Cited by 270Impact of Technology on AdolescentsGambling Behavior and TreatmentsSexuality, Behavior, and Technology

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A longitudinal study on psychosocial causes and consequences of Internet gaming disorder in adolescence

Wartberg, Lutz, Kriston, Levente, Zieglmeier, Matthias, Lincoln, Tania, Kammerl, Rudolf·2019·Psychological Medicine

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Abstract

Background: In 2013, Internet gaming disorder (IGD) was incorporated in the current version of the DSM-5. IGD refers to a problematic use of video games. Longitudinal studies on the etiology of IGD are lacking. Furthermore, it is currently unclear to which extent associated psychopathological problems are causes or consequences of IGD. In the present survey, longitudinal associations between IGD and adolescent and parental mental health were investigated for the first time, as well as the temporal stability of IGD. Methods: In a cross-lagged panel design study, family dyads (adolescent with a parent each) were examined in 2016 (t1) and again 1 year later (2017, t2). Overall, 1095 family dyads were assessed at t1 and 985 dyads were re-assessed at t2 with standardized measures of IGD and several aspects of adolescent and parental mental health. Data were analyzed with structural equation modeling (SEM). Results: Male gender, a higher level of hyperactivity/inattention, self-esteem problems and IGD at t1 were predictors of IGD at t2. IGD at t1 was a predictor for adolescent emotional distress at t2. Overall, 357 out of the 985 adolescents received a diagnosis of IGD at t1 or t2: 142 (14.4%) at t1 and t2, 100 (10.2%) only at t1, and 115 (11.7%) only at t2. Conclusions: Hyperactivity/inattention and self-esteem problems seem to be important for the development of IGD. We found first empirical evidence that IGD could prospectively contribute to a deterioration of adolescent mental health. Only a subgroup of affected adolescents showed IGD consistently over 1 year.

