Internet Gaming Disorder in Children and Adolescents

Disconnect to Reconnect: Practical Approaches to Managing Social Media's Impact on Pediatric Mental Health

INTRODUCTION

The pediatric mental health crisis has intensified, especially during the COVID-19 pandemic. Social media and electronic use have been significant contributors to this issue.

METHODS

This paper explores existing literature and clinical guidelines to assess the impact of electronic overuse on pediatric mental health, focusing on practical interventions for healthcare providers.

RESULTS

Studies show that increased screen time correlates with heightened levels of anxiety, depression, and suicidal ideation, particularly among vulnerable populations such as racial minorities and LGBTQ+ youth.

DISCUSSION

Healthcare providers, especially nurse practitioners, are in prime position to address these issues through evidence-based screening tools, setting boundaries for electronic use, and supporting caregivers. Proactive, holistic interventions are key to mitigating the long-term effects of social media on adolescent mental health.

Alternations voxel-wise interhemispheric and intrahemipheric functional connectivity dynamics in internet gaming disorder

BACKGROUND

Currently, numerous studies have indicated that individuals with internet gaming disorder (IGDs) have aberrant functional connection patterns between multiple brain regions and networks. However, temporal variability in the intra- and interhemispheric dynamic functional connectivity in IGDs remains unknown.

METHODS

This study investigated resting-state functional magnetic resonance data from 55 IGDs and 50 demographically matched healthy controls (HCs). Functional connectivity density (FCD) combined with sliding window analysis is employed to calculate the temporal variability of global functional connectivity. The temporal variability of dynamic functional connectivity further quantified utilizing the standard deviations of global, intra-, and interhemispheric FCD. Finally, correlation analyses were performed between dynamic FCD varience (dFCD) in differential brain regions and clinical behaviors.

RESULT

IGDs showed decreased intra- and interhemispheric dFCD variance in the visual attention network (precuneus and calcarine) and also demonstrated hemispheric-level dFCD variance abnormalities in the posterior cingulate cortex (PCC) compared to HCs. Moreover, abnormal global dFCD variability of the calcarine and ipsilateral dFCD variability of the PCC were negatively correlated with the severity of IGDs in the IGD group.

CONCLUSION

Our results demonstrate abberant intra- and interhemispheric dynamic functional connectivity in the visual attention network, which emphasizes the neurobiological basis for impaired concentration in IGDs.

Functional connectivity alterations in individuals with gaming disorder assessed by functional magnetic resonance imaging: a systematic review

Neuroimaging has continually advanced, playing a crucial role in the accurate diagnosis of various brain pathologies and disorders. This integrative review aimed to identify the main changes in brain connections found in fMRI scans of individuals with Internet Gaming Disorder (IGD). The data collection method involved searching for the terms "Magnetic Resonance Imaging", "Psychological Dependence" and "Internet Addiction Disorder" in the PubMed and Embase databases. Studies published between 2020 and January 2023 were included and manually analyzed through the virtual environment created in the "Rayyan" software, compiling a total of 18 scientific studies. The main findings reveal changes such as significant increases or decreases in functional connectivity in certain regions of the brain. Some potential negative impacts on the uncontrolled use of technologies among the young population were evaluated, such as the loss of inhibitory control in decision-making, transforming leisure into dependence, and although the IGD understands the associated risks and harms, it faces difficulties in resisting the desire to stop playing. This situation emphasizes the need for more long-term studies that can be comparative between different age groups. Conclusion, the brain regions with the most significant changes in functional connectivity in individuals with IGD symptoms are the prefrontal cortex, fronto-parietal regions, frontal gyrus, insula lobe, cingulate cortex and striatum. The lack of comprehensive knowledge about the effects of video game addiction across different age groups is a significant concern. Therefore, it is essential to carry out research that evaluates the impact of these technologies on different stages of human development.

The prospective associations between problematic gaming and phubbing among Chinese adolescents: Insights from a cross-lagged panel network model

BACKGROUND AND AIMS

Previous studies are limited in addressing the directionality of temporal relationships between problematic gaming and phubbing symptoms by exploring cross-sectional studies. Therefore, we estimated the longitudinal relationships between individual behavioral addictive symptoms including problematic gaming and phubbing in adolescence, and explored potential sex differences in these relationships.

METHODS

This study included 3296 participants in Shandong Province, China. Data were collected from November 2021 (mean [SD] age: 15.17 [1.44] years) to May 2023 (mean [SD] age: 17.50 [1.18] years), with females comprising 54.5 % of the sample. Problematic gaming and phubbing were assessed using validated scales at each wave. We construct cross-sectional networks and cross-lagged panel networks (CLPN) to explore the contemptuous and temporal relationships between problematic gaming and phubbing.

RESULTS

Contemporaneous networks revealed significant differences in problematic gaming and phubbing networks between males and females. Additionally, temporal network analyses indicated that among male adolescents, feeling anxious when unable to play games was the most influential predictor of subsequent behavioral addictive symptoms. For female adolescents, fantasizing about gaming had the most significant associations with future addictive behaviors. The strongest bridge symptom linking problematic gaming and phubbing for both sexes was focusing on phones rather than engaging in conversation.

DISCUSSION AND CONCLUSIONS

The study applied network modeling to panel data from a large, population-based cohort of adolescents, identifying unique longitudinal relationships between problematic gaming and phubbing across symptom domains. It provides valuable insights into the characterization of behavioral addictive symptoms among adolescents and the potential predictive relationships among these symptoms among different sexes, guiding sex-specific targeted interventions for adolescents.

The Development and Validation of the Adolescent Problematic Gaming Scale (PGS-Adolescent)

This study aims to develop and validate the Adolescent Problematic Gaming Scale (PGS-Adolescent). Following established scientific protocols, we developed an initial version of the PGS-Adolescent scale and validated it using data from 448 valid survey responses collected from adolescents in China. The dataset was split into two parts: 225 responses were allocated for exploratory factor analysis (EFA), and 223 for confirmatory factor analysis (CFA). The EFA and CFA processes necessitated the removal of 10 items due to low factor loadings, low communalities, misalignment with intended factors, and inadequate item retention. Significantly, all the survey items measuring daily-life disturbance (DD) were excluded. The final 20-item PGS-Adolescent scale includes four constructs: interpersonal relationships (IRE), schooling disruption (SD), physical consequences (Phy-C), and psychological consequences (Psy-C). Researchers may consider directly applying the validated PGS-Adolescent scale or evaluating its applicability and validity in diverse populations and contexts.

Patterns of Parent Media Use: The influence of parent media use profiles on parental mediation, technoference, and problematic media use

Mothers play an important role in setting the overall media culture within the home. Research suggests that children model parental behavior in many ways, including in media use habits. The current study explores profiles or patterns of maternal media use and associations between these patterns and parenting behaviors surrounding media use and parent and child problematic media use two years later. In our sample of 268 mothers of young children in a large Mountain West city, latent profile analysis was utilized, and four distinct profiles of media users were identified. Results suggest that mothers in a low media use profile set limits around their child's media use and report low levels of both technoference and parent problematic media use. Conversely, mothers in a higher social use profile exhibit high levels of parent and child problematic media use compared to other profiles. We encourage mothers to be mindful users of media, remembering that their media use behaviors can impact the overall media use climate in the home.

Detection and Characterization of Online Substance Use Discussions Among Gamers: Qualitative Retrospective Analysis of Reddit r/StopGaming Data

BACKGROUND

Video games have rapidly become mainstream in recent decades, with over half of the US population involved in some form of digital gaming. However, concerns regarding the potential harms of excessive, disordered gaming have also risen. Internet gaming disorder (IGD) has been proposed as a tentative psychiatric disorder that requires further study by the American Psychological Association (APA) and is recognized as a behavioral addiction by the World Health Organization. Substance use among gamers has also become a concern, with caffeinated or energy drinks and prescription stimulants commonly used for performance enhancement.

OBJECTIVE

This study aimed to identify substance use patterns and health-related concerns among gamers among a population of Reddit users.

