Global prevalence of gaming disorder: A systematic review and meta-analysis

Development of an Instrument to Assess Expectations for the Use of Online Gaming, Social Networking Sites, and Online Pornography: the Marburg Internet Use Expectations (MINUS-X) Questionnaire

User’s expectations contribute to the maintenance of problematic use of online gaming (OG), social networking (SN), and online pornography (OP). Since an instrument to assess use expectations across applications is lacking, this study aimed at developing and testing such a questionnaire. It consists of a general module (GM), which includes expectations relevant to all three applications, and three application-specific modules. A pilot and a validation study were conducted with 2880 German adults. We conducted item analyses, exploratory factor analyses (EFA), exploratory structural equation modelling, and correlation analyses. The EFA revealed six factors for the GM and two factors for each specific module. The GM demonstrated measurement invariance between applications. The instrument showed excellent psychometric properties, indicating its suitability for assessing expectations concerning the use of OG, SN, and OG reliably and validly. It could be helpful for treating patients with problematic use of the applications and investigating the role of the relevant expectations.

The Practice and Feasibility of Screening, Treatment, and Referral for Gaming Problems in Gambling, Alcohol and Other Drugs, and Youth Services

Screening, brief intervention, and referral to treatment (SBIRT) is a comprehensive approach to identifying people at risk of addiction, but its feasibility for gaming disorder is unknown. This study surveyed 88 clinicians from gambling, alcohol and other drugs, and youth services in New Zealand. Results indicated that the most frequent GD screening method was an unstructured interview (61%), but 74% stated they would use a standardized tool if available. Responsivity to the detection of GD was an immediate intervention (84%), and rates of referral were low (28%). Around 50% of clinicians indicated high confidence in administering motivational approaches and relapse prevention. There was strong support for screening training (85%), treatment guidelines (88%), self-help materials (92%), and access to internet-delivered CBT that could be used in conjunction with other treatment (84%). Clinicians appear motivated and willing to implement SBIRT for GD but report lacking necessary training and resources, including access to screening tools and treatment guidelines.

Role of Gaming Devices Associated With Internet Gaming Disorder in China: Cross-sectional Study

BACKGROUND

Chinese gamers use computer and mobile phone games widely. Consequently, concerns regarding the development of internet gaming disorder (IGD) in adolescents have been raised. However, only a few studies have focused on the influence of gaming devices on IGD.

OBJECTIVE

This study aims to compare sociodemographic information, gaming use characteristics, personality traits, and gaming motivations between computer game users (CGUs) and mobile phone game users (MGUs), as well as identifying IGD predictors.

METHODS

This was a cross-sectional study. A total of 3593 internet game players took part in an online survey, which included sociodemographic information, gaming patterns, gaming motivations, the Chinese version of the Video Game Dependency Scale, and the Chinese Big Five Personality Inventory brief version. The population was divided into 2 groups for comparison by mobile phone or computer use, and the IGD population was also compared within the 2 groups.

RESULTS

There were significant differences between the 2 gaming device groups in the time (t₂₉₉₄=7.75, P<.001) and money (t₂₉₉₄=5.11, P<.001) spent on gaming and in internet game addiction scores (t₂₉₉₄=3.68, P<.001). Individuals using different gaming devices had different game motivations and personality traits and preferred different genres of games. Results showed that IGD predictors were different for the 2 groups, for example, strategy (odds ratio [OR] 4.452, 95% CI 1.938-10.227; P<.001) and action shooter (OR 3.725, 95% CI 1.465-9.474; P=.01) games increased the risk for MGUs.

CONCLUSIONS

Gaming devices should be considered during early identification, such as long daily gaming time, much money spent on gaming, neuroticism, and conscientiousness. In addition, more research should be conducted on new gaming devices and IGD treatment.

Internet-Based Self-Assessment for Symptoms of Internet Use Disorder-Impact of Gender, Social Aspects, and Symptom Severity: German Cross-sectional Study

BACKGROUND

Internet use disorder (IUD) is a new type of behavioral addiction in the digital age. At the same time, internet applications and eHealth can also provide useful support in medical treatment.

OBJECTIVE

The purpose of this study is to examine if an internet-based eHealth service can reach individuals with IUD. In particular, it should be investigated whether both male and female individuals with more severe IUDs can be reached.

METHODS

Data were retrieved from the OMPRIS (online-based motivational intervention to reduce problematic internet use and promote treatment motivation in internet gaming disorder and internet use disorder) project (DRKS00019925), an internet-based motivational intervention to reduce problematic internet use and promote treatment motivation in internet gaming disorder and IUD. During the recruitment process (August 2020-March 2022), a total of 3007 individuals filled out the standardized scale for the assessment of internet and computer game addiction (AICA-S). The assessment was accessible via the project homepage. There was no preselection of participants at this stage of the study; however, the offer was addressed to people with hazardous internet use and IUDs. The web-based assessment was free and could be found via search engines, but attention was also drawn to the service via newspaper articles, radio reports, and podcasts.

RESULTS

Out of 3007 who participated in the web-based self-assessment, 1033 (34.4%) are female, 1740 (57.9%) are male, 67 (2.2%) are diverse individuals, and 167 (5.5%) did not disclose their gender. The IUD symptom severity score showed a wide range between the AICA-S extreme values of 0 and 27 points. On average, the total sample (mean 8.19, SD 5.47) was in the range of hazardous IUD behavior (AICA-S cutoff>7.0). Furthermore, 561 individuals (18.7% of the total sample; mean 17.42, SD 3.38) presented severe IUD (AICA-S cutoff>13.5). Focusing on female and male participants, 20.9% (363/1740) of the men and 14.9% (151/1033) of the women scored above 13.5 points, which can be considered pathological IUD behavior (χ²_2,2773=16.73, P<.001, effect size: Cramér V=0.078). Unemployment, being in vocational training or studying at a university, and being male were significantly associated with high IUD symptoms.

CONCLUSIONS

Using a large sample, the study showed that both mildly and severely IUD-affected individuals can be reached via the internet. An internet-based eHealth offer can thus be a good way to reach patients with IUD where they are addicted-on the internet. In addition, eHealth services increase the likelihood of reaching female patients, who hardly ever come to specialized outpatient clinics and hospitals. Since social problems, especially unemployment, have a strong association with disease severity, the integration of social counseling into treatment seems advisable in terms of a multidisciplinary approach.

TRIAL REGISTRATION

German Clinical Trials Register (DRKS) DRKS00019925; https://drks.de/search/de/trial/DRKS00019925.

Telemedicine as bridge to the offline world for person affected with problematic internet use or internet use disorder and concerned significant others

Introduction

Internet use disorder is a disorder of the digital age and presents a growing problem worldwide. It appears that due to structural and personal barriers, many persons affected (PA) and Concerned Significant Others (CSO) do not reach the health care system so far and thus a chronification of the pathology can proceed.

Methods

A telemedicine counseling service for PA and CSO of PA unwilling to enter treatment with two webcam-based sessions of 60 minutes for each group was created with the aim of reaching out to PA and CSO to provide a low-threshold support and refer the participants to the local health care system. Motivational interviewing for PA and CRAFT (Community Reinforcement and Family Training) for CSO were used as methods. Participants answered questions about their Internet use and sociodemographic data and six months after participation, participants were asked via email if they entered the local health care system. CSO answered the questions for themselves and in a third-party rating for PA unwilling to enter treatment.

Results

107 PA (34 years (SD = 13.64), 86% male) and 38 CSO (53 years (SD = 6.11), 28.9% male) participated in the two telemedicine sessions. After participation, 43.9% of the PA and 42.1% of the CSO reached the health care system. When there was consistency between the location of telemedicine consultation and treatment locally, over 90% of participants arrived (PA: 92.3%, CSO: 100%).

