How common is wanting to reduce gaming time among high-risk Chinese teens and what influences this intention

Adolescents are vulnerable to internet gaming disorder (IGD) [1] and its negative consequences in terms of physical health, mental health, and social relationships [2–4]. IGD has become a global public health issue and was included in the International Classification of Diseases, 11th Revision (ICD-11) [5]. Although long internet gaming time is not a diagnostic criterion of IGD, it was strongly associated with IGD [6] and various negative mental/physical health outcomes [7]. Extant interventions (e.g., cognitive-behavioral therapy) aimed at reducing IGD symptoms through the reduction of internet gaming time [8]. This approach demonstrated effectiveness in reducing IGD symptoms [9, 10]. It is hence important to understand the key determinants and related mechanisms underlying gaming time reduction. Such studies are lacking.

Behavioral intention is a predictor of actual behavior, both theoretically and empirically [11, 12]. According to the Theory of Planned Behavior, behavioural intention is a determinant of the behaviour of concern [11] and a commonly used dependent variable in research on addictive behaviors, including internet addiction [12–14]. Notably, in cross-sectional studies, it is hard to discern the direction of a significant association between a risk factor and a behavior (e.g., the potential bidirectionality between perceptions and health behaviors). As behavioral intention refers to the chance of performing a behavior in the future, it is not a temporal precedent of the independent variables (e.g., perceptions). The interpretation of an association between an independent variable and a behavioral intention is hence less subject to temporal bias. In this study, behavioral intention of gaming time reduction (BI-GTR) was used as the dependent variable.

The well-established Conservation of Resources (COR) Theory served as the theoretical framework of this study. The COR theory postulates that people strive to retain, protect, and build various resources (e.g., personal and interpersonal resources); when they experience actual or perceived resource losses, stress ensues and can lead to adverse health outcomes [15–18]. Internet gaming could provide important personal and interpersonal resources, as literature has documented that adolescents attain various rewards from internet gaming, such as self-esteem and peer recognition [19]. Gaming time reduction can thus be a potential stressor, as it may increase perceived losses of the gaming-related personal and interpersonal resources [19]. According to the COR theory [15–18], perceived resource losses would enhance perceived stress, which would in turn increase the risk of adopting maladaptive coping responses and mental distress. To avoid resource losses and resultant stress, those anticipating resource losses due to gaming time reduction might be less likely to indicate BI-GTR. A mediation mechanism is hence hypothesized that perceived personal/interpersonal resource losses due to gaming time reduction (PRL-GTR/IRL-GTR) may increase perceived stress due to gaming time reduction (PS-GTR; a mediator), which would in turn reduce BI-GTR. The strengths of such a mediation effect may, however, differ between those with or without IGD, as the former group might perceive stronger resource losses than the latter and find it more stressful. Furthermore, with impaired control, IGD cases may find it more difficult to reduce their gaming time. This invariance hypothesis has not been tested in literature.

The present study investigated the level of BI-GTR among junior middle school students with self-perception of IGD (SP-IGD) in Chengdu, China. This subgroup was selected because awareness of one’s IGD status may be a prerequisite for gaming time reduction. As adolescents with SP-IGD did not necessarily know their actual IGD status, SP-IGD likely had greater influence on subsequent gaming time reduction than diagnosed IGD status. Moreover, individuals with SP-IGD tended to report longer gaming time and more severe IGD symptoms [20], indicating a correspondingly stronger need for managing gaming time. Associated factors of BI-GTR were also investigated, including PRL-GTR, IRL-GTR, and PS-GTR. The mediation hypothesis that the associations between PRL-GTR/IRL-GTR and BI-GTR would be mediated by PS-GTR was further examined. Specifically, it was hypothesized that PRL-GTR/IRL-GTR would increase PS-GTR, which would in turn decrease BI-GTR. Multigroup analysis was performed to inspect whether the proposed mediation model would be invariant by IGD status.

This study was the first to observe a moderately high prevalence of BI-GTR among adolescent gamers with SP-IGD. Partially supporting the COR theory, path analysis found that PRL-GTR, but not IRL-GTR, was positively associated with PS-GTR, which was in turn negatively associated with BI-GTR, denoting a partial mediation effect of PS-GTR between PRL-GTR and BI-GTR. Multigroup path analysis further revealed that the structural/indirect paths in the proposed mediation mechanisms were invariant between those with and without probable IGD.

About one-third of the participants had probable IGD, which was much higher than that of 13% among general middle school students in previous studies [29]. The large difference is highly likely due to the sample characteristics of individuals with SP-IGD in this study, as SP-IGD status was positively associated with IGD [20, 30]. Notably, about two-thirds of those with SP-IGD did not have IGD (‘false positives’). Future studies are required to clarify whether the ‘false positives’ of SP-IGD were associated with equating intensive internet gaming with IGD erroneously [31] or incorrect judgments made by significant others (e.g., parents and peers).

In this study, the prevalence of BI-GTR was moderately high (67.4%). It suggests that many adolescents with SP-IGD might not find their internet gaming condition ideal and would like to rectify the situation. This observation was encouraging, as motivation is a key prerequisite for behavioural change [11]. Qualitative and quantitative research are required to understand the reasons behind BI-GTR and the obstacles to translating BI-GTR into actual behavior. Universal prevention may consider increasing the awareness of IGD. Interestingly, those with probable IGD exhibited lower BI-GTR than those without probable IGD. Possibly, IGD cases have addictive characteristics (e.g., tolerance and impaired control) that might hinder protective behaviors. Nonetheless, the prevalence of BI-GTR among those with both SP-IGD and probable IGD was still quite high (56.2%). Thus, many students simultaneously engaged in problematic gaming but intended to reduce gaming time. This reflects the cognitive dissonance status, a situation involving conflicting beliefs and behaviors, which would result in mental discomfort [32]. To reduce cognitive dissonance and resultant discomfort, individuals are expected to change either their beliefs (e.g., maladaptive cognitions justifying the problematic gaming patterns) or behaviors (e.g., protective behaviors of gaming time reduction) [32]. As the latter is difficult to achieve, adolescents might develop maladaptive cognitions instead, which potentially explain the commonly observed maladaptive cognitions among problematic gamers.

