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 Table of Contents  
ORIGINAL ARTICLE
Year : 2022  |  Volume : 6  |  Issue : 3  |  Page : 244-248

Gaming Disorder among College Students and Correlation of Gaming with Self-esteem, Perceived Stress, and Sleep Quality


1 Department of Psychiatry, LTMMC and Sion Hospital, Sion, Maharashtra, India
2 Department of Psychiatry, Seth G. S. Medical College and K. E. M. Hospital, Mumbai, Maharashtra, India

Date of Submission31-Dec-2021
Date of Acceptance08-Jan-2022
Date of Web Publication31-Oct-2022

Correspondence Address:
Dr. Himanshi Bansal
#404, GH 36, Sector 20, Panchkula, Haryana
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/aip.aip_155_21

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  Abstract 


Context: The trend of participating in online games which used to be quite prevalent in children and adolescents is now being seen commonly in college students. Heavy usage of these online games leads to various dysfunctional symptoms and socio-occupational impairment. Aim: The aim of the study is to find the prevalence of Gaming Disorder in college students and its correlation with self-esteem, perceived stress, and sleep quality. Methodology: A cross-sectional study was performed on 347 college students; in age range of 18–25 years. After obtaining Ethics Committee Approval, the selected participants were asked to fill in a questionnaire. The students having positive online gaming behavior were further evaluated for gaming disorder, self-esteem, perceived stress, and sleep quality. Statistical Analysis Used: Descriptive statistics were used to find the prevalence and correlations were done using Pearson's correlation coefficient. Results: The prevalence of online Gaming disorder was found to be 4.6% among the college students. An average of 2 h was spent on gaming per day with a positive, significant correlation with internet gaming disorder (IGD) score (r = 0.28, P = 0.00). Self-esteem was found to be weakly negatively correlated (r = −0.15, P = 0.02), perceived stress to be highly positively correlated (R = 0.87, P = 0.01), and poor sleep quality to be highly positively correlated (r = 0.92, P = 0.01) with IGD scale score. Conclusions: Online gaming behavior was found to be related to lower self-esteem and higher perceived stress and affecting sleep quality. Hence, we need to formulate preventive and treatment measures keeping these areas in mind.

Keywords: Gaming disorder, perceived stress, self-esteem, sleep quality


How to cite this article:
Bansal H, Kranti S K. Gaming Disorder among College Students and Correlation of Gaming with Self-esteem, Perceived Stress, and Sleep Quality. Ann Indian Psychiatry 2022;6:244-8

How to cite this URL:
Bansal H, Kranti S K. Gaming Disorder among College Students and Correlation of Gaming with Self-esteem, Perceived Stress, and Sleep Quality. Ann Indian Psychiatry [serial online] 2022 [cited 2022 Dec 10];6:244-8. Available from: https://www.anip.co.in/text.asp?2022/6/3/244/360075




  Introduction Top


A growing concern among the society is the avid involvement of children and adolescents in online gaming activity. This trend has now extended to college-going young adults and has increased the growing concern of the addiction potential of these online games.[1] Heavy users develop dysfunctional symptoms that impair their sociofunctional life. There have been few cases of suicide reported when children were stopped by their parents from playing games.[2]

Internet gaming disorder (IGD) is persistent and recurrent use of internet to engage in games, often with other players leading to clinically significant impairment or distress, a new diagnosable disorder in Diagnostic and Statistical Manual-5.[3] The WHO recognizes Gaming disorder as a newly diagnosable entity in the International Classification of Diseases (ICD-11).[4] Before this, there were varying terminologies used for the phenomena such as excessive online gaming, problematic or pathological internet use, problematic or pathological online gaming, compulsive internet use but none of these nomenclatures were standardized.[3]

According to the American Psychological Association, the prevalence of disorder is very small, with a wide variation in age groups involved-(from under 18 to over 50) and with no significant sex difference.[4] A study done in American youth in 8–18 age group found the prevalence to be 8% with increased time spending, poorer grades and attention problems.[5] Meta-analysis of various studies done on gaming disorder revealed a wide variation in prevalence depending on geographic location from 0.7% to 27.5%,[6] with majority in range of 1%–9%.[7] Male sex, younger age, familial discordance and disharmony, and marital difficulties including marital status have been found to be associated with increased prevalence of the disorder. Higher impulsivity and neuroticism, low self-esteem, low self-efficacy, and low life-satisfaction have been reported in people with this disorder. Comorbid psychiatric problems found to be associated with IGD include attention deficit hyperactivity disorder, depression, anxiety, sleep problems, conduct disorder, and substance use.[6]

