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Background Over the past decade, smartphone use has become widespread amongst today’s children and young people (CYP) which parallels increases in poor mental health in this group. Simultaneously, media concern abounds about the existence of ‘smartphone addiction’ or problematic smartphone use. There has been much recent research concerning the prevalence of problematic smartphone use is in children and young people who use smartphones, and how this syndrome relates to mental health outcomes, but this has not been synthesized and critically evaluated. Aims To conduct a systematic review and meta-analysis to examine the prevalence of PSU and quantify the association with mental health harms. Methods A search strategy using Medical Subject Headings was developed and adapted for eight databases between January 1, 1st 2011 to October 15th 2017. No language restriction was applied. Of 924 studies identified, 41 were included in this review, three of which were cohort studies and 38 were cross sectional studies. The mental health outcomes were self-reported: depression; anxiety; stress; poor sleep quality; and decreased educational attainment, which were synthesized according to an a priori protocol. Results The studies included 41,871 CYP, and 55% were female. The median prevalence of PSU amongst CYP was 23.3% (14.0–31.2%). PSU was associated with an increased odds of depression (OR = 3.17;95%CI 2.30–4.37; I 2  = 78%); increased anxiety (OR = 3.05 95%CI 2.64–3.53; I 2  = 0%); higher perceived stress (OR = 1.86;95%CI 1.24–2.77; I 2  = 65%); and poorer sleep quality (OR = 2.60; 95%CI; 1.39–4.85, I 2  = 78%). Conclusions PSU was reported in approximately one in every four CYP and accompanied by an increased odds of poorer mental health. PSU is an evolving public health concern that requires greater study to determine the boundary between helpful and harmful technology use. Policy guidance is needed to outline harm reduction strategies.

Background Smartphones are becoming a daily necessity for most undergraduates in Mainland China. Because the present scenario of problematic smartphone use (PSU) is largely unexplored, in the current study we aimed to estimate the prevalence of PSU and to screen suitable predictors for PSU among Chinese undergraduates in the framework of the stress-coping theory. Methods A sample of 1062 undergraduate smartphone users was recruited by means of the stratified cluster random sampling strategy between April and May 2015. The Problematic Cellular Phone Use Questionnaire was used to identify PSU. We evaluated five candidate risk factors for PSU by using logistic regression analysis while controlling for demographic characteristics and specific features of smartphone use. Results The prevalence of PSU among Chinese undergraduates was estimated to be 21.3%. The risk factors for PSU were majoring in the humanities, high monthly income from the family (≥1500 RMB), serious emotional symptoms, high perceived stress, and perfectionism-related factors (high doubts about actions, high parental expectations). Conclusions PSU among undergraduates appears to be ubiquitous and thus constitutes a public health issue in Mainland China. Although further longitudinal studies are required to test whether PSU is a transient phenomenon or a chronic and progressive condition, our study successfully identified socio-demographic and psychological risk factors for PSU. These results, obtained from a random and thus representative sample of undergraduates, opens up new avenues in terms of prevention and regulation policies.

Background This study evaluates the association between Internal Addiction (IA) and psychiatric co-morbidity in the literature. Methods Meta-analyses were conducted on cross-sectional, case–control and cohort studies which examined the relationship between IA and psychiatric co-morbidity. Selected studies were extracted from major online databases. The inclusion criteria are as follows: 1) studies conducted on human subjects; 2) IA and psychiatric co-morbidity were assessed by standardised questionnaires; and 3) availability of adequate information to calculate the effect size. Random-effects models were used to calculate the aggregate prevalence and the pooled odds ratios (OR). Results Eight studies comprising 1641 patients suffering from IA and 11210 controls were included. Our analyses demonstrated a significant and positive association between IA and alcohol abuse (OR = 3.05, 95% CI = 2.14-4.37, z = 6.12, P < 0.001), attention deficit and hyperactivity (OR = 2.85, 95% CI = 2.15-3.77, z = 7.27, P < 0.001), depression (OR = 2.77, 95% CI = 2.04-3.75, z = 6.55, P < 0.001) and anxiety (OR = 2.70, 95% CI = 1.46-4.97, z = 3.18, P = 0.001). Conclusions IA is significantly associated with alcohol abuse, attention deficit and hyperactivity, depression and anxiety.

