Regular gaming behavior and internet gaming disorder in European adolescents: results from a cross-national representative survey of prevalence, predictors, and psychopathological correlates

The prevalence of internet gaming disorder among medical students at King Saud University, Riyadh, Saudi Arabia. A cross-sectional study

Objectives:

To estimate the prevalence of internet gaming disorder (IGD) among King Saud University (KSU), Riyadh, Saudi Arabia medical students and to determine the association of IGD with gender, age, academic achievement, amount of sleep, and accommodation.

Methods:

We conducted a cross-sectional study between October 2019 and April 2020 on KSU medical students with a sample size of 281 medical students currently studying at KSU chosen by a stratified proportionate random sampling. The questionnaire contained the IGD short scale and questions eliciting demographic data.

Results:

The sample comprised of 228 responses. The prevalence of IGD was 8.8% (n=20), while 19.3% (n=44) of the participants were risky gamers. There was a significant association (p=0.0040) between IGD and gender, with 10.1% (n = 15) of males having IGD compared to 6.3% (n=5) of females. Additionally, 25% (n = 37) of males were risky gamers, as compared to 8.8% (n=7) of females.

Conclusion:

There is a high prevalence of internet gaming disorder among KSU medical students, with higher frequency among males. However, there was no significant association between this disorder and age, sleep, academic achievement, or accommodation.

Non-Substance Addiction in Childhood and Adolescence

BACKGROUND

Around 5.8% of adolescents and 2.8% of young adults have an Internet-related disorder. These figures underline the widespread concerns in our society regarding the potential dangers and risks associated with Internet and digital media use.

METHODS

Selective literature search for records on Internet-related disorders in children and adolescents.

RESULTS

Internet-related disorders are now viewed as belonging to the behavioral addiction. Research has revealed similarities to substance-related disorders. There are often associations with other mental illnesses such as depression, anxiety, attention deficit/hyperactivity disorder, and personality disorders, as well as disturbed sleep patterns, increased risk taking, nicotine abuse, an unbalanced diet, and lack of exercise. Female adolescents are statistically significantly more often affected than male adolescents (7.1% versus 4.5%). The German STICA study, the first randomized controlled trial worldwide, demonstrated that cognitive behavioral therapy was effective compared with a waiting group (odds ratio 10.10, 95% confidence interval [3.69; 27.65]).

CONCLUSION

Internet-related disorders have not yet been conclusively conceptualized and operationalized. Further work is urgently required to refine the concepts of both the illness and and its treatment.

Incentive sensitization in binge behaviors: A mini review on electrophysiological evidence

Introduction

Binge behavior not only refers to the consumption of substances such as alcohol or food, but is also used in relation to gaming, watching and gambling. Dependent on context it makes for a widespread, benign recreational activity or can pose a serious mental health problem with deleterious consequences. Incentive sensitization theory describes the attribution of salience towards stimuli strongly associated with dopamine-mediated reward as a result of repeated consumption. The sensitized neural networks cause cue-triggered craving and excessive desire, but thus, this mechanism may also be applicable to stimulus-induced behaviors not associated with classical withdrawal symptoms. Event-related potentials (ERP) are a useful method of examining motivated attention towards incentive stimuli. This mini review aims to synthesize ERP findings from different types of binge behaviors in order to compare cue-reactivity to incentive stimuli.

Methods

Studies investigating binge drinking, binge eating as well as binge watching, gaming and gambling were screened. To limit the influence of concurrent task demands, ERP studies applying picture viewing paradigms with incentive stimuli were selected.

Results

Across binge behaviors, evidence on altered mid-latency ERPs has been mixed. However, studies investigating later stages of attentional processes more consistently find enlarged P300 and late positive potentials (LPP) amplitudes to relevant cues.

Conclusion

An altered attentional processing of incentive stimuli reflecting motivated attention is in line with incentive sensitization theory. Considering the limited number of studies, especially regarding binge behaviors not involving substances, more research is needed to attain a more thorough understanding of incentive sensitization across binge behaviors.

Differences in resting-state functional connectivity according to the level of impulsiveness in patients with internet gaming disorder

BACKGROUND AND AIMS

Impulsiveness is an important factor in the pathophysiology of Internet gaming disorder (IGD), and regional brain functions can be different depending on the level of impulsiveness. This study aimed to demonstrate that different brain mechanisms are involved depending on the level of impulsiveness among patients with IGD.

METHODS

Resting-state functional MRI data were obtained from 23 IGD patients with high impulsivity, 27 IGD patients with low impulsivity, and 22 healthy controls, and seed-based functional connectivity was compared among the three groups. The seed regions were the ventromedial prefrontal cortex (vmPFC), dorsolateral prefrontal cortex, nucleus accumbens (NAcc), and amygdala.

RESULTS

Connectivity of the vmPFC with the left temporo-parietal junction (TPJ) and NAcc-left insula connectivity were significantly decreased in the patients with high impulsivity, compared with the patients with low impulsivity and healthy controls. On the other hand, amygdala-based connectivity with the left inferior frontal gyrus showed decreases in both patient groups, compared with the healthy controls.

CONCLUSION

These findings may suggest a potential relationship between impulsivity and deficits in reward-related social cognition processes in patients with IGD. In particular, certain interventions targeted at vmPFC-TPJ connectivity, found to be impulsivity-specific brain connectivity, are likely to help with addiction recovery among impulsive patients with IGD.

The recognition of gaming disorder in China: a case series of 223 patients

Background

Internet gaming disorder (IGD) was listed in the appendix of the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5) as a condition requiring further study in 2013, and gaming disorder (GD) was considered a mental disorder and listed in the 11th International Classification of Diseases Manual (ICD-11) in 2018. The study aims to obtain preliminary knowledge of the recognition of GD in China.

Methods

A total of 223 Chinese patients who met both the ICD-11 and DSM-5 criteria for GD participated in the study, and a self-administered questionnaire was used to collect demographic information, gaming use characteristics, and previous diagnoses.

Results

The average age of patients with GD was 20.5 years, and 71.3% were male. Most patients were diagnosed with emotion-related disorders at their first psychiatric visit: mood disorders (59.2%), bipolar affective disorder (18.4%), depressive episode (12.6%), and anxiety disorder (4.9%). Among the adolescent patients with a first diagnosis of mood disorders, 71.2% and 33.3% were diagnosed with bipolar affective disorder and personality disorders, respectively, at subsequent visits. Overall, after the first visit, the most common diagnosis was bipolar affective disorder (61.0%), followed by personality disorders (34.1%), mood disorders (17.0%), depressive episode (17.0%), and other disorders. Only three patients had Internet overuse.

Conclusion

The identification rate of GD is extremely low in routine psychiatric clinical practice in China. Most patients with GD were previously misdiagnosed with emotion-related disorders. Psychiatrists should be trained to improve their ability to recognize and manage GD.

Can Worried Parents Predict Effects of Video Games on Their Children? A Case-Control Study of Cognitive Abilities, Addiction Indicators and Wellbeing

Many parents worry over their children’s gaming habits, but to what extent do such worries match any detrimental effects of excessive gaming? We attempted to answer this question by comparing children of highly concerned parents with other adolescents of the same age. A cohort of parents who identified as highly concerned over their children’s video game habits were recruited for a public study in collaboration with a national television network. Using an online experimental platform in conjunction with surveys of parents’ beliefs and attitudes, we compared their children to age-matched peers in an exploratory case-control study. The scores of children with highly concerned parents on tests of cognitive control (cued task-switching and Iowa Gambling Task) and psychological wellbeing (WHO-5) were statistically similar to controls, suggesting no selective cognitive or psychological detriments from gaming or otherwise in the cases with concerned parents. The case group, however, did spend more time gaming, and scored higher than controls on problem gaming indicators (Gaming Addiction Scale), which also correlated negatively with wellbeing. Within the case group, wellbeing effects seemed mainly to consist in issues of relaxation and sleep, and related to gaming addiction indicators of playing to forget real-world problems, and the feeling of neglecting non-gaming activities. Where most results of research staged for TV never get published, making it difficult to interpret both methods and results, this paper describes findings and participant recruitment in detail. The relationship between parental concern and children’s gaming is discussed, as is the merits and challenges of research conducted with media, such as TV programs and their recruited on-screen participants.

