Childhood internalizing, externalizing and attention symptoms predict changes in social and nonsocial screen time

BACKGROUND

While accumulating research has tested the hypothesis that screen time causes psychiatric symptoms in children, less attention has been paid to the hypothesis that children with psychiatric symptoms change their patterns of screen time and digital media use. We aimed to test whether children with psychiatric symptoms subsequently change their patterns of screen time and digital media use.

METHODS

N = 9,066 children primarily aged 9-10 in the Adolescent Brain Cognitive Development Study at baseline and 1-year later. Psychiatric symptoms included internalizing, attention, and externalizing symptoms. Screen time was measured as ordinally defined weekday and weekend time on social and nonsocial [e.g., YouTube] digital media). Models assessed psychiatric symptoms as predictors of screen time, and screen time as predictors of psychiatric symptoms, controlled for baseline measures of each, sex, age, race/ethnicity, and income.

RESULTS

Children with psychiatric symptoms spent more time on non-social media one year later compared with peers. Considering total psychiatric problems, clinical levels of problems predicted higher levels of weekday (OR = 1.22, 95% CI 1.22-1.23) and weekend (OR = 1.10, 95% CI 1.09-1.11) nonsocial screen time. For nearly all analyses of psychiatric symptoms predicting screen time, associations were highest for a non-social screen time outcome rather than a social screen time outcome (Highest OR = 1.65, 95% CI 1.63-1.67, clinical rule breaking predicting weekday nonsocial screen time). Comparable magnitude associations were observed for social and nonsocial media use predicting future psychiatric symptoms, suggesting bidirectionality.

CONCLUSION

Children with psychiatric symptoms have different subsequent media use patterns, including higher rates of subsequent nonsocial engagement. Ensuring that ongoing data collection and analysis efforts attend to temporality and transitions in the relation between media use and psychiatric symptoms will accelerate progress in the field.

Annual Research Review: Sex, gender, and internalizing conditions among adolescents in the 21st century - trends, causes, consequences

Internalizing conditions of psychopathology include depressive and anxiety disorders; they most often onset in adolescence, are relatively common, and contribute to significant population morbidity and mortality. In this research review, we present the evidence that internalizing conditions, including depression and anxiety, as well as psychological distress, suicidal thoughts and self-harm, and fatal suicide, are considerably increasing in adolescent populations across many countries. Evidence indicates that increases are currently greatest in female adolescents. We present an epidemiological framework for evaluating the causes of these increases, and synthesize research on whether several established risk factors (e.g., age of pubertal transition and stressful life events) and novel risk factors (e.g., digital technology and social media) meet conditions necessary to be plausible causes of increases in adolescent internalizing conditions. We conclude that there are a multitude of potential causes of increases in adolescent internalizing conditions, outline evidence gaps including the lack of research on nonbinary and gender nonconforming populations, and recommend necessary prevention and intervention foci from a clinical and public health perspective.

Video games and disability-a risk and benefit analysis

Purpose

Over the past decades, video games have become a substantial part of the entertainment industry. While ubiquitous, video game participation remains low among people with disabilities amid potential negative effects. This article analyzes the risks and benefits that video games may present to individuals with disabilities.

Methodology

In this conceptual article, we explored the literature pertaining to video games and disability. To better understand the impact of video games on individuals with disabilities, we focused on the unique features of video games through the lens of the Self-Determination Theory.

Findings

Our findings show that individuals with disabilities are most at risk from excessive video game use, leading to increased aggression, sedentary behavior, and negative impact on academic performance. Identified benefits include promoting physical rehabilitation and psychological well-being, improving cognitive abilities and emotional regulation, and utility in promoting exercises, and managing chronic pain.

Originality

This article presents a number of strategies and resources to help guide individuals with disabilities, educators, practitioners, and researchers in maximizing the benefits of video games while controlling the risks.

Video gamers demonstrate superior bronchoscopy skills among beginners

While previous research has explored the connection between video gaming and medical procedures, studies on the connection between video gaming and bronchoscopy techniques are lacking. This study aimed to investigate how video gaming experience influences bronchoscopy skills, particularly among beginners. This study was conducted at Fukujuji Hospital from January 2021 to October 2023. Twenty-three participants were assigned to the inexperienced group, and eighteen participants were assigned to the experienced group. The observational time during bronchoscopy, measured using a simulator, and the playing time of SPLATOON 2 (NINTENDO Co. Ltd., Japan) were analyzed. Video gaming skills were assessed based on game completion time, with shorter times indicating faster task completion. Participants were also divided into gamer and nongamer subgroups for further comparisons. A moderate linear relationship existed between bronchoscopic observation time and game completion time in the inexperienced group (r = 0.453, p = 0.030). However, no correlation was found in the experienced group (r = 0.268, p = 0.283). Among the inexperienced group, the gamer subgroup (n = 12) exhibited significantly shorter bronchoscopic observation times than did the nongamer subgroup (n = 11) (median [range]: 200 [129-229] s) vs. 281 [184-342] s, p = 0.005). This study demonstrated a relationship between bronchoscopy technique and video gaming skills among individuals with little bronchoscopy experience.

An umbrella review of the benefits and risks associated with youths' interactions with electronic screens

The influence of electronic screens on the health of children and adolescents and their education is not well understood. In this prospectively registered umbrella review (PROSPERO identifier CRD42017076051 ), we harmonized effects from 102 meta-analyses (2,451 primary studies; 1,937,501 participants) of screen time and outcomes. In total, 43 effects from 32 meta-analyses met our criteria for statistical certainty. Meta-analyses of associations between screen use and outcomes showed small-to-moderate effects (range: r = -0.14 to 0.33). In education, results were mixed; for example, screen use was negatively associated with literacy (r = -0.14, 95% confidence interval (CI) = -0.20 to -0.09, P ≤ 0.001, k = 38, N = 18,318), but this effect was positive when parents watched with their children (r = 0.15, 95% CI = 0.02 to 0.28, P = 0.028, k = 12, N = 6,083). In health, we found evidence for several small negative associations; for example, social media was associated with depression (r = 0.12, 95% CI = 0.05 to 0.19, P ≤ 0.001, k = 12, N = 93,740). Limitations of our review include the limited number of studies for each outcome, medium-to-high risk of bias in 95 out of 102 included meta-analyses and high heterogeneity (17 out of 22 in education and 20 out of 21 in health with I2 > 50%). We recommend that caregivers and policymakers carefully weigh the evidence for potential harms and benefits of specific types of screen use.