Neurobiological mechanism is similar to other behavioral addictions and substance use disorders, hence diagnostic criteria have been formulated on similar lines. Pathological gaming leads to academic decline, greater levels of depression, social phobia, anxiety, strained relationships with parents, and aggressive tendencies. However, studies have found that only 26% of problematic users had symptoms over 2-year period with 50% resolution rate over 1-year period.[1]

Aggressive games involving teamwork and killing enemies are more habit forming than others.[4]

Massive multiplayer online role-playing game has higher addiction potential than others. Furthermore, it shows more social anxiety and social avoidance with fewer boosts to self-esteem than other genres like real-time strategy and first-person shooter.[8]

Parent-child relationship, parental restriction, and monitoring of online gaming, their marital and socioeconomic status may affect the likelihood of becoming a problematic gamer. Working parents are not able to spend time with their kids, or kids tend to isolate themselves to avoid marital disharmony amongst their parents. More diligent family members can direct child's attention toward other activities.[9]

Self-esteem is individual's perception of himself. Four cognitive factors have been found to be associated with underlying IGD: IGD-beliefs about game reward value and tangibility, maladaptive and inflexible rules about gaming behavior, over-reliance on gaming to meet self-esteem needs, and gaming as a method of gaining social acceptance.[10] A study has revealed that general self-esteem, social self-esteem, home-family self-esteem and total self-esteem, all are negatively correlated with Internet addiction and hence similarly affect gaming addiction potential also. Individuals, who evaluate themselves in a negative way, get a boost when they win in these games, compensate for the negations, thus escaping the reality. They perceive an increased sense of power and a higher status and thus this makes up for the perceived inefficiencies in the individual and has a positive evaluation of self for a short time.[11],[12] Depression mediates the relationship between self-esteem and various addiction potentials.[13]

Perceived stress mediates the relationship between emotional intelligence and online gaming addiction. Higher Perceived helplessness and lower perceived self-efficacy lead to increased addiction potential. Gaming serve as an escape from reality and stepping into a virtual world provides a feeling of relief from stress of daily life. People with good social skills develop effective coping strategies.[14]

Studies have shown that continuous gaming affects sleep. The severity of sleep disorder symptoms is directly proportional to the time spent in gaming. Those with online gaming disorder slept <5 h per night as compared to the casual online gamers who slept for approximately 7 h on an average.[15] Exposure to light while playing disturbs the circadian rhythm, the melatonin cycle, and cerebral plasticity leading to sleep disturbances and precipitation a number of psychiatric and neurological disorders. Furthermore, preoccupation with gaming and withdrawal can affect the sleep quality.[16]

Recently, games have become so popular and addiction prevalence is so increasing that schools are warning parents to monitor games' access and screen time for their child. Furthermore, although it is a diagnosable entity, mental health professionals are not trained enough to diagnose and manage the disorder yet. It is not clear if it requires treatment as other psychiatric illnesses or addictions.[4] Cognitive-behavioral therapy, family therapy, and motivational interviewing have been suggested, but efficacy and effectiveness cannot be concluded due to the lack of randomized controlled trials in this field.

Few studies have found no significant increase in the prevalence of IGD over past years in spite of increased usage of internet. Majority of the studies were done in schools as this phenomena is being studied more in adolescence.[3] Furthermore, there is a lack of consensus so as to what is to be considered as problematic gaming and there is debate on validity of IGD.[4] Many experts argue that there is not enough research on the same to call it a true disorder. Hence, the study is being taken up.

The aim of the study is to find the prevalence of gaming disorder in the college students and the relation of self-esteem, perceived stress, and sleep quality in these students with gaming behavior.


  Methodology Top


Ethical clearance from the Institutional Ethics Committee was sought before beginning of the study-(Approval statement number-IEC [III]/OUT/17/2019 dated 31st October 2019). Participants were selected from the entire 1st, 2nd, and 3rd year students pursuing various degrees from the college using the Stratified Random sampling technique. Students from 18 to 25 years of age were included. Total number of students in the college was found to be 3630. By applying Universal Sampling Formula,[17] taking 95% as confidence interval, 347 students were selected to participate in the study. Selected students were explained about the nature of the study and its application. Participant informed consent statement was taken from each participant as per Institutional Ethics Committee approval, along with consent taken for participation in the study and publication of the scientific results without revealing their identity, name, or initials. The participant is aware that although confidentiality would be maintained, anonymity cannot be guaranteed. Those who played online games were further assessed.

