Understanding motivational factors of problematic video gaming in the USMC and US Navy

Prepared for: Manpower and Reserve Affairs (M&RA), Headquarters Marine Corps (HQMC) and the Office of the Chief of Naval Operations/21st Century Sailor Office (OPNAV/N17). This research is supported by funding from the Naval Postgraduate School, Naval Research Program (PE 0605853N/2098). NRP Project ID: NPS-21-M035-A.The overarching aim of the study was to assess attributes and aspects of video gaming in the United States Navy (USN) and Marine Corps (USMC). Data were collected from two USN surface ships (in port) and three commands of the USMC. Sailors completed a cross-sectional survey and a 10-day activity log. Marines completed the survey and participated in semi-structured focus groups. Response rates to the surveys ranged from ~7.5% for Marines to ~22.5% for Sailors. Respondents consisted of 86 Sailors and 927 Marines (age MD=24 years, 92.4% males, 84.2% enlisted). From the 1,013 ADSMs, 91.6% reported playing video games (VGs) (age MD=23 years, 94.3% males, 86.1% enlisted). The information provided in the Marine focus groups along with the survey data of both Marines and Sailors suggest that video gaming is highly prevalent in the military. Many ADSMs began playing video games at 7 or 8 years of age. In general, self-identified gamers used problem-focused and emotion-focused coping styles more frequently than dysfunctional coping styles. Recreation was the most frequently reported motivational dimension for playing VGs, followed by coping with stress. Respondents reported playing VGs at home/off duty more often than when on duty or when underway/deployed. Sailors seem to be more consistent than Marines in their gaming habits. Depending on the setting, gamers reported playing VGs on average 3.75-6 days in a typical week for ~2-3 hours/day. Gamers reported playing VGs generally later in the day (i.e., after work and before bedtime) with 5% to 18% of gamers sleeping later due to VGs. Most gamers reported playing VGs in their racks or the mess decks/common areas when deployed/underway. Gamers reported symptoms of depression (~23% of ADSMs), generalized anxiety disorder (~19%), excessive daytime sleepiness (~33%), and AUDIT-C scores suggestive of heavy drinking (39%). Also, ~32% of gamers reported dissatisfaction with their life. More excessive gamers tended to be younger, used dysfunctional coping styles more frequently, and played video games more frequently and for more hours. Also, more excessive gamers were more likely to report sleeping later because of playing video games, and exhibited more symptoms of major depression, generalized anxiety, and excessive daytime sleepiness. Depending on the criterion used, the prevalence of disordered gaming in the study samples ranged from 0 to 4.85%. Of those who reported playing VGs, ~50% of Marines and 25% of Sailors were identified as problematic gamers. We developed several recommendations and action items, including suggestions for follow-on research.Naval Postgraduate SchoolNaval Research ProgramPE 0605853N/2098Approved for public release; distribution is unlimite

Understanding Motivational Factors of Problematic Video Gaming in the USMC and the US Navy

NPS NRP Executive SummaryA significant percentage of active duty service members (ADSMs) spends free time playing video games. This recreational activity is not unexpected given the relatively young age of many ADSMs and the prevalence of video gaming in the US population. The military operational environment, however, is characterized by high levels of occupational stress and poor sleep conditions which can result in increased risk of depression, anxiety, and sleep disorders. In such conditions, video games may be a strategy for coping with stress. In contrast, excessive video gaming can become problematic because it has the potential to affect well-being and behavior. For example, excessive video gaming is associated with high stress levels (Milani et al., 2018), lower psychosocial well-being and psychological functioning (von der Heiden et al., 2019), loneliness and depression (Lemmens et al., 2011), and delinquency and aggressive behavior (Milani et al., 2018; Engelhardt et al., 2011; Ewoldsen et al., 2012). Video gaming may also interfere with sleep when gamers stay up late playing video games instead of sleeping (Matsangas, Shattuck, & Saitzyk, 2020). In extreme cases, video gaming can become an addiction. In the scientific literature, Internet Gaming Disorder (IGD) is associated with poor emotion regulation, impaired prefrontal cortex functioning and cognitive control, poor working memory and decision-making capabilities, and a neuronal deficiency similar to substance-related addictions (Kuss et al., 2018). Given its potential negative impact on individual and team performance, we propose to assess problematic video gaming in two samples: US Marine Corps personnel and US Navy sailors. Based on surveys and focus groups, the research approach will be tailored for the needs of each service. Data will be collected from personnel in up to three USMC commands, whereas data from USN sailors will be collected on two ships, one in port and one underway. The study will focus on assessing the prevalence and extent of playing video games, identify factors associated with this activity, address whether Marines and Sailors are using gaming as a maladaptive coping mechanism, and provide appropriate recommendations.HQMC Manpower and Reserve Affairs (M&RA)This research is supported by funding from the Naval Postgraduate School, Naval Research Program (PE 0605853N/2098). https://nps.edu/nrpChief of Naval Operations (CNO)Approved for public release. Distribution is unlimited.

