Sex differences in the longitudinal association between high risk of internet gaming disorder and subsequent suicidality among adolescents: A cohort study

Objectives: Internet Gaming Disorder (IGD) has become a growing public health concern among adolescents. Although previous cross-sectional studies have linked problematic gaming with suicidality, longitudinal evidence remains limited. This study examined sex-specific associations between IGD risk and subsequent suicidal behaviors among adolescents who were not suicidal at baseline. Methods: Data were derived from the iCURE study, a prospective cohort involving 1,874 students (1,082 boys and 792 girls) aged 9-14 years. Participants with baseline suicidality were excluded. The Internet Game Use-Elicited Symptom Screen was used to identify adolescents at high risk of IGD (HRIGD). Suicidality was assessed at two-year follow-up using items adapted from the SCID-I. Relative risks (RRs) and 95% Confidence Intervals (CIs) were estimated using generalized linear models stratified by sex and adjusted for potential confounders. Results: At baseline, 8.0% of boys and 3.4% of girls were classified as HRIGD. At the two-year follow-up, boys in the HRIGD group showed significantly higher incidences of suicidality (17.4% vs. 5.0%), suicidal ideation (16.3% vs. 4.7%), and suicide plans or attempts (5.8% vs. 1.0%) than those at lower risk. In fully adjusted models, HRIGD remained associated with suicidality (RR = 3.05, 95% CI = 1.53-6.07), suicide ideation (RR = 2.99, 95% CI = 1.48-6.05), and suicide plans and/or attempts (RR = 4.03, 95% CI = 1.08-15.07) among boys, but not among girls. Conclusions: This longitudinal cohort study among adolescents without baseline suicidality indicates that IGD risk is related to subsequent suicidality in boys. Early identification and sex-specific preventive strategies targeting excessive gaming may help mitigate future suicide risk in adolescents.