Background and Aims: Using gaming to escape emotional difficulty has been suggested to be a candidate mechanism contributing to Internet gaming disorder (IGD). This study evaluated the associations among resilience, perceived stress, depression, and IGD. Methods: A total of 87 participants in an IGD group and 87 participants in a control group were recruited into this study. IGD was diagnosed using the Diagnostic and Statistical Manual of Mental Disorders. Stress levels, resilience, and depression were measured by a self-reported questionnaire. Results: The IGD group had a lower resilience, higher perceived stress, and depression than the control group. Hierarchical regression analysis demonstrated that resilience was associated with IGD when perceived stress was controlled. After depression was controlled, resilience and perceived stress were not associated with IGD. Among the IGD group, those with low resilience had higher depression. Furthermore, discipline was the resilience characteristic associated with IGD. Conclusions: Low resilience was associated with a higher risk of IGD. IGD individuals with low resilience had higher depression. Depression was more associated with IGD than resilience. Depression assessments and stress coping interventions should be provided for individuals with IGD who exhibit low resilience or high stress.

People diagnosed with Internet gaming disorder (IGD) have been frequently reported to experience depression, anxiety, and hostility. Emotional regulation contributes to these mood symptoms. This study evaluated emotional regulation in subjects with IGD and examined relationships between emotional regulation, depression, anxiety, and hostility in young adults with IGD. We recruited 87 people with IGD and a control group of 87 people without a history of IGD. All participants underwent a diagnostic interview based on the IGD criteria of the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition, and they completed a questionnaire on emotional regulation, depression, anxiety, and hostility. We found that subjects with IGD were less likely to practice cognitive reappraisal and were more likely to suppress their emotions. Linear regression revealed the higher cognitive reappraisal and lower expressive suppression associated with depression, anxiety, and hostility among subjects with IGD. The emotional regulation strategies that characterize those with IGD could be contributing factors to the depression and hostility tendencies of these people. When treating patients with IGD, in addition to providing appropriate interventions to relieve depression and hostility, practitioners should effectively assess emotional regulation strategies and provide emotional regulation therapy to prevent a vicious cycle of negative emotions.