This longitudinal study examined the long-term effects of the COVID-19 pandemic on social media use and its impact on psychiatric symptoms and well-being of 3,697 Israeli children and adolescents aged 8 to 14. Data were collected from October 2019 to June 2023, covering four school years and five measurement points prior to, throughout and post- COVID-19. Social media usage, psychiatric symptoms (depression, anxiety, somatization, and general distress), as well as subjective well-being (positive and negative emotions, and life satisfaction) were assessed. The analysis also probed the extent to which social support and extracurricular activities moderated the associations between social media use and mental health outcomes. The results of the growth mixed-effects models indicated a significant increase in social media use and psychiatric symptoms, and a significant decrease in subjective well-being over time. Greater social media use was related to more psychiatric symptoms and negative emotions, but also to more positive emotions and life satisfaction. Social support buffered the negative effects of excessive social media use on mental health, whereas extracurricular activities increased positive emotions, but also psychiatric symptoms related to social media use. These findings highlight the need for targeted interventions to regulate social media usage, given its lasting consequences on the mental health of children and adolescents in the wake of the COVID-19 pandemic.

OBJECTIVE:This study examined the long-term effects of the COVID-19 pandemic on adolescents' substance use, digital media use, and symptoms of internet, gaming, and social media addiction. METHOD:A nationally representative longitudinal cohort of 1665 Israeli teens and preteens, aged 9-16, completed questionnaires assessing substance use prevalence, daily screen time, symptoms of media addiction, and potential risk and protective factors. Data were collected before the pandemic (October 2019), after the second wave lockdown (November 2020), and after the fifth wave (April 2022) in Israel. RESULTS:The analysis documented significant increases in substance use, daily screen time, and social media addiction indices over time. Gratitude, life satisfaction, positive emotions, future orientation, grit, and secure attachment emerged as significant protective factors. Sensation-seeking, negative emotions, and mental health symptoms were identified as risk factors. CONCLUSIONS:These findings highlight the importance of educational and public mental health services in addressing the pandemic's long-term impact on the mental health and addictive behaviors of adolescents. They also emphasize the significance of enhancing protective factors and reducing risk factors to effectively mitigate substance and digital media abuse among adolescents.

Objective: Previous research suggests that well-being interventions are effective in moderating substance and digital media use and improving mental health. This study evaluated the feasibility and preliminary efficacy of a school-based Positive Psychology Addiction Prevention (PPAP) intervention aimed at reducing substance and digital media use and increasing the mental health of school children during the COVID-19 pandemic. Methods: The sample was composed of 1,670 children and adolescents (Mean age = 12.96, SD = 2.01) from six elementary and secondary schools in Israel who were randomly assigned to the PPAP intervention (n = 833) or the waiting-list control conditions (n = 837). A three-year longitudinal repeated-measures randomized control design was used to examine modifications in substance use, digital media use, and psychological symptoms in the intervention and control groups assessed on the pre-test (before the outbreak of COVID-19, September 2019), the post-test (May 2021), and the 12-month follow-up (May 2022). Results: The 12-month prevalence of tobacco use, alcohol use, and cannabis use decreased significantly from the pre-to the follow-up period in the intervention group, and increased significantly in the control group. Daily digital media use increased during the pandemic period in both groups, with a significantly higher increase in the control group. The intervention group reported significantly lower psychological symptoms and negative emo-tions, and greater positive emotions and life satisfaction after the intervention and at follow-up compared to the control group. Conclusions: The COVID-19 pandemic has profoundly disrupted the lives of children and adolescents. Well-being and addiction prevention interventions may be effective in improving the mental health of school children during pandemics and crisis periods.

The present study examined the long-term effects of the COVID-19 pandemic on adolescent internalizing symptoms, substance use, and digital media use before and during the pandemic. A nationally representative longitudinal cohort of 3718 Israeli adolescents aged 12–16 at baseline completed measures of internalizing symptoms (anxiety, depression, and somatization), the prevalence of substance use (i.e., previous 30-day use of tobacco, alcohol, and cannabis), and average daily use of internet/television, video games, and social media. Social support and daily routines were assessed as potential protective factors for mental health. Data were collected in 10 public schools at four measurement points: before the Covid-19 outbreak (September 2019), after the first wave lockdown (May 2020), after the third wave lockdown (May 2021), and after the fifth wave of the pandemic (May 2022). Multi-level mixed models were used to analyze the longitudinal data. The results showed significant increases in internalizing symptoms, substance use (tobacco, alcohol, and cannabis), and daily screen time from the start of the study to the 33-month follow-up. Social support and daily routines moderated the increases in internalizing symptoms and digital media use. These findings highlight the need for public and educational mental health services to address the continuing impact of the pandemic on adolescents.

