Delineating risk pathways and identifying distinct subgroups for internet gaming disorder: an integrated multi-level analysis

Abstract Background and aims: Internet gaming disorder (IGD) is a growing global mental health concern, yet its heterogeneity and the interplay of risk factors remain unclear. This study aimed to delineate interrelationships among psychological risk factors, identify distinct IGD subgroups, and inform personalized intervention strategies. Methods This cross-sectional, multicenter study employed a cluster sampling approach to obtain a final sample of 13,512 Chinese adolescents and young adults. We assessed IGD severity and multiple risk/protective factors using standardized scales. Analyses included multivariable logistic regression, network analysis, latent profile analysis (LPA), and random forest modeling with SHAP explanation. Results The prevalence of high-risk IGD was 15.9%. Independent risk factors included male gender, depression, anxiety, cognitive failures, social interaction anxiety, and impulsivity, while psychological resilience was protective. Network analysis revealed the Distraction and Resilience facets (Tenacity and Strength) as the most central nodes, with Distraction, Interaction Anxiousness and Sensation Serving as key bridges connecting different symptom clusters. LPA identified four subgroups: "Emotional-Cognitive Dysfunction" (high symptoms, low childhood adversity), "Moderate-Risk with Prevalent Family Dysfunction," "Executive Dyscontrol" (high impulsivity deficits, low reward sensitivity), and "High-Adversity Compensatory" (high childhood adversity, low current psychopathology). Random forest modeling achieved 85.3% accuracy in classifying subgroups, with family dysfunction as the most discriminative feature. Conclusions This study showed that IGD represented a heterogeneous condition with distinct risk pathways. Integrating network and person-centered analysis revealed two primary pathways to severe IGD—emotional-cognitive dysfunction and executive dyscontrol—and resolved paradoxical findings. This typology supported a precision-based approach to assessment and intervention.