Romuald Brunner

The Association between Pathological Internet Use and Comorbid Psychopathology: A Systematic Review

Background: 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. Sampling and Methods: 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 R2. The potential effect of publication bias was assessed using a funnel plot model and evaluated by Egger’s test based on a linear regression. Results: 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. Conclusions: 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.

The association of non-suicidal self-injury and suicidal behavior according to DSM-5 in adolescent psychiatric inpatients

Non-suicidal self-injury (NSSI) and suicidal behaviors frequently occur among adolescent psychiatric patients. Although those behaviors are distinct with regards to intent, NSSI has been shown to be an important risk-factor for suicide attempts. However, the association of NSSI and Suicidal Behavior Disorder (SBD) according to DSM-5 criteria has not yet been investigated. For investigating distinctive features and mutual risk-factors of NSSI-disorder and SBD, adolescent psychiatric inpatients (N=111, aged 12-19 years; 65.8% females) were interviewed using the Self-Injurious-Thoughts-And-Behaviors-Interview-German (SITBI-G). NSSI started significantly earlier in life (M=12.5 years, SD=2.2) than first suicide attempts (M=14.1 years, SD=2.0). Patients meeting NSSI-disorder and/or SBD were significantly more likely to be female and to be diagnosed with an affective disorder. NSSI-disorder and SBD seem to have several distinctive features (i.e. age of onset or frequency), but also seem to share certain mutual risk-factors (i.e. affective disorders, female gender). While both NSSI and SBD seem to be maintained by mainly automatic negative reinforcement, positive automatic and social functions were rated significantly higher for NSSI. Most importantly, NSSI seems to be a strong risk factor for the occurrence of SBD (even when controlling for suicidal ideation) and should therefore always be assessed when dealing with psychiatric adolescent patients.

A 2‑year longitudinal study of prospective predictors of pathological Internet use in adolescents

Longitudinal studies of prospective predictors for pathological Internet use (PIU) in adolescents as well as its course are lacking. This three-wave longitudinal study was conducted within the framework of the European Union-funded project “Saving and Empowering Young Lives in Europe” over a 2-year period. The sample consisted of 1444 students at the baseline investigation (T0); 1202 students after 1xa0year (T1); and 515 students after 2xa0years (T2). Structured self-report questionnaires were administered at all three time points. PIU was assessed using the Young Diagnostic Questionnaire (YDQ). In addition, demographic (i.e., gender), social (i.e., parental involvement), psychological (i.e., emotional problems), and Internet use-related factors (i.e., online activities) were assessed as prospective predictors. The prevalence of PIU was 4.3xa0% at T0, 2.7xa0% at T1 and 3.1xa0% at T2. However, only 3 students (0.58xa0%) had persistent categorical PIU (YDQ score of ≥5) over the 2-year period. In univariate models, a variety of variables that have been previously identified in cross-sectional investigations predicted PIU at T2. However, multivariate regression demonstrated that only previous PIU symptoms and emotional problems were significant predictors of PIU 2xa0years later (adjusted R2 0.23). The stability of categorical PIU in adolescents over 2xa0years was lower than previously reported. However, current PIU symptoms were the best predictor of later PIU; emotional symptoms also predicted PIU over and above the influence of previous problematic Internet use. Both PIU symptoms and emotional problems may contribute to the vicious cycle that supports the perpetuation of PIU.

Alcohol consumption patterns among adolescents are related to family structure and exposure to drunkenness within the family: results from the SEYLE project.