Problematic internet gaming in adolescents, and its relationship with emotional regulation and perceived social support

Technological developments and the increased use of the internet have created some risks for adolescents, including problematic internet gaming (PIG). The aim of this study is to investigate the role of age, gender, emotional dysregulation and perceived social support in PIG. The study was conducted with 1,291 adolescents. Participants completed the game addiction scale (GAS), difficulties in emotion regulation scale (DERS), and multidimensional scale of perceived social support (MSPSS) under the observation of their teachers. According to the results of the GAS, participants were divided into two groups: those with PIG and those without PIG. The effect of age, gender, DERS scores, and MSPSS scores on PIG was investigated using stepwise logistic regression analysis. The mean age of participants was 14.7 years and the frequency of PIG was 13.5% (n = 144). The frequency of PIG was significantly higher in males than in females. The results showed that male gender, high emotional dysregulation and low perceived social support were significantly associated with PIG. The present study indicate that PIG is highly observed in adolescents, especially in males, and as in other behavioral addictions, emotional dysregulation and perceived social support can play an important role in PIG.

How has Internet Addiction been Tracked Over the Last Decade? A Literature Review and 3C Paradigm for Future Research

Background:

The popularity of the internet aggravated by its excessive and uncontrolled use has resulted in psychological impairment or addiction. Internet addiction is hypothesized as an impulse-control disorder of internet use having detrimental impacts on daily life functions, family relationships, and emotional stability. The goal of this review is to provide an exhaustive overview of the empirical evidence on internet addiction and draw attention to future research themes.

Methods:

We performed a literature search on ScienceDirect and PubMed to review original research articles with empirical evidence published on peer-reviewed international journals from 2010 to 2019. Eight hundred and 26 articles were eligible for analysis. Frequency and descriptive statistics were calculated by Microsoft Excel.

Results:

A substantial contribution has been coming from researchers from China, Turkey, Korea, Germany, and Taiwan respectively. Despite controversies regarding its definition and diagnostic procedures, internet addiction has become the focal point of a myriad of studies that investigated this particular phenomenon from different exposures. Given observed literature review data regarding research design, data acquisition, and data analysis strategies, we proposed the 3C paradigm which emphasizes the necessity of research incorporating cross-disciplinary investigation conducted on cross-cultural settings with conscientious cross-validation considerations to gain a better comprehension of internet addiction.

Conclusions:

The findings of the present literature review will serve both academics and practitioners to develop new solutions for better characterize internet addiction.

Insomnia Status of Middle School Students in Indonesia and Its Association with Playing Games before Sleep: Gender Difference

The excessive use of online gaming before sleep in adolescents could be a risk factor of sleep disorders such as insomnia. This study aimed to assess the association between playing online games before sleep and insomnia based on gender perspective among middle school students in Indonesia. This was a retrospective study and the data came from a cross-sectional survey that included 315 of Grade 8 and 9 students from four middle schools in Jakarta, Indonesia. Self-reported data were collected via a structured questionnaire, which consisted of demographic variables, sleep duration per day, frequency of playing online games before sleep and the Insomnia Severity Index (ISI). Insomnia status was classified into "none or mild" and "moderate to severe" according to ISI score. The proportions of male and female students who often or always played online games before sleep were 50.3% and 21.7%, respectively. Grade 9 students were more likely to have moderate to severe insomnia than Grade 8 students for males (odds ratio-OR = 4.34, p = 0.005) but not for females (OR = 0.69, p = 0.363). However, female students who often or always played online games before sleep were more likely to have moderate to severe insomnia (OR = 4.60, p = 0.001); such an association was relatively smaller for male students (OR = 3.09, p = 0.061). Gender differences should be taken into account when developing health education or interventions.

Current Research and Viewpoints on Internet Addiction in Adolescents

PURPOSE OF REVIEW

This review describes recent research findings and contemporary viewpoints regarding internet addiction in adolescents including its nomenclature, prevalence, potential determinants, comorbid disorders, and treatment.

RECENT FINDINGS

Prevalence studies show findings that are disparate by location and vary widely by definitions being used. Impulsivity, aggression, and neuroticism potentially predispose youth to internet addiction. Cognitive behavioral therapy and medications that treat commonly co-occurring mental health problems including depression and ADHD hold considerable clinical promise for internet addiction.

SUMMARY

The inclusion of internet gaming disorder in the DSM-5 and the ICD-11 has prompted considerable work demonstrating the validity of these diagnostic approaches. However, there is also a movement for a conceptualization of the disorder that captures a broader range of media-use behaviors beyond only gaming. Efforts to resolve these approaches are necessary in order to standardize definitions and clinical approaches. Future work should focus on clinical investigations of treatments, especially in the USA, and longitudinal studies of the disorder's etiology.

Intrapersonal and interpersonal emotion regulation and identity: A preliminary study of avatar identification and gaming in adolescents and young adults

The aim of this study was to investigate the relationships between the process of identity formation, emotion regulation (intrapersonal and interpersonal), avatar identification, and gaming in adolescents and young adults. Data (from eight standardized questionnaires) were collected from 37 non-gamers (NGs), 133 non-problematic gamers (NPGs), and 37 problematic gamers (PGs). The results showed that PGs had higher scores in lack of emotional consciousness, lack of emotional clarity, and expressive suppression, while also having lower scores in cognitive reappraisal and interpersonal emotion regulation than NPGs or NGs. They also had higher scores in ruminative exploration and lower scores in exploration in depth. In addition, factors associated with Internet gaming disorder (IGD) differed by gender. In females, lack of emotional clarity, interpersonal emotion regulation, commitment, and in-depth exploration were associated with IGD. In males, however, negative emotions, lack of emotional consciousness, lack of emotional clarity, suppressive expression, and ruminative exploration were associated with the disorder. These results highlighted the need to consider gender specificities when caring for video game-players and using of therapies or psychotherapeutic techniques to improve their emotional processes and promote their identity-construction.

Differential Effects of Anxiety on Internet Gaming Disorder: A Large-Scale Cross-Sectional Survey

BACKGROUND

Internet gaming disorder (IGD) has become a serious public health problem in East Asia, and studies have reported IGD to be significantly associated with anxiety, but no causal relationship between the two has yet been demonstrated. Children are at high risk of developing IGD, however, previous studies have principally focused on the condition in adults and adolescents and reported non-clinical samples. A large-scale survey is needed to research and evaluate IGD and anxiety in children and adolescents to understand the current situation of IGD in children and explore the impact of IGD on anxiety.

METHODS

A cross-sectional study using an online questionnaire was conducted between March 1 and July 31, 2021. A total of 10,479 school children and adolescents in the western provinces of China were selected by convenience sampling. A questionnaire was used to collect data anonymously. The questionnaire covered IGD and the Revised Children's Manifest Anxiety Scale (RCMAS). Welch's ANOVA Test and Games-Howell test were used to test for differences in anxiety levels between IGD groups. Poisson regression analysis was used to further investigate the key predictors of IGD.

RESULTS

3.2% of participants (n = 334) (95% CI: 2.9-3.2%) were classified as at high risk of presenting with IGD, 71.1% (n = 7,454) (95% CI: 70.3-72.0%) were classified as low-risk players, and 25.7% (n = 2,691) (95% CI: 24.9-26.5%) were classified as non-gaming. The average RCMAS score was (7.18 ± 7.534). The high-risk group had a higher total score RCMAS, as well as scoring higher in its three dimensions. Regression analysis using gender, age, and total RCMAS score as independent variables, and risk of IGD as a dependent variable showed that the odds ratio (OR) for gender was 2.864 (95% CI: 2.267-3.618), and the OR for total RCMAS score was 1.101 (95% CI: 1.087-1.114). The OR for age was not statistically significant.

CONCLUSION

Anxiety was a predictor of IGD, with statistically significant group differences in total anxiety, as well as the dimensions of physiological anxiety, social correlation, and sensitivity. The timely assessment of anxiety in children and adolescents, training social skills, and facilitating effective integration into society could be effective ways of reducing the incidence and impact of IGD.

