@Article{info:doi/10.2196/60476, author="Diviani, Nicola and Chadha, Shelly and Mulas, Peter and Rubinelli, Sara", title="Safe Listening Beliefs, Attitudes, and Practices Among Gamers and Esports Participants: International Web-Based Survey", journal="JMIR Form Res", year="2025", month="Mar", day="25", volume="9", pages="e60476", keywords="video gaming", keywords="esports", keywords="hearing health", keywords="safe listening", keywords="auditory risk", keywords="health behavior", keywords="intervention design", keywords="games", keywords="listening", keywords="auditory", keywords="survey", keywords="college", keywords="data analysis", keywords="awareness", keywords="listening behavior", keywords="gaming", abstract="Background: The global rise of video gaming and esports has raised significant concerns about hearing loss due to loud sound exposure. While these activities provide entertainment and have applications in health care, the auditory health risks and behavioral factors influencing listening habits among gamers remain underexplored. Research is needed to develop tailored interventions that address the unique barriers, attitudes, and beliefs of gamers and esports participants, promoting safer listening practices and minimizing auditory health risks. Objective: This study aimed to explore listening behaviors, attitudes, and awareness regarding hearing health risks among video gamers and esports participants. The findings are intended to guide the design and implementation of technological features that encourage safer listening practices, in alignment with the World Health Organization's Safe Listening initiative. Methods: An open web-based survey was conducted from September 2022 to January 2023, targeting video gamers and esports enthusiasts. Participants were recruited via World Health Organization social media platforms and outreach to stakeholders. The survey assessed gaming behaviors, listening habits, awareness about hearing health, beliefs, readiness to change listening behaviors, and communication preferences. Data were analyzed using descriptive statistics and multinomial logistic regression. Results: A total of 488 responses were collected, with 67.2\% (n=328) of participants identifying as male, and 56.4\% (n=275) having a college degree or higher. Of the respondents, 90.8\% (n=443) were actively engaged in video gaming, while 54.9\% (n=268) viewed esports, and 13.9\% (n=68) participated in esports events. Notably, 24.8\% (n=110) of gamers, 18.3\% (n=49) of esports viewers, and 37.1\% (n=23) of esports players reported using high or very high volume settings. Despite around half of the participants experiencing symptoms indicative of hearing damage (eg, ringing in the ears), only 34.3\% (n=152) of gamers, 35.8\% (n=92) of esports players, and 39.7\% (n=27) of esports viewers reported taking sound breaks every hour. The study identified a balanced distribution across readiness-to-change stages, with 30.3\% (n=148) in the precontemplation stage, 35.3\% (n=173) in the contemplation stage, and 34.2\% (n=167) in the action stage. Factors such as perceived susceptibility to hearing loss, perceived benefits of preventive action, and self-efficacy significantly influenced readiness to change. Communication preferences indicated that 51\% (n=249) of participants were interested in receiving more information on hearing health, with health care professionals and governmental agencies being the most trusted sources. Conclusions: The findings highlight an urgent need for interventions to promote safe listening practices among gamers, emphasizing a gap between awareness and preventive action. The integration of safe listening features into video games and esports platforms, along with targeted communication strategies, can enhance auditory health awareness and protective behaviors. Future research should evaluate the effectiveness of these interventions to ensure comprehensive auditory health protection in the digital entertainment sector. ", doi="10.2196/60476", url="https://formative.jmir.org/2025/1/e60476", url="http://www.ncbi.nlm.nih.gov/pubmed/40131338" } @Article{info:doi/10.2196/66448, author="Kim, I. Sol and Jin, Jae-Chan and Yoo, Seo-Koo and Han, Hyun Doug", title="Changes in Internet Activities and Influencing Factors for Problematic Internet Use During the COVID-19 Pandemic in Korean Adolescents: Repeated Cross-Sectional Study", journal="JMIR Pediatr Parent", year="2025", month="Feb", day="11", volume="8", pages="e66448", keywords="coronavirus pandemic", keywords="internet use pattern", keywords="internet games", keywords="short-form videos", keywords="social network system", keywords="depressed mood", keywords="internet use", keywords="pandemic", keywords="internet", keywords="COVID-19", keywords="video", keywords="internet behavior", keywords="social media", keywords="internet addiction", keywords="depression", keywords="anxiety", keywords="digital platforms", keywords="mobile phone", abstract="Background: As adolescents increasingly engage with digital experiences, the internet serves as a platform for social interaction, entertainment, and learning. The COVID-19 pandemic accelerated this trend, with remote learning and restricted physical interactions driving changes in internet behavior. Adolescents spent more time on gaming and social media, reflecting a notable shift in use patterns. Objective: We hypothesized that the COVID-19 pandemic changed internet use patterns among Korean adolescents, including content types, time spent on web-based activities, and pathological use prevalence. Additionally, we anticipated that these changes would correlate with shifts in adolescents' psychological status during the pandemic. Methods: Data from 827 adolescents aged 12 to 15 years (n=144 in 2018, n=142 in 2019, n=126 in 2020, n=130 in 2021, n=143 in 2022, and n=142 in 2023) were gathered over 6 years from 43 middle schools across 16 regions and 1 hospital in South Korea. The demographic data collected included age, sex, and school year. Participants also provided information on their internet use patterns and levels of internet addiction. Additionally, psychological status, including mood, anxiety, attention, and self-esteem, was assessed. Results: There were significant differences in the depression scale (Patient Health Questionnaire 9). The Patient Health Questionnaire 9 scores for 2018, 2019, and 2023 decreased compared to those in 2020, 2021, and 2022 (F5=3.07; P=.007). Regarding changes in internet use behavior, game playing among adolescents decreased after the pandemic compared to before, while watching videos increased. Additionally, the rate of problematic internet use was highest for games before COVID-19, but after COVID-19, it was highest for videos, and this trend continued until 2023 ($\chi$23=8.16, P=.04). Furthermore, this study showed that the Young's Internet Addiction Scale (YIAS) score was highest in the game group in 2018 compared to other groups before COVID-19 (F5=14.63; P<.001). In 2019, both the game and video groups had higher YIAS scores than other groups (F5=9.37; P<.001), and by 2022, the YIAS scores among the game, video, and Social Network Service groups did not differ significantly. The degree of influence on the severity of internet addiction was also greatest for games before COVID-19, but after COVID-19, the effect was greater for videos than for games. Conclusions: During the COVID-19 pandemic, internet use for academic and commercial purposes, including remote classes and videoconferences, increased rapidly worldwide, leading to a significant rise in overall internet use time. The demand for and dependence on digital platforms is expected to grow even further in the coming era. Until now, concerns have primarily focused on the use of games, but it is now necessary to consider what types of internet behaviors cause problems and how to address them. ", doi="10.2196/66448", url="https://pediatrics.jmir.org/2025/1/e66448" } @Article{info:doi/10.2196/59656, author="Lu, Peng and Qiu, Jiamin and Huang, Shiqi and Wang, Xinman and Han, Shasha and Zhu, Sui and Ning, Youjing and Zeng, Fang-fang and Yuan, Yuan", title="Interventions for Digital Addiction: Umbrella Review of Meta-Analyses", journal="J Med Internet Res", year="2025", month="Feb", day="11", volume="27", pages="e59656", keywords="digital addiction", keywords="interventions", keywords="umbrella reviews", keywords="systematic review", keywords="internet addiction", keywords="loneliness", keywords="quality of life", keywords="well-being", keywords="internet", keywords="psychological", keywords="pharmacological treatment", keywords="cognitive behavioral therapy", abstract="Background: Numerous studies have explored interventions to reduce digital addiction outcomes, but inconclusive evidence makes it difficult for decision-makers, managers, and clinicians to become familiar with all available literature and find appropriate interventions. Objective: This study aims to summarize and assess the certainty of evidence of interventions proposed to decrease digital addiction from published meta-analyses. Methods: An umbrella review of published meta-analyses was performed. We searched PubMed, Cochrane Library, Web of Science, and Embase for meta-analyses published up to February 2024. Eligible studies evaluated interventions using randomized controlled trials, nonrandomized controlled trials, or quasi-experimental studies and were assessed for methodological quality using Assessment of Multiple Systematic Reviews version 2. A random effects model was used to analyze data, considering heterogeneity and publication bias. Grading of Recommendations, Assessment, Development, and Evaluations was applied to assess evidence with certainty. Results: A total of 5 studies assessing 21 associations were included in the umbrella review, of which 4 (80\%) were high-quality meta-analyses. Weak evidence was observed in 19 associations, whereas null associations appeared in the remaining 2 associations. These associations pertained to 8 interventions (group counseling, integrated internet addiction [IA] prevention programs, psychosocial interventions, reality therapy, self-control training programs, cognitive behavioral therapy, interventions to reduce screen time in children, and exercise) and 9 outcomes (self-control, self-esteem, internet gaming disorder symptoms, time spent gaming, IA scores, screen use time, interpersonal sensitivity longlines, anxiety, and depression). Cognitive behavioral therapy reduces anxiety (standardized mean difference [SMD] 0.939, 95\% CI 0.311 to 1.586), internet gaming disorder symptoms (SMD 1.394, 95\% CI 0.664 to 2.214), time spent gaming (SMD 1.259, 95\% CI, 0.311 to 2.206), and IA scores (SMD --2.097, 95\% CI --2.814 to --1.381). Group counseling had a large effect on improving self-control (SMD 1.296, 95\% CI 0.269 to 2.322) and reducing IA levels (SMD --1.417, 95\% CI --1.836 to --0.997). Exercise intervention reduced IA scores (SMD --2.322, 95\% CI --3.212 to --1.431), depression scores (SMD --1.421, 95\% CI --2.046 to --797), and interpersonal sensitivity scores (SMD --1.433, 95\% CI --2.239 to --0.627). Conclusions: The evidence indicates that current interventions to reduce digital addiction are weak. Data from more and better-designed studies with larger sample sizes are needed to establish robust evidence. Trial Registration: PROSPERO CRD42024528173; crd.york.ac.uk/PROSPERO/display\_record.php?RecordID=528173 ", doi="10.2196/59656", url="https://www.jmir.org/2025/1/e59656" } @Article{info:doi/10.2196/66045, author="Tjernberg, Johanna and Helgesson, Sara and H{\aa}kansson, Anders and Hansson, Helena", title="Exploring the Users' Perspective of the Nationwide Self-Exclusion Service for Gambling Disorder, ``Spelpaus'': Qualitative Interview Study", journal="JMIR Hum Factors", year="2025", month="Jan", day="31", volume="12", pages="e66045", keywords="gambling disorder", keywords="gambling addiction", keywords="behavioral addiction", keywords="harm reduction", keywords="self-exclusion", keywords="voluntary self-exclusion", keywords="Spelpaus", keywords="lived experience", keywords="human factors", keywords="usability", keywords="qualitative study", abstract="Background: Problem gambling and gambling disorder cause severe social, psychiatric, and financial consequences, and voluntary self-exclusion is a common harm reduction tool used by individuals with gambling problems. Objective: The aim of this study was to explore users' experience of a novel nationwide, multioperator gambling self-exclusion service, ``Spelpaus,'' in Sweden and to inform stakeholders and policy makers in order to improve harm reduction tools against gambling problems. Methods: Semistructured interviews were conducted with 15 individuals who reported self-perceived gambling problems and who had experience of having used the self-exclusion service Spelpaus in Sweden. Interviews were transcribed and analyzed through qualitative content analysis. Results: We identified 3 categories and 8 subcategories. The categories were (1) reasons for the decision to self-exclude, (2) positive experiences, and (3) suggestions for improvement. The subcategories identified a number of