Vol.:(0123456789)
In e na ional Jou nal o Men al Heal h and Addic ion
h ps://doi.o g/10.1007/s11469-024-01296-y
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ORIGINAL ARTICLE
P oblema ic Online Beha iou s amongUni e si y S uden s
andAssocia ions wi hPsychological Dis ess Symp oms
andEmo ional Role Limi a ions: ANe wo k Analysis
App oach
MagdalenaSánchez‑Fe nández1 · Me cedesBo da‑Mas1 · F anciscoRi e a2 ·
Ma kD.G i i hs3
Accep ed: 30 Ma ch 2024
© The Au ho (s) 2024
Abs ac
Ve y li le esea ch has simul aneously explo ed he in e ac ions be ween gene alized p ob-
lema ic in e ne use (GPIU), p oblema ic social media use (PSMU), p oblema ic online
gaming (POG), psychological dis ess, and emo ional well-being among uni e si y s u-
den s. The e o e, he p esen s udy aimed o de e mine (i) he associa ions be ween GPIU,
PSMU, and POG symp oms, (ii) whe he symp oms o hese h ee p oblema ic online
beha iou s o m dis inc en i ies, and (iii) whe he he e a e associa ions be ween p ob-
lema ic online beha iou s, psychological dis ess symp oms, and emo ional ole limi a ions
using ne wo k analysis. A o al o 807 Spanish uni e si y s uden s pa icipa ed (57.7%
emale; Mage = 21.22yea s [SD = 3.68]). Two ne wo k models we e compu ed. Ne wo k
1 showed a complex in e ac ion o nodes, wi h pa icula ly s ong connec ions be ween
analogous symp oms o GPIU and PSMU. Symp oms o ganised in o dis inc dimensions,
ea u ing a unique dimension o POG symp oms, one ha includes p eoccupa ion and a
con lic symp om o GPIU, and wo o he dimensions wi h symp oms o GPIU and PSMU.
Ne wo k 2 showed signi ican connec ions be ween GPIU and dep ession, GPIU and emo-
ional ole limi a ions, PSMU and anxie y, PSMU and emo ional ole limi a ions, POG and
dep ession, and POG and anxie y. The indings suppo he concep ualiza ion o GPIU as
a nonspeci ic diso de , he independence o PSMU and POG as dis inc cons uc s, and
aligning wi h pe spec i es ha sepa a e POG om he GPIU spec um. The s udy ein-
o ces he model o compensa o y in e ne use and emphasizes he impac o p oblema ic
online beha iou s on emo ional well-being. The indings ha e p ac ical implica ions o he
assessmen and in e en ion o p oblema ic online beha iou s.
Keywo ds P oblema ic online beha iou s· Psychological dis ess· Emo ional well-being·
College s uden s· Ne wo k analysis
Ex ended au ho in o ma ion a ailable on he las page o he a icle
In e na ional Jou nal o Men al Heal h and Addic ion
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In oduc ion
Du ing he pas wo decades, he e has been a ma ked inc ease in he numbe o in e ne
use s alongside he democ a isa ion o in e ne access. While he in e ne has b ough
nume ous ad an ages o socie y, o a small mino i y o use s, i s p oblema ic use has
eme ged as a signi ican public heal h conce n (Wo ld Heal h O ganiza ion, 2015). Such
p oblema ic use has become e iden h ough a ange o po en ially p oblema ic online
ac i i ies such as online gaming, online gambling, social media use, online shopping,
and online po nog aphy use (Hussain & S a ce ic, 2020; Lopez-Fe nandez e al., 2016;
Maue -Vakil & Bahji, 2020; Mo a-Salguei o e al., 2021; Mülle e al., 2021).
Uni e si y s uden s a e a popula ion o special in e es wi h ega d o hese p oblems
because hey a e ‘digi al na i es’, who ha e g own up su ounded by echnology and ha e
ne e known a wo ld wi hou he in e ne (Ande son e al., 2017), and need such echnol-
ogy o hei op imal academic, pe sonal, and social de elopmen (Sánchez-Caballé e al.,
2020; Zhao e al., 2021). P e ious esea ch has epo ed a clea associa ion be ween p ob-
lema ic use o online ac i i ies and heal h and unc ional impai men among s uden s (e.g.,
Chang e al., 2022; Kwok e al., 2021; Wong e al., 2020).
Rega ding he diagnos ic c i e ia ha ha e desc ibed hese p oblem beha iou s, G i -
i hs (2005) p oposed a biopsychosocial model o addic ion, common o subs ance and
beha iou al addic ions (such as in e ne addic ion), based on six componen s: salience,
mood modi ica ion, ole ance, wi hd awal, elapse, and con lic . This model has been es ed
no only o gene alized p oblema ic in e ne beha iou (Mee ke k e al., 2009), bu also
o speci ic beha iou s such as social media use (And eassen e al., 2012) and online ide-
ogame playing (Deme o ics e al., 2012).
Mo e ecen ly, applicable only o p oblema ic beha iou associa ed wi h ideogame
playing, he la es ( i h) edi ion o he Diagnos ic and S a is ical Manual o Men al Dis-
o de s (DSM-5; Ame ican Psychia ic Associa ion, 2013) included wi hin he sec ion
Eme ging Measu es and Models (Sec ion III), ‘in e ne gaming diso de ’ (IGD), wi h nine
diagnos ic c i e ia adap ed om hose used o subs ance use diso de s: p eoccupa ion,
wi hd awal, ole ance, loss o con ol, loss o p e ious in e es s, con inua ion despi e p ob-
lems, decep ion, mood modi ica ion, and jeopa diza ion.
Simila ly, he 11 h e ision o he In e na ional Classi ica ion o Diseases (ICD-11;
Wo ld Heal h O ganiza ion, 2018) included ‘gaming diso de ’ (GD), and p oposed in i s
desc ip ion he c i e ia o salience, loss o con ol, losing in e es in and educing o he ec-
ea ional ac i i ies, con inua ion o he playing beha iou despi e nega i e consequences,
and isking/losing ela ionships and oppo uni ies. Al hough he e is no o icial diagnos ic
ecogni ion o o he online p oblem beha iou s (apa om ‘gambling diso de ’ which can
occu bo h online and/o o line), cu en esea ch has ocused on b oadening he unde -
s anding o he na u e and scope o hese beha iou s and de e mining whe he hey ep e-
sen sepa a e psychopa hological condi ions ha me i u he in es iga ion and conside a-
ion in clinical p ac ice (Baggio e al., 2022).