Conclusion

The results from this study reveal that telemedicine services could be a promising approach to address PA and CSO and build a bridge to the local health care system. Future studies should verify if these results can be replicated in randomized controlled trials.

Acupuncture ameliorates Mobile Phone Addiction with sleep disorders and restores salivary metabolites rhythm

OBJECTIVES

Mobile Phone Addiction (MPA) is a novel behavioral addiction resulting in circadian rhythm disorders that severely affect mental and physical health. The purpose of this study is to detect rhythmic salivary metabolites in MPA with sleep disorder (MPASD) subjects and investigate the effects of acupuncture.

METHODS

Six MPASD patients and six healthy controls among the volunteers were enrolled by MPA Tendency Scale (MPATS) and Pittsburgh Sleep Quality Index (PSQI), then the salivary samples of MPASD and healthy controls were collected every 4-h for three consecutive days. Acupuncture was administered for 7 days to MPASD subjects, then saliva samples were collected again. Salivary metabolomes were analyzed with the method of LC-MS.

RESULT

According to our investigation, 70 (57.85%) MPA patients and 56 (46.28%) MPASD patients were identified among 121 volunteers. The symptoms of the 6 MPASD subjects were significantly alleviated after acupuncture intervention. The number of rhythmic saliva metabolites dropped sharply in MPASD subjects and restored after acupuncture. Representative rhythmic saliva metabolites including melatonin, 2'-deoxyuridine, thymidine, thymidine 3',5'-cyclic monophosphate lost rhythm and restored after acupuncture, which may attribute to promising MPASD treatment and diagnosis biomarkers. The rhythmic saliva metabolites of healthy controls were mainly enriched in neuroactive ligand-receptor interaction, whereas polyketide sugar unit biosynthesis was mainly enriched in MPASD patients.

CONCLUSION

This study revealed circadian rhythm characteristics of salivary metabolites in MPASD and that acupuncture could ameliorate MPASD by restoring part of the dysrhythmia salivary metabolites.

Predictive power of the DSM-5 criteria for internet use disorder: A CHAID decision-tree analysis

Introduction

Although the majority of internet users enjoy the internet as a recreational activity, some individuals report problematic internet use behaviors causing negative psychosocial consequences. Therefore, it is important to have precise and valid diagnostic criteria to ensure suitable treatment for those affected and avoid over-pathologization.

Methods

The aim of the present study was to determine which of the nine DSM-5 criteria of internet gaming disorder (IGD) are crucial in distinguish pathological from non-pathological internet use based on the questionnaire-based response behavior of the participants by applying the Chi-squared automatic interaction detection (CHAID) decision tree analysis. Under consideration of the nine DSM-5 criteria for IGD and according to the short-form scale to assess Internet Gaming Disorder (IGDS-SF9) the DSM-5 criteria were formulated as questions and applied to the broader concept of Internet Use Disorder (IUD). The nine questions were answered on a 5-point Likert scale from "never" to "very often." In accordance with the IGDS-SF9 participants were assigned to IUD-5plus if at least 5 of the 9 criteria were answered with "very often." The study was conducted in Germany (N = 37,008; mean age: 32 years, SD = 13.18, 73.8% male).

Results

Although "loss of control," "continued overuse" and "mood regulation" were the most endorsed criteria, the analysis indicated that the criterion "jeopardizing" was found as the best predictor for IUD-5plus, followed by "loss of interest" and "continued overuse." Overall 64.9% of all participants who were in the IUD-5plus, could been identified by the fulfillment of the three criteria mentioned above.

Discussion

The results found support for adjustment of the DSM-5 criteria of IGD in accordance to ICD-11. If the predictive power of the three criteria can be replicated in future representative studies, such a decision tree can be used as guidance for diagnostics to capture the particularly relevant criteria.

Internet addiction in adolescent psychiatric patient population: A hospital-based Study from China

BACKGROUND

Internet is gradually reshaping adolescents' behaviors in China. It is important to identify the prevalence and risk factors to predict Internet addiction among adolescent psychiatric patients.

METHODS

The survey was conducted among inpatient or outpatient adolescent patients with mental disorders. All participants were interviewed face-to-face and completed Young Internet Addiction Test and other relevant assessments. Binary logistic regression analysis was used to exam between-group differences of internet addiction.

RESULT

The prevalence for internet addiction (mild to severe) in adolescent psychiatric patients was 80.2%, where the prevalence for "medium and severe internet addiction was 25.5%. Logistic regression analysis identified two independent predictors for "medium and severe internet addiction" including the total score of Adolescent Non-suicidal-self-injury (NSSI) Behavior Function Assessment Scale (ANBFAS) and the diagnosis of generalized anxiety disorder (GAD) (R² =0.27, p = .02 for total ANBFAS score, p = .01 for GAD) in psychiatric adolescent patients.

CONCLUSION

The prevalence of internet addiction is notably high among adolescent psychiatric patients in China. Coping for Internet addiction in adolescent psychiatric patients should conclude the coping of NSSI and GAD.

Network analysis of internet gaming disorder, problematic social media use, problematic smartphone use, psychological distress, and meaning in life among adolescents

Background

Few studies have examined the connections between psychological distress, meaning in life, internet gaming disorder (IGD), problematic smartphone use (PSU), and problematic social media use (PSMU).

Methods

The central and bridging nodes of IGD, PSMU, and PSU symptoms were investigated using network analysis in China among 742 adolescents ( Mage = 15.39, SD = 1.68, range = 12–19; 53.23% female). The relationships between IGD, PSMU, and PSU and associated factors were investigated using a Directed Acyclic Graphs method.

Results

The results suggested that the central symptoms were withdrawal in IGD, mood modification in PSU, and tolerance in PSMU. Mood modification in IGD, mood modification in PSU, withdrawal in PSMU, and functional impairment in PSMU were the bridge symptoms. Males were more likely to experience symptoms of IGD than females, while females were more likely to need meaning than males. Stress is the root factor, while depression, meaning confusion, meaning anxiety, and meaning avoidance were closely associated with IGD, PSMU, and PSU.

Conclusions

The current research improved the understanding of IGD, PSMU, and PSU symptoms in teenagers and demonstrated the potential of dynamic systems perspectives on problematic use behaviors and stress/meaning-focused interventions.

Resting-state heart rate variability, level of stress and resilience in internet gaming disorder and alcohol use disorder

Stress and resilience are involved in the pathophysiology of addictive disorders, and heart rate variability (HRV) is an index of an individual's global capability to regulate psychological responses. In this study, we aimed to identify transdiagnostic and disorder-specific markers in people with addictive disorders by analyzing resting-state HRV and associations with the levels of stress and resilience. We compared relevant data between patients with internet gaming disorder (IGD) and/or alcohol use disorder (AUD) and healthy controls (HCs). In all, 163 adults aged 18-35 years (53 with IGD, 49 with AUD, 61 HCs) participated. The levels of stress and resilience were measured using the Psychosocial Wellbeing Index and the Connor-Davidson Resilience Scale, respectively. The HRV was obtained from each participant during a 5 min resting-state. The IGD and AUD patients exhibited increased levels of stress and decreased resilience compared to the HCs. Patients with either addictive disorder exhibited a lower standard deviation of the normal-to-normal beat interval (SDNN) index [SDNNi] compared to HCs even after adjusting for clinical variables such as depression, anxiety, and impulsivity. In multiple comparison tests among the three groups, the AUD group had lower HRV than HCs, but no differences were observed among the groups after adjusting for the clinical variables. The HRV indices were correlated with the levels of stress, resilience, and disease severity. In conclusion, IGD and AUD patients exhibit lower HRV as indicated by the SDNNi compared to HCs, revealing their vulnerability to stress as well as a common transdiagnostic marker of addiction.

