Video gaming in a hyperconnected world : a cross-sectional study of heavy gaming, problematic gaming symptoms, and online socializing in adolescents

Aims: Examining online social interactions along with patterns of video gaming behaviors and game addiction symptoms has the potential to enrich our understanding of disorders related to excessive video game play. Methods: We performed latent class analysis in a sample of 9733 adolescents based on heavy use of games, social networking and instant messaging, and game addiction symptoms. We used latent class regression to determine associations between classes, psychosocial well-being and friendship quality. Results: We identified two types of heavy gaming classes that differed in probability of online social interaction. Classes with more online social interaction reported fewer problematic gaming symptoms than those with less online social interaction. Most adolescents estimated to be in heavy gaming classes had more depressive symptoms than normative classes. Male non-social gamers had more social anxiety. Female social gamers had less social anxiety and loneliness, but lower self-esteem. Friendship quality attenuated depression in some male social gamers, but strengthened associations with loneliness in some male non-social gamers. Conclusions: In adolescents, symptoms of video game addiction depend not only on video game play but also on concurrent levels of online communication, and those who are very socially active online report fewer symptoms of game addiction

Video gaming in a hyperconnected world: A cross-sectional study of heavy gaming, problematic gaming symptoms, and online socializing in adolescents

Aims Examining online social interactions along with patterns of video gaming behaviors and game addiction symptoms has the potential to enrich our understanding of disorders related to excessive video game play. Methods We performed latent class analysis in a sample of 9733 adolescents based on heavy use of games, social networking and instant messaging, and game addiction symptoms. We used latent class regression to determine associations between classes, psychosocial well-being and friendship quality. Results We identified two types of heavy gaming classes that differed in probability of online social interaction. Classes with more online social interaction reported fewer problematic gaming symptoms than those with less online social interaction. Most adolescents estimated to be in heavy gaming classes had more depressive symptoms than normative classes. Male non-social gamers had more social anxiety. Female social gamers had less social anxiety and loneliness, but lower self-esteem. Friendship quality attenuated depression in some male social gamers, but strengthened associations with loneliness in some male non-social gamers. Conclusions In adolescents, symptoms of video game addiction depend not only on video game play but also on concurrent levels of online communication, and those who are very socially active online report fewer symptoms of game addiction

A weak scientific basis for gaming disorder: let us err on the side of caution

We greatly appreciate the care and thought that is evident in the 10 commentaries that discuss our debate paper, the majority of which argued in favor of a formalized ICD-11 gaming disorder. We agree that there are some people whose play of video games is related to life problems. We believe that understanding this population and the nature and severity of the problems they experience should be a focus area for future research. However, moving from research construct to formal disorder requires a much stronger evidence base than we currently have. The burden of evidence and the clinical utility should be extremely high, because there is a genuine risk of abuse of diagnoses. We provide suggestions about the level of evidence that might be required: transparent and preregistered studies, a better demarcation of the subject area that includes a rationale for focusing on gaming particularly versus a more general behavioral addictions concept, the exploration of non-addiction approaches, and the unbiased exploration of clinical approaches that treat potentially underlying issues, such as depressive mood or social anxiety first. We acknowledge there could be benefits to formalizing gaming disorder, many of which were highlighted by colleagues in their commentaries, but we think they do not yet outweigh the wider societal and public health risks involved. Given the gravity of diagnostic classification and its wider societal impact, we urge our colleagues at the WHO to err on the side of caution for now and postpone the formalization

