[Computer game playing: clinical characteristics of dependence and abuse among adolescents]

Online gaming motives, family relationships, and personality among Indian youth

Background

Youth involvement in gaming has become an important concern for mental health professionals due to its significant impact on functionality and relationships. However, the gaming motives and associated family relationships and personality traits in the Indian context are poorly understood.

Aim

The study examined problematic online gaming, including Internet gaming disorder in connection to gaming motives and personality, especially as they impact family relationships among Indian youth.

Materials and Methods

The study consisted of 179 participants (86 males; 93 females) with the age range of 18-25 years who were involved in Internet gaming in the last 1 year. The subjects were recruited using an online survey. Tools used were brief and included the Gaming Usage Questionnaire, Internet Gaming Disorder Scale-Short-Form, Motivation for Online Gaming Questionnaire UCLA Loneliness Scale, Sheehan Disability Scale, Brief Family Relationships Questionnaire, and MINI International Personality Item Pool.

Results

The mean age of the participants was 21.99 ± 2.202 years. A stepwise multivariate regression analysis indicated that escape and competition motives, low cohesion in family relationships, low level of conscientiousness, and low level of intellect/imagination contributed to problematic gaming behaviors.

Conclusions

The study established a relationship between gaming motives and both internal and external factors associated with problematic online gaming. Generalizing the findings across a larger youth population would help in developing informed preventive measures to reduce the risk of developing a gaming disorder.

Factor structure and psychometric properties of an Arabic version of the Internet Gaming Disorder Scale, short form (IGDS-SF9)

Background

In its most recent edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM), the American Psychological Association recognized that internet gaming disorder is a psychological condition and provides nine criteria for its diagnosis, and the Internet Gaming Disorder Scale, short form (IGDS-SF9) was developed to assess individuals.

Aim

To develop and investigate the psychometric properties of an Arabic version of IGDS-SF9.

Method

A five-stage translation and verification process produced an Arabic version of IGDS-SF9, and a study was conducted using a sample of 410 respondents (45.6% females, mean age = 17.6, SD = 1.56) to assess its psychometric properties. Respondents completed the Arabic version, the Smartphone Addiction Scale, the Smartphone Application-Based Addiction Scale, the Hospital Anxiety and Depression Scale, as well as a demographic survey. Exploratory and confirmatory factor analyses, measurement invariance, item response theory, convergent, concurrent, criterion validity, and internal consistency reliability and test-retest reliability were employed to validate the scale.

Results

The exploratory factor analysis suggested the scale's unidimensional structure; the confirmatory factor analysis exhibited good model fit and factor loadings. Measurement invariance, and concurrent, convergent, and criterion validity were established, resulting in good internal consistency and test-retest reliability for the scale.

Conclusion

The Arabic version of IGDS-SF9 is a valid and reliable measure for research and diagnosis in Arabic-speaking countries.

Reinforcing Relationships Between Gaming Disorder and Aggression and Intrusive Parenting Across 4 Years

Adolescent gaming disorder is associated with aggressive tendencies and parenting styles; however, few studies have examined the reinforcing spiral patterns between aggression or intrusive parenting and long-term gaming disorder across several years. Thus, we investigated the reciprocal relationships between aggression and gaming disorder and between intrusive parenting and gaming disorder among Korean adolescents (n = 801, mean age at T1 = 13.39 years old) using an annual five-wave longitudinal study design. The results of the autoregressive cross-lagged analyses showed that gaming disorder and aggression were reinforced across 4 years (five waves) among male adolescents. However, these reinforcing spiral effects were not found in female adolescents. More intrusive parenting showed reinforcing patterns with more gaming disorder in both male and female adolescents in early-to-middle adolescence. These findings suggest that interventions for gaming disorder need to involve monitoring the ways in which gaming disorder and adolescents' aggression affect each other in addition to regulating parents' degree of control.

The association between level of personality organization and problematic gaming: Anxiety, depression, and motivations for playing as mediators

Problematic gaming is a topic of great clinical and social relevance, so it is particularly important to identify its protective and risk factors. Literature already showed that maladaptive personality favors problematic gaming. In the light of Kernberg's model of personality organization, the present cross-sectional study aimed to evaluate the mediational process through which low level of personality organization associates with problematic gaming, exploring the role of depressive and anxious symptoms and of motivations for playing. A sample of 1036 video gamers filled in an online survey regarding: level of personality organization; depressive and anxious symptoms; socializing, achievement, and immersion motivations for playing; problematic gaming. The path analysis showed that lower level of personality organization associated with greater problematic gaming and that depressive (but not anxious) symptoms, and socializing and achievement (but not immersion) motivations positively mediated this relationship. Furthermore, results showed that psychopathological symptoms and achievement motivations sequentially mediated the relationship between low level of personality organization and problematic gaming, highlighting that depressive symptoms secondary to a low level of personality organization could lead to a risky use of video games, i.e., they could push to use video games to self-enhance oneself, a dysfunctional strategy that exposes to problematic gaming. The study gives some indications on the variables that associate with problematic gaming and has some practical relevance, providing suggestions in the design of effective problematic gaming prevention and treatment interventions.

The prevalence of problematic internet use among a sample of Egyptian adolescents and its psychiatric comorbidities

BACKGROUND

Problematic internet use has been identified in the last decade as a rising problem due to growing availability and impact of Internet use through social media, mobiles, and laptops are now a must in life, adolescents are most vulnerable for the misuse and its impacts.

AIM

To assess the prevalence of problematic internet use, Facebook, and gaming addiction among Egyptian adolescents and its impact.

METHODS

The study assessed 700 adolescents aged from 14 to 18 years, both sexes, using Young internet addiction test, Internet gaming disorder scale, the Bergen Facebook addiction scale, the MINI international neuropsychiatry interview for children and adolescents and the socioeconomic status scale.

RESULTS

A total of 584 students continued the study to the end with response rate more than 75%, the mean age was 16.1 = 1.2, 65.6% were having internet addiction, 61.3% were gaming addicts, and 92.8% Facebook addicts. Depression, dysthymia, suicide, social anxiety panic, and phobias were common comorbidities in addicted adolescents.

CONCLUSION

This study shows that a significant percentage of adolescents are having different patterns of problematic internet use which is negatively impacting their mental health.

Individual and Interpersonal Factors Associated with the Incidence, Persistence, and Remission of Internet Gaming Disorders Symptoms in an Adolescents Sample

Video game playing behavior has serious consequences for adolescents on a personal, family, social, and academic level. This research aimed to examine risk and protective factors involving incidence, persistence, and remission of gaming disorders symptoms (IGDs) in Spanish adolescents after nine months of follow-up. Data were drawn from self-administered questionnaires completed on two occasions: at the beginning (T1) and end of the academic year (T2). A total of 950 adolescents aged from 11 to 20 years (M = 14, SD = 1.52, 48.5% female) completed the questionnaire at T1, while 550 adolescents aged from 11 to 18 years (M = 13.43, SD = 1.23, 48.9% female) took part in the follow-up study (T2). The incidence, persistence, and remission rates were 6%, 2.7%, and 4.2%, respectively. Significant relationships with IGDs were found between the male gender and studying at a private school in T1 and T2. The findings show that the time spent playing video games during T1 was positively associated with IGDs in T1 and T2. The incidence of IGDs was associated with emotional problems and low family affection. The persistence of IGDs was linked to higher motor impulsivity, agreeableness, and lower family resolve. Remission was related to a decrease in anxiety and hostility as well as an increase in the emotional stability of adolescents. These findings imply that emotional well-being and family adjustment could be relevant for the effective management of gaming behaviors.