Effects of Electroacupuncture Combined With Psychological Intervention on Depressive Status and Contingent Negative Variation in Patients With Internet Addiction Disorder: A Randomized Controlled Trial

Background: Depressive symptoms often accompany people with Internet addiction syndrome (IAD). Acupuncture has been found to have significant advantages in improving the severity and depressive symptoms of IAD. Contingent negative variation (CNV) is a common method to explore the mechanism of neurophysiology. Objective: The purpose of this study was to observe the efficacy of electroacupuncture (EA), psychological intervention (PI), and comprehensive intervention (CI) in the treatment of depression in Internet addiction disorder (IAD), and to observe the changes of contingent negative variation (CNV) in each group. Methods: One hundred and twenty subjects diagnosed with IAD were randomly assigned to the EA group, the PI group, or the CI group. They received EA, PI, or a combination of EA and PI for 40 days. The Internet Addiction Test (IAT), the Zung Self-rating Depression Scale (SDS), and the Hamilton Depression Scale (HAMD) were evaluated for all subjects at baseline, 20th, and 40th days of treatment, while CNV data were collected at baseline and 40th days of treatment. Results: Three treatments effectively reduced IAT, SDS, and HAMD scores, and the intergroup comparison showed that CI was superior to EA, while EA was superior to PI. CNV results indicated that the CNV amplitude increased in all three groups of IAD patients after treatment. The CNV latency of point A and A-S2' wave area of the EA group and the CI group did not change significantly after treatment. Only the A-S2' wave area of the PI group increased significantly compared with the baseline period. In addition, IAD's IAT score was positively correlated with SDS and HAMD score at baseline but negatively correlated with CNV latency. After treatment, only the change of HAMD score in the CI group was negatively correlated with amplitude. Conclusion: Our results demonstrate the efficacy of acupuncture and psychological intervention in the treatment of IAD from an electrophysiological perspective. Simultaneously, the increase in CNV amplitude might be the underlying neurophysiological mechanism by which CI improves depression and cognitive function in IAD patients. Clinical Trial Registration: ClinicalTrials.gov, identifier NCT02362698.

Gaming and Social Media Addiction in University Students: Sex Differences, Suitability of Symptoms, and Association With Psychosocial Difficulties

Background: Previous research has shown that addictions to digital media can have negative impact on psychosocial health. Although Internet Gaming Disorder (IGD) has received most scholarly recognition, the potential negative consequences of Social Media Disorder (SMD) have also been found. However, few studies have assessed the symptoms of these two digital media addictions in the same way, making comparisons difficult. The present study aims to fill this gap by investigating differences and similarities regarding how common the symptoms are, sex differences, the suitability of the symptoms, and their association with psychosocial difficulties. Method: A total of 688 university students (63.2% women, Mean age = 25.98) completed a questionnaire measuring symptoms of IGD and SMD, as well as psychosocial difficulties (i.e., psychosomatic symptoms, low self-concept, and social problems). Results: Results showed that 1.2% of the men and 0.9% of the women met the symptom criteria for IGD (non-significant difference), whereas 3.2% men and 2.8% women met the symptom criteria for SMD (non-significant difference). Dimensional analyses indicated that men had higher IGD scores compared to women, whereas the opposite was found for SMD. Symptoms of heavy involvement in digital media (i.e., Preoccupation, Tolerance, Withdrawal, Unsuccessful attempts to control, and Escape) had high sensitivity, but low positive predictive value (PPV). However, symptoms associated with negative consequences of digital media use (i.e., Loss of interest, Continued excessive use, Deception, and Jeopardizing career/relationships) had low sensitivity, but high PPV. These symptom patterns were similar for IGD and SMD. Meeting the criteria for IGD or SMD as well as being at risk of these disorders were significantly associated with psychosocial difficulties. Symptoms of SMD generally had stronger associations with psychosomatic symptoms compared to symptoms of IGD. Conclusions: We conclude that heavy involvement in digital media seems common among individuals with IGD or SMD, but also among those not meeting the symptom criteria, whereas negative consequences are less common but highly predictive of digital media addictions once present. Further attention to SMD is warranted, as it seems more common than IGD and also seems to be equally or more strongly associated with psychosocial difficulties.

Structural and Functional Brain Abnormalities in Internet Gaming Disorder and Attention-Deficit/Hyperactivity Disorder: A Comparative Meta-Analysis

Background: Patients with Internet gaming disorder (IGD) and attention-deficit/hyperactivity disorder (ADHD) have high comorbidity but it is still unknown whether these disorders have shared and distinctive neuroimage alterations. Objective: The aim of this meta-analysis was to identify shared and disorder-specific structural, functional, and multimodal abnormalities between IGD and ADHD. Methods: A systematic literature search was conducted for whole-brain voxel-based morphometry (VBM) and functional magnetic resonance imaging (fMRI) studies comparing people with IGD or ADHD with healthy controls. Regional gray matter volume (GMV) and fMRI differences were compared over the patient groups and then a quantitative comparison was performed to find abnormalities (relative to controls) between IGD and ADHD using seed-based d mapping meta-analytic methods. Result: The meta-analysis contained 14 IGD VBM studies (contrasts covering 333 IGDs and 335 HCs), 26 ADHD VBM studies (1,051 patients with ADHD and 887 controls), 30 IGD fMRI studies (603 patients with IGD and 564 controls), and 29 ADHD fMRI studies (878 patients with ADHD and 803 controls). Structurally, VBM analysis showed disorder-specific GMV abnormality in the putamen among IGD subjects and orbitofrontal cortex in ADHD and shared GMV in the prefrontal cortex. Functionally, fMRI analysis discovered that IGD-differentiating increased activation in the precuneus and shared abnormal activation in anterior cingulate cortex, insular, and striatum. Conclusion: IGD and ADHD have shared and special structural and functional alterations. IGD has disorder-differentiating structural alterations in the putamen and ADHD has alterations in the orbitofrontal cortex. Disorder-differentiating fMRI activations were predominantly observed in the precuneus among IGD subjects and shared impairing function connection was in the rewards circuit (including ACC, OFC, and striatum).

The influence of depressive symptoms and fear of missing out on severity of problematic smartphone use and Internet gaming disorder among Chinese young adults: A three-wave mediation model

Internet gaming disorder (IGD) and problematic smartphone use (PSU) symptoms are associated with increased depression symptom severity across studies. The current study aimed to examine the fear of missing out (FoMO) as a possible mediator in this relationship. We employed a three-wave longitudinal design among 341 Chinese university students. Results indicated that depression severity was significantly related to increased symptoms of PSU and IGD symptoms. FoMO significantly mediated the linkage between depression and PSU severity. IGD symptoms also partially mediated the relation between FoMO and PSU severity. This longitudinal study demonstrates the key role of FoMO in the linkage between psychopathology symptoms and Internet-related overuse.

Problematic internet use/computer gaming among US college students: Prevalence and correlates with mental health symptoms

BACKGROUND

Despite widespread internet use and computer gaming, as well as concerns about online addiction, little is known regarding the relationship between problematic internet use/computer gaming and mental health (MH) symptomatology among US college students. To address this gap, the present study examines a large, nation-wide sample of US college students to assess the rate of problematic internet use/computer gaming and its association with MH symptoms.

METHODS

Using data from 43,003 undergraduates participating in the 2017 American College Health Association-National College Health Assessment, we examined rates of problematic internet use/computer gaming, defined as self-reported internet use/computer gaming that negatively affected academic performance. Logistic regression using a generalized estimating equations approach to adjust for clustering by school examined whether rates of MH symptomatology differed among students who reported problematic versus nonproblematic internet use and computer gaming.

RESULTS

Ten percent of students reported problematic internet use/computer gaming that had negatively impacted academic performance. Adjusting for a range of covariates, students reporting problematic internet use/computer gaming had higher rates of all 11 MH indicators examined, with odds ratios ranging from 1.42 ("ever attempted suicide") to 3.90 ("ever felt overwhelmed by all you had to do").

CONCLUSIONS

Problematic internet use/computer gaming is reported by 10% of undergraduate students and represents a significant correlate of MH symptomatology. These findings suggest that problematic internet use/computer gaming will be an important public health focus for college campuses.

Evaluating the quality of evidence for gaming disorder: A summary of systematic reviews of associations between gaming disorder and depression or anxiety

Gaming disorder has been described as an urgent public health problem and has garnered many systematic reviews of its associations with other health conditions. However, review methodology can contribute to bias in the conclusions, leading to research, policy, and patient care that are not truly evidence-based. This study followed a pre-registered protocol (PROSPERO 2018 CRD42018090651) with the objective of identifying reliable and methodologically-rigorous systematic reviews that examine the associations between gaming disorder and depression or anxiety in any population. We searched PubMed and PsycInfo for published systematic reviews and the gray literature for unpublished systematic reviews as of June 24, 2020. Reviews were classified as reliable according to several quality criteria, such as whether they conducted a risk of bias assessment of studies and whether they clearly described how outcomes from each study were selected. We assessed possible selective outcome reporting among the reviews. Seven reviews that included a total of 196 studies met inclusion criteria. The overall number of participants was not calculable because not all reviews reported these data. All reviews specified eligibility criteria for studies, but not for outcomes within studies. Only one review assessed risk of bias. Evidence of selective outcome reporting was found in all reviews-only one review incorporated any of the null findings from studies it included. Thus, none were classified as reliable according to prespecified quality criteria. Systematic reviews related to gaming disorder do not meet methodological standards. As clinical and policy decisions are heavily reliant on reliable, accurate, and unbiased evidence synthesis; researchers, clinicians, and policymakers should consider the implications of selective outcome reporting. Limitations of the current summary include using counts of associations and restricting to systematic reviews published in English. Systematic reviewers should follow established guidelines for review conduct and transparent reporting to ensure evidence about technology use disorders is reliable.

