Problematic Internet Use among Adults: A Cross-Cultural Study in 15 Countries.

BACKGROUND: The present study compared adult usage patterns of online activities, the frequency rate of problematic internet use (PIU), and risk factors (including the psychopathology associated with PIU, i.e., distress and impulsivity) among adults in 15 countries from Europe, America, and Asia. METHODS: A total of 5130 adults from Belgium, Finland, Germany, Italy, Spain, France, Switzerland, Hungary, Poland, UK, Norway, Peru, Canada, US, and Indonesia completed an online survey assessing PIU and a number of psychological variables (i.e., depression, anxiety, stress, and impulsivity). The sample included more females, with a mean age of 24.71 years (SD = 8.70). RESULTS: PIU was slightly lower in European countries (rates ranged from 1.1% in Finland to 10.1% in the UK, compared to 2.9% in Canada and 10.4% in the US). There were differences in specific PIU rates (e.g., problematic gaming ranged from 0.4% in Poland to 4.7% in Indonesia). Regression analyses showed that PIU was predicted by problematic social networking and gaming, lack of perseverance, positive urgency, and depression. CONCLUSIONS: The differences in PIU between countries were significant for those between continental regions (Europe versus non-European countries). One of the most interesting findings is that the specific PIU risks were generally low compared to contemporary literature. However, higher levels of PIU were present in countries outside of Europe, although intra-European differences existed.

The Electronic Mental Wellness Tool as a Self-Administered Brief Screening Instrument for Mental Disorders in the General Spanish Population during the Post-COVID-19 Era.

(1) Background: In the "post-COVID-19 era", there is a need to focus on properly assessing and addressing the extent of its well-established mental health collateral damage. The "Electronic Mental Wellness Tool" (E-mwTool) is a 13-item validated stepped-care or stratified management instrument that aims at the high-sensitivity captures of individuals with mental health disorders to determine the need for mental health care. This study validated the E-mwTool in a Spanish-speaking population. (2) Methods: It is a cross-sectional validation study using the Mini International Neuropsychiatric Interview as a criterion standard in a sample of 433 participants. (3) Results: About 72% of the sample had a psychiatric disorder, and 67% had a common mental disorder. Severe mental disorders, alcohol use disorders, substance use disorders, and suicide risk had a much lower prevalence rate (6.7%, 6.2%, 3.2%, and 6.2%, respectively). The first three items performed excellently in identifying any mental health disorder with 0.97 sensitivity. Ten additional items classified participants with common mental disorders, severe mental disorders, substance use disorders, and suicide risk. (4) Conclusions: The E-mwTool had high sensitivity in identifying common mental disorders, alcohol and substance use disorders, and suicidal risk. However, the tool's sensitivity in detecting low-prevalence disorders in the sample was low. This Spanish version may be useful to detect patients at risk of mental health burden at the front line of primary and secondary care in facilitating help-seeking and referral by their physicians.

What the grey literature can contribute to addictive behaviour disorder classification •.

This commentary examines the proposal made by Brand et al. (2022) regarding a framework outlining relevant criteria for considering possible behavioural addictions within the current World Health Organisation's International Classification of Diseases (ICD-11) category of 'other specified disorders due to addictive behaviours'. We agree with the framework as it highlights the clinical perspective requiring agreed-upon classifications and criteria to produce effective diagnostic procedures and efficacious treatments. Additionally, we propose to add the need of recognising potential addictive behaviour through the inclusion of a fourth meta-level criterion: 'grey literature evidence'. Utilising non-academic evidence can provide validity in the social context where the behaviour takes place, and it can support authorities in taking action to prevent and treat the resultant behavioural problems. The inclusion of the proposed fourth criterion will aid comprehensibility of the current proposal and provide clarity, as indicated in the present commentary, which includes the fourth criterion analysis for problematic pornography use, shopping/buying and social networking site use.

The Role of Shared Decision-Making in Personalised Medicine: Opening the Debate.

