Jurnal 1
Jurnal 1
Jurnal 1
Received: February 9, 2020 • Revised manuscript received: April 14, 2020 • Accepted: June 13, 2020
Published online: September 8, 2020
ABSTRACT
Background and aims: Internet gaming disorder (IGD) has been recognized as a mental illness.
Cognitive and emotional illness representations affect coping and health outcomes. Very little is known
about such perceptions related to IGD, in both general and diseased populations. This study examined
the psychometric properties of the Revised Illness Perception Questionnaire (IPQ-R) for IGD in a
general population that included mostly non-cases while a small proportion of the sample was IGD
cases. Methods: An anonymous cross-sectional telephone survey was conducted in a random sample of
1,501 Chinese community-dwelling adults (41.3% male; mean age 5 40.42, SD 5 16.85) in Macao,
China. Results: The confirmatory factor analysis identified a modified 6-factor model (i.e., timeline
cyclical, consequences, personal control, treatment control, illness coherence, and emotional repre-
sentations) of 26 items that showed satisfactory model fit and internal consistency. Criterion-related
validity was supported by the constructs’ significant correlations with stigma (positive correlations:
timeline cyclical, consequence, emotional representations; negative correlations: illness coherence).
Ever-gamers, compared to never-gamers, reported higher mean scores in the subscales of personal
control and illness coherence, and lower mean scores in time cyclical, consequence, and emotional
representations. Among the sampled gamers, probable IGD cases were more likely than non-IGD cases
to perceive IGD as cyclical and involved more negative emotions. Conclusions: This study shows that
the revised 26-item version of IPQ-R is a valid instrument for assessing illness representation regarding
IGD in a general population of Chinese adults. It can be used in future research that examines factors of
incidence and prevention related to IGD.
KEYWORDS
illness representation, Illness Perception Questionnaire-Revised, online gaming, behavioral addiction, Internet
gaming disorder
*Corresponding author.
E-mail: anisewu@umac.mo
the illness representations and stigma. For instance, Mak, the survey. Without any monetary reward, 1,501 partici-
Chong, and Wong (2014) found that various constructs of pants (41.3% male; mean 5 40.42, SD 5 16.85, Range 5
illness representation (e.g. controllability, timeline, con- 18–93) voluntarily completed an anonymous questionnaire
sequences, and illness coherence) were significantly via phone. With reference to the formula of the American
associated with public stigma toward mental disorders. Association for Public Opinion Research (2011), the
The authors pointed out that, according to the attribution cooperation rate of this study was 63.9%. The age distri-
theory (Weiner, Perry, & Magnusson, 1988) and previous bution of the sample was similar to the adult population
research (e.g., Weisman & L opez, 1997), low perceived parameter reported in the 2016 Population By-census of
controllability and stability of a mental disorder would Macao but the female sex was slightly overrepresented in
lead to social rejection and public stigma toward such this study (Macao Statistics and Census Services, 2017).
disorder, as people would be more sympathetic to the Over half of the participants had had secondary education
illness condition that is acute and have non-volitional or above (83.4%) and a full-time job (56.8%; and 12.4%
causes (Corrigan, 2000). In general, such attributions were students).
match with the constructs of illness representation (e.g.,
controllability and timeline). In particular, those with low
coherence of IGD might create misunderstandings that Measures
could lead to stigma; those who perceived high severity of
IGD might associate IGD cases with personal failure (e.g.,
drop-outs); those who perceived low personal control and Illness representation of IGD. The 38-item IPQ-R (Moss-
high chronicity might associate IGD cases with weak Morris et al., 2002) was translated by two professional
personality and self-control. In addition, Holliday et al. translators, following standard translation and back-trans-
(2005) also applied CSM to evaluate public perceptions lation procedures (Brislin, 1970). The items were modified
toward anorexia nervosa (e.g., caused by own behaviors to assess illness representation of IGD. For instance, “My
like eating habits) and suggested that such perceptions illness has serious financial consequences” was modified to
may have contributed to stigma toward anorexia nervosa. “IGD brings serious financial consequences to an IGD
Thus, stigma was used for testing criterion-related validity gamer”. The face validity of all the translated items was
in this study. We hypothesized that stigma toward people found satisfactory by two bilingual psychologists. The
with IGD would be negatively associated with illness version was also tested on six participants, and was finalized
coherence and positively associated with other constructs based on the feedbacks obtained. Using the 5-point Likert
of illness representations regarding IGD. scales (1 5 strongly disagree to 5 5 strongly agree), higher
summated scores represented higher levels of the corre-
The present study sponding construct.
