Video Game Addiction in Young People (8–18 Years Old) after the COVID-19 Pandemic: The Grey Area of Addiction and the Phenomenon of “Gaming Non-Pathological Abuse (GNPA)”
Round 1
Reviewer 1 Report
Comments and Suggestions for AuthorsThe authors have identified an important social problem and have rightly noted the powerful importance of social isolation and other mental health risk factors on video / online game use and users. However, the reporting is incomplete and revision is required.
The paper needs more and more specific definitions, e.g., how is video game addiction as psychopathology being defined? Without specific reference, it is unclear. simply citing the DSM does not define it.
Be careful with language. Recommend using person-first language instead of referring to people who are (for example) "moody" as having a psychopathological condition. Authors also indicate that video game addiction fuels outcomes such as criminal behavior in a way that could be read as meaning this progression is inevitable; recommend wording such as "potentially fuels" and avoiding words such as "deviant" and "reckless" in favor of less-loaded and more specific wordings. Current framings could be interpreted as stigmatizing, especially given the breadth of audience of this journal.
A paragraph at the end of the introduction that outlines the full process of the project would be helpful.
Clarify definitions relevant to specifics of this study: How is "presumed digital addiction" defined? Why was this group and the group "otherwise daily use of over 1 hour" chosen? In the introduction, it appears these are being conflated. It is not clear how a review of the literature of this type can analyze the direct impact of the pandemic on youth who may be addicted, may be playing for over an hour, or others, as there is no measure of direct impact.
How were the "5 more references" selected and how were they important to the project? Why were systematic reviews of the literature excluded? Literature analyses of this type should be replicable and decision-making choices should be clear.
Were "addiction" and "video games" the only choices used? (For example, was "video games OR online gaming" a search term?) Again, methods should be replicable.
Which languages other than English (and/or subjects from which countries) were included in the search? Were the authors fluent in all languages of included articles?
What is an example of an item in the search that was excluded due to "absence of direct relation to the theme"? Again, replicability is important.
What "automatic tools" were used in the automatic screening and why were these specific tools selected? If this is referring to an AI program, this is especially important.
The connection between the literature search and the survey is not explicit. Was the LR used to create a survey tool? If so, what was the process?
For the survey, the methods need to be made more explicit. For example, who were the "students"? The authors indicate that student participants were age 8-18. Percentages within each age group are given, but there are no totals for how many in each age group (e.g., primary school vs. high school). What were the actual recruitment methods for each age group (e.g., how were they similar/different because of age and consequent cognitive development)/ If they were identical for all groups/regions, this can simply be stated. Did all students fully complete the survey? Were the students offered any incentives (e.g., extra credit) for participating? Was the study approved by an IRB Board or are the authors solely asserting that ethical requirements were met? How was parental permission obtained in addition to students' informed consent? The authors include an IRB statement at the end, but do not describe the implementation in the article itself. Note that funding is not the sole grounding for a potential conflict of interest.
Table 1 is complete in terms of variable description. However, It des not include the questions themselves and so it is difficult to see how some of the questions reflect the variables: What is an example of the actual question a student answered? For example, how is a dichotomous variable labeled "gender" purely reflective of genetic risk factors, given differential socializations of individuals whose gender may be cis-male, cis-females, homosexual? Table 4 would be one appropriate place to provide clarification on how the questions were framed.
Some of the categorizations and explanations of the variables seem to have an underlying bias, though this may be due to English-language difficulties. For example, the authors refer to students who self-describe as transsexual as having an "undefined" gender and seems to include both males and females as "ambisexual." This may be an English-language difficulty; if not, it needs to be clarified.
Does "solo-game" refer to whether the player was physically alone when playing or to whether or not they were playing [a] in single-player games or [b] in online teams with others (e.g., MMORPGs, games in which players gather online in consistent groups, or games in which players gather online but form new groups each time they enter the game)? How was this defined for the participants/students (e.g., how was the question framed)?
Clarifying why the decision was made to design questions that have dichotomous vs. continuous variables would also be helpful for some items, e.g., why "time taken away from study" was designed as dichotomous rather than as continuous.
