Video Gaming in a Hyperconnected World: A Cross-sectional Study of Heavy Gaming, Problematic Gaming Symptoms, and Online Socializing in Adolescents

Abstract

Aims: Examining online social interactions along with patterns of video gaming behaviors and game addiction symptoms has the potential to enrich our understanding of disorders related to excessive video game play.
Methods: We performed latent class analysis in a sample of 9733 adolescents based on heavy use of games, social networking and instant messaging, and game addiction symptoms. We used latent class regression to determine associations between classes, psychosocial well-being and friendship quality.
Results: We identified two types of heavy gaming classes that differed in probability of online social interaction. Classes with more online social interaction reported fewer problematic gaming symptoms than those with less online social interaction. Most adolescents estimated to be in heavy gaming classes had more depressive symptoms than normative classes. Male non-social gamers had more social anxiety. Female social gamers had less social anxiety and loneliness, but lower self-esteem. Friendship quality attenuated depression in some male social gamers, but strengthened associations with loneliness in some male non-social gamers.
Conclusions: In adolescents, symptoms of video game addiction depend not only on video game play but also on concurrent levels of online communication, and those who are very socially active online report fewer symptoms of game addiction.

Full text

GAMING IN A HYPERCONNECTED WORLD-in press 1
Video Gaming in a Hyperconnected World: A Cross-sectional Study of Heavy Gaming,
Problematic Gaming Symptoms, and Online Socializing in Adolescents
Michelle Colder Carras, Ph.D., Antonius J. Van Rooij, Ph.D., Dike Van de Mheen, Ph.D.,
Rashelle Musci, Ph.D., Qian-Li Xue, Ph.D., and Tamar Mendelson, Ph.D.
Drs. Michelle Colder Carras, Tamar Mendelson, and Rashelle Musci are with the Department of
Mental Health, Johns Hopkins Bloomberg School of Public Health in Baltimore, Maryland,
USA; Drs. Antonius Van Rooij and Dike Van de Mheen are with IVO Addiction Research
Institute in Rotterdam, The Netherlands and Erasmus MC, University Medical Center in
Rotterdam, The Netherlands. Dr. Van Rooij is also with iMinds-MICT-Ghent University,
Department of Communication Sciences in Belgium and Dr. Van de Mheen is with Maastricht
University, Department of Health Promotion in Maastricht, The Netherlands. Dr. Qian-Li Xue is
with the Department of Medicine, School of Medicine, Johns Hopkins University, Baltimore,
Maryland and the Center on Aging and Health, Johns Hopkins Medical Institutions, Baltimore,
Maryland.
© 2016. This manuscript version is made available under the CC-BY-NC-ND 4.0 license:
http://creativecommons.org/licenses/by-nc-nd/4.0/ In press in Computers in Human Behavior,
12/2016.
Declaration of interests: This research was supported by the National Institute on Drug Abuse
Training Grant T32DA007292 and the National Institute of Mental Health Training Grant
5T32MH014592-39. The authors declare no competing interests.

GAMING IN A HYPERCONNECTED WORLD-in press 2
Abstract
Aims: Examining online social interactions along with patterns of video gaming behaviors and
game addiction symptoms has the potential to enrich our understanding of disorders related to
excessive video game play.
Methods: We performed latent class analysis in a sample of 9733 adolescents based on heavy
use of games, social networking and instant messaging, and game addiction symptoms. We used
latent class regression to determine associations between classes, psychosocial well-being and
friendship quality.
Results: We identified two types of heavy gaming classes that differed in probability of online
social interaction. Classes with more online social interaction reported fewer problematic gaming
symptoms than those with less online social interaction. Most adolescents estimated to be in
heavy gaming classes had more depressive symptoms than normative classes. Male non-social
gamers had more social anxiety. Female social gamers had less social anxiety and loneliness, but
lower self-esteem. Friendship quality attenuated depression in some male social gamers, but
strengthened associations with loneliness in some male non-social gamers.
Conclusions: In adolescents, symptoms of video game addiction depend not only on video game
play but also on concurrent levels of online communication, and those who are very socially
active online report fewer symptoms of game addiction.

