Exploring Differences Among Video Gamers With and Without Depression: Contrasting Emotion Regulation and Mindfulness

Abstract

Video games are a leisure activity with mass appeal for individuals of all ages. However, for some individuals, playing video games may become problematic and addictive, resulting in negative consequences affecting their physical, social, and psychological well-being. Internet gaming disorder (IGD) has estimated prevalence rates of around 3 percent and has been strongly associated with several psychopathologies, including depression. Given that emotion regulation (ER) and mindfulness are fluid constructs that can be enhanced, the potential for intervention and prevention is considerable. Thus, this study sought to, as a first step in determining clinical relevance, explore the differences in ER, mindfulness, and impulsivity among emerging adult gamers who met criteria for IGD, depression, or both IGD and depression (Dep + IGD). A sample of 1,536 gamers (45 percent male, M_age = 20.45 years old) completed an online survey, including an assessment for IGD, depression, difficulties with ER, impulsivity, and mindfulness. Relative to individuals below IGD and depression cutoffs (control), the clinical groups (IGD, depression, and Dep + IGD) reported greater ER difficulties, higher impulsivity, and lower mindfulness. Finally, relative to the IGD + depression group, the other two clinical groups had fewer difficulties with cognitive impulsivity, whereas the depression group reported more difficulties with strategy use. These results suggest that gamers should be considered a heterogeneous group and that comorbid disorders are important considerations when developing targeted treatments for individuals with IGD.

Introduction

Although video games are a leisure activity with mass appeal,^1,2 for some individuals, playing video games may become problematic, negatively affecting their physical, social, and psychological well-being.³ In its most recent version, the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) included a proposal for Internet gaming disorder (IGD) in Section III, recognizing IGD as a condition that merits further study.⁴ A meta-analysis of past studies revealed the prevalence rate for IGD to be around 3 percent⁵; however, the concept of IGD remains highly debated in the literature. Nonetheless, research has found an association between IGD and depression.⁶ Additionally, Wang et al.⁷ reported that 60 percent of individuals with IGD also met criteria for depression and those with a dual diagnosis reported poorer self-control (d = 0.48) and greater anxiety (d = 1.97) compared with those with only IGD.^a As such, IGD with co-occurring depression appears to present some unique clinical challenges, suggesting that further research is required. The present study builds on these findings by exploring differences in emotion regulation (ER), mindfulness, and impulsivity across groups of video game users who meet criteria for (a) IGD, (b) depression, and (c) depression + IGD.

Poor ER is implicated in a variety of psychopathologies.⁸ According to Gratz and Roemer,⁹ ER includes six essential dimensions: (a) an awareness, (b) understanding of one's emotions, (c) an acceptance of experienced emotions, (d) the ability to engage in goal-directed behavior when under high emotionality, (e) the ability to exert flexibility in the strategies used when highly emotional, and (f) the ability to control impulsive behaviors under conditions of high emotionality. Two past studies have found that IGD was most strongly associated with difficulty accepting emotions and managing emotions when experiencing negative emotions.^10,11 Depression has been found to be associated with deficits in ER strategies, attentional disengagement (particularly to negative stimuli), and inhibition when faced with mood-congruent stimuli.¹²

Tangentially related to the area of ER, mindfulness is a multidimensional construct that includes (a) noticing or attending to internal and external experiences (observing), (b) labeling internal experiences with words (describing), (c) attending to activities in the present moment (acting with awareness), (d) taking a nonevaluative stance toward one's thoughts and feelings (nonjudging inner experiences), and (e) allowing thoughts and feelings to come and go, without necessarily reacting to them (nonreactivity).¹³ It is associated with nonavoidant coping strategies, adaptive functioning, and increased flexibility to self-regulate and facilitate goal attainment.¹⁴ A recent study by Mettler et al.¹⁵ revealed a negative association between the acting with awareness component of mindfulness and IGD severity, suggesting that acting with greater awareness is a protective factor. To date, the relationship between IGD and other dimensions of mindfulness remains unknown. Nonetheless, research has found consistent evidence that each component plays a meaningful role in protecting individuals from the internalization of depressive symptoms.¹⁶

