Gaming disorder or Internet gaming disorder (IGD) is a disorder related to excessive video, computer, or online game play that results in psychological distress and/or functional impairment [1,2]. Results indicated 90% of studies found lower ER to be associated with reports of greater video gaming or gambling disorder symptomology, with 13 studies (65%) reporting medium to large effect sizes. We restricted to reviews published in English by June 24, 2020. This is a major concern because it seems to represent selective outcome reporting at the review level. In five of these 10 studies, results from both analyses were robust and positive, while five studies reported inconsistent results. Systematic reviewers should follow established guidelines for review conduct and transparent reporting to ensure evidence about technology use disorders is reliable. Gaming disorder is a new classification, so there is no clear treatment plan in place yet. Continuation or escalation of gaming despite the occurrence of negative consequences. Some No, Is the Subject Area "Metaanalysis" applicable to this article? Recent decades have witnessed a surge in the number of systematic reviews conducted [8]. In response to this gap in our understanding, the present study, a first for this research topic, estimated the period prevalence of this ⦠Reference King, Gainsbury, Delfabbro, Hing and Abarbanel2015). and broad scope, and wide readership – a perfect fit for your research every time. In this situation, choice of the result based on the largest (or smallest) magnitude of treatment effect, on statistical significance, and/or on the result that supports the reviewer’s conscious or subconscious preconceptions can be problematic and lead to bias. 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]. People diagnosed with Internet gaming disorder (IGD) have been frequently reported to experience depression, anxiety, and hostility. 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’). Is the buying of loot boxes in video games a form of gambling or gaming? (b) Including those adapted from Internet addiction scales where an example question is given. Six studies reported both bivariable and multivariable associations; half of these showed inconsistent results. It provides an overview of ⦠Given the established association between gaming disorder and two common mental health outcomes—depression and anxiety—we limited the scope of our study to systematic reviews that included data about these outcomes. 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). There is a large gambling element associated with esports (Bányai, Griffiths, Király, & Demetrovics), and it is estimated that gambling on esports will reach $10 billion US dollars by 2020 (MD Griffiths, Reference Griffiths2017). She is currently a member of the American Association for Suicidology Technology and Innovation Committee and believes that video games and social media have the potential to be useful platforms for delivering public health interventions. The pattern of gaming behavior may be continuous or epi-sodic and recurrent. Although there is much research to be done before we understand the full societal impact of IGD, there is already evidence of its impact on individuals. While gaming is an important form of entertainment, excessive gaming may cause serious consequences for players. Supervision, 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. https://doi.org/10.1371/journal.pone.0240032.t001. Reference Larche, Musielak and Dixon2017). Reference Kato, Cole, Bradlyn and Pollock2008). An overview of structural characteristics in problematic video game playing. It is likely that such a maladaptive use of gaming has become more frequent during the COVID-19 ⦠However, the same author (D. Gentile, Reference Gentile2009) and others (e.g. We adapted the definition of “reliability” of systematic reviews developed by Cochrane Eyes and Vision [17–21]. Interestingly, compared to other forms of gaming, mobile gaming is more popular with females compared to males (Mobile Marketing Association, 2015). Part of the success of contemporary online gaming is due to some of the psychological mechanisms (the so-called âstructural characteristicsâ) employed throughout these games, such as the utilisation of ânear-missesâ. Some specific strategies that can be employed in some online games are âpay to skipâ and âgrindingâ (the performance of repetitive and tedious tasks typically as a solo endeavour or as part of team play). Narcissists are motivated to play with friends in seeking for their admiration and praise; Machiavellians are motivated to have friends in order to manipulate and exploit ⦠Writing – original draft, Griffiths, Reference Griffiths2010) have demonstrated that prolonged engagement in gaming does not necessarily mean the individual has a gaming disorder. The introduction of gambling disorder in the latest (fifth) edition of the American Psychiatric Associationâs (2013) Diagnostic and Statistical Manual of Mental Disorders (DSM-5) represented a paradigm shift in how addiction is viewed. This definition, in turn, was informed by items identified from the Critical Appraisal Skills Programme (CASP), A Measurement Tool to Assess systematic Reviews (AMSTAR), and the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) tools [9,22,23]. We also