%0 Journal Article %@ 1438-8871 %I JMIR Publications %V 27 %N %P e72414 %T Exploring the Relationship Between Cyberchondria and Suicidal Ideation: Cross-Sectional Mediation Analysis %A Xu,Richard Huan %A Liang,Xiao %A Starcevic,Vladan %+ Department of Rehabilitation Sciences, Faculty of Health and Social Sciences, Hong Kong Polytechnic University, ST-538, Hung Hom, Kowloon, Hong Kong, China (Hong Kong), 852 27664199, richard.xu@polyu.edu.hk %K cyberchondria %K suicidal ideation %K distress %K structural equation modeling %K mediation analysis %D 2025 %7 2.4.2025 %9 Original Paper %J J Med Internet Res %G English %X Background: The proliferation of internet-based health information has intensified cyberchondria, or anxiety resulting from excessive health-related searches. The relationship between cyberchondria and suicidal ideation remains underexplored, although there are indications that people with high levels of cyberchondria may also be suicidal. Understanding this relationship is critical, given rising digital health-seeking behaviors and the need to mitigate suicide risk. Emerging evidence suggests that psychological distress can mediate the relationship between cyberchondria and suicidal ideation. However, to the best of our knowledge, no research has directly examined these associations. Objective: This study had two aims. The first was to examine the relationship between cyberchondria and suicidal ideation in a sample of the general Chinese population. The second aim was to investigate the possible role of psychological distress, reflecting the symptoms of depression and anxiety, as a mediator in the relationship between cyberchondria and suicidal ideation. Methods: Data were obtained from a cross-sectional and web-based survey conducted in 2024. Structural equation modeling analysis was used to assess the hypothesized association between cyberchondria and suicidal ideation, as well as the mediating effect of psychological distress on this association. The Cyberchondria Severity Scale-12 items, Suicidal Ideation Attributes Scale, and Kessler Psychological Distress Scale-10 items were used to measure cyberchondria, suicidal ideation, and psychological distress, respectively. Standardized (β) estimates, along with their 95% CIs, were calculated for all structural paths, adjusting for participants’ background characteristics. Results: A total of 2415 individuals completed the questionnaire (response rate=98.5%). Scores on the Cyberchondria Severity Scale-12 items ranged from 12 to 60, with the mean score being 40 (SD 7.9). The mean score on the Suicidal Ideation Attributes Scale was 12.7 (SD 9.9). Scores on the Kessler Psychological Distress Scale-10 items ranged from 10 to 50, and the mean score was 22 (SD 6.9). Cyberchondria, suicidal ideation, and psychological distress were significantly correlated. Structural equation modeling revealed a significant association between cyberchondria and psychological distress (β=.281; P<.001), between psychological distress and suicidal ideation (β=.504; P<.001), and between cyberchondria and suicidal ideation (β=.107; P<.001). The indirect effect of cyberchondria on suicidal ideation through psychological distress was also significant (β=.142; P<.001). Conclusions: The main contribution of this study is that it highlights an important relationship between cyberchondria and suicidal ideation, with a direct and statistically significant association between these variables. Their relationship is also mediated by psychological distress, which reflects the role of depressive and anxiety symptoms. %M 40173445 %R 10.2196/72414 %U https://www.jmir.org/2025/1/e72414 %U https://doi.org/10.2196/72414 %U http://www.ncbi.nlm.nih.gov/pubmed/40173445 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 27 %N %P e55072 %T Patterns of Internet Use in People Diagnosed With Severe Mental Illness: Qualitative Interview Study %A Wadman,Ruth %A Walker,Lauren %A Taylor,Olivia %A Heron,Paul %A Newbronner,Elizabeth %A Spanakis,Panagiotis %A Crosland,Suzanne %A Peckham,Emily Jane %+ School of Medical and Health Sciences, Bangor University, Wrexham Technology Park,, Croesnewydd Road, Wrexham, LL13 7YP, United Kingdom, 44 7934877022, lrw24ltt@bangor.ac.uk %K severe mental illness %K internet use %K qualitative %K typology %K protective strategies %K digital divide %D 2025 %7 28.3.2025 %9 Original Paper %J J Med Internet Res %G English %X Background: People with severe mental illness (SMI) face profound health inequalities, which may be exacerbated by increased rates of digital exclusion, especially as health services move to online provision. The activities that people carry out online can affect how they feel about the internet and may determine whether a person has a positive or negative experience when using the internet. This, in turn, could affect their mental health. To support people with SMI in using digital technology and the internet safely, it is important to understand the internet and digital technology use of those with SMI and their perceived positive or negative impact on their mental health. Objective: This study aimed to explore the internet and digital technology use of those with SMI, with particular focus on any association between greater use of the internet and poorer self-reported mental health. Methods: We carried out a qualitative interview study with 16 people with SMI. The sample was drawn from a wider investigation of the impact of the pandemic and its restrictions on the health and well-being of 367 people with SMI. We purposively sampled from the wider study based on age, gender, frequency of internet use, and self-reported mental health. The data were analyzed by 2 researchers using framework analysis. Results: Participant experiences fell into 3 broad categories: those who had a positive or neutral internet-based experience, those who had negative or difficult experiences, and low users or those with poor digital literacy. Those who had positive or neutral experiences could be broken down into 2 subcategories: first, those with positive or neutral experiences of the internet who were similar in terms of the activities participated in, feelings reported, and their concerns about the internet, and second, conscious users who were mindful of their interaction with the internet world. Participants with difficult experiences fell into 2 categories: those with worries and fears related to using the internet and those who had difficulty limiting their internet use. Conclusions: People with SMI, similarly the general population, are expected to conduct more of their activities of daily living online in the postpandemic world. This research shows that most internet users with SMI have positive or neutral experiences. However, our typology reveals subgroups of the population with SMI for whom there is a relationship between internet use and difficult feelings. These subgroups can be identified by asking questions about online activities; time spent online; feelings, difficulties, or issues experienced; and use of gambling, dating, adult content, and conspiracy theory websites. Our findings point to further work in collaboration with people with lived experience to modify and test this typology. %M 40153777 %R 10.2196/55072 %U https://www.jmir.org/2025/1/e55072 %U https://doi.org/10.2196/55072 %U http://www.ncbi.nlm.nih.gov/pubmed/40153777 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 27 %N %P e65786 %T Mindfulness-Based Cognitive Therapy–Game: An Ironic Way to Treat Internet Gaming Disorder %A Kim,Jaehyun %A Oh,Hayoung %A Yoon,Anderson Sungmin %+ , College of Computing and Informatics, Sungkyunkwan University, 25-2, Sungkyunkwan-ro, Jongno-gu, Seoul, 03063, Republic of Korea, 82 01053895996, hyoh79@skku.edu %K cognitive behavior therapy %K psychosocial intervention %K video games %K internet gaming disorder %K internet addiction %K mindfulness %K mental health %D 2025 %7 27.3.2025 %9 Viewpoint %J J Med Internet Res %G English %X Internet gaming disorder (IGD) affects 3% of the global population and poses an increasing risk due to advancements in technology. However, there is currently no definitive treatment for this condition. IGD is not a primary disorder but rather a result of “self-prescription” in response to emotional stressors. Unlike conventional mental health treatments that focus on the disorder itself, it is crucial to provide alternative activities that can alleviate negative emotions. This paper extends the concept of the self-medication hypothesis and integrates it with cognitive models of cognitive behavioral therapy and mindfulness-based cognitive therapy. In addition, it introduces the mindfulness-based cognitive therapy–game (MBCT-G), a program designed to explore alternative activities through gaming, focusing on the processes of response and reward, which are not typically emphasized in traditional treatments. This study serves as the theoretical foundation for the development of MBCT-G. MBCT-G aims to train individuals in positive coping strategies that alleviate psychological distress, offering a novel approach to treating self-prescription disorders such as IGD. %M 40146992 %R 10.2196/65786 %U https://www.jmir.org/2025/1/e65786 %U https://doi.org/10.2196/65786 %U http://www.ncbi.nlm.nih.gov/pubmed/40146992 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 27 %N %P e66191 %T Transdiagnostic Compulsivity Traits in Problematic Use of the Internet Among UK Residents: Cross-Sectional Network Analysis Study %A Liu,Chang %A Chamberlain,Samuel %A Ioannidis,Konstantinos %A Tiego,Jeggan %A Grant,Jon %A Yücel,Murat %A Hellyer,Peter %A Lochner,Christine %A Hampshire,Adam %A Albertella,Lucy %+ School of Psychological Sciences, Monash University, Level 5, 18 Innovation Walk, Wellington Road, Clayton, 3800, Australia, 61 07 33620222, chang.liu7@monash.edu %K compulsivity %K problematic use of the internet %K network analysis %K perfectionism %K reward drive %K cognitive rigidity %K transdiagnostic %K PUI %K mental health %K intrapersonal factor %K cognitive %K internet use %K network %D 2025 %7 26.3.2025 %9 Original Paper %J J Med Internet Res %G English %X Background: The societal and public health costs of problematic use of the internet (PUI) are increasingly recognized as a concern across all age groups, presenting a growing challenge for mental health research. International scientific initiatives have emphasized the need to explore the potential roles of personality features in PUI. Compulsivity is a key personality trait associated with PUI and has been recognized by experts as a critical factor that should be prioritized in PUI research. Given that compulsivity is a multidimensional construct and PUI encompasses diverse symptoms, different underlying mechanisms are likely involved. However, the specific relationships between compulsivity dimensions and PUI symptoms remain unclear, limiting our understanding of compulsivity’s role in PUI. Objective: This study aimed to clarify the unique relationships among different dimensions of compulsivity, namely, perfectionism, reward drive, cognitive rigidity, and symptoms of PUI using a symptom-based network approach. Methods: A regularized partial-correlation network was fitted using a large-scale sample from the United Kingdom. Bridge centrality analysis was conducted to identify bridge nodes within the network. Node predictability analysis was performed to assess the self-determination and controllability of the nodes within the network. Results: The sample comprised 122,345 individuals from the United Kingdom (51.4% female, age: mean 43.7, SD 16.5, range 9-86 years). The analysis identified several strong mechanistic relationships. The strongest positive intracluster edge was between reward drive and PUI4 (financial consequences due to internet use; weight=0.11). Meanwhile, the strongest negative intracluster edge was between perfectionism and PUI4 (financial consequences due to internet use; weight=0.04). Cognitive rigidity showed strong relationships with PUI2 (internet use for distress relief; weight=0.06) and PUI3 (internet use for loneliness or boredom; weight=0.07). Notably, reward drive (bridge expected influence=0.32) and cognitive rigidity (bridge expected influence=0.16) were identified as key bridge nodes, positively associated with PUI symptoms. Meanwhile, perfectionism exhibited a negative association with PUI symptoms (bridge expected influence=–0.05). The network’s overall mean predictability was 0.37, with PUI6 (compulsion, predictability=0.55) showing the highest predictability. Conclusions: The findings reveal distinct relationships between different dimensions of compulsivity and individual PUI symptoms, supporting the importance of choosing targeted interventions based on individual symptom profiles. In addition, the identified bridge nodes, reward drive, and cognitive rigidity may represent promising targets for PUI prevention and intervention and warrant further investigation. %M 40137076 %R 10.2196/66191 %U https://www.jmir.org/2025/1/e66191 %U https://doi.org/10.2196/66191 %U http://www.ncbi.nlm.nih.gov/pubmed/40137076 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 27 %N %P e70483 %T New Perspective on Digital Well-Being by Distinguishing Digital Competency From Dependency: Network Approach %A Chen,Si %A Ebrahimi,Omid V %A Cheng,Cecilia %+ Department of Psychology, University of Hong Kong, Pokfulam, Hong Kong, China (Hong Kong), 852 39174224, ceci-cheng@hku.hk %K digital wellness %K affective well-being %K emotional regulation %K coping %K digital competence %K digital autonomy %K artificial intelligence %D 2025 %7 25.3.2025 %9 Original Paper %J J Med Internet Res %G English %X Background: In the digital age, there is an emerging area of research focusing on digital well-being (DWB), yet conceptual frameworks of this novel construct are lacking. The current conceptualization either approaches the concept as the absence of digital ill-being, running the risk of pathologizing individual digital use, or follows the general subjective well-being framework, failing to highlight the complex digital nature at play. Objective: This preregistered study aimed to address this gap by using a network analysis, which examined the strength of the relationships among affective (digital stress and web-based hedonic well-being), cognitive (online intrinsic needs satisfaction), and social (online social connectedness and state empathy) dimensions of DWB and their associations with some major DWB protective and risk factors (ie, emotional regulation, nomophobia, digital literacy, self-control, problematic internet use, coping styles, and online risk exposure). Methods: The participants were 578 adults (mean age 38.7, SD 13.14 y; 277/578, 47.9% women) recruited from the United Kingdom and the United States who completed an online survey. Two network models were estimated. The first one assessed the relationships among multiple dimensions of DWB, and the second examined the relationships between DWB dimensions and related protective and risk factors. Results: The 2 resulting network structures demonstrated high stability, with the correlation stability coefficients being 0.67 for the first and 0.75 for the second regularized Gaussian graphical network models. The first network indicated that all DWB variables were positively related, except for digital stress, which was negatively correlated with the most central node—online intrinsic needs satisfaction. The second network revealed 2 distinct communities: digital competency and digital dependency. Emotional regulation emerged as the most central node with the highest bridge expected influence, positively associated with emotion-focused coping in the digital competency cluster and negatively associated with avoidant coping in the digital dependency cluster. In addition, some demographic differences were observed. Women scored higher on nomophobia (χ24=10.7; P=.03) and emotion-focused coping (χ24=14.9; P=.01), while men scored higher on digital literacy (χ24=15.2; P=.01). Compared with their older counterparts, younger individuals scored lower on both emotional regulation (Spearman ρ=0.27; P<.001) and digital self-control (Spearman ρ=0.35; P<.001) and higher on both digital stress (Spearman ρ=−0.14; P<.001) and problematic internet use (Spearman ρ=−0.25; P<.001). Conclusions: The network analysis revealed how different aspects of DWB were interconnected, with the cognitive component being the most influential. Emotional regulation and adaptive coping strategies were pivotal in distinguishing digital competency from dependency. %M 40132188 %R 10.2196/70483 %U https://www.jmir.org/2025/1/e70483 %U https://doi.org/10.2196/70483 %U http://www.ncbi.nlm.nih.gov/pubmed/40132188 %0 Journal Article %@ 2368-7959 %I JMIR Publications %V 12 %N %P e59869 %T Problematic Digital Technology Use Measures in Children Aged 0 to 6 Years: Scoping Review %A Selak,Špela %A Horvat,Janja %A Žmavc,Mark %+ National Institute of Public Health, Trubarjeva cesta 2, Ljubjana, 1000, Slovenia, 386 1 620 36 45, spela.selak@nijz.si %K scoping review %K measures %K problematic digital technology use %K children %K early childhood %K mobile phone %D 2025 %7 18.3.2025 %9 Review %J JMIR Ment Health %G English %X Background: In the interest of accurately assessing the effects of digital technology use in early childhood, researchers and experts have emphasized the need to conceptualize and measure children’s digital technology use beyond screen time. Researchers have argued that many patterns of early digital technology use could be problematic, resulting in the emerging need to list and examine their measures. Objective: We aimed to review existing empirical literature that is using measures for problematic digital technology use in preschool children with the end goal of identifying a set of reliable and valid measures, predicting negative outcomes for children’s health, development, or well-being. Methods: We conducted a scoping review across the Web of Science, PubMed, and Google Scholar databases to identify peer-reviewed publications that were published from January 2012 to December 2023, were written in the English language, described an empirical study, and included a measure of problematic digital technology use beyond exposure (ie, screen time) in children aged 0 to 6 years. Results: The search yielded 95 empirical studies, in which 18 composite measures of problematic use and 23 measures of specific problematic use aspects were found. Existing composite measures conceptualize problematic use as either a group of risky behaviors or as a group of symptoms of a presumed underlying disorder, with the latter being more common. Looking at their conceptual background and psychometric properties, existing composite measures fall short of reliably assessing all the crucial aspects of problematic digital technology use in early childhood. Therefore, the benefits and shortcomings of single-aspect problematic digital technology use measures are evaluated and discussed. Conclusions: On the basis of current research, early exposure to digital technologies, device use before sleep, and solitary device use represent measures that have been consistently associated with negative outcomes for children. In addition, potential measures of problematic use include device use during meals, device use for emotional regulation, device multitasking, and technoference, warranting further research. Public health benefits of defining problematic digital technology use as a group of risky behaviors rather than a group of addiction symptoms are discussed. %M 40100254 %R 10.2196/59869 %U https://mental.jmir.org/2025/1/e59869 %U https://doi.org/10.2196/59869 %U http://www.ncbi.nlm.nih.gov/pubmed/40100254 %0 Journal Article %@ 2368-7959 %I JMIR Publications %V 12 %N %P e63431 %T Understanding Problematic Smartphone and Social Media Use Among Adults in France: Cross-Sectional Survey Study %A Karila,Laurent %A Scher,Nathaniel %A Draghi,Clement %A Lichte,Delphine %A Darmon,Ilan %A Boudabous,Hanene %A Lamallem,Hanah %A Bauduceau,Olivier %A Bollet,Marc %A Toledano,Alain %K problematic smartphone use %K digital mental health %K compulsive behavior %K social network addiction %K nomophobia %K phubbing %K screen time effects %K public health interventions %K cross-sectional %K French %K smartphone use %K social media %K France %K mobile phone %D 2025 %7 6.3.2025 %9 %J JMIR Ment Health %G English %X Background: The Evaluation of Digital Addiction (EVADD) study investigates problematic smartphone use in the digital age, as global smartphone users reached 55.88 million in France in 2023. With increased screen time from digital devices, especially smartphones, the study highlights adult use issues and associated risks. Objective: The aim of the study is to assess the prevalence of compulsive smartphone use among French adults and identify patterns of problematic behaviors, including their impact on daily activities, sleep, and safety. Methods: The EVADD study used a cross-sectional, nonprobability sample design, conducted from May 3 to June 5, 2023. Participants were recruited through the French mutual insurance company PRO-BTP. Data were collected anonymously via a digital questionnaire, including the Smartphone Compulsive Use Test, capturing information on social network engagement, device ownership, and daily screen use. Results: A total of 21,244 adults (average age 53, SD 15 years; 9844 female participants) participated. Among 21,244 participants, 8025 of 12,034 (66.7%) respondents exhibited compulsive smartphone use (P<.001). Additionally, 7,020 (36.7%) participants scored ≥8 on the Smartphone Compulsion Test, indicating addiction. Younger participants (18‐39 years) were significantly more likely to show signs of addiction (2504/4394, 57%; odds ratio 2.5, 95% CI 1.9‐3.2) compared to participants aged ≥60 years. Problematic behaviors included unsafe smartphone use while driving (5736/12,953, 44.3%), frequent smartphone use before bedtime (9136/21,244, 43%), and using smartphones in the bathroom (7659/21,244, 36.1%). Sleep disturbances and risky behaviors correlated strongly with higher compulsion scores (P<.01). Conclusions: The EVADD study highlights the complex relationship between adults and smartphones, revealing the prevalence of compulsive behaviors and their impact on daily life, sleep, and safety. These findings emphasize the need for public awareness campaigns, preventive strategies, and therapeutic interventions to mitigate health risks associated with excessive smartphone use. Trial Registration: ClinicalTrials.gov NCT05860660; https://clinicaltrials.gov/ct2/show/NCT05860660 %R 10.2196/63431 %U https://mental.jmir.org/2025/1/e63431 %U https://doi.org/10.2196/63431 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 27 %N %P e66341 %T Assessing Short-Video Dependence for e-Mental Health: Development and Validation Study of the Short-Video Dependence Scale %A Jiang,AnHang %A Li,Shuang %A Wang,HuaBin %A Ni,HaoSen %A Chen,HongAn %A Dai,JunHong %A Xu,XueFeng %A Li,Mei %A Dong,Guang-Heng %+ Zhejiang Key Laboratory for Research in Assessment of Cognitive Impairments, No. 2318, Yuhangtang Rd, Yuhang District, Hangzhou, 311121, China, 86 15968849698, maylee530@126.com %K short-video dependence %K problematic short-video use %K cutoff point %K scale development %K mental health %K short video %K internet addiction %K latent profile analysis %K exploratory factor analysis %K confirmatory factor analysis %D 2025 %7 4.3.2025 %9 Original Paper %J J Med Internet Res %G English %X Background: Short-video dependence (SVD) has become a significant mental health issue around the world. The lack of scientific tools to assess SVD hampers further advancement in this area. Objective: This study aims to develop and validate a scientific tool to measure SVD levels, ensuring a scientifically determined cutoff point. Methods: We initially interviewed 115 highly engaged short-video users aged 15 to 63 years. Based on the summary of the interview and references to the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5) criteria for behavioral addictions, we proposed the first version of the short-video dependence scale (SVDS). We then screened the items through item analysis (second version) and extracted common factors using exploratory factor analysis (third version) and confirmatory factor analysis (final version). Convergent validity was tested with other scales (Chinese Internet Addiction Scale [CIAS] and DSM-5). Finally, we tested the validity of the final version in 16,038 subjects and set the diagnostic cutoff point through latent profile analysis and receiver operating characteristic curve analysis. Results: The final version of the SVDS contained 20 items and 4 dimensions, which showed strong structural validity (Kaiser-Meyer-Olkin value=0.94) and internal consistency (Cronbach α=.93), and good convergent validity (rCIAS=0.61 and rDSM-5=0.68), sensitivity (0.77, 0.83, 0.87, and 0.62 for each of the 4 dimensions), and specificity (0.75, 0.87, 0.80, and 0.79 for each of the 4 dimensions). Additionally, an SVDS score of 58 was determined as the best cutoff score, and latent profile analysis identified a 5-class model for SVD. Conclusions: We developed a tool to measure SVD levels and established a threshold to differentiate dependent users from highly engaged nondependent users. The findings provide opportunities for further research on the impacts of short-video use. %M 40053762 %R 10.2196/66341 %U https://www.jmir.org/2025/1/e66341 %U https://doi.org/10.2196/66341 %U http://www.ncbi.nlm.nih.gov/pubmed/40053762 %0 Journal Article %@ 1929-073X %I JMIR Publications %V 14 %N %P e53958 %T French Versions of 4 English Questionnaires on Problematic Smartphone Use: Cross-Cultural Linguistic Translation and Adaptation Study %A El Boudi,Islam %A Riant,Mathilde %A Bellier,Alexandre %A Vuillerme,Nicolas %+ Faculty of Medicine, AGEIS, Grenoble Alpes University, Jean Roget Bldg, 3rd Fl., Grenoble, 38000, France, 33 695685616, islam.el-boudi@univ-grenoble-alpes.fr %K problematic use %K smartphone %K French questionnaire %K linguistic translation %K forward/backward process %K mobile phone %D 2025 %7 26.2.2025 %9 Original Paper %J Interact J Med Res %G English %X Background: Excessive use of smartphones is recognized as a major problem in our modern society and can have dramatic consequences on the health of adolescents and young adults. Measuring problematic smartphone use in research and clinical practice is generally operationalized with self-reported questionnaires. In order to comprehensively assess the issue of problematic smartphone usage within the French population, it is imperative to employ validated French-language questionnaires. However, at this point, existing questionnaires are primarily available in English. Furthermore, to the best of our knowledge, these English questionnaires have yet to undergo validation processes for French-speaking cohorts. Objective: The aim of this study was to perform a cross-cultural translation of the Smartphone Addiction Scale, Nomophobia Questionnaire, Problematic Use of Mobile Phones scale, and Smartphone Addiction Proneness Scale to French. Methods: The translation process was performed using the forward/backward method. The first translation phase involved asking 4 independent French translators to translate the original English version of the questionnaires into French. In the second phase, the French version was backtranslated to English by a native English speaker. In the third phase, 2 concept experts were asked to comment and suggest modifications to the statements if necessary. Finally, the last version of the translated questionnaires was presented to 18 participants to assess the clarity, intelligibility, and acceptability of the translations. Results: During the forward translation step, the translation differences were minor. During the backward translation, the English native speaker correctly backtranslated 18 of the 33 items of the Smartphone Addiction Scale, 17 of the 20 items of the Problematic Use of Mobile Phones scale, and 13 of the 15 items of the Smartphone Addiction Proneness Scale. Backtranslation for the Nomophobia Questionnaire was less satisfactory, with only 10 out of 20 items that were correctly backtranslated. The linguistic verification step revealed a minimal modification for the 4 questionnaires. The participants also suggested few improvements that we have considered for the final version. We produced the final version directly after this step. Conclusions: We successfully adapted and effectively translated 4 questionnaires that assess problematic smartphone use to French. This step is a prerequisite for the validation of the French questionnaires. These adapted measures can serve as valuable research instruments for investigating and addressing issues related to problematic smartphone use in French-speaking countries and for making international comparisons. %M 40009839 %R 10.2196/53958 %U https://www.i-jmr.org/2025/1/e53958 %U https://doi.org/10.2196/53958 %U http://www.ncbi.nlm.nih.gov/pubmed/40009839 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 27 %N %P e57907 %T The Moderated Mediating Effects of Social Media Identity and Loneliness on the Relationship Between Problematic Internet Use and Mental Health in China: Nationwide Cross-Sectional Questionnaire Study %A Liu,Chenxi %A Liu,Yushu %A Liu,Chaojie %A Lin,Rujiao %A Wang,Xi %A Zhang,Xinyi %A Wu,Yibo %A Wang,Dan %+ School of Management, Hubei University of Chinese Medicine, 16 Huangjiahu West Rd, Hongshan District, Wuhan, 430065, China, 86 13476237004, 815310016@qq.com %K problematic internet use %K loneliness %K anxiety %K depression %K mediation and moderation model %D 2025 %7 26.2.2025 %9 Original Paper %J J Med Internet Res %G English %X Background: Mental health disorders are a major public health challenge, and problematic internet use (PIU) may play an important role in this issue. However, the underlying mechanisms of PIU and its effects on mental health have not yet been elucidated. Objective: This study examines the mediating effect of loneliness on the relationship between PIU and mental health, as well as the moderating effect of social media identity on the relationships among PIU, loneliness, and mental health. Methods: A cross-sectional questionnaire survey was conducted on 21,292 participants recruited using a multistage stratified sampling strategy from 31 provinces/regions in mainland China from June 20 to August 31, 2022. This study assesses PIU (PIU questionnaire-short form-6), depression (9-item Patient Health Questionnaire [PHQ-9]), anxiety (7-item Generalized Anxiety Disorder scale [GAD-7]), loneliness (3-item loneliness scale), and social media identity (identity bubble reinforcement scale). Additionally, we collected the sociodemographic characteristics of the participants. Participants whose total score of PHQ-9≥15 or total score of GAD-7≥10 were considered to have moderate or severe symptoms of depression or anxiety, respectively. A moderated mediation model was established to examine the mediating effect of loneliness on the association between PIU and mental health outcomes (depression and anxiety), moderated by social media identity. Results: Approximately 22.80% (4854/21,292) and 14.20% (3023/21,292) of the respondents reported moderate or severe symptoms of depression and anxiety, respectively. Loneliness significantly mediated the association between PIU and mental health outcomes, explaining 42.53% and 45.48% of the total effect of PIU on depression and anxiety, respectively. Social media identity significantly moderated the associations between PIU and depression (β=0.002, 95% CI 0.001-0.002), PIU and anxiety (β=0.001, 95% CI 0.000-0.002), loneliness and depression (β=0.010, 95% CI 0.007-0.013), and loneliness and anxiety (β=0.007, 95% CI 0.004-0.010), but not between PIU and loneliness (β=0.000, 95% CI –0.003 to 0.003). Higher levels of social media identity were significantly associated with lower levels of loneliness (β=–0.018, 95% CI –0.020 to –0.016). Conclusions: Addressing loneliness may serve as a valuable approach to mitigate the impact of PIU on mental health outcomes. However, social media identity poses a significant challenge in addressing health issues linked to PIU. %M 40009436 %R 10.2196/57907 %U https://www.jmir.org/2025/1/e57907 %U https://doi.org/10.2196/57907 %U http://www.ncbi.nlm.nih.gov/pubmed/40009436 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 9 %N %P e57512 %T Nomophobia, Psychopathology, and Smartphone-Inferred Behaviors in Youth With Depression: Longitudinal Study %A Zhang,Tianyi %A Camargo,Andres %A Schmaal,Lianne %A Kostakos,Vassilis %A D'Alfonso,Simon %+ School of Computing and Information Systems, University of Melbourne, Level 4, Melbourne Connect (Building 290), Melbourne, 3010, Australia, 61 449930128, tianyiz4@student.unimelb.edu.au %K mobile sensing %K nomophobia %K digital phenotyping %K depression %K mental health %K smartphone use %K personal sensing %K behavior analysis %K machine learning %K mobile health %K mobile phone %D 2025 %7 19.2.2025 %9 Original Paper %J JMIR Form Res %G English %X Background: Smartphones have become an indispensable part of people’s lives, and the fear of being without them, what has been termed “no mobile phone phobia” (nomophobia), is a growing phenomenon. The rise of problematic smartphone use highlights the urgent need to explore the intricate relationship between smartphones and human behavior. However, the connections between nomophobia, mental health indicators, smartphone use patterns, and daily activities remain largely underexplored. Objective: This study aimed to explore the relationship between young adults with depression and smartphones and investigate nomophobia by analyzing data obtained from a pilot study of depression in a youth cohort. Exploring nomophobia can enhance our understanding of the dynamics between young adults and smartphone use, potentially empowering them to manage and regulate their smartphone use more effectively. Methods: During an 8-week period, data collected via smartphone sensors, such as locations and screen status, were gathered from a cohort of 41 individuals diagnosed with major depressive disorder. In addition to passive-sensing smartphone data, the study collected ecological momentary assessments and psychometric measures, including the Nomophobia Questionnaire, which formed the basis of our investigation. We explored statistical associations among smartphone-derived behavioral features, psychometric indicators, and nomophobia. In addition, we used behavioral and psychometric data to develop regression models demonstrating the prediction of nomophobia levels. Results: Our findings revealed that the level of nomophobia was positively associated with depression and negative affect, lower geolocation movements, and higher comfort with smartphone sensing. The exploratory predictive linear regression models demonstrated the feasibility of predicting an individual’s Nomophobia Questionnaire score based on their smartphone sensing data. These models effectively used input features derived from both a combination of smartphone sensing data and psychometric measures and from smartphone sensing data alone. Conclusions: Our work is the first to explore the relationship between nomophobia and smartphone sensor data. It provides valuable insights into the predictors of nomophobia level, contributing to the understanding of the relationship between smartphones and human behavior and paving the way for future studies. %M 39969982 %R 10.2196/57512 %U https://formative.jmir.org/2025/1/e57512 %U https://doi.org/10.2196/57512 %U http://www.ncbi.nlm.nih.gov/pubmed/39969982 %0 Journal Article %@ 2561-6722 %I JMIR Publications %V 8 %N %P e66448 %T Changes in Internet Activities and Influencing Factors for Problematic Internet Use During the COVID-19 Pandemic in Korean Adolescents: Repeated Cross-Sectional Study %A Kim,Sol I %A Jin,Jae-Chan %A Yoo,Seo-Koo %A Han,Doug Hyun %+ Department of Psychiatry, Chung Ang University Hospital, 102 Heusok ro, Seoul, 06973, Republic of Korea, 82 62993132, hduk70@gmail.com %K coronavirus pandemic %K internet use pattern %K internet games %K short-form videos %K social network system %K depressed mood %K internet use %K pandemic %K internet %K COVID-19 %K video %K internet behavior %K social media %K internet addiction %K depression %K anxiety %K digital platforms %K mobile phone %D 2025 %7 11.2.2025 %9 Original Paper %J JMIR Pediatr Parent %G English %X Background: As adolescents increasingly engage with digital experiences, the internet serves as a platform for social interaction, entertainment, and learning. The COVID-19 pandemic accelerated this trend, with remote learning and restricted physical interactions driving changes in internet behavior. Adolescents spent more time on gaming and social media, reflecting a notable shift in use patterns. Objective: We hypothesized that the COVID-19 pandemic changed internet use patterns among Korean adolescents, including content types, time spent on web-based activities, and pathological use prevalence. Additionally, we anticipated that these changes would correlate with shifts in adolescents’ psychological status during the pandemic. Methods: Data from 827 adolescents aged 12 to 15 years (n=144 in 2018, n=142 in 2019, n=126 in 2020, n=130 in 2021, n=143 in 2022, and n=142 in 2023) were gathered over 6 years from 43 middle schools across 16 regions and 1 hospital in South Korea. The demographic data collected included age, sex, and school year. Participants also provided information on their internet use patterns and levels of internet addiction. Additionally, psychological status, including mood, anxiety, attention, and self-esteem, was assessed. Results: There were significant differences in the depression scale (Patient Health Questionnaire 9). The Patient Health Questionnaire 9 scores for 2018, 2019, and 2023 decreased compared to those in 2020, 2021, and 2022 (F5=3.07; P=.007). Regarding changes in internet use behavior, game playing among adolescents decreased after the pandemic compared to before, while watching videos increased. Additionally, the rate of problematic internet use was highest for games before COVID-19, but after COVID-19, it was highest for videos, and this trend continued until 2023 (χ23=8.16, P=.04). Furthermore, this study showed that the Young’s Internet Addiction Scale (YIAS) score was highest in the game group in 2018 compared to other groups before COVID-19 (F5=14.63; P<.001). In 2019, both the game and video groups had higher YIAS scores than other groups (F5=9.37; P<.001), and by 2022, the YIAS scores among the game, video, and Social Network Service groups did not differ significantly. The degree of influence on the severity of internet addiction was also greatest for games before COVID-19, but after COVID-19, the effect was greater for videos than for games. Conclusions: During the COVID-19 pandemic, internet use for academic and commercial purposes, including remote classes and videoconferences, increased rapidly worldwide, leading to a significant rise in overall internet use time. The demand for and dependence on digital platforms is expected to grow even further in the coming era. Until now, concerns have primarily focused on the use of games, but it is now necessary to consider what types of internet behaviors cause problems and how to address them. %M 39933170 %R 10.2196/66448 %U https://pediatrics.jmir.org/2025/1/e66448 %U https://doi.org/10.2196/66448 %U http://www.ncbi.nlm.nih.gov/pubmed/39933170 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 27 %N %P e59656 %T Interventions for Digital Addiction: Umbrella Review of Meta-Analyses %A Lu,Peng %A Qiu,Jiamin %A Huang,Shiqi %A Wang,Xinman %A Han,Shasha %A Zhu,Sui %A Ning,Youjing %A Zeng,Fang-fang %A Yuan,Yuan %+ Department of Chinese International Education, Chinese Language and Culture College, Huaqiao University, No 8 Jiageng Road, Xiamen, 361021, China, 86 6068002, yuanyuan361021@163.com %K digital addiction %K interventions %K umbrella reviews %K systematic review %K internet addiction %K loneliness %K quality of life %K well-being %K internet %K psychological %K pharmacological treatment %K cognitive behavioral therapy %D 2025 %7 11.2.2025 %9 Review %J J Med Internet Res %G English %X Background: Numerous studies have explored interventions to reduce digital addiction outcomes, but inconclusive evidence makes it difficult for decision-makers, managers, and clinicians to become familiar with all available literature and find appropriate interventions. Objective: This study aims to summarize and assess the certainty of evidence of interventions proposed to decrease digital addiction from published meta-analyses. Methods: An umbrella review of published meta-analyses was performed. We searched PubMed, Cochrane Library, Web of Science, and Embase for meta-analyses published up to February 2024. Eligible studies evaluated interventions using randomized controlled trials, nonrandomized controlled trials, or quasi-experimental studies and were assessed for methodological quality using Assessment of Multiple Systematic Reviews version 2. A random effects model was used to analyze data, considering heterogeneity and publication bias. Grading of Recommendations, Assessment, Development, and Evaluations was applied to assess evidence with certainty. Results: A total of 5 studies assessing 21 associations were included in the umbrella review, of which 4 (80%) were high-quality meta-analyses. Weak evidence was observed in 19 associations, whereas null associations appeared in the remaining 2 associations. These associations pertained to 8 interventions (group counseling, integrated internet addiction [IA] prevention programs, psychosocial interventions, reality therapy, self-control training programs, cognitive behavioral therapy, interventions to reduce screen time in children, and exercise) and 9 outcomes (self-control, self-esteem, internet gaming disorder symptoms, time spent gaming, IA scores, screen use time, interpersonal sensitivity longlines, anxiety, and depression). Cognitive behavioral therapy reduces anxiety (standardized mean difference [SMD] 0.939, 95% CI 0.311 to 1.586), internet gaming disorder symptoms (SMD 1.394, 95% CI 0.664 to 2.214), time spent gaming (SMD 1.259, 95% CI, 0.311 to 2.206), and IA scores (SMD –2.097, 95% CI –2.814 to –1.381). Group counseling had a large effect on improving self-control (SMD 1.296, 95% CI 0.269 to 2.322) and reducing IA levels (SMD –1.417, 95% CI –1.836 to –0.997). Exercise intervention reduced IA scores (SMD –2.322, 95% CI –3.212 to –1.431), depression scores (SMD –1.421, 95% CI –2.046 to –797), and interpersonal sensitivity scores (SMD –1.433, 95% CI –2.239 to –0.627). Conclusions: The evidence indicates that current interventions to reduce digital addiction are weak. Data from more and better-designed studies with larger sample sizes are needed to establish robust evidence. Trial Registration: PROSPERO CRD42024528173; crd.york.ac.uk/PROSPERO/display_record.php?RecordID=528173 %M 39933164 %R 10.2196/59656 %U https://www.jmir.org/2025/1/e59656 %U https://doi.org/10.2196/59656 %U http://www.ncbi.nlm.nih.gov/pubmed/39933164 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 27 %N %P e60630 %T Impact of Mobile Phone Usage on Sleep Quality Among Medical Students Across Latin America: Multicenter Cross-Sectional Study %A Izquierdo-Condoy,Juan S %A Paz,Clara %A Nati-Castillo,H A %A Gollini-Mihalopoulos,Ricardo %A Aveiro-Róbalo,Telmo Raul %A Valeriano Paucar,Jhino Renson %A Laura Mamami,Sandra Erika %A Caicedo,Juan Felipe %A Loaiza-Guevara,Valentina %A Mejía,Diana Camila %A Salazar-Santoliva,Camila %A Villavicencio-Gomezjurado,Melissa %A Hall,Cougar %A Ortiz-Prado,Esteban %+ One Health Research Group, Universidad de las Américas, Calle de los Colimes, Quito, 170137, Ecuador, 593 0995760693, e.ortizprado@gmail.com %K mobile phone %K addiction behavior %K sleep quality %K medical students %K Latin America %D 2025 %7 10.2.2025 %9 Original Paper %J J Med Internet Res %G English %X Background: The ubiquitous use of mobile phones among medical students has been linked to potential health consequences, including poor sleep quality. Objective: This study investigates the prevalence of mobile phone addiction and its association with sleep quality among medical students across 6 Latin American countries. Methods: A descriptive, cross-sectional, multicenter study was conducted between December 2023 and March 2024 using a self-administered online survey. The survey incorporated the Mobile Phone Addiction Scale and the Pittsburgh Sleep Quality Index to evaluate mobile phone addiction and sleep quality among 1677 medical students. A multiple regression model was applied to analyze the relationship between mobile phone addiction and poor sleep quality, adjusting for sex, age, and educational level to ensure robust results. Results: Mobile phone addiction was identified in 32.5% (545/1677) of participants, with significant differences across countries. The overall mean Pittsburgh Sleep Quality Index score was 7.26, indicating poor sleep quality. Multiple regression analysis revealed a strong association between mobile phone addiction and poor sleep, controlled for demographic variables (β=1.4, 95% CI 1.05-1.74). Conclusions: This study underscores a significant prevalence of mobile phone addiction among medical students and its detrimental association with sleep quality in Latin America. The findings advocate for the need to address mobile phone usage to mitigate its negative implications on student health and academic performance. Strategies to enhance digital literacy and promote healthier usage habits could benefit medical education and student well-being. %M 39928921 %R 10.2196/60630 %U https://www.jmir.org/2025/1/e60630 %U https://doi.org/10.2196/60630 %U http://www.ncbi.nlm.nih.gov/pubmed/39928921 %0 Journal Article %@ 2292-9495 %I JMIR Publications %V 12 %N %P e62955 %T Assessing the Relationship Between the Type of Internet Use and Internet Addiction in Early and Middle Adolescents: Cross-Sectional Study From Qatar %A Chemnad,Khansa %A Aziz,Maryam %A Al- Harahsheh,Sanaa %A Abdelmoneium,Azza %A Baghdady,Ahmed %A Alsayed Hassan,Diana %A Ali,Raian %+ Department of Public Health, College of Health Sciences, QU Health, Qatar University, PO Box 2713, Doha, Qatar, 974 31576271, dalsayed@qu.edu.qa %K internet addiction %K internet use %K early adolescence %K middle adolescence %K mobile phone %D 2025 %7 10.2.2025 %9 Original Paper %J JMIR Hum Factors %G English %X Background: With the increasing prevalence of digital technology, adolescent internet addiction (IA) has become a global concern. Excessive internet use, especially among adolescents, has been linked to various negative outcomes such as poor academic performance, social isolation, and mental health issues. Conducted among adolescents of Arab origin, our study addressed the limitations of the literature, which predominantly focuses on Western, educated, industrialized, rich, and democratic populations. Objective: This study aimed to differentiate between essential and nonessential internet use and how they relate to IA in early and middle adolescents, as well as the relationship between subjective happiness with the amount of time spent on nonessential internet use and IA. Methods: A cross-sectional survey was conducted among 377 students from 16 schools in Qatar. The survey measured essential and nonessential internet use, subjective happiness with nonessential use, and IA symptoms using the Internet Addiction Diagnostic Questionnaire, as well as participant demographics. To explore age-specific associations, participants were categorized into early (age 11-13 years) and middle (age 14-17 years) adolescents. Factorial analysis, multiple regression, and logistic regression were used for statistical analysis. Results: Nonessential internet use significantly predicted IA in both early (P<.001) and middle (P<.001) adolescents, with early adolescents showing a stronger association. Subjective happiness with nonessential internet use negatively predicted IA only in middle adolescents (P<.001) as greater dissatisfaction led to a higher IA risk. Essential internet use did not predict IA in either group. Conclusions: Differentiating between essential and nonessential internet use is crucial in understanding IA. This study highlights the importance of developmental differences in shaping IA symptoms. The findings suggest that interventions aimed at addressing IA should be age specific and focus on addressing nonessential use specifically rather than considering internet use and screen time in general as a single entity. Cultural and regional factors also play a role in shaping internet use patterns and IA in the Middle East, necessitating context-specific, culturally sensitive approaches to IA prevention. %M 39928940 %R 10.2196/62955 %U https://humanfactors.jmir.org/2025/1/e62955 %U https://doi.org/10.2196/62955 %U http://www.ncbi.nlm.nih.gov/pubmed/39928940 %0 Journal Article %@ 2368-7959 %I JMIR Publications %V 12 %N %P e64396 %T The Efficacy of Conversational AI in Rectifying the Theory-of-Mind and Autonomy Biases: Comparative Analysis %A Rządeczka,Marcin %A Sterna,Anna %A Stolińska,Julia %A Kaczyńska,Paulina %A Moskalewicz,Marcin %+ Institute of Philosophy, Maria Curie-Skłodowska University, Pl. Marii Curie-Skłodowskiej 4, pok. 204, Lublin, 20-031, Poland, 48 815375481, marcin.rzadeczka@umcs.pl %K cognitive bias %K conversational artificial intelligence %K artificial intelligence %K AI %K chatbots %K digital mental health %K bias rectification %K affect recognition %D 2025 %7 7.2.2025 %9 Original Paper %J JMIR Ment Health %G English %X Background: The increasing deployment of conversational artificial intelligence (AI) in mental health interventions necessitates an evaluation of their efficacy in rectifying cognitive biases and recognizing affect in human-AI interactions. These biases are particularly relevant in mental health contexts as they can exacerbate conditions such as depression and anxiety by reinforcing maladaptive thought patterns or unrealistic expectations in human-AI interactions. Objective: This study aimed to assess the effectiveness of therapeutic chatbots (Wysa and Youper) versus general-purpose language models (GPT-3.5, GPT-4, and Gemini Pro) in identifying and rectifying cognitive biases and recognizing affect in user interactions. Methods: This study used constructed case scenarios simulating typical user-bot interactions to examine how effectively chatbots address selected cognitive biases. The cognitive biases assessed included theory-of-mind biases (anthropomorphism, overtrust, and attribution) and autonomy biases (illusion of control, fundamental attribution error, and just-world hypothesis). Each chatbot response was evaluated based on accuracy, therapeutic quality, and adherence to cognitive behavioral therapy principles using an ordinal scale to ensure consistency in scoring. To enhance reliability, responses underwent a double review process by 2 cognitive scientists, followed by a secondary review by a clinical psychologist specializing in cognitive behavioral therapy, ensuring a robust assessment across interdisciplinary perspectives. Results: This study revealed that general-purpose chatbots outperformed therapeutic chatbots in rectifying cognitive biases, particularly in overtrust bias, fundamental attribution error, and just-world hypothesis. GPT-4 achieved the highest scores across all biases, whereas the therapeutic bot Wysa scored the lowest. Notably, general-purpose bots showed more consistent accuracy and adaptability in recognizing and addressing bias-related cues across different contexts, suggesting a broader flexibility in handling complex cognitive patterns. In addition, in affect recognition tasks, general-purpose chatbots not only excelled but also demonstrated quicker adaptation to subtle emotional nuances, outperforming therapeutic bots in 67% (4/6) of the tested biases. Conclusions: This study shows that, while therapeutic chatbots hold promise for mental health support and cognitive bias intervention, their current capabilities are limited. Addressing cognitive biases in AI-human interactions requires systems that can both rectify and analyze biases as integral to human cognition, promoting precision and simulating empathy. The findings reveal the need for improved simulated emotional intelligence in chatbot design to provide adaptive, personalized responses that reduce overreliance and encourage independent coping skills. Future research should focus on enhancing affective response mechanisms and addressing ethical concerns such as bias mitigation and data privacy to ensure safe, effective AI-based mental health support. %M 39919295 %R 10.2196/64396 %U https://mental.jmir.org/2025/1/e64396 %U https://doi.org/10.2196/64396 %U http://www.ncbi.nlm.nih.gov/pubmed/39919295 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 27 %N %P e69320 %T App-Based Ecological Momentary Assessment of Problematic Smartphone Use During Examination Weeks in University Students: 6-Week Observational Study %A Ahn,Ji Seon %A Jeong,InJi %A Park,Sehwan %A Lee,Jooho %A Jeon,Minjeong %A Lee,Sangil %A Do,Gangho %A Jung,Dooyoung %A Park,Jin Young %+ Department of Psychiatry, Yongin Severance Hospital, Yonsei University College of Medicine, 363, Dongbaekjukjeon-daero, Giheung-gu, Yongin, 16995, Republic of Korea, 82 31 5189 8148, empathy@yuhs.ac %K problematic smartphone use %K PSU %K ecological momentary assessment %K EMA %K GPS tracking %K digital phenotypes %K psychosocial measures %K university students %K academic stress %K mobile health %K mHealth %K mobile phone %D 2025 %7 5.2.2025 %9 Original Paper %J J Med Internet Res %G English %X Background: The increasing prevalence of problematic smartphone use (PSU) among university students is raising concerns, particularly as excessive smartphone engagement is linked to negative outcomes such as mental health issues, academic underperformance, and sleep disruption. Despite the severity of PSU, its association with behaviors such as physical activity, mobility, and sociability has received limited research attention. Ecological momentary assessment (EMA), including passive data collection through digital phenotyping indicators, offers an objective approach to explore these behavioral patterns. Objective: This study aimed to examine associations between self-reported psychosocial measures; app-based EMA data, including daily behavioral indicators from GPS location tracking; and PSU in university students during the examination period. Methods: A 6-week observational study involving 243 university students was conducted using app-based EMA on personal smartphones to collect data on daily behaviors and psychosocial factors related to smartphone overuse. PSU was assessed using the Korean Smartphone Addiction Proneness Scale. Data collected from the Big4+ app, including self-reports on mood, sleep, and appetite, as well as passive sensor data (GPS location, acceleration, and steps) were used to evaluate overall health. Logistic regression analysis was conducted to identify factors that significantly influenced smartphone overuse, providing insights into daily behavior and mental health patterns. Results: In total, 23% (56/243) of the students exhibited PSU. The regression analysis revealed significant positive associations between PSU and several factors, including depression (Patient Health Questionnaire-9; odds ratio [OR] 8.48, 95% CI 1.95-36.87; P=.004), social interaction anxiety (Social Interaction Anxiety Scale; OR 4.40, 95% CI 1.59-12.15; P=.004), sleep disturbances (General Sleep Disturbance Scale; OR 3.44, 95% CI 1.15-10.30; P=.03), and longer sleep duration (OR 3.11, 95% CI 1.14-8.48; P=.03). Conversely, a significant negative association was found between PSU and time spent at home (OR 0.35, 95% CI 0.13-0.94; P=.04). Conclusions: This study suggests that negative self-perceptions of mood and sleep, along with patterns of increased mobility identified through GPS data, increase the risk of PSU, particularly during periods of academic stress. Combining psychosocial assessments with EMA data offers valuable insights for managing PSU during high-stress periods, such as examinations, and provides new directions for future research. %M 39908075 %R 10.2196/69320 %U https://www.jmir.org/2025/1/e69320 %U https://doi.org/10.2196/69320 %U http://www.ncbi.nlm.nih.gov/pubmed/39908075 %0 Journal Article %@ 2368-7959 %I JMIR Publications %V 12 %N %P e60747 %T Exploring the Differentiation of Self-Concepts in the Physical and Virtual Worlds Using Euclidean Distance Analysis and Its Relationship With Digitalization and Mental Health Among Young People: Cross-Sectional Study %A Chan,Kai Tai %A Hui,Christy LM %A Cheung,Charlton %A Suen,Yi Nam %A Wong,Stephanie Ming Yin %A Wong,Corine SM %A Kam,Bosco PH %A Chen,Eric Yu Hai %+ Department of Psychiatry, University of Hong Kong, Rm 222, New Clinical Buildling, Queen Mary Hospital, 102, Pokfulam Road, Hong Kong, China (Hong Kong), 852 22554486, ericchen.hku@gmail.com %K digitalization %K self %K identity %K psychiatric symptomatology %K youth mental health %K Euclidean distance analysis %K self-differentiation %K smartphone addiction %K personal attributes %D 2025 %7 31.1.2025 %9 Original Paper %J JMIR Ment Health %G English %X Background: Increasing observation and evidence suggest that the process of digitalization could have profound impact to the development of human mind and self, with potential mental health consequences. Self-differentiation is important in human identity and self-concept formation, which is believed to be involved in the process of digitalization. Objective: This study aimed to investigate the relationship between digitalization and personal attributes in the actual selves in the physical and virtual worlds. Methods: A community cohort of 397 participants aged 15 to 24 years old was recruited consecutively over about 3 months. Assessment was conducted upon the indicators of digitalization (smartphone use time, leisure online time, and age of first smartphone ownership), smartphone addiction, 14 selected personal attributes in the actual selves in the physical and virtual worlds, psychiatric symptomatology and personality traits. Euclidean distance analysis between the personal attributes in the actual selves in the physical and virtual worlds for the similarities of the 2 selves was performed in the analysis. Results: The current primary findings are the negative correlations between the similarity of the personal attributes in the physical actual self and virtual actual self, and smartphone use time, smartphone addiction as well as anxiety symptomatology respectively (P<.05 to P<.01). Conclusions: The current findings provide empirical evidence for the importance of maintaining a congruent self across the physical and virtual worlds, regulating smartphone use time, preventing smartphone addiction, and safeguarding mental health. %M 39889302 %R 10.2196/60747 %U https://mental.jmir.org/2025/1/e60747 %U https://doi.org/10.2196/60747 %U http://www.ncbi.nlm.nih.gov/pubmed/39889302 %0 Journal Article %@ 2292-9495 %I JMIR Publications %V 12 %N %P e66045 %T Exploring the Users’ Perspective of the Nationwide Self-Exclusion Service for Gambling Disorder, “Spelpaus”: Qualitative Interview Study %A Tjernberg,Johanna %A Helgesson,Sara %A Håkansson,Anders %A Hansson,Helena %+ Department of Clinical Sciences Lund, Faculty of Medicine, Lund University, Psychiatry, Baravägen 1, Lund, 221 00, Sweden, 46 703135677, anders_c.hakansson@med.lu.se %K gambling disorder %K gambling addiction %K behavioral addiction %K harm reduction %K self-exclusion %K voluntary self-exclusion %K Spelpaus %K lived experience %K human factors %K usability %K qualitative study %D 2025 %7 31.1.2025 %9 Original Paper %J JMIR Hum Factors %G English %X Background: Problem gambling and gambling disorder cause severe social, psychiatric, and financial consequences, and voluntary self-exclusion