original adicciones vol.

30, nº 1 · 2018

Information and Communications Technologies (ICT):

Problematic use of Internet, video games, mobile phones,
instant messaging and social networks using MULTICAGE-TIC
Tecnologías de la Información y la Comunicación (TIC): uso
problemático de Internet, videojuegos, teléfonos móviles,
mensajería instantánea y redes sociales mediante el MULTICAGE-TIC

Eduardo J. Pedrero-Pérez*; José María Ruiz-Sánchez de León**; Gloria Rojo-Mota***; Marcos

Llanero-Luque****; Jara Pedrero-Aguilar*; Sara Morales-Alonso*; Carmen Puerta-García*.

* Instituto de Adicciones. Madrid Salud. Madrid City Council; ** Cognitive Deterioration Prevention Centre. Madrid Salud.
Madrid City Council. Complutense University of Madrid; *** Instituto de Adicciones. Madrid Salud. Madrid City Council. Rey
Juan Carlos University of Madrid; **** Cognitive Deterioration Prevention Centre. Madrid Salud. Madrid City Council.

Abstract Resumen
Use/abuse of Information and Communications Technologies (ICT) El uso/abuso de las Tecnologías de la Información y la Comunicación
has in recent years become a topic of great interest. Current discussion (TIC) es un tema que suscita enorme interés en los últimos años. Está
addresses whether it must be considered addictive behaviour and en discusión si debe recibir la consideración de conducta adictiva y si
if it is a problem that primarily affects adolescents and youth. This es un problema que afecte prioritariamente a adolescentes y jóvenes.
study aims to understand the problems that affect people of all ages El presente estudio pretende conocer los problemas que afectan a las
in controlling the use of these ICTs and whether they are related to personas de todas las edades en el control del uso de estas TICs y si
mental health problems, stress and difficulties in executive control están relacionados con problemas de salud mental, estrés y dificultades
of behaviour. A survey was administered through social networks and en el control superior del comportamiento. Se realiza una encuesta a
email, using the MULTICAGE-ICT, a questionnaire that explores través de redes sociales y correo electrónico, en el que se administra el
problems in the use of Internet, mobile phones, video games, cuestionario MULTICAGE-TIC, que explora problemas en el uso de
instant messaging and social networks. Additionally, the Prefrontal Internet, teléfono móvil, videojuegos, mensajería instantánea y redes
Symptom Inventory, General Health Questionnaire and Perceived sociales. Adicionalmente se administra el Inventario de Síntomas
Stress Scale were administered. The sample was comprised of 1,276 Prefrontales, el Cuestionario de Salud General y la Escala de Estrés
individuals of all ages from different Spanish-speaking countries. The Percibido. Se obtiene una muestra de 1.276 sujetos de todas las edades
results indicate that about 50% of the sample, regardless of age or y diferentes países de habla hispana. Los resultados apuntan a que
other variables, presents significant problems with the use of these alrededor del 50% de la muestra presenta importantes problemas
technologies, and that these problems are directly related to symptoms en el uso de estas tecnologías, y que esos problemas se relacionan
of poor prefrontal functioning, stress and mental health problems. directamente con síntomas de mal funcionamiento prefrontal, estrés
The results reveal the need for reconsidering whether we are facing y problemas de salud mental, independientemente de la edad u
an addictive behaviour or a new problem demanding environmental, otras variables. Estos resultados sugieren reconsiderar si se trata de
psychological, sociological and sociopolitical explanations; therefore, una patología adictiva o si estamos ante un problema novedoso que
it is necessary to reformulate actions to be implemented to address requiere de explicaciones de índole ambiental, psicológica, sociológica
and refocus our understanding of the problem. y sociopolítica, debiendo reformular las acciones a emprender para
Keywords: Behavioural addiction; Information and communications reorientar la comprensión y el abordaje del problema.
technologies; Perceived stress; Dysexecutive syndrome; Mental health. Palabras clave: adicciones comportamentales; tecnologías de la
información y la comunicación; estrés percibido; disfunción ejecutiva;
salud mental.

Received: April 2016; Accepted: December 2016.

Send correspondence to:
Eduardo J. Pedrero Pérez. Madrid Salud. C/ Alcalá 527, 28027 Madrid (Spain). Correo: ejpedrero@yahoo.es

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 Information and Communications Technologies (ICT): Problematic use of Internet, video games, mobile phones,
instant messaging and social networks using MULTICAGE-TIC

