JMIR Serious Games – Prevalence, Sex Differences, and Predictors of Internet Gaming Disorder Among Impoverished Rural Adolescents: Cross-Sectional and Potential Cohort Study

Introduction

In 2019, the World Health Organization formally included gaming dysfunction within the International Classification of Diseases, eleventh Revision, figuring out its core options as a shift in gaming precedence, lack of behavioral management, and impairment in social functioning. According to the newest meta-analyses, the prevalence of web gaming dysfunction (IGD) amongst adolescents in East Asia is roughly 6%, with a charge of roughly 6.4% reported in China [,].

To date, most analysis on IGD has targeted on city populations. However, kids and adolescents in economically underdeveloped rural areas could face distinctive challenges reminiscent of restricted parental supervision sources, lack of steerage on digital gadget use, and unequal distribution of digital sources between city and rural areas. These environmental variations could contribute to distinct threat profiles for IGD amongst rural youth in comparison with their city counterparts []. Given that IGD has been linked to damaging outcomes, together with poorer sleep high quality, impaired affective regulation, decreased consideration in studying, and elevated threat of suicidal ideation [-], the underlying mechanisms of IGD could also be carefully related to reward system dysfunction and impaired cognitive management skills [,]. Thus, systematically assessing the epidemiology and threat mechanisms of IGD in rural areas holds nice public well being significance. Unfortunately, current research focusing on rural populations are largely cross-sectional, which solely permit for identification of baseline associations however fall in need of revealing temporal dynamics or causal relationships. For instance, it stays unclear whether or not psychological well being points result in IGD, whether or not IGD triggers subsequent issues, or whether or not each exhibit a bidirectional relationship amongst rural adolescents. This limitation enormously restricts the applicability and scalability of present intervention methods in rural contexts.

Considerable proof signifies intercourse variations within the prevalence of IGD, with male people usually exhibiting increased charges than feminine people [,], however the underlying mechanisms stay insufficiently understood. Historically, increased prevalence in male people has been partly attributed to the predominance of male-targeted sport designs that emphasize stimulation and management; nevertheless, the market is more and more providing video games designed to cater to feminine gamers, and the variety of female and male players is now broadly comparable []. This signifies that variations in prevalence can’t be absolutely defined by sport sorts and motivation design alone. Current analysis is shifting focus towards potential particular person susceptibility components. For occasion, male people could exhibit better vulnerability in impulsivity and reward sensitivity, whereas being feminine could also be extra carefully related to difficulties in emotional regulation [,]. Crucial questions that stay unanswered embrace whether or not the intercourse disparity noticed in earlier research persists in rural samples, whether or not feminine college students with subthreshold baseline gaming issues are at elevated threat of development over time, and whether or not components reminiscent of household assist and affective signs exert differential results by intercourse. These questions warrant focused longitudinal investigation in rural school-aged populations to make clear sex-specific pathways and inform tailor-made preventive interventions.

This examine aimed to find out the prevalence of IGD amongst impoverished rural major and center college college students in China, establish sex-specific threat and protecting components, and consider longitudinal predictors of IGD over a 1-year follow-up interval. We hypothesized that (1) the prevalence of IGD on this rural school-aged cohort would differ from findings in broader or urban-representative samples; (2) people with longer baseline gaming time, extra extreme depressive state, and better impulsivity could be extra prone to develop IGD subsequently; (3) increased baseline vanity and better guardian or parental involvement could be related to decrease threat of IGD; and (4) predictive issue patterns would differ by intercourse. The findings of this longitudinal examine are anticipated to offer empirical proof to tell exact prevention and intervention methods for IGD in rural faculties.

Methods

Study Design and Data Collection Process

This examine adopted a cross-sectional and potential longitudinal cohort design and was performed and reported in accordance with the Strengthening the Reporting of Observational Studies in Epidemiology assertion []. The accomplished Strengthening the Reporting of Observational Studies in Epidemiology guidelines is offered as . From February 2023 to July 2024, the baseline survey was performed in major and center faculties throughout 13 impoverished rural counties in Hunan province, in addition to within the rural free clinic program of Hunan Children’s Hospital. As information assortment was certain to the free clinic schedule, no a priori pattern dimension calculation was performed; as a substitute, all eligible college students had been enrolled, yielding 18,967 legitimate questionnaires. Baseline information had been obtained through on-site paper questionnaires protecting demographics, vanity, affective standing, impulsivity, gaming time, and IGD.