is a common harm reduction tool used by individuals with gambling problems. Objective: The aim of this study was to explore users’ experience of a novel nationwide, multioperator gambling self-exclusion service, “Spelpaus,” in Sweden and to inform stakeholders and policy makers in order to improve harm reduction tools against gambling problems. Methods: Semistructured interviews were conducted with 15 individuals who reported self-perceived gambling problems and who had experience of having used the self-exclusion service Spelpaus in Sweden. Interviews were transcribed and analyzed through qualitative content analysis. Results: We identified 3 categories and 8 subcategories. The categories were (1) reasons for the decision to self-exclude, (2) positive experiences, and (3) suggestions for improvement. The subcategories identified a number of reasons for self-exclusion, such as financial reasons and family reasons, and positive experiences described as a relief from gambling; in addition, important suggestions for improvement were cited, such as a more gradual return to gambling post–self-exclusion, better ways to address loopholes in the system, and transfer from self-exclusion to treatment. Conclusions: Voluntary self-exclusion from gambling, using a nationwide multioperator service, remains an appreciated harm-reducing tool. However, transfer from self-exclusion to treatment should be facilitated by policy making, and loopholes allowing for breaching of the self-exclusion need to be counteracted. %M 39888656 %R 10.2196/66045 %U https://humanfactors.jmir.org/2025/1/e66045 %U https://doi.org/10.2196/66045 %U http://www.ncbi.nlm.nih.gov/pubmed/39888656 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 27 %N %P e64687 %T Real-Time fMRI Neurofeedback Modulation of Dopaminergic Midbrain Activity in Young Adults With Elevated Internet Gaming Disorder Risk: Randomized Controlled Trial %A Gu,Anqi %A Chan,Cheng Lam %A Xu,Xiaolei %A Dexter,Joseph P %A Becker,Benjamin %A Zhao,Zhiying %+ Centre for Cognitive and Brain Sciences, Institute of Collaborative Innovation, University of Macau, N21 Research building, Macau, 99078, China, 853 8822 9182, zhiyingzhao@um.edu.mo %K real-time functional magnetic resonance imaging neurofeedback %K internet gaming disorder %K craving %K reward processing %K ventral tegmental area %D 2025 %7 29.1.2025 %9 Research Letter %J J Med Internet Res %G English %X This study provides preliminary evidence for real-time functional magnetic resonance imaging neurofeedback (rt-fMRI NF) as a potential intervention approach for internet gaming disorder (IGD). In a preregistered, randomized, single-blind trial, young individuals with elevated IGD risk were trained to downregulate gaming addiction–related brain activity. We show that, after 2 sessions of neurofeedback training, participants successfully downregulated their brain responses to gaming cues, suggesting the therapeutic potential of rt-fMRI NF for IGD (Trial Registration: ClinicalTrials.gov NCT06063642; https://clinicaltrials.gov/study/NCT06063642). %M 39879613 %R 10.2196/64687 %U https://www.jmir.org/2025/1/e64687 %U https://doi.org/10.2196/64687 %U http://www.ncbi.nlm.nih.gov/pubmed/39879613 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 27 %N %P e57636 %T Parental Technoference and Child Problematic Media Use: Meta-Analysis %A Zhang,Jinghui %A Zhang,Qing %A Xiao,Bowen %A Cao,Yuxuan %A Chen,Yu %A Li,Yan %+ , Shanghai Institute of Early Childhood Education, Shanghai Normal University, 100 Guilin Road, Xuhui District, Shanghai, 200234, China, 86 18939892301, liyan@shnu.edu.cn %K parental technoference %K child %K problematic media use %K meta-analysis %K children %K youth %K adolescents %K phubbing %K screen distraction %K systematic reviews %K interventions %K mental health %K digital health %D 2025 %7 22.1.2025 %9 Review %J J Med Internet Res %G English %X Background: Parental technoference, the interruption of parent-child interactions by technology, has been associated with negative outcomes in children’s media use. However, the magnitude of this relationship and its moderating factors remain unclear. Objective: This study aims to systematically examine the relationship between parental technoference and child problematic media use, as well as to identify moderating factors such as age, parental technoference group, study design, and type of problematic media use. Methods: Following PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines, a comprehensive literature search was conducted up to August 2024 across multiple databases, including Web of Science, EBSCO, ProQuest, PubMed, PsycINFO, and China National Knowledge Infrastructure, using predefined search strings. A total of 53 studies with a total of 60,555 participants (mean age of 13.84, SD 1.18 years) were included. Inclusion criteria comprised studies involving children under the age of 22 years, assessing the association between parental technoference and child problematic media use with valid measures, and reporting necessary statistical data. Exclusion criteria included studies focusing on other child outcomes, having sample sizes <30, or being case reports or review papers. The risk of bias was assessed using the Quality Assessment Tool for Observational Cohort and Cross-Sectional Studies. A random-effects meta-analysis was performed using R (version 4.2.1; R Foundation for Statistical Computing) with the meta and metafor packages to evaluate the association and conduct moderator analyses. Results: The meta-analysis identified a significant positive association between parental technoference and child problematic media use (r=0.296, 95% CI 0.259-0.331). Moderator analyses revealed that both parental technoference group (P<.001) and study design (P=.008) significantly influenced this relationship. Specifically, the association was stronger when both parents engaged in technoference compared to when only 1 parent did, and in cross-sectional studies compared to longitudinal studies. Age, gender, publication status, and type of problematic media use did not significantly moderate the relationship (all P>.05). Conclusions: This meta-analysis provides robust evidence of the association between parental technoference and child problematic media use. The findings highlight the need for family-based interventions and underscore the importance of longitudinal research to understand the temporal dynamics of this relationship better. Trial Registration: PROSPERO CRD42023471997; https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=471997 %M 39841982 %R 10.2196/57636 %U https://www.jmir.org/2025/1/e57636 %U https://doi.org/10.2196/57636 %U http://www.ncbi.nlm.nih.gov/pubmed/39841982 %0 Journal Article %@ 2291-9279 %I JMIR Publications %V 13 %N %P e59441 %T Reciprocal Relationship Between Self-Control Belief and Gaming Disorder in Children and Adolescents: Longitudinal Survey Study %A Zhu,Shimin %A Qi,Di %K growth mindset %K gaming disorder %K cross-lagged panel model %K children %K self-control %K adolescents %D 2025 %7 15.1.2025 %9 %J JMIR Serious Games %G English %X Background: Children and adolescents are often at the crossroads of leisure gaming and excessive gaming. It is essential to identify the modifiable psychosocial factors influencing gaming disorder development. The lay theories of self-control (ie, the beliefs about whether self-control can be improved, also called self-control mindsets) may interplay with self-control and gaming disorder and serve as a promising influential factor for gaming disorder. Objective: This study aims to answer the research questions “Does believing one’s self-control is unchangeable predict more severe gaming disorder symptoms later?” and “Does the severity of gaming disorder symptoms prospectively predict self-control mindsets?” with a 1-year, 2-wave, school-based longitudinal survey. Methods: A total of 3264 students (338 in grades 4‐5 and 2926 in grades 7‐10) from 15 schools in Hong Kong participated in the classroom surveys. We used cross-lagged panel models to examine the direction of the longitudinal association between self-control mindsets and gaming disorder. Results: A bidirectional relationship was found between self-control mindsets and gaming disorder symptom severity (the cross-lagged path from mindsets to gaming disorder: regression coefficients [b] with 95% CI [0.070, 0.020-0.12o, P=.006]; and from gaming disorder to mindsets: b with 95% CI [0.11, 0.060-0.160, P<.001]). Subgroup analyses of boy and girl participants revealed that more growth mindsets regarding self-control predicted less severe gaming disorder symptoms in girls (b=0.12, 95% CI 0.053-0.190, P=.001) but not in boys (b=0.025, 95% CI –0.050 to 0.100, P=.51), while more severe gaming disorder symptoms predicted a more fixed mindset of self-control in both boys (b=0.15, 95% CI 0.069-0.230, P<.001) and girls (b=0.098, 95% CI 0.031-0.170, P=.004) after 1 year. Conclusions: Our findings demonstrated the negative impact of gaming disorder on one’s self-control malleability beliefs and implied that promoting a growth mindset regarding self-control might be a promising strategy for gaming disorder prevention and early intervention, especially for girls. %R 10.2196/59441 %U https://games.jmir.org/2025/1/e59441 %U https://doi.org/10.2196/59441 %0 Journal Article %@ 2291-9279 %I JMIR Publications %V 13 %N %P e59740 %T Scrutinizing the Gateway Relationship Between Gaming and Gambling Disorder: Scoping Review With a Focus on the Southeast Asian Region %A Siste,Kristiana %A King,Daniel L %A Hanafi,Enjeline %A Sen,Lee Thung %A Adrian,Adrian %A Murtani,Belinda Julivia %K behavioral addiction %K convergence %K gateway effect %K gambling advertisement %K gamblification %K monetized gaming %D 2025 %7 15.1.2025 %9 %J JMIR Serious Games %G English %X Background: The gaming and gambling overlap has intensified with new evidence emerging. However, the relationship between gaming and gambling in the digital space is still inconclusive, especially in resource-limited Asian countries. Objective: This study aims to review available evidence on the possible interaction and focuses specifically on the gateway interaction between gambling and gaming. Additionally, this review delves into the state of evidence from the Southeast Asian region, providing an in-depth analysis of this underexplored area. Methods: We performed a scoping review by sifting through the publications in five databases. We focused on the gateway interaction and provided a possible pathway model, while two other convergence relationships were provided for comparison. Results: The scoping review identified a total of 289 publications, with the majority being empirical (n=181), although only 12 studies used longitudinal designs. A significant proportion of the publications (n=152) concentrated on the correlation or comorbidity between gaming and gambling. Most of the evidence has originated from Global North countries, with very limited research emerging from Southeast Asia (n=8). The most commonly studied gambling-like element in video games was loot boxes (n=105). Other elements investigated included esports betting, skin betting, token wagering, gambling advertisements, and gambling-like features. Several longitudinal studies have highlighted the risk of the gateway effect associated with gamblification involvement. However, emerging evidence suggests more nuanced underlying mechanisms that drive the transition from gaming to gambling. Conclusions: Overall, there is early evidence of linkage between gambling and gaming, through shared structural and biopsychosocial characteristics. This association possibly extends beyond disparate comorbidity, as such engagement in one activity might influence the risk of partaking in the other behavior. The field requires further longitudinal data to determine the directionality and significant precipitating factors of the gateway effect, particularly evidence from Asia. %R 10.2196/59740 %U https://games.jmir.org/2025/1/e59740 %U https://doi.org/10.2196/59740 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 27 %N %P e49860 %T Pornography-Watching Disorder and Its Risk Factors Among Young Adults: Cross-Sectional Survey %A Erdős,Csaba %A Kelemen,Oguz %A Pócs,Dávid %A Paulik,Edit %A Papp,András %A Horváth,Edina %A Golan,Arbel %A Széll,Krisztián %+ Department of Public Health, University of Szeged, Albert Szent-Györgyi Medical School, Dóm tér 10, Szeged, H-6720, Hungary, 36 62545119, erdos.csaba@med.u-szeged.hu %K pornography %K Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition %K DSM-5 %K paraphilia %K satisfaction %K sexual disorder %K sexual education %K online survey %K young adults %K online %K risk factor %K cross sectional %K online survey %K pornography-watching disorder %K social media %K web-based questionnaire %K internet use %K public health %K prevention programs %K sexual well-being %D 2025 %7 8.1.2025 %9 Original Paper %J J Med Internet Res %G English %X Background: The widespread availability of internet-based pornography has led to growing concerns about its impact on mental health, particularly among young adults. Despite increasing recognition of problematic pornography use, standardized diagnostic criteria for pornography addiction are lacking. Objective: This study aimed to address this gap by applying adapted DSM-5 (Diagnostic and Statistical Manual of Mental Disorders [Fifth Edition]) criteria to evaluate “pornography-watching disorder” (PWD) in a large sample of young adults in Hungary. The primary objective was to assess the prevalence of PWD among young adults and identify key risk factors associated with its development using DSM-5 criteria adapted for pornography use. It also aimed to advance the understanding of PWD as a potential behavioral addiction. Methods: A cross-sectional web-based survey was conducted between September and December 2018, targeting young adults aged 18-35 years in Hungary. Participants were recruited through social media and the University of Szeged Albert Szent-Györgyi Medical School’s web page. Of the 9397 respondents, 7187 (76.5%) had previously consumed pornography and were included in the analysis. PWD was measured using 10 statements adapted from the DSM-5 substance use disorder criteria. Multivariable binary logistic regression was used to identify significant predictors of PWD. Results: The prevalence of PWD in the sample was 4.4% (n=315). Frequent pornography consumption was a significant risk factor, with weekly users (odds ratio [OR] 0.45, 95% CI 0.33-0.62, P<.001), monthly users (OR 0.18, 95% CI 0.11-0.28, P<.001), and less than monthly users (OR 0.05, 95% CI 0.03-0.10, P<.001) showing significantly lower odds compared with daily users as a reference category. Male sex was associated with a higher risk (OR 0.53, 95% CI 0.39-0.72, P<.001), as were early exposure to pornography (OR 0.94, 95% CI 0.90-0.98, P=.006), paraphilia (OR 3.95, 95% CI 2.37-6.56, P<.001), dissatisfaction with sexual life (OR 0.94, 95% CI 0.90-0.98, P=.006), difficulty forming personal relationships (OR 0.93, 95% CI 0.88-0.98, P=.005), and strong adherence to religious norms (OR 1.12, 95% CI 1.06-1.19, P<.001). Protective factors included adequate sexual education (OR 0.67, 95% CI 0.53-0.87, P=.02) and residing in the capital (OR 0.52, 95% CI 0.30-0.91, P=.02). The use of an anonymous web-based questionnaire likely reduced the influence of stigma, resulting in more accurate self-reporting of sensitive behaviors. Conclusions: This study is among the first to apply DSM-5 criteria to evaluate PWD, providing important insights into its prevalence and associated risk factors in young adults. The findings highlight the need for standardized diagnostic tools for PWD and suggest targeted interventions, particularly for high-risk groups. These results contribute to the ongoing discussion about whether pornography addiction should be recognized as a distinct behavioral disorder. %M 39778200 %R 10.2196/49860 %U https://www.jmir.org/2025/1/e49860 %U https://doi.org/10.2196/49860 %U http://www.ncbi.nlm.nih.gov/pubmed/39778200 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 27 %N %P e52083 %T The Association Between Internet Addiction and the Risk of Suicide Attempts in Chinese Adolescents Aged 11-17 Years: Prospective Cohort Study %A Li,Sihong %A Jin,Xingyue %A Song,Lintong %A Fan,Tianqing %A Shen,Yanmei %A Zhou,Jiansong %+ Department of Psychiatry, National Clinical Research Center for Mental Disorders, and National Center for Mental Disorders, The Second Xiangya Hospital of Central South University, No.139, Renmin Road Central Changsha-Hunan-China, Changsha, 410011, China, 86 15116269263, ymshen@csu.edu.cn %K adolescents %K pathological internet use %K internet addiction %K suicide attempts %K risk factors %K cohort study %D 2025 %7 3.1.2025 %9 Original Paper %J J Med Internet Res %G English %X Background: Suicide is a critical public health issue in adolescents worldwide. Internet addiction may play a role in the increased rate of suicide attempts in this population. However, few studies have explored the relationship between pathological internet use and suicide attempts among adolescents. Objective: This study aimed to conduct a prospective cohort study to examine whether higher severity of pathological internet use was associated with an increased risk of suicide attempts among Chinese adolescents. Methods: A total of 782 adolescents were recruited from a middle school from November 2020 to December 2020 and followed up for 6 months. An online self-reported questionnaire was used to collect the participants’ demographic data and assess their mental health. The Depression, Anxiety, and Stress Scale–21 items (DASS-21) was used to evaluate depression, anxiety, and stress. The Chen Internet Addiction Scale–Revised (CIAS-R) was used to assess the symptoms and severity of pathological internet use. χ2 test and ANOVA were used for intergroup comparison, and logistic regression analysis was used to examine the relationship between the severity of pathological internet use and suicide attempts. We also used a restricted cubic splines model to investigate the pattern of the association. Results: The participants had an average age of 12.59 (SD 0.64) years, with the majority being of Han ethnicity (743/782, 95.01%) and more than half being male (426/782, 54.48%). Most participants had no previous history of depression (541/782, 69.18%), anxiety (415/782, 53.07%), or stress (618/782, 79.03%). The rate of newly reported suicide attempts was 4.6% (36/782). A significant positive association was observed between internet addiction and suicide attempts (odds ratio 3.88, 95% CI 1.70-8.82), which remained significant after adjusting for age, sex, ethnicity, anxiety, depression, and stress (odds ratio 2.65, 95% CI 1.07-6.55). In addition, this association exhibited a linear pattern in the restricted cubic spline regression model. Conclusions: This study suggested that internet addiction, rather than internet overuse, was associated with a higher likelihood of suicide attempts, which highlighted the importance of addressing internet addiction symptoms among Chinese adolescents for suicide prevention. %M 39752720 %R 10.2196/52083 %U https://www.jmir.org/2025/1/e52083 %U https://doi.org/10.2196/52083 %U http://www.ncbi.nlm.nih.gov/pubmed/39752720 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 26 %N %P e59968 %T Prevention and Health Promotion Interventions for Young People in the Context of Digital Well-Being: Rapid Systematic Review %A Colder Carras,Michelle %A Aljuboori,Dahlia %A Shi,Jing %A Date,Mayank %A Karkoub,Fatima %A García Ortiz,Karla %A Abreha,Fasika Molla %A Thrul,Johannes %+ Carras Colder Carras, 3375 Ellicott Center Dr Unit 1675, Ellicott City, MD, 21043, United States, 1 410 412 0797, michelle@carrasandco.com %K digital well-being %K internet addiction %K gaming disorder %K social media %K screen time %K prevention %K children %K adolescents %K mobile phone %K PRISMA %D 2024 %7 18.12.2024 %9 Review %J J Med Internet Res %G English %X Background: Increasing digital technology and media use among young people has raised concerns about problematic use and negative consequences. The formal recognition of a technology addiction (eg, gaming disorder) requires an understanding of the landscape of interventions designed to prevent this disorder and related technology addictions. Objective: We conducted a rapid systematic review to investigate the current evidence on approaches to prevent problematic technology use and promote digital well-being, defined as the healthy use of digital media and technology and the absence of problems resulting from excessive use. Methods: We used a pragmatic and rapid approach to systematically review and synthesize recent literature with a focus on contextual factors that can aid in understanding translatability, making trade-offs appropriate for rapid reviews per the Cochrane Collaboration guidelines. We searched multiple databases, including gray literature, for primary studies and systematic reviews of prevention interventions targeting children, adolescents, and youth. We extracted data on study characteristics, quality, and translatability and synthesized evidence through narrative description and vote counting of controlled trials. Data are openly available on our Open Science Framework website. Results: We found 6416 citations, of which 41 (0.64%) were eligible for inclusion (6 reviews and 35 primary studies of 33 interventions). Most interventions (26/33, 79%) combined intervention approaches and included an education component. Synthesis through vote counting showed benefits for all forms of digital well-being. Both included meta-analyses reported small positive effects on reductions of screen time. However, study reporting was overall lacking, impairing the ability to draw conclusions. Conclusions: As digital technology use increases, interventions to prevent problematic technology use and promote digital well-being continue to proliferate. Understanding context factors that influence healthy technology use and understanding the limitations of the current evidence are vital for informing future research. This review demonstrates positive findings for the effectiveness of prevention interventions and describes factors that may contribute to translation and implementation. Future research would benefit from following appropriate reporting guidelines, reporting both the benefits and harms of interventions, and including greater detail on factors informing translation. Trial Registration: PROSPERO CRD42023444387; https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=444387 %M 39693138 %R 10.2196/59968 %U https://www.jmir.org/2024/1/e59968 %U https://doi.org/10.2196/59968 %U http://www.ncbi.nlm.nih.gov/pubmed/39693138 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 10 %N %P e52478 %T Cognitive Mechanisms Between Psychosocial Resources and the Behavioral Intention of Professional Help-Seeking for Internet Gaming Disorder Among Chinese Adolescent Gamers: Cross-Sectional Mediation Study %A Yu,Yanqiu %A Ng,Joyce Hoi-Yuk %A Li,Ji-bin %A Zhang,Jianxin %A Lau,Joseph T F %K professional help-seeking %K behavioral intention %K internet gaming disorder %K IGD %K perception %K China %K mental health %K psychosocial resource %K secondary school %K gamer %K cross-sectional survey %D 2024 %7 14.11.2024 %9 %J JMIR Public Health Surveill %G English %X Background: Internet gaming disorder (IGD) is a global public health concern for adolescents due to its potential severe negative consequences. Professional help-seeking is important for early screening, diagnosis, and treatment of IGD. However, research on the factors associated with professional help-seeking for IGD as well as relevant mediation mechanisms among adolescents is limited. Objective: Based on the stress coping theory, the conservation of resource theory, and behavioral change theories, this study investigated the prevalence and factors influencing the behavioral intention of professional help-seeking for internet gaming disorder (BI-PHSIGD). The research also explored the underlying mechanisms, including psychosocial resources like resilience and social support, perceived resource loss due to reduced gaming time, and self-efficacy, in professional help-seeking among adolescent internet gamers. Methods: A cross-sectional survey was conducted among secondary school students who were internet gamers in 2 Chinese cities from October 2019 to January 2020. Data from the full sample (N=1526) and a subsample of 256 IGD cases (according to the 9-item DSM-5 [Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition] IGD Checklist) were analyzed. Multivariate logistic regression analysis was conducted to examine the factors of BI-PHSIGD, while structural equation modeling was performed to test the proposed mediation mechanisms. Results: The prevalence of BI-PHSIGD was 54.3% (829/1526) in the full sample and 40.6% (104/256) in the IGD subsample (vs 708/1239, 57.1% among non-IGD cases). In the full sample, psychosocial resources of resilience (adjusted odds ratio [aOR] 1.03, 95% CI 1.02-1.05) and social support (aOR 1.03, 95% CI 1.02-1.04) as well as self-efficacy in professional help-seeking (aOR 1.64, 95% CI 1.49-1.81) were positively associated with BI-PHSIGD, while perceived resource loss due to reduced gaming time was negatively associated with BI-PHSIGD (aOR 0.97, 95% CI 0.96-0.98); the positive association between psychosocial resources and BI-PHSIGD was fully mediated via 2 single-mediator indirect paths (via self-efficacy in professional help-seeking alone: effect size=53.4%; indirect effect/total effect=0.10/0.19 and via perceived resource loss due to reduced gaming time alone: effect size=17.8%; indirect effect/total effect=0.03/0.19) and one 2-mediator serial indirect path (first via perceived resource loss due to reduced gaming time then via self-efficacy in professional help-seeking: effect size=4.7%; indirect effect/total effect=0.009/0.19). In the IGD subgroup, a full mediation via self-efficacy in professional help-seeking alone but not the other 2 indirect paths was statistically significant. Conclusions: Many adolescent internet gamers, especially those with IGD, were unwilling to seek professional help; as a result, early treatment is often difficult to achieve. To increase BI-PHSIGD, enhancing psychosocial resources such as resilience and social support, perceived resource loss due to reduced gaming time, and self-efficacy in professional help-seeking may be effective. Future longitudinal and intervention studies are needed to confirm and extend the findings. %R 10.2196/52478 %U https://publichealth.jmir.org/2024/1/e52478 %U https://doi.org/10.2196/52478 %0 Journal Article %@ 2291-9279 %I JMIR Publications %V 12 %N %P e50418 %T School Climate and School Identification as Determinants of Internet Gaming Disorder Among Chinese Adolescent Internet Gamers: Cross-Sectional Mediation Study %A Yu,Yanqiu %A Yen,Stefanie H Y %A Wang,Deborah Baofeng %A Wu,Anise M S %A Chen,Juliet Honglei %A Zhang,Guohua %A Du,Mengni %A Du,Dajin %A Du,Mingxuan %A Lau,Joseph T F %K school climate %K school identification %K adolescent %K structural equation modeling %K internet gaming disorder %D 2024 %7 12.11.2024 %9 %J JMIR Serious Games %G English %X Background: School climate and school identification are important features of the school environment and potential determinants of adolescent internet gaming disorder (IGD). Objective: This novel study investigated their joint effects on IGD and related mediation mechanisms via the interpersonal factor of teacher-student relationship and the individual factors of academic stress and anxiety. Methods: A large-scale cross-sectional study was conducted among adolescent internet gamers of junior, senior, and vocational middle schools in Taizhou City, China, from February to March 2022 (N=5778). Participants self-administered an anonymous, structured questionnaire in classrooms. Adjusted logistic regression and structural equation modeling (SEM) were used for data analysis. Results: Among all participants, the prevalence of IGD was 8% (461/5778). The 4 school climate subscales (student-student relationship subscale: adjusted odds ratio [ORa] 0.88, 95% CI 0.85-0.91; student-staff relations subscale: ORa 0.87, 95% CI 0.84-0.90; academic emphasis subscale: ORa 0.88, 95% CI 0.85-0.91; shared values approach: ORa 0.88, 95% CI 0.85-0.90), the school identification subscale (ORa 0.85, 95% CI 0.83-0.88), and teacher-student relationship (ORa 0.80, 95% CI 0.76-0.84) were significant protective factors against IGD, while academic stress (ORa 1.18, 95% CI 1.14-1.23) and anxiety (ORa 1.16, 95% CI 1.14-1.18) were risk factors of IGD. The SEM showed that the negative associations between school climate and IGD and between school identification and IGD were mediated via (1) three 2-step paths, each involving a single mediator—teacher-student relationship, academic stress, and anxiety, respectively—and (2) two 3-step paths involving 2 mediators—teacher-student relationship and academic stress first, respectively, and then anxiety. The direct effect of school climate on IGD was statistically nonsignificant (ie, full mediation with effect size ranging from 4.2% to 20.4%), while that of school identification was statistically significant (ie, partial mediation with effect size ranging from 4.5% to 38.2%). Conclusions: The relatively high prevalence of IGD among Chinese adolescents may be reduced through school-based interventions to improve school climate and school identification. Such improvements may reduce the levels of risk factors of IGD (poor teacher-student relationship, academic stress, and anxiety) and hence the risk of IGD. Future longitudinal and intervention studies are needed to confirm the findings. %R 10.2196/50418 %U https://games.jmir.org/2024/1/e50418 %U https://doi.org/10.2196/50418 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 26 %N %P e59490 %T Interaction Effects Between Low Self-Control and Meaning in Life on Internet Gaming Disorder Symptoms and Functioning in Chinese Adolescents: Cross-Sectional Latent Moderated Structural Equation Modeling Study %A Fong,Ted CT %A Cui,Kunjie %A Yip,Paul SF %+ Research Institute of Social Development, Southwestern University of Finance and Economics, No. 555 Liutai Road, Wenjiang District, Chengdu, 611100, China, 86 17512828565, cuikunjie@swufe.edu.cn %K Chinese %K impulsivity %K interaction effects %K internet gaming disorder %K latent moderation %K meaning in life %K self-control %K temper %D 2024 %7 4.11.2024 %9 Original Paper %J J Med Internet Res %G English %X Background: Internet gaming disorder (IGD) is an emerging behavioral addiction with mental health implications among adolescents. Low self-control is an established risk factor of IGD. Few studies have, however, examined the moderating role of meaning in life (MIL) on the relationships between low self-control and IGD symptoms and functioning. Objective: This study aimed to examine the effects of low self-control and MIL and their interaction effects on IGD symptoms and family and school functioning in a structural equation model. Methods: A sample of 2064 adolescents (967, 46.9% male; mean age 14.6 years) was recruited by multistage cluster random sampling from 5 middle schools in Sichuan, China, in 2022. The participants completed a self-report questionnaire with validated measures on low self-control, presence of MIL, search for MIL, IGD symptoms, school commitment, and family functioning. Construct validity, measurement invariance, and structural invariance of the measures were evaluated by confirmatory factor analysis across sex. Structural equation modeling was conducted to examine the indirect effects of low self-control and MIL on family and school functioning through IGD symptoms. Latent moderated structural equation modeling was performed to examine the interaction effects between low self-control and MIL on IGD symptoms, school commitment, and family functioning. Results: All scales showed satisfactory model fit and scalar measurement invariance by sex. Males showed significantly greater IGD symptoms and lower levels of self-control (Cohen d=0.25-1.20, P<.001) than females. IGD symptoms were significantly and positively associated with impulsivity (β=.20, P=.01), temper (β=.25, P<.001), and search for meaning (β=.11, P=.048) and significantly and negatively associated with presence of meaning (β=–.21, P<.001). Presence of MIL and impulsivity showed a significant and negative interaction effect (β=–.11, SE .05; P=.03) on IGD symptoms. The positive effect of impulsivity on IGD symptoms was stronger among adolescents with low presence of MIL than those with high presence of MIL. Temper showed significant and positive interaction effects with presence of MIL (β=.08, SE .04; P=.03) and search for MIL (β=.08, SE .04; P=.04) on family functioning. The negative effects of temper on family functioning were stronger among adolescents with low levels of MIL than among those with high levels of MIL. Conclusions: This study provides the first findings on the interaction effects between low self-control and presence of MIL and search for MIL on IGD symptoms and functioning among a large sample of adolescents in rural China. The results have implications for targeted interventions to help male adolescents with lower self-control and presence of meaning. %M 39496163 %R 10.2196/59490 %U https://www.jmir.org/2024/1/e59490 %U https://doi.org/10.2196/59490 %U http://www.ncbi.nlm.nih.gov/pubmed/39496163 %0 Journal Article %@ 2369-3762 %I JMIR Publications %V 10 %N %P e55149 %T Social Media Usage for Medical Education and Smartphone Addiction Among Medical Students: National Web-Based Survey %A Clavier,Thomas %A Chevalier,Emma %A Demailly,Zoé %A Veber,Benoit %A Messaadi,Imad-Abdelkader %A Popoff,Benjamin %K medical student %K social network %K social media %K smartphone addiction %K medical education %K mobile addiction %K social networks %D 2024 %7 22.10.2024 %9 %J JMIR Med Educ %G English %X Background: Social media (SoMe) have taken a major place in the medical field, and younger generations are increasingly using them as their primary source to find information. Objective: This study aimed to describe the use of SoMe for medical education among French medical students and assess the prevalence of smartphone addiction in this population. Methods: A cross-sectional web-based survey was conducted among French medical students (second to sixth year of study). The questionnaire collected information on SoMe use for medical education and professional behavior. Smartphone addiction was assessed using the Smartphone Addiction Scale Short-Version (SAS-SV) score. Results: A total of 762 medical students responded to the survey. Of these, 762 (100%) were SoMe users, spending a median of 120 (IQR 60‐150) minutes per day on SoMe; 656 (86.1%) used SoMe for medical education, with YouTube, Instagram, and Facebook being the most popular platforms. The misuse of SoMe in a professional context was also identified; 27.2% (207/762) of students posted hospital internship content, and 10.8% (82/762) searched for a patient’s name on SoMe. Smartphone addiction was prevalent among 29.1% (222/762) of respondents, with a significant correlation between increased SoMe use and SAS-SV score (r=0.39, 95% CI 0.33‐0.45; P<.001). Smartphone-addicted students reported a higher impact on study time (211/222, 95% vs 344/540, 63.6%; P<.001) and a greater tendency to share hospital internship content on social networks (78/222, 35.1% vs 129/540, 23.8%; P=.002). Conclusions: Our findings reveal the extensive use of SoMe for medical education among French medical students, alongside a notable prevalence of smartphone addiction. These results highlight the need for medical schools and educators to address the responsible use of SoMe and develop strategies to mitigate the risks associated with excessive use and addiction. %R 10.2196/55149 %U https://mededu.jmir.org/2024/1/e55149 %U https://doi.org/10.2196/55149 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 13 %N %P e56387 %T Family-Centered Treatment Program for Problematic Gaming and Excessive Screen Use in a Clinical Child and Youth Population (FAME): Protocol for a Feasibility Pilot Mixed Method Study %A Werner,Marie %A Kapetanovic,Sabina %A Claesdotter-Knutsson,Emma %+ Department of Clinical Sciences Lund, Faculty of Medicine, Lund University, BOX 117, Lund, 22100, Sweden, 46 724685697, marie.werner@skane.se %K gaming %K family program %K family intervention %K pilot study, %K adolescent %K problematic gaming %K excessive screen time %K children %K screen use %K child-parent relationship %K motivational interviewing %D 2024 %7 8.10.2024 %9 Protocol %J JMIR Res Protoc %G English %X Background: Screen time among children and adolescents has increased dramatically, raising concerns about its impact on development and mental health. While research highlights both potential benefits and risks, excessive use has been linked to issues like anxiety, depression, and gaming addiction. Despite growing concern, effective interventions are scarce. Recognizing the importance of family dynamics in child development, we propose a family-centered program to address problematic gaming and excessive screen use in a clinical population. By involving both children and parents, we aim to create a more comprehensive approach to prevention and treatment. Objective: This study aims to determine the possibility of distributing and evaluating a family-centered group program for problematic gaming and excessive screen use (FAME) in a clinical child and adolescent psychiatry (CAP) population. We will monitor the recruitment rate; track the retention and attendance rates of both parents and children; and assess whether each session’s objectives are met, the content is delivered within the allotted time, and the necessary resources (eg, facilitators and materials) are available. Additionally, we will gather qualitative and quantitative feedback from participants through postprogram surveys and individual interviews with both children and parents. Methods: A total of 10 families with ongoing contact with CAP in Skåne, Sweden, will be recruited and offered participation in a family-centered group program targeting children aged 10-18 years with reported difficulties regarding screen gaming or screen use. The intervention to be tested is a newly developed, family-centered, psychoeducational, cognitive behavioral therapy–based intervention addressing both positive and negative aspects of screen use; setting boundaries; the connection between thoughts, feelings, and behaviors; conflict triggers; and sleep hygiene. The primary goal of the pilot study is to test the feasibility of the program, as well as recruitment and the analysis of participants’ experiences with the program. Results: A total of 11 children and their parents were enrolled during first quarter of 2024. A 4-session pilot was delivered in first quarter of 2024, and the first results are expected in the third quarter of 2024. Conclusions: The overarching goal of this pilot study is to determine the possibility of distributing and evaluating a family-centered group program for problematic gaming and excessive screen use (FAME) in a clinical CAP population. The insights gained from this study will guide our future research, which will focus on conducting a larger-scale evaluation of the intervention’s impact on family screen time conflicts and inform future strategies for the implementation of family-centered interventions in child and youth clinics. Trial Registration: ClinicalTrials.gov NCT06098807; https://clinicaltrials.gov/study/NCT06098807 International Registered Report Identifier (IRRID): DERR1-10.2196/56387 %M 39378066 %R 10.2196/56387 %U https://www.researchprotocols.org/2024/1/e56387 %U https://doi.org/10.2196/56387 %U http://www.ncbi.nlm.nih.gov/pubmed/39378066 %0 Journal Article %@ 2561-6722 %I JMIR Publications %V 7 %N %P e60604 %T Videoconference-Delivered Cognitive Behavioral Therapy for Parents of Adolescents With Internet Addiction: Pilot Randomized Controlled Trial %A Horita,Hideki %A Seki,Yoichi %A Yamaguchi,Takumi %A Shiko,Yuki %A Kawasaki,Yohei %A Shimizu,Eiji %+ Department of Cognitive Behavioral Physiology, Graduate School of Medicine, Chiba University, 1-8-1 inohana, Chiba City, 2608670, Japan, 81 476207779, horitah@iuhw.ac.jp %K internet addiction %K adolescents %K parents %K cognitive behavioral therapy %K digital health %D 2024 %7 3.10.2024 %9 Original Paper %J JMIR Pediatr Parent %G English %X Background: The rise in internet addiction, including web-based gaming and social networking services, is a serious concern. Even with access to medical institutions and counseling services, individuals with internet addiction, particularly adolescents, often refuse medical treatment or counseling. Parent-focused psychological intervention may lead to positive outcomes by improving the parent-adolescent relationship and helping parents identify and modify their adolescent’s problematic behaviors, including internet addiction. Objective: This study was a pilot randomized controlled trial to test the feasibility of remote cognitive behavioral therapy via videoconferencing for parents of adolescents with internet addiction. Methods: A total of 13 parents of adolescents aged 12-20 years with internet addiction were recruited and randomly assigned to either 12 sessions of the videoconference-delivered cognitive behavioral therapy (vCBT) group (n=6, 46%) or the waitlist control group (n=7, 54%). The study period was from March 1, 2018, to March 31, 2022. The primary outcome was the scores of the Young Internet Addiction Test reported by the adolescents. The secondary outcomes were adolescents’ hours of internet use per day (Internet Addiction Test), reported by the adolescents and by their parents; the Young Diagnostic Questionnaire, completed by the parents; and the quality of life of the adolescents and the parents, measured by the EQ-5D-5L. These were evaluated at weeks 0 and 13. Results: As the primary outcome, the mean total Internet Addiction Test score decreased from 67.7 (SD 18.3; 6/13, 46%) at week 0 to 56.2 (SD 25.1; 5/9, 56%) at week 13 in the vCBT group, compared to an increase from 66.9 (SD 21.9; 7/13, 54%) to 68.0 (SD 18.7; 4/9, 44%) in the control group. For all outcomes, no significant differences were found between the 2 groups (all P>.05). Conclusions: This study suggested the practical feasibility of vCBT for parents of adolescents with internet addiction. Further large-scale, multicenter randomized controlled trials are necessary to examine the effectiveness. Trial Registration: UMIN Clinical Trials Registry UMIN000032483; https://tinyurl.com/yuhen6c9 %M 39361415 %R 10.2196/60604 %U https://pediatrics.jmir.org/2024/1/e60604 %U https://doi.org/10.2196/60604 %U http://www.ncbi.nlm.nih.gov/pubmed/39361415 %0 Journal Article %@ 2564-1891 %I JMIR Publications %V 4 %N %P e58201 %T Detection and Characterization of Online Substance Use Discussions Among Gamers: Qualitative Retrospective Analysis of Reddit r/StopGaming Data %A Le,Nicolette %A McMann,Tiana %A Yang,Luning %A Li,Zhuoran %A Cuomo,Raphael E %A Mackey,Tim K %+ Global Health Program, Department of Anthropology, University of California San Diego, 9500 Gilman Drive, MC: 0505, La Jolla, CA, 92093, United States, 1 9514914161, tmackey@ucsd.edu %K internet gaming disorder %K gaming disorder %K substance use %K alcohol use %K nicotine use %K stimulants %K gaming %K internet gaming %K video games %K addiction %K addiction medicine %K digital mental health %K reddit %D 2024 %7 2.10.2024 %9 Original Paper %J JMIR Infodemiology %G English %X Background: Video games have rapidly become mainstream in recent decades, with over half of the US population involved in some form of digital gaming. However, concerns regarding the potential harms of excessive, disordered gaming have also risen. Internet gaming disorder (IGD) has been proposed as a tentative psychiatric disorder that requires further study by the American Psychological Association (APA) and is recognized as a behavioral addiction by the World Health Organization. Substance use among gamers has also become a concern, with caffeinated or energy drinks and prescription stimulants commonly used for performance enhancement. Objective: This study aimed to identify substance use patterns and health-related concerns among gamers among a population of Reddit users. Methods: We used the public streaming Reddit application programming interface to collect and analyze all posts from the popular subreddit, r/StopGaming. From this corpus of posts, we filtered the dataset for keywords associated with common substances that may be used to enhance gaming performance. We then applied an inductive coding approach to characterize substance use behaviors, gaming genres, and physical and mental health concerns. Potential disordered gaming behavior was also identified using the tentative IGD guidelines proposed by the APA. A chi-square test of independence was used to assess the association between gaming disorder and substance use characteristics, and multivariable logistic regression was used to analyze whether mental health discussion or the mention of any substance with sufficient sample size was significantly associated with IGD. Results: In total, 10,551 posts were collected from Reddit from June 2017 to December 2022. After filtering the dataset for substance-related keywords, 1057 were included for further analysis, of which 286 mentioned both gaming and the use of ≥1 substances. Among the 286 posts that discussed both gaming and substance use, the most mentioned substances were alcohol (n=132), cannabis (n=104), and nicotine (n=48), while the most mentioned genres were role-playing games (n=120), shooters (n=90), and multiplayer online battle arenas (n=43). Self-reported behavior that aligned with the tentative guidelines for IGD was identified in 66.8% (191/286) posts. More than half, 62.9% (180/286) of the posts, discussed a health issue, with the majority (n=144) cited mental health concerns. Common mental health concerns discussed were depression and anxiety. There was a significant association between IGD and substance use (P<.001; chi-square test), and there were significantly increased odds of IGD among those who self-reported substance use (odds ratio 2.29, P<.001) and those who discussed mental health (odds ratio 1.64, P<.03). Conclusions: As gaming increasingly becomes highly prevalent among various age groups and demographics, a better understanding of the interplay and convergence among disordered gaming, substance use, and negative health impacts can inform the development of interventions to mitigate risks and promote healthier gaming habits. %M 39357050 %R 10.2196/58201 %U https://infodemiology.jmir.org/2024/1/e58201 %U https://doi.org/10.2196/58201 %U http://www.ncbi.nlm.nih.gov/pubmed/39357050 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 10 %N %P e53101 %T Dose-Response Associations of Internet Use Time and Internet Addiction With Depressive Symptoms Among Chinese Children and Adolescents: Cross-Sectional Study %A Li,Juanjuan %A Sun,Weidi %A Luo,Zeyu %A Liu,Yi %A Huang,Xuanyin %A Jiang,Denan %A Li,Shuting %A Meng,Jia %A Gu,Fang %A Zhang,Ronghua %A Song,Peige %K internet use %K internet addiction %K depression %K children %K adolescents %K China %K depressive symptoms %D 2024 %7 23.9.2024 %9 %J JMIR Public Health Surveill %G English %X Background: Children’s lives are increasingly mediated by digital technologies, yet evidence regarding the associations between internet use and depression is far from comprehensive and remains unclear. Objective: This study aimed to investigate the dose-response association between internet use, including use time and addiction behaviors, and depressive symptoms among children and adolescents in Zhejiang Province. Methods: Data were collected from a school-based health survey China Common Disease and Risk Factor Surveillance Among Students, encompassing 21,336 students in Zhejiang Province. The daily internet use time, internet addiction (IA) behaviors, and depressive symptoms were assessed with questionnaires. Logistic regression models were used to explore the associations of internet use time and IA behaviors with depressive symptoms among children and adolescents. Restricted cubic spline curves were used to determine the dose-response associations. Results: A total of 6225 (29.2%) students had depressive symptoms. Compared to those reporting no internet use, boys using the internet for >2 hours/day (odds ratio [OR] 1.53, 95% CI 1.34‐1.74) and girls using internet for 1.1‐2 hours/day (OR 1.22, 95% CI 1.06‐1.39) and >2 hours/day (OR 1.70, 95% CI 1.50‐1.93) were at higher risks of depressive symptoms. A significant J-shaped association was identified between internet use time and depressive symptoms among children and adolescents, especially in boys and primary school students (nonlinear P values were .006, .003, and <.001, respectively). Increased IA behaviors were associated with a higher odd of depressive symptoms (1 IA behavior: OR 2.01, 95% CI 1.83‐2.21; 2 IA behaviors: 2.91, 95% CI 2.57‐3.29; and ≥3 IA behaviors: 4.72, 95% CI 4.26‐5.22). A positive nonlinear association between the number of IA behaviors and depressive symptoms was found in total population, girls, and primary school students (nonlinear P values were .02, .002, .007, respectively). Conclusions: Findings suggested that excessive internet use time and IA behaviors were significantly associated with an increased risk of depressive symptoms, highlighting the importance of interventions to regulate and educate about adequate internet use during childhood and adolescence. %R 10.2196/53101 %U https://publichealth.jmir.org/2024/1/e53101 %U https://doi.org/10.2196/53101 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 26 %N %P e52670 %T Factors Associated With the Use of Digital Technology Among Youth in Zimbabwe: Findings From a Cross-Sectional Population-Based Survey %A Martin,Kevin %A Peh,Rachel Wei Chun %A Tembo,Mandikudza %A Mavodza,Constancia Vimbayi %A Doyle,Aoife M %A Dziva Chikwari,Chido %A Dauya,Ethel %A Bandason,Tsitsi %A Azizi,Steven %A Simms,Victoria %A Ferrand,Rashida A %+ Department of Clinical Research, London School of Hygiene & Tropical Medicine, Keppel Street, London, WC1E 7HT, United Kingdom, 44 2076368636, kevin.martin@lshtm.ac.uk %K Zimbabwe %K youth %K digital technology %K household wealth %D 2024 %7 23.9.2024 %9 Original Paper %J J Med Internet Res %G English %X Background: Globally, the increasing use of digital technologies such as mobile phones and the internet has allowed for the development of innovative mobile health interventions, particularly for reaching and engaging with youth. However, there is a risk that using such technologies may exclude those who lack access to them. Objective: In this study, we investigated the sociodemographic factors associated with mobile phone ownership, internet use, and social media use among youth in Zimbabwe. Methods: A population-based prevalence survey was conducted in 24 urban and periurban communities across 3 provinces of Zimbabwe (Harare, Mashonaland East, and Bulawayo). Youths aged 18 to 24 years resident in randomly selected households in the study communities completed an interviewer-administered questionnaire. The primary outcomes were mobile phone ownership and current internet and social media use. A household wealth indicator was developed using principal components analysis, based on household asset ownership. Multivariable logistic regression was used to investigate the factors associated with each primary outcome. Age, sex, and province were considered a priori confounders. Household wealth, marital status, education level, employment status, time lived at current address, and HIV status were included in the final multivariable model if there was an age-, sex-, and province-adjusted association with a primary outcome on univariable analysis at a significance level of P<.10. Results: Of the 17,636 participants assessed for the primary outcome, 16,370 (92.82%) had access to a mobile phone, and 15,454 (87.63%) owned a mobile phone. Among participants with access to a mobile phone, 58.61% (9594/16,370) and 57.79% (9460/16,370), respectively, used internet and social media at least weekly. Older age (adjusted odds ratio [aOR] 1.76, 95% CI 1.55-2.00), increasing wealth (ranging from aOR 1.85, 95% CI 1.58-2.16, for wealth quintile 2 to aOR 3.80, 95% CI 3.00-4.80, for wealth quintile 5, with quintile 1 as reference), and higher education level (secondary: aOR 1.96, 95% CI 1.60-2.39; tertiary: aOR 8.36, 95% CI 5.29-13.20) were associated with mobile phone ownership. Older age, male sex, increasing wealth, having never been married, higher education level, being in education or formal employment, and having lived at the same address for ≥2 years were associated with higher levels of internet and social media use. Conclusions: While mobile phone ownership was near-universal, over one-third of youths in urban and periurban settings did not have access to the internet and social media. Access to the internet and social media use were strongly associated with household wealth and education level. Mobile health interventions must ensure that they do not amplify existing inequalities in access to health care. Such interventions must be accompanied by alternative strategies to engage and enroll individuals without internet or social media access to prevent the exclusion of young people by sex and socioeconomic status. %M 39312390 %R 10.2196/52670 %U https://www.jmir.org/2024/1/e52670 %U https://doi.org/10.2196/52670 %U http://www.ncbi.nlm.nih.gov/pubmed/39312390 %0 Journal Article %@ 2291-9279 %I JMIR Publications %V 12 %N %P e57304 %T The Mediating Role of Problematic Use of Loot Boxes Between Internet Gaming Disorder and Online Gambling Disorder: Cross-Sectional Analytical Study %A González-Cabrera,Joaquín %A Caba-Machado,Vanessa %A Díaz-López,Adoración %A Jiménez-Murcia,Susana %A Mestre-Bach,Gemma %A Machimbarrena,Juan M %K loot boxes %K loot box %K gaming %K gambling %K problematic %K video games %K game %K games %K addict %K addiction %K addictions %K addictive %K internet %K virtual object %K virtual objects %K gamification %K IGD %K OGD %K monetize %K monetization %K reward %K rewards %K incentive %K incentives %K internet gaming disorder %K online gambling disorder %D 2024 %7 20.9.2024 %9 %J JMIR Serious Games %G English %X Background: The video game industry has introduced a new form of monetization through microtransactions. A controversial example has been the so-called “loot boxes” (LBs) as virtual objects, which are randomized and bought with legal money. In recent years, LBs have come to connect 2 distinct problem behaviors, namely internet gaming disorder (IGD) and online gambling disorder (OGD). Many association studies have been conducted on the 3 constructs, but few have delved into the relationship of problematic use of LBs (PU-LB) with IGD and OGD. Objective: This study aims to explore the mediating role of the PU-LB between IGD and OGD. Methods: This cross-sectional and analytical study used incidental sampling in 24 Spanish schools. The final sample consisted of 542 participants (male: n=523, 96.5%; age: range 11‐30 y) who played video games, bought LBs, and had gambled online in the last 12 months. Participants then completed the Spanish versions of the Internet Gaming Disorder Scale–Short Form, Online Gambling Disorder Questionnaire, and PU-LB scale. Results: IGD scores were found to be significantly associated with both PU-LB (r=0.473, P<.001) and OGD (r=0.209, P<.001). Moreover, PU-LB was significantly associated with OGD (r=0.351, P<.001). The structural equation model results indicated that IGD had no significant direct effect on OGD (P=.903). However, the indirect effect of IGD on OGD through PU-LB was significant (P<.001). Therefore, PU-LB fully mediated the relationship between IGD and OGD. Furthermore, these results were found in the subsamples of both minors (<18 y) and young adults (≥18 y). Conclusions: It is suggested that there is a mediation effect of problematic LB use between internet gambling and online gambling problems in both minors and young adults. This has potential practical implications by providing more evidence on how LBs have become a hinge feature between 2 clinically relevant and independent issues. In this regard, adequate industry self-regulation is needed, and effective legislation for the protection of minors is necessary. %R 10.2196/57304 %U https://games.jmir.org/2024/1/e57304 %U https://doi.org/10.2196/57304 %0 Journal Article %@ 2291-9279 %I JMIR Publications %V 12 %N %P e48439 %T Association Between Internet Gaming Disorder and Suicidal Ideation Mediated by Psychosocial Resources and Psychosocial Problems Among Adolescent Internet Gamers in China: Cross-Sectional Study %A Yu,Yanqiu %A Wu,Anise M S %A Fong,Vivian W I %A Zhang,Jianxin %A Li,Ji-bin %A Lau,Joseph T F %+ Public Mental Health Center, School of Mental Health, Wenzhou Medical University, Ouhai District, Wenzhou, 325000, China, 86 57786689810, jlau@cuhk.edu.hk %K internet gaming disorder %K suicidal ideation %K adolescents %K mediation %K structural equation modelling %K resilience %K loneliness %K social support %K social anxiety %D 2024 %7 19.9.2024 %9 Original Paper %J JMIR Serious Games %G English %X Background: Adolescent internet gaming disorder (IGD) was associated with severe harm, including suicidal ideation. While suicidal ideation was predictive of completed suicides, further research is required to clarify the association between IGD and suicidal ideation among adolescents, as well as the mechanisms involved. Objective: This study aimed to investigate the understudied association between IGD and suicidal ideation, as well as novel mechanisms associated with it, among Chinese adolescent internet gamers through psychosocial coping resources and psychosocial problems. Methods: An anonymous, self-administered, cross-sectional survey was conducted among secondary school students who had played internet games in the past year in Guangzhou and Chengdu, China (from October 2019 to January 2020). In total, 1693 adolescent internet gamers were included in this study; the mean age was 13.48 (SD 0.80) years, and 60% (n=1016) were males. IGD was assessed by the 9-item Internet Gaming Disorder Checklist of the DSM-5 (Diagnostic and Statistical Manual of Mental Disorders [Fifth Edition]), while a single item assessed suicidal ideation: “Have you ever considered committing suicide in the past 12 months?” Univariate and multivariate logistic regression associations were conducted to test the significance and directions of the potential factors for suicidal ideation. The mediation mechanism was examined by structural equation modeling. Results: Among all participants, the prevalence of IGD and suicidal ideation was 16.95% (287/1693) and 43.06% (729/1693), respectively. IGD cases were 2.42 times more likely than non-IGD cases to report suicidal ideation (adjusted odds ratio [OR] 2.42, 95% CI 1.73-3.37). Other significant factors of suicidal ideation included psychosocial coping resources (resilience and social support, both adjusted OR 0.97, 95% CI 0.96-0.98) and psychosocial problems (social anxiety: adjusted OR 1.07, 95% CI 1.05-1.09; loneliness, adjusted OR 1.13, 95% CI 1.10-1.16). The association between IGD and suicidal ideation was partially mediated by 3 indirect paths, including (1) the 2-step path that IGD reduced psychosocial coping resources, which in turn increased suicidal ideation; (2) the 2-step path that IGD increased psychosocial problems, which in turn increased suicidal ideation; and (3) the 3-step path that IGD reduced psychosocial coping resources which then increased psychosocial problems, which in turn increased suicidal ideation, with effect sizes of 10.7% (indirect effect/total effect: 0.016/0.15), 30.0% (0.05/0.15), and 13.3% (0.02/0.15), respectively. The direct path remained statistically significant. Conclusions: