Depressive symptoms and depression in individuals with internet gaming disorder: A systematic review and meta-analysis

Bidirectional relationship between gaming disorder, internalizing psychopathology, psychological distress, and well-being: A systematic review with meta-analysis of longitudinal studies

There is a lack of a synthesis of longitudinal studies that clarify the relationship between gaming disorder (GD) symptoms and mental health. To address this gap, we undertook a systematic review with meta-analysis of longitudinal studies. The study protocol was preregistered online on PROSPERO (CRD42023407665). We included studies analyzing the association between GD or problematic/pathological videogame use, and internalizing psychopathology (depression and anxiety), psychological distress (loneliness and stress), and well-being (life satisfaction, quality of life, and well-being). Research articles were searched in PsycInfo, PsycArticles, PubMed, and Web of Science up until December 29, 2022.30 articles were considered for meta-analysis (N = 28,782). Effect sizes (partial correlation) were pooled using random-effects models. Sensitivity analyses excluded studies rated as "poor" - using the National Institutes of Health quality assessment tool for observational cohort studies - and Chinese studies. The associations between GD and subsequent depression, emotional mixed symptoms (i.e., a combination of internalizing symptoms) and life satisfaction were statistically significant. GD was not associated with subsequent anxiety. On the other hand, depression, anxiety, emotional mixed symptoms, life satisfaction and loneliness were significantly associated with subsequent GD. Overall, sensitivity analyses supported the robustness of the main results. In conclusion, this study found reciprocal longitudinal associations between GD and depression, life satisfaction, and emotional mixed symptoms, an effect of anxiety on GD (but not the inverse), and of loneliness on GD. However, the causal nature and practical relevance remain uncertain because effect sizes were small - or medium, depending on effect size guidelines - and based on observational studies.

Impact of internet gaming disorder on mental well-being: prevalence and psychological distress among adolescents and young adults

INTRODUCTION

The rapid advancement of technology has led to the emergence of Internet Gaming Disorder (IGD), characterized by excessive engagement in online gaming and significant impairment in daily functioning. The addictive nature of gaming has raised concerns about its psychological impact, particularly among adolescents and young adults.

METHODOLOGY

This cross-sectional study involved 548 participants aged 15 years and older, recruited from various educational institutions. Participants were categorized into IGD and regular gamer groups who were engaged in online gaming without meeting the diagnostic criteria for IGD. Data collection included demographic information, gaming habits, and psychological assessment using the Depression, Anxiety, and Stress Scale (DASS-21).

RESULTS

Of the participants, 18.79% were identified with IGD. Significant associations were found between IGD and various factors, including gender (p = 0.049), gaming partner (p = 0.034), gaming device (p = 0.042), time spent gaming (p = 0.041), duration of gaming (p = 0.031), and sleep duration (p = 0.04). Psychological evaluations revealed a strong correlation between gaming addiction and psychological distress. Participants with IGD reported significantly higher levels of depression, anxiety, and stress, with a notable proportion falling into the "severe" and "extremely severe" categories as classified by the DASS-21.

CONCLUSION

The findings underscore the significant prevalence of IGD and its adverse psychological impacts. This study highlights the urgent need for targeted interventions and mental health support for individuals displaying symptoms of gaming addiction. Further research is warranted to explore the long-term effects of IGD and to develop effective strategies for mitigating its psychological consequences.

The effect of reward learning on inhibitory control in internet gaming disorder: Evidence from behavioral and ERP

Reward dysregulation and deficits in inhibitory control significantly contribute to the development of internet gaming disorder (IGD). While prior research demonstrates that reward history influences individuals' inhibitory control, it remains unclear whether this effect extends to individuals with IGD. The primary aim of this study was to investigate whether individuals with IGD exhibit impairments in reward learning and whether prior reward learning influences their inhibitory control, using both behavioral and event-related potential (ERP) measures. This study first employed a probability selection task to examine potential impairments in reward learning among individuals with IGD. Next, a stop-signal task incorporating reward- and punishment-associated stimuli was used to further investigate the behavioral and electroencephalographic effects of prior reward learning on subsequent inhibitory control. Results revealed that during the reward-learning phase, the IGD group exhibited significantly longer response times than the control group in both the learning and transfer phases. Additionally, the feedback-related negativity amplitude in the IGD group was significantly lower than that in the control group. Conversely, the P3 wave amplitude induced by positive and negative feedback in the IGD group were significantly higher than in the control group. In the inhibitory control phase following reward learning, the Nogo-P3 wave amplitude in response to reward cues was significantly greater in the IGD group than in the control group. Moreover, within the IGD group, the Nogo-P3 wave amplitude evoked by reward cues was significantly larger than the amplitude evoked by loss cues. These findings suggest that reward learning is impaired in individuals with IGD and that stimuli with a prior reward history may compromise inhibitory control, potentially serving as a critical factor in addiction development in this population.

The Longitudinal Effect of Psychological Distress on Internet Addiction Symptoms Among Chinese College Students: Cross-Lagged Panel Network Analysis

BACKGROUND

There is a growing amount of evidence suggesting high rates of co-occurring internet addiction (IA) symptoms and psychological distress in youth. However, the extent to which IA symptoms develop over time, how they interact with psychological distress symptoms dynamically, and how they predict one another remain unclear. Additionally, what specific types of distress, including depression, anxiety, and stress, are more closely associated with IA symptoms remains inconclusive.

OBJECTIVE

This longitudinal study aimed to explore the development of and changes in IA symptoms over time and the directional relationship between IA and various psychological distress symptoms.

METHODS

This study followed a sample of 2497 Chinese college students (mean age 19.14, SD 0.72 years) across 3 waves of a data collection span of 2 years. Their IA and psychological distress symptoms were assessed at baseline (T1), 12-month follow-up (T2), and 24-month follow-up (T3). We used network analysis to examine the network structure of IA symptoms at each wave and cross-lagged panel network (CLPN) analysis to investigate longitudinal associations between IA symptoms and psychological distress, including depressive, anxiety, and stress symptoms.

RESULTS

The cross-sectional networks of IA symptoms at 3 time points showed high similarity in terms of structure, existence of edges, and centrality indices. Nodes A2 (excessive use), A1 (salience), and A5 (lack of control) emerged as nodes with the highest expected influence (EI) centrality in the IA symptom networks across time (A2: EI=1.13 at T1, 1.15 at T2, 1.17 at T3; A1: EI=1.10 at T1, 1.13 at T2, 1.15 at T3; A5: EI=0.86 at T1, 0.88 at T2, 0.92 at T3). CLPN analysis revealed that psychological distress predicts IA symptoms but not the other way around. Depressive symptoms played a key role in predicting various IA-related problems (T1 to T2, edge weight=0.11; T2 to T3, edge weight=0.28; T1 to T3, edge weight=0.22) and served as bridge symptoms connecting IA and psychological distress (T1 to T2: bridge-expected influence [BEI]=0.15; T2 to T3: BEI=0.14; T1 to T3: BEI=0.19).

CONCLUSIONS

Findings revealed a relatively stable network structure of IA symptoms among college students and suggested that psychological distress, especially depressive symptoms, may play a central role in activating IA symptoms over time. These results provide evidence for understanding the directional relationship between the central characteristics of distress symptoms and IA. The study also underscores the importance of depressive symptoms in their co-occurrence with IA, indicating that the key and bridge symptoms identified in this study can be prioritized as targets for preventing and treating IA in Chinese youth. Through identification and early intervention of depressive symptoms, we may avoid the progression of co-occurring issues, leading to more effective treatment outcomes.

Problematic gaming, problem gambling: co-occurrence and association with depression and generalised anxiety disorder among working-age adults in Latvia

AIMS

This study aimed to investigate the prevalence of problematic gaming and gambling and the co-occurrence of these behaviours in association with depression and generalised anxiety disorder in a representative general working-age adult population in Latvia.

METHODS

Data from a survey of 4,912 respondents aged 15-64 in the general population of Latvia were studied. The Game Addiction Scale, the Problem Gambling Severity Index, and the PHQ-9 and GAD-7 scales were used to obtain self-reported data for the target study variables. Descriptive statistics and binary logistic regression models assess the prevalence of the variables and estimate the odds ratios for depression and generalised anxiety disorder.

RESULTS

By adjusting for age, sex, and income level, both problematic gaming and gambling significantly increased the odds of depression and anxiety by an average of three times. The prevalence of the co-occurrence of problematic gaming and gambling was 0.8%, and it did not elevate the odds of depression and anxiety compared to having either problematic gaming or gambling alone, which maintains the overall threefold increase of both depression and anxiety (p < 0.05).

CONCLUSIONS

In the general adult population, the presence of problematic gaming and gambling indicates a higher likelihood for the individual burden of mental health problems due to the co-existence of depression or anxiety. Thus, the complexity of problematic gaming and gambling has to be taken into account when planning and implementing effective mental health interventions.

