OBJECTIVE:This study aimed to cross-culturally adapt the Problem Gambling Severity Index (PGSI) into Brazilian Portuguese and to conduct a preliminary assessment of its content and face validity. METHODS:The adaptation process followed internationally recognized guidelines and included several stages: initial translation, translation synthesis, back-translation, review by a committee of experts, evaluation by an expert panel of 11 specialists, pre-test with participants from the general population, and final revision. The Content Validity Index (CVI), Clarity Index (CI), and Content Validity Ratio (CVR) were calculated based on the experts' evaluations. As a first step, establishing semantic and content validity is essential before broader psychometric testing can be meaningfully conducted in the target population. RESULTS:The adapted PGSI demonstrated strong content validity, with all items reaching a CVI of 0.90 or higher and an overall mean of 0.98. The CI ranged from 2.63 to 2.90, and the CVR indicated high agreement regarding the essentiality of the items. Face validity testing with 33 participants from the general population revealed that all items were rated as understandable or entirely understandable by most participants (84.9% to 100%). Expert feedback was also used to refine the wording of items, particularly to distinguish between "gaming" and "gambling" in the Brazilian context. CONCLUSION:The Brazilian Portuguese version of the PGSI presented robust preliminary evidence of semantic, conceptual, and cultural adequacy. This version fills a critical methodological gap and provides a culturally appropriate screening and monitoring tool for use in clinical and research settings in Brazil, supporting prevention and public health monitoring of gambling-related harms, including financial impacts. Future studies will evaluate additional psychometric properties further to consolidate its use in clinical and epidemiological contexts.

Brazil's Digital Child and Adolescent Act (2025) prohibits paid loot boxes in games accessible to minors under a public health and child-rights framework, regardless of whether they should be classified as gambling. The law focuses on psychological mechanisms underlying harm, including variable-ratio reinforcement and reward uncertainty, to which adolescents are developmentally vulnerable. It establishes administrative sanctions, including fines of up to 10% of the company's revenue and service suspension, and restricts personalized advertising and algorithmic systems targeting minors. As the first major market to adopt a preventive harm-reduction ban, Brazil creates measurable regulatory benchmarks and a natural experiment to assess whether legislative boundaries reduce harm, influence industry monetisation strategies, and inform proportionate digital governance internationally.

INTRODUCTION:Problematic gaming is recognized in both major diagnostic systems, as Internet Gaming Disorder (IGD) in the DSM-5 and Gaming Disorder in the ICD-11, yet no nationally representative prevalence data exist for Brazil. METHODS:Data were drawn from a cross-sectional, nationally representative Brazilian household survey conducted in 2023 (gaming module: n = 4,856). IGD risk was assessed among past-month gamers (n = 1,096; 1,050 analyzed) with the Ten-Item Internet Gaming Disorder Test (IGDT-10), a DSM-5-aligned screening instrument (cut-off ≥ 5 criteria); an exploratory four-level severity classification was also examined. Analyses accounted for the complex sampling design, with multiple imputation for missing predictors. RESULTS:Among past-month gamers, 3.4 % (95 % CI: 1.5-5.4) were classified as at risk for IGD; in the population aged ≥ 14 years, the weighted prevalence was 0.75 % (95 % CI: 0.33-1.16), corresponding to approximately 1.3 million individuals (95 % CI: 0.6-2.0 million). In the adjusted model, moderate-to-severe depressive symptoms (OR = 8.82, 95 % CI: 2.39-32.55) and frequent anxiety symptoms (OR = 4.15, 95 % CI: 1.01-17.02) were the strongest correlates, and higher household income was associated with reduced odds (OR = 0.035, 95 % CI: 0.005-0.24); associations were directionally consistent across Firth-penalized, reduced-model, and complete-case sensitivity analyses. An exploratory multinomial model showed progressively stronger associations of depressive symptoms across severity categories (relative risk ratio = 14.41 for the IGD Risk category). CONCLUSIONS:This study provides the first nationally representative estimate of IGD risk in Brazil and, to our knowledge, in Latin America; the 0.75 % prevalence indicates a relevant public health concern.