O
ver the last two decades, the so-called “beha- & Stein, 2016) and, given our actual knowledge, referring
vioural addictions” have become increasingly to these as compulsive habits seems more appropriate (Po-
important and have generated ongoing re- tenza, 2015).
search. For example, a query of the PubMed The so-called Information and Communications Tech-
database using the descriptor “behavioural addiction” shows nologies (ICTs) have been object of the greatest attention.
an increase from 304 studies in 1995 to 2,583 in 2014, an In recent decades, humanity has witnessed two global re-
uninterrupted exponential growth. Marks (1990) defined volutions of enormous scales. The first, in the final years
the concept of “behavioural addictions” as a group of be- of the last century, was the popularisation of and unlimi-
haviours characterised by the repeated need for assuming ted access to the Internet, with the arrival of modems to
behaviours with known negative consequences, developing the home. But, just shortly later, halfway through the first
behavioural sequences that generate stress and recurrent decade of the current century, the second revolution occu-
phases of urgency until they are completed, together com- rred: the transformation of pocket-sized, portable mobile
prising a syndrome that is activated by external and inter- phones into platforms that provide access to an immense
nal signals and that ultimately entails difficulty in one’s number of possibilities.
everyday functioning. Over time, concepts have been refi- This emergence of opportunities has entailed great
ned, empirical evidence has been gathered on similarities advantages, but also important risks and problems. Based
across behavioural addictions and those related to substan- on the concept of Internet addiction (Fernández-Villa et
ces with regards to their natural evolution, phenomeno- al., 2015; Griffiths, Kuss, Billieux & Pontes, 2016; Young,
logy, tolerance, associated psychopathology, contribution 2017) or mobile phone addiction (Pedrero-Pérez, Rodrí-
of genetics, neurobiological mechanisms, and response to guez-Monje & Ruiz-Sánchez de León, 2012), this study
treatment, among others (Grant, Potenza, Weinstein & Go- has shifted from supports to specific applications: instant
relick, 2010). messaging (Dlodlo, 2015; Sultan, 2014), social networks
A significant number of these neuroscientific studies (Schou Andreassen, 2015), online games (Bertran & Cha-
have found that, as occurs with substance addiction, defi- marro, 2016; Chen & Leung, 2015; Griffiths, 2015), among
cits in the functioning of the prefrontal cortex are central many others. Studies coincide in finding a relationship
elements of behavioural addictions that explain the loss between the abuse of some of these modes of online inte-
of executive control over problematic behaviour (Blum et raction and indicators of poor daily functioning, problems
al., 2015; Brand, Young & Laier, 2014; de Ruiter, Ooster- related to self-esteem, and decreased school performance
laan, Veltman, van den Brink & Goudriaan, 2012) and that (Grover et al., 2016; Hawi & Samaha, 2016; Ko, Yen, Yen,
important similarities may be found between both moda- Chen & Chen, 2012; Schou Andreassen et al., 2016; So-
lities in brain structures such as white matter (Yip et al., roush, Hancock & Bonns, 2014).
2016). Most of these studies have focused on adolescents or the
Other studies have focused on finding evidence of the population of youth under the age of 30, in interpreting
differences among many of these behavioural addictions that the vulnerabilities that may lead to abuse or addiction
and those entailing the use of substances. For example, become apparent at these ages. However, the penetration
one 5-year longitudinal study (Konkolÿ Thege, Woodin, of these technologies across all societal levels worldwide
Hodgins & Williams, 2015) found that the development of allows for hypothesising that all ages may be affected. Scar-
these excessive behaviours is usually short-term and that, ce evidence supports a relationship between the problems
in most cases, they are abandoned naturally. However, this associated with abuse of ICT and psychopathological symp-
is not proof of differences, given that most substance ad- toms or problems in daily activities beyond youth.
dicts also recover spontaneously and without professional The purpose of this study is to detect the frequency
assistance (Brevers & Noel, 2015). Some authors denoun- of problems associated with use and abuse of Informa-
ce that our determination in assimilating excessive repe- tion and Communications Technologies (ICTs) in all age
titive behaviours with criteria for diagnosing psychiatric groups and in different geographical and cultural settings.
disorders leads to the assumption of absurd categories that To this end, first the psychometric quality of a previous-
lack specificity and clinical validity and result in overpa- ly-used survey was evaluated and adapted to the problems
thologizing everyday life (Billieux, Schimmenti, Khazaal, object of the study. Furthermore, given that all of the avai-
Maurage & Heeren, 2015), ignore ideographic aspects lable models for characterizing behavioural addictions
(Spada, 2015), elude individual differential characteristics allude to a dysfunctional prefrontal cortex as an antece-
(Kardefelt-Winther, 2015) and functionality (Brevers & dent of the loss of executive control over behaviour, we
Noel, 2015), in addition to the behaviours’ environmental, hypothesized a direct relationship between the problema-
social and cultural determinants (Blaszczynski, 2015; Van tic use of ICTs and the symptoms of prefrontal dysfunction
der Linden, 2015). For these reasons, the concept of beha- in everyday life, as well as other psychological symptoms
vioural addiction is fiercely questioned (Sinclair, Lochner and perceived stress.

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 Eduardo J. Pedrero-Pérez, José María Ruiz-Sánchez de León, Gloria Rojo-Mota,
Marcos Llanero-Luque, Jara Pedrero-Aguilar, Sara Morales-Alonso, Carmen Puerta-García

