Mental health predictors of Internet Gaming Disorder: a longitudinal study

Mental health predictors of Internet Gaming Disorder: a longitudinal study | 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 Mental health predictors of Internet Gaming Disorder: a longitudinal study Guilherme Borges, Ricardo Orozco, Raúl Gutierrez-Garcia, Yesica Albor, and 5 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-4558929/v1 This work is licensed under a CC BY 4.0 License Status: Posted Version 1 posted You are reading this latest preprint version Abstract Purpose : While internet gaming disorder has been clinically delimited, we still know little about its mental health determinants. We aim to evaluate whether a wide range of baseline mental disorders predict Internet Gaming Disorder (IGD) one to three years later, among first year university students in Mexico. Methods : This is a prospective cohort study with a follow-up period of one to three years conducted from September 2018 to June 2022 in 6 Mexican universities. Participants were first-year university students (N=2,144) free of symptoms indicative of IGD at entry (baseline). Ten mental disorders (bipolar, major depressive disorder, generalized anxiety disorder, panic disorder, alcohol use disorder, drug use disorder, binging and/or purging, intermittent explosive disorder, psychotic experiences, attention deficit hyperactivity disorder) at baseline were the main risk factors explored for the incidence of IGD at the end of the follow-up. We used Cox regression to model the IGD incidence rate. Results : A composite measure of any mental disorder at baseline was associated with an increase in 2.33 times (1.26-4.31) the rate of IGD 1 to 3 years later. Several individual disorders were associated with rates of IGD in multiple models, with comorbid conditions diminishing most of these associations. Conclusion : While students with a range of mental disorders were at risk for development of IGD, only major depressive disorder and bipolar disorder remained associated with a new case of IGD. Discrepant results from available longitudinal studies on the role of specific mental disorders in the development of IGD needs to be further investigated. Internet gaming disorder (IGD) anxiety depression substance use disorders longitudinal epidemiology Figures Figure 1 1. Introduction While internet gaming disorder (IGD) [ 1 ]or gaming disorder (GD) [ 2 ] have been clinically delimited for more than 10 years, we still know little about its mental health determinants. At the time of publication of the DSM-5 and the ICD-11, the evidence on the impact of mental disorders on the development of IGD was scant, with few longitudinal studies available [ 3 – 5 ]. In the original 2013 formulation and in the new DSM-5TR [ 6 ], the DSM-5 mentions that IGD may be associated with major depression, attention deficit hyperactivity disorder (ADHD) and obsessive- compulsive disorder (OCD). The ICD-11 states that GD “commonly co-occurs with Disorders Due to Substance Use, Mood Disorders, Anxiety or Fear-Related Disorders, Attention Deficit Hyperactivity Disorder, Obsessive-Compulsive Disorder, and Sleep-Wake Disorders” [ 7 ]. Most of what we know about the co-occurrence of IGD with other mental disorders comes from cross-sectional studies that inform on the clinical features of IGD, its prevalence and correlates [ 8 ]. These correlates have been recently grouped as “(i) gaming-related factors (i.e., structural characteristics), (ii) individual factors (i.e., person-based characteristics), and (iii) environmental factors (i.e., situational characteristics)” [ 9 ]. We focus here on the role of mental health disorders as individual determinants of new onset IGD, where longitudinal studies that can separate causes of IGD from consequences of IGD are less common [ 10 ]. Some reviews do not differentiate longitudinal from cross-sectional studies and their estimates on the role of mental disorders as risk factors for IGD are, therefore, more prone to biases [ 11 , 12 ]. A comprehensive review of longitudinal studies on IGD identified only 6 studies with data for anxiety, 4 studies on attention/hyperactivity and 12 on depression, with effect sizes on the weak side [ 13 ]. Another review identified 6 longitudinal studies on ADHD and GD [ 14 ]. As expected, not all longitudinal reports agree on the likelihood of mental disorders causing IGD [ 12 , 15 – 17 ]. Differences in methods, screening scales used, analytical procedures, age groups included, and follow-up periods are among possible reasons for those inconsistent results. Absent from most literature reviews are longitudinal studies that include a wide range of mental disorders as possible predictors of IGD, as classified in the DSM-5 and ICD-11, and controls for comorbidity. We report here on a longitudinal cohort of Mexican college students from six universities located across the country. We aim to estimate the longitudinal associations of a large list of mental disorders with the onset (first occurrence) of IGD. These disorders include bipolar, major depressive disorder, generalized anxiety disorder, panic disorder, alcohol use disorder, drug use disorder, binging and/or purging, intermittent explosive disorder, psychotic experiences and attention deficit hyperactivity disorder. 2. Material and Methods 2.1 Study design This is a prospective cohort study with a follow-up period of one to three years [ 18 ]. Not all students responded to all years, thus some have a follow-up of one, two or three years. Exposed participants were first-year university students, free of IGD at entry (baseline), who reported at baseline symptoms compatible with a diagnosis of bipolar, major depressive disorder, generalized anxiety disorder, panic disorder, alcohol use disorder, drug use disorder, binging and/or purging, intermittent explosive disorder, psychotic experiences and attention deficit hyperactivity disorder. These disorders at baseline were the main potential risk factors for the incidence of IGD at the end of the follow-up. 2.2 Sample and procedures Participants were a cohort of first-year university students enrolled in six Mexican universities (two public and four private) for the PUERTAS study (University Project for Healthy Students) [ 19 ], that consisted of a baseline web-based survey conducted in the 2018–2019 academic year and three follow-ups ending in 2022. These students were the first cohort to be administered a scale of IGD [ 20 ]. All first-year students aged 18 or older were eligible (N = 11,099) and were recruited through school events (e.g., new student orientation and first-year courses), in which a URL to the online survey was provided. In 2018, 8,122 students agreed to participate in the baseline survey, with a 73% overall response rate. Later, e-mail invitations to three follow-up surveys were sent at the beginning of each academic year, with a 31.8% completion of at least one of these questionnaires. Data collection started in September 2018 and ended in June 2022 for a total of 2,267 students with complete data on the main variables for this analysis (see the STROBE flowchart – Supplementary Fig. 1). The PUERTAS study is part of the World Health Organization World Mental Health International College Student initiative (WMH-ICS) [ 21 ]. Participation was confidential and voluntary, and required informed consent. The Research Ethics Committee of the National Institute of Psychiatry in Mexico approved the study. 2.3 Measures The online, self-report survey was developed for the WMH-ICS Initiative [ 21 ] and comprises well-validated measures described below. 2.3.1 Baseline control variables Socio-demographic variables. These consisted of sex (“male”, “not male”), and age. Fully adjusted models also include whether students slept at least 8 hours for 2 days/week [ 22 ]. 2.3.2 Outcome variable: Internet Gaming Disorder at follow-up. All participants were asked whether they played video games in the past 12 months. The full IGD scale is asked only to those gamers who screened positive to the following: If they played, on average, at least 1 day per week and their duration of gaming (during weekday or weekend) was at least 30 minutes (thereafter called “active gamers”). IGD was assessed based on a section that consisted of 23 items comprising the 9 symptoms (domains) described in the DSM-5 as formulated by an international consensus led by Nancy Petry that included an English version and a Spanish translation [ 20 , 23 ]. As per DSM-5, the presence of 5 of 9 symptoms is considered as probable IGD. A description of the individual symptoms for IGD, together with the psychometric properties of the scale, was reported elsewhere [ 20 ]; briefly, reliability for the scale was adequate (α = 0.816), and factor analysis’ fit indices were excellent (CFI = 0.994, TLI = 0.992, RMSEA = 0.030). All students classified as positive to IGD at baseline (n = 123) were dropped from the follow-up analysis and those negative to IGD at baseline (n = 2144) were followed for new (incident) cases. 2.3.3 Mental health disorders as exposure variables at baseline. Mental disorders. The Composite International Diagnostic Interview Screening Scales (CIDI-SC) [ 24 ]at baseline assessed the DSM diagnostic criteria for lifetime symptoms of mood disorders: bipolar I and major depressive disorder; anxiety disorders: generalized anxiety disorder and panic disorder; substance use disorders: drug use disorder. These are called screening scales because they are non-clinician diagnosed, self-administered self-report measures. But they do assess each of the diagnostic criteria for the aforementioned disorders. The CIDI-SC scales have concordance with blinded clinical diagnoses in the range AUC = 0.70–0.78 [ 24 ]. The AUDIT screening scale[ 25 ] assessed lifetime alcohol disorder and has concordance with clinical diagnosis in the range AUC = 0.78–0.91 [ 26 ].We also included a screening for lifetime eating problems (binging and/or purging), intermittent explosive disorder, and psychotic experiences. Six-month Attention Deficit Hyperactivity Disorder was evaluated with the Adult ADHD Self-Report Scale [ 27 ]. These self‐report scales, though they cannot be considered a clinical diagnosis of these disorders, provide a screen for clinically significant symptoms. 2.3.4.Covariates Variables considered for the adjusted analysis were male sex (yes/no), age at baseline and sleeping 8 hours or more. A summary measure of any disorder was also included in the analyses. Additionally, models fully adjusted for possible comorbidity and included all 10 mental disorders. 2.4. Statistical analysis We analyzed this prospective cohort study by assessing the effect of mental disorders at baseline (exposures) over the first occurrence (i.e., incidence) of IGD (outcome) at follow-up [ 28 ]. For this, we used the information of all students with at least two measurements and, as mentioned previously, we excluded 123 students who were positive to IGD at baseline. Incidence rates (IR) per 1,000 persons per year were estimated by dividing the number of incident IGD cases over the sum of person-years (per 1,000). Person-time was computed, for censored observations (those who did not develop IGD), as the difference between the dates of the last follow-up and the baseline. We followed a similar procedure for incident IGD cases, but discounting half of the time between the incident occurrence and the previous date. Crude and adjusted Hazard Ratios (HR) and their respective 95% Confidence Intervals (CI) were estimated for the incidence of IGD by fitting proportional-hazards Cox models [ 29 ]. First, we fitted crude models for each individual mental disorder and also for the summary variable of any mental disorder. Then, we adjusted each model by sex, age at baseline and sleep duration. To account for comorbidity, we fitted a single model in which all 10 mental disorders were entered simultaneously [ 9 ]. Finally, to obtain a more parsimonious multivariate model for mental disorders, we used recommendations based on the change of the mean squared error [ 30 ] where age, gender and sleep duration were selected as key confounding variables. A nonresponse weight by sex and age was computed to account for loss to follow-up [ 31 ] (see Supplementary Table S1 ), and it was incorporated in all Cox models [ 32 ]. Statistical tests were evaluated at the 0.05 alpha level and all data analysis were performed in Stata 18.0 [ 33 ]. 