Classification of the risk of internet gaming disorder by flow short scale and cardiovascular response

The American Psychiatric Association has identified Internet gaming disorder (IGD) as a potential psychiatric disorder. Questionnaires are the main method to classify high-risk IGD (HIGD) and low-risk IGD (LIGD). However, the results obtained using questionnaires might be affected due to several factors. Flow can measure a person's state of concentration and cardiovascular signals can reflect the autonomic responses of a person. We propose to observe the cardiovascular responses and flow scores from the flow short scale of the HIGD and LIGD groups to assist questionnaires in IGD risk assessment. The preliminary study recruited 18 gamers from colleges. Games with the easy and hard levels were set to arouse desire for playing. The result showed that the flow scores of five HIGD participants were significantly lower compared with that of 13 LIGD participants. The stroke volume (SV) of the LIGD group during baseline (67.06 ± 11.61) was significantly greater that of (p < 0.05) while playing the easy game (64.08 ± 10.37) and playing the hard game (63.70 ± 9.89). For the LIGD group, the cardiac output (CO) during baseline (5.28 ± 0.97) was significantly greater (p < 0.01) than that of recovery (5.03 ± 0.83), and while playing the easy game (5.34 ± 0.98) it was significantly more than that during recovery (p < 0.05). For the HIGD group, a significant difference in the heart rate, SV, and CO was not observed. The changes in cardiovascular responses of the LIGD group are greater than that of the HIGD group. Gamers with LIGD might have a higher susceptibility to the negative effect of playing video games, but gamers with HIGD might not. The finding of this study might help psychologists to estimate the IGD risk.Clinical Relevance- This study investigated the differences in the score of flow short scale, self-assessment manikin, challenge/skill, emotional questionnaire, and the changes in the cardiovascular responses between the HIGD and LIGD groups.

Effects of an online-based motivational intervention to reduce problematic internet use and promote treatment motivation in internet gaming disorder and internet use disorder (OMPRIS): study protocol for a randomised controlled trial

INTRODUCTION

In May 2019, the WHO classified internet gaming disorder (IGD) as a mental disorder in the upcoming International Classification of Diseases 11th Revision. However, individuals affected by IGD or internet use disorders (IUDs) are often not provided with adequate therapy due to a lack of motivation or absence of adequate local treatment options. To close the gap between individuals with IUDs and the care system, we conduct an online-based motivational intervention to reduce problematic internet use and promote treatment motivation in internet gaming disorder and internet use disorder (OMPRIS).

METHODS AND ANALYSIS

Within the randomised controlled trial, a total of n=162 participants will be allocated by sequential balancing randomisation to the OMPRIS intervention or a waitlist control group. The study includes an extensive diagnostic, followed by a 4-week psychological intervention based on motivational interviewing, (internet-related) addiction therapy, behavioural therapy techniques and additional social counselling. The primary outcome is the reduction of problematic internet use measured by the Assessment of Internet and Computer Game Addiction Scale. Secondary outcomes include time spent on the internet, motivation for change (Stages of Change Readiness and Treatment Eagerness Scale for Internet Use Disorder), comorbid mental symptoms (Patient Health Questionnaire-9, Generalized Anxiety Disorder Screener-7), quality of life (EuroQoL Standardised Measure of Health-related Quality of Life-5 Dimensions, General Life Satisfaction-1), self-efficacy (General Self-Efficacy Scale), personality traits (Big Five Inventory-10), therapeutic alliance (Helping Alliance Questionnaire) and health economic costs. The diagnosis of (comorbid) mental disorders is carried out with standardised clinical interviews. The measurement will be assessed before (T0), at midpoint (T1) and after the OMPRIS intervention (T2), representing the primary endpoint. Two follow-up assessments will be conducted after 6 weeks (T3) and 6 months (T4) after the intervention. The outcomes will be analysed primarily via analysis of covariance. Both intention-to-treat and per-protocol analyses will be conducted.

ETHICS AND DISSEMINATION

Participants will provide written informed consent. The trial has been approved by the Ethics Committee of the Faculty of Medicine, Ruhr University Bochum (approval number 19-6779). Findings will be disseminated through presentations, peer-reviewed journals and conferences.

TRIAL REGISTRATION NUMBER

DRKS00019925.

Computer Gaming and Physiological Changes in the Brain: An Insight from QEEG Complexity Analysis

To compare the pattern of brain waves in video game addicts and normal individuals, a case-control study was carried out on both. Thirty participants were recruited from 14 to 20 years old males from two gaming centers. Twenty healthy participants were gathered from different schools in Tehran using the available sampling method. The QEEG data collection was performed in three states: closed-eye and open-eye states, and during a working memory task. As expected, the power ratios did not show a significant difference between the two groups. Regarding our interest in the complexity of signals, we used the Higuchi algorithm as the feature extractor to provide the input materials for the multilayer perceptron classifier. The results showed that the model had at least a 95% precision rate in classifying the addicts and healthy controls in all three types of tasks. Moreover, significant differences in the Higuchi Fractal Dimension of a few EEG channels have been observed. This study confirms the importance of brain wave complexity in QEEG data analysis and assesses the correlation between EEG-complexity and gaming disorder. Moreover, feature extraction by Higuchi algorithm can render support vector machine classification of the brain waves of addicts and healthy controls more accurate.

The Moderating Role of Coping Mechanisms and Being an e-Sport Player Between Psychiatric Symptoms and Gaming Disorder: Online Survey

BACKGROUND

The emerging popularity of playing video games (gaming) as a hobby and as a professional sport raises awareness about both the benefits and possible downsides of the activity. Although a healthy and passionate hobby for most, a minority of gamers experience addiction-like symptoms and are considered to have gaming disorder (GD). GD has previously been found to be related to aversive conditions, such as depression or anxiety, as well as putatively maladaptive coping strategies.

OBJECTIVE

The aim of this study is twofold: to explore the moderating effect of different coping strategies and type of video game usage (professional [e-sport] or recreational) on the relationship between psychiatric symptoms and GD.

METHODS

A sample of 3476 gamers (n=3133, 90.13% males; mean age 23.20, SD 6.48 years) was recruited via the website and social networking site of the most popular gaming magazine in Hungary (GameStar).

RESULTS

The main effect of psychiatric symptoms was moderate to large in all models, whereas the moderation effects were significant (P<.001) for 4 out of 8 coping strategies (ie, self-blame/self-distraction, denial, emotional/social support, and active coping). However, the explained variance of the models only increased negligibly (from 0.3% to 0.5%) owing to the moderation effect. The direction of the moderations was as expected (ie, putatively maladaptive strategies were associated with more GD symptoms when the level of psychiatric symptoms was high, while putatively adaptive strategies were associated with less). Furthermore, no considerable moderation effect of the player type (recreational vs professional players) was found on the association between psychiatric symptoms and GD (β=.04; P=.02; 0.1% change in the explained variance).

