Items used in the second National Mental Health
Survey of Child and Adolescent Mental Health and Wellbeing to
measure behaviour related to Internet use and electronic
gaming (Continued)
YIU8. On an average weekend day approximately how much time do
you spend playing electronic games?
1 - Less than 1 hour
2 - 1–2 hours
3 - 3–4 hours
4 - 5–6 hours
5 - 7–8 hours
6 - 9–10 hours
7 - 11 hours or more
ASK IF YIU3 = YES OR YIU6 = YES.
YIU9. Do you go without eating or sleeping because of the internet or
electronic games?
1 - Never/almost never
2 - Not very often
3 - Fairly often
4 - Very often
YIU10. Do you feel bothered when you cannot be on the internet or
play electronic games?
1 - Never/almost never
2 - Not very often
3 - Fairly often
4 - Very often
YIU11. Do you catch yourself surfing the internet or playing electronic
games when you are not really interested?
1 - Never/almost never
2 - Not very often
3 - Fairly often
4 - Very often
YIU12. Do you spend less time than you should with family or friends or
doing school work/work because of the time you spent on the internet
or playing electronic games?
1 - Never/almost never
2 - Not very often
3 - Fairly often
4 - Very often
YIU13. Have you tried unsuccessfully to spend less time on the internet
or playing electronic games?
1 - Never/almost never
2 - Not very often
3 - Fairly often
4 - Very often
Rikkers et al. BMC Public Health (2016) 16:399 Page 4 of 16
Although this scale is not as widely used as Young’s scale
for identifying Internet Addiction [2] or the Chen Internet
Addiction Scale [54], it is similar in intent and purpose
and can provide a useful tool for diagnosing those
children at risk of developing more serious Internet use
problems. With YMM data, Cronbach’s alpha was calculated
as 0.68. (No similar measure could be located online
from the EU Kids Online website.) Again, due to
space constraints, questions were asked of the two activities
combined to determine if time spent on them interfered
with the young person’s normal daily activities.
These questions sought information about five specific
behaviours that may be indicative of addiction to the
Internet, social media or electronic gaming (Table 1).
For analysis and reporting purposes, problematic behaviour
related to Internet use and electronic gaming
was defined as the existence of at least four out of the
five behaviours. This is referred to as ‘problem behaviour’
in this paper.
Mental disorders
Mental disorders captured via the parent/carer report
were assessed using the Diagnostic Interview Schedule
for Children Version IV (DISC-IV) [55]. The DISC-IV
implements the criteria for mental disorders set out in
the Diagnostic and Statistical Manual of Mental Disorders,
4th edition [56]. For the youth self-report, only one
measure on major depressive disorder was included,
mainly to reduce respondent burden. Specific disorders
examined in this study include major depressive disorder,
anxiety disorders, ADHD, and conduct disorder.
Young people also were also asked questions based on
the Kessler 10 Psychological Distress Scale (K10) [57]
about negative emotional states in the four weeks prior
to interview. Their questions included additional Kessler
items covering positive mental health, behaviour disorders,
and any days when they could not carry out normal
activities due to reported distress. For example:
Q. In the last four weeks, about how often did you feel
tired out for no good reason?
1 -None of the time
2 -A little of the time
3 -Some of the time
4 -Most of the time
5 -All of the time.
Scores in the ‘very high’ range may indicate a severe
mental disorder, while a ‘high’ score may indicate a moderate
mental disorder. For YMM, Cronbach’s alpha was
calculated as 0.93.
In addition, youth were administered the Strengths
and Difficulties Questionnaire (SDQ) [58, 59] in relation
to their behaviour during the six months prior to the
interview. The SDQ took the form of a series of statements.
For example:
Q. I try to be nice to other people.
1 -Not True
2 -Somewhat True
3 -Certainly True
Four subscales were examined: emotional problems,
conduct problems, hyperactivity, and peer problems.
The ratings used were normal, borderline and abnormal.
An abnormal SDQ rating is indicative of someone being
at substantial risk of clinically significant problems or
mental disorders and approximately 10 % of a community
sample scores this rating. For YMM data, Cronbach’s
alpha was calculated as 0.73.
Although not a mental disorder per se, self-esteem
was measured using The Adolescent Self-Esteem Scale
(ASQ), a new scale developed for this survey. The scale,
which was validated in an adolescent population, consists
of 12 items. The scale included both positively and
negatively worded items which were answered on a five
point Likert scale. For example,
Q. I am able to stand up for myself and what I believe in.
1 –Almost all of the time
2 –A lot of the time
3 –Some of the time
4 –A little of the time
5 –Hardly ever
Q. I fe