IGD and suicidal ideation were alarmingly prevalent. Evidently and importantly, IGD was a significant risk factor for suicidal ideation. The association was partially explained by psychosocial coping resources of resilience and social support and psychosocial problems of social anxiety and loneliness. Longitudinal studies are needed to confirm the findings. Pilot randomized controlled trials are recommended to evaluate the effectiveness of interventions in reducing suicidal ideation by reducing IGD, improving psychosocial coping resources, and reducing psychosocial problems investigated in this study. %M 39298753 %R 10.2196/48439 %U https://games.jmir.org/2024/1/e48439 %U https://doi.org/10.2196/48439 %U http://www.ncbi.nlm.nih.gov/pubmed/39298753 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 26 %N %P e54754 %T Introducing and Evaluating the Effectiveness of Online Cognitive Behavior Therapy for Gambling Disorder in Routine Addiction Care: Comparative Cohort Study %A Molander,Olof %A Berman,Anne H %A Jakobson,Miriam %A Gajecki,Mikael %A Hällström,Hanna %A Ramnerö,Jonas %A Bjureberg,Johan %A Carlbring,Per %A Lindner,Philip %+ Centre for Psychiatry Research, Department of Clinical Neuroscience, Karolinska Institutet, Stockholm Health Care Services, Region Stockholm, Stationsgatan 69, 7th floor, Stockholm, SE-113 64, Sweden, 46 700011241, olof.molander@ki.se %K gambling disorder %K internet-delivered cognitive behavioral therapy %K routine addiction care %K registry study %K gambling %K addiction %K health care setting %K iCBT %K Sweden %K feasibility %K clinic %K hospital %K psychological treatment %K digital intervention %K addictive disorder %K eHealth %K digital care %K survival analysis %K comorbidity %D 2024 %7 18.9.2024 %9 Original Paper %J J Med Internet Res %G English %X Background: Several treatment-related challenges exist for gambling disorder, in particular at-scale dissemination in health care settings. Objective: This study describes the introduction of a newly developed internet-delivered cognitive behavioral therapy (iCBT) program for gambling disorder (GD), provided with therapist support in routine addiction care, in a nationally recruited sample in Sweden. The study details the introduction of the iCBT program, evaluates its effectiveness and acceptability, and compares registry outcomes among iCBT patients with other patients with GD at the clinic who received face-to-face psychological treatment as usual. Methods: The study site was the Stockholm Addiction eClinic, which offers digital interventions for addictive disorders in routine care. The iCBT program was introduced nationally for treatment-seeking patients through the Swedish eHealth platform. After approximately 2 years of routine treatment provision, we conducted a registry study, including ordinary patients in routine digital care (n=218), and a reference sample receiving face-to-face psychological treatment for GD (n=216). Results: A statistically significant reduction in the Gambling Symptom Assessment Scale scores during the treatment was observed (B=–1.33, SE=0.17, P<.001), corresponding to a large within-group Cohen d effect size of d=1.39. The iCBT program was rated high for satisfaction. A registry-based survival analysis, controlling for psychiatric comorbidity, showed that patients receiving iCBT exhibited posttreatment outcomes (re-engagement in outpatient addiction care, receiving new psychiatric prescriptions, enrollment in psychiatric inpatient care, and care events indicative of contact with social services) similar to comparable patients who underwent face-to-face treatment-as-usual. Conclusions: A lack of randomized allocation notwithstanding, the iCBT program for GD evaluated in this study was well-received by patients in routine addiction care, was associated with the expected symptom decrease during treatment, and appears to result in posttreatment registry outcomes similar to face-to-face treatment. Future studies on treatment mechanisms and moderators are warranted. International Registered Report Identifier (IRRID): RR2-10.1186/s40814-020-00647-5 %M 39293054 %R 10.2196/54754 %U https://www.jmir.org/2024/1/e54754 %U https://doi.org/10.2196/54754 %U http://www.ncbi.nlm.nih.gov/pubmed/39293054 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 26 %N %P e52978 %T COVID-19–Related Social Isolation, Self-Control, and Internet Gaming Disorder Among Chinese University Students: Cross-Sectional Survey %A Guo,Yufang %A Yue,Fangyan %A Lu,Xiangyu %A Sun,Fengye %A Pan,Meixing %A Jia,Yannan %+ School of Nursing and Rehabilitation, Shandong University, 44 Wen Hua Xi Road, Jinan, 250012, China, 86 15269163352, cdguoyufang@163.com %K COVID-19 pandemic %K internet gaming disorder %K self-control %K social isolation %K university students %K game %K gaming %K games %K addict %K addictive %K addiction %K addictions %K university %K universities %K college %K colleges %K postsecondary %K higher education %K student %K students %K China %K Chinese %K isolation %K isolated %K self-compassion %K mental health %K association %K associations %K correlation %K causal %K correlated %K correlations %D 2024 %7 10.9.2024 %9 Original Paper %J J Med Internet Res %G English %X Background: Internet gaming disorder among university students has become a great concern for university counsellors worldwide since the COVID-19 pandemic. The factors influencing the development of internet gaming disorder in students during the COVID-19 pandemic could be different from those before the pandemic. Objective: This study aims to explore the associations among social isolation, self-control, and internet gaming disorder in Chinese university students and to examine whether self-control mediates the positive effects of social isolation on internet gaming disorder. Methods: A cross-sectional survey was employed to collect data from university students in Shandong province of China from April to September 2022. The Isolation subscale of the Self-Compassion Scale, Self-Control Scale, and Internet Gaming Disorder Scale were used to assess the social isolation, self-control, and internet gaming disorder among university students, respectively. Models 4 and 5 of PROCESS software were used to analyze the mediating role of self-control and the moderating role of gender on the association between social isolation and internet gaming disorder. Results: A total of 479 students were recruited from 6 universities located in 3 different regions of Shandong, China. Students had low levels of internet gaming disorder and moderate levels of social isolation and self-control, with mean scores of 8.94 (SD 9.06), 12.04 (SD 3.53), and 57.15 (SD 8.44), respectively. Social isolation was positively correlated with internet gaming disorder (r=0.217; P<.001), and self-control was negatively correlated with social isolation (r=–0.355; P<.001) and internet gaming disorder (r=–0.260; P<.001). Self-control played a mediating role in the association between social isolation and internet gaming disorder (β=–.185, 95% CI –.295 to –.087). The effects of social isolation on internet gaming disorder among female students were lower than those among male students. Conclusions: Self-control was a mediator in the association between social isolation and internet gaming disorder. Moreover, gender played a moderating role in the association between social isolation and internet gaming disorder. This study highlights the need to alleviate the development of internet gaming disorder among students during a pandemic, especially that of male students. Effective interventions that lessen social isolation and promote self-control should be developed. %M 39255486 %R 10.2196/52978 %U https://www.jmir.org/2024/1/e52978 %U https://doi.org/10.2196/52978 %U http://www.ncbi.nlm.nih.gov/pubmed/39255486 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 13 %N %P e58739 %T Problematic Social Media Use Among Italian Midadolescents: Protocol and Rationale of the SMART Project %A Donisi,Valeria %A Salerno,Laura %A Delvecchio,Elisa %A Brugnera,Agostino %+ Department of Philosophy, Social Sciences and Education, University of Perugia, Piazza Ermini 1, Perugia, 06123, Italy, 39 0755854943, elisa.delvecchio@unipg.it %K adolescents %K social media %K problematic social media use %K psychological distress %K wellbeing promotion %K eHealth interventions %K co-creation %K qualitative research %K biomarkers %D 2024 %7 9.9.2024 %9 Proposal %J JMIR Res Protoc %G English %X Background: Social media (SM) use constitutes a large portion of midadolescents’ daily lives as a way of peer interaction. A significant percentage of adolescents experience intense or problematic social media use (PSMU), an etiologically complex behavior potentially associated with psychological distress. To date, studies longitudinally testing for risk or protective factors of PSMU, and collecting qualitative data are still scarce among midadolescents. Self-help interventions specifically targeting PSMU in this population and involving midadolescents in co-creation are needed. Objective: The 2-year SMART multicenter project aims to (1) advance knowledge on PSMU; (2) co-design an unguided self-help app for promoting awareness and functional SM use; and (3) test feasibility and provide preliminary findings on its effectiveness to further improve and adapt the app. Methods: The SMART project is organized in 3 phases: phase 1 will focus on knowledge advancement on PSMU and its risk and protective factors using a longitudinal design; phase 2 will explore adolescents perspectives using qualitative approach and will co-design an unguided self-help app for reducing PSMU, which will be evaluated and adapted in phase 3. Around 1500 midadolescents (aged 14-18 years) will be recruited in northern, central, and southern Italy to investigate the potential intra- and interpersonal psychological risk and protective factors for PSMU and define specific PSMU profiles and test for its association with psychological distress. Subjective (self-report) PSMU’s psychosocial risk or protective factors will be assessed at 3 different time points and Ecological Momentary Assessment (EMA) will be used. Moreover, focus groups will be performed in a subsample of midadolescents to collect the adolescents’ unique point of view on PSMU and experiences with SM. Those previous results will inform the self-help app, which will be co-designed through working groups with adolescents. Subsequently, the SMART app will be deployed and adapted, after testing its feasibility and potential effectiveness in a pilot study. Results: The project is funded by the Italian Ministry of University and Research as part of a national grant (PRIN, “Progetti di Rilevante Interesse Nazionale”). The research team received an official notice of research funding approval in July 2023 (Project Code 2022LC4FT7). The project was preregistered on Open Science Framework, while the ethics approval was obtained in November 2023. We started the enrollments in December 2023, with the final follow-up data to be collected within May 2025. Conclusions: The innovative aspects of the SMART project will deepen the conceptualization of PSMU and of its biopsychosocial antecedents among midadolescents, with relevant scientific, technological, and socioeconomic impacts. The advancement of knowledge and the developed self-help app for PSMU will timely respond to midadolescents’ increased loneliness and psychological burden due to COVID-19 pandemic and humanitarian crisis. Trial Registration: OSF Registries; https://osf.io/2ucnk/ International Registered Report Identifier (IRRID): DERR1-10.2196/58739 %M 39248403 %R 10.2196/58739 %U https://www.researchprotocols.org/2024/1/e58739 %U https://doi.org/10.2196/58739 %U http://www.ncbi.nlm.nih.gov/pubmed/39248403 %0 Journal Article %@ 2368-7959 %I JMIR Publications %V 11 %N %P e56896 %T Preventive Interventions for Internet Addiction in Young Children: Systematic Review %A Theopilus,Yansen %A Al Mahmud,Abdullah %A Davis,Hilary %A Octavia,Johanna Renny %+ Centre for Design Innovation, Swinburne University of Technology, John St Hawthorn, Melbourne, 3122, Australia, 61 39214383, aalmahmud@swin.edu.au %K children %K digital device %K internet addiction %K intervention %K prevention %K problematic internet use %K technology %K young children %K problematic use %K preventive %K interventions %K systematic review %K internet %K addiction %K prevent %K reduce %K risk %K risks %K database %K databases %K child %K PICOS %K thematic analysis %K Population, Intervention, Comparison, Outcome, and Study type %D 2024 %7 30.8.2024 %9 Review %J JMIR Ment Health %G English %X Background: In this digital age, children typically start using the internet in early childhood. Studies highlighted that young children are vulnerable to internet addiction due to personal limitations and social influence (eg, family and school). Internet addiction can have long-term harmful effects on children’s health and well-being. The high risk of internet addiction for vulnerable populations like young children has raised questions about how best to prevent the problem. Objective: This review study aimed to investigate the existing interventions and explore future directions to prevent or reduce internet addiction risks in children younger than 12 years. Methods: The systematic review was conducted following the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines. We searched for relevant literature from 4 research databases (Scopus, Web of Science, PubMed, and PsycINFO). We included 14 primary studies discussing the interventions to prevent or reduce internet addiction risks in young children and their efficacy outcomes. Results: The preventive interventions identified were categorized into four approaches as follows: (1) children’s education, (2) parenting strategy, (3) strategic physical activity, and (4) counseling. Ten interventions showed promising efficacy in preventing or reducing internet addiction risks with small-to-medium effect sizes. Interventions that enhance children’s competencies in having appropriate online behaviors and literacy were more likely to show better efficacy than interventions that force children to reduce screen time. Interventions that shift children’s focus from online activities to real-world activities also showed promising efficacy in reducing engagement with the internet, thereby preventing addictive behaviors. We also identified the limitations of each approach (eg, temporariness, accessibility, and implementation) as valuable considerations in developing future interventions. Conclusions: The findings suggest the need to develop more sustainable and accessible interventions to encourage healthy online behaviors through education, appropriate parenting strategies, and substitutive activities to prevent children’s overdependence on the internet. Developing digital tools and social support systems can be beneficial to improve the capability, efficiency, and accessibility of the interventions. Future interventions also need to consider their appropriateness within familial context or culture and provide adequate implementation training. Last, policy makers and experts can also contribute by making design guidelines to prevent digital product developers from making products that can encourage overuse in children. %R 10.2196/56896 %U https://mental.jmir.org/2024/1/e56896 %U https://doi.org/10.2196/56896 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 13 %N %P e56315 %T Effectiveness and Acceptability of Cognitive Behavioral Therapy and Family Therapy for Gaming Disorder: Protocol for a Nonrandomized Intervention Study of a Novel Psychological Treatment %A Bore,Per %A Nilsson,Sara %A Andersson,Mitchell %A Oehm,Kajsa %A Attvall,Joel %A Håkansson,Anders %A Claesdotter-Knutsson,Emma %+ Section for Psychiatry, Department of Clinical Sciences Lund, Faculty of Medicine, Lund University, Sölvegatan 19 - BMC I12, Lund, 221 84, Sweden, 46 0702184963, per.bore@med.lu.se %K gaming disorder %K psychological treatment %K CBT %K cognitive behavioral therapy %K family therapy %K effectiveness %K acceptability %K gaming %K addiction %K mixed method design %K video games %K leisure activity %K Sweden %K young adult %K teenager %K internet gaming disorder %D 2024 %7 16.8.2024 %9 Protocol %J JMIR Res Protoc %G English %X Background: Gaming disorder (GD) is a new official diagnosis in the International Classification of Diseases, 11th Revision, and with its recognition, the need to offer treatment for the condition has become apparent. More knowledge is needed about the type of treatment needed for this group of patients. Objective: This study aims to evaluate the effectiveness and acceptability of a novel module-based psychological treatment for GD based on cognitive behavioral therapy and family therapy. Methods: This study is a nonrandomized intervention study, with a pretest, posttest, and 3-month follow-up design. It will assess changes in GD symptoms, psychological distress, and gaming time, alongside treatment satisfaction, working alliance, and a qualitative exploration of patients’ and relatives’ experiences of the treatment. Results: This study started in March 2022 and the recruitment is expected to close in August 2024. Conclusions: This study evaluates the effectiveness and acceptability of a psychological treatment for patients with problematic gaming behavior and GD. It is an effectiveness trial and will be conducted in routine care. This study will have high external validity and ensure that the results are relevant for a diverse clinical population with psychiatric comorbidity. Trial Registration: ClinicalTrials.gov NCT06018922; https://clinicaltrials.gov/study/NCT06018922 International Registered Report Identifier (IRRID): DERR1-10.2196/56315 %M 39151165 %R 10.2196/56315 %U https://www.researchprotocols.org/2024/1/e56315 %U https://doi.org/10.2196/56315 %U http://www.ncbi.nlm.nih.gov/pubmed/39151165 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 26 %N %P e51957 %T Exploring the Relationship Between Instagram Use and Self-Criticism, Self-Compassion, and Body Dissatisfaction in the Spanish Population: Observational Study %A Varaona,Andrea %A Alvarez-Mon,Miguel Angel %A Serrano-Garcia,Irene %A Díaz-Marsá,Marina %A Looi,Jeffrey C L %A Molina-Ruiz,Rosa M %+ Department of Medicine and Medical Specialities, Faculty of Medicine and Health Sciences, University of Alcala, C/19, Carretera Madrid-Barcelona, Km 33,600, Alcalá de Henares, 28805, Spain, 34 918854503, maalvarezdemon@icloud.com %K Instagram %K self-compassion %K self-esteem %K self-criticism %K self-worth %K body dissatisfaction %K dissatisfaction %K satisfaction %K appearance %K psychological %K social media %K body %K mental health %K mental wellbeing %K Spain %K Spanish %K Hispanic %K depression %K depressive %K usage %K correlation %K association %D 2024 %7 1.8.2024 %9 Original Paper %J J Med Internet Res %G English %X Background: The widespread use of online social networks, particularly among the younger demographic, has catalyzed a growing interest in exploring their influence on users’ psychological well-being. Instagram (Meta), a visually oriented platform, has garnered significant attention. Prior research has consistently indicated that Instagram usage correlates with heightened levels of perfectionism, body dissatisfaction, and diminished self-esteem. Perfectionism is closely linked to self-criticism, which entails an intense self-scrutiny and is often associated with various psychopathologies. Conversely, self-compassion has been linked to reduced levels of perfectionism and stress, while fostering greater positive affect and overall life satisfaction. Objective: This study investigates the relationship between Instagram usage (time of use and content exposure) and users’ levels of self-compassion, self-criticism, and body dissatisfaction. Methods: This study comprised 1051 adult participants aged between 18 and 50 years, either native to Spain or residing in the country for at least a decade. Each participant completed a tailored questionnaire on Instagram usage, along with abbreviated versions of the Self-Compassion Scale, the Body Shape Questionnaire, and the Depressive Experiences Questionnaire, spanning from January 23 to February 25, 2022. Results: A positive correlation was observed between daily Instagram usage and self-criticism scores. Participants of all age groups who spent over 3 hours per day on Instagram exhibited higher self-criticism scores than users who spent less than 1 hour or between 1 and 3 hours per day. Contrary to previous findings, no significant relationship was detected between Instagram usage time and levels of self-compassion or body dissatisfaction. Furthermore, content centered around physical appearance exhibited a positive correlation with self-criticism and body dissatisfaction scores. Among younger participants (aged 18-35 years), those who primarily viewed beauty or fashion content reported higher self-criticism scores than those consuming science-related content. However, this association was not significant for participants aged 35-50 years. Conversely, individuals who predominantly engaged with sports or fitness or family or friends content exhibited higher levels of body dissatisfaction than those focusing on science-related content. No significant associations were observed between self-compassion scores and daily Instagram usage or most-viewed content categories. Conclusions: The findings of this study underscore the considerable impact of Instagram usage on self-criticism and body dissatisfaction—2 variables known to influence users’ psychological well-being and be associated with various symptoms and psychological disorders. %M 39088263 %R 10.2196/51957 %U https://www.jmir.org/2024/1/e51957 %U https://doi.org/10.2196/51957 %U http://www.ncbi.nlm.nih.gov/pubmed/39088263 %0 Journal Article %@ 2292-9495 %I JMIR Publications %V 11 %N %P e54951 %T Probing the Role of Digital Payment Solutions in Gambling Behavior: Preliminary Results From an Exploratory Focus Group Session With Problem Gamblers %A Lakew,Nathan %A Jonsson,Jakob %A Lindner,Philip %+ Department of Clinical Neuroscience, Karolinska Institutet, Norra Stationsgatan 69, Plan 7, Stockholm, 113 64, Sweden, 46 852483391, nathan.lakew@ki.se %K digital payment solutions %K online gambling behavior %K sociotechnical %K subjective experience %K focus group %D 2024 %7 23.7.2024 %9 Original Paper %J JMIR Hum Factors %G English %X Background: Technology has significantly reshaped the landscape and accessibility of gambling, creating uncharted territory for researchers and policy makers involved in the responsible gambling (RG) agenda. Digital payment solutions (DPS) are the latest addition of technology-based services in gambling and are now prominently used for deposit and win withdrawal. The seamless collaboration between online gambling operators and DPS, however, has raised concerns regarding the potential role of DPS platforms in facilitating harmful behavior. Objective: Using a focus group session with problem gamblers, this study describes a preliminary investigation of the role of DPS in the online gambling context and its influence on players’ gambling habits, financial behavior, choices of gambling environment, and the overall outcome of gambling subjective experiences. Methods: A total of 6 problem gamblers participated in a one-and-half-hour focus group session to discuss how DPSs are integrated into their everyday gambling habits, what motivates them to use DPS, and what shifts they observe in their gambling behavior. Thematic analysis was used to analyze the empirical evidence with a mix of inductive and deductive research approaches as a knowledge claim strategy. Results: Our initial findings revealed that the influence of DPSs in online gambling is multifaced where, on the one hand, their ability to integrate with players’ existing habits seamlessly underscores the facilitating role they play in potentially maximizing harm. On the other hand, we find preliminary evidence that DPSs can have a direct influence on gambling outcomes in both subtle and pervasive ways—nudging, institutionalizing, constraining, or triggering players’ gambling activities. This study also highlights the increasingly interdisciplinary nature of online gambling, and it proposes a preliminary conceptual framework to illustrate the sociotechnical interplay between DPS and gambling habits that ultimately capture the outcome of gambling’s subjective experience. Conclusions: Disguised as a passive payment enabler, the role of DPS has so far received scant attention; however, this exploratory qualitative study demonstrates that given the technological advantage and access to customer financial data, DPS can become a potent platform to enable and at times trigger harmful gambling. In addition, DPS’s bird’s-eye view of cross-operator gambling behavior can open up an opportunity for researchers and policy makers to explore harm reduction measures that can be implemented at the digital payment level for gambling customers. Finally, more interdisciplinary studies are needed to formulate the sociotechnical nature of online gambling and holistic harm minimization strategy. %M 39042438 %R 10.2196/54951 %U https://humanfactors.jmir.org/2024/1/e54951 %U https://doi.org/10.2196/54951 %U http://www.ncbi.nlm.nih.gov/pubmed/39042438 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 12 %N %P e51307 %T Mobile App Intervention to Reduce Substance Use, Gambling, and Digital Media Use in Vocational School Students: Exploratory Analysis of the Intervention Arm of a Randomized Controlled Trial %A Grahlher,Kristin %A Morgenstern,Matthis %A Pietsch,Benjamin %A Gomes de Matos,Elena %A Rossa,Monika %A Lochbühler,Kirsten %A Daubmann,Anne %A Thomasius,Rainer %A Arnaud,Nicolas %+ German Centre for Addiction Research in Childhood and Adolescence, University Medical Centre Hamburg-Eppendorf, Martinistr 52, Hamburg, 20246, Germany, 49 40741059307, n.arnaud@uke.de %K prevention %K vocational students %K adolescents %K mobile intervention %K voluntary commitment %K substance use %K internet-related problems %K mobile phone %K adolescent %K youths %K student %K students %K use %D 2024 %7 23.7.2024 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: During adolescence, substance use and digital media exposure usually peak and can become major health risks. Prevention activities are mainly implemented in the regular school setting, and youth outside this system are not reached. A mobile app (“Meine Zeit ohne”) has been developed specifically for vocational students and encourages participants to voluntarily reduce or abstain from a self-chosen addictive behavior including the use of a substance, gambling, or a media-related habit such as gaming or social media use for 2 weeks. Results from a randomized study indicate a significant impact on health-promoting behavior change after using the app. This exploratory study focuses on the intervention arm of this study, focusing on acceptance and differential effectiveness. Objective: The aims of this study were (1) to examine the characteristics of participants who used the app, (2) to explore the effectiveness of the mobile intervention depending on how the app was used and depending on participants’ characteristics, and (3) to study how variations in app use were related to participants’ baseline characteristics. Methods: Log data from study participants in the intervention group were analyzed including the frequency of app use (in days), selection of a specific challenge, and personal relevance (ie, the user was above a predefined risk score for a certain addictive behavior) of challenge selection (“congruent use”: eg, a smoker selected a challenge related to reducing or quitting smoking). Dichotomous outcomes (change vs no change) referred to past-month substance use, gambling, and media-related behaviors. The relationship between these variables was analyzed using binary, multilevel, mixed-effects logistic regression models. Results: The intervention group consisted of 2367 vocational students, and 1458 (61.6%; mean age 19.0, SD 3.5 years; 830/1458, 56.9% male) of them provided full data. Of these 1458 students, 894 (61.3%) started a challenge and could be included in the analysis (mean 18.7, SD 3.5 years; 363/894, 40.6% female). Of these 894 students, 466 (52.1%) were considered frequent app users with more than 4 days of active use over the 2-week period. The challenge area most often chosen in the analyzed sample was related to social media use (332/894, 37.1%). A total of 407 (45.5%) of the 894 students selected a challenge in a behavioral domain of personal relevance. The effects of app use on outcomes were higher when the area of individual challenge choice was equal to the area of behavior change, challenge choice was related to a behavior of personal relevance, and the individual risk of engaging in different addictive behaviors was high. Conclusions: The domain-specific effectiveness of the program was confirmed with no spillover between behavioral domains. Effectiveness appeared to be dependent on app use and users’ characteristics. Trial Registration: German Clinical Trials Register DRKS00023788; https://tinyurl.com/4pzpjkmj International Registered Report Identifier (IRRID): RR2-10.1186/s13063-022-06231-x %M 39042436 %R 10.2196/51307 %U https://mhealth.jmir.org/2024/1/e51307 %U https://doi.org/10.2196/51307 %U http://www.ncbi.nlm.nih.gov/pubmed/39042436 %0 Journal Article %@ 1929-073X %I JMIR Publications %V 13 %N %P e46570 %T Biochemical Changes in Adult Male Gamers During Prolonged Gaming: Pilot Study %A Krarup,Kasper Bygum %A Riis,Johannes %A Mørk,Morten %A Nguyen,Hien Thi Thu %A Søkilde Pedersen,Inge %A Risom Kristensen,Søren %A Handberg,Aase %A Krarup,Henrik Bygum %+ Department of Geriatrics, Aalborg University Hospital, Reberbansgade 15, Aalborg, 9000, Denmark, 45 61781289, kasper.krarup@rn.dk %K long gaming sessions %K local area network party %K biochemistry %K cortisol %K glucose %K gaming %K biochemical %K blood sample %K hematology %K hematological %K games %K gamers %K hemoglobin %K adults %K males %K men %K blood %D 2024 %7 8.7.2024 %9 Original Paper %J Interact J Med Res %G English %X Background: Gaming has become an integrated part of life for children and adults worldwide. Previous studies on the impact of gaming on biochemical parameters have primarily addressed the acute effects of gaming. The literature is limited, and the study designs are very diverse. The parameters that have been investigated most thoroughly are blood glucose and cortisol. Objective: This exploratory study is the first to investigate the effects of long gaming sessions on the biochemical parameters of healthy male adults. The extensive testing allowed us to observe short-term changes (within 6 hours), long-term changes during the duration of the gaming sessions, and follow-up after 1 week to determine whether any changes were longer lasting. Methods: In total, 9 experienced gamers completed 2 back-to-back 18-hour gaming sessions interspersed with a 6-hour rest period. All participants adhered to a structured sleep pattern due to daytime employment or attending university. Blood, saliva, and urine samples were collected from the participants every 6 hours. Linear mixed-effect models were used to analyze the repeated-measures data accumulated during the study. A total of 51 biochemical parameters were investigated. Results: In total, 12 of the 51 biochemical parameters significantly changed during the study: alkaline phosphatase, aspartate aminotransferase, bilirubin, chloride, creatinine, glucose, hemoglobin, immature reticulocyte fraction, lactate, methemoglobin, sodium, and thrombocytes. All changes were within the normal range. The mean glucose level of the participants was 4.39 (SD 0.07) mmol/L at baseline, which increased significantly by 0.24 (SD 0.07) mmol/L per 6 hours during the first period and by 0.38 (SD 0.07) mmol/L per 6 hours in the second period (P<.001). The glucose levels during the second session increased even though the participants had little energy intake. Cortisol levels did not change significantly, although the cortisol pattern deviated from the typical circadian rhythm. During both gaming sessions, we observed increasing cortisol levels from 6 AM until noon. The participants were relatively dehydrated at the start of the study. The patients were asked to fast before the first blood sampling. Within the first 6 hours of the study, the participants rehydrated, followed by relative dehydration during the remainder of the study. This pattern was identified using the following parameters: albumin, creatinine, hemoglobin, erythrocytes, potassium, and platelets. Conclusions: This study is the first of its kind, and many of the analyses in the study yielded novel results. The study was designed to emulate the behavior of gamers during the weekend and other long gaming sessions. At this point, we are not able to determine the difference between the effects of gaming and behavior during gaming. Regardless, the results of this study suggest that healthy gamers can partake in long gaming sessions, with ample amounts of unhealthy foods and little rest, without acute impacts on health. %M 38976326 %R 10.2196/46570 %U https://www.i-jmr.org/2024/1/e46570 %U https://doi.org/10.2196/46570 %U http://www.ncbi.nlm.nih.gov/pubmed/38976326 %0 Journal Article %@ 1947-2579 %I JMIR Publications %V 16 %N %P e52686 %T The Association of Broadband Internet Use With Drug Overdose Mortality Rates in the United States: Cross-Sectional Analysis %A Karakis,Ioannis %A Kostandini,Genti %A Tsamakis,Konstantinos %A Zahirovic-Herbert,Velma %+ Department of Neurology, Emory University School of Medicine, 49 Jesse Hill Jr Dr SE, Atlanta, GA, 30303, United States, 1 404 727 6123, ioannis.karakis@emory.edu %K opioids %K broadband internet %K mortality %K public health %K digital divide %K access %K availability %K causal %K association %K correlation %K overdose %K drug abuse %K addiction %K substance abuse %K demographic %K United States %K population %D 2024 %7 26.6.2024 %9 Original Paper %J Online J Public Health Inform %G English %X Background: The availability and use of broadband internet play an increasingly important role in health care and public health. Objective: This study examined the associations between broadband internet availability and use with drug overdose deaths in the United States. Methods: We linked 2019 county-level drug overdose death data in restricted-access multiple causes of death files from the National Vital Statistics System at the US Centers for Disease Control and Prevention with the 2019 county-level broadband internet rollout data from the Federal Communications Commission and the 2019 county-level broadband usage data available from Microsoft’s Airband Initiative. Cross-sectional analysis was performed with the fixed-effects regression method to assess the association of broadband internet availability and usage with opioid overdose deaths. Our model also controlled for county-level socioeconomic characteristics and county-level health policy variables. Results: Overall, a 1% increase in broadband internet use was linked with a 1.2% increase in overall drug overdose deaths. No significant association was observed for broadband internet availability. Although similar positive associations were found for both male and female populations, the association varied across different age subgroups. The positive association on overall drug overdose deaths was the greatest among Hispanic and Non-Hispanic White populations. Conclusions: Broadband internet use was positively associated with increased drug overdose deaths among the overall US population and some subpopulations, even after controlling for broadband availability, sociodemographic characteristics, unemployment, and median household income. %M 38922664 %R 10.2196/52686 %U https://ojphi.jmir.org/2024/1/e52686 %U https://doi.org/10.2196/52686 %U http://www.ncbi.nlm.nih.gov/pubmed/38922664 %0 Journal Article %@ 2368-7959 %I JMIR Publications %V 11 %N %P e49010 %T Web-Based Forums for People Experiencing Substance Use or Gambling Disorders: Scoping Review %A Peart,Annette %A Horn,Freya %A Petukhova,Rachel %A Barnett,Anthony %A Lubman,Dan I %+ Eastern Health Clinical School, Monash University, Level 2, 110 Church St, Richmond, Victoria, 3121, Australia, 61 3 8413 8413, annette.peart@monash.edu %K web-based forums %K peer support %K substance use %K gambling %K scoping %K review method %K review methodology %K forum %K forums %K substance abuse %K addiction %K addictive %K addictions %K peer-based %K peer support %D 2024 %7 17.6.2024 %9 Review %J JMIR Ment Health %G English %X Background: For people experiencing substance use or gambling disorders, web-based peer-supported forums are a space where they can share their experiences, gather around a collective goal, and find mutual support. Web-based peer support can help to overcome barriers to attending face-to-face meetings by enabling people experiencing addiction to seek support beyond their physical location and with the benefit of anonymity if desired. Understanding who participates in web-based peer-supported forums (and how), and the principles underpinning forums, can also assist those interested in designing or implementing similar platforms. Objective: This study aims to review the literature on how people experiencing substance use or gambling disorders, and their family, friends, and supporters, use and participate in web-based peer-supported forums. Specifically, we asked the following research questions: (1) What are the characteristics of people who use web-based peer-supported substance use or gambling-focused forums? (2) How do people participate in web-based peer-supported forums? (3) What are the key principles reportedly underpinning the web-based peer-supported forums? (4) What are the reported outcomes of web-based peer-supported forums? Methods: Inclusion criteria for our scoping review were peer-reviewed primary studies reporting on web-based addiction forums for adults and available in English. A primary search of 10 databases occurred in June 2021, with 2 subsequent citation searches of included studies in September 2022 and February 2024. Results: Of the 14 included studies, the majority of web-based peer-supported forums reported were aimed specifically for, or largely used by, people experiencing alcohol problems. Results from the 9 studies that did report demographic data suggest forum users were typically women, aged between 40 years and early 50 years. Participation in web-based peer-supported forums was reported quantitatively and qualitatively. The forums reportedly were underpinned by a range of key principles, mostly mutual help approaches and recovery identity formation. Only 3 included studies reported on outcomes for forum users. Conclusions: Web-based peer-supported forums are used by people experiencing addiction in a number of ways, to share information and experiences, and give and receive support. Seeking web-based support offers an alternative approach to traditional face-to-face support options, and may reduce some barriers to engaging in peer support. %M 38885012 %R 10.2196/49010 %U https://mental.jmir.org/2024/1/e49010 %U https://doi.org/10.2196/49010 %U http://www.ncbi.nlm.nih.gov/pubmed/38885012 %0 Journal Article %@ 2368-7959 %I JMIR Publications %V 11 %N %P e50259 %T Digital Phenotypes for Early Detection of Internet Gaming Disorder in Adolescent Students: Explorative Data-Driven Study %A Cho,Kwangsu %A Kim,Minah %A Cho,Youngeun %A Hur,Ji-Won %A Kim,Do Hyung %A Park,Seonghyeon %A Park,Sunghyun %A Jang,Moonyoung %A Lee,Chang-Gun %A Kwon,Jun Soo %+ Department of Neuropsychiatry, Seoul National University Hospital, 101 Dahak-no, Jongno-gu, Seoul, 03080, Republic of Korea, 82 2 2072 2972, kwonjs@snu.ac.kr %K adolescents %K digital biomarkers %K digital phenotyping %K digital psychiatry %K early detection %K IGD %K internet gaming disorder %K pediatric psychiatry %K proactive medicine %K secondary school %K universal screening %D 2024 %7 29.4.2024 %9 Original Paper %J JMIR Ment Health %G English %X Background: Limited awareness, social stigma, and access to mental health professionals hinder early detection and intervention of internet gaming disorder (IGD), which has emerged as a significant concern among young individuals. Prevalence estimates vary between 0.7% and 15.6%, and its recognition in the International Classification of Diseases, 11th Revision and Diagnostic and Statistical Manual of Mental Disorders, 5th Edition underscores its impact on academic functioning, social isolation, and mental health challenges. Objective: This study aimed to uncover digital phenotypes for the early detection of IGD among adolescents in learning settings. By leveraging sensor data collected from student tablets, the overarching objective is to incorporate these digital indicators into daily school activities to establish these markers as a mental health screening tool, facilitating the early identification and intervention for IGD cases. Methods: A total of 168 voluntary participants were engaged, consisting of 85 students with IGD and 83 students without IGD. There were 53% (89/168) female and 47% (79/168) male individuals, all within the age range of 13-14 years. The individual students learned their Korean literature and mathematics lessons on their personal tablets, with sensor data being automatically collected. Multiple regression with bootstrapping and multivariate ANOVA were used, prioritizing interpretability over predictability, for cross-validation purposes. Results: A negative correlation between IGD Scale (IGDS) scores and learning outcomes emerged (r166=–0.15; P=.047), suggesting that higher IGDS scores were associated with lower learning outcomes. Multiple regression identified 5 key indicators linked to IGD, explaining 23% of the IGDS score variance: stroke acceleration (β=.33; P<.001), time interval between keys (β=–0.26; P=.01), word spacing (β=–0.25; P<.001), deletion (β=–0.24; P<.001), and horizontal length of strokes (β=0.21; P=.02). Multivariate ANOVA cross-validated these findings, revealing significant differences in digital phenotypes between potential IGD and non-IGD groups. The average effect size, measured by Cohen d, across the indicators was 0.40, indicating a moderate effect. Notable distinctions included faster stroke acceleration (Cohen d=0.68; P=<.001), reduced word spacing (Cohen d=.57; P=<.001), decreased deletion behavior (Cohen d=0.33; P=.04), and longer horizontal strokes (Cohen d=0.34; P=.03) in students with potential IGD compared to their counterparts without IGD. Conclusions: The aggregated findings show a negative correlation between IGD and learning performance, highlighting the effectiveness of digital markers in detecting IGD. This underscores the importance of digital phenotyping in advancing mental health care within educational settings. As schools adopt a 1-device-per-student framework, digital phenotyping emerges as a promising early detection method for IGD. This shift could transform clinical approaches from reactive to proactive measures. %M 38683658 %R 10.2196/50259 %U https://mental.jmir.org/2024/1/e50259 %U https://doi.org/10.2196/50259 %U http://www.ncbi.nlm.nih.gov/pubmed/38683658 %0 Journal Article %@ 2561-6722 %I JMIR Publications %V 7 %N %P e55364 %T Digital Interventions for Combating Internet Addiction in Young Children: Qualitative Study of Parent and Therapist Perspectives %A Theopilus,Yansen %A Al Mahmud,Abdullah %A Davis,Hilary %A Octavia,Johanna Renny %+ Centre for Design Innovation, Swinburne University of Technology, John St, Hawthorn, Melbourne, 3122, Australia, 61 39214383, aalmahmud@swin.edu.au %K addiction therapist %K children %K digital intervention %K internet addiction %K digital devices %K parents %K parental control %K mobile phone %D 2024 %7 26.4.2024 %9 Original Paper %J JMIR Pediatr Parent %G English %X Background: Internet addiction is an emerging mental health issue in this digital age. Nowadays, children start using the internet in early childhood, thus making them vulnerable to addictive use. Previous studies have reported that the risk of internet addiction tends to be higher in lower-income regions with lower quality of life, such as Indonesia. Indonesia has high risks and prevalence of internet addiction, including in children. Digital interventions have been developed as an option to combat internet addiction in children. However, little is known about what parents and therapists in Indonesia perceive about these types of interventions. Objective: This study aims to investigate the experiences, perceptions, and considerations of parents and therapists regarding digital interventions for combating internet addiction in young Indonesian children. Methods: This study used a qualitative exploratory approach through semistructured interviews. We involved 22 parents of children aged 7 to 11 years and 6 experienced internet addiction therapists for children. The interview data were transcribed and analyzed using thematic analysis. Results: Participants in this study recognized 3 existing digital interventions to combat internet addiction: Google Family Link, YouTube Kids, and Apple parental control. They perceived that digital interventions could be beneficial in continuously promoting healthy digital behavior in children and supporting parents in supervision. However, the existing interventions were not highly used due to limitations such as the apps’ functionality and usability, parental capability, parent-child relationships, cultural incompatibility, and data privacy. Conclusions: The findings suggest that digital interventions should focus not only on restricting and monitoring screen time but also on suggesting substitutive activities for children, developing children’s competencies to combat addictive behavior, improving digital literacy in children and parents, and supporting parental decision-making to promote healthy digital behavior in their children. Suggestions for future digital interventions are provided, such as making the existing features more usable and relatable, investigating gamification features to enhance parental motivation and capability in managing their children’s internet use, providing tailored or personalized content to suit users’ characteristics, and considering the provision of training and information about the use of interventions and privacy agreements. %M 38669672 %R 10.2196/55364 %U https://pediatrics.jmir.org/2024/1/e55364 %U https://doi.org/10.2196/55364 %U http://www.ncbi.nlm.nih.gov/pubmed/38669672 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 26 %N %P e48356 %T Electronic Media Use and Sleep Quality: Updated Systematic Review and Meta-Analysis %A Han,Xiaoning %A Zhou,Enze %A Liu,Dong %+ School of Journalism and Communication, Renmin University of China, No. 59 Zhongguancun Street, Haidian District, Beijing, 100872, China, 86 13693388506, bnuliudong@gmail.com %K electronic media %K sleep quality %K meta-analysis %K media types %K cultural difference %D 2024 %7 23.4.2024 %9 Review %J J Med Internet Res %G English %X Background: This paper explores the widely discussed relationship between electronic media use and sleep quality, indicating negative effects due to various factors. However, existing meta-analyses on the topic have some limitations. Objective: The study aims to analyze and compare the impacts of different digital media types, such as smartphones, online games, and social media, on sleep quality. Methods: Adhering to Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, the study performed a systematic meta-analysis of literature across multiple databases, including Web of Science, MEDLINE, PsycINFO, PubMed, Science Direct, Scopus, and Google Scholar, from January 2018 to October 2023. Two trained coders coded the study characteristics independently. The effect sizes were calculated using the correlation coefficient as a standardized measure of the relationship between electronic media use and sleep quality across studies. The Comprehensive Meta-Analysis software (version 3.0) was used to perform the meta-analysis. Statistical methods such as funnel plots were used to assess the presence of asymmetry and a p-curve test to test the p-hacking problem, which can indicate publication bias. Results: Following a thorough screening process, the study involved 55 papers (56 items) with 41,716 participants from over 20 countries, classifying electronic media use into “general use” and “problematic use.” The meta-analysis revealed that electronic media use was significantly linked with decreased sleep quality and increased sleep problems with varying effect sizes across subgroups. A significant cultural difference was also observed in these effects. General use was associated with a significant decrease in sleep quality (P<.001). The pooled effect size was 0.28 (95% CI 0.21-0.35; k=20). Problematic use was associated with a significant increase in sleep problems (P≤.001). The pooled effect size was 0.33 (95% CI 0.28-0.38; k=36). The subgroup analysis indicated that the effect of general smartphone use and sleep problems was r=0.33 (95% CI 0.27-0.40), which was the highest among the general group. The effect of problematic internet use and sleep problems was r=0.51 (95% CI 0.43-0.59), which was the highest among the problematic groups. There were significant differences among these subgroups (general: Qbetween=14.46, P=.001; problematic: Qbetween=27.37, P<.001). The results of the meta-regression analysis using age, gender, and culture as moderators indicated that only cultural difference in the relationship between Eastern and Western culture was significant (Qbetween=6.69; P=.01). All funnel plots and p-curve analyses showed no evidence of publication and selection bias. Conclusions: Despite some variability, the study overall confirms the correlation between increased electronic media use and poorer sleep outcomes, which is notably more significant in Eastern cultures. %M 38533835 %R 10.2196/48356 %U https://www.jmir.org/2024/1/e48356 %U https://doi.org/10.2196/48356 %U http://www.ncbi.nlm.nih.gov/pubmed/38533835 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e45700 %T Effect of the COVID-19 Pandemic on Gambling Behavior in Mainland Chinese Gamblers in Macau: Cross-Sectional Survey Study %A Zhou,Jinquan %A Ho,Hong-Wai %A Chan,ChiBiu %+ Macao Polytechnic University, R de Luís Gonzaga Gomes, Macao, China, 853 88593326, jqzhou@mpu.edu.mo %K Chinese gamblers %K gambling behavior %K online gambling %K COVID-19 %K Macau %D 2024 %7 22.4.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: This study examined the effects of the COVID-19 pandemic on the gambling behavior of individuals who were already actively engaged in such pursuits. We aimed to uncover the intricate consequences of the pandemic on this specific demographic, emphasizing the importance of understanding the complex connection between public health concerns such as the COVID-19 pandemic and gambling behavior from a public health perspective. In addition to identifying immediate impacts, this study holds significance in assessing potential long-term public health implications for the broader gambling industry. Objective: This study investigated how the COVID-19 pandemic has affected the gambling behavior of Mainland Chinese tourists in Macau from a public health perspective. We aimed to understand the changing patterns of gambling habits within this specific demographic by comparing their behavior before and during the pandemic, with a particular emphasis on the evolving dynamics of gambling and their public health consequences. This study provides a detailed exploration of the impact and implications of global health emergencies on this particular demographic’s gambling behaviors and preferences. Methods: This study used a robust cross-sectional analysis involving a sample of 334 Mainland Chinese gamblers with prior experiences in casinos in Macau. The sample deliberately encompassed individuals involved in gambling before and during the COVID-19 pandemic. Data were collected through carefully designed questionnaires to gather information on gambling habits, preferences, and observed behavioral changes in the sample. Results: This study unveiled a notable shift in Mainland Chinese gamblers’ behavior during the COVID-19 pandemic. A considerable number of participants opted for web-based platforms over traditional land-based casinos, resulting in reduced budgets, less time spent on gambling, and decreased participation in social gambling. Remarkably, there was a notable surge in online gambling, indicating a noteworthy adaptability of gamblers to changing circumstances. These findings emphasize the dynamic nature of gambling habits during global public health emergencies, revealing the resilient and evolving preferences of Mainland Chinese gamblers in response to the challenges posed by the pandemic. Conclusions: This study highlights the negative impact of the COVID-19 pandemic on casino gambling, notably evident in a significant decline in Mainland Chinese tourists visiting Macau for gambling. There is a noticeable shift from traditional gambling to web-based alternatives, with individuals seeking options within the pandemic constraints. Furthermore, the findings point out an increase in gambling among the younger generation and behavioral changes in individuals with mood disorders. The findings of this study emphasize the critical need for proactive measures to address evolving gambling preferences and associated risks during public health crises; furthermore, these findings underscore the importance of adaptive strategies within the gambling industry, as well as the necessity for effective public health interventions and regulatory frameworks to respond to unprecedented challenges with efficacy and precision. %M 38648630 %R 10.2196/45700 %U https://formative.jmir.org/2024/1/e45700 %U https://doi.org/10.2196/45700 %U http://www.ncbi.nlm.nih.gov/pubmed/38648630 %0 Journal Article %@ 2291-9279 %I JMIR Publications %V 12 %N %P e45985 %T Psychometric Properties of the Metacognitions About Online Gaming Scale in the Chinese Population and Its Relationship With Internet Gaming Disorder: Cross-Sectional Study %A Lin,Shuhong %A Chen,Xinxin %A Tan,Linxiang %A Liao,Zhenjiang %A Li,Yifan %A Tang,Ying %A Huang,Qiuping %A Shen,Hongxian %+ Department of Psychiatry, Second Xiangya Hospital of Central South University, 139 Renmin Road, Changsha, 410000, China, 86 13875970393, shenhx2018@csu.edu.cn %K metacognition %K metacognitions about online gaming %K Internet Gaming Disorder %K psychometric properties %K Chinese %D 2024 %7 22.4.2024 %9 Original Paper %J JMIR Serious Games %G English %X Background: Metacognitions about online gaming have been shown to be correlated with Internet Gaming Disorder (IGD). Knowledge of metacognitions about online gaming can help to understand IGD. The Metacognitions about Online Gaming Scale (MOGS) is a reliable and valid tool to measure specific metacognitions about online gaming in both adults and adolescents, which is lacking in China. Objective: This study was conducted to assess the psychometric properties of the Chinese version of the MOGS (C-MOGS) and its relationship with IGD in the Chinese population. Methods: A total of 772 Chinese individuals (age: mean 21.70, SD 8.81 years; age range: 13-57 years; 458/772, 59.3% male) completed a web-based questionnaire survey, including the C-MOGS and a battery of validated scales measuring IGD, gaming motives, depression, and anxiety. Results: Through exploratory and confirmatory factor analyses, the 3-factor structure was confirmed to have adequate model fit and internal consistency reliability (Cronbach α≥.799, Guttman split-half coefficients≥0.754). Concurrent validity of the C-MOGS was supported by its correlations with IGD (P<.001), gaming motives (P<.001), depression (P<.001), and anxiety (P<.001). Furthermore, the incremental validity analysis showed that the C-MOGS predicted 13% of the variance in IGD while controlling for gender, age, weekly gaming hours, gaming motives, depression, and anxiety. Conclusions: This study provides evidence that the psychometric properties of the C-MOGS are appropriate and emphasizes its positive association with IGD. The C-MOGS is a reliable and valid instrument for mental health workers to assess metacognitions about online gaming in the Chinese population. %M 38648634 %R 10.2196/45985 %U https://games.jmir.org/2024/1/e45985 %U https://doi.org/10.2196/45985 %U http://www.ncbi.nlm.nih.gov/pubmed/38648634 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 26 %N %P e48026 %T Status and Influencing Factors of Social Media Addiction in Chinese Workers: Cross-Sectional Survey Study %A Kong,Weitao %A Li,Yuanyuan %A Luo,Aijing %A Xie,Wenzhao %+ The Second Xiangya Hospital, Central South University, 139 Renmin Middle Road, Changsha, 410000, China, 86 0731 85292212, luoaj@csu.edu.cn %K social media addiction %K job burnout %K mindfulness %K mobile phone %K technology addiction %K cross-sectional survey %D 2024 %7 6.3.2024 %9 Original Paper %J J Med Internet Res %G English %X Background: Social media addiction (SMA) caused by excessive dependence on social media is becoming a global problem. At present, most of the SMA studies recruit college students as research participants, with very few studies involving workers and other age groups, especially in China. Objective: This study aims to investigate the current status of SMA among Chinese workers and analyze its influencing factors. Methods: From November 1, 2022, to January 30, 2023, we conducted an anonymous web-based questionnaire survey in mainland China, and a total of 5176 participants completed the questionnaire. The questionnaire included the Social Networking Service Addiction Scale, Maslach Burnout Inventory–General Survey scale, Mindful Attention Awareness Scale, as well as questionnaires regarding participants’ social media use habits and demographic information. Results: Through strict screening, 3468 valid questionnaires were included in this study. The main findings of this study revealed the following: the average SMA score of workers was higher (mean 53.19, SD 12.04), and some of them (393/3468, 11.33%) relied heavily on social media; there were statistically significant differences in SMA scores among workers in different industries (F14,3453=3.98; P<.001); single workers (t3106=8.6; P<.001) and workers in a relationship (t2749=5.67; P<.001) had higher SMA scores than married workers, but some married workers (214/3468, 6.17%) were highly dependent on social media; the level of SMA among female workers was higher than that of male workers (t3466=3.65; P<.001), and the SMA score of workers negatively correlated with age (r=−0.22; P<.001) and positively correlated with education level (r=0.12; P<.001); the frequency of using social media for entertainment during work (r=0.33; P<.001) and the frequency of staying up late using social media (r=0.14; P<.001) were positively correlated with the level of SMA in workers; and the level of SMA in workers was significantly positively correlated with their level of burnout (r=0.35; P<.001), whereas it was significantly negatively correlated with their level of mindfulness (r=−0.55; P<.001). Conclusions: The results of this study suggest that SMA among Chinese workers is relatively serious and that the SMA problem among workers requires more attention from society and academia. In particular, female workers, young workers, unmarried workers, highly educated workers, workers with bad social media habits, workers with high levels of job burnout, and workers with low levels of mindfulness were highly dependent on social media. In addition, occupation is an important influencing factor in SMA. Thus, the government should strengthen the supervision of social media companies. Medical institutions should provide health education on SMA and offer intervention programs for those addicted to social media. Workers should cultivate healthy