Investigating the Prevalence and Presentation of Problematic Internet Usage in Clinical Populations

In an increasingly digitalised world, public health concern surrounding problematic usage of the internet (PUI) has grown. Existing literature has investigated the rates of PUI in the general population as well as the risk factors in its development. People with mental health difficulties are considered a vulnerable group, with PUI rates of 19.36% recently reported in a meta-analysis, but PUI has received limited attention to date in the context of UK patients with mental health diagnoses. The aims of this study were: to explore the frequency of PUI in its various forms within a clinical population; its relationship with diagnosis and dimensions of impulsivity and compulsivity; the association between PUI and impairment of daily functioning. Online surveys were distributed to 1,600 NHS patients with a psychiatric diagnosis who had consented to be contacted for research purposes, and responses were collected via Qualtrics. The study collected data on demographics, self-reported clinical diagnosis and used a series of validated self-report measures including assessing problematic internet use (Internet Severity Activities Addiction Questionnaire – ISAAQ-10), trait compulsivity (Compulsive Personality Assessment Scale- CPAS), trait impulsivity (Barratt Impulsivity Scale – BIS), and functional impairment (Work & Social Adjustment Scale-WSAS). A total of 354 participants completed the study (90% questionnaires completed), of whom 39% reported a mood disorder, 16.4% an anxiety disorder and 11.3% a neurodevelopmental disorder. Fewer than 10% reported any other diagnostic grouping. Fifty-one participants (14.4%) exceeded the specified ISAAQ-10 threshold (score ≥34) for likely PUI, and the rate participants self-identified their usage as “problematic” also exceeded this. The likely PUI group had a mean age of 44.6 (S.D = 12.8) and 67% were female. No statistical association was found between diagnosis and PUI frequency. Unlike categorical diagnoses, dimensions of compulsivity and impulsivity both positively predicted PUI. Those with likely PUI and co-occurring mental health difficulties reported significantly greater impairment than those with solely a psychiatric diagnosis (p≤.001). Only 12% reported being asked about their internet habits by clinicians during their mental healthcare. Whilst there has been limited attention applied among UK patients with mental health diagnoses, roughly one in seven participants reported likely PUI using a validated scale, consistent with a recent meta-analysis. No particular diagnostic group was over-represented in terms of PUI rate, however the predictive power of trait compulsivity and impulsivity offers insight into the understanding of PUI and aligns with existing behavioural addiction models. Considering the additional functional impairment associated with PUI in people already impacted by mental health difficulties, clinicians working in all fields of mental health support need to be vigilant and consider enquiring about PUI during routine care.