CONCLUSIONS

Future studies should be designed to better understand coping-related mechanisms in the context of video gaming and GD.

„Gaming“ im Kindesalter

Hintergrund

Viele Kinder spielen Computer- und Videospiele („Gaming“). Doch übermäßiges Gaming kann sich zu einer „Gaming Disorder“ entwickeln, deren Ursachen nicht vollständig geklärt sind. Unter anderem werden elterliches Gaming und das Vorliegen einer Aufmerksamkeitsdefizit‑/Hyperaktivitätsstörung (ADHS) bei Kindern als Einflussfaktoren diskutiert.

Ziel der Arbeit

Es wurde untersucht, ob i) Zusammenhänge zwischen elterlichem und kindlichem Gaming bestehen, ii) Gaming und Tendenzen zur ADHS bei Kindern miteinander assoziiert sind, und iii) diese Assoziationen durch das Gaming-Verhalten der Eltern moderiert werden.

Material und Methoden

Es beurteilten 249 Eltern (n = 244 Frauen; Alter: 34,94 ± 4,88 Jahre) das eigene Gaming-Verhalten und das ihrer Kinder (n = 105 Mädchen, n = 144 Jungen; Alter: 5,72 ± 2,18 Jahre) mit dem Gaming Disorder Test (GDT). Mithilfe der Diagnose-Checkliste Aufmerksamkeitsdefizit‑/Hyperaktivitätsstörung (DCL-ADHS) wurden ADHS-Tendenzen der Kinder im Fremdbericht erfasst.

Ergebnisse

Gaming der Eltern und Kinder waren voneinander abhängig (χ2(1) = 15,52, p < 0,001). Die GDT-Werte der Eltern und Kinder korrelierten positiv (Jungen: ρ = 0,34, p = 0,029; Mädchen: ρ = 0,35, p = 0,047). Computerspielende Kinder hatten keine höheren ADHS-Tendenzen als Kinder, die nicht spielten, doch bei spielenden Jungen korrelierten Tendenzen zu Impulsivität (ρ = 0,23, p = 0,028) und bei spielenden Mädchen Tendenzen zu Unaufmerksamkeit (ρ = 0,38, p = 0,008) mit dem GDT-Wert. Elterliche GDT-Werte verstärkten den Zusammenhang zwischen dem GDT-Wert und der Impulsivität bei Kindern i. Allg.

Schlussfolgerung

Eltern können durch ihr eigenes Gaming-Verhalten möglicherweise das ihrer Kinder beeinflussen. Besonders bei Kindern mit einer ADHS muss problematisches Gaming frühzeitig erkannt werden, um der Entstehung einer Gaming Disorder vorbeugen zu können. Die vorgestellten Ergebnisse bedürfen längsschnittlicher Überprüfungen in größeren und heterogeneren Stichproben.

Linking Gaming Disorder Tendencies in Children to Their Personality and Parental Gaming Behavior

Playing computer and video games (so-called gaming) is of great popularity among children and adults. But for some people, gaming gets out of hand and can result in a Gaming Disorder (GD). Among others, high neuroticism and low conscientiousness are considered to play a role in the etiology of GD. Next to personality traits, environmental variables are debated such as the parental influence on children's gaming behavior. In detail, parental gaming behavior could have role model functions for children. Based on empirical observations and theoretical frameworks, it was hypothesized that higher tendencies to GD in children are associated with higher neuroticism, lower conscientiousness, and higher parental tendencies to GD. In an online survey N = 493 parents (n = 472 females; age: M = 36.30, SD = 5.46) rated their own and their children's (n = 233 girls, n = 260 boys; age: M = 6.03, SD = 2.30) tendencies to GD by the Gaming Disorder Test (GDT) and their children's personality by the Big Five Inventory (BFI). Neuroticism was significantly correlated with the GDT scores of boys (rho = 0.256, p = 0.001) and girls (rho = 0.300, p = 0.001), while a significant correlation with conscientiousness was only present for boys (rho = -0.196, p = 0.010). Parents' and children's general playing of computer and video games were interdependent [χ²(1) = 29.14, p < 0.001]; hence, if parents reported to be gamers, their children were more likely gamers as well. The GDT scores of parents and children were positively correlated (boys: rho = 0.36; p = 0.002; girls: rho = 0.33, p = 0.004). The results indicate that already in children the personality traits neuroticism and conscientiousness are associated with tendencies toward GD. Moreover, as gaming of parents and children was related to each other, it is conceivable that parents influence their children's gaming behavior via their own gaming behavior. Therefore, parents should be aware of their exemplary function for children and may overthink their own gaming behavior. But it has to be mentioned that the correlational nature of the present work allows no insights regarding causal relations.

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.

The effect of computer game playing habits of university students on their sleep states

OBJECTIVE

The aim of this study is to evaluate the effect of computer game playing habits of university students on their sleep states.

DESIGN AND METHODS

The study was conducted cross-sectionally with the online survey method.

FINDING

In this study, it was determined that the students who played games for an average of ≥2 hours per day had later bedtime and later wake-up time, poorer sleep quality, and higher daytime sleepiness. It was found that as the level of game addiction increased, sleep quality decreased, the severity of daytime sleepiness increased, and the wake-up time shifted to a later time.

PRACTICE IMPLICATIONS

Nurses should develop effective intervention strategies involving technology management and sleep hygiene studies to reduce game-playing time of students.

Self-Efficacy and Clinical Characteristics in Casual Gamers Compared to Excessive Gaming Users and Non-Gamers in Young Adults

This study investigated differences in the self-efficacy and clinical characteristics which were found relevant to addictive behaviors in young adults according to time spent gaming. To our knowledge, this is the first study to explore self-efficacy in casual gamers relative to patients with internet gaming disorder (IGD) and non-gamers. In total, 158 young adults participated in this study and were divided into three groups: excessive gamers, who were diagnosed with IGD based on the Diagnostic and Statistical Manual of Mental Disorder-fifth edition (DSM-5, n = 71); casual gamers, who played games regularly but did not meet the criteria for IGD (n = 37); and non-gamers/controls, who did not engage in gaming (n = 50). All participants completed self-administered questionnaires, including measures of self-efficacy and clinical features such as the Barratt Impulsiveness Scale, Beck Depression Inventory, Beck Anxiety Inventory, Behavioral Activation/Inhibition Systems, aggression, and psychosocial well-being. There were significant differences in the self-efficacy according to the extent of gaming (excessive gamers < casual gamers < non-gamers). In addition, aggression, impulsivity, depression, anxiety, level of stress, and behavioral inhibition system scores were significantly higher in excessive gamers than in casual gamers and non-gamers. These findings showed that individuals who spend more time playing games tend to have lower self-efficacy. Our study suggests that self-efficacy may protect against or constitute a risk of excessive gaming, particularly among casual gamers. It is necessary to pay attention to enhancing psychological well-being through self-efficacy to prevent addiction in young adult gamers.

The psychometric properties of the Chinese version internet gaming disorder scale

INTRODUCTION

The study tested the psychometric properties of two Chinese version Internet Gaming Disorder scales (IGDSs): a dichotomous IGDS with yes/no type of response and a polytomous IGDS with a 0-5 Likert-type response.

