Policy responses to problematic video game use: A systematic review of current measures and future possibilities

Emotional analysis of multiplayer online battle arena games addiction

Introduction

Multiplayer Online Battle Arena (MOBA) games have garnered widespread popularity as a form of recreational activity. The launch of League of Legends (LoL), a prominent MOBA game, has captivated the enthusiastic pursuit of gamers in the MOBA community. The surge in MOBA game fervor, coupled with the influence of personal emotions, can result in excessive engagement, ultimately leading to addiction.

Objective

This study aimed to investigate the moderating effects of visceral perception, behavior, and reflection on game players' addiction within the framework of Leisure Theory (LT), Uses and Gratification Theory (UGT), and Emotional Design Theory (EDT).

Methods

A hypothesized theoretical model was developed and empirically evaluated based on 236 self-reported validated responses from MOBA gamers. SPSS (version 26) was employed for demographic analysis and game duration analysis. The measurement model and structural model analyses were conducted in two stages using Partial Least Squares Structural Equation Modeling (PLS-SEM) with SmartPLS 4.1.0 to validate the nine theoretical hypotheses.

Results

It has been observed that personal emotions significantly contributes to MOBA game addiction during gamers' leisure time or moments of gratification. Specifically, a noteworthy connection exists between two dimensions, namely gamers' behavior and reflection, demonstrating a positive correlation with gaming addiction. Without taking entertainment as a motivating factor, there is no significant relationship between gamers' leisure-time and visceral perception.

Conclusion

This study enhances the theoretical model of gamers' behavioral motives in engaging with MOBA gaming and contributes to the expansion of research on game addiction theory. These findings offer valuable theoretical insights for emotional design in games and the design of mechanisms for preventing game addiction.

Harmful compared to what? The problem of gaming and ambiguous causal questions

BACKGROUND AND AIMS

There has been much concern regarding potential harmful effects of video game-play in the past 40 years, but limited progress in understanding its causal role. This paper discusses the basic requirements for identifying causal effects of video game-play and argues that most research to date has focused upon ambiguous causal questions.

METHODS

Video games and mental health are discussed from the perspective of causal inference with compound exposures; that is, exposures with multiple relevant variants that affect outcomes in different ways.

RESULTS

Not only does exposure to video games encompass multiple different factors, but also not playing video games is equally ambiguous. Estimating causal effects of a compound exposure introduces the additional challenge of exposure-version confounding.

CONCLUSIONS

Without a comparison of well-defined interventions, research investigating the effects of video game-play will be difficult to translate into actionable health interventions. Interventions that target games should be compared with other interventions aimed at improving the same outcomes.

Effect of online game policy on smartphone game play time, addiction, and emotion in rural adolescents of China

BACKGROUND

Smartphone game addiction has emerged as a major public health problem in China and worldwide. In November 2019 and August 2021, the National Press and Publication Administration of China implemented two increasingly strict policies, as a means of preventing smartphone game addiction in adolescents aged 18 or below. This study aimed to analyze the effect of the policies on smartphone game play time, addiction, and emotion among rural adolescents in China.

METHODS

We sent the questionnaire to rural adolescents through the online survey tool Questionnaire Star, a professional online survey evaluation platform. The questionnaire included demographic data, smartphone use survey, smartphone game addiction and emotion evaluation scales. The Smartphone Addiction Scale-Short Version (SAS-SV) measured adolescents' smartphone game addiction. The Short Version of UPPS-P Impulsive Behavior Scale (SUPPS-P) and Social Anxiety Scale for Children (SASC) measured emotion. According to SAS-SV score, the enrolled rural adolescents were divided into addiction group and non-addiction group. The t-test, Chi-square test, and repeated measure ANOVA assessed the effect of the policies on adolescents' smartphone game addiction and emotion.

RESULTS

Among enrolled 459 rural adolescents with a mean age of 14.36 ± 1.37years, 151 (32.90%) were in the addiction group and 308 (67.10%) were in the non-addiction group. Adolescents in the addiction group were older, more male, and higher grade. There were time and group effects between the two groups in playtime. After a year of policies implementation, the weekly game time dropped from 3.52 ± 1.89 h to 2.63 ± 1.93 h in the addiction group and from 2.71 ± 1.75 h to 2.36 ± 1.73 h in the non-addiction group. There were also time and group effects in SAS-SV and SASC scores, but not for SUPPS-P score. In the addiction group, the SAS-SV score dropped from 41.44 ± 7.45 to 29.58 ± 12.43, which was below the cut-off value for addiction, and the level of social anxiety was consistently higher than non-addiction group.

CONCLUSIONS

The playtime of rural adolescents spent on smartphone games has decreased significantly due to the restriction of the policies rather than the lack of addiction or social anxiety. The policies had practically significant effects in reducing smartphone game play time for rural adolescents in China.

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

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

Gaming disorder: A summary of its characteristics and aetiology

The emergence, development, and maintenance of gaming disorder (GD) is the result of an interplay between gaming-related factors, individual factors, and environmental factors. None of these alone are sufficient to cause a disordered state, but it is the interactive co-occurrence of all these factors, which in some cases leads to GD. The goal of the present paper is to discuss in detail these three factors based on relevant and recent findings of the literature. Among gaming-related factors, we discuss online vs. offline videogames, the role of game genres, structural characteristics, game design elements, as well as some important monetization techniques. Among individual factors demographic risk factors, personality traits, motivational factors, comorbid psychopathology, genetic predisposition, and neurobiological processes are considered. Finally, among environmental factors we discuss family factors, early life experiences, the role of peers and school-related factors, as well as the broader context of culture including the popularity of esports.

