Journal of Medical Internet Research

Introduction

Background

Video gaming is likely one of the most prevalent leisure actions amongst adolescents worldwide. For many, gaming supplies leisure, alternatives for social interplay, and cognitive advantages []. Yet, for a notable proportion of adolescents, gaming turns into addictive, characterised by preoccupation, impaired management, and persistence regardless of unfavourable penalties. A meta-analysis estimated the prevalence of gaming dysfunction, a extreme and scientific type of gaming habit (GA), amongst adolescents to be 8.8%, based mostly on over 400,000 contributors from 155 research throughout 33 nations []. This fee is significantly larger than that noticed in different age teams []. Therefore, it’s crucial to research the associations between GA and adolescents’ well being to tell interventions and insurance policies that foster more healthy gaming practices.

A considerable physique of analysis has documented that GA is related to a variety of unfavourable well being outcomes in adolescents [,]. Although these research have considerably superior our understanding of GA-related harms, a notable limitation is that the majority have adopted a comparatively slim conceptualization of well being, focusing disproportionately on pathological situations. According to the World Health Organization, well being is outlined as “a state of complete physical, mental, and social wellbeing” [], which highlights the necessity to examine the connection between GA and well being from a broader perspective. One assemble that captures this view is flourishing, which displays a state by which “all aspects of a person’s life are good” []. VanderWeele [] proposed that flourishing ought to, at a minimal, embody 5 domains of human life: (1) happiness and life satisfaction, (2) psychological and bodily well being, (3) that means and objective, (4) character and advantage, and (5) shut social relationships []. Collectively, these domains replicate distinct sides of a well-lived life. Happiness and life satisfaction replicate how good life feels total. Mental and bodily well being seize how effectively people are functioning psychologically and biologically. Meaning and objective communicate as to if life feels worthwhile and directed. Character and advantage replicate the capability for ethical self-regulation and for appearing effectively when going through challenges. Close social relationships replicate the standard of 1’s relational world. Although these domains are sometimes correlated, they’re conceptually distinct. Flourishing entails doing effectively throughout all 5 domains, and impairment in any single area signifies a substantive shortfall in total well-being. Therefore, inspecting the affiliation between GA and flourishing is essential, because it supplies a extra holistic understanding of how GA could constrain adolescents’ capacity to realize well-rounded lives and will inform prevention and coverage efforts to advertise adolescents’ well being.

Review of Relevant Scholarship

Previous analysis means that GA is related to a number of flourishing-related domains. In the area of happiness and life satisfaction, a big cross-national examine of over 14,000 adolescents discovered that GA was linked to decrease life satisfaction []. A longitudinal examine additional confirmed that GA predicted subsequent declines in adolescents’ life satisfaction over 6 months, whereas the reverse impact was not noticed []. These findings recommend that GA could operate as an antecedent of decreased life satisfaction. Although no research to this point have straight examined the affiliation between GA and happiness amongst adolescents, GA has been constantly proven to correlate with a number of components strongly linked to happiness [-], together with poorer educational achievement [], decrease vanity [], decreased health-related high quality of life [], extra frequent unfavourable life occasions [], and worse household monetary situations []. In abstract, present proof means that GA is related to decrease life satisfaction and may be linked to decrease ranges of happiness amongst adolescents.

The relationship between GA and psychological well being outcomes has been probably the most extensively investigated. Studies utilizing composite indicators of psychological well being have proven that GA was related to extra frequent psychological complaints [], elevated psychopathological signs [-], and a better chance of receiving at the least one psychological well being analysis []. Research specializing in particular psychological well being situations additional revealed that GA was related to elevated melancholy [,], anxiousness [-], common and educational stress [,,], loneliness [], emotional misery [,,,], suicidal ideation [,], suicide danger [], emotional and behavioral issues [], sleep difficulties [,], and govt dysfunction []. Just a few research have examined the affiliation between GA and bodily well being. Evidence means that GA is linked to unhealthy weight standing, together with each underweight and obese [,], extra somatic complaints [], musculoskeletal ache [], and dry eye signs []. Overall, these findings recommend that GA is related to a broad vary of psychological and bodily well being issues, with the literature to this point focusing predominantly on psychological well being outcomes.

Evidence supporting associations between GA and the remaining flourishing domains is restricted within the present literature. Existing findings recommend that adolescents with GA reported each a decrease presence of that means in life and a stronger seek for that means in life []. Although no adolescent research have straight examined GA in relation to sense of objective, analysis with younger adults signifies a unfavourable affiliation between GA and objective in life [,]. Regarding character and advantage, research have proven that GA is linked to decrease empathy [], decrease ethical ranges [], decreased educational perseverance [], and fewer prosocial behaviors []. In the relational area, GA has been related to decrease interpersonal belief [], conflictual parent-child relationships [,], peer alienation [], much less social assist [], and larger reliance on online-only friendships []. Overall, the out there proof means that GA could have broad antagonistic associations throughout these flourishing domains in adolescents.

