An Investigation of Changing Attitudes and Behaviors and Problematic Internet Use in Children Aged 8 to 17 Years During the COVID-19 Pandemic.

PURPOSE: To examine the effects of the COVID-19 pandemic on the lifestyle, habits, and behavioral differences in children, and their changing internet use habits. METHODS: The research was planned as a cross-sectional study involving 4892 children aged 8 to 17 years attending schools in the city center of Trabzon, Turkey. Children's daily living activities, social habits, mood and temperament changes, and internet use were investigated before and during the pandemic. In terms of problematic internet use, internet addiction rates were evaluated using the validated Turkish-language version of the Parent-Child Internet Addiction Scale (PCIAT-20). RESULTS: The children's mean age was 13 ± 2.45 years, and 17.1% (n = 837) exhibited problematic internet use features on the PCIAT-20. Problematic internet use was higher in boys and in children older than 13 years. The presence of COVID-19 infection among members of the household, quarantine measures, attending private schools, the mother's occupation, the time spent by the mother and father on their mobile phones, and high parental education levels were associated with a high level of internet addiction. Families also described significant changes in their children's temperament and character compared with the pre-pandemic period. CONCLUSION: The prevalence of problematic internet use increased during the COVID-19 pandemic compared with previous studies from Turkey. Children were also more introverted, irritable, and pessimistic during the pandemic.

Internet addiction and sleep quality among medical students during the COVID-19 pandemic: A multinational cross-sectional survey.

BACKGROUND: The emergence of the COVID-19 pandemic has affected the lives of many people, including medical students. The present study explored internet addiction and changes in sleep patterns among medical students during the pandemic and assessed the relationship between them. METHODS: A cross-sectional study was carried out in seven countries, the Dominican Republic, Egypt, Guyana, India, Mexico, Pakistan, and Sudan, using a convenience sampling technique, an online survey comprising demographic details, information regarding COVID-19, the Pittsburgh Sleep Quality Index (PSQI), and the Internet Addiction Test (IAT). RESULTS: In total, 2749 participants completed the questionnaire. Of the total, 67.6% scored above 30 in the IAT, suggesting the presence of an Internet addiction, and 73.5% scored equal and above 5 in the PSQI, suggesting poor sleep quality. Internet addiction was found to be significant predictors of poor sleep quality, causing 13.2% of the variance in poor sleep quality. Participants who reported COVID-19 related symptoms had disturbed sleep and higher internet addiction levels when compared with those who did not. Participants who reported a diagnosis of COVID-19 reported poor sleep quality. Those living with a COVID-19 diagnosed patient reported higher internet addiction and worse sleep quality compared with those who did not have any COVID-19 patients in their surroundings. CONCLUSION: The results of this study suggest that internet addiction and poor sleep quality are two issues that require addressing amongst medical students. Medical training institutions should do their best to minimize their negative impact, particularly during the current COVID-19 pandemic.

The relationship between smartphone use and dry eye disease: A systematic review with a narrative synthesis.

BACKGROUND: Emerging research findings suggest a potential relationship between smartphone use (SPU) and dry eye disease (DED), which has not been systematically reviewed. OBJECTIVES: The aim of this study was to systematically review and synthesize evidence on the relationship between SPU and DED. METHODS: A systematic search of Medline, EMBASE, CINAHL, and PsychINFO bibliographic databases from their inception to January 15, 2021. Study screening, full-text assessment, study selection and exclusion, data extraction, and quality assessment was performed independently by at least two review authors. RESULTS: Four studies were included in the review (3 cross-sectional studies and 1 nonrandomized clinical trial). A narrative synthesis of findings was used due to heterogeneity among study designs and measures of association summarizing the relationship between SPU and DED. All included studies were conducted in South Korea and included school children, college students, or young adults. Three of the 4 included studies showed an association between SPU and DED. CONCLUSIONS: There is some evidence that SPU is associated with DED. However, this evidence is limited by a small number of studies of satisfactory methodological quality. There is a great need for high-quality studies to further investigate the relationship between SPU and DED and identify mechanisms underlying this potential relationship. This information is important for raising public awareness about the negative effect of SPU on eye health and development of clinical guidelines for this potentially emerging SPU-driven eye condition.

Depression and anxiety symptoms associated with internet gaming disorder before and during the COVID-19 pandemic: A longitudinal study.

