Trajectory of internet gaming disorder among Chinese adolescents: Course, predictors, and long-term mental health outcomes

Jun 23, 2025Journal of behavioral addictions

Patterns and predictors of internet gaming disorder in Chinese teens and its long-term effects on mental health

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Abstract

A cohort of 16,833 adolescents revealed four distinct trajectories of (IGD), with 73.0% categorized as Low-Risk Stable.

Four IGD trajectories were identified: High-Risk Decreasing, Moderate-Risk Stable, Moderate-Risk Increasing, and Low-Risk Stable.
Factors such as age, gaming time, anxiety, sleep problems, conduct issues, hyperactivity, and low prosocial behavior were linked to worsening IGD symptoms.
The Moderate-Risk Increasing group exhibited significantly higher risks for negative mental health outcomes compared to the Low-Risk Stable group at the final assessment.
The High-Risk Decreasing group showed minimal differences in mental health outcomes compared to the Low-Risk Stable group after adjusting for initial characteristics.

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BACKGROUND AND OBJECTIVES: (IGD) is a growing public health concern, especially among adolescents. However, most IGD studies are cross-sectional, leaving its developmental course poorly understood. This study examined IGD trajectories, their predictors, and their long-term mental health outcomes among Chinese adolescents.

METHODS: A cohort of 16,833 adolescent gamers (mean age = 13.40, 46.56% girls) was recruited from 76 middle schools in Zigong City through cluster sampling. Assessments were conducted in November 2020 (T1), November 2021 (T2), and November 2022 (T3). IGD was measured using the Internet Gaming Disorder Scale-Short Form (IGDS9-SF). Demographic, gaming, environmental, and psychological factors (e.g., depression, anxiety, sleep problems, suicidal ideation, conduct problems, hyperactivity, resilience, mental wellbeing, prosocial behavior) were also assessed. (GMM) identified IGD trajectories, and logistic regression evaluated predictors and mental health outcomes at T3.

RESULTS: GMM identified four IGD trajectories: High-Risk Decreasing (4.5%), Moderate-Risk Stable (19.5%), Moderate-Risk Increasing (3.0%), and Low-Risk Stable (73.0%). Age, gaming time, anxiety, sleep problems, conduct problems, hyperactivity/inattention, and low prosocial behavior predicted worsening IGD symptoms. At T3, the Moderate-Risk Increasing group had significantly higher risks for adverse mental health outcomes compared to the Low-Risk Stable group, whereas the High-Risk Decreasing group showed no significant or minimal differences in most domains from the Low-Risk Stable group after adjusting for baseline characteristics.

DISCUSSION AND CONCLUSIONS: These findings underscore the heterogeneous nature of IGD development and highlight the need for long-term monitoring and tailored interventions to mitigate adverse mental health outcomes in at-risk adolescents.

Key numbers

4.5%

Prevalence of Trajectories

Proportion of adolescents in the High-Risk Decreasing trajectory.

14.65

Elevated Odds for Depression

Adjusted Odds Ratio for depression in the Moderate-Risk Increasing trajectory vs. Low-Risk Stable.

14.80

Elevated Odds for Anxiety

Adjusted Odds Ratio for anxiety in the Moderate-Risk Increasing trajectory vs. Low-Risk Stable.

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Trajectory of internet gaming disorder among Chinese adolescents: Course, predictors, and long-term mental health outcomes

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