Beyond analysis carried out on particular person domains of flourishing, no examine to this point has investigated GA in relation to flourishing as an built-in assemble. Existing work on different problematic behaviors has discovered that decrease flourishing was associated to larger hashish use [], larger media habit [], larger smartphone habit [], and better Facebook habit [,]. These findings suggest that GA, as a type of problematic habits, could likewise be related to decreased flourishing. It is essential to notice that the flourishing framework utilized in these research is derived from Diener and colleagues [], which captures all however the well being dimension of flourishing proposed by VanderWeele []. As a consequence, it stays unclear whether or not VanderWeele’s broader conceptualization of flourishing is related to any type of problematic habits, together with GA. A latest examine that employed VanderWeele’s flourishing framework examined the connection between digital recreation use and flourishing amongst older adults. No variations had been present in total flourishing or in any of the 5 subdomains between present players, former players, and nongamers []. As this examine didn’t concentrate on GA and was carried out in an older grownup inhabitants, its findings present minimal steerage relating to how GA pertains to flourishing amongst adolescent players.

Although prior research have documented associations between GA and particular person components of flourishing, a crucial hole stays relating to how GA pertains to total flourishing and its subdomains amongst adolescents. As flourishing is a multidimensional assemble encompassing numerous points of well-being, investigating these associations is crucial for establishing a extra complete understanding of how GA could relate to adolescents’ well-being throughout a number of life domains. An additional limitation of the prevailing literature is that the majority research have conceptualized gaming as a single, homogeneous exercise. It stays unclear whether or not GA is uniformly related to flourishing throughout completely different recreation genres. Emerging proof means that the psychological correlates of gaming could differ considerably by style. For instance, Park and colleagues [] reported that adolescents who primarily performed massively multiplayer on-line role-playing video games exhibited the best ranges of social anxiousness, those that most well-liked first-person shooter video games confirmed the bottom anxiousness ranges, and strategy-game gamers reported the best vanity []. Other research have demonstrated that sure genres had been related to elevated aggression, decreased empathy, and prosocial behaviors [-]. As these components are essential parts of flourishing, such findings recommend that the affiliation between GA and flourishing could differ relying on the sport genres adolescents play. Understanding these genre-specific associations may present a extra nuanced image of how GA pertains to adolescent well being, thereby informing the event of focused intervention methods tailor-made to particular recreation genres.

Hypothesis and Aim

To deal with these gaps, this examine aimed to research genre-specific associations between GA and flourishing amongst adolescents, utilizing VanderWeele’s multidimensional flourishing framework. Drawing on prior proof, we specified a single major speculation: GA could be negatively related to total flourishing and its subdomains for sure recreation genres, however not uniformly throughout all genres. Our secondary speculation was that total GA throughout recreation genres could be negatively related to total flourishing and its subdomains.

Methods

Inclusion and Exclusion

This examine was reported in accordance with the Journal Article Reporting Standards for Quantitative Research (JARS-Quant) guidelines []. A complete of 2194 center faculty college students from a non-public tutoring middle positioned in a northwestern metropolis in China participated on this examine. Inclusion standards had been as follows: (1) enrollment in collaborating courses on the tutoring middle; (2) provision of each pupil and parental consent; and (3) presence throughout questionnaire administration. No exclusion standards had been utilized.

Participant Characteristics

As proven in , contributors had a imply age of 14.53 (SD 0.76) years. Of the 2194 college students, there have been 985 (44.90%) boys and 1174 (53.51%) women. Regarding grade degree, 52 (2.37%) had been within the seventh grade, 969 (44.17%) had been within the eighth grade, and 1092 (49.77%) had been within the ninth grade. On common, contributors reported a household financial standing of two.23 (SD 0.70) and 18.81 (SD 16.40) hours of social media use per week. In phrases of gaming habits, 610 (27.80%) contributors reported not taking part in any video games, 327 (14.90%) reported taking part in 1 recreation, 525 (23.93%) reported taking part in 2 video games, and 732 (33.36%) reported taking part in 3 video games. The most ceaselessly performed recreation style was multiplayer on-line battle area (MOBA; n=808, 36.83%), adopted by taking pictures (n=589, 26.85%), motion and journey (AA; n=342, 15.59%), informal (n=302, 13.76%), sports activities (n=156, 7.11%), sandbox and simulation (SS; n=99, 4.51%), role-playing (n=89, 4.06%), and technique (n=54, 2.46%) video games.

