Clinical Neuropsychiatry (2023) 20, 1, 9-16

RESEARCH PAPER

INTERNET USE AMONGST PROFESSIONAL TENNIS PLAYERS

Donatella Marazziti, Elisabetta Parra, Alessandro Arone, Manuel Glauco Carbone, Luca Del Prete,
Sara Fantasia, Stefania Palermo, Liliana Dell’Osso

OPEN ACCESS
Abstract
Objective: Next to its well-known benefits, Internet may trigger harmful Citation: Marazziti, D., Parra, E.,
consequences due to its abuse, thus delineating clinical pictures that are similar Arone, A., Carbone, M. G., Del Prete,
to abuse disorders, such as Problematic Internet Use (PIU). The matter becomes L., Fantasia, S., Palermo, S., Dell’Osso,
more elusive for sportsmen, as data regarding PIU in this specific group are scarce, L. (2023). Internet Use amongst
Professional Tennis Players. Clinical
particularly for tennis players. Therefore, our aim was to assess the prevalence and Neuropsychiatry, 20(1), 9-16.
the features of PIU in a sample of either in current activity or retired professional
tennis players, as compared with healthy controls. doi.org/10.36131/
cnfioritieditore20230102
Method: Twenty-five professional tennis players were evaluated during two
events held in two different European countries and were matched to an equal © 2023 Giovanni Fioriti Editore s.r.l.
number of healthy subjects who were not performing any agonistic sport. The This is an open access article. Distribu-
tion and reproduction are permitted
characteristics of Internet use were assessed by a specific instrument we developed in any medium, provided the original
(QUNT). Statistical analyses were carried out to evaluate both demographic and author(s) and source are credited.
QUNT features and the possible intergroup differences.
Funding: None.
Results: Retired athletes presented statistically significant lower scores
compared to both athletes in current activity and control subjects in the “Time spent Competing interests: None.
online” and in the “Addiction to pornography” domains. Athletes in current activity Corresponding author
presented statistically significant higher scores compared to retired athletes in the Donatella Marazziti
“Ludopathy” and Total score domains. Male athletes had a statistically significant Department of Clinical and
lower score in the “Addiction to pornography” domain compared to both female Experimental Medicine,
and male healthy controls. University of Pisa,
Via Roma 57,
Conclusions: Tennis players frequently indulge in the use of Internet facilities, 56100, Pisa, Italy
particularly those in current activity, thus potentially being more vulnerable to Phone: +39 050 2219768
PIU. Men and women seem to use Internet for different activities. The lifestyle that E-mail: [email protected]
professional tennis players are obliged to follow might provide an explanation of
our findings.

Key words: internet, social media, problematic internet use, tennis, tennis players,
professional tennis players

Donatella Marazziti1,2, Elisabetta Parra2, Alessandro Arone2, Manuel Glauco Car-

bone3, Luca Del Prete2, Sara Fantasia2, Stefania Palermo2, Liliana Dell’Osso2
1
Saint Camillus International University of Health and Medical Sciences – Uni-
Camillus, Rome, Italy
2
Department of Clinical and Experimental Medicine, University of Pisa, Italy
3
Department of Medicine and Surgery, Division of Psychiatry, University of Insub-
ria, Varese, Italy

Introduction required to be a high-quality athlete, including eating

a healthy diet, getting adequate sleep, participating
Mental health and well-being are essential to being actively in practice, and maintaining hydration. The
able to perform one’s best within career, academics, social component reflects the connection to other
relationships, and sport. At the same time, sports athletes and a sometimes-narrow interaction with other
participation is important for physical and mental non-sports individuals, like fellow students (Benton
health. Many athletes develop a sense of identity Heird & Steunfeldt, 2013). Student athletes must exist
around their sports participation. This “athletic and thrive in the sport and academic worlds or face
identity” is reinforced from early childhood and is potential social isolation from other students with a
associated with a life centered around being an athlete more academic focus. A strong athletic identity is often
(Barcza-Renner et al., 2020). The athletic identity a source of support for athletes and can be very helpful
has two general components, cognitive and social. for athletic performance and self-esteem (Benton Heird
The cognitive component involves athlete behaviors & Steunfeldt, 2013). Successful athletes often develop a

Submitted November 2022, accepted February 2023 9

 Donatella Marazziti et al.

