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Xiang H, Liu L, Su X, Yang Y, Xue H, Liu B, Tu Y, Wang R, Mo X, Luo H, Li L, Tian X, Yang Y, Qiao Z, Li L, Xie T, Li S, Lau JTF, Yu Y. The association between a stress-is-enhancing mindset and internet gaming disorder was mediated by behavioral disengagement among medical undergraduate students: a multi-center survey in China. BMC Psychiatry 2025; 25:472. [PMID: 40355837 PMCID: PMC12070511 DOI: 10.1186/s12888-025-06910-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/13/2025] [Accepted: 04/24/2025] [Indexed: 05/15/2025] Open
Abstract
BACKGROUND The stress-is-enhancing mindset has beneficial effects on physical, psychological, and emotional well-being. However, its association with internet gaming disorder (IGD) had not been investigated. By integrating stress mindset into the cognitive evaluation process of commonly used stress coping theories, this study examined the association between stress mindset and IGD and explored relevant mediation mechanisms via behavioral disengagement. The gender differences in the above associations and mediations were also explored. METHODS An online, anonymous, cross-sectional survey was conducted among medical undergraduate students from seven cities (Baotou, Qiqihar, Harbin, Wenzhou, Guangxi, Dali, and Shantou) in China from December 2023 to February 2024. The final sample size was 8,552 (a mean response rate of 71.0%). The DSM-5 IGD Checklist, the Stress Mindset Measure-General, and the behavioral disengagement subscale of Brief-Coping Orientation to Problems Experienced Inventory were used to assess IGD, stress mindset, behavioral disengagement, respectively. Multivariate logistic regression analyses were conducted to test the significance and direction of the determinants of IGD. Path analysis was performed to examine the mediation mechanisms and the moderation effect of gender. All these analyses were adjusted for background factors. RESULTS Of all participants, the prevalence of IGD was 7.5%, and males had significantly higher prevalence than females (14.7% versus 7.4%, p < 0.001). Multivariate logistic regression analyses found that the stress-is-enhancing mindset was negatively associated with IGD (ORa = 0.94, 95% CI: 0.92 ~ 0.97) while behavioral disengagement was positively associated with IGD (ORa = 1.66, 95% CI: 1.57 ~ 1.76). Path analysis found that behavioral disengagement fully mediated the association between stress mindset and IGD, i.e., the stress-is-enhancing mindset was negatively associated with behavioral disengagement, which in turn was positively associated with IGD. However, gender did not significantly moderate the associations between stress mindset and behavioral disengagement, between behavioral disengagement and IGD, and between stress mindset and IGD. CONCLUSIONS This study observed the relatively high prevalence of IGD among Chinese medical undergraduate students. It also revealed that the stress-is-enhancing mindset was potentially protective against IGD, and behavioral disengagement might fully explain such a beneficial effect. Future longitudinal and interventional studies are needed to verify and extend these findings.
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Affiliation(s)
- Haiyan Xiang
- School of Public Health, Fudan University, Shanghai, China
| | - Lijing Liu
- School of Public Health, Fudan University, Shanghai, China
| | - Xin Su
- School of Public Health, Baotou Medical College, Inner Mongolia University of Science & Technology, Baotou, China
| | - Ying Yang
- Department of Nuclear Medicine, The First Affiliated Hospital of Baotou Medical College, Inner Mongolia University of Science & Technology, Baotou, China
| | - Haifeng Xue
- School of Public Health, Qiqihar Medical University, Qiqihar, China
| | - Bo Liu
- The Second Affiliated Hospital of Qiqihar Medical University, Qiqihar, China
| | - Yanling Tu
- School of Mental Health, Wenzhou Medical University, Wenzhou, China
| | - Ruxin Wang
- School of Mental Health, Wenzhou Medical University, Wenzhou, China
| | - Xinxin Mo
- Research Centre for Regenerative Medicine, Guangxi Medical University, Nanning, China
| | - Hongye Luo
- Information and Management School, Guangxi Medical University, Nanning, China
| | - Lijuan Li
- School of Public Health, Dali University, Dali, China
| | | | - Yanjie Yang
- Psychology and Health Management Center, Harbin Medical University, Harbin, China
| | - Zhengxue Qiao
- Psychology and Health Management Center, Harbin Medical University, Harbin, China
| | - Liping Li
- Shantou University Medical College, Shantou, China
| | - Tong Xie
- Shantou University Medical College, Shantou, China
| | - Siman Li
- School of Public Health, Fudan University, Shanghai, China
| | - Joseph T F Lau
- School of Mental Health, Wenzhou Medical University, Wenzhou, China.
