Addictive Behaviors Reports 12 (2020) 100324

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Addictive Behaviors Reports

journal homepage: www.elsevier.com/locate/abrep

Gaming addiction, problematic gaming and engaged gaming – Prevalence

and associated characteristics
Frida André , Niroshani Broman a, Anders Håkansson a, Emma Claesdotter-Knutsson a, *
a
Medical Faculty, Department of Clinical Sciences Lund, BMC F12, Sölvegatan 19, 221 84 Lund, Sweden

A R T I C L E I N F O A B S T R A C T

Keywords: Introduction: Gaming disorder was included in the 11th revision of the International Classification of Diseases
Gaming (ICD 11) and the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) included Internet Gaming
Gaming addiction Disorder as a tentative diagnosis. Most scholars agree upon the potential risk for pathological use of video games.
GAS
The primary aim of this study was to investigate the prevalence of engaged gamers, problem gamers and addicted
Risk factors
gamers. The secondary aim was to describe these groups in terms of gender, age, social satisfaction, psycho­
logical wellbeing and hours spent chatting on internet/social media.
Methods: We used survey-based data for this population-based research. The data was collected online in two
different settings in 2017. In total 2075 participants were included.
Results: 4.5 percent met the criteria for highly engaged gaming, 5.3 percent were shown to be problem gamers
and 1.2 percent met the cut off for game addiction. Young age, hours chatting on internet/social media, expe­
riencing loneliness and considering seeking treatment for psychological distress were associated with both
engaged, problematic and addictive gaming. Male gender was associated to problematic and addictive gaming.
Hours spent chatting showed a greater correlation to problem/addictive gaming than to engaged gaming.
Conclusion: The results of this study indicate that both highly engaged gamers, problem gamers and addicted
gamers all experience loneliness and psychological distress to a greater extent than the remaining study par­
ticipants. This adds to the knowledge of prevalence and features of gaming disorder. Additionally, preferably
longitudinal research is needed in order to understand causality.

1. Introduction gaming seemingly do so to an extent or manner that causes them

negative consequences (Ferguson, Coulson, & Barnett, 2011).
During recent decades video gaming has become one of the most Gaming disorder was included in the 11th revision of the Interna­
popular recreational activities. The video game industry has grown to a tional Classification of Diseases (ICD 11), defined as a gaming behaviour
turnover of nearly a $100 billion worldwide (Griffiths, Király, Pontes, & of sufficient severity to result in significant impairment in areas of
Demetrovics, 2015; Kiraly, Griffiths, & King, 2018). The Entertainment function. Gaming disorder is further characterized by impaired control
Software Association (ESA) showed that 75 percent of all US households and continuance despite the occurrence of undesirable effects (WHO,
have at least one person who plays video games and 70 percent of those 2018). The Diagnostic and Statistical Manual of Mental Disorders (DSM-
under 18 regularly play video games (Entertainment Software Associa­ 5) identifies Internet Gaming Disorder as a condition necessitating
tion, 2018). Though the benefits of gaming have been reported; with further clinical experience and research before inclusion as a formal
improved cognitive processes such as task-switching, attentional control disorder (American Psychiatric Association, 2013). Some scholars
and processing speed (Nuyens, Kuss, Lopez-Fernandez, & Griffiths, consider the application of gaming disorder as a clinical diagnosis to be
2018), most scholars agree on the potential risk for pathological use of premature and raise concerns about the risk of pathologizing normal
video games. A minority of the great number of individuals engaging in behaviour (Aarseth, Bean, & Boonen, 2017). Others express an

Abbreviations: ICD 11, International Classification of Diseases; DSM-5, Diagnostic and Statistical Manual of Mental Disorders (DSM–5); ESA, Entertainment
Software Association; RSP, Remaining Study Participants.
* Corresponding author at: IKVL BUP Barav 1, 22185 Lund Sweden.
E-mail addresses: [email protected] (F. André), [email protected] (N. Broman), [email protected] (A. Håkansson), emma.claesdotter-
[email protected] (E. Claesdotter-Knutsson).

