Intensive online videogame involvement: A new global idiom of wellness and distress

A Glossary of Distress Expressions Among Kannada-Speaking Urban Hindu Women

People's lived experiences of distress are complex, personal, and vary widely across cultures. So, too, do the terms and expressions people use to describe distress. This variation presents an engaging challenge for those doing intercultural work in transcultural psychiatry, global mental health, and psychological anthropology. This article details the findings of a study of common distress terminology among 63 Kannada-speaking Hindu women living in Mysuru, the second largest city in the state of Karnataka, South India. Very little existing scholarship focuses on cultural adaptation for speakers of Dravidian languages like Kannada; this study aims to fill this gap and support greater representation of this linguistic family in research on mental health, idioms of distress, and distress terminology. Between 2018 and 2019, we conducted a 3-phase study consisting of interviews, data reduction, and focus group discussions. The goal was to produce a non-exhaustive list of common Kannada distress terms that could be used in future research and practice to translate and culturally adapt mental health symptom scales or other global mental health tools.

Sluggish cognitive tempo (Cognitive Disengagement Syndrome) symptoms are more associated with a higher risk of internet addiction and internet gaming disorder than ADHD symptoms: A study with medical students and resident doctors

BACKGROUND & AIMS

The purpose of this study was to examine the relationships between Attention Deficit Hyperactivity Disorder (ADHD), Sluggish Cognitive Tempo (SCT), demographic factors, and Internet Addiction (IA) and internet gaming disorder (IGD) among medical students and resident doctors.

METHODS

The study included 274 medical students and resident doctors. (Ages:18-35, 70.4% female). Fisher exact test, Contingency Table analyses, Mann Whithey-U Test and structural equation model-path analysis were used for analysis. The Sociodemographic Information Form, ASRS Scale, Barkley SCT Scale, Young Internet Addiction Test-Short Form and The Digital Game Addiction Scale were utilized to collect data.

RESULTS

In the sample, 48 participants (17.51%, 22 female, 26 male) were classified as having a high-risk internet gaming disorder (IGD+), while 53 participants (19.3%, 37 female, 16 male) were classified as having a high-risk internet addiction (IA+). SCT Scale Daydreaming and Sluggishness scores, as well as ASRS Scale Inattention and Hyperactivity/Impulsivity ratings, were all substantially higher in high-risk groups (for all, p < 0.05). Instead of age, there was no difference between high and low-risk groups, but men had a significantly greater rate of high risk- IGD (%32.1 vs. 11.4; p = 0.001). Path analysis revealed that while older age has a substantial negative effect (β = -0.37, p = 0.001) on increased risk of IA, Inattention (β = 0.19, p = 0.028), Daydreaming (β = 0.62, p0.001), and Sluggishness ( β = 1.12, p0.001) had significant positive effects. On the other hand, results revealed that male gender (β = 5.08, p0.001), IA scores (β = 0.21, p0.001), and only Sluggishness ( = 0.52, p = 0.002), but not Inattention, Hyperactivity/impulsivity, or Daydreaming, have positive effects on greater risk of internet gaming disorder (IGD).

CONCLUSION & IMPLICATIONS

Our study is the first to show that SCT symptoms increase the risk of Internet addiction and Internet Gaming Disorder even when ADHD symptoms are controlled. To date, many research have highlighted the necessity of ADHD treatment when evaluating IA and IGD. However, SCT symptoms have a greater impact on people who are predisposed to these behavioral addictions, and despite high comorbidity rates, various treatment approaches for ADHD and SCT are effective. SCT should be kept in mind when assessing treatment-resistant individuals with IA and IGD.

Dynamics and moderating factors of esport participation and loneliness: A daily diary study

The purpose of this study was to examine the association between esport participation and loneliness, as well as its moderating factors. Chinese college students (N = 216) self-reported their esport playing time and degree of loneliness each day immediately before bedtime for four consecutive weeks. The findings revealed that as playing time increased, students did not experience reduced sense of loneliness during playing esport, but they experienced a temporary and intensified feeling of loneliness the same day following gameplay. Students with higher general loneliness tended to feel more after-game loneliness associated with increased esport participation. Students with higher obsessive passion about esport tended to experience more loneliness (both in-game and after-game) associated with increased esport participation. Students with greater coping motivation about esport tended to experience more in-game loneliness associated with previous increased esport participation. Students who played esport less often with friends in person, or with more escape motivation toward esport, tended to increase esport participation time more following previous increased after-game loneliness. The findings suggested that college students should avoid utilizing esport to achieve a sense of belonging and should be cautious of the loneliness-inducing effect after gameplay. A healthy level of loneliness can be maintained by playing esport more with friends in person, learning strategies to avoid obsessive passion, coping motivation, and escape motivation towards esport.

