|Year : 2022 | Volume
| Issue : 1 | Page : 33-39
Internet Gaming Disorder and Its Harmful Health Effects among the Medical Students in a Tertiary Care Teaching Hospital
Anshu Singh1, Tuhina Shree1, Prem Kumar2
1 Department of Community Medicine, School of Medical Sciences and Research, Sharda University, Gautam Buddh Nagar, Uttar Pradesh, India
2 Department of Medicine, School of Medical Sciences and Research, Sharda University, Gautam Buddh Nagar, Uttar Pradesh, India
|Date of Submission||09-Jun-2021|
|Date of Decision||23-Jun-2021|
|Date of Acceptance||28-Jan-2022|
|Date of Web Publication||29-Apr-2022|
Dr. Tuhina Shree
Department of Community Medicine, School of Medical Sciences and Research, Sharda University, Gautam Buddh Nagar, Uttar Pradesh
Source of Support: None, Conflict of Interest: None
Background: Online gaming has gained a lot of popularity due to easy accessibility of Internet-enabled devices. This has given rise to a new phenomenon of gaming addiction. The Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5) published by American Psychiatric Association, in 2013, included the term Internet gaming disorder (IGD). Impact of IGD on physical and psychologic health warrants further exploration. Objectives and methods: A cross-sectional study was carried out among medical students to find out the prevalence of IGD and the associated health effects. The study was conducted from July to September 2019. Data collection was carried out using a semistructured self-administered questionnaire consisting of sociodemographic profile, Pittsburgh sleep quality index, DSM-5 criteria for IGD and examination of participants. Data were entered and analyzed using frequency, percentage, and Chi-square test. Results: Almost three-fourth participants (72.2%) engaged in the online games out of which 30.9% had IGD. A higher proportion of male students were found to be suffering from IGD. Sleeping disorder was also found to be significantly more among those who had IGD. Conclusion: Prevalence of IGD was found to be high among medical students. The majority of gamers also faced various health consequences of which sleeping disorder was the major problem.
Keywords: Academic performance, DSM5, IGD, medical students, PSQI
|How to cite this article:|
Singh A, Shree T, Kumar P. Internet Gaming Disorder and Its Harmful Health Effects among the Medical Students in a Tertiary Care Teaching Hospital. MAMC J Med Sci 2022;8:33-9
|How to cite this URL:|
Singh A, Shree T, Kumar P. Internet Gaming Disorder and Its Harmful Health Effects among the Medical Students in a Tertiary Care Teaching Hospital. MAMC J Med Sci [serial online] 2022 [cited 2022 Jul 4];8:33-9. Available from: https://www.mamcjms.in/text.asp?2022/8/1/33/344352
| Introduction|| |
Living in this 21st century, there is a rapid and extensive proliferation of the Internet that has resulted in better opportunities for research, communication, and information. When used appropriately and responsibly, it has a vast application in the field of research, communication, information, leisure activities, business transactions, and learning. The benefits of Internet outweigh the risks but still it can sometimes cause a decline in physical and mental well-being owing to its potential for causing addiction in the form of, excessive gaming, pornography, chatting for long hours, gambling, online shopping, and promoting sedentary lifestyle. Goldberg in 1995 introduced the term “Internet addiction” for pathologic compulsive Internet use. Internet gaming addiction is the latest phenomenon in the world of the Internet. Many adolescents spend time playing video games on computer rather than using it for educational activities.
Online gaming revenue and customer base have steadily increased in the recent years. China’s worth online gaming market was 12 billion in 2013 as claimed by a market survey. A review article reported prevalence estimates ranging from 0.2% in Germany to 50% among Korean teenagers. Excessive Internet gaming has been described as a specific subtype of the Internet addiction. Online video games are considered the most popular recreational activities irrespective of age, gender, and culture. Few positive aspects of online gaming include personal affiliation and gamer couples strengthening their relationship. Gamers are also proven to be faster at complex procedures than nongamers and there is also an improvement in how their brain processes visual information. However, there is always a flip side of any new technology. Gaming disorder has been recently included in the 11th Revision of the International Classification of Diseases (ICD-11). Internet gaming disorder (IGD), defined as “ersistent and recurrent use of the Internet to engage in games, often with other players, leading to clinically significant impairment or distress,” is a condition for further study in the most recent version of the Diagnostic and Statistical Manual of Mental Disorders, the DSM-5. Research work exploring online gaming and the Internet addiction has increased in the last decade., The presentation of the IGD may range from a mild sociopersonal distress to a gross disorganization in behavior, self-care, health issues, and affected personal and professional life too.