Understanding Motivational Factors of Problematic Video Gaming in the USMC and the US Navy

NPS NRP Project PosterA significant percentage of active duty service members (ADSMs) spends free time playing video games. This recreational activity is not unexpected given the relatively young age of many ADSMs and the prevalence of video gaming in the US population. The military operational environment, however, is characterized by high levels of occupational stress and poor sleep conditions which can result in increased risk of depression, anxiety, and sleep disorders. In such conditions, video games may be a strategy for coping with stress. In contrast, excessive video gaming can become problematic because it has the potential to affect well-being and behavior. For example, excessive video gaming is associated with high stress levels (Milani et al., 2018), lower psychosocial well-being and psychological functioning (von der Heiden et al., 2019), loneliness and depression (Lemmens et al., 2011), and delinquency and aggressive behavior (Milani et al., 2018; Engelhardt et al., 2011; Ewoldsen et al., 2012). Video gaming may also interfere with sleep when gamers stay up late playing video games instead of sleeping (Matsangas, Shattuck, & Saitzyk, 2020). In extreme cases, video gaming can become an addiction. In the scientific literature, Internet Gaming Disorder (IGD) is associated with poor emotion regulation, impaired prefrontal cortex functioning and cognitive control, poor working memory and decision-making capabilities, and a neuronal deficiency similar to substance-related addictions (Kuss et al., 2018). Given its potential negative impact on individual and team performance, we propose to assess problematic video gaming in two samples: US Marine Corps personnel and US Navy sailors. Based on surveys and focus groups, the research approach will be tailored for the needs of each service. Data will be collected from personnel in up to three USMC commands, whereas data from USN sailors will be collected on two ships, one in port and one underway. The study will focus on assessing the prevalence and extent of playing video games, identify factors associated with this activity, address whether Marines and Sailors are using gaming as a maladaptive coping mechanism, and provide appropriate recommendations.HQMC Manpower and Reserve Affairs (M&RA)This research is supported by funding from the Naval Postgraduate School, Naval Research Program (PE 0605853N/2098). https://nps.edu/nrpChief of Naval Operations (CNO)Approved for public release. Distribution is unlimited.

The Rat Lux Actuating Search Task (LAST) and Effects of Sleep Deprivation on Task Reversal Performance

The article of record as published may be found at�https://papers.ssrn.com/sol3/papers.cfm?abstract_id=4124170Sleep deprivation (SD) causes significant deficits in multiple aspects of cognition, including sustained attention and working memory. Investigating the neural processes underpinning these cognitive losses has proven challenging due to the confounds of current animal tasks; many employ appetitive or aversive stimuli to motivate behavior, while others lack task complexity that translates to human studies of executive function. We established the Lux Actuating Search Task (LAST) to circumvent these issues. The LAST is performed in a circular, open-field arena that requires rats to find an unmarked, quasi-randomly positioned target. Constant low-level floor vibrations motivate ambulation, while light intensity (determined by the rodent's proximity to the target destination) provides continuous visual feedback. The task has two paradigms that differ based on the relationship between the light intensity and target proximity: the Low Lux Target (LLT) paradigm and the High Lux Target paradigm (HLT). In this study, on days 1 to 6, the rats completed nine trials per day on one of the two paradigms. On day 7, the rats were either sleep deprived by gentle handling or were left undisturbed before undertaking the opposite (reversal) paradigm on days 7 to 9. Our results showed that SD significantly impeded the ability of Long Evans rats to learn the reversal paradigm, as indicated by increased times to target and increased failure percentages compared to rats whose sleep was undisturbed. Rats also showed reduced learning with the HLT paradigm, as the initial task or as the reversal task, likely due to the rodents' photophobia limiting their motivation to navigate toward a bright light, which is required to succeed

