Gaming

Video gaming is highly prevalent in modern culture, particularly among young people, and a healthy hobby for the majority of users. However, there has been increasing global recognition that maladaptive patterns of video gaming may lead to marked functional impairment and psychological distress for a significant minority of players (see Kim et al., 2008; King & Delfabbro, 2014; Turel et al., 2016). In an increasing number of countries and jurisdictions, the problem has reached the magnitude of a significant public health concern.

Against this background, changes were made to the major psychiatric classification systems. In 2013, clinical descriptions and diagnostic criteria for “Internet gaming disorder” (IGD) were included in the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM‐5; APA, 2013) under the appendix section for conditions requiring further study. From 2014-2019, a series of annual World Health Organization (WHO) expert meetings - in Tokyo (Japan), Seoul (South Korea), Hong Kong (SAR, China), Istanbul (Turkey) and Changsha (China) – were convened on the public health implications of addictive behaviors. These meetings informed the general process and procedures of revising the International Classification System of Diseases (ICD) and, in 2019, gaming disorder was included in ICD-11 under the section ‘Disorders due to addictive behaviors’ (WHO, 2019).

These changes, coupled with the well established limitations of existing gaming instruments (Castro-Calvo et al., 2021; King et al., 2013, 2020) underscore the need for psychometrically robust instruments which distinguish across the spectrum of gaming behaviours, including “regular and otherwise healthy gaming behaviours”, “hazardous gaming” and “gaming disorder.”

Gambling

Gambling is a popular activity in many cultures and has a long-standing history. Even countries that do not offer gambling to its citizens based on religious or cultural grounds, sometimes permit casinos for overseas visitors (e.g., Malaysia, China, and South Korea) (Hodgins et al., 2011).  Although most people engage in gambling as an enjoyable social activity, it can become problematic for some and gambling disorder has long been included in formal disease classification systems. The expansion of legal gambling opportunities has raised public health concerns about gambling behaviour and potential progressions to gambling disorder (Hodgins et al., 2011, Potenza et al., 2019). Several screening and diagnostic instruments have been developed to assess gambling disorder. However, most are based on DSM-IV criteria and have been developed and/or validated in North American adult samples. Developing instruments for gambling that is equivalent across cultures and jurisdictions and reflect ICD-11 diagnostic guidelines would be highly useful. The identification of low- and moderate-risk gamblers is particularly important in light of evidence that the majority of total burden of harm is associated with lower risk categories due to their larger prevalence in the population (Dowling et al., 2018).

The project

The WHO Collaborative Project on the Development of New International Screening and Diagnostic Instruments for Gaming Disorder and Gambling Disorder was established in 2017 at the Fourth WHO Meeting on the Public Health Implications of Addictive Behaviours in Istanbul, Turkey. The purpose of this project is to develop psychometrically robust fully-structured and clinician-administered diagnostic interviews as well as screeners for gaming disorder and gambling disorder. The project is managed by a Working Group and Advisory Group. Members include international clinical and research experts in nosological classification, psychiatry, clinical psychology, internal medicine, family practice, epidemiology, neurobiology, and public health. Advice is also received from gamers.

Expected outcomes and public health relevance

The diagnostic interviews will yield clinical diagnoses, enable identification of prevalence rates across countries and regions, and provide important scaffolding for treatment decisions. The screeners will enable early identification of problems relating to gaming and facilitate early intervention and provision of treatment for individuals and families living with addictive behaviours.

More broadly, once completed, this project will facilitate identification and diagnosis of gaming and gambling disorders. It will contribute to the development of monitoring frameworks by generating comparable epidemiological data and facilitate training and capacity building of health professionals. Further, the new instruments will support clinical practice, and inform the development and evaluation of therapeutic interventions and services required by patients and relatives. Implementation of the project in multiple countries/jurisdictions will help to attract attention to these conditions on national health agendas, increase capacity of health and social services to help people with gaming and gambling disorders, and raise public awareness of the adverse consequences of excessive gaming and gambling. This process will strengthen international collaboration and support networking on clinical and public health dimensions of gaming and gambling. Dissemination of knowledge is a key area for global action at the WHO and, accordingly, the new instruments will be made available in multiple languages to facilitate international use.

References

Gambling

Gambling is a popular activity in many cultures and has a long-standing history. Even countries that do not offer gambling to its citizens based on religious or cultural grounds, sometimes permit casinos for overseas visitors (e.g., Malaysia, China, and South Korea) (Hodgins et al., 2011).  Although most people engage in gambling as an enjoyable social activity, it can become problematic for some and gambling disorder has long been included in formal disease classification systems. The expansion of legal gambling opportunities has raised public health concerns about gambling behaviour and potential progressions to gambling disorder (Hodgins et al., 2011, Potenza et al., 2019). Several screening and diagnostic instruments have been developed to assess gambling disorder. However, most are based on DSM-IV criteria and have been developed and/or validated in North American adult samples. Developing instruments for gambling that is equivalent across cultures and jurisdictions and reflect ICD-11 diagnostic guidelines would be highly useful. The identification of low- and moderate-risk gamblers is particularly important in light of evidence that the majority of total burden of harm is associated with lower risk categories due to their larger prevalence in the population (Dowling et al., 2018).

The project

The WHO Collaborative Project on the Development of New International Screening and Diagnostic Instruments for Gaming Disorder and Gambling Disorder was established in 2017 at the Fourth WHO Meeting on the Public Health Implications of Addictive Behaviours in Istanbul, Turkey. The purpose of this project is to develop psychometrically robust fully-structured and clinician-administered diagnostic interviews as well as screeners for gaming disorder and gambling disorder. The project is managed by a Working Group and Advisory Group. Members include international clinical and research experts in nosological classification, psychiatry, clinical psychology, internal medicine, family practice, epidemiology, neurobiology, and public health. Advice is also received from gamers.

Expected outcomes and public health relevance

The diagnostic interviews will yield clinical diagnoses, enable identification of prevalence rates across countries and regions, and provide important scaffolding for treatment decisions. The screeners will enable early identification of problems relating to gaming and facilitate early intervention and provision of treatment for individuals and families living with addictive behaviours.

More broadly, once completed, this project will facilitate identification and diagnosis of gaming and gambling disorders. It will contribute to the development of monitoring frameworks by generating comparable epidemiological data and facilitate training and capacity building of health professionals. Further, the new instruments will support clinical practice, and inform the development and evaluation of therapeutic interventions and services required by patients and relatives. Implementation of the project in multiple countries/jurisdictions will help to attract attention to these conditions on national health agendas, increase capacity of health and social services to help people with gaming and gambling disorders, and raise public awareness of the adverse consequences of excessive gaming and gambling. This process will strengthen international collaboration and support networking on clinical and public health dimensions of gaming and gambling. Dissemination of knowledge is a key area for global action at the WHO and, accordingly, the new instruments will be made available in multiple languages to facilitate international use.

References