Longitudinal Association Between Internet Gaming Disorder and School Refusal Among Adolescents Using a Random Intercept Cross-Lagged Panel Model: Three-Wave Prospective Cohort Study

Background: Internet gaming disorder (IGD) and school refusal are increasingly prevalent during adolescence, yet limited research has examined how they influence each other over time. Moreover, it is unclear whether the association differs by sex. Objective: This study aimed to investigate the within-person longitudinal associations between school refusal and IGD and potential sex differences in these associations among Chinese adolescent gamers. Methods: A 3-wave prospective cohort longitudinal study was conducted among students from 4 middle schools in Zhejiang Province, China. Adolescents who had played online games in the past 12 months were involved. Participants were recruited using convenience sampling. Data were collected at 6-month intervals: time 1 (T1, March 2024), time 2 (T2, September 2024), and time 3 (T3, March 2025). A total of 918 Chinese adolescents (n=609, 66.3% male; mean 13.55, SD 0.75) participated in the 3-wave survey. IGD and school refusal were assessed using the 9-item DSM-5 (Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition) IGD checklist and the School Refusal Assessment Scale-Revised. A random intercept cross-lagged panel model and multigroup analyses were conducted. Results: All statistical tests were 2-tailed with α=.05. The random intercept cross-lagged panel model demonstrated good fit to the data (χ²5=16.02; comparative fit index 0.970; root mean square error of approximation 0.035). Cross-lagged effects indicated a reciprocal association between school refusal and IGD. School refusal predicted later IGD (T1→T2: β=.06, 95% CI .02-.08; P=.02 and T2→T3: β=.06, 95% CI .02-.08; P=.02), and IGD predicted subsequent school refusal (T1→T2: β=.12, 95% CI .09-.15; P