This paper is in the following e-collection/theme issue:

Games and Gamification for Health (644) Problematic Internet Use, Online Gambling and Game Addiction (123) Mental Health Issues in Adolescence (437) Kids' and Adolescents' Use of Technology (86) Depression and Mood Disorders; Suicide Prevention (1351) Screen Time for Children and Adolescents (50)

Published on in Vol 26 (2024)

Preprints (earlier versions) of this paper are available at https://preprints.jmir.org/preprint/59490, first published .
Interaction Effects Between Low Self-Control and Meaning in Life on Internet Gaming Disorder Symptoms and Functioning in Chinese Adolescents: Cross-Sectional Latent Moderated Structural Equation Modeling Study

Interaction Effects Between Low Self-Control and Meaning in Life on Internet Gaming Disorder Symptoms and Functioning in Chinese Adolescents: Cross-Sectional Latent Moderated Structural Equation Modeling Study

Interaction Effects Between Low Self-Control and Meaning in Life on Internet Gaming Disorder Symptoms and Functioning in Chinese Adolescents: Cross-Sectional Latent Moderated Structural Equation Modeling Study

Authors of this article:

Ted CT Fong1, 2 Author Orcid Image ;   Kunjie Cui3 Author Orcid Image ;   Paul SF Yip3, 4, 5 Author Orcid Image
Article Authors Cited by Tweetations Metrics

    Original Paper

    1Research Hub of Population Studies, The University of Hong Kong, Pokfulam, Hong Kong, China (Hong Kong)

    2Centre on Behavioral Health, The University of Hong Kong, Pokfulam, Hong Kong, China (Hong Kong)

    3Research Institute of Social Development, Southwestern University of Finance and Economics, Chengdu, China

    4The HKJC Centre for Suicide Research and Prevention, The University of Hong Kong, Pokfulam, Hong Kong, China (Hong Kong)

    5Department of Social Work and Social Administration, The University of Hong Kong, Pokfulam, Hong Kong, China (Hong Kong)

    Corresponding Author:

    Kunjie Cui, PhD

    Research Institute of Social Development

    Southwestern University of Finance and Economics

    No. 555 Liutai Road

    Wenjiang District

    Chengdu, 611100

    China

    Phone: 86 17512828565

    Email: cuikunjie@swufe.edu.cn


    Background: Internet gaming disorder (IGD) is an emerging behavioral addiction with mental health implications among adolescents. Low self-control is an established risk factor of IGD. Few studies have, however, examined the moderating role of meaning in life (MIL) on the relationships between low self-control and IGD symptoms and functioning.

    Objective: This study aimed to examine the effects of low self-control and MIL and their interaction effects on IGD symptoms and family and school functioning in a structural equation model.

    Methods: A sample of 2064 adolescents (967, 46.9% male; mean age 14.6 years) was recruited by multistage cluster random sampling from 5 middle schools in Sichuan, China, in 2022. The participants completed a self-report questionnaire with validated measures on low self-control, presence of MIL, search for MIL, IGD symptoms, school commitment, and family functioning. Construct validity, measurement invariance, and structural invariance of the measures were evaluated by confirmatory factor analysis across sex. Structural equation modeling was conducted to examine the indirect effects of low self-control and MIL on family and school functioning through IGD symptoms. Latent moderated structural equation modeling was performed to examine the interaction effects between low self-control and MIL on IGD symptoms, school commitment, and family functioning.

    Results: All scales showed satisfactory model fit and scalar measurement invariance by sex. Males showed significantly greater IGD symptoms and lower levels of self-control (Cohen d=0.25-1.20, P<.001) than females. IGD symptoms were significantly and positively associated with impulsivity (β=.20, P=.01), temper (β=.25, P<.001), and search for meaning (β=.11, P=.048) and significantly and negatively associated with presence of meaning (β=–.21, P<.001). Presence of MIL and impulsivity showed a significant and negative interaction effect (β=–.11, SE .05; P=.03) on IGD symptoms. The positive effect of impulsivity on IGD symptoms was stronger among adolescents with low presence of MIL than those with high presence of MIL. Temper showed significant and positive interaction effects with presence of MIL (β=.08, SE .04; P=.03) and search for MIL (β=.08, SE .04; P=.04) on family functioning. The negative effects of temper on family functioning were stronger among adolescents with low levels of MIL than among those with high levels of MIL.

    Conclusions: This study provides the first findings on the interaction effects between low self-control and presence of MIL and search for MIL on IGD symptoms and functioning among a large sample of adolescents in rural China. The results have implications for targeted interventions to help male adolescents with lower self-control and presence of meaning.

    J Med Internet Res 2024;26:e59490

    doi:10.2196/59490

    Keywords

    Chinese; impulsivity; interaction effects; internet gaming disorder; latent moderation; meaning in life; self-control; temper 


    Technological advances in the past decade have contributed to increased gaming behaviors among younger generations. Internet gaming disorder (IGD) is a psychiatric condition involving persistent internet gaming behaviors that lead to significant distress [1]. IGD refers to the frequent occurrence of at least 5 of the 9 diagnostic criteria of DSM-5 (Diagnostic and Statistical Manual of Mental Disorders [Fifth Edition]) such as preoccupation (obsession with gaming), withdrawal symptoms, tolerance (need to play internet games for longer times or with greater intensity), displacement (neglect of work, study, or social life due to gaming), and deception (tendency to hide gaming time or negative consequences) [2]. Though a previous study [3] found only a minimal prevalence (0.3%-1%) of gamers qualified for IGD, this phenomenon has been aggravated by the social isolation brought on by the COVID-19 pandemic [4]. A recent meta-analysis estimated the pooled prevalence of IGD to be 8.8% among adolescents [5].

    Adolescence is a crucial transition period with greater vulnerability to addictive behaviors and adolescents exhibit higher tendencies toward sensation-seeking and risk-taking behaviors [6]. Apart from existing risk factors of IGD such as loneliness, hopelessness, being bullied, and low self-esteem [5,7], low self-control has been positively linked with maladaptive gaming motivations and IGD symptoms in adolescents [8-10]. Impulsivity and temper have shown significant associations with greater IGD symptoms in adolescent samples [11,12]. IGD has been associated with poor family functioning and school achievement in adolescents [13,14]. Recent studies have linked IGD symptoms with parental factors and family conflicts [15,16].

