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• Published: 10 December 2020

Effect of internet use and electronic game-play on academic performance of Australian children

• Md Irteja Islam 1 , 2 ,
• Raaj Kishore Biswas 3 &
• Rasheda Khanam 1  

Scientific Reports volume  10 , Article number:  21727 ( 2020 ) Cite this article

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This study examined the association of internet use, and electronic game-play with academic performance respectively on weekdays and weekends in Australian children. It also assessed whether addiction tendency to internet and game-play is associated with academic performance. Overall, 1704 children of 11–17-year-olds from young minds matter (YMM), a cross-sectional nationwide survey, were analysed. The generalized linear regression models adjusted for survey weights were applied to investigate the association between internet use, and electronic-gaming with academic performance (measured by NAPLAN–National standard score). About 70% of the sample spent > 2 h/day using the internet and nearly 30% played electronic-games for > 2 h/day. Internet users during weekdays (> 4 h/day) were less likely to get higher scores in reading and numeracy, and internet use on weekends (> 2–4 h/day) was positively associated with academic performance. In contrast, 16% of electronic gamers were more likely to get better reading scores on weekdays compared to those who did not. Addiction tendency to internet and electronic-gaming is found to be adversely associated with academic achievement. Further, results indicated the need for parental monitoring and/or self-regulation to limit the timing and duration of internet use/electronic-gaming to overcome the detrimental effects of internet use and electronic game-play on academic achievement.

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Introduction.

Over the past two decades, with the proliferation of high-tech devices (e.g. Smartphone, tablets and computers), both the internet and electronic games have become increasingly popular with people of all ages, but particularly with children and adolescents 1 , 2 , 3 . Recent estimates have shown that one in three under-18-year-olds across the world uses the Internet, and 75% of adolescents play electronic games daily in developed countries 4 , 5 , 6 . Studies in the United States reported that adolescents are occupied with over 11 h a day with modern electronic media such as computer/Internet and electronic games, which is more than they spend in school or with friends 7 , 8 . In Australia, it is reported that about 98% of children aged 15–17 years are among Internet users and 98% of adolescents play electronic games, which is significantly higher than the USA and Europe 9 , 10 , 11 , 12 .

In recent times, the Internet and electronic games have been regarded as important, not just for better results at school, but also for self-expression, sociability, creativity and entertainment for children and adolescents 13 , 14 . For instance, 88% of 12–17 year-olds in the USA considered the Internet as a useful mechanism for making progress in school 15 , and similarly, electronic gaming in children and adolescents may assist in developing skills such as decision-making, smart-thinking and coordination 3 , 15 .

On the other hand, evidence points to the fact that the use of the Internet and electronic games is found to have detrimental effects such as reduced sleeping time, behavioural problems (e.g. low self-esteem, anxiety, depression), attention problems and poor academic performance in adolescents 1 , 5 , 12 , 16 . In addition, excessive Internet usage and increased electronic gaming are found to be addictive and may cause serious functional impairment in the daily life of children and adolescents 1 , 12 , 13 , 16 . For example, the AU Kids Online survey 17 reported that 50% of Australian children were more likely to experience behavioural problems associated with Internet use compared to children from 25 European countries (29%) surveyed in the EU Kids Online study 18 , which is alarming 12 . These mixed results require an urgent need of understanding the effect of the Internet use and electronic gaming on the development of children and adolescents, particularly on their academic performance.

Despite many international studies and a smaller number in Australia 12 , several systematic limitations remain in the existing literature, particularly regarding the association of academic performance with the use of Internet and electronic games in children and adolescents 13 , 16 , 19 . First, the majority of the earlier studies have either relied on school grades or children’s self assessments—which contain an innate subjectivity by the assessor; and have not considered the standardized tests of academic performance 16 , 20 , 21 , 22 . Second, most previous studies have tested the hypothesis in the school-based settings instead of canvassing the whole community, and cannot therefore adjust for sociodemographic confounders 9 , 16 . Third, most studies have been typically limited to smaller sample sizes, which might have reduced the reliability of the results 9 , 16 , 23 .

By considering these issues, this study aimed to investigate the association of internet usage and electronic gaming on a standardized test of academic performance—NAPLAN (The National Assessment Program—Literacy and Numeracy) among Australian adolescents aged 11–17 years using nationally representative data from the Second Australian Child and Adolescent Survey of Mental Health and Wellbeing—Young Minds Matter (YMM). It is hypothesized that the findings of this study will provide a population-wide, contextual view of excessive Internet use and electronic games played separately on weekdays and weekends by Australian adolescents, which may be beneficial for evidence-based policies.

Subject demographics

Respondents who attended gave NAPLAN in 2008 (N = 4) and 2009 (N = 29) were removed from the sample due to smaller sample size, as later years (2010–2015) had over 100 samples yearly. The NAPLAN scores from 2008 might not align with a survey conducted in 2013. Further missing cases were deleted with the assumption that data were missing at random for unbiased estimates, which is common for large-scale surveys 24 . From the initial survey of 2967 samples, 1704 adolescents were sampled for this study.

The sample characteristics were displayed in Table 1 . For example, distribution of daily average internet use was checked, showing that over 50% of the sampled adolescents spent 2–4 h on internet (Table 1 ). Although all respondents in the survey used internet, nearly 21% of them did not play any electronic games in a day and almost one in every three (33%) adolescents played electronic games beyond the recommended time of 2 h per day. Girls had more addictive tendency to internet/game-play in compare to boys.

The mean scores for the three NAPLAN tests scores (reading, writing and numeracy) ranged from 520 to 600. A gradual decline in average NAPLAN tests scores (reading, writing and numeracy) scores were observed for internet use over 4 h during weekdays, and over 3 h during weekends (Table 2 ). Table 2 also shows that adolescents who played no electronic games at all have better scores in writing compared to those who play electronic games. Moreover, Table 2 shows no particular pattern between time spent on gaming and NAPLAN reading and numeracy scores. Among the survey samples, 308 adolescents were below the national standard average.

Internet use and academic performance

Our results show that internet (non-academic use) use during weekdays, especially more than 4 h, is negatively associated with academic performance (Table 3 ). For internet use during weekdays, all three models showed a significant negative association between time spent on internet and NAPLAN reading and numeracy scores. For example, in Model 1, adolescents who spent over 4 h on internet during weekdays are 15% and 17% less likely to get higher reading and numeracy scores respectively compared to those who spend less than 2 h. Similar results were found in Model 2 and 3 (Table 3 ), when we adjusted other confounders. The variable addiction tendency to internet was found to be negatively associated with NAPLAN results. The adolescents who had internet addiction were 17% less and 14% less likely to score higher in reading and numeracy respectively than those without such problematic behaviour.

Internet use during weekends showed a positive association with academic performance (Table 4 ). For example, Model 1 in Table 4 shows that internet use during weekends was significant for reading, writing and national standard scores. Youths who spend around 2–4 h and over 4 h on the internet during weekends were 21% and 15% more likely to get a higher reading scores respectively compared to those who spend less than 2 h (Model 1, Table 4 ). Similarly, in model 3, where the internet addiction of adolescents was adjusted, adolescents who spent 2–4 h on internet were 1.59 times more likely to score above the national standard. All three models of Table 4 confirmed that adolescents who spent 2–4 h on the internet during weekends are more likely to achieve better reading and writing scores and be at or above national standard compared to those who used the internet for less than 2 h. Numeracy scores were unlikely to be affected by internet use. The results obtained from Model 3 should be treated as robust, as this is the most comprehensive model that accounts for unobserved characteristics. The addiction tendency to internet/game-play variable showed a negative association with academic performance, but this is only significant for numeracy scores.

Electronic gaming and academic performance

Time spent on electronic gaming during weekdays had no effect on the academic performance of writing and language but had significant association with reading scores (Model 2, Table 5 ). Model 2 of Table 5 shows that adolescents who spent 1–2 h on gaming during weekdays were 13% more likely to get higher reading scores compared to those who did not play at all. It was an interesting result that while electronic gaming during weekdays tended to show a positive effect on reading scores, internet use during weekdays showed a negative effect. Addiction tendency to internet/game-play had a negative effect; the adolescents who were addicted to the internet were 14% less likely to score more highly in reading than those without any such behaviour.

All three models from Table 6 confirm that time spent on electronic gaming over 2 h during weekends had a positive effect on readings scores. For example, the results of Model 3 (Table 6 ) showed that adolescents who spent more than 2 h on electronic gaming during weekdays were 16% more likely to have better reading scores compared to adolescents who did not play games at all. Playing electronic games during weekends was not found to be statistically significant for writing and numeracy scores and national standard scores, although the odds ratios were positive. The results from all tables confirm that addiction tendency to internet/gaming is negatively associated with academic performance, although the variable is not always statistically significant.

Building on past research on the effect of the internet use and electronic gaming in adolescents, this study examined whether Internet use and playing electronic games were associated with academic performance (i.e. reading, writing and numeracy) using a standardized test of academic performance (i.e. NAPLAN) in a nationally representative dataset in Australia. The findings of this study question the conventional belief 9 , 25 that academic performance is negatively associated with internet use and electronic games, particularly when the internet is used for non-academic purpose.

In the current hi-tech world, many developed countries (e.g. the USA, Canada and Australia) have recommended that 5–17 year-olds limit electronic media (e.g. internet, electronic games) to 2 h per day for entertainment purposes, with concerns about the possible negative consequences of excessive use of electronic media 14 , 26 . However, previous research has often reported that children and adolescents spent more than the recommended time 26 . The present study also found similar results, that is, that about 70% of the sampled adolescents aged 11–17 spent more than 2 h per day on the Internet and nearly 30% spent more than 2-h on electronic gaming in a day. This could be attributed to the increased availability of computers/smart-phones and the internet among under-18s 12 . For instance, 97% of Australian households with children aged less than 15 years accessed internet at home in 2016–2017 10 ; as a result, policymakers recommended that parents restrict access to screens (e.g. Internet and electronic games) in children’s bedrooms, monitor children using screens, share screen hours with their children, and to act as role models by reducing their own screen time 14 .

This research has drawn attention to the fact that the average time spent using the internet, which is often more than 4 h during weekdays tends to be negatively associated with academic performance, especially a lower reading and numeracy score, while internet use of more than 2 h during weekends is positively associated with academic performance, particularly having a better reading and writing score and above national standard score. By dividing internet use and gaming by weekdays and weekends, this study find an answer to the mixed evidence found in previous literature 9 . The results of this study clearly show that the non-academic use of internet during weekdays, particularly, spending more than 4 h on internet is harmful for academic performance, whereas, internet use on the weekends is likely to incur a positive effect on academic performance. This result is consistent with a USA study that reported that internet use is positively associated with improved reading skills and higher scores on standardized tests 13 , 27 . It is also reported in the literature that academic performance is better among moderate users of the internet compared to non-users or high level users 13 , 27 , which was in line with the findings of this study. This may be due to the fact that the internet is predominantly a text-based format in which the internet users need to type and read to access most websites effectively 13 . The results of this study indicated that internet use is not harmful to academic performance if it is used moderately, especially, if ensuring very limited use on weekdays. The results of this study further confirmed that timing (weekdays or weekends) of internet use is a factor that needs to be considered.

Regarding electronic gaming, interestingly, the study found that the average time of gaming either in weekdays or weekends is positively associated with academic performance especially for reading scores. These results contradicted previous literatures 1 , 13 , 19 , 27 that have reported negative correlation between electronic games and educational performance in high-school children. The results of this study were consistent with studies conducted in the USA, Europe and other countries that claimed a positive correlation between gaming and academic performance, especially in numeracy and reading skills 28 , 29 . This is may be due to the fact that the instructions for playing most of the electronic games are text-heavy and many electronic games require gamers to solve puzzles 9 , 30 . The literature also found that playing electronic games develops cognitive skills (e.g. mental rotation abilities, dexterity), which can be attributable to better academic achievement 31 , 32 .

Consistent with previous research findings 33 , 34 , 35 , 36 , the study also found that adolescents who had addiction tendency to internet usage and/or electronic gaming were less likely to achieve higher scores in reading and numeracy compared to those who had not problematic behaviour. Addiction tendency to Internet/gaming among adolescents was found to be negatively associated with overall academic performance compared to those who were not having addiction tendency, although the variables were not always statistically significant. This is mainly because adolescents’ skipped school and missed classes and tuitions, and provide less effort to do homework due to addictive internet usage and electronic gaming 19 , 35 . The results of this study indicated that parental monitoring and/ or self-regulation (by the users) regarding the timing and intensity of internet use/gaming are essential to outweigh any negative effect of internet use and gaming on academic performance.

Although the present study uses a large nationally representative sample and advances prior research on the academic performance among adolescents who reported using the internet and playing electronic games, the findings of this study also have some limitations that need to be addressed. Firstly, adolescents who reported on the internet use and electronic games relied on self-reported child data without any screening tests or any external validation and thus, results may be overestimated or underestimated. Second, the study primarily addresses the internet use and electronic games as distinct behaviours, as the YMM survey gathered information only on the amount of time spent on internet use and electronic gaming, and included only a few questions related to addiction due to resources and time constraints and did not provide enough information to medically diagnose internet/gaming addiction. Finally, the cross-sectional research design of the data outlawed evaluation of causality and temporality of the observed association of internet use and electronic gaming with the academic performance in adolescents.