METHODS

We used the public streaming Reddit application programming interface to collect and analyze all posts from the popular subreddit, r/StopGaming. From this corpus of posts, we filtered the dataset for keywords associated with common substances that may be used to enhance gaming performance. We then applied an inductive coding approach to characterize substance use behaviors, gaming genres, and physical and mental health concerns. Potential disordered gaming behavior was also identified using the tentative IGD guidelines proposed by the APA. A chi-square test of independence was used to assess the association between gaming disorder and substance use characteristics, and multivariable logistic regression was used to analyze whether mental health discussion or the mention of any substance with sufficient sample size was significantly associated with IGD.

RESULTS

In total, 10,551 posts were collected from Reddit from June 2017 to December 2022. After filtering the dataset for substance-related keywords, 1057 were included for further analysis, of which 286 mentioned both gaming and the use of ≥1 substances. Among the 286 posts that discussed both gaming and substance use, the most mentioned substances were alcohol (n=132), cannabis (n=104), and nicotine (n=48), while the most mentioned genres were role-playing games (n=120), shooters (n=90), and multiplayer online battle arenas (n=43). Self-reported behavior that aligned with the tentative guidelines for IGD was identified in 66.8% (191/286) posts. More than half, 62.9% (180/286) of the posts, discussed a health issue, with the majority (n=144) cited mental health concerns. Common mental health concerns discussed were depression and anxiety. There was a significant association between IGD and substance use (P<.001; chi-square test), and there were significantly increased odds of IGD among those who self-reported substance use (odds ratio 2.29, P<.001) and those who discussed mental health (odds ratio 1.64, P<.03).

CONCLUSIONS

As gaming increasingly becomes highly prevalent among various age groups and demographics, a better understanding of the interplay and convergence among disordered gaming, substance use, and negative health impacts can inform the development of interventions to mitigate risks and promote healthier gaming habits.

High immersion/escapism motivation makes gaming disorder risk less dependent of playtime among highly engaged male gamers

In the realm of gaming-related concerns, the relationship between gaming time (GT) and gaming disorder (GD) remains an intriguing and complex subject. Although increased GT is not a reliable predictor of GD risk, the circumstances under which this relationship strengthens or weakens remain relatively unknown. This study explores the roles of immersion/escapism motive (IEM) and GT in the context of GD among highly engaged gamers (N = 294), each dedicating a minimum of 20 hours weekly to gaming. The findings confirm that IEM significantly moderates the relationship between GT and GD in the male sample. Specifically, low and moderate levels of IEM result in a stronger relationship between GT and GD. In the case of women, the effect was not significant. These findings suggest the importance of comprehensive assessments of gaming motivations when addressing gaming-related issues, particularly in GD research. Moreover, they emphasize the value of adopting a complex approach to comprehending the development of problematic gaming behaviors.

Investigating the mechanisms of internet gaming disorder and developing intelligent monitoring models using artificial intelligence technologies: protocol of a prospective cohort

BACKGROUND

Internet gaming disorder (IGD), recognized by the World Health Organization (WHO), significantly impacts adolescent mental and physical health. With a global prevalence of 3.05%, rates are higher in Asia, especially among adolescents and males. The COVID-19 pandemic has exacerbated IGD due to increased gaming time from isolation and anxiety. Vulnerable groups include adolescents with poor academic performance, introverted personalities, and comorbid mental disorders. IGD mechanisms remain unclear, lacking prospective research. Based on Skinner's reinforcement theory, the purpose of this study is to explore the mechanisms of IGD from individual and environmental perspectives, incorporating age-related changes and game features, and to develop intelligent monitoring models for early intervention in high-risk adolescents.

METHODS

This prospective cohort study will investigate IGD mechanisms in middle and high school students in Shenzhen, China. Data will be collected via online surveys and Python-based web scraping, with a 3-year follow-up and assessments every 6 months. Unstructured data obtained through Python-based web scraping will be structured using natural language processing techniques. Collected data will include personal characteristics, gaming usage, academic experiences, and psycho-behavioral-social factors. Baseline data will train and test predictive models, while follow-up data will validate them. Data preprocessing, normalization, and analysis will be performed. Predictive models, including Cox proportional hazards and Weibull regression, will be evaluated through cross-validation, confusion matrix, receiver operating characteristic (ROC) curve, area under the curve (AUC), and root mean square error (RMSE).

DISCUSSION

The study aims to understand the interplay between individual and environmental factors in IGD, incorporating age-related changes and game features. Active monitoring and early intervention are critical for preventing IGD. Despite limitations in geographic scope and biological data collection, the study's innovative design and methodologies offer valuable contributions to public health, promoting effective interventions for high-risk individuals.

Prevalence of video gaming disorder in Saudi Arabia: a school-based national study

BACKGROUND

Video gaming is a popular leisure activity among adolescents. Those who play excessively are in danger of educational and social drawbacks and may become addicted to video gaming. Several published studies determined the prevalence of GD among children in specific Saudi regions. However, the current study assessed the national prevalence of video gaming disorder (GD) and its risk factors among school students in Saudi Arabia.

METHODS

A school-based survey was conducted among adolescents in all regions of Saudi Arabia during the academic year 2021-2022. A multistage stratified cluster sampling technique was used to select the school students. An Arabic-validated version of the 9-item dichotomous (yes/no) GD Scale based on the DSM-5 criteria was used to determine GD prevalence among the students. The score ranged from zero to nine (0-9). Participants who scored five or more were deemed as having GD. Students who scored less than five were classified as normal gamers (score 0-1) or risky gamers (score 2-4).

RESULTS

 We recruited 5332 school students. Their mean age was 15.5 ± 1.7 years, and almost half of them were males (50.7%). According to the GD score, the prevalence of normal gamers was 39.08% (N = 1714), risky gamers 40.47% (N = 1775), and those with GD was, 20.45% (N = 897). Logistic regression was performed to determine the association between video gaming disorder and all the gathered variables, which include age, educational grade, sex, types of video gaming, and categories of video games played. The results showed that nationality, age, educational grade, sex, using only mobile devices to play, and playing puzzle and sports games were not associated with video gaming disorder. On the other hand, it was revealed that using tablets, game consoles, PCs; having multiple devices; and playing online, fighting, car racing, war, and adventure games were significantly linked to GD.

CONCLUSION

The prevalence of GD was 20.45% among Saudi school students who play video games. Utilizing more than one type of gaming device and playing games in the fighting, war, and multiplayer categories via an online connection were significantly linked to having GD. To limit video gaming addiction, we encourage screening, diagnosing, and treating disordered video gamers early. In addition, governmental authorities and video game companies should discuss and revise numerous policy measures to minimize the accessibility of video games, limit the harms and risks related to them, and assist video gamers in becoming effective members of society.

Video Game Addiction in Young People (8-18 Years Old) after the COVID-19 Pandemic: The Grey Area of Addiction and the Phenomenon of "Gaming Non-Pathological Abuse (GNPA)"

INTRODUCTION

In the literature, video game addiction in youths is correlated with dysfunctional symptoms of anxiety, emotional disorders, and mood disorders, and the pandemic period of 2020-2022 has favored the aggravation of this behavioral addiction. Therefore, we identified the need to analyze this phenomenon with an emphasis on the risks and correlates related to deviance and maladjustment from a prospective perspective, seeking to understand the impact of the individual variables examined.

AIM

To demonstrate whether the condition of "gaming non-pathological abuse" (GNPA) promotes psychopathological features of clinical interest, in the absence of a diagnosis of "gaming disorder" (GD).

MATERIALS AND METHODS

A search performed on PubMed and administration of an ad hoc sociological questionnaire were used to investigate individual variables of criminological interest in a representative population sample (531 males/females, 8-18 years old, M: 14.4, SD: 2.5).

RESULTS

Statistical analysis showed that after the pandemic period, digital video game addiction was reinforced, feeding psychopathological traits consistent with anxiety, emotional disorders, and mood disorders. Variables correlated with impulsive, aggressive, and violent behavior related to age, gender, socio-environmental and economic background, and the severity of digital video game addiction.

