Correlates of internet gaming among violent and nonviolent gamers and comparison of their psychological well-being with nongamers in a university student population.

Background: India's population has seen increasing access to the Internet and gaming mainly in adolescents and young adults. Aim: The aim of the study was to assess the prevalence and correlates of Internet gaming and its effects on the psychological well-being of gamers versus nongamers. Materials and
Methods: Cross-sectional survey was done to enroll a convenient sample of nongamers, violent gamers, and nonviolent gamers. Measures included Psychological general well-being scale-short (PGWB-S), Internet Gaming Disorder-Short Form-9 (IGDS9-SF), name, frequency, and duration of game use.
Results: The study enrolled 119 nongamers, 62 violent gamers, and 58 non-violent gamers. The prevalence of IGD was 0.8%. PGWB-S scores of gamers were comparable to nongamers. On multiple linear regression, lower PGWB-S score and higher frequency of use were found significantly associated with higher IGDSF-S9 scores. Violent gaming was found significantly associated with male gender (P ≤ 0.001), frequency (P = 0.012), and duration of game use (P ≤ 0.001). Conclusions: The study provides empirical evidence for the "gaming as a consequence of self-medication" hypothesis. Copyright:

INTRODUCTION

The prevalence of Internet Gaming Disorder (IGD) ranges from 0.7% to 15.6%, with an average prevalence of 4.7%.[1] Studies on the prevalence of IGD in India are lacking.[2] International Classification of Disease [ICD-11] has described “Gaming disorder” as a “pattern of persistent or recurrent gaming behavior” that becomes so extensive that it “takes precedence over other life interests” and classified it as a mental health disorder.[3] DSM-5 has classified IGD as a condition for further study.[4]

India has seen exponential growth in access to the Internet, with a significant portion of users being adolescents and young adults. It is important to know the prevalence, correlates of internet gaming, and its effect on the psychological well-being of gamers compared to nongamers in our population. Violent gaming is preferred more by males, whereas nonviolent games have been reported to be used more by females.[5] Differential associations with these two gaming types also need to be explored.

MATERIALS AND METHODS

A cross-sectional survey to assess the prevalence and correlates of IGD and its association with psychological well-being was conducted. Snowball method using WhatsApp was employed to enroll convenient samples from colleges of Bioscience, Commerce, and Arts in Anand, Gujarat from March to April 2019. To reduce sample contamination, WhatsApp link was shared through faculty and assigned students. Instructions specified participation only if the respondent met inclusion criteria. The study was conducted after the ethical approval from the Institutional Ethics Committee.

Inclusion criteria were 18–28 years old, met the operational definition for nongamer or gamer as follows. Non-gamer: not playing a video game (on laptop, mobile, or any device) in the past 12 months. Gamer: playing a video game (on laptop, mobile, or any device) in the past 12 months including the last 3 months. Violent gamer: most played a game in the last 3 months involved the use of weapons and equipment to kill. Nonviolent gamer: the most played game in the last 3 months did not involve killing.

Anonymous questionnaire in English made using PsyToolkit was shared using WhatsApp groups.[67] Demographic data included age, gender, locality, family type, relationship status, stream of study, and academic performance in the last academic year. Based on answers to the question, “Have you been playing video games (on laptop, mobile, or any device) in the pastt 12 months, including last 3 months?” respondent was presented differential questions for gamers (name of game, type of game [violent or nonviolent], frequency, duration, IGD-Short Form [IGDS-SF], and Psychological general well-being scale-short) and nongamers (only psychological general well-being scale-short).

IGDS9-SF is a nine-item scale valid for the assessment of IGD.[8] Total scores range from 9 to 45, with higher scores indicative of a greater degree of IGD. Endorsement of “Very Often” on 5 out of 9 questions was used to differentiate disordered gamers from nondisordered gamers. Psychological General Well Being Scale-Short (PGWB-S) is a validated six-item measure of general well-being.[9]

Statistical analysis was done using JAMOVI, version 1.1.9 (JAMOVI project, Sydney, Australia).[10] Descriptive statistics were used to describe sample characteristics. Chi-square test was used for categorical variables, and t-test and ANOVA were used to compare continuous variables. Post hoc analysis with Bonferroni correction was done. Multiple linear regression was conducted to determine whether variables with a significant bivariate relationship could be used to independently predict the IGDS9SF score. The level of statistical significance was P < 0.05 for this study.

