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10-10-18

10-10-18.

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10-10-18

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  1. 10-10-18 Gaming disorder among a sample of Mexican college freshmen.Guilherme Borges, Ricardo Orozco and Corina BenjetInstituto Nacional de Psiquiatría Ramon de la Fuente Muñiz, Calzada México Xochimilco No. 101, Col. San Lorenzo Huipulco, CP: 14370, CDMX, México.E-mail address: guibor@imp.edu.mx Diagnostic/Screening/Assessment of Internet/Gaming Addiction panel at the upcoming Digital Media and Developing Minds Cold Spring Harbor Laboratory, 7:30-8:15 pm Tuesday, October 16th, 2018.

  2. 1.Wendy Feng et al., 2017: Internet gaming disorder: Trends in prevalence 1998–2016 Fig. 2. IGD prevalence over time (N =27 studies in natural populations; 23 different scales). The average percentage was 4.7% across all years (range 0.7-15.6%). DSM-5 (2013) 2.JIA YUIN FAM et al., (2018):Prevalence of internet gaming disorder in adolescents: A meta-analysis across three decades Overall: 28 estimates since 1998; 4.6% (range 3.4-6.0%) (IGD strict sense= 1.6%; If sample size>5,000= 2.2%. 3.Mihara and Higuchi, 2017: Cross-sectional and longitudinal epidemiological studies of Internet gaming disorder: A systematic review of the literature. Up to May 2016- 37 cross-sectional (prevalence 0.7%-27.5%) and 13 longitudinal studies. 4.Paulus et al., 2018: Internet gaming disorder in children and adolescents: a systematic review. 41 studies prevalence ranged 0.6%-50%, median 5.5%. Median prevalence for 10 population based studies: 2.0% 5.Petry et al., 2018: Behavioral Addictions as Mental Disorders: To Be or Not To Be?. 9 studies sample size >3,000 respondentes prevalence ranged 0.3%-4.9%.

  3. Prevalence DSM-5 IGD byauthor (14 authors; 17 studies)-year (2015-2018) in total population (14 estimatesleft-range 1.16%-10.80%) and amonggamers (8 estimatesright- range 2.90%-13.80%) Random meta-regression Prev= 5.5% (95%CI-3.8-7.3%) Pontes, 2016: 7 scalesfor DSM-5; Almeida, 2018: 11 scalesfor DSM-5 Random meta-regression Prev= 3.5% (95%CI-2.6-4.5%)

  4. METHODS- DSM-5/IGD (total sample 5.6%; gamers 8.9%): males (10.8%)-females (1.8%); age 18-19 (5.1%)- age 20+ (7.3%) • Sample: Incoming first year students in Mexican universities. For this first analyses on gaming, sample consisted of N=3,799 students (63.5% gamers, 53.6% females, 75.1% 18-19 y/o) (and counting). Participants gave consent and were given access through a web-based survey, had to be at least 18 years of age to participate. Item Response Theory (IRT) main results for gamers: unidimensionaly with factors loading between 0.801-0.923. Cronbach's α = 0.8564 – Items from G and SU work well and are mingled together

  5. DSM-5 “leading to clinically significant impairment or distress”; ICD-11 “significant impairment in personal, family, social, educational, occupational or other important areas of functioning. Here, severity of health-related role impairment assessed by using an adapted version of the Sheehan Disability Scale. Four role domains: home management/chores, college-related and other work, close personal relationships, and social life. No interference (0), mild (1–3), moderate (4–6), severe (7–9), and very severe (10) interference. IGD+ were at increase odds of showing severe/very severe: home management/chores (2.1(0.9-4.8)), college-related and other work (3.2*(1.9-5.3)), close personal relationships (1.6(0.9-2.9)), and social life (1.7(0.9-2.9)). In summary total severe/very severe: 2.3*(1.6-3.5) In the total sample(3,779), IGD+(214) were more likely to: lifetime use of any psychological TX (aOR=1.6*(1.1-2.3)); any medical TX (1.9*(1.0-3.7)).

  6. DISCUSSION- Some limitations are apparent • DSM-5 frame has became predominant, but scales abound everywhere. ICD estimates to come next with its own scales and prevalence estimates? • Common approach used with prior addictions (alcohol, tobacco, drugs) framework (Item Response Theory- IRT) is sometimes available. Need to put IRT results all together (unidimensionality; discrimination&difficulty; INVARIANCE-DIF). • Mostly on children and adolescents. Sometimes broad age range and few estimates for adults only. Range of prevalence is not bad by itself (see SUD). • Some with few number of cases. We lack estimates from traditional epidemiological framework for sample representativeness (large community surveys). • Besides the few clinical studies, some studies are on selected samples of respondents in web sites (no response rates)- not good for population prevalence estimates. • Some reports on gamers only (not common definition). Do we need a definition of “gamers”? • Few, if any, external validators in non-clinical samples. Few discussion on impact on service use and/or impairment (DSM and ICD “extra” criterion). • Few (any?) studies in western low-middle income countries.