Sampling Procedures

Participants had been recruited utilizing comfort sampling. A complete of 2269 center faculty college students had been approached, of whom 2194 (96.69%) agreed to take part and accomplished the survey. Self-selection occurred at each the trainer and pupil ranges. At the trainer degree, instructors on the tutoring middle had been invited to help with knowledge assortment, and 10 lecturers agreed to take part. At the scholar degree, solely college students who expressed curiosity and offered each pupil assent and parental consent had been included. Each collaborating trainer administered the survey as soon as to every of their courses, all of which had been held on the tutoring middle. Each participant obtained ¥10 (US $1.44) in money as compensation for finishing the survey. Study procedures had been carried out in compliance with the Declaration of Helsinki and permitted by the ethics committee of the primary writer’s establishment (approval quantity H20250747I). Data had been collected between September 10 and October 10, 2025.

Sample Size, Power, and Precision

We carried out a priori energy evaluation utilizing G*Power for a linear a number of regression mannequin (fastened mannequin, R² enhance) to find out the required pattern measurement []. We assumed a small impact measurement for every genre-specific habit predictor (partial R²=0.01), an α degree of .05, and a desired statistical energy of 0.80. The mannequin specified 1 examined predictor and a complete of 12 predictors (8 genre-specific habit variables and 4 covariates). Under these assumptions, the minimal required pattern measurement was 779 contributors. Given the achieved pattern measurement of 2194 college students, the examine was sufficiently powered to detect genre-specific habit predictors accounting for as little as 1% of distinctive variance within the end result.

Measures and Covariates

Measures and covariates are offered in .

Data Collection

We contacted a pal of the primary writer (YL), a physics trainer on the personal tutoring middle, to tell him concerning the examine’s targets and knowledge assortment procedures. After agreeing to help, he launched us to different lecturers on the middle. Ten further lecturers consented to take part in knowledge assortment.

We compiled measurement devices right into a questionnaire, which additionally included demographic objects (age, intercourse, and grade). Each questionnaire was labeled with a singular identifier quantity on the backside of each web page to differentiate particular person responses. Digital variations of the questionnaire and consent kind had been despatched to the lecturers through WeChat (Tencent Holdings Limited). Teachers had been instructed to print these supplies to be used at school.

Each trainer administered the survey as soon as to every of their courses, all of which had been held on the tutoring middle. At the start of every class, lecturers defined the examine’s objective and distributed parental consent kinds to college students who expressed curiosity in collaborating. Students who missed 2 courses had been excluded from knowledge assortment. During the third class session, lecturers distributed the questionnaires. Students had been informed that the survey was nameless and that neither their dad and mom nor their lecturers would have entry to their responses. They had been instructed to reply truthfully, write legibly, and search clarification if any survey objects had been unclear. Completing the survey took roughly 10 minutes. The pal of the primary writer collected all of the questionnaires from the lecturers and shipped them to the primary writer. Each trainer obtained ¥800 (US $115.01) in money as compensation. The survey questionnaire is offered in .

Quality of Measurements

To improve the standard of measurements, we carried out an internet group assembly with all collaborating lecturers earlier than knowledge assortment to offer standardized coaching and clarify the information assortment protocol intimately. In addition, we skilled analysis assistants in standardized procedures for digitizing paper questionnaires to make sure correct knowledge entry.

Instrumentation

Video Game Name

The online game title was obtained utilizing the next query: “Please provide the names of all the games you have played during the past month (up to 3). If you have played more than 3, please list the 3 you played most frequently.”

Game-Specific Addiction

For every recreation, contributors rated their degree of habit by responding to the next query: “Please indicate your level of addiction for each of the games listed above.” Responses got on a 5-point Likert scale (0=none, 1=gentle, 2=reasonable, 3=reasonably extreme, and 4=extreme), with larger scores indicating stronger habit to a selected recreation. We used a single merchandise to measure GA for 3 causes. First, extensively used devices such because the Gaming Addiction Scale for Adolescents [] and the Internet Gaming Disorder Scale [] assess total GA and are subsequently unsuitable for measuring game-specific habit. Second, even when these scales had been tailored for game-specific evaluation, contributors who performed 2 or 3 video games would want to finish the identical scale a number of occasions, rising response burden and the chance of response bias. Third, multi-item scales would considerably enhance completion time, which was impractical on condition that the survey was administered throughout class. Similar single-item measures of GA have been utilized in prior analysis, though primarily in grownup samples [,]. In adolescent populations, single self-diagnostic objects assessing different behavioral addictions have proven sturdy correlations with standardized multi-item devices [,], suggesting that adolescents can comprehend and self-evaluate the severity of behavioral addictions utilizing a single query. The course of of reworking game-specific habit into genre-specific habit is described within the “Data Processing” part.

