qualitative research about online games addiction pdf

Online Game Addiction and the Level of Depression Among Adolescents in Manila, Philippines

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Introduction: World Health Organization recognizes online game addiction as a mental health condition. The rise of excessive online gaming is emerging in the Philippines, with 29.9 million gamers recorded in the country. The incidence of depression is also increasing in the country. The current correlational analysis evaluated the association between online game addiction and depression in Filipino adolescents.

Methods: A paper-and-pencil self-administered questionnaire assessing depression and online game addiction was distributed from August to November, 2018. The questionnaire included socio-demographic profiles of the respondents, and the 14-item Video Game Addiction Test (VAT) (Cronbach's ?=0.91) and the Patient Health Questionnaire-9 (Cronbach's ?=0.88) to determine levels of online game addiction and depression, respectively. Multiple regression analyses were used to test the association between depression and online game addiction.

Results: Three hundred adolescents (59% males, 41% females) participated in the study. Fifty-three out of 300 respondents (12.0% males, 5.7% females) had high level of online game addiction as reflected in their high VAT scores. In this study, 37 respondents (6.7% males, 5.7% females) had moderately severe depression and 6 (2.0%) females had severe depression. Online game addiction was positively correlated with depression in this study ( r =0.31; p <0.001). When multiple regression analysis was computed, depression was found to be a predictor of online game addiction ( Coefficient =0.0121; 95% CI-8.1924 - 0.0242; p =0.05).

Conclusion: Depression, as associated with online game addiction, is a serious threat that needs to be addressed. High level of online game addiction, as positively correlated to the rate of depression among adolescents in Manila, could potentially be attributed to the booming internet industry and lack of suffiicent mental health interventions in the country. Recommended interventions include strengthening depression management among adolescents and improving mental health services for this vulnerable population groups in schools and within the communities.

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Ryan V. Labana, Polytechnic University of the Philippines

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• Published: 10 December 2020

Effect of internet use and electronic game-play on academic performance of Australian children

• Md Irteja Islam 1 , 2 ,
• Raaj Kishore Biswas 3 &
• Rasheda Khanam 1  

Scientific Reports volume  10 , Article number:  21727 ( 2020 ) Cite this article

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This study examined the association of internet use, and electronic game-play with academic performance respectively on weekdays and weekends in Australian children. It also assessed whether addiction tendency to internet and game-play is associated with academic performance. Overall, 1704 children of 11–17-year-olds from young minds matter (YMM), a cross-sectional nationwide survey, were analysed. The generalized linear regression models adjusted for survey weights were applied to investigate the association between internet use, and electronic-gaming with academic performance (measured by NAPLAN–National standard score). About 70% of the sample spent > 2 h/day using the internet and nearly 30% played electronic-games for > 2 h/day. Internet users during weekdays (> 4 h/day) were less likely to get higher scores in reading and numeracy, and internet use on weekends (> 2–4 h/day) was positively associated with academic performance. In contrast, 16% of electronic gamers were more likely to get better reading scores on weekdays compared to those who did not. Addiction tendency to internet and electronic-gaming is found to be adversely associated with academic achievement. Further, results indicated the need for parental monitoring and/or self-regulation to limit the timing and duration of internet use/electronic-gaming to overcome the detrimental effects of internet use and electronic game-play on academic achievement.

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Introduction.

Over the past two decades, with the proliferation of high-tech devices (e.g. Smartphone, tablets and computers), both the internet and electronic games have become increasingly popular with people of all ages, but particularly with children and adolescents 1 , 2 , 3 . Recent estimates have shown that one in three under-18-year-olds across the world uses the Internet, and 75% of adolescents play electronic games daily in developed countries 4 , 5 , 6 . Studies in the United States reported that adolescents are occupied with over 11 h a day with modern electronic media such as computer/Internet and electronic games, which is more than they spend in school or with friends 7 , 8 . In Australia, it is reported that about 98% of children aged 15–17 years are among Internet users and 98% of adolescents play electronic games, which is significantly higher than the USA and Europe 9 , 10 , 11 , 12 .

In recent times, the Internet and electronic games have been regarded as important, not just for better results at school, but also for self-expression, sociability, creativity and entertainment for children and adolescents 13 , 14 . For instance, 88% of 12–17 year-olds in the USA considered the Internet as a useful mechanism for making progress in school 15 , and similarly, electronic gaming in children and adolescents may assist in developing skills such as decision-making, smart-thinking and coordination 3 , 15 .

On the other hand, evidence points to the fact that the use of the Internet and electronic games is found to have detrimental effects such as reduced sleeping time, behavioural problems (e.g. low self-esteem, anxiety, depression), attention problems and poor academic performance in adolescents 1 , 5 , 12 , 16 . In addition, excessive Internet usage and increased electronic gaming are found to be addictive and may cause serious functional impairment in the daily life of children and adolescents 1 , 12 , 13 , 16 . For example, the AU Kids Online survey 17 reported that 50% of Australian children were more likely to experience behavioural problems associated with Internet use compared to children from 25 European countries (29%) surveyed in the EU Kids Online study 18 , which is alarming 12 . These mixed results require an urgent need of understanding the effect of the Internet use and electronic gaming on the development of children and adolescents, particularly on their academic performance.

