it is will the number of pathological Internet users to This is a number to Thus, there is a clinical and public health perspective to the question of IUD, which are mentioned as the in this in mind, the recently published of on and Emerging an of the Indian Psychiatric by the Section on Substance Use Disorders, an entire on behavioral Some may contend that it is a mistake to clinical on that nosological at nosological A In a series article in the Indian Journal of and titled as "Internet addiction disorder: or into sufficient research might over time at it a the Internet to the of many but "Internet addiction" as of now more questions than can be a decade with and an scientific literature in hand, we are in with the second but no longer with the There are people out there who are because of their use of the Internet. need and at least some of can be There is evidence to suggest that Internet addiction (or what we to IUD, in with substance use disorders of DSM-5) can no longer be considered a there are still many questions to be answered, and it is the nature of to answer a few questions while agree that we need to the use of the term as opposed to its scientific use, and to estimates of the condition by use of instruments of This is to the concern of or of any behavior with or as a medical disorder. the same time, however, this concern our and to diagnose and for who are indeed in need of it would be the out with the In this there is to be some this way or that way before we can the between and is we need to of the to Einstein in the There is new that we are – each one of the questions above has been and with often upon the perspective. The on these will require a series of What we to do was to the key questions in a hierarchical the and make our stand, however, or it may be, with the that we would to be The purpose is to further in this important to some of a and to ask the question that the

Aboujaoude's review of problematic Internet use is a timely contribution to the literature on a poorly understood behaviour that has apparently caught the attention of the media more than that of mental health professionals. And, while psychiatrists and clinical psychologists seem to be sceptical about many aspects of the problematic Internet use, concern in the community about the adverse effects of the Internet use seems to be growing exponentially. This revolves mainly around two issues. The first is the impact of violent video games and other violent online content; the second is what has increasingly been referred to as "Internet addiction". The focus of this commentary will be on the latter issue. The problem starts with terminology, as the appropriate name for the condition or behaviour often labelled "Internet addiction" is not clear. Progress in this area can hardly be made without first reaching a consensus as to what terms to use. "Internet addiction" is a troublesome term, not only because of its pejorative connotations, but also because there is no evidence that this is really an addictive disorder, i.e., that it is characterized by the hallmarks of substance addiction such as tolerance and withdrawal. If adopted without sufficient evidence, "Internet addiction" will clearly be an arbitrary term. It is appropriate to be cautious and retain more descriptive and "neutral" terms, such as problematic (or problem) Internet use. Other terms have also been proposed, e.g., "pathological use of electronic media" 1, but "Internet addiction" still seems to dominate the literature and professional jargon. The terminological rigour should go hand in hand with conceptual clarity. A part of the reason for the ongoing struggle with terminology is the lack of clarity about the key features of problematic Internet use. Several features have been proposed, but many of them seem to overlap and boil down to the basic two characteristics. The first pertains to the aspects of Internet use, described as excessive or compulsive, along with preoccupation with and loss of control over the Internet use. The second refers to various adverse consequences of spending too much time on the Internet, such as neglecting social activities, relationships, health and work or school duties, and altering sleep and eating habits in a detrimental way. Further research is needed to ascertain more precisely to what extent these features characterize problematic Internet use. Problematic Internet use appears to be too heterogeneous as a concept. It has been suggested that it consists of at least three subtypes: excessive gaming, problematic sexual behaviour, and e-mail/text messaging 2. The Internet may also be used excessively and with negative consequences to gamble, shop, or chat. These different purposes of using the Internet may be associated with different patterns of use, different underlying psychopathology, and different adverse consequences. It may then be inappropriate to lump together all the instances of problematic Internet use and perhaps more useful to consider online gambling as a manifestation of pathological gambling, Internet-related problematic sexual behaviour as a feature of a sexual or some other disorder, and so on. In accordance with this approach, we have formulated and tested preliminary criteria for problem video game use 3, but these require further study. "New" disorders or patterns of behaviour may be no more than alternative expression of various psychopathological entities. Accordingly, it has been debated whether addictive disorders, including problematic Internet use, represent primary conditions in their own right or whether they can be better understood as a manifestation of some underlying psychopathology or poor coping, that is, a "secondary addiction" 4,5. Various mental and other disorders often co-occur with problematic Internet use, which suggests that in many cases the latter may be conceived of as being related to the former. The co-occurring conditions and corresponding dimensions of psychopathology include depressive and bipolar disorders, anxiety disorders (especially social anxiety disorder, generalized anxiety disorder, and obsessive-compulsive disorder), sleep disturbance, substance use disorders, impulse control disorders, attention deficit and hyperactivity disorder, personality disorders and traits (especially borderline, narcissistic, antisocial, and avoidant), and psychotic disorders. Several issues should be addressed when elucidating whether and when problematic Internet use is primary or secondary. First, prospective studies need to ascertain the sequence in the development of problematic Internet use and psychiatric disorders. Second, it is important to understand to what extent the relationship between problematic Internet use and the associated psychopathology is specific. Finally, treatment of individuals with problematic Internet use crucially depends on whether an underlying condition accounts for problematic Internet use, as that condition should then be targeted by treatment. There have been calls to conceptualize problematic Internet use as a mental disorder, include it in the DSM-V, and classify it as a "compulsive-impulsive spectrum disorder" 2. However, doing so seems premature in view of the following: a) it is not yet clear whether and how problematic Internet use can be distinguished from a pattern of behaviour usually labelled by others as undesirable or disturbed; b) the boundary between normal and problematic Internet use has not been established; c) it remains to be ascertained whether problematic Internet use possesses conceptual validity, including distinct presentation and sociodemographic and neurobiological correlates, internal homogeneity, and sufficient longitudinal stability with distinct course, prognosis, and response to treatment. Not endowing problematic Internet use with the status of a mental disorder would prevent its psychiatric reification at the time when so little is known about it, while fostering an open-minded attitude towards further research.