Medical curriculum covers an academic course duration of 5 and a half years and students have to continually study around the clock. They use one or the other outdoor or indoor recreational activities for relieving stress. Most of the activities acts as a stress buster and has a beneficial effect; however, a few activities result in detrimental effects such as the IGD. The addicted students had playtime of 7 hours compared to average time of 3 hours and lesser concentration during classes, mood disturbance, anxiety, and sleep disturbances. Due to all these conditions, they can further develop conditions such as dry eyes, early cataract, and worse can lead to neurodegenerative diseases and personality disorder. Thus, online video game addiction is a serious health issue which should not be disregarded. Unfortunately, research on this addiction is still in its infancy. With this background, our study examines the prevalence of problematic online gaming among undergraduate medical students and its association with academic performance, and other health problems encountered.
| Methodology|| |
A cross-sectional study was conducted among medical college students of a tertiary care medical college of Gautam Buddh Nagar district, Uttar Pradesh. The study was conducted from July to September 2019 among MBBS undergraduates and interns. Our aim was to determine the prevalence of IGD among the medical students of Gautam Buddh Nagar district and to assess harmful health effects of IGD among the medical students.
Study tools: Consisted of a semistructured self-administered questionnaire consisting of following sections:
- Section 1: Sociodemographic profile
- Section 2: Pittsburgh sleep quality index (PSQI)
- Section 3: Epworth daytime sleepiness scale (EDSS)
- Section 4: DSM5 criteria for IGD
- Section 5: Examination of participants for height and weight
[TAG:2]Criteria for Internet gaming disorder in DSM-5[/TAG:2]
Pittsburgh sleep quality index: It is a self-reported instrument to assess the quality of sleep. The questions are framed in a 4-point Likert type and analyze factors such as sleep quality, sleep latency, sleep duration, sleep efficiency, sleep disturbance, and use of sleep medication.
Epworth daytime sleepiness scale: It is a scale intended to measure daytime sleepiness that is measured by use of a very short questionnaire. This can be helpful in diagnosing sleep disorders. It was introduced in 1991 by Dr Murray Johns of Epworth Hospital in Melbourne, Australia. The questionnaire asks the subject to rate his or her probability of falling asleep on a scale of increasing probability from 0 to 3 for eight different situations. The scores for the eight questions are added together to obtain a single number. A number in the 0 to 9 range is considered to be normal, whereas the numbers 10 and 11 are border line and 12 to 24 range indicates that expert medical advice should be sought.
Sampling method: All the medical undergraduates from first to final year and interns who gave their verbal consent to participate in the study were included in the study. Convenient sampling method was used.
Inclusion criteria: Students who gave consent and those who were present at the time of study on that particular day.
Exclusion criteria: Students who refused to give consent to fill the form.
Data collection: The aim of the study been explained to all the study participants and their consent had been taken before the study. Information thus collected was kept strictly confidential. Questionnaire was distributed among all medical students and interns enrolled in the college. After the inclusion and exclusion criteria were met a total of 615 MBBS students and interns participated in the study.
Analysis of data: The information collected was converted into computer-based spreadsheet using SPSS software. Descriptive statistic such as mean standard deviation, percentage was used to describe the data collected in the present study.
Informed consent: Informed consent was obtained from all participants and they can terminate the survey anytime they desire.