Surgeons and cancer patients are starting to open the debate on how personalised medicine could use shared decision-making (SDM) to balance the personal and clinical components and thus improve the quality and value of care. Personalised precision medicine (PPM) has traditionally focused on the use of genomic information when prescribing treatments, which are usually pharmaceutical. However, the knowledge base is considerably scarcer in terms of how clinicians can individualise the information they provide patients about the consequences of different treatments, and in doing so involve them in the decision-making process. To achieve this, the ethical implications of SDM must be addressed from both sides. This paper explores the medical characteristics, the SDM implications in severe and fragile patients, potential risks, and observed benefits within this healthcare approach through four clinical cases. Findings shed light on current needs for clinician and patient training and tools related to SDM in PPM, and also remarks on the way in which this shift in healthcare settings is taking place to include the human component together with the biological and technological advances when designing care processes in colorectal cancer.

To Be or Not to Be a Female Gamer: A Qualitative Exploration of Female Gamer Identity.

The literature on online gaming has generally focused on male gamers and has been dominated by negative aspects of gaming. The present study addresses the gender gap in this field by exploring experiences of female gamers further by unravelling several positive experiences alongside some potentially harmful tendencies connected to gaming, including female gamers' wishes and ambitions for their future gaming. A total of 20 female adult gamers across Europe were interviewed and results were analysed using thematic analysis. Four main themes were identified: (i) to be or not to be a (female) gamer; (ii) improving social skills and levelling up on mental health; (iii) not always a healthy escape; and (iv) there is more to explore. The present study is one of few empirical studies regarding the construction of self-image, and experiences of female gamers. It has showed participants have a history as gamers from adolescence, but still face problems derived from the stigmatised internal gender self-image. Externally, female gamer stigmatisation may result in sexism, gender violence, harassment, and objectification. Additionally, females may decide against identifying as gamers, engaging in social gaming interaction, or hold back from online gaming in general, thereby missing out on the opportunities for recreation as well as social and psychological benefits that gaming brings. There is, therefore, urgent need for more research and actions to promote change, equity, education, and security for female gamers as well as their male counterparts. Game developers would benefit from understanding this large gamer demographic better and tailoring games for women specifically.

Perceptions Underlying Addictive Technology Use Patterns: Insights for Cognitive-Behavioural Therapy.

Cognitive-Behavioural Therapy (CBT) is considered the 'gold standard' in the treatment of addictive disorders related to excessive technology use. However, the cognitive components of problematic internet use are not yet well-known. The aim of the present study was to explore the cognitive components, that according to problematic users, can lead to potential internet addiction. A total of 854 European adults completed an online survey using a mixed-methods design. Internet problems and attachment styles were assessed, prevalence rates estimated, correlations, chi-squared automatic interaction detection, and content analysis were performed. Self-reported addictions to social networking, internet, and gaming had a prevalence between 1.2% (gaming) to 2.7% (social networking). Self-perception of the addiction problem and preoccupied attachment style were discriminative factors for internet addiction. In an analysis of qualitative responses from self-identified compulsive internet users, a sense of not belonging and feeling of disconnection during life events were perceived as causes for internet addiction. The development depended on a cycle of mixed feelings associated with negative thoughts, compensated by a positive online identity. The severity of this behaviour pattern produced significant impairment in various areas of the participants' functioning, suggesting a possible addiction problem. It is suggested that health professionals administering CBT should target unhealthy preoccupations and monitor mixed feelings and thoughts related to internet use to support coping with cognitive distortions.

Towards an Open Medical School without Checkerboards during the COVID-19 Pandemic: How to Flexibly Self-Manage General Surgery Practices in Hospitals?

BACKGROUND: Can we create a technological solution to flexibly self-manage undergraduate General Surgery practices within hospitals? Before the pandemic, the management of clerkships was starting to depend less on checkerboards. This study aims to explore undergraduates' perceptions of doing rotations in teaching hospitals using different teaching styles and elicit their views regarding the options of managing practices to design a mobile app that substitutes for checkerboards. METHODS: In this sequential exploratory mixed methods study, 38 semi-structured interviews at a teaching hospital were conducted. The data was used to survey 124 students doing their rotations in four teaching hospitals during the first wave of COVID-19. RESULTS: 21 themes highlighted concerns related to the practices, the teacher involvement in the students' education, and the students' adaptation to clinical culture. The students reported positive perceptions concerning self-managing and organizing practices via a mobile application. However, problems emerged regarding transparency, the lack of feedback, and the need for new tools. Regarding the teaching styles, the facilitator and personal models were perceived as optimal, but the personal style had no effect on using or not using a tool. CONCLUSIONS: A mobile-learning application designed like an educational opportunities' manager tool can probably promote self-directed learning, flexible teaching, and bidirectional assessments. However, teachers who employ a personal teaching style may not need either checkerboards or a tool. This solution supports teaching at hospitals in pandemic times without checkerboards.

