Clinical predictors of gaming abstinence in help-seeking adult problematic gamers

Scoping review of withdrawal's role in contemporary gaming disorder research: Conceptualizations and operationalizations

The global gaming community now exceeds 3 billion players, prompting increased attention from social and medical sciences regarding gaming-related disorders. Internet Gaming Disorder (IGD) was incorporated into DSM-5 in 2013, and Gaming Disorder (GD) found its place in ICD-11 in 2019. A contentious criterion in IGD, not present in GD, revolves around withdrawal symptoms. This paper offers a theoretical foundation on gaming withdrawal symptoms in gaming-related disorders and conducts a scoping review of withdrawal operationalization and conceptualization in 40 selected studies, following PRISMA-ScR guidelines. Most studies employed a correlation framework, relying on convenience samples and self-assessment questionnaires. A smaller portion focused on clinical samples and case studies. Withdrawal was predominantly conceptualized in terms of affective components, with less emphasis on behavioural, cognitive, physical, or neurological aspects. The prevailing terminology for gaming-related disorders was IGD, with only three studies referencing GD as defined in ICD-11. Notably, just six experimental studies included abstinence control. We advocate for an expansion of research on withdrawal symptoms, particularly through experimental studies that implement abstinence within experimental groups and offer alternative operationalizations beyond dominant self-assessment measures.

Operationalization and measurement of compulsivity across video gaming and gambling behavioral domains

BACKGROUND

Compulsivity is the hallmark of addiction progression and, as a construct, has played an important role in unveiling the etiological pathways from learning mechanisms underlying addictive behavior to harms resulting from it. However, a sound use of the compulsivity construct in the field of behavioral addictions has been hindered to date by the lack of consensus regarding its definition and measurement. Here we capitalize on a previous systematic review and expert appraisal to develop a compulsivity scale for candidate behavioral addictions (the Granada Assessment for Cross-domain Compulsivity, GRACC).

METHODS

The initial scale (GRACC90) consisted of 90 items comprising previously proposed operationalizations of compulsivity, and was validated in two panel samples of individuals regularly engaging in gambling and video gaming, using exploratory structural equation modeling (ESEM) and convergence analyses.

RESULTS

The GRACC90 scale is unidimensional and structurally invariant across samples, and predicted severity of symptoms, lower quality of life, and negative affect, to similar degrees in the two samples. Additionally, poorer quality of life and negative affect were comparably predicted by compulsivity and by severity of symptoms. A shorter version of the scale (GRACC18) is proposed, based on selecting the 18 items with highest factor loadings.

CONCLUSIONS

Results support the proposal that core symptoms of behavioral addictions strongly overlap with compulsivity, and peripheral symptoms are not essential for their conceptualization. Further research should clarify the etiology of compulsive behavior, and whether pathways to compulsivity in behavioral addictions could be common or different across domains.

What the grey literature can contribute to addictive behaviour disorder classification •

This commentary examines the proposal made by Brand et al. (2022) regarding a framework outlining relevant criteria for considering possible behavioural addictions within the current World Health Organisation's International Classification of Diseases (ICD-11) category of 'other specified disorders due to addictive behaviours'. We agree with the framework as it highlights the clinical perspective requiring agreed-upon classifications and criteria to produce effective diagnostic procedures and efficacious treatments. Additionally, we propose to add the need of recognising potential addictive behaviour through the inclusion of a fourth meta-level criterion: 'grey literature evidence'. Utilising non-academic evidence can provide validity in the social context where the behaviour takes place, and it can support authorities in taking action to prevent and treat the resultant behavioural problems. The inclusion of the proposed fourth criterion will aid comprehensibility of the current proposal and provide clarity, as indicated in the present commentary, which includes the fourth criterion analysis for problematic pornography use, shopping/buying and social networking site use.

Burden and Help-Seeking Behaviors Linked to Problem Gambling and Gaming: Observational Quantitative and Qualitative Analysis

BACKGROUND

Models based on the uniqueness of addiction processes between behavioral addictions are highly contentious, and the inclusion of gaming disorder in the addiction nosography remains controversial. An exploratory approach could clarify a hypothesized common and subjectively identifiable process in addictive behaviors and the necessarily different expressions of the disorder due to behavior specificities, in particular the sociocultural characteristics and profiles of users.

OBJECTIVE

The aim of this study was to describe the nature of contacts to a help service by exploring commonality and specificities of burden and help-seeking for problem gambling or gaming.

