A Test of the Self-Determination Health Behavior Model in Internet Gaming Disorder

A Test of the Self-Determination Health Behavior Model in Internet Gaming Disorder | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article A Test of the Self-Determination Health Behavior Model in Internet Gaming Disorder Haolin Ye, Yanli Wang, Chi Su, Wenxin Xu, Yu Huang, Zhibin Zhou, and 5 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-9297729/v1 This work is licensed under a CC BY 4.0 License Status: Under Review Version 1 posted 5 You are reading this latest preprint version Abstract Introduction: This study aimed to test the Self-Determination Health Behavior Model in Internet Gaming Disorder (IGD), by assessing the mediating role of Basic Psychological Needs (BPN) on the relationship between causality orientations and symptoms of IGD. Methods Data were collected from 1,362 college students through an online survey, using the Chinese versions Internet Gaming Disorder Scale (IGDS), General Causality Orientation Scale for Clinical Populations (GCOS-CP),Generalized Anxiety Disorder Scale (GAD-7), Patient Health Questionnaire (PHQ-9), and the Basic Psychological Needs Satisfaction and Frustration Scale (BPNSFS). Structural Equation Modeling (SEM) was used to assess the mediating effects of BPN satisfaction on the relationship between causality orientations and IGD symptoms. Results 1) the final model confirmed that causality orientations associated with IGD symptoms, through the mediating effects of BPNs Satisfaction/Frustration and anxiety/depression symptoms, which is in line with the prediction of the Self-Determination Health Behavior Model. 2) This pattern was also confirmed when using game craving and game time as the dependent variable separately, suggesting a consistent pattern regarding game-related behaviors. 3) separate models with BPNs satisfaction and BPNs frustration as mediator both exhibited good fit to the data, suggesting similar role of BPNs satisfaction and BPNs frustration in the model. Conclusion This study provides empirical preliminary evidence supporting the application Self-Determination Health Behavior Model in IGD by suggesting a mediating role BPNs satisfaction and frustration on the relationship between causality orientations and IGD symptoms, game craving, and game engagements. These findings emphasizes the importance of considering BPNs in understanding gaming behaviors and their relevance for preventive interventions. Self-Determination Theory Self-Determination Health Behavior Model Causality Orientation Internet Gaming Disorder Basic Psychological Needs Figures Figure 1 Figure 2 Figure 3 Figure 4 Introduction Internet gaming has emerged as a widely enjoyed leisure activity in contemporary society. In China, 52% of its 1123 million netizens are game players (China Internet Network Information 1). Internet Gaming Disorder (IGD) is a behavioral addiction characterized by excessive gaming, loss of control, and impaired social functioning. In 2018, the World Health Organization (WHO) formally recognized IGD (termed Gaming Disorder) as a behavioral addiction by including it in the 11th revision of the International Classification of Diseases (ICD-11). It has gained increasing attention and requires further research to establish diagnostic criteria and treatment methods ( 2 ). IGD is linked to various psychological consequences, such as depression, anxiety, and suicidal thoughts, as well as physical problems like substance abuse, self-harm, and sleep deprivation ( 3 – 11 ), which could arise from persistent and problematic gaming engagement. An in-depth investigation into the factors driving gaming behavior, particularly unhealthy patterns, could offer important insights for preventing and addressing IGD. Causality orientations refer to the sources of causation that individuals tend to rely on when initiating and regulating their behavior ( 12 ). It is considered a relatively stable personality trait. Three types of causality orientations were defined: autonomy orientation, characterized by behavior guided by personal interests and values with high intrinsic motivation; control orientation, refer to where behavior is regulated by external rules, or rewards; and finally, impersonal orientation, marked by a perceived lack of control or effectiveness in producing desired outcomes, often leading to amotivation and helplessness. These orientations are suggested to coexist within individuals to varying degrees. Causality orientation has been linked to various addictive disorders in prior research ( 13 , 14 ). For example, our previous study demonstrated a path model that autonomy orientation is associated with fewer symptoms of IGD, while control and impersonal orientations are linked to more severe IGD symptoms, partly mediated through anxiety and depression symptoms ( 15 ). Another study indicate that strong extrinsic motivations for playing video games are associated with higher levels of IGD ( 16 ). Beyond addictive symptoms, different causality orientations were also linked with different behavioral patterns related to addiction. Individuals with high in autonomous orientation tend to experience more self-determined motivation for engaging in health-promoting behaviors, which eventually lead to better health outcomes Ryan, Patrick ( 17 ). For example, college students scoring higher on control orientation were found to gamble more often, spend more on gambling activities, face more negative consequences related to gambling, and have a higher likelihood of meeting the criteria for gambling disorder, even when controlling for other risk factors ( 18 ). According to Richards, Waddell ( 19 ), causality orientation plays a pivotal role in the development and maintenance of alcohol dependence, less internalized motivational orientations - including control orientation (external regulation, e.g., "Because I feel pressured by others to drink responsibly") and impersonal orientation (motivation, e.g., "I don't really think about it") - show significant positive correlations with more severe alcohol use and greater negative consequences. Basic psychological needs (BPNs) are considered essential psychological nutrients necessary for optimal functioning and well-being, these needs including autonomy, competence, and relatedness ( 20 ). Autonomy is a state in which individuals are able to self-organize their experiences and actions, and align their behavior with their intrinsic values and interests. This state supports an individual's sense of self and intrinsic motivation, thereby promoting more positive behavior and psychological well-being ( 21 , 22 ). Competence, refers to the sense of effective and capable during an activity ( 22 ). Relatedness is a need in which individuals desire to establish close, trusting, and caring relationships with others, and to feel accepted and valued by them ( 20 ). Both satisfaction and frustration in BPNs were associated with addiction, but the specific effects of BPNs satisfaction and frustration were unclear. Studies of Hagfors, Vuorinen ( 23 ) find that a sense of frustration in BPNs can predict more severe gambling problems. Mills, Milyavskaya ( 16 ) found frustration to be a direct and significant predictor of problematic gaming, while Allen and Anderson ( 24 ) showed that frustration in both real-life and gaming contexts positively predicts IGD scores, underscoring its critical role over satisfaction. Conversely, other studies showed that BPNs satisfaction could also affect gaming behaviors and IGD symptoms in individuals. Video games have the potential to satisfy these three BPNs, which in turn contributes to users spending more time gaming and reporting greater enjoyment in these video games ( 25 – 27 ). Johnson, Gardner ( 25 ) found that higher levels of need satisfaction during video game engagement was predictive of greater enjoyment of games, stronger intentions to play, and increased time spent gaming. While gaming may temporarily fulfill these unmet needs ( 24 ), the strong motivational pull created by this satisfaction can lead to excessive engagement, increasing the risk of developing IGD over time. Similarly, Mills et al. ( 28 ) confirmed that both gaming need satisfaction and daily need frustration positively contributed to gaming frequency and problem video game use. The Self-Determination Health Behavior Model emphasizes the importance of human intrinsic motivation and BPNs on individual and mental behaviors ( 17 , 29 ). It proposed that we can promote the development of intrinsic motivation and the internalization of extrinsic motivation, thereby enhancing individuals' self-determination, mental health, and well-being by supporting individuals' BPNs. In this framework, personality traits such as causality orientations serve as prerequisites for regulating health behaviors, while the satisfaction and frustration of BPNs could mediate the effect of personality traits on health behaviors. Additionally, it was also proposed that the fulfillment of BPNs could facilitate the internalization and integration of motivation, thereby increasing the likelihood of engaging in health-promoting behaviors (such as alcohol harm reduction) ( 30 ). For instance, individuals with a high degree of autonomy orientation are more likely to pursue opportunities that fulfill their BPN ( 31 ). Johan Y Y Ng, Ntoumanis ( 32 ) tested this model in a meta-analysis, their results supported the expected relations among the SDT variables, as well as positive relations of BPN satisfaction and autonomous motivation to beneficial health outcomes. For example, they reported a mediation role of autonomy satisfaction in the relationship between autonomy-supportive health care climate and autonomous self-regulation, specifically through the pathway in which autonomy support enhances the satisfaction of the need for autonomy, which in turn facilitates autonomous self-regulation. Likewise, Howard, Slemp ( 33 ) revealed the relationship between causality orientations and BPNs, as well as their impact on students’ behavior. For example, they found a positive correlation between scores on autonomy orientation and perceived autonomy support from teachers (e.g., offering choices and listening to students’ opinions) in students, autonomy support satisfies students’ BPN for autonomy, thereby promoting positive behaviors (such as higher learning motivation and reduced negative behavioral outcomes). In contrast, students with a controlled causality orientation were less benefit from autonomy support but more susceptible to the negative effects of thwarting behaviors (such as excessive control or criticism) of teachers, which leading to frustrated BPNs and an increase in behavioral problems (such as misconduct, dropout intentions, procrastination, and absenteeism). Additionally a study indicates that autonomy orientation is positively correlated with positive affect (such as interested, excited, attentive, proud, and active), whereas controlled orientation and impersonal orientation are positively associated with negative affect and boredom ( 34 ). Previous studies have identified two potential mediating factors associated with IGD: anxiety and depression. Research has shown that the higher the levels of anxiety and depression, the more severe the gaming behavior and IGD symptoms ( 15 , 35 – 38 ). On one hand, playing games can alleviate feelings of anxiety and depression. On the other hand, excessive gaming can increase the risk of IGD ( 39 ). The cross-lagged analysis revealed that level of depression at baseline significantly predicted severity of IGD features 12 months later ( 40 ). According to SDT, causality orientations can predict unhealthy psychological states, an autonomy orientation is associated with lower intrusive stress, and better ability to cope with challenges, which finally leads to a reduction in anxiety and depression ( 12 , 41 ). A longitudinal study found that teacher support for autonomy in the seventh grade can enhance the satisfaction of basic psychological needs and reduce anxiety and depression in the eighth grade ( 42 ). In summary, the Self-Determination Health Behavior Model proposed that personality traits such as causality orientations serve as prerequisites for regulating health behaviors, while the satisfaction and frustration