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.

Nicotine pouches have expanded rapidly across the Gulf region, yet population-based evidence on gingival health remains scarce and users differ widely in intensity of consumption. We examined the association between nicotine pouch use and self-reported gingival symptom burden among 655 adults in Saudi Arabia using a bilingual self-administered online questionnaire. All data, including the outcome, were self-reported; no clinical periodontal examination was performed, so the study does not provide a clinical diagnosis of periodontal disease. Self-reported gingival symptom burden was assessed with a ten-item screening scale validated in Saudi adults, analysed as a continuous score and dichotomised at the sample median, and dependence among users was quantified with a six-item index adapted from the Fagerström Test for oral nicotine products. Tobacco exposure was modelled as a single four-level mutually exclusive variable. An above-median self-reported gingival symptom score was present in 277 participants (42.3%), and 180 (27.5%) reported pouch use. Pouch use status was not associated with the outcome (adjusted odds ratio 1.06, 95% CI 0.67–1.69). Among 179 users, the screening score rose by 1.63 points per dependence stratum (95% CI 0.88–2.37), and prevalence rose from 28.2% at low dependence to 38.9% and 58.3% at moderate and high dependence (Kendall τ-b = 0.186, p = 0.002), with adjusted odds of 5.86 (95% CI 2.30–14.96) for high dependence and a per-stratum trend of 2.43 (95% CI 1.52–3.87). The gradient persisted after additional adjustment for smoking status, former smoking and use of other tobacco products (trend odds ratio 2.53–2.65), and across ten sensitivity analyses. Self-reported gingival recession showed the steepest gradient across dependence strata, whereas gingival bleeding showed none. Self-reported gingival symptom burden among pouch users was associated with intensity of consumption rather than with use status; these findings are hypothesis-generating rather than evidence of a clinical effect, and require confirmation by studies with clinical periodontal assessment and longitudinal follow-up.