A cross-sectional study on extensive gaming in adolescents

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  • Frida André
    Department of Clinical Sciences Lund, Faculty of Medicine, Lund University, Lund, Sweden. https://orcid.org/0000-0003-2909-8470
  • Emma Claesdotter-Knutsson
    Department of Clinical Sciences Lund, Faculty of Medicine, Lund University, Lund; Region Skåne, Malmö Addiction Centre, Gambling Disorder Unit, Malmö, Sweden.
  • Maria Fridh
    Social Medicine and Health Policy, Department of Clinical Sciences in Malmo, Lund University, Sweden. https://orcid.org/0000-0002-7133-9971
  • Carl Delfin
    Department of Clinical Sciences Lund, Faculty of Medicine, Lund University, Lund, Sweden. https://orcid.org/0000-0003-4827-7650
  • Anders Håkansson
    Department of Clinical Sciences Lund, Faculty of Medicine, Lund University, Lund; Region Skåne, Malmö Addiction Centre, Gambling Disorder Unit, Malmö, Sweden. https://orcid.org/0000-0002-5800-8975
  • Martin Lindström
    Social Medicine and Health Policy, Department of Clinical Sciences in Malmo, Lund University, Sweden. https://orcid.org/0000-0002-1969-5119


Background: Extensive gaming and the consequences thereof is frequently reported from child and adolescent psychiatry and school health care. The behavior is associated with compulsion, psychiatric and physical symptoms, impaired cognitive development and poorer school performance. This phenomenon has been described as an emergent health issue for men and little is known about its potential gender-specific characteristics. The aim of this study was to explore extensive gaming among male and female adolescents and to investigate whether the frequency of often feeling low, often feeling anxious, self-reported ADHD, self-reported ASD, being satisfied with one’s own general health, poor sleep, loneliness, and having tried smoking, alcohol, and/or other substances differed among those with and without extensive gaming.

Design and Methods: 
This study was based on data collected through a public health survey distributed in 2016 to pupils in 9th grade of primary school and in second grade of secondary school, including a total of 13498 participants. The association between extensive gaming and different factors was estimated among male and female respondents separately.

: Roughly 30% of the male and 5% of the female respondents were categorized as extensive gamers. Extensive gaming was associated with a higher prevalence of poor sleep and a lower prevalence of being satisfied with one’s own health among boys and (to a higher degree) among girls.

 Altogether, our results contribute to the impression that extensive gaming is more heavily related to subjective health complaints among female than male adolescents.


American Psychiatric Association. Diagnostic and statistical manual of mental disorders (DSM-5®). Washington, DC: American Psychiatric Association; 2013. DOI: https://doi.org/10.1176/appi.books.9780890425596

Yau YH, Potenza MN. Gambling disorder and other behavioral addictions: recognition and treatment. Harv Rev Psychiatry 2015;23:134-46. DOI: https://doi.org/10.1097/HRP.0000000000000051

World Health Organization. International classification of diseases for mortality and morbidity statistics (11th Revision). 2018. Available from: https://icd.who.int/browse11/l-m/en

Paulus FW, Ohmann S, von Gontard A, Popow C. Internet gaming disorder in children and adolescents: a systematic review. Dev Med Child Neurol 2018;60:645-59. DOI: https://doi.org/10.1111/dmcn.13754

Desai RA, Krishnan-Sarin S, Cavallo D, Potenza MN. Video-gaming among high school students: health correlates, gender differences, and problematic gaming. Pediatrics 2010;126:e1414-24. DOI: https://doi.org/10.1542/peds.2009-2706

Aarseth E, Bean AM, Boonen H, et al. Scholars' open debate paper on the World Health Organization ICD-11 Gaming Disorder proposal. J Behav Addict 2017;6:267-70. DOI: https://doi.org/10.1556/2006.5.2016.088

Ferguson CJ, Coulson M, Barnett J. A meta-analysis of pathological gaming prevalence and comorbidity with mental health, academic and social problems. J Psychiatr Res 2011;45:1573-8. DOI: https://doi.org/10.1016/j.jpsychires.2011.09.005