Some variable descriptions appear to reflect bias, e.g., "reason for addiction" presupposes that the respondent/student is addicted/ has an addiction, yet individual students were not assessed. Similarly, in the discussion, the authors refer to an exacerbation of addiction although no clinical diagnosis of addiction was professionally verified; perhaps "increase in use" is a less value-laden and more accurate way of making the point. How were similar variables such as "anger" and "aggression" operationally distinguished? How is "time management" described (e.g., was it differently defined for 8 year-olds vs. 18 year-olds?)
Some of the variables are very well considered, e.g., "subjective perception of benefits..." Why did the researchers use a yes/no response option for such questions?
The statistical analysis is well described.
The rationale for defining participants/students as a "clinical" (presumed psychopathology??) population based on whether they participate in gaming for 1 hour / more than 1 hour is unclear. This is especially important because the authors' analysis of "time spent" was determined to be statistically significant rather than reflecting a self-sorting into the two categories of "1 hour or less" vs. "over 1 hour" as self-reported by children as young as 8. Note also that the two time categories are repeatedly referred to as dichotomous using this distinction, but a three-hour time span and a two-hour time span are referenced in the Discussion. Was this variable in fact presented to the participants/students as continuous? The authors also correlate time span spent playing with "deviant and criminal conduct" and "manipulative" behavior(?), but these were not variables in the study. Clear distinctions should be made between results of the project actually conducted by the authors and notes from the literature that they are trying to reference/highlight.
It is not clear how the project being reported on is "socio-criminological" or includes actual clinical data. The authors would be better served to focus on the scope of the actual study rather than framing it in these ways. Note earlier comments on framings in this review.
As the authors correctly point out, a regression analysis was not possible that would bear fruitful results. They also are correct in pointing out that, with revision and clarification, the report on this project could serve as a foundation for larger, potentially population based projects. Including more detail on how the survey was constructed and on the questions themselves would encourage others to also follow this line of research. Testing validity and reliability of the instrument would also benefit such a line of research.
Site selection is internally contradictory. For example, the authors state that selection was "random," but then state that choices were in part based on geographical location.
Table 3 presumes addiction. How was this verified, especially in the non-clinical population?
The point in Discussion point 8 is well-balanced. A callback to the point made in the introduction that this is a debate in the literature would highlight the need for further research on this point.
Comments on the Quality of English LanguageSometimes interferes with clarity and understandability of points. Shifts between nouns/adverbs/ etc. in lists especially muddy points because they require re-reading. Needs solid editing for English language.
Author Response
We thank the reviewer for the careful and timely analysis and respond point by point. In the newly attached file you will find all changes in red, to facilitate your evaluation, which we hope will be positive. The new file will be attached within 48h to facilitate new changes in the text to improve the English language. In the meantime, let's proceed with comments to the revisions to facilitate your work:
1) REVIEWER: The authors have identified an important social problem and have rightly noted the powerful importance of social isolation and other mental health risk factors on video / online game use and users. However, the reporting is incomplete and revision is required.
COMMENT: We take note of your choice and respond point by point.
2) REVIEWER: The paper needs more and more specific definitions, e.g., how is video game addiction as psychopathology being defined? Without specific reference, it is unclear. simply citing the DSM does not define it.
COMMENT: A whole section on diagnosis and criteria was included in the introduction.
3) REVIEWER: Be careful with language. Recommend using person-first language instead of referring to people who are (for example) "moody" as having a psychopathological condition. Authors also indicate that video game addiction fuels outcomes such as criminal behavior in a way that could be read as meaning this progression is inevitable; recommend wording such as "potentially fuels" and avoiding words such as "deviant" and "reckless" in favor of less-loaded and more specific wordings. Current framings could be interpreted as stigmatizing, especially given the breadth of audience of this journal.
COMMENT: The terminology used is consistent with the study profile and socio-criminological assessments. In fact, this study is not clinical in nature, although it examines subjects who might receive a diagnosis of gaming disorder, but it is a socio-criminological study, and therefore such terms are necessary and nonjudgmental.
4) REVIEWER: A paragraph at the end of the introduction that outlines the full process of the project would be helpful.
COMMENT: In our opinion, the required section is likely to be redundant, as there is already extensive coverage in the text.
5) REVIEWER: Clarify definitions relevant to specifics of this study: How is "presumed digital addiction" defined? Why was this group and the group "otherwise daily use of over 1 hour" chosen? In the introduction, it appears these are being conflated. It is not clear how a review of the literature of this type can analyze the direct impact of the pandemic on youth who may be addicted, may be playing for over an hour, or others, as there is no measure of direct impact.