Follow-up started in January 2024 amongst college students who accomplished the baseline survey and whose faculties organized a second free clinic. Using the identical questionnaire methodology, follow-up continued till June 2025, with 5254 responses collected. Loss to follow-up primarily mirrored faculties that had not but organized a second clinic, leading to a nonrandom attrition sample. Identity checks had been used to make sure correct matching of baseline and follow-up information.

Participants

Participants had been recruited by means of their respective faculties to answer on-site surveys by distributing questionnaires collectively at school teams throughout the free medical session occasion.

The inclusion standards for this examine had been age between 6 and 18 years; long-term residence in impoverished rural areas of Hunan province; common attendance to rural major or secondary faculties; and voluntary participation of each the coed and their major guardian, with signed knowledgeable consent.

Exclusion standards included the presence of cognitive or language impairments stopping comprehension or completion of the questionnaire, short-term attendance to rural faculties for lower than 6 months, and refusal to take part or withdrawal throughout questionnaire completion for private causes.

Measurements

A self-developed questionnaire was used to gather demographic data, together with age, intercourse, years of training, solely youngster standing, and every day time spent enjoying web video games (hours per day). The questionnaire additionally assessed the standard of the connection between the individuals and their major guardians (rated as very poor, poor, good, or excellent), in addition to whether or not the first guardian was in a position to present companionship when wanted (hereinafter known as companionship).

The Chinese model of the Rosenberg Self-Esteem Scale was used to evaluate general vanity. This scale consists of 10 gadgets and makes use of a 4-point Likert scale for scoring, with increased scores indicating increased ranges of general vanity. The scale’s Cronbach α was 0.88 []. The Patient Health Questionnaire–9 (PHQ-9) was used to evaluate depressive temper. This scale contains 9 gadgets and makes use of a 4-point Likert scale for scoring, with increased whole scores reflecting extra extreme depressive temper. The scale’s Cronbach α was 0.90 [,]. The Generalized Anxiety Disorder–7 (GAD-7) scale was used to evaluate anxious temper. This scale contains 7 gadgets and makes use of a 4-point Likert scale for scoring, with increased whole scores reflecting extra extreme anxious temper. The scale’s Cronbach α was 0.92 []. The Brief Barratt Impulsiveness Scale (BBIS) was used to evaluate impulsivity. This scale contains 8 gadgets and makes use of a 4-point Likert scale for scoring. The scale covers 2 dimensions: poor self-regulation and impulsive conduct. Higher scores point out better impulsivity. The Cronbach α was 0.85 for the overall scale and 0.88 and 0.80 for the two subscales []. The Internet Gaming Disorder Scale–Short Form (IGDS9-SF) was used to evaluate IGD. The scale incorporates 9 gadgets and makes use of a 5-point Likert scale for scoring, with increased scores indicating extra extreme IGD signs. The scale’s Cronbach α was 0.91 []. In this examine, individuals scoring >32 on the IGDS9-SF had been categorised as having IGD.

Quality Control

Before the assessments at every college, 5 skilled psychiatrists offered standardized coaching to the academics. The coaching lined the examine aims, interpretation of questionnaire gadgets, knowledgeable consent procedures, on-site steerage protocols, and dealing with of irregular conditions, enabling academics to help psychiatrists in guiding college students throughout questionnaire completion.

To guarantee information high quality, questionnaires had been excluded in the event that they met any of the next standards: (1) careless responding—outlined as 3 or extra scales having all legitimate gadgets scored identically or exhibition of systematic repetitive response patterns (eg, 1-2-3-4, 4-3-2-1, or 1-2-1) on any core scale; (2) failed validity examine gadgets—the questionnaires included lie detection gadgets requiring the response “most of the time,” and deviations from this response had been deemed invalid; (3) implausible key data (age outdoors the vary of 6 to 18 years; gaming time outdoors 0 to 24 hours; lacking information for age, intercourse, years of training, or gaming time; or inconsistency between age and years of training); and (4) greater than 10% of things left unanswered.

