Commentary on "Cross-Cultural Differences in the Pathways to Internet Gaming Disorder".

There is a lack of estimates of prevalence rates of Internet gaming disorder (IGD) and gaming disorder (GD) among young adults in Singapore. Consequently, the current study aimed to examine the prevalence rates of IGD and GD, and their relationships with known correlates. Participants were a representative sample of 1008 young adults in Singapore. They completed instruments that assess IGD, GD, gaming motivations, negative emotional states, and sleep quality. The results showed a prevalence rate of 10.3% for IGD and 5.0% for GD. Males had a higher IGD and GD prevalence rate (14.6% and 7.2%) than females (6.2% and 2.8%). Furthermore, participants with IGD or GD reported higher gaming time, and higher scores on gaming motivations, negative emotional states, and sleep quality than their counterparts with no IGD or GD. The higher prevalence rates in this study compared to other global studies suggest that problematic gaming is a social issue in Singapore. Known correlates relating to gender, gaming time, motivations, and emotions were confirmed in the current study. The finding that participants with IGD or GD had better sleep quality was inconsistent with previous studies and could be due to the use of a single item to assess sleep quality. Limitations include the use of a cross-sectional correlational design. Future research could develop and evaluate prevention programs or intervention programs to alleviate the symptoms and negative consequences of problematic gaming.

Internet addiction and Internet gaming disorders are increasingly prevalent. Whilst there has been much focus on the use of conventional psychological approaches in the treatment of individuals with these addictive disorders, there has also been ongoing research exploring the potential of cognitive bias modification amongst individuals with Internet and gaming addiction. Some studies have documented the presence of cognitive biases and the effectiveness of bias modification for Internet addiction and gaming disorders. However, there have not been any reviews that have synthesized the findings related to cognitive biases for Internet addiction and Internet gaming disorders. It is important for us to undertake a scoping review as an attempt to map out the literature for cognitive biases in Internet addiction and gaming disorders. A scoping review was undertaken, and articles were identified using a search through the following databases: PubMed, MEDLINE, and PsycINFO. Six articles were identified. There were differences in the methods of ascertaining whether an individual has an underlying Internet or gaming addiction, as several different instruments have been used. With regards to the characteristics of the cognitive bias assessment task utilized, the most common task used was that of the Stroop task. Of the six identified studies, five have provided evidence documenting the presence of cognitive biases in these disorders. Only one study has examined cognitive bias modification and provided support for its effectiveness. Whilst several studies have provided preliminary findings documenting the presence of cognitive biases in these disorders, there remains a need for further research evaluating the effectiveness of bias modification, as well as the standardization of the diagnostic tools and the task paradigms used in the assessment.

The DSM-5 is scheduled for publication in 2013, and internet gaming disorder will be included in its Section 3, the research appendix. This editorial reviews the DSM process and rationale for inclusion of this putative disorder, and it suggests directions for much needed research in this area.

Internet Gaming Disorder Within the DSM-5 Framework and With an Eye Toward ICD-11.

Internet gaming is recognized as a psychiatric disorder in the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5) and International Classification of Disease, version 11 (ICD-11) ‘Internet Gaming Disorder (IGD) and gaming disorder (GD), respectively. A strong association was seen between internet gaming behaviour and psychiatric disorders such as anxiety disorders, depression, suicidal ideation, behavioural disorders, social phobia, autism spectrum disorder, attention-deficit hyperactivity disorder, obsessive-compulsive disorder, and personality disorders. But the more profound nexus and causative relationship between internet games and psychiatric disorders are yet to unfold. Gross observations indicate a bidirectional relationship between internet gaming behaviours and psychiatric morbidities.
 With the advent of advanced gaming technology, such as Massively Multiplayer Online Role-Playing Games (MMORPGs) and Role-playing Games (RPGs) and their increasing use by children and adolescents again revamp the quest for some fundamental questions like how internet games affect our brains. Do video games predispose individuals to psychiatric disorders? If at all internet gaming is predisposed to psychiatric disorders, then how? For all practical purposes, we restrict our discussion to Role-playing Games only.

BackgroundAs Internet gaming became publicly available over the past 25 years, Internet gaming disorder emerged as a new diagnostic entity and became established in psychiatric diagnostic systems as a form of addiction. Given the recency of its advent, reliable data on the epidemiology and psychiatric comorbidity of this disorder in specific geographic regions are scarce and dearly needed for appropriate treatment.ResultsA total sample of number = 1332 participants completed the questionnaire. Four-hundred twenty-three of them were gamers; in this cohort, the prevalence of Internet gaming disorder was 6.1%. A strong association between Internet gaming and several psychiatric disorders (attention deficit, hyperactivity, depression, and anxiety) was found.ConclusionsInternet gaming disorder is frequent in adults from Arab countries. It is associated with psychiatric comorbidities in this current sample; the nature of this association needs to be properly investigated.