METHODS

The reliability and validity of two scales were tested separately, among two population-based samples of Chinese adolescents and adults (351 for dichotomous IGDS and 378 for polytomous IGDS). The diagnostic accuracy of the dichotomous IGDS was assessed in an independent sample of 114 gamers (56 disordered gamers and 58 average gamers) using Receiver Operating Characteristic (ROC) analysis.

RESULTS

The results demonstrated good internal consistency (α_dichotomous = 0.80 and α_polytomous = 0.89) and test-retest reliability (r_dichotomous = 0.83 and r_polytomous = 0.84) for both scales. Both scales showed sound validity, as indicated by significant correlations with measurements of internet addiction, aggression, impulsivity, craving for gaming and time spent playing games. Factor analysis demonstrated that both Chinese IGDSs have a similar single-component structure to the original scales. The ROC analysis indicated an excellent diagnostic accuracy of the dichotomous IGDS. When apply the five or more cutoff points, the prevalence of IGD was 7.41% in the population-based sample.

CONCLUSION

This study demonstrated robust psychometric properties of the Chinese version dichotomous IGDS and polytomous IGDS, and suggests that these scales are valid tools that suitable for clinical and research purposes.

Early-Life Interpersonal and Affective Risk Factors for Pathological Gaming

Internet gaming is among the most popular entertainment options, worldwide; however, a considerable proportion of gamers show symptoms of pathological gaming. Internet gaming disorder (IGD) has been proposed to describe a behavioral addiction, which shares many similarities, both physical and psychological, with substance use disorder. Environmental factors, such as interpersonal and relationship dynamics during childhood and adolescence, have been suggested to modulate the onset and trajectories of IGD. However, studies exploring the contributions of dysfunctional family environments to the development of IGD remain limited. This minireview aims to offer an overview of the current knowledge regarding the impacts of early-life interpersonal and relationship dynamics on the development of IGD and to provide a snapshot of the current state of the literature in this field. Specifically, it underlines the modulatory role of early-life relational factors such as a) family function, b) parent-child relationships, c) childhood maltreatment, and d) bullying and cyberbullying on the development of IGD. Consistent with this evidence, therapeutic interventions that aim to "restructure" the emotional ties and familiar dynamics that are known to be associated with dysfunctional behaviors and feelings, and likely promote pathological gaming, are recognized as the most successful clinical therapeutic approaches for IGD.

Cognitive-behavioral therapy for Internet gaming disorder: A systematic review and meta-analysis

OBJECTIVE

Although there is sufficient research and clinical evidence to support the inclusion of gaming disorder in the latest revision of the International Classification of Diseases, relatively little is known about the effectiveness of first-line psychological treatment for gaming disorder or internet gaming disorder (IGD) as it is listed in the Diagnostic and Statistical Manual. This systematic review employed meta-analytic techniques to determine the effectiveness of cognitive-behavioural therapy (CBT) for IGD on four key outcomes: IGD symptoms, anxiety, depression, and time spent gaming.

METHOD

A database search identified 12 independent CBT studies. Effect size estimates (Hedges' g) with associated confidence intervals, prediction intervals, and p values for each pre-post treatment outcome, were calculated. Study reporting quality was evaluated in accordance with the Consolidated Standards of Reporting Trials guidelines. Subgroup and moderator analyses were undertaken to investigate potential sources of heterogeneity.

RESULTS

CBT demonstrated high efficacy in reducing IGD symptoms (g = 0.92; [0.50, 1.34]) and depression (g = 0.80, [0.21, 1.38]), and showed moderate efficacy in reducing anxiety (g = 0.55, [0.17, 0.93]) at post-test. There was insufficient power to determine whether CBT was capable of reducing time spent gaming. Treatment gains at follow-up were nonsignificant across the four treatment outcomes.

CONCLUSIONS

The pooled findings suggest that CBT for IGD is an effective short-term intervention for reducing IGD and depressive symptoms. However, the effectiveness of CBT for reducing actual time spent gaming was unclear. Given the limitations of this evidence base, there is a need for more rigorous studies to determine the potential long-term benefits of CBT for IGD.

PUBLIC HEALTH SIGNIFICANCE STATEMENT

Given the rise in treatment demand for internet gaming disorder (IGD) and problematic gaming, it is necessary to determine which treatments are most effective for whom and under which conditions. This review shows that cognitive-behavioural therapy for IGD, which is often considered the first-line therapy, can improve IGD symptoms and comorbid depression. However, treatment gains tend to be short-term and their effect in reducing time spent gaming is unclear. Programs that target problematic gaming may be improved by additional support beyond the standard program of therapy sessions. More funding and resources are needed to support the development of a more rigorous evidence base on IGD and its treatment.

Association between computer game type, playing time and sense of coherence in Lithuanian adolescents

OBJECTIVE

As an excessive gaming is the addiction of the 21th century, purpose of our study was to investigate how sense of coherence interacts with gaming time, choice of various games types, age and gender characteristics. Our task was to evaluate relationship between computer gaming and an adolescent's sense of coherence.

METHODS

A cross-sectional study based on a self-reported questionnaire was performed among the representative samples of 1,806 adolescents aged 13-18 years. Adolescents reported the amount of time spent gaming computer games, types of games, as well as sense of coherence. The relations between the choice of computer games type, time spent gaming computer games and sense of coherence of respondents were assessed by odds ratio using multivariate regression analysis.

RESULTS

32.9% of boys and 81.1% of girls reported gaming computer games less than 5 hours per day during the last month (p < 0.001). 30.9% of boys and 4.1% of girls reported gaming computer games more than 10 hours per day during the last month (p < 0.001). Boys and girls aged 13-15 with a weak sense of coherence had significantly higher probability to play action or combat computer games for 5 or more hours per day in comparison to the respondents who had a strong sense of coherence. Also, this probability was 2 times higher among boys than among girls.

CONCLUSION

Sense of coherence is a useful tool to identify adolescents who are at risk of excessive gaming. Game playing time is linked to the sense of coherence. Adolescent with a weak sense of coherence had a higher probability to play more times, especially in younger age.

Internet gaming disorder in children and adolescents: a systematic review

AIM

Internet gaming disorder (IGD) is a serious disorder leading to and maintaining pertinent personal and social impairment. IGD has to be considered in view of heterogeneous and incomplete concepts. We therefore reviewed the scientific literature on IGD to provide an overview focusing on definitions, symptoms, prevalence, and aetiology.

METHOD

We systematically reviewed the databases ERIC, PsyARTICLES, PsycINFO, PSYNDEX, and PubMed for the period January 1991 to August 2016, and additionally identified secondary references.

RESULTS

The proposed definition in the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition provides a good starting point for diagnosing IGD but entails some disadvantages. Developing IGD requires several interacting internal factors such as deficient self, mood and reward regulation, problems of decision-making, and external factors such as deficient family background and social skills. In addition, specific game-related factors may promote IGD. Summarizing aetiological knowledge, we suggest an integrated model of IGD elucidating the interplay of internal and external factors.

INTERPRETATION

So far, the concept of IGD and the pathways leading to it are not entirely clear. In particular, long-term follow-up studies are missing. IGD should be understood as an endangering disorder with a complex psychosocial background.

