Medication adherence halves COPD patients' hospitalization risk - evidence from Swiss health insurance data.

Medication adherence is vital for patients suffering from Chronic Obstructive Pulmonary Disease (COPD) to mitigate long-term consequences. The impact of poor medication adherence on inferior outcomes like exacerbations leading to hospital admissions is yet to be studied using real-world data. Using Swiss claims data from 2015-2020, we group patients into five categories according to their medication possession ratio. By employing a logistic regression, we quantify each category's average treatment effect of the medication possession ratio on hospitalized exacerbations. 13,557 COPD patients are included in the analysis. Patients with high medication adherence (daily medication reserve of 80% to 100%) are 51% less likely to incur exacerbation following a hospital stay than patients with the lowest medication adherence (daily medication reserve of 0% to 20%). The study shows that medication adherence varies strongly among Swiss COPD patients. Furthermore, high medication adherence immensely decreases the risk of hospitalized exacerbations.

Gender health gap pre- and post-joint arthroplasty: identifying affected patient-reported health domains.

BACKGROUND: As patient-reported outcomes (PROs) gain prominence in hip and knee arthroplasty (HA and KA), studies indicate PRO variations between genders. Research on the specific health domains particularly impacted is lacking. Hence, we aim to quantify the gender health gap in PROs for HA/KA patients, differentiating between general health, health-related quality of life (HrQoL), physical functioning, pain, fatigue, and depression. METHODS: The study included 3,693 HA patients (1,627 men, 2,066 women) and 3,110 KA patients (1,430 men, 1,680 women) receiving surgery between 2020 to 2021 in nine German hospitals, followed up until March 2022. Questionnaires used were: EQ-VAS, EQ-5D-5L, HOOS-PS, KOOS-PS, PROMIS-F-SF, PROMIS-D-SF, and a joint-specific numeric pain scale. PROs at admission, discharge, 12-months post-surgery, and the change from admission to 12-months (PRO-improvement) were compared by gender, tested for differences, and assessed using multivariate linear regressions. To enable comparability, PROs were transformed into z-scores (standard deviations from the mean). RESULTS: Observed differences between genders were small in all health domains and differences reduced over time. Men reported significantly better health versus women pre-HA (KA), with a difference of 0.252 (0.224) standard deviations from the mean for pain, 0.353 (0.243) for fatigue (PROMIS-F-SF), 0.327 (0.310) for depression (PROMIS-D-SF), 0.336 (0.273) for functionality (H/KOOS-PS), 0.177 (0.186) for general health (EQ-VAS) and 0.266 (0.196) for HrQoL (EQ-5D-5L). At discharge, the gender health gap reduced and even disappeared for some health dimensions since women improved in health to a greater extent than men. No gender health gap was observed in most PRO-improvements and at month 12. CONCLUSIONS: Men experiencing slightly better health than women in all health dimensions before surgery while experiencing similar health benefits 12-months post-surgery, might be an indicator of men receiving surgery inappropriately early, women unnecessarily late or both. As studies often investigate the PRO-improvement, they miss pre-surgery gender differences, which could be an important target for improvement initiatives in patient-centric care. Moreover, future research on cutoffs for meaningful between-group PRO differences per measurement time would aid the interpretation of gender health disparities. TRIAL REGISTRATION: German Register for Clinical Trials, DRKS00019916, 26 November 2019.

Examining the interplay between internet use disorder tendencies and well-being in relation to sofalizing during the COVID-19 pandemic.

AIMS: The present study investigated the potential links between Internet Use Disorder tendencies, well-being and the impact of COVID-19 on Internet usage patterns. METHOD: A sample of 2498 participants filled out the Compulsive Internet Use Scale (CIUS), the Satisfaction with Life Scale (SWLS; the cognitive facet of well-being) and the Sofalizing Scale which comprises the Online Displacement and Social Compensation dimensions. Participants were also asked to report the extent to which changes in Internet use occurred due to COVID-19 pandemic (i.e., reductions, no changes, increases). The present study comprised a survey study with cross-sectional character. RESULTS: The statistical analyses demonstrated that the aforementioned variables were robustly associated with each other. In a first mediation model, the association between higher levels of Internet Use Disorder and reduced well-being was partially mediated by the two dimensions of the Sofalizing scale called Online Displacement and Social Compensation. The results of the second mediation model showed that the relationship between changes in Internet use due to COVID-19 pandemic and well-being was fully mediated by CIUS scores, suggesting that increased Internet use due to the COVID-19 pandemic increased levels of Internet Use Disorder tendencies, which in turn decreased levels of well-being. DISCUSSION: The findings are discussed in the context of human social needs in a time of crisis, where meeting people in-person was restricted.