Procedure

A cross-sectional observational study was performed. A semi-structured self-administered Proforma was filled by each participant. The following four scales were used:

  • IGD Scale–short form (IGDS9-SF) containing nine questions[18]: To make the diagnosis of gaming disorder and estimate its prevalence,
  • Rosenberg Self Esteem Scale (RSES)[19]: To determine the self-esteem of students,
  • Perceived Stress Scale 10 (PSS-10)[20]: For finding out stress perceived by students that lead them to gaming and
  • Pittsburgh Sleep Quality Index (PSQI)[21]: To assess the quality of sleep in students with gaming.


Proformas of the participants, who had no online gaming behavior or were incompletely filled, were discarded.

Analysis

The collected data were tabulated. The frequency distribution of collecting demographic data was made and analyzed using descriptive statistics. Correlation of demographic variables with IGD score was done using Pearson's Coefficient. The prevalence of Gaming Disorder was determined based on descriptive statistics on IGD Scale, i.e., scoring “very often” on at least five out of nine questions. The obtained scores on IGDS9-SF, RSES, PSS-10, and PSQI were tabulated, and correlation of self-esteem, perceived stress, and sleep quality with gaming score was done using Pearson's coefficient. Linear regression models were obtained. The entire statistical analysis was done using SPSS 23.0 (Armonk, NY:IBM Crop).


  Results Top


A total of 347 students were selected using stratified random sampling from all the years of the various degree courses available in the college. Out of these, 27 forms were found to be incomplete and were discarded. Out of 320 students, 136 students did not play online games (i.e., nongamers = 42.5%) and they were excluded from the analysis. Out of the 184 people who were found to be playing online games, 15 participants fulfilled the criteria of IGD on IGDS9-SF scale (i.e., disordered gamers = 4.6% of total and 8.1% of gamers, nondisordered gamers = 52.8. Minimum score on IGD scale was found to be 9 and maximum score was 38 with an average of 17.47 (±7.23) [Table 1].
Table 1: Gaming details and parametric variables of study population

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Hence the prevalence of gaming disorder was found to be 4.6%.

The age of the students ranged from 18 to 25 years with an average of 19 (±1.34) years [Table 1]. Description of various demographic variables is given in [Table 2].
Table 2: Demographic details of study population

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Total duration of gaming was found to be in the range of 6 months to 10 years with an average of 2.5 ± 1.7 years [Table 1]. A weakly positive correlation (r = 0.13) was found between total duration of gaming and IGD score but was not found to be significant (P = 0.06) [Table 3].
Table 3: Correlation of various variables with Internet Gaming Disorder Scale 9 - short form score

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Time spent on gaming in a day ranged from 15 min to 9 h with an average of 2.03 (±1.79) hours [Table 1]. A positive correlation was found between IGD score and time spent on gaming per day (r = 0.28) which was found to be highly significant (P = 0.000) [Table 3].

Average score on RSES was 23.89 (±2.16), on PSS-10 was 19.18 (±4.81) and on PSQI was 6.50 (±3.48) [Table 1]. Significant correlation was found between IGD score and RSES, PSS-10 and PSQI as given in [Table 3].

Positive correlation was also found between PSS-10 score and PSQI score (r = 0.29) which was highly significant (P = 0.000).


  Discussion Top


In this study, it was found that prevalence of Gaming disorder was 4.6% in college students. This was very similar to the prevalence found by Singh et al. in medical college students, i.e., 3.6%.[22] Male predominance was seen in the casual gamers (63.5%) but not in the disordered gamers (53.3%), highlighting that males have higher tendency to use internet to play games, but tendency to develop disorder is equal in both sexes, although most of the studies have found male preponderance.[6] Majority of disordered gamers belonged to nuclear families (66.6%) with one parent working (66.6%), but strained relationships were observed between the parents (divorced/widowed/separated-53.3%), which acts as a stressor for the children, thus leading them to indulge in more gaming. This result is in keeping with the other studies.[6] 40% of disordered gamers had a history of substance use. Although the diagnosis of substance use disorder was not established, this indicates an increased vulnerability of students to develop either disorder, indicating a common mechanism for addiction potential.[23] Furthermore, half of the disordered gamers had family history of psychiatric illness, thus increasing the vulnerability to develop disorder.

