Annotated Bibliography 3

ORIGINAL PAPER

Is time spent playing video games associated with mental health, cognitive and social skills in young children?

Viviane Kovess-Masfety1,9 • Katherine Keyes2 • Ava Hamilton2 • Gregory Hanson2 •

Adina Bitfoi3 • Dietmar Golitz4 • Ceren Koç5 • Rowella Kuijpers6 •

Sigita Lesinskiene7 • Zlatka Mihova8 • Roy Otten6 • Christophe Fermanian1 •

Ondine Pez1

Received: 13 October 2015 / Accepted: 17 January 2016 / Published online: 5 February 2016

� Springer-Verlag Berlin Heidelberg 2016

Abstract

Background Video games are one of the favourite leisure

activities of children; the influence on child health is usu-

ally perceived to be negative. The present study assessed

the association between the amount of time spent playing

video games and children mental health as well as cogni-

tive and social skills.

Methods Data were drawn from the School Children

Mental Health Europe project conducted in six European

Union countries (youth ages 6–11, n = 3195). Child

mental health was assessed by parents and teachers using

the Strengths and Difficulties Questionnaire and by chil-

dren themselves with the Dominic Interactive. Child video

game usage was reported by the parents. Teachers evalu-

ated academic functioning. Multivariable logistic regres-

sions were used.

Results 20 % of the children played video games more

than 5 h per week. Factors associated with time spent

playing video games included being a boy, being older, and

belonging to a medium size family. Having a less educated,

single, inactive, or psychologically distressed mother

decreased time spent playing video games. Children living

& Viviane Kovess-Masfety [email protected]; [email protected]

Katherine Keyes

[email protected]

Ava Hamilton

[email protected]

Gregory Hanson

[email protected]

Adina Bitfoi

[email protected]

Dietmar Golitz

[email protected]

Ceren Koç

[email protected]

Rowella Kuijpers

[email protected]

Sigita Lesinskiene

[email protected]

Zlatka Mihova

[email protected]

Roy Otten

[email protected]

Christophe Fermanian

[email protected]

Ondine Pez

[email protected]

1 EHESP, Paris Descartes University, EA 4057 Paris, France

2 Mailman School of Public Health, Columbia University,

New York, NY, USA

3 The Romanian League for Mental Health, Bucharest,

Romania

4 Institute of Psychology, University of Koblenz-Landau

(Campus Koblenz), Koblenz, Germany

5 Yeniden Health and Education Society, Istanbul, Turkey

6 Behavioural Science Institute, Radboud University,

Nijmegen, The Netherlands

7 Clinic of Psychiatry, Faculty of Medicine, University of

Vilnius, Vilnius, Lithuania

8 New Bulgarian University, Sophia, Bulgaria

9 EHESP, rue du Pr Leon Bernard, 35043 Rennes, France

123

Soc Psychiatry Psychiatr Epidemiol (2016) 51:349–357

DOI 10.1007/s00127-016-1179-6

in Western European countries were significantly less

likely to have high video game usage (9.66 vs 20.49 %)

though this was not homogenous. Once adjusted for child

age and gender, number of children, mothers age, marital

status, education, employment status, psychological dis-

tress, and region, high usage was associated with 1.75

times the odds of high intellectual functioning (95 % CI

1.31–2.33), and 1.88 times the odds of high overall school

competence (95 % CI 1.44–2.47). Once controlled for high

usage predictors, there were no significant associations

with any child self-reported or mother- or teacher-reported

mental health problems. High usage was associated with

decreases in peer relationship problems [OR 0.41

(0.2–0.86) and in prosocial deficits (0.23 (0.07, 0.81)].

Conclusions Playing video games may have positive

effects on young children. Understanding the mechanisms

through which video game use may stimulate children

should be further investigated.

