Leisure and Problem Gaming Behaviors Among Children and Adolescents During School Closures Caused by COVID-19 in Hong Kong: Quantitative Cross-sectional Survey Study

The relationships between positive/negative metacognitions and Internet gaming disorder among Chinese adult gamers: Cross-sectional and longitudinal evidence

Previous research investigating Internet gaming disorder (IGD) in China involved mainly youth samples despite the large population of adult gamers. Drawing on the self-regulatory executive function model, this study aimed to demonstrate the psychometric robustness of negative and positive gaming-specific metacognitions assessed by the short-form Metacognitions about Online Gaming Scale (MOGS; Study 1). Then, Study 2 aimed to explore bidirectional associations between these two factors of the MOGS and IGD among a broad age spectrum of Chinese adult gamers. Through online surveys, we obtained data from Chinese community adults: Study 1 surveyed 409 past-month gamers (Mage = 42.45, SD = 11.66; 53.8 % female) and Study 2 surveyed 266 past-month gamers (Mage = 34.76, SD = 11.78; 65.8 % female). Results of Study 1 supported the robustness of the two-factor structure, demonstrated the short-form MOGS' satisfactory convergent validity and reliability, and displayed its scalar invariance between community adults and university students. Study 2 found bidirectional associations between negative metacognitions only and IGD, in which baseline negative metacognitions were associated with higher levels of individuals' follow-up vulnerability to developing IGD. In contrast, IGD had a prospective effect on negative metacognitions 6 months later. IGD also showed a significant prospective effect on positive metacognitions. These findings demonstrate that the short-form MOGS is a cost-effective tool for measuring gaming-specific metacognitions in Chinese adults, highlighting the prominent role of negative metacognitions in the vicious circle of maladaptive metacognitions and IGD, which has implications for IGD preventions.

The Relationship Between Digital Game Addiction and Levels of Anxiety and Depression in Adolescents Receiving Cancer Treatment

BACKGROUND

Adolescents diagnosed with cancer are vulnerable to symptoms of anxiety, depression, and posttraumatic stress.

OBJECTIVE

To examine the relationship between digital game addiction and levels of anxiety and depression in adolescents receiving cancer treatment.

METHODS

This analytical cross-sectional study was carried out with 120 adolescents aged 12-17 years who were receiving cancer treatment. Data were collected using the Digital Game Addiction Scale (DGAS-7) and the Hospital Anxiety and Depression Scale (HADS). Data were analyzed using independent-samples t test, 1-way analysis of variance, Pearson correlation analysis, and simple linear regression.

RESULTS

The mean age of the adolescents participating in the study was 15.21 ± 1.64 years. The mean DGAS-7 score was 15.19 ± 5.58, whereas the mean HADS Anxiety subscale score was 8.54 ± 4.33, and the mean HADS Depression subscale score was 7.72 ± 3.96. A positive, statistically significant relationship was found between the DGAS-7 mean score and the HADS Anxiety and Depression subscale mean scores ( P < .001).

CONCLUSIONS

As the addiction levels increased in adolescents diagnosed with cancer, their anxiety and depression levels also increased.

IMPLICATIONS FOR PRACTICE

Health professionals should be mindful that in adolescents diagnosed and treated for cancer, digital game addiction and levels of anxiety and depression may mutually reinforce each other.

From classrooms to controllers: how school closures shaped children's video gaming habits

OBJECTIVES

This study aimed to assess the impact of COVID-19-related school closures on screen time and video gaming habits among governmental school students in Qatar and explore the prevalence of Internet Gaming Disorder (IGD) within this context.

METHODS

A cross-sectional approach was employed, spanning two months from June to August 2022. A random sample of students aged 8-15 years was drawn from the national electronic health record system of Qatar. Telephone interviews with parents were conducted to collect data. The Parental Internet Gaming Disorder Scale (PIGDS) was used for IGD assessment.

RESULTS

Of 428 parents, 257 (60%) confirmed their child's engagement in video gaming during school closures. Participants averaged 11 years in age with 92 (35.8%) females and 165 (64.2%) males. Nationality included 62.6% expatriates and 37.4% Qatari locals. Average weekly screen time increased significantly from 19.7 ± 10.1 h to 31.9 ± 12.6 h during closure (p < 0.001). Video gaming time rose from 8.6 ± 8.6 h to 13.0 ± 12.4 h per week (p < 0.001). The prevalence of IGD was 8.6% (95% CI 5.4-12.7). Male students, expatriates, and those reporting increased video gaming time were more likely to develop IGD than their female and local counterparts.

CONCLUSION

The observed associations between video gaming increase and IGD highlight the need for focused interventions to address potential risks and promote healthier digital habits among this population.

Digital Serious Games to Promote Behavior Change in Children With Chronic Diseases: Scoping Review and Development of a Self-Management Learning Framework

BACKGROUND

Digital serious games (SGs) have rapidly become a promising strategy for entertainment-based health education; however, developing SGs for children with chronic diseases remains a challenge.

OBJECTIVE

In this study, we attempted to provide an updated scope of understanding of the development and evaluation of SG educational tools and develop a framework for SG education development to promote self-management activities and behavior change in children with chronic diseases.

METHODS

This study consists of a knowledge base and an analytical base. This study followed the PRISMA-ScR (Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews) guidelines. To build the knowledge base, 5 stages of research were developed, including refining the review question (stage 1), searching for studies (stage 2), selecting relevant studies (stage 3), charting the information (stage 4), and collating the results (stage 5). Eligible studies that developed SG prototypes and evaluated SG education for children with chronic diseases were searched for in PubMed, Embase, Google Scholar, and peer-reviewed journals. In the analytical base, the context-mechanism-output approach and game taxonomy were used to analyze relevant behavioral theories and essential game elements. Game taxonomy included social features, presentation, narrative and identity, rewards and punishment, and manipulation and control. A total of 2 researchers selected the domains for the included behavioral theories and game elements. The intended SG framework was finalized by assembling SG fragments. Those SG fragments were appropriately reintegrated to visualize a new SG framework.

RESULTS

This scoping review summarized data from 16 randomized controlled trials that evaluated SG education for children with chronic diseases and 14 studies on SG frameworks. It showed that self-determination theory was the most commonly used behavioral theory (9/30, 30%). Game elements included feedback, visual and audio designs, characters, narratives, rewards, challenges, competitions, goals, levels, rules, and tasks. In total, 3 phases of a digital SG framework are proposed in this review: requirements (phase 1), design and development (phase 2), and evaluation (phase 3). A total of 6 steps are described: exploring SG requirements (step 1), identifying target users (step 2), designing an SG prototype (step 3), building the SG prototype (step 4), evaluating the SG prototype (step 5), and marketing and monitoring the use of the SG prototype (step 6). Safety recommendations to use digital SG-based education for children in the post-COVID-19 era were also made.

CONCLUSIONS

This review summarizes the fundamental behavioral theories and game elements of the available literature to establish a new theory-driven step-by-step framework. It can support game designers, clinicians, and educators in designing, developing, and evaluating digital, SG-based educational tools to increase self-management activities and promote behavior change in children with chronic diseases.

Cognitive-behavioral statuses in depression and internet gaming disorder of adolescents: A transdiagnostic approach

To investigate the comorbidity of adolescent depression and Internet gaming disorder (IGD) and their shared and unique cognitive-behavioral factors (i.e., self-esteem, dysfunctional attitudes, hopelessness, and coping), a large-scale school-based survey was conducted among 3147 Chinese secondary school students in Hong Kong. Probable depression and IGD were screened using the Centre for Epidemiological Studies-Depression Scale and DSM-5 IGD checklist, respectively. Multinomial logistic regression was performed to identify the associations between different condition statuses and cognitive-behavioral factors. Four groups were identified, including comorbidity group (having probable depression and IGD), IGD group (having probable IGD alone), depression group (probable depression alone), and healthy group (neither condition). Comorbidity group showed the worst cognitive-behavioral statuses, followed by depression group and then IGD group. Compared with healthy group, those with lower self-esteem and higher hopelessness and dysfunctional attitudes were more likely to be classified into depression group and comorbidity group, while maladaptive coping was positively associated with all three disorder groups. The results suggest that depression and IGD may share common cognitive-behavioral mechanisms (e.g., maladaptive coping) but also own their uniqueness regarding specific factors (e.g., hopelessness and self-esteem). A transdiagnostic intervention approach targeting the common factors may effectively address the comorbidity.

The nature and characteristics of problem gaming, with a focus on ICD-11 diagnoses

PURPOSE OF REVIEW

This review describes the diagnoses related to problem gaming that are included in ICD-11, published by the WHO in 2022. It summarizes the recent literature on the prevalence of Gaming Disorder, its structure, antecedents and comorbidities, and explores whether the range of diagnoses currently available adequately covers the range of experiences seen with problem gaming.

RECENT FINDINGS

Overall, between 3 and 6% of the population worldwide are reported to have a gaming disorder as defined by ICD-11 or DSM-5. However, most studies are constrained by methodological issues such as nonrepresentative samples and the use of brief questionnaires to determine prevalence. ICD-11 Gaming Disorder is a psychometrically sound diagnosis. There is no diagnosis that currently captures the experience of harm from gaming, where the requirements for the diagnosis of Gaming Disorder are not reached.

