Understanding Problematic Gaming During the Covid-19 Pandemic in Adolescents and Adults: A Systematic Review of the Literature.

Objective: A growing body of evidence suggests that online gaming increased during the COVID-19 outbreak. This systematic review aims to summarize extant literature that reported on problematic gaming among both adolescents and adults during the pandemic and to identify available research on the bidirectional association between problematic gaming and mental health outcomes. Method: A systematic search was carried out through PubMed, Web of Knowledge and AGRIS, Embase, Medline, PsychINFO (from January 2020 to January 2023), using keywords related to problematic gaming and mental health outcomes. Both cross-sectional and longitudinal empirical studies which used validated measures of problematic gaming and mental health outcomes during the COVID-19 pandemic were included. Results: Twenty-five empirical articles were eligible for the current review, comprising 28,978 participants. The majority of the selected studies had cross-sectional designs. Overall, most eligible studies showed significant association between problematic gaming and negative mental health outcomes during the pandemic. Correlations were mostly found between problematic gaming, depression and anxiety. Conclusions: Future research focusing on the relationship between problematic gaming and mental health outcomes should go beyond the considerable weaknesses due to methodological limitations of cross-sectional design, sampling and measures.

Psychosocial predictors of trajectories of mental health distress during the COVID-19 pandemic: A four-wave panel study.

Previous research suggested that during the COVID-19 pandemic, mental distress did not affect all people equally. This longitudinal study aims to examine joint trajectories of depressive, anxiety, and stress symptoms in a sample of Italian adults during the pandemic, and to identify psychosocial predictors of distress states. We analyzed four-wave panel data from 3,931 adults who had received assessments of depressive, anxiety and stress symptoms between April 2020 and May 2021. Trajectories of individual psychological distress were identified by Latent Class Growth Analysis (LCGA) with parallel processes, and multinomial regression models were conducted to identify baseline predictors. Parallel process LCGA identified three joint trajectory classes for depression, anxiety and stress symptoms. Most individuals (54%) showed a resilient trajectory. However, two subgroups showed vulnerable joint trajectories for depression, anxiety and stress. Expressive suppression, intolerance to uncertainty, and fear of COVID-19 were risk characteristics associated with vulnerable trajectories for mental health distress. Moreover, vulnerability to mental health distress was higher in females, younger age groups and those unemployed during the first lockdown. Findings support the fact that group heterogeneity could be detected in the trajectories of mental health distress during the pandemic and it may help to identify subgroups at risk of worsening states.

Sexual Satisfaction and Quality of Life in Cardiovascular Patients: The Mediating Role of Anxiety.

BACKGROUND: Cardiovascular diseases represent one of the most important problems for public health. Research indicates that elderly patients consider sexual satisfaction as a fundamental aspect of their quality of life and a better sexual function is related to higher general wellbeing. OBJECTIVE: The main objective of this study was to investigate the mediating role of anxiety and depression in the relationship between quality of life and sexual satisfaction in cardiovascular (CVD) patients. METHODS: The sample comprised 128 adult patients, males and females, hospitalized in a Cardiology Rehabilitation clinical center. To collect data, the following were used: a demographic information sheet, the left ventricular ejection fraction (EF) to evaluate cardiac function, cardiovascular diagnosis type, the HADS scale to evaluate anxiety and depression states, a test for sexual satisfaction evaluation (SAS) and the SF-36 survey to measure quality of life. RESULTS: The results indicated that only SF-36 physical health is indirectly related to SAS through its relationship with anxiety. CONCLUSION: A mediating model was proposed to explore the underlying association between sexual satisfaction and quality of life. We recommend investigating perceived general health and sexuality as clinical indicators for therapeutic decisions and risk evaluation for the management of cardiovascular diseases.

A three-wave panel study on longitudinal relations between problematic social media use and psychological distress during the COVID-19 pandemic.

