Setting the Game Agenda: Reviewing the Emerging Literature on Video Gaming and Psychological Well-Being of Sexual and Gender Diverse Youth

Abstract

Video gaming is a popular youth pastime that has prompted scholarship into its relationship with psychological well-being. However, sexual and gender diverse youth (SGDY) who play video games are largely overlooked in this research. SGDY experience significant mental health challenges, but utilize coping strategies mediated by digital technologies, necessitating an examination of their video game playing and its effects on well-being. This literature review synthesizes the emerging evidence base by identifying key constructs related to SGDY well-being and video gaming. Five themes were derived from the literature: (a) SGDY identity development and self-expression in video games; (b) SGDY video gaming and coping skills; (c) Social support in SGDY video gaming communities; (d) SGDY digital microaggressions in video gaming; and (e) SGDY civic engagement through video gaming. The findings establish multiple risks and opportunities for harnessing video games to support SGDY's well-being. Recommendations for practice, research, and industry collaborations are presented.

Introduction

Video games are a mainstream, interactive, and immersive technology-based form of entertainment that is rapidly replacing music as the most important aspect of youth culture today (Monahan, 2021). Western reports on youth technology trends use “youth” as a broad term to collectively describe several developmental periods lasting roughly from early adolescence to early adulthood. Nearly 78% of U.S. households with youth aged 8–18 own a gaming console (Rideout & Robb, 2019), and 90% of Canadian adolescents (aged 13–17) actively play video games (Entertainment Software Association of Canada, 2020). Australian households with children rank video games as the third most popular media choice, above music, reading, and social media (Brand et al., 2017); and video gaming ranks fourth as the most popular activities for young people aged 8–25 in the United Kingdom (Nominet, 2022). Video games span various genres, such as combat-focused first-person shooters and collaborative massively multiplayer online roleplaying games (MMORPGs), which can typically be discerned by their unique design conventions, stories, and themes.

Research on the social and psychological impacts of video gaming has changed over time in response to the aging demographic of video game players, the growing diversity of video game players, increasing complexity and diversity of video games, and their growing entrenchment in the culture (Dale & Shawn Green, 2017). Scholarship on video gaming accelerated in the early 2000s, with common topics of interest being the impacts of video gaming on attention, dexterity, aggression, and sedentary behaviors (Anderson et al., 2004). Alongside these research areas, video game research also focuses on the links between video gaming and well-being, and how to harness the popularity and design of video games to enhance players’ professional, educational, and health outcomes (Micallef et al., 2022).

Video Gaming and Well-being

Well-being is an overall positive psychological state combining several factors such as autonomy, environmental mastery, personal growth, positive relationships with others, a sense of purpose, and self-acceptance (Ryff, 2013). Evidence for multiple positive and negative affective, cognitive, and behavioral impacts on well-being related to video games has been presented in the literature. Video games can promote enhanced emotional regulation through immersive flow-like states during fun gameplay, mastery, and appreciation of its fictional properties (Villani et al., 2018); social connection through collaborative play (Raith et al., 2021); and the fostering of an overall optimistic motivational style (Granic et al., 2014). While there is some evidence that playing violent video games contributes to aggressive affect and decreased empathy and prosociality (Anderson et al., 2010), it has been difficult to replicate these findings (Ferguson, 2020). Research has also documented associations between video game playing and improved top-down attention and spatial awareness (Bediou et al., 2018); working memory (Waris et al., 2019); and executive control (Li et al., 2020) but there is also some evidence that playing video games during adolescence can be related to decreases in attention at school (Swing et al., 2010).

Given that there may be affective and cognitive benefits of video gaming (e.g., entertainment), players may be motivated to play to support their well-being (Johannes et al., 2021). Video games played through physical exercise may also support the physical well-being of players by promoting fitness and activeness (Zeng & Gao, 2016). However, video gaming has also been linked to several dysfunctional behaviors among problematic video game players (i.e., gamers who meet most of the criteria for video game addiction) who comprised 8% of the sample in one study of 1,178 U.S. youth aged 8–18 (Gentile, 2009). Estimates from surveys in Norway and Germany further suggest that 0.2–0.4% report addictive video game use, meeting all of the criteria for video game addiction (Festl et al., 2013; Mentzoni et al., 2011). Problematic and addictive video gaming is negatively associated with well-being and predicts higher rates of depression and anxiety symptoms and sleep disturbance (Männikkö et al., 2020). Relatedly, video games may feature paid luck-based features resembling gambling (e.g., mystery loot boxes), which have been linked to higher rates of problem gambling and spending in a large survey of 7,427 U.S. adult gamers (Zendle & Cairns, 2019).

