The Comorbidity of Gambling Disorder among Macao Adult Residents and the Moderating Role of Resilience and Life Purpose

The prevalence of gambling and problematic gambling: a systematic review and meta-analysis

BACKGROUND

Gambling behaviours have become of increased public health interest, but data on prevalence remain scarce. In this study, we aimed to estimate for adults and adolescents the prevalence of any gambling activity, the prevalence of engaging in specific gambling activities, the prevalence of any risk gambling and problematic gambling, and the prevalence of any risk and problematic gambling by gambling activity.

METHODS

We performed a systematic review and meta-analysis. We systematically searched for peer-reviewed literature (on MEDLINE, Embase, and PsycInfo) and grey literature to identify papers published between Jan 1, 2010, and March 4, 2024. We searched for any gambling, including engagement with individual gambling activities, and problematic gambling data among adults and adolescents. We included papers that reported the prevalence or proportion of a gambling outcome of interest. We excluded papers of non-original data or based on a biased sample. Data were extracted into a bespoke Microsoft Access database, with the Joanna Briggs Institute Critical Appraisal Tool used to identify the risk of bias for each sample. Representative population survey estimates were firstly meta-analysed into country-level prevalence estimates, using metaprop, of any gambling, any risk gambling, problematic gambling, and by gambling activity. Secondly, population-weighted regional-level and global estimates were generated for any gambling, any risk gambling, problematic gambling, and specific gambling activity. This review is registered on PROSPERO (CRD42021251835).

FINDINGS

We screened 3692 reports, with 380 representative unique samples, in 68 countries and territories. Overall, the included samples consisted of slightly more men or male individuals, with a mean age of 29·72 years, and most samples identified were from high-income countries. Of these samples, 366 were included in the meta-analysis. Globally, 46·2% (95% CI 41·7-50·8) of adults and 17·9% (14·8-21·2) of adolescents had gambled in the past 12 months. Rates of gambling were higher among men (49·1%; 45·5-52·6) than women (37·4%; 32·0-42·5). Among adults, 8·7% (6·6-11·3) were classified as engaging in any risk gambling, and 1·41% (1·06-1·84) were engaging in problematic gambling. Among adults, rates of problematic gambling were greatest among online casino or slots gambling (15·8%; 10·7-21·6). There were few data reported on any risk and problematic gambling among adolescent samples.

INTERPRETATION

Existing evidence suggests that gambling is prevalent globally, that a substantial proportion of the population engage in problematic gambling, and that rates of problematic gambling are greatest among those gambling on online formats. Given the growth of the online gambling industry and the association between gambling and a range of public health harms, governments need to give greater attention to the strict regulation and monitoring of gambling globally.

FUNDING

Australian National Health and Medical Research Council.

Desire Thinking About Gambling: Assessment and Associations With Gambling Disorder and Responsible Gambling Among Chinese Gamblers

Desire thinking, within the metacognitive model of addictive behaviors, is conceptualized as a transdiagnostic process linked to the escalation and maintenance of craving for various addictive disorders; however, its application to the understanding of gambling and the Chinese community remains at an early stage. The present study aimed to introduce desire thinking into gambling research in the Chinese context by: (1) testing the applicability of its two-factor conceptualization and assessment tool, the Desire Thinking Questionnaire (DTQ), and (2) exploring its association with dysregulated and regulated engagements in gambling (i.e., Gambling Disorder [GD] and responsible gambling [RG], respectively). We conducted a telephone survey in Macao, China, and obtained a probability sample of 837 Chinese adult past-year gamblers (48.5% men; age: M = 41.11, SD = 14.31) with a two-stage cluster random sampling method. Our data indicated the psychometric adequacy of the two-factor DTQ (i.e., verbal perseveration and imaginal prefiguration) for measuring Chinese gamblers' desire thinking about gambling. After controlling for craving and demographics, desire thinking contributed to an additional 12.1% and 18.9% variance explained in GD tendency and RG behaviors, respectively. This study provides the first empirical evidence of the utility of desire thinking and the DTQ in facilitating gambling research on Chinese gamblers. Our findings also suggest the value of incorporating desire thinking in detecting and treating GD and in promoting RG.