Flourishing

Flourishing was assessed utilizing the Chinese model of the Human Flourishing Index (HFI) []. The scale consists of 10 objects protecting 5 domains (2 objects per area): (1) happiness and life satisfaction; (2) psychological and bodily well being; (3) that means and objective; (4) character and advantage; and (5) shut social relationships. Items had been rated on an 11-point Likert scale starting from 0 to 10, with response labels various throughout objects. Domain scores had been computed by summing the scores of the respective objects. Overall flourishing was calculated because the sum of all merchandise scores, with larger values reflecting larger flourishing. If any merchandise required to compute a composite rating was lacking, the corresponding composite rating was coded as lacking.

Covariates

Previous analysis has discovered associations between GA, intercourse [], social media use [], and socioeconomic standing []. To account for his or her confounding results [], we measured contributors’ weekly social media time and perceived household financial standing utilizing 2 questions. Participants had been requested, “In general, how many hours per day do you spend browsing social media platforms (eg, Douyin, Weibo, WeChat Moments, Xiaohongshu, and Bilibili) on weekdays and weekends? Please report to the nearest 0 or 30 minutes (eg, 2 hours 0 minutes, 4 hours 30 minutes).” Total weekly social media time (in hours) was calculated utilizing the components: 5 × (weekday hours + weekday minutes/60) + 2 × (weekend hours + weekend minutes/60). The household financial standing query was, “How would you describe your family’s economic status?” Responses had been on a 5-point Likert scale (0=extraordinarily poor to 4=wonderful), with larger scores reflecting higher household financial standing.

Masking, Psychometrics, Conditions and Design, and Data Processing

As this examine employed a cross-sectional observational design with out experimental manipulation, masking of contributors, knowledge collectors, or end result assessors was not relevant.

The HFI demonstrated good inside consistency in our pattern (Cronbach α=0.93 for total flourishing, and starting from 0.76 to 0.89 throughout domains). Game-specific habit and household financial standing had been assessed utilizing single-item measures, and intercourse and social media use had been measured utilizing non–Likert-type objects. Therefore, inside consistency coefficients weren’t relevant for these measures.

This examine used a cross-sectional observational design with no experimental manipulation.

Details of the information processing are offered in .

Data Diagnostics

We screened social media use for implausible values and recoded 44 values exceeding 98 hours per week (>14 hours/day) as lacking. Extreme outliers had been recognized utilizing the IQR technique. Fourteen values falling under Q1 – 3 × IQR or above Q3 + 3 × IQR had been recoded as lacking. All different variables had been examined for implausible values, and none had been recognized. Responses had been thought-about lacking when contributors left an merchandise unanswered. Missing knowledge had been dealt with utilizing a number of imputation by chained equations earlier than statistical evaluation. We examined the distributions of the result variables and located that total flourishing and its 5 subscales had been negatively skewed throughout all datasets.

Analytic Strategy

All statistical analyses had been carried out in R (R Foundation) []. To scale back the affect of nonnormal end result distributions on parameter estimation, we employed sturdy linear regression fashions []. To take a look at the first speculation, for every of the 6 flourishing outcomes, we fitted sturdy a number of regression fashions for every dataset, together with the 8 genre-specific habit variables as predictors, and intercourse, social media time, household financial standing, and habit to different video games as covariates. To take a look at the secondary speculation, we fitted separate sturdy regression fashions for every of the 6 flourishing outcomes with total GA as a predictor, and intercourse, social media time, and household financial standing as covariates. Parameter estimates had been pooled throughout datasets utilizing Rubin’s guidelines. We managed the kind I error fee throughout all fashions for genre-specific habit predictors (6 pooled estimates × 8 genres=48 P values) and the general GA predictors (6 pooled estimates) by adjusting the 54 P values utilizing the Benjamini-Hochberg false discovery fee process. The adjusted P values had been hereafter known as q values. Statistical significance for all q values was set at α=.05.

As sensitivity analyses, we refitted all fashions utilizing complete-case knowledge to evaluate the robustness of the findings to the dealing with of lacking knowledge. The false discovery fee process was additionally utilized in complete-case analyses. We additional evaluated the robustness of the noticed associations to unmeasured confounding by calculating E values for statistically vital pooled regression coefficients utilizing the “EValue” package deal in R []. E values quantify the minimal power of affiliation (on the chance ratio scale) that unmeasured confounder(s) would want to have with each the publicity and the result, past the measured covariates, to completely clarify the noticed impact []. We additionally calculated E values for the CI restrict closest to the null, which quantify the minimal power of affiliation that unmeasured confounder(s) would want to render the noticed impact nonsignificant. E values had been calculated individually for every imputed dataset, and the imply and SD throughout the 20 imputed datasets had been reported.

