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With the growing accessibility and recognition of Internet video games, problematic gaming behaviors have change into more and more widespread.1 The Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5) has included Internet Gaming Disorder (IGD) as a situation warranting additional analysis.2 According to the DSM-5, people with a minimum of 5 of the 9 signs (ie, preoccupation, withdrawal, tolerance, unsuccessful management, giving up different actions, continuation regardless of issues, deception, escape, and detrimental penalties) up to now 12 months are categorized as IGD instances. Adolescent IGD has emerged as a big public well being concern. Globally, the pooled prevalence of adolescent IGD was 8.8%, with the next charge in males (15.4%) than in females (6.4%).3 The state of affairs is especially critical amongst adolescents in Hong Kong, with the prevalence starting from 12.7% to 14.9%.4–6 Furthermore, Internet gaming has change into more and more in style amongst middle-aged and older adults, together with mother and father. Globally, over 75% of adults aged 25 to 54 years performed video video games in 2025.7 In Hong Kong, over 50% of fogeys engaged in Internet gaming.8 However, no empirical examine has been discovered on the prevalence of parental IGD.
Emerging proof means that the affiliation between gaming time and IGD could also be non-linear. Prior research3 have indicated that amongst adolescents and younger adults, extreme gaming time elevated IGD dangers, whereas reasonable gaming time (eg, 5 hours/week or much less)9 didn’t exhibit such detrimental impacts. Instead, reasonable gaming has been related to potential advantages, resembling enhancing prosocial behaviors10 and bettering problem-solving abilities.11 These findings underscore the double-edged nature of Internet gaming and recommend that, reasonably than full restriction, figuring out a practical gaming-time threshold that balances enjoyment and dependancy danger could also be extra acceptable on this digital period. Such a suggestion (≤5 hours/week) has been proposed for adolescents;9 nonetheless, no research have examined this potential non-linear affiliation in middle-aged adults, together with mother and father, and no such gaming time-related suggestions have been proposed. Identifying a practical gaming-time suggestion for adults, notably for folks, is necessary, as gaming has change into more and more prevalent amongst them. This could not solely assist cut back their very own danger of IGD but in addition promote a more healthy household gaming atmosphere and inform family-based IGD intervention methods.
Parents play a vital function in shaping adolescents’ behavioral improvement, together with gaming behaviors.12 The relationship between parental gaming time and adolescent IGD might also be non-linear: On one hand, in response to the Social Learning Theory,13 kids could purchase gaming behaviors by remark and imitation of their mother and father, probably growing the chance of IGD. In addition, in response to the Family Systems Theory,14 household is an organized system wherein behaviors of members of the family are interdependent. Parental gaming could affect their youngster’s gaming conduct by parental gaming attitudes and supervision, father or mother–youngster relationship, and co-gaming practices.12,15 On the opposite hand, beneath sure situations, parental gaming could exert useful influences. For occasion, Sarah et al16 reported that father or mother–youngster co-playing Internet video games was related to decrease adolescent aggression and stronger father or mother–youngster connectedness, each of which have been recognized as protecting components in opposition to adolescent IGD.12,15,17
Despite these combined results, no research have examined the potential non-linear relationship between parental gaming time and adolescent IGD. Existing proof is restricted to a number of cross-sectional research that reported constructive associations between parental gaming frequency and adolescent IGD.18–20 However, these research relied on gaming frequency reasonably than gaming time in hours, with the previous one offering much less correct measures and limiting the power to look at the potential non-linear associations. Only one cross-sectional South Korean examine (N = 199 moms) assessed maternal gaming time and located no important variations between adolescents with and with out IGD.21 This examine relied solely on maternal self-reports, which is perhaps prone to social desirability bias,19 and restrict the validity of the findings. To date, no dyadic research have investigated the connection between parental gaming time and adolescent IGD.