BACKGROUND: It still remains unclear whether problematic social media use (PSMU) is a cause or a consequence of psychological distress. The present study aimed to investigate the temporal relationships between PSMU and psychological distress through a three-wave panel study (between April and July 2020, with an interval of 1 month between each period of time). METHODS: 3,912 adult Italian participants were surveyed during the COVID-19 pandemic for psychological distress (Depression, Anxiety and Stress Scale) and PSMU (Bergen Social Media Addiction Scale). Random-Intercept Cross-Lagged Panel Models were applied to disaggregate between-person from within-person associations as regards PSMU and an individual's distress. RESULTS: On a between-person level we found that adults with higher PSMU also reported heightened levels of psychological distress across the three waves. However, on a within-person level, no cross-lagged associations were found between changes in distress and subsequent changes in PSMU and vice versa. The results were largely unchanged with the inclusion of participants' gender and age or COVID-19-related fears as covariates, and when the three subscales of depression, anxiety and stress were examined in separate models. CONCLUSIONS: The current study suggests that the link between PSMU and psychological distress is mainly driven by trait-like differences and not by state-like individual changes over time.

The Thin Ideal and Attitudes towards Appearance as Correlates of Exercise Addiction among Sporty People during the COVID-19 Pandemic.

The stress and anxiety caused by the coronavirus pandemic (COVID-19) have exacerbated body image concerns. A society that perpetuates the attempt for a perfect and thin appearance represents a fertile ground for the development of exercise addiction (EA). This cross-sectional study aims to explore EA during the second wave of the pandemic (October−December 2020) and to examine the independent influence of both time spent on moderate and vigorous physical activities and body image variables (i.e., drive for leanness and sociocultural attitudes toward appearance) on EA. A sample of Italian sporty people (N = 194; 48.5% females; Mage = 25.91 ± 6.32) was surveyed using the Exercise Addiction Inventory, the Drive for Leanness Scale, the Sociocultural Attitudes Towards Appearance Questionnaire, and the Global Physical Activity Questionnaire. A total of 82% of the sample were symptomatic of and 11.3% were at risk of EA. Hierarchical regressions revealed an association between the time spent on vigorous physical activities and levels of EA (p < 0.05). Moreover, body image variables were positively related to EA, explaining an additional 11% of variance (p < 0.05). Results showed the importance of considering and addressing body image factors to investigate and dampen the risk of EA among sporty people.

The role of emotion regulation and intolerance to uncertainty on the relationship between fear of COVID-19 and distress.

The COVID-19 pandemic is increasing negative consequences on mental health around the globe. To date, research on what psychological factors could influence individuals' distress is still scarce. The current study aims to test a multiple mediation model to examine the role of Intolerance of Uncertainty (IU) and emotional regulation (i.e., expressive suppression and cognitive reappraisal) as joint factors, which can increase understanding of psychological distress due to the COVID-19 outbreak. An online survey measuring fear of COVID-19, IU, emotional regulation, and psychological distress was administered to 3863 Italian adults (females 73.3%; M age = 36.44; SD = 14.74) during lockdown. Results showed that IU partially mediated the effect of fear of COVID-19 on depression, anxiety and stress. Moreover, individuals with difficulties in managing the uncertainties due to their fear of COVID-19 may be at risk for heightened use of expressive suppression and depression. However, individuals with both higher IU and expressive suppression showed lower level of stress. High cognitive reappraisal has a mediational effect on the relationship between fear of COVID-19, IU, and lower psychological distress. Findings suggest that IU and emotional regulation should be targeted for informing the development of tailored treatments to reduce the negative consequences of the outbreak. Supplementary Information: The online version contains supplementary material available at 10.1007/s12144-022-03071-5.

Online Gaming and Prolonged Self-Isolation: Evidence from Italian Gamers During the Covid-19 Outbreak.