sense of self-efficacy related to their sport participation. many other common terms that more or less apply in
Not meeting an individual's personal definition of the current research context, such as Internet addiction,
success can result in self-doubt and limit feelings of pathological Internet use, compulsive Internet use,
self-efficacy, making the transition from sport is also excessive Internet use, or Internet gaming disorder
difficult, due to a sense of failure or lack of finishing. A (Schimmenti et al. 2014). In fact, on the theoretical level,
transition away from sport also is more difficult for those PIU is a more general and comprehensive concept than
with a low educational level, chronic pain or injury, no the others are. Thus, it could be more appropriate to use
defined employment after sport (Reardon et al., 2019), it in order to consider a wider range of problems related
or a faltering sport career before the transition (Barcza- to the abuse and misuse of the Internet (Schimmenti
Renner et al., 2020). A younger age at transition tends 2017).
to be more difficult for athletes who have not completed However, PIU and internet addiction still remain
their degree or have no work outside of sport (Park et an elusive concept, to the point that it is not actually
al., 2012). Any underlying mental health issues may recognized as a mental disorder with nosological
become more prominent or difficult to control during a dignity in the fifth edition of the Diagnostic and
time of transition. Statistical Manual of Mental Disorders (DSM-5;
However, a sports experience can also include a American Psychiatric Association, 2013). Given the
number of widespread stressors. Over the years, a controversial diagnostic criteria, the real prevalence of
growing body of studies progressively revealed both the internet addiction or PIU is hard to assess, as it seems to
benefits and the risks associated with physical activity, be related to the context, assessment tools, and cut-off
in particular when performed at a competitive level scores (Tokunaga, 2017). In any case, it is estimated to
(Carbone et al., 2017; Carbone et al., 2020; DeHaven range between 4.4 and 49.7% (Choi et al., 2009; Ko et
& Lintner, 1986; Malm et al., 2019). Increasing al., 2012; Pawłowska et al., 2015; Tsitsika et al., 2016;
focus has been directed towards the psycho(patho) Vigna-Taglianti et al., 2017; Wu et al., 2016), with a
logical features associated with high-level sport peak amongst students and individuals addicted to
disciplines. Athletes can develop a variety of mental psychostimulants (Baroni et al., 2019; Durkee et al.,
health conditions either related or unrelated to sport 2012; Spada, 2014).
participation, including anxiety and stress, obsessive- More recently, the use of the Internet amongst
compulsive disorder (OCD), post-traumatic stress professional athletes has become a topic of growing
disorder (PTSD), depression and suicide, disordered interest, as it is widely used, with both positive and
eating, sleep disturbance, and attentional deficit negative consequences (Encel et al., 2017). Athletes
hyperactivity disorder, that is not negligible and often generally use the Internet to communicate with relatives,
similar to that of the general population (Du Preez et friends and fans, but also to entertain and for shopping
al., 2017; Foskett & Longstaff, 2018; Gouttebarge et or business purposes (Pronschinske et al., 2012).
al., 2016; Gulliver et al., 2015; Lynch, 2021; Marazziti However, the current evidence on the matter is still
et al., 2021; Sundgot-Borgen & Torstveit, 2004). In limited for several sports and, in particular, for tennis, a
addition, much interest is related to the prevalence of sport that is as physically as mentally demanding and,
substance use disorders (SUD) amongst athletes, given as such, associated with high degrees of stress.
the significant presence of excessive use of alcohol, Therefore, the primary aim of this research was to
stimulants, cannabinoids and even of more dangerous evaluate the prevalence and characteristics of the use of
compounds, e.g., cocaine and opioids (Brisola-Santos the Internet and the eventual presence of PIU, through
et al., 2016; Exner et al., 2021; Murray et al., 2021). a questionnaire developed by us, the so-called QUNT,
Problematic behaviors, specifically gambling and acronym of the “Questionario per l’uso delle nuove
online gaming, have been also widely reported (Grall- tecnologie” (New Technologies Use Questionnaire)
Bronnec et al., 2016; Miller et al., 2001). Currently, (Baroni et al., 2019; Marazziti et al., 2021) in a sample
these last conditions have been included in the great of professional tennis players. The possible intergroup
realm of non-pharmacological addictions, a category differences in the use/abuse/misuse of the Internet were
of behaviors with features similar to those of SUD, also explored.
that has not been fully elucidated in both the general
population and high-profile athletes, with the exception
of the overtraining syndrome (Marazziti et al., 2014; Methods
Matos et al., 2011; Morgan et al., 1987). The excessive
use of Internet is one of the most challenging behavioral Twenty-five professional tennis players were
addictions given that Internet is diffuse everywhere recruited on two different occasions: during Fed
Cup Competition in Tallinn (Estonia) and during a
and can be ascribed to the fact that the potential of the
master meeting of coaches at “Centro di Preparazione
Internet seems limitless (“all world in one hand”). The Olimpica'' in Tirrenia (Pisa, Italy). The athletes were
benefits are immediately rewarding, and the positive matched with a similar group of healthy subjects
effects on almost all aspects of everyday life make it a who were not practicing any agonistic sport, among
formidable tool. However, the Internet revolution had university students, medical residents and nurses. The
and has a significant impact also in terms of mental psychopathological assessment was carried out with the
wellbeing, up to real cases in which its use may become New Technologies Use Questionnaire (QUNT) (Baroni
a real abuse. Not surprisingly the abuse of Internet is et al., 2019).
dramatically emerging as a latest epidemic, as, similarly
to SUD and other addictive behaviors, it may lead to
significant impairment in work, social and relational The New Technologies Use Questionnaire
activities (Beard & Wolf, 2001; Widyanto & Griffiths, (QUNT)
2006). The first recognition of this problem dates
back to 1996 when a Newyorker psychiatrist labeled The QUNT consists of two sections, one for
as "Internet addiction" the excessive use of Internet, demographic data and another including 101 items
accompanied by withdrawal symptoms and tolerance (Baroni et al., 2019; Marazziti et al., 2021). Forty-
(Young, 1996). It is worth noting here that the locution five, out of the total 101 items, consisted of five
“Problematic Internet Use” (PIU) was preferred over possible answers, according to a Likert five-point scale