Psychological distress and aggression among adolescents with internet gaming disorder symptoms

The present study aimed to investigate the current situation of internet gaming disorder (IGD) in Chinese adolescents and explore the impact of IGD-related factors on adolescent aggression. We hypothesized that IGD symptoms in adolescents would be associated with aggressive behavior and that risk factors for IGD symptoms could increase the aggressive tendencies of adolescents. To verify the above hypothesis, a cross-sectional survey of junior and senior high school students from southern, southwestern, central, and eastern China was conducted. A total of 9306 valid questionnaires were collected. The results showed that the prevalence of IGD symptoms was 1.78 % among Chinese adolescents. The adolescents in the disordered gamer group had the most severe IGD symptoms, with the highest levels of psychological distress and aggression. Interestingly, adolescents in the casual gamer group had the lowest psychological distress and aggression scores. Linear regression analysis further showed that higher levels of aggression were significantly associated with male sex, younger age, more severe psychological distress and IGD symptoms, and more violent game exposure. Our results suggested that excessive online gaming not only contributes to psychological distress in adolescents but also increases their levels of aggressive behavior. Apart from male sex and younger age, severe IGD symptoms and psychological distress are the most important predictors of the development of aggressive behavior.

Application and challenges of a metaverse in medicine

Metaverse has been confirmed as a relatively amorphous concept of innovation, which refers to technological advancement. Metaverse, i.e., a coalition between reality world and virtual world, has created significant significance and convenience in education, communication, economy, etc. The COVID-19 outbreak has stimulated the growth of metaverse applications in medicine. The above-mentioned technology has broad applications while comprising online remote medical treatment, online conferences, medical education, preparation of surgical plans, etc. Moreover, technical, security, and financial challenges should be tackled down by the future widespread use of metaverse. Metaverse is limitlessly promising, and it will exert a certain effect on future scientific and technological advancements in the medical industry. The review article primarily aims to summarize the application of the metaverse in medicine and their challenge in the future of medicine.

A new variation of modern prejudice: young Korean men's anti-feminism and male-victim ideology

In South Korea, anti-feminism is now rapidly spreading online among young men, who have started to identify themselves as a social minority or "victims" of female power. Despite its ramifications, theoretically, anti-feminism is indistinct from the racism and sexism of White men that emerged more than half a century ago. In view of this, it shares the same root as typical modern racism or sexism, although it appears to be a novel phenomenon. Such a hypothesis was buttressed by quantifying the attitudes of anti-feminists toward various outgroups based on the transference of prejudice theory. Moreover, the subtle sexist undertones hidden in their arguments have been discussed using various psychological theories and empirical data/statistics. Additionally, various potential factors that may shape or accelerate their attitudes or behaviors have been discussed on the basis of the threat-defense theory. Through comprehensive literature review based on this theory, this study proposes the features related to Korean anti-feminism, encompassing behavioral/situational (overindulging violent or degrading Internet contents, verbal aggression), relational/epistemic (ostracism, attachment insecurity, pseudo-rationalism), and group-level (provocative interactions, polarization) attributes, some of which may also influence groups other than young men and ingrain or exacerbate the extreme ideologies of other groups, including young women. Scrutinizing Korean online anti-feminism and male-victim ideology may improve our understanding of the psychological origins of various social extremities or radical ideologies beyond cultural barriers.

Relations between Video Game Engagement and Social Development in Children: The Mediating Role of Executive Function and Age-Related Moderation

The global proliferation of video games, particularly among children, has led to growing concerns about the potential impact on children's social development. Executive function is a cognitive ability that plays a crucial role in children's social development, but a child's age constrains its development. To examine the association between video game engagement and children's social development while considering the mediating role of executive function and the moderating role of age, a questionnaire was distributed to a sample of 431 parents. The results revealed a negative relation between video game engagement and social development in children, with executive function found to mediate this relation fully. Additionally, the negative association between video game engagement and executive function became more pronounced as children grew older. In light of these findings, it is advisable to adopt proactive strategies to limit excessive video game use, consider the developmental characteristics of children at different ages, and prioritize the promotion of executive function to facilitate social development among children.

Attention-deficit hyperactivity disorder in children is related to maternal screen time during early childhood in Taiwan: a national prospective cohort study

BACKGROUND

It is unclear to familial screen time in early childhood is associated with the subsequent diagnosis of attention-deficit and hyperactivity disorder (ADHD). Our study is to evaluate the association between screen time during early childhood in families and the incidence of ADHD.

METHODS

We conducted a population-based birth cohort study by using the Taiwan Birth Cohort Study, which recruited 24 200 mother-child pairs when children were 6 months old. Screen time exposure for children and parents were collected at the age of 18 and 36 months. Whether the child has ever been diagnosed with ADHD was determined at a follow-up interview at age 8. Factors including socioeconomic factors and screen time were analyzed using logistic regression to determine their association with the rate of ADHD.

RESULTS

A total of 16 651 term singletons were included in the final analysis. Of them, 382 (2.3%) were diagnosed as having ADHD before the age of 8 years. No significant relationship between children's or fathers' screen time and ADHD was noted. When compared to children whose mothers spent less time on screens, those whose mothers spent more than 3 h a day on screens when the child was 3 years old exhibited a higher incidence of ADHD (adjusted OR [aOR]: 1.31, 95% CI: 1.03-1.66).

CONCLUSION

Higher maternal screen time when the child was 3 years old was associated with an increased incidence of ADHD in this population-based study. However, children's screen time did not find related to ADHD. We found that it was the mother's screen time, who typically serves as the primary caregiver in our study participants, not the child's, that mattered. In addition to superficial screen use time, future research is needed to replicate the findings and clarify mechanisms underlying this association.

Emotional and Behavioral Correlates of Exposure to Electronic Media in School-Aged Children: A Prospective Study

BACKGROUND

Exposure to electronic media is increasing from early childhood. This study aimed to examine the association between screen time and behavioral outcomes in school-aged children with a prospective birth-cohort.

METHODS

We examined the association between screen time and behavioral outcomes in school-aged children with a Korean birth-cohort study. Participants were 2,150 children, recruited during their fetal period, assessed annually for developmental outcomes. Media exposure was assessed at T4 (3.2 y/o), T8 (7.3 y/o), and T10 (9.4 y/o). After exclusions for missing data, 1,368 children were categorized into four groups (Low-Low, Low-High, High-Low, and High-High) based on average daily media time in early childhood and during schooldays, respectively. Children's temperament was assessed from T1 (0.5 y/o) to T4. Emotional and behavioral outcomes were assessed using the Child Behavior Checklist (DSM-oriented subscales) at T8 and T10.

RESULTS

We found that early-years temperament was generally similar between the media-time groups: they only differed significantly on Activity at T1 and Emotionality at T2 (1.2 y/o). However, compared to the Low-Low group, the Low-High group had significantly higher odds of high-risk scores for Conduct Problems (increased odds ratios [ORs] of 1.82 at T8 and 1.83 at T10) and Anxiety Problems (increased ORs of 1.60 at T8 and 1.82 at T10). Self-rated self-esteem and overall happiness at T10 also significantly differed among the four groups.