habits while using social media. %M 38446542 %R 10.2196/48026 %U https://www.jmir.org/2024/1/e48026 %U https://doi.org/10.2196/48026 %U http://www.ncbi.nlm.nih.gov/pubmed/38446542 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 12 %N %P e46990 %T Identifying Game-Based Digital Biomarkers of Cognitive Risk for Adolescent Substance Misuse: Protocol for a Proof-of-Concept Study %A Aneni,Kammarauche %A Chen,Ching-Hua %A Meyer,Jenny %A Cho,Youngsun T %A Lipton,Zachary Chase %A Kher,Saatvik %A Jiao,Megan G %A Gomati de la Vega,Isabella %A Umutoni,Feza Anaise %A McDougal,Robert A %A Fiellin,Lynn E %+ Child Study Center, Yale School of Medicine, 230 S Frontage Road, New Haven, CT, 06519, United States, 1 844 362 9272, uche.aneni@yale.edu %K game-based digital biomarkers %K cognition %K adolescent substance misuse %K cognitive risk factors %K game-based measurement of cognitive function %K biomarker %K adolescent %K screening %K game %K barrier %K digital %K substance %K use %K misuse %D 2023 %7 23.11.2023 %9 Protocol %J JMIR Res Protoc %G English %X Background: Adolescents at risk for substance misuse are rarely identified early due to existing barriers to screening that include the lack of time and privacy in clinic settings. Games can be used for screening and thus mitigate these barriers. Performance in a game is influenced by cognitive processes such as working memory and inhibitory control. Deficits in these cognitive processes can increase the risk of substance use. Further, substance misuse affects these cognitive processes and may influence game performance, captured by in-game metrics such as reaction time or time for task completion. Digital biomarkers are measures generated from digital tools that explain underlying health processes and can be used to predict, identify, and monitor health outcomes. As such, in-game performance metrics may represent digital biomarkers of cognitive processes that can offer an objective method for assessing underlying risk for substance misuse. Objective: This is a protocol for a proof-of-concept study to investigate the utility of in-game performance metrics as digital biomarkers of cognitive processes implicated in the development of substance misuse. Methods: This study has 2 aims. In aim 1, using previously collected data from 166 adolescents aged 11-14 years, we extracted in-game performance metrics from a video game and are using machine learning methods to determine whether these metrics predict substance misuse. The extraction of in-game performance metrics was guided by literature review of in-game performance metrics and gameplay guidebooks provided by the game developers. In aim 2, using data from a new sample of 30 adolescents playing the same video game, we will test if metrics identified in aim 1 correlate with cognitive processes. Our hypothesis is that in-game performance metrics that are predictive of substance misuse in aim 1 will correlate with poor cognitive function in our second sample. Results: This study was funded by National Institute on Drug Abuse through the Center for Technology and Behavioral Health Pilot Core in May 2022. To date, we have extracted 285 in-game performance metrics. We obtained institutional review board approval on October 11, 2022. Data collection for aim 2 is ongoing and projected to end in February 2024. Currently, we have enrolled 12 participants. Data analysis for aim 2 will begin once data collection is completed. The results from both aims will be reported in a subsequent publication, expected to be published in late 2024. Conclusions: Screening adolescents for substance use is not consistently done due to barriers that include the lack of time. Using games that provide an objective measure to identify adolescents at risk for substance misuse can increase screening rates, early identification, and intervention. The results will inform the utility of in-game performance metrics as digital biomarkers for identifying adolescents at high risk for substance misuse. International Registered Report Identifier (IRRID): DERR1-10.2196/46990 %M 37995115 %R 10.2196/46990 %U https://www.researchprotocols.org/2023/1/e46990 %U https://doi.org/10.2196/46990 %U http://www.ncbi.nlm.nih.gov/pubmed/37995115 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 12 %N %P e47528 %T Effects and Limitations of a Unique, Nationwide, Self-Exclusion Service for Gambling Disorder and Its Self-Perceived Effects and Harms in Gamblers: Protocol for a Qualitative Interview Study %A Håkansson,Anders %A Tjernberg,Johanna %A Hansson,Helena %+ Department of Clinical Sciences Lund, Psychiatry, Faculty of Medicine, Lund University, Baravägen 1, Lund, 22100, Sweden, 46 46175596, anders_c.hakansson@med.lu.se %K gambling disorder %K problem gambling %K behavioral addiction %K self-exclusion %K Spelpaus %K gambling %K management %K data %K online gambling %K harm %K harm reduction tool %K recruitment %K qualitative interview study %K gambler %D 2023 %7 14.11.2023 %9 Protocol %J JMIR Res Protoc %G English %X Background: Voluntary self-exclusion from gambling is a common but underdeveloped harm reduction tool in the management of gambling problems or gambling disorders. Large-scale, multi-operator, and operator-independent self-exclusion services are needed. A recent nationwide multi-operator self-exclusion service in Sweden (Spelpaus), involving both land- and web-based gambling sites, is promising, but recent data have revealed limitations to this system and possibilities to breach one’s self-exclusion through overseas web-based gambling. More knowledge is needed about the benefits and challenges of such an extensive self-exclusion service, and its effects as perceived by gamblers. Objective: This study protocol describes the rationale and design of a qualitative interview study addressing the effects and limitations perceived by individuals with gambling problems and their concerned significant others. The study aims to provide an in-depth experience of this novel self-exclusion service and to inform stakeholders and policymakers in order to further improve harm reduction tools against gambling problems. Methods: Individuals with gambling problems will be recruited primarily through social media and also from a treatment unit, if needed, for a qualitative interview study. Recorded interview material will be analyzed through content analysis, and recruitment will continue until saturation in the material is reached. This study will provide in-depth information about a harm reduction tool that is promising and commonly used, but which has proven to be breached by a significant number of users, potentially limiting its efficiency. The aim is to interview a sufficient number of gamblers until saturation has been obtained in the interview material. Saturation will be considered through a continuous analysis, comparing recently collected data to previously collected data. Results: Results will be reported as the themes and subthemes identified after the thorough analysis and coding of the transcribed text material and will be accompanied by citations representing relevant themes and subthemes. Results are planned to be provided before the end of 2023. Conclusions: This study will likely provide new insights into user perspectives on a multi-operator self-exclusion service that involves both web- and land-based gambling operators, and which according to previous literature attracts many gamblers but also appears to have limitations and challenges in the target group of individuals with gambling problems. Policy and legislation implications, as well as clinical implications for treatment providers, will be discussed. Results and conclusions will be disseminated to policy makers in Sweden and internationally, as well as to peer organizations, treatment providers, and the research community. Trial Registration: ClinicalTrials.gov NCT05693155; https://clinicaltrials.gov/study/NCT05693155 International Registered Report Identifier (IRRID): PRR1-10.2196/47528 %M 37962917 %R 10.2196/47528 %U https://www.researchprotocols.org/2023/1/e47528 %U https://doi.org/10.2196/47528 %U http://www.ncbi.nlm.nih.gov/pubmed/37962917 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 25 %N %P e40190 %T The Relationship Between Lockdowns and Video Game Playtime: Multilevel Time-Series Analysis Using Massive-Scale Data Telemetry %A Zendle,David %A Flick,Catherine %A Halgarth,Darel %A Ballou,Nick %A Cutting,Joe %A Drachen,Anders %+ Department of Computer Science, University of York, Heslington Way, York, YO10 5GH, United Kingdom, 44 1904320000, david.zendle@york.ac.uk %K COVID-19 %K lockdown policy %K disordered gaming %K big data %K playtime %K policy %K lockdown %K public health %K side effects %K pandemic %K video games %K playing %K gaming %K time %K disordered %D 2023 %7 8.11.2023 %9 Original Paper %J J Med Internet Res %G English %X Background: COVID-19 led governments worldwide to enact a variety of containment and closure policies. Substantial attention has been directed toward the idea that these public health measures may have unanticipated negative side effects. One proposed effect relates to video games. There is a nascent evidence base suggesting that individuals played video games for longer and in a more disordered manner during lockdowns and school closures specifically. These increases are commonly framed as a potential health concern in relation to disordered gaming. However, the evidence base regarding changes in gaming during the COVID-19 pandemic is based on self-report and, thus, is susceptible to bias. Therefore, it is unclear what the true consequences of lockdowns were for gaming behavior worldwide. Objective: The primary objective of this study was to estimate whether any specific lockdown policy led to meaningful increases in the amount of time individuals spent playing video games. Methods: Rather than relying on self-report, we used >251 billion hours of raw gameplay telemetry data from 184 separate countries to assess the behavioral correlates of COVID-19–related policy decisions. A multilevel model estimated the impact of varying enforcement levels of 8 containment and closure policies on the amount of time that individual users spent in-game. Similar models estimated the impact of policy on overall playtime and the number of users within a country. Results: No lockdown policy can explain substantial variance in playtime per gamer. School closures were uniquely associated with meaningful increases in total playtime within a country (r2=0.048). However, this was associated with increases in the number of unique individuals playing games (r2=0.057) rather than increases in playtime per gamer (r2<0.001). Conclusions: Previous work using self-report data has suggested that important increases in heavy gaming may occur during pandemics because of containment and closure (“lockdown”) procedures. This study contrasts with the previous evidence base and finds no evidence of such a relationship. It suggests that significant further work is needed before increases in disordered or heavy gaming are considered when planning public health policies for pandemic preparedness. %M 37938889 %R 10.2196/40190 %U https://www.jmir.org/2023/1/e40190 %U https://doi.org/10.2196/40190 %U http://www.ncbi.nlm.nih.gov/pubmed/37938889 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 7 %N %P e42857 %T Social Media and Selfie-Related Mortality Amid COVID-19: Interrupted Time Series Analysis %A Kang-Auger,Sarit %A Lewin,Antoine %A Ayoub,Aimina %A Bilodeau-Bertrand,Marianne %A Marcoux,Sophie %A Auger,Nathalie %+ Institut national de santé publique du Québec, 190 Cremazie Blvd E, Montreal, QC, H2P 1E2, Canada, 1 514 864 1600, nathalie.auger@inspq.qc.ca %K COVID-19 %K injury %K mortality %K mortality rate %K web-based news %K selfie %K social media %K time series regression %D 2023 %7 25.9.2023 %9 Original Paper %J JMIR Form Res %G English %X Background: COVID-19 had a considerable impact on mortality, but its effect on behaviors associated with social media remains unclear. As travel decreased due to lockdowns during the pandemic, selfie-related mortality may have decreased, as fewer individuals were taking smartphone photographs in risky locations. Objective: In this study, we examined the effect of the COVID-19 pandemic on trends in selfie-related mortality. Methods: We identified fatal selfie-related injuries reported in web-based news reports worldwide between March 2014 and April 2021, including the deaths of individuals attempting a selfie photograph or anyone else present during the incident. The main outcome measure was the total number of selfie-related deaths per month. We used interrupted time series regression to estimate the monthly change in the number of selfie-related deaths over time, comparing the period before the pandemic (March 2014 to February 2020) with the period during the pandemic (March 2020 to April 2021). Results: The study included a total of 332 selfie-related deaths occurring between March 2014 and April 2021, with 18 (5.4%) deaths during the pandemic. Most selfie-related deaths occurred in India (n=153, 46.1%) and involved men (n=221, 66.6%) and young individuals (n=296, 89.2%). During the pandemic, two-thirds of selfie-related deaths were due to falls, whereas a greater proportion of selfie-related deaths before the pandemic were due to drowning. Based on interrupted time series regression, there was an average of 1.3 selfie-related deaths per month during the pandemic, compared with 4.3 deaths per month before the pandemic. The number of selfie-related deaths decreased by 2.6 in the first month of the pandemic alone and continued to decrease thereafter. Conclusions: Our findings indicate that the COVID-19 pandemic led to a marked decrease in selfie-related mortality, suggesting that lockdowns and travel restrictions likely prevented hazardous selfie-taking. The decrease in selfie-related mortality occurred despite a potential increase in social media use during the pandemic. %M 37747765 %R 10.2196/42857 %U https://formative.jmir.org/2023/1/e42857 %U https://doi.org/10.2196/42857 %U http://www.ncbi.nlm.nih.gov/pubmed/37747765 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 12 %N %P e50984 %T Effect of Technology and Digital Media Use on Adolescent Health and Development: Protocol for a Multimethod Longitudinal Study %A Cascio,Christopher N %A Selkie,Ellen %A Moreno,Megan A %+ School of Journalism and Mass Communication, University of Wisconsin-Madison, 821 University Ave, 5115 Vilas Hall, Madison, WI, 53706, United States, 1 6082634898, chris.n.cascio@wisc.edu %K social media %K adolescents %K teenagers %K health %K well-being %K risk behavior %K brain %K functional magnetic resonance imaging %K fMRI %K mobile phone %D 2023 %7 13.9.2023 %9 Protocol %J JMIR Res Protoc %G English %X Background: Technology and digital media (TDM) use is integral to modern adolescence; adolescents have been labeled as “digital natives,” since they have had exposure to digital technology for their entire lives. Previous evidence has illustrated TDM’s connections with adolescent risk behaviors such as increased alcohol use and social media exposure, as well as relationships with adolescent well-being such as improved socioemotional health and social media connections with peers. Although several recent review articles have described both the benefits and risks of technology use, most individual studies adopt a singular risk-centered approach. In addition, reviews suggest that little evidence exists on the potential mediating and moderating factors between TDM use and well-being and health outcomes, which limits our understanding of what influences the outcomes of interest. Therefore, there is an urgent need to fill these gaps. Objective: This protocol addresses the need to understand how TDM exposure and use affect multiple developmental domains and health outcomes. We address the fragmented nature of previous research, the common focus on single behaviors or conditions, and the typical narrow lens on risks. Our approach further aligns with reviews that called for studies identifying and investigating the factors that moderate the relationships between social media and health behaviors and outcomes. Methods: We will address our objective by longitudinally examining over a 2-year period a common set of adolescent participants (N=400, aged 13-15 years) across 3 studies that adopt a multimethodological approach. Study 1 will use TDM to understand the mechanisms behind adolescent health and risk behaviors. Study 2 will use functional magnetic resonance imaging to understand how positive and negative TDM experiences relate to mental and behavioral health in a subsample of 150 adolescents. Study 3 will use a mixed methods design to evaluate self- and other-generated TDM content as the predictors of socioemotional well-being in sexual and gender minority and non–sexual and gender minority adolescents. Results: Recruitment is ongoing, and the initial results from the first wave of recruitment are expected in 2024. Conclusions: This integrated approach to longitudinal data collection from a shared adolescent participant pool will lead to novel analyses and findings, allowing for the examination of the health and well-being risks and benefits associated with TDM use and factors that moderate these relationships. The findings from this study will advance conceptual models and inform new interventions to improve adolescent health. International Registered Report Identifier (IRRID): DERR1-10.2196/50984 %M 37703071 %R 10.2196/50984 %U https://www.researchprotocols.org/2023/1/e50984 %U https://doi.org/10.2196/50984 %U http://www.ncbi.nlm.nih.gov/pubmed/37703071 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 25 %N %P e45063 %T Challenging the Portrait of the Unhealthy Gamer—The Fitness and Health Status of Esports Players and Their Peers: Comparative Cross-Sectional Study %A Ketelhut,Sascha %A Bodman,Alex %A Ries,Thomas %A Nigg,Claudio R %+ Department of Health Sience, Institute of Sport Science, University of Bern, Bremgartenstrasse 145, Bern, 3012, Switzerland, 41 799412752, sascha.ketelhut@gmail.com %K blood pressure %K gamers %K health status %K physical activity behavior %K physical fitness %K esports %K health burden %K sedentary athlete %K health %K fitness %D 2023 %7 3.8.2023 %9 Original Paper %J J Med Internet Res %G English %X Background: Esports players are often referred to as sedentary athletes, as gaming requires prolonged sedentary screen exposure. As sedentary behavior and physical inactivity are major causes of noncommunicable diseases and premature death, esports players may be at an increased risk for health implications. Prior research has established esports players as having higher levels of body fat and lower levels of lean body mass versus age-matched controls, suggesting the need to assess further health and fitness outcomes of this demographic. However, while research interest is undoubtedly increasing, the majority of studies has focused on subjective self-report data and has lacked relevant objective health and fitness measurements. Objective: This study aimed to assess the health and fitness status of a group of competitive esports players in relation to an age- and sex-matched comparison group. Methods: In total, 51 competitive esports players (mean 23, SD 3 years, 2 female) and 51 nonesports players (mean 24, SD 3 years, 2 female) were enrolled in this cross-sectional laboratory study. The esports players and the nonesports players completed a questionnaire assessing demographic data and self-reported physical activity levels. Furthermore, physical parameters including BMI, waist-to-height ratio, body fat percentage, systolic blood pressure, diastolic blood pressure, pulse wave velocity, maximal grip strength, and maximal oxygen consumption were assessed. Results: There were no significant differences in BMI (t100=1.54; P=.13; d=0.30), waist-to-height ratio (t100=1.44; P=.16; d=0.28), body fat percentage (t100=−0.48; P=.63; d=−0.09), systolic blood pressure (t100=−0.06; P=.93; d=−0.01), diastolic blood pressure (t100=0.37; P=.71; d=0.07), pulse wave velocity (t93=−2.08; P=.15; d=−0.43), maximal grip strength (t100=−.08; P=.94; d=−0.02), maximal oxygen consumption (t100=−0.11; P=.92; d=−0.02), and physical activity (PA) levels (t86=2.17; P=.08; d=0.46) between the groups. Conclusions: While the health narrative directed toward esports players has been mainly negative, this laboratory-based study indicated that esports players are not less healthy or fit compared to their peers. However, it seems that esports players are very heterogeneous and seem to span across the whole range of the fitness and health spectrum. Thus, the generalized statements of the esports athlete as an obese and unhealthy individual may need to be reconsidered. %M 37535408 %R 10.2196/45063 %U https://www.jmir.org/2023/1/e45063 %U https://doi.org/10.2196/45063 %U http://www.ncbi.nlm.nih.gov/pubmed/37535408 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 25 %N %P e44438 %T Environmental Influence and Recruitment Bias in Studies on Internet Addiction. Comment on “Addiction Symptom Network of Young Internet Users: Network Analysis” %A Huang,Ting Yun %A Liaw,Yung-Po %+ School of Medicine, Chung Shan Medical University, No 110, Section 1, Jianguo N Rd, South District, Taichung City, 40201, Taiwan, 886 0424730022 ext 11838, liawyp@csmu.edu.tw %K internet addiction %K Internet Addiction Test %K network analysis %K adolescents %D 2023 %7 11.7.2023 %9 Letter to the Editor %J J Med Internet Res %G English %X %M 37432717 %R 10.2196/44438 %U https://www.jmir.org/2023/1/e44438 %U https://doi.org/10.2196/44438 %U http://www.ncbi.nlm.nih.gov/pubmed/37432717 %0 Journal Article %@ 2561-6722 %I JMIR Publications %V 6 %N %P e44920 %T Prospective Association Between Video and Computer Game Use During Adolescence and Incidence of Metabolic Health Risks: Secondary Data Analysis %A Lebby,Stephanie R %A Shyam,Sangeetha %A Ramadas,Amutha %A Bohm,Andrew R %A Hill,Julia C %A Fortuna,Karen L %A Zoltick,Stephanie R %+ Department of Psychiatry, Geisel School of Medicine at Dartmouth, 1 Medical Center Drive, Lebanon, NH, 03756, United States, 1 603 722 5727, Karen.L.Fortuna@dartmouth.edu %K video games %K obesity %K pediatrics %K computer games %K portable device %K teenager %K adolescents %K health data %K BMI %K diabetes %K high blood pressure %K high cholesterol %K metabolic disorder %D 2023 %7 6.7.2023 %9 Original Paper %J JMIR Pediatr Parent %G English %X Background: Video and computer games are popular activities, with 72% of adolescents aged 13 to 17 years reporting video game use on either a computer, game console, or portable device. Despite high levels of video and computer game use in adolescence, relatively little scientific literature exists examining the association and effects of video and computer games on adolescents. Objective: The objective of this study was to examine the prevalence of video and computer game use among US adolescents and rates of positive screens for obesity, diabetes, high blood pressure (BP), and high cholesterol. Methods: A secondary data analysis was conducted using the National Longitudinal Study of Adolescent to Adult Health (Add Health) data, including adolescents aged 12 to 19 years between 1994 and 2018. Results: Respondents (n=4190) who played the most video and computer games had a significantly (P=.02) higher BMI and were more likely to self-report having at least one of the evaluated metabolic disorders: obesity (BMI >30 kg/m2), diabetes, high BP (BP >140/90), and high cholesterol (>240). With increased video or computer game use, there was a statistically significant increase in high BP rates in each quartile, with those with more frequent use also having higher rates of high BP. A similar trend was observed for diabetes, though the association did not reach statistical significance. No significant association was observed between video or computer game use and diagnoses of dyslipidemia, eating disorders, or depression. Conclusions: Frequency of video and computer game use is associated with obesity, diabetes, high BP, and high cholesterol in adolescents aged 12 to 19 years. Adolescents who play the most video and computer games have a significantly higher BMI. They are more likely to have at least one of the evaluated metabolic disorders: diabetes, high BP, or high cholesterol. Public health interventions designed to target modifiable disease states through health promotion and self-management may support the health of adolescents aged 12 to 19 years. Video and computer games can integrate health promotion interventions in gameplay. This is an important area for future research as video and computer games are integrated into the lives of adolescents. %M 37410530 %R 10.2196/44920 %U https://pediatrics.jmir.org/2023/1/e44920 %U https://doi.org/10.2196/44920 %U http://www.ncbi.nlm.nih.gov/pubmed/37410530 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 7 %N %P e42986 %T Screening for Media Use in the Emergency Department Among Young Australians: Cross-sectional Study %A Dullur,Pravin %A Joseph,Joanne %A Diaz,Antonio Mendoza %A Lin,Ping-I %A Jairam,Rajeev %A Davies,Rhian %A Masi,Anne %A Shulruf,Boaz %A Eapen,Valsamma %+ Discipline of Psychiatry and Mental Health, University of New South Wales, High St Kensington, NSW 2052, Sydney, Australia, 61 9385 1000, z5173736@ad.unsw.edu.au %K internet %K mental illness %K overuse %K problematic internet behaviors %K emergency department %K screening %K adolescent %K youth %K internet use %K mental health %K technology use %K young people %K internet behavior %D 2023 %7 15.5.2023 %9 Original Paper %J JMIR Form Res %G English %X Background: Research on problematic internet use has largely adhered to addiction paradigms, possibly impeding the identification of specific internet behaviors related to psychopathology. This study presents a novel approach to screening for specific problematic internet behaviors by using a new measure, the emergency department media use screener (EDMUS). Objective: The purpose of this study was to identify patterns of internet use in young people presenting with mental health concerns to the emergency department (ED), ascertain associations with their mental health, and evaluate whether the EDMUS can be used to predict subsequent ED presentations within 3 months. Methods: This cross-sectional retrospective study of Australian young people (N=149, aged 11-25 years; female: n=92, 61.7%) sought to use the EDMUS, a 24-item questionnaire, to identify problematic internet behaviors, including accessing or posting prosuicidal or proeating disorder content, cyberbullying, and inappropriate digital content. Data on each person’s mental health were extracted from electronic medical records to look for associations with EDMUS responses and ED re-presentation over 3 months. EDMUS items were grouped into clusters for analysis using chi-square tests, binary logistic regression, and path analyses. Results: Sharing suicidal digital content was the most common problematic internet use pattern identified by the EDMUS. However, this did not correlate with having a prior mental health diagnosis or predict readmission. Most participants had families with a concern for their internet use; however, this was less likely in participants with a diagnosis of personality disorder. Diagnoses of personality disorder or posttraumatic stress disorder were independent predictors of readmission (P=.003; P=.048). Conclusions: Although a history of complex psychopathology increases the likelihood of subsequent ED presentations, its links to internet use–related behaviors are still unclear. The EDMUS has potential for identifying young people who are most vulnerable to problematic internet behaviors and offers the opportunity for early intervention and potential prevention of more entrenched difficulties. %M 37184914 %R 10.2196/42986 %U https://formative.jmir.org/2023/1/e42986 %U https://doi.org/10.2196/42986 %U http://www.ncbi.nlm.nih.gov/pubmed/37184914 %0 Journal Article %@ 2291-9279 %I JMIR Publications %V 11 %N %P e43388 %T Time to Think “Meta”: A Critical Viewpoint on the Risks and Benefits of Virtual Worlds for Mental Health %A Paquin,Vincent %A Ferrari,Manuela %A Sekhon,Harmehr %A Rej,Soham %+ Department of Psychiatry, McGill University, 1033 Avenue des Pins, Montreal, QC, H3A 1A1, Canada, 1 514 398 4909, vincent.paquin2@mail.mcgill.ca %K metaverse %K digital media %K virtual reality %K mental health %K addiction %K social functioning %K virtual %K technology %K augmented reality %K gaming %K social media %K cognitive %K physical activity %K behavior %K psychological %K development %K patient %K policy %D 2023 %7 7.2.2023 %9 Viewpoint %J JMIR Serious Games %G English %X The metaverse is gaining traction in the general population and has become a priority of the technological industry. Defined as persistent virtual worlds that exist in virtual or augmented reality, the metaverse proposes to afford a range of activities of daily life, from socializing and relaxing to gaming, shopping, and working. Because of its scope, its projected popularity, and its immersivity, the metaverse may pose unique opportunities and risks for mental health. In this viewpoint article, we integrate existing evidence on the mental health impacts of video games, social media, and virtual reality to anticipate how the metaverse could influence mental health. We outline 2 categories of mechanisms related to mental health: experiences or behaviors afforded by the metaverse and experiences or behaviors displaced by it. The metaverse may benefit mental health by affording control (over an avatar and its virtual environment), cognitive activation, physical activity, social connections, and a sense of autonomy and competence. However, repetitive rewarding experiences may lead to addiction-like behaviors, and high engagement in virtual worlds may facilitate and perpetuate the avoidance of challenges in the offline environment. Further, time spent in virtual worlds may displace (reduce) other determinants of mental health, such as sleep rhythms and offline social capital. Importantly, individuals will differ in their uses of and psychological responses to the metaverse, resulting in heterogeneous impacts on their mental health. Their technological motivations, developmental stage, sociodemographic context, and prior mental health problems are some of the factors that may modify and frame the positive and negative effects of the metaverse on their mental health. In conclusion, as the metaverse is being scaffolded by the industry and by its users, there is a window of opportunity for researchers, clinicians, and people with lived experience to coproduce knowledge on its possible impacts on mental health and illness, with the hope of influencing policy-making, technological development, and counseling of patients. %M 36661284 %R 10.2196/43388 %U https://games.jmir.org/2023/1/e43388 %U https://doi.org/10.2196/43388 %U http://www.ncbi.nlm.nih.gov/pubmed/36661284 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 25 %N %P e43174 %T Social Media is Addictive and Influences Behavior: Should it Be Regulated as a Digital Therapeutic? %A Perakslis,Eric %A Quintana,Yuri %+ Beth Israel Deaconess Medical Center, 133 Brookline Avenue, HVMA Annex, Suite 2200, Boston, MA, 02215, United States, 1 901 568 1964, yquintan@bidmc.harvard.edu %K social media %K mental health %K suicide %K health policy %K addictions %K youth mental health %K FDA %K Food and Drug Administration %K Canada %K United Kingdom %K United States %K European Union %K privacy %K security %K adverse event %D 2023 %7 26.1.2023 %9 Viewpoint %J J Med Internet Res %G English %X Recently, we were deeply saddened by the findings of the coroner investigating the death of 14-year-old Molly Russell. Deeply saddened and angry but not surprised. This case should be seen as a sentinel event, given that this is the first time social media was directly implicated as a cause of death. We should use this opportunity to advance proposals for the regulations of the health effects of social media. %M 36701180 %R 10.2196/43174 %U https://www.jmir.org/2023/1/e43174 %U https://doi.org/10.2196/43174 %U http://www.ncbi.nlm.nih.gov/pubmed/36701180 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 25 %N %P e43532 %T The Associations Between Loneliness, Hopelessness, and Self-control and Internet Gaming Disorder Among University Students Who Were Men Who Have Sex With Men: Cross-sectional Mediation Study %A Yu,Yanqiu %A Fong,Vivian W I %A Ng,Joyce Hoi-Yuk %A Wang,Zixin %A Tian,Xiaobing %A Lau,Joseph T F %+ Zhejiang Provincial Clinical Research Center for Mental Disorders, The Affiliated Wenzhou Kangning Hospital, Wenzhou Medical University, Shengjin Road, Huanglong Residential Area, Wenzhou, 325005, China, 86 13143882252, jlau@cuhk.edu.hk %K men who have sex with men %K internet gaming disorder %K self-control %K loneliness %K hopelessness %K structural equation modeling %D 2023 %7 17.1.2023 %9 Original Paper %J J Med Internet Res %G English %X Background: The minority stress model postulates that men who have sex with men (MSM) often encounter multiple stressors because of their sexual minority status, which may lead to psychological problems and maladaptive coping such as addictive behaviors (eg, internet gaming disorder [IGD]). It was hypothesized that hopelessness and loneliness would be associated with IGD via self-control among MSM. Objective: This study investigated the prevalence of IGD and its associations with variables related to minority stress (loneliness and hopelessness) among MSM who were university students. Mediation involving such associations via self-control was also explored. Methods: With informed consent, 305 MSM attending universities in Sichuan, China participated in the study. The validated Diagnostic and Statistical Manual of Mental Disorders (Fifth Edition) checklist was used to assess IGD. Multivariable logistic regression adjusted for background factors and structural equation modeling were conducted. Results: The prevalence of IGD was 12.8% (n=39). Logistic regression found that IGD was positively associated with hopelessness and loneliness, and negatively associated with self-control. The structural equation modeling identified three significant paths between hopelessness/loneliness and IGD: (1) hopelessness → lower self-control → higher IGD (full mediation), (2) loneliness → lower self-control → higher IGD (partial mediation: effect size of 28%), and (3) a direct effect from loneliness to IGD. Conclusions: IGD was prevalent among young MSM and warrants interventions that may try to reduce the level of psychosocial problems such as loneliness and hopelessness and improve self-control. According to the socioecological model, the promotion of social acceptance and reduction in stigma toward MSM are important in reducing loneliness and hopefulness among MSM. Self-control links up the relationships between psychosocial problems and IGD and should be given special attention. Longitudinal studies are warranted to confirm the findings and test new mediations between loneliness/hopelessness and MSM with IGD. %M 36649059 %R 10.2196/43532 %U https://www.jmir.org/2023/1/e43532 %U https://doi.org/10.2196/43532 %U http://www.ncbi.nlm.nih.gov/pubmed/36649059 %0 Journal Article %@ 2291-9279 %I JMIR Publications %V 11 %N %P e40130 %T Role of Gaming Devices Associated With Internet Gaming Disorder in China: Cross-sectional Study %A Li,Yifan %A Tang,Ying %A Huang,Shucai %A Tan,Linxiang %A Huang,Qiuping %A Chen,Xinxin %A Lin,Shuhong %A Hao,Jingyue %A Liao,Zhenjiang %A Shen,Hongxian %+ Department of Psychiatry, National Clinical Research Center for Mental Disorders, The Second Xiangya Hospital of Central South University, 139 Renmin Road, Changsha, 410011, China, 86 13875970393, shenhx2018@csu.edu.cn %K internet gaming disorder %K gaming device %K gaming motivation %K personality traits %K gaming use characteristics %D 2023 %7 16.1.2023 %9 Original Paper %J JMIR Serious Games %G English %X Background: Chinese gamers use computer and mobile phone games widely. Consequently, concerns regarding the development of internet gaming disorder (IGD) in adolescents have been raised. However, only a few studies have focused on the influence of gaming devices on IGD. Objective: This study aims to compare sociodemographic information, gaming use characteristics, personality traits, and gaming motivations between computer game users (CGUs) and mobile phone game users (MGUs), as well as identifying IGD predictors. Methods: This was a cross-sectional study. A total of 3593 internet game players took part in an online survey, which included sociodemographic information, gaming patterns, gaming motivations, the Chinese version of the Video Game Dependency Scale, and the Chinese Big Five Personality Inventory brief version. The population was divided into 2 groups for comparison by mobile phone or computer use, and the IGD population was also compared within the 2 groups. Results: There were significant differences between the 2 gaming device groups in the time (t2994=7.75, P<.001) and money (t2994=5.11, P<.001) spent on gaming and in internet game addiction scores (t2994=3.68, P<.001). Individuals using different gaming devices had different game motivations and personality traits and preferred different genres of games. Results showed that IGD predictors were different for the 2 groups, for example, strategy (odds ratio [OR] 4.452, 95% CI 1.938-10.227; P<.001) and action shooter (OR 3.725, 95% CI 1.465-9.474; P=.01) games increased the risk for MGUs. Conclusions: Gaming devices should be considered during early identification, such as long daily gaming time, much money spent on gaming, neuroticism, and conscientiousness. In addition, more research should be conducted on new gaming devices and IGD treatment. %M 36645700 %R 10.2196/40130 %U https://games.jmir.org/2023/1/e40130 %U https://doi.org/10.2196/40130 %U http://www.ncbi.nlm.nih.gov/pubmed/36645700 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 8 %N 12 %P e41606 %T The Relationship Between Physical Activity and Mobile Phone Addiction Among Adolescents and Young Adults: Systematic Review and Meta-analysis of Observational Studies %A Xiao,Wen %A Wu,Jinlong %A Yip,Joanne %A Shi,Qiuqiong %A Peng,Li %A Lei,Qiwen Emma %A Ren,Zhanbing %+ College of Physical Education, Shenzhen University, No 3588 Nanhai Road, Nanshan District, Shenzhen, 518060, China, 86 0755 265347, rzb@szu.edu.cn %K mobile phone addiction %K physical activity %K adolescents %K young adults %K systematic review %K phone addiction %K association %K correlation %K phone use %D 2022 %7 14.12.2022 %9 Review %J JMIR Public Health Surveill %G English %X Background: Previous studies have reported a potential negative correlation between physical activity (PA) and mobile phone addiction (MPA) among adolescents and young adults. To date, the strength of this correlation has not been well characterized. Objective: This review and meta-analysis aimed to synthesize available empirical studies to examine the correlations between PA and MPA among adolescents and young adults. We also explored several potential moderators, including time of data collection, country or region, and type of population, associated with the relationship between PA and MPA. Methods: Four electronic databases (PubMed, Scopus, PsycINFO, and Web of Science) were searched from database inception to March 2022 to identify relevant studies. The pooled Pearson correlation coefficients and their corresponding 95% CIs for the relationship between PA and MPA were calculated using the inverse variance method. The methodological quality of the included cross-sectional studies was determined based on the Joanna Briggs Institute appraisal checklist. The study conformed to the PRISMA (Preferred Reporting Items for Systematic Review and Meta-analyses) guidelines. Results: In total, 892 relevant articles were identified, of which 22 were selected based on the inclusion and exclusion criteria. The final meta-analysis included 17 of the 22 studies. Results of random effects modeling revealed a moderate correlation between PA and MPA among adolescents and young adults (summary r=–0.243, P<.001). Sensitivity and publication bias analyses further demonstrated the robustness of our results. All the included studies were scored as high quality with a low risk of bias. Subgroup analysis further indicated that none of the hypothesized moderators (time of data collection, country or region, and type of population) significantly affected the relationship between PA and MPA, as confirmed by the mixed effects analysis. In addition, in the data collection subgroups, medium effect sizes were obtained for data collected before COVID-19 (r=–0.333, P<.001) and data collected during COVID-19 (r=–0.207, P<.001). In subgroup analyses for country or region, the correlation coefficient for China and other developing regions showed a similarly moderate effect size (r=–0.201, P<.001 and r= –0.217, P<.001, respectively). However, the effect sizes for developed regions were not significant (r=–0.446, P=.39). In a subgroup analysis based on the type of population, we found that the effect size for young adults was moderate (r=–0.250, P<.001). However, that of adolescents was not significant (r=–0.129, P=.24). Conclusions: Our results demonstrate a moderately negative relationship between PA and MPA among young adults. The strength of this relationship was not influenced by the time of data collection, country or region, or type of population. %M 36515994 %R 10.2196/41606 %U https://publichealth.jmir.org/2022/12/e41606 %U https://doi.org/10.2196/41606 %U http://www.ncbi.nlm.nih.gov/pubmed/36515994 %0 Journal Article %@ 2561-6722 %I JMIR Publications %V 5 %N 4 %P e41480 %T Time Spent Gaming, Device Type, Addiction Scores, and Well-being of Adolescent English Gamers in the 2021 OxWell Survey: Latent Profile Analysis %A Skripkauskaite,Simona %A Fazel,Mina %A , %+ Department of Experimental Psychology, University of Oxford, Anna Watts Building, Radcliffe Observatory Quarter, Oxford, OX2 6GG, United Kingdom, 44 01865 271444, simona.skripkauskaite@psych.ox.ac.uk %K gaming %K adolescents %K latent profile analysis %K mobile phone %K well-being %K mental ill-health %K mental health %K digital technology %D 2022 %7 18.11.2022 %9 Original Paper %J JMIR Pediatr Parent %G English %X Background: The shift in the last decades to screen-based and increasingly web-based gaming activity has raised concerns about its impact on the development of children and adolescents. Despite decades of research into gaming and related psychosocial effects, the question remains how best to identify what degree or context of gaming may be a cause for concern. Objective: This study aimed to classify adolescents into gamer profiles based on both gaming behaviors and well-being. Once we distinguished the different gamer profiles, we aimed to explore whether membership to a specific profile could be predicted based on a range of personal characteristics and experiences that could then help identify those at risk. Methods: We explored gaming and well-being in an adolescent school population (aged 12-18 years) in England as part of the 2021 OxWell student survey. Self-report measures of time spent playing games on computers or consoles, time spent playing games on mobile phones, the Game Addiction Scale, and the Warwick-Edinburgh Mental Well-being Scale were used to classify adolescent heavy gamers (playing games for at least 3.5 hours a day) using latent profile analysis. We used multinomial logistic regression analysis to predict the profile membership based on a range of personal characteristics and experiences. Results: In total, 12,725 participants answered the OxWell gaming questions. Almost one-third (3970/12,725, 31.2%) indicated that they play games for at least 3.5 hours a day. The correlation between time spent playing video games overall and well-being was not significant (P=.41). The latent profile analysis distinguished 6 profiles of adolescent heavy gamers: adaptive computer gamers (1747/3970, 44%); casual computer gamers (873/3970, 22%); casual phone gamers (595/3970, 15%); unknown device gamers (476/3970, 12%); maladaptive computer gamers (238/3970, 6%); and maladaptive phone gamers (79/3970, 2%). In comparison with adaptive computer gamers, maladaptive phone gamers were mostly female (odds ratio [OR] 0.08, 95% CI 0.03-0.21) and were more likely to have experienced abuse or neglect (OR 3.18, 95% CI 1.34-7.55). Maladaptive computer gamers, who reported gaming both on their mobile phones and on the computer, were mostly male and more likely to report anxiety (OR 2.25, 95% CI 1.23-4.12), aggressive behavior (OR 2.83, 95% CI 1.65-4.88), and web-based gambling (OR 2.18, 95% CI 1.24-3.81). Conclusions: A substantial number of adolescents are spending ≥3.5 hours gaming each day, with almost 1 in 10 (317/3970, 8%) reporting co-occurring gaming and well-being issues. Long hours gaming using mobile phones, particularly common in female gamers, may signal poorer functioning and indicate a need for additional support. Although increased time gaming might be changing how adolescents spend their free time and might thus have public health implications, it does not seem to relate to co-occurring well-being issues or mental ill-health for the majority of adolescent gamers. %M 36399378 %R 10.2196/41480 %U https://pediatrics.jmir.org/2022/4/e41480 %U https://doi.org/10.2196/41480 %U http://www.ncbi.nlm.nih.gov/pubmed/36399378 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 24 %N 11 %P e38984 %T Addiction Symptom Network of Young Internet Users: Network Analysis %A Lu,Jianxia %A Zhang,Qinhan %A Zhong,Na %A Chen,Jin %A Zhai,Yujia %A Guo,Lei %A Lu,Chunlei %A Chen,Tianzhen %A Jiang,Zhongli %A Zheng,Hui %+ Shanghai Key Laboratory of Psychotic Disorders, Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, 600 Wan Ping Nan Road, Shanghai, 200030, China, 86 18267908575, zh.dmtr@gmail.com %K internet addiction %K Internet Addiction Test %K network analysis %K adolescents %D 2022 %7 10.11.2022 %9 Original Paper %J J Med Internet Res %G English %X Background: An increasing number of people are becoming addicted to the internet as a result of overuse. The Internet Addiction Test (IAT) is a popular tool for evaluating internet use behaviors. The interaction between different symptoms and the relationship between IAT and clinical diagnostic criteria are not well understood. Objective: This study aimed to explore the core symptoms of internet addiction (IA) and the correlation between different symptoms of the IA symptom network. Network analysis was also conducted to explore the association between the IAT scale and the Diagnostic and Statistical Manual of Mental Disorders–5th edition (DSM-5) criteria for IA. Methods: We recruited 4480 internet users (aged 14-24 years), and they completed the IAT. The final analysis included 63.50% (2845/4480) of the participants after screening the submitted questionnaires. Participants were classified into IA group and non-IA (NIA) group. By using partial correlation with Lasso regularization networks, we identified the core symptoms of IA in each group and compared the group differences in network properties (strength, closeness, and betweenness). Then, we analyzed the symptom networks of the DSM-5 diagnostic criteria and IAT scale for IA. Results: A total of 12.47% (355/2845) of the patients were in the IA group and 87.52% (2490/2845) of the patients were in the NIA group, and both groups were evaluated for the following nodes: IAT_06 (school work suffers; strength=0.511), IAT_08 (job performance suffers; strength=0.531), IAT_15 (fantasize about being on the web; strength=0.474), IAT_17 (fail to stop being on the web; strength=0.526), and IAT_12 (fear about boredom if offline; strength=0.502). The IA groups had a stronger edge between IAT_09 (defensive or secretive about being on the web) and IAT_18 (hidden web time) than the NIA groups. The items in DSM-5 had a strong association with IAT_12 (weight=−0.066), IAT_15 (weight=−0.081), IAT_17 (weight=−0.106), IAT_09 (weight=−0.198), and IAT_18 (weight=−0.052). Conclusions: The internet use symptom network of the IA group is significantly different from that of the NIA group. Nodes IAT_06 (school work affected) and IAT_08 (work performance affected) are the resulting symptoms affected by other symptoms, whereas nodes IAT_12 (fear about boredom if offline), IAT_17 (inability to stop being on the web), and IAT_15 (fantasize about being on the web) are key symptoms that activate other symptoms of IA and are strongly linked to the inability to control the intention to play games in the DSM-5. %M 36355402 %R 10.2196/38984 %U https://www.jmir.org/2022/11/e38984 %U https://doi.org/10.2196/38984 %U http://www.ncbi.nlm.nih.gov/pubmed/36355402 %0 Journal Article %@ 2291-9279 %I JMIR Publications %V 10 %N 4 %P e33806 %T Parental Factors Associated With Internet Gaming Disorder Among First-Year High School Students: Longitudinal Study %A She,Rui %A Zhang,Youmin %A Yang,Xue %+ The Jockey Club School of Public Health and Primary Care, Faculty of Medicine, The Chinese University of Hong Kong, 5/F, Ngan Shing Street, Shatin, Hong Kong, HKG, China, 852 2647 5108, sherryxueyang@cuhk.edu.hk %K internet gaming disorder %K adolescents %K parental factors %K longitudinal study %K parenting %K gaming %K gaming disorder %K health intervention %K treatment %K mental health %D 2022 %7 8.11.2022 %9 Original Paper %J JMIR Serious Games %G English %X Background: Parents play central roles in adolescents’ socialization, behavioral development, and health, including the development of internet gaming disorder (IGD). However, longitudinal research on the parental predictors of adolescent IGD is limited. Objective: This study aimed to investigate the reciprocal associations between various parental factors and adolescent IGD using 2-wave cross-lagged models. Methods: A sample of 1200 year-one high school students in central China completed a baseline assessment in 2018 (mean age 15.6 years; 633/1200, 52.8% male) and a follow-up survey in 2019. IGD was measured using the 9-item DSM-5 IGD Symptoms checklist. Perceptions related to parental variables, including psychological control, parental abuse, parental support, and the parent-child relationship, were also collected from the adolescents. Results: Of all the participants, 12.4% (148/1200) and 11.7% (140/1200) were classified as having IGD at baseline (T1) and follow-up (T2), respectively. All 4 cross-lagged models fit the data well (range for the comparative fit index .91-.95; range for the standardized root mean square residual .05-.06). Parental support (β=–.06, P=.02) and parental abuse (β=.08, P=.002) at T1 predicted IGD symptoms at T2, while parental psychological control (β=.03, P=.25) and a positive relationship with parents (β=–.05, P=.07) at T1 had nonsignificant effects on IGD symptoms at T2, when controlling for background variables. In addition, IGD symptoms at T1 did not predict parental factors at T2. Conclusions: The findings suggest that parental factors may be significant predictors of adolescent IGD. Health interventions should consider involving parents to increase the effectiveness of treatment to prevent and reduce adolescent IGD. %M 36346660 %R 10.2196/33806 %U https://games.jmir.org/2022/4/e33806 %U https://doi.org/10.2196/33806 %U http://www.ncbi.nlm.nih.gov/pubmed/36346660 %0 Journal Article %@ 2561-6722 %I JMIR Publications %V 5 %N 4 %P e35240 %T Associations Between Adolescent Problematic Internet Use and Relationship Problems in Chinese Families: Findings from a Large-scale Survey %A Hayixibayi,Alimila %A Strodl,Esben %A Chen,Wei-Qing %A Kelly,Adrian B %+ School of Psychology and Counselling, Faculty of Health, Queensland University of Technology, 149 Victoria Park Road, Brisbane, 4059, Australia, 61 0478793214, alimila.hayixibayi@hdr.qut.edu.au %K problematic internet use %K parental bonding %K verbal conflict %K emotional abuse %K physical abuse %K adolescent %K teenager %K internet use %K internet usage %K abuse %K abusive %K conflict %K family %K parental bond %K student %K Asia %K China %K parent-child bond %K high school %K child %D 2022 %7 24.10.2022 %9 Original Paper %J JMIR Pediatr Parent %G English %X Background: Problematic internet use (PIU) is prevalent among Chinese adolescents. There is a need to better understand how the quality of parent-adolescent relationship is associated with adolescent PIU to guide the development of effective prevention and early intervention programs. Objective: This study aims to evaluate parent-adolescent conflict and parenting styles as potential risk factors associated with adolescent PIU. Methods: A sample of 6552 students (aged 10-19 years) from 22 schools in Guangdong, China, was recruited. The participants completed self-report questionnaires measuring their perceptions of conflict with their parents (involving verbal conflict, emotional abuse, and physical abuse) as well as their perceptions of their parents’ parenting styles (including parental care and parental control as measured by the Parental Bonding Inventory), and PIU using the Adolescent Pathological Internet Use Scale. Grade level and gender were examined as moderators of these associations. Results: Using multiple regression analyses, we found that greater mother-adolescent conflict, father-adolescent conflict, and parental control, and lower levels of parental care, were associated with higher levels of adolescent PIU (P<.001). The association between mother-adolescent conflict and PIU was stronger in older students than in younger students (P=.04), whereas the association between father-adolescent conflict and PIU was stronger in male students than in female students (P=.02). Compared with those who reported no mother-adolescent conflict, participants who experienced verbal conflict and emotional abuse, but not physical abuse from their mothers, reported higher levels of PIU (P<.001). Compared with those who reported no father-adolescent conflict, participants who experienced verbal conflict, emotional abuse, and physical abuse from their fathers had significantly higher levels of PIU (P<.001, P<.001, and P=.02, respectively). Conclusions: These findings point to the value of interventions to reduce parental verbal conflict, emotional abuse, and physical abuse, and to increase positive parenting styles, to lower the risk of PIU in Chinese adolescents. %M 36279160 %R 10.2196/35240 %U https://pediatrics.jmir.org/2022/4/e35240 %U https://doi.org/10.2196/35240 %U http://www.ncbi.nlm.nih.gov/pubmed/36279160 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 24 %N 10 %P e38963 %T Assessment of the Popularity and Perceived Effectiveness of Smartphone Tools That Track and Limit Smartphone Use: Survey Study and Machine Learning Analysis %A Aboujaoude,Elias %A Vera Cruz,Germano %A Rochat,Lucien %A Courtois,Robert %A Ben Brahim,Farah %A Khan,Riaz %A Khazaal,Yasser %+ Stanford University School of Medicine, Department of Psychiatry and Behavioral Sciences, 401 Quarry Rd, Stanford, CA, 94305, United States, 1 650 498 9111, eaboujaoude@stanford.edu %K smartphone addiction %K internet addiction %K internet gaming disorder %K smartphone tools %K telepsychiatry %K machine learning %K telemedicine %K social media %K digital mental health interventions %K mobile phone %D 2022 %7 20.10.2022 %9 Original Paper %J J Med Internet Res %G English %X Background: Problematic smartphone use, like problematic internet use, is a condition for which treatment is being sought on the web. In the absence of established treatments, smartphone-provided tools that monitor or control smartphone use have become increasingly popular, and their dissemination has largely occurred without oversight from the mental health field. Objective: We aimed to assess the popularity and perceived effectiveness of smartphone tools that track and limit smartphone use. We also aimed to explore how a set of variables related to mental health, smartphone use, and smartphone addiction may influence the use of these tools. Methods: First, we conducted a web-based survey in a representative sample of 1989 US-based adults using the crowdsourcing platform Prolific. Second, we used machine learning and other statistical tools to identify latent user classes; the association between latent class membership and demographic variables; and any predictors of latent class membership from covariates such as daily average smartphone use, social problems from smartphone use, smartphone addiction, and other psychiatric conditions. Results: Smartphone tools that monitor and control smartphone use were popular among participants, including parents targeting their children; for example, over two-thirds of the participants used sleep-related tools. Among those who tried a tool, the highest rate of perceived effectiveness was 33.1% (58/175). Participants who experienced problematic smartphone use were more likely to be younger and more likely to be female. Finally, 3 latent user classes were uncovered: nonusers, effective users, and ineffective users. Android operating system users were more likely to be nonusers, whereas younger adults and females were more likely to be effective users. The presence of psychiatric symptoms did not discourage smartphone tool use. Conclusions: If proven effective, tools that monitor and control smartphone use are likely to be broadly embraced. Our results portend well for the acceptability of mobile interventions in the treatment of smartphone-related psychopathologies and, potentially, non–smartphone-related psychopathologies. Better tools, targeted marketing, and inclusive design, as well as formal efficacy trials, are required to realize their potential. %M 36264627 %R 10.2196/38963 %U https://www.jmir.org/2022/10/e38963 %U https://doi.org/10.2196/38963 %U http://www.ncbi.nlm.nih.gov/pubmed/36264627 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 6 %N 10 %P e39869 %T mHealth Technologies for Managing Problematic Pornography Use: Content Analysis %A Henry,Nathan %A Donkin,Liesje %A Williams,Matt %A Pedersen,Mangor %+ Auckland University of Technology, 55 Wellesley Street East, Auckland CBD, Auckland, 1010, New Zealand, 64 9 921 9666 ext 7304, nathan.henry@aut.ac.nz %K pornography %K compulsive sexual behavior disorder %K CSBD %K mobile health %K mHealth %K problematic pornography use %K PPU %K mobile intervention %K just-in-time adaptive intervention %K smartphone-based therapy %K addiction %K internet addiction %K behavioral addiction %K mobile phone %D 2022 %7 13.10.2022 %9 Original Paper %J JMIR Form Res %G English %X Background: Several mobile apps are currently available that purportedly help with managing pornography addiction. However, the utility of these apps is unclear, given the lack of literature on the effectiveness of mobile health solutions for problematic pornography use. Little is also known about the content, structure, and features of these apps. Objective: This study aims to characterize the purpose, content, and popularity of mobile apps that claim to manage pornography addiction. Methods: The phrase “pornography addiction” was entered as a search term in the app stores of the two major mobile phone platforms (Android and iOS). App features were categorized according to a coding scheme that contained 16 categories. Apps were included in the analysis if they were described as helpful for reducing pornography use, and data were extracted from the store descriptions of the apps. Metrics such as number of user ratings, mean rating score, and number of installations were analyzed on a per-feature basis. Results: In total, 170 apps from both app stores met the inclusion criteria. The five most common and popular features, both in terms of number of apps with each feature and minimum possible number of installations, were the ability to track the time since last relapse (apps with feature=72/170, 42.4%; minimum possible number of installations=6,388,000), tutorials and coaching (apps with