Digital media use and mental health: Difference between revisions

Digital media use and mental health
	The relationships between digital media use and mental health are under study.
Related	Screen time, gaming disorder, problematic internet use, problematic social media use, problematic smartphone use

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The relationships between digital media use and mental health have been investigated by various researchers—predominantly psychologists, sociologists, anthropologists and medical experts—for some years. A significant body of research has explored "overuse" phenomena, commonly known as "digital addictions", or "digital dependencies". These phenomena manifest differently in various societies and cultures. Some experts have investigated the benefits of moderate digital media use in various domains, including in mental health, and the treatment of mental health problems with novel technological solutions.

The delineation between beneficial and pathological use of digital media has not been established. There are no widely accepted diagnostic criteria, although some experts consider overuse a manifestation of underlying psychiatric disorders. The prevention and treatment of pathological digital media use is also not standardised, although guidelines for safer media use for children and families have been developed. The Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5) does not include diagnoses for problematic internet use, problematic social media use, and gaming disorder, whereas the eleventh revision of the International Classification of Diseases (ICD-11) recognises gaming disorder. Experts are still debating how and when to diagnose these conditions. The use of the term addiction to refer to these phenomena and diagnoses has also been questioned.

Digital media and screen time have changed how children think, interact and develop in positive and negative ways. Scientists, however, are unsure about the direct links between digital media use and mental health outcomes. Those links appear to depend on the individual and the platforms they use. Various large technology firms have made commitments or announced strategies to try to reduce the risks of digital media use.

History and terminology

A child looks into a smartphone — A young boy engaged with a smartphone

The relationship between digital technology and mental health has been investigated from many perspectives.^[2]^[3]^[4] Benefits of digital media use in childhood and adolescent development have been found.^[5] However, concerns have been expressed by researchers, clinicians and the public in regard to apparent compulsive behaviours of digital media users with correlations between technology overuse and mental health problems becoming apparent.^[2]^[6]

Terminology used to refer to compulsive digital-media-use behaviours are not standardised or universally recognized. They include "digital addiction", "digital dependence", "problematic use", or "overuse", often delineated by the digital media platform used or under study (such as problematic smartphone use or problematic internet use).^[7] Unrestrained use of technological devices may affect developmental, social, mental and physical well-being and may result in symptoms akin to other psychological dependence syndromes, or behavioural addictions.^[8] The focus on problematic technology use in research, particularly in relation to the behavioural addiction paradigm, is becoming more accepted, despite poor standardisation and conflicting research.^[9]

Internet addiction has been proposed as a diagnosis since the mid-1990s,^[10] and social media and its relation to addiction has been examined since 2009.^[11] A 2018 Organisation for Economic Co-operation and Development (OECD) report noted the benefits of structured and limited internet use in children and adolescents for developmental and educational purposes, but that excessive use can have a negative impact on mental well-being. It also noted an overall 40% increase in internet use in school age children between 2010 and 2015, and that different OECD nations had marked variations in rates of childhood technology use, as well as regional differences in platforms used.^[12]

The Diagnostic and Statistical Manual of Mental Disorders has not formally codified problematic digital media use in diagnostic categories, but it deemed internet gaming disorder to be a condition for further study in 2013.^[13] Gaming disorder has been recognised in the ICD-11.^[14]^[15] Different recommendations from the DSM and the ICD are due partly to the lack of expert consensus, the differences in emphasis in the classification manuals, as well as difficulties utilising animal models for behavioural addictions.^[8]

The utility of the term addiction in relation to overuse of digital media has been questioned, in regard to its suitability to describe new, digitally mediated psychiatric categories, as opposed to overuse being a manifestation of other psychiatric disorders.^[3]^[4] Usage of the term has also been criticised for drawing parallels with substance use behaviours. Careless use of the term may cause additional problems—both downplaying the risks of harm in seriously affected people, as well as overstating risks of excessive, non-pathological use of digital media.^[4] The evolution of terminology relating to excessive digital media use to problematic use rather than addiction was encouraged by Panova and Carbonell, psychologists at Ramon Llull University, in a 2018 review.^[16]

Due to the lack of recognition and consensus on the concepts used, diagnoses and treatments are difficult to standardise or develop. Heightened levels of public anxiety around new media further obfuscate population-based assessments, as well as posing management dilemmas.^[3] Radesky and Christakis, the 2019 editors of JAMA Paediatrics, published a review that investigated "concerns about health and developmental/behavioural risks of excessive media use for child cognitive, language, literacy, and social-emotional development."^[17] Due to the ready availability of multiple technologies to children worldwide, the problem is bi-directional, as taking away digital devices may have a detrimental effect, in areas such as learning, family relationship dynamics, and overall development.^[18]

Problematic use

While associations have been observed between digital media use and mental health symptoms or diagnoses, causality has not been established, with nuances and caveats published by researchers often misunderstood by the general public, or misrepresented by the media.^[4] Several studies have shown that women are more likely to overuse social media, and men video games.^[19] This has led multiple experts cited by Hawi and Samaha of Notre Dame University – Louaize to suggest that digital media overuse may not be a singular construct, with some calling for proposed disorders to be delineated based on the digital platform used.^[20]

The rapid pace of introduction of new technologies between 2008 and 2018 has caused difficulty with timely publishing of evidence-based guidelines.^[6] Experts from the fields of psychology and psychiatry have called for further study, especially to establish whether causal relationships exist.^[21]

Mental health

A 2019 systematic map of reviews suggested associations between some types of potentially problematic internet use and psychiatric or behavioural problems such as depression, anxiety, hostility, aggression and ADHD. The studies could not determine if causal relationships exist, with reviewers emphasising the importance of prospective study designs going forward.^[2] While overuse of digital media has been associated with depressive symptoms, digital media may also be utilised in some situations to improve mood.^[22]^[23] Symptoms of ADHD have been positively correlated with digital media use in a large prospective study.^[24] The ADHD symptom of hyperfocus may cause affected people to overuse digital media such as video games or online chatting.^[25]

A 2016 technical report by Chassiakos, Radesky, and Christakis identified benefits and concerns in adolescent mental health regarding digital media use. It showed that the manner of social media use was the key factor, rather than the amount of time engaged. A decline in well-being and life satisfaction was found in older adolescents who passively consumed social media; however, these were not apparent in those who were more actively engaged. The report also found a U-shaped curvilinear relationship in the amount of time spent on digital media, with risk of depression increasing at both the low and high ends of internet use.^[5] In the United Kingdom, a study of 1,479 individuals aged 14–24 compared psychological benefits and problems of five large social media platforms: Facebook, Instagram, Snapchat, Twitter and YouTube. It concluded that YouTube was the only platform with a net positive rating "based on the 14 health and wellbeing-related questions", and the other platforms measured had net negative ratings, with Instagram having the lowest rating. The study identified Instagram as having some positive effects including self-expression, self-identity, and community, but found that these were outweighed by the negative effects, specifically on sleep, body image, and "fear of missing out".^[26]

A report published in Clinical Psychological Science in 2018 featured two cross-sectional surveys of 506,820 American high school students, and found that use of new media was associated with higher rates of depressive symptoms and suicidality. They concluded that more time engaged with electronic devices, and less time on "non-screen activities" (such as in-person social interaction, sports/exercise, homework, and attending religious services) was correlated with depressive symptoms and suicide-related outcomes (suicidal ideation, plans, and attempts), especially among girls.^[27] However, a later report in the same publication questioned the survey's research methodology, citing "inaccurate research measurements, negligible correlations between the main variables, [and] insufficient and inadequate statistical analyses".^[28]

The relationship between bipolar disorder and technology use has been investigated in a singular survey of 84 participants for Computers in Human Behavior. The survey found marked variations in technology use based on self-reported mood states. The authors of the report then postulated that for patients with bipolar disorder, technology may be a "double-edged sword", with potential benefits and harms.^[29]

Screen time

A systematic examination of reviews, published in 2019, concluded that evidence, although of mainly low to moderate quality, showed an association of screen time with a variety of health problems including: "adiposity, unhealthy diet, depressive symptoms and quality of life". They also concluded that moderate use of digital media may have benefits for young people in terms of social integration, with a curvilinear relationship found with both depressive symptoms and overall well-being.^[6] A 2017 United Kingdom large-scale study of this "Goldilocks hypothesis"—of avoiding both too much and too little digital media use^[30]—was described as the "best quality" evidence to date by experts and NGOs reporting to a 2018 UK parliamentary committee. That study concluded that modest digital media use may have few adverse affects, and even some positive associations in terms of well-being.^[1]

Proposed diagnostic categories

Gaming disorder has been considered by the DSM-5 taskforce as warranting further study, and has been included in the ICD-11.^[13] Concerns have been raised by Aarseth and colleagues over this inclusion, particularly in regard to stigmatisation of heavy gamers.^[31]

Christakis has asserted that internet addiction may be "a 21st century epidemic".^[32] In 2018, he commented that childhood internet overuse may be a form of "uncontrolled experiment[s] on [...] children".^[33] International estimates of the prevalence of internet overuse have varied considerably, with marked variations by nation. A 2014 meta-analysis of 31 nations yielded an overall worldwide prevalence of six percent.^[34] A different perspective in 2018 by Musetti and colleagues reappraised the internet in terms of its necessity and ubiquity in modern society, as a social environment, rather than a tool, thereby calling for the reformulation of the internet addiction model.^[35]

Some medical and behavioural scientists recommend adding a diagnosis of "social media addiction" (or similar) to the next Diagnostic and Statistical Manual of Mental Disorders update.^[36]^[37] A 2015 review concluded there was a probable link between basic psychological needs and social media addiction. "Social network site users seek feedback, and they get it from hundreds of people—instantly. It could be argued that the platforms are designed to get users 'hooked'."^[38]

Internet sex addiction, also known as cybersex addiction, has been proposed as a sexual addiction characterised by virtual internet sexual activity that causes serious negative consequences to one's physical, mental, social, and/or financial well-being, in several papers cited in a 2009 textbook of anxiety disorders published by the American Psychiatric Association.^[39]^[40] It may be considered a form of problematic internet use.^[41]

Related phenomena

Online problem gambling

A 2015 review found evidence of higher rates of mental health comorbidities, as well as higher amounts of substance use, among internet gamblers, compared to non-internet gamblers. Causation, however, has not been established. The review postulates that there may be differences in the cohorts between internet and land-based problem gamblers.^[43]

Cyberbullying

Cyberbullying, bullying or harassment using social media or other electronic means, has been shown to have effects on mental health. Victims may have lower self-esteem, increased suicidal ideation, and a variety of emotional responses, including being scared, frustrated, angry or depressed.^[44]

According to the EU Kids Online project, the incidence of cyberbullying across seven European countries in children aged 8–16 increased from 8% to 12% between 2010 and 2014. Similar increases were shown in the United States and Brazil.^[45]

Media multitasking

Concurrent use of multiple digital media streams, commonly known as media multitasking, has been shown to be associated with depressive symptoms, social anxiety, impulsivity, sensation seeking, lower perceived social success and neuroticism.^[46] A 2018 review found that while the literature is sparse and inconclusive, overall, heavy media multitaskers also have poorer performance in several cognitive domains.^[47] One of the authors commented that the data does not "unambiguously show that media multitasking causes a change in attention and memory", but that it is not efficient, and one may argue to multitask less on digital media to be more productive and efficient.^[48]

Assessment and treatment

Rigorous, evidence-based assessment of problematic digital media use is yet to be comprehensively established. This is due partially to a lack of consensus around the various constructs and lack of standardization of treatments.^[49] The American Academy of Pediatrics (AAP) has developed a Family Media Plan, intending to help parents assess and structure their family's use of electronic devices and media more safely. It recommends limiting entertainment screen time to two hours or less per day.^[50]^[51] The Canadian Paediatric Society produced a similar guideline. Ferguson, a psychologist, has criticised these and other national guidelines for not being evidence-based.^[52] Other experts have recommended addressing potential underlying problems rather than arbitrarily enforcing screen time limits, as commented in a 2017 UNICEF Office of Research literature review.^[4]

A number of different methodologies of assessing pathological internet use have been developed, mostly self-report questionnaires, however none have been universally recognised as a gold standard.^[53] For gaming disorder, both the American Psychiatric Association^[54] and the World Health Organization (through the ICD-11)^[14] have released diagnostic criteria.