Table 1. Confirmatory factor analysis results and reliabilities of IPQ-R for IGD
Standardized factor loadings
Cronbach's a Endorsement %a
Item Original scale Revised scale Revised scale Revised scale
Factor timeline chronic –
1. IGD will last a short time (R) 0.000 – –
2. IGD is likely to be permanent rather than temporary 0.626 – –
3. IGD will last for a long time 0.266 –
4. IGD will pass quickly (R) 0.056 – –
5. IGD is expected to stay for the rest of one's life 0.746 – –
18. IGD will improve in time (R) 0.071 – –
Factor consequence 0.773
6. IGD is a serious condition 0.566 0.584 62.0
7. IGD has major consequences on one's life 0.572 0.588 57.5
8. IGD does not have much effect on one's life (R) 0.054 – –
9. IGD strongly affects the way others see that IGD gamer 0.617 0.609 44.8
10. IGD has serious financial consequences 0.655 0.652 46.6
11. IGD causes difficulties for those who are close to that IGD 0.736 0.723 45.5
gamer
Factor personal control 0.670
12. There is a lot which one can do to control IGD symptoms 0.236 0.457 61.2
13. What one does can determine whether IGD gets better or 0.173 0.686 69.6
worse
14. The course of IGD depends on that gamer 0.188 0.691 72.2
15. Nothing that addict does will affect his/her IGD (R) 0.601 – –
16. A person with IGD has the power to influence it (i.e., IGD) 0.206 0.464 58.6
17. One's action will have no effect on the outcome of his/her 0.815 – –
IGD (R)
Factor treatment control 0.889
19. There is very little that can be done to improve one's IGD (R) 0.737 –
20. Counseling treatment will be effective in improving IGD 0.146 0.833 70.3
21. The negative effects of IGD can be prevented (avoided) by 0.115 0.882 66.5
counseling treatment
22. Counseling treatment can control my illness 0.171 0.842 66.4
23. There is nothing which can help one's IGD condition (R) 0.761 – –
Factor illness coherence 0.722
24. The symptoms of IGD are puzzling to you 0.374 0.373 31.3
25. IGD is a mystery to you 0.554 0.548 25.5
26. You don't understand IGD 0.789 0.788 37.5
27. IGD doesn't make any sense to you 0.809 0.811 36.1
28. You have a clear picture or understanding of IGD (R) 0.512 0.419 29.9
Factor timeline cyclical 0.776
29. The symptoms of IGD change a great deal from day to day 0.826 0.825 49.5
30. IGD symptoms come and go in cycles 0.871 0.870 48.8
31. IGD is very unpredictable 0.466 0.467 46.0
32. One goes through cycle in which IGD gets better and worse 0.558 0.559 49.6
Factor emotional representations 0.910
33. You get depressed when you think about IGD 0.853 0.881 20.0
34. When you think about IGD you get upset 0.879 0.918 22.8
35. IGD makes you feel angry 0.813 0.789 22.0
36. IGD does not worry you (R) 0.143 – –
37. Problems regarding IGD makes you feel anxious 0.790 0.721 16.4
38. IGD makes you feel afraid 0.747 0.672 19.8
a
Valid percentage for the responses of “Agree” and “Strongly agree” to each item.
Table 3, in which items 13 and 14, from the personal control Differences in illness representation by gamer status
subscale, and Item 20, from the treatment control subscale, and IGD status
were the most commonly endorsed (69.6%, 72.2%, and
70.3% respectively), whereas the five items from the About two fifth (41.0%; n 5 615) of the participants had ever
emotional representations subscale were the least endorsed experienced online gaming (ever-gamers); 2.6% (n 5 39) had
(ranged from 16.4% to 22.8%). had probable IGD. In Table 3, it is seen that ever-gamers,
Table 2. Descriptive statistics and inter-correlations of constructs of IPQ-R, stigma, IGD symptoms, and socio-demographics
Item number M SD Range 1 2 3 4 5 6
1. IPQ-Cyc 4 13.11 2.90 4–20 –
2. IPQ-Con 5 16.69 3.66 5–25 0.34** –
3. IPQ-Pc 4 14.67 2.71 4–20 0.11** 0.07* –
4. IPQ-Tc 3 10.95 2.42 3–15 0.21** 0.14** 0.23** –
5. IPQ-Ic 5 15.60 3.68 5–25 0.26** 0.25** 0.08** 0.07* –
6. IPQ-Er 5 11.86 4.71 5–25 0.30** 0.34** 0.09** 0.05 0.35** –
7. Stigma 4 11.13 3.46 4–24 0.23** 0.51** 0.04 0.09** 0.29** 0.39**
8. IGD symptoms 9 0.57 1.29 0–9 0.07* 0.01 0.06* 0.02 0.13** 0.05*
9. Age 1 40.42 16.85 18–93 0.17** 0.23** 0.12** 0.06* 0.35** 0.26**
10. Education# 1 – – – 0.17** 0.11* 0.07** 0.02 0.30** 0.23**
11. Gender# 1 – – – 0.09** 0.15** 0.00 0.04 0.14** 0.14**
Note: *p < 0.05; **P < 0.01; # mean, standard deviation and range are not provided for binomial/ordinal variables.