Given that both ER and mindfulness are fluid constructs that can be taught and enhanced,^17,18 the potential for using these constructs within intervention and prevention programs for depression and IGD is considerable. Thus, as a first step in determining the potential clinical relevance, the current study sought to explore the differences in ER, mindfulness, and impulsivity among emerging adult gamers who met cutoff criteria for IGD, depression, or both. It was hypothesized that all three groups (i.e., IGD, depression, and Dep + IGD) would report greater ER difficulties and impulsivity as well as lower overall mindfulness relative to a group of gamers who were below cutoffs for both IGD and depression (i.e., healthy controls). It was further hypothesized that those in the Dep + IGD group would report the greatest level of ER difficulties and lowest level of mindfulness.

Methods

Participants and procedures

The present study was approved by the university ethics board before data collection. A total of 1,909 participants from colleges and universities, social media sites, and Amazon's Mechanical Turk submitted responses to a series of online questionnaires. All participants were between 18 and 27 years of age. Data were retained from 1,587 participants who played video games in the past year. Data from 51 participants were excluded due to duplicate IP addresses, failing any one of three attention items, or missing information on biological sex. The final sample consisted of 1,536 participants (45.25 percent male; M_age = 20.45 years).

Participants were classified based on two measures to create four groups for comparisons (i.e., IGD group, Depression group, Dep + IGD group, and control group). The first measure, the Internet Gaming Disorder Scale—Short-Form,¹⁹ includes nine dichotomous (yes/no) questions pertaining to each of the proposed IGD criteria. Endorsing five or more symptoms is indicative of IGD. The second measure, the Patient Health Questionnaire (PHQ-9), is a nine-item measure of depressive symptoms.²⁰ Each item is rated on a 4-point Likert scale, 0 (not at all) to 3 (nearly every day). A composite score of 1–9 indicates no or mild depression, 10–14 indicates moderate depression, and 15–27 is indicative of moderately severe depression. As shown in Table 1, 101 (12.97 percent) met the cutoff for IGD, 221 (28.37 percent) met the cutoff for moderately severe depression, and 57 (7.32 percent) met the cutoff for both IGD and moderately severe depression (Dep + IGD). Of the remaining 1,157 participants who were below thresholds for both moderately severe depression and IGD, data from 375 were excluded due to evidence of either moderate depression (i.e., PHQ scores 10–14) or moderate risk for IGD (i.e., IGD scores 3–4). Within the remaining 782 healthy controls, the median video gaming frequency was 7 hours per week for males and 2 hours per week for females. Only those who were above the gender-based median were included in the primary analyses. In summary, 101 participants were in the IGD group, 221 were in the moderately severe depression group, 57 were in the Dep + IGD group, and 374 (50.8 percent male) were in the control group (i.e., gamers who did not meet criteria for IGD or depression).

Table 1.

Means and Standard Deviations Between Males and Females and Across Internet Gaming Disorder and Depression Classifications