There is some limited evidence of the effectiveness of cognitive behavioural therapy and family-based interventions for treatment. Medications have not been shown to be effective in randomised controlled trials.^[49] A 2016 study of 901 adolescents suggested mindfulness may assist in preventing and treating problematic internet use.^[55] A 2019 United Kingdom parliamentary report deemed parental engagement, awareness and support to be essential in developing "digital resilience" for young people, and to identify and manage the risks of harm online.^[1] Treatment centres have proliferated in some countries, and China and South Korea have treated digital dependence as a public health crisis, with 300 and 190 centres opened nationwide, respectively.^[56] Other countries have also opened treatment centres.^[57]^[58]

A review published in Dao investigated internet addiction and its effects on well-being from a philosophical perspective. They suggested possible amelioration by reflecting on ancient Eastern and Western philosophies, as they "may give us inspiration to confront the challenges of technological enslavement in general". They recommended revisiting the ancient wisdom from both Daoist and Stoic philosophies, "as a way of restoring the importance of a reflective mind for the purpose of enhancing our individual and collective well-being".^[59]

NGOs, support and advocacy groups provide resources to people overusing digital media, with or without codified diagnoses,^[60]^[61] including the American Academy of Child and Adolescent Psychiatry.^[62]^[63]

Mental health benefits

Individuals with mental illness can develop social connections over social media, that develop a sense of social inclusion in online communities.^[5] Sufferers of mental illness may share personal stories in a perceived safer space, as well as gaining peer support for developing coping strategies.^[5] People with mental illness are likely to report avoiding stigma and gaining further insight into their mental health condition by using social media. However, this comes with the risk of unhealthy influences, misinformation, and delayed access to traditional mental health outlets.^[5]

Other benefits include connections to supportive online communities, including illness or disability specific communities, as well as the LGBTQI community. Furthermore, in children, the educational benefits of digital media use are well established.^[5]

Other disciplines

As public awareness of the potential effects of digital media on mental health increases, scholars in several disciplines continue to work on assessment, improving understanding, and developing innovative solutions.

Digital anthropology

Daniel Miller from University College London has contributed to the study of digital anthropology, especially ethnographic research on the use and consequences of social media and smartphones as part of the everyday life of ordinary people around the world. He notes the effects of social media are very specific to individual locations and cultures. He contends "a layperson might dismiss these stories as superficial. But the anthropologist takes them seriously, empathetically exploring each use of digital technologies in terms of the wider social and cultural context."^[64]

Digital anthropology is a developing field which studies the relationship between humans and digital-era technology. It aims to consider arguments in terms of ethical and societal scopes, rather than simply observing technological changes.^[65] Brian Solis, a digital analyst, anthropologist and keynote speaker working in the field, stated in 2018, "we've become digital addicts: it's time to take control of technology and not let tech control us".^[66]

Digital sociology

Digital sociology explores how people utilise digital media using various research methodologies, including surveys, interviews, focus groups, and ethnographic research. It intersects with digital anthropology, and studies cultural geography. It also investigates longstanding concerns, and contexts around young people's overuse of "these technologies, their access to online pornography, cyber bullying or online sexual predation".^[67]

A 2012 cross-sectional sociological study in Turkey showed differences in patterns of internet use that related to levels of religiosity in 2,698 subjects. With increasing religiosity, negative attitudes towards internet use increased. However, highly religious people showed different motivations for internet use, predominantly searching for information.^[68] A study of 1,296 Malaysian adolescent students found an inverse relationship between religiosity and internet addiction tendency in females, but not males.^[69]

A 2018 review published in Nature considered that young people may have different experiences online, depending on their socio-economic background, noting lower-income youths may spend up to three hours more per day using digital devices, compared to higher-income youths.^[70] They theorised that these same groups, that are already vulnerable to mental illness, may be more passive in their online engagements, being more susceptible to negative feedback online, with difficulty self-regulating their digital media use. It concluded this may be a new form of digital divide between at-risk young people and other young people, with pre-existing risks of mental illness becoming amplified amongst the already vulnerable population.^[70]

Neuroscience

Dar Meshi and colleagues noted in 2015 that "[n]euroscientists are beginning to capitalise on the ubiquity of social media use to gain novel insights about social cognitive processes".^[71] A 2018 neuroscientific review published in Nature found the density of the amygdala, a brain region involved in emotional processing, is related to the size of both offline and online social networks in adolescents. They considered that this and other evidence "suggests an important interplay between actual social experiences, both offline and online, and brain development". The authors postulated that social media may have benefits, namely social connections with other people, as well as managing impressions people have of other people such as "reputation building, impression management, and online self-presentation". It identified "adolescence [as] a tipping point in development for how social media can influence their self-concept and expectations of self and others", and called for further study into the neuroscience behind digital media use and brain development in adolescence.^[72] Although brain imaging modalities are under study, often neuroscientific findings in individual studies of digital media use patterns, similar to other behavioural addictions, fail to be replicated in further studies, and as of 2017,^[update] the exact biological or neural processes that could lead to excessive digital media use are unknown.^[4]

Digital technology use in mental health care

Digital technologies have also provided opportunities for delivery of mental health care online, with some benefits shown with cognitive behavioural therapy for depression and anxiety.^[73] Research of digital health interventions in young people is preliminary with a meta-review unable to draw firm conclusions because of problems in research methodology.^[74] However, potential benefits by one review include "the flexibility, interactivity, and spontaneous nature of mobile communications [...] in encouraging persistent and continual access to care outside clinical settings".^[75] Mindfulness as an online intervention has been shown to have small to moderate benefits on mental health. Psychological stress (the perceived ability to cope with life's demands) has shown the highest effect size, and benefits have also been shown in depression, anxiety, and well-being.^[76] Smartphone applications have proliferated in many mental health domains, with "demonstrably effective" recommendations from one 2016 review encouraging cognitive behavioural therapy, addressing both anxiety and mood. The review, however called for randomised controlled trials to validate their recommendations.^[73]

The Lancet commission on global mental health and sustainability report from 2018 evaluated both benefits and harms of technology. It considered the roles of various technologies in mental health, particularly in public education; patient screening; treatment; training and supervision; and system improvement. Digital media use in healthcare is unregulated in most countries.^[77]

Response of large technology firms

Various technology firms have implemented changes to mitigate the negative effects of excessive internet use. In December 2017, Facebook admitted passive consumption of social media could be harmful to mental health, although they said active engagement can have a positive effect. In January 2018, the platform made major changes to increase user engagement.^[78] In January 2019, Facebook's then head of global affairs, Nick Clegg, responding to criticisms of Facebook and mental health concerns, stated they would do "whatever it takes to make this environment safer online especially for youngsters". Facebook admitted "heavy responsibilities" to the global community, and invited regulation by governments.^[79] In 2018 Facebook and Instagram announced new tools that they asserted may assist with overuse of their products.^[80] In 2019, Instagram, which has been investigated specifically in one study in terms of addiction,^[81] began testing a platform change in Canada to hide the number of "likes" and views that photos and videos received in an effort to create a "less pressurised" environment.^[82] It then continued this trial in Australia, Italy, Ireland, Japan, Brazil and New Zealand.^[83] The platform also developed artificial intelligence to counter cyberbullying.^[84]

In 2018, Alphabet Inc released an update for Android smartphones, including a dashboard app enabling users to set timers on application use.^[85] Apple Inc purchased a third-party application and then incorporated it in iOS 12 to measure "screen time".^[86] However, journalists have questioned the functionality for users and for parents and companies' motivations for these interventions.^[85]^[87]

Two institutional investors in Apple Inc, JANA Partners LLC and the California State Teachers' Retirement System, stated in 2018 that they "believe[d] both the content and the amount of time spent on phones need to be tailored to youths". They called on Apple Inc to act before regulators and consumers potentially force them to do so.^[88]^[89] Apple Inc responded that they have, "always looked out for kids, and [they] work hard to create powerful products that inspire, entertain, and educate children while also helping parents protect them online". The firm is planning new features that they asserted may allow them to play a pioneering role in regards to young people's health.^[90]

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External links

Media related to Digital media use and mental health at Wikimedia Commons
Anthropology of Social Media: Why We Post, University College London, Free online five-week course, asking "What are the consequences of social media?"