The goal of this study was to explore people’s attitudes and opinions regarding addiction in Israel, among the general population and different sociodemographic categories. A national Internet-based survey (N = 2008) was conducted to examine attitudes within the adult Jewish Israeli population regarding feelings of shame, blame, alienation, and social discrimination towards people with an addiction, and opinions on treatment, awareness of resources, and public policy. Respondents held significantly negative views towards people experiencing an addiction. Women, more religious, older, and less-educated respondents expressed more stigmatizing attitudes, yet almost the same groups also expressed more supportive opinions regarding treatment and policy. Significant positive associations were found between several of these stigmatizing attitudes and supportive opinions. The association between stigmatizing attitudes and supportive opinions indicates both public support for policy change and the continued need for robust anti-stigma efforts. To improve these efforts, specific subpopulations with higher levels of stigma must be targeted. Policy makers should work towards building public health-focused policy and adapting anti-stigma efforts accordingly.

BACKGROUND:Addictive behaviors share clinical, genetic, neurobiological and phenomenological parallels with substance addictions. Despite the prevalence of compulsive sexual behaviors, particularly problematic pornography use (PPU), how neuroendocrine systems relate to PPU is not well understood. Preclinical studies demonstrate alterations in oxytocin and arginine vasopressin (AVP) function in animal models of addiction, but no human study has tested their involvement in PPU. METHOD:Participants included 122 males; 69 reported PPU, and 53 were demographically-matched participants without PPU. Plasma oxytocin and AVP levels and oxytocin-to-AVP balance were measured at baseline. Salivary oxytocin was assessed at baseline and in response to four videos depicting neutral/positive social encounters. Participants reported on empathy and psychiatric symptoms. RESULTS:Baseline plasma AVP levels were elevated in men with PPU, and the ratio of oxytocin-to-vasopressin suggested AVP dominance. Men with PPU reacted with greater oxytocin increases to presentation of neutral/positive social stimuli. Decreased empathic tendencies were found in men with PPU, and this reduced empathy mediated links between oxytocin and pornography-related hypersexuality. Structural equation modeling revealed three independent paths to pornography-related hypersexuality; two direct paths via increased AVP and higher psychiatric symptoms and one indirect path from oxytocin to pornography-related hypersexuality mediated by diminished empathy. CONCLUSIONS:Findings are among the first to implicate neuropeptides sustaining mammalian attachment in the pathophysiology of pornography-related hypersexuality and describe a neurobiological mechanism by which oxytocin-AVP systems and psychiatric symptomatology may operate to reduce empathy and lead to pornography-related hypersexuality.

Background and objectives To quantify the healthcare costs associated with opioid use disorder among members in a public healthcare system, and compare them to healthcare costs in the general population. Methods Retrospective cohort study in inpatient and outpatient care settings of Israel’s largest public healthcare provider (that covers 4.7 million members). Participants included 1,173 members who had a diagnosis of opioid use disorder in the years between 2013 and 2018. Each patient was matched with 10 controls based on age and sex. The main outcome was monthly healthcare costs. Results The mean monthly healthcare cost of members with opioid use disorder was $1,102 compared to $211 among controls (5.2-fold difference; 95% confidence interval [CI]: 4.6-6.0). After excluding members with heroin related diagnoses before the index date (in order to focus on prescription opioids), this healthcare cost ratio did not substantially change (4.6-fold; 95%-CI: 3.9-5.4). Members with opioid use disorder under the age of 65 years had a cost difference of 6.1-fold (95%-CI: 5.2-7.1), while those 65 years and older experienced cost difference of 3.4-fold (95%-CI: 2.6-4.5). The category with the highest cost for members with opioid use disorder was inpatient services, which was 8.7-fold (95%-CI 7.2-10.4) greater than among controls. Conclusions Healthcare costs among individuals with opioid use disorder in a public health system were substantially higher than among controls, at least partially attributed to prescription opioid use disorder. Differences were greater among individuals younger than 65 years, highlighting the importance of preventing and treating opioid use disorder among younger adult populations.