Method Factorial analysis found a three-factor solution: problems

Participants and procedure in behavioural control, problems in emotional control and
Given that the target population was comprised of fre- problems in social behaviour. Validation for the general
quent users of ICTs, a survey was created using Google population and for addicts in treatment reported suffi-
Docs® (available at https://goo.gl/4UAyIw) and anon- cient internal consistency of all of the subscales (0.87 < as <
ymous and voluntary participation was requested via ins- 0.89), clinical validity (Ruiz-Sánchez de León, Pedrero-Pé-
tant messaging applications (WhatsApp®), social networks rez, Gálvez, Fernández-Méndez & Lozoya-Delgado, 2015),
(Facebook®) and e-mail. Likewise, the Respondent-Driven ecological validity (Pedrero-Pérez et al., 2016) and trans-
Sampling technique was used, requesting participants to cultural validity (Cuello Prato & Mendoza Carmona, 2014;
disseminate the survey to their contacts. Given that the sur- González Roscigno, Mujica Díaz, Terán Mendoza, Guerre-
vey was comprised of 56 items, a minimum of 20 subjects ro Alcedo & Arroyo Alvarado, 2016). In the study sample,
was estimated per item, doubling the usual requirements multivariate consistency was αs= 0.91 for the complete test
of the rule of 10 subjects per item (Velicer & Fava, 1998), and 0.81 < αs < 0.90 for the scales.
requiring a minimum of 1,120 subjects. When this figure General Health Questionnaire, 12-item version (Gene-
was reached, a week was given for the study to be comple- ral Health Questionnaire, GHQ-12; Goldberg & Williams,
ted. Data collection took place between March 8-24, 2016 1998), Spanish version (Rocha, Pérez, Rodríguez-Sanz,
(n = 1,290). Exploratory data analysis was performed, ex- Borrell & Obiols, 2011) is a self-administered screening
cluding 14 surveys: 12 had identical responses, 1 was in- instrument used to detect indicators of mental illness and
complete and 1 was an outlier (all responses reflected the possible cases of psychopathological disorders in primary
most negative alternative). The final sample was comprised care contexts or in the general population. Responses are
of 1,276 subjects. given on a four-option Likert scale. It may be corrected in
several ways; the following two were adopted for this study:
Instruments GHQ-Likert, scores between 0 and 3, where higher scores
MULTICAGE-TIC, 20-item survey, comprised of 5 sca- correspond with worse health indicators; and GHQ crite-
les, posed questions on problematic use of Internet, Video rion-referenced scores, assigning the values 0, 0, 1, 1 to
Games, Mobile Phones, Instant Messaging and Social Ne- item responses. In the study sample, the consistency of the
tworks. It is based on MULTICAGE CAD-4, a survey used test was αs= 0.90.
for screening compulsive behaviours, with and without The “Escala de Estrés Percibido” (EEP), the Spanish
substances (Pedrero-Pérez et al., 2007), that has been used version (Remor & Carrobles, 2001) of the Perceived Stress
in primary care (Garrido-Elustondo, Reneses, Navalón, Scale (PSS) by Cohen, Kamarck & Mermelstein (1983).
Martín, Ramos & Fuentes, 2016; Reneses et al., 2015; Ro- The complete PSS is comprised of 14 items that measure
dríguez-Monje, Pedrero-Pérez, Fernández-Girón, Gallar- the degree to which, in the last month, persons have felt
do-Alonso & Sanz-Cuesta, 2009), behavioural addictions unsure or concerned about, or to the contrary have felt
(Estevez, Herrero-Fernández, Sarabia & Jauregui, 2015; certain about, their capacity for controlling their personal
Estévez Gutiérrez, Herrero Fernández, Sarabia Gonzalvo problems. A brief, 4-item version is also available, with ade-
& Jáuregui Bilbao, 2014) and substance addiction (Na- quate psychometric properties in the Spanish population,
vas, Torres, Cándido & Perales, 2014; Martínez-González, with an internal consistency of α= 0.83 in the general popu-
Munera-Ramos & Becoña-Iglesias, 2013; Pedrero-Pérez, lation and clinical samples (Pedrero-Pérez et al., 2015b).
2010). This new version’s design comprised four questions Responses are given on a 5-item Likert scale, ranging from
with dichotomous answers (Yes/No) for each problematic 0 (“Never”) to 4 (“Very frequently”), with scores of between
behaviour, asking about: item 1, estimated excessive time 0-16 and with higher scores corresponding to higher per-
dedication; item 2, excessive time estimated by significant ceived stress. This study used the 4-item version (PSS-4),
others; item 3, difficulty in refraining from the behaviour; with an internal consistency of αs= 0.81.
item 4, difficulties in voluntarily interrupting the beha- Participants were also asked to specify their age, level
viour. Given the newness of the survey, its psychometric of studies, gender, country of birth and actual country of
properties were tested with the sample itself. residence.
Prefrontal Symptoms Inventory, screening version (ISP-
20; Pedrero-Pérez, Ruiz-Sánchez de León, Morales-Alonso, Data analysis
Pedrero-Aguilar & Fernández-Méndez, 2015c) that ex- First, the psychometric properties of MULTICAGE-TIC
plores symptoms of malfunction in daily life related with were analysed. Initially, the distributions for each item
neuropsychological alterations attributable to the pre- were obtained and whether these were distributed in line
frontal cortex. Responses are given on a Likert scale (0: with the multivariate normality criteria of Mardia (1970).
never or almost never; 1: sometimes; 2: sometimes yes and Given that this property was not guaranteed, the tetracho-
sometimes no; 3: frequently; 4: always or almost always). ric correlations matrix was used, and the ω= McDonald’s

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 Information and Communications Technologies (ICT): Problematic use of Internet, video games, mobile phones,
instant messaging and social networks using MULTICAGE-TIC

Omega and αs= standardized Cronbach’s Alfa were used regression was done using the Durbin-Watson test to con-
as internal consistency estimates, according to the most trol for prediction errors. MANCOVA was performed to
recent recommendations (Dunn, Baguley & Brunsden, compare subgroups, using the partial eta-squared (η2) to
2014). The FACTOR 10.3.01 program (Lorenzo-Seva & estimate the effect size and the “rules of thumb” proposed
Ferrando, 2006) was used for these tests. Then, a confirma- by Cohen (1988): 0.01 small effect size, 0.06 medium effect
tory factorial analysis was performed of the theoretical pro- size and 0.14 large effect size. For these analyses, gender
posal of 5 scales for the data obtained, and the unweigh- was the dummy variable, with values 0 and 1. Analyses was
ted least squares (ULS) method was used, with indicators performed using the SPSS 19 statistics package.
of fit provided by the AMOS 18 application (RMR = Root
Mean Square Residual, with acceptable values below 0.06;
GFI = General Fit Index; AGFI = Adjusted Goodness of Fit Results
Index; NFI = Normed Fit Index; RFI = Relative Fit Index, Characteristics of the sample
all with acceptable values above 0.90; PNFI = Parsimonious Table 1 displays the complete sample’s descriptive va-
Normed Fit Index and PGFI = Parsimony Goodness of Fit riables.
Index, both acceptable with values above 0.7). Partial co- Psychometric properties of MULTICAGE-TIC
rrelation tests were performed, controlling for covariables, Table 2 displays the descriptive variables for the MULTI-
and using the Bonferroni correction for multiple correla- CAGE-TIC items, in addition to each scale’s Goodness of
tions to avoid committing a type 1 error. Stepwise linear Fit Index (GFI) and internal consistency measures. All sca-
les have adequate internal consistency, though lower, yet
still acceptable (> 0.70) for the Mobile Telephone scale, at
Table 1. Descriptive variables of the sample. the expense of low communality of the third item (“On a
day that you don’t have your mobile phone with you, do you feel
Country of origin Residence uneasy or as if something very important is missing?”) with the
n % Country of origin (%) scale’s remaining items.
Spain 960 75.2 97.8 The model was tested as a whole, with confirmatory
Colombia 138 10.8 86.2 factorial analysis to verify the fit of the 5-scale theoretical
Venezuela 94 7.4 89.4
Other countries
Europe 27 2.1 0 Covariance Scale Weighted regression Items Variance error