feature=63/170, 37.1%; minimum possible number of installations=9,286,505), access to accountability partners or communities (apps with feature=51/170, 30%; minimum possible number of installations=5,544,500), content blocking or content monitoring (apps with feature=46/170, 27.1%; minimum possible number of installations=17,883,000), and a reward system for progress (apps with feature=34/170, 20%; minimum possible number of installations=4,425,300). Of these features, content-blocking apps had the highest minimum possible number of installations. Content blocking was also the most detected feature combination in a combinatorial analysis (with 28 apps having only this feature), but it also had the lowest mean consumer satisfaction rating (4.04) and second-lowest median rating (4.00) out of 5 stars. None of the apps reviewed contained references to literature that provided direct evidence for the app’s efficacy or safety. Conclusions: There are several apps with the potential to provide low- or zero-cost real-time interventions for people struggling to manage problematic pornography use. Popular app features include blockers of pornographic content, behavior monitoring, and tutorials that instruct users how to eliminate pornography use. However, there is currently no empirical evidence to support the effectiveness and safety of these apps. Further research is required to be able to provide recommendations about which apps (and app features) are safe for public consumption. %M 36227634 %R 10.2196/39869 %U https://formative.jmir.org/2022/10/e39869 %U https://doi.org/10.2196/39869 %U http://www.ncbi.nlm.nih.gov/pubmed/36227634 %0 Journal Article %@ 2561-6722 %I JMIR Publications %V 5 %N 4 %P e35466 %T Parents’ Perspectives on Their Relationship With Their Adolescent Children With Internet Addiction: Survey Study %A Horita,Hideki %A Seki,Yoichi %A Shimizu,Eiji %+ Department of Cognitive Behavioral Physiology, Graduate School of Medicine, Chiba University, 1-8-1 Inohana, Chuo-ku, Chiba, 260-8670, Japan, 81 43 226 2027, horitah@iuhw.ac.jp %K internet addiction %K mental health %K parent-child relationship %D 2022 %7 5.10.2022 %9 Original Paper %J JMIR Pediatr Parent %G English %X Background: Parents of adolescents with internet addiction are confronted with their children’s internet problems on a daily basis. Parents may notice that adolescents with addiction may also have emotional and behavioral problems, including impulsivity and violence. Parenting styles have been found to be related to internet addiction. Objective: The purpose of this study is to investigate parents’ perspectives on their parenting style, relationship with their child, and the degree of internet addiction and emotional and behavioral problems of their child. Methods: A web survey was conducted with 600 parents of children between the ages of 12 and 17 years, from October 14 to 18, 2021, across Japan. Respondents were recruited by an internet research company and were asked to complete an anonymous online questionnaire. The survey was divided into two groups: 300 parents who answered “yes” to the question “Do you think your child is dependent on the internet?” and 300 parents who answered “no” to that question. Questionnaires were collected until each group had 300 participants. The questionnaire included (1) the Parent-Child Internet Addiction Test (PCIAT), (2) the daily time spent using the internet, (3) the Strengths and Difficulties Questionnaire (SDQ), (4) the Parenting Style and Dimensions Questionnaire (PSDQ), and (5) the Relationship Questionnaire (RQ) measuring self-report attachment style prototypes. Results: Mean scores of the PCIAT and the daily time spent using the internet for the group with probable internet addiction were significantly higher than those of the group without probable internet addiction (50%; P<.001). The total difficulties score from the SDQ for the group with probable internet addiction (mean 10.87, SD 5.9) was significantly higher than that for the group without probable internet addiction (mean 8.23, SD 5.64; P<.001). The mean score for authoritarian parenting from the PSDQ for the group with probable internet addiction (mean 2.1, SD 0.58) was significantly higher than that for the group without probable internet addiction (mean 2.1, SD 0.58; P<.001). Regarding the RQ, there were no significant differences between the two groups. Conclusions: Our findings suggest that parents who think their child is addicted to the internet may recognize emotional and behavioral problems of the child and have an authoritarian parenting style. %M 36197716 %R 10.2196/35466 %U https://pediatrics.jmir.org/2022/4/e35466 %U https://doi.org/10.2196/35466 %U http://www.ncbi.nlm.nih.gov/pubmed/36197716 %0 Journal Article %@ 2368-7959 %I JMIR Publications %V 9 %N 9 %P e36662 %T Content and Effectiveness of Web-Based Treatments for Online Behavioral Addictions: Systematic Review %A Park,Jennifer J %A King,Daniel L %A Wilkinson-Meyers,Laura %A Rodda,Simone N %+ School of Population Health, The University of Auckland, Building 507, 22-30 Park Ave, Grafton, Auckland, 1023, New Zealand, 64 210 822 6685, jpar956@aucklanduni.ac.nz %K systematic review %K gambling %K gaming %K internet intervention %K pornography %K treatment %K social media %D 2022 %7 9.9.2022 %9 Review %J JMIR Ment Health %G English %X Background: Very few people seek in-person treatment for online behavioral addictions including gaming and gambling or problems associated with shopping, pornography use, or social media use. Web-based treatments have the potential to address low rates of help seeking due to their convenience, accessibility, and capacity to address barriers to health care access (eg, shame, stigma, cost, and access to expert care). However, web-based treatments for online behavioral addictions have not been systematically evaluated. Objective: This review aimed to systematically describe the content of web-based treatments for online behavioral addictions and describe their therapeutic effectiveness on symptom severity and consumption behavior. Methods: A database search of MEDLINE, Embase, PsycInfo, Web of Science, Cochrane Central Register of Controlled Trials, and Google Scholar was conducted in June 2022. Studies were eligible if the study design was a randomized controlled trial or a pre-post study with at least 1 web-based intervention arm for an online behavioral addiction and if the study included the use of a validated measure of problem severity, frequency, or duration of online behavior. Data on change techniques were collected to analyze intervention content, using the Gambling Intervention System of CharacTerization. Quality assessment was conducted using the Effective Public Health Practice Project Quality Assessment Tool. Results: The review included 12 studies with 15 intervention arms, comprising 7 randomized controlled trials and 5 pre-post studies. The primary focus of interventions was gaming (n=4), followed by internet use inclusive of screen time and smartphone use (n=3), gambling (n=3), and pornography (n=2). A range of different technologies were used to deliver content, including websites (n=6), email (n=2), computer software (n=2), social media messaging (n=1), smartphone app (n=1), virtual reality (n=1), and videoconferencing (n=1). Interventions contained 15 different change techniques with an average of 4 per study. The techniques most frequently administered (>30% of intervention arms) were cognitive restructuring, relapse prevention, motivational enhancement, goal setting, and social support. Assessment of study quality indicated that 7 studies met the criteria for moderate or strong global ratings, but only 8 out of 12 studies evaluated change immediately following the treatment. Across included studies, two-thirds of participants completed after-treatment evaluation, and one-quarter completed follow-up evaluation. After-intervention evaluation indicated reduced severity (5/9, 56%), frequency (2/3, 67%), and duration (3/7, 43%). Follow-up evaluation indicated that 3 pre-post studies for gaming, gambling, and internet use demonstrated reduced severity, frequency, and duration of consumption. At 3-month evaluation, just 1 pre-post study indicated significant change to mental health symptoms. Conclusions: Web-based treatments for online behavioral addictions use an array of mechanisms to deliver cognitive and behavioral change techniques. Web-based treatments demonstrate promise for short-term reduction in symptoms, duration, or frequency of online addictive behaviors. However, there is limited evidence on the effectiveness of web-based treatments over the longer term due to the absence of controlled trials. %M 36083612 %R 10.2196/36662 %U https://mental.jmir.org/2022/9/e36662 %U https://doi.org/10.2196/36662 %U http://www.ncbi.nlm.nih.gov/pubmed/36083612 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 11 %N 8 %P e38958 %T A Gambling Just-In-Time Adaptive Intervention (GamblingLess: In-The-Moment): Protocol for a Microrandomized Trial %A Dowling,Nicki A %A Merkouris,Stephanie S %A Youssef,George J %A Lubman,Dan I %A Bagot,Kathleen L %A Hawker,Chloe O %A Portogallo,Hannah J %A Thomas,Anna C %A Rodda,Simone N %+ School of Psychology, Deakin University, 1 Gheringhap St, Geelong, 3220, Australia, 61 3 9244 5610, nicki.dowling@deakin.edu.au %K mobile health %K mHealth %K just-in-time adaptive intervention %K ecological momentary intervention %K microrandomized trial %K gambling %K addiction %K treatment %K intervention %K protocol %K relapse %K mobile phone %D 2022 %7 23.8.2022 %9 Protocol %J JMIR Res Protoc %G English %X Background: The presence of discrete but fluctuating precipitants, in combination with the dynamic nature of gambling episodes, calls for the development of tailored interventions delivered in real time, such as just-in-time adaptive interventions (JITAIs). JITAIs leverage mobile and wireless technologies to address dynamically changing individual needs by providing the type and amount of support required at the right time and only when needed. They have the added benefit of reaching underserved populations by providing accessible, convenient, and low-burden support. Despite these benefits, few JITAIs targeting gambling behavior are available. Objective: This study aims to redress this gap in service provision by developing and evaluating a theoretically informed and evidence-based JITAI for people who want to reduce their gambling. Delivered via a smartphone app, GamblingLess: In-The-Moment provides tailored cognitive-behavioral and third-wave interventions targeting cognitive processes explicated by the relapse prevention model (cravings, self-efficacy, and positive outcome expectancies). It aims to reduce gambling symptom severity (distal outcome) through short-term reductions in the likelihood of gambling episodes (primary proximal outcome) by improving craving intensity, self-efficacy, or expectancies (secondary proximal outcomes). The primary aim is to explore the degree to which the delivery of a tailored intervention at a time of cognitive vulnerability reduces the probability of a subsequent gambling episode. Methods: GamblingLess: In-The-Moment interventions are delivered to gamblers who are in a state of receptivity (available for treatment) and report a state of cognitive vulnerability via ecological momentary assessments 3 times a day. The JITAI will tailor the type, timing, and amount of support for individual needs. Using a microrandomized trial, a form of sequential factorial design, each eligible participant will be randomized to a tailored intervention condition or no intervention control condition at each ecological momentary assessment across a 28-day period. The microrandomized trial will be supplemented by a 6-month within-group follow-up evaluation to explore long-term effects on primary (gambling symptom severity) and secondary (gambling behavior, craving severity, self-efficacy, and expectancies) outcomes and an acceptability evaluation via postintervention surveys, app use and engagement indices, and semistructured interviews. In all, 200 participants will be recruited from Australia and New Zealand. Results: The project was funded in June 2019, with approval from the Deakin University Human Research Ethics Committee (2020-304). Stakeholder user testing revealed high acceptability scores. The trial began on March 29, 2022, and 84 participants have been recruited (as of June 24, 2022). Results are expected to be published mid-2024. Conclusions: GamblingLess: In-The-Moment forms part of a suite of theoretically informed and evidence-based web-based and mobile gambling interventions. This trial will provide important empirical data that can be used to facilitate the JITAI’s optimization to make it a more effective, efficient, and scalable tailored intervention. Trial Registration: Australian New Zealand Clinical Trials Registry (ANZCTR) ACTRN12622000490774; https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=380757&isClinicalTrial=False International Registered Report Identifier (IRRID): PRR1-10.2196/38958 %M 35998018 %R 10.2196/38958 %U https://www.researchprotocols.org/2022/8/e38958 %U https://doi.org/10.2196/38958 %U http://www.ncbi.nlm.nih.gov/pubmed/35998018 %0 Journal Article %@ 2368-7959 %I JMIR Publications %V 9 %N 8 %P e37837 %T Multi-operator Self-exclusion as a Harm Reduction Measure in Problem Gambling: Retrospective Clinical Study on Gambling Relapse Despite Self-exclusion %A Håkansson,Anders %A Åkesson,Gunny %+ Clinical Research Unit, Competence Center Addiction, Malmö Addiction Center, Region Skåne, Södra Tullgatan 4, plan 6, Malmö, 20502, Sweden, 46 40333883, anders_c.hakansson@med.lu.se %K web-based gambling %K gambling disorder %K behavioral addiction %K self-exclusion %K addiction %K gambling %K prevalence %K harm reduction %K abstain %K problem gambling %D 2022 %7 19.8.2022 %9 Original Paper %J JMIR Ment Health %G English %X Background: Voluntary self-exclusion from gambling is a common harm reduction option for individuals with gambling problems. Multi-operator, nationwide self-exclusion services are rare, and a system introduced in the highly web-based gambling market of Sweden is a rare and recent example. However, where web-based casino gambling and web-based betting are the predominate gambling types in those seeking treatment, the risk of breaching one’s own self-exclusion through overseas web-based operators may also be high. Objective: This study aims to assess the prevalence of a nationwide Spelpaus (“gambling break”) self-exclusion and the prevalence of gambling despite self-exclusion in patients seeking treatment for gambling disorder in 2021. Methods: Health care documentation of recent treatment seekers (January 1 through September 1, 2021, N=85) in a Swedish treatment facility was reviewed for data regarding problematic gambling types reported, history of self-exclusion, and history of breaching of that self-exclusion. Results: Common problem gambling types were web-based casino gambling (49/74, 66%) and sports betting (19/74, 26%). The majority who participated in this study (62/85, 73%) were men. All women reported web-based casino gambling. Self-exclusion through Spelpaus was common (60/74, 81%). Among self-excluders, gambling despite self-exclusion was common (41/60, 68%), most commonly on unlicensed gambling websites. Conclusions: The nationwide, multi-operator self-exclusion service of Sweden appears to reach many patients with a gambling disorder. However, the remaining gambling options in an web-based gambling setting present a major challenge despite self-exclusion. The recent data calls for further treatment efforts and potential improvements in services aiming to help voluntary self-excluders abstain from gambling. %M 35984678 %R 10.2196/37837 %U https://mental.jmir.org/2022/8/e37837 %U https://doi.org/10.2196/37837 %U http://www.ncbi.nlm.nih.gov/pubmed/35984678 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 24 %N 7 %P e31803 %T Item Response Theory Analyses of Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5) Criteria Adapted to Screen Use Disorder: Exploratory Survey %A Boudard,Mathieu %A Alexandre,Jean-Marc %A Kervran,Charlotte %A Jakubiec,Louise %A Shmulewitz,Dvora %A Hasin,Deborah %A Fournet,Lucie %A Rassis,Christophe %A Claverie,Patrice %A Serre,Fuschia %A Auriacombe,Marc %+ Sanpsy (Sleep Addiction and Neuropsychiatry), CNRS (Centre National de la Recherche Scientifique), UMR (Unité Mixte de Recherche) 6033, University of Bordeaux, 146, rue Léo Saignat, Bordeaux, 33076, France, 33 607764371, marc.auriacombe@u-bordeaux.fr %K screen media use %K screen addiction %K internet gaming disorder %K screen use disorder %K Item Response Theory %D 2022 %7 27.7.2022 %9 Original Paper %J J Med Internet Res %G English %X Background: Screen use is part of daily life worldwide and morbidity related to excess use of screens has been reported. Some use of screens in excess could indicate a screen use disorder (ScUD). An integrative approach to ScUD could better fit the polymodal reality of screens, and concurrent problems with screens, than a split approach, activity by activity. In that paradigm, a pragmatic and operationalized approach to study a potential ScUD requires the use of common criteria, for all screens and activities done on screens, in a single questionnaire. Objective: Our goals were (1) to describe screen uses in a general population sample and (2) to test the unidimensionality, local independence, and psychometric properties of the 9 Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5) internet gaming disorder (IGD) criteria adapted to screen use in a community sample. We hypothesized that the 9 DSM-5 IGD criteria adapted to ScUD would show unidimensionality, local independence, and good discrimination, with criteria distributed on the severity continuum. Methods: This cross-sectional survey in a French suburban city targeted adults and adolescents. A self-administered questionnaire covered the main types of screens used and their use for various activities in the past month. Presence of ScUD diagnostic criteria in past 12 months was also self-evaluated in the questionnaire. Factor and 2-parameter Item Response Theory analysis were used to investigate the dimensionality, local independence, and psychometric properties of the ScUD criteria. Results: Among the 300 participants, 171 (57.0%) were female (mean age 27 years), 297 (99.0%) used screens, 134 (44.7%) reported at least one criterion (potential problem users), and 5 (1.7%) reported 5 or more criteria and endorsed an ScUD. The most endorsed criteria were loss of control (60/300, 20.0%) and preoccupation (52/300, 17.3%). Screen types used and screen activities differed between participants with no ScUD criteria and those with at least one ScUD criterion. The latter were more likely to have a computer as the most used screen type, and more video gaming, communication/social network, and watching news and research of information as activities. Unidimensionality was confirmed by all fit indices. Local independence was confirmed by the absence of residual correlation between the items. Criteria had relatively high factor loading, with loss of interest in other recreational activities having the highest. However, criteria with the lowest factor loading all remained above the cut-offs, sanctioning unidimensionality. Most discriminating criteria were loss of interests, preoccupation, deceive/cover up, and risk/lose relationship/opportunities, which also provided the most information on the measurement of the latent trait. Conclusions: We described screen uses in a French community sample and have shown that the adaptation of the DSM-5 IGD to “ScUD” has good psychometric validity and is discriminating, confirming our hypothesis. We suggest to use those criteria to assess potential “ScUD.” Further studies should determine if all criteria are needed and whether others should be added. %M 35896018 %R 10.2196/31803 %U https://www.jmir.org/2022/7/e31803 %U https://doi.org/10.2196/31803 %U http://www.ncbi.nlm.nih.gov/pubmed/35896018 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 11 %N 7 %P e38919 %T Smartphone App Delivery of a Just-In-Time Adaptive Intervention for Adult Gamblers (Gambling Habit Hacker): Protocol for a Microrandomized Trial %A Rodda,Simone N %A Bagot,Kathleen L %A Merkouris,Stephanie S %A Youssef,George %A Lubman,Dan I %A Thomas,Anna C %A Dowling,Nicki A %+ Psychology and Neuroscience, Auckland University of Technology, 90 Akoranga Drive, Auckland, 0627, New Zealand, 64 99219999, simone.rodda@aut.ac.nz %K Just-In-Time Adaptive Intervention %K JITAI %K ecological momentary assessment %K EMA %K ecological momentary intervention %K EMI %K gambling %K behavior change technique %K implementation intentions %K action planning %K coping planning %K microrandomized trial %K mobile phone %D 2022 %7 26.7.2022 %9 Protocol %J JMIR Res Protoc %G English %X Background: People with gambling problems frequently report repeated unsuccessful attempts to change their behavior. Although many behavior change techniques are available to individuals to reduce gambling harm, they can be challenging to implement or maintain. The provision of implementation support tailored for immediate, real-time, individualized circumstances may improve attempts at behavior change. Objective: We aimed to develop and evaluate a Just-In-Time Adaptive Intervention (JITAI) for individuals who require support to adhere to their gambling limits. JITAI development is based on the principles of the Health Action Process Approach with delivery, in alignment with the principles of self-determination theory. The primary objective was to determine the effect of action- and coping planning compared with no intervention on the goal of subsequently adhering to gambling expenditure limits. Methods: Gambling Habit Hacker is delivered as a JITAI providing in-the-moment support for adhering to gambling expenditure limits (primary proximal outcome). Delivered via a smartphone app, this JITAI delivers tailored behavior change techniques related to goal setting, action planning, coping planning, and self-monitoring. The Gambling Habit Hacker app will be evaluated using a 28-day microrandomized trial. Up to 200 individuals seeking support for their own gambling from Australia and New Zealand will set a gambling expenditure limit (ie, goal). They will then be asked to complete 3 time-based ecological momentary assessments (EMAs) per day over a 28-day period. EMAs will assess real-time adherence to gambling limits, strength of intention to adhere to goals, goal self-efficacy, urge self-efficacy, and being in high-risk situations. On the basis of the responses to each EMA, participants will be randomized to the control (a set of 25 self-enactable strategies containing names only and no implementation information) or intervention (self-enactable strategy implementation information with facilitated action- and coping planning) conditions. This microrandomized trial will be supplemented with a 6-month within-group follow-up that explores the long-term impact of the app on gambling expenditure (primary distal outcome) and a range of secondary outcomes, as well as an evaluation of the acceptability of the JITAI via postintervention surveys, app use and engagement indices, and semistructured interviews. This trial has been approved by the Deakin University Human Research Ethics Committee (2020-304). Results: The intervention has been subject to expert user testing, with high acceptability scores. The results will inform a more nuanced version of the Gambling Habit Hacker app for wider use. Conclusions: Gambling Habit Hacker is part of a suite of interventions for addictive behaviors that deliver implementation support grounded in lived experience. This study may inform the usefulness of delivering implementation intentions in real time and in real-world settings. It potentially offers people with gambling problems new support to set their gambling intentions and adhere to their limits. Trial Registration: Australian New Zealand Clinical Trials Registry ACTRN12622000497707; www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=383568 International Registered Report Identifier (IRRID): DERR1-10.2196/38919 %M 35881441 %R 10.2196/38919 %U https://www.researchprotocols.org/2022/7/e38919 %U https://doi.org/10.2196/38919 %U http://www.ncbi.nlm.nih.gov/pubmed/35881441 %0 Journal Article %@ 2291-9279 %I JMIR Publications %V 10 %N 2 %P e33661 %T Video Game Addictive Symptom Level, Use Intensity, and Hedonic Experience: Cross-sectional Questionnaire Study %A Walia,Bhavneet %A Kim,Jeeyoon %A Ijere,Ignatius %A Sanders,Shane %+ Department of Public Health, Falk College, Syracuse University, 430B Barclay, White Hall, Syracuse, NY, 13244, United States, 1 3154433930, bwalia@syr.edu %K video game use %K addictive behaviors %K mental health %K video game addiction %K videogames %K addiction %K video games %D 2022 %7 9.6.2022 %9 Original Paper %J JMIR Serious Games %G English %X Background: The effects of behavioral addiction to video games has received increasing attention in the literature, given increased use intensity among subgroups of video game players. Objective: This study seeks to empirically determine the relationship between intensity of video gaming and hedonic experience of the player. Methods: We conducted a survey of 835 individuals who regularly play video games to determine the relationship between intensity of use and hedonic experience. We divided the sample into quartiles by self-reported video game addictive symptom level (from the Internet Gaming Disorder Scale) and conducted polynomial regressions separately for each quartile. Results: We found that the higher video game addictive symptom level groups experienced a U-shaped (curvilinear) relationship between hedonic experience and intensity of play, whereas groups with lower video game addictive symptom levels exhibited no such relationship. The coefficients for the highest addictive symptom level group (quartile 4) for marginal effects for hours played per week and hours played per week squared were significantly negative (P=.005) and significantly positive (P=.004), respectively. Conclusions: Our results are consistent with sensitization and tolerance theories, which suggest that high-symptom groups experience frustration and disappointment until they achieve excessive dopamine release, at which point their hedonic experience is expected to improve with additional play. Conversely, low-symptom groups experience no such fall-and-rise pattern. This result is consistent with the outcome that members of the latter group play the game for the direct experience, such that their hedonic experience is more directly related to events occurring in the game than to the increasingly elusive pursuit of excessive dopamine release. We also find that high-symptom groups spend substantially more time and money to support video game use and are much more likely to engage in video game use at the expense of other important activities, such as working, sleeping, and eating. %M 35471995 %R 10.2196/33661 %U https://games.jmir.org/2022/2/e33661 %U https://doi.org/10.2196/33661 %U http://www.ncbi.nlm.nih.gov/pubmed/35471995 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 24 %N 6 %P e36843 %T Cybersickness Variability by Race: Findings From 6 Studies and a Mini Meta-analysis %A Martingano,Alison Jane %A Brown,Ellenor %A Telaak,Sydney H %A Dolwick,Alexander P %A Persky,Susan %+ Social and Behavioral Research Branch, National Human Genome Research Institute, National Institutes of Health, 31 Center Drive, B1B36, Bethesda, MD, 20892, United States, 1 3014430098, perskys@mail.nih.gov %K cybersickness %K racial differences %K virtual reality %K head-mounted displays %K simulator sickness %D 2022 %7 1.6.2022 %9 Original Paper %J J Med Internet Res %G English %X Background: With the influx of medical virtual reality (VR) technologies, cybersickness has transitioned from a nuisance experienced during leisure activities to a potential safety and efficacy concern for patients and clinicians. To improve health equity, it is important to understand any potential differences in cybersickness propensity among demographic groups, including racial groups. Objective: This study aims to explore whether cybersickness propensity differs across racial groups. Methods: We collected self-reported cybersickness ratings from 6 racially diverse independent samples within 1 laboratory group (N=931). In these studies, the participants were asked to perform tasks in VR such as traversing environments, pointing at and selecting objects, and interacting with virtual humans. Results: Significant racial differences in cybersickness were found in 50% (3/6) of studies. A mini meta-analysis revealed that, on average, Black participants reported approximately one-third of SD less cybersickness than White participants (Cohen d=−0.31; P<.001), regardless of the nature of the VR experience. There was no overall difference in reported cybersickness between the Asian and White participants (Cohen d=−0.11; P=.51). Conclusions: Racial differences in cybersickness indicate that researchers, practitioners, and regulators should consider patient demographics when evaluating VR health intervention outcomes. These findings lay the groundwork for future studies that may explore racial differences in cybersickness directly. %M 35648477 %R 10.2196/36843 %U https://www.jmir.org/2022/6/e36843 %U https://doi.org/10.2196/36843 %U http://www.ncbi.nlm.nih.gov/pubmed/35648477 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 8 %N 5 %P e37451 %T Prevalence and Associated Factors of Problematic Use of Smartphones Among Adults in Qassim, Saudi Arabia: Cross-sectional Survey %A Al-Mohaimeed,Abdulrahman %A Alharbi,Mansour %A Mahmud,Ilias %+ Department of Public Health, College of Public Health and Health Informatics, Qassim University, King Abdulaziz Rd, Al Bukairiyah, 52741, Saudi Arabia, 966 594190118, i.emdadulhaque@qu.edu.sa %K smartphone %K smartphone addiction %K problematic use of smartphones %K mobile phone dependence %K problematic use of mobile phones %K Saudi Arabia %K addiction %K psychosocial %K cross-sectional survey %K psychological health %K student %K mental health %D 2022 %7 23.5.2022 %9 Original Paper %J JMIR Public Health Surveill %G English %X Background: The Kingdom of Saudi Arabia (KSA) ranks third globally in smartphone use. Smartphones have made many aspects of life easier. However, the overuse of smartphones is associated with physical and psychosocial problems. Objective: The aim of this paper is to estimate the prevalence and associated factors of problematic use of smartphones among adults in the Qassim region of KSA. Methods: We enrolled 715 participants using cluster random sampling for this cross-sectional survey. We assessed the problematic use of smartphones using the short version of the Smartphone Addiction Scale. Results: We estimated the prevalence of problematic smartphone use among adults at 64% (453/708). Multivariable logistic regression analysis suggested that students are 3 times more likely to demonstrate problematic use compared with unemployed individuals (P=.03); adults using more than five apps are 2 times more likely to demonstrate problematic use compared to those using a maximum of three apps (P=.007). Protective factors against problematic smartphone use include using apps for academic (odds ratio [OR] 0.66; P=.04) or religious needs (OR 0.55; P=.007) and having a monthly family income of 5001-10,000 SAR (Saudi Riyal; US $1300-$2700; OR 0.46; P=.01) or 10,001-20,000 SAR (US $2700-$5400; OR 0.51; P=.03) compared to the <1501 SAR (US $400) income group. Conclusions: We reported a very high prevalence of problematic use of smartphones in KSA. Considering its negative impact on physical and psychosocial health, public health programs should develop preventive strategies. %M 35604756 %R 10.2196/37451 %U https://publichealth.jmir.org/2022/5/e37451 %U https://doi.org/10.2196/37451 %U http://www.ncbi.nlm.nih.gov/pubmed/35604756 %0 Journal Article %@ 2291-9279 %I JMIR Publications %V 10 %N 2 %P e29077 %T Associations Between Addictive Behaviors, Individual Characteristics, and the Use of Gambling Services Within the World of Gaming: Cross-sectional Survey Study %A Kisch,Mark %A Håkansson,Anders %+ Division of Psychiatry, Department of Clinical Sciences, Lund University, Baravägen 1, Lund, 22100, Sweden, 46 070 3135677, anders_c.hakansson@med.lu.se %K gambling disorder %K gaming disorder %K behavioral addiction %K mental health %K gambling %K gaming %K addiction %K behavior %K cross-sectional %K online survey %K age %K gender %D 2022 %7 22.4.2022 %9 Original Paper %J JMIR Serious Games %G English %X Background: Gambling within the world of gaming is an emerging phenomenon that may share common conceptual characteristics with traditional forms of gambling. The current literature suggests a higher degree of problematic behaviors in this gambling pattern, but studies are few, prompting for further research regarding individual characteristics and comorbid conditions associated with this activity. Objective: The aim of the study is to investigate correlations between the use of gambling services within the world of gaming and individual characteristics and addictive behaviors including problem gambling. Methods: A cross-sectional web survey was distributed to an existing panel of online respondents in Sweden. A total of 2001 respondents were included. Chi-square and Mann-Whitney U tests, followed by a logistic regression, were used in order to determine independent variables associated with gambling in the context of gaming. Results: A total of 2.9% (58/1984) of respondents reported past-year gambling within gaming. Significant associations were found with male sex, younger age, history of treatment-seeking for alcohol problems, and higher Gaming Addiction Scale scores. Conclusions: The demonstrated findings strengthen previously found associations between gambling in gaming and younger age, male sex, and problematic gaming behaviors. Additionally, the association with a history of treatment needs for alcohol problems adds to the previous impression of increased problem severity and comorbidity in within-gaming gamblers. %M 35451974 %R 10.2196/29077 %U https://games.jmir.org/2022/2/e29077 %U https://doi.org/10.2196/29077 %U http://www.ncbi.nlm.nih.gov/pubmed/35451974 %0 Journal Article %@ 2368-7959 %I JMIR Publications %V 9 %N 4 %P e33450 %T Problematic Social Media Use in Adolescents and Young Adults: Systematic Review and Meta-analysis %A Shannon,Holly %A Bush,Katie %A Villeneuve,Paul J %A Hellemans,Kim GC %A Guimond,Synthia %+ Department of Psychiatry, The Royal's Institute of Mental Health Research, University of Ottawa, 1145 Carling Ave, Ottawa, ON, K1Z 7K4, Canada, 1 6135708402, synthia.guimond@theroyal.ca %K problematic social media use %K depression %K anxiety %K stress %D 2022 %7 14.4.2022 %9 Review %J JMIR Ment Health %G English %X Background: Technology is ever evolving, with more and more diverse activities becoming possible on screen-based devices. However, participating in a heavy screen-based lifestyle may come at a cost. Our hypothesis was that problematic social media use increased the prevalence of mental health outcomes. Objective: This study seeks to systematically examine problematic social media use in youth and its association with symptoms of depression, anxiety, and stress. Methods: A systematic search was conducted to identify studies in adolescents and young adults, using the databases Engineering Village, Psycinfo, Pubmed, and Web of Science. A total of 18 studies were identified, with a total of 9269 participants in our review and included in the meta-analysis. Results: Our metaregression shows moderate but statistically significant correlations between problematic social media use and depression (r=0.273, P<.001), anxiety (r=0.348, P<.001), and stress (r=0.313, P<.001). We did not find evidence of heterogeneity of these summary correlations by age, gender, or year of publication. Conclusions: This study provides further evidence of the association between problematic social media use and negative mental health among adolescents and young adults and supports future research to focus on the underlying mechanisms of problematic use of social media. Trial Registration: PROSPERO CRD42021222309; https://tinyurl.com/2p9y4bjx %M 35436240 %R 10.2196/33450 %U https://mental.jmir.org/2022/4/e33450 %U https://doi.org/10.2196/33450 %U http://www.ncbi.nlm.nih.gov/pubmed/35436240 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 6 %N 3 %P e32940 %T Adapting an Evidence-Based e-Learning Cognitive Behavioral Therapy Program Into a Mobile App for People Experiencing Gambling-Related Problems: Formative Study %A Humphrey,Gayl %A Chu,Joanna Ting %A Ruwhiu-Collins,Rebecca %A Erick-Peleti,Stephanie %A Dowling,Nicki %A Merkouris,Stephanie %A Newcombe,David %A Rodda,Simone %A Ho,Elsie %A Nosa,Vili %A Parag,Varsha %A Bullen,Christopher %+ National Institute for Health Innovation, University of Auckland, Private Bag 92019, Auckland, 1145, New Zealand, 64 21 1100901, g.humphrey@auckland.ac.nz %K gambling %K CBT %K mHealth %K co-design %K smartphone %K self-directed %K behavior change %K engagement %K mobile phone %D 2022 %7 25.3.2022 %9 Original Paper %J JMIR Form Res %G English %X Background: Many people who experience harm and problems from gambling do not seek treatment from gambling treatment services because of personal and resource barriers. Mobile health (mHealth) interventions are widely used across diverse health care areas and populations. However, there are few in the gambling harm field, despite their potential as an additional modality for delivering treatment and support. Objective: This study aims to understand the needs, preferences, and priorities of people experiencing gambling harms and who are potential end users of a cognitive behavioral therapy mHealth intervention to inform design, features, and functions. Methods: Drawing on a mixed methods approach, we used creators and domain experts to review the GAMBLINGLESS web-based program and convert it into an mHealth prototype. Each module was reviewed against the original evidence base to maintain its intended fidelity and conceptual integrity. Early wireframes, design ideas (look, feel, and function), and content examples were developed to initiate discussions with end users. Using a cocreation process with a young adult, a Māori, and a Pasifika peoples group, all with experiences of problem or harmful gambling, we undertook 6 focus groups: 2 cycles per group. In each focus group, participants identified preferences, features, and functions for inclusion in the final design and content of the mHealth intervention. Results: Over 3 months, the GAMBLINGLESS web-based intervention was reviewed and remapped from 4 modules to 6. This revised program is based on the principles underpinning the transtheoretical model, in which it is recognized that some end users will be more ready to change than others. Change is a process that unfolds over time, and a nonlinear progression is common. Different intervention pathways were identified to reflect the end users’ stage of change. In all, 2 cycles of focus groups were then conducted, with 30 unique participants (13 Māori, 9 Pasifika, and 8 young adults) in the first session and 18 participants (7 Māori, 6 Pasifika, and 5 young adults) in the second session. Prototype examples demonstrably reflected the focus group discussions and ideas, and the features, functions, and designs of the Manaaki app were finalized. Attributes such as personalization, cultural relevance, and positive framing were identified as the key. Congruence of the final app attributes with the conceptual frameworks of the original program was also confirmed. Conclusions: Those who experience gambling harms may not seek help. Developing and demonstrating the effectiveness of new modalities to provide treatment and support are required. mHealth has the potential to deliver interventions directly to the end user. Weaving the underpinning theory and existing evidence of effective treatment with end-user input into the design and development of mHealth interventions does not guarantee success. However, it provides a foundation for framing the intervention’s mechanism, context, and content, and arguably provides a greater chance of demonstrating effectiveness. %M 35108213 %R 10.2196/32940 %U https://formative.jmir.org/2022/3/e32940 %U https://doi.org/10.2196/32940 %U http://www.ncbi.nlm.nih.gov/pubmed/35108213 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 6 %N 3 %P e33066 %T Effects of a National Preventive Intervention Against Potential COVID-19–Related Gambling Problems in Online Gamblers: Self-Report Survey Study %A Håkansson,Anders %A Sundvall,Andreas %A Lyckberg,Axel %+ Department of Clinical Sciences Lund, Psychiatry, Faculty of Medicine, Lund University, Baravägen 1, Lund, 22100, Sweden, 46 46175596, anders_c.hakansson@med.lu.se %K gambling disorder %K problem gambling %K COVID-19 %K harm reduction %K behavioral addiction %D 2022 %7 9.3.2022 %9 Original Paper %J JMIR Form Res %G English %X Background: The COVID-19 pandemic has been suspected to increase gambling problems in the population. Several governments introduced COVID-19–specific interventions early with the aim to prevent gambling problems, but their effects have not been evaluated. Objective: This study aimed to evaluate a Swedish COVID-19–related temporary legislation imposing an automated weekly deposit limit for online casino gambling. Methods: The study was an anonymous survey sent by a state-owned gambling operator to online gamblers (N=619), among whom 54.0% (n=334) were moderate-risk/problem gamblers who reached the weekly limit on online gambling during the summer of 2020. Results: Overall, 60.1% (372/619) were aware of having been limited by the COVID-19–related deposit limit, and a minority (145/619, 23.4%) perceived the intervention as fairly bad or very bad. Among those aware of the intervention, 38.7% (144/372) believed the intervention decreased their overall gambling, whereas 7.8% (29/372) believed it rather increased it. However, 82.5% (307/372) reported having gambled at more than one operator after the limit, and the most common gambling type reported to have increased at another operator was online casino (42% among moderate-risk/problem gamblers and 19% among others; P<.001). An increase in gambling following the intervention was associated with being a moderate-risk/problem gambler and having negative attitudes toward the intervention. Conclusions: The weekly deposit limit had relatively high acceptability, but the study highlights the limitations of a single-operator deposit limit, given the high number of gamblers also reporting gambling at other operators and the lower effect in clients with gambling problems. %M 34678751 %R 10.2196/33066 %U https://formative.jmir.org/2022/3/e33066 %U https://doi.org/10.2196/33066 %U http://www.ncbi.nlm.nih.gov/pubmed/34678751 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 11 %N 2 %P e33376 %T Investigating Adolescents’ Video Gaming and Gambling Activities, and Their Relationship With Behavioral, Emotional, and Social Difficulties: Protocol for a Multi-Informant Study %A Cena,Loredana %A Rota,Matteo %A Trainini,Alice %A Zecca,Sara %A Bonetti Zappa,Sofia %A Tralli,Nella %A Stefana,Alberto %+ Department of Brain and Behavioural Sciences, University of Pavia, Via Bassi, 21, Pavia, 27100, Italy, 39 3381131304, alberto.stefana@gmail.com %K adolescents %K gaming disorder %K gambling disorder %K pathological video gaming %K pathological gambling %D 2022 %7 25.2.2022 %9 Protocol %J JMIR Res Protoc %G English %X Background: Growing empirical evidence suggests that adolescents have a relatively greater propensity to develop problematic video gaming or gambling habits. Objective: The main objectives of this study are to estimate the prevalence of potential pathological gambling and video game use among adolescent students and to evaluate their risk factors. Methods: This is a cross-sectional multi-informant study based on an online survey. It will include a sample of adolescents attending secondary schools located in Brescia, northern Italy, their schoolteachers, and parents. The survey includes extensive data on adolescents’ (1) demographic, social, economic, and environmental characteristics; (2) behavioral, emotional, and social problems and adaptive functioning; (3) emotional and social loneliness; (4) perception of the reasons to use social networks; (5) video game habits and pathological use of video gaming; and (6) gambling behaviors. Results: This protocol was approved by the Institutional Ethics Board of the Spedali Civili of Brescia (Italy). We expect to collect data from 793 or more adolescent students, as determined by our sample size calculation. Conclusions: This multisite project will make a substantial contribution to (1) the implementation of a system for identifying pathological gambling and pathological video game use among adolescents, allowing for interventions aimed at improving adolescents’ financial, emotional, and social well-being; and (2) the identification of distinct profiles of gamblers and pathological video gamers that will contribute to setting up effective targeted prevention measures. Understanding the causes and impact of gambling and pathological video gaming on adolescents is a public health issue. International Registered Report Identifier (IRRID): DERR1-10.2196/33376 %M 35212638 %R 10.2196/33376 %U https://www.researchprotocols.org/2022/2/e33376 %U https://doi.org/10.2196/33376 %U http://www.ncbi.nlm.nih.gov/pubmed/35212638 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 6 %N 2 %P e31089 %T Exploring Deeper Causes Linking Adolescents’ Mental Disorders to Mobile Phone Use Problems: Grounded Theory Approach %A Sun,Zeyuan %A Zhou,Yue %A Zhang,Yinan %A Gui,Bing %A Liu,Zhenmi %+ West China School of Public Health and West China Fourth Hospital, Sichuan University, No. 17, Section 3, Ren Min Nan Road, Chengdu, 610041, China, 86 18116636482, zhenmiliu@scu.edu.cn %K mobile phone use %K adolescent health %K mental disorder %D 2022 %7 21.2.2022 %9 Original Paper %J JMIR Form Res %G English %X Background: Evidence from a variety of studies link mobile phone use with an increase in mental health problems, with the situation being particularly prevalent in China and exacerbated by the COVID-19 quarantine. Objective: This study aims to reveal underlying connections between mobile phone use and mental disorders of adolescents, and to develop a theory to help parents and counseling psychologists better understand and intervene in future cases. Methods: A total of 37 teenagers having both mental health and mobile phone use problems, along with their parents, were included for individual interviews. These interviews were transcribed, coded, and analyzed using qualitative methods of grounded theory. Results: The grades-ranking-first mentality is one of the main factors causing problems such as defective family bonding and peer influences, pushing teenagers with mental disorders to seek comfort in the virtual world through their cellphones. Conclusions: The idea proposed in this study is not only inspiring for psychological counseling and therapy on adolescents with mental problems but also beneficial for school educators and parents to better understand the adolescents. The findings of the study are also particularly noteworthy in the postpandemic age, where parents whose work locations and schedules are substantially affected due to any emergencies should try to build a relaxing and cozy atmosphere at home to avoid possible conflicts with adolescents. %M 35188470 %R 10.2196/31089 %U https://formative.jmir.org/2022/2/e31089 %U https://doi.org/10.2196/31089 %U http://www.ncbi.nlm.nih.gov/pubmed/35188470 %0 Journal Article %@ 2368-7959 %I JMIR Publications %V 9 %N 2 %P e23700 %T The Associations Between Gaming Motivation and Internet Gaming Disorder: Systematic Review and Meta-analysis %A Wang,Hsin-Yi %A Cheng,Cecilia %+ Department of Psychology, The University of Hong Kong, Pokfulam, Hong Kong, Hong Kong, 852 39174224, ceci-cheng@hku.hk %K gaming motivation %K problematic gaming %K gaming disorder %K video gaming %K online gaming %K compulsive gaming %K escapism %K culture %K cross-cultural comparison, cultural individualism %D 2022 %7 17.2.2022 %9 Review %J JMIR Ment Health %G English %X Background: There has been a surge in interest in examining internet gaming disorder (IGD) and its associations with gaming motivation. Three broad components of gaming motivation have been proposed: achievement, immersion, and social. Achievement-oriented players are motivated by gaining in-game rewards, immersion-oriented players are motivated by the experience of immersion in the virtual world, and social-oriented players are motivated by the need to socialize with other players through gaming. Objective: This study aimed to (1) quantitatively synthesize the growing body of literature to systematically examine the discrepancies in the magnitude of associations between various components of gaming motivation and IGD and (2) examine the moderating role of cultural dimension on the association between escapism gaming motivation and IGD. Methods: We conducted a systematic search of multiple databases between 2002 and 2020. Studies were included if they (1) included quantitative data, (2) used measures assessing both gaming motivation and IGD, and (3) contained sufficient information for effect size calculation. Results: The findings revealed IGD to have a stronger association with achievement motivation (r=0.32) than with immersion (r=0.22) or social motivation (r=0.20), but the strongest such association was found to be with escapism motivation (r=0.40), a subcomponent of immersion motivation. Our cross-cultural comparison further showed a stronger association between escapism motivation and IGD in studies conducted in individualistic (vs collectivistic) regions. Conclusions: This meta-analysis highlights the importance of acknowledging the discrepancies among different components of gaming motivation with respect to their role in the development of IGD, as well as the potential cultural variations in the strength of such associations. %M 35175204 %R 10.2196/23700 %U https://mental.jmir.org/2022/2/e23700 %U https://doi.org/10.2196/23700 %U http://www.ncbi.nlm.nih.gov/pubmed/35175204 %0 Journal Article %@ 2368-7959 %I JMIR Publications %V 9 %N 2 %P e30838 %T Attentional Harms and Digital Inequalities %A Hartford,Anna %A Stein,Dan J %+ Brain-Behaviour Unit, University of Cape Town, J-Block, Groote Schuur Hospital, Cape Town, 7935, South Africa, 27 214042174, annahartford@gmail.com %K digital inequalities %K attentional harms %K excessive internet use %K persuasive technologies %K internet ethics %K attention economies %D 2022 %7 11.2.2022 %9 Viewpoint %J JMIR Ment Health %G English %X Recent years have seen growing public concern about the effects of persuasive digital technologies on public mental health and well-being. As the draws on our attention reach such staggering scales and as our ability to focus our attention on our own considered ends erodes ever further, the need to understand and articulate what is at stake has become pressing. In this ethical viewpoint, we explore the concept of attentional harms and emphasize their potential seriousness. We further argue that the acknowledgment of these harms has relevance for evolving debates on digital inequalities. An underdiscussed aspect of web-based inequality concerns the persuasions, and even the manipulations, that help to generate sustained attentional loss. These inequalities are poised to grow, and as they do, so will concerns about justice with regard to the psychological and self-regulatory burdens of web-based participation for different internet users. In line with calls for multidimensional approaches to digital inequalities, it is important to recognize these potential harms as well as to empower internet users against them even while expanding high-quality access. %M 35147504 %R 10.2196/30838 %U https://mental.jmir.org/2022/2/e30838 %U https://doi.org/10.2196/30838 %U http://www.ncbi.nlm.nih.gov/pubmed/35147504 %0 Journal Article %@ 2368-7959 %I JMIR Publications %V 9 %N 1 %P e33114 %T Problematic Internet Use Before and During the COVID-19 Pandemic in Youth in Outpatient Mental Health Treatment: App-Based Ecological Momentary Assessment Study %A Gansner,Meredith %A Nisenson,Melanie %A Lin,Vanessa %A Pong,Sovannarath %A Torous,John %A Carson,Nicholas %+ Department of Psychiatry, Cambridge Health Alliance, 1493 Cambridge Street, Cambridge, MA, 02139, United States, 1 617 575 5498, meredith.gansner@gmail.com %K COVID-19 %K problematic internet use %K ecological momentary assessment %K internet %K app %K youth %K young adult %K teenager %K outpatient %K mental health %K treatment %K pilot %K cohort %K change %D 2022 %7 28.1.2022 %9 Original Paper %J JMIR Ment Health %G English %X Background: Youth with existing psychiatric illness are more apt to use the internet as a coping skill. Because many “in-person” coping skills were not easily accessible during the COVID-19 pandemic, youth in outpatient mental health treatment may have been particularly vulnerable to the development of problematic internet use (PIU). The identification of a pandemic-associated worsening of PIU in this population is critical in order to guide clinical care; if these youth have become dependent upon the internet to regulate their negative emotions, PIU must be addressed as part of mental health treatment. However, many existing studies of youth digital media use in the pandemic do not include youth in psychiatric treatment or are reliant upon cross-sectional methodology and self-report measures of digital media use. Objective: This is a retrospective cohort study that used data collected from an app-based ecological momentary assessment protocol to examine potential pandemic-associated changes in digital media youth in outpatient mental health treatment. Secondary analyses assessed for differences in digital media use dependent upon personal and familial COVID-19 exposure and familial hospitalization, as well as factors associated with PIU in this population. Methods: The participants were aged 12-23 years and were receiving mental health treatment in an outpatient community hospital setting. All participants completed a 6-week daily ecological momentary assessment protocol on their personal smartphones. Questions were asked about depression (PHQ-8 [8-item Patient Health Questionnaire]), anxiety (GAD-7 [7-item General Anxiety Disorder]), PIU (PIU-SF-6 [Problematic Internet Use Short Form 6]), digital media use based on Apple’s daily screen time reports, and personal and familial COVID-19 exposure. The analyses compared screen time, psychiatric symptoms, and PIU between cohorts, as well as between youth with personal or familial COVID-19 exposures and those without. The analyses also assessed for demographic and psychiatric factors associated with clinically significant PIU-SF-6 scores. Results: A total of 69 participants completed the study. The participants recruited during the pandemic were significantly more likely to meet the criteria for PIU based on their average PIU-SF-6 score (P=.02) and to spend more time using social media each day (P=.049). The overall amount of daily screen time did not differ between cohorts. Secondary analyses revealed a significant increase in average daily screen time among subjects who were exposed to COVID-19 (P=.01). Youth with clinically significant PIU-SF-6 scores were younger and more likely to have higher PHQ-8 (P=.003) and GAD-7 (P=.003) scores. No differences in scale scores or media use were found between subjects based on familial COVID-19 exposure or hospitalization. Conclusions: Our findings support our hypothesis that PIU may have worsened for youth in mental health treatment during the pandemic, particularly the problematic use of social media. Mental health clinicians should incorporate screening for PIU into routine clinical care in order to prevent potential familial conflict and subsequent psychiatric crises that might stem from unrecognized PIU. %M 35089157 %R 10.2196/33114 %U https://mental.jmir.org/2022/1/e33114 %U https://doi.org/10.2196/33114 %U http://www.ncbi.nlm.nih.gov/pubmed/35089157 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 8 %N 1 %P e27719 %T Measuring Problematic Internet Use, Internet Gaming Disorder, and Social Media Addiction in Young Adults: Cross-sectional Survey Study %A Moreno,Megan %A Riddle,Karyn %A Jenkins,Marina C %A Singh,Ajay Paul %A Zhao,Qianqian %A Eickhoff,Jens %+ Department of Pediatrics, University of Wisconsin-Madison, 2870 University Ave, Suite 200, Madison, WI, 53705, United States, 1 6082632846, mamoreno@pediatrics.wisc.edu %K technology %K young adults %K addiction %K social media %K internet %K video games %K screening %K surveillance %K cross-sectional %K survey %K mobile phone %D 2022 %7 27.1.2022 %9 Original Paper %J JMIR Public Health Surveill %G English %X Background: Digital technology use is nearly ubiquitous among young adults; this use provides both benefits and risks. The risks of technology use include maladaptive technology use or technology addiction. Several conceptualizations of these addictions have emerged, each with its own assessment tools. These conditions include problematic internet use (PIU), internet gaming disorder (IGD), and social media addiction (SMA). These conditions have been associated with health outcomes such as problematic alcohol use, sleep disorders, and mental illness. These maladaptive technology conditions have been most commonly studied in isolation from each other. Objective: The aim of this study is to examine PIU, IGD, and SMA together to better inform future research approaches and provider screening practices for young adults. Methods: This cross-sectional survey study was conducted using Qualtrics panel-based recruitment and survey hosting. We recruited US young adults aged 18-25 years. The survey assessed PIU, IGD, and SMA. Survey measures also included assessments of problematic alcohol use, sleep, depression, and anxiety. We evaluated the frequency of and overlap in positive screening scores among PIU, IGD, and SMA and modeled each condition using multivariate logistic regression. Finally, we calculated sensitivity and specificity, as well as the positive predictive value and negative predictive value of the screening tools using the most prevalent maladaptive technology type. Results: Our 6000 participants had an average age of 21.7 (SD 2.5) years. Of these 6000 participants, 3062 (51.03%) were female, 3431 (57.18%) were Caucasian, 1686 (28.1%) were in a 4-year college program, and 2319 (38.65%) worked full time. The mean PIU score was 3.5 (SD 3.1), and 53.58% (3215/6000) of participants met the criteria for PIU. The mean IGD score was 2.7 (SD 2.6), and 24.33% (1460/6000) of participants met the criteria for IGD. The mean SMA score was 7.5 (SD 5.7), and 3.42% (205/6000) met the criteria for SMA. Across all 3 maladaptive technology use diagnoses, there were varied associations with demographic variables and similar overlap with health outcomes. The sensitivity of PIU screening to detect IGD was 82% and to detect SMA was 93%, whereas the specificity and positive predictive value were much lower (37%-54% specificity; 6%-37% positive predictive value). Conclusions: This cross-sectional survey screened a large national sample of adolescents and young adults for PIU, IGD, and SMA to determine prevalence and overlap, demographic associations with each, and associations between these technology-related conditions and health outcomes. There was overlap across PIU, IGD, and SMA in some associated demographic variables and health outcomes. However, the patterns in the associated variables demonstrated unique qualities of each of these conditions. %M 34081596 %R 10.2196/27719 %U https://publichealth.jmir.org/2022/1/e27719 %U https://doi.org/10.2196/27719 %U http://www.ncbi.nlm.nih.gov/pubmed/34081596 %0 Journal Article %@ 2291-9279 %I JMIR Publications %V 10 %N 1 %P e33059 %T Gaming Activity and Possible Changes in Gaming Behavior Among Young People During the COVID-19 Pandemic: Cross-sectional Online Survey Study %A Claesdotter-Knutsson,Emma %A André,Frida %A Håkansson,Anders %+ Department of Clinical Sciences Lund, Faculty of Medicine, Lund University, Barav. 