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 Table of Contents  
ORIGINAL ARTICLE
Year : 2021  |  Volume : 7  |  Issue : 2  |  Page : 114-118

Internet gaming disorder among medical students: An observational study from Central Kerala, India


Department of Community Medicine, Believers Church Medical College Hospital, Thiruvalla, Kerala, India

Date of Submission30-Apr-2021
Date of Decision08-Jun-2021
Date of Acceptance16-Jun-2021
Date of Web Publication30-Dec-2021

Correspondence Address:
Shaliet Rose Sebastian
Department of Community Medicine, Believers Church Medical College Hospital, Kuttapuzha, Thiruvalla - 689 103, Kerala
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/jcrsm.jcrsm_28_21

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  Abstract 


Background: The development of information technology has popularized Internet gaming as a leisure time activity. India is currently ranked fifth among the list of top countries by game downloads globally. This makes a subset of the population of India, especially the young and adolescents, extremely vulnerable to the harms associated with excessive digital gaming. Although, most of the time, playing video games is harmless and even may be associated with cognitive, social, or physical benefits, excessive use of playing games can lead to various health problems in some individuals.
Objective: The objective of the study was to estimate the prevalence of problematic gaming among medical students in Central Kerala by Internet Gaming Disorder Test (IGDT)-10 questionnaire using Diagnostic and Statistical Manual of Mental Disorders-5 (DSM-5) scale.
Materials and Methods: A cross-sectional study was conducted among undergraduate MBBS students across Pathanamthitta, Alappuzha, Kottayam, and Ernakulam districts. Data were collected using a ten-item IGDT-10-English version and analyzed by DSM-5 scale. Data on demographic details and information about gaming were expressed as proportions with a 95% confidence interval (CI).
Results: The prevalence of problematic gaming among medical students in Central Kerala is 6.98%. Playing video games (χ2 = 190.10, P = 0.001) and playing games for >3 h (χ2 = 207.05, P = 0.001) were significantly associated with the physical complaints of headaches, neck pain, and wrist pain among gamers (odds ratio = 40.6, 95% CI [18.776–87.936]).
Conclusion: Problematic gaming among medical students is on the rise, and therefore, there is a need for a check and timely remedial action.

Keywords: Central Kerala, gaming disorder, medical students, problematic gaming


How to cite this article:
Bhaskar R, Babu BP, Sebastian SR. Internet gaming disorder among medical students: An observational study from Central Kerala, India. J Curr Res Sci Med 2021;7:114-8

How to cite this URL:
Bhaskar R, Babu BP, Sebastian SR. Internet gaming disorder among medical students: An observational study from Central Kerala, India. J Curr Res Sci Med [serial online] 2021 [cited 2022 Jan 19];7:114-8. Available from: https://www.jcrsmed.org/text.asp?2021/7/2/114/334454




  Introduction Top


India is one of the largest and fastest-growing markets for digital consumers. The development of information technology, Internet, and gaming consoles have also popularized Internet gaming as a leisure time activity, regardless of age and gender. A recent market survey reported that India is currently ranked fifth among the list of top countries by game downloads globally.[1] This makes a subset of the population of India, especially the young and adolescents, extremely vulnerable to the harms associated with excessive digital gaming.[2] The phenomenon of Internet gaming disorder (IGD) is broadly described as a form of persistent and recurrent involvement with video games, often leading to the decline of daily work and/or education activities. Although, most of the time, playing video games is harmless and even may be associated with cognitive, social, or physical benefits, excessive use of playing games can lead to various health problems in some individuals, with reports of game-induced seizures and even deaths.[3] The published literature has documented physical, psychological, social, and work-related problems such as disturbed sleep pattern, dehydration, pressure sores, increased irritability and aggression, depressive and/or anxiety symptoms, poor academic performance, and neglect of interpersonal relationships and work-related commitments among persons with excessive and problematic gaming.[4]

The World Health Organization has classified IGD as a diagnosable mental disorder under the International Classification of Diseases-11. IGD is “Persistent and recurrent use of the Internet to engage in games, often with other players, leading to clinically significant impairment or distress as indicated by five (or more) of the following in a 12-month period.” The criteria are preoccupation, withdrawal, tolerance, unsuccessful attempts to control, loss of interests, continued excessive use despite psychosocial problems, deceiving, escape, and functional impairment.[5]