SUMMARY

There is evidence in support of the proposed new entity of 'Harmful Gaming', which encompasses mental and physical harm/impairment due to a repeated pattern of gaming, but where requirements for the diagnosis of Gaming Disorder are not met. Such a diagnosis would complete the spectrum of diagnoses available for problem or unhealthy gaming, similar to those for unhealthy substance use, and would provide a framework for a public health approach to reducing the overall harm from unhealthy gaming.

Well-being approaches targeted to improve child and youth health post-COVID-19 pandemic: a scoping review

BACKGROUND

Our previous work synthesized published studies on well-being interventions during COVID-19. As we move into a post-COVID-19 pandemic period there is a need to comprehensively review published strategies, approaches, and interventions to improve child and youth well-being beyond deleterious impacts experienced during COVID-19.

METHODS

Seven databases were searched from inception to January 2023. Studies were included if they: (1) presented original data on an approach (i.e., approach applied) or (2) provided recommendations to inform development of a future approach (i.e., approach suggested), (3) targeted to mitigate negative impacts of COVID-19 on child and youth (≤18 year) well-being, and (4) published on or after December 2019.

RESULTS

39 studies (n = 4/39, 10.3% randomized controlled trials) from 2021 to 2023 were included. Twenty-two studies applied an approach (n = 22/39, 56.4%) whereas seventeen studies (n = 17/39, 43.6%) suggested an approach; youth aged 13-18 year (n = 27/39, 69.2%) were most frequently studied. Approach applied records most frequently adopted an experimental design (n = 11/22, 50.0%), whereas approach suggested records most frequently adopted a cross-sectional design (n = 13/22, 59.1%). The most frequently reported outcomes related to good health and optimum nutrition (n = 28/39, 71.8%), followed by connectedness (n = 22/39, 56.4%), learning, competence, education, skills, and employability (n = 18/39, 46.1%), and agency and resilience (n = 16/39, 41.0%).

CONCLUSIONS

The rapid onset and unpredictability of COVID-19 precluded meaningful engagement of children and youth in strategy development despite widespread recognition that early engagement can enhance usefulness and acceptability of interventions. Published or recommended strategies were most frequently targeted to improve connectedness, belonging, and socialization among children and youth.

Factors influencing smartphone overdependence among adolescents

Adolescents are particularly vulnerable to smartphone overdependence. Therefore, we identified the factors influencing smartphone overdependence and risk subgroups among adolescents. The current study is a secondary analysis of nationally representative data from the 2020 Korea Youth Risk Behavior Survey. The survey targeted middle- and high-school students in South Korea aged 12-18 using stratified, clustered, multistage probability sampling, and 53,457 students from 793 schools participated in this study. Complex sample data were analyzed considering the strata, clusters, and weights. Multiple logistic regression analysis revealed age, gender, household economic status, anxiety, loneliness, depressive symptoms, and experience of violent treatment as significant predictors of smartphone overdependence. Adolescents with severe anxiety were at a 3.326 times higher risk of smartphone overdependence than adolescents with minimal anxiety. Decision tree analysis showed that anxiety, gender, loneliness, and depressive symptoms were important in differentiating risk subgroups, with anxiety being the most significant factor. Group 13, comprising girls with severe anxiety, had the highest risk at 52.9%. Thus, early detection and prevention of issues such as anxiety, loneliness, and depressive symptoms, as well as treatment for violence, can prevent smartphone overdependence among adolescents. Additionally, more thorough interventions for anxiety are warranted to prevent smartphone overdependence.

The mutual overlapping impact of stress and infection on mental health problems in adolescents and youths during and after COVID-19 pandemic in China

BACKGROUND

It is unclear about the mutual impact of COVID-19 related psychological stress and infection on mental health of adolescent and youth students. This study aimed to explore the mutual impact of COVID-19 related psychological stress and infection on mental health problems among students.

METHODS

This study was conducted from December 14, 2022 to February 28, 2023 in Sichuan, China. Patient Health Questionnaire-9, Generalized Anxiety Disorder-7, PTSD Checklist for DSM-5, Insomnia Severity Index, and Internet Addiction Test were used. Participants were grouped by COVID-19 infection and psychological stress level. The differences among groups were compared, and logistic regression analysis was used to investigate risk factors for depression, anxiety, PTSD and insomnia among groups.

RESULTS

Of 90,118 participants, 82,873 (92.0 %) finished the questionnaires and were included in the study. Of 82,873 participants, 33,314 (40.2 %) reported to be infected with COVID-19. Participants had depression symptoms (38.1 %), anxiety symptoms (31.8 %), PTSD (33.9 %), insomnia (34.0 %), and internet addiction (60.3 %). Compared with participants uninfected with low psychological stress level, the risk for symptoms of depression, anxiety, PTSD and insomnia increased by 9.6 %, 12.3 %, 6.6 %, and 12.0 % in participants infected with low psychological stress level (p < 0.001), 106.8 %, 125.9 %, 125.2 %, and 95.7 % in participants uninfected with high psychological stress level (p < 0.001), and 147.3 %, 161.1 %, 158.7 %, and 141.0 % in participants infected with high psychological stress level (p < 0.001).

LIMITATION

This study is a cross-sectional design, and no causal associations should be inferred. Infection status was based on self-report of participants with infectious symptoms.

CONCLUSION

COVID-19 related psychological stress and infection per se have mutually overlapping impacts on mental health problems among students. Further health policies and psychosocial interventions should be developed to reduce mutually overlapping impact and improve the long-term mental health among students.

Implementation of an Electronic Mental Health Platform for Youth and Young Adults in a School Context Across Alberta, Canada: Thematic Analysis of the Perspectives of Stakeholders

BACKGROUND

Youth, aged 15 to 24 years, are more likely to experience mental health (MH) or substance use issues than other age groups. This is a critical period for intervention because MH disorders, if left unattended, may become chronic and serious and negatively affect many aspects of a young person's life. Even among those who are treated, poor outcomes will still occur for a percentage of youth. Electronic MH (eMH) tools have been implemented in traditional MH settings to reach youth requiring assistance with MH and substance use issues. However, the utility of eMH tools in school settings has yet to be investigated.

OBJECTIVE

The objective of this study was to gain an understanding of the perspectives of key school staff stakeholders regarding barriers and facilitators to the implementation of the Innowell eMH platform in secondary schools across the province of Alberta, Canada.

METHODS

Guided by a qualitative descriptive approach, focus groups were conducted to elicit stakeholder perspectives on the perceived implementation challenges and opportunities of embedding the Innowell eMH platform in secondary school MH services. In total, 8 focus groups were conducted with 52 key school staff stakeholders.

RESULTS

Themes related to barriers and facilitators to youth and school MH care professional (MHCP) capacity in implementing and using eMH tools were identified. With respect to youth capacity barriers, the following themes were inductively generated: (1) concerns about some students not being suitable for eMH services, (2) minors requiring consent from parents or caregivers to use eMH services as well as confidentiality and privacy concerns, and (3) limited access to technology and internet service among youth. A second theme related to school MHCP barriers to implementation, which included (1) feeling stretched with high caseloads and change fatigue, (2) concerns with risk and liability, and (3) unmasking MH issues in the face of limited resources. In contrast to the barriers to youth and MHCP capacity, many facilitators to implementation were discussed. Youth capacity facilitators included (1) the potential for youth to be empowered using eMH tools, (2) the platform fostering therapeutic relationships with school personnel, and (3) enhancing access to needed services and resources. MHCP capacity facilitators to implementation were (1) system transformation through flexibility and problem-solving, (2) opportunities for collaboration with youth and MHCPs and across different systems, and (3) an opportunity for the continuity of services.

CONCLUSIONS

Our findings highlight nuanced school MHCP perspectives that demonstrate critical youth and MHCP capacity concerns, with consideration for organizational factors that may impede or enhance the implementation processes for embedding eMH in a school context. The barriers and facilitators to implementation provide future researchers and decision makers with challenges and opportunities that could be addressed in the preimplementation phase.

Problematic Gaming during COVID-19 Pandemic: A Systematic Review, Meta-Analysis, and Meta-Regression

The COVID-19 pandemic led to government measures enforcing isolation in order to mitigate the spread of the virus. Consequently, online activities, including gaming, increased during this challenging period. Thus, it was possible that problematic gaming (PG) patterns also increased. In this systematic review and meta-analysis, we estimated the prevalence of PG during the COVID-19 pandemic and examined differences among subpopulations. The evaluation of 38 studies revealed that the overall prevalence of PG during the COVID-19 pandemic was 3.6%. Furthermore, higher PG scores were found in undergraduate and gamer subpopulations, as well as in studies using the Gaming Addiction Scale. Finally, meta-regression analyses suggest that stricter government measures, as identified by the Government Stringency Index, may have contributed to a lower prevalence of PG behaviors. A potential explanation of this finding is that containment measures had a protective function with respect to emotional distress, and thus towards PG; alternatively, it could be that current measures for PG become less precise if an individual's functioning is already impaired due to other reasons, such as COVID-19 restrictions. Further theoretical, methodological, and practical implications of the findings are discussed.

