European Child & Adolescent Psychiatry

, Volume 25, Issue 7, pp 725–734 | Cite as

A 2-year longitudinal study of prospective predictors of pathological Internet use in adolescents

  • Esther Strittmatter
  • Peter Parzer
  • Romuald Brunner
  • Gloria Fischer
  • Tony Durkee
  • Vladimir Carli
  • Christina W. Hoven
  • Camilla Wasserman
  • Marco Sarchiapone
  • Danuta Wasserman
  • Franz Resch
  • Michael Kaess
Original Contribution


Longitudinal studies of prospective predictors for pathological Internet use (PIU) in adolescents as well as its course are lacking. This three-wave longitudinal study was conducted within the framework of the European Union-funded project “Saving and Empowering Young Lives in Europe” over a 2-year period. The sample consisted of 1444 students at the baseline investigation (T0); 1202 students after 1 year (T1); and 515 students after 2 years (T2). Structured self-report questionnaires were administered at all three time points. PIU was assessed using the Young Diagnostic Questionnaire (YDQ). In addition, demographic (i.e., gender), social (i.e., parental involvement), psychological (i.e., emotional problems), and Internet use-related factors (i.e., online activities) were assessed as prospective predictors. The prevalence of PIU was 4.3 % at T0, 2.7 % at T1 and 3.1 % at T2. However, only 3 students (0.58 %) had persistent categorical PIU (YDQ score of ≥5) over the 2-year period. In univariate models, a variety of variables that have been previously identified in cross-sectional investigations predicted PIU at T2. However, multivariate regression demonstrated that only previous PIU symptoms and emotional problems were significant predictors of PIU 2 years later (adjusted R 2 0.23). The stability of categorical PIU in adolescents over 2 years was lower than previously reported. However, current PIU symptoms were the best predictor of later PIU; emotional symptoms also predicted PIU over and above the influence of previous problematic Internet use. Both PIU symptoms and emotional problems may contribute to the vicious cycle that supports the perpetuation of PIU.


Internet gaming disorder Internet addiction Longitudinal course Predictors Adolescents 



The SEYLE project was supported through Coordination Theme 1 (Health) of the European Union Seventh Framework Program (FP7), Grant Agreement Number HEALTH-F2-2009-223091. The authors acted independently from the funders in all aspects of study design, data analysis, and writing of this manuscript. The Project Leader and Coordinator of the SEYLE project is Professor of Psychiatry and Suicidology Danuta Wasserman, Karolinska Institutet (KI), Head of the National Centre for Suicide Research and Prevention of Mental Ill-Health and Suicide (NASP), at KI, Stockholm, Sweden. The project manager is Vladimir Carli, Senior Lecturer at the National Centre for Suicide Research and Prevention of Mental Ill-Health (NASP), KI, Stockholm, Sweden. Other members of the Executive Committee include Professor Marco Sarchiapone, Department of Health Sciences, University of Molise, Campobasso, Italy; Professor of Child and Adolescent Psychiatry Christina Hoven and Anthropologist Camilla Wasserman, Department of Child and Adolescent Psychiatry, New York State Psychiatric Institute and Mailman School of Public Health, Columbia University, New York, USA. The site leader of the German SEYLE project was Romuald Brunner, and the site coordinator was Michael Kaess, both from the University of Heidelberg, Germany. The Medical Faculty of the University of Heidelberg supported the analyses.

Compliance with ethical standards

Conflict of interest

The authors declare that they have no conflicts of interest.

Ethical standards

The study was approved by the national ethics committees and was performed in accordance with the ethical standards laid down in the 1964 Declaration of Helsinki and its later amendments. All participants provided their informed consent prior to their inclusion in the study.

Supplementary material

787_2015_779_MOESM1_ESM.docx (27 kb)
ESM1 (DOCX 27 kb)


