Monday, 10 September 2018

Internet addiction and suicidal behaviours meta-analysed

"This meta-analysis provides evidence that internet addiction is associated with increased suicidality even after adjusting for potential confounding variables including depression."

That was the research bottom line reported on by Yu-Shian Cheng and colleagues [1] following their meta-analysis of the peer-reviewed research literature looking at 'internet addiction' ("internet addiction OR internet gaming disorder OR internet use disorder OR pathological internet use OR compulsive internet use OR problematic internet use") and suicidality.

Researchers, with some experience of meta-analysis it has to be said (see here and see here), trawled through the pertinent literature and settled on the analysis of some 25 studies, including over a quarter of a million participants, that looked at internet addiction and suicidal ideation, planning, and attempts. Boiling the data down, they observed some important *associations* that even held when important variables linked to suicidal behaviours - depression for example - were adjusted for. Children it seems, were also more 'vulnerable' to the link between internet addiction and suicidality. The authors caution that cause-and-effect were not proven from their analysis of the collected data, bearing in mind "the evidence was derived mostly from cross-sectional studies" but call for further investigations in this area.

This is an important area of research. As per some of the previous studies conducted on internet overuse and suicidality [2], there are some important further investigations to be undertaken on for example, the various types of online activity that might increase the risk of suicidality: "online gaming, chatting, watching movies, shopping, and gambling were associated with an increased risk of suicidal attempt." This in the context that social media use in particular, is under the spotlight when it comes to various different health issues (see here). Alongside gambling disorder, so it looks like gaming disorder is set to enter the diagnostic texts too (see here), where 'lack of control' and causing "significant impairment in personal, family, social, educational, occupational or other important areas of functioning" are key features. And minus any sweeping generalisations, 'control' *could* actually be a key element to consider when it comes to suicidal behaviours in certain circumstances.

Bearing in mind that this blog is predominantly concerned with autism research, I couldn't help but think about how the Cheng findings *might* relate to [some] autism. How for example, a diagnosis of autism also seems to elevate the risk of suicidality (see here) and how issues like depression are not uncommon in the context of autism (see here). I'm also minded to mention how compulsive internet use *might* show some important connections to the presentation of autistic traits [2] and how videogame use, in particular (see here), might have both positives and negatives in the context of autism [3].

By saying all that, I don't want to make any sweeping generalisations; the label of autism has had enough of those down the years. I don't also want to demonise the wonderful resource that is the internet, particularly when pastimes like gaming and social media use can be a good 'social' outlet for many people on the autism spectrum and beyond when used in moderation. Certainly the internet, through things like social media, provides an important voice and potentially quite a lot more to those whose voices might previously not have been heard...

But perhaps when it comes to the next stage of any research plan looking at internet overuse / addiction and suicidal behaviours it might be worth considering whether some of the features of autism or other, related labels [4] (see here) *might* also moderate any relationship. Whether there are some relevant lessons to be learned that *might* reduce the very worrying statistics on suicide and autism, and whether activities other than those done on online, could perhaps be seen as 'protective factors' when it comes to suicide risk (see here for example)?

Bear all that in mind by all means. But remember also that the paths that take someone to such suicidal behaviours are often numerous and individual. Internet overuse is probably only a small part of an often bigger and more complicated picture.

And in case anyone needs to talk or text, there's always someone who will listen (see here).

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[1] Cheng YS. et al. Internet Addiction and Its Relationship With Suicidal Behaviors: A Meta-Analysis of Multinational Observational Studies. J Clin Psychiatry. 2018 Jun 5;79(4). pii: 17r11761.

[2] Lin IH. et al. The association between suicidality and Internet addiction and activities in Taiwanese adolescents. Compr Psychiatry. 2014 Apr;55(3):504-10.

[3] Mazurek MO. & Wenstrup C. Television, video game and social media use among children with ASD and typically developing siblings. J Autism Dev Disord. 2013 Jun;43(6):1258-71.

[4] Wang B. et al. The association between attention deficit/hyperactivity disorder and internet addiction: a systematic review and meta-analysis. BMC Psychiatry. 2017;17:260.

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