reasons for self-exclusion, such as financial reasons and family reasons, and positive experiences described as a relief from gambling; in addition, important suggestions for improvement were cited, such as a more gradual return to gambling post--self-exclusion, better ways to address loopholes in the system, and transfer from self-exclusion to treatment. Conclusions: Voluntary self-exclusion from gambling, using a nationwide multioperator service, remains an appreciated harm-reducing tool. However, transfer from self-exclusion to treatment should be facilitated by policy making, and loopholes allowing for breaching of the self-exclusion need to be counteracted. ", doi="10.2196/66045", url="https://humanfactors.jmir.org/2025/1/e66045", url="http://www.ncbi.nlm.nih.gov/pubmed/39888656" } @Article{info:doi/10.2196/59441, author="Zhu, Shimin and Qi, Di", title="Reciprocal Relationship Between Self-Control Belief and Gaming Disorder in Children and Adolescents: Longitudinal Survey Study", journal="JMIR Serious Games", year="2025", month="Jan", day="15", volume="13", pages="e59441", keywords="growth mindset", keywords="gaming disorder", keywords="cross-lagged panel model", keywords="children", keywords="self-control", keywords="adolescents", abstract="Background: Children and adolescents are often at the crossroads of leisure gaming and excessive gaming. It is essential to identify the modifiable psychosocial factors influencing gaming disorder development. The lay theories of self-control (ie, the beliefs about whether self-control can be improved, also called self-control mindsets) may interplay with self-control and gaming disorder and serve as a promising influential factor for gaming disorder. Objective: This study aims to answer the research questions ``Does believing one's self-control is unchangeable predict more severe gaming disorder symptoms later?'' and ``Does the severity of gaming disorder symptoms prospectively predict self-control mindsets?'' with a 1-year, 2-wave, school-based longitudinal survey. Methods: A total of 3264 students (338 in grades 4?5 and 2926 in grades 7?10) from 15 schools in Hong Kong participated in the classroom surveys. We used cross-lagged panel models to examine the direction of the longitudinal association between self-control mindsets and gaming disorder. Results: A bidirectional relationship was found between self-control mindsets and gaming disorder symptom severity (the cross-lagged path from mindsets to gaming disorder: regression coefficients [b] with 95\% CI [0.070, 0.020-0.12o, P=.006]; and from gaming disorder to mindsets: b with 95\% CI [0.11, 0.060-0.160, P<.001]). Subgroup analyses of boy and girl participants revealed that more growth mindsets regarding self-control predicted less severe gaming disorder symptoms in girls (b=0.12, 95\% CI 0.053-0.190, P=.001) but not in boys (b=0.025, 95\% CI --0.050 to 0.100, P=.51), while more severe gaming disorder symptoms predicted a more fixed mindset of self-control in both boys (b=0.15, 95\% CI 0.069-0.230, P<.001) and girls (b=0.098, 95\% CI 0.031-0.170, P=.004) after 1 year. Conclusions: Our findings demonstrated the negative impact of gaming disorder on one's self-control malleability beliefs and implied that promoting a growth mindset regarding self-control might be a promising strategy for gaming disorder prevention and early intervention, especially for girls. ", doi="10.2196/59441", url="https://games.jmir.org/2025/1/e59441" } @Article{info:doi/10.2196/59740, author="Siste, Kristiana and King, L. Daniel and Hanafi, Enjeline and Sen, Thung Lee and Adrian, Adrian and Murtani, Julivia Belinda", title="Scrutinizing the Gateway Relationship Between Gaming and Gambling Disorder: Scoping Review With a Focus on the Southeast Asian Region", journal="JMIR Serious Games", year="2025", month="Jan", day="15", volume="13", pages="e59740", keywords="behavioral addiction", keywords="convergence", keywords="gateway effect", keywords="gambling advertisement", keywords="gamblification", keywords="monetized gaming", abstract="Background: The gaming and gambling overlap has intensified with new evidence emerging. However, the relationship between gaming and gambling in the digital space is still inconclusive, especially in resource-limited Asian countries. Objective: This study aims to review available evidence on the possible interaction and focuses specifically on the gateway interaction between gambling and gaming. Additionally, this review delves into the state of evidence from the Southeast Asian region, providing an in-depth analysis of this underexplored area. Methods: We performed a scoping review by sifting through the publications in five databases. We focused on the gateway interaction and provided a possible pathway model, while two other convergence relationships were provided for comparison. Results: The scoping review identified a total of 289 publications, with the majority being empirical (n=181), although only 12 studies used longitudinal designs. A significant proportion of the publications (n=152) concentrated on the correlation or comorbidity between gaming and gambling. Most of the evidence has originated from Global North countries, with very limited research emerging from Southeast Asia (n=8). The most commonly studied gambling-like element in video games was loot boxes (n=105). Other elements investigated included esports betting, skin betting, token wagering, gambling advertisements, and gambling-like features. Several longitudinal studies have highlighted the risk of the gateway effect associated with gamblification involvement. However, emerging evidence suggests more nuanced underlying mechanisms that drive the transition from gaming to gambling. Conclusions: Overall, there is early evidence of linkage between gambling and gaming, through shared structural and biopsychosocial characteristics. This association possibly extends beyond disparate comorbidity, as such engagement in one activity might influence the risk of partaking in the other behavior. The field requires further longitudinal data to determine the directionality and significant precipitating factors of the gateway effect, particularly evidence from Asia. ", doi="10.2196/59740", url="https://games.jmir.org/2025/1/e59740" } @Article{info:doi/10.2196/56663, author="Strojny, Pawe? and Kapela, Ksawery and Lipp, Natalia and Sikstr{\"o}m, Sverker", title="Use of 4 Open-Ended Text Responses to Help Identify People at Risk of Gaming Disorder: Preregistered Development and Usability Study Using Natural Language Processing", journal="JMIR Serious Games", year="2024", month="Dec", day="31", volume="12", pages="e56663", keywords="gaming disorder", keywords="natural language processing", keywords="machine learning", keywords="mental health", keywords="NLP", keywords="text", keywords="open-ended", keywords="response", keywords="risk", keywords="psychological", keywords="Question-based Computational Language Assessment", keywords="QCLA", keywords="transformers-based", keywords="language model analysis", keywords="Polish", keywords="Pearson", keywords="correlation", keywords="Python", abstract="Background: Words are a natural way to describe mental states in humans, while numerical values are a convenient and effective way to carry out quantitative psychological research. With the growing interest of researchers in gaming disorder, the number of screening tools is growing. However, they all require self-quantification of mental states. The rapid development of natural language processing creates an opportunity to supplement traditional rating scales with a question-based computational language assessment approach that gives a deeper understanding of the studied phenomenon without losing the rigor of quantitative data analysis. Objective: The aim of the study was to investigate whether transformer-based language model analysis of text responses from active gamers is a potential supplement to traditional rating scales. We compared a tool consisting of 4 open-ended questions formulated based on the clinician's intuition (not directly related to any existing rating scales for measuring gaming disorders) with the results of one of the commonly used rating scales. Methods: Participants recruited using an online panel were asked to answer the Word-Based Gaming Disorder Test, consisting of 4 open-ended questions about gaming. Subsequently, they completed a closed-ended Gaming Disorders Test based on a numerical scale. Of the initial 522 responses collected, we removed a total of 105 due to 1 of 3 criteria (suspiciously low survey completion time, providing nonrelevant or incomplete responses). Final analyses were conducted on the responses of 417 participants. The responses to the open-ended questions were vectorized using HerBERT, a large language model based on Google's Bidirectional Encoder Representations from Transformers (BERT). Last, a machine learning model, specifically ridge regression, was used to predict the scores of the Gaming Disorder Test based on the features of the vectorized open-ended responses. Results: The Pearson correlation between the observable scores from the Gaming Disorder test and the predictions made by the model was 0.476 when using the answers of the 4 respondents as features. When using only 1 of the 4 text responses, the correlation ranged from 0.274 to 0.406. Conclusions: Short open responses analyzed using natural language processing can contribute to a deeper understanding of gaming disorder at no additional cost in time. The obtained results confirmed 2 of 3 preregistered hypotheses. The written statements analyzed using the results of the model correlated with the rating scale. Furthermore, the inclusion in the model of data from more responses that take into account different perspectives on gaming improved the performance of the model. However, there is room for improvement, especially in terms of supplementing the questions with content that corresponds more directly to the definition of gaming disorder. Trial Registration: OSF Registries osf.io/957nz; https://osf.io/957nz ", doi="10.2196/56663", url="https://games.jmir.org/2024/1/e56663" } @Article{info:doi/10.2196/59968, author="Colder Carras, Michelle and Aljuboori, Dahlia and Shi, Jing and Date, Mayank and Karkoub, Fatima and Garc{\'i}a Ortiz, Karla and Abreha, Molla Fasika and Thrul, Johannes", title="Prevention and Health Promotion Interventions for Young People in the Context of Digital Well-Being: Rapid Systematic Review", journal="J Med Internet Res", year="2024", month="Dec", day="18", volume="26", pages="e59968", keywords="digital well-being", keywords="internet addiction", keywords="gaming disorder", keywords="social media", keywords="screen time", keywords="prevention", keywords="children", keywords="adolescents", keywords="mobile phone", keywords="PRISMA", abstract="Background: Increasing digital technology and media use among young people has raised concerns about problematic use and negative consequences. The formal recognition of a technology addiction (eg, gaming disorder) requires an understanding of the landscape of interventions designed to prevent this disorder and related technology addictions. Objective: We conducted a rapid systematic review to investigate the current evidence on approaches to prevent problematic technology use and promote digital well-being, defined as the healthy use of digital media and technology and the absence of problems resulting from excessive use. Methods: We used a pragmatic and rapid approach to systematically review and synthesize recent literature with a focus on contextual factors that can aid in understanding translatability, making trade-offs appropriate for rapid reviews per the Cochrane Collaboration guidelines. We searched multiple databases, including gray literature, for primary studies and systematic reviews of prevention interventions targeting children, adolescents, and youth. We extracted data on study characteristics, quality, and translatability and synthesized evidence through narrative description and vote counting of controlled trials. Data are openly available on our Open Science Framework website. Results: We found 6416 citations, of which 41 (0.64\%) were eligible for inclusion (6 reviews and 35 primary studies of 33 interventions). Most interventions (26/33, 79\%) combined intervention approaches and included an education component. Synthesis through vote counting showed benefits for all forms of digital well-being. Both included meta-analyses reported small positive effects on reductions of screen time. However, study reporting was overall lacking, impairing the ability to draw conclusions. Conclusions: As digital technology use increases, interventions to prevent problematic technology use and promote digital well-being continue to proliferate. Understanding context factors that influence healthy technology use and understanding the limitations of the current evidence are vital for informing future research. This review demonstrates positive findings for the effectiveness of prevention interventions and describes factors that may contribute to translation and implementation. Future research would benefit from following appropriate reporting