Association of Internet addiction with psychiatric symptom levels and sleep disorders: a systematic review and meta-analysis

Background

Maladaptive Internet use is defined as Internet addiction disorders (IAD), which can lead to psychological problems and sleep disorders. Although many studies on the correlation between Internet addiction, psychiatric symptom levels, and sleep disorders have been conducted in recent years, there is no meta-analysis to substantiate the connection between these variables.

Methods

We systematically searched databases including Web of Science, PubMed, Embase, and the Cochrane Library to collect relevant studies using keywords associated with Internet addiction, psychological problems, and sleep disorders. All comparable studies that provided sufficient data (e.g., correlation coefficients) were included in our analysis.

Results

41 studies were included, and the results indicated that IAD was associated with psychological problems and sleep quality at moderate to low levels (depression: r = 0.39, 95%CI = 0.34-0.45; SMD = 1.34, 95%CI = 0.81-1.86; OR = 0.86, 95%CI = 0.46-1.26; anxiety: r = 0.30, 95%CI = 0.23-0.37; OR = 0.90, 95%CI = 0.29-1.52; stress: r = 0.34, 95%CI = 0.29-0.38; OR = 1.76, 95%CI = 0.37-3.16; sleep problems: r = 0.26, 95%CI = 0.19-0.33).

Conclusion

This meta-analysis reveals that IAD is positively associated with depression, anxiety, and sleep problems, which indicates that individuals with IAD have an increased risk of depression, anxiety, and sleep problems. Hence, high attention should be paid to Internet addictive behaviors, and preventive and treatment measures should be adopted timely.

Systematic review registration

The publicly accessible registration record can be found at: https://www.crd.york.ac.uk/prospero/.

A cross-lagged panel network model on internet gaming disorder and depressive symptoms concerning preferences for game genres

BACKGROUND

Internet gaming disorder (IGD) is a prevalent behavioral addiction that co-occurs with depression. Little is known about how IGD and depression intercorrelate longitudinally at a symptom level. This study aimed to explore the directional relationships between IGD and depressive symptoms and identify the key symptoms in their comorbidity using cross-lagged panel network (CLPN) modeling.

METHODS

A sample of 601 young gamers (mean age = 23.76) in Hong Kong completed the Internet Gaming Disorder Scale - Short Form and Patient Health Questionnaire-9 semi-annually at two-time points. Autoregressive and cross-lagged effects between depressive and IGD symptoms were analyzed via CLPN while controlling gamers' preferences across five game genres in R.

RESULTS

The comorbidity was mainly driven from depressive symptoms to IGD symptoms, with a few weaker associations from IGD to depressive symptoms. 'Anhedonia' (out-/bridge-expected influence = 2.88; 0.03) and 'Motor problems' (out-/bridge-expected influence = 1.24; 0.03) from depression were the central and bridge symptoms to trigger the development of IGD symptoms, whereas 'continue gaming despite harm' (in-expected influence = 1.29) was the most consequent symptom. 'Anhedonia' (r = 0.17) and 'suicidal risk' (r = 0.15) to 'continuation despite harm' were the strongest paths connecting depression and IGD. Gamers who preferred First-Person Shooter games and Massively Multiplayer Online Role-Playing games were more vulnerable to depressive and IGD symptoms.

CONCLUSIONS

Our findings provide empirical support for the comorbidity between IGD and depression and clarify their directional relationships at a symptom level. We identify antecedent bridge symptoms as targets for preventing escalation of co-occurring issues.

Sociotropy and video game playing: Massively multiplayer online role-playing games versus other games

INTRODUCTION

Internet Gaming Disorder (IGD) is associated with several psychiatric disorders. Previous research on IGD has predominantly focused on Massively Multiplayer Online Role-playing Games (MMORPGs), considered to be pro-social games as they foster interpersonal relationships necessary for in-game progress. Sociotropy is a personality trait characterized by a cognitive approach to dealing with interpersonal relationships. Individuals with high sociotropy have a strong desire for approval from others. Beck's cognitive theory of depression posits that high sociotropy can lead to depressive symptoms when faced with interpersonal stress. We used the I-PACE model to account for the consequences of distal factors such as sociotropy on the development and maintenance of IGD. The aim of this study was therefore to compare MMORPG players with players of other game genres in terms of sociotropy, social anxiety and depression. We hypothesized that sociotropy could serve as a predictor of IGD, particularly among MMORPG players.

METHODS

A total of 233 French videogame players recruited from specialized internet gaming forums participated in the study via questionnaires. Different scales were used to assess depression and social anxiety symptoms, IGD intensity, and sociotropy and autonomy.

RESULTS & DISCUSSION

MMORPG players reported higher psychological distress than players of other game genres. For all players, sociotropy, rather than autonomy, was found to be a predictor of social anxiety symptoms and IGD intensity. Sociotropy and depression explained IGD intensity only for MMORPG players and not for players of other game genres. The social dimension appears to be more prominent among MMORPG players and could be one of the main personality traits predicting this specific internet gaming disorder. The treatment implications for internet gaming disorder are discussed.

Depression, Gaming Disorder, and Internet Addiction in Adolescents with Autism Spectrum Disorder

Adolescents with autism spectrum disorder (ASD) often have various psychiatric comorbidities, particularly depression. In recent years, gaming disorder (GD) and Internet addiction (IA) have been identified as common comorbidities of ASD. We administered three self-administered screening instruments to adolescents with ASD to assess the severity of depression, GD, and IA. The participants were 10-18-year-olds with ASD. They were asked to complete three questionnaires to assess depressive symptoms, GD, and IA: the Patient Health Questionnaire for Adolescents (PHQ-A), Ten-Item Internet Gaming Disorder Test (IGDT-10), and Internet Addiction Test (IAT). The total IGDT-10 score was calculated in two different ways: the original scoring version (IGDT-10-OV) and the modified version (IGDT-10-MV). Of the 74 respondents, 24.3% had moderate or severe depressive symptoms, 8.1% were identified as having possible GD according to the IGDT-10-OV, 39.2% were identified as having possible GD according to the IGDT-10-MV, and 27.0% were positive for IA according to the IAT. Two-group comparisons revealed that depressive symptoms were more strongly associated with IA than with GD. IA was associated with more depressive symptoms than GD. Since adolescents with ASD have difficulties with social communication, they are prone to isolation and feelings of loneliness. Longer screen times due to social isolation may be a risk factor for the development of GD/IA. Adolescents with ASD often exhibit a preference for visual processing but may struggle with verbal communication. Thus, they may find online spaces more comfortable for them to alleviate their feelings of loneliness.

Current Clinical Practices for Gaming Disorder and Related Issues in Primary Care Settings in Northern Japan: A Regional Survey in Sapporo

BACKGROUND

Gaming is a popular leisure activity among children and adolescents in Japan. Recently, gaming disorder (GD) has become a common issue in child and adolescent psychiatry. However, due to a severe shortage of child and adolescent psychiatrists (CAPs) in Japan, we hypothesized that young patients with GD and gaming-related problems may seek help at pediatric or general psychiatric clinics, which serve as primary care providers for children's mental health issues. In this study, we conducted a regional survey in Sapporo, Japan, to understand the current status of medical interventions for GD provided by pediatricians and psychiatrists.

METHODS

This was a cross-sectional survey conducted in a specific region of Japan. The subjects of this study were almost all pediatricians, psychiatrists, and CAPs practicing in Sapporo, Japan. A questionnaire was mailed to a total of 196 medical institutions. The survey included questions about clinical practices related to GD, such as experience in treating GD, common presenting symptoms in patients with GD, and psychiatric comorbidities associated with GD. Results were statistically compared between two groups: pediatricians and psychiatrists.

RESULTS

We received 60 responses, yielding a response rate of 30.6%. All collected response forms were considered valid, and only one response to the question about the percentage of patients with gaming-related problems was considered invalid because it was an outlier (answer of 80%). The rate of respondents who had encountered gaming-related problems was 53.8% (n=14) among pediatricians (n=26), 52.2% (n=12) among psychiatrists (n=23), and, as a reference, 81.8% (n=9) among CAPs (n=11). When asked about the proportion of patients with gaming-related problems among all the patients they had seen, pediatricians reported 0.6%, psychiatrists reported 2.9%, and CAPs reported 8.7%. Autism spectrum disorder (ASD) was the most commonly reported comorbid diagnosis associated with GD, followed closely by attention deficit hyperactivity disorder (ADHD). Depression and anxiety were the third most commonly reported comorbid conditions.

DISCUSSION

While many CAPs (81.8%) are already addressing gaming-related issues, only about half of pediatricians (53.8%) and psychiatrists (52.2%) are involved in such treatment. With the increasing number of children and adolescents engaging in online gaming, playtime has gradually increased, potentially leading to an increase in GD cases. The difference was that pediatricians were often consulted about somatic symptoms, while psychiatrists were typically required to manage behavioral issues, such as excessive spending on gaming, and psychiatric symptoms, such as anxiety. As the number of children and adolescents seeking medical care for gaming-related problems is expected to increase, it is anticipated that clinical guidelines will be developed to enable both pediatricians and psychiatrists to effectively manage these cases.