Identifying individuals in need of help for their uncontrolled gaming: A narrative review of concerns and comments regarding gaming disorder diagnostic criteria

OBJECTIVE

In 2013, the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5) included the diagnostic criteria of Internet gaming disorder (IGD). Then, in 2019, the 11th Revision of the International Classification of Diseases (ICD-11) categorized gaming disorder (GD) as an addictive disorder. This review aimed to review the raised concerns, debate, and research of IGD or GD criteria and provide suggestions to resolve them.

METHODS

A narrative review was conducted, and PubMed was searched for articles mentioning concerns and research on the DSM-5 criteria for IGD, ICD-11 criteria for GD, or criteria for other synonyms, such as problematic gaming or gaming addiction. A total of 107 articles were identified.

RESULTS

Concerns were organized into three categories: conceptual framework, moral panic, and diagnostic validity. Most argumentations supported the proposition that GD and other substance use disorders have similar presentations. A clear definition of GD and adequate public education could prevent rather than exacerbate moral panic. Several researchers reported concerns regarding the nosology, diagnostic validity, and wording of each criterion. However, the threshold, five of the nine criteria with impaired function, demonstrated adequate validity in interview studies.

CONCLUSION

The current findings support the addiction framework, functional impairment, and validity of the GD criteria. However, further prospective, experimental, and clinical studies validating these findings are warranted. Moreover, an integrative review or debate conference could contribute to the organization of the available results and concept development. Aggregating adequate scientific information could allay or resolve concerns related to the diagnosis of GD.

Psychometric properties and measurement invariance of the 7-item game addiction scale (GAS) among Chinese college students

BACKGROUND

The 7-item Gaming Addiction Scale (GAS) has been used as a screening tool for addictive game use worldwide, and this study aimed to examine its psychometric properties and measurement invariance among college students in China.

METHODS

Full-time students from multiple colleges in China were recruited. A total of 1040 completed questionnaires were used in the final analysis. Reliability of the GAS was assessed by internal consistency and split-half reliability. Validity of the GAS was assessed by structural validity, convergent validity, discriminant validity, and concurrent validity. A series of Multigroup Confirmatory Factor Analysis (MG-CFA) were conducted to test and establish measurement invariance across gender, class standing, family income and parental educational level.

RESULTS

Exploratory factor analysis revealed a unidimensional structure of the GAS. The GAS exhibited excellent internal consistency (Cronbach's α = 0.951, theta coefficient = 0.953, omega coefficient = 0.959) and structural validity (χ² /df = 0.877 (p < 0.05), CFI = 0.999, TIL = 0.996, RMSEA =0.000). Concurrent validity of the GAS was confirmed by its correlation with problematic internet use, sleep quality, nine dimensions of psychiatric symptoms, and substance use. The GAS also demonstrated measurement invariance across father's educational level (Δχ2 (df) = 19.128 (12), ΔCFI = - 0.009, ΔRMSEA = 0.010 for weak factorial model; Δχ2 (df) = 50.109 (42), ΔCFI = - 0.010, ΔRMSEA = 0.007 for strict factorial model.) and mother's educational level (Δχ2 (df) = 6.679 (12), ΔCFI = 0.007, ΔRMSEA = - 0.010 for weak factorial model; Δχ2 (df) =49.131 (42), ΔCFI = - 0.009, ΔRMSEA = - 0.004 for strict factorial model), as well as partial measurement invariance across gender (except for item 2), class standing (except for item 7) and family income (except for item 5).

CONCLUSIONS

The Chinese version of the 7-item GAS can be an adequate assessment tool to assess internet gaming disorder among the college student population in China.

The Spanish Version of the Internet Gaming Disorder Scale-Short Form (IGDS9-SF): Further Examination Using Item Response Theory

Internet gaming disorder (IGD) has been recognized by the American Psychiatric Association (APA) as a tentative disorder in the latest (fifth) revision of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5). However, psychometric evaluation of the nine IGD criteria remains necessary to further enhance its assessment. Therefore, the objective of this study was to evaluate the psychometric properties of the Spanish version of the Internet Gaming Disorder Scale-Short Form (IGDS9-SF). The internal structure, internal consistency, temporal stability, and relationships with other variables were assessed. Furthermore, a polytomous item response theory (IRT) approach was used to evaluate the performance of each item and the test as a whole. A sample of 388 online gamers (53.61% women, mean age 25.45 years, standard deviation (SD) = 9.62) was recruited for this study. Similar to previous research, the results supported a one-factor structure for the IGDS9-SF, adequate internal consistency and temporal stability of scores, goodness of fit of the items to the graded response model (GRM), and more precise scores at high trait levels to assess IGD in Spanish populations. These findings corroborate the suitability of the Spanish IGDS9-SF for clinical assessment and research within Spanish-speaking populations.

Need for systematic screening for IGD in adolescent psychiatric inpatients

Psychiatric comorbidities are frequent in adolescents with internet gaming disorder (IGD). In contrast, the proportion of IGD among adolescents hospitalized for a psychiatric disorder has not been documented yet. In addition, parental ratings of IGD could be useful for diagnosis, but very few data exist on this issue. The objectives of this study were to: (1) assess the prevalence of IGD among adolescent psychiatric inpatients, using the Ten-Item Internet Gaming Disorder Test (IGDT-10), and (2) assess the parental version developed for this study (IGDT-10-P). A total of 102 patients, aged from 12 to 17 years old, were included from four psychiatric units of the French region Auvergne-Rhône-Alpes, during a 6-month inclusion period. Adolescents completed the IGDT-10 while one of their parents completed the IGDT-10-P. The inclusion rate among the eligible population was 57.95%. The prevalence of IGD in the sample, based on the IGDT-10 and IGDT-10-P, was 6.00% and 12.79%, respectively. Psychometric features of the IGDT-10-P indicated excellent internal consistency, a good model fit to the one factor model in confirmatory factor analysis, a strong correlation with gaming time, and a moderate correlation with the IGDT-10. Our results support the need for a systematic screening of IGD among adolescents hospitalized for a psychiatric disorder. Future studies should aim to confirm and explain the prevalence gap between self- and parent-reported criteria.

The psychometric properties of the Revised Illness Perception Questionnaire (IPQ-R) regarding Internet gaming disorder in a general population of Chinese adults

BACKGROUND AND AIMS

Internet gaming disorder (IGD) has been recognized as a mental illness. Cognitive and emotional illness representations affect coping and health outcomes. Very little is known about such perceptions related to IGD, in both general and diseased populations. This study examined the psychometric properties of the Revised Illness Perception Questionnaire (IPQ-R) for IGD in a general population that included mostly non-cases while a small proportion of the sample was IGD cases.

METHODS

An anonymous cross-sectional telephone survey was conducted in a random sample of 1,501 Chinese community-dwelling adults (41.3% male; mean age = 40.42, SD = 16.85) in Macao, China.

RESULTS

The confirmatory factor analysis identified a modified 6-factor model (i.e., timeline cyclical, consequences, personal control, treatment control, illness coherence, and emotional representations) of 26 items that showed satisfactory model fit and internal consistency. Criterion-related validity was supported by the constructs' significant correlations with stigma (positive correlations: timeline cyclical, consequence, emotional representations; negative correlations: illness coherence). Ever-gamers, compared to never-gamers, reported higher mean scores in the subscales of personal control and illness coherence, and lower mean scores in time cyclical, consequence, and emotional representations. Among the sampled gamers, probable IGD cases were more likely than non-IGD cases to perceive IGD as cyclical and involved more negative emotions.

CONCLUSIONS

This study shows that the revised 26-item version of IPQ-R is a valid instrument for assessing illness representation regarding IGD in a general population of Chinese adults. It can be used in future research that examines factors of incidence and prevention related to IGD.

