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      Preventing problematic internet use during the COVID-19 pandemic: Consensus guidance

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      a , b , c , d , e , f , g , h , i , j , k , l , m , n , o , p , q , r , s , t , u , v , w , x , y , z , n , aa , ab , ac , ad , ae , af , ag , ah , ai , aj , ak , x , y , z , aj , ak , al , 1 , a , * , 1
      Comprehensive Psychiatry
      Published by Elsevier Inc.
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          There is no author summary for this article yet. Authors can add summaries to their articles on ScienceOpen to make them more accessible to a non-specialist audience.

          Abstract

          As a response to the COVID-19 pandemic, many governments have introduced steps such as spatial distancing and “staying at home” to curb its spread and impact. The fear resulting from the disease, the ‘lockdown’ situation, high levels of uncertainty regarding the future, and financial insecurity raise the level of stress, anxiety, and depression experienced by people all around the world. Psychoactive substances and other reinforcing behaviors (e.g., gambling, video gaming, watching pornography) are often used to reduce stress and anxiety and/or to alleviate depressed mood. The tendency to use such substances and engage in such behaviors in an excessive manner as putative coping strategies in crises like the COVID-19 pandemic is considerable. Moreover, the importance of information and communications technology (ICT) is even higher in the present crisis than usual. ICT has been crucial in keeping parts of the economy going, allowing large groups of people to work and study from home, enhancing social connectedness, providing greatly needed entertainment, etc. Although for the vast majority ICT use is adaptive and should not be pathologized, a subgroup of vulnerable individuals are at risk of developing problematic usage patterns. The present consensus guidance discusses these risks and makes some practical recommendations that may help diminish them.

          Highlights

          • The COVID-19 pandemic is impacting on individuals' mental health.

          • Technology is being used to help alleviate stress and anxiety caused by the pandemic.

          • The risk of problematic internet use (PIU) is increased during the pandemic.

          • Guidance is needed related to decreasing the risk of PIU.

          • Practical recommendations to diminish the risk of PIU are presented.

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          Most cited references13

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          Is Open Access

          The Fear of COVID-19 Scale: Development and Initial Validation

          Background The emergence of the COVID-19 and its consequences has led to fears, worries, and anxiety among individuals worldwide. The present study developed the Fear of COVID-19 Scale (FCV-19S) to complement the clinical efforts in preventing the spread and treating of COVID-19 cases. Methods The sample comprised 717 Iranian participants. The items of the FCV-19S were constructed based on extensive review of existing scales on fears, expert evaluations, and participant interviews. Several psychometric tests were conducted to ascertain its reliability and validity properties. Results After panel review and corrected item-total correlation testing, seven items with acceptable corrected item-total correlation (0.47 to 0.56) were retained and further confirmed by significant and strong factor loadings (0.66 to 0.74). Also, other properties evaluated using both classical test theory and Rasch model were satisfactory on the seven-item scale. More specifically, reliability values such as internal consistency (α = .82) and test–retest reliability (ICC = .72) were acceptable. Concurrent validity was supported by the Hospital Anxiety and Depression Scale (with depression, r = 0.425 and anxiety, r = 0.511) and the Perceived Vulnerability to Disease Scale (with perceived infectability, r = 0.483 and germ aversion, r = 0.459). Conclusion The Fear of COVID-19 Scale, a seven-item scale, has robust psychometric properties. It is reliable and valid in assessing fear of COVID-19 among the general population and will also be useful in allaying COVID-19 fears among individuals.
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            Are we overpathologizing everyday life? A tenable blueprint for behavioral addiction research

