Hyekyung Choo

Pathological Video Game Use Among Youths: A Two-Year Longitudinal Study

OBJECTIVES: We aimed to measure the prevalence and length of the problem of pathological video gaming or Internet use, to identify risk and protective factors, to determine whether pathological gaming is a primary or secondary problem, and to identify outcomes for individuals who become or stop being pathological gamers. METHODS: A 2-year, longitudinal, panel study was performed with a general elementary and secondary school population in Singapore, including 3034 children in grades 3 (N = 743), 4 (N = 711), 7 (N = 916), and 8 (N = 664). Several hypothesized risk and protective factors for developing or overcoming pathological gaming were measured, including weekly amount of game play, impulsivity, social competence, depression, social phobia, anxiety, and school performance. RESULTS: The prevalence of pathological gaming was similar to that in other countries (∼9%). Greater amounts of gaming, lower social competence, and greater impulsivity seemed to act as risk factors for becoming pathological gamers, whereas depression, anxiety, social phobias, and lower school performance seemed to act as outcomes of pathological gaming. CONCLUSION: This study adds important information to the discussion about whether video game “addiction” is similar to other addictive behaviors, demonstrating that it can last for years and is not solely a symptom of comorbid disorders.

Pathological video-gaming among youth: A prospective study examining dynamic protective factors

Abstract The primary aim of the study was to understand the phenomenon of pathological video-gaming by identifying protective factors for its development, and examining the dynamic interplay between protective factors and pathological video-gaming within a framework of change. The study was a 2-year longitudinal study involving 3034 children and adolescents recruited from 6 elementary and 6 secondary schools. Controlling for initial levels of pathological video-gaming, personal strengths and familial factors such as parent–child connectedness, and warm family environment were found to be protective factors for later pathological gaming. Increases in levels of emotional regulation and family environment warmth were related to decreases in pathological video-gaming. Higher initial levels and increases in pathological video-gaming were related to higher levels of later depressive symptoms, controlling for earlier levels of depressive symptoms. The study adds to the growing evidence that pathological video-gaming has potentially serious mental health consequences, in particular, on depression. For health providers who work with pathological video-gamers, the findings suggest that developing self-regulatory skills such as emotional regulation, and improving the family environment are useful strategies.

Impulsivity, Self-Regulation,and Pathological Video Gaming Among Youth Testing a Mediation Model

Given the potential negative mental health consequences of pathological video gaming, understanding its etiology may lead to useful treatment developments. The purpose of the study was to examine the influence of impulsive and regulatory processes on pathological video gaming. Study 1 involved 2154 students from 6 primary and 4 secondary schools in Singapore. Study 2 involved 191 students from 2 secondary schools. The results of study 1 and study 2 supported the hypothesis that self-regulation is a mediator between impulsivity and pathological video gaming. Specifically, higher levels of impulsivity was related to lower levels of self-regulation, which in turn was related to higher levels of pathological video gaming. The use of impulsivity and self-regulation in predicting pathological video gaming supports the dual-system model of incorporating both impulsive and reflective systems in the prediction of self-control outcomes. The study highlights the development of self-regulatory resources as a possible avenue for future prevention and treatment research.

The Role of Game Genres and the Development of Internet Gaming Disorder in School- Aged Children

Background and Objectives: Internet Gaming Disorder (IGD) is characterized by a pattern of video game playing that results in significant issues with daily life (e.g. problems with inter-personal relationships or poor academic/job performance), and where the gaming persists despite these negative outcomes. Here we tested the hypothesis that the prevalence of IGD depends on the types of games a child plays. Methods: A sample of 2,982 children from Singaporean primary and secondary schools were recruited for the current study. They filled out questionnaires related to IGD symptoms, general video game play habits, as well as other measures of daily life function. Games were categorized into five genres (Role-playing, Strategy, Action, Puzzle, Music) and the prevalence of IGD was examined as a function of each individual’s favorite genre of game. Results: Not all genres were equally associated with IGD. The highest rates of IGD were associated with players of Role-playing games followed by players of Action, Music, Strategy, and Puzzle games, respectively. However, this pattern was only found in secondary school-age children with primary school-aged children showing no differentiation by genre. Conclusion: Consistent with previous work, respondents’ favorite game genres predicted differential probabilities of IGD. However, this was only true in older children, not in younger children. Future work is needed to determine if this is because young children are not susceptible to the differential influence of various genres or because the games that young children play within these genres lack the critical ingredients that exist in these game types played by older children and adults.

