The Relationship Between Lockdowns and Video Game Playtime: Multilevel Time-Series Analysis Using Massive-Scale Data Telemetry.

BACKGROUND: COVID-19 led governments worldwide to enact a variety of containment and closure policies. Substantial attention has been directed toward the idea that these public health measures may have unanticipated negative side effects. One proposed effect relates to video games. There is a nascent evidence base suggesting that individuals played video games for longer and in a more disordered manner during lockdowns and school closures specifically. These increases are commonly framed as a potential health concern in relation to disordered gaming. However, the evidence base regarding changes in gaming during the COVID-19 pandemic is based on self-report and, thus, is susceptible to bias. Therefore, it is unclear what the true consequences of lockdowns were for gaming behavior worldwide. OBJECTIVE: The primary objective of this study was to estimate whether any specific lockdown policy led to meaningful increases in the amount of time individuals spent playing video games. METHODS: Rather than relying on self-report, we used >251 billion hours of raw gameplay telemetry data from 184 separate countries to assess the behavioral correlates of COVID-19-related policy decisions. A multilevel model estimated the impact of varying enforcement levels of 8 containment and closure policies on the amount of time that individual users spent in-game. Similar models estimated the impact of policy on overall playtime and the number of users within a country. RESULTS: No lockdown policy can explain substantial variance in playtime per gamer. School closures were uniquely associated with meaningful increases in total playtime within a country (r2=0.048). However, this was associated with increases in the number of unique individuals playing games (r2=0.057) rather than increases in playtime per gamer (r2<0.001). CONCLUSIONS: Previous work using self-report data has suggested that important increases in heavy gaming may occur during pandemics because of containment and closure ("lockdown") procedures. This study contrasts with the previous evidence base and finds no evidence of such a relationship. It suggests that significant further work is needed before increases in disordered or heavy gaming are considered when planning public health policies for pandemic preparedness.

Musculoskeletal disorders in video gamers - a systematic review.

BACKGROUND: Video gaming is a recreational activity with yearly increasing popularity. It is mostly a sedentary behavior combined with repetitive movements of the upper limbs. If performed excessively, these movements may promote strain injuries and a sedentary lifestyle is one of the contributing factors to musculoskeletal disorders. Therefore, a systematic review was conducted to evaluate if video gaming negatively affects the musculoskeletal system of video gamers. METHODS: PubMed, Web of Science and The Cochrane Library were systematically searched in order to identify relevant peer reviewed original articles in English published between 2000 and 2021. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) method was used for the analysis. Studies were included when they contained investigations of changes of the musculoskeletal system due to video gaming in healthy individuals. Studies with participants older than 60 years or solely psychological, social or cardiovascular outcomes were excluded. An adapted version of the Newcastle-Ottawa Scale was used for the risk of bias analysis. RESULTS: Sixteen observational studies involving a total of 62,987 participants met the inclusion criteria. A majority (11) of the studies reported statistical negative musculoskeletal changes due to video game playtime. Four studies did not report changes and one study found no effect of video game playtime on the musculoskeletal system. Out of the eleven studies, which demonstrated a negative impact of video game playtime on the musculoskeletal system, the most reported painful body parts were the neck (n = 4), shoulder (n = 4) and back (n = 3). Ten studies reported odds ratios (OR) for the dependence of the appearance of musculoskeletal disorders on video game playtime. In eight studies OR were significantly increased (1.3-5.2). CONCLUSION: Eleven out of twelve studies demonstrated a negative impact of video game playtime on the musculoskeletal system. In particular, excessive video game playtimes (> 3 h/day) seemed to be a predictor for the appearance of musculoskeletal disorders. Due to their great popularity across multiple generations, specific and tailored prevention and health promotion programs for video gamers need to be developed to counteract this important public health issue.

Gamer's Health Guide: Optimizing Performance, Recognizing Hazards, and Promoting Wellness in Esports.

Electronic sports (esports), or competitive video gaming, is a rapidly growing industry and phenomenon. While around 90% of American children play video games recreationally, the average professional esports athlete spends 5.5 to 10 h gaming daily. These times and efforts parallel those of traditional sports activities where individuals can participate at the casual to the professional level with the respective time commitments. Given the rapid growth in esports, greater emphasis has been placed on identification, management, and prevention of common health hazards that are associated with esports participation while also focusing on the importance of health promotion for this group of athletes. This review outlines a three-point framework for sports medicine providers, trainers, and coaches to provide a holistic approach for the care of the esports athlete. This esports framework includes awareness and management of common musculoskeletal and health hazards, opportunities for health promotion, and recommendations for performance optimization.

