Video gaming and gaming addiction in transgender people: An exploratory study

Setting the Game Agenda: Reviewing the Emerging Literature on Video Gaming and Psychological Well-Being of Sexual and Gender Diverse Youth

Video gaming is a popular youth pastime that has prompted scholarship into its relationship with psychological well-being. However, sexual and gender diverse youth (SGDY) who play video games are largely overlooked in this research. SGDY experience significant mental health challenges, but utilize coping strategies mediated by digital technologies, necessitating an examination of their video game playing and its effects on well-being. This literature review synthesizes the emerging evidence base by identifying key constructs related to SGDY well-being and video gaming. Five themes were derived from the literature: (a) SGDY identity development and self-expression in video games; (b) SGDY video gaming and coping skills; (c) Social support in SGDY video gaming communities; (d) SGDY digital microaggressions in video gaming; and (e) SGDY civic engagement through video gaming. The findings establish multiple risks and opportunities for harnessing video games to support SGDY's well-being. Recommendations for practice, research, and industry collaborations are presented.

Screen use in transgender and gender-questioning adolescents: Findings from the Adolescent Brain Cognitive Development (ABCD) Study

OBJECTIVE

To assess the association between transgender or gender-questioning identity and screen use (recreational screen time and problematic screen use) in a demographically diverse national sample of early adolescents in the U.S.

METHODS

We analyzed cross-sectional data from Year 3 of the Adolescent Brain Cognitive DevelopmentSM Study (ABCD Study®, N = 9859, 2019-2021, mostly 12-13-years-old). Multiple linear regression analyses estimated the associations between transgender or questioning gender identity and screen time, as well as problematic use of video games, social media, and mobile phones, adjusting for confounders.

RESULTS

In a sample of 9859 adolescents (48.8% female, 47.6% racial/ethnic minority, 1.0% transgender, 1.1% gender-questioning), transgender adolescents reported 4.51 (95% CI 1.17-7.85) more hours of total daily recreational screen time including more time on television/movies, video games, texting, social media, and the internet, compared to cisgender adolescents. Gender-questioning adolescents reported 3.41 (95% CI 1.16-5.67) more hours of total daily recreational screen time compared to cisgender adolescents. Transgender identification and questioning one's gender identity was associated with higher problematic social media, video game, and mobile phone use, compared to cisgender identification.

CONCLUSIONS

Transgender and gender-questioning adolescents spend a disproportionate amount of time engaging in screen-based activities and have more problematic use across social media, video game, and mobile phone platforms.

Problematic Internet Use and Technology Interactions Among Transgender Adolescents

Purpose

To compare risk of problematic internet use (PIU) and importance of digital media interactions for transgender and cisgender adolescents.

Methods

A nationally representative group of adolescents took an online survey that included a measure of PIU (Problematic and Risky Internet Use Screening Scale-3 [PRIUSS-3]) and technology interactions (Adolescent Digital Technology Interactions and Importance scale). We compared mean scores for these scales and their subscales and rates of positive screens for PIU for transgender and cisgender adolescents.

Results

Of 4575 adolescents participating, 53 (1.2%) were transgender, nonbinary, and gender-diverse (TNG) adolescents. TNG adolescents had higher PRIUSS-3 scores and higher mean scores for importance of technology to explore identity/go outside their offline environment.

Conclusions

TNG adolescents report higher PIU risk, which may relate to differences in technology importance for this group.

Trait anxiety and corresponding neuromarkers predict internet addiction: A longitudinal study

Background and Aims

The high prevalence of internet addiction (IA) has become a worldwide problem that profoundly affects people's mental health and executive function. Empirical studies have suggested trait anxiety (TA) as one of the most robust predictors of addictive behaviors. The present study investigated the neural and socio-psychological mechanisms underlying the association between TA and IA.

Methods

Firstly, we tested the correlation between TA and IA. Then we investigated the longitudinal influence of TA on IA using a linear mixed effect (LME) model. Secondly, connectome-based predictive modeling (CPM) was employed to explore neuromarkers of TA, and we tested whether the identified neuromarkers of TA can predict IA. Lastly, stressful life events and default mode network (DMN) were considered as mediating variables to explore the relationship between TA and IA.

