I
nte
rna
t
io
na
l J
o
urna
l o
f
P
u
bli
c
H
ea
lt
h Science
(
I
J
P
H
S)
Vo
l.
14
,
No
.
3
,
Sep
tem
b
er
2
0
2
5
,
p
p
.
1
52
4
~
1
5
31
I
SS
N:
2
2
5
2
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8
8
0
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DOI
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.
1
1
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1
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s
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1524
J
o
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e
:
h
ttp
:
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ijp
h
s
.
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co
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Parenting
s
tyles
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psy
cho
lo
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ica
l need
a
nd ga
me g
enre
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rnet
ga
ming
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Sh
im
il P
.
V.
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y:
R
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Oct
2
5
,
2
0
2
4
R
ev
is
ed
J
an
2
4
,
2
0
2
5
Acc
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ted
Ma
r
6
,
2
0
2
5
In
tern
e
t
g
a
m
in
g
d
iso
r
d
e
r
(IG
D)
is
a
g
ro
win
g
c
o
n
c
e
rn
a
m
o
n
g
a
d
o
les
c
e
n
ts.
Th
is
stu
d
y
e
x
a
m
in
e
s
t
h
e
imp
a
c
t
o
f
d
iffere
n
t
p
a
re
n
ti
n
g
st
y
les
o
n
IG
D,
fo
c
u
sin
g
o
n
th
e
m
e
d
iatin
g
ro
le
o
f
p
sy
c
h
o
lo
g
ica
l
n
e
e
d
sa
ti
sfa
c
ti
o
n
.
Us
in
g
a
c
ro
ss
-
se
c
ti
o
n
a
l
c
o
rre
latio
n
a
l
d
e
si
g
n
wit
h
m
e
d
iatio
n
a
n
a
l
y
sis,
t
h
is
re
se
a
rc
h
in
v
e
stig
a
tes
in
d
irec
t
e
ffe
c
ts
to
u
n
d
e
rsta
n
d
h
o
w
p
a
re
n
ti
n
g
sty
les
in
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e
n
c
e
IG
D.
Th
e
stu
d
y
in
v
o
lv
e
d
3
0
0
p
a
r
ti
c
ip
a
n
ts
a
n
d
a
n
a
l
y
z
e
d
th
re
e
m
a
in
p
a
re
n
ti
n
g
sty
les
:
a
u
th
o
rit
a
ti
v
e
(fir
m
b
u
t
su
p
p
o
rti
v
e
),
a
u
t
h
o
rit
a
rian
(st
rict
a
n
d
c
o
n
tro
ll
in
g
),
a
n
d
p
e
rm
issiv
e
(len
ien
t).
F
in
d
in
g
s
in
d
ica
te
th
a
t
a
u
th
o
rit
a
t
iv
e
p
a
re
n
ti
n
g
re
d
u
c
e
s
IG
D
b
y
s
u
p
p
o
rti
n
g
t
h
e
fu
lf
il
lme
n
t
o
f
b
a
sic
p
s
y
c
h
o
lo
g
ica
l
n
e
e
d
s,
su
c
h
a
s
a
u
t
o
n
o
m
y
,
c
o
m
p
e
ten
c
e
,
a
n
d
c
o
n
n
e
c
ti
o
n
,
a
s
o
u
t
li
n
e
d
i
n
se
lf
-
d
e
term
in
a
ti
o
n
t
h
e
o
r
y
(S
DT).
Co
n
v
e
rse
ly
,
a
u
th
o
rit
a
rian
p
a
re
n
ti
n
g
i
s
a
ss
o
c
iate
d
with
h
ig
h
e
r
IG
D,
a
s
it
re
stricts
th
e
se
p
sy
c
h
o
lo
g
ica
l
n
e
e
d
s
in
re
a
l
li
fe
,
lea
d
i
n
g
a
d
o
les
c
e
n
ts
t
o
se
e
k
f
u
lfi
ll
m
e
n
t
t
h
ro
u
g
h
e
x
c
e
ss
iv
e
g
a
m
in
g
,
p
a
rti
c
u
larly
in
g
e
n
re
s
li
k
e
b
a
tt
le
r
o
y
a
le.
p
e
rm
issiv
e
p
a
re
n
ti
n
g
d
id
n
o
t
sh
o
w
a
sig
n
ifi
c
a
n
t
e
ffe
c
t
o
n
IG
D.
Ad
d
i
ti
o
n
a
ll
y
,
t
h
e
stu
d
y
re
v
e
a
led
th
a
t
b
o
y
s
a
re
m
o
re
li
k
e
ly
th
a
n
g
irl
s
to
e
x
h
i
b
it
h
ig
h
e
r
IG
D
a
n
d
fin
d
g
re
a
ter
p
s
y
c
h
o
lo
g
ica
l
n
e
e
d
sa
ti
sfa
c
ti
o
n
i
n
g
a
m
in
g
.
T
h
e
se
re
su
lt
s
h
i
g
h
li
g
h
t
th
e
im
p
o
rtan
c
e
o
f
p
a
re
n
ti
n
g
sty
les
a
n
d
p
s
y
c
h
o
lo
g
i
c
a
l
n
e
e
d
s
in
u
n
d
e
rsta
n
d
in
g
IGD
a
m
o
n
g
a
d
o
les
c
e
n
ts.
K
ey
w
o
r
d
s
:
Ad
o
lescen
ts
Gam
e
g
en
r
e
I
n
ter
n
et
g
a
m
in
g
d
is
o
r
d
er
Par
en
tin
g
s
ty
le
Ps
y
ch
o
lo
g
ical
n
ee
d
s
T
h
is i
s
a
n
o
p
e
n
a
c
c
e
ss
a
rticle
u
n
d
e
r th
e
CC B
Y
-
SA
li
c
e
n
se
.
C
o
r
r
e
s
p
o
nd
ing
A
uth
o
r
:
Palak
Kan
war
Dep
ar
tm
en
t o
f
Ps
y
ch
o
lo
g
y
,
C
h
r
is
t U
n
iv
er
s
ity
B
en
g
alu
r
u
,
Kar
n
atak
a
5
6
0
0
2
9
,
I
n
d
ia
E
m
ail:
p
alak
.
k
an
war
@
ch
r
is
tu
n
iv
er
s
ity
.
in
1.
I
NT
RO
D
UCT
I
O
N
I
n
ter
n
et
g
a
m
in
g
d
is
o
r
d
er
(
I
G
D)
h
as
b
ec
o
m
e
a
co
m
m
o
n
way
f
o
r
teen
ag
er
s
in
I
n
d
ia
to
co
p
e
with
s
tr
ess
,
esp
ec
ially
d
u
r
in
g
th
e
C
OVI
D
-
1
9
lo
ck
d
o
wn
o
n
war
d
s
.
As
m
o
r
e
s
tu
d
e
n
ts
ar
e
g
iv
e
n
m
o
b
ile
p
h
o
n
es
in
h
ig
h
s
ch
o
o
l,
ac
ce
s
s
to
o
n
lin
e
g
am
in
g
h
as
g
r
ea
tly
in
c
r
ea
s
ed
[
1
]
.
T
h
e
r
ate
o
f
I
GD
am
o
n
g
I
n
d
ian
tee
n
ag
er
s
is
3
.
5
%,
wh
ich
is
a
g
r
o
win
g
c
o
n
ce
r
n
as
in
ter
n
et
g
am
in
g
b
ec
o
m
es
m
o
r
e
wid
esp
r
ea
d
[
2
]
,
[
3
]
.
A
r
ec
en
t
r
ev
iew
o
f
1
6
s
tu
d
ies
f
o
u
n
d
th
at
th
e
o
v
e
r
all
r
ate
o
f
I
GD
in
t
ee
n
ag
er
s
is
4
.
6
%,
with
b
o
y
s
h
av
in
g
a
m
u
ch
h
ig
h
e
r
r
ate
(
6
.
8
%)
th
an
g
i
r
ls
(
1
.
3
%)
[
4
]
,
[
5
]
.
Acc
o
r
d
in
g
to
a
KPMG
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ep
o
r
t,
o
v
e
r
o
n
e
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h
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o
f
I
n
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ian
g
am
e
r
s
p
lay
m
u
ltip
lay
er
g
am
es,
s
h
o
win
g
th
e
r
is
in
g
p
o
p
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lar
ity
an
d
r
i
s
k
s
o
f
ex
ce
s
s
iv
e
g
am
in
g
am
o
n
g
y
o
u
n
g
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le.
T
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ce
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s
PUB
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ch
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g
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ile
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p
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s
.
O
t
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p
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Mi
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$
9
.
1
b
i
l
l
i
o
n
b
y
2
0
2
9
[
6
]
.
Gam
in
g
,
wh
en
d
o
n
e
in
m
o
d
er
atio
n
,
h
as
s
ev
er
al
p
o
s
itiv
e
ef
f
ec
ts
.
I
t
ca
n
im
p
r
o
v
e
th
i
n
k
in
g
s
k
ills
lik
e
p
r
o
b
lem
-
s
o
lv
in
g
,
cr
itical
th
in
k
in
g
,
an
d
p
lan
n
in
g
.