Despite many international studies and a smaller number in Australia 12 , several systematic limitations remain in the existing literature, particularly regarding the association of academic performance with the use of Internet and electronic games in children and adolescents 13 , 16 , 19 . First, the majority of the earlier studies have either relied on school grades or children’s self assessments—which contain an innate subjectivity by the assessor; and have not considered the standardized tests of academic performance 16 , 20 , 21 , 22 . Second, most previous studies have tested the hypothesis in the school-based settings instead of canvassing the whole community, and cannot therefore adjust for sociodemographic confounders 9 , 16 . Third, most studies have been typically limited to smaller sample sizes, which might have reduced the reliability of the results 9 , 16 , 23 .

By considering these issues, this study aimed to investigate the association of internet usage and electronic gaming on a standardized test of academic performance—NAPLAN (The National Assessment Program—Literacy and Numeracy) among Australian adolescents aged 11–17 years using nationally representative data from the Second Australian Child and Adolescent Survey of Mental Health and Wellbeing—Young Minds Matter (YMM). It is hypothesized that the findings of this study will provide a population-wide, contextual view of excessive Internet use and electronic games played separately on weekdays and weekends by Australian adolescents, which may be beneficial for evidence-based policies.

Subject demographics

Respondents who attended gave NAPLAN in 2008 (N = 4) and 2009 (N = 29) were removed from the sample due to smaller sample size, as later years (2010–2015) had over 100 samples yearly. The NAPLAN scores from 2008 might not align with a survey conducted in 2013. Further missing cases were deleted with the assumption that data were missing at random for unbiased estimates, which is common for large-scale surveys 24 . From the initial survey of 2967 samples, 1704 adolescents were sampled for this study.

The sample characteristics were displayed in Table 1 . For example, distribution of daily average internet use was checked, showing that over 50% of the sampled adolescents spent 2–4 h on internet (Table 1 ). Although all respondents in the survey used internet, nearly 21% of them did not play any electronic games in a day and almost one in every three (33%) adolescents played electronic games beyond the recommended time of 2 h per day. Girls had more addictive tendency to internet/game-play in compare to boys.

The mean scores for the three NAPLAN tests scores (reading, writing and numeracy) ranged from 520 to 600. A gradual decline in average NAPLAN tests scores (reading, writing and numeracy) scores were observed for internet use over 4 h during weekdays, and over 3 h during weekends (Table 2 ). Table 2 also shows that adolescents who played no electronic games at all have better scores in writing compared to those who play electronic games. Moreover, Table 2 shows no particular pattern between time spent on gaming and NAPLAN reading and numeracy scores. Among the survey samples, 308 adolescents were below the national standard average.

Internet use and academic performance

Our results show that internet (non-academic use) use during weekdays, especially more than 4 h, is negatively associated with academic performance (Table 3 ). For internet use during weekdays, all three models showed a significant negative association between time spent on internet and NAPLAN reading and numeracy scores. For example, in Model 1, adolescents who spent over 4 h on internet during weekdays are 15% and 17% less likely to get higher reading and numeracy scores respectively compared to those who spend less than 2 h. Similar results were found in Model 2 and 3 (Table 3 ), when we adjusted other confounders. The variable addiction tendency to internet was found to be negatively associated with NAPLAN results. The adolescents who had internet addiction were 17% less and 14% less likely to score higher in reading and numeracy respectively than those without such problematic behaviour.

Internet use during weekends showed a positive association with academic performance (Table 4 ). For example, Model 1 in Table 4 shows that internet use during weekends was significant for reading, writing and national standard scores. Youths who spend around 2–4 h and over 4 h on the internet during weekends were 21% and 15% more likely to get a higher reading scores respectively compared to those who spend less than 2 h (Model 1, Table 4 ). Similarly, in model 3, where the internet addiction of adolescents was adjusted, adolescents who spent 2–4 h on internet were 1.59 times more likely to score above the national standard. All three models of Table 4 confirmed that adolescents who spent 2–4 h on the internet during weekends are more likely to achieve better reading and writing scores and be at or above national standard compared to those who used the internet for less than 2 h. Numeracy scores were unlikely to be affected by internet use. The results obtained from Model 3 should be treated as robust, as this is the most comprehensive model that accounts for unobserved characteristics. The addiction tendency to internet/game-play variable showed a negative association with academic performance, but this is only significant for numeracy scores.

Electronic gaming and academic performance

Time spent on electronic gaming during weekdays had no effect on the academic performance of writing and language but had significant association with reading scores (Model 2, Table 5 ). Model 2 of Table 5 shows that adolescents who spent 1–2 h on gaming during weekdays were 13% more likely to get higher reading scores compared to those who did not play at all. It was an interesting result that while electronic gaming during weekdays tended to show a positive effect on reading scores, internet use during weekdays showed a negative effect. Addiction tendency to internet/game-play had a negative effect; the adolescents who were addicted to the internet were 14% less likely to score more highly in reading than those without any such behaviour.

All three models from Table 6 confirm that time spent on electronic gaming over 2 h during weekends had a positive effect on readings scores. For example, the results of Model 3 (Table 6 ) showed that adolescents who spent more than 2 h on electronic gaming during weekdays were 16% more likely to have better reading scores compared to adolescents who did not play games at all. Playing electronic games during weekends was not found to be statistically significant for writing and numeracy scores and national standard scores, although the odds ratios were positive. The results from all tables confirm that addiction tendency to internet/gaming is negatively associated with academic performance, although the variable is not always statistically significant.