CONCLUSIONS

In the youth population (8-18 years), "gaming non-pathological abuse" (GNPA) is related to aggressive, impulsive and violent behaviors that foster phenomena of social maladjustment and deviance, especially in individuals living in disadvantaged or otherwise complex socio-economic and family contexts. Looking forward, the study of structural and functional personality profiles is essential in order to anticipate and reduce the future risk of psychopathological and criminal behavior.

Associations of excessive internet use, sleep duration and physical activity with school absences: a cross-sectional, population-based study of adolescents in years 8 and 9

BACKGROUND

Internet use has increased and sleep and physical activity (PA) have decreased in recent years among adolescents. Besides sleep and PA, another determinant of future health for adolescents is education. Our aim was to evaluate the associations of excessive internet use (EIU), short sleep duration and low PA with both unexcused absences and medical absences during lower secondary school.

METHODS

The School Health Promotion study is a national survey of adolescents conducted biennially in Finland. We used data collected in 2019, when EIU was assessed for the first time. Cumulative odds ratio analysis was conducted with unexcused absences and medical absences as outcome variables. Besides EIU, sleep duration and PA, the associations of maternal education and parental relations were assessed.

RESULTS

The mean age of the 86 270 participants was 15.3 years. Girls scored higher than boys on EIU. In all, 34.7% of participants slept less than 8 hours per night during the school week, and 34.3% reported low PA (ie, less than 3 days per week with minimum 1 hour of PA per day). EIU, short sleep and low PA were associated with both unexcused absences and medical absences from school. Longer sleep during weekends showed no association with absences, but good parental relations had the strongest protective association with both unexcused and medical absences.

CONCLUSIONS

EIU, short sleep duration and low PA were associated with both unexcused and medical absences from school. This has important implications for both the promotion of general health and the support offered to students with alarming school absences.

The role of internet addiction and academic resilience in predicting the mental health of high school students in Tehran

BACKGROUND

The World Health Organization defines mental health as a combination of two dimensions: the negative dimension, or negative mental health, which indicates the presence of mental disorders, symptoms, and problems, and the positive dimension, or positive mental health, which includes emotions and positive personal characteristics such as self-esteem, resilience against environmental challenges, a sense of integrity, and self-efficacy. The aim of the present study was to investigate the role of internet addiction and academic resilience in predicting the mental health of high school students in Tehran, Iran.

METHOD

The research method employed was a survey. 758 people participated in the study, and the samples consisted of high school students in Tehran during the academic year 2022-2023. The process of collecting information was carried out by distributing the questionnaire link through virtual networks and schools. The research utilized Young's Internet Addiction Test, Samuels' Academic Resilience Inventory, and Goldberg's Mental Health Questionnaire as the research tools. Statistical tests, including Pearson's correlation and multiple regression analysis, were employed to investigate the relationships between variables.

RESULT

The effect of internet addiction on mental health (ß=0.39) is negative and significant at the 0.001 level, while the effect of academic resilience on mental health (ß=0.66) is positive and significant at the 0.001 level. These two variables collectively predict 53% of the variance in students' mental health. This indicates that as internet addiction increases among students, their mental health significantly decreases, whereas higher levels of academic resilience correspond to higher mental health.

CONCLUSIONS

This study has elucidated the role of internet addiction and academic resilience in predicting the mental health of high school students in Tehran. Given the significance of adolescent mental health, it is imperative for healthcare professionals and other stakeholders to develop intervention and prevention models to address mental health crises and plan for the enhancement of adolescent mental health.

The Role of Self-Esteem in Protecting Against Cyber-Victimization and Gaming Disorder Symptoms Among Adolescents: A Temporal Dynamics Analysis

Previous literature has suggested that victimization is linked to low self-esteem and increases the symptoms of gaming disorder. However, little is known about the intra-individual processes, and the temporal dynamics of cyber-victimization, self-esteem, and gaming disorder symptoms. To address this gap, a three-year longitudinal study was performed using data collected at six different time points from 4206 Chinese adolescents (aged 12-17 years; 50.4% boys). Results of random intercept cross-lagged panel models (RI-CLPMs) indicated that at the within-person level, the fluctuation in self-esteem weakly predicted late cyber-victimization, and the fluctuation of cyber-victimization also weakly predicted late self-esteem. Additionally, the current study identified an interactive effect between self-esteem and gaming disorder symptoms at the within-person level. Fluctuations in self-esteem negatively predicted late gaming disorder symptoms, and vice versa. However, when combining the three variables (i.e., cyber-victimization, self-esteem, and gaming disorder symptoms) into one RI-CLPM, the results did not support the mediation of self-esteem in the relationship between cyber-victimization and gaming disorder symptoms at the within-person level. Moreover, fluctuations in self-esteem negatively predicted late gaming disorder symptoms and cyber-victimization at the within-person level in the RI-CLPM. These findings emphasize the protective role of self-esteem developed against cyber-victimization and gaming disorder symptoms among adolescents.

Measurement Invariance of the Lemmens Internet Gaming Disorder Scale-9 Across Age, Gender, and Respondents

Although Internet gaming disorder (IGD) has gained increased attention in scientific, clinical, and community contexts, there is still a lack of consensus regarding the best assessment tools (i.e., self-report or other reports) for assessing its symptoms. The present study aimed to investigate the reliability, validity, and measurement invariance of both versions (youth and parent) of The Lemmens Internet Gaming Disorder Scale-9. To achieve this goal, we recruited between June and October 2019 from five Romanian highschools a total of 697 adolescents (11-19 years old) and one of their parents (N = 391). The internal consistency was good in both versions of the instrument (α = 0.772 for the youth version and α = 0.781 for the parent version). Construct validity assessed through confirmatory factor analysis showed support for the one factor structure of the scales, while multigroup confirmatory factor analysis endorsed the invariance across age, gender, and respondents (i.e., parent vs. youth report). The current research identifies both IGD scales to be reliable and valid, arguing for their utility for assessing IGD symptomatology among adolescents. Implications for theory, assessment, and future directions are discussed.

Problematic video gaming is negatively associated with bone mineral density in adolescents

Adolescent bone health may be negatively impacted by problematic video gaming (PVG) due to factors such as prolonged screen time, poor sleep quality, and increased depression. Although sedentary behaviors have been linked to decreased bone mass, there is limited research on how PVG impacts bone health. We aimed to evaluate the association between PVG and bone mineral density (BMD) in adolescents by comparing the BMD z-scores of adolescents with and without PVG and by identifying PVG-related risk factors that may affect low BMD scores. This cross-sectional study took place between May 2019 and August 2021 with 110 adolescents who played video games for at least two hours per day. Data on screen time, game genre, tobacco, alcohol, caffeine consumption, and vigorous physical activity status were recorded. PVG was assessed using the Internet Gaming Disorder-Short Form (IGDS9-SF), with scores ≤ 16 comprising the control group and > 16 the PVG group. Sleep quality was assessed by Pittsburgh Sleep Quality Index, and depression was evaluated by Children's Depression Inventory. Dual-energy X-ray absorptiometry measurements of femoral neck and lumbar spine BMD were compared between the two groups. The mean age of the participants was 14.2 ± 1.8 years, and 86.4% were males. The PVG group exhibited lower femoral neck z-scores (p = 0.013) and a higher proportion of adolescents with low femoral neck BMD risk (27.8% vs 9.7%, p = 0.041). Lumber spine z-scores did not differ (p = 0.271). Despite poorer depressive symptoms and sleep quality in the PVG group, they were not associated with low BMD risk (OR 1.02, 95% CI 0.97-1.08, p = 0.398 and OR 1.00, 95% CI 0.87-1.18, p = 0.972, respectively). Among all PVG-related risk factors, video game time (aOR = 1.22, 95% CI = 1.06-1.41, p = 0.006) and vigorous physical activity amount (aOR = 2.86, 95% CI = 0.93-8.76, p = 0.080) showed the strongest associations with femoral neck z-scores.  Conclusion: The results of this study, showing a negative association between PVG and femoral neck BMD in adolescents, underscore the importance evaluating, monitoring, and supporting lower extremity bone health in adolescents with PVG. What is Known: • Adolescents with problematic video gaming are at risk for depression, impaired sleep; sedentary lifestyle; consumption of tobacco, alcohol, and drugs; and high caffeine intake. • These risk factors might lead to compromised bone health. What is New: • Problematic video gaming is associated with the low femoral neck bone mineral density risk in adolescents. • Extended video game time and reduced physical activity are found to be the primary risk factors.