3. Results At baseline (Table 1 ), males accounted for 31% of those negative to IGD, and 78% of all those positive to IGD. Cases of IGD were also more likely to report few hours of sleep. Importantly, apart from drug abuse/dependence, all other disorders were more prevalent among those with IGD at baseline with 88.6% of those with IGD reporting one of the 10 mental disorders included here. Persistency of IGD during follow-up was common since among the 123 IGD cases detected at baseline, 44 (35.8%) reported an IGD during the following 1 to 3 years. Table 1 Baseline sociodemographic characteristics and psychiatric disorders by baseline IGD (n = 2,267). DSM-5 12-month positive gaming > = 5 No Yes 2,144 (94.6%) 123 (5.4%) Male gender No 1,480 (69.0%) 27 (22.0%) Yes 664 (31.0%) 96 (78.0%) Age groups Age 18–19 1,673 (78.0%) 92 (74.8%) Age 20+ 471 (22.0%) 31 (25.2%) Slept at least 8 hours 2 days/week 1,292 (60.3%) 59 (48.0%) Major depressive disorder No 1,847 (86.1%) 97 (78.9%) Yes 297 (13.9%) 26 (21.1%) Bipolar I disorder No 2,075 (96.8%) 117 (95.1%) Yes 69 (3.2%) 6 (4.9%) Panic disorder No 2,065 (96.3%) 114 (92.7%) Yes 79 (3.7%) 9 (7.3%) Generalized anxiety disorder No 2,102 (98.0%) 119 (96.7%) Yes 42 (2.0%) 4 (3.3%) Probable alcohol dependence No 2,076 (96.8%) 114 (92.7%) Yes 68 (3.2%) 9 (7.3%) Drug abuse/dependence No 2,040 (95.1%) 119 (96.7%) Yes 104 (4.9%) 4 (3.3%) Binging and/or purging (screening items) No 1,475 (68.8%) 70 (56.9%) Yes 669 (31.2%) 53 (43.1%) Intermittent explosive disorder (screening item) No 1,413 (65.9%) 60 (48.8%) Yes 731 (34.1%) 63 (51.2%) Psychotic experiences (screening items) No 1,773 (82.7%) 82 (66.7%) Yes 371 (17.3%) 41 (33.3%) Possible ADHD (6-month) No 1,370 (63.9%) 37 (30.1%) Yes 774 (36.1%) 86 (69.9%) Any mental disorder No 749 (34.9%) 14 (11.4%) Yes 1,395 (65.1%) 109 (88.6%) DSM-5 12-month positive gaming > = 5 at follow-up No 2,064 (96.3%) 79 (64.2%) Yes 80 (3.7%) 44 (35.8%) All disorders are lifetime, except for ADHD (6 months) and IGD (12 months) Unweighted data As per our methodology, these 123 prevalent cases of IGD were discarded and the remaining 2,144 students free of IGD were followed for detecting new cases of IGD during the subsequent 1 to 3 years. Table 2 presents the distribution of these 80 incident cases of IGD by the 10 baseline mental disorders and the summary measure of any disorder. At baseline those with any mental disorder (bottom of Table 2 ) had an IR of 22.09 per 1,000 person-years of IGD, while those free of any disorder had a much lower IR of IGD, 9.26 per 1,000 person-years. An inspection of this table shows that, except for panic disorder, the incidence rate of IGD was higher among those with a mental disorder compared to those without a mental disorder. For example, the incidence rate of IGD among students that at baseline reported drug abuse/dependence was 45.92 per 1,000 person-years but it was 16.92 in the absence of drug abuse/dependence. Table 2 Sample sizes, incident cases, and incidence rates for Internet Gaming Disorder (IGD) by mental disorders at baseline (n = 2144). n Incident IGD cases Person-years IR per 1,000 Major depressive disorder No 1,847 62 3936.6 15.75 Yes 297 18 625.2 28.79 Bipolar I disorder No 2,075 75 4427.1 16.94 Yes 69 5 134.7 37.13 Panic disorder No 2,065 79 4394.9 17.98 Yes 79 1 166.9 5.99 Generalized anxiety disorder No 2,102 77 4468.8 17.23 Yes 42 3 93.0 32.27 Probable alcohol dependence No 2,076 75 4435.8 16.91 Yes 68 5 126.0 39.68 Drug abuse/dependence No 2,040 71 4365.8 16.26 Yes 104 9 196.0 45.92 Binging and/or purging (screening items) No 1,475 47 3152.7 14.91 Yes 669 33 1409.0 23.42 Intermittent explosive disorder (screening item) No 1,413 43 3010.0 14.29 Yes 731 37 1551.7 23.84 Psychotic experiences (screening items) No 1,773 56 3808.0 14.71 Yes 371 24 753.8 31.84 Possible ADHD (6-month) No 1,370 43 2934.5 14.65 Yes 774 37 1627.3 22.74 Any mental disorder No 749 15 1619.2 9.26 Yes 1395 65 2942.6 22.09 All disorders are lifetime, except for ADHD (6 months) and IGD (12 months) IR: Incidence Rate Unweighted data Incidence computed among those free of DSM-5 IGD at baseline. We modeled this follow-up data by using Cox regression analyses, with the results shown on Table 3 . Crude, bivariate analyses showed that major depressive disorder, bipolar I disorder, drug abuse/dependence, binging/purging, intermittent explosive disorder and psychotic experiences all increased the likelihood of developing an IGD. While the other disorders, except for panic disorder, also increased the rate of IGD they lacked statistical significance. These basic results were not changed in multivariate models that included controls for age, sex and amount of sleep. In these multiple models, at the bottom we show that any disorder was associated with an increase in 2.33 times the likelihood of developing IGD. The Kaplan Meier curve for any disorder (Fig. 1) suggests that after the first year of the follow-up the survival curves of IGD start to show differences for those with and without any mental disorder. Table 3 Baseline mental disorders as a predictors of DSM-5 IGD at follow-up. Cox models. Bivariate and adjusted by sex, age, and sleep duration. Crude models Models (adjusted by sex, age, and sleep) HR p 95% CI HR p 95% CI Major depressive disorder No 1.00 1.00 Yes 1.72* 0.049 (1.00,2.95) 1.98* 0.020 (1.11,3.54) Bipolar I disorder No 1.00 1.00 Yes 2.62* 0.037 (1.06,6.48) 2.60* 0.035 (1.07,6.32) Panic disorder No 1.00 1.00 Yes 0.37 0.324 (0.05,2.65) 0.36 0.303 (0.05,2.51) Generalized anxiety disorder No 1.00 1.00 Yes 1.44 0.544 (0.45,4.63) 1.55 0.469 (0.47,5.08) Probable Alcohol dependence No 1.00 1.00 Yes 2.19 0.097 (0.87,5.52) 1.92 0.171 (0.75,4.88) Drug abuse/dependence No 1.00 1.00 Yes 2.83* 0.004 (1.39,5.80) 2.60* 0.010 (1.26,5.38) Binging and/or purging (screening items) No 1.00 1.00 Yes 1.69* 0.024 (1.07,2.68) 1.83* 0.012 (1.14,2.95) Intermittent explosive disorder (screening item) No 1.00 1.00 Yes 1.59* 0.044 (1.01,2.50) 1.52 0.076 (0.96,2.41) Psychotic experiences (screening items) No 1.00 1.00 Yes 2.20* 0.002 (1.34,3.59) 2.04* 0.005 (1.24,3.37) Possible ADHD (6-month) No 1.00 1.00 Yes 1.49 0.085 (0.95,2.34) 1.42 0.140 (0.89,2.24) Any mental disorder No 1.00 1.00 Yes 2.42* 0.003 (1.34,4.35) 2.33* 0.007 (1.26,4.31) Notes. HRs estimated with weighted Cox models. All disorders are lifetime, except for ADHD (6 months) and IGD (12 months) Incident DSM-5 IGD is the outcome in all models. HR: Hazard Ratio; CI: Confidence Interval. * p < .05 On Table 4 , a full multivariate model that includes demographics and all mental disorders shows decreases in all individual estimates, except for panic disorder. This means that, at least, part of the increase in IGD rates seen in individual disorders is due to comorbid conditions. We fitted then a more parsimonious model that selected the most important individual mental disorders, as described in the methods section. In this final model (Table 4 ), the mental disorders that were found to be predictors of IGD were major depressive disorder (HR = 1.87) and bipolar disorder (HR = 2.70). Table 4 Baseline mental disorders as a predictors of DSM-5 IGD at follow-up. Multivariable Cox models. Full model Multiple model HR p 95% CI HR p 95% CI Major depressive disorder No 1.00 1.00 Yes 1.83 0.063 (0.97,3.46) 1.87* 0.042 (1.02,3.42) Bipolar I disorder No 1.00 1.00 Yes 2.48 0.071 (0.93,6.62) 2.70* 0.042 (1.04,7.02) Panic disorder No 1.00 1.00 Yes 0.19 0.081 (0.03,1.23) 0.20 0.087 (0.03,1.26) Generalized anxiety disorder No 1.00 Yes 1.08 0.916 (0.26,4.57) Probable alcohol dependence No 1.00 Yes 1.25 0.679 (0.44,3.57) Drug abuse/dependence No 1.00 Yes 1.85 0.138 (0.82,4.14) Binging and/or purging (screening items) No 1.00 1.00 Yes 1.41 0.229 (0.80,2.48) 1.43 0.199 (0.83,2.49) Intermittent explosive disorder (screening item) No 1.00 1.00 Yes 1.09 0.734 (0.65,1.84) 1.15 0.580 (0.70,1.91) Psychotic experiences (screening items) No 1.00 1.00 Yes 1.64 0.106 (0.90,2.99) 1.71 0.069 (0.96,3.04) Possible ADHD (6-month) No 1.00 Yes 0.96 0.887 (0.57,1.63) Notes. HRs estimated with weighted Cox models. All disorders are lifetime, except for ADHD (6 months) and IGD (12 months) Incident DSM-5 IGD is the outcome in all models. Multiple and full models add controls for baseline sex, age, and sleep. HR: Hazard Ratio; CI: Confidence Interval. * p < .05 4. Discussion In summary, in this follow-up study we found that persistency of IGD during the following three years was common (35.8%). Having a mental disorder at baseline increased 2.33 times the likelihood of developing a new IGD at follow-up. While most individual mental disorders increased the rate of IGD, comorbidity explained most of these longitudinal effects. In our multiple models, only major depressive disorder and bipolar disorder remained associated with incidence of IGD. A meta-analysis that included 9 longitudinal studies up to 2017 estimated a rate of persistency of IGD of 50%, with much heterogeneity and estimates ranging from 84–24% [ 34 ].Two more recent studies reported a persistency estimate of 39.4% during 2 years among 4th- and 7th-graders in Korea [ 35 ] and a persistency of 41.7% among six junior high schools in Shanghai, China [ 36 ]. We estimate that about 1 in every 3 university respondents with a IGD at baseline would still report it after one to three years, which is within the lower range of these prior reports. Since our sample is drawn from university students, a population older than the ones reported for most studies, it strongly suggests that IGD is not a transitory disorder that just goes away with maturity. Because of our small number of persistent cases, we were not able to delve into determinants of persistency, a matter for future work. In our sample, comorbidity of IGD with other mental disorders was a rule, with almost 89% of IGD cases reporting at least one of the other ten mental disorders studied here. As evident from meta-analysis [ 8 , 10 , 13 , 14 ] most studies on mental health disorders focus on the role of depression as a likely determinant of IGD, followed by studies on anxiety and some more on ADHD. Few studies include more than two disorders, and we know of no other study reporting on a large number of disorders and on a summary measure of “any” mental disorder as presented here. The result that the adjustment made for all mental disorders resulted in an overall decrease in the HR for most individual disorders shows the extent of comorbidity on IGD. Most longitudinal studies, nevertheless, tend to ignore comorbidity when modeling and presenting the results for a single disorder. Depression and bipolar disorder remained firmly associated with onset of IGD in our data. That affect is a greater driving force than impulsivity or compulsivity on the incidence of IDG, as suggested by these findings, supports evidence of the self-medication hypothesis of the etiology of the disorder [ 9 ] and the findings in Mexico that when mood disorders are comorbid with substance use disorders, generally the onset of mood disorders is prior to the substance use disorder [ 37 ]. Alternatively, it is possible that a particular disorder, such as depression or bipolar disorder, exerts its effects on the incidence of IGD because of a general mental health propensity or what has been called the p factor [ 38 , 39 ]. In fact, in a recent study which tested different theories of the p factor, bipolar disorder, mania and personality disorders (not included in our current study) were the highest loading individual disorders on the p factor [ 40 ]. Thus, our finding that when comorbidity is controlled for, bipolar disorder is one of the two disorders to remain significant may be reflective of a general mental health propensity that is associated to developing IGD rather than any particular disorder. Finally, it is also possible that a common, unknown, cause for both psychopathology and IGD exists [ 15 ] 4.1 Limitations Our survey has significant limitations to consider. Because the response rate at follow-up was low, we weighted the data to adjust for non-response bias in sex and age. However, the sample may be biased in other ways. Finally, the universities included were both public and private, but were not randomly selected, meaning that study participants are not representative of all university students in Mexico. Despite its limitations, this study provides evidence for the alleged effect of a long list of common mental disorders on the incidence of IGD among students, that go beyond traditional samples of unknown gamers from internet sites of video gamers. Our follow-up extends to three years, more than the usual one-year academic period reported in most reports. By using a longitudinal approach, we provided stronger evidence for directionality and causality than correlational studies, and our controls for all mental health symptoms at baseline allowed us to rule out the role of pure comorbidity in the alleged effects of some of these disorders. Conflicting results in longitudinal studies on the role of particular mental disorders, such as depression or bipolar, warrants further research. 