Digital risks and adolescents: The relationships between digital game addiction, emotional eating, and aggression

Prevalence and predisposing factors of digital game addiction and cyberbullying in adolescents: A cross-sectional study

OBJECTIVES

This research was conducted to measure the prevalence of digital game addiction and cyberbullying and their predisposing factors among adolescents.

STUDY DESIGN

A cross-sectional design.

METHODS

The sample consisted of 1002 adolescents (the mean age was 15.77 (SD = 1.08), and 95.1 % boys) from a vocational high school. Data were collected through a questionnaire, the Digital Game Addiction Scale, and the Revised Cyberbullying Inventory-II. Associations were analyzed with multiple logistic regression analyses.

RESULTS

The prevalence of digital game addiction was 41.5 %. The risk of digital game addiction was higher among adolescents who were cyberbullies (2.3 times), those who played games for 4 h or more (5.1 times), and those who played action/adventure (1.4 Times) and sci-fi games (1.5 times). The risk of cyberbullying was higher in adolescents who were addicted to digital games (2.3 times) or used the Internet for 5 h or more (2.2 times). Meeting on the Internet (2 times) and being a 9th-grader (2 times) compared to 10th and 11th-graders increased the risk of being a cyberbully.

CONCLUSIONS

The study concluded that about half of the adolescents were addicted to digital games, and the majority of them were cyberbullies. Common predisposing factor for digital game addiction and cyberbullying was found to be time spent on the Internet.

Exploring the Relationship Between Aggressive Behavior, Family Parenting Styles, and Self-Esteem Among Only-Child College Students in China: A Cross-Sectional Study

Background

The prevalence of aggressive behavior among adolescents in higher education settings, particularly within the unique context of China's one-child policy, has become an increasingly significant issue. This study aims to elucidate the interplay between aggressive behaviors, parenting styles, and self-esteem among college students who are only children.

Methods

Conducted as a cross-sectional study from September 2022 to September 2023, the research involved a sample of students from four higher education institutions in Anhui Province, employing a convenience sampling method stratified by year of study and academic major. A total of 5,700 college students participated, with 5,431 valid responses obtained, resulting in a 95.28% validity rate. The average age of the participants was 19.16 ± 1.1 years, with 50.19% male and 49.81% female. The Buss-Perry Aggression Questionnaire (BPAQ), a revised Chinese version of the short Egan's Memories of Parents' Education (s-EMBU) questionnaire, and the French version of the Rosenberg Self-Esteem Scale (R-SES) were utilized to assess levels of aggression, parental styles, and self-esteem, respectively. Data were analyzed using SPSS26.0 and SPSS PROCESS Macro.

Results

The findings revealed that only children exhibited significantly higher levels of physical aggression (19.26±5.33 vs 18.41±4.87, p < 0.001) and hostility (18.64±5.68 vs 18.30±5.33, p = 0.046) compared to their non-only child peers. Regression analysis showed that both paternal (β = 0.670, p = 0.004) and maternal rejection (β = 1.095, p < 0.001) positively predicted aggressive behavior, while self-esteem negatively correlated with aggression (β = -0.375, p < 0.001). Mediation analysis indicated that self-esteem partially mediated the relationship between parental rejection and aggression, accounting for 6.90% and 6.54% of the variance in paternal and maternal rejection, respectively. This suggests that self-esteem nurturing may be a potential strategy to reduce aggression among only-child college students.

Conclusion

The study concludes that nurturing self-esteem among only-child college students in China may be a pivotal strategy in curbing aggressive behaviors, underscoring the necessity to comprehend the intricate relationship between parenting styles, self-esteem, and aggression. The insights gained from this research are instrumental in enhancing social cohesion by addressing the distinctive needs of this demographic.

Impact of internet addiction and gaming disorder on body weight in children and adolescents: A systematic review

AIM

Internet use and gaming have increased in daily life. Internet addiction has not been recognised in the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition or 11th Revision of International Classification of Diseases despite gaming addiction having been listed since 2013. Previous studies have shown an association between internet use and weight gain or disordered eating patterns in the general population, however none have addressed this association in a paediatric population. The aim of this study is to investigate the relationship between internet addiction or gaming addiction and weight in children and adolescents under 18 years of age.

METHODS

A systematic search of electronic databases was conducted, and articles were screened for relevance. The Joanna Briggs Institute (JBI) 3 critical appraisal tool was used to assess quality of studies. Due to heterogeneity of the studies, a meta-analysis could not be performed, thus a narrative summary was performed with the results summarised and tabulated.