A Double-Edged-Sword Effect of Overplacement: Social Comparison Bias Predicts Gambling Motivations and Behaviors in Chinese Casino Gamblers

Overconfidence, a widely observed cognitive bias, has been linked to increased gambling motivations and behaviors. However, previous studies have largely overlooked overconfidence under a social comparison context, known as overplacement, i.e., the tendency of individuals to believe that they are better than their similar peers. In the present study, we tested the effect of overplacement on gambling motivations and behaviors though a Pilot Survey of Chinese college students (N = 129) and a Field Survey of Chinese Macao casino gamblers (N = 733). Our results revealed a double-edged sword effect of overplacement: Serving as a risk factor, evaluating one self's earning ability as higher than others was linked to more gambling motivations (β = 0.18, p = .005) and frequency (β = 0.18, p = .004); Serving as a protective factor, evaluating oneself as happier than others was linked to less gambling motivations (β = - 0.32, p < .001) and problem behaviors (β = - 0.26, p < .001). These findings expand the relationship between overconfidence and gambling from a cognitive bias perspective to a social comparison perspective. Our study not only revealed a typical profile of gambling motivations and behaviors among different demographic groups in Chinese casino gamblers, but also highlighted the importance of considering social factors in the study of the psychological mechanisms of gambling.

Characteristics of Gambling Helpline Callers in Macao: A Regional Comparison

Despite the continued focus on profiling gambling helpline callers, little is known about the characteristics of callers in Macao. To address this gap, this study aims to investigate the characteristics of problem gamblers calling the helpline in Macao and explore the regional differences between callers from Macao, mainland China, and Hong Kong. Specifically, the study examined their demographics, helpline usage, and gambling-related characteristics. The study used data collected by SKHSSCO between 2015 and 2021. The results showed that, at the aggregate level, the helpline callers in Macao were male, young, and full-time employees. The majority used the telephone and reported problems with casino table games. In addition, the referral rate was relatively low, while the rate of suicidal ideation was comparatively high. The results also revealed that callers from Macao, mainland China, and Hong Kong were notably distinct in these characteristics. The findings shed light on how to increase helpline accessibility and create tailored interventions and prevention efforts to better support individuals affected by problem gambling.

The protective effects of cognitive empathy and emotional empathy on gambling disorder are mediated by risk aversion and responsible gambling attitude

BACKGROUND

Based on social cognitive theory, this study aimed to examine whether and how social abilities (i.e., cognitive empathy and emotional empathy) are associated with gambling disorder (GD) by incorporating attitudes toward general risk (i.e., risk aversion) and responsible gambling as potential mediators of this link.

METHODS

A convenience sample of 580 past-year lottery gamblers (Mage = 34.07, SD = 13.36; 50.4% female), recruited near lottery sales shops, completed an anonymous paper-version questionnaire on site. Data were collected using the DSM-5 diagnostic criteria for GD, Interpersonal Reactivity Index, Risk Aversion Scale, Positive Play Scale, and demographic items. Path analysis and mediation analysis were applied to examine the effects of cognitive empathy and emotional empathy on GD and the mediating roles of risk aversion and responsible gambling attitude.

RESULTS

Our results showed that cognitive empathy, but not emotional empathy, was significantly and negatively correlated with GD. Also, the effect of cognitive empathy on GD was fully mediated by risk aversion and responsible gambling attitude, whilst the total indirect effect of emotional empathy on GD was nonsignificant. As hypothesized, the indirect paths from both types of empathy to GD were significantly and serially mediated by risk aversion and responsible gambling attitude.

CONCLUSION

Cognitive empathy, distinct from emotional empathy, was a statistically significant correlate of GD. Moreover, the path model results also suggest that responsible gambling attitude was a salient protective factors against GD. Future GD prevention efforts may benefit from paying more attention to the role of responsible gambling attitude.