Keywords Mental health � Children � Epidemiology � Gambling

Abbreviations

SDQ Strengths Difficulties Questionnaire

DI Dominic Interactive

SCHME School Children Mental Health Europe

Background

According to the APA Council on Communications and

Media Executive Committee, ‘‘Children and teenagers

spend more time engaged in various media than they do

in any other activity except for sleeping’’. This assess-

ment was based on a 2010 Kaiser Family Foundation

survey of more than 2000 youths 8–18 years old which

revealed that children and teenagers in the US spend an

average of 7 h per day with a variety of media. The

survey further indicated that 70 % of American teenagers

have a TV in their bedroom, and half have a video game

console. The Council recommended limiting media time

to 2 h per day for children and suggested that pediatrician

or family practitioners inquire about media exposure

during visits to educate parents on recommended guide-

lines and on health risks associated with exaggerated

exposure.

In the European Union (EU), video games are very

popular across age groups and socio-economic categories.

An EU council resolution is in place to rate video games

and provide warning labels regarding violence or adult

content, allowing parents to decide which games are

appropriate for their child. This resolution has since been

extended to 20 Member States. However, this rating system

is not in place in four Member States including Cyprus,

Luxembourg, Romania and Slovenia. Furthermore, 15 EU

States have legislation concerning the sale of video games

with adult content to minors in stores, although the scope

of this legislation varies greatly between Member States.

For instance, Germany, Ireland, Italy and the UK have

banned certain violent video games, while other countries

have not. Despite these efforts to control access to violent

or inappropriate games in the EU, no recommendations

have been issued towards physicians to provide guidelines

on how media exposure should be addressed with the

parents during routine health examinations.

The effect of video games on child mental health has

been researched relatively thoroughly over the past few

decades with regard to the time spent playing video

games, and the effects of sometimes violent, ultra-realistic

video games. High media usage (including TV, videos,

computer/internet use and more specifically video games)

has been linked to an increased risk of suicidality and

depression in adolescents [1, 2] and in adults [3] in the

US and in Norway. However, this elevated risk was not

replicated in other countries. A large Canadian study

showed non-significant or even inverse associations

between video game use and depression or binge drink-

ing, while it was significantly associated with increased

risk of obesity [4]. Violent video games were also

reported to desensitize children towards violence and to

decrease morality and empathy [5]. Finally, other studies

reported addictive behavior associated with video games

comparable to substance dependence [6, 7] along with its

negative consequences.

A 1997 meta-analysis [8] indicated that video games

might not lead to aggressive behavior, and suggested that

playing video games may even help children to express

their aggression, suggesting that they could even be used

for health education. However, data from this meta-

analysis were limited to adolescents and young adults, yet

children as young as 8 or younger have access to those

games and have not been thoroughly studied and more

recent data has shown that the influence of media such as

video games and TV on children is not uniformly nega-

tive [9–12]. This is an important gap in the literature

given that patterns of media use may be established

during this developmental window, and it is also a critical

window for the onset of childhood mental health

problems.

To our knowledge, the present study is the first ever to

utilize survey data on more than 3000 European

schoolchildren aged 6–11, across six countries representing

very diverse cultural contexts to investigate the association

between video game use and mental health. The objectives

350 Soc Psychiatry Psychiatr Epidemiol (2016) 51:349–357

123

are (1) to determine the amount of time spent on video

games by primary school children in diverse European

countries, and to examine the determinants of video game

use; (2) to determine whether high video game use is

associated with decrease academic performance; and (3) to

investigate whether high video game use is associated with

mental health problems.

Methods

The School Children Mental Health Europe (SCHME)

study is a cross-sectional survey of European schoolchil-

dren aged 6–11 conducted in 2010. The present study

included data collected in Germany, The Netherlands,

Lithuania, Romania, Bulgaria, and Turkey. Details on

country-specific sampling are provided elsewhere [13].

Briefly, approximately 45–50 schools were approached per

country (a greater number of schools were approached in

Germany and The Netherlands), with varying participation

rates from 6.5 % in The Netherlands and 95.6 % in

Romania. Schools were selected randomly though they

were not selected to be representative of the country.