Building on past research on the effect of the internet use and electronic gaming in adolescents, this study examined whether Internet use and playing electronic games were associated with academic performance (i.e. reading, writing and numeracy) using a standardized test of academic performance (i.e. NAPLAN) in a nationally representative dataset in Australia. The findings of this study question the conventional belief 9 , 25 that academic performance is negatively associated with internet use and electronic games, particularly when the internet is used for non-academic purpose.

In the current hi-tech world, many developed countries (e.g. the USA, Canada and Australia) have recommended that 5–17 year-olds limit electronic media (e.g. internet, electronic games) to 2 h per day for entertainment purposes, with concerns about the possible negative consequences of excessive use of electronic media 14 , 26 . However, previous research has often reported that children and adolescents spent more than the recommended time 26 . The present study also found similar results, that is, that about 70% of the sampled adolescents aged 11–17 spent more than 2 h per day on the Internet and nearly 30% spent more than 2-h on electronic gaming in a day. This could be attributed to the increased availability of computers/smart-phones and the internet among under-18s 12 . For instance, 97% of Australian households with children aged less than 15 years accessed internet at home in 2016–2017 10 ; as a result, policymakers recommended that parents restrict access to screens (e.g. Internet and electronic games) in children’s bedrooms, monitor children using screens, share screen hours with their children, and to act as role models by reducing their own screen time 14 .

This research has drawn attention to the fact that the average time spent using the internet, which is often more than 4 h during weekdays tends to be negatively associated with academic performance, especially a lower reading and numeracy score, while internet use of more than 2 h during weekends is positively associated with academic performance, particularly having a better reading and writing score and above national standard score. By dividing internet use and gaming by weekdays and weekends, this study find an answer to the mixed evidence found in previous literature 9 . The results of this study clearly show that the non-academic use of internet during weekdays, particularly, spending more than 4 h on internet is harmful for academic performance, whereas, internet use on the weekends is likely to incur a positive effect on academic performance. This result is consistent with a USA study that reported that internet use is positively associated with improved reading skills and higher scores on standardized tests 13 , 27 . It is also reported in the literature that academic performance is better among moderate users of the internet compared to non-users or high level users 13 , 27 , which was in line with the findings of this study. This may be due to the fact that the internet is predominantly a text-based format in which the internet users need to type and read to access most websites effectively 13 . The results of this study indicated that internet use is not harmful to academic performance if it is used moderately, especially, if ensuring very limited use on weekdays. The results of this study further confirmed that timing (weekdays or weekends) of internet use is a factor that needs to be considered.

Regarding electronic gaming, interestingly, the study found that the average time of gaming either in weekdays or weekends is positively associated with academic performance especially for reading scores. These results contradicted previous literatures 1 , 13 , 19 , 27 that have reported negative correlation between electronic games and educational performance in high-school children. The results of this study were consistent with studies conducted in the USA, Europe and other countries that claimed a positive correlation between gaming and academic performance, especially in numeracy and reading skills 28 , 29 . This is may be due to the fact that the instructions for playing most of the electronic games are text-heavy and many electronic games require gamers to solve puzzles 9 , 30 . The literature also found that playing electronic games develops cognitive skills (e.g. mental rotation abilities, dexterity), which can be attributable to better academic achievement 31 , 32 .

Consistent with previous research findings 33 , 34 , 35 , 36 , the study also found that adolescents who had addiction tendency to internet usage and/or electronic gaming were less likely to achieve higher scores in reading and numeracy compared to those who had not problematic behaviour. Addiction tendency to Internet/gaming among adolescents was found to be negatively associated with overall academic performance compared to those who were not having addiction tendency, although the variables were not always statistically significant. This is mainly because adolescents’ skipped school and missed classes and tuitions, and provide less effort to do homework due to addictive internet usage and electronic gaming 19 , 35 . The results of this study indicated that parental monitoring and/ or self-regulation (by the users) regarding the timing and intensity of internet use/gaming are essential to outweigh any negative effect of internet use and gaming on academic performance.

Although the present study uses a large nationally representative sample and advances prior research on the academic performance among adolescents who reported using the internet and playing electronic games, the findings of this study also have some limitations that need to be addressed. Firstly, adolescents who reported on the internet use and electronic games relied on self-reported child data without any screening tests or any external validation and thus, results may be overestimated or underestimated. Second, the study primarily addresses the internet use and electronic games as distinct behaviours, as the YMM survey gathered information only on the amount of time spent on internet use and electronic gaming, and included only a few questions related to addiction due to resources and time constraints and did not provide enough information to medically diagnose internet/gaming addiction. Finally, the cross-sectional research design of the data outlawed evaluation of causality and temporality of the observed association of internet use and electronic gaming with the academic performance in adolescents.