https://doi.org/10.1016/j.abrep.2020.100324
Received 16 September 2020; Received in revised form 29 November 2020; Accepted 2 December 2020
Available online 5 December 2020
2352-8532/© 2020 The Authors. Published by Elsevier Ltd. This is an open access article under the CC BY license (http://creativecommons.org/licenses/by/4.0/).
F. André et al. Addictive Behaviors Reports 12 (2020) 100324

obligation to systematically distinguish between engagement and Table 1

addiction in order to avoid such implications (Brunborg et al., 2013, Excluded individuals.
2015; Charlton & Danforth, 2007). Basic demographics
The GAS (Game Addiction Scale) is one of the most frequently used Total no. Percent
questionnaires for game addiction (Brunborg et al., 2013, 2015; Costa Gender
et al., 2019; Khazaal, Chatton, & Rothen, 2016; King, Chamberlain, & Male 98 47.1
Carragher, 2020; Lemmens, Valkenburg, & Peter, 2009; Lin et al., 2019; Female 107 51.4
Mentzoni, Brunborg, & Molde, 2011; Wittek, Finserås, & Pallesen, Transgender 3 1.4
Total* 208 12.9
2015). The scale was theoretically based on the DSM-5 criteria for Age, Years
pathological gambling, namely; salience, tolerance, mood modification, 15–18 48 14.1
withdrawal, relapse, conflict and problems. (Lemmens et al., 2009) The 19–24 60 17.6
DSM-5 requires half (or more) of their criteria to be met when diag­ 25–29 40 11.8
30–39 85 25.0
nosing pathological gamblers. Scholars within the field of gaming on the
40–49 52 15.3
other side suggests a ranking of the criteria in order to separate highly 50–59 30 8.8
engaged, and possibly less destructive gaming from problematic or 60- 25 7.4
addictive gaming. They describe how the criteria tolerance, mood Total** 340 21.0
modification and cognitive salience rather associate to high engagement *
Numbers and percent of excluded individuals responding on gender items.
and not necessarily to addiction, while the opposite applies for the **
Numbers and percent of excluded individuals responding on age items.
criteria withdrawal, relapse, conflict and problems (Brunborg, Ment­
zoni, & Melkevik, 2013; Charlton & Danforth, 2007; Ferguson et al.,
2011; Lehenbauer-Baum & Fohringer, 2015; Lehenbauer-Baum et al., Table 2
2015; Snodgrass, Zhao, Lacy, Zhang, & Tate, 2019). Hence research Characteristics.
suggests application of the “core approach”, a system that distinguishes First database Second database Current study
highly engaged gamers from problem- and addicted gamers by accen­ Total Percent Total Percent Total Percent
tuating the latter criteria (withdrawal, relapse, conflict and problems) in no. no. no.
order to estimate a precise and relevant prevalence, whereas a potential
Gender
diagnosis of game addiction is expected to relate to interference and Male 260 52.5 770 50.7 1030 49.6
comorbidity rather than engagement (Brunborg et al., 2013, 2015; Female 292 46.8 747 49.2 1039 50.1
Charlton & Danforth, 2007) (see Fig. 1). Transgender 4 0.7 2 0.1 6 0.3
A great diversity in prevalence has been reported due to measure­ Age, Years
15–18 43 7.7 60 3.9 103 5.0
ment approach and diagnostic criteria, in turn affecting the association 19–24 123 22.1 170 11.2 293 14.1
with negative outcome such as mental health or social difficulties 25–29 64 11.5 152 10.0 216 10.4
(Brunborg et al., 2013, 2015; Ferguson et al., 2011). Stevens et al. report 30–39 127 22.8 268 17.6 395 19.0
in a meta-analysis that the prevalence of pathological gaming worldwide 40–49 90 16.2 276 18.2 366 17.6
50–59 61 11.0 291 19.2 352 17.0
stands at 3.05 percent (Ferguson et al., 2011). Despite nearly two de­
60- 48 8.6 302 19.9 350 16.9
cades of research, there is still debate and controversy in the field Gaming
regarding diagnostic criteria. The lack of consensus affects the reports of behavior
prevalence but also the comorbidity estimates and hence the mediated Addicted 5 0.9 20 1.3 25 1.2
relevance of the condition (Aarseth et al., 2017; Ferguson et al., 2011) Problem 57 10.3 52 3.4 109 5.3
Engaged 34 6.1 60 3.9 94 4.5
(see Tables 1–6). RSP-group 460 82.7 1387 91.3 1847 89
The addictive gaming has been associated to anxiety, depression,
social phobia/anxiety, low social competence, low self-esteem, sleeping
disorders and loneliness. It has also been associated to other computer approach. The secondary aim was to describe how these groups of
based behavioural addictions such as Internet addiction and Facebook gamers differentiate in terms of gender, age, social satisfaction, psy­
addiction (Andreassen et al., 2013; Gonzalez-Bueso et al., 2018; Lam, chological wellbeing and hours chatting on internet/social media.
2014; Lemmens, Valkenburg, & Peter, 2011; Pontes, 2017). Most of the
research reports a higher prevalence of pathological gaming in males 2. Material and methods
(Gonzalez-Bueso et al., 2018) and among teenagers and adolescents
(Mentzoni et al., 2011; Wittek et al., 2015). A considerable part of 2.1. Study procedure
previous research focuses on subpopulations such as young individuals
or samples of a specific group of gamers. (Charlton & Danforth, 2007; The present study was designed as a web-based questionnaire. The
Ferguson et al., 2011; Griffiths et al., 2015). data was collected online in two different settings in 2017. Both settings
The primary aim of this study was to investigate the prevalence of addressed problematic gaming, Internet use and gambling in the general
engaged gamers, problem gamers and addicted gamers, using the core population with the aim, among others, to study these behavioural