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Internet-Related Disorders and Their Effects on Personality Development in Adolescents from Germany—Results from a Prospective Study
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E-attachment and Online Communication
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Gaming for Self-Searching? A Three-Wave Longitudinal Investigation on the Correlations and Predictions Among Self-Concept Clarity, Player-Avatar Identification, and Internet Gaming Disorder
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“…internet use and self-esteem, findings have remained inconsistent: some studies reported reciprocal relationships (Nie et al., 2024 ), others found only uni - directional prediction (Teng et al., 2020; Wartberg et al., 2019 ), and some observed no significant relationship (Lai et al., 2023 ).”
The Role of Psychological Flexibility in Adolescent Internet Gaming Disorder and Social Media Addiction: Emotional Regulation and Stress Coping Mechanisms
Wang, Y., Li, Q., Su, J., & Yang, X. (2026) · International Journal of Mental Health and Addiction · doi:10.1007/s11469-026-01644-0 · Cited by 6
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“Longitudinal studies may be useful to generate clearer explanations about the direction of the relationships (akin to Wartberg et al., 2019).”
Problematic online gaming mediates the association between attention-deficit/hyperactivity and subsequent mental health issues in adolescents
Narita, Z. C., DeVylder, J., Knowles, G., Ando, S., Yamasaki, S., Miyashita, M., Stanyon, D., Yamaguchi, S., Furukawa, T. A., Kasai, K., et al. (2025) · Communications Psychology · doi:10.1038/s44271-025-00296-5 · Cited by 9
Internet addiction and psychological impact on adolescents: A scoping review
Dermani, H., & Perdikaris, P. (2022) · International Journal of Biological and Pharmaceutical Sciences Archive · doi:10.53771/ijbpsa.2022.4.2.0096 · Cited by 7
Association Between Self-Esteem and Cyber Victimization: The Mediating Roles of Digital Game Playing and Cyberbullying
Eryılmaz, A., Huebner, E. S., KURTULUŞ, H. Y., & Kara, A. (2024) · American Journal of Health Education · doi:10.1080/19325037.2024.2375646 · Cited by 4
“Longitudinal studies confirm that children with low self-esteem are more likely to engage in digital gaming to seek social support and connection (Mun & Lee, 2023; Wartberg et al., 2019).”
The prevalence of suboptimal health status among Chinese secondary school students and its relationship with family health: the mediating role of perceived stress and problematic internet use
Xue, B., Zheng, X., Yang, L., Xiao, S., Chen, J., Zhang, X., Li, X., Chen, Y., Liao, Y., Zhang, M., et al. (2024) · BMC Public Health · doi:10.1186/s12889-024-20720-5 · Cited by 4
“Problematic internet use could prospectively contribute to a deterioration of mental health of adolescents [45].”
Influence of Gender, Parental Control, Academic Performance and Physical Activity Level on the Characteristics of Video Game Use and Associated Psychosocial Problems in Adolescents
Folgar, M. I., Mateo‐Orcajada, A., Garrido, J. M. F., Conde, M. D. D., & Vaquero‐Cristóbal, R. (2024) · Behavioral Sciences · doi:10.3390/bs14121204 · Cited by 5
Family Context Matters: A Serial Mediation Model Extending the Relationship Between Interparental Conflict and Online Gaming Addiction of Adolescents
Cheng, Y., & Jiang, S. (2025) · Child and Adolescent Social Work Journal · doi:10.1007/s10560-025-01021-1 · Cited by 4
“Consequently, the presence of negative emotions may lead to adolescent’s overuse of the Internet and excessive occupation in online gaming (Burleigh et al., 2018; Wartberg et al.,2019).”
Behavioral Addictions in Children: A Focus on Gambling, Gaming, Internet Addiction, and Excessive Smartphone Use
Derevensky, J. L., Marchica, L. A., Gilbeau, L., & Richard, J. (2022) · Springer eBooks · doi:10.1007/978-3-030-67928-6_161-1 · Cited by 5
A Brief Comprehensive Review of the Interactions Between Attention-Deficit/Hyperactivity Disorder and Internet Gaming Disorder
Michael, T., & Seymour, P. (2023) · International Journal of Mental Health and Addiction · doi:10.1007/s11469-023-01215-7 · Cited by 4
“Third, Wartberg et al. (2019) found that hyperactivity and inattentiveness, common features of ADHD, are associated with the development of IGD.”
Family Factors and Internet Gaming Disorder among Adolescents: A Systematic Review
Ergin, D. A., & Essau, C. A. (2025) · International Journal of Developmental Science · doi:10.1177/2192001x251352496 · Cited by 6
“Studies have shown a positive association between IGD and parental mental health problems such as anxiety and depression (Lam & Cheng, 2022; Lin et al., 2023; Wartberg et al., 2017, 2018).”
Associations between Internet addiction, life satisfaction, and post-traumatic stress symptoms among disaster-exposed children and early adolescents: a three-wave longitudinal study
Shi, W., Yuan, G. F., Chen, Z., Tan, Y., Jiang, L., & Zhao, L. (2025) · Frontiers in Psychiatry · doi:10.3389/fpsyt.2025.1628873 · Cited by 3
Revisiting the Relationship Between Adolescent Internet Gaming Disorder and Depression: A Systematic Review and Meta-Analysis
Zheng, C., Liu, K., Liang, L., Yuan, T., Li, H., Qing, Y., Zhang, C., Su, Y., Cui, Y., & Mei, S. (2025) · Adolescent Research Review · doi:10.1007/s40894-025-00275-1 · Cited by 5
“Internet gam - ing disorder may result in various health issues, including sleep disturbances (Wong et al., 2020 ), emotional distress (Wartberg et al., 2019 ), and impaired socialization (van den Eijnden et al., 2018 ).”
Not all screens are equal: associations between screen-based sedentary behavior and physical activity in Chinese children and adolescents
Wang, Y., Gong, B., Zhang, J., Chen, W., & Guo, M. (2025) · Frontiers in Public Health · doi:10.3389/fpubh.2025.1681183 · Cited by 4
Associations of bullying victimization with problematic internet gaming and problematic social media use among adolescents: moderators and differences
Neumayer, F., Jantzer, V., Killer, A., Lerch, S., & Kaess, M. (2025) · Child and Adolescent Psychiatry and Mental Health · doi:10.1186/s13034-025-01008-x · Cited by 3
“In previous adolescent samples the reliability coefficients were between 0.56 and 0.83, and criterion validity was demonstrated [66, 67].”
Influential
Comorbidity of internet gaming disorder and anxiety in first-year Chinese university students: the mediating role of behavioral inhibition and activation systems
Chen, J., Zhang, Z., Fu, S., Wen, B., Chen, Z., & Wang, X. C. (2025) · BMC Psychiatry · doi:10.1186/s12888-025-07663-w · Cited by 5
Online Gaming Disorder and Sports Betting Addiction: Convergences and Divergences