GAMING IN A HYPERCONNECTED WORLD-in press 3
1. Introduction
Youth in the United States are part of a “hyperconnected” world where constant digital
multitasking leads to a new type of social environment that has benefits but also detractions
(Anderson & Rainie, 2012). Most adolescents in the U.S. and other developed countries play
video games (Lenhart, 2008; Müller et al., 2014), and while low to moderate levels of gaming
may be beneficial for some adolescents (Hofferth & Moon, 2012; Przybylski, 2014), excessive
video game play may lead to problems for others. This concern led to the inclusion of Internet
Gaming Disorder (IGD) in the Emerging Measures section of the Diagnostic and Statistical
Manual for Mental Disorders 5 (American Psychiatric Association, 2013). Although the primary
focus of IGD is online gaming, many online behaviors have been associated with addiction-like
problems, and because multiple behaviors can occur simultaneously, it is not simple to
distinguish which behaviors may result in problematic use (Kuss, Griffiths, Karila, & Billieux,
2013). Despite decades of research, questions remain about how best to distinguish “engaged”
(positive and non-pathological heavy gaming) from problematic gaming (PG), which has been
conceptualized as a loss of control over gaming associated with problems and the potential for
clinically significant harm (Van Rooij, 2011). Debate continues as to the appropriateness of IGD
as a potential disorder, as well as the applicability of substance addiction criteria and theory to
problems related to video gaming (Griffiths et al., 2016).
Most previous studies of PG and psychosocial well-being have used both generalized
(Internet) and specific (video gaming) scales of problematic use to measure PG (King, Haagsma,
Delfabbro, Gradisar, & Griffiths, 2013), potentially overlooking the contribution of person-level
factors such as reasons for using games and other media, personality traits, and demographic
characteristics as well as social factors such as friendship quality, contact with friends and

GAMING IN A HYPERCONNECTED WORLD-in press 4
playing with others (Billieux et al., 2015; Desjarlais & Willoughby, 2010; Elson, Breuer, &
Quandt, 2014; Kardefelt Winther, 2014b). Indeed, previous studies in representative samples
have found that individual-level factors such as gender (Kaess et al., 2014), age (Scharkow,
Festl, & Quandt, 2014), and education level (Rehbein, Kliem, Baier, Mossle, & Petry, 2015), as
well as social-level factors such as friendship quality (Van Rooij, 2011) and relationships with
parents (Mößle & Rehbein, 2013) modify relationships between PG and well-being.
Adolescents who interact online, whether through games or social communication and
networking applications, are part of a virtual community that may expand opportunities for
friendship and its protective effects on development. Online gaming may help shy adolescents
expand their sources of social support (Domahidi, Festl, & Quandt, 2014) and can also provide
an important way to keep up with existing friendships (Valkenburg & Peter, 2007) and make
new friends and social connections (Kuss & Griffiths, 2011). According to the social
compensation hypothesis (Valkenburg & Peter, 2007), online media users who have difficulty
with real-life social interactions may use online relationships in an attempt to meet their social
needs. In contrast, the augmentation hypothesis (Kraut et al., 2002) suggests that those who
successfully use the Internet for social support are extraverts who apply their friend-making
skills to this online arena. Many current video games offer the opportunity for interaction
through text or voice chat as a way to coordinate strategies and activities in the game as well as
foster the in-game social relationships, groups and teams that promote progress toward mutual
in-game goals (Williams, 2006). When game-based communications are extended outside the
game, players may experience even more social support (Trepte, Reinecke, & Juechems, 2012).
However, adolescents with social anxiety, depression, or low academic achievement may also

GAMING IN A HYPERCONNECTED WORLD-in press 5
use games as a way to compensate, leading to compulsive or problematic use over time
(Brunborg, Mentzoni, & Froyland, 2014; Lemmens, Valkenburg, & Peter, 2011).
If PG were a construct limited to the traditional domains of addiction, we would expect
severity of addiction-like symptoms to aggregate with an increase in gaming behaviors
independently of online social behavior, and this is in fact described in the entry for Internet
gaming disorder in DSM 5 (American Psychiatric Association, 2013). This situation would
support a syndrome indicative of discrete and unidimensional gaming disorder, or possibly
quantitative levels of disorder. In contrast, examining combinations of behaviors and symptoms
may provide greater explanatory power for characterizing underlying subgroups along multiple
related dimensions (Lanza & Rhoades, 2013), which may help determine whether an addiction-
like disorder is associated only with video game play or is, in fact, a construct requiring
additional content assessing media-based social interaction in order to ensure adequate
specificity of measurement. To investigate this, we used latent class analysis to identify
subgroups (classes) of adolescent gamers based on the intersection between types of gameplay,
social interaction and symptoms of PG. We hypothesized that: 1) classes characterized by high
levels of PG would also have the lowest levels of online social interaction; 2) these classes would
differ with respect to psychosocial well-being, 3) classes characterized by high online social
interaction will have better online friendship quality, and 4) consistent with the social
compensation and augmentation hypotheses, classes with high-quality online or offline
friendships will have lower associations with negative well-being.
2. Methods
The Monitor Internet and Youth study (Meerkerk, Van Den Eijnden, & Van Rooij, 2006)
is a yearly cross-sectional school-based survey designed to measure technology use and

