Journal of Mental Health and Human Behaviour

: 2021  |  Volume : 26  |  Issue : 1  |  Page : 68--73

Gaming pattern, prevalence of problematic gaming, and perceived stress level among the Indian medical graduate

Parveen Kumar1, Vishal Kanaiyalal Patel2, Deepak Sachidanand Tiwari1, Disha Alkeshbhai Vasavada1, Renish Bhupendraderbhai Bhatt1, Nirav Bhupendraderbhai Chanpa1,  
1 Department of Psychiatry, M. P. Shah Medical College, Jamnagar, Gujarat, India
2 Dr. M. K. Shah Medical College and Research Center, Ahmadabad, Gujarat, India

Correspondence Address:
Parveen Kumar
2nd Floor Trauma Building, Department of Psychiatry, G. G Hospital, Jamnagar - 361 008, Gujarat


Background: Problematic gaming use is prevalent among the adolescents and young adults. The awareness of problematic gaming as a behavioral addiction is low in the community. Aims: This study was aimed to find the prevalence of problematic gaming, gaming pattern, and perceived stress level among Indian medical graduates. Methods: A total of 922 undergraduate medical students participated in this cross-sectional study. Demographic details, different gaming variables, “internet gaming disorder scale short form (IGDS9),” and “Perceived stress scale” were filled by participants using the Google form. Results: Out of 595 students, 8.71% reported problematic gaming use. Positive correlation was observed between Internet gaming disorder score and perceived stress score (r = 0.446, P < 0.001). Male participants, younger age group, first year medical students, and participants playing more hours per day were associated with higher score on IGDS (P < 0.001). Positive correlation was observed between the duration of game play (in years) with IGDS score (r = 0.359, P < 0.001). Action games playing participants had higher score on Gaming Disorder Scale followed by simulation games playing participants (P = 0.001). Conclusion: Problematic gaming use is prevalent behavioral addiction among the medical students. Students with problematic gaming reported a high level of stress. Education and interactive workshop of problematic gaming should be conducted as a part of foundation course in the medical education.

How to cite this article:
Kumar P, Patel VK, Tiwari DS, Vasavada DA, Bhatt RB, Chanpa NB. Gaming pattern, prevalence of problematic gaming, and perceived stress level among the Indian medical graduate.J Mental Health Hum Behav 2021;26:68-73

How to cite this URL:
Kumar P, Patel VK, Tiwari DS, Vasavada DA, Bhatt RB, Chanpa NB. Gaming pattern, prevalence of problematic gaming, and perceived stress level among the Indian medical graduate. J Mental Health Hum Behav [serial online] 2021 [cited 2022 Aug 13 ];26:68-73
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Full Text


Easy availability and accessibility of gadgets, games, and internet lead to increase use of gaming (either offline/online) in adolescents and young adults. Gaming use is associated with some cognitive, good hand-eye coordination, and social benefits but problematic gaming or gaming disorder is associated with various health problems in some individuals. Previous research estimates the prevalence of gaming addiction (GA) ranges from 0.3% to 12%.[1] Gaming disorder is defined as a pattern of gaming behavior (“digital-gaming” or “video-gaming”) characterized by impaired control over gaming, increasing priority is given to gaming over other activities to the extent that gaming takes precedence over other interests and daily activities and continuation or escalation of gaming occurs despite the occurrence of deteriorating consequences.[2] Furthermore, GA is associated with psychiatric morbidities such as attention-deficit hyperactivity disorder, depression, anxiety, and psychosomatic disorders, and other behavioral and substance use disorders.[3] Depression may play a mediating role in the association between resilience, perceived stress, and internet gaming disorder (IGD).[4]

Increased online gaming hours specifically during week days increases the probability of having musculoskeletal and psychosomatic symptoms. However, these relations with hours spent in gaming were further explained by online gaming motives. Online gaming on weekdays for more than 5 hours a day in combination with escape motives was associated with an increased probability of anxiety and depressive symptoms.[5] Furthermore, certain game genres such as action-adventure games (First Person Shooters [FPS]) and real-time strategy games have been found to be associated with higher levels of pathological gaming.[6]

Individuals with the age group of 18–24 years were more vulnerable to become addicts than older individuals.[7] Males were significantly associated with addictive use of video games, whereas females were significantly associated with addictive use of social media. Unmarried, divorced and separated people were positively related to both, social media and video GA.[8] Nicotine, alcohol, and cannabis users were more likely to be problematic gamers. Irrespective of gender, a strong association was also found between problematic gaming and decreased psychosocial well-being, low school performance, depressive mood, social anxiety, negative self-esteem, and loneliness.[9]