10 Clinical Neuropsychiatry (2023) 20, 1

 Internet use amongst professional tennis players

with 1 indicating ‘completely false’ and 5 indicating intergroup differences, in order to determine which
‘completely true’; three items were multiple-choice groups are different from others, post-hoc testing can
questions; ten were focused on the use of “instant be conducted. Dunn’s Multiple Comparison Test with
messaging”, and 42 items on the use of “social adjustment using Bonferroni correction was used as
networks” (instant messaging: whatsapp, telegram, post-hoc test.
skype, and social networks: facebook, twitter and H expresses the test statistic for the Kruskal-Wallis
instagram). The item #101 was actually a question on test and adjusted p-value with Bonferroni correction
the liking/utility or not the questionnaire. The scores of was indicated with alpha (α).
each item are then summed to obtain the global QUNT Epsilon squared (ε2) was used to estimate the
score. The items considered of greater relevance were measure of the effect size (0.00 < 0.01 – Negligible,
put together in order to identify possible factors that 0.01 < 0.04 – Weak, 0.04 < 0.16 – Moderate, 0.16 <
are the following: “Time spent online” (item 2, 3, 4, 5, 0.36 - Relatively strong, 0.36 < 0.64 – Strong, 0.64 <
6, 7, 25, 33), “Social withdrawal” (item 8, 10, 18, 22, 1.00 - Very strong).
30, 35), “Abstraction from reality” (item 11, 13, 24), All statistical analyses were carried out using SPSS,
“Loss of control” (item 19, 20, 32, 36), “Addiction to version 27 (IBM Corp. Released 2020. IBM SPSS
pornography” (item 26, 27), “Ludopathy” (item 40 a-1, Statistics for Windows, Version 27.0. Armonk, NY:
41, 42, 43), “Addiction to social networks”. (49, 50, IBM Corp).
51, 52, 53, 54, 55, 56, 57). The “Addiction to social
networks” factor was further divided into the following Results
sub-factors: “Addiction to facebook” (item 60 a.d, 61-
75), “Addiction to twitter” (item 76-86), “Addiction A total of 25 athletes were included, of whom 18
to instagram” (item 86-97). The factor scores were were men (72.00%) and 7 (28.00%) were women. Their
calculated as the sum of the scores obtained in each mean age was 42.3 ± 13.4 years (44.8 ± 12.8 in men and
item divided by the maximum score in percentage. We 37.9 ± 13.9 in women). Thirteen (52.00%, 10 men and
established the answer 4 (between 4 and 6 hr/day) or 5 3 women) out of 25 athletes were in current activity and
(> 6 hr/day) of the item 2 “time spent online” the cut-off 12 (48.00%, 8 men and 4 women) had already retired
points to identify the presence of, respectively, possible from agonistic activity.
or certain/severe PIU, in agreement with current The control group consisted of 25 healthy subjects
literature, although controversies do exist (American (13 men and 12 women, 52.00% and 48.00%,
Psychiatric Association, 2013). respectively), with a mean age of 33.8 ± 11.9 years
(33.3 ± 9.3 in men vs 34.2 ± 14.5 in women).
For data analysis we decided to divide the sample
Statistical analyses into three groups: athletes in current activity, athletes
retired from agonistic activity, control subjects.
All demographic data were presented for continuous Results of Kruskal-Wallis test and the post-hoc
variables in terms of mean ± standard deviation (SD). Dunn's multiple comparisons test, showed significant
Categorical variables were expressed as frequencies differences in the mean age, specifically retired athletes
(number) and percentages. presented a statistically significantly higher value than
Due to the small sample size, it is not possible to that of both athletes in activity and control subjects (H
demonstrate whether the data are normally distributed, = 15.296, α = 0.007 and α > 0.001, respectively) (see
thus non-parametric tests will be used. figure 1).
Kruskal-Wallis test was used to determine eventual Stratifying each group by gender, it resulted that
differences of various variables between three or more retired male athletes had a statistically significantly
groups. Once Kruskal-Wallis has found significant higher age of both females in current activity and
Figure 1. Differences in mean age between groups

Clinical Neuropsychiatry (2023) 20, 1 11

 Donatella Marazziti et al.