This study found that the average time spent on the internet on weekends and electronic gaming (both in weekdays and weekends) is positively associated with academic performance (measured by NAPLAN) of Australian adolescents. However, it confirmed a negative association between addiction tendency (internet use or electronic gaming) and academic performance; nonetheless, most of the adolescents used the internet and played electronic games more than the recommended 2-h limit per day. The study also revealed that further research is required on the development and implementation of interventions aimed at improving parental monitoring and fostering users’ self-regulation to restrict the daily usage of the internet and/or electronic games.

Data description

Young minds matter (YMM) was an Australian nationwide cross-sectional survey, on children aged 4–17 years conducted in 2013–2014 37 . Out of the initial 76,606 households approached, a total of 6,310 parents/caregivers (eligible household response rate 55%) of 4–17 year-old children completed a structured questionnaire via face to face interview and 2967 children aged 11–17 years (eligible children response rate 89%) completed a computer-based self-reported questionnaire privately at home 37 .

Area based sampling was used for the survey. A total of 225 Statistical Area 1 (defined by Australian Bureau of Statistics) areas were selected based on the 2011 Census of Population and Housing. They were stratified by state/territory and by metropolitan versus non-metropolitan (rural/regional) to ensure proportional representation of geographic areas across Australia 38 . However, a small number of samples were excluded, based on most remote areas, homeless children, institutional care and children living in households where interviews could not be conducted in English. The details of the survey and methodology used in the survey can be found in Lawrence et al. 37 .

Following informed consent (both written and verbal) from the primary carers (parents/caregivers), information on the National Assessment Program—Literacy and Numeracy (NAPLAN) of the children and adolescents were also added to the YMM dataset. The YMM survey is ethically approved by the Human Research Ethics Committee of the University of Western Australia and by the Australian Government Department of Health. In addition, the authors of this study obtained a written approval from Australian Data Archive (ADA) Dataverse to access the YMM dataset. All the researches were done in accordance with relevant ADA Dataverse guidelines and policy/regulations in using YMM datasets.

Outcome variables

The NAPLAN, conducted annually since 2008, is a nationwide standardized test of academic performance for all Australian students in Years 3, 5, 7 and 9 to assess their skills in reading, writing numeracy, grammar and spelling 39 , 40 . NAPLAN scores from 2010 to 2015, reported by YMM, were used as outcome variables in the models; while NAPLAN data of 2008 (N = 4) and 2009 (N = 29) were excluded for this study in order to reduce the time lag between YMM survey and the NAPLAN test. The NAPLAN gives point-in-time standardized scores, which provide the scope to compare children’s academic performance over time 40 , 41 . The NAPLAN tests are one component of the evaluation and grading phase of each school, and do not substitute for the comprehensive, consistent evaluations provided by teachers on the performance of each student 39 , 41 . All four domains—reading, writing, numeracy and language conventions (grammar and spelling) are in continuous scales in the dataset. The scores are given based on a series of tests; details can be found in 42 . The current study uses only reading, writing and numeracy scores to measure academic performance.

In this study, the National standard score is a combination of three variables: whether the student meets the national standard in reading, writing and numeracy. Based on national average score, a binary outcome variable is also generated. One category is ‘below standard’ if a child scores at least one standard deviation (one below scores) from the national standard in reading, writing and numeracy, and the rest is ‘at/above standard’.

Independent variables

Internet use and electronic gaming.

In the YMM survey, owing to the scope of the survey itself, an extensive set of questions about internet usage and electronic gaming could not be included. Internet usage omitted the time spent in academic purposes and/or related activities. Playing electronic games included playing games on a gaming console (e.g. PlayStation, Xbox, or similar console ) online or using a computer, or mobile phone, or a handled device 12 . The primary independent covariates were average internet use per day and average electronic game-play in hours per day. A combination of hours on weekdays and weekends was separately used in the models. These variables were based on a self-assessed questionnaire where the youths were asked questions regarding daily time spent on the Internet and electronic game-play, specifically on either weekends or weekdays. Since, internet use/game-play for a maximum of 2 h/day is recommended for children and adolescents aged between 5 and 17 years in many developed countries including Australia 14 , 26 ; therefore, to be consistent with the recommended time we preferred to categorize both the time variables of internet use and gaming into three groups with an interval of 2 h each. Internet use was categorized into three groups: (a) ≤ 2 h), (b) 2–4 h, and (c) > 4 h. Similar questions were asked for game-play h. The sample distribution for electronic game-play was skewed; therefore, this variable was categorized into three groups: (a) no game-play (0 h), (b) 1–2 h, and (c) > 2 h.

Other covariates

Family structure and several sociodemographic variables were used in the models to adjust for the differences in individual characteristics, parental inputs and tastes, household characteristics and place of residence. Individual characteristics included age (continuous) and sex of the child (boys, girls) and addiction tendency to internet use and/or game-play of the adolescent. Addiction tendency to internet/game-play was a binary independent variable. It was a combination of five behavioural questions relating to: whether the respondent avoided eating/sleeping due to internet use or game-play; feels bothered when s/he cannot access internet or play electronic games; keeps using internet or playing electronic games even when s/he is not really interested; spends less time with family/friends or on school works due to internet use or game-play; and unsuccessfully tries to spend less time on the internet or playing electronic games. There were four options for each question: never/almost never; not very often; fairly often; and very often. A binary covariate was simulated, where if any four out of five behaviours were reported as for example, fairly often or very often, then it was considered that the respondent had addictive tendency.

Household characteristics included household income (low, medium, high), family type (original, step, blended, sole parent/primary carer, other) 43 and remoteness (major cities, inner regional, outer regional, remote/very remote). Parental inputs and taste included education of primary carer (bachelor, diploma, year 10/11), primary carer’s likelihood of serious mental illness (K6 score -likely; not likely); primary carer’s smoking status (no, yes); and risk of alcoholic related harm by the primary carer (risky, none).

Statistical analysis

Descriptive statistics of the sample and distributions of the outcome variables were initially assessed. Based on these distributions, the categorization of outcome variables was conducted, as mentioned above. For formal analysis, generalized linear regression models (GLMs) 44 were used, adjusting for the survey weights, which allowed for generalization of the findings. As NAPLAN scores of three areas—reading, writing and numeracy—were continuous variables, linear models were fitted to daily average internet time and electronic game play time. The scores were standardized (mean = 0, SD = 1) for model fitness. The binary logistic model was fitted for the dichotomized national standard outcome variable. Separate models were estimated for internet and electronic gaming on weekends and weekdays.

We estimated three different models, where models varied based on covariates used to adjust the GLMs. Model 1 was adjusted for common sociodemographic factors including age and sex of the child, household income, education of primary carer’s and family type 43 . However, the results of this model did not account for some unobserved household characteristics (e.g. taste, preferences) that are unobserved to the researcher and are arguably correlated with potential outcomes. The effects of unobserved characteristics were reduced by using a comprehensive set of observable characteristics 45 , 46 that were available in YMM data. The issue of unobserved characteristics was addressed by estimating two additional models that include variables by including household characteristics such as parental taste, preference and inputs, and child characteristics in the model. In addition to the variables in Model 1, Model 2 included remoteness, primary carer’s mental health status, smoking status and risk of alcoholic related harm by the primary carer. Model 3 further included internet/game addiction of the adolescent in addition to all the covariates in Model 2. Model 3 was expected to account for a child’s level of unobserved characteristics as the children who were addicted to internet/games were different from others. The model will further show how academic performance is affected by internet/game addiction. The correlation among the variables ‘internet/game addiction’ and ‘internet use’ and ‘gaming’ (during weekdays and weekends) were also assessed, and they were less than 0.5. Multicollinearity was assessed using the variance inflation factor (VIF), which was under 5 for all models, suggesting no multicollinearity 47 .

p value below the threshold of 0.05 was considered the threshold of significance. All analysis was conducted in R (version 3.6.1). R-package survey (version 3.37) was used for modelling which is suited for complex survey samples 48 .

Data availability

The authors declare that they do not have permission to share dataset. However, the datasets of Young Minds Matter (YMM) survey data is available at the Australian Data Archive (ADA) Dataverse on request ( https://doi.org/10.4225/87/LCVEU3 ).

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Acknowledgements

The authors would like to thank the University of Western Australia, Roy Morgan Research, the Australian Government Department of Health for conducting the survey, and the Australian Data Archive for giving access to the YMM survey dataset. The authors also would like to thank Dr Barbara Harmes for proofreading the manuscript.

This research did not receive any specific Grant from funding agencies in the public, commercial, or not-for-profit sectors.

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Centre for Health Research and School of Commerce, University of Southern Queensland, Workstation 15, Room T450, Block T, Toowoomba, QLD, 4350, Australia

Md Irteja Islam & Rasheda Khanam

Maternal and Child Health Division, International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Mohakhali, Dhaka, 1212, Bangladesh

Md Irteja Islam

Transport and Road Safety (TARS) Research Centre, School of Aviation, University of New South Wales, Sydney, NSW, 2052, Australia

Raaj Kishore Biswas

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M.I.I.: Methodology, Validation, Visualization, Investigation, Writing—Original draft preparation, Writing—Reviewing and Editing. R.K.B.: Methodology, Software, Data curation, Formal Analysis, Writing—Original draft preparation. R.K.: Conceptualization, Methodology, Supervision, Writing- Reviewing and Editing.

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Islam, M.I., Biswas, R.K. & Khanam, R. Effect of internet use and electronic game-play on academic performance of Australian children. Sci Rep 10 , 21727 (2020). https://doi.org/10.1038/s41598-020-78916-9

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1 Introduction to Games User Research

• Published: January 2018
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This chapter provides an introduction to the field of Games User Research (GUR) and to the present book. GUR is an interdisciplinary field of practice and research concerned with ensuring the optimal quality of usability and user experience in digital games. GUR inevitably involves any aspect of a video game that players interface with, directly or indirectly. This book aims to provide the foundational, accessible, go-to resource for people interested in GUR. It is a community-driven effort—it is written by passionate professionals and researchers in the GUR community as a handbook and guide for everyone interested in user research and games. We aim to provide the most comprehensive overview from an applied perspective, for a person new to GUR, but which is also useful for experienced user researchers.

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SYSTEMATIC REVIEW article

Massively multiplayer online games and well-being: a systematic literature review.

• 1 School of Health and Behavioural Sciences, University of the Sunshine Coast, Maroochydore, QLD, Australia
• 2 Institute of Health and Sports, Victoria University, Melbourne, VIC, Australia
• 3 School of Psychology, National and Kapodistrian University of Athens, Athens, Greece
• 4 Thompson Institute, University of the Sunshine Coast, Maroochydore, QLD, Australia

Background: Massively multiplayer online games (MMOs) evolve online, whilst engaging large numbers of participants who play concurrently. Their online socialization component is a primary reason for their high popularity. Interestingly, the adverse effects of MMOs have attracted significant attention compared to their potential benefits.

Methods: To address this deficit, employing PRISMA guidelines, this systematic review aimed to summarize empirical evidence regarding a range of interpersonal and intrapersonal MMO well-being outcomes for those older than 13.

Results: Three databases identified 18 relevant English language studies, 13 quantitative, 4 qualitative and 1 mixed method published between January 2012 and August 2020. A narrative synthesis methodology was employed, whilst validated tools appraised risk of bias and study quality.

Conclusions: A significant positive relationship between playing MMOs and social well-being was concluded, irrespective of one's age and/or their casual or immersed gaming patterns. This finding should be considered in the light of the limited: (a) game platforms investigated; (b) well-being constructs identified; and (c) research quality (i.e., modest). Nonetheless, conclusions are of relevance for game developers and health professionals, who should be cognizant of the significant MMOs-well-being association(s). Future research should focus on broadening the well-being constructs investigated, whilst enhancing the applied methodologies.

Introduction

Internet gaming is a popular activity enjoyed by people around the globe, and across ages and gender ( Internet World Stats, 2020 ). With the addition of Internet Gaming Disorder (IGD) in the 5th edition of the Diagnostic and Statistical Manual for Mental Health Disorders (DSM-5; American Psychiatric Association, 2013 ) as a condition requiring further study, followed by the introduction of Gaming Disorder (GD) as a formal diagnostic classification in the 11th edition of the International Classification of Diseases (ICD-11; World Health Organization, 2019 ), research concerning the associated adverse effects of gaming has increased ( Kircaburun et al., 2020 ; Teng et al., 2020 ). Accordingly, a series of potentially harmful aspects of internet gaming, such as reduced social skills, aggression, reduced family connection, interruptions to one's work and education have been cited ( Pontes et al., 2020 ).

Despite such likely aversive connotations, the uptake of internet gaming continues to increase. Recent statistics suggest that 64% of adults in the United States (U.S.) are gamers, 59% of those being male, with the average age range situated between 34 to 45 ( Entertainment Software Association, 2020 ). Of note is that 65% of those gamers are playing with others online or in person and they spend an average of 6.6 h playing per week with others online. Similarly, a survey of 801 New Zealand households (2,225 individuals) revealed that two-thirds play video games, with 34 years being the average age ( Brand et al., 2019 ).

