Altered Resting-State Network in Adolescents with Problematic Internet Use.

Problematic internet use (PIU) is increasingly recognized as a mental health concern, particularly among adolescents. The resting-state functional connectivity (rsFC) of the triple-network model has been described inconsistently in PIU. Using resting-state fMRI (rsFMRI) and hypothesizing a lower rsFC between default mode (DMN) and central executive networks (CEN) but a higher rsFC within the salience network (SN), this study scrutinized the neural substrates of PIU adolescents. A total of 30 adolescents with PIU and 30 control subjects underwent rsFMRI. The severity of PIU was evaluated by the Internet Addiction Test. Additionally, personality traits as well as emotional and behavioral problems were evaluated by the Temperament and Character Inventory (TCI) and the Strength and Difficulties Questionnaire (SDQ), respectively. Focusing on the DMN, SN, and CEN, we compared rsFC values between PIU and the control. Subsequently, within the combined group of subjects, TCI and SDQ correlation and mediation effects were investigated. Higher rsFC values of the left lateral prefrontal cortex (LPFC(L)) with the left anterior insula (aIns(L)) were observed for PIU than for the control, while rsFCs of the LPFC(L) with the medial PFC (MPFC), LPFC(L), as well as with the right lateral parietal cortex (LP(R)) were lower for PIU. Among these significant group differences, the rsFC between the LPFC(L) and MPFC was mediated by emotional symptoms (standardized ß = -0.12, 95% CI -0.29, -0.0052). The dysfunctional attention switching and incentive salience regulated by the SN were implicated as being a neural correlate of PIU, and this relationship would in part be explained by the emotional dysregulation associated with PIU in adolescents.

The Effect of Cyberbullying, Abuse, and Screen Time on Non-suicidal Self-Injury Among Adolescents During the Pandemic: A Perspective From the Mediating Role of Stress.

Adolescence is often a period of turmoil. The COVID-19 pandemic has increased adolescents' difficulty due to mental health consequences that may affect their developmental milestones. This study constructed and empirically tested a theoretical model of three predictive factors (cyberbullying, abuse, and screen time) and stress as the mediating factor in adolescent non-suicidal self-injury (NSSI). Structural equation model (SEM) analysis was applied to investigate stress as a mediating factor in the relationship between adolescent NSSI and cyberbullying, abuse, and screen time. This cross-sectional study used a "crowdsourcing" sample collection method to recruit 464 adolescents aged 11-17 years who were administered a questionnaire comprising scales on cyberbullying, abuse, screen time, stress, and NSSI. All scales had construct reliabilities ranging from 0.759 to 0.958. SEM statistical analysis was performed using Lisrel version 8.8 (Scientific Software International, USA) for Windows (Microsoft Corporation, Redmond, WA, USA). The mean (± SD) age of the cohort was 14.61 ± 1.65 years, and consisted of 66.7% females. Secondary high school was the highest educational background (58%). The study found that cyberbullying and abuse were direct positive predictors (critical t-value for the path > 1.96; p < 0.05) of adolescent NSSI; however, screen time did not have any direct relationship. Furthermore, stress was a significant full mediating factor of screen time and a partial mediating factor of cyberbullying and abuse in the relationship with adolescent NSSI (critical t-value of the path = 5.27; p < 0.05). Cyberbullying, screen time, and abuse with the mediating effect of stress could explain 48% of the variance in adolescent NSSI (R 2 = 0.48). Adolescent mental health prevention and promotion programs need to be redesigned during the current COVID-19 pandemic to manage their stress and minimize the mental health consequences of cyberbullying, abuse, and inappropriately increased screen time.

Insights Into Adolescents' Substance Use in a Low-Middle-Income Country During the COVID-19 Pandemic.

