Comorbid Depression Interferes with Emotional Regulation in Adolescents with Internet Gaming Disorder

Junghan Lee; Seojung Lee; Ji Won Chun; Hyun Cho; Dai-Jin Kim; Young-Chul Jung

doi:10.4306/jknpa.2015.54.3.322

Journal List > J Korean Neuropsychiatr Assoc > v.54(3) > 1017748

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Lee, Lee, Chun, Cho, Kim, and Jung: Comorbid Depression Interferes with Emotional Regulation in Adolescents with Internet Gaming Disorder

Original Article

Journal of Korean Neuropsychiatric Association 2015; 54(3): 322-329.

Published online: 21 August 2015

DOI: https://doi.org/10.4306/jknpa.2015.54.3.322

Comorbid Depression Interferes with Emotional Regulation in Adolescents with Internet Gaming Disorder

Junghan Lee, MD^1,², Seojung Lee, MD², Ji Won Chun, PhD³, Hyun Cho³, Dai-Jin Kim, MD, PhD³, Young-Chul Jung, MD, PhD^1,²

¹Department of Psychiatry, Yonsei University College of Medicine, Seoul, Korea.

²Institute of Behavioral Science in Medicine, Yonsei University College of Medicine, Seoul, Korea.

³Department of Psychiatry, Seoul St. Mary's Hospital, The Catholic University of Korea College of Medicine, Seoul, Korea.

Address for correspondence: Young-Chul Jung, MD, PhD. Department of Psychiatry, Yonsei University College of Medicine, 50-1 Yonsei-ro, Seodaemun-gu, Seoul 03722, Korea. Tel +82-2-2228-1620, Fax +82-2-313-0891, eugenejung@yuhs.ac

Address for correspondence: Dai-Jin Kim, MD, PhD. Department of Psychiatry, The Catholic University of Korea College of Medicine, 222 Banpo-daero, Seocho-gu, Seoul 06591, Korea. Tel +82-2-2258-6086, Fax +82-2-594-3870, kdj922@chollian.net

Received 10 March 2015 Revised 13 May 2015 Accepted 1 June 2015

Abstract

Objectives

We investigated the effects of depression on emotional regulation in adolescents with internet gaming disorder.

Methods

A stroop Match-to-Sample task with emotional interference was applied to 36 male adolescents to investigate how emotional stimuli (angry faces) interfered with performance of the stroop task in male adolescents with internet gaming disorder. For evaluation of psychiatric symptoms and personal characteristics, participants were asked to complete self-reports, including Beck Depression Inventory (BDI), Beck Anxiety Inventory, Barratt Impulsiveness Scale, and the Aggression Questionnaire.

Results

In emotionally interfered conditions, there was no significant difference of reaction time between the internet gaming disorder group and the healthy control group. However, the internet gaming disorder group showed a tendency of longer reaction time and lower accuracy rate in emotionally interfered condition, which can account for emotion regulation difficulties in the internet gaming disorder group. According to analysis of covariance and stepwise multiple linear regression analysis, BDI score showed association with reaction time of results.

Conclusion

These results indicate that adolescents with internet gaming disorder may experience more difficulties in emotion regulation during attention-required situations than those in the control group, and comorbid depression contributes to faulty emotional regulation in adolescents with internet gaming disorder.

Keywords: Internet gaming disorder, Adolescents, Emotion regulation, Depression

Figures and Tables

Fig. 1

Stroop Match-to-Sample Task with emotional interference. Colored cue were displayed for 500 ms followed by interferer of 1700 ms. We used angry faces in emotion interfering condition as interferer and grey plate in neutral condition. The target word was either congruent or incongruent (for example, the target word 빨강, which means RED in Korean, was written in red font in congruent condition ; otherwise the target 파랑, which means BLUE in Korean, was written in red or green font in incongruent condition). Inter-trial interval was 1200 ms.

Table 1

Demographic and clinical characteristics of subjects

^*: Verbal Intelligence Quotient (IQ) was assessed with the Wechsler Adult Intelligence Scale (Vocabulary), ^†: Performance Intelligence Quotient (IQ) was assessed with the Wechsler Adult Intelligence Scale (Block design). BDI: Beck Depression Inventory, BAI: Beck Anxiety Inventory, BIS: Barratt Impulsiveness Scale

Table 2

Behavioral performance of subjects

^*: In trials with emotional interference, angry faces were presented between the cue and target word during the inter-stimulus interval. By contrast, in trials without emotional interference, grey squares were presented during the inter-stimulus interval