Findings

A significant positive correlation between TA and IA was found and the high TA group demonstrated higher IA across time. CPM results revealed that the functional connectivity of cognitive control and emotion-regulation circuits and DMN were significantly correlated with TA. Furthermore, a significant association was found between the neuromarkers of TA and IA. Notably, the CPM results were all validated in an independent sample. The results of mediation demonstrated that stressful life events and correlated functional connectivity mediated the association between TA and IA.

Conclusions

Findings of the present study facilitate a deeper understanding of the neural and socio-psychological mechanisms linking TA and IA and provide new directions for developing neural and psychological interventions.

Autism Spectrum, Hikikomori Syndrome and Internet Gaming Disorder: Is There a Link?

The aim of this study is to review the available literature investigating the relationship between hikikomori, a pathological condition characterized by severe social withdrawal or isolation, autism spectrum disorder (ASD) and Internet gaming disorder (IGD). Studies on the relationship between ASD and IGD have found significant positive correlations between these two conditions. Individuals with ASD would appear to be at risk of developing a problematic use of the Internet, which, to the right extent, would represent a useful tool for social interaction and cognitive development. Even subjects with hikikomori, in whom rarefied interpersonal relationships and social isolation could be balanced by the use of online connections, appear to be at high risk of developing IGD. On the other hand, the finding of significant autistic traits in populations with hikikomori could lead to considering this psychopathological condition as a particular presentation of autism spectrum, a hypothesis that requires further investigation.

Why imaginary worlds? The role of self-exploration within online gaming worlds

Dubourg and Baumard posited that preferences for exploration are the key to the popularity in imaginary worlds. This commentary argues that other forms of exploration may also account for the success and appeal of specific types of imaginary worlds, namely self-exploration within interactive imaginary worlds such as videogames.

Behavioral addiction and autism spectrum disorder: A systematic review

BACKGROUND

According to DSM-5 criteria, Autism spectrum disorder (ASD) is a neurodevelopmental condition characterized by deficiencies in social communication and interaction along with the presence of restrictive and repetitive patterns of behavior. Few studies have explored the prevalence of behavioral addiction in individuals with ASD. Since addiction and ASD share common characteristics, individuals with ASD may be more vulnerable to addictive behaviors. Some typical behavioral addictions include internet, gaming, and gambling addiction. While most previous studies on ASD and addiction have looked at chemical addiction, behavioral addiction has not been thoroughly studied to date.

AIMS

The objective of this study was to investigate the presence of behavioral addiction among individuals diagnosed with autism spectrum disorder.

METHODS AND PROCEDURES

A systematic literature search of five databases was conducted in accordance with the PRISMA guidelines. Search results were reviewed for the predetermined inclusion criteria independently by two authors.

OUTCOMES AND RESULTS

The search yielded 539 publications after the removal of duplicates. 61 met the inclusion criteria for title and abstract review. Full texts were reviewed resulting in an additional 31 being removed. The remaining 30 included 4 case reports and 26 original studies. Results included 27 studies that found a positive correlation (15 of significance, 12 of unknown significance) between a behavioral addiction and either ASD or Autistic traits, 1 found a significant negative correlation, 3 did not find a correlation.

CONCLUSIONS AND IMPLICATIONS

This review is inconclusive about links between ASD and behavioral addictions. While a vast majority of studies show a positive correlation, many do not provide the statistical analysis to show if the correlations are significant. In addition, a positive correlation between ASD and behavioral addiction is observed in the presence of comorbid mental health conditions in many of the studies. Further research with proper controls and statistical analysis is needed to determine whether the development of behavioral addiction is directly influenced by ASD or if the presence of a comorbid mental health condition is the true cause.

