The relationship between game genre, monetization strategy and symptoms of gaming disorder in a clinical sample of adolescents
Keywords:
Gaming disorder, game genre, microtransactions, loot boxes, monetization
Abstract
Background: Gaming disorder (GD) has been introduced as a new diagnosis in the International Classification of Disease 11 (ICD-11). Currently, there’s limited understanding of how various video games may differentially contribute to the risk of developing GD. The main aim of this study was to examine the relationship between individuals’ game genre preferences, their preferred games’ monetization strategies, and GD Symptoms.
Methods: A total of 85 patients undergoing treatment for GD at a child and youth psychiatric clinic were included in the study. Their preferred games were classified into five novel genres based on gameplay similarities and objectives, and further categorized based on their monetization strategy.
Results: Symptom burden of GD, measured with Game Addiction Scale for Adolescents (GASA), was highest for those playing Free-to-Play (F2P) games and lowest for Pay-to-Play (P2P) players. Players of Competitive Games endorsed higher GD symptom burden, whereas players of Story-driven games reported lower GD symptom burden. Symptoms of GD were associated with attention-deficit hyperactivity disorder (ADHD) diagnosis in males.
Conclusions: This study reveals that game genre preference is influenced by sex, age, and certain psychiatric diagnoses. The categorizing of games into genres is increasingly complex and our research introduces a novel categorization in a developing research field. The result of this study suggests that the monetization model is important to consider while trying to understand the relationship between game characteristics and GD symptoms.
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References
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25. Király O, Koncz P, Griffiths MD, Demetrovics Z. Gaming disorder: a summary of its characteristics and aetiology. Comprehens Psychiatry. 2023;122:152376. https://doi.org/10.1016/j.comppsych.2023.152376
26. King D, Delfabbro P, Griffiths M. Video game structural characteristics: a new psychological taxonomy. Int J Ment Health Addiction. 2010;8: 90–106. https://doi.org/10.1007/s11469-009-9206-4
27. King DL, Delfabbro PH. Video game monetization (e.g., ‘Loot Boxes’): a blueprint for practical social responsibility measures. Int J Ment Health Addict. 2019;17:166–79. https://doi.org/10.1007/s11469-018-0009-3
28. King DL, Russell AMT, Delfabbro PH, Polisena D. Fortnite microtransaction spending was associated with peers’ purchasing behaviors but not gaming disorder symptoms. Addict Behav. 2020;104:106311. https://doi.org/10.1016/j.addbeh.2020.106311
29. Drummond A, Sauer JD. Video game loot boxes are psychologically akin to gambling. Nat Hum Behav. 2018;2:530–2. https://doi.org/10.1038/s41562-018-0360-1
30. Brooks GA, Clark L. Associations between loot box use, problematic gaming and gambling, and gambling-related cognitions. Addict Behav. 2019;96:26–34. https://doi.org/10.1016/j.addbeh.2019.04.009
31. Li W, Mills D, Nower L. The relationship of loot box purchases to problem video gaming and problem gambling. Addict Behav. 2019;97:27–34. https://doi.org/10.1016/j.addbeh.2019.05.016
32. Kapetanovic S, Gurdal S, Einarsson I, Werner M, André F, Håkansson A, et al. Relapse prevention therapy for problem gaming or Internet gaming disorder in Swedish child and youth psychiatric clinics: protocol for a randomized controlled trial. JMIR Res Protoc. 2023;12:e44318. https://doi.org/10.2196/44318
33. Lemmens JS, Valkenburg PM, Peter J. Development and validation of a game addiction scale for adolescents. Media Psychol. 2009;12:77–95. https://doi.org/10.1080/15213260802669458
34. King DL, Chamberlain SR, Carragher N, Billieux J, Stein D, Mueller K, et al. Screening and assessment tools for gaming disorder: a comprehensive systematic review. Clin Psychol Rev. 2020;77:101831. https://doi.org/10.1016/j.cpr.2020.101831
35. Alshehri AG, Mohamed A. The relationship between electronic gaming and health, social relationships, and physical activity among males in Saudi Arabia. Am J Mens Health. 2019;13:1557988319873512. https://doi.org/10.1177/1557988319873512
36. King DL, Delfabbro PH. The cognitive psychology of Internet gaming disorder. Clin Psychol Rev. 2014;34:298–308. https://doi.org/10.1016/j.cpr.2014.03.006
37. Lohse P. How instability in virtual economies of mobile digital games drives and ruins profit. EAI Endorsed Trans Context-aware Syst Appl. 2019;6:e2. https://doi.org/10.4108/eai.13-7-2018.162632