Optimising adolescent wellbeing in a digital age

Empowering adolescents and strengthening governance of digital media are among the urgent actions required to tackle the digital determinants of adolescent wellbeing, argue Louise Holly and colleagues

Systematic review of health promotion policies or regulations with CCAT theory

One of the five Ottawa Charter's means of action is the concept of "healthy public policy," which is an approach to health promotion that is integrated with public policy. This concept can be used as an approach/method in solving health problems at the broader policy level and involving all sectors comprehensively, not just health promotion at the community level and the partial health sector, so that public health problems can be resolved properly. We conducted a systematic review of health promotion policies or regulations using CCAT theory. The purpose of this study is to find the state of the art of research related to stakeholder synergy in online game addiction prevention policies in adolescents. References and literature for this systematic review were collected from the Proquest, ScienceDirect, Pubmed, and Google Scholar databases. The search uses the boolean phrases "OR" and "AND." Keywords: policy or regulation, health promotion, and community coalition action theory. The results of the systematic review conducted by the researchers showed that of the twenty selected articles, three articles used the coalition/partnership dimension from the CCAT theory, four articles used the stakeholder dimension, two articles used the collaboration dimension, five articles discussed school health policies, policies related to gaming disorders. One article on the analysis of the juvenile contraceptive law, one article on the prevention of mental health disorders, one article on health promotion interventions, and two articles on risk factors and self-regulation focus on online gaming addiction in adolescents. This study concludes that in the future, further research is needed regarding health promotion policies to prevent online game addiction in adolescents to develop specific policy recommendations related to preventing online game addiction in adolescents.

Public Health Approach to Problems Related to Excessive and Addictive Use of the Internet and Digital Media

Purpose of Review

Advances in digital technology and media have provided convenience and advantages in all areas of our daily lives. However, there is a risk of excessive and addictive use, which increases the risk of addiction as a disease and other related mental and physical problems. This article reviews the public health approach to problems related to excessive and addictive use of the Internet and digital media.

Recent Findings

The public health model views addiction as the result of interactions among individuals, digital media, and the environment; therefore, interventions should aim to reduce risk factors and increase protective factors in these three areas. This includes developing and providing evidence-based services according to each individual's problem type and severity. Regarding interventions for digital media and the environment, restricting accessibility and regulating content may be necessary. This calls for an integrative, comprehensive, and continuous intervention strategy, and to achieve such a framework, we need to establish an information system to monitor the magnitude and patterns of related problems.

Summary

This review suggests a surveillance system that provides a list of evidence-based policies from the public health perspective. Suggestions for an advanced international information, policy, and monitoring system are discussed.

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.

Content and Effectiveness of Web-Based Treatments for Online Behavioral Addictions: Systematic Review

BACKGROUND

Very few people seek in-person treatment for online behavioral addictions including gaming and gambling or problems associated with shopping, pornography use, or social media use. Web-based treatments have the potential to address low rates of help seeking due to their convenience, accessibility, and capacity to address barriers to health care access (eg, shame, stigma, cost, and access to expert care). However, web-based treatments for online behavioral addictions have not been systematically evaluated.

OBJECTIVE

This review aimed to systematically describe the content of web-based treatments for online behavioral addictions and describe their therapeutic effectiveness on symptom severity and consumption behavior.

METHODS

A database search of MEDLINE, Embase, PsycInfo, Web of Science, Cochrane Central Register of Controlled Trials, and Google Scholar was conducted in June 2022. Studies were eligible if the study design was a randomized controlled trial or a pre-post study with at least 1 web-based intervention arm for an online behavioral addiction and if the study included the use of a validated measure of problem severity, frequency, or duration of online behavior. Data on change techniques were collected to analyze intervention content, using the Gambling Intervention System of CharacTerization. Quality assessment was conducted using the Effective Public Health Practice Project Quality Assessment Tool.

RESULTS

The review included 12 studies with 15 intervention arms, comprising 7 randomized controlled trials and 5 pre-post studies. The primary focus of interventions was gaming (n=4), followed by internet use inclusive of screen time and smartphone use (n=3), gambling (n=3), and pornography (n=2). A range of different technologies were used to deliver content, including websites (n=6), email (n=2), computer software (n=2), social media messaging (n=1), smartphone app (n=1), virtual reality (n=1), and videoconferencing (n=1). Interventions contained 15 different change techniques with an average of 4 per study. The techniques most frequently administered (>30% of intervention arms) were cognitive restructuring, relapse prevention, motivational enhancement, goal setting, and social support. Assessment of study quality indicated that 7 studies met the criteria for moderate or strong global ratings, but only 8 out of 12 studies evaluated change immediately following the treatment. Across included studies, two-thirds of participants completed after-treatment evaluation, and one-quarter completed follow-up evaluation. After-intervention evaluation indicated reduced severity (5/9, 56%), frequency (2/3, 67%), and duration (3/7, 43%). Follow-up evaluation indicated that 3 pre-post studies for gaming, gambling, and internet use demonstrated reduced severity, frequency, and duration of consumption. At 3-month evaluation, just 1 pre-post study indicated significant change to mental health symptoms.

CONCLUSIONS

Web-based treatments for online behavioral addictions use an array of mechanisms to deliver cognitive and behavioral change techniques. Web-based treatments demonstrate promise for short-term reduction in symptoms, duration, or frequency of online addictive behaviors. However, there is limited evidence on the effectiveness of web-based treatments over the longer term due to the absence of controlled trials.