Impulsivity and aggression as risk factors for internet gaming disorder among university students

Internet gaming addiction is a global problem, especially among young individuals. Exhibiting characteristics similar to other addictions, Internet Gaming Disorder (IGD) is linked to adverse mental health outcomes. Identified as risk factors for dependence behaviors, the association of impulsivity and aggression with IGD is relatively under-researched in the student population. The present sample of 350 university students (Mage = 21.30 years, SDage = 4.96 years) from Najran university in Saudi Arabia completed an online questionnaire that included the Internet Gaming Disorder Scale-Short-Form (IGDS9-SF), the Buss-Perry Aggression Questionnaire-Short Form, and the Barratt Impulsiveness Scale (BIS-15). Results indicated that impulsivity and aggression were positively associated with IGD severity and both personality traits explained 34.6% of the variance in IGD scores. Further bivariate analyses suggested that individuals spending 7 or more hours on internet gaming were more likely to exhibit high impulsivity and aggression, and had a relatively higher severity of IGD. These results suggest that individuals with these personality traits may be more vulnerable to developing an addiction to internet gaming. These findings need to be confirmed in future more robust studies; however, this exploratory study provides insights for potential programs to prevent IGD among young individuals.

Treatment effects of therapeutic interventions for gaming disorder: A systematic review and meta-analysis

The prevalence of gaming disorder is assumed to be between 2%-5%. The treatment effect of different therapeutic interventions of gaming disorder has not been studied extensively. This systematic review and meta-analysis sought to identify all intervention studies on gaming disorder with a control group, determine the effect of the interventions, and examine moderators. Studies applying a therapeutic intervention and using an appropriate comparison group were identified by searching electronic databases, previous reviews, and reference lists. Data on type of treatment, name of outcome measurement, symptom level and other study characteristics were extracted and analyzed using meta-analysis and meta-regression. A total of 38 studies and 76 effect sizes, originating from 9524 participants were included. RoB2 and ROBINS-I risk of bias tools were used to assess within-study risk of bias. Correlational hierarchical models with robust variance estimation were fitted to effect size data and yielded a moderate summary estimate. Egger's sandwich test, funnel plot inspections, and other tests were conducted to assess risk of bias between studies. Results indicate that there may be an overall effect of therapeutic interventions for gaming disorder, but confidence in these findings is compromised by small-study effects, possible publication bias, a limited study pool, and a lack of standardization. The field needs more higher quality studies before the evidence-base can support reliable meta-analytic estimates.

Psychological distress and aggression among adolescents with internet gaming disorder symptoms

The present study aimed to investigate the current situation of internet gaming disorder (IGD) in Chinese adolescents and explore the impact of IGD-related factors on adolescent aggression. We hypothesized that IGD symptoms in adolescents would be associated with aggressive behavior and that risk factors for IGD symptoms could increase the aggressive tendencies of adolescents. To verify the above hypothesis, a cross-sectional survey of junior and senior high school students from southern, southwestern, central, and eastern China was conducted. A total of 9306 valid questionnaires were collected. The results showed that the prevalence of IGD symptoms was 1.78 % among Chinese adolescents. The adolescents in the disordered gamer group had the most severe IGD symptoms, with the highest levels of psychological distress and aggression. Interestingly, adolescents in the casual gamer group had the lowest psychological distress and aggression scores. Linear regression analysis further showed that higher levels of aggression were significantly associated with male sex, younger age, more severe psychological distress and IGD symptoms, and more violent game exposure. Our results suggested that excessive online gaming not only contributes to psychological distress in adolescents but also increases their levels of aggressive behavior. Apart from male sex and younger age, severe IGD symptoms and psychological distress are the most important predictors of the development of aggressive behavior.

Relationship between gaming disorder across various dimensions among PUBG players: a machine learning-based cross-sectional study

Background

PlayerUnknown's battlegrounds (PUBG), a widely played multiplayer online game, has sparked interest and concern regarding its impact on players. This study explored the relationship between factors such as cultivation level, motivation, religious engagement, gaming disorder, and addiction among PUBG players.

Methods

This study employed a convenience sampling technique to select a sample of 500 PUBG players. An Artificial Neural Network (ANN) model was used to identify the primary factors contributing to the level of cultivation.

Results

Male participants exhibited a higher level of cultivation than their female counterparts did. According to the ANN model, gaming disorder exhibited the greatest normalized importance, with a value of 100%. This was followed by the religious level, which had a normalized importance of 54.6%. Additionally, motivation level and gaming addiction demonstrated normalized importance values of 47.6 and 44.4%, respectively. This study revealed a statistically significant correlation between engaging in PUBG and the cultivation effect observed among respondents.

Conclusion

This study highlights several noteworthy factors, including gaming disorder, religious affiliation, motivation level, and gaming addiction. These factors offer valuable insights into understanding gaming behavior and devising effective interventions.

Relapse prevention therapy for internet gaming disorder in Swedish child and adolescent psychiatric clinics: a randomized controlled trial

Objectives

To evaluate the effectiveness of relapse prevention (RP) as a treatment for internet gaming disorder (IGD).

Design

Randomized controlled trial.

Setting

Three child and adolescent psychiatry (CAP) units in Region Skåne, Sweden.

Participants

Children aged 13-18 years, coming for their first visit to CAP during 2022, were screened for gaming behavior. Those who met the proposed DSM-5 criteria for IGD were offered participation in the trial, if they had the capacity to provide written informed consent and if they spoke Swedish. A total of 111 CAP patients agreed to participate. Out of those, 11 patients were excluded due to incorrect inclusion such as young age (n = 1), or due to the absence of responses to follow-up measures (n = 9). After exclusion, 102 participants remained (intervention = 47, control = 55).

Interventions

The intervention, RP, is based on cognitive behavioral treatment (CBT) and was provided individually, comprising of five to seven 45-min sessions over a period of 5 to 7 weeks versus treatment as usual.

Outcome measures

Participants were assessed with Game Addiction Scale for Adolescents pre-treatment (GASA) (baseline), post-treatment (treatment group only), and 3 months after baseline (follow-up).

Results

The repeated measures ANOVA showed a significant interaction effect between treatment and time. Both the control group and treatment group lowered their mean GASA score from baseline to follow-up significantly, but the improvement was greater in the treatment group (mean difference in control group -5.1, p < 0.001, 95% CI = - 3.390 to -6.755, mean difference in treatment group -9.9, p < 0.001, 95% CI = -11.746 to -8.105).

Conclusion

RP was found to be superior to treatment as usual in terms of reduction of IGD symptoms. Future research should address which aspects within a given treatment are effective, who benefits from treatment, in what aspects, and why.

Trial registration number

ClinicalTrials.gov, NCT05506384 https://clinicaltrials.gov/ct2/show/NCT05506384.

Problematic media use in early childhood: The role of parent-child relationships and parental wellbeing in families in New Zealand and the United States

Problematic media use (PMU) during early childhood has the potential to interfere with the healthy functioning of family systems and may be associated with significant long-term problems for the child. However, we know very little about what contributes to early childhood PMU, particularly in the family context. We examine parenting factors as correlates of child PMU in two studies, from two different countries, using two different methods. Study 1 (N=93, Mage=45.3months, SD=10.15, 58%males, 87%mothers) investigated the concurrent role of self-reported parental burnout and parent-child conflict and closeness as correlates of child PMU in an early childhood sample in New Zealand. Study 2 (N=269, Mage=41.17months, SD=3.06 months, 49%males, 95%mothers) investigated observed parental warmth and harsh criticism as predictors of concurrent and longitudinal PMU in an early childhood sample in the United States. Together, findings showed that in both countries approximately 22-25% of young children show symptoms of PMU. After controlling for parent's PMU, parent-child conflict, warmth and parental burnout were not associated with child PMU. Low levels of parent-child closeness and parent's use of harsh criticism were predictive of child PMU. The findings advance our understanding of some of the parenting factors that influence the development of PMU in young children.