GAMING IN A HYPERCONNECTED WORLD-in press 6
psychosocial well-being in the Netherlands. The study uses stratified sampling to enhance
representativeness by region, urbanicity and education level. We aggregated data from the 2009-
12 study years combined for the current cross-sectional study. The final sample contained
439 classes from thirty schools. Non-response was mainly at the classroom level. Average
response rates per class were 93% (2009), 93% (2010), 92% (2011) and 86.5% (2012).
Measures of self-reported problematic video game use, video game, and social Internet
use were used to identify unique groups of individuals in latent class analysis. The Video game
Addiction Test (VAT) assesses self-reported frequency of problematic symptoms of online and
offline video games based on traditional addiction domains (Van Rooij, Schoenmakers, Van Den
Eijnden, Vermulst, & Van De Mheen, 2012) using a 5-point interval scale. The VAT
demonstrated a single factor structure with factor loadings ranging from .62 to .78 and excellent
reliability (Cronbach’s alpha=0.93) in a previous study using the MIY sample (Van Rooij et al.,
2012). While the 14 items on the VAT do not cover the IGD criteria on a one-to-one basis, the
instrument was found to be strongly associated with the IGD criteria: a clinical study with a
sample of 32 problematic gamers (as confirmed by a treatment professional) showed both an
elevated average VAT score in this group (symptoms endorsed an average of “Sometimes”, vs.
“Never” to “Seldom” in general population samples) and 91% positive identification using the
nine proposed DSM-5 IGD criteria and the suggested cut-off criteria of five out of nine (Van
Rooij, Schoenmakers, & Van De Mheen, 2015).
Youth were also asked how many days per week and hours per day they used instant
messaging, social networking, and three types of games: multiplayer online games, browser
games, and offline games played on a console. We dichotomized use into high (four or more
hours per day for six or seven days per week) or low (any other use, including no use) to more

GAMING IN A HYPERCONNECTED WORLD-in press 7
precisely identify those whose gaming may be problematic, in alignment with both clinical
qualitative findings and local and international population samples (Jap, Tiatri, Jaya, & Suteja,
2013; Romer, Bagdasarov, & More, 2013; Van Rooij, Kuss, et al., 2013).
To assess psychosocial well-being, we used the average of individual items from each of
the following scales, all of which have demonstrated good reliability in Dutch adolescents
(Cronbach’s  >.80 for all scales in this study) (Van Rooij, Schoenmakers, Vermulst, Van den
Eijnden, & Van de Mheen, 2011). Depressive symptoms were assessed with the Depressive
Mood List (Kandel & Davies, 1982). Loneliness was measured with the UCLA Loneliness Scale
(Russell, Peplau, & Cutrona, 1980). Social anxiety was measured with the Social Anxiety Scale
Revised (La Greca & Lopez, 1998). Self-esteem was assessed with Rosenberg’s Self-Esteem
Scale (Rosenberg, 1989); negatively worded items were reverse-coded such that a high score
indicates good self-esteem. We investigated transformations to better approximate normal
distributions, and all scales of psychosocial well-being were log-transformed and standardized in
analyses.
Friendship quality was assessed with online and offline versions of the Network of
Relationships Inventory (Furman & Buhrmester, 1985; Van Rooij, Schoenmakers, Van Den
Eijnden, Vermulst, & Van De Mheen, 2013) on a 5-point scale. Students were told to skip the
questions about online friendship quality if they had no friends they spoke to only on the
Internet. As the rate of missing values on that scale was high due to this intentional skip pattern,
we imputed missing values as “Never” and included a missing indicator in analyses. We
categorized the scale into Low (Never, Almost Never or Sometimes), or High (Often to Very
Often) and created a composite variable with four categories representing possible combinations
of dichotomized online friendship quality (OLF) and real-life friendship quality (RLF).