Ethical concerns: This was a cross-sectional study without intervention. Consent was obtained from participants. Approval of the study protocol was obtained from institutional ethical committee and all research data were kept secure and participant confidentiality was maintained.
| Results|| |
A total of 615 medical students consented to participate in the study. All the students enrolled in the first professional participated in the study forming the largest proportion (24.4%) of the total participants. The proportion of fourth professional students (15.1%) and interns (13.3%) participating in the study was the least. Nearly equal proportion of male (48.2%) and female (51.2%) study subjects were present in the study [Table 1].
|Table 1 Year-wise distribution of gender profile of medical undergraduates (N = 615)|
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As shown in [Table 2], almost three-fourth participants (72.2%) engaged in the online games. At the time of the interview more than one-third of the participants (35.2%) had been playing online games for greater than 6 months. Prevalence of IGD was found to be high in our study with almost one-third of the students (30.9%) suffering from IGD according to DSM-5 criteria. Most preferred place of playing online games was bed or couch (60.1%) followed by classroom (26.6%).
|Table 2 Distribution of participants according to gaming characteristics (N = 615)|
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Nearly one-third of the participants (32%) suffered from various health problems due to indulging in online gaming. Out of those who faced problems, more than half had been playing online games for more than 12 months [Figure 1]. Based on PSQI and EDSS, abnormal sleeping quality was found among more than one-third of the participants (36.9%). Academic performance of more than one-third of the students (35.3%) had suffered with a calculated average score of less than 60% in last 1 year. More than one-third of the students fell under the category of overweight and obese of WHO classification of body mass index (BMI) [Table 3].
|Figure 1 Health problems related to gaming among the study subjects’ (N = 142) multiple responses.|
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|Table 3 Distribution of participants according to the key issues faced due to online gaming (N = 615)|
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Majority of gamers suffered negative consequences of online gaming. Sleeping disorder was most often reported health problem followed by dry eyes and weight gain. On determining association of duration spent in playing online games and its negative health impact, health problems were found to be significantly more among participants playing online games for more than 12 months (62.7%) when compared with those who had been playing for less than 12 months (37.3%; P < 0.001) [Figure 1].
[Table 4] depicts the association of IGD and associated problems. When compared with female students, a higher proportion of male students was found to be suffering from IGD (P < 0.001). Sleeping disorder was found to be significantly more in participants suffering from IGD (P < 0.001). The proportion of overweight/obese participants did not differ by presence of IGD (P = 0.49). Academic performance was also not found to be statistically significantly associated with the IGD (P = 0.14) [Table 4].
| Discussion|| |
With the advancement of technology, we have entered the era of Internet. The Internet is now available even in the far reaches of our country and has become integral part of our lives. With time, Internet gaming, both online and offline, gained popularity, not only among youth but adults too. Gamers spend a considerable amount of time in online gaming. With the easy accessibility of the Internet and an increase in problematic Internet usage, there is a high likelihood of potentially addictive behavior. The occurrence of IGD can further lead to lifestyle disorders and health problems among gamers. This study attempts to expand our knowledge of IGD among medical students in India.
In our study, among 615 medical students who participated, nearly three-fourth students (72.2%) engaged in online games. Similarly, a study conducted among undergraduate medical and dental students in Ludhiana, Punjab reported a high proportion of students (79.2%) playing online games. However, Gammal et al. in a study among university students, observed that only 37% participants engaged online games which is quite less than the prevalence we found in our study.
A high prevalence of IGD (30.9%) was observed in our study among medical students. This was in accordance to a study conducted by Severo et al. reporting a prevalence of 38.2% of IGD among secondary students and undergraduates in Southern Brazil. Another study conducted in Lebanon found prevalence of IGD as 9.2%; however, 35.7% were reported to be at the risk of developing IGD. By contrast, Singh et al. in a study investigating the pattern of IGD in India observed a prevalence of 3.6% among medical undergraduates. Mihara and Higuchi in a systematic review estimated global prevalence of IGD ranging from 0.70% to 27.50%. Another systematic review of IGD among children and adolescents between the period of 1991 and 2016 found the prevalence in the range of 0.60–50%. Darvesh et al. in a scoping review found that the prevalence of IGD ranging from 0.21% to 57.50% in general populations and 3.20% to 91.00% in clinical populations. The prevalence of IGD observed in our study was higher when compared with the prevalence observed in various other international and national studies.,, This high prevalence of IGD observed in our study can be attributed to the higher socioeconomic status of all the study participants with readily available Internet and smartphones which provide them an easier access to Internet games that too with the latest technologic advancements. In addition, the criteria and definition employed to diagnose IGD varied across different studies which can be the reason for difference of prevalence observed between present study and above-mentioned studies. The geographical and cultural diverseness could also be the contributing factors in the variation of prevalence.
