Hertfordshire Partnership University NHS Foundation Trust, Hertfordshire, UK; School of Life and Medical Sciences, University of Hertfordshire, Hatfield, UK; School of Clinical Medicine, University of Cambridge, Cambridge, UK.
Department of Psychiatry, Bellvitge University Hospital-IDIBELL, University of Barcelona, Cibersam, Barcelona, Spain.
Compr Psychiatry. 2022 Oct;118:152346. doi: 10.1016/j.comppsych.2022.152346. Epub 2022 Aug 16.
Global concern about problematic usage of the internet (PUI), and its public health and societal costs, continues to grow, sharpened in focus under the privations of the COVID-19 pandemic. This narrative review reports the expert opinions of members of the largest international network of researchers on PUI in the framework of the European Cooperation in Science and Technology (COST) Action (CA 16207), on the scientific progress made and the critical knowledge gaps remaining to be filled as the term of the Action reaches its conclusion. A key advance has been achieving consensus on the clinical definition of various forms of PUI. Based on the overarching public health principles of protecting individuals and the public from harm and promoting the highest attainable standard of health, the World Health Organisation has introduced several new structured diagnoses into the ICD-11, including gambling disorder, gaming disorder, compulsive sexual behaviour disorder, and other unspecified or specified disorders due to addictive behaviours, alongside naming online activity as a diagnostic specifier. These definitions provide for the first time a sound platform for developing systematic networked research into various forms of PUI at global scale. Progress has also been made in areas such as refining and simplifying some of the available assessment instruments, clarifying the underpinning brain-based and social determinants, and building more empirically based etiological models, as a basis for therapeutic intervention, alongside public engagement initiatives. However, important gaps in our knowledge remain to be tackled. Principal among these include a better understanding of the course and evolution of the PUI-related problems, across different age groups, genders and other specific vulnerable groups, reliable methods for early identification of individuals at risk (before PUI becomes disordered), efficacious preventative and therapeutic interventions and ethical health and social policy changes that adequately safeguard human digital rights. The paper concludes with recommendations for achievable research goals, based on longitudinal analysis of a large multinational cohort co-designed with public stakeholders.
全球对互联网使用障碍（PUI）及其对公共卫生和社会成本的关注持续增长，在 COVID-19 大流行的困境下，这一问题更加受到关注。本综述报告了在欧洲科学技术合作组织（COST）行动（CA 16207）框架下，PUI 最大国际研究网络成员就科学进展和仍需填补的关键知识空白提出的专家意见，该行动即将结束。一个关键进展是就各种形式的 PUI 的临床定义达成共识。基于保护个人和公众免受伤害以及促进最高可达健康标准的总体公共卫生原则，世界卫生组织在 ICD-11 中引入了几种新的结构化诊断，包括赌博障碍、游戏障碍、强迫性行为障碍，以及其他因成瘾行为引起的未指定或指定障碍，同时将在线活动命名为诊断特征。这些定义首次为在全球范围内对各种形式的 PUI 进行系统的网络研究提供了一个合理的平台。在精炼和简化一些现有评估工具、阐明潜在的基于大脑和社会的决定因素以及构建更基于经验的病因学模型等方面也取得了进展，为治疗干预和公众参与倡议提供了基础。然而，我们的知识仍存在重要差距有待解决。其中最重要的包括更好地了解不同年龄组、性别和其他特定弱势群体中与 PUI 相关问题的过程和演变、可靠的方法用于早期识别处于危险中的个体（在 PUI 变得紊乱之前）、有效的预防和治疗干预措施以及充分保障人类数字权利的道德健康和社会政策变化。本文最后根据与公众利益相关者共同设计的大型跨国队列的纵向分析，提出了可实现的研究目标建议。