- Zhejiang Provincial Clinical Research Center for Mental Disorders, The Affiliated Wenzhou Kangning Hospital, Wenzhou Medical University, Wenzhou, China.
- Center for Health Behaviour Research, The Jockey Club School of Public Health and Primary Care, the Chinese University of Hong Kong, Hong Kong SAR, Hong Kong, China.
| | - Yanqiu Yu
- School of Public Health, Fudan University, Shanghai, China.
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Hammad MA, Al-Shahrani HF. Impulsivity and aggression as risk factors for internet gaming disorder among university students. Sci Rep 2024; 14:3712. [PMID: 38355642 PMCID: PMC10867029 DOI: 10.1038/s41598-024-53807-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2023] [Accepted: 02/05/2024] [Indexed: 02/16/2024] Open
Abstract
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.
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Affiliation(s)
| | - Hend Faye Al-Shahrani
- Department of Social Work, College of Humanities and Social Sciences, Princess Nourah Bint Abdulrahman University, Riyadh, Kingdom of Saudi Arabia
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Ma J, Yang B, Wang S, Yao Y, Wu C, Li M, Dong GH. Adverse childhood experiences predict internet gaming disorder in university students: the mediating role of resilience. Curr Opin Psychiatry 2024; 37:29-37. [PMID: 37972967 DOI: 10.1097/yco.0000000000000910] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2023]
Abstract
BACKGROUND To investigate the relationship between adverse childhood experiences and internet gaming disorder (IGD) and the mediating role of resilience in the relationship between these two factors. METHODS The adverse childhood experience scale, resilience scale and IGD Scale were administered to 9349 university students. Correlations and mediating effects were calculated among these scores. RESULTS After controlling for sex and age, significant correlations among adverse childhood experiences, resilience and IGD were observed; resilience was a partial mediator variable in the relationship between adverse childhood experiences and IGD. CONCLUSIONS The more adverse childhood experiences an individual has, the less their mental toughness and the greater their tendency to become addicted to internet games. Adverse childhood experiences can effectively predict IGD, and the risk of becoming addicted to the internet can be decreased by increasing one's mental toughness.
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Affiliation(s)
- Jinghao Ma
- Center for Mental Health Education and Counselling, Hangzhou Normal University
- Center for Cognition and Brain Disorders, School of Clinical Medicine and the Affiliated Hospital of Hangzhou Normal University, Hangzhou, Zhejiang Province, PR China
| | - Bo Yang
- Center for Mental Health Education and Counselling, Hangzhou Normal University
- Center for Cognition and Brain Disorders, School of Clinical Medicine and the Affiliated Hospital of Hangzhou Normal University, Hangzhou, Zhejiang Province, PR China
| | - Shizhen Wang
- Center for Mental Health Education and Counselling, Hangzhou Normal University
- Center for Cognition and Brain Disorders, School of Clinical Medicine and the Affiliated Hospital of Hangzhou Normal University, Hangzhou, Zhejiang Province, PR China
| | - Yujie Yao
- Center for Mental Health Education and Counselling, Hangzhou Normal University
- Center for Cognition and Brain Disorders, School of Clinical Medicine and the Affiliated Hospital of Hangzhou Normal University, Hangzhou, Zhejiang Province, PR China
| | - Chencheng Wu
- Center for Mental Health Education and Counselling, Hangzhou Normal University
- Center for Cognition and Brain Disorders, School of Clinical Medicine and the Affiliated Hospital of Hangzhou Normal University, Hangzhou, Zhejiang Province, PR China
| | - Mei Li
- Center for Mental Health Education and Counselling, Hangzhou Normal University
| | - Guang-Heng Dong
- Center for Cognition and Brain Disorders, School of Clinical Medicine and the Affiliated Hospital of Hangzhou Normal University, Hangzhou, Zhejiang Province, PR China
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Malak MZ, Shuhaiber AH, Alsswey A, Tarawneh A. Social support as the mediator for the relationship between internet gaming disorder and psychological problems among university students. J Psychiatr Res 2023; 164:243-250. [PMID: 37385003 DOI: 10.1016/j.jpsychires.2023.06.007] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/01/2022] [Revised: 06/02/2023] [Accepted: 06/15/2023] [Indexed: 07/01/2023]
