The Comorbidity Between Internet Gaming Disorder and Depression: Interrelationship and Neural Mechanisms

Going beyond video game consumption when considering Internet Gaming Disorder

BACKGROUND

Recognizing the crucial importance of understanding the impact of video games on health in today's gaming-dominated world, our study aimed to investigate the relationship between gaming time and Internet Gaming Disorder (IGD). Despite the widespread assumption that a connection exists between both, previous studies have revealed highly variable associations, highlighting significant weaknesses in establishing a robust link.

METHODS

To unravel this complex relationship, we recruited two independent samples of League of Legends players. We combined the collection of self-reported and actual gameplay data, together with assessments of mental health, personality traits, and cognitive abilities.

RESULTS

Surprisingly, none of the gaming variables demonstrated a robust and stable association with IGD, regardless of whether players spent less than or more than 30 hours per week gaming-a threshold suggested by the American Psychiatric Association as a potential indicator of disordered gaming. Notably, mental health factors, such as anxiety, depression and ADHD, emerged as the most influential predictors of IGD.

CONCLUSION

These findings, replicated across two independent samples, challenge the prevailing belief that limiting screen time alone effectively combats IGD. Instead, mental health factors play a crucial role in mitigating risks associated with gaming. Policies focusing solely on restricting screen time are insufficient in reducing the prevalence or symptoms of IGD. Rather, a comprehensive approach that considers mental health and key personality traits must be adopted to safeguard the well-being of individuals engaged in gaming.

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.

Sex differences of neural connectivity in internet gaming disorder and its association with sleep quality: an exploratory fMRI study

Objectives

Sex-specific differences in internet gaming disorder (IGD) neurophysiology remain underexplored. Here we investigated sex-related variability in regional homogeneity (ReHo) and functional connectivity (FC) in IGD and their correlations with sleep quality.

Methods

Resting-state functional magnetic resonance imaging (fMRI) scans were performed on 52 subjects with IGD and 50 healthy controls (HCs). Two-way ANOVA was used to examine sex and diagnosis interactions in ReHo and FC, followed by post-hoc analyses to explore FC biomarkers for different sexes.

Results

In ReHo analysis, the four groups showed significant sex and diagnosis interactions in the right middle frontal gyrus (rMFG). FC analysis with rMFG as the seed region revealed a significant sex and diagnosis interaction effect in FC of the rMFG with the bilateral postcentral gyrus (PoCG). In male IGD group, FC between the rMFG and the bilateral PoCG correlates strongly with daytime dysfunction score and the Pittsburgh sleep quality inventory (PSQI) total score.

Conclusion

These findings emphasize the importance of considering sexual dimorphism in the neurobiology of IGD, which might influence subsequent treatment strategies.

Relationships of gaming disorder, ADHD, and academic performance in university students: A mediation analysis

This study investigates the intersection of Gaming Disorder (GD) and Attention-Deficit/Hyperactivity Disorder (ADHD), and Grade Point Average (GPA), among university students, a critical demographic often overlooked in research on these disorders. A sample of 348 university students was analyzed using the IGD-20 Test for risk of GD, the Adult ADHD Self-Report Scale (ASRS-v1.1) for ADHD symptoms, and GPA as a metric of academic performance. The findings indicate that 4.3% of the surveyed sample scored within the range for GD. The prevalence was higher in males, with 5.3% of the male cohort affected, compared to 1.2% of the female cohort. Significantly, the prevalence of ADHD was substantially higher in the GD group (35.7%) than in the non-GD group (24.2%). Further, ADHD symptoms were found to be a stronger predictor of GD in females than in males. Incorporating the mediating role of Gaming Disorder, this study also probes into how GD may serve as an intermediary in the impact of ADHD on academic performance. By examining the intricate relationship between these disorders, our findings suggest that GD exacerbates the negative effects of ADHD on academic performance, thereby underscoring the potential for Gaming Disorder to act as a bridge in this dynamic. This mediation analysis clarifies how ADHD may indirectly impact academic performance through GD. The study reveals a positive correlation between ADHD symptoms and GD severity, which in turn correlates negatively with academic achievement. In addition, the findings underscore the need for gender-sensitive interventions and highlight the importance of considering the comorbidity of ADHD and GD in academic settings, advocating for systematic screening for GD among students with ADHD, and vice versa. The dual challenges posed by ADHD and GD should be addressed to prevent their escalation into pervasive academic and psychosocial adversities.

A three-wave longitudinal study on the underlying metacognitive mechanism between depression and Internet gaming disorder

BACKGROUND AND AIMS

Internet Gaming Disorder (IGD) and depression have negative consequences on individuals' mental health, but their relationships are complex. This three-wave longitudinal study aimed to detect the metacognitive mechanisms underlying the association between IGD tendency and depression based on the self-regulatory executive function model.

METHODS

A total of 1,243 Chinese undergraduate student gamers (57% female, M = 19.77, SD = 1.29) were recruited at the baseline survey (Wave 1 [W1]), with 622 and 574 of them taking part in the two follow-up surveys (Wave 2 [W2] at 6 and Wave 3 [W3] at 12 months later), respectively.

RESULTS

The three-wave path model demonstrated, after controlling for the autoregressive effect of each variable, that depression consistently predicted IGD tendency but not vice versa, while negative but not positive metacognitions about online gaming (MOG) significantly predicted both depression and IGD tendency. Moreover, two statistically significant mediation paths: (i) negative MOG [W1] → depression [W2] → IGD tendency [W3]; and (ii) depression [W1] → negative MOG [W2] → IGD tendency [W3] were identified.

DISCUSSION AND CONCLUSIONS

These findings extend the understanding of the associations among depression, IGD tendency, and MOG, highlighting how negative MOG has a stronger prospective effect than positive MOG on depression and IGD tendency, and also reveal the mutual mediation effects of depression and negative MOG on IGD tendency. Integrated programmes with both emotional regulation training and Metacognitive Therapy are recommended for IGD treatment.

Digital Media and Developing Brains: Concerns and Opportunities

Purpose of Review

The incorporation of digital technologies and their use in youth's everyday lives has been increasing rapidly over the past several decades with possible impacts on youth development and mental health. This narrative review aimed to consider how the use of digital technologies may be influencing brain development underlying adaptive and maladaptive screen-related behaviors.

Recent Findings

To explore and provide direction for further scientific inquiry, an international group of experts considered what is known, important gaps in knowledge, and how a research agenda might be pursued regarding relationships between screen media activity and neurodevelopment from infancy through childhood and adolescence. While an understanding of brain-behavior relationships involving screen media activity has been emerging, significant gaps exist that have important implications for the health of developing youth.

Summary

Specific considerations regarding brain-behavior relationships involving screen media activity exist for infancy, toddlerhood, and early childhood; middle childhood; and adolescence. Transdiagnostic frameworks may provide a foundation for guiding future research efforts. Translating knowledge gained into better interventions and policy to promote healthy development is important in a rapidly changing digital technology environment.