Sleep problems and parental stress among caregivers of children and adolescents enrolled in a digital mental health intervention

IntroductionCaregivers of children with mental health problems such as anxiety, depression, and attention-deficit/hyperactivity disorder often experience heightened sleep problems, largely due to their children's disrupted sleep, and increased parental stress. Evidence suggests that mental and behavioral health care for children and adolescents has the potential to positively affect their caregivers; however, this has not been investigated in the context of pediatric digital mental health interventions (DMHIs). Therefore, the current study used caregivers' self-report measures to determine whether caregivers whose children are involved in a DMHI exhibit improvements in sleep problems and parental stress after initiation of their children's care.MethodsCaregivers with a child or adolescent participating in behavioral coaching and/or therapy with Bend Health Inc., a pediatric DMHI that involves both the child and caregiver in care (e.g., coaching and therapy), were included in the study (n = 662). Caregiver insomnia severity and parental stress were reported approximately every 30 days using the Insomnia Severity Index (ISI) and Parental Stress Scale (PSS). Changes in symptoms were assessed by comparing caregivers' symptom scores from baseline to first assessment after starting care.ResultsAmong caregivers with elevated insomnia severity (n = 88) and parental stress (n = 119) at baseline, 77% showed improvements in sleep and 73% showed improvements in parental stress after the initiation of their child's care, with significant decreases in score from baseline to post-care (ISI: t 72 = −4.83, P < .001, d = 0.61; PSS: Z = −4.98, P < .001, d = 0.59).DiscussionWhile extant research suggests ongoing links between child behavioral problems, parent sleep, and parent well-being, this is the first study to demonstrate improvements in caregiver sleep and stress when a child's mental health symptoms are addressed with behavioral care. Our findings offer promising preliminary evidence that caregivers experience significant secondary benefits to their sleep and parental stress when their children participate in a pediatric DMHI. Further research is warranted to investigate additional moderating and mediating factors, such as caregiver demographics and magnitude of child mental health improvement

THE ROLE OF VIGILANT ATTENTION IN ATTENTIONAL CONTROL DEFICITS CAUSED BY SLEEP DEPRIVATION

Sleep deprivation diminishes activity of the ascending arousal system, causing reduced vigilant attention. It has been proposed that reduced vigilant attention during sleep deprivation causes impairments on an array of tasks via a general deterioration of performance. However, there is evidence that the effects of sleep deprivation on performance are multi-faceted and cannot be explained solely in terms of vigilant attention. Specifically, studies have shown that sleep loss may impair attentional control, but the role of vigilant attention in performance impairments was not thoroughly investigated. This dissertation addresses this issue. First, an experiment was conducted to test whether vigilant attention-related failures of information acquisition could explain deficits from sleep deprivation in a reversal-learning performance task. Simulated information acquisition failures did not produce impairments like those previously observed during sleep deprivation, suggesting that reversal- \nlearning deficits caused by sleep loss are not simply downstream effects of reduced vigilant attention. \nNext, the effects of sleep deprivation on performance of an attentional control task were investigated, and outcome measures were dissociated into statistically independent components of performance. Three separable components were identified, of which two were significantly impacted by sleep loss. One was specifically related to vigilant attention and the other to aspects of attentional control. These results indicate that sleep deprivation affects vigilant attention and attentional control differentially, suggesting potentially distinct underlying mechanisms. \nFinally, a novel rodent search task was developed, in which rats use floor vibrations as a mode of directional feedback to find an unmarked target destination. This vibration actuating search task (VAST), which was designed to require attentional control, was learned by rats within 2 days, and performance was impaired by sleep deprivation in a manner not easily explained by reduced arousal alone. Thus, the VAST may serve as a testbed for future investigations into the mechanisms underlying deficits in attentional control caused by sleep loss. \nThis dissertation contributes new evidence demonstrating that performance impairment due to sleep deprivation is not just a downstream effect of reduced vigilant attention, and that attentional control deficits constitute a separate and dissociable aspect of the detrimental impact of sleep deprivation on cognition

Exploring the Number of Web-Based Behavioral Health Coaching Sessions Associated With Symptom Improvement in Youth: Observational Retrospective Analysis