5. Conclusions This longitudinal study contributes to the scant literature on IGD among young adults based on prospective evidence, going further than cross-sectional studies on the issue of the short-term (one year) impact of mental health problems on IGD. Our analysis suggests that only a few mental disorders have an independent effect on the incidence of IGD. More work is needed in this area on the large comorbidity between IGD and other mental disorders and should be explored longitudinally. Declarations Funding Dr. Benjet received support from the National Council on Science and Technology (CONACYT; CB 285548) and Fundación Miguel Alemán A.C. The funders had no role in study design; in the collection, analysis, and interpretation of the data; in the writing of the report; and in the decision to submit the manuscript for publication. Dr. Borges had full access to all the data in the study and had final responsibility for the decision to submit for publication. Author Contributions: The initial draft of this paper was prepared by G.B. in conjunction with C.B. and R.O. G.B. confirms that he had full access to all the data in the study and takes responsibility for the integrity of the data and the accuracy of the data analysis. C.B. was responsible for obtaining funding. G.B., C.B., and R.O. participated in the study concept and design. G.B. and R.O. participated in the data analysis and interpretation. R.G.-G , Y.A., A.L.J.P., K.P.V.G., P.M.B.-M., A.M.C.D-M, were responsible for the investigation, data collection and supervision of the field work. All the authors reviewed the initial drafts for substantive inputs and approved the final version of the article. All authors have read and agreed to the published version of the manuscript. Conflict of Interest All authors declare that they have no conflicts of interest. 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Wichstrøm L, Stenseng F, Belsky J, von Soest T, Hygen BW (2019) Symptoms of Internet Gaming Disorder in Youth: Predictors and Comorbidity. J Abnorm Child Psychol 47:71–83. https://doi.org/10.1007/s10802-018-0422-x Lash T, VanderWeele T, Haneuse S, Rothman K, Kluwer W (2021) Modern Epidemiology, 4th ed. Benjet C, Gutiérrez-García RA, Abrego-Ramírez A, et al (2019) Psychopathology and self-harm among incoming first-year students in six Mexican universities. Salud Publica Mex 61:16–26. https://www.saludpublica.mx/index.php/spm/article/view/9158 Borges G, Orozco R, Benjet C, et al (2019) DSM-5 Internet gaming disorder among a sample of Mexican first-year college students. J Behav Addict 13:1–11. https://doi: 10.1556/2006.8.2019.62. Cuijpers P, Auerbach RP, Benjet C, Bruffaerts R, Ebert D, Karyotaki E, Kessler RC (2019) Introduction to the special issue: The WHO World Mental Health International College Student (WMH-ICS) initiative. Int J Methods Psychiatr Res. https://doi.org/10.1002/MPR.1762 Zheng H, Wang M, Zheng Y, Dong GH (2022) How sleep disturbances affect internet gaming disorder: The mediating effect of hippocampal functional connectivity. J Affect Disord 300:84–90. https://doi.org/10.1016/J.JAD.2021.12.085 Petry NM, Rehbein F, Ko CH, O’Brien CP (2015) Internet Gaming Disorder in the DSM-5. Curr Psychiatry Rep. https://doi.org/10.1007/S11920-015-0610-0 Kessler RC, Santiago PN, Colpe LJ, et al (2013) Clinical reappraisal of the Composite International Diagnostic Interview Screening Scales (CIDI-SC) in the Army Study to Assess Risk and Resilience in Servicemembers (Army STARRS). Int J Methods Psychiatr Res 22:303–321. https://doi.org/10.1002/MPR.1398 Saunders JB, Aasland OG, Babor TF, de la Fuente JR, Grant M (1993) Development of the alcohol use disorders identification tests (AUDIT): WHO Collaborative project on early detection of persons with harmful alcohol consumption II. Addiction 88:791–804. https://doi.org/10.1111/j.1360-0443.1993.tb02093.x Reinert DF, Allen JP (2002) The Alcohol Use Disorders Identification Test (AUDIT): A Review of Recent Research. Alcohol Clin Exp Res 26:272–279. https://doi.org/10.1111/J.1530-0277.2002.TB02534.X Kessler RC, Adler L, Ames M, et al (2005) The World Health Organization Adult ADHD Self-Report Scale (ASRS): a short screening scale for use in the general population. Psychol Med 35:245–256.https://doi.org/10.1017/S0033291704002892 Rothman K, Greenland S, Lash T (2008) Modern Epidemiology, 3rd ed. Lippincott Williams & Wilkins, Philadelphia, USA Hosmer D, Lemeshow S (2000) Applied Logistic Regression. 2nd ed. Greenland S, Daniel R, Pearce N (2016) Outcome modelling strategies in epidemiology: traditional methods and basic alternatives. Int J Epidemiol 45:565–575. https://doi.org/10.1093/ije/dyw040 Valliant R, Dever J (2018) Adjustment for non response. Survey Weights: A Step-by-Step guide to calculation StataCorp (2023) Stata Survival Analysis Reference Manual. Release 18. Retrieved 09 January 2024, from https://www.stata.com/bookstore/survival-analysis-reference-manual/ StataCorp. (2023) Stata Statistical Software: Release 18. Retrieved 09 January 2024, from https://www.stata.com/ Dahl D, Bergmark KH (2020) Persistence in Problematic Internet Use-A Systematic Review and Meta-Analysis. Frontiers in sociology. https://doi.org/10.3389/FSOC.2020.00030 Jeong H, Yim HW, Lee SY, Lee HK, Potenza MN, Lee H (2021) Factors associated with severity, incidence or persistence of internet gaming disorder in children and adolescents: a 2-year longitudinal study. Addiction (Abingdon, England) 116:1828–1838. https://doi.org/10.1111/add.15366 Liu Y, Gong R, Yu Y, Xu C, Yu X, Chang R, Wang H, Wang S, Wang Q, Cai Y (2021) Longitudinal predictors for incidence of internet gaming disorder among adolescents: The roles of time spent on gaming and depressive symptoms. J Adolesc 92:1–9. https://doi.org/10.1016/J.ADOLESCENCE.2021.06.008 Borges G, Benjet C, Orozco R, Medina-Mora ME (2018) A longitudinal study of reciprocal risk between mental and substance use disorders among Mexican youth. J Psychiatr Res 105:45–53. https://doi.org/10.1016/j.jpsychires.2018.08.014 Caspi A, Moffitt TE (2018) All for One and One for All: Mental Disorders in One Dimension. Am J Psychiatry 175:831–844. https://doi.org/10.1176/APPI.AJP.2018.17121383 Krueger RF, Markon KE (2006) Reinterpreting comorbidity: a model-based approach to understanding and classifying psychopathology. Annu Rev Clin Psychol 2:111–133. https://doi.org/10.1146/ANNUREV.CLINPSY.2.022305.095213 Southward MW, Cheavens JS, Coccaro EF (2023) Defining the p-factor: an empirical test of five leading theories. Psychol Med 53:2732–2743. https://doi.org/10.1017/S0033291722001635 Additional Declarations No competing interests reported. Supplementary Files SPPEsupplementarymaterialsent.docx Cite Share Download PDF Status: Posted Version 1 posted 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. We do this by developing innovative software and high quality services for the global research community. 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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-4558929","acceptedTermsAndConditions":true,"allowDirectSubmit":true,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":318313629,"identity":"87100d2f-0999-4300-aebf-439a904333f6","order_by":0,"name":"Guilherme Borges","email":"data:image/png;base64,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","orcid":"","institution":"Instituto Nacional de Psiquiatría \"Ramón de la Fuente Muñiz\"","correspondingAuthor":true,"prefix":"","firstName":"Guilherme","middleName":"","lastName":"Borges","suffix":""},{"id":318313631,"identity":"9be37f72-f981-4f6b-bd71-2c5a73f382ce","order_by":1,"name":"Ricardo Orozco","email":"","orcid":"","institution":"Instituto Nacional de Psiquiatría \"Ramón de la Fuente Muñiz\"","correspondingAuthor":false,"prefix":"","firstName":"Ricardo","middleName":"","lastName":"Orozco","suffix":""},{"id":318313633,"identity":"fe7efcd1-2585-4af0-9e49-9e70af9a0c1f","order_by":2,"name":"Raúl Gutierrez-Garcia","email":"","orcid":"","institution":"Universidad De La Salle Bajío","correspondingAuthor":false,"prefix":"","firstName":"Raúl","middleName":"","lastName":"Gutierrez-Garcia","suffix":""},{"id":318313634,"identity":"8f06912e-2511-4673-9a3c-238db99849dc","order_by":3,"name":"Yesica Albor","email":"","orcid":"","institution":"Instituto Nacional de Psiquiatría \"Ramón de la Fuente Muñiz\"","correspondingAuthor":false,"prefix":"","firstName":"Yesica","middleName":"","lastName":"Albor","suffix":""},{"id":318313635,"identity":"9274ff85-3d1b-4f69-9e8c-9dbbc6d65155","order_by":4,"name":"Ana Lucía Jiménez Pérez","email":"","orcid":"","institution":"Universidad Autónoma de Baja California, Campus Ensenada","correspondingAuthor":false,"prefix":"","firstName":"Ana","middleName":"Lucía Jiménez","lastName":"Pérez","suffix":""},{"id":318313636,"identity":"1df9abfc-e375-4302-8335-abc7010f7ab1","order_by":5,"name":"Karla Patricia Valdés-García","email":"","orcid":"","institution":"Universidad Autónoma de Coahuila","correspondingAuthor":false,"prefix":"","firstName":"Karla","middleName":"Patricia","lastName":"Valdés-García","suffix":""},{"id":318313639,"identity":"7fd1276b-041b-46ef-ad60-6f003dc10c38","order_by":6,"name":"Patricia M. Baez Mansur","email":"","orcid":"","institution":"Universidad La Salle Victoria","correspondingAuthor":false,"prefix":"","firstName":"Patricia","middleName":"M. Baez","lastName":"Mansur","suffix":""},{"id":318313640,"identity":"232adba6-a337-4be6-abbc-34a88b3aebf9","order_by":7,"name":"María Anabell Covarrubias Díaz-Couder","email":"","orcid":"","institution":"Universidad la Salle Noroeste","correspondingAuthor":false,"prefix":"","firstName":"María","middleName":"Anabell Covarrubias","lastName":"Díaz-Couder","suffix":""},{"id":318313641,"identity":"6d1aa54d-4709-4f90-82ac-d6cc3f0bd0e2","order_by":8,"name":"Corina Benjet","email":"","orcid":"","institution":"Instituto Nacional de Psiquiatría \"Ramón de la Fuente Muñiz\"","correspondingAuthor":false,"prefix":"","firstName":"Corina","middleName":"","lastName":"Benjet","suffix":""}],"badges":[],"createdAt":"2024-06-10 15:21:09","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-4558929/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-4558929/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":59606079,"identity":"a0ad0f0e-a056-43e2-b232-c915d49a287d","added_by":"auto","created_at":"2024-07-03 18:51:28","extension":"png","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":149925,"visible":true,"origin":"","legend":"\u003cp\u003eLegend not included with this version\u003c/p\u003e","description":"","filename":"f1anydx1.png","url":"https://assets-eu.researchsquare.com/files/rs-4558929/v1/00b946fe8d392d787de1b5bc.png"},{"id":59722370,"identity":"1fd73b16-9ede-4424-adec-fa8031bcc194","added_by":"auto","created_at":"2024-07-05 