Development and validation study of Game Overuse Screening Questionnaire

The aim of this study was to develop a screening questionnaire to distinguish high-risk individuals associated with game overuse from casual internet users. Reliability, validity, and diagnostic ability were evaluated for the newly developed Game Overuse Screening Questionnaire (GOS-Q). Preliminary items were assessed by 50 addiction experts online and 30 questions were selected. A total of 158 subjects recruited from six community centers for internet addiction participated in this study. Finally, 150 people were used in the analysis after excluding eight non-respondents. GOS-Q, Young's internet addiction scale, and Korean scale for internet addiction were used to assess concurrent validity. Internal consistency and item-total correlations were favorable (α= 0.96, r= 0.47-0.82). Test-retest reliability was moderate in size (r= 0.74). GOS-Q showed superior concurrent validity, and the highest correlation with Y-Scale (r= 0.77). The construct validity was marginally supported by a six-factor model using exploratory factor analysis. The area under the Receiver Operating Characteristic curve was 0.945. The high-risk addiction group was effectively characterized by a cut-off point of 38.5, with a sensitivity of 0.87 and a specificity of 0.88. Overall, the current study supports the use of GOS-Q as a reliable screening tool in a variety of settings.

Diagnostic Usefulness of an Ultra-Brief Screener to Identify Risk of Online Gaming Disorder for Children and Adolescents

OBJECTIVE

This study examined the diagnostic validity of a three-item ultra-brief screening tool for online gaming disorder in line with the gaming disorder criteria in the International Classification of Diseases 11th Revision.

METHODS

The Three-item Gaming disorder Test-Online-Centered (TIGTOC) was composed of three items using a four-point Likert scale selected from the Internet Game Use-Elicited Symptom Screen (IGUESS). Among a cohort of 2319 young-adolescent Internet users, the baseline data of 228 healthy controls and 45 Internet-gaming-disorder cases were analyzed. Receiver operation characteristic (ROC) analysis was performed using mental health specialists' diagnoses as the gold standard.

RESULTS

The ROC curve analysis showed an area under the curve of 86%. Using a cut-off score of 4 from a full range of 0-9, the sensitivity, specificity, and Cronbach's α were 72%, 90%, and 0.811, respectively. TIGTOC scores was positively associated with time spent on online gaming, depressive symptoms, attention-deficit/hyperactivity disorder symptoms, and addictive Internet use.

CONCLUSION

The TIGTOC appears to be a brief, valid, and reliable screening tool for online gaming disorder within the community or in primary care settings.

Conduct problems and depressive symptoms in association with problem gambling and gaming: A systematic review

BACKGROUND AND AIMS

Behavioral addictions such as gambling and gaming disorder are significant public health issues that are of increasing importance to policy makers and health care providers. Problem gambling and gaming behaviors have been identified as being associated with externalizing and internalizing problems, with theoretical models suggesting that both conduct problems and depressive symptoms may be significant risk factors in the development of problem gambling and gaming. As such, the purpose of this systematic review is to provide an overview of research identifying the relationship between conduct problems, depressive symptoms and problem gambling and gaming among adolescents and young adults.

METHODS

Systematic literature searches in accordance with PRISMA guidelines found 71 eligible studies that met the inclusion criteria, 47 for problem gambling, 23 for problem gaming and one for both problem behaviors.

RESULTS

Based on cross-sectional evidence, both problem gambling and gaming are consistently concurrently associated with conduct problems and depressive symptoms. Longitudinal evidence appears to be clearer for conduct problems as a risk factor for problem gambling, and depressive symptoms as a risk factor for problem gaming. However, both risk factors appear to increase the risk for these problem behaviors.

DISCUSSION AND CONCLUSIONS

Results from the literature review suggest that problem gambling and gaming are associated with the presence of conduct problems and depressive symptoms, with the potential of sharing common etiological factors. Additional research is necessary to confirm these longitudinal relationships with an emphasis on investigating the interaction of both early conduct problems and depressive symptoms.

Social anxiety and Internet gaming disorder: The role of motives and metacognitions

BACKGROUND AND AIMS

In recent years, Internet Gaming Disorder (IGD) has been recognized as a mental health problem. Although research has found that social anxiety, motives, the preference for online social interactions (POSI), and metacognitions about online gaming are independent predictors of IGD, less is known about their relative contribution to IGD. The aim of the current study was to model the relationship between social anxiety, motives, POSI, metacognitions about online gaming, and IGD.

METHODS

Five hundred and forty three Italian gamers who play more than 7 h a week (mean age = 23.9 years; SD = 6.15 years; 82.5% males) were included in the study. The pattern of relationships specified by the theoretical model was examined through path analysis.

RESULTS

Results showed that social anxiety was directly associated with four motives (escape, coping, fantasy, and recreation), POSI, and positive and negative metacognitions about online gaming, and IGD. The Sobel test showed that negative metacognitions about online gaming played the strongest mediating role in the relationship between social anxiety and IGD followed by escape, POSI, and positive metacognitions. The model accounted for 54% of the variance for IGD.

DISCUSSION AND CONCLUSIONS

Overall, our findings show that, along with motives and POSI, metacognitions about online gaming may play an important role in the association between social anxiety and IGD. The clinical and preventive implications of these findings are discussed.

Social and Behavioral Health Factors Associated with Violent and Mature Gaming in Early Adolescence

We examined how risk level of video games, measured by maturity and violence level, was associated with behavioral health, social impacts, and online social interactions. School-based surveys in two different cohorts assessed self-reported gaming behaviors, health, and social media use. For Study 1, our 700 participants were 52% female and 48% White (mean age 12.7). Middle school students who played the high-risk games reported higher depressive symptoms and problematic internet behaviors, less sleep, more time spent playing games, and higher frequency of checking social media than non-gaming students. Those who played high-risk games were less likely to play alone and to play with strangers than those who played minimal-risk games. For Study 2, our 772 participants were 50% female and 57% White (mean age 12.6). Similar to Study 1, we found that those who played the high-risk games spent significantly more time playing games, were more interactive with other players, and had poorer sleep outcomes than non-high-risk gamers. Additionally, playing high-risk games had significantly different social impacts of gaming compared to less-risky gaming, including spending more money on games, spending less time on homework and with family or skipping meals due to gaming. Mature and violent content of video games and amount of online social interaction associated with gaming play a strong role in behavioral health and social impacts within families. These results can inform guidelines to intervene when problematic behaviors emerge.

Assessment of attitude of parents towards adolescents with Internet gaming disorder

BACKGROUND

The determination of the protective and risk factors associated with Internet gaming disorder (IGD) is among the most important pathways to the development of prevention strategies for IGD. Previous research has shown that familial factors are associated with IGD. In our study, we aimed to assess the parental attitude of adolescents with IGD and investigate psychiatric comorbidity.

METHODS

We assessed family structure, family relationship, parental attitude (in a bi-directional assessment), and psychiatric comorbidity in 50 adolescents aged 12-18 years who meet DSM-5 criteria for IGD in comparison with the control group. Parental attitudes were assessed with the Parental Attitude Research Instrument (filled by the mother) and the Parenting Style Inventory (filled by adolescents).

RESULTS

Our findings suggest that according to mothers' opinions there were no significant differences in the subscale scores between the IGD group and the control group. On the other hand, acceptance-involvement and psychological autonomy subscale scores of the PSI filled by adolescents were found to be significantly lower in the IGD group. Limit setting in areas other than the Internet was significantly lower in the IGD group. High rates of psychiatric comorbidity were also found in adolescents with IGD.

CONCLUSIONS

Our study identified that adolescents with IGD perceived their parents "cared less about them" and "minded less on their autonomy" compared with the control group. Our survey demonstrated that parental attitudes may be among the risk factors for IGD and the presence of psychiatric comorbidity may affect the management of IGD.

Adverse childhood experiences, dissociation, and anxious attachment style as risk factors of gaming disorder

INTRODUCTION

The aim of this study was to explore the relationship between adverse childhood experiences (ACEs), attachment styles, dissociation, and symptoms of gaming disorder (GD). Methods: The total sample of the survey was 1288 gamers who completed a set of questionnaires via the Internet; they included questions on ACEs, attachment styles (anxious and avoidance styles in intimate relationships), symptoms of dissociation, and GD. Structural equation modeling (SEM) was performed to examine the detailed relationships between variables.

