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 Table of Contents  
ORIGINAL ARTICLE
Year : 2021  |  Volume : 30  |  Issue : 5  |  Page : 615-619

Prevalence and predictors of gaming disorder among undergraduate medical students in Enugu, Nigeria: Video game addiction in focus


1 Department of Community Medicine, Enugu State University College of Medicine; Department of Community Medicine, Enugu State University Teaching Hospital, Enugu, Nigeria
2 Department of Paediatrics, Enugu State University College of Medicine and Enugu State University Teaching Hospital, Enugu, Nigeria

Date of Submission20-Feb-2021
Date of Decision31-Aug-2021
Date of Acceptance31-Aug-2021
Date of Web Publication11-Oct-2021

Correspondence Address:
Dr. Awoere T Chinawa
Department of Community Medicine, Enugu State University College of Medicine, Parklane, Enugu; Department of Community Medicine, Enugu State University Teaching Hospital, Enugu
Nigeria
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/NJM.NJM_40_21

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  Abstract 


Objective: The objective of the study was to determine the factors and predictors of gaming disorder among medical students in Enugu, Nigeria. Methods: A cross-sectional study design involving undergraduate medical students in Enugu. Addiction to video games was measured using a Video game Addiction Test. This was used to obtain information from 400 respondents. Results: Addiction to video games was recorded in 158 students (39.5%). On both bivariate analyses, gender and academic level were associated with being addicted to video games while on the multivariate analysis being male (adjusted odds ratio [AOR] = 3.95, confidence interval [CI] = 2.52–6.20) in 300 academic levels and below (AOR = 2.03, CI = 1.29–3.19) and sponsorship were predictors. Conclusion: The majority of students in this study are not addicted to video games. Being males predicted video game addiction. Since this disorder is yet to be fully explored in this setting, there is a need for health-care workers to create awareness about the effects and means to mitigate against the disorder in this setting. Further research is needed on the physical and psychological health effects of this form of addiction on the players.

Keywords: Addiction, Enugu, gaming disorder, undergraduate medical students, video games


How to cite this article:
Chime OH, Chinawa AT, Nduagubam OO. Prevalence and predictors of gaming disorder among undergraduate medical students in Enugu, Nigeria: Video game addiction in focus. Niger J Med 2021;30:615-9

How to cite this URL:
Chime OH, Chinawa AT, Nduagubam OO. Prevalence and predictors of gaming disorder among undergraduate medical students in Enugu, Nigeria: Video game addiction in focus. Niger J Med [serial online] 2021 [cited 2021 Dec 5];30:615-9. Available from: http://www.njmonline.org/text.asp?2021/30/5/615/327961




  Introduction Top


Gaming disorder is characterized by loss of control over gaming, worsening credence attributed to gaming over other leisure to the point that it takes precedence over other interests with its attendant negative consequences.[1] Like other behavioral addictions, gaming disorders are often characterized by an irresistible urge, to repeatedly engage in a task and an insurmountable difficulty to stop this behavior despite its devastating sequel.[1]

Video gaming is a very topical issue among students with attendant psychosocial and economic impact. For instance, in 2015 about $100 billion was spent on gaming worldwide, with the United States contributing almost 25%. Video games play a major role in the lives of children, with 97% of them being involved for at least 1 h every day in the United States.[2] Engaging in this activity has educational, social, and therapeutic benefits.[3],[4] While this can be a form of relaxation for some video game players, studies have shown that other players lose control over the act with this excessive and addictive activity similar to that seen among gamblers.[3],[5] Video game addiction is defined as behavioral addiction characterized by loss of control over gaming, preoccupation with gaming, using video games for mood modifications and control, resulting in social and/or emotional problems with withdrawal symptoms on quitting.[6] Although it had not been recognized as a disorder, the problems related to playing video games have been a source of concern for gamers, their families, researchers, and politicians as far back as 1980s in the US and UK.[7] Video games are potentially addictive and have resulted in a number of claims of delinquency including theft, prostitution, drug trafficking, and other vices.[7] Certain types of video games are more addictive than others with the most addictive video games being online games, usually employing well-established psychological principles to encourage longer periods of play. These games provide a sense of companionship, feature colorful graphics and sound effects, provide in-game rewards and bonuses for winning moves, and allow massive online participation and role-playing by the gamers. They require minimal efforts in the early stage but slowly evolving into extensive gaming sessions.[8] Research has shown that the amount of time spent playing video games is associated with poor school performance, increased violence, and erratic behavior.[9],[10],[11] The WHO on the other hand reports that having this disorder is not directly related to the time spent playing these games, rather to the severity of its distortion with the total well-being of the individual.[1] However, for a diagnosis of gaming disorder to be made, this behavioral pattern would have lasted for not <12 months.[1]

Although studies showed that fewer people who involve in these activities present with gaming disorder, students should take cognizance of the time spent on these activities, especially in a situation when other daily activities are omitted, as there could be alteration in their physical, psychological, and social well-being.[1] Like other forms of addiction, students preoccupied with video games have lesser concentration during classes have different levels of anxiety and depression; thereby resulting in poor academic performance, especially among males.[12],[13]

With increasing accessibility to video games due to technological advancements, this addiction is expected to be on the increase. At present, there is a paucity of information on the prevalence of gaming disorder in this setting. This happens to be the first study on video game addiction among undergraduate medical students in southeast Nigeria. This study is therefore aimed at determining the factors that influence gaming disorder among undergraduate medical students and comparing findings across other regions of the world.