Negative associations were observed between PRL-GTR/IRL-GTR and BI-GTR, which corroborated previous results [23]. PRL-GRT and IRL-GRT can be seen as negative outcome expectancies of gaming time reduction. According to Social Cognitive Theory, negative outcome expectancies would reduce the likelihood of practicing the behavior [33]. It may be potentially useful to increase BI-GTR by reducing PRL-GTR/IRL-GTR. In addition, PRL-GTR and IRL-GTR are reflections of potential rewards from internet gaming. Extant theories (e.g., the Interaction of Person-Affect-Cognition-Execution model) [34] and empirical studies [22, 35] have reported that overreliance on internet gaming to obtain rewards was positively associated with IGD. Internet gaming might be used to fulfil adolescents’ unmet needs. Without addressing those needs, interventions on gaming time reduction may cause psychological reactance and even disrupt parent-child relationships [36]. Future interventions should consider adding elements to compensate for PRL-GTR and IRL-GTR, such as provision of alternative activities (e.g., art and exercise) and social skill training [8].

The positive association between PS-GTR and BI-GTR indicates that PS-GTR would undermine motivation to reduce gaming time. Thus, stress management may increase BI-GTR. The hypothesis that PS-GTR mediated the association between PRL-GTR was supported by the data. Although the COR theory does not postulate directly that perceived resource losses would lead to behavioral changes, previous studies have shown that mental distress may reduce health-seeking behaviours (gaming time reduction in this case) [37]. Thus, the significant mediation can be an extension of applying the COR theory to IGD research and behavioral changes. Attention is needed that the observed mediation effect size was moderate. Thus, other potential mediators need to be considered (e.g., mental distress and coping resources/styles).

The similar direct and mediation effects involving IRL-GTR were statistically non-significant. Different types of resource losses might induce differential impacts on mental health and health-related behaviors. The current findings suggest that concerns about losing personal resources seemed more influential on BI-GTR than those about losing interpersonal resources. Although internet-based peer support is important to adolescents, internet gaming might only be one of many sources of peer support. In contrast, personal resources obtained via internet gaming (e.g., sense of achievement and self-esteem) might be less replaceable. Notably, simple correlation analyses found significant correlations between IRL-GTR and PS-/BI-GTR, which were non-significant in path analysis. A methodological reminder is that, since PRL-GTR was associated with IRL-GTR, the effect of IRL-GTR might become smaller or non-significant after adjusting for PRL-GTR in path analysis.

The null hypothesis that the mediation model would be invariant by IGD status was supported by the data. PRL-GTR and IRL-GTR had similar effects on BI-GTR among those with and without IGD. Thus, interventions modifying perceived resource losses to increase BI-GTR among those with SP-IGD are warranted, disregarding their actual IGD status.

This study was subjected to several limitations. First, the self-administered questionnaire may incur reporting bias, such as recall bias and social desirability bias. Second, the cross-sectional study design renders the inability to make temporal or causal inferences. The findings need to be verified by future longitudinal and intervention studies. Third, the participating schools were conveniently selected from one Chinese city; generalization of the results to other regions or populations in and outside China should be made with caution. Fourth, the measurement of PS-GTR was constructed for this study. The measurement of probable IGD was based on DSM-5 instead of ICD-11; the prevalence of IGD may have been inflated [38]. Fifth, some domains of PRL-GTR (e.g., material losses and emotional losses) might not be included in this study. Sixth, some probable IGD cases without SP-IGD were excluded in this study, but the number should be relatively small. Last, some mediators between PPL-GTR/PIL-GTR and BI-GTR were not investigated in this study (e.g., mental distress and coping strategies).

In conclusion, this study reported high prevalence of BI-GTR among adolescent gamers with SP-IGD in China, and this prevalence was higher among those without probable IGD than those with probable IGD. An important finding is that PRL-GTR, but not IRL-GTR, was negatively associated with BI-GTR. The reasons behind the discrepancy need to be clarified in future studies. Interventions need to compensate for such potential resource losses by offering alternative rewarding activities. Although PS-GTR mediated between PRL-GTR and BI-GTR, the mediation effect size was not large. This study was thus only a starting point to understand the mechanisms explaining the development of BI-GTR, as well as the extension of applying the COR theory to health-seeking behaviors. Future longitudinal and intervention studies are needed to verify the current findings and explore other potential mediators between resource losses and behavioral outcomes.

We would like to thank the participants for their contribution to the present study.

Conceptualization: YY and JTFL; Methodology: YY and JTFL; Software: YY; Formal analysis: YY; Data curation: YY; Validation: JTFL; Resources: JTFL; Writing-original draft: YY and JTFL; Writing-review & editing: YY and JTFL; Supervision: JTFL; Funding acquisition: YY. All authors have contributed to the manuscript substantially and agreed to the final submitted version.

This study was funded by Shanghai Pujiang Programme (23PJC018) and the National Natural Science Foundation of China (82304258). The funding sources had no role in any part of this study.

Data is available on reasonable request from the corresponding author.