Autistic Traits and Attention-Deficit Hyperactivity Disorder Symptoms Predict the Severity of Internet Gaming Disorder in an Italian Adult Population

Over the last decade, internet gaming has been a fast-growing recreational activity. Gamers risk their leisure activity becoming an addiction. In the present study, we aimed to measure the prevalence of Internet Gaming Disorder (IGD) in an adult population of video game players and to investigate the association between demographic variables, Autism Spectrum Disorder (ASD) traits, Attention-Deficit Hyperactivity Disorder (ADHD) severity, and IGD in adults. Through an online survey, we recruited 4260 individuals aged between 18 and 55 years old, who were members of online communities of video gamers. We collected demographic data and administered three questionnaires: the Internet Gaming Disorder Scale-Short Form (IGD9-SF), the Autism Spectrum Quotient (AQ), and the Adult ADHD Self-Report Scale (ASRS). Of the overall sample, 29.67% scored above the cut-off of 21 points for the IGD9-SF. Multiple linear regression models showed that daily spare time, autistic traits, and ADHD symptoms were positively associated with the severity of IGD in adults, after controlling for demographic variables. Future studies are required in order to explore factors linked to IGD in adults.

Autism, Problematic Internet Use and Gaming Disorder: A Systematic Review

The present study investigated the association between autism and problematic internet use (PIU) and gaming disorder (GD). A systematic literature search was conducted in accordance with PRISMA guidelines. A total of 2286 publications were screened, and 21 were deemed eligible for inclusion in the review. The majority of the studies found positive associations between PIU and subclinical autistic-like traits with weak and moderate effect sizes and between PIU and Autism Spectrum Disorder (ASD) with varying effect sizes. Additionally, individuals with ASD were more likely to exhibit symptoms of GD with moderate and strong effect sizes. Future research would benefit from high-quality studies examining GD and PIU at a clinical level and their relationship with both clinical and subclinical autism.

Psychometric Properties of the Malay Version of the Internet Gaming Disorder Scale-Short Form (IGDS9-SF-M): Evidence from a Sample of Malaysian Undergraduates

In recent years, increased interest in Internet Gaming Disorder has led to the development of the Internet Gaming Disorder Scale-Short Form. Translation and subsequent validation of such a scale are important for cross-cultural use. The aim of the present study was to examine the psychometric properties (factor structure, reliability, and validity) of the Malay Version of the Internet Gaming Disorder Scale-Short Form using a sample of Malaysian undergraduates. The present sample included 137 Malaysian undergraduates. Participants completed a self-administered online survey containing demographic items, the Malay Version of the Internet Gaming Disorder Scale-Short Form, the Problematic Online Gaming Questionnaire-Short Form, and the Malay Version of the Internet Addiction Test. The present findings confirm the one-factor model of the Malay Version of the Internet Gaming Disorder Scale-Short Form. Good reliability, as measured by Cronbach alpha, was found for the Malay Version of the Internet Gaming Disorder Scale-Short Form. The Malay Version of the Internet Gaming Disorder Scale-Short Form has demonstrated concurrent validity by significantly correlating with the Problematic Online Gaming Questionnaire-Short Form as well as demonstrated convergent validity with respect to the Malay Version of the Internet Addiction Test. The Malay Version of the Internet Gaming Disorder Scale-Short Form is a reliable and valid tool for assessing Internet Gaming Disorder in Malaysian undergraduates. As more research is still needed to confirm the status of Internet Gaming Disorder as a formal disorder, it is hoped that the Malay Version of the Internet Gaming Disorder Scale-Short Form can facilitate future research examining antecedents and consequences of Internet Gaming Disorder in a Malaysian setting.

Exploring the mental health experiences of young trans and gender diverse people during the Covid-19 pandemic

Background

Both anxiety and depression have been identified as negative health outcomes associated with the distressing nature of the Covid-19 pandemic, especially among young people. Within this age demographic, trans and gender diverse people may be particularly vulnerable to pandemic-related mental health outcomes, such as anxiety and depression, due to the social challenges, gender dissonance, and poor mental health they experience. Furthermore, the social distancing measures impose several unique social and help-seeking challenges which may further contribute to the worsening of mental health. While there has been acknowledgment that vulnerable populations may be disproportionally affected by the pandemic, the experiences of trans and gender diverse youth have received very little empirical attention.

Aims

To explore the mental health impact of Covid-19 on the lives of young trans and gender diverse people in the UK.

Method

In total, 243 people took part in an online survey between May and July in 2020. Eighty-two people were removed due to providing insufficient data. The analyzed dataset therefore comprised of 161 respondents ranging from 16 to 25 years (M = 20; SD = 2.68). Participants were asked how social distancing measures had impact on their social lives, mental health and access to health services. They were also asked to complete validated measures of anxiety and depression.