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

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

The interplay between mental health and dosage for gaming disorder risk: a brief report

The relationship between gaming time and gaming disorder can be moderated by other variables. This study aimed to test the moderating role of mental health. Participants (N = 461) were recruited online. Gaming time was a statistically significant predictor of gaming disorder risk, with an explained variance of 3.3%. The goodness of fit of the model that took into account both moderators (anxiety and depression) improved to 13.9%. The interaction between gaming time and both moderators was significant. The results showed that depression and anxiety acted as moderators of the dosage effect, possibly by amplifying the gratification of playing games and thus contributing to the development of gaming disorder. It may be important in practise, as it seems to place the mental health at the right place, namely among risk factors that can contribute to gaming disorder in combination with a key trigger, which is gaming.

EEG components of inhibitory control ability in internet gaming disorder: A systematic review and meta-analysis of randomized controlled trials

BACKGROUND

Inhibitory control ability is a crucial cognitive function that enables individuals to regulate their impulses and behaviors in a goal-directed manner. However, with the increasing prevalence of internet gaming disorder (IGD), there has been growing concern about the impact of excessive gaming on inhibitory control ability. Despite the accumulating evidence on this topic, the research conclusion on whether people with IGD have worse inhibition control ability than healthy controls remains inconsistent, and the lack of effective electroencephalography prediction indicators further complicates this issue. To address this research gap, the present study aimed to investigate whether N2 event-related potential (ERP) and P3 ERP components could serve as reliable indicators of inhibitory control ability in individuals with IGD.

METHODS

To achieve this goal, a systematic literature search was conducted in several databases, including Web of Science, ScienceDirect (EBSCO), SpringerLink, PubMed, and Wiley Online Library. The inclusion criteria were strictly implemented to ensure the quality of the studies included in the meta-analysis. In the end, a total of 5 studies, with 139 participants diagnosed with IGD and 139 healthy controls, were included in the analysis.

RESULTS

Meta-analysis revealed large effect sizes of N2 and P3 amplitudes in individuals with IGD, indicating that these two ERP components could be potential indicators of inhibitory control ability. Specifically, the N2 and P3 amplitude was significantly larger in individuals with IGD than in the healthy control group, suggesting deficits in inhibitory control function and increased impulsivity in the IGD group. In the inhibition control task, the IGD group required more cognitive resources to suppress impulsive responses.

CONCLUSION

Overall, the findings of this meta-analysis shed light on the potential use of N2 and P3 amplitudes as reliable indicators of inhibitory control ability in individuals with IGD. The results provide crucial insights into the neural mechanisms underlying inhibitory control impairment in IGD, which could inform the development of effective interventions for this condition. Further research is needed to explore the functional significance of these ERP components and their potential clinical applications in the diagnosis and treatment of IGD.

Regional brain activity of resting-state fMRI and auditory oddball ERP with multimodal approach in individuals with internet gaming disorder

Background and aims

Resting-state brain activity may be associated with the ability to perform tasks; however, a multimodal approach involving resting-state functional magnetic resonance imaging (fMRI) and event-related potentials (ERPs) has not been widely used to investigate addictive disorders.

Methods

We explored resting-state fMRI and auditory oddball ERP values from 26 with internet gaming disorder (IGD) patients and 27 age- and intelligence quotient-matched healthy controls (HCs). To assess the characteristics of resting-state fMRI, we calculated regional homogeneity (ReHo), amplitude of low-frequency fluctuation (ALFF), and fractional amplitude of low-frequency fluctuation (fALFF); we also calculated the P3 component of the ERPs.

Results

Compared with HCs, the individuals with IGD exhibited significant decreases in ReHo and fALFF values in the left inferior occipital gyrus, increased ReHo and ALFF values in the right precuneus, increased ALFF in the left superior frontal gyrus, and lower P3 amplitudes in the midline centro-parietal area during the auditory ERP task. Furthermore, the regional activity of resting-state fMRI in the right inferior temporal gyrus and the occipital regions were positively correlated with the P3 amplitudes in IGD patients, whereas ReHo values of the left hippocampus and the right amygdala were negatively correlated with P3.

Discussion and conclusions

Our results suggest that IGD patients have difficulty interacting effectively with cognitive function and sensory processing, although its interpretations need some cautions. The findings in this study will broaden the overall understanding of the neurobiological mechanisms that underlie IGD pathophysiology.

A Systematic Review of the Association of Internet Gaming Disorder and Excessive Social Media Use With Psychiatric Comorbidities in Children and Adolescents: Is It a Curse or a Blessing?

Internet gaming and social media usage (SMU), particularly among children and teenagers, have witnessed a remarkable surge over the past decade. However, it remains uncertain whether this widespread usage has a positive or negative impact. The primary objective of this systematic review was to investigate the diverse effects of excessive video game playing and extensive SMU, both favorable and detrimental, on the psychological and mental well-being of children and adolescents. To assess the influence of internet gaming disorder (IGD) and disordered SMU on the mental health of children aged 6-12 years and adolescents aged 13-18 years, we conducted a systematic review of 20 studies on the subject. These studies utilized a substantial sample size of 48,652 participants, encompassing online and in-person questionnaires administered to children, teenagers, and their parents in educational institutions, healthcare facilities, and online platforms. Our findings suggest that multiple factors contribute to the intricate relationship between SMU, video game playing, and mental health outcomes. The majority of research indicates that excessive gaming or SMU among children and teenagers leads to adverse consequences on their mental well-being. Furthermore, certain studies have even reported fatal consequences, while others have identified a worsening of preexisting mental health issues. A few studies have explored the potential positive impacts of SMU and gaming on individuals and society at large. In light of this, we have concluded that it is inappropriate to categorize internet gaming and SMU as solely beneficial or detrimental without considering the broader context and the interplay of various factors.

Social support as the mediator for the relationship between internet gaming disorder and psychological problems among university students

BACKGROUND

There has been increasing recognition of internet gaming disorder as a psychiatric problem that is linked with serious impairment and distress and correlated with psychological reactions and social consequences. Thus, this study proposed that psychological problems (stress, anxiety, and depression) and social support could be associated with IGD and social support had a mediating role between these psychological problems and IGD among university students in Jordan.

METHODS

A cross-sectional, descriptive correlational design was adopted. The university students (N = 1020) were selected randomly from four universities (two public and two private) in Jordan. A self-structured questionnaire was used to collect data using the Internet Gaming Disorder Test (IGD-20 Test), Depression Anxiety Stress Scales-21 (DASS-21), Multidimensional Social Support Scale (MSPSS), and sociodemographic data.

FINDINGS

Findings of this study found that the mean age of the participants was 21.38 (S.D ± 2.12) and 55.9% of them were males The prevalence of internet gaming disorder was 12.16% among the participants, where the cut-off point for internet gaming disorder was 71 out of 100. Internet gaming disorder was significantly correlated with stress, anxiety, social support, and depression. However, stress, anxiety, and social support had a direct effect on internet gaming disorder, while social support had the strongest effect on internet gaming disorder. It was found that social support had a mediating role between anxiety and stress (β = -0.172, T-Statistics = 3.92, p < 0.001; β = -0.268, T-Statistics = 5.45, p < 0.001, respectively) and internet gaming disorder (p < 0.001).

CONCLUSION

This study can help policymakers and instructors develop health education programs and/or health training programs that focus on using social support as a coping method when experiencing psychological problems including stress and anxiety and adopt social support in management programs for excessive use of internet gaming.