COMMENT: In the text, the selection criteria and the reasons why we decided to make this choice are very clear. However, the reason for the 1-hour cut-off has been added in the discussions.
6) REVIEWER: How were the "5 more references" selected and how were they important to the project? Why were systematic reviews of the literature excluded? Literature analyses of this type should be replicable and decision-making choices should be clear.
COMMENT: The section has been modified to better clarify the analysis processes.
7) REVIEWER: Were "addiction" and "video games" the only choices used? (For example, was "video games OR online gaming" a search term?) Again, methods should be replicable.
COMMENT: The part has been modified to better clarify the analysis processes
8) REVIEWER: Which languages other than English (and/or subjects from which countries) were included in the search? Were the authors fluent in all languages of included articles?
COMMENT: The part has been modified to better clarify the analysis processes
9) REVIEWER: What is an example of an item in the search that was excluded due to "absence of direct relation to the theme"? Again, replicability is important.
COMMENT: The part has been modified to better clarify the analysis processes
10) REVIEWER: What "automatic tools" were used in the automatic screening and why were these specific tools selected? If this is referring to an AI program, this is especially important.
COMMENT: The part has been modified to better clarify the analysis processes
11) REVIEWER: The connection between the literature search and the survey is not explicit. Was the LR used to create a survey tool? If so, what was the process?
COMMENT: The part has been modified to better clarify the analysis processes
12) REVIEWER: For the survey, the methods need to be made more explicit. For example, who were the "students"? The authors indicate that student participants were age 8-18. Percentages within each age group are given, but there are no totals for how many in each age group (e.g., primary school vs. high school). What were the actual recruitment methods for each age group (e.g., how were they similar/different because of age and consequent cognitive development)/ If they were identical for all groups/regions, this can simply be stated. Did all students fully complete the survey? Were the students offered any incentives (e.g., extra credit) for participating? Was the study approved by an IRB Board or are the authors solely asserting that ethical requirements were met? How was parental permission obtained in addition to students' informed consent? The authors include an IRB statement at the end, but do not describe the implementation in the article itself. Note that funding is not the sole grounding for a potential conflict of interest.
COMMENT: What is asked is already in the text in the selected population section
13) REVIEWER: Table 1 is complete in terms of variable description. However, It des not include the questions themselves and so it is difficult to see how some of the questions reflect the variables: What is an example of the actual question a student answered? For example, how is a dichotomous variable labeled "gender" purely reflective of genetic risk factors, given differential socializations of individuals whose gender may be cis-male, cis-females, homosexual? Table 4 would be one appropriate place to provide clarification on how the questions were framed.
COMMENT: What is asked is already in the text in the selected results section
14) REVIEWER: Some of the categorizations and explanations of the variables seem to have an underlying bias, though this may be due to English-language difficulties. For example, the authors refer to students who self-describe as transsexual as having an "undefined" gender and seems to include both males and females as "ambisexual." This may be an English-language difficulty; if not, it needs to be clarified.
COMMENT: What is asked is already in the text in the selected results section
15) REVIEWER: Does "solo-game" refer to whether the player was physically alone when playing or to whether or not they were playing [a] in single-player games or [b] in online teams with others (e.g., MMORPGs, games in which players gather online in consistent groups, or games in which players gather online but form new groups each time they enter the game)? How was this defined for the participants/students (e.g., how was the question framed)?
COMMENT: What is asked is already in the text in the selected results and discussion sections
16) REVIEWER: Clarifying why the decision was made to design questions that have dichotomous vs. continuous variables would also be helpful for some items, e.g., why "time taken away from study" was designed as dichotomous rather than as continuous.
COMMENT: The dichotomous choice was exclusively made to aid statistical analysis. Continuous variables were transformed to dichotomous as follows.
17) REVIEWER: Some variable descriptions appear to reflect bias, e.g., "reason for addiction" presupposes that the respondent/student is addicted/ has an addiction, yet individual students were not assessed. Similarly, in the discussion, the authors refer to an exacerbation of addiction although no clinical diagnosis of addiction was professionally verified; perhaps "increase in use" is a less value-laden and more accurate way of making the point. How were similar variables such as "anger" and "aggression" operationally distinguished? How is "time management" described (e.g., was it differently defined for 8 year-olds vs. 18 year-olds?)