Results

This study found that those who experienced a greater impact of the Covid-19 outbreak and its associated social distancing measures, reported poorer mental health. Lack of social support, negative interpersonal interactions, unsupportive and non-affirming living environments and the inability to access mental health support and gender-affirming interventions were all factors that were associated with poor mental health.

Conclusion

The findings provide specific direction for the tailoring of mental health service delivery to this population, noting the need for private, safe spaces in which young people can feel supported and have their gender identity affirmed.

Mediating Effects of Emotional Symptoms on the Association between Homophobic Bullying Victimization and Problematic Internet/Smartphone Use among Gay and Bisexual Men in Taiwan

Problematic internet/smartphone use (PI/SU) and homophobic bullying has become a new type of mental health problem among sexual minorities. However, few studies have investigated the mediators of the association between these factors. We aimed to develop a model to estimate the mediating effect of emotional symptoms, including depression and anxiety, on this association among gay and bisexual men in Taiwan. In total, 500 gay or bisexual men in early adulthood were recruited, and their histories of homophobic bullying victimization during childhood and adolescence, current severity of PI/SU, and current emotional symptoms were evaluated using self-administered questionnaires. A mediation model was developed to test the mediating effect of emotional symptoms on the association between homophobic bullying victimization and PI/SU. In total, 190 (38%) and 201 (40.2%) of the participants had experiences of traditional and cyber homophobic bullying victimization, respectively. A higher level of homophobic bullying victimization was significantly associated with a more severe level of PI/SU, and this was mediated by a higher severity of emotional symptoms. There was a significant effect of emotional symptoms on the association between homophobic bullying victimization and PI/SU. Timely interventions for emotional symptoms are necessary for gay and bisexual men, especially for those who are victims of homophobic bullying.

Measurement, Profiles, Prevalence, and Psychological Risk Factors of Problematic Gaming Among the Turkish Community: A Large-scale National Study

The present study investigated the prevalence, the potential different profiles, and the associated psychological factors of disordered gaming using data from a large-scale epidemiological study (TURBAHAR [Turkey’s Addiction and Mental Health Risk Profile Map Project]) carried out in Turkey in 2018 with 24,494 participants aged 18–81 years. Participants completed a comprehensive survey comprising a demographic questionnaire, Gaming Addiction Risk Questionnaire, Brief Symptom Inventory, Personal Well-Being Index Adult Form, Positive and Negative Affect Schedule, Toronto Alexithymia Scale, and Experiences in Close Relationships-Revised Scale. Latent class analysis showed the existence of eight different game profiles, which differed in relation to the intensity and specific features of the behavior. Results showed that 1.6% of the participants were problematic gamers. Being male, being younger, lower education level, being single, using alcohol and cigarettes, psychiatric distress, positive and negative affect, and anxious adult attachment were positively associated with problematic gaming.

Predicting likelihood of psychological disorders in PlayerUnknown's Battlegrounds (PUBG) players from Asian countries using supervised machine learning

Multiplayer Online Battle Arena (MOBA) has become one of the most popular genre of online video games played by gamers worldwide. Previous studies have exhibited that excessive engagement in games can lead to Internet Gaming Disorder (IGD). Internet Gaming Disorder has been associated with psychological disorders like impulsivity, anxiety and Attention Deficit Hyperactivity Disorder (ADHD). In this study, we propose an approach to use the game and player statistics along with self-esteem measure of a PlayerUnknown's Battlegrounds (PUBG, a MOBA game) player to predict whether he/she suffers from IGD and psychological disorders namely ADHD and Generalized Anxiety Disorder (GAD). We extract the game and player statistics of PUBG players from Asian countries and then run several state of the art supervised machine learning models to predict the occurrence of IGD, ADHD, and GAD. Initial experiments and results show that we are able to predict IGD, ADHD, and GAD with an accuracy of 93.18%, 81.81% and 84.9% respectively. Game statistics of PUBG players show strong positive correlation with IGD and ADHD indicating detrimental effects of MOBA games.