RESULTS

Of 8114 initial articles identified, we included 14 studies. The review produced inconsistent results, with three of the 14 studies demonstrating no statistically significant relationship between internet and/or gaming addiction and obesity. The remaining 11 studies showed a statistically significant positive association. One study demonstrated that those who are underweight as well as overweight and obese were more likely to have problematic internet use. Four articles demonstrated increased rates of poor nutritional habits, poor eating patterns and weight control behaviour in children and adolescents with internet addiction or gaming disorder. Another study showed no statistically significant association between internet addiction and disordered eating or eating disorder.

CONCLUSION

Most of the available studies revealed increased rates of obesity in children and adolescents with internet addiction or gaming disorder, with poor patterns of eating. Clearer definitions and consistent use of terminology are required to enable more robust research in this field.

Digital addiction: Are children in danger? Are parents aware?

PURPOSE

To determine the digital game addiction levels of secondary school students and to examine the parental awareness against digital game addiction levels of students.

DESIGN AND METHODS

This is a descriptive and correlational study. The population of the study consisted of students in a secondary school and 392 students were included in the study. The data were collected using the "Digital Parenting Awareness Scale (DPAS)," and "Digital Game Addiction Scale for Children (DGAS-child form). In the study, Kurtosis and Skewness coefficients were used for normal distribution; mean, standard deviation, percentage, and frequency were used to evaluate quantitative data; and Pearson chi-square analysis was used to make correlational inferences.

RESULT

The DGAS mean score of the students was 47.31 ± 16.19. The results of the study showed that the parents had high level of digital awareness. It was found that the students' DGAS mean score had a weak positive correlation with RM subscale of DPAS and a moderate positive correlation with DN subscale of DPAS. DGAS mean score had a weak negative correlation with EU and PR subscales of DPAS. Parents-children's age did not affect the levels of DGAS and DPAS.

CONCLUSION

Raising parents' digital awareness reduces digital game addiction in their children.

PRACTICAL IMPLICATIONS

One of the most important roles of nurses is education. Parent trainings for children to use digital devices correctly and efficiently contribute to improving digital awareness of parents and protecting/promoting child health.

A cross-sectional descriptive analysis of technology addiction in adolescents: associations with food addiction, emotional eating, and body weight status

BACKGROUND

This cross-sectional descriptive study aimed to determine the prevalence and risk factors of technology addiction (TA) in adolescents, as well as investigate the association of TA with food addiction and emotional eating by body weight status.

METHODS

Adolescents (n = 1388) completed a questionnaire that featured socio-demographic characteristics, the Game Addiction Scale (GAS), the Social Media Disorder Scale (SMD), the dimensional Yale Food Addiction Scale for Children 2.0 (dYFAS-C 2.0), and the Emotional Eating Scale Adapted for Use in Children and Adolescents (EES-C). The body mass index (BMI) Z-score was classified according to the World Health Organization.

RESULTS

TA was present in one-fifth of adolescents, and boys were four times more likely to develop a digital game addiction (p < 0.001). A 1-point increase in the GAS score is associated with a 1.08-point increase in the dYFAS-C-2.0 score and a 0.5-point increase in the total EES-C score (p < 0.001). A 1-point increase in the SMD score was also related to an increased of 1.21 and 1.26, respectively (p < 0.001). All of these positive associations were significant in adolescents with overweight (p < 0.001).

CONCLUSIONS

Given the rapidly increasing prevalence of TA among adolescents, its association with food addiction, emotional eating, and body weight status is worrisome, and our findings shed light on the relevance of developing strategies to reduce the prevalence of TA in this population.

The effect of digital game addiction on aggression and anger levels in adolescents: A cross-sectional study

PURPOSE

In this study, it was aimed to determine the effect of digital game addiction on aggression and anger levels in adolescents.

DESIGN AND METHODS

The participants of this cross-sectional study were adolescents. Data were collected using a socio-demographic questionnaire, Game Addiction Scale, and Buss-Perry Aggression Scale. Descriptive statistics, t-test, Anova, correlation and linear regression analysis were used in the analysis of the data.