In e ms o concep ualising hese beha iou s, much o he li e a u e has used e ms such
as ‘in e ne addic ion’, ‘compulsi e in e ne use’ and ‘p oblema ic in e ne use’ o e e o
maladap i e online beha iou mani es ed h ough di e en p oblema ic online beha iou s
associa ed wi h di e en ac i i ies (Finebe g e al., 2018). Howe e , his concep ion has
been subjec o c i icism suppo ed by he idea ha he in e ne is only a means o access
di e en online ac i i ies (G i i hs, 2000; Mee ke k e al., 2009) and ha online ac i i ies
a e no subs i u ed o each o he when indi iduals canno pe o m hei a ou i e ac i i y
In e na ional Jou nal o Men al Heal h and Addic ion
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(G i i hs & Szabo, 2014; Pon es e al., 2015). As a possible solu ion o hese c i icisms,
he spec um hypo hesis a gues ha p oblema ic online beha iou s can be de ined as a
spec um o ela ed bu dis inc i e beha iou s associa ed wi h common and speci ic ae io-
logical ac o s (Billieux, 2012; S a ce ic & Billieux, 2017).
P e ious esea ch has suppo ed his las concep ualisa ion o p oblema ic online beha -
iou s, demons a ing hese beha iou s a e co ela ed and he magni ude o his co ela-
ion is mo e p onounced be ween speci ic p oblema ic beha iou s (e.g., p oblema ic social
media use [PSMU] o p oblema ic online gaming [POG]) and gene alized p oblema ic
in e ne use (GPIU) han i is be ween indi idual beha iou s hemsel es (Rigó e al., 2023;
Sánchez-Fe nández & Bo da-Mas, 2024; Van Rooij e al., 2017). Mo eo e , s udies ha e
ound simila i ies and di e ences in he impac o speci ic isk ac o s on di e en p ob-
lema ic online beha iou s (Akba i e al., 2023; Chang e al., 2022; Naidu e al., 2023; Pe is
e al., 2020; Sayili e al., 2023; Van Rooij e al., 2017).
An e ec i e way o es he spec um hypo hesis is h ough he ne wo k analysis
app oach. In his app oach, diso de s a e conside ed complex ne wo ks whe e symp oms a e
ep esen ed as ‘nodes’ connec ed by ‘edges’ (Bo sboom, 2017; Schmi mann e al., 2013).
The s eng h o hese connec ions e lec s he p obabili y ha symp oms appea oge he ,
iden i ying he co e and pe iphe al symp oms. This app oach cap u es he complexi y and
dynamics o diso de s and allows he analysis o ela ionships be ween hem. Unlike he
la en a iable app oach, whe e an unde lying ac o is assumed, ne wo k analysis consid-
e s he ne wo k i sel as he main cons uc , explo ing dynamic causal ela ionships wi hou
assump ions o local independence (Guyon e al., 2017). I also acili a es he iden i ica-
ion o ‘b idging symp oms’ ha connec seemingly dis inc diso de s (Baggio e al., 2016;
C ame e al., 2010), and he e o e p o ides e idence o he spec um hypo hesis.
Following his app oach, p e ious s udies ha e analysed he ela ionships be ween
symp oms o di e en p oblema ic online beha iou s and ound ha hese o m dis inc
en i ies (e.g., Baggio e al., 2018, 2022; Li e al., 2023b; Rozgonjuk e al., 2021; Za a e
e al., 2022). Howe e , o da e, no s udies ha e examined he ela ionship be ween GPIU,
PSMU, and POG symp oms among he uni e si y s uden popula ion using he ne wo k
analysis app oach. I is essen ial o ad ance esea ch speci ically wi hin his popula ion and
hese h ee beha iou s o enable he de elopmen o a ge ed in e en ions.
In addi ion, his app oach has been commonly used in ecen esea ch demons a ing he
ela ionship be ween p oblema ic online beha iou s and a ious symp oms o psychological
dis ess. Fo example, some s udies showed ha GPIU was ela ed o dep ession symp oms
(Cai e al., 2022; Zhao e al., 2023). Rela ionships ha e been epo ed be ween GPIU and
suicidal idea ion (Yang e al., 2023), and be ween GPIU and anxie y (Cai e al., 2021). Spe-
ci ic s udies ha e shown ha dep ession is s ongly associa ed wi h PSMU and POG (Li
e al., 2023b; Si e al., 2023). O he ela ionships ha e been epo ed be ween PSMU and
psychological dis ess (Peng & Liao, 2023; Tulle -P ado e al., 2023; Wang e al., 2022),
and be ween PSMU and di e en psychopa hological symp oms (Fou nie e al., 2023).
Focusing on he uni e si y s uden popula ion, signi ican ela ionships ha e been epo ed
be ween gaming diso de , dep ession, alexi hymia, bo edom and loneliness (Li e al., 2021),
and be ween gaming diso de , umina ion, and sleep quali y (Li e al., 2023a, b).
Howe e , o da e, no p e ious s udy has analysed he ela ionships be ween di e en
p oblema ic online beha iou s and psychological dis ess symp oms in he same ne wo k,
which may ha e impo an implica ions o he ea men o hese beha iou s. I signi -
ican ela ionships a e es ablished, changes in hese psychological dis ess a iables can
ac i a e and/o inhibi p oblem beha iou s in he ne wo k (Bo sboom, 2017). Fu he -
mo e, al hough PIU has been shown o ha e a nega i e impac on well-being (Dienlin &
In e na ional Jou nal o Men al Heal h and Addic ion
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Johannes, 2022; Machimba ena e al., 2019), no p e ious s udies ha e examined he ela-
ionship be ween hese a iables using ne wo k analysis.
The P esen S udy
Based on he spec um hypo hesis and p e ious empi ical e idence, he objec i es o he
p esen s udy we e o su ey a sample o uni e si y s uden s and o de e mine (i) o wha
ex en symp oms o online p oblem beha iou s, such as GPIU, PSMU and POG, a e asso-
cia ed wi h each o he ; (ii) whe he symp oms o hese h ee p oblema ic online beha iou s
o m dis inc en i ies; and (iii) whe he he e is a ela ionship be ween p oblema ic online
beha iou s, symp oms o psychological dis ess (i.e., s ess, anxie y, dep ession), and an
indica o o well-being (i.e., emo ional ole limi a ions). Wi h ega d o hese objec i es,
he ollowing hypo heses (Hs) we e p oposed. I was hypo hesised ha :
• The symp oms o GPIU, PSMU, and POG would be posi i ely associa ed wi h each
o he (H1).
• The symp oms o PSMU and POG would o m dis inc clus e s o p oblema ic online
beha iou symp oms, and he umb ella cons uc s o GPIU would no cons i u e a spe-
ci ic diso de (H2).
• GPIU, PSMU, and POG would be posi i ely associa ed wi h dep ession, anxie y, s ess
and emo ional ole limi a ions (H3).