Ethical Considerations

This examine was permitted by the Ethics Committee of Shanghai Jiao Tong University (approval quantity H20250747I). After the examine procedures had been defined, college students who expressed curiosity got parental consent kinds to take house. Written knowledgeable consent was obtained from dad and mom via signed consent kinds earlier than participation. Only college students who returned signed parental consent kinds and agreed to take part accomplished the survey, and participation was voluntary. Data had been collected anonymously to guard contributors’ confidentiality, and solely the analysis group had entry to the dataset. Each participant obtained ¥10 (US $1.44) in money as compensation for finishing the survey. No identifiable photos of contributors are included within the manuscript or its multimedia appendices.

Results

Participant Flow and Recruitment

Of the 2269 center faculty college students eligible for participation, 68 had been excluded on account of absence from 2 consecutive knowledge assortment classes, and seven declined to take part. reveals the circulation of contributors throughout every stage of the examine. The closing pattern included 2194 contributors.

Participants had been recruited between September 10 and September 24, 2025.

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Statistics and Data Analysis

Inspection of lacking knowledge revealed that, among the many 2194 collaborating college students, knowledge had been lacking for age in 22 (1%) circumstances, intercourse in 35 (1.60%), grade in 81 (3.69%), household financial standing in 254 (11.58%), and social media time in 378 (17.23%). For the HFI, lacking knowledge had been noticed for happiness and life satisfaction in 34 (1.55%) contributors, psychological and bodily well being in 34 (1.55%), that means and objective in 170 (7.75%), character and advantage in 174 (7.93%), shut social relationships in 164 (7.47%), and total flourishing in 226 (10.30%). Across particular person HFI objects, lacking knowledge ranged from 24 (1.09%) to 164 (7.47%). For genre-specific habit variables, lacking knowledge ranged from 3 (0.14%) to 76 (3.46%). In addition, knowledge had been lacking for the addiction-to-other-games variable in 24 (1.09%) contributors, whereas no lacking knowledge had been noticed for the general habit variable.

The Little lacking utterly at random take a look at utilized to the dataset was statistically vital, χ²₁₂₉₈=1495.00 (P<.001), indicating that the lacking mechanism was not lacking utterly at random. As a number of variables exceeded 5% missingness and complete-case evaluation can scale back statistical energy and introduce bias [], we assumed that the missingness mechanism was lacking at random and utilized a number of imputation by chained equations to impute lacking knowledge []. The predictor matrix included intercourse, household financial standing, social media time, 10 flourishing objects, 8 genre-specific habit variables, and the addiction-to-other-games variable. The total habit variable was excluded on account of its excessive linear dependence on different habit variables. Sex was imputed utilizing logistic regression, and all different variables had been imputed utilizing predictive imply matching. We generated 20 imputed datasets, every with 20 iterations. Convergence was confirmed utilizing hint plots, and the distributions of the imputed values aligned effectively with these of the noticed knowledge. After imputation, we calculated composite scores for every dataset.

As proven in , on common, contributors reported a imply total GA rating of 1.49 (SD 1.23). Among genre-specific addictions, contributors reported the best ranges of habit to technique video games (imply 1.65, SD 1.11), adopted by AA (imply 1.62, SD 1.24), taking pictures (imply 1.58, SD 1.21), MOBA (imply 1.46, SD 1.10), SS (imply 1.38, SD 1.36), role-playing (imply 1.36, SD 1.02), informal (imply 1.11, SD 1.09), and sports activities (imply 0.96, SD 1.01) video games. Regarding the HFI, the imply area scores had been 13.54 (SD 4.82) for happiness and life satisfaction, 14.54 (SD 4.72) for psychological and bodily well being, 13.72 (SD 4.58) for that means and objective, 12.50 (SD 4.96) for character and advantage, and 14.24 (SD 4.99) for shut social relationships. The total flourishing rating averaged 68.60 (SD 20.99).

