How do video games affect mental health? A narrative review of 13 proposed mechanisms

Researchers have proposed a variety of mechanisms through which playing video games might affect mental health by displacing more psychosocially beneficial activities, satisfying or frustrating basic psychological needs, relieving stress, and many more. However, these mechanisms and their underlying causal structures are rarely made explicit. Here, we review 13 proposed effects of gaming on mental health. For each, we specify a counterfactual-that is, what concrete aspect of gaming should be changed in a hypothetical alternative universe to produce the effect of interest-and illustrate these with example directed acyclic graphs. In doing so, we hope to encourage more focused efforts to propose, falsify, and iterate on (causal) theories using well-established formal methods of causal inference. Only in doing so can the field realize its potential to inform clinical interventions, regulation, game design, and the behavior of players and parents.