BACKGROUND: The coronavirus disease-2019 (COVID-19) pandemic has profoundly impacted aspects of human life globally. Playing videogames has been encouraged by several organizations to help individuals cope with the COVID-19 pandemic and associated restrictive measures. This longitudinal study was the first to examine gaming in the context of the pandemic and its association with depressive and anxiety symptoms. METHODS: The sample comprised 1,778 children and adolescents (50.7% male) who were part of the Project of School Mental Health in Southwest China. Data were collected at two-time intervals: before the COVID-19 pandemic (October to November 2019 - [T1]) and during the COVID-19 pandemic (April to May 2020 - [T2]). Data were collected on perceived COVID-19 impacts, videogame use, Internet Gaming Disorder (IGD), and depressive and anxiety symptoms. Cross-lagged panel models were computed to examine longitudinal relationships. RESULTS: The results indicated that both videogame use and IGD increased significantly for adolescents at T2. The cross-lagged panel model results suggested that depressive and anxiety symptoms at T1 positively predicted IGD and videogame use at T2 (especially for boys), but not inversely. Perceived COVID-19 impacts mediated the relationship between depressive and anxiety symptoms at T1 and IGD at T2. CONCLUSION: Children and adolescents both increased videogame use at T2, but only adolescents significantly increased IGD severity at T2. The findings supported the compensatory hypothesis, and are consistent with the Interaction of Person-Affect-Cognition-Execution model as individual responses to COVID-19 may function as a mediator between personal predisposing variables and IGD.

Internet addiction and sleep quality among adolescents in a peri-urban setting in Nepal: A cross-sectional school-based survey.

BACKGROUND: Excessive use of the internet among adolescents often led to later bedtimes and poor sleep quality. This study assessed the relationship between internet addiction and sleep quality among adolescents in a peri-urban setting in Nepal. METHOD: This cross-sectional study employed a questionnaire survey among 390 adolescent students recruited from two schools in Kirtipur Municipality in Nepal. The Internet Addiction Test and the Pittsburgh Sleep Quality Index were used to assess internet addiction and poor sleep quality respectively. The association between internet addiction and sleep quality was analysed by logistic regression. RESULTS: One-fifth (21.5%) of the participants were identified with borderline internet addiction and 13.3% with possible internet addiction. Poor sleep quality was found among 31% of the participants. Internet addiction was significantly associated with poor sleep quality (OR = 1.85, p = 0.022 for borderline, and OR = 3.98, p = <0.001 for possible internet addiction compared to no internet addiction). CONCLUSION: Adolescents with internet addiction were more vulnerable to suffer from poor sleep quality. It is recommended that municipalities and schools should aware the adolescent students on the adverse effects of excessive internet use including poor sleep quality. The findings have implications for adolescents, parents, school authorities and researchers.

The Mediating Effect of Depressive Symptoms on the Relationship between Adverse Childhood Experiences and Problematic Internet Use in Children and Adolescents.

The purpose of this study was to evaluate the mediating effect of depressive symptoms on the relationship between adverse childhood experiences (ACEs) and problematic internet use. The study participants were 180 students between the ages of 9 and 18 years. Path analysis was performed to measure the relationships among ACEs, depressive symptoms and problematic internet use. ACEs significantly affected depressive symptoms (standardized regression weight, 0.36; P < 0.01), and depressive symptoms also affected problematic internet use (standardized regression weight, 0.40; P < 0.01). We found that depressive symptoms had a significant mediating effect on the relationship between problematic internet use and ACEs. The management of depressive symptoms would be important to prevent problematic internet use in children and adolescents with ACEs.

Associations of Internet Addiction Severity With Psychopathology, Serious Mental Illness, and Suicidality: Large-Sample Cross-Sectional Study.