What is the association between gender and self-perceived health status when controlling for disease-specific conditions? A retrospective data analysis of pre- and post-operative EQ-5D-5L differences in total hip and knee arthroplasty.

BACKGROUND: The self-perceived health status of patients undergoing total hip and knee arthroplasty (THA and TKA) might differ post-operatively due to gender, age, or comorbidities. Patient-reported outcome measures (PROMs) such as the EQ-5D-5L measure the self-perceived health status. This study investigates whether the index score of the EQ-5D-5L is a valid tool for interpreting gender differences in outcomes for patients undergoing THA and TKA. METHODS: Routine and PROM-data of elective primary THA or TKA patients in two German hospitals between 2016 and 2018 were analyzed. Univariate analysis with Pearson's chi-square was conducted to identify control variables for gender. To quantify the association between gender and the EQ-5D-5L dimensions, a cumulative odds ordinal logistic regression with proportional odds was conducted. RESULTS: Two thousand three hundred sixty-eight​​ THA patients (m = 978; f = 1390) and 1629 TKA patients (m = 715; f = 914) were considered. The regression analysis of the individual EQ-5D-5L dimensions showed that female gender was significantly associated with better self-care (THA and TKA) and better post-operative mobility (THA). In contrast, male gender was significantly associated with less pain/discomfort (TKA) and less anxiety/depression (THA) pre-surgery and 3-months post-surgery. CONCLUSION: Our results confirmed that the self-perceived health status improved after surgery. However, due to the different associations of gender to the individual dimensions of the EQ-5D-5L, the weighted index score clouds the comparability between patients with different gender undergoing THA or TKA. Therefore, we argue to use the individual five dimensions for health status analysis, to reveal relevant additional information.

Patients undergoing total hip and knee arthroplasty (THA and TKA) can fill out standardized questionnaires pre- and post-surgery, such as the EQ-5D-5L, to measure the improvement in the self-perceived health status. The EQ-5D-5L includes mobility, self-care, usual activity, pain/discomfort, and anxiety/depression. We do not know whether male and female patients experience the same improvement in the dimensions or whether significant differences exist. Currently, only index scores of the EQ-5D-5L are used for the comparison of pre- and post-operative health status. However, due to the questionnaire's weighted composition, relevant changes in individual dimensions might be easily missed. Thus, we investigated whether significant differences between gender and the EQ-5D-5L dimensions in patients undergoing TKA and TKA are observable. We found that female patients reported significantly better scores in self-care (THA and TKA) and post-operative mobility (THA). In contrast, male gender was significantly associated with less pain/discomfort (TKA) and less anxiety/depression (THA) pre-surgery and 3-months post-surgery. The EQ-5D-5L's weighted index score, however, does not directly represent these differences. Therefore, we argue to use the individual five dimensions for health status analysis, as relevant additional information on improvement over time would otherwise be missed.

Making the cut on caesarean section: a logistic regression analysis on factors favouring caesarean sections without medical indication in comparison to spontaneous vaginal birth.