VIDEO GAME PLAY, SOCIAL INTERACTIONS AND FRIENDSHIP QUALITY IN ADOLESCENTS: A LATENT CLASS ANALYSIS

Rationale. Video games and the Internet are an indispensable part of teens’ lives and are tightly woven into their daily routines. The ever-changing nature of games and online settings poses challenges for public health researchers who categorize exposures to determine how they affect health. Previous research has identified a range of correlates and outcomes of problematic gaming; many of these are shared with addiction to Internet activities such as social networking and instant messaging, which are also very popular with adolescents (D. L. King, Haagsma, Delfabbro, Gradisar, & Griffiths, 2013; D. J. Kuss, Griffiths, Karila, & Billieux, 2013). Since most youth use a variety of Internet social applications at once (Rideout, Foehr, & Roberts, 2010), it is important to consider how these concurrent activities affect the nature, course, and outcomes of problematic gaming. Given the overlapping nature of Internet use, some forms of gaming, and social interactions, the outcomes of heavy or excessive gaming are likely vary as a function of online social interactions (e.g., those occurring through instant messaging, social media use and chat; S. Caplan, Williams, & Yee, 2009; Ng & Wiemer-Hastings, 2005). This thesis adds to the literature by first providing a systematic examination of factors related specifically to problematic gaming (as opposed to problematic Internet use) in representative samples of adolescents, then conducting two empirical studies to determine (1) how patterns of self-reported problematic gaming symptoms, video game and social Internet use help distinguish adolescents whose high levels of gaming are associated with high problematic gaming symptoms and (2) how these patterns are associated with psychosocial well-being, and how these associations change when online and offline friendship quality is considered. Methods. We used survey results from 9738 adolescents in the 2009-2012 waves of the Monitor Internet and Youth study (Meerkerk, van den Eijnden, & van Rooij, 2006), a yearly survey on technology use and addiction in the Netherlands. We conducted a latent class analysis using indicators of problematic gaming symptoms (as measured by the Videogame Addiction Test; van Rooij, Schoenmakers, van den Eijnden, Vermulst, & van de Mheen, 2012a) and high levels of use (4+ hours per day for 6 -7 days per week) of social networking, instant messaging and three types of video games. This analysis was then extended to a multivariate latent class regression that examined associations between the estimated latent classes and depression, social anxiety, loneliness and low self-esteem. Finally, we evaluated moderation by friendship quality. Results: In both boys and girls, we identified several classes of gamers with varying levels of problematic gameplay. Classes were generally split into those having high probabilities of highly engaged online social interaction and those having lower probabilities, and classes with more online social interaction showed fewer symptoms of problematic gaming at the same levels of gaming. Classes with higher self-reported problematic gaming were associated with lower values of self-esteem and more social anxiety overall, whereas boys and girls estimated to be in the Social Engaged Gamers classes had less loneliness and social anxiety. All classes with high levels of gaming also reported more depressive symptoms. However, these associations changed for some subgroups when interactions with online and offline friendship quality were considered. Specifically, for girls who had good online friendships but poor real-life friendships, the chance of membership in the Social Engaged Gamers class compared to the Average class decreased as depression scores increased. High self-esteem was negatively associated for most boys who were At-Risk Social Gamers, but for boys who had high quality online and offline friendships, the relationship was positive. In addition, social anxiety was only associated with the most symptomatic Problematic Gamers class for boys with high-quality online friendships, but was associated with both heavy gaming classes for girls who had high-quality online and real-life friendships. Conclusion: Adolescent gamers who were more socially active online reported lower distress related to gaming. Although all highly engaged gamers reported more depression than average classes, high-quality online friendships negated this finding for girls who reported low-quality real-life friendships. Exploring moderation also revealed that associations between social anxiety and certain classes were much stronger for those with high-quality online friendships, and self-esteem was higher for some social gamers if both online and offline friendship quality were high. Online social interaction, especially when it is associated with high-quality online friendships, may have positive implications for some heavy gamers but may be associated with more negative psychological functioning in others

Stakeholders’ Consensus on Strategies for Self- and Other-Regulation of Video Game Play: A Mixed Methods Study

Background: Little is known about strategies or mechanics to improve self-regulation of video game play that could be developed into novel interventions. This study used a participatory approach with the gaming community to uncover insider knowledge about techniques to promote healthy play and prevent gaming disorder. Methods: We used a pragmatic approach to conduct a convergent-design mixed-methods study with participants attending a science fiction and education convention. Six participants answered questions about gaming engagement and self- or game-based regulation of gaming which were then categorized into pre-determined (a priori) themes by the presenters during the presentation. The categorized themes and examples from participant responses were presented back to participants for review and discussion. Seven participants ranked their top choices of themes for each question. The rankings were analyzed using a nonparametric approach to show consensus around specific themes. Results: Participants suggested several novel potential targets for preventive interventions including specific types of social (e.g., play with others in a group) or self-regulation processes (e.g., set timers or alarms). Suggestions for game mechanics that could help included clear break points and short missions, but loot boxes were not mentioned. Conclusions: Our consensus development approach produced many specific suggestions that could be implemented by game developers or tested as public health interventions, such as encouraging breaks through game mechanics, alarms or other limit setting; encouraging group gaming; and discussing and supporting setting appropriate time or activity goals around gaming (e.g., three quests, one hour). As some suggestions here have not been addressed previously as potential interventions, this suggests the importance of including gamers as stakeholders in research on the prevention of gaming disorder and the promotion of healthy gaming. A large-scale, online approach using these methods with multiple stakeholder groups could make effective use of players’ in-depth knowledge and help speed discovery and translation of possible preventive interventions into practice and policy

Evaluating the quality of evidence for gaming disorder: A summary of systematic reviews of associations between gaming disorder and depression or anxiety.