Effects of User-Reported Risk Factors and Follow-Up Care Activities on Satisfaction With a COVID-19 Chatbot: Cross-Sectional Study

BACKGROUND

The COVID-19 pandemic influenced many to consider methods to reduce human contact and ease the burden placed on health care workers. Conversational agents or chatbots are a set of technologies that may aid with these challenges. They may provide useful interactions for users, potentially reducing the health care worker burden while increasing user satisfaction. Research aims to understand these potential impacts of chatbots and conversational recommender systems and their associated design features.

OBJECTIVE

The objective of this study was to evaluate user perceptions of the helpfulness of an artificial intelligence chatbot that was offered free to the public in response to COVID-19. The chatbot engaged patients and provided educational information and the opportunity to report symptoms, understand personal risks, and receive referrals for care.

METHODS

A cross-sectional study design was used to analyze 82,222 chats collected from patients in South Carolina seeking services from the Prisma Health system. Chi-square tests and multinomial logistic regression analyses were conducted to assess the relationship between reported risk factors and perceived chat helpfulness using chats started between April 24, 2020, and April 21, 2022.

RESULTS

A total of 82,222 chat series were started with at least one question or response on record; 53,805 symptom checker questions with at least one COVID-19-related activity series were completed, with 5191 individuals clicking further to receive a virtual video visit and 2215 clicking further to make an appointment with a local physician. Patients who were aged >65 years (P<.001), reported comorbidities (P<.001), had been in contact with a person with COVID-19 in the last 14 days (P<.001), and responded to symptom checker questions that placed them at a higher risk of COVID-19 (P<.001) were 1.8 times more likely to report the chat as helpful than those who reported lower risk factors. Users who engaged with the chatbot to conduct a series of activities were more likely to find the chat helpful (P<.001), including seeking COVID-19 information (3.97-4.07 times), in-person appointments (2.46-1.99 times), telehealth appointments with a nearby provider (2.48-1.9 times), or vaccination (2.9-3.85 times) compared with those who did not perform any of these activities.

CONCLUSIONS

Chatbots that are designed to target high-risk user groups and provide relevant actionable items may be perceived as a helpful approach to early contact with the health system for assessing communicable disease symptoms and follow-up care options at home before virtual or in-person contact with health care providers. The results identified and validated significant design factors for conversational recommender systems, including triangulating a high-risk target user population and providing relevant actionable items for users to choose from as part of user engagement.

The Relationship Between Lockdowns and Video Game Playtime: Multilevel Time-Series Analysis Using Massive-Scale Data Telemetry

BACKGROUND

COVID-19 led governments worldwide to enact a variety of containment and closure policies. Substantial attention has been directed toward the idea that these public health measures may have unanticipated negative side effects. One proposed effect relates to video games. There is a nascent evidence base suggesting that individuals played video games for longer and in a more disordered manner during lockdowns and school closures specifically. These increases are commonly framed as a potential health concern in relation to disordered gaming. However, the evidence base regarding changes in gaming during the COVID-19 pandemic is based on self-report and, thus, is susceptible to bias. Therefore, it is unclear what the true consequences of lockdowns were for gaming behavior worldwide.

OBJECTIVE

The primary objective of this study was to estimate whether any specific lockdown policy led to meaningful increases in the amount of time individuals spent playing video games.

METHODS

Rather than relying on self-report, we used >251 billion hours of raw gameplay telemetry data from 184 separate countries to assess the behavioral correlates of COVID-19-related policy decisions. A multilevel model estimated the impact of varying enforcement levels of 8 containment and closure policies on the amount of time that individual users spent in-game. Similar models estimated the impact of policy on overall playtime and the number of users within a country.

RESULTS

No lockdown policy can explain substantial variance in playtime per gamer. School closures were uniquely associated with meaningful increases in total playtime within a country (r2=0.048). However, this was associated with increases in the number of unique individuals playing games (r2=0.057) rather than increases in playtime per gamer (r2<0.001).

CONCLUSIONS

Previous work using self-report data has suggested that important increases in heavy gaming may occur during pandemics because of containment and closure ("lockdown") procedures. This study contrasts with the previous evidence base and finds no evidence of such a relationship. It suggests that significant further work is needed before increases in disordered or heavy gaming are considered when planning public health policies for pandemic preparedness.

Single-session intervention on growth mindset on negative emotions for university student mental health (U-SIGMA): a protocol of two-armed randomized controlled trial

BACKGROUND

The university years are a developmentally crucial phase and a peak period for the onset of mental disorders. The beliefs about the changeability of negative emotion may play an important role in help-seeking. The brief digital growth mindset intervention is potentially scalable and acceptable to enhance adaptive coping and help-seeking for mental health needs in university students. We adapted the Single-session Intervention on Growth Mindset for adolescents (SIGMA) to be applied in university students (U-SIGMA). This protocol introduces a two-armed waitlist randomized controlled trial study to examine the effectiveness and acceptability of U-SIGMA in promoting help-seeking among university students in the Greater Bay Area.

METHODS

University students (N = 250, ages 18-25) from universities in the Greater Bay Area will be randomized to either the brief digital growth mindset intervention group or the waitlist control group. Participants will report on the mindsets of negative emotions, perceived control over anxiety, attitude toward help-seeking, physical activity, hopelessness, psychological well-being, depression, anxiety, and perceived stress at baseline and the 2-week and 8-week follow-ups through web-based surveys. A 30-min digital intervention will be implemented in the intervention group, with a pre- and post-intervention survey collecting intervention feedback, while the control group will receive the link for intervention after 8 weeks.

DISCUSSION

This protocol introduces the implementation plan of U-SIMGA in multi-cities of the Greater Bay Area. The findings are expected to help provide pioneer evidence for the effectiveness and acceptability of the brief digital intervention for university students in the Chinese context and beyond and contribute to the development of accessible and effective prevention and early intervention for university students' mental health.

TRIAL REGISTRATION

HKU Clinical Trials Registry: HKUCTR-3012; Registered 14 April 2023.  http://www.hkuctr.com/Study/Show/7a3ffbc0e03f4d1eac0525450fc5187e .

Unravelling the intricacies between gaming motivations and internet gaming disorder symptoms in adolescents: a network analysis of 2-year healthy and deteriorating transition profiles

BACKGROUND

The increasing prevalence of internet gaming disorder (IGD) among adolescents has become a global concern, while gaming plays a large role in many adolescents' lives. While prior research emphasised the significance of investigating IGD through an etiological lens, the interconnections between diverse gaming motivations and IGD symptoms in adolescents remain inadequately understood. This study explored the associations between distinct gaming motivations and IGD symptoms by conducting network analysis in adolescents.

METHODS

Data from a two-year longitudinal school-based survey (N = 2148) was utilized. LPA was used to offer a straightforward and interpretable solution for identifying adolescents with two-year healthy and deteriorating transitions of IGD profiles. Subsequently, we conducted a network analysis to explore and compare the associations between gaming motivations and IGD symptoms in adolescents with two-year healthy transition profiles and deteriorating transition profiles.

RESULTS

Three profiles were delineated: 'low IGD' (T1: n = 808, 37.62%; T2: n = 731; 34.03%), 'middle IGD' (T1: n = 1063, 49.49%; T2: n = 1103, 51.35%), and 'severe IGD' (T1: n = 277, 12.89%; T2: n = 314, 14.62%), classifying adolescents with healthy transitions and those with deteriorating transitions. Three gaming motivations (i.e., 'Daily entertainment', 'I am good at it', and 'Improvement of ability and mindset') were identified as protective motivations. Two others, 'Enjoy being in the gaming world' and 'Preoccupation', were identified as bridge nodes in adolescents with deteriorating transitions. Three core nodes (i.e., 'Sense of victory', 'Enjoy being in the gaming world', and 'Sense of achievement') were identified in both adolescents with healthy profile transitions and deteriorating transitions.

CONCLUSION

Findings suggest that not all gaming motivations contribute to the development of IGD in adolescents. Adolescents with deteriorating transitions showed specific gaming motivation and IGD symptom that is closely connected. Future interventions should consider corresponding gaming motivation when addressing IGD among adolescents.

Relations between Video Game Engagement and Social Development in Children: The Mediating Role of Executive Function and Age-Related Moderation

The global proliferation of video games, particularly among children, has led to growing concerns about the potential impact on children's social development. Executive function is a cognitive ability that plays a crucial role in children's social development, but a child's age constrains its development. To examine the association between video game engagement and children's social development while considering the mediating role of executive function and the moderating role of age, a questionnaire was distributed to a sample of 431 parents. The results revealed a negative relation between video game engagement and social development in children, with executive function found to mediate this relation fully. Additionally, the negative association between video game engagement and executive function became more pronounced as children grew older. In light of these findings, it is advisable to adopt proactive strategies to limit excessive video game use, consider the developmental characteristics of children at different ages, and prioritize the promotion of executive function to facilitate social development among children.