IPQ-Cyc 5 timeline cyclical; IPQ-Con 5 consequences; IPQ-Pc 5 personal control; IPQ-Tc 5 treatment control; IPQ-Ic 5 illness
coherence; IPQ-Er 5 emotional representations; IGD 5 Internet gaming disorder.
Table 3. Mean (standard deviation) of IPQ-R factor scores by gamer status and IGD status
Ever-gamers Never-gamers Probable IGD Non-IGD
(n 5 615) (n 5 886) t (n 5 39) (n 5 1,462) t
IPQ-Cyc 12.85 (2.92) 13.32 (2.87) 2.92** 14.92 (2.96) 13.05 (2.88) 3.88**
IPQ-Con 16.05 (3.58) 17.18 (3.64) 5.76** 17.81 (3.82) 16.66 (3.65) 1.89
IPQ-Pc 15.09 (2.66) 14.35 (2.72) 5.02** 14.00 (2.90) 14.69 (2.72) 1.49
IPQ-Tc 10.85 (2.48) 11.03 (2.38) 1.38 10.95 (2.74) 10.95 (2.42) 0.13
IPQ-Ic 16.86 (3.43) 14.66 (3.57) 11.53** 15.61 (3.01) 15.60 (3.69) 0.03
IPQ-Er 10.96 (4.36) 12.53 (4.86) 6.39**þ 15.00 (4.94) 11.78 (4.68) 4.18**
Note: *p < 0.05; **P < 0.01; þ statistic for “equal variance not assumed” given the significant Leven's test result.
IPQ-Cyc 5 timeline cyclical; IPQ-Con 5 consequences; IPQ-Pc 5 personal control; IPQ-Tc 5 treatment control; IPQ-Ic 5 illness
coherence; IPQ-Er 5 emotional representations.
compared to never-gamers, reported significantly higher reached consensus on its chronicity; the general public
scores for personal control and illness coherence, but signif- might hence have little idea about its curability, remission,
icantly lower scores for time cyclical, consequences, and and hence chronicity, as they have not been informed by the
emotional representations, than those without gaming expe- scientists. Daily observations of cure over long time periods,
rience (p < 0.05). Those with IGD reported significantly which are necessary for formation of the perception on
higher scores than non-IGD participants for timeline cyclical chronicity, may also be lacking as the disease is a new one.
and emotional representations (p < 0.05). Furthermore, as the value, motives, and time availability for
online gaming may change over one’s life course, the general
public may know little about whether remission from IGD
DISCUSSION would occur along different life stages. In the absence of
clear symptoms and diagnostic tools, lay people may find it
With some modifications, the 26-item IPQ-R for IGD difficult to identify onset and remission regarding IGD.
possessed satisfactory factorial validity, criteria-related val- Thus, it is understandable that the general public may not
idity, and reliability. This is the first study investigating possess a clear perception whether IGD is chronic or tran-
illness representation and IPQ-R for IGD, and in fact, the sitory. We contend that the perception would be formed
first one in behavioral addiction research. Since the analysis when the science community have reached and disseminated
was not pre-registered, the results should be considered their consensus.
exploratory. Given that IGD is recognized and presented as a type of
We removed the factor of timeline chronic, as its items addiction, its natural course of development may be seen as
all showed non-significant factor loadings. Similar observa- diverse; relapse is not uncommon (Mihara & Higuchi, 2017).
tions have been reported for some IPQ-R’s timeline chronic It is therefore not surprising that timeline cyclical, compared
subscales such as that of esophageal cancer (Dempster & to timeline chronic, was found to be a more structurally
McCorry, 2012). This construct is supposed to assess the stable and meaningful factor in IPQ-R for IGD. Moss-
perceived chronicity nature of IGD. As IGD is a newly Morris et al. (2002) who developed the IPQ-R, also sug-
defined disease, even the scientific community may not have gested timeline cyclical is a more useful dimension than
timeline chronic when the illness concerned cannot be The participants, as a whole, did not perceive much se-
adequately captured on a simple acute/chronic dimension. vere emotional distress due to IGD. It is understandable as
Given some poor factor loadings, the original IPQ scale the participants were asked about their present emotional
was modified by removal of six items (i.e., items 8, 15, 17, 19, representations toward IGD, while most of them may not
23, and 36) from the factors of consequences, personal have trouble with Internet gaming. Those with IGD showed
control, treatment control, and emotional representations. more negative emotional representations that those without
Similar modifications have been commonly reported in IGD. It is plausible that, compared to the non-IGD cases,
other IPQ-R validation studies (Abubakari et al., 2012; those IGD cases were more likely to experience symptoms
Chen, Tsai, & Lee, 2008; Hagger & Orbell, 2005). All these and show related emotional responses. A reminder is that
six removed items involved reverse wording expressions. the level of emotional representation was quite low, possibly
Researchers have pointed out that instead of preventing because many participants have not recognized that IGD
response biases, reversed item wordings may weaken val- being a disease, and have not observed immediate serious
idity, as such responses were more prone to errors due to consequences that evoke emotions (unlike drug addiction).