Emotion dysregulation mediates the relationship between adverse childhood experiences and problematic gaming

Gaming disorder (i.e., gaming addiction) is a relatively common mental health disorder with a worldwide prevalence rate of 3.05%. In the present research, we examined whether emotion dysregulation mediates the relation between adverse childhood experiences and problematic gaming in two samples of current video game players. The first sample consisted of 1,262 students recruited from five universities across Canada. The second sample comprised 417 community adults residing in Canada. Both samples of participants completed an online survey which included measures of adverse childhood experiences, problematic gaming, and emotion dysregulation. A total of 45.64% (n = 576) in the university sample and 49.76% (n = 205) in the community sample met the threshold for problematic gaming. In the student sample, adverse childhood experiences were positively associated with problematic gaming. In contrast, there was no significant association between adverse childhood experiences and problematic gaming in the community sample. In both samples, adverse childhood experiences were positively associated with emotion dysregulation, and emotion dysregulation was positively associated with problematic gaming. Importantly for the present research, emotion dysregulation mediated the relationship between adverse childhood experiences and problematic gaming in both the university and community sample. Although adverse childhood experiences are distal and static risk factors for problematic gaming, emotion dysregulation is a more proximal and modifiable risk factor. The results suggest that increasing adaptive emotion regulation skills may decrease the risk of problematic gaming among individuals who have experienced an adverse childhood experience.

Personality traits and their role as risk modifiers in gaming disorder and internet use disorders

PURPOSE OF REVIEW

After its initial recognition in the DSM-5, Gaming Disorder has now officially been included as a mental disorder in the ICD-11 as a behavioral addiction. In the past decades, research on this phenomenon has increased and in particular theories on its etiopathology have been suggested. In that respect, underlying factors, including neurobiological, social, and psychological factors, have been described. One commonly discussed etiological factor is supposed in specific personality traits. Knowing more about underlying personality factors of Gaming Disorder and other subtypes of internet use disorders would allow for a construction of more sophisticated etiological models, tailored prevention approaches, and would affect the specificity of treatment strategies. This overview provides information on current research on the role of the Big Five personality traits in Gaming Disorder as potential risk modifiers and maintaining factors.

RECENT FINDINGS

Research has especially identified high neuroticism and low conscientiousness as correlates of Gaming Disorder. Yet, results based on prospective studies are lacking largely, although there is the first evidence that personality traits might not only act as risk modifying factors but could also be influenced by Gaming Disorder.

SUMMARY

Suggestions for future research and the need for a more pronounced perspective taking into account the changing dynamics of personality are presented in this contribution. Addressing personality traits in treatment programs could be a promising approach in preventing patients from premature treatment termination and later relapse.

Psychometric properties of three online-related addictive behavior instruments among Bangladeshi school-going adolescents

BACKGROUND

Due to the ease of access to the internet in modern society users have become more prone to experiencing addictive behaviors online. The present study aimed to develop and investigate the psychometric properties of the Bangla Internet Gaming Disorder Scale-Short-Form (IGDS9-SF), Gaming Disorder Test (GDT), and Bergen Social Media Addiction Scale (BSMAS) due to a lack of existing sound psychometric tools in Bangladesh.

METHODS

A cross-sectional paper-and-pencil survey was carried out among 428 school-aged adolescents who were active gamers (90.89% males; Meanage: 16.13±1.85 years; age range: 10-19 years). Participants were recruited using convenience sampling across four selected schools in Dhaka City, Bangladesh. Data collected included sociodemographic information, frequency of internet use and gaming behaviors, psychological states (i.e., Patient Health Questionnaire [PHQ-9], Generalized Anxiety Disorder [GAD-7]), disordered gaming and social media use (i.e., IGDS9-SF, GDT, and BSMAS). Psychometric testing was conducted to examine the validity and reliability levels of the Bangla IGDS9-SF, GDT, and BSMAS.

RESULTS

The newly adapted Bangla IGDS9-SF, GDT, and BSMAS exhibited adequate levels of internal consistency. All total scores were significantly correlated with depression, anxiety, frequencies of internet use/online activities and gaming, supporting criterion and convergent validity. CFA indicated excellent construct validity as all instruments had a good fit to the data.

CONCLUSIONS

The findings suggest that the Bangla IGDS9-SF, GDT, and BSMAS are sound psychometric instruments due to their satisfactory psychometric properties including internal consistency, criterion validity, convergent validity, and construct validity.

Examining the Indirect Effect of Online Gaming on Depression via Sleep Inequality and Anxiety-A Serial and Parallel Mediation Analysis

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.

Problematic smartphone use and specific problematic Internet uses among university students and associated predictive factors: a systematic review

University students are a high-risk population with problematic online behaviours that include generalized problematic Internet/smartphone use and specific problematic Internet uses (for example, social media or gaming). The study of their predictive factors is needed in order to develop preventative strategies. This systematic review aims to understand the current state of play by examining the terminology, assessment instruments, prevalence, and predictive factors associated with problematic smartphone use and specific problematic Internet uses in university students. A literature review was conducted according to the PRISMA guidelines using four major databases. A total of 117 studies were included, divided into four groups according to the domain of problem behaviour: problematic smartphone use (n = 67), problematic social media use (n = 39), Internet gaming disorder (n = 9), and problematic online pornography use (n = 2). Variability was found in terminology, assessment tools, and prevalence rates in the four groups. Ten predictors of problematic smartphone use, five predictors of problematic social media use, and one predictor of problematic online gaming were identified. Negative affectivity is found to be a common predictor for all three groups, while social media use, psychological well-being, and Fear of Missing Out are common to problematic smartphone and social media use. Our findings reaffirm the need to reach consistent diagnostic criteria in cyber addictions and allow us to make progress in the investigation of their predictive factors, thus allowing formulation of preventive strategies.

Psychological treatments for excessive gaming: a systematic review and meta-analysis

Despite widespread public interest in problematic gaming interventions, questions regarding the empirical status of treatment efficacy persist. We conducted pairwise and network meta-analyses based on 17 psychological intervention studies on excessive gaming (n = 745 participants). The pairwise meta-analysis showed that psychological interventions reduce excessive gaming more than the inactive control (standardized mean difference [SMD] = 1.70, 95% confidence interval [CI] 1.27 to 2.12) and active control (SMD = 0.88, 95% CI 0.21 to 1.56). The network meta-analysis showed that a combined treatment of Cognitive Behavioral Therapy (CBT) and Mindfulness was the most effective intervention in reducing excessive gaming, followed by a combined CBT and Family intervention, Mindfulness, and then CBT as a standalone treatment. Due to the limited number of included studies and resulting identified methodological concerns, the current results should be interpreted as preliminary to help support future research focused on excessive gaming interventions. Recommendations for improving the methodological rigor are also discussed.

The Japanese version of the Generalized Problematic Internet Use Scale 2 (GPIUS2): Psychometric evaluation and analysis of the theoretical model

BACKGROUND

The Generalized Problematic Internet Use Scale 2 (GPIUS2) is a self-administered questionnaire that evaluates problematic internet use (PIU) from a multidimensional perspective. We analysed the psychometric properties and adequacy of the theoretical model of Japanese version of the GPIUS2.

METHODS

This study included 291 healthy Japanese adults (median age = 25 years; interquartile range 22-43 years; 128 women) who completed the GPIUS2 and several other questionnaires evaluating the degree of PIU, self-esteem, depression, and impulsivity.

RESULTS

Exploratory factor analysis (EFA) revealed a similar factor structure between the original and Japanese versions of the GPIUS2, with only minor differences in item composition. Higher-order confirmatory factor analyses revealed a good overall fit for the factorial model suggested by EFA, indicating adequate construct validity. The model showed acceptable internal consistency. Partial correlation analyses between GPIUS2 and other measures, with age as a control variable, revealed good convergent validity. Finally, structural equation modelling showed a good fit to the data, supporting the cognitive-behavioural model of Caplan (2010).