This study found that the average time spent on the internet on weekends and electronic gaming (both in weekdays and weekends) is positively associated with academic performance (measured by NAPLAN) of Australian adolescents. However, it confirmed a negative association between addiction tendency (internet use or electronic gaming) and academic performance; nonetheless, most of the adolescents used the internet and played electronic games more than the recommended 2-h limit per day. The study also revealed that further research is required on the development and implementation of interventions aimed at improving parental monitoring and fostering users’ self-regulation to restrict the daily usage of the internet and/or electronic games.

Data description

Young minds matter (YMM) was an Australian nationwide cross-sectional survey, on children aged 4–17 years conducted in 2013–2014 37 . Out of the initial 76,606 households approached, a total of 6,310 parents/caregivers (eligible household response rate 55%) of 4–17 year-old children completed a structured questionnaire via face to face interview and 2967 children aged 11–17 years (eligible children response rate 89%) completed a computer-based self-reported questionnaire privately at home 37 .

Area based sampling was used for the survey. A total of 225 Statistical Area 1 (defined by Australian Bureau of Statistics) areas were selected based on the 2011 Census of Population and Housing. They were stratified by state/territory and by metropolitan versus non-metropolitan (rural/regional) to ensure proportional representation of geographic areas across Australia 38 . However, a small number of samples were excluded, based on most remote areas, homeless children, institutional care and children living in households where interviews could not be conducted in English. The details of the survey and methodology used in the survey can be found in Lawrence et al. 37 .

Following informed consent (both written and verbal) from the primary carers (parents/caregivers), information on the National Assessment Program—Literacy and Numeracy (NAPLAN) of the children and adolescents were also added to the YMM dataset. The YMM survey is ethically approved by the Human Research Ethics Committee of the University of Western Australia and by the Australian Government Department of Health. In addition, the authors of this study obtained a written approval from Australian Data Archive (ADA) Dataverse to access the YMM dataset. All the researches were done in accordance with relevant ADA Dataverse guidelines and policy/regulations in using YMM datasets.

Outcome variables

The NAPLAN, conducted annually since 2008, is a nationwide standardized test of academic performance for all Australian students in Years 3, 5, 7 and 9 to assess their skills in reading, writing numeracy, grammar and spelling 39 , 40 . NAPLAN scores from 2010 to 2015, reported by YMM, were used as outcome variables in the models; while NAPLAN data of 2008 (N = 4) and 2009 (N = 29) were excluded for this study in order to reduce the time lag between YMM survey and the NAPLAN test. The NAPLAN gives point-in-time standardized scores, which provide the scope to compare children’s academic performance over time 40 , 41 . The NAPLAN tests are one component of the evaluation and grading phase of each school, and do not substitute for the comprehensive, consistent evaluations provided by teachers on the performance of each student 39 , 41 . All four domains—reading, writing, numeracy and language conventions (grammar and spelling) are in continuous scales in the dataset. The scores are given based on a series of tests; details can be found in 42 . The current study uses only reading, writing and numeracy scores to measure academic performance.

In this study, the National standard score is a combination of three variables: whether the student meets the national standard in reading, writing and numeracy. Based on national average score, a binary outcome variable is also generated. One category is ‘below standard’ if a child scores at least one standard deviation (one below scores) from the national standard in reading, writing and numeracy, and the rest is ‘at/above standard’.

Independent variables

Internet use and electronic gaming.

In the YMM survey, owing to the scope of the survey itself, an extensive set of questions about internet usage and electronic gaming could not be included. Internet usage omitted the time spent in academic purposes and/or related activities. Playing electronic games included playing games on a gaming console (e.g. PlayStation, Xbox, or similar console ) online or using a computer, or mobile phone, or a handled device 12 . The primary independent covariates were average internet use per day and average electronic game-play in hours per day. A combination of hours on weekdays and weekends was separately used in the models. These variables were based on a self-assessed questionnaire where the youths were asked questions regarding daily time spent on the Internet and electronic game-play, specifically on either weekends or weekdays. Since, internet use/game-play for a maximum of 2 h/day is recommended for children and adolescents aged between 5 and 17 years in many developed countries including Australia 14 , 26 ; therefore, to be consistent with the recommended time we preferred to categorize both the time variables of internet use and gaming into three groups with an interval of 2 h each. Internet use was categorized into three groups: (a) ≤ 2 h), (b) 2–4 h, and (c) > 4 h. Similar questions were asked for game-play h. The sample distribution for electronic game-play was skewed; therefore, this variable was categorized into three groups: (a) no game-play (0 h), (b) 1–2 h, and (c) > 2 h.

Other covariates

Family structure and several sociodemographic variables were used in the models to adjust for the differences in individual characteristics, parental inputs and tastes, household characteristics and place of residence. Individual characteristics included age (continuous) and sex of the child (boys, girls) and addiction tendency to internet use and/or game-play of the adolescent. Addiction tendency to internet/game-play was a binary independent variable. It was a combination of five behavioural questions relating to: whether the respondent avoided eating/sleeping due to internet use or game-play; feels bothered when s/he cannot access internet or play electronic games; keeps using internet or playing electronic games even when s/he is not really interested; spends less time with family/friends or on school works due to internet use or game-play; and unsuccessfully tries to spend less time on the internet or playing electronic games. There were four options for each question: never/almost never; not very often; fairly often; and very often. A binary covariate was simulated, where if any four out of five behaviours were reported as for example, fairly often or very often, then it was considered that the respondent had addictive tendency.

