PONE-D-23-37762Cognitive-behavioral statuses in depression and internet gaming disorder of adolescents: A transdiagnostic approachPLOS ONE

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The Role of Nonverbal Cognitive Ability in the Association of Adverse Life Events With Dysfunctional Attitudes and Hopelessness in Adolescence - https://doi.org/10.1016/j.apnu.2012.02.004

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Reviewers' comments:

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Reviewer #1: Yes

Reviewer #2: Yes

Reviewer #3: Yes

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2. Has the statistical analysis been performed appropriately and rigorously?

Reviewer #1: Yes

Reviewer #2: Yes

Reviewer #3: Yes

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Reviewer #1: No

Reviewer #2: No

Reviewer #3: Yes

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Reviewer #1: Yes

Reviewer #2: Yes

Reviewer #3: Yes

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5. Review Comments to the Author

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Reviewer #1: This study, examining Internet gaming disorder, depression and psychological characteristics in a sample of Hong Kong adolescents, presents intriguing findings in a vital area of adolescent mental health research.

However, I have identified several areas where minor adjustments could significantly enhance the paper's rigor.

Measurement Tools and Internal Reliability of Hopelessness scale:

o Issue: The employment of abbreviated scales for measuring dysfunctional attitudes and hopelessness, alongside the lower internal reliability of the hopelessness scale, could potentially limit the depth and reliability of your findings.

o Suggested Action: I recommend explicitly addressing this in your limitations section, acknowledging the potential impact on your study's outcomes.

Geographical Focus:

o Issue: The study's concentration on a specific geographical area may restrict its broader applicability.

o Suggested Action: Detail this in the limitations section and elaborate on potential idiosyncrasies of your context in the implications section. This approach will provide a clearer understanding of how the findings might differ in other settings.

Data Sharing

Encouragement for Open Data:

o Issue: While respecting anonymity concerns, I suggest aligning more closely with the open data philosophy of this journal.

o Suggested Action: Consider creating an anonymized version of your dataset for public sharing. This will enhance the transparency and reproducibility of your research.

Extended discussion and bibliography enhancement

The discussion section of this study could be enhanced by addressing several key areas, while maintaining an updated and extensive comparison with prior studies:

a. Impact of the COVID-19 Pandemic: Given the timing of this study, it would be insightful to discuss the potential impact of the COVID-19 pandemic on adolescent mental health, particularly in relation to increased online activity and gaming during lockdowns. This discussion should consider how these factors might explain aspects of your data, especially concerning maladaptive coping strategies that could emerge in such situations.

i. Teng, Z., Pontes, H., Nie, Q., Griffiths, M., & Guo, C. (2021). Depression and anxiety symptoms associated with internet gaming disorder before and during the COVID-19 pandemic: A longitudinal study. Journal of Behavioral Addictions, 10, 169-180. https://doi.org/10.1556/2006.2021.00016.

ii. Sheen, A., Ro, G., Santos, A., Kagadkar, F., & Zeshan, M. (2020). 51.15 SCREEN TIME IN THE CONTEXT OF COVID-19: THE GOOD, THE BAD, AND THE UGLY. Journal of the American Academy of Child and Adolescent Psychiatry, 59, S255-S255. https://doi.org/10.1016/j.jaac.2020.08.425.

iii. Volpe U, Orsolini L, Salvi V, Albert U, Carmassi C, Carrà G, Cirulli F, Dell'Osso B, Luciano M, Menculini G, Nanni MG, Pompili M, Sani G, Sampogna G, Group W, Fiorillo A. (2022). COVID-19-Related Social Isolation Predispose to Problematic Internet and Online Video Gaming Use in Italy. International Journal of Environmental Research and Public Health, 19(3):1539. doi: 10.3390/ijerph19031539. PMID: 35162568; PMCID: PMC8835465.

iv. Marciano L, Ostroumova M, Schulz PJ, Camerini AL. (2022). Digital Media Use and Adolescents' Mental Health During the Covid-19 Pandemic: A Systematic Review and Meta-Analysis. Frontiers in Public Health, 9:793868. doi: 10.3389/fpubh.2021.793868. PMID: 35186872; PMCID: PMC8848548.

b. Gender Differences: A deeper exploration of gender differences in the experiences of depression and Internet Gaming Disorder (IGD) among male and female adolescents is warranted. This includes a separate analysis for each condition and its implications for targeted interventions, and how this is specifically manifested in your data.

i. Wang, R., Yang, S., Yan, Y., Tian, Y., & Wang, P. (2021). Internet Gaming Disorder in Early Adolescents: Gender and Depression Differences in a Latent Growth Model. Healthcare, 9. https://doi.org/10.3390/healthcare9091188.

ii. Phan, O., Prieur, C., Bonnaire, C., & Obradović, I. (2019). Internet Gaming Disorder: Exploring Its Impact on Satisfaction in Life in PELLEAS Adolescent Sample. International Journal of Environmental Research and Public Health, 17. https://doi.org/10.3390/ijerph17010003.

c. Long-term Consequences: The potential long-term consequences of untreated IGD and depression in adolescence should be discussed, including impacts on academic performance, social relationships, and future mental health, and how this relates to your findings.

i. Demirtas, O., Alnak, A., & Coskun, M. (2020). Lifetime depressive and current social anxiety are associated with problematic internet use in adolescents with ADHD: a cross-sectional study. Child and Adolescent Mental Health. https://doi.org/10.1111/camh.12440.

