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The trajectory of psychological distress and problematic Internet gaming among primary school boys: a longitudinal study across different periods of COVID-19 in China

  • I-Hua Chen1
  • Yi-Ching Lin2,*,
  • Chung-Ying Lin3
  • Wen-Chao Wang4
  • Jeffrey H. Gamble5,*,

1Chinese Academy of Education Big Data, Qufu Normal University, 273165 Qufu, Shandong, China

2Department of Early Childhood and Family Education, College of Education, National Taipei University of Education, 10671 Taipei, Taiwan

3Institute of Allied Health Sciences, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, 701401 Tainan, Taiwan

4Experimental Teaching Department, Guizhou University of Finance and Economics, 550025 Guiyang, Guizhou, China

5Department of Foreign Languages, National Chiayi University, Minhsiung County, 62103 Chiayi, Taiwan

DOI: 10.31083/j.jomh1803070 Vol.18,Issue 3,March 2022 pp.1-14

Submitted: 26 October 2021 Accepted: 03 December 2021

Published: 31 March 2022

(This article belongs to the Special Issue COVID-19 impact on men's mental health)

*Corresponding Author(s): Yi-Ching Lin E-mail:
*Corresponding Author(s): Jeffrey H. Gamble E-mail:


Background: Children are a vulnerable population in terms of the impact of COVID-19 on their psychological well-being. When restricted to their homes, children are susceptible to problematic Internet gaming (PG). Primary school boys are particularly at risk of PG, which may lead to negative psychological effects, such as distress. Emerging research has identified perceived weight stigma (PWS) as a variable closely associated with both PG and psychological distress, particularly during the COVID-19 pandemic. The purpose of this study was to evaluate the trajectory of psychological distress among this vulnerable population from a longitudinal perspective, evaluating the role of PG and PWS. Methods: Self-report measures were used to assess psychological distress, PG, and PWS among primary school boys (grades 4 to grade 6; N = 283). Data were collected across three waves: before the pandemic, during school closure, and following the lifting of restrictions. Results: The trajectory of psychological distress among primary school boys was concave, indicating their mental health was negatively impacted during home restriction but recovered after the lockdown ended (linear change = 0.98, p < 0.01; quadratic change = –0.19, p < 0.01). PG was a significant covariate in terms of the trajectory of psychological distress (b = 0.02, p < 0.01). Moreover, baseline values for PWS were shown to have a negative direct effect on mental health before the pandemic (b = 0.05, p < 0.01), and moderated the time factor for boys’ psychological distress over time (b of PWS × linear change = 0.04, p = 0.006; b of PWS × Quadratic change was negative at –0.01, p = 0.002). Conclusions: Although mental health gradually improved as home restrictions subsided, future studies are required to address changes in mental health upon return to school for students reporting higher levels of weight stigma.


Psychological distress; Problematic Internet gaming; COVID-19; Perceived weight stigma; Longitudinal study

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I-Hua Chen,Yi-Ching Lin,Chung-Ying Lin,Wen-Chao Wang,Jeffrey H. Gamble. The trajectory of psychological distress and problematic Internet gaming among primary school boys: a longitudinal study across different periods of COVID-19 in China. Journal of Men's Health. 2022. 18(3);1-14.


[1] Santoso A, Pranata R, Wibowo A, Al-Farabi MJ, Huang I, An-tariksa B. Cardiac injury is associated with mortality and criti-cally ill pneumonia in COVID-19: a meta-analysis. The Ameri-can Journal of Emergency Medicine. 2021; 44: 352–357.

[2] Bansal A, Kumar A, Patel D, Puri R, Kalra A, Kapadia SR, et al. Meta-analysis Comparing Outcomes in Patients with and with-out Cardiac Injury and Coronavirus Disease 2019 (COVID-19). The American Journal of Cardiology. 2021; 141: 140–146.

[3] Wu S, Zhang K, Parks-Stamm EJ, Hu Z, Ji Y, Cui X. Increases in anxiety and depression during COVID-19: A large longitudinal study from China. Frontiers in Psychology. 2021; 12: 675839.

[4] Bueno-Notivol J, Gracia-García P, Olaya B, Lasheras I, López-Antón R, Santabárbara J. Prevalence of depression during the COVID-19 outbreak: a meta-analysis of community-based stud-ies. International Journal of Clinical and Health Psychology. 2021; 21: 100196.

[5] Xiong J, Lipsitz O, Nasri F, Lui LMW, Gill H, Phan L, et al. Impact of COVID-19 pandemic on mental health in the general population: a systematic review. Journal of Affective Disorders. 2020; 277: 55–64.