RESULTS

In the hypothesized model, ACEs, dissociation, and the scales of avoidance and anxiety were considered predictors of gaming disorder. Only the avoidance subscale proved to be statistically insignificant; the model without this variable fit the data and had good psychometric properties.

CONCLUSIONS

To conclude, this study showed a link between adverse childhood experiences, dissociation, and anxiety experienced in relationships as significant risk factors for symptoms of gaming disorder.

Inattention and Disordered Gaming: Does Culture Matter?

Problematic gaming has emerged as a contemporary concern, leading to the introduction of the diagnostic term 'Internet Gaming Disorder' (IGD; American Psychiatric Association). The present study aims to empirically assess the association between inattention and IGD, in the light of variable levels of vertical-individualism that reflects cultural inclinations towards independence, competitiveness, and hierarchy. The participants (N = 1032) comprised a normative cohort of Massively Multiplayer Online (MMO) gamers (Mage = 24 years; 48.7% male). IGD was measured with the nine-item short-form IGD Scale (IGD9-SF), inattention with the Attention Deficit Hyperactivity Disorder (ADHD) Self-Report Scale, and vertical individualism with the Individualism-Collectivism Questionnaire. Complex hierarchical and moderated regressions were employed. Findings demonstrated an association between IGD and inattention, and additionally showed that this association was exacerbated by a more vertically-individualistic cultural orientation without significant gender differences. The need of differentially addressing IGD risk among inattentive gamers of diverse cultural orientation is highlighted.

“Who Am I” and “How Should I Be”: a Systematic Review on Self-Concept and Avatar Identification in Gaming Disorder

Purpose of Review

Gaming disorder (GD) appears to be associated with self-concept deficits and increased identification with one’s avatar. The goal of this literature review is to highlight study findings assessing psychological and neurobiological correlates of self-concept-related characteristics and avatar identification in GD.

Recent Findings

The review was based on three literature researches on GD: (1) self-esteem, (2) emotional, social, and academic self-concept domains and avatar identification, and (3) neurobiological correlates of self-concept and avatar identification. The results indicate that GD is associated with decreased self-esteem as well as deficits in physical, social, and emotional self-concept domains. A relatively stable relationship between higher avatar identification and GD was reported in addicted gamers. Furthermore, addicted gamers showed increased activation of brain regions associated with Theory-of-Mind processing while contemplating their own avatar.

Summary

The results point towards impairments in self-concept and increased identification with the virtual gaming character in addicted gamers. This virtual compensation fosters the formation of an idealized self-concept, which grows increasingly distant from their own self-image. Thus, additional empirically based psychological interventions should focus on the development of a realistic self-image by reducing the dysfunctional discrepancy between the ideal self and the real self.

Analysis of the applicability and utility of a gamified didactics with exergames at primary schools: Qualitative findings from a natural experiment

One of the main objectives of Physical Education in elementary schools is to encourage motivation so that the subject enhances academic performance and the practice of physical exercise. Didactic research should evaluate the effectiveness of educational methods to know if they are applicable, useful, and in what sense. Exergames are digital motor games that aim to stimulate players' motor skills. Gamification refers to the use of game-based elements in nongame contexts to motivate actions. This research evaluates a gamified exergaming intervention, designed to improve children's academic performance by focusing on understanding applicability and usefulness. A natural experiment was set up in schools according to a mixed methods design. The qualitative data herein reported were collected during a natural experiment with a nonrandomized controlled design. The qualitative research design was used with field notes, an open-questions questionnaire, individual semi-structured interviews and focus group interviews. Eight teachers and 417 students took part. A content analysis was chosen as the methodological orientation. The facilitators were the realism of their didactic design and their adaptability to different educational contexts. The main barriers were the required materials and facilities. Teachers and students' attitudes were very positive, although future use was inconclusive. These findings may imply that this study is one of the few to provide positive evidence for educational gamification. The "Mechanics-Dynamics-Aesthetics" gamification model and the "Just Dance Now" exergame may be applicable and useful for didactics in Physical Education, but all the participants' suggestions need to be considered to improve teaching interventions.

Prevalence of Internet Addiction and Gaming Disorders in Southeast Asia: A Meta-Analysis

This meta-analytic review aimed to examine the pooled prevalence rates of Internet addiction and gaming disorders in Southeast Asia. Several databases including PubMed, MEDLINE, PsycINFO, Web of Science, Embase, and Cochrane Central were searched and a total of 24 studies were included in this study. The selection of studies was conducted in accordance to the preferred reporting items for systematic reviews and meta-analyses (PRISMA) guidelines. Two meta-analyses were conducted to examine data on Internet addiction and gaming disorders separately. A random-effects model was employed to derive the pooled prevalence rate. Mixed-effects meta-regression and subgroup analyses were performed to examine the moderators of the between-study heterogeneity. Publication bias was tested using the Egger's regression test and funnel plot. Only seven out of the 11 Southeast Asian countries were represented in the literature. All except for two of the included studies were cross-sectional in nature. The findings revealed a pooled prevalence rate of 20.0% (95% confidence interval: 14.5%-27.0%) and 10.1% (95% confidence interval: 7.3%-13.8%) for Internet addiction and gaming disorders respectively. Mean age and study population were significant moderators of the between-study heterogeneity in the prevalence rates of gaming disorders such that samples involving older participants showed higher prevalence rate than those involving younger individuals. Country of study was found to be significant moderator of the between-heterogeneity for both Internet addiction and gaming disorders, however the findings should be interpreted with caution due to the small and unbalanced sample sizes. There was no significant publication bias. Such epidemiology research should be extended to the Southeast Asian countries that have not been studied or are under-studied. Given that the prevalence rates appear to be higher in Southeast Asia than in other world regions, future research should also explore the factors behind these inter-regional differences. Further longitudinal studies should also be conducted to examine the trajectories of such disorders.

The relationship between childhood trauma and Internet gaming disorder among college students: A structural equation model

BACKGROUND

The aim of this study was to investigate the mechanisms of Internet gaming disorder (IGD) and the associated interaction effects of childhood trauma, depression and anxiety in college students.

METHODS

Participants were enrolled full-time as freshmen at a University in the Hunan province, China. All participants reported their socio-demographic characteristics and undertook a standardized assessment on childhood trauma, anxiety, depression and IGD. The effect of childhood trauma on university students' internet gaming behaviour mediated by anxiety and depression was analysed using structural equation modelling (SEM) using R 3.6.1.

RESULTS

In total, 922 freshmen participated in the study, with an approximately even male-to-female ratio. A mediation model with anxiety and depression as the mediators between childhood trauma and internet gaming behaviour allowing anxiety and depression to be correlated was tested using SEM. The SEM analysis revealed that a standardised total effect of childhood trauma on Internet gaming was 0.18, (Z = 5.60, 95% CI [0.02, 0.05], P < 0.001), with the direct effects of childhood trauma on Internet gaming being 0.11 (Z = 3.41, 95% CI [0.01, 0.03], P = 0.001), and the indirect effects being 0.02 (Z = 2.32, 95% CI [0.00, 0.01], P = 0.020) in the pathway of childhood trauma-depression-internet gaming; and 0.05 (Z = 3.67, 95% CI [0.00, 0.02], P < 0.001) in the pathway of childhood trauma-anxiety-Internet gaming. In addition, the two mediators anxiety and depression were significantly correlated (r = 0.50, Z = 13.54, 95% CI [3.50, 5.05], P < 0.001).

CONCLUSIONS

The study revealed that childhood trauma had a significant impact on adolescents' Internet gaming behaviours among college students. Anxiety and depression both significantly mediated the relationship between childhood trauma and internet gaming and augmented its negative influence. Discussion of the need to understand the subtypes of childhood traumatic experience in relationship to addictive behaviours is included.

Gaming patterns and related symptoms in adolescents using cluster analysis: Baseline results from the Internet User Cohort for Unbiased Recognition of Gaming Disorder in Early Adolescence (iCURE) study

PURPOSE

The risk and protective factors of Internet gaming disorder (IGD) could vary by individual. The identification of more homogeneous subgroups may lead to better understanding of gaming behaviors and their consequences in adolescents. The purpose of this study was to investigate the prevalence of IGD among the subgroups defined by cluster analysis in adolescents.

METHODS

A total of 2319 adolescents were enrolled in the Internet User Cohort for Unbiased Recognition of Gaming Disorder in Early Adolescence (iCURE) study at baseline. Self-reported IGD was assessed with a DMS-5 adapted measurement. Smartphone addiction, musculoskeletal discomfort, and dry eye symptoms were evaluated by self-administered questionnaires. Cluster analysis was performed using risk and protective factors of IGD after considering multicollinearity.