OBJECTIVE: The self-isolation measures employed during the COVID-19 pandemic made it dificult for basic needs to be met, thus increasing emotional distress. It has been suggested that socially meaningful online gaming bufered emotional distress during the lockdown. This study aimed to test the protective effect of online gaming during the lockdown and to investigate the diferences between highly involved gamers (those who play videogames intensely without adverse consequences) and problematic gamers in this regard. METHOD: Capitalizing on a data collection that started before the pandemic, we adopted a cross-sectional between-groups study design in which gaming patterns, gaming-related variables and levels of emotional distress were compared between a pre-COVID group (N=298) and a COVID group (N=366). RESULTS: Compared to the pre-COVID group, high involvement in gaming was more prominent and emotional distress was decreased in the COVID group. Moderated regression analyses further revealed that the interaction between social compensation via gaming and highly involved gaming was associated with lower levels of emotional distress in the COVID-19 group. In contrast, the interaction between gaming-related relaxation and problematic gaming predicted higher emotional distress in the COVID-19 group. CONCLUSIONS: This study suggests that gaming for social compensation might mitigate the experienced emotional distress during pandemic related self-isolation, whereas maladaptive gaming patterns could constitute a vulnerability factor deserving clinical attention.

Factors Related to Women's Psychological Distress during the COVID-19 Pandemic: Evidence from a Two-Wave Longitudinal Study.

BACKGROUND: A growing body of research has highlighted the negative effects of the COVID-19 pandemic on women's mental health. Previous studies showed that women have higher levels of depression, anxiety and PTSD, and worse psychological adjustment than men, which also persisted after the earlier phase of the pandemic. This study aimed to evaluate changes in women's psychological distress during the pandemic and to evaluate the factors that have a more significant impact in predicting women's psychological distress. METHODS: This two-wave longitudinal study (T1 = Italian first lockdown, and T2 = second phase, when the restrictive measures were eased) involved 893 women (Mage = 36.45, SD = 14.48). Participants provided demographic and health data as well as measures of psychological distress, emotion regulation processes, and ability to tolerate uncertainty. RESULTS: No significant changes were found in women's psychological distress between T1 and T2, i.e., during and after the first lockdown. Lower social stability status and higher maladaptive emotional coping predicted high psychological distress. CONCLUSIONS: Results showed that modifiable psychological variables play a central role in predicting distress and indicated that emotion regulation interventions might be helpful in increasing psychological resilience and mitigating the adverse impacts of the COVID-19 pandemic within the female population.

Psychological distress associated with the COVID-19 lockdown: A two-wave network analysis.

BACKGROUND: Although preliminary research has evidenced negative psychological consequences of the COVID-19 pandemic among the general population, little research has been carried out examining the interplay among the broader dimensions and correlates of individual distress. Via network analysis, the current study investigated the pathways that underlie some components of psychological distress and their changes over time (during and post COVID-19-related lockdown). METHODS: 1,129 adult participants (79.1% women) completed a two-wave online survey during and after the lockdown, and reported on variables such as depression, anxiety, stress, fear of COVID, intolerance of uncertainty, emotion regulation and social support. The networks were estimated via Gaussian Graphical Models and their temporal changes were compared through the centrality measures. RESULTS: Depression, stress, anxiety and fear of COVID formed a spatially contiguous pattern, which remained unchanged in both the two waves. After the lockdown, the fear of COVID node reduced its strength in the network, whereas inhibitory intolerance of uncertainty and emotion suppression were associated with depression. Emotion regulation was connected to depression, but not to stress and anxiety during both waves. Perceived emotional support had few connections to the other nodes. LIMITATIONS: Only 32.7% of participants provided complete responses for both waves. CONCLUSION: The COVID-19 outbreak has had a significant psychosocial impact on adults. In the context of the network approach, depressive symptoms had the highest strength and their associations to other dimensions of individual distress may be key factors in understanding the influence of exposure to the COVID-19 outbreak on mental health.

Group as a social microcosm: The reciprocal relationship between intersession intimate behaviors and in-session intimate behaviors.

