Commentary on ‘The association between problematic internet use and depression, suicidal ideation and bipolar disorder in Korean adolescents’

The paper by Park et al. (2012) is a timely and important contribution to the growing – though often still speculative – field of ‘internet psychology’, particularly as it applies to those of school age. In little more than a decade, there has been increasing public, clinical and research interest in the broad field of ‘cybersafety and wellbeing’, which includes issues such as cyberbullying, inappropriate website access by young people, and problematic internet use (PIU) – popularly dubbed ‘internet addiction’. As a marker of the academic interest, at least three international journals are dedicated to the field of internet psychology: the first and leading one, Cyberpsychology, Behaviour, and Social Networking was established in 1997, with mainstream psychiatry journals, including the Australian & New Zealand Journal of Psychiatry, now regularly publishing articles investigating PIU (e.g. Du et al., 2010; Porter et al., 2010). This would appear noteworthy, given that the status of PIU as a distinct clinical and nosological entity remains unclear (Starcevic, 2010). The DSM-5 Task Force is currently considering placing PIU alongside other, controversial ‘behavioural addictions’ in an Appendix, pending further research and clarification (American Psychiatric Association, 2012), rather than according it the status of a full disorder. In Park et al.’s (2012) present study, which utilised as subjects a predominantly female population in a high school in the Korean capital, the team investigated the potential associations between PIU and depression, as well as potential links with suicidal ideation and with early-onset bipolar disorder. Standardised and validated questionnaires were utilised, without direct investigator input / interviewing. This broad clinical focus is in line with recently demonstrated associations of PIU with depression, anxiety, low selfesteem and, more tentatively, ADHD (Yen et al., 2009) and Asperger’s disorder (Charlton, 2008). Prominent co-morbidity status adds weight to the conceptualisation of PIU being a ‘complex end-point behaviour’ of many other ‘primary’ problems (made more pertinent given the near-ubiquity of internet access and usage in young people today), rather than a unitary condition in its own right. The authors found a point prevalence for PIU (definite and probable) of 9.4% of their sample of 795 students. This is broadly in line with most of the international prevalence studies into PIU in young people (though slightly less, the authors note, than in recent Korean studies). The only methodologically sound and valid multicentre, international comparison study to date, by Gentile et al. (2011), also found a prevalence rate similar to that in the present study, though it focused more on problem video-gaming. This ‘baseline’ data set having been established, the team then investigated potential associations with the three psychopathological domains. Strong associations were found with depression, with a less strong link with suicidal ideation. To this reader at least, it would appear that there is a rather large ‘conceptual leap’ from linking PIU to, for example, suicidal ideation. It is well-recognised that factors such as self-esteem, general wellbeing and personal stress are associated with PIU (Valkenburg and Peter, 2006) and it is suggested that these latter factors are a key mediating factor in developing subsequent psychopathology. Explicitly exploring these factors could have added more sophistication and subtlety their model – though this would have added to the (already large) number of questionnaires being completed. Another concern – indeed a feature of almost all similar research – is the lack of specific data on how the subjects were utilising their time online. The World Wide Web is clearly not a unitary phenomenon: almost all of human experience and endeavour can be accessed online, and in a more immediate, intense and personalised form. Current surveys (e.g. the Nielsen online survey; Nielsen, 2011) indicate that social networking is the commonest online activity, followed by gaming, and then general browsing / media viewing. Commentaries