Associations in Both Directions Between Internet Gaming Disorder and Suicidal Ideation and Attempts Among Chinese Adolescent Gamers: Two-Wave Prospective Cohort Study

Vollständiger Abstract

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Background Internet gaming disorder (IGD) has been associated with suicidal outcomes in adolescents, but most evidence is cross-sectional or has examined only whether IGD predicts later suicidality. Whether suicidal ideation and suicidal attempts are also associated with subsequent IGD remains unclear. Objective This study aimed to examine prospective associations in both directions between IGD and suicidal ideation and suicidal attempts among Chinese adolescent gamers. Methods This school-based, 2-wave prospective cohort study was conducted in Zigong, China, with assessments in November 2021 and November 2022. The analytic sample included 57,985 adolescents who completed both waves and reported gaming in the past 12 months at baseline. Students were recruited through school-based cluster sampling and completed electronic questionnaires during school sessions. IGD was assessed using the 9-item Internet Gaming Disorder Scale-Short Form (IGDS9-SF), with probable IGD defined as a score of 32 or higher. Suicidal ideation referred to serious consideration of suicide during the past month, whereas suicidal attempt was assessed over the lifetime. Both outcomes were assessed at both waves. Incident outcomes were defined among participants without the corresponding outcome at baseline. Logistic regression models estimated cross-sectional and prospective associations with sequential adjustment for demographic, lifestyle, and mental health covariates. Results At baseline, 1333 of 57,985 adolescents had IGD (2.3%, 95% CI 2.2%-2.4%), 8450 had suicidal ideation (14.6%, 95% CI 14.3%-14.9%), and 6666 reported a suicidal attempt (11.5%, 95% CI 11.2%-11.8%). IGD was associated with higher baseline prevalence of suicidal ideation (crude odds ratio [COR] 6.45, 95% CI 5.78-7.20, P