The gender distribution of male and female students was almost equal in our study (48.2% and 51.8%, respectively) which was in line to a study conducted by Singh et al. among medical undergraduates. Moreover, occurrence IGD was found to be significantly more in male participants when compared with female participant in our study which was consistent with study carried out by Wartberg et al., Salam et al., and Taechoyotin et al.,, Another study carried out among undergraduate medical and dental students also found male gender to be a risk factor for IGD. In contrast, Przybylski et al. found no association of IGD with gender.,
In the current study, one-third of the students (32%) suffered health problems due to playing online games. Sleeping problems, dry eyes, and weight gain were the most commonly reported health problems. A wide range of health problems were identified in previously conducted studies. Israel Ayenigbara in his literature review carried out to understand the impact of gaming on health, reported that the eye problems, musculoskeletal problems, and weight gain were the most frequently encountered health issues. A study among Swedish adolescents reported symptoms of depression, musculoskeletal problems, and psychosomatic issues. Headache was found to be the most commonly reported problem due to online gaming in studies conducted in Punjab and Kerala.
The present study used PQSI scale to assess sleep quality of the participants and more than one-third of the students (36.9%) were found to have poor sleep quality. Gammal et al. and Severo et al. reported a very high proportion of participants (52% and 60%, respectively) suffering from a poor sleep quality which are in concordance with our study., Abnormal sleep quality was found to be significantly associated with IGD in our study which was supported by findings from other global studies.,,, Findings in our study was also comparable to other studies carried out in various regions of India.,
In our study, more than one-third of the participants (38.5%) were found to be overweight/obese, although IGD was not found to be significantly associated with BMI. Similarly, inconclusive evidence of association of obesity with video gaming was found in a scoping review which examined research papers published between 2013 and 2018. Contrary to our study fourth Thai National Health Examination Survey, found increased risk of overweight with online games. A study conducted among adolescents also found a positive correlation between videogame addiction and abdominal obesity. Melchior et al. in study conducted among young adults also reported that those who were engaged in video games were more likely to be overweight.
In our study, more than one-third of the students (35.3%) had a score of less than 60% in last 1 year and no significant association of academic performance was found with IGD. Similarly, Gammal et al. and Taechoyotin et al. also reported no significant association among them., On the contrary, a study conducted among Lebanese adolescents found a low academic performance among IGD group.
Our study reflected the findings in medical students which limits the generalizability of the findings. In addition, we only measured height and weight of the participants; other parameters such as diet and other behavioral factors were not evaluated. BMI is a flawed indicator of fitness, as it does not take into account sex, age, or body fat. Moreover, impact of behavioral risk factors such as smoking and alcohol consumption was not taken into consideration. Effect of other recreational interests involving outdoor activities also was not taken into account.
| Conclusion|| |
Based on the findings of the current study, there is a high prevalence of IGD among medical students. Online gaming affects all aspects of life, whether it is academic progress or lifestyle disorders. Quality of sleep was also found to be poor among gamers. Compared to girls, boys were found to be more at risk of IGD. Its time that IGD gets the attention it deserves, as online gaming is becoming increasingly prevalent among the different strata of the society.
Limiting Internet usage can also be practiced. Family members should be promoted to get more involved and create a positive environment to prevent the occurrence of IGD. Children should be made aware right from the school days regarding the addicting potential of Internet. Parents as well as students in their initial classes should be sensitized regarding IGD by conducting awareness sessions in schools and colleges. Parents can be taught to monitor the Internet usage timing. Service for Healthy Use of Technology clinic, a first of its kind initiative by National Institute of Mental Health and Neurosciences is helping people in deaddiction from technology. It uses a digital detox mobile-based application. Awareness regarding such applications and clinics can be raised among the multitude and also the individuals affected with IGD.
Financial support and sponsorship
Conflicts of interest
There are no conflicts of interest.
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[Table 1], [Table 2], [Table 3], [Table 4]