Objective:To assess associations between early childhood screen time trajectories and problematic media use scores by age 5.5. Methods:The present study is based on a prospective, community-based convenience sample of 315 parents of preschoolers, from Canada studied at the ages of 3.5 (2020), 4.5 (2021), and 5.5 (2022) during the Covid-19 pandemic. Parent-reported screen use at the ages of 3.5, 4.5, and 5.5 was used to estimate preschooler screen use trajectories. Using latent growth modeling, we identified low (mean = 0.9 h/day, 23%), average (mean = 3.0 h/day, 56%), and high (mean = 6.38 h/day, 21%) screen time trajectories. Parents reported child problematic media using the Problematic Media Use Measure - Short Form (PMUM-SF). Results:A multiple regression, adjusted for child sex, effortful control and parent education and stress revealed that compared to children in the low screen time trajectory, children in the high screen time trajectory had higher problematic media use scores at age 5.5 (β = 0.378, p < 0.001). In addition, children in the average screen time trajectory scored higher than children in the low screen time trajectory (β = 0.229, p ≤ 0.001). Conclusion:Our findings suggest that higher screen use in early childhood is associated with an increased risk for the development of dysregulated media use, which can interfere with family functioning. As such, parents should be encouraged to follow screen time recommendations of ≤1 h/day for children between the ages of 2 and 5.

Objectives. - The primary objective of this study was to compare the estimates of Problematic Internet Use (PIU) from 14 countries around the world, considering gender. The second objective was to explore the relationships between PIU and personality-related variables (pathological personality traits, defense mechanisms, coping strategies, and self-esteem). Materials and methods. - Our total sample consisted of 7726 participants (30.8% male, n = 2378), aged between 18 and 86 years old (M = 25.55; SD = 9.8). Recruited online, they completed several scales about their Internet use, defense mechanisms and coping strategies, self-esteem, and pathological personality traits. Results. - The PIU accounted for between 20.5% and 75% of participants using the PIUQ-9, while "selfperception" of PIU with a single item revealed estimates from 2% to 60.1%, with gender differences. Systematically, PIU significantly correlated with two variables: borderline personality traits (from .09 at P < .05 to .42 at P < .01) and immature defense mechanisms (from .13 to .42 at P < .01). Dependent, avoidant, narcissistic, histrionic, and antisocial personality traits were positive predictors of PIU and selfesteem, paranoid and schizoid personalities were negative predictors. Conclusions. - This research highlights the many cross-cultural differences. Its design also allows for a better understanding of gender differences. (C) 2022 Elsevier Masson SAS. All rights reserved.

Objective: Despite growing recognition of gaming disorder as a mental disorder, there is still debate about how best to screen for it. This is especially relevant in countries where prevalence studies that could support evidence-based policymaking have not yet been conducted. This study aims to evaluate the psychometric properties of the Brazilian Portuguese version of the Ten-Item Internet Gaming Disorder Test (IGDT-10) and to explore its association with functional impairment. Methods: An online convenience sample of 805 Brazilian adults who reported playing games completed the adapted version of the IGDT-10 and the World Health Organization Disability Assessment Schedule 2.0 (WHODAS 2.0), as well as the Problematic Internet Use Questionnaire (PIUQ), the Center for Epidemiologic Studies-Depression Scale (CES-D), the Rosenberg Self-Esteem Scale (RSES), and a sociodemographic questionnaire. Results: The Brazilian Portuguese version of the IGDT-10 demonstrated a unidimensional structure in both confirmatory and exploratory factor analyses with satisfactory internal consistency and adequate temporal stability. Participants who scored five or more on the IGDT-10 presented higher levels offunctional impairment compared to those who scored positive for four symptoms or fewer. The difference between the two groups was statistically significant with a moderate effect size. Network analysis showed a direct connection between IGDT-10 scores and functional impairment and identified "negative consequences" as the most relevant item connecting these variables. Conclusion: The IGDT-10 is a brief, easy-to-understand, valid, and reliable instrument, proving to be a suitable candidate for screening gaming disorder in future epidemiological studies.