Self-harm among youth during the first 28 months of the COVID-19 pandemic in Ontario, Canada: a population-based study

BACKGROUND

Youth have reported worsening mental health during the COVID-19 pandemic. We sought to evaluate rates of pediatric acute care visits for self-harm during the pandemic according to age, sex and mental health service use.

METHODS

We conducted a population-based, repeated cross-sectional study using linked health administrative data sets to measure monthly rates of emergency department visits and hospital admissions for self-harm among youth aged 10-17 years between Jan. 1, 2017, and June 30, 2022, in Ontario, Canada. We modelled expected rates of acute care visits for self-harm after the pandemic onset based on prepandemic rates. We reported relative differences between observed and expected monthly rates overall and by age group (10-13 yr and 14-17 yr), sex and mental health service use (new and continuing).

RESULTS

In this population of about 1.3 million children and adolescents, rates of acute care visits for self-harm during the pandemic were higher than expected for emergency department visits (0.27/1000 population v. 0.21/1000 population; adjusted rate ratio [RR] 1.29, 95% confidence interval [CI] 1.19-1.39) and hospital admissions (0.74/10 000 population v. 0.43/10 000 population, adjusted RR 1.72, 95% CI 1.46-2.03). This increase was primarily observed among females. Rates of emergency department visits and hospital admissions for self-harm were higher than expected for both those aged 10-13 years and those aged 14-17 years, as well as for both those new to the mental health system and those already engaged in care.

INTERPRETATION

Rates of acute care visits for self-harm among children and adolescents were higher than expected during the first 2 and a half years of the COVID-19 pandemic, particularly among females. These findings support the need for accessible and intensive prevention efforts and mental health supports in this population.

Biopsychosocial factors of gaming disorder: a systematic review employing screening tools with well-defined psychometric properties

Background and aims

Considering the growing number of gamers worldwide and increasing public concerns regarding the negative consequences of problematic gaming, the aim of the present systematic review was to provide a comprehensive overview of gaming disorder (GD) by identifying empirical studies that investigate biological, psychological, and social factors of GD using screening tools with well-defined psychometric properties.

Materials and methods

A systematic literature search was conducted through PsycINFO, PubMed, RISS, and KISS, and papers published up to January 2022 were included. Studies were screened based on the GD diagnostic tool usage, and only five scales with well-established psychometric properties were included. A total of 93 studies were included in the synthesis, and the results were classified into three groups based on biological, psychological, and social factors.

Results

Biological factors (n = 8) included reward, self-concept, brain structure, and functional connectivity. Psychological factors (n = 67) included psychiatric symptoms, psychological health, emotion regulation, personality traits, and other dimensions. Social factors (n = 29) included family, social interaction, culture, school, and social support.

Discussion

When the excess amount of assessment tools with varying psychometric properties were controlled for, mixed results were observed with regards to impulsivity, social relations, and family-related factors, and some domains suffered from a lack of study results to confirm any relevant patterns.

Conclusion

More longitudinal and neurobiological studies, consensus on a diagnostic tool with well-defined psychometric properties, and an in-depth understanding of gaming-related factors should be established to settle the debate regarding psychometric weaknesses of the current diagnostic system and for GD to gain greater legitimacy in the field of behavioral addiction.

Psychosocial dysfunction of children and adolescents during the COVID-19 lockdown in Ecuador: a cross-sectional study

OBJECTIVE

Although the risk of morbidity and mortality of children and adolescents was lower during the COVID-19 pandemic, it appears that their mental health was strongly impacted. The goal of this study is to document psychological dysfunction among children and adolescents who underwent confinement due to COVID-19 in Ecuador.

DESIGN

A cross-sectional, internet-based questionnaire.

SETTING

Ecuador.

PARTICIPANTS

A total of 1077 caregivers of children and adolescents (4-16 years old).

OUTCOME MEASURES

Caregivers responded to Pediatric Symptom Checklist-35 to assess psychosocial dysfunction.

RESULTS

The prevalence of psychosocial dysfunction was 20.8%, with internalising symptoms being the most common (30.7%). The prevalence of psychosocial dysfunction was higher in children who had a poor family relationship during confinement (prevalence ratio (PR) 2.23; 95% CI 1.22 to 4.07), children who never helped with housework (PR 2.63; 95% CI 1.13 to 6.14) and those whose caregivers were worried about children's need for emotional therapy (PR 2.86; 95% CI 1.97 to 4.15). Never playing video games (PR 0.34; 95% CI 0.17 to 0.69) or playing video games infrequently (PR 0.39; 95% CI 0.20 to 0.79) was a protective factor for the psychosocial problems of children and adolescents.

CONCLUSION

Our study demonstrates that children and adolescents have experienced a deterioration of mental health due to the pandemic. Family factors played an important role in the mental health of children during the lockdown. When a public crisis occurs, supportive mental health policies should be developed and implemented to promote children's psychological welfare.

Internet addiction and mental health disorders in high school students in a Peruvian region: a cross-sectional study

OBJECTIVES

To determine the association between internet addiction disorder (IAD) and anxiety and depressive symptomatology in high school students in two private schools in Chiclayo, Peru, during the COVID-19 pandemic.

MATERIALS AND METHODS

Analytical cross-sectional investigation of 505 adolescents from two private schools. The dependent variables were anxiety and depressive symptomatology, measured with the Beck Adapted Depression Questionnaire (BDI-IIA) and the Beck Anxiety Inventory (BAI), respectively. The main independent variable was IAD, measured with the Internet Addiction Test instrument(IATI). Prevalence ratios (PR) and 95% confidence intervals (95%CI) were estimated.

RESULTS

The average age was 14.16 years and 54.9% were women. 22.2% and 3.2% presented mild and moderate IAD; respectively. 9.3% presented severe anxiety and 34.3% severe depressive symptomatology. In the simple regression, adolescents with mild, moderate and severe IAD presented 19% (PR = 1.19; 95%CI: 1.05-1.35), 25% (PR = 1.25; 95%CI: 1.02-1.53) and 53% (PR = 1.47; 95% CI: 1.47-1.60) higher prevalence of depressive symptomatology; however, this association was not maintained in the multiple model. Anxiety increased 196% in adolescents with severe IAD (PR = 2.96; 95%CI: 1.86-4.71).

CONCLUSION

 We found that 2, 1, and 3 out of 10 students presented IAD, depressive symptomatology, and anxiety, respectively. We did not find an association between IAD and depressive symptomatology, but we did find an association with anxiety. Among the factors associated with the development of depressive symptomatology were the male sex, the presence of eating disorders, subclinical insomnia, using devices for more than 2 h, and using the Internet for academic activities. About anxiety, the associated factors are the female sex, the presence of eating disorders, subclinical insomnia, and the use of the Internet as social interaction. We recommend implementing counseling programs in view of the imminent introduction of the Internet as a pillar in education.

Adolescent problematic gaming and its association with maternal behaviors: A dyadic study focusing on the relational-emotional correlates

INTRODUCTION

Associations between Problematic Gaming (PG) and the relational-emotional correlates of parenting have been reported in the literature. Previous research mostly collected information from adolescents, however, and suggested that little is known about the perceptions of parents and whether these are shared among parent-adolescent dyads. Therefore, this study aimed to (a) examine multiple informants' reports of adolescent PG and maternal behaviors (i.e., warmth and indifference) and (b) disentangle the associations between the behaviors shared by mothers and adolescents from those unique to each member.

METHOD

Data were collected by using self-administered online questionnaires from 137 Italian mother-adolescent dyads in Italy. The mean age of adolescents (n = 92 males, n = 42 females, n = 3 nonbinary) was 14.68 (±1.25) years and that of mothers 47.48 (±4.69) years. Descriptive statistics and common fate model (CFM) analyses were conducted.

RESULTS

Mothers reported higher scores of their offspring's PG. Within-reporter interclass correlations revealed positive associations between maternal indifference and adolescent PG for both informants. CFM indicated that correlations between maternal behaviors and adolescent PG based on shared perceptions did not reach statistical significance, whereas correlations based on unique mothers' perceptions were statistically significant for all the observed relationships.

CONCLUSIONS

In the context of adolescent PG, mothers may have a heightened motivation to perceive their parenting as crucial. The multi-informant approach allows a more accurate examination of the associations between adolescent PG and maternal behaviors and underscores the need to consider discordant assessment of the same phenomenon between mothers and adolescents.

Predicting preschool children's digital play addiction tendency during Covid-19 pandemic: Regarding the mother-child relationship, and child- and family-related factors

Previous research about children's digital play has predominantly focused on parental perspectives and parental mediation strategies. Although research on the effects of digital play on young children's development is plentiful, there is little evidence on young children's digital play addiction tendency. Herein, preschool children's digital play addiction tendency, and the mother-child relationship perceived by mothers, examining child- and family-related factors were explored. The present study also aimed to contribute to the current research pertaining to preschool-aged children's digital play addiction tendency through an examination of the mother-child relationship, and child- and family-related factors as potential predictors of children's digital play addiction tendency. A sample of 450 mothers of children between 4 and 6 years filled out two measures that identify the mother-child relationship and children's digital play addiction tendency. Correlational analyses revealed that in general, the mother-child relationship was significantly associated with children's digital play addiction tendency. Significant differences were evident in the relationship between numerous child- and family-related factors, and children's digital play addiction tendency, as well as the mother-child relationship. Hierarchical regression analyses indicated that a negative mother-child relationship, the children's digital play usage, and the mothers' digital device usage predicted the children's digital play addiction tendency.