38. Laconi S, Pirès S, Chabrol H. Internet gaming disorder, motives, game genres and psychopathology. Comput Hum Behav. 2017;75:652–9. https://doi.org/10.1016/j.chb.2017.06.012
39. Engelhardt CR, Mazurek MO, Hilgard J. Pathological game use in adults with and without Autism Spectrum Disorder. PeerJ. 2017;5:e3393. https://doi.org/10.7717/peerj.3393
40. Dreier M, Wölfling K, Duven E, Giralt S, Beutel ME, Müller KW. Free-to-play: about addicted Whales, at risk Dolphins and healthy Minnows. Monetarization design and Internet Gaming Disorder. Addict Behav. 2017;64:328–33. https://doi.org/10.1016/j.addbeh.2016.03.008
41. Zendle D, Meyer R, Over H. Adolescents and loot boxes: links with problem gambling and motivations for purchase. R Soc Open Sci. 2019;6: 190049. https://doi.org/10.1098/rsos.190049
42. King A, Wong-Padoongpatt G. Do gamers play for money? A moderated mediation of gaming motives, relative deprivation, and upward mobility. Int J Environ Res Public Health. 2022;19:15384. https://doi.org/10.3390/ijerph192215384
43. Björk S, Holopainen J. Patterns in game design. Boston, MA: Charles River Media; 2005.
2. Jones CM, Scholes L, Johnson D, Katsikitis M, Carras MC. Gaming well: links between videogames and flourishing mental health. Front Psychol. 2014;5:260. https://doi.org/10.3389/fpsyg.2014.00260
3. Halbrook Y, O’Donnell A, Msetfi R. When and how video games can be good: a review of the positive effects of video games on well-being. Perspect Psychol Sci. 2019;14:1096–104. https://doi.org/10.1177/1745691619863807
4. World Health Organization. International classification of diseases for mortality and morbidity statistics (11th Revision). 2018. Available from: https://icd.who.int/browse11/l-m/en [cited 19 Nov 2023].
5. Griffiths MD, Nuyens F. An overview of structural characteristics in problematic video game playing. Curr Addict Rep. 2017;4:272–83. https://doi.org/10.1007/s40429-017-0162-y
6. Müller KW, Janikian M, Dreier M, Wölfling K, Beutel ME, Tzavara C, et al. Regular gaming behavior and internet gaming disorder in European adolescents: results from a cross-national representative survey of prevalence, predictors, and psychopathological correlates. Eur Child Adolesc Psychiatry. 2015;24:565–74. https://doi.org/10.1007/s40429-017-0162-y
7. Stevens MW, Dorstyn D, Delfabbro PH, King DL. Global prevalence of gaming disorder: a systematic review and meta-analysis. Aust N Z J Psychiatry. 2021;55:553–68. https://doi.org/10.1177/0004867420962851
8. López-Fernández FJ, Mezquita L, Griffiths MD, Ortet G, Ibáñez MI. The role of personality on disordered gaming and game genre preferences in adolescence: gender differences and person-environment transactions. Adicciones. 2021;33:263–72. https://doi.org/10.20882/adicciones.1370
9. Lopez-Fernandez O, Williams AJ, Kuss DJ. Measuring female gaming: gamer profile, predictors, prevalence, and characteristics from psychological and gender perspectives. Front Psychol. 2019;10:898. https://doi.org/10.3389/fpsyg.2019.00898
10. González-Bueso V, Santamaría JJ, Fernández D, Merino L, Montero E, Ribas J. Association between Internet gaming disorder or pathological video-game use and comorbid psychopathology: a comprehensive review. Int J Environ Res Public Health. 2018;15:668. https://doi.org/10.3390/ijerph15040668
11. Schou Andreassen C, Billieux J, Griffiths MD, Kuss DJ, Demetrovics Z, Mazzoni E, Pallesen S. The relationship between addictive use of social media and video games and symptoms of psychiatric disorders: a large-scale cross-sectional study. Psychol Addict Behav. 2016;30:252–62. https://doi.org/10.1037/adb0000160
12. Ostinelli EG, Zangani C, Giordano B, Maestri D, Gambini O, D’Agostino A, et al. Depressive symptoms and depression in individuals with internet gaming disorder: a systematic review and meta-analysis. J Affect Disord. 2021;284:136–42. https://doi.org/10.1016/j.jad.2021.02.014
13. Dullur P, Krishnan V, Diaz AM. A systematic review on the intersection of attention-deficit hyperactivity disorder and gaming disorder. J Psychiatr Res. 2021;133:212–22. https://doi.org/10.1016/j.jpsychires.2020.12.026
14. Murray A, Koronczai B, Király O, Griffiths MD, Mannion A, Leader G, et al. Autism, problematic Internet use and gaming disorder: a systematic review. Rev J Autism Dev Dis. 2021;9:120–40. https://doi.org/10.1007/s40489-021-00243-0
15. American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders: DSM-5. Vol 5. Washington, DC: American Psychiatric Association; 2013.