09:49:08","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":1007537,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-4558929/v1/28a3d70a-db96-4a06-97c2-b26be65af76d.pdf"},{"id":59606078,"identity":"b0366232-9bab-4bc1-879c-bd911fde3c26","added_by":"auto","created_at":"2024-07-03 18:51:28","extension":"docx","order_by":1,"title":"","display":"","copyAsset":false,"role":"supplement","size":40692,"visible":true,"origin":"","legend":"","description":"","filename":"SPPEsupplementarymaterialsent.docx","url":"https://assets-eu.researchsquare.com/files/rs-4558929/v1/380e3b518d3df5bf23a12b0f.docx"}],"financialInterests":"No competing interests reported.","formattedTitle":"Mental health predictors of Internet Gaming Disorder: a longitudinal study","fulltext":[{"header":"1. Introduction","content":"\u003cp\u003eWhile internet gaming disorder (IGD) [\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e]or gaming disorder (GD) [\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e] have been clinically delimited for more than 10 years, we still know little about its mental health determinants. At the time of publication of the DSM-5 and the ICD-11, the evidence on the impact of mental disorders on the development of IGD was scant, with few longitudinal studies available [\u003cspan additionalcitationids=\"CR4\" citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e]. In the original 2013 formulation and in the new DSM-5TR [\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e], the DSM-5 mentions that IGD may be associated with major depression, attention deficit hyperactivity disorder (ADHD) and obsessive- compulsive disorder (OCD). The ICD-11 states that GD \u0026ldquo;commonly co-occurs with Disorders Due to Substance Use, Mood Disorders, Anxiety or Fear-Related Disorders, Attention Deficit Hyperactivity Disorder, Obsessive-Compulsive Disorder, and Sleep-Wake Disorders\u0026rdquo; [\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eMost of what we know about the co-occurrence of IGD with other mental disorders comes from cross-sectional studies that inform on the clinical features of IGD, its prevalence and correlates [\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e]. These correlates have been recently grouped as \u0026ldquo;(i) gaming-related factors (i.e., structural characteristics), (ii) individual factors (i.e., person-based characteristics), and (iii) environmental factors (i.e., situational characteristics)\u0026rdquo; [\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e]. We focus here on the role of mental health disorders as individual determinants of new onset IGD, where longitudinal studies that can separate causes of IGD from consequences of IGD are less common [\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e]. Some reviews do not differentiate longitudinal from cross-sectional studies and their estimates on the role of mental disorders as risk factors for IGD are, therefore, more prone to biases [\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e, \u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e]. A comprehensive review of longitudinal studies on IGD identified only 6 studies with data for anxiety, 4 studies on attention/hyperactivity and 12 on depression, with effect sizes on the weak side [\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e]. Another review identified 6 longitudinal studies on ADHD and GD [\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e]. As expected, not all longitudinal reports agree on the likelihood of mental disorders causing IGD [\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e, \u003cspan additionalcitationids=\"CR16\" citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e]. Differences in methods, screening scales used, analytical procedures, age groups included, and follow-up periods are among possible reasons for those inconsistent results. Absent from most literature reviews are longitudinal studies that include a wide range of mental disorders as possible predictors of IGD, as classified in the DSM-5 and ICD-11, and controls for comorbidity.\u003c/p\u003e \u003cp\u003eWe report here on a longitudinal cohort of Mexican college students from six universities located across the country. We aim to estimate the longitudinal associations of a large list of mental disorders with the onset (first occurrence) of IGD. These disorders include bipolar, major depressive disorder, generalized anxiety disorder, panic disorder, alcohol use disorder, drug use disorder, binging and/or purging, intermittent explosive disorder, psychotic experiences and attention deficit hyperactivity disorder.\u003c/p\u003e"},{"header":"2. Material and Methods","content":"\u003cdiv id=\"Sec3\" class=\"Section2\"\u003e \u003ch2\u003e2.1 Study design\u003c/h2\u003e \u003cp\u003eThis is a prospective cohort study with a follow-up period of one to three years [\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e]. Not all students responded to all years, thus some have a follow-up of one, two or three years. Exposed participants were first-year university students, free of IGD at entry (baseline), who reported at baseline symptoms compatible with a diagnosis of bipolar, major depressive disorder, generalized anxiety disorder, panic disorder, alcohol use disorder, drug use disorder, binging and/or purging, intermittent explosive disorder, psychotic experiences and attention deficit hyperactivity disorder. These disorders at baseline were the main potential risk factors for the incidence of IGD at the end of the follow-up.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec4\" class=\"Section2\"\u003e \u003ch2\u003e2.2 Sample and procedures\u003c/h2\u003e \u003cp\u003eParticipants were a cohort of first-year university students enrolled in six Mexican universities (two public and four private) for the PUERTAS study (University Project for Healthy Students) [\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e], that consisted of a baseline web-based survey conducted in the 2018\u0026ndash;2019 academic year and three follow-ups ending in 2022. These students were the first cohort to be administered a scale of IGD [\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e]. All first-year students aged 18 or older were eligible (N\u0026thinsp;=\u0026thinsp;11,099) and were recruited through school events (e.g., new student orientation and first-year courses), in which a URL to the online survey was provided. In 2018, 8,122 students agreed to participate in the baseline survey, with a 73% overall response rate. Later, e-mail invitations to three follow-up surveys were sent at the beginning of each academic year, with a 31.8% completion of at least one of these questionnaires. Data collection started in September 2018 and ended in June 2022 for a total of 2,267 students with complete data on the main variables for this analysis (see the STROBE flowchart \u0026ndash; Supplementary Fig.\u0026nbsp;1). The PUERTAS study is part of the World Health Organization World Mental Health International College Student initiative (WMH-ICS) [\u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e]. Participation was confidential and voluntary, and required informed consent. The Research Ethics Committee of the National Institute of Psychiatry in Mexico approved the study.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec5\" class=\"Section2\"\u003e \u003ch2\u003e2.3 Measures\u003c/h2\u003e \u003cp\u003eThe online, self-report survey was developed for the WMH-ICS Initiative [\u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e] and comprises well-validated measures described below.\u003c/p\u003e \u003cdiv id=\"Sec6\" class=\"Section3\"\u003e \u003ch2\u003e2.3.1 Baseline control variables\u003c/h2\u003e \u003cp\u003e \u003cb\u003eSocio-demographic variables.\u003c/b\u003e These consisted of sex (\u0026ldquo;male\u0026rdquo;, \u0026ldquo;not male\u0026rdquo;), and age. Fully adjusted models also include whether students slept at least 8 hours for \u0026lt;\u0026thinsp;=\u0026thinsp;2 days/week or \u0026gt;\u0026thinsp;2 days/week [\u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e].\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec7\" class=\"Section3\"\u003e \u003ch2\u003e2.3.2 Outcome variable: Internet Gaming Disorder at follow-up.\u003c/h2\u003e \u003cp\u003eAll participants were asked whether they played video games in the past 12 months. The full IGD scale is asked only to those gamers who screened positive to the following: If they played, on average, at least 1 day per week and their duration of gaming (during weekday or weekend) was at least 30 minutes (thereafter called \u0026ldquo;active gamers\u0026rdquo;). IGD was assessed based on a section that consisted of 23 items comprising the 9 symptoms (domains) described in the DSM-5 as formulated by an international consensus led by Nancy Petry that included an English version and a Spanish translation [\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e, \u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e]. As per DSM-5, the presence of 5 of 9 symptoms is considered as probable IGD. A description of the individual symptoms for IGD, together with the psychometric properties of the scale, was reported elsewhere [\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e]; briefly, reliability for the scale was adequate (α\u0026thinsp;=\u0026thinsp;0.816), and factor analysis\u0026rsquo; fit indices were excellent (CFI\u0026thinsp;=\u0026thinsp;0.994, TLI\u0026thinsp;=\u0026thinsp;0.992, RMSEA\u0026thinsp;=\u0026thinsp;0.030). All students classified as positive to IGD at baseline (n\u0026thinsp;=\u0026thinsp;123) were dropped from the follow-up analysis and those negative to IGD at baseline (n\u0026thinsp;=\u0026thinsp;2144) were followed for new (incident) cases.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec8\" class=\"Section3\"\u003e \u003ch2\u003e2.3.3 Mental health disorders as exposure variables at baseline.\u003c/h2\u003e \u003cp\u003e \u003cem\u003eMental disorders.\u003c/em\u003e The Composite International Diagnostic Interview Screening Scales (CIDI-SC) [\u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e]at baseline assessed the DSM diagnostic criteria for lifetime symptoms of mood disorders: bipolar I and major depressive disorder; anxiety disorders: generalized anxiety disorder and panic disorder; substance use disorders: drug use disorder. These are called screening scales because they are non-clinician diagnosed, self-administered self-report measures. But they do assess each of the diagnostic criteria for the aforementioned disorders. The CIDI-SC scales have concordance with blinded clinical diagnoses in the range AUC\u0026thinsp;=\u0026thinsp;0.70\u0026ndash;0.78 [\u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e]. The AUDIT screening scale[\u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e] assessed lifetime alcohol disorder and has concordance with clinical diagnosis in the range AUC\u0026thinsp;=\u0026thinsp;0.78\u0026ndash;0.91 [\u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e26\u003c/span\u003e].We also included a screening for lifetime eating problems (binging and/or purging), intermittent explosive disorder, and psychotic experiences. Six-month Attention Deficit Hyperactivity Disorder was evaluated with the Adult ADHD Self-Report Scale [\u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e27\u003c/span\u003e]. These self‐report scales, though they cannot be considered a clinical diagnosis of these disorders, provide a screen for clinically significant symptoms.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec9\" class=\"Section3\"\u003e \u003ch2\u003e2.3.4.Covariates\u003c/h2\u003e \u003cp\u003eVariables considered for the adjusted analysis were male sex (yes/no), age at baseline and sleeping 8 hours or more. A summary measure of any disorder was also included in the analyses. Additionally, models fully adjusted for possible comorbidity and included all 10 mental disorders.