CONCLUSION

Our findings suggest the negative impacts of media exposure on the emotional and behavioral development of school-aged children, which substantiates the guidelines that restrict media exposure during childhood.

Screen media exposure and young children's vocabulary learning and development: A meta-analysis

This meta-analysis synthesizes research on media use in early childhood (0-6 years), word-learning, and vocabulary size. Multi-level analyses included 266 effect sizes from 63 studies (Ntotal  = 11,413) published between 1988-2022. Among samples with information about race/ethnicity (51%) and sex/gender (73%), most were majority White/Non-Hispanic and between 40%-60% female. Analyses revealed a small overall positive relation between screen media exposure and vocabulary (r = .23). Experimental studies yielded a small-to-medium effect (r = .30), with stronger effects for e-books than TV/video or games/apps, and non-significant effects for video chat. In correlational studies, there was no overall association between vocabulary size and naturalistic media exposure (r = .07), with the exception of naturalistic exposure to educational media (r = .17).

Video Game Use, Aggression, and Social Impairment in Adolescents with Autism Spectrum Disorder

We used parent report data to investigate video game playing, aggression, and social impairment in adolescents with autism spectrum disorder. Parents of autistic adolescents were more likely to report that their child plays video games as a hobby compared to parents of adolescents with typical development and also reported that their children spent more time playing video games. For autistic participants, we found no differences in aggression levels or social impairment when comparing players versus non-players. However, playing video games "more than average," as compared to "average" was associated with greater aggression and greater social impairment on "awareness" and "mannerisms" subscales. Future studies should focus on how type of video game(s) played is associated with these clinically important variables.

Earlier smartphone acquisition negatively impacts language proficiency, but only for heavy media users. Results from a longitudinal quasi-experimental study

There is a growing debate about the proper age at which teens should be given permission to own a personal smartphone. While experts in different disciplines provide parents and educators with conflicting guidelines, the age of first smartphone acquisition is constantly decreasing and there is still limited evidence on the impact of anticipating the age of access on learning outcomes. Drawing on two-wave longitudinal data collected on a sample of 1672 students in 2013 (at grade 5) and 2016 (at grade 8), this study evaluates whether obtaining the first personal smartphone at 10 or 11 years old, during the transition to lower secondary school (early owning), affected their language proficiency trends compared to receiving it from the age of 12 onwards (late owning). Results indicate an overall null effect of smartphone early owning on adolescents' language proficiency trajectories, while a negative effect is found on those who were already heavy screen media users before receiving the device.

The Prevalence of Video Game Addiction and Its Relation to Anxiety, Depression, and Attention Deficit Hyperactivity Disorder (ADHD) in Children and Adolescents in Saudi Arabia: A Cross-Sectional Study

Background and objective Video games have become a popular source of entertainment among children and adolescents, not only targeting the young generation but also increasingly popular among older demographics as well. This study aimed to assess the association between video game addiction and depression, anxiety, and attention deficit hyperactivity disorder (ADHD) among children and adolescents in Saudi Arabia. Materials and methods This was a cross-sectional study involving Saudi adolescents aged 12-16 years. A self-administered online survey was distributed on social media (Twitter, WhatsApp, and Snapchat). The survey addressed sociodemographic characteristics (i.e., age, gender, area of residence city, etc.). Arabic versions of the Patient Health Questionnaire-9 (PHQ-9), the seven-item Generalized Anxiety Disorder Scale (PHQ-GAD7), the ADHD Rating Scale-IV (ADHD-RS), and the seven-item Game Addiction Scale (GAS-7) questionnaires were distributed as well, including Arabic terms for depression, anxiety, and ADHD. Results A total of 393 surveys were completed (males: 58.3% vs. females: 41.7%). Of note, 63.1% of the respondents reported playing video games every day with an average of more than five hours of gaming time per day (25.2%). The prevalence of video game addiction was 62.1%. Independent risk factors of video game addiction included being young in age, playing video games every day, playing more than three hours per day, and playing multiplayer games. Furthermore, our findings suggest that a higher video game addiction score is correlated with higher scores in inattention, anxiety, and depression. Conclusion This study found a high prevalence of video game addiction among Saudi children and adolescents. Excessive video game playing negatively influences mental health and leads to issues including anxiety, depression, and ADHD. Also, younger males with an increased rate of regular playtime were more likely to exhibit video game addiction in comparison to the rest of the population. Further research is required to more comprehensively assess the prevalence rate of video game addiction and its effect on the mental health of the younger generation within the region.

The relationship between screen time and attention deficit/hyperactivity disorder in Chinese preschool children under the multichild policy: a cross-sectional survey

BACKGROUND

Long screen time has become a public health problem that cannot be ignored. The association between screen time and attention-deficit/hyperactivity disorder (ADHD) in preschool children has received widespread attention.

METHODS

A questionnaire was used to survey 2452 people. ADHD symptoms were assessed by the Conners Child Behavior Scale. Considering that the ADHD symptoms of boys and girls might be different, we stratified the data by gender. Logistic regression model was used for regression analysis. To exclude the influence of multichild family and obesity level, we also conducted a sensitivity analysis. P values were two-tailed with a significance level at 0.05.

RESULTS

The results showed that the association between screen time and ADHD symptoms in preschool children was significant (OR = 1.826, 95%CI: 1.032, 3.232). After grouping the genders, the correlation was not significant. There was an association between screen time and ADHD symptoms in children from families with multiple children. However, after excluding overweight and obese children from the overall population, the association between screen time and ADHD symptoms did not have statistical significance.

CONCLUSIONS

The issue of screen time for preschoolers needs to be taken seriously. Although the results indicate a significant correlation between screen time and ADHD symptoms, clearer evidence is needed to provide recommendations to policy makers.

The associations between screen time and mental health in adolescents: a systematic review

BACKGROUND

Adolescents have extensive use of screens and, they have common complains related to mental health. Here a systematic review was done to understand the association between screen time and adolescent's mental health.

METHOD

This review was conducted in compliance with Preferred Reporting Items for Systematic Reviews and Meta-Analyses - PRISMA. An update search was performed in January 2023 with the following keywords: "screen time," "adolescent," and "mental health" on PubMed, PsycINFO and Scopus databases.

RESULTS

50 articles were included, most have found associations between screen exposure and mental health in adolescents. The most used device by adolescents was the smartphone and the use on weekdays was associated with diminished mental well-being. Social media use was negatively associated with mental well-being and, in girls, associated at higher risk for depression.