	Total	Gender			Classifications
	Total	Male	Female	Univariate test	Control	IGD	Depression	Depression + IGD	Univariate test
	n/M (percent/SD)	n/M(percent/SD)	n/M (percent/SD)	Univariate test	n/M (percent/SD)	n/M (percent/SD)	n/M (percent/SD)	n/M (percent/SD)	Univariate test
Total	753 (100 percent)	345 (45.82 percent)	408 (54.18 percent)	n/a	374 (49.67 percent)	101 (13.41 percent)	221 (29.35 percent)	57 (7.57 percent)	n/a
Female	n/a	n/a	n/a	n/a	184 (49.20 percent)	30 (29.70 percent)	164 (74.21 percent)	30 (52.63 percent)	χ² (3) = 63.88 p < 0.001
Age (in years)	20.77 (2.73)	20.92 (2.73)	20.65 (2.72)	F(1, 745) = 0.50 p = 0.480, η_p² = 0.00	21.06 (2.75)	20.90 (2.88)	20.19 (2.62)	20.91 (2.37)	F(3, 745) = 2.12 p = 0.096, η_p² = 0.00
Gaming frequency (in hours)	11.92 (11.82)	15.72 (12.22)	8.72 (10.47)	F(1, 745) = 27.05 p < 0.001, η_p² = 0.04	12.57^a (10.32)	15.74^a (13.99)	6.55^b (8.54)	21.73^c (17.05)	F(3, 745) = 26.74 p < 0.001, η_p² = 0.10
IGD composite score	2.16 (2.32)	2.58 (2.48)	1.80 (2.12)	F(1, 745) = 3.57 p = 0.060, η_p² = 0.00	0.90^a (0.78)	5.93^b (1.11)	1.42^c (1.26)	6.56^d (1.38)	F(3, 745) = 929.53 p < 0.001, η_p² = 0.79
PHQ composite score	10.28 (7.64)	8.22 (6.95)	12.02 (7.77)	F(1, 745) = 16.30 p = 0.001, η_p² = 0.02	4.10^a (2.88)	8.96^b (3.83)	18.98^c (3.51)	19.44^c (3.46)	F(3, 745) = 1004.66 p < 0.001, η_p² = 0.80
Impulsivity	1.22 (0.58)	1.14 (0.59)	1.28 (0.57)	F(1, 745) = 4.24 p = 0.040, η_p² = 0.01	1.02^a (0.52)	1.31^b (0.56)	1.40^b (0.57)	1.68^c (0.48)	F(3, 745) = 37.32 p < 0.001, η_p² = 0.13
Emotion regulation
Nonacceptance	2.53 (1.15)	2.22 (1.04)	2.79 (1.18)	F(1, 745) = 20.07 p < 0.001, η_p² = 0.03	1.97^a (0.87)	2.51^b (1.02)	3.27^c (1.05)	3.38^c (1.20)	F(3, 745) = 76.76 p < 0.001, η_p² = 0.24
Goals	3.11 (1.09)	2.88 (1.07)	3.30 (1.07)	F(1, 745) = 3.38 p = 0.067, η_p² = 0.00	2.65^a (0.93)	2.99^b (1.05)	3.76^c (0.95)	3.77^c (1.02)	F(3, 745) = 60.53 p < 0.001, η_p² = 0.20
Impulse	2.23 (0.96)	1.99 (0.88)	2.42 (0.98)	F(1, 745) = 14.32 p = 0.001, η_p² = 0.02	1.73^a (0.66)	2.43^b (0.95)	2.80^c (0.92)	2.91^c (1.01)	F(3, 745) = 81.94 p < 0.001, η_p² = 0.25
Awareness	2.79 (0.85)	2.79 (0.86)	2.78 (0.84)	F(1, 745) = 1.67 p = 0.196, η_p² = 0.00	2.62^a (0.82)	2.98^b (0.79)	2.93^b (0.86)	2.97^b (0.92)	F(3, 745) = 8.42 p < 0.001, η_p² = 0.03
Strategies	2.54 (1.06)	2.24 (0.96)	2.80 (1.08)	F(1, 745) = 14.04 p = 0.001, η_p² = 0.02	1.93^a (0.74)	2.54^b (0.89)	3.40^c (0.90)	3.27^c (0.95)	F(3, 745) = 129.96 p < 0.001, η_p² = 0.34
Clarity	2.53 (0.88)	2.36 (0.86)	2.68 (0.87)	F(1, 745) = 7.13 p = 0.008, η_p² = 0.01	2.12^a (0.71)	2.66^b (0.83)	3.02^c (0.83)	3.12^c (0.85)	F(3, 745) = 67.92 p < 0.001, η_p² = 0.22
Mindfulness
Describe	2.23 (0.84)	2.43 (0.81)	2.06 (0.83)	F(1, 745) = 12.93 p < 0.001, η_p² = 0.02	2.50^a (0.78)	2.20^b (0.71)	1.87^c (0.82)	1.94^b,c (0.89)	F(3, 745) = 23.45 p < 0.001, η_p² = 0.09
Nonreactivity	1.98 (0.80)	2.20 (0.82)	1.81 (0.73)	F(1, 745) = 13.22 p = 0.002, η_p² = 0.02	2.22^a (0.75)	1.96^b (0.78)	1.68^c (0.74)	1.67^b,c (0.83)	F(3, 745) = 18.78 p < 0.001, η_p² = 0.07
Observe	2.51 (0.87)	2.41 (0.88)	2.59 (0.85)	F(1, 745) = 5.61 p = 0.018, η_p² = 0.01	2.50 (0.83)	2.25 (0.87)	2.63 (0.92)	2.50 (0.87)	F(3, 745) = 2.06 p = 0.106, η_p² = 0.00
Act with awareness	2.35 (0.71)	2.46 (0.69)	2.25 (0.71)	F(1, 745) = 4.94 p = 0.027, η_p² = 0.01	2.65^a (0.62)	2.35^b (0.49)	1.94^c (0.69)	1.94^c (0.64)	F(3, 745) = 59.43 p < 0.001, η_p² = 0.19