\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv id=\"Sec10\" class=\"Section2\"\u003e \u003ch2\u003e2.4. Statistical analysis\u003c/h2\u003e \u003cp\u003eWe analyzed this prospective cohort study by assessing the effect of mental disorders at baseline (exposures) over the first occurrence (i.e., incidence) of IGD (outcome) at follow-up [\u003cspan citationid=\"CR28\" class=\"CitationRef\"\u003e28\u003c/span\u003e]. For this, we used the information of all students with at least two measurements and, as mentioned previously, we excluded 123 students who were positive to IGD at baseline.\u003c/p\u003e \u003cp\u003eIncidence rates (IR) per 1,000 persons per year were estimated by dividing the number of incident IGD cases over the sum of person-years (per 1,000). Person-time was computed, for censored observations (those who did not develop IGD), as the difference between the dates of the last follow-up and the baseline. We followed a similar procedure for incident IGD cases, but discounting half of the time between the incident occurrence and the previous date.\u003c/p\u003e \u003cp\u003eCrude and adjusted Hazard Ratios (HR) and their respective 95% Confidence Intervals (CI) were estimated for the incidence of IGD by fitting proportional-hazards Cox models [\u003cspan citationid=\"CR29\" class=\"CitationRef\"\u003e29\u003c/span\u003e]. First, we fitted crude models for each individual mental disorder and also for the summary variable of any mental disorder. Then, we adjusted each model by sex, age at baseline and sleep duration. To account for comorbidity, we fitted a single model in which all 10 mental disorders were entered simultaneously [\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e]. Finally, to obtain a more parsimonious multivariate model for mental disorders, we used recommendations based on the change of the mean squared error [\u003cspan citationid=\"CR30\" class=\"CitationRef\"\u003e30\u003c/span\u003e] where age, gender and sleep duration were selected as key confounding variables. A nonresponse weight by sex and age was computed to account for loss to follow-up [\u003cspan citationid=\"CR31\" class=\"CitationRef\"\u003e31\u003c/span\u003e] (see Supplementary Table \u003cspan refid=\"MOESM1\" class=\"InternalRef\"\u003eS1\u003c/span\u003e), and it was incorporated in all Cox models [\u003cspan citationid=\"CR32\" class=\"CitationRef\"\u003e32\u003c/span\u003e]. Statistical tests were evaluated at the 0.05 alpha level and all data analysis were performed in Stata 18.0 [\u003cspan citationid=\"CR33\" class=\"CitationRef\"\u003e33\u003c/span\u003e].\u003c/p\u003e \u003c/div\u003e"},{"header":"3. Results","content":"\u003cp\u003eAt baseline (Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e), males accounted for 31% of those negative to IGD, and 78% of all those positive to IGD. Cases of IGD were also more likely to report few hours of sleep. Importantly, apart from drug abuse/dependence, all other disorders were more prevalent among those with IGD at baseline with 88.6% of those with IGD reporting one of the 10 mental disorders included here. Persistency of IGD during follow-up was common since among the 123 IGD cases detected at baseline, 44 (35.8%) reported an IGD during the following 1 to 3 years.\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\u003eBaseline sociodemographic characteristics and psychiatric disorders by baseline IGD (n\u0026thinsp;=\u0026thinsp;2,267).\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"3\"\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 \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e \u003cp\u003eDSM-5 12-month positive gaming\u0026thinsp;\u0026gt;\u0026thinsp;=\u0026thinsp;5\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e2,144 (94.6%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e123 (5.4%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMale gender\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1,480 (69.0%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e27 (22.0%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e664 (31.0%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e96 (78.0%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAge groups\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAge 18\u0026ndash;19\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1,673 (78.0%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e92 (74.8%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAge 20+\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e471 (22.0%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e31 (25.2%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSlept at least 8 hours\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u0026lt;=2 days/week\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e852 (39.7%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e64 (52.0%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u0026gt;2 days/week\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1,292 (60.3%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e59 (48.0%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMajor depressive disorder\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1,847 (86.1%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e97 (78.9%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e297 (13.9%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e26 (21.1%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eBipolar I disorder\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e2,075 (96.8%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e117 (95.1%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e69 (3.2%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e6 (4.9%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePanic disorder\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e2,065 (96.3%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e114 (92.7%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e79 (3.7%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e9 (7.3%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eGeneralized anxiety disorder\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e2,102 (98.0%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e119 (96.7%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e42 (2.0%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e4 (3.3%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eProbable alcohol dependence\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e2,076 (96.8%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e114 (92.7%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e68 (3.2%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e9 (7.3%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eDrug abuse/dependence\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e2,040 (95.1%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e119 (96.7%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e104 (4.9%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e4 (3.3%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eBinging and/or purging (screening items)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1,475 (68.8%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e70 (56.9%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e669 (31.2%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e53 (43.1%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eIntermittent explosive disorder (screening item)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1,413 (65.9%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e60 (48.8%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e731 (34.1%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e63 (51.2%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePsychotic experiences (screening items)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1,773 (82.7%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e82 (66.7%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e371 (17.3%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e41 (33.3%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePossible ADHD (6-month)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1,370 (63.9%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e37 (30.1%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e774 (36.1%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e86 (69.9%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAny mental disorder\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e749 (34.9%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e14 (11.4%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1,395 (65.1%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e109 (88.6%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eDSM-5 12-month positive gaming\u0026thinsp;\u0026gt;\u0026thinsp;=\u0026thinsp;5 at follow-up\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e2,064 (96.3%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e79 (64.2%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e80 (3.7%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e44 (35.8%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"3\" nameend=\"c3\" namest=\"c1\"\u003e \u003cp\u003eAll disorders are lifetime, except for ADHD (6 months) and IGD (12 months)\u003c/p\u003e \u003cp\u003eUnweighted data\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003eAs per our methodology, these 123 prevalent cases of IGD were discarded and the remaining 2,144 students free of IGD were followed for detecting new cases of IGD during the subsequent 1 to 3 years. Table\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e presents the distribution of these 80 incident cases of IGD by the 10 baseline mental disorders and the summary measure of any disorder. At baseline those with any mental disorder (bottom of Table\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e) had an IR of 22.09 per 1,000 person-years of IGD, while those free of any disorder had a much lower IR of IGD, 9.26 per 1,000 person-years. An inspection of this table shows that, except for panic disorder, the incidence rate of IGD was higher among those with a mental disorder compared to those without a mental disorder. For example, the incidence rate of IGD among students that at baseline reported drug abuse/dependence was 45.92 per 1,000 person-years but it was 16.92 in the absence of drug abuse/dependence.\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab2\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 2\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eSample sizes, incident cases, and incidence rates for Internet Gaming Disorder (IGD) by mental disorders at baseline (n\u0026thinsp;=\u0026thinsp;2144).