CONCLUSION

Excessive screen time in adolescents seems associated with mental health problems. Given the profusion and disparity of the results, additional studies are needed to clarify elements such as the screen content or the interaction of adolescents with different screen devices.

SYSTEMATIC REVIEW REGISTRATION

PROSPERO CRD42022302817.

Prevalence and Awareness of Musculoskeletal Injuries Associated With Competitive Video Gaming in Saudi Arabia

Background In recent years, the use of electronic devices has become an important part of the lives of adolescents who regularly use computers for academic activities and leisure. The excessive use of these devices has been associated with several health problems, such as obesity, headaches, anxiety, stress, sleep disorders, and musculoskeletal pain. This study aimed to assess the prevalence and awareness of musculoskeletal injuries associated with competitive video gaming in Saudi Arabia. Methodology This descriptive, cross-sectional study targeted all individuals involved in competitive video gaming aged 18 years or older in Saudi Arabia. The data were collected using a researcher-initiated online questionnaire. The final electronic questionnaire contained questions on participants' data, frequency and pattern of playing competitive video gaming, the associated musculoskeletal injuries, the most reported sites, and the associated consequences. The final questionnaire was sent to the participants via social media platforms and no more answers were obtained. Results A total of 116 competitive video gaming participants were included. Participants' ages ranged from 18 to 48 years, with a mean age of 22.5. The majority of the participants were males (86.2%; 100). A total of 100 (86.2%) participants had at least one site-associated musculoskeletal injury, while only 16 (13.8%) had none. Regarding sites, the most reported sites included the lower back (63.8%), neck (50%), hand/wrist (44.8%), and shoulder (35.3%). A total of 58 (50.4%) thought that competing in electronic game tournaments negatively affects the musculoskeletal system, and 43 (37.1%) had an idea that competing in electronic gaming tournaments is linked to conditions such as tendinopathy, carpal tunnel syndrome, and repetitive stress injuries. Conclusions This study showed that the majority of competitive video gamers had musculoskeletal injuries mainly at the lower back, neck, hand/ wrist, and shoulder. A higher pain rate was reported among females and new gamers.

Association Between Screen Time of Mobile Devices and TV and School Readiness in Preschool Children: A Cross-Sectional Study

We aimed to investigate the relationship between screen time and school readiness. A total of 80 ppreschool children were included. Parents were interviewed about their children's daily screen time. The Metropolitan Readiness Test was utilized. Results showed that the school readiness of those with a total screen time of 3 hours or less was significantly higher. TV time was inversely associated with reading readiness (B=- 2.30,p < .001), whereas mobile device time was inversely associated with both reading (B = -0.96,p = .04) and numbers readiness (B = -0.98,p = .02). This study point to the importance of supervising children's screen use, and of awareness of parents and professionals.

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

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

Lack of educational impact of video game addiction in children and adolescents diagnosed with ADHD: A cross-sectional study

Introduction

The use of video games has become widespread worldwide. Excessive use of video games is increasingly becoming a matter of concern, particularly in patients diagnosed with Attention Deficit Hyperactivity Disorder (ADHD). Currently, internet gaming disorder (IGD) is not included within the DSM-5-chapter Disorders related to substances and addictive disorders.

Methods

This is a post-hoc descriptive naturalistic study comparing children and adolescents diagnosed with ADHD with and without IGD. We used the 85% cut-off point of the test ADITEC-V for video game addiction to split our sample of ADHD patients into those with IGD (>=85%) and those without IGD (<85%).

Results

13 (25%) out of the 51 children and adolescents with ADHD included in our study had an IGD. Patients with IGD had a first contact with internet, smartphones, and videogames at a very early age (5.67 ± 3.31, 6.33 ± 4.60, and 7.50 ± 2.61, respectively). However, only age at first contact with the internet was statistically significantly different when comparing ADHD patients with and without IGD (8.68 ± 2.71 vs. 5.67 ± 3.31, t = 3.166, df = 47, p = 0.01). Different neurodevelopmental, clinical, and neuropsychological measures converging in impulsivity is a risk factor for IGD. Unexpectedly, we found no association between IGD and poor academic achievement.

Discussion

Future studies may include randomized controlled trials for treating IGD, the study of social adjustment as a protective factor against developing an IGD, and the role of serious and non-serious video games in the development of an IGD, among others. Additional research is clearly needed on IGD.

The untapped potential of Games for Health in times of crises. A critical reflection

Given its promising role in public health to address hard to reach population groups, game-based interventions (i.e., Games for Health, G4H) have experienced growing interest in recent years. Therefore, it is surprising that they have played only a minor role during the COVID-19 pandemic. Hence, the aim of this paper is to reflect the opportunities and challenges of G4H especially during the pandemic but also with regard to future health crises. As commercial video games (i.e., those that primarily aim to entertain its users) were often used to deal with the containment measures during the COVID-19 pandemic, we call for greater cooperation with commercial game makers to distribute health-related messages via entertainment games. With regard to G4H we see a need to (i) strengthen the intervention theory underlying game-based applications, (ii) to enhance the appeal of games in order to maintain the interest of users in the long term, and (iii) to improve the evidence base using appropriate study designs. Finally, we argue for (iv) greater user involvement, both in terms of developing game-based approaches and as co-researchers in solving complex health problems.

Longitudinal associations between digital media use and ADHD symptoms in children and adolescents: a systematic literature review

Previous reviews have often shown a link between digital media ADHD symptom levels. However, longitudinal studies are needed to find stronger evidence of a causal effect as well as to determine the direction of effects. The aim of the present review (PROSPERO CRD42021262695) was therefore to provide a systematic review of studies meeting the following inclusion criteria: (1) include longitudinal data investigating associations between digital media (i.e., gaming and social media) and later ADHD symptoms or vice versa, (2) be published within the past 10 years (i.e., 2011 until June 2021), (3) be published in a peer-reviewed journal in English, and (4) include children or adolescents (age 0-17 years). After a systematic search in the Web of Science and PsycInfo databases, we included 28 studies, all with adequate or high quality. Results showed support for reciprocal associations between digital media and ADHD symptoms, with associations being more consistent for problematic use of digital media than for screen time. Thus, children with ADHD symptoms appear more vulnerable to developing high or problematic use of digital media (i.e., selection effects), and digital media also have effects on later ADHD symptom levels, either because of specific characteristics of digital media or because of indirect effects on, for example, sleep and social relations (i.e., media effects). However, it should be emphasized that further studies investigating potential moderators and mediators are needed if we are to better understand the complex associations between digital media and ADHD symptom levels.