The social microcosm is defined as group members replicating their everyday (intersession) interpersonal behaviors in group sessions and new behaviors, learned in the group (in-session), replicating in the members' everyday life. We examined intersession and in-session intimate behaviors, at the within-member (differences in intimate behaviors between weeks/sessions), between-member (average differences in intimate behaviors between group members) and between-groups (group-level differences in intimate behaviors). Participants were 178 graduate students (86% identifying as women and 14% as men) participating in 10 5-session growth groups led by experienced group therapists. Before group sessions, group members completed the Interpersonal Relations Scale Checklist (IRScl; Shadish, 1984) indicating their number of intersession intimate behaviors for the previous week and, at the end of group sessions, they filled in the IRScl to indicate their in-session intimate behaviors. A 3-level HLM analysis (sessions, members, groups) predicting in-session intimate behaviors from previous week intersession intimate behaviors showed significant within-member, between-member, and between-groups effects. A second 3-level HLM analysis (sessions, members, groups), predicting following week intersession intimate behaviors from in-session intimate behaviors, showed significant between-member and between-groups effects. Between-member and within-member in-session intimate behaviors interacted to predict intersession intimate behaviors. Group members who generally had a low number of in-session intimate behaviors engaged in more intersession intimate behaviors in weeks following sessions with higher than average in-session intimate behaviors. These results provide support for the social microcosm proposition that members' trait-like everyday behaviors are replayed in the group. However state-like and other-member everyday behaviors also contribute to members' social microcosm. (PsycInfo Database Record (c) 2021 APA, all rights reserved).

Italian adaptation of the Group Questionnaire: validity and factorial structure.

The Group Questionnaire (GQ) is a measure recently developed by Krogel et al. (2013) for the evaluation of the therapeutic relationship in group. The GQ identifies a three-factor model of the relationship that allows to measure quality (Positive Bonding, Positive Working and Negative Relationship) and structure (member-member, member-leader and member-group), dimensions in group. This work shows the results of a first study on the Italian validation of the GQ. In this study the GQ was administered to 536 subjects from 32 non-clinical groups of undergraduate students. The cross-cultural validity of the GQ in the Italian population has been examined by comparing the psychometric properties and equivalence in factor structure and scores of the Italian GQ with the original American version. Multilevel confirmatory factor analysis was used to examine both the between- and within-group structures. Data concerning reliability and validity of GQ and the results for different SEM in Multilevel CFA confirm the three factors structure of the GQ. Data from the Italian population have a good fit with the original proposed model. Finally, we discuss the importance of an instrument like GQ, short but consistent, for the evaluation of the therapeutic relationship in clinical and training group.

Examining bi-directionality between Fear of Missing Out and problematic smartphone use. A two-wave panel study among adolescents.

BACKGROUND: In recent years, the Fear of Missing Out (FoMO) construct has been the object of growing attention in digital technology research with previous studies finding support for the relationship between FoMO and problematic smartphone use (PSU) among adolescents and young adults. However, no previous studies clarified the causal link between FoMO and PSU using a longitudinal design. METHODS: An auto-regressive, cross-lagged panel design was tested by using a longitudinal dataset with two waves of data collection (T0 and T1, one year apart). Participants included two hundred and forty-two adolescents (109 males and 133 females), with a mean age of 14.16 years, who filled out the Fear of Missing Out scale (FoMOs) and the Smartphone Addiction Scale (SAS). Moreover, participants filled out the Difficulties in Emotion Regulation Scale (DERS), at the first time-point of data collection. RESULTS: The findings of the study show that FoMO (both FoMO-Fear and FoMO-Control subscales) and PSU are positively related at both time-points (i.e. at a cross-sectional level). However no cross-lagged associations between them were longitudinally supported. Females and older adolescents show higher FoMO-Fear at T1. CONCLUSIONS: The findings of the present study suggest caution when causal links between FoMO and PSU are inferred.

Relationship between device acceptance and patient-reported outcomes in Left Ventricular Assist Device (LVAD) recipients.