González-Bueso V, Santamaría JJ, Fernández D, et al. Association between internet gaming disorder or pathological video-game use and comorbid psychopathology: A comprehensive review. Int J Environ Res Public Health 2018;15:668. DOI: https://doi.org/10.3390/ijerph15040668

Lemmens JS, Valkenburg PM, Peter J. Psychosocial causes and consequences of pathological gaming. Comput Hum Behav 2011;27:144-52. DOI: https://doi.org/10.1016/j.chb.2010.07.015

Lam LT. Internet gaming addiction, problematic use of the internet, and sleep problems: a systematic review. Curr Psychiatry Rep 2014;16:444. DOI: https://doi.org/10.1007/s11920-014-0444-1

Engelhardt CR, Mazurek MO, Hilgard J. Pathological game use in adults with and without Autism Spectrum Disorder. PeerJ 2017;5:e3393. DOI: https://doi.org/10.7717/peerj.3393

Mazurek MO, Engelhardt CR. Video game use in boys with autism spectrum disorder, ADHD, or typical development. Pediatrics 2013;132:260-6. DOI: https://doi.org/10.1542/peds.2012-3956

Weinstein A, Weizman A. Emerging association between addictive gaming and attention-deficit/hyperactivity disorder. Curr Psychiatry Rep 2012;14:590-7. DOI: https://doi.org/10.1007/s11920-012-0311-x

Hellström C, Nilsson KW, Leppert J, Åslund C. Effects of adolescent online gaming time and motives on depressive, musculoskeletal, and psychosomatic symptoms. Ups J Med Sci 2015;120:263-75. DOI: https://doi.org/10.3109/03009734.2015.1049724

Rho MJ, Lee H, Lee TH, et al. Risk factors for internet gaming disorder: Psychological factors and internet gaming characteristics. Int J Environ Res Public Health 2017;15:40. DOI: https://doi.org/10.3390/ijerph15010040

Salam Z, Sadiq Z, Tajamul U, et al. Internet gaming disorder in students of Peshawar: A cross sectional survey. J Ayub Med Coll Abbottabad 2019;31:548-52.

Chen KH, Oliffe JL, Kelly MT. Internet gaming disorder: An emergent health issue for men. Am J Mens Health 2018;12:1151-9. DOI: https://doi.org/10.1177/1557988318766950

Stevens MW, Dorstyn D, Delfabbro PH, King DL. Global prevalence of gaming disorder: A systematic review and meta-analysis. Aust N Z J Psychiatry 2021;55:553-68. DOI: https://doi.org/10.1177/0004867420962851

van den Eijnden R, Koning I, Doornwaard S, et al. The impact of heavy and disordered use of games and social media on adolescents' psychological, social, and school functioning. J Behav Addict 2018;7:697-706. DOI: https://doi.org/10.1556/2006.7.2018.65

Lee HH, Sung JH, Lee JY, Lee JE. Differences by sex in association of mental health with video gaming or other nonacademic computer use among US adolescents. Prev Chronic Dis 2017;14:E117. DOI: https://doi.org/10.5888/pcd14.170151

Haugland S, Wold B. Subjective health complaints in adolescence – – Reliability and validity of survey methods. J Adolesc 2001;24:611-24. DOI: https://doi.org/10.1006/jado.2000.0393

R Core Team. R: A language and environment for statistical computing. Vienna: R Foundation for Statistical Computing; 2021.

Wickham H, Averick M, Bryan J, et al. Welcome to the Tidyverse. J Open Source Softw 2019;4:1686. DOI: https://doi.org/10.21105/joss.01686

Wagenmakers E-J, Marsman M, Jamil T, et al. Bayesian inference for psychology. Part I: Theoretical advantages and practical ramifications. Psychon Bull Rev 2018;25:35-57. DOI: https://doi.org/10.3758/s13423-017-1343-3

Bürkner P-C. brms: An R Package for Bayesian Multilevel Models Using Stan. 2017. 2017;80:28. DOI: https://doi.org/10.18637/jss.v080.i01

Carpenter B, Gelman A, Hoffman MD, et al. Stan: A probabilistic programming language. J Stat Soft 2017;76:32. DOI: https://doi.org/10.18637/jss.v076.i01