Emerging Health and Education Issues Related to Internet Technologies and Addictive Problems.

This timely editorial paper outlines some of the main emerging research on technological topics on health and education approaches to Internet use-related problems before and during the beginning of coronavirus disease 2019 (COVID-19). BACKGROUND: The aim is to provide a brief overview to facilitate a rapid comprehensive and practical approach to these new trends to promote research, interventions, education, and prevention. METHODS: The rapid review includes an analysis of both health and education technologies studies on Internet use-related addiction problems included in the Special Issue "Internet and Smartphone Use-Related Addiction Health Problems: Treatment, Education and Research" to extract recent findings and a few reflections about the development of the field before and during the first wave of the COVID-19. RESULTS: Main findings highlighted studies which tended to be empirical, with a relational type associating specific addictive problems with individual and a few contextual factors in adult populations. Psychometric studies about scales are prevalent, but predictive and mixed methods ones are starting to emerge, together with reviews about conceptualisation, measure, treatment, and prevention. CONCLUSIONS: From the arrival of Internet, our societies have converged in a global culture which has impacted health and educational domains. Internet use-related addiction problems have globally emerged and common knowledge, advances, and strategies exist to overcome challenges which are starting to be tested, and prevention interest has arisen in a pandemic situation with global health problems holistically tackled.

Difficulties in Establishing "Truth" Conditions in the Assessment of Addictive Smartphone Use in Young Adults.

The smartphone revolution has placed powerful, multipurpose devices in the hands of youth across the globe, prompting worries about the potential negative consequences of these technologies on mental health. Many assessment tools have been created, seeking to classify individuals into problematic and non-problematic smartphone users. These are identified using a cutoff value: a threshold, within the scale range, at which higher scores are expected to be associated with negative outcomes. Lacking a clinical assessment of individuals, the establishment of this threshold is challenging. We illustrate this difficulty by calculating cutoff values for the Short Version of the Smartphone Addiction Scale (SAS-SV) in 13 Spanish-speaking samples in 11 countries, using common procedures (i.e., reliability, validity, ROC methodology). After showing that results can be very heterogeneous (i.e., they lead to diverse cutoff points and rates of addiction) depending on the decisions made by the researchers, we call for caution in the use of these classifications, particularly when researchers lack a clinical definition of true addiction-as is the case with most available scales in the field of behavioral addictions-which can cause an unnecessary public health alert.

Raising Spanish Children With an Antisocial Tendency: Do We Know What the Optimal Parenting Style Is?

Families can play an essential role in preventing violent and antisocial behaviors, which are considered a significant public health issue. However, some studies argue that most children are antisocial only during adolescence, and even teenagers can mimic antisocial behavior in ways that are normative and well-adjusted. This study analyzed patterns of competence and adjustment in young adults with and without an antisocial tendency during adolescence from authoritative (characterized by warmth and strictness), authoritarian (strictness but not warmth), indulgent (warmth but not strictness), and neglectful (neither warmth nor strictness) families. Emergent research has indicated that in a European context, the indulgent parenting style is optimal. Offspring's competence and adjustment were captured through self-esteem (academic and family), psychosocial development (self-competence and empathy), and low emotional maladjustment (nervousness and hostility). Participants consisted of a community sample of 489 Spanish young adults, 191 men (39.1%) and 298 women (60.9%), aged 18 to 34 years old. The design was a 4 × 2 × 2 × 2 MANOVA (parenting style × antisocial tendency × sex × age). Analysis of main effects showed that youths with an antisocial tendency have less self-esteem and psychosocial development, but more emotional maladjustment. Regardless of the parenting style, an antisocial tendency during adolescence is consistently associated with worse adjustment in young adults. Both the authoritative and indulgent parenting styles are consistently associated with better outcomes (higher self-esteem and psychosocial development, and lower emotional maladjustment) than the authoritarian and neglectful parenting styles. However, there are interactions between the parenting style and the antisocial tendency. For young adults without an antisocial tendency, only indulgent parenting is associated with less emotional maladjustment. These results support the idea that in Europe the indulgent parenting style performs better than the authoritative style, but only when raising adolescents without an antisocial tendency. For young adults with an antisocial tendency, indulgent and authoritative parenting are equally optimal for all the studied outcomes.