Symptoms of internet gaming disorder and depression in Chinese adolescents: A network analysis

The current study aimed to investigate comorbidity among symptoms of depression and internet gaming disorder (IGD) utilizing symptom network analysis in a sample of Chinese adolescents. A total of 1,362 Chinese adolescents (Mean age = 15.19 ± 1.67; range 13-21; 39.79% female, 56.02% male, 4.19% not disclosed) were recruited from 11 local secondary schools between June and July 2020. Symptoms of depression and IGD were assessed by the 7-item DASS-21 depression subscale and the 9-item Internet Gaming Disorder Scale. We conducted network analysis to estimate network models and the most central symptoms of depression and IGD and computed a combined network model of both depression and IGD symptoms to find bridge symptoms and illustrate the comorbidity between depression and IGD. We found that feeling 'Worthless', 'Meaningless', and 'Down-hearted' were identified as the most central symptoms of depression, whereas 'Preoccupation' and 'Tolerance' were the two most central symptoms of IGD. The bridge symptoms in the combined network model were 'Gaming for escape or mood relief' from the IGD cluster and 'No initiative' and 'Down-hearted" from the depression cluster. The current study was the first to investigate the relationship between depression and IGD symptoms among adolescents utilizing a symptom network perspective. Also, it highlighted key bridge symptoms in understanding how IGD and depression contribute to each other.

Differences between recreational gamers and Internet Gaming Disorder candidates in a sample of Animal Crossing: New Horizons players

Throughout the last decade, research has considered players' gaming motives as risk and the perceived social support (PSS) as protective factors in the context of Internet Gaming Disorder (IGD). However, the literature is lacking diversity regarding the representation of female gamers as well as of casual and console-based games. The aim of this study was to assess IGD, gaming motives, and PSS comparing recreational gamers and IGD candidates in a sample of Animal Crossing: New Horizons players. A total of 2909 ACNH players (93.7% of them female gamers) took part in an online survey which collected demographic, gaming-related, motivational, and psychopathologic data. Using the cut-off of at least five positive answers to the IGDQ, potential IGD candidates were identified. ACNH players reported a high prevalence rate for IGD (10.3%). IGD candidates differed from recreational players regarding age, sex, and game-related, motivational, and psychopathological variables. A binary logistic regression model was computed to predict membership in the potential IGD group. Age, PSS, escapism and competition motives as well as psychopathology were significant predictors. To discuss IGD in the context of casual gaming, we consider demographic, motivational, and psychopathological player characteristics as well as game design and the COVID-19 pandemic. IGD research needs to broaden its focus concerning game types as well as gamer populations.

A comprehensive review on emerging trends in the dynamic evolution of digital addiction and depression

Introduction

Using digital addiction as an umbrella term to cover any type of addictions to digital technologies such as the internet, smartphones, social media, or video games, the current study aimed to reveal the intellectual structure and evolution of research addressing digital addiction-depression relationship.

Methods

The study combined bibliometric and science mapping analysis methods for this purpose. Data for the study was gathered from Web of Science Core Collection after a comprehensive process of data search/extraction, and 241 articles were included in the final data set. A period-based, comparative science mapping analysis was performed using the SciMAT software.

Results

The analysis of data over three periods, Period 1 (1983-2016), Period 2 (2017-2019), and Period 3 (2020-2022) showed that internet addiction was the most significant theme across all three periods, which was followed by social media addiction. Depression, which emerged as a significant theme during Period 1, was later covered under anxiety disorder theme. Research interest was mostly on factors related to both addiction and depression such as cognitive distortion, insomnia, loneliness, self-esteem, social support, alexithymia, as well as cybervictimization or academic performance.

Discussion

The results suggested that much research is warranted on the digital addiction-depression relationship in different age cohorts, especially children and elderly. Similarly, the current analysis showed that this line of research particularly focused on internet, gaming and social media addiction, and evidence with regard to other types of digital addiction or related compulsive behaviors was almost absent. In addition, research was mostly inclined to understanding cause-effect relationships, which is significant, but preventive strategies seemed to be barely addressed. Likewise, the smartphone addiction-depression relationship arguably garnered less research interest, so future research would contribute to the field in this respect.

Developing Personas of Gamers with Problematic Gaming Behavior among College Students Based on Qualitative Data of Gaming Motives and Push-Pull-Mooring

Gaming is a popular but possibly problematic activity among college students. To distinguish gamers with potential problematic gaming behaviors (PGB) is crucial to mental health staff. Two studies were conducted that aimed to explore portraits of gamers with PGB in college campuses. The first study selected 20 college students, diagnosed with problematic gaming behaviors, from a longitudinal dataset and semi-structured interviews were conducted for a systematic description of long-term PGB. The second study selected four personas with the richest coding data of internet addiction and depression from 20 gamers. The profiles and life experiences of the personas showed changing processes of gaming motives and push-pull-mooring effects across the years. "Loss of purpose in life" and "desperate to escape from stress or boredom in the real world" were the important push effects. Mooring effects revealed their addiction or depression symptoms and the process of developing the addiction. The dynamics of "push", "pull", and "mooring" effects were clearly indicated in the results suggesting PGB might be a long-term coping strategy and a consequence of depression and loneliness. Dealing with depression and finding real-life goals could help PGB gamers to change the dynamics of their gaming motives and push-pull-mooring effects. The results may help develop interventions for gamers with problematic gaming behaviors.

Psychological Effects of FIFA, PES, and Clash of Clans Games on Young Men at Risk of Developing Internet Gaming Disorder

BACKGROUND

The present study aimed to investigate the psychological effects of FIFA, PES, and Clash of Clans games on young men at risk of developing internet gaming disorder (IGD).

METHODS

The sample consisted of 150 young men, 50 of whom were in the FIFA and PES group, 50 in the Clash of Clans group, and 50 in the control group. Two groups of young men at risk of developing IGD were compared with a control group. The participants completed the General Health Questionnaire (GHQ), Quality of Relationships Inventory (QRI), Game Addiction Scale, and Behavior Rating Inventory of Executive Function (BRIEF).

FINDINGS

The results of the study showed that the scores of mental health problems, conflict with friends, and executive function problems in the Clash of Clans group were significantly higher than those of the FIFA, PES, and control groups. Concerning conflict with parents, the FIFA group had a higher score than the Clash of Clans and control groups. In addition, the results indicated that gaming addiction affects mental health by affecting executive functions.

CONCLUSION

The Clash of Clans game has more negative effects on psychological functions.

Worsened Anxiety and Loneliness Influenced Gaming and Gambling during the COVID-19 Pandemic

Aim: To study the prevalence and patterns of problematic gaming and gambling during the COVID-19 pandemic and the association with psychiatric traits and major types of anxiety categories. Method: 1067 young adults participated in both wave 3 (2018) and wave 4 (2021) of the SALVe Cohort. Associations with psychiatric symptoms and anxiety were examined using logistic regression and Chi-square tests. Results: Problematic gaming decreased by 1.3 percentage points to 23.2% since the start of the pandemic, while problematic gambling increased by 0.9 percentage points to 6.5% in w4. Average time spent playing video games/day decreased from 2.2 h (w3) to 1.7 h (w4), while increases in gaming activity were associated with worsened feelings of loneliness (p = 0.002), depression (p < 0.001), and anxiety (p < 0.01) during the pandemic. Predictors for problematic gaming at w4 were previous problematic gaming and social anxiety (p = < 0.001 and 0.01, respectively). Moreover, previous problem gambling also predicted problem gambling at w4 p < 0.001. All anxiety categories were associated with both problematic gaming and gambling when adjusted for age and sex. However, after adjusting for depression and insomnia, social anxiety was associated with problematic gaming (p < 0.001), while panic was associated with problem gambling (p < 0.001). Conclusion: Overall, problematic gaming has decreased since the start of the pandemic, while problem gambling has increased. Worsened feelings of loneliness, depression, and anxiety during the pandemic are associated with increased gaming. Moreover, the association between problematic gaming and gambling and anxiety is independent of depression and sleep problems.