Note: Post hoc differences between classifications were assessed using Sidak's adjustment to account for multiple comparisons. Values with differing superscripts within each row correspond to significant differences using an adjusted alpha.

SD, standard deviation; n/a, not available; IGD, Internet gaming disorder; PHQ, Patient Health Questionnaire.

Measures

Emotion regulation

The Difficulties in Emotion Regulation Scale (DERS) is a 36-item self-report ER measure.⁹ Each item is based upon a 5-point Likert scale, with responses ranging from 1 (almost never) to 5 (almost always). The DERS has six subscales (a) assessing participants' lack of emotional clarity (α = 0.92); (b) lack of emotional awareness (α = 0.83); (c) nonacceptance of emotional responses (α = 0.92); (d) impulse control difficulties (α = 0.87); (e) limited access to ER strategies (α = 0.81); and (f) difficulties engaging in goal-directed behavior when emotionally aroused (α = 0.88).

Mindfulness

The Five Facet Mindfulness Questionnaire—Short-Form (FFMQ-SF)²¹ is a 24-item measure scored on a 5-point Likert-type scale ranging from 0 (never or very rarely true) to 4 (very often or always true). The FFMQ-SF assesses the five dimensions of mindfulness: (a) observing (α = 0.75); (b) describing (α = 0.83); (c) acting with awareness (α = 0.79); (d) nonjudging (α = 0.51), and (e) nonreactivity (α = 0.75). Due to finding a low internal consistency for the nonjudging subscale, an exploratory analysis was conducted to assess the integrity of the factor structure. Results suggested that items from the nonjudging subscale could not be reliably retained within the model as intended, and therefore this subscale was removed from all subsequent analyses.

Impulsivity

Due to space limitations within the online questionnaire, the full 30-item Barratt Impulsiveness Scale²² was not included. Rather, the top five loading items²³ were selected from the scale to assess general executive control: (a) I plan tasks carefully; (b) I do things without thinking; (c) I am self-controlled; (d) I concentrate easily; and (e) I am a careful thinker. Items were rated on 4-point scale ranging from 1 (never or rarely) to 4 (almost always) with each reversed scored except for the second item. The internal consistency of this five-item impulsivity measure was adequate (α = 0.72).

Results

Little's²⁴ missing completely at random test resulted in a χ²/df ratio that was less than two, indicating that missing values could be reliably imputed using estimation–maximization in SPSS, Version 25.²⁵ As no interactions between gender and classifications were found within the present data (p > 0.05), only univariate differences between males and females and across the four classifications are presented in Table 1. Males reported a greater video gaming frequency, but less depression and impulsivity than females. Contrary to expectations, IGD composite scores did not differ between males and females. Males generally reported fewer ER difficulties and greater mindfulness than females; however, the corresponding effect sizes suggest that these differences were small.