Such high levels of game involvement have been interwoven with high reports of potential well-being benefits in the U.S. sample, including 80% for mental stimulation, 63% for problem solving, 55% for connecting with friends, 79% for relaxation and stress relief, 57% for enjoyment, and 50% for accommodating family quality time ( Entertainment Software Association, 2020 ). Interestingly, 30% of U.S. gamers met a good friend, spouse, or significant other through gaming ( Entertainment Software Association, 2020 ). Thus, video gaming does offer benefits, especially for one's socialization; indeed, gaming can simultaneously engage multiple online players ( Pierre-Louis, 2020 ; Pontes et al., 2020 ).

Multiplayer online games involve a broad genre of internet games, which entail participants playing with others in teams or competing within online virtual worlds ( Barnett and Coulson, 2010 ). A 2017 report of 1,234 Australian households (3,135 individuals) found 67% regularly played video games on computers, tablets, mobile phones, handheld devices, and gaming consoles, with 92% of those playing online with others ( Brand et al., 2017 ). When the “multiple-players” component allows the concurrent inclusion of large numbers (i.e., masses) of gamers, games are referred as massively multiplayer online games (MMOs; Stavropoulos et al., 2019 ). Such games employ the internet to simultaneously host millions of users globally. Participants tend to be organized in groups/teams/alliances competing with each other in the context of game worlds with progressively higher demands and challenges ( Adams et al., 2019 ). Massively multiplayer online role-playing games (MMORPG) expand on this format of play with the introduction of role-playing characteristics through the creation of an avatar. This involves the player establishing their own customizable character for their gameplay, providing an opportunity for gamers to experiment with their own identity in a safe environment ( Stavropoulos et al., 2020 ). Thus, MMORPGs constitute a distinct subgenre of MMOs.

A preponderance of recent research on MMOs has focused specifically on the negative effects of problematic gaming or IGD ( Kircaburun et al., 2020 ; Pontes et al., 2020 ). For instance, a systematic review conducted by Männikkö et al. (2017) focused on health-related outcomes of problematic gaming behavior. This review aligns with prior research that looked at the risk factors and adverse health outcomes of excessive internet usage, particularly among adolescents ( Lam, 2014 ; Goh et al., 2019 ). Despite these efforts, Sublette and Mullan (2012) suggested that the evidence regarding the negative health consequences of gaming is inconclusive (e.g., overall health, sleep, aggression). As Internet games, and especially MMOs, may be also played moderately, they can accommodate a series of beneficial effects for the users such as socialization, a sense of achievement, and positive emotion ( Halbrook et al., 2019 ; Zhonggen, 2019 ; Colder Carras et al., 2020 ). Accordingly, the systematic literature review of Scott and Porter-Armstrong (2013) aimed to offer a more balanced view of the whole range of the positive and the negative effects of participation in MMORPGs, including on the psychosocial well-being of adolescents and young adults. They studied six research articles, where both negative and positive outcomes were identified; for instance, they concluded that problematic/pathological gaming associated with the negative outcomes such as depression, disrupted sleep, and avoidance of unpleasant thoughts. However, they also suggested that the MMORPG context could often provide a refuge from real-world issues, where new friendships and cooperative play could provide enjoyment. Correspondingly, a review of videogame use and flourishing mental health employing Seligman's 2011 positive psychology model of well-being (i.e., positive emotion; engagement; relationships; meaning and purpose; and accomplishment) reported that moderate levels of play was associated with improved mood and emotional regulation, decreased stress and emotional distress, and relaxation. Decisively, Jones and colleagues ( Jones et al., 2014 ) asserted that “videogame research must move beyond a “good-bad” dichotomy and develop a more nuanced understanding about videogame play” (p. 7).

Despite the progress made, no systematic literature to date has synthesized the state of the empirical evidence considering the well-being influences of MMOs. This is important for three reasons: (a) MMOs have had significant advancements in the last 5 years, which may have radically altered their well-being potential (i.e., audio, visual, and augmented reality effects; Alha et al., 2019 ; Semanová, 2020 ); (b) the MMO players community has significantly expanded ( Statista, 2021 ) and; (c) growing empirical evidence has widened the available knowledge of the effects of multiplayer gaming ( Sourmelis et al., 2017 ; Cole et al., 2020 ). Consequently, this present systematic review will contribute to the niche research area referring to the MMOs and well-being association. To address this purpose, the notion of psychosocial well-being and its operationalization needs to be clarified. Scott and Porter-Armstrong (2013) conceived one's level of well-being as expressed through an individual's interpersonal and intrapersonal functioning. In that context, the complexity related to the assessment of one's well-being is acknowledged ( Burns, 2015 ; Linton et al., 2016 ). On that basis, this review utilized the six broad well-being themes as delineated by Linton et al. (2016) to inform the theoretical framework of synthesizing MMO well-being related effects and evidence. The six themes are: (a) mental well-being (e.g., a person's thoughts and emotions); (b) social well-being (e.g., interactions and relationships with others, social support); (c) activities and functioning (e.g., daily activities and behavior); (d) physical well-being (e.g., person's physical functioning and capacity); (e) spiritual well-being (e.g., connection to something greater, faith) and; (f) personal circumstances (e.g., environmental factors; Linton et al., 2016 ).

To enhance the utility of findings, the present review will focus on the most prevalent age range of MMO gamers. The entertainment software association reported that of those playing video games, 21% are under the age of 18 years, 38% between 18 and 34, 26% between 35 and 54 and 15% 55 and over ( Pierre-Louis, 2020 ). In addition, the currently most popular MMOs were identified and targeted. According to the entertainment software association, these involve World of Warcraft, RuneScape, and Guild Wars 2 among gamers older than 13 years ( BeStreamer, 2020 ; Entertainment Software Association, 2020 ). All the available empirical evidence derived by randomized, controlled trials, cross-sectional studies, and case studies with n > 1 that identified any MMOs linked well-being outcomes was included and examined across the six well-being domains identified (see Linton et al., 2016 ). Thus, all the range of interpersonal and intrapersonal well-being outcomes for MMO players over the age of 13 were considered. The ultimate aim of this review is to contribute to balancing the available knowledge surrounding the impact of the popular MMO genre, whilst concurrently illustrating directions for gamer-centered and beneficial future research and mental health practice initiatives.

Materials and Methods

This systematic review followed the methodology suggested in the Preferred Reporting Items for Systematic Reviews and Meta-analysis (PRISMA; Moher et al., 2009 ; Shamseer et al., 2015 ). Research team discussion and perusal of related published reviews assisted the development of the initial research eligibility, search strategy, and related terms. Inclusion and exclusion criteria were further refined at the selection process stage, after exposure and familiarity with the research area; this review was limited to research obtained from database searches.

Eligibility Criteria

All research investigating massively multiplayer online gaming were eligible for review. The initial search eligibility criteria were (i) a publication date between 2012 to 2020; (ii) written in or translated into English language; and (iii) full-text, peer-reviewed primary research.

Information Sources and Search Strategy

Searches were conducted in August 2020 using online databases, JB searched PsycNET (APA), and PUBMED; whereas, LR searched Scopus (see Figure 1 ). In each case, the following search terms and protocol were used (massively multiplayer online OR multiplayer online OR MMORPG OR MMOG) to search abstracts and/or titles. Searches were limited by publication date, 2012 to the present. No specific terms for well-being outcomes were prescribed to ensure that the literature search remained expansive. Accordingly, potential well-being effects were assessed at the screening stage.

Figure 1 . PRISMA flow diagram for the present study.

Selection Process and Data Management

After the title search, abstracts were independently screened by two investigators (JB & LR) for positive outcome measures, fitting within the identified well-being parameters (i.e., Linton et al., 2016 ). Example terms included, but were not limited to, “well-being,” “quality of life,” “social support,” “belonging,” “positive affect,” and “cognitive ability.” Where abstracts contained insufficient/unclear information, the full-text was reviewed for accurate evaluation. The resultant items/studies/records were pooled, and duplicates were removed. The remaining, potentially relevant studies were divided equally between LR and JB, and the full studies were subsequently (and independently) assessed. Where uncertainty of inclusion was noted, articles were screened by the alternate investigator (i.e., JB or LR). Then, if uncertainty regarding inclusion still remained, investigator LK was the final arbitrator (see Figure 1 ).

This detailed screening process utilized the following inclusion criteria: (i) qualitative or quantitative research of any design; (ii) written in or translated into English language; (iii) a primary study aim was psychological well-being (or a component of psychological well-being; Linton et al., 2016 ); and (iv) it was clearly indicated that participants were aged 13 years or over [according to Entertainment Software Association (2020) age ranges of high gaming prevalence]. Studies were excluded if: (i) they were single case studies, reviews of any kind (e.g., systematic reviews or meta-analyses), dissertations or theses, or opinions or discussion papers; (ii) the focus was IGD, problematic gaming or addiction; (iii) they involved online gambling, sexual foci (e.g., cybersex), exergaming, or e-sports; (iv) the game was not generally available to the wider community or was an educational tool; (v) they focused on motivations for engaging in online gaming or on learning English language; or (vi) gaming was not played on computers. Once articles were pooled, each reviewer independently recorded the reasons for excluding the articles in a shared file.

Data Extraction Process

The final studies were summarized according to the following characteristics: (1) study design (e.g., cross-sectional survey); (2) sample characteristics (i.e., size, source of recruitment); (3) the specific MMORPG(s) emphasized; (4) variables (i.e., types of social capital, types of networks); (5) instruments for assessing key variables (e.g., time in game, social capital); (6) the type of analysis used; (7) main findings in relation to well-being (e.g., relationship between game and well-being or with belongingness); and (8) limitations. Investigators SR and LR each independently reviewed half of the studies, with joint discussion to resolve any uncertainties. Table 1 summarizes the reviewed studies.

Table 1 . Main characteristics of reviewed studies ( N = 18).

Data Analysis Procedures and Quality

Given the diversity of study objectives and well-being outcomes reviewed, meta-analysis was not plausible. Therefore, a narrative synthesis methodology was adopted, as it involves a textual summation and explanation of the data which was considered appropriate considering the focus of this review ( Greenhalgh et al., 2005 ; Popay et al., 2006 ). Following the goals of this review, the analysis aimed to identify the key positive or well-being outcomes of playing MMORPGs. Consequently, comparable studies/results were grouped together categorizing the data into themes (and subthemes) that drew on the six well-being themes identified by Linton et al. (2016) . A narrative account of these results is presented under relevant thematic headings, along with any pertinent moderating factors ( Greenhalgh et al., 2005 ).

Risk of bias and quality of evidence evaluations were undertaken using the Appraisal tool for Cross-Sectional Studies ( Downes et al., 2016 ) for the quantitative studies, and the Critical Appraisal Checklist for Qualitative Research ( Joanna Briggs Institute, 2020 ) for the studies that used a qualitative methodology. The Mixed Methods Appraisal Tool ( Hong et al., 2018 ) was used by JB and LR to conduct their independent appraisals of each study. These were then compared and discussed across each item/study/record to conclude agreement.

Study Selection

As per the flow of information and studies is shown in Figure 1 , a total of 1695 studies (PsycNET n = 524, PubMed n = 500, Scopus n = 671) were identified through the initial search. After abstracts were reviewed, 1,431 studies were excluded due to not being suitable for the present review. A further 64 studies were removed for duplication. A full-text review was done on the remaining 200 studies. Of these 182 studies were excluded due to age of participants ( n = 8), focus on IGD or addiction ( n = 32), focus on motivations/predictors of play ( n = 24), not being in English ( n = 4), not being primary research ( n = 30), focused on education ( n = 16), full-text unable to be accessed ( n = 4), not exclusively MMO ( n = 8), only measuring in-game behaviors ( n = 29), or not meeting well-being criteria ( n = 27). Following this screening process, 18 studies were included in the final narrative synthesis (see Figure 1 ).

Study Characteristics

The main characteristics, including the aims and purpose of each study, the well-being measures used, and the results of each of the final 18 studies are noted Table 1 . For those studies which reported the gender of their participants, males accounted for the majority, ranging from 65 to 100% [the latter being the case in the qualitative study of Gallup et al. (2016) ]. One study was equally represented gender-wise ( Cole et al., 2020 ) and one had slightly more females (51%) than males ( Doh and Whang, 2014 ). Participants were from North America, China, Korea, Greece, and Australia. For those studies that reported the game platform, World of Warcraft was the most common ( n = 10). Twelve studies measured time spent gaming with variable time measures, such as hours weekly, per week-day, and weekend. Averages of hours per week ranged from 11 to 36.7, while daily hours were estimated to vary between 2 and 5.