As all individuals who faced stress did not develop addictions due to the presence of many different resilience factors.[10] According to negative reinforcement model, the negative emotional state was derived from deregulation of brain stress systems involved in addiction process. Research found the addictive behaviors to gaming was associated with maladaptive coping and distress.[11] Stress was delineated as a risk factor for addiction and triggers relapses, this high concordance was explained by self-medication hypothesis, which suggests that a person often abuses substance to cope with tension associated with life stressors or to relieve symptoms of anxiety and depression resulting from a traumatic event.[12]

To find the perceived stress among young adults with IGD could contribute to the understanding of its role in developing addictive online gaming behavior.[13] There were few studies published in the Indian literature about internet gaming and perceived stress. Thus, the present study aimed to find the prevalence of problematic gaming, gaming patterns, and perceived stress levels among the medical students.


A cross-sectional study was carried out to find the magnitude of problematic gaming, gaming pattern, perceived level of stress among the undergraduate medical students. A Google document form was made and shared with all students from first year to internship through Email address and WhatsApp group consisting of 1050 students. The Google document contained structured questionnaire in four different parts: (1) Demographic details of students, (2) gaming variables such as mode of gaming, gaming genres, per day time spent on gaming, platform used for gaming and total years of gaming, (3) IGD Scale Short Form (IGDS9-SF), and (4) Perceived stress scale (PSS). Participants who gave the consent and submitted the complete forms were included in the study; participants who did not respond to the questionnaire were sent three reminders at a gap of 3 days. While those who were diagnosed or receiving any treatment for mental disorders were excluded from the study using the semi-structured question. Ethical approval was taken from the Institutional Ethical Committee.


Internet gaming disorder scale short form[14]

The IGDS9-SF was used to assess severity and potential detrimental effects of both online and/or offline gaming activities occurring over a 12-month period. It comprised of nine questions on a five-point Likert scale: one (never), two (rarely), three (sometimes), four (often), and five (very often). The scores were obtained by summing the individual's responses ranging from 9 to 45, with higher scores being indicative of higher degree of IGD. The IGDS9-SF also shows satisfactory level of reliability using Cronbach's alpha (0.88).[14] In this study, IGDS9-SF demonstrated satisfactory internal consistency using Cronbach's alpha (0.90).

Perceived stress scale[15]

PSS was used to measure the extent to which situations in one's life were perceived as stressful. It is a ten-item Likert scale. Each item has range: Zero (never), one (almost never), two (sometimes), three (fairly often), and four (very often) with total score ranging from 0 to 40. Scores ranging from 0 to 13 were considered as low stress, scores 14–26 as moderate stress, and scores 27–40 as severe stress. The level of stress experienced by participants and its internal consistency reliability (Cronbach's alpha) was 0.86.[15] This scale shows satisfactory psychometric property for the present study using Cronbach's alpha (0.79).

Statistical analysis

Data entry and analysis were done using Microsoft excel and SPSS 26 version software (International business machines, Armonk, New York, United States). The sociodemographic profile and details of gaming variables have been expressed in terms of frequency and percentage. Mean and standard deviation of IGDS score was used to describe across various demographic and gaming variables. In demographic variables where IGD score followed normal distribution parametric test such as independent t-test and one-way analysis of variance (ANOVA) was applied, with P < 0.05 was considered statistically significant. Independent t-test was applied to find the relation of genders, different relationship status, and different geographical areas with IGD score. Welch test was used to find the relation between academic year of participants, gaming genres, mode of gaming, and time spent on gaming per day with IGD score, as there was no homogeneity of variance in ANOVA test. ANOVA test was applied between different platforms used for gaming and IGD score. Being continuous variable, Pearson correlation test was used to find out the relationship between IGD score and Perceived Stress Score. Pearson test was also applied between the continuous variable such as age and total duration (years) of game play of participants to find relation with IGD score.


A total of 922 participants completed the survey. Out of them 64.53% (n = 595) played games while 35.47% (n = 327) did not play games. Participant's age ranged from 17 to 25 years with a mean age of 20.52 ± 1.52 years. Out of 595 participants (gamers), 67.22% were male gamers and 32.77% were female gamers. Total of all gamers, 8.71% participants had reported problematic gaming. Among them 11.5% males and 4.10% female participants had problematic gaming.