BACKGROUND: Internet addiction has become a major global concern and a burden on mental health. However, there is a lack of consensus on its link to mental health outcomes. OBJECTIVE: The aim of this study was to investigate the associations between internet addiction severity and adverse mental health outcomes. METHODS: First-year undergraduates enrolled at Sichuan University during September 2015, 2016, 2017, and 2018 were invited to participate in the current study survey, 85.13% (31,659/37,187) of whom fully responded. Young's 20-item Internet Addiction Test, Patient Health Questionnaire-15, Patient Health Questionnaire-9, Symptom Checklist 90, Six-Item Kessler Psychological Distress Scale, and Suicidal Behaviors Questionnaire-Revised were used to evaluate internet addiction, four psychopathologies (high somatic symptom severity, clinically significant depression, psychoticism, and paranoia), serious mental illness, and lifetime suicidality. RESULTS: The prevalence of students with mild, moderate, and severe internet addiction was 37.93% (12,009/31,659), 6.33% (2003/31,659), and 0.20% (63/31,659), respectively. The prevalence rates of high somatic symptom severity, clinically significant depression, psychoticism, paranoid ideation, and serious mental illness were 6.54% (2072/31,659), 4.09% (1294/31,659), 0.51% (160/31,659), 0.52% (165/31,659), and 1.88% (594/31,659), respectively, and the lifetime prevalence rates of suicidal ideation, suicidal plan, and suicidal attempt were 36.31% (11,495/31,659), 5.13% (1624/31,659), and 1.00% (315/31,659), respectively. The prevalence rates and odds ratios (ORs) of the four psychopathologies and their comorbidities, screened serious mental illness, and suicidalities in the group without internet addiction were much lower than the average levels of the surveyed population. Most of these metrics in the group with mild internet addiction were similar to or slightly higher than the average rates; however, these rates sharply increased in the moderate and severe internet addiction groups. Among the four psychopathologies, clinically significant depression was most strongly associated with internet addiction after adjusting for the confounding effects of demographics and other psychopathologies, and its prevalence increased from 1.01% (178/17,584) in the students with no addiction to 4.85% (582/12,009), 24.81% (497/2,003), and 58.73% (37/63) in the students with mild, moderate, and severe internet addiction, respectively. The proportions of those with any of the four psychopathologies increased from 4.05% (713/17,584) to 11.72% (1408/12,009), 36.89% (739/2003), and 68.25% (43/63); those with lifetime suicidal ideation increased from 24.92% (4382/17,584) to 47.56% (5711/12,009), 67.70% (1356/2003), and 73.02% (46/63); those with a suicidal plan increased from 2.59% (456/17,584) to 6.77% (813/12,009), 16.72% (335/2003), and 31.75% (20/63); and those with a suicidal attempt increased from 0.50% (88/17,584) to 1.23% (148/12,009), 3.54% (71/2003), and 12.70% (8/63), respectively. CONCLUSIONS: Moderate and severe internet addiction were strongly associated with a broad group of adverse mental health outcomes, including somatic symptoms that are the core features of many medical illnesses, although clinically significant depression showed the strongest association. This finding supports the illness validity of moderate and severe internet addiction in contrast to mild internet addiction. These results are important for informing health policymakers and service suppliers from the perspective of resolving the overall human health burden in the current era of "Internet Plus" and artificial intelligence.

Inhibitory neuromodulation of the putamen to the prefrontal cortex in Internet gaming disorder: How addiction impairs executive control.

BACKGROUND AND AIMS: Individuals with addictive disorders are usually characterized by impaired executive control, persistent craving and excessive reward-seeking. However, it is unclear whether there is a deviation in the connection pattern among the neural systems implicated in these problem behaviors. METHODS: One hundred thirty-six online gaming players were recruited in the current study (68 Internet gaming disorder (IGD) subjects and 68 recreational game users (RGUs) who served as controls matched on age, sex, years of education, and years of gaming). Dynamic interactions among the reward system (striatum), control system (prefrontal cortex), and the interoceptive awareness system (insula) were calculated and compared when subjects were facing gaming cues. RESULTS: The results revealed that RGUs showed a significant positive correlation in the putamen-middle frontal gyrus (MFG)-insula neural pathway when facing gaming cues, which was missing in the IGD subjects. Additionally, dynamic causal modeling (DCM) analysis revealed that the MFG region was more inhibited by the putamen in the IGD subjects relative to the RGUs. CONCLUSIONS: These findings suggest that the inhibitory neuromodulation of the putamen to the prefrontal cortex in IGD individuals undermines the balance among the tripartite systems. Our findings provide novel neurobiological evidence for understanding the internal connection bias of the addicted individual's neural system and how the addictive disorder impairs executive control; consequently, the pathway from the striatum to the prefrontal cortex may serve as a potential biomarker to predict the risk of developing an addiction.

The co-occurrence between symptoms of internet gaming disorder and psychiatric disorders in childhood and adolescence: prospective relations or common causes?