Introduction: The COVID-19 pandemic and its lockdown have been a significant life event for many individuals, particularly adolescents. The immense psychological pressure could drive risky behavior, e.g., substance use, while lockdown might lead to decreased use. This study aimed to observe the change in substance use among adolescents in Indonesia and the moderating variables to consumption during the COVID-19 lockdown period. Methods: This study utilized an online survey from April 28, 2020 to June 30, 2020. The hyperlink was disseminated to school administrators and parenting groups through social media and direct messages. A total of 2,932 adolescents (17.4 ± 2.24 and 78.7% females) submitted valid responses. The survey was comprised of a sociodemographic section, substance use details, and psychometric sections, including the Alcohol Use Disorders Identification Test (AUDIT), Cigarette Dependence Scale 12 (CDS-12), Pittsburgh Sleep Quality Index (PSQI), and Strength and Difficulties Questionnaire (SDQ). Results: Overall, adolescent alcohol use during the pandemic was 5.1%, cigarette smoking was 3.1%, and drug consumption was 0.4%. Over half (53.4%) of alcohol drinkers reported increased drinking, and 33.1% had harmful or dependence-like drinking behavior; in contrast, 44.4% of adolescent smokers disclosed reduced cigarette consumption. Around 37.8% of the drug users indicated increased use. During the pandemic, adolescent alcohol use was associated with higher education [adjusted odds ratio (AOR) = 2.67, 95% confidence interval (CI) 1.02-4.86, p = 0.04], higher AUDIT scores (AOR = 1.33, 95% CI 1.25-1.42, p < 0.001), and very low prosocial behavior (AOR = 2.46, 95% CI 1.52-3.88, p < 0.001). Cigarette smoking was correlated with male sex (AOR = 9.56, 95% CI 5.64-16.62, p < 0.001), age (AOR = 1.40, 95% CI 1.14-1.75, p < 0.001), and higher CDS score (AOR = 1.17, 95% CI 1.13-1.20, p < 0.001). Conclusions: Rates of adolescent substance use were significant, with sizeable proportions reporting higher usage. This appeared to occur predominantly in specific demographics and those with a lower protective psychosocial attribute, i.e., prosocial behavior, during the lockdown. These findings should urge the strengthening of adolescent addiction care during and after the pandemic.

Developing and feasibility testing of the Indonesian computer-based game prototype for children with attention deficit/hyperactivity disorder.

The aim of this study was to develop an Indonesian computer-based game prototype, including feasibility testing, targeted on attention deficit/hypersensitivity disorder (ADHD) clinical symptoms and executive function. The study comprised five steps. The first to third steps used an exploratory qualitative research design. The Delphi technique with FGD was applied to collect qualitative data. During the study, seven experts participated in ten FGDs. Feasibility testing was conducted as a one group pre- and post-test design that included ten children with drug-naïve ADHD without other mental or physical disorders. Feasibility data were collected before and after 20 training sessions with the Indonesian computer-based game prototype. The framework analysis was performed for qualitative data. Quantitative data were analyzed using the paired t-test, Pearson's correlation and Spearman's rank-order correlation. Outputs of the exploratory qualitative study were the Indonesian computer-based game prototype constructs and general agreements of the prototype,. The Indonesian computer-based game prototype construct comprised six components: reward-related processing, control inhibition, improved sustained attention, specific timing, increased arousal, and improved emotional regulation. After 20 sessions of training, several indicators decreased significantly, such as CATPRS-teacher rating (18.5 [5.31] vs. 12.9 [5.51], p = 0.047), BRIEF-GEC (64.80 [10.21] vs. 57.50 [7.51], p = 0.02), BRIEF-MI (66.1 [7.61] vs. 58.4 [7.56], p = 0.014), BRIEF-Initiate (66.6 [10.15] vs. 54.1 [6.49], p = 0.008), BRIEF-Working Memory (68.0 [6.89] vs. 60.9 [10.05], p = 0.02), and BRIEF-Organization of Material (60.7 [12.88] vs. 49.3 [11.79], p = 0.04). There was a low to moderate correlation between CATPRS-teacher and -parent rating and several BRIEF domains. Feasibility testing output also included the training procedure guideline. The present study indicated that the Indonesian computer-based game prototype could be used as a framework to develop a fixed computer-based game intervention for children with ADHD. However, further randomized controlled studies need to be conducted to show its effectiveness.

Implications of COVID-19 and Lockdown on Internet Addiction Among Adolescents: Data From a Developing Country.

