Reviewed by Robert Jasmer, MD; Associate Clinical Professor of Medicine, University of California, San Francisco and Dorothy Caputo, MA, RN, BC-ADM, CDE, Nurse Planner
Spending hours with a PlayStation or an Xbox every day can lead to serious psychiatric problems in children -- but "pathological" video game playing may not be just a result of preexisting mental disorders, researchers reported.
A two-year prospective study of more than 3,000 children identified several baseline psychological factors such as impulsivity that predicted excessive video game playing, according to Douglas Gentile, PhD, of Iowa State University in Ames, Iowa, and colleagues.
Nevertheless, such conditions as depression, social difficulties, and poor school performance "seemed to act as outcomes of pathological gaming," Gentile and co-authors wrote online in Pediatrics.
"Pathological gaming seems not to be simply secondary to other disorders but to predict poorer functioning longitudinally, and it can last for several years," they added.
For their study, the researchers gave questionnaires to 3,034 elementary and middle-school children in Singapore from 2007 to 2009. The survey, conducted in the students' classrooms, asked age-appropriate questions to elicit information on video gaming habits, social interactions, decision-making skills, affect, and other aspects of their psychiatric status as well as school performance.
Gentile and colleagues noted that response patterns indicated that causation could go in both directions for some factors.
"For example, although impulsivity is a risk factor for becoming a pathological gamer, impulsivity worsens after a youth becomes a pathological gamer," they wrote.
Game-playing habits were considered pathological when the young respondents checked off at least five of 10 items related to gaming on the questionnaire. These covered such matters as the amount of time they spent playing video games, whether schoolwork suffered as a result of gaming, and whether they ever stole money to buy games.
The mean number of pathological gaming symptoms reported in the sample was 2.28 at baseline and 1.78 at the last follow-up.
Pathological gaming was diagnosed in 9.9% of the sample initially -- predominantly boys, by a 3:1 margin -- which fell to 7.6% in the subsequent surveys.
Gentile and colleagues found that gaming behavior that was initially pathological in 36 children subsequently improved such that they no longer had five or more symptoms. Almost the same number (35) of those with four or fewer symptoms at baseline later added enough to qualify as pathological gamers.
The researchers were particularly interested in the latter group, conducting statistical analyses to compare their baseline characteristics and subsequent outcomes with those whose gaming never reached pathological levels.
Baseline characteristics that predicted onset of pathological gaming during the study period included the following:
Impulsivity score: 2.49 versus 2.25 (P=0.006)
Social competence score: 2.58 versus 2.96 (P=0.001)
Emotional regulation score: 2.53 versus 2.77 (P=0.02)
Empathy score: 2.20 versus 2.34 (P=0.48)
Weekly game-playing time: 31.12 hours versus 19.28 hours (P=0.005)
Gentile and colleagues also found that the more pathological gaming symptoms participants had at baseline, the more likely they were to show symptoms of depression, anxiety, social phobia, and lower school grades at the last follow-up -- all with P values less than 0.001.
Increases in pathological gaming symptoms during the prospective study were also predictive of depression, anxiety, social phobia, and school performance at the last follow-up, again with P<0.001.
The relationships were especially strong for depression, for which the r2 value was 0.49 (P<0.001).
Whether the study location limits the study's generalizability "is unclear," Gentile and colleagues indicated. The prevalence of pathological gaming in the Singapore sample was similar to what other researchers have reported in Western populations -- about 9% -- and the researchers could think of "no specific reason to assume the relationships between variables would be different in other countries."
On the other hand, they conceded that reliance on data supplied by the children was a limitation. "The study ... would have been improved by gathering information from additional sources, such as teachers and parents," the researchers wrote.
The study was funded by the Ministry of Education and the Media Development Authority of Singapore.
Study authors declared they had no relevant financial interests.
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