\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"6\"\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 \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003en\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eIncident IGD cases\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003ePerson-years\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c6\"\u003e \u003cp\u003eIR per 1,000\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e \u003cp\u003eMajor depressive disorder\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1,847\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e62\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e3936.6\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e15.75\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e297\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e18\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e625.2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e28.79\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e \u003cp\u003eBipolar I disorder\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e2,075\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e75\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e4427.1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e16.94\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e69\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e134.7\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e37.13\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e \u003cp\u003ePanic disorder\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e2,065\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e79\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e4394.9\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e17.98\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e79\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e166.9\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e5.99\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e \u003cp\u003eGeneralized anxiety disorder\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e2,102\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e77\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e4468.8\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e17.23\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e42\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e93.0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e32.27\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e \u003cp\u003eProbable alcohol dependence\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e2,076\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e75\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e4435.8\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e16.91\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e68\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e126.0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e39.68\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e \u003cp\u003eDrug abuse/dependence\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e2,040\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e71\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e4365.8\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e16.26\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e104\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e9\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e196.0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e45.92\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e \u003cp\u003eBinging and/or purging (screening items)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1,475\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e47\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e3152.7\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e14.91\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e669\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e33\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e1409.0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e23.42\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e \u003cp\u003eIntermittent explosive disorder (screening item)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1,413\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e43\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e3010.0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e14.29\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e731\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e37\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e1551.7\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e23.84\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e \u003cp\u003ePsychotic experiences (screening items)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1,773\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e56\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e3808.0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e14.71\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e371\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e24\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e753.8\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e31.84\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e \u003cp\u003ePossible ADHD (6-month)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1,370\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e43\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e2934.5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e14.65\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e774\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e37\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e1627.3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e22.74\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e \u003cp\u003eAny mental disorder\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e749\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e15\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e1619.2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e9.26\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1395\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e65\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e2942.6\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e22.09\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"6\" nameend=\"c6\" namest=\"c1\"\u003e \u003cp\u003eAll disorders are lifetime, except for ADHD (6 months) and IGD (12 months)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"6\" nameend=\"c6\" namest=\"c1\"\u003e \u003cp\u003eIR: Incidence Rate\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"6\" nameend=\"c6\" namest=\"c1\"\u003e \u003cp\u003eUnweighted data\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"6\" nameend=\"c6\" namest=\"c1\"\u003e \u003cp\u003eIncidence computed among those free of DSM-5 IGD at baseline.\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003eWe modeled this follow-up data by using Cox regression analyses, with the results shown on Table\u0026nbsp;\u003cspan refid=\"Tab3\" class=\"InternalRef\"\u003e3\u003c/span\u003e. Crude, bivariate analyses showed that major depressive disorder, bipolar I disorder, drug abuse/dependence, binging/purging, intermittent explosive disorder and psychotic experiences all increased the likelihood of developing an IGD. While the other disorders, except for panic disorder, also increased the rate of IGD they lacked statistical significance. These basic results were not changed in multivariate models that included controls for age, sex and amount of sleep. In these multiple models, at the bottom we show that any disorder was associated with an increase in 2.33 times the likelihood of developing IGD. The Kaplan Meier curve for any disorder (Fig.\u0026nbsp;1) suggests that after the first year of the follow-up the survival curves of IGD start to show differences for those with and without any mental disorder.\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab3\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 3\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eBaseline mental disorders as a predictors of DSM-5 IGD at follow-up. Cox models. Bivariate and adjusted by sex, age, and sleep duration.\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"7\"\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 \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colspan=\"3\" nameend=\"c4\" namest=\"c2\"\u003e \u003cp\u003eCrude models\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colspan=\"3\" nameend=\"c7\" namest=\"c5\"\u003e \u003cp\u003eModels (adjusted by sex, age, and sleep)\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eHR\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003ep\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e95% CI\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eHR\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003ep\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e95% CI\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMajor depressive disorder\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1.00\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e1.00\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1.72*\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.049\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e(1.00,2.95)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e1.98*\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.020\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e(1.11,3.54)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eBipolar I disorder\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1.00\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e1.00\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e2.62*\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.037\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e(1.06,6.48)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e2.60*\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.035\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e(1.07,6.32)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePanic disorder\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1.00\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e1.00\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0.37\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.324\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e(0.05,2.65)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.36\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.303\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e(0.05,2.51)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eGeneralized anxiety disorder\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1.00\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e1.00\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1.44\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.544\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e(0.45,4.63)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e1.55\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.469\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e(0.47,5.08)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eProbable Alcohol dependence\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1.00\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e1.00\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e2.19\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.097\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e(0.87,5.52)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e1.92\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.171\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e(0.75,4.88)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eDrug abuse/dependence\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1.00\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e1.00\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e2.83*\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.004\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e(1.39,5.80)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e2.60*\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.010\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e(1.26,5.38)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eBinging and/or purging (screening items)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1.00\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e1.00\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1.69*\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.024\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e(1.07,2.68)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e1.83*\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.012\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e(1.14,2.95)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eIntermittent explosive disorder (screening item)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1.00\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e1.00\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1.59*\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.044\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e(1.01,2.50)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e1.52\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.076\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e(0.96,2.41)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePsychotic experiences (screening items)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1.00\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e1.00\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e2.20*\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.002\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e(1.34,3.59)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e2.04*\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.005\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e(1.24,3.37)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePossible ADHD (6-month)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1.00\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e1.00\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1.49\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.085\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e(0.95,2.34)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e1.42\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.140\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e(0.89,2.24)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAny mental disorder\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1.00\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e1.00\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e2.42*\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.003\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e(1.34,4.35)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e2.33*\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.007\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e(1.26,4.31)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"7\" nameend=\"c7\" namest=\"c1\"\u003e \u003cp\u003eNotes. HRs estimated with weighted Cox models.\u003c/p\u003e \u003cp\u003eAll disorders are lifetime, except for ADHD (6 months) and IGD (12 months)\u003c/p\u003e \u003cp\u003eIncident DSM-5 IGD is the outcome in all models.\u003c/p\u003e \u003cp\u003eHR: Hazard Ratio; CI: Confidence Interval.\u003c/p\u003e \u003cp\u003e* p\u0026thinsp;\u0026lt;\u0026thinsp;.05\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003eOn Table\u0026nbsp;\u003cspan refid=\"Tab4\" class=\"InternalRef\"\u003e4\u003c/span\u003e, a full multivariate model that includes demographics and all mental disorders shows decreases in all individual estimates, except for panic disorder. This means that, at least, part of the increase in IGD rates seen in individual disorders is due to comorbid conditions. We fitted then a more parsimonious model that selected the most important individual mental disorders, as described in the methods section. In this final model (Table\u0026nbsp;\u003cspan refid=\"Tab4\" class=\"InternalRef\"\u003e4\u003c/span\u003e), the mental disorders that were found to be predictors of IGD were major depressive disorder (HR\u0026thinsp;=\u0026thinsp;1.87) and bipolar disorder (HR\u0026thinsp;=\u0026thinsp;2.70).\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab4\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 4\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eBaseline mental disorders as a predictors of DSM-5 IGD at follow-up. Multivariable Cox models.\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"7\"\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 \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colspan=\"3\" nameend=\"c4\" namest=\"c2\"\u003e \u003cp\u003eFull model\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colspan=\"3\" nameend=\"c7\" namest=\"c5\"\u003e \u003cp\u003eMultiple model\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eHR\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003ep\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e95% CI\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eHR\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003ep\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e95% CI\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMajor depressive disorder\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1.00\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e1.00\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1.83\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.063\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e(0.97,3.46)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e1.87*\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.042\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e(1.02,3.42)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eBipolar I disorder\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1.00\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e1.00\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e2.48\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.071\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e(0.93,6.62)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e2.70*\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.042\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e(1.04,7.02)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePanic disorder\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1.00\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e1.00\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0.19\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.081\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e(0.03,1.23)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.20\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.087\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e(0.03,1.26)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eGeneralized anxiety disorder\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1.00\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1.08\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.916\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e(0.26,4.57)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eProbable alcohol dependence\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1.00\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1.25\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.679\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e(0.44,3.57)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eDrug abuse/dependence\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1.00\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1.85\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.138\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e(0.82,4.14)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eBinging and/or purging (screening items)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1.00\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e1.00\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1.41\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.229\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e(0.80,2.48)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e1.43\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.199\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e(0.83,2.49)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eIntermittent explosive disorder (screening item)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1.00\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e1.00\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1.09\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.734\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e(0.65,1.84)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e1.15\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.580\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e(0.70,1.91)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePsychotic experiences (screening items)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1.00\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e1.00\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1.64\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.106\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e(0.90,2.99)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e1.71\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.069\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e(0.96,3.04)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePossible ADHD (6-month)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1.00\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0.96\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.887\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e(0.57,1.63)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"7\" nameend=\"c7\" namest=\"c1\"\u003e \u003cp\u003eNotes. HRs estimated with weighted Cox models.\u003c/p\u003e \u003cp\u003eAll disorders are lifetime, except for ADHD (6 months) and IGD (12 months)\u003c/p\u003e \u003cp\u003eIncident DSM-5 IGD is the outcome in all models.\u003c/p\u003e \u003cp\u003eMultiple and full models add controls for baseline sex, age, and sleep.\u003c/p\u003e \u003cp\u003eHR: Hazard Ratio; CI: Confidence Interval.\u003c/p\u003e \u003cp\u003e* p\u0026thinsp;\u0026lt;\u0026thinsp;.05\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e"},{"header":"4. Discussion","content":"\u003cp\u003eIn summary, in this follow-up study we found that persistency of IGD during the following three years was common (35.8%). Having a mental disorder at baseline increased 2.33 times the likelihood of developing a new IGD at follow-up. While most individual mental disorders increased the rate of IGD, comorbidity explained most of these longitudinal effects. In our multiple models, only major depressive disorder and bipolar disorder remained associated with incidence of IGD.\u003c/p\u003e \u003cp\u003eA meta-analysis that included 9 longitudinal studies up to 2017 estimated a rate of persistency of IGD of 50%, with much heterogeneity and estimates ranging from 84\u0026ndash;24% [\u003cspan citationid=\"CR34\" class=\"CitationRef\"\u003e34\u003c/span\u003e].Two more recent studies reported a persistency estimate of 39.4% during 2 years among 4th- and 7th-graders in Korea [\u003cspan citationid=\"CR35\" class=\"CitationRef\"\u003e35\u003c/span\u003e] and a persistency of 41.7% among six junior high schools in Shanghai, China [\u003cspan citationid=\"CR36\" class=\"CitationRef\"\u003e36\u003c/span\u003e]. We estimate that about 1 in every 3 university respondents with a IGD at baseline would still report it after one to three years, which is within the lower range of these prior reports. Since our sample is drawn from university students, a population older than the ones reported for most studies, it strongly suggests that IGD is not a transitory disorder that just goes away with maturity. Because of our small number of persistent cases, we were not able to delve into determinants of persistency, a matter for future work.