Ayala-Rojas, R.-E., Granero, R., Fernández‐Aranda, F., Gómez‐Peña, M., Moragas, L., Perales, I., & Jiménez‐Múrcia, S. (2024) · International Journal of Mental Health and Addiction · doi:10.1007/s11469-024-01386-x · Cited by 6
“While some studies have reported values around 1 to 2% (Haagsma et al., 2012; Müller et al., 2015; Rehbein et al., 2015), others are as high as 14% (Wang et al., 2015; Wartberg et al., 2019) and even 20% (Vadlin et al., 2018).”
Beyond the screen: Dissecting the nexus of victimization and cyberhate among adolescents through excessive internet use, online interactions with strangers and parental restrictions
Korol, L., & Blaya, C. (2025) · British Journal of Psychology · doi:10.1111/bjop.12766 · Cited by 6
Psycho-Emotional Factors Associated with Internet Gaming Disorder Among Japanese and Israeli University Students and Other Young Adults
Porat, S.-L. R., Reznik, A. D., Masuyama, A., Sugawara, D., Sternberg, G. G., Kubo, T., & Isralowitz, R. (2025) · Behavioral Science · doi:10.3390/bs15070841 · Cited by 4
“Internet Gaming Disorder (IGD) may include emotional distress, depression, impaired cognitive function and social life, and reduced self-esteem among those affected (Benjet et al., 2023; G. Dong & Potenza, 2016; Muyeed et al., 2024; Q. Wang et al., 2019b; Wartberg et al., 2019).”
Gaming addiction: Study of gaming characteristics and personality traits among the health professional undergraduates
Patel, V. K., Raja, H. H., Tiwari, D. S., Kadavala, N. B., & Patel, N. L. (2020) · Annals of Indian Psychiatry · doi:10.4103/aip.aip_21_20 · Cited by 3
The Influence of Health Education and Group Therapy on Adolescent Online Gamers' Self-Concepts
Nurmagandi, B., Hamid, A. Y. S., & Panjaitan, R. U. (2022) · European Journal of Mental Health · doi:10.5708/ejmh/17.2022.1.4 · Cited by 7
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Mun, I. B., & Lee, S. (2023) · The Social Science Journal · doi:10.1080/03623319.2023.2194472 · Cited by 3
“Additionally, in accordance with longitudinal literature (Lemmens et al., 2011; Wartberg et al., 2019), children’s poor self-esteem was positively linked to their digital media addiction one year later.”
A mixed-method non-randomized pilot evaluation of a mentalization-informed motivational interviewing group intervention for concerned significant others of adolescents with excessive gaming behaviors
Lo, C. K. M., Tse, N., & Chiu, J. (2024) · Children and Youth Services Review · doi:10.1016/j.childyouth.2024.107496 · Cited by 3
Internet Gaming Disorder
Ko, C., & Yen, J. (2023) · Springer eBooks · doi:10.1007/978-3-030-42825-9_164-1 · Cited by 3
Gaming disorder and psychological distress among Iranian adolescents: the mediating role of sleep hygiene
Molaeipour, L., Jabarbeigi, R., Lari, T., Osooli, M., & Jafari, E. (2025) · BMC Public Health · doi:10.1186/s12889-025-22040-8 · Cited by 3
“Moreover, GD is associated with self-esteem issues [6], anxiety, and depression [7, 8].”
Treatment effects of art therapy on adolescents with problematic Internet gaming behavior
Han, D. H., Kim, S. K., Kim, S., & Park, Y. S. (2025) · The Arts in Psychotherapy · doi:10.1016/j.aip.2025.102287 · Cited by 3
Internet gaming disorder in adolescents
Orbatu, D., Alaygut, D., & Eliaçık, K. (2019) · MOJ Women s Health · doi:10.15406/mojwh.2019.08.00259 · Cited by 3
Reliability of the fMRI-based assessment of self-evaluation in individuals with internet gaming disorder
Bach, P., Hill, H., Reinhard, I., Gädeke, T., Kiefer, F., & Leménager, T. (2021) · European Archives of Psychiatry and Clinical Neuroscience · doi:10.1007/s00406-021-01307-2 · Cited by 3
Biopsychosocial factors of gaming disorder: A systematic review employing screening tools with well-defined psychometric propertiesPreprint
Chang, R. S., Lee, M., Im, J. J., Choi, K., Kim, J., Chey, J., Shin, S.-H., & Ahn, W. (2021) · doi:10.31234/osf.io/b8fxr · Cited by 3
The Prevalence of Major Depressive Disorder and Anxiety Disorder among Iranian Adolescents and their Association with Video Gaming and Internet Use
Heidari, F., Norouzi, S., Kazemi-Shishvan, M. A., & Rezaei, H. (2022) · Adolescent Psychiatry · doi:10.2174/2210676612666220415114504 · Cited by 2
Internet Gaming Disorder and Mental Health of Pakistani Adolescents: A Cross-Sectional Study
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Clinical and Cognitive Metacognition in Gaming and Gambling Disorder: A Narrative Review
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“…recognised as a clinical disorder, excessive gaming have been associated to increased levels of loneliness, reduced self-esteem, and emotional distress [9, 10], stressing the need to understand the aetiology of such behaviours and develop effective interventions to reduce their negative impact.”
Time spent on the Internet, problematic gaming and social media use among adolescents
Berber, S., Potzel, K., Kammerl, R., Wartberg, L., & Meyer, C. (2025) · MedienPädagogik Zeitschrift für Theorie und Praxis der Medienbildung · doi:10.21240/mpaed/00/2025.02.18.x · Cited by 2
Self-citation
Internet Gaming Addiction: Prevalence, Causes, Consequences, and Intervention Strategies
Ramachandran, V., Marimuthu, A., & Vishwa Prasanth, G. (2025) · International Conference on Data Science, Agents & Artificial Intelligence (ICDSAAI) · doi:10.1109/icdsaai65575.2025.11011874 · Cited by 2
“When playing games for short periods it becomes hard to concentrate on lengthy tasks which creates mental overload that hurts school or work results [30, 31].”
Understanding the gaming disorder–depression co-occurrence: A narrative literature review
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The double-edged perfectionist parenting: an examination of its impact on adolescent internet gaming addiction (IGA)
Luo, Z., Li, H., & Xiong, Y. (2025) · BMC Psychology · doi:10.1186/s40359-025-03366-9 · Cited by 2
“A common manifestation of this anxiety is when parents become excessively concerned about their children’s safety, leading them to frequently imagine that their children are in danger [62].”
Mindfulness-based therapy for adolescent internet gaming disorder: A feasibility and pilot study
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Adolescent gamers: a four-wave study of gaming trajectories and psychosocial development
van Nierop, B., Wijsbroek, S. A. M., Kleinjan, M., van den Eijnden, R. J. J. M., & Peeters, M. (2026) · Current Psychology · doi:10.1007/s12144-026-09242-y · Cited by 2
“Finally, at age 13, boys in the “Stable High” group had lower self-esteem; this signal is provisional after multiple-testing correction but is consistent with findings that lower self-esteem prospectively relates to IGD and that IGD predicts later emotional distress (Wartberg et al., 2019 ).”