Abstract
BACKGROUND There has been increasing recognition of internet gaming disorder as a psychiatric problem that is linked with serious impairment and distress and correlated with psychological reactions and social consequences. Thus, this study proposed that psychological problems (stress, anxiety, and depression) and social support could be associated with IGD and social support had a mediating role between these psychological problems and IGD among university students in Jordan. METHODS A cross-sectional, descriptive correlational design was adopted. The university students (N = 1020) were selected randomly from four universities (two public and two private) in Jordan. A self-structured questionnaire was used to collect data using the Internet Gaming Disorder Test (IGD-20 Test), Depression Anxiety Stress Scales-21 (DASS-21), Multidimensional Social Support Scale (MSPSS), and sociodemographic data. FINDINGS Findings of this study found that the mean age of the participants was 21.38 (S.D ± 2.12) and 55.9% of them were males The prevalence of internet gaming disorder was 12.16% among the participants, where the cut-off point for internet gaming disorder was 71 out of 100. Internet gaming disorder was significantly correlated with stress, anxiety, social support, and depression. However, stress, anxiety, and social support had a direct effect on internet gaming disorder, while social support had the strongest effect on internet gaming disorder. It was found that social support had a mediating role between anxiety and stress (β = -0.172, T-Statistics = 3.92, p < 0.001; β = -0.268, T-Statistics = 5.45, p < 0.001, respectively) and internet gaming disorder (p < 0.001). CONCLUSION This study can help policymakers and instructors develop health education programs and/or health training programs that focus on using social support as a coping method when experiencing psychological problems including stress and anxiety and adopt social support in management programs for excessive use of internet gaming.
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Affiliation(s)
- Malakeh Z Malak
- Community Health Nursing, Faculty of Nursing, Al-Zaytoonah. University of Jordan, Amman, Jordan.
| | - Ahmed H Shuhaiber
- College of Technological Innovation, Zayed University, Abu Dhabi, United Arab Emirates
| | - Ahmed Alsswey
- Multimedia Technology Department, Faculty of Architecture and Design, AL-Zaytoonah University of Jordan, Amman, Jordan
| | - Anwar Tarawneh
- Civil and Infrastructure Engineering Department, Faculty of Engineering and Technology AL-Zaytoonah University of Jordan, Amman, Jordan
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Gopali L, Dhital R, Koirala R, Shrestha T, Bhusal S, Rimal R, Shrestha C, Shah R. Effect of COVID-19 pandemic on internet gaming disorder among general population: A systematic review and meta-analysis. PLOS GLOBAL PUBLIC HEALTH 2023; 3:e0001783. [PMID: 37027365 PMCID: PMC10081738 DOI: 10.1371/journal.pgph.0001783] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/22/2022] [Accepted: 03/09/2023] [Indexed: 04/08/2023]
Abstract
Internet gaming disorder (IGD) has been rising in recent years. The COVID-19 pandemic has led to a noticeable shift in the way people interact with technology, which could have further contributed to an increase in IGD. Post-pandemic, the concern for IGD is likely to continue as people have become increasingly reliant on online activities. Our study aimed to assess the prevalence of IGD among the general population globally during the pandemic. Relevant studies that assessed IGD during COVID-19 were identified using PubMed, EMBASE, Scopus, CINAHL, and PsycNET between 2020, Jan 1 and 2022, May 23. We used NIH Quality Assessment Tool for Observational Cohort and Cross-Sectional Studies to assess the risk of bias, and GRADEpro for the certainty of the evidence. Three separate meta-analyses were performed using Comprehensive meta-analysis software and Revman 5.4. In total, 362 studies were identified, of which 24 observational (15 cross-sectional and 9 longitudinal) studies among 83,903 population were included in the review, and 9 studies in the meta-analysis. The risk of bias assessment showed an overall fair impression among the studies. The meta-analysis for a single group of 3 studies showed the prevalence rate of 8.00% for IGD. Another meta-analysis of 4 studies for a single group showed a pooled mean of 16.57 which was lower than the cut-off value of the IGDS9-SF tool. The two-group meta-analysis of 2 studies showed no significant difference between the groups before and during COVID-19. Our study showed no clear evidence of increased IGD during COVID-19 due to limited number of comparable studies, substantial heterogeneity, and low certainty of evidence. Further well-designed studies are needed to provide stronger evidence to implement suitable interventions to address IGD worldwide. The protocol was registered and published in the International Prospective Register for Systematic Review (PROSPERO) with the registration number CRD42021282825.