Objective: The restrictions to contain the coronavirus disease 2019 (COVID-19) pandemic have led to considerable social isolation, posing significant threats to mental health worldwide. The preventive lockdowns may be especially difficult for children and adolescents, who rely extensively on their daily routines and peer connections for stability and optimal development. However, there is a dearth of longitudinal research examining the mental health and daily life impact of the pandemic among children and adolescents. This study addresses this gap by examining the influence of the COVID-19 pandemic on children and adolescents' mental health and well-being, and potential risk and protective moderators of mental health change. Method: In the present study, 1,537 Israeli children and adolescents (M-age = 13.97; 52% girls) completed a battery of questionnaires in September 2019; before the COVID-19 outbreak and immediately after an 8-week lockdown period when schools reopened in May 2020. Results: A repeated measures multivariant analysis of variance (MANOVA) revealed significantly greater anxiety, depression, and panic symptoms, increases in video game, Internet and TV screen time use, and decreases in positive emotions, life satisfaction, social media use, and peer support during the pandemic. Participants with higher baseline mental health symptoms showed greater symptoms after the lockdown period. Perceived social support and consistent daily routines were found to act as significant protective factors against symptomatology. Conclusions: The results highlight the significant mental health consequences of the pandemic on children and adolescents, and substantiate the significant parents' and peers' roles in children's and adolescents' coping during this global pandemic. Clinical Impact Statement The study highlights the significant mental health burden during the coronavirus disease 2019 (COVID-19) pandemic on children and adolescents, in terms of greater anxiety, depression, and panic symptoms, increases in screen time use, and decreases in subjective well-being and peer support. In addition, the study demonstrates that peer and family support and regularity of daily routines during the pandemic lockdown period moderated the effects of the pandemic on changes in mental health. The study emphasizes the need to provide resilience-promoting interventions to children during the pandemic, and underscore the importance of creating supportive and organized home and school environments that support mental health.

Introduction: Substance use disorders (SUDs) are a leading cause of morbidity and mortality worldwide, having a profound and global impact on health, well-being, safety, and productivity. Although traditionally the prevalence of SUDs in Israel has been estimated to be lower than those in high-income countries, estimates and characteristics of individuals with SUDs in the past decade are lacking. In this work, we explored the prevalence of SUDs among the adult Jewish population in Israel, per different classes of substances across sex, age group, and other sociodemographic factors. Methods: Data from an online representative sample of 4,025 respondents were collected, including the alcohol, smoking, and substance involvement screening test (ASSIST) metric and sociodemographic data. Results: We found that the most common SUDs were alcohol (10.5% [9.5–11.4]), cannabis (9.0% [8.2–9.9]), and sedative (3.6% [3.0–4.2]) use disorders. Alcohol-cannabis (3.2% [2.7–3.7]) and alcohol-sedative (1.04% [0.7–1.35]) were the most prevalent co-occurring SUDs. Among those with cannabis use disorder, the prevalence of alcohol use disorder was found to be 35.3% [30.4–40.2]. The estimated risk for alcohol use disorder was found to be inversely proportional to age, cannabis use disorder increased, peaked, and decreased with age, and that of sedative use disorder increased with age, particularly among women. While older individuals (in the 51–60 years of age group) were at lower risk (OR = 0.5 [0.3, 0.8]) compared to those <20 years of age for alcohol use disorder, they were at increased risk for sedative use disorder (OR = 3.1 [1.2, 9.7]). Conclusions: These findings represent substantially higher rates of SUDs in Israel than those previously reported and should affect resources allocated to addiction prevention and treatment. Further research on the role of gender, age, culture, and ethnicity in the propensity to develop SUDs is necessary for the development of more focused preventive and intervention measures. Focusing on non-Jewish populations in Israel and broadening the scope to include behavioral addictions should be addressed in future studies.

The Internet Addiction Test (IAT) (Young, 1998) is one of the most utilized diagnostic instruments to evaluate internet addiction. Despite the wide use of IAT in research and clinical settings, there is lack of an empirical validation of this scale among a largescale adult population. The present study aimed to: (1) investigate the psychometric properties of a Hebrew version of the IAT among large-scale Israeli adult sample. (2) Assess the socio-demographic characteristics of individuals who suffer from IA. (3) Assess the co-morbidity of IA in relation to substance and behavioral addictions. A cross sectional study was conducted, by constructing a representative sample (N = 4035) of the Jewish adult (18-70 y/o, M = 40.5, SD = 14.5) population in Israel. Participants responded an online survey, that measured IAT, socio-demographic characteristics, substance and behavioral addictions. Results showed that two-factor model (Emotional and Cognitive Preoccupation with the Internet and Loss of Control and Interference with Daily Life) has good psychometric properties and fits the data well. Young age, not being married (Risk Ratio [RR] = 1.98, 95% CI [1.51-2.63]), and having a low socio-economic status (RR = 1.41, 95% CI [1.05-1.90]) were found to be associated with IA. Drug (RR = 4.50, 95% CI [2.89-7.01]) and alcohol (RR = 3.54, 95% CI [1.50-5.42]) use disorders were associated with IA. High co-morbidity between behavioral addictions and IA was also found (RR = 15.24, 95% CI [11.17-20.78]). Overall, results show that the Hebrew version of the IAT is a valid and reliable instrument, and provide a comprehensive picture of IA prevalence and profile in adult Israeli sample.