BACKGROUND: In the absence of medical necessity, opting for caesarean sections exposes mothers and neonates to increased risks of enduring long-term health problems and mortality. This ultimately results in greater economic burden when compared to the outcomes of spontaneous vaginal births. In Switzerland around 33% of all births are by caesarean section. However, the rate of caesarean sections without medical indication is still unknown. Therefore, we devise an identification strategy to differentiate caesarean sections without medical indication using routine data. In addition, we aim to categorize the influencing factors for women who undergo spontaneous vaginal births as opposed to those with caesarean sections without medical indication. METHOD: We use Swiss Federal Statistics data including 98.3% of all women giving birth from 2014 to 2018. To determine non-medically indicated caesarean sections in our dataset, we base our identification strategy on diagnosis-related groups, diagnosis codes, and procedure classifications. Subsequently, we compare characteristics of women who give birth by non-medically CS and external factors such as the density of practicing midwives to women with spontaneous vaginal birth. Logistic regression analysis measures the effect of factors, such as age, insurance class, income, or density of practicing midwives on non-medically indicated caesarean sections. RESULTS: Around 8% of all Swiss caesarean sections have no medical indication. The regression analysis shows that higher age, supplemental insurance, higher income, and living in urban areas are associated with non-medically indicated caesarean sections, whereas a higher density of midwives decreases the likelihood of caesarean sections without medical indication. CONCLUSIONS: By identifying non-medically indicated caesarean sections using routine data, it becomes feasible to gain insights into the characteristics of impacted mothers as well as the external factors involved. Illustrating these results, our recommendation is to revise the incentive policies directed towards healthcare professionals. Among others, future research may investigate the potential of midwife-assisted pregnancy programs on strengthening spontaneous vaginal births in absence of medical complications.

Internet Use Disorders: Subjective Importance of Online Friends in the Context of Real-Life Social Support and Comorbid Mental Disorders.

INTRODUCTION: Previous studies analyzing friendships with people only known through the Internet mainly focused on quantitative aspects (e.g., the number of online friends or the time spent with them). Little is known about the perceived quality of online compared to real-life friends in individuals with an Internet use disorder (IUD). This study aimed to analyze associations of the increased subjective importance of online friends and IUD by controlling for the perceived real-life social support and comorbid mental disorders. METHODS: Based on a general population sample, 192 participants who were screened positive for risky Internet use took part in face-to-face clinical diagnostic interviews. IUD was assessed using the structure of the Munich-Composite International Diagnostic Interview (M-CIDI) and the adapted criteria of Internet gaming disorder in the 5th edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5). The number and the increased subjective importance of online compared to real-life friends were assessed with the Online and Real-Life Friends scale (ORLF), real-life social support was assessed with the Berlin Social Support Scales (BSSS), and comorbidity was assessed with the M-CIDI. Data were analyzed with binary regression models. RESULTS: Of 192 participants with risky Internet use, 39 participants (19 men; age M = 29.9, SD = 12.2) fulfilled the criteria of IUD in the last 12 months. IUD was not associated with the number or perceived social support of online friends per se. In multivariate analyses, IUD was associated with increased subjective importance of online friends, independently from comorbid anxiety or mood disorders. However, when controlling for real-life social support, associations of IUD and increased subjective importance of online friends were no longer present. CONCLUSION: These findings highlight the necessity of therapeutic interventions aimed at strengthening social skills and engaging in real-life relationships in the prevention and therapy of IUD. Due to the small sample size and the cross-sectional analysis, however, further research is needed.

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.

Psychometric Properties of Screening Instruments for Social Network Use Disorder in Children and Adolescents: A Systematic Review.

Importance: Children and adolescents spend considerable time on the internet, which makes them a highly vulnerable group for the development of problematic usage patterns. A variety of screening methods have already been developed and validated for social network use disorder (SNUD); however, a systematic review of SNUD in younger age groups has not been performed. Objective: To review published reports on screening tools assessing SNUD in children and adolescents with a maximum mean age of 18.9 years. Evidence Review: To identify instruments for the assessment of SNUD, a systematic literature search was conducted in the databases PsycINFO, PubMed, Web of Science, PsycArticles, and Scopus. The final search took place on May 2, 2022. Psychometric properties of available tools were examined and evaluated to derive recommendations for suitable instruments for individuals up to 18 years of age. Findings: A total of 5746 publications were identified, of which 2155 were excluded as duplicates. Of the remaining 3591 nonredundant publications, 3411 studies were assessed as not relevant after title and abstract screening. A full-text analysis of 180 remaining studies classified as potentially eligible resulted in a final inclusion of 29 studies revealing validation evidence for a total of 19 tools. The study quality was mostly moderate. With regard to validation frequency, 3 tools exhibited the largest evidence base: Social Media Disorder Scale (SMDS), the short version of the Bergen Facebook Addiction Scale, and Bergen Social Media Addiction Scale-Short Form (BSMAS-SF). Among these, 1 study tested a parental version (SMDS-P) for its psychometric properties. Taking all criteria into account, the strongest recommendation was made for the SMDS and BSMAS-SF. Conclusions and Relevance: Results suggest that the SMDS-SF and BSMAS-SF were appropriate screening measures for SNUD. Advantages of the SMDS are the availability of a short version and the possibility of an external parental rating.