A meta-analysis of polychronicity: Applying modern perspectives of multitasking and person-environment fit

We apply modern theory on multitasking and person-environment fit to holistically explain the relations of polychronicity as well as provide justifications for disparate results found in prior studies, such as undetected differences regarding task-switching and dual-tasking. We then conduct a meta-analysis of polychronicity's relations. We show that the nomological net surrounding polychronicity matches our proposed fit perspective. We likewise demonstrate that differences in task-switching and dual-tasking indeed influence the observed results of polychronicity, and the growing complexity of businesses may have caused the association of polychronicity and job performance to strengthen over time. Our discussion highlights that polychronicity plays an important role in personal well-being and employee performance, which can be understood by our person-environment fit perspective.

Plain Language Summary

We apply modern theory on multitasking and person-environment fit to holistically explain the relations of polychronicity as well as provide justifications for disparate results found in prior studies, such as undetected differences regarding task-switching and dual-tasking. We then conduct a meta-analysis of polychronicity's relations. We show that the nomological net surrounding polychronicity matches our proposed fit perspective. We likewise demonstrate that differences in task-switching and dual-tasking indeed influence the observed results of polychronicity, and the growing complexity of businesses may have caused the association of polychronicity and job performance to strengthen over time. Our discussion highlights that polychronicity plays an important role in personal well-being and employee performance, which can be understood by our person-environment fit perspective.

Emotion Recognition and Inhibitory Control in Adolescent Players of Violent Video Games

Developmental changes during adolescence may make youth susceptible to violent media effects. Two studies with male adolescents (N₁  = 241; N₂  = 161; aged 12-17) examined how habitual and short-term violent video gaming may affect emotion recognition and inhibitory control. We found that not habitual exposure to violent video games, but to antisocial media content predicted worse emotion recognition. Furthermore, higher habitual exposure to violent games predicted better inhibitory control over emotional stimuli in a stop signal task. However, short-term causal effects of violent gameplay on adolescents were not found. While these results do not indicate a negative impact of violent video games on young players, future research may further investigate possible effects of antisocial media content on adolescents.

Understanding Problematic Social Media Use in Adolescents with Attention-Deficit/Hyperactivity Disorder (ADHD): A Narrative Review and Clinical Recommendations

Attention-Deficit/Hyperactivity Disorder (ADHD) is consistently associated with a host of social problems, such as victimization and difficulties in maintaining close friendships. These problems are not limited to offline relations but also manifest in the online social world, as previous research shows that ADHD is associated with problematic use of social media. Given the ubiquitous nature of social media, the goal of the current review is to understand why adolescents with ADHD demonstrate more problematic social media use than their typically developing peers. To this end, we provide a narrative review on the evidence for the link between ADHD and social media use, and consequently present an integrative framework, which encompasses neurobiological mechanisms (i.e., imbalance theory of brain development and dual pathway model of ADHD) and social mechanisms, including influences from peers and parents. We conclude that empirical work shows most consistent evidence for the link between problematic social media use and ADHD (symptoms), while intensity of social media use is also associated with several other behaviors and outcomes. Finally, we hypothesize how existing interventions for ADHD may work on the identified mechanisms and provide at-hand clinical recommendations for therapists working with adolescents with ADHD who exhibit problematic social media use.

The Association between Video Game Time and Adolescent Mental Health: Evidence from Rural China

As digital devices like computers become more widely available in developing countries, there is a growing need to understand how the time that adolescents spend using these devices for recreational purposes such as playing video games is linked with their mental health outcomes. We measured the amount of time that adolescents in rural China spent playing video games and the association of video game time with their mental health. We collected data from primary and junior high schools in a poor, rural province in northwest China (n = 1603 students) and used the Depression, Anxiety, and Stress Scales (DASS-21) to measure mental health symptoms. The results indicated that the average video game time was about 0.69 h per week. There was a significant association between adolescent video game time and poorer mental health. Each additional hour of playing video games also increased the chance of having moderate or above symptoms. Moreover, boys and non-left-behind children had worse mental health if they played more video games. Our study contributes to literature on the links between recreational screen time and mental health, and it sheds light on an issue addressed by recent government legislation to limit the video game time of minors in China.

Correlates of domain-specific sedentary behaviors and objectively assessed sedentary time among elementary school children

Understanding the correlates of sedentary behavior among children is essential in developing effective interventions to reduce sitting time in this vulnerable population. This study aimed to identify correlates of domain-specific sedentary behaviors and objectively assessed sedentary time among a sample of children in Japan. Data from 343 children (aged 6-12 years) living in Japan were used. Domain-specific sedentary behaviors were assessed using a questionnaire. Total sedentary time was estimated using hip-worn accelerometers. Twenty-two potential correlates across five categories (parental characteristics, household indoor environment, residential neighborhood environment, school environment, and school neighborhood environment) were included. Multivariable linear regression models were used to identify correlates of domain-specific sedentary behaviors and objectively assessed sedentary time. Eight correlates were significantly associated with children's domain-specific sedentary behaviors: mother's and father's age, mother's educational level, having a video/DVD recorder/player, having a video console, having a TV one's own room, home's Walk Score^®, and pedestrian/cycling safety. No significant associations were found between potential correlates and accelerometer-based total sedentary time. These findings highlight that strategies to reduce children's sedentary time should consider the context of these behaviors. For example, urban design attributes such as perceived pedestrian and cycling safety can be improved to reduce children's car sitting time.

Video game playing among preschoolers: prevalence and home environment in three provinces from Turkey

We aimed to investigate the video game habits and their relationship with home environment in children 2-5 years in Turkey. A structured questionnaire about the child's demographic, screen, and video gaming characteristics was completed by parents in five health centers from three provinces. One-quarter of 1245 preschoolers were found to play video games. The prevalence of playing video games was higher in older age, male gender, low parental education, families with 3 or more children, having a game console, computers and tablets at home, child's screen time of more than 2 hours per day, child's non-compliance with the parental screen rules, and presence of someone else playing videogame at home. Of the parents, 54.5% did not know the name of the video game the child was playing. Parents should be counseled about supervising on their children's video game playing habits and selection of well-designed games with the right content.

Parental Phubbing and Internet Gaming Addiction in Children: Mediating Roles of Parent-Child Relationships and Depressive Symptoms

Mounting research has well documented that parental phubbing is significantly associated with Internet gaming addiction (IGA) in children. However, the mediating mechanisms of this relations are poorly understood. This study used a multi-informant design to investigate whether parent-child relationships (closeness and conflict) and depressive symptoms mediate the relation between parental phubbing and IGA. A total of 1,021 Chinese children (44.30 percent girls; M_age = 10.33, standard deviation = 0.98) and their mothers completed anonymous questionnaires. The results showed that parent-child conflict and depressive symptoms each played a mediating role between parental phubbing and the children's IGA, whereas parent-child closeness did not. Moreover, parental phubbing demonstrated an indirect effect on the children's IGA successively through the parent-child conflict and children's depressive symptoms. The findings suggest that improved parent-child relationships and immediate intervention for depressive symptoms can reduce the risk of IGA among children.