I
t
also
h
elp
s
with
h
an
d
-
ey
e
co
o
r
d
in
at
io
n
an
d
f
in
e
m
o
to
r
s
k
ills
.
Mu
ltip
lay
er
g
am
es
en
co
u
r
ag
e
s
o
cial
in
ter
ac
tio
n
,
te
am
wo
r
k
,
an
d
c
o
m
m
u
n
icatio
n
,
wh
ile
g
am
in
g
in
Evaluation Warning : The document was created with Spire.PDF for Python.
I
n
t J Pu
b
lic
Hea
lth
Sci
I
SS
N:
2252
-
8
8
0
6
P
a
r
en
tin
g
s
tyles,
p
s
yc
h
o
lo
g
ica
l n
ee
d
a
n
d
g
a
me
g
en
r
e
in
i
n
tern
et
g
a
min
g
d
is
o
r
d
er
(
S
h
imil P
.
V
.
)
1525
g
en
er
al
p
r
o
v
id
es
s
tr
ess
r
elief
an
d
h
elp
s
p
lay
e
r
s
d
ea
l
with
c
h
allen
g
es.
E
d
u
ca
tio
n
al
g
am
es
h
elp
with
lear
n
in
g
,
an
d
cr
ea
tiv
e
g
am
es b
o
o
s
t im
ag
in
atio
n
.
Gam
in
g
ca
n
also
im
p
r
o
v
e
f
o
cu
s
an
d
atten
tio
n
.
Ho
wev
er
,
th
ese
b
en
ef
its
n
ee
d
to
b
e
b
alan
ce
d
with
th
e
r
is
k
s
o
f
p
lay
in
g
to
o
m
u
ch
[
7
]
.
E
x
ce
s
s
iv
e
g
am
in
g
,
esp
ec
ially
wh
e
n
it
b
ec
o
m
es
co
m
p
u
ls
iv
e,
ca
n
h
ar
m
p
er
s
o
n
al,
s
o
cial,
ac
ad
em
ic,
an
d
wo
r
k
life
.
I
n
ter
n
et
g
am
in
g
d
is
o
r
d
er
(
I
GD)
is
a
s
er
io
u
s
p
r
o
b
lem
with
b
o
th
m
en
tal
an
d
p
h
y
s
ical
co
n
s
eq
u
e
n
ce
s
.
I
t’
s
r
ec
o
g
n
ized
b
y
th
e
DSM
-
5
a
n
d
I
C
D
-
1
1
,
an
d
it’s
lin
k
ed
to
m
en
tal
h
ea
lth
is
s
u
es
li
k
e
an
x
iety
,
d
ep
r
ess
io
n
,
an
d
s
o
cial
is
o
latio
n
.
Peo
p
le
wh
o
p
lay
to
o
m
u
ch
o
f
ten
s
tr
u
g
g
le
to
c
o
p
e
with
r
ea
l
-
wo
r
ld
p
r
o
b
lem
s
.
Ph
y
s
ically
,
lo
n
g
g
am
in
g
s
ess
io
n
s
ca
n
ca
u
s
e
p
o
o
r
p
o
s
tu
r
e,
s
leep
p
r
o
b
lem
s
,
an
d
a
s
ed
en
tar
y
life
s
ty
le,
in
cr
ea
s
in
g
th
e
r
is
k
o
f
h
e
alth
is
s
u
es
lik
e
o
b
esit
y
[
8
]
.
I
n
s
ch
o
o
l
o
r
at
wo
r
k
,
p
eo
p
le
with
I
GD
d
ec
r
ea
s
e
t
h
eir
p
er
f
o
r
m
an
ce
d
r
o
p
b
ec
au
s
e
th
ey
p
r
io
r
itize
g
am
in
g
o
v
e
r
r
esp
o
n
s
ib
ilit
ies
[
9
]
.
So
cially
,
I
GD
ca
n
lead
to
w
ith
d
r
awa
l
f
r
o
m
in
-
p
e
r
s
o
n
in
t
er
ac
tio
n
s
,
h
ar
m
in
g
r
elatio
n
s
h
ip
s
,
an
d
lead
in
g
to
lo
n
el
in
ess
[
1
0
]
,
[
1
1
]
.
On
e
o
f
t
h
e
b
ig
g
est
ch
allen
g
es
in
d
ea
lin
g
with
I
GD
is
th
at
o
n
lin
e
g
a
m
es
ar
e
d
esig
n
ed
to
b
e
v
er
y
e
n
g
ag
in
g
,
m
ak
i
n
g
it
h
ar
d
f
o
r
p
lay
er
s
to
co
n
tr
o
l
th
eir
g
am
in
g
.
W
ith
ea
s
y
ac
ce
s
s
to
g
am
es
o
n
th
e
in
ter
n
et
an
d
m
o
b
ile
d
ev
ices,
th
e
r
is
k
o
f
a
d
d
icti
o
n
is
esp
ec
ial
ly
h
ig
h
a
m
o
n
g
teen
ag
er
s
.
Stu
d
ies h
av
e
s
h
o
wn
th
at
co
g
n
i
tiv
e
b
eh
av
io
r
al
th
er
a
p
y
(
CBT
)
ca
n
ef
f
ec
tiv
ely
r
ed
u
ce
g
am
in
g
tim
e
an
d
im
p
r
o
v
e
em
o
tio
n
al
r
eg
u
latio
n
b
y
f
o
s
ter
in
g
h
ea
lth
ier
co
p
in
g
m
ec
h
an
is
m
s
[
1
2
]
.
Par
en
t
p
s
y
ch
o
ed
u
ca
tio
n
p
r
o
g
r
a
m
s
h
av
e
also
d
em
o
n
s
t
r
ated
ef
f
icac
y
b
y
e
q
u
ip
p
in
g
ca
r
eg
iv
er
s
with
s
tr
ateg
ies
to
s
et
b
o
u
n
d
ar
ies
an
d
s
u
p
p
o
r
t
h
ea
lth
ier
g
am
in
g
h
ab
i
ts
[
1
3
]
.
Ad
d
itio
n
ally
,
m
in
d
f
u
l
n
ess
-
b
ased
in
ter
v
en
tio
n
s
h
av
e
g
ain
ed
tr
ac
tio
n
,
as
th
ey
en
h
an
ce
s
elf
-
awa
r
en
ess
an
d
r
ed
u
ce
co
m
p
u
ls
iv
e
g
am
in
g
ten
d
en
c
ies
[
1
4
]
.
Mu
ltimo
d
al
t
r
ea
tm
en
t
p
r
o
g
r
am
s
th
at
co
m
b
in
e
th
er
ap
y
,
p
s
y
ch
o
ed
u
ca
tio
n
,
an
d
life
s
ty
le
m
o
d
if
icatio
n
s
ar
e
in
cr
ea
s
in
g
ly
r
ec
o
m
m
en
d
ed
to
ad
d
r
ess
th
e
m
u
ltifa
ce
ted
n
at
u
r
e
o
f
I
G
D.
T
h
e
b
asic
p
s
y
ch
o
lo
g
ical
n
ee
d
th
eo
r
y
[
1
5
]
,
[
1
6
]
o
f
f
er
s
a
cr
u
cial
f
r
am
ewo
r
k
f
o
r
u
n
d
e
r
s
tan
d
in
g
I
GD
am
o
n
g
a
d
o
lescen
ts
,
p
o
s
itin
g
th
at
ex
ce
s
s
iv
e
g
am
in
g
m
a
y
s
er
v
e
as
a
m
alad
ap
tiv
e
s
tr
ateg
y
to
f
u
l
f
ill
th
e
p
s
y
ch
o
lo
g
ical
n
ee
d
s
o
f
au
to
n
o
m
y
,
r
elate
d
n
ess
,
an
d
co
m
p
eten
ce
.
W
h
en
ad
o
lescen
ts
f
ac
e
f
r
u
s
tr
atio
n
in
m
e
etin
g
th
ese
n
ee
d
s
in
r
ea
l lif
e,
s
u
ch
as th
r
o
u
g
h
p
o
o
r
r
elatio
n
s
h
i
p
s
o
r
ac
ad
em
ic
s
tr
u
g
g
les,
th
ey
m
a
y
tu
r
n
to
g
am
in
g
f
o
r
s
u
p
er
f
icial
s
atis
f
ac
tio
n
,
wh
ich
ca
n
ex
ac
er
b
ate
I
GD.
Par
en
tin
g
s
ty
les
also
p
lay
a
s
ig
n
if
ic
an
t
r
o
le
in
s
h
ap
in
g
I
GD
r
is
k
.
Au
th
o
r
itar
ian
p
ar
e
n
ts
,
th
r
o
u
g
h
r
i
g
id
co
n
tr
o
l,
m
ay
d
r
iv
e
ad
o
lescen
ts
to
g
am
in
g
as
a
f
o
r
m
o
f
r
eb
ellio
n
,
w
h
ile
p
er
m
is
s
iv
e
p
ar
en
ts
m
ay
f
ail
to
p
r
o
v
i
d
e
th
e
s
tr
u
ctu
r
e
n
ee
d
ed
to
p
r
ev
e
n
t
ex
ce
s
s
iv
e
g
am
in
g
[
1
7
]
,
[
1
8
]
.