Risk of Bias and Quality of Studies

Quality of reporting, study design quality and risk of bias was assessed for each of the 13 cross-sectional studies. All the cross-sectional studies had a moderate level of risk of bias [studies: 1–4, 8–10, 12, 13, 15-18]. This included sample issues [studies, 1-4, 8-10, 12, 13, 15, 17, 18]. Only one study provided information to justify their sample size, and this was through pragmatic rather than statistical reasons ( Zhang and Kaufman, 2015 ). Although seven studies [studies, 1, 4, 8, 10, 12, 13, 17] had sample sizes over 300, sample size was deemed to be an issue of concern given the millions of MMOG players globally ( Internet World Stats, 2020 ). Sampling methods raised concerns regarding risk of bias and study design quality, as most studies relied on self-selection, and one MMOG was the primary data collection source [six studies used this MMOG alone (studies 2, 9, 11, 16–18), while four studies (studies 1, 4, 14, 15) included this MMOG], although conclusions were often made with reference to MMOGs as a whole. Only six studies [studies, 2, 3, 10, 13, 15, 16] acknowledged or raised concerns regarding response rates, but did not provide clear information on this or expected response rates due to the impossibility of determining sampling frames. Furthermore, due to participant self-selection, the majority of studies did not compare responders and non-responders. Of the two studies [4, 15] that did consider response bias, one ( Cole et al., 2020 ) found no difference between non-completers and completers, while the other ( Xanthopoulou and Papagiannidis, 2012 ) found differences on four demographic characteristics (age, gender, occupational, and marital status). Considering the quality of design, the majority of the 13 cross-sectional studies were deemed to fall into a fair category, with a major concern being the omission of whether ethical approval or participant consent was obtained [studies 2, 3, 8–10, 12, 13, 15] and only three studies reporting that there were no funding or other conflicts [studies 2, 12, 17].

The Joanna Briggs Institute (JBI) critical appraisal checklist for qualitative research was used to assess risk of bias for the qualitative studies ( Joanna Briggs Institute, 2020 ). Overall, the quality of these four studies [5, 6, 7, 11] was assessed as quite good. The JBI checklist highlighted two key concerns: adequate reporting of the positioning and of the research influence of the investigators. Only two of the four studies provided details as to the role or possible influence of the investigators on the research [studies 5, 7], and only one study [7] provided a statement showing the cultural and or theoretical perspective of the investigator.

Of the 18 studies, four were qualitative [5, 6, 7, 11] one was a mixed method design [14] and the others were all cross-sectional by design [1–4, 8–10, 12, 13, 15–18]. This led to all results showing exclusively correlational and/or regression links/effects, with unclear direction of causality regarding the MMO gaming and well-being experiences association. Only one study ( Xanthopoulou and Papagiannidis, 2012 ) was longitudinal in design with the second measurement being obtained 1 month after the first responses were collected, allowing for stronger predictive inference.

The well-being outcomes assessed in all the studies were operationalized similarly to authors' expectations aligning with the framework provided by Linton et al. (2016) . Two predominant types of positive outcomes were addressed by the included studies: social well-being and mental well-being. Additionally, one study ( Shen and Chen, 2015 ) [13] considered physical well-being. Several game attributes were considered as predictors across the studies reviewed. The most common attribute was the social aspect as examined by 15 studies [2–4, 6–14, 16–18]. This referred to modes of communication (e.g., in-game talk, game bulletin boards, online comms outside the game), “who” the gamers play with (e.g., real-world friends, on-line friends, family), and time spent gaming. The synthesized results are presented through the lenses of the 2 main well-being outcomes identified.

Social Well-Being

Of the 18 studies, 15 included some form of measurement of social well-being. O'Connor et al. (2015) [study 11] reported that participants of WoW game received social support from others within this gaming community. Gallup et al. (2016) [study 6] and Gallup et al. (2017) [study 7] found that using the online game environment was beneficial for secondary and tertiary students with an Autism Spectrum Disorder (ASD) diagnosis, to develop social connections as well as communication and relationship skills. This skill development also led to improved post-secondary education transitioning. Cole et al. (2020) [study 4] also looked at whether social support increased in the gaming environment, finding that more time spent in playing in guilds as related to higher levels of social support, and that this was correlated with cognitive-emotional outcomes. Additionally, they compared on-line and in-person social support and outcomes, finding differential effects. Cole et al. (2020) [study 4] concluded that MMOGs represent different social support environments, and as such, online worlds could be used as a new and different source of social support. These findings are echoed by Voulgari et al. (2014) [study 14], whose mixed methods research across more than 10 MMOGs found that gaming developed collaborative skills and social bonds additional to real-life relationships. Moreover, gaming constituted a part of the gamers' existing real-world social life.

Social capital effects investigated by the reviewed studies included bonding and bridging aspects. Bonding related social capital implies a deeper form of social support, experienced by those with whom one maintains emotional intimacy, such as their family and friends ( Meng et al., 2015 ) [study 10]. In the game context, bonding social capital refers to the support networks within a specific online gaming group or community, such as one's guild (i.e., group of in-game allies) or group within a particular game ( Claridge, 2020 ). Bridging social capital refers to the support, mainly by sharing information and resources, one may experience from broader and less intimate social groups they belong into, such as their social class, race, and religion ( Perry et al., 2018 ) [study 12]. Castillo (2019) [study 2] found greater bridging social capital experienced when gamers presented more motivated to form relationships with others, compared to gaming for competitive reasons. Moreover, Meng et al. (2015) [study 10] found that playing frequently in the online gaming environment with existing offline friends was positively correlated with both higher bridging and higher bonding social capital. This aligned with Kaye et al. (2017) findings, that playing with online and real-world friends, as well as online interactions in-game and outside, was positively related to both higher bridging and higher bonding social capital.

The study by Perry et al. (2018) [study 12] reported that harmonious passion for playing MMOGs helped build social capital; however, when this passion was obsessive, the outcomes were negative. Their study further found that playing with real-life friends was positively associated with higher bonding social capital experienced by gamers. Interestingly, playing with strangers, and possible new friends, was positively associated with increased bridging social capital. Choi (2019) [study 3] extended such findings by focusing on the link between a gamer's social interactions, avatar identification, and social capital. Higher avatar (i.e., in-game figure representing the gamer) identification was related to increased real-life social capital, with one's greater perception of in-game social interactions linked to higher levels of avatar identification and subsequently elevated social capital.

Three of the articles reviewed [Studies 16, 17, & 18] focused specifically on social well-being among older populations, with all participants exceeding 55 years. These studies by Zhang and Kaufman (2015) [study 16], Zhang and Kaufman (2016) [study 17], and Zhang and Kaufman (2017) [study 18] all looked at the social interactions of older adults in MMORPGs. It was found that enjoyment of relationships in the online game was positively related to both bridging and bonding social capital, and this was partly associated to a gamer's amount of game play, active participation in guilds, and their reported enjoyment of the game. The same three studies also suggested that gaming contributed to maintaining existing family and friend relationships, as well as the development of new meaningful friendships. One of the studies, did imply, however, that new online friends did not easily integrate into the older gamers' real lives ( Zhang and Kaufman, 2017 ) [study 18]. They explained that as the result of older adults' lesser need for large networks, as well as geographical limitations.

Lastly, one article looked at social well-being through the lens of marital satisfaction ( Ahlstrom et al., 2012 ) [study 1]. They reported that compared to couples where only one member is a gamer, couples who game together experience higher levels of marital satisfaction. Higher marital satisfaction was related to more time spent in in-game interaction and higher satisfaction of playing together. They supported that gaming is a leisure activity, where when only one person is immersed, disruption to marital harmony may be caused. Indeed, this was confirmed by both types of couples (e. g., only one gaming vs. both gaming), when considering their different or similar bedtimes and their arguments over the time spent in gaming compared to the time spent together.

Mental Well-Being

A smaller proportion of studies looked at the effects of MMOG on components of mental well-being such as self-esteem, depression, stress, general affect, and skill acquisition. Self-esteem was specifically identified in three articles [Studies 3, 4, & 8] and was related to social support received in the game and with positive gamer identities in an MMORPG ( Kaye et al., 2017 ; Choi, 2019 ; Cole et al., 2020 ). In their study investigating MMO involvement, gamer identity, and social capital, Kaye et al. (2017) [study 8] found that higher MMO involvement increased with higher bonding and bridging social capital and solidified gamers' identity, which in turn increased their self-esteem and decreased their loneliness. Similarly, Choi's 2019 [study 3] study into the effects of avatar self-identification indicated that perceptions of social support from MMORPG increased avatar identification alongside the gamers' real-life self-esteem. In their examination of a Compensatory Social Interaction Model, Cole et al. (2020) [study 2] investigated the associations between one's MMORPG guild play, social support, peer victimization, self-esteem, depression and stress. Gamers who engaged more in guild play, experienced higher levels of social support (compared to levels of peer victimization), which resulted in improved self-esteem, lower depression, and stress symptoms. Martončik and Lokša (2016) [study 9] directly looked at the social effects of WoW's (i.e., guild affiliation, communication used) on individual's mental well-being. Their study revealed that gamers perceived their level of loneliness as significantly lower in the online world than in the real world. Additionally, gaming with others already known to the player in their real-life decreased perceptions of real-world loneliness. Martončik and Lokša (2016) [study 9] also found that levels of anxiety were lower in the online world, when gamers perceived themselves as less lonely. Similarly, lower levels of loneliness and depression among gamers aged over 55 years were predicted by higher quality of guild play [study 18]. This suggested that for older adults, being an active member of an in-game guild, may improve their emotional well-being ( Zhang and Kaufman, 2017 ).

The mixed methods study by Voulgari et al. (2014) [study 14] contributed information across a combination of different social, cognitive, and emotional well-being outcomes of gaming. Their study found that playing MMOGs had positive impacts on gaining social skills and improving cognitive skills, as well as a positive affective impact. The cognitive skills they identified to have been improved included procedural knowledge and problem-solving skills. The acquisition of such cognitive and social skills was reported to be transferable into their offline world. The authors also reported that for some gamers, positive affective impacts, such as enjoyment and satisfaction, were the most important outcomes. In-game and work leadership skills were looked at by Xanthopoulou and Papagiannidis (2012) [study 15] in their examination on the effects of gaming on real-life employment. They found that in-game active learning was reflected in active learning at work, but only for high game performers. Moreover, transformational leadership was shown to spill over into a player's work life, although this appears to be enhanced by higher game performance.

In that line, Doh and Whang (2014) focused on the development of behavioral statements to establish the gaming environment as a different pathway to use in identity development. They reported that a player's motivation to participate in online gaming could progressively lead to an alternated identity. Lastly, Shen and Chen (2015) explored the effect of gaming related social capital into health-related outcomes. This study found that bonding and not bridging social capital occurring while playing online related to reduced health disruption in one's daily lives.

The increasing preference for MMO gaming for leisure and e-sport has led to a large body of research investigating the possible adverse outcomes related to their excessive usage ( Stavropoulos et al., 2019 , 2020 ). However, less is known about the possible benefits of moderate MMO gaming for one's individual psychosocial well-being. The aim of this review was two-fold: (a) to identify and summarize the empirical evidence for the potential interpersonal and intrapersonal positive well-being outcomes for non-excessive MMO players over the age of 13; and (b) to identify possible research priorities in relation to better understanding the beneficial effects of MMO gaming. Overall, a positive relationship between playing MMOs and social well-being was found.

This systematic review identified 18 studies that were published between 2012 and 2020, and which investigated the adaptive well-being outcomes of MMOG for adolescent and adult players. These studies examined two key aspects of psychosocial well-being, as defined by Linton et al. (2016) . Firstly, one's social well-being, encompassing individuals' connections with others—their interactions, their depth of relationships, and the social support their connections provided, was emphasized by the reviewed empirical evidence. This was the dominant topic of interest, while the gamers' mental well-being (e.g., individual psychological, emotional, and cognitive aspects) followed. In order to investigate these outcomes, gaming attributes such as gaming time, game performance, gamer identity, types of communication one is engaged in, type of co-players (e.g., online or offline friends, family, strangers), and guild membership were examined.

In that context, a commonly used measure of social well-being employed in the studies reviewed was social capital. The significant positive relationship found between MMOG engagement and bridging and bonding social capital in those studies appears promising. Specifically, reviewed findings in studies 2, 10, 12, and 16 suggest there is strong support for the notion that MMO gaming may foster one's social well-being in both virtual worlds and in their off-line lives ( Meng et al., 2015 ; Zhang and Kaufman, 2015 ; Perry et al., 2018 ; Castillo, 2019 ). Moreover, such evidence is strengthened by studies 1, 3, 4, 6, & 18, which utilized more discrete measures of social well-being, such as one's perceptions of social support, social interactions, and marital satisfaction, showing that MMO gaming bolstered these too ( Ahlstrom et al., 2012 ; Gallup et al., 2016 ; Zhang and Kaufman, 2017 ; Choi, 2019 ; Cole et al., 2020 ). These overall positive conclusive impacts on one's social well-being seem to be reasonably robust given (a) the diverse game attributes considered in these studies (e.g., time spent in play, gamer identity, frequency of play with different types of co-players, avatar identification); and (b) the diverse age and ethnicities of gamers that these impacts were found with-including a small and unique group of gamers with ASD. Moreover, the impacts of MMORPG on social well-being were apparent in both quantitative and qualitative research. Nevertheless, and in line with the current PRISMA systematic literature review's study eligibility criteria, it should be reiterated that the majority of the gamers in the studies reviewed were classified as non-problematic gamers, with study 5 actively excluding those who fit criteria for addiction (e.g., Doh and Whang, 2014 ). Similarly, reviewed studies 12 and 18 included gamers who could be classified as experienced and/or as heavy users, yet they had received no formal diagnosis ( Zhang and Kaufman, 2017 ; Perry et al., 2018 ). Thus, due to the wide range of time participants spent gaming, the findings are applicable to both the more casual and immersed gamer populations, solidifying the positive effects of MMO gaming on one's social well-being.