  7. Panel: Who has a problem with Internet use? Screening for, Assessing and Diagnosing Internet and Gaming Addiction Matthias Brand Digital Media and Developing Minds, Second National Conference, Cold Spring Harbor Laboratory

  8. Introduction (Young, 1998)

  9. Theoretical embedding: Addiction framework

  10. 5 Steps I-PACE model • Biopsychological constitution • Genetic factors • Early childhood experiences • Stress vulnerability • Personality • Impulsivity • Low self-esteem • Low conscientiousness Person’s core characteristics • Psychopathology • Depression • Social anxiety • ADHD • Specific motives • for using • Games • Gambles • Cybersex and pornography • Shopping sites • Communication sites/apps • Social cognitions • Loneliness • Perceived social support • Social distrust Specific Internet-use disorder Diminishedcontroloverthe Internet use Negative consequences in dailylife

  11. Affective and cognitive processes in the interaction between the person and digital media • Digital media: • Accessible • Affordance • Deliverreward • Intermittentreinforcement • Chance toescape stress • Discovery ofnewworlds • … • Person: • Experiencesreward • Experiencespleasureandrelief • Developscertainuseexpectancies • Developshabits • Developsautomaticresponses (e.g., cue-reactivity) • … Neuraladaptations

  12. Other types Specific Internet-use disorders Gaming (e.g., Brand et al., 2016; Davis, 2001; Young, 1998) Gambling • Cautionbeforeusingtheterm „addiction“! • It‘sonlyadequateforconditionswhichhave: • Clinical relevance/functionalimpairment in dailylife • Theoreticalembedding in addictionframework • Empiricalevidence Pornography Buying/Shopping Communication

  13. Thank you!

  14. Who Has a Problem with Internet Use? Screening for, Assessing and Diagnosing Internet and Gaming Addictions Moderator: Prof. Marc Potenza, Yale University School of Medicine Speaker: Prof. Matthias Brand, University of Duisburg-Essen Speaker: Prof. Hans Jürgen Rumpf, University of Lübeck Speaker: Prof. Guilherme Borges, Universidad NacionalAutonoma de Mexico CSHL, October 16, 2018

  15. Classification of Internet/gamingaddiction Hans-Jürgen Rumpf University of Lübeck Department of psychiatry und psychotherapy Research Group S:TEP (Substanceuse and relateddisorders:treatment, Epidemiology, and prevention)

  16. Young, K. S. (1996). Psychologyofcomputeruse: XL. Addictiveuseofthe Internet: a casethatbreaksthe stereotype. Psychol Rep, 79(3 Pt 1), 899-902.

  17. Griffiths, M. (1996). Internet addiction: An issueforclinicalpsychology? ClinPsychol Forum, 97, 32-36.

  18. Kaplan, R. (1996). Carrot addiction. Aust N Z J Psychiatry, 30(5), 698-700.

  19. Pubmed Search carrotaddiction

  20. Pubmed Search Internet addiction 2017 1996

  21. Diagnosticclassifications

  22. Internet Gaming Disorder Preoccupation with Internet Games Withdrawal symptoms Tolerance (needtospendmore time) Unsuccessfulattemptstocontrolparticipation in games Loss of interest (previoushobbiesorentertainments)

  23. Internet Gaming Disorder Continued use despite knowledge of psychosocial problems Deceivingothersregardingtheamount of gaming Use ofgamestoescape/relieve a negative mood Hasjeopardized/lost significantrelationship, job, educationalorcareeroportunity due togaming --- 5 criteriahavetobefulfilled ---

  24. Emotion regulation?

  25. Internet Gaming Disorder Continued use despite knowledge of psychosocial problems Deceivingothersregardingtheamount of gaming Use ofgamestoescape/relieve a negative mood Hasjeopardized/lost significantrelationship, job, educationalorcareeroportunity due togaming --- 5 criteriahavetobefulfilled ---

  26. ICD-11 06 Mental, behaviouralorneurodevelopmentaldisorders Disorders due tosubstanceuseoraddictivebehaviours - Disorders due toaddictivebehaviours - 6C50 Gamblingdisorder - 6C51 Gaming disorder --- predominantly online/offline - 6C5Y Other specifieddisorders due toaddictivebehaviours - 6C5Z Disorders due toaddictivebehaviours, unspecified

  27. Diagnosticcriteria - i Impaired control over gaming (e.g., onset, frequency, intensity, duration, termination, context) Increasing priority given to gaming to the extent that gaming takes precedence over other life interests and daily activities Continuation or escalation of gaming despite the occurrence of negative consequences.

  28. Diagnosticcriteria - ii The behaviourpatternisofsufficientseveritytoresult in significantimpairment in personal, family, social, educational, occupationalorotherimportantareasoffunctioning. The patternofgamblingbehaviourmaybecontinuousorepisodicandrecurrent. The gamblingbehaviourandotherfeaturesarenormally evident over a periodof at least 12 monthsin orderfor a diagnosistobeassigned, althoughtherequireddurationmaybeshortenedif all diagnosticrequirementsaremetandsymptomsaresevere.

  29. ICD-11: Next steps

  30. Assessment

  31. Thankyouverymuchforyourattention! hans-juergen.rumpf@uksh.de

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