    Adolescents may play internet games for motivations such as socialization, risk-seeking, achievement, immersion, or escape from reality [17,18]. The self-determination theory posits that adolescents seek to fulfil 3 basic psychological needs: autonomy, competence, and relatedness [19]. In the gaming context, adolescents could make decisions and control their virtual characters to acquire a sense of autonomy in the context of “virtual reality.” They could gain a sense of competence by overcoming in-game challenges and tasks and achieve a sense of relatedness by connecting with other gamers. A previous study [8] found that failure to meet these psychological needs could undermine individuals’ self-control in regulating behaviors and impulses, which in turn contributes to greater IGD symptoms.

    Meaning in life (MIL) measures the coherence and purpose of one’s life [20] and is operationalized in 2 dimensions: presence of MIL and search for MIL [21]. Though a recent study [22] found that MIL mediated the relationship between basic psychological needs and IGD, the authors only used the total MIL score and did not differentiate between the 2 dimensions. Lower presence of MIL has been consistently associated with greater IGD symptoms in adolescents [23-25]. In comparison, search for MIL has shown positive or nonsignificant associations with IGD symptoms [24,25]. A previous study found that the identity formation process during adolescence could contribute to internet gaming behaviors in the search for identity [26]. Excessive internet gaming could make this exploration maladaptive and lead to negative player identity [27]. The paradoxical roles of the 2 MIL factors on IGD symptoms warrant further investigation.

    Both self-control and the presence of MIL could be important psychological resources for resilience and coping. Despite the negative association between search for MIL and subjective well-being [28], the presence of MIL showed positive moderating effects on happiness when individuals were searching for MIL. Schnell and Krampe [29] found that the presence of MIL could buffer the adverse effect of low self-control on mental distress. Another study [30] found that presence of MIL and search for MIL attenuated and amplified the effects of bullying victimization on IGD, respectively, in Chinese male adolescents. However, no existing studies have investigated the interaction effects between MIL and low self-control on IGD symptoms and functioning. Such an investigation would provide insights into how adolescents’ presence of MIL and search for MIL may moderate the effects of low self-control on IGD symptoms and functioning.

    This study had 3 objectives. Figure 1 depicts the conceptual model and hypothesized relationships of the present study. In the figure, positive and negative associations are hypothesized and depicted in orange solid arrows and blue dashed arrows, respectively. The green dotted arrows denote the potential moderating role of meaning in life on the relationships between low self-control and outcome variables. First, we aimed to examine the relationships among low self-control, MIL, IGD symptoms, and family and school functioning in a structural equation model (SEM). Second, we investigated the indirect effects of low self-control and MIL on adolescents’ family and school functioning through IGD symptoms. Third, we aimed to examine the interactive effects between MIL and low self-control on IGD symptoms and family and school functioning of adolescents. The study proposed several hypotheses. In hypothesis 1, low self-control would be positively associated with IGD symptoms and negatively with family and school functioning. In hypothesis 2, the presence of MIL would be negatively associated with IGD symptoms. In hypothesis 3, search for MIL would show positive or nonsignificant associations with IGD symptoms. In hypothesis 4, presence of MIL and search for MIL would have interaction effects with low self-control on IGD symptoms and family and school functioning.

    ‎
    Figure 1. Conceptual model and hypothesized relationships among the study variables in the present study. Positive and negative associations are hypothesized and depicted in solid orange arrows and dash blue arrows, respectively. The dotted green arrows denote the potential moderating role of meaning in life on the relationships between low self-control and outcome variables.

    Study Design and Procedure

    This study was cross-sectional in nature and adopted a multistage cluster random sampling method. In the first stage, 5 middle schools were randomly sampled in Liangshan Yi Autonomous prefecture of Sichuan province in China. The Liangshan prefecture is an impoverished region known with its high ethnic diversity in rural China [31]. Adolescents in this region are at risks of developing IGD given the shortage of qualified teachers, limited collaboration between schools and families, and low effectiveness of family education [10]. Next, grade 7-8 classes were randomly selected from each school between June and July 2022. A total of 2378 students were invited from 38 classes through invitation letters in the 5 middle schools. Inclusion criteria of the study were age 11 to 17 years, students studying in grade 7 or 8, and ability to read simplified Chinese. Exclusion criteria of the study were presence of substantial visual and psychiatric impairment that interfered with completion of the questionnaire and inability to obtain written informed consent from the parent or guardian of the students. The eligibility of the students to participate was screened by a research assistant with reference to school records. The overall response rate of the survey was 86.8% and 2064 participants voluntarily elected to join the survey.

    Measures

    In this study, the self-report questionnaire included the following measures on low self-control, MIL, IGD symptoms, school commitment, and family functioning. The questionnaire also asked the following sociodemographic characteristics of the participants, namely, sex, age, ethnicity, urban or rural registration, and whether they were left-behind children. The questionnaire was administered in a paper-and-pencil format and completed in 20-30 minutes in classroom settings without interference from the school teachers. Participants were reminded to avoid discussion during the survey completion and encouraged to answer the questionnaire honestly. The questionnaire was field tested in May 2022 with minor revisions based on comments from the adolescents.

    Low self-control was measured by the Grasmick Low Self-Control Scale [32]. This 23-item scale assessed 6 trait types of low self-control: impulsivity (3 items), physical activity (4 items), risk-seeking (4 items), self-centeredness (4 items), simple task (4 items), and temper (4 items). The items are scored on a 4-point scale ranging from 1=“strongly disagree” to 4=“strongly agree.” Higher scores indicated lower levels of self-control.

    MIL was assessed by the 6-item Meaning in Life Questionnaire–short form [21] on 2 dimensions of MIL: presence of MIL (3 items) and search for MIL (3 items). Items are scored on a 7-point scale ranging from 1=“absolutely untrue” to 7=“absolutely true.” Higher scores indicated higher levels of presence of and search for MIL.

    The 9-item IGD Scale–short form [33] was used to assess the severity of IGD symptoms according to the DSM-5 diagnostic criteria over the past year. The 9 items are scored on a 5-point scale ranging from 1=“Never” to 5=“Very often” and added up for the total IGD score (theoretical range=9-45). Higher scores indicated greater levels of IGD symptoms.

    School commitment was assessed by 4 self-constructed items on a 5-point scale from 1=“strongly disagree” to 5=“strongly agree.” Example of items included “Getting good grades is important to me.” Family functioning was measured by 5 self-constructed items on a 5-point scale ranging from 1=“absolutely untrue” to 5=“absolutely true.” Example of items included “When problems arise, we are able to work together to solve them and rely on each other.” Higher scores indicated greater levels of commitment to school and family functioning.

    Composite reliability of the latent factors was evaluated using McDonald omega (ω) with values ≥.70 indicating good reliability. All of the measures showed good levels of reliability (ω=.71-.94).