Figure 2. Differences in mean age between groups, stratified by gender

female controls (H = 21.545 α = 0.005 and α = 0.031, “Ludopathy” (H = 8.023 and α = 0.015) and Total score
respectively) (see figure 2). domains (H = 7.439 and α = 0.022) (see table 1 and 2).
The QUNT results are depicted in table 1. Stratifying each group by gender, it resulted that retired
Retired athletes presented statistically significant male athletes had statistically significantly lower score
lower scores compared to both athletes in current in “Addiction to pornography” domain compared to
activity and control subjects in the “Time spent online” both female and male healthy controls (H = 14.051 α =
(H = 8.891, α = 0.028 and α = 0.019, respectively) 0.031 and α = 0.025, respectively) (see figure 3 and 4).
and in the “Addiction to pornography” domains (H =
11.366, α = 0.048 and α = 0.003, respectively). Athletes
in current activity presented a statistically significant Discussion
higher scores compared to retired athletes in the
To the best of our knowledge, this is the first study

Figure 3. Addiction to pornography domain scores in each group

Figure 4. QUNT total scores in each group

12 Clinical Neuropsychiatry (2023) 20, 1

 Internet use amongst professional tennis players

Table 1. Differences in QUNT factor scores (mean ± SD) between groups using Kruskal-Wallis test
Athletes in Retired athletes Controls (C) H p ε2
activity (CA) (RA)

Age 33.69 ± 9.94 51.67 ± 10.18 33.8 ± 11.9 15.296 > 0.001 0.278****

Years of using 3.92 ± 0.28 3.67 ± 0.89 3.92 ± 0.28 0.882 0.643 0.017**

Time spent online 2.00 ± 0.71 1.17 ± 0.72 1.96 ± 0.98 8.891 0.012 0.154***

Social withdrawal 34.54 ± 12.03 23.25 ± 9.62 23.08 ± 8.64 2.654 0.265 0.029**
Abstraction from 2.46 ± 2.43 1.33 ± 1.07 1.92 ± 2.68 1.390 0.499 0.015**
reality
Loss of control 1.85 ± 1.28 2.17 ± 1.34 2.00 ± 1.19 0.211 0.900 0.002*

Addiction to 4.15 ± 1.95 4.33 ± 1.37 2.60 ± 1.91 11.366 0.003 0.222****
pornography
Ludopathy 18.15 ± 8.53 10.08 ± 6.04 12.72 ± 5.07 8.023 0.018 0.106***
Addiction to 23.46 ± 14.01 11.00 ± 8.28 14.44 ± 6.18 5.737 0.057 0.077***
social networks
Total score 90.23 ± 39.45 56.00 ± 17.63 65.16 ± 17.56 7.439 0.024 0.097***

Legend. * Negligible; ** Weak; *** Moderate; **** Relatively strong.

Table 2. Differences between groups showing adjusted p-value with Bonferroni correction (α)

Features Kruskal-Wallis test Dunn’s multiple comparisons test

CA-RA CA-C RA-C
H p α α α
Age 15.30 > 0.001 0.007 n.s. 0.001
(RA > CA) (RA > C)
Time spent online 8.891 0.012 0.028 n.s. 0.019
(CA > RA) (C > RA)
Addiction to 11.366 0.003 0.048 n.s. 0.003
pornography (CA > RA) (C > RA)
Ludopathy 8.023 0.018 0.015 n.s. n.s.
(CA > RA)
Total score 7.439 0.024 0.022 n.s. n.s.
(CA > RA)

assessing the use of the Internet among tennis players, that of the retired ones, so that this factor cannot be
either in current activity or retired, by using the self- ignored, as young people tend to increasingly use the
assessment questionnaire called QUNT developed by Internet (Choi et al., 2009, Ko et al., 2005; Marazziti et
us to explore the use of the Internet amongst tennis al., 2020; Winds et al., 2022).
players, as compared with healthy controls (Baroni et The “age” factor also provides a rationale for the
al., 2019; Marazziti et al., 2021). greater use of texting, streaming and social media,
In our opinion, the present study led to some as these are activities that are mostly, even if not
noteworthy, albeit preliminary intriguing findings. exclusively, the prerogative of young people. This
Tennis players in activity and healthy controls element could also justify the higher scores totalized
presented higher scores compared to the retired ones in by healthy controls (having a lower average age than
the “Time spent online” and “Addiction to pornography” retired players) in the “Total Score” and “Addiction to
domains. pornography” domains compared to retired players.
Moreover, active tennis players showed higher Secondly, these data might, albeit partially, support
scores in the “QUNT total score” and “Ludopathy” the notion of the “stress related use” among high
domains compared to retired ones, but there were not performance athletes; this is not surprising while
statistically significant differences regarding healthy considering the high level of stress related to intensive
controls. training, the peculiar lifestyle characterized by reclusion
Different factors might explain such data. First of and long periods away from families, friends and lovers
all, the mean age of the active athletes is lower than of high-rank tennis players, all factors promoting the