1, Lund, 22185, Sweden, 46 768871765, emma.claesdotter-knutsson@med.lu.se %K COVID-19 pandemic %K gaming %K screen time %K psychological distress %D 2022 %7 25.1.2022 %9 Original Paper %J JMIR Serious Games %G English %X Background: Young people’s daily lives and social interactions changed remarkably during the COVID-19 pandemic as schools and cinemas closed, leisure activities were cancelled, and gatherings were regulated. Questions have been raised by the media, schools, policy makers, and research communities about the effect on young people’s online behaviors. Objective: This cross-sectional study aimed to study self-reported changes in gaming, focusing on a younger section of the population during the COVID-19 pandemic in Sweden. We also wanted to look at potential risk factors behind problematic gaming during the pandemic, including gaming patterns, gambling behavior, psychological distress, certain sociodemographic characteristics, health factors, and school situation. Methods: This was an anonymous online survey study of web panel participants in Sweden (n=1501) to study changes in gaming behaviors during the COVID-19 pandemic. Self-reported increases in gaming were analyzed in logistic regression analyses against sociodemographic and health factors. Results: Within the study population that reported changes in gaming activity, we found significant differences in age, employment status, disposable income, whether they ever played on loot boxes, time spent at home, school attendance, psychological distress, and gambling and gaming problems, as well as significant differences in changes in alcohol consumption and exercise habits. When examining the 16–24-year-old age group who reported changes in gaming activity, we found significant differences within the group in disposable income, time at home, and school attendance. When examining the 25–39-year-old age group who reported changes in gaming activity, we found significant differences within the group in employment status, disposable income, time spent at home, whether the respondents were studying, school attendance level, psychological distress, and gaming problems, as well as significant differences in changes in alcohol consumption and exercise habits. Psychological distress (all age groups analyzed together; 25–39-year-old age group), drinking less alcohol (all age groups analyzed together), spending more time at home (all age groups analyzed together), gaming problems, and exercising less (25–39-year-old age group) were positively correlated with a self-reported increase in gaming activity. Being employed (25–39-year-old age group) and being over 40 years of age (all age groups analyzed together) were negatively correlated with increased gaming. We found no significant correlations in the 16–24-year-old age group. Conclusions: Those who reported increased gaming during the COVID-19 pandemic were more likely to be 16 years to 39 years old. In the age group of 25 years to 39 years old, the increase was associated with psychological distress, reporting less exercise, and being unemployed. COVID-19 may present as a risk factor of increased online gaming in a small but vulnerable group. More research and preferably longitudinal studies are needed in the field of gaming and effects of the COVID-19 pandemic. %M 34817386 %R 10.2196/33059 %U https://games.jmir.org/2022/1/e33059 %U https://doi.org/10.2196/33059 %U http://www.ncbi.nlm.nih.gov/pubmed/34817386 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 24 %N 1 %P e27000 %T Heterogeneity of Prevalence of Social Media Addiction Across Multiple Classification Schemes: Latent Profile Analysis %A Cheng,Cecilia %A Ebrahimi,Omid V %A Luk,Jeremy W %+ Social and Health Psychology Lab, Department of Psychology, The University of Hong Kong, Pokfulam, China (Hong Kong), 852 39174224, ceci-cheng@hku.hk %K behavioral addiction %K compulsive social media use %K information technology addiction %K mental health %K psychological assessment %K sensitivity %K social network site %K social networking %K well-being %D 2022 %7 10.1.2022 %9 Original Paper %J J Med Internet Res %G English %X Background: As social media is a major channel of interpersonal communication in the digital age, social media addiction has emerged as a novel mental health issue that has raised considerable concerns among researchers, health professionals, policy makers, mass media, and the general public. Objective: The aim of this study is to examine the prevalence of social media addiction derived from 4 major classification schemes (strict monothetic, strict polythetic, monothetic, and polythetic), with latent profiles embedded in the empirical data adopted as the benchmark for comparison. The extent of matching between the classification of each scheme and the actual data pattern was evaluated using sensitivity and specificity analyses. The associations between social media addiction and 2 comorbid mental health conditions—depression and anxiety—were investigated. Methods: A cross-sectional web-based survey was conducted, and the replicability of findings was assessed in 2 independent samples comprising 573 adults from the United Kingdom (261/573, 45.6% men; mean age 43.62 years, SD 12.24 years) and 474 adults from the United States (224/474, 47.4% men; mean age 44.67 years, SD 12.99 years). The demographic characteristics of both samples were similar to those of their respective populations. Results: The prevalence estimates of social media addiction varied across the classification schemes, ranging from 1% to 15% for the UK sample and 0% to 11% for the US sample. The latent profile analysis identified 3 latent groups for both samples: low-risk, at-risk, and high-risk. The sensitivity, specificity, and negative predictive values were high (83%-100%) for all classification schemes, except for the relatively lower sensitivity (73%-74%) for the polythetic scheme. However, the polythetic scheme had high positive predictive values (88%-94%), whereas such values were low (2%-43%) for the other 3 classification schemes. The group membership yielded by the polythetic scheme was largely consistent (95%-96%) with that of the benchmark. Conclusions: Among the classification schemes, the polythetic scheme is more well-balanced across all 4 indices. %M 35006084 %R 10.2196/27000 %U https://www.jmir.org/2022/1/e27000 %U https://doi.org/10.2196/27000 %U http://www.ncbi.nlm.nih.gov/pubmed/35006084 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 6 %N 1 %P e30286 %T Implications and Preventions of Cyberbullying and Social Exclusion in Social Media: Systematic Review %A Ademiluyi,Adesoji %A Li,Chuqin %A Park,Albert %+ Department of Software and Information Systems, University of North Carolina at Charlotte Charlotte, Woodward 310H, 9201 University City Blvd, Charlotte, NC, 28223, United States, 1 704 687 8668, apark11@uncc.edu %K cyberbullying %K cybervictimization %K cyberaggression %K bullying %K mental health %K social isolation %K social media %K mobile phone %D 2022 %7 4.1.2022 %9 Review %J JMIR Form Res %G English %X Background: The growth of social networking has created a paradigm in which many forms of personal communication are being replaced by internet communication technologies, such as social media. This has led to social issues, such as cyberbullying. In response, researchers are investigating cyberbullying to determine its implications in various life sectors. Objective: This manuscript reviews the methods, results, and limitations of the current cyberbullying research and discusses the physical and mental repercussions of cyberbullying and social exclusion as well as methods of predicting and counteracting these events. On the basis of the findings, we discuss future research directions. Methods: Using ScienceDirect, ACM Digital Library, and PubMed, 34 research articles were used in this review. A review was conducted using the selected articles with the goal of understanding the current landscape of cyberbullying research. Results: Studies have analyzed correlations between depressive and suicidal ideations in subjects as well as relationships in the social, educational, and financial status of the perpetrators. Studies have explored detection methods for monitoring cyberbullying. Automated detection has yet to become effective and accurate; however, several factors, such as personal background and physical appearance, have been identified to correlate with the likelihood that a person becomes a survivor or perpetrator of web-based cybervictimization. Social support is currently common in recovery efforts but may require diversification for specific applications in web-based incidents. Conclusions: Relations between social status, age, gender, and behaviors have been discovered that offer new insights into the origins and likeliness of cyberbullying events. Rehabilitation from such events is possible; however, automatic detection is not yet a viable solution for prevention of cyberbullying incidents. Effects such as social exclusion and suicidal ideations are closely tied to incidents of cyberbullying and require further study across various social and demographical populations. New studies should be conducted to explore the experiences of survivors and perpetrators and identify causal links. The breadth of research includes demographics from China, Canada, Taiwan, Iran, the United States, and Namibia. Wider ranges of national populations should be considered in future studies for accurate assessments, given global internet communication technology activity. The studies emphasize the need for formal classification terminology. With formal classification, researchers will have a more definite scope, allowing specific research on a single definable topic rather than on general bullying events and symptoms. Of all the studies, 2 used a longitudinal design for their research methodology. The low number of longitudinal studies leaves gaps between causation and correlation, and further research is required to understand the effects of cyberbullying. Research addressing ongoing victimization is required for the various forms of cyberbullying; social support offers the most effective current standard for prevention. %M 34982712 %R 10.2196/30286 %U https://formative.jmir.org/2022/1/e30286 %U https://doi.org/10.2196/30286 %U http://www.ncbi.nlm.nih.gov/pubmed/34982712 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 5 %N 12 %P e27852 %T Understanding Adolescents’ Perceptions and Aspirations Towards Their Relationship With Personal Technology: Survey Study %A Jee,Muhammad %A Khan,Alsa %A Nazneen,Nazneen %+ Twinbits, 1201 Big Falls Dr, Flower Mound, TX, 75028, United States, 1 214 972 8988, muhammadjee1@gmail.com %K adolescents’ perceptions %K personal technology %K technology relationship %K adolescents as technology users %K adolescents as technology bystanders %D 2021 %7 23.12.2021 %9 Original Paper %J JMIR Form Res %G English %X Background: Understanding adolescents' relationship with technology is a pressing topic in this digital era. There seem to be both beneficial and detrimental implications that originate from use of technology by adolescents. Approximately 95% of adolescents have access to a smartphone, and several studies show a positive correlation between screen addiction and trends of anxiety and depression. At the same time, research shows that two-thirds of adolescents believe that technology is a necessity for connecting and making new friends. Objective: The aim of this formative study was to understand adolescents' perception of their own and others’ relationship with personal technology. Methods: A survey was conducted with 619 adolescents ranging in age from 13 to 19 years. Adolescents were asked how they perceived the relationship with their personal technology, how they perceived others' (parents, siblings, or friends) relationship with personal technology, and how they wish to relate to their personal technology in the future. Results: "Essential,” “Distractive,” and “Addictive” were the most commonly selected descriptors to describe both adolescents' own relationship with technology (essential: 106/619, 17.1%; distractive: 105/619, 17%; addictive: 88/619, 14.2% ) and others’ relationship as well (essential: 96/619, 15.6%; distractive: 88/619, 14.3%; addictive: 90/619, 14.5%). Adolescents selected “Provides an escape” more to describe their own relationship with technology. Whereas, they selected “It's just a tool” and “Creates Barrier” more to describe others' relationship with technology. These trends are consistent across ages and genders. In addition, adolescents' aspirations for their relationship with their personal technology varied across ages: 13 to 15-year olds' top choice was “best friend”, 16 to 17-year olds’ top choice was “I don't believe in personal connection with mobile technology,” and 18 to 19-year olds’ top choice was “My personal assistant.” Conclusions: Our 3-lens method allows us to examine how adolescents perceive their relationship with personal technology in comparison to others, as well as their future technological aspirations. Our findings suggest that adolescents see both communalities as well as differences in their own and others' relationships with technology. Their future aspirations for personal technology vary across age and gender. These preliminary findings will be examined further in our follow-up research. %M 34941556 %R 10.2196/27852 %U https://formative.jmir.org/2021/12/e27852 %U https://doi.org/10.2196/27852 %U http://www.ncbi.nlm.nih.gov/pubmed/34941556 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 23 %N 12 %P e26733 %T Effects of Social Networking Service (SNS) Addiction on Mental Health Status in Chinese University Students: Structural Equation Modeling Approach Using a Cross-sectional Online Survey %A Wang,Tingxuan %A Wong,Janet Y H %A Wang,Man Ping %A Li,Amanda Chiu Yin %A Kim,Sang Suk %A Lee,Jung Jae %+ School of Nursing, The University of Hong Kong, 4/F William MW Mong Block Building, 21 Sassoon Rd, Pokfulam, Hong Kong, China, 852 39176971, leejay@hku.hk %K social networking service %K SNS %K addiction %K depression %K anxiety %K psychosocial status %K youth %K mental health %D 2021 %7 8.12.2021 %9 Original Paper %J J Med Internet Res %G English %X Background: Although social networking services (SNSs) have become popular among young people, problematic SNS use has also increased. However, little is known about SNS addiction and its association with SNS use patterns and mental health status. Objective: This study aims to test the mediating role of SNS addiction between SNS use patterns and mental health status among Chinese university students in Hong Kong (HK). Methods: An online cross-sectional survey was conducted using a convenience sampling method. In total, 533 university students (323 [66.9%] female, mean age [SD]=20.87 [2.68] years) were recruited from February to March 2019. Multiple linear regression was used to assess the association between SNS use and SNS addiction. Structural equation modeling (SEM) was performed to examine the pathways and associations among SNS use, SNS addiction, psychosocial status, and mental health status (including anxiety and depressive symptoms). Results: A longer time spent on SNSs per day (>3 h), a longer time spent on each SNS access (≥31 min), a higher frequency of SNS access (≤every 30 min), a longer duration of SNS use before sleeping (≥61 min), and a shorter duration from waking to first SNS use (≤5 min) were significantly associated with a higher level of SNS addiction (adjusted beta [aβ]=6.03, 95% CI 4.66-7.40; aβ=4.99, 95% CI 3.14-6.83; aβ=5.89, 95% CI 4.14-7.64; aβ=5.92, 95% CI 4.19-7.65; and aβ=3.27, 95% CI 1.73-4.82, respectively). SEM showed a significant mediating effect of SNS addiction in the relationship between SNS use and psychosocial status, and mental health status, including an indirect effect (β=0.63, 95% CI 0.37-0.93) and the total effect (β=0.44, 95% CI 0.19-0.72), while the direct effect was insignificant (β=–0.19, 95% CI –0.49 to 0.08). Conclusions: SNS use patterns were associated with SNS addiction, and SNS addiction mediated the associations between SNS use, psychosocial status, and mental health status of Chinese university students in HK. The findings suggest that screening for and addressing excessive SNS use are needed to prevent SNS addiction and mental distress among young people. %M 34889760 %R 10.2196/26733 %U https://www.jmir.org/2021/12/e26733 %U https://doi.org/10.2196/26733 %U http://www.ncbi.nlm.nih.gov/pubmed/34889760 %0 Journal Article %@ 2291-9279 %I JMIR Publications %V 9 %N 4 %P e28117 %T Relationship Between Illness Representations and Symptoms of Internet Gaming Disorder Among Young People: Cross-Lagged Model %A Yang,Xue %A Wong,Kei Man %A She,Rui %A Zhao,Chengjia %A Ding,Nani %A Xu,Huihui %A Tu,Xiaolian %A Lai,Xinyi %A Zhang,Guohua %+ Institute of Aging, Key Laboratory of Alzheimer's Disease of Zhejiang Province, Wenzhou Medical University, University Town, Chashan, Wenzhou, 325035, China, 86 +8613957764528, zghcnu@wmu.edu.cn %K illness representations %K internet gaming disorder %K youth %K cross-lagged model %D 2021 %7 30.11.2021 %9 Original Paper %J JMIR Serious Games %G English %X Background: The common-sense model of illness suggests that mental representations of health threats may affect one’s behavioral reactions to them and health status. Internet gaming disorder is a newly defined mental disorder. Illness representations of internet gaming disorder may affect one’s risk of internet gaming disorder. In turn, symptoms of internet gaming disorder may affect one’s perceptions of the disorder. Objective: This study aimed to investigate the relationships between illness representations and symptoms of internet gaming disorder in college students. Methods: A 1-year longitudinal study was conducted with a convenience sample of Chinese college students (n=591; 342/591, 57.9% female). Results: Of the participants, 10.1% (60/591) and 9.1% (54/591) were classified as having probable internet gaming disorder at baseline (T1) and follow-up (T2), respectively. The correlations between some dimensions of illness representations regarding internet gaming disorder (ie, consequence, timeline, personal control, treatment control, and concern) at T1 and symptoms of internet gaming disorder at T2 and between symptoms of internet gaming disorder at T1 and the dimensions of illness representations at T2 (ie, consequence, timeline, personal control, and emotional response) were statistically significant. The cross-lagged model fit the data well ((χ2/df=2.28, comparative fit index=.95, root mean square error of approximation=.06) and showed that internet gaming disorder at T1 was positively associated with unfavorable illness representations at T2. Conclusions: Individuals with more severe symptoms of internet gaming disorder had more pessimistic perceptions about the disorder. Such cognitive perceptions may affect one’s emotional and behavioral reactions towards the disorder (eg, greater levels of depression and low self-control intention) and should be modified by educational programs and psychological interventions. %M 34851298 %R 10.2196/28117 %U https://games.jmir.org/2021/4/e28117 %U https://doi.org/10.2196/28117 %U http://www.ncbi.nlm.nih.gov/pubmed/34851298 %0 Journal Article %@ 2368-7959 %I JMIR Publications %V 8 %N 11 %P e26521 %T Burden and Help-Seeking Behaviors Linked to Problem Gambling and Gaming: Observational Quantitative and Qualitative Analysis %A Luquiens,Amandine %A von Hammerstein,Cora %A Benyamina,Amine %A Perney,Pascal %+ Universitary Hospital of Nîmes, University of Montpellier, Place Robert Debré, Nîmes, 30000, France, 33 466022569, amandineluquiens@gmail.com %K gambling %K gaming %K helpline %K burden, relatives %K qualitative research %D 2021 %7 26.11.2021 %9 Original Paper %J JMIR Ment Health %G English %X Background: Models based on the uniqueness of addiction processes between behavioral addictions are highly contentious, and the inclusion of gaming disorder in the addiction nosography remains controversial. An exploratory approach could clarify a hypothesized common and subjectively identifiable process in addictive behaviors and the necessarily different expressions of the disorder due to behavior specificities, in particular the sociocultural characteristics and profiles of users. Objective: The aim of this study was to describe the nature of contacts to a help service by exploring commonality and specificities of burden and help-seeking for problem gambling or gaming. Methods: This was an observational quantitative-qualitative study. We included all contacts (ie, online questions and contacts by phone or chat when the helper completed a summary) to a helpline for gamers, gamblers, and relatives over a 7-year period. We constituted a text corpus with online questions and summaries of contacts by phone or chat. We collected basic sociodemographic data, including the device used to contact the service (phone or internet), contacting the service for oneself (“user”) or being a relative of a user and type of relative, gambling (yes/no), gaming (yes/no), and age and sex of the gambler/gamer. We describe the corpus descriptively and report the computerized qualitative analysis of online questions, chat, and summary of phone calls. We performed a descendant hierarchical analysis on the data. Results: A total of 14,564 contacts were made to the helpline, including 10,017 users and 4547 relatives. The corpus was composed of six classes: (1) gaming specificities, (2) shared psychological distress and negative emotions, (3) the procedure for being banned from gambling, (4) the provided help, (5) gambling specificities, and (6) financial problems. Conclusions: Negative emotions and shared distress linked to gambling and gaming support current scientific consensus that these behaviors can produce psychological distress in se; however, meaningful differences were observed in core symptoms of addiction between gamers and gamblers, beyond specificities related to the behavior itself: loss of control was elicited in the class corresponding to gambling specificities and not by gamers and their relatives. %M 34842562 %R 10.2196/26521 %U https://mental.jmir.org/2021/11/e26521 %U https://doi.org/10.2196/26521 %U http://www.ncbi.nlm.nih.gov/pubmed/34842562 %0 Journal Article %@ 2291-9279 %I JMIR Publications %V 9 %N 4 %P e30310 %T Predicting Video Game Addiction Through the Dimensions of Consumer Video Game Engagement: Quantitative and Cross-sectional Study %A Abbasi,Amir Zaib %A Rehman,Umair %A Afaq,Zahra %A Rafeh,Mir Abdur %A Hlavacs,Helmut %A Mamun,Mohammed A %A Shah,Muhammad Umair %+ Department of Management Sciences, Shaheed Zulfikar Ali Bhutto Institute of Science and Technology, Street # 09, Plot # 67 Sector H-8/4, Islamabad, 46000, Pakistan, 92 514863363 ext 517, aamir.zaib.abbasi@gmail.com %K consumer video game engagement %K dedication %K absorption %K social connection %K interaction %K conscious attention %K enthusiasm %K video game addiction %K uses and gratifications theory %K cultivation theory %D 2021 %7 26.11.2021 %9 Original Paper %J JMIR Serious Games %G English %X Background: Video games are expanding exponentially with their increased popularity among users. However, this popularity has also led to an increase in reported video game addiction. There may be consumer engagement–related factors that may influence video game addiction. Objective: This study aims to empirically examine the impact of the dimensions of consumer video game engagement on video game addiction. The dimensions are dedication, absorption, conscious attention, social connection, enthusiasm, and interaction. We utilize the uses and gratifications theory to study the video game engagement dimensions as potential factors through which gamers feel gratified and engaged in video game playing. Additionally, this study incorporates the cultivation theory to investigate how video game engagement factors trigger video game addiction. Methods: A two-step process was applied for data analysis on valid cases of 176 gamers aged 15-25 years: video game addiction was specified and validated as a reflective-formative construct, and hypothesis testing was later performed using the WarpPLS on valid respondents. Results: The analysis uncovered 2 dimensions of video game engagement: social connection with P=.08 and interaction with P=.49, which did not significantly contribute to video game addiction. Conclusions: This study offers unique insights to a myriad of stakeholders, mostly psychologists and psychiatrists, who routinely prescribe behavior modification techniques to treat video game addiction. %M 34842539 %R 10.2196/30310 %U https://games.jmir.org/2021/4/e30310 %U https://doi.org/10.2196/30310 %U http://www.ncbi.nlm.nih.gov/pubmed/34842539 %0 Journal Article %@ 2561-6722 %I JMIR Publications %V 4 %N 4 %P e30889 %T Gender-Based Differences and Associated Factors Surrounding Excessive Smartphone Use Among Adolescents: Cross-sectional Study %A Claesdotter-Knutsson,Emma %A André,Frida %A Fridh,Maria %A Delfin,Carl %A Hakansson,Anders %A Lindström,Martin %+ Child and Adolescent Psychiatry, Department of Clinical Sciences Lund, Faculty of Medicine, Lund University, Sofiavägen 2D, Lund, SE-22241, Sweden, 46 768871765, emma.claesdotter-knutsson@med.lu.se %K smartphone %K cell phone %K adolescent %K sleep %K anxiety %K substance use %K nicotine %K alcohol drinking %K smartphone use %K addiction %K behavioral addiction %K worry %K pathology %K internet %D 2021 %7 22.11.2021 %9 Original Paper %J JMIR Pediatr Parent %G English %X Background: Excessive smartphone use is a new and debated phenomenon frequently mentioned in the context of behavioral addiction, showing both shared and distinct traits when compared to pathological gaming and gambling. Objective: The aim of this study is to describe excessive smartphone use and associated factors among adolescents, focusing on comparisons between boys and girls. Methods: This study was based on data collected through a large-scale public health survey distributed in 2016 to pupils in the 9th grade of primary school and those in the 2nd grade of secondary school. Bayesian binomial regression models, with weakly informative priors, were used to examine whether the frequency of associated factors differed between those who reported excessive smartphone use and those who did not. Results: The overall response rate was 77% (9143/11,868) among 9th grade pupils and 73.4% (7949/10,832) among 2nd grade pupils, resulting in a total of 17,092 responses. Based on the estimated median absolute percentage differences, along with associated odds ratios, we found that excessive smartphone use was associated with the use of cigarettes, alcohol, and other substances. The reporting of anxiety and worry along with feeling low more than once a week consistently increased the odds of excessive smartphone use among girls, whereas anxiety and worry elevated the odds of excessive smartphone use among boys. The reporting of less than 7 hours of sleep per night was associated with excessive smartphone use in all 4 study groups. Conclusions: The results varied across gender and grade in terms of robustness and the size of estimated difference. However, excessive smartphone use was associated with a higher frequency of multiple suspected associated factors, including ever having tried smoking, alcohol, or other substances; poor sleep; and often feeling low and feeling anxious. This study sheds light on some features and distinctions of a potentially problematic behavior among adolescents. %M 34813492 %R 10.2196/30889 %U https://pediatrics.jmir.org/2021/4/e30889 %U https://doi.org/10.2196/30889 %U http://www.ncbi.nlm.nih.gov/pubmed/34813492 %0 Journal Article %@ 2291-9279 %I JMIR Publications %V 9 %N 4 %P e30747 %T Changes in Self-Reported Web-Based Gambling Activity During the COVID-19 Pandemic: Cross-sectional Study %A Claesdotter-Knutsson,Emma %A Håkansson,Anders %+ Child and Adolescent Psychiatry, Department of Clinical Sciences, Lund University, Barav 1, Lund, 221 85, Sweden, 46 768871765, emma.claesdotter-knutsson@med.lu.se %K COVID-19 %K pandemic %K web-based gambling %K psychological distress %K gender %D 2021 %7 3.11.2021 %9 Original Paper %J JMIR Serious Games %G English %X Background: The COVID‑19 pandemic has affected not only somatic health with over 3.7 million deaths worldwide, but also has had a huge impact on psychological health, creating what amounts to a mental health crisis. The negative effect of the pandemic on traditional addictions is well described and concerning, and the same has been seen for gambling. Objective: This study explores self-reported web-based gambling behavior during the COVID‑19 pandemic in Sweden. We investigated overall changes, but also changes in specific web-based gambling types, and whether they are associated with certain risk factors or lifestyle changes. Methods: Our study is based on an anonymous web-based survey of web panel participants in Sweden (N=1501) designed to study a range of behavioral changes during the COVID‑19 pandemic. Increases in gambling were analyzed using logistic regression models against sociodemographic data and psychological distress. Results: The majority of the respondents who gambled reported no changes in their gambling habits during the COVID‑19 pandemic. We found significant associations with the problem gambling severity index (PGSI), the Kessler score (indicating psychological distress), employment status, changes in alcohol habits, and self-exclusion when looking at overall changes in gambling activity in the pandemic. In the subgroup that reported an increase in gambling activity, we found an association with both the PGSI and Kessler scores. The PGSI score was also an independent predictor for all specific web-based gambling (horses, sports, poker, and casino) whereas the Kessler score only had a significant impact on changes in casino gambling. In addition, male gender was an independent predictor for gambling on sports and casino gambling. Conclusions: The majority of respondents who gambled reported no changes in their gambling activity during the COVID‑19 pandemic. The group that reported an increase in overall gambling activity during the COVID-19 pandemic represent a group with gambling problems and psychological distress. The group that reported increased sports and casino gambling were often male, and this group seemed to experience more psychological distress. %M 34730540 %R 10.2196/30747 %U https://games.jmir.org/2021/4/e30747 %U https://doi.org/10.2196/30747 %U http://www.ncbi.nlm.nih.gov/pubmed/34730540 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 23 %N 10 %P e26810 %T Impulsivity, Self-control, Interpersonal Influences, and Maladaptive Cognitions as Factors of Internet Gaming Disorder Among Adolescents in China: Cross-sectional Mediation Study %A Yu,Yanqiu %A Mo,Phoenix Kit-Han %A Zhang,Jianxin %A Li,Jibin %A Lau,Joseph Tak-Fai %+ Center for Health Behaviours Research, Jockey Club School of Public Health and Primary Care, The Chinese University of Hong Kong, Ngan Shing St, Sha Tin, Hong Kong, Hong Kong, 852 2252 8713, jlau@cuhk.edu.hk %K cognition %K adolescent health %K health risk behaviors %K internet %K self-control %K China %D 2021 %7 27.10.2021 %9 Original Paper %J J Med Internet Res %G English %X Background: Gaming disorder, including internet gaming disorder (IGD), was recently defined by the World Health Organization as a mental disease in the 11th Revision of the International Classification of Diseases (ICD-11). Thus, reducing IGD is warranted. Maladaptive cognitions related to internet gaming (MCIG) have been associated with IGD, while impulsivity, self-control, parental influences, and peer influences are key risk factors of IGD. Previous literature suggests that MCIG is associated with the aforementioned 4 risk factors and IGD, and may thus mediate between these risk factors and IGD. These potential mediations, if significant, imply that modification of MCIG may possibly alleviate these risk factors’ harmful impacts on increasing IGD. These mediation hypotheses were tested in this study for the first time. Objective: This study tested the mediation effects of MCIG between intrapersonal factors (impulsivity and self-control) and IGD, and between interpersonal factors (parental influences and peer influences) and IGD among adolescents in China. Methods: An anonymous, cross-sectional, and self-administered survey was conducted among secondary school students in classroom settings in Guangzhou and Chengdu, China. All grade 7 to 9 students (7 to 9 years of formal education) of 7 secondary schools were invited to join the study, and 3087 completed the survey. The Diagnostic and Statistical Manual of Mental Disorders (DSM-5) checklist was used to assess IGD. MCIG was assessed by using the Chinese version of the Revised Internet Gaming Cognition Scale. Impulsivity, self-control, and parental or peer influences were measured by using the motor subscale of the Barratt Impulsiveness Scale, the Brief Self-Control Scale, and the modified interpersonal influence scale, respectively. Structural equation modeling was conducted to examine the mediation effects of MCIG between these risk factors and IGD. Results: The prevalence of IGD was 13.57% (418/3081) and 17.67% (366/2071) among all participants and adolescent internet gamers, respectively. The 3 types of MCIG (perceived rewards of internet gaming, perceived urges for playing internet games, and perceived unwillingness to stop playing without completion of gaming tasks) were positively associated with IGD. Impulsivity, self-control, parental influences, and peer influences were all significantly associated with the 3 types of MCIG and IGD. The 3 types of MCIG partially mediated the associations between the studied factors and IGD (effect size of 30.0% to 37.8%). Conclusions: Impulsivity, self-control, and interpersonal influences had both direct and indirect effects via MCIG on IGD. Modifications of the 3 types of MCIG can potentially reduce the harmful impacts of impulsivity and interpersonal influences on IGD and enhance the protective effect of self-control against IGD. Future longitudinal studies are warranted. %M 34704960 %R 10.2196/26810 %U https://www.jmir.org/2021/10/e26810 %U https://doi.org/10.2196/26810 %U http://www.ncbi.nlm.nih.gov/pubmed/34704960 %0 Journal Article %@ 2369-3762 %I JMIR Publications %V 7 %N 4 %P e25662 %T Effect of Electronic Device Addiction on Sleep Quality and Academic Performance Among Health Care Students: Cross-sectional Study %A Qanash,Sultan %A Al-Husayni,Faisal %A Falata,Haneen %A Halawani,Ohud %A Jahra,Enas %A Murshed,Boshra %A Alhejaili,Faris %A Ghabashi,Ala’a %A Alhashmi,Hashem %+ Department of Internal Medicine, National Guard Hospital, King Abdulaziz Medical City, 6993 Albatarji St, Alzahra District, Jeddah, Saudi Arabia, 966 55 661 2749, Sultangan@hotmail.com %K electronic devices %K addiction %K sleep quality %K grade point average %K academic performance %K health care students %K medical education %K sleep %K student performance %K screen time %K well-being %D 2021 %7 6.10.2021 %9 Original Paper %J JMIR Med Educ %G English %X Background: Sleep quality ensures better physical and psychological well-being. It is regulated through endogenous hemostatic, neurogenic, and circadian processes. Nonetheless, environmental and behavioral factors also play a role in sleep hygiene. Electronic device use is increasing rapidly and has been linked to many adverse effects, raising public health concerns. Objective: This study aimed to investigate the impact of electronic device addiction on sleep quality and academic performance among health care students in Saudi Arabia. Methods: A descriptive cross-sectional study was conducted from June to December 2019 at 3 universities in Jeddah. Of the 1000 students contacted, 608 students from 5 health sciences disciplines completed the questionnaires. The following outcome measures were used: Smartphone Addiction Scale for Adolescents–short version (SAS-SV), Pittsburgh Sleep Quality Index (PSQI), and grade point average (GPA). Results: The median age of participants was 21 years, with 71.9% (437/608) being female. Almost all of the cohort used smartphones, and 75.0% (456/608) of them always use them at bedtime. Half of the students (53%) have poor sleep quality, while 32% are addicted to smartphone use. Using multivariable logistic regression, addiction to smartphones (SAS-SV score >31 males and >33 females) was significantly associated with poor sleep quality (PSQI >5) with an odds ratio of 1.8 (1.2-2.7). In addition, male gender and older students (age ≥21 years) were significantly associated with lower GPA (<4.5), with an odds ratio of 1.6 (1.1-2.3) and 2.3 (1.5-3.6), respectively; however, addiction to smartphones and poor sleep quality were not significantly associated with a lower GPA. Conclusions: Electronic device addiction is associated with increased risk for poor sleep quality; however, electronic device addiction and poor sleep quality are not associated with increased risk for a lower GPA. %M 34612827 %R 10.2196/25662 %U https://mededu.jmir.org/2021/4/e25662 %U https://doi.org/10.2196/25662 %U http://www.ncbi.nlm.nih.gov/pubmed/34612827 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 23 %N 9 %P e27093 %T Exploring the Associations Between Self-reported Tendencies Toward Smartphone Use Disorder and Objective Recordings of Smartphone, Instant Messaging, and Social Networking App Usage: Correlational Study %A Marengo,Davide %A Sariyska,Rayna %A Schmitt,Helena Sophia %A Messner,Eva-Maria %A Baumeister,Harald %A Brand,Matthias %A Kannen,Christopher %A Montag,Christian %+ Department of Molecular Psychology, Institute of Psychology and Education, Ulm University, Helmholtzstraße 8/1, Ulm, 89081, Germany, 49 07315026550, christian.montag@uni-ulm.de %K smartphone use disorder %K smartphone use %K social media %K objective measures %K mediation model %K smartphone %K web-based communication %K social networking %K mobile phone %D 2021 %7 30.9.2021 %9 Original Paper %J J Med Internet Res %G English %X Background: Social communication via instant messaging (IM) and social networking (SN) apps makes up a large part of the time that smartphone users spend on their devices. Previous research has indicated that the excessive use of these apps is positively associated with problematic smartphone use behaviors. In particular, image-based SN apps, such as Instagram (Facebook Inc) and Snapchat (Snap Inc), have been shown to exert stronger detrimental effects than those exerted by traditional apps, such as Facebook (Facebook Inc) and Twitter (Twitter Inc). Objective: In this study, we investigated the correlation between individuals’ tendencies toward smartphone use disorder (SmUD) and objective measures of the frequency of smartphone usage. Additionally, we put to test the hypothesis that the pathway linking the frequency of actual smartphone usage to self-reported tendencies toward SmUD was mediated by the increased frequency of IM and SN app usage. Methods: We recruited a sample of 124 adult smartphone users (females: 78/124, 62.9%; age: mean 23.84 years, SD 8.29 years) and collected objective information about the frequency of smartphone and SN app usage over 1 week. Participants also filled in a self-report measure for assessing the multiple components of tendencies toward SmUD. Bivariate associations were investigated by using Spearman correlation analyses. A parallel mediation analysis was conducted via multiple regression analysis. Results: The frequency of smartphone usage, as well as the use of IM apps (Messenger, Telegram, and WhatsApp [Facebook Inc]), Facebook, and image-based apps (Instagram and Snapchat), had significant positive associations with at least 1 component of SmUD, and the cyberspace-oriented relationships factor exhibited the strongest associations overall. We found support for an indirect effect that linked actual smartphone usage to SmUD tendencies via the frequency of the use of image-based SN apps. Conclusions: Our novel results shed light on the factors that promote SmUD tendencies and essentially indicate that image-based SN apps seem to be more strongly associated with problematic smartphone behaviors compared to IM apps and traditional SN apps, such as Facebook. %M 34591025 %R 10.2196/27093 %U https://www.jmir.org/2021/9/e27093 %U https://doi.org/10.2196/27093 %U http://www.ncbi.nlm.nih.gov/pubmed/34591025 %0 Journal Article %@ 2368-7959 %I JMIR Publications %V 8 %N 9 %P e26203 %T The Role of Mental Well-Being and Perceived Parental Supportiveness in Adolescents’ Problematic Internet Use: Moderation Analysis %A Hwang,Juwon %A Toma,Catalina L %+ School of Media and Strategic Communication, Oklahoma State University, 317-A Paul Miller Building, Stillwater, OK, 74078, United States, 1 6083324571, juwon.hwang.23@gmail.com %K problematic internet use %K PIU %K subjective mental well-being %K perceived parental supportiveness %K adolescents %K well-being %K young adult %K internet %K mental health %K support %K parent %K engagement %K social media %D 2021 %7 15.9.2021 %9 Original Paper %J JMIR Ment Health %G English %X Background: Given the growing number of adolescents exhibiting problematic internet use (PIU) and experiencing its harmful consequences, it is important to examine the factors associated with PIU. Existing research has identified perceived parental supportiveness and adolescents’ subjective mental well-being as strong predictors of PIU. However, it is unknown how these factors work together in shaping adolescents’ engagement in PIU. Objective: This paper aimed to examine the role played by adolescents’ perception of parental supportiveness in conjunction with their subjective mental well-being in shaping their PIU. Methods: The study analyzed one of the Technology & Adolescent Mental Wellness (TAM) data sets that were collected from a nationally representative cross-sectional sample. Adolescents self-reported their internet use behavior, perceived parental supportiveness, and subjective mental well-being through an online research panel survey. Hierarchical linear regression analysis with an interaction term was performed. Results: A total of 4592 adolescents, aged 12 to 17 years, completed the survey. Adolescents reported a mean age of 14.61 (SD 1.68) and were 46.4% (2130/4592) female and 66.9% (3370/4592) White. Findings revealed that, controlling for adolescents’ demographics and social media use, higher levels of perceived parental supportiveness (β=–.285, P<.001) and higher levels of subjective mental well-being (β=–.079, P<.001) were associated with a lower likelihood of adolescent PIU. The moderation analysis showed that the negative association between perceived parental supportiveness and PIU was stronger when adolescents reported high (vs low) levels of mental well-being (β=–.191, P<.001). Conclusions: This study shows that perceived parental supportiveness was a stronger protective factor than adolescents’ mental well-being against PIU. The protective power of perceived parental supportiveness against PIU was strongest when adolescents had high mental well-being. The highest risk of PIU occurred when adolescents’ mental well-being was high, but parents were perceived as unsupportive. Our findings suggest that parental supportiveness should be targeted as part of PIU prevention efforts. %M 34524093 %R 10.2196/26203 %U https://mental.jmir.org/2021/9/e26203 %U https://doi.org/10.2196/26203 %U http://www.ncbi.nlm.nih.gov/pubmed/34524093 %0 Journal Article %@ 2369-3762 %I JMIR Publications %V 7 %N 3 %P e28495 %T Rates of Assessment of Social Media Use in Psychiatric Interviews Prior to and During COVID-19: Needs Assessment Survey %A Raphaely,Shiri %A Goldberg,Simon B %A Moreno,Megan %A Stowe,Zachary %+ Department of Psychiatry, University of Wisconsin, 6001 Research Park Boulevard, Madison, WI, 53719, United States, 1 2063510110, shiri.raphaely@gmail.com %K social media %K screentime %K problematic Internet use %K psychiatric interview %K psychiatric training %K COVID-19 %K residency %K training %K survey %K psychiatry %K evaluation %K quarantine %D 2021 %7 14.9.2021 %9 Short Paper %J JMIR Med Educ %G English %X Background: Current research suggests that there is a nuanced relationship between mental well-being and social media. Social media offers opportunities for empowerment, information, and connection while also showing links with depression, high-risk behavior, and harassment. As this medium rapidly integrates into interpersonal interactions, incorporation of social media assessment into the psychiatric evaluation warrants attention. Furthermore, the COVID-19 pandemic and containment measures (ie, social distancing) led to increased dependence on social media, allowing an opportunity to assess the adaptation of psychiatric interviews in response to sociocultural changes. Objective: The first aim of this study was to evaluate if general psychiatry residents and child and adolescent psychiatry fellows assessed social media use as part of the clinical interview. Second, the study examined whether changes were made to the social media assessment in response to known increase of social media use secondary to social distancing measures during the COVID-19 pandemic. Methods: As part of a quality improvement project, the authors surveyed general psychiatry residents and child psychiatry fellows in a university-based training program (n=21) about their assessment of social media use in patient evaluations. Soon after the survey closed, “stay-at-home” orders related to the COVID-19 pandemic began. A subsequent survey was sent out with the same questions to evaluate if residents and fellows altered their interview practices in response to the dramatic sociocultural changes (n=20). Results: Pre-COVID-19 pandemic survey results found that 10% (2/21) of respondents incorporated social media questions in patient evaluations. In a follow-up survey after the onset of the pandemic, 20% (4/20) of respondents included any assessment of social media use. Among the 15 participants who completed both surveys, there was a nonsignificant increase in the likelihood of asking about social media use (2/15, 13% vs 4/15, 27%, for pre- and during COVID-19, respectively; McNemar χ21=0.25, P=.617, Cohen d=0.33). Conclusions: These small survey results raise important questions relevant to the training of residents and fellows in psychiatry. The findings suggest that the assessment of social media use is a neglected component of the psychiatric interview by trainees. The burgeoning use and diversity of social media engagement warrant scrutiny with respect to how this is addressed in interview training. Additionally, given minimal adaptation of the interview in the midst of a pandemic, these findings imply an opportunity for improving psychiatric training that incorporates adapting clinical interviews to sociocultural change. %M 34375297 %R 10.2196/28495 %U https://mededu.jmir.org/2021/3/e28495 %U https://doi.org/10.2196/28495 %U http://www.ncbi.nlm.nih.gov/pubmed/34375297 %0 Journal Article %@ 2369-3762 %I JMIR Publications %V 7 %N 3 %P e22235 %T The Association Between Gaming Practices and Scholastic Performance Among Medical Students in India: Case-Control Study %A Suryawanshi,Deodatt Madhav %A Rajaseharan,Divya %A Venugopal,Raghuram %A Mathew,Madhu %A Joy,Anju %A Goyal,Ramchandra %+ Department of Community Medicine, Trichy SRM Medical College Hospital and Research Centre, Irungular, SRM Nagar, Trichy, Tamil Nadu, 621105, India, 91 8220180486, drdeodattms1983@gmail.com %K gaming %K gaming disorder %K medical students %K gaming addiction %K scholastic performance %K academic performance %K addiction %K smartphones %K mobile phones %K youth %K medical education %D 2021 %7 9.9.2021 %9 Original Paper %J JMIR Med Educ %G English %X Background: Gaming is a billion-dollar industry that is expanding at a compound annual growth rate of 9% to 14.3%, with the biggest market in Southeast Asian countries. The availability of low-cost smartphones and the ease at which the internet can be accessed have made gaming popular among youth, who enjoy it as a leisure activity. According to the World Health Organization, excessive indulgence in gaming can lead to gaming disorder. Medical students indulging in excessive gaming can succumb to gaming disorder, which can affect their scholastic performance. Objective: This study aimed to assess the association between gaming practices and scholastic performance among medical students. Methods:  This study used a case-control design, where 448 medical undergraduate students (first year to prefinal) were preliminarily surveyed using universal sampling on their gaming practices in the last 6 months. Out of this sample, the 91 participants who admitted to gaming in the past 6 months were recruited as cases, while participants who never engaged in gaming in the last 6 months were recruited as controls. Both the cases and controls were matched for age and gender in a 1:1 ratio. The internal assessment scores (based on 2 midterms completed in the last 6 months) of cases and controls were compared. The Snedecor F test was used to determine the association between the number of hours spent gaming and internal assessment scores (%), while the Student t test was used to determine significant differences between the internal assessment scores of cases and controls. Odds ratios were calculated to identify the risk of poor scholastic performance among cases compared to the controls. The prevalence of gaming disorder among cases was assessed using the Gaming Addiction Scale (GAS). Results: The frequency of gaming (in hours) was not associated with mean internal assessment scores (P=.13). Male cases reported significantly lower internal assessment scores compared to male controls (P=.005 vs P=.01), whereas no significant differences were observed between the internal assessment scores of female cases and controls (P=.89 vs P=.59). A negative correlation was observed between GAS scores and internal assessment scores (r=–0.02). The prevalence of gaming disorder using the GAS was observed to be 6.3% (28/448) in the study population and 31% (28/91) among cases. The risk of low scores (<50%) among gamers was observed to be 1.9 (95% CI 1.04-3.44, P=.03) times higher in the first midterm and 1.80 (95% CI 0.97-3.36, P=.06) times higher in the second midterm compared to nongamers. Conclusions: The findings suggest that excessive gaming adversely affects the scholastic performance of male participants more than female participants. Awareness about gaming disorder needs to be created among students, parents, and teachers. Treatment services should be made available to medical students with gaming disorders. %M 34340961 %R 10.2196/22235 %U https://mededu.jmir.org/2021/3/e22235 %U https://doi.org/10.2196/22235 %U http://www.ncbi.nlm.nih.gov/pubmed/34340961 %0 Journal Article %@ 2291-9279 %I JMIR Publications %V 9 %N 3 %P e25793 %T Association of Extensive Video Gaming and Cognitive Function Changes in Brain-Imaging Studies of Pro Gamers and Individuals With Gaming Disorder: Systematic Literature Review %A Choi,Eunhye %A Shin,Suk-Ho %A Ryu,Jeh-Kwang %A Jung,Kyu-In %A Hyun,Yerin %A Kim,Jiyea %A Park,Min-Hyeon %+ Department of Psychiatry, Eunpyeong St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, 1021, Tongil-ro, Eunpyeong-gu, Seoul, 03312, Republic of Korea, 82 2 2030 2720, neominnie00@daum.net %K brain imaging %K cognitive function %K gaming disorder %K pro gamers %K video games %K cognition %K brain %K games %K gaming %D 2021 %7 9.7.2021 %9 Review %J JMIR Serious Games %G English %X Background: The World Health Organization announced the inclusion of gaming disorder (GD) in the International Classification of Diseases, 11th Revision, despite some concerns. However, video gaming has been associated with the enhancement of cognitive function. Moreover, despite comparable extensive video gaming, pro gamers have not shown any of the negative symptoms that individuals with GD have reported. It is important to understand the association between extensive video gaming and alterations in brain regions more objectively. Objective: This study aimed to systematically explore the association between extensive video gaming and changes in cognitive function by focusing on pro gamers and individuals with GD. Methods: Studies about pro gamers and individuals with GD were searched for in the PubMed and Web of Science databases using relevant search terms, for example, “pro-gamers” and “(Internet) gaming disorder.” While studies for pro gamers were searched for without date restrictions, only studies published since 2013 about individuals with GD were included in search results. Article selection was conducted by following the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines. Results: By following the PRISMA guidelines, 1903 records with unique titles were identified. Through the screening process of titles and abstracts, 86 full-text articles were accessed to determine their eligibility. A total of 18 studies were included in this systematic review. Among the included 18 studies, six studies included pro gamers as participants, one study included both pro gamers and individuals with GD, and 11 studies included individuals with GD. Pro gamers showed structural and functional alterations in brain regions (eg, the left cingulate cortex, the insula subregions, and the prefrontal regions). Cognitive function (eg, attention and sensorimotor function) and cognitive control improved in pro gamers. Individuals with GD showed structural and functional alterations in brain regions (eg, the striatum, the orbitofrontal cortex, and the amygdala) that were associated with impaired cognitive control and higher levels of craving video game playing. They also showed increased cortical thickness in the middle temporal cortex, which indicated the acquisition of better skills. Moreover, it was suggested that various factors (eg, gaming expertise, duration or severity of GD, and level of self-control) seemed to modulate the association of extensive video game playing with changes in cognitive function. Conclusions: Although a limited number of studies were identified that included pro gamers and/or individuals who reported showing symptoms of GD for more than 1 year, this review contributed to the objective understanding of the association between extensive video game playing and changes in cognitive function. Conducting studies with a longitudinal design or with various comparison groups in the future would be helpful in deepening the understanding of this association. %M 34255648 %R 10.2196/25793 %U https://games.jmir.org/2021/3/e25793 %U https://doi.org/10.2196/25793 %U http://www.ncbi.nlm.nih.gov/pubmed/34255648 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 23 %N 6 %P e24088 %T A Change Talk Model for Abstinence Based on Web-Based Anonymous Gambler Chat Meeting Data by Using an Automatic Change Talk Classifier: Development Study %A Yokotani,Kenji %+ Department of Clinical Psychology, Graduate School of Sciences and Technology for Innovation, Tokushima University, 1-1, Minamijosanjimacho, Tokushima-shi, 770-0814, Japan, 81 88 656 7103, yokotanikenji@tokushima-u.ac.jp %K problem gambling %K web-based anonymous gambler chat meetings %K self-help group %K change talk classifier %K computerized text analysis %K long-term data with dropout gamblers %K recovery gradient %K gradient descent method %K gambling %K addiction %K abstinence %D 2021 %7 21.6.2021 %9 Original Paper %J J Med Internet Res %G English %X Background: Change and sustain talks (negative and positive comments) on gambling have been relevant for determining gamblers’ outcomes but they have not been used to clarify the abstinence process in anonymous gambler meetings. Objective: The aim of this study was to develop a change talk model for abstinence based on data extracted from web-based anonymous gambler chat meetings by using an automatic change talk classifier. Methods: This study used registry data from the internet. The author accessed web-based anonymous gambler chat meetings in Japan and sampled 1.63 million utterances (two-sentence texts) from 267 abstinent gamblers who have remained abstinent for at least three years and 1625 nonabstinent gamblers. The change talk classifier in this study automatically classified gamblers’ utterances into change and sustain talks. Results: Abstinent gamblers showed higher proportions of change talks and lower probability of sustain talks compared with nonabstinent gamblers. The change talk model for abstinence, involving change and sustain talks, classified abstinent and nonabstinent gamblers through the use of a support vector machine with a radial basis kernel function. The model also indicated individual evaluation scores for abstinence and the ideal proportion of change talks for all participants according to their previous utterances. Conclusions: Abstinence likelihood among gamblers can be increased by providing personalized evaluation values and indicating the optimal proportion of change talks. Moreover, this may help to prevent severe mental, social, and financial problems caused by the gambling disorder. %M 34152282 %R 10.2196/24088 %U https://www.jmir.org/2021/6/e24088 %U https://doi.org/10.2196/24088 %U http://www.ncbi.nlm.nih.gov/pubmed/34152282 %0 Journal Article %@ 2368-7959 %I JMIR Publications %V 8 %N 5 %P e23688 %T Problematic Social Media Use in Sexual and Gender Minority Young Adults: Observational Study %A Vogel,Erin A %A Ramo,Danielle E %A Prochaska,Judith J %A Meacham,Meredith C %A Layton,John F %A Humfleet,Gary L %+ Stanford Prevention Research Center, Department of Medicine, Stanford University, 1265 Welch Road, X3C16, Stanford, CA, 943050000, United States, 1 6507243608, eavogel@stanford.edu %K sexual and gender minorities %K social media %K Facebook %K internet %K social stigma %K mobile phone %D 2021 %7 28.5.2021 %9 Original Paper %J JMIR Ment Health %G English %X Background: Sexual and gender minority (SGM) individuals experience minority stress, especially when they lack social support. SGM young adults may turn to social media in search of a supportive community; however, social media use can become problematic when it interferes with functioning. Problematic social media use may be associated with experiences of minority stress among SGM young adults. Objective: The objective of this study is to examine the associations among social media use, SGM-related internalized stigma, emotional social support, and depressive symptoms in SGM young adults. Methods: Participants were SGM young adults who were regular (≥4 days per week) social media users (N=302) and had enrolled in Facebook smoking cessation interventions. As part of a baseline assessment, participants self-reported problematic social media use (characterized by salience, tolerance, and withdrawal-like experiences; adapted from the Facebook Addiction Scale), hours of social media use per week, internalized SGM stigma, perceived emotional social support, and depressive symptoms. Pearson correlations tested bivariate associations among problematic social media use, hours of social media use, internalized SGM stigma, perceived emotional social support, and depressive symptoms. Multiple linear regression examined the associations between the aforementioned variables and problematic social media use and was adjusted for gender identity. Results: A total of 302 SGM young adults were included in the analyses (assigned female at birth: 218/302, 72.2%; non-Hispanic White: 188/302, 62.3%; age: