Inattention

Electronic Gaming and Mental Health

By R. Ryan S Patel DO, FAPA OSU-CCS Psychiatrist

Electronic gaming is very common among young adults and comes in many forms including smartphones, tablets, computers, game consoles, etc.

By some estimates, the market size for electronic gaming is almost the same size as the movie industry.

Almost 90% of people ages 16 to 24 play video games (1); and almost half were at risk of video game addiction (2).

While many adults engage in gaming in healthy ways, gaming addiction has been linked to insomnia, anxiety, depression, stress among college students (3).

One study looked at  gaming addiction, and depression (4).

Who was studied?

3267 undergraduate students from United States, China and Singapore(4).

What was studied?

Rates of addictions to Internet use, online gaming, and online social networking,

Their association with depressive symptoms (4).

What were the results?

31% of male students were addicted to online gaming, compared to 13% of female students (OR = 0.522, 95% CI = 0.440-0.620) (4)

37.3% of female students were addicted to social networking compared to 27.8% of male students (OR = 1.543, 95% CI = 1.329-1.791). (4)

Regarding depression rates:

  • Among students with online gaming addiction depression rates were 65.5% for students in United States, 70.8% for China, and 69.6% for Singapore. (4)
  • Among students with internet addiction, depression rates were 76.5% for students in United States, 88.9% for China, and 75.9% for Singapore. (4)
  • Among students with online social networking addiction, depression rates were 68.8% for students in United States, 76% for China, and 71% for Singapore. (4)

What are some signs of Internet gaming disorder?

While there is no uniform criteria, some signs could include (5,6):

  • Preoccupation. (The individual thinks about previous gaming activity or anticipates playing the next game; internet gaming becomes the dominant activity in daily life.)
  • Experienced withdrawal symptoms when internet gaming is taken away. (These symptoms are typically described as irritability, anxiety, or sadness, but there are no physical signs of pharmacological withdrawal.)
  • Developed Tolerance—the need to spend increasing amounts of time engaged in games.
  • Unsuccessful attempts to control the participation in gaming.
  • Continued excessive use despite knowledge of psychosocial problems.
  • Mislead/deceive family members, therapists, or others regarding the amount of gaming.
  • Use as escape or relieve a negative mood (e.g., feelings of helplessness, guilt, anxiety).
  • Loss of interest in previous hobbies and entertainment as a result of, and with the exception of gaming.
  • Jeopardized or lost a significant relationship, job, or educational or career opportunity because of participation in electronic gaming.

What are some caveats?

  • Further study is needed in the area of internet, and gaming addiction.
  • To learn more about internet addiction, click here.
  • While this study shows that males were more likely to have gaming addiction and female students were more likely to have internet addiction, newer research indicates that this gap appears to be narrowing.
  • For other studies on men and mental health, click here, and here.
  • To learn more about disparities of men, suicide, and mental health, go here:  Movember National Men’s Health Campaign.

Any other useful links?

Disclaimer: This article is intended to be informative only. It is advised that you check with your own physician/mental health provider before implementing any changes. With this article, the author is not rendering medical advice, nor diagnosing, prescribing, or treating any condition, or injury; and therefore claims no responsibility to any person or entity for any liability, loss, or injury caused directly or indirectly as a result of the use, application, or interpretation of the material presented.

References:

