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      Internet Addiction Increases in the General Population During COVID‐19: Evidence From China

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          Abstract

          Background and Objectives

          COVID‐19‐related quarantine and stress have likely escalated the crisis of Internet addiction. This study aimed to determine the impact of the COVID‐19 pandemic on Internet use and related risk factors among the general public in China.

          Methods

          A large‐sample cross‐sectional online survey was conducted from March 24 to April 30, 2020, in China, and 20,472 participants completed the survey. We investigated the prevalence and severity of Internet addiction based on the Internet Addiction Test (IAT), and explored the risk factors related to increases in time spent on Internet use and severity of Internet addiction, as well as severe Internet addiction.

          Results

          The overall prevalence of Internet addiction was 36.7% among the general population during the pandemic, and that of severe Internet addiction was 2.8%, according to IAT scores. Time spent on recreational Internet use had significantly increased during the pandemic, and almost half of participants reported increases in the severity of Internet addiction. Risk factors for increases in time spent on Internet use and severity of Internet addiction and severe Internet addiction included having fewer social supporters, perceiving pressure and impact on mental health status due to COVID‐19, and being over‐engaged in playing videogames.

          Discussion and Conclusions

          The COVID‐19 pandemic adversely impacted Internet use and increased the prevalence and severity of Internet addiction among the general population in China, especially in vulnerable populations.

          Scientific Significance

          This study provides evidence for policymakers to refine public health policies to control the pandemic and make efforts to provide population‐specific prevention and interventions for people at risk of developing Internet addiction. (Am J Addict 2021;00:00–00)

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          Most cited references29

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          A brief measure for assessing generalized anxiety disorder: the GAD-7.

          Generalized anxiety disorder (GAD) is one of the most common mental disorders; however, there is no brief clinical measure for assessing GAD. The objective of this study was to develop a brief self-report scale to identify probable cases of GAD and evaluate its reliability and validity. A criterion-standard study was performed in 15 primary care clinics in the United States from November 2004 through June 2005. Of a total of 2740 adult patients completing a study questionnaire, 965 patients had a telephone interview with a mental health professional within 1 week. For criterion and construct validity, GAD self-report scale diagnoses were compared with independent diagnoses made by mental health professionals; functional status measures; disability days; and health care use. A 7-item anxiety scale (GAD-7) had good reliability, as well as criterion, construct, factorial, and procedural validity. A cut point was identified that optimized sensitivity (89%) and specificity (82%). Increasing scores on the scale were strongly associated with multiple domains of functional impairment (all 6 Medical Outcomes Study Short-Form General Health Survey scales and disability days). Although GAD and depression symptoms frequently co-occurred, factor analysis confirmed them as distinct dimensions. Moreover, GAD and depression symptoms had differing but independent effects on functional impairment and disability. There was good agreement between self-report and interviewer-administered versions of the scale. The GAD-7 is a valid and efficient tool for screening for GAD and assessing its severity in clinical practice and research.
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            The PHQ-9: validity of a brief depression severity measure.

            While considerable attention has focused on improving the detection of depression, assessment of severity is also important in guiding treatment decisions. Therefore, we examined the validity of a brief, new measure of depression severity. The Patient Health Questionnaire (PHQ) is a self-administered version of the PRIME-MD diagnostic instrument for common mental disorders. The PHQ-9 is the depression module, which scores each of the 9 DSM-IV criteria as "0" (not at all) to "3" (nearly every day). The PHQ-9 was completed by 6,000 patients in 8 primary care clinics and 7 obstetrics-gynecology clinics. Construct validity was assessed using the 20-item Short-Form General Health Survey, self-reported sick days and clinic visits, and symptom-related difficulty. Criterion validity was assessed against an independent structured mental health professional (MHP) interview in a sample of 580 patients. As PHQ-9 depression severity increased, there was a substantial decrease in functional status on all 6 SF-20 subscales. Also, symptom-related difficulty, sick days, and health care utilization increased. Using the MHP reinterview as the criterion standard, a PHQ-9 score > or =10 had a sensitivity of 88% and a specificity of 88% for major depression. PHQ-9 scores of 5, 10, 15, and 20 represented mild, moderate, moderately severe, and severe depression, respectively. Results were similar in the primary care and obstetrics-gynecology samples. In addition to making criteria-based diagnoses of depressive disorders, the PHQ-9 is also a reliable and valid measure of depression severity. These characteristics plus its brevity make the PHQ-9 a useful clinical and research tool.
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              Is Open Access

              Immediate Psychological Responses and Associated Factors during the Initial Stage of the 2019 Coronavirus Disease (COVID-19) Epidemic among the General Population in China