COMMENT: In the discussion section it is amply explained what was asked
18) REVIEWER: Some of the variables are very well considered, e.g., "subjective perception of benefits..." Why did the researchers use a yes/no response option for such questions?
COMMENT: The dichotomous choice was exclusively made to aid statistical analysis. Continuous variables were transformed to dichotomous as follows
19) REVIEWER: The statistical analysis is well described.
COMMENT: Thanks!
20) REVIEWER: The rationale for defining participants/students as a "clinical" (presumed psychopathology??) population based on whether they participate in gaming for 1 hour / more than 1 hour is unclear. This is especially important because the authors' analysis of "time spent" was determined to be statistically significant rather than reflecting a self-sorting into the two categories of "1 hour or less" vs. "over 1 hour" as self-reported by children as young as 8. Note also that the two time categories are repeatedly referred to as dichotomous using this distinction, but a three-hour time span and a two-hour time span are referenced in the Discussion. Was this variable in fact presented to the participants/students as continuous? The authors also correlate time span spent playing with "deviant and criminal conduct" and "manipulative" behavior(?), but these were not variables in the study. Clear distinctions should be made between results of the project actually conducted by the authors and notes from the literature that they are trying to reference/highlight.
COMMENT: We have already answered this question, explaining the reasons for the cut-off.
21) REVIEWER: It is not clear how the project being reported on is "socio-criminological" or includes actual clinical data. The authors would be better served to focus on the scope of the actual study rather than framing it in these ways. Note earlier comments on framings in this review.
COMMENT: We have already answered this question, explaining the differents of clinical study and socio-crim study
22) REVIEWER: As the authors correctly point out, a regression analysis was not possible that would bear fruitful results. They also are correct in pointing out that, with revision and clarification, the report on this project could serve as a foundation for larger, potentially population based projects. Including more detail on how the survey was constructed and on the questions themselves would encourage others to also follow this line of research. Testing validity and reliability of the instrument would also benefit such a line of research.
COMMENT: The questionnaire is a survey instrument and not a psychometric one, so the assessment is not clinical but socio-crim, and it does not need validation and/or standardization because the variables are investigated directly in the survey
23) REVIEWER: Site selection is internally contradictory. For example, the authors state that selection was "random," but then state that choices were in part based on geographical location.
COMMENT: The section in the text has been corrected to remove the contradiction
24) REVIEWER: Table 3 presumes addiction. How was this verified, especially in the non-clinical population?
COMMENT: able 3 is functional to the text and has no critical issues in our view, having distinguished the groups in the discussions. In that table, we preferred to combine the groups to make it easier to understand the value of individual variables compared to the total sample
25) REVIEWER: The point in Discussion point 8 is well-balanced. A callback to the point made in the introduction that this is a debate in the literature would highlight the need for further research on this point.
COMMENT: We think it is redundant
Reviewer 2 Report
Comments and Suggestions for AuthorsThis is an interesting survey and experimental design. However, I have a few questions regarding the results:
1. In the introduction, a full literature search process was shown with details indicated in the PRISMA flow diagram. However, how did the work in the literature search correlated to the research? It seems like a stronger correlation needs to be shown to support the gap/innovation of the research
2. The survey was well-designed. However, I'd be interested to see more details. For example, several education institutions was mentioned. I wonder specifically how many institutions (how many elementary school, middle school, high school?) as well as how large of a population was sampled from?
3. It seems like the sampling didn't have a gender balance, which I believe gender shouldn't be a variable in correlation analysis.
4. It seems like most of the generic variables don't have a strong correlation with clinical variables. I would recommend to only highlight the ones that have correlation > 0.5 with statistically significance and leave the weakly correlated variables in supplementary materials
5. Figure 2 is missing a legend. What does red and blue colors represent in this figure?
6. Instead of using numbers to represent variables from the survey in discussion section, I would recommend to discuss using the actual variable names to better engage the readers.
7. More evidence would be needed to support the conclusion, especially in line 239 where cases discussed with not disadvantaged family background. According to your data, 83.3% percent of addiction is related to emotional and family difficulties while not all reports had indicated criminal tendencies. More data or discussion will be needed to support the conclusion.