A comprehensive model to understand and assess the motivational background of video game use: The Gaming Motivation Inventory (GMI)

BACKGROUND AND AIMS

The popularity of video gaming has generated significant interest in research methods to examine motivations for gaming. Current measures of gaming motives are limited by lack of scope and/or their applicability to specific game genres only. We aimed to create a comprehensive motivation inventory applicable to any gaming genre and to evaluate its psychometric properties in a large sample of highly engaged video gamers.

METHODS

Stage 1 of this project involved a systematic review that generated the items for the Gaming Motivation Inventory (GMI). Stages 2-4 involved an evaluation of the psychometric properties of the GMI. A sample of 14,740 video gamers (89.3% male; mean age 24.1 years) were recruited via an online survey promoted by a popular gaming magazine.

RESULTS

In Stage 2, twenty-six gaming motives were identified, which clustered into six higher-order dimensions (Mastery, Immersion/Escapism, Competition, Stimulation, Social, Habit/Boredom). In Stage 3, construct validity of the six higher-order motives was assessed by associations with gaming-related, personality, and psychological variables. In Stage 4, the relationships between motives and depression symptoms and gaming disorder symptoms were explored. Although gaming motives had weak associations with gaming genres, they were moderately related to variables such as competitiveness, sociability, and positive and negative affect. Gaming disorder symptoms were directly predicted by depression symptoms and indirectly via Immersion/Escapism, Habit/Boredom, and Competition motives.

DISCUSSION AND CONCLUSIONS

These findings support the notion that motives are one of the primary causes of gaming behavior and play an important role in predicting its problematic nature. The GMI is a psychometrically valid tool that will be useful for gaining insights into factors underlying gaming behaviors.

Problematic gaming risk among European adolescents: a cross-national evaluation of individual and socio-economic factors

BACKGROUND AND AIMS

Previous research has identified numerous risk and protective factors of adolescent problematic gaming (PG) at the individual and social levels; however, the influence of socio-economic indicators on PG is less known. This study aimed to measure the contribution of individual and socio-economic factors involved in PG risk among adolescents from 30 European countries.

DESIGN

Multi-level logistic regression analysis of survey data from the 2019 European School Survey Project on Alcohol and Other Drugs (ESPAD) cross-sectional study using self-administered anonymous questionnaires.

SETTING

Thirty European countries.

PARTICIPANTS

A representative cohort of 15-16-year-old students (n = 88 998 students; males = 49.2%).

MEASUREMENTS

The primary outcome measure was adolescents' (low and high) risk of PG. Individual key predictors included self-report assessments of socio-demographic characteristics, time spent gaming and family variables (parental regulation and monitoring, family support). Main country-level predictors comprised Gini coefficient for economic inequalities and benefits for families and children (% gross domestic product), retrieved from international public data sets and national thematic reports. The data analysis plan involved multi-level logistic regression.

FINDINGS

Participants who reported stronger parental regulation [odds ratio (OR) = 0.81, 95% confidence interval (CI) = 0.79-0.83] and higher family support (OR = 0.93, 95% CI = 0.91-0.95) reported lower risk of PG. At the country-level, economic inequalities (OR = 1.05, 95% CI = 1.03-1.07) were positively associated with the risk of PG, while benefits for families and children (OR = 0.78, 95% CI = 0.70-0.89) were negatively correlated with the risk of PG.

CONCLUSIONS

Supportive family environments, lower country-level economic inequalities and higher government expenditures on benefits for families and children appear to be associated with a lower risk of problematic gaming among European adolescents.

Response to the Regulation of Video Games under the Youth Media Protection Act: A Public Health Perspective

The Swiss Youth and Media Act, which is about to enter into force, is an attempt to provide a legislative framework for video game use. Among other inclusions, the law intends to make providers more accountable by taking measures to protect minors from harm that can be caused by improper use of video games. However, it is a challenge to create a legal framework that can adequately regulate the evolving features of video games. Legislators must find a suitable regulatory approach which takes into account the fact that there is an increasing convergence between video games and gambling, particularly with the introduction of loot boxes. Moreover, there is a need for regulation, including the prohibition of misleading designs, the introduction of additional protection for minors, and the assurance of transparency of transactions. Appropriate policy legislation and consumer-protection measures are needed to protect people using these types of products, particularly children and adolescents. Further work should focus on assessing game characteristics to refine regulatory models to promote safe gaming. Based on experiences from the field of psychoactive substances as well as that of gambling, it is now a matter of developing a matrix of harm with elaborated categories: a tool that makes it possible to evaluate the potential harms of certain game design in an evidence-based manner.

Exploring Internet gaming disorder: an updated perspective of empirical evidence (from 2016 to 2021)

BACKGROUND AND AIMS

Since the acceptance of Internet gaming disorder (IGD) as a "disorder due to addictive behaviors", research has proliferated exponentially. The present review focuses on the conceptualization of IGD, its diagnosis and assessment, associated factors and existing prevention and treatment plans to address it.

RESULTS AND CONCLUSIONS

The discrepancies between the diagnostic criteria for IGD proposed by the two central diagnostic entities, as well as the questioning of their clinical validity, have generated multiple proposals for the diagnosis and psychometric evaluation of IGD. Likewise, there have been numerous suggestions to prevent this pathology, with the involvement of governments, the gaming industry and health institutions. Finally, multiple treatment plans have been proposed, both pharmacological and psychological, although only the efficacy of cognitive behavioral therapy has been tested. It is essential, therefore, to delve deeper into this disorder by addressing the central limitations of the current literature.