    Sample Size Planning

    Power analysis was performed through Monte Carlo simulation with 1000 replications to determine the required sample size for SEM [34]. In the SEM, we specified a latent predictor with 4 observed indicators, a latent mediator with 3 observed indicators, and a latent outcome variable with 5 observed indicators. The factor loadings (λ) of the latent factors were fixed at 0.7. The acceptable α error level was set at P<.05. Effect size of the standardized path coefficients was denoted by 0.14 (small effect) and 0.39 (moderate effect) [35]. The sample size of male (n=967) and female (n=1097) subsamples showed adequate statistical power for detecting statistical significance for direct effects (91.2%-97.3%) and indirect effects (83.5%-89.6%) with small effect sizes.

    Data Analyses

    Construct Validity of Measures

    This study conducted data analysis in 4 steps. The first step examined the factorial validity of the measures by confirmatory factor analysis (CFA). The 47 items on low self-control, MIL, IGD symptoms, school commitment, and family functioning were analyzed in separate CFA models and a combined 11-factor CFA model in Mplus (version 8.6, Muthén and Muthén) [36]. Preliminary item analysis found substantial floor effects for the low self-control and IGD items and substantial ceiling effects for the school commitment and family functioning items. Given the skewed distributions of the items, these items were treated as ordinal items using the robust weighted least square estimator [37]. Model fit was evaluated through the following criteria on the fit indices [38]: comparative fit index (CFI) ≥.95, Tucker-Lewis index (TLI) ≥.95, root-mean-square error of approximation (RMSEA) ≤.06, and standardized root-mean-square residuals (SRMR) ≤.06. Statistical significance was set at P<.05 in the present study.

    Measurement and Structural Invariance Across Sex

    The second step evaluated the measurement invariance of the scales across sex. Multiple group CFA estimated the configural invariance model with different item loadings and thresholds across sex. Scalar invariance model fixed all item loadings and thresholds to be equal across sex [39]. Model comparison was performed using the chi-square difference test and change in model fit indices, with ΔCFI >–.01 and ΔRMSEA and ΔSRMR <.01 supporting the more constrained model [40]. Structural invariance tests compared the means of latent factors across sex on a standardized metric. Cohen d denoted the effect sizes with cutoff scores of 0.2, 0.5, and 0.8 for small, moderate, and large sizes, respectively [41]. Missing data were minimal and were handled using full information maximum likelihood under the missing-at-random assumption [42].

    Structural Equation Model

    Third, SEM was conducted to examine the direct and indirect effects from low self-control and MIL to school commitment and family functioning through IGD symptoms. In the SEM, the 6 low self-control factors and 2 MIL factors were the latent predictors; the IGD factor was the latent mediator; and the school commitment and family functioning factors were the latent outcomes. The model included sex, age, ethnic minority, urban registration, and left-behind children as control variables. Indirect effects were estimated using 5000 bootstrap draws and considered statistically significant if their 95% bootstrapped CI excluded 0. R2 values denoted the proportion of explained variance for the dependent variables. Sensitivity analysis was performed by conducting multigroup SEM across sex to examine potential sex differences.

    Interaction Effects Between MIL and Low Self-Control

    In the fourth step, we conducted latent interaction analysis by adding interaction terms between the latent MIL factors and low self-control factors to the SEM separately. The latent interaction SEM was estimated using the XWITH option with numerical integration in Mplus, which allowed us to examine whether MIL factors moderated the relationships between low self-control and IGD symptoms and latent outcomes. Standardized coefficients for the latent interaction terms were interpreted in terms of direction and statistical significance. Simple slopes analysis was conducted to probe the interaction effects by testing the conditional effects of low-self-control on IGD symptoms and functioning at mean, low (mean –1.5SD), and high (mean + 1.5SD) levels of MIL.

    Ethical Considerations

    The study received ethical approval from the Ethics Committee of the Southwestern University of Finance and Economics (approval number 2422CSH068). The study objectives and procedures were clearly explained to the participants by the research assistant in each classroom. Participation was completely voluntary. Written informed consent was obtained from the parents or legal guardians of the adolescents. Participants had the right to opt out of the survey and not answer specific questions without any adverse outcomes. All collected data was anonymized to preserve confidentiality of personal information. No financial compensation was provided to the study participants. All procedures contributing to this work comply with the Helsinki Declaration of 1975, as revised in 2008.


    Sample Characteristics

    As shown in Table S1 in Multimedia Appendix 1, a total of 1097 out of 2064 participants (53.1%) were females, and the average age was 14.6 (SD 1.10) years. Most of the participants were ethnic minorities (1931/2064, 93.6%) and had rural registration (1929/2064, 93.5%). Over 1 quarter (592/2064, 28.7%) of the sample were left-behind children in their hometown. Out of 2064, a total of 1281 (62.1%) participants were regular gamers who played internet games for at least 3 hours per week. Overall, the sample reported moderate levels of self-control, presence of MIL, and search for MIL, moderately high levels of school commitment and family functioning, and low levels of IGD symptoms (Multimedia Appendix 1). The sample prevalence of IGD was 2% (36/2064). The IGD prevalence was significantly higher (χ21=14.1, P<.001) in males (prevalence=3%; 28/967) than females (prevalence=1%; 8/1097).

    Construct Validity of Measures

    All measurement scales showed acceptable model fit to the data in CFA with CFI>.95, TLI≥.95, RMSEA≈.06, and SRMR<.06 (Multimedia Appendix 2). Substantial factor loadings were found for low self-control (λ=0.53-0.85), MIL (λ=0.68-0.87), IGD (λ=0.70-0.88), school commitment (λ=0.45-0.77), and family functioning (λ=0.83-0.93).

    Measurement and Structural Invariance Across Sex

    Both configural and scalar invariance models provided adequate model fits across sex. Despite significant chi-square difference test between the 2 models (Δχ2155=357.6, P<.001), the scalar invariance model did not show deterioration in fit indices. As Table 1 shows, males showed significantly higher latent means in physical activity, risk-seeking, self-centeredness, and IGD symptoms (d=0.25-1.20, P<.001) and significantly lower latent means in school commitment (d=–0.42, P<.001) than females. The latent mean differences in other factors were not significant (d =–0.08-0.14, P=.12-.86).

    Table 1. Latent mean difference of males compared with females in the study variables in the scalar invariance model (N=2064).
    VariablesCohen da,bSEP value
    Low self-control

    		Impulsivity0.030.054.53

    		Physical activity0.330.056<.001

    		Risk-seeking0.340.064<.001

    		Self-centeredness0.250.062<.001

    		Simple task0.140.057.06

    		Temper0.010.053.86
    Presence of meaning0.010.046.77
    Search for meaning–0.070.048.17
    Internet gaming disorder symptoms1.200.209<.001
    School commitment–0.420.058<.001
    Family functioning–0.080.051.12

    aAll latent means were fixed at zeros in the female subgroup for identification purpose.

    bCohen d: SD for males over females.