16. Richard J, Temcheff C, Derevensky J. Gaming disorder across the lifespan: a scoping review of longitudinal studies. Curr Addict Rep. 2020;7: 561–87. https://doi.org/10.1007/s40429-020-00339-3
17. Dell’Osso L, Amatori G, Muti D, Giovannoni F, Parri F, Violi M, et al. Autism spectrum, Hikikomori Syndrome and Internet Gaming Disorder: is there a link? Brain Sci. 2023;13:117. https://doi.org/10.3390/brainsci13071116
18. Kim DJ, Kim K, Lee HW, Hong JP, Cho MJ, Fava M, et al. Internet game addiction, depression, and escape from negative emotions in adulthood: a nationwide community sample of Korea. J Nerv Ment Dis. 2017; 205:568–73. https://doi.org/10.1097/NMD.0000000000000698
19. Kristensen JH, Pallesen S, King DL, Hysing M, Erevik EK. Problematic gaming and sleep: a systematic review and meta-analysis. Front Psychiatry. 2021;12:675237. https://doi.org/10.3389/fpsyt.2021.675237
20. Bonnaire C, Baptista D. Internet gaming disorder in male and female young adults: the role of alexithymia, depression, anxiety and gaming type. Psychiatry Res. 2019;272:521–30. https://doi.org/10.1016/j.psychres.2018.12.158
21. Billieux J, Potenza MN, Maurage P, Brevers D, Brand M, King DL. Chapter 16 – Cognitive factors associated with gaming disorder. In: Verdejo-Garcia A, ed. Cognition and addiction. Adelaide: Academic Press; 2020, pp. 221–30.
22. Bäcklund C, Elbe P, Gavelin HM, Sörman DE, Ljungberg JK. Gaming motivations and gaming disorder symptoms: a systematic review and meta-analysis. J Behav Addict. 2022;11:667–88. https://doi.org/10.1556/2006.2022.00053
23. King DL, Delfabbro PH, Perales JC, Deleuze J, Király O, Krossbakken E, et al. Maladaptive player-game relationships in problematic gaming and gaming disorder: a systematic review. Clin Psychol Rev. 2019;73: 101777. https://doi.org/10.1016/j.cpr.2019.101777
24. Rehbein F, King D, Staudt A, Hayer T, Rumpf H-J. Contribution of game genre and structural game characteristics to the risk of problem gaming and gaming disorder: a systematic review. Curr Addict Rep. 2021;8: 1–19. https://doi.org/10.1007/s40429-021-00367-7
25. Király O, Koncz P, Griffiths MD, Demetrovics Z. Gaming disorder: a summary of its characteristics and aetiology. Comprehens Psychiatry. 2023;122:152376. https://doi.org/10.1016/j.comppsych.2023.152376
26. King D, Delfabbro P, Griffiths M. Video game structural characteristics: a new psychological taxonomy. Int J Ment Health Addiction. 2010;8: 90–106. https://doi.org/10.1007/s11469-009-9206-4
27. King DL, Delfabbro PH. Video game monetization (e.g., ‘Loot Boxes’): a blueprint for practical social responsibility measures. Int J Ment Health Addict. 2019;17:166–79. https://doi.org/10.1007/s11469-018-0009-3
28. King DL, Russell AMT, Delfabbro PH, Polisena D. Fortnite microtransaction spending was associated with peers’ purchasing behaviors but not gaming disorder symptoms. Addict Behav. 2020;104:106311. https://doi.org/10.1016/j.addbeh.2020.106311
29. Drummond A, Sauer JD. Video game loot boxes are psychologically akin to gambling. Nat Hum Behav. 2018;2:530–2. https://doi.org/10.1038/s41562-018-0360-1