While much has been learned about the effects of video gaming on well-being, most of the research has studied the general population of video game players, overlooking demographic differences. For example, problematic and addictive video gaming may be more prevalent among boys and young men experiencing loneliness (Pallavicini et al., 2022). Further investigation of marginalized video game players is particularly warranted as evidence indicates that online video gaming can be a vehicle for racist, sexist, and ableist abuse by other players (Cote, 2017; Crooks & Magnet, 2018; TaeHyuk Keum & Hearns, 2022).

Digital Risks and Resilience Among Sexual and Gender Diverse Youth

Recent research highlights that sexual and gender diverse youth (SGDY) can live drastically different offline and online lives. Offline, SGDY can experience familial rejection (Salerno et al., 2022), adverse childhood experiences (Craig et al., 2020), discrimination from healthcare providers (Henriquez & Ahmad, 2021), and homophobic and transphobic bullying at school (Domínguez-Martínez & Robles, 2019; Moyano & Sánchez-Fuentes, 2020). In turn, these minority stressors (Meyer, 2003) can increase the risk of developing mental illnesses like anxiety and depression and problematic behaviors like substance use, self-harm, and suicide (Russell & Fish, 2016).

While these negative experiences could make SGDY more susceptible to problematic and addictive gaming behaviors and psychological distress from online harassment (Arcelus et al., 2017; Gillin & Signorella, 2023), other findings suggest that SGDY often live vibrant and fulfilling digital lives that are protective for SGDY experiencing harm offline (Craig et al., 2015; Craig & McInroy, 2014). The internet is a vital source of information and resources for SGDY, which can support identity development and service use (McInroy, McClosky et al., 2020). SGDY have also been found to be creating affirmative virtual peer support network on platforms such as YouTube, Facebook, and Tumblr, which provide respite from stigma and violence, belonging, confidence, hope, and political mobilization (Craig et al., 2020, 2021; Tortajada et al., 2021).

Altogether, these behaviors may constitute a “digital resilience”; digital processes and actions that generate positive growth (Craig et al., 2023) but, to date, much of the research in this area has focused on social media, online streaming services, forums, and websites. Given that trans people and gay males aged 14–29 have particularly high rates of video game console ownership within SGDY populations, video games could be a critical but overlooked site that contributes to the well-being of SGDY (McInroy, Craig et al., 2019). Indeed, approximately 80% of U.S. teens aged 13–17 own a video game console, with even greater numbers owning desktop computers/laptops (90%) and smartphones (95%) with gaming capabilities (Pew Research Center, 2022). As such, the present literature review aims to collate the research findings in this emergent area and answer the following research question: How does video game playing relate to the well-being of SGDY?

Methods

Creswell and Creswell (2018) propose the following literature search recommendations: (1) identifying search terms that capture the research topic's core domains; (2) inputting search terms into research databases; (3) prioritizing peer-reviewed journal articles and incorporating other published and unpublished materials as appropriate; (4) ascertaining relevance of the found articles; (5) grouping relevant articles thematically; (6) summarizing key articles; and (7) writing the results.

Search terms utilizing Boolean operators were used, such as “sexual and gender diverse,” “LGBT*” and its constituent identity labels, “youth,” “young adults,” “well*,” “mental*,” “resilience,” “video gam*,” names of specific video game franchises, and “Gaymer,” a label that some SGD video game players adopt for themselves (Sundén, 2009). The search terms were entered into research databases (e.g., Google Scholar, JSTOR, Semantic Scholar) and abstracts from peer-reviewed English-language papers published since 2000 were screened for relevance to the research question and the target age cohort of 10–29 years. Accepted articles were read thoroughly and grouped thematically according to their findings. Where research themes required further development and context, findings from book chapters, unpublished graduate theses, gray literature, and journalism were incorporated. Finally, the findings were synthesized and key research gaps and opportunities for future research were identified.