Classes were then randomly selected within each partici-

pating school. Approximately 48 children were then ran-

domly selected in each school. One exception is in The

Netherlands, where a smaller number of schools partici-

pated and complete classes were included. Parents received

a letter describing the study and a consent form to be

returned to the school. Children were included if they were

present on the day of the assessment, unless their parent

actively refused. Among participating schools, between

50.5 % (Turkey) and 90.5 % (The Netherlands) of eligible

children participated in the study, and between 45.5 %

(The Netherlands) and 90.9 % (Lithuania) of the child

informants (parents and teachers) participated. The total

sample size was 4911 for teacher-reported outcomes and

5115 for mother-reported outcomes. Among those with

both informants, we restricted the dataset to include only

mother respondents 4079 (81.61 % of sample) to maintain

comparability since proportion of fathers largely varies

across countries and gender differences influence most of

the mental heath evaluations and we excluded few kids

aged 5 or 12/13 to concentrate on the 6–11 range.

Respondents for whom data on video games were not

available (n = 884, 21.67 %) were excluded. The final

sample included in the present study is 3195.

Measures

In each country, data were collected from the child, the

teacher and the mother. The mothers completed self-reports

documenting socio-demographic variables such as

household composition (including age, gender and parental

status for each member), parental education (highest level

completed), marital status, occupational level (profession-

ally active vs inactive), as well as the MH5 a subscale of

the SF36 1 [14] assessing psychological distress. In The

Netherlands the same questions were completed electron-

ically using a secured website, though paper questionnaires

were made available upon request.

Video game use

Parents were asked how long their child spends playing

video games on average during the week. We used tertiles

of reported time spent for analyses based on distributions in

the data and preliminary analyses. Low video game use

was defined as 0–60 min per week; moderate use was

defined as 61–300 min, and high use was [300 min.

Mother-reported and teacher-reported mental health status

Child psychopathology was assessed using the Strengths

and Difficulties Questionnaire (SDQ) [15, 16]. The SDQ

has been validated in a number of languages and has been

used extensively in Europe [17–20]. The parent and tea-

cher versions of the SDQ include a brief questionnaire

divided into five subscales for which the author provided

cuts points in order to define normal, doubtful and

probable cases of emotional problems, hyperactivity and

inattention, conduct problems, peer relationship difficul-

ties, and pro-social behaviors. A total difficulties score

was computed, excluding pro-social behaviors and peer

relationship difficulties with cut points for parent and

teacher evaluations. In addition, parents and teachers were

asked to rate the level of impairment caused by the

child’s mental health issues. These responses were scored

as recommended [15]. The present study also considers

probable cases combining parents and teachers answers

plus impairment [21] for three diagnoses as for a pooled

‘‘any diagnosis’’ Subjects were then excluded if they did

not include a mother and teacher response. Of the 4342

subjects with a maternal response, 4079 also had a full

teacher report.

Child-self-reported mental health status

Self-reported mental health was evaluated using a com-

puterized cartoon-like assessment tool known as the ‘‘Do-

minic Interactive’’. The Dominic Interactive (DI) was

designed for young children (6 years old and older), and

consists of 91 cartoons depicting a child named Dominic/

Dominique experiencing a feeling, a thought or an action.

1 http://www.sf-36.org.

Soc Psychiatry Psychiatr Epidemiol (2016) 51:349–357 351

123

A voice-over asks the child if she or he acts, feels or thinks

similarly. Children completed the DI individually on a

computer station at school under the supervision of a

research assistant. A series of yes/no questions provides

greater scope for self-expression [22, 23]. The DI has been

validated in several studies and has been found to be more

reliable than structured interviews in the assessment of

mental health in young children. A recent study established

the construct validity of the DI among the seven partici-

pating countries [24].