A complete of 6452 invalid questionnaires had been excluded. Data entry was performed utilizing EpiData (model 3.1; EpiData Association). To guarantee accuracy, 30% of entered questionnaires had been randomly rechecked, sustaining an error charge beneath 1%.

Handling of Missing Data

As the follow-up survey of this examine solely focused college students whose faculties subsequently organized a second free medical session, there have been circumstances of lacking information. To assess the mechanism of lacking information, this examine adopted the Little lacking fully at random (MCAR) check. If the P worth of this check is lower than .05, the null speculation that the information are MCAR is rejected. On this foundation, to additional use all baseline data and cut back potential bias, this examine used the mice bundle within the R language (R Foundation for Statistical Computing) to carry out a number of imputation for the lacking information. All statistical analyses associated to the standing of IGD throughout the follow-up interval—together with IGD prevalence charge, persistence charge, and the longitudinal predictors of IGD—had been performed primarily based on the a number of imputation datasets, whereas the cross-sectional analyses involving solely baseline information had been accomplished utilizing the unique noticed information.

Statistical Analysis

Statistical analyses had been performed utilizing SPSS (model 26.0; IBM Corp ). The prevalence of IGD was calculated for the overall pattern and by intercourse at baseline and follow-up. The Kolmogorov-Smirnov check was used to evaluate the normality of the continual variables. Categorical variables (eg, solely youngster standing and relationship with guardian) had been analyzed utilizing chi-square assessments. Normally distributed steady variables (eg, age and PHQ-9 scores) had been in contrast utilizing independent-sample t assessments, whereas nonnormally distributed variables had been analyzed utilizing the Mann-Whitney U check. Furthermore, the false discovery charge (FDR) multiple-testing (Benjamini-Hochberg) correction methodology was used to manage the false constructive charge of variations in variable comparisons between different-sex people at baseline, and a postcorrection P worth of lower than .05 was thought of statistically vital. The Spearman rank correlation was used to look at associations between IGD indicators and different variables. Multivariate logistic regression was carried out to establish components related to baseline IGD and predict follow-up IGD. First, baseline IGD standing was set because the dependent variable, with variables displaying significance in univariate analyses included as unbiased variables to establish related components. Next, follow-up IGD standing was set because the dependent variable, with baseline IGD and its unbiased related components included as predictors to discover threat components. The statistical significance degree for correlation and regression was set at P<.05 for 2-tailed assessments.

Ethical Considerations

This examine was performed in accordance with the Declaration of Helsinki as set forth by the World Medical Association. Ethics approval was obtained from the institutional evaluate board of the Hunan Children’s Hospital affiliated with Xiangya School of Medicine, Central South University (KS2025-169). This examine was a part of a free medical outreach program in impoverished rural areas, so no monetary compensation was offered to individuals. Before information assortment, academics defined the questionnaire content material to individuals and their major guardians. The first part of the questionnaire included knowledgeable consent data, and individuals or their guardians had been free to say no participation or withdraw at any time with out penalty. All individuals offered written knowledgeable consent. The knowledgeable consent for the first information assortment complied with the institutional evaluate board’s tips and permitted secondary information evaluation with out the necessity for added consent.

While the unique information contained private identifiers, all individuals’ names had been hidden throughout the evaluation part to make sure confidentiality. Data had been securely saved in password-protected techniques accessible solely to approved researchers. No identification of particular person individuals or customers in any photographs of the manuscript or supplementary materials is feasible.

Results

Prevalence of IGD and Sex Differences

A complete of 18,967 baseline information entries had been collected on this examine. After high quality management, 13,931 legitimate questionnaires had been obtained for the baseline cross-sectional examine; please seek advice from for the detailed screening course of. These information revealed a prevalence of IGD of 5.2% (725/13,931; 95% CI 4.8%-5.6%). The prevalence amongst male people (489/7304, 6.7%; 95% CI 6.1%-7.3%) was considerably increased than that amongst feminine people (236/6627, 3.6%; 95% CI 3.1%-4%; χ²₁=69.2; threat distinction [RD] 0.31, 95% CI 0.02-0.04; P<.001).