Increased adolescent game usage and health-related risk behaviors during the COVID-19 pandemic

This study examines adolescent game usage and corresponding health-related risk behaviors during a period of limited social interaction and activity due to the COVID-19 pandemic. Participants included 225 middle- and 225 high-school students in Seoul who completed a survey online from October 1 to 30, 2021. The study measured participants' game usage level and the health-related risk behavior index. Findings showed that participants who engaged in excessive gaming showed higher levels of health-related risk behaviors. A multivariate analysis of variance was conducted to compare the health-related risk behaviors of students in the general, potential, and high-risk groups on excessive gaming. Results indicated that female students in the high-risk group showed higher stress levels and fatigue (f = 5.549, p < .01, Cohen's d = 0.016) than the males of the same group. However, male students showed higher physical inactivity levels (f = 3.195, p > .05, Cohen's d = 0.009) than females. The post hoc test indicated clear sex distinctions among the general, potential, and high-risk groups on excessive gaming (p < .001). Among the high-risk game usage group, female students displayed a higher level of risk behaviors than males. Adolescent gaming addiction should be considered an emotional and behavioral disorder for which parental guidance and support are needed, and counseling experts and professionals must come together to provide a cure and reform program.

Is internet gaming disorder associated with suicidal behaviors among the younger generation? Multiple logistic regressions on a large-scale purposive sampling survey

The ubiquity of Internet gaming as part of the younger generation's (11-35 year-olds) lifestyle to-day warrants a deeper understanding of its impact on their mental health. In particular, there has been scant research investigating the link between Internet Gaming Disorder (IGD) and suicidal behaviors in this demographic group, even though several mental health symptoms of the former are known risk factors for the latter. This paper aims to establish the presence or absence of association between IGD and each of suicidal ideation, self-harm, and suicide attempt among the younger generation. A large-scale online survey on Internet gamers in Hong Kong was conducted in February 2019. 3430 respondents were recruited through purposive sampling. Study samples were stratified into distinct age groups and multiple logistic regression was conducted for each measured suicidal behavior in each age group. After controlling for sociodemographics, Internet usage, self-reported bullying perpetration and bullying victimization, social withdrawal, and self-reported psychiatric diagnoses such as depression and psychosis, analyses revealed that adolescent (11-17 year-old) gamers with IGD were more likely than their peers who had no IGD to have had suicidal ideation, self-harm, and suicide attempt in their lifetime. These associations did not hold for 18-35 year-old gamers. Findings suggest that it may be prudent to recognize IGD as a growing public mental health priority for the young populace, particularly adolescents. Existing suicide prevention efforts can be complemented through screening adolescents for IGD, and could be expanded to online gaming platforms to reach more hidden at-risk individuals.

Internet Addiction and Online Gaming Disorder in Children and Adolescents During COVID-19 Pandemic: A Systematic Review

The Indonesian government has enforced several social restrictions to prevent the spread of the coronavirus disease-2019 (COVID-19) virus, such as closures of in-person schools, public areas, and playgrounds as well as reduced outdoor activities. These restrictions will affect mental health of school-age children and adolescents. The internet is chosen as one of the media to keep academic activities running, but excessive internet use will increase internet addiction and online gaming disorder. This study aimed to understand the prevalence and psychological impacts of internet addiction and online gaming disorder on children and adolescents globally during the pandemic. Systematic searches were carried out on the PubMed, ProQuest, and Google Scholar search engines. All studies were assessed according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses 2020 criteria and the Newcastle Ottawa Scale. Five studies met the criteria for assessing internet addiction and online gaming disorder cases in children and adolescents. Four studies discussed internet addiction, and one study addressed the negative impacts of online gaming on children and adolescents during the COVID-19 pandemic. There has been an increase in internet use and online gaming disruption in children and adolescents in almost all parts of Asian and Australian countries during the COVID-19 pandemic period.

Uncovering sample heterogeneity in gaming and social withdrawal behaviors in adolescent and young adult gamers in Hong Kong

OBJECTIVE

The current study aimed to examine the latent heterogeneity of gaming and social withdrawal behaviors in internet gamers and their associations with help-seeking behaviors.

METHOD

The present study recruited 3430 young people (1874 adolescents and 1556 young adults) in Hong Kong in 2019. The participants completed the Internet Gaming Disorder (IGD) Scale, Hikikomori Questionnaire, and measures on gaming characteristics, depression, help-seeking, and suicidality. Factor mixture analysis was used to classify the participants into latent classes based on their latent factors of IGD and hikikomori in separate age groups. Latent class regressions examined the associations between help-seeking and suicidality.

RESULTS

Both adolescents and young adults supported a 4-class, 2-factor model on gaming and social withdrawal behaviors. Over two-third of the sample were classified as healthy or low-risk gamers with low IGD factor means and low prevalence of hikikomori. Around one-fourth was moderate-risk gamers with elevated prevalence of hikikomori, higher IGD symptoms and psychological distress. A minority of the sample (3.8%-5.8%) belonged to high-risk gamers with the highest IGD symptoms and prevalence of hikikomori and heightened suicidal risks. Help-seeking in low-risk and moderate-risk gamers was positively associated with depressive symptoms and negatively associated with suicidal ideation. Perceived usefulness of help-seeking was significantly linked with lower likelihoods of suicidal ideation in the moderate-risk gamers and suicide attempt in the high-risk gamers.

CONCLUSIONS

The present findings explicate the latent heterogeneity of gaming and social withdrawal behaviors and associated factors on help-seeking and suicidality among internet gamers in Hong Kong.

A Longitudinal Network Analysis of the Interactions of Risk and Protective Factors for Suicidal Potential in Early Adolescents

Few studies have applied the "ideation-to-action" theories and the buffering hypothesis of resilience to suicide in early adolescents, and existing research is primarily cross-sectional. This study examined the interactions between risk factors (i.e., thwarted belongingness, perceived burdensomeness, and hopelessness), protective factors (i.e., resilience, self-efficacy, and subjective happiness), and suicidal potential (i.e., family distress, anxious-impulsive depression, and suicidal ideation or acts) in early adolescents. The participants (N = 1615; 55.6% females; M age = 10.93, SD age = 1.14, range: 9-15) who were recruited from four primary and four secondary schools in Hong Kong completed the survey in 2020 and 2021. The contemporaneous networks suggested that perceived burdensomeness and hopelessness were positively associated with suicidal potential. Protective factors were negatively associated with risk factors studied and suicidal potential. The node with the greatest centrality strength was anxious-impulsive depression. The nodes most likely to connect with other constructs were self-efficacy and hopelessness. A temporal network suggested the predictive effect of hopelessness and the protective effect of subjective happiness on future suicidal ideation or acts. Moreover, self-efficacy was found to buffer the impact of hopelessness on future suicidal ideation or acts. These findings highlighted the contribution of hopelessness to suicidal potential among early adolescents and the buffering effects of subjective happiness and self-efficacy.

Loneliness and Well-Being in Children and Adolescents during the COVID-19 Pandemic: A Systematic Review

Concerns have been raised about the loneliness and well-being of children and adolescents during the COVID-19 pandemic. The extent to which the ongoing pandemic has impacted loneliness and the association between loneliness and well-being is unclear. Therefore, a systematic review of empirical studies on the COVID-19 pandemic was conducted to examine the (1) prevalence of loneliness in children and adolescents, (2) associations between loneliness and indicators of well-being, and (3) moderators of these associations. Five databases (MEDLINE, Embase, PsycInfo, Web of Science, ERIC) were searched from 1 January 2020 to 28 June 2022 and 41 studies met our inclusion criteria (cross-sectional: n = 30; longitudinal: n = 11; registered on PROSPERO: CRD42022337252). Cross-sectional prevalence rates of pandemic loneliness varied, with some finding that over half of children and adolescents experienced at least moderate levels of loneliness. Longitudinal results reflected significant mean increases in loneliness compared to pre-pandemic levels. Cross-sectional results indicated that higher levels of loneliness were significantly associated with poorer well-being, including higher depression symptoms, anxiety symptoms, gaming addiction, and sleep problems. Longitudinal associations between loneliness and well-being were more complex than cross-sectional associations, varying by assessment timing and factors in the statistical analyses. There was limited diversity in study designs and samples, preventing a thorough examination of moderating characteristics. Findings highlight a broader challenge with child and adolescent well-being that predates the pandemic and the need for future research to examine underrepresented populations across multiple timepoints.

Gaming Disorder Scale for Parents: Reliability and Validity Study of the Turkish Form

OBJECTIVE

This study aimed to conduct the validity and reliability study of the Turkish version of the Gaming Disorder Scale for Parents (GADIS-P).