The unbalanced behavioral activation and inhibition system sensitivity in internet gaming disorder: Evidence from resting-state Granger causal connectivity analysis

BACKGROUND

Patients with behavioral or substance addiction show an unbalanced behavioral activation system (BAS) and behavioral inhibition system (BIS) sensitivity. However, the relationship between internet gaming disorder (IGD) and BAS/BIS is obscure and the neurobiological mechanism underlying this relationship remains unclear.

METHODS

We recruited 154 IGDs and 229 recreational game users (RGUs) in the current study. First, we explored the relationship between BAS/BIS and IGD. Second, subjects were subdivided into subgroups by BAS/BIS sensitivity. Third, whole-brain Granger causal connectivity (GCC) of striatum and amygdala subdivisions was estimated for the subgroup. Fourth, mediation analysis was performed to explore the role of connectivity in the relationship between IGD and BAS/BIS sensitivity.

RESULTS

We found the IGD group scored higher than the RGU on BIS and BASf (fun-seeking) sensitivity. Then, we identified 4 (2*2) subgroups: low/high risk of IGD with low/high BAS/BIS sensitivity groups. Two-way ANCOVA main results of interaction effects showed that in the high BAS/BIS group, the RGU exhibited increased strength in the GCC from the left putamen to the right cuneus, and the IGD exhibited decreased strength in the GCC from the right medial frontal gyrus to the caudate, from the left superior frontal gyrus to the centromedial amygdala, and from the right superior parietal lobule to the left laterobasal amygdala. Moreover, the GCC from the centromedial amygdala to the middle frontal gyrus mediated the directional relationship between BIS and IAT (Young's internet addiction test) scores.

CONCLUSIONS

The IGD individuals exhibited higher BIS and BAS-fun seeking sensitivity. Moreover, IGD with unbalanced BAS/BIS sensitivity exhibited alternative connectivity patterns involving amygdala and striatum subdivisions. These findings suggest a neurobiological mechanism for an alternation between IGD and RGU with different BAS/BIS sensitivity.

Increasing important roles of child and adolescent psychiatrists in the treatment of gaming disorder: Current status in Japan

Background

Digital gaming is the most common leisure activity among children and adolescents in Japan, especially in males. Playing online gaming has become more common among school-age children over the years. As a result, excessive online gaming in younger children has become a significant social problem in Japan. Previous studies have demonstrated that excessive online gaming could cause various mental health issues in children and adolescents. At medical institutions having child and adolescent psychiatry services, there is an increasing number of children and adolescents with various problems related to excessive gaming. The aim of this study was to investigate the current practice of gaming disorder (GD) in clinical settings in Japan.

Methods

The subjects of this study were all of 414 child and adolescent psychiatrists certified by the Japanese Society for Child and Adolescent Psychiatry (JSCAP). The study questionnaire was mailed to all subjects from the official secretariat of JSCAP. Study subjects were requested to answer the questionnaire anonymously. The survey contained three types of responses: open responses; single and multiple-choice responses; and, responses on a five-point Likert scale. The questionnaire consisted of 14 questions regarding GD.

Results

We received 159 responses. The most common reason for a visit to child and adolescent psychiatry service which results in a subsequent diagnosis of GD was school refusal/absenteeism followed by disruption of sleep-awake rhythm. The most common specialized treatment for GD currently offered at child and adolescent psychiatry service is individual psychotherapy. The two most frequently experienced difficulties in the treatment of GD were low motivation to achieve recovery and a large variety of combined problems other than excessive gaming itself. With regard to the three most common psychiatric comorbidities of GD, they were autism spectrum disorder (ASD), attention deficit hyperactivity disorder (ADHD), and depression.

Discussion

The results of our survey revealed that although GD is a behavioral addiction, many children and adolescents with GD first visit child and adolescent psychiatry clinics rather than specialized clinics for addiction which are usually designed and staffed for adult patients. Because it is known that GD is more prevalent among young males, including junior high and high school students, GD has become one of the most important clinical issues in child and adolescent psychiatry today. The important roles of child and adolescent psychiatrists in the treatment of GD has been increasing.

Longitudinal path analysis for the directional association of depression, anxiety and posttraumatic stress disorder with their comorbidities and associated factors among postpartum women in Northwest Ethiopia: A cross-lagged autoregressive modelling study

Introduction

Vulnerability for depression, anxiety and posttraumatic stress disorder symptoms due to perceived traumatic birth increase during the postpartum period. Traumatic birth has been defined as an event occurring during labour and birth that may be a serious threat to the life and safety of the mother and/or child. However, the comorbidity and multimorbidity of depression, anxiety and PTSD with their direct and indirect predictors is not well investigated in the postpartum period. In addition, the longitudinal directional association of depression, anxiety and PTSD with their comorbidities is not studied in Ethiopia.

Objective

The aim of this study was to assess prevalence of postnatal comorbid and multimorbid anxiety, depression and PTSD. It also aimed to determine the directional association of postnatal anxiety, depression and PTSD with the comorbidity and multimorbidity of these mental health problems over time and to explore the factors that are directly or indirectly associated with comorbidity and multimorbidity of anxiety, depression and PTSD.

Methods

A total of 775 women were included at the first, second and third follow-up of the study (6^th, 12^th and 18^th week of postpartum period) during October, 2020 –March, 2021. A cross-lagged autoregressive path analysis was carried out using Stata 16.0 software in order to determine the autoregressive and cross-lagged effects of depression, anxiety and PTSD with their comorbidities. In addition, a linear structural equation modelling was also carried out to determine the direct and indirect effects of independent variables on the comorbidities of depression, anxiety and PTSD.

Results

Comorbidity of anxiety with depression was the most common (14.5%, 12.1% and 8.1%) at the 6^th, 12^th and 18^th week of postnatal period respectively. With regard to the direction of association, comorbidity of PTSD (due to perceived traumatic birth) with depression, PTSD with anxiety, depression with anxiety and triple comorbidity predicted depression and anxiety in subsequent waves of measurement. Direct and indirect maternal morbidity, fear of childbirth and perceived traumatic childbirth were found to have a direct and indirect positive association with comorbidities of depression, anxiety and PTSD. In contrast, higher parity, higher family size and higher social support had a direct and indirect negative association with these mental health disorders.

Conclusion

Postnatal mental health screening, early diagnosis and treatment of maternal morbidities, developing encouraging strategies for social support and providing adequate information about birth procedures and response to mothers’ needs during childbirth are essential to avert comorbidity of anxiety, depression and PTSD in the postpartum period.