inattention and confusion (Van Sonderen, Sanderman, & IGD cases were also more likely than non-IGD cases to score
Coyne, 2013). Past research has encountered similar prob- higher in the level of the time cyclical factor; some of the
lems with items of reverse wording; some of such studies IGD cases might have made attempts to regulate gaming
eventually removed the reversed items from the scales time, experienced fluctuations in level of symptoms, and/or
(Abubakari et al., 2012; Cabassa et al., 2008; Chen et al., experienced remission and relapses. Similarly, IGD cases
2008). tended to show better comprehensiveness than non-IGD
Other psychometric properties of the 26-item modified cases; it is plausible that their IGD-related experience might
IPQ-R for IGD were found to be satisfactory. Compared to have driven them to seek information about IGD. Such
the original IPQ-R (a 5 0.43–0.85; Moss-Morris et al., comparisons between IGD and non-IGD cases are poten-
2002), the modified scale showed comparative or even tially important. The number of sampled IGD cases in this
higher internal consistency (a 5 0.69–0.91). The mild inter- study was however small; further research is warranted to
factor correlations suggested that each factor was measuring understand levels and impact of these two factors among
a distinct underlying construct of illness representation. those with and without IGD.
Criterion-related validity was supported by the positive The study has several limitations. First, our sample was
correlations of stigma with the factors of timeline cyclical, drawn from the general population and not confined to only
consequence, treatment control, and emotional representa- those with IGD. As mentioned in the last paragraph, the levels
tions, and its negative correlation with illness coherence. of illness representations did differ between IGD cases and
Corroborating previous studies regarding mental disorders non-IGD cases. The sample size of the IGD group was
(Mak et al., 2014; Munson et al., 2009), subscales scores of however, very small and interpretation need to be cautious.
the cyclical nature, negative consequences, and negative The number of sampled IGD cases was too small for separate
emotions was positively associated with stigma. The negative testing of the psychometric properties in this important
correlation between illness coherence and stigma also sug- group. Further validation is therefore greatly warranted for
gests that promoting understanding and knowledge about testing whether the factor structure of this version of IPQ-R
IGD in the general population may reduce negative public’s for IGD among IGD cases would differ from the one reported
views against people with IGD, and may foster a more here. The revised tool validated in this study can be applied to
encouraging environment for help-seeking. general populations that have not been screened for IGD, but
The findings suggest that in general, the participants should not be applied to IGD cases until further validation
believed that IGD is subjected to relatively good personal confirms the findings of the present study among IGD cases.
control and treatment control. The findings are encouraging Second, the findings may not be generalizable to Western
as low perceived treatment control is a potential barrier of and/or adolescent populations. Cross-validations in such
help-seeking behaviors, and were associated with avoidance samples are also warranted. Third, this cross-sectional study
and negative coping (Richardson et al., 2017). However, future does not allow for causal inferences. Fourth, the study did not
research need to examine the extent of perceived treatment examine test-retest reliability. Fifth, the study was conducted
control among those with IGD. Presently, there is a dearth of prior to the formal inclusion of gaming disorder into ICD-11;
evidence-based treatment for IGD. We thus also need to the influence of such announcement to the public’s illness
understand deeper what treatment participants refer to. representation of the disorder as well as stability of the per-
Furthermore, the results showed that ever-gamers were more ceptions are unknown. It is also a limitation that the selection
likely than never-gamers to perceive better understanding on of stigma for testing criterion validity was not theory-based.
IGD, higher perceived control over IGD, less severe outcomes Future research may use other variables for such testing, such
of IGD, and less negative emotions due to IGD. Gamers thus as intention to regulate gaming time or worry about devel-
seem to feel less threatened by IGD than never-gamers. The oping IGD for validations in general populations and coping
stronger threat perceived by never-gamers might be partial and health outcomes for validations among IGD cases (ac-
reasons for their staying away from Internet gaming. Again, cording to CSM). Lastly, measurement invariance test was not
future research is needed to test this contention. conducted for the comparisons between IGD versus non-IGD
cases, as the small sample size of IGD cases would not allow American Psychiatric Association. (2013). Diagnostic and statistical
for such testing. We also did not use the test before manual of mental disorders (5th ed.). Arlington, VA: American
comparing ever-gamers and never-gamers, since our valida- Psychiatric Publishing.
tion refers to the entire general population. We recommend Ayu, A. P., Dijkstra, B., Golbach, M., De Jong, C., & Schellekens, A.
future studies to include such tests to confirm whether the (2016). Good psychometric properties of the addiction version
identified factor structure would be applicable to particular of the revised illness perception questionnaire for health care
subgroups of significance. professionals. PLOS ONE, 11(11), e0164262. https://doi.org/10.
