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Razum J, Baumgartner B, Glavak-Tkalić R. Psychometric validity and the appropriateness of tolerance as a criterion for internet gaming disorder: A systematic review. Clin Psychol Rev 2023; 101:102256. [PMID: 36878146 DOI: 10.1016/j.cpr.2023.102256] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2022] [Revised: 12/16/2022] [Accepted: 02/16/2023] [Indexed: 02/26/2023]
Abstract
Tolerance is a controversial but still an omnipresent criterion in measuring problematic gaming and Internet Gaming Disorder (IGD). Despite criticisms, a systematic review of its suitability has not been conducted until now. The aim of this study was to assess the evidence of psychometric validity and the appropriateness of tolerance as a criterion for IGD. A total of 61 articles were included in the review, 47 quantitative, 7 qualitative studies,plus 7 studies that introduce potential item wordings for operationalizing tolerance. Results showed that the tolerance item tends to have acceptable to high factor loadings on the single IGD factor. While tolerance sometimes did not adequately differentiate the engaged gamers from those with a probable disorder, it was endorsed at medium to high levels of IGD severity and had a good performance in the interviews. It, however, showed weak relations with distress and well-being. In qualitative studies, tolerance as currently defined by DSM-5 and measured by questionnaires (i.e., increasing amounts of time spent on gaming) was almost unequivocally rejected by gamers. The solid performance of tolerance in psychometric studies was probably due to deficiencies of the IGD construct, which also contains other disputed criteria. Tolerance lacks relevance in measuring IGD and care should be taken when using and interpreting IGD measures with this criterion.
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Affiliation(s)
- Josip Razum
- Ivo Pilar Institute of Social Sciences, Marulićev trg 19/1, 10000 Zagreb, Croatia
| | - Benedict Baumgartner
- Klinik und Poliklinik für Psychiatrie und Psychotherapie, Technische Universität, Ismaningerstr. 22, 81675, München, Germany
| | - Renata Glavak-Tkalić
- Ivo Pilar Institute of Social Sciences, Marulićev trg 19/1, 10000 Zagreb, Croatia.
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Finserås TR, Sivertsen B, Pallesen S, Leino T, Mentzoni RA, Skogen JC. Different Typologies of Gamers Are Associated with Mental Health: Are Students DOOMed? INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:15058. [PMID: 36429777 PMCID: PMC9690902 DOI: 10.3390/ijerph192215058] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 10/18/2022] [Revised: 11/11/2022] [Accepted: 11/12/2022] [Indexed: 06/16/2023]
Abstract
(1) Background: The inclusion of Internet Gaming Disorder in the Diagnostic and Statistical Manual for Mental Disorders (DSM-5) led to a rapid development of assessment instruments based on the suggested diagnosis. However, previous studies suggest that some of the symptoms in the diagnosis reflect engagement in gaming rather than a disorder or addiction. The aim of the present cross-sectional study was to investigate mental health associations with different typologies of gamers. (2) Methods: Data stemmed from a large national survey of students (SHoT2022) that was conducted between February and April 2022 (N = 59,544). Participants were categorized into non-gamers, recreational gamers, engaged gamers, problematic gamers, and addicted gamers. Logistic regression models adjusted for age were analyzed with and without gender-stratification for mental distress and life satisfaction as dependent variables across gaming categories. (3) Results: The proportion reporting case-level mental distress was lower for recreational gamers compared to non-gamers, indicating fewer mental health problems for recreational gamers. However, after stratifying the analysis by gender, female recreational gamers had higher levels of mental distress compared to female non-gamers, reflecting Simpson's paradox. (4) Conclusions: Future studies investigating mental health and gaming should include a gender perspective.