Me hod andMa e ials
Pa icipan s andP ocedu e
Be ween Oc obe 2022 and May 2023, a c oss-sec ional su ey s udy was conduc ed a a
uni e si y in Andalusia, Spain. Uni e si y s uden s we e ec ui ed using con enience sam-
pling. The su eys we e dis ibu ed online by he uni e si y’s eaching s a . The inclusion
c i e ia we e: (i) being olde han 17yea s, (ii) being en olled in a deg ee p og amme a
his uni e si y, (iii) ha ing a sma phone o any o he de ice wi h in e ne access, and (i )
gi ing in o med consen o pa icipa e. Be o e comple ion o he su ey, he pa icipan s
we e in o med abou he backg ound and pu pose o he s udy, along wi h ins uc ions on
an in o ma ion shee . No c edi o cou se emune a ion was gi en o pa icipa ion. The
s udy was app o ed by he E hics Commi ee o he uni e si y o he i s h ee au ho s and
adhe ed o he Decla a ion o Helsinki.
A o al o 807 s uden s (330 males, 466 emales, and 11 nonbina ies) pa icipa ed in he
su ey. The mean age o he s uden s was 21.22yea s (SD = 3.68, ange = 17–41yea s).
Table1 shows he cha ac e is ics o he pa icipan s. The sample comp ised a highe p opo -
ion o emales, bachelo s uden s, hose unde 20yea s o age, enginee ing and a chi ec u e
s uden s, hose wi h a medium economic le el, and hose li ing wi h a amily membe .
Measu es
In addi ion o he sociodemog aphic in o ma ion shown in Table1, he ollowing psycho-
me ic measu es we e included in he su ey.
In e na ional Jou nal o Men al Heal h and Addic ion
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Compulsi e In e ne Use Scale (CIUS‑14)
The CIUS-14 (Mee ke k e al., 2009; Spanish e sion: Lopez-Fe nandez e al., 2019) was
used o assess GPIU. The scale comp ises 14 i ems ocussing on lack o con ol, in ap-
e sonal and in e pe sonal con lic s, cogni i e and beha iou al p eoccupa ion, impai ed
mood, and wi hd awal symp oms. I ems (e.g., “Do you hink you should use he in e ne
less o en?”) a e esponded o on a i e-poin Like scale om 0 (ne e ) o 4 ( e y e-
quen ly). Highe sco es e e o a g ea e se e i y o GPIU. I ems and associa ed symp oms
can be ound in TableS1 o he Supplemen a y Ma e ial. The CIUS-14 has been ansla ed
in o many languages and has used in c oss-cul u al esea ch showing obus psychome ic
quali ies (Lopez-Fe nandez e al., 2019). In he p esen s udy, CIUS-14 showed high le els
o in e nal consis ency (α = 0.89, ω = 0.89) and an adequa e i (χ2 = 393.12, d = 76; χ2/
d = 5.17; CFI = 0.98; IFI = 0.98; NFI = 0.97; TLI = 0.97; RMSEA = 0.07).
Table 1 Cha ac e is ics o he
s udy pa icipan s (N = 807)
a Le els de e mined based on an i em ("Conside ing you household
income le el") wi h h ee esponse op ions: “We s uggle o make ends
mee o ba ely manage wi hou addi ional expenses” (low), “We li e
com o ably bu wi hou luxu ies” (medium), and “We a e inancially
com o able” (high)
Cha ac e is ics F equency %
Gende
Male
Female
Non-bina y
330
466
11
40.9
57.7
1.4
Age (yea s)
< 20
20–22
22–24
> 24
313
305
93
96
38.8
37.8
11.5
11.9
Educa ional deg ee (cu en ly en olled)
Bachelo
Mas e
Doc o al
720
58
29
89.2
7.2
3.6
Field o knowledge
Sciences
Sciences Heal h sciences
Social sciences
A s and humani ies
Enginee ing and A chi ec u e
130
124
196
88
269
16.1
15.4
24.3
10.9
33.3
Income le ela
Low
Medium
High
174
385
248
21.5
47.7
30.7
Residence
Wi h a amily membe
In a s uden esidence/ la
Wi h a couple/alone
458
287
622
56.6
35.8
7.6
In e na ional Jou nal o Men al Heal h and Addic ion
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Be gen Social Media Addic ion Scale (BSMAS)
The BSMAS (And eassen e al., 2016; Spanish e sion: Vallejos-Flo es e al., 2018) was
used o assess PSMU o e he pas yea . The scale comp ises six i ems e lec ing co e
addic ion elemen s (i.e., salience, mood modi ica ion, ole ance, wi hd awal, con lic ,
and elapse) p oposed by G i i hs (2005). I ems (e.g., “Do you eel an u ge o use social
media mo e and mo e?”) a e esponded o on a i e-poin Like scale anging om 1 ( e y
a ely) o 5 ( e y o en). Highe sco es e e o a g ea e se e i y o PSMU. I ems and asso-
cia ed symp oms can be ound in TableS1 o he Supplemen a y Ma e ial. I s obus psy-
chome ic p ope ies ha e been e i ied in di e en language e sions (e.g., And eassen
e al., 2016; Monacis e al., 2017; Pon es e al., 2016; Za a e e al., 2023). In he p esen
s udy, BSMAS showed high le els o in e nal consis ency (α = 0.81, ω = 0.81) and an ade-
qua e i (χ2 = 15.70, d = 8; χ2/d = 1.96; CFI = 1.00; IFI = 1.00; NFI = 0.99; TLI = 0.99;
RMSEA = 0.03).
In e ne Gaming Diso de Scale–Sho Fo m (IGDS9‑SF)
The IGDS9-SF (Pon es & G i i hs, 2015; Spanish e sion: Be anuy e al., 2020) was used
o assess POG o e he pas yea . The scale comp ises nine i ems based on he c i e ia o
in e ne gaming diso de in he DSM-5 (Ame ican Psychia ic Associa ion, 2013). I ems
(e.g., “Do you eel p eoccupied wi h you gaming beha io ?”) a e esponded o on a i e-
poin Like scale om 1 (ne e ) o 5 ( e y o en). Highe sco es e e o a highe se e -
i y o POG. I ems and associa ed symp oms can be ound in TableS1 o he Supplemen-
a y Ma e ial. The IGDS9-SF has been ound o ha e excellen psychome ic p ope ies in
di e en languages (Poon e al., 2021). The Spanish IGDS9-SF has been shown o ha e
obus psychome ic p ope ies (Be anuy e al., 2020; Maldonado-Mu ciano e al., 2020;
Sánchez-Iglesias e al., 2020). In he p esen s udy, IGDS9-SF showed high le els o in e -
nal consis ency (α = 0.87, ω = 0.87) and an adequa e i (χ2 = 76.16, d = 27; χ2/d = 2.82;
CFI = 1.00; IFI = 1.00; NFI = 0.99; TLI = 0.99; RMSEA = 0.05).
