Prevalence, Sex Differences, and Predictors of Gaming Disorder in a Large-Scale Sample of Poor Rural Chinese Adolescents: Longitudinal Observational Study (Preprint)

<sec> <title>BACKGROUND</title> Gaming disorder is prevalent in the world and poses significant harm. Poor rural adolescents face unique risks due to limited supervision and unequal digital resources, with limited longitudinal research. Existing studies show sex differences in its prevalence, but their manifestations and mechanisms in rural populations remain unclear. </sec> <sec> <title>OBJECTIVE</title> This study aims to determine the prevalence of gaming disorder among poor rural adolescents in China, identify sex-specific risk and protective factors, and evaluate longitudinal predictors of new-onset gaming disorder over a one-year follow-up period. </sec> <sec> <title>METHODS</title> A longitudinal study was conducted among poor rural students. Questionnaires collected demographics, psychological status, and gaming symptoms. Analyses included correlation analysis, followed by multivariate logistic regression to identify baseline associated factors and predict follow-up disorder. </sec> <sec> <title>RESULTS</title> Baseline included 13,931 valid responses (prevalence: 5.2%; males: 6.7%, females: 3.6%). A 1-year follow-up with 3,838 responses showed 5.6% prevalence (males: 7.8%, females: 3.4%). Common baseline factors: longer gaming time, lower self-esteem, higher depression, and greater impulsivity. Sex differences: companionship protected females; age and poor self-regulation posed extra risks for males. Follow-up predictors: baseline longer gaming time, lower self-esteem, and greater impulsivity. Sex differences: baseline companionship protected females; baseline poor self-regulation and disorder history predicted males. </sec> <sec> <title>CONCLUSIONS</title> Rural prevalence is lower than urban, with males higher than females. Depression, self-esteem, impulsivity, gaming duration, and caregiver companionship are key factors with sex differences: females rely more on companionship, while males are more vulnerable to poor self-regulation. Interventions should address these differences, strengthening family support and psychological adjustment. </sec>