Typology of Internet gaming disorder and its clinical implications

Various perspectives exist regarding Internet gaming disorder. While the concept of behavioral addiction is gaining recognition, some view the phenomenon as merely excessive indulgence in online pastimes. Still, in recent years, complaints from patients or their family members about problems related to Internet use, particularly Internet gaming, have become more common. However, the clinical picture of Internet gaming disorder could be obscured by its heterogeneous manifestations with other intertwined factors, such as psychiatric comorbidities, neurodevelopmental factors, sociocultural factors, and game‐related factors, which may influence the pathogenesis as well as the clinical course. To mitigate such problems, clinicians should be able to consider diverse aspects related to Internet gaming disorder. Classifying such a heterogeneous problem into subtypes that share a similar etiology or phenomenology may provide additional clues in the diagnostic process and allow us to designate available clinical resources for particularly vulnerable factors. In this review paper, we suggest a typology of ‘impulsive/aggressive,’ ‘emotionally vulnerable,’ ‘socially conditioned,’ and ‘not otherwise specified’ as subtypes of the heterogeneous phenomena of pathological Internet gaming. The implications of these subtypes for assessment and treatment planning will also be highlighted.

Bedroom media: One risk factor for development.

Mass media have numerous effects on children, ranging from influencing school performance to increased or reduced aggression. What we do not know, however, is how media availability in the bedroom moderates these effects. Although several researchers have suggested that bedroom media may influence outcomes by displacing other activities (the displacement hypothesis) or by changing the content of media consumed (the content hypothesis), these have rarely been tested directly. This study tested both hypotheses using several outcomes that are associated with bedroom media and some of the underlying mediating mechanisms. The hypotheses were tested using 3 longitudinal samples of varying methods, age, duration, and country. The results indicate that children who have bedroom media are likely to watch larger amounts of screen time which displaced important activities, such as reading and sleeping, which mediated later negative outcomes such as poor school performance. Bedroom media also influence risk for obesity and video game addiction. Children with bedroom media are also likely to be exposed to more media violence. The violent content increased normative beliefs about aggression, which increased physical aggression, providing support for the content hypothesis. This study demonstrates that media can have effects not just from what they show, but also because of what children are not exposed to. Bedroom media are therefore a robust risk factor for several aspects of child development.

Immigrant status and disparities in health care delivery in patients with myocardial infarction

BACKGROUND We investigated the differences in socioeconomic status and quality health care between Singapore-born citizens and immigrants presenting with ST-segment elevation myocardial infarction (STEMI). METHODS In a prospective study, patients admitted with STEMI were recruited for a questionnaire survey. The recruited patients were categorized based on their immigration status into Singapore-born citizens (SBC), foreign-born citizens (FBC), permanent residents (PR) and non-residents (NR). RESULTS Among the 374 recruited patients, 286 (76.5%) patients were categorized as SBC, and the remaining 88 (23.5%) as immigrants. Further breakdown of the immigrants revealed that 33 were FBC (median duration of living in Singapore, 53 years), 22 were PR (18 years), and 33 were NR (11 years). Significant differences in socioeconomic status among SBC, FBC, PR and NR were detected. NR were in the lowest, while PR in the highest, socioeconomic class based on occupation (p=0.003), education level (p<0.001), and average monthly household income (p=0.020). There were no disparities in the proportion of patients treated with primary PCI (SBC 88%, FBC 82%, PR 91%, NR 79%, p=0.555). Median door-to-balloon times were similar among the four groups (56, 52, 60, 56min, p=0.614). Compared with SBC, PR was associated with longer symptom-to-balloon times (median difference 54.1 min; 95% CI 9.0 to 99.2). CONCLUSION There were major differences in the socioeconomic status among SBC, FBC, PR and NR who presented with STEMI. Although there were no major disparities in access to high quality health care to these patients with different immigration status, symptom-to-balloon time differed substantially among the different migrant classes.