CONCLUSIONS

The Japanese version of the GPIUS2 has good psychometric properties and the theoretical model of the original GPIUS2 is applicable to Japanese adults.

Different Typologies of Gamers Are Associated with Mental Health: Are Students DOOMed?

(1) Background: The inclusion of Internet Gaming Disorder in the Diagnostic and Statistical Manual for Mental Disorders (DSM-5) led to a rapid development of assessment instruments based on the suggested diagnosis. However, previous studies suggest that some of the symptoms in the diagnosis reflect engagement in gaming rather than a disorder or addiction. The aim of the present cross-sectional study was to investigate mental health associations with different typologies of gamers. (2) Methods: Data stemmed from a large national survey of students (SHoT2022) that was conducted between February and April 2022 (N = 59,544). Participants were categorized into non-gamers, recreational gamers, engaged gamers, problematic gamers, and addicted gamers. Logistic regression models adjusted for age were analyzed with and without gender-stratification for mental distress and life satisfaction as dependent variables across gaming categories. (3) Results: The proportion reporting case-level mental distress was lower for recreational gamers compared to non-gamers, indicating fewer mental health problems for recreational gamers. However, after stratifying the analysis by gender, female recreational gamers had higher levels of mental distress compared to female non-gamers, reflecting Simpson's paradox. (4) Conclusions: Future studies investigating mental health and gaming should include a gender perspective.

Functional impairment, insight, and comparison between criteria for gaming disorder in the International Classification of Diseases, 11 Edition and internet gaming disorder in Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition

AIM

This study evaluated the consistency between the International Classification of Diseases, 11th Edition (ICD-11) for gaming disorder (ICD-11-GD) and Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5) criteria for internet gaming disorder (DSM-5-IGD). Moreover, the functional impairment of participants and their insight of their GD were evaluated.

METHODS

We recruited 60 participants with GD, 45 participants who engaged in hazardous gaming (HG), and 120 controls based on a diagnostic interview. Their operationalization of functional impairment and stage of change were evaluated by interviews and questionnaires, including the Brief Gaming Negative Consequence Scale (BGNCS).

RESULTS

We observed satisfactory consistency (kappa value = 0.80) with a diagnostic accuracy of 91.5% between the ICD-11-GD and DSM-5-IGD criteria. Furthermore, 16 participants with IGD in DSM-5 were determined to have HG based on the ICD-11 criteria. Participants of GD group experienced impaired functioning in their health (96.7%), career (73.3%), social life (61.6%), academic performance (36.7%), and job performance (35%). Moreover, a proportion of them were in the pre-contemplation (25.0%), contemplation (61.7%), preparation (10%), and action stages (3.3%).

CONCLUSION

There is a good consistency between ICD-11-GD and DSM-5-IGD criteria. The ICD-11 criteria have a high threshold for diagnosing GD. HG criteria could compensate for this high threshold and identify individuals with a gaming-related functional impairment who require help. Most of the participants with GD were in the early stage of change. Interventions to promote their insight are essential. The BGNCS can be used to examine the negative consequences of gaming and aid mental health professionals in assessing functional impairment.

Reliability Generalization Meta-Analysis of Internet Gaming Disorder Scale

The objective of this study was to carry out a reliability generalization meta-analysis of the Internet Gaming Disorder Scale (IGDS) to find out if it presents adequate values that justify its application in its four versions: original and abbreviated with dichotomous or ordinal response. A systematic review including 26 studies that apply this instrument from 2015 to June 2022 was conducted. For each version, a reliability generalization meta-analysis was performed with the random coefficients (RC) and varying coefficients (VC) model. Results showed reliability levels > 0.80 in the ordinal versions (IGDS9P and IGDS27P) and in the dichotomous 27-item version (IGDS27D), while the dichotomous 9-item version (IGDS9D) produced levels > 0.70. High heterogeneity was found in all versions (I2 > 95%; Rb > 90%). Cronbach’s α means with both models (RC-VC) did not differ significantly except for the IGDS9D version. It is concluded that, considering the dependence of the results on sample size, abbreviated versions do not guarantee that reliability remains acceptable, and dichotomous versions may provide limited but acceptable reliability. Finally, IGDS27P version is recommended in contexts where high precision is required.

ADHD-Gaming Disorder Comorbidity in Children and Adolescents: A Narrative Review

Attention Deficit/Hyperactivity Disorder (ADHD) is a neurobiological condition characterized by developmentally inadequate levels of inattention, hyperactivity, and impulsivity, and a neurobiological disruption in brain neurotransmitters and circuitry causing abnormal responses to rewards. Playing electronic games generates a biological response that activates the neuronal circuits linked to pleasure and reward, and there is a growing attention to this type of activity, which can also turn into a mental health condition. The existence and the boundaries between the functional and the dysfunctional are still a source of debate, with the recognition of 'Internet Gaming Disorder' (IGD) as a condition belonging to the broader area of addiction requiring more in-depth study with respect to the DSM-5, while 'Gaming Disorder' (GD) was officially recognized as a new diagnosis by the World Health Organization (WHO) in the updated revision of the International Classification of Diseases (ICD-11). Notwithstanding, the suggested criteria for the diagnosis of Gaming Disorder are still debated. Since ADHD has been reported as a risk factor for developing addictions, this narrative review aims to provide the current state-of-the art of the knowledge about the comorbidity between ADHD and Gaming Disorder. For this aim, a literature search was conducted using a combination of specific keywords and the results are discussed within the R-Do-C framework and dimensions, and implications for treatment are considered.

Toward a delineation of the differences between high engagement and problem gaming

The boundary between highly engaged and problematic video gaming is often debated in the behavioral addictions field. The present study assessed whether quality of life, motivational and protective factors may differentiate high-frequency gamers (i.e., those who play 30 + hours per week) who did, and did not, meet the DSM-5 criteria for gaming disorder (GD). A total of 403 respondents completed an online survey including standard measures of GD, gaming motivation, quality of life (QOL), and protective factors for behavioral addiction (e.g., adequate sleep and healthy diet). Respondents with GD scored lower on all QOL measures and were more strongly motivated to use gaming to escape problems. Fewer protective factors were identified in GD cases, with an inability to balance gaming with sleep being the largest significant difference between the two groups. High-frequency gaming appears most likely to be problematic if it is used to escape real-world problems or prioritized over important everyday activities.

Psychometric Assessment and Gender Invariance of the Polish Version of the Gaming Disorder Test

In 2019, Gaming Disorder (GD) was officially recognised by the World Health Organization (WHO) as an official mental health disorder. Currently, the Gaming Disorder Test (GDT) is one of the most widely utilised psychometric tools to assess GD symptoms according to the WHO framework. In this context, the present study aimed to develop the Polish version of the GDT so that this tool can be used within the Polish cultural context. Additionally, the research aimed to ascertain the psychometric properties and appropriateness of the Polish GDT. To achieve this goal, the Polish GDT was investigated in terms of its validity, reliability, and gender measurement invariance through two studies. Accordingly, study 1 recruited a total of 675 gamers (340 female; Meanage = 31.74 years; SD = 7.75 years; range: 15-45 years) and study 2 comprised 575 gamers (275 female; M age = 29.45 years; SD = 4.25 years; range: 18-35 years). A Confirmatory Factor Analysis (CFA) was used to assess psychometric properties of the Polish GDT. The reliability was assessed using Cronbach's alpha, McDonald's omega, and Average Variance Extracted. Gender measurement invariance was investigated using multiple-group CFA, and the unidimensionality was tested using mean of item residual absolute loadings (MIREAL), explained common variance (ECV), and unidimensional congruence (UC). The results of the psychometric analysis showed that the Polish GDT had a one-factor structure. Additionally, the present study demonstrated that the Polish GDT exhibited adequate levels of convergent validity, reliability, and strict gender measurement invariance. These findings suggest that the Polish version of GDT is a suitable psychometric test to assess GD and facilitate research on GD.