Clinical Neuropsychiatry (2023) 20, 1 13

 Donatella Marazziti et al.

use of Internet and social media. the excessive use of Internet by the players.
Furthermore, social and economic reasons may The results of the present study are the first gathered
contribute to this discrepancy. Indeed, following the in high-level tennis players in current and past activities.
massive use and often abuse since their roll out, social Our data could indicate that high-level athletes
media (Facebook, Instagram, Twitter and TikTok) in current activities, given the intensive training
represent a good opportunity for the athletes to bond and the pressure to attain and/or maintain elevated
with fans, who may feel deeply engaged (Mullin et standards of results (it might require more relaxation
al., 2014). Indeed, the athletes may feel rewarded by through Internet to cope with the matches) as well as
sharing features of their professional and personal lives, economic and marketing interests related to social
and original posting and sociality are also frequently networks, represent a potential population vulnerable to
rewarding (Pronschinske et al., 2012). Moreover, problematic internet use.
social media represent a real means of business, due to More research is necessary to determine the direct
branding, merchandising, and content production, thus impact on athletic performance and whether athletes
overall building a worldwide network (Mullin et al., in certain sports are more prone to develop internet
2014). addiction. At the same time, Ludopathy or Gambling are
Finally, higher scores in the “Ludopathy” domain often a hidden addiction and the related consequences
among active players are not surprising. could be devastating for elite athletes and the integrity
Athletes may be particularly at risk of a gambling of the sport.
disorder as a result of their over-representation of
young men, their high degree of competitiveness, high
levels of sensation-seeking, impulsivity, increased Acknowledgement
risk-taking behaviors, and their perceived knowledge
and information concerning sports and the health of We thank the “Federazione Italiana Tennis” (FIT;
teammates. Reported prevalence rates of gambling Italian Federation of Tennis) for its availability to carry
disorders among elite athletes typically are higher out this study.
than their non-athletic peers (Derevensky et al., 2019).
Further, male athletes showed problematic video References
gaming, without association with hazardous alcohol
drinking or treatment for psychological distress American Psychiatric Association. (2013). Diagnostic and
(Håkansson et al., 2018). Although QUNT evaluates statistical manual of mental disorders (5th ed.). https://doi.
online gaming, it does not represent a diagnostic tool org/10.1176/appi.books.9780890425596
for Internet gaming disorder, according to DSM-5 Barcza-Renner K, Shipherd AM, Basevitch I. (2020). A
criteria. However, it is plausible that it might be a cue qualitative examination of sport retirement in former
or a predictor of this disorder (Chen et al., 2018). NCAA Division I athletes. Journal of Athlete Development
The paucity of the studies so far makes it hard to and Experience.; 2:1–13. https://doi.org/10.25035/
extrapolate conclusions on the matter, but we may jade.02.01.01
consider that the lifestyle required to play tennis at Baroni, S., Marazziti, D., Mucci, F., Diadema, E., & Dell’Osso,
such a high level should decrease the amount of time L. (2019). Problematic Internet use in drugs addicts
available for recreational activities that are limited to under treatment in public rehab centers. World Journal
those offered by Internet and social media. of Psychiatry, 9(3), 55–64. https://doi.org/10.5498/wjp.
The present study suffers from some limitations that v9.i3.55
include the small sample size. It should be, however, Beard, K. W., & Wolf, E. M. (2001). Modification in the
underlined that it was not easy to recruit the overall proposed diagnostic criteria for Internet Addiction.
sample of athletes, especially of those in current activity, CyberPsychology & Behavior, 4(3), 377–383. https://doi.
as they continuously complained of shortage of time, org/10.1089/109493101300210286
even when they had to complete a short questionnaire Benton Heird E, Steinfeldt JA. An interpersonal psychotherapy
like the QUNT requiring no more than 10 minutes. approach to counseling student athletes: clinical
Again, the sex composition was not balanced, and implications of athletic identity. Journal of College
this prevented us from performing reliable statistical Counseling. 2013; 16:143–57. https://doi.org/10.1002
analyses in the two sexes, especially within tennis /j.2161-1882.2013.00033.
players’ groups. For this reason, we cannot draw any Brisola-Santos, M. B., Gallinaro, J. G. D. M. E., Gil, F.,
definitive conclusions on the presence of PIU amongst Sampaio-Junior, B., Marin, M. C. D., de Andrade, A. G.,
athletes and eventual gender differences (Macur et al., Richter, K. P., Glick, I. D., Baltieri, D. A., & Castaldelli-
2016; Marazziti et al., 2020; Mei et al., 2016; Su et al., Maia, J. M. (2016). Prevalence and correlates of cannabis
2019). use among athletes-A systematic review. The American
Journal on Addictions, 25(7), 518–528. https://doi.
org/10.1111/ajad.12425
Conclusions Carbone, A., D’Andrea, A., Riegler, L., Scarafile, R., Pezzullo,
E., Martone, F., America, R., Liccardo, B., Galderisi,
The Internet has greatly revolutionized the global
M., Bossone, E., & Calabrò, R. (2017). Cardiac damage
population’s everyday life worldwide, as its potential
in athlete’s heart: When the “supernormal” heart fails!
seems limitless. However, its excessive use may lead to
World Journal of Cardiology, 9(6), 470-480. https://doi.
negative consequences that might cloud its unequivocal
org/10.4330/wjc.v9.i6.470
benefits, up to the point of becoming an addiction.
Carbone MG, Pagni G, Maiello M, Tagliarini C, Pratali
This phenomenon is present everywhere, but
L, Pacciardi B, Maremmani I. Misperceptions and
especially amongst young generations and students.
hallucinatory experiences in ultra-trailer, high-
However, even high-level athletes are not immune from
altitude runners. Rivista di Psichiatria. 2020 May-
excessive use of Internet. It is interesting to mention
Jun;55(3):183-190. doi: 10.1708/3382.33575.
the episode occurred during the last Olympic games
Chen, K. H., Oliffe, J. L., & Kelly, M. T. (2018). Internet
held in 2021, when the trainer of the Italian national
Gaming Disorder: An emergent health issue for men.
female volleyball team charged the loss of a match to
American Journal of Men’s Health, 12(4), 1151–1159.