of BPNs could mediate the effect of personality traits on health behaviors. The associations between causality orientations, and BPNs as well as IGD symptoms have been demonstrated previously, but the specific pattern of mediation is yet to be fully tested. This study aims to validate the Self-Determination Health Behavior Model in IGD, thereby providing a theoretical basis for the prevention and intervention of IGD. Based on the Self-Determination Health Behavior Model and previous studies, we hypothesis that the satisfaction and frustration of BPNs mediate the effect of causality orientations on symptoms of IGD. Materials and methods Participants and procedure The questionnaires were given to 1465 college and graduate students. All responses were made through the wjx platform (https://www.wjx.cn/). As a result, 1419 participants completed the questionnaires. Data of 57 respondents were excluded due to indiscriminate filling or incomplete response, resulting in 1362 valid participants (mean age = 20.85±1.38, range:17-28, 770 women, response rate = 93%). This study was carried out in accordance with the Declaration of Helsinki and was approved by the Institutional Review Board of Southwest Medical University. Measures Demographic and information on gaming behaviors, such as weekly gaming time and craving for gaming (assessed via a visual analog scale from 0 = not at all to 10 = extremely), were collected using a home-designed questionnaire (see Additional File 1). This questionnaire was developed for the purpose of this study and has not been published elsewhere. The Chinese version Internet Gaming Disorder Scale (IGDS) was used to assess IGD behaviors during the last 12-month period (43, 44). The scale has nine items, each item is scored by "yes" or "no", where "yes" scored 1 point and "no" scored 0 points. A higher total score indicates more severe IGD symptoms. Cronbach's α of IGDS was 0.934 in the current study. The Chinese version of the General Causality Orientation Scale for Clinical Populations (GCOS-CP) (45, 46) was used to assess participants’ causality orientations. The scale consists of eight scenarios, each presenting a situation followed by three possible responses that correspond to the three causality orientations, resulting in a total of 24 items. Each item is rated on a 7-point Likert scale ranging from 1 (very unlikely) to 7 (very likely). The GCOS-CP measures three types of causality orientations: (i) autonomy orientation, (ii) control orientation, and (iii) impersonal orientation. Higher scores on a given subscale indicate a stronger tendency toward that particular orientation. In current study, the Chinese version of the GCOS-CP demonstrated acceptable internal consistency, with Cronbach’s α Autonomy = 0.798, α Control = 0.826, α Impersonal = 0.784. The Chinese version Generalized Anxiety Disorder Scale (GAD-7) was used to assess anxiety symptoms in the past two weeks (47, 48). The scale includes 7 items rated on a Likert scale ranging from 0 (Not a day) to 3 (Almost every day). The total score ranges from 0 to 21. A higher total score indicates worse anxiety. Cronbach's α of GAD-7 was 0.922 in the current study. The Chinese version Patient Health Questionnaire (PHQ-9) was used to assess the severity of depressive symptoms in the past two weeks Spitzer, Kroenke (49), Zhang, Liang (50). The scale includes 9 items rated on a Likert scale ranging from 0 (Not a day) to 3 (Almost every day). A higher total score indicates more depression. Cronbach's α of PHQ-9 was 0.914 in the current study. The Chinese version Basic psychological need satisfaction, need frustration was used to assess participants' levels of basic psychological need satisfaction and frustration (51). The scale includes 24 items rated on a 1 (Not true at all)-5 (Completely true) Likert scale. Cronbach's α of BPNSFS was 0.931 in the current study. Statistical analysis To investigate if the satisfying and/or frustrating of BPN mediating the effect of causality orientations on IGD symptoms, we constructed several SEM models using Lavaan package Version 0.6-18 (Rosseel, 2012) in R. Specifically, the following models were specified: Full models with one BPN total scores (Model 1, Figure 1A): The purpose of Model 1 is to explore if the overall satisfaction of BPN (BPNSFS as one complete measurement of BPN satisfaction) mediated the effect of causality orientations on IGD, and its mediating effect was implemented via negative emotions (through PHQ-9 and GAD-7). Full models with separated scores of BPN satisfaction and frustration (Model 2, Figure 1B): The Model 2 is to explore if, as suggested by Mills, Milyavskaya (52), BPN satisfaction and frustration have separate mediating effects on IGD and causality orientation. To this end, separated scores of BPN satisfaction and BPN frustration were entered the model as mediators, and its mediating effect was implemented via negative emotions. Full models with 3 separate BPN satisfaction scores (Model 3, Figure 1C): Model 3 was set up to investigate if the satisfaction of the three BPNs (Autonomy, Competence, and Relatedness) would show distinct mediation roles between causality orientations and IGD symptoms. Therefore, for model 3 separated scores of BPN satisfaction of Autonomy, Competence, and Relatedness were entered as mediators, and theirs mediating effects was further mediated via anxiety and depression symptoms. The sem function of Lavaan was utilized to fit the defined models. The parameter estimation was carried out using the maximum likelihood estimation method. The following criteria were deemed acceptable model fit: a χ 2 /df ratio ≤ 5, the root means a square error of approximation (RMSEA) 0.95 were considered a good fitness (53). Pathways with low mediation effects were removed to allow refine of the models. The mediating tests were performed with 5000 bootstrap samples. In bootstrapping tests, 95% confidence intervals (CIs) for the indirect effect that does not include zero indicate a significant indirect effect at p < 0.05 (54). According to the recommendations of Mehmetoglu and Jakobsen (55), standardization coefficients of ≤ 0.09, 0.1-0.2, and ≥ 0.2 correspond to small, moderate, and large effects, respectively (56). Finally, a multiple linear regression equation was employed to calculate the correlations between IGD and the causality orientation, BPNS, as well as anxiety and depression. Additionally, we examined the residual correlation between PHQ-9 and GAD-7, as well as the variance estimation of the observed variables. Results 3.1 Full models with one BPN total scores The initial Model 1 was saturated according to the fitting results (CFI = 1; RMSEA = 1) (Fig. 1 A). After removing non-significant paths, the refined model demonstrated a good fit with the data (p = 0.022, χ²/df = 3.223, CFI = 0.998, RMSEA = 0.040) (refer to Model 1.2 in Table 1 and Fig. 2 ). Table 1 models and fit results Models X1 X2 X3 Y χ²/df GFI Cfi Tli Rmsea Model 1 GCOS BPNSFS PHQ-9 + GAD-7 IGDS 0 1 1 1 0 Model 1.2 GCOS BPNSFS PHQ-9 + GAD-7 IGDS 3.223 0.997 0.998 0.989 0.040 Model 2 GCOS BPN Satisfaction + BPN Frustration PHQ-9 + GAD-7 IGDS 550.452 0.892 0.882 -1.938 0.635 Model 2.2 GCOS BPN Satisfaction + BPN Frustration PHQ-9 + GAD-7 IGDS 112.687 0.889 0.881 0.403 0.286 Model 2.3 GCOS BPN Satisfaction PHQ-9 + GAD-7 IGDS 3.032 0.997 0.998 0.990 0.039 Model 2.4 GCOS BPN Frustration PHQ-9 + GAD-7 IGDS 3.590 0.997 0.998 0.987 0.044 Model 3 GCOS AUS + COS+RES PHQ-9 + GAD-7 IGDS 256.372 0.674 0.717 -2.116 0.657 Model 3.2 GCOS AUS + COS+RES PHQ-9 + GAD-7 IGDS 295.293 0.675 0.717 -0.558 0.465 Model 4 GCOS BPNSFS PHQ-9 + GAD-7 Craving 3.223 0.997 0.998 0.989 0.040 Model 5 GCOS BPNSFS PHQ-9 + GAD-7 Time 3.223 0.997 0.998 0.989 0.040 Note: The final model was highlighted with bold font. GCOS means General Causality Orientation Scale-Clinical Population. BPNSFS means Basic Psychological Needs Satisfaction and Frustration Scale. AUS means Autonomy Scores, COS means Competence Scores, RES means Relatedness Scores. BPN Satisfaction means Basic Psychological Needs Satisfaction. BPN Frustration means Basic Psychological Needs Frustrations. IGDS means Internet Gaming Disorder Symptom. Craving means Gaming Craving. Time means Gaming Time. As shown in Fig. 2 , the impersonal orientation was associated with IGDS through partial mediation effects of BPNSFS total score, the control orientation was associated with IGDS through partial mediation effects of GAD-7 and BPNSFS, the autonomy orientation was associated with IGDS through partial mediation effects of GAD-7, PHQ-9 and BPNSFS. All pathways showed moderate-to-large effect size, except the autonomy-PHQ-9, autonomy།IGDS, control།GAD-7, control།BPNSFS, impersonal།BPNSFS, and the BPNSFS།IGDS paths. These results confirmed the hypothesis of the mediating effect of BPN total score between causality orientations and the IGDS. 3.2 Full models with separated BPN satisfaction and frustration scores The initial Model 2 showed unsatisfied fit to the data (Fig. 1 B). A refined model (Model 2.2 in Table 1 ) after removed non-significant pathways, still not fit the data well (CFI = 0.881; RMSEA = 0.286). To further examine if the satisfaction or frustration of BPNs could independently mediate the relationship between causality orientations and IGDS, we fitted two additional models (Model 2.3 and Model 2.4). In these models, scores for either BPN satisfaction or BPN frustration were entered as mediators. After removing non-significant pathways, both models demonstrated a good fit (Fig. 3 ). For BPN Satisfaction (Model 2.3), the results were: p = 0.028, χ²/df = 0.032, CFI = 0.998, RMSEA = 0.039. For BPN Frustration (Model 2.4), the results were: p = 0.013, χ²/df = 3.590, CFI = 0.998, RMSEA = 0.044. 3.3 Full models with 3 separate BPN satisfaction scores The initial Model 3 with three separate BPN satisfactions (AUS\COS\RES) do not fit the data well (CFI = 0.674; RMSEA = 0.657) (Fig. 1 C). The refined model with non-significant paths removed still not fit well (CFI = 0.717; RMSEA = 0.465) (Model 3.2 in Table 1 ). Within this hypothesized framework, we additionally examined the effects of separate BPN satisfaction or frustration scores on the between causality orientations and the IGDS. The results indicated poor model fit (satisfaction: CFI = 0.798; RMSEA = 0.512, frustration: CFI = 0.709; RMSEA = 0.639), leading to the rejection of these alternative models. 3.4 Additional fitting of the final model with craving and game time as outcome variables Model 1.2, which provided the best fit for our data, was selected as the final model. It demonstrated that BPN satisfaction and frustration mediate the effect of causality orientations on IGD symptoms. However, since the Self-Determination Health Behavior Model emphasizes the interaction between BPN satisfaction/frustration and causality orientations in influencing health-related behaviors, we expect a similar effect on other gaming behaviors, such as game craving and engagement. To further investigate these mediation effects, we developed two additional models focusing on game time and game craving as outcome variables. The model with craving as the dependent variable demonstrated a good fit (p = 0.022, χ²/df = 3.223, CFI = 0.998, RMSEA = 0.040) (Model 4 in Table 1 , Fig. 4 A). The BPNs, GAD-7, control orientation, and impersonal orientation were significantly associated with increased game craving, whereas the autonomy orientation showed a protective effect against game craving. Similarly, the model with Game Time as the dependent variable also yielded good fits (p = 0.022, χ²/df = 3.223, CFI = 0.998, RMSEA = 0.040) (Model 5 in Table 1 , Fig. 4 B). The BPNs, GAD-7, control orientation, and impersonal orientation were significantly associated with longer game time, whereas the autonomy orientation was associated with shorter game time. These findings aligns closely with the pattern of the model 1.2, suggesting that both game time and game craving are driven by similar psychological mechanisms. Discussion The present study aimed to elucidate the mediating role of BPNs in the association between causal orientations and symptoms of IGD among college students. Grounded in SDT, our study confirmed that the causality orientations affects the degree of satisfaction/frustration of BPNs, which in turn influences the occurrence and severity of anxiety and depression symptoms, ultimately predicting the occurrence and severity of IGD symptoms. We found that: 1) the final model confirmed that causality orientations associated with IGD symptoms, through the mediating effects of BPNs satisfaction/frustration and anxiety/depression symptoms, which is in line with the prediction of the Self-Determination Health Behavior Model. 