Dissociable effects of acute versus cumulative violent video game exposure on the action simulation circuit in university students

There is an ongoing debate as to whether violent video game exposure (VGE) has a negative impact on social functioning. This debate continues in part because of methodological concerns and the paucity of identifiable neurocognitive mechanisms. Also, little attention has been given to how specific personality characteristics may influence susceptibility to the purported effects. Using a combined experimental and cross-sectional approach, we examined the impact of VGE on action simulation as a function of trait coldheartedness in a sample of university students. Healthy adults played a violent or nonviolent version of Grand Theft Auto V before completing an fMRI measure of action simulation circuit (ASC) activity. Simulation-related activity was not significantly different between groups; however, greater overall activation was observed in left inferior frontal gyrus for those in the violent condition. Contrary to predictions, no evidence was observed that trait coldheartedness significantly interacts with violent gaming to influence ASC activation. However, prior cumulative VGE was negatively correlated with simulation-related activity in a subsection of the ASC. This study highlights a potential dissociation between the effects of acute versus cumulative violent gaming and may challenge assumptions that the directionality of effects for cross-sectional associations always mirror those of acute exposure.

Immersive Media Presentation and Preschoolers’ Prosocial Behaviors: The Mediating Role of Theory of Mind

Although scholars have asserted that it is necessary to explore the effect of immersive media presentation on preschoolers’ prosocial behaviors, the empirical research, as well as the moderating roles of this link, remained limited. One hundred and twenty preschoolers (mean age = 5.4 years) were involved in three experiments of four waves. This study empirically examined the effect of media presentation, including immersive media presentation and traditional media presentation, on preschoolers’ prosocial behaviors and the moderating effect of theory of mind (ToM) on such links. After the experimental intervention, we find that the extent to which traditional media presentation and immersive media presentation impact preschoolers’ prosocial behaviors is different. First, the results show that preschoolers, who have been involved in traditional media presentation, do not notably reveal the development of their prosocial behaviors. However, in the group of high ToM, we find that traditional media presentation positively and significantly relates to preschoolers’ prosocial behaviors. That is to say, the positive influence of traditional media presentation depends on ToM. Second, the results also show that immersive media presentation positively and significantly relates to preschoolers’ prosocial behaviors whether ToM is high or not. Furthermore, ToM encourages the positive influence of immersive media presentation on preschoolers’ prosocial behaviors.

What are the effects of different elements of media on radicalization outcomes? A systematic review

BACKGROUND

Most national counter-radicalization strategies identify the media, and particularly the Internet as key sources of risk for radicalization. However, the magnitude of the relationships between different types of media usage and radicalization remains unknown. Additionally, whether Internet-related risk factors do indeed have greater impacts than other forms of media remain another unknown. Overall, despite extensive research of media effects in criminology, the relationship between media and radicalization has not been systematically investigated.

OBJECTIVES

This systematic review and meta-analysis sought to (1) identify and synthesize the effects of different media-related risk factors at the individual level, (2) identify the relative magnitudes of the effect sizes for the different risk factors, and (3) compare the effects between outcomes of cognitive and behavioral radicalization. The review also sought to examine sources of heterogeneity between different radicalizing ideologies.

SEARCH METHODS

Electronic searches were carried out in several relevant databases and inclusion decisions were guided by a published review protocol. In addition to these searches, leading researchers were contacted to try and identify unpublished or unidentified research. Hand searches of previously published reviews and research were also used to supplement the database searches. Searches were carried out until August 2020.

SELECTION CRITERIA

The review included quantitative studies that examined at least one media-related risk factor (such as exposure to, or usage of a particular medium or mediated content) and its relationship to either cognitive or behavioral radicalization at the individual level.

DATA COLLECTION AND ANALYSIS

Random-effects meta-analysis was used for each risk factor individually and risk factors were arranged in rank-order. Heterogeneity was explored using a combination of moderator analysis, meta-regression, and sub-group analysis.

RESULTS

The review included 4 experimental and 49 observational studies. Most of the studies were judged to be of low quality and suffer from multiple, potential sources of bias. From the included studies, effect sizes pertaining to 23 media-related risk factors were identified and analyzed for the outcome of cognitive radicalization, and two risk factors for the outcome of behavioral radicalization. Experimental evidence demonstrated that mere exposure to media theorized to increase cognitive radicalization was associated with a small increase in risk (g = 0.08, 95% confidence interval [CI] [-0.03, 19]). A slightly larger estimate was observed for those high in trait aggression (g = 0.13, 95% CI [0.01, 0.25]). Evidence from observational studies shows that for cognitive radicalization, risk factors such as television usage have no effect (r = 0.01, 95% CI [-0.06, 0.09]). However, passive (r = 0.24, 95% CI [0.18, 0.31]) and active (r = 0.22, 95% CI [0.15, 0.29]) forms of exposure to radical content online demonstrate small but potentially meaningful relationships. Similar sized estimates for passive (r = 0.23, 95% CI [0.12, 0.33]) and active (r = 0.28, 95% CI [0.21, 0.36]) forms of exposure to radical content online were found for the outcome of behavioral radicalization.

AUTHORS' CONCLUSIONS

Relative to other known risk factors for cognitive radicalization, even the most salient of the media-related risk factors have comparatively small estimates. However, compared to other known risk factors for behavioral radicalization, passive and active forms of exposure to radical content online have relatively large and robust estimates. Overall, exposure to radical content online appears to have a larger relationship with radicalization than other media-related risk factors, and the impact of this relationship is most pronounced for behavioral outcomes of radicalization. While these results may support policy-makers' focus on the Internet in the context of combatting radicalization, the quality of the evidence is low and more robust study designs are needed to enable the drawing of firmer conclusions.

Psychosocial risks and benefits of exposure to heavy metal music with aggressive themes: Current theory and evidence

Concerns have been raised that prolonged exposed to heavy metal music with aggressive themes can increase the risk of aggression, anger, antisocial behaviour, substance use, suicidal ideation, anxiety and depression in community and psychiatric populations. Although research often relies on correlational evidence for which causal inferences are not possible, it is often claimed that music with aggressive themes can cause psychological and behavioural problems. This narrative review of theory and evidence suggests the issues are more complicated, and that fans typically derive a range of emotional and social benefits from listening to heavy metal music, including improved mood, identity formation, and peer affiliation. In contrast, non-fans of heavy metal music — who are often used as participants in experimental research on this topic — invariably report negative psychological experiences. Our review considers a comprehensive set of empirical findings that inform clinical strategies designed to identify fans for whom heavy metal music may confer psychological and behavioural risks, and those for whom this music may confer psychosocial benefits.

