¹University of Hertfordshire, School of Life and Medical Sciences, Hatfield, United Kingdom

Background: There is global concern about problematic usage of the internet (PUI) (an umbrella term for diverse problematic forms of interaction with the internet and digital technology more broadly), PUI-related disorders, and their public health and societal costs. Increased awareness of the association between PUI and mental disorders in general, and the potential negative effects of social media use and other digital platforms empowered by artificial intelligence (AI) in particular, have led to calls for more action to protect individuals, particularly children and young people, from online harms.

Aims & Objectives: The Lancet Psychiatry Commission on Global Action on Problematic Usage of the Internet is a multidisciplinary and international group with knowledge and expertise in the study of compulsive, impulsive, and addictive behaviours, public health and policy, informed by an advisory group including people with lived experience of PUI. The Commission set an agenda for evidence-based action to reduce population-level PUI-related harms through public health and regulatory measures, and to guide development and provision of evidence-based health and social care for those affected by these harms.

Method: ​​​​​ A narrative synthesis of research evidence pertaining to individual, and societal (including commercial) risk factors for PUI. A critical examination of the use of public health preventative and therapeutic interventions and regulatory measures for harm mitigation and reduction.

Results: PUI is prevalent, increasing and causes considerable harm to individuals and society. The concept of PUI covers a wide range of problem behaviours. While accepting the limitations of existing data pertaining to PUI, PUI impacts upon 5 of the 17 United Nations Sustainable Development Goals considered essential for improving health and education, reducing inequality and spurring economic growth to end deprivation at a global level. Treatment of and assistance for those suffering from PUI and its consequences are available, developing and much needed. A range of interventional approaches exist, indicating the need to move beyond healthcare for specific disorders and to consider societal efforts across the globe to reduce the burden of PUI. These include the need for feasible prevention, mitigation and treatment approaches including safety by design standards as applied to digital technology, ethical regulatory approaches limiting unsafe access that adequately safeguard young people and other vulnerable groups and protect their digital human rights, consumer protection against harms from online products and development of age appropriate clinical services for those affected.

Discussion & Conclusions: The newness of PUI and the digital products and services underpinning it necessitate comprehensive and rigorous research and development activities to improve the effectiveness of preventative, harm-mitigation, and treatment programs. The evidence base is growing but sufficient to justify national and internationally coordinated action to mitigate the current and emerging harm from PUI today.