Association Between Problematic Internet Use, Quality of Parent-Adolescents Relationship, Conflicts, and Mental Health Problems 網路使用不當、親子關係品質、衝突和心理健康問題之間的關聯
Ahmet Özaslan, et al. [full author details at the end of the article] Ahmet Özaslan 等人 [完整作者資料請見文章末]
Increasingly widespread use of Internet resources has facilitated the emergence of problematic Internet use (PIU) in adolescence developmental process, where significant changes occur in social, emotional, cognitive, and behavioral domains. This study examined the associations between the PIU, mental health problems, quality of parentadolescent relationship, and adolescent-parent conflicts among adolescents. Participants were 318 adolescents ( 56.9%56.9 \% girls and 43.1%43.1 \% boys), whose ages ranged between 14 and 18 years, with a mean age of 15.79 ( SD=0.87\mathrm{SD}=0.87 ), enrolled in various high school programs in Ankara. Participants completed the Problematic Internet Use Scale-Adolescent, the Quality of the Parent-Adolescent Relationship, the Adolescent-Parent Conflict Scale, and the Strength and Difficulties Questionnaire. Significant relationships were found between the PIU, mental health problems, quality of parent-adolescent relationship, and adolescent-parent conflicts. Correlation analysis indicated that PIU was positively related with adolescent-parent conflicts, negative quality relationship, and difficulties, while it was negatively related with disclosure, positive quality relationship, and prosocial behaviors. Adolescent-parent conflict was also positively related with negative quality relationship and negatively related with disclosure, positive quality relationship, and prosocial behaviors. Multiple regression analysis showed that excessive use and social benefit of Internet significantly predicted difficulties and adolescent-parent conflicts. Disclosure and positive quality relationship respectively predicted prosocial and adolescent-parent conflicts while negative quality relationship predicted difficulties and adolescent-parent conflict. These results elucidate our understanding of the association between the PIU, quality of parent-adolescent relationship, adolescent-parent conflict, and mental health problems. This would have important implications for prevention of the spreading of these problems. 網路資源日益廣泛的使用促使了青少年發展過程中網路使用問題（PIU）的出現，青少年在社會、情緒、認知和行為領域發生重大變化。本研究探討了 PIU 與青少年心理健康問題、親子關係品質以及青少年與父母的衝突之間的關係。參與者為 318 名青少年（ 56.9%56.9 \% 名女孩和 43.1%43.1 \% 名男孩），年齡介於 14 至 18 歲之間，平均年齡為 15.79 歲（ SD=0.87\mathrm{SD}=0.87 ），就讀於安卡拉的各個高中課程。參與者完成了青少年網路使用問題量表、親子關係品質、青少年與父母衝突量表、優勢與困難問卷。研究發現，PIU、心理健康問題、親子關係品質以及青少年與父母的衝突之間有顯著關係。相關性分析表明，PIU 與青少年親子衝突、負面品質關係和困難程度呈正相關，與揭露、正向品質關係和親社會行為呈負相關；青少年親子衝突與負面品質關係呈正相關，與揭露、正向品質關係和親社會行為呈負相關。多元迴歸分析表明，網路過度使用和社會效益顯著預測困難程度和青少年親子衝突，揭露和正向品質關係分別預測親社會衝突和青少年親子衝突，負面品質關係預測困難程度和青少年親子衝突。 這些結果闡明了我們對 PIU、親子關係品質、青少年與父母的衝突以及心理健康問題之間關聯的理解。這對於預防這些問題的蔓延具有重要意義。
Keywords Problematic Internet use *\cdot Quality of parent-adolescents relationship *\cdot Adolescentparent conflict *\cdot Mental health problems *\cdot Turkish adolescents 關鍵字 網路使用問題 *\cdot 青少年親子關係品質 *\cdot 青少年親子衝突 *\cdot 心理健康問題 *\cdot 土耳其青少年
Over the last two decades, PIU has been a serious public health problem worldwide (Tsitsika et al., 2013). The prevalence of problematic Internet use among adolescents in different regions of the world varies between 0.8%0.8 \% (Italy) (Poli & Agrimi, 2012) and 26.7%26.7 \% (China) (Shek & Yu, 2012). In general, the prevalence of PIU in Asian countries is higher than that in European countries (Kuss et al., 2014). In a study conducted by Yilmaz et al. (2014) with the participation of 2853 high school students randomly selected from 32 high schools in Turkey, the prevalence of Internet addiction among high school students has been shown to be around 16%16 \%. Lee & Stapinski (2012) suggested that anxious individuals tend to increase their Internet use as a protective strategy to avoid anxiety and they have demonstrated that overreliance on Internet use as a primary means of coping with anxiety could lead to PIU. It has been shown that difficulties in various areas such as low self-esteem, timidity, difficulty in coping with stress and problem solving, tendency to procrastination, attention and concentration difficulties, and inhibited temperament in adolescents can lead to PIU (Brand et al., 2014; Li et al., 2015). 