RESULTS

Study recorded 360 responses, of which 239 complete responses were analyzed (19 [49.8%] nongamers, 62 [25.9%] violent gamers, and 58 [24.3%] nonviolent gamers). Mean age of respondents was 21 ± 2.28 years (122 [51.0%] males, 117 [49.0%] females). The sample represented single students, urban residing, coming from nuclear families, and studying in science streams. There was a higher proportion of females in nonviolent gamers. Players Unknown Battle Ground (PUBG) was the most endorsed violent game (n = 53); Candy crush (n = 12), and FIFA mobile (n = 8) were the most endorsed nonviolent games.

The mean IGDS9-SF score of the gamers was 16.4 (standard devition: 6.70). The prevalence of IGD among the study respondents using IGDS9-SF was 0.8% (n = 2 out of 239). There was no significant difference in the psychological well-being score of gamers compared to nongamers.

Patterns and correlates of Internet gaming were calculated by comparing violent and nonviolent gamers. Moderate negative correlation between IGDS9-SF score and PGWB-S Score (n = 111; Pearson’s r value: −0.480, P ≤ 0.001; Spearman’s rho value: −0.486, P ≤ 0.001). IGDS9-SF score was found significantly associated with gender (P = 0.017), type of game use (P = 0.011), frequency of game use (P = 0.011), and duration of game use (P < 0.001).

Multiple linear regression analysis was conducted, using variables showing a significant relationship with IGDS9-SF in bivariate analysis. Multicollinearity was checked using tolerance statistic and variance inflation factor, which did not reveal significant multicollinearity. The model [Table 1] was statistically significant (F = 15.2; P ≤ 0.001) and explained 41.9% of the variance in the IGDSF-S9 scores. It was observed that lower psychological well-being and higher frequency of game use were significantly associated with higher IGDSF-S9 scores. Gender and greater duration of game use suggested a trend toward higher IGDSF-S9 scores.

Table 1

Multiple linear regression for correlates of Internet gaming disorder-short form-Scale 9 score among current gamers

Variable	Beta	95% CI	t	P
Gender	−0.17	−4.83-0.03	−1.96	0.053
Type of game	−0.05	−2.86-1.57	−0.54	0.567
PGWB-score	−0.52	−0.84-−0.46	−6.79	<0.001
Frequency of game use	0.22	0.29-2.03	2.65	0.009
Duration of game use	0.17	−0.01-2.44	1.96	0.052
Constant		19.45-33.52	7.469	<0.001

CI – Confidence interval; PGWB – Psychological general well-being

Violent gaming was found to be significantly associated with male gender (P ≤ 0.001), frequency (P = 0.012), and duration of game use (P = 0.001). On analysis of the individual questions of IGDS9-SF, “Play in order to temporarily escape or relieve a negative mood” was significantly associated with violent game use (P = 0.027) [Table 2].

Table 2

Comparison of violent gamers and nonviolent gamers

Variable	Category, n (%)	Violent gamers (n=62; 25.9), n (%)	Nonviolent gamers (n=58; 24.3), n (%)	P*
Gender	Male (n=83; 69.2)	52 (83.9)	31 (53.4)	<0.001
	Female (n=37; 30.8)	10 (16.1)	27 (46.6)
Frequency of game use	Occasional (n=35; 29.2)	11 (17.7)	24 (41.4)	0.012
	<3 days per week (n=15; 12.5)	7 (11.3)	8 (13.8)
	>3 days per week (n=23; 19.2)	12 (19.4)	11 (19.0)
	Daily (n=47; 39.2)	32 (51.6)	15 (25.9)
Duration of game use	<½ h (n=39; 32.5)	10 (16.1)	29 (50.0)	<0.001
	½–1 h (n=42; 35)	25 (40.3)	17 (29.3)
	1–3 h (n=29; 24.2)	18 (29.0)	11 (19.0)
	>3 h (n=10; 8.3)	9 (14.5)	1 (1.7)
IGDS9-SF Q8. Play in order to temporarily escape or relieve a negative mood	Not clinically significant (n=103; 85.8)	49 (79.0)	54 (93.1)	0.027
	Clinically significant (rated as very often) (n=17; 14.2)	13 (21.0)	4 (6.9)