Given the growing prevalence of gaming engagement amongst mother and father, and its potential combined influences on adolescents and themselves, analyzing the non-linear relationship between them is warranted to tell family-based IGD intervention methods. Accordingly, this examine aimed to (1) look at the non-linear and threshold-dependent associations between parental gaming time and parental/adolescent IGD utilizing a consultant father or mother–youngster dyadic pattern in Hong Kong; (2) establish a non-zero, pragmatic gaming-time threshold for folks; and (3) discover gender-specific thresholds for fathers, moms, boys, and women. Conducting this analysis in Hong Kong is necessary given its particular sociocultural context: High parental expectations concerning educational achievement, intense educational strain on adolescents, and widespread entry to digital applied sciences could contribute to extreme gaming and IGD in each mother and father and adolescents. Identifying a practical gaming threshold for folks has necessary public well being implications. It may assist mother and father self-monitor their gaming behaviors, allow healthcare professionals to establish households at elevated danger for IGD, and supply an empirical foundation for growing family-based IGD intervention methods.
This is a one-year, two-wave longitudinal dyadic examine carried out in Hong Kong from 2022 to 2024. Secondary faculty college students in public colleges and one in all their mother and father (the first caregiver) had been invited. Inclusion standards for father or mother–youngster dyads are: 1) Secondary faculty college students in grades 1–3 in public colleges; 2) Both prepared to take part on this examine; 3) Both converse and skim Chinese; 4) Living collectively; 5) The youngster’s predominant caregiver is father or mom. Exclusion standards embody: (1) both the father or mother or the kid is presently receiving remedy for a psychological dysfunction; and (2) both has an mental incapacity that forestalls impartial completion of the questionnaire. Secondary faculty college students in grades 4–6 had been excluded as a result of they wanted to organize for public examinations and had been troublesome to comply with up with after commencement.
Stratified random sampling was used to recruit contributors. Among the 18 districts in Hong Kong, eight districts had been randomly chosen, and one secondary faculty was randomly chosen from every district. Schools that agreed to take part submitted software kinds, and alternative colleges had been recruited in instances of refusal. With the help of lecturers and social employees, the analysis workforce distributed leaflets and consent kinds to folks. As a token of appreciation, mother and father obtained grocery store digital vouchers, and adolescents got bookmarks. Adolescents accomplished a structured, nameless, self-administered questionnaire in classroom settings with out the presence of lecturers. Parents accomplished a web based questionnaire based mostly on the Qualtrics platform by WhatsApp or by a phone interview carried out by skilled analysis employees. In complete, 1,277 dyads accomplished the baseline survey (T1), with 712 dyads finishing the follow-up survey (T2) (follow-up charge: 55.8%). Among the dyads misplaced to follow-up, eight adolescents had transferred to different colleges, whereas the remaining mother and father declined to take part within the follow-up survey (Supplementary Figure 1).
The DSM-5 IGD signs guidelines2 was employed to evaluate parental IGD signs, which has been validated amongst Chinese adults.22 The complete rating ranges from 0 to 9, with larger scores indicating extra extreme IGD signs. Participants with a cutoff of 5 or extra had been thought of as IGD instances.23 In the present father or mother pattern, Cronbach’s α was 0.74 at baseline and 0.72 at follow-up.
Parents reported their gaming time on computer systems, consoles, tablets, or smartphones over the previous six months. Response choices embody “did not play”, 0.5 hours/day (h/d), 1 h/d, 2 h/d, 3 h/d, 4 h/d, 5 h/d, and 6 h/d or extra.
Potential covariates had been collected, together with melancholy measured by the two-item Patient Health Questionnaire (PHQ-2)24 and different Internet-related actions (looking information and data, on-line chatting, on-line purchasing, and on-line leisure (eg, watching motion pictures or listening to music) per day over the previous six months. Background variables, together with age, gender, employment, marriage, socioeconomic standing, academic degree, and psychological well being service historical past, had been collected.
The similar DSM-5 IGD signs guidelines was used to evaluate adolescent IGD signs.2 Adolescents scoring 5 or extra had been categorized as IGD instances. The Chinese model of the DSM-5 IGD guidelines has been validated in Chinese adolescents and demonstrated good psychometric properties.4,25 In the current examine, the Cronbach’s α was 0.75 at baseline and 0.73 at follow-up.