近二十年來，PIU 已成為全球嚴重的公共衛生問題（Tsitsika 等，2013）。世界不同地區青少年網路使用問題盛行率在 0.8%0.8 \% （義大利）（Poli 和 Agrimi，2012）和 26.7%26.7 \% （中國）（Shek 和 Yu，2012）之間不等。整體而言，亞洲國家的 PIU 盛行率高於歐洲國家（Kuss 等，2014）。 Yilmaz 等人（2014）對土耳其 32 所高中隨機抽取的 2853 名高中生進行了一項研究，結果顯示高中生網路成癮的盛行率約為 16%16 \% 。 Lee & Stapinski (2012) 認為，焦慮個體傾向於增加網路使用量，以此作為避免焦慮的保護策略。他們已證明，過度依賴網路作為應對焦慮的主要手段可能會導致行為性行為性學習障礙 (PIU)。研究表明，青少年在低自尊、膽怯、難以應對壓力和解決問題、拖延傾向、注意力和專注力不足以及性格壓抑等各方面存在的問題都可能導致行為性行為性學習障礙 (PIU)（Brand 等人，2014 年；Li 等人，2015 年）。
Correlates of PIU Regarding Mental Health or Social Relationships PIU 與心理健康或社會關係的相關性
Investigation of PIU is an important research area with adolescents as they can easily access the Internet compared to younger children and are more susceptible to the adverse effects of the Internet (Anderson et al., 2017). This was found in a study of adolescents that PIU is commonly associated with depression, self-destructive behavior, anxiety, attention deficit/ hyperactivity, hostility/aggression, obsessive-compulsive symptoms, and relationship problems (Cerniglia et al., 2017). Different studies on adolescents indicated that comorbidities such as ADHD, anxiety disorders especially social phobia, aggressive behaviors, mood disorders, and obsessive-compulsive disorder have been associated with PIU (Carli et al., 2013; Akay & Ercan, 2016). PIU has also been associated with negative academic outcomes such as lower grades, grade repetition, and even academic dismissal (Chen & Tzeng, 2010). Many studies show that there is a possible relationship between adolescents’ excessive use of the Internet and negative health outcomes such as excessive daytime sleepiness, problematic alcohol use, and physical health problems (Moreno et al., 2011). Problematic Internet use can interfere with adolescents’ development, peer, family, and social relationships (American Psychiatric Association, 2013; Yau et al., 2012). Excessive Internet use significantly reduces adolescents’ interaction with their peers and families, and their participation in other activities, resulting in higher conflicts and poor relationships. According to Chng et al. (2015), adolescents who are unhappy with their home life measured by positive attitudes toward living at home scale can 對 PIU 的研究是青少年的重要研究領域，因為與年幼的兒童相比，青少年可以輕鬆上網，並且更容易受到網路的不利影響（Anderson 等人，2017）。一項針對青少年的研究發現，PIU 通常與憂鬱、自毀行為、焦慮、注意力不足/過動、敵意/攻擊、強迫症症狀和人際關係問題有關（Cerniglia 等人，2017）。針對青少年的不同研究表明，注意力不足過動症、焦慮症（尤其是社交恐懼症）、攻擊行為、情緒障礙和強迫症等合併症與 PIU 有關（Carli 等人，2013；Akay & Ercan，2016）。 PIU 也與負面學業結果有關，例如成績較低、留級甚至開除（Chen & Tzeng，2010）。許多研究表明，青少年過度使用網路可能與負面健康結果（例如白天過度嗜睡、酗酒和身體健康問題）之間存在關聯（Moreno 等人，2011）。過度使用網路會影響青少年的成長發展以及與同儕、家庭和社會的關係（美國精神醫學會，2013；Yau 等人，2012）。過度使用網路會顯著減少青少年與同儕、家庭的互動，以及他們參與其他活動的次數，從而導致衝突增加和人際關係惡化。根據 Chng 等人（2015）的研究，以對居家生活的正面態度衡量，對家庭生活不滿意的青少年可能會
view the Internet as a way to escape. They may even have poor communication with parents. Therefore, determining the role of parents in problematic Internet use of adolescents is necessary both for the environment, in which problematic use can occur, and for determining possible intervention points (Bleakley et al., 2016). 將網路視為一種逃避的方式。他們甚至可能與父母溝通不良。因此，確定父母在青少年網路使用問題中扮演的角色，對於了解問題使用可能發生的環境以及確定可能的干預點都至關重要（Bleakley 等人，2016）。
Quality of Parent-Adolescent Relationship 親子關係質量