METHODS

In this methodological study, the study sample consisted of 345 parents who had children within the age range of 10-17 years who played digital games. The study data were collected through the Gaming Disorder Scale for Parents, the Scale for Determining Parents' Perceptions of Computer Game Addiction, and the Digital Parenting Attitude Scale. The Cronbach's alpha analysis for reliability, item total correlation analysis, confirmatory and exploratory factor analysis for construct validity, and clustering analysis for identifying gaming disorder according to the scale scores were used.

RESULTS

It was determined that the content validity index of the scale was 0.97, that item loads varied between 0.617 and 0.863 according to exploratory factor analysis, and that the scale had good fit indices in the confirmatory factor analysis. The Cronbach's reliability coefficient of the scale was found to be α=0.907, and the item total correlations were determined to be adequate. The criterion validity analysis found a positive and strong correlation with the Scale for Identifying Parents' Perceptions Regarding Digital Game Addiction (r=0.717 p0.001). As a result of the clustering analysis, it was determined that the cut-off value was found as >9 points for "Cognitive Behavioral Symptoms" subscale and as >6 points for "Negative Consequences" subscale.

CONCLUSION

The results obtained show that the Turkish version of the Gaming Disorder Scale for Parents is a valid and reliable measurement tool.

Impact of increased digital use and internet gaming on nursing students' empathy: A cross-sectional study

BACKGROUND

The COVID-19 restrictions and quarantines had led to increased dependence and usage of digital devices for various human activities and internet gaming to the extent of risking vulnerable individuals to develop addiction towards it. Little is known on such risks among populations of nursing students and its impact on their empathy skills or trait.

OBJECTIVE

Determining the impact of digital use and internet gaming on empathy of nursing students undergoing remote learning during closure of learning institutions nationwide.

DESIGN

Cross-sectional online survey was conducted from October to December 2020.

SETTINGS

Two established public institutions located in Malaysia.

PARTICIPANTS

A total of 345 nursing students pursuing diploma and bachelor nursing programs.

METHODS

Toronto Empathy Questionnaire (TEQ), Digital Addiction Scale (DAS) and Internet Gaming Disorder Scale-Short form (IGDS9-SF) were self-administered via Google Form™. Following principal component analysis of TEQ using IBM-SPSS™ (V-27), path analyses was performed using SmartPLS™ (V-3).

RESULTS

Despite the increased time spent on digital devices (∆ 2.8 h/day) and internet gaming (∆ 1 h/week) before and during the pandemic, the proportion of high digital users (1.4 %) and gamers (20.9 %) were low; and sizable ≈75 % had higher-than-normal empathy. Digital-related emotions and overuse of them were associated with lower empathy (β = -0.111, -0.192; p values < 0.05) and higher callousness (β = 0.181, 0.131; p values < 0.05); internet gaming addiction predicted callousness (β = 0.265, p < 0.001) but digital dependence correlated with higher empathy (β = 0.172, p = 0.009).

CONCLUSIONS

Digital and internet gaming addiction potentially impact empathy. The negative impact of digital dependence can be attenuated by "digital empathy" - an emerging phenomenon becoming increasingly vital in digital health and communication.

Social networking use, mental health, and quality of life of Hong Kong adolescents during the COVID-19 pandemic

Background

During the COVID-19 pandemic, adolescents' use of social networking sites/apps has surged, and their mental health and quality of life have also been significantly affected by the pandemic and its associated social-protection measures. The present study first examined the prevalence of social networking sites/apps use and social networking addiction, the mental health status, and the health-related quality of life among Hong Kong adolescent students. We further investigated the associations of the youths' daily use of social networking sites/apps and their social networking addiction with their mental health and quality of life during the pandemic.

Methods

A total of 1,147 students (age = 15.20 ± 0.53 years) recruited from 12 randomly selected local secondary schools in Hong Kong participated in a questionnaire survey in classroom settings between January and June, 2020, right after the COVID-19 outbreak. The questionnaire includes demographic characteristics and scales that measure social networking sites/apps use and social networking addiction, mental health, and quality of life.

Results

Approximately 46.4% of the participants reported using social networking sites/apps often or very often, and 7.8% met the criteria for social networking addiction using Bergen's Social Media Addiction Scale. The prevalence of mild to extremely severe depression, anxiety, and stress among the adolescents stood at 39.6, 37.5, 48.8%, respectively, and the participants' physical, social, and school functioning were lower than the norms of healthy adolescents before the pandemic. Participants who used social networking sites/apps but for <3 h per day (excluding students who never used social networking sites/apps) showed significantly fewer problems of depression, anxiety, and stress than did those who spent more than 3 h per day on social networking sites/apps. Social networking addiction was found to be consistently associated with poor mental health and health-related quality of life.

Conclusion

This study provides important evidence supporting the potential protective effect of guiding adolescents to use social networking sites/apps appropriately in order to mitigate their negative emotions during contexts such as that of the pandemic; it further points to the need to provide extra support to promote the well-being of young people, especially those in disadvantaged situations (e.g., non-intact family) during and after the pandemic.

Loot boxes use, video gaming, and gambling in adolescents: Results from a path analysis before and during COVID-19-pandemic-related lockdown in Italy

Loot Boxes (LBs), i.e., virtual items embedded within video games with numerous features reminiscent of gambling, are increasingly widespread among adolescents. LB use is associated with problem gambling in youth, but few studies have been conducted on the association between LB use and gambling behavior considering adolescents. Thus, the mechanisms underlying this relationship are not clear. As LB use is a significant and positive risk factor for video gaming severity, and video gaming is associated with problem gambling, we hypothesized that LB use would be related to gambling frequency and problem gambling through the intermediary role of video gaming frequency and problem video gaming. We tested our hypothesis before COVID-19-pandemic-related lockdown and during COVID-19-pandemic-related lockdown, in Italy. Study 1 was conducted with 1,078 high school students (39% boys, mean age = 16.46, SD = 1.28) before COVID-19-pandemic-related lockdown, and Study 2 was conducted with 1,204 high school students (57% boys, mean age = 15.62, SD = 0.64) during COVID-19-pandemic-related lockdown. A path analysis was carried out to analyze the significance of indirect effects from LB use to gambling behavior and problem gambling through video gaming and problem video gaming. In both the studies, results showed that LB use exerted significant and positive direct effects on video gaming frequency, problem video gaming, and gambling frequency. Moreover, LB use had indirect significant and positive effects on problem gambling through video gaming frequency, problem video gaming, and gambling frequency. Findings attest that LB use can be related to problem gambling through a greater involvement in videogames. Thus, a specific subtype of young gamblers can develop Gambling Disorder symptoms from the use of LBs and through an intense use of video games. Practical implications for prevention and treatment are discussed.

Screening, Brief Intervention, and Referral to Treatment Model Based on ICD-11 Criteria of Gaming Disorder and Hazardous Gaming During the COVID-19 Pandemic

Purpose of Review

This commentary aimed to propose the screening, brief intervention, and referral to treatment (SBIRT) model for gaming disorder (GD) and hazardous gaming (HG) on the basis of the International Classification of Disease, 11th version (ICD-11) classification.

Recent Findings

COVID-19 and its preventive measures increase the risk of GD and the treatment needs could exceed the capacities of mental health systems. Brief intervention could be provided for adolescents with HG after screening. Psychiatrists make diagnoses of GD or HG and then refer them to school counselors, specialized psychologists, or integrated teams based on the severity, comorbidity, and complication of GD.

Summary

The classification of GD and HG was suitable to develop a SBIRT model intervention. The SBIRT should work through the shortage of resources and provide a brief intervention guild to make it practical.

Supporting adolescents' mental health during COVID-19 by utilising lessons from the aftermath of the Great East Japan Earthquake

Historical data can determine how adolescents recover from difficult situations such as the Coronavirus disease 2019 (COVID-19) pandemic. This study analysed 3 years of data obtained from high-school students who had been affected by the 2011 Great East Japan Earthquake and consequently evidenced the importance of increasing resilience among affected adolescents. This involved identifying factors contributing to resilience through a model that assessed for each tsunami disaster. This model was determined by assessing the correlation between survivors' resilience scores and their measured psychological and lifestyle scores. This approach showed that, in all tsunami damage models, resilience was most affected by the depressed emotions. Thus, our approach suggests that interventions for improving the depressed mood may improve resilience in adolescents during the COVID-19 pandemic.

Estimation of Behavioral Addiction Prevalence During COVID-19 Pandemic: A Systematic Review and Meta-analysis

Purpose of Review

The COVID-19 pandemic changed people’s lifestyles and such changed lifestyles included the potential of increasing addictive behaviors. The present systematic review and meta-analysis aimed to estimate the prevalence of different behavioral addictions (i.e., internet addiction, smartphone addiction, gaming addiction, social media addiction, food addiction, exercise addiction, gambling addiction, and shopping addiction) both overall and separately.