GAMING IN A HYPERCONNECTED WORLD-in press 8
Control variables. Gender was assessed with a binary self-report variable and year as the
year the survey was administered (2009-2012). Education level was coded dichotomously as
high (pre-university) or low. Age ranged from 13 to 16. Ethnicity was coded as Dutch (both
parents born in the Netherlands) or non-Dutch.
2.1 Statistical analysis
We first excluded responses that were likely invalid (e.g., the highest values endorsed for each
VAT item, yet low self-reported gaming). We used the first observation for students who
provided data in multiple years to allow for clustering at the class level. We explored missing
data, sample means and distributions and tested for differences by gender in media use and self-
reported PG. We used latent class analysis with the six indicators defined above (i.e., continuous
VAT score, high use of instant messaging, social networking, multiplayer online games, browser
games, and offline games) to test our first hypothesis regarding the potential to identify distinct
classes, accounting for clustering at the class level. The optimal number of classes was
determined based on the lowest values of Bayesian Information Criterion (BIC) and low
bivariate residuals, a significant Lo-Mendell-Rubin test, and classes that appeared meaningful
and distinct. Although missing data for observed indicators in latent class analysis is treated with
full information maximum likelihood estimation, missing data on covariates is treated by listwise
deletion in Mplus (Muthén & Muthén, 2012). To determine how this treatment affected our
findings, we performed a sensitivity analysis, limiting results to the part of the sample that had
no missing values on covariates.
To assess our remaining hypotheses regarding associations of gaming subgroups with
psychosocial wellbeing and friendship quality, we used latent class regression with a 3-step
approach (Asparouhov & Muthén, 2014b). We compared changes in associations between latent

GAMING IN A HYPERCONNECTED WORLD-in press 9
classes and psychosocial well-being before and after inclusion of a friendship quality covariate.
Our final model included all control variables, the four psychosocial covariates of loneliness,
depression, social anxiety and self-esteem and friendship quality. Because of our large
multivariable models, we report associations as significant using Bonferroni-corrected p-values.
Exploratory analyses were conducted with Stata 13 (StataCorp., 2013) and latent class analyses
with Mplus v. 7.3.1 (Muthén & Muthén, 1998).
3. Results
Of the 12,348 students in our sample from 2009-2012, 10,804 had values for gender and
classroom, our grouping variables, and had valid data based on consistency checks. However, an
additional 9.9% of that subsample had missing data on one or more covariates (other than online
friendship quality). This subsample was more likely than the study sample to have higher
education level, to be younger, to have better real-life friendship quality, to have less multiplayer
online game use and more social anxiety, but a sensitivity analysis (i.e., latent class modeling
with two through six classes) using this smaller sample revealed that the chosen numbers of
classes were still the best fit and did not change class sizes or structure appreciably, so the
smaller subsample (n=9733) was used in all analyses. Of this sample, 48.8% were male and
82.1% were of Dutch background; the average age was 14.1. Use of most video games and social
Internet applications differed significantly by gender, as did most psychosocial covariates (Table
1).

GAMING IN A HYPERCONNECTED WORLD-in press 10
Table 1: Descriptive statistics by sex in analysis sample
Males
(n=4753)
Females
(n=4980)
No. , % or
Mean, SD
No. , % or
Mean, SD
χ2/ta
Latent class indicators
High use ( 4+ hours/ day, 6+ days/week)
Any high use of games
521
11.0%
79
1.6%
369.5**
Instant messaging
345
7.4%
603
12.2%
64.1**
Social networking
247
5.3%
482
9.8%
69.4**
Multiplayer online games
406
8.7%
32
0.6%
357.9**
Browser games
30
0.6%
20
0.4%
2.6
Offline games
170
3.7%
37
0.8%
95.8**
Problematic gamingb
1.77
0.69
1.33
0.51
32.0**
Psychosocial covariatesc
Loneliness
1.64
0.49
1.60
0.51
4.17**
Depression
2.06
0.67
2.33
0.73
-19.4**
Social anxiety
1.98
0.67
2.13
0.70
-10.6**
Self-esteem
3.36
0.51
3.17
0.58
17.0**
Friendship quality
Low OLF/High RLF
2,554
53.7%
3,043
61.1%
485.7**
High OLF/High RLF
1,326
27.9%
1,707
34.3%
Low OLF/Low RLF
744
15.7%
155
9.2%
High OLF/Low RLF
129
2.7%
75
1.5%
Note: (a) p-value for continuous variables is for two-tailed t-test with unequal variances using Satterthwaite’s d.f.;
*=p<.05, **=p<.01. (b) Mean score, standard deviation on Videogame Addiction Test (c) Higher values indicate
higher perceived friendship quality and better SE; otherwise, higher values indicate lower psychosocial well-being.
Abbreviations: OLF=Online friendship quality, RLF=Real-life friendship quality
3.1 Hypothesis 1: Qualitative structure of latent classes
For both males and females, we observed that classes could be characterized as generally
“social” (e.g., having a greater than 50% chance of having high online social interaction of some
kind) and less social heavy gamers, with the classes with more online social interaction having
fewer symptoms of PG. Consistent with previous studies of PG that characterized excessive
gaming based on average item endorsement (Rehbein, Kleimann, & Mossle, 2010), we labeled
classes “problematic” if VAT items were, on average, endorsed at the level of “Often” or above