Employee Perceptions of Responsible Gambling in Macao: Concepts, Indicators, and Intervention Barriers

Despite the importance of venue employees in identifying problem gamblers and making interventions, little is known concerning what role venue employees play in responsible gambling practices in Macao. This study examined what venues employees' perceptions of responsible gambling are, how they detect problem gamblers, and what barriers are impeding them from taking action. Semi-structured interviews with 49 venue staff in Macao yielded a wealth of in-depth data that were then thematically analyzed. The results indicated that employees generally understand what responsible gambling entails. While they are all confident in their ability to recognize the signs of problem gambling and provide adequate assistance to problem gamblers when asked, the majority of them rarely approach problem gamblers proactively. The barriers that prevent them from intervening were probed. The findings shed light on how to encourage venue employees to intervene on their own initiative in order to improve responsible gambling practices in Macao.

Is Empathy Associated with Gambling and Its Addiction? A Scoping Review of Empirical Studies

Considering the low levels of empathy associated with substance-related addictions and the similarities between gambling disorder (GD) and substance-related addiction, understanding the relationship between empathy and GD may clarify the mechanism of addiction development. This scoping review aimed to evaluate the empirical evidence for the potential protective role of emotional and cognitive empathy against GD development via internalizing and/or externalizing pathways. We followed the preferred reporting items for systematic review and meta-analyses extension for scoping reviews and 11 articles met the inclusion criteria. Although most of the reviewed studies used correlational designs and non-gambling-specific samples, this review highlights (1) significant relationships between both types of empathy and the neural activity of gambling behaviors, and (2) reduced cognitive empathy (i.e., fantasy and perspective taking) and increased emotional empathy (i.e., personal distress) among problem gamblers than their gambling counterparts. Despite the lack of studies directly testing the protective role of empathy against GD, the existing studies (n = 8) nevertheless shed light on the potential protective effects of both types of empathy on GD development. This review identified research gaps, which can be addressed in future studies by discovering the underlying mechanisms (e.g., internalizing and externalizing pathways) of these relationships. Experimental or longitudinal studies in gamblers investigating how different types of empathy are associated with GD via these pathways are called for as their findings have implications for prevention and intervention designs for GD and other addictive disorders.

Effects of Psychological Distress and Coping Resources on Internet Gaming Disorder: Comparison between Chinese and Japanese University Students

The high prevalence of Internet gaming disorder (IGD) among Asian youth indicates an urgent need to identify protective factors and examine their consistency across Asian cultures in order to facilitate cost-effective interventions. Based on the transactional theory of stress and coping, this study collected data of 1243 online gamers (45% males; 18-25 years) through an anonymous survey from universities in China and Japan and investigated whether three coping resources (i.e., mindfulness, coping flexibility, and social support) serve to protect Chinese and Japanese youth from the impact of psychological distress on IGD tendency. After adjusting for the measurement non-invariance across samples, we found that Japanese students reported higher levels of IGD tendency and psychological distress than Chinese students. The results of multiple-group SEM analyses showed that, after controlling for other predictors, mindfulness served as the strongest protective factor against IGD across samples. Moreover, the buffering effect of mindfulness on the association between psychological distress and IGD tendency of female (but not male) students was observed. Our findings highlighted the cross-cultural invariance of the impact of psychological distress and coping resources on IGD in Chinese and Japanese youth, which can be considered in future IGD prevention programs.

Short-Term Effectiveness of the Youth Gambling Prevention Program "Who Really Wins?"-Results from the First National Implementation

As a response to significant adolescent gambling involvement, a Croatian team of researchers and practitioners developed a universal, comprehensive, evidence-based youth gambling prevention program called "Who Really Wins?". This study presents the results on its short-term effectiveness following the first national implementation in 18 Croatian cities, with a total of 629 high school students (66.5% male) who completed the program. A design with two measurement sessions (pre-test and post-test) was used to explore the short-term effects of the program on gambling-related knowledge and cognition, frequency of gambling, and various socio-emotional skills. The results showed significant effects when it comes to knowledge, cognitive distortions, and the frequency of sports betting and playing lottery games. Furthermore, the program had no harmful effects on any of the measured variables. The results are interpreted in terms of methodological challenges in measuring effects, possible improvements of the program, and implications for future evaluation research.