Exposure to trauma is considered a risk factor for the development of addictive disorders. Currently, there is a knowledge gap concerning specific links between types and levels of exposure to traumatic events and addiction.In this study we explored the associations between interpersonal trauma and risk of addictive behaviors, stratified by type of trauma (physical, weapon, sexual assault, and combat) and level of exposure (direct/indirect), focusing on a wide range of substances and behaviors. Data from an online representative sample of 4025 respondents were collected, including the Life Events Checklist (LEC-5), substance use disorders and behavioral addictions metrics, and sociodemographic data. Substantial differences were found between specific types of trauma and risk of addiction. Among those exposed to sexual assault, the risk of alcohol use disorder was found to 15.4%, 95%CI[14.4-16.4%], compared to 12.1%,95%CI[11.3-12.8] among those exposed to combat-related trauma. Both direct and indirect exposure to trauma were found to be significantly related with risk of addiction. While direct exposure was most highly associated with addictions across several types of trauma, in the case of combat-related trauma, indirect exposure was more highly associated with alcohol and pornography addiction (14.5%,95%CI[13.2-15.8%] and 10.0%, 95%CI[6.3-15.0%], respectively) compared to direct exposure (10.7%,95%CI[9.9-11.6%] and 7.4%, 95%CI[4.7-11.6%], respectively). Our findings emphasize the strong association between all types of trauma and the risk of several specific substance and behavioral addictions. Specifically, the role of indirect exposure to trauma is highlighted.

Using data from 1,352 middle-school Israeli adolescents, the current study examines the interface of spirituality and character strengths and its longitudinal contribution to subjective well-being and prosociality. Participants were approached three times over a 14-months period and completed measures of character strengths, spirituality, subjective well-being (positive emotions, life satisfaction), and prosociality. Findings revealed a fourth-factor structure of character strengths that included the typical tripartite classification of intrapersonal, interpersonal, and intellectual strengths together with spirituality emerging as a statistically autonomous factor. Spirituality was stable over time and contributed to higher subjective well-being and prosociality both cross-sectionally and longitudinally. Discussion focuses on spirituality as a fundamental character strength and an important aspect of positive development.

In their Comment in The Lancet Psychiatry, John B Saunders and colleagues1 aptly described current debates regarding the consideration and classification of gambling and gaming disorders as addictive disorders, which occurred during the generation of DSM-52 and in anticipation of ICD-11.3 Compulsive sexual behaviour disorder is being proposed as an impulse-control disorder for ICD-11.3 However, we believe the logic applied by Saunders and colleagues1 might also apply to compulsive sexual behaviour disorder.

Commentary to: Should compulsive sexual behavior be considered an addiction?

Spirituality and the surge of its development in adolescence have been established in the research. To date, however, these studies look at tendencies across full samples of adolescence rather than investigating multiple subgroups or multiple pathways of spiritual development. The current study uses latent class analysis to identify subgroup portraits of spiritual life in adolescence, based upon a range of dimensions of spiritual experience, religious practice, and mindfulness. Mindfulness, as a dispositional trait, is examined alongside the impact of religious practice on the level of spiritual experience (relationship with the Higher Power, spiritual values, and spiritual self). The findings suggest there is a complimentary contribution to spiritual life in adolescence from religious practice and mindfulness, with both as supportive pathways for spiritual development. Adolescents with the highest level of spiritual experience benefit from both religious practice and trait mindfulness, suggesting that taken together, there is an additive and augmenting contribution.

Caring for children is a known psychosocial stressor; however, its effects on psychological functioning may have substantial cross-cultural variance. We explored relationships between family size and a variety of psychological outcomes among Orthodox Jews in four separate studies: (1) an international treatment-seeking sample (n = 82), (2) a community sample from Canada (n = 226), (3) an out-patient clinical sample from greater New York (n = 82), and (4) a large dyadic sample of Israeli couples (n = 789). Surprisingly, results suggested that family size was not associated with greater stress, anxiety, depression, global functioning, family functioning, family communication, family satisfaction, or even parenting stress. It is possible that the high religious value placed on family life as well as structural adaptions in families buffer against potential stressors associated with child rearing, and further research on these potential effects is warranted.

While prior research suggests that religion influences relationships positively, it may also be a source of conflict. This may be particularly relevant in religion-centric cultures and in families with individuating adolescent children. The current research analysed data from 789 orthodox Jewish couples residing throughout Israel and we hypothesised that religious conflict is related to lower family functioning and higher parenting stress, and that it is more frequent among couples with insecure attachment. Results of a structural equation model indicated that religious conflict was significantly associated with outcome variables within various religious subgroups, and that attachment insecurity was related to higher levels of conflict and was fully or partially mediated by religious conflict. This suggests that within the orthodox community, religious conflict is an important correlate, and perhaps cause, of family dysfunction. Future research exploring causality, cross-cultural relevance, comparability to other forms of conflict, and effective treatment appears warranted.