2)This pattern was also confirmed when using game craving and game time as the out variable separately, suggesting a consistent pattern regarding game-related behaviors. 3) Separate models with BPNs satisfaction and BPNs frustration as mediator both exhibited good fit to the data, suggesting similar role of BPNs satisfaction and BPNs frustration in the model. The primary finding of this study is the validation of the Self-Determination Health Behavior Model, which posits that the interaction of causality orientations and BPNs satisfaction/frustration impact on health-related behaviors ( 17 ). The final model (Model 1.2) demonstrates that individuals with an autonomy orientation are more likely to experience higher BPN satisfaction, which is associated with lower levels of anxiety and depression, ultimately leading to fewer IGD symptoms. Conversely, control and impersonal orientations were associated with lower BPN satisfaction, which associated with higher levels of anxiety and depression, and eventually sever symptoms. This finding is largely consistent with our previous SEM study in which “the autonomy-IGD relationship was totally mediated by anxiety and depression, whereas the control and impersonal orientations showed partial mediation” and that control and impersonal orientations were “positively associated with IGD symptoms” ( 15 ). In extending these findings, the current study emonstrated a mediating role of BPNs satisfaction and frustration between causality orientations and IGD symptoms, which is aligning with the similar findings considering BPNs ( 16 , 28 ). Our models underscores the importance of considering both BPN and causality orientations as critical mechanisms in the development of problematic gaming behaviors. This finding further confirmed the generalizability of the SDT–based motivational model by replacing IGD symptoms with gaming craving and gaming time as outcome variables. The results showed that the structural pathways remained highly stable: autonomy orientation continued to reduce gaming behaviors through greater BPN satisfaction, whereas control and impersonal orientations reinforced them. This consistency indicates that IGD, game craving, and gaming time are all governed by the same underlying constellation of motivational and need-related processes. These findings parallel SDT-based evidence from other addiction domains—for example, autonomy and competence have been shown to promote smoking cessation ( 57 ), and levels of self-determination moderate the effects of alcohol-related thoughts on drinking behavior ( 58 ). Similarly, in gambling research, Rodriguez, Neighbors ( 14 ) demonstrated that motivational orientations influence behavior through specific gambling motives, further reinforcing the applicability of SDT. Moreover, our results also align with previous studies on the Self-Determination Health Behavior Model, where satisfaction of BPNs was related to more health-related behaviors ( 32 ). Taken together, our model 1.2, model 4 and model 5 demonstrated that the interaction of BPNs satisfaction/frustration and causality orientations significantly influence both IGD symptoms and gaming behaviors. Our analyses showed that when BPN satisfaction and frustration were modeled separately, both acted as significant and comparable mediators between causality orientations and IGD symptoms (Models 2.3 and 2.4). This indicates that examining either dimension alone yields an incomplete picture. By contrast, the model incorporating the total BPN score (Model 1.2) achieved superior fit, suggesting that an integrative measure better captures the overall role of basic psychological needs in shaping gaming behavior. This pattern supports the view that BPN satisfaction and frustration are not simple opposites but represent distinct motivational pathways, as argued by Vansteenkiste and Ryan ( 59 ). Our results clarify these pathways: satisfaction was mainly tied to autonomy orientation and played a protective role by supporting emotional well-being, while frustration was linked to controlled and impersonal orientations, contributing to IGD risk through psychological distress. These dual processes also help explain why previous studies that focus only on one side—such as those highlighting frustration as the key mediator of maladaptive outcomes ( 16 ) or those emphasizing the motivational appeal of in-game need satisfaction ( 25 )—tend to capture only part of the mechanism. Previous research has indicated a moderate to high negative correlation between need satisfaction and frustration, suggesting that its maybe better to consider the BPNs satisfaction and frustration as a opposite ends of the same continuum other than independent unities ( 51 ). In sum, although the independent effects of satisfaction and frustration are evident, our findings support the utility of integrated BPN measures in both research and clinical practice. The total score more effectively reflects the combined “health-promotion” and “distress-escape” pathways, offering a more holistic framework for understanding IGD and providing dual targets for more precise intervention. In addition to BPNs, our results indicate that anxiety and depression must also be incorporated to fully explain how these motivational tendencies translate into gaming-related problems. Consistent with Peng, Wang ( 15 ), who found that negative affect mediated the effects of all three causality orientations on IGDS. Our study suggests that need satisfaction and frustration alone cannot account for individuals’ actual levels of IGD well. As we find that lower BPNSFS (characteristic of control and impersonal orientations) appears to increase vulnerability to anxiety and depressive symptoms, and these emotional states subsequently intensify the likelihood of using gaming as a way to cope with distress. In contrast, autonomy-oriented individuals benefit from greater BPNSFS, experience fewer negative emotions, and thereby show less reliance on gaming for mood regulation. Therefore, integrating anxiety and depression is essential to fully represent the functional sequence from causality orientations to need satisfaction/frustration, to emotional states, and finally to IGDS, yielding a theoretically coherent and empirically supported account of IGD development. Limitations This study employs a cross-sectional design, which limits causal inference. Future research adopting a longitudinal design, with repeated measurements of the same individuals, are needed to examine the causal pathways between basic psychological needs and internet gaming disorder. Additionally, the sample comprises college and graduate students from the same university, which may limit the generalizability of the findings. Future studies should include a more diverse and representative sample to enhance the external validity of the results. Conclusions In conclusion, the study provides empirical evidence supporting the mediating role of BPN in the relationship between causal orientations and IGD symptoms. It emphasizes the importance of considering psychological needs in understanding gaming behaviors and highlights potential targets for preventive interventions. Future research should address the limitations of this study and continue to explore the intricate relationships between motivation, psychological needs, and mental health outcomes. The findings highlight the potential of interventions that focus on enhancing autonomous motivation and BPN satisfaction to prevent IGD. Educational and health care settings could benefit from incorporating strategies that support autonomy, such as providing choice, fostering competence, and nurturing relatedness. Such interventions may not only reduce IGD symptoms but also promote overall mental health and well-being. Declarations Funding This work was supported by the National Science Foundation of China [32200882], the Humanities and Social Science Fund of Ministry of Education of China [23YJA190004], and Sichuan Science and Technology Department [23ZDYF2557]. Ethics Approval This study was approved by the Institutional Review Board of Southwest Medical University (Approval No. KY2024181) and was conducted in accordance with the Declaration of Helsinki (2024 version). All participants provided written informed consent before participation. Consent to Participate Informed consent was obtained from all participants. Consent for Publication No identifiable personal data are included in this manuscript. Competing Interests The authors declare no competing interests. Data Availability The data that support the findings of this study are available from the corresponding author upon reasonable request. References Center CINI. The 56th statistical Report on China's Internet Development 2025. Petry NM, O'Brien CP. Internet gaming disorder and the DSM-5. Addiction. 2013;108(7):1186-7. Bonnaire C, Baptista D. Internet gaming disorder in male and female young adults: The role of alexithymia, depression, anxiety and gaming type. 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Indirect associations between impulsivity and alcohol outcomes through motives for drinking responsibly among US college students: an integration of self-determination theory and the acquired preparedness model. Addiction research & theory. 2023;31(5):313-20. Deci EL, Ryan RM. Self-determination theory. Handbook of theories of social psychology. 2012;1(20):416-36. Deci EL, Ryan RM. The" what" and" why" of goal pursuits: Human needs and the self-determination of behavior. Psychological inquiry. 2000;11(4):227-68. Vansteenkiste M, Niemiec CP, Soenens B. The development of the five mini-theories of self-determination theory: An historical overview, emerging trends, and future directions. The decade ahead: Theoretical perspectives on motivation and achievement. 2010;16:105-65. Hagfors H, Vuorinen I, Savolainen I, Oksanen A. A longitudinal study of gambling motives, problem gambling and need frustration. Addictive Behaviors. 2023;144:107733. Allen JJ, Anderson CA. 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Causality orientations and supportive/controlled environment: understanding their influence on basic needs, motivation for health and emotions in French hospitalized older adults. Frontiers in Psychology. 2020;11:575489. González-Bueso V, Santamaría JJ, Fernández D, Merino L, Montero E, Ribas J. Association between Internet Gaming Disorder or Pathological Video-Game Use and Comorbid Psychopathology: A Comprehensive Review. International Journal of Environmental Research and Public Health. 2018;15(4):668. Mentzoni RA, Brunborg GS, Molde H, Myrseth H, Skouverøe KJM, Hetland J, et al. Problematic Video Game Use: Estimated Prevalence and Associations with Mental and Physical Health. Cyberpsychology, Behavior, and Social Networking. 2011;14(10):591-6. Ostinelli EG, Zangani C, Giordano B, Maestri D, Gambini O, D’Agostino A, et al. Depressive symptoms and depression in individuals with internet gaming disorder: A systematic review and meta-analysis. Journal of Affective Disorders. 2021;284:136-42. Stockdale L, Coyne SM. Video game addiction in emerging adulthood: Cross-sectional evidence of pathology in video game addicts as compared to matched healthy controls. Journal of Affective Disorders. 2018;225:265-72. King DL, Delfabbro PH, Billieux J, Potenza MN. Problematic online gaming and the COVID-19 pandemic. Journal of Behavioral Addictions. 2020;9(2):184-6. Jeong H, Yim HW, Lee S-Y, Lee HK, Potenza MN, Jo S-J, et al. Reciprocal relationship between depression and Internet gaming disorder in children: A 12-month follow-up of the iCURE study using cross-lagged path analysis. Journal of Behavioral Addictions. 2019;8(4):725-32. Weinstein N, Ryan RM. A self-determination theory approach to understanding stress incursion and responses. Stress and Health. 2011;27(1):4-17. Çelik E, Yıldırım S. Examining test anxiety in terms of academic expectations stress and motivation to study. Pegem Journal of Education and Instruction. 