From idioms of distress, concern, and care to moral distress leading to moral injury in the time of Covid

In this invited commentary on the thematic issue of Transcultural Psychiatry on idioms of distress, concern, and care, I provide a brief overview of how my research agenda evolved over the years while conducting community and clinic-based research in South and Southeast Asia as well as North America. I then suggest areas where future research on idioms of distress, concern, care, and resilience will be needed among different demographics given social change and shifts in how we communicate face to face and in virtual reality, the impact of medicalization, pharmaceuticalization and bracket creep, changes in indigenous healing systems, and hybridization. I further call attention to the importance of conducting idioms guided research in occupational settings. Toward this end I highlight the moral distress health care workers in the U.S. have experienced during the Covid-19 pandemic and point out the importance of differentiating individual burnout from moral injury related to structural distress. I conclude by discussing the general utility of an idioms of distress perspective in the practice of cultural psychiatry and suggest that this perspective needs to be included in the training of all practitioners regardless of the system of medicine they practice. Doing so may enable the formation of mental health communities of practice in contexts where there are pluralistic health care arenas.

Conceptual and methodological challenges in idioms of distress research: Common questions and a step-by-step guide

Research premised on the construct of idioms of distress has proliferated in the last 40 years. The aim of this work is to foreground the experiential and socially adaptive functions of cultural expressions of distress around the world. Researchers who work in this field often begin from very different starting points in terms of their prior knowledge of the research context, their interest in theoretical or applied implications of their work, and the target areas of distress that they study. While this multiplicity of approaches ensures that the literature captures diverse manifestations of suffering, it also creates confusion for those who are new to the field and who may not know where to begin. This article seeks to resolve some of that confusion by identifying common conceptual challenges across the idioms of distress literature, and then providing a detailed step-by-step methodological example of an idioms of distress study in India that could be adapted for similar work in other contexts.

Emerging experience with selected new categories in the ICD-11: complex PTSD, prolonged grief disorder, gaming disorder, and compulsive sexual behaviour disorder

Among the important changes in the ICD-11 is the addition of 21 new mental disorders. New categories are typically proposed to: a) improve the usefulness of morbidity statistics; b) facilitate recognition of a clinically important but poorly classified mental disorder in order to provide appropriate management; and c) stimulate research into more effective treatments. Given the major implications for the field and for World Health Organization (WHO) member states, it is important to examine the impact of these new categories during the early phase of the ICD-11 implementation. This paper focuses on four disorders: complex post-traumatic stress disorder, prolonged grief disorder, gaming disorder, and compulsive sexual behaviour disorder. These categories were selected because they have been the focus of considerable activity and/or controversy and because their inclusion in the ICD-11 represents a different decision than was made for the DSM-5. The lead authors invited experts on each of these disorders to provide insight into why it was considered important to add it to the ICD-11, implications for care of not having that diagnostic category, important controversies about adding the disorder, and a review of the evidence generated and other developments related to the category since the WHO signaled its intention to include it in the ICD-11. Each of the four diagnostic categories appears to describe a population with clinically important and distinctive features that had previously gone unrecognized as well as specific treatment needs that would otherwise likely go unmet. The introduction of these categories in the ICD-11 has been followed by a substantial expansion of research in each area, which has generally supported their validity and utility, and by a significant increase in the availability of appropriate services.

Is Increased Video Game Participation Associated With Reduced Sense of Loneliness? A Systematic Review and Meta-Analysis

The purpose of this systematic review was to evaluate the existing evidence in literature addressing the relationship between video game participation and loneliness. The following databases were searched on October 2, 2021: Medline, Psychinfo, SportDiscus, Web of Science, and CINAHL. The risk of bias of cross-sectional study was assessed by using the Joanna Briggs Institute (JBI) critical appraisal checklist for analytical cross-sectional studies with attrition bias added for longitudinal studies. The results of all included studies were synthesized using narrative synthesis. Meta-analysis was utilized to synthesis the findings of the studies that had sufficient degree of statistical and methodological homogeneity. Eighteen studies were included in this systematic review, which comprised of 20,372 participants. The narrative synthesis showed mixed findings on the relationship between video game participation and loneliness. Meta-analysis that was conducted to nine cross-sectional studies revealed that video game participation was positively and weakly associated with loneliness (r = 0.10, 95% CI = 0.03-0.17). Both cross-sectional and longitudinal studies demonstrated serious risk of bias with the addition of serious inconsistency of findings from cross-sectional studies. The existing literature is equivocal in terms of making a definitive judgment on the association between video game participation and loneliness. PROSPERO registration number: CRD42021283025. Systematic Review Registration: https://www.crd.york.ac.uk/PROSPERO, identifier: CRD42021283025.

