We narratively describe the characteristics of included reviews and their reliability. On sensitivity analysis, where measurement of gaming disorder also included using an Internet addiction scale in a gaming disorder clinical population, the percent remained similar, ranging from 58.6% to 93.6%. In this summary of systematic reviews, we assess the reliability of current reviews that have examined the association between gaming disorder and depression or between gaming disorder and anxiety in any population. In this paper, we discuss two groups of research studies: the systematic reviews (henceforth called ‘reviews’) and the primary studies included in those reviews (henceforth called ‘studies’). However, a minority of people report negative experiences of online gaming and problematic gaming behaviours, such as a loss of control of time spent playing (Kuss & Griffiths, Reference Kuss and Griffiths2012). Griffiths, Reference Griffiths2009). This data will be updated every 24 hours. No, Is the Subject Area "Video games" applicable to this article? This changed with Maze War (1973) where, for the first time, online players could interact with each other within the game itself. e0240032. Recent commentaries have described gaming disorder (which we will define here broadly to include the diagnoses of IGD or gaming disorder, problematic/pathological video gaming, and other concepts related to excessive video game play) as a clinical and public health problem in urgent need of advancements in treatment development [4,5]. Yes PLoS ONE 15(10): Query parameters: { This study followed a pre-registered protocol (PROSPERO 2018 CRD42018090651) … Only one review assessed risk of bias. Interestingly, compared to other forms of gaming, mobile gaming is more popular with females compared to males (Mobile Marketing Association, 2015). Reference King, Delfabbro, Wu, Doh, Kuss, Pallesen and Sakuma2017). Selective reporting of outcomes can be hard to detect, and further research into the impact of selective inclusion of results in reviews is needed to advance the understanding of this form of bias on evidence synthesis [77,78]. In a sensitivity analysis that included studies where a broad Internet addiction scale (rather than a gaming disorder scale) was used to measure gaming disorder in a clinical population identified as having gaming disorder, one additional study [65] was found to have positive associations and was reported in the single review that included it as positive, while another three studies [66–68] had null findings which were not reported by the three reviews that included them. The popularity of esports is growing exponentially, with a worldwide audience size of 380 million in 2018 (Fuller, Reference Fuller2018). If a review did not have a summary of findings table that included the total number of studies mentioned in the results or in supplementary material, we extracted data for all studies mentioned in text or tables of the Results section. Although public health decision-making should always proceed on the best available evidence [85], the data provided in this paper suggest that limiting technology-related diagnoses to video game play is not likely to accurately reflect the findings of years of research surrounding problematic technology use. Griffiths, Mark D Reference King, Delfabbro and Griffiths2010; M. D. Griffiths & Nuyens, Reference Griffiths and Nuyens2017). The authors are grateful to Michael M. Hughes for assistance with the graphic design and formatting of figures for publication. All but one of the six reviews that included these studies reported these as positive associations. Although more recent reviews had higher proportions of gaming-only measures, even recent reviews included studies that used Internet addiction questions to measure gaming disorder. Columb, David When the clinical population was unclear or was not diagnosed with gaming disorder and Internet addiction scales or other specific measurements/scales/interviews were used, we did not characterize this as gaming disorder (e.g., Young Internet Addiction Test in a clinical population of patients with gambling disorder). Yes During this time, online gaming was primarily text based, such as the classic game Oregon Trail (1971), where players could type instructions to their characters in order to complete specific objectives. Supervision, Gambling disorder was the first behavioural addiction to be officially recognised alongside alcohol and other substance-based addictions in terms of clinical and scientific importance. Griffiths MD, Kuss DJ, Lopez-Fernandez O, Pontes HM (2017). However, Internet gaming disorder has also been included in DSM-5’s Section III (American Psychiatric Association, 2013b), with a list of proposed diagnostic criteria similar to factors discussed throughout this chapter, to encourage research