METHODS

This was an observational quantitative-qualitative study. We included all contacts (ie, online questions and contacts by phone or chat when the helper completed a summary) to a helpline for gamers, gamblers, and relatives over a 7-year period. We constituted a text corpus with online questions and summaries of contacts by phone or chat. We collected basic sociodemographic data, including the device used to contact the service (phone or internet), contacting the service for oneself ("user") or being a relative of a user and type of relative, gambling (yes/no), gaming (yes/no), and age and sex of the gambler/gamer. We describe the corpus descriptively and report the computerized qualitative analysis of online questions, chat, and summary of phone calls. We performed a descendant hierarchical analysis on the data.

RESULTS

A total of 14,564 contacts were made to the helpline, including 10,017 users and 4547 relatives. The corpus was composed of six classes: (1) gaming specificities, (2) shared psychological distress and negative emotions, (3) the procedure for being banned from gambling, (4) the provided help, (5) gambling specificities, and (6) financial problems.

CONCLUSIONS

Negative emotions and shared distress linked to gambling and gaming support current scientific consensus that these behaviors can produce psychological distress in se; however, meaningful differences were observed in core symptoms of addiction between gamers and gamblers, beyond specificities related to the behavior itself: loss of control was elicited in the class corresponding to gambling specificities and not by gamers and their relatives.

Prevalence and risk factors of internet gaming disorder and problematic internet use before and during the COVID-19 pandemic: A large online survey of Japanese adults

Internet gaming disorder (IGD) and problematic internet use (PIU) are becoming increasingly detrimental to modern society, with serious consequences for daily functioning. IGD and PIU may be exacerbated by lifestyle changes imposed by the coronavirus 2019 (COVID-19) pandemic. This study investigated changes in IGD and PIU during the pandemic and risk factors for them. This study is a part of a larger online study of problematic smartphone use in Japan, originally planned in 2019, and expanded in August 2020 to include the impact of COVID-19. 51,246 adults completed an online survey during the pandemic (August 2020), in Japan. Of these, 3,938 had also completed the survey before the onset of the pandemic (December 2019) and were used as the study population to determine how the pandemic has influenced IGD and PIU. IGD was assessed using the Internet Gaming Disorder Scale (IGDS). PIU was measured using the Compulsive Internet Use Scale (CIUS). The prevalence of probable IGD during COVID-19 was 4.1% overall [95%CI, 3.9%-4.2%] (N = 51,246), and 8.6% among younger people (age < 30), 1-2.5% higher than reported before the pandemic. Probable PIU was 7.8% overall [95%CI, 7.6%-8.1%], and 17.0% [95%CI, 15.9%-18.2%] among younger people, 3.2-3.7% higher than reported before the pandemic. Comparisons before and during the pandemic, revealed that probable IGD prevalence has increased 1.6 times, and probable PIU prevalence by 1.5 times (IGD: χ²= 619.9, p < .001, PIU: χ²= 594.2, p < .001). Youth (age < 30) and COVID-19 infection were strongly associated with IGD exacerbation (odds ratio, 2.10 [95%CI, 1.18 to 3.75] and 5.67 [95%CI, 1.33 to 24.16]). Internet gaming disorder and problematic internet use appear to be aggravated by the pandemic. In particular, younger persons and people infected with COVID-19 are at higher risk for Internet Gaming Disorder. Prevention and treatment of these problems are needed.

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

BACKGROUND

Gaming disorder was included in the latest revision of the International Classification of Diseases (11th ed.). Worldwide, prevalence estimates of gaming disorder are considerably heterogeneous and often appear to be exceedingly high. However, few studies have examined the methodological, cultural and/or demographic factors that might explain this phenomenon. This review employed meta-analytic techniques to compute the worldwide-pooled prevalence of gaming disorder and evaluate the potential contributing factors for varied prevalence estimates.

METHOD

Prevalence estimates were extracted from 53 studies conducted between 2009 and 2019, which included 226,247 participants across 17 different countries. Study findings were meta-analyzed using a random-effects model. Subgroup and moderator analyses examined potential sources of heterogeneity, including assessment tool and cut-off, participant age and gender, sample size and type, study region, and year of data collection.

RESULTS

The worldwide prevalence of gaming disorder was 3.05% (confidence interval: [2.38, 3.91]); this figure was adjusted to 1.96% [0.19, 17.12] when considering only studies that met more stringent sampling criteria (e.g. stratified random sampling). However, these estimates were associated with significant variability. The choice of screening tool accounted for 77% of the variance, with the Lemmens Internet gaming disorder-9, Gaming Addiction Identification Test and Problematic Videogame Playing scales associated with the highest estimates. Adolescent samples, lower cut-off scores and smaller sample size were significant predictors of higher prevalence. Gaming disorder rates were approximately 2.5:1 in favor of males compared to females.