Adolescents’ communication and interaction with their parents, teachers, and peers can significantly contribute to the development of their self-esteem and identity. In adolescence, a negative relationship between adolescents and parents has been shown to be one of the factors facilitating the emergence of many problems in the emotional and behavioral domains (Wang et al., 2014). It has been shown that the quality of the parent-adolescent relationship is important in the development of adolescent self-esteem (Wissink et al., 2006). Quality of parent-adolescent relationship is a broader concept than classical parenting behaviors and the nature of the relationship is two-sided. While parenting behaviors express the concrete and purposeful practices in which the parents perform their parenting duties when interacting with their children, the quality of parent adolescent-relationship characterizes the behavior of both the parent and the adolescent and reflects the formation of attitudes that arise from the relationships they have established with each other over the years (Deković et al., 2003). Quality of parent-adolescent relationship is defined as including three separate dimensions; disclosure, positive quality of parent-adolescent relationship, and negative quality of parentadolescent relationship. The disclosure dimension is considered as an indicator of the openness of the adolescent to their parents, such as the transferring of daily life events and secret sharing with their parents. The dimension of the positive parent-adolescent relationship represents proximity and satisfaction in the relationship between parents and adolescents. The dimension of negative quality of parent-adolescent relationships refers to conflict and antagonism arising from parent-adolescent relationships (Wissink et al., 2006). Conflict is a process of interaction that often creates tensions in the interpersonal relationship where biopsychosocial needs are met. It has been suggested that conflict with the parent is generally higher in adolescence and gradually decreasing towards the end of this period (Van Doorn et al., 2011). 青少年與父母、老師和同儕的溝通互動對其自尊和認同的發展有顯著的促進作用。研究表明，青少年與父母之間的負面關係是導致情緒和行為領域出現許多問題的因素之一（Wang 等，2014）。研究表明，親子關係的品質對青少年自尊的發展至關重要（Wissink 等，2006）。親子關係的品質是一個比傳統育兒行為更廣泛的概念，其關係的本質是雙向的。父母行為表達了父母在與子女互動時履行養育職責的具體和有目的的實踐，而青少年親子關係的品質則表徵了父母和青少年雙方的行為，反映了他們多年來建立的關係所形成的態度（Deković 等，2003）。親子關係的品質被定義為包含三個獨立的向度：揭露、親子關係的正向品質和親子關係的負向品質。揭露維度被視為衡量青少年對父母開放程度的指標，例如轉移日常生活事件和與父母分享秘密。正向的親子關係向度代表了父母與青少年關係的親密程度與滿意度。 親子關係的負面品質維度指的是親子關係中產生的衝突和對抗（Wissink 等人，2006）。衝突是一個互動過程，在滿足生物、心理、社會需求的人際關係中，它往往會造成緊張。有研究表明，青少年時期與父母的衝突通常較高，並在青春期末期逐漸減少（Van Doorn 等人，2011）。
The Relationship Between PIU and Parent-Adolescent Relationship PIU 與青少年親子關係的關係
Several studies have examined the correlation of PIU with the parental styles and relationships. As a result of studies conducted in both Asia and Europe, the PIU was found to be related with poor parental relationships (Chng et al., 2015; Siomos et al. 2012). In particular, a home environment with effective communication about PIU has been shown to reduce the risk of PIU in adolescents (van Den Eijnden et al., 2010; Yu & Shek, 2013). In addition, factors associated with high PIU may include less protective parenting style, poor family functionality, low parent education, and divorced or less positively related parents (Chen et al., 2015; Ko et al. 2007; Willoughby 2008). It has been shown that adolescent-parent conflict can potentially contribute to PIU in adolescents (Zhou et al., 2017). With regard to Internet use, Siomos et al. (2012) have shown that a good parent relationship, characterized by more emotional warmth, love, and less intrusive control, is an important determinant for the reduction of problematic Internet use. Liu and Kuo (2007) reported that the weak parent-adolescent 多項研究已經檢驗了 PIU 與父母教養方式和關係的相關性。在亞洲和歐洲進行的研究發現，PIU 與不良的父母關係有關（Chng 等人，2015 年；Siomos 等人，2012 年）。具體而言，研究表明，在家庭環境中就 PIU 進行有效溝通可以降低青少年患 PIU 的風險（van Den Eijnden 等人，2010 年；Yu 和 Shek，2013 年）。此外，與高 PIU 相關的因素可能包括保護性較差的養育方式、家庭功能差、父母受教育程度低以及父母離婚或親子關係較差（Chen 等人，2015 年；Ko 等人，2007 年；Willoughby，2008 年）。研究表明，青少年與父母的衝突可能會導致青少年患有 PIU（Zhou 等人，2017 年）。關於網路使用，Siomos 等人（2012）的研究顯示，良好的親子關係，以更多的情感溫暖、愛和較少的侵入性控制為特徵，是減少問題性網路使用的重要決定因素。劉和郭（2007）的研究報告顯示，親子關係較弱的青少年