Problematic online gaming and the COVID-19 pandemic.

Stay-at-home mandates and quarantines related to the coronavirus (COVID-19) pandemic have led to greatly increased participation in online gaming. Initiatives such as #PlayApartTogether that promote gaming for socializing and stress reduction may achieve positive outcomes. Although gaming can be a healthy coping strategy for the majority, it can also pose risks to some vulnerable individuals. Protracted periods of social isolation and technology-based activity pose the danger of solidifying unhealthy lifestyle patterns, leading to difficulties to readaptation when the COVID-19 crisis has passed. Balanced and effective approaches to gaming during the COVID-19 pandemic are needed to support physical and psychological wellbeing

The concept of "harm" in Internet gaming disorder

Internet gaming disorder (IGD) is a proposed condition that refers to persistent gaming leading to clinically significant impairment. However, there have been few attempts to study the different types and degrees of harm caused by IGD. This commentary describes some of the negative intrapersonal and interpersonal effects of an extreme time investment in gaming activities in the context of IGD. Future research should examine the way in which IGD harms may occur at different levels and degrees. This may enhance the screening of individuals whose behavior is suspected to meet the definition of the proposed IGD criteria.Daniel L. King, Paul H. Delfabbr

Predatory monetization schemes in video games (e.g. 'loot boxes') and internet gaming disorder

EditorialDaniel L. King and Paul H. Delfabbr

Loot box limit-setting is not sufficient on its own to prevent players from overspending: a reply to Drummond, Sauer & Hall

Abstract not availableDaniel L. King, Paul H. Delfabbr

The convergence of gambling and monetised gaming activities

Available online 9th November 2019A recent innovation contributing to the massive growth and profitability of the gaming industry has been the development of in-game monetisation. In-game purchasing features (e.g. ‘loot boxes’, ‘skins’, and other microtransactions) have also generated debate in some jurisdictions as to whether some activities constitute a form of gambling. This brief review presents some academic perspectives and recent studies that have examined the validity of this claim. Evidence has focused on the nature of micro-transaction purchase behaviour, its similarity with gambling, parallel involvement in gambling, and its association with problematic gaming. Early evidence suggests that higher levels of involvement in monetised gaming activities may be associated with symptoms of problematic gaming or gambling.Daniel L King and Paul H Delfabbr

Prevention strategies to address problematic gaming: an evaluation of strategy support among habitual and problem gamers

Psychosocial problems arising from excessive gaming are a public health issue across the developed world. In its most serious form, problematic gaming is recognized as gaming disorder (GD) in the ICD-11. Research has tended to focus on the value of outpatient treatment for GD, but less attention has been paid to broader prevention strategies to address less serious but nevertheless harmful gaming behaviors. Another gap in this literature has been the lack of involvement of the gaming community as stakeholders to identify feasible prevention approaches. This study investigated: (1) regular and problematic gamers’ level of support for different prevention strategies within primary, secondary, and tertiary approaches; and, (2) whether self-efficacy is associated with greater support for prevention strategies, as predicted by the Health Belief Model. A total of 992 participants completed an online survey that evaluated support for problem gaming prevention strategies and included measures of self-efficacy, gaming involvement, and GD symptoms, psychological distress, and mental health help-seeking behaviors. Participants reported stronger support for primary prevention strategies, including education, screening, and warning labels, than for other prevention approaches. Overall, 61% of participants expressed support for primary prevention as compared to secondary (39%) and tertiary (36%) approaches. There was stronger support for outpatient care (48%) than inpatient services (25%). In-game shutdown features received the lowest support (65% disapproval). Contrary to the Health Belief Model, self-efficacy was not associated with prevention support. Younger, female, and less frequent gamers were more likely to support primary and secondary prevention strategies. These findings suggest that gamers may be more favorable toward prevention measures aligned with informed decision-making, autonomy, and self-directed actions. Gamers may be strongly opposed to modifications to the structure of gaming activities (e.g., shutdown features). Future research should evaluate the efficacy and cost-effectiveness of problem gaming prevention measures in different populations and regions.Matthew W. R. Stevens, Paul H. Delfabbro and Daniel L. Kin

Prevention approaches to problem gaming: a large-scale qualitative investigation

Prevention and harm minimization approaches to problem gaming have become a matter of growing public health interest, following the recognition of gaming disorder and hazardous gaming in the ICD-11. The present study was the first to gather firsthand accounts of the potential options and challenges for prevention approaches among regular and problematic gamers. An online survey of 992 adult gamers (N = 221 problem gamers) yielded 1987 text responses to open-ended questions. Qualitative analysis of 53,458 words extracted 9 subcategories. Participants believed that some gaming activities were inherently riskier than others, particularly those with ‘predatory’ in-game spending features (microtransactions) that resemble or facilitate electronic gambling. Some participants supported the introduction of in-game features that might facilitate greater self-monitoring and awareness (e.g., education, playing time notifications, limit-setting). Some participants believed that the gaming industry should proactively support and/or fund prevention schemes and share its player data for the purpose of independent health-focused research. These results highlight some of the complexities in developing population-level approaches to problem gaming, and anticipate some of the practical barriers to gaining support from stakeholders, including the industry and the gaming community. Future research should examine the effectiveness and feasibility of voluntary primary prevention measures in real-world settings.Matthew W.R. Stevens, Paul H. Delfabbro, Daniel L. Kin