Despite these limitations, the modified version of IPQ-R 1371/journal.pone.0164262.
has acceptable reliability and validity, and is suitable for Baines, T., & Wittkowski, A. (2013). A systematic review of the
measuring illness representation of IGD in general pop- literature exploring illness perceptions in mental health utilising
ulations of Chinese adults. Based on the CSM (Leventhal the Self-Regulation Model. Journal of Clinical Psychology in
et al., 1998), illness representation influences coping strate- Medical Settings, 20(3), 263–274. https://doi.org/10.1007/
gies and behaviors related to the illness. Using the validated s10880-012-9337-9.
tool, future research may examine how illness representation Brislin, R. W. (1970). Back-translation for cross-cultural research.
regarding IGD would influence incidence, remission, and Journal of Cross-Cultural Psychology, 1(3), 185–216. https://doi.
treatment-seeking behaviors. It is warranted to develop in- org/10.1177/135910457000100301.
terventions to modify illness representation regarding IGD Broadbent, E., Ellis, C., Thomas, J., Gamble, G., & Petrie, K. (2009).
for prevention and remission of IGD, and promote related Further development of an illness perception intervention for
help-seeking behaviors. myocardial infarction patients: A randomized controlled trial.
Journal of Psychosomatic Research, 67(1), 17–23. https://doi.
Funding sources: The research was supported by the research org/10.1016/j.jpsychores.2008.12.001.
grant of the University of Macau (Ref #: MYRG2016-00162- Browning, K. K., Wewers, M. E., Ferketich, A. K., Otterson, G. A., &
FSS and MYRG2019-00014-FSS). The funding source had Reynolds, N. R. (2009). The Self-regulation Model of Illness
no role in the study design, collection, analysis or interpre- applied to smoking behavior in lung cancer. Cancer Nursing,
tation of the data, writing the manuscript, or the decision to 32(4), E15–E25. https://doi.org/10.1097/NCC.0b013e3181a0238f.
submit the paper for publication. Cabassa, L. J., Lagomasino, I. T., Dwight-Johnson, M., Hansen, M.
C., & Xie, B. (2008). Measuring Latinos’ perceptions of depres-
Authors’ contribution: TFL was involved in research sion: A confirmatory factor analysis of the illness perception
conception, questionnaire design, as well as writing and questionnaire. Cultural Diversity and Ethnic Minority Psychology,
finalizing the manuscript. LD was involved in literature review 14(4), 377–384. https://doi.org/10.1037/a0012820.
and manuscript writing. RYHC was responsible for data Chen, J. H., Tong, K. K., Wu, A., Lau, J. T., & Zhang, M. X. (2018).
analysis and result interpretation. MXZ was involved in The comorbidity of gambling disorder among Macao adult
literature review, data preparation, and manuscript prepara- residents and the moderating role of resilience and life purpose.
tion. JHC was involved in data collection and preparation. International Journal of Environmental Research and Public
AMSW was the principal investigator of the project and Health, 15(12), 2774. https://doi.org/10.3390/ijerph15122774.
responsible for research conception, design, and coordination, Chen, S.-L., Tsai, J.-C., & Chou, K.-R. (2011). Illness perceptions
data interpretation, and manuscript preparation. All authors and adherence to therapeutic regimens among patients with
contributed to and approved the final manuscript. hypertension: A structural modeling approach. International
Journal of Nursing Studies, 48(2), 235–245. https://doi.org/10.
Conflict of interest: All authors declare no conflict of interest. 1016/j.ijnurstu.2010.07.005.
Chen, S. L., Tsai, J. C., & Lee, W. L. (2008). Psychometric validation
of the Chinese version of the Illness Perception Questionnaire-
Revised for patients with hypertension. Journal of Advanced
REFERENCES Nursing, 64(5), 524–534. https://doi.org/10.1111/j.1365-2648.
2008.04808.x.
Abubakari, A. R., Jones, M. C., Lauder, W., Kirk, A., Devendra, D., Corrigan, P. W. (2000). Mental health stigma as social attribution:
& Anderson, J. (2012). Psychometric properties of the revised Implications for research methods and attitude change. Clinical
illness perception questionnaire: Factor structure and reliability Psychology: Science and Practice, 7, 48–67. https://doi.org/10.
among African-origin populations with type 2 diabetes. Inter- 1093/clipsy.7.1.48.
national Journal of Nursing Studies, 49(6), 672–681. https://doi. Cortina, J. M. (1993). What is coefficient alpha? An examination of
org/10.1016/j.ijnurstu.2011.11.008. theory and applications. Journal of Applied Psychology, 78(1),
American Association for Public Opinion Research. (2011). Stan- 98–104. https://doi.org/10.1037/0021-9010.78.1.98.
dard definitions: Final dispositions of case codes and outcome Dempster, M., Howell, D., & McCorry, N. K. (2015). Illness per-
rates for surveys (7th ed.). Retrieved https://www.aapor.org/ ceptions and coping in physical health conditions: A meta-
Content/NavigationMenu/AboutAAPOR/StandardsampEthics/ analysis. Journal of Psychosomatic Research, 79(6), 506–513.