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 ==History and terminology==
 [[File:Boysmartphone.jpg|thumb|alt=A child looks into a smartphone|right|A young boy engaged with a smartphone]]
-The relationship between digital technology and mental health has been investigated from many perspectives.<ref name=":16">{{cite web|url=http://eppi.ioe.ac.uk/cms/Portals/0/PDF%20reviews%20and%20summaries/Systematic%20Map%20of%20Reviews%20on%20Screen-based%20activties_08.01.19.pdf?ver=2019-01-29-155200-517|title=Screen-based activities and children and young people's mental health: A Systematic Map of Reviews|last=Dickson|first=K|last2=Richardson|first2=M|date=2019-01-01|website=Department of Health Reviews Facility|publisher=[[EPPI-Centre]], Social Science Research Unit, UCL Institute of Education, University College London|archive-url=https://web.archive.org/web/20190211144646/http://eppi.ioe.ac.uk/cms/Portals/0/PDF%20reviews%20and%20summaries/Systematic%20Map%20of%20Reviews%20on%20Screen-based%20activties_08.01.19.pdf?ver=2019-01-29-155200-517|archive-date=2019-02-11|dead-url=|access-date=2019-05-15|last3=Kwan|first3=I|last4=MacDowall|first4=W|last5=Burchett|first5=H|last6=Stansfield|first6=C|last7=Brunton|first7=G|last8=Sutcliffe|first8=K|last9=Thomas|first9=J|url-status=live}}</ref><ref name=":10" /><ref name=":12">{{cite web|url=https://www.unicef-irc.org/publications/pdf/Children-digital-technology-wellbeing.pdf|title=How does the time children spend using digital technology impact their mental well-being, social relationships and physical activity? – An evidence-focused literature review|last=Kardefelt-Winther|first=Daniel|date=2017-02-01|website=[[UNICEF]] Office of Research – Innocenti|publisher=[[UNICEF]] Office of Research|archive-url=https://web.archive.org/web/20190705215123/https://www.unicef-irc.org/publications/pdf/Children-digital-technology-wellbeing.pdf|archive-date=2019-07-05|dead-url=|access-date=2019-05-12|name-list-format=vanc|url-status=live}}</ref> Benefits of digital media use in childhood and adolescent development have been found.<ref name=":18">{{cite journal | vauthors = Reid Chassiakos YL, Radesky J, Christakis D, Moreno MA, Cross C | title = Children and Adolescents and Digital Media | journal = [[Pediatrics (journal)|Pediatrics]] | volume = 138 | issue = 5 | pages = e20162593 | date = November 2016 | pmid = 27940795 | doi = 10.1542/peds.2016-2593 }}</ref> However, concerns have been expressed by researchers, clinicians and the public in regard to apparent compulsive behaviours of digital media users with correlations between technology overuse and mental health problems becoming apparent.<ref name=":16" /><ref name=":15">{{cite journal | vauthors = Stiglic N, Viner RM | title = Effects of screentime on the health and well-being of children and adolescents: a systematic review of reviews | journal = [[BMJ Open]] | volume = 9 | issue = 1 | pages = e023191 | date = January 2019 | pmid = 30606703 | pmc = 6326346 | doi = 10.1136/bmjopen-2018-023191 }}</ref>
+The relationship between digital technology and mental health has been investigated from many perspectives.<ref name=":16">{{cite web|url=http://eppi.ioe.ac.uk/cms/Portals/0/PDF%20reviews%20and%20summaries/Systematic%20Map%20of%20Reviews%20on%20Screen-based%20activties_08.01.19.pdf?ver=2019-01-29-155200-517|title=Screen-based activities and children and young people's mental health: A Systematic Map of Reviews|last=Dickson|first=K|last2=Richardson|first2=M|date=2019-01-01|website=Department of Health Reviews Facility|publisher=[[EPPI-Centre]], Social Science Research Unit, UCL Institute of Education, University College London|archive-url=https://web.archive.org/web/20190211144646/http://eppi.ioe.ac.uk/cms/Portals/0/PDF%20reviews%20and%20summaries/Systematic%20Map%20of%20Reviews%20on%20Screen-based%20activties_08.01.19.pdf?ver=2019-01-29-155200-517|archive-date=2019-02-11|access-date=2019-05-15|last3=Kwan|first3=I|last4=MacDowall|first4=W|last5=Burchett|first5=H|last6=Stansfield|first6=C|last7=Brunton|first7=G|last8=Sutcliffe|first8=K|last9=Thomas|first9=J|url-status=live}}</ref><ref name=":10" /><ref name=":12">{{cite web|url=https://www.unicef-irc.org/publications/pdf/Children-digital-technology-wellbeing.pdf|title=How does the time children spend using digital technology impact their mental well-being, social relationships and physical activity? – An evidence-focused literature review|last=Kardefelt-Winther|first=Daniel|date=2017-02-01|website=[[UNICEF]] Office of Research – Innocenti|publisher=[[UNICEF]] Office of Research|archive-url=https://web.archive.org/web/20190705215123/https://www.unicef-irc.org/publications/pdf/Children-digital-technology-wellbeing.pdf|archive-date=2019-07-05|access-date=2019-05-12|name-list-format=vanc|url-status=live}}</ref> Benefits of digital media use in childhood and adolescent development have been found.<ref name=":18">{{cite journal | vauthors = Reid Chassiakos YL, Radesky J, Christakis D, Moreno MA, Cross C | title = Children and Adolescents and Digital Media | journal = [[Pediatrics (journal)|Pediatrics]] | volume = 138 | issue = 5 | pages = e20162593 | date = November 2016 | pmid = 27940795 | doi = 10.1542/peds.2016-2593 }}</ref> However, concerns have been expressed by researchers, clinicians and the public in regard to apparent compulsive behaviours of digital media users with correlations between technology overuse and mental health problems becoming apparent.<ref name=":16" /><ref name=":15">{{cite journal | vauthors = Stiglic N, Viner RM | title = Effects of screentime on the health and well-being of children and adolescents: a systematic review of reviews | journal = [[BMJ Open]] | volume = 9 | issue = 1 | pages = e023191 | date = January 2019 | pmid = 30606703 | pmc = 6326346 | doi = 10.1136/bmjopen-2018-023191 }}</ref>
 Terminology used to refer to compulsive digital-media-use behaviours are not standardised or universally recognized. They include "digital addiction", "digital dependence", "problematic use", or "overuse", often delineated by the digital media platform used or under study (such as [[problematic smartphone use]] or [[problematic internet use]]).<ref>{{cite journal|vauthors=Stiglic N, Viner RM|date=January 2019|title=Effects of screentime on the health and well-being of children and adolescents: a systematic review of reviews|journal=[[BMJ Open]]|volume=9|issue=1|pages=e023191|doi=10.1136/bmjopen-2018-023191|pmc=6326346|pmid=30606703}}<br />{{bull}}{{cite book|title=Are we all addicts now? : digital dependence|last1=Beales|first1=Katriona|last2=MacDonald|first2=Fiona|last3=Bartlett|first3=Vanessa|last4=Bowden-Jones|first4=Henrietta|publisher=Liverpool University Press|year=2017|isbn=978-1-78694-081-0|location=Liverpool|pages=|oclc=988053669|name-list-format=vanc}}<br />{{bull}}{{cite journal|vauthors=Pantic I|date=October 2014|title=Online social networking and mental health|url=|journal=Cyberpsychology, Behavior and Social Networking|volume=17|issue=10|pages=652–657|doi=10.1089/cyber.2014.0070|pmc=4183915|pmid=25192305}}<br />{{bull}}{{cite journal|vauthors=Kuss DJ, Griffiths MD|date=March 2017|title=Social Networking Sites and Addiction: Ten Lessons Learned|journal=[[International Journal of Environmental Research and Public Health]]|volume=14|issue=3|pages=311|doi=10.3390/ijerph14030311|pmc=5369147|pmid=28304359}}<br />{{bull}}{{cite web|url=https://www.steinereducation.edu.au/wp-content/uploads/uk_screen_time.pdf|title=The Impact Of Screen Media On Children: A Eurovision For Parliament|last1=Sigman|first1=Aric|website=Steiner Education Australia (reprint of original speech)|archive-url=https://web.archive.org/web/20190317061823/https://www.steinereducation.edu.au/wp-content/uploads/uk_screen_time.pdf|archive-date=17 March 2019|url-status=live|access-date=10 January 2019|name-list-format=vanc}}</ref> Unrestrained use of technological devices may affect developmental, social, mental and physical well-being and may result in symptoms akin to other [[Psychological dependence|psychological dependence syndromes]], or [[behavioural addiction]]s.<ref name="ReferenceA">{{cite journal | vauthors = Grant JE, Chamberlain SR | title = Expanding the definition of addiction: DSM-5 vs. ICD-11 | journal = CNS Spectrums | volume = 21 | issue = 4 | pages = 300–303 | date = August 2016 | pmid = 27151528 | pmc = 5328289 | doi = 10.1017/S1092852916000183 }}</ref> The focus on problematic technology use in research, particularly in relation to the behavioural addiction paradigm, is becoming more accepted, despite poor standardisation and conflicting research.<ref>{{Cite journal|last=Ellis|first=David A.|date=2019-08-01|title=Are smartphones really that bad? Improving the psychological measurement of technology-related behaviors|journal=[[Computers in Human Behavior]]|volume=97|pages=60–66|doi=10.1016/j.chb.2019.03.006|issn=0747-5632}}</ref>
-Internet addiction has been proposed as a diagnosis since the mid-1990s,<ref>{{cite book|title=Caught in the net : how to recognize the signs of internet addiction--and a winning strategy for recovery|last=Young|first=Kimberly|date=27 February 1998|publisher=Wiley|isbn=978-0-471-19159-9|location=New York, New York|pages=|oclc=38130573|name-list-format=vanc}}</ref> and social media and its relation to addiction has been examined since 2009.<ref>{{cite journal | vauthors = La Barbera D, La Paglia F, Valsavoia R | title = Social network and addiction | journal = Studies in Health Technology and Informatics | volume = 144 | pages = 33–36 | date = 2009 | pmid = 19592725 }}</ref> A 2018 [[OECD|Organisation for Economic Co-operation and Development]] (OECD) report noted the benefits of structured and limited internet use in children and adolescents for development and education, and that excessive digital media use is associated with mental illness. It also noted an overall 40% increase in internet use in school age children between 2010 and 2015, and that different OECD nations had marked variations in rates of childhood technology use, as well as regional differences in platforms used.<ref>{{cite web|url=http://www.oecd.org/els/health-systems/Children-and-Young-People-Mental-Health-in-the-Digital-Age.pdf|title=Children & Young People's Mental Health in the Digital Age|last=Cornford|first=Kate|name-list-format=vanc|date=2018|website=OECD.org|access-date=2019-03-22|archive-url=https://web.archive.org/web/20190111123203/http://www.oecd.org/els/health-systems/Children-and-Young-People-Mental-Health-in-the-Digital-Age.pdf|archive-date=2019-01-11|url-status=live}}</ref>
+Internet addiction has been proposed as a diagnosis since the mid-1990s,<ref>{{cite book|title=Caught in the net : how to recognize the signs of internet addiction--and a winning strategy for recovery|last=Young|first=Kimberly|date=27 February 1998|publisher=Wiley|isbn=978-0-471-19159-9|location=New York, New York|pages=|oclc=38130573|name-list-format=vanc}}</ref> and social media and its relation to addiction has been examined since 2009.<ref>{{cite journal | vauthors = La Barbera D, La Paglia F, Valsavoia R | title = Social network and addiction | journal = Studies in Health Technology and Informatics | volume = 144 | pages = 33–36 | date = 2009 | pmid = 19592725 }}</ref> A 2018 [[OECD|Organisation for Economic Co-operation and Development]] (OECD) report noted the benefits of structured and limited internet use in children and adolescents for developmental and educational purposes, but that excessive use can have a negative impact on mental well-being. It also noted an overall 40% increase in internet use in school age children between 2010 and 2015, and that different OECD nations had marked variations in rates of childhood technology use, as well as regional differences in platforms used.<ref>{{cite web|url=http://www.oecd.org/els/health-systems/Children-and-Young-People-Mental-Health-in-the-Digital-Age.pdf|title=Children & Young People's Mental Health in the Digital Age|last=Cornford|first=Kate|name-list-format=vanc|date=2018|website=OECD.org|access-date=2019-03-22|archive-url=https://web.archive.org/web/20190111123203/http://www.oecd.org/els/health-systems/Children-and-Young-People-Mental-Health-in-the-Digital-Age.pdf|archive-date=2019-01-11|url-status=live}}</ref>
-The ''Diagnostic and Statistical Manual of Mental Disorders'' has not formally codified problematic digital media use in diagnostic categories, but it deemed internet gaming disorder to be a condition for further study in 2013.<ref name=":17">{{cite web | first = Ranna | last = Parekh | name-list-format = vanc | url = https://www.psychiatry.org/patients-families/internet-gaming | title = Internet Gaming | work = The American Psychiatric Association | access-date = 10 May 2019 | archive-url = https://web.archive.org/web/20190526172908/https://www.psychiatry.org/patients-families/internet-gaming | archive-date = 2019-05-26 |url-status=live }}</ref> Gaming disorder has been recognised in the ICD-11.<ref name=":1">{{cite web|url=http://www.who.int/features/qa/gaming-disorder/en/|title=Gaming disorder|date=September 2018|website=Gaming disorder|publisher=[[World Health Organisation]]|access-date=2019-05-10|archive-url=https://web.archive.org/web/20190206190538/https://www.who.int/features/qa/gaming-disorder/en/|archive-date=2019-02-06|url-status=live}}</ref><ref>{{cite web|url=https://icd.who.int/browse11/l-m/en#/http://id.who.int/icd/entity/1448597234|title=ICD-11 – Mortality and Morbidity Statistics|website=icd.who.int|access-date=2019-05-11|archive-url=https://archive.today/20180801205234/https://icd.who.int/browse11/l-m/en%23/http://id.who.int/icd/entity/294762853#/http://id.who.int/icd/entity/1448597234|archive-date=2018-08-01|url-status=live}}</ref> Different recommendations from the DSM and the ICD are due partly to the lack of   expert consensus, the differences in emphasis in the classification manuals, as well as difficulties utilising animal models for behavioural addictions.<ref name="ReferenceA"/>