North America 2 0.2 0

Other countries of Latin
America 48 3.8 60.4
Internet
Asia 3 0.2 0
Africa 4 0.3 0

Gender
Mobile
Males 425 33.3 Phones
Females 851 66.7

Level of studies
Primary or lower 28 2.2 Video
Games
Secondary 65 5.1
Higher secondary 176 13.8
University student 193 15.1
University graduate 814 63.8 Instant
Messaging
Age
< 18 57 4.5
18 - 25 272 21.3
Social
25 - 30 129 10.1 Networks
30-45 393 30.8
45 - 60 365 28.6
> 60 60 4.7
Figure 1. MULTICAGE-TIC structural model.

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 Eduardo J. Pedrero-Pérez, José María Ruiz-Sánchez de León, Gloria Rojo-Mota,
Marcos Llanero-Luque, Jara Pedrero-Aguilar, Sara Morales-Alonso, Carmen Puerta-García

Table 2. Descriptive variables and indicators of fit and internal consistency of the MULTICAGE-TIC scales.

Scale Item Median Mean 95% confidence Variance Asymmetry Kurtosis Communa- rit GFI ω as
interval lities
1 1 0.51 (0.48 - 0.55) 0.25 -0.04 -2.00 0.62 0.45
2 0 0.26 (0.23 - 0.29) 0.19 1.11 -0.76 0.43 0.38
Internet 0.99 0.81 0.80
3 1 0.51 (0.47 - 0.54) 0.25 -0.02 -2.00 0.35 0.36
4 0 0.21 (0.18 - 0.24) 0.16 1.45 0.11 0.68 0.46
1 1 0.60 (0.57 - 0.64) 0.24 -0.42 -1.82 0.72 0.41
2 0 0.38 (0.34 - 0.41) 0.23 0.52 -1.73 0.50 0.38
Mobile Phone 1.00 0.74 0.72
3 0 0.64 (0.60 - 0.67) 0.23 -0.56 -1.68 0.11 0.21
4 0 0.15 (0.13 - 0.18) 0.13 1.93 -1.73 0.43 0.30
1 0 0.12 (0.10 - 0.14) 0.11 2.34 3.48 0.75 0.56
2 0 0.10 (0.08 - 0.12) 0.09 2.62 4.86 0.76 0.57
Video Games 1.00 0.91 0.90
3 0 0.13 (0.11 - 0.15) 0.11 2.21 2.89 0.60 0.46
4 0 0.05 (0.03 - 0.06) 0.05 4.16 15.32 0.71 0.49
1 0 0.41 (0.37 - 0.44) 0.24 0.38 -1.86 0.77 0.60
2 0 0.29 (0.26 - 0.32) 0.21 0.94 -1.13 0.65 0.56
Instant Messaging 1.00 0.89 0.89
3 0 0.51 (0.48 - 0.55) 0.25 -0.05 -2.00 0.58 0.49
4 0 0.17 (0.14 - 0.19) 0.14 1.80 1.22 0.71 0.49
1 0 0.31 (0.27 - 0.34) 0.21 0.83 -1.31 0.92 0.68
2 0 0.14 0.12 - 0.17) 0.12 2.03 2.11 0.68 0.55
Social Networks 1.00 0.93 0.93
3 0 0.27 (0.24 - 0.31) 0.20 1.02 -0.97 0.81 0.66
4 0 0.13 (0.10 - 0.15) 0.11 2.26 3.12 0.71 0.54

Note. rit= corrected item-test correlation; GFI = Goodness of Fit Index; ω= McDonald’s Omega; αs= standardised Cronbach’s Alpha..

Table 3. Affirmative responses for each item of the MULTICAGE-TIC and the percentage
of subjects with affirmative responses to a given number of questions.

Affirmative responses (%) % Affirmative responses

Item for all items

Scale 1 2 3 4 0-1 2 3 4
Internet 51.1 25.7 50.5 20.6 51.1 25.7 50.5 20.6
Mobile Phone 60.3 37.5 63.6 15.3 60.3 37.5 63.6 15.3
Video Games 12.0 10.3 12.9 4.9 12.0 10.3 12.9 4.9
Instant Messaging 40.8 28.8 51.3 16.6 40.8 28.8 51.3 16.6
Social Networks 30.8 14.4 27.4 12.5 30.8 14.4 27.4 12.5

model to the data obtained. None of the surveys met mul- items, the percentage increases to 45.1% for the Internet
tivariate normality criteria (Mardia p < 0.05 in all cases). and 57.5% for Mobile Phones.
Therefore, the unweighted least squares (ULS) method Table 4 shows that the ISP, whether as a whole or by subs-
was used. Indicators of fit were satisfactory (RMR = 0.012; cales, correlates with all of the MULTICAGE-TIC scales,
GFI = 0.96; AGFI = 0.95; NFI = 0.94; RFI = 0.92; PGFI = 0.73; once implementing corrections to avoid type 1 error (Bon-
PNFI = 0.79) and the third item of the Mobile Phone scale ferroni) and controlling for age, gender and level of stu-
would just slight improve the model’s fit (RMR = 0.011; GFI dies. The effect size is small or medium in all cases (0.06 < r2
= 0.97; AGFI = 0.96; NFI = 0.94; the others remain unchan- < 0.01). The case is the same for the GHQ (0.04 < r2 < 0.01),
ged). Figure 1 shows the resulting structural model. while with the PSS it only occurs in relation to three scales
Table 3 displays the percentage of affirmative response (0.02 < r2 < 0.01), but not with the other two (r2< 0.01).
for each item and the percentage of subjects with affirmati- Table 5 displays the results of joint regression of the
ve responses to a given number of questions. While for Vi- items of the ISP-20, GHQ-12 and PSS-4, marking those with
deo Games only 10.9% respond affirmatively to 2 or more predictive capacity (R2 * 100 > 1) for MULTICAGE-TIC sca-