A cross-lagged panel model for testing the bidirectional relationship between depression and smartphone addiction and the influences of maladaptive metacognition on them in Chinese adolescents

AIMS

Despite the high prevalence of both depression and smartphone addiction among Chinese adolescents, research examining their bidirectional relationship has been limited. Moreover, longitudinal research regarding the influence of maladaptive metacognitive beliefs on smartphone addiction is scarce. This 6-month longitudinal study aimed to address these research gaps by testing a cross-lagged panel model of maladaptive metacognition, depression, and smartphone addiction.

METHODS

Four hundred and fifty-nine Chinese high school students voluntarily completed an anonymous questionnaire at baseline, and 313 of them (36.1% male; age = 14 to 18; M = 16.88, SD = 0.62) completed the same questionnaire at follow-up.

RESULTS

Positive correlations were shown among depression, smartphone addiction, and maladaptive metacognition at both waves (r = 0.16 to 0.57, p < .01). The results of the cross-lagged analysis demonstrated only the prospective effect of depression on smartphone addiction (β = 0.18, p < .001) but not vice versa. Moreover, maladaptive metacognition assessed at baseline significantly predicted subsequent depression (β = 0.14, p < .01) but not smartphone addiction (p>.05). Additional path analysis showed a significant indirect effect of baseline maladaptive metacognition (0.099 [95% CI = 0.042, 0.183]) on subsequent smartphone addiction, via depression.

CONCLUSIONS

Findings of this study showed that the relationship between depression and smartphone addiction was unidirectional rather than bidirectional among Chinese adolescents. Specifically, depression predicted smartphone addiction, while maladaptive metacognition predicted depression. Depression also mediated the relationship between maladaptive metacognition and smartphone addiction. The findings suggest that incorporating metacognition and depression interventions into smartphone addiction prevention designs for adolescents may be beneficial.

Gambling and Attachment: The Mediating Role of Alexithymia in Adolescents and Young Adults

Attachment and alexithymia play a central role in the appearance and persistence of pathological gambling and related comorbid addictive behaviours among adolescents and young adults. The aim of the present study was to explore the differences between problem gamblers and non-problem gamblers in gambling severity, spending, video gaming, alcohol and drugs use, attachment, and alexithymia, as well as the interaction among these variables. The study sample included 560 participants non-problem gamblers (mean age = 15.49 years) and 54 problem gamblers (mean age = 16.43 years). Gambling disorder (SOGS-RA), drugs, alcohol, video games and spending (MULTICAGE CAD-4), attachment (IPPA), and alexithymia (TAS-20) were measured. Student's t, Pearson's r, and multiple mediation analyses were conducted. Problem gamblers scored significantly higher in all substance and non-substance addictive behaviours and alexithymia; as well as significantly lower scores in mother and father attachment scales. Moreover, gambling was negatively associated to father and mother attachment, and positively associated to alexithymia. Finally, alexithymia was found to mediate between parental attachment and gambling, spending, videogame, drug and alcohol abuse, especially in the case of mother attachment. This study demonstrated that adolescent and young adult problem gamblers show higher comorbid addictions than non-problem gamblers, in the same way as higher levels of alexithymia and poorer father attachment. Given that higher comorbidity in early ages is associated with worse prognosis and higher psychopathology in adult life, early detection and treatment purposes becomes essential.