14 Clinical Neuropsychiatry (2023) 20, 1

 Internet use amongst professional tennis players

https://doi.org/10.1177/1557988318766950 Lynch, J. H. (2021). Posttraumatic Stress Disorder in elite

Choi, K., Son, H., Park, M., Han, J., Kim, K., Lee, B., & athletes. Current Sports Medicine Reports, 20(12), 645–
Gwak, H. (2009). Internet overuse and excessive daytime 650. https://doi.org/10.1249/jsr.0000000000000918
sleepiness in adolescents. Psychiatry and Clinical Macur, M., Király, O., Maraz, A., Nagygyörgy, K., &
Neurosciences, 63(4), 455–462. https://doi.org/10.1111/ Demetrovics, Z. (2016). Prevalence of problematic internet
j.1440-1819.2009.01925.x use in Slovenia. Zdravstveno varstvo, 55(3), 202–211.
DeHaven, K. E., & Lintner, D. M. (1986). Athletic injuries: https://doi.org/10.1515/sjph-2016-0026
Comparison by age, sport, and gender. The American Malm, C., Jakobsson, J., & Isaksson, A. (2019). Physical
Journal of Sports Medicine, 14(3), 218–224. https://doi. activity and sports-real health benefits: A review with
org/10.1177/036354658601400307 insight into the public health of Sweden. Sports, 7(5), 127.
Derevensky JL, McDuff D, Reardon CL, Hainline B, Hitchcock https://doi.org/10.3390/sports7050127
ME, Richard J. Problem gambling and associated mental Marazziti, D., Presta, S., Baroni, S., Silvestri, S., & Dell’Osso,
health concerns in elite athletes: a narrative review. British L. (2014). Behavioral addictions: A novel challenge for
Journal of Sports Medicine. 2019 Jun;53(12):761-766. doi: psychopharmacology. CNS Spectrums, 19(6), 486–495.
10.1136/bjsports-2019-100668. https://doi.org/10.1017/s1092852913001041
Du Preez, E. J., Graham, K. S., Gan, T. Y., Moses, B., Ball, Marazziti, D., Baroni, S., Mucci, F., Piccinni, A., Ghilardi,
C., & Kuah, D. E. (2017). Depression, anxiety, and alcohol A., Fiorillo, A., Massimetti, G., Luciano, M., Sampogna,
use in elite rugby league players over a competitive season. G., Moroni, I., & Dell’Osso, L. (2020). Characteristics
Clinical Journal of Sport Medicine, 27(6), 530–535. https:// of Internet Use amongst Italian University Students.
doi.org/10.1097/jsm.0000000000000411 Psychiatria Danubina, 32(3–4), 411–419. https://doi.
Durkee, T., Kaess, M., Carli, V., Parzer, P., Wasserman, C., org/10.24869/psyd.2020.411
Floderus, B., Apter, A., Balazs, J., Barzilay, S., Bobes, Marazziti, D., Parra, E., Amadori, S., Arone, A., Palermo,
J., Brunner, R., Corcoran, P., Cosman, D., Cotter, P., S., Massa, L., Simoncini, M., Carbone, M. G., & Dell’
Despalins, R., Graber, N., Guillemin, F., Haring, C., Kahn, Osso, L. (2021). Obsessive-compulsive and depressive
J. P., . . . Wasserman, D. (2012). Prevalence of pathological symptoms in professional tennis players. Clinical
internet use among adolescents in Europe: Demographic Neuropsychiatry, 18(6), 304–311. https://doi.org/10.36131/
and social factors. Addiction, 107(12), 2210–2222. https:// cnfioritieditore20210604
doi.org/10.1111/j.1360-0443.2012.03946.x Matos, N. F., Winsley, R. J., & Williams, C. A. (2011).
Encel, K., Mesagno, C., & Brown, H. (2017). Facebook use Prevalence of nonfunctional overreaching/overtraining
and its relationship with sport anxiety. Journal of Sports in young English athletes. Medicine & Science in Sports
Sciences, 35(8), 756–761. https://doi.org/10.1080/0264041 Exercise, 43(7), 1287–1294. https://doi.org/10.1249/
4.2016.1186817 mss.0b013e318207f87b
Exner, J., Bitar, R., Berg, X., Pichler, E. M., Herdener, M., Mei, S., Yau, Y. H., Chai, J., Guo, J., & Potenza, M. N. (2016).
Seifritz, E., & Claussen, M. C. (2021). Use of psychotropic Problematic Internet use, well-being, self-esteem and
substances among elite athletes – A narrative review. Swiss self-control: Data from a high-school survey in China.