School assets and bullying in Chinese youth: A multiple mediation model of intentional self-regulation and internet gaming disorder

Bullying is a severe social problem affecting young people all over the world. Previous studies suggested that engagement in bullying had massive effects on teenagers' physical and psychological development. It is critical and necessary to investigate the antecedents and underlying mechanisms of this phenomenon among young generations. The present study, based on the positive youth development perspective and the developmental assets theory, attempts to explore the positive factors in the school subsystem that could effectively prevent adolescents from bullying, as well as the multiple mediation effects of intentional self-regulation (ISR) and internet gaming disorder (IGD). In this study, we adopted a two-wave design and recruited a sample of 768 Chinese adolescents using a randomized cluster sampling method in the post-pandemic era. The results revealed that T1 school assets significantly and negatively predicted T2 adolescent bullying. Furthermore, T2 ISR and T2 IGD mediated the association between T1 school assets and T2 bullying separately and sequentially. Overall, school resources play a protective role in adolescent development and could effectively prevent them from negative outcomes. These current findings contribute to the literature by providing a further understanding of the direct and indirect protective effects of school assets on adolescent bullying. Moreover, practitioners could also benefit from these findings in preventing and intervening in bullying in the school subsystem.

The role of illness representations of internet gaming disorder (IGD) in help-seeking intention among undergraduates: A longitudinal study

BACKGROUND AND AIMS

The Common-Sense Model asserts that illness representations of a health threat affect coping and behavioral reactions to it. Internet gaming disorder (IGD) is a newly defined mental disorder and leads to various health consequences. Little is known about illness representations of IGD and help-seeking for IGD among young adults who are at particular risk of IGD.

OBJECTIVE

This study investigated the roles of illness representations in intention to seek help from professionals and important others (families and friends) for IGD in college students in China.

METHODS

A two-wave longitudinal study was conducted with a convenience sample of college students in China (N = 591, 57.9% females, Mean_age = 19.10). Descriptive analyses and logistic regression analyses were conducted.

RESULTS

Approximately 10% of participants were classified as having probable IGD. However, over 70% endorsed self-diagnosed IGD. Less than 40% perceived resources of help-seeking, and most perceived shame for help-seeking. Less than 40% intended to seek help from professionals, and 26% from family and friends. Significant predictors of intention to seek professional help included probable IGD, perceived resources of help-seeking for IGD, consequence, timeline, and treatment. Significant predictors of intention to seek help from family and friends included probable IGD, self-diagnosed IGD, perceived resources of help-seeking for IGD, shame for help-seeking for IGD, timeline, treatment control, identity, concern, and emotional response. Females were more likely to seek both types of help.

DISCUSSION AND CONCLUSIONS

Perceptions of IGD and help-seeking play significant roles in help-seeking intentions. These modifiable factors can be used to guide the development of health promotion and behavioral change programs to promote help-seeking for IGD.

Prefrontal cortical activation in Internet Gaming Disorder Scale high scorers during actual real-time internet gaming: A preliminary study using fNIRS

Background

Observation of real-time neural characteristics during gameplay would provide distinct evidence for discriminating the currently controversial diagnosis of internet gaming disorder (IGD), and elucidate neural mechanisms that may be involved in addiction. We aimed to provide preliminary findings on possible neural features of IGD during real-time internet gaming using functional near-infrared spectroscopy (fNIRS).

Methods

Prefrontal cortical activations accompanying positive and negative in-game events were investigated. Positive events: (1) participant's champion slays or assists in slaying an opponent without being slain. (2) the opposing team's nexus is destroyed. Negative events: (1) participant's champion is slain without slaying or assisting in slaying any opponent. (2) the team's nexus is destroyed. Collected data were compared between the IGD group and control group, each with 15 participants.

Results

The IGD group scored significantly higher than the CTRL group on the craving scale. Following positive events, the IGD group displayed significantly stronger activation in the DLPFC. Following negative events, the IGD group displayed significantly weaker activation in the lateral OFC.

Discussion and Conclusions

Individuals scoring high on the IGD scale may crave for more internet gaming after encountering desired events during the game. Such observations are supported by the correlation between the craving scale and DLPFC activation. The IGD group may also show diminished punishment sensitivity to negative in-game experiences rendering them to continue playing the game. The present study provides preliminary evidence that IGD may demonstrate neural characteristics observed in other addictive disorders and suggests the use of fNIRS in behavioral addiction studies.

Internet addiction and its association with quality of life in patients with major depressive disorder: a network perspective

Depressive disorders and internet addiction (IA) are often comorbid. The aims of this study were to examine the network structure of IA in patients with major depressive disorders (MDD) and explore the association between IA and quality of life (QoL) in this population. This was a multicenter, cross-sectional survey. IA and QoL were assessed with the Internet Addiction Test (IAT) and the World Health Organization Quality of Life-brief version, respectively. Node expected influence (EI) was used to identify central symptoms in the network model, while the flow network of QoL was generated to examine its association with IA. A total of 1,657 patients with MDD was included. "Preoccupation with the Internet," "Job performance or productivity suffer because of the Internet," and "Neglect chores to spend more time online" were central symptoms. The symptom "Form new relationships with online users" had the strongest direct positive relation with QoL, while "Spend more time online over going out with others" and "Job performance or productivity suffer because of the Internet" had the strongest direct negative relations with QoL. Neglecting work caused by IA correlated with QoL, while making friends online appropriately was related to better QoL among MDD patients. Appropriate interventions targeting the central symptoms may potentially prevent or reduce the risk of IA in MDD patients.

Functional connectivity between the parahippocampal gyrus and the middle temporal gyrus moderates the relationship between problematic mobile phone use and depressive symptoms: Evidence from a longitudinal study

BACKGROUND AND AIM

Problematic mobile phone use (PMPU) is prevalent and increases the risk for a variety of health problems. However, few studies have explored the neural mechanisms that might render adolescents more or less vulnerable. Here, we aimed to identify whether PMPU is associated with depressive symptoms and whether this relationship is moderated by intrinsic functional connectivity (iFC) which is associated with PMPU.

METHODS

In this longitudinal study, we included 238 students (mean age = 19.05, SD = 0.81) that came from a university in Hefei, China. They all finished MRI scans at baseline and completed questionnaires both at baseline and 1 year later. A self-rating questionnaire for adolescent problematic mobile phone use and depression anxiety stress scale-21 were used to assess PMPU and depressive symptoms. We first assessed the relationship between PMPU and depressive symptoms using an autoregressive cross-lagged model. Then, we detected the brain regions that were associated with PMPU. Moreover, the neuroimaging results were extracted to explore whether the iFC of these brain regions moderated the relationship between PMPU and depression.

RESULTS

Consistent with our hypotheses, PMPU was positively associated with depressive symptoms, and the relationship between PMPU and depressive symptoms was moderated by iFC of the left parahippocampal gyrus-right middle temporal gyrus both at baseline and after 1 year (β = 0.554, P = 0.003; β = 0.463, P = 0.016, respectively).

CONCLUSIONS

These results advance the understanding of PMPU and suggest that iFC of the left parahippocampal gyrus-right middle temporal gyrus may be a neurobiological contributor to its relationship with depressive symptoms.

