Long Term Effects of Video and Computer Gaming Overuse On Depression, Conduct Disorder, and Substance Use Disorder Among Adolescents in the U.S

Purpose: Adolescent video and computer game addiction, also called pathological gaming or gaming overuse, has developed rapidly and become a global public health problem. Among American youth gamers, approximately 8% exhibit pathological patterns of play (Gentile, 2009). Current research shows that gaming overuse is related to poor academic performance, poor health conditions, depression, aggression, and substance use problems; however, little is known about whether gaming overuse is a causal factor or merely associated with these problems. Using an ecological systems perspective, this longitudinal secondary data analysis tested the long term effects of adolescent gaming overuse on the onset or increase in the following mental health outcomes: depression, conduct disorder, and substance use disorder.

Method: Data analysis was performed using three waves of the National Longitudinal Study of Adolescent Health data (1994-95, 1996, 2001-02), a nationally representative panel study of U.S. students in grades 7-12 at baseline, whose mean age was 15 in Wave 1 (W1) and 21 in Wave 3 (W3).  A propensity score matching (PSM) method was used to create two equivalent groups in W2 based on 27 relevant characteristics in W1 including: demographics, personal characteristics, parenting style, school attachment, community cohesion, and baseline measures of all outcome variables. Fixed effects of schools were also included in the matching process to further enhance the rigor of the study. PSM identified a proxy control group of adolescents without gaming overuse who were “matched” with gamers on a wide range of characteristics that could affect both gaming overuse and outcomes, thus minimizing self-selection bias. PSM thus provide a rigorous and novel approach for testing gaming overuse as a causal risk factor for the onset or increase in mental health symptoms. After matching was achieved, multiple logistic regressions were used to test differences between groups on W3 outcomes.

Results: Adolescents who exhibited gaming overuse (>42 hours/week) had higher rates of depression, conduct disorder, or substance abuse at each wave than those without gaming overuse. Gaming overuse was significantly associated with conduct disorder in W1 and W3. According to the multivariate analysis after matching, gaming overuse in W2 predicted an increase in depression by W3 (β=.14, CI[.04-.23], p = 0.005).  The effect size was 0.32, which has practical significance. However, gaming overuse in W2 did not predict increase in conduct disorder or substance use problems in W3.  

Implication:  Based on rigorous methods this study  suggests that gaming overuse is a causal risk factor for onset and increase of depressive symptoms. This study is among the first of several studies which test the long term negative effect of adolescent gaming overuse on mental health outcomes. This study provides evidence that gaming overuse is not just a symptom of underlying problems, but a distinct causal risk factor for poor mental health. Findings support the case that gaming addiction should be considered for inclusion as a separate diagnostic category in the DSM-6.  Finally, this study shows the need for interventions to prevent and treat gaming overuse because of its long term negative consequences on mental health.