Advances in technology and increased accessibility to modern gadgets have opened up new options for giving alternate recreational activities. The country has seen rapid growth in the smartphone market over the past decade, and mobile phones are preferred by the vast majority of gamers over traditional personal computers and laptops. The coronavirus disease 2019 (COVID-19) pandemic and related restrictions, online teaching, and the use of the internet for work have forced people to resort to the internet more than during the pre-pandemic period. There have not been many studies done to evaluate internet addiction (IA) and internet gaming disorder(IGD) among young people in India, and research is needed to quantify the magnitude of the problem and undertake timely public health actions. A cross-sectional study was conducted among 400 young people aged 10 to 24 years in Kolar district. Young people meeting the eligibility criteria from schools and colleges were randomly selected to include 67 participants per taluk. Standardized validated nine-item Internet Gaming Disorder Scale-Short-Formand 20-item Internet Addiction Test questionnaire were used to collect data. Data were entered using EpiData version 3.1 (EpiData Association,Odense, Denmark) and analyzed using IBM SPSS version 20 (IBM Corp., Armonk, NY). A p-value < 0.05 was considered statistically significant. COVID-19 control measures have caused more young people to access the internet in the recent past. Among young people studied, 58.5% and 6.5% have IA and IGD, respectively. Factors like living in urban areas, belonging to families above the poverty line, not living with parents, years of internet use, and increased access to internet/gadgets during the COVID-19 pandemic were significantly associated with IA and IGD. Since addiction to the internet and online gaming is known to have a negative impact on the mental health and well-being of young people, in light of IGD being listed in the International Classification of Diseases, there is an urgent need to target these conditions, especially for young people.

Objective: Individuals with internet gaming disorder (IGD) or gaming disorder (GD) had a higher prevalence of ADHD than individuals without IGD or GD. The overpathologizing of excessive gaming behaviors may be associated with the functional impairment due to ADHD in individuals with GD. Methods: The present study was designed to compare the gaming patterns, accompanying psychopathology, and co-occurring psychiatric disorders, especially ADHD, between clinical and general gamer samples (17–29 years old). Results: Out of the nine IGD criteria, the item “functional impairment” had low diagnostic accuracy in participants with IGD or GD. The IGD (GD) group had a higher prevalence of ADHD compared to the general gamer group. Conversely, there was a higher prevalence of IGD (GD) in the ADHD group compared to the non-ADHD group. Discussion: The possibility of ADHD should be considered when IGD or GD is diagnosed in patients with problematic Internet gaming.

Internet gaming disorder: Trends in prevalence 1998–2016

Internet addiction has recently been suggested as a possible diagnostic entity in the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) and incorporated in the International Classification of Diseases 11th Revision (ICD-11) as a gaming disorder, predominantly, online or offline. Mostly, psychotic phenomena have been described by either alcohol or opioid withdrawal, but there is a paucity of literature on Internet-related psychosis. We report two cases from Northern India of sudden onset of psychosis due to Internet addiction. The contents of hallucinations and delusions reflected themes of Internet gaming. Psychosis as a specifier for Internet gaming disorder (IGD) is not defined in DSM-5, whereas it should be considered as one of the presentations of Internet addiction.

Many concerns have been raised regarding the Diagnostic and Statistical Manual of Mental Disorders (5th ed.; DSM-5) criteria for Internet gaming disorder and International Classification of Diseases, 11th Revision (ICD-11) criteria for gaming disorder. In this study, we demonstrated the diagnostic validity of each criterion for Internet gaming disorder in the DSM-5 in terms of their intensity and frequency thresholds and evaluated functional impairments, unhealthy behaviors and complications among adults with Internet gaming disorder and gaming disorder. We recruited 69 subjects with Internet gaming disorder, 69 regular gamers and 69 controls without regular gaming based on diagnostic interviewing conducted by a psychiatrist according to the DSM-5 Internet gaming disorder criteria. Except for the 'deceiving' and 'escapism' criteria, all criteria for Internet gaming disorder had a diagnostic accuracy ranging from 84.7% to 93.5% in differentiating between adults with Internet gaming disorder and regular gamers. A total of 44 participants with Internet gaming disorder (63.8%) fulfilled the gaming disorder criteria. In addition, 89% and 100% of the Internet gaming disorder and gaming disorder groups, respectively, had academic, occupational or social functional impairment. Both the Internet gaming disorder and gaming disorder groups had higher rates of delayed sleep phase syndrome and insomnia. The gaming disorder group also had a higher obesity proportion. The 'deceiving' and 'escapism' criteria had relatively lower diagnostic accuracy. Both the Internet gaming disorder and gaming disorder groups demonstrated functional impairments and unhealthy behaviors. They also exhibited complications, such as obesity and sleep disorders. These results support the utility of the DSM-5 Internet gaming disorder and ICD-11 gaming disorder criteria in identifying individuals who need treatment for both gaming addiction symptoms and complications resulting from the addiction.