Dep ession, Anxie y, andS ess Scale‑21 (DASS‑21)
The DASS-21 (Lo ibond & Lo ibond, 1995; Spanish e sion: Daza e al., 2002) was
used o assess psychological dis ess. The 21-i em scale comp ises h ee subscales, each
con aining se en i ems ela ed o dep ession (DASS-D), anxie y (DASS-A), and s ess
(DASS-S). I ems (e.g., “I el ha li e was meaningless”) a e esponded o on a ou -poin
scale om 0 (did no apply o me a all) o 3 (applied o me e y much, o mos o he
ime). A highe sco e indica es g ea e symp oms o psychological dis ess. The Spanish
DASS-21 has been shown o ha e obus psychome ic p ope ies (Daza e al., 2002). In
he p esen s udy, he h ee DASS-21 subscales showed high le els o in e nal consis -
ency (dep ession: α = 0.90, ω = 0.90; anxie y: α = 0.88, ω = 0.88; s ess: α = 0.88, ω = 0.88)
and an adequa e i (dep ession: χ2 = 27.69, d = 14, χ2 / d = 1.98, CFI = 1.00; IFI = 1.00;
NFI = 1.00; TLI = 1.00; RMSEA = 0.04; anxie y: χ2 = 14.41, d = 14; χ2/d = 1.03;
CFI = 1.00; IFI = 1.00; NFI = 1.00; TLI = 1.00; RMSEA = 0.03; s ess: χ2 = 23.10, d = 14;
χ2/d = 1.65; CFI = 1.00; IFI = 1.00; NFI = 0.99; TLI = 1.00; RMSEA = 0.04).
In e na ional Jou nal o Men al Heal h and Addic ion
1 3
Sho Fo m 36 Heal h Su ey (SF‑36) (Wa e andShe bou ne, 1992)
The SF-36 (Wa e and She bou ne, 1992; Spanish e sion: Vilagu e al., 2005) comp ises
36 i ems and assesses physical and men al heal h. In he p esen s udy, he h ee-i em emo-
ional ole limi a ions (ER) subscale was used. I ems (e.g., “Accomplished less han you
would like”) a e esponded o on a i e-poin scale om 1(s ongly disag ee) o 5(s ongly
ag ee). A highe sco e indica es a highe le el o emo ional ole limi a ions. The psycho-
me ic p ope ies o SF-36 has been ound o ha e obus psychome ic p ope ies among
gene al popula ions (Su e al., 2014), uni e si y s uden s (Zhang e al., 2012), and Span-
ish popula ions (Gi aldo-Rod íguez and López-O ega, 2024). In he p esen s udy, he
ER subscale o he SF-36 showed high le els o in e nal consis ency (α = 0.92, ω = 0.93)
and an adequa e i (χ2 = 393.12, d = 76; χ2/d = 5.17; CFI = 1.00; IFI = 1.00; NFI = 1.00;
TLI = 1.00; RMSEA = 0.04).
Assessmen c i e ia
Table2 shows he c i e ia used in he assessmen o p oblema ic online beha iou s (GPIU,
PSMU, and POG). Pa allels can be seen be ween he i s i e c i e ia (i.e., loss o con-
ol elapse, con lic /jeopa diza ion, p eoccupa ion/salience, mood modi ica ion, and wi h-
d awal) in all h ee cases and be ween he i s six c i e ia ( he p e ious i e and he addi-
ion o ole ance) in he case o PSMU and POG. The scale used o assess POG includes
h ee u he c i e ia (i.e., loss o in e es s, con inua ion despi e p oblems, and decep ion).
S a is ical Analysis
Desc ip i e and bi a ia e da a analysis we e pe o med in Je eys’ Amazing S a is ics
P og am (JASP) e sion 0.17.1 (In el) s a is ical so wa e (JASP Team, 2023). Ne wo k
da a analysis was pe o med wi h R e sion 4.3.0 (R Co e Team, 2023). Fo he dis ibu-
ion o a iables, he absolu e alues o skewness anged om 0.24 (ER) o 2.69 (POG),
and he ku osis alues o ku osis anged om 0.16 (GPIU) o 9.38 (POG). Gi en he
Table 2 Assessmen ools and c i e ia used o gene alized p oblema ic in e ne use, p oblema ic social
media use and p oblema ic online gaming
GPIU: gene alized p oblema ic in e ne use, PSMU: p oblema ic social media use, POG: p oblema ic
online gaming
GPIU PSMU POG
Compulsi e In e ne Use Scale
(CIUS-14)
Be gen Social Media Addic ion Scale
(BSMAS)
In e ne Gaming Diso de
Scale–Sho Fo m (IGDS9-SF)
Loss o con ol Relapse Loss o con ol
Con lic Con lic Jeopa diza ion
P eoccupa ion Salience P eoccupa ion
Coping o mood modi ica ion Mood modi ica ion Mood modi ica ion
Wi hd awal Wi hd awal Wi hd awal
Tole ance Tole ance
Loss o in e es s
Con inua ion despi e p oblems
Decep ion
In e na ional Jou nal o Men al Heal h and Addic ion
1 3
c i e ia o absolu e skewness ≤ 2.0 and absolu e ku osis ≤ 7.0 (Kim, 2013), he dis ibu-
ion can be conside ed no mal o all a iables excep o POG. Fi s , means, s anda d
de ia ions, ange, eliabili ies (C onbach’s alphas and McDonald’s omegas), con i ma o y
ac o analysis (CFA), and co ela ions be ween s udy a iables we e calcula ed. Mul i-
ple c i e ia we e used o e alua e he CFA i : χ2/d ≤ 2 (Cole, 1987), he compa a i e i
index (CFI) ≥ 0.90, an inc emen al i index (IFI) ≥ 0.90, no med i index (NFI) ≥ 0.90,
Tucke Lewis index (TLI) ≥ 0.90, and he oo -mean-squa e e o o app oxima ion
(RMSEA) < 0.08 (Kline, 2015). As χ2 is a sensi i e sample size, he in e p e a ion o he
i o he model was based on an o e all assessmen o he gene al pa e n o all i indi-
ces (Ala i e al., 2020). Pea son’s co ela ions we e used o all a iables excep POG,
which used Spea man’s co ela ion. The ollowing cu -o poin s we e used o in e p e he
s eng h o he associa ions: small < 0.3, medium > 0.3, and la ge > 0.5 (Hemphill, 2003).
To examine he ela ionships be ween he p oblema ic online beha iou s s udied, a
ne wo k model was calcula ed wi h he 14 GPIU symp oms p esen in CIUS-14, he six
PSMU symp oms p esen in BSMAS, and he nine POG symp oms p esen in IGDS9-SF
(Ne wo k 1). To examine he ela ionship be ween GPIU, PSMU, and POG, psychological
dis ess, and emo ional ole limi a ions, a second ne wo k model was gene a ed (Ne wo k
2). To simpli y he model, he sum sco es o CIUS-14, BSMAS, IGDS9-SF, h ee DASS
subscales and he ER subscale o SF-36 we e used ins ead o he symp oms sco es.
