Association Between Anxiety, Self-Control, Aggression, and Internet Gaming Disorder Among Children and Adolescents with Elevated Depressive Symptoms

Background/Objectives: Internet gaming disorder (IGD) has been officially classified as a gaming disorder in the ICD-11, and clinical interest in it has been growing rapidly. Using data from a large-scale, school-based cohort, the aim of this study was to compare the psychological characteristics of a group with elevated depressive symptoms (DSG) and a control group, and to identify the variables most strongly associated with IGD within the DSG. Methods: We analyzed 2093 participants (1113 in the DSG and 980 in the control group) in a school-based cohort of internet, game, and smartphone users (iCURE), established by the National Center for Mental Health (NCMH). The measures included the Children’s Depression Inventory (CDI), the Trait Anxiety Inventory for Children (TAIC), the Self-Esteem Scale (SES), the Self-Control Scale, the Korean version of the Aggression Questionnaire (K-AQ), the School Bullying scale (SB), and the Internet Game Use-Elicited Symptom Screen (IGUESS). Analyses of covariance (ANCOVA) and multiple regression analyses controlling for sex were performed in R 4.4.5. Results: Compared with the control group, the DSG showed significantly higher anxiety, aggression, bullying, and gaming disorder symptoms, along with lower self-esteem and self-control (ANCOVA). Within the DSG, trait anxiety (β = 0.15), self-control (β = −0.275), and aggression (β = 0.111) emerged as significant correlates of IGD. Conclusions: These findings suggest that not only anxiety and self-control but also aggression are independently associated with gaming disorder. Therefore, for the prevention and treatment of IGD in emotionally vulnerable adolescents, self-regulation and anger-management programs, along with anxiety reduction, may be beneficial.