Au
th
o
r
itativ
e
p
ar
en
tin
g
,
wh
ich
b
alan
ce
s
war
m
th
an
d
co
n
tr
o
l,
is
ass
o
ci
ated
with
h
ea
lth
ier
o
u
tco
m
es
an
d
r
e
d
u
ce
d
I
GD
r
is
k
b
y
s
u
p
p
o
r
tin
g
ad
o
lescen
ts
'
n
ee
d
s
in
r
ea
l
life
.
Oth
er
s
tu
d
ies
ec
h
o
th
is
,
h
ig
h
lig
h
tin
g
th
e
im
p
o
r
tan
ce
o
f
p
ar
e
n
tal
in
f
l
u
en
ce
an
d
p
s
y
c
h
o
lo
g
ical
n
ee
d
f
u
lf
illme
n
t.
A
n
o
th
er
s
tu
d
y
f
o
u
n
d
th
at
p
ar
en
tal
m
o
n
ito
r
in
g
p
r
o
m
o
tes
h
ea
lth
ier
o
n
lin
e
b
eh
av
io
r
s
,
wh
ile
em
p
h
asizin
g
t
h
e
r
o
le
o
f
f
am
ily
in
v
o
lv
em
e
n
t
in
p
r
ev
en
ti
n
g
g
a
m
in
g
ad
d
ictio
n
.
lin
k
ed
u
n
m
et
p
s
y
ch
o
lo
g
ical
n
ee
d
s
t
o
I
GD,
an
d
e
x
p
lo
r
e
d
h
o
w
au
to
n
o
m
y
-
s
u
p
p
o
r
tiv
e
p
a
r
en
tin
g
r
ed
u
ce
d
I
GD
s
y
m
p
to
m
s
.
Stu
d
ies
s
h
o
wed
th
at
ad
o
lesce
n
ts
with
s
u
p
p
o
r
tiv
e
f
am
ily
en
v
ir
o
n
m
e
n
ts
wer
e
less
lik
ely
to
d
e
v
elo
p
p
r
o
b
lem
atic
g
am
in
g
b
eh
av
io
r
s
[
1
9
]
,
[
2
0
]
.
B
asic
p
s
y
ch
o
lo
g
ical
n
ee
d
s
s
u
ch
as
a
u
to
n
o
m
y
,
co
m
p
eten
ce
,
an
d
r
elate
d
n
ess
ca
n
u
n
d
er
m
in
e
a
n
in
d
iv
id
u
al'
s
s
elf
-
co
n
tr
o
l,
wh
ich
in
tu
r
n
ex
ac
e
r
b
ates
p
r
o
b
l
em
atic
g
am
in
g
b
e
h
av
io
r
s
.
E
s
s
en
tially
,
wh
en
in
d
iv
id
u
als
ar
e
u
n
ab
le
to
m
ee
t
th
eir
f
u
n
d
am
en
tal
n
ee
d
s
in
d
aily
life
,
th
eir
ab
ilit
y
to
r
eg
u
late
em
o
tio
n
s
an
d
b
eh
av
io
r
s
wea
k
en
s
,
m
ak
in
g
th
em
m
o
r
e
s
u
s
ce
p
tib
le
to
ex
ce
s
s
iv
e
g
am
in
g
[
2
1
]
.
An
o
th
er
s
tu
d
y
f
u
r
th
er
ex
p
lo
r
es
th
e
r
o
le
o
f
p
s
y
c
h
o
lo
g
ical
n
e
ed
s
atis
f
ac
tio
n
in
I
GD
b
u
t
i
n
tr
o
d
u
ce
s
ad
d
itio
n
al
f
ac
to
r
s
:
r
esp
o
n
s
ib
ilit
y
a
n
d
m
ea
n
in
g
i
n
life
.
I
t
d
em
o
n
s
tr
at
es
th
at
th
ese
co
n
s
tr
u
cts
m
ed
ia
te
th
e
r
elatio
n
s
h
ip
b
etwe
en
u
n
m
et
p
s
y
ch
o
lo
g
ical
n
ee
d
s
an
d
o
n
lin
e
g
am
i
n
g
ad
d
i
ctio
n
.
Sp
ec
if
i
ca
lly
,
in
d
i
v
id
u
al
s
wh
o
h
av
e
a
s
en
s
e
o
f
r
esp
o
n
s
ib
ilit
y
an
d
p
u
r
p
o
s
e
in
life
ar
e
b
etter
a
b
le
to
co
p
e
with
f
r
u
s
tr
atio
n
s
r
elate
d
to
t
h
e
ir
u
n
m
et
n
ee
d
s
,
th
er
eb
y
r
e
d
u
ci
n
g
th
e
lik
elih
o
o
d
o
f
tu
r
n
in
g
t
o
g
am
in
g
as a
m
alad
a
p
tiv
e
s
tr
ateg
y
[
2
2
]
,
[
2
3
]
.
T
h
is
s
tu
d
y
aim
s
to
ex
am
in
e
h
o
w
d
if
f
er
en
t
p
ar
en
tin
g
s
ty
le
s
in
f
lu
en
ce
t
h
e
d
e
v
elo
p
m
e
n
t
o
f
I
GD
i
n
ad
o
lescen
ts
,
f
o
cu
s
in
g
o
n
th
e
m
ed
iatin
g
r
o
le
o
f
p
s
y
ch
o
l
o
g
ical
n
ee
d
s
.
I
t
also
s
ee
k
s
to
ex
p
lo
r
e
g
en
d
er
d
if
f
er
en
ce
s
in
p
s
y
c
h
o
lo
g
ical
n
ee
d
s
atis
f
ac
tio
n
an
d
I
GD
b
eh
av
io
r
s
,
alo
n
g
with
th
e
ass
o
cia
tio
n
b
etwe
en
g
am
e
g
en
r
es
an
d
ad
d
ictio
n
s
ev
er
ity
.
B
y
ad
d
r
ess
in
g
th
ese
d
im
en
s
io
n
s
,
th
is
r
esear
ch
h
o
p
es
to
p
r
o
v
id
e
ac
tio
n
ab
le
in
s
ig
h
ts
f
o
r
p
ar
en
ts
,
ed
u
ca
to
r
s
,
an
d
m
en
tal
h
ea
lth
p
r
o
f
ess
io
n
als
to
d
esig
n
tailo
r
ed
in
ter
v
en
t
io
n
s
f
o
r
p
r
ev
e
n
tin
g
an
d
m
an
a
g
in
g
I
GD
ef
f
ec
tiv
ely
.
2.
M
E
T
H
O
D
I
n
th
is
s
tu
d
y
,
ad
o
lescen
ts
ag
ed
1
6
-
1
9
y
ea
r
s
wer
e
r
ec
r
u
ited
f
r
o
m
d
iv
er
s
e
p
r
e
-
u
n
iv
e
r
s
ity
co
lleg
es
in
Ker
ala
to
en
s
u
r
e
a
r
e
p
r
esen
t
ativ
e
s
am
p
le.
Usi
n
g
a
s
tr
atif
ied
r
an
d
o
m
s
am
p
lin
g
m
eth
o
d
,
th
e
r
esear
ch
e
r
s
d
is
tr
ib
u
ted
th
e
I
GD
-
2
0
Scal
e
t
o
2
,
4
0
0
s
tu
d
en
ts
,
id
e
n
tif
y
in
g
t
h
o
s
e
with
s
co
r
es
ab
o
v
e
5
0
as
p
o
ten
tial
p
ar
ticip
an
ts
.
T
h
is
cu
to
f
f
en
s
u
r
ed
th
e
in
clu
s
io
n
o
f
in
d
iv
id
u
als
with
v
ar
y
in
g
d
eg
r
ee
s
o
f
I
GD,
ca
teg
o
r
ized
as
m
ild
(
5
0
-
5
9
)
,
m
o
d
er
ate
(
6
0
-
6
9
)
,
a
n
d
s
ev
e
r
e
(
7
0
+)
wh
ich
is
s
h
o
wn
in
T
ab
le
1
.
Af
t
er
o
b
tain
in
g
in
f
o
r
m
ed
co
n
s
en
t
f
r
o
m
p
ar
ticip
an
ts
a
n
d
th
eir
g
u
ar
d
ian
s
,
th
e
s
am
p
le
was
f
u
r
th
er
d
i
v
id
ed
b
y
g
e
n
d
er
.
Fro
m
ea
ch
s
tr
atu
m
o
f
m
ale
an
d
f
em
ale
s
tu
d
e
n
ts
,
a
s
im
p
le
r
an
d
o
m
s
elec
tio
n
p
r
o
ce
s
s
was
ap
p
lied
,
y
ield
in
g
1
5
0
m
ale
an
d
1
5
0
f
em
ale
ad
o
lescen
ts
,
r
esu
l
tin
g
i
n
a
b
alan
ce
d
to
tal
o
f
3
0
0
p
ar
ticip
an
ts
.