and current sturdy linear regression outcomes inspecting the associations between GA and flourishing outcomes utilizing multiply imputed knowledge. Regarding the first speculation, AA habit was the one predictor that was negatively related to all flourishing outcomes (total flourishing: b=–3.11, 95% CI –4.34 to –1.88, q<.001; happiness and life satisfaction: b=–0.46, 95% CI –0.75 to –0.17, q=.009; psychological and bodily well being: b=–0.61, 95% CI –0.88 to –0.34, q<.001; that means and objective: b=–0.55, 95% CI –0.82 to –0.27, q=.001; character and advantage: b=–0.74, 95% CI –1.06 to –0.43, q<.001; and shut social relationships: b=–0.62, 95% CI –0.92 to –0.32, q<.001). MOBA habit was negatively related to total flourishing (b=–1.33, 95% CI –2.34 to –0.32, q=.03), that means and objective (b=–0.34, 95% CI –0.56 to –0.11, q=.02), and character and advantage (b=–0.34, 95% CI –0.59 to –0.08, q=.03). SS habit was negatively related to total flourishing (b=–3.42, 95% CI –5.80 to –1.04, q=.02), psychological and bodily well being (b=–1.09, 95% CI –1.60 to –0.58, q<.001), and shut social relationships (b=–0.86, 95% CI –1.46 to –0.27, q=.02). Other genre-specific associations weren’t statistically vital (q≥.05 for all; mentioned later). Analyses testing the secondary speculation confirmed that total GA was negatively related to all flourishing outcomes (total flourishing: b=–1.99, 95% CI –2.74 to –1.24, q<.001; happiness and life satisfaction: b=–0.24, 95% CI –0.41 to –0.07, q=.02; psychological and bodily well being: b=–0.38, 95% CI –0.55 to –0.22, q<.001; that means and objective: b=–0.45, 95% CI –0.62 to –0.28, q<.001; character and advantage: b=–0.60, 95% CI –0.78 to –0.41, q<.001; and shut social relationships: b=–0.35, 95% CI –0.53 to –0.17, q=.001).

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Although total GA was negatively related to all flourishing domains, the genre-specific findings point out substantial heterogeneity within the addiction-flourishing relationship throughout recreation genres. The most outstanding genre-specific predictor was AA habit, which was related to decrease scores throughout all flourishing domains, suggesting that adolescents with AA habit could represent a very high-risk subgroup with broadly impaired well-being. Although each SS and MOBA habit had been related to decrease total flourishing, their domain-specific patterns differed. The SS-flourishing affiliation gave the impression to be pushed primarily by poorer psychological and bodily well being and weaker shut social relationships, whereas the MOBA-flourishing affiliation was pushed primarily by decrease that means and objective and character and advantage. The absence of serious associations for different genres (total flourishing: q=.57, .17, .36, .22, and .84; happiness and life satisfaction: q=.18, .36, .84, .36, and .84; psychological and bodily well being: q=.20, .12, .26, .36, and .22; that means and objective: q=.84, .13, .32, .18, and .78; character and advantage: q=.61, .51, .22, .43, and .84; and shut social relationships: q=.36, .18, .72, .61, and .51, for taking pictures, informal, sports activities, technique, and role-playing, respectively) means that habit to those genres could also be comparatively much less detrimental to flourishing than habit to AA, SS, and MOBA.

We carried out mannequin diagnostics to guage regression assumptions. Multicollinearity amongst predictors was assessed utilizing variance inflation components. The maximal variance inflation issue throughout the 20 imputed datasets and all end result variables (together with the general GA fashions) was 1.22, indicating no problematic collinearity amongst predictors []. Visual inspection of residuals-versus-fitted plots throughout all imputed datasets and fashions indicated no substantial departures from linearity or different patterns suggesting mannequin misspecification.

presents the outcomes of the sturdy linear regression analyses inspecting the associations between GA and flourishing outcomes utilizing complete-case knowledge. The sample of serious predictors was according to the analyses based mostly on a number of imputed knowledge for total flourishing, psychological and bodily well being, that means and objective, and character and advantage. Compared with the a number of imputation analyses, the impact of total GA on happiness and life satisfaction grew to become nonsignificant within the complete-case evaluation (b=–0.22, 95% CI –0.41 to –0.03, q=.07), whereas the impact of MOBA on shut social relationships grew to become statistically vital within the complete-case evaluation (b=–0.39, 95% CI –0.66 to –0.12, q=.02). Despite these discrepancies, the general sample of outcomes was usually constant throughout the two approaches, suggesting that the findings had been largely sturdy to the dealing with of lacking knowledge.

presents the E values for the numerous pooled results from the sturdy linear regression analyses based mostly on a number of imputed knowledge. Across all flourishing outcomes, the E values for the regression coefficients ranged from 1.31 to 1.55, indicating reasonable robustness to unmeasured confounding. This means that unmeasured confounder(s) would have to be related to each GA and flourishing outcomes by at the least a 1.3-fold danger ratio, past the measured covariates, to completely clarify the noticed results. The E values for the CI limits closest to the null ranged from 1.14 to 1.43, with 7 values under 1.20. These findings point out that comparatively weak unmeasured confounder(s) may attenuate the statistical significance of some estimates. Therefore, sure genre-specific associations needs to be interpreted with warning, given their potential susceptibility to residual confounding.