Gaming disorder has been described as an urgent public health problem and has garnered many systematic reviews of its associations with other health conditions. However, review methodology can contribute to bias in the conclusions, leading to research, policy, and patient care that are not truly evidence-based. This study followed a pre-registered protocol (PROSPERO 2018 CRD42018090651) with the objective of identifying reliable and methodologically-rigorous systematic reviews that examine the associations between gaming disorder and depression or anxiety in any population. We searched PubMed and PsycInfo for published systematic reviews and the gray literature for unpublished systematic reviews as of June 24, 2020. Reviews were classified as reliable according to several quality criteria, such as whether they conducted a risk of bias assessment of studies and whether they clearly described how outcomes from each study were selected. We assessed possible selective outcome reporting among the reviews. Seven reviews that included a total of 196 studies met inclusion criteria. The overall number of participants was not calculable because not all reviews reported these data. All reviews specified eligibility criteria for studies, but not for outcomes within studies. Only one review assessed risk of bias. Evidence of selective outcome reporting was found in all reviews-only one review incorporated any of the null findings from studies it included. Thus, none were classified as reliable according to prespecified quality criteria. Systematic reviews related to gaming disorder do not meet methodological standards. As clinical and policy decisions are heavily reliant on reliable, accurate, and unbiased evidence synthesis; researchers, clinicians, and policymakers should consider the implications of selective outcome reporting. Limitations of the current summary include using counts of associations and restricting to systematic reviews published in English. Systematic reviewers should follow established guidelines for review conduct and transparent reporting to ensure evidence about technology use disorders is reliable

Commercial Video Games As Therapy: A New Research Agenda to Unlock the Potential of a Global Pastime

Emerging research suggests that commercial, off-the-shelf video games have potential applications in preventive and therapeutic medicine. Despite these promising findings, systematic efforts to characterize and better understand this potential have not been undertaken. Serious academic study of the therapeutic potential of commercial video games faces several challenges, including a lack of standard terminology, rapidly changing technology, societal attitudes toward video games, and understanding and accounting for complex interactions between individual, social, and cultural health determinants. As a vehicle to launch a new interdisciplinary research agenda, the present paper provides background information on the use of commercial video games for the prevention, treatment, and rehabilitation of mental and other health conditions, and discusses ongoing grassroots efforts by online communities to use video games for healing and recovery

The role of internet gaming in the association between anxiety and depression : a preliminary cross-sectional study

Background: Disordered Internet gaming is thought to be perpetuated by one's need to escape their real-life distress or mental health symptoms, which may in turn generate depressive feelings. Nevertheless, moderate engagement with Internet games has also been suggested to provide relief, thus improving one's mood. This study aspires to clarify the contribution of Internet gaming and gender in the association between anxiety and depression. Methods: A large sample of Internet gamers (N = 964) were recruited online. Disordered Internet gaming was assessed with the Internet Gaming Disorder Scale, 9 Items Short Form (IGD9S-SF). Anxiety and depression symptoms were assessed using the Depression, Anxiety and Stress Scale, 21 items (DASS-21). Results: Regression, moderation and moderated moderation analyses accounting for the effects of gender on the relationship between disordered gaming, anxiety, and depression found a significant effect for anxiety symptoms on depression symptoms and a significant interaction between anxiety and Internet gaming disorder on depression symptoms. Findings support the theory that although anxious gamers bear a higher depression risk, this is buffered with lower and exacerbated with higher disordered gaming symptoms. Conclusion: Findings suggest a dual role of Internet gaming in the association between anxiety and depression, depending on the intensity of one's disordered gaming symptoms. Depression prevention and intervention protocols should be optimized by considering the effects of Internet gaming among anxious gamers by focusing on the intensity of a gamer's involvement and any gaming disorder symptoms. Further research should include clinical samples to better understand this interaction. © 2021 John Wiley & Sons Australia, Ltd

Draconian policy measures are unlikely to prevent disordered gaming

In August of 2021, China imposed severe restrictions on children's online gaming time. We argue that such a policy may seem useful on the surface but does not reflect the current evidence concerning prevention of disordered gaming. Videogame play is normal for children worldwide, and like other leisure activities can lead to benefits for the majority and problems for a minority. Problematic or disordered play results from the interaction of multiple risk factors that are not addressed by draconian policy measures. Identifying these factors through stakeholder-engaged research and current evidence will be much more likely to succeed in preventing disordered gaming and promoting youth wellbeing

Friendships matter: a cross-sectional latent class analysis of game addiction symptoms and online social interactions

We found that when combinations of online and gaming behaviors are considered as part of a PG syndrome, gamers could be clearly separated into social and non-social subgroups, with social classes reporting fewer feelings of problematic use at similar levels of play. These findings suggest that patterns of symptoms and gaming behavior thought to delineate problematic or disordered gaming are not independent of social online behaviors. The social subgroups may represent “engaged gamers” whose heavy gaming may be part of their active participation in a digital community. Before friendship quality was taken into account, all heavy gaming classes in both boys and girls were associated with more depressive symptoms. One possible explanation for this is heavy gamers feel depressed, and their heavy gaming, even with extensive social interaction, is not enough to relieve symptoms (Caplan, Williams, & Yee, 2009)