Data on suicidal thoughts were directly drawn from two

of the 91 cartoons [25] included in the DI: ‘‘Do you often

think about death or about killing yourself’’ and ‘‘Do you

often think about death or dying?’’.

Academic performance

Academic performance was evaluated by teachers who

answered questions regarding the child’s school perfor-

mance and learning behavior observed in the classroom. It

was formulated as ‘‘compared to the other children in the

class, how does he or she fare in the following areas: school

performance, reading, mathematics, spelling and intellec-

tual functioning?’’ to be classified into five levels from [5]

marked difficulties to [1] very good. An additional question

evaluated the child motivation to succeed at school.

Ethics statement

A personal letter allowing for a written refusal informed

parents. Surveys were completed in anonymity and no

names were available on the questionnaires sent to the

research team.

Each country received the support of their government,

and minister of education and obtained the support of rel-

evant ethical committees. In Bulgaria: The Deputy Minis-

ter of Education, Youth and Science of the Republic of

Bulgaria; in Germany approval was obtained through lan-

ders: (a) Ministry of Education, Science and Culture,

Mecklenburg-Vorpommern (b) State school authority,

Luneburg (c) Ministry of Education and Culture of Sch-

leswig–Holstein country; in Lithuania: the Ministry of

Education and Science of the Republic of Lithuania; in The

Netherlands: the Commission of Faculty Ethical Behavior

Research (ECG); in Romania the Bucharest School

Inspectorate General Municipal, and in Turkey: the Istan-

bul-directorate of National Education.

In addition, ethical committees were given their

approval in each of the countries except Germany where

the school authorization clearly mentioned in its text the

ethical conditions for the authorization and Turkey where

such committee does not exist but a parental signed consent

form was mandatory.

No child was obliged to participate; any refusal to par-

ticipate will have stopped his or her participation.

Statistical analyses

Statistical analyses were performed using SAS V9.3.

Multivariable logistic regressions were performed to assess

the association between mental health outcomes and video

game use adjusting for the child’s sex and age, the number

of children in household, region (Eastern vs Western Eur-

ope), mother’s age, socio-economic status, marital status,

mother’s psychological distress. Statistical significance

was evaluated using 0.05-level. Odds ratios are shown with

the corresponding 95 % confidence interval. Data were

weighted to correct for size of schools and probability of

child selection.

Results

Sample characteristics

A table available online presents the demographic char-

acteristics of the final sample. There were significant dif-

ferences with regard to age with a higher mean age in

Eastern Europe (8.72 years). Differences were also

observed regarding gender and number of children in the

family with Eastern Europe having a higher percentage of

families with four or more children. In addition, the Wes-

tern European sample had a significantly lower percentage

of mothers living apart from the father when compared to

Eastern Europe. Mothers in the sample were also signifi-

cantly more educated in Western Europe as well as sig-

nificantly older with an average age of 40.52 years.

Video game use

Overall, 20 % of the children were in the high usage group

defined as spending more than 5 h a week playing video

games, 39 % spent less than 1 h a week using video games

and 40 % between 1 and 5 h a week. Among the high

usage category, very few children played more than 20 h

(0.69 %), 4.32 % played 10–20 h, 6.89 % 7–10 h, and

8.11 % between 5 and 7 h. The remaining, 59.47 % played

more than 7 h and 20 % more than 10 h.

Table 1 shows that most demographic characteristics

were associated with video-game usage. Factors associated

with increased usage included being a boy, being older,

belonging to a medium size family. Conversely, a less

educated, single, inactive, or psychologically distressed

mother decreases the probability of high usage. Children

living in Western European countries were significantly

less likely to be high users as compared to their Eastern

352 Soc Psychiatry Psychiatr Epidemiol (2016) 51:349–357

123

Table 1 Demographics by Video Game use category

Demographic characteristic Subcategory Less than 1 h or 1 h/week Greater than 1–5 h/week Greater than 5 h/week p value

Total sample size (n = 1254) (n = 1294) (n = 636)

