Short answer: The relationship may work in both directions. Among adolescents, earlier mental-health difficulties can increase the risk of developing gaming disorder, while persistent, compulsive gaming may also be followed by worsening mental-health symptoms.
How the two directions can work
- Psychopathology may come first. Difficulties such as depression, anxiety, attention problems, or trouble managing emotions may make gaming an especially appealing way to escape distress or feel successful and connected. For some young people, this could contribute to gaming becoming difficult to control.
- Gaming problems may come first. When gaming repeatedly interferes with sleep, schoolwork, exercise, or relationships, those disruptions may contribute to later emotional or behavioral difficulties. Gaming problems may also add stress or increase isolation.
What the evidence can—and cannot—tell us
Longitudinal studies, which follow adolescents over time, have reported both kinds of links. This supports a possible two-way relationship, but it does not prove that gaming disorder directly causes a mental-health condition, or that a mental-health condition inevitably leads to gaming disorder. Other factors—such as family stress, social difficulties, or existing vulnerabilities—may affect both.
It is also important to distinguish frequent gaming from gaming disorder. Spending many hours gaming is not, by itself, enough for a disorder; the key concern is persistent loss of control and significant harm or impairment in everyday life.
Bottom line: Preexisting psychological difficulties can be associated with later gaming disorder, and compulsive gaming can be associated with later psychological difficulties. The direction and strength of the relationship may differ from one adolescent to another.