Table 3

Differences in reaction time between groups after adjusted for covariates

BDI: Beck Depression Inventory, BAI: Beck Anxiety Inventory, BIS: Barratt Impulsiveness Scale, AQ: Aggression Questionnaire

Table 4

Differences in accuracy between groups after adjusted for covariates

BDI: Beck Depression Inventory, BAI: Beck Anxiety Inventory, BIS: Barratt Impulsiveness Scale, AQ: Aggression Questionnaire

Table 5

Association of reaction time with BDI, BAI, BIS_c, AQ_pa, AQ_host

BDI: Beck Depression Inventory, BAI: Beck Anxiety Inventory, BIS_c: Barratt Impulsiveness Scale_cognitive impulsiveness, AQ_pa : Aggression Questionnaire_physical aggression, AQ_host: Aggression Questionnaire_hostility

Table 6

Association of accuracy with BDI, BAI, BIS_c, AQ_pa, AQ_host

BDI: Beck Depression Inventory, BAI: Beck Anxiety Inventory, BIS_c: Barratt Impulsiveness Scale_cognitive impulsiveness, AQ_pa: Aggression Questionnaire_physical aggression, AQ_host: Aggression Questionnaire_hostility

Acknowledgments

This study was supported by a grant of the Korean Mental Health Technology R&D Project, Ministry of Health & Welfare, Republic of Korea (HM14C2578).

Notes

^{Conflicts of Interest} The authors have no financial conflicts of interest.

References

1. American Psychiatric Association. Diagnostic and statistical manual of mental disorders: DSM-5. 5th ed. Washington, DC: American Psychiatric Association;2013.

2. Grant JE, Potenza MN, Weinstein A, Gorelick DA. Introduction to behavioral addictions. Am J Drug Alcohol Abuse. 2010; 36:233–241.

3. Heo J, Oh J, Subramanian SV, Kim Y, Kawachi I. Addictive internet use among Korean adolescents: a national survey. PLoS One. 2014; 9:e87819.

4. Rehbein F, Kliem S, Baier D, Möβle T, Petry NM. Prevalence of Internet gaming disorder in German adolescents: diagnostic contribution of the nine DSM-5 criteria in a state-wide representative sample. Addiction. 2015; 110:842–851.

5. Bozkurt H, Coskun M, Ayaydin H, Adak I, Zoroglu SS. Prevalence and patterns of psychiatric disorders in referred adolescents with Internet addiction. Psychiatry Clin Neurosci. 2013; 67:352–359.

6. Floros G, Siomos K, Stogiannidou A, Giouzepas I, Garyfallos G. Comorbidity of psychiatric disorders with Internet addiction in a clinical sample: the effect of personality, defense style and psychopathology. Addict Behav. 2014; 39:1839–1845.

7. Morrison CM, Gore H. The relationship between excessive Internet use and depression: a questionnaire-based study of 1,319 young people and adults. Psychopathology. 2010; 43:121–126.

8. Yen JY, Ko CH, Yen CF, Wu HY, Yang MJ. The comorbid psychiatric symptoms of Internet addiction: attention deficit and hyperactivity disorder (ADHD), depression, social phobia, and hostility. J Adolesc Health. 2007; 41:93–98.

9. Carli V, Durkee T, Wasserman D, Hadlaczky G, Despalins R, Kramarz E, et al. The association between pathological internet use and comorbid psychopathology: a systematic review. Psychopathology. 2013; 46:1–13.

10. Ho RC, Zhang MW, Tsang TY, Toh AH, Pan F, Lu Y, et al. The association between internet addiction and psychiatric co-morbidity: a meta-analysis. BMC Psychiatry. 2014; 14:183.

11. Ko CH, Yen JY, Yen CF, Chen CS, Chen CC. The association between Internet addiction and psychiatric disorder: a review of the literature. Eur Psychiatry. 2012; 27:1–8.

12. Kim EJ, Namkoong K, Ku T, Kim SJ. The relationship between online game addiction and aggression, self-control and narcissistic personality traits. Eur Psychiatry. 2008; 23:212–218.

13. Park MH, Park EJ, Choi J, Chai S, Lee JH, Lee C, et al. Preliminary study of Internet addiction and cognitive function in adolescents based on IQ tests. Psychiatry Res. 2011; 190:275–281.

14. Park SM, Park YA, Lee HW, Jung HY, Lee JY, Choi JS. The effects of behavioral inhibition/approach system as predictors of Internet addiction in adolescents. Pers Individ Differ. 2013; 54:7–11.

15. Ko CH, Yen JY, Chen CC, Chen SH, Yen CF. Proposed diagnostic criteria of Internet addiction for adolescents. J Nerv Ment Dis. 2005; 193:728–733.