  1. 1.
    Medienpädagogischer Forschungsverbund Südwest (2014) JIM 2014 (Jugend, Information, (Multi-) Media). Basisstudie zum Medienumgang 12- bis 19-Jähriger in Deutschland. [Internet]. Accessed 4 July 2015
  2. 2.
    Greenfield P, Yan Z (2006) Children, adolescents, and the internet: a new field of inquiry in developmental psychology. Dev Psychol 42(3):391–394. doi: 10.1037/0012-1649.42.3.391 CrossRefPubMedGoogle Scholar
  3. 3.
    Young KS (1998) Caught in the net: how to recognize the signs of Internet addiction—and a winning strategy for recovery. Wiley, New York, p 248Google Scholar
  4. 4.
    Davis RA (2001) A cognitive-behavioral model of pathological Internet use. Comput Hum Behav 17(2):187–195. doi: 10.1016/S0747-5632(00)00041-8 CrossRefGoogle Scholar
  5. 5.
    Durkee T, Kaess M, Carli V, Parzer P, Wasserman C, Floderus B et al (2012) Prevalence of pathological internet use among adolescents in Europe: demographic and social factors. Addict Abingdon Engl 107(12):2210–2222. doi: 10.1111/j.1360-0443.2012.03946.x CrossRefGoogle Scholar
  6. 6.
    Petry NM, Rehbein F, Gentile DA, Lemmens JS, Rumpf H-J, Mößle T et al (2014) An international consensus for assessing internet gaming disorder using the new DSM-5 approach. Addict Abingdon Engl 109(9):1399–1406. doi: 10.1111/add.12457 CrossRefGoogle Scholar
  7. 7.
    Meerkerk G-J, Van Den Eijnden RJJM, Garretsen HFL (2006) Predicting compulsive Internet use: it’s all about sex! Cyberpsychol Behav Impact Internet Multimed Virtual Real Behav Soc 9(1):95–103. doi: 10.1089/cpb.2006.9.95 Google Scholar
  8. 8.
    Caplan SE (2002) Problematic Internet use and psychosocial well-being: development of a theory-based cognitive–behavioral measurement instrument. Comput Hum Behav 18(5):553–575. doi: 10.1016/S0747-5632(02)00004-3 CrossRefGoogle Scholar
  9. 9.
    Van den Eijnden RJJM, Meerkerk G-J, Vermulst AA, Spijkerman R, Engels RCME (2008) Online communication, compulsive Internet use, and psychosocial well-being among adolescents: a longitudinal study. Dev Psychol 44(3):655–665. doi: 10.1037/0012-1649.44.3.655 CrossRefPubMedGoogle Scholar
  10. 10.
    Tao R, Huang X, Wang J, Zhang H, Zhang Y, Li M (2010) Proposed diagnostic criteria for internet addiction. Addict Abingdon Engl 105(3):556–564. doi: 10.1111/j.1360-0443.2009.02828.x CrossRefGoogle Scholar
  11. 11.
    Mann K, Fauth-Bühler M, Seiferth N, Heinz A, Expertengruppe Verhaltenssüchte der DGPPN (2013) The concept of behavioral addiction and limits of the term addiction. Nervenarzt 84(5):548–556. doi: 10.1007/s00115-012-3718-z CrossRefPubMedGoogle Scholar
  12. 12.
    Schimmenti A, Caretti V, La Barbera D (2014) Internet gaming disorder or Internet addiction? A plea for conceptual clarity. Clin Neuropsychiatry 11(5):145–146Google Scholar
  13. 13.
    Billieux J, Thorens G, Khazaal Y, Zullino D, Achab S, Van der Linden M (2015) Problematic involvement in online games: a cluster analytic approach. Comput Hum Behav 43:242–250. doi: 10.1016/j.chb.2014.10.055 CrossRefGoogle Scholar
  14. 14.
    Strittmatter E, Kaess M, Parzer P, Fischer G, Carli V, Hoven CW et al (2015) Pathological Internet use among adolescents: comparing gamers and non-gamers. Psychiatry Res 228(1):128–135. doi: 10.1016/j.psychres.2015.04.029 CrossRefPubMedGoogle Scholar
  15. 15.
    Tsitsika A, Janikian M, Schoenmakers TM, Tzavela EC, Ólafsson K, Wójcik S et al (2014) Internet addictive behavior in adolescence: a cross-sectional study in seven European countries. Cyberpsychol Behav Soc Netw 17(8):528–535. doi: 10.1089/cyber.2013.0382 CrossRefPubMedGoogle Scholar
  16. 16.
    Rumpf H-J, Vermulst AA, Bischof A, Kastirke N, Gürtler D, Bischof G et al (2014) Occurence of internet addiction in a general population sample: a latent class analysis. Eur Addict Res 20(4):159–166. doi: 10.1159/000354321 CrossRefPubMedGoogle Scholar
  17. 17.
    Gentile DA, Choo H, Liau A, Sim T, Li D, Fung D et al (2011) Pathological video game use among youths: a two-year longitudinal study. Pediatrics 127(2):e319–e329. doi: 10.1542/peds.2010-1353 CrossRefPubMedGoogle Scholar
  18. 18.
    Van Rooij AJ, Schoenmakers TM, Vermulst AA, Van den Eijnden RJJM, Van de Mheen D (2011) Online video game addiction: identification of addicted adolescent gamers. Addict Abingdon Engl 106(1):205–212. doi: 10.1111/j.1360-0443.2010.03104.x CrossRefGoogle Scholar
  19. 19.
    Scharkow M, Festl R, Quandt T (2014) Longitudinal patterns of problematic computer game use among adolescents and adults-a 2-year panel study. Addict Abingdon Engl 109(11):1910–1917. doi: 10.1111/add.12662 CrossRefGoogle Scholar
  20. 20.
    Kuss DJ, Griffiths MD, Karila L, Billieux J (2014) Internet addiction: a systematic review of epidemiological research for the last decade. Curr Pharm Des 20(25):4026–4052. doi: 10.2174/13816128113199990617 CrossRefPubMedGoogle Scholar