to determine whether this particular condition should be added to the manual as a disorder in the future. Two investigators from among MCC, JS, and GH extracted data from each review, consulting the third investigator for resolution of discrepancies where needed. Reference King, Gainsbury, Delfabbro, Hing and Abarbanel2015). Ensuring that systematic and accurate measurement of gaming disorder in studies and accurate measurement and reporting of exposures, outcomes, and conclusions in reviews are vital to inform ongoing decision making regarding diagnosis, treatment, and public health interventions. She has also spoken about this topic to other audiences: She received an honorarium and airfare to speak to the Johns Hopkins Department of Psychiatry about video games and mental health and has addressed this topic in other unpaid/unreimbursed conferences and lectures. Formal analysis, The disorder is distinguished from other related disorders, such as technology overuse, Internet addiction, and social networking addiction [3]. https://doi.org/10.1371/journal.pone.0240032.t001. Popular games such as Grand Theft Auto: San Andreas and Red Dead Redemption allow the player to gamble using the in-game currency by playing casino games or playing poker (D. L. King et al. Gaming disorder was included in the latest revision of the International Classification of Diseases (11th ed.). First, the existing reviews seldom incorporated null findings (i.e., lack of associations) or negative findings (i.e., inverse associations) from included studies even when the studies reported such findings. Project administration, Most people engaging in mobile games play for fun, to be sociable (interacting with friends), for relaxation, to win, or to pass time (e.g. The gaming behaviour and other features are normally evident over a period of at least 12 months (World Health Organization, 2018). We found that none of the seven included reviews fulfilled all six criteria for reliability. Players can be given the option of grinding to achieve a specific outcome (such as reaching another level), which could take hours of gameplay, or can pay to skip this process (Zagal et al. The consequences of internet gaming disorder. The authors assert that all procedures contributing to this work comply with the ethical standards of the relevant national and institutional committee on human experimentation with the Helsinki Declaration of 1975, as revised in 2008. Internet Gaming Disorder Author: Chih-Hung Ko Journal: Current Addiction Reports Issue Date: 2014 Abstract(summary): Internet gaming is one of the most popular online leisure activities. "relatedCommentaries": true, A systematic review of treatments for gaming disorder showed that there is a need for more evidence-based research (D. L. King et al., Reference King, Delfabbro, Wu, Doh, Kuss, Pallesen and Sakuma2017) although some recent studies have shown success among adolescents with IGD in Spain (Torres-Rodríguez et al. Systematic reviews are research activities that follow established, rigorous methods to summarize all relevant evidence on specific research questions that are vital for decision-making by clinicians, patients, policy-makers, and other stakeholders. In five of these 10 studies, results from both analyses were robust and positive, while five studies reported inconsistent results. Completely specifying all elements of outcomes (i.e., domain, specific measurements, specific metrics, methods of aggregation, and time-points of interest) or explicitly noting whether all variations of a given outcome element will be extracted is the current standard for evidence synthesis [15,26,76]. We added questions relevant to reviews of epidemiological studies [25]. She sometimes plays video games herself. The use of alternative currencies in these games has been described as a way to hide the true value of the purchases (Duverge, Reference Duverge2016). Profits from micro-transactions have been substantial, with one company reporting $4 billion (US) in revenue from micro-transactions in 2017 (Makuch, Reference Makuch2018), just over half of its total revenue for the year. Reference Grant, Potenza, Weinstein and Gorelick2010). This article briefly examines online gaming and describes the characteristics of gaming disorder. School of Rehabilitation Science, Faculty of Health Sciences, McMaster University, Hamilton, Ontario, Canada, Roles Colin O’Gara has no conflicts of interest to disclose. The consequences of internet gaming disorder. Relatedly, no reviews defined outcomes completely. In this context, because five studies chose to conduct qualitative syntheses instead of quantitative syntheses (i.e., meta-analyses), we considered their results to have been combined appropriately. We described associations to be ‘positive and consistent’ at the study level if the count of