conducted a sensitivity analysis to examine how our findings differed when other measurements (e.g., the Young Internet Addiction Test) were used with a clinical population diagnosed with gaming disorder. onset, frequency, intensity, duration, termination, context), Increasing priority given to gaming to the extent that gaming takes precedence over other life interests and daily activities. The reinforcement offered by these random boxes has been cited as a critical psychological ingredient of gaming addiction (M.D. We excluded reviews that: Fig 2 illustrates how we defined the domains of depression and anxiety in our study. Six studies reported results that were not incorporated into any review; four of these had inconsistent or null findings. Overall, no review satisfied all the criteria we used to identify reliable reviews, so we could not address this research question. Problematic gaming exists and is an example of disordered gaming. Limitations of the current summary include using counts of associations and restricting to systematic reviews published in English. The shades of blue highlighting pertain to different percentages of reviews that incorporated a given relevant result from a given study (darker highlighting indicates higher percentages). 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. Because of the lack of clarity around how study outcomes were selected, the reporting of outcomes that was inconsistent with study findings (see Figs 5 and 6), the inclusion of studies that did not measure gaming disorder, and the lack of systematic assessment of bias (except for one review [30]), we determined that review conclusions were not supported by the evidence from included studies. To advance the field of addictive behaviors and ensure that research measures and reports constructs rigorously and with clarity, existing standards for systematic review conduct and reporting should be followed. "metricsAbstractViews": false, Griffiths MD, Kuss DJ, Lopez-Fernandez O, Pontes HM (2017). "peerReview": true, Gaming disorder includes symptoms related to substance use disorder, such as loss of control (that continues despite negative consequences), functional impairment, distress, and/or interference with daily activities. In a large survey of 7422 gamers, the more money a person spent buying loot boxes, the more likely they were to be a problem gambler (Zendle & Cairns, Reference Zendle and Cairns2018). Investigation, No financial support was provided for this work. The consequences of internet gaming disorder. In addition, we reviewed all years of the Journal of Behavioral Addictions, including its supplements, and all proceedings of the International Conference on Behavioral Addictions. Why do players buy in-game content? "languageSwitch": true We conducted a sensitivity analysis to examine the impact of measuring gaming disorder with a scale for Internet addiction in a clinical population of individuals with gaming disorder. Reference Stevens, King, Dorstyn and Delfabbro2018). 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. Google Scholar | Crossref | Medline Kuss, DJ, Griffiths, MD ( 2012 ) Internet gaming addiction: A ⦠The specific measurement or scale asked questions about gaming or online gaming rather than Internet or computer use in general (e.g., did not use only an Internet addiction measure, such as the Young Internet Addiction Test or the Compulsive Internet Use Test). All reported associations within the studies were extracted from the original study reports and characterized as present and positive, present and negative, present and null, unclear, or absent. 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. Writing – review & editing, Affiliation All but one of the three reviews that incorporated these studies reported these associations as positive. A major difference between mobile gaming and traditional gaming is the increased availability of these games given the ubiquity and availability of mobile phones (Engl & Nacke, Reference Engl and Nacke2013). We examined reviews that included studies of the associations between the exposure of gaming disorder (as defined by the review authors) and the outcomes of depression or anxiety. Here, gaming disorder is characterised by âa pattern of persistent or recurrent gaming behaviour (âdigital gamingâ or âvideo-gamingâ), which may be online (i.e., over the internet) or offlineâ (e.g. 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. 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). We assessed possible selective outcome reporting among the reviews. Delineation and measurement of a clear construct with no overlap with other related conditions, such as gambling, Internet use, and technology use, are crucial to this field. Given the rise of online gaming and the recognition of gaming disorder as an addictive behaviour, there is a need for increased recognition of this disorder within the Irish healthcare system. Extracted data for a 10% random sample of studies were validated by the second and third investigator. Yes 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). No, Is the Subject Area "Internet addiction" applicable to this article? Cudo, Andrzej Writing – review & editing, Current address: International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, United States of America, Affiliation Project administration, 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). Players looking to immerse themselves in the game world enjoy the role-playing aspect of gaming. All but one of the six reviews that included these studies reported these as positive associations. MGH Institute of Health Professions, Mass General Brigham, Boston, Massachusetts, United States of America, Roles Therefore, it is premature to include Gaming Disorder as a formal diagnosis in another classification system. 