Text messaging is the primary form of technology-mediated interpersonal contact and the most carried out activity on cell phones. Despite its advantages, text messaging is not exempt from risks. The present paper aimed to validate and expand the psychometric properties of the Self-perception of Text-message Dependency Scale (STDS) in a Brazilian sample of adult internet users. In this cross-sectional study, we recruited a convenience sample of Brazilian internet users aged 18 and over. A total of 1,642 (Mage = 38.6, SD = 13.5; 73

Homo digitalis se refere ao homem modificado pela tecnologia. A realidade virtual (RV) e a realidade aumentada permitem ver o mundo sob a perspectiva de outras pessoas, sendo chamadas de “a máquina de empatia”. Objetivo: analisar como a RV pode ser usada na psiquiatria e na educação médica para promover empatia. Método: realizou-se uma revisão narrativa nas plataformas Medline e Embase, Google Scholar, listas de referências de artigos e em sítios eletrônicos de tecnologia. Artigos em inglês e francês foram selecionados, sem limites temporais para a busca. Resultados: uma revisão de 66 referências demonstrou que a RV pode gerar mudanças cognitivas, emocionais e comportamentais positivas, especialmente em relação a indivíduos de grupos diferentes. As narrativas imersivas com RV facilitam a compreensão empática, colocando o usuário na perspectiva de outra pessoa. A RV também está associada a jogos aplicados e estudos funcionais de atividade cerebral, que indicam potencial para gerar mudanças comportamentais positivas. Estudos maiores e ensaios clínicos são necessários para validar a efetividade dos desfechos e garantir o uso seguro e ético da tecnologia. Conclusão: a revisão demonstrou resultados promissores e um olhar otimista da RV como ferramenta para gerar empatia e promover o bem-estar mental.

Objectives: Little is known about the relationship between depression in mothers and problematic gaming in their children. Therefore, we aimed to investigate the potential role of mothers' depression in childhood as a risk factor for problematic gaming in their offspring in late adolescence/young adulthood. Methods: We assessed data from 1557 participants on three waves (T0 collected in 2010/2011, T1 in 2013/2014, and T2 in 2018/2019) of a large Brazilian school-based cohort. Mother's depression at T0 was tested as a pre-dictor of problematic gaming at T2 in a logistic regression model. In mediation analyses, we individually assessed internalizing or externalizing disorders at T1 as mediators in this association, with participants' sex being tested as a moderator in both models. Inverse probability weights were used to account for sample attrition at T2. All models were adjusted for maternal and participant-related covariates. Results: Mother's depression at T0 was significantly associated with problematic gaming at T2 (OR = 2.09, p < 0.001) even after adjusting for multiple confounding factors. The presence of any internalizing disorder at T1 was a partial mediator of this relationship, accounting for 8.18% (p = 0.032) of the total effect, while the presence of any externalizing disorder at T1 was not a significant mediator. Participants' sex was not a significant moderator in mediation models. Conclusions: These findings suggest mother's depression in childhood as a risk factor for problematic gaming in later developmental stages, which may be partially mediated by internalizing psychopathology.

