Abstract
Background: There is increasing global concern about the harms associated with problematic usage of the internet (PUI) affecting young people. Various risk factors have been proposed, but there is a scarcity of reliable evidence on the extent of the problem, who is most at risk of developing PUI and why, and how best to tackle it.
Objectives: BootStRaP (ISRCTN59576080) is a five-year multinational research programme designed to boost young people's health and resilience by determining, through prospective longitudinal assessment, the risk factors associated with PUI and its health economic impact and designing and testing preventative self-management interventions tailored to individual risk factors.
Methods: This paper describes the first phase of the project (i.e., Cohort 1). A sample of over 2500 schoolchildren aged 12–16 years was recruited across nine European countries. They were prospectively monitored over a 6-month period using a dedicated smartphone application (BootstrApp), through which their internet use habits, health and wellbeing were measured. Young people were involved in the co-design of aspects of the protocol including the recruitment plan and elements of the app design. The components of the assessment battery were chosen to investigate specific individual, clinical, cognitive and environmental risk determinants as defined a priori in an evidence-based logic-model. Participants were assessed using a combination of standardised demographic and clinical questionnaires, ambulatory assessment techniques, cognitive testing and passive digital monitoring. Multimodal data is analysed according to machine learning and structured equation modelling.
Expected outcomes: Our findings will contribute toward A) developing algorithms for predicting individuals at risk for PUI, B) identifying actionable variables for application to subjects as interventions for testing in the second phase of the project, C) validating risk hypotheses stated in the logic model of PUI including the interplay between predisposing risk factors (e.g., impulsivity, compulsivity), affective and cognitive processes (e.g., reward-related attentional biases), and executive functions (e.g., inhibitory control), D) calculating the health economic cost and impact of PUI in young people across Europe.
| Original language | English |
|---|---|
| Article number | 152653 |
| Pages (from-to) | 1-17 |
| Number of pages | 17 |
| Journal | Comprehensive Psychiatry |
| Volume | 145 |
| Early online date | 19 Dec 2025 |
| DOIs | |
| Publication status | Published - Feb 2026 |
Bibliographical note
Publisher Copyright:© 2025 The Authors
Funding
This work was funded by the European Union (BootStRaP project grant number: 101080238 ). Views and opinions expressed are however those of the authors only and do not necessarily reflect those of the European Union or the European Health and Digital Executive Agency (HaDEA). Neither the European Union nor the granting authority can be held responsible for them. This work was supported by UK Research and Innovation program (the University of Cambridge project number: 10077671 , the Euro Youth Mental Health project number: 10082693 , the University of Hertfordshire project number: 10075008 , the University of Southampton project number: 10075760 ). UK Research and Innovation accepts no liability, financial or otherwise, for expenditure or liability arising from the research funded by the Grant except as set out in these Terms and Conditions, or otherwise agreed in writing. This work has received funding from the Swiss State Secretariat for Education, Research and Innovation (SERI) . The authors gratefully acknowledge the data storage service SDS@hd supported by the Ministry of Science, Research, and the Arts Baden-Württemberg (MWK) and the German Research Foundation (DFG) through grants INST 35/1314-1 FUGG and INST 35/1503-1 FUGG. The BootStRaP study is managed and overseen by the University of Hertfordshire who provide the Quality Management System ensuring the trial is managed to the highest standards. The BootStRaP project's data management plan was created by the ULM University and is supported by a Data Sharing Agreement with all joint data controllers as signatories with local Data Processing Impact Assessments as required. The agreements conform to the GDPR Regulations (EU) 2016/679. All the study data, where possible, will be made freely available in an anonymised form at the end of the study and once the main study outcomes have been published, along with a range of supporting documents, code, and training materials.Célia Sales and Hernâni Oliveira are supported by the Portuguese Foundation for Science and Technology (FCT ref. UIDB/00050/2020).Diane Purper-Ouakil has received grants from the European Union