Professional Esports Players: Motivation and Physical Activity Levels

The professionalisation of esports has increased in recent years, generating the need for further study. Its evolution and continuous development have led the consideration of esports as a profession, increasing the number of players, practice modalities, and hours of play dedicated to this field. The aim of this study was to analyse the relationship between physical activity levels and motivational orientations in an international sample of professional esports players. A cross-sectional and observational study was conducted in European and Latin American countries. The sample was non-probabilistic by convenience, and 260 male professional esports players were recruited. A survey was used that included demographic data, body composition, physical activity (International Physical Activity Questionnaire), and motivation (Sport Motivation Scale). The results show that 92.7% of professional esports players have moderate and high levels of physical activity and that players with low levels of physical activity have positive values in all dimensions of motivation. It is concluded that extrinsic and intrinsic motivation correlates inversely with energy expenditure.

Draconian policy measures are unlikely to prevent disordered gaming

In August of 2021, China imposed severe restrictions on children's online gaming time. We argue that such a policy may seem useful on the surface but does not reflect the current evidence concerning prevention of disordered gaming. Videogame play is normal for children worldwide, and like other leisure activities can lead to benefits for the majority and problems for a minority. Problematic or disordered play results from the interaction of multiple risk factors that are not addressed by draconian policy measures. Identifying these factors through stakeholder-engaged research and current evidence will be much more likely to succeed in preventing disordered gaming and promoting youth wellbeing.

Development and Verification of an Internet Game Literacy Scale

BACKGROUND

Education on internet games for parents and internet game literacy are needed to prevent problematic internet game playing in Korea. We created an 18-item Internet Game Literacy Scale (IGLS). It is a valuable tool for assessing the positive and negative aspects of internet game play. We aimed to determine the validity of the IGLS and the cut-off for the tendency for internet gameplay.

METHODS

An online research company gathered data from 300 participants. Factor analysis, including Cronbach's α and consistency coefficient, exploratory factor analysis, and confirmatory factor analysis were conducted to verify the 18 items of the IGLS. Additionally, a K-means cluster analysis was performed to determine the cut-off values for positive and negative IGLS scores.

RESULTS

The 18 items of the IGLS were proven to be reliable, as evidenced by a high Cronbach's alpha (α = 0.892). The Kaiser-Meyer-Olkin measure of sampling adequacy was 0.903, and Bartlett's test of sphericity was good (χ² = 1,623.314, P < 0.001). All 18 items were segregated into two factors, with nine items each. The eigenvalue of all 18 items was significant at > 0.4. In the analysis of the validity of the 18-item IGLS with confirmatory factor analysis (CFA) (maximum likelihood estimation, with an oblique method), the fit indices of the standard three-factor model reached acceptable standards. The cut-off point of the total score between the low positive and average positive groups was 23, and the cut-off point of the total score between the average positive and high positive groups was 30. The cut-off point of the total score between the low negative and the average negative groups was 24. The cut-off point of the total score between the average negative group and the high negative group was 32.

CONCLUSION

The study assessed the reliability and validity of the IGLS and suggested a cut-off for low, average, and high Internet game literacy degree with 300 Korean adults aged 21-49 years. The current results suggest that the IGLS has good internal consistency and a proper cut-off for positive and negative internet game literacy degrees.

What game we are playing: the psychosocial context of problem gambling, problem gaming and poor well-being among Italian high school students

Gambling and gaming are not infrequent among adolescents and preventing low-risk youth from becoming at-risk appears to be a priority of public health strategies. Greater scrutiny of the risk and protective factors in the relationships and community of young people appears crucial in steering prevention initiatives adequately. This study aimed to explore the role of the qualities of relational networks (i.e. family functioning, perceived social and class support), family and peer approval and view of the social environment in predicting problem gambling, problem gaming and overall well-being among adolescents. High-school students aged 14-18 years (N: 595; female: 68,7%) completed a survey including the target variables. A multivariate multiple regression analysis was performed to examine the role of socio-demographic characteristics and psychosocial predictors on gaming, gambling, and well-being. Multivariate multiple regressions identify a common core underpinning problem gambling, gaming and poor well-being but also the distinct roles of psychosocial variables: being male, with low parental monitoring, and an anomic view of the social environment all predict problem gambling and gaming, which were also found to be associated. Low social support predicts problem gambling but not problem gaming; poor family functioning predicts problem gaming but not problem gambling. All the target psychosocial variables, except approval of gambling, predict poor well-being. On the whole the findings suggest the need to look more closely at the way adolescents, their system of activity and their culture participate in constructing the meaning of gambling and gaming activities and their impact on adolescents' well-being, so that future studies and strategies can more effectively examine the relational dynamics in which problem gambling and gaming develop.

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.

Person-centred interventions for problem gaming: a stepped care approach

BACKGROUND

Problem gaming is reported by approximately 1-3% of the population and is associated with decreased health and wellbeing. Research on optimal health responses to problem gaming remains limited. This study aimed to identify and describe the key components of a person-centred approach to interventions for problem gaming for individuals who voluntary seek assistance.

METHODS

Online interviews were conducted with 20 adults (90% male; M_age = 23y) currently seeking help for problem gaming. The interview protocol was guided by a health care access framework which investigated participants' experiences and needs related to accessing professional support. Transcripts were analysed in NVivo using qualitative content analysis to systematically classify participant data into the themes informed by this framework.