ii. Fumero, A., Marrero, R., Bethencourt, J., & Peñate, W. (2020). Risk factors of internet gaming disorder symptoms in Spanish adolescents. Computers in Human Behavior, 111, 106416. https://doi.org/10.1016/j.chb.2020.106416.

iii. Teng, Z., Pontes, H., Nie, Q., Xiang, G., Griffiths, M., & Guo, C. (2020). Internet gaming disorder and psychosocial well-being: A longitudinal study of older-aged adolescents and emerging adults. Addictive Behaviors, 110, 106530. https://doi.org/10.1016/j.addbeh.2020.106530.

d. Role of Social Media: Including the influence of social media on adolescent mental health, particularly in relation to self-esteem and depressive symptoms, would add value to the discussion. This should consider the intertwined nature of social media use and online gaming.

i. Fernandes, B., Biswas, U., Tan-Mansukhani, R., Vallejo, A., & Essau, C. (2020). The impact of COVID-19 lockdown on internet use and escapism in adolescents. Revista de Psicología Clínica con Niños y Adolescentes. https://doi.org/10.21134/RPCNA.2020.MON.2056.

ii. Nilsson, A., Rosendahl, I., & Jayaram-Lindström, N. (2022). Gaming and social media use among adolescents in the midst of the COVID-19 pandemic. Nordisk Alkohol- & Narkotikatidskrift: NAT, 39, 347-361. https://doi.org/10.1177/14550725221074997.

e. Mind Wandering: Discussing the role of mind wandering, a form of spontaneous thought not related to the task at hand, in adolescent mental health could be significant. This includes its relation to Internet Gaming Disorder (IGD), mental pain, self-reflection abilities, and other outcomes of interest.

i. Zhang, J., Zhou, H., Geng, F., Song, X., & Hu, Y. (2021). Internet Gaming Disorder Increases Mind-Wandering in Young Adults. Frontiers in Psychology, 11. https://doi.org/10.3389/fpsyg.2020.619072.

ii. Rodolico, A.; Cutrufelli, P.; Brondino, N.; Caponnetto, P.; Catania, G.; Concerto, C.; Fusar-Poli, L.; Mineo, L.; Sturiale, S.; Signorelli, M.S.; et al. (2023). Mental Pain Correlates with Mind Wandering, Self-Reflection, and Insight in Individuals with Psychotic Disorders: A Cross-Sectional Study. Brain Sciences, 13, 1557. https://doi.org/10.3390/brainsci13111557.

With these minor revisions to the discussion and associated bibliography, the article is in my opinion well-positioned for publication in this journal.

Reviewer #2: Thank you for the opportunity to review this work. Here, the authors investigated shared and unique cognitive-behavioral factors for depression and IGD among adolescents in Hong Kong secondary schools. It is an interesting read, and the topic is also timely.

The methodology employed aptly answers the research problem being investigated here.

Below are my specific comments that may be of help in strengthening the current paper:

1. Study procedures have been clearly described. Nevertheless, I would recommend the authors to describe the context of school disruptions caused by pandemic-related measures that coincided with the data collection period, and wherever applicable, also comment on their implications to the paper’s results.

2. The authors may consider to also report the 95% Cis when reporting odds ratios in the Results section.

3. p14, under the Discussion section: “When treating adolescents with IGD … other mood symptoms.”

This statement here does not seem to be well-supported by the results presented in this paper; the two disorders being comorbid may not imply anything about effectiveness of treatment. Clarification and/or justification on this point would be appreciated.

Minor comment:

- Fig. 2 – more horizontal separation between clusters may be helpful for visual interpretation.

Reviewer #3: This study found that depression and IGD may share common cognitive-behavioral mechanisms (e.g., maladaptive coping) but also own their uniqueness regarding specific factors (e.g., hopelessness and self-esteem). It is a novel transdiagnostic approach to explore the cognitive behavioral differences between comorbidity and solitary diseases. It provides a new idea for diagnosis and treatment.

However, there are some issues that need to be addressed as a transdiagnostic approach.

(1) Since IGD and depression have their own scales, and they are used as the standard to divide the categories in this study, then their cognitive behavioral differences were investigated. How does the cognitive behavioral scale increase diagnostic reliability and validity in this study? That is, the comorbidity can be diagnosed directly with IGD and depression scales without using cognitive behavioral scales.

(2) The particularity of comorbidity (compared with solitary disease, with healthy group) needs to be further highlighted to explain its mechanism and cause.

(3) Since comorbidity (321 people) suggested that IGA and depression share a common pathogenesis, why were there a large number of depressed people (1133 people) without IGA? Why were some IGAs (141 people) not depressed?

Further data analysis should be done to show which protective factors prevent a people solitary disease from developing into a comorbidity.

(4) Could IGA be a protective strategy for depression? It is suggested that this possibility be added to the discussion.

(5) This study only examined the cognitive behavioral scale and reached the mechanistic conclusion that cognitive behavioral variables were related to comorbidity. However, other scales were not examined, so other mechanisms cannot be ruled out. That is, if the other scale is used, will the mechanical conclusion of comorbidity and other variables be also obtained? The study did not test for exclusivity. It is suggested to discuss within limitations.

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Reviewer #1: Yes: Pierfelice Cutrufelli

Reviewer #2: No

Reviewer #3: Yes: Jianxin Zhang

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Cognitive-behavioral statuses in depression and internet gaming disorder of adolescents: A transdiagnostic approach

PONE-D-23-37762R1

Dear Dr. Yang,

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Carmen Concerto

Academic Editor

PLOS ONE

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