Computers in Human Behavior: Wenliang Su, Xiaoli Han, Hanlu Yu, Yiling Wu, Marc N. Potenza

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Computers in Human Behavior 113 (2020) 106480

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Computers in Human Behavior


journal homepage: http://www.elsevier.com/locate/comphumbeh

Do men become addicted to internet gaming and women to social media? A


meta-analysis examining gender-related differences in specific
internet addiction
Wenliang Su a, *, Xiaoli Han a, Hanlu Yu a, Yiling Wu a, Marc N. Potenza b, c, d, **
a
Department of Applied Psychology, School of Humanities and Social Sciences, Fuzhou University, Fuzhou, China
b
Department of Psychiatry, Child Study Center, Department of Neuroscience, Yale University School of Medicine, New Haven, CT, United States
c
Connecticut Mental Health Center, New Haven, CT, United States
d
Connecticut Council on Problem Gambling, Wethersfield, CT, United States

A R T I C L E I N F O A B S T R A C T

Keywords: Males have been proposed to be more vulnerable to internet addiction (IA) than females. However, males and
Internet addiction females may differ with respect to specific patterns and types of internet usage and related IA. To investigate
Internet gaming disorder further, a meta-analysis was conducted to investigate gender-related differences in internet gaming disorder
Problematic online gaming
(IGD) and social media addiction (SMA). The current meta-analysis aimed to quantify gender-related effect sizes
Social media addiction
Gender difference
relating to IGD and SMA, examine potential moderating influences of regions and other possible confounds, and
Meta-analysis compare the findings with generalized IA at the country level. The meta-analysis comprised 53 effect sizes with
82,440 individuals from 21 countries/regions for IGD, and 41 effect sizes with 58,336 individuals from 22
countries/regions for SMA. A random-effects model confirmed important gender-specific distinctions as men
were more likely to exhibit IGD than women (g ¼ 0.479) and less likely to exhibit SMA than women (g ¼
0.202). Additional moderator analyses revealed that effect sizes of IGD and SMA were larger in Europe and the
Americas than in Asia. Further analyses indicated that the effect sizes of gender-related differences in IGD and
SMA at the country-level were significantly larger than those in generalized IA, which suggests that gender-
related differences in specific IAs may be underestimated in the “umbrella” of generalized IA. Results have
implications for explaining why males and females may become addicted to internet use through different
pathways.

1. Introduction like “Internet Addiction Disorder,” “Pathological Internet Use,” “Prob­


lematic Internet Use,” “Excessive Internet Use” and “Compulsive
1.1. Internet addiction Internet Use” have all been used in the literature to describe similar
concepts relating to IA (Widyanto & Griffiths, 2006). Although it is still
The internet has become an indispensable part of people’s lives. By controversial whether IA constitutes a behavioral addiction since it was
June 2019, there were more than 4.5 billion internet users worldwide, not specifically acknowledged in DSM-5 or ICD-11, research into IA has
and the internet penetration rate reached 58.8% (Internet World Stats, proliferated in recent decades, and multiple reports highlight the po­
2019). The internet provides a wide range of information and facilitates tential negative consequences of IA and its psychiatric comorbidities
communication, and it also brings potential problems, including the (Bisen & Deshpande, 2018). For example, IA has been related to anxiety,
phenomenon of internet addiction (IA). IA has been defined as “a psy­ depression, and poor sleep quality (Lam, 2014; Liang et al., 2016; Malak
chological dependence on the internet” (Kandell, 1998), and it is char­ et al., 2017), as well as reported problems in relationship, academy, and
acterized by excessive or poorly controlled preoccupations, urges, or occupation (Bisen & Deshpande, 2018). A multinational meta-analysis,
behaviors regarding internet usage that lead to impairment or distress including 31 countries, reported the IA prevalence over the world was
(Shaw & Black, 2008; Weinstein & Lejoyeux, 2010). Some other labels as high as 6.0% (Cheng & Li, 2014), indicating it’s an important

* Corresponding author. Department of Applied Psychology, School of Humanities and Social Sciences, Fuzhou University, Fuzhou, 350108, China.
** Corresponding author. Department of Psychiatry, Yale University School of Medicine, New Haven, CT, United States.
E-mail addresses: suwenliang@fzu.edu.cn (W. Su), marc.potenza@yale.edu (M.N. Potenza).