Fig. 1. Inclusion procedure.

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F. André et al. Addictive Behaviors Reports 12 (2020) 100324

Table 3
Prevalence of gaming categories within subgroups.
Highly engaged gamers Problem gamers Addicted gamers RSP-group

% (n) p-value* % (n) p-value* % (n) p-value* % (n)

Overall frequency 4.5 (94) 5.3 (109) 1.2 (25) 89.0 (1847)
Male gender
Yes 3.9 (40) 0.211 6.4 (66) 0.021 1.6 (16) 0.140 88.2 (908)
No 5.2 (54) 4.1 (43) 0.9 (9) 89.9 (939)
Ever considered seeking treatment
Yes 8.0 (59) <0.001 7.6 (56) <0.001 1.6 (12) 0.110 82.7 (607)
No 2.6 (35) 4.0 (53) 1.0 (13) 92.5 (1240)
Enough friends
Yes 3.8 (63) 0.001 4.5 (75) 0.001 1.1 (19) 0.437 90.6 (1551)
No 7.7 (31) 8.4 (34) 1.5 (6) 82.4 (332)
Age
15–18** 5.8 (6) 0.026 14.6 (15) <0.001 2.9 (3) 0.053 76.7 (79)
19–24** 8.2 (24) <0.001 10.6 (31) <0.001 1.4 (4) 0.505 79.9 (234)
**
25–29 11.6 (25) <0.001 6.9 (15) 0.003 0.9 (2) 0.975 80.5 (174)
***
30- 2.7 (39) <0.001 3.2 (48) <0.001 1.1 (16) 0.278 93.0 (1360)
Hours chatting on internet/social media
<1–4 4.1 (81) <0.001 4.5 (88) <0.001 0.6 (12) <0.001 90.7 (1775)
>4 10.9 (13) 17.6 (21) 10.9 (13) 60.5 (72)
*
Compared with RSP-group.
**
Compared with frequencies within the age group 30 years of age or older.
***
Compared with frequencies within all of the younger age categories.