    Structural Equation Model

    The SEM with covariates provided an adequate fit to the whole sample. Multimedia Appendix 3 shows the standardized effects of demographic variables on the latent factors in the model. Figure 2 depicts the standardized regression paths from low self-control and MIL to school commitment and family functioning through IGD symptoms. For simplicity of presentation, the figure does not display the 47 observed items of the latent variables, demographic variables, and their associated pathways. Positive and negative paths are represented by continuous orange lines and dash blue lines, respectively. Significant paths involving IGD symptoms are highlighted in bold. Residual correlation between school commitment and family functioning is shown in black dashed arrows. IGD symptoms were significantly and positively associated with impulsivity (β=.20, P=.01), temper (β=.25, P<.001), and search for meaning (β=.11, P=.048), and significantly and negatively associated with presence of meaning (β=–.21, P<.001). IGD symptoms were significantly and negatively associated with school commitment (β=–.34, P<.001) and family functioning (β=–.08, P=.03). The model explained 37.1%, 41.1%, and 33.7% of the variances of IGD symptoms, school commitment, and family functioning, respectively.

    As Table 2 shows, out of the 6 low self-control factors, impulsivity and temper showed significant and negative indirect effects on school commitment and family functioning through IGD symptoms. The presence of MIL had significant and positive indirect effects on school commitment and family functioning through IGD symptoms. Search for MIL showed a significant and negative indirect effect on school commitment through IGD symptoms. Multigroup SEM found comparable indirect effects from impulsivity, temper, and presence of MIL to school commitment and family functioning through IGD symptoms across sex. The negative indirect effect from search for meaning to school commitment through IGD symptoms was significant in males (αβ=–.059, 95% CI –0.115 to –0.008) but not in females (αβ=–.012, 95% CI –0.074 to 0.046).

    ‎
    Figure 2. Standardized path coefficients and standard errors (in parenthesis) from low self-control factors and meaning in life factors to school commitment and family functioning through internet gaming disorder symptoms in the structural equation model. *P<.05; **P<.01.
    Table 2. Standardized indirect effects from low self-control and meaning in life to school commitment and family functioning through internet gaming disorder symptoms in the structural equation model (N=2064).
    Predictor variableSchool commitmentFamily functioning

    		Estimate (95% CI)Estimate (95% CI)
    Impulsivity–0.066 (–0.119 to –0.016)–0.016 (–0.041 to –0.001)
    Physical activity0.029 (–0.018 to 0.083)0.007 (–0.005 to 0.025)
    Risk-seeking–0.058 (–0.132 to 0.003)–0.014 (–0.038 to 0.000)
    Self-centered0.039 (–0.038 to 0.119)0.010 (–0.011 to 0.034)
    Simple task–0.004 (–0.073 to 0.049)–0.001 (–0.021 to 0.012)
    Temper–0.086 (–0.136 to –0.044)–0.021 (–0.046 to –0.004)
    Presence of meaning in life0.071 (0.036 to 0.107)0.018 (0.002 to 0.035)
    Search for meaning in life–0.037 (–0.075 to –0.006)–0.009 (–0.023 to 0.000)

    Interaction Effects Between MIL and Low Self-Control

    Latent interaction SEM was conducted to examine 4 interaction effects between MIL factors and impulsivity and temper. Presence of MIL and impulsivity showed a significant and negative interaction effect (β=–.11, SE 0.05; P=.03) on IGD symptoms. As Figure 3 shows, the positive effect of impulsivity on IGD symptoms was stronger (dash orange line) among adolescents with low presence of MIL and was much weaker (solid blue line) among those with high presence of MIL. The effects of other 3 interaction terms on IGD symptoms were not significant (β=–.06-.01, SE 0.05-0.06; P=.17-.92). Both impulsivity and temper showed positive but nonsignificant interaction effects with presence of MIL and search for MIL on school commitment (β=.04-.08, SE 0.05; P=.09-.44). Presence of MIL and search for MIL showed significant and positive interaction effects (β=.08, SE 0.04; P=.03-.045) with temper on family functioning. As Figure 4 shows, the negative effects of temper on family functioning were stronger (dash orange lines) among adolescents with low levels of MIL and were much weaker (solid blue lines) among those with high levels of MIL.

    ‎
    Figure 3. Effects of impulsivity on internet gaming disorder symptoms conditional on presence of meaning in life. For presence of meaning in life, high levels=mean+1.5SD and low levels=mean−1.5SD.
    ‎
    Figure 4. Effects of temper on family functioning conditional on presence of meaning in life and search for meaning in life. For presence of meaning in life and search for meaning in life, high levels=mean+1.5SD and low levels=mean−1.5SD.

    Principal Findings

    This study evaluated the effects of low self-control and MIL on IGD symptoms and family and school functioning in a large sample of Chinese adolescents. Two low self-control factors (impulsivity and temper) were significantly associated with greater IGD symptoms, and 5 low self-control factors (except simple task) were directly or indirectly associated with worse school commitment and family functioning. These provided empirical support for hypothesis 1. IGD symptoms were found to have significant and negative associations with presence of MIL and significant and positive associations with search for MIL. These results are consistent with hypothesis 2 and hypothesis 3. Consistent with hypothesis 4, MIL factors showed interaction effects with impulsivity and temper on IGD symptoms and family functioning.

    Comparison With Previous Work

    Consistent with previous literature [22-24,43], adolescents with greater presence of MIL showed lower IGD symptoms and better family functioning and school commitment. Presence of MIL has found a significant and negative indirect effect on suicidal ideation through psychological distress in Hong Kong young adults [44]. The indirect effects from low self-control and MIL to school commitment were stronger than those for family functioning. This appears to suggest greater relevance of IGD in the school context than the family context. Furthermore, this study found that presence of MIL could play a buffering role on the adverse effect of impulsivity on IGD symptoms among adolescents. This is consistent with previous findings on the moderating role of presence of MIL on drug use, suicide risk, and internet addiction [45-47].

    In line with recent findings [25], search for MIL showed a positive effect on IGD symptoms after controlling for presence of MIL. In contrast to the positive direct effect from search for MIL to school commitment, the negative indirect effect through IGD symptoms implies that adolescents could search for MIL by internet gaming and maladaptive gaming behaviors could lead to decrement in school commitment. Nevertheless, search for MIL was found to positively modulate the negative effect of temper on family functioning. Overall, the present results suggest that search for MIL plays a complex role in relation to adolescents’ functioning through their IGD symptoms.