Study protocol for a randomised controlled trial of an e-health stepped care approach for the treatment of internet use disorders versus a placebo condition: the SCAPIT study.

INTRODUCTION: Excessive internet use can lead to problems for some individuals. The WHO has introduced Gaming Disorder in the International Classification of Diseases-11 (ICD-11). Previous research has shown that other internet applications can cause serious mental health problems as well. It is important to provide measures of prevention, early intervention and therapy for internet use disorders (IUDs). METHODS AND ANALYSIS: The study 'Stepped Care Approach for Problematic Internet use Treatment' is a randomised, two-arm, parallel-group, observer-blind trial. The aim of the study is to investigate if a stepped care approach is effective to reduce symptom severity for IUD. The sample is primarily recruited online with a focus on employees in companies with support of health insurances. After screening, the stepped care approach depends on the success of the previous step-that is, the successful reduction of criteria-and comprise: (1) app-intervention with questionnaires and feedback, (2) two telephone counsellings (duration: 50 min) based on motivational interviewing, (3) online therapy over 17 weeks (15 weekly group sessions, eight individual sessions) based on cognitive-behavioural therapy. A follow-up is conducted after 6 months. A total of 860 participants will be randomised. Hierarchical testing procedure is used to test the coprimary endpoints number of Diagnostic and Statistical Manual of Mental Disorders, fifth edition and ICD-11 criteria. Primary analysis will be performed with a sequential logit model. ETHICS AND DISSEMINATION: The study has been approved by the Ethics Committees of the Universities of Lübeck (file number: 21-068), Mainz (file number: 2021-15907) and Berlin (file number: 015.2021). Results will be reported in accordance to the CONSORT statement. If the approach is superior to the control condition, it may serve as part of treatment for IUD. TRIAL REGISTRATION NUMBER: DRKS00025994.

Motivational brief interventions for adolescents and young adults with Internet use disorders: A randomized-controlled trial.

Background: Adolescents and young adults (AYA) have an increased risk for Internet use disorders (IUD) compared to older individuals that may lead to functional impairments in daily life. To date, evidence-based brief interventions are lacking. This study aimed to test the efficacy of a low-threshold counseling approach based on Motivational Interviewing (MI) in a vocational school setting. Methods: Of 8.230 vocational students (age M=20.56, SD=4.68; 51.85% female) being proactively screened for IUD, 937 with positive screenings took part in telephone-based diagnostic interviews. IUD were assessed in line with the criteria of the Internet Gaming Disorder in the Diagnostic and Statistical Manual of Mental Disorders, 5th edition (DSM-5). Readiness to change, self-efficacy, and impairments in daily life were additionally assessed with standardized screening instruments. Participants fulfilling at least two IUD criteria were randomized to the intervention group (n=240, up to three MI-based counseling sessions via telephone) or the control group (n=257, information brochure on responsible Internet use). Follow-up interviews were conducted after five and ten months. The primary outcome was the reduction of IUD criteria. Secondary outcomes were improvements of readiness/ self-efficacy to change and the reduction of daily impairments. Data were analyzed with Intention-to-Treat (ITT) and complier average causal effect (CACE) analyses. Results: Overall, 153 (63.75%) individuals assigned to the intervention group participated at least in one counseling session (=compliers). Both groups reduced the number of IUD criteria over time. In ITT analyses, however, we did not find intervention effects for primary and secondary outcomes. Bayes statistics were inconclusive. Based on low participation rates in the intervention group, explorative CACE analyses were conducted to compare compliers in the intervention group to potential compliers in the control group. Again, we did not find intervention effects apart from improvements in self-efficacy after five months. Discussion: Telephone-based counseling seems not appropriate to address AYA at risk for IUD. Low participation rates in the intervention group caused underpowered analyses. Besides, dealing with the own Internet use during intensive assessments and receiving an information brochure led to behavioral changes also in the control group. Since the efficacy of brief interventions under the condition of higher participation rates cannot be fully ruled out, further research is required by taking the implications of this study into account.