Age of child Mean age 8.5 8.83 9 \0.01 6 55.65 28.87 15.47

7 51.92 36.66 11.43

8 44.61 35.12 20.27

9 41.16 38.79 20.05

10 34.03 42.16 23.8

11 26.29 46.52 27.19

Demographic characteristic Subcategory Less than 1 h or 1 h/week Greater than 1–5 h/week Greater than 5 h/week p value

Total sample size (n = 1258) (n = 1298) (n = 639)

Sex of child Girl 47.43 35.73 16.84 \0.01 Boy 35.97 41.41 22.62

Demographic characteristic Subcategory Less than 1 h or 1 h/week Greater than 1–5 h/week Greater than 5 h/week p value

Total sample size (n = 1258) (n = 1298) (n = 639)

Number of children in family 1 39.89 41.5 18.61 \0.01 2 or 3 39.32 39.86 20.82

C4 51.65 29.89 18.46

Demographic characteristic Subcategory Less than 1 h or 1 h/

week

Greater than 1–5 h/

week

Greater than 5 h/

week

p value

Total sample size (n = 1161) (n = 1223) (n = 601)

Mother’s highest level of

education

College completed 66.07 25.64 8.28 \0.01 Secondary

completed

51.19 31.15 17.65

Some secondary 39.09 39.06 21.86

None/primary 33.81 44.38 21.8

Other 50.26 34.71 15.03

Demographic characteristic Subcategory Less than 1 h or 1 h/week Greater than 1–5 h/week Greater than 5 h/week p value

Total sample size (n = 1253) (n = 1298) (n = 635)

Age of mother Mean age 35.73 35.83 35.79 \0.01 B35 42.68 38.31 19.01

[35, B40 38.74 39.02 22.24 [40 41.79 40.19 18.01

Demographic characteristic Subcategory Less than 1 h or 1 h/week Greater than 1–5 h/week Greater than 5 h/week p value

Total sample size (n = 1253) (n = 1298) (n = 635)

Maternal psychological distress Psych distress 40.36 39.41 20.23 \0.01 No psych distress 44.15 36.65 19.2

Demographic characteristic Subcategory Less than 1 h or 1 h/week Greater than 1–5 h/week Greater than 5 h/week p value

Total sample size (n = 1210) (n = 1256) (n = 622)

Maternal activity Active 37.99 41.39 20.63 \0.01 Inactive 46.21 35.74 18.05

Soc Psychiatry Psychiatr Epidemiol (2016) 51:349–357 353

123

European peers (9.66 vs 20.49 %),though this pattern was

not homogenous.

Video game usage, academic performance

and motivation to succeed

High usage was associated with good intellectual func-

tioning and academic achievement (Table 2). The positive

associations included competence in reading (p = 0.05),

mathematics (p = 0.0031), and spelling (p = 0.002).

Motivation to succeed at school did not vary as a function

of usage (data not shown).

Once adjusted for child age and gender, number of

children, mother’s age, marital status, education, employ-

ment status, psychological distress, and European Region

(West/East), high usage was associated with increased odds

of elevated intellectual functioning (aOR 1.58 (1.22, 2.05)

[0.001]), and high overall competence (aOR 1.67 (1.31,

2.12) [\0.001]) (Table 2), moderate usage as well but to a lesser extend.

Video games and child mental health

Table 3 shows that in univariate analyses, playing video

games was associated with a lower prevalenceofself-reported

internalizing disorders and fewer reports of thoughts of death.

However, once adjusted for child age and gender, number of

children, mother’s age, marital status, education, employment

status, psychological distress, and European Region (West/

East), these differences were no longer significant.