BackgroundRates of anxiety and depression have been increasing among children and adolescents for the past decade; however, many young people do not receive adequate mental health care. Digital mental health interventions (DMHIs) that include web-based behavioral health coaching are widely accessible and can confer significant improvements in youth anxiety and depressive symptoms. However, more research is necessary to determine the number of web-based coaching sessions that confer clinically significant improvements in anxiety and depressive symptoms in youth. ObjectiveThis study uses data from a pediatric DMHI to explore the number of web-based coaching sessions required to confer symptom improvements among children and adolescents with moderate or moderately severe symptoms of anxiety and depression. MethodsWe used retrospective data from a pediatric DMHI that offered web-based behavioral health coaching in tandem with self-guided access to asynchronous chat with practitioners, digital mental health resources, and web-based mental health symptom assessments. Children and adolescents who engaged in 3 or more sessions of exclusive behavioral health coaching for moderate to moderately severe symptoms of anxiety (n=66) and depression (n=59) were included in the analyses. Analyses explored whether participants showed reliable change (a decrease in symptom scores that exceeds a clinically established threshold) and stable reliable change (at least 2 successive assessments of reliable change). Kaplan-Meier survival analyses were performed to determine the median number of coaching sessions when the first reliable change and stable reliable change occurred for anxiety and depressive symptoms. ResultsReliable change in anxiety symptoms was observed after a median of 2 (95% CI 2-3) sessions, and stable reliable change in anxiety symptoms was observed after a median of 6 (95% CI 5-8) sessions. A reliable change in depressive symptoms was observed after a median of 2 (95% CI 1-3) sessions, and a stable reliable change in depressive symptoms was observed after a median of 6 (95% CI 5-7) sessions. Children improved 1-2 sessions earlier than adolescents. ConclusionsFindings from this study will inform caregivers and youth seeking mental health care by characterizing the typical time frame in which current participants show improvements in symptoms. Moreover, by suggesting that meaningful symptom improvement can occur within a relatively short time frame, these results bolster the growing body of research that indicates web-based behavioral health coaching is an effective form of mental health care for young people

Rates of Trauma Exposure and Posttraumatic Stress in a Pediatric Digital Mental Health Intervention: Retrospective Analysis of Associations With Anxiety and Depressive Symptom Improvement Over Time

BackgroundMore than 2 out of 3 children and adolescents in the United States experience trauma by the age of 16 years. Exposure to trauma in early life is linked to a range of negative mental health outcomes throughout the lifespan, particularly co-occurring symptoms of posttraumatic stress (PTS), anxiety, and depression. There has been an increasing uptake of digital mental health interventions (DMHIs) among youths, particularly for anxiety and depression. However, little is known regarding the incidence of trauma exposure and PTS symptoms among youths participating in DMHIs and whether PTS symptoms impact anxiety and depressive symptom treatment response. Moreover, it is unclear whether participation in a DMHI for anxiety and depressive symptoms is associated with secondary effects on PTS symptoms among trauma-exposed youths. ObjectiveThis study aims to use retrospective data from youths participating in a DMHI to (1) characterize rates of trauma, PTS, and comorbid anxiety and depressive symptoms; (2) determine whether trauma exposure and elevated PTS symptoms impact the improvement of comorbid anxiety and depressive symptoms throughout participation in care; and (3) determine whether participation in a non–posttraumatic DMHI is linked to reductions in PTS symptoms. MethodsThis study was conducted using retrospective data from members (children ages 6 to 12 years) involved in a pediatric collaborative care DMHI. Participating caregivers reported their children’s trauma exposure. PTS, anxiety, and depressive symptom severity were measured monthly using validated assessments. ResultsAmong eligible participants (n=966), 30.2% (n=292) reported at least 1 traumatic event. Of those with trauma exposure and elevated symptoms of PTS (n=119), 73% (n=87) exhibited elevated anxiety symptoms and 50% (n=59) exhibited elevated depressive symptoms. Compared to children with no trauma, children with elevated PTS symptoms showed smaller reductions per month in anxiety but not depressive symptoms (anxiety: F2,287=26.11; P<.001). PTS symptoms also decreased significantly throughout care, with 96% (n=79) of participants showing symptom reductions. ConclusionsThis study provides preliminary evidence for the frequency of trauma exposure and comorbid psychiatric symptoms, as well as variations in treatment response between trauma-exposed and nontrauma-exposed youths, among participants in a pediatric collaborative care DMHI. Youths with traumatic experiences may show increased psychiatric comorbidities and slower treatment responses than their peers with no history of trauma. These findings deliver compelling evidence that collaborative care DMHIs may be well-suited to address mental health symptoms in children with a history of trauma while also highlighting the critical need to assess symptoms of PTS in children seeking treatment