RESULTS

In this study, game addiction and aggression levels of adolescents were determined as moderate. The game type that adolescents played the most was determined as war games with 35 %. The mean score of the Game Addiction Scale for male adolescents, those with medium and high income levels, those who play digital games for >8 h a day and every day, was found to be significantly higher. In this study, a positive and moderately significant correlation was found between Game Addiction Scale and Aggression Total Scale and Anger subscale (p < 0.05). Especially male gender (β = 0.273), high income status (β = -0.089), long time playing digital games (β = 0.173) and playing digital games every day (β = 0.360) were determined as predictors that increase game addiction.

CONCLUSIONS

Digital game addiction can trigger aggression and anger in adolescents. Nurses play a crucial role in screening and identifying adolescents at risk of game addiction to prevent aggression and anger.

PRACTICE IMPLICATIONS

According to the findings of this research, it is necessary to provide training and counseling to prevent digital game addiction in schools and to plan strategies by psychiatric nurses.

Sociodemographic Factors Associated with Video Game Addiction in Schoolchildren from the South-Central Region of Chile

Video game addiction is a worldwide concern, particularly in schoolchildren where it has impact on academic, social, and emotional spheres. The objective of this study was to determine the sociodemographic factors associated with video game addiction in schoolchildren from the south-central region of Chile. Methods: An analytical cross-sectional study that included a sample of 308 schoolchildren was performed. Sociodemographic factors were analyzed and levels of video game addiction was assessed using the Video Game Addiction Test (VAT) developed by Chóliz and Marco. A general linear regression model (ANCOVA) (α = 0.05) was applied (STATA v16). The prevalence of video game use was 82.7%, while addiction reached 10%. Risk factors associated with the increased risk of addiction were as follows: being male (β = 13.99; p < 0.001); being in the care of another relative (β = 11.1; p < 0.001); a higher number of people in the household (β = 11.2; p < 0.001); the caregiver in employment (β = 12.8; p < 0.001); and not performing extracurricular physical activity (β = 9.9; p < 0.001).

The impact of artistic and sporting activities on children's levels of digital addiction, aggression, and psychological resilience

OBJECTIVE

This study aims to investigate the effects of engaging in artistic and sporting activities on children's levels of digital addiction, aggression, and psychological resilience.

MATERIAL AND METHOD

This cross-sectional study encompasses children aged 11-12 who are regularly engaged and not engaged in artistic or sporting education. The study involved 623 children. Data collection utilized the "Digital Addiction Scale," "Child and Adolescent Psychological Resilience Scale," and "Reactive and Proactive Aggression Scale."

RESULTS

The study found statistically significant effects of engaging in sporting and artistic activities on digital addiction, psychological resilience, and reactive aggression (p < 0.05). Compared to the group with no activity, children engaged in artistic activities scored -4.38 units lower on the digital addiction scale, while those engaged in sports scored -4.23 units lower. Similarly, compared to the group with no activity, children engaged in artistic activities scored 3.32 units higher on the psychological resilience scale, and those engaged in sports scored 3.30 units higher. As children's psychological resilience scores increased, their scores for digital addiction and aggression decreased.

CONCLUSION AND RECOMMENDATIONS

Participation in such activities can help children acquire healthy coping skills, strengthen their emotional regulation abilities, and reduce problems associated with anger. Therefore, encouraging children to engage in these activities is crucial for contributing to their overall well-being and promoting a balanced lifestyle.

IMPLICATIONS FOR NURSING PRACTICE

Nurses can educate families about the importance of sports and artistic activities for the healthy development of children. Moreover, diversifying the activities offered to children in schools and youth centers and encouraging these activities can help promote healthy lifestyles and reduce digital addiction.

Adolescent Health and Dark Personalities: The Role of Socioeconomic Status, Sports, and Cyber Experiences

By investigating the impact of dark personality traits on adolescent health, this study explores the interplay among economic disadvantage, spectator sports involvement, and cyber victimization. We analyzed data from 1844 students aged 13-17 in a school district in the USA, and our findings reveal positive associations between economic disadvantage and both Machiavellianism and psychopathy, influencing negative emotions-driven eating. Spectator sports engagement exhibits links with Machiavellianism and narcissism, suggesting potential drawbacks to competitive behaviors. Cyber victimization shows associations with psychopathy and negative emotions-driven eating. The results illuminate the dynamic associations between emotional eating and health outcomes, including BMI and perceived quality of life. These findings deepen our understanding of how dark personality is shaped and subsequently influences adolescents' well-being, offering insights for targeted interventions.