RESULTS

Participants had mixed views on how the negative consequences of problem gaming could be best addressed. Some indicated problems could be addressed through self-help resources whereas others suggested in-person treatment with a health professional who had expertise in gaming. Participants described the essential components of an effective health service for problem gaming as including: valid and reliable screening tools; practitioners with specialist knowledge of gaming; and access to a multimodal system of intervention, including self-help, internet and in-person options that allow gamers to easily transition between types and intensity of support.

CONCLUSION

A comprehensive health care approach for interventions for problem gaming is in its infancy, with numerous service access and delivery issues still to be resolved. This study highlights the importance of involving individuals with gaming-related problems in developing solutions that are fit for purpose and address the spectrum of individual preferences and needs. These findings recommend a stepped healthcare system that adheres to evidence-based practice tailored to each individual and the implementation of standard assessment and routine outcome monitoring.

Policy Recommendations for Preventing Problematic Internet Use in Schools: A Qualitative Study of Parental Perspectives

Parenting in the digital age has been characterized as one of the most challenging tasks of the modern era. Parents are ambivalent about their mediating role. However, problematic aspects of adolescent online use have not been adequately addressed in education. The present study investigated parental perceptions of intervention needs within schools to prevent excessive/problematic use, enhance parent-child communication, and reduce family conflicts. Nine interviews with parents of adolescents residing in the UK were carried out and analyzed utilizing thematic analysis. Three main themes emerged as parental proposals: (i) schools as digital education providers and prevention hubs, (ii) provision of mental health literacy to raise awareness, resolve ambiguity regarding impacts and mitigate excessive use and impacts, and (iii) psychoeducation and upskilling. The third theme related to impacts from time spent on screens (time displacement), content-related impacts, and context-related impacts. The present study offers recommendations for media literacy during adolescence beyond e-safety (i.e., addressing interpersonal communication problems, privacy vs. disclosure issues), based on parents' views, and provides new insights for media and emotional health literacy collaboration efforts. Future work should investigate the feasibility and effectiveness of such interventions to support the emotional health of young people and prevent problematic internet use escalation.

Prevention Strategies to Address Problematic Gaming: An Evaluation of Strategy Support Among Habitual and Problem Gamers

Psychosocial problems arising from excessive gaming are a public health issue across the developed world. In its most serious form, problematic gaming is recognized as gaming disorder (GD) in the ICD-11. Research has tended to focus on the value of outpatient treatment for GD, but less attention has been paid to broader prevention strategies to address less serious but nevertheless harmful gaming behaviors. Another gap in this literature has been the lack of involvement of the gaming community as stakeholders to identify feasible prevention approaches. This study investigated: (1) regular and problematic gamers' level of support for different prevention strategies within primary, secondary, and tertiary approaches; and, (2) whether self-efficacy is associated with greater support for prevention strategies, as predicted by the Health Belief Model. A total of 992 participants completed an online survey that evaluated support for problem gaming prevention strategies and included measures of self-efficacy, gaming involvement, and GD symptoms, psychological distress, and mental health help-seeking behaviors. Participants reported stronger support for primary prevention strategies, including education, screening, and warning labels, than for other prevention approaches. Overall, 61% of participants expressed support for primary prevention as compared to secondary (39%) and tertiary (36%) approaches. There was stronger support for outpatient care (48%) than inpatient services (25%). In-game shutdown features received the lowest support (65% disapproval). Contrary to the Health Belief Model, self-efficacy was not associated with prevention support. Younger, female, and less frequent gamers were more likely to support primary and secondary prevention strategies. These findings suggest that gamers may be more favorable toward prevention measures aligned with informed decision-making, autonomy, and self-directed actions. Gamers may be strongly opposed to modifications to the structure of gaming activities (e.g., shutdown features). Future research should evaluate the efficacy and cost-effectiveness of problem gaming prevention measures in different populations and regions.

Perceived Challenges and Online Harms from Social Media Use on a Severity Continuum: A Qualitative Psychological Stakeholder Perspective

Evidence suggests that problematic use of gaming, the internet, and social media among adolescents is on the rise, affecting multiple psycho-emotional domains. However, research providing a comprehensive and triangulated stakeholder perspective of perceived harms is lacking. How are adolescent online harms experienced and conceptualized by students, parents, and teachers? The present study comprised part of a qualitative needs assessment investigation with the use of focus groups and individual interviews among key stakeholder groups assessing perceived impacts with a focus on the negative consequences and perceived harms. The study’s sample consisted of students (N = 42, M_age = 13.5, SD = 2.3), parents (N = 9, M_age = 37, SD = 5.6) and teachers (N = 9, M_age = 34, SD = 4.9) from the UK. Data were analysed with thematic analysis. Findings focused primarily on social media use impacts and indicated that processes underlying impacts experienced by adolescents may be conceptualized on a severity continuum. Stakeholder consensus on perceptions of challenges and perceived harms formed the second theme, with impacts further analysed as relating to time displacement, peer judgement, sensory overload and context of the adolescent with functional (performance, task switching, use of multiple devices), cognitive (loss or deterioration of attentional focus, attention deficit), and emotional consequences (stress, anxiety, obsessive-compulsive/checking behaviours). A third theme formed was individual vulnerabilities predisposing poor mental health outcomes. The final theme related to impacts dependent on context and meaning attached. Findings suggest a consideration of a spectrum approach encompassing a broader range of potential psychological challenges and perceived harms beyond safety concerns and addiction in understanding problematic adolescent online experiences. Understanding perceived harms can aid the objective setting of interventions and consideration of mental health literacy in school curricula.