https://doi.org/10.1016/j.chb.2020.106480
Received 27 February 2020; Received in revised form 29 June 2020; Accepted 3 July 2020
Available online 13 July 2020
0747-5632/© 2020 Elsevier Ltd. All rights reserved.
W. Su et al. Computers in Human Behavior 113 (2020) 106480

emerging public health problem. Psychiatric Association, 2013). Moreover, gaming disorder including
In the process of evaluating factors related to IA from a multidi­ online variants has been officially included in the 11th edition of the
mensional perspective, demographic factors are often first considered by International Classification of Diseases (ICD-11) (WHO, 2019).
researchers (Yen et al., 2009). Among them, “gender is a crucial factor to Males typically spend more time gaming per day than females
explain why people are addicted to the internet through different (Chang et al., 2018), and this has been observed across jurisdictions in
pathways” (Tang et al., 2017). Gender-related differences in addictive adults (Laconi et al., 2017) and adolescents (Wichstrom et al., 2019).
behaviors and their motivations have been reported, and these have Not surprisingly, males are more prone to develop IGD than females
been considered important for understanding IA (Liang et al., 2016). across age groups (Choliz & Marco, 2011; De Pasquale et al., 2018;
Males have often been reported to have higher levels of IA than females Stavropoulos, Adams, et al., 2019). In German adolescents, the preva­
(Anderson et al., 2017; Chen et al., 2015), but there exist some contrary lence of IGD in boys was 5.9% and in girls was 1.0% (Wartberg et al.,
results (Rukuye Aylaz, 2015; Sun et al., 2012). To investigate further, Su 2020). In the Netherlands, boys scored higher on IGD measures than
et al. (2019) conducted a meta-analysis involving 34 global jurisdictions girls, and the effect size was moderate in magnitude (Cohen’s d ¼ 0.57)
and found that males were more likely than females to experience IA (Kokonyei et al., 2019). In adults, Amendola et al. (2019) reported that
with a small effect size of 0.145 (Hedges’ g). According to the study, the males were at greater risk of IGD than females. Similarly, according to
gender-related effect sizes of IA were larger in Asia and smaller in other the study by Bonnaire and Baptista (2019), most young adult partici­
regions, which may be explained by both economic and cultural factors pants in a problematic gaming group were male (78.4%). Several
(Su et al., 2019). possible explanations have been forwarded regarding gender-related
Previous studies of generalized IA have demonstrated the impor­ differences in IGD. With respect to neural mechanisms, gaming cues
tance of how gender may influence online behaviors. However, gender elicit higher cravings in male subjects and exhibit different neural cor­
may relate differently to specific types of IA. Young et al. (1999) clas­ relates (Dong et al., 2019; Dong, Zheng, et al., 2018). Competitive
sified IA into five types, including cybersex, cyber-relationships, online structures in games may be more attractive to males, who may gain
stock trading or gambling, information overload, and computer games. feelings of success and achievement from gaming (Hamlen, 2010;
Davis (2001) proposed a cognitive-behavior model to distinguish be­ Wartberg et al., 2020). From a sociocultural perspective, male aggres­
tween “generalized pathological internet use” and “specific pathological siveness may be considered more socially acceptable, and some game
internet use.” Specific pathological internet use refers to the condition in designers set males as the target users of violent and adventurous online
which an individual pathologically uses the internet for a particular games (Barua & Barua, 2012; Bryce & Rutter, 2003). Such gaming may
purpose (e.g., online shopping or online gambling), whereas generalized then link to adverse behaviors in individuals with specific tempera­
pathological internet use defines as “a general, multidimensional over­ mental tendencies (e.g., those high in sensation-seeking) (Zhai et al.,
use of the internet” (Davis, 2001; Montag et al., 2015). Differences be­ 2020).
tween generalized and specific IAs were supported by a cross-cultural Although multiple studies support a higher prevalence of IGD in
empirical study (Montag et al., 2015). Thus, it appears important to males, there exist some contrary findings (Scerri, Anderson, Stavro­
distinguish between specific forms of IA when considering poulos, & Hu, 2019; Stavropoulos, Adams, et al., 2019; Stavropoulos,
gender-related differences. With respect to specific IAs, internet gaming Anderson, et al., 2019). In a sample from India, girls scored higher on
disorder (IGD) and social media addiction (SMA) have been described IGD measures than boys (Rajanna et al., 2016). Consequently, whether
particularly frequently (M�erelle et al., 2017). As examples of specific males are more likely than females to exhibit internet-gaming IA war­
types of online behaviors, Spilkova et al. (2017) commented, “there is a rants additional systematic research.
need to distinguish between online gaming and social media use, and
perceive them as separate concepts that should not be combined into a 1.3. Gender-related differences in social media addiction
unique category of generalized internet use.” Therefore, we focused our
analytical efforts on IGD and SMA in this study. The development of the internet and the popularity of smartphones
According to research on IGD and SMA over the last decade, exten­ have increased the use of social media, which allows people to develop,
sive findings suggest that females are more prone to problems with initiate, and maintain existing relationships and new ones (Abbasi,
online communication and social media use, while internet gaming is 2019). The umbrella term ‘social media’ comprises multiple types of
more prevalent among males (Bouna-Pyrrou et al., 2015; Spilkova et al., websites including social networks, messengers, and blogs(van den
2017; van den Eijnden et al., 2018), and these findings may differ for Eijnden, Lemmens, & Valkenburg, 2016). SMA has been defined as an
generalized IA. For example, in the study by Tang et al. (2017) involving “inability to regulate the use of social networks, which leads to negative
a Chinese sample, the male-related effect size for generalized IA was personal outcomes” (Larose et al., 2010; Ryan et al., 2014). As there still
small at 0.15, but it was 0.67 for IGD and 0.10 for SMA; similarly, in exist ongoing debates, relatively limited research, and less direct evi­
results from their United States sample, no significant male-related ef­ dence of clinically significant impairment, SMA as well as other
fect size was found in generalized IA (g ¼ 0.03), but there was a pos­ non-substance addictions (except gambling disorder and IGD) have not
itive medium effect size for IGD (g ¼ 0.58) and negative effect size for been officially included in the DSM-5 (Petry et al., 2014). However, it
SMA (g ¼ 0.42). It is possible that males consider internet gaming and has been proposed that the category of “other specified disorders due to
females consider social media when completing IA assessments; thus, addictive behaviors” may be used to diagnose SMA (Brand et al., 2020).
the effects of the two gender groups may “cancel” each other (Hawi & Multiple studies have investigated gender-related differences in SMA
Samaha, 2019). As such, it is important to distinguish gender-related (Andreassen et al., 2017), with girls spending more time on social media
differences in specific IA subtypes, especially IGD and SMA. than boys and being younger when first exposed to social media (Chae
et al., 2018). Females may be more vulnerable to developing SMA than
1.2. Gender-related differences in internet gaming disorder males (Andreassen et al., 2017; Martinez-Ferrer et al., 2018; Romer­
o-Abrio et al., 2019). According to Demirciog �lu and Go €ncü Ko€se (2018),
IGD has increasingly been considered an important research topic females score significantly higher than males on measures of SMA. Fe­
given the increasing prevalence of gaming and associations between IGD males in general may have higher tendencies for SMA related to inter­
and psychological distress and impaired functioning (Lemos et al., personal relationship orientations (Chae et al., 2018). Females often
2016). IGD has been defined as, “persistent and recurrent use of the value relationships more than males and tend to use social media as
internet to engage in games, often with other players, leading to interaction tools (Fujimori et al., 2015; Kim et al., 2010). Gender-related
impairment or clinically significant distress” and categorized as a differences in motivation to use social media exist, as males primarily
“condition for further study” in the DSM-5 Section III (American use social media for entertainment and recreation and females use social