Psychometric evaluation of the Russian version of the Gaming Disorder Scale for Adolescents

Problematic gaming has become an emerging global health issue. Formal recognition of gaming disorder in the ICD-11 is a new opportunity for the discipline to conduct further investigation concerning the psychological consequences of problematic gaming. The present study investigated the psychometric properties and construct structure of the recently developed Gaming Disorder for Scale for Adolescents (GADIS-A), a multi-dimensional instrument that screens for gaming disorder symptoms, among Russian adolescent gamers. The sample comprised 933 adolescent gamers (547 boys and 386 girls) recruited via a web-based platform, using a multistage sampling method. Analysis showed the GADIS-A had very good internal consistency (Cronbach's alpha coefficient = .891; Composite reliability = .89) and adequate test-retest reliability after two weeks (intraclass coefficient  =0.68 with 95% CI [0.61, 0.77]. Exploratory structural equation modeling (ESEM) showed the data fitted well. Measurement invariance testing indicated the GADIS-A was invariant by gender and gaming medium (online vs. offline). As for criterion-related validity, high scores on the GADIS-A positively correlated with scales assessing depression, anxiety, impulsivity, and difficulties in emotion regulation, and negatively correlated with social connectedness and life satisfaction. Using latent profile analysis, four groups of gamers were identified, and problematic gaming was associated with greater mental health problems. The findings indicated that psychological comorbidity (e.g., depression and anxiety) was more prevalent among gamers with higher risk of GD. The findings indicate that GADIS-A is a reliable and valid instrument to assess the symptoms and severity of gaming disorder among Russian adolescents.

SUPPLEMENTARY INFORMATION

The online version contains supplementary material available at 10.1007/s12144-021-02575-w.

Prevalence and Clinical Correlates of Internet Addiction Symptoms and Their Association With Quality of Life in Adolescents With Major Depressive Disorder: A Multicenter Cross-Sectional Study

BACKGROUND

Internet addiction (IA) symptoms are common among adolescents and negatively impact their academic performance and development. These symptoms are also associated with lower quality of life (QOL) and increased suicidality. This study aimed to examine the prevalence and the sociodemographic and clinical correlates of IA symptoms in adolescents with major depressive disorder (MDD) and their association with QOL.

METHODS

This cross-sectional study was conducted in three general and four psychiatric hospitals in Anhui Province, China, from January to July 2021. Sociodemographic and clinical data were collected. The Internet Addiction Test (IAT), Center for Epidemiologic Studies of Depression Symptom Scale (CES-D), and World Health Organization Quality of Life Brief version (WHOQOL-BREF) were utilized to examine IA, depressive symptoms, and QOL, respectively.

RESULTS

In a multicenter sample of 278 adolescents with MDD, the prevalence of IA symptoms in adolescents with MDD was 46.8% (95% CI: 40.9-52.7%). Logistic regression analysis showed that patients with more severe depressive symptoms (odds ratio [OR] = 1.05, 95% CI: 1.03-1.08), those living in a rural area (OR = 1.94, 95% CI: 1.15-3.27), and those with poor academic performance (OR = 2.90, 95% CI: 1.42-5.95) were more likely to have IA symptoms. After controlling for confounding factors, patients with IA symptoms had significantly poorer QOL in the physical, psychological, and environmental domains than those without IA symptoms.

CONCLUSION

IA symptoms are common in adolescents with MDD and appear to be associated with clinical symptoms. We could not infer a causal relationship between IA and depression because this was a cross-sectional study. Considering the positive association between IA symptoms and lower QOL, screening for IA symptoms should be conducted, and effective measures should be implemented for adolescents with MDD.

Reliability, and Convergent and Discriminant Validity of Gaming Disorder Scales: A Meta-Analysis

Background: An association between gaming disorder (GD) and the symptoms of common mental disorders is unraveled yet. In this preregistered study, we quantitatively synthesized reliability, convergent and discriminant validity of GD scales to examine association between GD and other constructs. Methods: Five representative GD instruments (GAS-7, AICA, IGDT-10, Lemmens IGD-9, and IGDS9-SF) were chosen based on recommendations by the previous systematic review study to conduct correlation meta-analyses and reliability generalization. A systematic literature search was conducted through Pubmed, Proquest, Embase, and Google Scholar to identify studies that reported information on either reliability or correlation with related variables. 2,124 studies were full-text assessed as of October 2020, and 184 were quantitatively synthesized. Conventional Hedges two-level meta-analytic method was utilized. Results: The result of reliability generalization reported a mean coefficient alpha of 0.86 (95% CI = 0.85-0.87) and a mean test-retest estimate of 0.86 (95% CI = 0.81-0.89). Estimated effect sizes of correlation between GD and the variables were as follows: 0.33 with depression (k = 45; number of effect sizes), 0.29 with anxiety (k = 37), 0.30 with aggression (k = 19), -0.22 with quality of life (k = 18), 0.29 with loneliness (k = 18), 0.56 with internet addiction (k = 20), and 0.40 with game playtime (k = 53), respectively. The result of moderator analyses, funnel and forest plots, and publication bias analyses were also presented. Discussion and Conclusion: All five GD instruments have good internal consistency and test-retest reliability. Relatively few studies reported the test-retest reliability. The result of correlation meta-analysis revealed that GD scores were only moderately associated with game playtime. Common psychological problems such as depression and anxiety were found to have a slightly smaller association with GD than the gaming behavior. GD scores were strongly correlated with internet addiction. Further studies should adopt a rigorous methodological procedure to unravel the bidirectional relationship between GD and other psychopathologies. Limitations: The current study did not include gray literature. The representativeness of the five tools included in the current study could be questioned. High heterogeneity is another limitation of the study. Systematic Review Registration: [https://www.crd.york.ac.uk/PROSPERO/], identifier [CRD42020219781].

A Literature Review on the Efficacy and Related Neural Effects of Pharmacological and Psychosocial Treatments in Individuals With Internet Gaming Disorder

OBJECTIVE

Internet gaming disorder (IGD) has attracted considerable attention as a serious mental and public health issue worldwide. Currently, there are no established treatment guidelines for IGD. Herein, we review the latest findings on the efficacy and related neural effects of pharmacological and psychosocial treatments for individuals with IGD.

METHODS

A database search of relevant studies published between 2007 and 2020 was conducted using PubMed and Google Scholar. Twenty-seven studies were reviewed for current evidence related to the efficacy and neural effects of pharmacological and psychosocial IGD treatments.

RESULTS

Pharmacological studies suggest that bupropion may play a significant role in IGD. Additionally, nuclear imaging studies on IGD have demonstrated functional impairment of the dopamine system, providing a neurobiological basis for the efficacy of dopamineenhancing drugs. Among the various psychosocial interventions, current evidence suggests that cognitive behavioral therapy may be an effective intervention for IGD. Cognitive behavioral therapy and bupropion were found to influence resting-state functional connectivity within the cortico-subcortical circuit and default mode network, suggesting a possible neural mechanism. Innovative approaches, including virtual reality treatment, residential camps, voluntary abstinence, and transcranial direct current stimulation, have shown promising results. However, methodological limitations, such as the absence of proper controls, small sample sizes, short duration, inconsistency of inclusion criteria across studies, and self-report measures of outcome, hamper conclusions regarding the efficacy of treatments.

CONCLUSION

Ongoing basic research and clinical trials overcoming these limitations could add to the existing knowledge on IGD and contribute to the development of evidence-based treatments.