There were no significant associations with any SDQ

dimension: emotional, ADHD, conduct, peer relationship,

Table 1 continued

Demographic characteristic Subcategory Less than 1 h or 1 h/week Greater than 1–5 h/week Greater than 5 h/week p value

Total sample size (n = 1205) (n = 1270) (n = 620)

Mother’s marital status In couple 39.85 39.69 20.46 \0.01 Single 46.32 36.4 17.27

Demographic characteristic Subcategory Less than 1 h or 1 h/week Greater than 1–5 h/week Greater than 5 h/week p value

Total sample size (n = 1258) (n = 1298) (n = 639)

Country Bulgaria 39.82 36.27 23.91 \0.01 East Germany 53.7 40.38 5.92

West Germany 59.4 37.05 3.55

Lithuania 47.37 30.45 22.18

The Netherlands 38.43 47.54 14.03

Romania 31.03 48.87 20.1

Turkey 45.11 43.34 11.55

Demographic characteristic Subcategory Less than 1 h or 1 h/week Greater than 1–5 h/week Greater than 5 h/week p value

Total sample size (n = 1258) (n = 1298) (n = 639)

Region East 41.11 38.4 20.49 \0.01 West 47.17 43.17 9.66

Intellectual functioning High 64.03 69.96 77.35 0.000

Low/average 35.97 30.04 22.65

School achievement High 53.15 60.28 68.72 0.000

Low/average 46.85 39.72 31.28

Table 2 Intellectual functioning and school competences and video games

Teacher Unadjusted Adjusted a

High intellectual functioning vs low or average

1–5 h of

usage

1.34 (1.13, 1.59) [0.001] 1.25 (1.03, 1.53) [0.028]

[5 h of usage

1.82 (1.46, 2.28) [\0.001] 1.58 (1.22, 2.05) [0.001]

School competence high vs low or average

1–5 h of

usage

1.36 (1.16, 1.60) [\0.001] 1.38 (1.14, 1.67) [0.001]

[5 h of usage

1.83 (1.49, 2.25) [\0.001] 1.67 (1.31, 2.12) [\0.001]

a Adjusted child age and gender, number of children, mothers age,

marital status, maternal education, activity status, psychological dis-

tress, European Region (West/East)

354 Soc Psychiatry Psychiatr Epidemiol (2016) 51:349–357

123

total difficulties as reported separately by the mother or the

teacher (tables on request).

Children whose mother and teacher both reported as

having problems with peer relationships or with an ele-

vated total difficulties score were less likely to be in the

high usage group (Table 4). Once adjusted for child age

and sex, number of children, mother’s age, marital status,

education, employment status, psychological distress and

regions, the association between combined mother and

teacher evaluations of peer relationship problems and odds

of high video game usage remained (aOR 0.41, 95 % CI

0.2–0.86) as well as the one with total difficulties (aOR

0.41, 95 % CI 0.2–0.86). Prosocial deficits were also

milder among those with moderate video game usage (OR

0.23, 95 % CI 0.07–0.81).

Discussion

In a sample of over 3000 young children across six Euro-

pean countries, high video game usage (playing video

games more than 5 h per week) was significantly associ-

ated with higher intellectual functioning, increased aca-

demic achievement, a lower prevalence of peer relationship

problems and a lower prevalence of mental health diffi-

culties. High video game usage was not associated with an

increase of conduct disorder or any externalizing disorder

nor was it associated with suicidal thoughts or thoughts of

death. Controlling for demographic and other risk factors

explained part of the association between video game use

Table 3 Child Mental health self evaluation (DI) in relation to video game playing (1–5, and 5? vs 1 or less h)

Children DI Unadjusted Adjusted a

External dx

1–5 h of usage 0.95 (0.64, 1.42) 0.93 (0.6, 1.44)

[5 h of usage 0.86 (0.52, 1.44) 0.74 (0.42, 1.33) Internal dx

1–5 h of usage 0.75 (0.59, 0.97) [0.03]

0.88 (0.66, 1.17)

[5 h of usage 0.72 (0.53, 0.99) [0.05]

0.85 (0.59, 1.22)

Specific phobia

1–5 h of usage 0.8 (0.53, 1.22) 1.11 (0.68, 1.81)