Table 4 Table 6
Problem/addicted gamers vs highly engaged gamers and the RSP-group. Problem/addicted gamers vs engaged gamers.
Problem/addicted gamers vs the remaining Problem/addicted gamers vs engaged OR 95% CI p-
gamers value
% (n) p-value
Male gender
Overall frequency 6.5 (134)
Yes 2.066 1.170–3.647 0.012
Male gender
No 1
Yes 8.0 (82) 0.006
Age
No 5.0 (52)
15–18 1
Ever considered seeking treatment
Per increase in age range 1.001 0.760–1.319 0.992
Yes 9.3 (68) <0.001
Enough friends
No 4.9 (66)
Yes 1.010 0.544–1.876 0.975
Enough friends
No 1
Yes 5.6 (94) 0.002
Ever considered seeking treatment
No 9.9 (40)
Yes 0.751 0.413–1.365 0.347
Age
No 1
15–18* 17.5 (18) <0.001
Hours chatting on internet/social media
19–24* 11.9 (35) <0.001
>4 2.262 1.058–4.833 0.035
25–29* 7.9 (17) 0.025
<1–4 1
30-** 4.4 (64) <0.001
Hours chatting on internet/social media
<1–4 5.1 (100) <0.001
>4 28.6 (34)
addictions in relation to sexual minority status (Broman & Hakansson,
*
2018; Karlsson, Broman, & Håkansson, 2019). The dataset was distrib­
Compared with frequencies within the age group 30 years of age or older. uted online and presented as a self-test for problem gaming and
**
Compared with frequencies within all of the younger age categories.
gambling, targeting individuals above 15 years of age. Two Swedish
universities assisted in distributing the survey online among students
Table 5 and staff and the survey was promoted through online advertising in
Problem/addicted gamers vs both highly engaged gamers and the RSP-group. social media as well as in Swedish news media.
The data collection was designed in collaborated with a marketing
Problem/addicted gamers vs highly OR 95% CI p-
engaged gamers and RSP-group value
survey company in order to set up the questionnaire online, to handle
the incoming data and to ensure anonymity blocking the IP addresses
Male gender
when collecting the data (Broman & Hakansson, 2018). During the first
Yes 2.737 1.826–4.104 <0.001
No 1 data collection the questionnaire was presented in Swedish yet with the
Age option to choose from a range of minority languages. In the second data
15–18 1 collection the questionnaire was presented in Swedish only. The first
Per increase in age range 0.653 0.544–0.782 <0.001
material was merged with the second database. This was possible as
Enough friends
Yes 0.652 0.429–0.991 0.045
both of them used the measurement needed for the aimed prevalence
No 1 estimate and addressed the same potential correlates.
Ever considered seeking treatment The measures were based on self-reporting including demographics
Yes 1.939 1.310–2.871 0.001 such as gender and age. Structured and well-established measuring tools
No 1
were used for the problem behaviours of interest (problematic gambling,
Hours chatting on internet/social media
>4 5.299 3.237–8.673 <0.001 gaming and internet use) and the answering of these were mandatory
<4 1 while other questions were optional. The survey addressed social
isolation – whether the individual felt that they had a sufficient number