WHAT THIS PAPER ADDS

In representative samples of children and adolescents, on average, 2% are affected by Internet gaming disorder (IGD). The mean prevalences (overall, clinical samples included) reach 5.5%. Definitions are heterogeneous and the relationship with substance-related addictions is inconsistent. Many aetiological factors are related to the development and maintenance of IGD. This review presents an integrated model of IGD, delineating the interplay of these factors.

Association between Internet Gaming Disorder or Pathological Video-Game Use and Comorbid Psychopathology: A Comprehensive Review

The addictive use of video games is recognized as a problem with clinical relevance and is included in international diagnostic manuals and classifications of diseases. The association between "Internet addiction" and mental health has been well documented across a range of investigations. However, a major drawback of these studies is that no controls have been placed on the type of Internet use investigated. The aim of this study is to review systematically the current literature in order to explore the association between Internet Gaming Disorder (IGD) and psychopathology. An electronic literature search was conducted using PubMed, PsychINFO, ScienceDirect, Web of Science and Google Scholar (r.n. CRD42018082398). The effect sizes for the observed correlations were identified or computed. Twenty-four articles met the eligibility criteria. The studies included comprised 21 cross-sectional and three prospective designs. Most of the research was conducted in Europe. The significant correlations reported comprised: 92% between IGD and anxiety, 89% with depression, 85% with symptoms of attention deficit hyperactivity disorder (ADHD), and 75% with social phobia/anxiety and obsessive-compulsive symptoms. Most of the studies reported higher rates of IGD in males. The lack of longitudinal studies and the contradictory results obtained prevent detection of the directionality of the associations and, furthermore, show the complex relationship between both phenomena.

Relationships between parental attitudes, family functioning and Internet gaming disorder in adolescents attending school

While recent data suggest a high prevalence of adolescent with Internet gaming disorder, little is known about interpersonal factors that contributes or protect to this disorder. Thus, the aim of this study was to examine the relationships between parental attitudes, adolescent perception of family functioning and Internet gaming disorder (IGD) and explore gender differences. From a sample of 434 adolescents attending school (n =434; age 13.2 years), 383 non-problematic gamers (NPG, 196 males; 187 females) were compared with 37 problematic gamers (PG, 29 males; 8 females). Family functioning was assessed with the Family Relationship Index and parental attitudes with a questionnaire measuring rules, access to video games, monitoring and banning of video games. NPG have a better family cohesion while PG have more family conflict and a poorer family relationship. While rules about gaming use are important in males, for females, banning is associated with IGD. For both sex, parental monitoring, conflicts and family relationship are associated with IGD. These findings highlight the strong influence of parental attitudes and family functioning on the occurrence of IGD in adolescents and their gender specificities. Thus, prevention programs need to take into account the importance of parents, parenting and gender specificities.

[The epidemiology of mental disorders in youth : A narrative review including Austrian data]

For decades, epidemiological studies have consistently and impressively demonstrated the frequency of mental illness in childhood and adolescence. Mental health disorders are among the most common causes of diminished quality of life among young people, sometimes casting long shadows into adulthood. This narrative review looks at this phenomenon using a selection of research findings dealing with overall prevalence figures, with the prevalence of individual disorders, and with the progression of mental illness from childhood and adolescence to adulthood. Austrian epidemiological studies supplementing these findings are also presented.

Addictive Potential of Internet Applications and Differential Correlates of Problematic Use in Internet Gamers versus Generalized Internet Users in a Representative Sample of Adolescents

AIMS

This paper examines the addictive potential of 8 different Internet applications, distinguishing male and female users. Moreover, differential correlates of problematic use are investigated in Internet gamers (IG) and generalized Internet users (GIU).

METHOD

In a representative sample of 5,667 adolescents aged 12-19 years, use of Internet applications, problematic Internet use, psychopathologic symptoms (emotional problems, hyperactivity/inattention, and psychosomatic complaints), personality (conscientiousness and extraversion), psychosocial correlates (perceived stress and self-efficacy), and coping strategies were assessed. The addictive potential of Internet applications was examined in boys and girls using regression analysis. MANOVAs were conducted to examine differential correlates of problematic Internet use between IG and GIU.

RESULTS

Chatting and social networking most strongly predicted problematic Internet use in girls, while gaming was the strongest predictor in boys. Problematic IG exhibited multiple psychosocial problems compared to non-problematic IG. In problematic Internet users, GIU reported even higher psychosocial burden and displayed dysfunctional coping strategies more frequently than gamers.

CONCLUSION

The results extend previous findings on the addictive potential of Internet applications and validate the proposed distinction between specific and generalized problematic Internet use. In addition to Internet gaming disorder, future studies should also focus on other highly addictive Internet applications, that is, chatting or social networking, regarding differential correlates of problematic use.

Free-to-play: About addicted Whales, at risk Dolphins and healthy Minnows. Monetarization design and Internet Gaming Disorder

INTRODUCTION

Video games are not only changing due to technical innovation, but also because of new game design and monetization approaches. Moreover, elite gamer groups with financial in-game-investments co-finance all users of free-to-play-games. Besides questions on youth protection, the growing popularity of free-to-play games has fostered discussions on supposed associations to Internet Gaming Disorder (IGD).

METHOD

Children and adolescents using free-to-play browser games were examined in a German school-based representative study (N=3967; age range 12 to 18). Based on a clinical self-report AICA-S (Wölfling et al., 2011), students were categorized into non-problematic, risky, and addicted users. Psycho-social problems (SDQ; Goodman, 1997), perceived stress (PSS; Cohen, Kamarck & Mermelstein, 1983), coping strategies (BriefCOPE; Carver, 1997), and Average Revenue per (Paying) User (ARPU) were investigated as dependent variables. Furthermore, an industry classification (Freeloaders, Minnows, Dolphins, and Whales) for free-to-play gamers was used for additional relations regarding IGD, SDQ, PSS, BriefCOPE, and ARPU.

RESULTS

Among free-to-play gamers the prevalence of IGD amounted to 5.2%. Subjects classified with IGD displayed higher psycho-social symptoms than non-problematic users, reported higher degrees of perceived stress, and applied dysfunctional coping strategies more frequently. Additionally, we found a higher ARPU among subjects with IGD.

CONCLUSION

ARPU is significantly associated with IGD. Whales share significant characteristics with addicted video gamers; Dolphins might be classified as risky consumers; Minnows and Freeloaders are rather non-pathological gamers. Vulnerability for stress, dysfunctional coping, and free-to-play gaming represent an unhealthy combination.

[Usage patterns of internet and computer games : Results of an observational study of Tyrolean adolescents]

BACKGROUND

The use of digital media such as the Internet and Computer games has greatly increased. In the western world, almost all young people regularly use these relevant technologies. Against this background, forms of use with possible negative consequences for young people have been recognized and scientifically examined. The aim of our study was therefore to investigate the prevalence of pathological use of these technologies in a sample of young Tyrolean people.

METHODS

398 students (average age 15.2 years, SD ± 2.3 years, 34.2% female) were interviewed by means of the structured questionnaires CIUS (Internet), CSV-S (Computer games) and SWE (Self efficacy). Additionally, socio demographic data were collected.