Results

The literature review collated 27 peer-reviewed journal articles, four book chapters, three news articles, three conference proceedings, two reports, and one Master's thesis. The literature was grouped into five themes: (a) SGDY identity development and self-expression in video games; (b) SGDY video gaming and stress coping skills; (c) Social support through SGD video gaming communities; (d) SGD digital microaggressions in video gaming; and (e) SGDY civic engagement through video gaming.

SGDY Identity Development and Self-Expression in Video Games

One of the most widely studied aspects of SGD identities and video game playing is the avatar, an in-game representation of the player whose name and appearance can be customized (Morningstar & Farmer, 2008). In one focus group study of 17 trans and gender diverse youth aged 11–22, the participants reported that they used avatars to explore, develop, and rehearse their gender identities and expressions, supporting their well-being (Morgan et al., 2020). Another interview-based study with 10 trans and gender diverse youth aged 13–18 found that avatar customization facilitated participants to explore their gender in a low-stakes environment, affirming their feelings and decisions about their evolving gender identity, signaling to other players how they wish to be gendered, and feeling closer to an aspirational gendered self (J. L. McKenna et al., 2022). Specifically, choosing a name, pronouns, and a personalized look for the avatar provided an agentic way to cue other players and the video game itself how they wanted to be seen and addressed. Accordingly, other players and dialogue in the game respond to these gender signifiers at face value, affirming the player's gender. This may be particularly beneficial for younger trans and gender diverse youth exploring their identity.

It has been theorized that roleplaying as one's avatar can reduce uncomfortable feelings of perceived discrepancy between the actual self (i.e., the person as they currently are) and the ideal self (i.e., the person as they would like to be) because it allows one to emulate and act out aspirational aspects of the ideal self (Klimmt et al., 2010). In gameplay, this can enhance the player's enjoyment in the game and temporarily alter the player's self-concept, facilitating more positive feelings toward oneself (Klimmt et al., 2009). One published case study documents the author's innovative attempt to integrate the avatar into a therapeutic setting with a trans patient struggling with their gender identity and presentation, which appeared to support the building of rapport (Rivera, 2022). Although embodying a gender-affirming avatar may have a positive psychological influence on the player (Strauss et al., 2019), these feelings are temporary and state bound to the in-game world (Klimmt et al., 2010). As such, the potential benefits of an affirming in-game avatar may be inhibited by important offline factors such as poor mental health, familial rejection, and other interpersonal problems (i.e., discrimination and transphobia), requiring further study (Arcelus et al., 2017).

There is also some growing interest in how SGD video game streamers (i.e., people who broadcast themselves playing games on platforms such as Twitch) construct and manage their identities while livestreaming video games. In a qualitative study of 25 Twitch streamers (eight of whom identified as SGD), participants indicated that sharing their sexual and gender diversity with their audience was a common coming out “ritual” that may also encourage viewers to come out in their offline lives (Freeman & Wohn, 2020). Twitch streaming offers several technical and practical affordances that facilitate this identity management. For trans and gender diverse youth who are uncomfortable with broadcasting their present appearance or voice, technologies such as greenscreen or experimenting with camera positioning allow them to exert control over how they are seen by their audience to mitigate against online harassment (Freeman & Wohn, 2020).

In summary, research highlights that video games and video game streaming offer several technical affordances that support the self-expression, agency, and autonomy of SGDY, and especially that of trans and gender diverse youth. Video game avatar creation specifically seems to play a notable role in identity exploration, expression, and validation among trans and gender diverse youth who play video games. Emerging evidence suggests that player avatars could be harnessed in therapeutic contexts, but further study is needed.