Satisfaction, Perceived Usefulness, and Therapeutic Alliance as Correlates of Participant Engagement in a Pediatric Digital Mental Health Intervention: Cross-Sectional Questionnaire Study

BackgroundAlthough evidence suggests that digital mental health interventions (DMHIs) are effective alternatives to traditional mental health care, participant engagement continues to be an issue, especially for pediatric DMHIs. Extant studies of DMHIs among adults suggest that participants’ satisfaction, perceived usefulness, and therapeutic alliance are closely tied to engagement. However, these associations have not been investigated among children and adolescents involved in DMHIs. ObjectiveTo address these gaps in extant DMHI research, the purpose of this study was to (1) develop and implement a measure to assess satisfaction, perceived usefulness, and therapeutic alliance among children and adolescents participating in a DMHI and (2) investigate satisfaction, perceived usefulness, and therapeutic alliance as correlates of children’s and adolescents’ engagement in the DMHI. MethodsMembers (children and adolescents) of a pediatric DMHI who had completed at least one session with a care provider (eg, coach or therapist) were eligible for inclusion in the study. Adolescent members and caregivers of children completed a survey assessing satisfaction with service, perceived usefulness of care, and therapeutic alliance with care team members. ResultsThis study provides evidence for the reliability and validity of an adolescent- and caregiver-reported user experience assessment in a pediatric DMHI. Moreover, our findings suggest that adolescents' and caregivers’ satisfaction and perceived usefulness are salient correlates of youths’ engagement with a DMHI. ConclusionsThis study provides valuable preliminary evidence that caregivers’ satisfaction and perceived usefulness are salient correlates of youths’ engagement with a DMHI. Although further research is required, these findings offer preliminary evidence that caregivers play a critical role in effectively increasing engagement among children and adolescents involved in DMHIs

Using Digital Measurement–Based Care for the Treatment of Anxiety and Depression in Children and Adolescents: Observational Retrospective Analysis of Bend Health Data

BackgroundA growing body of evidence supports the efficacy of measurement-based care (MBC) for children and adolescents experiencing mental health concerns, particularly anxiety and depression. In recent years, MBC has increasingly transitioned to web-based spaces in the form of digital mental health interventions (DMHIs), which render high-quality mental health care more accessible nationwide. Although extant research is promising, the emergence of MBC DMHIs means that much is unknown regarding their effectiveness as a treatment for anxiety and depression, particularly among children and adolescents. ObjectiveThis study uses preliminary data from children and adolescents participating in an MBC DMHI administered by Bend Health Inc, a mental health care provider that uses a collaborative care model to assess changes in anxiety and depressive symptoms during participation in the MBC DMHI. MethodsCaregivers of children and adolescents participating in Bend Health Inc for anxiety or depressive symptoms reported measures of their children’s symptoms every 30 days throughout the duration of participation in Bend Health Inc. Data from 114 children (age 6-12 years) and adolescents (age 13-17 years) were used for the analyses (anxiety symptom group: n=98, depressive symptom group: n=61). ResultsAmong children and adolescents participating in care with Bend Health Inc, 73% (72/98) exhibited improvements in anxiety symptoms and 73% (44/61) exhibited improvement in depressive symptoms, as indicated by either a decrease in symptom severity or screening out of completing the complete assessment. Among those with complete assessment data, group-level anxiety symptom T-scores exhibited a moderate decrease of 4.69 points (P=.002) from the first to the last assessment. However, members’ depressive symptom T-scores remained largely stable throughout their involvement. ConclusionsAs increasing numbers of young people and families seek DMHIs over traditional mental health treatments due to their accessibility and affordability, this study offers promising early evidence that youth anxiety symptoms decrease during involvement in an MBC DMHI such as Bend Health Inc. However, further analyses with enhanced longitudinal symptom measures are necessary to determine whether depressive symptoms show similar improvements among those involved in Bend Health Inc