2019;9(4):1139-58. Lei W, Liu K, Zeng Z, Liang X, Huang C, Gong K, et al. The psychometric properties of the Chinese version internet gaming disorder scale. Addictive Behaviors. 2020;106:106392. Lemmens JS, Valkenburg PM, Gentile DA. The internet gaming disorder scale. Psychological assessment. 2015;27(2):567. Cooper S, Lavaysse LM, Gard DE. Assessing motivation orientations in schizophrenia: Scale development and validation. Psychiatry research. 2015;225(1-2):70-8. Lei W, Liu K, Li N, Liang X, Xiang B, Huang C, et al. Validation of the Chinese version General Causality Orientation Scale-Clinical Population and causality orientations assessing in major depressions. Asia-Pacific Psychiatry. 2019;11(3):e12348. Spitzer RL, Kroenke K, Williams JBW, Löwe B. A Brief Measure for Assessing Generalized Anxiety Disorder: The GAD-7. Archives of Internal Medicine. 2006;166(10):1092-7. He X, Li C, Qian J, Cui H, Wu W. Reliability and validity of a generalized anxiety disorder scale in general hospital outpatients. Shanghai Arch Psychiatry. 2010;22(4):200-3. Spitzer RL, Kroenke K, Williams JBW, Group atPHQPCS. Validation and Utility of a Self-report Version of PRIME-MDThe PHQ Primary Care Study. JAMA. 1999;282(18):1737-44. Zhang Y-L, Liang W, Chen Z-M, Zhang H-M, Zhang J-H, Weng X-Q, et al. Validity and reliability of Patient Health Questionnaire-9 and Patient Health Questionnaire-2 to screen for depression among college students in China. Asia-Pacific Psychiatry. 2013;5(4):268-75. Chen B, Vansteenkiste M, Beyers W, Boone L, Deci EL, Van der Kaap-Deeder J, et al. Basic psychological need satisfaction, need frustration, and need strength across four cultures. Motivation and Emotion. 2015;39(2):216-36. Mills DJ, Milyavskaya M, Mettler J, Heath NL, Derevensky JL. How do passion for video games and needs frustration explain time spent gaming? British Journal of Social Psychology. 2018;57(2):461-81. Hu Lt, Bentler PM. Cutoff criteria for fit indexes in covariance structure analysis: Conventional criteria versus new alternatives. Structural Equation Modeling: A Multidisciplinary Journal. 1999;6(1):1-55. Shrout PE, Bolger N. Mediation in experimental and nonexperimental studies: new procedures and recommendations. Psychological methods. 2002;7(4):422. Mehmetoglu M, Jakobsen TG. Applied statistics using Stata: a guide for the social sciences: Sage; 2022. Mehmetoglu M, Jakobsen T. Applied Statistics Using Stata - A Guide for the Social Sciences: Applied Statistics Using Stata - A Guide for the Social Sciences; 2016. Williams GC, Minicucci DS, Kouides RW, Levesque CS, Chirkov VI, Ryan RM, et al. Self-determination, smoking, diet and health. Health Education Research. 2002;17(5):512-21. Neighbors C, Walker DD, Larimer ME. Expectancies and evaluations of alcohol effects among college students: self-determination as a moderator. Journal of Studies on Alcohol. 2003;64(2):292-300. Vansteenkiste M, Ryan RM. On psychological growth and vulnerability: basic psychological need satisfaction and need frustration as a unifying principle. Journal of psychotherapy integration. 2013;23(3):263. Additional Declarations No competing interests reported. Supplementary Files SupplementaryFile1HomeDesignedQuestionnaireEnglish.docx Cite Share Download PDF Status: Under Review Version 1 posted Reviewers invited by journal 27 Apr, 2026 Editor assigned by journal 11 Apr, 2026 Editor invited by journal 09 Apr, 2026 Submission checks completed at journal 09 Apr, 2026 First submitted to journal 09 Apr, 2026 You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. 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Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-9297729","acceptedTermsAndConditions":true,"allowDirectSubmit":false,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":630427997,"identity":"e94ec88b-73c4-42df-b801-7f5f80b1b8d3","order_by":0,"name":"Haolin Ye","email":"","orcid":"","institution":"Southwest Medical University","correspondingAuthor":false,"prefix":"","firstName":"Haolin","middleName":"","lastName":"Ye","suffix":""},{"id":630427998,"identity":"0ce05cac-dbb7-43f3-a211-42c46dad009b","order_by":1,"name":"Yanli Wang","email":"","orcid":"","institution":"Southwest Medical University","correspondingAuthor":false,"prefix":"","firstName":"Yanli","middleName":"","lastName":"Wang","suffix":""},{"id":630427999,"identity":"12542ba2-7fdc-4d64-9f91-b36922ed3a8d","order_by":2,"name":"Chi Su","email":"","orcid":"","institution":"Southwest Medical University","correspondingAuthor":false,"prefix":"","firstName":"Chi","middleName":"","lastName":"Su","suffix":""},{"id":630428000,"identity":"f92e5ef1-6a44-4750-a400-f4c0fd12f3f8","order_by":3,"name":"Wenxin Xu","email":"","orcid":"","institution":"Southwest Medical University","correspondingAuthor":false,"prefix":"","firstName":"Wenxin","middleName":"","lastName":"Xu","suffix":""},{"id":630428001,"identity":"9ba45ec4-ddcb-4981-a0ce-70146b3db77d","order_by":4,"name":"Yu Huang","email":"","orcid":"","institution":"Southwest Medical University","correspondingAuthor":false,"prefix":"","firstName":"Yu","middleName":"","lastName":"Huang","suffix":""},{"id":630428002,"identity":"c959927f-72ee-44e0-9362-50e6cf04c44e","order_by":5,"name":"Zhibin Zhou","email":"","orcid":"","institution":"Southwest Medical University","correspondingAuthor":false,"prefix":"","firstName":"Zhibin","middleName":"","lastName":"Zhou","suffix":""},{"id":630428003,"identity":"e55c9ce7-83f5-4706-b48c-f1b793bc4893","order_by":6,"name":"Shiyin Wang","email":"","orcid":"","institution":"Southwest Medical University","correspondingAuthor":false,"prefix":"","firstName":"Shiyin","middleName":"","lastName":"Wang","suffix":""},{"id":630428004,"identity":"c4daafb6-08f1-4280-be60-c187d4e5c2ac","order_by":7,"name":"Yueshan Xu","email":"","orcid":"","institution":"Southwest Medical University","correspondingAuthor":false,"prefix":"","firstName":"Yueshan","middleName":"","lastName":"Xu","suffix":""},{"id":630428005,"identity":"e41a44cd-4e40-4fe7-8240-737bebed5478","order_by":8,"name":"Kezhi Liu","email":"","orcid":"","institution":"Southwest Medical University","correspondingAuthor":false,"prefix":"","firstName":"Kezhi","middleName":"","lastName":"Liu","suffix":""},{"id":630428006,"identity":"353c620f-abad-40ae-a514-706fb7f69897","order_by":9,"name":"Jing Chen","email":"","orcid":"","institution":"Southwest Medical University","correspondingAuthor":false,"prefix":"","firstName":"Jing","middleName":"","lastName":"Chen","suffix":""},{"id":630428008,"identity":"b6ce7623-b234-4f7d-b3d3-e3e7f7fd17f2","order_by":10,"name":"Wei Lei","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAA5UlEQVRIie3RMQrCMBSA4VeEdgl1TSxYjxARdPEwKa4VnBy1UIiLB9BbeASdsohzSyYRdBVcFAVNtK5pR8H8EAiP95EhADbbD+aDkwBQqIOXFKN1CXELQhL0XS0nn0iCWVXipRyfR4Bpfjo2cg5NP2POZWQiaMPJgioi424w5NAhGasFCxPBEZeIwkQRVyoSrTLm1pCJhHsuH/qVXBw1mZYT7HAJmmTQ1YTRUoKi2W2uCNnGvXu8w+3ldp8GJlL3xIFeH4B9IQ6deNwPfTHYXEyk6Amt9fuC1dGfW6Ww4p7NZrP9YS+/ZEkjij1rxAAAAABJRU5ErkJggg==","orcid":"","institution":"Southwest Medical University","correspondingAuthor":true,"prefix":"","firstName":"Wei","middleName":"","lastName":"Lei","suffix":""}],"badges":[],"createdAt":"2026-04-02 03:54:50","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-9297729/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-9297729/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":108630284,"identity":"8d48b06c-3faf-4a71-abf2-cff51a6e25bb","added_by":"auto","created_at":"2026-05-06 16:35:51","extension":"png","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":252922,"visible":true,"origin":"","legend":"\u003cp\u003eThe hypothesis models. The models depict the associations among causality orientations, PHQ-9, GAD-7 and IGDS, these relationships were assuming mediated by BPNSFS scores. The BPNSFS scores were coded as a single BPNSFS total score (A), separated BPN satisfaction and BPN frustration subscale scores (B) and BPN satisfaction in autonomy, competence, relatedness(C).\u003c/p\u003e","description":"","filename":"Figure1.png","url":"https://assets-eu.researchsquare.com/files/rs-9297729/v1/3bb552610c5f494ff6684c84.png"},{"id":108630285,"identity":"f0ef017b-b99a-4823-8d88-b71ca177b502","added_by":"auto","created_at":"2026-05-06 16:35:51","extension":"png","order_by":2,"title":"Figure 2","display":"","copyAsset":false,"role":"figure","size":258488,"visible":true,"origin":"","legend":"\u003cp\u003eThese model depicts the associations among causality orientations, BPNSFS, GAD-7, PHQ-9 and IGDS.\u003c/p\u003e","description":"","filename":"Figure2.png","url":"https://assets-eu.researchsquare.com/files/rs-9297729/v1/b93d7600b19ea79cc6fd30aa.png"},{"id":108805202,"identity":"28d2b1ea-0e3c-4429-b521-f2c698003018","added_by":"auto","created_at":"2026-05-08 15:25:11","extension":"png","order_by":3,"title":"Figure 3","display":"","copyAsset":false,"role":"figure","size":410007,"visible":true,"origin":"","legend":"\u003cp\u003eThese model depicts the associations among causality orientations, BPN Satisfaction (A), BPN Frustration (B), GAD-7, PHQ-9 and IGDS.\u003c/p\u003e","description":"","filename":"Figure3.png","url":"https://assets-eu.researchsquare.com/files/rs-9297729/v1/d14147eca68bb5ec7b98fb88.png"},{"id":108630287,"identity":"e4750a59-3426-46ba-84a1-acf1be39668e","added_by":"auto","created_at":"2026-05-06 16:35:51","extension":"png","order_by":4,"title":"Figure 4","display":"","copyAsset":false,"role":"figure","size":342341,"visible":true,"origin":"","legend":"\u003cp\u003eThese model depicts the associations among causality orientations, Craving (A), Time (B), GAD-7, PHQ-9 and IGDS.\u003c/p\u003e","description":"","filename":"Figure4.png","url":"https://assets-eu.researchsquare.com/files/rs-9297729/v1/1d333c51fa14dfcd024c460e.png"},{"id":108809882,"identity":"b4c9e797-d11d-4ae6-9df6-13e7d1aef5b4","added_by":"auto","created_at":"2026-05-08 15:56:04","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":1604353,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-9297729/v1/bf17d962-b7cb-4a2d-8dba-d696dfa8b9ac.pdf"},{"id":108630289,"identity":"4e988d33-ba56-4303-81ff-a8ceff83e315","added_by":"auto","created_at":"2026-05-06 16:35:52","extension":"docx","order_by":1,"title":"","display":"","copyAsset":false,"role":"supplement","size":17737,"visible":true,"origin":"","legend":"","description":"","filename":"SupplementaryFile1HomeDesignedQuestionnaireEnglish.docx","url":"https://assets-eu.researchsquare.com/files/rs-9297729/v1/ae88545daacbd6774f5b0922.docx"}],"financialInterests":"No competing interests reported.","formattedTitle":"A Test of the Self-Determination Health Behavior Model in Internet Gaming Disorder","fulltext":[{"header":"Introduction","content":"\u003cp\u003eInternet gaming has emerged as a widely enjoyed leisure activity in contemporary society. In China, 52% of its 1123\u0026nbsp;million netizens are game players (China Internet Network Information 1). Internet Gaming Disorder (IGD) is a behavioral addiction characterized by excessive gaming, loss of control, and impaired social functioning. In 2018, the World Health Organization (WHO) formally recognized IGD (termed Gaming Disorder) as a behavioral addiction by including it in the 11th revision of the International Classification of Diseases (ICD-11). It has gained increasing attention and requires further research to establish diagnostic criteria and treatment methods (\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e). IGD is linked to various psychological consequences, such as depression, anxiety, and suicidal thoughts, as well as physical problems like substance abuse, self-harm, and sleep deprivation (\u003cspan additionalcitationids=\"CR4 CR5 CR6 CR7 CR8 CR9 CR10\" citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e), which could arise from persistent and problematic gaming engagement. An in-depth investigation into the factors driving gaming behavior, particularly unhealthy patterns, could offer important insights for preventing and addressing IGD.