The prevalence of IGD varies worldwide and is estimated to be between 0.2% and 8.5%.[6],[7] Publications have reported cases of game-induced seizures and even death reported among individuals with severe GD.[8] Past research has shown that excessive mobile gaming adversely affects sleep by causing increased sleep-onset latency and sleep deficiency.[9] Previous studies have shown that people who spend a lot of time playing video games may have reduced hippocampal integrity, which is a risk factor for neurological disorders such as Alzheimer's disease.[10] A study conducted by Caplan,[11] revealed that there was cognitive impairment among video game addicts. A research done by Buiza - Aguado et al.[12] on problematic video gaming in a Young Spanish Population in Association with psychosocial health in a sample size of 708 adolescents using IGD-9 Scale showed a prevalence of 8.3. A research done by Deleuze et al.[13] on established risk factors for addiction fail to discriminate between healthy gamers and gamers endorsing Diagnostic and Statistical Manual of Mental Disorders 5 (DSM-5) IGD in Belgium in a population of 97 using DSM-5 and Latent Class Analysis Scale among adolescents showed a prevalence of 36. A research done by Kim et al.[14] on characteristics and psychiatric symptoms of IGD among adults using self-reported DSM-5 criteria in a population of 3041 in the Korean population showed a prevalence of 13.8.

Playing online games is a widespread activity among undergraduate medical students and a substantial proportion of these students exhibit addictive behavior with regard to online gaming.[15] The analysis of the extent and pattern of gaming behaviors (both offline and online) among medical students showed that 3.6% of them have self-reported IGDs according to the DSM-5 criteria.[2] Majority of the reviews and studies published have considered IGD synonymous to Internet addiction disorder. Most of these studies have used scales to assess addiction to Internet to diagnose and assess the severity of online gaming addiction. However, internet addiction and IGD are distinct entities according to Griffith and Pontes.[16] To the best of our knowledge, there are no published studies regarding gaming disorder diagnosed by the IGD questionnaire among youth, especially medical students in Central Kerala. Hence, in this context, this study was conducted to know the prevalence of gaming disorder among medical students in Central Kerala.


  Materials and Methods Top


This cross-sectional survey was conducted among medical students of age group 18–30 years from Central Kerala during the months of December and January 2020. This survey was conducted in the nonexamination season across the undergraduate MBBS students. All medical colleges in Pathanamthitta, Alappuzha, Kottayam, and Ernakulam districts were included in the study. Ethical clearance was obtained from the Institutional Ethical Committee. The sample size was calculated as 1340, according to the formula n = (1.96) 2 pq/L2 using the prevalence from a previous study.[17] The sampling frame consisting of the names of all medical students enrolled in the medical colleges in Central Kerala was prepared. After obtaining consent, the English version of the ten-item IGD test (IGDT)-10[18] incorporated into an online Google Docs Form was sent to 1340 medical students randomly selected from the sampling frame. The ten-item IGDT is a short screening instrument that assesses IGD corresponding to the nine diagnostic criteria of the DSM-5 IGD (the last item is split in two but should only be counted once). In agreement with DSM-5, a diagnosis of IGD is considered positive if five criteria are validated. Each criterion is filled by the patient as “never,” “sometimes,” or “often,” a criterion is validated if it is reported to be present “often” in the past 12 months according to DSM-5 guidelines. The DSM-5 lists nine IGD criteria reflecting the following symptoms: preoccupation, tolerance, withdrawal, deception, escape, continuing despite problems, loss of control, giving up other activities, and negative consequences.[5] The responses to the nine items were self-rated by the participants on a 5-point Likert scale as follows: 1= “Never,” 2= “Rarely,” 3= “Sometimes,” 4= “Often,” and 5= “Very Often.” The total score was calculated by adding the scores obtained on all the nine items. It ranged from 9 to 45, with higher scores suggestive of a greater severity of IGD. Prevalence was calculated by taking the count of all the students who have scored 5 and above in the total IGDT scoring. Of 1340 survey forms sent, 802 responses were received. The data collected were analyzed using the software Statistical Package for the Social Sciences version 21 (Armonk, NY: IBM Corp). Data on demographic details and information about gaming were expressed as proportions with a 95% confidence interval (CI). A Chi-square test was used to evaluate statistical significance of association; odds ratio (OR) with 95% CI was calculated. P < 0.05 was considered statistically significant.