The qg aph package (Epskamp e al., 2023) was applied o ne wo k isualisa ion and
analysis. A Gaussian g aphical model was compu ed using Leas Absolu e Sh inkage and
Selec ion Ope a o (GLASSO) based on he Ex ended Bayesian In o ma ion C i e ion
(EBIC). GLASSO educes spu ious connec ions be ween nodes (symp oms in Ne wo k 1
and a iables in Ne wo k 2) by minimising small co ela ions o ze o. The EBIC is a good-
ness o i me ic o model selec ion, which is adjus ed by a hype pa ame e γ. This hype -
pa ame e was se o 0.5 o achie e an op imal balance be ween sensi i i y and speci ici y
(Foygel & D on, 2010). The ‘Exclude pai wise me hod’ was used o manage missing da a.
Ne wo k isualisa ion ollowed he F uch e man–Reingold algo i hm (F uch e man &
Reingold, 1991). Symp oms (Ne wo k 1) and a iables (Ne wo k 2) we e ep esen ed by
‘nodes’ and he ela ionships be ween hem by ‘edges’. Blue edges indica e posi i e links,
while ed edges indica e nega i e links. Mo eo e , he s eng h o he link be ween nodes
is p esen ed h ough he hickness and colou densi y o he connec ing edge, whe e hicke
and dense lines indica e s onge weigh s. In addi ion, he dis ance be ween he nodes
showed he ela ionship be ween hem. Finally, he cen e o he ne wo k holds he nodes
wi h highe co ela ions, whe eas he edges o he ne wo k ha e he nodes wi h lowe
co ela ions.
In addi ion, edge weigh s and cen ali y o nodes we e used o desc ibe he ne wo k. The
s eng h o he ela ionship be ween he nodes is indica ed by an edge weigh . The mini-
mum absolu e alue o he edge weigh o 0.03 is deemed in e p e able (Is o anu e al.,
2017). Cen ali y desc ibes he ela i e signi icance o he a ious nodes wi hin a ne wo k.
A cen al node is closely ela ed o o he nodes, and, when ac i a ed, o he symp oms
a e likely o be a ec ed as well. On he o he hand, a low cen ali y symp om has ewe
links o o he nodes and less impac on he ne wo k. S eng h, be weenness, closeness, and
expec ed in luence a e equen ly ci ed measu es o cen ali y (Opsahl e al., 2010).
Following his, he edge accu acy and he s abili y o he cen ali y coe icien s o Ne -
wo k 1 we e e alua ed using he boo ne package (Epskamp, 2023). The accu acy o edge
weigh s was examined using boo s ap 95% non-pa ame ic con idence in e als (CIs).
Na owe CIs imply a mo e accu a e es ima e o he edge (Epskamp e al., 2018). The s a-
bili y o he cen ali y indices was es ima ed using case-d opping boo s apping (Epskamp
In e na ional Jou nal o Men al Heal h and Addic ion
1 3
& F ied, 2018). This coe icien e lec s he co ela ion be ween he o iginal cen ali y indi-
ces (based on he ull da a) and he co ela ion ob ained om he subse o da a ep esen -
ing di e en pe cen ages o he o e all sample. Epskamp e al. (2018) sugges ed ha he
co ela ion s abili y coe icien should no be below 0.25, and p e e ably i should be abo e
0.5. In he p esen s udy, he s abili y o he cen ali y indices and he edge accu acy o he
ne wo k we e examined using he a o emen ioned p ocedu es. Bo h p ocedu es we e es i-
ma ed wi h 1000 boo s aps.
To in es iga e he communi ies be ween he di e en symp oms o PIU, explo a-
o y g aph analysis (EGA) (Golino and Epskamp, 2017) was used. This ne wo k analy ic
app oach allows he implemen a ion o a communi y de ec ion algo i hm, acili a ing he
empi ical iden i ica ion o clus e s in mul idimensional da a (Ch is ensen, 2020). The Lou-
ain communi y de ec ion algo i hm was used since i has been shown o pe o m well
wi h o dinal da a (Ch is ensen, 2020). TheEGAne package (Golino & Ch is ensen, 2023)
was used o eplica e EGA ne wo ks 1,000 imes wi h andom sample pe mu a ion. The
qg aph packagewas used o isualise he median EGA ne wo k.
Finally, o examine he b idge cen ali y be ween PIU symp oms, he ne wo k ools pack-
age (Jones, 2023)was used o es ima e he b idge s eng h and b idge expec ed in luence
(bo h 1-s ep and 2-s ep).
Resul s
Desc ip i e S a is ics
Table3 p esen s desc ip i e s a is ics and bi a ia e co ela ions be ween he psychological
a iables. GPIU, PSMU, and POG we e posi i ely co ela ed, wi h a e y s ong co ela-
ion be ween GPIU and PSMU, a medium co ela ion be ween GPIU and POG, and a small
co ela ion be ween PSMU and POG. GPIU and PSMU showed posi i e medium co ela-
ions wi h all h ee subscales o psychological dis ess and wi h emo ional ole limi a ions.
Table 3 Means, s anda d de ia ions (SDs) and Pea son/Spea man co ela ions o he s udy a iables
(N = 807)
GPIU: gene alized p oblema ic In e ne use, PSMU: p oblema ic social media use, POG: p oblema ic
online gaming, Dep: dep ession, Anx: anxie y, S : s ess, ER: emo ional ole unc ioning, α: C onbach’s
alpha coe icien , ω: omega coe icien , M: mean, SD: s anda d de ia ion, Rg: ange. *p < 0.05 **p < 0.01
***p < 0.001 (2- ailed)
Va iable 1 2 3 4 5 6 7
1. GPIU —
2. PSMU 0.72*** —
3. POG 0.36*** 0.21*** —
4. Dep 0.38*** 0.33*** 0.16*** —
5. Anx 0.33*** 0.37*** 0.08* 0.68*** —
6. S 0.32*** 0.34*** 0.07* 0.71*** 0.81*** —
7. ER 0.38*** 0.38*** 0.06 0.60*** 0.57*** 0.58*** —
M17.67 11.66 11.61 5.99 5.94 8.23 8.23
SD 9.85 4.68 4.44 5.07 5.14 4.90 4.03
Rg 0 – 52 6 – 30 9—42 0—21 0—21 0—21 3—15
In e na ional Jou nal o Men al Heal h and Addic ion
1 3
On he o he hand, nega i e connec ions we e ound be ween he POG i ems and some
GPIU and PSMU i ems. The mo e p onounced connec ion be ween GPIU and PSMU,
compa ed o hese wo o ms o PIU and POG, could indica e ha , despi e he p esence
o sha ed elemen s be ween hese p oblema ic beha iou s (B and e al., 2019; Epskamp
e al., 2018), he e is some a iabili y be ween hem. This asse ion is u he suppo ed by
H2. Rega ding he associa ions be ween he di e en symp oms o each o he diso de s,
he s onges connec ions we e es ablished be ween he symp oms o loss con ol/ elapse
and con lic , and be ween he symp oms o wi hd awal and mood modi ica ion in GPIU
and PSMU, be ween he symp oms o salience and ole ance in PSMU, and be ween wi h-
d awal and ole ance, p eoccupa ion and wi hd awal, loss o con ol and loss o p e ious
in e es s, loss o p e ious in e es s and decep ion, and p eoccupa ion and loss o con ol in
POG. These indings sugges ha he e a e g ea e simila i ies be ween GPIU and PSMU
han be ween hem and POG.