For the 1-year follow-up evaluation, 3838 legitimate questionnaires had been obtained (loss to follow-up charge: 10,093/13,931, 72.4%; 95% CI 71.7%-73.2%). The results of the Little MCAR check indicated that the information weren’t MCAR (χ²₉=1358.2, P<.001). The longitudinal information after a number of imputation confirmed that the general prevalence of IGD was 5% (692/13,931; 95% CI 4.6%-5.3%), and the prevalence amongst male people remained considerably increased than that amongst feminine people (511/7304, 7%; 95% CI 6.4%-7.6% vs 181/6627, 2.7%; 95% CI 2.4%-3.2%, respectively; χ²₁=133.9; RD 0.04, 95% CI 0.04-0.05; P<.001).

Among individuals with IGD at baseline, the persistence charge at follow-up of IGD was 9.1% (66/725; 95% CI 7.2%-11.45%). Specifically, the persistence charge was 7.2% (17/236; 95% CI 4.5%-11.2%) within the feminine subgroup and 10% (49/489; 95% CI 7.7%-13.1%) within the male subgroup. There was no statistically vital distinction between the two subgroups (χ²₁=1.5; RD 0.03, 95% CI –0.02 to 0.07; P=.22).

As a sensitivity evaluation, we additionally performed the identical evaluation on the full-case information, yielding outcomes that had been largely in step with the a number of imputation evaluation (see Table S1 in for particulars).

‎

Sex Differences in Baseline Demographic and Clinical Variables

An evaluation of baseline cross-sectional information revealed vital intercourse variations in a number of demographic and scientific variables. When grouped by intercourse, there was the next proportion of male people who had been solely kids than feminine people (χ²₁=71.8, post-FDR P<.001; RD 0.06, 95% CI 0.04-0.07) and a better proportion who reported “very good” relationships with their major guardian (Z=–4.69; median distinction [MD] 0.03, 95% CI 0.02-0.05; post-FDR P<.001) and longer every day gaming time (Z=–2.83; MD –0.23, 95% CI −0.35 to −0.10; post-FDR P=.008). Male people additionally scored increased on the IGDS9-SF (Z=–18.79; MD –2.20, 95% CI –2.45 to −1.95; post-FDR P<.001) and vanity (t_13,929=–9.89; MD –0.81, 95% CI −0.97 to −0.65; post-FDR P<.001). Conversely, male people had considerably decrease scores on the GAD-7 (Z=–13.57; MD 0.83, 95% CI 0.68-0.98; post-FDR P<.001), the PHQ-9 (Z=–9.27; MD 0.71, 95% CI 0.54-0.89; post-FDR P<.001), self-regulation (t_13,929=3.81; MD 0.18, 95% CI 0.09-0.27; post-FDR P<.001), and the overall BBIS impulsivity scale (t_13,929=2.51; MD 0.18, 95% CI 0.04-0.32; post-FDR P=.01). For particular baseline variable variations between sexes, please seek advice from .

Correlation Analysis of IGD Indicators

On the premise of the baseline cross-sectional information, IGD indicators had been considerably correlated with a number of components (), together with age (r=0.07, 95% CI 0.05-0.08; P<.001), years of training (r=0.06, 95% CI 0.04-0.08; P<.001), relationship with major guardian (r=–0.09, 95% CI −0.11 to −0.07; P<.001), companionship (r=–0.08, 95% CI −0.10 to −0.06; P<.001), solely youngster standing (r=0.02, 95% CI 0.004-0.04; P=.02), gaming time (r=0.16, 95% CI 0.15-0.18; P<.001), poor self-regulation (r=0.10, 95% CI 0.08-0.12; P<.001), impulsive conduct (r=0.12, 95% CI 0.10-0.13; P<.001), BBIS rating (r=0.14, 95% CI 0.12-0.15; P<.001), vanity (r=–0.16, 95% CI −0.17 to −0.14; P<.001), GAD-7 rating (r=0.15, 95% CI 0.14-0.17; P<.001), and PHQ-9 rating (r=0.20, 95% CI 0.18-0.21; P<.001).