This study examined (a) differences in estimates of Problematic Mobile Phone Use (PMPU) in adults across 14 countries worldwide and (b) whether personality and psychopathology variables predict PMPU. A sample of 7531 adults (69.6

INTRODUCTION:Several barriers for mental health help-seeking were identified among medical students, including minimizing mental illness. Studies examining aspects particular to those who perceive psychological impairment but do not access treatment are necessary for planning interventions. AIMS:To identify help-seeking barriers based on the students' perception about their need for treatment and psychiatric symptoms. Methods: Cross-sectional study assessing 436 Brazilian medical students (833 attending the medical school = 52.3% response rate). Data collection covered sociodemographic data, mental health, academic environment, and Beck Inventories of Depression (BDI) and Anxiety (BAI). Non-parametric tests and hierarchical logistic regression were used to compare students undergoing treatment, those willing to access treatment, and the ones reporting no need for treatment. RESULTS:Among the 382 students who completed the survey (87.6% completion rate), 38.5% (n = 147) were in treatment, and 33% (n = 126) were in need. Moderate to severe risk of alcohol abuse was observed in 45.9% (n = 50) of students reporting no need for treatment. Regression models suggested that perceiving need for treatment - whether already undergoing it or not - was associated with the severity of depressive symptoms (OR 1.14 [95% CI 1.07-1.21]), female assigned sex (OR 2.18 [95% CI 1.23-3.88]), LGBTQ+ (OR 2.47 [95% CI 1.09-5.60]) and reporting good relationship with the family (OR 0.26 [95% CI 0.08-0.83]). Models comparing students in treatment and those in need, pointed that the factors associated with lacking mental health care were age (OR 0.90 [95% CI 0.82-0.99]), perception of a heavy workload (OR 2.43 [95% CI 1.35-4.38]) and good relationship with colleagues (OR 3.51 [95% CI 1.81-6.81]). DISCUSSION:Social variables and the severity of depressive symptoms are positively associated with perceived need for treatment. Age and academic environment factors were related to help-seeking behavior among students with appropriate self-awareness. We discuss these findings' implications for planning interventions.

Objective: The goal of the study is to adapt and examine the psychometric properties of the Brazilian version of the nine-item Problematic Internet Use Questionnaire (PIUQ-SF-9). Methods: A convenience sample of Brazilian internet users aged between 18 and 89 years (72.7% female, mean age 38.7 years ± 13.5) was recruited online from September 2018 to July 2019 (test sample = 1,525; retest sample = 237). Participants responded to the adapted version of the PIUQ-SF-9, as well as the Center for Epidemiologic Studies-Depression Scale (CES-D-10) and sociodemographic questions. Results: A bifactor model with one general factor and three specific dimensions (obsession, neglect and control disorder) yielded the best fit indices [χ 2 = 67.66, df = 15, CFI = 0.99, TLI = 0.99, RMSEA = 0.048 (0.037–0.060), RMSEA p close = 0.587 and SRMR = 0.01]. McDonald's hierarchical omega coefficient was 0.76 for the general factor and varied between 0.16 and 0.33 for the specific dimensions. The intraclass correlation coefficient was 0.73 for the general factor and varied between 0.64 and 0.72 for the specific dimensions. The MIMIC model supported the scale's construct validity as the relationship of the predictors (age, time spent online, self-perception of problematic internet use, and depression symptoms) with the PIUQ-SF-9 factors was in line with the assumptions based on the literature. Conclusion: PIUQ-SF-9 seems to be a brief and culturally validated instrument with sound psychometric properties to be used in future studies on problematic internet use in the Brazilian population.