StandardDefinitions/StandardDefinitions2011.pdf. https://doi.org/10.1016/j.jpsychores.2015.10.006.
Dempster, M., & McCorry, N. K. (2012). The factor structure of the Ko, C. H., Yen, J. Y., Chen, S. H., Wang, P. W., Chen, C. S., & Yen,
revised Illness Perception Questionnaire in a population of C. F. (2014). Evaluation of the diagnostic criteria of Internet
oesophageal cancer survivors. Psycho-Oncology, 21(5), 524–530. gaming disorder in the DSM-5 among young adults in Taiwan.
https://doi.org/10.1002/pon.1927. Journal of Psychiatric Research, 53, 103–110. https://doi.org/10.
Eickhoff, E., Yung, K., Davis, D. L., Bishop, F., Klam, W. P., & Doan, 1016/j.jpsychires.2014.02.008.
A. P. (2015). Excessive video game use, sleep deprivation, and Lam, W. W. T., Liao, Q., Wong, J. H. F., Lai, C. L., Yuen, M. F.,
poor work performance among U.S. Marines treated in a military Tsang, J. W. H., et al. (2015). Measuring and validating a
mental health clinic: A case series. Military Medicine, 180(7), general cancer predisposition perception scale: An adaptation
e839–e843. https://doi.org/10.7205/milmed-d-14-00597. of the Revised-IPQ-Genetic predisposition scale. PloS One,
Enders, C. K., & Bandalos, D. L. (2001). The relative performance of 10(11), e0142620. https://doi.org/10.1371/journal.pone.
full information maximum likelihood estimation for missing data 0142620.
in structural equation models. Structural Equation Modeling, 8(3), Leventhal, H., Leventhal, E. A., & Contrada, R. J. (1998). Self-
430–457. https://doi.org/ 10.1207/S15328007SEM0803_5. regulation, health, and behavior: A perceptual-cognitive
Fan, Y., Huang, Z., Zhang, D., Chang, J., Jia, Y., He, S., et al. (2017). approach. Psychology and Health, 13(4), 717–733. https://doi.
Psychometric validation of the Chinese version of the Illness org/10.1080/08870449808407425.
Perception Questionnaire-Revised for women with stress uri- Lobban, F., & Barrowclough, C. (2005). Common sense represen-
nary incontinence. Journal of Obstetrics and Gynaecology tations of schizophrenia in patients and their relatives. Clinical
Research, 43(8), 1305–1316. https://doi.org/10.1111/jog.13351. Psychology & Psychotherapy, 12(2), 134–141. https://doi.org/10.
Feng, W., Ramo, D. E., Chan, S. R., & Bourgeois, J. A. (2017). 1002/cpp.443.
Internet gaming disorder: Trends in prevalence 1998–2016. Lobban, F., Barrowclough, C., & Jones, S. (2004). The impact of
Addictive Behaviors, 75, 17–24. https://doi.org/10.1016/j. beliefs about mental health problems and coping on outcome in
addbeh.2017.06.010. schizophrenia. Psychological Medicine, 34(7), 1165–1176.
Fleming, M. P., Martin, C. R., Miles, J., & Atkinson, J. (2009). The https://doi.org/10.1017/s003329170400203x.
utility of the Illness Perception Questionnaire in the evaluation Macao Statistics and Census Services. (2017). Detailed results of
of mental health practitioners’ perspectives on patients with 2016 population by-census. Macao: Macao Statistics and Census
schizophrenia. Journal of Evaluation in Clinical Practice, 15(5), Services. Retrieved from https://www.dsec.gov.mo/
826–831. https://doi.org/10.1111/j.1365-2753.2008.01103.x. getAttachment/bfa0112a-eaf3-49a9-9168-b5add46e9d65/C_
Gentile, D. A., Bailey, K., Bavelier, D., Brockmyer, J. F., Cash, H., ICEN_PUB_2016_Y.aspx.