Discussion

Principal Findings

Using VanderWeele’s multidimensional flourishing framework, this examine examined genre-specific associations between GA and flourishing amongst adolescents. Consistent with our major speculation, the associations between GA and flourishing different throughout recreation genres reasonably than being uniform. Addiction to AA, SS, and MOBA video games confirmed vital unfavourable associations with all or some flourishing outcomes, whereas habit to different genres was not considerably related to any flourishing outcomes. Consistent with our secondary speculation, total GA was negatively related to all flourishing outcomes.

Interpretations and Comparisons to Existing Literature

A considerable physique of analysis has linked adolescents’ GA to a variety of well being outcomes, together with decreased life satisfaction [], poorer well being [,], decrease that means in life [], decrease empathy and ethical ranges [,], and difficulties in social relationships [,]. Consistent with this literature, this examine discovered that total GA was negatively related to all 5 flourishing subdomains (ie, happiness and life satisfaction, psychological and bodily well being, that means and objective, character and advantage, and shut social relationships). In addition, our findings prolong prior work by displaying that the unfavourable correlates of GA will not be confined to remoted sides of well-being however as an alternative span the complete spectrum of adolescents’ flourishing. This means that addictive gaming could constrain adolescents’ capability to thrive throughout a number of life domains. Moreover, our outcomes point out that the antagonistic affiliation between GA and flourishing is just not uniform throughout recreation genres. While habit to sure genres was negatively associated to flourishing, habit to others was not related to any flourishing outcomes.

The genre-specific analyses revealed that AA habit was the one constant unfavourable predictor of total flourishing and all 5 of its domains. Several mechanisms could clarify these findings. First, AA video games possess design options that will heighten the chance of decreased flourishing. Compared with different genres, AA video games typically function open-world exploration and story-driven adventures that lack pure stopping factors []. Such options can promote extended, uninterrupted play, ceaselessly in solitary contexts, which can displace real-life actions important for flourishing [,]. Second, AA video games generally embody fast-paced, skill-based actions (eg, defeating enemies and fixing puzzles) that produce speedy cycles of in-game achievement []. Although such digital accomplishments could quickly “scratch the itch” for achievement [], prior analysis means that they operate extra as compensators than as substitutes for real-world competence []. Thus, adolescents with addictive gaming patterns could really feel competent throughout gameplay, but their underlying want for real-world competence stays unmet, probably resulting in decreased well-being []. Third, adolescents with preexisting low ranges of flourishing could also be notably drawn to AA video games. Those with low life satisfaction, weak social relationships, poor emotional well-being, or an absence of life objective could discover AA video games particularly interesting as a result of they provide immersive narratives, clear missions, and speedy reward cycles that present a brief sense of escape, competence, and development []. When actual life feels unsatisfying, finishing quests, advancing storylines, and gaining in-game achievements can function substitutes for the that means and accomplishments they wrestle to expertise in every day life, making these video games notably engaging [].

Higher MOBA habit was related to poorer character and advantage. This relationship could also be defined by the extremely aggressive and performance-driven nature of those video games, which emphasize successful, dominance, and ability mastery reasonably than empathy or ethical reflection []. Prior analysis has proven that many MOBA gamers expertise in-game hostility and poisonous communication [], which can erode prosocial tendencies and empathy—core components of character and advantage. Higher MOBA habit was additionally related to a decrease sense of that means and objective. Similar to AA video games, MOBA video games present clear targets (eg, destroying the enemy nexus) and fast rewards (eg, rank will increase after successful) [], which are sometimes extra attainable than real-life achievements. When adolescents repeatedly flip to those video games for accomplishment, real-world targets akin to educational progress or private progress could really feel much less rewarding or harder to pursue [], resulting in fewer significant experiences and a weakened sense of objective []. It can be believable that adolescents who already exhibit decrease character and advantage or a decreased sense of that means and objective are extra weak to MOBA habit, as these game-design options could quickly compensate for these deficits [].

Higher SS habit was related to fewer shut social relationships and poorer psychological and bodily well being. Several mechanisms could account for these associations. First, SS video games are sometimes structured round solitary play, permitting gamers to advance independently, in distinction to team-based genres that require interpersonal coordination []. Such solitary engagement could displace real-world interplay, which is crucial for constructing and sustaining shut social relationships []. Second, SS video games present a robust sense of autonomy and management (eg, gamers can design cities, handle assets, and make strategic choices about budgets and insurance policies) [], which can be notably interesting to adolescents who really feel powerless in actual life on account of restricted social assist [,]. Third, adolescents with poorer psychological well being ensuing from real-world challenges could also be vulnerable to taking part in these video games, as they permit them to simulate idealized achievements and life eventualities (eg, constructing excellent cities, working profitable companies, or creating superb households) []. These experiences could quickly compensate for dissatisfaction with real-life circumstances [].