Considering existing classic and contemporary proposals for preventing online addiction problems: Some old recipes for new problems. •.

This commentary examines the proposed framework in relation to current policy options and preventive strategies and adds classical prevention and ecological models to tackle internet use-related addiction problems. Specifically, it highlights the preventive developments regarding contributions to promote the healthy use of technologies, and the need of designing and testing prevention strategies targeting the incidence, prevalence and severity of these problems at all population levels. In summary, to start preventing and minimising harms due to the problematic and addictive use of emerging technologies, we already have old models we can apply to these new problems to ensure secure behaviours through the technologies, and enhance users' wellness and quality of life.

Preventing Harmful Internet Use-Related Addiction Problems in Europe: A Literature Review and Policy Options.

Internet use-related addiction problems are increasingly being recognized on a European scale due to international health organizations considering gaming addiction. In April 2013, the American Psychiatric Association recognized Internet Gaming Disorder in the fifth Diagnostic and Statistical Manual of Mental Disorders, and in April 2018, the World Health Organization included Gaming Disorder in the eleventh International Classification of Diseases. However, findings on these problems within this period are lacking in Europe, and a preventive approach is missing globally. A detailed critical literature review was conducted using PsycINFO and Web of Science in this five-year period. A total of 19 studies were reviewed and problems identified were: generalized Internet addiction and online gaming and gambling addictions across seven European countries (i.e., Spain, Germany, France, Italy, Greece, The Netherlands, and Denmark). The individuals with problematic use were found to be educated adolescents, usually young males with comorbid disorders, and gaming and gambling disorders were implicated in the most severe cases. Cognitive behavioral therapy was the main treatment, sometimes combined with a systemic approach for adolescents. Prevalence, high-risk populations, and factors contributing to these addiction problems are discussed, and a set of policy options are developed for this region. The implications for early detection, diagnosis, treatment, and prevention in Europe are considered.

Cross-Cultural Validation of the Compulsive Internet Use Scale in Four Forms and Eight Languages.

The 14-item Compulsive Internet Use Scale (CIUS) is one of the most frequently internationally adapted psychometric instruments developed to assess generalized problematic Internet use. Multiple adaptations of this instrument have led to versions in different languages (e.g., Arabic and French), and different numbers of items (e.g., from 5 to 16 items instead of the original 14). However, to date, the CIUS has never been simultaneously compared and validated in several languages and different versions. Consequently, the present study tested the psychometric properties of four CIUS versions (i.e., CIUS-14, CIUS-9, CIUS-7, and CIUS-5) across eight languages (i.e., German, French, English, Finnish, Spanish, Italian, Polish, and Hungarian) to (a) examine their psychometric properties, and (b) test their measurement invariance. These analyses also identified the optimal versions of the CIUS. The data were collected via online surveys administered to 4,226 voluntary participants from 15 countries, aged at least 18 years, and recruited from academic environments. All brief versions of the CIUS in all eight languages were validated. Dimensional, configural, and metric invariance were established across all languages for the CIUS-5, CIUS-7, and CIUS-9, but the CIUS-5 and CIUS-7 were slightly more suitable because their model fitted the ordinal estimate better, while for cross-comparisons, the CIUS-9 was slightly better. The brief versions of the CIUS are therefore reliable and structurally stable instruments that can be used for cross-cultural research across adult populations.

Female Gaming, Gaming Addiction, and the Role of Women Within Gaming Culture: A Narrative Literature Review.