Abstract Background and aims Following the recognition of ‘internet gaming disorder’ (IGD) as a condition requiring further study by the DSM‐5, ‘gaming disorder’ (GD) was officially included as a diagnostic entity by the World Health Organization (WHO) in the 11th revision of the International Classification of Diseases (ICD‐11). However, the proposed diagnostic criteria for gaming disorder remain the subject of debate, and there has been no systematic attempt to integrate the views of different groups of experts. To achieve a more systematic agreement on this new disorder, this study employed the Delphi expert consensus method to obtain expert agreement on the diagnostic validity, clinical utility and prognostic value of the DSM‐5 criteria and ICD‐11 clinical guidelines for GD. Methods A total of 29 international experts with clinical and/or research experience in GD completed three iterative rounds of a Delphi survey. Experts rated proposed criteria in progressive rounds until a pre‐determined level of agreement was achieved. Results For DSM‐5 IGD criteria, there was an agreement both that a subset had high diagnostic validity, clinical utility and prognostic value and that some (e.g. tolerance, deception) had low diagnostic validity, clinical utility and prognostic value. Crucially, some DSM‐5 criteria (e.g. escapism/mood regulation, tolerance) were regarded as incapable of distinguishing between problematic and non‐problematic gaming. In contrast, ICD‐11 diagnostic guidelines for GD (except for the criterion relating to diminished non‐gaming interests) were judged as presenting high diagnostic validity, clinical utility and prognostic value. Conclusions This Delphi survey provides a foundation for identifying the most diagnostically valid and clinically useful criteria for GD. There was expert agreement that some DSM‐5 criteria were not clinically relevant and may pathologize non‐problematic patterns of gaming, whereas ICD‐11 diagnostic guidelines are likely to diagnose GD adequately and avoid pathologizing.

dated in Portuguese for the Brazilian cultural context, as well as the impossibility of objectively identifying and measuring tokophobia, make adequate therapeutic guidance difficult. A systematic review and meta-analysis was performed of the risk factors. The perception of tokophobia was assessed among pregnant women and prenatal health care professionals to identify the peculiarities of tokophobia in the Brazilian socio-cultural and clinical-obstetric context. The conceptual and psychometric analysis process allowed the development and validation of the Tokophobia Assessment Questionnaire (Questionário de Avaliação da Partofobia) in Brazilian Portuguese, available from the authors upon request. This research project was approved by the Universidade do Sul de Santa Catarina research ethics committee (protocol 87312818.0.0000.5369). The Tokophobia Assessment Questionnaire has been validated; its reliability was measured with the Pearson correlation coefficient (0.766) and the intraclass correlation coefficient (0.856). Bland-Altman analysis showed a central tendency between the difference and mean of the two Tokophobia Assessment Questionnaire applications in almost the entire sample. The general Cronbach’s alpha was 0.935 (Table 1). The Kappa index was 0.444 and the Pearson correlation coefficient between the first application of the Tokophobia Assessment Questionnaire and the Depression, Anxiety and Stress Scale was 0.607. Exploratory factor analysis identified six factors categorized into conceptual groups: physical repercussions (factor 1); feeling of panic (factor 2); social involvement (factor 3); interference in daily habits (factor 4); pregnancy avoidance (factor 5); self-perception of tokophobia (factor 6) (Table 1). Use of the item response theory demonstrated the suitability of all items (Figure 1). Therefore, the 25-item Tokophobia Assessment Questionnaire is reliable and valid and is the first instrument for assessing the clinical, emotional and psychiatric manifestations of tokophobia. Although developed for the Brazilian population, the instrument may have worldwide applicability.

therapy was recommended to all evaluees. These cases demonstrate that the assessment of parental alienation demands attentive study of the legal process, multiple evaluations carried out with different family members, and collateral sources of information. In a context of conjugal disputes and possible psychiatric disorders (in parents or children), it is mandatory to characterize the child behavior as consistent in rejecting one parent due to manipulation and indoctrination performed by the other – therefore, identifying incorporation of the alienating parent’s speech. It is also important to identify in the child a phenomenon known as the ‘‘independent thinker’’: the child consistently claims that his resistance to the unfavored parent is due to his own independent thought, and not the result of the other parent’s influence. Additional challenges are listed in Box 1. Moreover, the distinction between parental alienation and estrangement (justified rejection of one parent following a real history of neglect, physical and sexual abuse, or domestic violence) must be made. Finally, the most important factor according to expert recommendations refers to a ‘‘potential harm to the child’’ criterion, related to developmental and psychological maladaptation.