Using the Internet as a source of information and support: a discussion paper on the risks and benefits for children and young people with long-term conditions.

Children and young people who have long-term conditions are likely to seek health-related information via the Internet. Because of their continuing contact with children with such conditions, primary care practitioners may be well placed to discuss with them and their families the risks and benefits of accessing information online. This includes not only the relative merits of particular sites but also more general online safety issues. To achieve this, it may be helpful for primary care practitioners to consider how they view risk in general, the risks associated with the Internet and the vulnerabilities of children and young people, particularly those with long-term conditions

A Cyberbullying Needs Assessment in a Middle School Population: Identifying a Direction for Nurses

Cyberbullying is a fairly new phenomenon that most adolescents will experience or be exposed to during their lifetime. It produces devastating outcomes on those who are victims and perpetrators of cyberbullying. There is a limited amount of research regarding the prevention of cyberbullying. The evidence that is available is mostly exploratory in nature. Currently, the literature recommends conducting a needs assessment to validate the problem, raise awareness, and identify potential solutions that are specific to a population and/or setting. Therefore, the purpose of this scholarly project was to administer a cyberbullying needs assessment at a local west Michigan middle school. Two conceptual frameworks were used to guide this project: the model for evidence-based practice change and the social cognitive theory. The sample included 296 seventh and eighth grade students from a local west Michigan middle school. The Cyberbullying and Online Aggression Instrument created by Hinduja and Patchin (2014) was used. Three qualitative questions were asked. These pertained to how teachers, peers and parents could prevent cyberbullying. Descriptive statistics were used to report the data and categories were identified from the qualitative data. Findings included that most students at this middle school have been exposed to cyberbullying. Differences were observed in cyberbullying methods between the seventh and eighth grade students. Differences were also observed in cyberbullying frequency between male and female students. Based on the findings, recommendations related to future prevention efforts are made for this west Michigan middle school

Ο Εθισμός Παιδιών και Εφήβων στο Διαδίκτυο και Προτάσεις για Παρέμβαση

Η παρούσα βιβλιογραφική ανασκόπηση αποσκοπεί στη διερεύνηση του επιπέδου του εθισμού στο διαδίκτυο τόσο σε εφήβους όσο και σε παιδιά μικρότερης ηλικίας, καθώς έχει καταγραφεί πως αυτές οι ηλικιακές ομάδες αποτελούν τους πιο επιρρεπείς πληθυσμούς στο σύγχρονο αυτό φαινόμενο της διαδικτυακής εξάρτησης, καθώς διαθέτουν ιδιαίτερα αναπτυξιακά στοιχεία και αποτελούν «γενιές» της τεχνολογίας. Η βιβλιογραφία διαπιστώνει πως η ραγδαία αύξηση του εθισμού στο διαδίκτυο των παραπάνω πληθυσμών παρατηρείται τόσο στην Ελλάδα όσο και στο εξωτερικό και οι διαδικτυακές δραστηριότητες παιδιών και εφήβων ποικίλλουν, με κυριότερες τα διαδικτυακά παιχνίδια και τα μέσα κοινωνικής δικτύωσης. Μέσα από τη μελέτη και σύγκριση σύγχρονων επιστημονικών ερευνών, βρέθηκε πως ο εθισμός στο διαδίκτυο αποτελεί ένα πολυπαραγοντικό φαινόμενο, καθώς τα αίτια της εμφάνισής του μπορεί να είναι ψυχικής, βιολογικής, περιβαλλοντικής ή κοινωνικής φύσεως. Παράλληλα, ο εθισμός στο διαδίκτυο φαίνεται να επηρεάζει σημαντικά την ψυχική και σωματική υγεία των προβληματικών χρηστών, την ακαδημαϊκή τους απόδοση, καθώς και τις σχέσεις τους με την οικογένεια, η οποία διαδραματίζει πρωταρχικό ρόλο στην ανάπτυξη και αντιμετώπιση της διαδικτυακής εξάρτησης. Η βιβλιογραφική ανασκόπηση παραθέτει μια σειρά από εργαλεία μέτρησης του διαδικτυακού εθισμού, τα οποία, ωστόσο, εστιάζουν κυρίως στην οπτική γωνία του χρήστη και όχι της οικογένειας, με αποτέλεσμα η διάγνωση να μην καθίσταται αντικειμενική και σφαιρική. Συμπερασματικά, οι μελλοντικές έρευνες θα πρέπει να συμπεριλάβουν μεγαλύτερο δείγμα παιδιών και προεφήβων αλλά και να αξιολογούν περισσότερο τις απόψεις των γονέων. Τέλος, κρίνεται απαραίτητη η έγκαιρη πρόληψη και παρεμβατική προσέγγιση του εθισμού στο διαδίκτυο μέσα από την εφαρμογή προγραμμάτων που συμβάλλουν στην ενημέρωση των μαθητών, τη συνειδητοποίηση της υπερβολικής ενασχόλησης τους με το διαδίκτυο και την κινητοποίησή τους για αλλαγή της παθολογικής συμπεριφοράςThe current literature review aims to examine the level of internet addiction identified in teenagers and students of younger age, as it has been noted that these groups constitute the most vulnerable populations to internet addiction due to their special developmental traits as well as their identity as a “generation” born and raised in the era of technology. The literature highlights the rapid increase of internet addiction among students which takes place in Greece and abroad and refers to a variety of online activities, emphasizing online games and social media as the children’s most preferable ones. Modern scientific studies consider internet addiction to be a multifaceted phenomenon, as the factors of its emergence may be of psychological, biological, environmental or social nature. Internet addiction also seems to highly affect the pathological internet users’ mental and physical health, academic performance and relationships with the family, the latter being vital for the development and treatment of internet addiction. Moreover, the literature review details a list of existing questionnaires on internet addiction. However, they mainly focus on the viewpoint of excessive internet users and not the one of their family members. As a result, the diagnosis may not be objective and complete. In conclusion, future research should include a bigger sample of elementary school internet users and take into greater consideration parents’ viewpoint. Simultaneously, the implementation of prevention and intervention programs on internet addiction appears necessary, especially in schools, aiming to inform children and adolescents on the excessive internet use and motivate them in order to change the pathological behavior