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of friends to spend time with or whether they experienced feelings of seek treatment for to psychological health complaints and could answer
loneliness and a desire to have more friends. The respondents were either Yes, No or Do not want to answer. As low psychological well-being
asked whether they had felt the need to seek treatment because of has been associated with pathological gaming (Khazaal et al., 2016;
psychological health problems (Yes, No or Do not want to answer) and Lemmens et al., 2011; Przybylski, Weinstein, & Murayama, 2017), a
how many hours per day they spent on communication through social binary variable was created in which Yes was coded as 1 and the No as
media, online chatting, Skype, WhatsApp or similar services (<1, 1–2, well as Do not want to answer as 0.
2–3, 4–3 or more than 4).
2.2.5. Enough friends
2.2. Measures Previous research has found an association between low social
competence and loneliness with pathological gaming (Khazaal et al.,
2.2.1. Game addiction scale 2016; Lemmens et al., 2011). In order to address social isolation, the
For the assessment of gaming behaviour, the seven-item version of respondents were asked whether they felt that they had a sufficient
the Gaming Addiction Scale (GAS) was used (Lemmens et al., 2009). The number of friends to spend time with, too many, or whether they
scale was constructed by Lemmens et al. in order to reflect components experienced feelings of loneliness and a desire to have more friends.
of addiction as well as the consequences thereof, namely: salience, Those reporting feelings of loneliness were coded as 1 and the remaining
tolerance, mood modification, relapse, withdrawal, conflict and prob­ respondents were coded as 0.
lems (Griffiths, 2005; Lemmens et al., 2009). Each question covers one
criterion, answered on a five-point continuum scale: 1 (never), 2 2.2.6. Hours chatting on internet/social media
(rarely), 3 (sometimes), 4 (often), 5 (very often) and should according to It has been hypothesized that excessive use of social media could be
the developer be accounted as endorsed when rated 3 or higher (Lem­ positively associated with pathological gaming (Andreassen et al., 2013;
mens et al., 2009). Pontes, 2017), such that the measure of time spent on social media was
Aiming to distinguish level of severity within the group of gamers, included in this investigation. There is no consensus regarding how
the core approach was applied whereby the individuals meeting all of many hours spent on social media that is pathological but several re­
the core criteria (relapse, withdrawal, conflicts and problems) consti­ searchers suggest a cut-off around three-four hours(Jagtiani, Kelly,
tuted the group addicted gamers. The respondents that endorsed 2–3 of Fancourt, Shelton, & Scholes, 2019; Kaur, Rutherford, Martins, & Keyes,
the core criteria but none of the peripheral criteria (salience, tolerance, 2018; Strong, Lee, Chao, Lin, & Tsai, 2018). The respondents were asked
mood-modification) were grouped as problem gamers and those that about how many hours per day they usually spent on communication
endorsed all 3 of the peripheral criteria but not more than 1 of the core- with others through social media - including chat functions within on­
criteria were grouped as engaged gamers (Brunborg et al., 2013, 2015; line games, WhatsApp, Skype or corresponding services, and were able
Wittek et al., 2015). Those who remained comprised the fourth and to answer Less than one hour, 1–2 h, 2–3 h, 3–4 h or More than 4 h. A
contrasting group, hereafter named remaining study participants (RSP). binary variable was created in which More than 4 h was coded as 1
The RSP-group included individuals without gaming behaviour and in­ whereas reporting of anything less was coded as 0.
dividuals with gaming behaviour below the cut off for highly engaged
gaming. The chosen methodology assumes that several core criteria
being met implies a problematic use of video game which does not rule 2.3. Statistics
out a simultaneous endorsement of peripheral criteria. However, the
group of engaged gamers is here considered as less problematic as they Estimates of frequencies and percentages as well as statistical anal­
did not endorse more than one of the core criteria. ysis were performed in SPSS (IBM SPSS statistics version 24). The Chi-
Since both the problem gamers and the addicted gamers were square test was used for statistical association between frequencies of
assumed to be associated with more severe gaming behaviour as well as engaged gamers, problem gamers and addicted gamers within sub­
more negative outcomes (Brunborg et al., 2013, 2015; Charlton & groups such as gender, age categories, individuals experiencing feelings
Danforth, 2007), these two groups also constituted one combined group of loneliness, individuals experiencing the need to seek treatment for
(2–4 endorsed core criteria) enabling analyses against the rest of the psychological distress and groupings based on hours chatting on
respondents (=<3 endorsed core criteria). internet/social media, in comparison to the RSP-group. The groups
based on gender, age categories, the experience of loneliness, psycho­
2.2.2. Gender logical distress and hours spent chatting were further analysed in a lo­
The respondents could report male, female or transgender as their gistic regression using problem/addictive gaming as the outcome and
gender identity. As male gender was supposed to be associated with compared separately with both engaged gamers and the RSP-group.
pathological gaming (Gonzalez-Bueso et al., 2018; Mentzoni et al.,
2011), a binary variable was created in which male gender was coded as 3. Results
1 and female and transgender (non-male gender) were coded as 0.
3.1. Sample characteristics
2.2.3. Age
Respondents age was a matter of interest since young age was After merging the two files the sample consisted of 3692 individuals.
thought to be associated with pathological gaming (Mentzoni et al., Only those registered as complete respondents (2777) were included.
2011; Wittek et al., 2015). Out of the originally seven age categories Among the complete respondents there were still a number of in­
(15–18, 19–24, 25–29, 30–39, 40–49, 50–59 and 60 years of age or dividuals who had abstained from answering some of the questions of
older), four binary variables were created (15–18, 19–24, 25–29, 30–) interest or answered them with Do not want to answer– those were also
out of which the respondents reporting 15–18 years of age were coded as excluded. The exclusion resulted in 2075 remaining individuals, of
1 and those reporting 30 years or older (30–39, 40–49, 50–59 and 60 which 49.6 percent were male, 50.1 percent female and 0.3 percent
years of age or older) were coded as 0, etcetera. The fourth variable transgender. A majority were aged 30 years or older and the smallest
composed of those reporting 30 years of age or older, coded as 1 and all number (103 individuals, 5 percent) were seen in the age category
of those reporting a younger age coded as 0. 15–18. The excluded individuals were seemingly evenly distributed in
terms of gender and showed a similar age distribution as the included
2.2.4. Ever considered seeking care population though the excluded group contained a greater proportion of
The respondents were asked whether they ever had felt the need to the youngest individuals and a smaller proportion the oldest individuals.