Digital Engagement and Academic Functioning

Abstract. Since the turn of the millennium, the digital revolution has opened a new layer of opportunities for adolescents to participate, create and learn. Simultaneously there has been growth in both debate and worries regarding how the intensive engagement with digital media affects students’ academic performance, engagement, and school-related well-being, that is, academic functioning. Students’ continuously evolving digital practices are not always in congruence with the more traditional ways of schoolwork. Students flourish and fulfill their potential when the informal and formal practices of learning reach congruence, but when this is not the case, frictions can emerge. Spending time with digital media can provide new avenues for learning and development, but it can equally well divert young people from their studies or increase the daily demands. In this narrative review, we address these continuities and discontinuities between engagement with digital media and academic functioning for school-aged children and young people, focusing on meta-analyses, reviews, and key studies. Following the examination of the current literature, we conclude that, in general, the field of “digital media effects” needs to move beyond screen time and utilize the research on the students’ multidimensional socio-digital engagement already conducted. Second, we conclude that the average effects of digital engagement on academic functioning are negligibly small but heterogeneous, further corroborating the claim to examine the qualitative differences in students’ digital engagement, the individual differences between students, as well as the contextual interplay.

Problem Technology Use, Academic Performance, and School Connectedness among Adolescents

Background: Little is known about the association between problem technology use in adolescents and school-related outcomes. The purpose of this study was to determine the prevalence of problem technology use and examine its association with academic performance and school connectedness in a sample of students across Ontario, Canada. Methods: Self-reported data from a sample of 4837 students in grades 9 to 12 (mean age: 15.9 years; 49.5% females) were cross-sectionally analyzed. Ordered logistic regression models were adjusted for important covariates. Results: We found that 35.8% of students used their screen device for at least 5 h a day and about 18.6% had moderate-to-serious symptoms of problem technology use, a prevalence that was higher in females (22.4%) than males (14.9%). Heavy technology use was differentially associated with lower academic performance and lower levels of school connectedness in males and females. Having moderate-to-serious symptoms of problem technology use was associated with lower academic performance among males (AOR = 0.68, 95% CI = 0.53–0.87) and females (AOR = 0.66, 95% CI = 0.52–0.84). It was also associated with less school connectedness in both males (AOR = 0.65, 95% CI = 0.50–0.86) and females (AOR = 0.63, 95% CI = 0.51–0.78). Conclusion: Excessive use and problem technology use are highly prevalent among secondary school students, and they are associated with lower academic performance and lower levels of school connectedness.

Desensitization and Violent Video Games: Mechanisms and Evidence

Desensitization, the reduction of cognitive, emotional, and/or behavioral responses to a stimulus, is an automatic and unconscious phenomenon often experienced in everyday life. Exposure to violent media, especially violent video games, may cause desensitization to real-life violence. Desensitization to violence blocks empathy which is needed to trigger the moral reasoning process that triggers prosocial responding. Representative research was reviewed to examine links between exposure to violent video games and desensitization to violence in children and adolescents. It was concluded that exposure to violent video games increases the risk of desensitization to violence, which in turn may increase aggression and decrease prosocial behavior. Parents should be counseled to discuss the differences between real and screen violence, to encourage nonviolent problem-solving, and to provide empathy-building experiences for their children.

Pornography and Sexual Aggression: Can Meta-Analysis Find a Link?

Whether pornography contributes to sexual aggression in real life has been the subject of dozens of studies over multiple decades. Nevertheless, scholars have not come to a consensus about whether effects are real. The current meta-analysis examined experimental, correlational, and population studies of the pornography/sexual aggression link dating back from the 1970s to the current time. Methodological weaknesses were very common in this field of research. Nonetheless, evidence did not suggest that nonviolent pornography was associated with sexual aggression. Evidence was particularly weak for longitudinal studies, suggesting an absence of long-term effects. Violent pornography was weakly correlated with sexual aggression, although the current evidence was unable to distinguish between a selection effect as compared to a socialization effect. Studies that employed more best practices tended to provide less evidence for relationships whereas studies with citation bias, an indication of researcher expectancy effects, tended to have higher effect sizes. Population studies suggested that increased availability of pornography is associated with reduced sexual aggression at the population level. More studies with improved practices and preregistration would be welcome.

Media use, attention, mental health and academic performance among 8 to 12 year old children

The rise in digital media consumption, especially among children, raises the societal question of its impact on cognition, mental health and academic achievement. Here, we investigate three different ways of measuring technology use--total hours of media consumed, hours of video game play and number of media used concurrently--in 118 eight-to-twelve year-old children. At stake is the question of whether different technology uses have different effects, which could explain some of the past mixed findings. We collected data about children's media uses as well as (i) attentional and behavioral control abilities, (ii) psychological distress, psychosocial functioning, and sleep, and (iii) academic achievement and motivation. While attentional control abilities were assessed using both cognitive tests and questionnaires, mental health and sleep were all questionnaire-based. Finally, academic performance was based on self-reported grades, with motivational variables being measured through the grit and the growth-mindset questionnaires. We present partial correlation analyses and construct a psychological network to assess the structural associations between different forms of media consumption and the three categories of measures. We observe that children consume large amounts of media and media multitask substantially. Partial correlation analyses show that media multitasking specifically was mostly correlated with negative mental health, while playing video games was associated with faster responding and better mental health. No significant partial correlations were observed for total hours on media. Psychological network analysis complement these first results by indicating that all three ways of consuming technology are only indirectly related to self-reported grades. Thus, technology uses appear to only indirectly relate to academic performance, while more directly affecting mental health. This work emphasizes the need to differentiate among technology uses if one is to understand how every day digital consumption impacts human behavior.

The Impact of Socialisation on Children's Prosocial Behaviour. A Study on Primary School Students

Background: Studying prosociality in children is a complex but relevant issue related to the qualitative development of human interactions. The main objective of the present study is to identify the psychosocial factors that most promote or inhibit the adoption of prosocial behaviours among children. Method: In Spring 2021, a survey was conducted amongst primary school children through a structured paper questionnaire. The data analysis has been carried out through bivariate and multivariate statistical techniques. Path analysis has been used. Results: The results highlight the role played by the parental education level, the perception of positive and negative emotions, the adherence to gender roles and the involvement in cyberbullying actions in predicting prosocial tendencies among children. On the other hand, adopting prosocial behaviours affects the screen-time as well as the devices’ interference in face-to-face interactions and the attitude towards school. Conclusions: The results are relevant and useful for the study of trends in prosocial behaviours among children. Family education level, individual status, peer interactions and social conditionings are variables that highly influence this multidimensional phenomenon. Further research is needed, including the definition of new measures and indicators concerning the context where children live and interact with others, with the aim of designing interventions aimed at facilitating relational well-being of children.