‎

Subgroup analyses by intercourse revealed that, for feminine people, there have been vital correlations with age (r=0.04, 95% CI 0.02-0.06; P=.002), years of training (r=0.04, 95% CI 0.01-0.06; P=.005), relationship with major guardian (r=–0.09, 95% CI −0.11 to −0.06; P<.001), companionship (r=–0.09, 95% CI −0.12 to −0.05; P<.001), gaming time (r=0.14, 95% CI 0.11-0.16; P<.001), vanity (r=–0.15, 95% CI −0.17 to −0.13; P<.001), GAD-7 rating (r=0.16, 95% CI 0.14-0.18; P<.001), PHQ-9 rating (r=0.16, 95% CI 0.14-0.17; P<.001), poor self-regulation (r=0.09, 95% CI 0.07-0.12; P<.001), impulsive conduct (r=0.12, 95% CI 0.10-0.15; P<.001), and BBIS rating (r=0.14, 95% CI 0.11-0.16; P<.001). For male people, vital correlations had been discovered with age (r=0.09, 95% CI 0.07-0.11; P<.001), years of training (r=0.08, 95% CI 0.06-0.10; P<.001), relationship with major guardian (r=–0.10, 95% CI −0.12 to −0.07; P<.001), companionship (r=–0.08, 95% CI −0.11 to −0.06; P<.001), gaming time (r=0.18, 95% CI 0.16-0.21; P<.001), vanity (r=–0.18, 95% CI −0.20 to −0.15; P<.001), GAD-7 rating (r=0.16, 95% CI 0.14-0.19; P<.001), PHQ-9 rating (r=0.20, 95% CI 0.18-0.23; P<.001), poor self-regulation (r=0.11, 95% CI 0.09-0.13; P<.001), impulsive conduct (r=0.11, 95% CI 0.09-0.14; P<.001), and BBIS rating (r=0.14, 95% CI 0.12-0.17; P<.001). Additionally, being male was positively correlated with IGD within the general pattern (r=0.07; P<.001).

Identification of Factors Associated With IGD

Overview

Multivariate logistic regression fashions utilizing backward stepwise choice (Wald check) had been used, first, to establish components cross-sectionally related to IGD at baseline and, second, to longitudinally predict IGD case standing at follow-up, as proven in .

‎

Baseline IGD Identification Factors (Cross-Sectional Analysis)

In the general pattern, male intercourse (odds ratio [OR] 2.50, 95% CI 2.10-2.98; P<.001), gaming time (OR 1.11, 95% CI 1.10-1.13; P<.001), PHQ-9 rating (OR 1.12, 95% CI 1.10-1.13; P<.001), impulsive conduct (OR 1.11, 95% CI 1.08-1.15; P<.001), and self-regulation (OR 1.06, 95% CI 1.03-1.10; P<.001) had been recognized as threat components. Protective components included vanity rating (OR 0.95, 95% CI 0.93-0.97; P<.001) and companionship (OR 0.74, 95% CI 0.62-0.89; P=.001).

In intercourse subgroup analyses, widespread cross-sectional identification components for IGD included gaming time (feminine people: OR 1.11, 95% CI 1.08-1.14, P<.001; male people: OR 1.11, 95% CI 1.09-1.13, P<.001), vanity rating (feminine people: OR 0.95, 95% CI 0.92-0.98, P=.002; male people: OR 0.95, 95% CI 0.92-0.97, P<.001), PHQ-9 rating (feminine people: OR 1.14, 95% CI 1.11-1.16, P<.001; male people: OR 1.11, 95% CI 1.09-1.13, P<.001), and impulsive conduct (feminine people: OR 1.16, 95% CI 1.10-1.22, P<.001; male people: OR 1.10, 95% CI 1.06-1.14, P<.001). Differences included that companionship was a protecting issue for feminine people (OR 0.71, 95% CI 0.52-0.97; P=.03), whereas age (OR 1.08, 95% CI 1.02-1.15; P=.02) and poor self-regulation (OR 1.07, 95% CI 1.03-1.11; P=.001) had been extra threat components for male people.

Predictors of IGD on the 1-Year Follow-Up (Longitudinal Analysis)

This examine then examined baseline variables as longitudinal predictors of creating IGD at follow-up. In the general pattern, male intercourse (OR 3.07, 95% CI 2.56-3.68; P<.001), baseline gaming time (OR 1.03, 95% CI 1.01-1.04; P=.005), baseline poor self-regulation (OR 1.29, 95% CI 1.25-1.33; P<.001), and baseline impulsive conduct (OR 1.28, 95% CI 1.24-1.31; P<.001) had been threat components. Protective components included companionship at baseline (OR 0.46, 95% CI 0.39-0.55; P<.001).