Introduction: Physical distancing policy during coronavirus disease 2019 (COVID-19) pandemic requires adolescents to spend most of their time at home, thus increasing Internet use duration. Limited social interaction with their peers may lead to loneliness and an increased risk of mental health among adolescents. This study aimed to assess the prevalence of Internet addiction (IA) among adolescents and analyze the influence of psychosocial factors toward the heightened risk of IA during the COVID-19 pandemic. Methods: An online survey comprising sociodemographic questionnaire, Internet Addiction Diagnostic Questionnaire (KDAI), Strengths and Difficulties Questionnaire (SDQ), and Pittsburgh Sleep Quality Index (PSQI) was distributed. Overall, a total of 2,932 adolescents (mean age, 17.38 ± 2.24 years old; female, 78.7%), originating from 33 of 34 provinces in Indonesia, completed the survey. Results: The point prevalence of IA among Indonesian adolescents during the COVID-19 outbreak was 19.3%. Increased Internet use duration, internalization, externalization, low prosocial behavior, and sleep disturbances were found as risk factors of IA, either directly or as mediating variables. Physical distancing, large-scale social restriction (PSBB), and health status were not correlated to IA. Discussion: Physical distancing was not established as a risk of IA. This could be due to other psychological factors such as internalization, externalization, prosocial, and sleep problems that had correlations to IA occurrence among adolescents in the COVID-19 pandemic. Sleep impairment might have resulted from the emotional and behavioral issues and directly contributed to IA development. Conclusion: The present study found the prevalence of IA among Indonesian adolescents to be higher than the adult during the COVID-19 pandemic. Several psychological measures were indicated to increase the risk of IA, while physical distancing did not elevate the risk. Thus, remote schooling is preferable in Indonesia along with proper parental supervision to minimize Internet use for entertainment purposes.

Anxiety and Its Associated Factors During the Initial Phase of the COVID-19 Pandemic in Indonesia.

Introduction: Coronavirus disease 2019 (COVID-19) is caused by a novel coronavirus which has not been identified previously in humans. The disease leads to respiratory problems, systemic disorders, and death. To stop the virus transmission, physical distancing was strongly implemented, including working and school from home (WFH & SFH). The limitation altered daily routines and needs advanced to adapt. Many have felt uncomfortable and this could have triggered anxiety symptoms. This study aimed to evaluate the proportion of significant anxiety symptoms and its association with COVID-19-related situations in an Indonesian context during the initial months of the pandemic. Methods: An online community survey was distributed through social media and communication platforms, mainly WhatsApp, targeting people >18 years old in Indonesia. Anxiety symptoms were assessed using Generalized Anxiety Disorder-7 (Indonesian Version). Demographical data and information on social situation related to the COVID-19 pandemic were collected. The proportion of clinically significant anxiety symptoms was calculated and the association with demographic and social factors was assessed using chi square test (χ2) and logistic regression for multivariate analysis. Results: Out of 1215 subjects that completed the survey, 20.2% (n = 245) exhibited significant anxiety symptoms. Several factors, such as age (AOR = 0.933 CI 95% = 0.907-0.96), sex (AOR = 1.612 CI 95% = 1.097-2.369), medical workers (AOR = 0.209 CI 95% = 0.061-0.721), suspected case of COVID-19 (AOR = 1.786 CI 95% = 1.001-3.186), satisfaction level of family support (AOR = 3.052 CI 95% = 1.883-4.946), and satisfaction level of co-workers (AOR = 2.523 CI 95% = 1.395-4.562), were associated with anxiety. Conclusion: One out of five Indonesian people could have suffered from anxiety during the COVID-19 pandemic. The riskiest group being young females, people who had suspected cases of COVID-19, and those with less satisfying social support. Nevertheless, health workers were found to have a lesser risk of developing anxiety. Accessible information and healthcare, social connection, supportive environment, and mental health surveillance are important to prevent bigger psychiatric problems post-pandemic.

Internet addiction in adolescents: Development and validation of Internet Addiction Diagnostic Questionnaire (KDAI).

Internet addiction (IA) is an emerging behavioral problem that constitutes a major health threat to vulnerable populations, including adolescents. However, there is a paucity of IA screening tools specifically designed for adolescents, especially in Indonesia. Therefore, the current study developed and validated the IA Diagnostic Questionnaire (KDAI) in adolescents while acknowledging local cultural influences. The KDAI was conceived through extensive literature reviews, expert discussions based on Delphi methods, a face validity study, focus group discussion (N = 31) for initial reliability testing, and a recruited pilot study (N = 385) and main study (N = 643) for exploratory and confirmatory factor analyses, respectively. The multi-sample analyses demonstrated that the KDAI model with the best fit and reliability comprised a seven-factor structure, including withdrawal, loss of control, increase of priority, negative consequences, mood modification, salience, and impairment. These factors were scrutinized against domains of IA Test, and concurrent validity was ascertained. Subsequently, a receiver operating characteristic curve and area under the curve determined a cutoff score of 108 to discern adolescents with IA. Taken together, the KDAI displayed excellent psychometric indices and sensitivity as a screening tool for IA in adolescents.