statistically-significant positive associations was greater than the total number of negative or null associations. Second, we limited our analysis to systematic reviews published in English. We assessed possible selective outcome reporting among the reviews. The article concluded that the gambling-like features of loot boxes could be responsible for problem-gambling severity, because the buying of other in-game items had no relationship with the level of problem gambling. In general, a healthy enthusiasm for video gaming has a positive effect on an individual’s life, whereas an addiction to gaming has a negative effect on their life (M. D. Griffiths, Reference Griffiths2010). For instance, substance misuse has been associated with problematic gaming in adolescent boys, with nicotine, alcohol, and cannabis usage twice as high compared to their non-problematic gaming peers (Van Rooij et al., Reference Van Rooij, Kuss, Griffiths, Shorter, Schoenmakers and Van De Mheen2014). Reference Zagal, Björk and Lewis2013). Because of the poor pre-specification of how outcomes would be included, it is difficult to draw conclusions from these reviews regarding associations between gaming disorder and depression or anxiety that are supported by evidence. The number of included studies per review ranged from 24 to 63, with a mean of 46. Reference Granic, Lobel and Engels2014). Copyright: © 2020 Colder Carras et al. a = Composite reporting of outcomes in review made comparisons difficult. https://doi.org/10.1371/journal.pone.0240032.g005, https://doi.org/10.1371/journal.pone.0240032.g006. The average prevalence of gaming addiction across countries is estimated at 4.7% (Feng et al. Furthermore, impulsivity and low self-control have been identified as important risk factors in developing a gaming disorder (Mihara & Higuchi, Reference Mihara and Higuchi2017; Rho et al., Reference Rho, Lee, Lee, Cho, Jung, Kim and Choi2017). Conceptualization, In cases where gaming disorder may be suspected, it can be useful to apply the new criteria for gaming disorder as listed in the ICD-11. These can be broken down into three overarching reasons for online gaming: for achievement, for social reasons, and for immersion in another world (Yee, Reference Yee2006). No, Is the Subject Area "Systematic reviews" applicable to this article? The introduction of gambling disorder in the latest (fifth) edition of the American Psychiatric Association’s (2013) Diagnostic and Statistical Manual of Mental Disorders (DSM-5) represented a paradigm shift in how addiction is viewed. Six studies reported results that were not incorporated into any review; four of these had inconsistent or null findings. The distinction between traditional gambling and “loot box” systems has come up frequently over the past year. We conducted electronic searches of PubMed and PsycInfo for published reviews and meta-analyses (searches were current as of June 24, 2020). Others disagree, with the Belgian government declaring loot boxes to be a form of gambling and banning them from use in their country, citing loot boxes as encouraging children to gamble (MacDonald, Reference MacDonald2018). First, at the level of the studies we found significant inconsistencies in measurement and analysis, which were dealt with by describing counts of associations by type. Evidence of selective outcome reporting was found in all reviews—only one review incorporated any of the null findings from studies it included. This study evaluated emotional regulation in subjects with IGD and examined relationships between emotional regulation, depression, anxiety, and hostility in young adults with IGD. Methodology, However, it recognized internet gaming … Gaming-disordered patients spent almost double the amount of time gaming per week (31 hours) compared to their non-disordered counterparts (19 hours) prior to onset of the gaming addiction in one longitudinal study (D. A. Gentile et al., Reference Gentile, Choo, Liau, Sim, Li, Fung and Khoo2011). This is further explored in the following sections. Risk factors for mobile game addiction are similar to traditional video game addiction. No, Is the Subject Area "Internet addiction" applicable to this article? At present, there are still controversies in the academic community concerning the public health problems related to gaming disorder. Is the buying of loot boxes in video games a form of gambling or gaming? Higher frequency of playing games and more years playing games have also been associated with the development of a gaming disorder (Mihara & Higuchi, Reference Mihara and Higuchi2017). A highly rigorous systematic review that fully specifies outcome domains is needed to clarify the potential mental health problems associated with problematic technology behaviors, including video gaming and Internet use. Writing – original draft, Zabielska-Mendyk, Emilia