Associations between Marketing Exposure, In-game Purchases, Problem Gaming, Simulated Gambling, and Psychological Distress among Adolescents.

This study examined the relationships between marketing exposure, in-game purchase, problem gaming, online simulated gambling game playing, and psychological distress. Data were obtained from a sample of 2,595 seventh-grade students from 30 middle schools in Taiwan. A self-administered questionnaire was conducted in 2020. The results indicated that 94% of adolescents engage in online gaming, with 38% making in-game purchases, and 9% playing online simulated gambling games. The multiple regression results showed that adolescents who are exposed to higher levels of gaming marketing, influenced by advertising effects, involved in in-game purchases, and have lower levels of active parental mediation were more likely to experience problem gaming. Adolescents who have increased exposure to gambling game marketing, are influenced by advertising effects, are involved in in-game purchases, and who are experiencing problem gaming were more likely to engage in online simulated gambling game playing and token purchasing. Involvement in in-game purchases, problem gaming, and playing online simulated gambling games were associated with higher levels of psychological distress and poor sleep quality. In conclusion, the results of this study link adolescents' exposure to marketing with their involvement in in-game purchases, problem gaming, and engaging in online simulated gambling.

Working memory performance in disordered gambling and gaming: A systematic review.

BACKGROUND: Converging evidence supports that gaming and gambling disorders are associated with executive dysfunction. The involvement of different components of executive functions (EF) in these forms of behavioural addiction is unclear. AIM: In a systematic review, we aim to uncover the association between working memory (WM), a crucial component of EF, and disordered gaming and gambling. Note that, in the context of this review, gaming has been used synonymously with video gaming. METHODS: Adhering to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA), we systematically searched for studies published from 2012 onwards. RESULTS: The search yielded 6081 records after removing duplicates, from which 17 peer-reviewed journal articles were eligible for inclusion. The association between WM and problem or disordered gaming and gambling have been categorized separately to observe possible differences. Essentially, problem gaming or gambling, compared to disorder, presents lesser severity and clinical significance. The results demonstrate reduced auditory-verbal WM in individuals with gambling disorder. Decreased WM capacity was also associated with problem gambling, with a correlation between problem gambling severity and decreased WM capacity. Similarly, gaming disorder was associated with decreased WM. Specifically, gaming disorder patients had lower WM capacity than the healthy controls. CONCLUSION: Working memory seems to be a significant predictor of gambling and gaming disorders. Therefore, holistic treatment approaches that incorporate cognitive techniques that could enhance working memory may significantly boost gambling and gaming disorders treatment success.

Relapse Prevention Therapy for Problem Gaming or Internet Gaming Disorder in Swedish Child and Youth Psychiatric Clinics: Protocol for a Randomized Controlled Trial.

BACKGROUND: Although gaming is a common arena where children socialize, an increasing number of children are exhibiting signs of problem gaming or internet gaming disorder. An important factor to the development of problem gaming is parent-child relationships. A cognitive behavioral therapy-based form of treatment, labeled relapse prevention, has been developed as a treatment for child and adolescent problem gaming or internet gaming disorder. However, no study has evaluated the effect of this treatment among Swedish children and youth nor the role of the parent-child relationships in this treatment. OBJECTIVE: This study aims (1) to evaluate a relapse prevention treatment for patients showing signs of problem gaming or internet gaming disorder recruited from child and youth psychiatric clinics and (2) to test whether the quality of parent-child relationships plays a role in the effect of relapse prevention treatment and vice versa-whether the relapse prevention treatment has a spillover effect on the quality of parent-child relationships. Moreover, we explore the carer's attitudes about parent-child relationships and child gaming, as well as experiences of the treatment among the children, their carers, and the clinicians who carried out the treatment. METHODS: This study is a 2-arm, parallel-group, early-stage randomized controlled trial with embedded qualitative components. Children aged 12-18 years who meet the criteria for problem gaming or internet gaming disorder will be randomized in a 1:1 ratio to either intervention (relapse prevention treatment) or control (treatment as usual), with a total of 160 (80 + 80) participants. The primary outcomes are measures of gaming and gambling behavior before and after intervention, and the secondary outcomes include child ratings of parent-child communication and family functioning. The study is supplemented with a qualitative component with semistructured interviews to capture participants' and clinicians' experiences of the relapse prevention, as well as attitudes about parent-child relationships and parenting needs in carers whose children completed the treatment. RESULTS: The trial started in January 2022 and is expected to end in December 2023. The first results are expected in March 2023. CONCLUSIONS: This study will be the first randomized controlled trial evaluating relapse prevention as a treatment for child and adolescent problem gaming and internet gaming disorder in Sweden. Since problem behaviors in children interact with the family context, investigating parent-child relationships adjacent to the treatment of child problem gaming and internet gaming disorder is an important strength of the study. Further, different parties, ie, children, carers, and clinicians, will be directly or indirectly involved in the evaluation of the treatment, providing more knowledge of the treatment and its effect. Limitations include comorbidity in children with problem gaming and internet gaming disorder and challenges with the recruitment of participants. TRIAL REGISTRATION: ClinicalTrials.gov NCT05506384 (retrospectively registered); https://clinicaltrials.gov/ct2/show/NCT05506384. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID): DERR1-10.2196/44318.