Validation study of the Indonesian internet addiction test among adolescents.

BACKGROUND: Internet addiction is a serious problem that can negatively impact both the physical and mental health of individuals. The Internet Addiction Test (IAT) is the most common used instrument to screen internet addiction worldwide. This study sought to investigate the psychometric properties of an Indonesian version of the IAT. METHODS: The IAT questionnaire was made the focus of forward translation, expert panel discussions, back translation, an item analysis (30 subjects), a pilot study (385 subjects), and field testing (643 subjects). Factor structure was analysed by exploratory (EFA) and confirmatory factor (CFA) analyses, whereas reliability was measured with Cronbach's alpha coefficient. RESULTS: Factor analysis revealed that the Indonesian version of IAT, consisted of 3 domains, and had good validity (χ2 p < 0.001; RMSEA = 0.076; CFI = 0.95; SRMR = 0.057, and AIC = 784.63). The Cronbach's alpha score is 0.855. A significant association was also observed between the level of internet addiction with gender (p = 0.027) and the duration of internet use per day (p = 0.001). CONCLUSION: The Indonesian version of IAT provides good validity and reliability in a three-dimensional model. Therefore, it can be utilised as a tool for screening internet addiction in the Indonesian population.

Alcohol- and Cigarette-Use Related Behaviors During Quarantine and Physical Distancing Amid COVID-19 in Indonesia.

Background: In light of the coronavirus disease 2019 (COVID-19) pandemic, Indonesia implemented large-scale social restrictions (pembatasan sosial berskala besar/PSBB) to combat the spread of COVID-19, which might influence addictive behaviors. The current study aimed to explore the fluctuation of substance use during the pandemic and association of physical distancing and related factors toward consumption of alcohol and cigarettes. Method: An online survey was conducted from April 28 to June 1, 2020. Data regarding sociodemographic information, physical distancing profile, alcohol and cigarette usages, Alcohol Use Disorders Identification Test (AUDIT), Cigarette Dependence Scale (CDS), Symptom Checklist-90, and Pittsburg Sleep Quality Index (PSQI) were collected. A total of 4,584 respondents from all 34 provinces in Indonesia completed the survey. Data were summarized descriptively and analyzed using chi-square, ANOVA, and multinomial regression on SPSS 23.0 for Windows. Results: This study found that during the COVID-19 pandemic in Indonesia alcohol consumption was 9.50% and daily cigarette smoking was 20.3%. Around 44.5% and 47.6% of respondents reported stable alcohol consumption and cigarette consumption, respectively. The mean AUDIT score was 3.52 ± 4.66 and the mean CDS score was 24.73 ± 8.86. Physical distancing was not correlated to any substance use changes. Increased alcohol consumption was negatively correlated with being unmarried and positively correlated with a higher PSQI score. Decreased alcohol use positively correlated with living in PSBB-implementing provinces and higher AUDIT scores when compared to stable alcohol drinking. Increased cigarette smoking was positively correlated with being male, unmarried, and higher CDS scores. Reduced cigarette smoking was negatively correlated with living in provinces implementing PSBB, higher CDS scores, and phobic anxiety, hostility, and psychoticism subscales of SCL-90. Discussion and Conclusion: The prevalence of alcohol and cigarette consumption changes showed a similar trend with other available studies in other countries. This study established that substance use was mainly sustained with a smaller proportion of respondents amplifying their substance usages. The changes were correlated with PSBB policy but not the practice of physical distancing. Psychiatry and addiction services in Indonesia should be strengthened to cope with the increased burden of psychological distress. Future studies should conduct more comparisons to determine whether the overall rising intensity of consumption was maintained post-pandemic and delineate acute psychopathologies' effects on substance use.

Brief Research Report on Adolescent Mental Well-Being and School Closures During the COVID-19 Pandemic in Indonesia.

