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      Bidirectional predictions between Internet addiction and probable depression among Chinese adolescents

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          Background and aims

          The aim of the study is to investigate (a) whether probable depression status assessed at baseline prospectively predicted new incidence of Internet addiction (IA) at the 12-month follow-up and (b) whether IA status assessed at baseline prospectively predicted new incidence of probable depression at follow-up.


          We conducted a 12-month cohort study ( n = 8,286) among Hong Kong secondary students, and derived two subsamples. The first subsample ( n = 6,954) included students who were non-IA at baseline, using the Chen Internet Addiction Scale (≤63), and another included non-depressed cases at baseline ( n = 3,589), using the Center for Epidemiological Studies Depression Scale (<16).


          In the first subsample, 11.5% of the non-IA cases developed IA during follow-up, and probable depression status at baseline significantly predicted new incidence of IA [severe depression: adjusted odds ratio (ORa) = 2.50, 95% CI = 2.07, 3.01; moderate: ORa = 1.82, 95% CI = 1.45, 2.28; mild: ORa = 1.65, 95% CI = 1.32, 2.05; reference: non-depressed], after adjusting for sociodemographic factors. In the second subsample, 38.9% of those non-depressed participants developed probable depression during follow-up. Adjusted analysis showed that baseline IA status also significantly predicted new incidence of probable depression (ORa = 1.57, 95% CI = 1.18, 2.09).

          Discussion and conclusions

          The high incidence of probable depression is a concern that warrants interventions, as depression has lasting harmful effects in adolescents. Baseline probable depression predicted IA at follow-up and vice versa, among those who were free from IA/probable depression at baseline. Healthcare workers, teachers, and parents need to be made aware of this bidirectional finding. Interventions, both IA and depression prevention, should thus take both problems into consideration.

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          Most cited references 75

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          Internet Addiction: A New Clinical Phenomenon and Its Consequences

           K. S. Young (2004)
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            The association between pathological internet use and comorbid psychopathology: a systematic review.

            Pathological Internet use (PIU) has been conceptualized as an impulse-control disorder that shares characteristics with behavioral addiction. Research has indicated a potential link between PIU and psychopathology; however, the significance of the correlation remains ambiguous. The primary objective of this systematic review was to identify and evaluate studies performed on the correlation between PIU and comorbid psychopathology; the secondary aims were to map the geographical distribution of studies, present a current synthesis of the evidence, and assess the quality of available research. An electronic literature search was conducted using the following databases: MEDLINE, PsycARTICLES, PsychINFO, Global Health, and Web of Science. PIU and known synonyms were included in the search. Data were extracted based on PIU and psychopathology, including depression, anxiety, symptoms of attention deficit and hyperactivity disorder (ADHD), obsessive-compulsive symptoms, social phobia and hostility/aggression. Effect sizes for the correlations observed were identified from either the respective publication or calculated using Cohen's d or R(2). The potential effect of publication bias was assessed using a funnel plot model and evaluated by Egger's test based on a linear regression. The majority of research was conducted in Asia and comprised cross-sectional designs. Only one prospective study was identified. Twenty articles met the preset inclusion and exclusion criteria; 75% reported significant correlations of PIU with depression, 57% with anxiety, 100% with symptoms of ADHD, 60% with obsessive-compulsive symptoms, and 66% with hostility/aggression. No study reported associations between PIU and social phobia. The majority of studies reported a higher rate of PIU among males than females. The relative risks ranged from an OR of 1.02 to an OR of 11.66. The strongest correlations were observed between PIU and depression; the weakest was hostility/aggression. Depression and symptoms of ADHD appeared to have the most significant and consistent correlation with PIU. Associations were reported to be higher among males in all age groups. Limitations included heterogeneity in the definition and diagnosis of PIU. More studies with prospective designs in Western countries are critically needed. Copyright © 2012 S. Karger AG, Basel.
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              Predictive values of psychiatric symptoms for internet addiction in adolescents: a 2-year prospective study.

              To evaluate the predictive values of psychiatric symptoms for the occurrence of Internet addiction and to determine the sex differences in the predictive value of psychiatric symptoms for the occurrence of Internet addiction in adolescents. Internet addiction, depression, attention-deficit/hyperactivity disorder, social phobia, and hostility were assessed by self-reported questionnaires. Participants were then invited to be assessed for Internet addiction 6, 12, and 24 months later (the second, third, and fourth assessments, respectively). Ten junior high schools in southern Taiwan. A total of 2293 (1179 boys and 1114 girls) adolescents participated in the initial investigation. The course of time. Internet addiction as assessed using the Chen Internet Addiction Scale. Depression, attention-deficit/hyperactivity disorder, social phobia, and hostility were found to predict the occurrence of Internet addiction in the 2-year follow-up, and hostility and attention-deficit/hyperactivity disorder were the most significant predictors of Internet addiction in male and female adolescents, respectively. These results suggest that attention-deficit/hyperactivity disorder, hostility, depression, and social phobia should be detected early on and intervention carried out to prevent Internet addiction in adolescents. Also, sex differences in psychiatric comorbidity should be taken into consideration when developing prevention and intervention strategies for Internet addiction.

                Author and article information

                Journal of Behavioral Addictions
                J Behav Addict
                Akadémiai Kiadó (Budapest )
                21 September 2018
                September 2018
                : 7
                : 3
                : 633-643
                [ 1 ]Centre for Health Behaviours Research, The Jockey Club School of Public Health and Primary Care, Faculty of Medicine,The Chinese University of Hong Kong , Hong Kong, China
                [ 2 ]School of Public Health, Zhengjiang University , Hangzhou, China
                [ 3 ]Department of Psychology, Faculty of Social Sciences, University of Macau , Macao, China
                Author notes
                [* ]Corresponding author: Joseph T. F. Lau; Faculty of Medicine, Centre for Health Behaviours Research, The Jockey Club School of Public Health and Primary Care, The Chinese University of Hong Kong, 5/F, Hong Kong, China; Phone: +852 2637 6606; Fax: +852 2645 3098; E-mail: jlau@
                © 2018 The Author(s)

                This is an open-access article distributed under the terms of the Creative Commons Attribution-NonCommercial 4.0 International License, which permits unrestricted use, distribution, and reproduction in any medium for non-commercial purposes, provided the original author and source are credited, a link to the CC License is provided, and changes – if any – are indicated.

                Page count
                Figures: 0, Tables: 2, Equations: 0, References: 81, Pages: 11
                Funding sources: This study was supported by the Health and Medical Research Fund (award number: 09100591).
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