The directionality of anxiety and gaming disorder: An exploratory analysis of longitudinal data from an Australian youth population.

Gaming activities among adolescents have increased during the COVID-19 pandemic, bringing with it a growing concern for the potential harms of excessive gaming and its risk factors. Anxiety is frequently linked with gaming disorder, but studies investigating this association were mostly cross-sectional in design. Longitudinal studies that explore risk factors associated with gaming disorder are sparse and the trajectories of gaming disorder remain unclear. To address this paucity, the present study analyzed a large longitudinal dataset with a 12-month follow-up of 4,968 Australian adolescents (ages 13-14) during the pandemic. Logistic regression and multiple regression analyses were conducted to investigate the temporal relationships between anxiety, gaming frequency, the amount of money spent within video games, and gaming disorder. Prevalence rates for gaming disorder in adolescents aged 13 and 14 were 15 and 16%, respectively. The regression models indicated a bidirectional relationship between anxiety and gaming disorder symptoms, where higher levels of anxiety were associated with higher levels of gaming disorder 12 months later and vice versa. The study also found that the interaction between anxiety and higher gaming frequency could predict gaming disorder symptoms. Overall, the findings suggest that young adolescents may be more vulnerable to developing gaming disorder and highlight the importance of addressing the interactions between risk factors and gaming disorder in treatment approaches.

Problem mobile gaming: The role of mobile gaming habits, context, and platform.

Aims: Mobile gaming is a dominant form of gaming, known for its portability and for game characteristics that motivate continuous play and spending. Such involvement may also turn problematic, but research on problem gaming (PG) has tended to focus on non-mobile forms of gaming. The study was based on a cross-sectional observational design where students in upper secondary schools were recruited to a survey about mobile gaming. The age of the respondents ranged from 16 to 23 years (n = 519; 52.4% men; mean age = 17.2 years, SD = 1.1). Methods: We examined (1) gaming frequency, gaming contexts, and in-game spending in relation to PG; (2) gaming context in relation to academic achievement and sleep quality; and (3) PG according to gaming platform (i.e., playing on mobile, console/computer, or mixed platforms) with Kruskal-Wallis tests, chi-square tests and Spearman rank-order correlations. Results: PG was positively associated with mobile gaming hours per week (η2 = .02, p < .01), minutes per session (η2 = .03, p < .001), making in-app purchases (Cramer's V = .15, p < .05), and gaming during homework (Cramer's V = .14, p < .05). Statistically significant associations were found between mobile gaming in bed and later sleep midpoint for weekdays (rs = .18, p < .001) and weekends (rs = .11, p < .05). Mixed platform gamers had increased likelihood of PG, console/computer gamers had increased likelihood of being at risk for PG, and mobile gamers had lower risk for PG (Cramer's V = .18, p < .001). Conclusion: Future studies should include specific measures of mobile gaming as it appears implicated in problem gaming, albeit to a lesser degree than console and computer gaming.

Gaming Behaviors and the Association with Sleep Duration, Social Jetlag, and Difficulties Falling Asleep among Norwegian Adolescents.