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 Information and Communications Technologies (ICT): Problematic use of Internet, video games, mobile phones,
instant messaging and social networks using MULTICAGE-TIC

Table 4. Partial correlations (controlling for gender, age and level of studies) between the MULTICAGE-TIC and the ISP-20, GHQ-12
and EEP questionnaires.

Internet Mobile Phone Video Games Instant Messaging Social Networks

ISP-20 0.24* 0.17* 0.17* 0.22* 0.19*
Executive problems 0.22* 0.15* 0.16* 0.19* 0.18*
Social Behaviour Problems 0.16* 0.11* 0.13* 0.18* 0.13*
Emotional Control Problems 0.16* 0.13* 0.08 0.15* 0.13*
GHQ-12
Likert Scores 0.19* 0.09 0.12* 0.14* 0.12*
Criterion-referenced score 0.19* 0.12* 0.13* 0.17* 0.14*
EEP-4
Perceived Stress 0.15* 0.09 0.09 0.15* 0.11*

Note. *Significant correlation after applying the Bonferroni correction for multiple correlations.

Age Groups

Internet Mobile Phones Video Games Instant Messaging Social Networks

Figure 2. Average scores in the MULTICAGE-TIC scales by age groups.

les. Problems with concentration, difficulties with emotio- Mobile Phones, in which similar levels are maintained un-
nal control, motivational deficits and disinhibited social til the age of 45.
behaviour are the problems most-related with the different
scales on the use of ICTs, though it cannot be determined Gender differences
whether they cause, or result of, problematic use. Table 7 displays the average scores and dispersion of the
When subjects are categorized according to the number estimated variables by surveys and gender. Significant di-
of affirmative responses to the MULTICAGE-TIC scales, it fferences are found for all variables, with low to moderate
is observed (Table 6) that the prefrontal symptoms increa- effect sizes. Females obtain higher scores in the scales on
se almost in parallel, somewhat similar to what occurs with the use of Mobile Phones, Instant Messaging, and Social
the scores in the GHQ and the PSS. Networks, while males obtain higher scores in the use of
Figure 2 shows the average scores by age groups. The hi- the Internet and Video Games. Females also obtain higher
ghest scores are obtained by the youngest age groups (ex- scores in prefrontal symptoms (though only at the expense
cept for the Social Networks scale, which peaks between of declaring more symptoms related with poor emotional
the ages of 18-25), showing a gradual decrease, except for control), risk of poor mental health and perceived stress.

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 Eduardo J. Pedrero-Pérez, José María Ruiz-Sánchez de León, Gloria Rojo-Mota,
Marcos Llanero-Luque, Jara Pedrero-Aguilar, Sara Morales-Alonso, Carmen Puerta-García

Table 5. Items with predictive capacity (R2*100> 1) of the items of the ISP-20, GHQ-12 and EEP-4 for the MULTICAGE-TIC scales.

Items Internet Mobile Video Instant Social

Phone Games Messaging Networks

It is difficult for me to concentrate on anything 6.5 1.0 1.0

Have you been able to concentrate well on your activities over the last few weeks? 1.0
Have you constantly felt overwhelmed and stressed? 1.0
I laugh or cry too easily 1.0 3.0 2.2 1.4
Many times I am incapable of doing things unless someone tells me I must do them 2.0 1.9 1.8 3.9
I forget that there are things I must do but I remember when reminded 1.0
I feel lethargic, sleepy 4.1
I make very personal comments in front of others 1.2
I make inappropriate sexual comments 1.2
I tell unsuitable jokes in inappropriate situations 3.0

Table 6. Scores on prefrontal symptoms, mental health and perceived stress according to the number of affirmative responses in each
scale of MULTICAGE-TIC (controlling for gender, age and level of studies).

Number of affirmative responses

MULTICAGE-TIC
0 1 2 3 4 F7 h2
M 14.65 15.84 19.57 21.47 24.63
ISP-20 25.21* 0.12
SD 9.327 10.28 10.64 10.42 12.59
M 9.25 10.21 10.39 11.81 12.96
Internet GHQ-12 10.78* 0.06
SD 4.25 4.49 4.95 5.90 6.89
M 4.15 4.59 5.16 5.86 6.18
EEP-4 17.34* 0.09
SD 3.05 2.88 3.19 3.24 3.29
M 14.63 16.98 17.57 19.91 23.81
ISP-20 20.31* 0.10
SD 9.76 10.26 10.36 10.94 12.75
M 9.81 10.22 10.02 11.15 12.24
Mobile Phone GHQ-12 6.06* 0.03
SD 4.62 4.58 5.06 5.55 6.15
M 4.13 4.82 4.78 5.57 5.63
EEP-4 15.05* 0.08
SD 3.08 3.13 3.09 3.12 3.36
M 16.90 19.28 22.04 25.85 23.87
ISP-20 18.85* 0.09
SD 10.52 9.81 11.38 10.77 15.06
M 10.12 10.94 11.55 13.39 11.88
Video Games GHQ-12 6.15* 0.03
SD 4.88 5.25 5.62 6.19 7.30
M 4.72 5.26 5.74 6.41 5.38
EEP-4 15.54* 0.07
SD 3.10 2.96 3.68 3.36 2.79
M 15.15 17.23 17.85 21.64 24.05
ISP-20 23.84* 0.12
SD 9.83 10.67 10.06 10.46 12.04
M 9.73 10.21 10.08 11.62 12.40
Instant Messaging GHQ-12 7.59* 0.04
SD 4.37 4.94 4.96 5.86 6.31
M 4.27 4.80 4.89 5.73 6.22
EEP-4 17.60* 0.09
SD 3.02 3.12 2.97 3.31 3.12
M 16.22 18.94 18.70 21.83 25.26
ISP-20 21.26* 0.11
SD 10.30 10.80 9.51 10.79 12.97
M 9.93 10.79 10.89 11.35 12.60
Social Networks GHQ-12 6.11* 0.03
SD 4.48 5.67 5.16 6.19 6.91
M 4.57 5.08 5.11 5.89 6.15
EEP-4 15.33* 0.08
SD 3.05 3.23 2.96 3.37 3.47