SGDY Video Gaming and Stress Coping Skills

Video games provide a highly entertaining experience through their storylines, visual aesthetics, gameplay, music and sound design, and cultural significance, and video games with SGDY representation may be especially appreciated by SGDY players who do not see their lives reflected in media (Kohlburn et al., 2023). Given the enjoyment and fun derived from video games, video gaming has been associated with a range of coping skills among SGDY, varying in adaptiveness. In a survey of 711 trans and gender diverse youth aged 14–25 in Australia, 57.7% reported using video games to make them feel better when experiencing distress, whereas 54% reported accessing mental health support/counseling and 40.2% reported accessing peer support groups or youth centers (Strauss et al., 2017). A semistructured interview study with 20 SGDY aged 14–18 who were experiencing bullying elaborates that playing video games was useful for “sidetracking” (e.g., coping through distraction; Craig et al., 2020) and that video games provided a highly customizable environment that allowed them to assert agency and autonomy, reducing stress and other negative feelings (R. T. O’Brien et al., 2022). These findings are extended in a semistructured interview study with 12 trans and gender diverse adults aged 21–34 who discussed their experiences playing choice-based games (in which the storyline is driven by choices that the player makes). The findings highlighted that the high degree of fun, autonomy, customization, and freedom within these games instilled a sense of meaningfulness into the players’ choices and created a low-stakes environment to explore and make sense of oneself through inclusive character creation and dating features (Cantrell & Zhu, 2022).

Nonetheless, some evidence suggests that excessive video gaming is detrimental to SGDY well-being. In one qualitative study of self-care practices during COVID-19 shelter-in-place orders using open-ended cross-sectional survey responses of 770 sexual minority adolescents aged 15–19, several participants indicated that they played video games to escape reality and connect with their peers whom they could not see in-person. However, some participants communicated that excessive video gaming for escapism may have negative mental health consequences and isolate them from their peers (O’Brien et al., 2021). While video gaming may have facilitated coping processes (i.e., distraction, escapism, agency) that reduced psychological distress and supported the well-being of SGDY during COVID, more research is needed to ascertain when these coping strategies are maladaptive and the psychosocial factors that predict problematic video gaming behaviors among SGDY (Arcelus et al., 2017; Broman & Hakansson, 2018).

A complementary area of scholarship is exploring the potential applications of serious video games in evidence-based therapeutic interventions for SGDY. Video game-based mental health interventions may demonstrate a high degree of acceptability among SGDY because therapeutic approaches can be discreetly woven into the game narrative and mechanics while preserving aspects of video games (e.g., customization) that already appeal to the target audience (Strauss et al., 2019). One such serious game, SPARX, is a computerized cognitive behavioral therapy self-help program available for free for youth in New Zealand and shows some promise in reducing depressive symptoms among adolescents (Merry et al., 2012). An adaptation for sexual diverse adolescents, Rainbow SPARX, demonstrated similarly positive results (Lucassen et al., 2015). However, SPARX presently lacks the affordances of many commercial video games (e.g., gender expansive character design options), which undermines its acceptability among trans and gender diverse youth specifically (Lucassen et al., 2021). Co-design to refine SPARX with trans and gender diverse youth has indicated that factors like binary character creation options and a lack of bespoke SGD content are key participation barriers for this cohort (Lucassen et al., 2018; Strauss et al., 2019).

Overall, there is consistent evidence showing that SGDY play video games for entertainment, distraction, and escapism, which can support stress coping and well-being. However, there is also recognition that this manner of coping may be less adaptive in the face of chronic stressors requiring diverse coping skills and may be problematic or addictive among SGDY experiencing greater psychosocial risk or younger SGDY who are still developing stress coping skills. Yet, there is also promising emerging evidence that SGDY can develop more adaptive coping skills through a video game-based mental health intervention, yet more research is needed to improve its acceptability among this cohort and further build the evidence base for its efficacy in improving key indicators of well-being.

Social Support Through SGD Gaming Communities

Research findings show that online communities can be vital sources of support for SGDY (Austin et al., 2020; McInroy, 2020). However, much of the research to date has focused on fan communities based on TV and film, with relatively less attention to how SGDY connect around their shared affinity for video gaming (Shaw, 2010). Social media offers ample opportunities for SGD gamers to connect with each other around their shared interest in video games on platforms such as Discord in SGD texting and audiovisual chat servers, on Reddit in SGD Subreddits such as r/Gaymers and r/TransGamers, and by watching SGD video game streamers and interacting with other audience members on Twitch (Brown & Moberly, 2020; Fiorellini, 2021).