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Affiliation(s)
- Turi Reiten Finserås
- Department of Health Promotion, Norwegian Institute of Public Health, 5015 Bergen, Norway
| | - Børge Sivertsen
- Department of Health Promotion, Norwegian Institute of Public Health, 5015 Bergen, Norway
- Department of Research and Innovation, Helse Fonna HF, 5525 Haugesund, Norway
- Department of Mental Health, Norwegian University of Science and Technology, 7034 Trondheim, Norway
| | - Ståle Pallesen
- Department of Psychosocial Science, University of Bergen, 5015 Bergen, Norway
- Norwegian Competence Center for Gambling and Gaming Research, University of Bergen, 5015 Bergen, Norway
| | - Tony Leino
- Department of Health Promotion, Norwegian Institute of Public Health, 5015 Bergen, Norway
| | - Rune Aune Mentzoni
- Department of Psychosocial Science, University of Bergen, 5015 Bergen, Norway
- Norwegian Competence Center for Gambling and Gaming Research, University of Bergen, 5015 Bergen, Norway
| | - Jens Christoffer Skogen
- Department of Health Promotion, Norwegian Institute of Public Health, 5015 Bergen, Norway
- Centre for Evaluation of Public Health Measures, Norwegian Institute of Public Health, 0473 Oslo, Norway
- Alcohol and Drug Research Western Norway, Stavanger University Hospital, 4068 Stavanger, Norway
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Sexual Differences in Internet Gaming Disorder (IGD): From Psychological Features to Neuroanatomical Networks. J Clin Med 2022; 11:jcm11041018. [PMID: 35207293 PMCID: PMC8877403 DOI: 10.3390/jcm11041018] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2021] [Revised: 01/26/2022] [Accepted: 02/13/2022] [Indexed: 01/27/2023] Open
Abstract
Internet gaming disorder (IGD) has been included in the 2013 Diagnostic and Statistical Manual of Mental Disorders (DSM-5) as a condition in need of further study, and gaming disorder was recognized by the World Health Organization as a mental disorder in the International Classification of Disease (ICD-11) of 2018. IGD has different characteristics in the two sexes and is more prevalent in males than females. However, even if the female gamer population is constantly growing, the majority of available studies analyzed only males, or the data were not analyzed by sex. To better elucidate sex differences in IGD, we selectively reviewed research publications that evaluated IGD separately for males and females collected in approximately one hundred publications over the past 20 years. The available data in this narrative review indicate that IGD is strongly dimorphic by sex for both its psychological features and the involvement of different brain areas. Impulsivity, low self-control, anxiety, emotion dysregulation, and depression are some of the psychological features associated with IGD that show a sex dimorphism. At the same time, IGD and its psychological alterations are strongly correlated to dimorphic functional characteristics in relevant brain areas, as evidenced by fMRI. More research is needed to better understand sex differences in IGD. Animal models could help to elucidate the neurological basis of this disorder.
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André F, Munck I, Håkansson A, Claesdotter-Knutsson E. Game Addiction Scale for Adolescents-Psychometric Analyses of Gaming Behavior, Gender Differences and ADHD. Front Psychiatry 2022; 13:791254. [PMID: 35356720 PMCID: PMC8959768 DOI: 10.3389/fpsyt.2022.791254] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/08/2021] [Accepted: 01/31/2022] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND Internet gaming disorder (IGD) was recently added in the Diagnostic and Statistical Manual of Mental Disorder as a "condition for further studies." There is no consensus regarding which rating scales should be used but many scholars suggest the GASA (Game Addiction Scale for Adolescents) and a ranking of the criteria, "the core approach" to avoid over-diagnosing of disordered gaming. Male gender and ADHD are commonly listed as risk factors for disordered gaming but little is known about sex differences in gaming and gender specific health correlates. PURPOSE The present study aims to evaluate the core approach and the specific indicators of gaming behavior in GASA from a multifactorial perspective and explore the gender differences in a clinical setting, focusing on ADHD. PATIENTS AND METHODS Children and adolescents aged 8-18 years (n = 144) from Child and adolescent psychiatry (CAP) in Skane were assessed with the GASA. Psychometric analyses including confirmatory factor analyses (CFA) and structural equation modeling (SEM) were used to identify well-defined constructs and gender differences. Refined factor scores for single constructs were the outcome of alignment, a procedure for assessing measurement equivalence across gender. New model-based gaming behavior variables were used for descriptive statistics and ANOVA testing of gender differences. RESULTS The results confirm that the core approach two-factor model is valid for the CAP sample, as well as a theory based psycho-social model for gaming behavior with over consumption and negative social and emotional consequences. Our findings suggest that negative consequences of over consumption take a social direction for boys and an emotional direction for girls. Also, ADHD was significantly associated with over consumption of video games and the negative consequences thereof for girls. CONCLUSION Guided by psychometric analyses, the GASA could be strengthened by advancing the questionnaire design and by adding complementary items in order to illuminate the complexity of gaming behavior. Our findings suggest that additional research on potential gender related discrepancies of disordered gaming is needed.
