In addition to gaming and gambling, the relationships among some variables, such as mood, gender, physiological state, motivation, and loot box engagement, were examined. Overall, this review identified positive relationships among Internet gaming disorder–related symptoms, disordered gambling symptoms, and engagement with, or investment in, loot boxes. Of the 201 studies examined for eligibility, we reviewed 20 studies that met the predefined criteria, which were extracted by searching electronic databases (PsycINFO, PubMed, Ovid, EBSCO, and Web of Science) and the reference lists of included studies, and that were published up to March 27, 2021. We conducted a systematic review to identify the characteristics of people who purchase loot boxes with real money, focusing on the relationships (a) between loot boxes and gaming, (b) between loot boxes and gambling, and (c) between loot boxes and other variables. Research has indicated that loot boxes are risky gaming components that could exacerbate Internet gaming disorder due to a link between loot box purchasing and gambling.
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