The language of this paper will need to be improved for better clarity:
1. The abstract has a lot of overlap with the conclusion, where line 10-11 need to be revised for better understanding
2. The phrase "deviant and criminal conduct" appeared multiple times in writing. I would recommend substitute with different phrases to better engage the readers
3. Introduction was comprehensive. However, the wording and formatting needs to be improve for clarity
4. In line 216 "himself" was used for a population. I believe "themselves" would be a better word to indicate the group being discussed.
Author Response
We thank the reviewer for his excellent work! We will attach the file with revisions within 48 hours so as to improve the English language as well (we are waiting for changes from our colleague). In the meantime, however, we attach the comments to facilitate the reviewer's work, hoping for his approval. In red are all the changes made to the text, as indicated:
1) REV: In the introduction, a full literature search process was shown with details indicated in the PRISMA flow diagram. However, how did the work in the literature search correlated to the research? It seems like a stronger correlation needs to be shown to support the gap/innovation of the research
COMMENT: The search on Pubmed and included in PRISMA is only meant to introduce the topic and variables, as there is no study in the literature that examines what we did, as our analysis is socio-criminological and not clinical, although we do examine variables of a clinical nature. Our purpose is not to make diagnoses but to show that there are consequences to video game abuse, and the data from the study demonstrate just that.
2) REV: The survey was well-designed. However, I'd be interested to see more details. For example, several education institutions was mentioned. I wonder specifically how many institutions (how many elementary school, middle school, high school?) as well as how large of a population was sampled from?
COMMENT: We have modified the section to accommodate the reviewer
3) REV: It seems like the sampling didn't have a gender balance, which I believe gender shouldn't be a variable in correlation analysis.
COMMENT: In the results and discussion sections we have given ample space to this variable
4) REV: It seems like most of the generic variables don't have a strong correlation with clinical variables. I would recommend to only highlight the ones that have correlation > 0.5 with statistically significance and leave the weakly correlated variables in supplementary materials
COMMENT: The results and statistical analysis section largely assesses what is required, but unfortunately there is not enough data to perform a regression (and this is also indicated in the limits of the study).
5) REV: Figure 2 is missing a legend. What does red and blue colors represent in this figure?
COMMENT: That's right, our mistake! We have proceeded to insert it
6) REV: Instead of using numbers to represent variables from the survey in discussion section, I would recommend to discuss using the actual variable names to better engage the readers.
COMMENT: Unfortunately, this complicates the organizational structure of the article, which for simplicity's sake we preferred this way. In our opinion, having seen both versions, this is the less chaotic and more schematic one, although apparently more complex for reading
7) REV: More evidence would be needed to support the conclusion, especially in line 239 where cases discussed with not disadvantaged family background. According to your data, 83.3% percent of addiction is related to emotional and family difficulties while not all reports had indicated criminal tendencies. More data or discussion will be needed to support the conclusion.
COMMENT: The conclusions reflect the limitations of the study but also the discussions, and in our opinion marking further risks being only redundant, as the message that needs to get through is that prolonged use of video games, along with other variables such as age, type, social and economic context play against healthy psychological growth.
Round 2
Reviewer 2 Report
Comments and Suggestions for AuthorsI wanted to take a moment to commend you on the revision. Great job! The introduction is now much clearer and sets a strong foundation for the rest of the piece. The only suggestion I have would be to consider adding a x-axis, y-axis, and figure legend for Figure 2. Figure 2 seems to be an important piece of your conclusion, but right now it's still a bit confusing to understand. Could you explain for x-axis, what do you mean by "increasing scale of severity based on the other axis"?
Comments on the Quality of English LanguageLine 50-60 was too long to understand. Consider breakdown the sentence and only cite when needed. This sentence has multiple 'but also" phrases and the logic can be better structured.
Line 62-66 seems to be repetitive to line 50-60. If it is correlated to the PRISMA work I would recommend moving it to later section when you discuss that.
For the literature review/PRISMA section, I would recommend discuss more about the gap you mentioned in your reply, such that the logic will flow better with the later experiment design and the overall purpose of this work.
Author Response
Dear, thank you for your excellent work! I have edited Table 2 as requested and included all the specifics, also in the "discussions" section to better clarify the conclusions.