            Background Behavioral addiction research has been particularly flourishing over the last two decades. However, recent publications have suggested that nearly all daily life activities might lead to a genuine addiction. Methods and aim In this article, we discuss how the use of atheoretical and confirmatory research approaches may result in the identification of an unlimited list of “new” behavioral addictions. Results Both methodological and theoretical shortcomings of these studies were discussed. Conclusions We suggested that studies overpathologizing daily life activities are likely to prompt a dismissive appraisal of behavioral addiction research. Consequently, we proposed several roadmaps for future research in the field, centrally highlighting the need for longer tenable behavioral addiction research that shifts from a mere criteria-based approach toward an approach focusing on the psychological processes involved.
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              First COVID-19 suicide case in Bangladesh due to fear of COVID-19 and xenophobia: Possible suicide prevention strategies

              The novel coronavirus 2019 (COVID-19) pandemic has become a global concern. Healthcare systems in many countries have been pushed to breaking point in an attempt to deal with the pandemic. At present, there is no accurate estimation about how long the COVID-19 situation will persist, the number of individuals worldwide who will be infected, or how long people’s lives will be disrupted (Suicide Awareness Voices of Education, 2020; Zandifar and Badrfam, 2020). Like previous epidemics and pandemics, the unpredictable consequences and uncertainty surrounding public safety, as well as misinformation about COVID-19 (particularly on social media) can often impact individuals’ mental health including depression, anxiety, and traumatic stress (Cheung et al., 2008; Zandifar and Badrfam, 2020). Additionally, pandemic-related issues such as social distancing, isolation and quarantine, as well as the social and economic fallout can also trigger psychological mediators such as sadness, worry, fear, anger, annoyance, frustration, guilt, helplessness, loneliness, and nervousness. These are the common features of typical mental health suffering that many individuals will experience during and after the crisis (Ahorsu et al., 2020; Banerjee, 2020; Cheung et al., 2008; Xiang et al., 2020). In extreme cases, such mental health issues can lead to suicidal behaviors (e.g., suicidal ideation, suicide attempts, and actual suicide). It is well stablished that around 90 % of global suicides are due to individuals with mental health conditions such as depression (Mamun and Griffiths, 2020). Similar situations have been reported in previous pandemics. For example, the suicide rate among elderly people increased in Hong Kong both during and after the SARS (Severe Acute Respiratory Syndrome) pandemic in 2003 (Cheung et al., 2008). On March 25 (2020), after returning from Dhaka, a 36-year-old Bangladeshi man (Zahidul Islam, from the village of Ramchandrapur) committed suicide because he and the people in his village thought he was infected with COVID-19 based on his fever and cold symptoms and his weight loss (Somoy News, 2020). Due to the social avoidance and attitudes by others around him, he committed suicide by hanging himself from a tree in the village near his house. Unfortunately, the autopsy showed that the victim did not have COVID-19 (Somoy News, 2020). The main factor that drove the man to suicide was prejudice by the others in the village who thought he had COVID-19 even though there was no diagnosis. Arguably, the villagers were xenophobic towards Mr. Islam. Although xenophobia is usually defined as a more specific fear or hatred of foreigners or strangers, xenophobia is actually the general fear of something foreign or strange (in this case COVID-19 rather than the victim’s ethnicity). Given that