Household characteristics included household income (low, medium, high), family type (original, step, blended, sole parent/primary carer, other) 43 and remoteness (major cities, inner regional, outer regional, remote/very remote). Parental inputs and taste included education of primary carer (bachelor, diploma, year 10/11), primary carer’s likelihood of serious mental illness (K6 score -likely; not likely); primary carer’s smoking status (no, yes); and risk of alcoholic related harm by the primary carer (risky, none).

Statistical analysis

Descriptive statistics of the sample and distributions of the outcome variables were initially assessed. Based on these distributions, the categorization of outcome variables was conducted, as mentioned above. For formal analysis, generalized linear regression models (GLMs) 44 were used, adjusting for the survey weights, which allowed for generalization of the findings. As NAPLAN scores of three areas—reading, writing and numeracy—were continuous variables, linear models were fitted to daily average internet time and electronic game play time. The scores were standardized (mean = 0, SD = 1) for model fitness. The binary logistic model was fitted for the dichotomized national standard outcome variable. Separate models were estimated for internet and electronic gaming on weekends and weekdays.

We estimated three different models, where models varied based on covariates used to adjust the GLMs. Model 1 was adjusted for common sociodemographic factors including age and sex of the child, household income, education of primary carer’s and family type 43 . However, the results of this model did not account for some unobserved household characteristics (e.g. taste, preferences) that are unobserved to the researcher and are arguably correlated with potential outcomes. The effects of unobserved characteristics were reduced by using a comprehensive set of observable characteristics 45 , 46 that were available in YMM data. The issue of unobserved characteristics was addressed by estimating two additional models that include variables by including household characteristics such as parental taste, preference and inputs, and child characteristics in the model. In addition to the variables in Model 1, Model 2 included remoteness, primary carer’s mental health status, smoking status and risk of alcoholic related harm by the primary carer. Model 3 further included internet/game addiction of the adolescent in addition to all the covariates in Model 2. Model 3 was expected to account for a child’s level of unobserved characteristics as the children who were addicted to internet/games were different from others. The model will further show how academic performance is affected by internet/game addiction. The correlation among the variables ‘internet/game addiction’ and ‘internet use’ and ‘gaming’ (during weekdays and weekends) were also assessed, and they were less than 0.5. Multicollinearity was assessed using the variance inflation factor (VIF), which was under 5 for all models, suggesting no multicollinearity 47 .

p value below the threshold of 0.05 was considered the threshold of significance. All analysis was conducted in R (version 3.6.1). R-package survey (version 3.37) was used for modelling which is suited for complex survey samples 48 .

Data availability

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Acknowledgements

The authors would like to thank the University of Western Australia, Roy Morgan Research, the Australian Government Department of Health for conducting the survey, and the Australian Data Archive for giving access to the YMM survey dataset. The authors also would like to thank Dr Barbara Harmes for proofreading the manuscript.

This research did not receive any specific Grant from funding agencies in the public, commercial, or not-for-profit sectors.

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Islam, M.I., Biswas, R.K. & Khanam, R. Effect of internet use and electronic game-play on academic performance of Australian children. Sci Rep 10 , 21727 (2020). https://doi.org/10.1038/s41598-020-78916-9

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Online Game Addiction and the Level of Depression Among Adolescents in Manila, Philippines

Ryan v. labana.

1 Department of Biology, College of Science, Polytechnic University of the Philippines, Manila, Philippines

Jehan L. Hadjisaid

2 Senior High School, Polytechnic University of the Philippines, Manila, Philippines

Adrian R. Imperial

Kyeth elmerson jumawid, marc jayson m. lupague, daniel c. malicdem, introduction:.

World Health Organization recognizes online game addiction as a mental health condition. The rise of excessive online gaming is emerging in the Philippines, with 29.9 million gamers recorded in the country. The incidence of depression is also increasing in the country. The current correlational analysis evaluated the association between online game addiction and depression in Filipino adolescents.

A paper-and-pencil self-administered questionnaire assessing depression and online game addiction was distributed from August to November, 2018. The questionnaire included socio-demographic profiles of the respondents, and the 14-item Video Game Addiction Test (VAT) (Cronbach's α=0.91) and the Patient Health Questionnaire-9 (Cronbach's α=0.88) to determine levels of online game addiction and depression, respectively. Multiple regression analyses were used to test the association between depression and online game addiction.

Three hundred adolescents (59% males, 41% females) participated in the study. Fifty-three out of 300 respondents (12.0% males, 5.7% females) had high level of online game addiction as reflected in their high VAT scores. In this study, 37 respondents (6.7% males, 5.7% females) had moderately severe depression and 6 (2.0%) females had severe depression. Online game addiction was positively correlated with depression in this study ( r =0.31; p <0.001). When multiple regression analysis was computed, depression was found to be a predictor of online game addiction ( Coefficient =0.0121; 95% CI-8.1924 - 0.0242; p =0.05).

Conclusions:

Depression, as associated with online game addiction, is a serious threat that needs to be addressed. High level of online game addiction, as positively correlated to the rate of depression among adolescents in Manila, could potentially be attributed to the booming internet industry and lack of suffiicent mental health interventions in the country. Recommended interventions include strengthening depression management among adolescents and improving mental health services for this vulnerable population groups in schools and within the communities.