    In our study, the sex differences in the IGD symptoms and self-control agree with the literature [8,48-50]. In a qualitative study [51], gaming was a meaningful activity for problem gamers and the gaming experience offered a sense of meaning to them. Our multigroup SEM results suggest a more salient role for search for MIL in predicting IGD symptoms and school commitment in males. A previous study [30] found that presence of MIL and search for MIL attenuated and amplified the effects of bullying victimization on IGD, respectively, in male adolescents but not in female adolescents. This discrepancy highlights greater service needs to foster a sense of meaning among male adolescents.

    IGD is a prominent public health issue in Asian countries such as China and South Korea [52]. The present sample displayed substantially lower levels of IGD symptoms (Cohen d=0.87, P<.01) than that reported in a recent study among young people in Hong Kong [49]. Adolescents in China are only allowed to play internet games for at most 1.5 hours on weekdays and 3 hours on weekends and holidays [53]. It is plausible that the government restriction on internet gaming contributed to substantially lower severity of IGD in adolescents in China than in Hong Kong. However, presence of floor effects for low self-control and IGD and ceiling effects for functioning indicated potential lack of sensitivity of the measures in capture individual differences. Underestimation of the true variability could cast doubts on the validity of the present findings.

    Implications for Future Work

    In Liangshan, many parents migrated to urban areas for work opportunities and better livelihood, resulting in many left-behind children. These adolescents showed lower levels of presence of meaning, family functioning, and self-control in the present sample. Previous studies have found inadequate parental supervision and greater loneliness among left-behind children in rural China [54,55]. Interestingly, ethnic minorities showed fewer IGD symptoms and higher school commitment than the Han counterparts. The high proportion of ethnic minorities denotes a sense of cultural similarity and better social support, both of which could contribute to lower IGD risks [56]. From a practical perspective, positive psychology interventions such as character strength intervention [57] and life skills development programs [58] could be implemented in schools to facilitate the adolescents’ search for identity and MIL to promote holistic development during adolescence. A previous study found that awareness of medicalization of IGD was linked with reduced gaming time, fewer maladaptive cognitions, and greater help-seeking intention in Chinese adolescents [59]. School-based prevention programs should aim to increase the adolescents’ awareness of the IGD symptoms and their adverse effects in a nonstigmatizing manner.

    Besides, recent studies have suggested the use of mindfulness-based intervention [60] and self-control intervention [61] to reduce aggression and promote self-control in adolescents. For instance, a recent study [62] has examined the effectiveness of relapse prevention therapy on parent-child communication, parent-child relationships, and parenting needs for youths with IGD. A recent study identifies digital phenotypes (faster stroke acceleration, reduced word spacing, decreased deletion behavior, and longer horizontal strokes) by student tablet data for early detection of IGD among 168 Korean adolescents [63]. Large-scale studies are recommended to evaluate the effectiveness of digital phenotyping as an early detection method of IGD for adolescents. Further research should explore the associations between preferences toward gaming devices and genres and gamification user types [64]. The results could inform the development of targeted treatment programs toward different types of gamers in different gaming devices. Future studies could examine the inter-relationships between IGD and other risk factors such as social withdrawal, cybersex experiences, deviant behaviors at a symptom level through network analysis [65-67].

    Limitations

    This study used the full latent variable approach to account for the measurement errors of the item indicators, which mitigates the measurement bias and provides more reliable estimates of the regression paths. However, the present study has a few limitations. First, the cross-sectional design did not permit inference of directional relationships between MIL, self-control, and IGD symptoms. Reciprocal effects from IGD to self-control and MIL could not be ruled out. Panel studies are needed to elucidate their temporal relationships. Second, the present study focused on the effects of low self-control and MIL on IGD symptoms and functioning. Omission of important confounding variables could lead to omitted variable bias in the present results. Further studies should examine the effects of factors such as maladaptive cognitions, peer influences, social withdrawal, resilience on IGD [68-70]. Third, the adolescents were recruited from 5 middle schools and were mostly ethnic minorities. There are self-selection and response biases associated with cluster sampling method. Cautions are warranted in generalizing the present results to the general population of adolescents in China.

    Fourth, the present results were based solely on self-report data from the adolescents and were subject to common method bias. It was plausible that participants with IGD would under-report their symptoms, leading to an underestimation of the IGD severity in the sample. Future studies should incorporate additional sources of information from parents or teachers to provide a more accurate evaluation of IGD symptoms. Fifth, recent studies have indicated potential overlap between IGD and smartphone addiction and social media addiction [24,71,72]. A recent study found that gaming devices (computer or mobile phone) contributed to differences in gaming time, gaming motivations, and IGD symptoms [73]. It is plausible that IGD and smartphone addiction are simply manifestations of the same underlying disorder as a result of confounding effect of gaming device. Further studies should clarify the comorbid relationships and the nature of digital addictions through network analysis to ensure precise use of diagnostic categories.

    Conclusions

    This study provided the first findings on the interaction effects between low self-control and presence of MIL and search for MIL on IGD symptoms and functioning among a large sample of adolescents in rural China. Presence of MIL and search for MIL could mitigate the adverse effects of impulsivity on IGD symptoms and temper on family functioning, respectively. The results have implications for targeted interventions to help male adolescents with lower self-control and presence of meaning.

    Acknowledgments

    The authors would like to thank all adolescents for their participation in the study and the school principals and teachers for their help in the study coordination and data collection. This study was supported by the National Social Science Fund of China (grant 22CSH068), a ChiangKiang visiting scholar program, and a General Research Fund grant (GRF/HKU 17608522) by the Research Grants Council of Hong Kong. The sponsors had no role in the study design; in the collection, analysis and interpretation of data; in the writing of the report; and in the decision to submit the article for publication.

    Data Availability

    The raw data and Mplus syntax analyzed in this study are available from the first author upon reasonable request.

    Authors' Contributions

    TCTF conceptualized the current study, conducted the formal analysis, visualized and interpreted the results, and wrote the original draft. KC was responsible for conceptualization, data curation, project administration, funding acquisition, and reviewed and edited the manuscript. PSFY contributed to conceptualization, methodology, validation, funding acquisition, supervision, and reviewed and edited the manuscript.

    Conflicts of Interest

    None declared.

    Multimedia Appendix 1

    Demographics and descriptive statistics of the sample.

