Development and Internal Validation of Multivariable Prediction Models for Depression, Anxiety, and Stress Among Saudi Adolescent Video Game Players: A Cross-Sectional Study

Background: Anxiety, stress, and depression are increasingly prevalent mental health problems among adolescents, and several studies have reported significant associations between these conditions and video game addiction. The present study was therefore conducted to develop and internally validate multivariable prediction models based on gaming-related and demographic factors in order to identify Saudi adolescent video game players with concurrent moderate-to-extremely severe depression, anxiety, and stress symptoms. Methods: A school-based cross-sectional study was conducted among adolescents. A multistage random sampling technique was used to select 466 participants. Data were collected using a structured questionnaire comprising the Arabic version of the Depression Anxiety Stress Scale (DASS-21) and the validated Arabic version of the 21-item Gaming Addiction Scale (GAS). The prevalence of moderate-to-extremely severe depressive symptoms was 29.2%, whereas the prevalence of moderate-to-extremely severe anxiety and stress symptoms was 47.6% and 27.5%, respectively. Multivariable logistic regression analysis was performed to identify the factors associated with the three mental health outcomes and to derive prediction models and concurrent risk scores. Model performance was evaluated in terms of discrimination and calibration, and the developed risk scores were internally validated using bootstrap resampling. Results: Female gender, prolonged gaming duration (>4 h/day), and playing violent video games were significantly associated with all three mental health outcomes, namely moderate-to-extremely severe depression, anxiety, and stress symptoms, whereas additional factors were independently associated with each individual outcome. Overall, the three internally validated models demonstrated acceptable-to-good discrimination and generally satisfactory calibration. Conclusion: The internally validated models show potential as screening tools for identifying adolescent video game players with concurrent moderate-to-extremely severe depression, anxiety, and stress symptoms on the basis of a combination of demographic and gaming-related characteristics. However, external validation and prospective evaluation is required before they can be applied in clinical or public health practice.