A controversial issue in adolescents: Is the effect of digital games on creative personality traits positive or negative?

AIM

This study aimed to determine the effect of digital games on the creativity of adolescents.

METHODS

This study was designed as a cross-sectional study using simple random sampling following the STROBE checklist. It was conducted with 384 adolescents between January and June 2022. Data were collected using the Digital Game Addiction Scale for Children and the Creative Personality Traits Scale.

RESULTS

The adolescents were at risk for digital game addiction and had moderate creativity levels. The adolescents who had a male sex, had mothers who received primary education, started playing digital games before the age of 6 years, were using the internet for >5 h a day, had no activity other than playing digital games, and preferred action, adventure, and fighting games had higher digital game addiction levels than the other adolescents. In addition, the male adolescents had higher creativity levels than the female adolescents. There was a significant negative relationship between digital game addiction and creative personality traits among the adolescents. Digital game addiction had a negative effect on creativity.

CONCLUSIONS

Adolescents are at risk for digital game addiction and have moderate creativity levels. Digital game addiction negatively affects the development of creative personality traits. Interventions should be planned to prevent digital game addiction among adolescents, and adolescents should be guided to increase awareness of the effects of digital games on their creativity.

Impulsivity and aggression as risk factors for internet gaming disorder among university students

Internet gaming addiction is a global problem, especially among young individuals. Exhibiting characteristics similar to other addictions, Internet Gaming Disorder (IGD) is linked to adverse mental health outcomes. Identified as risk factors for dependence behaviors, the association of impulsivity and aggression with IGD is relatively under-researched in the student population. The present sample of 350 university students (Mage = 21.30 years, SDage = 4.96 years) from Najran university in Saudi Arabia completed an online questionnaire that included the Internet Gaming Disorder Scale-Short-Form (IGDS9-SF), the Buss-Perry Aggression Questionnaire-Short Form, and the Barratt Impulsiveness Scale (BIS-15). Results indicated that impulsivity and aggression were positively associated with IGD severity and both personality traits explained 34.6% of the variance in IGD scores. Further bivariate analyses suggested that individuals spending 7 or more hours on internet gaming were more likely to exhibit high impulsivity and aggression, and had a relatively higher severity of IGD. These results suggest that individuals with these personality traits may be more vulnerable to developing an addiction to internet gaming. These findings need to be confirmed in future more robust studies; however, this exploratory study provides insights for potential programs to prevent IGD among young individuals.

Social Networking Site Use and Emotional Eating Behaviors among Chinese Adolescents: The Effects of Negative Social Comparisons and Perspective-Taking

Emotional eating has emerged as a significant disordered eating and public health concern among adolescents. Despite the widespread prevalence of social networking site (SNS) use among this population, research investigating the influence of SNS use on adolescent eating behaviors remains limited. This study is to examine the impact of SNS use on emotional eating among Chinese adolescents, with a specific focus on exploring the mediating role of negative social comparisons and the moderating effect of perspective-taking. Data were obtained through an online survey involving 778 middle school students in China. The findings indicate that SNS use exerts a positive influence on adolescents' engagement in emotional eating, with this association being mediated by the presence of negative social comparisons. Perspective-taking demonstrated a protective role in the context of adolescents' utilization of social media platforms. For individuals characterized by high levels of perspective-taking, the effects of SNS use on negative social comparisons are mitigated, subsequently reducing its impact on emotional eating.

Unveiling common psychological characteristics of proneness to aggression and general psychopathology in a large community youth cohort

Elevated aggression in individuals with psychiatric disorders is frequently reported yet aggressive acts among people with mental illness are often intertwined with proneness to aggression and other risk factors. Evidence has suggested that both general psychopathology and proneness to aggression may share common psychological characteristics. This study aims to investigate the complex relationship between general psychopathology, proneness to aggression, and their contributing factors in community youth. Here, we first examined the association between proneness to aggression and the level of general psychopathology in 2184 community youths (male: 41.2%). To identify common characteristics, we trained machine learning models using LASSO based on 230 features covering sociodemographic, cognitive functions, lifestyle, well-being, and psychological characteristics to predict levels of general psychopathology and proneness to aggression. A subsequent Gaussian Graph Model (GGM) was fitted to understand the relationships between the general psychopathology, proneness to aggression, and selected features. We showed that proneness to aggression was associated with a higher level of general psychopathology (discovery: r = 0.56, 95% CI: [0.52-0.59]; holdout: r = 0.60, 95% CI: [0.54-0.65]). The LASSO model trained on the discovery dataset for general psychopathology was able to predict proneness to aggression in the holdout dataset with a moderate correlation coefficient of 0.606. Similarly, the model trained on the proneness to aggression in the discovery dataset was able to predict general psychopathology in the holdout dataset with a correlation coefficient of 0.717. These results suggest that there is substantial shared information between the two outcomes. The GGM model revealed that isolation and impulsivity factors were directly associated with both general psychopathology and proneness to aggression. These results revealed shared psychological characteristics of general psychopathology and proneness to aggression in a community sample of youths.