and the French National Health Authorities. She has also received honoraria for lectures or participation in a speaker's bureau from Medice, as well as travel fees from HAC Pharma.Hans-Jürgen Rumpf has received grants from the German Federal Ministry of Health, the Innovations Fonds, the German Research Foundation, the European Union, Children and Screens: Institute for Digital Media and Child Development, and the World Health Organization. He has received remunerations for lecturing and for Motivational Interviewing training courses from addiction services, mental health treatment centers, health care and prevention institutions.Jose M Menchon has received research funds, conference grants, or honoraria from Carlos III Health Institute, Medtronic, Biohaven, Bioprojet, European Cooperation in Science and Technology, and Horizon Europe.Julius Burkauskas has been serving as a consultant at IQVIA, has received research funding grants from Research Council of Lithuania; speaking fees from the Council of Europe International Cooperation Group on Drugs and Addiction (Pompidou Group).Katajun Lindenberg has received royalties from Thieme, Kohlhammer and Springer. Her work was supported by the German Federal Ministry of Education and Research (BMBF), the State Ministry of Social Affairs in Baden-Württemberg, Germany, the Dietmar-Hopp-Stiftung and Hopp Foundation for Media Literacy, the Heidelberg University research priority program and Horizon Europe.Konstantinos Ioannidis receives an honorarium for journal editorial work at Elsevier. Konstantinos Ioannidis is supported by NIHR ARC Wessex. The views expressed are those of the authors and not necessarily those of the NIHR, NHS, or Department of Health and Social Care.Matthias Brand receives funding from the Deutsche Forschungsgemeinschaft (DFG, German Research Foundation), from the EU, and the German Federal Ministry of Education and Research. Matthias Brand has performed grant reviews for research-funding agencies, has edited journals and journal sections, has given academic lectures in clinical or scientific venues, and has generated book chapters for publishers of mental health texts.Murat Yücel receives funding from: government funding bodies such as the National Health and Medical Research Council (NHMRC) of Australia, Australian Research Council (ARC), Australian Defence Science and Technology (DST), the Department of Industry, Science and Resources (DISR), the Department of Industry, Innovation and Science (DIIS), the National Institutes of Health (NIH, USA), the European Research Council (ERC); philanthropic donations from the David Winston Turner Endowment Fund, Wilson Foundation; and sponsored Investigator-Initiated trials from Incannex Healthcare Ltd. These funding sources had no role in the data analysis, presentation, or interpretation and write-up of the data. Murat Yücel also sits on the Advisory Boards of: Centre of The Urban Mental Health, University of Amsterdam; and Enosis Therapeutics.Naomi A Fineberg has received research funding grants from Compass Pathways Plc, Orchard OCD, National Institute of Health and Care Research, United Kingdom Research and Innovation (Innovate), European Cooperation in Science and Technology; speaking fees from Mental Health Academy and has been a board member and/or received travel reimbursement from Orchard OCD, European College of Neuropsychopharmacology, British Association for Psychopharmacology and International College of Neuropsychopharmacology.Samuel R Chamberlain receives an honorarium for journal editorial work at Elsevier. Samuel R Chamberlain is supported by NIHR ARC Wessex.Susanne Walitza has received in the last 5 years royalties from Thieme, Hogrefe, Kohlhammer, Springer, Beltz. In 2023 and 2024 she received speakers honorary from Takeda and Medice. Her work was supported in the last years by the Swiss National Science Foundation (SNF), diff. EU FP7s, HSM Hochspezialisierte Medizin of the Kanton Zurich, Switzerland, Bfarm Germany, ZInEP, Hartmann Müller Stiftung, Olga Mayenfisch, Gertrud Thalmann, Vontobel, Uniscentia, Erika Schwarz, Heuberg Fonds, National Government of Health (BAG), Gesundheitsförderung Schweiz, University Zürich Research Priority Programme; Messerli Foundation and Horizon Europe; www.uzh.ch/prof/ssl-dir/interessenbindungen/client/web/.This work was funded by the European Union (BootStRaP project grant number: 101080238). Views and opinions expressed are however those of the authors only and do not necessarily reflect those of the European Union or the European Health and Digital Executive Agency (HaDEA). Neither the European Union nor the granting authority can be held responsible for them. This work was supported by UK Research and Innovation program (the University of Cambridge project number: 