Supplementary Information

The online version contains supplementary material available at 10.1007/s11469-022-00929-4.

Validation of the Ten-Item Internet Gaming Disorder Test (IGDT-10) based on the clinical diagnosis of IGD in Japan

BACKGROUND AND AIMS

Although the Ten-Item Internet Gaming Disorder Test (IGDT-10) has been translated into Japanese and widely used, the Japanese version has not previously been validated. We used the clinical diagnosis of IGD as a gold standard for validating the test.

METHODS

The Japanese version was validated using 244 gamers drawn from the general young population in Japan. Expert interviews using the Japanese version of the Structured Clinical Interview for Internet Gaming Disorder evaluated diagnoses of Internet gaming disorder (IGD). This resulted in a diagnosis of IGD for eight individuals, categorized as the gold standard group. The screening performance of the two Japanese versions with different scoring conditions was examined: the scoring method proposed by the original study (original version) and a less stringent scoring method where responses of either "often" or "sometimes" were regarded as affirmative (modified version).

RESULTS

The results of the sensitivity and specificity analyses, the Cronbach's alpha and the receiver operating characteristics analysis revealed a higher screening performance for the modified versus the original version. The optimum cutoff for the modified version was 5 or more - the sensitivity, specificity, and Youden's index were 87.5, 85.2, and 72.7%, respectively. The rate of probable IGD using the original and modified versions were 1.8% and 11.3%, respectively.

DISCUSSION AND CONCLUSION

A less stringent scoring method for the Japanese version of IGDT-10 showed a higher screening performance than the original scoring method. Future studies comprising different ethnic groups and gaming cultures should further examine the suggested scoring method.

Advances in problematic usage of the internet research - A narrative review by experts from the European network for problematic usage of the internet

Global concern about problematic usage of the internet (PUI), and its public health and societal costs, continues to grow, sharpened in focus under the privations of the COVID-19 pandemic. This narrative review reports the expert opinions of members of the largest international network of researchers on PUI in the framework of the European Cooperation in Science and Technology (COST) Action (CA 16207), on the scientific progress made and the critical knowledge gaps remaining to be filled as the term of the Action reaches its conclusion. A key advance has been achieving consensus on the clinical definition of various forms of PUI. Based on the overarching public health principles of protecting individuals and the public from harm and promoting the highest attainable standard of health, the World Health Organisation has introduced several new structured diagnoses into the ICD-11, including gambling disorder, gaming disorder, compulsive sexual behaviour disorder, and other unspecified or specified disorders due to addictive behaviours, alongside naming online activity as a diagnostic specifier. These definitions provide for the first time a sound platform for developing systematic networked research into various forms of PUI at global scale. Progress has also been made in areas such as refining and simplifying some of the available assessment instruments, clarifying the underpinning brain-based and social determinants, and building more empirically based etiological models, as a basis for therapeutic intervention, alongside public engagement initiatives. However, important gaps in our knowledge remain to be tackled. Principal among these include a better understanding of the course and evolution of the PUI-related problems, across different age groups, genders and other specific vulnerable groups, reliable methods for early identification of individuals at risk (before PUI becomes disordered), efficacious preventative and therapeutic interventions and ethical health and social policy changes that adequately safeguard human digital rights. The paper concludes with recommendations for achievable research goals, based on longitudinal analysis of a large multinational cohort co-designed with public stakeholders.

Recovery Experiences Protect Emotionally Exhausted White-Collar Workers from Gaming Addiction

Gaming addiction and its negative consequences have attracted public concern, but relatively little is known regarding its impact on adult workers. This study aims to test the association between gaming addiction and emotional exhaustion as well as the protective effect of recovery experiences on such an association among white-collar workers. We recruited 205 working adults (female = 58%) who voluntarily completed an online questionnaire. The results showed that male and younger workers were more vulnerable to gaming addiction. Emotional exhaustion was significantly and positively associated, while two (i.e., relaxation and control) of the four recovery experiences were negatively correlated with gaming addiction. Control experience had an indirect effect on gaming addiction via emotional exhaustion. Moreover, relaxation experience buffered the risk effect of emotional exhaustion on gaming addiction so that the effect is less pronounced at high levels of relaxation. Interventions are suggested to raise workers' awareness of effective recovery experiences (especially for control and relaxation) and to facilitate their recovery opportunities.

The prevalence and possible risk factors of internet gaming disorder among adolescents and young adults: Systematic reviews and meta-analyses

BACKGROUND

As a spreading addictive behaviour in recent years, internet gaming disorder (IGD) has been studied a lot and the overall research results indicate that IGD has a high prevalence among adolescents and young adults (AYAs). To update the status quo of prevalence, it is necessary to conduct comprehensive analyses.

METHODS

On the premise of following the PRISMA statement, the study conducted two systematic reviews and meta-analyses to assess the global prevalence of IGD among AYAs and identify its possible risk factors. To achieve the goals, PubMed and CNKI databases were used to select the concerned studies published up to May 31, 2021. Heterogeneity was assessed using a funnel plot, Begg's test, Egger's test, and trim-and-fil method, followed by sensitivity analysis, subgroup analysis, and meta-regression analysis.

RESULTS

For the meta-analysis of prevalence, 407,620 participants from 155 reports in 33 countries were included. The pooled prevalence of IGD among AYAs was 9.9% (95% CI: 8.6%-11.3%, P = 0.000, I² = 94.4%), including 8.8% (95% CI: 7.5%-10.0%) among adolescents and 10.4% (95% CI: 8.8%-11.9%) among young adults. The following 12 factors are the possible risk factors of IGD among AYAs, which are stress, long average game time, family dysfunction, poor academic performance, being bullied, bullying, interpersonal problems, hyperactivity/inattention, anxiety, depression, emotional distress and low self-esteem.

CONCLUSIONS

This study confirms the prevalence and possible risk factors for IGD among AYAs. It's valuable in understanding the threat of IGD and finding intervention strategies for IGD among AYAs.

An Evaluation of the Factors Related to Internet Gaming Disorder in Young Adults

BACKGROUND

Game addiction is a growing problem all over the world. The present study aimed to evaluate the prevalence and psychological, social, and behavioral effects of internet gaming disorder (IGD) on young adults.

METHODS

A preliminary study was conducted and the game types most commonly played on the internet were determined. Then, approximately 60 gaming site managers were contacted. After obtaining consent, the questionnaires were sent to gaming site members and they were asked to complete the questionnaires. Data were collected through a sociodemographic form, Internet Gaming Disorder Scale-Short Form (IGDS9-SF), Strengths and Difficulties Questionnaire (SDQ), and State-Trait Anxiety Inventory (STAI).

FINDINGS

The study was conducted with 613 participants. The age of the participants ranged from 15 to 30 years, with a mean age of 20.80±4.63 years. The prevalence of IGD was 10% (n=67). Those with low-income families and low academic performance were identified as more likely to develop IGD. Moreover, IGD was revealed to be more likely in individuals with fewer close friends, playing games from an early age, and those with a habit of devoting extensive time to watching online game videos on Twitch or YouTube. In addition, the risk of gaming disorder was approximately two times higher in individuals who preferred First Person Shooter (FPS) games and Massively Multiplayer Online Role-Playing Games (MMORPG).

CONCLUSION

The results of this study could be useful for estimating the level of IGD and carrying out more comprehensive studies to possibly be able to control IGD.

COVID-19-related impact on mental health and career uncertainty in student-athletes—Data from a cohort of 7,025 athletes in an elite sport high school system in Sweden

Objectives

Mental health consequences and behavior change has been described in elite athletes following the vast impact of the COVID-19 pandemic on the world of sports. However, most study samples have been of limited size, and few studies have assessed student-athletes. This study aimed to analyze perceived mental health impact, measured as clinical degree of depression and anxiety, worry about one's sport and about one's career, and behavioral change with respect to video gaming behavior, in high-school athletes in Sweden.