[6] Wang C, Pan R, Wan X, Tan Y, Xu L, McIntyre RS, et al. A longitudinal study on the mental health of general population during the COVID-19 epidemic in China. Brain, Behavior, and Immunity. 2020; 87: 40–48.

[7] Li J, Yang Z, Qiu H, Wang Y, Jian L, Ji J, et al. Anxiety and depression among general population in China at the peak of the COVID-19 epidemic. World Psychiatry. 2020; 19: 249–250.

[8] Liu X, Zhu M, Zhang R, Zhang J, Zhang C, Liu P, et al. Public mental health problems during COVID-19 pandemic: a largescale meta-analysis of the evidence. Translational Psychiatry. 2021; 11: 384.

[9] Sonnentag S. Dynamics of well-being. Annual Review of Or-ganizational Psychology and Organizational Behavior. 2015; 2: 261–293.

[10] Mukhtar S. Psychological health during the coronavirus disease 2019 pandemic outbreak. International Journal of Social Psychi-atry. 2020; 66: 512–516.

[11] Canet-Juric L, Andrés ML, del Valle M, López-Morales H, Poó F, Galli JI, et al. A longitudinal study on the emotional impact cause by the COVID-19 pandemic quarantine on general popu-lation. Frontiers in Psychology. 2020; 11: 565688.

[12] Brosschot JF, Verkuil B, Thayer JF. The default response to un-certainty and the importance of perceived safety in anxiety and stress: an evolution-theoretical perspective. Journal of Anxiety Disorders. 2016; 41: 22–34.

[13] Wade M, Prime H, Browne DT. Why we need longitudinal mental health research with children and youth during (and after) the COVID-19 pandemic. Psychiatry Research. 2020; 290: 113143.

[14] Shanahan L, Steinhoff A, Bechtiger L, Murray AL, Nivette A, Hepp, U., et al. Emotional distress in young adults during the COVID-19 pandemic: evidence of risk and resilience from a longitudinal cohort study. Psychological Medicine. 2020; 1–10.

[15] Robinson E, Sutin AR, Daly M, Jones A. A systematic review and meta-analysis of longitudinal cohort studies comparing mental health before versus during the COVID-19 pandemic. MedRxiv. 2021. (in press)

[16] Daly M, Sutin AR, Robinson E. Longitudinal changes in men-tal health and the COVID-19 pandemic: evidence from the UK Household Longitudinal Study. Psychological Medicine. 2020; 1–10.

[17] González-Sanguino C, Ausín B, Castellanos MÁ, Saiz J, López-Gómez A, Ugidos C, et al. Mental health consequences of the Coronavirus 2020 Pandemic (COVID-19) in Spain. A longitu-dinal study. Frontiers in Psychiatry. 2020; 11: 65474.

[18] O’Connor RC, Wetherall K, Cleare S, McClelland H, Melson AJ, Niedzwiedz CL, et al. Mental health and well-being during the COVID-19 pandemic: longitudinal analyses of adults in the UK COVID-19 Mental Health & Wellbeing study. The British Journal of Psychiatry. 2021; 218: 326–333.

[19] Pierce M, Hope H, Ford T, Hatch S, Hotopf M, John A, et al. Mental health before and during the COVID-19 pandemic: a longitudinal probability sample survey of the UK population. The Lancet Psychiatry. 2020; 7: 883–892.

[20] Breslau J, Finucane ML, Locker AR, Baird MD, Roth EA, Collins RL. A longitudinal study of psychological distress in the United States before and during the COVID-19 pandemic. Pre-ventive Medicine. 2021; 143: 106362.

[21] Ramiz L, Contrand B, Rojas Castro MY, Dupuy M, Lu L, Sztal-Kutas C, et al. A longitudinal study of mental health before and during COVID-19 lockdown in the French population. Global-ization and Health. 2021; 17: 29.

[22] Saladino V, Algeri D, Auriemma V. The psychological and social impact of Covid-19: New perspectives of well-being. Frontiers in Psychology. 2020; 11: 577684.

[23] Mao W, Agyapong VIO. The role of social determinants in men-tal health and resilience after disasters: Implications for public health policy and practice. Frontiers in Public Health. 2021; 9: 658528–658528.

[24] Orgilés M, Morales A, Delvecchio E, Mazzeschi C, Espada JP. Immediate psychological effects of the COVID-19 quarantine in youth from Italy and Spain. Frontiers in Psychology. 2020; 11: 2986.

[25] Mendolia S, Suziedelyte A, Zhu A. Have girls been left behind during the COVID-19 Pandemic? Gender differences in pan-demic effects on children’s mental wellbeing (No. 14665). Insti-tute of Labor Economics. 2021.