GAMING IN A HYPERCONNECTED WORLD-in press 11
(i.e., around four out of five), and “at-risk” if VAT items were, on average, not rejected (e.g.,
average greater than “Seldom”, or three out of five). Classes labeled as Engaged had symptoms
comparable to the Normative class.
We fit between two and seven classes for males. While BIC decreased throughout and
entropy was acceptable in all models, only the six-class model had acceptably low residual
correlations (average bivariate Pearson residual <15) (Asparouhov & Muthén, 2014a). Aside
from a large class considered Normative (52.5%, estimated VAT 1.31), two classes with high
levels of gaming (Problematic and Social At-Risk Gamers) and two with moderate levels of
gaming (At-Risk and Social Engaged Gamers) showed similar patterns of gaming yet differed by
social interaction (Figure 1).
Figure 1: Estimated probabilities of high usea by latent classb, males
Notes: (a) High use defined as 6/7 days per week for 4+ hours per day (b) Normative class had <3% probability of
any high media use. VAT=Videogame Addiction Test.

GAMING IN A HYPERCONNECTED WORLD-in press 12
For females, the best-fitting model had three classes (Figure 2), with the Normative class
(83.2%) having little likelihood of high media use. The other two classes could again be
characterized into social and less social types, and the less social type had higher estimated
symptoms of PG.
Figure 2. : Estimated probabilities of high usea by latent classb, females
Note: (a) High use defined as 6/7 days per week for 4+ hours per day. (b) Normative class had <3% probability of
high use of any latent class indicator. (c) Probability estimates for instant messaging (0.81) and social networking
(0.73) truncated in the Social Engaged Gamers class to better illustrate the distribution of indicators in other
classes. VAT=Videogame Addiction Test.
3.2 Hypothesis 2: Associations between latent classes and psychosocial well-being
predictors
For males, depression was significantly associated with membership in all non-normative
classes (see Table 2), and social classes (Social At-Risk and Social Engaged Gamers) had less
depression than their corresponding non-social classes (Bonferroni-corrected p values <.004).
Higher values of social anxiety were associated with membership in the At-Risk and Extensive

GAMING IN A HYPERCONNECTED WORLD-in press 13
Gamers classes, and At-Risk Gamers were more likely to be lonely. Of note, lower education
level was associated with Problematic and Social Engaged Gamers, and Social Engaged Gamers
were more likely to be older and non-Dutch (data not shown).