Trans and gender diverse young people's attitudes towards game-based digital mental health interventions: A qualitative investigation

BACKGROUND

Trans and gender diverse (TGD) young people are at high risk for mental health difficulties. Previous research has shown that three in four TGD young people have been diagnosed with an anxiety disorder and/or depression and almost one in two have attempted suicide. TGD young people experience barriers to traditional mental health services, commonly faced with inexperienced providers and discrimination. Video and computer games, as well as online spaces, are sources of resilience for TGD young people. Digital mental health interventions are a feasible, but understudied, approach to consider for this population.

METHODS

N = 14 TGD young people aged 11-18 years were recruited to take part in focus groups as part of a multistage project. The focus groups were transcribed verbatim and analysed using a general inductive thematic analysis approach. This paper reports on their attitudes towards digital games and game-based digital mental health interventions.

DISCUSSION

Aspects of game-based digital mental health interventions should be inclusive of diverse genders and sexuality, moderated appropriately and include content such as storylines and characters who are of diverse sexualities and/or gender. Participants were of the opinion that games should be preventative rather than treatment-focused; however, considering the high rate of mental health difficulties in this population, interventions should ideally address symptoms along the continuum from sub-clinical to clinical.

Problematic Gaming and Internet Use but Not Gambling May Be Overrepresented in Sexual Minorities - A Pilot Population Web Survey Study

Background: Substance-related addictive disorders are known to be overrepresented in non-heterosexual individuals, but it is largely unknown whether this is also the case for behavioral addictions such as problem gaming and gambling. This study aimed, in a pilot web survey design, to assess whether problematic gambling, gaming and internet use may be more common in individuals with a non-heterosexual orientation. Methods: An online survey was distributed through media and social media, and answered by 605 individuals (51% women and 11% non-heterosexual). Problem gambling, problem gaming and problematic internet use were measured through structured screening instruments (the CLiP, the GAS and the PRIUSS, respectively). Results: Problem gaming and problematic internet use were significantly more prevalent in non-heterosexual subjects. Instead, problem gambling did not differ between heterosexual and non-heterosexual respondents. Psychological distress and social media use for more than 3 h daily were significantly more common in non-heterosexual respondents. In the overall sample, gaming and gambling were associated statistically. Conclusion: Based on the present pilot online survey, problematic gaming and internet use, but not problem gambling, may be more common in non-heterosexual populations. This area merits more and larger studies, and potentially preventive efforts aimed for non-heterosexual individuals in the population. Possible explanations and study limitations are discussed in the paper.

Psychometric assessment of the Internet Gaming Disorder diagnostic criteria: An Item Response Theory study

Internet Gaming Disorder (IGD) has been recognized by the American Psychiatric Association (APA) as a tentative disorder in the latest fifth revision of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5). In order to advance research on IGD, the APA has suggested that further research on the nine IGD criteria to investigate its clinical and empirical feasibility is necessary. The aim of the present study was to develop the Polish the Internet Gaming Disorder Scale–Short-Form (IGDS9-SF) and scrutinize the nine IGD criteria empirically. To achieve this, the newly developed IGDS9-SF was examined using a wide range of psychometric methods, including a polytomous Item Response Theory (IRT) analysis to evaluate the measurement performance of the nine IGD criteria. A sample of 3377 gamers (82.7% male, mean age 20 years, SD = 4.3 years) was recruited online for the present study. Overall, the findings obtained confirmed that suitability of the Polish IGDS9-SF to assess IGD amongst Polish gamers given the adequate levels of validity and reliability found. The IRT analysis revealed that the IGDS9-SF is a suitable tool to measure IGD levels above the average; however, criteria “continuation” (item 6), “deception” (item 7), and “escape” (item 8) presented with poor fit. Taken together, these results suggest that some of the diagnostic criteria may present with a different clinical weighting towards final diagnosis of IGD. The implications of these findings are further discussed.

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The APA diagnostic criteria for IGD was investigated in a large sample of gamers.

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The construct of IGD was examined via validity analysis and Item Response Theory.

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The results revealed the suitability of the IGDS9-SF to assess IGD-related symptoms.

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Each IGD criterion present with distinct clinical diagnostic weighting.

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The nine IGD criteria need to take into account different clinical weighting.