Problematic online gaming mediates the association between attention-deficit/hyperactivity and subsequent mental health issues in adolescents

Abstract Theoretical models suggest that attention-deficit/hyperactivity and problematic online gaming could contribute to negative mental health outcomes, yet evidence on their interplay remains limited. Using data from 3171 adolescents in the Tokyo Teen Cohort, the present study examined the inter...

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Main Authors: Zui C. Narita, Jordan DeVylder, Gemma Knowles, Shuntaro Ando, Syudo Yamasaki, Mitsuhiro Miyashita, Daniel Stanyon, Satoshi Yamaguchi, Toshiaki A. Furukawa, Kiyoto Kasai, Atsushi Nishida
Format: Article
Language:English
Published: Nature Portfolio 2025-08-01
Series:Communications Psychology
Online Access:https://doi.org/10.1038/s44271-025-00296-5
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author Zui C. Narita
Jordan DeVylder
Gemma Knowles
Shuntaro Ando
Syudo Yamasaki
Mitsuhiro Miyashita
Daniel Stanyon
Satoshi Yamaguchi
Toshiaki A. Furukawa
Kiyoto Kasai
Atsushi Nishida
author_facet Zui C. Narita
Jordan DeVylder
Gemma Knowles
Shuntaro Ando
Syudo Yamasaki
Mitsuhiro Miyashita
Daniel Stanyon
Satoshi Yamaguchi
Toshiaki A. Furukawa
Kiyoto Kasai
Atsushi Nishida
author_sort Zui C. Narita
collection DOAJ
description Abstract Theoretical models suggest that attention-deficit/hyperactivity and problematic online gaming could contribute to negative mental health outcomes, yet evidence on their interplay remains limited. Using data from 3171 adolescents in the Tokyo Teen Cohort, the present study examined the interplay of attention-deficit/hyperactivity at age 12 and problematic online gaming at age 14 associated with mental health issues at age 16. The sample consisted of 1487 girls (46.9%) and 1684 boys (53.1%). Doubly robust estimation revealed that a high degree of problematic online gaming consistently elevated the absolute and relative risks of mental health issues. The fully adjusted risk difference and risk ratio (95% confidence intervals (CIs)) were: incident depression, 7.8% (3.0%–13.1%) and 1.62 (1.25–2.05); incident anxiety, 5.7% (2.7%–8.7%) and 1.98 (1.45–2.67); incident psychotic experiences, 5.9% (2.3%–10.8%) and 1.72 (1.30–2.47); diminished well-being, 9.6% (5.1%–14.3%) and 1.54 (1.27–1.84). Higher attention-deficit/hyperactivity scores were associated with a greater degree of problematic online gaming (adjusted β per 1 SD: 0.18, 95% CI: 0.12–0.24). Causal mediation analysis—ensuring temporal plausibility, carefully adjusting for confounders, and accounting for exposure–mediator interaction—showed that problematic online gaming partially mediated the association between attention-deficit/hyperactivity and mental health issues: depressive symptoms (29.2%), anxiety (12.3%), psychotic experiences (20.6%), and diminished well-being (22.1%). The findings highlight the interplay of psychopathology, diminished inhibitory control, and addictive behaviors associated with negative consequences. Problematic online gaming may represent a modifiable mediator, warranting further intervention research to examine its potential as a treatment target.
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spelling doaj-art-e02dbffd8f754832a3cd7941b39af7222025-08-20T03:43:02ZengNature PortfolioCommunications Psychology2731-91212025-08-013111010.1038/s44271-025-00296-5Problematic online gaming mediates the association between attention-deficit/hyperactivity and subsequent mental health issues in adolescentsZui C. Narita0Jordan DeVylder1Gemma Knowles2Shuntaro Ando3Syudo Yamasaki4Mitsuhiro Miyashita5Daniel Stanyon6Satoshi Yamaguchi7Toshiaki A. Furukawa8Kiyoto Kasai9Atsushi Nishida10National Center of Neurology and PsychiatryNew York UniversityKing’s College LondonThe University of TokyoTokyo Metropolitan Institute of Medical ScienceTokyo Metropolitan Institute of Medical ScienceKing’s College LondonTokyo Metropolitan Institute of Medical ScienceKyoto UniversityThe University of TokyoTokyo Metropolitan Institute of Medical ScienceAbstract Theoretical models suggest that attention-deficit/hyperactivity and problematic online gaming could contribute to negative mental health outcomes, yet evidence on their interplay remains limited. Using data from 3171 adolescents in the Tokyo Teen Cohort, the present study examined the interplay of attention-deficit/hyperactivity at age 12 and problematic online gaming at age 14 associated with mental health issues at age 16. The sample consisted of 1487 girls (46.9%) and 1684 boys (53.1%). Doubly robust estimation revealed that a high degree of problematic online gaming consistently elevated the absolute and relative risks of mental health issues. The fully adjusted risk difference and risk ratio (95% confidence intervals (CIs)) were: incident depression, 7.8% (3.0%–13.1%) and 1.62 (1.25–2.05); incident anxiety, 5.7% (2.7%–8.7%) and 1.98 (1.45–2.67); incident psychotic experiences, 5.9% (2.3%–10.8%) and 1.72 (1.30–2.47); diminished well-being, 9.6% (5.1%–14.3%) and 1.54 (1.27–1.84). Higher attention-deficit/hyperactivity scores were associated with a greater degree of problematic online gaming (adjusted β per 1 SD: 0.18, 95% CI: 0.12–0.24). Causal mediation analysis—ensuring temporal plausibility, carefully adjusting for confounders, and accounting for exposure–mediator interaction—showed that problematic online gaming partially mediated the association between attention-deficit/hyperactivity and mental health issues: depressive symptoms (29.2%), anxiety (12.3%), psychotic experiences (20.6%), and diminished well-being (22.1%). The findings highlight the interplay of psychopathology, diminished inhibitory control, and addictive behaviors associated with negative consequences. Problematic online gaming may represent a modifiable mediator, warranting further intervention research to examine its potential as a treatment target.https://doi.org/10.1038/s44271-025-00296-5
spellingShingle Zui C. Narita
Jordan DeVylder
Gemma Knowles
Shuntaro Ando
Syudo Yamasaki
Mitsuhiro Miyashita
Daniel Stanyon
Satoshi Yamaguchi
Toshiaki A. Furukawa
Kiyoto Kasai
Atsushi Nishida
Problematic online gaming mediates the association between attention-deficit/hyperactivity and subsequent mental health issues in adolescents
Communications Psychology
title Problematic online gaming mediates the association between attention-deficit/hyperactivity and subsequent mental health issues in adolescents
title_full Problematic online gaming mediates the association between attention-deficit/hyperactivity and subsequent mental health issues in adolescents
title_fullStr Problematic online gaming mediates the association between attention-deficit/hyperactivity and subsequent mental health issues in adolescents
title_full_unstemmed Problematic online gaming mediates the association between attention-deficit/hyperactivity and subsequent mental health issues in adolescents
title_short Problematic online gaming mediates the association between attention-deficit/hyperactivity and subsequent mental health issues in adolescents
title_sort problematic online gaming mediates the association between attention deficit hyperactivity and subsequent mental health issues in adolescents
url https://doi.org/10.1038/s44271-025-00296-5
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