Application of the eleventh revision of the International Classification of Diseases gaming disorder criteria to treatment-seeking patients: Comparison with the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders Internet gaming disorder criteria

The World Health Organization included gaming disorder (GD) in the eleventh revision of International Classification of Diseases in 2019. Due to the lack of diagnostic tools for GD, a definition has not been adequately applied. Therefore, this study aimed to apply an operationalized definition of GD to treatment-seekers. The relationship between the diagnoses of GD and Internet gaming disorder (IGD) in the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders was also examined. Methods: Study participants comprised 241 treatment-seekers who had engaged in excessive gaming and experienced related problems. Psychiatrists applied the GD diagnostic criteria to the participants using a diagnostic form developed for this study. Information on gaming behavior and functional impairment was obtained through face-to-face interviews conducted by clinical psychologists. Results: In total, 78.4 and 83.0% of the participants fulfilled the GD and IGD diagnostic criteria, respectively. The sensitivity and specificity of GD diagnosis were both high when the IGD diagnosis was used as the gold standard. Participants with GD preferred online PC and console games, spent significantly more time gaming, and showed a higher level of functional impairment compared to those who did not fulfill the GD diagnostic criteria. Discussion and Conclusion: The definition of GD can be successfully applied to treatment-seekers with excessive gaming and related problems. A high concordance of GD and IGD diagnoses was found in those participants with relatively severe symptoms. The development and validation of a diagnostic tool for GD should be explored in future studies.

Problematic risk-taking involving emerging technologies: A stakeholder framework to minimize harms

BACKGROUND AND AIMS

Despite the many benefits of technological advancements, problematic use of emerging technologies may lead to consumers experiencing harms. Substantial problems and behavioral addictions, such as gambling and gaming disorders, are recognized to be related to Internet-based technologies, including the myriad of new devices and platforms available. This review paper seeks to explore problematic risk-taking behaviors involving emerging technologies (e.g., online gambling and gaming, online sexual behaviors, and oversharing of personal information via social networking sites) that have the potential to lead to problematic outcomes for individuals.

RESULTS AND DISCUSSION

Previous research has focused on policy frameworks for responding to specific issues (e.g., online gambling), but a broader framework is needed to address issues as they emerge, given lags in governments and regulators responding to dynamically evolving technological environments. In this paper, key terms and issues involved are identified and discussed. We propose an initial framework for the relative roles and responsibilities of key stakeholder groups involved in addressing these issues (e.g., industry operators, governments and regulators, community groups, researchers, treatment providers, and individual consumers/end users).

CONCLUSION

Multidisciplinary collaboration can facilitate a comprehensive, unified response from all stakeholders that balances individual civil liberties with societal responsibilities and institutional duty of care.

A systematic review on the intersection of attention-deficit hyperactivity disorder and gaming disorder

INTRODUCTION

Studies of Gaming Disorder (GD) consistently identify co-morbidity with various psychiatric disorders including major depression, obsessive compulsive disorder and anxiety disorders. One of the strongest associations has been with Attention Deficit Hyperactivity Disorder (ADHD). We present a systematic review of this association by pooling and integrating available evidence.

METHODS

PubMed, EMBASE, PsychInfo and CINHAHL were searched for articles that reported a quantitative association between GD and ADHD and its dimensions, using equivalent search terms. Quality appraisal was done using criteria adapted from the Critical Appraisal Skills Package (CASP) checklists.

RESULTS

1028 articles were identified, of which 29 studies were included for systematic review (n = 56650 participants). Most of these studies were observational in nature, and were of moderate quality, with deficits particularly in the domains of generalisability and confounding. Community surveys (n = 18) of purposive samples constituted the majority, with fewer clinic-based samples (n = 11). While ADHD symptoms were consistently associated with GD, More frequent associations were displayed with inattention associations with GD than other ADHD subscales. There were no conclusive findings regarding the type of game on severity of either condition, or on completion of treatment.

CONCLUSIONS

The findings suggest an association between ADHD and GD, although the direction of the relationship is unclear. This has implications for clinical practice, policy and research. We recommend that ADHD is screened for when evaluating IGD as part of routine practice."

Expanding on the multidisciplinary stakeholder framework to minimize harms for problematic risk-taking involving emerging technologies. •

As new types of problematic behaviors and new forms of online risk-taking emerge, forming collaborative relationships while understanding complexities of motivations may help to promote harm reduction and intervention. While it may be too early to form a stakeholder framework without first conceptually understanding the problematic behaviors involved, we attempt to build upon a proposed multidisciplinary stakeholder framework to minimize harms for problematic risk-taking involving emerging technologies. We propose an expansion of roles for individual stakeholders and an expansion of proposed roles for family stakeholders to include partner/spouses, others living in the household, and/or those with close relationships with individuals who are experiencing problems. Empowering individuals who use emerging technologies through participatory action research and knowledge translation/dissemination may lead to improvements in the quality of research and a greater impact on policy and practice. Also, we discuss benefits of industry self-regulation and collaboration on data-sharing practices. We recommend approaches to promote global collaboration with a larger group of relevant stakeholders (including but not limited to individual consumers of technology, families, communities, treatment and welfare providers, researchers, industries, and governments) to address protection of vulnerable populations and reduce harms for users of rapidly advancing technologies.

Gaming addiction, problematic gaming and engaged gaming - Prevalence and associated characteristics

Introduction

Gaming disorder was included in the 11th revision of the International Classification of Diseases (ICD 11) and the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) included Internet Gaming Disorder as a tentative diagnosis. Most scholars agree upon the potential risk for pathological use of video games. The primary aim of this study was to investigate the prevalence of engaged gamers, problem gamers and addicted gamers. The secondary aim was to describe these groups in terms of gender, age, social satisfaction, psychological wellbeing and hours spent chatting on internet/social media.