[5 h of usage 0.67 (0.39, 1.13) 0.99 (0.54, 1.8) Separation anxiety

1–5 h of usage 0.76 (0.57, 1.03) 0.87 (0.63, 1.21)

[5 h of usage 0.68 (0.45, 1.01) 0.73 (0.45, 1.17) GAD

1–5 h of usage 1.08 (0.69, 1.7) 1.21 (0.73, 1.99)

[5 h of usage 0.95 (0.53, 1.69) 1.15 (0.6, 2.18) Depression

1–5 h of usage 1.35 (0.82, 2.2) 1.42 (0.82, 2.45)

[5 h of usage 1.04 (0.56, 1.96) 1.05 (0.52, 2.12) Oppositional dx

1–5 h of usage 1.39 (0.78, 2.47) 1.24 (0.7, 2.18)

[5 h of usage 1.35 (0.69, 2.67) 1.08 (0.5, 2.31) ADHD

1–5 h of usage 1.14 (0.63, 2.05) 1.12 (0.61, 2.06)

[5 h of usage 1.04 (0.48, 2.23) 1.12 (0.51, 2.44) Conduct Dx

1–5 h of usage 0.76 (0.42, 1.37) 0.78 (0.4, 1.51)

[5 h of usage 0.6 (0.28, 1.29) 0.43 (0.18, 1.05) Think about suicide

1–5 h of usage 0.83 (0.64, 1.07) 1.11 (0.88, 1.39

[5 h of usage 0.87 (0.63, 1.18) 1.15 (0.86, 1.51 Thoughts of death

1–5 h of usage 1.01 (0.80, 1.28) 1.06 (0.81, 1.4)

[5 h of usage 0.68 (0.50, 0.92) [0.01]

0.76 (0.54, 1.06)

Bold indicates significance at 0.05 and above a Adjusted child age and gender, number of children, mothers age,

marital status, maternal education, activity status, psychological dis-

tress, European Region (West/East)

Table 4 Parent and teacher combined SDQ variables in relation to video game playing

Parent and teacher Unadjusted Adjusted a

Emotional

1–5 h of usage 0.87 (0.41, 1.84) 1.14 (0.42, 3.1)

[5 h of usage 0.7 (0.3, 1.63) 0.79 (0.26, 2.42) ADHD

1–5 h of usage 1.05 (0.66, 1.67) 1.03 (0.59, 1.8)

[5 h of usage 0.67 (0.37, 1.21) 0.61 (0.31, 1.19) Conduct

1–5 h of usage 0.82 (0.52, 1.29) 0.97 (0.54, 1.73)

[5 h of usage 0.73 (0.43, 1.25) 0.66 (0.33, 1.3) Any pb with impact

1–5 h of usage 0.89 (0.41, 1.95) 1.29 (0.47, 3.53)

[5 h of usage 0.43 (0.17, 1.07) 0.67 (0.2, 2.21) Prosocial

1–5 h of usage 0.43 (0.14, 1.37) 0.23 (0.07, 0.81) [0.02]

[5 h of usage 0.81 (0.26, 2.51) 1.09 (0.31, 3.9) Peer relationship

1–5 h of usage 0.68 (0.41, 1.11) 0.83 (0.44, 1.57)

[5 h of usage 0.35 (0.18, 0.7) [<0.01]

0.43 (0.19, 0.99) [0.05]

Total difficulties

1–5 h of usage 0.75 (0.46, 1.23) 0.97 (0.5, 1.88)

[5 h of usage 0.5 (0.27, 0.92) [0.03]

0.41 (0.2, 0.86) [0.02]

Bold indicates significance at 0.05 and above a Adjusted child age and gender, number of children, mothers age,

marital status, maternal education, activity status, psychological dis-

tress, European Region (West/East)

Soc Psychiatry Psychiatr Epidemiol (2016) 51:349–357 355

123

and protective associations in mental health and cognitive

function, nevertheless all these relations particularly cog-

nitive functioning persisted despite control.