A primary care pediatrician's guide to assessing problematic interactive media use.

PURPOSE OF REVIEW: To review the literature and provide a guide to assessing patients with problematic interactive media use (PIMU). RECENT FINDINGS: 0.3-1.0% of the world population meets criteria for internet gaming disorder (IGD). 26.8-83.3% of adolescents meeting criteria for internet addiction have comorbid attention-deficit/hyperactivity disorder. IGD is associated with increased anxiety and social anxiety/phobias. Group counseling, cognitive behavioral therapy, and sports intervention are associated with significant reductions in internet addiction. SUMMARY: With the Diagnostic and Statistical Manual of Mental Disorders-5 inclusion of IGD under 'Conditions for Further Study' and the addition of gaming disorder to International Classification of Diseases (ICD)-11, the idea that PIMU is a mental health disorder gained traction. Although certain populations may be at increased risk, all children and adolescents should be screened for PIMU given now-normal heavy media usage rates. Effective treatment of PIMU starts with identification and management of comorbid mental and behavioral health problems. Depending on their degree of functional impairment, patients may benefit from various forms of psychotherapy with coordinated outpatient management or may warrant higher level of care in one of several established residential treatment programs. Few studies have evaluated pharmacologic approaches to treating PIMU, but some medications targeting comorbid mental and behavioral health conditions improve PIMU-related behaviors.

Case Report: Internet Gaming Disorder Associated With Pornography Use.

Internet gaming disorder (IGD) is not currently a recognized diagnosis in the Diagnostic and Statistical Manual for Mental Disorders-5 (DSM-5). However, IGD has been noted to warrant further research for possible future inclusion in the DSM. In many ways, IGD strongly resembles substance and gambling addictions. Such characteristics include tolerance, withdrawal, and social and occupational neglect resulting from increased time invested in video game use and acquisition. The use of similar or closely related media is also seen, which mirrors the natural course of substance and gambling addictions. We present a case of a 22-year-old man who exhibited IGD and problems associated with pornography use. This case report exemplifies the sequelae of IGD. Our paper also reviews the possible mechanisms of behavioral addiction, as well as the status of IGD as a potential subcategory of behavioral addiction. Additional research is needed to determine if IGD co-occurs with problematic use of pornography.

Internet gaming disorder treatment: a review of definitions of diagnosis and treatment outcome.

OBJECTIVE: Internet gaming disorder (IGD) is a new disorder currently positioned in the appendix of the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition. Few clinical studies report that psychological and pharmacological interventions can significantly reduce the severity of IGD symptomatology. The aim of this review was to assess current knowledge of the short- and long-term benefits of IGD interventions. This review presents a systematic evaluation of definitions of diagnosis and treatment outcomes employed in IGD treatment studies, including an assessment of goodness of fit with the DSM-5 classification. METHOD: A computer database search of Academic Search Premier, PubMed, PsychINFO, ScienceDirect, Web of Science, and Google Scholar was conducted to identify all available research evidence on Internet gaming disorder treatment (N = 8 studies). Diagnostic and treatment outcome parameters were systematically evaluated. RESULTS: Several weaknesses of IGD treatment literature were identified. Only 2 treatment studies have employed an equivalent method of diagnosis for IGD. Studies have not assessed formative change in diagnostic status at posttreatment or follow-up. Duration of follow-up has been inadequate to assess relapse and remission. Posttreatment assessment has been predominantly limited to IGD symptomatology, comorbidity, and frequency of gaming behavior. CONCLUSION: Currently, there is insufficient evidence to warrant suggestion that trialled IGD interventions confer a long-term therapeutic benefit. Several improvements to study design and reporting are proposed to guide future studies of IGD.

Playing with danger.

Young people who sit still for hours playing computer games can double their risk of potentially fatal blood clots. The charity Lifeblood is alerting nurses to 'e-thrombosis'. It is calling on them to ensure young people are aware of the risks of prolonged immobility and the need to take regular breaks from gaming or using a computer.

Preventing Harmful Internet Use-Related Addiction Problems in Europe: A Literature Review and Policy Options.

