Children spending many hours playing with a PlayStation or an Xbox every day can lead to serious psychiatric problems in children, researchers found.  And “pathological” video game playing is not linked to preexisting psychiatric conditions.

A two-year prospective study of involving over 3,000 children determined several baseline psychological factors such as impulsivity that predicted excessive video game playing, according to Douglas Gentile, PhD, of Iowa State University in Ames, Iowa, and colleagues.

However,  mental health disorders including depression,  poor school performance, poor social relationships “seemed to act as outcomes of pathological gaming,” Gentile and co-authors wrote online in Pediatrics.

“Pathological gaming seems not to be simply secondary to other disorders but to predict poorer functioning longitudinally, and it can last for several years,” they added.

From 2007 to 2009, the researchers provided questionnaires to 3,034 elementary and middle-school children in Singapore, Indonesia.  The surveys were conducted in the students’ classrooms.  They were asked age-appropriate questions to obtain  information on their video game playing habits, social interactions, decision-making skills, mood , and other aspects of their mental health status as well as school performance.

Gentile and colleagues noted that response patterns indicated that causation could go in both directions for some factors.

“For example, although impulsivity is a risk factor for becoming a pathological gamer, impulsivity worsens after a youth becomes a pathological gamer,” they wrote.

Game-playing habits were considered abnormal when the young respondents checked off at least five of 10 items related to gaming on the questionnaire. The areas included the amount of time they spent playing video games, if their schoolwork suffered as a result of gaming, and whether they ever stole money to buy games.

The mean number of pathological gaming symptoms reported in the sample was 2.28 at baseline and 1.78 at the last follow-up.

Pathological gaming was diagnosed in almost 10% of the sample initially — predominantly boys, by a 3:1 margin — which fell to 7.6% in the subsequent surveys.

Gentile and colleagues found that gaming behavior that was initially pathological in 36 children subsequently improved such that they no longer had five or more symptoms. Almost the same number (35) of those with four or fewer symptoms at baseline later added enough to qualify as pathological gamers.

The researchers were particularly interested in the second group and analyzed their characteristics to determine if the characteristics at the beginning of the study and those at the end  to children whose playing never reached pathological levels.

Baseline characteristics that predicted onset of pathological gaming during the study period included the following:

  • Impulsivity
  • Social competence
  • Emotional regulation
  • Empathy score
  • Weekly game-playing time: 31.12 hours versus 19.28 hours (P=0.005)

Gentile and colleagues also found that the more pathological gaming symptoms participants had at baseline, the more likely they were to show symptoms of depression, anxiety, social phobia, and lower school grades at the last follow-up — all with P values less than 0.001.

Increases in pathological gaming symptoms during the study also predicted anxiety, school performance, depression, and  social phobia, and school performance at the last follow-up, again with.

The relationships were especially strong for depression.

The researchers also noted the incidence of prevalence of pathological gaming in the Singapore sample was similar to what other researchers have reported in Western populations — about 9% — and the researchers could think of “no specific reason to assume the relationships between variables would be different in other countries.”

On the other hand, they conceded that reliance on data supplied by the children was a limitation. “The study … would have been improved by gathering information from additional sources, such as teachers and parents,” the researchers wrote.

Gentile D, et al “Pathological video game use among youths: a two-year longitudinal study” Pediatrics 2011; DOI:10.1542/peds.2010-1353.