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W. Su et al. Computers in Human Behavior 113 (2020) 106480

media mainly for information and interpersonal communication (Noguti 2.2. Selection of studies
et al., 2019). Females are more likely to use social media in response to
feelings of emptiness when their social needs are not fully met in real The inclusion criteria for the current meta-analysis were: a) studies
life, which may increase the likelihood of SMA (Chae et al., 2018). reporting original empirical findings in peer-reviewed academic jour­
Although data suggest that SMA is more prevalent among females nals; b) the sample was assessed using IGD or SMA measures; c) studies
than males, there exist some contrary findings. For instance, males score reporting enough information to calculate the effect sizes (Hedges’ g) of
higher on SMA measures than females in some studies (Araujo Robles, gender-related differences in IGD or SMA; and, e) studies written in
2016; Cam & Isbulan, 2012). As such, systematic studies of English. Exclusion criteria included: a) data were collected from clinical
gender-related differences in SMA are warranted. samples or other samples that had been screened using IGD or SMA
measures; b) data were collected from more than one country and could
1.4. The current study not be separated; c) studies reported the same sample pool used in
previously included studies; and, d) the IGD measurement assessed the
As research on gender-related differences in IGD and SMA has offline gaming behavior rather than online gaming behavior. Finally,
increased recently, systematic evaluation of accumulated data is needed. our search resulted in 2663 records related to IGD and 1479 records
While multiple reports suggest that males more frequently experience related to SMA that were searched to identify eligible studies.
IGD and females SMA, contrary research findings also exist, and a meta- We coded the latest data when there was more than one wave of data
analysis may help to resolve such apparent discrepancies (Gurevitch reported. Studies that only reported the prevalence of IGD/SMA were
et al., 2018). Meta-analyses provide a more powerful and less biased identified, and the authors were emailed to request the means and
means for clarifying, quantifying and disproving (or confirming) hy­ standard deviations of addiction measure scores for males and females.
potheses than do many other approaches (Murad & Montori, 2013). The In IGD-related records, we emailed 32 authors, and 3 provided the
primary aim of the present study is to synthesize findings from research effect-size data; for SMA-related records, we emailed 31 authors, and 7
on gender-related differences in IGD and SMA and to identify factors (e. provided the effect-size data. Ultimately, 49 studies with 53 indepen­
g., geographic region) that may influence the relationships. The current dent samples met the criteria for the IGD meta-analysis (see Fig. 1A), and
study sought to investigate specific IAs (IGD and SMA), and we sus­ 38 studies with 41 independent samples met the criteria for the SMA
pected that in a meta-analysis investigating specific IAs that we would meta-analysis (see Fig. 1B).
observe more pronounced gender-related differences than have typically
been reported for generalized IA. The following hypotheses were 2.3. Data extraction
proposed:
Studies that met the inclusion criteria were coded for: study identi­
H1. Males will demonstrate higher levels of IGD (i.e., demonstrate a
fication data (author, year of publication, title), year of data collection,
positive effect size), and females will demonstrate higher levels of SMA
effect-size data (sample size of males and females, means and standard
(i.e., demonstrate a negative effect size).
deviations of IGD/SMA scores in males and females), IGD/SMA mea­
H2. Generalized IA will have a “masking effect” on gender-related surement, sample age characteristics (mean, standard deviation, range,
differences in IGD and SMA, with the effect size in generalized IA and age group), and country of the sample. Three coders (XH, HY, YW)
being significantly smaller than the absolute value of the effect sizes of independently scored all coding dimensions. All coders had adequate
IGD and SMA. research experience in the meta-analysis and were well trained in coding
IGD/SMA measurements and effect size data. The inter-rater consistency
2. Methods was 0.95.