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3.2. Prevalence measure of game addiction (Brunborg et al., 2013, 2015; Lemmens et al.,
2009). Previous research in this field is scarce and rather inconsequen­
The respondents who endorsed all four of the core criteria and tial in terms of measurement approach and attitudes towards the
consequently met the addiction cut-off comprised 1.2 percent. The tentative diagnosis (Ferguson et al., 2011). The DSM-5 requests more
problem gamers were 5.3 percent, the engaged gamers 4.5 percent and research before inclusion of the disorder and as the gaming industry
the respondents who met the cut off for at least problem gaming and at grows and currently engages a wide range of the population, research
most addictive gaming, composed 6.5 percent. needs to keep up with development (American Psychiatric Association,
2013; Entertainment Software Association, 2007, 2018). An increasing
3.3. Highly engaged gamers quantity of scholars emphasize a distinction between engagement and
addiction regarding gaming research and a ranking of the criteria has
Being an engaged gamer, was significantly associated with reporting been suggested (Lehenbauer-Baum & Fohringer, 2015; Lehenbauer-
a need to seek treatment for psychological health complaints in com­ Baum et al., 2015; Snodgrass et al., 2019). Previous research describes
parison to the RSP-group who denied such consideration. Engaged how the criteria tolerance, mood modification and cognitive salience
gaming was also associated to the reporting of feelings of loneliness. The correlates stronger to engagement and the criteria, here termed “core
engaged gamers were significantly overrepresented in the age ranges criteria”; withdrawal, relapse, conflict and problems correlates stronger
15–18, 19–24 and 25–29, in comparison to the respondents of age 30 to addiction (Brunborg et al., 2013, 2015; Charlton & Danforth, 2007).
years or older. The engaged gamers were also shown to be significantly This study presents a prevalence measure in the Swedish population of
overrepresented in the subgroup that spent more than four hours per day highly engaged gamers, problem gamers and addicted gamers using the
on communication with others through social media/internet. core approach. The study also shows how these groups of gamers differ.
Male gender, young age, social satisfaction, treatment need and hours
3.4. Problem gamers chatting on internet/social media was shown to increase the probability
of problematic or addictive gaming, whereas no difference was seen
When comparing frequencies of problem gamers with the RSP-group regarding young age, social satisfaction or treatment need when
within subgroups, the former was revealed to be significantly over­ compared directly with the highly engaged gamers.
represented amongst respondents of male gender, amongst individuals The present study showed that the prevalence of addicted gamers
who had considered seeking treatment, amongst individuals assenting was 1.2 percent. The most precise prevalence worldwide, reported as
feelings of loneliness, and in all of the younger age ranges, in comparison 3.05 percent by Stevens et al., was indeed higher though not entirely
to the respondents 30 years of age or older. The problem gamers were comparable - their meta-analysis only included studies with youths and
also shown to be overrepresented amongst the respondents who spent young adults. Their numbers are, however comparable with the preva­
more than four hours chatting on internet/social media. lence presented within the younger age categories in the present study
(Ferguson et al., 2011). A Norwegian population-based investigation
3.5. Addicted gamers actually reported an identical prevalence rate of addicted gamers; 1.2
percent, whereas their prevalence of problem gamers was slightly higher
The addicted gamers were shown to be significantly overrepresented (Brunborg, Hanss, Mentzoni, & Pallesen, 2015).
amongst the respondents assenting that they spent more than four hours Male gender showed a disproportionate prevalence of problem
per day on communication with others through social media/internet, gamers, in concordance with previous research (Gonzalez-Bueso et al.,
when compared with the RSP-group. 2018; Mentzoni et al., 2011). The addicted gamers showed the same
gender tendency though not significantly, while the opposite applied for
3.6. Problem/addicted gamers versus highly engaged gamers and the RSP- the highly engaged gamers but again not significantly. The group called
group RSP showed no gender difference which could suggest that men and
women in the Swedish population overall engage in excessive gaming to
The respondents endorsing 3–4 of the core criteria and hence an analogous extent, but that gaming implies a greater pathological
meeting the cut off for problem gaming or addiction, were shown to be potential for men. In 2015 Brunborg et al. presented a comparable
significantly overrepresented amongst all of the subgroups of interest Norwegian study, also using the core approach (Brunborg et al., 2015).
when compared with the other respondents (highly engaged gamers and They consistently stated that engaged, problem and addicted gamers
the RSP-group). Thus, they were more common amongst the male re­ were more likely to be male (Wittek et al., 2015). Simultaneously, ESÁs
spondents, those who considered seeking treatment for psychological bulletin of the computer and video game industry from 2007 reports on
health complaints, those who experienced feelings of loneliness, and 38 percent female gamers while the equivalent from 2020 reports on 41
amongst the younger age ranges, as well as amongst the individuals percent female gamers (Entertainment Software Association, 2007,
spending more than four hours chatting on internet/social media. The 2018). Perhaps, as the demographics in gaming patterns change, so will
regression analysis presented corresponding associations in which the gender differences regarding problematic gaming. Additional
spending more than four hours on chatting showed the most powerful research is needed to widen the understanding of gender-specific
correlation of problem-/ addictive gaming, elevating the probability 5.3 gaming behaviour.
times. The highly engaged gamers, as well as the problem gamers, were
overrepresented amongst those assenting that they had considered
3.7. Problem/addicted gamers versus engaged gamers seeking treatment for psychological health complaints. Pathological
gaming has been associated to various psychosocial problems (Gonza­
When comparing the probability of problem/addicted gaming with lez-Bueso et al., 2018; Lam, 2014; Lemmens, Valkenburg, & Peter, 2011)
engaged gaming in a regression analysis, male gender and spending and one could assume that the tendency noted within the groups of
more than four hours chatting on internet/social media increased the addicted gamers would have achieved a significant value if the popu­
probability of more adverse gaming significantly. lation had been greater in number. On the other hand, the denial of such
consideration should perhaps not automatically be interpreted as a
4. Discussion guarantee of good psychological health. Even though it is possible to
experience poor psychological well-being without considering seeking
The present study contributes to the knowledge about pathological help, it is relevant that confirming treatment had been considered
gaming through an empirical as well as theoretically based prevalence implied an increased probability of problematic or addictive gaming 1.9