Research on SGD video gamer subcultures has also studied player-made communities in MMORPGs, which allow players to create and roleplay as their own characters, immerse themselves in a rich storyline, improve skills, and play with up to millions of other players online (Romero, 2017). Among the most popular MMORPG titles today are Final Fantasy XIV (FFXIV) and World of Warcraft (WoW), which are each estimated to be played by over 2 million people daily (MMO Populations, n.d.). A focus group study with 14 trans and gender nonconforming youth aged 11–18 found that MMORPGs were a highly accessible place for finding SGD peers internationally and provided consistent sources of support, information, social networks, and therapeutic experiences (Strauss et al., 2019). Another systematic review of 18 peer-reviewed studies showed that playing MMORPGs may improve self-esteem, reduce feelings of loneliness and depression, and promote a positive outlook on life (Raith et al., 2021). Accordingly, MMORPGs are a popular digital space for community building, with one survey of 30,000 MMORPG players estimating that 79% join collaborative (and sometimes competitive) social groups variously known as “guilds,” “clans,” “free companies,” and other terms (Yee, 2006), which are often integrated with text-based, audiovisual, and teleconferencing platforms like Discord. For clarity, these communities will be collectively referred to as guilds.

Early SGD video game guilds were founded in response to hostile and microaggressive video gaming communities (Kelley, 2012). Developers have disciplined guild founders for advertising alleged “exclusionary” SGD guilds (Shaw, 2015) and analysis of MMORPG forums have also echoed these hostilities within the player base (Pulos, 2013). As such, SGD guilds enforce rules that prohibit hate speech and preserve a positive atmosphere (Collister, 2014). SGD guilds are particularly attractive for players living in rural and conservative areas to reliably have fun and foster friendship, highlighting important motivational parallels in help-seeking behaviors within hostile online and offline ecosystems (McKenna & Chughtai, 2020).

To summarize, video games are a common interest among SGDY, around which communities with a predominantly SGD membership form. These communities aim to maintain an affirming and positive environment, enacted through rules and moderation, and include social media-based sites on Reddit as well as communities specific to certain video game titles and franchises. MMORPGs are particularly well documented as a virtual space for SGDY to find inclusive and accepting communities, potentially related to their tendency to include comprehensive avatar creation features—a key technical affordance for SGDY players.

SGD Digital Microaggressions While Video Gaming

Digital spaces can expose marginalized users to messages and content that can jeopardize their well-being (Keighley, 2022; Ștefăniță & Buf, 2021). One survey of U.S. adult gamers aged 18–45 (n  =  1045) found that 74% of online multiplayer gamers reported an experience of harassment in-game, with 35% of SGD players reporting harassment based on gender identity or sexual orientation (Ingersoll, 2020). Research has documented that heterosexual video game players engage in cyberbullying more than do SGD players and, inversely, that SGD players experience significantly higher rates of sexually related cyber victimization (Ballard & Welch, 2017). These digital microaggressions, while often brief, communicate hostile and derogatory views about SGD and other marginalized people (Nadal et al., 2016) and are pervasive online (Craig et al., 2023), threatening the well-being of younger SGDY who may not have yet developed adaptive coping skills (Craig et al., 2020). Racialized players also report being unfairly targeted in player-versus-player combat when they are identified by other players as being a person of color (Cote, 2017; Gray, 2012, 2018; Nakamura, 2012). Less cooperative in-game activities that rely on skill, individualism, and competitiveness (e.g., player-versus-player combat; PvP) are less likely to motivate positive interpersonal relationships with other players (Castillo, 2019). However, there is not yet any documented evidence of similarly biased in-game violence against players identified as (or perceived to be) SGD.

Gamers from marginalized communities can be targets of “hate raids” (Thach et al., 2024), coordinated attacks organized to spam hate messages facilitated by the anonymity of the internet and automated bot software that is able to rapidly communicate hate speech through text messages and text to speech (Uttarapong et al., 2021). The moderation responses of gaming-related social media platforms may also contribute to a microaggressive digital environment for SGDY. A policy analysis of Twitch's content rules prohibiting obscene and pornographic content suggests that they could be applied in biased ways that discriminate against SGD video game streamers (Ruberg, 2021). As well, trans and gender diverse youth may face unique challenges in engaging with voice and video communications as they may be uncomfortable about how they look or sound and be misgendered and harassed by others (Baldwin, 2018).