GAMING IN A HYPERCONNECTED WORLD-in press 14
Table 2: Latent class regression in males based on most likely latent class
Latent Classa
Problematic (1.3%)
At-risk (10.3%)
Social At-risk (1.8%)
Extensive (26.3%)
Social Engaged (5.1%)
b
SE
p-
valueb
b
SE
p-
value
b
SE
p-
value
b
SE
p-
value
b
SE
p-
value
Model 1: Psychosocial covariates
Loneliness
0.17
0.22
0.43
0.40
0.08
0.00
0.06
0.19
0.77
0.17
0.07
0.01
-0.36
0.14
0.01
Depression
1.21
0.32
0.00
0.81
0.08
0.00
0.85
0.17
0.00
0.55
0.06
0.00
0.40
0.12
0.00
Social anxiety
0.24
0.23
0.29
0.20
0.07
0.00
-0.11
0.15
0.46
0.40
0.06
0.00
-0.21
0.11
0.05
Self-esteem
-0.44
0.17
0.01
-0.24
0.09
0.01
-0.17
0.18
0.34
-0.08
0.10
0.42
-0.26
0.17
0.12
Model 2: Psychosocial covariates and friendship qualityc
Loneliness
0.13
0.23
0.57
0.45
0.09
0.00
0.13
0.21
0.54
0.22
0.07
0.00
-0.27
0.14
0.04
Depression
1.17
0.32
0.00
0.78
0.08
0.00
0.82
0.17
0.00
0.54
0.06
0.00
0.35
0.12
0.00d
Social anxiety
0.24
0.22
0.28
0.22
0.07
0.00
-0.10
0.15
0.53
0.40
0.06
0.00
-0.23
0.11
0.04
Self-esteem
-0.42
0.17
0.02
-0.25
0.09
0.01
-0.14
0.19
0.46
-0.09
0.10
0.36
-0.30
0.17
0.07
Missing OLF
-0.89
0.55
0.10
-0.55
0.16
0.00
-0.67
0.57
0.24
-0.45
0.13
0.00
-0.25
0.23
0.28
Low OLF/ Low
RLF
-0.35
0.48
0.47
-0.13
0.18
0.47
-0.10
0.53
0.86
-0.37
0.16
0.02
-0.55
0.35
0.11
High OLF/ Low
RLF
1.81
0.55
0.00
0.66
0.40
0.10
1.42
0.72
0.05
0.02
0.44
0.96
1.29
0.52
0.01
High OLF /High
RLF
0.64
0.39
0.11
0.58
0.15
0.00
0.93
0.40
0.02
0.13
0.14
0.36
0.62
0.24
0.01
Notes: (a) Latent class regressions comparing to Normative class (55.4%). (b) Bold indicates significance at Bonferroni-adjusted p-value for that model (varies
by model): Model 1 p<.004, Model 2: p< .003. (c) Model 2 friendship quality logistic regression coefficients are compared to reference category of Low
OLF/High RLF. (d) p=.004. OLF=Online friendship quality, RLF=Real-life friendship quality.

GAMING IN A HYPERCONNECTED WORLD-in press 15
In females, depression was also a significant predictor of both non-normative classes
(Table 3). Lower self-esteem was associated with Social Engaged Gamers, but Social Engaged
Gamers were also found to have less social anxiety and loneliness. Lower education level, non-
Dutch ethnicity, and older age were associated with Social Engaged Gamers, and cohort effects
were found for 2011 for both classes and 2012 for Social Engaged Gamers (data not shown).
Table 3: Latent class regression in females based on most likely latent class
Latent Classa
At-risk (4.2%)
Social Engaged (13.4%)
b
SE
p-valueb
b
SE
p-value
Model 1: Psychosocial covariates
Loneliness
0.07
0.11
0.53
-0.37
0.07
0.00
Depression
0.79
0.15
0.00
0.56
0.08
0.00
Social anxiety
0.17
0.10
0.11
-0.26
0.08
0.00
Self-esteem
-0.19
0.08
0.02
-0.29
0.06
0.00
Model 2: Psychosocial covariates and friendship qualityc
Loneliness
0.04
0.11
0.69
-0.34
0.07
0.00
Depression
0.74
0.15
0.00
0.53
0.08
0.00
Social anxiety
0.17
0.10
0.10
-0.26
0.08
0.00
Self-esteem
-0.15
0.08
0.07
-0.28
0.06
0.00
Missing OLF
-0.72
0.27
0.01
-0.07
0.19
0.72
Low OLF/ Low RLF
0.45
0.44
0.31
-0.34
0.41
0.41
High OLF/ Low RLF
1.07
0.46
0.02
0.12
0.49
0.80
High OLF /High RLF
0.64
0.24
0.01
0.64
0.16
0.00
Notes: (a) Latent class regressions comparing class to Normative class (82.4%). (b) Bold indicates significance at
Bonferroni-adjusted p-value for that model (varies by model): Model 1: p<.004, Model 2: p< .003. (c) Model 2
friendship quality logistic regression coefficients are compared to reference category of Low OLF/High RLF.
OLF=Online friendship quality, RLF=Real-life friendship quality.

GAMING IN A HYPERCONNECTED WORLD-in press 16
3.3 Hypothesis 3: Associations between latent classes and friendship quality
Compared to the reference group of those high in real-life friendship quality but low in
online friendship quality (the most common category), males having both good online and real-
life friendships were significantly more likely to be At-Risk Gamers, while those with high-
quality online friendships but low quality real-life friendships were more likely to be Problematic
Gamers (Bonferroni-corrected p values <.003). For females, the only statistically significant
finding was that those with high quality friendships on- and offline were more likely to be Social
Engaged Gamers.
3.4 Hypothesis 4: Associations between latent classes and psychosocial well-being while
accounting for friendship quality
For males, adding friendship quality to the model with covariates (Model 2; Table 2)
produced changes in effects for Social Engaged Gamers, who were now no longer more likely
from a statistical standpoint to report higher values of depression than the Normative class
(Bonferroni-corrected p-value=.004, required p value <.003), and for Extensive Gamers, who
were now significantly more likely to report more loneliness (Bonferroni-corrected p
value=.001). For females, adding friendship quality to the model had no effect on psychosocial
covariates (Model 2, Table 3).
4. Discussion
Using a data-driven, person-centered approach, we found support for our first hypothesis,
that including information about online social interaction provided a meaningful way to
distinguish subgroups of heavy gamers into those reporting more or fewer problems. Using this
approach, gamers could be separated into social and non-social classes, with social classes
reporting fewer or no feelings of problematic use at equivalent levels of play. This pattern was
true for both sexes, although the overall magnitude of game use and distress was much lower in