Avatar- and self-related processes and problematic gaming: a systematic review

The concept of self has become increasingly relevant to understanding the psychological mechanisms of problematic online gaming. Many gaming activities feature in-game avatars that enable the adoption of, and experimentation with, different roles and identities. Avatars enable players to compensate for perceived deficiencies in their real-world self (e.g., lack of physical strength, beauty, or social status). Currently, how avatar- and self-related processes may develop and maintain problematic gaming, including gaming disorder (GD), is unclear. This systematic review examined 18 quantitative studies of avatar- and self-related concepts and problematic gaming, including 13 survey-based and 5 neuroimaging studies. Despite variability in the conceptualization and measurement of avatar/self-related concepts, survey-based studies have consistently reported that negative self-concept, avatar identification, and large self-avatar discrepancies are significantly associated with problematic gaming. Poor self-concept appears to be a risk factor for GD, particularly for games that facilitate role-playing and identity formation. Further research and clinical evidence are needed to explain how avatar- and self-related processes may relate to the addictive mechanisms of GD (e.g., cognitive distortions, reward-seeking, inhibitory control, self-regulation systems), amid calls for problem gaming-related assessment and interventions to incorporate a focus on avatar identification.Raquel Green, Paul H.Delfabbro, Daniel L.Kin

Avatar identification and problematic gaming: the role of self-concept clarity

Some video-gaming activities feature customizable avatars that enable users to fulfil self-identity needs. Research evidence (e.g., fMRI and survey studies) has suggested that poorer self-concept and stronger avatar identification are associated with problematic gaming. Player-avatar relationships have thus been proposed to require attention in gaming disorder assessment and interventions. To examine the interplay of player-avatar interactions in problematic gaming, this study investigated whether avatar identification differed according to avatar characteristics and game types, and whether the association between avatar identification and problem gaming was mediated by self-concept clarity. A total of 993 adult respondents completed an online survey that assessed problematic gaming, avatar identification, and self-concept clarity. The results indicated that avatar identification scores were generally unrelated to avatar characteristics (e.g., human resemblance, degree of customizability, and in-game perspective). Avatar identification was significantly positively related to problematic gaming and significantly negatively related to self-concept clarity. There was a significant indirect relationship between avatar identification on problem gaming mediated through self-concept clarity. These findings suggest that poorer self-concept clarity may be one mechanism by which avatar identification affects problem gaming. Future research with clinical samples may help to gain a better understanding of avatar-related processes and psychological vulnerabilities related to problematic gaming.Raquel Green, Paul H.Delfabbro, Daniel L.Kin

Global prevalence of gaming disorder: a systematic review and meta-analysis

BACKGROUND: Gaming disorder was included in the latest revision of the International Classification of Diseases (11th ed.). Worldwide, prevalence estimates of gaming disorder are considerably heterogeneous and often appear to be exceedingly high. However, few studies have examined the methodological, cultural and/or demographic factors that might explain this phenomenon. This review employed meta-analytic techniques to compute the worldwide-pooled prevalence of gaming disorder and evaluate the potential contributing factors for varied prevalence estimates. METHOD: Prevalence estimates were extracted from 53 studies conducted between 2009 and 2019, which included 226,247 participants across 17 different countries. Study findings were meta-analyzed using a random-effects model. Subgroup and moderator analyses examined potential sources of heterogeneity, including assessment tool and cut-off, participant age and gender, sample size and type, study region, and year of data collection. RESULTS: The worldwide prevalence of gaming disorder was 3.05% (confidence interval: [2.38, 3.91]); this figure was adjusted to 1.96% [0.19, 17.12] when considering only studies that met more stringent sampling criteria (e.g. stratified random sampling). However, these estimates were associated with significant variability. The choice of screening tool accounted for 77% of the variance, with the Lemmens Internet gaming disorder-9, Gaming Addiction Identification Test and Problematic Videogame Playing scales associated with the highest estimates. Adolescent samples, lower cut-off scores and smaller sample size were significant predictors of higher prevalence. Gaming disorder rates were approximately 2.5:1 in favor of males compared to females. CONCLUSION: The worldwide prevalence of gaming disorder appears to be comparable to obsessive-compulsive disorder and some substance-related addictions, but lower than compulsive buying and higher than problem gambling. Gaming disorder prevalence rates appear to be inflated by methodological characteristics, particularly measurement and sampling issues.Matthew W R Stevens, Diana Dorstyn, Paul H Delfabbro, Daniel L Kin