\u003c/p\u003e \u003cp\u003eCausality orientations refer to the sources of causation that individuals tend to rely on when initiating and regulating their behavior (\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e). It is considered a relatively stable personality trait. Three types of causality orientations were defined: autonomy orientation, characterized by behavior guided by personal interests and values with high intrinsic motivation; control orientation, refer to where behavior is regulated by external rules, or rewards; and finally, impersonal orientation, marked by a perceived lack of control or effectiveness in producing desired outcomes, often leading to amotivation and helplessness. These orientations are suggested to coexist within individuals to varying degrees.\u003c/p\u003e \u003cp\u003eCausality orientation has been linked to various addictive disorders in prior research (\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e, \u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e). For example, our previous study demonstrated a path model that autonomy orientation is associated with fewer symptoms of IGD, while control and impersonal orientations are linked to more severe IGD symptoms, partly mediated through anxiety and depression symptoms (\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e). Another study indicate that strong extrinsic motivations for playing video games are associated with higher levels of IGD (\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e). Beyond addictive symptoms, different causality orientations were also linked with different behavioral patterns related to addiction. Individuals with high in autonomous orientation tend to experience more self-determined motivation for engaging in health-promoting behaviors, which eventually lead to better health outcomes Ryan, Patrick (\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e). For example, college students scoring higher on control orientation were found to gamble more often, spend more on gambling activities, face more negative consequences related to gambling, and have a higher likelihood of meeting the criteria for gambling disorder, even when controlling for other risk factors (\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e). According to Richards, Waddell (\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e), causality orientation plays a pivotal role in the development and maintenance of alcohol dependence, less internalized motivational orientations - including control orientation (external regulation, e.g., \"Because I feel pressured by others to drink responsibly\") and impersonal orientation (motivation, e.g., \"I don't really think about it\") - show significant positive correlations with more severe alcohol use and greater negative consequences.\u003c/p\u003e \u003cp\u003eBasic psychological needs (BPNs) are considered essential psychological nutrients necessary for optimal functioning and well-being, these needs including autonomy, competence, and relatedness (\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e). Autonomy is a state in which individuals are able to self-organize their experiences and actions, and align their behavior with their intrinsic values and interests. This state supports an individual's sense of self and intrinsic motivation, thereby promoting more positive behavior and psychological well-being (\u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e, \u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e). Competence, refers to the sense of effective and capable during an activity (\u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e). Relatedness is a need in which individuals desire to establish close, trusting, and caring relationships with others, and to feel accepted and valued by them (\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eBoth satisfaction and frustration in BPNs were associated with addiction, but the specific effects of BPNs satisfaction and frustration were unclear. Studies of Hagfors, Vuorinen (\u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e) find that a sense of frustration in BPNs can predict more severe gambling problems. Mills, Milyavskaya (\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e) found frustration to be a direct and significant predictor of problematic gaming, while Allen and Anderson (\u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e) showed that frustration in both real-life and gaming contexts positively predicts IGD scores, underscoring its critical role over satisfaction. Conversely, other studies showed that BPNs satisfaction could also affect gaming behaviors and IGD symptoms in individuals. Video games have the potential to satisfy these three BPNs, which in turn contributes to users spending more time gaming and reporting greater enjoyment in these video games (\u003cspan additionalcitationids=\"CR26\" citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e27\u003c/span\u003e). Johnson, Gardner (\u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e) found that higher levels of need satisfaction during video game engagement was predictive of greater enjoyment of games, stronger intentions to play, and increased time spent gaming. While gaming may temporarily fulfill these unmet needs (\u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e), the strong motivational pull created by this satisfaction can lead to excessive engagement, increasing the risk of developing IGD over time. Similarly, Mills et al. (\u003cspan citationid=\"CR28\" class=\"CitationRef\"\u003e28\u003c/span\u003e) confirmed that both gaming need satisfaction and daily need frustration positively contributed to gaming frequency and problem video game use.\u003c/p\u003e \u003cp\u003eThe Self-Determination Health Behavior Model emphasizes the importance of human intrinsic motivation and BPNs on individual and mental behaviors (\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e, \u003cspan citationid=\"CR29\" class=\"CitationRef\"\u003e29\u003c/span\u003e). It proposed that we can promote the development of intrinsic motivation and the internalization of extrinsic motivation, thereby enhancing individuals' self-determination, mental health, and well-being by supporting individuals' BPNs. In this framework, personality traits such as causality orientations serve as prerequisites for regulating health behaviors, while the satisfaction and frustration of BPNs could mediate the effect of personality traits on health behaviors. Additionally, it was also proposed that the fulfillment of BPNs could facilitate the internalization and integration of motivation, thereby increasing the likelihood of engaging in health-promoting behaviors (such as alcohol harm reduction) (\u003cspan citationid=\"CR30\" class=\"CitationRef\"\u003e30\u003c/span\u003e). For instance, individuals with a high degree of autonomy orientation are more likely to pursue opportunities that fulfill their BPN (\u003cspan citationid=\"CR31\" class=\"CitationRef\"\u003e31\u003c/span\u003e). Johan Y Y Ng, Ntoumanis (\u003cspan citationid=\"CR32\" class=\"CitationRef\"\u003e32\u003c/span\u003e) tested this model in a meta-analysis, their results supported the expected relations among the SDT variables, as well as positive relations of BPN satisfaction and autonomous motivation to beneficial health outcomes. For example, they reported a mediation role of autonomy satisfaction in the relationship between autonomy-supportive health care climate and autonomous self-regulation, specifically through the pathway in which autonomy support enhances the satisfaction of the need for autonomy, which in turn facilitates autonomous self-regulation. Likewise, Howard, Slemp (\u003cspan citationid=\"CR33\" class=\"CitationRef\"\u003e33\u003c/span\u003e) revealed the relationship between causality orientations and BPNs, as well as their impact on students\u0026rsquo; behavior. For example, they found a positive correlation between scores on autonomy orientation and perceived autonomy support from teachers (e.g., offering choices and listening to students\u0026rsquo; opinions) in students, autonomy support satisfies students\u0026rsquo; BPN for autonomy, thereby promoting positive behaviors (such as higher learning motivation and reduced negative behavioral outcomes). In contrast, students with a controlled causality orientation were less benefit from autonomy support but more susceptible to the negative effects of thwarting behaviors (such as excessive control or criticism) of teachers, which leading to frustrated BPNs and an increase in behavioral problems (such as misconduct, dropout intentions, procrastination, and absenteeism). Additionally a study indicates that autonomy orientation is positively correlated with positive affect (such as interested, excited, attentive, proud, and active), whereas controlled orientation and impersonal orientation are positively associated with negative affect and boredom (\u003cspan citationid=\"CR34\" class=\"CitationRef\"\u003e34\u003c/span\u003e).\u003c/p\u003e \u003cp\u003ePrevious studies have identified two potential mediating factors associated with IGD: anxiety and depression. Research has shown that the higher the levels of anxiety and depression, the more severe the gaming behavior and IGD symptoms (\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e, \u003cspan additionalcitationids=\"CR36 CR37\" citationid=\"CR35\" class=\"CitationRef\"\u003e35\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR38\" class=\"CitationRef\"\u003e38\u003c/span\u003e). On one hand, playing games can alleviate feelings of anxiety and depression. On the other hand, excessive gaming can increase the risk of IGD (\u003cspan citationid=\"CR39\" class=\"CitationRef\"\u003e39\u003c/span\u003e). The cross-lagged analysis revealed that level of depression at baseline significantly predicted severity of IGD features 12 months later (\u003cspan citationid=\"CR40\" class=\"CitationRef\"\u003e40\u003c/span\u003e). According to SDT, causality orientations can predict unhealthy psychological states, an autonomy orientation is associated with lower intrusive stress, and better ability to cope with challenges, which finally leads to a reduction in anxiety and depression (\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e, \u003cspan citationid=\"CR41\" class=\"CitationRef\"\u003e41\u003c/span\u003e). A longitudinal study found that teacher support for autonomy in the seventh grade can enhance the satisfaction of basic psychological needs and reduce anxiety and depression in the eighth grade (\u003cspan citationid=\"CR42\" class=\"CitationRef\"\u003e42\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eIn summary, the Self-Determination Health Behavior Model proposed that personality traits such as causality orientations serve as prerequisites for regulating health behaviors, while the satisfaction and frustration of BPNs could mediate the effect of personality traits on health behaviors. The associations between causality orientations, and BPNs as well as IGD symptoms have been demonstrated previously, but the specific pattern of mediation is yet to be fully tested. This study aims to validate the Self-Determination Health Behavior Model in IGD, thereby providing a theoretical basis for the prevention and intervention of IGD. Based on the Self-Determination Health Behavior Model and previous studies, we hypothesis that the satisfaction and frustration of BPNs mediate the effect of causality orientations on symptoms of IGD.\u003c/p\u003e"},{"header":"Materials and methods","content":"\u003ch2\u003eParticipants and procedure\u003c/h2\u003e\n\u003cp\u003eThe questionnaires were given to 1465 college and graduate students. All responses were made through the wjx platform (https://www.wjx.cn/). As a result, 1419 participants completed the questionnaires. Data of 57 respondents were excluded due to indiscriminate filling or incomplete response, resulting in 1362 valid participants (mean age = 20.85±1.38, range:17-28, 770 women, response rate = 93%). This study was carried out in accordance with the Declaration of Helsinki and was approved by the Institutional Review Board of Southwest Medical University.\u003c/p\u003e\n\u003ch2\u003eMeasures\u003c/h2\u003e\n\u003cp\u003eDemographic and information on gaming behaviors, such as weekly gaming time and craving for gaming (assessed via a visual analog scale from 0 = not at all to 10 = extremely), were collected using a home-designed questionnaire (see\u0026nbsp;Additional File 1). This questionnaire was developed for the purpose of this study and has not been published elsewhere.