Examining Changes in Problematic Internet Use During the COVID-19 Pandemic: An App-Based Ecological Momentary Assessment Study of Youth in Outpatient Mental Health Treatment (Preprint)

BACKGROUND Youth with existing psychiatric illness are more apt to use the Internet as a coping skill. Because many “in-person” coping skills were not easily accessible during the COVID-19 pandemic, youth in outpatient mental health treatment may have been particularly vulnerable to the development of problematic Internet use, or PIU. Identification of a pandemic-associated worsening of PIU in this population is critical in order to guide clinical care; if these youth have become dependent upon the Internet to regulate their negative emotions, PIU must be addressed as part of mental health treatment. However, many existing studies of youth digital media use in the pandemic do not include youth in psychiatric treatment, or are reliant upon cross-sectional methodology and self-report measures of digital media use. OBJECTIVE This study pilots use of an app-based ecological momentary assessment (EMA) protocol to investigate potential pandemic-associated changes in digital media use in cohorts of youth in outpatient mental health treatment before and during the COVID-19 pandemic. Secondary analyses assess for differences in digital media use dependent upon personal and familial COVID-19 exposure and familial hospitalization, as well as factors associated with PIU in this population. METHODS Participants were aged 12-23 and receiving mental health treatment in an outpatient community hospital setting. All participants completed a six-week daily EMA protocol on their personal smartphones. Questions asked about depression (PHQ-8), anxiety (GAD-7), and PIU (PIU-SF-6), digital media use based on Apple’s daily screen time reports, and personal and familial COVID-19 exposure. Regression models compared screen time, psychiatric symptoms and PIU between cohorts, as well as between youth with personal/familial COVID-19 exposures, and those without. Regression models also assessed for demographic and psychiatric factors associated with clinically significant PIU-SF-6 scores. RESULTS 69 participants completed the study. Participants recruited during the pandemic were significantly more likely to meet criteria for PIU based on their average PIU-SF-6 score (P =.02) and to spend more time using social media each day (P =.02). Overall amount of daily screen time did not differ between cohorts. Secondary analyses revealed a significant increase in average daily screen time among subjects who were exposed to COVID-19 (P =.01). Youth with clinically significant PIU-SF-6 scores were significantly younger and more likely to have higher PHQ-8 (P =.01) and GAD-7 (P =.007) scores. No differences in scale scores or media use were found between subjects based on familial COVID-19 exposure or hospitalization. CONCLUSIONS Our findings support our hypothesis that PIU may have worsened for youth in mental health treatment during the pandemic, particularly problematic use of social media. Mental health clinicians should incorporate screening for PIU into routine clinical care in order to prevent potential familial conflict and subsequent psychiatric crises that might stem from unrecognized PIU. CLINICALTRIAL N/A