Medical Weekly. https://doi.org/10.4414/smw.2021.20412 Addictive Behaviors, 61, 74–79. https://doi.org/10.1016/j.
Foskett, R., & Longstaff, F. (2018). The mental health of addbeh.2016.05.009
elite athletes in the United Kingdom. Journal of Science Miller, T. W., Adams, J. M., Kraus, R. F., Clayton, R., Miller,
and Medicine in Sport, 21(8), 765–770. https://doi. J. M., Anderson, J., & Ogilvie, B. (2001). Gambling as an
org/10.1016/j.jsams.2017.11.016 addictive disorder among athletes. Sports Medicine, 31(3),
Gouttebarge, V., Jonkers, R., Moen, M., Verhagen, E., 145–152. https://doi.org/10.2165/00007256-200131030-
Wylleman, P., & Kerkhoffs, G. (2016). The prevalence and 00001
risk indicators of symptoms of common mental disorders Morgan, W. P., O’Connor, P. J., Sparling, P. B., & Pate, R B..
among current and former Dutch elite athletes. Journal of (1987). Psychological characterization of the elite female
Sports Sciences, 35(21), 2148–2156. https://doi.org/10.108 distance runner. International Journal of Sports Medicine,
0/02640414.2016.1258485 8(2), 124–131. https://doi.org/10.1055/s-2008-1025717
Grall-Bronnec, M., Caillon, J., Humeau, E., Perrot, B., Remaud, Mullin, B. J., Hardy, S., & Sutton, W. (2014) W. Sport
M., Guilleux, A., Rocher, B., Sauvaget, A., & Bouju, G. Marketing (4th ed.) Human Kinetics.
(2016). Gambling among European professional athletes. Murray, K., Murphy, C., Herlihy, A., McCaffrey, J., Codd, M.,
Prevalence and associated factors. Journal of Addictive & Murray, F. E. (2022). Harmful alcohol consumption in
Diseases, 35(4), 278–290. https://doi.org/10.1080/105508 elite sports players in Ireland. Irish Journal of Medical
87.2016.1177807 Science, 191(5), 2091–2098. https://doi.org/10.1007/
Gulliver, A., Griffiths, K. M., Mackinnon, A., Batterham, s11845-021-02819-5
P. J., & Stanimirovic, R. (2015). The mental health of Park S, Lavallee D, Tod D. (2012). Athletes' career transition
Australian elite athletes. Journal of Science and Medicine out of sport: a systematic review. International Review of
in Sport, 18(3), 255–261. https://doi.org/10.1016/j. Sport and Exercise Psychology. 6:22–53. https://doi.org/10
jsams.2014.04.006 .1080/1750984X.2012.687053
Håkansson, A., Kenttä, G., & Åkesdotter, C. (2018). Pawłowska, B., Zygo, M., Potembska, E., Kapka-Skrzypczak,
Problem gambling and gaming in elite athletes. Addictive L., Dreher, P., & Kędzierski, Z. (2015). Prevalence of Internet
Behaviors Reports, 8, 79–84. https://doi.org/10.1016/j. addiction and risk of developing addiction as exemplified
abrep.2018.08.003 by a group of Polish adolescents from urban and rural areas.
Ko, C. H,, Yen, J. Y., Chen, C. C., Chen, S. H., & Yen, C.F. (2005). Annals of Agricultural and Environmental Medicine, 22(1),
Gender differences and related factors affecting online 129–136. https://doi.org/10.5604/12321966.1141382
gaming addiction among Taiwanese adolescents. Journal Pronschinske, M., Groza, M. D., & Walker, M. (2012). Attracting
of Nervous &Amp; Mental Disease, 193(4), 273–277. Facebook “Fans”: The importance of authenticity and
https://doi.org/10.1097/01.nmd.0000158373.85150.57 engagement as a social networking strategy for professional
Ko, C. H., Yen, J. Y., Yen, C. F., Chen, C. S., & Chen, C. C. sport teams. Sport Marketing Quarterly, 21(4), 221-231.
(2012). The association between Internet addiction and https://www.questia.com/library/journal/1P3-2939177671/
psychiatric disorder: A review of the literature. European attracting-facebook-fans-the-importance-of-authenticity
Psychiatry, 27(1), 1–8. https://doi.org/10.1016/j. Reardon CL, Hainline B, AronCM, et al.Mental health
eurpsy.2010.04.011 in elite athletes: International Olympic Committee