Empirical studies have identified increasing rates of problematic Internet use worldwide and a host of related negative consequences. However, researchers disagree as to whether problematic Internet use is a subtype of behavioral addiction. Thus, there are not yet widely accepted and validated diagnostic criteria for problematic Internet use. To address this gap, we used mixed-methods to examine the extent to which signs and symptoms of problematic Internet use mirror DSM-5 diagnostic criteria for substance use disorder, gambling disorder, and Internet gaming disorder. A total of 27 university students, who self-identified as intensive Internet users and who reported Internet-use-associated health and/or psychosocial problems were recruited. Students completed two measures that assess problematic Internet use (Young’s Diagnostic Questionnaire and the Compulsive Internet Use Scale) and participated in focus groups exploring their experiences with problematic Internet use. Results of standardized measures and focus group discussions indicated substantial overlap between students’ experiences of problematic Internet use and the signs and symptoms reflected in the DSM-5 criteria for substance use disorder, gambling disorder, and Internet gaming disorder. These signs and symptoms included: a) use Internet longer than intended, b) preoccupation with the Internet, c) withdrawal symptoms when unable to access the Internet, d) unsuccessful attempts to stop or reduce Internet use, e) craving, f) loss of interest in hobbies or activities other than the Internet, g) excessive Internet use despite the knowledge of related problems, g) use of the Internet to escape or relieve a negative mood, and h) lying about Internet use. Tolerance, withdrawal symptoms, and recurrent Internet use in hazardous situations were uniquely manifested in the context of problematic Internet use. Implications for research and practice are discussed.

Background: Substance-related addictive disorders are known to be overrepresented in non-heterosexual individuals, but it is largely unknown whether this is also the case for behavioral addictions such as problem gaming and gambling. This study aimed, in a pilot web survey design, to assess whether problematic gambling, gaming and internet use may be more common in individuals with a non-heterosexual orientation.Methods: An online survey was distributed through media and social media, and answered by 605 individuals (51% women and 11% non-heterosexual). Problem gambling, problem gaming and problematic internet use were measured through structured screening instruments (the CLiP, the GAS and the PRIUSS, respectively).Results: Problem gaming and problematic internet use were significantly more prevalent in non-heterosexual subjects. Instead, problem gambling did not differ between heterosexual and non-heterosexual respondents. Psychological distress and social media use for more than 3 h daily were significantly more common in non-heterosexual respondents. In the overall sample, gaming and gambling were associated statistically.Conclusion: Based on the present pilot online survey, problematic gaming and internet use, but not problem gambling, may be more common in non-heterosexual populations. This area merits more and larger studies, and potentially preventive efforts aimed for non-heterosexual individuals in the population. Possible explanations and study limitations are discussed in the paper.