The relationship between gaming and sleep is mostly informed by studies of addictive gaming behavior, thus limiting our understanding of sleep in the context of nonproblematic engaged gaming. The present study investigated whether addicted, problem, and engaged gaming behavior was associated with sleep duration, social jetlag, and difficulties falling asleep. The sample consisted of 13- and 16-year-old Norwegian adolescents (n = 3228) participating in the Health Behavior in School-Aged Children (HBSC) survey in 2018. Participants were categorized into addicted, problem, engaged, and normal/non-gaming behavior groups according to which GAS-7 criteria they fulfilled. Robust generalized linear mixed models with a random intercept for class ID were used to examine the association between the sleep variables and gaming behavior. Addicted gaming behavior was unfavorably associated with all sleep parameters. The findings for engaged gaming and problem gaming behavior were somewhat mixed. Engaged gamers slept less on weekends, less on weekdays for those aged 16, and experienced greater social jetlag compared to the normal/non-gaming group. Problem gamers experienced greater social jetlag and had higher odds of experiencing difficulties falling asleep. Overall, the results suggest that all types of gaming behaviors might harm sleep health, but to a greater extent for the addicted gamers.

Pay-to-Win Gaming and its Interrelation with Gambling: Findings from a Representative Population Sample.

Pay-to-Win gaming describes a common type of video game design in which players can pay to advance in the game. The frequency and value of payments is unlimited, and payments are linked to players' competitiveness or progress in the game, which can potentially facilitate problematic behavioral patterns, similar to those known from gambling. Our analyses focus on assessing similarities and differences between Pay-to-Win and different forms of gambling. Based on a survey among 46,136 German adult internet users, this study presents the demographic and socio-economic profile of (1) Pay-to-Win gamers who make purchases in such games, (2) heavy users who conduct daily payments, and (3) gamers who are also gamblers. Motives for making payments were assessed and participation, frequency and spending in gambling by Pay-to-Win gamers are presented. To assess the similarity of Pay-to-Win gaming and gambling, we tested whether Pay-to-Win participation, frequency of payments and problematic gaming behavior are predictors for gambling and cross-tested the opposite effects of gambling on Pay-to-Win. We find that Pay-to-Win gamers are a distinct consumer group with considerable attraction to gambling. High engagement and problematic behavior in one game form affects (over)involvement in the other. Common ground for Pay-to-Win gaming and gambling is the facilitation of recurring payments.

What game we are playing: the psychosocial context of problem gambling, problem gaming and poor well-being among Italian high school students.

Gambling and gaming are not infrequent among adolescents and preventing low-risk youth from becoming at-risk appears to be a priority of public health strategies. Greater scrutiny of the risk and protective factors in the relationships and community of young people appears crucial in steering prevention initiatives adequately. This study aimed to explore the role of the qualities of relational networks (i.e. family functioning, perceived social and class support), family and peer approval and view of the social environment in predicting problem gambling, problem gaming and overall well-being among adolescents. High-school students aged 14-18 years (N: 595; female: 68,7%) completed a survey including the target variables. A multivariate multiple regression analysis was performed to examine the role of socio-demographic characteristics and psychosocial predictors on gaming, gambling, and well-being. Multivariate multiple regressions identify a common core underpinning problem gambling, gaming and poor well-being but also the distinct roles of psychosocial variables: being male, with low parental monitoring, and an anomic view of the social environment all predict problem gambling and gaming, which were also found to be associated. Low social support predicts problem gambling but not problem gaming; poor family functioning predicts problem gaming but not problem gambling. All the target psychosocial variables, except approval of gambling, predict poor well-being. On the whole the findings suggest the need to look more closely at the way adolescents, their system of activity and their culture participate in constructing the meaning of gambling and gaming activities and their impact on adolescents' well-being, so that future studies and strategies can more effectively examine the relational dynamics in which problem gambling and gaming develop.

Gaming in the Military: A Longitudinal Study of Changes in Gaming Behavior Among Conscripts During Military Service and Associated Risk Factors.