RESULTS

Three different clusters were identified. Cluster 1 (19.2%) was users with combined potential psychological and social issues. Cluster 2 (32.3%) was users with potential social but no psychological issues. Cluster 3 (45.6%) was users with no potential issues of either a social or psychological nature. Adolescents from both clusters 1 and 2 showed higher degrees of IGD, smartphone addiction, musculoskeletal discomfort, and dry eye symptoms than did those from cluster 3. Also compared with adolescents in cluster 3, those in cluster 1 showed statistically higher risks of IGD (aOR:11.9, 95%CI:7.5-19.9), smartphone addiction (aOR:5.4, 95%CI:4.0-7.2), musculoskeletal discomfort (aOR:2.6, 95%CI:2.1-7.4), and dry eye symptoms (aOR:3.8, 95%CI:3.0-4.9). Those in cluster 2 also showed statistically higher risk of IGD, smartphone addiction, musculoskeletal discomfort, and dry eye symptoms compared with cluster 3 (aOR:4.5, 95%CI:2.8-7.6; aOR:2.8, 95%CI:2.1-3.7; aOR:1.6, 95%CI:1.3-1.9; and aOR:1.9, 95%CI:1.6-2.4, respectively).

CONCLUSIONS

Clustering based on the risk and preventive factors of IGD may be suitable for determination of high risk of IGD in adolescents. However, we need to confirm the usefulness and clinical application of the classifications by observing their longitudinal changes.

Screening and assessment tools for gaming disorder: A comprehensive systematic review

The inclusion of gaming disorder (GD) as an official diagnosis in the ICD-11 was a significant milestone for the field. However, the optimal measurement approaches for GD are currently unclear. This comprehensive systematic review aimed to identify and evaluate all available English-language GD tools and their corresponding evidence. A search of PsychINFO, PsychArticles, ScienceDirect, Scopus, Web of Science, and Google Scholar identified 32 tools employed in 320 studies (N = 462,249 participants). The evaluation framework examined tools in relation to: (1) conceptual and practical considerations; (2) alignment with DSM-5 and ICD-11 criteria; (3) type and quantity of studies and samples; and (4) psychometric properties. The evaluation showed that GD instrumentation has proliferated, with 2.5 tools, on average, published annually since 2013. Coverage of DSM-5 and ICD-11 criteria was inconsistent, especially for the criterion of continued use despite harm. Tools converge on the importance of screening for impaired control over gaming and functional impairment. Overall, no single tool was found to be clearly superior, but the AICA-Sgaming, GAS-7, IGDT-10, IGDS9-SF, and Lemmens IGD-9 scales had greater evidential support for their psychometric properties. The GD field would benefit from a standard international tool to identify gaming-related harms across the spectrum of maladaptive gaming behaviors.

Problematic Facebook Use and Problematic Video Gaming Among Female and Male Gamers

The development of modern technologies has facilitated positive functioning in various aspects of everyday life. However, in addition to positive changes, there are also issues related to problematic behavior associated with new technologies and new media, such as problematic Facebook use (PFU) and problematic video gaming (PVG). Therefore, the purpose of this study was to present the specificity of these problematic behaviors in a group of gamers and determine their predictors and interrelatedness. In addition, the aim was to analyze the differences between male and female gamers. The study comprised 1,270 gamers (684 female gamers; age range from 15 to 34 years; M = 19.17 years; SD = 2.91 years). The intensity of PFU was assessed using the Facebook Intrusion Scale, and intensity of PVG was assessed using the Problem Video Game Playing Questionnaire. Results showed that 6.4% of females had high levels of PFU compared to 3.1% of males, and that 1.8% of females had high levels of PVG compared to 5.8% of males. Structural equation modeling showed different predicators for problematic internet use and PVG, despite the correlation between both problematic behaviors. These findings enable better understanding of the relationship between PVG and PFU among gamers and differences between female and male gamers.

Depression and Disordered Gaming: Does Culture Matter?

The dearth of evidence related to cultural and gender variations of established associations between Internet Gaming Disorder (IGD) and other psychopathologies has been highlighted. Accordingly, the present study examined the association between depression and disordered gaming behaviors, while considering cultural perspectives of vertical individualism (independence and hierarchy) and gender as potentially variating factors. To achieve this, an ethnically diverse online sample of internet gamers from multicultural societies (N = 1032; Australia = 738; 71.5%; USA = 222; 21.5%; other multicultural countries = 72; 13.3%; Mage = 24 years; males = 503 [48.7%], females = 529 [51.3%]) completed the Internet Gaming Disorder Scale–Short-Form (IGDS9-SF); the Depression, Anxiety and Stress Scale (DASS-21) and the Individualism and Collectivism Scale (ICS). Regression, moderation and moderated moderation analyses were conducted. Results demonstrated that gamers presenting concurrently with symptoms of depression and vertically individualistic inclinations reported higher levels of disordered gaming behaviors, with no significant gender differences. The findings obtained imply that practitioners globally, and especially in multicultural societies (e.g., Australia, USA), should consider cultural differences when developing prevention and intervention strategies for disordered gaming.

A Scoping Review of Cognitive Bias in Internet Addiction and Internet Gaming Disorders

Internet addiction and Internet gaming disorders are increasingly prevalent. Whilst there has been much focus on the use of conventional psychological approaches in the treatment of individuals with these addictive disorders, there has also been ongoing research exploring the potential of cognitive bias modification amongst individuals with Internet and gaming addiction. Some studies have documented the presence of cognitive biases and the effectiveness of bias modification for Internet addiction and gaming disorders. However, there have not been any reviews that have synthesized the findings related to cognitive biases for Internet addiction and Internet gaming disorders. It is important for us to undertake a scoping review as an attempt to map out the literature for cognitive biases in Internet addiction and gaming disorders. A scoping review was undertaken, and articles were identified using a search through the following databases: PubMed, MEDLINE, and PsycINFO. Six articles were identified. There were differences in the methods of ascertaining whether an individual has an underlying Internet or gaming addiction, as several different instruments have been used. With regards to the characteristics of the cognitive bias assessment task utilized, the most common task used was that of the Stroop task. Of the six identified studies, five have provided evidence documenting the presence of cognitive biases in these disorders. Only one study has examined cognitive bias modification and provided support for its effectiveness. Whilst several studies have provided preliminary findings documenting the presence of cognitive biases in these disorders, there remains a need for further research evaluating the effectiveness of bias modification, as well as the standardization of the diagnostic tools and the task paradigms used in the assessment.

Prevalence of Internet Gaming Disorder and Its Association With Personality Traits and Gaming Characteristics Among Chinese Adolescent Gamers

Background: Internet gaming is extremely popular in China. However, some players overuse it, with negative outcomes. Knowing the prevalence rate and specific risk factors can provide a better understanding of the etiology of Internet Gaming Disorder (IGD). This study aimed to estimate the prevalence of IGD among Chinese adolescents and its association with their personality traits and Internet gaming characteristics. Methods: A cross-sectional study design was utilized in this study. Participants were recruited from 34 provincial administrative districts in China and consisted of 6,379 adolescent game players aged 15-25 (males/females = 3,701/2,678, mean age: 19.35 ± 1.61). A self-report structured questionnaire containing questions regarding demographic information and Internet gaming use characteristics, the Video Gaming Dependency Scale, and the Chinese Big Five Inventory-brief version, was used in the study. Results: The prevalence of IGD among Chinese adolescent game players was 17.0%. All participants were divided into the IGD group (males/females = 751/333, mean age: 19.74 ± 1.85) or the non-IGD group (males/females = 2,950/2,345, mean age: 19.27 ± 1.54). Specifically, twelve factors were significantly associated with IGD (p < 0.001), including neuroticism (β = 0.17), conscientiousness (β = -0.14), Internet gaming time per day (Hour) (β = 0.21), Internet gaming charge per month (Yuan) (β = 0.21), motive: escaping (β = 0.15), motive: sensation seeking (β = 0.13), motive: maintaining (β = 0.08), motive: coping (β = 0.06), having one or two long-term game partners (β = 0.06), male (β = 0.12), undergraduate and above (β = 0.04), and relationship status of couple (β = 0.04). Conclusion: Our findings offer evidence with respect to the prevalence of IGD and its relationships with specific personality traits and Internet gaming characteristics in China. It is necessary for Chinese parents, teachers, and social workers to pay more attention to adolescents' personality traits of high neuroticism and low conscientiousness, long time and high expense they spend on game, as well as their motives.