+The ''Diagnostic and Statistical Manual of Mental Disorders'' has not formally codified problematic digital media use in diagnostic categories, but it deemed internet gaming disorder to be a condition for further study in 2013.<ref name=":17">{{cite web | first = Ranna | last = Parekh | name-list-format = vanc | url = https://www.psychiatry.org/patients-families/internet-gaming | title = Internet Gaming | work = The American Psychiatric Association | access-date = 10 May 2019 | archive-url = https://web.archive.org/web/20190526172908/https://www.psychiatry.org/patients-families/internet-gaming | archive-date = 2019-05-26 |url-status=live }}</ref> Gaming disorder has been recognised in the [[ICD-11]].<ref name=":1">{{cite web|url=http://www.who.int/features/qa/gaming-disorder/en/|title=Gaming disorder|date=September 2018|website=Gaming disorder|publisher=[[World Health Organisation]]|access-date=2019-05-10|archive-url=https://web.archive.org/web/20190206190538/https://www.who.int/features/qa/gaming-disorder/en/|archive-date=2019-02-06|url-status=live}}</ref><ref>{{cite web|url=https://icd.who.int/browse11/l-m/en#/http://id.who.int/icd/entity/1448597234|title=ICD-11 – Mortality and Morbidity Statistics|website=icd.who.int|access-date=2019-05-11|archive-url=https://archive.today/20180801205234/https://icd.who.int/browse11/l-m/en%23/http://id.who.int/icd/entity/294762853#/http://id.who.int/icd/entity/1448597234|archive-date=2018-08-01|url-status=live}}</ref> Different recommendations from the DSM and the ICD are due partly to the lack of   expert consensus, the differences in emphasis in the classification manuals, as well as difficulties utilising [[Model organism|animal models]] for behavioural addictions.<ref name="ReferenceA"/>
-The utility of the term ''addiction'' in relation to overuse of digital media has been questioned, in regard to its suitability to describe new, digitally mediated psychiatric categories, as opposed to overuse being a manifestation of other psychiatric disorders.<ref name=":10" /><ref name=":12" /> Usage of the term has also been criticised for drawing parallels with substance use behaviours. Careless use of the term may cause additional problems—both downplaying the risks of harm in seriously affected people, as well as overstating risks of excessive, non-pathological  use of digital media.<ref name=":12" /> The evolution of terminology relating to excessive digital media use to ''problematic use'' rather than ''addiction'' was encouraged by Panova and Carbonell in a  2018 review.<ref>{{Cite journal|last=Panova|first=Tayana|last2=Carbonell|first2=Xavier|date=2018-06-01|title=Is smartphone addiction really an addiction?|journal=Journal of Behavioral Addictions|language=en|volume=7|issue=2|pages=252–259|doi=10.1556/2006.7.2018.49|pmid=29895183|pmc=6174603|issn=2062-5871}}</ref>
+The utility of the term ''addiction'' in relation to overuse of digital media has been questioned, in regard to its suitability to describe new, digitally mediated psychiatric categories, as opposed to overuse being a manifestation of other psychiatric disorders.<ref name=":10" /><ref name=":12" /> Usage of the term has also been criticised for drawing parallels with substance use behaviours. Careless use of the term may cause additional problems—both downplaying the risks of harm in seriously affected people, as well as overstating risks of excessive, non-pathological  use of digital media.<ref name=":12" /> The evolution of terminology relating to excessive digital media use to ''problematic use'' rather than ''addiction'' was encouraged by Panova and Carbonell, psychologists at [[Ramon Llull University]], in a 2018 review.<ref>{{Cite journal|last=Panova|first=Tayana|last2=Carbonell|first2=Xavier|date=2018-06-01|title=Is smartphone addiction really an addiction?|journal=Journal of Behavioral Addictions|language=en|volume=7|issue=2|pages=252–259|doi=10.1556/2006.7.2018.49|pmid=29895183|pmc=6174603|issn=2062-5871}}</ref>
-Due to the lack of recognition and consensus on the concepts used, diagnoses and treatments are difficult to standardise or develop. Heightened levels of public anxiety around new media further obfuscate population based assessments, as well as posing management dilemmas.<ref name=":10">{{cite journal | vauthors = Ryding FC, Kaye LK | title="Internet Addiction": a Conceptual Minefield | journal = International Journal of Mental Health and Addiction | volume = 16 | issue = 1 | pages = 225–232 | date = 2018 | pmid = 29491771 | pmc = 5814538 | doi = 10.1007/s11469-017-9811-6 }}</ref> Radeski and Christiakis, the 2019 editors of [[JAMA Pediatrics|JAMA Paediatrics]], published a review that investigated "concerns about health and developmental/behavioural risks of excessive media use for child cognitive, language, literacy, and social-emotional development."<ref>{{cite journal | vauthors = Radesky JS, Christakis DA | title = Increased Screen Time: Implications for Early Childhood Development and Behavior | journal = [[Pediatric Clinics of North America]] | volume = 63 | issue = 5 | pages = 827–839 | date = October 2016 | pmid = 27565361 | doi = 10.1016/j.pcl.2016.06.006 }}</ref> Due to the ready availability of multiple technologies to children worldwide, the problem is bi-directional, as taking away digital devices may have a detrimental effect, in areas such as learning, family relationship dynamics, and overall development.<ref>{{cite journal|last=Hsin|first=Chong-Ting | name-list-format = vanc |year=2014|title=The Influence of Young Children's Use of Technology on Their Learning: A Review|journal=[[Journal of Educational Technology & Society]]|volume=17|issue=4|pages=85–99|jstor=jeductechsoci.17.4.85|via=}}<br />{{bull}}{{cite journal| vauthors = Gordo López AJ, Contreras PP, Cassidy P |date=2015-08-01|title=The [not so] new digital family: disciplinary functions of representations of children and technology|journal=Feminism & Psychology|volume=25|issue=3|pages=326–346|doi=10.1177/0959353514562805}}<br />{{bull}}{{cite journal | vauthors = Subrahmanyam K, Kraut RE, Greenfield PM, Gross EF | title = The impact of home computer use on children's activities and development | journal = [[The Future of Children]] | volume = 10 | issue = 2 | pages = 123–144 | date = 22 September 2000 | pmid = 11255703 | doi = 10.2307/1602692 | jstor = 1602692 }}</ref>
+Due to the lack of recognition and consensus on the concepts used, diagnoses and treatments are difficult to standardise or develop. Heightened levels of public anxiety around new media further obfuscate population-based assessments, as well as posing management dilemmas.<ref name=":10">{{cite journal | vauthors = Ryding FC, Kaye LK | title="Internet Addiction": a Conceptual Minefield | journal = International Journal of Mental Health and Addiction | volume = 16 | issue = 1 | pages = 225–232 | date = 2018 | pmid = 29491771 | pmc = 5814538 | doi = 10.1007/s11469-017-9811-6 }}</ref> Radesky and Christakis, the 2019 editors of ''[[JAMA Pediatrics|JAMA Paediatrics]]'', published a review that investigated "concerns about health and developmental/behavioural risks of excessive media use for child cognitive, language, literacy, and social-emotional development."<ref>{{cite journal | vauthors = Radesky JS, Christakis DA | title = Increased Screen Time: Implications for Early Childhood Development and Behavior | journal = [[Pediatric Clinics of North America]] | volume = 63 | issue = 5 | pages = 827–839 | date = October 2016 | pmid = 27565361 | doi = 10.1016/j.pcl.2016.06.006 }}</ref> Due to the ready availability of multiple technologies to children worldwide, the problem is bi-directional, as taking away digital devices may have a detrimental effect, in areas such as learning, family relationship dynamics, and overall development.<ref>{{cite journal|last=Hsin|first=Chong-Ting | name-list-format = vanc |year=2014|title=The Influence of Young Children's Use of Technology on Their Learning: A Review|journal=[[Journal of Educational Technology & Society]]|volume=17|issue=4|pages=85–99|jstor=jeductechsoci.17.4.85|via=}}<br />{{bull}}{{cite journal| vauthors = Gordo López AJ, Contreras PP, Cassidy P |date=2015-08-01|title=The [not so] new digital family: disciplinary functions of representations of children and technology|journal=Feminism & Psychology|volume=25|issue=3|pages=326–346|doi=10.1177/0959353514562805}}<br />{{bull}}{{cite journal | vauthors = Subrahmanyam K, Kraut RE, Greenfield PM, Gross EF | title = The impact of home computer use on children's activities and development | journal = [[The Future of Children]] | volume = 10 | issue = 2 | pages = 123–144 | date = 22 September 2000 | pmid = 11255703 | doi = 10.2307/1602692 | jstor = 1602692 }}</ref>
 ==Problematic use==
-While associations have been observed between digital media use and mental health symptoms or diagnoses, causality has not been established, with nuances and caveats published by researchers often misunderstood by the general public, or misrepresented by the media.<ref name=":12" /> Several studies have shown that women are more likely to overuse social media, and men video games.<ref>{{cite journal |vauthors=Hawi N, Samaha M |date=August 2019 |title=Identifying commonalities and differences in personality characteristics of internet and social media addiction profiles: traits, self-esteem, and self-construal |journal=[[Behaviour & Information Technology]] |volume=38 |issue=2 |pages=110–119 |doi=10.1080/0144929X.2018.1515984 |url=https://www.researchgate.net/publication/327328659 }}<br />{{bull}}{{cite journal | vauthors = Kuss DJ, Griffiths MD | title = Social Networking Sites and Addiction: Ten Lessons Learned | journal = [[International Journal of Environmental Research and Public Health]] | volume = 14 | issue = 3 | pages = 311 | date = March 2017 | pmid = 28304359 | pmc = 5369147 | doi = 10.3390/ijerph14030311 }}<br />{{bull}}{{cite journal| vauthors = Van Deursen AJ, Bolle CL, Hegner SM, Kommers PA |date=2015-04-01|title=Modeling habitual and addictive smartphone behavior|journal=[[Computers in Human Behavior]]|volume=45|pages=411–420|doi=10.1016/j.chb.2014.12.039|issn=0747-5632}}<br />{{bull}}{{cite journal | vauthors = Dong G, Wang J, Yang X, Zhou H | title = Risk personality traits of internet addiction: a longitudinal study of internet-addicted Chinese university students | journal = Asia-Pacific Psychiatry | volume = 5 | issue = 4 | pages = 316–321 | date = December 2013 | pmid = 23857796 | doi = 10.1111/j.1758-5872.2012.00185.x }}<br />{{bull}}{{cite journal | vauthors = Wittek CT, Finserås TR, Pallesen S, Mentzoni RA, Hanss D, Griffiths MD, Molde H | title = Prevalence and Predictors of Video Game Addiction: A Study Based on a National Representative Sample of Gamers | journal = International Journal of Mental Health and Addiction | volume = 14 | issue = 5 | pages = 672–686 | date = 23 September 2015 | pmid = 27688739 | pmc = 5023737 | doi = 10.1007/s11469-015-9592-8 }}<br />{{bull}}{{cite journal | vauthors = Andreassen CS, Pallesen S, Griffiths MD | title = The relationship between addictive use of social media, narcissism, and self-esteem: Findings from a large national survey | journal = [[Addictive Behaviors]] | volume = 64 | pages = 287–293 | date = January 2017 | pmid = 27072491 | doi = 10.1016/j.addbeh.2016.03.006 | url = http://irep.ntu.ac.uk/id/eprint/27358/1/PubSub5118_Griffiths.pdf | access-date = 2019-01-08 | archive-url = https://web.archive.org/web/20180920234347/http://irep.ntu.ac.uk/id/eprint/27358/1/PubSub5118_Griffiths.pdf | archive-date = 2018-09-20 |url-status=live }}</ref> This has led multiple experts cited by Hawi and colleagues to suggest that digital media overuse may not be a singular construct, with some calling for proposed disorders to be delineated based on the type of digital media used.<ref>{{cite journal | vauthors = Hawi N, Samaha M |date= August 2019 |title=Identifying commonalities and differences in personality characteristics of internet and social media addiction profiles: traits, self-esteem, and self-construal |journal=[[Behaviour & Information Technology]] |volume=38 |issue=2 |pages=110–119 |doi=10.1080/0144929X.2018.1515984 |url=https://www.researchgate.net/publication/327328659 }}<br />{{bull}}{{cite journal | vauthors = Starcevic V, Aboujaoude E | title = Internet addiction: reappraisal of an increasingly inadequate concept | journal = CNS Spectrums | volume = 22 | issue = 1 | pages = 7–13 | date = February 2017 | pmid = 26831456 | doi = 10.1017/s1092852915000863 }}<br />{{bull}}{{cite journal| vauthors = Van Rooij AJ, Meerkerk GJ, Schoenmakers TM, Griffiths M, Van de Mheen D |date=2010-08-26|title=Video game addiction and social responsibility|journal=Addiction Research & Theory|volume=18|issue=5|pages=489–493|doi=10.3109/16066350903168579|issn=1606-6359}}</ref>