Internet use-related addiction problems are increasingly being recognized on a European scale due to international health organizations considering gaming addiction. In April 2013, the American Psychiatric Association recognized Internet Gaming Disorder in the fifth Diagnostic and Statistical Manual of Mental Disorders, and in April 2018, the World Health Organization included Gaming Disorder in the eleventh International Classification of Diseases. However, findings on these problems within this period are lacking in Europe, and a preventive approach is missing globally. A detailed critical literature review was conducted using PsycINFO and Web of Science in this five-year period. A total of 19 studies were reviewed and problems identified were: generalized Internet addiction and online gaming and gambling addictions across seven European countries (i.e., Spain, Germany, France, Italy, Greece, The Netherlands, and Denmark). The individuals with problematic use were found to be educated adolescents, usually young males with comorbid disorders, and gaming and gambling disorders were implicated in the most severe cases. Cognitive behavioral therapy was the main treatment, sometimes combined with a systemic approach for adolescents. Prevalence, high-risk populations, and factors contributing to these addiction problems are discussed, and a set of policy options are developed for this region. The implications for early detection, diagnosis, treatment, and prevention in Europe are considered.

Youth Screen Media Habits and Sleep: Sleep-Friendly Screen Behavior Recommendations for Clinicians, Educators, and Parents.

With the widespread use of portable electronic devices and the normalization of screen media devices in the bedroom, insufficient sleep has become commonplace. In a recent literature review, 90% of included studies found an association between screen media use and delayed bedtime and/or decreased total sleep time. This pervasive phenomenon of pediatric sleep loss has widespread implications. There is a need for basic, translational, and clinical research examining the effects of screen media on sleep loss and health consequences in children and adolescents to educate and motivate clinicians, teachers, parents and youth themselves to foster healthy sleep habits.

Screen Violence and Youth Behavior.

Violence in screen entertainment media (ie, television, film, video games, and the Internet), defined as depictions of characters (or players) trying to physically harm other characters (or players), is ubiquitous. The Workgroup on Media Violence and Violent Video Games reviewed numerous meta-analyses and other relevant research from the past 60 years, with an emphasis on violent video game research. Consistent with every major science organization review, the Workgroup found compelling evidence of short-term harmful effects, as well as evidence of long-term harmful effects. The vast majority of laboratory-based experimental studies have revealed that violent media exposure causes increased aggressive thoughts, angry feelings, physiologic arousal, hostile appraisals, aggressive behavior, and desensitization to violence and decreases prosocial behavior (eg, helping others) and empathy. Still, to more fully understand the potential for long-term harm from media violence exposure, the field is greatly in need of additional large-sample, high-quality, longitudinal studies that include validated measures of media violence exposure and measures of other known violence risk factors. Also, although several high-quality media violence intervention studies have been conducted, larger-scale studies with more comprehensive and longer-term assessments are needed to fully understand long-term effects and to inform the development of tools that will help to reduce problems associated with aggression and violence. The evidence that violent screen media constitutes a causal risk factor for increased aggression is compelling. Modern social-cognitive theories of social behavior provide useful frameworks for understanding how and why these effects occur.

Evaluating Existing Strategies to Limit Video Game Playing Time.

Public concern surrounding the effects video games have on players has inspired a large body of research, and policy makers in China and South Korea have even mandated systems that limit the amount of time players spend in game. The authors present an experiment that evaluates the effectiveness of such policies. They show that forcibly removing players from the game environment causes distress, potentially removing some of the benefits that games provide and producing a desire for more game time. They also show that, with an understanding of player psychology, playtime can be manipulated without significantly changing the user experience or negating the positive effects of video games.

Video and computer games: effect on children and implications for health education.

Video and computer-based games have assumed a prominent role in the culture of American children and adolescents. Given the pervasiveness of their influence, it is likely that these games may affect the health and well-being of children. This paper examines the health effects of these games on children, suggests criteria upon which parents and teachers may evaluate the games, and notes some implications for health educators.

Nintendonitis? A case report of repetitive strain injury in a child as a result of playing computer games.

Repetitive strain injury is a common occupational hazard but has not been previously reported in a child. With the escalating use of computers both in the home for recreational purposes and in schools for teaching, the possible incidence of hand and wrist problems may need to be highlighted. Perhaps "hand care" instruction should be implemented in UK schools as prophylaxis.

The physical impact of computers and electronic game use on children and adolescents, a review of current literature.

Children using computers and electronic games may adopt the kinds of sustained and awkward postures that are associated with musculoskeletal disorders in working adults. If they do, the physical demands of extensive use could lead to a wide range of adverse effects on developing children, including visual, neurological and physical changes. This article reviews the literature related to media use, ergonomics, epidemiology and pediatrics that address the physical impact of computer use by children. The literature establishes that computer use is common, but does not demonstrate a causal or statistical association with any physical disorders. Laboratory studies on vision, case reports of game-related tendonitis and ergonomic analyses of classroom computers suggest that concern is warranted.