Based on the report of the European Mobile Game Market in 2016, there were more than 2.5 billion video gamers across the globe. 1 Several studies have found that the majority of these players were adolescents aged 12-17 years, 2 - 5 with more usage among males than females. 6 In 2017, newzoo.com reported that the active gamers in the Philippines were 52% males and 48% females. 7 In the US, 60% of the video gamers were males and 40% are females. 6 Studies have shown that there are similarities between males and females in regard to choice of games, behavior toward video gaming, and motives for engaging in this activity. 8 Some of the reported reasons to engage in video games include having fun and for recreation, 9 - 10 to de-stress, 11 – 12 and to avoid real life issues. 13 – 14 The prevalence of video gaming addiction varies from region to region based on the socio-cultural context and the criteria used for the assessment. 15 However, it is well established that video gaming is addictive, 16 – 18 and there is clinical evidence for the symptoms of biopsychosocial problems among video game addicts. 19 It is a serious threat to the mental and psychosocial aspects of an individual, as it lead to stress, loss of control, aggression, anxiety, and mood modification. 20 – 21

In the Philippines, online gaming is an emerging industry. The country ranks 29 th in game revenues across the globe. In 2017, there were more than 29.9 million gamers recorded in the country. Most of the gamers were 21–35 years of age, followed by the adolescents 10–20 years of age. 7 Adolescents accounted for 30.5% of the total population in the country. 22 In general, this age group is already facing mental health issues, such as anxiety, mood disorders, and depression. This concern gets more alarming as rates of suicide among high school and college students are growing worldwide. 23

World Health Organization lists video game addiction as a mental health problem. 24 Psychiatric research reported evidence on the links between depression and video game addiction. Among the findings are MRI scans of video game addicts showing disruption of some brain parts and overriding of the 'emotional' part with the 'executive' part. 25 A study in China has also reported that gamers are at increased risk of being depressed in comparison to those who did not play video games. 26 In the field of neuroscience, depression caused by online game addiction is explained as a reduction of synaptic activities due to permanent changes in the dopaminergic pathways. This means that long exposure to online gaming causes changes in a person's sense of natural rewards, often making activities less pleasurable. This neuroadaptation is also associated with chronic depression. 27

There is a paucity of studies on video game addiction in the Philippines, making its implications not well understood. There are reports of the impact of video game addiction on the academic performance of the gamers, 28 – 30 but no study has been found associating video game addiction and depression in the Philippine setting. Based on the 2004 report from the Department of Health in the Philippines, over 4.5 million cases of depression were reported in the country. Recently, World Health Organization reported that 11.6% of the 8,761 surveyed young Filipinos considered committing suicide; 16.8% of them (of 8,761) had attempted it. 31 This phenomenon is said to be instigated by several factors, including the individual's exposures to technology. Video game addiction and depression are two emerging public health issues among adolescents in the Philippines. 31 – 32 This small-scale study aims to understand the association between these two factors and produce baseline information that can be used in formulating evidence-based public health policies in the country.

Research site and participants

This study was conducted in the months of August-November 2018 in the city of Manila, the capital of the Philippines. Manila is situated on the eastern shores of Manila Bay, on the western edge of Luzon (14∘35’45”N 120∘58’38”E). It is one of the most urbanized areas and the center of technological innovation in the country. It has a population of 1.78 million, based on 2016 census. 33 Manila covers 896 barangays (villages), which are grouped into six districts. Based on the 2010 census, the total population of Filipino adolescents, regardless of sex, was 166,391. 34 This population estimate was used for computing the sample size needed for this study. Sample size calculation was estimated using the online calculator from OpenEpi. 35 The completion rate of the questionnaires was 78.13%, for a total of 300 consenting respondents who were all online video gamers. They were selected if they were residents of Manila City and reported playing video games on the regular basis.

Map of Manila from the National Capital Region of the Philippines

Instruments

The study used a paper-and-pencil self-administered questionnaire. To determine the level of online game addiction of the respondents, the study used the Video Game Addiction Test (VAT) developed by van Rooij et al . 36 from the 14-item version of the Compulsive Internet Use Scale (CIUS). 37 VAT was utilized in several studies among adolescents in the past, and it has demonstrated excellent reliability and validity. The scale outcomes were found to be comparable across gender, ethnicity, and learning year, making it a helpful tool in studying video game addiction among various subgroups. 36 The survey contains questions in five categories: loss of control, conflict, salience, mood modification, and withdrawal symptoms. Each question was measured on a 5-point scale: 0–never to 4–very often. The results were then used as an indicator of the level of addiction. This study adapted the calculations conducted by van Rooij et al. 38 wherein the average scale scores of all the respondents were arranged from 0-4 and then were divided into two groups. The first group had an average of 0-2 or 'never' to 'sometimes', while the second group had an average of 3-4 or 'often' to 'very often'. The latter group was considered to have the highest level of problematic gaming or, in this study, with online game addiction. 38 The internal reliability of the VAT in this study was excellent at Cronbach's α of 0.91.