T
h
e
s
tu
d
y
estab
lis
h
ed
clea
r
in
clu
s
io
n
an
d
Evaluation Warning : The document was created with Spire.PDF for Python.
I
SS
N
:
2
2
5
2
-
8
8
0
6
I
n
t J Pu
b
lic
Hea
lth
Sci
,
Vo
l.
14
,
No
.
3
,
Sep
tem
b
er
20
25
:
1
5
2
4
-
15
31
1526
ex
clu
s
io
n
cr
iter
ia
to
m
ain
tain
s
am
p
le
co
n
s
is
ten
cy
.
T
h
e
in
clu
s
io
n
cr
iter
ia
r
eq
u
ir
ed
p
ar
ticip
a
n
ts
to
b
e
with
in
th
e
16
-
1
9
ag
e
r
a
n
g
e,
en
r
o
lled
in
p
r
e
-
u
n
iv
e
r
s
ity
co
lleg
es
o
r
co
m
m
u
n
ity
ce
n
ter
s
,
an
d
h
av
e
a
n
I
GD
s
co
r
e
ab
o
v
e
5
0
o
n
th
e
I
GD
-
20
s
ca
le,
en
s
u
r
in
g
o
n
ly
th
o
s
e
with
I
GD
s
y
m
p
to
m
s
p
ar
ticip
ated
.
E
x
clu
s
io
n
cr
iter
ia
elim
in
ated
ad
o
lescen
ts
with
p
r
ev
i
o
u
s
I
G
D
in
ter
v
en
tio
n
s
,
as
well
as
th
o
s
e
with
s
ev
er
e
p
s
y
ch
o
lo
g
ical
d
is
o
r
d
er
s
,
to
p
r
e
v
en
t
th
ese
f
ac
to
r
s
f
r
o
m
c
o
n
f
o
u
n
d
i
n
g
th
e
r
elatio
n
s
h
ip
b
etwe
en
p
ar
en
tin
g
s
ty
les
an
d
p
s
y
ch
o
lo
g
ic
al
n
ee
d
s
atis
f
ac
tio
n
.
T
h
is
cr
iter
ia
-
b
ased
ap
p
r
o
ac
h
allo
wed
f
o
r
a
f
o
cu
s
ed
ex
am
i
n
atio
n
o
f
I
GD
an
d
its
ass
o
ci
atio
n
s
.
T
h
e
s
tu
d
y
em
p
lo
y
ed
a
cr
o
s
s
-
s
ec
tio
n
al
co
r
r
elati
o
n
al
d
esig
n
with
m
ed
iatio
n
an
al
y
s
is
to
ex
p
lo
r
e
in
d
ir
ec
t
e
f
f
ec
ts
,
s
p
ec
if
ically
wh
eth
er
p
s
y
ch
o
lo
g
ical
n
ee
d
s
atis
f
ac
tio
n
ex
p
lain
s
(
o
r
m
ed
iates)
th
e
r
elatio
n
s
h
ip
b
etwe
en
d
if
f
er
en
t
p
ar
en
tin
g
s
ty
les an
d
I
GD,
as illu
s
tr
ated
in
Fig
u
r
e
1
.
T
h
e
s
tu
d
y
h
y
p
o
t
h
eses
h
av
e
b
e
en
id
en
tifie
d
as th
e
f
o
llo
win
g
:
-
H1
: Ps
y
ch
o
lo
g
ical
n
ee
d
s
ig
n
if
ican
tly
m
ed
iates th
e
r
elatio
n
s
h
ip
b
etwe
en
p
ar
e
n
tin
g
s
ty
le
an
d
I
GD.
-
H2
:
T
h
er
e
will
b
e
less
I
GD
in
au
th
o
r
itativ
e
p
ar
en
tin
g
c
o
m
p
ar
ed
to
o
th
e
r
two
p
a
r
en
tin
g
s
ty
le
am
o
n
g
ad
o
lescen
ts
.
-
H3
:
T
h
er
e
will
b
e
a
s
ig
n
i
f
ican
t
d
if
f
er
e
n
ce
in
I
GD
an
d
p
s
y
ch
o
lo
g
ical
n
ee
d
s
am
o
n
g
m
ale
an
d
f
e
m
ale
ad
o
lescen
ts
-
H4
: T
h
er
e
will b
e
a
s
ig
n
if
ica
n
t a
s
s
o
ciatio
n
b
etwe
en
g
am
e
g
e
n
r
e
an
d
I
GD.
T
h
e
b
asic
p
s
y
c
h
o
lo
g
ical
n
ee
d
s
atis
f
ac
tio
n
in
g
e
n
er
al
s
ca
le
(
B
PNS
G)
ass
es
s
es
h
o
w
well
in
d
iv
id
u
als
f
ee
l th
eir
p
s
y
ch
o
lo
g
ical
n
ee
d
s
f
o
r
au
to
n
o
m
y
,
c
o
m
p
eten
ce
,
a
n
d
r
elate
d
n
ess
ar
e
m
et.
I
t h
as 2
1
item
s
,
with
s
ev
e
n
item
s
f
o
r
ea
ch
d
o
m
ai
n
,
r
ated
o
n
a
7
-
p
o
in
t
L
ik
er
t
s
ca
le
f
r
o
m
1
(
n
o
t
tr
u
e
at
all)
to
7
(
v
e
r
y
t
r
u
e)
.
Hig
h
e
r
s
co
r
es
r
ef
lect
g
r
ea
te
r
s
atis
f
ac
tio
n
o
f
p
s
y
ch
o
lo
g
ical
n
ee
d
s
,
an
d
th
e
s
ca
le
s
h
o
ws
h
ig
h
r
eliab
ilit
y
with
C
r
o
n
b
ac
h
'
s
alp
h
a
ab
o
v
e
0
.
8
0
[
2
4
]
.
T
h
e
i
n
ter
n
et
g
am
in
g
d
is
o
r
d
er
2
0
T
est
(
I
G
D
-
2
0
)
is
a
2
0
-
item
s
ca
le
th
at
ev
alu
ates
s
ix
asp
ec
ts
o
f
g
am
in
g
a
d
d
ictio
n
b
ased
o
n
DSM
-
5
cr
iter
ia.
Pa
r
ticip
an
ts
r
ate
item
s
lik
e
"I
o
f
ten
lo
s
e
s
le
ep
b
ec
au
s
e
o
f
lo
n
g
g
am
in
g
s
ess
io
n
s
"
o
n
a
5
-
p
o
in
t
s
ca
le
f
r
o
m
1
(
s
tr
o
n
g
ly
ag
r
ee
)
to
5
(
s
tr
o
n
g
l
y
d
is
ag
r
ee
)
.
A
s
co
r
e
o
f
7
1
o
r
m
o
r
e
in
d
icate
s
a
p
o
ten
tial I
GD
d
iag
n
o
s
is
.
T
h
e
I
GD
-
2
0
h
as st
r
o
n
g
v
alid
ity
an
d
r
eliab
ilit
y
w
ith
a
C
r
o
n
b
ac
h
'
s
alp
h
a
o
f
0
.
8
8
[
2
5
]
.
T
h
e
p
a
r
en
tal
au
th
o
r
ity
q
u
esti
o
n
n
air
e
(
PAQ)
m
ea
s
u
r
es
p
ar
en
tin
g
s
ty
les
(
au
th
o
r
it
ar
ian
,
au
th
o
r
itativ
e,
p
er
m
is
s
iv
e)
u
s
in
g
3
0
item
s
.
E
ac
h
s
u
b
s
ca
le
h
as
a
s
co
r
e
r
an
g
e
o
f
1
0
to
3
0
,
with
to
tal
s
co
r
es
r
an
g
in
g
f
r
o
m
3
0
to
9
0
.
T
h
e
P
AQ
is
r
eliab
le
(
C
r
o
n
b
ac
h
'
s
alp
h
a
b
etwe
en
0
.
7
4
an
d
0
.
8
7
)
an
d
p
r
o
v
id
es
in
s
ig
h
ts
in
to
p
ar
en
tin
g
f
r
o
m
th
e
ch
ild
’
s
p
er
s
p
ec
tiv
e
[
2
6
]
.
T
ab
le
1
.
Sam
p
le
d
is
tr
ib
u
tio
n
b
ased
o
n
in
ten
s
ity
o
f
ad
d
ictio
n
I
G
D
S
e
v
e
r
i
t
y
M
a
l
e
(
n
=
1
5
0
)
M
a
l
e
p
e
r
c
e
n
t
a
g
e
(
%)
F
e
mal
e
(
n
=
1
5
0
)
F
e
mal
e
p
e
r
c
e
n
t
a
g
e
(
%)
T
o
t
a
l
(
n
=
3
0
0
)
T
o
t
a
l
p
e
r
c
e
n
t
a
g
e
(
%)
M
i
l
d
20
1
3
.
3
3
%
80
5
3
.