    DOCX File , 15 KB
    Multimedia Appendix 2

    Fit indices of confirmatory factor analysis models of the measurement scales, measurement invariance models across gender, and structural equation modeling models in the whole sample and across gender subgroups.

    DOCX File , 19 KB
    Multimedia Appendix 3

    Standardized effects of demographic variables on the latent variables in the structural equation model.

    DOCX File , 16 KB
    1. Yao YW, Potenza MN, Zhang JT. Internet gaming disorder within the DSM-5 framework and with an eye toward ICD-11. Am J Psychiatry. 2017;174(5):486-487. [CrossRef] [Medline]
    2. Poon LYJ, Tsang HWH, Chan TYJ, Man SWT, Ng LY, Wong YLE, et al. Psychometric properties of the internet gaming disorder scale-short-form (IGDS9-SF): systematic review. J Med Internet Res. 2021;23(10):e26821. [FREE Full text] [CrossRef] [Medline]
    3. Przybylski AK, Weinstein N, Murayama K. Internet gaming disorder: investigating the clinical relevance of a new phenomenon. Am J Psychiatry. 2017;174(3):230-236. [FREE Full text] [CrossRef] [Medline]
    4. Teng Z, Pontes HM, Nie Q, Griffiths MD, Guo C. Depression and anxiety symptoms associated with internet gaming disorder before and during the COVID-19 pandemic: a longitudinal study. J Behav Addict. 2021;10(1):169-180. [FREE Full text] [CrossRef] [Medline]
    5. Gao YX, Wang JY, Dong GH. The prevalence and possible risk factors of internet gaming disorder among adolescents and young adults: systematic reviews and meta-analyses. J Psychiatr Res. 2022;154:35-43. [CrossRef] [Medline]
    6. Balogh KN, Mayes LC, Potenza MN. Risk-taking and decision-making in youth: relationships to addiction vulnerability. J Behav Addict. 2013;2(1). [CrossRef] [Medline]
    7. Yu Y, Fong VWI, Ng JHY, Wang Z, Tian X, Lau JTF. The associations between loneliness, hopelessness, and self-control and internet gaming disorder among university students who were men who have sex with men: cross-sectional mediation study. J Med Internet Res. 2023;25:e43532. [FREE Full text] [CrossRef] [Medline]
    8. Mills DJ, Allen JJ. Self-determination theory, internet gaming disorder, and the mediating role of self-control. Computers in Human Behavior. 2020;105:106209. [CrossRef]
    9. Jo SJ, Yim HW, Jeong H, Lee HK. Moderating effects of depressive symptoms and self-control trait on the association between problematic internet gaming and time spent. Cyberpsychol Behav Soc Netw. 2022;25(4):237-244. [CrossRef] [Medline]
    10. Quancai L, Meng C, Kunjie C. Social control and self-control: factors linking exposure to domestic violence and adolescents' internet gaming addiction. Front Psychiatry. 2023;14:1245563. [FREE Full text] [CrossRef] [Medline]
    11. Yu Y, Mo PKH, Zhang J, Li J, Lau JTF. Impulsivity, self-control, interpersonal influences, and maladaptive cognitions as factors of internet gaming disorder among adolescents in China: cross-sectional mediation study. J Med Internet Res. 2021;23(10):e26810. [FREE Full text] [CrossRef] [Medline]
    12. Siste K, Hanafi E, Sen LT, Wahjoepramono POP, Kurniawan A, Yudistiro R. Correction: potential correlates of internet gaming disorder among indonesian medical students: cross-sectional study. J Med Internet Res. 2021;23(4):e29790. [FREE Full text] [CrossRef] [Medline]
    13. Wartberg L, Kriston L, Thomasius R. Internet gaming disorder and problematic social media use in a representative sample of German adolescents: prevalence estimates, comorbid depressive symptoms and related psychosocial aspects. Computers in Human Behavior. 2020;103:31-36. [CrossRef]
    14. Bonnaire C, Phan O. Relationships between parental attitudes, family functioning and internet gaming disorder in adolescents attending school. Psychiatry Res. 2017;255:104-110. [CrossRef] [Medline]
    15. She R, Zhang Y, Yang X. Parental factors associated with internet gaming disorder among first-year high school students: longitudinal study. JMIR Serious Games. 2022;10(4):e33806. [FREE Full text] [CrossRef] [Medline]
    16. Shin YB, Kim JJ, Kim H, Kim SJ, Eom H, Jung YH, et al. Managing game-related conflict with parents of young adults with internet gaming disorder: development and feasibility study of a virtual reality app. JMIR Serious Games. 2021;9(1):e22494. [FREE Full text] [CrossRef] [Medline]
    17. Wang HY, Cheng C. The associations between gaming motivation and internet gaming disorder: systematic review and meta-analysis. JMIR Ment Health. 2022;9(2):e23700. [FREE Full text] [CrossRef] [Medline]
    18. Marques LM, Uchida PM, Aguiar FO, Kadri G, Santos RIM, Barbosa SP. Escaping through virtual gaming-what is the association with emotional, social, and mental health? a systematic review. Front Psychiatry. 2023;14:1257685. [FREE Full text] [CrossRef] [Medline]
    19. Ryan RM, Deci EL. Intrinsic and extrinsic motivation from a self-determination theory perspective: definitions, theory, practices, and future directions. Contemporary Educational Psychology. 2020;61:101860. [CrossRef]
    20. King LA, Hicks JA. The science of meaning in life. Annu Rev Psychol. 2021;72:561-584. [CrossRef] [Medline]
    21. Steger MF, Frazier P, Oishi S, Kaler M. The meaning in life questionnaire: assessing the presence of and search for meaning in life. Journal of Counseling Psychology. 2006;53(1):80-93. [CrossRef]
    22. Kaya A, Türk N, Batmaz H, Griffiths MD. Online gaming addiction and basic psychological needs among adolescents: the mediating roles of meaning in life and responsibility. Int J Ment Health Addict. 2023;22:2413-2437. [FREE Full text] [CrossRef] [Medline]
    23. Zhang MX, Wang X, Yu SM, Wu AMS. Purpose in life, social support, and internet gaming disorder among Chinese university students: a 1-year follow-up study. Addict Behav. 2019;99:106070. [CrossRef] [Medline]
    24. Li Y, Mu W, Xie X, Kwok SYCL. Network analysis of internet gaming disorder, problematic social media use, problematic smartphone use, psychological distress, and meaning in life among adolescents. DIGITAL HEALTH. 2023;9:205520762311580. [CrossRef]