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Affiliation(s)
| | | | | | | | | | | | | | - Richa Shah
- Health Action and Research, Kathmandu, Nepal
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Wang Y, Liu M, Nogueira OCBL. Prevalence and Risk Factors of Internet Gaming Disorder Under the COVID-19 Pandemic Among University Students in Macao. SAGE Open Nurs 2023; 9:23779608231158158. [PMID: 36865753 PMCID: PMC9972052 DOI: 10.1177/23779608231158158] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2022] [Revised: 12/11/2022] [Accepted: 01/30/2023] [Indexed: 03/03/2023] Open
Abstract
Introduction During the COVID-19 pandemic, the zero-tolerance policy implemented in Macao affected university students' life and learning styles. Objectives This study aimed to investigate the prevalence of internet gaming disorder (IGD) and analyze its risk factors among university students of Macao amid the COVID-19 pandemic. Methods Two hundred and twenty-nine university students were recruited by convenience sampling. The cross-sectional investigation was conducted using the 9-item Chinese version of the IGD Scale, the Chinese Version of the Self-Compassion Scale, and the Chinese version of the Brief Resilience Scale. Results The prevalence was 7.4%. Compared to Non-IGD gamers, the IGD gamers were more likely to be the older, male gender, with a longer gaming history, with more game hours per day in the last month, and with a lower self-compassion score and resilience. Conclusion The prevalence of IGD increased. Students who are the older, male gender, with more gaming time, low self-compassion, and low resilience, have a high possibility of IGD.
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Affiliation(s)
- Yan Wang
- Faculty of Health Sciences and Sports, Macao Polytechnic
University, Macao, China
| | - Ming Liu
- Peking University Health Science Center, Macao Polytechnic University Nursing
Academy, Macao, China,Ming Liu, M707, Macao Polytechnic
University, R. de Luís Gonzaga Gomes, Macao, China.
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Alshammari T, Alseraye S, Rogowska A, Alrasheed N, Alshammari M. Examining the Indirect Effect of Online Gaming on Depression via Sleep Inequality and Anxiety-A Serial and Parallel Mediation Analysis. J Clin Med 2022; 11:7293. [PMID: 36555910 PMCID: PMC9781004 DOI: 10.3390/jcm11247293] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2022] [Revised: 12/02/2022] [Accepted: 12/05/2022] [Indexed: 12/14/2022] Open
Abstract
Stress-related disorders are highly prevalent among first-year college students. Gaming disorder (GD) is an emerging disorder linked to physical and psychological consequences. We aimed to investigate the mechanism linking GD with anxiety, depression, and sleep disorders among first-year undergraduate students. Four hundred fifty-seven participants were recruited, and the survey included the Internet Gaming Disorder Scale Short-Form (IGDS9-SF), Generalized Anxiety Disorder-7 (GAD-7), Patient Health Questionnaire-9 (PHQ-9), and Pittsburgh Sleep Quality Index (PSQI). Our results showed that female students scored significantly higher than males in anxiety and depression. Furthermore, we found that depression is positively and strongly correlated to anxiety, and both are moderately associated with sleep quality. Gaming is positively related to depression, anxiety, and sleep quality. Interestingly, the health sciences tracks showed lower sleep quality than undergraduates from other tracks. There was a 64% variance in depression explained by many predictors, including anxiety, sleep quality, gaming, painkiller use, and gender. In addition, the mediation models showed that the association between gaming and depression is mediated indirectly by sleep quality, and sleep quality may be mediated directly by anxiety. The first year in college occurs at a critical developmental and professional stage, and our results highlight the need to establish support programs and conduct mental health educational workshops.