There is expedient evidence showing that differences in adolescent alcohol consumption and other risk-behaviour depend on both family structure and family member drunkenness exposure. Data were obtained among adolescents (N = 12,115, mean age 14.9 ± 0.89) in Austria, Estonia, France, Germany, Hungary, Ireland, Israel, Italy, Romania, Slovenia and Spain within the European Union’s 7th Framework Programme funded project, ‘Saving and Empowering Young Lives in Europe (SEYLE)’. The current study reveals how adolescents’ alcohol consumption patterns are related to their family structure and having seen their family member drunk. The results revealed statistically significant differences in adolescent alcohol consumption depending on whether the adolescent lives in a family with both birth parents, in a single-parent family or in a family with one birth parent and one step-parent. The study also revealed that the abstaining from alcohol percentage among adolescents was greater in families with both birth parents compared to other family types. The study also showed that the more often adolescents see their family member drunk the more they drink themselves. There is no difference in adolescent drinking patterns whether they see their family member drunk once a month or once a week. This study gives an insight on which subgroups of adolescents are at heightened risk of alcohol abuse and that decrease of family member drunkenness may have positive effects on the drinking habits of their children.

Pathological Internet Use Is on the Rise Among European Adolescents.

PURPOSEnIncreased Internet accessibility has been accompanied by an increased awareness of pathological Internet use (PIU). The aim of the study was to investigate a potential increase of PIU among European adolescents.nnnMETHODSnComparable data from two large cross-sectional multicentre, school-based studies conducted in 2009/2010 and 2011/2012 in five European countries (Estonia, Germany, Italy, Romania, and Spain) were used. The Youngs Diagnostic Questionnaire was used to assess the prevalence of PIU.nnnRESULTSnThe comparison of the two samples provides evidence that the prevalence of PIU is on the rise (4.01%-6.87%, odds ratioxa0= 1.69, p < .001) except in Germany. Comparison with data on Internet accessibility suggests that the rise in prevalence of adolescent PIU may be a consequence of increased Internet accessibility.nnnCONCLUSIONSnOur findings are the first data to confirm the rise of PIU among European adolescents. They definitively warrant further efforts in the implementation and evaluation of preventive interventions.

Psychopathological factors associated with problematic alcohol and problematic Internet use in a sample of adolescents in Germany

In Germany, high prevalence rates for problematic alcohol use and problematic Internet use in adolescents were reported. The objective of the present study was to identify psychopathological factors associated with these two behavior patterns. To our knowledge, this is the first investigation assessing psychopathological factors for both problematic alcohol and problematic Internet use in the same sample of adolescents. We surveyed a sample of 1444 adolescents in Germany regarding problematic alcohol use, problematic Internet use, psychopathology and psychological well-being. We conducted binary logistic regression analyses. 5.6% of the sample showed problematic alcohol use, 4.8% problematic Internet use, and 0.8% both problematic alcohol and problematic Internet use. Problematic alcohol use was higher in adolescents with problematic Internet use compared to those without problematic Internet use. Conduct problems and depressive symptoms were statistically significant associated with both problematic alcohol and problematic Internet use. Prosocial behavior was related to problematic Internet use. Male gender and less peer problems were associated with problematic alcohol use. For the first time associations between adolescent problematic alcohol and problematic Internet use due to common psychopathological factors were identified. However, in addition to shared factors, we found also specific psychopathological correlates associated with these two behavior patterns.

Parents' childhood experiences of bonding and parental psychopathology predict borderline personality disorder during adolescence in offspring

Previous studies on borderline personality disorder (BPD) development suggest a transgenerational transmission of parent-child relationship quality, which may also be influenced by parents mental health status. The aim of this study was twofold. First, we aimed to investigate the transgenerational effect of parental bonding experiences on the development of BPD in their offspring. Second, we examined the association between parents mental health status and BPD in offspring. Ninety-one female adolescent psychiatric inpatients along with 87 mothers and 59 fathers were enrolled in the study. Adolescent BPD was assessed with the Structured Clinical Interview for DSM-IV-II, parental bonding with the Parental Bonding Instrument, and parents´ psychiatric symptoms with the Patient Health Questionnaire. We found that low parental care produced a transgenerational effect from mother to BPD in offspring. Further, significant associations were found between paternal psychiatric symptoms and adolescent BPD. High paternal stress levels mediated the association between maternal affect reported by fathers and BPD in daughters. There is evidence of a transgenerational effect of parental bonding specifically for female adolescents with BPD, compared with other clinical control subjects. Our findings highlight the importance of including both parents in future research and in early clinical treatment in adolescents with BPD.