In intercourse subgroup analyses, widespread longitudinal predictors included baseline gaming time (feminine people: OR 1.06, 95% CI 1.03-1.09, P<.001; male people: OR 1.02, 95% CI 1.00-1.05, P=.03) and baseline impulsive conduct (feminine people: OR 1.38, 95% CI 1.30-1.46, P<.001; male people: OR 1.27, 95% CI 1.22-1.31, P<.001). Differences included that companionship at baseline was a protecting predictor for feminine people (OR 0.32, 95% CI 0.23-0.43; P<.001), whereas poor self-regulation at baseline (OR 1.32, 95% CI 1.27-1.37; P<.001) was a predictor for male people.

Discussion

Principal Findings

To our data, this examine is the primary large-scale longitudinal investigation in China specializing in the prevalence, influencing components, and intercourse variations relating to IGD amongst rural adolescents, and it offers new proof for intervention methods focusing on IGD amongst adolescents in impoverished rural areas. This pioneering work fills a essential hole in rural psychological well being analysis and has sensible implications for designing tailor-made interventions. Key findings point out that, within the general pattern, the baseline prevalence of IGD was 5.2% (725/13,931), with a 1-year follow-up prevalence of 5% (692/13,931). Both analyses revealed considerably increased prevalence charges amongst male people than amongst feminine people. There had been widespread cross-sex threat components for IGD at each the baseline and follow-up phases: longer gaming time and better impulsivity behaviors. Sex-specific variations had been primarily noticed in protecting components and long-term predictive results—guardian companionship exhibited a big protecting impact for feminine people, whereas poor self-regulation at baseline was a novel long-term predictor for male people. Excluding vanity and depressive states, these findings align with the 4 hypotheses of this examine.

The baseline (725/13,931, 5.2%) and 1-year follow-up (692/13,931, 5%) prevalence charges of IGD amongst rural college students on this examine had been notably decrease than the ten% reported in city Chinese samples []. This discrepancy could also be attributed to restricted web infrastructure, fewer gaming gadgets, and financial constraints limiting frequent gaming in rural areas. Regarding intercourse variations, male people constantly exhibited considerably increased prevalence charges throughout all phases, aligning with most earlier analysis []. This sample could replicate male people’ better choice for aggressive, task-oriented video games and gaming motivations centered on achievement and self-affirmation [].

Individual psychological traits demonstrated secure results in figuring out or predicting IGD. Depressive signs had been vital threat components throughout intercourse subgroups at baseline [], supporting the “emotion escape model” [], which means that people with damaging feelings reminiscent of melancholy or anxiousness could flip to on-line actions reminiscent of gaming as a method to briefly escape these emotions. This maladaptive coping technique can contribute to the event of IGD over time. Impulsivity and poor self-regulation had been considerably related to each cross-sectional and longitudinal outcomes, in step with the interplay of person-affect-cognition-execution mannequin []. The interplay of the person-affect-cognition-execution mannequin proposes that addictive behaviors, together with IGD, come up from the interplay of non-public traits (eg, impulsivity), affective responses, cognitive components, and govt functioning deficits. These components work together to scale back a person’s potential to withstand the quick rewards provided by gaming, thereby rising the probability of creating a dysfunction.

Self-esteem served as a cross-sex protecting issue at baseline, significantly pronounced in feminine people. Individuals with increased vanity could exhibit better psychological resilience when going through peer stress or identification challenges, decreasing reliance on gaming for self-worth—corroborating the buffering impact of vanity in adolescent web dependancy []. Thus, psychological interventions focusing on affective regulation, self-regulation, and self-evaluation could supply efficient pathways for stopping and treating IGD. Notably, after a number of imputation of your complete baseline pattern, baseline vanity now not considerably predicted follow-up IGD, suggesting selective bias within the earlier full case evaluation. The affiliation patterns between low vanity and IGD differed between the follow-up pattern and the pattern misplaced to follow-up, and a number of imputation corrected this bias by estimating the IGD standing of these misplaced to follow-up. Evidently, vanity’s long-term predictive energy for IGD is much less direct and secure than in cross-sectional research, doubtlessly mediated or masked by components reminiscent of impulsivity and household companionship.

