Adverse childhood experiences and gaming disorder among Chinese adolescents: Insights from multiple approaches

This study comprehensively explored the associations of individual adverse childhood experiences (ACEs), cumulative ACE exposure, and latent ACE patterns with GD among Chinese adolescents using network analysis, latent class analysis (LCA), and regression modeling.

A total of 11,335 students from 333 classes across 9 high schools in Guangzhou, China, were surveyed. Network analysis, LCA, and generalized linear mixed-effects models (GLMMs) were conducted.

Among participants (mean [SD] age: 15.89 (0.61) years; 48.2 % female), 81.1 % reported at least one ACE. Network analysis identified "witnessing domestic violence" as the core node and "poor academic performance" as the bridge node connecting ACEs and GD symptoms. LCA identified four distinct ACE patterns: Class 1 ("less-educated parents"; 66.1 %), Class 2 ("poor school relationships"; 16.2 %), Class 3 ("violence and bullying"; 12.2 %), and Class 4 ("parental loss"; 5.5 %). Results from the GLMMs showed that among all individual ACEs, "poor academic performance" demonstrated the strongest association with GD symptoms (β = 2.72; 95 % CI, 2.38-3.07). A dose-response relationship was observed between cumulative ACE scores and GD symptoms. Compared with the "less-educated parents" class, all other ACE patterns were significantly associated with higher GD symptoms, with the strongest association observed in the "violence and bullying" class (β = 3.15; 95 % CI, 2.73-3.57), followed by the "poor school relationships" class (β = 2.66; 95 % CI, 2.29-3.04) and the "parental loss" class (β = 1.14, 95 % CI, 0.54-1.74).

Exposure to ACEs, especially poor academic performance and latent patterns involving violence and bullying, was significantly associated with GD among Chinese adolescents.