Pathological Internet use and psychopathology among European adolescents

Background: Internet use and accessibility has grown exponentially across the globe. The highest rates are noted in adolescents and youth. The swift development of technological improvements combined with interactive and enticing online activities has demonstrated to be unprecedented. As a result, the endless possibilities of the Internet become exceptionally appealing, whereby the risk of excessive use becomes elevated. Excessive use of the Internet is a strong precursor for subsequent pathological Internet use (PIU). Considered to be a subtype of a behavioural addiction, the construct of PIU is closely related to the biopsychosocial model of addiction. This suggests that there are genetic, biological, psychological and social components involved in the complex pathways of PIU development. Thus, initiatives that adopt such a multifaceted approach are critically needed in order to attain a better understanding of PIU and related factors. Objectives: The primary aim of this thesis is to improve our knowledge of adolescent PIU by utilising a multifactorial approach. The objective of Study I is to estimate the prevalence of PIU and assess its potential link with demographic and social factors. The objectives in Studies II and III are to ascertain the correlations between PIU, psychopathology and suicidality, while Study IV investigates the association between PIU and health risk-behaviours. The objective of Study V is to evaluate the preventive effect of mental health action in schools on PIU and related psychosocial impairments. Methods and materials: The studies in this thesis were conducted within the framework of the FP7 European Union project: Saving and Empowering Young Lives in Europe (SEYLE). SEYLE is a randomised controlled trial (RCT) assessing the efficacy of mental health interventions based on different strategies and approaches. Adolescents were recruited from randomly-selected schools across study sites in eleven countries, including Austria, Estonia, France, Germany, Hungary, Ireland, Israel, Italy, Romania, Slovenia and Spain, with Sweden serving as the coordinating centre. PIU was measured using Young’s Diagnostic Questionnaire (YDQ). Social factors, health risk-behaviours, psychopathology and suicidality were measured using validated psychometric instruments. Apposite statistical models were applied in each study in order to assess the respective outcomes of interests. Results: Findings for each study are described accordingly: Study I comprised a sample of 11,956 adolescents (female/male: 6731/5225; mean age: 14.9 ±0.89). The overall prevalence of PIU was 4.4%. Prevalence rates of PIU were significantly higher in males than females (5.2% versus 3.8%). Adolescents in Israel had the highest prevalence of PIU, whereas Italy had the lowest. A significant correlation between mean hours online per day and male gender were observed. In terms of online activities, Internet gaming was significantly associated with males, while social networking was significantly correlated with females. Students not living with a biological parent, low parental involvement and parental unemployment showed the strongest association with PIU. Study II was a systematic review and meta-analysis. An electronic literature search was conducted using the following databases: MEDLINE, PsycARTICLES, PsychINFO, Global Health, and Web of Science. PIU and known synonyms were included in the search as well as psychopathology (i.e. depression, anxiety, symptoms of attention deficit and hyperactivity disorder (ADHD), obsessive-compulsive symptoms, social phobia and hostility/aggression). Effect sizes for the correlations observed were identified from either the respective publication or calculated using Cohen’s d or R2. The potential effect of publication