The absence of associations between habit to taking pictures, sports activities, informal, technique, or role-playing video games and flourishing could also be defined by a number of components. First, these genres are extremely heterogeneous of their modes of play [-]. For instance, taking pictures video games could contain aggressive player-versus-player matches, cooperative missions towards computer-controlled opponents, or single-player narrative development []. Sports video games could be performed via team-on-team matches or profession modes that simulate long-term athlete growth []. Casual, technique, and role-playing video games could be performed in both solitary or extremely social modes [-]. This variability signifies that potential optimistic and unfavourable associations with flourishing on the recreation degree could offset each other on the style degree. Second, many video games in these genres function brief matches or rounds, which can make disengagement simpler in contrast with genres that lack pure stopping factors []. This, in flip, reduces the chance of extended immersion that displaces real-life actions important for flourishing [,].

Implications

The findings of this examine have a number of sensible implications. First, larger habit to taking pictures, sports activities, informal, technique, or role-playing video games was not related to poorer flourishing outcomes. This means that encouraging adolescents to spend their gaming time inside these comparatively lower-risk genres could not enhance the chance of antagonistic outcomes related to GA. This doesn’t suggest that habit to such video games is innocent. Rather, when gaming is already a part of adolescents’ lives, guiding them towards lower-risk genres could signify a extra practical harm-reduction technique. Second, when adolescents are extremely engaged in AA, MOBA, or SS video games, focused methods could also be required to scale back addiction-related dangers. For dad and mom, setting clear cut-off dates and implementing obligatory breaks could assist stop extended, immersive play. Conversations that unpack why sure video games really feel notably absorbing may enhance adolescents’ consciousness of dangerous recreation design options, thereby empowering them to higher self-regulate their play. Providing various actions that provide comparable psychological rewards may be efficient. For instance, adolescents drawn to SS video games could discover comparable satisfaction in robotics golf equipment, artwork workshops, or sandbox-style board video games, which might fulfill wants for autonomy and creativity. MOBA gamers could profit from real-world group sports activities, which might fulfill wishes for competitors, collaboration, and ability mastery. Third, for coverage makers, reasonably than imposing one-size-fits-all guidelines, insurance policies might be extra focused towards high-risk recreation genres. For occasion, China’s present “Online Game Anti-Indulgence System” restricts adolescents to a single hour of play on weekend evenings throughout all video games (though many adolescents have discovered methods to avoid this rule). A extra nuanced coverage may impose stricter limits on high-risk genres whereas permitting extra time for genres related to fewer unfavourable well being outcomes. Such differentiation may higher steadiness adolescents’ enjoyment of gaming with the objective of minimizing potential hurt to their well-being.

Limitations

Several limitations needs to be thought-about when decoding the findings. First, the outcomes could also be influenced by the style classification method adopted on this examine. Although the categorization was knowledgeable by established frameworks, substantial variation should still exist amongst video games throughout the identical style with respect to design options that would result in distinct associations with health-related outcomes. Future analysis would profit from creating or validating a style classification system particularly optimized for well being analysis. Such a system may scale back within-genre heterogeneity and facilitate extra sturdy conclusions relating to genre-specific associations with adolescent well being. Second, the cross-sectional design of this examine limits causal inference between GA and flourishing. The E worth evaluation additionally urged that some associations may probably be defined by unmeasured confounders of small magnitude. To strengthen causal inference, future research may make use of longitudinal and experimental designs to make clear whether or not genre-specific GA undermines flourishing, whether or not adolescents with decrease flourishing usually tend to develop habit to explicit genres, or whether or not these processes function reciprocally. Third, on account of sensible constraints, GA was measured utilizing single-item self-reports, that are inherently much less exact than multi-item scales and will have launched measurement error. Future research ought to use validated multi-item measures when possible.

Conclusions

This examine supplies novel proof that the affiliation between GA and adolescent flourishing varies by recreation style. In distinction to prior work that treats well being as a slim or unidimensional assemble, the adoption of a multidimensional well being framework provides a extra nuanced understanding of gaming-related dangers. The findings contribute to the sector by indicating that habit to AA, MOBA, and SS video games poses larger dangers to adolescent well being than habit to different genres. Accordingly, prevention, schooling, and coverage efforts ought to prioritize these higher-risk genres to extra successfully assist adolescent well being.