10077671, the Euro Youth Mental Health project number: 10082693, the University of Hertfordshire project number: 10075008, the University of Southampton project number: 10075760). UK Research and Innovation accepts no liability, financial or otherwise, for expenditure or liability arising from the research funded by the Grant except as set out in these Terms and Conditions, or otherwise agreed in writing. This work has received funding from the Swiss State Secretariat for Education, Research and Innovation (SERI). The authors gratefully acknowledge the data storage service SDS@hd supported by the Ministry of Science, Research, and the Arts Baden-Württemberg (MWK) and the German Research Foundation (DFG) through grants INST 35/1314-1 FUGG and INST 35/1503-1 FUGG. We acknowledge support by the Open Access Publication Fund of the University of Duisburg-Essen, Germany. We acknowledge support by the Open Access Publication Fund of the University of Duisburg-Essen, Germany. BootStRaP (Boosting Societal Adaptation and Mental Health in a Rapidly Digitalizing, Post-Pandemic Europe) is a five-year multinational citizen-science initiative, funded by the European Health and Digital Executive Agency (HaDEA) under its 2022 Horizon Europe Health programme (Grant Agreement ID 101080238; signed 21/04/2023). This work was supported by UK Research and Innovation program (the University of Cambridge project number: 10077671, the Euro Youth Mental Health project number: 10082693, the University of Hertfordshire project number: 10075008, the University of Southampton project number: 10075760). This work has received funding from the Swiss State Secretariat for Education, Research and Innovation (SERI). BootStRaP's ambition is to leverage multi-stakeholder agreement, and advance health and social policy and practice change to safeguard vulnerable adolescents as a public health research priority [ 3 , 4 ]. The consortium started its work in July 2023.
| Funders | Funder number |
|---|---|
| UK Research and Innovation program | |
| Australian Research Council | |
| French National Health Authorities | |
| Dietmar Hopp Stiftung | |
| Kanton Zürich | |
| Ministry of Science, Research, and the Arts Baden-Württemberg | |
| National Institute on Handicapped Research | |
| University of Duisburg-Essen | |
| University Zürich Research Priority Programme | |
| Universität Heidelberg | |
| Ministerium für Wissenschaft, Forschung und Kunst Baden-Württemberg | |
| Instituto de Salud Carlos III | |
| Erika Schwarz | |
| Lietuvos Mokslo Taryba | |
| Spine Education and Research Institute | |
| European Health and Digital Executive Agency | |
| Department of Industry, Science and Resources | |
| Staatssekretariat für Bildung, Forschung und Innovation | |
| Europe International Cooperation Group on Drugs and Addiction | |
| Department of Industry, Innovation and Science, Australian Government | |
| Heuberg Fonds | |
| Gesundheitsförderung Schweiz | |
| National Institute for Health and Care Research | |
| State Ministry of Social Affairs in Baden-Württemberg | |
| Innovations Fonds | |
| Bundesministerium für Forschung, Technologie und Raumfahrt | |
| National Institutes of Health | |
| Deutsche Forschungsgemeinschaft | |
| Department for Industry, Innovation and Science | |
| European Commission | |
| European Cooperation in Science and Technology | |
| MWK | |
| Messerli-Stiftung | |
| Hartmann Müller-Stiftung für Medizinische Forschung | |
| Universität Duisburg-Essen | |
| National Health and Medical Research Council | |
| German Research Foundation | |
| Horizon Europe.Julius | |
| Incannex Healthcare Ltd | |
| NIHR ARC Wessex | |
| EU | |
| Wilson Foundation | |
| Schweizerischer Nationalfonds zur Förderung der Wissenschaftlichen Forschung | |
| Australian Defence Science and Technology | |
| European Research Council | |
| Bundesministerium für Gesundheit | |
| National Government of Health | |
| Bundesamt für Gesundheit | |
| Defence Science and Technology Group | |
| Medtronic | |
| World Health Organization | |
| European Union, Children and Screens: Institute for Digital Media and Child Development | |
| University of Cambridge | 10077671 |
| European Union | 101080238 |
| Universität Ulm | 2016/679 |
| HORIZON EUROPE Framework Programme | 101080238, 21/04/2023 |
| Fundação para a Ciência e a Tecnologia | UIDB/00050/2020 |
| University of Southampton | 10075760 |
| Euro Youth Mental Health | 10082693 |
| DFG | INST 35/1314-1 FUGG, INST 35/1503-1 FUGG |
| University of Hertfordshire | 10075008 |
Keywords
- Addictive behaviours
- Affect regulation
- Behavioural addictions
- Children and adolescents
- Impulsive behaviour
- Inhibitory control
- Internet addiction
- Prevention
- Problematic use of the internet
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