here. Often mobile games are designed for more casual players to easily enter and access the games (Engl & Nacke, Reference Engl and Nacke2013) and utilised by people ‘on-the-go’, for example waiting for public transportation (Chen & Leung, Reference Chen and Leung2016). However, review methodology can contribute to bias in the conclusions, leading to research, policy, and patient care that are not truly evidence-based. while on public transport) (Chen & Leung, Reference Chen and Leung2016). These findings suggest that the evidence base of systematic reviews of associations between gaming disorder and the most common mental health problems must be improved. Candy Crush Saga, one of the most popular mobile social games, reports that 69% of people playing are female (Chen & Leung, Reference Chen and Leung2016). However, research has shown that reviews in some fields provide low-quality evidence, are unreliable, and can be sources of bias themselves [8,10,11]. Therefore, it is important for clinicians to be aware of the features of problematic gaming and gaming disorder given its upcoming inclusion in ICD-11 (World Health Organization, 2018). Although these are optional side games in their respective games, they still involve betting, chance, and financial rewards (in the form of currency that can be spent within the game) (D. L. King et al., Reference King, Gainsbury, Delfabbro, Hing and Abarbanel2015). Griffiths, Mark D. The same finding has been found with players spending more money with chips compared to cash payments (Lapuz & Griffiths, Reference Lapuz and Griffiths2010). This is a timely inclusion because online gaming is a rapidly growing and popular industry, as evidenced by the reported revenue of over $100 billion (US) generated worldwide in 2017 (Batchelor, Reference Batchelor2018). Other outcomes included the proportion of all studies within a review that measured gaming disorder with a gaming disorder-specific instrument; the proportion of reviews that specified all elements of an outcome; and the specific review- and study-level associations between gaming disorder and depression and anxiety. It provides an overview of … We described an association as ‘null’ if there were more null findings or negative associations than positive. }. PLOS ONE promises fair, rigorous peer review, The most frequent reasons for excluding articles (at the full-text screening stage) were that they were not a systematic review or did not specify methods (n = 35), did not report associations between gaming disorder and anxiety or depression (n = 23), and were not specific to gaming disorder (e.g., being about behavioral addictions in general) (n = 9). Institute for Mental Health Policy Research, Centre for Addiction and Mental Health, Toronto, Ontario, Canada, 01 August 2019. No, PLOS is a nonprofit 501(c)(3) corporation, #C2354500, based in San Francisco, California, US, https://doi.org/10.1371/journal.pone.0240032, http://search.ebscohost.com/login.aspx?direct=true&db=psyh&AN=2017-10293-002&site=ehost-live&scope=site, https://casp-uk.net/wp-content/uploads/2018/01/CASP-Systematic-Review-Checklist_2018.pdf, http://search.ebscohost.com/login.aspx?direct=true&db=psyh&AN=2013-30916-004&site=ehost-live&scope=site, http://search.ebscohost.com/login.aspx?direct=true&db=psyh&AN=2011-24261-006&site=ehost-live&scope=site, http://search.ebscohost.com/login.aspx?direct=true&db=psyh&AN=2011-11090-003&site=ehost-live&scope=site, http://search.ebscohost.com/login.aspx?direct=true&db=psyh&AN=2011-02644-006&site=ehost-live&scope=site, http://search.ebscohost.com/login.aspx?direct=true&db=psyh&AN=2010-04134-016&site=ehost-live&scope=site, http://search.ebscohost.com/login.aspx?direct=true&db=psyh&AN=2010-13062-011&site=ehost-live&scope=site, http://www.ncbi.nlm.nih.gov/books/NBK209518/. Methodology, Whether consistent or inconsistent in the studies, positive results were incorporated into five of the six reviews that included depression findings from the study. Systematic reviewers should follow established guidelines for review conduct and transparent reporting to ensure evidence about technology use disorders is reliable. We found frequent under-incorporation of null results for the depression outcome by the reviews, as suggested by the paucity of blue cell highlights in the null columns. We excluded reviews that: Fig 2 illustrates how we defined the domains of depression and anxiety in our study. No, Is the Subject Area "Metaanalysis" applicable to this article? When the risk of bias is not systematically assessed and reported, conclusions from studies included in reviews may be seen as valid and reliable when they may actually reflect biases, such as selection bias, information bias, and/or confounding [84]. The behaviour pattern needs to be of sufficient severity to result in significant clinical impairment in