  1. Brand J. (2012). Digital Australia (2012). National Research Prepared by Bond University for the Interactive Games and Entertainment Association. School of Communication and Media, Faculty of Humanities and Social Sciences, Bond University.
  2. Hussain Z, Griffiths MD, Baguley T. Online gaming addiction: classification, prediction and associated risk factors. Addict Res Theory. 2012;20:359-371.
  3. Younes F, Halawi G, Jabbour H, et al. Internet addiction and relationships with insomnia, anxiety, Depression, stress and self-esteem in university students: a cross-sectional designed study. PLoS One. 2016;11:e0161126
  4. Catherine So-Kum Tang, PhD, Yee Woen Koh, PhD, and YiQun Gan, PhD Asia Pacific Journal of Public Health Vol 29, Issue 8, pp. 673 – 682 First Published November 30, 2017 https://doi.org/10.1177/1010539517739558
  5. American Psychiatric Association: Diagnostic and StatisticalManual of Mental Disorders, 5th ed. Washington, DC, American Psychiatric Publishing, 2013Section III (“Emerging Measures and Models”) of DSM-5 (1, pp. 795–796).
  6. Andrew K. Przybylski, Ph.D., Netta Weinstein, Ph.D., Kou Murayama, Ph.D. Internet Gaming Disorder: Investigating the Clinical Relevance of a New Phenomenon. Am J Psychiatry 2017; 174:230–236; doi: 10.1176/appi.ajp.2016.16020224.

Digital Media and Inattention Symptoms

By R. Ryan S Patel DO, FAPA OSU-CCS Psychiatrist

While there are many positive benefits of media consumption, excessive consumption can have negative consequences.

The average American consumer spends about 4.9 hours per day watching TV, 75 minutes per day on their smartphone and 62 minutes per day listening to radio (1). Many people spend most of their workday working on a computer.

TV and video gaming has been associated with adhd and related symptoms in a review of studies from 1987 to 2011 (2).

A recent study looked at many forms of digital media usage and adhd type symptoms (2).

Who was involved in the study? (3)

  • 4100 students ages 15 and 16 years were followed for 2 years.
  • Starting baseline and every 6 months, they were given surveys on digital media usage, inattention and hyperactivity.

How did the study define digital media (3)?

In this study digital media usage included using a variety of devices for social media, smart phone usage, streaming media, web browsing, messaging/video chatting, etc.

How did they define frequency of digital media usage? (3)

High-frequency (many times per day) vs other frequency levels (0, 1-2 times per week, 1-2 times per day).

What were the results? (3)

  • Among students with no adhd symptoms to begin with, those who used digital media at high frequency were more as likely to report symptoms of inattention and hyperactivity compared to those use rarely used digital media.
  • The most common high frequency media activity reported was checking social media.
  • Over 2 years of  follow up, the students who reported no high-frequency media use at baseline were half as likely to have ADHD symptoms across follow-ups vs students who reported 14 high-frequency activities.

What are some caveats?

  • This is a large study of young adults followed over 2 years.
  • They looked at many participants with little or no adhd symptoms to begin with.
  • While this study shows an association between digital media usage and adhd symptoms, it does not necessarily show that one causes the other.
  • This study was done on adolescents, which limits applicability of results to other age groups.
  • Further study is needed.

What are some negative consequences of excessive screen time?

Excessive screen time can (4):

  • Worse executive functioning
  • Increase aggressive behavior due to violent media content
  • Elevate depression risk
  • Decrease sleep quality.

Some individuals may also spend less time sleeping because of screen usage; which can worsen daytime fatigue and productivity.

Other studies show that screen time can also worsen the physical health of adults in many different ways.

Oftentimes, excessive media consumption can take time away from other self-care activities.

Are there some useful ideas around media usage?

American Academy of Pediatrics guidelines on media use for children and adolescents advise to (6,7):

  • Prioritize activities that promote executive functioning and well-being, including
    • Sleep
    • Physical activity
    • Distraction-free homework
    • And positive interactions with family and friends.
  • Encourages discussions about pro-social uses of media, digital citizenship, misinformation, and persuasion awareness—are relevant to the cognitive and emotional reactions to digital media of adolescents.

Consider periodic breaks, and rules around how often and how much media you consume electively.

  • Consider limiting elective screen-time to less than 2 hours per day (5).  Focus on quality instead of quantity.
  • Some people find it useful to use a timer.
  • There are apps that can help you limit excessive screen time.
  • For other tips, go here
  • In some cases excessive media consumption may be a red flag for mental health concerns.

Any other thoughts on media consumption?

