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Cognitive deficits in problematic internet use: meta-analysis of 40 studies
Open accessAbstract
BACKGROUND: Excessive use of the internet is increasingly recognised as a global public health concern. Individual studies have reported cognitive impairment in problematic internet use (PIU), but have suffered from various methodological limitations. Confirmation of cognitive deficits in PIU would support the neurobiological plausibility of this disorder. AIMS: To conduct a rigorous meta-analysis of cognitive performance in PIU from case-control studies; and to assess the impact of study quality, the main type of online behaviour (for example gaming) and other parameters on the findings. METHOD: A systematic literature review was conducted of peer-reviewed case-controlled studies comparing cognition in people with PIU (broadly defined) with that of healthy controls. Findings were extracted and subjected to a meta-analysis where at least four publications existed for a given cognitive domain of interest. RESULTS: The meta-analysis comprised 2922 participants across 40 studies. Compared with controls, PIU was associated with significant impairment in inhibitory control (Stroop task Hedge's g = 0.53 (s.e. = 0.19-0.87), stop-signal task g = 0.42 (s.e. = 0.17-0.66), go/no-go task g = 0.51 (s.e. = 0.26-0.75)), decision-making (g = 0.49 (s.e. = 0.28-0.70)) and working memory (g = 0.40 (s.e. = 0.20-0.82)). Whether or not gaming was the predominant type of online behaviour did not significantly moderate the observed cognitive effects; nor did age, gender, geographical area of reporting or the presence of comorbidities. CONCLUSIONS: PIU is associated with decrements across a range of neuropsychological domains, irrespective of geographical location, supporting its cross-cultural and biological validity. These findings also suggest a common neurobiological vulnerability across PIU behaviours, including gaming, rather than a dissimilar neurocognitive profile for internet gaming disorder. DECLARATION OF INTEREST: S.R.C. consults for Cambridge Cognition and Shire. K.I.'s research activities were supported by Health Education East of England Higher Training Special interest sessions. A.E.G.'s research has been funded by Innovational grant (VIDI-scheme) from ZonMW: (91713354). N.A.F. has received research support from Lundbeck, Glaxo-SmithKline, European College of Neuropsychopharmacology (ECNP), Servier, Cephalon, Astra Zeneca, Medical Research Council (UK), National Institute for Health Research, Wellcome Foundation, University of Hertfordshire, EU (FP7) and Shire. N.A.F. has received honoraria for lectures at scientific meetings from Abbott, Otsuka, Lundbeck, Servier, Astra Zeneca, Jazz pharmaceuticals, Bristol Myers Squibb, UK College of Mental Health Pharmacists and British Association for Psychopharmacology (BAP). N.A.F. has received financial support to attend scientific meetings from RANZCP, Shire, Janssen, Lundbeck, Servier, Novartis, Bristol Myers Squibb, Cephalon, International College of Obsessive-Compulsive Spectrum Disorders, International Society for Behavioral Addiction, CINP, IFMAD, ECNP, BAP, the World Health Organization and the Royal College of Psychiatrists. N.A.F. has received financial royalties for publications from Oxford University Press and payment for editorial duties from Taylor and Francis. J.E.G. reports grants from the National Center for Responsible Gaming, Forest Pharmaceuticals, Takeda, Brainsway, and Roche and others from Oxford Press, Norton, McGraw-Hill and American Psychiatric Publishing outside of the submitted work.
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“Research on PIU has exposed compelling evidence regarding its detrimental effects on critical cognitive faculties such as working memory and decision-making (Ioannidis et al., 2019).”
From From tools to threats: a reflection on the impact of artificial-intelligence chatbots on cognitive health (2024) · cites this paper as Ioannidis et al., 2019
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“Problematic Internet use was associated with deficits in decision making that were assessed on the Iowa Gambling Task, Balloon Analogue Risk Task (BART), Cambridge Gambling Task, and Game of Dice Task ( 18 ).”
From Neurocognitive function among individuals with problematic social media use (2026) · cites this paper as [18]
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Metadata
- Authors
- Ioannidis, K., Hook, R., Goudriaan, A. E., Vlies, S., Fineberg, N. A., Grant, J. E., & Chamberlain, S. R.
- Affiliations
- University of Cambridge (GB)
- Amsterdam UMC Location University of Amsterdam (NL)
- Cambridgeshire and Peterborough NHS Foundation Trust (GB)
- University of Hertfordshire (GB)
- University of Chicago (US)
- Corresponding author
- Ioannidis, Konstantinos
- ORCID
- Venue
- British Journal of Psychiatry
- Publisher
- Royal College of Psychiatrists
- Published
- 2019-02-20
- Volume
- 215
- Issue
- 5
- Pages
- 639-646
- ISSN
- 0007-1250 (ISSN-L)
- 1472-1465
- PMC
- PMC6949138
- OpenAlex
- W2914811992
- Cited by
- 246
- References
- 61
- Citations by year
- 2026: 48 · 2025: 52 · 2024: 30 · 2023: 34 · 2022: 34 · 2021: 26 · 2020: 15 · 2019: 7
- FWCI
- 5.35
- Type
- journal article
- Language
- en
- Open access
- hybrid
- doi.org
- Locations
- The British Journal of Psychiatry (publishedVersion, cc-by)
- Europe PMC (PubMed Central) (publishedVersion, cc-by)
- PubMed Central (publishedVersion, cc-by)
- PubMed (publishedVersion)
- ePrints Soton (University of Southampton) (acceptedVersion)
- Pure Amsterdam UMC (acceptedVersion, cc-by)
- University of Hertfordshire Research Archive (University of Hertfordshire) (acceptedVersion)
- University of Hertfordshire Research Archive (University of Hertfordshire) (submittedVersion)
- Data Archiving and Networked Services (DANS) (submittedVersion, other-oa)
- Funders
- Bristol-Myers Squibb
- Wellcome Trust (110,049/Z/15/Z, 110049)
- Jazz Pharmaceuticals
- National Institute for Health and Care Research
- Department of Health and Social Care
- University of Hertfordshire
- ZonMw (91713354)
- Universiteit van Amsterdam
- European College of Neuropsychopharmacology
- Servier
- H. Lundbeck A/S
- Pritzker School of Medicine
- Medical Research Council
- Topics
- Social Sciences › Sociology and Political Science › Impact of Technology on Adolescents
- Social Sciences › Psychology › Clinical Psychology › Gambling Behavior and Treatments
- Social Sciences › Psychology › Clinical Psychology › Sexuality, Behavior, and Technology
- Keywords
- problematic internet use, internet gaming disorder, cognitive impairment, inhibitory control, decision-making, working memory, Stroop task, stop-signal task, go/no-go task, online games, neurobiological vulnerability, cross-cultural validity, comorbidities, case-control study, study quality, cognitive bias modification, cognitive flexibility, executive function
- MeSH terms
- Internet Use, Cognition, Cognition Disorders, England, Humans, Behavior, Addictive, Internet, Cognitive Dysfunction
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