Think-aloud analysis of commonly used screening instruments for Internet use disorders: The CIUS, the IGDT-10, and the BSMAS.

Background: Despite the constant publication of new screening instruments for Internet use disorders (IUD), little is known about their content validity. This study aimed to identify potential mismatches between the items' intention and young adults' interpretation of these items when answering three screening instruments that are commonly used in research and clinical settings: The Compulsive Internet Use Scale (CIUS), the 10 Item-Internet Gaming Disorder Test (IGDT-10), and the Bergen Social Media Addiction Scale (BSMAS). Methods: In total, 30 vocational students (50% female, age = 21.3; SD = 2.1) took part in individual think-aloud interviews. All participants were asked to report their thoughts while completing the CIUS. In addition, participants who reported online games (OG) as their main Internet activity (n = 11) answered the IGDT-10. Participants who reported social networks (SN) as their main Internet activity (n = 18) answered the BSMAS. One participant used OG and SN equally and completed both screening instruments. All interviews were audio-recorded, transcribed, and content-analysed. Results: Overall, four potential sources for errors were identified: (1) High scorings were often not congruent with the underlying diagnostic criteria. In particular, such discrepancies were found in items aimed to assess dysfunctional emotional regulation strategies and cognitive involvement. (2) Some participants were uncertain which time frame or Internet activity should be considered in their answers. (3) Long and complex items led to the building of mean values or the choice of the middle answer category. (4) Some wordings were perceived to be outdated and difficult to understand. Discussion: These findings might help to provide recommendations on how to improve screening instruments for IUD. Most important, items should more clearly distinguish between Internet use as a "normal" leisure activity and Internet use that leads to functional impairments in daily life.

Prevalence and self-rated health and depression of family members affected by addictive disorders: results of a nation-wide cross-sectional study.

AIMS: To estimate the prevalence of family members affected by addictive disorders (FMA) with regard to various types of addictive disorders, and self-rated health and depression in the general population. DESIGN: Cross-sectional general population survey. SETTING: The German Health Update study (GEDA) 2014/2015, a nationally representative panel of German residents aged 15 years or older. PARTICIPANTS: A total of 24 824 residents aged 15 years or older. MEASUREMENTS: Participants were asked if they had a family member with current or past addictive disorder, the type of addiction and the relationship status. In addition, self-rated health and depression were assessed using standardized questionnaires. FINDINGS: Of the respondents, 9.5% [95% confidence interval (CI) = 9.0-10.0] reported being affected by a current addictive disorder of a relative (cFMA), with a further 4.5% (95% CI = 4.2-4.9) reported having been affected by the addictive disorders of a relative in the past but not within the last 12 months (pFMA). Most FMAs reported having been affected by disorders due to alcohol, followed by cannabis and other drugs. Compared with life-time non-FMAs, FMAs reported significantly (P < 0.001) higher odds ratios for depression (cFM = 2.437; 95% CI = 2.082-2.853; pFMA = 1.850; 95% CI = 1.519-2.253) and ill-health (cFMA = 1.574; 95% CI = 1.374-1.805; pFMA = 1.297; 95% CI = 1.082-1.555). CONCLUSIONS: In Germany, family members affected by addictive disorder are a substantial group within the general population. This group is characterized by ill-health and has not yet been adequately addressed by the addiction treatment system.

Dispositional and online-specific Fear of Missing Out are associated with the development of IUD symptoms in different internet applications.