Effects of digital game addiction on cardiovascular health behavior on secondary school students during the COVID-19 pandemic

PURPOSE

This study aimed to investigate factors affecting digital game addiction in secondary school students during the COVID-19 pandemic and the effects of digital game addiction on cardiovascular health behavior.

DESIGN AND METHODS

This descriptive, correlational, and cross-sectional study was conducted with 619 secondary school students aged 10-14 years. Study data were analyzed using World Health Organization AnthroPlus and SPSS programs. Simple linear regression and multiple linear regression methods were used in the analysis process.

RESULTS

Findings showed that 43.6% of the students played digital games for more than two hours a day. Descriptive characteristics (gender, age, basal metabolic rate, educational status of parent, income status, etc.) and digital gaming habits of the students accounted for 37.0% of the variance in digital game addiction. Digital game addiction adversely affected cardiovascular health behavior and all its sub-dimensions.

CONCLUSION

The first factor that predicted digital game addiction, in order of significance, was daily digital game playing time. Digital game addiction negatively affected the sedentary lifestyle sub-dimension of cardiovascular health behavior most. Digital game addiction may trigger an increase in the incidence of diseases such as diabetes, cancer, and especially cardiovascular diseases, at later ages.

PRACTICE IMPLICATIONS

Nurses, schools, and parents have critical responsibilities in preventing digital game addiction. Results of this research will make a remarkable contribution to the development of preventive services by revealing risk factors for digital game addiction and the effects of digital game addiction on cardiovascular health behavior.

Increased adolescent game usage and health-related risk behaviors during the COVID-19 pandemic

This study examines adolescent game usage and corresponding health-related risk behaviors during a period of limited social interaction and activity due to the COVID-19 pandemic. Participants included 225 middle- and 225 high-school students in Seoul who completed a survey online from October 1 to 30, 2021. The study measured participants' game usage level and the health-related risk behavior index. Findings showed that participants who engaged in excessive gaming showed higher levels of health-related risk behaviors. A multivariate analysis of variance was conducted to compare the health-related risk behaviors of students in the general, potential, and high-risk groups on excessive gaming. Results indicated that female students in the high-risk group showed higher stress levels and fatigue (f = 5.549, p < .01, Cohen's d = 0.016) than the males of the same group. However, male students showed higher physical inactivity levels (f = 3.195, p > .05, Cohen's d = 0.009) than females. The post hoc test indicated clear sex distinctions among the general, potential, and high-risk groups on excessive gaming (p < .001). Among the high-risk game usage group, female students displayed a higher level of risk behaviors than males. Adolescent gaming addiction should be considered an emotional and behavioral disorder for which parental guidance and support are needed, and counseling experts and professionals must come together to provide a cure and reform program.

Structural equation modeling analysis of risk factors for digital game addiction in adolescents: A web-based study

AIM

Digital game addiction warrants study as it has serious negative impacts on adolescents' lives. This study aims to examine digital game addiction in adolescents and its factors.

METHODS

This cross-sectional study sample consisted of 297 students among 2400 students enrolled in four high schools located in Turkey's Mediterranean region. Data were collected from the adolescents using the Digital Game Addiction Scale for Children between September and December 2021. The STROBE checklist was used for reporting.

RESULTS

The study found that adolescents who are male, who started playing digital games before the age of six, whose play is unlimited and unsupervised, who play for >10 h a day, who play digital games on the computer, and who do not participate in any other activities are the most at-risk group for digital addiction.

CONCLUSIONS

Starting to play digital games in early childhood, and having unlimited and unsupervised play increases the risk of digital game addiction. It is recommended that school-based intervention programs are designed to prevent and reduce digital game addiction. In this regard, awareness projects, involving teachers, adolescents, and parents should be planned.