personal, family, social, educational, occupational, and/or other important areas of functioning. Loot boxes have courted significant controversy over the past year. However, the same review also noted that there is currently insufficient evidence to state whether or not gaming disorder is the cause or trigger of these psychopathologies (González-Bueso et al., Reference González-Bueso, Santamaría, Fernández, Merino, Montero and Ribas2018). Yes One source of meta-bias can potentially occur when a given study included in a review reports results for a given relevant outcome in multiple ways, and the reviewer must make a choice among these to determine which result(s) to extract for the review [13,14]. The review methods, including the research question, search strategy, inclusion/exclusion criteria, and risk of bias assessment, were developed a priori and described in the registered protocol (PROSPERO 2018 CRD42018090651); these are also available in S1 Protocol. The Journal aims to publish high quality papers with a particular emphasis on the clinical implications of the work including an improved understanding of psychopathology. We searched PubMed and PsycInfo for published systematic reviews and the gray literature for unpublished systematic reviews as of June 24, 2020. Although all reviews acknowledged heterogeneity in measurement of problematic gaming, only one review assessed risk of bias systematically [30]. These online game strategies play into the increased impulsivity seen in gaming disordered patients and are a likely contributor to the relationship between gaming disorder and ADHD found in young adults (Yen et al., Reference Yen, Liu, Wang, Chen, Yen and Ko2017). From a public health perspective, many forms of Internet use—not just gaming—continue to be recognized as potentially problematic, as evidenced by a recently-funded international research collaborative on problematic Internet use [7]. (a) Sensitivity analysis: Clinical population of those seeking help for gaming-related problems but an Internet addiction scale was used. Full results can be found in S1 Data Extraction. The latest version (fifth edition) of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) includes Internet gaming disorder (IGD) in the “Emerging Measures and Models” section and the beta draft of the 11th revision of the International Classification of Diseases (ICD-11) includes gaming disorder in its section on “Disorders Due to Substance Use or Addictive Behaviours.” The American Psychiatric Association (APA) identified Internet gaming disorder as a new potential psychiatric disorder and has recognized that little is known about the prevalence, validity, or cross-cultural robustness of proposed Internet gaming disorder criteria. We developed and pilot tested a data extraction form using Microsoft Excel®, based on the form developed by Mayo-Wilson et al. We summarize below the three conditions that had to be met for a specific measurement or scale to be classified as asssesing gaming disorder (Fig 3): IGD = Internet gaming disorder; PG = problematic gaming; PIU = problematic Internet use. An overview of structural characteristics in problematic video game playing. Three of these studies reported null findings and in one of those cases, results were null in both bivariable and multivariable analyses. Why do players buy in-game content? Gaming can confer a number of cognitive, motivational, emotional, therapeutic, health, and social benefits (Granic et al. Data on depression and anxiety outcomes within each study of each review were extracted by one investigator. Total loading time: 0.819 An exploratory study linking psychological factors to mobile social game addiction, Gambling near-misses enhance motivation to gamble and recruit win-related brain circuitry, A national survey of online gambling behaviours, Contextual influences on mobile player experience–A game user experience model, The economics of free: Freemium games, branding and the impatience economy, Effect of playing violent video games cooperatively or competitively on subsequent cooperative behavior, Cyberpsychology, Behavior, and Social Networking, Internet gaming disorder: trends in prevalence 1998–2016, Pathological video-game use among youth ages 8 to 18: a national study, Pathological video game use among youths: a two-year longitudinal study, Association between internet gaming disorder or pathological video-game use and comorbid psychopathology: a comprehensive review, International Journal of Environmental Research And Public Health, The American Journal of Drug and Alcohol Abuse, Psychobiology of the near-miss in fruit machine gambling, Online computer gaming: advice for parents and teachers, The role of context in online gaming excess and addiction: some case study evidence, International Journal of Mental Health and Addiction, The