[26] Figlio D, Karbownik K, Roth J, Wasserman M. Family disad-vantage and the gender gap in behavioural and educational out-comes. American Economic Journal: Applied Economics. 2019; 11: 338–381.

[27] Moore SA, Faulkner G, Rhodes RE, Brussoni M, Chulak-Bozzer T, Ferguson LJ, et al. Impact of the COVID-19 virus outbreak on movement and play behaviours of Canadian children and youth: a national survey. International Journal of Behavioral Nutrition and Physical Activity. 2020; 17: 85.

[28] Chen I, Chen C, Pakpour AH, Griffiths MD, Lin C. Internet-Related Behaviors and Psychological Distress among Schoolchildren during COVID-19 School Suspension. Journal of the American Academy of Child & Adolescent Psychiatry. 2020; 59: 1099–1102.e1.

[29] King DL, Delfabbro PH, Billieux J, Potenza MN. Problematic online gaming and the COVID-19 pandemic. Journal of Behav-ioral Addictions. 2020; 9: 184–186.

[30] Lemenager T, Neissner M, Koopmann A, Reinhard I, Geor-giadou E, Müller, A, et al. COVID-19 lockdown restrictions and online media consumption in Germany. International Journal of Environmental Research and Public Health. 2021; 18: 14.

[31] Dufour M, Brunelle N, Khazaal Y, Tremblay J, Leclerc D, Cousineau M, et al. Gender difference in online activities that determine problematic internet use. Journal De ThéRapie Com-portementale Et Cognitive. 2017; 27: 90–98.

[32] Canale N, Marino C, Griffiths MD, Scacchi L, Monaci MG, Vieno A. The association between problematic online gaming and perceived stress: the moderating effect of psychological re-silience. Journal of Behavioral Addictions. 2019; 8: 174–180.

[33] Ko C, Yen J, Chen C, Chen S, Yen C. Gender Differences and Related Factors Affecting Online Gaming Addiction among Tai-wanese Adolescents. Journal of Nervous & Mental Disease. 2005; 193: 273–277.

[34] Király O, Potenza MN, Stein DJ, King DL, Hodgins DC, Saun-ders JB, et al. Preventing problematic internet use during the COVID-19 pandemic: Consensus guidance. Comprehensive Psychiatry. 2020; 100: 152180.

[35] Xu S, Park M, Kang UG, Choi JS, Koo JW. Problematic use of alcohol and online gaming as coping strategies During the COVID-19 pandemic: A mini review. Frontiers in Psychiatry. 2021; 12: 685964.

[36] Duan L, Shao X, Wang Y, Huang Y, Miao J, Yang X, et al. An investigation of mental health status of children and adolescents in china during the outbreak of COVID-19. Journal of Affective Disorders. 2020; 275: 112–118.

[37] Fung XCC, Siu AMH, Potenza MN, O’Brien KS, Latner JD, Chen C-Y, et al. Problematic use of Internet-related activities and perceived weight stigma in schoolchildren: A longitudinal study across different epidemic periods of COVID-19 in China. Frontiers in Psychiatry. 2021; 12: 675839.

[38] Major B, Hunger JM, Bunyan DP, Miller CT. The ironic effects of weight stigma. Journal of Experimental Social Psychology. 2014; 51: 74–80.

[39] Alimoradi Z, Golboni F, Griffiths MD, Broström A, Lin C, Pakpour AH. Weight-related stigma and psychological distress: a systematic review and meta-analysis. Clinical Nutrition. 2020; 39: 2001–2013.

[40] Schafer MH, Ferraro KF. The Stigma of Obesity. Social Psy-chology Quarterly. 2011; 74: 76–97.

[41] Puhl RM, Lessard LM, Larson N, Eisenberg ME, Neumark-Stzainer D. Weight Stigma as a Predictor of Distress and Mal-adaptive Eating Behaviors during COVID-19: Longitudinal Findings from the EAT Study. Annals of Behavioral Medicine. 2020; 54: 738–746.

[42] Himmelstein MS, Puhl RM, Quinn DM. Weight Stigma in Men: what, when, and by whom? Obesity. 2018; 26: 968–976.

[43] Emmer C, Bosnjak M, Mata J. The association between weight stigma and mental health: a meta-analysis. Obesity Reviews. 2020; 21: e12935.

[44] Hayward LE, Vartanian LR, Pinkus RT. Weight Stigma Predicts Poorer Psychological well‐being through Internalized Weight Bias and Maladaptive Coping Responses. Obesity. 2018; 26: 755–761.