+While associations have been observed between digital media use and mental health symptoms or diagnoses, causality has not been established, with nuances and caveats published by researchers often misunderstood by the general public, or misrepresented by the media.<ref name=":12" /> Several studies have shown that women are more likely to overuse social media, and men video games.<ref>{{cite journal |vauthors=Hawi N, Samaha M |date=August 2019 |title=Identifying commonalities and differences in personality characteristics of internet and social media addiction profiles: traits, self-esteem, and self-construal |journal=[[Behaviour & Information Technology]] |volume=38 |issue=2 |pages=110–119 |doi=10.1080/0144929X.2018.1515984 |url=https://www.researchgate.net/publication/327328659 }}<br />{{bull}}{{cite journal | vauthors = Kuss DJ, Griffiths MD | title = Social Networking Sites and Addiction: Ten Lessons Learned | journal = [[International Journal of Environmental Research and Public Health]] | volume = 14 | issue = 3 | pages = 311 | date = March 2017 | pmid = 28304359 | pmc = 5369147 | doi = 10.3390/ijerph14030311 }}<br />{{bull}}{{cite journal| vauthors = Van Deursen AJ, Bolle CL, Hegner SM, Kommers PA |date=2015-04-01|title=Modeling habitual and addictive smartphone behavior|journal=[[Computers in Human Behavior]]|volume=45|pages=411–420|doi=10.1016/j.chb.2014.12.039|issn=0747-5632}}<br />{{bull}}{{cite journal | vauthors = Dong G, Wang J, Yang X, Zhou H | title = Risk personality traits of internet addiction: a longitudinal study of internet-addicted Chinese university students | journal = Asia-Pacific Psychiatry | volume = 5 | issue = 4 | pages = 316–321 | date = December 2013 | pmid = 23857796 | doi = 10.1111/j.1758-5872.2012.00185.x }}<br />{{bull}}{{cite journal | vauthors = Wittek CT, Finserås TR, Pallesen S, Mentzoni RA, Hanss D, Griffiths MD, Molde H | title = Prevalence and Predictors of Video Game Addiction: A Study Based on a National Representative Sample of Gamers | journal = International Journal of Mental Health and Addiction | volume = 14 | issue = 5 | pages = 672–686 | date = 23 September 2015 | pmid = 27688739 | pmc = 5023737 | doi = 10.1007/s11469-015-9592-8 }}<br />{{bull}}{{cite journal | vauthors = Andreassen CS, Pallesen S, Griffiths MD | title = The relationship between addictive use of social media, narcissism, and self-esteem: Findings from a large national survey | journal = [[Addictive Behaviors]] | volume = 64 | pages = 287–293 | date = January 2017 | pmid = 27072491 | doi = 10.1016/j.addbeh.2016.03.006 | url = http://irep.ntu.ac.uk/id/eprint/27358/1/PubSub5118_Griffiths.pdf | access-date = 2019-01-08 | archive-url = https://web.archive.org/web/20180920234347/http://irep.ntu.ac.uk/id/eprint/27358/1/PubSub5118_Griffiths.pdf | archive-date = 2018-09-20 |url-status=live }}</ref> This has led multiple experts cited by Hawi and Samaha of [[Notre Dame University – Louaize]] to suggest that digital media overuse may not be a singular construct, with some calling for proposed disorders to be delineated based on the digital platform used.<ref>{{cite journal | vauthors = Hawi N, Samaha M |date= August 2019 |title=Identifying commonalities and differences in personality characteristics of internet and social media addiction profiles: traits, self-esteem, and self-construal |journal=[[Behaviour & Information Technology]] |volume=38 |issue=2 |pages=110–119 |doi=10.1080/0144929X.2018.1515984 |url=https://www.researchgate.net/publication/327328659 }}<br />{{bull}}{{cite journal | vauthors = Starcevic V, Aboujaoude E | title = Internet addiction: reappraisal of an increasingly inadequate concept | journal = CNS Spectrums | volume = 22 | issue = 1 | pages = 7–13 | date = February 2017 | pmid = 26831456 | doi = 10.1017/s1092852915000863 }}<br />{{bull}}{{cite journal| vauthors = Van Rooij AJ, Meerkerk GJ, Schoenmakers TM, Griffiths M, Van de Mheen D |date=2010-08-26|title=Video game addiction and social responsibility|journal=Addiction Research & Theory|volume=18|issue=5|pages=489–493|doi=10.3109/16066350903168579|issn=1606-6359}}</ref>
 The rapid pace of introduction of new technologies between 2008 and 2018 has caused difficulty with timely publishing of [[Evidence-based practice|evidence-based]] guidelines.<ref name=":15" />  Experts from the fields of psychology and psychiatry have called for further study, especially to establish whether causal relationships exist.<ref>{{cite journal | vauthors = Radesky J | title = Digital Media and Symptoms of Attention-Deficit/Hyperactivity Disorder in Adolescents | journal = [[JAMA (journal)|JAMA]] | volume = 320 | issue = 3 | pages = 237–239 | date = July 2018 | pmid = 30027231 | doi = 10.1001/jama.2018.8932 }}</ref>
@@ Line 41: / Line 41: @@
 A 2019 systematic map of reviews suggested associations between some types of potentially problematic internet use and psychiatric or behavioural problems such as [[Major depressive disorder|depression]], [[anxiety]], hostility, aggression and [[Attention deficit hyperactivity disorder|ADHD]]. The studies could not determine if causal relationships exist, with reviewers emphasising the importance of prospective study designs going forward.<ref name=":16" /> While overuse of digital media has been associated with depressive symptoms, digital media may also be utilised in some situations to improve mood.<ref>{{cite journal | vauthors = Hoge E, Bickham D, Cantor J | title = Digital Media, Anxiety, and Depression in Children | journal = [[Pediatrics (journal)|Pediatrics]] | volume = 140 | issue = Suppl 2 | pages = S76–S80 | date = November 2017 | pmid = 29093037 | doi = 10.1542/peds.2016-1758G }}</ref><ref>{{cite journal | vauthors = Elhai JD, Dvorak RD, Levine JC, Hall BJ | title = Problematic smartphone use: A conceptual overview and systematic review of relations with anxiety and depression psychopathology | journal = [[Journal of Affective Disorders]] | volume = 207 | pages = 251–259 | date = January 2017 | pmid = 27736736 | doi = 10.1016/j.jad.2016.08.030 }}</ref> Symptoms of ADHD have been positively correlated with digital media use in a large prospective study.<ref>{{cite web|url=https://www.uptodate.com/contents/attention-deficit-hyperactivity-disorder-in-children-and-adolescents-clinical-features-and-diagnosis?sectionName=Diagnosis%20in%20adolescents&topicRef=8349&anchor=H830607539&source=see_link#H830607539|title=Attention deficit hyperactivity disorder in children and adolescents, clinical features and diagnosis|last=Krull|first=Kevin|name-list-format=vanc|date=2019-02-19|website=UpToDate.com|publisher=[[UpToDate]]|access-date=2019-03-23|archive-url=https://web.archive.org/web/20190401134427/https://www.uptodate.com/contents/attention-deficit-hyperactivity-disorder-in-children-and-adolescents-clinical-features-and-diagnosis?sectionName=Diagnosis%20in%20adolescents&topicRef=8349&anchor=H830607539&source=see_link#H830607539|archive-date=2019-04-01|url-status=live}}</ref> The ADHD symptom of [[hyperfocus]] may cause affected people to overuse digital media such as video games or online chatting.<ref name=":02">{{cite journal | vauthors = Kooij JJ, Bijlenga D, Salerno L, Jaeschke R, Bitter I, Balázs J, Thome J, Dom G, Kasper S, Nunes Filipe C, Stes S, Mohr P, Leppämäki S, Casas M, Bobes J, Mccarthy JM, Richarte V, Kjems Philipsen A, Pehlivanidis A, Niemela A, Styr B, Semerci B, Bolea-Alamanac B, Edvinsson D, Baeyens D, Wynchank D, Sobanski E, Philipsen A, McNicholas F, Caci H, Mihailescu I, Manor I, Dobrescu I, Saito T, Krause J, Fayyad J, Ramos-Quiroga JA, Foeken K, Rad F, Adamou M, Ohlmeier M, Fitzgerald M, Gill M, Lensing M, Motavalli Mukaddes N, Brudkiewicz P, Gustafsson P, Tani P, Oswald P, Carpentier PJ, De Rossi P, Delorme R, Markovska Simoska S, Pallanti S, Young S, Bejerot S, Lehtonen T, Kustow J, Müller-Sedgwick U, Hirvikoski T, Pironti V, Ginsberg Y, Félegyházy Z, Garcia-Portilla MP, Asherson P | display-authors = 6 | title = Updated European Consensus Statement on diagnosis and treatment of adult ADHD | journal = [[European Psychiatry]] | volume = 56 | pages = 14–34 | date = February 2019 | pmid = 30453134 | doi = 10.1016/j.eurpsy.2018.11.001 }}</ref>
-A 2016 technical report by Chassiakos, Radesky, and Christakis identified benefits and concerns in adolescent mental health regarding digital media use. It showed that the manner of social media use was the key factor, rather than the amount of time engaged. A decline in well-being and life satisfaction was found in older adolescents who passively consumed social media; however, these were not apparent in those who were more actively engaged. The report also found a U-shaped [[Correlation and dependence#Correlation and linearity|curvilinear relationship]] in the amount of time spent on digital media, with risk of depression increasing at both the low and high ends of internet use.<ref name=":18" /> In the United Kingdom, a study of 1,479&nbsp;individuals aged {{nowrap|14–24}} compared psychological benefits and problems of five large social media platforms: [[Facebook]], [[Instagram]], [[Snapchat]], [[Twitter]] and [[YouTube]]. It concluded that YouTube was the only platform with a net positive rating "based on the 14&nbsp;health and wellbeing-related questions", and the other platforms measured had net negative ratings, with Instagram having the lowest rating. The study identified Instagram as having some positive effects including self-expression, self-identity, and community, but these were outweighed by negative effects, including those on sleep, body image, and "fear of missing out".<ref name=":2">{{cite web|url=https://www.rsph.org.uk/uploads/assets/uploaded/62be270a-a55f-4719-ad668c2ec7a74c2a.pdf|title=#StatusOfMind – Social media and young people's mental health and wellbeing|date=|work=[[Royal Society for Public Health]]|archive-url=https://web.archive.org/web/20181125171341/https://www.rsph.org.uk/uploads/assets/uploaded/62be270a-a55f-4719-ad668c2ec7a74c2a.pdf|archive-date=2018-11-25|url-status=live|access-date=2019-01-10}}</ref>
+A 2016 technical report by Chassiakos, Radesky, and Christakis identified benefits and concerns in adolescent mental health regarding digital media use. It showed that the manner of social media use was the key factor, rather than the amount of time engaged. A decline in well-being and life satisfaction was found in older adolescents who passively consumed social media; however, these were not apparent in those who were more actively engaged. The report also found a U-shaped [[Correlation and dependence#Correlation and linearity|curvilinear relationship]] in the amount of time spent on digital media, with risk of depression increasing at both the low and high ends of internet use.<ref name=":18" /> In the United Kingdom, a study of 1,479&nbsp;individuals aged {{nowrap|14–24}} compared psychological benefits and problems of five large social media platforms: [[Facebook]], [[Instagram]], [[Snapchat]], [[Twitter]] and [[YouTube]]. It concluded that YouTube was the only platform with a net positive rating "based on the 14&nbsp;health and wellbeing-related questions", and the other platforms measured had net negative ratings, with Instagram having the lowest rating. The study identified Instagram as having some positive effects including self-expression, self-identity, and community, but found that these were outweighed by the negative effects, specifically on sleep, body image, and "fear of missing out".<ref name=":2">{{cite web|url=https://www.rsph.org.uk/uploads/assets/uploaded/62be270a-a55f-4719-ad668c2ec7a74c2a.pdf|title=#StatusOfMind – Social media and young people's mental health and wellbeing|date=|work=[[Royal Society for Public Health]]|archive-url=https://web.archive.org/web/20181125171341/https://www.rsph.org.uk/uploads/assets/uploaded/62be270a-a55f-4719-ad668c2ec7a74c2a.pdf|archive-date=2018-11-25|url-status=live|access-date=2019-01-10}}</ref>
-Twenge and colleagues published in 2018 two cross sectional surveys of 506,820 American high school students, and found that use of new media was associated with higher rates of depressive symptoms and [[suicidality]]. They concluded that more time engaged with electronic device use, and less time on "non-screen activities" (such as in-person social interaction, sports/exercise, homework, and attending religious services) was correlated with depressive symptoms and suicide-related outcomes ([[suicidal ideation]], plans, and attempts), especially among girls.<ref>{{Cite journal|last=Twenge|first=Jean M.|last2=Joiner|first2=Thomas E.|last3=Rogers|first3=Megan L.|last4=Martin|first4=Gabrielle N.|date=2018|title=Increases in Depressive Symptoms, Suicide-Related Outcomes, and Suicide Rates Among U.S. Adolescents After 2010 and Links to Increased New Media Screen Time|journal=Clinical Psychological Science|language=en-US|volume=6|issue=1|pages=3–17|doi=10.1177/2167702617723376}}</ref> However, Ophir and colleagues questioned in 2018 the survey's research methodology, citing "inaccurate research measurements, negligible correlations between the main variables, [and] insufficient and inadequate statistical analyses".<ref>Ophir, Y., Lipshits-Braziler, Y., & Rosenberg, H. (2019). New-Media Screen Time is Not (Necessarily) Linked to Depression: Comments on Twenge, Joiner, Rogers, and Martin (2018). ''Clinical Psychological Science''. Advance online publication. https://doi.org/10.1177/2167702619849412</ref>
+A report published in ''[[Clinical Psychological Science]]'' in 2018 featured two cross-sectional surveys of 506,820 American high school students, and found that use of new media was associated with higher rates of depressive symptoms and [[suicidality]]. They concluded that more time engaged with electronic devices, and less time on "non-screen activities" (such as in-person social interaction, sports/exercise, homework, and attending religious services) was correlated with depressive symptoms and suicide-related outcomes ([[suicidal ideation]], plans, and attempts), especially among girls.<ref>{{Cite journal|last=Twenge|first=Jean M.|last2=Joiner|first2=Thomas E.|last3=Rogers|first3=Megan L.|last4=Martin|first4=Gabrielle N.|date=2018|title=Increases in Depressive Symptoms, Suicide-Related Outcomes, and Suicide Rates Among U.S. Adolescents After 2010 and Links to Increased New Media Screen Time|journal=Clinical Psychological Science|language=en-US|volume=6|issue=1|pages=3–17|doi=10.1177/2167702617723376}}</ref> However, a later report in the same publication questioned the survey's research methodology, citing "inaccurate research measurements, negligible correlations between the main variables, [and] insufficient and inadequate statistical analyses".<ref>Ophir, Y., Lipshits-Braziler, Y., & Rosenberg, H. (2019). New-Media Screen Time is Not (Necessarily) Linked to Depression: Comments on Twenge, Joiner, Rogers, and Martin (2018). ''Clinical Psychological Science''. Advance online publication. https://doi.org/10.1177/2167702619849412</ref>
-The relationship between [[bipolar disorder]] and technology use has been investigated in a singular survey of 84&nbsp;participants. The survey found marked variations in technology use based on self-reported mood states. Matthews and colleagues then postulated that for patients with bipolar disorder, technology may be a "double-edged sword", with potential benefits and harms.<ref>{{cite journal| vauthors = Matthews M, Murnane E, Snyder J, Guha S, Chang P, Doherty G, Gay G |date=2017-10-01|title=The double-edged sword: A mixed methods study of the interplay between bipolar disorder and technology use|journal=[[Computers in Human Behavior]]|volume=75|pages=288–300|doi=10.1016/j.chb.2017.05.009 }}</ref>