A bidirectional association between internet addiction and depression: A large-sample longitudinal study among Chinese university students

BACKGROUND

Internet addiction (IA) is associated with adverse consequences, especially for younger people. Evidence indicates that IA is associated with depression, but no studies have yet investigated potential common vulnerability between them.

METHODS

IA (measured by the Young's 20-item Internet Addiction Test Scale) and depressive symptoms (measured by the Patient Health Questionnaire-9 Scale) among 12 043 undergraduates were surveyed at baseline and at a respective 12 month follow-up for each participant. Application of a cross-lagged panel model approach (CLPM) revealed an association between IA and depression after adjusting for demographic variables.

RESULTS

Rates of baseline IA and depression were 5.47% (95% CI: 5.07%, 5.88%) and 3.85% (95% CI: 3.51%, 4.20%), respectively; increasing to 9.47% (95% CI: 8.94%, 9.99%) and 5.58% (95% CI: 5.17%,5.99%), respectively, at follow-up. Rates of new-incidences of IA and depression over 12 months were 7.43% (95% CI: 6.95%, 7.91%) and 4.47% (95% CI: 4.09%, 4.84%), respectively. Models in the present analysis revealed that baseline depression had a significant net-predictive effect on follow-up IA, and baseline IA had a significant net-predictive effect on follow-up depression.

LIMITATIONS

The follow-up survey response rate was moderate (54.69%) in this analysis of university students. Moreover, the IAT-20 scale did not allow differentiate between specific forms of Internet activity.

CONCLUSIONS

Common vulnerability and bidirectional cross-causal effects may both contribute to the association between IA and depression, with common vulnerability likely playing a more significant role than cross-causal effects.

Internet gaming, embodied distress, and psychosocial well-being: A syndemic-syndaimonic continuum

We examine internet gaming-related suffering as a novel syndemic most prevalent among contemporary emerging adults. Synthetic analysis of our prior research on internet gaming and health affirms how social factors and mental and physical wellness mutually condition each other in this online play context. Employing biocultural anthropological mixed methods, we focus on statistical interactions between intensive gaming and social well-being in relation to genomic markers of immune function. We show that among gamers with low social well-being, intensive game play is associated with compromised immunity markers, but among those with robust social connection, that same play correlates with decreased activation of stress-related immunity activation. The apparently beneficial interaction of higher social well-being and intensive game play resonates with an emerging body of research showing how positive practices-in this case, engaged and pleasurable videogame play-can increase resilience to the negative linked psychological and genomic responses to precarity. Based on these findings, we argue, in relation to gaming behaviors, a syndemics analysis could usefully be expanded by attending to both sides of the synergistic interaction between two social conditions: not just exacerbation of dysfunction in relation to their combined effect, but also non-additive enhancement of health that may stem from such combinations. We draw on literature emphasizing the relevance to health of "eudaimonic" well-being-psychosocial processes that transcend immediate self-gratification and involve the pursuit of meaningful and pro-social goals. On that basis, we propose the term "syndaimonics" to capture synergies between social context and mental flourishing, which, in this context and presumably others, can illuminate sources of health resilience and overall improved psychosocial wellbeing.

Expert appraisal of criteria for assessing gaming disorder: an international Delphi study

BACKGROUND AND AIMS

Following the recognition of 'internet gaming disorder' (IGD) as a condition requiring further study by the DSM-5, 'gaming disorder' (GD) was officially included as a diagnostic entity by the World Health Organization (WHO) in the 11th revision of the International Classification of Diseases (ICD-11). However, the proposed diagnostic criteria for gaming disorder remain the subject of debate, and there has been no systematic attempt to integrate the views of different groups of experts. To achieve a more systematic agreement on this new disorder, this study employed the Delphi expert consensus method to obtain expert agreement on the diagnostic validity, clinical utility and prognostic value of the DSM-5 criteria and ICD-11 clinical guidelines for GD.

METHODS

A total of 29 international experts with clinical and/or research experience in GD completed three iterative rounds of a Delphi survey. Experts rated proposed criteria in progressive rounds until a pre-determined level of agreement was achieved.