Methods

We used survey-based data for this population-based research. The data was collected online in two different settings in 2017. In total 2075 participants were included.

Results

4.5 percent met the criteria for highly engaged gaming, 5.3 percent were shown to be problem gamers and 1.2 percent met the cut off for game addiction. Young age, hours chatting on internet/social media, experiencing loneliness and considering seeking treatment for psychological distress were associated with both engaged, problematic and addictive gaming. Male gender was associated to problematic and addictive gaming. Hours spent chatting showed a greater correlation to problem/addictive gaming than to engaged gaming.

Conclusion

The results of this study indicate that both highly engaged gamers, problem gamers and addicted gamers all experience loneliness and psychological distress to a greater extent than the remaining study participants. This adds to the knowledge of prevalence and features of gaming disorder. Additionally, preferably longitudinal research is needed in order to understand causality.

Maternal Education Level and Excessive Recreational Screen Time in Children: A Mediation Analysis

There is increasing recognition of the adverse health consequences of excessive recreational screen time (RST) in children and adolescents. Early interventions that aim to reduce RST are crucial, but there are some controversies about which individual and parental variables affect RST in children. The aim of this study was to determine the relationship of parental education level with RST in children and early adolescents and to identify mediators of these relationships. This cross-sectional study examined a sample of children (2–14 year-old) who attended routine childcare visits in primary health care centers in Spain (n = 402; 53.7% males; mean age: 7 ± 4 year-old). A self-reported questionnaire was given to the parents to assess sociodemographic data, parental education, the home media environment, and RST in children. Separate analysis was performed for two age groups (2–6 year-old and 6–14 year-old). Path analysis, an application of structural equation modeling, was used to analyze the data. Fitty three percent of the children had excessive RST (≥2 h/day). The maternal education level, eating lunch/dinner in front of a TV, presence of a background TV, and the amount of parental TV viewing had significant associations with excessive RST in both age groups. For the younger group, the maternal education level had direct and indirect effects on RST (total effect: β = −0.29, p < 0.01). For the older group, maternal education level only had a significant indirect effect on RST, and this was mediated by the presence of a background TV and the time of parental TV viewing (total indirect effect: β = −0.11, p < 0.01). A higher maternal education level appears to be associated with certain environmental factors or habits that prevent excessive RST.

Considering existing classic and contemporary proposals for preventing online addiction problems: Some old recipes for new problems. •

This commentary examines the proposed framework in relation to current policy options and preventive strategies and adds classical prevention and ecological models to tackle internet use-related addiction problems. Specifically, it highlights the preventive developments regarding contributions to promote the healthy use of technologies, and the need of designing and testing prevention strategies targeting the incidence, prevalence and severity of these problems at all population levels. In summary, to start preventing and minimising harms due to the problematic and addictive use of emerging technologies, we already have old models we can apply to these new problems to ensure secure behaviours through the technologies, and enhance users' wellness and quality of life.

Identifying individuals in need of help for their uncontrolled gaming: A narrative review of concerns and comments regarding gaming disorder diagnostic criteria

OBJECTIVE

In 2013, the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5) included the diagnostic criteria of Internet gaming disorder (IGD). Then, in 2019, the 11th Revision of the International Classification of Diseases (ICD-11) categorized gaming disorder (GD) as an addictive disorder. This review aimed to review the raised concerns, debate, and research of IGD or GD criteria and provide suggestions to resolve them.

METHODS

A narrative review was conducted, and PubMed was searched for articles mentioning concerns and research on the DSM-5 criteria for IGD, ICD-11 criteria for GD, or criteria for other synonyms, such as problematic gaming or gaming addiction. A total of 107 articles were identified.

RESULTS

Concerns were organized into three categories: conceptual framework, moral panic, and diagnostic validity. Most argumentations supported the proposition that GD and other substance use disorders have similar presentations. A clear definition of GD and adequate public education could prevent rather than exacerbate moral panic. Several researchers reported concerns regarding the nosology, diagnostic validity, and wording of each criterion. However, the threshold, five of the nine criteria with impaired function, demonstrated adequate validity in interview studies.

CONCLUSION

The current findings support the addiction framework, functional impairment, and validity of the GD criteria. However, further prospective, experimental, and clinical studies validating these findings are warranted. Moreover, an integrative review or debate conference could contribute to the organization of the available results and concept development. Aggregating adequate scientific information could allay or resolve concerns related to the diagnosis of GD.

Career as a Professional Gamer: Gaming Motives as Predictors of Career Plans to Become a Professional Esport Player

Increasing numbers of young video gamers view esports (i.e., competitive video gaming) as a career opportunity, rather than just a recreational activity. Previous studies have explored the motivational differences between esport and recreational gamers and the motivational changes through career journey to become a professional esport player. The present study explored the predictors of career plans to become a professional esport player, with a specific focus on gaming motivations. Gaming time, gaming motivations, and esport-related playing experience were also examined among Hungarian gamers with competitive gaming experience (N = 190), such as years spent in esports, medium and frequency of participating in esport tournaments, the effort put into training before the tournaments, and the plans to become a professional esport player. Binary logistic regressions were carried out and results showed that the gaming motivations of competition, skill development, and social motivations predicted career planning as a professional esport player. Additionally, results showed that younger players were more likely to seek career opportunity as professional esport players than older players. Future studies should focus on novice esport players’ psychological exposure to the hypercompetitive scene of esports, such as high expectations or the risk of becoming problematic videogame users due to their motivational changes.