Coyne, S. M., et al. (2017). Internet gaming disorder in children Mak, W. W. S., Chong, E. S. K., & Wong, C. C. Y. (2014). Beyond
and adolescents. Pediatrics, 140(Suppl. 2), S81–S85. https://doi. attributions: Understanding public stigma of mental illness with
org/10.1542/peds.2016-1758h. the common sense model. American Journal of Orthopsychiatry,
Glattacker, M., Heyduck, K., & Meffert, C. (2012). Illness be- 84(2), 173–181. https://doi.org/10.1037/h0099373.
liefs, treatment beliefs and information needs as starting Mihara, S., & Higuchi, S. (2017). Cross-sectional and longitudinal
points for patient information–evaluation of an intervention epidemiological studies of internet gaming disorder: A sys-
for patients with chronic back pain. Patient Education and tematic review of the literature. Psychiatry and Clinical Neu-
Counseling, 86(3), 378–389. https://doi.org/10.1016/j.pec. rosciences, 71(7), 425–444. https://doi.org/10.1111/pcn.12532.
2011.05.028. Mo, P. K. H., Lau, J. T. F., Cheng, K. M., Mak, W. W. S., Gu, J., Wu,
Hagger, M. S., & Orbell, S. (2005). A confirmatory factor analysis of A. M. S., et al. (2015). Investigating the factor structure of the
the revised illness perception questionnaire (IPQ-R) in a cer- Illness Perception Questionnaire-Revised for substance depen-
vical screening context. Psychology and Health, 20(2), 161–173. dence among injecting drug users in China. Drug and Alcohol
https://doi.org/10.1080/0887044042000334724. Dependence, 148, 195–202. https://doi.org/10.1016/j.drugalcdep.
Hawi, N. S., Samaha, M., & Griffiths, M. D. (2018). Internet gaming 2015.01.008.
disorder in Lebanon: Relationships with age, sleep habits, and Moss-Morris, R., Weinman, J., Petrie, K., Horne, R., Cameron, L., &
academic achievement. Journal of Behavioral Addictions, 7(1), Buick, D. (2002). The revised illness perception questionnaire
70–78. https://doi.org/10.1556/2006.7.2018.16. (IPQ-R). Psychology and Health, 17(1), 1–16. https://doi.org/10.
Holliday, J., Wall, E., Treasure, J., & Weinman, J. (2005). Percep- 1080/08870440290001494.
tions of illness in individuals with anorexia nervosa: A com- M€uller, K. W., Janikian, M., Dreier, M., W€ olfling, K., Beutel, M. E.,
parison with lay men and women. International Journal of Tzavara, C., et al. (2015). Regular gaming behavior and internet
Eating Disorders, 37(1), 50–56. https://doi.org/10.1002/eat. gaming disorder in European adolescents: Results from a cross-
20056. national representative survey of prevalence, predictors, and
Hou, R., Cleak, V., & Peveler, R. (2010). Do treatment and illness psychopathological correlates. European Child & Adolescent
beliefs influence adherence to medication in patients with bi- Psychiatry, 24(5), 565–574. https://doi.org/10.1007/s00787-014-
polar affective disorder? A preliminary cross-sectional study. 0611-2.
European psychiatry : The Journal of the Association of Euro- Munson, M. R., Floersch, J. E., & Townsend, L. (2009). Attitudes
pean Psychiatrists, 25(4), 216–219. https://doi.org/10.1016/j. toward mental health services and illness perceptions among
eurpsy.2009.09.003. adolescents with mood disorders. Child and Adolescent Social
Kline, R. B. (2015). Principles and practice of structural equation Work Journal, 26(5), 447–466. https://doi.org/10.1007/s10560-
modeling (4th ed.). Guilford Press. 009-0174-0.
Richardson, E. M., Sch€ uz, N., Sanderson, K., Scott, J. L., & Sch€
uz, B. Williams, K., & Steer, H. (2011). Illness perceptions: Are beliefs
(2017). Illness representations, coping, and illness outcomes in about mental health problems associated with self-perceptions
people with cancer: A systematic review and meta-analysis. Psy- of engagement in people with psychosis? Behavioural and
cho-Oncology, 26(6), 724–737. https://doi.org/10.1002/pon.4213. Cognitive Psychotherapy, 39(2), 151–163. https://doi.org/10.
Satghare, P., Abdin, E., Vaingankar, J., Chua, B. Y., Pang, S., Picco, 1017/S1352465810000627.
L., et al. (2016). Prevalence of sleep problems among those with World Health Organization. (2018). Gaming disorder. Retrieved
internet gaming disorder in Singapore. ASEAN Journal of from https://icd.who.int/dev11/l-m/en#/http://id.who.int/icd/
Psychiatry, 17(2), 188–198. entity/1448597234.
Stockford, K., Turner, H., & Cooper, M. (2007). Illness perception Wu, A. M. S., Chen, J. H., Tong, K.-K., Yu, S., & Lau, J. T. F.
and its relationship to readiness to change in the eating dis- (2018a). Prevalence and associated factors of Internet gaming
orders: A preliminary investigation. The British Journal of disorder among community dwelling adults in Macao, China.