RESULTS

In line with previous studies, 7.7% of the adolescents of our sample showed criteria for problematic internet use, 3.3% for pathological internet use. 5.4% of the sample reported pathological computer game usage. The most important aspect to influence our results was the gender of the subjects. Intensive users in the field of Internet and Computer games were more often young men, young women, however, showed significantly less signs of pathological computer game use.

CONCLUSIONS

A significant percentage of Tyrolean adolescents showed difficulties in the development of competent media use, indicating the growing significance of prevention measures such as media education. In a follow-up project, a sample of adolescents with mental disorders will be examined concerning their media use and be compared with our school-sample.

Predictors and patterns of problematic Internet game use using a decision tree model

Background and aims Problematic Internet game use is an important social issue that increases social expenditures for both individuals and nations. This study identified predictors and patterns of problematic Internet game use. Methods Data were collected from online surveys between November 26 and December 26, 2014. We identified 3,881 Internet game users from a total of 5,003 respondents. A total of 511 participants were assigned to the problematic Internet game user group according to the Diagnostic and Statistical Manual of Mental Disorders Internet gaming disorder criteria. From the remaining 3,370 participants, we used propensity score matching to develop a normal comparison group of 511 participants. In all, 1,022 participants were analyzed using the chi-square automatic interaction detector (CHAID) algorithm. Results According to the CHAID algorithm, six important predictors were found: gaming costs (50%), average weekday gaming time (23%), offline Internet gaming community meeting attendance (13%), average weekend and holiday gaming time (7%), marital status (4%), and self-perceptions of addiction to Internet game use (3%). In addition, three patterns out of six classification rules were explored: cost-consuming, socializing, and solitary gamers. Conclusion This study provides direction for future work on the screening of problematic Internet game use in adults.

Attentional bias in excessive Internet gamers: Experimental investigations using an addiction Stroop and a visual probe

Background and aims Internet Gaming Disorder is included in the Diagnostic and statistical manual of mental disorders (5^th edition) as a disorder that merits further research. The diagnostic criteria are based on those for Substance Use Disorder and Gambling Disorder. Excessive gamblers and persons with Substance Use Disorder show attentional biases towards stimuli related to their addictions. We investigated whether excessive Internet gamers show a similar attentional bias, by using two established experimental paradigms. Methods We measured reaction times of excessive Internet gamers and non-gamers (N = 51, 23.7 ± 2.7 years) by using an addiction Stroop with computer-related and neutral words, as well as a visual probe with computer-related and neutral pictures. Mixed design analyses of variance with the between-subjects factor group (gamer/non-gamer) and the within-subjects factor stimulus type (computer-related/neutral) were calculated for the reaction times as well as for valence and familiarity ratings of the stimulus material. Results In the addiction Stroop, an interaction for group × word type was found: Only gamers showed longer reaction times to computer-related words compared to neutral words, thus exhibiting an attentional bias. In the visual probe, no differences in reaction time between computer-related and neutral pictures were found in either group, but the gamers were faster overall. Conclusions An attentional bias towards computer-related stimuli was found in excessive Internet gamers, by using an addiction Stroop but not by using a visual probe. A possible explanation for the discrepancy could lie in the fact that the visual probe may have been too easy for the gamers.

Internet Gaming Addiction: A Technological Hazard

INTRODUCTION

The Internet is considered a beneficial tool in research, communication, and information. Still, its excessive and prolonged use has the potential of causing addiction. The presentation of this technological hazard may range from a mild socio-personal distress to a gross disorganization in behavior and self-care. No reported study on Internet gaming addiction is available from India.

CASE PRESENTATION

We reported a case of two brothers, diagnosed with Internet gaming addiction, who showed grossly disorganized behavior and severely compromised self-care. The condition was managed by pharmacological and non-pharmacological therapies, with sustained improvement after 6 months follow up.

CONCLUSIONS

Internet gaming addiction may cause severe personal, social, and occupational problems. Despite the range of severity and various presentations of this disorder, DSM-5 lacks the severity classifier. Early identification and management may result in complete recovery.

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

Excessive use of online computer games which leads to functional impairment and distress has recently been included as Internet Gaming Disorder (IGD) in Section III of the DSM-5. Although nosological classification of this phenomenon is still a matter of debate, it is argued that IGD might be described best as a non-substance-related addiction. Epidemiological surveys reveal that it affects up to 3% of adolescents and seems to be related to heightened psychosocial symptoms. However, there has been no study of prevalence of IGD on a multi-national level relying on a representative sample including standardized psychometric measures. The research project EU NET ADB was conducted to assess prevalence and psychopathological correlates of IGD in seven European countries based on a representative sample of 12,938 adolescents between 14 and 17 years. 1.6% of the adolescents meet full criteria for IGD, with further 5.1% being at risk for IGD by fulfilling up to four criteria. The prevalence rates are slightly varying across the participating countries. IGD is closely associated with psychopathological symptoms, especially concerning aggressive and rule-breaking behavior and social problems. This survey demonstrated that IGD is a frequently occurring phenomenon among European adolescents and is related to psychosocial problems. The need for youth-specific prevention and treatment programs becomes evident.

Prevalence of Internet gaming disorder in German adolescents: diagnostic contribution of the nine DSM-5 criteria in a state-wide representative sample

BACKGROUND AND AIMS

Internet gaming disorder (IGD) is included as a condition for further study in Section 3 of the DSM-5. Nine criteria were proposed with a threshold of five or more criteria recommended for diagnosis. The aims of this study were to assess how the specific criteria contribute to diagnosis and to estimate prevalence rates of IGD based on DSM-5 recommendations.

DESIGN

Large-scale, state-representative school survey using a standardized questionnaire.

SETTING

Germany (Lower Saxony).

PARTICIPANTS

A total of 11 003 ninth-graders aged 13-18 years (mean = 14.88, 51.09% male).

MEASUREMENTS

IGD was assessed with a DSM-5 adapted version of the Video Game Dependency Scale that covered all nine criteria of IGD.

FINDINGS

In total, 1.16% [95% confidence interval (CI) = 0.96, 1.36] of respondents were classified with IGD according to DSM-5 recommendations. IGD students played games for longer periods, skipped school more often, had lower grades in school, reported more sleep problems and more often endorsed feeling 'addicted to gaming' than their non-IGD counterparts. The most frequently reported DSM-5 criteria overall were 'escape adverse moods' (5.30%) and 'preoccupation' (3.91%), but endorsement of these criteria rarely related to IGD diagnosis. Conditional inference trees showed that the criteria 'give up other activities', 'tolerance' and 'withdrawal' were of key importance for identifying IGD as defined by DSM-5.

CONCLUSIONS

Based on a state-wide representative school survey in Germany, endorsement of five or more criteria of DSM-5 internet gaming disorder (IGD) occurred in 1.16% of the students, and these students evidence greater impairment compared with non-IGD students. Symptoms related to 'give up other activities', 'tolerance' and 'withdrawal' are most relevant for IGD diagnosis in this age group.

Stress moderates the relationship between problematic Internet use by parents and problematic Internet use by adolescents

PURPOSE

Based on the theoretical framework of Problem Behavior and Stress Reduction theories for problematic Internet use (PIU), this study aimed to investigate the relationship between parental PIU and the PIU among adolescents taking into consideration the stress levels of young people.