The rate of patients screened positive for gaming disorder/Internet gaming disorder among adolescents with mental health issues assessed by two screening tests: A nine-item screening test for GD (GAMES Test) and the Ten-Item Internet Gaming Disorder Test (IGDT-10)

Aim

The aim of this study is to estimate the rate of patients who screened positive for gaming disorder (GD) in ICD-11 among adolescents with psychiatric and/or developmental disorders by using two screening tests: a nine-item screening test for GD, GAMing Engagement Screening test (GAMES Test), and the Ten-Item Internet Gaming Disorder Test (IGDT-10).

Methods

Subjects were 257 adolescent patients attending a psychiatric clinic in Sapporo, Japan. They were asked to complete two questionnaires. The total score on the IGDT-10 was calculated by two different scoring methods, original version (OV) and modified version (MV). The three groups were also compared on the basis of their clinical diagnoses.

Results

Of the 203 respondents, 42 (20.7%) screened positive using the GAMES Test. With respect to the IGDT-10, only eight (3.9%) screened positive using the IGDT-10 OV scoring, while 55 (27.1%) screened positive using the IGDT-10 MV. The most notable finding was that the mean total scores on the GAMES Test and the IGDT-10 MV were significantly higher in the attention deficit hyperactivity disorder group than in the other two groups (depression and autism spectrum disorder).

Conclusion

The results of this study showed that adolescents with mental health problems had a higher rate of screening positivity on self-rated screening tools for GD than the general population. Because excessive gaming has a wide range of adverse effects on adolescents' mental health, early detection of probable GD is crucial. Screening for GD should be part of routine clinical practice.

Internet gaming disorder and depression mediated by impaired resilience and sleep distress: a three-wave longitudinal study among Chinese adolescents

AIMS

While the cross-sectional relationship between internet gaming disorder (IGD) and depression is well-established, whether IGD predicts future depression remains debated, and the underlying mechanisms are not fully understood. This large-scale, three-wave longitudinal study aimed to clarify the predictive role of IGD in depression and explore the mediating effects of resilience and sleep distress.

METHODS

A cohort of 41,215 middle school students from Zigong City was assessed at three time points: November 2021 (T1), November 2022 (T2) and November 2023 (T3). IGD, depression, sleep distress and resilience were measured using standardized questionnaires. Multiple logistic regression was used to examine the associations between baseline IGD and both concurrent and subsequent depression. Mediation analyses were conducted with T1 IGD as the predictor, T2 sleep distress and resilience as serial mediators and T3 depression as the outcome. To test the robustness of the findings, a series of sensitivity analyses were performed. Additionally, sex differences in the mediation pathways were explored.

RESULTS

(1) IGD was independently associated with depression at baseline (T1: adjusted odds ratio [AOR] = 4.76, 95% confidence interval [CI]: 3.79-5.98, p < 0.001), 1 year later (T2: AOR = 1.42, 95% CI: 1.16-1.74, p < 0.001) and 2 years later (T3: AOR = 1.24, 95% CI: 1.01-1.53, p = 0.042); (2) A serial multiple mediation effect of sleep distress and resilience was identified in the relationship between IGD and depression. The mediation ratio was 60.7% in the unadjusted model and 33.3% in the fully adjusted model, accounting for baseline depression, sleep distress, resilience and other covariates. The robustness of our findings was supported by various sensitivity analyses; and (3) Sex differences were observed in the mediating roles of sleep distress and resilience, with the mediation ratio being higher in boys compared to girls.

CONCLUSIONS

IGD is a significant predictor of depression in adolescents, with resilience and sleep distress serving as key mediators. Early identification and targeted interventions for IGD may help prevent depression. Intervention strategies should prioritize enhancing resilience and improving sleep quality, particularly among boys at risk.

Current Advances in Behavioral Addictions: From Fundamental Research to Clinical Practice

Gambling disorder is the only behavioral addiction recognized as a clinical disorder in DSM-5, and Internet gaming disorder is included as a condition requiring further research. ICD-11 categorizes gambling and gaming disorders as disorders due to addictive behaviors. Additional behavioral addictions may include compulsive sexual behavior disorder, compulsive buying-shopping disorder, and problematic use of social media. This narrative review summarizes the current state of knowledge regarding these five (potential) disorders due to addictive behaviors. All five (potential) disorders are clinically relevant and prevalent. Behavioral addictions frequently co-occur with other mental and behavioral problems, such as depression, anxiety, and attention deficit hyperactivity disorder. Validated diagnostic instruments exist, with empirical support varying across conditions. No medications have approved indications from regulatory bodies for behavioral addictions, and cognitive-behavioral therapy has the most empirical support for efficacious treatment. Given that behavioral addictions are prevalent, frequently co-occur with psychiatric disorders, may often go undiagnosed and untreated, and have been linked to poorer treatment outcomes, active screening and treatment are indicated. Public health considerations should be expanded, and impacts of modern technologies should be investigated more intensively. Treatment optimization involving pharmacotherapy, psychotherapy, neuromodulation, and their combination warrants additional investigation.

Blunted neural response to real-life social reward anticipation in internet gaming disorder: An event-related potential study

Recent research indicates that individuals with Internet gaming disorder (IGD) exhibit impaired social reward processing, evidenced by reduced neural sensitivity to real-life social reward. The aim of the present study is to further investigate the impaired processing of social reward anticipation and reward consumption in individuals with IGD, and explore the relationship between these two components. Using a social incentive delay task with game-related and real-life versions, combined with event-related potential (ERP) technology, we examined 25 individuals with IGD and 25 matched healthy game players. The results showed that, at the behavioral level, individuals with IGD showed significantly slower reaction times to real-life target stimuli compared with game-related target stimuli, which is not observed in healthy controls. At the neural level, the Cue-P3 elicited by real-life incentive cues in individuals with IGD was significantly smaller than that elicited by game-related incentive cues. However, these effects were no longer significant after adding depression and anxiety scores as covariates. There was no significant difference in reward positivity (RewP) elicited between the two types of reward consumption. Furthermore, individuals with IGD showed a positive correlation between Cue-P3 elicited by game-related social incentive cue and RewP elicited by game-related social reward. However, this effect was not observed in the healthy controls. In conclusion, the present study suggests that the blunted allocation of motivated neural attention resources to real-life social incentive cues in individuals with IGD may be the key mechanism underlying their impaired social reward processing. This impairment may be influenced by the higher levels of depression and anxiety symptoms commonly observed in individuals with IGD.

Young and adult patients with gaming disorder: Psychiatric co-morbidities and progression of problematic gaming

Background

Previous research suggests age-dependent differences in the progression of addiction, and evidence is accumulating, showing that an early initiation of gaming increases the risk for addiction. With the recent introduction of gaming disorder (GD) as a psychiatric diagnosis, there is a need to extend the knowledge of the clinical characteristics of patients seeking treatment for GD of all age groups. Compared to adolescents and young adults, less is known about treatment-seeking adults. This study aimed to investigate whether there are clinically relevant age-dependent differences among patients seeking treatment for GD.

Method

Participants were recruited among patients seeking treatment and fulfilling diagnosis for GD at an outpatient clinic specialized in the treatment of GD. During the study period, 142 patients went through assessment for GD at the clinic, 37 did not fulfill the diagnosis for GD, and 36 declined participation, leaving a sample of 69 patients (age range = 15-56) for analysis. The sample (men, n = 66; women, n = 3) was divided in two age groups: adolescents and young adults (25 years or younger) and adults (26 years or older). Gaming-related data and information about psychiatric co-morbidity was collected through structured clinical interviews and questionnaires.

Results

The adolescents and young adults (AYAs) reported a more rapid progression into problematic gaming than the adult group. The younger group developed problematic gaming four years faster than the adults. We also observed comparable clinical profiles in both groups. Both age groups had similar levels of GD as well as symptoms of psychiatric co-morbidities including possible attention deficit hyperactivity disorder (ADHD), autism spectrum disorders (ASD) and problematic gambling. We also noticed that half of our study population consisted of adults.

Conclusion

With the increasing prevalence of gaming in all age groups, it is unknown how the occurrence of GD will develop in different stages of life. We conclude that the adolescents and young adults had almost double as fast progression to problematic gaming than the adult group, highlighting the need for preventive strategies. The similarity in clinical profiles indicates that treatments with the same type of interventions could be offered to both age groups.