Mental distress during the COVID-19 pandemic: Its association with public perceptions toward government's pandemic responses and lifestyle changes

In order to propose better mental health interventions under the pandemic threat, the present study aimed to investigate whether depression and anxiety are associated to Chinese adults' perceptions of government's pandemic responses and the personal lifestyle changes imposed by those responses during the COVID-19 pandemic. We used a telephone survey with random sampling and obtained a probability community sample of 616 adults (39.1% men; M age = 41.7, SD age = 16.3) in Macao, China in April 2020. The prevalence of 8.8% probable depression and 12.0% probable anxiety was observed in this sample. Positive perceptions toward government's pandemic responses were found to be negatively associated with probable depression and probable anxiety (ORu = .36 and .41, p < .05). Three lifestyle-changing stressors (i.e., increased family conflict, friendship deterioration, and weight gain), were commonly reported (29.9, 27.5, and 43.0% respectively), and displayed positive associations with probable depression (ORu = 1.67 to 1.87, p < .05) and probable anxiety (ORu = 1.54 to 2.10, p < .05). Our findings suggest protective effects of perceived trust and satisfaction regarding government's pandemic responses against mental distress and the potential mental health threats from three pandemic-specific lifestyle-changing stressors. These findings can inform clinicians and policymakers to better prepare for the mental health impacts of the current and future pandemics.

Gambling motives: Association with addictive disorders and negative and positive mood in youth

Gambling disorder and other comorbid addictive disorders may have similar underlying affective and motivational patterns. This study aims at examining the association between gambling disorder, comorbid addictive disorders (i.e., alcohol, drugs, spending, and videogames), positive and affective mood, and gambling motives in a community sample. A sample of 1099 adolescents and young adults was recruited from educational centres, from which 569 (51.7%) scored as non-problem gamblers, 42 (3.8%) as at-risk gamblers, and 53 (4.8%) as problem gamblers. Results suggest that enhancement, social, and coping motives are greater among problem gamblers and at-risk gamblers as compared to non-problem gamblers. Problem gamblers scored higher in gambling and comorbid disorders than at-risk gamblers, and also higher in gambling motives and negative mood when compared to non-problem gamblers. Likewise, gambling severity was significantly associated to gambling motives, negative mood, and other addictive disorders. Finally, enhancement motives were predictive of gambling, alcohol, drugs, and spending while controlling for the effect of age, sex, and positive and negative mood. These results shed light into the nature of the relationship between gambling and other comorbid addictions and can be used to tailor prevention and treatment strategies.

The prospective effect of purpose in life on gambling disorder and psychological flourishing among university students

BACKGROUND AND AIMS

Gambling disorder (GD) is a mental disorder with a relatively higher prevalence in university students compared to adolescents and adults. Its reciprocity with mental being indicators, such as psychological flourishing, would be expected, but prior to this study had not yet been empirically examined. In addition, the predictive value of purpose in life (PIL) on university students' GD and psychological flourishing also remained unknown. This 1-year longitudinal study was the first to test the potential bidirectional relationships among PIL, self-reported GD symptoms, and psychological flourishing.

METHODS

In this study, a total of 283 university students (39.6% females; age = 18-27 years, M = 20.47, SD = 1.15) completed an anonymous questionnaire at both baseline and a year later in a follow-up study.

RESULTS

The results of our cross-lagged analysis did not show the hypothesized reciprocity between GD symptoms and psychological flourishing (P > 0.05). However, PIL significantly predicted fewer GD symptoms (β = -0.23, P < 0.001) and higher levels of psychological flourishing (β = 0.30, P < 0.001) in the follow-up study. Moreover, psychological flourishing predicted PIL a year later.

CONCLUSION

The findings demonstrate the potential efficacy of purpose/meaning oriented interventions in gambling prevention and in well-being promotion programs.

The psychometric properties of the Revised Illness Perception Questionnaire (IPQ-R) regarding Internet gaming disorder in a general population of Chinese adults

BACKGROUND AND AIMS

Internet gaming disorder (IGD) has been recognized as a mental illness. Cognitive and emotional illness representations affect coping and health outcomes. Very little is known about such perceptions related to IGD, in both general and diseased populations. This study examined the psychometric properties of the Revised Illness Perception Questionnaire (IPQ-R) for IGD in a general population that included mostly non-cases while a small proportion of the sample was IGD cases.