2.1. Literature search 2.4. Methodological quality evaluation

For the meta-analysis, the databases searched included ScienceDir­ For the purpose of weighting effect sizes by study quality, we used a
ect, Springer, Wiley, MEDLINE, ProQuest, and Web of Science. As the Data Quality Index (DQI) developed by Su et al. (2019) through the
internet and how people use it has been changing over time, the current following two measures. First, sample representativeness, in which each
study focused on the most recent 10 years from January 2010 to August included study would have an initial score of 1, and if the sample came
2019 (including online-first publications). For IGD, search terms were: from a national distribution, with probability sampling, or with age
(“internet gaming disorder” OR “internet gaming addiction” OR “com­ diversity it would get one more point added to the score for each feature.
puter game addiction” OR “online game addiction” OR “problematic Thus, scores ranged from 1 to 4. Second, sample size, in which the larger
internet game use” OR “problematic online gaming” OR “pathological sample size would get higher scores, were determined logarithmically
game use” OR “gaming addiction” OR “gaming disorder” OR “prob­ (score ¼ lg(N)). The score of the sample size was 2.0–4.4 in the current
lematic gaming behavior” OR “pathological video game use” OR “video study. The DQI total score ¼ sample representativeness score þ sample
game addiction” OR “psychosocially problematic gaming”) AND size score.
(“gender”).
Similarly, the search terms for SMA were: (“social media addiction” 2.5. Statistical analysis
OR “social network addiction” OR “social network sites addiction” OR
“problematic social media use” OR “excessive social media use” OR To control for variations in sample sizes among studies, we calcu­
“compulsive social media use” OR “problematic social networking site lated Hedge’s g coefficients for the effect-size estimates. The formula for
use” OR “Facebook addiction” OR “problematic Facebook use” OR calculating Hedges’ g is g ¼ (Mmale – Mfemale)/SD*pooled, where the
“Twitter addiction” OR “Instagram addiction”) AND (“Gender”). SD*pooled is the pooled and weighted standard deviation (Hedges, 1981).
In order to include more eligible studies for meta-analysis, a “back­ The effect sizes were bias-corrected for small samples (Hedges, 1981).
ward search” procedure was used to look for more relevant earlier Effect sizes of �0.80 were considered large, �0.50 were considered
studies from the references of recent studies and reviews. Furthermore, moderate, and �0.20 were small effects (Cohen, 1988). Positive effect
authors of retrieved articles reporting insufficient effect size data were sizes indicated males having higher IGD/SMA levels than females, while
emailed to request such data. negative effect sizes showed females have higher IGD/SMA levels than
males. Effect sizes were computed using random-effects models with the
method of restricted maximum likelihood (REML) (Langan et al., 2019),

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W. Su et al. Computers in Human Behavior 113 (2020) 106480

Fig. 1. Flow diagram for included studies in the meta-analysis.