Further, the reviewed studies examined the mental well-being effects of one's MMO gaming. Self-esteem, loneliness, depression, and positive affect were the main psychological outcomes investigated, while studies 7 and 14 looked at cognitive skill acquisition ( Voulgari et al., 2014 ; Gallup et al., 2017 ). Overall, these studies found that gaming bolstered self-esteem, and reduced depression, stress, and loneliness, whilst fostering cognitive and social skills. However, these positive findings should be treated with some caution, as these variables were only considered in a handful of the studies and such revealed effects may be interwoven with one's concurrently experienced positive social well-being outcomes. More studies need to be conducted among MMO gamers, in which mental well-being outcomes are of primary focus, and social variables are controlled for.

Taken together, this review provides validation to game developers, educators, health professionals, and policy makers, that despite evidence regarding the adverse outcomes of excessive MMO gaming and problematic gaming behavior, there are important psychosocial benefits to be gained from moderate and adaptive gaming. This information is relevant to game developers as they should be encouraged to find ways to enhance social contact opportunities. Moreover, it is important that health professionals and educators are aware that MMO gaming is an avenue for social connection and support, similar to other real-world leisure and sporting pursuits. Pathologizing gaming could well undermine the identity, social, and psychological well-being of those who actively benefit by their moderate and adaptive gaming engagement.

Strengths and Limitations

The validity of these results is restricted due to the heterogeneity of methodologies used in the studies reviewed. Although qualitative and quantitative empirical evidence was included, most studies used a descriptive design to assess the self-reported effects of MMO gaming on well-being. Moreover, although many of the studies controlled for some covariates, such as demographic variables or gaming time, variables of interest were narrow, and other unmeasured variables might account for some of the observed effects. Additionally, although many of the predictor measures had solid theoretical bases, others have not been fully trialed (e.g., intensity of interaction, multimodal connectedness), contributing to possible validity issues. Furthermore, the value of the findings is impacted by a lack of generalizable results. For example, self-selection bias was reported by several studies, where heavy gamers or an overly well-educated sample was used, and some studies looked at specific populations (e.g., 55+ years, those with ASD; Zhang and Kaufman, 2015 ; Gallup et al., 2017 ) [See studies 7 & 16]. The sample of MMO games examined was also narrow, with WoW dominating. Finally, only a limited number of well-being constructs were examined by the 18 studies, thus the conclusions regarding well-being have limited generalizability/need to be treated with caution due to narrow constructs covered. Of note was a lack of variety in the well-being outcomes being studied. While social well-being is an important part of MMO gaming, little is known about other aspects of well-being such as mental well-being, spiritual well-being, and physical well-being. The fact that no randomized control trials have been undertaken to contribute to the research on well-being outcomes and MMO participation is an important omission in this field of study.

This review was limited to peer-reviewed studies published in three academic databases between 2012 and August 2020, at one particular point in time. Therefore, the review may be subject to English-language and publication bias, and the studies included may not be a representative sample. Relevant research may also have been missed due to including the use of selected search terms, and this review did not include non-peer-reviewed literature (e.g., theses, conference proceedings), which may have omitted important data. Finally, well-being is a broad concept, and other reviews may generate different empirical evidence dependent on the operationalizations followed.

Despite the noted review-level limitations, this study has several strengths. First, this review used rigorous methodology, following PRISMA guidelines and assessing quality and risk of bias using validated tools. Additionally, the inclusivity of study design has meant we have captured data through diverse approaches with similar outcomes. Finally, the broad search parameters with regards well-being ensured that we did not limit the construct to narrow conceptualizations of well-being outcomes related to MMO gaming.

This review has offered a valuable examination of the current research on the psychosocial benefits of multiplayer online gaming. It is important to note the number of reviewed studies that reported significant positive outcomes regarding social well-being. The major limitation of the review relates to the modest quality of research in the area, and the limited aspects of well-being investigated to date. While social well-being is an important part of MMO gaming, there is very little known about other aspects of well-being such as mental well-being, spiritual well-being, and physical well-being.

Recommendations for future research include broadening the well-being constructs that are investigated in relation to gaming. Clear and consistent operationalization of commonly used variables and measures and standardized demographic information would provide greater validity and comparability of results. Longitudinal research in which baseline measurements of well-being and other variables are taken to assess changes in this outcome, to determine causation and not merely correlational effects is also required. Finally, using a greater variety of gaming platforms, instead of mostly WoW, would provide increased robustness for positive well-being outcomes related to MMOGs.

Data Availability Statement

The original contributions presented in the study are included in the article, further inquiries can be directed to the corresponding author/s.

Author Contributions

LR and JB performed the bibliographic search, participated in the selection of included studies, resolved methodological doubts of possible studies, and helped in the all versions of this manuscript. LK-D and VS were senior authors and were involved in the review design and review aim, also the above processes conducted by LR and JB, and manuscript revision and submission. PM, AA, HS, JM, TD, and AW contributed in the interpretation of the results and the improvement of the manuscript. PM also contributed to mentoring in the PRISMA process. All authors contributed to the article and approved the submitted version.

VS has received the Australian Research Council, Discovery Early Career Researcher Award (DE210101107).

Conflict of Interest

The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

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Keywords: MMOs, internet gaming, systematic literature review, PRISMA, well-being, massively multiplayer online

Citation: Raith L, Bignill J, Stavropoulos V, Millear P, Allen A, Stallman HM, Mason J, De Regt T, Wood A and Kannis-Dymand L (2021) Massively Multiplayer Online Games and Well-Being: A Systematic Literature Review. Front. Psychol. 12:698799. doi: 10.3389/fpsyg.2021.698799

Received: 22 April 2021; Accepted: 25 May 2021; Published: 30 June 2021.

Reviewed by:

Copyright © 2021 Raith, Bignill, Stavropoulos, Millear, Allen, Stallman, Mason, De Regt, Wood and Kannis-Dymand. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY) . The use, distribution or reproduction in other forums is permitted, provided the original author(s) and the copyright owner(s) are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.

*Correspondence: Vasileios Stavropoulos, Vasileios.Stavropoulos@vu.edu.au

† These authors have contributed equally to this work and share first authorship

Disclaimer: All claims expressed in this article are solely those of the authors and do not necessarily represent those of their affiliated organizations, or those of the publisher, the editors and the reviewers. Any product that may be evaluated in this article or claim that may be made by its manufacturer is not guaranteed or endorsed by the publisher.

Knowledge check-based concept mapping in digital games: impacts on students’ learning performance and behaviors

• Development Article
• Published: 24 April 2024

Cite this article

• Kuan-Fu Chen 1 , 5 ,
• Gwo-Jen Hwang   ORCID: orcid.org/0000-0001-5155-276X 1 , 2 , 3 &
• Mei-Rong Alice Chen 4  

Many studies have incorporated concept maps into digital games to enable learners to make connections between subject concepts in the game. However, most learners do not associate spontaneously with the thematic concepts in the game but need to be facilitated by effective scaffolding mechanisms to reconceptualize the learning process and content. Therefore, this study proposed a knowledge check-based concept map-guided gaming strategy for chemistry learning for secondary-level learners. Specifically, the knowledge check-based concept map-guided gaming strategy was employed as a learning strategy while playing digital games. The knowledge check mechanismwas developed based on the notation of two-tier testing. Moreover, the learning environment was a self-developed chemical classification-based digital game, in which learners learned through concept mapping guided gaming tasks with factual and conceptual questions to confirm that they can actually learn content and conceptual understanding in the game. To understand the effects of the proposed strategy, a quasi-experimental design was adopted to measure compare two groups’ learning achievement, problem-solving awareness, critical thinking tendency, and germane cognitive load of seventh-grade students using the knowledge check-based concept map-guided gaming strategy and the conventional concept map-guided gaming strategy. The results of the study showed that learners’ learning achievement, problem-solving awareness, critical thinking tendency, and germane cognitive load in chemistry learning were effectively improved by the knowledge check-based concept map-guided gaming strategy. Furthermore, this study implies that teachers can adjust their teaching scaffolds and provide strategies according to learners’ learning behaviors in digital game-based learning.

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The datasets generated and analyzed during the current study are not publicly available due to privacy and ethical considerations concerning student data. However, the manuscript provides a comprehensive account of the data used, the methodologies employed in data collection, and the analytical processes applied. Researchers interested in replicating the study or inquiring further into the data may contact the corresponding author. Access to the data will be granted following an assessment of the request and ensuring compliance with privacy regulations and institutional policies.

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This study is supported in part by the National Science and Technology Council of Taiwan under contract numbers NSTC 112-2410-H-011-012-MY3 and MOST 111-2410-H-011 -007 -MY3. The study is also supported by the “Empower Vocational Education Research Center” of National Taiwan University of Science and Technology (NTUST) from the Featured Areas Research Center Program within the framework of the Higher Education Sprout Project by the Ministry of Education (MOE) in Taiwan.

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Chen, KF., Hwang, GJ. & Chen, MR.A. Knowledge check-based concept mapping in digital games: impacts on students’ learning performance and behaviors. Education Tech Research Dev (2024). https://doi.org/10.1007/s11423-024-10378-6

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Internet gaming addiction: current perspectives

Daria j kuss.

Psychology Research and Behavior Management, Birmingham City University, Birmingham, UK

In the 2000s, online games became popular, while studies of Internet gaming addiction emerged, outlining the negative consequences of excessive gaming, its prevalence, and associated risk factors. The establishment of specialized treatment centers in South-East Asia, the US, and Europe reflects the growing need for professional help. It is argued that only by understanding the appeal of Internet gaming, its context, and neurobiologic correlates can the phenomenon of Internet gaming addiction be understood comprehensively. The aim of this review is to provide an insight into current perspectives on Internet gaming addiction using a holistic approach, taking into consideration the mass appeal of online games, the context of Internet gaming addiction, and associated neuroimaging findings, as well as the current diagnostic framework adopted by the American Psychiatric Association. The cited research indicates that the individual’s context is a significant factor that marks the dividing line between excessive gaming and gaming addiction, and the game context can gain particular importance for players, depending on their life situation and gaming preferences. Moreover, the cultural context is significant because it embeds the gamer in a community with shared beliefs and practices, endowing their gaming with particular meaning. The cited neuroimaging studies indicate that Internet gaming addiction shares similarities with other addictions, including substance dependence, at the molecular, neurocircuitry, and behavioral levels. The findings provide support for the current perspective of understanding Internet gaming addiction from a disease framework. The benefits of an Internet gaming addiction diagnosis include reliability across research, destigmatization of individuals, development of efficacious treatments, and the creation of an incentive for public health care and insurance providers. The holistic approach adopted here not only highlights empirical research that evidences neurobiologic correlates of Internet gaming addiction and the establishment of a preliminary diagnosis, but also emphasizes the necessity of an indepth understanding of the meaning, context, and practices associated with gaming.

Introduction: the mass appeal of Internet gaming

Internet gaming is a booming market. In 2012, more than one billion individuals played computer games, which fuelled the 8% growth of the computer gaming industry in the same year. 1 A recent report by the market research company Niko Partners has estimated the People’s Republic of China’s online gaming market at $12 billion in 2013. 2 Massively Multiplayer Online games (MMOs) offer the possibility to play together with many other players and can be differentiated based on game content and player experience. A latent profile analysis of survey data from 4,374 Hungarian online gamers (91% male, mean age 21±6 years) indicated that the most prominent MMOs were role-playing games, first-person shooters, real-time strategy, and other games. 3 First-person MMO shooter games are based on skill because they require good reaction time and attention, and competition is a key aspect of these games. In real-time MMO strategy games, players organize teams, develop their skills, and play for status in the game. 4

Massively Multiplayer Online Role-Playing Games (MMORPGs), on the other hand, appear of particular interest to players because they offer a variety of incentives for play relative to other game genres. Of all online gamers, 46% play MMORPGs, 3 confirming their position as the most popular online games. MMORPGs are game universes inhabited by thousands of players at the same time (massively multiplayer) with no spatial or temporal boundaries because they are played online, and they allow players to adopt various virtual personas vis-à-vis their avatars (role playing). 5 Today’s most popular MMORPG is “World of Warcraft”, the latest game in Blizzard’s Warcraft series, situated in the fantasy world of Azeroth that is populated by members of the opposing factions of the Alliance and the Horde. 6 According to a recent report published by the Entertainment Software Association, 7 World of Warcraft’s extension “Cataclysm” was among the top five selling computer games in 2011. In 2013, eight million players immersed themselves in the world of Azeroth, 8 clearly demonstrating the game’s mass appeal. The game tailors to most age groups, both sexes, and various player interests and preferences, 6 making it an MMORPG success story par excellence.