METHODS

An anonymous cross-sectional telephone survey was conducted in a random sample of 1,501 Chinese community-dwelling adults (41.3% male; mean age = 40.42, SD = 16.85) in Macao, China.

RESULTS

The confirmatory factor analysis identified a modified 6-factor model (i.e., timeline cyclical, consequences, personal control, treatment control, illness coherence, and emotional representations) of 26 items that showed satisfactory model fit and internal consistency. Criterion-related validity was supported by the constructs' significant correlations with stigma (positive correlations: timeline cyclical, consequence, emotional representations; negative correlations: illness coherence). Ever-gamers, compared to never-gamers, reported higher mean scores in the subscales of personal control and illness coherence, and lower mean scores in time cyclical, consequence, and emotional representations. Among the sampled gamers, probable IGD cases were more likely than non-IGD cases to perceive IGD as cyclical and involved more negative emotions.

CONCLUSIONS

This study shows that the revised 26-item version of IPQ-R is a valid instrument for assessing illness representation regarding IGD in a general population of Chinese adults. It can be used in future research that examines factors of incidence and prevention related to IGD.

The prospective effect of purpose in life on gambling disorder and psychological flourishing among university students

BACKGROUND AND AIMS

Gambling disorder (GD) is a mental disorder with a relatively higher prevalence in university students compared to adolescents and adults. Its reciprocity with mental being indicators, such as psychological flourishing, would be expected, but prior to this study had not yet been empirically examined. In addition, the predictive value of purpose in life (PIL) on university students' GD and psychological flourishing also remained unknown. This 1-year longitudinal study was the first to test the potential bidirectional relationships among PIL, self-reported GD symptoms, and psychological flourishing.

METHODS

In this study, a total of 283 university students (39.6% females; age = 18-27 years, M = 20.47, SD = 1.15) completed an anonymous questionnaire at both baseline and a year later in a follow-up study.

RESULTS

The results of our cross-lagged analysis did not show the hypothesized reciprocity between GD symptoms and psychological flourishing (P > 0.05). However, PIL significantly predicted fewer GD symptoms (β = -0.23, P < 0.001) and higher levels of psychological flourishing (β = 0.30, P < 0.001) in the follow-up study. Moreover, psychological flourishing predicted PIL a year later.

CONCLUSION

The findings demonstrate the potential efficacy of purpose/meaning oriented interventions in gambling prevention and in well-being promotion programs.

Validation and Application of the Positive Play Scale Adapted for Chinese Gamblers: Its Relation to Disordered Gambling and Gambling Attitudes

The Positive Play Scale (PPS) was designed to track the effectiveness of responsible gambling (RG) policy, with a focus on positive changes in beliefs and behaviors instead of the absence of problem gambling symptoms. The current study aimed to (1) validate the Positive Play Scale Adapted for Chinese gamblers (PPS-AC) using a probability Chinese community sample in Macao, (2) explore the relationships between the PPS-AC and symptoms of gambling disorder (GD), and (3) evaluate the associations of gambling attitudes with the PPS-AC. Through a two-step random sampling procedure, we interviewed 1,002 locally dwelling Macao Chinese adults (44.3% males; M_age = 44.28 years, SD_age = 17.35 years) by phone, in which 237 were past-year gamblers (49.8% males; M_age = 40.76 years, SD_age = 15.78 years). Results showed that a two-dimension structure fitted the data well for both the positive play behaviors scale and the positive play beliefs scale of the PPS-AC among past-year gamblers. In addition to findings of satisfactory internal consistency, the convergent validity of the PPS-AC was supported by its significant association with RG self-efficacy. All four PPS-AC constructs were negatively correlated with GD symptoms, whereas two behavior constructs of the PPS-AC significantly explained the variance of GD symptoms with negative valences. All gambling attitude dimensions were associated with at least one PPS-AC construct. The current study was the first to adapt the PPS on a probability Chinese community sample and extended its applicability. The findings support the PPS-AC as a reliable and valid tool for assessing positive play, which was negatively associated with symptoms of disordered gambling. Further, the significant associations between gambling attitudes and the PPS-AC provide insights for RG policies.