  Results Top


The sociodemographic details of the study population are shown in [Table 1].
Table 1: Sociodemographic details of the study population

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The responses of the study population to IGD 10 questionnaire are summarized in [Table 2]. About 18% of the study participants reported to resort to gaming to relieve a negative mood.
Table 2: Responses of the study population to Internet Gaming Disorder-10 Questionnaire

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The prevalence of problematic gaming is shown in [Figure 1]. Of 802 study participants, 47% gave a history of physical illnesses such as headaches, neck pain, and pain in the hands and wrists which they attributed to their habit of gaming [Figure 2].
Figure 1: Prevalence of problematic gaming among study participants

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Figure 2: Bar graph showing the physical symptoms among the study participants

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Test of association

The Chi-square analysis of study data revealed no significant association between the age and gender of study participants and online gaming behavior. The Chi-square analysis of the data revealed a significant association between playing video games (χ2 = 190.10, P = 0.001) and playing games for >3 h (χ2 = 207.05, P = 0.001) and physical complaints of headaches, neck pain, and wrist pain among gamers (OR = 40.6, 95% CI: 18.776–87.936).


  Discussion Top


The present study was done to find out the prevalence of gaming disorder among medical students in Central Kerala. Of 802 students who responded to IGDT questionnaire, 56 students have IGDT scores equal to and above 5. The prevalence of problematic gaming was found to be 6.98%. A study analyzing the extent and pattern of gaming behaviors (both offline and online) among medical students showed that 3.6% of them have self-reported IGDs according to the DSM-5 criteria.[2] While a similar research conducted among medical students in Goa revealed that 8% of the study participants showed problematic online gaming,[15] a study on Internet use behavior among medical students from Kerala revealed that <33% of the 368 study participants played online games.[19] The present study revealed a significant association between online gaming and occurrence of physical illness among gamers. A similar research identified that physical (eye strain)/psychological distress (decrease sleep, irritability, and restlessness) was present as morbidity - 6.8% with mobile phone addiction; 4.2% with Internet use; and 3% with social networking sites among a sample of 2755.[20] Another study found that 40% of study participants reported disturbance in lifestyle in the form of sleep disturbance/irregular eating pattern/decreased involvement in offline activities and decrease communication/interaction with others.[21]


  Conclusion Top


The rising prevalence of gaming addiction among youth, especially medical students, is a cause for concern and requires timely intervention. Increasing awareness regarding gaming addiction, limiting gaming time, and indulging in outdoor activities such as badminton and football are some of the measures that could help combat the problem. Further research is necessary to explore various effective interventional strategies in gaming addiction among youth.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
  References Top

1.
Kola V. About the Future of Gaming in India. Web Report; 2017. Available from: https://yourstory.com/2017/05/future-gaming-India/. [Last accessed on 2020 Mar 15].  Back to cited text no. 1
    
2.
Singh S, Dahiya N, Singh AB, Kumar R, Balhara YP. Gaming disorder among medical college students from India: Exploring the pattern and correlates. Ind Psychiatry J 2019;28:107-14.  Back to cited text no. 2
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3.
Petry NM, Rehbein F, Ko CH, O'Brien CP. Internet Gaming Disorder in the DSM-5. Curr Psychiatry Rep 2015;17:72.  Back to cited text no. 3
    
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Saunders JB, Hao W, Long J, King DL, Mann K, Fauth-Bühler M, et al. Gaming disorder: Its delineation as an important condition for diagnosis, management, and prevention. J Behav Addict 2017;6:271-9.  Back to cited text no. 4
    
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American Psychiatric Association. Condition for further studies. Diagnostic and Statistical Management of Mental Disorders. 5th ed., Sec. 3. Washington, DC: American Psychiatric Association; 2013.  Back to cited text no. 5
    