as was evidence for heterogeneity. To test the heterogeneity of effect high levels of heterogeneity were due to real differences among the
sizes, we used the Q statistic and the I2 statistic indexes (Borenstein selected samples as opposed to sampling errors (Higgins et al., 2003).
et al., 2005). To explain observed heterogeneity in effect sizes, we per­ This observation warranted the use of a random-effects model. For the
formed subgroup analyses with categorical moderators (e.g., region, 53 independent samples from 21 countries/regions, the average effect
measurement, age-related population, and survey method) and size was 0.479 for the random-effects, which was a moderate effect size
meta-regression with continuous moderators (e.g., sample representa­ according to Cohen (1988).
tiveness, sample size, and publication year). To test for possible publi­ The dataset of SMA studies included 41 independent effect sizes of
cation bias, we used funnel plots and the Egger regression test with a gender-related differences in SMA tendencies from 58,336 participants
weighted regression model using the standard error as the predictor of 22 countries/regions. The sample sizes ranged from 179 to 23,532.
(Egger et al., 1997) to assess for asymmetry. The trim-and-fill analysis Approximately 40.6% of participants were male. Features, including
was adopted to estimate the number of missing studies and obtain sample characteristics, measures and effect sizes, were recorded for each
adjusted effect sizes that take into account publication bias (Duval & sample (see Table 2 for descriptive statistics and Supplementary
Tweedie, 2000). To obtain effect sizes for each country, effect sizes from Table S2 for details).
the same country’s independent samples were averaged by weighting The meta-analysis of SMA studies also showed high levels of het­
the DQI. erogeneity (97.96%). The Q statistic was significant (Q(40) ¼ 1357.70,
Meta-analyses were conducted in R (version 3.4.2) using the “met­ p < 0.001) in our study, and I2 values (97.96%) were also over 75%. This
afor” package (version 2.0, Viechtbauer, 2010). One-way ANOVA was observation warranted the use of a random-effects model. For the 41
used for comparing the effect sizes among IA, IGD and SMA at independent samples from 22 countries/regions, the average effect size
country-levels. The effect sizes of generalized IA at country-levels used was 0.202 for the random-effects, which was a small effect size ac­
in the ANOVA (n ¼ 34) and radar chart (n ¼ 12) were retrieved from our cording to Cohen (1988).
prior meta-analysis study (Su et al., 2019).
3.2. Publication bias
3. Results
The funnel plots for the IGD and SMA meta-analysis are presented in
3.1. Effect size and homogeneity tests Fig. 2A and B, respectively. There was no evidence of publication bias
according to the Egger’s regression test in both the IGD (t ¼ 0.68, df ¼
The dataset included 53 independent effect sizes of gender-related 51, p ¼ 0.501) and SMA (t ¼ 1.41, df ¼ 39, p ¼ 0.165) samples. Addi­
differences in IGD tendencies from 82,440 participants of 21 coun­ tionally, the Trim-and-Fill procedure indicated none was missing in both
tries/regions. The sample sizes ranged from 104 to 25,573. About half samples from IGD (SE ¼ 4.201) and SMA (SE ¼ 3.867), resulting in an
(53.2%) of participants were male. Features, including sample charac­ adjusted mean effect size equal to the observed mean.
teristics, measures, and effect sizes, were recorded for each sample (see
Table 1 for descriptive statics and Supplementary Table S1 for details). 3.3. The moderating role of region
The results showed a high level of heterogeneity (96.84%) in the IGD
studies. The Q statistic was significant (Q(52) ¼ 1182.06, p < 0.001) in In addition to effect sizes, moderation effects were also examined.
the study, and I2 values (96.84%) were over 75%, suggesting that the We examined whether there were systematic differences in effect sizes

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W. Su et al. Computers in Human Behavior 113 (2020) 106480

Table 1 Table 2
Characteristics of samples included in the internet gaming disorder meta- Characteristics of the sample included in the social media addiction meta-
analysis (Total k ¼ 53). analysis (Total k ¼ 41).
Variable Category K % Variable Category K %