  21. 21.
    Carli V, Durkee T, Wasserman D, Hadlaczky G, Despalins R, Kramarz E et al (2013) The association between pathological internet use and comorbid psychopathology: a systematic review. Psychopathology 46(1):1–13. doi: 10.1159/000337971 CrossRefPubMedGoogle Scholar
  22. 22.
    Ko C-H, Yen J-Y, Chen C-S, Yeh Y-C, Yen C-F (2009) Predictive values of psychiatric symptoms for internet addiction in adolescents: a 2-year prospective study. Arch Pediatr Adolesc Med 163(10):937–943. doi: 10.1001/archpediatrics.2009.159 CrossRefPubMedGoogle Scholar
  23. 23.
    Black DW, Belsare G, Schlosser S (1999) Clinical features, psychiatric comorbidity, and health-related quality of life in persons reporting compulsive computer use behavior. J Clin Psychiatry 60(12):839–844CrossRefPubMedGoogle Scholar
  24. 24.
    Ha JH, Yoo HJ, Cho IH, Chin B, Shin D, Kim JH (2006) Psychiatric comorbidity assessed in Korean children and adolescents who screen positive for Internet addiction. J Clin Psychiatry 67(5):821–826CrossRefPubMedGoogle Scholar
  25. 25.
    Kaess M, Durkee T, Brunner R, Carli V, Parzer P, Wasserman C et al (2014) Pathological Internet use among European adolescents: psychopathology and self-destructive behaviours. Eur Child Adolesc Psychiatry 23(11):1093–1102. doi: 10.1007/s00787-014-0562-7 CrossRefPubMedPubMedCentralGoogle Scholar
  26. 26.
    Ko CH, Yen JY, Yen CF, Chen CS, Chen CC (2012) The association between Internet addiction and psychiatric disorder: a review of the literature. Eur Psychiatry J Assoc Eur Psychiatr 27(1):1–8. doi: 10.1016/j.eurpsy.2010.04.011 CrossRefGoogle Scholar
  27. 27.
    Mehroof M, Griffiths MD (2010) Online gaming addiction: the role of sensation seeking, self-control, neuroticism, aggression, state anxiety, and trait anxiety. Cyberpsychol Behav Soc Netw 13(3):313–316. doi: 10.1089/cyber.2009.0229 CrossRefPubMedGoogle Scholar
  28. 28.
    Shapira NA, Goldsmith TD, Keck PE, Khosla UM, McElroy SL (2000) Psychiatric features of individuals with problematic internet use. J Affect Disord 57(1–3):267–272. doi: 10.1016/S0165-0327(99)00107-X CrossRefPubMedGoogle Scholar
  29. 29.
    Lin I-H, Ko C-H, Chang Y-P, Liu T-L, Wang P-W, Lin H-C et al (2014) The association between suicidality and Internet addiction and activities in Taiwanese adolescents. Compr Psychiatry 55(3):504–510. doi: 10.1016/j.comppsych.2013.11.012 CrossRefPubMedGoogle Scholar
  30. 30.
    Tsai HF, Cheng SH, Yeh TL, Shih C-C, Chen KC, Yang YC et al (2009) The risk factors of Internet addiction—a survey of university freshmen. Psychiatry Res 30 167(3):294–299. doi: 10.1016/j.psychres.2008.01.015 CrossRefGoogle Scholar
  31. 31.
    Bakken IJ, Wenzel HG, Götestam KG, Johansson A, Oren A (2009) Internet addiction among Norwegian adults: a stratified probability sample study. Scand J Psychol 50(2):121–127. doi: 10.1111/j.1467-9450.2008.00685.x CrossRefPubMedGoogle Scholar
  32. 32.
    Hur MH (2006) Demographic, habitual, and socioeconomic determinants of Internet addiction disorder: an empirical study of Korean teenagers. Cyberpsychol Behav 9(5):514–525. doi: 10.1089/cpb.2006.9.514 CrossRefPubMedGoogle Scholar
  33. 33.
    Kuss DJ, Griffiths MD (2011) Online social networking and addiction–a review of the psychological literature. Int J Environ Res Public Health 8(9):3528–3552. doi: 10.3390/ijerph8093528 CrossRefPubMedPubMedCentralGoogle Scholar
  34. 34.
    Ferguson CJ, Coulson M, Barnett J (2011) A meta-analysis of pathological gaming prevalence and comorbidity with mental health, academic and social problems. J Psychiatr Res 45(12):1573–1578. doi: 10.1016/j.jpsychires.2011.09.005 CrossRefPubMedGoogle Scholar
  35. 35.
    Wasserman D, Carli V, Wasserman C, Apter A, Balazs J, Bobes J et al (2010) Saving and empowering young lives in Europe (SEYLE): a randomized controlled trial. BMC Public Health 10:192. doi: 10.1186/1471-2458-10-192 CrossRefPubMedPubMedCentralGoogle Scholar
  36. 36.
    Carli V, Wasserman C, Wasserman D, Sarchiapone M, Apter A, Balazs J et al (2013) The saving and empowering young lives in Europe (SEYLE) randomized controlled trial (RCT): methodological issues and participant characteristics. BMC Public Health 13:479. doi: 10.1186/1471-2458-13-479 CrossRefPubMedPubMedCentralGoogle Scholar
  37. 37.
    Johansson A, Götestam KG (2004) Internet addiction: characteristics of a questionnaire and prevalence in Norwegian youth (12–18 years). Scand J Psychol 45(3):223–229. doi: 10.1111/j.1467-9450.2004.00398.x CrossRefPubMedGoogle Scholar
  38. 38.
    Young KS (1998) Internet addiction: the emergence of a new clinical disorder. CyberPsychol Behav 1:237–244. doi: 10.1089/cpb.1998.1.237 CrossRefGoogle Scholar
