Association Between Internet Gaming Disorder and SuicidalIdeation Mediated by Psychosocial Resources and Psychosocial Problems Among Adolescent Internet Gamers in China: Cross-Sectional Study

Background: Adolescent internet gaming disorder (IGD) was associated with severe harm, including suicidal ideation. Whilesuicidal ideation was predictive of completed suicides, further research is required to clarify the association between IGD andsuicidal ideation among adolescents, as well as the mechanisms involved.Objective: This study aimed to investigate the understudied association between IGD and suicidal ideation, as well as novelmechanisms associated with it, among Chinese adolescent internet gamers through psychosocial coping resources and psychosocialproblems.Methods: An anonymous, self-administered, cross-sectional survey was conducted among secondary school students who hadplayed internet games in the past year in Guangzhou and Chengdu, China (from October 2019 to January 2020). In total, 1693adolescent internet gamers were included in this study; the mean age was 13.48 (SD 0.80) years, and 60% (n=1016) were males.IGD was assessed by the 9-item Internet Gaming Disorder Checklist of the DSM-5(Diagnostic and Statistical Manual of MentalDisorders[Fifth Edition]), while a single item assessed suicidal ideation: "Have you ever considered committing suicide in thepast 12 months?" Univariate and multivariate logistic regression associations were conducted to test the significance and directionsof the potential factors for suicidal ideation. The mediation mechanism was examined by structural equation modeling.Results: Among all participants, the prevalence of IGD and suicidal ideation was 16.95% (287/1693) and 43.06% (729/1693),respectively. IGD cases were 2.42 times more likely than non-IGD cases to report suicidal ideation (adjusted odds ratio [OR]2.42, 95% CI 1.73-3.37). Other significant factors of suicidal ideation included psychosocial coping resources (resilience andsocial support, both adjusted OR 0.97, 95% CI 0.96-0.98) and psychosocial problems (social anxiety: adjusted OR 1.07, 95% CI 1.05-1.09; loneliness, adjusted OR 1.13, 95% CI 1.10-1.16). The association between IGD and suicidal ideation was partiallymediated by 3 indirect paths, including (1) the 2-step path that IGD reduced psychosocial coping resources, which in turn increasedsuicidal ideation; (2) the 2-step path that IGD increased psychosocial problems, which in turn increased suicidal ideation; and(3) the 3-step path that IGD reduced psychosocial coping resources which then increased psychosocial problems, which in turnincreased suicidal ideation, with effect sizes of 10.7% (indirect effect/total effect: 0.016/0.15), 30.0% (0.05/0.15), and 13.3%(0.02/0.15), respectively. The direct path remained statistically significant.Conclusions: IGD and suicidal ideation were alarmingly prevalent. Evidently and importantly, IGD was a significant risk factorfor suicidal ideation. The association was partially explained by psychosocial coping resources of resilience and social supportand psychosocial problems of social anxiety and loneliness. Longitudinal studies are needed to confirm the findings. Pilotrandomized controlled trials are recommended to evaluate the effectiveness of interventions in reducing suicidal ideation byreducing IGD, improving psychosocial coping resources, and reducing psychosocial problems investigated in this study