Purpose in life, social support, and internet gaming disorder among Chinese university students: A 1-year follow-up study

AIMS

Given the high prevalence of Internet gaming disorder (IGD) among university students and the beneficial effects of positive psychological factors on mental illness, the present longitudinal research aimed to investigate whether purpose in life and social support yields long-term results in protecting university students from IGD.

METHODS

We recruited 469 Chinese university students to voluntarily fill out an anonymous questionnaire at baseline, and 283 of them were followed up and given similar measures after one year.

RESULTS

The prevalence of probable IGD at the baseline and follow-up surveys was 14.8% and 9.9% respectively. Purpose in life and social support were negatively correlated with IGD symptoms in both surveys (p < .05). The results of a cross-lagged analysis showed that purpose in life, but not social support, assessed at baseline predicted fewer IGD symptoms at follow-up (p < .001). In addition, social support and purpose in life predicted one another across time.

CONCLUSIONS

The prevalence of probable IGD was high among Chinese university students. Purpose in life was shown to be an effective significant protective factor against IGD, while the effect of social support might be indirect. Positive psychology interventions, which promote the search for and attainment life purpose, may be incorporated in school-based program for IGD prevention.

The Predictive Value of Emotional Intelligence for Internet Gaming Disorder: A 1-Year Longitudinal Study

This one-year longitudinal study examined trait emotional intelligence as a predictor of Internet gaming disorder (IGD). To date, only cross-sectional research has been conducted to test the protective effects of emotional intelligence against IGD tendency. Based on the Interaction of Person-Affect-Cognition-Execution (I-PACE) model, this study aimed to address the research gap by examining not only the direct effects of trait emotional intelligence, but also its indirect effects (via depressive symptoms and coping flexibility) on IGD, with both a cross-sectional and longitudinal design. The participants were 282 Chinese university students (mean age = 20.47; 39.4% males) who voluntarily completed an anonymous questionnaire at both baseline (W1) and one-year follow-up (W2). Path analysis results revealed that trait emotional intelligence had a protective but indirect effect on IGD tendency in both our cross-sectional and longitudinal data. Depression was found to have a significant, full mediating effect on the relationship between: (i) trait emotional intelligence and IGD tendency (W2) and (ii) coping flexibility and IGD tendency (W2), after adjusting for IGD tendency at the baseline (W1). Gender invariance of the path coefficient was also observed in the prospective model. This study provided longitudinal evidence to support the I-PACE model. Interventions should address both IGD and depressive symptoms, and school-based workshops to increase emotional intelligence and coping flexibility are also recommended.

The Mediating Effects of Affect on Associations between Impulsivity or Resilience and Internet Gaming Disorder

Internet gaming disorder (IGD) is a new disease proposed by the Diagnostic and Statistical Manual of Mental Disorders-Fifth Edition (DSM-5), and has been studied extensively in relation to depression and impulsivity. The relationship between resilience and disease has been found in a variety of addictive disorders, but studies on IGD are lacking. In this study, 71 IGD patients and 78 healthy controls (HCs) were recruited. Impulsivity, resilience, affects, and the degree of internet game addiction were measured using formal tools. The measured values were analyzed by mediation analysis to evaluate the mediating role of affects on resilience and impulsivity related to IGD symptoms. The IGD group showed higher impulsivity, lower resilience, lower positive affect, and higher negative affect than the HC group. The mediation analysis showed that a positive affect was a mediator between impulsivity and the severity of addiction in both groups. Negative affect mediated impulsivity/resilience and the severity of addiction only in the IGD group. Although the results of this study are based on a narrow category of subjects, who are young male adults around 25 years of age, the results suggest that positive affect can be strengthened to prevent the IGD illness, and that illness symptoms may be alleviated by reducing negative affect.