3
3
%
1
0
0
3
3
.
3
3
%
M
o
d
e
r
a
t
e
65
4
3
.
3
3
%
40
2
6
.
6
7
%
1
0
5
3
5
.
0
0
%
S
e
v
e
r
e
65
4
3
.
3
3
%
30
2
0
.
0
0
%
95
3
1
.
6
7
%
T
o
t
a
l
1
5
0
1
0
0
%
1
5
0
1
0
0
%
3
0
0
1
0
0
%
Fig
u
r
e
1
.
C
o
n
ce
p
tu
al
f
r
a
m
ewo
r
k
Evaluation Warning : The document was created with Spire.PDF for Python.
I
n
t J Pu
b
lic
Hea
lth
Sci
I
SS
N:
2252
-
8
8
0
6
P
a
r
en
tin
g
s
tyles,
p
s
yc
h
o
lo
g
ica
l n
ee
d
a
n
d
g
a
me
g
en
r
e
in
i
n
tern
et
g
a
min
g
d
is
o
r
d
er
(
S
h
imil P
.
V
.
)
1527
3.
RE
SU
L
T
S
AND
D
I
SCU
SS
I
O
N
T
h
e
m
ed
iatio
n
T
ab
le
2
r
ev
e
als
th
at
p
s
y
ch
o
lo
g
ical
n
ee
d
s
atis
f
ac
tio
n
s
ig
n
if
ican
tly
m
ed
iates
th
e
r
elatio
n
s
h
ip
b
etwe
en
p
ar
en
tin
g
s
ty
les
an
d
I
GD
th
at
au
th
o
r
itativ
e
p
ar
en
tin
g
is
ass
o
ciate
d
with
a
r
ed
u
ctio
n
in
I
GD
th
r
o
u
g
h
th
is
m
e
d
iatio
n
,
with
a
s
ig
n
if
ican
t
n
eg
ativ
e
ef
f
ec
t
(
β
=
-
2
.
7
,
p
=
0
.
0
4
)
.
T
h
is
s
u
g
g
ests
th
at
f
u
lf
illi
n
g
p
s
y
ch
o
l
o
g
ical
n
ee
d
s
is
an
im
p
o
r
tan
t
p
ath
way
th
r
o
u
g
h
wh
ich
au
th
o
r
itativ
e
p
ar
en
tin
g
r
ed
u
ce
s
I
GD.
C
o
n
v
er
s
ely
,
au
th
o
r
itar
ian
p
a
r
en
tin
g
is
lin
k
ed
to
an
in
c
r
ea
s
e
in
I
GD,
with
a
s
ig
n
if
ican
t
p
o
s
itiv
e
m
ed
iatio
n
ef
f
ec
t
(
β
=
2
.
1
,
p
=
0
.
0
1
9
)
,
in
d
icatin
g
th
at
u
n
m
et
p
s
y
c
h
o
l
o
g
ical
n
ee
d
s
m
ay
e
x
p
lain
th
e
h
ar
m
f
u
l
im
p
ac
t
o
f
au
th
o
r
itar
ian
p
a
r
en
tin
g
o
n
I
G
D.
Ho
wev
er
,
n
o
s
ig
n
if
ican
t
m
ed
iatio
n
ef
f
ec
t
was
f
o
u
n
d
f
o
r
p
er
m
is
s
iv
e
p
ar
en
tin
g
(
β
=
1
,
p
=
0
.
5
0
8
)
,
s
u
g
g
esti
n
g
th
at
p
s
y
ch
o
lo
g
ical
n
ee
d
s
atis
f
ac
tio
n
d
o
es
n
o
t
p
lay
a
m
ea
n
in
g
f
u
l
r
o
le
in
th
e
r
elatio
n
s
h
ip
b
etwe
en
p
e
r
m
is
s
iv
e
p
ar
en
tin
g
an
d
I
GD.
Ov
e
r
all,
th
ese
r
esu
lts
u
n
d
er
s
co
r
e
th
e
im
p
o
r
tan
ce
o
f
p
s
y
ch
o
lo
g
ical
n
ee
d
s
atis
f
ac
tio
n
in
u
n
d
er
s
tan
d
in
g
h
o
w
d
if
f
e
r
en
t
p
ar
e
n
tin
g
s
ty
les
in
f
lu
en
c
e
I
GD,
p
ar
ticu
lar
l
y
f
o
r
au
th
o
r
itativ
e
an
d
au
th
o
r
i
tar
ian
p
ar
en
tin
g
s
ty
les.
H1
:
Ps
y
ch
o
lo
g
ical
n
ee
d
s
ig
n
if
ican
tly
m
ed
iates
th
e
r
elatio
n
s
h
ip
b
etwe
en
p
ar
en
tin
g
s
ty
le
an
d
I
GD
ac
ce
p
ted
.
T
ab
le
3
p
r
esen
ts
th
e
r
e
s
u
lts
o
f
a
o
n
e
-
way
ANOV
A
ex
am
in
in
g
d
if
f
e
r
en
ce
s
in
I
GD
s
co
r
es
am
o
n
g
ad
o
lescen
ts
b
ased
o
n
th
eir
p
ar
en
tin
g
s
ty
les.
T
h
e
a
n
aly
s
is
r
ev
ea
ls
a
s
ig
n
if
ican
t
ef
f
ec
t
o
f
p
ar
en
tin
g
s
ty
le
o
n
I
GD
s
co
r
es
(
F
=
1
3
,
p
<
0
.
0
0
1
)
.
Ad
o
lescen
ts
r
aised
with
an
au
th
o
r
i
tar
ian
p
ar
en
tin
g
s
ty
le
h
ad
t
h
e
h
ig
h
est
m
ea
n
I
GD
s
co
r
e
(
M
=
7
7
,
SD
=
1
3
.
8
)
,
f
o
llo
wed
b
y
th
o
s
e
with
p
er
m
is
s
iv
e
p
ar
en
ts
(
M
=
6
9
.
5
,
SD
=
2
3
.
6
)
.
Ad
o
lescen
ts
with
au
th
o
r
itativ
e
p
ar
en
ts
h
a
d
th
e
lo
west m
ea
n
I
GD
s
co
r
e
(
M
=
5
5
,
SD =
1
9
.
5
)
.
H2
: T
h
er
e
will b
e
less
I
GD
in
au
th
o
r
itativ
e
p
a
r
en
tin
g
c
o
m
p
a
r
ed
to
o
t
h
er
two
p
ar
en
tin
g
s
ty
le
am
o
n
g
ad
o
lescen
ts
.
T
ab
le
4
h
ig
h
lig
h
ts
s
ig
n
if
ica
n
t
g
en
d
er
d
if
f
er
e
n
ce
s
ac
r
o
s
s
a
ll
s
tu
d
y
v
ar
iab
les,
i
n
clu
d
in
g
I
GD
an
d
p
s
y
ch
o
lo
g
ical
n
ee
d
s
atis
f
ac
tio
n
.
m
al
es
s
co
r
e
d
s
ig
n
if
ican
tly
h
ig
h
er
o
n
I
GD
(
M
=
7
1
.
3
,
S
D
=
2
1
.
7
)
co
m
p
a
r
ed
to
f
em
ales
(
M
=
6
0
.
8
,
SD
=
1
9
.
7
)
,
with
a
t
-
v
alu
e
o
f
2
.
2
6
an
d
p
=
0
.
0
2
7
,
in
d
icatin
g
th
at
m
ales
ar
e
m
o
r
e
p
r
o
n
e
to
I
GD
th
an
f
em
ales.
Ps
y
ch
o
lo
g
ical
n
ee
d
s
atis
f
ac
tio
n
wa
s
also
s
ig
n
if
ican
tly
h
ig
h
er
in
m
ales
(
M
=
6
2
.
8
,
SD
=
1
8
.
3
)
th
an
in
f
em
ales
(
M
=
5
5
.
4
,
SD
=
1
6
.
5
)
,
with
a
t
-
v
alu
e
o
f
2
.
1
an
d
p
=
0
.
0
3
8
,
s
u
g
g
esti
n
g
m
ales
r
ep
o
r
t
g
r
ea
ter
p
s
y
ch
o
l
o
g
ical
n
ee
d
s
atis
f
ac
tio
n
.
H
3
:
T
h
e
r
e
will
b
e
a
s
ig
n
if
ica
n
t
d
if
f
e
r
en
ce
in
I
GD
an
d
p
s
y
ch
o
lo
g
ical
n
ee
d
s
am
o
n
g
m
ale
an
d
f
em
ale
a
d
o
lescen
ts
.
T
ab
le
5
p
r
esen
ts
th
e
ass
o
ciatio
n
b
etwe
en
g
am
e
g
e
n
r
e
an
d
t
h
e
lev
el
o
f
ad
d
ictio
n
,
ca
teg
o
r
ize
d
as
m
ild
,
m
o
d
er
ate,
a
n
d
s
ev
er
e.
T
h
e
χ²
v
alu
e
o
f
2
8
.
1
with
a
p
-
v
alu
e
o
f
less
th
an
0
.