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Affiliation(s)
- Frida André
- Department of Clinical Sciences Lund, Faculty of Medicine, Lund University, Lund, Sweden
| | - Ingrid Munck
- Department of Education and Special Education, University of Gothenburg, Gothenburg, Sweden
| | - Anders Håkansson
- Department of Clinical Sciences Lund, Psychiatry, Faculty of Medicine, Lund University, Lund, Sweden.,Gambling Disorder Unit, Malmö Addiction Centre, Malmö, Sweden
| | - Emma Claesdotter-Knutsson
- Department of Clinical Sciences Lund, Psychiatry, Faculty of Medicine, Lund University, Lund, Sweden.,Child and Adolescent Psychiatry, Regional Out-Patient Care, Lund University Hospital, Region Skåne, Lund, Sweden
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André F, Håkansson A, Claesdotter-Knutsson E. Gaming, substance use and distress within a cohort of online gamblers. J Public Health Res 2021. [PMID: 34351102 DOI: 10.4081/jphr.2021.2434] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND The fifth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) included Internet Gaming Disorder (IGD) as a tentative diagnosis and inquires for additional research. The research on gaming is inconsistent regarding measurement approach and diagnostic cut-offs. Some scholars suggest the core approach, accentuating some of the diagnostic criteria to avoid pathologizing harmless behavior. Also, the co-occurrence of gaming and other addictions, gambling in specifically, is frequently reported but poorly understood. The present study aimed to explore gaming within a population of online gamblers in order to evaluate the core approach but also to investigate the possible co-occurrence of different addictions. DESIGN AND METHODS The present study is derived from material collected for a study on online gambling. The study addressed 1007 adult individuals from the general population who had gambled for money on an online casino site or an online betting site, on at least 10 occasions during the past 12 months. RESULTS Both the level of distress and problem gambling increased as the severity of gaming increased. The co-occurrence of problems with alcohol, illicit drug use/prescription sedatives/strong painkillers and gambling was roughly 50% among the addictive gamers. CONCLUSION The present study suggests that the core approach manages to distinguish in severity of gaming in regards to interference and comorbidity. We also brought light to the occurrence of gaming within a population of gamblers and our results indicate that this specific group of addicted gamers are particularly burdened by co-occurrent addictive behaviors and severe distress.
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Affiliation(s)
- Frida André
- Department of Clinical Sciences, Faculty of Medicine, Lund University, Lund.
| | - Anders Håkansson
- Department of Clinical Sciences Lund, Faculty of Medicine, Lund University, Lund; Region Skåne, Malmö Addiction Centre, Gambling Disorder Unit, Malmö.
| | - Emma Claesdotter-Knutsson
- Department of Clinical Sciences, Faculty of Medicine, Lund University, Lund; Region Skåne, Child and Adolescent Psychiatry, Regional Out-patient Care, Lund University Hospital, Lund.
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André F, Håkansson A, Claesdotter-Knutsson E. Gaming, substance use and distress within a cohort of online gamblers. J Public Health Res 2021; 11:3434. [PMID: 35586184 PMCID: PMC8847953 DOI: 10.4081/jphr.2021.3434] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2021] [Accepted: 06/17/2021] [Indexed: 11/22/2022] Open
Abstract
Background: The fifth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) included Internet Gaming Disorder (IGD) as a tentative diagnosis and inquires for additional research. The research on gaming is inconsistent regarding measurement approach and diagnostic cut-offs. Some scholars suggest the core approach, accentuating some of the diagnostic criteria to avoid pathologizing harmless behaviour. Also, the co-occurrence of gaming and other addictions, gambling in specifically, is frequently reported but poorly understood. The present study aimed to explore gaming within a population of online gamblers in order to evaluate the core approach but also to investigate the possible co-occurrence of different addictions. Design and methods: The present study is derived from material collected for a study on online gambling. The study addressed 1007 adult individuals from the general population who had gambled for money on an online casino site or an online betting site, on at least 10 occasions during the past 12 months. Results: Both the level of distress and problem gambling increased as the severity of gaming increased. The co-occurrence of problems with alcohol, illicit drug use/prescription sedatives/strong painkillers and gambling was roughly 50% among the addictive gamers. Conclusion: The present study suggests that the core approach manages to distinguish in severity of gaming in regards to interference and comorbidity. We also brought light to the occurrence of gaming within a population of gamblers and our results indicate that this specific group of addicted gamers are particularly burdened by co-occurrent addictive behaviours and severe distress.
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Affiliation(s)
- Frida André
- Department of Clinical Sciences, Faculty of Medicine, Lund University, Lund
| | - Ander Håkansson
- Department of Clinical Sciences Lund, Faculty of Medicine, Lund University, Lund,Region Skåne, Malmö Addiction Centre, Gambling Disorder Unit, Malmö
| | - Emma Claesdotter-Knutsson
- Department of Clinical Sciences, Faculty of Medicine, Lund University, Lund,Region Skåne, Child and Adolescent Psychiatry, Regional Out-patient Care, Lund University Hospital, Lund, Sweden,Department of Clinical Sciences Lund, Faculty of Medicine; Region Skåne, Child and Adolescent Psychiatry, Regional Out-patient Care, Lund University Hospital, Sofiavägen 2D, SE-22241 Lund, Sweden. Tel. +0046.768871765.
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