J Adolesc Health. 2025 Oct 31:S1054-139X(25)00457-4. doi: 10.1016/j.jadohealth.2025.09.029. Online ahead of print.
ABSTRACT
PURPOSE: Loneliness and social anxiety have both been linked to problematic gaming, though they may reflect distinct motivational profiles. Loneliness often involves a desire for connection, while social anxiety may lead to social avoidance. This study examined how these internalizing symptoms relate to adolescents’ in-game social behaviors, including how frequently they play, whom they play with, and how they communicate during gameplay. These patterns were also evaluated as potential mediators linking internalizing symptoms to problematic gaming.
METHODS: A nationwide cross-sectional survey of 1,468 US adolescents (aged 13-17 years) assessed self-reported loneliness, social anxiety, problematic gaming, and gaming-related behaviors (e.g., frequency, play partners, and real-time communication). Structural equation modeling with 10,000 bootstrap iterations tested direct and indirect pathways among internalizing symptoms, gaming behaviors, and problematic gaming.
RESULTS: Loneliness was associated with more gaming with both strangers and known peers, and these play patterns were linked to higher levels of problematic gaming. Social anxiety was positively associated with solo gaming only. Communication with known peers was associated with lower problematic gaming, whereas communication with strangers was associated with higher levels. Frequent communication with strangers was associated with a stronger link between gaming frequency and problematic use. Mediation analyses showed that social gaming behaviors mediated the association between loneliness and problematic gaming, but not between social anxiety and problematic gaming.
DISCUSSION: These findings underscore the nuanced ways mental health vulnerabilities may shape adolescents’ digital behaviors. Interventions should look beyond screen time to consider social dynamics, communication patterns, and emotional needs underlying digital play.
PMID:41171243 | DOI:10.1016/j.jadohealth.2025.09.029