mean 21.9 years, SD 2.2 years). The sexual identity composition of the sample was 59.3% (179/302) bisexual and/or pansexual, 17.2% (52/302) gay, 16.9% (51/302) lesbian, and 6.6% (20/302) other. The gender identity composition of the sample was 61.3% (185/302) cisgender; 24.2% (73/302) genderqueer, fluid, nonbinary, or other; and 14.6% (44/302) transgender. Problematic social media use averaged 2.53 (SD 0.94) on a 5-point scale, with a median of 17 hours of social media use per week (approximately 2.5 h per day). Participants with greater problematic social media use had greater internalized SGM stigma (r=0.22; P<.001) and depressive symptoms (r=0.22; P<.001) and lower perceived emotional social support (r=−0.15; P=.007). Greater internalized SGM stigma remained was significantly associated with greater problematic social media use after accounting for the time spent on social media and other correlates (P<.001). In addition, participants with greater depressive symptoms had marginally greater problematic social media use (P=.05). In sum, signs of problematic social media use were more likely to occur among SGM young adults who had internalized SGM stigma and depressive symptoms. Conclusions: Taken together, problematic social media use among SGM young adults was associated with negative psychological experiences, including internalized stigma, low social support, and depressive symptoms. SGM young adults experiencing minority stress may be at risk for problematic social media use. %M 34047276 %R 10.2196/23688 %U https://mental.jmir.org/2021/5/e23688 %U https://doi.org/10.2196/23688 %U http://www.ncbi.nlm.nih.gov/pubmed/34047276 %0 Journal Article %@ 2291-9279 %I JMIR Publications %V 9 %N 2 %P e26808 %T Leisure and Problem Gaming Behaviors Among Children and Adolescents During School Closures Caused by COVID-19 in Hong Kong: Quantitative Cross-sectional Survey Study %A Zhu,Shimin %A Zhuang,Yanqiong %A Lee,Paul %A Li,Jessica Chi-Mei %A Wong,Paul W C %+ Department of Social Work and Social Administration, The University of Hong Kong, 511, JC Teaching Tower, Pok Fu Lam, 000, Hong Kong, 852 39175029, paulw@hku.hk %K COVID-19 %K leisure gaming %K excessive gaming %K pathological gaming %K familial factors %K loneliness %K COVID-19 lockdown %K school closure %D 2021 %7 7.5.2021 %9 Original Paper %J JMIR Serious Games %G English %X Background: School closures during the COVID-19 pandemic may have exacerbated students’ loneliness, addictive gaming behaviors, and poor mental health. These mental health issues confronting young people are of public concern. Objective: This study aimed to examine the associations between loneliness and gaming addiction behaviors among young people in Hong Kong and to investigate how familial factors, psychological distress, and gender differences moderate these relationships. Methods: This cross-sectional study was conducted in June 2020 when schools reopened after 6 months of school closures. Participants included 2863 children and adolescents in primary (Grades 4 to 6) and secondary (Grades 7 and 8) schools (female participants: 1502/2863, 52.5%). Chi-square tests, one-way analyses of variance, and independent-samples t tests were performed to compare the differences of distribution in gaming addiction behaviors across gender, age, and other sociodemographic characteristics. Multinomial logistic regression analyses were conducted to identify factors that relate to excessive or pathological gaming behaviors separately, in comparison with leisure gaming. Results: A total of 83.0% (2377/2863) of the participants played video games during the COVID-19 pandemic. The prevalence of excessive and pathological game addiction behaviors was 20.9% (597/2863) and 5.3% (153/2863), respectively. More male students had gaming addiction symptoms than female students. The multinomial logistic regressions showed that feeling lonely was associated with more problematic gaming behaviors, and the association was stronger for older female students. Low socioeconomic status, less parental support and less supervision, and poor mental health were risk factors for gaming addiction behaviors, especially among primary school students. Conclusions: Loneliness was associated with gaming addiction behaviors; the findings from this study suggested that this association was similar across gender and age groups among young people. Familial support and supervision during school closures can protect young people from developing problematic gaming behaviors. Results of this study have implications for prevention and early intervention on behalf of policy makers and game developers. %M 33960954 %R 10.2196/26808 %U https://games.jmir.org/2021/2/e26808 %U https://doi.org/10.2196/26808 %U http://www.ncbi.nlm.nih.gov/pubmed/33960954 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 23 %N 4 %P e25468 %T Potential Correlates of Internet Gaming Disorder Among Indonesian Medical Students: Cross-sectional Study %A Siste,Kristiana %A Hanafi,Enjeline %A Sen,Lee Thung %A Wahjoepramono,Petra Octavian Perdana %A Kurniawan,Andree %A Yudistiro,Ryan %+ Faculty of Medicine, Universitas Pelita Harapan, Siloam Hospitals, Jl Siloam No 6, Tangerang, 15811, Indonesia, 62 811971169, petra.wahjoepramono@uph.edu %K internet gaming disorder %K medical students %K psychopathology %K temperament %K risk factors %D 2021 %7 19.4.2021 %9 Original Paper %J J Med Internet Res %G English %X Background: Internet gaming disorder has been a controversial topic for nearly a decade. Although internet addiction has been studied in medical students, there is a paucity of evidence regarding internet gaming disorder. Previous studies in Indonesia explored only the prevalence rate and characteristics. Objective: This study aimed to determine the prevalence rate of internet gaming disorder and correlations between internet gaming disorder, temperament, and psychopathology among Indonesian medical students. Methods: A cross-sectional study was performed from August 2019 to September 2019 using total and convenience sampling at a private university and a public university, respectively. The study variables were measured using the Indonesian version of the 10-item Internet Gaming Disorder Test, the Temperament and Character Inventory, and the Symptoms Checklist 90. Chi-square and logistic regression analyses were conducted to examine the relationships between demographic factors, temperament, psychopathology, and the presence of internet gaming disorder. Results: Among the 639 respondents, the prevalence rate of internet gaming disorder was 2.03% (n=13), with a mean age of 20.23 (SD 0.13) years and an average gaming duration of 19.0 (SD 0.96) hours/week. Up to 71.2% respondents played using their mobile phones, and respondents with internet gaming disorder reported experiencing all psychopathologies assessed, except phobic anxiety. Bivariate analysis demonstrated that internet gaming disorder was associated with gender, gaming duration, gaming community affiliation, and 9 out of 10 domains of psychopathology. In a logistic regression model, internet gaming disorder was correlated with weekly gaming hours ≥20 hours (odds ratio [OR] 4.21, 95% CI 1.08-16.38, P=.04). Conclusions: These findings suggest that the prevalence of internet gaming disorder among medical students in Jakarta, Indonesia is similar to that in other populations of Asian countries. The predisposing factor for internet gaming disorder was weekly gaming duration, while other demographic, temperament, and psychopathology variables acted as probable moderators. Strategies should, therefore, be developed and integrated into medical curriculum to screen and aid individuals with these predisposing factors. %M 33871379 %R 10.2196/25468 %U https://www.jmir.org/2021/4/e25468 %U https://doi.org/10.2196/25468 %U http://www.ncbi.nlm.nih.gov/pubmed/33871379 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 23 %N 3 %P e25786 %T A Smartphone-Delivered Ecological Momentary Intervention for Problem Gambling (GamblingLess: Curb Your Urge): Single-Arm Acceptability and Feasibility Trial %A Hawker,Chloe O %A Merkouris,Stephanie S %A Youssef,George J %A Dowling,Nicki A %+ Deakin University, 1 Gheringhap St, Geelong, 3220, Australia, 61 03 9244 5610, chawker@deakin.edu.au %K gambling %K craving %K urge %K self-efficacy %K relapse %K smartphone %K self-help %K treatment %K ecological momentary assessment %K ecological momentary intervention %K mobile phone %D 2021 %7 26.3.2021 %9 Original Paper %J J Med Internet Res %G English %X Background: Low uptake rates of traditional gambling treatments highlight the need for innovative treatment modalities. Smartphone apps can provide unprecedented access to real-time ecological momentary interventions (EMIs) delivered in people’s everyday lives. Objective: This study aims to examine the acceptability, feasibility, and preliminary effectiveness of GamblingLess: Curb Your Urge, the first smartphone app–delivered EMI that aims to prevent gambling episodes by reducing craving intensity in people seeking help for gambling problems. Methods: This study was a single-arm, 5-week acceptability and feasibility trial (1-week baseline and 4-week intervention periods) involving ecological momentary assessments (EMAs) delivered 3 times daily. The EMAs measured gambling episodes, cravings, and self-efficacy. Web-based evaluations at baseline, postintervention, and 1-month follow-up measured gambling outcomes (severity, cravings, frequency, expenditure, and self-efficacy) and the intervention’s perceived helpfulness, relevance, burden, satisfaction, and impact in relation to gambling cravings. Results: A total of 36 participants, of whom 22/36 (61%) were male and 34/36 (94%) were problem gamblers, completed the baseline measures, with 61% (22/36) completing the postintervention evaluation and 58% (21/36) completing the follow-up evaluation. The intervention was considered acceptable, as participants perceived all intervention content to be above average in helpfulness and the EMA to be highly relevant but somewhat burdensome. Participants reported that they were satisfied with the intervention and that the intervention improved their knowledge, attitudes, awareness, behavior change, intention to change, and help-seeking behavior for gambling cravings. Regarding the intervention’s feasibility, compliance rates for the EMA (51%) and EMI (15%) were low; however, the intervention was used 166 times, including 59 uses within 60 minutes of EMA completion and 107 on-demand uses. Regarding the intervention’s preliminary effectiveness, descriptive EMA data showed that, compared with the baseline period, 71% and 72% reductions in the average number of gambling episodes and craving occurrences were reported in the intervention period, respectively. In addition, clustered paired-sample two-tailed t tests revealed a significant 5.4% reduction in real-time craving intensity (P=.01) immediately after intervention use, which increased to 10.5% (P=.01), where use was recommended based on craving occurrence. At the group level, significant medium-to-large reductions were observed in mean gambling symptom severity (P=.01 and .003), cravings (P=.03 and .02), frequency (P=.01 and .004), and expenditure (P=.04 and .003) at postintervention and follow-up; moreover, increased mean gambling self-efficacy and craving self-efficacy (P=.01 and .01) were observed at postintervention and increased gambling self-efficacy (P=.04) was observed at follow-up. At the individual level, over a quarter of participants (6/22, 27% to 10/21, 48%) could be categorized as recovered or improved regarding their gambling symptom severity and cravings. Conclusions: The results support the acceptability, feasibility, and preliminary effectiveness of this app-delivered EMI for preventing gambling episodes through craving management in people with gambling problems, which has implications for extending the reach of evidence-based treatment to moments of vulnerability in people’s everyday lives. %M 33769294 %R 10.2196/25786 %U https://www.jmir.org/2021/3/e25786 %U https://doi.org/10.2196/25786 %U http://www.ncbi.nlm.nih.gov/pubmed/33769294 %0 Journal Article %@ 2368-7959 %I JMIR Publications %V 8 %N 3 %P e21115 %T The Moderating Role of Coping Mechanisms and Being an e-Sport Player Between Psychiatric Symptoms and Gaming Disorder: Online Survey %A Bányai,Fanni %A Zsila,Ágnes %A Kökönyei,Gyöngyi %A Griffiths,Mark D %A Demetrovics,Zsolt %A Király,Orsolya %+ Centre of Excellence in Responsible Gaming, University of Gibraltar, Europa Point Campus, Europa Point, Gibraltar, GX111AA, Gibraltar, 36 30 976 1097, zsolt.demetrovics@unigib.edu.gi %K gaming disorder %K esports %K professional gaming %K video games %K coping skills %K psychiatric symptoms %K psychiatry %K mental health %K gaming %D 2021 %7 23.3.2021 %9 Original Paper %J JMIR Ment Health %G English %X Background: The emerging popularity of playing video games (gaming) as a hobby and as a professional sport raises awareness about both the benefits and possible downsides of the activity. Although a healthy and passionate hobby for most, a minority of gamers experience addiction-like symptoms and are considered to have gaming disorder (GD). GD has previously been found to be related to aversive conditions, such as depression or anxiety, as well as putatively maladaptive coping strategies. Objective: The aim of this study is twofold: to explore the moderating effect of different coping strategies and type of video game usage (professional [e-sport] or recreational) on the relationship between psychiatric symptoms and GD. Methods: A sample of 3476 gamers (n=3133, 90.13% males; mean age 23.20, SD 6.48 years) was recruited via the website and social networking site of the most popular gaming magazine in Hungary (GameStar). Results: The main effect of psychiatric symptoms was moderate to large in all models, whereas the moderation effects were significant (P<.001) for 4 out of 8 coping strategies (ie, self-blame/self-distraction, denial, emotional/social support, and active coping). However, the explained variance of the models only increased negligibly (from 0.3% to 0.5%) owing to the moderation effect. The direction of the moderations was as expected (ie, putatively maladaptive strategies were associated with more GD symptoms when the level of psychiatric symptoms was high, while putatively adaptive strategies were associated with less). Furthermore, no considerable moderation effect of the player type (recreational vs professional players) was found on the association between psychiatric symptoms and GD (β=.04; P=.02; 0.1% change in the explained variance). Conclusions: Future studies should be designed to better understand coping-related mechanisms in the context of video gaming and GD. %M 33755024 %R 10.2196/21115 %U https://mental.jmir.org/2021/3/e21115 %U https://doi.org/10.2196/21115 %U http://www.ncbi.nlm.nih.gov/pubmed/33755024 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 23 %N 2 %P e22393 %T Awareness and Potential Impacts of the Medicalization of Internet Gaming Disorder: Cross-sectional Survey Among Adolescents in China %A Yu,Yanqiu %A Li,Ji-Bin %A Lau,Joseph T F %+ Center for Health Behaviours Research, Jockey Club School of Public Health and Primary Care, The Chinese University of Hong Kong, Prince Whales Hospital, Sha Tin, Hong Kong, Hong Kong, 852 22528727, jlau@cuhk.edu.hk %K gaming disorder %K ICD-11 %K high-risk subgroups %K disease awareness %K medicalization %K internet gaming %K awareness %K impact %K adolescent %K young adult %K China %K game %K disorder %K ICD %D 2021 %7 24.2.2021 %9 Original Paper %J J Med Internet Res %G English %X Background: The Eleventh Revision of International Classification of Diseases (ICD-11) newly listed gaming disorder, including internet gaming disorder (IGD), as a disease. The level of awareness and potential positive and negative impacts of this medicalization among adolescents were unknown. Objective: This study investigated the levels, associated factors, and potential positive and negative impacts of awareness of the medicalization of IGD among adolescents in China. Methods: In a cross-sectional survey, 1343 middle school students in Guangzhou, China, self-administered an anonymous questionnaire in classrooms (October to December 2019). Three risk subgroups were identified: those who scored ≥5 items in the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition checklist (IGD-S), those who self-perceived having IGD currently (IGD-PC), and those who self-perceived having IGD within 12 months (IGD-P12M). Results: Of the internet gamers, 48.3% (460/952) were aware of the medicalization of IGD; they were more likely to belong to the IGD-P12M/IGD-S risk subgroups. Within the IGD-PC/IGD-P12M (but not IGD-S) risk subgroups, IGD medicalization awareness was positively associated with favorable outcomes (reduced internet gaming time in the past 12 months, seeking help from professionals if having IGD, and fewer maladaptive cognitions). After being briefed about the ICD-11 inclusion of IGD, 54.2% (516/952) and 32.8% (312/952) expressed that it would lead to the reduction of gaming time and help-seeking behaviors, respectively; however, 17.9% (170/952), 21.5% (205/952), 15.9% (151/952), and 14.5% (138/952) perceived self-doubt for being diseased, stronger pressure from family members, negative emotional responses, and labeling effect, respectively. With a few exceptions, such perceived positive or negative impacts were stronger among the IGD-S, IGD-PC, and IGD-P12M risk subgroups. Conclusions: The exploratory study shows that the medicalization of IGD may have benefits that need maximization and potentially harmful effects that need minimization. Future studies should test the efficacies of health promotion that increases IGD medicalization awareness. %M 33625362 %R 10.2196/22393 %U https://www.jmir.org/2021/2/e22393 %U https://doi.org/10.2196/22393 %U http://www.ncbi.nlm.nih.gov/pubmed/33625362 %0 Journal Article %@ 2561-6722 %I JMIR Publications %V 4 %N 1 %P e24988 %T Factors Contributing to Adolescents’ and Young Adults’ Participation in Web-Based Challenges: Survey Study %A Khasawneh,Amro %A Chalil Madathil,Kapil %A Zinzow,Heidi %A Rosopa,Patrick %A Natarajan,Gitanjali %A Achuthan,Krishnashree %A Narasimhan,Meera %+ Department of Anesthesiology and Critical Care, Johns Hopkins University, 750 E Pratt St, 15th Fl, Baltimore, MD, 21202, United States, 1 607 245 9600, akhasaw1@jhmi.edu %K web-based challenges %K self-injurious behavior %K behavior %K integrated behavioral model %K social media %K challenge %K adolescent %K young adult %K participation %K survey %D 2021 %7 17.2.2021 %9 Original Paper %J JMIR Pediatr Parent %G English %X Background: Web-based challenges, phenomena that are familiar to adolescents and young adults who spend large amounts of time on social media, range from minimally harmful behaviors intended to support philanthropic endeavors to significantly harmful behaviors that may culminate in injury or death. Objective: This study aims to investigate the beliefs that lead adolescents and young adults to participate in these activities by analyzing the amyotrophic lateral sclerosis (ALS) ice bucket challenge, representing nonharmful behaviors associated with web-based challenges, and the cinnamon challenge, representing web-based challenges that lead to harmful behaviors. Methods: A retrospective quantitative study was conducted with a total of 471 participants aged between 13 and 35 years who either had participated in the ALS ice bucket challenge or the cinnamon challenge, or had never participated in any web-based challenge. Binomial logistic regression models were used to classify those who participated in the ALS ice bucket challenge or cinnamon challenge versus those who did not engage in either challenge using the integrated behavioral model’s beliefs as predictors. Results: The findings showed that participants of both the cinnamon challenge and the ALS ice bucket challenge had significantly greater expectations from the public to participate in the challenge they completed in comparison with individuals who never participated in any challenge (P=.01 for the cinnamon challenge and P=.003 for the ALS ice bucket challenge). Cinnamon challenge participants had greater value for the outcomes of the challenge (P<.001) and perceived positive public opinion about the challenge (P<.001), in comparison with individuals who never participated in any challenge. In contrast, ALS ice bucket challenge participants had significantly greater positive emotional responses than individuals who never participated in any challenge (P<.001). Conclusions: The constructs that contribute to the spread of web-based challenges vary based on the level of self-harm involved in the challenge and its purpose. Intervention efforts could be tailored to address the beliefs associated with different types of web-based challenges. %M 33595450 %R 10.2196/24988 %U http://pediatrics.jmir.org/2021/1/e24988/ %U https://doi.org/10.2196/24988 %U http://www.ncbi.nlm.nih.gov/pubmed/33595450 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 23 %N 2 %P e22694 %T Identification of Behavior Change Techniques From Successful Web-Based Interventions Targeting Alcohol Consumption, Binge Eating, and Gambling: Systematic Review %A Humphreys,Gabrielle %A Evans,Rebecca %A Makin,Harriet %A Cooke,Richard %A Jones,Andrew %+ School of Psychology, University of Liverpool, Eleanor Rathbone Building, L69 7ZT, Liverpool, United Kingdom, 44 07311550101, gabrielle.humphreys@liverpool.ac.uk %K systematic review %K web-based intervention %K behavior and behavior mechanism %K behavior change technique %K alcohol consumption %K binge eating %K gambling %D 2021 %7 9.2.2021 %9 Review %J J Med Internet Res %G English %X Background: Web-based interventions are thought to overcome barriers to treatment, such as accessibility and geographical location, which can undermine the effectiveness of traditional face-to-face interventions. Owing to these features, researchers are increasingly testing the efficacy of web-based interventions as ways to reduce alcohol misuse, binge eating, and gambling. However, many web-based interventions have poorly defined mechanisms of action; therefore, it is often uncertain how they propose to bring about behavior change. Objective: This systematic review aims to identify effective behavior change techniques (BCTs) present in web-based interventions aimed at reducing alcohol consumption, binge eating, or gambling. Methods: This systematic review covered research conducted in the last 20 years. Inclusion criteria for interventions were web-based administration; targeting alcohol use, binge eating, and/or gambling; and reporting on baseline and postintervention measures of behavior. The PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-analyses) guidelines were followed. We coded intervention effectiveness, study quality, and BCTs present in the interventions. Results: Following removal of 4152 ineligible articles, 45 were included in the review: 32 (71%) targeted alcohol misuse, 6 (13%) targeted binge eating, and 7 (16%) targeted gambling. In total, 5 frequency counts were performed to identify the most commonly used BCTs: all studies, effective interventions, high-quality studies at 2 thresholds, and both high quality and effective studies. The results obtained from this were integrated to identify 7 BCTs. These 7 BCTs were problem solving, feedback on behavior, self-monitoring of behavior, self-monitoring of outcomes, instruction on how to perform a behavior, information about social and health consequences, and social comparison. A total of 4 BCTs were found in all frequency counts: feedback on behavior, self-monitoring of behavior, instruction on how to perform a behavior, and social comparison. Self-monitoring of outcomes of behavior was found in 3 of the 5 frequency counts, problem solving was found in 2 frequency counts, and information about social and health consequences was found in 1 frequency count. Conclusions: This systematic review identified 7 of the most frequently used BCTs used in web-based interventions focused on alcohol misuse, binge eating, and gambling. These results can inform the development of evidence-based eHealth interventions that have the potential to lead to effective, positive behavior changes in all 3 areas. %M 33560243 %R 10.2196/22694 %U http://www.jmir.org/2021/2/e22694/ %U https://doi.org/10.2196/22694 %U http://www.ncbi.nlm.nih.gov/pubmed/33560243 %0 Journal Article %@ 2291-9279 %I JMIR Publications %V 9 %N 1 %P e23886 %T Adolescent Problem Gaming and Loot Box Purchasing in Video Games: Cross-sectional Observational Study Using Population-Based Cohort Data %A Ide,Soichiro %A Nakanishi,Miharu %A Yamasaki,Syudo %A Ikeda,Kazutaka %A Ando,Shuntaro %A Hiraiwa-Hasegawa,Mariko %A Kasai,Kiyoto %A Nishida,Atsushi %+ Research Center for Social Science & Medicine, Tokyo Metropolitan Institute of Medical Science, 2-1-6 Kamikitazawa, Setagaya-ku, Tokyo, 156-8506, Japan, 81 3 5316 2298, nishida-at@igakuken.or.jp %K loot box purchasing %K gambling %K adolescents %K primary caregivers %D 2021 %7 9.2.2021 %9 Short Paper %J JMIR Serious Games %G English %X Background: Video game loot boxes, which can typically be purchased by players or are given as reward, contain random virtual items, or loot, ranging from simple customization options for a player's avatar or character, to game-changing equipment such as weapons and armor. Loot boxes have drawn concern, as purchasing loot boxes might lead to the development of problematic gambling for adolescents. Although parental problem gambling is associated with adolescent problem gambling, no studies have evaluated the prevalence of loot box purchases in adolescents’ parents. Objective: This study investigated the association between loot box purchasing among adolescents and parents, and problem online gaming in population-based samples. Methods: In total, 1615 adolescent (aged 14 years) gamers from Japan responded to a questionnaire regarding their loot box purchasing and problem online gaming behaviors. Problem online gaming was defined as four or more of the nine addictive behaviors from the Diagnostic and Statistical Manual of Mental Disorders. The adolescents’ primary caregivers were asked about their loot box purchasing. Results: Of the 1615 participants, 57 (3.5%) reported loot box purchasing. This prevalence did not differ according to primary caregivers’ loot box purchasing, but adolescents who purchased loot boxes were significantly more likely to exhibit problem online gaming (odds ratio 3.75, 95% CI 2.17-6.48). Conclusions: Adolescent loot box purchasing is linked to problem online gaming, but not with parents’ loot box purchasing. Measures to reduce these behaviors should target reducing addictive symptoms in young video gamers. %M 33560241 %R 10.2196/23886 %U http://games.jmir.org/2021/1/e23886/ %U https://doi.org/10.2196/23886 %U http://www.ncbi.nlm.nih.gov/pubmed/33560241 %0 Journal Article %@ 2291-9279 %I JMIR Publications %V 9 %N 1 %P e22494 %T Managing Game-Related Conflict With Parents of Young Adults With Internet Gaming Disorder: Development and Feasibility Study of a Virtual Reality App %A Shin,Yu-Bin %A Kim,Jae-Jin %A Kim,Hyunji %A Kim,Soo-Jeong %A Eom,Hyojung %A Jung,Young Hoon %A Kim,Eunjoo %+ Department of Psychiatry, Gangnam Severance Hospital, Yonsei University College of Medicine, Eonju-ro 211, Gangnam-gu, Seoul, 06273, Republic of Korea, 82 2 2019 3340, ejkim96@yuhs.ac %K internet gaming disorder %K family conflict %K coping behavior %K virtual reality %D 2021 %7 18.1.2021 %9 Original Paper %J JMIR Serious Games %G English %X Background: Individuals with internet gaming disorder (IGD) report facing family conflicts repeatedly because of their excessive internet gaming. With recent advancements in virtual reality (VR) technology, VR therapy has emerged as a promising method for the management of various psychiatric disorders, including IGD. Given that several risk and protective factors for young people with addiction can be influenced by their interpersonal context, the potential utility of VR-based apps for managing family conflicts needs to be examined with reference to IGD management. However, few studies have evaluated potential treatment modules related to interpersonal conflict management, such as emotion regulation and taking the perspective of others. Objective: This preliminary study aims to examine the potential use of a VR-based app in the management of game-related conflicts with parents of young adults with IGD and matched controls. Methods: In total, 50 young male adults (24 with IGD and 26 controls) were recruited to participate in the study. We developed a virtual room where game-related family conflicts arise. Using this room, participants completed 2 VR tasks that required them to express anger and then implement coping skills (ie, risk/benefit assessment of stopping a game and taking parents’ perspective) to deal with negative emotions in interpersonal conflict situations and to decrease one’s gaming behavior. Results: The results showed that immersion in our VR app tended to provoke negative emotions in individuals with IGD. In addition, after a risk/benefit assessment of stopping a game, the response of stopping a game immediately increased significantly in the IGD group, suggesting that patients’ gaming behavior could be changed using our VR program. Furthermore, in individuals with IGD, longer gaming hours were associated with a lower level of perceived usefulness of the coping skills training. Conclusions: The findings of this study indicate that our VR app may be useful for implementing more desirable behaviors and managing gaming-related family conflicts in individuals with IGD. Our VR app may offer an alternative for individuals with IGD to learn how a vicious cycle of conflicts is developed and to easily and safely assess their dysfunctional thoughts behind the conflicts (ie, perceived unreasonable risks of stopping a game and thoughts acting as a barrier to taking the perspective of others). %M 33459603 %R 10.2196/22494 %U http://games.jmir.org/2021/1/e22494/ %U https://doi.org/10.2196/22494 %U http://www.ncbi.nlm.nih.gov/pubmed/33459603 %0 Journal Article %@ 2368-7959 %I JMIR Publications %V 7 %N 12 %P e17341 %T Associations Among Internet Addiction, Genetic Polymorphisms, Family Functioning, and Psychopathological Risk: Cross-Sectional Exploratory Study %A Cerniglia,Luca %A Cimino,Silvia %A Marzilli,Eleonora %A Pascale,Esterina %A Tambelli,Renata %+ International Telematic University Uninettuno, Corso Vittorio Emanuele II, 39, Rome, 00186, Italy, 39 06679201, l.cerniglia@uninettunouniversity.net %K internet addiction %K mobile phones %K family functioning %K depression %K anxiety %K avoidant personality %K MAO-A %K 5-HTTPR %K DRD4 %K DAT1 %D 2020 %7 24.12.2020 %9 Original Paper %J JMIR Ment Health %G English %X Background: International research has emphasized that youths are at higher risk for the onset of internet addiction (IA), but studies investigating biological, psychological, and social factors associated with this condition are limited. Objective: This study aims to investigate the possible association between IA and genetic polymorphisms in monoamine oxidase A (MAO-A), serotonin-transporter (5-HTTPR), dopamine receptor (DRD4), and dopamine transporter (DAT1) genes by considering the role played by the perception of young adults in their family functioning and their depression, anxiety, and avoidant personality problems. Methods: In a sample of 104 male and female young adults aged between 19 and 23 years (mean age 21.87, SD 2.29 years) recruited from universities in the central southern part of Italy, we addressed the presence of IA using the Young criteria of the IA test. Moreover, the perception of young adults of their family functioning and their psychopathological symptoms were assessed through the Family Assessment Device (FAD) and the Adult Self-Report, respectively. Results: We found no significant association between IA and any genetic polymorphisms, neither among males or females. Young adults with IA reported significantly higher scores in the subscale of FAD affective responsiveness (AR; P=.01) and in depressive problems (P=.02), anxiety problems (P=.009), and avoidant personality problems (P=.003) than those in the control group. Results of mediation analyses showed a mediation role played by depressive symptoms (B=0.99; 95% CI 0.22 to 1.97) and avoidant personality problems (B=1.09; 95% CI 0.32 to 2.05) of young adults on the relationship between the FAD, AR, and IA. Finally, this relationship was moderated by the genotype of the 5-HTTLPR (P<.001), DAT1 (P<.001), and MAO-A (P<.001) genes in young adults. Conclusions: This exploratory study supports the recent evidence on the mutual relationship among biological, individual, and social risk factors associated with IA in young adulthood. Our findings may have important clinical implications for the development of prevention and treatment programs. %M 33361057 %R 10.2196/17341 %U http://mental.jmir.org/2020/12/e17341/ %U https://doi.org/10.2196/17341 %U http://www.ncbi.nlm.nih.gov/pubmed/33361057 %0 Journal Article %@ 2291-9279 %I JMIR Publications %V 8 %N 4 %P e18473 %T Choice of Leisure Activities by Adolescents and Adults With Internet Gaming Disorder: Development and Feasibility Study of a Virtual Reality Program %A Lee,Narae %A Kim,Jae-Jin %A Shin,Yu-Bin %A Eom,Hyojung %A Kim,Min-Kyeong %A Kyeong,Sunghyon %A Jung,Young Hoon %A Min,Sarang %A Kwon,Joon Hee %A Kim,Eunjoo %+ Department of Psychiatry, Yonsei University Gangnam Severance Hospital, Eonju-ro 211, Gangnam-gu, Seoul, 06273, Republic of Korea, 82 2 2019 3345, ejkim96@yuhs.ac %K virtual reality %K VR %K internet game disorder %K IGD %K cognitive behavioral therapy %K CBT %K motivation %D 2020 %7 11.12.2020 %9 Original Paper %J JMIR Serious Games %G English %X Background: Excessive internet game use frequently leads to various physical, psychological, and social problems, and internet gaming disorder (IGD) has become a serious public health issue worldwide. Recently, virtual reality (VR) therapy has emerged as a promising method to increase psychological treatment motivation and accessibility. However, few studies have examined the potential of VR technology for the management of IGD, and VR content tailored to IGD characteristics remains scarce. Objective: This preliminary study aimed to examine the potential of a VR-based program that was designed to help users identify their leisure time use patterns, especially those related to gaming, and to modify their gaming overuse by alternative activities provided in the VR content. Moreover, to investigate whether users’ VR activities reflect various clinical variables of IGD in youth, we examined the relationships among the leisure time activity selection pattern, built-in response, and speech data obtained from the VR program, as well as symptom severity of internet gaming, psychiatric comorbidities, and motivation of participants reported through relevant questionnaire data. Methods: Three types of VR content (understanding my daily activities at home, finding an alternative activity to internet gaming at home, expressing contradictory opinions toward a friend’s gaming beliefs) were developed by simulating the daily situations in which patients with IGD can select alternative free-time leisure activities. We examined internet addiction, mental health problems, and motivation for 23 IGD and 29 control participants. Behavioral and self-rated responses from VR, such as alternative activity selection data and speech patterns (speech time, speech satisfaction, and speech accordance), and results from various questionnaires were compared between groups. The correlations between IGD behaviors in VR and real-life behaviors assessed by questionnaire measures were analyzed. Results: Significant correlations were found between internet gaming behavior and user activity data, such as speech and activity selection pattern, in our VR program. Our results showed that the IGD group had fewer leisure activities and preferred game or digital activities to other types of activities compared to controls, even in VR. There was a positive relationship between the viability of alternative leisure activities the participants selected in VR and the amount of perceived satisfaction from that activity (r=.748, P<.001). Speech accordance in the IGD group was lower than in the control group and was correlated negatively with Internet Addiction Test and Internet Addiction Test–gaming scores (r=.300, P=.03) but positively with users’ motivation (r=.312, P=.02). Conclusions: The results from our VR program can provide information about daily activity patterns of youths with IGD and the relationship between user VR activities and IGD symptoms, which can be useful in applying VR technology to IGD management. %M 33306033 %R 10.2196/18473 %U http://games.jmir.org/2020/4/e18473/ %U https://doi.org/10.2196/18473 %U http://www.ncbi.nlm.nih.gov/pubmed/33306033 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 8 %N 9 %P e18505 %T Excessive Smartphone Use and Self-Esteem Among Adults With Internet Gaming Disorder: Quantitative Survey Study %A Kim,Hyunmin %A Choi,In Young %A Kim,Dai-Jin %+ Department of Medical Informatics, College of Medicine, The Catholic University of Korea, Seoul St. Mary's Hospital, 222 Banpo-daero, Seocho-gu, Seoul, Republic of Korea, 82 2258 7870, iychoi@catholic.ac.kr %K excessive smartphone use %K internet gaming disorder %K smartphone overuse %K self-esteem %K mental health %K gender difference %K Korean smartphone addiction proneness scale %K smartphone %K gaming %K young adult %K adult %K gender %D 2020 %7 29.9.2020 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Smartphone overuse can harm individual health and well-being. Although several studies have explored the relationship between problematic or excessive smartphone use and mental health, much less is known about effects on self-esteem, which is essential in having a healthy life, among adults with mental health disorders, including internet gaming disorder. Furthermore, given that smartphone usage differs by gender, little is known about gender differences in the relationship between smartphone overuse and self-esteem. Objective: The objective of this study was to assess self-esteem among individuals with mental health disorders and explore the relationship with excessive smartphone use. Methods: Participants were selected based on their responses to the internet gaming disorder assessment, which includes 9 items developed based on Diagnostic and Statistical Manual of Mental Disorders (Fifth Edition) criteria, from among a Korean cohort of smartphone users aged 20-40 years, resulting in a sample of 189 participants (men:120, women: 69). The Rosenberg self-esteem scale and the Korean smartphone addiction proneness scale were utilized to assess the outcome self-esteem with excessive smartphone use as the primary independent variable. Guided by the Bowlby attachment theory and prior studies, we selected several covariates. Generalized linear regression analyses, as well as subgroup analyses by gender, were performed. Results: Among adults with internet gaming disorder, the average Korean smartphone addiction proneness scale score was significantly higher in women than that in men (41.30 vs. 37.94; P=.001), and excessive smartphone use was significantly more prevalent in women than it was in men (30.43% vs. 20.83%; P=.02). Our findings from the generalized linear regression analyses indicated that an increase in Korean smartphone addiction proneness scale score had a negative relationship with self-esteem among those with internet gaming disorder (β=–0.18, P=.001). Furthermore, our interaction models showed that, among those with internet gaming disorder, more men than women had lower self-esteem associated with an increase in Korean smartphone addiction proneness scale score and a high degree of smartphone overuse (β=–0.19, P=.004; β=–3.73, P<.001). Conclusions: Excessive smartphone use was found to be adversely associated with self-esteem among young and middle-aged adults with internet gaming disorder; notably, more men than women were negatively influenced (regarding self-esteem) by smartphone overuse. Based on our findings, more efforts should be made to reduce excessive or problematic smartphone use by considering developing public health interventions or policy, particularly among those with mental health disorders such as internet gaming disorder. %M 32990637 %R 10.2196/18505 %U https://mhealth.jmir.org/2020/9/e18505 %U https://doi.org/10.2196/18505 %U http://www.ncbi.nlm.nih.gov/pubmed/32990637 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 22 %N 8 %P e17675 %T Modeling Early Gambling Behavior Using Indicators from Online Lottery Gambling Tracking Data: Longitudinal Analysis %A Challet-Bouju,Gaëlle %A Hardouin,Jean-Benoit %A Thiabaud,Elsa %A Saillard,Anaïs %A Donnio,Yann %A Grall-Bronnec,Marie %A Perrot,Bastien %+ Addictology and Psychiatry Department, Centre Hospitalier Universitaire de Nantes, Hôpital Saint Jacques, 85 rue Saint Jacques, Nantes, 44093, France, 33 253482532, gaelle.bouju@chu-nantes.fr %K gambling %K internet %K trajectory %K latent class analysis %K growth mixture modeling %K gambling tracking data %K early detection %D 2020 %7 12.8.2020 %9 Original Paper %J J Med Internet Res %G English %X Background: Individuals who gamble online may be at risk of gambling excessively, but internet gambling also provides a unique opportunity to monitor gambling behavior in real environments which may allow intervention for those who encounter difficulties. Objective: The objective of this study was to model the early gambling trajectories of individuals who play online lottery. Methods: Anonymized gambling‐related records of the initial 6 months of 1152 clients of the French national lottery who created their internet gambling accounts between September 2015 and February 2016 were analyzed using a two-step approach that combined growth mixture modeling and latent class analysis. The analysis was based upon behavior indicators of gambling activity (money wagered and number of gambling days) and indicators of gambling problems (breadth of involvement and chasing). Profiles were described based upon the probabilities of following the trajectories that were identified for the four indicators, and upon several covariates (age, gender, deposits, type of play, net losses, voluntary self-exclusion, and Playscan classification—a responsible gambling tool that provides each player with a risk assessment: green for low risk, orange for medium risk and red for high risk). Net losses, voluntary self-exclusion, and Playscan classification were used as external verification of problem gambling. Results: We identified 5 distinct profiles of online lottery gambling. Classes 1 (56.8%), 2 (14.8%) and 3 (13.9%) were characterized by low to medium gambling activity and low values for markers of problem gambling. They displayed low net losses, did not use the voluntary self-exclusion measure, and were classified predominantly with green Playscan tags (range 90%-98%). Class 4 (9.7%) was characterized by medium to high gambling activity, played a higher breadth of game types (range 1-6), and had zero to few chasing episodes. They had high net losses but were classified with green (66%) or orange (25%) Playscan tags and did not use the voluntary self-exclusion measure. Class 5 (4.8%) was characterized by medium to very high gambling activity, played a higher breadth of game types (range 1-17), and had a high number of chasing episodes (range 0-5). They experienced the highest net losses, the highest proportion of orange (32%) and red (39%) tags within the Playscan classification system and represented the only class in which voluntary self-exclusion was present. Conclusions: Classes 1, 2, 3 may be considered to represent recreational gambling. Class 4 had higher gambling activity and higher breadth of involvement and may be representative of players at risk for future gambling problems. Class 5 stood out in terms of much higher gambling activity and breadth of involvement, and the presence of chasing behavior. Individuals in classes 4 and 5 may benefit from early preventive measures. %M 32254041 %R 10.2196/17675 %U http://www.jmir.org/2020/8/e17675/ %U https://doi.org/10.2196/17675 %U http://www.ncbi.nlm.nih.gov/pubmed/32254041 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 22 %N 8 %P e17560 %T Associations of Internet Addiction Severity With Psychopathology, Serious Mental Illness, and Suicidality: Large-Sample Cross-Sectional Study %A Guo,Wanjun %A Tao,Yujie %A Li,Xiaojing %A Lin,Xia %A Meng,Yajing %A Yang,Xia %A Wang,Huiyao %A Zhang,Yamin %A Tang,Wanjie %A Wang,Qiang %A Deng,Wei %A Zhao,Liansheng %A Ma,Xiaohong %A Li,Mingli %A Chen,Ting %A Xu,Jiajun %A Li,Jing %A Hao,Wei %A Lee,Sing %A Coid,Jeremy W %A Greenshaw,Andrew J %A Li,Tao %+ Mental Health Center and Psychiatric Laboratory, State Key Laboratory of Biotherapy, West China Hospital of Sichuan University, 28 Dianxin South Street, Chengdu, Sichuan, China, 86 18980601817, xuntao26@hotmail.com %K internet %K addiction %K psychopathology %K suicidality %K serious mental illness %D 2020 %7 11.8.2020 %9 Original Paper %J J Med Internet Res %G English %X 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. %M 32780029 %R 10.2196/17560 %U https://www.jmir.org/2020/8/e17560 %U https://doi.org/10.2196/17560 %U http://www.ncbi.nlm.nih.gov/pubmed/32780029 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 22 %N 7 %P e17996 %T The Cyclic Value-Context Reinforcement Model of Problematic Internet Use: Empirical Validation Using a Thematic Analysis of Children’s Counseling Data %A Doh,Young Yim %A Kim,Bugeun %A Lee,Seul %A Gweon,Gahgene %+ Graduate School of Convergence Science and Technology, Seoul National University, 1 Gwanakro, Seoul, Republic of Korea, 82 318889172, ggweon@snu.ac.kr %K problematic internet use %K children %K cyclic value context reinforcement model %K psychosocial value %K environmental context %K internet utility %D 2020 %7 14.7.2020 %9 Original Paper %J J Med Internet Res %G English %X Background: Research on problematic internet use has focused on devising diagnostic criteria or describing the factors that influence internet overuse. However, a paradigm shift is necessary in studying the phenomenon of increased internet use not just from a pathological point of view but also from a developmental point of view that considers children’s behavior of adapting to a technology-oriented society. Objective: In this paper, we propose the Cyclic Value-Context Reinforcement Model (CVCRM) to understand problematic internet use behavior. The purpose of our study was to construct a developmental process model that provides a holistic understanding of problematic internet use behavior of children and to empirically validate the proposed model by conducting a thematic analysis on actual counseling data. Methods: To validate the CVCRM, we conducted thematic analysis using the counseling data from 312 Korean children aged 7-18 years. For the coding process, 7 master’s and doctoral student researchers participated as coders, and 2 professors supervised the coding process and results. Results: This project was funded from October 2015 to September 2019 to analyze counseling data from 312 children who participated in counseling sessions during January 2012 to May 2014. Based on the data analysis, we present the CVCRM, which integrates existing theoretical approaches and encompasses the 3 interacting aspects that induce and reinforce problematic internet use in children: psychosocial value, environmental context, and internet utility. Specifically, using counseling data, we empirically ascertained that problematic internet use behavior feeds into children’s psychosocial values and environmental contexts, which in turn facilitates problematic internet use in a cyclical manner. Conclusions: Through this empirical validation, the CVCRM can provide a theoretical framework and an integrated perspective on the developmental mechanism of problematic internet use behavior of children. %M 32460233 %R 10.2196/17996 %U https://www.jmir.org/2020/7/e17996 %U https://doi.org/10.2196/17996 %U http://www.ncbi.nlm.nih.gov/pubmed/32460233 %0 Journal Article %@ 2368-7959 %I JMIR Publications %V 7 %N 6 %P e15403 %T Associations of Electronic Device Use Before and After Sleep With Psychological Distress Among Chinese Adults in Hong Kong: Cross-Sectional Study %A Lee,Jung Jae %A Wang,Man Ping %A Luk,Tzu Tsun %A Guo,Ningyuan %A Chan,Sophia Siu-Chee %A Lam,Tai Hing %+ School of Nursing, University of Hong Kong, 4/F William MW Mong Block Building,, 21 Sassoon Rd, Pokfulam,, Hong Kong, , China (Hong Kong), 852 3917 6636, mpwang@hku.hk %K addictive behavior %K anxiety %K computers %K depression %K devices %K internet %K smartphone %K withdrawal symptoms %D 2020 %7 11.6.2020 %9 Original Paper %J JMIR Ment Health %G English %X Background: Hong Kong has a high rate of electronic device (e-device; computer, smartphone, and tablet) use. However, little is known about the associations of the duration of e-device use before and after sleep with psychological symptoms. Objective: This study aimed to investigate the associations of the duration of e-device use before and after sleep with psychological distress. Methods: A probability-based telephone survey was conducted on 3162 Hong Kong adults (54.6% female; mean age 47.4 years, SD 18.3 years) in 2016. Multivariate linear and Poisson regressions were used to calculate adjusted regression coefficients (aBs) and prevalence ratios (aPRs) of anxiety and depressive symptoms (measured by Patient Health Questionnaire-4) for the duration from waking to the first e-device use (≥61, 31-60, 6-30, and ≤5 minutes) and the duration of e-device use before sleeping (≤5, 6-30, 31-60, and ≥61 minutes). Results: The first e-device use in ≤5 (vs ≥61) minutes after waking was associated with anxiety (aB 0.35, 95% CI 0.24-0.46; aPR 1.74, 95% CI 1.34-2.25) and depressive symptoms (aB 0.27, 95% CI 0.18-0.37; aPR 1.84, 95% CI 1.33-2.54). Using e-devices for ≥61 (vs ≤5) minutes before sleeping was also associated with anxiety (aB 0.17, 95% CI 0.04-0.31; aPR 1.32, 95% CI 1.01-1.73) and depressive symptoms (aB 0.17, 95% CI 0.05-0.28; aPR 1.47, 95% CI 1.07-2.02). E-device use both ≤5 minutes after waking and for ≥61 minutes before sleeping was strongly associated with anxiety (aB 0.68, 95% CI 0.47-0.90; aPR 2.64, 95% CI 1.90-3.67) and depressive symptoms (aB 0.55, 95% CI 0.36-0.74; aPR 2.56, 95% CI 1.69-3.88). Conclusions: E-device use immediately (≤5 minutes) after waking and use for a long duration (≥61 minutes) before sleeping were associated with anxiety and depressive symptoms among Chinese adults in Hong Kong. %M 32525489 %R 10.2196/15403 %U http://mental.jmir.org/2020/6/e15403/ %U https://doi.org/10.2196/15403 %U http://www.ncbi.nlm.nih.gov/pubmed/32525489 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 22 %N 5 %P e16210 %T Mediating Effect of Internet Addiction on the Relationship Between Individualism and Cyberbullying: Cross-Sectional Questionnaire Study %A Arpaci,Ibrahim %A Abdeljawad,Thabet %A Baloğlu,Mustafa %A Kesici,Şahin %A Mahariq,Ibrahim %+ Department of Computer Education and Instructional Technology, Tokat Gaziosmanpasa University, Faculty of Education, Tokat, 60250, Turkey, 90 356 252 16 16, ibrahimarpaci@gmail.com %K vertical individualism %K horizontal individualism %K cyberbullying %K internet addiction %D 2020 %7 28.5.2020 %9 Original Paper %J J Med Internet Res %G English %X Background: Among a variety of dynamics that may have effects on internet-related behaviors, cultural orientation is particularly important. Previous studies suggest that individualism is a strong determinant of certain behaviors. In addition, findings suggest that vertical individualism may lead to the development of more tolerance for addiction and aggression on the internet. Objective: This study aimed to investigate whether vertical individualism has significant positive effects on cyberbullying and internet addiction and whether horizontal individualism has significant negative effects on cyberbullying and internet addiction. A theoretical model was specified to test the relationships among vertical versus horizontal individualism, cyberbullying, and internet addiction. Methods: A total of 665 college students were selected using a convenience sampling method and willingly participated in the study. Participants’ ages ranged from 17 to 19 years (mean 17.94 years, SD 1.12 years). Of the group, 462 were women (462/665, 69.5%), and 203 were men (203/665, 30.5%). Study majors represented were mathematics (113/665, 17%), sciences (102/665, 15.3%), instructional technology (99/665, 14.9%), psychology (98/665, 14.7%), and others (253/665, 38.1%). Self-report instruments were used to measure vertical/horizontal individualism, cyberbullying, and internet addiction. Results: Results show a significant positive effect of vertical individualism (effect size 0.10) and significant negative effect of horizontal individualism (effect size –0.12) on cyberbullying. In addition, the direct effect of vertical individualism on internet addiction was significant (effect size 0.28), but the direct effect of horizontal individualism was not (effect size –0.05). Internet addiction had a significant direct effect on cyberbullying (effect size 0.39) as well as an intervening effect on the relationship between vertical individualism and cyberbullying. Results also indicate significant gender differences in cultural patterns and internet addiction. Conclusions: The findings suggest that horizontal and vertical individualism have significant effects on internet addiction. The findings also suggest that vertical individualists are more vulnerable to internet addiction. Further, the findings indicate a significant relationship between internet addiction and cyberbullying. %M 32463369 %R 10.2196/16210 %U http://www.jmir.org/2020/5/e16210/ %U https://doi.org/10.2196/16210 %U http://www.ncbi.nlm.nih.gov/pubmed/32463369 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 4 %N 5 %P e13388 %T Characteristics of Gamblers Who Use the French National Problem Gambling Helpline and Real-Time Chat Facility: Longitudinal Observational Study %A Darbeda,Stéphane %A Aubin,Henri-Jean %A Lejoyeux,Michel %A Luquiens,Amandine %+ Addiction Science, Paris Sud University, CESP Inserm UMR-1018, 16 Avenue Paul Vaillant Couturier, Villejuif, 94800, France, 33 145595037, stephane.darbeda@gmail.com %K gambling %K helpline %K chat %K counseling %K gender %K time-series analysis %D 2020 %7 20.5.2020 %9 Original Paper %J JMIR Form Res %G English %X Background: Problem gambling is a growing public health issue that is characterized by low rates of face-to-face help seeking. Helplines and real-time chat services could reduce shortfalls in treatment. Objective: This study aimed to (1) describe the characteristics of gamblers contacting a government-funded help service, (2) study the evolution of their characteristics over time, (3) evaluate the differences between subgroups (ie, gender, media used for gambling, and media used to contact the service), and (4) explore factors influencing referral to care. Methods: From January 2011 to December 2015, a government-funded gambling helpline and real-time chat website in France received 9474 contacts from gamblers. Counselors filled in a form for each contact, collecting demographics, gambling characteristics, and referrals. Time-series analyses were performed. Univariate logistic models were used to assess differences across subgroups. A multivariate analysis was conducted to determine the variables related to an actual referral. Results: Gamblers were predominantly men (7017/9474, 74.07%); the average age was 41 years (SD 14). Compared with the men, the women were older (mean 50.7 years, SD 14.0 vs mean 37.9 years, SD 13.0, respectively; P<.001), were more often solely offline gamblers (1922/2457, 78.23% vs 4386/7017, 62.51%, respectively; P<.001), and had different gambling patterns. Compared with helpline contacts, real-time chat contacts were more often men (124/150, 82.7% vs 3643/4881, 74.64%, respectively; P=.04), younger (mean 32.8 years, SD 12.9 vs mean 41.3 years, SD 14.3, respectively; P<.001), more often poker gamblers (41/150, 27.3% vs 592/4881, 12.13%, respectively; P<.001), and more often web-based gamblers (83/150, 55.3% vs 1462/4881, 29.95%, respectively; P<.001). Referral was positively associated with betting (adjusted odds ratio [aOR] 1.46, 95% CI 1.27-1.67; P<.001), casino gambling (aOR 1.38, 95% CI 1.21-1.57; P<.001), scratch cards (aOR 1.83, 95% CI 1.58-2.12; P<.001), poker gambling (aOR 1.35, 95% CI 1.14-1.61; P<.001), lottery (aOR 1.27, 95% CI 1.03-1.56; P=.03), weekly gambling (aOR 1.73, 95% CI 1.40-2.15; P<.001), request for referral (aOR 17.76, 95% CI 14.92-21.13; P<.001), and a history of suicide attempts (aOR 2.13, 95% CI 1.51-3.02; P<.001), and it was negatively associated with web-based gambling (aOR 0.86, 95% CI 0.75-0.98; P=.030) and refusal to be referred (aOR 0.35, 95% CI 0.26-0.49; P<.001). Conclusions: The governmental helpline and chat contacts included a broad range of sociodemographic profiles. Compared with the helpline, real-time chat exchanges reached a younger population of web-based gamblers, which was the target population. The development of the gambling helpline and help online website is a considerable challenge for the future. %M 32432554 %R 10.2196/13388 %U http://formative.jmir.org/2020/5/e13388/ %U https://doi.org/10.2196/13388 %U http://www.ncbi.nlm.nih.gov/pubmed/32432554 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 22 %N 5 %P e16468 %T The Mediator Roles of Problematic Internet Use and Perceived Stress Between Health Behaviors and Work-Life Balance Among Internet Users in Germany and China: Web-Based Cross-Sectional Study %A Gao,Lingling %A Gan,Yiqun %A Whittal,Amanda %A Yan,Song %A Lippke,Sonia %+ School of Psychological Cognitive Sciences and Beijing Key Laboratory of Behavior and Mental Health, Peking University, 5 Yiheyuan Rd, Haidian District, Beijing, China, 86 10 62757271, ygan@pku.edu.cn %K healthy lifestyle %K work-life balance %K internet %K healthy diet %K exercise %K culture %D 2020 %7 11.5.2020 %9 Original Paper %J J Med Internet Res %G English %X Background: Work-life balance is associated with health behaviors. In the face of digitalization, understanding this link requires a theory-based investigation of problematic internet use and perceived stress, which are so far unknown. Objective: On the basis of the compensatory carry-over action model, this study aimed to determine whether problematic internet use and perceived stress mediate the relationship between health behaviors and work-life balance in two groups of internet users from different environments (residents in Germany and China). We also investigated whether the place of residence was a moderator. Methods: An online questionnaire (N=877) was administered to residents from Germany (n=374) and China (n=503) in 3 languages (German, English, and Chinese). Moderated mediation analyses were run with health behaviors as the independent variable, work-life balance as the dependent variable, problematic internet use and perceived stress as the mediator variables, and place of residence as a potential moderator. Results: On a mean level, individuals in Germany reported less problematic internet use and more health behaviors than individuals in China; however, they also had lower work-life balance and higher perceived stress. Results showed that health behaviors seem to be directly related to work-life balance in both groups. Among the residents of Germany, a partial mediation was revealed (β=.13; P=.01), whereas among the residents of China, a full mediation was found (β=.02; P=.61). The mediator role of perceived stress was compared with problematic internet use in all the serial models and the parallel model. Residence