METHODS

This was a population-based parent and adolescent dyad health survey utilizing a random sampling technique. PIU for both parents and adolescents was measured by the Internet addiction test designed by Young. The stress level of adolescents was assessed using the stress subscale of the Depression Anxiety Stress Scale (DASS). Data were analyzed using logistic regression modeling techniques with adjustment for potential confounding factors with analysis on the modification effect of stress levels on the relationship between parent and adolescent PIU.

RESULTS

Of the total 1,098 parent and adolescent dyads with usable information, 263 adolescents (24.0%) and 62 parents (5.7%) could be classified as moderate and severe problematic users of the Internet. About 14% (n = 157) of adolescents could be classified with moderate-to-severe stress. Regression analysis results suggested a significant interaction between parental PIU and adolescents' stress levels on adolescent PIU. Stratified regression analyses by stress level resulted in a significant parent and adolescent PIU relationship in the low stress group (odds ratio, 3.18; 95% confidence interval 1.65-6.14). However, the association between parent and adolescent PIU in the high stress group became insignificant.

CONCLUSIONS

There was a significant parent and adolescent PIU relationship; however, this relationship is differentially affected by the stress status of the adolescent. The direct implication of the results is that parental Internet use should also be assessed and included as part of the treatment regime for adolescents.

Internet gaming disorder, social network disorder and laterality: handedness relates to pathological use of social networks

The internet age bears new challenges that include health risks. It is agreed that excessive internet use may reach pathological levels. However, the concept of internet addiction lacks specificity and, therefore, warrants studies on its diagnostic and etiologic classification. This study was conducted to characterize the novel DSM-5 criteria for internet gaming disorder and the adapted criteria for the “social network disorder”. Based on the established association of handedness and substance use disorders, we also explored whether internet use related to laterality. For this study, 3,287 volunteers participated in the online survey and gave particulars concerning their internet use in general, internet gaming and use of social networks, laterality markers (hand, foot, eye, ear, rotational preference in gymnastics, and head turning asymmetry) and health status. Of the participants, 1.1 % fulfilled the criteria for internet gaming disorder, and 1.8 % fulfilled the criteria for social network disorder. The applied criteria were highly correlated with the time spent on the respective internet activities (p < 4 × 10⁻⁵⁶). The analyses of comorbidity and working hours support the thresholds of 5/9 criteria and ≥30 h/week spent on the internet for the classification as pathological (p < 5 × 10⁻²). Moreover, we found that left-handedness related to more affirmed criteria and longer times spent on social networks (p ≤ 4 × 10⁻²). The provided criteria proved to be user-friendly, comprehensible and well accepted. The results contribute to a better understanding of pathological internet gaming and social network use and provide evidence that biological markers of substance use disorders are involved in internet addiction.

Altered reward processing in pathological computer gamers--ERP-results from a semi-natural gaming-design

INTRODUCTION

Internet Gaming Disorder has been added as a research diagnosis in section III for the DSM-V. Previous findings from neuroscientific research indicate an enhanced motivational attention toward cues related to computer games, similar to findings in substance-related addictions. On the other hand in clinical observational studies tolerance effects are reported by patients with Internet Gaming disorder. In the present study we investigated whether an enhanced motivational attention or tolerance effects are present in patients with Internet Gaming Disorder.

METHODS

A clinical sample from the Outpatient Clinic for Behavioral Addictions in Mainz, Germany was recruited, fulfilling the diagnostic criteria for Internet Gaming Disorder. In a semi-natural EEG design participants played a computer game during the recording of event-related potentials to assess reward processing.

RESULTS

The results indicated an attenuated P300 for patients with Internet Gaming Disorder in response to rewards in comparison to healthy controls, while the latency of N100 was prolonged and the amplitude of N100 was increased.

CONCLUSIONS

Our findings support the hypothesis that tolerance effects are present in patients with Internet Gaming Disorder, when actively playing computer games. In addition, the initial orienting toward the gaming reward is suggested to consume more capacity for patients with Internet Gaming Disorder, which has been similarly reported by other studies with other methodological background in disorders of substance-related addictions.

Latent class analysis on internet and smartphone addiction in college students

PURPOSE

This study aimed to classify distinct subgroups of people who use both smartphone and the internet based on addiction severity levels. Additionally, how the classified groups differed in terms of sex and psychosocial traits was examined.

METHODS

A total of 448 university students (178 males and 270 females) in Korea participated. The participants were given a set of questionnaires examining the severity of their internet and smartphone addictions, their mood, their anxiety, and their personality. Latent class analysis and ANOVA (analysis of variance) were the statistical methods used.

RESULTS

Significant differences between males and females were found for most of the variables (all <0.05). Specifically, in terms of internet usage, males were more addicted than females (P<0.05); however, regarding smartphone, this pattern was reversed (P<0.001). Due to these observed differences, classifications of the subjects into subgroups based on internet and smartphone addiction were performed separately for each sex. Each sex showed clear patterns with the three-class model based on likelihood level of internet and smartphone addiction (P<0.001). A common trend for psychosocial trait factors was found for both sexes: anxiety levels and neurotic personality traits increased with addiction severity levels (all P<0.001). However, Lie dimension was inversely related to the addiction severity levels (all P<0.01).

CONCLUSION

Through the latent classification process, this study identified three distinct internet and smartphone user groups in each sex. Moreover, psychosocial traits that differed in terms of addiction severity levels were also examined. It is expected that these results should aid the understanding of traits of internet and smartphone addiction and facilitate further study in this field.

A contribution to the clinical characterization of Internet addiction in a sample of treatment seekers: validity of assessment, severity of psychopathology and type of co-morbidity

OBJECTIVE

Internet addiction becomes a growing health problem worldwide with prevalence rates up to 3%. Still, uncertainties exist regarding its diagnostics and clinical characterization. Especially the lacking clinical evidence regarding self-report measures assessing Internet addiction has been criticized.

METHODS

This study aimed to characterize 290 German treatment seekers and to determine the diagnostic accuracy of a self-report scale for Internet addiction. Patients filled in self-report measures (SCL-90R, PHQ, AICA-S - Scale for the Assessment of Internet and Computer game Addiction) and underwent diagnostic interviews to assess symptoms of Internet addiction and level of functioning.

RESULTS

Of the predominantly male treatment seekers 71% met the clinical diagnosis of Internet addiction. These displayed higher levels of psychopathology, especially depressive and dissociative symptoms. Half of the patients met criteria for one further psychiatric disorder according to clinical interviews, especially depressive disorders. Their level of functioning was decreased in all domains. AICA-S showed good psychometric properties and satisfying diagnostic accuracy (sensitivity: 80.5%; specificity: 82.4%).

DISCUSSION

In this sample, Internet addiction was associated with high levels of psychosocial distress that is mainly related to depressive symptoms. Co-morbid disorders were common among those patients. First analyses on diagnostic accuracy of AICA-S (using the therapist's rating on Internet addiction as an independent external criterion) showed promising results.

A cross-sectional online survey of compulsive internet use and mental health of young adults in Malaysia

Background:

The last decade has seen the emergence of the internet as the prime communication medium changing the way people live and interact. Studies from various countries have reported on internet addiction and its association with mental health, but none have come from Malaysia.