Toddlers and the Telly: A latent profile analysis of children's television time and content and behavioral outcomes one year later in the U.S

Despite the ubiquity of tablets and smartphones, television remains the most frequently used screen media consumed by young children. However, it is likely that variability exists in how young children use media; for example, while some may view small amounts of aggressive content, others may view many hours each day of aggressive and prosocial media content. It is possible that differences in toddler television time and content also impact behavioral outcomes. The aims of this study were two-fold; first, we examined profiles of children's time spent watching television and media content viewed. Second, we examined longitudinal relations between media use profiles and outcomes including aggression, prosocial behavior, and problematic media use. Results suggested a three-profile solution of children's television time and content, including "Low TV content," "High child-centered content," and "High aggressive content" profiles. The "High aggressive content" group experienced higher levels of problematic media use and aggressive behavior one year later compared to other classes. The discussion focuses on implications of these findings. We urge parents to become aware of both television time and media content as they may relate to problematic media use behaviors in young children.

Digital Dependence in Organizations: Impacts on the Physical and Mental Health of Employees

Digital Dependence is a person's persistent inability to regulate digital devices on which they have become highly dependent. Internet dependence has been described since the mid-1990s, and studies on this topic have intensified since 2010. This type of individual dependence has received considerable published literature, but it is new in the collective setting of organizations, offering the hypothesis that it can also be collective, given the impacts it can provide. Research has evolved geographically from three countries to 17 since the beginning of the last decade, with 7 new scales for digital dependence. There were 13 new revalidations of the Nomophobia Questionnaire (NMP-Q), with an increase from 1,000 to 13,000 volunteers. Geographical evolution and an increase in the number of scales and volunteers and their different profiles were described. New approaches reinforce evolution and its impacts on human behavior. This study provides historical insight into Digital Dependence and opens new prospects for research on the differences between nations and people, sexes, professionals, and the need for further research in organizations.

Relapse Prevention Therapy for Problem Gaming or Internet Gaming Disorder in Swedish Child and Youth Psychiatric Clinics: Protocol for a Randomized Controlled Trial

BACKGROUND

Although gaming is a common arena where children socialize, an increasing number of children are exhibiting signs of problem gaming or internet gaming disorder. An important factor to the development of problem gaming is parent-child relationships. A cognitive behavioral therapy-based form of treatment, labeled relapse prevention, has been developed as a treatment for child and adolescent problem gaming or internet gaming disorder. However, no study has evaluated the effect of this treatment among Swedish children and youth nor the role of the parent-child relationships in this treatment.

OBJECTIVE

This study aims (1) to evaluate a relapse prevention treatment for patients showing signs of problem gaming or internet gaming disorder recruited from child and youth psychiatric clinics and (2) to test whether the quality of parent-child relationships plays a role in the effect of relapse prevention treatment and vice versa-whether the relapse prevention treatment has a spillover effect on the quality of parent-child relationships. Moreover, we explore the carer's attitudes about parent-child relationships and child gaming, as well as experiences of the treatment among the children, their carers, and the clinicians who carried out the treatment.

METHODS

This study is a 2-arm, parallel-group, early-stage randomized controlled trial with embedded qualitative components. Children aged 12-18 years who meet the criteria for problem gaming or internet gaming disorder will be randomized in a 1:1 ratio to either intervention (relapse prevention treatment) or control (treatment as usual), with a total of 160 (80 + 80) participants. The primary outcomes are measures of gaming and gambling behavior before and after intervention, and the secondary outcomes include child ratings of parent-child communication and family functioning. The study is supplemented with a qualitative component with semistructured interviews to capture participants' and clinicians' experiences of the relapse prevention, as well as attitudes about parent-child relationships and parenting needs in carers whose children completed the treatment.

RESULTS

The trial started in January 2022 and is expected to end in December 2023. The first results are expected in March 2023.

CONCLUSIONS

This study will be the first randomized controlled trial evaluating relapse prevention as a treatment for child and adolescent problem gaming and internet gaming disorder in Sweden. Since problem behaviors in children interact with the family context, investigating parent-child relationships adjacent to the treatment of child problem gaming and internet gaming disorder is an important strength of the study. Further, different parties, ie, children, carers, and clinicians, will be directly or indirectly involved in the evaluation of the treatment, providing more knowledge of the treatment and its effect. Limitations include comorbidity in children with problem gaming and internet gaming disorder and challenges with the recruitment of participants.

TRIAL REGISTRATION

ClinicalTrials.gov NCT05506384 (retrospectively registered); https://clinicaltrials.gov/ct2/show/NCT05506384.

INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID)

DERR1-10.2196/44318.

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.

The Health Effects of Video Games in Children and Adolescents

Play has always been an essential part of childhood, but it looks different for modern children, who increasingly engage in virtual play. More than 90% of children older than 2 years play video games, and three-quarters of American households own a video game console. Children 8 to 17 years of age spend an average of 1.5 to 2 hours daily playing video games. Recent developments framed by decades of research have provided insight into how games influence children's physical health, mental health, social behaviors, and cognitive development. Anticipatory guidance surrounding media use is often centered on screen time, but pediatricians should have some knowledge of the unique benefits and risks associated with this nearly ubiquitous activity. In light of the recent addition of gaming disorder to the International Classification of Diseases, 11th Revision, this review includes a discussion of the epidemiology, clinical features, and diagnosis of gaming disorder, including the use of existing screening tools. As games become more popular while ever-increasing in scope and complexity, this review aims to educate the modern pediatric provider about what is known, what is uncertain, and how to use this knowledge in the management of both healthy and unhealthy video gaming in children.

Lack of educational impact of video game addiction in children and adolescents diagnosed with ADHD: A cross-sectional study

Introduction

The use of video games has become widespread worldwide. Excessive use of video games is increasingly becoming a matter of concern, particularly in patients diagnosed with Attention Deficit Hyperactivity Disorder (ADHD). Currently, internet gaming disorder (IGD) is not included within the DSM-5-chapter Disorders related to substances and addictive disorders.

Methods

This is a post-hoc descriptive naturalistic study comparing children and adolescents diagnosed with ADHD with and without IGD. We used the 85% cut-off point of the test ADITEC-V for video game addiction to split our sample of ADHD patients into those with IGD (>=85%) and those without IGD (<85%).

Results

13 (25%) out of the 51 children and adolescents with ADHD included in our study had an IGD. Patients with IGD had a first contact with internet, smartphones, and videogames at a very early age (5.67 ± 3.31, 6.33 ± 4.60, and 7.50 ± 2.61, respectively). However, only age at first contact with the internet was statistically significantly different when comparing ADHD patients with and without IGD (8.68 ± 2.71 vs. 5.67 ± 3.31, t = 3.166, df = 47, p = 0.01). Different neurodevelopmental, clinical, and neuropsychological measures converging in impulsivity is a risk factor for IGD. Unexpectedly, we found no association between IGD and poor academic achievement.

Discussion

Future studies may include randomized controlled trials for treating IGD, the study of social adjustment as a protective factor against developing an IGD, and the role of serious and non-serious video games in the development of an IGD, among others. Additional research is clearly needed on IGD.