The number of Left Ventricular Assist Devices (LVADs) implanted each year is rising. Nevertheless, there are minimal data on device acceptance after LVAD implant, and on its relationship with patient-reported outcomes. We designed a cross-sectional study to address this knowledge gap and test the hypothesis that low device acceptance is associated with poorer quality of life, depression and anxiety. Self-report questionnaires were administered to assess quality of life (12-item Kansas City Cardiomyopathy Questionnaire quality of life subscale), level of anxiety (7-item Generalized Anxiety Disorder; GAD-7), level of depression (9-item Patient Health Questionnaire; PHQ-9) and device acceptance (Florida Patient Acceptance Survey; FPAS) to 101 consecutive patients presenting to LVAD clinic. Regression analysis showed a strong correlation between device acceptance and both psychological distress (p < 0.001) and quality of life (p < 0.001). Analysis of the sub-scales of the FPAS showed that patients had significant body image concerns, but return to function and device-related distress were the main drivers of the observed correlation between device acceptance and patient well-being. Younger age was associated with lower device acceptance (r = 0.36, p < 0.001) and lower quality of life (r = 0.54, p < 0.001). These findings suggest that interventions targeting device acceptance should be explored to improve outcomes in LVAD recipients.

Magic Mirror on the Wall: Selfie-Related Behavior as Mediator of the Relationship Between Narcissism and Problematic Smartphone Use.

OBJECTIVE: Recent research has suggested that problematic smartphone use is associated with several psychological factors and that mobile apps and smartphone-related behavior (i.e. selfie behavior) may encourage the development of problematic smartphone use. However, little is known about how the interplay between dysfunctional personality characteristics and selfie-related behavior can influence problematic smartphone use. The aim of this study was to examine the relationship between narcissism and problematic smartphone use, as well as the mediating role of selfie-related behavior in this relationship among young men and women. METHOD: In the current study, a total of 627 undergraduate students (283 males and 344 females) completed a cross-sectional survey. A structural equation model was tested separately for males and females in order to evaluate the associations between narcissism, selfie-related behavior and problematic smartphone use. RESULTS: The results showed that greater narcissism was related to increased selfie-related behavior, which in turn were positively associated with problematic smartphone use both for males and females. However, selfie-related behavior mediated the relationship between narcissism and problematic smartphone use only for females. CONCLUSIONS: The study provides fresh insight into our understanding of the psychological mechanisms underlying problematic smartphone use, which may inform prevention and treatment interventions.

Self-image and psychological distress in treatment-seeking adolescents.

BACKGROUND: Adolescence has been recognized as a critical period for mental health during which it is fundamental to the well-being of adolescents to provide early and appropriate mental health interventions. Self-image perceptions play a particularly relevant role during adolescence since individuals are extensively involved in reorganizing their identity and relationships. Although the self-image development implies adaptive outcomes for most adolescents, some age-related tasks can be difficult to deal with and lead to psychological suffering for a minority of them. METHOD: This study examined how domain-specific self-image was associated with psychological distress in 128 treatment-seeking adolescents aged 13-18 (60.9% female). The adolescents completed the Offer Self-Image Questionnaire to measure their global and domain-specific self-image and the Youth-Outcome Questionnaire to assess their psychological distress. RESULTS: Regression analyses indicated that impulse control, emotional tone, family, and social functioning significantly predict worse psychological functioning in the entire group. Moreover, significant gender differences emerged showing a more complex set of risk factors among adolescent females, thus suggesting the need for gender-targeted preventive and treatment strategies. CONCLUSIONS: The findings highlight that adolescents' feelings and concerns about their self-image may be key factors to consider in planning, developing, and delivering effective public mental health services for adolescents.

Mediating Effects of Global Negative Effect Expectancies on the Association between Problematic Cannabis Use and Social Anxiety.

The relationship between social anxiety (SA) and cannabis use among adolescents and young adults is a highly debated topic. In this cross-sectional study, we tested whether cannabis use expectancies mediated the association between SA and cannabis use severity in a sample of 343 young adults (74.3% male) who used cannabis. They completed self-report measures for the screening of problematic cannabis use (Cannabis Use Problems Identification Test) and SA symptoms (Social Interaction Anxiety Scale and Social Phobia Scale). A multiple mediation analysis was used to test whether marijuana effect expectancies mediate SA effect on problematic cannabis use. SA was negatively associated with cannabis use severity in this sample, and we found evidence that cannabis use expectancies fully mediated this relationship. Specifically, global negative effect expectancies influence the relationship between SA and problematic cannabis use. These findings may inform current prevention strategies and clinical intervention for young adults who use cannabis.