BACKGROUND AND AIMS: An increasing number of people experience negative consequences from the excessive use of different Internet applications or sites (e.g., Instagram, League of Legends, YouTube). These consequences have been referred to as specific Internet Use Disorders (IUDs). The present study aims to examine the Fear of Missing Out (FoMO) on rewarding experiences with respect to specific Internet activities. FoMO has been found to mediate the link between psychopathology and symptoms of Internet Communication Disorder (ICD). However, the role of FoMO in other IUDs is controversial. METHODS: The current study (N = 7,990) consecutively screened in vocational schools) analyzed the associations between online-specific state-FoMO, general trait-FoMO, mental health, and IUD symptoms in a structural equation model. After testing the model for the entire sample of Internet users, it was analyzed separately for the two main user groups: Social Networking Site (SNS) users and gamers. RESULTS: The proposed model explained 42.0% of the variance in IUD symptoms in the total sample, 46.8% for SNS users, and 32.8% for gamers. Results suggest that impaired mental health and high trait-FoMO predict IUD symptoms. For both SNS users and gamers, trait-FoMO mediated the link between low mental health and IUD, whereas state-FoMO mediated the link between trait-FoMO and IUD in both user groups. DISCUSSION: Our results partly support the theoretical model of specific IUDs, highlighting trait-FoMO as a predisposing fear of disconnection related to general mental health. Online-specific FoMO appears to contribute to problematic Internet use mainly because of its link to the general fear of disconnection. Moreover, the described mechanism seems to be comparable for both females and males. CONCLUSIONS: FoMO is a multidimensional construct underlying IUD symptoms related to the use of socially gratifying, but distinct Internet applications. FoMO and psychopathology should be targeted together in prevention and treatment plans of IUDs.

Association of Increased Impulsiveness and Internet Use Disorder in Adolescents and Young Adults with Different Main Activities on the Internet.

Objective: Increased impulsiveness is a risk factor for health-endangering behavior patterns. Little is known about whether increased impulsiveness is associated with Internet Use Disorder (IUD) and whether individuals with various main activities on the internet differ in their levels of impulsiveness. Methods: In total, we screened 8,230 vocational students for problematic internet use with the Compulsive Internet Use Scale (CIUS). Participants scoring at least 21 points in the CIUS took part in an in-depth diagnostic interview. IUD was assessed according to the criteria of Internet Gaming Disorder (IGD) as suggested in the 5th edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5). Impulsiveness was assessed with the Barratt Impulsiveness Scale (BIS-15). We analyzed the data using binary logistic regression models and nonparametric tests. Results: Participants with IUD (n = 144) showed increased impulsiveness (p = .005) compared to those without IUD (n = 774). Participants with different main activities on the internet did not differ in their levels of impulsiveness. Conclusions: Results indicate that impulsiveness is associated with IUD, independent of the main internet activity. This highlights the necessity to consider patients' impulsiveness in prevention and therapeutic approaches. Because of the cross-sectional study design, further research with longitudinal study designs is needed.

Motivational Interviewing: An Evidence-Based Approach for Use in Medical Practice.

BACKGROUND: Motivational factors in health-relevant modes of behavior are an important matter in medical practice. Motivational interviewing (MI) is a technique that has been specifically developed to help motivate ambivalent patients to change their behav - ior. METHODS: This review is based on pertinent publications retrieved by a selective search in the PubMed, Cochrane, and Web of Science databases. Special attention was paid to systematic reviews and meta-analyses concerning the efficacy of MI in the medical care of various target groups. The present review focuses on the relevance of MI for patients with highly prevalent disorders. RESULTS: Meta-analyses reveal statistically significant mean intervention effects of MI in medical care with respect to a variety of health-relevant modes of behavior, in comparison to standard treatment and no treatment in the control groups (odds ratio [OR]: 1.55; 95% confidence interval: [1.40; 1.71]). Statistically significant effect sizes were reported for substance consumption, physical activity, dental hygiene, body weight, treatment adherence, willingness to change behavior, and mortality; effects on healthpromoting behavior were mixed. Studies of the factors that contribute to the efficacy of MI suggest that it exerts its effects largely through the selective reinforcement of statements made by the patients themselves about potential changes in their behavior. CONCLUSION: MI has been found useful for strengthening the motivation for behavioral change in patients with various behavioral - ly influenced health problems and for promoting treatment adherence. It can be used to optimize medical interventions. Further research is needed with respect to its specific mechanisms of action, its efficacy in reinforcing health-promoting modes of be - havior, differential indications for different patient groups, and the cost-efficiency of the technique across the spectrum of disorders in which it is used.

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.

Performance of the DSM-5-based criteria for Internet addiction: A factor analytical examination of three samples.