RESULTS

For DSM-5 IGD criteria, there was an agreement both that a subset had high diagnostic validity, clinical utility and prognostic value and that some (e.g. tolerance, deception) had low diagnostic validity, clinical utility and prognostic value. Crucially, some DSM-5 criteria (e.g. escapism/mood regulation, tolerance) were regarded as incapable of distinguishing between problematic and non-problematic gaming. In contrast, ICD-11 diagnostic guidelines for GD (except for the criterion relating to diminished non-gaming interests) were judged as presenting high diagnostic validity, clinical utility and prognostic value.

CONCLUSIONS

This Delphi survey provides a foundation for identifying the most diagnostically valid and clinically useful criteria for GD. There was expert agreement that some DSM-5 criteria were not clinically relevant and may pathologize non-problematic patterns of gaming, whereas ICD-11 diagnostic guidelines are likely to diagnose GD adequately and avoid pathologizing.

Exploring the Emerging Domain of Research on Video Game Live Streaming in Web of Science: State of the Art, Changes and Trends

In recent years, interest in video game live streaming services has increased as a new communication instrument, social network, source of leisure, and entertainment platform for millions of users. The rise in this type of service has been accompanied by an increase in research on these platforms. As an emerging domain of research focused on this novel phenomenon takes shape, it is necessary to delve into its nature and antecedents. The main objective of this research is to provide a comprehensive reference that allows future analyses to be addressed with greater rigor and theoretical depth. In this work, we developed a meta-review of the literature supported by a bibliometric performance and network analysis (BPNA). We used the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analysis) protocol to obtain a representative sample of 111 published documents since 2012 and indexed in the Web of Science. Additionally, we exposed the main research topics developed to date, which allowed us to detect future research challenges and trends. The findings revealed four specializations or subdomains: studies focused on the transmitter or streamer; the receiver or the audience; the channel or platform; and the transmission process. These four specializations add to the accumulated knowledge through the development of six core themes that emerge: motivations, behaviors, monetization of activities, quality of experience, use of social networks and media, and gender issues.

Avatar Creation in Videogaming: Between Compensation and Constraint

Objective: We examine the extent that videogame avatars provide players with opportunities for identity exploration, aiming to test the findings of self-discrepancy theory research on the user/avatar relationship with novel cognitive anthropological methods. Specifically, we examine if avatar traits are idealized (more representative of players' ideal rather than actual self) or actualized (more representative of players' actual self) as a function of players' self-esteem. Materials and Methods: Utilizing cognitive anthropological methods, we examine the relationship between actual, avatar, and ideal selves. We first asked 21 respondents to list traits they associated with their various selves. We then asked 57 new respondents to perform four pile sorts of the salient items from these lists (1 unconstrained sort of like-traits, and 3 sorts of terms indicative of respondents' ideal/actual/avatar self). Analysis of this "free list" and "pile sort" data allowed us to clarify (in a manner sensitive to gamer culture) relationships between respondents' various conceptions of self, including how those relationships were modified by self-esteem. Illustrative quotes from the interviews further clarified these relationships. Results: Paired t-test analysis shows that informants as a whole describe their avatar compared with actual selves with fewer negative terms (idealization). Low-esteem players actualize what they deem as positive traits onto their avatars, while simultaneously idealizing avatars' negative traits by minimizing them. Compared with low-esteem gamers, high-esteem players associate significantly more positive attributes with all their various selves-actual, avatar, and ideal-while describing avatar compared with actual selves with fewer positive terms and comparable numbers of negative terms (the latter a process of actualization). Conclusion: Results point to the necessity of theoretical accounts that recognize that avatars may reflect a complex relationship with the user's actual and ideal self, without assuming that avatar play frees gamers from offline social, psychological, or bodily constraints.

Culture-bound syndromes, idioms of distress, and cultural concepts of distress: New directions for an old concept in psychological anthropology

This issue of Transcultural Psychiatry showcases some recent work on idioms of distress – the latest in a long line of anthropological research concerned with cross-cultural concepts and experiences of distress.1 Mark Nichter’s (1981) seminal paper introducing idioms of distress has become a cynosure for psychological anthropology and transcultural psychiatry. A growing body of work has since accumulated; however, the last time a collection of such research was brought together was the 2010 publication of a special issue in the journal Culture, Medicine and Psychiatry organized by Devon Hinton and Roberto Lewis-Fernández. In the decade since, new questions have arisen about the boundaries and applications of idioms of distress research. In this introduction, we provide a brief history of work on idioms of distress and related concepts. Then, we introduce several major themes explored by the papers in this special issue.

