Matthias Wicki

Although suicidality is a major public health concern, the clinical relevance of behavioural addictions (BAs) with respect to suicide risk remains poorly understood. Guided by the ideation-to-action framework, we examined whether six BAs (gambling disorder, gaming disorder, problematic internet use, problematic pornography use, problematic smartphone use, work addiction) at age 25 were prospectively associated with a) the onset and recurrence of suicidal ideation and suicide attempts at age 28 and b) the likelihood of a suicide attempt versus ideation only. We also assessed whether these associations overlapped with co-occurring risk factors, including substance use disorders (SUDs), other mental health problems (MHPs) and psychological distress (PD). Using a population-based longitudinal design, a non-self-selected sample of 5,611 young Swiss men completed baseline (age 25) and follow-up (age 28) questionnaires. Measurements included BAs, SUDs, MHPs, PD, lifetime suicidality at baseline and 12-month suicidality at follow-up. Logistic regression models tested associations between BAs and suicidality. Overlaps with co-occurring SUDs, MHPs and PDs were quantified using the Karlson–Holm–Breen method. Results revealed that all BAs were significantly prospectively associated with the onset of suicidal ideation or a suicide attempt; only some BAs were associated with the recurrence of ideation (gaming disorder, work addiction, having ≥ 1 BA) or an attempt (gambling disorder). Baseline gambling disorder, problematic pornography use and having ≥ 1 BA were associated with reporting a suicide attempt rather than ideation-only among participants reporting suicidal ideation at follow-up. Adjusting for co-occurring factors attenuated BAs’ associations with onset and recurrence but not for suicide attempts versus ideation only. Overall, BAs showed consistent longitudinal associations with suicidality, with relationships frequently persisting after adjustment for co-occurring risk factors. These findings underscore the clinical relevance of BAs and the importance of systematic screening and prevention efforts within mental health and suicide risk assessment, alongside evidence-based interventions.

Background and Aims: The co-occurrence of behavioral addictions (BAs) and substance use disorders (SUDs) or other mental health problems (MHPs) is well documented. However, there is limited evidence on associations between changes in the severity of BAs, SUDs, and MHPs, or their directions of influence or causation. Methods: A non-self-selecting sample of 5,611 young Swiss men (mean age 25.5 at baseline and 28.3 at follow-up) completed a self-reporting questionnaire on various BAs (gambling, gaming, internet, internet pornography, smartphone, work), SUDs (alcohol, cannabis) and MHPs (major depressive disorder, ADHD, borderline personality disorder, social anxiety disorder). Latent change score models were used to evaluate pairwise, bidirectional associations in symptom severity among different BAs, and between BAs and SUDs or MHPs. Results: Overall, changes in each BA's symptom severity were significantly and positively correlated with changes in the symptom severity of other BAs, alcohol use disorder, and MHPs; for cannabis use disorder, such correlations were only found with gaming and work. Significant bidirectional cross-lagged associations were found between the severity of BAs and MHPs, and between the severity of internet and smartphone addiction and other BAs. For SUDs, cross-lagged pathways were often not significant (e.g., with gambling or pornography) or even negative (between cannabis use disorder and work). Discussion and Conclusions: This study provides strong evidence that BAs and MHPs mutually reinforce each other over time. While this interplay can develop and maintain dysfunction, it may also enable positive change, highlighting the need for a comprehensive theoretical framework and integrated intervention approaches.

Background: Individuals with a minority sexual orientation have consistently been found to face a greater risk of mental health problems and problematic substance use than heterosexual individuals. The present study examined whether differences in alcohol use or alcohol use disorder (AUD) symptoms across the spectrum of sexual orientations could be explained by drinking motives (i.e., enhancement, social, coping and conformity motives).Method: A non-self-selective sample of non-abstinent, young Swiss men (N = 5,139; mean age = 25.4, SD = 1.25) completed a self-reporting questionnaire on sexual orientation (on a five-point attraction scale: heterosexual, mostly-heterosexual, bisexual, mostly-homosexual, homosexual), drinking motives, alcohol use indicators (e.g., heavy episodic drinking, Alcohol Use Disorders Identification Test-Consumption [AUDIT-C]), and AUD symptoms. Structural equation modeling was used to test whether drinking motives mediated the associations between dummy-coded sexual orientation (with heterosexual men as the reference) and alcohol use indicators or AUD symptoms.Results: Mostly-heterosexual men exhibited higher scores on alcohol use indicators than heterosexual men, with almost full mediation through their drinking motives, specifically higher enhancement motives. They also reported more AUD symptoms, partially mediated through drinking motives, with comparable contributions from enhancement and coping motives. Homosexual men, however, displayed similar or lower scores for alcohol use indicators and AUD symptoms than heterosexual men, but these differences were not mediated by drinking motives. Indeed, homosexual men exhibited greater coping motives than heterosexual men. No significant results or discernible patterns emerged for bisexual or mostly-homosexual men.Discussion: These findings highlight the importance of considering the full spectrum of sexual orientations in healthcare and of broadening the focus on drinking motives beyond coping. Understanding the varied motives for alcohol use across the spectrum of sexual orientations facilitates tailored prevention strategies.