The objective of this article is to fully understand Internet addiction, we aimed to compare the attachment styles and psychopathologies associated with problematic Internet use with those related to alcohol use. Through the participation of 141 male participants, the present study assessed problematic Internet and alcohol use, attachment, psychopathology, and demographic data via the use of self-rating questionnaires. We explored the significant predictors among avoidant and anxious attachments, depression, anxiety, and phobia to explain problematic Internet and alcohol use. The results showed that anxious attachment, depression, and anxiety could explain problematic alcohol use. In contrast, both anxious and avoidant attachment as well as depression and phobia explained problematic Internet use. Additionally, depression moderated the effects of avoidant attachment on problematic Internet use. We demonstrated that the interaction of attachment and psychopathology predicts problematic Internet use originating from an earlier stage of life than that associated with problematic alcohol use.

Objective: While benefitted from highly developed Informational Technology, Internet addiction might be a mental health issue for Taiwanese adolescents and worth research and professional attentions. Nevertheless, environmental and developmental factors associated with Internet addiction in adolescents are less explored. Specifically, little is known about the stress types that may be more related to Internet addiction or the relationship between impulsivity and Internet addiction. Moreover, few studies have attempted to explain higher prevalence of Internet addiction in boys. Therefore, in order to understand the etiological factors and gender differences of Internet addiction in Taiwanese adolescents, the present study attempts to explore the relationship among Internet addiction, stress and impulsivity from a stress-diathesis perspective. It is hypothesized that high-risk adolescents have higher stress and higher impulsivity than low-risk adolescents. In addition, stress is hypothesized to moderate the relationship between impulsivity and Internet addiction tendency. The relationship between different types of stress and Internet addiction is explored. Finally, the gender difference of Internet addiction with respect to Internet use, impulsivity, and stress is explored. Method: 759 adolescents (387 boys, 372 girls, age range = 12-15 years old) from a local junior high school in Taipei participated in the study. Both participants and their parents completed the informed consent form. Self-report questionnaires assessing Internet usage, adolescents life stress, impulsivity and Internet addiction tendency were completed by participants anonymously. Results: Using analyses of variance and hierarchical multiple regressions, the present study found: 1) While online gaming and using cyberporn were more predictive of Internet addiction for boys, using social interaction device was more predictive for girls. 2) Stress of self and future concern was more related to Internet addiction for boys, while romantic relationship stress was more related to Internet addiction for girls. 3) Significant gender × group (low/high risk) interaction was found for objective academic stress and subjective/objective romantic relationship stress. 4) Both high-risk boys and girls showed significant higher impulsivity than low-risk group. 5) Stress did not moderate the relationship between impulsivity and Internet addiction. 6) Subjective academic stress had a curvilinear relationship with Internet addiction, whereas such relationship existed only for boys but not for girls. Discussion: In Taiwanese adolescents, boys and girls may have different etiological patterns of Internet addiction. The roles of Internet use, types of stress, and impulsivity playing in the etiological links to Internet addiction are addressed. The limitation of study as well as clinical implication and future direction are discussed.

Background While pathological gambling, or gambling disorder, is an established diagnosis, a link to other potential behavioural addictions has been suggested. The present study aimed to investigate whether signs of problem gaming and problematic internet use are related to problem gambling in the general population, while including other potential risk factors. Methods A cross-sectional study design, using an electronical questionnaire, administered through a marketing survey company for relative representativeness with respect to age and gender. Potential correlates of problem gambling were measured in binary analyses, and significant associations were entered in a logistic regression analysis controlling them for one another. Problem gambling, gaming, and internet use were measured through established screening instruments (the CLiP, the GAS, and the PRIUSS). Results Statistically significant associations were found between problem gambling and both problem gaming and problematic internet use, as well as with male gender. In logistic regression, problem gaming, problematic internet use, and male gender remained associated with problem gambling. Conclusion After controlling for potential demographic risk factors, problem gaming and problematic internet use may be related to problem gambling, suggesting that these constructs may interact or may share similar risk factors. More research is needed to clarify factors mediating the links between these conditions.