    25. Fraser R, Slattery J, Yakovenko I. Escaping through video games: using your avatar to find meaning in life. Computers in Human Behavior. 2023;144:107756. [CrossRef]
    26. Monacis L, de Palo V, Griffiths MD, Sinatra M. Exploring individual differences in online addictions: the role of identity and attachment. Int J Ment Health Addict. 2017;15(4):853-868. [FREE Full text] [CrossRef] [Medline]
    27. Kokkini V, Tseliou E, Abakoumkin G, Bozatzis N. “Immersed in World of Warcraft”: a discursive study of identity management talk about excessive online gaming. Journal of Language and Social Psychology. 2022;41(5):590-612. [CrossRef]
    28. Cohen K, Cairns D. Is searching for meaning in life associated with reduced subjective well-being? confirmation and possible moderators. J Happiness Stud. 2011;13(2):313-331. [CrossRef]
    29. Schnell T, Krampe H. Meaning in life and self-control buffer stress in times of COVID-19: moderating and mediating effects with regard to mental distress. Front Psychiatry. 2020;11:582352. [FREE Full text] [CrossRef] [Medline]
    30. Zhao H, Li X, Zhou J, Nie Q, Zhou J. The relationship between bullying victimization and online game addiction among Chinese early adolescents: the potential role of meaning in life and gender differences. Children and Youth Services Review. 2020;116:105261. [CrossRef]
    31. Cao M, Xu D, Xie F, Liu E, Liu S. The influence factors analysis of households' poverty vulnerability in southwest ethnic areas of China based on the hierarchical linear model:a case study of Liangshan Yi autonomous prefecture. Applied Geography. 2016;66:144-152. [CrossRef]
    32. Arneklev BJ, Grasmick HG, Tittle CR, Bursik RJ. Low self-control and imprudent behavior. J Quant Criminol. 1993;9(3):225-247. [CrossRef]
    33. Pontes HM, Griffiths MD. Measuring DSM-5 internet gaming disorder: development and validation of a short psychometric scale. Computers in Human Behavior. 2015;45:137-143. [CrossRef]
    34. Wolf EJ, Harrington KM, Clark SL, Miller MW. Sample size requirements for structural equation models: an evaluation of power, bias, and solution propriety. Educ Psychol Meas. 2013;76(6):913-934. [FREE Full text] [CrossRef] [Medline]
    35. Miočević M, O'Rourke HP, MacKinnon DP, Brown HC. Statistical properties of four effect-size measures for mediation models. Behav Res Methods. 2018;50(1):285-301. [FREE Full text] [CrossRef] [Medline]
    36. Muthén LK, Muthén BO. Mplus statistical analysis with latent variables: User's guide. Los Angeles. Muthén & Muthén; 2017. URL: https://www.statmodel.com/ugexcerpts.shtml
    37. Rhemtulla M, Brosseau-Liard PÉ, Savalei V. When can categorical variables be treated as continuous? a comparison of robust continuous and categorical SEM estimation methods under suboptimal conditions. Psychol Methods. 2012;17(3):354-373. [CrossRef] [Medline]
    38. Hu L, Bentler PM. Cutoff criteria for fit indexes in covariance structure analysis: conventional criteria versus new alternatives. Structural Equation Modeling: A Multidisciplinary Journal. 1999;6(1):1-55. [CrossRef]
    39. van de Schoot R, Lugtig P, Hox J. A checklist for testing measurement invariance. European Journal of Developmental Psychology. 2012;9(4):486-492. [CrossRef]
    40. Chen FF. Sensitivity of goodness of fit Indexes to lack of measurement invariance. Structural Equation Modeling: A Multidisciplinary Journal. 2007;14(3):464-504. [CrossRef]
    41. Cohen J. Statistical Power Analysis for the Behavioral Sciences. Hillsdale, New Jersey. Lawrence Erlbaum Associates; 1988.
    42. Little RJ, Rubin DB. Statistical Analysis with Missing Data, Third edition. Hoboken, New Jersey. John Wiley & Sons; 2019.
    43. Wu AMS, Lei LLM, Ku L. Psychological needs, purpose in life, and problem video game playing among Chinese young adults. Int J Psychol. 2013;48(4):583-590. [CrossRef] [Medline]
    44. Fong TCT, Ho RTH, Yip PSF. Psychometric properties of the patient health questionnaire-4 among Hong Kong young adults in 2021: associations with meaning in life and suicidal ideation. Front Psychiatry. 2023;14:1138755. [FREE Full text] [CrossRef] [Medline]
    45. Krause N, Pargament KI, Ironson G, Hill P. Religious involvement, financial strain, and poly-drug use: exploring the moderating role of meaning in life. Subst Use Misuse. 2017;52(3):286-293. [CrossRef] [Medline]
    46. Wang Z, Wang X, Peng Y, Liu C, He J. Recalled childhood maltreatment and suicide risk in chinese college students: the mediating role of psychache and the moderating role of meaning in life. J Adult Dev. 2022;30(1):156-165. [CrossRef]
    47. Zhang Y, Mei S, Li L, Chai J, Li J, Du H. The relationship between impulsivity and internet addiction in Chinese college students: a moderated mediation analysis of meaning in life and self-esteem. PLoS One. 2015;10(7):e0131597. [FREE Full text] [CrossRef] [Medline]
    48. Shulman EP, Harden KP, Chein JM, Steinberg L. Sex differences in the developmental trajectories of impulse control and sensation-seeking from early adolescence to early adulthood. J Youth Adolesc. 2015;44(1):1-17. [CrossRef] [Medline]
    49. Fong TCT, Cheng Q, Pai CY, Kwan I, Wong C, Cheung SH, et al. Uncovering sample heterogeneity in gaming and social withdrawal behaviors in adolescent and young adult gamers in Hong Kong. Soc Sci Med. 2023;321:115774. [CrossRef] [Medline]
    50. Su W, Han X, Yu H, Wu Y, Potenza MN. Do men become addicted to internet gaming and women to social media? A meta-analysis examining gender-related differences in specific internet addiction. Computers in Human Behavior. 2020;113:106480. [CrossRef]
    51. Shi J, Renwick R, Turner NE, Kirsh B. Understanding the lives of problem gamers: the meaning, purpose, and influences of video gaming. Computers in Human Behavior. 2019;97:291-303. [CrossRef]
    52. Liao Z, Chen X, Huang Q, Shen H. Prevalence of gaming disorder in East Asia: a comprehensive meta-analysis. J Behav Addict. 2022;11(3):727-738. [FREE Full text] [CrossRef] [Medline]
    53. Zhan JD, Chan HC. Government regulation of online game addiction. CAIS. 2012;30(1):13. [CrossRef]