0
0
1
in
d
i
ca
tes
a
s
ig
n
if
ican
t
r
elatio
n
s
h
ip
b
etwe
en
th
e
g
a
m
e
g
en
r
e
an
d
th
e
s
ev
er
ity
o
f
a
d
d
ictio
n
.
No
tab
l
y
,
b
attle
r
o
y
a
le
g
am
es
s
h
o
w
th
e
h
ig
h
est
p
r
o
p
o
r
tio
n
o
f
s
ev
er
e
ad
d
ictio
n
(
6
5
%
)
,
wh
er
ea
s
g
en
r
es
lik
e
r
ac
in
g
an
d
p
u
zz
le
ar
e
m
o
r
e
co
m
m
o
n
am
o
n
g
m
ild
a
n
d
m
o
d
er
ate
lev
els.
Pu
zz
le
g
am
es
ar
e
p
r
ed
o
m
in
an
t
in
t
h
e
m
ild
ca
teg
o
r
y
(
4
4
%).
T
h
is
s
u
g
g
ests
th
at
ce
r
tain
g
en
r
es,
esp
ec
ially
b
attle
r
o
y
ale
g
am
es
,
ar
e
ass
o
ciate
d
with
a
h
ig
h
e
r
r
is
k
o
f
s
e
v
er
e
ad
d
ictio
n
.
H4
:
T
h
er
e
will b
e
a
s
ig
n
if
ican
t a
s
s
o
ciatio
n
b
etwe
en
g
am
e
g
e
n
r
e
an
d
I
GD.
Fig
u
r
e
2
s
h
o
ws
th
at
b
attle
r
o
y
ale
g
am
es
ar
e
s
tr
o
n
g
ly
lin
k
e
d
to
s
ev
er
e
I
GD,
with
th
e
h
ig
h
es
t
s
co
r
es
in
th
is
ca
teg
o
r
y
.
Mo
d
er
ate
I
GD
also
h
as
h
ig
h
s
co
r
es
f
o
r
th
is
g
en
r
e,
wh
ile
m
ild
I
GD
is
lo
wer
.
Pu
zz
le
g
am
es
ar
e
m
o
r
e
p
o
p
u
lar
with
p
lay
e
r
s
in
th
e
m
ild
I
GD
ca
teg
o
r
y
.
I
n
c
o
n
tr
ast,
r
ac
in
g
,
s
p
o
r
ts
,
a
n
d
s
h
o
o
ter
g
am
es
h
av
e
lo
wer
I
GD
s
co
r
es
ac
r
o
s
s
all
l
ev
els,
s
h
o
win
g
a
wea
k
e
r
c
o
n
n
ec
tio
n
to
g
a
m
in
g
d
is
o
r
d
e
r
.
Ov
er
all,
b
attle
r
o
y
ale
g
am
es h
a
v
e
th
e
s
tr
o
n
g
est lin
k
to
s
ev
er
e
I
GD;
wh
ile
r
ac
in
g
a
n
d
s
p
o
r
ts
g
am
es h
a
v
e
th
e
least
.
T
ab
le
2
.
R
eg
r
ess
io
n
an
aly
s
is
f
o
r
m
ed
iatio
n
o
f
p
s
y
ch
o
lo
g
ical
n
ee
d
s
atis
f
ac
tio
n
b
etwe
en
p
ar
en
tin
g
s
ty
le
a
n
d
I
GD
M
e
d
i
a
t
i
o
n
Β
SE
C
I
l
o
w
e
r
C
I
u
p
p
e
r
z
-
v
a
l
u
e
p
-
v
a
l
u
e
A
u
t
h
o
r
i
t
a
t
i
v
e
→
I
G
D
(
w
i
t
h
me
d
i
a
t
i
o
n
)
-
2
.
7
1
.
3
0
.
1
6
5
.
2
4
2
.
0
8
0
.
0
4
A
u
t
h
o
r
i
t
a
r
i
a
n
→
I
G
D
(
w
i
t
h
m
e
d
i
a
t
i
o
n
)
2
.
1
1
.
2
5
0
.
3
5
4
.
5
5
1
.
6
8
0
.
0
1
9
P
e
r
mi
ssi
v
e
→
I
G
D
(
w
i
t
h
me
d
i
a
t
i
o
n
)
1
1
.
5
2
1
.
9
9
4
0
.
6
6
0
.
5
0
8
T
ab
le
3
.
On
e
-
way
an
aly
s
is
o
f
v
ar
ian
ce
o
f
I
GD
s
co
r
e
in
a
d
o
l
escen
ts
b
y
p
ar
en
tin
g
s
ty
les
V
a
r
i
a
b
l
e
P
a
r
e
n
t
i
n
g
s
t
y
l
e
N
M
e
a
n
SD
SE
F
p
IGD
P
e
r
mi
ssi
v
e
1
2
0
6
9
.
5
2
3
.
6
5
.
2
7
A
u
t
h
o
r
i
t
a
t
i
v
e
95
55
1
9
.
5
3
.
2
9
13
<
.
0
0
1
A
u
t
h
o
r
i
t
a
r
i
a
n
85
77
1
3
.
8
2
.
7
6
T
ab
le
4
.
Gen
d
er
d
if
f
er
en
ce
s
in
I
GD
an
d
p
s
y
c
h
o
lo
g
ical
n
ee
d
V
a
r
i
a
b
l
e
G
r
o
u
p
N
M
e
a
n
SD
SE
t
-
v
a
l
u
e
p
IGD
F
e
mal
e
1
5
0
6
0
.
8
1
9
.
7
2
.
9
8
2
.
2
6
0
.
0
2
7
M
a
l
e
1
5
0
7
1
.
3
2
1
.
7
3
.
6
2
P
sy
c
h
o
l
o
g
i
c
a
l
n
e
e
d
F
e
mal
e
1
5
0
5
5
.
4
1
6
.
5
2
.
3
4
2
.
1
0
.
0
3
8
M
a
l
e
1
5
0
6
2
.
8
1
8
.
3
2
.
8
8
Evaluation Warning : The document was created with Spire.PDF for Python.
I
SS
N
:
2
2
5
2
-
8
8
0
6
I
n
t J Pu
b
lic
Hea
lth
Sci
,
Vo
l.
14
,
No
.
3
,
Sep
tem
b
er
20
25
:
1
5
2
4
-
15
31
1528
T
ab
le
5
.
Ass
o
ciatio
n
b
etwe
en
g
am
e
g
en
r
e
an
d
lev
el
o
f
ad
d
ic
tio
n
G
a
me
g
e
n
r
e
M
i
l
d
(
n
=
1
0
0
)
M
o
d
e
r
a
t
e
(
n
=
1
0
0
)
S
e
v
e
r
e
(
n
=
1
0
0
)
χ²
p
R
a
c
i
n
g
10
20
3
P
u
z
z
l
e
44
30
8
B
a
t
t
l
e
r
o
y
a
l
e
g
a
me
s
12
33
65
2
8
.
1
<
.
0
0
1
S
p
o
r
t
s
16
9
8
S
h
o
o
t
e
r
18
13
11
T
o
t
a
l
1
0
0
1
0
5
95
Fig
u
r
e
2
.
Ass
o
ciatio
n
b
etwe
en
g
am
e
g
e
n
r
e
an
d
I
GD
3
.
1
.
Dis
cus
s
io
n
T
h
e
r
esu
lts
s
h
o
w
th
at
au
th
o
r
itativ
e
p
ar
en
tin
g
is
n
eg
ativ
ely
ass
o
ciate
d
with
I
GD
th
r
o
u
g
h
th
e
m
ed
iatio
n
o
f
p
s
y
ch
o
lo
g
ical
n
ee
d
s
atis
f
ac
tio
n
.
T
h
is
alig
n
s
with
s
elf
-
d
eter
m
in
atio
n
th
eo
r
y
(
SDT)
b
y
wh
ich
em
p
h
asizes
th
e
im
p
o
r
tan
ce
o
f
s
atis
f
y
in
g
p
s
y
ch
o
lo
g
ical
n
e
ed
s
au
to
n
o
m
y
,
co
m
p
eten
ce
,
an
d
r
elate
d
n
ess
f
o
r
h
ea
lth
y
p
s
y
ch
o
lo
g
ical
f
u
n
ctio
n
in
g
.
Au
th
o
r
itativ
e
p
ar
e
n
tin
g
,
ch
ar
ac
ter
ize
d
b
y
war
m
th
,
s
tr
u
ctu
r
e,
an
d
s
u
p
p
o
r
t
f
o
r
au
to
n
o
m
y
,
is
k
n
o
wn
to
p
r
o
m
o
te
th
ese
n
ee
d
s
,
wh
ich
in
t
u
r
n
m
ay
p
r
o
tect
ag
ain
s
t m
alad
ap
tiv
e
b
eh
av
io
r
s
lik
e
I
GD.