Students with special educational needs (SEN) often face rejection from peers. Research suggests that intervention programs can enhance students’ attitudes and social participation of peers with SEN. However, many teachers lack the resources or time to implement comprehensive programs. The extent to what easy-to-implement teaching units have positive effects is less clear. Based on the Theory of Planned Behavior, this study assessed the effect of a series of classroom lessons based on the teaching resource Prinzip Vielfalt on students’ attitudes, subjective norms, perceived behavioral control (PBC), and their intentions to include peers with SEN. In a cluster-controlled trial, 51 elementary school classes (3rd–6th grade) were assigned to either the experimental or waiting-control group based on the timing of teachers’ registration for a continuing education course. The experimental group consisted of 34 classes (652 students), where teachers implemented a standardized 12-lesson plan over a 6-week period, while the control group continued with their regular curriculum. Data were collected at three points: pre-test, post-test, and follow-up three months later. Student self-report measures were analyzed using mixed-effects and mediation models in R. Analyses indicated no significant long-term effects for PBC or inclusion intentions. However, attitudes and subjective norms toward peers with disabilities improved significantly. Further, mediation analyses revealed significant indirect effects of attitudes and subjective norms on inclusion intentions. Thus, while the intervention did not directly influence intentions, it had a positive effect on attitudes and subjective norms, which could enhance inclusive behavior over time. Thus, carefully constructed, accessible, and easy-to-implement teaching resources such as Prinzip Vielfalt demonstrate promising effects on inclusive peer behavior.

In Switzerland, support from a special education teacher (SET) is the most common measure to support learners with mild special educational needs (SEN). We explore variations regarding target group, resourcing, and implementation of support from special education teachers between and within cantons. On the one hand, the observed heterogeneity implies that not all learners with SEN can benefit from SET support to the same extent, which can lead to a reinforcement of existing educational inequalities. On the other hand, it affects the general and working conditions of the school teams. In research, disparities in terms of target group and concrete implementation of SET support should be considered and clearly documented to allow conclusions and comparisons across studies or regions.

Negative peer attitudes are a significant barrier to social participation of students with disabilities in inclusive classrooms. Although many intervention studies have demonstrated the effectiveness of interaction or disability awareness programmes in promoting positive peer attitudes, reliance on students’ self-reported attitudes is prone to social desirability bias and is unable to capture implicit prejudice. The present study examined changes in students’ explicit and implicit attitudes toward peers with disabilities after a curriculum-based intervention programme (“Prinzip Vielfalt”), which aims to promote an open-minded attitude toward human diversity. Teachers in 12 primary school classes in the experimental group (n = 195 students) used the programme for eight weeks, whereas a control group of 12 classes (n = 191 students) used no intervention. Students’ pre- and post-intervention attitudes were assessed using an adapted version of the Chedoke–McMaster Attitudes Towards Children with Handicaps Scale and a disability Implicit Association Test for children. Post-intervention analyses revealed a significant relative improvement in explicit attitudes toward peers with disabilities in the experimental group compared to the control group (b = 0.20, 95% CI = [0.03; 0.37]) but no change in implicit attitudes (b = -0.03, 95% CI = [-0.10; 0.03]). Thus, while the intervention positively affected self-reported attitudes, implicit negative associations were unchanged. Using explicit and implicit measures of attitudes and attitude changes among children can provide valuable insights into the mechanisms and effectiveness of different intervention strategies.

