Bidirectional relationship between gaming disorder, internalizing psychopathology, psychological distress, and well-being: A systematic review with meta-analysis of longitudinal studies

There is a lack of a synthesis of longitudinal studies that clarify the relationship between gaming disorder (GD) symptoms and mental health. To address this gap, we undertook a systematic review with meta-analysis of longitudinal studies. The study protocol was preregistered online on PROSPERO (CRD42023407665). We included studies analyzing the association between GD or problematic/pathological videogame use, and internalizing psycho- pathology (depression and anxiety), psychological distress (loneliness and stress), and well-being (life satisfac- tion, quality of life, and well-being). Research articles were searched in PsycInfo, PsycArticles, PubMed, and Web of Science up until December 29, 2022.30 articles were considered for meta-analysis (N = 28,782). Effect sizes (partial correlation) were pooled using random-effects models. Sensitivity analyses excluded studies rated as “poor” - using the National Institutes of Health quality assessment tool for observational cohort studies - and Chinese studies. The associations between GD and subsequent depression, emotional mixed symptoms (i.e., a combination of internalizing symptoms) and life satisfaction were statistically significant. GD was not associated with subsequent anxiety. On the other hand, depression, anxiety, emotional mixed symptoms, life satisfaction and loneliness were significantly associated with subsequent GD. Overall, sensitivity analyses supported the robustness of the main results. In conclusion, this study found reciprocal longitudinal associations between GD and depression, life satis- faction, and emotional mixed symptoms, an effect of anxiety on GD (but not the inverse), and of loneliness on GD. However, the causal nature and practical relevance remain uncertain because effect sizes were small - or medium, depending on effect size guidelines - and based on observational studies.