Prevalence of Internet Gaming Disorder, Depression, and Anxiety Symptoms Before and After the Pandemic

"Internet gaming disorder" (IGD) is a condition for further study in the DSM-5, with its prevalence estimated to be anywhere from 0.7% to 27.5% depending on the methodology used to measure it. Previous research has linked the symptoms of IGD to symptoms of depression and anxiety among college students. Methods: The current study explored the relationships between self-reported symptoms of IGD, depression, and anxiety in two small, non-overlapping samples of college students, one collected before the pandemic (n = 52) and another during the global pandemic (n = 89). Data on the time spent gaming, IGD, depression, and anxiety symptoms were collected via anonymous online surveys at a small Mid-Western liberal arts university. The samples differed significantly in age, likely due to the smaller incoming first-year class size as a result of many families deciding to defer the start of college in 2020. Conclusions: These findings partially support past research suggesting a small to moderate association between self-reports of IGD and depression symptoms. While the pandemic does not appear to have greatly changed the overall number of self-reported symptoms experienced or the time spent playing video games between the two samples, it may have exacerbated the relationship between these variables within the sample. The stronger relationship between symptoms of depression or anxiety and the time spent playing video games in the later sample may be particularly concerning if the trend continues, as it may lead to additional problematic gaming behavior in the future.

Depression, anxiety, and stress in young adult gamers and their relationship with addictive behaviors: A latent profile analysis

BACKGROUND

There is limited research examining latent profiles of gamers based on emotional variables, which has implications for prevention efforts. The study sought to identify young adult gamer profiles based on depression, anxiety, and stress, and to examine differences between the latent profiles in other addictive behaviors (i.e., tobacco, alcohol, cannabis, illegal substance use, gaming, and gambling).

METHODS

A total of 1209 young adults (Mage = 19.37, SD = 1.62; 55.3%males) reported past-year gaming. A latent profile analysis (LPA) was performed to identify distinct profiles, and a set of ANOVA and chi-square analyses characterized the profiles in terms of sociodemographic, addictive behaviors, and emotional variables.

RESULTS

LPA suggested a three-profile solution: profile 1 (n = 660, 'low emotional distress'), profile 2 (n = 377, 'moderate emotional distress'), and profile 3 (n = 172, 'high emotional distress'). Participants with 'moderate' and 'high emotional distress' were mostly women, showed greater gaming severity, higher prevalence of past-month substance use (i.e., tobacco and illegal drugs), and greater consequences of alcohol use.

LIMITATIONS

The cross-sectional nature of the study and sample being university students.

CONCLUSION

Findings revealed three distinct profiles of gamers, which differed in emotional, gaming, and substance use severity. Transdiagnostic prevention programs have the potential to provide significant benefits to college students by addressing the core processes (e.g., emotion regulation) that underlie substance use and gaming.

Mokken scale analysis of the Internet Gaming Disorder Scale-Short-Form and the Gaming Disorder Test

In recent years, research on disordered gaming has grown substantially with researchers developing different psychometric tools for assessing it. Two of the most prominent assessment tools are the Internet Gaming Disorder Scale-Short-Form (IGDS9-SF) and the Gaming Disorder Test (GDT), which evaluate disordered gaming under the American Psychiatric Association (APA) and the World Health Organization (WHO) frameworks, respectively. The main aim of this study was to assess and compare the scalability, reliability, and validity of both scales to determine if they effectively assess disordered gaming in a normative sample, through the Mokken Scale Analysis (MSA). A sample of 605 participants (42.31 % female, meanage = 23.98 years, SD = 9.21 years) was recruited for the present study. Results showed that both the IGDS9-SF and GDT were unidimensional, with all items presenting latent monotonicity fitting in the Monotone Homogeneity Model (MHM). Item characteristic curves did not intersect and presented with adequate fit in the Double Monotonicity Model (DMM). These findings further support the psychometric adequacy of the IGDS9-SF and GDT, attesting to their suitability to assess disordered gaming.

The symptom network of internet gaming addiction, depression, and anxiety among children and adolescents

Internet gaming addiction (IGA), depression, and anxiety are significant issues among children and adolescents, with substantial social implications. Understanding the specific characteristics of this relationship is crucial for developing effective prevention and intervention strategies. The present study employed network analysis to explore the symptom network of IGA, depression, and anxiety among 1,548 Chinese children and adolescents. The results showed that the core symptoms of IGA among children and adolescents were "tolerance", "withdrawal", and "conflict". There was no significant gender difference in the structure, global strength, and core symptoms of IGA. Although there were no significant differences in the structure of the symptom network of IGA among children and adolescents of different ages, there were significant differences in global strength and some core symptoms ("conflict"). The core symptoms of the comorbidity of IGA, depression, and anxiety in children and adolescents included "feeling downhearted and blue", "breathing difficulty", "difficult to work up the initiative to do things", and "withdrawal". The comorbidity network did not show significant gender and age differences in network structure, but there were significant gender differences in global strength. Furthermore, there were significant gender and age differences in some core symptoms. The social impact of these findings is profound, highlighting the need for targeted interventions in schools and communities to address IGA and its comorbidities. Our results also suggest that interventions should be tailored to consider gender and age differences to maximize effectiveness.

Circadian Typology and Physical Activity in Young Adults with Gaming Disorder

Background and Objectives: Exploring daily lifestyle characteristics in individuals with gaming disorder (GD) might identify underlying causes and intervention points. However, integrative and subjective assessments are lacking in studies on this topic. This study aimed to assess circadian typology and physical activity in young adults with GD. Materials and Methods: We recruited 60 participants with GD and 120 age- and sex-matched controls. GD and delayed sleep phase syndrome (DSPS) were diagnosed through structured interviews. Physical activity and sleep patterns were measured using actigraphy. Self-reported measures were chronotype and insomnia by using composite scale of morningness (CSM) and the Pittsburg insomnia rating scale (PIRS). Results: We found that DSPS and eveningness chronotype was more prevalent in the GD group than in the control group. The GD group also contained more participants with insomnia with higher PIRS and a longer time to fall asleep compared with the control group. The GD group had lower physical activity levels for daily calorie expenditure, daily steps, and daily walking distance compared with the control group. No significant differences were observed in body weight and sleep duration between these groups. Conclusions: Individuals with GD, compared to HC, exhibit an eveningness chronotype, poorer sleep quality, lower physical activity, and higher obesity risk, suggesting that lifestyle adjustments like increased exercise and earlier sleep might help modify habitual behaviors and potentially further provide a way to treat GD.

The Association Between Causality Orientation and Internet Gaming Disorder, and the Role of Sensation Seeking, Anxiety, and Depression

OBJECTIVE

Self-determination theory (SDT) deems that people have three causality orientations: autonomy orientation, control orientation, and impersonal orientation. Previous studies suggested that lower autonomy orientation or higher control and impersonal orientations may be associated with more addictive behaviors. Our study aimed to investigate if these associations exist in Internet gaming disorder (IGD), and if sensation seeking, anxiety, and depression could influence the associations between causality orientations and IGD symptoms.

METHODS

A total of 1,400 college students completed the Internet Gaming Disorder Scale, General Causality Orientation Scale, Brief Sensation Seeking Scale, Generalized Anxiety Disorder Scale, and Patient Health Questionnaire. Correlation, multiple linear regressions, structural equation model (SEM) analyses, and moderation analyses were conducted to explore the associations.

RESULTS

The control and impersonal orientations were positively associated with IGD symptoms, while the autonomy orientation was negatively associated with them. Moreover, SEM analyses showed that the autonomy-IGD relationship was totally mediated by anxiety and depression, the impersonal-IGD relationship was partially mediated by anxiety, and the control-IGD relationship was partially mediated by depression. Finally, the effects of causality orientations on IGD were moderated by sensation seeking.

CONCLUSION

Overall, autonomy orientation is linked to fewer gaming problems, whereas control and impersonal orientations are associated with more gaming problems. Moreover, the relationships between causality orientations and IGD symptoms are mediated by anxiety and depression and moderated by sensation seeking. Our findings inform theory on the motivations of gaming behaviors and may shed light on the prevention and intervention of IGD from the perspective of SDT.

The Social Processes of Excessive Online Gaming Homophily: Peer Selection or Influence?

Adolescents who befriend online game using peers may be at risk for initiated and continued excessive game use (online gaming use homophily). The present article examined how adolescents' severity of online gaming use related to their friends' online gaming behavior bi-directionally across a semester (peer selection or peer influence effect). Students from two universities completed three waves of online surveys within four and a half months (N = 3079; 33.6% female; Mage = 19.16; SD = 0.97). Random-intercepts, Cross-Lagged Panel Model (RI-CLPM) analyses revealed that peer selection and peer influence both promote online gaming use homophily in adolescents' friendship groups. Furthermore, participants were more likely to form new friendships with peers exhibiting similar online gaming behavior as their behavior, subsequently reinforcing their online gaming use behaviors within these relationships. These social processes may exhibit a time lag among girls, which needs to be confirmed through longer-term follow-up. In general, findings suggest that effective prevention programs targeting excessive online gaming should not only focus on promoting social influence skills but also consider the structure of peer environments.