[45] Chen C, Chen I, O’Brien KS, Latner JD, Lin C. Psychological distress and internet-related behaviors between schoolchildren with and without overweight during the COVID-19 outbreak. International Journal of Obesity. 2021; 45: 677–686.

[46] Clemmensen C, Petersen MB, Sørensen TIA. Will the COVID-19 pandemic worsen the obesity epidemic? Nature Reviews En-docrinology. 2020; 16: 469–470.

[47] Zhuang Z, Cao P, Zhao S, Lou Y, Yang S, Wang W, et al. Estima-tion of local Novel Coronavirus (COVID-19) cases in Wuhan, China from off-site reported cases and population flow data from different sources. Frontiers in Physics. 2020; 8: 336.

[48] Tian W. How China Managed the COVID-19 Pandemic*. Asian Economic Papers. 2021; 20: 75–101.

[49] Yu X, Li N, Dong Y. Observation on China’s strategies to prevent the resurgence of the COVID-19 epidemic. Risk Management and Healthcare Policy. 2021; 14: 2011–2019.

[50] Qureshi HA. Theoretical sampling in qualitative research: A multi-layered nested sampling scheme. International Journal of Contemporary Research and Review. 2018; 9: 20218–20222.

[51] Lessard LM, Puhl RM. Adolescents’ Exposure to and Experi-ences of Weight Stigma during the COVID-19 Pandemic. Jour-nal of Pediatric Psychology. 2021; 46: 950–959.

[52] Lovibond SH, Lovibond PF. Manual for the depression anxiety stress scales. Psychology Foundation of Australia. 1996.

[53] Patrick J, Dyck M, Bramston P. Depression anxiety stress scale: is it valid for children and adolescents? Journal of Clinical Psy-chology. 2010; 66: 996–1007.

[54] Szabó M, Lovibond PF. Anxiety, Depression, and Ten-sion/Stress in Children. Journal of Psychopathology and Behav-ioral Assessment. 2006; 28: 192–202.

[55] Mellor D, Vinet EV, Xu X, Hidayah Bt Mamat N, Richardson B, Román F. Factorial Invariance of the DASS-21 among Ado-lescents in Four Countries. European Journal of Psychological Assessment. 2014; 31: 138–142.

[56] Chan RCK, Xu T, Huang J, Wang Y, Zhao Q, Shum DHK, et al. Extending the utility of the Depression Anxiety Stress scale by examining its psychometric properties in Chinese settings. Psychiatry Research. 2012; 200: 879–883.

[57] Pontes HM, Griffiths MD. Measuring DSM-5 internet gaming disorder: Development and validation of a short psychometric scale. Computers in Human Behavior. 2015; 45: 137–143.

[58] Poon LYJ, Tsang HWH, Chan TYJ, Man SWT, Ng LY, Wong YLE, et al. Psychometric properties of the Internet Gaming Dis-order Scale–Short-Form (IGDS9-SF): Systematic review. Jour-nal of Medical Internet Research. 2021; 23: e26821.

[59] Chen I, Strong C, Lin Y, Tsai M, Leung H, Lin C, et al. Time in-variance of three ultra-brief internet-related instruments: Smart-phone Application-Based Addiction Scale (SABAS), Bergen Social Media Addiction Scale (BSMAS), and the nine-item In-ternet Gaming Disorder Scale- Short Form (IGDS-SF9) (Study Part B). Addictive Behaviors. 2020; 101: 105960.

[60] Chen I-H, Ahorsu DK, Pakpour AH, Griffiths MD, Lin C-Y, Chen C-Y. Psychometric properties of three simplified Chinese online-related addictive behavior instruments among mainland Chinese primary school students. Frontiers in Psychiatry. 2020; 11: 875.

[61] Pakpour AH, Tsai M, Lin Y, Strong C, Latner JD, Fung XCC, et al. Psychometric properties and measurement invariance of the Weight Self-Stigma Questionnaire and Weight Bias Internaliza-tion Scale in children and adolescents. International Journal of Clinical and Health Psychology. 2019; 19: 150–159.

[62] Duckworth AL, Tsukayama E, May H. Establishing Causality Using Longitudinal Hierarchical Linear Modeling: an Illustra-tion Predicting Achievement from Self-Control. Social Psycho-logical and Personality Science. 2010; 1: 311–317.

[63] Helson R, Jones C, Kwan VS. Personality change over 40 years of adulthood: Hierarchical linear modeling analyses of two lon-gitudinal samples. Journal of Personality and Social Psychology. 2002; 83: 752.

[64] Pinheiro P, Gonçalves MM, Sousa I, Salgado J. What is the effect of emotional processing on depression? a longitudinal study. Psychotherapy Research. 2021; 31: 507–519.