Note. M= Mean; SD = Standard Deviation; * p < 0.001; η2= Partial eta-squared for estimating the effect size.

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 Information and Communications Technologies (ICT): Problematic use of Internet, video games, mobile phones,
instant messaging and social networks using MULTICAGE-TIC

Table 7. Gender differences in the different scales (controlling for age and level of studies).

Males Females
MULTICAGE-TIC M SD Females SD F3 h2
Internet 1.55 1.25 1.44 1.28 55.74* 0.12
Mobile Phone 1.60 1.19 1.85 1.16 26.08* 0.06
Video Games 0.53 1.03 0.34 0.79 15.41* 0.04
Instant Messaging 1.06 1.24 1.53 1.40 49.77* 0.11
Social Networks 0.71 1.15 0.92 1.31 26.69* 0.06

ISP-20 17.51 11.01 18.08 10.68 30.69* 0.07

Executive problems 11.63 7.89 11.49 7.38 18.69* 0.04
Social Behaviour Problems 2.50 2.77 1.68 2.11 24.99* 0.06
Emotional Control Problems 3.37 2.82 4.90 3.25 59.17* 0.12

GHQ-12
Likert Scores 10.11 4.75 10.60 5.27 7.34* 0.02
Criterion-referenced score 1.46 2.41 1.77 2.76 16.95* 0.04

EEP-4
Perceived Stress 4.66 3.02 5.03 3.22 29.91* 0.07

Note. NOTE: M= Mean; SD = Standard Deviation; * p < 0.001; η2= Partial eta-squared for estimating the effect size.

Geographical differences of the device. Someone may forego playing video games,
To study geographical differences, subjects that resided chatting or checking their social networks, but the mobile
in their country of origin were selected and the three su- phone offers infinite additional functions that may have
fficiently numerous populations were compared (Spain, transformed it into an indispensable object in our everyday
Colombia and Venezuela). Table 8 shows that Venezuelans activities. A recent report by Telefónica provides data on
obtained higher scores in the scales on the use of ICTs the increasing importance of the smartphone in everyday
and prefrontal symptoms, but not in those of poor mental life of the Spanish population, which checks it an average
health and perceived stress. The Colombian sample assu- of 150 times per day, reflecting an unstoppable trend: it is
med an intermediate position, except for perceived stress, increasingly difficult for us to live without a smartphone
which was lower compared with the other two samples. (Telefónica, 2015).
Second, the results show high percentages of people
who experiment difficulties with the use of these devices
Discussion and resources. MULTICAGE was initially based on CAGE
The purpose of this study was to detect the frequency (Ewing, 1984), the validation studies of which established
of problems associated with the use and abuse of Informa- that affirmative responses to 2, 3 or 4 items corresponded
tion and Communications Technologies (ICTs) in all age with hazardous drinkers, harmful use of alcohol and alco-
groups and in different geographical and cultural settings. hol dependency, respectively. However, for ICTs, no clas-
To this end, it was necessary, first, to find evidence of vali- sification criteria are available for determining the item
dity of the survey to be used in exploring these issues. The content, nor universally established gold standard tests for
MULTICAGE-TIC has shown adequate internal consisten- determining cut-off scores. If we assume, even provisiona-
cy and evidence of validity. Only item 3 (“On a day that you lly, CAGE scores, the results would be as follows: 57.5% of
don’t have your mobile phone with you, do you feel uneasy or as survey participants obtained scores in problematic use of
if something very important is missing?”) of the Mobile Phone Mobile Phones (7.9% dependency), 45.1% in problematic
scale showed low communality with the other three. It is use of the Internet (8.6% dependency), 39% in problema-
possible that, in the case of Mobile Phones, unavailability tic use of Instant Messaging (10.7% dependency), 25.3%
fails to have a relationship with the remaining problems ex- in problematic use of Social Networks (6.1% dependency)
plored by the scale. This is probable because, in today’s so- and 10.9% in problematic use of Video Games (1.9% de-
ciety, doing without a mobile phone in everyday life entails pendency). Furthermore, though these percentages achie-
a notable loss, even when someone makes adequate use ve their peak in subjects under the age of 18, they remain

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 Eduardo J. Pedrero-Pérez, José María Ruiz-Sánchez de León, Gloria Rojo-Mota,
Marcos Llanero-Luque, Jara Pedrero-Aguilar, Sara Morales-Alonso, Carmen Puerta-García

Table 8. Differences by geographic location (controlling for age and level of studies).