the victim believed he had COVID-19, it is also thought that he committed suicide out of a moral duty to ensure he did not pass on the virus to anyone in his village. A very similar case was reported in India on February 12 (2020), where the victim, returning from a city to his native village, committed suicide by hanging to avoid spreading COVID-19 throughout the village (Goyal et al., 2020). Based on these two cases, it appears that village people and the victim’s moral conscience had major roles in contributing the suicides. In the south Asian country like Bangladesh and India, village people arguably less educated than those that live in cities. Therefore, elevated fears and misconceptions surrounding COVID-19 among villagers may have led to higher levels of xenophobia, and that xenophobia may have been a major contributing factor in committing suicide. Suicide is the ultimate human sacrifice for anyone who cannot bear the mental suffering. However, the fact that the fear of having COVID-19 led to suicide is preventable and suggests both research and prevention is needed to avoid such tragedies. At present, it is not known what the level of fear of COVID-19 is among the Bangladeshi population although levels of fear are high among countries where there have been many deaths such as Iran according to a recent study examining fear of COVID-19 (Ahorsu et al., 2020). We would suggest there is an urgent need to carry out a nationwide epidemiological study to determine the level fear, worry, and helplessness, as well as other associated issues concerning mental health in relation to COVID-19. This would help in developing targeted mental wellbeing strategies (e.g., such as those who live in villages). Additional mental health care is also needed for patients confirmed as having COVID-19, patients with suspected COVID-19 infection, quarantined family members, and healthcare personnel (Xiang et al., 2020). We would also suggest the following to the general public: (i) avoid unreliable and non-credible news and information sources (such as that on social media and what neighbors say) to reduce fear and panic surrounding COVID-19, (ii) help individuals with known mental health issues (e.g., depression, anxiety) in appropriate ways such as consultation with healthcare professionals using telemedicine (i.e., online interventions) where possible, (iii) offer support and signposting for individuals displaying pre-suicidal behavior (i.e., talking about death and dying, expressing feelings of being hopeless and/or helpless, feeling like they are a burden or that they are trapped), (iv) offer basic help (e.g., foods, medicines) to those most in need during lock-down situations (Suicide Awareness Voices of Education, 2020; Yao et al., 2020). We would also recommend online-based mental health intervention programs as a way of promoting more reliable and authentic information about COVID-19, and making available possible telemedicine care, as suggested in recent previous papers (Liu et al., 2020; Xiang et al., 2020; Yao et al., 2020). Finally, as suggested by Banerjee (2020), the role of a psychiatrist during a pandemic such as COVID-19 should include as (i) educating individuals about the common adverse psychological consequences, (ii) encouraging health-promoting behaviors among individuals, (iii) integrating available healthcare services, (iv) facilitate problem-solving, (v) empowering patients, their families, and health-care providers, and (vi) promoting self-care among health-care providers. Role of the funding source Self-funded. Financial disclosure The authors involved in this research project do not have any relationships with other people or organizations that could inappropriately influence (bias) their work. Declaration of Competing Interest The authors of the correspondence do not have any conflict of interest.
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                Author and article information