Potential covariates, together with melancholy measured by the nine-item Patient Health Questionnaire (PHQ-9),26 nervousness measured by the seven-item Generalized Anxiety Disorder (GAD-7),27 and father or mother–youngster relationship measured by the Relationship subscale of the 27-item Family Environment Scale,28 had been collected. These scales demonstrated good reliability within the present pattern at each baseline and follow-up, with Cronbach’s α starting from 0.87 to 0.94. Adolescent IG time and time on different Internet-related actions had been assessed utilizing the identical objects as these reported by mother and father.
Background variables, together with age, gender, faculty rating, dwelling association, siblings’ gaming engagement and historical past of psychological well being service, had been collected.
Generalized additive fashions (GAMs) by the restricted most probability (REML) had been first utilized to look at potential non-linear associations between parental gaming time and adolescent IGD. As the prevalence of parental IGD was very low (1.1% at T1 and 0.8% at T2), to make sure mannequin robustness, the full rating of parental IGD signs was used as a substitute in GAMs. Following earlier analysis, the nadir of the curve was outlined as a “minimum-risk threshold”.29 If no non-zero “minimum-risk threshold” was recognized, a stepwise strategy could be employed to establish an alternate “low-risk gaming level”.
Specifically, parental gaming time was categorized into three teams (ie, non-gamers, beneath and over the cutoff) from the smallest non-zero cutoff out there on this examine (0.5 h/d). Generalized linear combined fashions (GLMMs) and linear combined fashions (LMMs) had been used to look at the longitudinal associations of parental gaming time with adolescent IGD and parental IGD signs, respectively. Cluster results inside colleges and repeated measurements had been adjusted for. Significant background variables recognized in univariable fashions had been adjusted for in multivariable analyses. Post‑hoc pairwise comparisons had been carried out utilizing Tukey–Kramer adjustment. If parental gaming time >0.5 h/d confirmed a considerably larger danger than that of each non-gamers and 0.5 h/d, then 0.5 h/d was thought of as a “low-risk gaming level”. Otherwise, a bigger cutoff worth could be used to categorize parental gaming time and repeat the identical analyses till an outlined “low-risk gaming level” was recognized. Chi-square assessments had been used to additional examine the prevalence and incidence of adolescent and parental IGD throughout the three teams. If the p-value of the general chi-square take a look at was lower than 0.05, post-hoc a number of comparisons could be additional carried out with Holm-Bonferroni correction. Subgroup analyses had been carried out to discover gender-specific thresholds amongst moms, fathers, boys, and women.
Sensitivity evaluation by inverse likelihood weighting (IPW) was carried out to regulate for potential choice bias attributable to biased loss to follow-up. Weights had been calculated based mostly on background variables that considerably differed between contributors who accomplished the 12-month follow-up and those that dropped out. Multiple imputations (MI) by chained equations (N of imputed datasets =10) had been carried out to scale back the potential biases attributable to lacking information. To assess the adequacy of the present pattern, sensitivity energy analyses had been carried out for examined GLMM and LMM based mostly on 1000 Monte Carlo simulations.30 The SIMR bundle30 in R was used to carry out all energy analyses. The energy of all fashions within the complete mother and father, fathers, moms, complete adolescents, boys, and women was over 95% (Supplementary Table 1).
All analyses had been carried out utilizing R model 4.1.3. Two-tailed p-values lower than 0.05 had been thought of statistically important.
All examine procedures had been carried out in accordance with the Declaration of Helsinki. Written knowledgeable consent was obtained from each adolescents and their mother and father. Ethical approval was granted by the Ethics Committee of the corresponding writer’s establishment at The Chinese University of Hong Kong (Reference: SBRE-19-451).