Spain (n = 939) Colombia (n = 119) Venezuela (n = 84)

M SD M SD M SD
MULTICAGE-TIC F4 h2
Internet 1.38 1.23 1.41 1.26 2.00 1.40 42.84* 0.13
Mobile Phone 1.69 1.13 1.78 1.33 2.50 1.12 23.80* 0.08
Video Games 0.36 0.81 0.41 1.01 0.77 1.21 12.95* 0.04
Instant Messaging 1.30 1.32 1.45 1.49 2.21 1.34 40.76* 0.13
Social Networks 0.67 1.13 1.18 1.44 1.63 1.47 32.78* 0.10

ISP-20 17.61 10.47 17.20 12.01 19.42 10.51 17.35* 0.06

Executive problems 11.32 7.33 11.17 8.26 12.15 7.15 11.25* 0.04
Social Behaviour Problems 1.94 2.28 1.78 2.53 2.18 2.76 13.29* 0.04
Emotional Control Problems 4.35 3.15 4.25 3.12 5.08 3.44 31.11* 0.10

GHQ-12
Likert Scores 10.62 4.86 9.15 6.14 9.07 5.00 7.75* 0.03
Criterion-referenced score 1.61 2.66 1.66 2.66 1.63 2.07 10.78* 0.04

EEP-4
Perceived Stress 5.01 3.10 3.76 3.23 5.02 3.09 23.70* 0.08

Note. M= Mean; SD = Standard Deviation; * p < 0.001; η2= Partial eta-squared for estimating the effect size.

quite stable, though with a continued decline, through suc- overcomes some of the limitations of previous studies in
cessive age groups, and are higher in university students. relation to sample size and participant variability.
Even if the responses necessary for considering problema- Another of this study’s goals was to explore the rela-
tic use or dependency are limited to 3 or 4, problematic tionship between problematic use and psychopathological
use would still be the case in 27.7% of the subjects with variables. The results reveal a positive, linear relationship
Mobile Phones, 22.7% with the Internet and 24% with Ins- between problematic use of all devices or resources explo-
tant Messaging. red and symptoms of prefrontal dysfunction in everyday
Dispersed percentages also predominate in previous stu- life, risk of poor mental health and perceived stress. This
dies. According to the criteria and instruments applied, a relationship is consistent and highly significant, despite a
review found that prevalence of addiction to the Mobile low to moderate effect size. In other words: people with
Phone varied between 0 and 38% (Pedrero-Pérez, Rodrí- difficulties in managing their relationship with ICTs show
guez-Monje & Ruiz-Sánchez de León, 2012) and that ad- difficulties in managing their everyday activities, not only
diction to the Internet varied between 0.8% and 18.8% those related with ICTs. What others prefer to interpret
(Pontes, Kuss & Griffiths, 2015). Results are insufficient as as evidence of pathology remains a redundant argument.
regards the use of Social Networks and Instant Messaging. The task of managing ICTs involves personal characteris-
It may be argued that this study sample was comprised tics, like personality (Wilmer & Chein, 2016), and perso-
of subjects who were already users of these devices and nality traits are strongly supported by prefrontal lobe func-
applications, and was not extracted from the general po- tioning (Pedrero-Pérez, Ruiz-Sánchez de León & Llanero
pulation. In addition, most prior studies were completed Luque, 2015a; Pedrero-Pérez et al., 2013). The data also
using convenience samples, usually university students raises another question, though it remains unanswered, gi-
or adolescents, and applied a wide range of instruments ven the study’s methodology: does prefrontal dysfunction
and diagnostic criteria (Pedrero et al., 2012; Pontes et al., precede difficulties with ICTs and, therefore, represents
2015). Furthermore, according to studies of the National a vulnerability, or does it result of excessive immersion in
Statistics Institute, 74.4% of Spanish households are con- these types of devices or applications, negatively impacting
nected to the Internet, 76.2% of the population uses the everyday life?
Internet, 77.1% access the web via Mobile Phone, and Results suggest that males and females very frequently
51.1% use Social Networks. The most striking fact is that have problems with controlling their use of these devices
the percentage of Internet users rose almost five points in and resources, but with some differences: males obtain hi-
just one year, compared with 2013. Therefore, this study gher scores on the Internet and Video Game scales, whi-

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 Information and Communications Technologies (ICT): Problematic use of Internet, video games, mobile phones,
instant messaging and social networks using MULTICAGE-TIC

