الفهرس 
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Abstract
N
owadays, Internet use has become a global phenomenon. The Internet has grown exponentially and has become central within the adolescent and emergent adult population and this growth has received an additional powerful boost worldwide by lockdowns since early 2020, thus making it even more difficult for clinicians to distinguish between regular daily use, excessive Internet use, and IA.
Also the portability of the Internet via smart- phones allows fast availability and widespread usage of the global net- work.
And adolescence is the period in life when an individual is no longer a child, but not yet an adult due to the multiple physical and psychological changes.
Thus, they can enter in addictive practices to cope with anxiety, frustration, and failure or due to the need for excitement, unrealistic optimism in relation to the feeling of invulnerability, or even the need to achieve their goals as a part of their transition into adult age.
It is one of the preliminary studies done in Egypt aiming to investigate the rate of occurrence of internet addiction, internet gaming disorder and smartphone addiction and their clinical correlation with depression and anxiety also to highlight that addiction is a reward center pathology rather than the ordinary concept of being a substance use disorder.
SUMMARY
I
nternet addiction is a common and challenging problem among adolescents where studies conducted from 2003 to 2018 from 31 different countries with a total of 693,306 participant shows prevalence for problematic internet use (PIU) and Internet gaming disorder (IGD) were 7.02 % and 2.47 % respectively
The global population calculated by 2022 was around 7,934,716,815, and internet users were 5,168,780,607 in march 2021, with a growth rate throughout 2000-2022 was around 1,355%.
In Egypt, total population 104,258,327, in which it is estimated 54,741,493 are internet users, with growth rate through 2000-2021 estimated as 12,064 %.
Nationwide, in Egypt, it was reported that more than 80% of Internet café customers are young people, 60% of surveyed youth spent their time chatting, 20% of them browsed porn sites, and 12% did work or scientific research 8% of them visited political websites.
The negative effects of the problematic use of the Internet have increasingly emerged. It was found that adolescents’ use of the Internet was accompanied by more severe psychological symptoms and interpersonal problems.
Today, about one-sixth of the world’s population is between 10-19 years old, which is represented by 1.2 billion adolescents.
Adolescence is a pivotal point in the life course, which implicates major physical, psychological, cognitive and emotional growth, an openness to change, and the desire to reconstruct the social environment which could be stressful to the adolescent.
Young suggested that Internet addicts have become addicted to various aspects of Internet use. It distinguishes between three subtypes of Internet addicts: excessive gaming, online sexual preoccupation, and email/texting, Social networking is a type of online activity in which email/text messages predominate.
Recently, due to the high prevalence of psychological symptoms, depression, suicidal thoughts, interpersonal problems, and hostile behavior associated with Internet addiction especially among adolescents, this has been considered as an important social problem in different countries especially in adolescents.
SO we do this study, which is considered a case-control study aiming to measure the rate of occurrence of Problematic Internet Use, Internet gaming disorder and Smart phone addiction in a sample of depressed, anxious and healthy adolescents,
Also to study the association and clinical correlation between (depression and anxiety) and (Problematic Internet Use, Internet gaming disorder and Smart phone addiction) in the study sample,
Meanwhile the study discussed the association between (demographic and clinical factors) and Problematic Internet Use, Internet gaming disorder and Smart phone addiction in the study sample.
where all the adolescents were subjected to an informative designed questionnaire, Internet Addiction Test (IAT), Internet Gaming Disorder (IGD) scale, Smart phone addiction test (SPA), Hamilton Depression Rating scale and Hamilton anxiety Rating scale, but the General Health Questionnaire-28 (GHQ-28) only for the controls and Kiddie Schedule for Affective Disorders and Schizophrenia, Present and Lifetime version (K-SADSPL) only for the cases.