[Table 1] shows that male participants have a high score on IGDS as compared to female participants as denoted by the independent t-test and found to be statistically significant (P < 0.001). No significant difference was observed in IGD score with participants' relationship status as denoted by the independent t-test (P = 0.244). There was no statistically significant difference observed in IGDS in relation with geographical area and residence of participants.{Table 1}

[Table 1] also shows that first year students had higher score on IGDS; as academic year increases, gaming disorder score reduces as denoted by Welch test and was found to be statistically significant within and along the group (P = 0.002).

[Table 2] shows that participants playing action games had a high score on gaming disorder scale followed by simulation games as denoted by Welch test, which was found to be statistically significant within and along the group (P = 0.001). Participants playing online games had higher score on gaming disorder scale and were found to be statistically significant (P < 0.001) within and along the group as denoted by Welch test.{Table 2}

[Table 2] also shows that as numbers of hours of game play per day increases, there was a statistically significant increase in gaming disorder score (P < 0.001) within and along the group. There was no significant relation observed between different platform used by participants with IGD score (P = 0.249).

[Figure 1] shows a positive correlation between IGD score and perceived stress (r = 0.446, P < 0.001) and the relation was found to be statistically significant as denoted by the Pearson correlation test.{Figure 1}

A significant negative correlation was observed between the age of participants in years with IGD score (r = −0.157, P < 0.001). A significant positive correlation was observed between the duration of game play (in years) with IGD score (r = 0.359, P < 0.001).


In the present study, it was observed that 08.71% (n = 52) of participants had problematic gaming. This finding consistent with Choo et al.'s study that found the prevalence of 8.7% among Singaporean youth.[16] A study by Singh et al.[17] among 306 medical students from India reported 3.6% and Aggarwal and Pandian (2019)[18] among 400 medical and dental college students reported 9% prevalence of IGD. While a study by Wang et al.[19] from Hong Kong observed a high prevalence of 15.6%. This inconsistent findings may be explained by several factors such as sociocultural and criteria used in the different studies.[20]

In the present study, it was observed that participants with higher score on IGDS also had higher score of perceived stress. Park et al. observed that the social anxiety score of participants was positively correlated with Internet addiction score.[21] Loton et al. among 552 adult Australian participants reported that participants having video game addiction had symptoms of depression, anxiety, and stress.[22] Similarly, Canale et al. in a study among 605 participants also observed that perceived stress was associated with higher scores of IGD. This may be due to the fact that gaming may help individuals to satisfy their need for psychological escape when confronted with stressful situations.[23] Plante et al. also reported that the people with greater anxiety were more prone to video game addiction and use video games as a mean to cope with anxiety.[24] As internet gaming may serve as a coping strategy for anxiety, the specific management of anxiety for individuals is efficacious in preventing high risk IGD.[25]

In the present study, it was observed that male participants play more mobile games and have higher score on IGDS as compared to female participants. Similarly, a study by Ko et al. at Taiwan found that males play more online games and had higher severity score on online GA and lower satisfaction than female participants.[26] Lin and Tsai also found similar results that male adolescents play more online games as compared to females.[27] A meta-analysis study by Su et al. reports that men were more likely to use all type of illicit activities such as online games or cyber-sexual activities than female participants.[28] Moon et al. reports the possible reason for this as to pursue feeling of achievement, make social contacts, and to enhance self-esteem among male participants.[29]

The current study found that higher IGDS score in first year and younger students; as academic year and age of participants increases, there was reduction in the IGD score. Canale et al. observed that males, young adults and those with high gaming hours per day have higher scores of perceived stress as well as IGD.[23] Na et al. in a study found that males and younger adults had been associated with high risk of behavioral addiction than their counterparts.[30] Mentzoni et al. found that male gender and younger age group were the strong predictors of problematic gaming and higher stress.[31] These results may be due to difficulty in coping due to increased work load, academic pressure of vast curriculum, and examination anxiety.