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). Although all reviews acknowledged heterogeneity in measurement of problematic gaming, only one review assessed risk of bias systematically [30]. Ireland have decided against labelling loot boxes as a form of gambling, with the Department of Justice stating that it âdoes not have a role to regulate game developers on how their games work nor, in the offering of in-game purchasesâ (Irish Legal, Reference Zendle and Cairns2018). Do systematic reviews of the associations between gaming disorder and depression and between gaming disorder and anxiety report outcomes selectively? Discover a faster, simpler path to publishing in a high-quality journal. Supervision, 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]. 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 âon-the-goâ, for example waiting for public transportation (Chen & Leung, Reference Chen and Leung2016). The announcement comes at a curious time for the video game industry as both consumers and governments pay increased attention to its practices. However, a recent cross-cultural study found little evidence of gaming disorder among smartphone users who played mobile games (Lopez-Fernandez et al., Reference Lopez-Fernandez, Männikkö, Kääriäinen, Griffiths and Kuss2018). The same finding has been found with players spending more money with chips compared to cash payments (Lapuz & Griffiths, Reference Lapuz and Griffiths2010). Addiction to gaming is described in the American Psychiatric Association's Diagnostic and Statistical Manual of Mental Disorders (DSM-5), which is used by mental health professionals to diagnose mental disorders. Most reviews discussed limitations at the study, outcome, and review level, but two reviews did not discuss limitations systematically [27,29]. In relation to specific treatment efficacy, there is a need for further research in this area. A second major concern is that reviews did not limit evidence synthesis and conclusions to studies that measured the construct of gaming disorder and at times used overly-broad definitions of depression and anxiety (e.g., combined depression, anxiety, and stress), which might have led to reports of associations between gaming disorder and depression or anxiety when none might exist. Because measurements of exposures and outcomes were heterogeneous, we present counts of positive or null/negative outcomes from studies and how they were reported in reviews [26]. Referral pathways need to be established to manage the current presentations of gaming disorder to our services with the goal of providing the most up-to-date and effective treatment options for these patients. 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. Escitalopram was found to be beneficial in the treatment of gaming disorder in a randomised control trial alongside bupropion (with bupropion showing greater efficacy in relation to attention and impulsivity than escitalopram in the same trial) (Song et al. Six studies reported additional cross-sectional depression results that were not incorporated into any review. 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. They engage in gaming in order to relax and to temporarily escape from real-life (Yee, Reference Yee2006). This summary of systematic reviews found methodological problems in all seven systematic reviews that reported on associations between gaming disorder and depression or anxiety; no reviews could be classified as reliable based on established criteria. 2020. Mobile games are now the largest growing gaming market and represent the largest share of the global games market, with more than 50% of the market share (Wijman, Reference Wijman2018). (a) Sensitivity analysis: Clinical population of those seeking help for gaming-related problems but an Internet addiction scale was used. Competing interests: I have read the journal’s policy and the authors of this manuscript have the following competing interests: Dr. Colder Carras has spoken to the World Health Organization about this topic at the request of the Entertainment Software Association but has received no funding, honorarium, fees, meals, lodging, donations or reimbursement. Of the 28 studies that reported associations between anxiety and gaming disorder, results from only 22 of these studies were incorporated into reviews (Fig 6, including citations [34–75]). These findings suggest that the way systematic reviews of gaming disorder have been reporting results and drawing conclusions may have introduced bias into the gaming disorder literature, possibly misleading future research, policy-making, and patient care. For example, depressed individuals can be attracted to online gaming as a way of decreasing their dysphoria (Peng & Liu, Reference Peng and Liu2010). 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