Region North America 6 11.3 Region North America 8 19.5


Asia 12 22.6 Asia 11 26.9
Europe 32 60.4 Europe 20 48.8
Oceania 3 5.7 South America 1 2.4
Article publication year 2010–2012 8 15.1 Oceania 1 2.4
2013–2015 10 18.9 Article publication year 2010–2012 1 2.4
2016–2019 35 66.0 2013–2015 3 7.3
Sample Size 100–499 22 41.5 2016–2019 37 90.3
500–999 11 20.8 Sample Size 100–499 15 36.5
1000–1999 12 22.6 500–999 18 43.9
2000þ 8 15.1 1000–1999 4 9.8
Sample age adolescent 13 24.5 2000þ 4 9.8
adult 10 18.9 Sample age adolescent 5 12.2
adolescent & adult 16 30.2 adult 5 12.2
child & adolescent 3 5.7 adolescent & adult 7 17.1
secondary school 4 7.5 middle school 3 7.3
college 7 13.2 high school 2 4.9
Measurement IGDS9-SF 9 17.0 college 19 46.3
GAS 7 13.2 Measurement BFAS 10 24.4
PVPS 5 9.4 BSMAS 6 14.6
POGQ-SF 4 7.5 FIQ 3 7.3
DSM-5 4 7.5 PUSNS 2 4.9
IGDS 4 7.5 SMAQ 2 4.9
PVGPS 3 5.7 Adapted IAT 5 12.2
CSAS 2 3.8 Others 13 31.7
ICGD 2 3.8
IGDT-10 2 3.8 Note: k ¼ number of effect sizes; BFAS ¼ Bergen Facebook Addiction Scale;
Adapted IAT 2 3.8 BSMAS ¼ Bergen Social Media Addiction Scale; FIQ ¼ Facebook Intrusion
Others 9 17.0 Questionnaire; PUSNS ¼ Problematic Use of Social Networking Sites Scale;
SMAQ ¼ Social Media Addiction Questionnaire; Adapted IAT ¼ Adapted
Note: k ¼ number of effect sizes; IGDS9-SF ¼ Internet Gaming Disorder Sca­
Internet Addiction Test.
le–Short-Form; GAS ¼ Game Addiction Scale; PVPS ¼ Pathological Video
Gaming Play scale; POGQ-SF ¼ Problematic Online Gaming Questionnaire
Short-Form; DSM-5 ¼ DSM-5 criteria for IGD; IGDS ¼ Internet Game Disorder continuous moderators of two measures of DQI (sample representa­
scale; PVGPS ¼ Problem Video Game Playing scale; CSAS ¼ Video Game De­ tiveness and sample size) as well as the publication year were also
pendency Scale; ICGD ¼ International Consensus Gaming Disorder Items; IGDT- conducted, and the results are presented in Supplementary Table S6.
10 ¼ Internet Gaming Disorder Test-10; Adapted IAT ¼ Adapted Internet
Addiction Test.
3.4. A “masking effect” of IA on gender-related differences in IGD and
between different continental regions (e.g., North America, Asia and SMA
Europe). The results of the IGD analysis in the upper panel of Table 3
indicated that Asia (g ¼ 0.295), North America (g ¼ 0.534) and Europe To examine the potential masking effect of generalized IA relative to
(g ¼ 0.584) had statistically significant positive effect sizes, while there IGD and SMA, a one-way ANOVA at the country-level revealed a sig­
was a negative effect size of Oceania (g ¼ 0.062) that was not statis­ nificant difference among the three addiction types (F(2,74) ¼ 34.75, p
tically significant. < 0.001, η2 ¼ 0.48). Simple main effects analysis with Bonferroni
The results of the SMA analysis in the lower panel of Table 3 indi­ correction showed that the IGD effect size (MIGD ¼ 0.453, SDIGD ¼ 0.309)
cated that South America had a positive but not statistically significant was significantly higher than both those for IA (MIA ¼ 0.079, SDIA ¼
effect (g ¼ 0.193, only one country included), while Asia (g ¼ 0.125), 0.195, p < 0.001) and SMA (MSMA ¼ 0.173, SDSMA ¼ 0.256, p <
North America (g ¼ 0.228) and Europe (g ¼ 0.256) had statistically 0.001), while IA was also significantly higher than SMA (p ¼ 0.001). The
significant negative effect sizes. averaged effect sizes of addiction types are shown in Fig. 5. The absolute
Information about each country’s effect size of IGD and SMA are gender-related effect size of IA was significantly smaller than those of
depicted visually in Fig. 3A and Fig. 3B, respectively. The weighted- IGD and SMA.
mean effect sizes of IGD and SMA for individual countries/regions are To further visualize the relationship among generalized IA, IGD and
presented in Supplementary Table S3. SMA, a radar chart with 12 countries/regions having all the gender-
To investigate the relationship between the effect sizes relating to related effect sizes is presented in Fig. 6. The radar chart demonstrates
IGD and SMA, a scatter plot with 16 countries/regions having both that effect sizes relating to IA (red circle) are located between the values
effect-size data is illustrated in Fig. 4. As shown in Fig. 4, the typical relating to IGD (yellow circle) and SMA (blue circle) in most countries/
gender-specific distinctions with higher effects of IGD in males and SMA regions.
in females were observed in most countries/regions (12/16). Germany
and Taiwan differed from these 12 countries/regions with male- 4. Discussion
dominant effects for both IGD and SMA. India showed a unique
pattern with higher effects of IGD in females and SMA in males. The main purpose of this meta-analytic study was to synthesize
To examine other possible contributors to the heterogeneity of the empirical evidence on gender-related differences in levels of IGD and
effect sizes, we also conducted subgroup analyses with categorical SMA, as well as to identify possible moderators and relationship with
moderators of measurement, age-related populations, and survey generalized IA. This study clarifies important gender-specific distinc­
method. The results are shown in Supplementary Table S4 and Table S5, tions in IGD and SMA from a global perspective, a point that has not yet
for IGD and SMA respectively. The meta-regression analyses with been adequately established. A total of 53 independent samples from 21
countries/regions were identified for IGD, and 41 independent samples

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W. Su et al. Computers in Human Behavior 113 (2020) 106480

Fig. 2. Funnel plot of the effect sizes versus standard errors.