Recent Findings

Four databases (PubMed, Scopus, ISI Web of Knowledge, and ProQuest) were searched. Peer-reviewed papers published in English between December 2019 and July 2022 were reviewed and analyzed. Search terms were selected using PECO-S criteria: population (no limitation in participants’ characteristics), exposure (COVID-19 pandemic), comparison (healthy populations), outcome (frequency or prevalence of behavioral addiction), and study design (observational study). A total of 94 studies with 237,657 participants from 40 different countries (mean age 25.02 years; 57.41% females). The overall prevalence of behavioral addiction irrespective of addiction type (after correcting for publication bias) was 11.1% (95% CI: 5.4 to 16.8%). The prevalence rates for each separate behavioral addiction (after correcting for publication bias) were 10.6% for internet addiction, 30.7% for smartphone addiction, 5.3% for gaming addiction, 15.1% for social media addiction, 21% for food addiction, 9.4% for sex addiction, 7% for exercise addiction, 7.2% for gambling addiction, and 7.2% for shopping addiction. In the lockdown periods, prevalence of food addiction, gaming addiction, and social media addiction was higher compared to non-lockdown periods. Smartphone and social media addiction was associated with methodological quality of studies (i.e., the higher the risk of boas, the higher the prevalence rate). Other associated factors of social media addiction were the percentage of female participants, mean age of participants, percentage of individuals using the internet in country, and developing status of country. The percentage of individuals in the population using the internet was associated with all the prevalence of behavioral addiction overall and the prevalence of sex addiction and gambling addiction. Gaming addiction prevalence was associated with data collection method (online vs. other methods) that is gaming addiction prevalence was much lower using online methods to collect the data.

Summary

Behavioral addictions appeared to be potential health issues during the COVID-19 pandemic. Healthcare providers and government authorities should foster some campaigns that assist people in coping with stress during COVID-19 pandemics to prevent them from developing behavioral addictions during COVID-19 and subsequent pandemics.

Supplementary Information

The online version contains supplementary material available at 10.1007/s40429-022-00435-6.

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

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

Risks of Digital Screen Time and Recommendations for Mitigating Adverse Outcomes in Children and Adolescents

BACKGROUND

The COVID-19 pandemic caused an unprecedented move to emergency remote learning around the world, leading to increased digital screen time for children and adolescents. This review highlights the potential risk of increased screen time to the eye and general health and makes recommendations to mitigate the risks posed.

METHODS

A narrative review of evidence of increased digital time during the COVID-19 pandemic, the risks linked to increased screen time and offer possible steps to mitigate these in students.

RESULTS

Digital screen time was found to have increased for children and adolescents in all the studies examined during the pandemic and data suggests that this has an impact on eye and general health. We discuss the associated risk factors and adverse outcomes associated with increased digital screen time.

CONCLUSIONS

This review offers evidence of increased digital time, highlights some of the well-known and not so well-known risks linked to increased screen time, and offers possible steps to mitigate these in children and adolescents during the pandemic, as well as offering schools and parents strategies to support the eye health of children and adolescents post-pandemic. We discuss a number of interventions to reduce the risk of eye strain, myopia, obesity, and related diseases that have been shown to be linked to increased digital screen time.

COVID in Pediatric Age: an opinion paper

The incidence of COVID in pediatrics was underestimated during the first months of the pandemic due to the oligosymptomatic nature of the infection in many children and the scarcity of diagnostic tests applied to this population. It is now accepted that children are infected and transmit the disease in the same way as adults. On the contrary, children have less severe and less lethal COVID, probably due to a lower maturity of the child's immune system, a lower number of ACE2 receptors and the lower presence of comorbidities in this population group. The development of a multisystemic inflammatory syndrome after SARS-CoV-2 infection in children, despite its rarity, is a very serious condition that frequently requires intensive care. Other less severe post-COVID manifestations have been described in children but are not yet well defined. COVID has had and continues to have a significant psychological impact on the children themselves, on their caregivers and on the exacerbation of pre-existing psychiatric conditions. We apply adult therapeutic principles to children but with very low levels of evidence. Information on the tolerability of the available medications in this population group is still scarce. The mortality of COVID in children is very low and generally affects children with significant comorbidities. There are, at present, three vaccines licensed for pediatric use which are compatible with all other vaccines applicable to children. In these circumstances, there has been much speculation about the indication for vaccination in the pediatric age group, but given its good tolerance, there are clinical and ethical reasons that, in our opinion, justify it.

[Psychological and behavioral problems in children and adolescents during the coronavirus disease 2019 epidemic: a Scoping review]

OBJECTIVES

To investigate the psychological and behavioral problems and related influencing factors in children and adolescents during the coronavirus disease 2019 (COVID-19) epidemic.

METHODS

China National Knowledge Infrastructure, Wanfang Data, PubMed, and Web of Science were searched using the method of subject search for articles published up to March 31, 2022, and related data were extracted for Scoping review.

RESULTS

A total of 3 951 articles were retrieved, and 35 articles from 12 countries were finally included. Most of the articles were from the journals related to pediatrics, psychiatry, psychology, and epidemiology, and cross-sectional survey was the most commonly used research method. Psychological and behavioral problems in children and adolescents mainly included depression/anxiety/stress, sleep disorder, internet behavior problems, traumatic stress disorder, and self-injury/suicide. Influencing factors were analyzed from the three aspects of socio-demographic characteristics, changes in living habits, and ways of coping with COVID-19.

CONCLUSIONS

During the COVID-19 epidemic, the psychological and behavioral problems of children and adolescents in China and overseas are severe. In the future, further investigation and research can be carried out based on relevant influencing factors to improve the psychological and behavioral problems.

Evaluating the daily life of child and adolescent psychiatric outpatients during temporary school closure over COVID-19 pandemic: A single-center case-control study in Japan

This study evaluated the clinical characteristics of mental health of child and adolescent psychiatric patients during temporary school closure throughout the coronavirus 2019 (COVID-19) pandemic in Japan using the Questionnaire - Children with Difficulties (QCD) and other useful psychological rating scales. The participants were those who visited the Department of Child and Adolescent Psychiatry, Kohnodai Hospital. From those 1,463 participants, case and control groups were selected: 92 patients who visited the hospital during the temporary school closure from March 2020 to May 2020 (case group) and randomly sampled sex- and age-matched 92 patients during the pre-COVID period from April 2017 to March 2020 (control group). QCD is a parent-assessed questionnaire designed to evaluate the difficulties of children along the course of a day, right from waking up in the morning to retiring to bed at night. Lower scores indicate stronger difficulties. QCD scores were compared between the two groups in each of the following age groups: elementary school (6-12 years of age) and junior high school (12-15 years of age). In elementary school students, scores "during school" of QCD indicating functioning or disabilities during school hours were 3.31 ± 2.52 and 4.52 ± 2.33 in case group and control group, respectively (p < 0.05). In junior high school students, scores "Attention-Deficit Hyperactivity Disorder Rating Scale (ADHD-RS)" indicating ADHD symptoms were 16.78 ± 12.69 and 11.80 ± 10.40 in case group and control group, respectively (p < 0.05). The findings suggest that the closure of schools due to the pandemic might worsen difficulties among elementary school patients, and hyperactivity and impulsivity might increase among junior high school patients. The long-term impact of stress caused by school closure on child and adolescent psychiatric patients needs to be investigated in the future.

The Effects of Playing Video Games on Stress, Anxiety, Depression, Loneliness, and Gaming Disorder During the Early Stages of the COVID-19 Pandemic: PRISMA Systematic Review

During the initial phases of the COVID-19 pandemic, playing video games has been much more than just a pastime. Studies suggested that video games for many individuals have helped to cope with such difficult life experience. However, other research indicates that gaming may have had harmful effects. Within this context, this systematic review aimed to describe the literature on the effects of video games during the early stages of the COVID-19 crisis on stress, anxiety, depression, loneliness, and gaming disorder (GD), examining the study characteristics and outcomes. A systematic search of the literature was made following the Preferred Reporting Items for Systematic Reviews and Meta-Analysis guidelines. It was preregistered in the International Platform of Registered Systematic Review and Meta-Analysis Protocols (INPLASY)-INPLASY202180053. The search databases were PsycINFO, Web of Science, and Medline. The search string was: [("video game*") OR ("computer game*") OR ("gaming")] AND [("COVID-19")]. Twenty-four studies met the inclusion criteria. Four research explored the effects of playing video games during the COVID-19 pandemic on stress, anxiety, and depression. Four studies investigated loneliness, while 18 research investigated game disorder. Video games, especially augmented reality and online multiplayer ones, mitigated stress, anxiety, depression, and loneliness among adolescents and young adults during stay-at-home restrictions. However, in the case of at-risk individuals (i.e., particularly male youths), playing video games had detrimental effects.