The four groups differed across nearly all demographic variables except age. Gender was associated with group classification with a greater proportion of the IGD group (70.30 percent) being male, whereas a greater proportion of the depression group was female (74.21 percent). Gender was relatively balanced in the control and Dep + IGD groups. Individuals in the Dep + IGD group reported the highest video gaming frequency, IGD composite scores, and impulsivity scores among the four groups. Furthermore, these individuals also reported higher depression scores than those in the control and IGD-only groups; however, there were no significant differences in depression scores between the depression-only group and the Dep + IGD group. Similarly, those in the Dep + IGD group reported greater ER difficulties than those in the control and IGD-only groups, but not relative to those in the depression-only group. Finally, those in the Dep + IGD group also reported lower mindfulness than the control group, but did not largely differ from those in either the IGD-only group or depression-only group.

Table 2 presents results from a multinomial logistic regression (Nagelkerke pseudo R² = 0.62). Relative to the control group, those in the IGD-only group were more likely to be male [odds ratio (OR) = 3.54, Wald χ² (1) = 19.64, p < 0.001], report issues with greater impulse control when upset [OR = 2.76, Wald χ² (1) = 18.87, p < 0.001], and have difficulties with identifying emotions [OR = 1.87, Wald χ² (1) = 8.17, p = 0.004]. Additionally, relative to those in the control group, difficulties with goal-directed behavior when upset [OR = 0.71, Wald χ² (1) = 3.87, p = 0.049] were associated with a modest decrease in the likelihood of being in the IGD-only group. Relative to the control group, those in the depression-only group reported a lower video gaming frequency [OR = 0.93, Wald χ² (1) = 19.58, p < 0.001], limited access to adaptive ER strategies [OR = 3.93, Wald χ² (1) = 34.23, p < 0.001], difficulties with identifying emotions [OR = 2.02, Wald χ² (1) = 12.05, p = 0.001], and less present awareness [OR = 0.30, Wald χ² (1) = 24.55, p < 0.001]. However, reports of higher observation of internal and external experiences [OR = 1.43, Wald χ² (1) = 5.92, p = 0.015] were associated with an increased likelihood of being in the depression-only group relative to the control group. Finally, relative to the control group, those in the Dep + IGD group reported a greater video gaming frequency [OR = 1.05, Wald χ² (1) = 12.41, p < 0.001], elevated impulsivity [OR = 3.65, Wald χ² (1) = 12.26, p < 0.001], difficulties with identifying emotions [OR = 2.63, Wald χ² (1) = 11.39, p = 0.001], and lower present awareness [OR = 0.44, Wald χ² (1) = 5.93, p = 0.015].

Table 2.

Results from Multinomial Logistic Regression Predicting Classification Membership

	Control vs. IGD		Control vs. depression		Control vs. depression + IGD
	OR (95 percent CI)	p	OR (95 percent CI)	p	OR (95 percent CI)	p
Male	3.54 (2.02–6.19)^***	0.000	1.08 (0.63–1.86)	0.769	1.66 (0.79–3.49)	0.180
Age (in years)	1.03 (0.94–1.13)	0.518	1.02 (0.93–1.11)	0.702	1.06 (0.93–1.20)	0.397
Gaming frequency (in hours)	1.02 (1.00–1.04)	0.130	0.93 (0.91–0.96)^***	0.000	1.05 (1.02–1.07)^***	0.000
Impulsivity	1.38 (0.82–2.33)	0.231	1.30 (0.80–2.14)	0.292	3.65 (1.77–7.53)^***	0.000
Emotion regulation
Nonacceptance	1.1 (0.79–1.53)	0.574	1.15 (0.85–1.54)	0.373	1.50 (0.99–2.27)	0.053
Goals	0.71 (0.50–1.00)^*	0.049	1.04 (0.76–1.42)	0.801	1.15 (0.71–1.87)	0.562
Impulse	2.76 (1.75–4.36)^***	0.000	1.10 (0.73–1.66)	0.636	1.59 (0.91–2.75)	0.101
Awareness	1.1 (0.75–1.60)	0.627	1.22 (0.85–1.76)	0.281	1.10 (0.66–1.84)	0.704
Strategies	1.38 (0.83–2.28)	0.212	3.93 (2.48–6.21)^***	0.000	1.88 (0.98–3.61)	0.057
Clarity	1.87 (1.22–2.87)^**	0.004	2.02 (1.36–2.99)^**	0.001	2.63 (1.50–4.61)^**	0.001
Mindfulness
Describe	1.13 (0.76–1.70)	0.544	1.03 (0.69–1.53)	0.888	1.32 (0.75–2.31)	0.341
Nonreactivity	1.08 (0.71–1.63)	0.730	1.17 (0.78–1.77)	0.447	1.18 (0.67–2.07)	0.567
Observe	0.89 (0.64–1.22)	0.464	1.48 (1.08–2.02)^*	0.015	1.28 (0.81–2.01)	0.292
Act with awareness	0.70 (0.44–1.12)	0.136	0.30 (0.19–0.48)^***	0.000	0.44 (0.23–0.85)^*	0.015