Clinical Neuropsychiatry (2023) 20, 1 15

 Donatella Marazziti et al.

consensus statement (2019).British Journal of Sports F., Richardson, C., Chrousos, G. P., & Tsolia, M. (2016).
Medicine; 53:667–99. http://dx.doi.org/10.1136/ Association between problematic internet use, socio-de-
bjsports-2019-100715 mographic variables and obesity among European ado-
Schimmenti A, Caretti V, La Barbera D (2014). Internet Gaming lescents. The European Journal of Public Health, 26(4),
Disorder or Internet Addiction? A plea for conceptual 617–622. https://doi.org/10.1093/eurpub/ckw028
clarity. Clinical Neuropsychiatry 11, 5, 145-146. Vigna-Taglianti, F., Brambilla, R., Priotto, B., Angelino, R.,
Schimmenti, A. (2017). Problematic Internet use: Theory, Cuomo, G., & Diecidue, R. (2017). Problematic internet
research, and clinical perspectives [Editorial]. Clinical use among high school students: Prevalence, associated
Neuropsychiatry: Journal of Treatment Evaluation, 14(1), factors and gender differences. Psychiatry Research, 257,
3. 163–171. https://doi.org/10.1016/j.psychres.2017.07.039
Spada, M. M. (2014). An overview of problematic Internet use. Widyanto, L., & Griffiths, M. (2006). ‘Internet Addiction’:
Addictive Behaviors, 39(1), 3–6. https://doi.org/10.1016/j. A critical review. International Journal of Mental He-
addbeh.2013.09.007 alth and Addiction, 4(1), 31–51. https://doi.org/10.1007/
Su, W., Han, X., Jin, C., Yan, Y., & Potenza, M. N. (2019). s11469-006-9009-9
Are males more likely to be addicted to the internet than
Winds, K., Aebi, M., & Plattner, B. (2022). Problematic In-
females? A meta-analysis involving 34 global jurisdictions.
ternet Use among adolescent male and female psychiatric
Computers in Human Behavior, 99, 86–100. https://doi.
inpatients: A gender perspective. Child Psychiatry and
org/10.1016/j.chb.2019.04.021
Sundgot-Borgen, J., & Torstveit, M. K. (2004). Prevalence of Human Development. https://doi.org/10.1007/s10578-
Eating Disorders in elite athletes is higher than in the gene- 022-01408-6
ral population. Clinical Journal of Sport Medicine, 14(1), Wu, X. S., Zhang, Z. H., Zhao, F., Wang, W. J., Li, Y. F., Bi,
25–32. https://doi.org/10.1097/00042752-200401000- L., Qian, Z. Z,, Lu, S. S,, Feng, F., Hu, C. Y., Gong, F.
00005 F., & Sun, Y. H. (2016). Prevalence of Internet addiction
Tokunaga, R. S. (2017). A meta-analysis of the relationships and its association with social support and other related
between psychosocial problems and internet habits: Syn- factors among adolescents in China. Journal of Adolescen-
thesizing internet addiction, problematic internet use, and ce, 52(1), 103–111. https://doi.org/10.1016/j.adolescen-
deficient self-regulation research. Communication Mono- ce.2016.07.012
graphs, 84(4), 423–446. https://doi.org/10.1080/0363775 Young, K. S. (1996). Psychology of Computer Use: XL. Ad-
1.2017.1332419 dictive use of the Internet: A case that breaks the stere-
Tsitsika, A. K., Andrie, E. K., Psaltopoulou, T., Tzavara, C. K., otype. Psychological Reports, 79(3), 899–902. https://doi.
Sergentanis, T. N., Ntanasis-Stathopoulos, I., Bacopoulou, org/10.2466/pr0.1996.79.3.899

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