Avatar- and self-related processes and problematic gaming: A systematic review

The concept of self has become increasingly relevant to understanding the psychological mechanisms of problematic online gaming. Many gaming activities feature in-game avatars that enable the adoption of, and experimentation with, different roles and identities. Avatars enable players to compensate for perceived deficiencies in their real-world self (e.g., lack of physical strength, beauty, or social status). Currently, how avatar- and self-related processes may develop and maintain problematic gaming, including gaming disorder (GD), is unclear. This systematic review examined 18 quantitative studies of avatar- and self-related concepts and problematic gaming, including 13 survey-based and 5 neuroimaging studies. Despite variability in the conceptualization and measurement of avatar/self-related concepts, survey-based studies have consistently reported that negative self-concept, avatar identification, and large self-avatar discrepancies are significantly associated with problematic gaming. Poor self-concept appears to be a risk factor for GD, particularly for games that facilitate role-playing and identity formation. Further research and clinical evidence are needed to explain how avatar- and self-related processes may relate to the addictive mechanisms of GD (e.g., cognitive distortions, reward-seeking, inhibitory control, self-regulation systems), amid calls for problem gaming-related assessment and interventions to incorporate a focus on avatar identification.

Stakeholders' Consensus on Strategies for Self- and Other-Regulation of Video Game Play: A Mixed Methods Study

Background: Little is known about strategies or mechanics to improve self-regulation of video game play that could be developed into novel interventions. This study used a participatory approach with the gaming community to uncover insider knowledge about techniques to promote healthy play and prevent gaming disorder. Methods: We used a pragmatic approach to conduct a convergent-design mixed-methods study with participants attending a science fiction and education convention. Six participants answered questions about gaming engagement and self- or game-based regulation of gaming which were then categorized into pre-determined (a priori) themes by the presenters during the presentation. The categorized themes and examples from participant responses were presented back to participants for review and discussion. Seven participants ranked their top choices of themes for each question. The rankings were analyzed using a nonparametric approach to show consensus around specific themes. Results: Participants suggested several novel potential targets for preventive interventions including specific types of social (e.g., play with others in a group) or self-regulation processes (e.g., set timers or alarms). Suggestions for game mechanics that could help included clear break points and short missions, but loot boxes were not mentioned. Conclusions: Our consensus development approach produced many specific suggestions that could be implemented by game developers or tested as public health interventions, such as encouraging breaks through game mechanics, alarms or other limit setting; encouraging group gaming; and discussing and supporting setting appropriate time or activity goals around gaming (e.g., three quests, one hour). As some suggestions here have not been addressed previously as potential interventions, this suggests the importance of including gamers as stakeholders in research on the prevention of gaming disorder and the promotion of healthy gaming. A large-scale, online approach using these methods with multiple stakeholder groups could make effective use of players’ in-depth knowledge and help speed discovery and translation of possible preventive interventions into practice and policy.

Preventing Harmful Internet Use-Related Addiction Problems in Europe: A Literature Review and Policy Options

Internet use-related addiction problems are increasingly being recognized on a European scale due to international health organizations considering gaming addiction. In April 2013, the American Psychiatric Association recognized Internet Gaming Disorder in the fifth Diagnostic and Statistical Manual of Mental Disorders, and in April 2018, the World Health Organization included Gaming Disorder in the eleventh International Classification of Diseases. However, findings on these problems within this period are lacking in Europe, and a preventive approach is missing globally. A detailed critical literature review was conducted using PsycINFO and Web of Science in this five-year period. A total of 19 studies were reviewed and problems identified were: generalized Internet addiction and online gaming and gambling addictions across seven European countries (i.e., Spain, Germany, France, Italy, Greece, The Netherlands, and Denmark). The individuals with problematic use were found to be educated adolescents, usually young males with comorbid disorders, and gaming and gambling disorders were implicated in the most severe cases. Cognitive behavioral therapy was the main treatment, sometimes combined with a systemic approach for adolescents. Prevalence, high-risk populations, and factors contributing to these addiction problems are discussed, and a set of policy options are developed for this region. The implications for early detection, diagnosis, treatment, and prevention in Europe are considered.

Fortnite microtransaction spending was associated with peers' purchasing behaviors but not gaming disorder symptoms

Monetized video games have received academic and regulatory scrutiny following concerns that these products may foster addiction-like behaviors, including compulsive spending. Previous studies have reported that individuals with markedly higher in-game financial expenditure are more likely to endorse symptoms of addictive behavior (i.e., gaming or gambling disorder). The present study recruited 428 adult Fortnite players from online forums and investigated gaming motivations and behaviors, as well as online social network influences, in relation to microtransaction spending and gaming disorder (GD) symptoms. The results showed that microtransaction spending was predicted by social influences (i.e., the frequency of spending by the participants' closest friend who spends money on Fortnite), greater accessibility to Fortnite across multiple devices, and having a higher in-game level. Spenders reported stronger motivation to acquire in-game rewards and were more likely to perceive game items as representing good value for money. Higher spenders were older and reported using more payment methods, having a close friend who pays for Fortnite more often, and spent more hours playing Fortnite. Problematic gaming was associated with trait impulsivity, weekly time spent playing the game, and the perception that reducing time spent playing would diminish one's sense of self-worth. Fortnite loot box spending was not associated with GD symptoms. These data suggest that different implementations of in-game monetization schemes may have different risk potential for consumers across games.