+The relationship between [[bipolar disorder]] and technology use has been investigated in a singular survey of 84&nbsp; participants for ''[[Computers in Human Behavior]]''. The survey found marked variations in technology use based on self-reported mood states. The authors of the report then postulated that for patients with bipolar disorder, technology may be a "double-edged sword", with potential benefits and harms.<ref>{{cite journal| vauthors = Matthews M, Murnane E, Snyder J, Guha S, Chang P, Doherty G, Gay G |date=2017-10-01|title=The double-edged sword: A mixed methods study of the interplay between bipolar disorder and technology use|journal=[[Computers in Human Behavior]]|volume=75|pages=288–300|doi=10.1016/j.chb.2017.05.009 }}</ref>
 ===Screen time===
@@ Line 55: / Line 55: @@
 Gaming disorder has been considered by the DSM-5 taskforce as warranting further study, and has been included in the ICD-11.<ref name=":17" /> Concerns have been raised by Aarseth and colleagues over this inclusion, particularly in regard to stigmatisation of heavy gamers.<ref>{{cite journal | vauthors = Aarseth E, Bean AM, Boonen H, Colder Carras M, Coulson M, Das D, Deleuze J, Dunkels E, Edman J, Ferguson CJ, Haagsma MC, Helmersson Bergmark K, Hussain Z, Jansz J, Kardefelt-Winther D, Kutner L, Markey P, Nielsen RK, Prause N, Przybylski A, Quandt T, Schimmenti A, Starcevic V, Stutman G, Van Looy J, Van Rooij AJ | display-authors = 6 | title = Scholars' open debate paper on the World Health Organization ICD-11 Gaming Disorder proposal | journal = Journal of Behavioral Addictions | volume = 6 | issue = 3 | pages = 267–270 | date = September 2017 | pmid = 28033714 | pmc = 5700734 | doi = 10.1556/2006.5.2016.088 }}</ref>
-Christiakis has asserted that internet addiction may be "a 21st century epidemic".<ref name=":3">{{cite journal | vauthors = Christakis DA | title = Internet addiction: a 21st century epidemic? | journal = [[BMC Medicine]] | volume = 8 | issue = 1 | pages = 61 | date = October 2010 | pmid = 20955578 | pmc = 2972229 | doi = 10.1186/1741-7015-8-61 }}</ref> In 2018, he commented that childhood internet overuse may be a form of  "uncontrolled experiment[s] on [...] children".<ref name=":7">{{cite web|url=https://www.cbsnews.com/news/groundbreaking-study-examines-effects-of-screen-time-on-kids-60-minutes/|last1=Cooper|first1=Anderson|name-list-format=vanc|date=2018-12-09|access-date=12 December 2018|publisher=[[CBS News]]|title=Groundbreaking study examines effects of screen time on kids|website=60 Minutes Canada|archive-url=https://web.archive.org/web/20181211194256/https://www.cbsnews.com/news/groundbreaking-study-examines-effects-of-screen-time-on-kids-60-minutes/|archive-date=11 December 2018|url-status=live}}</ref> International estimates of the prevalence of internet overuse have varied considerably, with marked variations by nation. A 2014 [[meta-analysis]] of 31&nbsp;nations yielded an overall worldwide prevalence of six percent.<ref name=":5">{{cite journal | vauthors = Cheng C, Li AY | title = Internet addiction prevalence and quality of (real) life: a meta-analysis of 31 nations across seven world regions | journal = Cyberpsychology, Behavior and Social Networking | volume = 17 | issue = 12 | pages = 755–760 | date = December 2014 | pmid = 25489876 | pmc = 4267764 | doi = 10.1089/cyber.2014.0317 }}</ref> A different perspective in 2018 by Musetti and colleagues reappraised the internet in terms of its necessity and ubiquity in modern society, as a social environment, rather than a tool, thereby calling for the reformulation of the internet addiction model.<ref>{{cite journal | vauthors = Musetti A, Corsano P | title = The Internet Is Not a Tool: Reappraising the Model for Internet-Addiction Disorder Based on the Constraints and Opportunities of the Digital Environment | journal = [[Frontiers in Psychology]] | volume = 9 | pages = 558 | date = 18 April 2018 | pmid = 29720954 | pmc = 5915628 | doi = 10.3389/fpsyg.2018.00558 }}</ref>
+Christakis has asserted that internet addiction may be "a 21st century epidemic".<ref name=":3">{{cite journal | vauthors = Christakis DA | title = Internet addiction: a 21st century epidemic? | journal = [[BMC Medicine]] | volume = 8 | issue = 1 | pages = 61 | date = October 2010 | pmid = 20955578 | pmc = 2972229 | doi = 10.1186/1741-7015-8-61 }}</ref> In 2018, he commented that childhood internet overuse may be a form of  "uncontrolled experiment[s] on [...] children".<ref name=":7">{{cite web|url=https://www.cbsnews.com/news/groundbreaking-study-examines-effects-of-screen-time-on-kids-60-minutes/|last1=Cooper|first1=Anderson|name-list-format=vanc|date=2018-12-09|access-date=12 December 2018|publisher=[[CBS News]]|title=Groundbreaking study examines effects of screen time on kids|website=60 Minutes Canada|archive-url=https://web.archive.org/web/20181211194256/https://www.cbsnews.com/news/groundbreaking-study-examines-effects-of-screen-time-on-kids-60-minutes/|archive-date=11 December 2018|url-status=live}}</ref> International estimates of the prevalence of internet overuse have varied considerably, with marked variations by nation. A 2014 [[meta-analysis]] of 31&nbsp;nations yielded an overall worldwide prevalence of six percent.<ref name=":5">{{cite journal | vauthors = Cheng C, Li AY | title = Internet addiction prevalence and quality of (real) life: a meta-analysis of 31 nations across seven world regions | journal = Cyberpsychology, Behavior and Social Networking | volume = 17 | issue = 12 | pages = 755–760 | date = December 2014 | pmid = 25489876 | pmc = 4267764 | doi = 10.1089/cyber.2014.0317 }}</ref> A different perspective in 2018 by Musetti and colleagues reappraised the internet in terms of its necessity and ubiquity in modern society, as a social environment, rather than a tool, thereby calling for the reformulation of the internet addiction model.<ref>{{cite journal | vauthors = Musetti A, Corsano P | title = The Internet Is Not a Tool: Reappraising the Model for Internet-Addiction Disorder Based on the Constraints and Opportunities of the Digital Environment | journal = [[Frontiers in Psychology]] | volume = 9 | pages = 558 | date = 18 April 2018 | pmid = 29720954 | pmc = 5915628 | doi = 10.3389/fpsyg.2018.00558 }}</ref>
-Some medical and behavioural scientists recommend adding a diagnosis of "social media addiction" (or similar) to the next [[Diagnostic and Statistical Manual of Mental Disorders]] update.<ref>{{cite journal | vauthors = Pantic I | title = Online social networking and mental health | journal = Cyberpsychology, Behavior and Social Networking | volume = 17 | issue = 10 | pages = 652–7 | date = October 2014 | pmid = 25192305 | pmc = 4183915 | doi = 10.1089/cyber.2014.0070 }}</ref><ref name=":4">{{cite journal| vauthors = van den Eijnden RJ, Lemmens JS, Valkenburg PM |date=2016-08-01|title=The Social Media Disorder Scale|journal=[[Computers in Human Behavior]]|volume=61|pages=478–487|doi=10.1016/j.chb.2016.03.038 }}</ref> A 2015 review concluded there was a probable link between basic psychological needs and social media addiction. "Social network site users seek feedback, and they get it from hundreds of people—instantly. It could be argued that the platforms are designed to get users 'hooked'."<ref>{{cite journal|last=Andreassen|first=Cecilie Schou|date=2015-06-01|title=Online Social Network Site Addiction: A Comprehensive Review|url=https://link.springer.com/content/pdf/10.1007%2Fs40429-015-0056-9.pdf|url-status=live|journal=Current Addiction Reports|volume=2|issue=2|pages=175–184|doi=10.1007/s40429-015-0056-9|issn=2196-2952|archive-url=https://web.archive.org/web/20170827000018/https://link.springer.com/content/pdf/10.1007%2Fs40429-015-0056-9.pdf|archive-date=August 27, 2017|via=|name-list-format=vanc}}</ref>
+Some medical and behavioural scientists recommend adding a diagnosis of "social media addiction" (or similar) to the next ''Diagnostic and Statistical Manual of Mental Disorders'' update.<ref>{{cite journal | vauthors = Pantic I | title = Online social networking and mental health | journal = Cyberpsychology, Behavior and Social Networking | volume = 17 | issue = 10 | pages = 652–7 | date = October 2014 | pmid = 25192305 | pmc = 4183915 | doi = 10.1089/cyber.2014.0070 }}</ref><ref name=":4">{{cite journal| vauthors = van den Eijnden RJ, Lemmens JS, Valkenburg PM |date=2016-08-01|title=The Social Media Disorder Scale|journal=[[Computers in Human Behavior]]|volume=61|pages=478–487|doi=10.1016/j.chb.2016.03.038 }}</ref> A 2015 review concluded there was a probable link between basic psychological needs and social media addiction. "Social network site users seek feedback, and they get it from hundreds of people—instantly. It could be argued that the platforms are designed to get users 'hooked'."<ref>{{cite journal|last=Andreassen|first=Cecilie Schou|date=2015-06-01|title=Online Social Network Site Addiction: A Comprehensive Review|url=https://link.springer.com/content/pdf/10.1007%2Fs40429-015-0056-9.pdf|url-status=live|journal=Current Addiction Reports|volume=2|issue=2|pages=175–184|doi=10.1007/s40429-015-0056-9|issn=2196-2952|archive-url=https://web.archive.org/web/20170827000018/https://link.springer.com/content/pdf/10.1007%2Fs40429-015-0056-9.pdf|archive-date=August 27, 2017|via=|name-list-format=vanc}}</ref>
-Internet sex addiction, also known as cybersex addiction, has been proposed by Stein and Parashar as a [[sexual addiction]] characterized by virtual internet [[Human sexual activity|sexual activity]] that causes serious negative consequences to one's physical, mental, social, and/or financial well-being.<ref name="SteinHollander2009">{{cite book|url=https://books.google.com/books?id=quQY1R8vsZcC&pg=PA359|title=Textbook of Anxiety Disorders|last1=Stein|first1=Dan J.|last2=Hollander|first2=Eric|last3=Rothbaum|first3=Barbara Olasov|date=31 August 2009|publisher=American Psychiatric Publishing|isbn=978-1-58562-254-2|location=Washington, DC|pages=359|accessdate=24 April 2010|archive-url=https://web.archive.org/web/20131011082608/http://books.google.com/books?id=quQY1R8vsZcC&pg=PA359|archive-date=11 October 2013|url-status=live}}</ref><ref name="pmid17503551">{{cite journal |author=Parashar A, Varma A |title=Behavior and substance addictions: is the world ready for a new category in the DSM-V? |journal=CNS Spectr |volume=12 |issue=4 |pages=257; author reply 258–9 |date=April 2007 |pmid=17503551 |doi= 10.1017/S109285290002099X}}</ref> It may be considered a form of problematic internet use.<ref name=Griffiths>{{cite journal|last=Griffiths|first=Mark|title=Sex on the internet: Observations and implications for internet sex addiction.|journal=The Journal of Sex Research|date=November 2001|volume=38|issue=4|pages=333–342|doi=10.1080/00224490109552104|url=http://journals1.scholarsportal.info/details-sfx.xqy?uri=/00224499/v38i0004/333_sotioaifisa.xml|accessdate=2 April 2013}}</ref>
+Internet sex addiction, also known as cybersex addiction, has been proposed as a [[sexual addiction]] characterised by virtual internet [[Human sexual activity|sexual activity]] that causes serious negative consequences to one's physical, mental, social, and/or financial well-being, in several papers cited in a 2009 textbook of [[anxiety disorders]] published by the [[American Psychiatric Association]].<ref name="SteinHollander2009">{{cite book|url=https://books.google.com/books?id=quQY1R8vsZcC&pg=PA359|title=Textbook of Anxiety Disorders|last1=Stein|first1=Dan J.|last2=Hollander|first2=Eric|last3=Rothbaum|first3=Barbara Olasov|date=31 August 2009|publisher=American Psychiatric Publishing|isbn=978-1-58562-254-2|location=Washington, DC|pages=359|accessdate=24 April 2010|archive-url=https://web.archive.org/web/20131011082608/http://books.google.com/books?id=quQY1R8vsZcC&pg=PA359|archive-date=11 October 2013|url-status=live}}</ref><ref name="pmid17503551">{{cite journal |author=Parashar A, Varma A |title=Behavior and substance addictions: is the world ready for a new category in the DSM-V? |journal=CNS Spectr |volume=12 |issue=4 |pages=257; author reply 258–259 |date=April 2007 |pmid=17503551 |doi= 10.1017/S109285290002099X}}</ref> It may be considered a form of problematic internet use.<ref name=Griffiths>{{cite journal|last=Griffiths|first=Mark|title=Sex on the internet: Observations and implications for internet sex addiction.|journal=The Journal of Sex Research|date=November 2001|volume=38|issue=4|pages=333–342|doi=10.1080/00224490109552104|url=http://journals1.scholarsportal.info/details-sfx.xqy?uri=/00224499/v38i0004/333_sotioaifisa.xml|accessdate=2 April 2013}}</ref>
 ===Related phenomena===
@@ Line 81: / Line 81: @@
 Rigorous, evidence-based assessment of problematic digital media use is yet to be comprehensively established. This is due partially to a lack of consensus around the various constructs and lack of standardization of treatments.<ref name=":11">{{cite journal | vauthors = Zajac K, Ginley MK, Chang R, Petry NM | title = Treatments for internet gaming disorder and internet addiction: A systematic review | journal = [[Psychology of Addictive Behaviors]] | volume = 31 | issue = 8 | pages = 979–994 | date = December 2017 | pmid = 28921996 | pmc = 5714660 | doi = 10.1037/adb0000315 }}</ref> The [[American Academy of Pediatrics]] (AAP) has developed a Family Media Plan, intending to help parents assess and structure their family's use of electronic devices and media more safely. It recommends limiting entertainment screen time to two hours or less per day.<ref>{{cite web|url=http://www.healthychildren.org/English/family-life/Media/Pages/How-to-Make-a-Family-Media-Use-Plan.aspx|title=How to Make a Family Media Use Plan|website=HealthyChildren.org|access-date=2019-06-06|archive-url=https://web.archive.org/web/20190606111436/https://www.healthychildren.org/English/family-life/Media/Pages/How-to-Make-a-Family-Media-Use-Plan.aspx|archive-date=2019-06-06|url-status=live}}</ref><ref>{{cite journal|last=Korioth|first=Trisha|name-list-format=vanc|date=2018-12-12|title=Family Media Plan helps parents set boundaries for kids|url=http://www.aappublications.org/news/2016/10/21/MediaParents102116|journal=AAP News|access-date=2019-01-09|archive-url=https://web.archive.org/web/20190109155630/http://www.aappublications.org/news/2016/10/21/MediaParents102116|archive-date=2019-01-09|url-status=live}}</ref> The [[Canadian Paediatric Society]] produced a similar guideline. Ferguson, a psychologist, has criticised these and other national guidelines for not being evidence-based.<ref>{{cite journal|last=Ferguson|first=Christopher J.|last2=Beresin|first2=Eugene | name-list-format = vanc |date=2017-06-01|title=Social science's curious war with pop culture and how it was lost: The media violence debate and the risks it holds for social science|journal=[[Preventive Medicine (journal)|Preventive Medicine]]|volume=99|pages=69–76|doi=10.1016/j.ypmed.2017.02.009|pmid=28212816|issn=0091-7435}}</ref> Other experts have recommended addressing potential underlying problems rather than arbitrarily enforcing screen time limits, as commented in a 2017 [[UNICEF]] Office of Research literature review.<ref name=":12" />