Table 3
Continental regional subgroup analyses of gender-related effect sizes for internet gaming disorder and social media addiction.
Region n k Hedges’ g (95%CI) p Q p I2

IGD
Overall 86831 53 0.479 [0.392,0.565] <0.001 1182.06 <0.001 96.84%
Asia 37066 14 0.295 [0.112,0.478] 0.002 147.46 <0.001 97.32%
Europe 36755 31 0.584 [0.499,0.669] <0.001 413.48 <0.001 92.16%
North America 10860 5 0.534 [0.139,0.929] 0.008 421.29 <0.001 98.70%
Oceania 2150 3 0.062 [ 0.408,0.532] 0.796 25.13 <0.001 89.71%
SMA
Overall 58336 41 0.202 [ 0.335, 0.069] 0.003 1357.70 <0.001 97.96%
Asia 7084 11 0.125 [ 0.278,0.027] 0.109 89.19 <0.001 89.73%
Europe 35971 20 0.256 [ 0.507, 0.005] 0.045 1167.54 <0.001 98.71%
North America 14340 8 0.228 [ 0.363, 0.093] <0.001 44.67 <0.001 89.19%
South Americaa 200 1 0.193[ 0.127, 0.514] 0.236 – – –
Oceaniab 741 1 0.150[ 0.297, 0.003] 0.046 – – –

Note: n ¼ combined sample size; k ¼ number of effect size; Hedges’ g (random-effects); CI ¼ confidence interval; Q ¼ homogeneity statistic; I2 ¼ inconsistency, a second
measure of heterogeneity; IGD¼Internet gaming disorder; SMA ¼ Social media addiction.
a
only Peru was included in analysis.
b
only Australia was included in analysis.

Fig. 3. World distribution of gender-related differences in internet gaming disorder (A) and social media addiction (B). Note: Positive effect size reflects greater
likelihoods for males versus females.

from 22 countries/regions were identified for SMA. The main findings The results of the meta-analysis confirmed our first hypothesis that
suggest gender-related differences exist not only for generalized IA (Su males are more likely to experience IGD than females globally with a
et al., 2019), but are more pronounced for specific IAs, with IGD (mal­ moderate effect size (g ¼ 0.462). By contrast, females are more likely to
e-predominant) and SMA (female-predominant) showing opposite experience SMA than males globally with a small effect size (g ¼
effects. 0.202). This outcome corroborates findings from previous studies,

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W. Su et al. Computers in Human Behavior 113 (2020) 106480

Fig. 4. Effect sizes of gender difference in IGD by the effect sizes of SMA from 16 countries/regions. Note. IGD ¼ Internet gaming disorder; SMA ¼ Social media
addiction; the circle size represents the total number of effect sizes for IGD and SMA; positive effect size means males were more likely to demonstrate the specific
type of internet addiction.

SMA.
The current meta-analysis provides stronger evidence for higher IGD
levels in males overall. As mentioned earlier, this pattern may be
explained by gender-related differences in neural mechanisms. Gaming-
related cues elicited higher cravings in males, accompanied by having
higher activations of reward-related brain regions including
corticostriatal-limbic circuitry (Dong, Wang, et al., 2018; Sayette,
2016). Overall, these factors may promote engagement in specific
addictive behaviors like gaming in IGD. From an evolutionary
perspective, males may have become more aggressive in maintaining
dominance and defending territory (Becker & Koob, 2016). Aggres­
siveness is a masculine trait in many cultures, while it is not consonant
with typical social expectations for females (Barua & Barua, 2012).
Indeed, competitive elements of online games are more attractive to
men than women (Hartmann & Klimmt, 2006). Consequently, game
designers and related market investors identify males as target users of
violent and adventurous video games (Barua & Barua, 2012). As males
may experience feelings of success and achievement from engaging in
Fig. 5. Effect sizes of gender difference in IA (n ¼ 34), IGD (n ¼ 21) and SMA online games, this may lead to greater desires for gaming (Hamlen,
(n ¼ 22), with error bars (standard error). Note. IA ¼ generalized internet
2010).
addiction, IGD ¼ internet gaming disorder, SMA ¼ social media addiction.
Regarding social media, the present findings support the female
predominance of SMA. A possible explanation may involve greater fe­
showing opposite directions of gender-related differences in IGD and male sensitivity to social signals and the valuation of interpersonal re­
SMA (Tang et al., 2017; van den Eijnden et al., 2018), and suggests that lations (Fujimori et al., 2015; Proverbio et al., 2008). Evolutionary
people may become addicted to internet activities through different scholars propose that sex/gender differences in brain and behavior may
pathways (Tang et al., 2017). The findings indicate that in most coun­ relate to different demands for female’s child-care and male’s hunting
tries/regions, there is a male predominance for IGD and female pre­ strategies (Keverne, 2007). Compared with males, females are often
dominance for SMA, suggesting a pattern consistent across many more interpersonal (Barua & Barua, 2012; Keller & Scharff-Goldhaber,
cultures and geographic locations. Our findings also highlight 1987). Females also demonstrate more tendencies to use social media
geographic variation in gender-related effect sizes in IGD and SMA. as interactional tools, while males are inclined to access social media for
Specifically, for IGD, gender has the largest effect size in Europe and entertainment (Fujimori et al., 2015; Lin et al., 2013). SMA tendencies
North America, smaller in Asia and negligible in Oceania. Similar results are also related to psychosocial factors in females (Chae et al., 2018).
were found for SMA, although in the opposite direction. According to Specifically, females may use social media to fill voids when depressed
our prior study (Su et al., 2019), gender-related differences in IA may be and social needs are not fully met, thereby increasing the likelihood of
related to both sociocultural and economic factors. Future study is SMA (Block et al., 2014; Chae et al., 2018). Together, data suggest that
needed to examine potentially hidden factors impacting geographic gender-related differences in IGD and SMA likely involve biological,
variance in gender-related differences in effect sizes relating to IGD and