Research investigating female gaming has begun to emerge despite gaming being traditionally more popular with males. Research in the 21st century has drawn attention to the role of women in culture, society, and technology, and female gaming is one of the growing phenomena not to have been researched in depth. The aim of the present paper was to review female gaming (i.e., the role of females within video game culture) and identify any associated psychopathological symptomatology. The review adapted the Sample, Phenomenon of Interest, Design, Evaluation, Research (SPIDER) model in conducting a narrative literature review. A search of three scientific electronic databases yielded 49 papers for further evaluation. From a methodological perspective, studies had to fulfill the following criteria to be included: i) published between the years 2000 and 2018; ii) assessed female gaming or the female position within gaming culture, iii) contained quantitative, qualitative, or mixed methods approaches to produce empirical data or discuss theoretical implications through reviews, iv) be retrievable as a full-text peer-reviewed journal paper, and v) published in English, German, Polish, Spanish, Italian, Portuguese, or French. Four categories emerged from the papers: i) the benefits of female gaming, ii) why women might play video games less than men, iii) perceptions and realities of female characters within video games, and iv) women's position in gaming culture. The main findings showed playing video games has benefits for women in terms of enhancing cognitive, social, and physical abilities. However, they are less encouraged to play video games due to negative expectations based on gender and/or experiences during game play. Video games are associated with stereotypical male characteristics, such as being overly aggressive, and frequently contain sexualized content. Female gamers appear to require coping strategies to handle online harassment. Females look for different things in video games, which are not often included in game designs thereby limiting their abilities. For instance, female avatar representation-which is exaggerated and hypersexualized-can prompt social comparisons and lead to feelings of decreased self-esteem, depression, and other impacts on well-being. Overall, there are still obstacles for women playing video games even though they comprise half of the gaming population.

Measuring Female Gaming: Gamer Profile, Predictors, Prevalence, and Characteristics From Psychological and Gender Perspectives.

Research investigating female gaming is relatively scarce, and past research has demonstrated that men are more likely to be problematic gamers. Few studies have focused on female gamers in community samples, and those that have been published have mainly collected qualitative data in Europe. There is case study evidence suggesting clinicians are increasingly treating problem female gamers. The aim of this study is threefold: (i) to establish an international female gamer profile, (ii) to determine predictors associated with perceived internet gaming disorder (IGD), and (iii) to identify those who are potentially at risk of developing gaming addiction and its characteristics by applying a quantitative approach. A cross-sectional online survey was applied through international gaming forums recruiting 625 female gamers, assessing sociodemographics, gaming devices used and play genres, and a set of questionnaires on gaming [e.g., problem online gaming (e.g., the nine-item short-form scale to assess IGD: IGDS9-SF), female stereotypes (e.g., sex role stereotyping scale), and psychological symptoms (e.g., Symptom CheckList-27-plus)]. Female gamers from all continents reported the use of all videogames, especially popular online games using computers and consoles. The proportion of gamers with potential IGD was one per cent. Regression analyses identified several risk factors for increased scores on the IGDS9-SF, namely having achievement and social motivations, embodied presence and identification with the avatar, hostility and social phobia together with negative body image, playing Multiplayer Online Battle Arena games, Massively Multiplayer Online Role-Playing Games, and First-Person-Shooter games. Findings contribute to filling the gap in knowledge on female gaming, to aid in the applicability of problematic gaming measurements in female gamers, especially those who are at risk of problematic gaming. The purpose of this study is to enhance the validity of the current measures to diagnose problem gaming appropriately in both genders.

Generalised Versus Specific Internet Use-Related Addiction Problems: A Mixed Methods Study on Internet, Gaming, and Social Networking Behaviours.

The field of technological behavioural addictions is moving towards specific problems (i.e., gaming disorder). However, more evidence of generalised versus specific Internet use-related addiction problems (generalised pathological Internet use (GPIU) vs. specific pathological Internet use (SPIU)) is still needed. This mixed methods study aimed to disentangle GPIU from SPIU. A partially mixed sequential equal status study design (QUAN→QUAL) was undertaken. First, through an online survey, which adapted the compulsive Internet use scale (CIUS) for three types of problems (i.e., generalised Internet use, and specific online gaming and social networking). Second, potential problem users' perceptions of the evolution of these problems (aetiology, development, consequences, and factors) were ascertained, through semi-structured interviews, together with their opinion on present Internet gaming disorder (IGD) criteria adapted to each problem studied. Findings showed the CIUS remains valid and reliable for GPIU and SPIUs examined; a prevalence between 10.8% and 37.4% was estimated for potential at-risk problem gamers and Internet users, respectively, who reported their preference for maintaining their virtual lives. Half of the sample had a risk of a unique or mixed profile of these problems. Moreover, device patterns, gender, and age issues emerged, such as problem gamers being proportionally equal male and female young or middle-aged adults. GPIU was highly associated with problem social networking use, and weakly with problematic gaming, but both SPIUs were independent. Concerning addictive symptoms, salience, deception, and tolerance required redefinition, especially for SPIUs, while better-valued IGD criteria applied to GPIU and SPIUs were: Risk relationships or opportunities, give up other activities, withdrawal, and continue despite problems. Thus, although problems studied are present as risk behaviours, SPIUs seem to cover the addictive symptomatology in those categorised as potential problem users, online gaming being the most severe behavioural addiction problem.