Assessing online gaming and pornography consumption patterns during COVID-19 isolation using an online survey: Highlighting distinct avenues of problematic internet behavior

Background and aim

The Coronavirus (COVID-19) pandemic has required drastic safety precautions to contain virus spread, involving a protracted self-isolation period. Those with greater perceived or actual life stress are vulnerable to develop problematic internet behaviors. Thus, we assessed how COVID-19 social isolation affected online gaming (OG) and pornography viewing (PV) in the general population.

Methods

We developed an online cross-sectional survey, Habit Tracker (HabiT), completed by 1,344 adults (≥18 years). HabiT was released internationally with individuals from 80 countries participating; a majority residing in the United States and United Kingdom. We measured changes in OG (IGDS9-SF) and PV (CYPAT) behaviors before and during the COVID-19 quarantine period. We also assessed psychiatric factors such as anxiety, depression (HADS), and impulsivity (SUPPS-P). The primary outcome measures were change in amount of, and current OG and PV severity during quarantine. These measures were related to ten COVID-19-related stress factors.

Results

Overall, we observed a large increase in OG and a minor increase in PV. Those who increased OG (63%) and PV (43%) during quarantine were younger individuals, males, those who left the quarantine household infrequently, those who reported low frequency or poor quality social interactions, and those with higher depression, anxiety, and urgency impulsivity.

Discussion

Our findings highlight similarities between forms of problematic internet behaviors driven by stress, depression, anxiety; while highlighting distinct avenues which these behaviors can manifest.

Conclusion

We emphasize the relevance of identifying those in need of emotional regulation interventions, to mitigate problematic internet behaviors in the context of COVID-19 isolation.

Relationship Between Illness Representations and Symptoms of Internet Gaming Disorder Among Young People: Cross-Lagged Model

BACKGROUND

The common-sense model of illness suggests that mental representations of health threats may affect one's behavioral reactions to them and health status. Internet gaming disorder is a newly defined mental disorder. Illness representations of internet gaming disorder may affect one's risk of internet gaming disorder. In turn, symptoms of internet gaming disorder may affect one's perceptions of the disorder.

OBJECTIVE

This study aimed to investigate the relationships between illness representations and symptoms of internet gaming disorder in college students.

METHODS

A 1-year longitudinal study was conducted with a convenience sample of Chinese college students (n=591; 342/591, 57.9% female).

RESULTS

Of the participants, 10.1% (60/591) and 9.1% (54/591) were classified as having probable internet gaming disorder at baseline (T1) and follow-up (T2), respectively. The correlations between some dimensions of illness representations regarding internet gaming disorder (ie, consequence, timeline, personal control, treatment control, and concern) at T1 and symptoms of internet gaming disorder at T2 and between symptoms of internet gaming disorder at T1 and the dimensions of illness representations at T2 (ie, consequence, timeline, personal control, and emotional response) were statistically significant. The cross-lagged model fit the data well ((χ2/df=2.28, comparative fit index=.95, root mean square error of approximation=.06) and showed that internet gaming disorder at T1 was positively associated with unfavorable illness representations at T2.

CONCLUSIONS

Individuals with more severe symptoms of internet gaming disorder had more pessimistic perceptions about the disorder. Such cognitive perceptions may affect one's emotional and behavioral reactions towards the disorder (eg, greater levels of depression and low self-control intention) and should be modified by educational programs and psychological interventions.

Depression Mediates the Relationship between Childhood Trauma and Internet Addiction in Female but Not Male Chinese Adolescents and Young Adults

Internet addiction is associated with a range of psychological risk factors such as childhood trauma and depression. Studies have also suggested sex differences in internet and other behavioral addictions. However, it remains unclear how childhood trauma, depression and internet addiction inter-relate differently between the sexes. A total of 1749 adolescents and young adults aged 12–27 participated in a survey of sociodemographic characteristics and standardized assessments to evaluate internet addiction (Internet Addiction Test), childhood trauma (Childhood Trauma Questionnaire) and depression (Beck Depression Inventory). Mediation and path analyses were used to examine the relationship between childhood trauma, depression and internet addiction. Internet-addicted females relative to males showed more severe depression but the control participants showed the opposite. Childhood trauma was associated with depression for both internet-addicted males and females; however, internet-addicted females but not males showed significant associations between depression and the severity of internet addiction as well as between childhood trauma and the severity of internet addiction. Further, in females, depression mediated the correlations between all types of childhood trauma and the severity of internet addiction. A path analysis suggested that sexual abuse and emotional neglect contributed most significantly to internet addiction when all types of childhood trauma were examined in one model. The findings suggest sex differences in the relationship between childhood trauma, depression and internet addiction. Childhood trauma contributes to internet addiction through depression only in females. The findings may guide future prevention and intervention strategies of internet addiction.

How COVID-19 stress related to schooling and online learning affects adolescent depression and Internet gaming disorder: Testing Conservation of Resources theory with sex difference

BACKGROUND AND AIMS

The COVID-19 pandemic poses a grim challenge to adolescents' daily life, including schooling and learning, which has great impacts on their mental and behavioral health. This study aimed to test the roles of stress related to schooling and online learning during COVID-19 (COVID-19 stress) in depression and Internet gaming disorder (IGD) among adolescents and the potential mediators of social support, academic stress, and maladaptive emotion regulation based on the framework of Conservation of Resources theory. Sex differences in these associations were further examined.

METHODS

A school-based survey was conducted among Chinese adolescents in 13 secondary schools in Hong Kong (n = 3,136) from September to November 2020 (48.1% males; mean age = 13.6 years old) using stratified random sampling.

RESULTS

The prevalence of probable depression and IGD was 60% and 15%, respectively. Results of structural equation modeling indicated that the proposed model fit the data well (χ2/df = 7.77, CFI = 0.92, IFI = 0.92, RMSEA = 0.05). COVID-19 stress was positively and indirectly associated with both depression and IGD through social support, academic stress, and maladaptive emotion regulation. Multi-group analyses identified that the associations between COVID-19 stress and academic stress, between academic stress and depression, and between social support and depression were stronger among females compared to males.

DISCUSSION AND CONCLUSIONS

Findings highlight the roles of academic stress, poor social support, maladaptive emotion regulation, and sex to understand how disruption and stress caused by COVID-19 increases adolescent depression and IGD. Psychosocial interventions based on these factors are highly warranted.

Gaming to relieve tension or anxiety and associations with health functioning, substance use and physical violence in high school students

Gaming is popular among youth and gaming disorders have been introduced recently into psychiatric nomenclature systems. Motivations underlying gaming may include involvement to reduce negative emotional states and thus may link to psychiatric and overall health. Thus, the extent to which adolescents engage in gaming to relieve anxiety warrants additional investigation. Data from 2005 Connecticut high-school students were used to examine how adolescents who reported gaming to relieve tension or anxiety differed from those who reported gaming but not to relieve tension or anxiety on measures of demographics, academic performance, general health, extracurricular activities, dysphoria/depression symptoms, substance use, and aggressive or violent behaviors. Chi-square analyses and binomial and multinomial logistic regression models were conducted. Gaming to relieve anxiety was more prevalent in boys and Hispanic and Asian adolescents and associated with less extracurricular involvement, poorer academic performance, increased cigarette and other drug use, problematic internet use, and depression. Participants with gaming to relieve tension or anxiety were also more likely to report weapon-carrying, missing school because they felt unsafe, having been threatened with a weapon, having engaged in physical fights, and having experienced injuries from fights. As gaming to relieve anxiety was related to mental-health- and functioning-related measures, additional research is needed to examine the precise natures of these relationships and to translate the information into improved intervention strategies.