The current study found that participants who spent more time on gaming and playing time (in years) have high score on IGDS. A study by Wang et al. from Hong Kong also reported GA was significantly associated with the longer average time of gaming per week.[19] A study by Mentzoni et al. reports that high frequency gamers have more problematic gaming behavior as compared to low frequency gamers.[31] A nationwide survey conducted by Rehbein et al. reports that those who played multiplayer online games and played for more hours per week had higher risk for GA and increased levels of psychological and social stress.[32]

In the present study, it was observed that action and simulation genre was associated with higher score on IGDS. Na et al. observed that participants who play strategy and FPS (action) games spent more time on gaming and had higher score on IGD.[30] Elliott et al. observed that IGD was more prevalent in participants using role-playing and FPS games than other gaming genres and participants more frequently used substances such as tobacco and alcohol.[33] Mehroof and Griffiths observed that anxiety was positively associated with IGD in each of genre-specific group in the United Kingdom.[25] Laconi et al. found that IGD scores were higher with action/adventure than other games in both genders and depressive symptoms were higher among RTS and Action/adventure gamers.[34] Park et al. reported reason behind playing different genres by gamers as these were differentially related to psychological functioning such as status of anxiety varied significantly with game genre.[21] Hence, the assessment of gaming patterns among gamers could be useful in predicting the risk of problematic consequences and behavioral modifications.


Problematic gaming is also prevalent among the medical undergraduates. Gamers with more hours of game play per day had higher score on IGDS. Male gamers were spent more time on gaming and reported more problematic gaming as compared to female gamers. Action genre was associated with higher score of Internet GA score. As academic year and age of participants' advances, there was reduction in internet gaming scale score. Higher level of perceived stress among the gamers was significantly associated with higher IGDS scores. Education and interactive workshop about problematic gaming and/or gaming disorder must be required to raise the awareness of problems and periodic screening of medical undergraduates for problematic gaming should be done.

Limitation and future scope

The present study contains self-reported data that could be biased in the direction of both over-reporting and/or underreporting. Due to cross-sectional nature of the study, it is difficult to preclude any causal interpretations; longitudinal and experimental studies are required to better elucidate causality. In the present study, no structured psychiatric interview was used for diagnosis IGDs. Validation and reliability of IGDS-SF were not available for the Indian population but scales show satisfactory psychometric property for the present study. There was no control group in this study which was required for added value to the study. Further researches are needed to understand the underlying mechanisms of IGD and to explore effective preventative or interventional strategies.

Financial support and sponsorship


Conflicts of interest

There are no conflicts of interest.