Online games such as World of Warcraft satisfy various gaming motivations. The analysis by Yee 9 of 3,000 MMORPG players’ gaming motivations revealed that MMORPGs allow players to achieve game goals, be social, and immerse in the game. Each of these factors is composed of a number of subcomponents as particularized by the gamers. First, achievement includes advancing in the game, namely progressing via leveling up, acquiring status and power in the game, the game’s mechanics, including the possibilities for optimizing game play, and competition, including challenging and dominating others. 9 Reputation and admiration from the gaming community for gaming achievements are further key factors motivating players to keep playing. 6 The game mechanics or structural characteristics have been claimed to reinforce the potentially addictive qualities of games because they contribute to initiation, development, and maintenance of gaming. 10

Second, the social factor is composed of socializing, including chatting and making new friends in the game, forming new relationships, and working in a team. 9 Research 11 suggests that the social element in MMORPGs is particularly important for gamers because it is an integral component of the enjoyment of playing. Moreover, it denotes a complex interaction between real and virtual social networks, further blurring the boundaries between these networks, making MMORPGs inherently social spaces. 12

Third, immersion in the game is denoted by discovery, ie, exploring the game and “hidden” game content, role-playing via one’s avatar, customization of one’s online character (such as sex, race, profession, appearance), and escapism, ie, playing in order to avoid real life. 9 Escapism is an aspect of mood modification whereby individuals suffering from addictions induce a subjective shift in their mood by way of engaging in an addictive behavior, making the latter a coping strategy to deal with everyday problems. 13

The variety of gaming motivations satisfied by MMOR-PGs indicates that these types of games are particularly versatile because they can be tailored to individual players with different game preferences. Consequently, one could assume that there are many ways that might lead some individuals to get hooked on MMORPGs. In a sample of 696 MMORPG players (93% male, mean age 26±7.4 years), achievement, socializing, and escapism motivations were found to be predictive of addictive play, together with sex accounting for 19% of variance in the MMORPG addiction score. 14 Similarly, in a sample of 175 primarily Dutch MMORPG players (87% male, mean age 21±6.5 years), escapism and game mechanics predicted excessive gaming over and above the contribution of the time spent gaming, together explaining 46% of the variance in problematic gaming. 5 In a nutshell, the mass appeal of MMORPGs rests on their versatility because they are tailored to gamers young and old, male and female, who have different game preferences. MMORPGs are particularly good at meeting various players’ different needs. This mass appeal may have contributed to findings from research which indicate that online games, and specifically MMORPGs, are more addictive than any other types of both offline and online games 15 because they reward players on partial reinforcement schedules, leading to maintenance of play. 16

Internet gaming addiction

In recent years, research about Internet gaming addiction has increased both in quantity as well as in quality. Research on gaming addiction dates back to 1983, when the first report emerged suggesting that video gaming addiction is a problem for students. 17 Shortly thereafter, the first empirical study on gaming addiction was published by Shotton, 18 based on self-reports of young male players who claimed they were “hooked” on their games. The early studies suffered from a lack of standardized psychometric instruments used for assessing gaming addiction. 19 However, research 20 indicates that self-reports correlate with standardized measures. Following on from that, further studies were carried out in the 1990s, initially assessing gaming addiction based on the criteria for pathologic gambling as stipulated in the third and fourth editions of the Diagnostic and Statistical Manual for Mental Disorders (DSM). 21 Although similar, pathological gambling and excessive gaming do not present with the same clinical picture, and some have argued that using the diagnostic criteria for pathological gambling in order to diagnose pathological gaming only taps into obsessive use and preoccupation rather than actual psychopathology. 22 In the 2000s, online games became popular, while studies of Internet gaming addiction emerged. 23 , 24

The studies on Internet gaming addiction in the new millennium reported prevalence estimates which vary significantly and range from 0.2% in Germany 25 , 26 to 50% of Korean teenagers. 27 This discrepancy in estimates is due to various conceptualizations, diverse measurement instruments, as well as the different cutoff points used. Further, dissimilar constructs (“Internet gaming addiction”, “dependence”, “problematic”, and “excessive play”) are measured in various samples (children, adolescents, gamers) and cultures. In most studies, self-reports have been used, which puts the reliability and validity of the potential diagnosis in question. 28 However, research 20 indicates that self-diagnosis correlates with standardized measures of addiction, suggesting that the individual’s perception of problems can be relatively accurate.

In South-East Asian countries, the negative impacts of Internet gaming addiction have led governments and health care providers to take the problem seriously and to develop a series of initiatives to curb and alleviate the problem. In South Korea, Internet gaming addiction is viewed as a significant concern for public health, 29 and up to 24% of children who have been diagnosed with Internet addiction are hospitalized. 30 In Japan, the government has recognized the problem following a study by the Ministry of Education, which has led to the development of “fasting camps” where individuals suffering from Internet and gaming addiction are helped by being cut off from technology completely. 31 It has been stated that the higher the Internet penetration and social acceptance of gaming, the higher the prevalence of gaming problems, 32 partially explaining the higher prevalence rates reported in South-East Asian countries. In addition to this, there is good reason to think that the lower acceptance of excessive gaming in a culture, the more distress (not less) gamers experience in engaging in the activity, potentially fuelling problem perception. Therefore, a lack of acceptance of excessive gaming and thus stigmatization of the behavior might contribute to higher rates of addiction and problematic play in some way. Following growing concern, specialized treatment centers and programs have been established in Europe (including the outpatient clinic for behavioral addictions in Mainz, Germany, and the Capio Nightingale Hospital in London, UK) and the US (including the inpatient centers RESTART Internet Addiction Recovery Program in Seattle and the recently opened digital detoxification and recovery center in Pennsylvania), reflecting the growing need for professional help.

The concerns appear to be grounded as a growing number of studies indicate that Internet gaming addiction is associated with various negative consequences. 15 The psychological consequences include the following: sacrificing real-life relationships, other pastime activities, sleep, work, education, socializing, and relationships, 33 – 40 obsession with gaming and a lack of real-life relationships, 41 lack of attention, 33 , 42 aggression and hostility, 42 , 43 stress, 33 dysfunctional coping, 33 , 44 , 45 worse academic achievement, 38 , 46 problems with verbal memory, 47 and low well-being and high loneliness. 48 Moreover, psychosomatic consequences have been found in a number of studies. These included problems with sleeping, 41 , 47 seizures, 49 and psychosomatic challenges. 33 This long list indicates that Internet gaming problems must be taken seriously as they can affect the individual negatively in a variety of ways.

Internet gaming addiction is a behavioral problem that has been classified and explained in numerous ways. According to Griffiths, 13 biopsychosocial processes lead to the development of addictions, such as Internet gaming addiction, which include the following components. First, the behavior is salient (the individual is preoccupied with gaming). Second, the individual uses the behavior in order to modify their mood (ie, gaming is used to escape reality or create the feeling of euphoria). Third, tolerance develops (the individual needs increasingly more time to feel the same effect). Fourth, withdrawal symptoms occur upon discontinuation of the behavior (the individual feels anxious, depressed, and irritable if they are prevented from playing). Fifth, interpersonal and intra-personal conflict develops as a consequence of the behavior (the individual has problems with their relationship, job, and hobbies, and lack of success in abstinence). Finally, upon discontinuation of the behavior, the individual experiences relapse (they reinitiate gaming). 13

Although the core criteria appear to be established, the etiology of Internet gaming addiction has yet to be studied in detail. Research 15 indicates that a number of risk factors are associated with Internet gaming addiction. These risk factors include certain personality traits, gaming motivations, and structural game characteristics. The personality traits most commonly associated with Internet addiction include neuroticism, 37 , 50 aggression and hostility, 43 , 50 – 52 and sensation-seeking. 43 , 50 Factors that appear to protect frequent online gamers from developing problems with their gaming were found to be conscientiousness and extraversion, 53 suggesting that for different individuals the same behavior can have different psychological repercussions.

In addition to this, the following gaming motivations were found to be most commonly associated with gaming addiction: coping with daily stressors and escapism, 5 , 16 , 44 , 54 – 57 online relationships, 16 , 51 , 57 – 59 and mastery, control, recognition, completion, excitement, and challenge. 34 , 56 , 60 This indicates that the reasons for game play may be an important indicator of potential risk for Internet gaming addiction. Specifically, in comparison with non-MMORPG players, MMORPG players preferred their online friends over their real-life friends. 16 Similarly, significantly more dependent gamers were found to prefer spending time with their online friends than their offline friends relative to nondependent gamers and felt their social needs were met better online than offline. 44 Moreover, while online games provide nonaddicted players with satisfaction, addicted players play to avoid dissatisfaction, 55 which can be an indication of withdrawal symptoms they want to overcome by engaging in gaming compulsively. The motivational differences to play games between dependent and nondependent as well as MMORPG and other gamers appear to be useful clinical information because these motivations can be specifically targeted in treatment sessions. For instance, elements of exposure therapy may be used for the socially fearful in order to decrease discomfort and reintroduce clients to real-life social environments. Also, alternative pastime activities that are perceived as satisfying can be encouraged specifically in group therapy sessions. Encouraging engagement in group sports might satisfy both the need to engage in competitive and satisfying activities and the need to interact with peers in real life.

Moreover, a number of structural game characteristics have been found to increase the risk for developing Internet gaming addiction, namely online relative to offline gaming, 61 positive reinforcement, 62 the enjoyment of particular game features, such as adult content, finding rare in-game items, and watching game cut scenes, 63 and viewing one’s virtual persona as better than oneself. 64 These characteristics indicate that particular games can be more addictive than others, 15 which appears important for game developers and public prevention campaigns that focus on decreasing risk and raising awareness of potential problems. Prevention campaigns could target school-aged children, teachers, and parents in education settings. They could be based on the principles of providing information and a discussion platform concerning Internet and gaming use and possible negative consequences via psychoeducation, with the ultimate goal of encouraging healthy media use. Success could be determined over the long term using triangulation of data and reports obtained from the targeted populations.

Most reviews to date have primarily focused on specific aspects of Internet gaming addiction, including methods used to assess gaming addiction, 65 , 66 structural characteristics, 60 and treatment. 67 – 69 In light of this, the aim of this review is to provide an insight into current perspectives on Internet gaming addiction using a holistic approach, taking into consideration the mass appeal of online gaming, the context of Internet gaming addiction, and associated neuroimaging findings, as well as the current diagnostic framework adopted by the American Psychiatric Association. 70 It is argued that only by understanding the appeal of Internet gaming, its context, and neurobiologic correlates can the phenomenon of Internet gaming addiction be understood comprehensively. An evaluation of the findings will be presented in the overall discussion.

Gaming addiction: context

Research on gaming addiction has paid little attention to the context of online gaming. However, a few studies have now shed some light on the embedding of Internet gaming addiction in the context of the individual, 71 the game and gaming environment, 6 , 72 and the broader framework of culture. 73 Each of these will be addressed in turn.

Griffiths 71 provided case study evidence of two young men who spent an average of 14 hours a day playing MMORPGs in order to emphasize that the context of the individual’s life is an important factor demarcating gaming excess from gaming addiction. Aged 21 years, unemployed and single, “Dave” reported that gaming had a positive influence on his life because his social life revolved almost exclusively around the game, and playing boosted his self-esteem and gave structure to his everyday life. Dave did not perceive that his excessive gaming impacted upon his life negatively at all. For Dave, his extensive gaming did not lead to significant distress or have a negative impact in his daily life, and therefore his behavior cannot be classified as a condition that would fulfill the requirements of a mental disorder classification as outlined in the DSM-5. 74 Upon starting a new job and entering into a relationship with a woman he met in-game, his excessive gaming decreased significantly.

The second case reported was that of “Jeremy”, a 38-year old financial accountant who was married with two children and experienced detrimental consequences due to his “severe gaming addiction”, namely a relationship breakdown, lack of time for family activities, and loss of his job. Moreover, his playing time, craving for the game, and feelings of low mood and anxiety had increased dramatically. He used gaming to escape from his real-life problems and tried to quit on several occasions, but was unsuccessful in staying abstinent. This led to a number of relapse episodes. 71 The examples of Dave and Jeremy make a compelling case for how the same behavior (namely regular online gaming for excessive periods of time) can have almost diametrically opposed consequences due to different individual contexts, with one experiencing gaming as pleasurable and ultimately beneficial, whereas the other’s entire life was negatively affected by his excessive gaming.