\u003c/p\u003e\n\u003cp\u003eThe Chinese version Internet Gaming Disorder Scale (IGDS) was used to assess IGD behaviors during the last 12-month period (43, 44). The scale has nine items, each item is scored by \"yes\" or \"no\", where \"yes\" scored 1 point and \"no\" scored 0 points. A higher total score indicates more severe IGD symptoms. Cronbach's α of IGDS was 0.934 in the current study.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eThe Chinese version of the General Causality Orientation Scale for Clinical Populations (GCOS-CP) (45, 46) was used to assess participants’ causality orientations. The scale consists of eight scenarios, each presenting a situation followed by three possible responses that correspond to the three causality orientations, resulting in a total of 24 items. Each item is rated on a 7-point Likert scale ranging from 1 (very unlikely) to 7 (very likely). The GCOS-CP measures three types of causality orientations: (i) autonomy orientation, (ii) control orientation, and (iii) impersonal orientation. Higher scores on a given subscale indicate a stronger tendency toward that particular orientation. In current study, the Chinese version of the GCOS-CP demonstrated acceptable internal consistency, with Cronbach’s α\u003csub\u003eAutonomy\u003c/sub\u003e = 0.798, α\u003csub\u003eControl\u0026nbsp;\u003c/sub\u003e= 0.826, α\u003csub\u003eImpersonal\u0026nbsp;\u003c/sub\u003e= 0.784.\u003c/p\u003e\n\u003cp\u003eThe Chinese version Generalized Anxiety Disorder Scale (GAD-7) was used to assess anxiety symptoms in the past two weeks (47, 48). The scale includes 7 items rated on a Likert scale ranging from 0 (Not a day) to 3 (Almost every day). The total score ranges from 0 to 21. A higher total score indicates worse anxiety. Cronbach's α of GAD-7 was 0.922 in the current study.\u003c/p\u003e\n\u003cp\u003eThe Chinese version Patient Health Questionnaire (PHQ-9) was used to assess the severity of depressive symptoms in the past two weeks Spitzer, Kroenke (49), Zhang, Liang (50). The scale includes 9 items rated on a Likert scale ranging from 0 (Not a day) to 3 (Almost every day). A higher total score indicates more depression. Cronbach's α of PHQ-9 was 0.914 in the current study.\u003c/p\u003e\n\u003cp\u003eThe Chinese version Basic psychological need satisfaction, need frustration was used to assess participants' levels of basic psychological need satisfaction and frustration (51). The scale includes 24 items rated on a 1 (Not true at all)-5 (Completely true) Likert scale. Cronbach's α of BPNSFS was 0.931 in the current study.\u003c/p\u003e\n\u003ch2\u003eStatistical analysis\u003c/h2\u003e\n\u003cp\u003eTo investigate if the satisfying and/or frustrating of BPN mediating the effect of causality orientations on IGD symptoms, we constructed several SEM models using Lavaan package Version 0.6-18 (Rosseel, 2012) in R. Specifically, the following models were specified:\u003c/p\u003e\n\u003col\u003e\n \u003cli\u003e\u003cstrong\u003eFull models with one BPN total scores (Model 1, Figure 1A):\u0026nbsp;\u003c/strong\u003eThe purpose of Model 1 is to explore if the overall satisfaction of BPN (BPNSFS as one complete measurement of BPN satisfaction) mediated the effect of causality orientations on IGD, and its mediating effect was implemented via negative emotions (through PHQ-9 and GAD-7).\u0026nbsp;\u003c/li\u003e\n \u003cli\u003e\u003cstrong\u003eFull models with separated scores of BPN satisfaction and frustration (Model 2, Figure 1B):\u003c/strong\u003e The Model 2 is to explore if, as suggested by Mills, Milyavskaya (52), BPN satisfaction and frustration have separate mediating effects on IGD and causality orientation. To this end, separated scores of BPN satisfaction and BPN frustration were entered the model as mediators, and its mediating effect was implemented via negative emotions.\u0026nbsp;\u003c/li\u003e\n \u003cli\u003e\u003cstrong\u003eFull models with 3 separate BPN satisfaction scores (Model 3, Figure 1C):\u0026nbsp;\u003c/strong\u003eModel 3 was set up to investigate if the satisfaction of the three BPNs (Autonomy, Competence, and Relatedness) would show distinct mediation roles between causality orientations and IGD symptoms. Therefore, for model 3 separated scores of BPN satisfaction of Autonomy, Competence, and Relatedness were entered as mediators, and theirs mediating effects was further mediated via anxiety and depression symptoms. \u0026nbsp;\u003c/li\u003e\n\u003c/ol\u003e\n\u003cp\u003eThe sem function of Lavaan was utilized to fit the defined models.\u0026nbsp;The parameter estimation was carried out using the maximum likelihood estimation method. The following criteria were deemed acceptable model fit: a χ\u003csup\u003e2\u003c/sup\u003e/df ratio ≤ 5, the root means a square error of approximation (RMSEA) \u0026lt; 0.08, comparative fit index (CFI), Goodness of Fit Index (GFI), and Tucker-Lewis Index (TLI) \u0026gt; 0.95 were considered a good fitness (53). Pathways with low mediation effects were removed to allow refine of the models. The mediating tests were performed with 5000 bootstrap samples. In bootstrapping tests, 95% confidence intervals (CIs) for the indirect effect that does not include zero indicate a significant indirect effect at p \u0026lt; 0.05 (54). According to the recommendations of Mehmetoglu and Jakobsen (55), standardization coefficients of ≤ 0.09, 0.1-0.2, and ≥ 0.2 correspond to small, moderate, and large effects, respectively (56). Finally, a multiple linear regression equation was employed to calculate the correlations between IGD and the causality orientation, BPNS, as well as anxiety and depression. Additionally, we examined the residual correlation between PHQ-9 and GAD-7, as well as the variance estimation of the observed variables.\u003c/p\u003e"},{"header":"Results","content":"\u003cp\u003e \u003cb\u003e3.1 Full models with one BPN total scores\u003c/b\u003e \u003c/p\u003e \u003cp\u003eThe initial Model 1 was saturated according to the fitting results (CFI\u0026thinsp;=\u0026thinsp;1; RMSEA\u0026thinsp;=\u0026thinsp;1) (Fig.\u0026nbsp;\u003cspan refid=\"Fig1\" class=\"InternalRef\"\u003e1\u003c/span\u003eA). After removing non-significant paths, the refined model demonstrated a good fit with the data (p\u0026thinsp;=\u0026thinsp;0.022, χ\u0026sup2;/df\u0026thinsp;=\u0026thinsp;3.223, CFI\u0026thinsp;=\u0026thinsp;0.998, RMSEA\u0026thinsp;=\u0026thinsp;0.040) (refer to Model 1.2 in Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e and Fig.\u0026nbsp;\u003cspan refid=\"Fig2\" class=\"InternalRef\"\u003e2\u003c/span\u003e).\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab1\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003emodels and fit results\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"10\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c7\" colnum=\"7\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c8\" colnum=\"8\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c9\" colnum=\"9\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c10\" colnum=\"10\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eModels\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cem\u003eX1\u003c/em\u003e\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003e\u003cem\u003eX2\u003c/em\u003e\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u003cem\u003eX3\u003c/em\u003e\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003e\u003cem\u003eY\u003c/em\u003e\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c6\"\u003e \u003cp\u003e\u003cem\u003eχ\u0026sup2;/df\u003c/em\u003e\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c7\"\u003e \u003cp\u003e\u003cem\u003eGFI\u003c/em\u003e\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c8\"\u003e \u003cp\u003e\u003cem\u003eCfi\u003c/em\u003e\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c9\"\u003e \u003cp\u003e\u003cem\u003eTli\u003c/em\u003e\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c10\"\u003e \u003cp\u003e\u003cem\u003eRmsea\u003c/em\u003e\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eModel 1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eGCOS\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eBPNSFS\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003ePHQ-9\u0026thinsp;+\u0026thinsp;GAD-7\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eIGDS\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eModel 1.2\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cb\u003eGCOS\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e\u003cb\u003eBPNSFS\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u003cb\u003ePHQ-9\u0026thinsp;+\u0026thinsp;GAD-7\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e\u003cb\u003eIGDS\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e\u003cb\u003e3.223\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e\u003cb\u003e0.997\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e\u003cb\u003e0.998\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e\u003cb\u003e0.989\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003e\u003cb\u003e0.040\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eModel 2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eGCOS\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eBPN Satisfaction\u0026thinsp;+\u0026thinsp;BPN Frustration\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003ePHQ-9\u0026thinsp;+\u0026thinsp;GAD-7\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eIGDS\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e550.452\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0.892\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e0.882\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e-1.938\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003e0.635\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eModel 2.2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eGCOS\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eBPN Satisfaction\u0026thinsp;+\u0026thinsp;BPN Frustration\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003ePHQ-9\u0026thinsp;+\u0026thinsp;GAD-7\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eIGDS\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e112.687\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0.889\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e0.881\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e0.403\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003e0.286\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eModel 2.3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eGCOS\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eBPN Satisfaction\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003ePHQ-9\u0026thinsp;+\u0026thinsp;GAD-7\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eIGDS\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e3.032\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0.997\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e0.998\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e0.990\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003e0.039\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eModel 2.4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eGCOS\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eBPN Frustration\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003ePHQ-9\u0026thinsp;+\u0026thinsp;GAD-7\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eIGDS\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e3.590\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0.997\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e0.998\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e0.987\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003e0.044\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eModel 3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eGCOS\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eAUS\u0026thinsp;+\u0026thinsp;COS+RES\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003ePHQ-9\u0026thinsp;+\u0026thinsp;GAD-7\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eIGDS\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e256.372\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0.674\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e0.717\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e-2.116\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003e0.657\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eModel 