Teenagers, games and the psyche: what comes first - "gaming addiction" or health problems?

For some, “gaming disorder” is just a headline in the media. But in a new JAMA Network Open study based on the American ABCD cohort (4,289 adolescents), scientists tracked trajectories for several years and came to a simple but important conclusion: first, mental difficulties, then symptoms of a disorder associated with games. The data did not show the opposite, that is, that passion for games “spins up” depression or anxiety.

The focus is not on the “harm of gaming” per se, but on the direction of the connection between psychological symptoms and subsequent gaming problems. This is fundamental for schools, families and clinicians: if gaming often becomes a coping strategy in the face of depression, anxiety or social isolation, then it is pointless to fight the screen alone – the cause must be treated.

Background of the study

Gaming disorder has been officially recognized in ICD-11 for several years now as a behavioral addiction, in which it is the loss of control and functional losses (study, sleep, relationships) that distinguish it from simply high involvement. Teenagers are a vulnerable group here: reward systems mature earlier than prefrontal "brakes", and games provide quick rewards, sociality and stress relief. At the same time, teenagers often develop depression, anxiety, attention/hyperactivity problems, and family and school stress increases. Against this background, the main scientific question of recent years arises: what comes first - games "shake up" the psyche or mental difficulties push towards problematic, compulsive gaming behavior as a way of coping?

For a long time, the field relied on cross-sectional surveys, where both sides - high gaming performance and symptoms of psychopathology - were recorded simultaneously. Such designs capture associations, but do not show the direction of the relationship and are subject to reverse causality ("I play a lot because I already feel bad"). In addition, the tools varied: from screening scales for "video game addiction" to clinical criteria, and the sources of information (parents vs. adolescents themselves) gave different pictures. All this diffused the findings and prevented the development of practical recommendations for schools and families.

Attention has therefore shifted to longitudinal cohorts with annual assessments and cross-lagged models that allow testing the “causality arrow” over time while simultaneously accounting for personal and contextual risk factors (bullying, family conflict, negative events, impulsivity). The American ABCD cohort is one of the few sites where this is feasible: tens of thousands of children are followed from pre-adolescence, standardized mental health questionnaires, behavioral data, and information on screen media use are collected.

The practical stakes are high. If games themselves increase depression/anxiety, the logic of prevention is strict screen limits and “digital hygiene.” If problematic gaming behavior is more often a consequence of existing mental health issues, then the priority shifts to early screening and treatment of depression, anxiety, ADHD, sleep, stress, and family dynamics—and screen regulation becomes an auxiliary measure, not a central “cure.” New longitudinal data are precisely what is needed to stop arguing at the level of opinions and to build help for adolescents based on real trajectories, not stereotypes.

How the study is structured

• Subjects followed: 4289 adolescents from the ABCD project (mean age ≈14 years; 56% boys), with annual visits and repeat assessments.
• What and with what was measured:
  • Psychopathology - according to the CBCL questionnaire from parents (depression, anxiety, attention/hyperactivity problems (ADHD), social problems, aggression/behavioral problems).
  • Gaming disorder - according to the Video Game Addiction Questionnaire, consistent with DSM-5 criteria for Internet gaming disorder.
• How we analyzed: cross-lagged models (CLPM) for the direction of the causal arrow and hierarchical mixed models that take into account the panel structure of the data. “Personal” risk factors were added to the models: past negative events, family conflicts, bullying, impulsivity.

The result is a neat but consistent pattern. Higher levels of psychopathology one year predicted a greater risk of gaming disorder the following year. The effect was small to medium in size, but it persisted even after controlling for other factors. And the disorder itself did not predict increased mental symptoms later—that is, the arrow pointed predominantly from the psyche to the gaming, rather than the other way around.

Key numbers

Of the 4,289 adolescents, the psychopathology → gaming disorder association was significant:

• • from the 2nd to the 3rd year of observation: β = 0.03 (95% CI 0.002-0.06);
  • from year 3 to year 4: β = 0.07 (95% CI 0.04–0.10).
  • After adjustment for personality factors: β = 0.04 (95% CI 0.002–0.07).
• On the contrary, the trajectory “gaming disorder → increase in psychopathology” was not statistically confirmed.

In practical terms, this means that a teenager with depression, anxiety, attention problems, or family stress often “goes” into games so deeply that the criteria for a disorder appear. Therefore, prevention and treatment should begin with targeted mental health assistance, and not with total prohibitions and timers.

What should schools, families and doctors do?

• Screening and early intervention: As play time increases, screen for depression, anxiety, ADHD, bullying, and family stress - these are often the "root".
• Focus on internal symptoms. Internalizing symptoms (depression, anxiety, social problems) are a particularly important target: their correction reduces the risk of full-blown gaming disorder.
• Therapy, not a “ban.” Cognitive-behavioral approaches, self-regulation skills, and working with daily and sleep routines are more effective than the “cold turkey” of gadgets. (This is consistent with modern review papers on the treatment of gaming disorder.)
• Communication without stigma. The “games are evil” conversation is of little help. It is much more productive to discuss what exactly the teenager is “treating” with games and to offer alternative ways to cope with anxiety and stress.

It is also important to remember the context: gaming disorder is an official ICD-11 diagnosis in the group of “addictive behavior disorders.” But there is a debate in science: some researchers remind us that for many teenagers, excessive gaming is more of a marker of hidden problems than a separate “infection.” The new work carefully supports this interpretation.

Restrictions

• This is an observational study: the direction of the association statistic ≠ evidence of causation in a specific individual.
• Psychopathology assessments are based on parent reports (CBCL), which do not always coincide with adolescent self-report or clinical interview.
• "Gaming disorder" was assessed by questionnaire rather than by medical diagnosis; actual clinical severity may vary.

And yet, for policy and practice, the message is clear: address mental health, and there will be “too” less gaming. This does not negate reasonable screen time and sleep hygiene, but it does shift priorities: treat the cause, not the symptom.

Source: Falcione K., Weber R. Psychopathology and Gaming Disorder in Adolescents. JAMA Network Open. Published July 29, 2025. doi:10.1001/jamanetworkopen.2025.28532