On he o he hand, he assessmen o cen ali y indices showed he ela i e impo ance
o he di e en symp oms o GPIU, PSMU, and POG wi hin he b oade ne wo k o he
h ee analysed beha iou s (Epskamp e al., 2018). Symp oms wi h mo e equen connec-
ions and sho e ajec o ies included: “Use he in e ne o escape om you so ows o
ge elie om nega i e eelings” (coping o mood modi ica ion), “Feel es less, us a ed,
o i i a ed when you canno use he in e ne ” (wi hd awal), “Look o wa d o you nex
in e ne session” (p eoccupa ion) in GPIU, “T ied o cu down on he use o social media
wi hou success” ( elapse) and “Become es less o oubled i you ha e been p ohibi ed
om using social media” (wi hd awal) in PSMU, and “Con inued you gaming ac i i y
despi e knowing i was causing p oblems be ween you and o he people” (con inua ion
despi e p oblems) in POG.
These symp oms a e mo e equen ly and s ongly connec ed o o he symp oms o
p oblema ic online beha iou s and may inc ease he isk o cu en symp oma ology, while
inc easing he likelihood o de eloping u he p oblem beha iou s (F ied e al., 2017).
Mo eo e , e en he less impac ul symp oms o p oblema ic online beha iou s in he o e -
all ne wo k could o e meaning ul insigh s. Fo example, he less in luen ial symp oms
iden i ied in he p esen s udy included “Do o he s (e.g., pa ne , child en, pa en s) say
you should use he in e ne less” (con lic ) and “A e you sho o sleep because o he
in e ne ” (loss o con ol) in GPIU, and “Spen a lo o ime hinking abou social media o
planned use o social media” (salience) in PSMU. This means ha hese symp oms may be
mo e pe iphe al han in he co e o hei diso de (Wes & B own, 2013).
I was also hypo hesised ha each speci ic p oblema ic beha iou in es iga ed in he
s udy would o m dis inc clus e s o symp om se e i y a he i em-le el esponses, while
he umb ella cons uc s o GPIU would no cons i u e a speci ic diso de (H2). The commu-
ni y de ec ion algo i hm showed he exis ence o ou clus e s. One o hem co esponded
o he nine i ems o he POG scale, ano he co esponded o he p eoccupa ion i ems and
one o he con lic i ems o he GPIU, while wo o he communi ies had mixed i ems om
he GPIU and PSMU scales, one ocussing on he i ems o loss o con ol/ elapse and con-
lic , and he o he s on salience, ole ance, wi hd awal, and mood modi ica ion. These ind-
ings indica e ha H2 was pa ially suppo ed. Fi s , i was shown ha he PSMU and POG
i ems o med dis inc i e clus e s. This esul demons a es ha al hough he speci ic p ob-
lema ic online beha iou s analysed we e associa ed wi h each o he , hey we e independen
psychopa hological en i ies, which is also in line wi h p e ious esea ch using he same
me hodological app oach (Li e al., 2023b; Rozgonjuk e al., 2021; Za a e e al., 2022).
Fu he mo e, he inding o wo clus e s consis ing o GPIU and PSMU i ems also sup-
po s he spec um hypo hesis by sugges ing ha GPIU and PSMU a e no sepa a e en i ies,
In e na ional Jou nal o Men al Heal h and Addic ion
1 3
wi h he o me ac ing as a nonspeci ic diso de . This esul suppo s he idea ha p oblem-
a ic online beha iou s a e speci ic (B and e al., 2019; Mon ag e al., 2015) and ha he
in e ne is only he medium ha acili a es hem (G i i hs, 2000; Mee ke k e al., 2009;
Sha e e al., 2000; S a ce ic & Billieux, 2017). The iden i ica ion o a clus e con aining
GPIU-speci ic i ems (Dimension 2) equi es an explana ion. I migh ha e been expec ed
ha he p eoccupa ion symp oms o GPIU would align wi h he salience symp oms o
PSMU, gi en hei analogous na u e as discussed in he li e a u e (e.g., G i i hs, 2000,
2005; Mee ke k e al. (2009). Howe e , he o mula ion o hese i ems di e s, possibly
e e ing o ela ed bu dis inc symp oms.
On he o he hand, by iden i ying a speci ic clus e wi h POG i ems, he esul s p o ide
e idence o a i m ha POG is a diso de independen o GPIU. This esul is in line wi h
he au ho s who conside hese diso de s as sepa a e cons uc s (G i i hs, 2018; Ki ály
e al., 2014; Pon es & G i i hs, 2014), as well as wi h p e ious e idence using he ne -
wo k analysis app oach (Baggio e al., 2018; Li e al., 2023b). O e all, hese esul s sugges
ha GPIU being a gene ic concep ha includes o he speci ic beha iou s such as PSMU
(Billieux, 2012; S a ce ic & Billieux, 2017), POG would no be included among hem.
The e o e, GPIU and POG, while showing signi ican connec ions be ween some o hei
symp oms, a e di e en en i ies.
Symp oms wi h he highes b idge cen ali y indices we e con inua ion despi e p ob-
lems o POG and symp oms associa ed wi h con lic , p eoccupa ion, coping, and mood
modi ica ion o GPIU. These symp oms could heigh en he chances o adop ing c oss-
p oblema ic online beha iou s and/o adop ing a new o m o p oblema ic beha iou while
disengaging om a p eexis ing one (Za a e e al., 2022).
Finally, i was hypo hesised ha GPIU, PSMU, and POG would be posi i ely
associa ed wi h dep ession, anxie y, s ess, and emo ional ole limi a ions (H3). The
esul s showed ha H3 was pa ially suppo ed. Ne wo k 2 was easonably dense, wi h
61.9% o he nodes showing signi ican connec ions wi h o he nodes. In e ms o
signi ican ly connec ed nodes, (i) GPIU was posi i ely associa ed wi h dep ession
and emo ional ole limi a ions, (ii) PSMU was posi i ely associa ed wi h anxie y and
emo ional ole limi a ions; and (iii) POG was posi i ely associa ed wi h dep ession.