16. Sadock BJ, Kaplan HI, Sadock VA. Kaplan & Sadock's Synopsis of Psychiatry: behavioral sciences/clinical psychiatry. 10th ed. Philadelphia, PA: Lippincott Williams & Wilkins;2007.

17. Davidson RJ, Putnam KM, Larson CL. Dysfunction in the neural circuitry of emotion regulation--a possible prelude to violence. Science. 2000; 289:591–594.

18. Petersen SE, Posner MI. The attention system of the human brain: 20 years after. Annu Rev Neurosci. 2012; 35:73–89.

19. Bench CJ, Frith CD, Grasby PM, Friston KJ, Paulesu E, Frackowiak RS, et al. Investigations of the functional anatomy of attention using the Stroop test. Neuropsychologia. 1993; 31:907–922.

20. Bush G, Frazier JA, Rauch SL, Seidman LJ, Whalen PJ, Jenike MA, et al. Anterior cingulate cortex dysfunction in attention-deficit/hyperactivity disorder revealed by fMRI and the Counting Stroop. Biol Psychiatry. 1999; 45:1542–1552.

21. Harrison BJ, Shaw M, Yücel M, Purcell R, Brewer WJ, Strother SC, et al. Functional connectivity during Stroop task performance. Neuroimage. 2005; 24:181–191.

22. Peterson BS, Skudlarski P, Gatenby JC, Zhang H, Anderson AW, Gore JC. An fMRI study of Stroop word-color interference: evidence for cingulate subregions subserving multiple distributed attentional systems. Biol Psychiatry. 1999; 45:1237–1258.

23. Schulte T, Mueller-Oehring EM, Rosenbloom MJ, Pfefferbaum A, Sullivan EV. Differential effect of HIV infection and alcoholism on conflict processing, attentional allocation, and perceptual load: evidence from a Stroop Match-to-Sample task. Biol Psychiatry. 2005; 57:67–75.

24. Park JY, Oh JM, Kim SY, Lee MK, Lee CR, Kim BR, et al. Korean Facial Expressions of Emotion (KOFEE). Seoul: Section of Affect & Neuroscience, Institute of Behavioral Science in Medicine, Yonsei University College of Medicine;2011.

25. Sin GW, Kim DI, Jeung YI. Third standardization of Korean internet addiction proneness scale. Daegu: National Information Society Agency;2011.

26. Steer RA, Kumar G, Ranieri WF, Beck AT. Use of the Beck Depression Inventory-II with adolescent psychiatric outpatients. J Psychopathol Behav Assess. 1998; 20:127–137.

27. Fydrich T, Dowdall D, Chambless DL. Reliability and validity of the Beck Anxiety Inventory. J Anx Disord. 1993; 6:55–61.

28. Patton JH, Stanford MS, Barratt ES. Factor structure of the Barratt impulsiveness scale. J Clin Psychol. 1995; 51:768–774.

29. Stanford MS, Mathias CW, Dougherty DM, Lake SL, Anderson NE, Patton JH. Fifty years of the Barratt Impulsiveness Scale: An update and review. Pers Individ Dif. 2009; 47:385–395.

30. Buss AH, Perry M. The aggression questionnaire. J Pers Soc Psychol. 1992; 63:452–459.

31. Banich MT, Milham MP, Jacobson BL, Webb A, Wszalek T, Cohen NJ, et al. Attentional selection and the processing of task-irrelevant information: insights from fMRI examinations of the Stroop task. Prog Brain Res. 2001; 134:459–470.

32. Ko CH, Yen JY, Chen CS, Yeh YC, Yen CF. Predictive values of psychiatric symptoms for internet addiction in adolescents: a 2-year prospective study. Arch Pediatr Adolesc Med. 2009; 163:937–943.

33. Scimeca G, Bruno A, Cava L, Pandolfo G, Muscatello MR, Zoccali R. The relationship between alexithymia, anxiety, depression, and internet addiction severity in a sample of Italian high school students. ScientificWorldJournal. 2014; 2014:504376.

34. Dalbudak E, Evren C, Aldemir S, Coskun KS, Ugurlu H, Yildirim FG. Relationship of internet addiction severity with depression, anxiety, and alexithymia, temperament and character in university students. Cyberpsychol Behav Soc Netw. 2013; 16:272–278.

35. Ko CH, Liu TL, Wang PW, Chen CS, Yen CF, Yen JY. The exacerbation of depression, hostility, and social anxiety in the course of Internet addiction among adolescents: a prospective study. Compr Psychiatry. 2014; 55:1377–1384.

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