The role of life satisfaction in the association between problematic technology use and anxiety in children and adolescents during the COVID-19 pandemic

The main aim of this study is to explore problematic technology use among adolescents (Internet, video games, mobiles, and television) and its association with anxiety symptoms. Furthermore, we also analysed the possible moderating role of life satisfaction in this relationship during the COVID-19 pandemic in Spain. A cross-sectional survey of 4025 children and adolescents (52% females and 48% males) between 12 and 18 years old was carried out to explore problematic technology use and its correlation with anxiety and life satisfaction after pandemic lockdown. Four multivariate regressions containing the independent variable (problematic technology use), the moderator (life satisfaction), and their interaction were entered to predict the outcome (anxiety). The moderated models were examined using SPSS PROCESS macro software (Model 1). Analyses showed significant positive correlations with anxiety and negative correlations with life satisfaction regarding problematic technology use (mobile phone, television, and internet). Both gender and age had a significant direct effect on anxiety (showing that women and older participants had the greatest anxiety). In the moderation analysis, when life satisfaction was higher, the presence of anxiety symptoms depended to a greater extent on the problematic use of technology. Our results confirm that problematic technology use is related to higher levels of anxiety in adolescents, with differences by age and gender. The results also showed that life satisfaction mediated the relationship between technology abuse and anxiety, such that when life satisfaction was higher, the presence of anxiety symptoms was more dependent on problematic technology use. These findings have implications for health and education professionals.

Internet gaming disorder and aggression: A meta-analysis of teenagers and young adults

Background and aims

Internet gaming disorder (IGD) and aggression (AG) are widespread phenomena around the world. Numerous studies have explored the relationship between the two but findings from such studies are inconsistent. The meta-analysis aimed to evaluate the relationship between IGD and AG as well as identify the variables moderating the relationship.

Method

Studies investigating the relationship between IGD and AG were searched using selected terms to identify studies published from 1999 to 2022 on CNKI, Wanfang Data, Chongqing VIP Information Co., Ltd. (VIP), Baidu scholar, ProQuest dissertations, Taylor & Francis, Springer, Web of Science, Google Scholar, Elsevier Science (Science Direct), EBSCO, and PsycINFO. The identified studies were pooled and analyzed.

Results

A total of 30 samples comprising 20,790 subjects were identified. Results showed that there was a moderate relationship between IGD and AG (r = 0.300, 95%CI [0.246, 0.353]). Moderator analysis revealed that the relationship between IGD and AG was moderated by the region, age, and survey year.

Conclusion

This meta-analysis indicated that people with a higher level of IGD might show more aggression, and people with more aggression might have a higher level of IGD. The correlation coefficient between IGD and AG was significantly higher in Asia than in Europe, higher in primary school than in middle school and university, and higher by increasing year. Overall, our findings provide a basis for developing prevention and intervention strategies against IGD and AG.

Systematic review registration

https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42022375267, 42022375267.

Longitudinal Relationship between Cognitive Function and Health-Related Quality of Life among Middle-Aged and Older Patients with Diabetes in China: Digital Usage Behavior Differences

BACKGROUND

Cognitive function and health-related quality of life (HRQoL) are important issues in diabetes care. According to the China Association for Aging, it is estimated that by 2030, the number of elderly people with dementia in China will reach 22 million. The World Health Organization reports that by 2044, the number of people with diabetes in China is expected to reach 175 million.

METHODS

Cohort analyses were conducted based on 854 diabetic patients aged ≥45 years from the third (2015) and fourth (2018) survey of the China Health and Retirement Longitudinal Study (CHARLS). Correlation analysis, repeated-measures variance analysis, and cross-lagged panel models were used to measure the difference in digital usage behavior in the established relationship.

RESULTS

The results show that the cognitive function of middle-aged and older diabetic patients is positively correlated with HRQoL. HRQoL at T1 could significantly predict cognitive function at T2 (PCS: B = 0.12, p < 0.01; MCS: B = 0.14, p < 0.01). This relationship is more associated with individual performance than digital usage behavior.

CONCLUSIONS

Unidirectional associations may exist between cognitive function and HRQoL among middle-aged and older Chinese diabetes patients. In the future, doctors and nurses can recognize the lowering of self-perceived HRQoL of middle-aged and older diabetic patients, and thus draw more attention to their cognitive function, in turn strengthening the evaluation, detection, and intervention of their cognitive function.