Persistence in Problematic Internet Use-A Systematic Review and Meta-Analysis

Background and Aims: Problematic internet use, internet addiction, and internet gaming disorder all describe a global phenomenon where individuals have trouble limiting their use of internet to such an extent that their use has negative consequences. Past systematic reviews and meta-analyses have focused on estimating prevalence, but there has been no comprehensive research synthesis of the trajectory of the problem. The research objective was to create a pooled estimate of the persistence of problematic internet use. This review included studies using a longitudinal panel data design with a follow-up of at least a year. Studies had to be published before the end of the year 2017, in peer-reviewed academic journals, using English language. Samples from populations in any country were accepted, given they were of acceptable quality. Methods: A literature search was conducted in Web of Science, Pro Quest, and Scopus. Several definitions of problematic internet use were included. Inverse-variance, random-effect meta-analysis was used to estimate weighted summary means of persistence. Attrition and selection bias was investigated using pre-specified tools, and heterogeneity was assessed in subgroup analysis. Results: Nine studies fit the criteria, all using samples from Asian or Western countries. The aggregate estimate for 1-year persistence it was 50% (CI: 40-61%), but results were heterogeneous. Prevalence and persistence estimates were correlated and generally higher in Asian countries. Methodological differences only explain part of the heterogeneity. Conclusion: All included studies found individuals with persistent problems, but the between-studies variation is substantial.

Internet Gaming Disorder: Exploring Its Impact on Satisfaction in Life in PELLEAS Adolescent Sample

Among adolescents, heavy video game use and socializing online may be valued socially by peers, depending on gender and age, which can increase life satisfaction. However, heavy video gaming may also be linked to symptoms of Internet Gaming Disorder, which can decrease life satisfaction. Overall, when symptoms of Internet Gaming Disorder are present, do subjects experience decreased or increased life satisfaction, all other things being equal? The aim of this study was to explore the association between Internet Gaming Disorder symptoms and life satisfaction, while controlling for gender, age, and other conditions that may impact life satisfaction. More than 2000 adolescents filled out an anonymous questionnaire at school, and 43 patients in a care center filled out the same questionnaire. Sociodemographic characteristics, family life conditions, use of screens (videos, video games, and social networks), mental health screenings, and a life satisfaction measure were collected. Distribution of participants' characteristics was provided, and stratified multivariate analyses by young male, older male, young female, and older female school populations were carried out. Results suggested that Internet Gaming Disorder symptoms had similar prevalence before and after the age of 15 in males (21% vs. 19%) and in females (6% vs. 7%) respectively and was significantly associated with decreased life satisfaction in older males, even after adjusting for parental support, depression, and economic conditions. Associations between symptoms of Internet Gaming Disorder and life satisfaction may be different depending on adolescent gender and age group.

Maladaptive Personality Functioning and Psychopathological Symptoms in Problematic Video Game Players: A Person-Centered Approach

BACKGROUND

A need exists to increase our understanding of the association between maladaptive personality traits, psychopathological symptoms, game preference, and different types of video game use. In the present study, we used a person-centered approach to identify different subtypes of video game players and we explored how they differ in personality profiles, clinical symptoms, and video game usage.

METHODS

We assessed problematic gaming via the nine-item Internet Gaming Disorder Scale and self-reported screen time playing video games in a sample of 366 adolescents and young adult gamers. Participants also completed measures on maladaptive personality domains (Personality Inventory for DSM-5 Brief Form), alexithymia (Toronto Alexithymia Scale-20 items), and psychopathological symptoms (DSM-5 Self-Rated Level 1 Cross-Cutting Symptom Measure) and reported which genre of video games they preferred.

RESULTS

Using a person-centered, cluster-analytic approach, we identified four clusters of video game players (Occasional, Passionate, Preoccupied, and Disordered) presenting peculiar combinations of problematic gaming scores and time spent online playing video games. Non-problematic gamers (Occasional and Passionate) represented the majority of the sample (62.3% of the participants). Highly involved gamers who exhibited excessive screen time playing video games (Disordered gamers) presented the highest level of maladaptive personality traits and psychopathological symptoms, and were characterized by the greatest use of Multiplayer Online Battle Arena (MOBA) games.

CONCLUSION

These results have clinical implications on suggesting the importance to determining whether or not problematic gaming activities reflect a dysfunctional emotion-focused coping strategy to avoid inner unpleasant emotional or a more generally compromised emotional and social functioning.

Gamification for Internet Gaming Disorder Prevention: Evaluation of a Wise IT-Use (WIT) Program for Hong Kong Primary Students

Internet gaming disorder and risky online behavior (e.g., cyberbullying, exposure to online violent content) have emerged as serious problems in the digital age. Prevalence rates range from 4% to 40% across the globe, with Asia being one of the hardest-hit regions. To address these pressing problems, our team designed the Wise IT-use (WIT) program, a universal prevention program that (a) enhances students' awareness of Internet gaming disorder and an array of common risky online behaviors, and (b) equips them with sufficient knowledge to handle such problems. The WIT program design was based on gamification principles and flow theory to enhance users' motivation and learning experience. A program evaluation study was conducted to assess the social impact of this program in mitigating symptoms of Internet gaming disorder and risky online behavior, and in bolstering emotional well-being. The participants were 248 students aged 7 to 13 from four primary schools in various regions of Hong Kong. They completed validated questionnaires 1 month before and 2 months after participating in the program to evaluate changes in their symptoms of Internet gaming disorder, the frequency with which they displayed risky online behaviors, and their ratings of emotional well-being across the period. The results revealed that both the symptoms of Internet gaming disorder and the proportion of students at risk of the disorder were reduced after the program. The changes observed in students were related to higher levels of positive affect and lower levels of negative affect. Evidence from this study indicates that Internet gaming disorder and risky online behavior are detrimental to the emotional well-being of Hong Kong primary school students. More importantly, the findings demonstrate that our newly developed WIT program can have a social impact in successfully mitigating the symptoms of Internet gaming disorder and enhancing emotional well-being over time. The implications of these findings for the program's broader impact on society and culture are discussed.

Maladaptive player-game relationships in problematic gaming and gaming disorder: A systematic review

While certain player vulnerabilities are known to increase risk of gaming disorder (GD), the topic of maladaptive player × game relationships in GD has received limited attention. This review aimed to: (1) identify game types associated with GD symptomatology; and (2) evaluate individual differences (e.g., age, personality, depression) in the relationship between gaming and GD symptomatology. A systematic review of six databases identified 23 studies of the relations between game types and GD, including 13 studies employing multivariate analyses. Player vulnerabilities implicated in GD included impulsivity, risk-taking, psychopathological symptoms (e.g., depression, anxiety), and stronger gaming motivations (e.g., escapism, achievement). MMORPG involvement had the strongest positive association with GD. Problematic MMORPG players tend to have a socially anxious profile and may be attracted to the work-like roles and conventions of this genre. Problematic players of shooters tend to score higher on measures of sensation-seeking and impulsivity than other players. These findings suggest that GD may develop more readily and at more severe levels in complex, endless, socially driven games, irrespective of person-level characteristics. Some player vulnerabilities may selectively increase risk of GD for certain game types. Further research should investigate different player-game interactions to refine current models and interventions for GD.

Associations between Problematic Gambling, Gaming, and Internet Use: A Cross-Sectional Population Survey

Background

While pathological gambling, or gambling disorder, is an established diagnosis, a link to other potential behavioural addictions has been suggested. The present study aimed to investigate whether signs of problem gaming and problematic internet use are related to problem gambling in the general population, while including other potential risk factors.

Methods

A cross-sectional study design, using an electronical questionnaire, administered through a marketing survey company for relative representativeness with respect to age and gender. Potential correlates of problem gambling were measured in binary analyses, and significant associations were entered in a logistic regression analysis controlling them for one another. Problem gambling, gaming, and internet use were measured through established screening instruments (the CLiP, the GAS, and the PRIUSS).

Results

Statistically significant associations were found between problem gambling and both problem gaming and problematic internet use, as well as with male gender. In logistic regression, problem gaming, problematic internet use, and male gender remained associated with problem gambling.

Conclusion

After controlling for potential demographic risk factors, problem gaming and problematic internet use may be related to problem gambling, suggesting that these constructs may interact or may share similar risk factors. More research is needed to clarify factors mediating the links between these conditions.