Background Everyday internet usage is particularly significant in the population of adolescents and young people. Besides numerous benefits, internet usage brings certain risks of addictive behavior. Internet Addiction Test (IAT) is the most spread scale for measuring internet addiction. The aim of this study was to investigate internet addiction on a sample of Croatian adolescents. Methods Overall, 352 students aged between 15 and 20 from randomly selected high schools participated in the study. We have collected the data on the Internet Addiction Test along with basic demographic information. The main analyses included the factorization of IAT test and the measurement of prevalence of internet addiction with the analysis of the gender differences. Results The results showed that 3.4% of high school students reported high levels of internet addiction, while 35.4% of respondents reported some signs of addiction. Three-factor structure of IAT was obtained with dimensions: Emotional and cognitive internet preoccupation , then Neglecting work and lack of self-control and the last one is Social problems . Although the first factor has the most significant role in internet addiction risk, gender differences were found only in the last two factors, where boys have higher scores on Social Problems , while girls have higher scores on Neglecting work and lack of self-control . Conclusions Based on our results, the prevention activities should be focused on the area of ​​emotional and social competence and the responsible use of internet. Since the result show that a third of the sample show moderate signs of addiction, programs of both indicated and selective prevention should be systematically planned for the general population of adolescents as well as for the groups in risk. The obtained gender differences indicate that the preventive and treatment programs should take into account gender specifics.

Background The aim of this study was to systematically summarize knowledge on the association between exposure to interpersonal trauma and addictive behaviors. Extant reviews on this association focused on a restricted range of substance-related addictions, and/or used a narrative instead of a systematic approach. Methods Systematic searches of 8 databases yielded 29,841 studies, of which 3054 studies were included and subsequently classified in relation to study design (scoping review). A subset of observational studies ( N  = 181) prospectively investigating the relationship between exposure to interpersonal traumata and subsequent behavioral or substance-related addiction problems were characterized. Heterogeneity in study methodologies and types of addictive behaviors and traumatic experiences assessed precluded meta-analysis. Instead, the proportions of associations tested in this literature that revealed positive, negative, or null relationships between trauma exposure and subsequent addictive behaviors were recorded, along with other methodological features. Results Of 3054 included studies, 70.7% ( n  = 2160) used a cross-sectional design. In the 181 prospective observational studies (407,041 participants, 98.8% recruited from developed countries), 35.1% of the tested associations between trauma exposure and later addictive behaviors was positive, 1.3% was negative, and 63.6% was non-significant. These results were primarily obtained among non-treatment seeking samples (80.7% of studies; n  = 146), using single and multi-item measures of addictive behaviors of unknown psychometric quality (46.4% of studies). Positive associations were more frequently observed in studies examining childhood versus adult traumatization (39.7% vs. 29.7%). Conclusions Longitudinal research in this area emphasizes alcohol abuse, and almost no research has examined behavioral addictions. Results provide some support for a positive association between exposure to interpersonal trauma and subsequent addictive behaviors but this relationship was not consistently reported. Longitudinal studies typically assessed trauma exposure retrospectively, often after addictive behavior onset, thus precluding robust inferences about whether traumatization affects initial onset of addictive behaviors.