                Contributors
                Journal
                Compr Psychiatry
                Compr Psychiatry
                Comprehensive Psychiatry
                Published by Elsevier Inc.
                0010-440X
                1532-8384
                12 May 2020
                12 May 2020
                : 152180
                Affiliations
                [a ]Institute of Psychology, ELTE Eötvös Loránd University, Budapest, Hungary
                [b ]Department of Psychiatry, Yale University School of Medicine, New Haven, CT, USA
                [c ]Child Study Center, Yale University School of Medicine, New Haven, CT, USA
                [d ]Connecticut Mental Health Center, New Haven, CT, USA
                [e ]Connecticut Council on Problem Gambling, Wethersfield, CT, USA
                [f ]Department of Neuroscience, Yale University, New Haven, CT, USA
                [g ]SA MRC Unit on Risk & Resilience in Mental Disorders, Department of Psychiatry & Neuroscience Institute, University of Cape Town, Cape Town, South Africa
                [h ]College of Education, Psychology, & Social Work, Flinders University, Adelaide, Australia
                [i ]Department of Psychology, University of Calgary, Calgary, Canada
                [j ]Centre for Youth Substance Abuse Research, University of Queensland, Brisbane, Australia
                [k ]Psychology Department, Nottingham Trent University, Nottingham, United Kingdom
                [l ]Academy of Sciences and Arts of North Macedonia, Skopje, Macedonia
                [m ]Institute of Psychology, University of Lausanne, Lausanne, Switzerland
                [n ]General Psychology: Cognition and Center for Behavioral Addiction Research (CeBAR), University of Duisburg-Essen, Duisburg, Germany
                [o ]Gambling and Addictions Research Centre, Auckland University of Technology, Auckland, New Zealand
                [p ]Department of Psychiatry, University of Cambridge, UK
                [q ]Cambridgeshire & Peterborough NHS Foundation Trust, Cambridge, United Kingdom
                [r ]Department of Clinical and Pharmaceutical Sciences, University of Hertfordshire, United Kingdom
                [s ]Department of Medico-Surgical Sciences and Biotechnologies, Sapienza University of Rome, Rome, Italy
                [t ]Laboratory of Behavioral Medicine, Neuroscience Institute, Lithuanian University of Health Sciences, Palanga, Lithuania
                [u ]Psychology and Education Sciences, Center for Psychology University of Porto, Portugal
                [v ]Department of Molecular Psychology, Institute of Psychology and Education, Ulm University, Ulm, Germany
                [w ]SA MRC Unit on Risk & Resilience in Mental Disorders, Department of Psychiatry, Stellenbosch University, South Africa
                [x ]Department of Child and Adolescent Psychiatry and Psychotherapy, Psychiatric Hospital, University of Zurich, Zürich, Switzerland
                [y ]Neuroscience Center Zurich, University of Zurich and the ETH, Zurich, Zürich, Switzerland
                [z ]Zurich Center for Integrative Human Physiology, University of Zurich, Zurich, Switzerland
                [aa ]Department of Neuroscience, Imaging, Clinical Sciences, ‘Gabriele d'Annunzio’ University of Chieti-Pescara, Italy
                [ab ]Department of Psychiatry, The Catholic University of Korea, Seoul, South Korea
                [ac ]Department of Psychiatry and Psychotherapy, University of Lübeck, Germany
                [ad ]Department of Personality, Assessment, and Psychological Treatments, Faculty of Psychology, University of Valencia, Valencia, Spain
                [ae ]Iranian National Center for Addiction Studies (INCAS), Tehran University of Medical Sciences, Tehran, Iran
                [af ]National Hospital Organization Kurihama Medical and Addiction Center, National Center for Addiction Services Administration, Yokosuka, Japan
                [ag ]Department of Psychiatry, Bellvitge University Hospital-IDIBELL, University of Barcelona, Cibersam, Barcelona, Spain
                [ah ]Sackler Medical School, Tel Aviv University, Chaim Sheba Medical Center Tel Hashomer, Tel Aviv, Israel
                [ai ]Department of Biomedical and Neuromotor Sciences, University of Bologna, Italy
                [aj ]University of Hertfordshire, Hatfield, UK
                [ak ]Hertfordshire Partnership University NHS Foundation Trust, Welwyn Garden City, Hertfordshire, United Kingdom
                [al ]University of Cambridge School of Clinical Medicine, Cambridge, United Kingdom
                Author notes
                [* ]Corresponding author at: Institute of Psychology, ELTE Eötvös Loránd University, Izabella utca 46, H-1064 Budapest, Hungary. demetrovics.zsolt@ 123456ppk.elte.hu
                [1]

                The last two authors contributed equally to the manuscript.

                Article
                S0010-440X(20)30022-5 152180
                10.1016/j.comppsych.2020.152180
                7215166
                32422427
                98074c91-3283-41fc-ba4d-c2a4b51bc4fa
                Crown Copyright © 2020 Published by Elsevier Inc.

                Since January 2020 Elsevier has created a COVID-19 resource centre with free information in English and Mandarin on the novel coronavirus COVID-19. The COVID-19 resource centre is hosted on Elsevier Connect, the company's public news and information website. Elsevier hereby grants permission to make all its COVID-19-related research that is available on the COVID-19 resource centre - including this research content - immediately available in PubMed Central and other publicly funded repositories, such as the WHO COVID database with rights for unrestricted research re-use and analyses in any form or by any means with acknowledgement of the original source. These permissions are granted for free by Elsevier for as long as the COVID-19 resource centre remains active.

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