guidelines, reporting both the benefits and harms of interventions, and including greater detail on factors informing translation. Trial Registration: PROSPERO CRD42023444387; https://www.crd.york.ac.uk/prospero/display\_record.php?RecordID=444387 ", doi="10.2196/59968", url="https://www.jmir.org/2024/1/e59968", url="http://www.ncbi.nlm.nih.gov/pubmed/39693138" } @Article{info:doi/10.2196/50418, author="Yu, Yanqiu and Yen, Y. Stefanie H. and Wang, Baofeng Deborah and Wu, S. Anise M. and Chen, Honglei Juliet and Zhang, Guohua and Du, Mengni and Du, Dajin and Du, Mingxuan and Lau, F. Joseph T.", title="School Climate and School Identification as Determinants of Internet Gaming Disorder Among Chinese Adolescent Internet Gamers: Cross-Sectional Mediation Study", journal="JMIR Serious Games", year="2024", month="Nov", day="12", volume="12", pages="e50418", keywords="school climate", keywords="school identification", keywords="adolescent", keywords="structural equation modeling", keywords="internet gaming disorder", abstract="Background: School climate and school identification are important features of the school environment and potential determinants of adolescent internet gaming disorder (IGD). Objective: This novel study investigated their joint effects on IGD and related mediation mechanisms via the interpersonal factor of teacher-student relationship and the individual factors of academic stress and anxiety. Methods: A large-scale cross-sectional study was conducted among adolescent internet gamers of junior, senior, and vocational middle schools in Taizhou City, China, from February to March 2022 (N=5778). Participants self-administered an anonymous, structured questionnaire in classrooms. Adjusted logistic regression and structural equation modeling (SEM) were used for data analysis. Results: Among all participants, the prevalence of IGD was 8\% (461/5778). The 4 school climate subscales (student-student relationship subscale: adjusted odds ratio [ORa] 0.88, 95\% CI 0.85-0.91; student-staff relations subscale: ORa 0.87, 95\% CI 0.84-0.90; academic emphasis subscale: ORa 0.88, 95\% CI 0.85-0.91; shared values approach: ORa 0.88, 95\% CI 0.85-0.90), the school identification subscale (ORa 0.85, 95\% CI 0.83-0.88), and teacher-student relationship (ORa 0.80, 95\% CI 0.76-0.84) were significant protective factors against IGD, while academic stress (ORa 1.18, 95\% CI 1.14-1.23) and anxiety (ORa 1.16, 95\% CI 1.14-1.18) were risk factors of IGD. The SEM showed that the negative associations between school climate and IGD and between school identification and IGD were mediated via (1) three 2-step paths, each involving a single mediator---teacher-student relationship, academic stress, and anxiety, respectively---and (2) two 3-step paths involving 2 mediators---teacher-student relationship and academic stress first, respectively, and then anxiety. The direct effect of school climate on IGD was statistically nonsignificant (ie, full mediation with effect size ranging from 4.2\% to 20.4\%), while that of school identification was statistically significant (ie, partial mediation with effect size ranging from 4.5\% to 38.2\%). Conclusions: The relatively high prevalence of IGD among Chinese adolescents may be reduced through school-based interventions to improve school climate and school identification. Such improvements may reduce the levels of risk factors of IGD (poor teacher-student relationship, academic stress, and anxiety) and hence the risk of IGD. Future longitudinal and intervention studies are needed to confirm the findings. ", doi="10.2196/50418", url="https://games.jmir.org/2024/1/e50418" } @Article{info:doi/10.2196/51833, author="Yewale, Prasad and Rathi, Renu and Mate, Swapnali", title="Study to Evaluate the Comparative Efficacy of Medhya Rasayana (Pharmacological) Versus Nonpharmacological Interventions in Management of Gadget Addiction in Children: Protocol for Parallel, Triple-Arm, Randomized Clinical Trial", journal="JMIR Res Protoc", year="2024", month="Nov", day="11", volume="13", pages="e51833", keywords="addiction", keywords="Ayurveda", keywords="gadget addiction", keywords="children", keywords="Kaumarbhritya", keywords="Medhya Rasayana", keywords="yoga", keywords="complementary and alternative medicine", abstract="Background: Gadget addiction is a common behavioral problem among children. It is known to hamper social and academic life as well as adversely affect the lives of children. Ayurveda offers many therapeutic modalities and Ayurvedic medicines that can be used in the management of gadget addiction in children. The purpose of this study is to evaluate and compare the effectiveness of nonpharmacological therapies and the pharmaceutical intervention Medhya Rasayana in treating childhood gadget addiction. Objective: This study aims to provide a detailed description of the study methodology that will be used to compare the efficacy of nonpharmacological versus pharmaceutical interventions in the treatment of children's gadget addiction. Methods: A randomized, parallel, triple-arm interventional study will be conducted on diagnosed participants of gadget addiction with an age group of 6- to 16-year-old children, which will be selected and equally distributed in 2 groups. Group P will be given Medhya Rasayana (pharmacological intervention), group N will be nonpharmacological Ayurveda intervention, and group C (cognitive behavioral therapy) will be an external group. The Study duration is 180 days with assessment at baseline, midpoint, and endpoint Appropriate statistical techniques, such as ANOVA and regression analysis, will be used to examine the data and evaluate the efficacy of the 3 groups' interventions. We will perform subgroup analysis according to initial addiction severity, gender, and age. Primary outcome measures include a reduction in gadget addiction and changes in the psychosocial well-being of participants. Standardized questionnaires and instruments will be used to collect data. Results: In December 2023, the randomized controlled study got underway. Since participants may begin at any time, our goal is for everyone to be finished by December 2024. Conclusions: This research will provide crucial new information about the relative effectiveness of Ayurveda nonpharmacological therapies and Medhya Rasayana in treating children's gadget addiction. The results will guide evidence-based treatments aimed at reducing the negative impact of excessive gadget use on this susceptible population's psychosocial development. In the end, the findings are meant to help policy makers and medical professionals create sensible plans to deal with the rising issue of childhood gadget addiction. International Registered Report Identifier (IRRID): PRR1-10.2196/51833 ", doi="10.2196/51833", url="https://www.researchprotocols.org/2024/1/e51833" } @Article{info:doi/10.2196/56387, author="Werner, Marie and Kapetanovic, Sabina and Claesdotter-Knutsson, Emma", title="Family-Centered Treatment Program for Problematic Gaming and Excessive Screen Use in a Clinical Child and Youth Population (FAME): Protocol for a Feasibility Pilot Mixed Method Study", journal="JMIR Res Protoc", year="2024", month="Oct", day="8", volume="13", pages="e56387", keywords="gaming", keywords="family program", keywords="family intervention", keywords="pilot study,", keywords="adolescent", keywords="problematic gaming", keywords="excessive screen time", keywords="children", keywords="screen use", keywords="child-parent relationship", keywords="motivational interviewing", abstract="Background: Screen time among children and adolescents has increased dramatically, raising concerns about its impact on development and mental health. While research highlights both potential benefits and risks, excessive use has been linked to issues like anxiety, depression, and gaming addiction. Despite growing concern, effective interventions are scarce. Recognizing the importance of family dynamics in child development, we propose a family-centered program to address problematic gaming and excessive screen use in a clinical population. By involving both children and parents, we aim to create a more comprehensive approach to prevention and treatment. Objective: This study aims to determine the possibility of distributing and evaluating a family-centered group program for problematic gaming and excessive screen use (FAME) in a clinical child and adolescent psychiatry (CAP) population. We will monitor the recruitment rate; track the retention and attendance rates of both parents and children; and assess whether each session's objectives are met, the content is delivered within the allotted time, and the necessary resources (eg, facilitators and materials) are available. Additionally, we will gather qualitative and quantitative feedback from participants through postprogram surveys and individual interviews with both children and parents. Methods: A total of 10 families with ongoing contact with CAP in Sk{\aa}ne, Sweden, will be recruited and offered participation in a family-centered group program targeting children aged 10-18 years with reported difficulties regarding screen gaming or screen use. The intervention to be tested is a newly developed, family-centered, psychoeducational, cognitive behavioral therapy--based intervention addressing both positive and negative aspects of screen use; setting boundaries; the connection between thoughts, feelings, and behaviors; conflict triggers; and sleep hygiene. The primary goal of the pilot study is to test the feasibility of the program, as well as recruitment and the analysis of participants' experiences with the program. Results: A total of 11 children and their parents were enrolled during first quarter of 2024. A 4-session pilot was delivered in first quarter of 2024, and the first results are expected in the third quarter of 2024. Conclusions: The overarching goal of this pilot study is to determine the possibility of distributing and evaluating a family-centered group program for problematic gaming and excessive screen use (FAME) in a clinical CAP population. The insights gained from this study will guide our future research, which will focus on conducting a larger-scale evaluation of the intervention's impact on family screen time conflicts and inform future strategies for the implementation of family-centered interventions in child and youth clinics. Trial Registration: ClinicalTrials.gov NCT06098807; https://clinicaltrials.gov/study/NCT06098807 International Registered Report Identifier (IRRID): DERR1-10.2196/56387 ", doi="10.2196/56387", url="https://www.researchprotocols.org/2024/1/e56387", url="http://www.ncbi.nlm.nih.gov/pubmed/39378066" } @Article{info:doi/10.2196/57304, author="Gonz{\'a}lez-Cabrera, Joaqu{\'i}n and Caba-Machado, Vanessa and D{\'i}az-L{\'o}pez, Adoraci{\'o}n and Jim{\'e}nez-Murcia, Susana and Mestre-Bach, Gemma and Machimbarrena, M. Juan", title="The Mediating Role of Problematic Use of Loot Boxes Between Internet Gaming Disorder and Online Gambling Disorder: Cross-Sectional Analytical Study", journal="JMIR Serious Games", year="2024", month="Sep", day="20", volume="12", pages="e57304", keywords="loot boxes", keywords="loot box", keywords="gaming", keywords="gambling", keywords="problematic", keywords="video games", keywords="game", keywords="games", keywords="addict", keywords="addiction", keywords="addictions", keywords="addictive", keywords="internet", keywords="virtual object", keywords="virtual objects", keywords="gamification", keywords="IGD", keywords="OGD", keywords="monetize", keywords="monetization", keywords="reward", keywords="rewards", keywords="incentive", keywords="incentives", keywords="internet gaming disorder", keywords="online gambling disorder", abstract="Background: The video game industry has introduced a new form of monetization through microtransactions. A controversial example has been the so-called ``loot boxes'' (LBs) as virtual objects, which are randomized and bought with legal money. In recent years, LBs have come to connect 2 distinct problem behaviors, namely internet gaming disorder (IGD) and online gambling disorder (OGD). Many association studies have been conducted on the 3 constructs, but few have delved into the relationship of problematic use of LBs (PU-LB) with IGD and OGD. Objective: This study aims to explore the mediating role of the PU-LB between IGD and OGD. Methods: This cross-sectional and analytical study used incidental sampling in 24 Spanish schools. The final sample consisted of 542 participants (male: n=523, 96.5\%; age: range 11?30 y) who played video games, bought LBs, and had gambled online in the last 12 months. Participants then completed the Spanish versions of the Internet Gaming Disorder Scale--Short Form, Online Gambling Disorder Questionnaire, and PU-LB scale. Results: IGD scores were found to be significantly associated with both PU-LB (r=0.473, P<.001) and OGD (r=0.209, P<.001). Moreover, PU-LB was significantly associated with OGD (r=0.351, P<.001). The structural equation model results indicated that IGD had no significant direct effect on OGD (P=.903). However, the indirect effect of IGD on OGD through PU-LB was significant (P<.001). Therefore, PU-LB fully