30. Brooks GA, Clark L. Associations between loot box use, problematic gaming and gambling, and gambling-related cognitions. Addict Behav. 2019;96:26–34. https://doi.org/10.1016/j.addbeh.2019.04.009
31. Li W, Mills D, Nower L. The relationship of loot box purchases to problem video gaming and problem gambling. Addict Behav. 2019;97:27–34. https://doi.org/10.1016/j.addbeh.2019.05.016
32. Kapetanovic S, Gurdal S, Einarsson I, Werner M, André F, Håkansson A, et al. Relapse prevention therapy for problem gaming or Internet gaming disorder in Swedish child and youth psychiatric clinics: protocol for a randomized controlled trial. JMIR Res Protoc. 2023;12:e44318. https://doi.org/10.2196/44318
33. Lemmens JS, Valkenburg PM, Peter J. Development and validation of a game addiction scale for adolescents. Media Psychol. 2009;12:77–95. https://doi.org/10.1080/15213260802669458
34. King DL, Chamberlain SR, Carragher N, Billieux J, Stein D, Mueller K, et al. Screening and assessment tools for gaming disorder: a comprehensive systematic review. Clin Psychol Rev. 2020;77:101831. https://doi.org/10.1016/j.cpr.2020.101831
35. Alshehri AG, Mohamed A. The relationship between electronic gaming and health, social relationships, and physical activity among males in Saudi Arabia. Am J Mens Health. 2019;13:1557988319873512. https://doi.org/10.1177/1557988319873512
36. King DL, Delfabbro PH. The cognitive psychology of Internet gaming disorder. Clin Psychol Rev. 2014;34:298–308. https://doi.org/10.1016/j.cpr.2014.03.006
37. Lohse P. How instability in virtual economies of mobile digital games drives and ruins profit. EAI Endorsed Trans Context-aware Syst Appl. 2019;6:e2. https://doi.org/10.4108/eai.13-7-2018.162632
38. Laconi S, Pirès S, Chabrol H. Internet gaming disorder, motives, game genres and psychopathology. Comput Hum Behav. 2017;75:652–9. https://doi.org/10.1016/j.chb.2017.06.012
39. Engelhardt CR, Mazurek MO, Hilgard J. Pathological game use in adults with and without Autism Spectrum Disorder. PeerJ. 2017;5:e3393. https://doi.org/10.7717/peerj.3393
40. Dreier M, Wölfling K, Duven E, Giralt S, Beutel ME, Müller KW. Free-to-play: about addicted Whales, at risk Dolphins and healthy Minnows. Monetarization design and Internet Gaming Disorder. Addict Behav. 2017;64:328–33. https://doi.org/10.1016/j.addbeh.2016.03.008
41. Zendle D, Meyer R, Over H. Adolescents and loot boxes: links with problem gambling and motivations for purchase. R Soc Open Sci. 2019;6: 190049. https://doi.org/10.1098/rsos.190049
42. King A, Wong-Padoongpatt G. Do gamers play for money? A moderated mediation of gaming motives, relative deprivation, and upward mobility. Int J Environ Res Public Health. 2022;19:15384. https://doi.org/10.3390/ijerph192215384
43. Björk S, Holopainen J. Patterns in game design. Boston, MA: Charles River Media; 2005.
Published
2024-03-07
How to Cite
André F., Bore P., Toresson T., Andersson M., & Claesdotter-Knutsson E. (2024). The relationship between game genre, monetization strategy and symptoms of gaming disorder in a clinical sample of adolescents. Upsala Journal of Medical Sciences, 129, e10386. https://doi.org/10.48101/ujms.v129.10386
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