On March 11, 2020, the World Health Organization (WHO) declared the COVID-19 outbreak a global pandemic. Prevention measures of physical distancing have been implemented all over the world. Mental health specialists emphasize that the term physical distancing (Wasserman, 2020) is less suggestive of social exclusion or rejection and is preferred over the more often used term of social distancing, which has an overall negative connotation.
Intuitively, physical distancing and internet usage proved to grow in tandem. A multicentric study that included Romania (alongside Australia, Belgium, China, France, Germany, India, Italy, Japan, New Zealand, Philippines, Poland, Singapore, South Africa, Spain, The United Kingdom of Great Britain and Northern Ireland, and the United States of America), with participants aged between 16 and 64 years old, showed that the subjects reported they spent more time using their devices due to COVID-19: 70% – the smartphone, 47% – the laptop, 33% – the desktop, 23% – the tablet, 32% – the smart TV, and 18% – games consoles. Half of the participants watched movies or TV shows, 40% spent a longer time on social media, and over 30% played computer or video games. The numbers reported are from July – i.e., a few months after initiating the measures of physical distaning (GlobalWebIndex, 2020).
The Ericsson report included participants aged 15 to 69 years old, from Brazil, China, France, Germany, India, Italy, South Korea, Spain, Sweden, the United Kingdom and the United States. The listed reasons behind the screen time were: 83% – finding help coping with the lockdown, 76% – finding help with children’s education, 74% – staying in touch with friends and family, 67% – working from home, 45% – shopping online, 43% – improving mental health and well-being, 41% – facilitating access to doctors and health care, 40% – staying fit and exercising (Ericsson, 2020). Five hundred million people currently use online conferencing platforms, as stated by Zoom, Google Meet, Microsoft Teams and Skype.
Undoubtedly, the internet has a series of significant advantages, some of which have been included in the World Health Organization booklet of mental health recommendations during the COVID-19 pandemic: maintaining social contacts, entertainment and physical exercise (WHO, 2020). Online education, teleworking and telehealth represent other significant advantages. However, keeping oneself informed from the internet is a double-edged sword. Too much exposure overall or exposure to negative news content have been associated in studies from China and other countries with higher levels of stress, depression and anxiety (Chao, 2020). Too much exposure to COVID-19-related news has also been contraindicated by WHO in their booklet (WHO, 2020). On the other hand, exposure to experts’ opinions and informing oneself objectively about infection and prevention proved to have a positive psychological impact. Digital health interventions, like apps that can calculate the risk of infection, chatbots with CDC, WHO or Google are only some of the useful digital innovations during this pandemic (Sarbadhikari, 2020).
Still, there are some disadvantages of internet usage that could turn into psychopathology. Roughly, we could classify them as affective disorders and addictive disorders.
The affective disorders induced by inappropriate internet use – anxiety disorders, depressive disorders, stress-related disorders, suicides – have been in large focus. Special mention should be paid to vulnerable groups – i.e., persons with previous mental or physical health disorders, those lacking social support, and front-line health care workers. It should also be noted that a similar phenomenon, the rise of affective disorders incidence following exposure to inappropriate online content, has been reported during the H1N1 pandemic in 2009 and the Ebola outbreak between 2014 and 2016.
The addictive disorders could follow otherwise normal activities: playing video or computer games, gambling, watching series or pornography, online shopping, social media or internet surfing are activities that, in the pre-pandemic normality, could have been considered adequate coping mechanisms or escapisms. During the COVID-19 pandemic, they could release stress, anxiety or depression. However, being potentially addictive activities, they could turn into disorders, either as a first episode or as recurrences.
In one study from China that included 6416 participants (53% females, mean age: 28 years old), there was a much-reported (46.8%) increased dependence on internet use. In addition, 4.3% of the participants declared they have severe internet addiction (23% more than before the COVID‑19 pandemic). Internet addiction was also associated with other addictive disorders, like alcohol or tobacco consuption (Sun, 2020).
Regarding gaming, video or PC, on March 28, 2020, WHO launched the “Play apart together” campaign, stating that online gaming is an activity that promotes both physical distancing and social connectedness. Gaming can be an effective coping mechanism for the majority of people, reducing feelings of loneliness or stress levels. In the vulnerable groups, however, this could be a risk factor for mental health disorders. Gaming disorder, classified as a diagnosis in the ICD11, is only one of the consequences, alongside sleep disorders or somatic disorders. In the United States, a 75% increase in online gaming activity was reported during the first days of the lockdown. In Italy, a 70% increase in Fortnite-gaming-related internet traffic was reported. A leading gaming distributor reported more than 20 million concurrent active users, the most in its history (King, 2020).
Regarding gambling disorder, while casinos are closed and sports events are suspended or occur much rarely, online gambling is on the rise; 64% of gamblers increased their playtime or financial expenditure in an 81-participant UK study (Yahya, 2020). A rise in the incidence of gambling disorder during a financial crisis was observed in the past in Greece, Iceland or the US (Price, 2020). The current data could predict a peak in the incidence of gambling disorder because of the pandemic’s financial circumstances, based on some predisposing factors such as boredom, escapism and availability of the method (Yahya, 2020).
Pornography is another potentially addictive behavior; its use incidence rose by 11% in the first days of the pandemic, from the end of February to the beginning of March, respectively up to more than 50% after Pornhub made their premium services free (Mestre-Bach, 2020). The potential reasons are physical distancing, high stress and anxiety levels, lack of adolescent supervision by teachers (resulting in them spending more time online), or even using pornography as a substitutive addictive behavior – as seen in South Africa, where, at the same time with the lockdown measures, alcohol and tobacco sales were restricted (Sinclair, 2020). Furthermore, in the content of pornography searches, terms like “coronavirus”, “corona” or “covid” were found. The reasons for this are not clear yet, but similarly, when the Fortnite server crashed, the number of Fortnite-related pornography terms rose. There may also be a rise in problematic pornography use disorder incidence or relapses of those already suffering from it (Mestre-Bach, 2020).
The prevention of internet use disorders during the COVID-19 pandemic has been the focus of an international working group, which released a recommendations guide (Kiraly, 2020). They highlighted the importance of being aware of and self-monitoring one’s screen time, monitoring children’s screen time and online content consumed. They also recommend using alternative devices, such as smartwatches or alarm clocks, that have only the functional component. They also recommend video group calls for maintaining social belonging and, of course, seeking specialized help when necessary.
The importance of internet use disorders and of prevention recommendations among Romanians is proven by the study mentioned at the beginning of this paper: 27% of the Romanian participants included declared they will continue to work from home, 17% expect to use online video conferencing platforms, and 44% expect to keep doing their shopping online even after the COVID-19 pandemic ends (GlobalWebIndex, 2020).