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W. Su et al. Computers in Human Behavior 113 (2020) 106480

Fig. 6. Radar-chart of gender-related effect sizes in generalized and specific internet addiction. Note. IA ¼ generalized internet addiction, IGD ¼ internet gaming
disorder, SMA ¼ social media addiction. Positive effect size reflects greater likelihoods for males versus females.

psychological, and social factors. (Brand et al., 2020).


The findings also revealed that the gender-related effect sizes for IGD The findings suggest the males and females demonstrate different IA
and SMA are larger than those for IA, which supports a possible masking subtypes globally, raising important questions regarding how to make
effect of generalized IA (Hawi & Samaha, 2019). Importantly, this the best use of internet in the digital era. According to the online/offline
finding suggests that it is advisable to replace the concept of generalized integration hypothesis proposed by Lin et al. (2018), a healthier pattern
IA with descriptions of specific IAs (Hawi & Samaha, 2019). Debates of internet use may be achieved through harmonious integration of
remain about whether IGD and SMA are subtypes of IA, with some people’s online and offline worlds, especially, by way of integrating
proposing that SMA may be better characterized as a generalized IA than online and offline self-identities, interpersonal relationships, and social
a specific form of IA (Montag et al., 2015) or IGD may be better char­ functioning, following the practical principles of communication,
acterized as a subtype of video game addiction rather than a specific transfer, consistency, and “offline-first” priorities. For example, in­
form of IA (Griffiths & Pontes, 2014). The current study suggests that it dividuals who use social medias and online games may benefit from
is important for future studies to focus on specific forms of internet ac­ online/offline relationship integration (Lin et al., 2018). Studies indicate
tivities rather than general internet behavior when considering that communicating with existing friends versus strangers online may
gender-related differences (Laconi et al., 2015), consistent with ap­ result in higher friendship quality and more well-being (Valkenburg &
proaches taken in the DSM-5, ICD-11, and recent proposals (Brand et al., Peter, 2007; van den Eijnden et al., 2008). Similarly, playing online
2020). games with known real-life friends may help players avoid IGD, expe­
rience less loneliness, and improve their offline lives (Marton�cik &
Lok�sa, 2016; Snodgrass et al., 2011). As a higher level of harmonious
4.1. Implications for practice and policy integration may reflect a healthier pattern of internet use and lead to
better psychological health and well-being, it is worthwhile for future
The present meta-analysis is the first study that systematically ana­ studies to find more effective and operable ways to maintain balance of
lyzes gender-related differences in IGD and SMA, as well as their re­ online and offline for both males and females.
lationships with generalized IA, and the study has important practical
implications. For policy makers, it may be useful to remind parents,
other care providers or teachers about students’/children’s internet 4.2. Limitations and future research
behaviors from a gender-informed perspective, and guide/monitor their
internet usage using different approaches. For example, they may focus Several limitations of the current study should be noted. First, the
educational efforts on how to play internet games in a healthy way for majority of studies included in the meta-analysis included samples of
males while promoting healthy social media use for females. Our results adolescents and young adults, so the conclusions may not generalize to
may also emphasize the consideration of subtypes and gender when older age groups. Second, although we distinguished IGD and SMA from
providing medical/psychological treatments for the IA. As the current generalized IA, there may exist some overlaps between internet games
study revealed a masking effect of generalized IA and distinctions be­ and social media. For instance, Laconi et al. (2017) proposed that online
tween IGD and SMA, it is important to specify types of IA (e.g., IGD or gaming has become a space of virtual socialization in which players
SMA) rather than using generalized IA to best describe experiences and experience social interactions as integral parts of gaming. Moreover,
conditions of patients or clients; thereby, different treatment approaches Facebook, a popular and frequently used social media platform, has
may be required (Zajac et al., 2017). Furthermore, it is important to become a specific website promoting multiple online activities including
consider gender-related differences in internet-use behaviors and moti­ gaming (Griffiths et al., 2014). Future studies should examine
vations when developing intervention programs. Given that IGD is the gender-related differences in social interactions within online gaming,
only subtype of IA currently included in DSM-5 and ICD-11, the absence as well as gaming behaviors in social media. Third, although IGD and
of formal diagnostic criteria for other subtypes is problematic for clinical SMA are important components of IA, gender-related differences in
practice (Winkler et al., 2013). More empirical evidence and academic other subtypes (e.g., problematic online shopping and pornography use)
discussions are needed to better understand the nature of specific IAs should be examined in future studies (Montag et al., 2015). Finally,

8
W. Su et al. Computers in Human Behavior 113 (2020) 106480

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