Prosocial Video Game Content, Empathy and Cognitive Ability in a Large Sample of Youth

Whether playing video games with prosocial content has an influence on empathy among players remains contentious in the research literature. Some evidence suggests playing cooperatively with other gamers enhances empathy, but data have not conclusively linked prosocial content with empathy. Further, mechanisms of this potential relationship are unclear, and little work has been conducted on how cognitive skills, such as fluid reasoning, may mediate this relationship. The current study examines these relationships with a large sample of 3034 youth (27.2% female, Mage = 11.2; range 8-17 at time 1) in Singapore. Data were considered longitudinally across two years in three waves. Ultimately, no evidence emerged that prosocial content in video games had any impact on empathy related outcomes, nor was fluid reasoning a mediator variable for any relationship. However, variables such as social competence and depression and anxiety symptoms were highly related to empathy measures. This evidence adds to the growing debate in the field that video games may not dramatically alter, whether positively or negatively, the development of emotional and behavioral outcomes for youth.

Association between Adverse Childhood Experiences and Time Spent Playing Video Games in Adolescents: Results from A-CHILD Study

Background: Excessive time spent playing video games is associated with adverse health outcomes in adolescents. Although poor child–parent relationship and social relations with peers are considered as possible predictors, little is known as to whether adverse childhood experiences (ACEs) are associated with time spent playing video games. The aim is to examine the association between ACEs and time spent playing video games in adolescents. Methods: We used pooled data from the Adachi Child Health Impact of Living Difficulty (A-CHILD) study in 2016 and 2018, which is a population-based cross-sectional study in Adachi City, Tokyo, Japan (N = 6799, 4th, 6th, and 8th-grade students). Adolescents answered questionnaires examining the time spent playing video games, per day, on weekdays (“less than 1 h”, “less than 3 h”, and “more than 3 h”) and ACEs (eight types). Results: The results of the ordinal logistic regression analysis showed a positive association between ACE total score and time spent playing video games after adjusting for covariates (1 ACE: OR = 1.28, 95% CI = 1.10–1.48; 2 ACEs: OR = 1.25, 95% CI = 1.06–1.48; 3 + ACEs: OR = 1.44, 95% CI = 1.14–1.82, p for trend < 0.001). Regarding each type of ACE, the experiences of single parenthood, parental history of psychiatric disorders, and peer isolation were independently positively associated with time spent playing video games. Conclusions: Health policy to address ACEs might be important to shorten the time spent playing video games.

Commercial Off-The-Shelf Video Games for Reducing Stress and Anxiety: Systematic Review

BACKGROUND

Using commercial off-the-shelf video games rather than custom-made computer games could have several advantages for reducing stress and anxiety, including their low cost, advanced graphics, and the possibility to reach millions of individuals worldwide. However, it is important to emphasize that not all commercial video games are equal, and their effects strongly depend on specific characteristics of the games.

OBJECTIVE

The aim of this systematic review was to describe the literature on the use of commercial off-the-shelf video games for diminishing stress and anxiety, examining the research outcomes along with critical variables related to computer game characteristics (ie, genre, platform, time of play).

METHODS

A systematic search of the literature was performed following the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analysis) guidelines. The search databases were PsycINFO, Web of Science, Medline, IEEExplore, and the Cochrane Library. The search string was: [("video game*") OR ("computer game*")] AND [("stress") OR ("anxiety") OR ("relaxation")] AND [("study") OR ("trial") OR ("training")].

RESULTS

A total of 28 studies met the inclusion criteria for the publication period 2006-2021. The findings demonstrate the benefit of commercial off-the-shelf video games for reducing stress in children, adults, and older adults. The majority of the retrieved studies recruited young adults, and fewer studies have involved children, middle-aged adults, and older adults. In addition to exergames and casual video games, other genres of commercial off-the-shelf games helped to reduce stress and anxiety.

CONCLUSIONS

Efficacy in reducing stress and anxiety has been demonstrated not only for exergames and casual video games but also for other genres such as action games, action-adventure games, and augmented reality games. Various gaming platforms, including consoles, PCs, smartphones, mobile consoles, and virtual reality systems, have been used with positive results. Finally, even single and short sessions of play had benefits in reducing stress and anxiety.

TRIAL REGISTRATION

International Platform of Registered Systematic Review and Meta-analysis Protocols INPLASY202130081; https://inplasy.com/?s=INPLASY202130081.

Evaluating the Social Cost of Conflict between New Media and Society: The Case of Gaming Disorder in South Korea

Historically, the introduction of a new media in mass market caused a strong conflict starting from the nineteenth century popular literature, comics, rock music and film. Interestingly, these conflicts have shown similar and repeated patterns, which is now called media panic and moral regulation, and games are following this pattern. In 2019, Gaming disorder (GD) was decided to be included in the International Classification of Diseases (ICD-11), and similar conflicts on games arenow expected. However, the social cost and damage have not been fully addressed until now. Thus, this study focuses on the estimation of the social cost induced by GD for policy design and decisions in the public healthcare of South Korea. Using the contingent valuation method, a popular valuation method in econometrics for non-market goods, this study has tried to estimate the social cost induced by the introduction of GD into the public healthcare practice. Focusing on a false positive problem in the diagnosis, this study estimates that the willingness to pay for GD diagnosis for children is about KRW 152 K (USD 135). Considering the difference between the prevalence of GD (1.9%) and GD suspicion rate of children in the respondents (12.54%), the excessive medical diagnosis cost due to the false positive problem is estimated to KRW 101 billion (USD 89.6 M), which is about four times more than the annual medical cost for Attention Deficit Hyperactivity Disorder (ADHD) treatment in South Korea. Thus, strong scientific proof and a cautious policy approach on GD are needed before the inclusion of GD in the public health practice.

Testing Moral Disengagement and Proteus Effect Predictions on Feelings of Guilt and Self-Empowerment Attributed to Bearing Guns

This study (179 participants, mean age 19. 98, 85% female) examined how violence justification via avatar role manipulations affected first-person shooter game players' subsequent feelings of guilt and self-empowerment attributed to bearing guns in the real-world. In support of the moral disengagement in violent video games model, an independent samples t-test suggested that participants assigned to play as gang members shooting at police officers felt guiltier than those assigned to play as police officers shooting at gang members. In support of Proteus effect predictions linked with self-perception and priming mechanisms, a one-way repeated measures analysis of variance suggested that self-empowerment attributed to carrying guns for both avatar roles increased from baseline to after gameplay, but avatar roles did not influence the increase. The lack of influence could be because participants did not adopt avatar behaviors with undesirable connotations. The results highlight avatar-user bonds through which the associations raised by virtual personas affected players' emotions and self-perception when engaging in simulated violence.