Anxiety-Depressive Syndrome and Binge-Watching Among Young Adults

In recent years, binge-watching becomes a highly popular way of spending free time. Even though binge-watching usually is related to entertainment, there are concerns about some negative and unhealthy outcomes of excessive form of this behavior. The study examined the predictive value of anxiety-depressive syndrome in explaining the symptoms of problematic binge-watching and the tendency to adopt a specific motivation to watch series. Research group consists of 645 Polish young adults. The State-Trait Anxiety Inventory, Depression Measurement Questionnaire, Viewing Motivation Scale, and Questionnaire of Excessive Binge-Watching were used in this study. The results of the path analysis show that anxiety-depressive syndrome and motivation to watch TV series are the significant factors in the manifestation of all symptoms of problematic binge-watching. Moreover, there is a significant relation between anxiety-depressive syndrome and motivation to watch TV series, which especially concerns escape motivation and motivation to deal with loneliness. Furthermore, motivation to deal with loneliness, escape motivation, and motivation to spend free time have mediating effect on the relationship between anxiety-depressive syndrome and problematic binge-watching. Results of this research show that there could be not only normative binge-watching behavior but also unhealthy and problematic form of this behavior.

Neurobiological mechanisms underlying internet gaming disorder

This review summarizes studies on the neurobiological correlates of internet gaming disorder (IGD), presently the most direct approach to analyzing the impact of digital technology and the internet on brain mechanisms. Brain imaging studies have shown that IGD shares, to a large extent, neurobiological alterations that are typical for other addictions, such as: (i) activation in brain regions associated with reward, as evident from cue exposure and craving studies and neurotransmitter systems studies that indicate an involvement of dopamine-mediated reward mechanisms; (ii) reduced activity in impulse control areas and impaired decision making; and (iii) reduced functional connectivity in brain networks that are involved in cognitive control, executive function, motivation, and reward. Moreover, there are structural changes, mainly reduction in gray-matter volume and white-matter density. Comorbidity studies indicate that executive control networks in attention deficit-hyperactivity disorder (ADHD) may increase the susceptibility to develop IGD. Most importantly, this review also outlines findings that show the effects of excessive use of screens, here referring to the playing of computer games, which activate many brain regions associated with cognitive, motor, and sensory function and not directly involved in other forms of addiction. This review describes and summarizes comprehensively the neurobiological correlates of addictive internet use in adolescents and young adults.
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Large-scale network dysfunction in youths with Internet gaming disorder: a meta-analysis of resting-state functional connectivity studies

Internet gaming disorder (IGD) has been defined as a specific behavioral disorder, associated with abnormal interactions among large-scale brain networks. Researchers have sought to identify the network dysfunction in IGD using resting-state functional connectivity (rsFC). However, results across studies have not reached an agreement yet and the mechanism remains unclear. The present research aimed to investigate network dysfunction in IGD through a meta-analysis of rsFC studies. Twenty-two seed-based voxel-wise rsFC studies from 25 publications (594 individuals with IGD and 496 healthy controls) were included. By categorizing seeds into seed-networks based on their location within a prior functional network parcellations, we performed a Multilevel kernel density analysis (MKDA) within each seed-network to identify which brain systems showed abnormal interaction with particular seed-network in individuals with IGD. Compared to healthy control groups, individuals with IGD exhibited significant hypoconnectivity within the default mode network, and enhanced connectivity between the default mode network and insula within the ventral attention network. IGD was also associated with increased connectivity between the ventral attention network and somatomotor regions. Furthermore, the IGD groups showed hyperconnectivity between the limbic network and regions of the frontoparietal network. The results suggest that individuals with IGD show large-scale functional network alteration which underpins their core symptoms including poor emotional competence, cue-reactivity and craving, habitual addictive behaviors and impaired executive control. Whether the compensation mechanism exists in IGD is discussed, and further research is needed. The findings provide a neurocognitive network model of IGD, which may serve as functional biomarkers for IGD and have potentials for development of effective diagnosis and therapeutic interventions.

Longitudinal predictors for incidence of internet gaming disorder among adolescents: The roles of time spent on gaming and depressive symptoms

INTRODUCTION

Internet gaming disorder (IGD) was popular among adolescents worldwide, but whether some associated factors could contribute to the development of IGD was unclear. This longitudinal study explored the temporal stability of IGD over one year and determined the predictors for IGD incidence.

METHODS

Participants were 1121 adolescents from six junior high schools in Shanghai, China (50.6% males; median age = 13.0 years). The baseline and follow-up questionnaire survey measured IGD, time spent on gaming, depressive symptoms, insomnia condition, substance use and background variables from 7th to 8th grade. Multivariate logistic regression analysis was conducted to test the associations between other factors and IGD incidence.

RESULTS

IGD incidence was 7.7% at one-year follow-up. Gender, family financial condition, parental educational level, time spent on gaming, insomnia condition and depressive symptoms were associated with IGD incidence in univariate analysis, whereas only gender, family financial condition, time spent on gaming and depressive symptoms were associated with IGD incidence in multivariate logistic regression.

CONCLUSIONS

IGD might persist for years during adolescence. After controlling for sociodemographic factors, time spent on gaming and depressive symptoms were independent predictors for IGD incidence.

The functional connectivity between the prefrontal cortex and supplementary motor area moderates the relationship between internet gaming disorder and loneliness

BACKGROUND

Individuals with internet gaming disorder (IGD) usually report a higher sense of loneliness. Although studies have suggested a key role of the prefrontal cortex-based resting-state functional connectivity (rsFC) in both IGD and loneliness, the potential mechanism between IGD and loneliness remains unclear.

METHODS

Fifty-seven IGD and 81 matched recreational internet gamer users (RGU) underwent resting-state fMRI scans. The UCLA loneliness scale was used to measure loneliness. We first explored the brain areas that are both associated with loneliness and IGD severity. Then, the neuroimaging findings were extracted to test whether the rsFC of these brain regions moderates the relationship between IGD and loneliness.

RESULTS

We observed reduced rsFC between the left dorsolateral prefrontal cortex (DLPFC) and the left precentral and the postcentral gyri and the supplementary motor area (SMA), which also correlated with increased IAT (Young''s internet addiction test) scores. More importantly, the rsFC of the DLPFC-precentral gyrus and the DLPFC-postcentral gyrus moderated the relationship between IGD severity and loneliness scores. Additionally, we also found that the rsFC of the left DLPFC-precentral gyrus, the DLPFC-postcentral gyrus and the right DLPFC-SMA moderated the relationship between self-reported gaming craving and the UCLA scores.

CONCLUSIONS

The current study confirmed the role of the DLPFC in reward control (game craving) and emotion regulation (loneliness). Additionally, the rsFC of the prefrontal cortex-supplementary motor area moderates IGD and loneliness. These findings provide valuable understanding of the two-way relationship between IGD and loneliness.