Effects of maternal history of depression and early life maltreatment on children's health-related quality of life

BACKGROUNDnThere is a well-established link between maternal depression and child mental health. Similar effects have been found for maternal history of early life maltreatment (ELM). However, studies investigating the relationship of childrens quality of life and maternal depression are scarce and none have been conducted for the association with maternal ELM. The aim of the present study was to investigate the effects of maternal history of ELM and depression on childrens health-related quality of life and to identify mediating factors accounting for these effects.nnnMETHODSnOur study involved 194 mothers with and without history of depression and/or ELM and their children between five and 12 years. Childrens health-related quality of life was assessed by maternal proxy- and child self-ratings using the KIDSCREEN. We considered maternal sensitivity and maternal parenting stress as potential mediators.nnnRESULTSnWe found an effect of maternal history of depression but not of maternal history of ELM on health-related quality of life. Maternal stress and sensitivity mediated the effects of maternal depression on child global health-related quality of life, as well as on the dimensions Autonomy & Parent Relation, School Environment (maternal and child rating), and Physical Wellbeing (child rating).nnnLIMITATIONnDue to the cross-sectional design of the study, causal interpretations must be made with caution. Some scales yielded low internal consistency.nnnCONCLUSIONSnMaternal impairments in areas of parenting which possibly developed during acute depression persist even after remission of acute affective symptoms. Interventions should target parenting stress and sensitivity in parents with prior depression.

Dual-task performance under acute stress in female adolescents with borderline personality disorder

Research to elucidate early alterations of higher cognitive processes in adolescents with BPD is rare. This study investigated differences in dual-task performance in adolescents with BPD during stress and non-stress conditions. The study sample comprised 30 female adolescents with BPD and 34 healthy controls. The impact of stress on dual-task performance was measured using a standardized stressor. Self-reports of distress and measures of heart rate (HR) were obtained to measure stress reactivity. There were no group differences in task performance. Under stress conditions, the performance on the auditory task decreased in both groups but without significant group differences. Healthy controls showed an increase of mean HR after stress induction compared to no change in the BPD group. The finding of attenuated HR response to acute stress in adolescent patients with BPD may contradict current theories that the affective hyperresponsivity in BPD is based on a biologically determined mechanism.

1827 – Prevalence of risk behaviours among european young. preliminary data from an italian sample we-stay project

Introduction Truancy negatively affects almost every aspect in the life, including physical, mental health, social and economical conditions. Objectives To implement and evaluate outcomes of three different kinds of intervention against truancy. A mechanistic intervention to stop truancy will be used as control. Aims To reduce truancy among European adolescents improving mental health in European high schools. Methods The WE- STAY intervention carried out in 6 different European Countries. In Italy a sample of 2265 High school students (mean age 15.6xa0±xa00,6; 64,4% females) was selected. The students were randomized into one of four different intervention arms. Baseline evaluation of students lifestyle, coping styles, at-risk truancy, self-harm behaviours and mental health issues was collected using a structured questionnaire. Results 6% has been absent from school for 7 days or more without a valid excuse during the past year. 55,0% of the sample has smoked cigarettes; 7,2% drank alcohol 4 or more time during the week (13,9% male and 3,4% female). About the use of drugs, 17,4% of them used drugs at least once in a lifetime. 16% of the students started a fight at least once in a lifetime. Conclusions Truancy is often related to mental health problems and at-risk behaviours. The truancy has been the focus of a different policy initiatives, often ended in failure. Through the implementation of WE-STAY is possible to acquire more data on truancy prevalence and its correlated psycho-social and psychiatric aspects, as well as information on school and parents attitudes toward this phenomenon.