	Depression + IGD vs. control		Depression + IGD vs. IGD		Depression + IGD vs. depression
	OR (95 percent CI)	p	OR (95 percent CI)	p	OR (95 percent CI)	p
Male	0.60 (0.29–1.26)	0.180	2.13 (0.98–4.65)	0.057	0.65 (0.31–1.36)	0.253
Age (in years)	0.95 (0.83–1.08)	0.397	0.97 (0.85–1.12)	0.709	0.96 (0.84–1.10)	0.565
Gaming frequency (in hours)	0.96 (0.93–0.98)^***	0.000	0.97 (0.95–1.00)^*	0.025	0.89 (0.86–0.92)^***	0.000
Impulsivity	0.27 (0.13–0.57)^***	0.000	0.38 (0.18–0.80)^*	0.011	0.36 (0.18–0.73)^**	0.005
Emotion regulation
Nonacceptance	0.67 (0.44–1.01)	0.053	0.73 (0.47–1.13)	0.160	0.76 (0.51–1.14)	0.185
Goals	0.87 (0.53–1.40)	0.562	0.61 (0.36–1.03)	0.064	0.90 (0.56–1.46)	0.677
Impulse	0.63 (0.36–1.09)	0.101	1.74 (0.98–3.09)	0.059	0.70 (0.42–1.16)	0.167
Awareness	0.91 (0.54–1.51)	0.704	0.99 (0.58–1.69)	0.983	1.11 (0.68–1.81)	0.685
Strategies	0.53 (0.28–1.02)	0.057	0.73 (0.37–1.45)	0.371	2.09 (1.11–3.93)^*	0.022
Clarity	0.38 (0.22–0.67)^**	0.001	0.71 (0.40–1.27)	0.249	0.77 (0.45–1.29)	0.318
Mindfulness
Describe	0.76 (0.43–1.34)	0.341	0.86 (0.48–1.55)	0.618	0.78 (0.45–1.36)	0.381
Nonreactivity	0.85 (0.48–1.49)	0.567	0.91 (0.51–1.64)	0.758	1.00 (0.58–1.72)	0.986
Observe	0.78 (0.50–1.23)	0.292	0.69 (0.43–1.12)	0.132	1.16 (0.74–1.80)	0.520
Act with awareness	2.27 (1.17–4.38)^*	0.015	1.58 (0.79–3.16)	0.192	0.68 (0.37–1.27)	0.231

Note: ^*p < 0.05; ^**p < 0.01; ^***p < 0.001.

CI, confidence interval; OR, odds ratio.

The multinomial logistic regression was repeated with the Dep + IGD group entered as the reference group. This allowed for a direct comparison between those in the Dep + IGD group and those in either the IGD group or depression-only group. Relative to those in the Dep + IGD group, those in the IGD-only group reported a lower video gaming frequency [OR = 0.97, Wald χ² (1) = 5.01, p = 0.025] and lower impulsivity [OR = 0.38, Wald χ² (1) = 6.39, p = 0.011]. Similarly, relative to those in the Dep + IGD group, those in the depression-only group reported a lower video gaming frequency [OR = 0.89, Wald χ² (1) = 47.60, p < 0.001] and lower impulsivity [OR = 0.36, Wald χ² (1) = 8.05, p < 0.001], but reported greater issues stemming from limited access to adaptive ER strategies [OR = 2.09, Wald χ² (1) = 5.22, p = 0.022].