GAMING IN A HYPERCONNECTED WORLD-in press 17
females than males and fewer classes were distinguished. These findings do not support the idea
of PG as a discrete addiction-like disorder, as symptoms and gaming behaviors were not
independent of social interaction, and suggest that the proposed IGD may be more complex than
expected. Rather, our results support the notion that social interactions may separate problematic
gamers from “engaged gamers” who have an active online social life and experience few
symptoms of problematic use at high levels of play (Charlton & Danforth, 2007). Engaged
adolescent gamers might thus represent a group whose heavy gaming may be part of their active
participation in a digital community. This implies that the current proposed criteria for IGD (and
the recently proposed IGD-11 diagnosis Gaming Disorder) will lack specificity due to inadequate
content validity, as the criteria do not assess the social interaction that is associated with more
normative gaming. Failing to address this in future iterations of criteria will muddy the
association between truly pathological gaming and related risk factors, comorbidities and course
of disorder, as the group of individuals who test as disordered by these criteria will actually
include many who are not.
Consistent with our second study hypothesis, we found differences in well-being across
gaming subgroups, such that non-social classes were associated with lower levels of
psychosocial well-being. Importantly, before friendship quality was taken into account, all heavy
gaming classes in both boys and girls were associated with more depressive symptoms. One
possible explanation for this is heavy gamers feel depressed, and their heavy gaming does not
relieve symptoms (Caplan, Williams, & Yee, 2009). It may be that depressive symptoms in the
setting of heavy gaming represent a level of dysregulation that is not amenable to any benefits of
social interaction.

GAMING IN A HYPERCONNECTED WORLD-in press 18
Associations between social classes and well-being differed between males and females.
While male social gamers had no significant associations with well-being other than depression,
female Social Engaged gamers reported less loneliness and social anxiety than average
adolescents did. When combined with high online social interaction, heavy gaming may thus be
a way for female adolescents to successfully reduce loneliness and social anxiety by making new
friends or extending their real-life friendships without developing feelings of PG (Domahidi et
al., 2014). However, this class also showed lower self-esteem, suggesting that social support
received online may not be associated with better self-worth for this group. Girls in this group
may correspond to the “unregulated escapers” found by Billieux and colleagues in a cluster
analysis of adult online gamers (Billieux et al., 2015). This group, which had more females than
other groups in the cluster analysis, was found to have more negative affect and lower self-
esteem, and cited social motivations as their primary reason for playing online games. It is also
possible that girls with low self-esteem are drawn to social networking use (Kuss & Griffiths,
2011) and later come into contact with online games (Rehbein & Mößle, 2013). This is more
consistent with the pattern of game and social Internet use found here.
The classes with the least amount of online social interaction in males, At-Risk and
Extensive Gamers, were associated with social anxiety. In addition, At-Risk boys reported more
loneliness, supporting the idea that patterns of heavy gaming in the absence of heavy online
social interaction may be a maladaptive way to cope (Kardefelt Winther, 2014a). This suggests
that boys with social anxiety who game heavily in the absence of significant online social
interaction may have a less adaptive pattern of use and might be at greater risk of problems with
gaming. This could also reflect motivations for gaming such as gaming to escape or to garner in-
game achievements, which may be tied to unmet psychological needs (Kardefelt Winther,