The COVID-19 pandemic does not affected only physical but also mental health and socioeconomic part. The social distancing, social quarantine, school from home, and work from becomes a new normal these days. Being adolescence, the above conditions may be challenging due to their developmental milestones. Therefore, this brief report aimed to preliminary identify proportion of adolescents' emotional and behavior problems and several factors related to it during COVID-19 pandemic in Indonesia. The findings might raise some understanding of youth mental well-being and programs that can be applied in schools and community in general to overcome the issues. The study was designed as cross sectional and used online survey that started on April 2020. During April 15-May 10, 2020, there were 113 adolescents participated on this survey. Strength and Difficulties Questionnaire (SDQ) 11-17 years old was used to assess adolescent emotional and behavior problems; and specific life experience questionnaire was designed to collect other independents variables (Cronbach's α = 0.75). All participants fulfilled the online informed consent before they started to complete the questionnaire. All data was analyzed by using SPSS version 20 for Mac. The average age of research subjects were 14.07 (2.18) years old; 98.2% was school from home. There was 14.2% of the total research subject at risk on total difficulties problems; 38.1% of adolescent was at risk on peer-relationship problems, 28.3% at risk on pro-social behavior problems, 15% at risk on conduct behavior and 10.6% at risk on emotional problems. The number of adolescent that perceived worse to significantly worse self-mental well-being prior COVID-19 increased during COVID-19 pandemic in Indonesia (p < 0.05). There was significantly association between having mental health information and conduct behavior (OR = 10.34, 95%CI = 1.27-78.86); Subjective anxiety due to COVID-19 pandemic and pro-social behavior problems (OR = 2.37, 95% CI = 1.00-5.63), parental support and total difficulties (OR = 0.09, 95% CI = 0.14-0.60) and pro-social behavior problems (OR = 0.09, 95% CI = 0.01-0.82); friends support during COVID-19 pandemic and conduct behavior (OR = 0.20, 95% CI = 0.04-1.00) and pro-social behavior problems (OR = 0.14, 95% CI = 0.02-0.75). To be concluded, during phase 1 and 2 COVID-19 pandemic and school closures in Indonesia, adolescents were at risk for having emotional and behavior problems. Therefore, maintain clear mental health information, keep them on connection with school by designing an optimal tele-education, tele-consultation, and virtual activity programs to accommodate adolescents' biopsychosocial needs in the near future.

The Impact of Physical Distancing and Associated Factors Towards Internet Addiction Among Adults in Indonesia During COVID-19 Pandemic: A Nationwide Web-Based Study.

INTRODUCTION: Physical distancing has encouraged the public to utilize the Internet for virtually all daily activities during the COVID-19 pandemic. This study aimed to assess the impact of COVID-19 on Internet addiction (IA) prevalence and analyzed the correlated factors during quarantine and pandemic. METHODS: An online survey was generated, comprising of a sociodemographic section, Internet Addiction Diagnostic Questionnaire (KDAI), Symptoms Checklist-90, and Pittsburgh Sleep Quality Index. The hyperlink was disseminated through social media, companies, and universities. Overall, 4,734 adults, (mean age 31.84 ± 7.73 years old and 55.2% males) representing all 34 provinces of Indonesia, gave valid responses. RESULTS: Point prevalence of IA during the COVID-19 pandemic was 14.4% in Indonesian adults. Online duration increased by 52% compared to before the pandemic. Physical distancing was not established as a risk of IA. Increased daily online duration, specific motivations, types of application, and having confirmed/suspected COVID-19 cases within the household were predictive of IA. All subscales of SCL-90 and PSQI were higher in the group with positive/suspect cases of COVID-19 within households and were correlated to higher scores of IA. DISCUSSION: Physical distancing alone was not associated with an increased risk of IA. The prevalence of IA during COVID-19 was higher than the previously proposed rate among Indonesian adults, which might be related to digital activities associated with COVID-19 and the popularity of virtual socializing. Furthermore, psychopathologies and sleep disruptions were related to IA occurrences and especially prevalent in groups with proximity to COVID-19. Fear of COVID-19 contraction and rampant misinformation of COVID-19 probably contributed to these factors, which potentially harbor long-term consequences. CONCLUSION: The current study demonstrated a high point prevalence of IA and identified several preventable factors predictive of IA during home-quarantine and COVID-19, especially in adults with confirmed/suspected COVID-19 cases within the household. However, physical distancing did not increase the odds of IA. Public health agencies should maintain physical distancing advisory while providing adaptive psychiatric education and service.