mediated the relationship between IGD and OGD. Furthermore, these results were found in the subsamples of both minors (<18 y) and young adults (?18 y). Conclusions: It is suggested that there is a mediation effect of problematic LB use between internet gambling and online gambling problems in both minors and young adults. This has potential practical implications by providing more evidence on how LBs have become a hinge feature between 2 clinically relevant and independent issues. In this regard, adequate industry self-regulation is needed, and effective legislation for the protection of minors is necessary. ", doi="10.2196/57304", url="https://games.jmir.org/2024/1/e57304" } @Article{info:doi/10.2196/48439, author="Yu, Yanqiu and Wu, S. Anise M. and Fong, I. Vivian W. and Zhang, Jianxin and Li, Ji-bin and Lau, F. Joseph T.", title="Association Between Internet Gaming Disorder and Suicidal Ideation Mediated by Psychosocial Resources and Psychosocial Problems Among Adolescent Internet Gamers in China: Cross-Sectional Study", journal="JMIR Serious Games", year="2024", month="Sep", day="19", volume="12", pages="e48439", keywords="internet gaming disorder", keywords="suicidal ideation", keywords="adolescents", keywords="mediation", keywords="structural equation modelling", keywords="resilience", keywords="loneliness", keywords="social support", keywords="social anxiety", abstract="Background: Adolescent internet gaming disorder (IGD) was associated with severe harm, including suicidal ideation. While suicidal ideation was predictive of completed suicides, further research is required to clarify the association between IGD and suicidal ideation among adolescents, as well as the mechanisms involved. Objective: This study aimed to investigate the understudied association between IGD and suicidal ideation, as well as novel mechanisms associated with it, among Chinese adolescent internet gamers through psychosocial coping resources and psychosocial problems. Methods: An anonymous, self-administered, cross-sectional survey was conducted among secondary school students who had played internet games in the past year in Guangzhou and Chengdu, China (from October 2019 to January 2020). In total, 1693 adolescent internet gamers were included in this study; the mean age was 13.48 (SD 0.80) years, and 60\% (n=1016) were males. IGD was assessed by the 9-item Internet Gaming Disorder Checklist of the DSM-5 (Diagnostic and Statistical Manual of Mental Disorders [Fifth Edition]), while a single item assessed suicidal ideation: ``Have you ever considered committing suicide in the past 12 months?'' Univariate and multivariate logistic regression associations were conducted to test the significance and directions of the potential factors for suicidal ideation. The mediation mechanism was examined by structural equation modeling. Results: Among all participants, the prevalence of IGD and suicidal ideation was 16.95\% (287/1693) and 43.06\% (729/1693), respectively. IGD cases were 2.42 times more likely than non-IGD cases to report suicidal ideation (adjusted odds ratio [OR] 2.42, 95\% CI 1.73-3.37). Other significant factors of suicidal ideation included psychosocial coping resources (resilience and social support, both adjusted OR 0.97, 95\% CI 0.96-0.98) and psychosocial problems (social anxiety: adjusted OR 1.07, 95\% CI 1.05-1.09; loneliness, adjusted OR 1.13, 95\% CI 1.10-1.16). The association between IGD and suicidal ideation was partially mediated by 3 indirect paths, including (1) the 2-step path that IGD reduced psychosocial coping resources, which in turn increased suicidal ideation; (2) the 2-step path that IGD increased psychosocial problems, which in turn increased suicidal ideation; and (3) the 3-step path that IGD reduced psychosocial coping resources which then increased psychosocial problems, which in turn increased suicidal ideation, with effect sizes of 10.7\% (indirect effect/total effect: 0.016/0.15), 30.0\% (0.05/0.15), and 13.3\% (0.02/0.15), respectively. The direct path remained statistically significant. Conclusions: IGD and suicidal ideation were alarmingly prevalent. Evidently and importantly, IGD was a significant risk factor for suicidal ideation. The association was partially explained by psychosocial coping resources of resilience and social support and psychosocial problems of social anxiety and loneliness. Longitudinal studies are needed to confirm the findings. Pilot randomized controlled trials are recommended to evaluate the effectiveness of interventions in reducing suicidal ideation by reducing IGD, improving psychosocial coping resources, and reducing psychosocial problems investigated in this study. ", doi="10.2196/48439", url="https://games.jmir.org/2024/1/e48439" } @Article{info:doi/10.2196/51307, author="Grahlher, Kristin and Morgenstern, Matthis and Pietsch, Benjamin and Gomes de Matos, Elena and Rossa, Monika and Lochb{\"u}hler, Kirsten and Daubmann, Anne and Thomasius, Rainer and Arnaud, Nicolas", title="Mobile App Intervention to Reduce Substance Use, Gambling, and Digital Media Use in Vocational School Students: Exploratory Analysis of the Intervention Arm of a Randomized Controlled Trial", journal="JMIR Mhealth Uhealth", year="2024", month="Jul", day="23", volume="12", pages="e51307", keywords="prevention", keywords="vocational students", keywords="adolescents", keywords="mobile intervention", keywords="voluntary commitment", keywords="substance use", keywords="internet-related problems", keywords="mobile phone", keywords="adolescent", keywords="youths", keywords="student", keywords="students", keywords="use", abstract="Background: During adolescence, substance use and digital media exposure usually peak and can become major health risks. Prevention activities are mainly implemented in the regular school setting, and youth outside this system are not reached. A mobile app (``Meine Zeit ohne'') has been developed specifically for vocational students and encourages participants to voluntarily reduce or abstain from a self-chosen addictive behavior including the use of a substance, gambling, or a media-related habit such as gaming or social media use for 2 weeks. Results from a randomized study indicate a significant impact on health-promoting behavior change after using the app. This exploratory study focuses on the intervention arm of this study, focusing on acceptance and differential effectiveness. Objective: The aims of this study were (1) to examine the characteristics of participants who used the app, (2) to explore the effectiveness of the mobile intervention depending on how the app was used and depending on participants' characteristics, and (3) to study how variations in app use were related to participants' baseline characteristics. Methods: Log data from study participants in the intervention group were analyzed including the frequency of app use (in days), selection of a specific challenge, and personal relevance (ie, the user was above a predefined risk score for a certain addictive behavior) of challenge selection (``congruent use'': eg, a smoker selected a challenge related to reducing or quitting smoking). Dichotomous outcomes (change vs no change) referred to past-month substance use, gambling, and media-related behaviors. The relationship between these variables was analyzed using binary, multilevel, mixed-effects logistic regression models. Results: The intervention group consisted of 2367 vocational students, and 1458 (61.6\%; mean age 19.0, SD 3.5 years; 830/1458, 56.9\% male) of them provided full data. Of these 1458 students, 894 (61.3\%) started a challenge and could be included in the analysis (mean 18.7, SD 3.5 years; 363/894, 40.6\% female). Of these 894 students, 466 (52.1\%) were considered frequent app users with more than 4 days of active use over the 2-week period. The challenge area most often chosen in the analyzed sample was related to social media use (332/894, 37.1\%). A total of 407 (45.5\%) of the 894 students selected a challenge in a behavioral domain of personal relevance. The effects of app use on outcomes were higher when the area of individual challenge choice was equal to the area of behavior change, challenge choice was related to a behavior of personal relevance, and the individual risk of engaging in different addictive behaviors was high. Conclusions: The domain-specific effectiveness of the program was confirmed with no spillover between behavioral domains. Effectiveness appeared to be dependent on app use and users' characteristics. Trial Registration: German Clinical Trials Register DRKS00023788; https://tinyurl.com/4pzpjkmj International Registered Report Identifier (IRRID): RR2-10.1186/s13063-022-06231-x ", doi="10.2196/51307", url="https://mhealth.jmir.org/2024/1/e51307" } @Article{info:doi/10.2196/46570, author="Krarup, Bygum Kasper and Riis, Johannes and M{\o}rk, Morten and Nguyen, Thu Hien Thi and S{\o}kilde Pedersen, Inge and Risom Kristensen, S{\o}ren and Handberg, Aase and Krarup, Bygum Henrik", title="Biochemical Changes in Adult Male Gamers During Prolonged Gaming: Pilot Study", journal="Interact J Med Res", year="2024", month="Jul", day="8", volume="13", pages="e46570", keywords="long gaming sessions", keywords="local area network party", keywords="biochemistry", keywords="cortisol", keywords="glucose", keywords="gaming", keywords="biochemical", keywords="blood sample", keywords="hematology", keywords="hematological", keywords="games", keywords="gamers", keywords="hemoglobin", keywords="adults", keywords="males", keywords="men", keywords="blood", abstract="Background: Gaming has become an integrated part of life for children and adults worldwide. Previous studies on the impact of gaming on biochemical parameters have primarily addressed the acute effects of gaming. The literature is limited, and the study designs are very diverse. The parameters that have been investigated most thoroughly are blood glucose and cortisol. Objective: This exploratory study is the first to investigate the effects of long gaming sessions on the biochemical parameters of healthy male adults. The extensive testing allowed us to observe short-term changes (within 6 hours), long-term changes during the duration of the gaming sessions, and follow-up after 1 week to determine whether any changes were longer lasting. Methods: In total, 9 experienced gamers completed 2 back-to-back 18-hour gaming sessions interspersed with a 6-hour rest period. All participants adhered to a structured sleep pattern due to daytime employment or attending university. Blood, saliva, and urine samples were collected from the participants every 6 hours. Linear mixed-effect models were used to analyze the repeated-measures data accumulated during the study. A total of 51 biochemical parameters were investigated. Results: In total, 12 of the 51 biochemical parameters significantly changed during the study: alkaline phosphatase, aspartate aminotransferase, bilirubin, chloride, creatinine, glucose, hemoglobin, immature reticulocyte fraction, lactate, methemoglobin, sodium, and thrombocytes. All changes were within the normal range. The mean glucose level of the participants was 4.39 (SD 0.07) mmol/L at baseline, which increased significantly by 0.24 (SD 0.07) mmol/L per 6 hours during the first period and by 0.38 (SD 0.07) mmol/L per 6 hours in the second period (P<.001). The glucose levels during the second session increased even though the participants had little energy intake. Cortisol levels did not change significantly, although the cortisol pattern deviated from the typical circadian rhythm. During both gaming sessions, we observed increasing cortisol levels from 6 AM until noon. The participants were relatively dehydrated at the start of the study. The patients were asked to fast before the first blood sampling. Within the first 6 hours of the study, the participants rehydrated, followed by relative dehydration during the remainder of the study. This pattern was identified using the following parameters: albumin, creatinine, hemoglobin, erythrocytes, potassium, and platelets. Conclusions: This study is the first of its kind, and many of the analyses in the study yielded novel results. The study was designed to emulate the behavior of gamers during the weekend and other long gaming sessions. At this point, we are not able to determine the difference between the effects of gaming and behavior during gaming. Regardless, the results of this study suggest that healthy gamers can partake in long gaming sessions, with ample amounts of unhealthy foods and little rest, without acute impacts on health. ", doi="10.2196/46570", url="https://www.i-jmr.org/2024/1/e46570", url="http://www.ncbi.nlm.nih.gov/pubmed/38976326" } @Article{info:doi/10.2196/50259, author="Cho, Kwangsu and Kim, Minah and Cho, Youngeun and Hur, Ji-Won and Kim, Hyung Do and Park, Seonghyeon and Park, Sunghyun and Jang, Moonyoung and Lee, Chang-Gun and Kwon, Soo Jun", title="Digital Phenotypes for Early Detection of Internet Gaming Disorder in Adolescent Students: Explorative Data-Driven Study", journal="JMIR Ment Health", year="2024", month="Apr", day="29", volume="11", pages="e50259", keywords="adolescents", keywords="digital biomarkers", keywords="digital