Including gaming disorder in the ICD-11: The need to do so from a clinical and public health perspective.

The proposed introduction of gaming disorder (GD) in the 11th revision of the International Classification of Diseases (ICD-11) developed by the World Health Organization (WHO) has led to a lively debate over the past year. Besides the broad support for the decision in the academic press, a recent publication by van Rooij et al. (2018) repeated the criticism raised against the inclusion of GD in ICD-11 by Aarseth et al. (2017). We argue that this group of researchers fails to recognize the clinical and public health considerations, which support the WHO perspective. It is important to recognize a range of biases that may influence this debate; in particular, the gaming industry may wish to diminish its responsibility by claiming that GD is not a public health problem, a position which maybe supported by arguments from scholars based in media psychology, computer games research, communication science, and related disciplines. However, just as with any other disease or disorder in the ICD-11, the decision whether or not to include GD is based on clinical evidence and public health needs. Therefore, we reiterate our conclusion that including GD reflects the essence of the ICD and will facilitate treatment and prevention for those who need it.

Measurement Invariance of the Short Version of the Problematic Mobile Phone Use Questionnaire (PMPUQ-SV) across Eight Languages.

The prevalence of mobile phone use across the world has increased greatly over the past two decades. Problematic Mobile Phone Use (PMPU) has been studied in relation to public health and comprises various behaviours, including dangerous, prohibited, and dependent use. These types of problematic mobile phone behaviours are typically assessed with the short version of the Problematic Mobile Phone Use Questionnaire (PMPUQ⁻SV). However, to date, no study has ever examined the degree to which the PMPU scale assesses the same construct across different languages. The aims of the present study were to (i) determine an optimal factor structure for the PMPUQ⁻SV among university populations using eight versions of the scale (i.e., French, German, Hungarian, English, Finnish, Italian, Polish, and Spanish); and (ii) simultaneously examine the measurement invariance (MI) of the PMPUQ⁻SV across all languages. The whole study sample comprised 3038 participants. Descriptive statistics, correlations, and Cronbach's alpha coefficients were extracted from the demographic and PMPUQ-SV items. Individual and multigroup confirmatory factor analyses alongside MI analyses were conducted. Results showed a similar pattern of PMPU across the translated scales. A three-factor model of the PMPUQ-SV fitted the data well and presented with good psychometric properties. Six languages were validated independently, and five were compared via measurement invariance for future cross-cultural comparisons. The present paper contributes to the assessment of problematic mobile phone use because it is the first study to provide a cross-cultural psychometric analysis of the PMPUQ-SV.

Mobile gaming and problematic smartphone use: A comparative study between Belgium and Finland.

Background and aims Gaming applications have become one of the main entertainment features on smartphones, and this could be potentially problematic in terms of dangerous, prohibited, and dependent use among a minority of individuals. A cross-national study was conducted in Belgium and Finland. The aim was to examine the relationship between gaming on smartphones and self-perceived problematic smartphone use via an online survey to ascertain potential predictors. Methods The Short Version of the Problematic Mobile Phone Use Questionnaire (PMPUQ-SV) was administered to a sample comprising 899 participants (30% male; age range: 18-67 years). Results Good validity and adequate reliability were confirmed regarding the PMPUQ-SV, especially the dependence subscale, but low prevalence rates were reported in both countries using the scale. Regression analysis showed that downloading, using Facebook, and being stressed contributed to problematic smartphone use. Anxiety emerged as predictor for dependence. Mobile games were used by one-third of the respective populations, but their use did not predict problematic smartphone use. Very few cross-cultural differences were found in relation to gaming through smartphones. Conclusion Findings suggest mobile gaming does not appear to be problematic in Belgium and Finland.