bias was assessed using a funnel plot model and evaluated by Egger’s test based on a linear regression. Twenty articles met the pre-set inclusion and exclusion criteria: 75% reported significant correlations of PIU with depression, 57% with anxiety, 100% with symptoms of ADHD, 60% with obsessivecompulsive symptoms, and 66% with hostility/aggression. The majority of studies reported a higher rate of PIU among males than females. Depression and symptoms of ADHD appeared to have the most significant and consistent correlation with PIU. Study III comprised a sample of 11,356 school-based adolescents (M/F: 4,856/6,500; mean age: 14.9). Results showed that suicidal behaviours (suicidal ideation and suicide attempts), depression, anxiety, conduct problems and hyperactivity/inattention were significant and independent predictors of PIU. The correlation between PIU, conduct problems and hyperactivity/inattention was stronger among females, while the link between PIU and symptoms of depression, anxiety and peer relationship problems was stronger among males. The association between PIU, psychopathology and self-destructive behaviours was stronger in countries with a higher prevalence of PIU and suicide rates. These findings ascertain that psychopathology and suicidal behaviours are strongly related to PIU. This association is significantly influenced by gender and country suggesting socio-cultural influences. Study IV involved a sample of 11,931 adolescents who were included in the analyses: 43.4% male and 56.6% female (M/F: 5179/6752), with a mean age of 14.89±0.87 years. Adolescents reporting poor sleeping habits and risk-taking actions showed the strongest associations with PIU, followed by tobacco use, poor nutrition and physical inactivity. Among adolescents in the PIU group, 89.9% were characterized as having multiple risk-behaviours. The significant association observed between PIU and risk-behaviours, combined with a high rate of cooccurrence, underline the importance of considering PIU when screening, treating or preventing high-risk behaviours among adolescents. Study V included a sample of n=2,831 school-based adolescents. The sample comprised 47.1% male and 52.9% female adolescents (M/F: 1333/1498), with a mean age of 14.83±0.90 years. In order to avoid contamination from the SEYLE interventions, only those who were in the control group were included in this study. Mental health action in schools (MHAS) was defined as adolescents reporting to have received mental health education at their school and was approached by a teacher to discuss psychosocial issues prior to baseline assessment. Outcomes showed that adolescents exposed to MHAS had a 50 percent lower risk for the onset of PIU compared to the unexposed group. When analysing psychosocial impairments, results showed that adolescents in the MHAS group also exhibited a significantly lower incidence of ≥30 percent for emotional distress, depression and coping problems. Conclusion: Significant correlations between PIU and health risk-behaviours, psychopathology and suicidality were observed among European adolescents. Given the momentous proclivity of evidence-based research, it is clear that PIU is a condition that merits international recognition as a potential disorder. Implementing evidence-based mental health action in schools appear to be effective in the overall risk-reduction of PIU. Of course, the level of efficacy, in terms of prevention efforts, is dependent on the structure of the respective intervention. It is, therefore, critical that an international accord is reached in order to develop a standardized approach to ascertain the nomenclature, taxonomy and diagnostic criteria of PIU. The future direction of PIU research must focus on this fundamental issue in order to legitimize and advance our knowledge and understanding of this condition