phenotyping", keywords="digital psychiatry", keywords="early detection", keywords="IGD", keywords="internet gaming disorder", keywords="pediatric psychiatry", keywords="proactive medicine", keywords="secondary school", keywords="universal screening", abstract="Background: Limited awareness, social stigma, and access to mental health professionals hinder early detection and intervention of internet gaming disorder (IGD), which has emerged as a significant concern among young individuals. Prevalence estimates vary between 0.7\% and 15.6\%, and its recognition in the International Classification of Diseases, 11th Revision and Diagnostic and Statistical Manual of Mental Disorders, 5th Edition underscores its impact on academic functioning, social isolation, and mental health challenges. Objective: This study aimed to uncover digital phenotypes for the early detection of IGD among adolescents in learning settings. By leveraging sensor data collected from student tablets, the overarching objective is to incorporate these digital indicators into daily school activities to establish these markers as a mental health screening tool, facilitating the early identification and intervention for IGD cases. Methods: A total of 168 voluntary participants were engaged, consisting of 85 students with IGD and 83 students without IGD. There were 53\% (89/168) female and 47\% (79/168) male individuals, all within the age range of 13-14 years. The individual students learned their Korean literature and mathematics lessons on their personal tablets, with sensor data being automatically collected. Multiple regression with bootstrapping and multivariate ANOVA were used, prioritizing interpretability over predictability, for cross-validation purposes. Results: A negative correlation between IGD Scale (IGDS) scores and learning outcomes emerged (r166=--0.15; P=.047), suggesting that higher IGDS scores were associated with lower learning outcomes. Multiple regression identified 5 key indicators linked to IGD, explaining 23\% of the IGDS score variance: stroke acceleration ($\beta$=.33; P<.001), time interval between keys ($\beta$=--0.26; P=.01), word spacing ($\beta$=--0.25; P<.001), deletion ($\beta$=--0.24; P<.001), and horizontal length of strokes ($\beta$=0.21; P=.02). Multivariate ANOVA cross-validated these findings, revealing significant differences in digital phenotypes between potential IGD and non-IGD groups. The average effect size, measured by Cohen d, across the indicators was 0.40, indicating a moderate effect. Notable distinctions included faster stroke acceleration (Cohen d=0.68; P=<.001), reduced word spacing (Cohen d=.57; P=<.001), decreased deletion behavior (Cohen d=0.33; P=.04), and longer horizontal strokes (Cohen d=0.34; P=.03) in students with potential IGD compared to their counterparts without IGD. Conclusions: The aggregated findings show a negative correlation between IGD and learning performance, highlighting the effectiveness of digital markers in detecting IGD. This underscores the importance of digital phenotyping in advancing mental health care within educational settings. As schools adopt a 1-device-per-student framework, digital phenotyping emerges as a promising early detection method for IGD. This shift could transform clinical approaches from reactive to proactive measures. ", doi="10.2196/50259", url="https://mental.jmir.org/2024/1/e50259", url="http://www.ncbi.nlm.nih.gov/pubmed/38683658" } @Article{info:doi/10.2196/45985, author="Lin, Shuhong and Chen, Xinxin and Tan, Linxiang and Liao, Zhenjiang and Li, Yifan and Tang, Ying and Huang, Qiuping and Shen, Hongxian", title="Psychometric Properties of the Metacognitions About Online Gaming Scale in the Chinese Population and Its Relationship With Internet Gaming Disorder: Cross-Sectional Study", journal="JMIR Serious Games", year="2024", month="Apr", day="22", volume="12", pages="e45985", keywords="metacognition", keywords="metacognitions about online gaming", keywords="Internet Gaming Disorder", keywords="psychometric properties", keywords="Chinese", abstract="Background: Metacognitions about online gaming have been shown to be correlated with Internet Gaming Disorder (IGD). Knowledge of metacognitions about online gaming can help to understand IGD. The Metacognitions about Online Gaming Scale (MOGS) is a reliable and valid tool to measure specific metacognitions about online gaming in both adults and adolescents, which is lacking in China. Objective: This study was conducted to assess the psychometric properties of the Chinese version of the MOGS (C-MOGS) and its relationship with IGD in the Chinese population. Methods: A total of 772 Chinese individuals (age: mean 21.70, SD 8.81 years; age range: 13-57 years; 458/772, 59.3\% male) completed a web-based questionnaire survey, including the C-MOGS and a battery of validated scales measuring IGD, gaming motives, depression, and anxiety. Results: Through exploratory and confirmatory factor analyses, the 3-factor structure was confirmed to have adequate model fit and internal consistency reliability (Cronbach $\alpha$?.799, Guttman split-half coefficients?0.754). Concurrent validity of the C-MOGS was supported by its correlations with IGD (P<.001), gaming motives (P<.001), depression (P<.001), and anxiety (P<.001). Furthermore, the incremental validity analysis showed that the C-MOGS predicted 13\% of the variance in IGD while controlling for gender, age, weekly gaming hours, gaming motives, depression, and anxiety. Conclusions: This study provides evidence that the psychometric properties of the C-MOGS are appropriate and emphasizes its positive association with IGD. The C-MOGS is a reliable and valid instrument for mental health workers to assess metacognitions about online gaming in the Chinese population. ", doi="10.2196/45985", url="https://games.jmir.org/2024/1/e45985", url="http://www.ncbi.nlm.nih.gov/pubmed/38648634" } @Article{info:doi/10.2196/48317, author="Teng, Huina and Zhu, Lixin and Zhang, Xuanyu and Qiu, Boyu", title="The Relationship Between Cognitive Resource Consumption During Gameplay and Postgame Aggressive Behaviors: Between-Subjects Experiment", journal="JMIR Serious Games", year="2023", month="Nov", day="14", volume="11", pages="e48317", keywords="video games", keywords="hurting", keywords="helping", keywords="cognitive resources", keywords="aggressive behaviors", abstract="Background: The question of how video games can shape aggressive behaviors has been a focus for many researchers. Previous research has focused on how violent video game content leads to postgame aggressive behaviors. However, video games not only convey violence or prosocial content to players but also require cognitive effort from individuals. Since human cognitive resources are limited, consuming more cognitive resources in a game leads to less cognitive resources to suppress aggressive impulses. Therefore, the depletion of cognitive resources from playing video games may also lead to changes in postgame aggressive behaviors. Objective: This study aimed to examine the relationship between cognitive resources consumed in video games and postgame aggressive behaviors. Methods: A total of 60 participants (age: mean 20.22; range 18-24 y) were randomly assigned to either the high-load group or the low-load group. Participants from both groups played a video game centered around college life. In the low-load group, participants followed the gameplay instructions to complete it. In the high-load group, participants were given an extra digital memory task to complete while playing the game. Participants in both groups played the video game for about 25 minutes. A maze selection task was then conducted to measure the participants' helping and hurting behaviors. Results: The independent samples 2-tailed t tests showed that the high-load group had significantly higher hurting scores (mean 3.13, SD 2.47) than the low-load group (mean 1.90, SD 2.12; t58=?2.07, P=.04; Cohen d=?0.535), whereas helping behaviors were not significantly affected (t58=1.52, P=.13; Cohen d=0.393). Conclusions: As more cognitive resources are consumed in a video game, more hurting behaviors are exhibited after the game. This finding proposes an alternative route by which video games impact aggressive behaviors, adding to previous theories and raising concerns about the popularity of cognitive training games. ", doi="10.2196/48317", url="https://games.jmir.org/2023/1/e48317" } @Article{info:doi/10.2196/40130, author="Li, Yifan and Tang, Ying and Huang, Shucai and Tan, Linxiang and Huang, Qiuping and Chen, Xinxin and Lin, Shuhong and Hao, Jingyue and Liao, Zhenjiang and Shen, Hongxian", title="Role of Gaming Devices Associated With Internet Gaming Disorder in China: Cross-sectional Study", journal="JMIR Serious Games", year="2023", month="Jan", day="16", volume="11", pages="e40130", keywords="internet gaming disorder", keywords="gaming device", keywords="gaming motivation", keywords="personality traits", keywords="gaming use characteristics", abstract="Background: Chinese gamers use computer and mobile phone games widely. Consequently, concerns regarding the development of internet gaming disorder (IGD) in adolescents have been raised. However, only a few studies have focused on the influence of gaming devices on IGD. Objective: This study aims to compare sociodemographic information, gaming use characteristics, personality traits, and gaming motivations between computer game users (CGUs) and mobile phone game users (MGUs), as well as identifying IGD predictors. Methods: This was a cross-sectional study. A total of 3593 internet game players took part in an online survey, which included sociodemographic information, gaming patterns, gaming motivations, the Chinese version of the Video Game Dependency Scale, and the Chinese Big Five Personality Inventory brief version. The population was divided into 2 groups for comparison by mobile phone or computer use, and the IGD population was also compared within the 2 groups. Results: There were significant differences between the 2 gaming device groups in the time (t2994=7.75, P<.001) and money (t2994=5.11, P<.001) spent on gaming and in internet game addiction scores (t2994=3.68, P<.001). Individuals using different gaming devices had different game motivations and personality traits and preferred different genres of games. Results showed that IGD predictors were different for the 2 groups, for example, strategy (odds ratio [OR] 4.452, 95\% CI 1.938-10.227; P<.001) and action shooter (OR 3.725, 95\% CI 1.465-9.474; P=.01) games increased the risk for MGUs. Conclusions: Gaming devices should be considered during early identification, such as long daily gaming time, much money spent on gaming, neuroticism, and conscientiousness. In addition, more research should be conducted on new gaming devices and IGD treatment. ", doi="10.2196/40130", url="https://games.jmir.org/2023/1/e40130", url="http://www.ncbi.nlm.nih.gov/pubmed/36645700" } @Article{info:doi/10.2196/33806, author="She, Rui and Zhang, Youmin and Yang, Xue", title="Parental Factors Associated With Internet Gaming Disorder Among First-Year High School Students: Longitudinal Study", journal="JMIR Serious Games", year="2022", month="Nov", day="8", volume="10", number="4", pages="e33806", keywords="internet gaming disorder", keywords="adolescents", keywords="parental factors", keywords="longitudinal study", keywords="parenting", keywords="gaming", keywords="gaming disorder", keywords="health intervention", keywords="treatment", keywords="mental health", abstract="Background: Parents play central roles in adolescents' socialization, behavioral development, and health, including the development of internet gaming disorder (IGD). However, longitudinal research on the parental predictors of adolescent IGD is limited. Objective: This study aimed to investigate the reciprocal associations between various parental factors and adolescent IGD using 2-wave cross-lagged models. Methods: A sample of 1200 year-one high school students in central China completed a baseline assessment in 2018 (mean age 15.6 years; 633/1200, 52.8\% male) and a follow-up survey in 2019. IGD was measured using the 9-item DSM-5 IGD Symptoms checklist. Perceptions related to parental variables, including psychological control, parental abuse, parental support, and the parent-child relationship, were also collected from the adolescents. Results: Of all the participants, 12.4\% (148/1200) and 11.7\% (140/1200) were classified as having IGD at baseline (T1) and follow-up (T2), respectively. All 4 cross-lagged models fit the data well (range for the comparative fit index .91-.95; range for the standardized root mean square residual .05-.06). Parental support ($\beta$=--.06, P=.02) and parental abuse ($\beta$=.08, P=.002) at T1 predicted IGD symptoms at T2, while parental psychological control ($\beta$=.03, P=.25) and a positive relationship with parents ($\beta$=--.05, P=.07) at T1 had nonsignificant effects on IGD symptoms at T2, when controlling for background variables. In addition, IGD symptoms at T1 did not predict parental factors at T2. Conclusions: The findings suggest that parental factors may be significant predictors