BACKGROUND AND AIMS: The diagnosis "Internet Gaming Disorder" (IGD) has been included in the fifth edition of Diagnostic and Statistical Manual of Mental Disorders. However, the nine criteria have not been sufficiently reviewed for their diagnostic value. This study focuses on a broader approach of Internet addiction (IA) including other Internet activities. It is not yet clear what the construct of IA is in terms of dimensionality and homogeneity and how the individual criteria contribute to explained variance. METHODS: Three separate exploratory factor analyses and multinomial logistic regression analyses were carried out based on information collected from a general population-based sample (n = 196), a sample of people recruited at job centers (n = 138), and a student sample (n = 188). RESULTS: Both of the adult samples show a distinct single-factor solution. The analysis of the student sample suggests a two-factor solution. Only one item (criterion 8: escape from a negative mood) can be assigned to the second factor. Altogether, high endorsement rates of the eighth criterion in all three samples indicate low discriminatory power. DISCUSSION AND CONCLUSIONS: Overall, the analysis shows that the construct of IA is represented one dimensionally by the diagnostic criteria of the IGD. However, the student sample indicates evidence of age-specific performance of the criteria. The criterion "Escape from a negative mood" might be insufficient in discriminating between problematic and non-problematic Internet use. The findings deserve further examination, in particular with respect to the performance of the criteria in different age groups as well as in non-preselected samples.

Deficits in emotion regulation strategies among problematic and pathological gamblers in a sample of vocational school students.

BACKGROUND AND AIMS: Deficits in emotion regulation (ER) are associated with mental disorders. To date, there are hardly any studies focusing on the role of ER strategies in the context of gambling behavior. The aim of this study was to investigate the association between specific ER strategies and pathological as well as problematic gambling in a proactively recruited sample. METHODS: A large and unselected sample (n = 4,928) has been screened proactively and systematically in vocational schools. We assessed the Affective Style Questionnaire to measure ER strategies and the Stinchfield questionnaire for assessing problematic and pathological gambling. Associations were investigated with linear and multinomial logistic regression analyses. RESULTS: The analyses showed a significant negative correlation between the subscales "Adjusting" and "Tolerating" and the Stinchfield sum score. Lower scores on these subscales were associated with a higher number of endorsed Stinchfield items. A lower score on the ER strategies "Adjusting" [conditional odds ratio (COR) = 0.95, confidence interval (CI) = 0.91-0.99] and "Tolerating" [COR = 0.95, CI = 0.92-99] led to a higher chance of being classified as a pathological gambler. In problematic gambling, on a subthreshold level, only "Tolerating" turned out to be significant [COR = 0.96, CI = 0.93-0.99]. DISCUSSION AND CONCLUSIONS: For the first time, deficits in specific ER strategies were identified as independent risk factors for problematic and pathological gambling in a large and proactively recruited sample. ER skills, especially acceptance-focused strategies, should be considered in prevention and psychotherapy.

The role of self-esteem in Internet addiction within the context of comorbid mental disorders: Findings from a general population-based sample.

BACKGROUND AND AIMS: Internet Addiction (IA) has consistently been related to comorbid psychiatric disorders and lowered self-esteem. However, most studies relied on self-report questionnaires using non-representative samples. This study aims to analyze the relative impact of self-esteem and comorbid psychopathology with lifetime IA in a population-based sample of excessive Internet users using clinical diagnoses assessed in a personal interview. METHODS: The sample of this study is based on a general population survey. Using the Compulsive Internet Use Scale, all participants with elevated Internet use scores were selected and invited to a follow-up interview. Current DSM-5 criteria for Internet gaming disorder were rephrased to apply to all Internet activities. Out of 196 participants, 82 fulfilled the criteria for IA. Self-esteem was measured with the Rosenberg's Self-Esteem Scale. RESULTS: Self-esteem is significantly associated with IA. For every unit increase in self-esteem, the chance of having IA decreased by 11%. By comparison, comorbidities such as substance-use disorder (excluding tobacco), mood disorder, and eating disorder were significantly more likely among Internet-addicted than in the non-addicted group. This could not be reported for anxiety disorders. A logistic regression showed that by adding self-esteem and psychopathology into the same model, self-esteem maintains its strong influence on IA. DISCUSSION AND CONCLUSIONS: Self-esteem was associated with IA, even after adjustment for substance-use disorders, mood disorder, and eating disorder. Self-esteem and psychopathology should be considered in prevention, intervention measures, as well as in the conception of etiological models.

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.