Background People with severe mental ill health are more likely to smoke than those in the general population. It is therefore important that effective smoking cessation strategies are used to help people with severe mental ill health to stop smoking. This study aims to assess the effectiveness and cost –effectiveness of smoking cessation and reduction strategies in adults with severe mental ill health in both inpatient and outpatient settings. Methods This is an update of a previous systematic review. Electronic databases were searched during September 2016 for randomised controlled trials comparing smoking cessation interventions to each other, usual care, or placebo. Data was extracted on biochemically-verified, self-reported smoking cessation (primary outcome), as well as on smoking reduction, body weight, psychiatric symptom, and adverse events (secondary outcomes). Results We included 26 trials of pharmacological and/or behavioural interventions. Eight trials comparing bupropion to placebo were pooled showing that bupropion improved quit rates significantly in the medium and long term but not the short term (short term RR = 6.42 95% CI 0.82–50.07; medium term RR = 2.93 95% CI 1.61–5.34; long term RR = 3.04 95% CI 1.10–8.42). Five trials comparing varenicline to placebo showed that that the addition of varenicline improved quit rates significantly in the medium term (RR = 4.13 95% CI 1.36–12.53). The results from five trials of specialised smoking cessation programmes were pooled and showed no evidence of benefit in the medium (RR = 1.32 95% CI 0.85–2.06) or long term (RR = 1.33 95% CI 0.85–2.08). There was insufficient data to allowing pooling for all time points for varenicline and trials of specialist smoking cessation programmes. Trials suggest few adverse events although safety data were not always reported. Only one pilot study reported cost effectiveness data. Conclusions Bupropion and varenicline, which have been shown to be effective in the general population, also work for people with severe mental ill health and their use in patients with stable psychiatric conditions. Despite good evidence for the effectiveness of smoking cessation interventions for people with severe mental ill health, the percentage of people with severe mental ill health who smoke remains higher than that for the general population.

Background With the popularity of mobile phones, problematic mobile phone use is getting increasing attention in recent years. Although self-control was found to be a critical predictor of problematic mobile phone use, no study has ever explored the association between self-control and mobile phone use patterns as well as the possible pathway how self-control affects problematic mobile phone use. Methods Four hundred sixty-eight college students were randomly selected in this study. Data were collected using the Problematic Mobile Phone Use Scale, the Self-Control Scale, and the Mobile Phone Use Pattern Questionnaire. Statistical tests were conducted to identify the potential role of mobile phone use patterns in the association between self-control and problematic mobile phone use. Results In this sample, female students displayed significant higher mobile phone dependence than males. Self-control was negatively correlated with interpersonal, transaction and entertainment mobile phone use patterns, but positively correlated with information seeking use pattern. Self-control could predict problematic mobile phone use directly and indirectly via interpersonal and transaction patterns. Conclusions Our research provided additional evidence for the negative association between self-control and problematic mobile phone use. Moreover, interpersonal and transaction use patterns played a mediating role in this link.

Background Alcohol use is part of many cultural, religious and social practices, and provides perceived pleasure to many users. In many societies, alcoholic beverages are a routine part of the social landscape for many in the population. Relatively low rates were reported for Alcohol Use Disorders (AUD) in a community-based survey and facility detection survey conducted in the study site contrary to findings in earlier formative studies where alcohol use was reported to be a major health problem. The aim of this study was to understand the reasons for under-reporting and the low detection rate for AUDs, exploring societal perceptions of alcohol use in the study district. Methods The study was conducted in Kamuli District (implementation site for the PRIME project). Semi-structured interviews and focus group discussions were conducted with purposively selected participants that included local and religious leaders, lay people, health workers as well as heavy alcohol drinkers and their spouses. Interviews were tape-recorded and transcribed verbatim. The analysis followed four thematic areas, which include the extent and acceptability of alcohol use, patterns of alcohol use, perceived health problems associated with alcohol use and help-seeking behavior for persons with alcohol related problems. Results The findings indicate that alcohol consumption in the study site was common and widely acceptable across all categories of people and only frowned upon if the person becomes a nuisance to others. These findings suggest that the health problems associated with alcohol use are overlooked except when they are life-threatening. Help-seeking for such problems was therefore reported to be relatively rare. Conclusion Alcohol was readily available in the community and its consumption widely acceptable, with less social sanctions despite the legal restrictions to the minors. The social acceptance results in low recognition of alcohol use related health problems, consequently resulting in poor help-seeking behavior.