of adolescent IGD. Health interventions should consider involving parents to increase the effectiveness of treatment to prevent and reduce adolescent IGD. ", doi="10.2196/33806", url="https://games.jmir.org/2022/4/e33806", url="http://www.ncbi.nlm.nih.gov/pubmed/36346660" } @Article{info:doi/10.2196/37837, author="H{\aa}kansson, Anders and {\AA}kesson, Gunny", title="Multi-operator Self-exclusion as a Harm Reduction Measure in Problem Gambling: Retrospective Clinical Study on Gambling Relapse Despite Self-exclusion", journal="JMIR Ment Health", year="2022", month="Aug", day="19", volume="9", number="8", pages="e37837", keywords="web-based gambling", keywords="gambling disorder", keywords="behavioral addiction", keywords="self-exclusion", keywords="addiction", keywords="gambling", keywords="prevalence", keywords="harm reduction", keywords="abstain", keywords="problem gambling", abstract="Background: Voluntary self-exclusion from gambling is a common harm reduction option for individuals with gambling problems. Multi-operator, nationwide self-exclusion services are rare, and a system introduced in the highly web-based gambling market of Sweden is a rare and recent example. However, where web-based casino gambling and web-based betting are the predominate gambling types in those seeking treatment, the risk of breaching one's own self-exclusion through overseas web-based operators may also be high. Objective: This study aims to assess the prevalence of a nationwide Spelpaus (``gambling break'') self-exclusion and the prevalence of gambling despite self-exclusion in patients seeking treatment for gambling disorder in 2021. Methods: Health care documentation of recent treatment seekers (January 1 through September 1, 2021, N=85) in a Swedish treatment facility was reviewed for data regarding problematic gambling types reported, history of self-exclusion, and history of breaching of that self-exclusion. Results: Common problem gambling types were web-based casino gambling (49/74, 66\%) and sports betting (19/74, 26\%). The majority who participated in this study (62/85, 73\%) were men. All women reported web-based casino gambling. Self-exclusion through Spelpaus was common (60/74, 81\%). Among self-excluders, gambling despite self-exclusion was common (41/60, 68\%), most commonly on unlicensed gambling websites. Conclusions: The nationwide, multi-operator self-exclusion service of Sweden appears to reach many patients with a gambling disorder. However, the remaining gambling options in an web-based gambling setting present a major challenge despite self-exclusion. The recent data calls for further treatment efforts and potential improvements in services aiming to help voluntary self-excluders abstain from gambling. ", doi="10.2196/37837", url="https://mental.jmir.org/2022/8/e37837", url="http://www.ncbi.nlm.nih.gov/pubmed/35984678" } @Article{info:doi/10.2196/33661, author="Walia, Bhavneet and Kim, Jeeyoon and Ijere, Ignatius and Sanders, Shane", title="Video Game Addictive Symptom Level, Use Intensity, and Hedonic Experience: Cross-sectional Questionnaire Study", journal="JMIR Serious Games", year="2022", month="Jun", day="9", volume="10", number="2", pages="e33661", keywords="video game use", keywords="addictive behaviors", keywords="mental health", keywords="video game addiction", keywords="videogames", keywords="addiction", keywords="video games", abstract="Background: The effects of behavioral addiction to video games has received increasing attention in the literature, given increased use intensity among subgroups of video game players. Objective: This study seeks to empirically determine the relationship between intensity of video gaming and hedonic experience of the player. Methods: We conducted a survey of 835 individuals who regularly play video games to determine the relationship between intensity of use and hedonic experience. We divided the sample into quartiles by self-reported video game addictive symptom level (from the Internet Gaming Disorder Scale) and conducted polynomial regressions separately for each quartile. Results: We found that the higher video game addictive symptom level groups experienced a U-shaped (curvilinear) relationship between hedonic experience and intensity of play, whereas groups with lower video game addictive symptom levels exhibited no such relationship. The coefficients for the highest addictive symptom level group (quartile 4) for marginal effects for hours played per week and hours played per week squared were significantly negative (P=.005) and significantly positive (P=.004), respectively. Conclusions: Our results are consistent with sensitization and tolerance theories, which suggest that high-symptom groups experience frustration and disappointment until they achieve excessive dopamine release, at which point their hedonic experience is expected to improve with additional play. Conversely, low-symptom groups experience no such fall-and-rise pattern. This result is consistent with the outcome that members of the latter group play the game for the direct experience, such that their hedonic experience is more directly related to events occurring in the game than to the increasingly elusive pursuit of excessive dopamine release. We also find that high-symptom groups spend substantially more time and money to support video game use and are much more likely to engage in video game use at the expense of other important activities, such as working, sleeping, and eating. ", doi="10.2196/33661", url="https://games.jmir.org/2022/2/e33661", url="http://www.ncbi.nlm.nih.gov/pubmed/35471995" } @Article{info:doi/10.2196/29077, author="Kisch, Mark and H{\aa}kansson, Anders", title="Associations Between Addictive Behaviors, Individual Characteristics, and the Use of Gambling Services Within the World of Gaming: Cross-sectional Survey Study", journal="JMIR Serious Games", year="2022", month="Apr", day="22", volume="10", number="2", pages="e29077", keywords="gambling disorder", keywords="gaming disorder", keywords="behavioral addiction", keywords="mental health", keywords="gambling", keywords="gaming", keywords="addiction", keywords="behavior", keywords="cross-sectional", keywords="online survey", keywords="age", keywords="gender", abstract="Background: Gambling within the world of gaming is an emerging phenomenon that may share common conceptual characteristics with traditional forms of gambling. The current literature suggests a higher degree of problematic behaviors in this gambling pattern, but studies are few, prompting for further research regarding individual characteristics and comorbid conditions associated with this activity. Objective: The aim of the study is to investigate correlations between the use of gambling services within the world of gaming and individual characteristics and addictive behaviors including problem gambling. Methods: A cross-sectional web survey was distributed to an existing panel of online respondents in Sweden. A total of 2001 respondents were included. Chi-square and Mann-Whitney U tests, followed by a logistic regression, were used in order to determine independent variables associated with gambling in the context of gaming. Results: A total of 2.9\% (58/1984) of respondents reported past-year gambling within gaming. Significant associations were found with male sex, younger age, history of treatment-seeking for alcohol problems, and higher Gaming Addiction Scale scores. Conclusions: The demonstrated findings strengthen previously found associations between gambling in gaming and younger age, male sex, and problematic gaming behaviors. Additionally, the association with a history of treatment needs for alcohol problems adds to the previous impression of increased problem severity and comorbidity in within-gaming gamblers. ", doi="10.2196/29077", url="https://games.jmir.org/2022/2/e29077", url="http://www.ncbi.nlm.nih.gov/pubmed/35451974" } @Article{info:doi/10.2196/23700, author="Wang, Hsin-Yi and Cheng, Cecilia", title="The Associations Between Gaming Motivation and Internet Gaming Disorder: Systematic Review and Meta-analysis", journal="JMIR Ment Health", year="2022", month="Feb", day="17", volume="9", number="2", pages="e23700", keywords="gaming motivation", keywords="problematic gaming", keywords="gaming disorder", keywords="video gaming", keywords="online gaming", keywords="compulsive gaming", keywords="escapism", keywords="culture", keywords="cross-cultural comparison, cultural individualism", abstract="Background: There has been a surge in interest in examining internet gaming disorder (IGD) and its associations with gaming motivation. Three broad components of gaming motivation have been proposed: achievement, immersion, and social. Achievement-oriented players are motivated by gaining in-game rewards, immersion-oriented players are motivated by the experience of immersion in the virtual world, and social-oriented players are motivated by the need to socialize with other players through gaming. Objective: This study aimed to (1) quantitatively synthesize the growing body of literature to systematically examine the discrepancies in the magnitude of associations between various components of gaming motivation and IGD and (2) examine the moderating role of cultural dimension on the association between escapism gaming motivation and IGD. Methods: We conducted a systematic search of multiple databases between 2002 and 2020. Studies were included if they (1) included quantitative data, (2) used measures assessing both gaming motivation and IGD, and (3) contained sufficient information for effect size calculation. Results: The findings revealed IGD to have a stronger association with achievement motivation (r=0.32) than with immersion (r=0.22) or social motivation (r=0.20), but the strongest such association was found to be with escapism motivation (r=0.40), a subcomponent of immersion motivation. Our cross-cultural comparison further showed a stronger association between escapism motivation and IGD in studies conducted in individualistic (vs collectivistic) regions. Conclusions: This meta-analysis highlights the importance of acknowledging the discrepancies among different components of gaming motivation with respect to their role in the development of IGD, as well as the potential cultural variations in the strength of such associations. ", doi="10.2196/23700", url="https://mental.jmir.org/2022/2/e23700", url="http://www.ncbi.nlm.nih.gov/pubmed/35175204" } @Article{info:doi/10.2196/33059, author="Claesdotter-Knutsson, Emma and Andr{\'e}, Frida and H{\aa}kansson, Anders", title="Gaming Activity and Possible Changes in Gaming Behavior Among Young People During the COVID-19 Pandemic: Cross-sectional Online Survey Study", journal="JMIR Serious Games", year="2022", month="Jan", day="25", volume="10", number="1", pages="e33059", keywords="COVID-19 pandemic", keywords="gaming", keywords="screen time", keywords="psychological distress", abstract="Background: Young people's daily lives and social interactions changed remarkably during the COVID-19 pandemic as schools and cinemas closed, leisure activities were cancelled, and gatherings were regulated. Questions have been raised by the media, schools, policy makers, and research communities about the effect on young people's online behaviors. Objective: This cross-sectional study aimed to study self-reported changes in gaming, focusing on a younger section of the population during the COVID-19 pandemic in Sweden. We also wanted to look at potential risk factors behind problematic gaming during the pandemic, including gaming patterns, gambling behavior, psychological distress, certain sociodemographic characteristics, health factors, and school situation. Methods: This was an anonymous online survey study of web panel participants in Sweden (n=1501) to study changes in gaming behaviors during the COVID-19 pandemic. Self-reported increases in gaming were analyzed in logistic regression analyses against sociodemographic and health factors. Results: Within the study population that reported changes in gaming activity, we found significant differences in age, employment status, disposable income, whether they ever played on loot boxes, time spent at home, school attendance, psychological distress, and gambling and gaming problems, as well as significant differences in changes in alcohol consumption and exercise habits. When examining the 16--24-year-old age group who reported changes in gaming activity, we found significant differences within the group in disposable income, time at home, and school attendance. When examining the 25--39-year-old age group who reported changes in gaming activity, we found significant differences within the group in employment status, disposable income, time spent at home, whether the respondents were studying, school attendance level, psychological distress, and gaming problems, as well as significant differences in changes in alcohol consumption and exercise habits. Psychological distress (all age groups analyzed together; 25--39-year-old age group), drinking less alcohol (all age groups analyzed together), spending more time at home (all age groups analyzed together), gaming problems, and exercising less (25--39-year-old age group) were positively correlated with a self-reported increase in gaming activity. Being employed (25--39-year-old age group) and being over 40 years of age (all age groups analyzed together) were negatively correlated with increased gaming. We found no significant correlations in the 16--24-year-old age group. Conclusions: Those who reported increased gaming during the COVID-19 pandemic were more likely to be 16 years to 39 years old. In the age group of 25 years to 39 years old, the increase was associated with psychological distress, reporting less exercise, and being unemployed. COVID-19 may present as a risk factor of increased online gaming in a small but vulnerable group. More research and preferably longitudinal studies are needed in the field of gaming and effects of the COVID-19 pandemic. ", doi="10.2196/33059", url="https://games.jmir.org/2022/1/e33059", url="http://www.ncbi.nlm.nih.gov/pubmed/34817386" } @Article{info:doi/10.2196/27852, author="Jee, Muhammad and Khan, Alsa and Nazneen, Nazneen", title="Understanding Adolescents' Perceptions and Aspirations Towards Their Relationship With Personal Technology: Survey Study", journal="JMIR Form Res", year="2021", month="Dec", day="23", volume="5", number="12", pages="e27852", keywords="adolescents' perceptions", keywords="personal technology", keywords="technology relationship", keywords="adolescents as technology users", keywords="adolescents as technology bystanders", abstract="Background: Understanding adolescents' relationship with technology is a pressing topic in this digital era. There seem to be both beneficial and detrimental implications that originate from use of technology by adolescents. Approximately 95\% of adolescents have access to a smartphone, and several studies show a positive correlation between screen addiction and trends of anxiety and depression. At the same time, research shows that two-thirds of adolescents believe that technology is a necessity for connecting and making new friends. Objective: The aim of this formative study was to understand adolescents' perception of their own and others' relationship with personal technology. Methods: A survey was conducted with 619 adolescents ranging in age from 13 to 19 years. Adolescents were asked how they perceived the relationship with their personal technology, how they perceived others' (parents, siblings, or friends) relationship with personal technology, and how they wish to relate to their personal technology in the future. Results: ``Essential,'' ``Distractive,'' and ``Addictive'' were the most commonly selected descriptors to describe both adolescents' own relationship with technology (essential: 106/619, 17.1\%; distractive: 105/619, 17\%; addictive: 88/619, 14.2\% ) and others' relationship as well (essential: 96/619, 15.6\%; distractive: 88/619, 14.3\%; addictive: 90/619, 14.5\%). Adolescents selected ``Provides an escape'' more to describe their own relationship with technology. Whereas, they selected ``It's just a tool'' and ``Creates Barrier'' more to describe others' relationship with technology. These trends are consistent across ages and genders. In addition, adolescents' aspirations for their relationship with their personal technology varied across ages: 13 to 15-year olds' top choice was ``best friend'', 16 to 17-year olds' top choice was ``I don't believe in personal connection with mobile technology,'' and 18 to 19-year olds' top choice was ``My personal assistant.'' Conclusions: Our 3-lens method allows us to examine how adolescents perceive their relationship with personal technology in comparison to others, as well as their future technological aspirations. Our findings suggest that adolescents see both communalities as well as differences in their own and others' relationships with technology. Their future aspirations for personal technology vary across age and gender. These preliminary findings will be examined further in our follow-up research. ", doi="10.2196/27852", url="https://formative.jmir.org/2021/12/e27852", url="http://www.ncbi.nlm.nih.gov/pubmed/34941556" } @Article{info:doi/10.2196/28117, author="Yang, Xue and Wong, Man Kei and She, Rui and Zhao, Chengjia and Ding, Nani and Xu, Huihui and Tu, Xiaolian and Lai, Xinyi and Zhang, Guohua", title="Relationship Between Illness Representations and Symptoms of Internet Gaming Disorder Among Young People: Cross-Lagged Model", journal="JMIR Serious Games", year="2021", month="Nov", day="30", volume="9", number="4", pages="e28117", keywords="illness representations", keywords="internet gaming disorder", keywords="youth", keywords="cross-lagged model", abstract="Background: The common-sense model of illness suggests that mental representations of health threats may affect one's behavioral reactions to them and health status. Internet gaming disorder is a newly defined mental disorder. Illness representations of internet gaming disorder may affect one's risk of internet gaming disorder. In turn, symptoms of internet gaming disorder may affect one's perceptions of the disorder. Objective: This study aimed to investigate the relationships between illness representations and symptoms of internet gaming disorder in college students. Methods: A 1-year longitudinal study was conducted with a convenience sample of Chinese college students (n=591; 342/591, 57.9\% female). Results: Of the participants, 10.1\% (60/591) and 9.1\% (54/591) were classified as having probable internet gaming disorder at baseline (T1) and follow-up (T2), respectively. The correlations between some dimensions of illness representations regarding internet gaming disorder (ie, consequence, timeline, personal control, treatment control, and concern) at T1 and symptoms of internet gaming disorder at T2 and between symptoms of internet gaming disorder at T1 and the dimensions of illness representations at T2 (ie, consequence, timeline, personal control, and emotional response) were statistically significant. The cross-lagged model fit the data well (($\chi$2/df=2.28, comparative fit index=.95, root mean square error of approximation=.06) and showed that internet gaming disorder at T1 was positively associated with unfavorable illness representations at T2. Conclusions: Individuals with more severe symptoms of internet gaming disorder had more pessimistic perceptions about the disorder. Such cognitive perceptions may affect one's emotional and behavioral reactions towards the disorder (eg, greater levels of depression and low self-control intention) and should be modified by educational programs and psychological interventions. ", doi="10.2196/28117", url="https://games.jmir.org/2021/4/e28117", url="http://www.ncbi.nlm.nih.gov/pubmed/34851298" } @Article{info:doi/10.2196/30310, author="Abbasi, Zaib Amir and Rehman, Umair and Afaq, Zahra and Rafeh, Abdur Mir and Hlavacs, Helmut and Mamun, A. Mohammed and Shah, Umair Muhammad", title="Predicting Video Game Addiction Through the Dimensions of Consumer Video Game Engagement: Quantitative and Cross-sectional Study", journal="JMIR Serious Games", year="2021", month="Nov", day="26", volume="9", number="4", pages="e30310", keywords="consumer video game engagement", keywords="dedication", keywords="absorption", keywords="social connection", keywords="interaction", keywords="conscious attention", keywords="enthusiasm", keywords="video game addiction", keywords="uses and gratifications theory", keywords="cultivation theory", abstract="Background: Video games are expanding exponentially with their increased popularity among users. However, this popularity has also led to an increase in reported video game addiction. There may be consumer engagement--related factors that may influence video game addiction. Objective: This study aims to empirically examine the impact of the dimensions of consumer video game engagement on video game addiction. The dimensions are dedication, absorption, conscious attention, social connection, enthusiasm, and interaction. We utilize the uses and gratifications theory to study the video game engagement dimensions as potential factors through which gamers feel gratified and engaged in video game playing. Additionally, this study incorporates the cultivation theory to investigate how video game engagement factors trigger video game addiction. Methods: A two-step process was applied for data analysis on valid cases of 176 gamers aged 15-25 years: video game addiction was specified and validated as a reflective-formative construct, and hypothesis testing was later performed using the WarpPLS on valid respondents. Results: The analysis uncovered 2 dimensions of video game engagement: social connection with P=.08 and interaction with P=.49, which did not significantly contribute to video game addiction. Conclusions: This study offers unique insights to a myriad of stakeholders, mostly psychologists and psychiatrists, who routinely prescribe behavior modification techniques to treat video game addiction. ", doi="10.2196/30310", url="https://games.jmir.org/2021/4/e30310", url="http://www.ncbi.nlm.nih.gov/pubmed/34842539" } @Article{info:doi/10.2196/30747, author="Claesdotter-Knutsson, Emma and H{\aa}kansson, Anders", title="Changes in Self-Reported Web-Based Gambling Activity During the COVID-19 Pandemic: Cross-sectional Study", journal="JMIR Serious Games", year="2021", month="Nov", day="3", volume="9", number="4", pages="e30747", keywords="COVID-19", keywords="pandemic", keywords="web-based gambling", keywords="psychological distress", keywords="gender", abstract="Background: The COVID?19 pandemic has affected not only somatic health with over 3.7 million deaths worldwide, but also has had a huge impact on psychological health, creating what amounts to a mental health crisis. The negative effect of the pandemic on traditional addictions is well described and concerning, and the same has been seen for gambling. Objective: This study explores self-reported web-based gambling behavior during the COVID?19 pandemic in Sweden. We investigated overall changes, but also changes in specific web-based gambling types, and whether they are associated with certain risk factors or lifestyle changes. Methods: Our study is based on an anonymous web-based survey of web panel participants in Sweden (N=1501) designed to study a range of behavioral changes during the COVID?19 pandemic. Increases in gambling were analyzed using logistic regression models against sociodemographic data and psychological distress. Results: The majority of the respondents who gambled reported no changes in their gambling habits during the COVID?19 pandemic. We found significant associations with the problem gambling severity index (PGSI), the Kessler score (indicating psychological distress), employment status, changes in alcohol habits, and self-exclusion when looking at overall changes in gambling activity in the pandemic. In the subgroup that reported an increase in gambling activity, we found an association with both the PGSI and Kessler scores. The PGSI score was also an independent predictor for all specific web-based gambling (horses, sports, poker, and casino) whereas the Kessler score only had a significant impact on changes in casino gambling. In addition, male gender was an independent predictor for gambling on sports and casino gambling. Conclusions: The majority of respondents who gambled reported no changes in their gambling activity during the COVID?19 pandemic. The group that reported an increase in overall gambling activity during the COVID-19 pandemic represent a group with gambling problems and psychological distress. The group that reported increased sports and casino gambling were often male, and this group seemed to experience more psychological distress. ", doi="10.2196/30747", url="https://games.jmir.org/2021/4/e30747", url="http://www.ncbi.nlm.nih.gov/pubmed/34730540" } @Article{info:doi/10.2196/26810, author="Yu, Yanqiu and Mo, Kit-Han Phoenix and Zhang, Jianxin and Li, Jibin and Lau, Tak-Fai Joseph", title="Impulsivity, Self-control, Interpersonal Influences, and Maladaptive Cognitions as Factors of Internet Gaming Disorder Among Adolescents in China: Cross-sectional Mediation Study", journal="J Med Internet Res", year="2021", month="Oct", day="27", volume="23", number="10", pages="e26810", keywords="cognition", keywords="adolescent health", keywords="health risk behaviors", keywords="internet", keywords="self-control", keywords="China", abstract="Background: Gaming disorder, including internet gaming disorder (IGD), was recently defined by the World Health Organization as a mental disease in the 11th Revision of the International Classification of Diseases (ICD-11). Thus, reducing IGD is warranted. Maladaptive cognitions related to internet gaming (MCIG) have been associated with IGD, while impulsivity, self-control, parental influences, and peer influences are key risk factors of IGD. Previous literature suggests that MCIG is associated with the aforementioned 4 risk factors and IGD, and may thus mediate between these risk factors and IGD. These potential mediations, if significant, imply that modification of MCIG may possibly alleviate these risk factors' harmful impacts on increasing IGD. These mediation hypotheses were