  39. 39.
    Goodman R (1997) The Strengths and Difficulties Questionnaire: a research note. J Child Psychol Psychiatry 38(5):581–586. doi: 10.1111/j.1469-7610.1997.tb01545.x CrossRefPubMedGoogle Scholar
  40. 40.
    Beck AT, Steer RA, Ball R, Ranieri W (1996) Comparison of Beck Depression Inventories -IA and -II in psychiatric outpatients. J Pers Assess 67(3):588–597. doi: 10.1207/s15327752jpa6703_13 CrossRefPubMedGoogle Scholar
  41. 41.
    Osman A, Kopper BA, Barrios F, Gutierrez PM, Bagge CL (2004) Reliability and Validity of the Beck Depression Inventory-II with adolescent psychiatric inpatients. Psychol Assess 16(2):120–132CrossRefPubMedGoogle Scholar
  42. 42.
    Zung WW (1971) A rating instrument for anxiety disorders. Psychosomatics 12(6):371–379CrossRefPubMedGoogle Scholar
  43. 43.
    Paykel ES, Myers JK, Lindenthal JJ, Tanner J (1974) Suicidal feelings in the general population: a prevalence study. Br J Psychiatry J Ment Sci 124:460–469CrossRefGoogle Scholar
  44. 44.
    Spear LP (2013) Adolescent neurodevelopment. J Adolesc Health 52(2):S7–S13. doi: 10.1016/j.jadohealth.2012.05.006 CrossRefPubMedPubMedCentralGoogle Scholar
  45. 45.
    Kar BR, Vijay N, Mishra S (2013) Development of cognitive and affective control networks and decision making. Prog Brain Res 202:347–368. doi: 10.1016/B978-0-444-62604-2.00018-6 CrossRefPubMedGoogle Scholar
  46. 46.
    Jessor R (2014) Problem Behavior Theory. In: Lerner RM (ed) The developmental science of adolescence: history through autobiography. Psychology Press, New York, pp 239–256Google Scholar
  47. 47.
    Mentzoni RA, Brunborg GS, Molde H, Myrseth H, Skouverøe KJM, Hetland J et al (2011) Problematic video game use: estimated prevalence and associations with mental and physical health. Cyberpsychol Behav Soc Netw 14(10):591–596. doi: 10.1089/cyber.2010.0260 CrossRefPubMedGoogle Scholar
  48. 48.
    Tzavela EC, Karakitsou C, Dreier M, Mavromati F, Wölfling K, Halapi E et al (2015) Processes discriminating adaptive and maladaptive Internet use among European adolescents highly engaged online. J Adolesc 40:34–47. doi: 10.1016/j.adolescence.2014.12.003 CrossRefPubMedGoogle Scholar
  49. 49.
    Coghill D, Sonuga-Barke EJS (2012) Annual research review: categories versus dimensions in the classification and conceptualisation of child and adolescent mental disorders—implications of recent empirical study: Categories and dimensions. J Child Psychol Psychiatry 53(5):469–489. doi: 10.1111/j.1469-7610.2011.02511.x CrossRefPubMedGoogle Scholar
  50. 50.
    Ko C-H, Liu T-L, Wang P-W, Chen C-S, Yen C-F, Yen J-Y (2014) The exacerbation of depression, hostility, and social anxiety in the course of Internet addiction among adolescents: a prospective study. Compr Psychiatry 55(6):1377–1384. doi: 10.1016/j.comppsych.2014.05.003 CrossRefPubMedGoogle Scholar
  51. 51.
    Ko C-H, Wang P-W, Liu T-L, Yen C-F, Chen C-S, Yen J-Y (2014) The bidirectional associations between the family factors and internet addiction among adolescents in a prospective investigation. Psychiatry Clin Neurosci 69(4):192–200. doi: 10.1111/pcn.12204 CrossRefPubMedGoogle Scholar
  52. 52.
    Van Rooij AJ, Schoenmakers TM, van de Eijnden RJJM, van de Mheen D (2010) Compulsive internet use: the role of online gaming and other internet applications. J Adolesc Health 47(1):51–57. doi: 10.1016/j.jadohealth.2009.12.021 CrossRefPubMedGoogle Scholar
  53. 53.
    Wartberg L, Aden A, Thomsen M, Thomasius R (2015) Zusammenhänge zwischen familialen Aspekten und pathologischem Internetgebrauch bei Jugendlichen. Z Für Kinder- Jugendpsychiatrie Psychother 43(1):9–19. doi: 10.1024/1422-4917/a000328 CrossRefGoogle Scholar
  54. 54.
    Gustavson K, von Soest T, Karevold E, Røysamb E (2012) Attrition and generalizability in longitudinal studies: findings from a 15-year population-based study and a Monte Carlo simulation study. BMC Public Health 12(1):918. doi: 10.1186/1471-2458-12-918 CrossRefPubMedPubMedCentralGoogle Scholar
  55. 55.
    Fischer EH, Dornelas EA, Goethe JW (2001) Characteristics of people lost to attrition in psychiatric follow-up studies. J Nerv Ment Dis 189(1):49–55CrossRefPubMedGoogle Scholar
  56. 56.
    Tambs K, Rønning T, Prescott CA, Kendler KS, Reichborn-Kjennerud T, Torgersen S et al (2009) The Norwegian Institute of Public Health Twin Study of Mental Health: examining Recruitment and Attrition Bias. Twin Res Hum Genet 12(02):158–168. doi: 10.1375/twin.12.2.158 CrossRefPubMedPubMedCentralGoogle Scholar
  57. 57.
    Eaton WW, Anthony JC, Tepper S, Dryman A (1992) Psychopathology and attrition in the epidemiologic catchment area surveys. Am J Epidemiol 135(9):1051–1059PubMedGoogle Scholar