Children's mobile-gaming preferences, online risks, and mental health

This study examined the relationships between children's mobile gaming preferences, online risks, and mental health. Data were obtained from a sample of 2,702 third and fourth grade students from 16 elementary schools in Taiwan and 9 schools in China. A self-administered questionnaire was used. The mental state of the children who participated in the study was assessed using the Strengths and Difficulties Questionnaire (SDQ), while mobile gaming addiction was assessed using the short form of the Internet Gaming Disorders Scale (IGDS9-SF). The results showed that about 54% of children played mobile games with others (multi-player), while 31% played mobile games alone, and 15% did not play mobile games. Multiple logistic regression results indicated that behaviors such as participating in multi-player games, playing violent games, a poor parent-child relationship, and living in a rural area were associated with a greater risk of mobile gaming addiction. Involvement in multi-player games, playing violent games, mobile gaming addiction, and exposure to mobile violence/pornography were associated with greater risks of cyber aggression/victimization. Multiple regression results showed that being a multi-player, playing violent games, mobile gaming addiction, exposure to violence/pornography, exposure to cyber aggression/victimization, and having a poor parent-child relationship were associated with emotional and behavioral problems.

From one year to the next: Video gaming life-style predicts subsequent psychosocial risk in adolescent boys and girls

AIM

The ubiquitous societal presence of screens and gaming software is ever growing in popularity. However, can this recreational life-style pose risks for children's psychosocial adjustment? We thus examine associations between gaming life-style and later psychosocial development.

METHODS

The study sample originates from the 2120 boys and girls from the Quebec Longitudinal Study of Child Development birth cohort. At age 12, 625 boys and 702 girls from the original sample self-reported the number of hours engaged in video gaming per week and 1 year later, they self-reported psychosocial outcomes.

RESULTS

Among boys, higher weekly video gaming frequency at age 12 forecasted increases in subsequent reactive aggression, emotional distress and ADHD symptoms at age 13. For girls, higher weekly video gaming frequency at age 12 predicted increases in subsequent reactive aggression and ADHD symptoms at age 13. No association between video game use and emotional distress was found for girls.

CONCLUSION

In both boys and girls, a more intense video gaming life-style predicted subsequent risks for reactive aggression and ADHD symptoms, compared with their same sex counterparts reporting less intensity. For boys only, video gaming was associated with subsequent reactive emotional distress, likely due to the gender differences in violent content. Our data were collected at a time when there were less versatile screen-based technologies; therefore, our findings can be interpreted as very conservative compared to current estimates. Paediatric professionals and allied disciplines must take preventive measures to ensure that parents are aware of the risks associated with excessive use by their sons and daughters.

Longitudinal association between parental involvement and internet gaming disorder among Chinese adolescents: Consideration of future consequences as a mediator and peer victimization as a moderator

BACKGROUND AND AIMS

Internet gaming disorder (IGD) in adolescents is a concerning issue. Positive parenting has been found to protect against adolescent IGD, but the underlying mechanisms await further investigation. As such, this study examined the longitudinal association between parental involvement (PI) - a specific type of positive parenting understudied in the literature of adolescent gaming disorder - and IGD. Moreover, this study also tested consideration of future consequences (CFC) as a mediator and peer victimization (PV) as a moderator.

METHODS

A two-wave longitudinal research spanning 6 months apart was conducted. Participants were Chinese adolescents (final N = 434; 222 females; Mage = 14.44 years, SD = 1.56). They provided ratings on PI, PV, and IGD at Wave 1, and CFC-immediate, CFC-future, and IGD at Wave 2.

RESULTS

Descriptive statistics showed that the prevalence rate of IGD was 10.81% and 9.45% at Waves 1 and 2, respectively. Moreover, results of moderated mediation model found that after controlling for Wave 1 IGD and covariates, Wave 1 PI was associated with Wave 2 IGD via preventing adolescents who had higher levels of PV from developing a tendence of CFC-immediate and via promoting adolescents who had lower levels of PV to develop a tendence of CFC-future.

DISCUSSION AND CONCLUSIONS

Altogether, these results suggest that facilitative ecological systems (e.g., positive parenting and good relationships with peers) and personal strengths (e.g., positive future orientation) jointly contribute to the mitigation of adolescent IGD.

Association between Media Use and Bedtime Delays in Young Children: An Adjunct Study of the Japan Environment and Children’s Study

Excessive screen media use has been reported to cause shorter sleep; however, the types of media environments that affect early childhood sleep are less known. This study examined the association of multiple media use, screen time for each device, and the purpose of smartphone and tablet use with delayed bedtime among 4–8-year-olds. Participants were recruited from the Japan Environment and Children’s Study, a nationwide birth cohort study. Mothers of 1837 children reported screen media use and bedtime in a questionnaire. The association between delayed bedtimes (after 22:00 h) and media device use (smartphones, tablets, portable and console games, and TV/DVDs) was examined by logistic regression analysis. Children who used three or more devices besides TV/DVDs were more likely to have delayed bedtimes. Delayed bedtimes were associated with smartphone use, even with a 0.1–1 h/day screen time, and with prolonged screen time for tablets, portable games, and console games, but not for TV/DVDs. Gaming on smartphones and tablets was also associated with delayed bedtime. To ensure adequate sleep for young children, families must develop feasible measures to discourage children’s use of multiple devices and prolonged device use, especially for games, and a social environment that supports such measures.

The Association Between Internet Gaming Disorder and Sensation Seeking Among Arab Adolescents

Research on internet gaming disorder (IGD) has increased considerably over the last decade. Although most IGD research has focused on Western or South Asian samples, it is critical to understand and assess this disorder among other populations. The present study investigated the association between IGD and sensation seeking among Arab adolescents. An online survey consisting of the short internet gaming disorder short scale (IGDSS) and brief sensation seeking scale (B-SSS) was completed by 260 participants (mean age = 14.61, SD = 2.43). The results showed that sensation seeking behaviours were associated with higher gaming hours and greater chances of exhibiting IGD. The findings support the current perspective of understanding this disorder from a disease framework as it highlights the relevance of behavioural components in gaming addiction. Importantly, the results will further aid the development of reliable diagnosis and efficacious treatments within clinical practices.

Prevalence and factors associated with Internet gaming disorder among adolescents in Saudi Arabia: A cross-sectional study

This study aimed to assess the prevalence of internet gaming disorder (IGD) and its associated factors among a sample of adolescents in the Faifa governorate in the south of Saudi Arabia. This was a cross-sectional study targeting intermediate and secondary school adolescent students in the Faifa governorate. Multistage sampling was performed to reach the required sample, where 9 schools were randomly selected, followed by the distribution of the questionnaire to all students at all levels. IGD was assessed using a validated Arabic version of the 20-item IGD scale. A chi-square test was used to evaluate the presence of statistical differences between sample demographic data and IGD. Four hundred and fifty students participated in the current study, where 132 (29.3%) of them were classified as having IGD. The prevalence of IGD was associated with gender, year of study, maternal education status, and the number of hours spent online and playing with friends (P values 0.05). Analysis of the IDG items among the current sample indicated that most were at the conflict stage of IGD. The IGD level identified in our sample is high compared to the published literature. Faifa is a mountainous region and, due to its geographical nature, there are limited public entertainment areas. Adolescents tend to spend more time at home, where they may be more exposed to IGD. This suggests the need for strategies to ensure early identification of those at risk of IGD and to provide preventive and treatment options for these students.

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

BACKGROUND AND AIMS

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

RESULTS AND CONCLUSIONS

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

Psychometric properties of the Indonesian Ten-item Internet Gaming Disorder Test and a latent class analysis of gamer population among youths

Internet gaming disorder (IGD) is a rising health concern. Indonesia has yet to have any validated instrument specifically designed to screen for this disorder. This study aims to validate the Indonesian version of the Ten-item Internet Gaming Disorder Test (IGDT-10) and conduct a latent class analysis of gamers among the youth. An online survey was conducted between October and December 2020 at two universities in Depok and Jakarta, Indonesia. In total, 1233 respondents (62.6% female and 20.3±1.90 years old) gave valid responses and played video games. Confirmatory factor analysis (CFA) confirmed the unidimensional structure of the scale. Cronbach’s alpha was 0.72 and composite reliability was 0.92. The latent class analysis yielded three distinct classes of gamers. The continuation and negative consequences were highly distinctive for the group at high risk of IGD (class 3). Deception had the lowest endorsement rate (41.7%); while, the continuation domain had the highest endorsement, 91.2%. The IGD prevalence estimate was 1.90% among the respondents. Approximately 70.2% of the gamers did not show IGD symptoms. The adapted Indonesian IGDT-10 was demonstrated as valid and reliable among Indonesian youths. Consistent with previous studies, the deception domain had a low endorsement rate. The detected IGD rates were comparable to the global range. The majority of the current sample disclosed no symptoms; however, a considerable proportion would benefit from early preventive measures.