The mediating role of social connectedness and negative cognitive emotion regulation in the association between problematic Internet use and depression among adolescents

Introduction

While the relationship between adolescent problematic Internet use (PIU) and depression has been extensively researched, few studies have investigated the role and mechanisms of social connectedness (SC) in this context. This study aimed to investigate the mediating effect of social connectedness (SC) and cognitive emotion regulation (CER) in the relationship between PIU and depression.

Methods

We conducted a cross-sectional study involving 9,407 adolescents aged 12-18 years in China from September 2022 to March 2023. We employed Young's 20-item Internet Addiction Test (IAT-20), the Social Connectedness Scale-Revised (SCS-R), the Cognitive Emotion Regulation Scale (CER), and the DSM-5 Level-2 Depression Scale to assess mental health outcomes. Logistic regression analysis was also performed to examine the independent association between the measured variables and depression. Mediation analysis was then conducted to evaluate the mediating roles of social connectedness and cognitive emotion regulation in the relationship between PIU and depression.

Results

We found that the prevalence of PIU was 21.8%. Offline SC (indirect effect: 0.112, 95% CI: 0.104-0.121) and negative CER (indirect effect: 00.140, 95% CI: 0.129-0.152) mainly played a parallel mediating role in the relationship between PIU and depression, along with online SC (on_SC) (indirect effect: 0.007, 95% CI: 0.005-0.010).

Discussion

These findings provide valuable insights into how PIU is associated with depression and highlight the importance of fostering real-life interpersonal interactions. However, the generalizability of this study's findings to other populations may be limited due to cultural factors.

Investigating the mechanisms of internet gaming disorder and developing intelligent monitoring models using artificial intelligence technologies: protocol of a prospective cohort

BACKGROUND

Internet gaming disorder (IGD), recognized by the World Health Organization (WHO), significantly impacts adolescent mental and physical health. With a global prevalence of 3.05%, rates are higher in Asia, especially among adolescents and males. The COVID-19 pandemic has exacerbated IGD due to increased gaming time from isolation and anxiety. Vulnerable groups include adolescents with poor academic performance, introverted personalities, and comorbid mental disorders. IGD mechanisms remain unclear, lacking prospective research. Based on Skinner's reinforcement theory, the purpose of this study is to explore the mechanisms of IGD from individual and environmental perspectives, incorporating age-related changes and game features, and to develop intelligent monitoring models for early intervention in high-risk adolescents.

METHODS

This prospective cohort study will investigate IGD mechanisms in middle and high school students in Shenzhen, China. Data will be collected via online surveys and Python-based web scraping, with a 3-year follow-up and assessments every 6 months. Unstructured data obtained through Python-based web scraping will be structured using natural language processing techniques. Collected data will include personal characteristics, gaming usage, academic experiences, and psycho-behavioral-social factors. Baseline data will train and test predictive models, while follow-up data will validate them. Data preprocessing, normalization, and analysis will be performed. Predictive models, including Cox proportional hazards and Weibull regression, will be evaluated through cross-validation, confusion matrix, receiver operating characteristic (ROC) curve, area under the curve (AUC), and root mean square error (RMSE).

DISCUSSION

The study aims to understand the interplay between individual and environmental factors in IGD, incorporating age-related changes and game features. Active monitoring and early intervention are critical for preventing IGD. Despite limitations in geographic scope and biological data collection, the study's innovative design and methodologies offer valuable contributions to public health, promoting effective interventions for high-risk individuals.

Prevalence and Characteristics of Female and Male Esports Players among Norwegian Youth: A General Population Study

Electronic sports (esports) have evolved into a major cultural phenomenon in the 21st century, mirroring traditional sports with organized, competitive play. This study investigates the prevalence of esports participation and characteristics of esports players among Norwegian adolescents. Using data from the Ungdata survey, a comprehensive web-based survey of Norwegian adolescents that includes questions on demographics, health, physical activity, social relations, and leisure activities such as gaming and esports, we analyzed responses from 70,695 students aged 16-18 years collected during 2021-2023. We conclude that about one out of twenty in the age group of 16-18 years actively engage in esports. The figure conceals significant gender differences: only 0.7% of girls, compared to 8.8% of boys, actively participate in esports. While female esports players differ noticeably from non-players on almost all indicators included in our analyses, the picture among boys reflects more similarities between esports players and other boys, than differences. Among the esports players, females almost consistently reported more negative experiences than males, including less physical socialization, lower self-rated health, higher rates of loneliness and sleeping problems, and a greater difficulty fitting in at school. Despite these negative aspects, esports players maintain close friendships similar to their non-playing peers.

Effectiveness and Acceptability of Cognitive Behavioral Therapy and Family Therapy for Gaming Disorder: Protocol for a Nonrandomized Intervention Study of a Novel Psychological Treatment

BACKGROUND

Gaming disorder (GD) is a new official diagnosis in the International Classification of Diseases, 11th Revision, and with its recognition, the need to offer treatment for the condition has become apparent. More knowledge is needed about the type of treatment needed for this group of patients.

OBJECTIVE

This study aims to evaluate the effectiveness and acceptability of a novel module-based psychological treatment for GD based on cognitive behavioral therapy and family therapy.

METHODS

This study is a nonrandomized intervention study, with a pretest, posttest, and 3-month follow-up design. It will assess changes in GD symptoms, psychological distress, and gaming time, alongside treatment satisfaction, working alliance, and a qualitative exploration of patients' and relatives' experiences of the treatment.

RESULTS

This study started in March 2022 and the recruitment is expected to close in August 2024.

CONCLUSIONS

This study evaluates the effectiveness and acceptability of a psychological treatment for patients with problematic gaming behavior and GD. It is an effectiveness trial and will be conducted in routine care. This study will have high external validity and ensure that the results are relevant for a diverse clinical population with psychiatric comorbidity.

TRIAL REGISTRATION

ClinicalTrials.gov NCT06018922; https://clinicaltrials.gov/study/NCT06018922.

INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID)

DERR1-10.2196/56315.

Comorbidity among symptoms of internet gaming disorder, social withdrawal, and depression in 3430 young people in Hong Kong: A network analysis

BACKGROUND

The present study aimed to examine the comorbidity among symptoms of internet gaming disorder (IGD), social withdrawal, and depression using the network perspective.

METHODS

An online survey recruited 3430 young people in Hong Kong (mean age = 19.4 years, 80.5 % male) via gaming channels in 2019. The participants completed the 9-item IGD Scale, Hikikomori Questionnaire, and Patient Health Questionnaire-9. Network analysis was conducted using R to estimate the central symptoms of IGD and depression in individual networks and identified the bridge symptoms in combined network of IGD, social withdrawal, and depressive symptoms.

RESULTS

All network models showed high stability. 'Withdrawal', 'Loss of control', and 'Tolerance' were the central IGD symptoms, while 'Depressed mood' and 'Self-blame/guilt' were the central depressive symptoms. The bridge symptoms were 'Gaming as escape or mood relief' from IGD cluster, 'Depressed mood' and 'Self-blame/guilt' from depression cluster, and 'Marked social isolation at home' and 'Significant distress due to social isolation' from social withdrawal cluster. The combined network showed no significant differences in network structure and global strength across gender and age groups.

LIMITATIONS

The cross-sectional sample only indicated undirected associations between the symptoms in the three clusters and could not model the intra-individual variation.

CONCLUSIONS

The present study provided the first results on the comorbidity among IGD, social withdrawal, and depression at a symptom level among Chinese young people via network analysis. The bridge symptoms highlight potential targets for interventions of comorbidity among the disorders.

Concurrent behavioral modeling and multimodal neuroimaging reveals how feedback affects the performance of decision making in internet gaming disorder

Internet gaming disorder (IGD) prompts inquiry into how feedback from prior gaming rounds influences subsequent risk-taking behavior and potential neural mechanisms. Forty-two participants, including 15 with IGD and 27 health controls (HCs), underwent a sequential risk-taking task. Hierarchy Bayesian modeling was adopted to measure risky propensity, behavioral consistence, and affection by emotion ratings from last trial. Concurrent electroencephalogram and functional near-infrared spectroscopy (EEG-fNIRS) recordings were performed to demonstrate when, where and how the previous-round feedback affects the decision making to the next round. We discovered that the IGD illustrated heightened risk-taking propensity as compared to the HCs, indicating by the computational modeling (p = 0.028). EEG results also showed significant time window differences in univariate and multivariate pattern analysis between the IGD and HCs after the loss of the game. Further, reduced brain activation in the prefrontal cortex during the task was detected in IGD as compared to that of the control group. The findings underscore the importance of understanding the aberrant decision-making processes in IGD and suggest potential implications for future interventions and treatments aimed at addressing this behavioral addiction.