Background Nonmedical prescription drug use (NMPDU) refers to the self-treatment of a medical condition using medication without a prescriber’s authorization as well as use to achieve euphoric states. This article reports data from a cross-national investigation of NMPDU in five European Countries, with the aim to understand the prevalence and characteristics of those engaging in NMPDU across the EU. Methods A parallel series of self-administered, cross-sectional, general population surveys were conducted in 2014. Data were collected using multi-stage quota sampling and then weighted using General Exponential Model. A total of 22,070 non-institutionalized participants, aged 12 to 49 years, in 5 countries: Denmark, Germany, Great Britain, Spain, and Sweden. Lifetime and past-year nonmedical use of prescription medications such as stimulants, opioids, and sedatives were ascertained via a modified version of the World Health Organization’s Composite International Diagnostic Interview. Information about how the medications were acquired for NMPDU were also collected from the respondent. Results Lifetime and past-year prevalence of nonmedical prescription drug use was estimated for opioids (13.5 and 5.0 %), sedatives (10.9 and 5.8 %), and stimulants (7.0 and 2.8 %). Germany exhibited the lowest levels of NMPDU, with Great Britain, Spain, and Sweden having the highest levels. Mental and sexual health risk factors were associated with an increased likelihood of past-year nonmedical prescription drug use. Among past-year users, about 32, 28, and 52 % of opioid, sedative, and stimulant nonmedical users, respectively, also consumed illicit drugs. Social sources (sharing by friends/family) were the most commonly endorsed methods of acquisition, ranging from 44 % (opioids) to 62 % (sedatives). Of interest is that Internet pharmacies were a common source of medications for opioids (4.1 %), stimulants (7.6 %), and sedatives (2.7 %). Conclusions Nonmedical prescription drug use was reported across the five EU countries we studied, with opioids and sedatives being the most prevalent classes of prescription psychotherapeutics. International collaborations are needed for continued monitoring and intervention efforts to target population subgroups at greatest risk for NMDU.

Background Many studies reported the high prevalence of problematic internet use (PIU) among adolescents (13–50%), and PIU was associated with various psychiatric symptoms. In contrast, only a few studies investigated the prevalence among the adult population (6%). This study aimed to investigate the prevalence of PIU and psychiatric co-morbidity among adult psychiatric patients. Methods Three hundred thirty-three adult psychiatric patients were recruited over a 3-month period. Two hundred thirty-one of them completed the survey (response rate: 69.4%, 231/333; Male/Female/Transgender: 90/139/2; mean age = 42.2). We divided participants into “normal internet users” and “problematic internet users” using a combination of Young’s Internet Addiction Test (IAT) and the Compulsive Internet Use Scale (CIUS). Demographic data and comorbid psychiatric symptoms were compared between the two groups using self-rating scales measuring insomnia (Athens Insomnia Scale, AIS), depression (Beck Depression Inventory, BDI), anxiety (State-trait Anxiety Inventory, STAI), attention deficit hyperactivity disorder (ADHD) (Adult ADHD Self-report Scale, ASRS), autism (Autism Spectrum Quotient, AQ), obsessive-compulsive disorder (OCD) (Obsessive-Compulsive Inventory, OCI), social anxiety disorder (SAD) (Liebowitz Social Anxiety Scale, LSAS), alcohol abuse, and impulsivity (Barratt Impulsive Scale, BIS). Results Among 231 respondents, 58 (25.1%) were defined as problematic internet users, as they scored high on the IAT (40 or more) or CIUS (21 or more). The age of problematic internet users was significantly lower than that of normal internet users ( p  < 0.001, Mann–Whitney U test). The problematic internet users scored significantly higher on scales measuring sleep problems (AIS, 8.8 for problematic internet users vs 6.3 for normal internet users, p  < 0.001), depression (BDI, 27.4 vs 18.3, p  < 0.001), trait anxiety (STAI, 61.8 vs 53.9, p < 0.001), ADHD (ASRS, part A 3.1 vs 1.8 and part B 3.5 vs 1.8, p  < 0.001), autism (AQ, 25.9 vs 21.6, p  < 0.001), OCD (OCI, 63.2 vs 36.3, p  < 0.001), SAD (LSAS, 71.4 vs 54.0, p  < 0.001), and impulsivity (BIS, 67.4 vs 63.5, p  = 0.004). Conclusions The prevalence of PIU among adult psychiatric patients is relatively high. As previous studies reported in the general population, lower age and psychiatric comorbidity were associated with PIU among adult psychiatric patients. More research is needed to determine any causal relations between PIU and psychopathological illnesses.