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times. 19–24 years of age as well as a greater number of problem gamers.

The feeling of having enough friends was shown to be negatively However, both of the included data set used the measurement needed
associated with problem gaming in accordance with previous research for the aimed prevalence estimate and were included considering our
(Ferguson et al., 2011; Gonzalez-Bueso et al., 2018). Having enough exploratory intention in a still rather unsatisfactory field of research. In
friends decreased the probability of problematic or addictive gaming terms of demographics such as gender and age, the final material was,
0.65 times. Interestingly, the highly engaged gamers were also more however, representatively distributed and in order to avoid giving some
likely to experience feelings of loneliness and a desire to have more groups a disproportionate impact no weighting was used. An additional
friends. ESÁs bulletin of 2018 states that 55 percent of the most frequent limitation is the relatively excessive loss in terms of excluded individuals
gamers report that video games help connect them with their friends and which could entail a selection bias. The excluded individuals were
that 46 percent communicate that gaming helps their family to spend evenly distributed in terms of gender but the excluded population con­
time together (Entertainment Software Association, 2018). Perhaps the tained a greater proportion of the youngest individuals and less of the
gaming could be interpreted as a way towards the goal of decreasing oldest individuals. As gaming is known to be more common among
one’s loneliness. young individuals(Mentzoni et al., 2011; Wittek et al., 2015) this could
As age increased, the frequency of both engaged and problem gamers result in an underrate of the overall prevalence estimates. The present
was shown to decrease; this is not surprising as young age is usually study used the seven-item version of GAS, in order to shorten the survey
reported as associated to game addiction (Mentzoni et al., 2011; Wittek in this online survey context as much as possible. Some gaming research
et al., 2015). The probability of problematic or addictive gaming was applies instruments based on all of the nine proposed criteria from DSM-
consistently shown to decrease 0.65 times as the category increased by 517.32, which could be clinically favourably as they could be considered
age. more direct applicable for APA’s internet gaming disorder criteria.
The one factor showing the most powerful correlation with prob­ Hence the choice to use the seven-item version of GAS could also be
lematic or addictive gaming was, interestingly, spending more than four considered a limitation. However, GAS is an established, brief and well-
hours daily chatting on internet/social media, increasing the probability studied instrument with psychometric properties that has been
5.3 times. This subgroup also showed a disproportionate prevalence of demonstrated as equal to instruments based on all of the nine DSM-5
both engaged, problem, and addicted gamers. The original survey asked criteria(Brunborg et al., 2013, 2015; Khazaal et al., 2016; King et al.,
about hours chatting on internet/social media specified such as chat 2020; Lemmens et al., 2009; Lin et al., 2019; Mentzoni et al., 2011;
functions including online gaming, which could imply a self-fulfilling Wittek et al., 2015). Further, the cross-sectional design of this study
association. The relationship between social networking site addiction obviously does not permit conclusions to be drawn regarding causation
and internet gaming disorder has, however, been described in previous since such would require longitudinal investigation.
research, hypothetically due to an underlying commonality such as to
connecting with friends, or as a consequence of traits predisposing for 5. Conclusion
behavioural addiction (Andreassen et al., 2013; Pontes, 2017).
Previous research emphasizes a qualitative difference between Given the occurrence of game addiction as a tentative clinical diag­
engagement and addiction whereby addiction but not engagement is nosis, there are still unanswered questions to be addressed. There is still
related to negative outcome(Snodgrass et al., 2019). Brunborg et al. no established diagnostic cut off and the field of research consequently
described how the magnitude of problems gradually increased from lacks consistency. Furthermore, additional longitudinal investigations
engagement to problematic to addictive gaming(Brunborg et al., 2013). are required in order to fully understand the causality of comorbidity.
They reported that both problem gamers and addicted gamers (to However, this study contributes with a prevalence measure of game
different degrees), but not the engaged gamers, showed greater risk of addiction, problem gaming and engaged gaming using an approach
irritability, nervousness, tiredness, exhaustion and feeling low, afraid or aiming to distinguish the interfering features of gaming in order to avoid
in bad mood. In direct comparison however, they found no difference in pathologizing a recreational activity. This study presents results that
terms of sleep problems, fear or symptoms of depression between indicate that highly engaged gamers, problem gamers and addicted
addicted, problem and engaged gamers. In the present study a com­ gamers experience loneliness and psychological distress to a greater
parison between the probability of problematic or addictive gaming extent than the remaining study participants.
with highly engaged gaming within the variables of interest, only male
gender and hours spent chatting was shown to increase the probability Ethical approval
of a greater intensity of gaming. Interestingly, there was no detectable
difference in terms of considering seeking treatment or experiencing All procedures performed in studies involving human participants
feelings of loneliness. Previous research reports addictive gamers as were in accordance with the ethical standards of the institutional and/or
more likely to be lonely and less socially competent (Khazaal et al., national research committee and with the 1964 Helsinki declaration and
2016; Lemmens et al., 2011). The fact that the group that experienced its later amendments or comparable ethical standards.
feeling of loneliness in the present study showed a disproportionate Consent for publication
prevalence of both engaged gamers and problem gamers suggests that Consent for publication has been given by all participants in the
also the engaged gamers also experience social difficulties. Regarding study.
the need to seek treatment for poor psychological wellbeing, one could
only speculate whether the group displaying more intense gaming Funding
behaviour would be less inclined to seek help, despite poorer psycho­
logical wellbeing, or whether the measures used failed to capture an The study was enabled through funding from Region Skåne; Craaford
actual discrepancy. Foundation grant; Fanny Ekdahls stiftelse and Svenska spels
The material used for this study was collected during two different forskningsråd
studies; the previous was intended to serve as a database for a pilot
investigation and was collected via a survey spread as wide as possible, CRediT authorship contribution statement
while the other selected respondents deliberately, aiming to distribute
gender and age evenly. The latter material was based on respondents Frida André: Investigation, Visualization, Software, Methodology,
recruited via a web panel, which could imply a selection bias, so it is Conceptualization, Writing - original draft, Data curation, Formal
possible that some groups participated less frequently. The groups did analysis, Writing - review & editing. Niroshani Broman: Investigation,
differ in some regards; the first data set had a greater proportion aged Writing - review & editing, Resources. Anders Håkansson: Validation,