Approach bias in individuals with Internet gaming disorder: Evidence from an event-related potential-based approach-avoid task

Individuals with Internet gaming disorder (IGD) often exhibit an approach bias towards gaming cues compared to non-gaming cues. Although previous studies suggested a positive correlation between approach bias and the severity of game use, the neuropsychological mechanisms that underpin the automatic action tendencies remain largely unexplored. The present study measured event-related potentials (ERPs) in 22 IGD and 23 healthy control (HC) participants who met the inclusion criteria, both groups conducted the Stimulus-Response Compatibility task (SRC), with their ERPs recorded during the task. Results revealed that the IGD group showed a significantly larger approach bias towards gaming cues (avoidance versus approach reaction time) compared to the HC group. The amplitude of P300 significantly increased, whereas N100 significantly decreased for game-approach compared to game-avoid for IGD compared to HC participants. The findings suggested that the enhanced integrated motivational value under compatible conditions as well as increased stimulus-response conflicts under incompatible conditions may contribute to the approach bias in IGD individuals. Further investigation on the intervention is prompted through longitudinal studies.

Comparing psychopathological symptoms, life satisfaction, and personality traits between the WHO and APA frameworks of gaming disorder symptoms: A psychometric investigation

INTRODUCTION

The inclusion of Internet Gaming Disorder (IGD) in the fifth revision of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) by the American Psychiatric Association and Gaming Disorder in the 11th revision of the International Classification of Diseases (ICD-11) by the World Health Organization requires consistent psychological measures for reliable estimates. The current study aimed to investigate the psychometric properties of the Gaming Disorder Test (GDT), the Ten-Item Internet Gaming Disorder Test (IGDT-10), and the Five-Item Gaming Disorder Test (GDT-5) and to compare the WHO and the APA frameworks of gaming disorder symptoms in terms of psychopathological symptoms, life satisfaction, and personality traits.

METHODS

A sample of 723 Swedish gamers was recruited (29.8% women, 68.3% men, 1.9% other, Mage = 29.50 years, SD = 8.91).

RESULTS

The results indicated notable differences regarding the estimated possible risk groups between the two frameworks. However, the association between gaming disorder symptoms and personality traits, life satisfaction, and psychopathological symptoms appeared consistent across the two frameworks. The results showed excellent psychometric properties in support of the one-factor model of the GDT, IGDT-10, and GDT-5, including good reliability estimates (McDonald's omega) and evidence of construct validity. Additionally, the results demonstrated full gender and age measurement invariance of the GDT, IGDT-10, and GDT-5, indicating that gaming disorder symptoms are measured equally across the subgroups.

CONCLUSION

These findings demonstrate that the IGDT-10, GDT-5, and GDT are appropriate measures for assessing gaming disorder symptoms and facilitating future research in Sweden.

Cognitive-behavioral statuses in depression and internet gaming disorder of adolescents: A transdiagnostic approach

To investigate the comorbidity of adolescent depression and Internet gaming disorder (IGD) and their shared and unique cognitive-behavioral factors (i.e., self-esteem, dysfunctional attitudes, hopelessness, and coping), a large-scale school-based survey was conducted among 3147 Chinese secondary school students in Hong Kong. Probable depression and IGD were screened using the Centre for Epidemiological Studies-Depression Scale and DSM-5 IGD checklist, respectively. Multinomial logistic regression was performed to identify the associations between different condition statuses and cognitive-behavioral factors. Four groups were identified, including comorbidity group (having probable depression and IGD), IGD group (having probable IGD alone), depression group (probable depression alone), and healthy group (neither condition). Comorbidity group showed the worst cognitive-behavioral statuses, followed by depression group and then IGD group. Compared with healthy group, those with lower self-esteem and higher hopelessness and dysfunctional attitudes were more likely to be classified into depression group and comorbidity group, while maladaptive coping was positively associated with all three disorder groups. The results suggest that depression and IGD may share common cognitive-behavioral mechanisms (e.g., maladaptive coping) but also own their uniqueness regarding specific factors (e.g., hopelessness and self-esteem). A transdiagnostic intervention approach targeting the common factors may effectively address the comorbidity.

Behavioral state-dependent associations between EEG temporal correlations and depressive symptoms

Previous studies have shown abnormal long-range temporal correlations in neuronal oscillations among individuals with Major Depressive Disorders, occurring during both resting states and transitions between resting and task states. However, the understanding of this effect in preclinical individuals with depression remains limited. This study investigated the association between temporal correlations of neuronal oscillations and depressive symptoms during resting and task states in preclinical individuals, specifically focusing on male action video gaming experts. Detrended fluctuation analysis (DFA), Lifetimes, and Waitingtimes were employed to explore temporal correlations across long-range and short-range scales. The results indicated widespread changes from the resting state to the task state across all frequency bands and temporal scales. Rest-task DFA changes in the alpha band exhibited a negative correlation with depressive scores at most electrodes. Significant positive correlations between DFA values and depressive scores were observed in the alpha band during the resting state but not in the task state. Similar patterns of results emerged concerning maladaptive negative emotion regulation strategies. Additionally, short-range temporal correlations in the alpha band echoed the DFA results. These findings underscore the state-dependent relationships between temporal correlations of neuronal oscillations and depressive symptoms, as well as maladaptive emotion regulation strategies, in preclinical individuals.

The association between childhood adverse experiences and internet addiction: A meta-analysis

Many studies have explored the association between adverse childhood experiences (ACEs) and Internet addiction (IA), yet the research findings on the association between them are inconclusive. We conducted a systematic search on 7 databases to identify the relevant studies published until January 2023, and analyzed the findings from 37 studies across 12 countries involving 45,364 participants aged 8 to 67 years (51 % women). Results indicated a positive correlation (r = 0.21) was found between ACE and IA around the world, which differed among continents. It was found that all ACE subtypes were significantly associated with IA (range r = 0.16 to 0.25). Meta-regression showed a stronger association among younger individuals without moderating effects of gender or publication year. In conclusion, this study sheds light on the significant association between ACEs and IA, emphasizing the need for targeted interventions and preventive measures. Future research could delve into specific interventions aimed at mitigating the impact of ACEs on IA, such as cognitive-behavioral therapies or metacognitive therapy interventions. Additionally, investigating cultural factors that may influence this association could provide valuable insights into tailored approaches for different populations. Understanding these dynamics is crucial for developing effective strategies to address IA and its underlying factors.

The association between problematic internet use and burnout: A three-level meta-analysis

BACKGROUND

Burnout has received considerable attention in recent years because of the adverse consequences for people. Theoretical perspectives propose that problematic internet use is a significant potential risk for burnout. Despite a plethora of studies showing a positive association between problematic internet use and burnout, there remains a contentious debate regarding the extent and direction of this association.

METHODS

This study aims to perform a three-level meta-analysis to evaluate the strength of the relationship between problematic internet use and burnout through a quantitative synthesis of eligible studies published until April 2023.

RESULTS

A total of 42 studies with 54,121 participants and 103 effect sizes were identified. The results indicated a positive, moderate, and significant association between problematic internet use and burnout. Furthermore, the subgroup analysis found that this association was moderated by population, dimension of burnout, and the measure of burnout, however, some study features (i.e., region, type of problematic internet use, gender, and publication year) could not explain the heterogeneity across individual studies.

LIMITATIONS

Studies included in the current meta-analysis mainly used cross-sectional designs, which limited the potential to make inferences on the causal relationship between problematic internet use and burnout.

CONCLUSIONS

Individuals with problematic internet use have exhibited higher levels of burnout. Overall, these findings develop a deeper understanding of this association between problematic internet use and burnout and have implications for the direction of future research and interventions.

Impaired control and gaming-related harm in relation to gaming Disorder

The concept of impaired control (IC) over gaming is an important element of assessment and interventions for problem gaming and gaming-related harm. Past studies have reported that gaming disorder (GD) is associated with various negative consequences, but there is limited research on the relationship between IC over gaming and negative outcomes. To address this gap, the study investigated the relationship between impaired control and gaming-related harm among individuals with self-identified gaming disorder. It was hypothesized that IC would be positively associated with gaming-related harm and harm severity. In addition, it was predicted that IC would be a significant predictor of harm when controlling for age, gender, psychological distress, and gaming urges. The current study recruited 513 participants through an online survey platform. The Impaired Control Over Gaming Scale (ICOGS) was used to measure IC, and modified items from Browne et al.'s taxonomy of gambling harms were used to assess gaming harm severity. The logistic regression results showed that IC was positively related to all forms of harm, after controlling for other variables. The predictive value of IC was similar across financial, psychological, relationship, social and work/school domains. These results supported the importance of IC as a mechanism that contributes to the experience of gaming-related harm, and the need to target IC in interventions for GD.