Structural Equation Modeling (SEM): Gaming Disorder Leading Untreated Attention-Deficit/Hyperactivity Disorder to Disruptive Mood Dysregulation

(1) Background: Internet gaming disorder (IGD) in youths likely leads to disruptive mood dysregulation, especially among those with attention-deficit/hyperactivity disorder (ADHD). Whether IGD mediates the pathways leading ADHD to disruptive emotional dysfunction remains unclear. This study aims to elucidate the direct or indirect influence of IGD on ADHD; (2) Method: The Swanson, Nolan, and Pelham Version IV questionnaire was used to evaluate symptoms of ADHD and oppositional defiant disorder, and the Chen gaming disorder scale was used to measure IGD. A psychiatrist diagnosed ADHD, IGD, and disruptive mood dysregulation disorder (DMDD)-like symptoms. Structural equation modeling was applied to evaluate the role of IGD in mediating ADHD progression to disruptive mood dysregulation; (3) Results: Among a total of 102 ADHD youths, 53 (52%) of them with IGD were significantly more likely to have poor interpersonal relationships (p < 0.01) and DMDD-like symptoms (p < 0.01) than ADHD youths without IGD. IGD played a mediating role in increasing the risk of disruptive mood dysregulation in ADHD youths; (4) Conclusions: The findings suggest that IGD mediates ADHD’s progression to disruptive mood dysregulation. Intensive biopsychosocial interventions are warranted for ADHD youths with IGD. More children and adolescents became mood-dysregulated after excessive gaming during the COVID-19 pandemic; this study’s results suggest that child mental health experts develop earlier detection and prevention strategies for children and adolescents hidden behind internet addiction.

Parental Depression and Leisure Activity Engagement on Children's Gaming Disorder: A Dyadic Study

Nowadays, playing both online and offline video games is a popular leisure activity among youngsters, but excessive gaming activity engagement may lead to gaming disorder that disrupts daily functioning. Identifying risk and protective factors of this emerging problem is thus essential for devising prevention and intervention strategies. This mixed-method, cross-sectional study aimed to examine the roles of parental depressive symptoms and children’s leisure activity engagement on children’s gaming disorder symptoms. Furthermore, the moderating roles of risky and protective leisure activity engagement were investigated. The sample comprised 104 parent-child dyads recruited from a population-based survey (parents: M_age = 45.59 years, SD = 6.70; children: M_age = 11.26 years; SD = 4.12). As predicted, parental depressive symptoms and children’s gaming activity engagement were positively associated with children’s gaming disorder symptoms, whereas children’s literacy activity engagement was negatively associated with these symptoms. Moreover, engagement in these two types of leisure activity moderated the association between parental depressive symptoms and children’s gaming disorder symptoms in distinct manners, further indicating literacy activities as beneficial and gaming activities as risk-enhancing. These new findings imply that parental depressive symptoms and children’s leisure activity engagement should be considered when designing parent-based programs for gaming disorder prevention and intervention.

Novel approaches for treating Internet Gaming Disorder: A review of technology-based interventions

Internet Gaming Disorder (IGD) has become a significant issue in mental healthcare over the past decades as the number of people engaging in excessive and unhealthy gaming increases with each year. Despite its inclusion in the 5th Edition of Diagnostic Statistical Manual and the development of a number of treatment methods that have been designed and tested for IGD, treatment remains a challenge. This review attempts to give an overview of the current state of IGD and its treatment with a specific focus on the potential of technology-based solutions, such as web-based programs, mobile applications, and virtual reality. The review also highlights the need for additional work in the area of treatment development for IGD and the preliminary evidence for the usefulness and importance of technology-based treatment methods which offer unique advantages, such as accessibility, scalability, and cost-effectiveness, over other existing treatment options.

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.

Animal Crossing and COVID-19: A Qualitative Study Examining How Video Games Satisfy Basic Psychological Needs During the Pandemic

The COVID-19 pandemic has affected the way many people live their lives. The increasing amount of time spent indoors and isolated during periods of lockdown has been accompanied by an increase in the time people spend playing video games. One such game which soared in popularity during the early stages of the pandemic was Animal Crossing: New Horizons. Through semi-structured interviews with players, and using a theory-informed qualitative analysis, we document and examine players’ motivations and experiences playing Animal Crossing: New Horizons during the pandemic. Findings suggest that playing the game helped satisfy various psychological needs—autonomy, relatedness, and competence—as described by Self-Determination Theory. Conversely, players stopped playing the game when they found that their psychological needs were thwarted or better met through other activities. Our findings offer support that video games can offer psychological relief in stressful contexts by providing opportunities for people to satisfy key psychological needs. Theoretical and practical implications are discussed.

The Nine-Item Internet Gaming Disorder Scale (IGDS9-SF): Its Psychometric Properties among Sri Lankan Students and Measurement Invariance across Sri Lanka, Turkey, Australia, and the USA

The prevalence of internet gaming disorders (IGD) is considerably high among youth, especially with the social isolation imposed by the ongoing COVID-19 pandemic. IGD adversely affects mental health, quality of life, and academic performance. The Internet Gaming Disorder Scale (IGDS9-SF) is designed to detect IGD according to DSM-IV diagnostic criteria. However, inconsistent results are reported on its capacity to diagnose IGD evenly across different cultures. To ensure the suitability of the IGDS9-SF as a global measure of IGD, this study examined the psychometric properties of the IGDS9-SF in a sample of Sri Lankan university students (N = 322, mean age = 17.2 ± 0.6, range = 16-18 years, 56.5% males) and evaluated its measurement invariance across samples from Sri Lanka, Turkey, Australia, and the USA. Among Sri Lankan students, a unidimensional structure expressed good fit, invariance across different groups (e.g., gender, ethnicity, and income), adequate criterion validity (strong correlation with motives of internet gaming, daily gaming duration, and sleep quality), and good reliability (alpha = 0.81). Males and online multiplayers expressed higher IGD levels, greater time spent gaming, and more endorsement of gaming motives (e.g., Social and Coping) than females and offline players. Across countries, the IGDS9-SF was invariant at the configural, metric, and scalar levels, although strict invariance was not maintained. The lowest and highest IGD levels were reported among Turkish and American respondents, respectively. In conclusion, the IGDS9-SF can be reliably used to measure IGD among Sri Lankan youth. Because the scale holds scalar invariance across countries, its scores can be used to compare IGD levels in the studied countries.

The Comparative Efficacy of Treatments for Children and Young Adults with Internet Addiction/Internet Gaming Disorder: An Updated Meta-Analysis

Internet gaming disorder (IGD) is a formal mental disorder leading to bad outcomes for children and adolescents. This study comprehensively compared the estimated effect of various pharmacotherapy and psychosocial interventions for IGD from randomized controlled trials (RCT) through updated meta-analysis, using meta-regression. A search of PubMed/MEDLINE, Cochrane Library, and Airiti Library between 2000 and 2017 was conducted for various IA/IGD intervention modalities. A total of 124 studies from 29 selected papers involving 5601 children and young adults with IA/IGD were found. Meta-analyzing the pooled standardized mean difference (SMD) revealed a preliminary random effect of 1.399 with a 95% confidence interval of 1.272–1.527, suggesting highly effective treatment of IA/IGD. After adjusting for the confounding risks of age, publication year, type of subjects, and type of study, this study revealed that combining pharmacotherapy with cognitive behavioral therapy (CBT) or multi-level counseling (MLC) was the most effective treatment option. Using a scale of time spent online or a severity of IA symptoms scale was a more effective measurement, with p-values = 0.006 and 0.002, respectively. IA/IGD patients with comorbid depression showed worse outcomes than youth with another comorbidity. The corresponding model goodness-of-fit indices were τ² = 1.188; I²-Residual = 89.74%; and Adjusted-R² = 16.10%. This systematic review indicates that pharmacotherapy combined with CBT or MLC might be an effective therapeutic strategy for youth with gaming disorder.

A systematic review of the impact of COVID-19 on the game addiction of children and adolescents

BACKGROUND

During the COVID-19 pandemic, it is reported that children and adolescents who are socially isolated experience high levels of stress and various mental health problems. At present, little research has been done to collect previous studies that focused on game addiction in children and adolescents during the COVID-19 pandemic. In this research, we aimed to investigate the prevalence of gaming disorder during COVID-19 in children and adolescents and the various factors experienced by children and adolescents that affected gaming disorder.

METHODS

We searched PubMed, Embase, PsycINFO, and Cochrane on 5 May 2021 to identify relevant literature. We extracted the prevalence estimates of game addiction from the studies to measure the global prevalence of game addiction. Then, we found the answers to the questions raised and synthesized them into several themes.

RESULTS

We identified 2,609 articles. Among them, studies that were not related to the topic, duplicated, and that did not meet the selection criteria were excluded, and 18 studies were selected. We rated most of the studies as moderate, and a few were low, and high. A majority of studies found an increase in game usage time and game addiction score during the COVID-19 pandemic. Some children and adolescents in emotional pain play games to communicate with their peers. Regarding parenting, violent parenting and the absence of parental supervision increase levels of game addiction in children. Gaming disorder was caused by the impact of COVID-19 in a vulnerable group with predisposing factors such as depression, anxiety, and attention-deficit/hyperactivity disorder. Adolescents and males scored higher on a game addiction scale, although we could not find any quantitative correlations due to the heterogeneous scales used for gaming addiction.

CONCLUSIONS

During the COVID-19 pandemic, isolated children and adolescents reported increased gaming hours as a result of coping with their psychological pain and avoiding social isolation. Their parents, who should provide proper supervision, also failed to provide appropriate support due to the stress caused by the pandemic. Mental health providers should educate children, adolescents, and their guardians on alternative ways to relieve stress and help parents effectively control their children's usage of games.