The imply (SD) age of fogeys (81.5% moms) was 45.41 (5.41) years. Most mother and father (85.4%) performed video games for one hour or much less per day, with a mean gaming length of 0.59 (0.88) h/d. Among adolescents (49.6% feminine), the imply (SD) age was 12.28 (1.35) years, and the imply gaming time was 1.78 (1.64) h/d (Table 1). Significant variations between contributors who accomplished follow-up and those that dropped out had been noticed in adolescents’ faculty banding, age, gender, dwelling association, time spent on different Internet-related actions, and siblings’ gaming engagement (Supplementary Table 2).
| Table 1 Demographic Characteristics of Participants
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As shown in Figure 1, parental gaming time had a monotonically constructive affiliation with parental IGD signs in each fathers and moms. After adjusting for important background variables (Supplementary Table 3), mother and father gaming greater than 0.5 h/d exhibited extra extreme IGD signs than non-gamers (b (95% CI) = 2.409 (2.280–2.538)) and people gaming for 0.5 h/d (1.787 (1.603–1.972)). Subgroup analyses confirmed constant outcomes for moms and dads (Table 2). These findings had been strong in sensitivity analyses utilizing IPW (Supplementary Table 4) and MI (Supplementary Table 5 and Supplementary Figure 2).
| Table 2 Adjusted Analyses of Parent-Reported Parental IG Time and Parental IGD Symptoms
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Figure 2 illustrates an inverted U-shaped affiliation between parental gaming time and adolescent IGD, with danger peaking at roughly 1.5 h/d for boys and a pair of h/d for women. Although danger appeared to say no past these ranges, the extraordinarily large CIs precluded a definitive conclusion. After controlling for important background components (Supplementary Table 6), parental gaming exceeding 0.5 h/d was related to the next adolescent IGD danger in contrast with non-gaming mother and father (OR (95% CI) = 11.124 (6.658–18.584)) and oldsters gaming for 0.5 h/d (5.119 (2.684–9.765)). Subgroup analyses confirmed related patterns amongst women, whereas amongst boys, parental gaming for 0.5 h/d didn’t considerably enhance boys’ IGD in comparison with these with non-gaming mother and father (Table 3). Results had been constant in IPW (Supplementary Table 7) and MI analyses (Supplementary Table 8 and Supplementary Figure 3).
| Table 3 Adjusted Analyses of Parent-Reported Parental IG Time and Adolescent IGD
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| Table 4 Prevalence and Conversion Rates of Parental and Adolescent IGD
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As shown in Table 3, adolescents whose mother and father gamed for greater than 0.5 h/d had considerably larger IGD prevalence at T1 (33.5%) and T2 (29.0%) than these whose mother and father had been non-gamers or gamed for 0.5 h/d (each p < 0.001). The quantity wanted to be uncovered for hurt (NNH)31 was 5, indicating that each 5 adolescents with parental gaming exceeding 0.5 h/d was related to one extra adolescent IGD case, in comparison with these with parental gaming time of 0.5 h/d. Among mother and father, gaming for greater than 0.5 h/d was related to larger IGD prevalence at T1 (3.5%) in contrast with non-gamers. No important variations in IGD incidence had been noticed among the many three teams.
This examine is the primary to look at the non-linear relationship between parental gaming time and parental IGD signs/adolescent IGD. We discovered that parental gaming time was monotonically related to better severity of parental IGD signs and exhibited an inverted U-shaped affiliation with adolescent IGD, with large CIs at parental gaming occasions above 4 h/d. We didn’t establish a “non-zero safe threshold”; as a substitute, our findings recommend a practical “low-risk gaming level” of parental gaming time inside 0.5 h/d based mostly on categorical comparability. Compared with gaming greater than 0.5 h/d, gaming 0.5 h/d or much less was related to decrease dangers for each parental IGD signs and adolescent IGD, though dangers remained barely larger than these of non-gaming mother and father. Based on the noticed associations, in comparison with gaming over 0.5 h/d, each 5 mother and father whose gaming time was inside 0.5 h/d was related to one fewer case of adolescent IGD.