Clinical Psychology, 46(2), 139–154. https://doi.org/10.1348/ Journal of Behavioral Addictions, 7(1), 62–69. https://doi.org/
014466506X115786. 10.1556/2006.7.2018.12.
Van Sonderen, E., Sanderman, R., & Coyne, J. C. (2013). Ineffec- Wu, A. M. S., & Lau, J. T. F. (2015). Gambling in China: Socio-
tiveness of reverse wording of questionnaire items: Let’s learn historical evolution and current challenges. Addiction, 110(2),
from cows in the rain. PLOS ONE, 8(7), e68967. https://doi.org/ 210–216. https://doi.org/10.1111/add.12710.
10.1371/journal.pone.0068967. Wu, C.-Y., Lee, M.-B., Liao, S.-C., & Ko, C.-H. (2019). A nation-
Wang, H. R., Cho, H., & Kim, D. J. (2018). Prevalence and wide survey of the prevalence and psychosocial correlates of
correlates of comorbid depression in a nonclinical online internet addictive disorders in Taiwan. Journal of the Formosan
sample with DSM-5 internet gaming disorder. Journal of Medical Association, 118(1), 514–523. https://doi.org/10.1016/j.
Affective Disorders, 226, 1–5. https://doi.org/10.1016/j.jad. jfma.2018.10.022.
2017.08.005. Wu, X., Lau, J. T. F., Mak, W. W. S., Gu, J., Mo, P. K. H., & Wang,
Wartberg, L., Kriston, L., & Thomasius, R. (2017). The prevalence X. (2018b). How newly diagnosed HIV-positive men who have
and psychosocial correlates of internet gaming disorder. sex with men look at HIV/AIDS-validation of the Chinese
Deutsches Arzteblatt International, 114(25), 419–424. https:// version of the revised illness perception questionnaire. BMC
doi.org/10.3238/arztebl.2017.0419. Infectious Diseases, 18(1), 2. https://doi.org/10.1186/s12879-
Weiner, B., Perry, R. P., & Magnusson, J. (1988). An attributional 017-2902-y.
analysis of reactions to stigmas. Journal of Personality and So- Yen, J.-Y., Liu, T.-L., Wang, P.-W., Chen, C.-S., Yen, C.-F., & Ko,
cial Psychology, 55, 738–748. https://doi.org/10.1037/0022-3514. C.-H. (2016). Association between Internet gaming disorder
55.5.738. and adult attention deficit and hyperactivity disorder and their
Weinman, J., & Petrie, K. J. (1997). Illness perceptions: A new para- correlates: Impulsivity and hostility. Addictive Behaviors, 64,
digm for psychosomatics? Journal of Psychosomatic Research, 303–318. https://doi.org/10.1016/j.addbeh.2016.04.024.
42(2), 113–116. https://doi.org/10.1016/s0022-3999(96)00294-2. Yu, H., & Cho, J. (2016). Prevalence of internet gaming disorder
Weinman, J., Petrie, K. J., Moss-Morris, R., & Horne, R. (1996). The among Korean adolescents and associations with non-psychotic
illness perception questionnaire: A new method for assessing psychological symptoms, and physical aggression. American
the cognitive representation of illness. Psychology and Health, Journal of Health Behavior, 40(6), 705–716. https://doi.org/ 10.
11(3), 431–445. https://doi.org/10.1080/08870449608400270. 5993/AJHB.40.6.3.
Weisman, A. G., & L opez, S. R. (1997). An attributional analysis of Zhang, M. X., Wang, X., Yu, S. M., & Wu, A. M. S. (2019). Purpose
emotional reactions to schizophrenia in Mexican and Anglo in life, social support, and internet gaming disorder among
American cultures 1. Journal of Applied Social Psychology, Chinese university students: A 1-year follow-up study. Addic-
27(3), 223–244. tive Behaviors, 99, 106070. https://doi.org/10.1016/j.addbeh.
Wichstrøm, L., Stenseng, F., Belsky, J., von Soest, T., & Hygen, B. W. 2019.106070.
(2019). Symptoms of Internet gaming disorder in youth: Pre- Zhao, M., & Hao, W. (2019). Challenges of gaming disorder: Sug-
dictors and comorbidity. Journal of Abnormal Child Psychology, gestions from a public health perspective. General Psychiatry,
47(1), 71–83. https://doi.org/10.1007/s10802-018-0422-x. 32(3), e100086. https://doi.org/10.1136/gpsych-2019-100086.
Open Access statement. This is an open-access article distributed under the terms of the Creative Commons Attribution-NonCommercial 4.0 International License
(https://creativecommons.org/licenses/by-nc/4.0/), which permits unrestricted use, distribution, and reproduction in any medium for non-commercial purposes, provided
the original author and source are credited, a link to the CC License is provided, and changes – if any – are indicated.