In addi ion, he nodes o dep ession, anxie y, and s ess we e connec ed o each o he
and o he node o emo ional ole limi a ions. Fu he mo e, i was ound ha he
nodes co esponding o he a iables o dep ession, anxie y, and s ess we e cen al in
he ne wo k, while emo ional ole limi a ions had a low alue in he s eng h cen al-
i y coe icien .
Wi h hese esul s and heo e ical models ha explain he de elopmen o p oblema ic
online beha iou s (e.g., B and e al., 2019; Ka de el -Win he , 2014), i could be in e -
p e ed ha an inc ease in emo ional dis ess would be associa ed wi h he isk o p oblem-
a ic use o di e en in e ne ac i i ies, wi h dep essi e symp oms associa ed wi h GPIU
and POG and anxie y symp oms wi h PSMU (Chang e al., 2022; Lai e al., 2023; Liu
e al., 2021). GPIU and PSMU would, in u n, be associa ed wi h he emo ional ole as an
indica o o men al heal h (Machimba ena e al., 2019). Social ela ionships a e p edic o s
o posi i e de elopmen a his s age o li e (O’Conno e al., 2011). The e o e, emo ional
heal h could be a ec ed when hey a e mainly loca ed in he i ual con ex . Fu he mo e,
he inding o a connec ion o emo ional ole limi a ions wi h GPIU and PSMU, bu no
POG, could also be ela ed o he na u e o he ac i i y.
In hei habi ual connec ion o social ne wo ks, s uden s o en engage passi ely, which
has been shown o ha e a mo e p onounced impac on men al heal h han ac i e use (Ve -
duyn e al., 2021). On he con a y, many ideogame gen es equi e signi ican cogni i e
In e na ional Jou nal o Men al Heal h and Addic ion
1 3
esou ces (Dale e al., 2020), posing challenges o mee hese demands wi hin speci ic daily
con ex s, such as p o essional o academic se ings, which could ac as p o ec i e ac o s
o emo ional well-being.
Limi a ions
The p esen s udy has se e al limi a ions ha should be conside ed when in e p e ing he
esul s. Fi s , he sample used, al hough ela i ely la ge in size, came om a single Span-
ish uni e si y. This uni e si y has speci ic cha ac e is ics (i.e., la ge size, public eaching,
bilingual Spanish–English ins uc ion), and is si ua ed wi hin a speci ic demog aphic con-
ex (i.e., u ban popula ion concen a ion, a high p opo ion o young esiden s, signi ican
na ional and in e na ional mig a ion, widesp ead access o e ia y educa ion, and medium
socioeconomic backg ounds), ha make i se e as a ep esen a i e example o ins i u ions
sha ing simila sociocul u al ea u es. Howe e , he limi a ions ela ed o he gene alisabil-
i y o he esul s make i ad isable o eplica e he s udy among samples o uni e si y s u-
den s om o he egions wi h di e en sociocul u al cha ac e is ics. Fo example, u u e
s udies could in es iga e simila ela ionships wi hin popula ions wi h dis inc cha ac e is-
ics, such as u al communi ies. In hese se ings, indi iduals may employ di e en coping
mechanisms o deal wi h nega i e emo ional s a es, which di e ge om he eliance on he
in e ne and i s unc ions. Mo eo e , o add ess he limi a ions associa ed wi h con enience
sampling, u u e s udies could employ mo e igo ous sampling me hods, such as andom
sampling o a combina ion o mul iple sampling echniques o enhance he ep esen a i e-
ness o he sample.
Second, only sel - epo ins umen s we e used o collec he da a. These echniques
may ha e some limi a ions ela ed o insu iciency and con usion in he unde s anding o
he ques ions, social desi abili y, dis o ion o he u h, and/o memo y bias (Ibáñez Agu-
i e, 2016). Fo u u e esea ch, quali a i e me hods, such as in e iews and ocus g oups,
a e ecommended, which could imp o e he comple eness o he a iables’ assessmen s, by
p o iding a nuanced and con ex ual unde s anding o expe iences, pe cep ions, and mean-
ings associa ed wi h he s udied a iables. Fu he mo e, he assessmen o a iables could
bene i om he use o daily logs o educe ecall bias. Mo eo e , conside ing he endency
o no malise p oblema ic online beha iou , i is ecommended ha u u e s udies comple-
men sel - epo assessmen s wi h an ex e nal e alua ion. Fo example, he pe spec i e o a
oomma e o pa ne could o e addi ional insigh s, acili a ing he c oss- e i ica ion o he
in o ma ion p o ided by he indi idual in ques ion.
Thi d, in he p esen s udy, only one a iable assessing well-being (i.e., emo ional ole
limi a ions) was conside ed. Fu u e esea ch could examine he ela ionships be ween p ob-
lema ic online beha iou s and o he po en ially- ela ed men al heal h a iables such as li e
sa is ac ion, pe cei ed social suppo , o sel -es eem.
Fou h, ne wo k analysis emb aces a o ma i e pe spec i e in unde s anding men al
diso de s. Consequen ly, he connec ions be ween a iables a e in e p e ed as causal sys-
ems ( an Bo kulo e al., 2015). Howe e , gi en he use o c oss-sec ional da a in he p e-
sen s udy, he assump ion o causali y is p ecluded. Subsequen in es iga ions may seek
o ackle his issue by u ilising longi udinal o expe imen al designs. This would acili a e
he examina ion o di ec ionali y in he ela ionships among p oblema ic online beha iou
symp oms and psychological a iables. Fo example, u u e esea ch could in es iga e he
ela ionships be ween PIU symp oms and men al heal h a iables a a ious poin s in ime,
In e na ional Jou nal o Men al Heal h and Addic ion
1 3
spanning om childhood o uni e si y yea s, in o de o es ablish he empo al sequence
be ween hem.
Finally, h ee p oblema ic online beha iou s we e assessed, which, al hough hey a e he
mos s udied in he uni e si y s uden popula ion, a e no he only ones on he spec um.
Fu u e s udies could include he analysis o o he beha iou s such as p oblema ic online
gambling, shopping, o po nog aphy.
Theo y‑Based Implica ions
The p esen s udy makes impo an heo e ical con ibu ions o he ield o online p oblem
beha iou s. The applica ion o he ne wo k analysis app oach o he symp oms o h ee
p oblema ic online beha iou s p o ided suppo o concep ions ha a gue ha GPIU is
a nonspeci ic diso de , encompassing he en i e spec um o online p oblem beha iou s
(Finebe g e al., 2018). The p esen s udy also suppo s he idea ha PSMU and POG a e
independen cons uc s ha , al hough hey sha e he same medium (i.e., he in e ne ), hey
possess dis inc i e cha ac e is ics ha make hem wo hy o de ailed analysis (Billieux,
2012; S a ce ic & Billieux, 2017).