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Hur MH. Demographic, habitual, and socioeconomic determinants of internet addiction disorder: An empirical study of Korean teenagers. Cyberpsychol Behav 2006;9:514-25.  Back to cited text no. 6
    
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Gentile D. Pathological video-game use among youth ages 8 to 18: A national study. Psychol Sci 2009;20:594-602.  Back to cited text no. 7
    
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Lee H. A new case of fatal pulmonary thromboembolism associated with prolonged sitting at computer in Korea. Yonsei Med J 2004;45:349-51.  Back to cited text no. 8
    
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Hysing M, Pallesen S, Stormark KM, Jakobsen R, Lundervold AJ, Sivertsen B, et al. Sleep and use of electronic devices in adolescence: Results from a large population-based study. BMJ Open 2015;5:e006748.  Back to cited text no. 9
    
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West GL, Drisdelle BL, Konishi K, Jackson J, Jolicoeur P, Bohbot VD, et al. Habitual action video game playing is associated with caudate nucleus-dependent navigational strategies. Proc Biol Sci 2015;282:20142.  Back to cited text no. 10
    
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Caplan SE. Relations among loneliness, social anxiety, and problematic internet use. Cyberpsychol Behav 2007;10:234-42.  Back to cited text no. 11
    
12.
Buiza-Aguado C, Alonso-Canovas A, Conde-Mateos C, Buiza-Navarrete JJ, Gentile D. Problematic video gaming in a young Spanish population: Association with psychosocial health. Cyberpsychol Behav Soc Netw 2018;21:388-94.  Back to cited text no. 12
    
13.
Deleuze J, Nuyens F, Rochat L, Rothen S, Maurage P, Billieux J. Established risk factors for addiction fail to discriminate between healthy gamers and gamers endorsing DSM-5 internet gaming disorder. J Behav Addict 2017;6:516-24.  Back to cited text no. 13
    
14.
Kim NR, Hwang SS, Choi JS, Kim DJ, Demetrovics Z, Király O, et al. Characteristics and psychiatric symptoms of internet gaming disorder among adults using self-reported DSM-5 criteria. Psychiatry Investig 2016;13:58-66.  Back to cited text no. 14
    
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Bicholkar AU, Dias A, Mascarenhas V. Prevalence of problematic online gaming among undergraduate medical students and its relation to well-being, self-esteem and depressive mood in Goa, India. Int J Community Med Public Health 2019;6:1133-8.  Back to cited text no. 15
    
16.
Griffiths MD, Pontes HM. Internet Addiction Disorder and Internet Gaming Disorder are Not the Same. J Addict Res Ther 2014;5:e124. doi:10.4172/2155-6105.1000e124.  Back to cited text no. 16
    
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Yarasani P, Shaik RS, Myla AR. Prevalence of addiction to online video games: Gaming disorder among medical students. Int J Community Med Public Health 2018;5:4237-41.  Back to cited text no. 17
    
18.
Király O, Bőthe B, Ramos-Diaz J, Rahimi-Movaghar A, Lukavska K, Hrabec O, et al. Ten-Item Internet Gaming Disorder Test (IGDT-10): Measurement invariance and cross-cultural validation across seven language-based samples. Psychol Addict Behav 2019;33:91-103.  Back to cited text no. 18
    
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Smitha CA, Parvathy RS. Emotional intelligence, perceived stress, and internet use behavior among undergraduate medical students-a cross sectional study. Kerala J Psychiatry 2020;33:105-13.  Back to cited text no. 19
    
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Sharma MK, Rao GN, Benegal V, Thennarasu K, Thomas D. Technology addiction survey: An emerging concern for raising awareness and promotion of healthy use of technology. Indian J Psychol Med 2017;39:495-9.  Back to cited text no. 20
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21.
Archana R, Sharma MK, Kumar KJ, Marimuthu P. Internet gaming disorder and psychiatric symptoms in Bengaluru, India: Treatment implication for promotion of user mental health. Indian J Soc Psychiatry 2019;35:135-6.  Back to cited text no. 21
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    Figures

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