Video game microaggressions may also be communicated in environmental ways that subtly invalidate and erase sexual and gender diversity and other intersectional experiences. Video game mechanics such as gender-restricted clothing limit the ability of SGD players to express and experiment with their gender presentation and identity, alienating gender diverse players (McKenna et al., 2022; Morgan et al., 2020). Similarly, although same-sex relationships and romance options are increasingly present in video games (Shaw et al., 2019; Utsch et al., 2017), they have also been critiqued for emulating heteronormative values and not reflecting more transgressive aspects of SGD identity and relationships (Greer, 2013). SGD characters may also embody negative stereotypes like being a sexual predator or psychotic (Colliver, 2020). As well, MMORPGs have been criticized for their conspicuous absence of Black and other people of color, further impacting racialized SGDY (Gray, 2012).

Overall, there is strong evidence that digital microaggressions are commonly enacted against SGDY in video games and video game communities. Despite the unique and diverse ways (e.g., in-game violence) video games, players, and gaming-related social media platforms can communicate microaggressions that exclude and stigmatize SGDY players, there is little peer-reviewed literature studying the possible impacts this could have on the well-being of SGDY. While some research indicates that SGDY may develop and strengthen coping skills (e.g., help-seeking, reframing, utilizing platform features like blocking) when exposed to hateful social media content (Craig et al., 2020), this has not been adequately studied in the context of video gaming accounting for developmental differences between younger and older SGDY.

SGDY Civic Engagement Through Video Gaming

A notable extension of the findings from the prior two themes is the civic engagement of SGD gamers in response to discrimination, microaggressions, and violence. Responses from a survey of U.S. adolescents (n  =  1102) identified that those who played games with civic experiences, defined as simulations of civic or political activities (e.g., helping other players, debating ethical issues), were more likely to express interest in politics or current events, and were more likely to give or raise money for charity (Granic et al., 2014; Lenhart et al., 2020). As such these players may be more civically and politically engaged, engaging in self-advocacy behaviors such as protesting, persuading others to vote in an election, and staying informed about current events (Lenhart et al., 2008).

Participating in politically engaged guilds may enable SGD to influence political or social justice movements through virtual protest. For example, one ethnographic study of an SGD social movement within WoW forums found that SGD players banded together online to address reporting procedures for anti-SGD hate in-game, unifying against harassment, hate speech, and digital microaggressions. Player-led campaigns also targeted WoW's developer to implement change, leading to the revision of reporting procedures and the removal of discriminatory policies that placed restrictions on the use of SGD acronyms for avatars (McKenna & Chughtai, 2020). Similarly, in response to inadequate content moderation practices, in 2021, marginalized Twitch streamers protested. This action resulted in Twitch adding new account verification options and suing two hate raid participants who persistently targeted marginalized streamers with racist, sexist, and homophobic content (Chalk, 2022; Thach et al., 2024). Organizing has also taken the form of community mourning; in response to the traumatic community losses in the Pulse shooting in Orlando on June 12, 2016, FFXIV players held a public vigil to honor the victims and process their grief (Mother Vane, 2016).

In summary, there is anecdotal evidence that political engagement and self-advocacy do occur within video games and video game communities. The use of social media to “fight back” against oppression and develop leadership skills has been observed among SGDY elsewhere (Craig et al., 2020, 2023) but there has so far been no research exploring how self-advocacy in video gaming may support SGDY in developing leadership and coping skills (e.g., assertiveness) that may support their well-being.

Discussion

The literature review presented five emerging themes outlining the potential effects that video game playing may have on the well-being of SGDY. Evidently, video games can be a vital source of social connection and support for SGD players; afford customization and features that allow SGDY to control their gaming experience, explore and express themselves, and protect themselves online; and provide some ways of coping with adversity and minority stress. However, significant challenges include antisocial and hate speech from other players, inadequate SGD representation in video game content, the limited adaptiveness of coping skills developed through video gaming, problematic gaming behaviors, and the limited application of these findings to consumer video gaming. Altogether, these early findings suggest that video games could represent an innovative and technology-engaged way to support the resilience of SGDY, but more research is required.

A Digital World of Opportunities

Recent research findings indicate that SGDY use social media to support their well-being by way of emotional regulation, identity development, self-advocacy, and community building (Craig et al., 2023). The emerging findings reviewed here indicate that SGDY are similarly using video games to support their well-being, but research has so far made limited efforts to operationalize and measure well-being quantitatively. As part of a repertoire of coping strategies, video gaming may be helpful in mitigating against minority stressors in both physical and digital worlds by providing entertainment, escapism, cathartic experiences, supportive communities, space to explore oneself, resonant SGD storylines, and personal growth. However, these constructs require explicit measurement and testing.