Promoting Awareness about Psychological Consequences of Living in a Community Oppressed by the Mafia: A Group-Analytic Intervention.

The effects of the Mafia have been extensively studied from sociological, economic, and historical points of view. However, little research has investigated the influence of the Mafia on individuals and communities in terms of its psychological and social impact. In order to contribute to the advancement of our understanding of the psychological effects of the Mafia on individuals and communities and to promote a participative process of social change, a group analytic intervention was conducted within a Community Based Participatory Research carried out in Corleone, a small Sicilian town with a historically recognized role in the evolution of the Mafia, as well as in the fight against its control. Qualitative findings from the group intervention revealed the development of an awareness process that allowed participants to become aware of their social unconscious anxieties and defenses and to recognize and manage the strong emotional impact related to the Mafia's presence in their lives. Highlighting how psychological processes can have negative impacts on individual and collective capacity to pursuit transformation and resilience, this article provides important insight on how clinical psychology may operate in socio-cultural contexts to promote the reconstruction of the traumatic social dimensions in the community.

The Influence of Retention, Turnover, and Alliance on Process and Outcomes in Rolling Group Psychotherapy for Cocaine Disorder.

A longitudinal repeated measures design was used to investigate the influence of treatment retention, and membership turnover on individual outcomes, and the relationship between individual-level and group-level therapeutic alliance in rolling group psychotherapy for individuals with cocaine abuse disorder. Eighteen patients were studied; data were collected prior to therapy and then monthly for 24 months. Patient outcomes and process were assessed. Improvements in symptoms and psychological functioning were associated with retention in psychotherapy. Membership turnover had a negative influence on symptoms. Development of an individual alliance was affected by the development of group-level therapeutic alliance, but not by time spent in therapy.

Group Psychotherapy in Italy.

This article describes the history and the prevailing orientations of group psychotherapy in Italy (psychoanalytically oriented, psychodrama, CBT groups) and particularly group analysis. Provided free of charge by the Italian health system, group psychotherapy is growing, but its expansion is patchy. The main pathways of Italian training in the different group psychotherapy orientations are also presented. Clinical-theoretical elaboration on self development, psychopathology related to group experiences, and the methodological attention paid to objectives and methods in different clinical groups are issues related to group therapy in Italy. Difficulties in the relationship between research and clinical practice are discussed, as well as the empirical research network that tries to bridge the gap between research and clinical work in group psychotherapy. The economic crisis in Italy has led to massive cuts in health care and to an increasing demand for some forms of psychological treatment. For these reasons, and because of its positive cost-benefit ratio, group psychotherapy is now considered an important tool in the national health care system to expand the clinical response to different forms of psychological distress.

The relationship between self-Image and social anxiety in adolescence.

BACKGROUND: Self-image is the subjective perception about one's own self, body, mental functioning, social attitudes, and adjustment in different aspects of life. Research has linked negative self-image with a number of problem behaviors and psychiatric symptoms in adolescence; however, studies of the relationship between self-image and anxiety disorders are still scarce. METHOD: This study involved a community sample of 1305 high-school students (51.4% female) who ranged in age from 14 to 19 years old. They completed self-report measures of self-image and social anxiety disorder (SAD). RESULTS: A quarter of the students reported high levels of social anxiety. Statistical analyses showed significant differences between these students and the other students in all the self-image subscales. Several dimensions of impaired self-image (emotional tone, social attitudes, vocational and educational goals, family relationships, external mastery, and psychological health) were associated with high levels of social anxiety, with some gender differences underpinning these relationships. CONCLUSIONS: Clinicians treating SAD in youth may wish to consider that a negative self-image may play a critical role in the onset and retention of social anxiety symptoms.