Objectives:

We aimed at assessing the frequency of the use of various internet applications and exploring the association of compulsive internet use with mental health and socio-demographic factors.

Materials and Methods:

A cross-sectional online survey was carried out among participants registered for the monthly opinion poll survey of University Tunku Abdul Rahman, Malaysia. The questionnaire contained socio-demographic information, the use of various internet applications on a five-point Likert scale, compulsive internet use scale (CIUS) and 12 item general health questionnaire (GHQ-12). Correlations and linear regression analyzes were carried out.

Results:

Of the 330 respondents, 182 were females and 148 were males. The mean age was 23.17 (SD = 3.84). Mean CIUS score was 19.85 (SD = 10.57) and mean GHQ score was 15.47 (SD = 6.29). Correlation coefficients of CIUS score with age, years of use and daily hours of internet use were −0.118 (P = 0.03), −0.014 (P = 0.81) and 0.242 (P < 0.001) respectively. Multiple linear regression analysis showed that age (β = −0.111, P = 0.033) and marital status (β = −0.124, P = 0.018) were negatively associated with CIUS scores whereas daily hours of internet use (β = 0.269, P = 0.001) and GHQ score (β = 0.259, P = 0.001) were positively associated with the CIUS score.

Conclusions:

Compulsive internet use was correlated with GHQ score. More research is needed to confirm our results. Psychologists may consider assessing internet addiction when evaluating young psychiatric patients.

Investigating risk factors for Internet gaming disorder: a comparison of patients with addictive gaming, pathological gamblers and healthy controls regarding the big five personality traits

Engaging in online games has become increasingly important as a part of leisure activity in adolescents and adults. While the majority of people use these games in a healthy way, epidemiological studies show that some develop excessive use and symptoms that are related to those of substance-related addictions. Despite increasing research concerning the epidemiology of internet gaming disorder (IGD), predisposing factors have been examined to a lesser extent. Knowing about specific risk factors would help clarify the nosological features of IGD and enhance prevention and intervention. This study aimed to evaluate the relationships between personality traits and IGD. A total of 115 patients meeting the criteria for IGD were compared to 167 control subjects displaying either regular or intense use of online games. Additionally, 115 patients meeting diagnostic criteria for pathological gambling were included. IGD was associated with higher neuroticism, decreased conscientiousness and low extraversion. The comparisons to pathological gamblers indicate that low conscientiousness and low extraversion in particular are characteristic of IGD. An integration of personality variables into an etiopathological model describing presumable mechanisms fostering and maintaining addictive online gaming is proposed. This model could be helpful for the theoretical understanding of addictive gaming, public health campaigns and psychoeducation within therapeutic settings.

Internet gaming addiction: current perspectives

In the 2000s, online games became popular, while studies of Internet gaming addiction emerged, outlining the negative consequences of excessive gaming, its prevalence, and associated risk factors. The establishment of specialized treatment centers in South-East Asia, the US, and Europe reflects the growing need for professional help. It is argued that only by understanding the appeal of Internet gaming, its context, and neurobiologic correlates can the phenomenon of Internet gaming addiction be understood comprehensively. The aim of this review is to provide an insight into current perspectives on Internet gaming addiction using a holistic approach, taking into consideration the mass appeal of online games, the context of Internet gaming addiction, and associated neuroimaging findings, as well as the current diagnostic framework adopted by the American Psychiatric Association. The cited research indicates that the individual’s context is a significant factor that marks the dividing line between excessive gaming and gaming addiction, and the game context can gain particular importance for players, depending on their life situation and gaming preferences. Moreover, the cultural context is significant because it embeds the gamer in a community with shared beliefs and practices, endowing their gaming with particular meaning. The cited neuroimaging studies indicate that Internet gaming addiction shares similarities with other addictions, including substance dependence, at the molecular, neurocircuitry, and behavioral levels. The findings provide support for the current perspective of understanding Internet gaming addiction from a disease framework. The benefits of an Internet gaming addiction diagnosis include reliability across research, destigmatization of individuals, development of efficacious treatments, and the creation of an incentive for public health care and insurance providers. The holistic approach adopted here not only highlights empirical research that evidences neurobiologic correlates of Internet gaming addiction and the establishment of a preliminary diagnosis, but also emphasizes the necessity of an indepth understanding of the meaning, context, and practices associated with gaming.

Addressing the question of disorder-specific risk factors of internet addiction: a comparison of personality traits in patients with addictive behaviors and comorbid internet addiction

Uncontrolled use of the internet has been reported to affect the lives of some users in a negative way. According to epidemiological studies, about 1% of the general population is showing signs of internet addiction. Since internet addiction is becoming a growing health concern, research on potential risk factors is becoming more important in order to develop strategies for prevention and to adopt therapeutic treatment. Although there are some studies investigating personality traits in internet addiction, most of these studies are based on samples of healthy subjects. In this research project, we compared personality profiles of a sample of patients in different rehabilitation centers. 70 patients with an addiction disorder that additionally met the criteria for internet addiction were compared to 48 patients suffering from alcohol dependence. Besides Big Five personality traits, we also assessed depressive symptoms. It was shown that patients with comorbid internet addiction can be discriminated from other patients by higher neuroticism and lower extraversion as well as lower conscientiousness. After controlling for depressive symptoms, lower conscientiousness especially turned out to be a disorder-specific risk factor. As internet addiction is related to unique patterns of personality traits and can be discriminated from alcohol dependence, treatment approaches are needed that meet the specific requirements of patients with internet addiction.

Problematic computer game use among adolescents, younger and older adults

AIMS

Playing digital games has been associated with forms of addictive behavior. Past research on the subject has often been criticized on theoretical and empirical grounds, due mainly to measurement or sampling issues. The present study aims to overcome these two limitations, and presents data from a representative study in Germany using an already established instrument for measuring problematic game use.

DESIGN

Large-scale, representative study using a computer-assisted telephone survey.

SETTING

Germany.

PARTICIPANTS

A total of 580 adolescents between 14 and 18 years of age, 1866 younger adults between 19-39 years and 1936 older adults aged 40 years and older (overall n = 4382).

MEASUREMENTS

Problematic game use was measured with the Gaming Addiction Short Scale (GAS), which covers seven criteria including salience, withdrawal and conflicts. Additionally, differential aspects of personality, as well as gaming behaviour, were measured.

FINDINGS

Only seven respondents [0.2%, 95% confidence interval (CI): 0.1, 0.3] met all criteria of the GAS Scale. In contrast, 3.7% (95% CI: 3.1, 4.3) of the respondents can be considered problematic users, meeting at least half these conditions. The percentage of problematic gamers among adolescents is above average (7.6%, 95% CI: 5.6, 10.1). High GAS scores are associated with aggression, low sociability and self-efficacy and lower satisfaction with life. Additionally, these scores correspond with intensive use and preferences for certain gaming genres across all age groups.

CONCLUSIONS

Following Gaming Addiction Short Scale criteria, gaming addiction is currently not a widespread phenomenon among adolescents and adults in Germany. Gaming Addiction Short Scale scores are associated with intensive use, as well as certain problematic aspects of individuals' personalities and social lives.