BACKGROUND: Internet gaming disorder (IGD) is highlighted as a condition for further study in the Diagnostic and Statistical Manual of Mental Disorders Fifth Edition (DSM-5). Some studies indicate that IGD appears comorbid with other psychiatric disorders. We examine concurrent and prospective links between symptoms of IGD and symptoms of common psychiatric disorders in childhood and adolescence to determine whether observed comorbidity is a result of (a) reciprocal relations or (b) common underlying causes. METHODS: A community sample (n = 702) of Norwegian children completed the Internet Gaming Disorder Interview (IGDI) to assess DSM-5 defined IGD symptoms at ages 10, 12 and 14 years. The Child and Adolescent Psychiatric Assessment (CAPA) assessed symptoms of depression, anxiety, attention-deficit hyperactivity disorder (ADHD), oppositional defiant disorder (ODD) and conduct disorder (CD) at the same time points. RESULTS: A Random Intercept Cross-lagged Panel Model (RI-CLPM), which captures pure within-person changes and adjusts for all unmeasured time-invariant factors (e.g., genetics, parent education) revealed no associations between IGD symptoms and psychopathology, except that increased IGD symptoms at ages 10 and 12 predicted decreased symptoms of anxiety two years later. CONCLUSIONS: No support emerged for concurrent or prospective relations between IGD and psychiatric symptoms, except in one case: increased IGD symptoms forecasted reduction in anxiety symptoms. Observed co-occurrence between IGD symptoms and mental health problems can mainly be attributed to common underlying factors.

The Smartphone Addiction Levels and the Association With Communication Skills in Nursing and Medical School Students.

BACKGROUND: The use of smartphones among young people is quite common. However, smartphones are associated with negative effects when used excessively. It has been reported that smartphone use may adversely affect learning in the classroom, cause safety issues, and negatively affect interpersonal communications. PURPOSE: The aims of this study were to determine the level of smartphone addiction among nursing and medical school students and to examine the effect of smartphone addiction level on communication skills. METHODS: This cross-sectional study was conducted with medical school and nursing students at a public university (502 participants). Data were collected using a personal information form, the Smartphone Addiction Scale-Short Version (SAS-SV), and the Communication Skills Assessment Scale. RESULTS: All of the participants in the study owned smartphones. Most (70.9%) were female, and 58.2% were in the nursing program. The participants used smartphones for a mean time of 5.07 ± 3.32 hours a day, primarily for messaging. The mean total SAS-SV score for the participants was 31.89 ± 9.90, and a significant difference in SAS-SV mean scores was found with regard to the variables of department, gender, daily smartphone use duration, academic success, status regarding smartphone use in the classroom, participation in sports, easy communication with patients and relatives, preferred mode of communication, health problems tied to phone use, and injury status (p < .05). In addition, a positive weak-to-moderate relationship was found between SAS-SV mean scores and the variables of daily smartphone use duration and years of smartphone use, whereas a negative weak relationship was found between SAS-SV mean scores and Communication Skills Assessment Scale scores. Daily smartphone use duration was found to be the most important predictor of smartphone addiction. CONCLUSIONS/IMPLICATIONS FOR PRACTICE: Higher SAS-SV scores have a negative impact on interpersonal communication and social life and reduce learning efficacy in students. Therefore, students and lecturers should be better informed regarding the benefits and risks of smartphone use in education, with precautions provided against excessive and needless use.

Examining the associations between smartphone use and mother-infant bonding and family functioning: A survey design.

Excessive smartphone use has been found to be associated with dysfunctional social and family relations. While most studies of this phenomenon have focused on adolescent and adult addiction, none has yet to focus on mothers with infants. This study examined the association of excessive smartphone use with mother-infant bonding, maternal mental health, and family functioning in Jordan. The predictive value of the study variables with respect to the level of smartphone use was evaluated. A descriptive correlational cross-sectional survey design was used. A sample of 114 mothers with infants was interviewed in person and completed a web-based questionnaire. Approximately 16% reported using smartphones 5 to 14 hours per day; 6.7% described themselves as smartphone addicts. The results suggest that excessive smartphone use may be linked to unhealthy family functioning. No associations were found between smartphone use and mother-infant bonding or maternal mental health. Raising awareness of this linkage and limiting smartphone use are recommended as precautionary measures. Although this study failed to find any association between smartphone use and mother-infant bonding, further studies using empirical methods might have better success.

Attention Deficit Hyperactivity Disorder-Symptoms, Social Media Use Intensity, and Social Media Use Problems in Adolescents: Investigating Directionality.

Cross-sectional research shows that adolescents' social media use (SMU) and attention deficit hyperactivity disorder (ADHD)-symptoms are related, but it is unclear whether this relation is explained by SMU intensity or by addiction-like SMU problems. Also, due to the lack of longitudinal studies, the direction of this relation remains unknown. This study aims to disentangle which type of SMU is related to ADHD-symptoms, and in which direction, using a three-wave longitudinal study among Dutch adolescents aged 11-15 years (n = 543). Findings suggest a unidirectional relation: SMU problems increased ADHD-symptoms over time, SMU intensity did not. This implies that problematic use, rather than the intensity of use harmfully affects adolescents' ADHD-symptoms.