This study shows that the rate of occurrence of Internet Addiction and it’s severity showed that the majority of the depressed adolescents were 45.7%, had moderate dependence while that of the anxious adolescents were 42.9%, had moderate dependence and that of the healthy adolescents were 37.1%, had mild dependence while the severe dependence in the depressed, anxious and healthy adolescents are only 5.7%, 2.9% and 2.9% respectively.
While Internet Gaming Disorder (IGD) Scale showed that 40%, 40%, 22.9% are Risky gamers in the depressed, anxious and healthy groups respectively, while 5.7%, 11.4%, 34.3% are having IGD in the depressed, anxious and healthy groups respectively.
While Smart phone addiction (SPA) Scale showed that 62.9% of the depressed group, 77.1% of the anxious group and 68.6% of the control group were smartphone addict,
Moreover, This study shows the association and clinical correlation between (depression and anxiety) and the psychometric assessments, so as regard the internet gaming disorder test revealed that the cases group are risky to have internet gaming disorder while the controls having IGD more than the cases group, while as regard the internet addiction test and smartphone addiction, there is no association and clinical correlation between them and (depression and anxiety).
As regard the association between (demographic and clinical factors) and psychometric assessments used in the study sample, it was found that gender and sociodemographic data are not related to internet addiction, internet gaming disorder and smartphone addiction.
However, age as a factor couldn`t be assessed due to the narrow age range between the students.
But there is statistically significant relation found regarding father’s work and residency regarding smartphone addiction test in the depressed group and not in the anxious and healthy group, where those whose fathers work as business men or merchants are more smartphone addict than that those work as professionals and also who lives in a classy neighborhood have less smartphone addiction than that who lives in a popular neighborhood but our conclusion as regard that, due to the higher parental control and their concern about this addictive behavior
Our conclusion about our results, that the COVID-19 pandemic would potentially lead to children and adolescents being more engaged and become addicted to various aspects of Internet use, so the difference is not significant.
Given the new expansion and expected increase in Internet availability and use in the coming years, it is important that health care professionals be aware of this behavior and the problems associated with it, as Internet addiction is a newly emerging disorder. It has been shown to be associated with autoimmune distress, functional impairment and mental disorders.
Also it is important to Screen all adolescents expressing any form of addictive behavior for underlying psychiatric morbidities, as it is essential for proper intervention and management.
Moreover, more public awareness campaigns about problematic internet use, internet gaming disorder and smartphone addiction, their causes and preventive measures especially among children and adolescence should be established in schools & social media that to decrease the rate of occurrence of these addictive behaviors.
RECOMMENDATIONS
Clinical recommendations:
1- Comprehensive training of psychiatric / psychology staff on other forms of addictive behavior e.g. internet addiction, internet gaming disorder and smart phone addiction.
2- Assessment of internet addiction, internet gaming disorder and smart phone addiction in specific and behavioral addiction in general among all patients presented in outpatient clinics.
3- Exclusion of internet addiction, internet gaming disorder and smart phone addiction in adolescents attending psychiatric outpatient clinics and school clinical settings.
4- Screening for all adolescents expressing any form of addictive behavior for underlying psychiatric morbidities is essential for proper intervention and management.
5- The importance of considering not only depression and anxiety but also the full range of mental disorders when evaluating patients’ risk for addictive behavior.
6- More public awareness campaigns about problematic internet use, its causes and preventive measures especially among children and adolescence should be established in schools & social media.
7- Establishing specific programs for management of internet addiction, internet gaming disorder and smart phone addiction and other forms of addictive behavior.
Research recommendations:
1- Further research on correlation between (depression and anxiety) and (internet addiction, internet gaming disorder and smart phone addiction) at a larger scale.
2- Further research on correlation between (depression and anxiety) and (internet addiction, internet gaming disorder and smart phone addiction) among different age groups.
3- Further research of other forms of behavior addiction among these specific groups.
4- The weight of impact of internet and social media platforms on medical field especially psychiatry needs further research work, especially their potential harming effect on the vulnerable groups such as adolescents.