Gelman A, Simpson D, Betancourt M. The prior can often only be understood in the context of the likelihood. Entropy 2017;19:555. DOI: https://doi.org/10.3390/e19100555

Lenth RV. Emmeans: Estimated marginal means, aka least-squares mean. 2021. Available from: https://cran.r-project.org/web/packages/emmeans/emmeans.pdf

Kruschke J. Rejecting or accepting parameter values in Bayesian estimation. Adv Meth Pract Psychol Scie 2018;1:270-80. DOI: https://doi.org/10.1177/2515245918771304

Brunborg GS, Mentzoni RA, Melkevik OR, et al. Gaming addiction, gaming engagement, and psychological health complaints among Norwegian adolescents. Media Psychology 2013;16:115-28. DOI: https://doi.org/10.1080/15213269.2012.756374

Hale L, Guan S. Screen time and sleep among school-aged children and adolescents: a systematic literature review. Sleep Med Rev 2015;21:50-8. DOI: https://doi.org/10.1016/j.smrv.2014.07.007

Stormark KM, Fosse HE, Pallesen S, Hysing M. The association between sleep problems and academic performance in primary school-aged children: Findings from a Norwegian longitudinal population-based study. PLoS One 2019;14:e0224139. DOI: https://doi.org/10.1371/journal.pone.0224139

Marmet S, Studer J, Wicki M, et al. Unique versus shared associations between self-reported behavioral addictions and substance use disorders and mental health problems: A commonality analysis in a large sample of young Swiss men. J Behav Addict 2019;8:664-77. DOI: https://doi.org/10.1556/2006.8.2019.70

Fridh M, Grahn M, Lindström M, Modén B. [Folkhälsorapport Barn och Unga i Skåne 2016 – en undersökning om barn och ungdomars livsvillkor, levnadsvanor och hälsa. (Public health report children and young in Scania 2016 – a survey of living conditions, living habits and health among the young)].[in Norwegian]. Samhällsanalys, Region Skåne, 2016. Updated: 2016-02-26. Accessed: 2021 June 8. Available from: https://utveckling.skane.se/utvecklingsomraden/folkhalsa-och-social-hallbarhet/folkhalsorapporter/folkhalsorapport-barn-och-unga-i-skane/

Skogen JC, Bøe T, Sivertsen B, Hysing M. Use of alcohol, tobacco and illicit drugs among ethnic Norwegian and ethnic minority adolescents in Hordaland county, Norway: the [email protected] Ethn Health 2018;23:43-56. DOI: https://doi.org/10.1080/13557858.2016.1246422

Reebye P. Attention-deficit hyperactivity disorder: A handbook for diagnosis and treatment, third Edition. J Can Acad Child Adolesc Psychiatry 2008;17:31-3.

Nuyens F, Deleuze J, Maurage P, et al. Impulsivity in multiplayer online battle arena gamers: Preliminary results on experimental and self-report measures. J Behav Addict 2016;5:351-6. DOI: https://doi.org/10.1556/2006.5.2016.028

Walther B, Morgenstern M, Hanewinkel R. Co-occurrence of addictive behaviours: personality factors related to substance use, gambling and computer gaming. Eur Addict Res 2012;18:167-74. DOI: https://doi.org/10.1159/000335662

Yen JY, Liu TL, Wang PW, et al. Association between Internet gaming disorder and adult attention deficit and hyperactivity disorder and their correlates: Impulsivity and hostility. Addict Behav 2017;64:308-13. DOI: https://doi.org/10.1016/j.addbeh.2016.04.024

Tachibana Y, Miyazaki C, Ota E, et al. A systematic review and meta-analysis of comprehensive interventions for pre-school children with autism spectrum disorder (ASD). PLoS One 2017;12:e0186502-e. DOI: https://doi.org/10.1371/journal.pone.0186502

Newschaffer CJ, Croen LA, Daniels J, et al. The epidemiology of autism spectrum disorders. Annu Rev Public Health 2007;28:235-58. DOI: https://doi.org/10.1146/annurev.publhealth.28.021406.144007

Rattray J, Jones MC. Essential elements of questionnaire design and development. J Clin Nurs 2007;16:234-43. DOI: https://doi.org/10.1111/j.1365-2702.2006.01573.x

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