3.2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eGCOS\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eAUS\u0026thinsp;+\u0026thinsp;COS+RES\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003ePHQ-9\u0026thinsp;+\u0026thinsp;GAD-7\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eIGDS\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e295.293\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0.675\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e0.717\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e-0.558\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003e0.465\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eModel 4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eGCOS\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eBPNSFS\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003ePHQ-9\u0026thinsp;+\u0026thinsp;GAD-7\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eCraving\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e3.223\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0.997\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e0.998\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e0.989\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003e0.040\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eModel 5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eGCOS\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eBPNSFS\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003ePHQ-9\u0026thinsp;+\u0026thinsp;GAD-7\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eTime\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e3.223\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0.997\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e0.998\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e0.989\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003e0.040\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003ctfoot\u003e \u003ctr\u003e\u003ctd colspan=\"10\"\u003eNote: The final model was highlighted with bold font.\u003c/td\u003e\u003c/tr\u003e \u003ctr\u003e\u003ctd colspan=\"10\"\u003eGCOS means General Causality Orientation Scale-Clinical Population.\u003c/td\u003e\u003c/tr\u003e \u003ctr\u003e\u003ctd colspan=\"10\"\u003eBPNSFS means Basic Psychological Needs Satisfaction and Frustration Scale.\u003c/td\u003e\u003c/tr\u003e \u003ctr\u003e\u003ctd colspan=\"10\"\u003eAUS means Autonomy Scores, COS means Competence Scores, RES means Relatedness Scores.\u003c/td\u003e\u003c/tr\u003e \u003ctr\u003e\u003ctd colspan=\"10\"\u003eBPN Satisfaction means Basic Psychological Needs Satisfaction.\u003c/td\u003e\u003c/tr\u003e \u003ctr\u003e\u003ctd colspan=\"10\"\u003eBPN Frustration means Basic Psychological Needs Frustrations.\u003c/td\u003e\u003c/tr\u003e \u003ctr\u003e\u003ctd colspan=\"10\"\u003eIGDS means Internet Gaming Disorder Symptom.\u003c/td\u003e\u003c/tr\u003e \u003ctr\u003e\u003ctd colspan=\"10\"\u003eCraving means Gaming Craving.\u003c/td\u003e\u003c/tr\u003e \u003ctr\u003e\u003ctd colspan=\"10\"\u003eTime means Gaming Time.\u003c/td\u003e\u003c/tr\u003e \u003c/tfoot\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003cp\u003eAs shown in Fig.\u0026nbsp;\u003cspan refid=\"Fig2\" class=\"InternalRef\"\u003e2\u003c/span\u003e, the impersonal orientation was associated with IGDS through partial mediation effects of BPNSFS total score, the control orientation was associated with IGDS through partial mediation effects of GAD-7 and BPNSFS, the autonomy orientation was associated with IGDS through partial mediation effects of GAD-7, PHQ-9 and BPNSFS. All pathways showed moderate-to-large effect size, except the autonomy-PHQ-9, autonomy།IGDS, control།GAD-7, control།BPNSFS, impersonal།BPNSFS, and the BPNSFS།IGDS paths. These results confirmed the hypothesis of the mediating effect of BPN total score between causality orientations and the IGDS.\u003c/p\u003e \u003cp\u003e \u003cb\u003e3.2 Full models with separated BPN satisfaction and frustration scores\u003c/b\u003e \u003c/p\u003e \u003cp\u003eThe initial Model 2 showed unsatisfied fit to the data (Fig.\u0026nbsp;\u003cspan refid=\"Fig1\" class=\"InternalRef\"\u003e1\u003c/span\u003eB). A refined model (Model 2.2 in Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e) after removed non-significant pathways, still not fit the data well (CFI\u0026thinsp;=\u0026thinsp;0.881; RMSEA\u0026thinsp;=\u0026thinsp;0.286).\u003c/p\u003e \u003cp\u003eTo further examine if the satisfaction or frustration of BPNs could independently mediate the relationship between causality orientations and IGDS, we fitted two additional models (Model 2.3 and Model 2.4). In these models, scores for either BPN satisfaction or BPN frustration were entered as mediators. After removing non-significant pathways, both models demonstrated a good fit (Fig.\u0026nbsp;\u003cspan refid=\"Fig3\" class=\"InternalRef\"\u003e3\u003c/span\u003e). For BPN Satisfaction (Model 2.3), the results were: p\u0026thinsp;=\u0026thinsp;0.028, χ\u0026sup2;/df\u0026thinsp;=\u0026thinsp;0.032, CFI\u0026thinsp;=\u0026thinsp;0.998, RMSEA\u0026thinsp;=\u0026thinsp;0.039. For BPN Frustration (Model 2.4), the results were: p\u0026thinsp;=\u0026thinsp;0.013, χ\u0026sup2;/df\u0026thinsp;=\u0026thinsp;3.590, CFI\u0026thinsp;=\u0026thinsp;0.998, RMSEA\u0026thinsp;=\u0026thinsp;0.044.\u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003cp\u003e \u003cb\u003e3.3 Full models with 3 separate BPN satisfaction scores\u003c/b\u003e \u003c/p\u003e \u003cp\u003eThe initial Model 3 with three separate BPN satisfactions (AUS\\COS\\RES) do not fit the data well (CFI\u0026thinsp;=\u0026thinsp;0.674; RMSEA\u0026thinsp;=\u0026thinsp;0.657) (Fig.\u0026nbsp;\u003cspan refid=\"Fig1\" class=\"InternalRef\"\u003e1\u003c/span\u003eC). The refined model with non-significant paths removed still not fit well (CFI\u0026thinsp;=\u0026thinsp;0.717; RMSEA\u0026thinsp;=\u0026thinsp;0.465) (Model 3.2 in Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e). Within this hypothesized framework, we additionally examined the effects of separate BPN satisfaction or frustration scores on the between causality orientations and the IGDS. The results indicated poor model fit (satisfaction: CFI\u0026thinsp;=\u0026thinsp;0.798; RMSEA\u0026thinsp;=\u0026thinsp;0.512, frustration: CFI\u0026thinsp;=\u0026thinsp;0.709; RMSEA\u0026thinsp;=\u0026thinsp;0.639), leading to the rejection of these alternative models.\u003c/p\u003e \u003cp\u003e \u003cb\u003e3.4 Additional fitting of the final model with craving and game time as outcome variables\u003c/b\u003e \u003c/p\u003e \u003cp\u003eModel 1.2, which provided the best fit for our data, was selected as the final model. It demonstrated that BPN satisfaction and frustration mediate the effect of causality orientations on IGD symptoms. However, since the Self-Determination Health Behavior Model emphasizes the interaction between BPN satisfaction/frustration and causality orientations in influencing health-related behaviors, we expect a similar effect on other gaming behaviors, such as game craving and engagement. To further investigate these mediation effects, we developed two additional models focusing on game time and game craving as outcome variables.\u003c/p\u003e \u003cp\u003eThe model with craving as the dependent variable demonstrated a good fit (p\u0026thinsp;=\u0026thinsp;0.022, χ\u0026sup2;/df\u0026thinsp;=\u0026thinsp;3.223, CFI\u0026thinsp;=\u0026thinsp;0.998, RMSEA\u0026thinsp;=\u0026thinsp;0.040) (Model 4 in Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e, Fig.\u0026nbsp;\u003cspan refid=\"Fig4\" class=\"InternalRef\"\u003e4\u003c/span\u003eA). The BPNs, GAD-7, control orientation, and impersonal orientation were significantly associated with increased game craving, whereas the autonomy orientation showed a protective effect against game craving. Similarly, the model with Game Time as the dependent variable also yielded good fits (p\u0026thinsp;=\u0026thinsp;0.022, χ\u0026sup2;/df\u0026thinsp;=\u0026thinsp;3.223, CFI\u0026thinsp;=\u0026thinsp;0.998, RMSEA\u0026thinsp;=\u0026thinsp;0.040) (Model 5 in Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e, Fig.\u0026nbsp;\u003cspan refid=\"Fig4\" class=\"InternalRef\"\u003e4\u003c/span\u003eB). The BPNs, GAD-7, control orientation, and impersonal orientation were significantly associated with longer game time, whereas the autonomy orientation was associated with shorter game time. These findings aligns closely with the pattern of the model 1.2, suggesting that both game time and game craving are driven by similar psychological mechanisms.\u003c/p\u003e \u003cp\u003e \u003c/p\u003e"},{"header":"Discussion","content":"\u003cp\u003eThe present study aimed to elucidate the mediating role of BPNs in the association between causal orientations and symptoms of IGD among college students. Grounded in SDT, our study confirmed that the causality orientations affects the degree of satisfaction/frustration of BPNs, which in turn influences the occurrence and severity of anxiety and depression symptoms, ultimately predicting the occurrence and severity of IGD symptoms. We found that: 1) the final model confirmed that causality orientations associated with IGD symptoms, through the mediating effects of BPNs satisfaction/frustration and anxiety/depression symptoms, which is in line with the prediction of the Self-Determination Health Behavior Model. 2)This pattern was also confirmed when using game craving and game time as the out variable separately, suggesting a consistent pattern regarding game-related behaviors. 3) Separate models with BPNs satisfaction and BPNs frustration as mediator both exhibited good fit to the data, suggesting similar role of BPNs satisfaction and BPNs frustration in the model. The primary finding of this study is the validation of the Self-Determination Health Behavior Model, which posits that the interaction of causality orientations and BPNs satisfaction/frustration impact on health-related behaviors (\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e). The final model (Model 1.2) demonstrates that individuals with an autonomy orientation are more likely to experience higher BPN satisfaction, which is associated with lower levels of anxiety and depression, ultimately leading to fewer IGD symptoms. Conversely, control and impersonal orientations were associated with lower BPN satisfaction, which associated with higher levels of anxiety and depression, and eventually sever symptoms. This finding is largely consistent with our previous SEM study in which \u0026ldquo;the autonomy-IGD relationship was totally mediated by anxiety and depression, whereas the control and impersonal orientations showed partial mediation\u0026rdquo; and that control and impersonal orientations were \u0026ldquo;positively associated with IGD symptoms\u0026rdquo; (\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e). In extending these findings, the current study emonstrated a mediating role of BPNs satisfaction and frustration between causality orientations and IGD symptoms, which is aligning with the similar findings considering BPNs (\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e, \u003cspan citationid=\"CR28\" class=\"CitationRef\"\u003e28\u003c/span\u003e). Our models underscores the importance of considering both BPN and causality orientations as critical mechanisms in the development of problematic gaming behaviors. This finding further confirmed the generalizability of the SDT\u0026ndash;based motivational model by replacing IGD symptoms with gaming craving and gaming time as outcome variables. The results showed that the structural pathways remained highly stable: autonomy orientation continued to reduce gaming behaviors through greater BPN satisfaction, whereas control and impersonal orientations reinforced them. This consistency indicates that IGD, game craving, and gaming time are all governed by the same underlying constellation of motivational and need-related processes. These findings parallel SDT-based evidence from other addiction domains\u0026mdash;for example, autonomy and competence have been shown to promote smoking cessation (\u003cspan citationid=\"CR57\" class=\"CitationRef\"\u003e57\u003c/span\u003e), and levels of self-determination moderate the effects of alcohol-related thoughts on drinking behavior (\u003cspan citationid=\"CR58\" class=\"CitationRef\"\u003e58\u003c/span\u003e). Similarly, in gambling research, Rodriguez, Neighbors (\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e) demonstrated that motivational orientations influence behavior through specific gambling motives, further reinforcing the applicability of SDT. Moreover, our results also align with previous studies on the Self-Determination Health Behavior Model, where satisfaction of BPNs was related to more health-related behaviors (\u003cspan citationid=\"CR32\" class=\"CitationRef\"\u003e32\u003c/span\u003e). Taken together, our model 1.2, model 4 and model 5 demonstrated that the interaction of BPNs satisfaction/frustration and causality orientations significantly influence both IGD symptoms and gaming behaviors.