T
h
is
f
in
d
in
g
is
co
n
s
is
ten
t
with
r
esear
ch
b
y
Z
h
u
an
d
C
h
en
[
2
7
]
wh
ich
f
o
u
n
d
th
at
c
h
ild
r
en
r
aised
with
au
th
o
r
itativ
e
p
a
r
en
tin
g
s
ty
les
ten
d
to
e
x
h
ib
it
lo
wer
le
v
els
o
f
p
r
o
b
lem
atic
in
ter
n
et
u
s
e
d
u
e
t
o
b
etter
em
o
tio
n
al
r
eg
u
latio
n
a
n
d
s
elf
-
co
n
tr
o
l.
C
o
n
v
er
s
e
ly
,
th
e
s
tu
d
y
f
o
u
n
d
t
h
at
au
th
o
r
itar
ian
p
a
r
en
tin
g
is
p
o
s
itiv
ely
ass
o
ciate
d
with
I
G
D
th
r
o
u
g
h
th
e
m
ed
iatio
n
o
f
p
s
y
ch
o
lo
g
ica
l
n
ee
d
s
atis
f
ac
tio
n
.
Au
th
o
r
itar
ian
p
ar
e
n
tin
g
,
m
ar
k
ed
b
y
h
ig
h
d
em
an
d
s
an
d
lo
w
r
esp
o
n
s
iv
en
ess
,
lik
ely
h
am
p
er
s
th
e
f
u
lf
illme
n
t
o
f
b
asic
p
s
y
c
h
o
lo
g
ical
n
ee
d
s
,
as p
o
s
ited
b
y
SDT.
T
h
is
ca
n
lead
to
co
m
p
e
n
s
ato
r
y
b
eh
a
v
io
r
s
li
k
e
ex
ce
s
s
iv
e
g
am
i
n
g
,
wh
er
e
a
d
o
lescen
ts
m
ig
h
t
s
ee
k
au
to
n
o
m
y
,
co
m
p
eten
ce
,
o
r
s
o
cial
co
n
n
ec
tio
n
in
v
ir
t
u
al
en
v
ir
o
n
m
en
ts
to
co
m
p
en
s
ate
f
o
r
th
e
lack
o
f
n
ee
d
f
u
lf
illme
n
t
in
r
ea
l
life
.
Su
p
p
o
r
tin
g
th
is
,
s
tu
d
ies
b
y
[
2
8
]
,
[
2
9
]
h
av
e
s
h
o
wn
th
at
h
a
r
s
h
an
d
co
n
tr
o
llin
g
p
ar
e
n
tin
g
s
ty
les
ar
e
ass
o
ciate
d
with
h
ig
h
er
lev
els
o
f
in
ter
n
e
t
ad
d
ictio
n
an
d
o
th
er
p
r
o
b
le
m
atic
b
eh
av
io
r
s
d
u
e
to
in
cr
e
ased
p
s
y
ch
o
lo
g
ical
d
is
tr
ess
an
d
r
ed
u
ce
d
s
elf
-
e
f
f
ic
ac
y
.
I
n
ter
esti
n
g
ly
,
p
er
m
is
s
iv
e
p
a
r
en
tin
g
d
id
n
o
t
s
h
o
w
a
s
ig
n
if
ican
t
m
ed
iatio
n
ef
f
ec
t
th
r
o
u
g
h
p
s
y
ch
o
lo
g
ical
n
ee
d
s
atis
f
ac
tio
n
o
n
I
GD.
T
h
is
m
ay
i
n
d
icate
t
h
at
p
er
m
is
s
iv
e
p
ar
e
n
tin
g
,
ch
ar
ac
ter
ized
b
y
a
lack
o
f
s
tr
u
ctu
r
e
an
d
co
n
tr
o
l,
n
e
ith
er
s
tr
o
n
g
ly
s
u
p
p
o
r
ts
n
o
r
h
in
d
er
s
th
e
f
u
lf
illme
n
t
o
f
p
s
y
ch
o
lo
g
ical
n
ee
d
s
(
au
to
n
o
m
y
,
r
elate
d
n
ess
,
an
d
c
o
m
p
eten
cy
)
in
a
way
th
at
d
ir
ec
tly
in
f
lu
en
ce
s
I
GD.
T
h
is
r
e
s
u
lt
co
n
tr
asts
with
s
o
m
e
s
tu
d
ies,
s
u
ch
as
th
o
s
e
b
y
[
3
0
]
,
[
3
1
]
wh
ich
s
u
g
g
ested
th
at
p
er
m
is
s
iv
e
p
ar
en
tin
g
co
u
ld
lead
to
g
r
ea
ter
in
ter
n
et
ad
d
ictio
n
d
u
e
to
a
lac
k
o
f
b
o
u
n
d
ar
ies.
T
h
er
e
is
a
s
tr
o
n
g
ass
o
ciatio
n
b
etwe
en
I
GD
an
d
s
p
ec
if
ic
g
am
e
g
en
r
es,
p
a
r
ticu
lar
ly
b
at
tle
r
o
y
ale
g
am
es
wh
ich
ar
e
m
u
ltip
lay
er
o
n
lin
e
g
am
es.
C
o
n
n
ec
tin
g
w
ith
o
th
er
a
d
d
icts
in
th
ese
g
a
m
es
m
ay
ex
ac
er
b
ate
p
r
o
b
lem
.
T
h
is
o
b
s
er
v
atio
n
al
ig
n
s
with
p
r
ev
io
u
s
r
esear
ch
,
r
ein
f
o
r
cin
g
th
e
id
ea
th
at
th
ese
g
en
r
es
p
o
s
s
ess
s
p
ec
if
ic
ch
ar
ac
ter
is
tics
th
at
m
ak
e
th
em
m
o
r
e
p
r
o
n
e
to
tr
ig
g
er
in
g
a
d
d
ictiv
e
b
e
h
av
io
r
s
[
3
2
]
,
[
3
3
]
.
T
h
e
f
ea
t
u
r
es
o
f
b
attle
r
o
y
ale
g
am
es
id
en
ti
f
ied
as
co
n
tr
ib
u
tin
g
to
a
d
d
ict
io
n
ar
e
d
iv
er
s
e.
T
h
e
im
m
e
r
s
iv
e
v
ir
tu
al
wo
r
ld
s
,
co
m
p
ellin
g
n
ar
r
ativ
es,
an
d
e
x
ten
s
iv
e
s
o
cial
in
ter
ac
tio
n
s
cr
ea
te
a
s
en
s
e
o
f
b
elo
n
g
in
g
an
d
en
g
a
g
em
en
t,
p
o
ten
tially
lead
in
g
to
p
r
o
lo
n
g
ed
p
lay
.
Ad
d
itio
n
ally
,
r
ewa
r
d
s
y
s
tem
s
,
co
m
p
etitiv
e
elem
en
ts
,
an
d
co
n
tin
u
o
u
s
u
p
d
ates
ac
t
as
in
ce
n
tiv
es,
tr
ig
g
er
in
g
p
leasu
r
e
ce
n
ter
s
.
T
h
at
way
,
u
n
m
et
p
s
y
ch
o
lo
g
ical
n
ee
d
s
au
to
n
o
m
y
,
r
elate
d
n
ess
,
co
m
p
eten
cy
s
atis
f
y
th
r
o
u
g
h
t
h
is
v
ir
tu
al
wo
r
ld
,
a
n
d
th
ey
b
ec
o
m
e
ad
d
icted
t
o
th
is
.
T
h
e
f
in
d
i
n
g
th
at
m
ales
ex
h
ib
it
h
ig
h
er
le
v
els
o
f
I
GD
co
m
p
ar
ed
to
f
em
ales
alig
n
s
with
p
r
ev
io
u
s
r
esear
ch
s
u
g
g
esti
n
g
th
at
m
al
es
ar
e
m
o
r
e
s
u
s
ce
p
tib
le
to
g
am
in
g
d
is
o
r
d
er
s
[
3
4
]
-
[
3
6
]
.
T
h
is
co
u
ld
b
e
d
u
e
to
Evaluation Warning : The document was created with Spire.PDF for Python.
I
n
t J Pu
b
lic
Hea
lth
Sci
I
SS
N:
2252
-
8
8
0
6
P
a
r
en
tin
g
s
tyles,
p
s
yc
h
o
lo
g
ica
l n
ee
d
a
n
d
g
a
me
g
en
r
e
in
i
n
tern
et
g
a
min
g
d
is
o
r
d
er
(
S
h
imil P
.
V
.
)
1529
g
en
d
er
d
if
f
er
en
ce
s
i
n
g
a
m
in
g
p
r
ef
e
r
en
ce
s
a
n
d
s
o
cializa
tio
n
p
r
ac
tices,
with
m
ales
m
o
r
e
l
ik
ely
to
en
g
a
g
e
i
n
ex
ce
s
s
iv
e
g
am
in
g
as
a
f
o
r
m
o
f
s
o
cial
in
ter
ac
tio
n
o
r
s
tr
ess
r
elief
.
Ma
les
r
ep
o
r
t
g
r
ea
ter
p
s
y
ch
o
lo
g
ical
n
ee
d
s
atis
f
ac
tio
n
.