These findings would have important implications for researchers, community members, and industry who all stand to gain from the creation of more positive, safe, and enriching online experiences for marginalized and vulnerable SGDY who are entrenched in video game subculture (Strauss et al., 2017). Further, creating safer spaces may attract more SGDY to gaming. Efforts are also underway to develop evidence-based mental health interventions in the form of serious games (Lucassen et al., 2015, 2021, 2022) and future research should seek to understand how to best tailor these interventions to the diverse needs of SGDY, how to best integrate therapeutic approaches into video game design, and how they can be designed in innovative ways that are responsive to the increasing availability of consumer technologies like virtual reality (Bolesnikov et al., 2022).

The Need for Academic-Industry Alliance

The findings point toward significant risks on platforms but addressing these challenges requires working closely with the video game and social media industries to ensure that their technologies contain features, safeguarding, themes, characters, and storylines that preserve and nurture the well-being of SGDY and other marginalized communities while also providing an entertaining experience (Kohlburn et al., 2023). Trends toward more SGD representation in video games over time and a gradual queering of the game developer profession may indicate some industry receptiveness toward addressing social issues in video games (Shaw et al., 2019). However, much of this work is being taken up by SGD video game enthusiasts creating modifications (or “mods”) as a hobby (Howard, 2021) or by indie developers (an individual or small team of game developers without monetary or technical support from a larger game publisher) with smaller audiences (Ruberg, 2019), pointing toward a need for more uptake among mainstream developers and popular franchises. This work could expand and diversify video game audiences; encourage creativity and innovation; enhance the reputation of video gaming; and promote positive social change. Relatedly, while there is promising evidence of the efficacy of serious games in supporting SGDY well-being, these video games are unable to engage players longitudinally because they are highly structured and self-contained in scope. As such, there are significant opportunities for academic-industry partnerships to investigate how mainstream video games can create more prosocial play and support the well-being of players beyond entertainment (Snodgrass et al., 2020).

Another significant area for improvement that the research highlights is content moderation and community building in online multiplayer games, whose in-game chats can be used to bully, abuse, and harass marginalized players (Kou & Gui, 2021). Current video game community moderation is evidently not sufficient in safeguarding vulnerable SGDY and other marginalized players—and may even censor them (Thach et al., 2024). Recent structural equation modeling suggests that teamwork, competition, player competence, and player embodiment of and identification with their in-game avatars are all key constructs that can influence the likelihood of espousing prejudicial views while playing video games (Cary et al., 2020). Academic-industry collaboration may be able to uncover how these factors can be manipulated in video games to promote prosocial play and player well-being.

Limitations

There are some limitations to highlight. While many of the findings speak favorably to the potential benefits of video gaming on SGDY well-being, most of the studies are qualitative. Although there is methodological diversity, encompassing semistructured interviews, focus groups, digital ethnography, screenshot elicitation, and text-based interviews, their small sample sizes limit their generalizability. As well, much of the findings are couched within the lens of media and cultural studies, queer studies, communications, video game studies, and human–computer interaction research. More research from the health sciences that adopts a stronger developmental lens is required, given how broadly “youth” is defined in the literature. As well, because the search was restricted to English-language papers, much of the collated literature pertained to Western research contexts. Further, the search incorporated a small selection of book chapters, news articles, conference proceedings, reports, and a graduate thesis to supplement the peer-reviewed journal article findings. Altogether, these limitations highlight a need for more quantitative research, disciplinary buy-in from health sciences and applied social sciences researchers, and more robust studies accounting for developmental and cultural differences.

Conclusion

This literature review showed that video games may contribute to the well-being of SGDY in both positive and negative ways. Video games may support facets of SGDY well-being such as stress coping skills, identity development, self-expression, creativity, skill mastery, affirming community, and civic engagement. But video gaming can also expose SGDY to hate speech and digital microaggressions or develop into a maladaptive coping behavior. Research now needs to quantitatively test these key constructs to elaborate on and generalize emerging qualitative findings and more fully understand video gaming as a coping behavior among SGDY. This scholarship would be of value to researchers and practitioners working in mental health, video game industry professionals, who can work toward making video gaming a safer and more inclusive hobby, and SGDY video gamers who will ultimately benefit from this work.