Prevalence and association between emotional and behavioral problems and gaming disorder in children and adolescents: Evidence from 201,906 participants

Existing evidence suggested a potential link between mental health problems in children and adolescents and an increased odds of developing gaming disorder (GD). However, the relationship between emotional and behavioral problems (EBP) and GD remains unknown. This cross-sectional study, involving a sample size of 201,906 students aged 6–18 years from Guangzhou city, aims to investigate this association. The assessment of GD was performed using the Gaming Disorder Test, while EBP was evaluated via parent-reported Strength and Difficulty Questionnaire. Statistical analyses, including multiple logistic regression, subgroup analyses, and sensitivity analyses, were employed to examine the association between EBP and GD. The prevalence rate of GD was 11.4 %, with higher rates observed among adolescents and boys. After adjusting for covariates, children and adolescents with border or abnormal levels of total difficulties, internalizing problems, externalizing problems, emotional symptoms, conduct problems, hyperactivity/inattention problems, and pro-social behaviors exhibited a significantly increased odds of developing GD. This study suggests that Chinese children and adolescents with EBP may be more vulnerable to developing GD. Further longitudinal researches are needed to better understand this association. Copyright © 2025 Published by Elsevier Ltd.