CONCLUSION

The worldwide prevalence of gaming disorder appears to be comparable to obsessive-compulsive disorder and some substance-related addictions, but lower than compulsive buying and higher than problem gambling. Gaming disorder prevalence rates appear to be inflated by methodological characteristics, particularly measurement and sampling issues.

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.

Potential Correlates of Internet Gaming Disorder Among Indonesian Medical Students: Cross-sectional Study

BACKGROUND

Internet gaming disorder has been a controversial topic for nearly a decade. Although internet addiction has been studied in medical students, there is a paucity of evidence regarding internet gaming disorder. Previous studies in Indonesia explored only the prevalence rate and characteristics.

OBJECTIVE

This study aimed to determine the prevalence rate of internet gaming disorder and correlations between internet gaming disorder, temperament, and psychopathology among Indonesian medical students.

METHODS

A cross-sectional study was performed from August 2019 to September 2019 using total and convenience sampling at a private university and a public university, respectively. The study variables were measured using the Indonesian version of the 10-item Internet Gaming Disorder Test, the Temperament and Character Inventory, and the Symptoms Checklist 90. Chi-square and logistic regression analyses were conducted to examine the relationships between demographic factors, temperament, psychopathology, and the presence of internet gaming disorder.

RESULTS

Among the 639 respondents, the prevalence rate of internet gaming disorder was 2.03% (n=13), with a mean age of 20.23 (SD 0.13) years and an average gaming duration of 19.0 (SD 0.96) hours/week. Up to 71.2% respondents played using their mobile phones, and respondents with internet gaming disorder reported experiencing all psychopathologies assessed, except phobic anxiety. Bivariate analysis demonstrated that internet gaming disorder was associated with gender, gaming duration, gaming community affiliation, and 9 out of 10 domains of psychopathology. In a logistic regression model, internet gaming disorder was correlated with weekly gaming hours ≥20 hours (odds ratio [OR] 4.21, 95% CI 1.08-16.38, P=.04).

CONCLUSIONS

These findings suggest that the prevalence of internet gaming disorder among medical students in Jakarta, Indonesia is similar to that in other populations of Asian countries. The predisposing factor for internet gaming disorder was weekly gaming duration, while other demographic, temperament, and psychopathology variables acted as probable moderators. Strategies should, therefore, be developed and integrated into medical curriculum to screen and aid individuals with these predisposing factors.

Avatar identification and problematic gaming: The role of self-concept clarity

Some video-gaming activities feature customizable avatars that enable users to fulfil self-identity needs. Research evidence (e.g., fMRI and survey studies) has suggested that poorer self-concept and stronger avatar identification are associated with problematic gaming. Player-avatar relationships have thus been proposed to require attention in gaming disorder assessment and interventions. To examine the interplay of player-avatar interactions in problematic gaming, this study investigated whether avatar identification differed according to avatar characteristics and game types, and whether the association between avatar identification and problem gaming was mediated by self-concept clarity. A total of 993 adult respondents completed an online survey that assessed problematic gaming, avatar identification, and self-concept clarity. The results indicated that avatar identification scores were generally unrelated to avatar characteristics (e.g., human resemblance, degree of customizability, and in-game perspective). Avatar identification was significantly positively related to problematic gaming and significantly negatively related to self-concept clarity. There was a significant indirect relationship between avatar identification on problem gaming mediated through self-concept clarity. These findings suggest that poorer self-concept clarity may be one mechanism by which avatar identification affects problem gaming. Future research with clinical samples may help to gain a better understanding of avatar-related processes and psychological vulnerabilities related to problematic gaming.

Current diagnostic procedures and interventions for Gaming Disorders: A Systematic Review

Background: Despite the growth in the number of studies on Gaming Disorders (GD), assessing the characteristics of clinical subjects is still limited. Driven by the need to overcome this limitation, a broad systematic review is essential to cover the studies that have already assessed the clinical characteristics of individuals diagnosed with GD.

Objectives: The aim of this systematic review is to provide a broad cross-cultural picture of the current diagnostic procedures and interventions used for GDs in clinical practice.

Methods: A total of 28 studies met the inclusion criteria, and data were synthesized in these categories: (1) the cultural background of the country where the research took place; (2) the instruments used to measure GD; (3) the diagnostic criteria for GD; (4) the diagnostic procedures used; and (5) the treatment protocol applied.

Results: Results of this systematic review suggest that in GD clinical practice, there is a great deal of heterogeneity in the choice of instruments, the diagnostic and intervention processes for GD.

Conclusions: This systematic review indicates that a validation process of standard procedures in clinical populations with GD is necessary to create clear shared guidelines for practitioners.