Gaming time considerably predicted IGD throughout intercourse subgroups, in step with earlier research [,]. Excessive gaming not solely will increase publicity to digital environments but additionally diminishes real-life social and emotional interactions, reinforcing quick reward mechanisms and deepening immersion [], thereby intensifying dependence. Over time, the weakening of real-world features could lead people to more and more flip to gaming as an escape from stress, which in flip drives longer gaming periods, making a closed loop of addictive conduct. Therefore, focused interventions to manage gaming time mustn’t solely cut back alternatives for triggering addictive conduct at its supply but additionally create circumstances for people to rebuild real-world social connections and restore a way of objective, thereby reducing the danger of creating and progressing into IGD.

Guardian companionship emerged as a big protecting issue at each baseline and follow-up, particularly for feminine adolescents. Stable emotional assist and supervision cut back adolescents’ reliance on digital worlds, in step with household functioning analysis indicating that constructive parent-child interactions, emotional assist, and behavioral monitoring decrease the danger of web dependancy [,]. For impoverished rural college students, the significance of caregiver companionship is much more pronounced: rural left-behind kids generally expertise emotional assist deficits [], and unmet emotional wants could drive compensatory gaming behaviors the place quick suggestions and a way of belonging reinforce use. This discovering aligns with attachment concept, which posits that safe attachment reduces dependence on various emotional sources. For feminine adolescents, lack of companionship considerably elevates threat, underscoring the buffering function of emotional assist [].

This examine highlights vital intercourse variations in predictors of IGD. For feminine adolescents, caregiver companionship was essentially the most salient protecting issue, indicating that familial emotional assist and presence successfully mitigate the danger of gaming dependence when vulnerability arises. Female people with entry to emotional assist, significantly throughout adversity, could higher regulate damaging feelings and cut back the probability of gaming dependancy []. Conversely, poor self-regulation was a big threat predictor for male adolescents. Due to increased extraversion and decrease self-regulation, male people are extra vulnerable to participating in high-stimulation, immediate-feedback gaming actions, rising IGD threat []. This sample aligns with male behavioral tendencies to control feelings by means of exterior stimulation []. The distinct pathways noticed between female and male people recommend that future analysis and intervention methods ought to absolutely contemplate intercourse variations, avoiding one-size-fits-all approaches.

Limitations

There had been a number of limitations to this examine. First, all information relied on self-report, which can introduce social desirability bias (underreporting gaming time to keep away from disapproval) and recall bias (inaccurate reminiscence of previous gaming behaviors), affecting information reliability. Second, the restricted variety of evaluation scales restricted the measurement of key components reminiscent of household parenting types and college interventions, leaving potential associations with IGD unexamined. Third, a single 1-year follow-up didn’t seize long-term dynamic modifications in IGD and the sustained results of influencing components. Fourth, nonrandom sampling (counting on medical packages and government-recommended faculties) could restrict the generalizability of the outcomes to a broader inhabitants of impoverished rural adolescents. Fifth, a second free medical session was not organized in some areas, ensuing within the lack of follow-up information. This could restrict, to a sure extent, the generalizability of this examine’s conclusions to adolescents in areas with out follow-up. Future analysis might handle these limitations by integrating goal information (eg, cell phone use logs) to confirm self-reports, increasing the scales to incorporate parenting- and school-related variables, rising follow-up frequency and period, and adopting random sampling to enhance representativeness.

Conclusions

In abstract, this pioneering large-scale potential longitudinal examine offers strong proof on the prevalence and sex-specific predictors of IGD amongst impoverished rural adolescents in China. The findings reveal that IGD prevalence in rural areas is decrease than that in city areas, with male adolescents exhibiting considerably increased charges than their feminine counterparts. Impulsivity, gaming time, and caregiver companionship emerged as key influencing components, demonstrating notable intercourse variations in each protecting and threat profiles. Specifically, feminine people benefited extra from the protecting function of caregiver companionship, whereas male people had been extra weak to deficits in self-regulation. These findings maintain vital sensible implications, underscoring the need of creating tailor-made public well being methods that handle sex-specific wants, strengthen household assist techniques, and improve psychological resilience to successfully stop and mitigate IGD in these weak communities. Future analysis ought to combine multisource information and conduct long-term follow-ups to deepen understanding of IGD improvement and refine intervention approaches.