In addition to the individual context, the context of the game appears important in determining the extent to which excessive gaming can truly be an addiction. 6 , 72 Karlsen 72 conducted 12 interviews with online gamers (75% male, mean age 23±2.4 years) who play World of Warcraft and used virtual ethnography 75 in order to assess the consequences of their excessive gaming. The results indicated that some of the players experienced behavioral addiction symptoms as specified by Griffiths, 13 namely salience, mood modification, tolerance, withdrawal, conflict, and relapse, with the latter two demarcating excessive from potentially addictive play. However, rather than advocating current diagnostic frameworks for “pathologizing” gaming, Karlsen 72 advocates to view gaming excess from the vantage point of game structure and gaming context, including the social practice and cultural meaning of games as well as the individual’s connection to the game from the perspective of game and media studies. This understanding entails a move away from the overly simplistic approach of focusing on the psychological rewards that reinforce gaming to include an indepth exploration of gaming motivations, gaming structure and mechanics, as well as the meaning of gaming for the individual. 72

Kuss 6 analyzed online gaming and potential gaming excess by interviewing eleven World of Warcraft players (72% male, mean age 27±7.3 years) and used virtual ethnography 75 as well as ludology principles 76 to understand how playing this particular game mirrors participation in popular media culture. In this context, media culture is understood as a flexible and evolving area of engagement that requires active participation. Potential gaming addiction was found to be associated with escapist motivations and in this context gaming was understood as fulfilling a “narcotic” function. The game context gained particular significance in one participant’s life because of two features of the game. First, he was able to enact heroic tales through his avatar and faction membership. As a member of the Horde, he fought the opposing faction, the Alliance, and was involved in killing their king, an episode “he would not forget until the end of his life”. Second, he was enabled to return to a familiar cultural context by means of his guild which consisted of fellow countrymen, after he had physically migrated to a foreign country. In this way, the provisions of the game (namely participation in the game’s narrative, 77 community, and belonging) 78 were utilized to a problematic extent, leaving the participant feeling “addicted to wow [World of Warcraft]”. Eventually, the analysis revealed that the meaning that is attached to the game can lead to excessive play which may cause a retreat from real life. 6

Snodgrass et al 73 surveyed 252 respondents (78% male, mean age 27±9.0 years) using Yee’s 9 motivational factors achievement, social and immersion to assess problematic MMORPG play in World of Warcraft from the perspective of culture under the supposition that gaming allows for formation of communities and cultures. 12 , 79 , 80 The cultural context situates the individual and his potentially addictive game play (assessed using Young’s Internet Addiction Test) 81 within the framework of commonly shared beliefs and practices. 82 Snodgrass et al 73 used an anthropological approach focusing on meaning, practice, and experience, mirrored in their understanding of gaming motivations and problematic play. They found that achievement motivation may lead to problematic play if players are less successful in real life (ie, less “culturally consonant”) and use game success to compensate, 73 causing stress and negative health outcomes. 83 In terms of social motivation, the extent to which online relationships gain significance over offline relationships was analyzed 73 because research indicates that lack of cultural consonance regarding social networks impacts negatively upon health. 84 Regarding immersion, the amalgamation of online and offline life and identities was assessed, 73 because association of the self with the game and the avatar could lead to dissociation. 85 , 86 The results indicated that game play in World of Warcraft mirrors cultural models of success regarding objectives and responsibilities, indicating that the game world can in some ways substitute the real world. Moreover, the culturally sensitive motivations achievement, social and immersion significantly predicted problematic MMORPG play if they were incongruent with real life, that is, if the game was used to compensate for lack of success and relationships in real life, and to dissociate from real life. 73

Taken together, the individual, game, and cultural contexts appear to have a significant impact upon the extent to which problems occur as a consequence of excessive gaming in terms of how Internet gaming addiction is conceptualized. In this way, the cultural context can be seen as a lens through which individuals and others around them perceive and give meanings to behaviors and their consequences. It is critical to understand gaming problems not only by means of the observable symptoms, but to situate them within the broader context of the game, the individual, and culture.

Gaming addiction: neuroscience

In the last decade, psychiatry has increasingly made use of neuroscientific evidence to understand and conceptualize mental disorders. 87 The major funding body for mental health research, the National Institute of Mental Health, has recently introduced research domain criteria to reclassify mental disorders as based on neuroscience and shared underlying pathophysiology rather than the more subjective approach of phenomenology and clinical presentation that has been utilized previously. 88 The ultimate aim is to improve the reliability and validity of clinical diagnosis and accordingly to deliver optimal treatment. 89 In accordance with this approach, research on Internet gaming addiction is now increasingly making use of neuroimaging techniques to allow for analysis of neurobiological changes due to excessive gaming and neurochemical correlates of addiction. 90

Some studies have shown that changes in brain activity and structure related to addiction are relevant for brain regions involved in reward, motivation, and memory, as well as cognitive control. 91 It has been hypothesized that initially the prefrontal cortex and ventral striatum are involved in the decision to initiate the addictive behavior. Over time, the individual habituates to the behavior and develops a compulsion to engage in it, which is accompanied by alterations of activity in the dorsal striatum as it becomes activated through dopaminergic innervation. There is some evidence for the idea that dopamine is released. 92 The longer the engagement continues, the more permanent the changes in the dopaminergic pathways become. It has been suggested that activity in the anterior cingulate, orbitofrontal cortex, and nucleus accumbens is modified in such a way that natural rewards are experienced as less pleasurable, further reducing control over the behavior. 93 , 94 Research suggests that over time, synaptic activity is reduced, leading to long-term depression and neuroadaptation, 95 as well as behavioral sensitization. The synapses in the ventral tegmental area become stronger, glutamate in the nucleus accumbens is reduced, and activity in the amygdala and hippocampus (related to memory) is increased, which can in turn result in craving 91 , 96 and increased response to the availability and particular context of the addictive behavior. 93 , 97 Some studies have shown that the addictive behavior becomes associated with these cues through activity in the nucleus accumbens, which reinforces the effects of the behavior. 98 With time, tolerance to the addictive behavior develops and natural rewards are depreciated, resulting in a reward system deficiency and activation of the antireward system. 99 The consequent lack of dopamine in mesocortical brain regions can lead to withdrawal symptoms, and in order to overcome these, renewed engagement in the addictive behavior ensues, and may ultimately impact upon the functions of the orbitofrontal cortex and cingulate gyrus. 91 , 100 , 101

Over the last decade, a number of neuroimaging techniques have been applied to Internet gaming research, allowing for an analysis of addiction correlates regarding both brain function as well as brain structure. Electroencephalograms measure brain activity via changes in voltage in the cerebral cortex via electrodes, 102 and were used in six studies of Internet and gaming addiction. 103 – 108 Positron emission tomography measures neuronal metabolism through photons from positron emissions via positively charged electrons. 109 Two studies 110 , 111 made use of positron emission tomography to measure Internet and gaming addiction. Like positron emission tomography, single photon emission computed tomography measures metabolic activity in the brain at the level of individual photons, 112 and was applied in one study of Internet addiction. 113 Eight studies 114 – 121 used functional magnetic resonance imaging to measure changes in blood oxygen levels in order to indicate brain activity in individuals with Internet and gaming addiction. 122 Finally, structural magnetic resonance imaging uses methods such as voxel-based morphometry 123 and diffusion-tensor imaging 124 to image brain morphometry, 125 and was used in two studies 126 , 127 in order to assess Internet addiction.

A systematic review of all Internet and gaming addiction studies using neuroimaging methods until 2012 90 revealed that Internet gaming addiction appears similar to other addictions, including substance-related addictions, at the molecular, neurocircuitry, and behavioral levels. From a molecular perspective, gaming results in the release of striatal dopamine. 111 On the other hand, it has been suggested that, in small samples, Internet and gaming addiction is associated with a reward deficiency whereby dopaminergic transporters in the brain are reduced. 110 , 113 In order to reinstate a biochemical equilibrium, 99 individuals whose reward system is deficient seek substances and activities which result in the release of dopamine. Under normal circumstances, pleasure drives (including eating and reproduction) are natural rewards that are craved, whereas unnatural rewards include psychoactive substances and addictive behaviors. 128 Over time, the individual habituates to the hedonic feelings produced by Internet gaming and develops abstinence symptoms, tolerance, and withdrawal. 129 Internet gaming addiction is initiated and maintained. 90 The decreased dopaminergic transporters in Internet gaming addiction may explain its frequent co-occurrence with depression, 130 bipolar disorder, 131 and borderline personality disorder and dissociative symptoms. 132

With regards to neural circuitry, when gaming, brain areas associated with addictions are frequently utilized and therefore the activity in regions such as the orbitofrontal cortex and cingulate gyrus is high, which over time can lead to significant alterations in neuronal connectivity 114 , 116 , 118 , 119 and brain structure. 115 , 126 , 127 Internet gaming becomes increasingly salient and individuals lose control over their gaming. 90 The individual is immanently motivated to play online games as they have learned the behavior, eventuating in continuous engagement. 133

In terms of behavior, excessive Internet gaming can result in problems with impulse control, behavioral inhibition, executive functioning, attention, and general cognitive functioning. 103 , 104 , 107 , 115 , 126 , 127 However, there are plus sides as well, in that the frequent gamer develops and improves a number of other capabilities, namely the integration of perceptual information into the brain and hand-eye coordination. 118 , 120

Taken together, research on Internet gaming addiction has made use of various neuroimaging techniques in order to shed light upon the neurochemical and neuroanatomic correlates of addiction. Although in most studies the direction of the relationship has not been investigated (ie, it is unclear whether Internet gaming addiction causes changes in brain structure and activity or vice versa), the current evidence suggests a relationship between brain alterations and Internet gaming addiction. Neuroimaging studies of Internet gaming addiction contribute to the current understanding of addiction as based on a disease framework. 128 , 134 This indicates that, similar to cardiovascular diseases, lifestyle (ie, excessive gaming) can result in changes to underlying neurobiology. Moreover, the utilization of sophisticated imaging methods in Internet gaming addiction research is in line with research domain criteria, 88 which makes a significant contribution to our understanding of Internet gaming addiction as a chronic neurobiological disease requiring professional care and adequate treatment. 135

Gaming addiction: clinical diagnosis

Following nearly two decades of research, the American Psychiatric Association has now officially recognized Internet Gaming Disorder as a condition that requires consideration by clinicians and researchers. In June 2013, Internet gaming disorder appeared in the appendix of the updated version of the Diagnostic and Statistical Manual for Mental Disorders (DSM-5) for the first time. 70 It stands alongside the only other behavioral addiction, ie, pathological gambling, situating it clearly within the diagnostic category of Substance-Related and Addictive Disorders. Internet gaming disorder has pulled ahead of other behaviors that can become addictive, such as exercise, 136 , 137 work, 138 and shopping. 139

Up until now, researchers have understood Internet addiction or Internet gaming addiction as similar to either impulse control disorders in general or pathological gambling specifically, 140 – 142 substance dependence, 33 , 38 or a combination of the two. 143 , 144 This has led to the development of multiple psychometric instruments, each measuring different aspects associated with Internet gaming problems and addiction. 144 – 153 The multiplicity of conceptualizations used for Internet gaming addiction have led to a diagnostic conundrum leading some researchers to question its existence, 29 and have called for commonly agreed upon criteria which increase reliability across studies and advocate adequate and efficacious treatment. 15

Under the new DSM-5 framework, Internet gaming disorder refers to the “persistent and recurrent use of the Internet to engage in games, often with other players, leading to clinically significant impairment or distress as indicated by five (or more) [criteria] in a 12-month period”. 70 The diagnostic criteria are a preoccupation with gaming, withdrawal symptoms, tolerance (ie, spending more time gaming), lack of control, loss of other interests, use despite negative consequences, deception, mood modification, and losing a relationship, job, and similarly important aspects of life. 70 From a public health perspective, an official diagnosis of Internet gaming addiction is necessary for a number of reasons. First, it will encourage individuals who suffer from associated symptoms to ask for professional help, decreasing morbidity rates, hospitalizations, and potential legal and medical problems. 30 Second, the diagnosis may decrease barriers to care and stigmata with regards to public perception of problematic Internet and gaming use. Third, the diagnosis will support research efforts. 134 Fourth, a diagnostic category will provide the necessary incentive for health care and insurance providers to develop, test, and finance adequate treatment. Ultimately, individuals who require professional care because of substantial distress, suffering, and individual impairment must be helped in an appropriate way. 74 Accordingly, an official diagnosis of Internet gaming addiction is critical for a number of reasons, further emphasizing the need to fully acknowledge and utilize it.

The aim of this review was to provide an insight into current perspectives on Internet gaming addiction using a holistic approach encompassing gaming appeal, context, neuroimaging research, and the diagnostic framework adopted for Internet gaming addiction. It has been shown that Internet gaming has gained increasing popularity since the new millennium, and has led to a substantial growth of the gaming industry and the player fan base. MMORPGs have further been highlighted as offering a wide variety of incentives for players to initiate and maintain playing because they satisfy a variety of needs and tailor to various gaming motives relative to alternative online game genres. Some of these motives, especially escapism, the game’s mechanics, achievement and socializing have been found to be indicative of gaming addiction, 5 suggesting that MMORPGs are more addictive than other offline and online games. 15

This review further shows that until now few studies have investigated the gaming context. Therefore, the context of the individual, the game and gaming environment, and the broader framework of culture are specifically addressed. It has been shown that the individual’s context is a significant factor that marks the dividing line between excessive gaming and gaming addiction. 71 Moreover, it has been emphasized that gaming cannot simply be medicalized if done in excess, but it must be understood from within the context of gaming and the meanings the individual attaches to it. 72 The game context can gain particular importance for players, depending on their life situation and gaming preferences, including the enactment of heroic tales as well as the re-embedding in a (virtual) cultural context that differs from the players’ real-life context. Ultimately, this may lead to a retreat from real life for some individuals. 6 In addition to this, the cultural context is significant because it embeds the gamer in a community with shared beliefs and practices, endowing their gaming with particular meaning. If gaming is used to compensate for lack of success and relationships in real life and to dissociate from real life, Internet gaming addiction can be the consequence. 73 In this context, the “disease” model of addiction can be viewed from the perspective of diseases other than those based on Mendelian genetic mutations or other simple biologically determined pathways. Cardiovascular diseases or adult onset diabetes appear as better models/prototypes for Internet gaming addiction, because these are medical conditions where lifestyles and experiences systematically reshape the body and thus “get under the skin”. That is, the cultural context can become the disease (here addiction) through repeated experiences. Alternatively, cultural norms related to how acceptable game-play is might structure the appeal of the game, which in turn promotes addictive play patterns, which would not be the case in places without such norms.