No research to date has examined cross-cultural differences in the pathways to internet gaming disorder (IGD). The current study aimed to address this limitation by examining the relationships between nationality (Singaporeans vs. Australians), culture orientation, gaming motivations, and IGD. Participants were 101 Singaporeans (55.4% males) and 98 Australians (52.0% males). They completed the Culture Orientation Scale, the Motives for Online Gaming Questionnaire, and the Internet Gaming Disorder Scale-Short-Form. A series of mediational analyses showed that Singaporeans tend to be more collectivistic (both horizontally and vertically). In turn, this culture orientation motivates them to play games for social reasons, increasing the risk for IGD. In contrast, Australians tend to be more individualistic (vertically only). In turn, this culture orientation motivates them to play games for competitive reasons, increasing the risk for IGD. Limitations include the use of samples from two countries only, precluding a generalization of the results. Future research directions include examining the role of game genres as a mediator in the nationality-IGD relationship.

Objective During the coronavirus disease (COVID-19) pandemic, several studies have found that Internet usage and gaming times have increased among adolescents. Parents’ Internet literacy and attitudes toward Internet gaming have been reported to affect children’s Internet gaming disorder (IGD). We hypothesized that parents’ attitudes toward Internet use and gaming would affect the prevalence of IGD among adolescents. Methods A total of 199 mothers of children who played Internet games were surveyed online to gather information regarding their demographic characteristics, children’s Internet use patterns, psychological factors, and Internet gaming literacy. Results Among adolescents, increased Internet usage or gaming time was not associated with IGD, but the presence of attention deficit hyperactivity disorder (ADHD) was. Among parents, anxiety, depression, and family togetherness were not related to IGD, but a positive perception of gaming protected against the development of IGD, whereas a negative perception was a risk factor for IGD. Conclusion Increased gaming time neither causes nor correlates with IGD in adolescents, even though ADHD may be a risk factor for IGD. Parents’ positive or negative perceptions of gaming can be protective or present a risk factor, respectively, for their children’s development of IGD.

INTERNET GAMING AMONG CHILDREN IN THE TIME OF COVID-19: AN EMERGING PSYCHOLOGICAL PROBLEM

This meta-analytic review aimed to examine the pooled prevalence rates of Internet addiction and gaming disorders in Southeast Asia. Several databases including PubMed, MEDLINE, PsycINFO, Web of Science, Embase, and Cochrane Central were searched and a total of 24 studies were included in this study. The selection of studies was conducted in accordance to the preferred reporting items for systematic reviews and meta-analyses (PRISMA) guidelines. Two meta-analyses were conducted to examine data on Internet addiction and gaming disorders separately. A random-effects model was employed to derive the pooled prevalence rate. Mixed-effects meta-regression and subgroup analyses were performed to examine the moderators of the between-study heterogeneity. Publication bias was tested using the Egger’s regression test and funnel plot. Only seven out of the 11 Southeast Asian countries were represented in the literature. All except for two of the included studies were cross-sectional in nature. The findings revealed a pooled prevalence rate of 20.0% (95% confidence interval: 14.5%–27.0%) and 10.1% (95% confidence interval: 7.3%–13.8%) for Internet addiction and gaming disorders respectively. Mean age and study population were significant moderators of the between-study heterogeneity in the prevalence rates of gaming disorders such that samples involving older participants showed higher prevalence rate than those involving younger individuals. Country of study was found to be significant moderator of the between-heterogeneity for both Internet addiction and gaming disorders, however the findings should be interpreted with caution due to the small and unbalanced sample sizes. There was no significant publication bias. Such epidemiology research should be extended to the Southeast Asian countries that have not been studied or are under-studied. Given that the prevalence rates appear to be higher in Southeast Asia than in other world regions, future research should also explore the factors behind these inter-regional differences. Further longitudinal studies should also be conducted to examine the trajectories of such disorders.