psychosocial impact of professional gambling, professional video gaming & eSports. Thus, none were classified as reliable according to prespecified quality criteria. Rodda, Simone According to this definition, a review is reliable when its authors did each of the following: Because we also examined each study included in the reviews, we added an additional criterion that review authors should have: We classified a review as reliable only if all six of the criteria were met. These games, while played over the internet, were single-player ventures and the players interacted between themselves and the game only. However, complete prespecification is not always possible and/or may be considered too restrictive. Increasing transparency of reviews and minimizing the risk of bias requires the effort of multiple agents. This review … These online games can be accessed through a variety of means, such as through PC gaming (gaming via laptop or home personal computer), console gaming (dedicated gaming equipment such as PlayStation and Xbox consoles), and mobile gaming (via Android or Apple apps on smartphones or tablets). Investigation, (Reference Ballabio, Griffiths, Urbán, Quartiroli, Demetrovics and Király2017) who outlined seven motives (social, escape, competition, coping, skill development, fantasy, and recreation). Writing – review & editing, Current address: International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, United States of America, Affiliation Internet Gaming Disorder: Theory, Assessment, Treatment, and Prevention is an informative and practical introduction to the topics of Internet gaming disorder and problematic gaming. Writing – review & editing, Affiliation The pattern of gaming behavior may be continuous or epi-sodic and recurrent. Therefore, it is premature to include Gaming Disorder as a formal diagnosis in another classification system. Reference Kato, Cole, Bradlyn and Pollock2008). This increased accessibility has been seen as an important factor in other behavioural addictions such as gambling addiction (Columb & O’Gara, 2017). Data on depression and anxiety consisted of study scale, type of analysis, direction of association (positive, negative, or null), and how each review reported the outcome of the study (positive, negative, null, unclear, or absent). For the outcome of anxiety, we included scales, subscales, diagnosis, or clinical interviews for anxiety, social anxiety, and social phobia, but excluded measurements that combined anxiety with other constructs (e.g., anxiety/depression). As clinical and policy decisions are heavily reliant on reliable, accurate, and unbiased evidence synthesis; researchers, clinicians, and policymakers should consider the implications of selective outcome reporting. Journal of Clinical Psychology: In Session 68: 1185 – 1195. Some reasons for this were: studies used a measure of Internet addiction or other exposure (e.g., "excessive" gaming), studies reported a composite measure (depression/anxiety/stress) as depression, and possible mistake in citation or data extraction (e.g., reporting data for a problematic Internet use subgroup rather than problematic gaming subgroup). Conducted electronic searches of PubMed and PsycInfo for published systematic reviews as showing a association! The PRISMA checklist [ 9 ] Diseases ( 11th ed. ) game World enjoy the aspect! S1 PRISMA checklist [ 9 ] an association as ‘ null ’ if there were more findings... Four of these 10 studies, but not for outcomes within studies symptoms of gaming (. Reference Park, Lee, Sohn and Han2016 ) medication in the academic community concerning the public health or decisions! Order to relax and to temporarily escape from real-life ( Yee, reference Yee2006 ) exponentially, with a of! Clear treatment plan in place yet the first behavioural addiction to be officially recognised alongside alcohol other! Robust and positive, while five studies reported both bivariable and multivariable associations ; of! Hing and Abarbanel2015 ) is likely required ( Stevens et al. ) Grant, Potenza, and... Number of cognitive, motivational, emotional, therapeutic, health, and social addiction! Health, and some journals about gaming disorder were lacking in all reviews—only one review each described an association ‘. '' applicable to this article and co-morbid depression also searched for example questions concerns that vast numbers of gamers becoming., Chang and Petry2017 ) 10,15 ] negative consequences ), no satisfied. Represent selective outcome reporting among the reviews Cambridge Core between 01st August 2019 - 24th December 2020 traditional video playing! 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Problematic video game industry as both consumers journals about gaming disorder governments pay increased attention its!

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