Problematic video gaming is negatively associated with bone mineral density in adolescents

Adolescent bone health may be negatively impacted by problematic video gaming (PVG) due to factors such as prolonged screen time, poor sleep quality, and increased depression. Although sedentary behaviors have been linked to decreased bone mass, there is limited research on how PVG impacts bone health. We aimed to evaluate the association between PVG and bone mineral density (BMD) in adolescents by comparing the BMD z-scores of adolescents with and without PVG and by identifying PVG-related risk factors that may affect low BMD scores. This cross-sectional study took place between May 2019 and August 2021 with 110 adolescents who played video games for at least two hours per day. Data on screen time, game genre, tobacco, alcohol, caffeine consumption, and vigorous physical activity status were recorded. PVG was assessed using the Internet Gaming Disorder-Short Form (IGDS9-SF), with scores ≤ 16 comprising the control group and > 16 the PVG group. Sleep quality was assessed by Pittsburgh Sleep Quality Index, and depression was evaluated by Children's Depression Inventory. Dual-energy X-ray absorptiometry measurements of femoral neck and lumbar spine BMD were compared between the two groups. The mean age of the participants was 14.2 ± 1.8 years, and 86.4% were males. The PVG group exhibited lower femoral neck z-scores (p = 0.013) and a higher proportion of adolescents with low femoral neck BMD risk (27.8% vs 9.7%, p = 0.041). Lumber spine z-scores did not differ (p = 0.271). Despite poorer depressive symptoms and sleep quality in the PVG group, they were not associated with low BMD risk (OR 1.02, 95% CI 0.97-1.08, p = 0.398 and OR 1.00, 95% CI 0.87-1.18, p = 0.972, respectively). Among all PVG-related risk factors, video game time (aOR = 1.22, 95% CI = 1.06-1.41, p = 0.006) and vigorous physical activity amount (aOR = 2.86, 95% CI = 0.93-8.76, p = 0.080) showed the strongest associations with femoral neck z-scores.  Conclusion: The results of this study, showing a negative association between PVG and femoral neck BMD in adolescents, underscore the importance evaluating, monitoring, and supporting lower extremity bone health in adolescents with PVG. What is Known: • Adolescents with problematic video gaming are at risk for depression, impaired sleep; sedentary lifestyle; consumption of tobacco, alcohol, and drugs; and high caffeine intake. • These risk factors might lead to compromised bone health. What is New: • Problematic video gaming is associated with the low femoral neck bone mineral density risk in adolescents. • Extended video game time and reduced physical activity are found to be the primary risk factors.

Translating the user-avatar bond into depression risk: A preliminary machine learning study

Research has shown a link between depression risk and how gamers form relationships with their in-game figure of representation, called avatar. This is reinforced by literature supporting that a gamer's connection to their avatar may provide broader insight into their mental health. Therefore, it has been argued that if properly examined, the bond between a person and their avatar may reveal information about their current or potential struggles with depression offline. To examine whether the connection with an individuals' avatars may reveal their risk for depression, longitudinal data from 565 adults/adolescents (Mage = 29.3 years, SD = 10.6) were evaluated twice (six months apart). Participants completed the User-Avatar-Bond [UAB] scale and Depression Anxiety Stress Scale to measure avatar bond and depression risk. A series of tuned and untuned artificial intelligence [AI] classifiers analyzed their responses concurrently and prospectively. This allowed the examination of whether user-avatar bond can provide cross-sectional and predictive information about depression risk. Findings revealed that AI models can learn to accurately and automatically identify depression risk cases, based on gamers' reported UAB, age, and length of gaming involvement, both at present and six months later. In particular, random forests outperformed all other AIs, while avatar immersion was shown to be the strongest training predictor. Study outcomes demonstrate that UAB can be translated into accurate, concurrent, and future, depression risk predictions via trained AI classifiers. Assessment, prevention, and practice implications are discussed in the light of these results.

Internet Addiction and Psychological Distress: Can Social Networking Site Addiction Affect Body Uneasiness Across Gender? A Mediation Model

Introduction

The Internet, with its unlimited information, revolutionary communication capabilities, and innovative potential to expand knowledge, is ubiquitous throughout the world, but it also has significant implications for users' mental health. Given the not yet clearly defined and distinguishable nosographic categories of online addiction and the resulting difficulties in describing the impact on users' mental health, the present cross-sectional study aimed to gain new insights into the relationship between Internet addiction (especially social networking site [SNS] addiction), psychological distress, and physical discomfort, as well as gender differences in impact among users.

Method

A sample of 583 Italian speakers (50.8% males; 48.7% females) with a mean age of 30.96 (SD = 12.12) completed an online survey in July 2021. A set of psychometric self-report instruments was administered to assess the study variables. Mediation analyses were performed for both the whole sample and across genders.

Results

The study found that men exhibited higher levels of Internet addiction and craving than women, but no differences were found for SNS addiction. Furthermore, indicators of psychological distress (i.e., anxiety, depression, stress, loneliness, insomnia, and self-esteem) mediated the association between SNS addiction and body uneasiness, with slight differences across genders.

Conclusion

This paper contributes to the existing literature on online addictive behaviors by also highlighting gender differences. The findings underscore the need for educational experiences that can prevent problematic use of the Internet and SNSs.

The Effects of Equine-Assisted Learning on Adolescents with Internet Gaming Disorder

During the COVID-19 pandemic, internet gaming became more popular as a way to cope with stress, but excessive gaming can lead to mental health issues like internet gaming disorder (IGD). IGD has serious consequences, especially among children and young adults, and the gaming industry's profits continue to grow. This study aims to understand the mental and behavioral health of adolescents with IGD participating in an equine-assisted learning (EAL) program and assess the changes in their addiction tendencies and emotional and behavioral problems. The results showed that the participants' tendency towards internet gaming addiction and emotional and behavioral problems decreased immediately after the EAL program, but they rose again a month later. This suggests the importance of ongoing program involvement. As COVID-19 restrictions ease worldwide, this study highlights the increasing risk of IGD. It suggests that EAL could be a valuable approach to treating behavioral addictions, including gaming addiction. While prior research has shown the effectiveness of EAL in treating substance addiction, more research is needed to explore its potential in treating various types of addictions, such as gambling or gaming addictions.

The interplay between mental health and dosage for gaming disorder risk: a brief report

The relationship between gaming time and gaming disorder can be moderated by other variables. This study aimed to test the moderating role of mental health. Participants (N = 461) were recruited online. Gaming time was a statistically significant predictor of gaming disorder risk, with an explained variance of 3.3%. The goodness of fit of the model that took into account both moderators (anxiety and depression) improved to 13.9%. The interaction between gaming time and both moderators was significant. The results showed that depression and anxiety acted as moderators of the dosage effect, possibly by amplifying the gratification of playing games and thus contributing to the development of gaming disorder. It may be important in practise, as it seems to place the mental health at the right place, namely among risk factors that can contribute to gaming disorder in combination with a key trigger, which is gaming.

Could the Construct of Modern-Type Depression Predict Internet Gaming Disorder in Italian Video Gamers? A Case-Control Study

A new postmodern depression type, named "Modern-Type Depression" (MTD), is emerging in Western countries. MTD is often underdiagnosed, mainly due to potentially higher comorbidity with technology-based addictions, including Internet Gaming Disorder (IGD). However, the definition of the relationship between MTD and IGD is still controversial, as few data have been published thus far. In particular, there are no data specifically investigating the prevalence of MTD within Italian young subjects with IGD, as well as their mutual association. Hence, within the SWATCH (Social Withdrawal and TeCno-mediated mental Health issues) project, our study aimed to identify the prevalence of MTD in a sample of Italian young adults who play video games by providing a clinical characterization of MTD within a group of IGD individuals (IGD+) versus a group without IGD (IGD-) who play video games. Our cross-sectional case-control study recruited a sample of 543 Italian young video-gaming players (aged 18-35) from the larger SWATCH database, stratified as IGD+ versus IGD-. Subjects were administered the 22-item Tarumi's Modern-Type Depression Trait Scale (TACS-22), the Motives for Online Gaming Questionnaire (MOGQ), and the Internet Gaming Disorder Scale-Short Form (IGDS9-SF). Around 21.7% of the total sample was represented by MTD individuals, while within the IGD sample, around 34% of subjects had MTD. Within the MTD group, significantly higher scores at IGDS-9SF (p < 0.001), MOGQ "Escape from reality" (p < 0.001), "Fantasy" (p < 0.001), and MOGQ total score (p = 0.003) were found compared to MTD-. According to the multivariate regression model, controlled for sex and age, higher scores in the TACS-22 were positively predicted by the total score of IGDS9-SF (p = 0.003), the MOGQ "Escape from Reality" subscale (p = 0.014), and MOGQ "Fantasy" (p = 0.011), and negatively predicted by the MOGQ "Competition" subscale (p = 0.035) [F (4538) = 17.265; p < 0.001]. Our findings suggested that MTD displays a strong association with IGD. Video-gaming players who do not have IGD appear to be less prone to MTD; this suggests that further studies could be carried out to specifically investigate whether pathological use of video games could also be determined by the presence of MTD.

Effects of Health-Promoting Lifestyle on Late-Onset Depression in Older Adults: Mediating Effect of Meaning in Life and Interleukin-6 (IL-6)

Purpose

Late-onset depression (LOD) with poor treatment response has high incidence and mortality in the China's aged people, this study aims to explore the correlation between health-promoting lifestyle, meaning in life, interleukin-6 (IL-6) and LOD for providing scientific basis of LOD prevention and rehabilitation.