6
F. André et al. Addictive Behaviors Reports 12 (2020) 100324

Methodology, Conceptualization, Writing - review & editing, Project sites and well-being among U.K. Young Adults. Cyberpsychol Behav Soc Netw. 22
(12):753–760.
administration. Emma Claesdotter-Knutsson: Validation, Visualiza­
Karlsson, J., Broman, N., & Håkansson, A. (2019). Associations between problematic
tion, Software, Writing - original draft, Supervision, Writing - review & gambling, gaming and internet use: A cross-sectional population survey. Journal of
editing, Project administration. Addiction. in press.
Kaur, N., Rutherford, C. G., Martins, S. S., & Keyes, K. M. (2020). Associations between
digital technology and substance use among U.S. adolescents: Results from the 2018
Declaration of Competing Interest monitoring the Future survey. Drug and alcohol dependence. 213:108124.
Khazaal, Y., Chatton, A., Rothen, S., et al. (2016). Psychometric properties of the 7-item
The authors declare that they have no known competing financial game addiction scale among french and German speaking adults. BMC Psychiatry., 16
(1).
interests or personal relationships that could have appeared to influence King, D. L., Chamberlain, S. R., Carragher, N., et al. (2020). Screening and assessment
the work reported in this paper. tools for gaming disorder: A comprehensive systematic review. Clin Psychol Rev, 77,
Article 101831.
Kiraly, O., Griffiths, M. D., King, D. L., et al. (2018). Policy responses to problematic
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