Approximately half of fogeys on this pattern (48.2%) reported gaming engagement, which was decrease than estimates for the final grownup inhabitants in Hong Kong (83% amongst adults aged 25–34 years and 72% amongst these aged 35–44 years).32 This discrepancy is believable provided that our pattern comprised main caregivers, who could have much less discretionary time attributable to family and childcare tasks. The predominance of mom samples (81.5%) on this examine could have additional contributed to the underestimation of general parental gaming engagement. Despite widespread parental gaming, mother and father appeared much less prone to IGD than adolescents. This disparity could also be partially defined by adolescents’ immature neurodevelopment, which can enhance their vulnerability to exterior influences and addictive behaviors.33
Contrary to earlier findings that reasonable gaming time amongst adolescents didn’t enhance their IGD danger,9 our examine didn’t establish such a “safe threshold” of parental gaming for adolescents. Rather, any parental gaming engagement could sign an elevated probability of adolescent IGD. This sample means that parental modeling results could rely extra on the presence of gaming conduct than on its length. Adolescents observing parental gaming could normalize gaming throughout the household, cut back perceived harms, and weaken the legitimacy of parental restrictions. Evidence from different addictive behaviors helps this interpretation. For instance, kids with smoking mother and father had been discovered to are inclined to understand smoking as much less dangerous than these with non-smoking mother and father.34 In addition, the noticed affiliation might also be partly defined by different unmeasured family-level components, resembling extra permissive family media norms, decrease ranges of parental monitoring, and shared genetic susceptibility between mother and father and adolescents.12,15 These findings recommend that parental gaming behaviors, along with adolescents’ personal gaming behaviors, could warrant better consideration in family-based IGD intervention methods.
Notably, the chance of adolescent IGD elevated quickly with parental gaming time as much as 1.5–2 h/d, adopted by a plateau. This “diminishing marginal effect” (ie, successive will increase in an publicity produce progressively smaller incremental results on an end result) was additionally noticed in different household research, resembling extreme parental involvement in schooling not persistently bettering kids’s faculty efficiency.35 The plateau could recommend that after adolescents’ notion of gaming as a normative conduct has been totally activated, additional will increase in parental gaming time could not introduce extra dangers to adolescents’ IGD. Although the IGD danger appeared to say no after the plateau, the extraordinarily large CIs, as a result of small variety of mother and father gaming for 4 h/d or extra (N=10), could result in instability of estimates on this vary and subsequently ought to be interpreted with warning.
This examine additional proposed a practical “low-risk gaming level” of parental gaming time at 0.5 h/d by categorical comparisons. Based on the NNH, each 5 mother and father whose gaming time was inside, reasonably than above, 0.5 h/d was related to one fewer adolescent IGD case. However, the present examine didn’t look at whether or not the proposed gaming degree diverse in response to mother and father’ gaming motivations, sport genres, or co-playing behaviors with their kids. Future research ought to examine these potential moderators and conduct subgroup analyses to judge the robustness and generalizability of the proposed gaming degree. The giant ORs ought to be interpreted cautiously. They could also be attributable to the near-zero prevalence of adolescent IGD within the non-gaming reference group and residual confounding, resembling shared genetic vulnerability, household media guidelines, parental monitoring, and gaming motivations.7,15,36 Reverse causation (ie, adolescents’ gaming influencing parental gaming) might also have contributed to the noticed giant ORs. Parental gaming time could partly signify a marker of adolescents’ earlier gaming propensity, resulting in an overestimation of its affiliation with adolescent IGD. Future longitudinal research ought to concurrently look at reciprocal associations between them utilizing structural equation modelling, such because the Actor-Partner Interdependence Model.37
Gender-specific analyses revealed that in contrast with having non-gaming mother and father, parental gaming for 0.5 h/d elevated the chance of IGD amongst women however not boys, which suggests better tolerance of parental gaming amongst boys. One attainable clarification is that women could place better emphasis on emotional assist and connectedness throughout the household,38 which can make them extra delicate to understand parental unavailability and emotional neglect related to gaming. Such detrimental perceptions could encourage compensatory engagement in on-line gaming for social and emotional fulfilment. Given that over 80% of fogeys within the current examine had been moms (81.5%), the noticed findings could primarily replicate feminine caregivers’ gaming behaviors and will not be generalizable to male caregivers. Future research with extra balanced samples of fathers and moms are wanted to find out whether or not these associations stay steady.