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Affiliation(s)
- Tahani Alshammari
- Department of Pharmacology and Toxicology, College of Pharmacy, King Saud University, Riyadh 11451, Saudi Arabia
| | - Sarah Alseraye
- Clinical Pharmacy Department, King Fahad Medical City, Ministry of Health, Riyadh 12231, Saudi Arabia
| | | | - Nouf Alrasheed
- Department of Pharmacology and Toxicology, College of Pharmacy, King Saud University, Riyadh 11451, Saudi Arabia
| | - Musaad Alshammari
- Department of Pharmacology and Toxicology, College of Pharmacy, King Saud University, Riyadh 11451, Saudi Arabia
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Jouhki H, Savolainen I, Sirola A, Oksanen A. Escapism and Excessive Online Behaviors: A Three-Wave Longitudinal Study in Finland during the COVID-19 Pandemic. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:12491. [PMID: 36231799 PMCID: PMC9565969 DOI: 10.3390/ijerph191912491] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/27/2022] [Revised: 09/26/2022] [Accepted: 09/27/2022] [Indexed: 06/16/2023]
Abstract
Excessive online behaviors refer to harmful or disproportionate use of digital network applications. Such behaviors are likely to be associated with escapist motives. Our aim was to analyze whether escapism predicts excessive gambling, excessive gaming, and excessive internet use over time. A longitudinal sample of Finnish residents aged 18-75 years (n = 1022, 51.27% male) was surveyed at three time points during the COVID-19 pandemic in 6-month intervals: April 2021 (Time 1), October-November 2021 (Time 2), and April-May 2022 (Time 3). Of the original Time 1 respondents, 66.80% took part in the surveys at both Time 2 and Time 3. All surveys included measures for excessive gambling (Problem Gambling Severity Index), excessive gaming (Internet Gaming Disorder Test), and excessive internet use (Compulsive Internet Use Scale). Three escapism-specific questions were used to construct a dedicated escapism variable. Socio-demographic variables, alcohol consumption, and psychological distress were used as controls. The study was conducted with multilevel regression analyses using hybrid models. Our research showed that escapism had strong within-person effects on excessive gambling, B = 0.18, p = 0.003; excessive gaming, B = 0.50, p < 0.001; and excessive internet use, B = 0.77, p < 0.001 over time. The between-person effect of escapism was demonstrated on excessive gaming B = 0.91, p < 0.001, and excessive internet use B = 0.61, p = 0.036. Adverse societal events and uncertain times can manifest in excessive online behaviors motivated by escapism, highlighting a need to focus prevention efforts on healthy coping methods.
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Affiliation(s)
- Hannu Jouhki
- Faculty of Social Sciences, Tampere University, 33014 Tampere, Finland
- A-Clinic Foundation, Ratamestarinkatu 7 A, 00520 Helsinki, Finland
| | - Iina Savolainen
- Faculty of Social Sciences, Tampere University, 33014 Tampere, Finland
| | - Anu Sirola
- Department of Social Sciences and Philosophy, University of Jyväskylä, 40014 Jyväskylä, Finland
| | - Atte Oksanen
- Faculty of Social Sciences, Tampere University, 33014 Tampere, Finland
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