Idioms of resilience among cancer patients in urban South Africa: An anthropological heuristic for the study of culture and resilience

Despite the large body of research on idioms of distress in anthropology and transcultural psychiatry, few scholars have examined the concepts that people use to describe social and psychological resilience. The experience of social and psychological resilience is embedded in and shaped by social, political, and economic contexts-much like the factors that shape idioms of distress. As resilience literature more broadly has adopted a socio-ecological rather than trait-based approach, anthropology has much to contribute. This article investigates what idioms of resilience and cultural scripts emerge among low-income patients with cancer residing in Soweto, a peri-urban neighborhood in Johannesburg, South Africa. We conducted 80 life history interviews to better understand what social and psychological factors led some people to thrive more than others despite extraordinary adversity. We describe one idiom of resilience, acceptance (ukwamukela in isiZulu), and three broader themes of resilience that emerged from life history narrative interviews (social support, religious support, and receiving medical care). We also present two examples from study participants that weave these concepts together. Our findings suggest that rarely is one form of resilience experienced in isolation. A focus on idioms of resilience can help chart the complex dimensions of acceptance and the dynamic social, religious, political, and temporal factors that mediate both suffering and resilience within individuals and communities.

The cross-cultural expression of internet gaming distress in North America, Europe, and China

We compare the forms online gaming-related distress takes cross-culturally, and examine how much such distress resembles the World Health Organization's (WHO) “Gaming disorder,” understood to be an “addiction.” Our preliminary exploratory factor analysis (EFA) in North America (n = 2025), Europe (n = 1198), and China (n = 841) revealed a constant four-factor structure across the three regions, with classic “addiction” symptoms always clustering together on the first and most important factor, though with some variability in regional factors' exact item composition. In the present study, we use second-order confirmatory factor analysis (CFA) to further examine this factor structure and the cultural similarities and differences. Specifically, we focus on confirming the regional structure and composition of an ethnographically developed 21-item gaming distress scale, which contains a wider symptoms pool than typical gaming disorder scales, and thus allows us to better separate generalized gaming distress's “addictive” from other culturally-influenced “problem” experiences and behaviors in each regional case. We use propensity score matching to separate the impact on gaming-related distress of regional culture from demographic variables (North America/Europe: n = 1043 pairs; North America/China: n = 535 pairs). Although our results support current WHO formulations of gaming-related distress as an addictive disorder, we show how cultural forces can shape how “addictive” and “problem” gaming are experienced and thus psychiatrically presented in different parts of the world. In particular, generalized gaming distress's addictive and problematic dimensions seem to be shaped by culture-specific expressions of achievement motivations, social connection and disconnection, and unique psychosomatic experiences.

•

Second-order CFA shows similarities and differences between online gaming distress in North America, Europe, and China.

•

Our 21-item distress scale allows us to separate “addictive” from “problem” experiences and behaviors in each regional case.

•

Propensity score matching helps us separate the impact on gaming distress of regional culture from demographic variables.

•

Generalized gaming distress consists of four dimensions, with three closely related to addiction experiences and behaviors.

•

Our results support current WHO and APA formulations of gaming-related distress as an addictive disorder.

•

Culture also shapes how “addictive” and “problem” gaming are experienced in different parts of the world.

Distinguishing Core from Peripheral Psychiatric Symptoms: Addictive and Problematic Internet Gaming in North America, Europe, and China

We explore the problem of distinguishing the relatively constant versus culturally variable dimensions of mental suffering and disorder in the context of a cross-cultural study of Internet gaming-related distress. We extend the conceptual contrast of "core" and "peripheral" symptoms drawn from game studies and use a framework that synthesizes cultural and neurobiological understandings of emotional distress. In our framework, "core" symptoms are relatively constant across cultures and therefore presumed to be more closely tied to a neurobiological base. By contrast, we treat as "peripheral" symptoms those that are more culturally variable, and thus less directly tied to the neurobiology of addiction. We develop and illustrate this approach with a factor analysis of cross-cultural survey data, resting on previous ethnographic work, through which we compare online gaming distress experienced in North America (n = 2025), Europe (n = 1198), and China (n = 841). We identify the same four-factor structure across the three regions, with Addiction always the first and most important factor, though with variability in regional factors' exact item composition. The study aims to advance an integrative biocultural approach to distinguishing universal as opposed to culturally contingent dimensions of human suffering, and to help resolve debates about whether problem gaming represents a form of addiction.