BackgroundYoung people start using the Internet in problematic ways partially because it allows them to escape real-life problems or compensate for relational deficits such as loneliness and lack of social support. So far, especially loneliness has usually been treated as a one-dimensional construct, despite its complexity. Moreover, considering various combinations of relational deficits can offer a more comprehensive understanding of human behavior.Participants and procedureParticipants (N = 2210, aged 18-25, Mage = 20.55 ± 2.12 years) completed questionnaires on loneliness types, social support sources, generalized and specific forms (social media, online games, online pornography) of problematic Internet use, and Big Five personality traits. We performed a latent profile analysis to distinguish groups of Internet users with specific com-binations of loneliness types and social support sources. Next, differences between these groups in forms of problematic Internet use were examined, controlling for gender and personality traits.ResultsFive profiles were identified: (1) family lonely, (2) lonely in every aspect, (3) supported in every aspect, (4) romantic lonely, and (5) social lonely. Lonely in every aspect exhibited the most problematic Internet, online game, and online pornography use. In contrast, supported in every aspect had the lowest levels of problematic Internet, online game, and online pornogra-phy use. Other profiles obtained intermediate scores, but there were specific differences depending on the form of problem-atic Internet use. Distinguished groups did not differ in terms of problematic social media use.ConclusionsIndividuals lacking satisfying interpersonal relations are particularly susceptible to using the Internet and its applications in problematic ways.

Background Mental health disparity in sexual minorities is a crucial clinical and public health issue worldwide. A total of 500 homosexual or bisexual men aged between 20 and 25 years participated in this study. Objectives The aims of the study were to examine the relationships of victimization of traditional and cyber homophobic bullying during childhood and adolescence with problematic internet and smartphone use and activities during early adulthood among sexual minority men in Taiwan. Methods The seveirities of problematic internet and smartphone use and activities in early adulthood were compared between victims and non-victims of bullying. The severities of problematic internet and smartphone use were also compared among the groups of various types of bullying as well as among the groups of various persistence durations of being bullied. Results Victims of traditional and cyber homophobic bullying had more severe problematic internet and smartphone use than non-victims. Victims of multi-type bullying had more severe problematic internet use than victims of single-type bullying. Prolonged victimization was significantly associated with problematic internet and smartphone use. Discussion: Victimization of traditional and cyber homophobic bullying during childhood and adolescence predicts problematic internet and smartphone use during early adulthood among sexual minority men.

ObjectiveNon-suicidal self-injury (NSSI) constitutes an important public health concern. Here, we systematically reviewed and synthesized existing literature to provide an up-to-date overview of associations between NSSI, problem gambling, problem gaming, and problematic internet use (PIU).MethodsWe searched four databases through April 2025: Web of Science, Scopus, PubMed, and PsycINFO. The Joanna Briggs Institute's tool was used to assess the quality of studies. Empirical studies utilizing quantitative or qualitative methods or case studies that presented evidence on the relationships between NSSI and frequent or problematic gambling, internet use, and gaming were included.ResultsForty studies published between 2009 and 2025 were reviewed. Four investigated the relationship between NSSI and problem gambling, seven focused on problem gaming, and twenty-nine examined PIU. Cross-sectional designs and surveys were common. Findings suggest that at-risk or problem gambling was associated with NSSI in adolescents, college students, and adults. An association between PIU and NSSI appeared moderated by social support, with impulsivity representing a shared factor. Similarly, internet gaming disorder and its severity were linked to NSSI, with anxiety acting both as a mediator and moderator. Limitations entailed self-reported measures, limited generalizability, poor ability to establish causal relationships due to cross-sectional designs, and frequent use of single unvalidated questions to assess NSSI.ConclusionThe review provides a comprehensive overview and suggests complex relationships between NSSI and problem gambling, problem gaming, and PIU. Clinicians and future studies should focus on co-occurring disorders and identify risk factors, predictors, and moderators that influence these relationships.