The p esen s udy also p o ided addi ional e idence o concep ions ha sepa a e POG
om he PIU spec um (Ki ály e al., 2014). Al hough GPIU and POG a e diso de s ha
sha e elemen s, such as he common elemen s o addic i e diso de s (G i i hs, 2005),
gaming is an ac i i y ha does no need he online componen o be ealised, and i s p ob-
lema ic use de elops om di e en mo i a ions and p ocesses. Mo eo e , he simila i ies
be ween GPIU and PSMU may e lec g ea e o e laps be ween hese p oblema ic beha -
iou s. Tha is, he unc ions ha social media enable (e.g., main aining social ela ionships)
a e one o he main easons why indi iduals use he in e ne (S a is a, 2024), so i may be
ha when answe ing CIUS-14, when assessing hei in e ne p oblem beha iou , hey had
social media ne wo ks la gely in mind. Fo all hese easons, o u u e esea ch, abandon-
ing he s udy o gene alised beha iou in a ou o he analysis o speci ic beha iou s is
ad oca ed.
P ac ice‑Based Implica ions
The indings ha e p ac ical implica ions o he assessmen and in e en ion o hese p ob-
lem beha iou s. In e ms o assessmen , he esul s sugges ha al hough hese beha iou s
ha e common elemen s (G i i hs, 2005), hey need o be speci ically assessed, bo h in
esea ch and in clinical p ac ice. The e o e, i is ecommended, o u u e diagnos ic manu-
als, o include di e en in e ne -media ed beha iou s, as hey p esen cha ac e is ics ha
make hem dis inc i e.
In he amewo k o he in e en ion, he esul s o he p esen s udy may be bene i-
cial in he ea men o p oblema ic online beha iou s among uni e si y s uden s. Mo e
speci ically, based on he esul s p esen ed and aking in o accoun he applica ions in he
ne wo k app oach ield (Bo sboom, 2017), i is necessa y o ea symp oma ology, ocus-
ing on symp oms o coping o mood modi ica ion, wi hd awal and p eoccupa ion o GPIU,
elapse and wi hd awal in PSMU, and con inua ion despi e p oblems in POG, as hey a e
cen al in he ne wo k. Addi ionally, o a oid como bidi y and ansmission o symp oms
om one o m o ano he , i is ecommended o ea b idging symp oms, con inua ion
despi e p oblems o POG, and symp oms associa ed wi h con lic , p eoccupa ion, and
In e na ional Jou nal o Men al Heal h and Addic ion
1 3
coping/mood modi ica ion o GPIU. Finally, e idence o ela ionships be ween p oblem-
a ic online beha iou s and symp oms o dep ession, anxie y, and s ess, as well as he cen-
ali y o hese a iables in he join ne wo k, sugges s ha ea men o hese symp oms
could ha e posi i e e ec s on hese p oblema ic beha iou s. The ul ima e pu pose would
be o con ibu e o he well-being o hese s uden s.
Conclusion
The p esen s udy iden i ied a ne wo k o in e ela ed nodes be ween he symp oms o
GPIU, PSMU, and POG, wi h he mos p onounced associa ions obse ed be ween he
analogous symp oms o GPIU and PSMU. These symp oms we e g ouped in o ou dis inc
dimensions, including one exclusi e o he nine symp oms o POG, ano he ha comp ised
p eoccupa ion and a con lic symp om o GPIU, a dimension ha comp ised loss o con-
ol/ elapse and con lic symp oms o GPIU and PSMU, and a inal dimension ha com-
p ised salience and ole ance symp oms o PSMU and wi hd awal and mood modi ica ion
symp oms o GPIU and PSMU. Finally, ele an connec ions be ween dep ession and bo h
GPIU and POG, anxie y and PSMU, and emo ional ole limi a ions and bo h GPIU and
PSMU we e es ablished.
Supplemen a y In o ma ion The online e sion con ains supplemen a y ma e ial a ailable a h ps:// doi.
o g/ 10. 1007/ s11469- 024- 01296-y.
Au ho Con ibu ion Magdalena Sánchez-Fe nández: Concep ualiza ion, Me hodology, Fo mal analysis,
In es iga ion, W i ing—O iginal D a , Funding acquisi ion. Me cedes Bo da-Mas: Concep ualiza ion,
Me hodology, In es iga ion, W i ing—Re iew & Edi ing, Supe ision; F ancisco Ri e a: Me hodology,
Fo mal analysis, W i ing—Re iew & Edi ing; Ma k D. G i i hs: Concep ualiza ion, W i ing—Re iew &
Edi ing, Supe ision.
Funding Funding o open access publishing: Uni e sidad de Se illa/CBUA. This s udy was unded by a
esea ch g an om he “VI Plan P opio de In es igación y T ans e encia” o he Uni e sidad de Se illa
(VI-PPITUS) awa ded o he i s au ho (MSF).
Da a A ailabili y Da a a ailable on eques due o p i acy/e hical es ic ions.
Decla a ions
Compe ing In e es The au ho s decla e ha hey ha e no known compe ing inancial in e es s o pe sonal
ela ionships ha could ha e appea ed o in luence he wo k epo ed in his pape . MDG has ecei ed
esea ch unding om No sk Tipping ( he gambling ope a o owned by he No wegian go e nmen ). MDG
has ecei ed unding o a numbe o esea ch p ojec s in he a ea o gambling educa ion o young people,
social esponsibili y in gambling and gambling ea men om Gamble Awa e ( o me ly he Responsibili y in
Gambling T us ), a cha i able body which unds i s esea ch p og am based on dona ions om he gambling
indus y. MDG unde akes consul ancy o a ious gambling companies in he a ea o playe p o ec ion and
social esponsibili y in gambling.
E hical App o al The s udy was app o ed by he Uni e si y o Se ille Resea ch E hics Commi ee (Comi é
de É ica de In es igaciónde la Uni e sidad de Se illa, CEIUS) and adhe ed o he ene s o he Decla a ion
o Helsinki (In e nal code: 1346-N-22; Da e o app o al: 28 Sep embe 2022).
In o med Consen All p ocedu es ollowed we e in acco dance wi h he e hical s anda ds o he esponsible
commi ee on human expe imen a ion (ins i u ional and na ional) and wi h he Helsinki Decla a ion o 1975,
as e ised in 2000. In o med consen was ob ained om all pa icipan s o being included in he s udy.
In e na ional Jou nal o Men al Heal h and Addic ion
1 3
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