    54. Jin F, Liu Z, Liu Y, Yao C, Cheng Y. Health status of left-behind children and parenting behaviors of caregivers in poor rural areas - 6 provinces, China, 2018. China CDC Wkly. 2021;3(3):54-57. [FREE Full text] [CrossRef] [Medline]
    55. Tang D, Choi WI, Deng L, Bian Y, Hu H. Health status of children left behind in rural areas of Sichuan province of China: a cross-sectional study. BMC Int Health Hum Rights. 2019;19(1):4. [FREE Full text] [CrossRef] [Medline]
    56. Jian W. Reflections on the difficulties of educational development in minority areas of Western China. Chinese Education & Society. 2017;50(1):4-11. [CrossRef]
    57. Schnitker SA, Balkaya-Ince M, Houltberg B. On the importance of attending to meaning, contextualization, and collaboration for character intervention development for adolescents. The Journal of Positive Psychology. 2024;19(5):753-757. [CrossRef]
    58. To SM. Loneliness, the search for meaning, and the psychological well-being of economically disadvantaged Chinese adolescents living in Hong Kong: Implications for life skills development programs. Child Youth Serv Rev. 2016;71:52-60. [CrossRef]
    59. Yu Y, Li JB, Lau JTF. Awareness and potential impacts of the medicalization of internet gaming disorder: cross-sectional survey among adolescents in China. J Med Internet Res. 2021;23(2):e22393. [FREE Full text] [CrossRef] [Medline]
    60. Zhang A, Zhang Q. How could mindfulness-based intervention reduce aggression in adolescent? mindfulness, emotion dysregulation and self-control as mediators. Curr Psychol. 2021;42(6):4483-4497. [CrossRef]
    61. Gabbiadini A, Riva P, Andrighetto L, Volpato C, Bushman BJ. Preliminary evidence of the effectiveness of a brief self‐control intervention on reducing the short‐term harmful consequences of violent video games on adolescents. J Applied Social Pyschol. 2021;52(4):246-258. [CrossRef]
    62. Kapetanovic S, Gurdal S, Einarsson I, Werner M, André F, Håkansson A, et al. Relapse prevention therapy for problem gaming or internet gaming disorder in swedish child and youth psychiatric clinics: protocol for a randomized controlled trial. JMIR Res Protoc. 2023;12:e44318. [FREE Full text] [CrossRef] [Medline]
    63. Cho K, Kim M, Cho Y, Hur JW, Kim DH, Park S, et al. Digital phenotypes for early detection of internet gaming disorder in adolescent students: explorative data-driven study. JMIR Ment Health. 2024;11:e50259. [FREE Full text] [CrossRef] [Medline]
    64. Fong TCT, Lu S, Ye X, Junus A, Yip PSF. Validation of the 12-item gamification user types hexad scale in 1,610 Hong Kong young gamers. Int J Ment Health Addiction. 2024. [CrossRef]
    65. Fong TCT, Junus A, Wen M, Yip PSF. Comorbidity among symptoms of internet gaming disorder, social withdrawal, and depression in 3430 young people in Hong Kong: a network analysis. J Affect Disord. 2024;359:319-326. [CrossRef] [Medline]
    66. Cui K, Fong TCT, Yip PSF. Latent heterogeneity of deviant behaviors and associated factors among ethnic minority adolescents: a latent class analysis. Child Adolesc Psychiatry Ment Health. 2024;18(1):93. [FREE Full text] [CrossRef] [Medline]
    67. Fong TCT, Cheung DYT, Choi EPH, Fong DYT, Ho RTH, Ip P, et al. Latent heterogeneity of online sexual experiences and associations with sexual risk behaviors and behavioral health outcomes in Chinese young adults: cross-sectional study. JMIR Public Health Surveill. 2024;10:e50020. [FREE Full text] [CrossRef] [Medline]
    68. Ji Y, Yin MXC, Zhang AY, Wong DFK. Risk and protective factors of internet gaming disorder among Chinese people: a meta-analysis. Aust N Z J Psychiatry. 2022;56(4):332-346. [CrossRef] [Medline]
    69. Fong TCT, Yip PSF. Prevalence of hikikomori and associations with suicidal ideation, suicide stigma, and help-seeking among 2,022 young adults in Hong Kong. Int J Soc Psychiatry. 2023;69(7):1768-1780. [CrossRef]
    70. Lin S, Chen X, Tan L, Liao Z, Li Y, Tang Y, et al. Psychometric properties of the metacognitions about online gaming scale in the Chinese population and its relationship with internet gaming disorder: cross-sectional study. JMIR Serious Games. 2024;12:e45985. [FREE Full text] [CrossRef] [Medline]
    71. Kim H, Choi IY, Kim DJ. Excessive smartphone use and self-esteem among adults with internet gaming disorder: quantitative survey study. JMIR Mhealth Uhealth. 2020;8(9):e18505. [FREE Full text] [CrossRef] [Medline]
    72. Moreno M, Riddle K, Jenkins MC, Singh AP, Zhao Q, Eickhoff J. Measuring problematic internet use, internet gaming disorder, and social media addiction in young adults: cross-sectional survey study. JMIR Public Health Surveill. 2022;8(1):e27719. [FREE Full text] [CrossRef] [Medline]
    73. Li YF, Tang Y, Huang SC, Tan LX, Huang QP, Chen XX, et al. Role of gaming devices associated with internet gaming disorder in China: cross-sectional study. JMIR Serious Games. 2023;11:e40130. [FREE Full text] [CrossRef] [Medline]

    ‎
    CFA: confirmatory factor analysis
    CFI: comparative fit index
    DSM-5: Diagnostic and Statistical Manual of Mental Disorders (Fifth Edition)
    IGD: Internet gaming disorder
    MIL: meaning in life
    RMSEA: root-mean-square error of approximation
    SEM: structural equation modeling
    SRMR: standardized root-mean-square residuals
    TLI: Tucker-Lewis index

    Edited by A Schwartz; submitted 13.04.24; peer-reviewed by X Wang, A Rizvi; comments to author 05.07.24; revised version received 24.07.24; accepted 17.09.24; published 04.11.24.

    Copyright

    ©Ted CT Fong, Kunjie Cui, Paul SF Yip. Originally published in the Journal of Medical Internet Research (https://www.jmir.org), 04.11.2024.

    This is an open-access article distributed under the terms of the Creative Commons Attribution License (https://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work, first published in the Journal of Medical Internet Research (ISSN 1438-8871), is properly cited. The complete bibliographic information, a link to the original publication on https://www.jmir.org/, as well as this copyright and license information must be included.