moderated the relationship between health behaviors and work-life balance: The interrelation between health behaviors and work-life balance was stronger in Germany (β=.19; P<.001) than in China (β=.11; P=.01) when controlling for other variables. Conclusions: The findings of this study are in line with the compensatory carry-over action model. To promote work-life balance, individuals should perform health behaviors to help overcome problematic internet use and perceived stress. Both problematic internet use and perceived stress mediated health behaviors and work-life balance partially in German study participants and fully in Chinese study participants. %M 32391798 %R 10.2196/16468 %U https://www.jmir.org/2020/5/e16468 %U https://doi.org/10.2196/16468 %U http://www.ncbi.nlm.nih.gov/pubmed/32391798 %0 Journal Article %@ 2561-6722 %I JMIR Publications %V 3 %N 1 %P e17165 %T College Student Problematic Internet Use and Digital Communication Medium Used With Parents: Cross-Sectional Study %A Kerr,Bradley %A D'Angelo,Jon D %A Diaz-Caballero,Ali %A Moreno,Megan A %+ University of Wisconsin-Madison, 2870 University Ave, Suite 200, Madison, WI, , United States, 1 608 262 4440, bkerr@wisc.edu %K parents %K young adults %K social media %D 2020 %7 23.4.2020 %9 Original Paper %J JMIR Pediatr Parent %G English %X Background: Problematic internet use (PIU) is associated with mental health concerns such as depression and affects more than 12% of young adults. Few studies have explored potential influences of parent–college student digital communication on college students’ risk of PIU. Objective: This study sought to understand the relationship between parent–college student digital communication frequency via phone calls, text messages, and Facebook contacts and PIU among college students. Methods: Incoming first-year students were randomly selected from registrar lists of a midwestern and northwestern university for a 5-year longitudinal study. Data from interviews conducted in summer 2014 were used. Measures included participants’ daily Facebook visits, communication frequency with parents via phone call and text message, and 3 variables related to Facebook connection status and communication: (1) parent–college student Facebook friendship status, (2) college student blocking personal Facebook content from parent, and (3) Facebook communication frequency. PIU risk was assessed using the Problematic and Risky Internet Use Screening Scale. Analysis included participants who reported visiting Facebook at least once per day. Multiple linear regression was used, followed by a post hoc mediation with Hayes process macro to further investigate predictive relationships among significant variables. Results: A total of 151 participants reported daily Facebook use and were included in analyses. Among these participants, 59.6% (90/151) were female, 62.3% (94/151) were from the midwestern university, and 78.8% (119/151) were white. Mean Facebook visits per day was 4.3 (SD 3.34). There was a collective significant effect between participant daily Facebook visits, college student–parent phone calls, texts, and all 3 Facebook connection variables (F6,144=2.60, P=.02, R2=.10). Phone calls, text messages, and Facebook contacts were not associated with PIU risk. However, two individual items were significant predictors for PIU: participant daily Facebook visits were positively associated with increased PIU risk (b=0.04, P=.006) and being friends with a parent on Facebook was negatively associated with PIU risk (b=–0.66, P=.008). Participant daily Facebook visits were not a significant mediator of the relationship between college student–parent Facebook friendship and PIU risk (b=–0.04; 95% CI –0.11 to 0.04). Conclusions: This study did not find support for a relationship between parent–college student digital communication frequency and PIU among college students. Instead, results suggested Facebook friendship may be a protective factor. Future studies should examine how a parent-child Facebook friendship might protect against PIU among children at varying developmental stages. %M 32324140 %R 10.2196/17165 %U http://pediatrics.jmir.org/2020/1/e17165/ %U https://doi.org/10.2196/17165 %U http://www.ncbi.nlm.nih.gov/pubmed/32324140 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 22 %N 2 %P e16736 %T Measuring Interests Not Minutes: Development and Validation of the Adolescents’ Digital Technology Interactions and Importance Scale (ADTI) %A Moreno,Megan A %A Binger,Kole %A Zhao,Qianqian %A Eickhoff,Jens %+ Department of Pediatrics, University of Wisconsin-Madison, 2870 University Ave, Suite 200, Madison, WI, 53705, United States, 1 6082632846, mamoreno@pediatrics.wisc.edu %K technology %K adolescents %K methodology, survey %K social media %K screen time %K instrument development %D 2020 %7 12.2.2020 %9 Original Paper %J J Med Internet Res %G English %X Background: Interactive digital technology use is integral to adolescents’ lives and has been associated with both health benefits and risks. Previous studies have largely focused on measuring the quantity of technology use or understanding the use of specific platforms. To better understand adolescents’ interactive digital technology use, we need new approaches that consider technology interactions and their importance. Objective: This study aimed to develop an assessment tool to evaluate adolescents’ digital technology interactions and their perceived importance. Methods: We used a validated scale development approach comprising 2 initial steps to create an item pool: item pool development and item pool refinement. These steps relied upon empirical literature review and an expert convening. We then evaluated the item pool using a Web-based survey. Data were collected via Qualtrics panel recruitment from a national sample of 12- to 18-year-olds. Participant data were randomly split into a development subsample for exploratory factor analysis (EFA) and a test subsample for confirmatory factor analysis (CFA). We assessed Cronbach alpha as well as model fit characteristics including root mean square error of approximation (RMSEA) and comparative fit index (CFI). Results: Our initial item pool had 71 items and the refined item pool contained 40. A total of 761 adolescents assessed the item pool via Web-based survey. Participants had a mean age of 14.8 (SD 1.7) years and were 52.8% (402/761) female and 77.5% (590/761) white. The EFA analysis included 500 participants and an 18-item draft scale was created. The CFA included 261 participants to test the draft scale. Adequate model fit for the scale was indicated by an RMSEA of 0.063 and a CFI of 0.95. The final scale included 18 items in a 3-factor model, with Cronbach alpha for the 3 factors of .87 (factor 1), .90 (factor 2) and .82 (factor 3). The 3 factors were named (1) technology to bridge online and offline experiences, (2) technology to go outside one’s identity or offline environment, and (3) technology for social connection. Conclusions: The resulting Adolescents’ Digital Technology Interactions and Importance (ADTI) scale is a promising and psychometrically validated tool for identifying the importance of distinct technology interactions. The scale is informed by relevant theory and expert input. The 3 subscales have utility for future studies to understand whether certain subscale score ranges are associated with health or well-being outcomes. %M 32049068 %R 10.2196/16736 %U https://www.jmir.org/2020/2/e16736 %U https://doi.org/10.2196/16736 %U http://www.ncbi.nlm.nih.gov/pubmed/32049068 %0 Journal Article %@ 2368-7959 %I JMIR Publications %V 7 %N 1 %P e14035 %T The Role of Perceived Loneliness in Youth Addictive Behaviors: Cross-National Survey Study %A Savolainen,Iina %A Oksanen,Atte %A Kaakinen,Markus %A Sirola,Anu %A Paek,Hye-Jin %+ Faculty of Social Sciences, Tampere University, Kalevantie 4, Tampere, 33014, Finland, 358 504377111, iina.savolainen@tuni.fi %K youth %K problem behavior %K excessive alcohol consumption %K internet %K gambling %K loneliness %D 2020 %7 2.1.2020 %9 Original Paper %J JMIR Ment Health %G English %X Background: In the ever-growing and technologically advancing world, an increasing amount of social interaction takes place through the Web. With this change, loneliness is becoming an unprecedented societal issue, making youth more susceptible to various physical and mental health problems. This societal change also influences the dynamics of addiction. Objective: Employing the cognitive discrepancy loneliness model, this study aimed to provide a social psychological perspective on youth addictions. Methods: A comprehensive survey was used to collect data from American (N=1212; mean 20.05, SD 3.19; 608/1212, 50.17% women), South Korean (N=1192; mean 20.61, SD 3.24; 601/1192, 50.42% women), and Finnish (N=1200; mean 21.29, SD 2.85; 600/1200, 50.00% women) youths aged 15 to 25 years. Perceived loneliness was assessed with the 3-item Loneliness Scale. A total of 3 addictive behaviors were measured, including excessive alcohol use, compulsive internet use, and problem gambling. A total of 2 separate models using linear regression analyses were estimated for each country to examine the association between perceived loneliness and addiction. Results: Loneliness was significantly related to only compulsive internet use among the youth in all 3 countries (P<.001 in the United States, South Korea, and Finland). In the South Korean sample, the association remained significant with excessive alcohol use (P<.001) and problem gambling (P<.001), even after controlling for potentially confounding psychological variables. Conclusions: The findings reveal existing differences between youths who spend excessive amounts of time online and those who engage in other types of addictive behaviors. Experiencing loneliness is consistently linked to compulsive internet use across countries, although different underlying factors may explain other forms of addiction. These findings provide a deeper understanding in the mechanisms of youth addiction and can help improve prevention and intervention work, especially in terms of compulsive internet use. %M 31895044 %R 10.2196/14035 %U https://mental.jmir.org/2020/1/e14035 %U https://doi.org/10.2196/14035 %U http://www.ncbi.nlm.nih.gov/pubmed/31895044 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 21 %N 10 %P e14834 %T A Web-Based Intervention for Social Media Addiction Disorder Management in Higher Education: Quantitative Survey Study %A Dogan,Huseyin %A Norman,Helmi %A Alrobai,Amen %A Jiang,Nan %A Nordin,Norazah %A Adnan,Anita %+ Faculty of Education, Universiti Kebangsaan Malaysia, Jalan Reko, Bangi, 43600, Malaysia, 60 389216062, helmi.norman@ukm.edu.my %K Facebook addiction %K intervention features %K postgraduate education %K social media addiction %K obsessive-compulsive disorder (OCD) %K PLS-SEM analysis %D 2019 %7 2.10.2019 %9 Original Paper %J J Med Internet Res %G English %X Background: Social media addiction disorder has recently become a major concern and has been reported to have negative impacts on postgraduate studies, particularly addiction to Facebook. Although previous studies have investigated the effects of Facebook addiction disorder in learning settings, there still has been a lack of studies investigating the relationship between online intervention features for Facebook addiction focusing on postgraduate studies. Objective: In an attempt to understand this relationship, this study aimed to carry out an investigation on online intervention features for effective management of Facebook addiction in higher education. Methods: This study was conducted quantitatively using surveys and partial least square-structural equational modeling. The study involved 200 postgraduates in a Facebook support group for postgraduates. The Bergen Facebook Addiction test was used to assess postgraduates’ Facebook addiction level, whereas online intervention features were used to assess postgraduates’ perceptions of online intervention features for Facebook addiction, which are as follows: (1) self-monitoring features, (2) manual control features, (3) notification features, (4) automatic control features, and (5) reward features. Results: The study discovered six Facebook addiction factors (relapse, conflict, salience, tolerance, withdrawal, and mood modification) and five intervention features (notification, auto-control, reward, manual control, and self-monitoring) that could be used in the management of Facebook addiction in postgraduate education. The study also revealed that relapse is the most important factor and mood modification is the least important factor. Furthermore, findings indicated that notification was the most important intervention feature, whereas self-monitoring was the least important feature. Conclusions: The study’s findings (addiction factors and intervention features) could assist future developers and educators in the development of online intervention tools for Facebook addiction management in postgraduate education. %M 31579018 %R 10.2196/14834 %U https://www.jmir.org/2019/10/e14834 %U https://doi.org/10.2196/14834 %U http://www.ncbi.nlm.nih.gov/pubmed/31579018 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 21 %N 4 %P e11837 %T The Relationship Between Personality Traits, Psychopathological Symptoms, and Problematic Internet Use: A Complex Mediation Model %A Koronczai,Beatrix %A Kökönyei,Gyöngyi %A Griffiths,Mark D %A Demetrovics,Zsolt %+ Department of Developmental and Clinical Child Psychology, Institute of Psychology, Eötvös Loránd University, 46 Izabella St, Budapest, H-1064, Hungary, 36 1 461 2600, koronczai.beatrix@ppk.elte.hu %K problematic internet use %K personality %K psychopathology %K psychopathological symptoms %D 2019 %7 26.04.2019 %9 Original Paper %J J Med Internet Res %G English %X Background: There are many empirical studies that demonstrate the associations between problematic internet use, psychopathological symptoms, and personality traits. However, complex models are scarce. Objective: The aim of this study was to build and test a mediation model based on problematic internet use, psychopathological symptoms, and personality traits. Methods: Data were collected from a medical addiction center (43 internet addicts) and internet cafés (222 customers) in Beijing (mean age 22.45, SD 4.96 years; 239/265, 90.2% males). Path analysis was applied to test the mediation models using structural equation modeling. Results: Based on the preliminary analyses (correlations and linear regression), two different models were built. In the first model, low conscientiousness and depression had a direct significant influence on problematic internet use. The indirect effect of conscientiousness—via depression—was nonsignificant. Emotional stability only affected problematic internet use indirectly, via depressive symptoms. In the second model, low conscientiousness also had a direct influence on problematic internet use, whereas the indirect path via the Global Severity Index was again nonsignificant. Emotional stability impacted problematic internet use indirectly via the Global Severity Index, whereas it had no direct effect on it, as in the first model. Conclusions: Personality traits (ie, conscientiousness as a protective factor and neuroticism as a risk factor) play a significant role in problematic internet use, both directly and indirectly (via distress level). %M 31025955 %R 10.2196/11837 %U http://www.jmir.org/2019/4/e11837/ %U https://doi.org/10.2196/11837 %U http://www.ncbi.nlm.nih.gov/pubmed/31025955 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 21 %N 4 %P e11485 %T To Each Stress Its Own Screen: A Cross-Sectional Survey of the Patterns of Stress and Various Screen Uses in Relation to Self-Admitted Screen Addiction %A Khalili-Mahani,Najmeh %A Smyrnova,Anna %A Kakinami,Lisa %+ PERFORM Centre, Design and Computation Arts, Concordia University, 7200 Rue Sherbrooke O, Montreal, QC, H4B1R6, Canada, 1 5148482424 ext 5370, najmeh.khalili-mahani@concordia.ca %K psychological stress %K addictive behavior %K coping behavior %K social network %K gaming, internet %K communications %K telemedicine %K eHealth %D 2019 %7 02.04.2019 %9 Original Paper %J J Med Internet Res %G English %X Background: The relationship between stress and screen addiction is often studied by exploring a single aspect of screen-related behavior in terms of maladaptive dependency or the risks associated with the content. Generally, little attention is given to the pattern of using different screens for different types of stressors, and variations arising from the subjective perception of stress and screen addiction are often neglected. Given that both addiction and stress are complex and multidimensional factors, we performed a multivariate analysis of the link between individual’s subjective perceptions of screen addiction, various types of stress, and the pattern of screen usage. Objective: Using the media-repertoires framework to study usage patterns, we explored (1) the relation between subjective and quantitative assessments of stress and screen addiction; and (2) differences in stress types in relation to subjective screen addiction and different types of needs for screens. We hypothesized that interindividual heterogeneity in screen-related behavior would reflect coping differences in dealing with different stressors. Methods: A multifactorial Web-based survey was conducted to gather data about screen-related behaviors (such as screen time, internet addiction, and salience of different types of screens and related activities), and different sources of stress (emotional states, perceptual risks, health problems, and general life domain satisfaction). We performed group comparisons based on whether participants reported themselves as addicted to internet and games (A1) or not (A0), and whether they had experienced a major life stress (S1) or not (S0). Results: Complete responses were obtained in 459 out of 654 survey responders, with the majority in the S1A0 (44.6%, 205/459) group, followed by S0A0 (25.9%, 119/459), S1A1 (19.8%, 91/459), and S0A1 (9.5%, 44/459). The S1A1 group was significantly different from S0A0 in all types of stress, internet overuse, and screen time (P<.001). Groups did not differ in rating screens important for short message service (SMS) or mail, searching information, shopping, and following the news, but a greater majority of A1 depended on screens for entertainment (χ23=20.5; P<.001), gaming (χ23=35.6; P<.001), and social networking (χ23=26.5; P<.001). Those who depended on screens for entertainment and social networking had up to 19% more emotional stress and up to 14% more perceptual stress. In contrast, those who relied on screens for work and professional networking had up to 10% higher levels of life satisfaction. Regression models including age, gender, and 4 stress types explained less than 30% of variation in internet use and less than 24% of the likelihood of being screen addicted. Conclusions: We showed a robust but heterogeneous link between screen dependency and emotional and perceptual stressors that shift the pattern of screen usage toward entertainment and social networking. Our findings underline the potential of using ludic and interactive apps for intervention against stress. %M 30938685 %R 10.2196/11485 %U https://www.jmir.org/2019/4/e11485/ %U https://doi.org/10.2196/11485 %U http://www.ncbi.nlm.nih.gov/pubmed/30938685 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 7 %N 3 %P e12171 %T Temporal Stability of Smartphone Use Data: Determining Fundamental Time Unit and Independent Cycle %A Pan,Yuan-Chien %A Lin,Hsiao-Han %A Chiu,Yu-Chuan %A Lin,Sheng-Hsuan %A Lin,Yu-Hsuan %+ National Health Research Institutes, Institute of Population Health Sciences, 35 Keyan Road, Zhunan, Miaoli County, Miaoli County, 35053, Taiwan, 886 37246166 ext 36383, yuhsuanlin@nhri.org.tw %K temporal stability %K smartphone use %K smartphone addiction %K smartphone %K mobile phone %D 2019 %7 26.03.2019 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Assessing human behaviors via smartphone for monitoring the pattern of daily behaviors has become a crucial issue in this century. Thus, a more accurate and structured methodology is needed for smartphone use research. Objective: The study aimed to investigate the duration of data collection needed to establish a reliable pattern of use, how long a smartphone use cycle could perpetuate by assessing maximum time intervals between 2 smartphone periods, and to validate smartphone use and use/nonuse reciprocity parameters. Methods: Using the Know Addiction database, we selected 33 participants and passively recorded their smartphone usage patterns for at least 8 weeks. We generated 4 parameters on the basis of smartphone use episodes, including total use frequency, total use duration, proactive use frequency, and proactive use duration. A total of 3 additional parameters (root mean square of successive differences, Control Index, and Similarity Index) were calculated to reflect impaired control and compulsive use. Results: Our findings included (1) proactive use duration correlated with subjective smartphone addiction scores, (2) a 2-week period of data collection is required to infer a 2-month period of smartphone use, and (3) smartphone use cycles with a time gap of 4 weeks between them are highly likely independent cycles. Conclusions: This study validated temporal stability for smartphone use patterns recorded by a mobile app. The results may provide researchers an opportunity to investigate human behaviors with more structured methods. %M 30912751 %R 10.2196/12171 %U http://mhealth.jmir.org/2019/3/e12171/ %U https://doi.org/10.2196/12171 %U http://www.ncbi.nlm.nih.gov/pubmed/30912751 %0 Journal Article %@ 2368-7959 %I JMIR Publications %V 6 %N 3 %P e10784 %T Gender Moderates the Partial Mediation of Impulsivity in the Relationship Between Psychiatric Distress and Problematic Online Gaming: Online Survey %A Su,Wenliang %A Király,Orsolya %A Demetrovics,Zsolt %A Potenza,Marc N %+ Institute of Psychology, Eötvös Loránd University, Izabella 46, Budapest, 1064, Hungary, 36 30 976 1097, demetrovics@t-online.hu %K internet %K video games %K addictive behavior %K psychopathology %K impulsivity %K gender %D 2019 %7 19.03.2019 %9 Original Paper %J JMIR Ment Health %G English %X Background: Research has shown that some individuals can develop problematic patterns of online gaming, leading to significant psychological and interpersonal problems. Psychiatric distress and impulsivity have been suggested to contribute to problematic online gaming (POG). Objective: This study aimed to investigate the potential mediating or moderating mechanisms of impulsivity and gender-related differences in possible associations between psychiatric distress and POG. Methods: A total of 596 matched female and male participants, ranging in age from 14 to 38 years (mean 21.4, SD 4.5), were chosen from a large cross-sectional, nationwide Hungarian online gaming sample. Participants completed online questionnaires about self-reported impulsivity, psychiatric distress, and POG. Results: Psychiatric distress directly predicted POG, and impulsivity partially mediated the relationship between psychiatric distress and POG. However, this mediation effect was found only for the impatience factor of impulsivity. Impulsivity did not moderate the relationship between psychiatric distress and POG. A moderating effect of gender was not found in the direct relationship between psychiatric distress and POG. However, a moderated mediation analysis revealed that impatience mediated the association between psychiatric distress and POG in males, whereas the indirect effect of impatience was not significant in females. Conclusions: The results of this work highlight gender-related difference among online gamers in the mediation effect of impulsivity between psychiatric distress and POG and provide novel insights regarding clinical implications for preventing or treating POG. %M 30888322 %R 10.2196/10784 %U http://mental.jmir.org/2019/3/e10784/ %U https://doi.org/10.2196/10784 %U http://www.ncbi.nlm.nih.gov/pubmed/30888322 %0 Journal Article %@ 2368-7959 %I JMIR Publications %V 6 %N 1 %P e9978 %T Sexual Desire, Mood, Attachment Style, Impulsivity, and Self-Esteem as Predictive Factors for Addictive Cybersex %A Varfi,Nektaria %A Rothen,Stephane %A Jasiowka,Katarzyna %A Lepers,Thibault %A Bianchi-Demicheli,Francesco %A Khazaal,Yasser %+ Geneva University Hospitals, Grand Pré 70 C, Geneve, 1206, Switzerland, 41 0766792018, yasser.khazaal@hcuge.ch %K sex %K internet %K addictive behavior %K impulsivity %D 2019 %7 21.01.2019 %9 Original Paper %J JMIR Ment Health %G English %X Background: An increasing number of studies are concerned with various aspects of cybersex addiction, the difficulty some persons have in limiting cybersex use despite a negative impact on everyday life. Objective: The aim of this study was to assess potential links between the outcome variable cybersex addiction, assessed with the Compulsive Internet Use Scale (CIUS) adapted for cybersex use, and several psychological and psychopathological factors, including sexual desire, mood, attachment style, impulsivity, and self-esteem, by taking into account the age, sex, and sexual orientation of cybersex users. Methods: A Web-based survey was conducted in which participants were assessed for sociodemographic variables and with the following instruments: CIUS adapted for cybersex use, Sexual Desire Inventory, and Short Depression-Happiness Scale. Moreover, attachment style was assessed with the Experiences in Close Relationships-Revised questionnaire (Anxiety and Avoidance subscales). Impulsivity was measured by using the Urgency, Premeditation (lack of), Perseverance (lack of), Sensation Seeking, Positive Urgency Impulsive Behavior Scale. Global self-esteem was assessed with the 1-item Self-Esteem Scale. Results: A sample of 145 subjects completed the study. Addictive cybersex use was associated with higher levels of sexual desire, depressive mood, avoidant attachment style, and male gender but not with impulsivity. Conclusions: Addictive cybersex use is a function of sexual desire, depressive mood, and avoidant attachment. %M 30664470 %R 10.2196/mental.9978 %U https://mental.jmir.org/2019/1/e9978/ %U https://doi.org/10.2196/mental.9978 %U http://www.ncbi.nlm.nih.gov/pubmed/30664470 %0 Journal Article %@ 2368-7959 %I JMIR Publications %V 6 %N 1 %P e65 %T Internet-Based Interventions for Problem Gambling: Scoping Review %A van der Maas,Mark %A Shi,Jing %A Elton-Marshall,Tara %A Hodgins,David C %A Sanchez,Sherald %A Lobo,Daniela SS %A Hagopian,Sylvia %A Turner,Nigel E %+ Institute for Mental Health Policy Research, Centre for Addiction and Mental Health, 33 Russell Street, Toronto, ON, M5S 3B1, Canada, 1 4165358501 ext 36493, vandermaas.mark@gmail.com %K problem gambling %K treatment %K intervention %D 2019 %7 07.01.2019 %9 Review %J JMIR Ment Health %G English %X Background: This study seeks to give an overview of academic research on internet-based interventions that are used to address problem gambling. The rate of treatment seeking has been demonstrated to be low across several research environments. This is in part because of the systemic barriers that treatment seekers face to accessing traditional face-to-face treatment. Making treatment resources for problem gambling available through the internet is one way to reduce the impact of those systemic barriers. The use of internet-based resources to address problem gambling has been growing, and a field of research evaluating it has developed as well. However, little has been done to summarize this collection of research. Objective: This study aimed to provide a scoping review of the use of internet-based interventions for problem gambling treatment and prevention to provide an understanding of the current state of the field. Methods: A scoping review was performed for 6 peer-reviewed research databases (Web of Science, PsycINFO, Cumulative Index to Nursing and Allied Health Literature, MEDLINE, Social Science Abstracts, and Scopus) and 3 gray literature databases (MedEdPortal, Proquest: Dissertations, and OpenGrey). Article inclusion criteria were as follows: published over the 10-year period of 2007 to 2017, including an intervention for problem gambling, and involving the use of internet to deliver that intervention. Results: A total of 27 articles were found that met the review criteria. Studies were found from several different areas, with particularly strong representation for Australia, New Zealand, and Scandinavia. Cognitive behavioral therapy was the most common form of internet-based intervention. Internet-based interventions were generally shown to be effective in reducing problem gambling scores and gambling behaviors. A wide range of interventions that made use of internet resources included text-based interactions with counselors and peers, automated personalized and normative feedback on gambling behaviors, and interactive cognitive behavioral therapies. A lack of diversity in samples, little comparison with face-to-face interventions, and issues of changes in the treatment dynamic are identified as areas that require further investigation. Conclusions: Internet-based interventions are a promising direction for treatment and prevention of problem gambling, particularly in reducing barriers to accessing professional help. The state of the current literature is sparse, and more research is needed for directly comparing internet-based interventions and their traditional counterparts. %M 30617046 %R 10.2196/mental.9419 %U https://mental.jmir.org/2019/1/e65/ %U https://doi.org/10.2196/mental.9419 %U http://www.ncbi.nlm.nih.gov/pubmed/30617046 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 20 %N 8 %P e10058 %T Game Addiction Scale Assessment Through a Nationally Representative Sample of Young Adult Men: Item Response Theory Graded–Response Modeling %A Khazaal,Yasser %A Breivik,Kyrre %A Billieux,Joel %A Zullino,Daniele %A Thorens,Gabriel %A Achab,Sophia %A Gmel,Gerhard %A Chatton,Anne %+ Geneva University, Grand Pré 70c, Geneve, 1202, Switzerland, 41 223725550, yasser.khazaal@hcuge.ch %K internet addiction %K internet gaming disorder %K internet gaming %K item response theory %K game addiction scale %D 2018 %7 27.08.2018 %9 Original Paper %J J Med Internet Res %G English %X Background: The 7-item Game Addiction Scale (GAS) has been validated under standard confirmatory factor analysis and exhibits good psychometric properties. Whether this scale satisfies the necessary conditions for consideration by item response theory (IRT) modeling remains unknown. However, the Diagnostic and Statistical Manual of Mental Disorders, 5th Edition (DSM-5) recently proposed criteria, in its section 3, to define internet gaming disorder (IGD) to promote research on this possible condition. Objective: The objective of our study was to (1) analyze GAS in the context of IRT (graded-response) modeling; (2) investigate differential item functioning (DIF), a feature of IRT modeling, in 2 subsamples; and (3) contribute to the ongoing (IGD) debate related to the validity of the DSM-5 criteria using GAS items as a proxy. Methods: We assessed 2 large representative samples of Swiss men (3320 French-speaking and 2670 German-speaking) with GAS. Results: All items comprised high discrimination parameters. GAS items such as relapse, conflict, withdrawal, and problems (loss of interests) were endorsed more frequently in more severe IGD stages, whereas items related to tolerance, salience (preoccupation), and mood modification (escape) were endorsed more widely among participants (including in less severe IGD stages). Several DIF effects were found but were classified as negligible. Conclusions: The results of the analyses partly support the relevance of using IRT to further establish the psychometric properties of the GAS items. This study contributes to testing the validity of the IGD criteria, although cautious generalization of our findings is required with GAS being only a proxy of the IGD criteria. %M 30150204 %R 10.2196/10058 %U http://www.jmir.org/2018/8/e10058/ %U https://doi.org/10.2196/10058 %U http://www.ncbi.nlm.nih.gov/pubmed/30150204 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 20 %N 1 %P e33 %T Gender Differences in and the Relationships Between Social Anxiety and Problematic Internet Use: Canonical Analysis %A Baloğlu,Mustafa %A Özteke Kozan,Hatice İrem %A Kesici,Şahin %+ Department of Special Education, Faculty of Education, Hacettepe University, Beytepe Campus, Ankara, 06610, Turkey, 90 3127806315, baloglu@hotmail.com %K anxiety %K Internet %K sex characteristics %K social anxiety disorder %K addictive behavior %D 2018 %7 24.01.2018 %9 Original Paper %J J Med Internet Res %G English %X Background: The cognitive-behavioral model of problematic Internet use (PIU) proposes that psychological well-being is associated with specific thoughts and behaviors on the Internet. Hence, there is growing concern that PIU is associated with psychological impairments. Objective: Given the proposal of gender schema theory and social role theory, men and women are predisposed to experience social anxiety and engage in Internet use differently. Thus, an investigation of gender differences in these areas is warranted. According to the cognitive-behavioral model of PIU, social anxiety is associated with specific cognitions and behaviors on the Internet. Thus, an investigation of the association between social anxiety and PIU is essential. In addition, research that takes into account the multidimensional nature of social anxiety and PIU is lacking. Therefore, this study aimed to explore multivariate gender differences in and the relationships between social anxiety and PIU. Methods: Participants included 505 college students, of whom 241 (47.7%) were women and 264 (52.3%) were men. Participants’ ages ranged from 18 to 22 years, with a mean age of 20.34 (SD=1.16). The Social Anxiety Scale and Problematic Internet Use Scale were used in data collection. Multivariate analysis of variance (MANOVA) and canonical correlation analysis were used. Results: Mean differences between men and women were not statistically significant in social anxiety (λ=.02, F3,501=2.47, P=.06). In all three PIU dimensions, men scored higher than women, and MANOVA shows that multivariate difference was statistically significant (λ=.94, F3,501=10.69, P<.001). Of the canonical correlation functions computed for men, only the first was significant (Rc=.43, λ=.78, χ29=64.7, P<.001) and accounted for 19% of the overlapping variance. Similarly, only the first canonical function was significant for women (Rc=.36, λ=.87, χ29=33.9, P<.001), which accounted for 13% of the overlapping variance. Conclusions: On the basis of the findings, we conclude that enhanced educational opportunities for women and their increasing role in the society have led women to become more active and thus closed the gap in social anxiety levels between men and women. We found that men showed more difficulties than women in terms of running away from personal problems (ie, social benefit), used the Internet more excessively, and experienced more interpersonal problems with significant others due to Internet use. We conclude that men are under a greater risk of social impairments due to PIU. Our overall conclusion is that there is a substantial amount of association between social anxiety and PIU and the association is stronger for men than it is for women. We advise that future research continue to investigate PIU and social anxiety as multidimensional constructs. %M 29367182 %R 10.2196/jmir.8947 %U http://www.jmir.org/2018/1/e33/ %U https://doi.org/10.2196/jmir.8947 %U http://www.ncbi.nlm.nih.gov/pubmed/29367182 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 19 %N 5 %P e170 %T Attachment Style and Internet Addiction: An Online Survey %A Eichenberg,Christiane %A Schott,Markus %A Decker,Oliver %A Sindelar,Brigitte %+ Sigmund Freud PrivatUniversität Wien, Kelsenstr 2, Vienna,, Austria, 43 1 7984098, eichenberg@sfu.ac.at %K Internet %K addictive behavior %K surveys and questionnaires %K Rorschach test %D 2017 %7 17.05.2017 %9 Original Paper %J J Med Internet Res %G English %X Background: One of the clinically relevant problems of Internet use is the phenomenon of Internet addiction. Considering the fact that there is ample evidence for the relationship between attachment style and substance abuse, it stands to reason that attachment theory can also make an important contribution to the understanding of the pathogenesis of Internet addiction. Objective: The aim of this study was to examine people’s tendency toward pathological Internet usage in relation to their attachment style. Methods: An online survey was conducted. Sociodemographic data, attachment style (Bielefeld questionnaire partnership expectations), symptoms of Internet addiction (scale for online addiction for adults), used Web-based services, and online relationship motives (Cyber Relationship Motive Scale, CRMS-D) were assessed. In order to confirm the findings, a study using the Rorschach test was also conducted. Results: In total, 245 subjects were recruited. Participants with insecure attachment style showed a higher tendency to pathological Internet usage compared with securely attached participants. An ambivalent attachment style was particularly associated with pathological Internet usage. Escapist and social-compensatory motives played an important role for insecurely attached subjects. However, there were no significant effects with respect to Web-based services and apps used. Results of the analysis of the Rorschach protocol with 16 subjects corroborated these results. Users with pathological Internet use frequently showed signs of infantile relationship structures in the context of social groups. This refers to the results of the Web-based survey, in which interpersonal relationships were the result of an insecure attachment style. Conclusions: Pathological Internet use was a function of insecure attachment and limited interpersonal relationships. %M 28526662 %R 10.2196/jmir.6694 %U http://www.jmir.org/2017/5/e170/ %U https://doi.org/10.2196/jmir.6694 %U http://www.ncbi.nlm.nih.gov/pubmed/28526662 %0 Journal Article %@ 2368-7959 %I JMIR Publications %V 4 %N 2 %P e11 %T Internet Addiction Through the Phase of Adolescence: A Questionnaire Study %A Karacic,Silvana %A Oreskovic,Stjepan %+ Health Center Sveti Kriz, Cesta domovinske zahvalnosti 1, Trogir - Arbanija, 21224, Croatia, 385 21 888118, hotel-sveti-kriz@st.t-com.hr %K adolescents %K Internet addiction %K stages of adolescence %D 2017 %7 03.04.2017 %9 Original Paper %J JMIR Ment Health %G English %X Background: Adolescents increasingly use the Internet for communication, education, entertainment, and other purposes in varying degrees. Given their vulnerable age, they may be prone to Internet addiction. Objective: Our aim was to identify possible differences in the purpose of Internet use among adolescents with respect to age subgroup, country of residence, and gender and the distribution of Internet addiction across age subgroups. Another aim was to determine if there is a correlation between the purpose of Internet use and age and if this interaction influences the level of addiction to the Internet. Methods: The study included a simple random sample of 1078 adolescents—534 boys and 525 girls—aged 11-18 years attending elementary and grammar schools in Croatia, Finland, and Poland. Adolescents were asked to complete an anonymous questionnaire and provide data on age, gender, country of residence, and purpose of Internet use (ie, school/work or entertainment). Collected data were analyzed with the chi-square test for correlations. Results: Adolescents mostly used the Internet for entertainment (905/1078, 84.00%). More female than male adolescents used it for school/work (105/525, 20.0% vs 64/534, 12.0%, respectively). Internet for the purpose of school/work was mostly used by Polish adolescents (71/296, 24.0%), followed by Croatian (78/486, 16.0%) and Finnish (24/296, 8.0%) adolescents. The level of Internet addiction was the highest among the 15-16-year-old age subgroup and was lowest in the 11-12-year-old age subgroup. There was a weak but positive correlation between Internet addiction and age subgroup (P=.004). Male adolescents mostly contributed to the correlation between the age subgroup and level of addiction to the Internet (P=.001). Conclusions: Adolescents aged 15-16 years, especially male adolescents, are the most prone to the development of Internet addiction, whereas adolescents aged 11-12 years show the lowest level of Internet addiction. %M 28373154 %R 10.2196/mental.5537 %U http://mental.jmir.org/2017/2/e11/ %U https://doi.org/10.2196/mental.5537 %U http://www.ncbi.nlm.nih.gov/pubmed/28373154 %0 Journal Article %@ 1438-8871 %I JMIR Publications Inc. %V 18 %N 2 %P e36 %T The Efficacy of Three Modalities of Internet-Based Psychotherapy for Non–Treatment-Seeking Online Problem Gamblers: A Randomized Controlled Trial %A Luquiens,Amandine %A Tanguy,Marie-Laure %A Lagadec,Marthylle %A Benyamina,Amine %A Aubin,Henri-Jean %A Reynaud,Michel %+ Paul Brousse Hospital, APHP, Villejuif - University Paris-Sud - Inserm U1178 - CESP, Department of Addiction, 12 avenue Paul Vaillant-Couturier, Villejuif cedex, 94804, France, 33 145594018, amandineluquiens@yahoo.fr %K internet-based cognitive behavioral therapy %K brief intervention %K internet-based randomized controlled trial %K problem gambling %K non-help seeking %K poker %K guidance %D 2016 %7 15.02.2016 %9 Original Paper %J J Med Internet Res %G English %X Background: Internet-based interventions targeted at the most at-risk gamblers could reduce the treatment gap for addictive disorders. Currently, no clinical trial has included non–treatment-seeking patients who have been recruited directly in their gambling environment. This study was the first exclusively Internet-based randomized controlled trial among non–help-seeking problem gamblers with naturalistic recruitment in their gambling environment. Objective: The aim of this study was to assess the efficacy of three modalities of Internet-based psychotherapies with or without guidance, compared to a control condition, among problem gamblers who play online poker. Methods: All active poker gamblers on the Winamax website were systematically offered screening. All problem poker gamblers identified with a Problem Gambling Severity Index (PGSI) score of ≥5 were eligible to be included in the trial. Problem gamblers were randomized into four groups: (1) waiting list (control group), (2) personalized normalized feedback on their gambling status by email, (3) an email containing a self-help book to be downloaded with a Cognitive Behavioral Therapy (CBT) program without guidance, and (4) the same CBT program emailed weekly by a trained psychologist with personalized guidance. Efficacy was assessed based on the change in PGSI between baseline and 6 weeks (end of treatment) or 12 weeks (maintenance) and supported by player account-based gambling data automatically collected at the three time points. Results: All groups met high attrition rates (83%), but the group with guidance had a significantly higher dropout rate than the other three groups, including the control group. Although all groups showed some improvement, with a mean decrease of 1.35 on the PGSI, no significant difference in efficacy between the groups was observed. One-third of the problem gamblers fell below the problem gambling threshold at 6 weeks. Conclusions: Guidance could have aversively affected problem gamblers who had not sought help. Despite the lack of significant difference in efficacy between groups, this naturalistic trial provides a basis for the development of future Internet-based trials in individuals with gambling disorders. Comorbidities, natural course of illness, and intrinsic motivation seem to be critical issues to consider in future designs. Trial Registration: ANSM 2013-A00794-41 %M 26878894 %R 10.2196/jmir.4752 %U http://www.jmir.org/2016/2/e36/ %U https://doi.org/10.2196/jmir.4752 %U http://www.ncbi.nlm.nih.gov/pubmed/26878894 %0 Journal Article %@ 2368-7959 %I JMIR Publications Inc. %V 2 %N 2 %P e12 %T Factor Structure of the Internet Addiction Test in Online Gamers and Poker Players %A Khazaal,Yasser %A Achab,Sophia %A Billieux,Joel %A Thorens,Gabriel %A Zullino,Daniele %A Dufour,Magali %A Rothen,Stéphane %+ Geneva University Hospitals, Grand Pré 70C, Geneva, 1206, Switzerland, 41 223725550, yasser.khazaal@hcuge.ch %K Internet addiction %K Internet Addiction Test (IAT) %K poker players %K World of Warcraft %K massively multiplayer online role playing %K validation %K factorial structure %D 2015 %7 22.04.2015 %9 Original Paper %J JMIR Mental Health %G English %X Background: The Internet Addiction Test (IAT) is the most widely used questionnaire to screen for problematic Internet use. Nevertheless, its factorial structure is still debated, which complicates comparisons among existing studies. Most previous studies were performed with students or community samples despite the probability of there being more problematic Internet use among users of specific applications, such as online gaming or gambling. Objective: To assess the factorial structure of a modified version of the IAT that addresses specific applications, such as video games and online poker. Methods: Two adult samples—one sample of Internet gamers (n=920) and one sample of online poker players (n=214)—were recruited and completed an online version of the modified IAT. Both samples were split into two subsamples. Two principal component analyses (PCAs) followed by two confirmatory factor analyses (CFAs) were run separately. Results: The results of principal component analysis indicated that a one-factor model fit the data well across both samples. In consideration of the weakness of some IAT items, a 17-item modified version of the IAT was proposed. Conclusions: This study assessed, for the first time, the factorial structure of a modified version of an Internet-administered IAT on a sample of Internet gamers and a sample of online poker players. The scale seems appropriate for the assessment of such online behaviors. Further studies on the modified 17-item IAT version are needed. %M 26543917 %R 10.2196/mental.3805 %U http://mental.jmir.org/2015/2/e12/ %U https://doi.org/10.2196/mental.3805 %U http://www.ncbi.nlm.nih.gov/pubmed/26543917 %0 Journal Article %@ 1438-8871 %I JMIR Publications Inc. %V 17 %N 4 %P e88 %T The Mediating Effect of Gaming Motivation Between Psychiatric Symptoms and Problematic Online Gaming: An Online Survey %A Király,Orsolya %A Urbán,Róbert %A Griffiths,Mark D %A Ágoston,Csilla %A Nagygyörgy,Katalin %A Kökönyei,Gyöngyi %A Demetrovics,Zsolt %+ Institute of Psychology, Eötvös Loránd University, 1st Fl., 46 Izabella St, Budapest, 1064, Hungary, 36 30 976 1097, demetrovics@t-online.hu %K video games %K Internet %K motivation %K behavior, addictive %K psychopathology %K coping behavior %D 2015 %7 07.04.2015 %9 Original Paper %J J Med Internet Res %G English %X Background: The rapid expansion of online video gaming as a leisure time activity has led to the appearance of problematic online gaming (POG). According to the literature, POG is associated with different psychiatric symptoms (eg, depression, anxiety) and with specific gaming motives (ie, escape, achievement). Based on studies of alcohol use that suggest a mediator role of drinking motives between distal influences (eg, trauma symptoms) and drinking problems, this study examined the assumption that there is an indirect link between psychiatric distress and POG via the mediation of gaming motives. Furthermore, it was also assumed that there was a moderator effect of gender and game type preference based on the important role gender plays in POG and the structural differences between different game types. Objective: This study had two aims. The first aim was to test the mediating role of online gaming motives between psychiatric symptoms and problematic use of online games. The second aim was to test the moderator effect of gender and game type preference in this mediation model. Methods: An online survey was conducted on a sample of online gamers (N=3186; age: mean 21.1, SD 5.9 years; male: 2859/3186, 89.74%). The Brief Symptom Inventory (BSI), the Motives for Online Gaming Questionnaire (MOGQ), and the Problematic Online Gaming Questionnaire (POGQ) were administered to assess general psychiatric distress, online gaming motives, and problematic online game use, respectively. Structural regression analyses within structural equation modeling were used to test the proposed mediation models and multigroup analyses were used to test gender and game type differences to determine possible moderating effects. Results: The mediation models fitted the data adequately. The Global Severity Index (GSI) of the BSI indicated that the level of psychiatric distress had a significant positive direct effect (standardized effect=.35, P<.001) and a significant indirect (mediating) effect on POG (standardized effect=.194, P<.001) via 2 gaming motives: escape (standardized effect=.139, P<.001) and competition (standardized effect=.046, P<.001). The comparison of the 2 main gamer types showed no significant differences in the model. However, when comparing male and female players it was found that women had (1) slightly higher escape scores (on a 5-point Likert scale: mean 2.28, SD 1.14) than men (mean 1.87, SD 0.97) and (2) a stronger association between the escape motive and problematic online gaming (standardized effect size=.64, P<.001) than men (standardized effect size=.20, P=.001). Conclusions: The results suggest that psychiatric distress is both directly and indirectly (via escape and competition motives) negatively associated with POG. Therefore, the exploration of psychiatric symptoms and gaming motives of POG can be helpful in the preparation of prevention and treatment programs. %M 25855558 %R 10.2196/jmir.3515 %U http://www.jmir.org/2015/4/e88/ %U https://doi.org/10.2196/jmir.3515 %U http://www.ncbi.nlm.nih.gov/pubmed/25855558 %0 Journal Article %@ 1438-8871 %I JMIR Publications Inc. %V 17 %N 1 %P e13 %T Characteristics and Help-Seeking Behaviors of Internet Gamblers Based on Most Problematic Mode of Gambling %A Hing,Nerilee %A Russell,Alex Myles Thomas %A Gainsbury,Sally Melissa %A Blaszczynski,Alex %+ Centre for Gambling Education and Research, Southern Cross University, PO Box 157, Lismore, 2478, Australia, 61 428115291, nerilee.hing@scu.edu.au %K gambling %K Internet %K pathological gambling %K treatment %D 2015 %7 07.01.2015 %9 Original Paper %J J Med Internet Res %G English %X Background: Previous studies of problem Internet gamblers have failed to distinguish whether their problem gambling relates to Internet or land-based gambling modes. Therefore, characteristics and help-seeking behaviors of people whose gambling problems relate specifically to Internet gambling are unknown, but could inform the optimal alignment of treatment and support services with the needs and preferences of problem gamblers. Objective: This study aimed to compare (1) characteristics of problem Internet gamblers and problem land-based gamblers and (2) uptake of different types and modes of help between problem Internet gamblers and problem land-based gamblers. Hypothesis 1 was that problem Internet gamblers are less likely to seek help. Hypothesis 2 was that problem Internet gamblers are more likely to use online modes of help. Methods: A sample of 620 respondents meeting criteria for problem gambling was drawn from an online survey of 4594 Australian gamblers. Respondents were recruited through advertisements on gambling and gambling help websites, Facebook, and Google. Measures consisted of gambling participation; proportion of gambling on the Internet; most problematic mode of gambling; help seeking from 11 different sources of formal help, informal help, and self-help for gambling problems; psychological distress (Kessler 6); problem gambling severity (Problem Gambling Severity Index, PGSI); and demographics. Results: Problem Internet gamblers were significantly more likely than problem land-based gamblers to be male (χ21=28.3, P<.001, φ=0.21), younger (t616.33=4.62, P<.001, d=0.37), have lower psychological distress (χ21=5.4, P=.02, φ=0.09), and experience problems with sports and race wagering (χ24=228.5, P<.001, φ=0.61). Uptake of help was significantly lower among problem Internet compared to problem land-based gamblers (χ21=6.9, P<.001, φ=0.11), including from face-to-face services, gambling helplines, online groups, self-exclusion from land-based venues, family or friends, and self-help strategies. Both problem Internet and problem land-based gamblers had similarly low use of online help. However, problem land-based gamblers (37.6%, 126/335) were significantly more likely to have sought land-based formal help compared to problem Internet gamblers (23.5%, 67/285; χ21=14.3, P<.001, φ=0.15). Conclusions: The findings suggest that more targeted and innovative efforts may be needed to increase use of gambling help by problem Internet gamblers. Alternatively, their lower PGSI and K6 scores suggest Internet problem gamblers may have less need for gambling-related help. This is the first known study to classify problem Internet gamblers as those whose problem gambling specifically relates to Internet gambling. Further research is needed to better understand why help-seeking rates are lower among Internet problem gamblers. %M 25567672 %R 10.2196/jmir.3781 %U http://www.jmir.org/2015/1/e13/ %U https://doi.org/10.2196/jmir.3781 %U http://www.ncbi.nlm.nih.gov/pubmed/25567672 %0 Journal Article %@ 1929-0748 %I JMIR Publications Inc. %V 2 %N 2 %P e51 %T A Prospective Natural History Study of Quitting or Reducing Gambling With or Without Treatment: Protocol %A Kushnir,Vladyslav %A Cunningham,John A %A Hodgins,David C %+ Center for Addiction and Mental Health, 33 Russell Street, T526, Toronto, ON, , Canada, 1 416 535 8501 ext 36258, vlad.kushnir@camh.ca %K gambling %K treatment %K life events %K motivational factors %K natural recovery %K prospective natural history study %K longitudinal study %D 2013 %7 02.12.2013 %9 Protocol %J JMIR Res Protoc %G English %X Background: Only a small percentage of gamblers ever seek treatment, often due to stigma, embarrassment, or a desire to handle their problems on their own. While the majority of pathological gamblers who achieve remittance do so without accessing formal treatment, factors related to successful resolution have not been thoroughly explored. Objective: Employing a prospective natural history design, the study will therefore undertake an investigation to explore life events, motivating factors, and strategies used by problem gamblers to quit or reduce their gambling without formal treatment. Methods: Prospective participants (19 years or older) currently gambling at problematic levels with strong intentions toward quitting gambling will be directed to fill out a Web-based survey. Eligible participants will subsequently complete a survey that will assess: (1) types, frequency, and amount of money spent on gambling, (2) life events experienced in the past 12 months, (3) level of autonomous motivation for change, and (4) use of treatment services. Every 3 months for the duration of one year following the completion of their baseline survey, participants will be sent an email notification requesting them to complete a follow-up survey similar in content to the baseline survey. The four surveys will assess whether participants have experienced changes in their gambling behaviors along with positive or negative life events and motivations for change since the last survey. Individuals who are in the action and maintenance stages of quitting gambling at follow-up will be also asked about their techniques and strategies used to quit or reduce gambling. At 18 months post baseline, participants will be asked to complete a fifth and final follow-up survey that will also assess whether participants have experienced any barriers to change and whether they resolved their gambling to low risk levels. Results: The study has commenced in May 2013 and is currently in the recruitment stage. The study is scheduled to conclude in 2016. Conclusions: As this study will examine the active ingredients in natural recovery from gambling problems, the results will inform ways of promoting change among the large number of problem gamblers who do not seek treatment as well as improve treatment for those who do seek help. The information gained will also be useful in identifying effective self-help strategies for those who face challenges in accessing treatment, may be incorporated in standard treatment, provide brief intervention techniques, as well as inform relapse prevention strategies. %M 24297873 %R 10.2196/resprot.2727 %U http://www.researchprotocols.org/2013/2/e51/ %U https://doi.org/10.2196/resprot.2727 %U http://www.ncbi.nlm.nih.gov/pubmed/24297873 %0 Journal Article %@ 14388871 %I JMIR Publications Inc. %V 15 %N 5 %P e99 %T Web-Based Counseling for Problem Gambling: Exploring Motivations and Recommendations %A Rodda,Simone %A Lubman,Dan I %A Dowling,Nicki A %A Bough,Anna %A Jackson,Alun C %+ Turning Point Alcohol and Drug Centre, 54-62 Gertrude Street, Fitzroy, 3065, Australia, 61 0384138433, simoner@turningpoint.org.au %K Internet %K motivation %K gambling %K counseling %K Web-based interventions %K health services accessibility %D 2013 %7 24.05.2013 %9 Original Paper %J J Med Internet Res %G English %X Background: For highly stigmatized disorders, such as problem gambling, Web-based counseling has the potential to address common barriers to treatment, including issues of shame and stigma. Despite the exponential growth in the uptake of immediate synchronous Web-based counseling (ie, provided without appointment), little is known about why people choose this service over other modes of treatment. Objective: The aim of the current study was to determine motivations for choosing and recommending Web-based counseling over telephone or face-to-face services. Methods: The study involved 233 Australian participants who had completed an online counseling session for problem gambling on the Gambling Help Online website between November 2010 and February 2012. Participants were all classified as problem gamblers, with a greater proportion of males (57.4%) and 60.4% younger than 40 years of age. Participants completed open-ended questions about their reasons for choosing online counseling over other modes (ie, face-to-face and telephone), as well as reasons for recommending the service to others. Results: A content analysis revealed 4 themes related to confidentiality/anonymity (reported by 27.0%), convenience/accessibility (50.9%), service system access (34.2%), and a preference for the therapeutic medium (26.6%). Few participants reported helpful professional support as a reason for accessing counseling online, but 43.2% of participants stated that this was a reason for recommending the service. Those older than 40 years were more likely than younger people in the sample to use Web-based counseling as an entry point into the service system (P=.045), whereas those engaged in nonstrategic gambling (eg, machine gambling) were more likely to access online counseling as an entry into the service system than those engaged in strategic gambling (ie, cards, sports; P=.01). Participants older than 40 years were more likely to recommend the service because of its potential for confidentiality and anonymity (P=.04), whereas those younger than 40 years were more likely to recommend the service due to it being helpful (P=.02). Conclusions: This study provides important information about why online counseling for gambling is attractive to people with problem gambling, thereby informing the development of targeted online programs, campaigns, and promotional material. %R 10.2196/jmir.2474 %U http://www.jmir.org/2013/5/e99/ %U https://doi.org/10.2196/jmir.2474