Methods

Data on anxiety and depression as well as on perceived behavioral changes during COVID-19 were collected from students at sports high schools in Sweden (N = 7,025) in February 2021, during the ongoing COVID-19 pandemic.

Results

Sixteen and 14% met criteria of moderate/severe depression and anxiety, respectively. Many respondents reported feeling mentally worse during the pandemic (66%), and were worried about the future of their sport (45%) or about their own future in sports (45%). Increased gaming behavior during COVID-19 was reported by 29%. All mental health variables were significantly more common in women, except increased gaming (more common in men). Being worried about one's career was less common in winter sports, more common in team sports and more common in older student-athletes, and associated with both depression and anxiety in regression analyses.

Discussion

Self-reported mental health impact of COVID-19 is substantial in student-athletes, and even more so in women and in team sports. The lower impact in winter athletes suggests a moderating effect of the seasons in which the COVID-19 outbreak occurred.

Evaluation of psychometric properties of the Arabic version of the Internet Disorder Scale (IDS-15)

The internet in modern society has impacted individuals of all ages, especially youth. Over the past 25 years, internet has become increasingly accessible, affordable, and available to a large proportion of individuals worldwide. Despite the clear advantages the internet has brought, adverse effects including potential disordered internet use have been noted among a minority of users. This has led to an increase in the development of screening instruments and numerous validation studies in many countries. Although Arabic is spoken in 25 countries worldwide, little research has been carried out, probably because there is a lack of Arabic instruments assessing problematic internet use. The present study evaluated the psychometric properties of the Arabic version of the 15-item Internet Disorder Scale (IDS-15). A cross-sectional study was conducted among 327 active internet users (35.5 % male; mean age = 21.49 years [SD = 3.06]) using a pen-and-paper-based survey. All participants completed the IDS-15, Bergen Social Media Addiction Scale (BSMAS), and Satisfaction with Life Scale (SWLS). The concurrent validity of the Arabic IDS-15 was satisfactory as its total score was significantly correlated with scores on the BSMAS (standardized coefficient [β] = 0.382), time spent online (β = 0.310), time spent on social media (β = 0.368), time spent on sleep (β = -0.176), and SWLS score (β = -0.281). The internal consistency indicated good internal reliability. Confirmatory factor analysis supported the factor structure of the IDS-15. The Arabic version IDS-15 is a psychometrically sound and robust instrument for assessing internet disorder due to its excellent concurrent validity, good reliability, and satisfactory construct validity.

Gaming motivations and gaming disorder symptoms: A systematic review and meta-analysis

BACKGROUND AND AIMS

The present systematic review and meta-analysis aimed to synthesize the available literature on the relationship between gaming motivations and gaming disorder symptoms. Specifically, to (1) explore what gaming motivation questionnaires and classifications are used in studies on gaming disorder symptoms and (2) investigate the relationship between motivational factors and symptoms of gaming disorder.

METHOD

An electronic database search was conducted via EBSCO (MEDLINE and PsycINFO) and the Web of Science Core Collection. All studies using validated measurements on gaming disorder symptoms and gaming motivations and available correlation coefficients of the relationship between gaming disorder and gaming motivations were included. The meta-analyses were conducted using a random-effects model.

RESULTS

In total, 49 studies (k = 58 independent sub-samples), including 51,440 participants, out of which 46 studies (k = 55 sub-samples, n = 49,192 participants) provided data for the meta-analysis. The synthesis identified fourteen different gaming motivation instruments, seven unique motivation models, and 26 motivational factors. The meta-analysis showed statistically significant associations between gaming disorder symptoms and 23 out of 26 motivational factors, with the majority of the pooled mean effect sizes ranging from small to moderate. Moreover, large heterogeneity was observed, and the calculated prediction intervals indicated substantial variation in effects across populations and settings. Motivations related to emotional escape were robustly associated with gaming disorder symptoms.

DISCUSSION AND CONCLUSIONS

The present meta-analysis reinforces the importance of motivational factors in understanding problematic gaming behavior. The analysis showed significant heterogeneity in most outcomes, warranting further investigation.

REGISTRATION DETAIL

PROSPERO (CRD42020220050).

Prevalence and comorbidity in a Swedish adolescent community sample - gambling, gaming, substance use, and other psychiatric disorders

BACKGROUND

This study investigates a broad spectrum of psychiatric disorders, substance use disorders, gambling, and internet gaming disorders in Swedish 18-year-old boys and girls with the aim of estimating the prevalence of disorders and comorbidity.

METHODS

We used a two-phase design with screening to detect candidates for clinical interviews. Screening included 949 adolescents (55.6% girls), out of which 758 adolescents (57.0% girls) were selected for interview with at least one of four instruments: M.I.N.I., ADDIS, NODS and IGDS. Of these, 387 (61.2% girls) were interviewed. Gender separated prevalence was estimated on the assumption that those selected but not interviewed had the same distribution as those interviewed based on similar outcomes above screening cut-offs. Comorbidity between types of disorders was estimated on similar assumptions. In addition, comorbidity between dyads of the ten most common specified disorders was calculated based on recorded data without these assumptions.

RESULTS

We estimated that 14.6% met the criteria of a substance use disorder (SUD), mostly concerning alcohol and more frequent in girls than in boys. Those meeting the criteria lifetime of at least one of 16 other psychiatric disorders were 26.7%, more than twice as frequent in girls compared to boys, and with depression being the most common disorder. Gambling and gaming disorders were found almost exclusively in boys, of which 5.8% met the criteria for gambling, and 2.3% for gaming disorders. Of girls with a SUD, 40% also had a psychiatric disorder, while on the other hand more than 28% of girls with a psychiatric disorder also had a SUD. In boys with a SUD, 22% had another psychiatric disorder, while 15% of those with a psychiatric disorder also had a SUD.

CONCLUSIONS

Psychiatric comorbidity is common in SUDs in adolescents, which calls for screening and diagnostic efforts in young patients presenting with symptoms of SUDs. Girls with SUDs are at higher risk of also suffering from psychiatric conditions. Gambling and gaming disorders appear in a substantial minority of adolescents and warrant further study of their comorbidity. Since prevalences and comorbidity were estimated on the assumptions mentioned, some caution in interpreting the results is needed.

Technological Addictions

PURPOSE OF REVIEW

Modern methods of communication and engagement, such as social media, video games, and online shopping, use a variety of behavioral techniques to encourage and reward frequent use, opening the door to addiction. The technological addictions (TAs) are a set of disorders that accompany the technological advances that define the digital age. The TAs are an active source of research in the literature, with promising treatment options already available.

RECENT FINDINGS

There are promising therapeutic and psychopharmacologic treatments for a broad range of TAs. Stimulants, antidepressants, and cognitive therapies may all be effective for internet gaming disorder (IGD). Cognitive therapies may be effective for other TAs, such as social media addiction (SMA), online shopping addiction (OSA), and online porn addiction. Society's dependence on addictive technologies will only increase. Many of the TAs can be addressed with medication and therapy, with more research and literature developing at a rapid pace.

Game-related behaviors among children and adolescents after school closure during the COVID-19 pandemic: A cross-sectional study

Aim

Increased exposure to digital gaming content among youth in recent years has raised serious health concerns. Social restrictions such as school closures, imposed worldwide because of the ongoing COVID-19 pandemic, may increase exposure to gaming and lead to addictive gaming behavior in young people. In this study, we investigated gaming behaviors among Japanese students during COVID-19 school closures.