\u003c/p\u003e \u003cp\u003eOur analyses showed that when BPN satisfaction and frustration were modeled separately, both acted as significant and comparable mediators between causality orientations and IGD symptoms (Models 2.3 and 2.4). This indicates that examining either dimension alone yields an incomplete picture. By contrast, the model incorporating the total BPN score (Model 1.2) achieved superior fit, suggesting that an integrative measure better captures the overall role of basic psychological needs in shaping gaming behavior. This pattern supports the view that BPN satisfaction and frustration are not simple opposites but represent distinct motivational pathways, as argued by Vansteenkiste and Ryan (\u003cspan citationid=\"CR59\" class=\"CitationRef\"\u003e59\u003c/span\u003e). Our results clarify these pathways: satisfaction was mainly tied to autonomy orientation and played a protective role by supporting emotional well-being, while frustration was linked to controlled and impersonal orientations, contributing to IGD risk through psychological distress. These dual processes also help explain why previous studies that focus only on one side\u0026mdash;such as those highlighting frustration as the key mediator of maladaptive outcomes (\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e) or those emphasizing the motivational appeal of in-game need satisfaction (\u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e)\u0026mdash;tend to capture only part of the mechanism. Previous research has indicated a moderate to high negative correlation between need satisfaction and frustration, suggesting that its maybe better to consider the BPNs satisfaction and frustration as a opposite ends of the same continuum other than independent unities (\u003cspan citationid=\"CR51\" class=\"CitationRef\"\u003e51\u003c/span\u003e). In sum, although the independent effects of satisfaction and frustration are evident, our findings support the utility of integrated BPN measures in both research and clinical practice. The total score more effectively reflects the combined \u0026ldquo;health-promotion\u0026rdquo; and \u0026ldquo;distress-escape\u0026rdquo; pathways, offering a more holistic framework for understanding IGD and providing dual targets for more precise intervention.\u003c/p\u003e \u003cp\u003eIn addition to BPNs, our results indicate that anxiety and depression must also be incorporated to fully explain how these motivational tendencies translate into gaming-related problems. Consistent with Peng, Wang (\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e), who found that negative affect mediated the effects of all three causality orientations on IGDS. Our study suggests that need satisfaction and frustration alone cannot account for individuals\u0026rsquo; actual levels of IGD well. As we find that lower BPNSFS (characteristic of control and impersonal orientations) appears to increase vulnerability to anxiety and depressive symptoms, and these emotional states subsequently intensify the likelihood of using gaming as a way to cope with distress. In contrast, autonomy-oriented individuals benefit from greater BPNSFS, experience fewer negative emotions, and thereby show less reliance on gaming for mood regulation. Therefore, integrating anxiety and depression is essential to fully represent the functional sequence from causality orientations to need satisfaction/frustration, to emotional states, and finally to IGDS, yielding a theoretically coherent and empirically supported account of IGD development.\u003c/p\u003e \u003cdiv id=\"Sec8\" class=\"Section2\"\u003e \u003ch2\u003eLimitations\u003c/h2\u003e \u003cp\u003eThis study employs a cross-sectional design, which limits causal inference. Future research adopting a longitudinal design, with repeated measurements of the same individuals, are needed to examine the causal pathways between basic psychological needs and internet gaming disorder. Additionally, the sample comprises college and graduate students from the same university, which may limit the generalizability of the findings. Future studies should include a more diverse and representative sample to enhance the external validity of the results.\u003c/p\u003e \u003c/div\u003e"},{"header":"Conclusions","content":"\u003cp\u003eIn conclusion, the study provides empirical evidence supporting the mediating role of BPN in the relationship between causal orientations and IGD symptoms. It emphasizes the importance of considering psychological needs in understanding gaming behaviors and highlights potential targets for preventive interventions. Future research should address the limitations of this study and continue to explore the intricate relationships between motivation, psychological needs, and mental health outcomes. The findings highlight the potential of interventions that focus on enhancing autonomous motivation and BPN satisfaction to prevent IGD. Educational and health care settings could benefit from incorporating strategies that support autonomy, such as providing choice, fostering competence, and nurturing relatedness. Such interventions may not only reduce IGD symptoms but also promote overall mental health and well-being.\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eFunding\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis work was supported by the National Science Foundation of China [32200882], the Humanities and Social Science Fund of Ministry of Education of China [23YJA190004], and Sichuan Science and Technology Department [23ZDYF2557].\u003c/p\u003e\n\u003cp\u003eEthics Approval\u003cbr\u003e\u0026nbsp;This study was approved by the Institutional Review Board of Southwest Medical University (Approval No. KY2024181) and was conducted in accordance with the Declaration of Helsinki (2024 version). All participants provided written informed consent before participation.\u003c/p\u003e\n\u003cp\u003eConsent to Participate\u003cbr\u003e\u0026nbsp;Informed consent was obtained from all participants.\u003c/p\u003e\n\u003cp\u003eConsent for Publication\u003cbr\u003e\u0026nbsp;No identifiable personal data are included in this manuscript.\u003c/p\u003e\n\u003cp\u003eCompeting Interests\u003cbr\u003e\u0026nbsp;The authors declare no competing interests.\u003c/p\u003e\n\u003cp\u003eData Availability\u003cbr\u003e\u0026nbsp;The data that support the findings of this study are available from the corresponding author upon reasonable request.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\n \u003cli\u003eCenter CINI. The 56th statistical Report on China\u0026apos;s Internet Development 2025.\u003c/li\u003e\n \u003cli\u003ePetry NM, O\u0026apos;Brien CP. Internet gaming disorder and the DSM-5. 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On psychological growth and vulnerability: basic psychological need satisfaction and need frustration as a unifying principle. Journal of psychotherapy integration. 2013;23(3):263.\u003c/li\u003e\n\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"bmc-psychiatry","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"bpsy","sideBox":"Learn more about [BMC Psychiatry](http://bmcpsychiatry.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/bpsy/default.aspx","title":"BMC Psychiatry","twitterHandle":"@BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true},"keywords":"Self-Determination Theory, Self-Determination Health Behavior Model, Causality Orientation, Internet Gaming Disorder, Basic Psychological Needs","lastPublishedDoi":"10.21203/rs.3.rs-9297729/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-9297729/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003ch2\u003eIntroduction:\u003c/h2\u003e \u003cp\u003eThis study aimed to test the Self-Determination Health Behavior Model in Internet Gaming Disorder (IGD), by assessing the mediating role of Basic Psychological Needs (BPN) on the relationship between causality orientations and symptoms of IGD.\u003c/p\u003e\u003ch2\u003eMethods\u003c/h2\u003e \u003cp\u003eData were collected from 1,362 college students through an online survey, using the Chinese versions Internet Gaming Disorder Scale (IGDS), General Causality Orientation Scale for Clinical Populations (GCOS-CP),Generalized Anxiety Disorder Scale (GAD-7), Patient Health Questionnaire (PHQ-9), and the Basic Psychological Needs Satisfaction and Frustration Scale (BPNSFS). Structural Equation Modeling (SEM) was used to assess the mediating effects of BPN satisfaction on the relationship between causality orientations and IGD symptoms.\u003c/p\u003e\u003ch2\u003eResults\u003c/h2\u003e \u003cp\u003e1) the final model confirmed that causality orientations associated with IGD symptoms, through the mediating effects of BPNs Satisfaction/Frustration and anxiety/depression symptoms, which is in line with the prediction of the Self-Determination Health Behavior Model. 2) This pattern was also confirmed when using game craving and game time as the dependent variable separately, suggesting a consistent pattern regarding game-related behaviors. 3) separate models with BPNs satisfaction and BPNs frustration as mediator both exhibited good fit to the data, suggesting similar role of BPNs satisfaction and BPNs frustration in the model.\u003c/p\u003e\u003ch2\u003eConclusion\u003c/h2\u003e \u003cp\u003eThis study provides empirical preliminary evidence supporting the application Self-Determination Health Behavior Model in IGD by suggesting a mediating role BPNs satisfaction and frustration on the relationship between causality orientations and IGD symptoms, game craving, and game engagements. These findings emphasizes the importance of considering BPNs in understanding gaming behaviors and their relevance for preventive interventions.\u003c/p\u003e","manuscriptTitle":"A Test of the Self-Determination Health Behavior Model in Internet Gaming Disorder","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2026-05-06 16:35:46","doi":"10.21203/rs.3.rs-9297729/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"reviewersInvited","content":"","date":"2026-04-27T14:35:56+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2026-04-11T05:06:45+00:00","index":"","fulltext":""},{"type":"editorInvited","content":"","date":"2026-04-09T21:15:34+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2026-04-09T04:58:26+00:00","index":"","fulltext":""},{"type":"submitted","content":"BMC Psychiatry","date":"2026-04-09T04:53:55+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"bmc-psychiatry","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"bpsy","sideBox":"Learn more about [BMC Psychiatry](http://bmcpsychiatry.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/bpsy/default.aspx","title":"BMC Psychiatry","twitterHandle":"@BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"bf34492b-91ad-4973-9116-54b17dd97fce","owner":[],"postedDate":"May 6th, 2026","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"under-review","subjectAreas":[],"tags":[],"updatedAt":"2026-05-06T16:35:47+00:00","versionOfRecord":[],"versionCreatedAt":"2026-05-06 16:35:46","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-9297729","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-9297729","identity":"rs-9297729","version":["v1"]},"buildId":"XKTyCvWXoU3ODBz1xrDgd","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}