Understanding the gaming disorder–depression co-occurrence: A narrative literature review

• Gaming disorder often co-occurs with depression. • Depression may be the mediator between some risk factors and gaming disorders. • Individuals may engage in gaming to self-medicate or regulate their depression or negative emotions. • Pathological gaming may result in negative psychosocial consequences that facilitate depression. • The bi-directional relationship between gaming disorder and depression should be integrated into clinical assessments and treatments. Because gaming disorder (GD) often co-occurs with depression, understanding how both disorders work together enables clinicians to better treat individuals with GD – depression comorbidity. The extant literature on GD – depression comorbidity is unsystematic and contradictory, with some studies suggesting depression predicts GD but not vice versa, some claiming GD predicts depression but not vice versa, and some proposing a bidirectional relationship between the two. The goal of this narrative review is to explore and organize these findings to establish a holistic and coherent conceptual framework that explains how GD co-occurs with depression. The PubMed, PsycINFO, and Web of Sciences databases were searched for relevant peer-reviewed journal articles published 2013-2025, using the search terms (gaming disorder OR gaming addiction) AND (depression OR depressive symptoms) . Results included 127 empirical studies that meet the inclusion criteria and are relevant to building a coherent map to explain the GD – depression relationship. The resulting framework combines their findings to map paths and mechanisms, as well as salient contextual factors, explaining how GD and depression may be connected. Specifically, the self-medication perspective indicates that psychiatric disorders, adverse life experiences, and other factors may predict GD via the mediation of depression. By comparison, the negative consequences perspective suggests that GD may lead to negative consequences (e.g., withdrawal, unhealthy lifestyles, and compromised self-esteem), which subsequently foster depression. Together, these two paths form a chronic vicious cycle.