Teens who play video games for more than four hours might suffer from depression — but socializing can ward off the danger, according to a new study.

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Heavy gaming, particularly in boys, might raise a few warning signs. However, not everyone who plays extensively every day risks developing gaming addiction. The negative effects of heavy gaming can be mitigated by socially engaging with friends either online or in real life while playing. High-quality friendships may even make teens immune from depression symptoms associated with heavy video game use, the researchers report.

“If these adolescents are sitting around playing games together with their friends or chatting regularly with their friends online as they play, this could be part of a perfectly normal developmental pattern,” says study leader Michelle Colder Carras, PhD, a post-doctoral researcher in the Department of Mental Health at the Bloomberg School.

“We shouldn’t assume all of them have a problem.”

Gaming hard

Carras and her team used data recorded between 2009-2012 by the annual Monitor Internet and Youth Study, a school-based survey of almost 10,000 teenagers in the Netherlands. The kids were asked about their gaming habits, such as how often they played games, about their social media use, and their friendships. It also included questions about addictive behaviors — do they feel like they can stop gaming if they want to? Maybe they can’t? Do they get irritable when they can’t play?

The analysis focused on several types of respondents, most notably on heavy gamers who reported frequent online socializing and those who didn’t. Carras’ team found that in broad lines, symptoms of video game addiction depend on time spent gaming as well as the level of social engagement that is included in gaming. Those who were socially active online reported fewer symptoms.

All subsets of heavy gamers had more depressive symptoms than their peers, but boys seem especially vulnerable — those who were not very active on online communication media reported higher levels of loneliness and anxiety, no matter how good their friendships were. Girls who played video games heavily but were very active in online social settings were less lonely and socially anxious but reported lower self-esteem.

Most of the respondents who said they play four or more hours each day did report depressive symptoms, Carras said. But not all gaming-related disorders need treatment, she added. Parents and doctors need to work at understanding the underlying reasons why their teen plays.

Good games, bad games

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Instead of worrying that playing a lot of games means there’s a problem, they should focus on the kids who don’t seem socially engaged or show other depressive symptoms.

“Our findings open up the idea that maybe playing a lot of video games can be part of having an active social life,” she says.

“Rather than seeing a lot of video game playing and worrying that this reflects gaming-related problems, parents and clinicians should figure out whether these teens also have high-quality friendships. It could just be that they have good friends who they like to hang out and play video games with. That is probably not a worrisome equation.”

Is the child playing to bond or socialize with others? That’s a-ok.

Is he or she playing all the time to cope with the real world, seeing the game world as a safe place or an escape from loneliness? That’s not.

Carras believes that older teens can usually tell if their use of games or the internet is unhealthy, but younger ones may need help to understand their own behavior. They also need help to handle the problems that may arise from their excessive gaming, and the underlying causes that pushed them to it in the first place.

The team says the results, though based on data from the Netherlands, are likely indicative for other developed countries such as the US as well. Internet Gaming Disorder has been proposed for further study in the Diagnostic and Statistical Manual of Mental Disorders, the DSM-5. Still, it’s not yet clear how to distinguish engaged gamers, who show few symptoms of addiction and depression, from problematic gamers, who lose control over gaming.

The full paper “Video gaming in a hyperconnected world: A cross-sectional study of heavy gaming, problematic gaming symptoms, and online socializing in adolescents” has been published in the journal Computers and Human Behavior