A central task in military leadership is to take care of one's followers, which presupposes knowledge about relevant risk factors. Very little research has focused on the risks of developing problematic gaming behavior during military service. The present study tries to bridge this gap by assessing prevalence rates and associated risk factors of problem gaming in a sample of Norwegian conscripts across two time-points: at the beginning and end of duty. The sample comprised 2,555 individuals aged 18-24 years. A total of 1,017 (39.8%) completed the questionnaire at Time 1, ~1 month after starting the military service. Respondents who completed the first wave, at enrollment, were invited to participate in wave two, after completing their service. At Time 2, 259 (25.5%) participants responded. The prevalence rates of gaming addiction were 0.5% at Time 1 and 4.6% at Time 2, while problem gaming use was reported by 4.8% of the sample at Time 1 and 8.1% of the sample at Time 2. Paired sample t-tests revealed an overall significant increase in the mean scores on the Gaming Addiction Scale from T1 (M = 0.86, SD = 1.35) to T2 (M = 1.31, SD = 2.14), t = -2.40, p < 0.05. According to the reliable change index, 17.1% of the sample showed a reliable negative change, whereas 8.3% exhibited a reliable positive change in gaming addiction scores. However, no psychological variables measured at T1 (loneliness, boredom proneness-Internal, boredom proneness-External, anxiety, depression, game addiction, and time spent gaming) were related to attrition (from T1 to T2), or worsening of game addiction, while a positive relationship was observed between boredom proneness-External and reduced gaming addiction from T1 to T2. In sum, we observed a tendency toward a negative change in gaming behaviors during military service which may complicate the soldiers' reintegration into civilian life after their service. More research is needed to assess potential gaming problems in the Military.

Conduct problems and depressive symptoms in association with problem gambling and gaming: A systematic review.

BACKGROUND AND AIMS: Behavioral addictions such as gambling and gaming disorder are significant public health issues that are of increasing importance to policy makers and health care providers. Problem gambling and gaming behaviors have been identified as being associated with externalizing and internalizing problems, with theoretical models suggesting that both conduct problems and depressive symptoms may be significant risk factors in the development of problem gambling and gaming. As such, the purpose of this systematic review is to provide an overview of research identifying the relationship between conduct problems, depressive symptoms and problem gambling and gaming among adolescents and young adults. METHODS: Systematic literature searches in accordance with PRISMA guidelines found 71 eligible studies that met the inclusion criteria, 47 for problem gambling, 23 for problem gaming and one for both problem behaviors. RESULTS: Based on cross-sectional evidence, both problem gambling and gaming are consistently concurrently associated with conduct problems and depressive symptoms. Longitudinal evidence appears to be clearer for conduct problems as a risk factor for problem gambling, and depressive symptoms as a risk factor for problem gaming. However, both risk factors appear to increase the risk for these problem behaviors. DISCUSSION AND CONCLUSIONS: Results from the literature review suggest that problem gambling and gaming are associated with the presence of conduct problems and depressive symptoms, with the potential of sharing common etiological factors. Additional research is necessary to confirm these longitudinal relationships with an emphasis on investigating the interaction of both early conduct problems and depressive symptoms.

A Latent Class Approach for Classifying the Problem and Disordered Gamers in a Group of Adolescence.

Gaming disorder is not yet recognized as a formal psychiatric disorder, and consensus is still lacking in the field concerning the definition of gaming disorder and what methods should be used to measure it. In order to deal with methodological challenges related to previously suggested approaches, the aim of the present study was to develop an alternative assessment procedure for gaming disorder using a latent class cluster approach, and to compare the criterion validity of this procedure with existing assessment procedures. A representative sample of 3,000 adolescents (n = 1,500 female) aged 17.5 years was drawn from the National Registry, and 2,055 participants responded (yielding a response rate of 70.3%). The Gaming Addiction Scale for Adolescents was used to measure gaming disorder and measures of loneliness, anxiety, depression, and aggression were used to test criterion validity. A model with five Latent Class Clusters represented the best fit [BIC(LL) = 21,253,7; L2 = 3,881,204; df = 1,978; Class. Err. = 0.1239]. The five different groups were labeled never symptoms (46.2%), rarely symptoms (22.3%), occasionally symptoms (23.5%), problem gamers (6.9%), and disordered gamers (1.2%). The groups displayed different probabilities of responses (never/rarely/sometimes/often/very often) to the seven Gaming Addiction Scale items. Regarding criterion validity, MANOVA revealed a significant overall main effect of latent classes [F (20, 6359) = 13.50, p < 0.001; Wilks Lambda = 0.871]. All dependent variables (loneliness, depression, anxiety, verbal, and physical aggression) reached statistical significance when results from the dependent variables were considered separately. Comparing the present approach with previous suggested classifications of gaming addiction offered by Lemmens et al. and Charlton and Danforth, the present approach showed greater specificity in terms of number of classes identified. We conclude that the Latent Class approach identifying five different groups of gamers offers a more refined view on addiction compared to previous assessment procedures.