The level of depression of the respondents was determined by using the Patient Health Questionnaire-9 (PHQ-9). 39 It is a 9-item depression module taken from the full PHQ. The questionnaire allows the respondents to rate their health status in the past six weeks. There are 9 diagnostic questions in which the respondents rated 0 for 'not at all', 1 for 'several days', 2 for 'more than half the days', and 3 for 'nearly every day'. The total of the PHQ-9 scores was used to measure severity of depression. Since there are 9 items in the questionnaire and each question can be rated from 0-3, the PHQ-9 scores can range from 0-27. The score was interpreted as ‘no depression’ (0-4 points), ‘mild depression’ (5-9 points), ‘moderate depression’ (10-14 points), ‘moderately severe depression’ (15-19 points), and ‘severe depression’ (20-27 points). 39 In this study, the internal reliability of PHQ-9 had a Cronbach's α of 0.88.

Data gathering procedure

The study randomly surveyed gamers in various parts of Manila. Since there are no reliable records of the gamers in the area available for research, various sampling techniques were utilized. A convenience sampling was done by visiting internet cafes in the city and requesting the gamers to answer the questionnaire during their time-out (from the game). A verbal consent was provided by each respondent after hearing a brief explanation of the research objectives and the necessary instructions. While answering the questionnaire, the respondents were assisted by the investigator for any clarifications and questions. The questionnaire was completed by the respondents in approximately 2.5 minutes. Other procedures included snowball sampling, accidental, and voluntary response sampling after the distribution of invitation to respond among internet cafes, gamers’ social media groups/sites, and online gamers’ organizations. The study was approved by the ethical board of the Polytechnic University of the Philippines.

Statistical analysis

All the responses from the questionnaires were inputted into MS Excel and into SPSS version 23.0 (IBM Corp., Armonk, NY, USA). Descriptive statistics of responses were computed and included the frequencies ( f ), percentages (%), averages x and standard deviations (SD). The association between online game addiction and depression was analyzed using Pearson's correlation and was further analyzed using a multiple regression analysis. The study hypothesized that there is no significant correlation between online game addiction and level of depression among adolescents in the City of Manila, Philippines. All statistical results were considered significant at the p value <0.05.

Profile of the respondents

A total of 300 consenting adolescents participated in the study. There were more males ( n =176; 59%) than females ( n =124; 41%) who participated in the study. Most of the respondents were adolescents (aged less than 19 years), except for the six respondents who were already 20 years old during the data gathering. The mean age of the participants was 17 years old (SD=0.90). Figure 2 presents the profiles of the respondents based on their gender and age characteristics. The VAT analysis shows that there were more males (12.0%) who were addicted to online games than females (5.7%). Meanwhile, 15-, 17-, and 18-year old respondents had the highest VAT scores among the six age groups.

Profiles of the respondents based on gender and age

Level of online game addiction

The 14-item VAT was ranked from the highest to the lowest mean score to understand the common conditions experienced by the respondents. The item with the highest mean was No. 13: Do you game because you are feeling down? ( x =2.1, SD=1.40). This question had the third greatest number of “4-very often” ratings ( N =46/300). It was followed by the item No. 3: Do others (e.g., parents or friends) say you should spend less time on games? ( x =2.06, SD=1.41).. The third item with the highest mean score was item No. 7: Do you look forward to the next time you can game? ( x =2.0, SD=1.27). The item with the highest number of “4-very often” rating was item No. 14: Do you game to forget about problem? ( N =67/300). Items 12 and 2 also had high mean scores: Do you neglect to do your homework because you prefer to game? (Item 12; x =1.98, SD=1.34); and Do you continue to use the games despite your intention to stop ? (Item 2; x =1.84, SD=1.20).

Levels of online game addiction based on gender and age

Level of depression

The PHQ-9 was used to quantify the symptoms of depression of the respondents and identify its severity. The majority of the respondents demonstrated no depression (47%), followed by having mild depression (22%), and moderate depression (17%). Of note, the current study revealed 12% of the respondents had moderately severe depression and 2% had severe depression. We found that higher PHQ-9 scores were associated with decreased functional status. The most common symptoms reported by the respondents based on the mean scores of each item in PHQ-9 include …feeling tired or having little energy ( x =1.89, SD=1.30), …poor appetite or overeating ( x =1.87, SD=1.37), … feeling down, depressed or hopeless ( x =1.81, SD=1.18), …trouble falling or staying asleep, or sleeping too much ( x =1.78, SD=1.33), and …trouble concentrating on things, such as reading newspaper or watching television ( x =1.75, SD=1.40). Interestingly, the six respondents who were identified to have “severe” depression were all females, and four of them had high VAT scores.

Level of depression of the respondents based on the PHQ-9 scores

Association between online game addiction and depression

The association between online game addiction based on the VAT scores and the level of depression among the respondents was evaluated through Pearson's correlation analysis. Results ( Table 3 ) show that the level of online game addiction was positively correlated with the level of depression ( r =0.31, p <0.001) but was not significantly correlated with age or gender ( r =-0.80, p <0.171 and r = 0.10, p <0.097, respectively).

Pearson's correlation coefficient among gender, age, online game addiction, and depression of the adolescents in Manila

A multiple linear regression was calculated to predict online game addiction based on gender and depression. This regression analysis was performed with all participants and with the subset of participants with high VAT scores, which indicated online game addiction. A significant regression equation was found (F(2.50)= 2.247, 0.10), with an R 2 of 0.082. Table 4 shows that depression was a significant predictor of online game addiction.