-A number of different methodologies of assessing pathological internet use have been developed, mostly  self-report questionnaires, however none have been universally recognised as a gold standard.<ref>{{cite journal | vauthors = Shaw M, Black DW | title = internet addiction: definition, assessment, epidemiology and clinical management | journal = [[CNS Drugs (journal)|CNS Drugs]] | volume = 22 | issue = 5 | pages = 353–365 | date = 2008 | pmid = 18399706 | doi = 10.2165/00023210-200822050-00001 }}</ref> For gaming disorder, both the American Psychiatric Association<ref>{{cite journal | vauthors = Petry NM, Rehbein F, Gentile DA, Lemmens JS, Rumpf HJ, Mößle T, Bischof G, Tao R, Fung DS, Borges G, Auriacombe M, González Ibáñez A, Tam P, O'Brien CP | display-authors = 6 | title = An international consensus for assessing internet gaming disorder using the new DSM-5 approach | journal = [[Addiction (journal)|Addiction]] | volume = 109 | issue = 9 | pages = 1399–406 | date = September 2014 | pmid = 24456155 | doi = 10.1111/add.12457 }}</ref> and the World Health Organization (through the [[ICD-11]])<ref name=":1" /> have released diagnostic criteria.
+A number of different methodologies of assessing pathological internet use have been developed, mostly  self-report questionnaires, however none have been universally recognised as a gold standard.<ref>{{cite journal | vauthors = Shaw M, Black DW | title = internet addiction: definition, assessment, epidemiology and clinical management | journal = [[CNS Drugs (journal)|CNS Drugs]] | volume = 22 | issue = 5 | pages = 353–365 | date = 2008 | pmid = 18399706 | doi = 10.2165/00023210-200822050-00001 }}</ref> For gaming disorder, both the American Psychiatric Association<ref>{{cite journal | vauthors = Petry NM, Rehbein F, Gentile DA, Lemmens JS, Rumpf HJ, Mößle T, Bischof G, Tao R, Fung DS, Borges G, Auriacombe M, González Ibáñez A, Tam P, O'Brien CP | display-authors = 6 | title = An international consensus for assessing internet gaming disorder using the new DSM-5 approach | journal = [[Addiction (journal)|Addiction]] | volume = 109 | issue = 9 | pages = 1399–406 | date = September 2014 | pmid = 24456155 | doi = 10.1111/add.12457 }}</ref> and the World Health Organization (through the ICD-11)<ref name=":1" /> have released diagnostic criteria.
 There is some limited evidence of the effectiveness of [[Cognitive behavioral therapy|cognitive behavioural therapy]] and family-based interventions for treatment. Medications have not been shown to be effective in randomised controlled trials.<ref name=":11" /> A 2016 study of 901&nbsp;adolescents suggested [[mindfulness]] may assist in preventing and treating problematic internet use.<ref>{{cite journal|last=Gámez-Guadix|first=Manuel|last2=Calvete|first2=Esther | name-list-format = vanc |date=2016-12-01|title=Assessing the Relationship between Mindful Awareness and Problematic Internet Use among Adolescents|journal=[[Mindfulness (journal)|Mindfulness]] |volume=7|issue=6|pages=1281–1288|doi=10.1007/s12671-016-0566-0 }}</ref> A 2019 United Kingdom parliamentary report deemed parental engagement, awareness and support to be essential in developing "digital resilience" for young people, and to identify and manage the risks of harm online.<ref name=":13" /> Treatment centres have proliferated in some countries, and China and South Korea have treated digital dependence as a public health crisis, with 300 and 190&nbsp;centres opened nationwide, respectively.<ref>{{cite journal|vauthors=Sharma MK, Palanichamy TS|date=February 2018|title=Psychosocial interventions for technological addictions|url=|journal=[[Indian Journal of Psychiatry]]|volume=60|issue=Suppl 4|pages=S541–S545|pmc=5844169|pmid=29540928}}</ref> Other countries have also opened treatment centres.<ref>{{cite journal | vauthors = Kuss DJ, Griffiths MD | title = Online social networking and addiction—a review of the psychological literature | journal = [[International Journal of Environmental Research and Public Health]] | volume = 8 | issue = 9 | pages = 3528–3552 | date = September 2011 | pmid = 22016701 | pmc = 3194102 | doi = 10.3390/ijerph8093528 }}</ref><ref>{{cite journal | vauthors = Romano M, Osborne LA, Truzoli R, Reed P | title = Differential psychological impact of internet exposure on internet addicts | journal = [[PLOS ONE]] | volume = 8 | issue = 2 | pages = e55162 | date = 7 February 2013 | pmid = 23408958 | pmc = 3567114 | doi = 10.1371/journal.pone.0055162 | bibcode = 2013PLoSO...855162R }}</ref>
@@ Line 98: / Line 98: @@
 ===Digital anthropology===
-[[Daniel Miller (anthropologist)|Daniel Miller]] from [[University College London]] has contributed to the study of digital anthropology, especially ethnographic research on the use and consequences of social media and smartphones as part of the everyday life of ordinary people around the world. He notes the effects of social media are very specific to individual locations and cultures. He contends "a layperson might dismiss these stories as superficial. But the anthropologist takes them seriously, empathetically exploring each use of digital technologies in terms of the wider social and cultural context."<ref>{{cite web|url=https://blogs.scientificamerican.com/observations/the-anthropology-of-social-media/|title=The Anthropology of Social Media|last=Miller|first=Daniel|date=|website=Scientific American Blog Network|access-date=2018-12-13|name-list-format=vanc|archive-url=https://web.archive.org/web/20181215070144/https://blogs.scientificamerican.com/observations/the-anthropology-of-social-media/|archive-date=2018-12-15|url-status=live}}</ref>
+[[Daniel Miller (anthropologist)|Daniel Miller]] from [[University College London]] has contributed to the study of [[digital anthropology]], especially ethnographic research on the use and consequences of social media and smartphones as part of the everyday life of ordinary people around the world. He notes the effects of social media are very specific to individual locations and cultures. He contends "a layperson might dismiss these stories as superficial. But the anthropologist takes them seriously, empathetically exploring each use of digital technologies in terms of the wider social and cultural context."<ref>{{cite web|url=https://blogs.scientificamerican.com/observations/the-anthropology-of-social-media/|title=The Anthropology of Social Media|last=Miller|first=Daniel|date=|website=Scientific American Blog Network|access-date=2018-12-13|name-list-format=vanc|archive-url=https://web.archive.org/web/20181215070144/https://blogs.scientificamerican.com/observations/the-anthropology-of-social-media/|archive-date=2018-12-15|url-status=live}}</ref>
-[[Digital anthropology]] is a developing field which studies the relationship between humans and digital-era technology. It aims to consider arguments in terms of ethical and societal scopes, rather than simply observing technological changes.<ref name="Miller_2018">{{cite journal|last=Miller|first=Daniel|date=2018-08-28|title=Digital Anthropology|url=http://www.anthroencyclopedia.com/entry/digital-anthropology|journal=Cambridge Encyclopedia of Anthropology|name-list-format=vanc|access-date=2019-01-07|archive-url=https://web.archive.org/web/20181230030108/http://www.anthroencyclopedia.com/entry/digital-anthropology|archive-date=2018-12-30|url-status=live}}</ref> Brian Solis, a digital analyst, anthropologist and keynote speaker working in the field, stated in 2018, "we've become digital addicts: it's time to take control of technology and not let tech control us".<ref>{{cite web|url=https://medium.com/@briansolis/breaking-digital-facades-its-time-to-take-tech-back-c7af059dfd51|title=We've Become Digital Addicts: It's Time to Take Control of Technology and Not Let Tech Control Us|last=Solis|first=Brian|date=2018-03-28|website=Medium|access-date=2019-01-06|name-list-format=vanc|archive-url=https://web.archive.org/web/20181230130551/https://medium.com/@briansolis/breaking-digital-facades-its-time-to-take-tech-back-c7af059dfd51|archive-date=2018-12-30|url-status=live}}</ref>
+Digital anthropology is a developing field which studies the relationship between humans and digital-era technology. It aims to consider arguments in terms of ethical and societal scopes, rather than simply observing technological changes.<ref name="Miller_2018">{{cite journal|last=Miller|first=Daniel|date=2018-08-28|title=Digital Anthropology|url=http://www.anthroencyclopedia.com/entry/digital-anthropology|journal=Cambridge Encyclopedia of Anthropology|name-list-format=vanc|access-date=2019-01-07|archive-url=https://web.archive.org/web/20181230030108/http://www.anthroencyclopedia.com/entry/digital-anthropology|archive-date=2018-12-30|url-status=live}}</ref> Brian Solis, a digital analyst, anthropologist and keynote speaker working in the field, stated in 2018, "we've become digital addicts: it's time to take control of technology and not let tech control us".<ref>{{cite web|url=https://medium.com/@briansolis/breaking-digital-facades-its-time-to-take-tech-back-c7af059dfd51|title=We've Become Digital Addicts: It's Time to Take Control of Technology and Not Let Tech Control Us|last=Solis|first=Brian|date=2018-03-28|website=Medium|access-date=2019-01-06|name-list-format=vanc|archive-url=https://web.archive.org/web/20181230130551/https://medium.com/@briansolis/breaking-digital-facades-its-time-to-take-tech-back-c7af059dfd51|archive-date=2018-12-30|url-status=live}}</ref>
 ===Digital sociology===
@@ Line 107: / Line 107: @@
 A 2012 cross-sectional sociological study in Turkey showed differences in patterns of internet use that related to levels of religiosity in 2,698&nbsp;subjects. With increasing religiosity, negative attitudes towards internet use increased. However, highly religious people showed different motivations for internet use, predominantly searching for information.<ref>{{cite journal|last=Sanaktekin|first=Ozlem Hesapci|date=2011-12-20|title=The Effects of Religiosity on Internet Consumption|journal=[[Information, Communication & Society]]|volume=16|issue=10|pages=1553–1573|doi=10.1080/1369118x.2012.722663|name-list-format=vanc}}</ref> A study of 1,296&nbsp;Malaysian adolescent students found an inverse relationship between religiosity and internet addiction tendency in females, but not males.<ref>{{cite journal|last=Charlton|first=John P.|last2=Soh|first2=Patrick C.-H.|last3=Ang|first3=Peng Hwa|last4=Chew|first4=Kok-Wai|date=2013-12-01|title=Religiosity, Adolescent Internet Usage Motives and Addiction|journal=[[Information, Communication & Society]]|volume=16|issue=10|pages=1619–1638|doi=10.1080/1369118X.2012.735251|issn=1369-118X|name-list-format=vanc}}</ref>
-A 2018 review published in ''[[Nature (journal)|Nature]]'' considered that young people may have different experiences online, depending on their socio-economic background, noting lower-income youths may spend up to three hours more time per day using digital devices, compared to higher income youths.<ref name="OdgersSmartphones"/> They theorised that these same groups, that are already vulnerable to mental illness, may be more passive in their online engagements, being more susceptible to negative feedback online, with difficulty self-regulating their digital media use. It concluded this may be a new form of [[digital divide]] between at-risk young people and other young people, with pre-existing risks of mental illness becoming amplified amongst the already vulnerable population.<ref name="OdgersSmartphones">{{cite journal|vauthors=Odgers C|date=February 2018|title=Smartphones are bad for some teens, not all|journal=[[Nature (journal)|Nature]]|volume=554|issue=7693|pages=432–434|doi=10.1038/d41586-018-02109-8|pmc=6121807|pmid=29469108|bibcode=2018Natur.554..432O}}</ref>
+A 2018 review published in ''[[Nature (journal)|Nature]]'' considered that young people may have different experiences online, depending on their socio-economic background, noting lower-income youths may spend up to three hours more per day using digital devices, compared to higher-income youths.<ref name="OdgersSmartphones"/> They theorised that these same groups, that are already vulnerable to mental illness, may be more passive in their online engagements, being more susceptible to negative feedback online, with difficulty self-regulating their digital media use. It concluded this may be a new form of [[digital divide]] between at-risk young people and other young people, with pre-existing risks of mental illness becoming amplified amongst the already vulnerable population.<ref name="OdgersSmartphones">{{cite journal|vauthors=Odgers C|date=February 2018|title=Smartphones are bad for some teens, not all|journal=[[Nature (journal)|Nature]]|volume=554|issue=7693|pages=432–434|doi=10.1038/d41586-018-02109-8|pmc=6121807|pmid=29469108|bibcode=2018Natur.554..432O}}</ref>
 ===Neuroscience===