IntroductionPIU has not yet been recognized by diagnostic classification systems, but it has received increasing research and clinical attention. It is defined as a generalized and compulsive use of the Internet associated with a loss of control and negative consequences for the individualObjectivesThe main goal was to analyze the relation between problematic Internet Use and wellbeing in adolescentsMethodsThe sample included a total of 1059 adolescents (47% were males). Age range was between 14 and 18 years old (M = 15,12; SD = 1,03). We used the Compulsive Internet Use Scale to assess Problematic Internet Use and the Strengths and Difficulties Questionnaire to screen for psychological difficulties and prosocial behaviour.ResultsThe results found in the ANOVA revealed that problematic internet use was statistically significant associated with psychological difficulties and prosocial capabilities (λ = 0.475, F(3,83,000) = 25.569, P ≤ 0.001, η² = 0.215).Adolescents with higher levels of Problematic Internet Use revealed more emotional and behavioural difficulties. In addition. those adolescents with higher levels of prosocial ablities were at a lower risk for Problematic Internet Use.ConclusionsPrevious research have revealed that the use of Internet has almost doubled in the last decade among adolescents across different European countries. Results revealed statistically significant correlations between Problematic Internet Use and indicators of well-being such as emotional difficulties and behavioral problems, as well as prosocial behaviours. Prevention strategies should focus on detecting problematic internet use among adolescents, as it is a variable related with different psychological difficulties that are diminishing adolescents’ well-being.DisclosureNo significant relationships.

The Study of Computer Technology and Information Systems Students’ Problematic Internet Use Levels and Predictiveness with the Regard to Various Variables

Problematic Internet Use: A Longitudinal Study Evaluating Prevalence and Predictors

Problematic Internet and smartphone use is associated with serious mental health problems. We thus investigated the effectiveness of psychological interventions on problematic Internet and smartphone use. We conducted a systematic review and meta-analysis and searched in PubMed, PsyArticles, PsycInfo, Medline and Google Scholar for peer-reviewed experimental and quasi-experimental research published between 2008 and 2021. A total of 10 studies accompanied by 14 effect sizes were included in the meta-analyses for problematic Internet use and 3 studies accompanied by 4 effect sizes for problematic smartphone use. The total sample size was n = 1439 with a mean age of 20.34 (SD = 6.63) years. Psychological interventions were effective for both problematic Internet use (g = -1.41, 95% confidence interval = [-1.90, -0.91], p < 0.001) and problematic smartphone use (g = -0.40, 95% confidence interval = [-0.79, -0.01], p < 0.001). Current evidence indicates that psychological interventions can be effective in reducing problematic Internet use/problematic smartphone use. However, the results must be considered preliminary due to the limited number of studies available in the respective fields.

HighlightsPublic health relevance—How does this work relate to a public health issue?Adolescent Problematic Internet Use (PIU) and Fear of Missing Out (FoMO) are increasingly prevalent and have been linked to adverse mental, social, and academic outcomes.This study examines how PIU and FoMO interact during adolescence, a critical development period marked by heightened vulnerability to digital overuse.Public health significance—Why is this work of significance to public health?Findings highlight that the relationship between PIU and FoMO is not uniform, but varies by gender.By identifying different patterns of risk, this work advances understanding of how maladaptive digital behaviors manifest across subgroups of adolescents.Public health implications—What are the key implications or messages for practitioners, policy makers and/or researchers in public health?Prevention and intervention efforts may benefit from being tailored to both gender and level of PIU severity, rather than adopting a one-size-fits-all approach.(1) Background: Previous studies have shown that increased Problematic Internet Use (PIU) is associated with higher Fear of Missing Out (FoMO). However, the role of gender in this association remains unclear. Evidence suggests that males and females may experience PIU and FoMO differently, warranting further examination of gender differences. (2) Methods: In this cross-sectional study, a total of 4370 U.S. adolescents aged 12–17 years (47% female) were recruited through Qualtrics research panels and completed a national online survey on adolescent health and technology. Demographic information collected included age, race, and gender. PIU was measured using the validated three-item Problematic and Risky Internet Use Screening Scale (PRIUSS-3), while FoMO was measured using a validated 10-item FoMO scale. Multiple linear regression analysis examined the relationship between PIU and FoMO, including an interaction term between PIU and gender to assess the potential gender moderation effect while adjusting for age and race. (3) Results: Gender significantly moderated the relationship between PIU and FoMO, indicating that males experience a stronger association between PIU and FoMO compared to females. While higher PIU scores were significantly associated with higher FoMO for both males and females, each unit increase in PIU corresponded to a 0.15 point increase in FoMO for females (SE = 0.01, p < 0.01), and an additional 0.03 point increase for males (SE = 0.01, p < 0.01). (4) Conclusion: These findings illustrate the complex relationship between PIU and FoMO, highlighting the importance of gender-specific strategies and targeted interventions for promoting healthy Internet use.