\u003c/p\u003e \u003cp\u003eIn our sample, comorbidity of IGD with other mental disorders was a rule, with almost 89% of IGD cases reporting at least one of the other ten mental disorders studied here. As evident from meta-analysis [\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e, \u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e, \u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e, \u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e] most studies on mental health disorders focus on the role of depression as a likely determinant of IGD, followed by studies on anxiety and some more on ADHD. Few studies include more than two disorders, and we know of no other study reporting on a large number of disorders and on a summary measure of \u0026ldquo;any\u0026rdquo; mental disorder as presented here. The result that the adjustment made for all mental disorders resulted in an overall decrease in the HR for most individual disorders shows the extent of comorbidity on IGD. Most longitudinal studies, nevertheless, tend to ignore comorbidity when modeling and presenting the results for a single disorder. Depression and bipolar disorder remained firmly associated with onset of IGD in our data. That affect is a greater driving force than impulsivity or compulsivity on the incidence of IDG, as suggested by these findings, supports evidence of the self-medication hypothesis of the etiology of the disorder [\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e] and the findings in Mexico that when mood disorders are comorbid with substance use disorders, generally the onset of mood disorders is prior to the substance use disorder [\u003cspan citationid=\"CR37\" class=\"CitationRef\"\u003e37\u003c/span\u003e]. Alternatively, it is possible that a particular disorder, such as depression or bipolar disorder, exerts its effects on the incidence of IGD because of a general mental health propensity or what has been called the p factor\u003c/p\u003e \u003cp\u003e[\u003cspan citationid=\"CR38\" class=\"CitationRef\"\u003e38\u003c/span\u003e, \u003cspan citationid=\"CR39\" class=\"CitationRef\"\u003e39\u003c/span\u003e]. In fact, in a recent study which tested different theories of the p factor, bipolar disorder, mania and personality disorders (not included in our current study) were the highest loading individual disorders on the p factor [\u003cspan citationid=\"CR40\" class=\"CitationRef\"\u003e40\u003c/span\u003e]. Thus, our finding that when comorbidity is controlled for, bipolar disorder is one of the two disorders to remain significant may be reflective of a general mental health propensity that is associated to developing IGD rather than any particular disorder. Finally, it is also possible that a common, unknown, cause for both psychopathology and IGD exists [\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e]\u003c/p\u003e \u003cdiv id=\"Sec13\" class=\"Section2\"\u003e \u003ch2\u003e4.1 Limitations\u003c/h2\u003e \u003cp\u003eOur survey has significant limitations to consider. Because the response rate at follow-up was low, we weighted the data to adjust for non-response bias in sex and age. However, the sample may be biased in other ways. Finally, the universities included were both public and private, but were not randomly selected, meaning that study participants are not representative of all university students in Mexico.\u003c/p\u003e \u003cp\u003eDespite its limitations, this study provides evidence for the alleged effect of a long list of common mental disorders on the incidence of IGD among students, that go beyond traditional samples of unknown gamers from internet sites of video gamers. Our follow-up extends to three years, more than the usual one-year academic period reported in most reports. By using a longitudinal approach, we provided stronger evidence for directionality and causality than correlational studies, and our controls for all mental health symptoms at baseline allowed us to rule out the role of pure comorbidity in the alleged effects of some of these disorders. Conflicting results in longitudinal studies on the role of particular mental disorders, such as depression or bipolar, warrants further research.\u003c/p\u003e \u003c/div\u003e"},{"header":"5. Conclusions","content":"\u003cp\u003eThis longitudinal study contributes to the scant literature on IGD among young adults based on prospective evidence, going further than cross-sectional studies on the issue of the short-term (one year) impact of mental health problems on IGD. Our analysis suggests that only a few mental disorders have an independent effect on the incidence of IGD. More work is needed in this area on the large comorbidity between IGD and other mental disorders and should be explored longitudinally.\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003eFunding\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eDr. Benjet received support from the National Council on Science and Technology (CONACYT; CB 285548) and Fundaci\u0026oacute;n Miguel Alem\u0026aacute;n A.C. The funders had no role in study design; in the collection, analysis, and interpretation of the data; in the writing of the report; and in the decision to submit the manuscript for publication. Dr. Borges had full access to all the data in the study and had final responsibility for the decision to submit for publication.\u003c/p\u003e\n\u003cp\u003eAuthor Contributions:\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eThe initial draft of this paper was prepared by G.B. in conjunction with C.B. and R.O. G.B. confirms that he had full access to all the data in the study and takes responsibility for the integrity of the data and the accuracy of the data analysis. C.B. was responsible for obtaining funding. G.B., C.B., and R.O. participated in the study concept and design. G.B. and R.O. participated in the data analysis and interpretation. R.G.-G , Y.A., A.L.J.P., K.P.V.G., P.M.B.-M., A.M.C.D-M, were responsible for the investigation, data collection and supervision of the field work. All the authors reviewed the initial drafts for substantive inputs and approved the final version of the article. All authors have read and agreed to the published version of the manuscript.\u003c/p\u003e\n\u003cp\u003eConflict of Interest\u003c/p\u003e\n\u003cp\u003eAll authors declare that they have no conflicts of interest.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eAcknowledgments\u003c/p\u003e\n\u003cp\u003eThe survey was carried out in conjunction with the WHO World Mental Health International College Surveys Initiative (WHO WMH-ICS). The authors thank the WHO WMH-ICS collaborators and staff for assistance with instrumentation and fieldwork.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\n\u003cli\u003eAmerican Psychiatric Associaton (2013) Diagnostic and statistical manual of mental disorders: DSM-5 (1 ed.). https://doi.org/10.1176/appi.books.9780890425596\u003c/li\u003e\n\u003cli\u003eWorld Health Organization, WHO (2018) ICD-11 Gaming disorder. 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J Abnorm Child Psychol 47:71\u0026ndash;83. https://doi.org/10.1007/s10802-018-0422-x\u003c/li\u003e\n\u003cli\u003eLash T, VanderWeele T, Haneuse S, Rothman K, Kluwer W (2021) Modern Epidemiology, 4th ed. \u003c/li\u003e\n\u003cli\u003eBenjet C, Guti\u0026eacute;rrez-Garc\u0026iacute;a RA, Abrego-Ram\u0026iacute;rez A, et al (2019) Psychopathology and self-harm among incoming first-year students in six Mexican universities. Salud Publica Mex 61:16\u0026ndash;26. https://www.saludpublica.mx/index.php/spm/article/view/9158\u003c/li\u003e\n\u003cli\u003eBorges G, Orozco R, Benjet C, et al (2019) DSM-5 Internet gaming disorder among a sample of Mexican first-year college students. J Behav Addict 13:1\u0026ndash;11. https://doi: 10.1556/2006.8.2019.62.\u003c/li\u003e\n\u003cli\u003eCuijpers P, Auerbach RP, Benjet C, Bruffaerts R, Ebert D, Karyotaki E, Kessler RC (2019) Introduction to the special issue: The WHO World Mental Health International College Student (WMH-ICS) initiative. 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Retrieved 09 January 2024, from https://www.stata.com/ \u003c/li\u003e\n\u003cli\u003eDahl D, Bergmark KH (2020) Persistence in Problematic Internet Use-A Systematic Review and Meta-Analysis. Frontiers in sociology. https://doi.org/10.3389/FSOC.2020.00030\u003c/li\u003e\n\u003cli\u003eJeong H, Yim HW, Lee SY, Lee HK, Potenza MN, Lee H (2021) Factors associated with severity, incidence or persistence of internet gaming disorder in children and adolescents: a 2-year longitudinal study. Addiction (Abingdon, England) 116:1828\u0026ndash;1838. https://doi.org/10.1111/add.15366\u003c/li\u003e\n\u003cli\u003eLiu Y, Gong R, Yu Y, Xu C, Yu X, Chang R, Wang H, Wang S, Wang Q, Cai Y (2021) Longitudinal predictors for incidence of internet gaming disorder among adolescents: The roles of time spent on gaming and depressive symptoms. J Adolesc 92:1\u0026ndash;9. https://doi.org/10.1016/J.ADOLESCENCE.2021.06.008\u003c/li\u003e\n\u003cli\u003eBorges G, Benjet C, Orozco R, Medina-Mora ME (2018) A longitudinal study of reciprocal risk between mental and substance use disorders among Mexican youth. J Psychiatr Res 105:45\u0026ndash;53. https://doi.org/10.1016/j.jpsychires.2018.08.014\u003c/li\u003e\n\u003cli\u003eCaspi A, Moffitt TE (2018) All for One and One for All: Mental Disorders in One Dimension. Am J Psychiatry 175:831\u0026ndash;844. https://doi.org/10.1176/APPI.AJP.2018.17121383\u003c/li\u003e\n\u003cli\u003eKrueger RF, Markon KE (2006) Reinterpreting comorbidity: a model-based approach to understanding and classifying psychopathology. Annu Rev Clin Psychol 2:111\u0026ndash;133. https://doi.org/10.1146/ANNUREV.CLINPSY.2.022305.095213\u003c/li\u003e\n\u003cli\u003eSouthward MW, Cheavens JS, Coccaro EF (2023) Defining the p-factor: an empirical test of five leading theories. Psychol Med 53:2732\u0026ndash;2743. https://doi.org/10.1017/S0033291722001635\u003c/li\u003e\n\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":true,"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":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true},"keywords":"Internet gaming disorder (IGD), anxiety, depression, substance use disorders, longitudinal, epidemiology","lastPublishedDoi":"10.21203/rs.3.rs-4558929/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-4558929/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003e\u003cstrong\u003ePurpose\u003c/strong\u003e: While internet gaming disorder has been clinically delimited, we still know little about its mental health determinants. We aim\u003cstrong\u003e \u003c/strong\u003eto evaluate whether a wide range of baseline mental disorders predict Internet Gaming Disorder (IGD) one to three years later, among first year university students in Mexico.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eMethods\u003c/strong\u003e: This is a prospective cohort study with a follow-up period of one to three years conducted from September 2018 to June 2022 in 6 Mexican universities. Participants were first-year university students (N=2,144) free of symptoms indicative of IGD at entry (baseline). Ten mental disorders (bipolar, major depressive disorder, generalized anxiety disorder, panic disorder, alcohol use disorder, drug use disorder, binging and/or purging, intermittent explosive disorder, psychotic experiences, attention deficit hyperactivity disorder) at baseline were the main risk factors explored for the incidence of IGD at the end of the follow-up. We used Cox regression to model the IGD incidence rate.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eResults\u003c/strong\u003e: A composite measure of any mental disorder at baseline was associated with an increase in 2.33 times (1.26-4.31) the rate of IGD 1 to 3 years later. Several individual disorders were associated with rates of IGD in multiple models, with comorbid conditions diminishing most of these associations.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConclusion\u003c/strong\u003e: While students with a range of mental disorders were at risk for development of IGD, only major depressive disorder and bipolar disorder remained associated with a new case of IGD. Discrepant results from available longitudinal studies on the role of specific mental disorders in the development of IGD needs to be further investigated.\u003c/p\u003e","manuscriptTitle":"Mental health predictors of Internet Gaming Disorder: a longitudinal study","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2024-07-03 18:51:23","doi":"10.21203/rs.3.rs-4558929/v1","editorialEvents":[{"type":"communityComments","content":0}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"73045cc4-6996-463d-8a51-33068b7716a3","owner":[],"postedDate":"July 3rd, 2024","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[],"tags":[],"updatedAt":"2024-07-05T09:41:01+00:00","versionOfRecord":[],"versionCreatedAt":"2024-07-03 18:51:23","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-4558929","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-4558929","identity":"rs-4558929","version":["v1"]},"buildId":"8U1c8b4HqxoKbykW_rLl7","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}