Copyright information

© Springer-Verlag Berlin Heidelberg 2015

Authors and Affiliations

  • Esther Strittmatter
    • 1
    • 2
  • Peter Parzer
    • 1
  • Romuald Brunner
    • 1
  • Gloria Fischer
    • 1
  • Tony Durkee
    • 3
  • Vladimir Carli
    • 3
  • Christina W. Hoven
    • 4
    • 5
  • Camilla Wasserman
    • 4
    • 6
  • Marco Sarchiapone
    • 6
  • Danuta Wasserman
    • 3
  • Franz Resch
    • 1
  • Michael Kaess
    • 1
  1. 1.Department of Child and Adolescent PsychiatryUniversity Hospital HeidelbergHeidelbergGermany
  2. 2.Department of Child and Adolescent Psychiatry, Psychosomatics and PsychotherapyUniversity Medical Center MünsterMünsterGermany
  3. 3.National Centre for Suicide Research and Prevention of Mental Ill-Health (NASP)Karolinska InstituteStockholmSweden
  4. 4.Department of Child and Adolescent Psychiatry, New York State Psychiatric InstituteColumbia UniversityNew YorkUSA
  5. 5.Department of Epidemiology, Mailman School of Public HealthColumbia UniversityNew YorkUSA
  6. 6.Department of Health SciencesUniversity of MoliseCampobassoItaly

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