1Ferguson 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.
2World Health Organization. International Classification of Diseases for Mortality and Morbidity Statistics (11th Revision); 2018. Available from: [Last accessed on 2020 Aug 15].
3Kuss DJ, Griffiths MD. Internet and gaming addiction: A systematic literature review of neuroimaging studies. Brain Sci 2012;2:347-74.
4Baron RM, Kenny DA. The moderator-mediator variable distinction in social psychological research: Conceptual, strategic, and statistical considerations. J Pers Soc Psychol 1986;51:1173-82.
5Hellström C, Nilsson KW, Leppert J, Åslund C. Effects of adolescent online gaming time and motives on depressive, musculoskeletal, and psychosomatic symptoms. Ups J Med Sci 2015;120:263-75.
6Eichenbaum A, Kattner F, Bradford D, Gentile DA, Green CS. Role-playing and real-time strategy games associated with greater probability of internet gaming disorder. Cyberpsychol Behav Soc Netw 2015;18:480-5.
7Soule LC, Shell LW, Kleen BA. Exploring internet addiction: Demographic characteristics and stereotypes of heavy internet users. J Comput Inform Syst 2003;44:64-73.
8Schou Andreassen C, Billieux J, Griffiths MD, Kuss DJ, Demetrovics Z, Mazzoni E, et al. The relationship between addictive use of social media and video games and symptoms of psychiatric disorders: A large-scale cross-sectional study. Psychol Addict Behav 2016;30:252-62.
9Van Rooij AJ, Kuss DJ, Griffiths MD, Shorter GW, Schoenmakers MT, Van de Mheen D. The (co-) occurrence of problematic video gaming, substance use, and psychosocial problems in adolescents. J Behav Addict 2014;3:157-65.
10McEwen BS. Protective and damaging effects of stress mediators: Central role of the brain. Dialogues Clin Neurosci 2006;8:367-81.
11Valentino RJ, Lucki I, Van Bockstaele E. Corticotropin-releasing factor in the dorsal raphe nucleus: Linking stress coping and addiction. Brain Res 2010;1314:29-37.
12Goeders NE. The impact of stress on addiction. Eur Neuropsychopharmacol 2003;13:435-41.
13Koob GF, Buck CL, Cohen A, Edwards S, Park PE, Schlosburg JE, et al. Addiction as a stress surfeit disorder. Neuropharmacology 2014;76 Pt B: 370-82.
14Pontes HM, Griffiths MD. Measuring DSM-5 internet gaming disorder: Development and validation of a short psychometric scale. Comput Human Behav 2015;45:137-43.
15Cohen S, Kamarck T, Mermelstein R. A global measure of perceived stress. J Health Soc Behav 1983;24:385-96.
16Choo H, Gentile DA, Sim T, Li D, Khoo A, Liau AK. Pathological video-gaming among Singaporean youth. Ann Acad Med Singap 2010;39:822-9.
17Singh S, Dahiya N, Singh AB, Kumar R, Balhara YPS. Gaming disorder among medical college students from India: Exploring the pattern and correlates. Ind Psychiatry J 2019;28:107-14.
18Aggarwal A, Pandian JD. Internet gaming disorder in undergraduate medical and dentistry students. CHRISMED J Health Res 2019;6:237-41.
19Wang CW, Chan CL, Mak KK, Ho SY, Wong PW, Ho RT. Prevalence and correlates of video and internet gaming addiction among Hong Kong adolescents: A pilot study. ScientificWorldJournal 2014;2014:e874648.
20Tao R, Huang X, Wang J, Zhang H, Zhang Y, Li M. Proposed diagnostic criteria for internet addiction. Addiction 2010;105:556-64.
21Park JH, Han DH, Kim BN, Cheong JH, Lee YS. Correlations among social anxiety, self-esteem, impulsivity, and game genre in patients with problematic online game playing. Psychiatry Investig 2016;13:297-304.
22Loton D, Borkoles E, Lubman D, Polman R. Video game addiction, engagement and symptoms of stress, depression and anxiety: The mediating role of coping. Int J Ment Health Addict 2016;14:565-78.
23Canale N, Marino C, Griffiths MD, Scacchi L, Monaci MG, Vieno A. The association between problematic online gaming and perceived stress: The moderating effect of psychological resilience. J Behav Addict 2019;8:174-80.
24Plante CN, Gentile DA, Groves CL, Modlin A, Blanco-Herrera J. Video games as coping mechanisms in the etiology of video game addiction. Psychol Pop Media Cult 2019;8:385-94.
25Mehroof M, Griffiths MD. Online gaming addiction: The role of sensation seeking, self-control, neuroticism, aggression, state anxiety, and trait anxiety. Cyberpsychol Behav Soc Netw 2010;13:313-6.
26Ko CH, Yen JY, Chen CC, Chen SH, Yen CF. Gender differences and related factors affecting online gaming addiction among Taiwanese adolescents. J Nerv Ment Dis 2005;193:273-7.
27Lin SS, Tsai CC. Sensation seeking and internet dependence of Taiwanese high school adolescents. Comput Human Behav 2002;18:411-26.
28Su W, Han X, Jin C, Yan Y, Potenza MN. Are males more likely to be addicted to the internet than females? A meta-analysis involving 34 global jurisdictions. Comput Human Behav 2019;99:86-100.
29Moon DG, Hecht ML, Jackson KM, Spellers RE. Ethnic and gender differences and similarities in adolescent drug use and refusals of drug offers. Subst Use Misuse 1999;34:1059-83.
30Na E, Choi I, Lee TH, Lee H, Rho MJ, Cho H, et al. The influence of game genre on Internet gaming disorder. J Behav Addict 2017;6:1-8.
31Mentzoni RA, Brunborg GS, Molde H, Myrseth H, Skouverøe KJ, Hetland J, et al. Problematic video game use: Estimated prevalence and associations with mental and physical health. Cyberpsychol Behav Soc Netw 2011;14:591-6.
32Rehbein F, Kleimann M, Mössle T. Prevalence and risk factors of video game dependency in adolescence: Results of a German nationwide survey. Cyberpsychol Behav Soc Netw 2010;13:269-77.
33Elliott L, Ream G, McGinsky E, Dunlap E. The contribution of game genre and other use patterns to problem video game play among adult video gamers. Int J Ment Health Addict 2012;10:948-69.
34Laconi S, Pirs S, Chabrol H. Internet gaming disorder, motives, game genres and psychopathology. Comput Human Behav 2017;75:652-9.