There was a wide variation in total duration of gaming disorder (from 6 months to 10 years with an average of 2.5 ± 1.7 years), and no significant relationship could be found between IGD score and total duration. This can be attributed to either recall bias in the students or to the other contributory factors affecting the addiction potential like family history of psychiatry illness or gaming disorder or substance use or other environmental factors and stressors which increase the vulnerability to develop disorder in a short duration of game usage. Study done by Hussain et al. also showed variable number of years and total time spent on gaming to have a major impact on addiction,[24] though majority of studies found significant correlation between gaming disorder and total duration of gaming.[6]

Time spent on gaming per day has been to be as low as 15 min to as high as 9 h with an average of 2.03 (±1.79) hours. This shows a wide variation in time spent on gaming. It has been found to have a highly significant correlation (r = 0.28, P = 0.000) with IGD score, which means that more is the spent on gaming, more are the chances of developing the disorder. This clearly explains that people indulged in gaming start initially with few minutes increasing then to hours and ultimately, they have difficulty in controlling their time spent on gaming, thus it takes precedence over all other activities, ultimately leading to socio-occupational impairment and academic decline.[25]

IGD score was found to be significantly correlated to self-esteem (P = 0.02) with a weakly negative relationship (r = −0.15), which means that lower is the self-esteem, more is the probability of indulging into gaming. This is so because winning in these games boost up their self-esteems, leading to self-worth and thus increased gaming, hence they enter a vicious cycle. Similar results have been found in the studies conducted by Aydin et al.[11] and Hyun et al.[12]

A strong positive correlation (r = 0.87, P = 0.01) has been found between perceived stress and IGD score, between PSQI which means a poorer sleep quality (r = 0.92, P = 0.01) and IGD score, and between perceived stress and sleep quality (r = 0.29, P = 0.000), all found to be highly significant. This means that increased stress leads to increased gaming as games provide them a virtual world where they feel relieved of their stress and form a faulty coping mechanism, which leads to increased time spent on gaming leading to interference with sleep, which further increases the stress. Sleep and stress both interfere with the physical and psychological health of the person, hence increasing the vulnerability to develop gaming disorder. Similar findings have been found in other studies like Mannikko et al.,[26] Che et al.[14] and Wong et al.[16]

The study is unique in the sense that most of the previous studies have been done in adolescent population and school children. There have been very few studies in college students. Further very few studies have been done in India since the disorder has gained popularity only recently after being added as a diagnosable entity in ICD-11.

The study was done in a single college and from a metropolitan city and thus the results obtained cannot be generalized nationally. Since the study was a cross-sectional one, no causal relationships could be established. Response and recall bias may be present while answering the questions. Furthermore, since all the questionnaires were self-reported, individual factors like upcoming exams, family relations, various stressors, and personal goals may result in variation of scores in the self-esteem and perceived stress levels even in otherwise similar situations.

The study emphasizes the need for longitudinal studies on a large scale taking into account other variables that can overcome the above limitations. Further studies at various other centers and in multiple clinical and cultural settings across the country can draw a roadmap for the student community. Studying psychopathology in students with Gaming disorder is a future recommendation.


  Conclusions Top


The prevalence of gaming disorder among college students is 4.6%. Risk factors associated are nuclear families with strained relationships among parents, history of substance use, and family history of psychiatric illness. Total duration of gaming has been found to be on an average 2 years, and time spent in gaming in a day has been found to be on an average 2 h, which has significant positive correlation with IGD score. Furthermore, IGD score has been found to have a significant correlation with lower self-esteem, more perceived stress, and poorer sleep quality.

Implications

Gaming disorder is a new problem behavior which is gaining popularity. In depth understanding of contextual factors associated with gaming behavior would aid to formulate effective preventive and treatment modalities. Measures to create awareness among college students as well as school-going students are necessary for early identification and hence prevent further consequences like academic decline. Furthermore, this is being used as a faulty coping mechanism to deal with stress and low self-esteem, so dialogue needs to be increased between parents and their child.

Acknowledgment

The authors would like to thank the college and its students.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
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