Zusammenfassung: Ausgehend von der sozialen Selektivität bei der äußeren Differenzierung und der zunehmenden Verlagerung der Selektionsprozesse in die Regelschulklassen hinein wird der Frage nachgegangen, inwiefern unterschiedliche integrative schulische Maßnahmen entlang der sozialen Herkunft vergeben werden. Dies ist insofern relevant, weil die Maßnahmen Lernzielreduktion, Nachteilsausgleich und integrative Förderung unterschiedliche Zielgruppen fokussieren und sich unterschiedlich auf inhaltliche und formale Bildungsergebnisse auswirken können. Die Studie basiert auf einer Stichprobe aus der Schweiz von insgesamt 1126 Schüler*innen der 5./6. Klassenstufe aus 66 Schulklassen aus dem Kanton Bern. Von den Schüler*innen hatten 71 eine Lernzielreduktion, 51 einen Nachteilsausgleich und 86 integrative Förderung. Die Analysen zeigten, dass Schüler*innen aus Familien mit höherem Sozialstatus häufiger von einem Nachteilsausgleich profitierten, und dies selbst unter Kontrolle von individuellen, kognitiven und schulischen Leistungsmerkmalen. Maßnahmen wie die Lernzielreduktion hingegen wurden häufiger an Schüler*innen aus Familien mit niedrigerem sozialem Status vergeben. Diese Selektivität birgt das Risiko, dass integrative Maßnahmen, die eigentlich dazu gedacht sind, Bildungsungleichheiten zu reduzieren, diese im Gegenteil noch verstärken können. Entsprechend sollten Schulleitungen, Lehr- und Fachpersonen Chancen und Risiken potenziell stigmatisierender Maßnahmen wie die der Lernzielreduktion sorgfältig abwägen und für mögliche soziale Herkunftseffekte bei der Vergabe „vorteilhafterer“ Maßnahmen wie dem Nachteilsausgleich sensibilisiert werden.

Single-measurement-point data collection to assess change has increased with studies assessing the impact of the Covid-19 pandemic and of its containment, despite evidence of its lack of validity. Retrospective change is not equivalent to change in repeated self-reported measures giving raise to questions about the validity of the former. This paper purports to investigate inconsistencies between change measures by confronting retrospective change to information from longitudinally self-reported measures from the C-SURF cohort study. The study sample consists of 2,279 young men who participated in C-SURF between 2020 and 2021, and completed between May and June 2021 a survey covering change in alcohol, cigarette, cannabis and other addictive behaviors related to the pandemic. The aforementioned behaviors were assessed longitudinally at two time points using self-reports, and retrospective change since the onset of the Covid-19 crisis was also assessed at the second measurement time. Information from both prospective and retrospective change measures were confronted to identify inconsistent information for each behavior. Additionally, multiple logistic regressions were performed to assess associations between socioeconomic status, impulsivity, depression, and different indicators of motivation to complete the study and inconsistency between both measures for each behavior of interest. Importantly, inconsistent information in at least one of the investigated behaviors was found in about 90% of the participants. Small associations were found between inconsistency and different factors with a consistent effect of impulsivity. In the absence of evidence of the validity of retrospective change measures, studies relying on retrospective change should be interpreted with caution.

Background: Video gaming is a popular activity among young people. Time spent with gaming was found to be only moderately associated with gaming disorder. However, patterns of binge gaming (playing more than 5 h consecutively) were rarely considered in research on gaming. This study explores how binge gaming frequency is related with gaming disorder and mental health.Methods: The sample came from the Cohort study on substance use risk factors (C-SURF) and comprised 5,358 young men aged 28.26 years (SD = 1.27). ANCOVA was conducted to estimate the association between binge gaming frequency (gaming at least 5 h consecutively) and gaming disorder (measured with the Game Addiction Scale) as well as indicators of mental health.Results: A total of 33.3% of the sample engaged in binge gaming at least once in the previous year, and 6.1% at least weekly. Frequency of binge gaming was associated with gaming disorder score in a linear dose-response relationship (linear trend = 2.30 [2.14, 2.46]) even if adjusted for time spent gaming (linear trend = 1.24 [1.03, 1.45). More frequent binge gaming was associated with lower life satisfaction and sleep quality, and with more major depression and social anxiety disorder symptoms.Conclusions: Binge gaming patterns, especially daily or almost daily binge gaming, are important to consider with regard to gaming disorder and mental health. Asking about binge gaming may be a promising screening question for gaming related problems. Encouraging regular breaks from gaming may be a valuable prevention strategy to reduce negative outcomes of gaming.