Policy, prevention, and regulation for Internet Gaming Disorder.

In this commentary, I discuss the recent paper by Király et al. (2018), which provides a systematic review of current and potential policies addressing problematic gaming and suggesting current approaches include those (a) limiting video game availability, (b) reducing risk and harm, and (c) supporting gamers. This commentary uses a number of points raised by Király et al. (2018) to address the issue of policy context by discussing (a) the sociocultural environment and (b) the gamer and the game environment to (c) create the case for prevention to reduce risk and harm and to provide support for gamers and their families.

Problem gambling and gaming in elite athletes.

BACKGROUND: High-level sports have been described as a risk situation for mental health problems and substance misuse. This, however, has been sparsely studied for problem gambling, and it is unknown whether problem gaming, corresponding to the tentative diagnosis of internet gaming disorder, may be overrepresented in athletes. This study aimed to study the prevalence and correlates of problem gambling and problem gaming in national team-level athletes. METHODS: A web-survey addressing national team-level athletes in university studies (survey participation 60%) was answered by 352 individuals (60% women, mean age 23.7), assessing mental health problems, including lifetime history of problem gambling (NODS-CLiP) and problem gaming (GASA). RESULTS: Lifetime prevalence of problem gambling was 7% (14% in males, 1% in females, p < 0.001), with no difference between team sports and other sports. Lifetime prevalence of problem gaming was 2% (4% in males and 1% in females, p = 0.06). Problem gambling and problem gaming were significantly associated (p = 0.01). CONCLUSIONS: Moderately elevated rates of problem gambling were demonstrated, however with large gender differences, and interestingly, with comparable prevalence in team sports and in other sports. Problem gaming did not seem more common than in the general population, but an association between problem gambling and problem gaming was demonstrated.

Conceptual Issues Concerning Internet Addiction and Internet Gaming Disorder: Further Critique on Ryding and Kaye (2017).

The recent commentary paper by Ryding and Kaye Journal of Mental Health and Addiction (doi 10.1007/s11469-017-9811-6, 2017) rightly claimed that "internet addiction" (IA) is a conceptual minefield and raised some important issues for researchers and treatment providers working in the online addiction field. In the present commentary paper, some of the assertions made by Ryding and Kaye are briefly critiqued and extended. More specifically, the present paper (i) examines IA and Internet-based addictions and argues that IA is now a misnomer, (ii) examines IA and its relationship to Internet Gaming Disorder (IGD) and argues IA and IGD are two completely different constructs, and that IGD is a sub-type of gaming disorder rather than a sub-type of IA, (iii) argues that the time spent engaging in online activities is not a good criterion for assessing online addictions and that the context of use is far more important criterion, and (iv) argues that those researchers working in the IA field can learn a lot from the problem gambling field in collecting robust data. More specifically, one of the innovative ways forward could be to build strategic partnerships with commercial online companies to analyze their behavioral tracking data.

Problem Gaming: A Short Primer.

As the popularity of video games has risen so too has the worry about the problems associated with playing them. The authors review the research concerning problem gaming, its similarity to some clinical addictions like gambling and drug and alcohol abuse, and current treatment options. They conclude that, regardless of how researchers and medical professionals assess the nature of a gaming disorder, few who play video games experience negative consequences from doing so and, at best, only a small subset of players might be considered to suffer from an addiction to it.