  • While there are no specific guidelines for adults, if most of your day studying or working in front of a screen, choosing to spend leisurely time spent on other electronic devices, phones, tablets etc. may not balance your life or your brain.  It may lead to increased stress and fatigue.
  • How much time are you spending on electronic devices? Is this making you productive or just busy?
  • How do you feeling during and afterwards?
  • How is this impacting your mental health, physical health, productivity, academics ?
  • Have you set limits on elective media consumption and should you cut back?
  • Should you be doing other activities to balance your life; such as sleep, exercise, cooking nutritious food, spending quality time with others, etc. ?

Disclaimer: This article is intended to be informative only. It is advised that you check with your own physician/mental health provider before implementing any changes. With this article, the author is not rendering medical advice, nor diagnosing, prescribing, or treating any condition, or injury; and therefore claims no responsibility to any person or entity for any liability, loss, or injury caused directly or indirectly as a result of the use, application, or interpretation of the material presented.

References:

  1. https://www.statista.com/topics/1536/media-use/
  2. Nikkelen  SW, Valkenburg  PM, Huizinga  M, Bushman  BJ.  Media use and ADHD-related behaviors in children and adolescents: a meta-analysis.  Dev Psychol. 2014;50(9):2228-2241. doi:10.1037/a0037318
  3. Ra CK, Cho J, Stone MD, et al. Association of Digital Media Use With Subsequent Symptoms of Attention-Deficit/Hyperactivity Disorder Among Adolescents. JAMA. 2018;320(3):255–263. doi:10.1001/jama.2018.8931
  4. Reid Chassiakos Y., Radesky J., Christakis D., et al: Children and Adolescents and Digital Media. Elk Grove Village (IL): The American Academy of Pediatrics, 2016.
  5. https://www.nhlbi.nih.gov/health/educational/wecan/reduce-screen-time/index.htm
  6. Radesky J. Digital Media and Symptoms of Attention-Deficit/Hyperactivity Disorder in Adolescents. JAMA.2018;320(3):1–2. doi:10.1001/jama.2018.8932
  7. Media Use in School-Aged Children and Adolescents. COUNCIL ON COMMUNICATIONS AND MEDIA. Pediatrics Oct 2016, e20162592; DOI: 10.1542/peds.2016-2592

Do Energy drinks help or hurt your attention?

By R. “Ryan” S Patel DO, FAPA, OSU-CCS Psychiatrist

energy drinks

About 16% of young adults and teenagers consumed at least one energy drink in the past 7 days (1). Some students consume energy drinks for many perceived benefits. But what if energy drinks could actually hurt your attention?

What does this study show?
A recent study (2) of 1649 middle school students found that energy drink consumption was associated with 66% greater risk for hyperactivity and inattention. In other words, energy drinks may be impacting inattention and hyperactivity, which could also hurt your ability to concentrate. This might be important if you are trying to study for classes, be organized so that you can meet deadlines, conduct research, etc.

Do the results account for individual differences?
The effect remained even after accounting for differences in multiple variables.
It is important to consider that energy drinks contain both caffeine and sugar.

Are caffeine or sugar causing difficulties with your attention or hyperactivity?
How do you know? Have you tried reducing or eliminating your caffeine/sugar intake and looked at the impact on your attention or hyperactivity?
Disclaimer: This article is intended to be informative only. It is advised that you check with your own physician/mental health provider before implementing any changes. With this article, the author is not rendering medical advice, nor diagnosing, prescribing, or treating any condition, or injury; and therefore claims no responsibility to any person or entity for any liability, loss, or injury caused directly or indirectly as a result of the use, application, or interpretation of the material presented.
References:
1. Emod, JA, et al. Energy Drink Consumption and the Risk of Alcohol Use Disorder among a National Sample of Adolescents and Young Adults. J Pediatr 2014;165:1194-200
2. Schwartz DL et al. Academic Pediatrics 2015 Feb 8. Energy Drinks and Youth Self-Reported Hyperactivity/Inattention Symptoms. DOI: http://dx.doi.org/10.1016/j.acap.2014.11.006