Abstract
Problematic Usage of the Internet (PUI) has been linked to diverse structural gray matter changes in individual data studies. However, no quantitative synthesis across studies has been conducted. We aimed to identify gray matter regions showing significant spatial convergence across neuroimaging studies in PUI. We searched PubMed and PsycINFO up to 10/03/2021 and included original, cross-sectional comparative studies that examined structural gray matter imaging in PUI versus control groups; reported a whole-brain analysis; and provided peak coordinates for gray matter differences. From a total of 624 potentially relevant studies, 15 (including 355 individuals with PUI and 363 controls) were included in a meta-analysis of voxel-based morphometry studies. Anatomical likelihood estimation (ALE) meta-analysis was performed using extracted coordinates and identified significant spatial convergence in the medial/superior frontal gyri, the left anterior cingulate cortex/cingulate gyrus, and the left middle frontal/precentral gyri. Datasets contributing to these findings all indicated reduced gray matter in cases compared to controls. In conclusion, voxel-based morphometric studies indicate replicable gray matter reductions in the dorsolateral prefrontal cortex and anterior cingulate cortex in PUI, regions implicated in reward processing and top-down inhibitory control. Further studies are required to understand the nature of gray matter differences across PUI behaviors, as well as the contribution of particular mental health disorders, and the influence of variation in study and sample characteristics.
Highlights
The Internet plays a useful role in many areas of life, a subset of Internet users develops Problematic Usage of the Internet (PUI), characterized by loss of control and adverse consequences, such as feelings of distress and functional impairment in daily life [1]
From a total of 624 studies considered, 15 were identified for the main analysis focusing on voxel-based morphometry (VBM)
Included studies: (1) were original, cross-sectional comparative studies that used structural gray matter imaging in a PUI population versus a control group, in which PUI was confirmed using a psychiatric interview or a validated questionnaire; (2) reported a whole-brain analysis; and (3) reported peak coordinates for gray matter differences between the PUI and control groups
Summary
The Internet plays a useful role in many areas of life, a subset of Internet users develops Problematic Usage of the Internet (PUI), characterized by loss of control and adverse consequences, such as feelings of distress and functional impairment in daily life [1]. PUI is a broad term that refers to a range of excessive online activities, including general surfing, gaming, gambling, buying/shopping, pornography use, and social networking [2, 3]. Other examples of problematic Internet-related behaviors, such as social networking [10], are not currently included in classification systems. Despite the heterogeneity of PUI, a meta-analysis of cognitive deficits in PUI found that, irrespective of whether gaming was the predominant type of online behavior, PUI was characterized by pronounced impairment on cognitive domains which are known to be related to the fronto-striatal brain circuitry with small-medium effect sizes [12]. Further research is needed to understand the similarities and differences between different forms of PUI and between PUI and other mental disorders [3]
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