[65] Longford NT, Bryk AS, Raudenbush SW. Hierarchical Linear Models: Applications and Data Analysis Methods. Contempo-rary Sociology. 1992; 22: 293.

[66] Petscher YM, Schatschneider C, Compton DL. Applied quanti-tative analysis in education and the social sciences. Routledge. 2013.

[67] Shapiro ES, Dennis MS, Fu Q. Comparing computer adaptive and curriculum-based measures of math in progress monitoring. School Psychology Quarterly. 2015; 30: 470–487.

[68] Grundy AM, Gondoli DM, Blodgett Salafia EH. Hierarchical Linear Modeling Analysis of Change in Maternal Knowledge over the Transition to Adolescence. The Journal of Early Ado-lescence. 2009; 30: 707–732.

[69] Pachankis JE, Sullivan TJ, Feinstein BA, Newcomb ME. Young adult gay and bisexual men’s stigma experiences and mental health: an 8-year longitudinal study. Developmental Psychol-ogy. 2018; 54: 1381–1393.

[70] Cohen J. Statistical power analysis for the behavioral sciences. Lawrence Erlbaum. 1988.

[71] Kline RB. Principles and practice of structural equation model-ing. Guilford Publications. 2015.

[72] Guo K, Zhang X, Bai S, Minhat HS, Nazan AINM, Feng J, et al. Assessing social support impact on depression, anxiety, and stress among undergraduate students in Shaanxi province dur-ing the COVID-19 pandemic of China. PLoS ONE. 2021; 16: e0253891.

[73] Shen K, Yang Y, Wang T, Zhao D, Jiang Y, Jin R, et al. Diagno-sis, treatment, and prevention of 2019 novel coronavirus infec-tion in children: experts’ consensus statement. World Journal of Pediatrics. 2020; 16: 223–231.

[74] Biddle SJH, Gorely T, Stensel DJ. Health-enhancing physical activity and sedentary behaviour in children and adolescents. Journal of Sports Sciences. 2004; 22: 679–701.

[75] Sallis JF, Prochaska JJ, Taylor WC. A review of correlates of physical activity of children and adolescents. Medicine and Sci-ence in Sports and Exercise. 2000; 32: 963–975.

[76] Singh S, Roy D, Sinha K, Parveen S, Sharma G, Joshi G. Impact of COVID-19 and lockdown on mental health of children and adolescents: a narrative review with recommendations. Psychi-atry Research. 2020; 293: 113429.

[77] Teng Z, Pontes HM, Nie Q, Griffiths MD, Guo C. Depression and anxiety symptoms associated with internet gaming disor-der before and during the COVID-19 pandemic: a longitudinal study. Journal of Behavioral Addictions. 2021; 10: 169–180.

[78] Chen I, Chen C, Pakpour AH, Griffiths MD, Lin C, Li X, et al. Problematic internet-related behaviors mediate the as-sociations between levels of internet engagement and distress among schoolchildren during COVID-19 lockdown: a longitu-dinal structural equation modeling study. Journal of Behavioral Addictions. 2021; 10: 135–148.

[79] Chen C, Chen I, Hou W, Potenza MN, O’Brien KS, Lin C, et al. The Relationship between Children’s Problematic Internet-related Behaviors and Psychological Distress during the Onset of the COVID-19 Pandemic. Journal of Addiction Medicine. 2021.(in press)

[80] Lin Y, Latner JD, Fung XCC, Lin C. Poor Health and Expe-riences of being Bullied in Adolescents: Self-Perceived Over-weight and Frustration with Appearance Matter. Obesity. 2018; 26: 397–404.

[81] Gladstone TR, Schwartz JA, Pössel P, Richer AM, Buchholz KR, Rintell L. Depressive symptoms among adolescents: Test-ing vulnerability-stress and protective models in the context of COVID-19. Child Psychiatry and Human Development. 2021; 1–11.

[82] Galea S, Vlahov D, Resnick H, Ahern J, Susser E, Gold J, et al. Trends of probable post-traumatic stress disorder in New York City after the September 11 terrorist attacks. American Journal of Epidemiology. 2003; 158: 514–524.

[83] Blix I, Birkeland MS, Thoresen S. Worry and mental health in the Covid-19 pandemic: vulnerability factors in the general Nor-wegian population. BMC Public Health. 2021; 21: 928.

[84] Ren Z, Zhou Y, Liu Y. The psychological burden experienced by Chinese citizens during the COVID-19 outbreak: prevalence and determinants. BMC Public Health. 2020; 20: 1–10.

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