Methods

Students completed questionnaires regarding their living conditions, game-related behaviors, diagnosis of Internet addiction, psychological difficulties, and the impact of the COVID-19 pandemic. We compared differences between the responses of potentially at risk for gaming disorder (potentially at risk for gaming disorder; defined in this paper with reference to the ICD-11 MMS criteria for gaming disorder [PGD]) students who met the criteria for a diagnosis of gaming disorder in ICD-11 MMS and those of control students. Logistic regression analysis was performed to predict the extent of factors contributing to potential gaming disorder.

Results

Four thousand and forty-eight participants completed the survey. Compared with control students (93%), potentially at risk for gaming disorder (defined in this paper with reference to the ICD-11 MMS criteria for gaming disorder, PGD) students (7%) reported playing games for longer times, spending more money on in-game purchases, were of younger age at the start of game playing, showed a tendency toward Internet dependence, practised school avoidance or absenteeism, and demonstrated the need for psychological support. Moreover, participants in the PGD group reported more anxiety about COVID-19 than control participants, as well as an increase in game-playing time and amount of money spent on games during the COVID-19 pandemic.

Conclusion

These results indicate that young people classified as having a gaming disorder not only exhibit characteristic game-related behaviors but may be psychologically and socially vulnerable and need special support, especially during the ongoing COVID-19 pandemic.

Alexithymia and internet gaming disorder in the light of depression: A cross-sectional clinical study

BACKGROUND

Social and emotional deficits are assumed to be involved in the development and maintenance of internet gaming disorder (IGD). Alexithymia refers to a personality construct, which is characterized by deficits in emotional awareness and processing. The constructs of alexithymia and depression share similarities, and depression is a common comorbidity of IGD patients. The aim of this study was to analyze the relationship between alexithymia and IGD when controlling for depression symptom severity. Moreover, we compared alexithymia traits of IGD patients with those of non-pathological video gamers.

METHODS

In a cross-sectional study n = 38 male IGD patients (EG) were recruited at specialized healthcare services in Germany. In addition, n = 39 male non-pathological video gamers (CG) were recruited via social media and bulletin board announcement. Both groups completed questionnaires measuring alexithymia (TAS-20), depression symptom severity (BDI) and IGD severity (s-IAT).

RESULTS

Alexithymia and depression symptom severity both predicted IGD severity. Yet, when including both factors in multiple regression analysis, only alexithymia predicted IGD severity. The prevalence of alexithymia in the EG was 34.2 % (n = 13). None of the non-pathological video gamers scored above the cut-off indicating alexithymia. IGD patients showed higher traits of alexithymia in general and on each subscale, irrespective of whether or not they were currently consuming video games. As previously observed, depression symptom severity was significantly greater in IGD patients compared to healthy video gamers. Yet, group differences in alexithymia traits remained stable, with a ~29 % decrease of effectiveness in the relationship, when controlling for depression symptom severity and sociodemographic factors.

CONCLUSION

The results reveal that alexithymia is associated with and predicts IGD severity independently of depression symptom severity. Moreover, alexithymia is highly prevalent in IGD patients.

Internet use and internet-based addictive behaviours during coronavirus pandemic

PURPOSE OF REVIEW

The COVID-19 outbreak profoundly influenced human lives on different levels. This narrative review aims to present recent data relating to the COVID-19 pandemic and internet use and internet-based addictive behaviours [problematic Internet use (PIU), Internet addiction, Internet gaming disorder, problem gambling or gambling disorder, social media addiction including smartphone use disorder, problematic pornography use, and compulsive buying].

RECENT FINDINGS

During the COVID-19 pandemic, the prevalence of Internet use and Internet-based addictive behaviours increased in all age groups. The COVID-19 pandemic and related containment measures were been associated with increased levels of stress, anxiety, and depression in the general population, especially among children and adolescents, which are the vulnerable groups for the development of mental disorders during the crisis. Furthermore, the fear resulting from the disease, the 'lockdown' measures, high levels of uncertainty regarding the future, and financial insecurity increased levels of loneliness, PIU, and Internet addiction.

SUMMARY

Longitudinal researches focused on the negative impacts of Internet use in prolonged stress situations on mental health, vulnerable groups, and quality of life (QoL) are needed to help clinicians and policymakers to reduce adverse consequences. Prevention programs for Internet use and Internet-based addictive behaviours must be customized to meet the needs of children, adolescents, and adults. Also, treatment programs must be tailored to the needs of patients with different Internet-based addictions.

Technological Addictions

Modern technology rewards constant engagement and discourages sparing use, opening the door to unhealthy use and even addiction. The technological addictions (TAs) are a newly described set of disorders that come with the technological advances that define the new era. Internet gaming disorder (IGD) is already codified as a proposed diagnosis in the 5th Edition of the Diagnostic and Statistical Manual (DSM-5) of the American Psychiatric Association. Others, such as social media addiction (SMA), are in the earlier stages of our understanding. This article provides an overview of the more common TAs including their evaluation and treatment techniques.

DNA Directed Pro-Dopamine Regulation Coupling Subluxation Repair, H-Wave® and Other Neurobiologically Based Modalities to Address Complexities of Chronic Pain in a Female Diagnosed with Reward Deficiency Syndrome (RDS): Emergence of Induction of “Dopamine Homeostasis” in the Face of the Opioid Crisis

Addiction is a complex multifactorial condition. Established genetic factors can provide clear guidance in assessing the risk of addiction to substances and behaviors. Chronic stress can accumulate, forming difficult to recognize addiction patterns from both genetic and epigenetic (environmental) factors. Furthermore, psychological/physical/chemical stressors are typically categorized linearly, delaying identification and treatment. The patient in this case report is a Caucasian female, aged 36, who presented with chronic pain and partial disability following a surgically repaired trimalleolar fracture. The patient had a history of unresolved attention deficit disorder and an MRI scan of her brain revealed atrophy and functional asymmetry. In 2018, the patient entered the Bajaj Chiropractic Clinic, where initial treatment focused on re-establishing integrity of the spine and lower extremity biomechanics and graduated into cognitive behavior stabilization assisted by DNA pro-dopamine regulation guided by Genetic Addiction Risk Severity testing. During treatment (2018–2021), progress achieved included: improved cognitive clarity, focus, sleep, anxiety, and emotional stability in addition to pain reduction (75%); elimination of powerful analgesics; and reduced intake of previously unaddressed alcoholism. To help reduce hedonic addictive behaviors and pain, coupling of H-Wave with corrective chiropractic care seems prudent. We emphasize the importance of genetic assessment along with attempts at inducing required dopaminergic homeostasis via precision KB220PAM. It is hypothesized that from preventive care models, a new standard is emerging including self-awareness and accountability for reward deficiency as a function of hypodopaminergia. This case study documents the progression of a patient dealing with the complexities of an injury, pain management, cognitive impairment, anxiety, depression, and the application of universal health principles towards correction versus palliative care.

Excessive Gaming and Online Energy-Drink Marketing Exposure Associated with Energy-Drink Consumption among Adolescents

In this study, we examined excessive online gaming by adolescents and the resultant effects of their exposure to the online marketing of energy drinks and alcohol, and whether marketing literacy could serve as a mitigating factor. This cross-sectional study was conducted in 2020. Data were obtained from a sample of 2613 seventh-grade students from 30 middle schools in Taiwan. A self-administered questionnaire was conducted. The results showed that nearly 18% of the adolescent respondents had used energy drinks, while 75% reported seeing energy-drink advertisements on the internet in the past year. Multiple regression results indicated that factors such as being male, reporting excessive gaming, being exposed to higher levels of online energy-drink marketing, and reporting alcohol use were positively associated with energy-drink consumption. A higher level of online energy-drink marketing-affective literacy, however, was negatively associated with energy-drink consumption. In conclusion, factors that predicted energy-drink consumption among adolescents included excessive gaming and exposure to online energy-drink marketing, but marketing-affective literacy tended to lessen the impact of such advertising.