Profiles of Stress and Coping Associated With Mental, Behavioral, and Internet Use Problems Among Adolescents During the COVID-19 Pandemic: A Stratified Random Sampling and Cluster Analysis

Background

Adolescents are vulnerable to behavioral and mental health problems, which might be further exacerbated during the COVID-19 pandemic. This study explored how participants with different profiles of stressful life events, coping resources (i.e., self-esteem and perceived social support) and coping strategies (i.e., maladaptive and adaptive coping) varied in the prevalence of mental, behavioral, and Internet use problems.

Methods

Data were collected from a large and representative sample of Chinese secondary school students in Hong Kong (n = 3,136) from September to November 2020 (48.1% males; mean age = 13.6 years old). Cluster analysis and logistic regression models were used for analysis.

Results

The prevalence of suicidal ideation and sleep disturbance was 29.8 and 55.4%, respectively. Behavioral problems were most frequently reported in excessive social media use (53.5%), followed by excessive Internet gaming (43.6%), obesity (34.1%), damaging properties (14.6%), and alcohol or substance abuse (5.1%). The results of cluster analysis yielded three distinctive stress and coping profiles: severe profile (High Risk/Low Protective; 17.0%), moderate profile (Moderate Risk/Moderate Protective; 35.8%), and mild profile (Low Risk/High Protective; 47.2%). Participants with severe and moderate profiles displayed significantly higher levels of mental (range for AOR: 2.08–15.06; all p < 0.001) and behavioral health problems (range for AOR: 1.22–11.22; all p < 0.05) compared to the mild profile cluster.

Conclusions

Adolescents' mental and behavioral health may be shaped by a combination of stressful life events and variations in coping resources as well as strategies. Transdiagnostic and multimodal interventions on these factors are warranted to reduce mental, behavioral, and Internet use problems among adolescents.

Gambling, Gaming, and Internet Behavior in a Sexual Minority Perspective. A Cross-Sectional Study in Seven European Countries

Background

Addictive behavior of gambling, gaming and internet activity is partly a new research domain and has not been well investigated with regard to sexual minority populations. Although health disparities between sexual minorities and the general population are well documented, there is a lack of inclusion of sexual minorities in both research and clinic. Among lesbian, gay and bisexual populations certain features could be present that play a role for the development of addictive behaviors, such as social isolation and increased risk of other psychiatric problems. The aim of this study was to investigate problem gambling, problem gaming and problematic internet behavior in a European context and if it is affected by sexual orientation status.

Methods

An online web-survey was distributed among web-panels in England, Poland, Switzerland, Italy, Spain, Denmark, and Sweden in 2017-2018.

Result

10 983 complete answers were collected. 7.1% of the participants had a sexual minority status (n = 774). Regression models found that there was no difference in gambling, gaming and internet behavior among heterosexual and sexual minority men. Sexual minority women were associated with problematic gambling and gaming behavior, when also controlling for age and nationality. When also controlling for psychological distress, women defining as having another sexual minority status than lesbian and bisexual remained significant for having a problematic gaming behavior (AOR = 2.3).

Conclusion

An awareness of female sexual minority perspectives is relevant in facilities treating behavioral addiction as well as in future research in behavioral addiction. More research is needed in problematic gambling and gaming behavior in different sexual minority populations with regard to psychiatric comorbidity and living conditions. An inclusion of sexual minority groups defining as other than gay and bisexual is needed in future research. No significant differences were found between heterosexual and sexual minority men in adjusted analysis in this study.

Escapism-Based Motivation Affected the Psychological Performances of High-Risk Internet Gaming Disorder Individuals

Background

Escapism-based motivation (EBM) is considered as one of the diagnostic criteria for internet gaming disorder (IGD). However, how EBM affects the high risk of IGD (HIGD) population remains unclear.

Methods

An initial number of 789 college students participated in the general, internet gaming behavior, and motivation surveys. After multiple evaluations, 57 individuals were identified as HIGD (25 with EBM, H-EBM; 32 with non-EBM, H-nEBM). In addition, 51 no-gaming individuals were included as the control group (CONTR). The cohorts completed the psychological assessments and eye-tracking tests, and analyses of group differences, correlations, and influencing factors of the indicators were performed.

Results

The Barratt impulsiveness score of H-nEBM and H-EBM was significantly higher than that of CONTR (MD = 3.605, P = 0.017; MD = 3.744, P = 0.022). In addition, emotional intelligence self-emotion management ability was significantly lower in the H-EBM than in CONTR (MD = -2.038, P = 0.004). Correct rates and reaction times in the anti-saccade task differed significantly between the three groups (F = 3.525, P = 0.033; F = 4.459, P = 0.014). However, no differences were found in the comparison of the digital span test (DST), trail making test (TMT), animal verbal fluency test, Stroop test, and mental rotation test results. The anti-saccade test indicators were positively correlated with the DST results but negatively correlated with the Stroop test results (P < 0.05). Correct rates in the mental rotation test were negatively correlated with the TMT results but positively correlated with the DST results (P < 0.05). The participants with high Stroop test scores and no lover experience and who were raised by their grandparents were likely to develop EBM to engage in high risk of internet gaming disorder (P < 0.05).

Conclusion

EBM has a significantly negative effect on impulsivity, self-emotion management ability, and response inhibition in the HIGD participants.

Evidence on Problematic Online Gaming and Social Anxiety over the Past Ten Years: a Systematic Literature Review

Purpose of Review

The present study aimed to review the literature concerning the relationship between problematic online gaming (POG) and social anxiety, taking into account the variables implicated in this relationship. This review included studies published between 2010 and 2020 that were indexed in major databases with the following keywords: Internet gaming, disorder, addiction, problematic, social phobia, and social anxiety.

Recent Findings

In recent years, scientific interest in POG has grown dramatically. Within this prolific research field, difficulties associated with social anxiety have been increasingly explored in relation to POG. Indeed, evidence showed that individuals who experience social anxiety are more exposed to the risk of developing an excessive or addictive gaming behavior.

Summary

A total of 30 studies satisfied the initial inclusion criteria and were included in the present literature review. Several reviewed studies found a strong association between social anxiety and online gaming disorder. Furthermore, the relationships among social anxiety, POG, age, and psychosocial and comorbid factors were largely explored. Overall, the present review showed that socially anxious individuals might perceive online video games as safer social environments than face-to-face interactions, predisposing individuals to the POG. However, in a mutually reinforcing relationship, individuals with higher POG seem to show higher social anxiety. Therefore, despite online gaming might represent an activity able to alleviate psychopathological symptoms and/or negative emotional states, people might use online gaming to counterbalance distress or negative situations in everyday life, carrying out a maladaptive coping strategy.

A Mobile App to Increase Fruit and Vegetable Acceptance Among Finnish and Polish Preschoolers: Randomized Trial

Background

Early childhood education and care (ECEC) centers are ideal venues for food education. As smartphones and tablets are becoming increasingly popular in ECEC centers, technology can be used to deliver such pedagogical content. Evidence suggests that video games can affect fruit and vegetable (FV) consumption among 9- to 12-year-old children, but studies among preschoolers are scarce.

Objective

This paper describes the development of the Mole’s Veggie Adventures app and its effectiveness in increasing FV acceptance among Finnish and Polish preschoolers aged 3 to 6 years.