Current public well being steering primarily emphasizes limiting kids’s display time.39 Our findings recommend that parental gaming conduct was carefully associated to their youngster’s IGD. The “low-risk gaming level” of 0.5 h/d recognized by categorical comparability could function a preliminary reference for figuring out parental gaming patterns related to decrease adolescent IGD danger. Schools and neighborhood organizations may think about incorporating data on the noticed affiliation between parental gaming and adolescent IGD into family-based gaming schooling. Similarly, clinicians and counselors working with adolescents affected by problematic gaming could think about parental gaming conduct as a related family-context issue when discussing gaming patterns with households. Given the observational nature of this examine, these implications ought to be interpreted cautiously. Future longitudinal and intervention research are wanted to validate the noticed associations and gaming ranges in different populations and cultural settings.
Several limitations ought to be acknowledged. First, potential confounders, resembling genetic predisposition, cultural components in Hong Kong (eg, excessive educational strain for adolescents and excessive educational expectations for folks), and household media guidelines, weren’t measured or managed for. These potential confounders could have led to overestimation of the noticed associations between parental gaming time and adolescent IGD. Besides, potential moderators, resembling parental gaming contexts (eg, co-playing vs solitary), gaming genres and motivations, weren’t measured, which can reasonable each the magnitude and route of the associations with adolescent IGD. Second, parental gaming time was measured utilizing a single merchandise with fastened response choices starting from “did not play” to “6 h/d or more”. Therefore, the gaming degree of 0.5 h/d was constrained by the predefined response classes and mirrored a categorical comparability. It was not a found threshold from steady gaming time, and a decrease threshold can’t be dominated out. In addition, the precise impact past six hours stays unexplored. Future research utilizing steady or diary-based measures of gaming time are wanted to validate and refine the gaming degree. Third, the small variety of mother and father within the longer gaming-time classes could have diminished the precision and stability of the estimates for GAM and GLMM. Fourth, the attrition charge was comparatively excessive (44.2%). Although the IPW sensitivity analyses adjusted for noticed variations between contributors who had been misplaced to follow-up and those that accomplished follow-up, they might not account for unmeasured components. For instance, households with better issues about gaming could have been extra prone to retain, probably resulting in an overestimation of the noticed associations. Finally, solely the first caregiver per household was invited to take part on this examine, with a disproportionately larger proportion of moms. This gender imbalance could have amplified the noticed affiliation between parental gaming time and women’ IGD. Future research are advisable to recruit extra balanced samples of fathers and moms, ideally, together with each mother and father to seize the total spectrum of parental gaming influences.
Although no non-zero “minimum-risk threshold” was recognized, gaming for 0.5 h/d or much less could also be thought of a practical “low-risk gaming level” that preserves parental enjoyment whereas maintaining IGD danger at a comparatively low degree, notably for adolescents. Given the observational design, the unmeasured potential confounders, and the specific measurement of gaming time, these findings ought to be interpreted with warning. It is value noting that the noticed findings could primarily replicate feminine caregivers’ gaming behaviors and will not be generalizable to male caregivers. Future longitudinal and intervention research are wanted to validate the findings in different populations and settings.
AI instruments weren’t used within the preparation of this manuscript.
The information that assist the findings of this examine can be found on request from the corresponding writer.
We want to sincerely thank Miss Eva Li, Mr Yilun Huang, and Mr Agassi Wong for his or her help with the information assortment.
All authors made a big contribution to the work reported, whether or not that’s within the conception, examine design, execution, acquisition of knowledge, evaluation and interpretation, or in all these areas; took half in drafting, revising or critically reviewing the article; gave last approval of the model to be revealed; have agreed on the journal to which the article has been submitted; and comply with be accountable for all features of the work.
This examine was funded by the General Research Fund [#14609820]. The funder had no function in examine design, information assortment and evaluation, choice to publish, or preparation of the manuscript.
The authors declare that they don’t have any conflicts of curiosity.
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