Discussion

Consistent with past research, the present study revealed that the groups who were above previously established cutoffs for IGD, depression, or both did report greater ER difficulties, higher impulsivity, and lower mindfulness relative to those who were below cutoffs. However, results from a multivariate logistic regression revealed for the first time that more nuanced differences exist across groups, creating significant implications for practice and future research.

Results from the current study suggest that only a third of those meeting the cutoff for IGD also met the cutoff for moderately severe depression.^b Demographically, the proportion of females in the Dep + IGD group was greater than the proportion of females in the IGD-only group. This may suggest that the presence of co-occurring depression may be more pronounced among female video game users. Additionally, it is noteworthy that the Dep + IGD group played significantly more frequently than the IGD-only group. It is possible that this is due to an overreliance on video games as part of a maladaptive ER strategy, potentially explaining why limited access to ER strategies differentiated the depression-only group from those in the Dep + IGD group. This appears to coincide with research showing that excessive and problematic gaming engagement is most often motivated by a desire to escape negative emotions.^26,27

Those in the Dep + IGD group were also differentiated from those in the three other groups by higher impulsivity. This is likely a by-product of increased susceptibility for depression and IGD among impulsive individuals. Importantly, impulsivity is conceptually different from the impulse subscale of the DERS, which measures the inability to function adaptively when upset. Rather, impulsivity measures deficits in concentration and planning. Future research should explore the relationship between IGD, depression, and impulsivity longitudinally to assess directionality.

Consistent with previous research, individuals with depression and/or IGD reported difficulties being in the present moment. This potentially suggests that decreases in IGD severity previously observed from mindfulness-based programs may be targeting affective difficulties and/or the comorbid mood disorders often associated with IGD.²⁸ However, it remains unclear whether this limits the usefulness of mindfulness-based interventions to only those with comorbid mood disorders. As such, additional research examining the protective role of mindfulness in IGD with/without comorbid disorders needs to be conducted.

Limitations

The results of this study should be understood under the context of the study's limitations. First, self-report data were used, which allow for a certain level of potential biases to occur. It is possible that participants were not sincere or fully engaged when completing the survey; however, a series of checks and filters were employed to help confirm validity and sincerity of responses. Furthermore, studies have shown higher prevalence rates for mood disorders and ER difficulties among females,²⁹ which may point to a reluctance of males to report ER difficulties. However, this study is strengthened by the comparable sample based on gender.

Conclusion

With the recent inclusion of gaming disorder in the ICD-11³⁰ as an official diagnosis, there is increased attention given to potential risk and protective factors for individuals with IGD and what prevention/intervention measures would be best suited for this disorder. These results suggest that gamers with IGD require targeted treatment for controlling emotional impulsivity (i.e., teaching individuals to respond to emotions rather than react) and gamers with depression require increased access to various ER strategies and tools to stay in the present moment, rather than overattending to internal processes. Finally, gamers with comorbid depression and IGD require general ER knowledge (i.e., ability to understand and label one's emotions), tools to stay in the present moment, and tools to increase executive control (e.g., learning to plan ahead and think carefully before acting). Only by understanding the unique profiles of problematic gamers with and without depression and how they compare with nonproblematic gamers can we extricate the most crucial areas among each group that need to be addressed in clinical practice.

Notes

a. The authors used a lower cutoff of 10 on the PHQ (depression scale), which is indicative of moderate depression according to Kroenke et al.²⁰

b. When using the same cutoff as Wang et al.,⁷ we found that >68 percent of the 158 meeting the threshold for IGD also met the threshold for moderate depression. As such, our results are largely consistent with their findings.

Disclaimer

The findings and conclusions of this article are those solely of the authors and do not necessarily represent the views of Manitoba Liquor and Lotteries.

Footnotes

Author Disclosure Statement

No competing financial interests exist.

Funding Information

L.A.M. is supported by a doctoral scholarship from the Fonds de Recherche Société et Culture Québec—Concerted Actions program in partnership with Mise sur toi. This research was funded by the Manitoba Gambling Research Program of Manitoba Liquor and Lotteries (grant number SM-17-14).

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