  Methods Top


Study design, population, and sampling

A descriptive study was carried out in Enugu State, southeast Nigeria. The study population includes the undergraduate medical and dental students in the two medical schools and one school of dental technology, respectively; this includes Enugu State University College of Medicine, UNTH, Ituku Ozalla campus, and Federal School of Dental Technology and Therapy Enugu. The ethical permit was obtained from the Health and Research Ethics Committee of ESUCOM. The sampling frame for the study includes students in the three schools. The sample size for each school was proportionally allocated to the schools based on the students' population in each school. The students were first stratified according to their academic levels after which the simple random sampling was used to select participants.

Measurement of variable

A pretested self-administered questionnaire was used to determine the prevalence of gaming addiction. The study instrument used is the Video Game Addiction Test (VAT).[6] This is a 13-item questionnaire containing the Likert scale. A score of 4 indicated a strong tendency toward addiction to the specific item. Addiction was calculated by summing all 13 items. The sum of the responses, ranging from 0 to 52, was categorized into two using the mean score of 10 as the cutoff score. Students with scores of 10 or below were categorized as not addicted, whereas those with scores above 10 were said to be addicted. Among those addicted, score within the range of 11–21 was categorized as mild addiction, 22–32 as moderate addiction. whereas above 32 as severe addictions.

Data collection and analysis

Data collection was done by trained researchers over 8 weeks. The questionnaires were distributed in the classes during free lecture periods and collected immediately. Data were analyzed by means of Statistical Package for the Social Sciences IBM (SPSS) Chicago, version 22. Results are presented as frequencies in tables and cross-tabulations. Chi-square was used for correlation between two variables, whereas predictors of online gaming addiction were assessed using logistic regression. P = 0.05 is obtained as statistical significance.


  Results Top


The mean age of respondents was 21.9 ± 3.6 years with the modal age range (49.3%) within 21–25 years. The majority were females (62.2%) whereas 149 (37.3) were in 100 level. A greater proportion of the students (70.3%) received a monthly stipend of ₦20,000 or more from their sponsors who were chiefly parents (87.8%) [Table 1].
Table 1: Sociodemographics of undergraduate medical students

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Concerning video game addiction, only 5 (1.3%) of the respondents persistently think about video games when they are not playing. Twenty-six (6.5%) always need to repeat a game anytime they did not obtain desired results. The majority of the respondents reported that playing video games has never affected their class attendance (76.0%) nor reduced homework or chores (72.3%). Rarely (14.8%) do students spend less time with friends and family due to attention to video games than intended [Table 2].
Table 2: Video game addiction among undergraduate medical students

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Having categorized addiction to video gaming into two, 158 students (39.5%) were found to be addicted, whereas the remaining 242 (60.5%) were found not to be addicted to video games.

Based on the further categorization of students with addiction, 81 students were reportedly classified as having mild addiction, 54 had moderate, whereas 23 were severely addicted to playing video games [Table 3].
Table 3: Prevalence of addiction based on gender

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The difference between males and females was statistically significant with a higher proportion of female students (71.1%) presenting with no addiction when compared with their male counterparts (43.0%).

Gender was significantly associated with addiction to video games with males having approximately four times the odds of being addicted (adjusted odds ratio [AOR] = 3.95, confidence interval [CI] = 2.52-6.20) when compared with their female counterparts (P < 0.001). Students in 300 academic levels and below were about two times more likely to be addicted than those above 300 level (AOR = 2.03, CI = 1.29–3.19) and this finding was statistically significant (P = 0.035). Although not significant at the bivariate level, students sponsored by their parents were about three times less likely to be addicted (AOR = 0.39, CI = 0.18–0.86) than those sponsored by “others” [Table 4].
Table 4: Predictors of video game addiction among undergraduate medical students

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Ethical approval

This was obtained from the research and ethical committee of Enugu State University Teaching Hospital (Parklane) Enugu, Nigeria.


  Discussion Top


This study determined the prevalence of addiction to video games using VAT. From the results, the prevalence of addiction among undergraduate medical students is 39.5%. Which is a lot higher than previous studies done among adolescents aged 11–18 of 15.6%.[14] This may be due to the age difference as the mean age of participants in this study is 22.2 years. It was however comparable to a study done in Belgium which had a prevalence of 36% with a similar mean age.[14] However, Ikenna and Wole,[15] in Nigeria university, noted a low prevalence of 3.3%. This low prevalence is explained by the adolescent sample population used in the study.