              Background: The 2019 coronavirus disease (COVID-19) epidemic is a public health emergency of international concern and poses a challenge to psychological resilience. Research data are needed to develop evidence-driven strategies to reduce adverse psychological impacts and psychiatric symptoms during the epidemic. The aim of this study was to survey the general public in China to better understand their levels of psychological impact, anxiety, depression, and stress during the initial stage of the COVID-19 outbreak. The data will be used for future reference. Methods: From 31 January to 2 February 2020, we conducted an online survey using snowball sampling techniques. The online survey collected information on demographic data, physical symptoms in the past 14 days, contact history with COVID-19, knowledge and concerns about COVID-19, precautionary measures against COVID-19, and additional information required with respect to COVID-19. Psychological impact was assessed by the Impact of Event Scale-Revised (IES-R), and mental health status was assessed by the Depression, Anxiety and Stress Scale (DASS-21). Results: This study included 1210 respondents from 194 cities in China. In total, 53.8% of respondents rated the psychological impact of the outbreak as moderate or severe; 16.5% reported moderate to severe depressive symptoms; 28.8% reported moderate to severe anxiety symptoms; and 8.1% reported moderate to severe stress levels. Most respondents spent 20–24 h per day at home (84.7%); were worried about their family members contracting COVID-19 (75.2%); and were satisfied with the amount of health information available (75.1%). Female gender, student status, specific physical symptoms (e.g., myalgia, dizziness, coryza), and poor self-rated health status were significantly associated with a greater psychological impact of the outbreak and higher levels of stress, anxiety, and depression (p < 0.05). Specific up-to-date and accurate health information (e.g., treatment, local outbreak situation) and particular precautionary measures (e.g., hand hygiene, wearing a mask) were associated with a lower psychological impact of the outbreak and lower levels of stress, anxiety, and depression (p < 0.05). Conclusions: During the initial phase of the COVID-19 outbreak in China, more than half of the respondents rated the psychological impact as moderate-to-severe, and about one-third reported moderate-to-severe anxiety. Our findings identify factors associated with a lower level of psychological impact and better mental health status that can be used to formulate psychological interventions to improve the mental health of vulnerable groups during the COVID-19 epidemic.
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                Author and article information

                Contributors
                linlu@bjmu.edu.cn
                shijie@bjmu.edu.cn
                Journal
                Am J Addict
                Am J Addict
                10.1111/(ISSN)1521-0391
                AJAD
                The American Journal on Addictions
                John Wiley and Sons Inc. (Hoboken )
                1055-0496
                1521-0391
                19 March 2021
                July 2021
                : 30
                : 4 ( doiID: 10.1111/ajad.v30.4 )
                : 389-397
                Affiliations
                [ 1 ] Beijing Key Laboratory of Drug Dependence, National Institute on Drug Dependence Peking University Beijing China
                [ 2 ] Department of Social Work and Social Administration University of Hong Kong Hong Kong China
                [ 3 ] NHC Key Laboratory of Mental Health (Peking University), National Clinical Research Center for Mental Disorders (Peking University Sixth Hospital), Peking University Sixth Hospital, Peking University Institute of Mental Health Beijing China
                [ 4 ] Division of Alcohol and Addiction Psychiatry Baylor College of Medicine Houston Texas
                [ 5 ] Department of Addiction Institute of Psychiatry, Psychology & Neuroscience, King's College London London UK
                [ 6 ] Peking University Shenzhen Hospital Beijing China
                Author notes
                [*] [* ] Address correspondence to Drs Shi and Lu, Beijing Key Laboratory of Drug Dependence, National Institute on Drug Dependence, Peking University, 38 Xueyuan Road, Haidian District, 100191 Beijing, China.

                E‐mail: shijie@ 123456bjmu.edu.cn (JS); linlu@ 123456bjmu.edu.cn (LL)

                Author information
                http://orcid.org/0000-0002-1881-0939
                http://orcid.org/0000-0001-6567-8160
                Article
                AJAD13156
                10.1111/ajad.13156
                8251395
                33738888
                c014aff1-f8d9-4e9b-af6f-39eb5d6fa4ca
                © 2021 American Academy of Addiction Psychiatry

                This article is being made freely available through PubMed Central as part of the COVID-19 public health emergency response. It can be used for unrestricted research re-use and analysis in any form or by any means with acknowledgement of the original source, for the duration of the public health emergency.

                History
                : 03 January 2021
                : 16 October 2020
                : 26 January 2021
                Page count
                Figures: 0, Tables: 2, Pages: 9, Words: 5652
                Funding
                Funded by: Youth Elite Scientists Sponsorship Program by CASR
                Award ID: CSTQT2017002
                Funded by: National Natural Science Foundation of China , open-funder-registry 10.13039/501100001809;
                Award ID: 81761128036
                Award ID: 81901352
                Award ID: U180220091
                Funded by: Special Research Fund of PKUHSC for Prevention and Control of COVID‐19
                Award ID: BMU2020HKYZX008
                Funded by: Beijing Municipal Science & Technology Commission
                Award ID: Z181100001518005
                Categories
                Regular Article
                Regular Articles
                Custom metadata
                2.0
                July 2021
                Converter:WILEY_ML3GV2_TO_JATSPMC version:6.0.4 mode:remove_FC converted:02.07.2021

                Health & Social care
                Health & Social care

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