The Relationship between Depressive Symptoms, Loneliness, Self-Control, and Gaming Disorder among Polish Male and Female Gamers: The Indirect Effects of Gaming Motives

The present study analyzed the relationship between gaming disorder (GD), motives for gaming, and psychological problems in daily life (i.e., depression, loneliness, and self-control deficits) among Polish gamers. More specifically, the purpose of the present study was to analyze the indirect effects between GD and psychological problems in daily life via motives for gaming among male and female gamers. Additionally, the present study examined gender differences in motives for gaming and the relationship between the analyzed variables. The sample comprised 652 gamers (233 females; M = 28.77 years; SD = 7.18; age range: 18-48 years). The nine-item Internet Gaming Disorder Scale-Short Version (IGDS9-SF) was used to assess GD. The motives for gaming were assessed using the Motives for Online Gaming Questionnaire (MOGQ). The nine-item Patient Health Questionnaire (PHQ-9) was used to assess depressive symptoms, and the Brief Self-Control Scale (BSCS) was used to assess self-control. Loneliness was assessed using the De Jong Gierveld Loneliness Scale. In order to examine the relationship between the study variables, path analysis and indirect effects analysis were performed among both male and female gamers. The present study showed that depressive symptoms and self-control exerted a significant indirect effect on GD via escape and fantasy motives for gaming. Additionally, there was an indirect effect between depressive symptoms and GD via social motives for gaming. However, these indirect effects were found among male gamers only. The present study also showed gender differences in all analyzed gaming motives except escape (males scoring higher on all of them) and in the relationship between depressive symptoms and escape. These findings contribute to a better understanding of GD development mechanisms, which are associated with psychological problems in daily life.

Relationship between time spent playing internet gaming apps and behavioral problems, sleep problems, alexithymia, and emotion dysregulations in children: a multicentre study

BACKGROUND

Internet gaming addiction (IGA) is a serious condition that can significantly impact personal and social functioning. Many studies of IGA have been conducted in adolescents and young adults, but there are limited data available in children. We investigated the time spent using internet gaming apps in children and its association with behavioral problems, sleep problems, alexithymia, and emotional regulation.

METHODS

The research populations (N = 564) were categorized based on the number of hours spent using online gaming applications. The Strengths and Difficulties Questionnaire, the Children's Sleep Habits Questionnaire Abbreviated, the Children's Alexithymia Measure (CAM), and the Clinical Evaluation of Emotional Regulation-9 were used to assess all participants.

RESULTS

Compared to other groups, children who used internet gaming applications for more than 6 h had a higher proportion of abnormal responses on the emotional symptoms and hyperactivity scales. Children who used internet gaming applications for more than 6 h had the poorest sleep quality (75%), while children who used internet gaming applications for 1-2 h had the best (36.7%). Participants who used internet gaming apps for 1-2 h had significantly lower mean total scores on the emotional regulation scale and total CAM, whereas those using internet gaming apps for more than 6 h had the highest mean scores in the CAM.

CONCLUSIONS

Excessive use of internet gaming apps during childhood may be associated with hyperactivity, peer problems, high socioeconomic level, alexithymia concerns, shorter daytime sleep duration, and a delayed morning wake-up.

Prevalence and Factors Associated with Gaming Disorder in Latin America and the Caribbean: A Systematic Review

We aimed to determine the prevalence and factors associated with gaming disorder (GD) in the population of Latin America and the Caribbean (LAC). A systematic review was performed (PROSPERO protocol registration: CRD42021230565). We included studies that identified participants with GD and/or factors associated with this condition, reported the prevalence of GD, or contained data that assisted in its estimation, were published after 2013 (the year of inclusion of GD in the Fifth Edition of the Diagnostic and Statistical Manual of Mental Disorders) and were carried out in a population residing in an LAC country. Evaluation of the quality of the studies was carried out using the Joanna Briggs Institute Critical appraisal checklist tool. A qualitative synthesis of the data was performed. Of the total of 1567 records identified, 25 passed the full-text review phase, and 6 met the selection criteria. These studies were published between 2018 and 2021 and had a cross-sectional design (three in Brazil, one in Ecuador, Mexico, and the other was multi-country, including a LAC country [Peru]). The prevalence of GD ranged from 1.1% to 38.2%. The three studies in Brazil had the highest figures of GD prevalence (20.4-38.2%). Four studies evaluated factors associated with GD. Characteristics regarding the game (type), pattern of use (hours played), as well as gender (higher in men), tobacco and alcohol consumption, poor interpersonal relationships, and the presence of mental disorders were found to be associated with GD in LAC. Evidence on the prevalence and factors associated with GD in LAC is limited. Studies on GD in LAC evaluate different population subgroups, describing a wide prevalence of this condition (present in up to 38 out of 100 evaluated). Characteristics such as the type and hours of use of the games, sociodemographic data, lifestyles, interpersonal relationships, and the presence of mental disorders increase the probability of presenting GD.

Psychometric properties of the Farsi version of the gaming disorder scale for adolescents (GADIS-A)

BACKGROUND

Gaming disorder was added to the 11th version of the international classification of disease by the world health organization in early 2019. Adolescents are the most vulnerable group in this area. Thus, a screening tool for this age range is essential. This study aims to examine the psychometric properties of the gaming disorder scale for adolescents (GADIS-A) in an Iranian male sample.

METHODS

260 male students-7th to 12th grade-from Isfahan city in the academic year 2020-2021 were selected using convenience sampling. The participants responded to the Farsi version of the GADIS-A and problematic online game questionnaire (POGQ). Thirty participants answered the scale again to assess the validity of the retest. Pearson's correlation analysis, Cronbach's alpha, and confirmatory factor analysis were used. The data were analyzed by SPSS version 24 and R software packages psych and lavaan.

RESULTS

Confirmatory factor analysis revealed that the two-factor model, which included cognitive-behavioral symptoms and negative consequences, had good fitness indices. The GADIS-A convergent validity is confirmed by the scale's significant correlation with the POGQ. Cronbach's alpha coefficient was used to determine the scale's validity, which was 0.85 for the full scale and 0.70 and 0.75 for two factors. The validity of the retest after two weeks also showed a correlation of 0.88.

CONCLUSION

The Farsi version of the gaming disorder scale for adolescents has a two-factor structure and is valid for use in Iran.

Prevalence of gaming disorder in East Asia: A comprehensive meta-analysis

BACKGROUND AND AIMS

Asian countries are deemed to be high prevalence areas for gaming disorder (GD). This meta-analysis is the first to synthesize the overall prevalence of GD in East Asia and investigate characteristics that influence prevalence estimates.

METHODS

Systematic and independent searches were conducted across PubMed, Web of Science, Embase, PsycINFO, and the Cochrane Library since their inception to January 27, 2021. The Agency for Healthcare Research and Quality scale was used for quality assessment. A random effect model was used to calculate the overall GD prevalence and 95% confidence intervals (CIs).

RESULTS

In total, 22 articles (26 studies) comprising 51,525 participants were included in this meta-analysis. The overall pooled prevalence of GD in East Asia was 12%, 95% CI (10%-15%); this figure was adjusted to 6%, 95% CI (3%-9%) for a representative sample. Higher prevalence was observed in males than in females (16% vs. 8%, respectively, P < 0.05). Subgroup and meta-regression analyses revealed that studies among gamers or those without random sampling reported significantly higher prevalence rates. There were no significant differences between countries/regions, sample size, quality score, proportion of males, and scale used.

DISCUSSION AND CONCLUSIONS

The prevalence of GD in East Asia is higher than that in other world regions. Future studies should extend such epidemiological research to other regions to calculate the accurate prevalence of GD to benefit the local identification, prevention, policy formulation, and treatment efforts. Considering its negative effects, effective preventive and treatment measures for GD in East Asia need greater attention.