le females do so in the Mobile Phone, Instant Messaging population, or even merely 25%, considering it “psycho-
and Social Networks scales. The effect size for Internet and pathological” may seem hardly adequate, and much less
Instant Messaging is quite considerable and points to solid referring to “social pathology” of “epidemic” proportions,
differences which may be associated with different levels terms customarily used in mass media but that lack scien-
of use and problems with controlling use. Males declared tific relevance. It is probably necessary to accelerate the
more prefrontal symptoms in general, but females score paradigm shift suggested by some authors, abandoning
higher in problems related with Emotional Control. These the trend toward the psychiatrisation of any occurrence
differences are common in all studies; likewise, it is normal and refocusing research on environmental elements that
for females to score higher in symptoms of mental illness foster new behaviours (Pemberton & Wainwright, 2014),
and perceived stress (Davis, Matthews & Twamley, 1999). urgently demanded since years ago in the field of addic-
Gender differences in the completion of self-reports must tions specifically (Deacon & McKay, 2015; Hall, Carter &
always be kept in mind to refrain from generating erro- Forlini, 2015). As occurs in substance addiction, the first
neous interpretations. focus is expected to accumulate evidence of “comorbidity”
There are also differences in the participants’ place of and “dual diagnosis”, which contributes little or nothing to
origin. An analysis was performed of three samples with our understanding and problem-solving (Seo, Kim & Da-
a sufficient number of subjects, born in and residents of vid, 2015), while the second focus may serve to understand
three different countries. Though we have already alluded excessive behaviours from an evolutionary perspective, and
to individual differences in ICT management styles, it is contributes educational and therapeutic elements (Kwan
also necessary to point out that different sociocultural bac- & Leung, 2015).
kgrounds entail, without a doubt, another notable source This study’s main limitation refers to the method used
of variability. for obtaining the sample. Dissemination using social ne-
When we study the predictive capacity of the items of tworks does not allow for controlling the quality of partici-
the MULTICAGE scale scores, we find that four groups of pation, the participants’ motivation, nor, of course, for ge-
items have this capacity: those referring to problems with neralizing results. The only way to control, at least globally,
maintaining attention, those referring to emotional insta- the quality of the responses, is to obtain a sufficiently large
bility, those alluding to motivational problems, and those sample so that the percentage of inadequate responses will
reflecting lack of control as regards disinhibited social be- lose specific weight in the global results. For this purpose,
haviour. As is the case with the remaining results, a dual a minimum value of 20 participants/item was estimated,
explanation is possible: that these problems favour lack of doubling the strictest requirements in similar studies (Ve-
control, or that these result of excessive immersion in the- licer & Fava, 1998). Nevertheless, the Respondent-Driven
se resources. For example, it is worth questioning whether Sampling technique is recommendable when it is difficult
problems with concentrating favour the problematic use of to access the target population, or when large sample sizes
the Internet, or if this difficulty in concentrating in one’s are desired. Like all sampling methods, it entails risks that
everyday life results of excessive browsing of the Web. In must be considered (Bowling, 2005). Internal consistency
any case, the fact that just one item has the capacity for of tests, on both item and scale levels, is the main evidence
predicting 6.5% of a scale’s total variance is grounds for that the data has been adequately obtained, at least for the
developing new hypotheses and lines of research. most part.
All of these data require reflection. While the psychia- In summary, the data of this study report the high fre-
tric perspective tends to include substanceless addictions quency of problems associated with excessive use and
in diagnostic classifications (this has already been achie- immersion in the so-called Information and Communica-
ved for Gaming in the recent DSM-5), create new terms tions Technologies (ICTs), a fact that is generalised across
associated with the abuse of ICTs (nomophobia, phubbing, different countries, both genders, and all ages and cultural
vibranxiety, FoMO) and pathologise any excess, other trends levels. This excessive use is related to difficulties in con-
warn of the absurdity of this procedure, the effect of which trolling behaviours, emotions and socializing in everyday
is the overpathologication of everyday life (see Billieux et activities, as well as to risk symptoms for developing men-
al., 2015 and all of the following commentaries in the same tal health problems and for experimenting higher stress
Journal number). In fact, many authors advocate for stud- levels. Future studies should explore the directionality of
ying other issues, like the functionality of these technolo- these relationships to determine whether they are vulne-
gies in the lives of individuals and groups, the socioeco- rabilities for or consequences of abuse, or if both proba-
nomic and sociopolitical conditions that favour new uses bilities reinforce one another. Classifying these excessive
and new problems, the improvements these contribute behaviours as mental disorders will hardly favour unders-
to everyday life and the pressures that may lead to an ex- tanding them and most likely will extend the borders of
cessive use of these technologies or to feeling coerced to the psychiatric diagnosis to a disproportionate percentage
decrease their use. When a “problem” affects 50% of the of the population, which, no doubt, is an unacceptable ex-

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 Eduardo J. Pedrero-Pérez, José María Ruiz-Sánchez de León, Gloria Rojo-Mota,
Marcos Llanero-Luque, Jara Pedrero-Aguilar, Sara Morales-Alonso, Carmen Puerta-García

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Conflict of interests life more difficult on Mars or Venus? A meta-analytic re-
The authors declare the inexistence of conflicts of interest. view of sex differences in major and minor life events.
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 Information and Communications Technologies (ICT): Problematic use of Internet, video games, mobile phones,
instant messaging and social networks using MULTICAGE-TIC

Appendix 1. MULTICAGE-TIC

YES NO
1 Do you spend more time than you think you should
connected to the Internet for purposes other than work?
2 Have your family members complained about the number
of hours you dedicate to the Internet?
3 Is it difficult for you to remain away from the Internet for
several consecutive days?
4 Do you have problems in controlling your impulse to
connect to the Internet, or have you failed in trying to
reduce the time you dedicate to being connected?
5 Do you use the mobile phone more often or for longer
time periods than you should?
6 Have your family members or friends at any time
commented that you make too much use of the mobile
phone for chatting or sending messages?
7 On a day that you don’t have your mobile phone with
you, do you feel uneasy or as if something very important
is missing?
8 Have you tried to reduce your use of the mobile phone
without achieving this in a satisfactory way?
9 Do you dedicate more time than you think you should
to playing Video Games, using a console, computer or
mobile phone?
10 Does your family complain that you dedicate too much
time to playing Video Games, using a console, computer
or mobile phone?
11 Is it difficult for you to be several days without playing
Video Games using the console, computer or mobile
phone?
12 Have you failed in trying to reduce the time you dedicate
to playing Video Games, using a console, computer or
mobile phone?
13 Do you spend more time than you think you should
chatting with your contacts via WhatsApp (or similar
application) over the mobile phone?
14 Do your family members or friends complain that you
dedicate too much time to chatting via WhatsApp (or
similar application)?
15 Is it difficult for you to spend time without checking
if you have new messages in WhatsApp (or similar
application)?
16 Have you failed in trying to reduce the time you dedicate
to WhatsApp (or similar application)?
17 Do you dedicate more time than you think you should to
participating in social networks, like Facebook, Twitter,
Instagram or similar networks?
18 Do your family members or friends complain that you
dedicate too much time to checking and communicating
via Facebook (or Twitter, Instagram or similar networks)?
19 Is it difficult for you to spend time without checking
Facebook (or Twitter, Instagram or similar networks) to
check whether there is new information?
20 Have you failed in trying to reduce the time you dedicate
to Facebook (or Twitter, Instagram or similar networks)?

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