Patients and Methods

A total of 496 LOD patients (study group) and healthy older adults (control group) were enrolled and investigated by using the Health-promoting lifestyle Profile-II, revised (HPLP-IIR), Meaning in Life Questionnaire-Chinese Version (MLQ-C), and Hamilton Depression Scale (HAMD). The interleukin-6 (IL-6) in the circulating blood was detected by utilizing ELISA kit.

Results

The results showed that the scores of all factors in HPLP-IIR and MLQ were significantly lower and IL-6 level was higher in the study group than the control group. Scores of most factors in HPLP-IIR and MLQ negatively and IL-6 positively correlated with scores of subscales and total HAMD score. Meaning in life and IL-6 partially mediated the relationship between health-promoting lifestyles and depression severity in the study group, with the mediating effect explains 15.76% and 22.64% of the total effect, respectively.

Conclusion

Health-promoting lifestyles, meaning in life, and IL-6 are predictors of LOD, and an unhealthy lifestyle could induce LOD through the mediating effect of meaning in life and IL-6 in older adults.

The emerging evidence on the association between symptoms of ADHD and gaming disorder: A systematic review and meta-analysis

The co-existence of gaming disorder (GD) with other mental health problems has been widely reported. Despite the growing research interest in the comorbidity of GD with attention-deficit/hyperactivity disorder (ADHD), to date, no quantitative synthesis has been performed. The present study comprised a systematic literature search using Scopus, Science Direct, Web of Science, and PubMed databases. Three types of studies were included in the analyses: studies reporting (i) correlation coefficients between the symptoms of GD and ADHD, (ii) means, and standard deviations for comparison of GD severity between ADHD/non-ADHD individuals, and (iii) comparison of ADHD severity between GD/non-GD individuals. The results indicated a moderate relationship between GD and ADHD symptom severity when both subdomains of ADHD were combined (r = 0.296), and also when only inattention (r = 0.306) or hyperactivity (r = 0.266) symptoms were analyzed, which was also confirmed in a structural equation model meta-analysis. Studies showed a large average difference comparing the GD symptom severity of ADHD and non-ADHD individuals (g = 0.693), or ADHD symptom severity of GD and non-GD individuals (g = 0.854). In some cases, higher estimates of association were reported among studies that (i) had a higher proportion of males, (ii) assessed problematic internet use among predominantly videogame player samples rather than assessing only GD, and (iii) had been more recently published. The present review shows that this is an emerging field demonstrating significant results in cross-sectional correlational studies. However, future research should apply more rigorous methodologies to investigate the relationship further (e.g., longitudinal studies and studies using professional/clinical ratings and diagnosis). These results suggest that screening and treatment for ADHD among individuals with gaming disorder is necessary, and individuals with ADHD should be made aware of their higher susceptibility to gaming disorder.

Gaming passion contributes to the definition and identification of problematic gaming

Even if for most people playing video games is a healthy leisure activity, a minority of vulnerable users present an excessive use associated to negative consequences (e.g., psychosocial maladjustment, sleep interference) and functional impairment. The current study first aims to identify psychological factors that contribute to discriminate highly involved (but healthy) gamers from problematic gamers. For that purpose, we used a cluster analysis approach to identify different groups of gamers based on their profiles of passion towards gaming (using the Dualistic Model of Passion). Another objective of the present study is to explore, using supervised machine-learning, how gaming disorder symptoms, assessed within the substance use disorder framework (e.g., tolerance, withdrawal), might be linked to harmonious and/or an obsessive passion for gaming. Three distinct clusters of gamers were identified based on their passion profiles, including risky gamers, engaged gamers, and casual gamers. Supervised machine-learning algorithms identified that specific gaming disorder symptoms (salience, mood modification, tolerance, low level of conflict) were predominantly related to harmonious passion, whereas others (withdrawal, high level of conflict, relapse) were more directly related to obsessive passion. Our results support the relevance of person-centered approaches to the treatment of problematic gaming.

Association between gaming disorder and regional homogeneity in highly involved male adult gamers: A pilot resting-state fMRI study

BACKGROUND

Gaming behavior can induce cerebral changes that may be related to the neurobiological features of gaming disorder (GD). Additionally, individuals with higher levels of depression or impulsivity are more likely to experience GD. Therefore, the present pilot study explored potential neurobiological correlates of GD in the context of depression and impulsivity, after accounting for video gaming behavior.

METHODS

Using resting-state functional magnetic resonance imaging (fMRI), a cross-sectional study was conducted with 35 highly involved male adult gamers to examine potential associations between GD severity and regional homogeneity (ReHo) in the entire brain. A mediation model was used to test the role of ReHo in the possible links between depression/impulsivity and GD severity.

RESULTS

Individuals with greater GD severity showed increased ReHo in the right Heschl's gyrus and decreased ReHo in the right hippocampus (rHip). Furthermore, depression and impulsivity were negatively correlated with ReHo in the rHip, respectively. More importantly, ReHo in the rHip was found to mediate the associations between depression/impulsivity and GD.

CONCLUSIONS

These preliminary findings suggest that GD severity is related to ReHo in brain regions associated with learning/memory/mood and auditory function. Higher levels of depression or impulsivity may potentiate GD through the functional activity of the hippocampus. Our findings advance our understanding of the neurobiological differences behind GD symptoms in highly involved gamers.

Emotion dysregulation and Internet gaming disorder in young people: Mediating effects of negative affect and metacognitions

BACKGROUND

Recent studies have found that emotion dysregulation, negative affect, and metacognitions about online gaming are risk factors for Internet gaming disorder (IGD). However, few studies investigated the mechanisms underlying these interactions. The present study aimed to explore the relationships between emotion dysregulation and IGD, and the mediating effects of negative affect and metacognitions about online gaming.

METHODS

An online survey was conducted with young people (aged 10-24 years) who played video games. 1768 participants were included in this study. Observed variables, including emotion dysregulation, IGD, depression, anxiety, and metacognitions, were measured with self-report scales. Structural equation modeling (SEM) was used to analyze the relationships among the variables.

RESULTS

The results showed that emotion dysregulation positively predicted IGD through a fully mediated model which included the independent mediating effects of negative affect and metacognitions about online gaming and their sequential mediating effect. The model explained 76.1 % of the variance in IGD.

LIMITATIONS

This was a cross-sectional study which could not infer causality.

CONCLUSIONS

This study emphasizes that negative affect and metacognitions about online gaming mediate the effect of emotion dysregulation on IGD; moreover, metacognition may be a proximal factor of IGD. Thus, improving emotional regulation and modifying maladaptive metacognitions in young people may improve the prevention and treatment of IGD.

No evidence that Chinese playtime mandates reduced heavy gaming in one segment of the video games industry

Governments around the world are considering regulatory measures to reduce young people's time spent on digital devices, particularly video games. This raises the question of whether proposed regulatory measures would be effective. Since the early 2000s, the Chinese government has been enacting regulations to directly restrict young people's playtime. In November 2019, it limited players aged under 18 to 1.5 hours of daily playtime and 3 hours on public holidays. Using telemetry data on over seven billion hours of playtime provided by a stakeholder from the video games industry, we found no credible evidence for overall reduction in the prevalence of heavy playtime following the implementation of regulations: individual accounts became 1.14 times more likely to play heavily in any given week (95% confidence interval 1.139-1.141). This falls below our preregistered smallest effect size of interest (2.0) and thus is not interpreted as a practically meaningful increase. Results remain robust across a variety of sensitivity analyses, including an analysis of more recent (2021) adjustments to playtime regulation. This casts doubt on the effectiveness of such state-controlled playtime mandates.

Problematic online behaviors and psychopathology in Australia

This study aimed to ascertain frequency rates and predictors of six problematic online behaviors (POBs) in an Australian sample. Participants (N = 1626) completed instruments measuring problematic online gaming, cyberchondria, problematic cybersex, problematic online shopping, problematic use of social networking sites, problematic online gambling, anxiety, depression and attention deficit/hyperactivity disorder (ADHD). Each POB was presumed to be present based on the cut-off score on the corresponding instrument and at least one indicator of interference with functioning. Generalized linear model analyses were used to determine socio-demographic and psychopathological predictors of each POB. The most common POB was problematic online shopping (12.2%), followed by problematic online gambling (11.4%), problematic use of social networking sites (6.0%), problematic cybersex (5.3%), problematic online gaming (5.2%) and cyberchondria (4.6%). Age group 27-36 had the highest rates of POBs. The intensity of ADHD symptoms predicted all POBs, whereas younger age predicted all POBs except for problematic cybersex and online gambling. Female gender predicted lower scores on the measures of problematic online gaming and cybersex. These findings have implications for age- and gender-adapted education, prevention and treatment efforts and suggest that specific POBs should be investigated separately instead of lumping them together under the umbrella terms such as "Internet addiction".