Methods

A multiprofessional team created an app to be used in ECEC centers in groups of 3 to 10 children. The app aimed to increase vegetable acceptance, and it was built using elements that support the development of self-regulation and social skills. Altogether, 7 Finnish and 4 Polish ECEC centers participated in the study. Before randomization, parents reported background factors and their children’s willingness to taste different FVs. The ECEC professionals in the intervention arm were instructed to use the app at least once a week during the 3- to 4-week intervention period. The main outcomes in this unblinded, cluster-randomized study were FV acceptance and relative FV acceptance. The first was calculated as a sum variable describing the children’s willingness to taste 25 different FVs, the second as FV acceptance divided by the number of FVs served. We used analysis of covariance to compare the FV acceptance and relative FV acceptance scores between the intervention and control groups at follow-up.

Results

A total of 221 children were included in the analysis. At follow-up, the intervention group (115/221, 52%) had higher FV acceptance scores (baseline adjusted difference of mean 7.22; 95% CI 1.41-13.03) than the control group (106/221, 48%). The intervention effect was parallel for relative FV acceptance scores (baseline adjusted difference of mean 0.28; 95% CI 0.05-0.52).

Conclusions

The Mole’s Veggie Adventures app has the potential to increase FV acceptance among preschoolers and can be a valuable tool in supporting food education in ECEC centers. Furthermore, the app can be feasibly incorporated into preschool routines in countries with different educational environments.

Trial Registration

ClinicalTrials.gov NCT05173311; https://tinyurl.com/4vfbh283

Cognitive behavioral treatment for disordered gaming and problem gambling in adolescents: a pilot feasibility study

BACKGROUND

Disordered gaming and problem gambling (DG/PG) are associated with a range of functional impairments as well as psychiatric comorbidity. With the proliferation of digital gaming apps aimed at children and adolescents, which involve in-game purchases, there is increasing evidence that DG/PG are on the rise in this age range. The behavior can be detected in youth presenting at school-based health clinics and community psychiatric clinics. Cognitive behavioral therapy (CBT) is one of several recommended treatments for adults, but little evidence is available for the efficacy of this approach in adolescents with DG/PG.

AIM

To evaluate the acceptability and feasibility of a CBT-based intervention developed for adolescents with DG/PG, which can be delivered in routine psychiatric care facilities.

METHODS

Adolescents who were patients at a child and adolescent psychiatry service were screened for DG/PG. Those aged 12-17 years with pronounced symptoms were invited to participate in a 7-week CBT program called Relapse Prevention. Nine adolescents agreed to participate and five consented to repeated assessments of outcome (pre-, post-treatment, and 6-month follow-up). In addition to acceptability and satisfaction with treatment, symptoms of DG were assessed with standardized interview and self-report measures.

RESULTS

There were no dropouts from the treatment. Participants who completed treatment and all outcome assessments reported satisfaction with the treatment. The participants showed fewer symptoms of DG after treatment, and the proportion who met criteria for computer game addiction decreased from 56 to 0%. There was no reduction in the number of participants who met criteria for PG.

CONCLUSION

This study provides preliminary evidence for the acceptability and feasibility of a CBT-based intervention for DG/PG in adolescents. Preliminary data suggest that the treatment may be effective for DG but not PG. Further studies are needed to evaluate the efficacy of this approach for both conditions.

Gaming Disorder Seen Through the Prism of Dual Diagnosis: Prevalence and Associated Factors

INTRODUCTION

Dual diagnosis (DD) is defined as the co-occurrence of at least a psychiatric disorder and at least an addictive disorder. Most studies about DD considered substance use disorders. In 2018, gaming disorder (GD) was recognized as a formal disorder and integrated into the category of addictive disorders in the 11th version of the International Classification of Diseases. Our objectives were to measure DD prevalence among GD patients and to assess factors associated with the presence of DD.

METHODS

As part of the EVALuation of behavioral ADDictions (EVALADD) cohort, 92 patients with GD were included in the present study. Psychiatric disorders, including anxiety, mood, and psychotic disorders, were explored with the Mini International Neuropsychiatric Interview (MINI 5.0.0). Probable adult attention-deficit/hyperactivity disorder (ADHD) was screened with the Wender Utah Rating Scale (WURS) in childhood and with the ADHD Self-Report Scale-V1.1 (ASRS) in adulthood. Finally, personality was assessed using the 125-item version of the Temperament and Character Inventory (TCI-125), motives for gaming with the Videogame Motives Questionnaire (VMQ) and attachment styles with the Relationship Scales Questionnaire (RSQ). To measure the prevalence of DD among GD patients, we considered the occurrence of current GD with current anxiety, mood, or psychotic disorders, or with probable current ADHD. We also performed a multivariate analysis to identify independent factors associated with DD.

RESULTS

More than half (55.4%) of GD patients suffered from DD. We found a high prevalence of probable ADHD (38%) and anxiety disorders (29% suffering from generalized anxiety disorder, social, agoraphobia or panic disorder). Four variables were significantly associated with DD: suicidal thoughts [odds ratio (OR) = 6.83, 95% confidence interval (95%CI) (1.66-28.09)], VMQ "coping" scores [OR = 1.18, 95%CI (1.01-1.38)], TCI-125 "harm avoidance" scores [OR = 1.04, 95%CI (1.01-1.07)] and "novelty seeking" scores [OR = 1.03, 95%CI (1.00-1.06)].

DISCUSSION

The prevalence of certain psychiatric disorders among GD patients far exceeded that observed in the general population. Both ADHD and suicidal ideations should particularly be screened among GD patients. Specific interventions targeting personality dimensions associated with DD but also on the management of negative affect should represent new treatment opportunities.

Excessive and pathological Internet use - Risk-behavior or psychopathology?

Pathological Internet use (but only with respect to gaming) is classified as mental disorder in the ICD-11. However, there is a large group of adolescents showing excessive Internet use, which may rather be considered adolescent risk-behavior. The aim was to test whether pathological and excessive Internet use should be considered as "psychopathology" or "risk-behavior". A representative, cross-sectional sample of 11.110 students from 10 European Union countries was analyzed. Structural equation models, including the factors "risk-behavior" and "psychopathology" and the variables excessive and pathological Internet use, were tested against each other. "Risk-behavior" was operationalized by several risk-behaviors (e.g. drug abuse, truancy, etc). "Psychopathology" included measures of several mental disorders (e.g. depression, hyperactivity, etc). Excessive Internet use was assessed as the duration and frequency of Internet use. Pathological Internet use was assessed with the Young Diagnostic Questionnaire (i.e., presence of addiction criteria). Excessive Internet use loaded on "risk-behavior" (λ = 0.484, p < .001) and on "psychopathology" (λ = 0.071, p < .007). Pathological Internet use loaded on "risk-behavior" (λ = 0.333, p < .001) and on "psychopathology" (λ = 0.852, p < .001). Chi-square tests determined that the loadings of excessive Internet use (χ² (1) = 81.98, p < .001) were significantly stronger on "risk-behavior" than "psychopathology". Vice versa, pathological Internet use loaded significantly stronger on "psychopathology" (χ² (1) = 107.10, p < .001). The results indicate that pathological Internet use should rather be considered as psychopathology. Excessive Internet use on the other hand, should be classified as adolescent risk-behavior.

[French validation of a scale evaluating Internet Gaming Disorder: the Internet Gaming Disorder-20]

BACKGROUND

The study aims to validate an online video game problematic use (Internet Gaming Disorder or IGD) scale in French language: the IGD-20. IGD-20 has been elaborated considering the discussion about the etiology of the IGD, which was included in the section III of the DSM-5. The IGD-20 is composed of 20 items split in six components based on the six components model of addiction from Griffiths.

METHODS

A total of 166 online video game players were recruited on specialized forums, playing 21.9 hours per week. The French version of the IGD-20 was validated through a confirmatory factor analysis via structural equation modeling (SEM).

RESULT

The French version of the IGD-20 showed a good validity and a six-factor structure (salience, mood modification, tolerance, withdrawal symptoms, conflict and relapse) (RMSEA = 0.063 [0.049; 0,077], CFI = 0.912, TLI = 0.909).

CONCLUSION

The validation of a French scale such as the IGD-20 shows some interest for the French-speaking population, including therapists who could use this scale to investigate the IGD-20 more precisely and for people with IGD-20 who could benefit from a more refined support.