B
at
t
l
e
r
o
y
a
le
g
a
m
e
s
o
f
t
e
n
f
u
l
f
il
l
i
n
t
r
i
n
s
ic
n
e
e
d
s
l
ik
e
a
u
t
o
n
o
m
y
,
c
o
m
p
e
t
e
n
c
e
,
a
n
d
m
u
l
t
i
p
l
a
y
e
r
g
a
m
es
c
r
e
a
t
e
a
s
e
n
s
e
o
f
c
o
m
m
u
n
i
t
y
,
en
a
b
l
i
n
g
m
a
l
e
s
t
o
f
o
r
m
s
o
c
ia
l
b
o
n
d
s
a
n
d
e
n
h
a
n
c
e
r
e
l
a
t
e
d
n
es
s
.
T
h
e
s
e
f
a
c
t
o
r
s
,
a
l
o
n
g
w
i
t
h
g
e
n
d
e
r
-
s
p
e
ci
f
i
c
d
i
f
f
e
r
e
n
c
es
i
n
d
e
r
i
v
i
n
g
s
a
t
is
f
a
c
ti
o
n
,
m
a
k
e
g
a
m
i
n
g
p
a
r
t
i
c
u
l
a
r
l
y
f
u
l
f
il
l
i
n
g
f
o
r
m
a
l
e
s
.
4.
CO
NCLU
SI
O
N
T
h
is
s
tu
d
y
h
ig
h
lig
h
ts
th
e
co
m
p
lex
r
elatio
n
s
h
ip
b
etwe
en
p
ar
en
tin
g
s
ty
les
an
d
I
GD,
m
ed
iated
b
y
p
s
y
ch
o
lo
g
ical
n
ee
d
s
atis
f
ac
tio
n
.
Au
t
h
o
r
itativ
e
p
ar
e
n
tin
g
,
wh
ich
f
o
s
ter
s
a
u
to
n
o
m
y
,
co
m
p
eten
ce
,
an
d
r
elate
d
n
ess
,
s
er
v
es
as
a
p
r
o
tectiv
e
f
ac
to
r
ag
ain
s
t
I
GD
b
y
p
r
o
v
id
in
g
ad
o
lescen
ts
with
th
e
o
p
p
o
r
t
u
n
ity
to
ex
p
er
ien
ce
th
ese
n
ee
d
s
in
th
e
r
e
al
wo
r
ld
.
W
h
en
th
ese
n
ee
d
s
ar
e
u
n
m
et,
m
ain
ly
m
ale
a
d
o
l
escen
ts
m
ay
tu
r
n
to
th
e
v
ir
tu
al
wo
r
ld
,
p
ar
ticu
lar
l
y
th
r
o
u
g
h
h
ig
h
ly
im
m
e
r
s
iv
e
an
d
ad
d
ictiv
e
g
am
es
lik
e
b
attle
r
o
y
ale
,
wh
ich
ar
e
d
esig
n
ed
to
s
atis
f
y
au
to
n
o
m
y
,
r
elate
d
n
ess
,
an
d
co
m
p
eten
ce
.
So
,
we
ca
n
g
et
a
n
in
s
ig
h
t
th
a
t
wh
ile
m
ak
in
g
th
e
th
er
ap
y
it
is
im
p
o
r
tan
t
to
c
o
n
s
id
er
th
eir
p
a
r
en
tin
g
a
n
d
e
n
v
ir
o
n
m
e
n
t
is
p
r
o
v
i
d
e
o
p
p
o
r
t
u
n
ity
to
m
ee
t
th
eir
p
s
y
ch
o
lo
g
ical
n
ee
d
in
r
ea
l lif
e
wh
ich
ca
n
b
e
th
e
o
n
e
o
f
th
e
m
ain
f
ac
to
r
s
lead
s
to
I
GD.
Ho
wev
er
,
th
e
s
tu
d
y
h
as
ce
r
tai
n
l
im
itatio
n
s
.
First,
it
s
cr
o
s
s
-
s
ec
tio
n
al
d
esig
n
lim
its
th
e
ab
ili
ty
to
m
ak
e
ca
u
s
al
in
f
er
en
ce
s
a
b
o
u
t
th
e
r
elatio
n
s
h
ip
b
etwe
en
p
ar
e
n
tin
g
s
ty
les,
p
s
y
c
h
o
lo
g
ical
n
ee
d
s
,
a
n
d
I
GD.
L
o
n
g
itu
d
i
n
al
s
tu
d
ies
wo
u
ld
p
r
o
v
id
e
a
clea
r
er
u
n
d
e
r
s
tan
d
in
g
o
f
h
o
w
p
ar
e
n
tin
g
a
n
d
n
ee
d
s
atis
f
ac
tio
n
in
f
lu
en
ce
I
GD
d
ev
elo
p
m
en
t
o
v
er
tim
e.
Fu
r
th
er
s
tu
d
ies
s
h
o
u
ld
in
v
esti
g
ate
th
e
s
ig
n
if
ican
t
d
if
f
er
en
ce
s
in
p
ar
en
tin
g
s
ty
les
f
o
r
m
ale
an
d
f
em
ale
a
d
o
lescen
ts
to
u
n
d
er
s
tan
d
wh
y
m
ales
ex
h
ib
it
h
i
g
h
er
p
s
y
ch
o
lo
g
ical
n
ee
d
s
.
T
h
is
i
n
q
u
ir
y
co
u
ld
ex
p
lo
r
e
wh
eth
er
u
n
m
et
p
s
y
ch
o
lo
g
ical
n
ee
d
s
d
r
i
v
e
m
ales
to
en
g
ag
e
m
o
r
e
in
b
attle
r
o
y
ale
g
am
es
as
a
m
ea
n
s
o
f
f
u
lf
illi
n
g
th
ese
n
ee
d
s
.
ACK
NO
WL
E
DG
E
M
E
NT
S
W
e
ex
p
r
ess
o
u
r
s
in
ce
r
e
g
r
atitu
d
e
to
th
e
L
ib
r
ar
ian
o
f
C
h
r
is
t U
n
iv
er
s
ity
an
d
St Alo
y
s
iu
s
Un
iv
er
s
ity
f
o
r
th
eir
in
v
alu
a
b
le
s
u
p
p
o
r
t
in
c
o
n
d
u
ctin
g
th
e
liter
atu
r
e
s
ea
r
c
h
.
Sp
ec
ial
th
an
k
s
to
Dr
.
Ma
d
h
av
i
R
an
g
aswam
y
,
Pro
f
ess
o
r
in
th
e
Dep
ar
tm
en
t
o
f
Ps
y
ch
o
lo
g
y
at
C
HR
I
ST
D
ee
m
ed
to
b
e
Un
iv
e
r
s
ity
,
f
o
r
h
er
g
u
id
a
n
ce
an
d
ass
is
tan
ce
.
F
UNDING
I
NF
O
R
M
A
T
I
O
N
Au
th
o
r
s
s
tate
n
o
f
u
n
d
in
g
in
v
o
lv
ed
.
AUTHO
R
CO
NT
RI
B
UT
I
O
NS ST
A
T
E
M
E
N
T
T
h
is
jo
u
r
n
al
u
s
es
th
e
C
o
n
tr
ib
u
to
r
R
o
les
T
ax
o
n
o
m
y
(
C
R
ed
iT)
to
r
ec
o
g
n
ize
in
d
iv
id
u
al
au
th
o
r
co
n
tr
ib
u
tio
n
s
,
r
ed
u
ce
au
th
o
r
s
h
ip
d
is
p
u
tes,
an
d
f
ac
ilit
ate
co
llab
o
r
atio
n
.
Na
m
e
o
f
Aut
ho
r
C
M
So
Va
Fo
I
R
D
O
E
Vi
Su
P
Fu
Sh
im
il P
.
V
.
✓
✓
✓
✓
✓
✓
✓
✓
✓
✓
Palak
Kan
war
✓
✓
✓
✓
✓
C
:
C
o
n
c
e
p
t
u
a
l
i
z
a
t
i
o
n
M
:
M
e
t
h
o
d
o
l
o
g
y
So
:
So
f
t
w
a
r
e
Va
:
Va
li
d
a
ti
o
n
Fo
:
Fo
r
mal
a
n
a
l
y
s
i
s
I
:
I
n
v
e
s
t
i
g
a
t
i
o
n
R
:
R
e
so
u
r
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e
s
D
:
D
a
t
a
C
u
r
a
t
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o
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O
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W
r
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&
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P
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P
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Fu
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Fu
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CO
NF
L
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NT
Au
th
o
r
s
s
tate
n
o
co
n
f
lict o
f
in
t
er
est.
DATA AV
AI
L
AB
I
L
I
T
Y
Data
av
ailab
ilit
y
is
n
o
t
a
p
p
li
ca
b
le
to
th
is
p
ap
er
as
n
o
n
e
w
d
ata
wer
e
c
r
ea
ted
o
r
an
al
y
ze
d
in
t
h
is
s
tu
d
y
.
Evaluation Warning : The document was created with Spire.PDF for Python.
I
SS
N
:
2
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