*Chi square test was used to test difference between the groups, No significant difference between the groups on locality, family type, relationship status, stream of study, academic performance in last year (data not shown). IGD-S9-SF – Internet Gaming Disorder Scale-Short Form

DISCUSSION

The prevalence of IGD among the study respondents using the IGDS9-SF was 0.8%, which is lower than the 3.6% prevalence reported by a previous Indian study among medical students and near the lower limit of the range 0.7%–27.5% reported by a recent systematic review of prevalence studies of IGD from mostly Western countries.[1112] PUBG was the most endorsed violent game. Cases of addiction to PUBG have been reported in Indian media.[13]

There was no significant difference in the psychological well-being score of gamers compared to non-gamers. This could be due to the small sample size of the study population and needs to be evaluated in a larger study population.

Findings suggest that lower psychological well-being was associated with a higher IDGS9-SF score. This negative correlation was maintained when in multiple linear regression. Singh et al. have reported that a higher degree of depressive symptoms was found to be associated with a higher score on IGDSF-S9.[11] Possible explanation may be that players with greater psychological distress resort to gaming as a “way of coping.” Partial evidence for this was found. IGDS9-SF item “Q8. Play in order to temporarily escape or relieve a negative mood” was significantly associated with violent game use, which is in line with the “Gaming as a consequence of self-medication” hypothesis described by Singh et al.[11]

Male gender was significantly associated with violent game use. Previous studies have reported male gender preference for violent game use.[1415] Hartmann et al. found that males anticipate more pleasure and less guilt as they tend to be less empathic and have a higher need for sensation and aggression.[16]

Frequency, duration, and type of game use were found to be associated with higher IGDS9-SF scores. The only association with frequency of game use was maintained in multiple linear regression. Study participants had a preference for Multiplayer Online Games (MPOG). New content and in-game socialization within MPOGs can act as reinforcement and lead to frequent game use.[11] Singh et al. reported a preference for MPOGs to be associated with a higher risk for IGD.[11]

Violent gaming was associated with higher frequency and duration of game use. MPOG nature of violent games lets players choose “avatars” and become part of a “seemingly real” virtual world, where players develop a community and have social interactions.[17] Violent players significantly endorsed “very often” on the IGDS9-SF question “play in order to temporarily escape or relieve a negative mood.” This suggests violent games may be used to escape reality or satisfy social needs, resulting in higher frequency and duration of game use.[17]

Limitations of the study are the use of a cross-sectional study method, WhatsApp-based survey,[18] use of questionnaire for IGD evaluation, and one-third of responses could not be included in the analysis due to missing data. On scrutiny of the most played games in the last 3 months, it was observed that most of the violent games come under the ambit of “internet games” and many of the games endorsed under the nonviolent category could be played in offline mode. Hence, this study considered some games which can be played without internet under the ambit of IGD. The generalizability of the study findings has to be done with caution due to the limited sample size, and the inability to calculate the response rate as it was an open survey. Nonetheless, the study highlights IGD may be an emerging health problem and needs to be studied further.

CONCLUSIONS

The prevalence of IGD among college students using IGDS9-SF was 0.8%. However, the prevalence rate should be evaluated in light of the study limitations. PUBG was the most endorsed game among violent gamers. Lower psychological well-being and higher frequency were associated with higher IGDS9-SF score providing empirical evidence for the “gaming as a consequence of self-medication” hypothesis. Violent gaming was found to be associated with male gender, higher frequency, and duration of game use. There was no significant difference in the psychological well-being of gamers and non-gamers, possibly due to the small sample size of the study population.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.