GAMING IN A HYPERCONNECTED WORLD-in press 19
2014b). A previous cluster analytic study found that clusters characterized by either or both of
these motivations had more impulsivity or problems with self-regulation and higher levels of PG
symptoms (Billieux et al., 2015). If this is the case, treatment and prevention efforts should focus
on helping less-social gamers to develop additional coping skills.
We found support for our third hypothesis, that classes with high online social interaction
would have better friendship quality, only in females, where Social Engaged gamers were found
to have higher-quality friendships both on-and offline compared to the Normative class. In fact,
some classes that were less active on social networking and instant messaging reported high
online friendship quality, either in the presence of low-quality real-life (male Problematic
Gamers) or high quality real-life (male At-Risk Gamers) friendships. As Problematic Gamers did
have some online social interaction, they may have spent significant time developing social
relationships. Previous studies have shown that social motivations for video game play are
associated with more PG symptoms (Kuss et al., 2013) as well as a greater sense of community
online (Shen & Chen, 2015), which may alleviate some problems but contribute to others
(Kardefelt Winther, 2014b). Further studies should include motivation for play and could
investigate the potential for interactions between social anxiety, social motivation and friendship
quality. Another unexpected finding is that At-Risk Gamers, who reported low levels of online
social interaction, felt both online and real-life friendships to be high quality. This may reflect
the subjective nature of self-reports of friendship quality by adolescents (Zurko, 2011), but it is
also possible that this group uses another form of online interaction such as voice chat to develop
relationships. However, that possibility would not be consistent with this subgroup’s report of
more loneliness and social anxiety. The subjective experience of online friendships is thus an
important topic for further study.

GAMING IN A HYPERCONNECTED WORLD-in press 20
We found support for our fourth hypothesis that associations between gaming subgroups
and psychosocial indicators would change when friendship quality was considered, only for
males. For male Social Engaged Gamers, the association between depression and heavy gaming
classes was no longer significant when friendship quality was included. Since boys (and girls)
seek social support online (Lenhart, Smith, Anderson, Duggan, & Perrin, 2015; Valkenburg &
Peter, 2007, 2011), male Social Engaged gamers may be successfully pursuing a pattern that
improves their well-being. Although female Social Engaged Gamers had similar findings and
were significantly more likely to have high-quality online and offline friendships, they showed
no difference in depression as a result. This finding is puzzling; females seek relief from
depression in social support (Khurana & Romer, 2012), so the finding of good-quality
friendships both on and offline suggests that girls may have access to additional social support
through online friendships and thus the potential to relieve symptoms. Others have suggested that
the relationship between depression and heavy Internet and game use is complex (Romer et al.,
2013); further studies could examine depression using more complex modeling techniques,
including changes over time. The effect of loneliness on membership in the Extensive Gamers
class was strengthened by accounting for friendship quality. It is possible that this represents
inconsistent mediation—a suppression effect—or some more complicated relationship. While
this study attempted to include multiple predictors of PG, there are many potential interrelations
between well-being variables, friendship quality and problems related to gaming that may
require testing specific hypotheses regarding mediation and moderation.
Limitations of our study include our use of cross-sectional data, which means we were
unable to draw conclusions about causal relationships between gaming and psychosocial well-
being. An alternative explanation could be that interactions between the proposed gaming

GAMING IN A HYPERCONNECTED WORLD-in press 21
disorder and social factors could be driving our findings. In addition, because our data are self-
report, they may reflect social desirability or recall biases.
Our findings indicate that PG may not be a discrete combination of gaming behaviors and
addiction-like symptoms as suggested by the proposed IGD diagnosis, but rather a construct that
cannot be separated from concurrent online social interaction. This suggests that including data
on social Internet interactions and friendship quality in analyses of problems related to gaming is
necessary for understanding of adolescents’ problematic gaming and psychosocial well-being.
For some adolescents, heavy gaming combined with a highly engaged online social life may
seem excessive but ultimately be useful. Adolescent heavy gamers who spurn online social
interactions, on the other hand, may have lower emotional functioning in more domains, which
may indicate underlying pathology. In this case, it may be helpful for clinicians to address
reasons for heavy gaming in conjunction with techniques such as motivational interviewing to
promote behavior change (Van Rooij, 2011). Future longitudinal research can build on these
findings to advance our understanding of trajectories of gaming and psychosocial well-being
across subgroups, ultimately contributing to strategies for preventing or treating problems related
to excessive media use. In addition, as stated above, further discussion of potential disorders
related to video gaming should include discussion of social or non-social gaming patterns and the
importance of distinguishing adaptive from maladaptive gaming through assessment of
functional impairment or distress not only in a clinical diagnosis, but also in self-report scales.
Evaluating concurrent online social interactions in the consideration of preventive interventions
may also help identify those who may be at higher risk of problems in order to target prevention
efforts, which might address enhancing the development of social skills and promoting activities
to enrich social participation.

GAMING IN A HYPERCONNECTED WORLD-in press 22
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