Bullying Experience of Racial and Ethnic Minority Youth in South Korea

This study compared bullying experiences between ethnic minority youth and Korean majority youth in South Korea, and examined whether the student-teacher relationship is associated with their bullying experiences. Participants comprised 148 ethnic minority students and 165 Korean majority students in Grades 4 to 11 in South Korea. Bivariate analyses revealed that ethnic minority youth were more likely to be relationally bullied, but were less likely to bully their peers than Korean majority youth. Ethnic minority youth, with Southeast Asian mothers in particular, are most likely to be victimized and least likely to perpetrate bullying. Generalized linear model analyses identified that the youth’s positive perception of teachers decreased the risk of both victimization and perpetration. Policy and practice implications were discussed.

The acculturation experiences of Asian immigrants in Singapore

ABSTRACT This study aims to understand the acculturation experiences of Asian immigrants to Singapore. A qualitative exploratory study using focus group discussions was conducted among 40 permanent residents and new citizens. Each of the seven focus groups had an average of six participants and lasted 1–2 hours. Immigrants described Singaporean culture as a blended culture featuring multiracialism. Their acculturation strategies were influenced by the way they were perceived and treated by the host society, based on their country of origin and whether they had been members of a minority community there. Although the respondents valued multiracialism, they also faced challenges in maintaining interethnic contacts. Implications for further enhancing existing acculturation models are discussed.

Balancing between prejudice and fact for Gaming Disorder: Does the existence of alcohol use disorder stigmatize healthy drinkers or impede scientific research?

The inclusion of Gaming Disorder (GD) criteria in the 11th Revision of the International Classification of Diseases (ICD-11) beta draft was recently criticized, and an argument was made for its removal to “avoid a waste of public resources.” However, these misleading statements are believed to be based on under estimation of this ever-growing problem. Such claims may endanger public health and the psychosocial well-being of affected individuals. Thus, the seriousness of the problem was briefly emphasized in our response paper. We provided an overview of how debates of this kind were developed in our region. In addition, we addressed the arguments made on research and children’s rights. The accusation that GD exerts negative impacts on children’s freedom and stigmatizes healthy gamers may arise from a false belief that this new digital media is benign or not addictive. Such statements could be true in some, but not all, cases. Unwillingness to recognize the addictive potential of gaming, as well as insiste...The inclusion of Gaming Disorder (GD) criteria in the 11th Revision of the International Classification of Diseases (ICD-11) beta draft was recently criticized, and an argument was made for its removal to “avoid a waste of public resources.” However, these misleading statements are believed to be based on under estimation of this ever-growing problem. Such claims may endanger public health and the psychosocial well-being of affected individuals. Thus, the seriousness of the problem was briefly emphasized in our response paper. We provided an overview of how debates of this kind were developed in our region. In addition, we addressed the arguments made on research and children’s rights. The accusation that GD exerts negative impacts on children’s freedom and stigmatizes healthy gamers may arise from a false belief that this new digital media is benign or not addictive. Such statements could be true in some, but not all, cases. Unwillingness to recognize the addictive potential of gaming, as well as insistence on treating GD simply as an individual problem, are reminiscent of the era in which alcoholism was viewed as a personality problem. These dangerous views place affected individuals at greater health risk and further stigmatize them. Formalization of the disorder is also expected to help in standardization of research and treatment in the field. The inclusion of GD in the upcoming ICD-11 is a responsible step in the right direction.