These findings are in line with several studies. Dorman

[8] reviewed several studies conducted on children which

reported that video gaming seemed to increase prosocial

skills. For example, in a free play setting, young children

(ages 4–6) displayed an increase in violent behavior as well

as in prosocial behaviors after playing violent games.

A Japanese study of kindergarten children found that those

who played video games had more friends and were more

willing to talk to others [26].

More recently, a literature review [27] described the

‘‘social benefits of gaming’’. The authors concluded that

playing video games is today, even more so than in the past

two decades, a highly social activity for most children as the

vast majority of children play their video games with a

friend. Some games explicitly reward effective cooperation,

supporting and helping behavior [28]. In addition, playing

prosocial video games increased prosocial behaviors: chil-

dren who frequently played prosocial video games were

more inclined to engage in helpful behavior later in the year

[29]. Children who engaged in social interactions while

playing video games were also more likely to take an interest

in civic engagement once adults. Violent and nonviolent

games appear to be equally predictive of such involvement.

The same review [27] reported cognitive benefits of video

games as children developed problem-solving skills and

enhanced creativity. In addition, children seemed to develop

beliefs about their intelligence and abilities that affected

their level of achievement, which extended beyond their

performance on video games and applied to school activities.

An important future direction of this work is to determine

whether there are differential associations between video

game playing and childhood health outcomes depending on

the content of the game; for example, whether violent con-

tent specifically vs more complex cognitive problems solv-

ing tasks differently predict health outcomes.

Several limitations should be considered when inter-

preting the findings. First, due to the cross-sectional nature

of the SCMHE study, we cannot establish temporality

between video game usage and mental health outcomes.

Second, video game usage was reported by the mother,

which may have led to an overestimation or underestima-

tion of the time spent playing video games. We did not

assess children’s own perception of their time spent. While

this information would be useful as corroborative evidence,

children may not be accurate reporters of time spent

playing, compared with parents who most likely manage

children’s schedules. Third, mental health symptoms were

assessed via self report of the mother, teacher, and children

themselves, but not by trained clinicians. While clinician

assessments would be informative, assessments by multiple

reporters increase the reliability and validity of the infor-

mation we obtain in the present study. Finally, the overall

participation rate is a concern as only 21.67 % of eligible

families did not respond to the video game question.

Missing data are mainly due to data collected in Turkey,

where only 55.67 % responded to video game-related

questions, whereas in the remaining countries the response

rate was between 70 and 80 %. That being said, the anal-

yses controlled for the main socio-demographics variables,

which differentiated respondents from non-respondents,

correcting much of the potential bias.

Conclusion

The results of the present study suggest that video game

use is not associated with an increased risk of mental health

problems. On the contrary, the data presented here suggest

that video games are a protective factor, especially

regarding peer relationship problems for the children who

are the most involved in video games. Finally, video games

seem to be linked to better intellectual functioning and

academic achievement.

According to our data, video gaming is entirely benefi-

cial for cognitive functioning as well as for some aspects of

mental health. However, the cross-sectional nature of the

survey precludes us from drawing conclusions on the long-

term effects of high video game usage. Longitudinal

studies are needed to monitor mental health, cognitive and

social functioning through adolescence and into early

adulthood to ensure that the positive effects observed in

children are maintained later in life.

Acknowledgments This project had been financed by the European Union, Grant Number 2006336. The funders had no role in study

design, data collection and analysis, decision to publish, or prepara-

tion of the manuscript. We would like to thank the SCMHE group and

everyone that contributed to the European report including inter-

viewers who worked in the participating countries. In addition, we

would like to thank the parents, young people, and teachers for their

cooperation in contributing to the survey. Special thanks for Jean-

Pierre Valla, for making the Dominic Interactive available in the

participating countries languages.

Compliance with ethical standards

Conflict of interest The authors have declared that no competing interests exist.

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