Authors: Wartberg, L., Kriston, L., Zieglmeier, M., Lincoln, T., & Kammerl, R.
Affiliations: University Medical Center Hamburg-Eppendorf (DE)
Friedrich-Alexander-Universität Erlangen-Nürnberg (DE)
Universität Hamburg (DE)
Corresponding author: Wartberg, Lutz
ORCID: Wartberg, Lutz
Kriston, Levente
Lincoln, Tania
Kammerl, Rudolf
Venue: Psychological Medicine
Publisher: Cambridge University Press (CUP)
Published: 2018-04-06
Volume: 49
Issue: 2
Pages: 287-294
ISSN: 0033-2917 (ISSN-L)
1469-8978
DOI: 10.1017/s003329171800082x
OpenAlex: W2795455895
Cited by: 270
References: 28
Citations by year: 2026: 23 · 2025: 49 · 2024: 40 · 2023: 39 · 2022: 34 · 2021: 39 · 2020: 32 · 2019: 12 · 2018: 2
FWCI: 48.35
Type: journal article
Language: en
Open access: closed
Licence: www.cambridge.org/core/terms (unspecified)
Locations: Psychological Medicine (publishedVersion)
PubMed (publishedVersion)
Funders: Deutsche Forschungsgemeinschaft
Topics: Social Sciences › Sociology and Political Science › Impact of Technology on Adolescents
Social Sciences › Psychology › Clinical Psychology › Gambling Behavior and Treatments
Social Sciences › Psychology › Clinical Psychology › Sexuality, Behavior, and Technology
Keywords: internet gaming disorder, adolescents, psychosocial etiology, hyperactivity/inattention, self-esteem problems, emotional distress, parental mental health, family dyads, temporal stability, DSM-5
MeSH terms: Psychological Distress, Adolescent, Adolescent Behavior, Adult, Attention Deficit Disorder with Hyperactivity, Child, Female, Humans, Longitudinal Studies, Male, Self Concept, Behavior, Addictive, Video Games, Internet

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A longitudinal study on psychosocial causes and consequences of Internet gaming disorder in adolescence

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