tested in this study for the first time. Objective: This study tested the mediation effects of MCIG between intrapersonal factors (impulsivity and self-control) and IGD, and between interpersonal factors (parental influences and peer influences) and IGD among adolescents in China. Methods: An anonymous, cross-sectional, and self-administered survey was conducted among secondary school students in classroom settings in Guangzhou and Chengdu, China. All grade 7 to 9 students (7 to 9 years of formal education) of 7 secondary schools were invited to join the study, and 3087 completed the survey. The Diagnostic and Statistical Manual of Mental Disorders (DSM-5) checklist was used to assess IGD. MCIG was assessed by using the Chinese version of the Revised Internet Gaming Cognition Scale. Impulsivity, self-control, and parental or peer influences were measured by using the motor subscale of the Barratt Impulsiveness Scale, the Brief Self-Control Scale, and the modified interpersonal influence scale, respectively. Structural equation modeling was conducted to examine the mediation effects of MCIG between these risk factors and IGD. Results: The prevalence of IGD was 13.57\% (418/3081) and 17.67\% (366/2071) among all participants and adolescent internet gamers, respectively. The 3 types of MCIG (perceived rewards of internet gaming, perceived urges for playing internet games, and perceived unwillingness to stop playing without completion of gaming tasks) were positively associated with IGD. Impulsivity, self-control, parental influences, and peer influences were all significantly associated with the 3 types of MCIG and IGD. The 3 types of MCIG partially mediated the associations between the studied factors and IGD (effect size of 30.0\% to 37.8\%). Conclusions: Impulsivity, self-control, and interpersonal influences had both direct and indirect effects via MCIG on IGD. Modifications of the 3 types of MCIG can potentially reduce the harmful impacts of impulsivity and interpersonal influences on IGD and enhance the protective effect of self-control against IGD. Future longitudinal studies are warranted. ", doi="10.2196/26810", url="https://www.jmir.org/2021/10/e26810", url="http://www.ncbi.nlm.nih.gov/pubmed/34704960" } @Article{info:doi/10.2196/26821, author="Poon, J. Lok Y. and Tsang, H. Hector W. and Chan, J. Tsan Y. and Man, T. Sze W. and Ng, Y. Lok and Wong, E. Yi L. and Lin, Chung-Ying and Chien, Chi-Wen and Griffiths, D. Mark and Pontes, M. Halley and Pakpour, H. Amir", title="Psychometric Properties of the Internet Gaming Disorder Scale--Short-Form (IGDS9-SF): Systematic Review", journal="J Med Internet Res", year="2021", month="Oct", day="18", volume="23", number="10", pages="e26821", keywords="psychometrics", keywords="IGDS9-SF", keywords="gaming addiction", keywords="gaming disorder", keywords="problematic gaming", keywords="internet", keywords="gaming", keywords="internet gaming", abstract="Background: The Internet Gaming Disorder Scale--Short-Form (IGDS9-SF) is among the best with regard to its psychometric properties. Therefore, clinical psychologists are likely guided to use the IGDS9-SF if they want to assess or screen the disordered gaming in their practice. However, the information, especially psychometric evidence, concerning the IGDS9-SF has not been fully examined and summarized. Objective: This systematic review evaluated the psychometric properties of different language versions of the IGDS9-SF and assessed its methodological quality in order to improve the clinicians' understanding of the IGDS9-SF and facilitate its use. Methods: Systematic literature searches were carried out using Embase, MEDLINE, PsycINFO, PubMed, ScienceDirect, Scopus, and Web of Science. The review included English-language studies of any research design that have reported at least one psychometric property of the IGDS9-SF, as defined by the COnsensus-based Standards for the selection of health status Measurement INstrument (COSMIN), and have aimed at testing the psychometric properties of the IGDS9-SF. Results: In total, 21 studies comprising 15 language versions of the IGDS9-SF were included. Overall, the IGDS9-SF showed adequate internal consistency (although some items did not have satisfactory item-total correlation [IT]), excellent criterion validity, and the ability to distinguish different subgroups with measurement invariance being supported across gender and age. In terms of factor structure, the IGDS9-SF was shown to have a unidimensional factor structure across all 21 studies. Conclusions: Although there is insufficient evidence regarding the responsiveness and properties of the IGDS9-SF using item response theory, the existing evidence supports its use in assessing disordered gaming among individuals. ", doi="10.2196/26821", url="https://www.jmir.org/2021/10/e26821", url="http://www.ncbi.nlm.nih.gov/pubmed/34661543" } @Article{info:doi/10.2196/26808, author="Zhu, Shimin and Zhuang, Yanqiong and Lee, Paul and Li, Chi-Mei Jessica and Wong, C. Paul W.", title="Leisure and Problem Gaming Behaviors Among Children and Adolescents During School Closures Caused by COVID-19 in Hong Kong: Quantitative Cross-sectional Survey Study", journal="JMIR Serious Games", year="2021", month="May", day="7", volume="9", number="2", pages="e26808", keywords="COVID-19", keywords="leisure gaming", keywords="excessive gaming", keywords="pathological gaming", keywords="familial factors", keywords="loneliness", keywords="COVID-19 lockdown", keywords="school closure", abstract="Background: School closures during the COVID-19 pandemic may have exacerbated students' loneliness, addictive gaming behaviors, and poor mental health. These mental health issues confronting young people are of public concern. Objective: This study aimed to examine the associations between loneliness and gaming addiction behaviors among young people in Hong Kong and to investigate how familial factors, psychological distress, and gender differences moderate these relationships. Methods: This cross-sectional study was conducted in June 2020 when schools reopened after 6 months of school closures. Participants included 2863 children and adolescents in primary (Grades 4 to 6) and secondary (Grades 7 and 8) schools (female participants: 1502/2863, 52.5\%). Chi-square tests, one-way analyses of variance, and independent-samples t tests were performed to compare the differences of distribution in gaming addiction behaviors across gender, age, and other sociodemographic characteristics. Multinomial logistic regression analyses were conducted to identify factors that relate to excessive or pathological gaming behaviors separately, in comparison with leisure gaming. Results: A total of 83.0\% (2377/2863) of the participants played video games during the COVID-19 pandemic. The prevalence of excessive and pathological game addiction behaviors was 20.9\% (597/2863) and 5.3\% (153/2863), respectively. More male students had gaming addiction symptoms than female students. The multinomial logistic regressions showed that feeling lonely was associated with more problematic gaming behaviors, and the association was stronger for older female students. Low socioeconomic status, less parental support and less supervision, and poor mental health were risk factors for gaming addiction behaviors, especially among primary school students. Conclusions: Loneliness was associated with gaming addiction behaviors; the findings from this study suggested that this association was similar across gender and age groups among young people. Familial support and supervision during school closures can protect young people from developing problematic gaming behaviors. Results of this study have implications for prevention and early intervention on behalf of policy makers and game developers. ", doi="10.2196/26808", url="https://games.jmir.org/2021/2/e26808", url="http://www.ncbi.nlm.nih.gov/pubmed/33960954" } @Article{info:doi/10.2196/22393, author="Yu, Yanqiu and Li, Ji-Bin and Lau, F. Joseph T.", title="Awareness and Potential Impacts of the Medicalization of Internet Gaming Disorder: Cross-sectional Survey Among Adolescents in China", journal="J Med Internet Res", year="2021", month="Feb", day="24", volume="23", number="2", pages="e22393", keywords="gaming disorder", keywords="ICD-11", keywords="high-risk subgroups", keywords="disease awareness", keywords="medicalization", keywords="internet gaming", keywords="awareness", keywords="impact", keywords="adolescent", keywords="young adult", keywords="China", keywords="game", keywords="disorder", keywords="ICD", abstract="Background: The Eleventh Revision of International Classification of Diseases (ICD-11) newly listed gaming disorder, including internet gaming disorder (IGD), as a disease. The level of awareness and potential positive and negative impacts of this medicalization among adolescents were unknown. Objective: This study investigated the levels, associated factors, and potential positive and negative impacts of awareness of the medicalization of IGD among adolescents in China. Methods: In a cross-sectional survey, 1343 middle school students in Guangzhou, China, self-administered an anonymous questionnaire in classrooms (October to December 2019). Three risk subgroups were identified: those who scored ?5 items in the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition checklist (IGD-S), those who self-perceived having IGD currently (IGD-PC), and those who self-perceived having IGD within 12 months (IGD-P12M). Results: Of the internet gamers, 48.3\% (460/952) were aware of the medicalization of IGD; they were more likely to belong to the IGD-P12M/IGD-S risk subgroups. Within the IGD-PC/IGD-P12M (but not IGD-S) risk subgroups, IGD medicalization awareness was positively associated with favorable outcomes (reduced internet gaming time in the past 12 months, seeking help from professionals if having IGD, and fewer maladaptive cognitions). After being briefed about the ICD-11 inclusion of IGD, 54.2\% (516/952) and 32.8\% (312/952) expressed that it would lead to the reduction of gaming time and help-seeking behaviors, respectively; however, 17.9\% (170/952), 21.5\% (205/952), 15.9\% (151/952), and 14.5\% (138/952) perceived self-doubt for being diseased, stronger pressure from family members, negative emotional responses, and labeling effect, respectively. With a few exceptions, such perceived positive or negative impacts were stronger among the IGD-S, IGD-PC, and IGD-P12M risk subgroups. Conclusions: The exploratory study shows that the medicalization of IGD may have benefits that need maximization and potentially harmful effects that need minimization. Future studies should test the efficacies of health promotion that increases IGD medicalization awareness. ", doi="10.2196/22393", url="https://www.jmir.org/2021/2/e22393", url="http://www.ncbi.nlm.nih.gov/pubmed/33625362" } @Article{info:doi/10.2196/23886, author="Ide, Soichiro and Nakanishi, Miharu and Yamasaki, Syudo and Ikeda, Kazutaka and Ando, Shuntaro and Hiraiwa-Hasegawa, Mariko and Kasai, Kiyoto and Nishida, Atsushi", title="Adolescent Problem Gaming and Loot Box Purchasing in Video Games: Cross-sectional Observational Study Using Population-Based Cohort Data", journal="JMIR Serious Games", year="2021", month="Feb", day="9", volume="9", number="1", pages="e23886", keywords="loot box purchasing", keywords="gambling", keywords="adolescents", keywords="primary caregivers", abstract="Background: Video game loot boxes, which can typically be purchased by players or are given as reward, contain random virtual items, or loot, ranging from simple customization options for a player's avatar or character, to game-changing equipment such as weapons and armor. Loot boxes have drawn concern, as purchasing loot boxes might lead to the development of problematic gambling for adolescents. Although parental problem gambling is associated with adolescent problem gambling, no studies have evaluated the prevalence of loot box purchases in adolescents' parents. Objective: This study investigated the association between loot box purchasing among adolescents and parents, and problem online gaming in population-based samples. Methods: In total, 1615 adolescent (aged 14 years) gamers from Japan responded to a questionnaire regarding their loot box purchasing and problem online gaming behaviors. Problem online gaming was defined as four or more of the nine addictive behaviors from the Diagnostic and Statistical Manual of Mental Disorders. The adolescents' primary caregivers were asked about their loot box purchasing. Results: Of the 1615 participants, 57 (3.5\%) reported loot box purchasing. This prevalence did not differ according to primary caregivers' loot box purchasing, but adolescents who purchased loot boxes were significantly more likely to exhibit problem online gaming (odds ratio 3.75, 95\% CI 2.17-6.48). Conclusions: Adolescent loot box purchasing is linked to problem online gaming, but not with parents' loot box purchasing. Measures to reduce these behaviors should target reducing addictive symptoms in young video gamers. ", doi="10.2196/23886", url="http://games.jmir.org/2021/1/e23886/", url="http://www.ncbi.nlm.nih.gov/pubmed/33560241" }