v t e Digital media use and mental health
Proposed or recognised diagnostic categories	Computer addiction Internet addiction disorder Internet sex addiction Online problem gambling Problematic smartphone use Nomophobia Problematic social media use Television addiction Video game addiction
Disciplines involved	Digital anthropology Digital sociology Ergonomics Cognitive ergonomics Computer-mediated communication Cyberpsychology Engineering psychology Human–computer interaction Media naturalness theory Neuroergonomics Neuroscience Psychiatry Evolutionary Psychology Clinical Cognitive Evolutionary Social
Associated psychiatric conditions	Anxiety disorder Generalized anxiety disorder Obsessive–compulsive disorder Social anxiety disorder Attention deficit hyperactivity disorder Autism Bipolar disorder Depression Eating disorder Anorexia nervosa Body image disturbance Insomnia Narcissistic personality disorder
Related topics	Behavioral addiction Behavioral modernity Body image Criticism of Facebook 2021 Facebook company files leak Cyberbullying Cyberpathology Digital detox Digital zombie Evolution of cognition Evolutionary mismatch Fear of missing out Mobile phones and driving safety Promotion of anorexia Psychological effects of Internet use Screen time Binge-watching Social aspects of television Television consumption Smartphones and pedestrian safety Social media and suicide Spaving Suicide and the Internet Technophilia Technophobia Technostress Texting while driving