The study revealed that, among students with addiction to gaming, 20.3% had mild addiction, 13.5% had moderate forms, whereas 6% had severe forms. A study in India has shown that 6.1% of students had severe gaming disorder, 22% had moderate, and 71% had mild gaming addiction.[16] Skoric et al.[17] and Ferguson et al.[18] also noted excessive/severe gaming in his participants with parents reporting the severity to be associated with craving, loss of control, low self-esteem, and aggressive behavior.

This difference in the prevalence of addiction could be the participants/study population used; these were students involved in online gaming, not necessarily on any form of a video game. This is not comparable in Nigeria where students have limited resources and do not readily have access to free internet services,[19] hence they tend to focus more on managing their resources on their basic needs instead of buying data that they may not afford. On both bivariate analysis, gender and academic level were associated with being addicted to video games, whereas on multivariate analysis, gender, academic level, and sponsorship were predictors of addiction to video games. Males are consistently involved in playing games more than females.[13],[19],[20] This may be due to the boisterous and adventurous nature of males. Hazarded reasons for this male dominance could be the frequency of gaming per week and male genetic makeup concerning endorphins. Endorphins are hormones or neurotransmitters which function in producing feelings of pleasure. This can also be linked to greater connectivity and activation in the mesocorticolimbic system during the playing of video games reported more in males than females.[21] However, statistics have shown a potential increase in the rate of gaming among females.[22]

Medical students at lower academic levels appear to be more involved in playing video games when compared to their counterparts at the higher levels. The excess workload in the high class and the high level of stress associated with a rigorous examination in this high class could make the students lose interest in extracurricular activities and gaming to focus on their studies.

Students sponsored by their parents were about three times less likely to be addicted than those sponsored by “others.” Students who were sponsored by their parents will rather concentrate on their studies as they felt that gaming could impair their academic performance.

Although gaming was noted not to be affected by the age of medical students, it is however more prevalent among students who are between 18 and 24 years. This finding was also corroborated in a study where gaming was common in people aged 18–24.[2] That students in the medical school usually cluster between the age of 18 and 24 years could explain this high prevalence of gaming among them.[2]

Gaming is seen to be more prevalent among medical students with a high level of parental education.[2] Parents with a high educational level provide internet services for their children in medical school to enhance their learning. Nevertheless, they use the internet service provided by their parents for video gaming.[2]


  Conclusion Top


The majority of students in this study are not addicted to video games. Being males predicted video game addiction. Since this disorder is yet to be fully explored in this setting, there is a need for health-care workers to create awareness about the effects and means to mitigate against the disorder in this setting. Further research is needed on the physical and psychological health effects of this form of addiction on the players.

Acknowledgments

We are grateful to the research assistants who helped in distributing the questionnaire.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
  References Top

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Public Health Implications of Excessive Use of the Internet, Computers, Smartphones and Similar Electronic Devices: Meeting Report, Main Meeting Hall, Foundation for Promotion of Cancer Research, National Cancer Research Center, Tokyo, Japan, 27-29 August 2014. World Health Organization; 2015. Available from: https://apps.who.int/iris/ handle/10665/184264. [Last accessed on 2020 Oct 03].  Back to cited text no. 1
    
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Singh M. Compulsive digital gaming: An emerging mental health disorder in children. Indian J Pediatr 2019;86:171-3.  Back to cited text no. 8
    
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Stavropoulos V, Adams BL, Beard CL, Dumble E, Trawley S, Gomez R, et al. Associations between attention deficit hyperactivity and internet gaming disorder symptoms: Is there consistency across types of symptoms, gender and countries? Addict Behav Rep 2019;9:100158.  Back to cited text no. 9
    
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Onyemaka SB, Igbokwe DO, Adekeye OA, Agbu J. I failed because I was playing videogames: An examination of undergraduate males videogame addiction and academic performance. Covenant Int J Psychol 2017;2:35-45.  Back to cited text no. 13
    
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Ikenna A, Wole O. Prevalence and determinants of internet addiction among adolescents. Comput Human Behav 2014;31:100-10.  Back to cited text no. 15
    
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Skoric MM, Teo LL, Neo RL. Children and video games: Addiction, engagement, and scholastic achievement. Cyberpsychol Behav 2009;12:567-72.  Back to cited text no. 17
    
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Ferguson CJ, Coulson M, Barnett J. A meta-analysis of pathological gaming prevalence and comorbidity with mental health, academic and social problems. J Psychiatr Res 2011;45:1573-8.  Back to cited text no. 18
    
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Male and Female Gamers: How their Similarities and. Available from: https://newzoo.com/insights/articles/male-and-female-gamers-how-their-similarities-and-differences-shape-the-games-market-\. [Last accessed on 2020 Sep 26].  Back to cited text no. 20
    
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