The cited neuroimaging studies of Internet gaming addiction and associated changes in brain structure and function furthermore correspond with the research domain criteria developed by the National Institute of Mental Health 88 because they emphasize a move away from phenomenology to focus on pathophysiology for clinical diagnosis. Internet gaming addiction was found to share similarities with other addictions, including substance dependence, at the molecular, neurocircuitry, and behavioral levels. These similarities include altered dopaminergic and neuronal activity and brain morphometry, as well as deficient impulse control, behavioral inhibition, and general cognitive functioning. However, there are no known biomarkers of Internet addiction at this point in time. Indeed, there are no known biomarkers of any mental disorder. Ever since Kraepelin, 154 and thus for a century, psychiatrists have been searching to understand mental disorders as underlying physiological diseases, providing an additional incentive to continue research on the neurobiological underpinnings of mental health problems, including Internet gaming addiction.

The findings provide support for the current perspective of understanding Internet gaming addiction from a disease framework. 128 , 134 The dependence classification adopted in previous classification systems 74 , 155 is stigmatizing to patients who require medication because dependence refers to a normal physiological response to the use of a substance (including medication) which, when discontinued, can lead to withdrawal symptoms. 74 The term addiction, on the other hand, denotes a chronic neurobiological disease, 135 which is less stigmatizing because it does not suggest that patients who require medication become “addicted” to their required psychopharmacological treatment. 156 Addiction, unlike dependence, leads to compulsively pursuing rewarding behaviors irrespective of associated biological, psychological, and social problems. 135 Ultimately, the current research base on Internet gaming addiction has led the American Psychiatric Association 70 to include Internet gaming disorder in the appendix of the DSM-5 as the second behavioral addiction alongside pathological gambling, suggesting that the problem is taken seriously. The benefits of such a diagnosis include comparability across research, destigmatization of individuals, development of efficacious treatment, and creation of an incentive for public health care and insurance providers. Once the behavioral problem has an official code, it is worthy of being taken seriously and treated adequately.

However, research concerning the natural course of Internet gaming addiction, the most appropriate interventions, and large-scale epidemiology is scarce, 157 suggesting that more work needs to be done to understand this behavioral problem more fully. King and Delfabbro 158 further question the blurring of the boundaries between Internet addiction and video gaming addiction, as this may “promote further confusion”. Instead, they advocate a conceptualization of Internet addiction which incorporates various subtypes of online behavior, and establishing a diagnostic category of “video gaming disorder” which applies to both online and offline gaming addiction. Ultimately, however, King and Delfabbro 158 concede that the research diagnosis has sparked discussion regarding the nature of behavioral addictions, which testifies to a move away from acknowledging substances only as potentially addictive, and to broaden our understanding of addiction in general.

Moreover, there appear to be problems with regards to the criteria for Internet gaming disorder adopted by the DSM-5 taskforce. Starcevic 29 points out that there exists a debate of whether tolerance is a valid criterion as researchers have validated scales on problematic video game use 159 and compulsive Internet use 160 that do not contain tolerance as a symptom, and some question whether tolerance is a factor involved in gaming. 44 This exemplifies the intricacy of measuring Internet gaming addiction, particularly in light of the reliability of studies as well as the equivalence of findings across studies. Based on these issues, Starcevic 29 recommends the following research approaches: understand when online gaming can be considered a mental disorder; study risk factors and comorbidities, and its position as primary or secondary condition; test a continuum of video gaming problems and video gaming disorder; and revisit its classification as “addiction” rather than an impulse control disorder. 161 Moreover, Pies 134 specifies further that only if the following criteria are satisfied, the condition would qualify to be understood as disease: identify a pattern of genetic transmission; understand its etiology, pathophysiology and/or pathological anatomy; and its course, prognosis, stability, and response to treatment. The current review indicates that research on Internet gaming addiction is on its way to fulfilling these requirements. In terms of understanding the context of Internet gaming addiction, more research is necessary.

Limitations, implications, and suggestions for future research

This review has shown that research on Internet gaming addiction has increased in quality and quantity, particularly over the last decade. Future research is required to overcome the limitations of current research, including closer scrutiny of gaming context (including the individual, game, and culture) and the direction of the relationship between Internet gaming addiction, as well as neuroanatomical and neurochemical changes. Specifically, the following research question requires further exploration: How do individual, game-related, and cultural factors contribute to the etiology, phenomenological experience, and treatment approaches of Internet gaming addiction? Furthermore, the causality of the relationship between neurobiological alterations and neurostructural abnormalities and Internet gaming addiction symptoms should be explored. The further exploration of these issues will enhance our understanding of this potential mental health concern. Moreover, a solid and unequivocal research base will enable the American Psychiatric Association and the World Health Organization to include Internet gaming addiction as an actual diagnosis in their diagnostic systems, which will in turn facilitate future research endeavors as well as clinical parlance.

The context appears crucial to the meaning of the game for the player, and is influenced by individual characteristics, the gaming culture, and the broader society that gamers are situated in. Ultimately, this will allow for developing treatment approaches which can be tailored to different individuals and meet idiosyncratic needs most effectively. The reviewed literature can inform procedures for improving the current treatment of Internet gaming addiction because it puts an emphasis on exploring the life and cultural context of the individual. In terms of neuroimaging studies, the reviewed empirical research has revealed associations between excessive online gaming and alterations in brain structure and function associated with substance addictions. However, understanding the direction of this relationship is crucial because it will provide invaluable insights into the etiology of Internet gaming addiction as well as its status as a primary or secondary disorder. In terms of treatment, establishing the treatment seeker’s most pressing present problem will allow an efficient and efficacious treatment plan to be developed and structuring of treatment sessions. Overall, this literature review suggests that targeting pathogenic neurobiological mechanisms and associated neurological and neurochemical alterations only does not suffice when the clinician’s goal is to alleviate the individual’s idiosyncratic problems. It indicates that Internet gaming addiction must be viewed from a holistic perspective, integrating the neurobiological, individual, game-related, and cultural factors contributing to pathogenesis and symptom experience.

The present review of current perspectives on Internet gaming addiction has shown that research has progressed significantly over the last decade, leading to a larger evidence base which includes important findings from neuroimaging research. Further, it indicates that contextual factors play an important part in our understanding of Internet gaming addiction as a holistic phenomenon. It is suggested that an official diagnosis of Internet gaming addiction must regard embedding of the problematic behavior within the context of the individual, the game, and gaming practices, as well as the broader sociocultural environment as the meaning of the gaming behavior derives from its context. The holistic approach adopted here not only highlights empirical research that confirms neurobiological correlates of Internet gaming addiction and establishment of a preliminary diagnosis, but also emphasizes the need for an indepth understanding of meaning, context, and practices associated with gaming. Ultimately, a holistic understanding will benefit individuals who seek professional help for problematic online gaming as treatment approaches become more targeted and consequently more efficacious.

The author reports no conflicts of interest in this work.

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New Group Joins the Political Fight Over Disinformation Online

The group intends to fight what its leader, Nina Jankowicz, and others have described as a coordinated campaign by conservatives and their allies to undermine researchers who study disinformation.

By Steven Lee Myers and Jim Rutenberg

Two years ago, Nina Jankowicz briefly led an agency at the Department of Homeland Security created to fight disinformation — the establishment of which provoked a political and legal battle over the government’s role in policing lies and other harmful content online that continues to reverberate.

Now she has re-entered the fray with a new nonprofit organization intended to fight what she and others have described as a coordinated campaign by conservatives and others to undermine researchers, like her, who study the sources of disinformation.

Already a lightning rod for critics of her work on the subject, Ms. Jankowicz inaugurated the organization with a letter accusing three Republican committee chairmen in the House of Representatives of abusing their subpoena powers to silence think tanks and universities that expose the sources of disinformation.

“These tactics echo the dark days of McCarthyism, but with a frightening 21st-century twist,” she wrote in the letter on Monday with the organization’s co-founder Carlos Álvarez-Aranyos, a public-relations consultant who in 2020 was involved in efforts to defend the integrity of the American voting system.

The inception of the group, the American Sunlight Project, reflects how divisive the issue of identifying and combating disinformation has become as the 2024 presidential election approaches. It also represents a tacit admission that the informal networks formed at major universities and research organizations to address the explosion of disinformation online have failed to mount a substantial defense against a campaign, waged largely on the right, depicting their work as part of an effort to silence conservatives.

Taking place in the courts, in conservative media and on the Republican-led House Judiciary Select Subcommittee on the Weaponization of the Federal Government, the campaign has largely succeeded in eviscerating efforts to monitor disinformation, especially around the integrity of the American election system.

Many of the nation’s most prominent researchers, facing lawsuits, subpoenas and physical threats, have pulled back.

“More and more researchers were getting swept up by this, and their institutions weren’t either allowing them to respond or responding in a way that really just was not rising to meet the moment,” Ms. Jankowicz said in an interview. “And the problem with that, obviously, is that if we don’t push back on these campaigns, then that’s the prevailing narrative.”

That narrative is prevailing at a time when social media companies have abandoned or cut back efforts to enforce their own policies against certain types of content.

Many experts have warned that the problem of false or misleading content is only going to increase with the advent of artificial intelligence.

“Disinformation will remain an issue as long as the strategic gains of engaging in it, promoting it and profiting from it outweigh consequences for spreading it,” Common Cause, the nonpartisan public interest group, wrote in a report published last week that warned of a new wave of disinformation around this year’s vote.

Ms. Jankowicz said her group would run advertisements about the broad threats and effects of disinformation and produce investigative reports on the backgrounds and financing of groups conducting disinformation campaigns — including those targeting the researchers.

She has joined with two veteran political strategists: Mr. Álvarez-Aranyos, formerly a communications strategist for Protect Democracy, a nonpartisan group that seeks to counter domestic authoritarian threats, and Eddie Vale, formerly of American Bridge, a liberal group devoted to gathering opposition research into Republicans.

The organization’s advisory board includes Katie Harbath, a former Facebook executive who was previously a top digital strategist for Senate Republicans; Ineke Mushovic, a founder of the Movement Advancement Project , a think tank that tracks threats to democracy and gay, lesbian and transgender issues; and Benjamin Wittes, a national security legal expert at the Brookings Institution and editor in chief of Lawfare .

“We need to be a little bit more aggressive about how we think about defending the research community,” Mr. Wittes said in an interview, portraying the attacks against it as part of “a coordinated assault on those who have sought to counter disinformation and election interference.”

In the letter to congressional Republicans, Ms. Jankowicz noted the appearance of a fake robocall in President Biden’s voice discouraging voters in New Hampshire from voting in the state’s primary and artificially generated images of former President Donald J. Trump with Black supporters, as well as renewed efforts by China and Russia to spread disinformation to American audiences.

The American Sunlight Project has been established as a nonprofit under the section of the Internal Revenue Code that allows it greater leeway to lobby than tax-exempt charities known as 501(c)(3)s. It also does not have to disclose its donors, which Ms. Jankowicz declined to do, though she said the project had initial commitments of $1 million in donations.

The budget pales in comparison with those behind the counteroffensive like America First Legal, the Trump-aligned group that, with a war chest in the tens of millions of dollars, has sued researchers at Stanford and the University of Washington over their collaboration with government officials to combat misinformation about voting and Covid-19.

The Supreme Court is expected to rule soon in a federal lawsuit filed by the attorneys general of Missouri and Louisiana accusing government agencies of using the researchers as proxies to pressure social media platforms to take down or restrict the reach of accounts.

The idea for the American Sunlight Project grew out of Ms. Jankowicz’s experience in 2022 when she was appointed executive director of a newly created Disinformation Governance Board at the Department of Homeland Security.

From the instant the board became public, it faced fierce criticism portraying it as an Orwellian Ministry of Truth that would censor dissenting voices in violation of the First Amendment, though in reality it had only an advisory role and no enforcement authority.

Ms. Jankowicz, an expert on Russian disinformation who once served as an adviser to Ukraine’s Ministry of Foreign Affairs, stepped down shortly after her appointment. Even then, she faced such a torrent of personal threats online that she hired a security consultant. The board was suspended and then, after a short review, abolished.

“I think we’re existing in an information environment where it is very easy to weaponize information and to make it seem sinister,” Mr. Álvarez-Aranyos said. “And I think we’re looking for transparency. I mean, this is sunlight in the very literal sense.”

Ms. Jankowicz said that she was aware that her involvement with the new group would draw out her critics, but that she was well positioned to lead it because she had already “gone through the worst of it.”

Steven Lee Myers covers misinformation and disinformation from San Francisco. Since joining The Times in 1989, he has reported from around the world, including Moscow, Baghdad, Beijing and Seoul. More about Steven Lee Myers

Jim Rutenberg is a writer at large for The Times and The New York Times Magazine and writes most often about media and politics. More about Jim Rutenberg