Multiple regression analysis for prediction of online game addiction based on age and level of depression

The correlation between online game addiction and the levels of depression in this study was weak but statistically significant. This positive correlation was previously reported in other research studies across the globe. 40 – 41 In a study conducted by Rikkers et al. 40 among children and adolescents (11-17 years old) in Australia, electronic gaming was positively associated with emotional and behavioral problems including depression. Longer gaming hours were also associated with severe depressive symptoms, somatic symptoms, and pain symptoms among young people in Taiwan. 41 Online game addiction was associated by Zamani et al. 42 not only with depression but also with sleep disorder, physical complaints, and social dysfunctions of students in Iran. In a study conducted by Dong et al., 43 depression came out as one of the outcomes of the internet addiction disorder.

In the current study, most of the respondents looked forward to the next time they would game, with the most common reason of engaging in games reported to be easing the moments of feeling down. Another reason of the respondents’ addiction to online games was that they want to forget about problems. It is considered as one of the core symptoms of addiction as described by Brown. 44 The second most common experience of the respondents was the 'inability to voluntarily reduce the time spent on online games', which is another core symptom of addiction. 45 Most of the respondents admitted that they were getting advice from their parents or friends to spend less time on games, but they could not control it, despite their intention to stop. In fact, gaming negatively affected homework completion among many study participants. This effect was previously studied among high school students in Los Baños, Philippines, where the video gamers had 39% probability to fail in school. In this previously published study, 6 out of 10 video gamers spent their daily allowances on computer games, giving them access to continuously spend their time playing. 29 The addiction of the adolescents in Manila could have been influenced by the ubiquitous nature of internet in the city. Internet cafes are very accessible in the country, and they are thriving in almost all corners of the city. In addition, the rent for internet and online games in Metro Manila costs 10 to 20 pesos per hour only (US $0.19 to US $0.38 per hour), making playing video games affordable. Some internet hubs are even offering discounts and promotions for longer stays of 10-12 straight hours of playing online games.

Based on the most cited symptoms of the respondents in this study, it could be implied that adolescents cope with their emotional distress by playing online games. This means that the high occurrence of online game addiction goes along with the high occurrence of depression among the same group. In regard to depression, most respondents in this study were feeling tired, having poor appetite, feeling hopeless, having trouble falling asleep, or having trouble concentrating on things that require enough attention, like reading books. These symptoms were also reported by Schmit et al. 45 as related to online game addiction, where the people who spent longer hours playing online games got higher scores for loneliness and isolation. This study did not capture the number of hours spent by the respondents in online games, which could be incorporated in the next study for further analysis.

Depression, as associated to online game addiction, may lead to anxiety, compulsion, and suicide ideations. 46 This is a serious threat to the population health that needs to be addressed. Interventions may include strengthening depression management among adolescents, either in school or in the community. There are several ways to manage depression. The schools and the community should reinforce sports by making it more challenging, engaging, and motivating. In the Philippines, numerous factors make receiving mental health care a challenge. There is only one psychiatrist for every 250,000 mentally ill patients, budget dedicated to mental health interventions is limited, 47 a guidance and counseling system has not yet matured, 48 and there was even a report that online counseling was preferred by the students than its face-to-face counterpart. 49 The poor availability of the mental health interventions in the country may lead to upsurge of depression cases among adolescents. Meanwhile, the booming online game industry in the country leads to the increased numbers of addicted adolescents to online game addiction. Policy makers, the government, and its stakeholders should start addressing these issues before it becomes an even bigger health concern, especially in the face of ongoing COVID-19 pandemic.

The Philippine government should also assess their existing intervention programs in mental health issues. In 2016, “Hopeline” was launched in the Philippines. It was a national hotline for mental health assistance for the prevention of depression and suicide cases in the country. The hotline is equipped with a professional team of counselors as responders. 50 No study has been found to assess the effectiveness of this intervention for depression. National trainings and workshop programs have been implemented in other countries to empower the people in dealing with the stigma of depression which includes mental health literacy campaign, peer services, and advocacies. 51 This is an essential step to correct various misconceptions on depression, especially among adolescents.

This study was cross-sectional and cannot determine causality. This is the first report on the association between online game addiction and the levels of depression among adolescents in the city of Manila, Philippines. Despite the small sample and the limited scope of the research, the current study has shown interesting preliminary results that could be instrumental in the conduct of a bigger scale study in the country. To facilitate participation of the larger number of respondents, the future investigators are suggested to coordinate with various high schools in Metro Manila and use these schools as a sampling frame for a robust sampling technique. In this study, the level of online game addiction has no statistically significant association with age and gender. The association between age and online game addiction could have been improved by including older age groups in this study. Data from a group of young adults (college students), who are also exposed to online gaming, could be compared to these data for further analysis. Gender is commonly associated with the level of online game addiction in many studies, but it is not statistically significant in this present study. The sample size in this study was only 300 and may not have been representative enough of a general population. Also, our sample size was not large enough to capture distinctions between males and females. This could also be addressed by a wider scale of surveys in the future research.

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A Qualitative Analysis of Online Gaming Addicts in Treatment

• Published: 27 October 2012
• Volume 11 , pages 149–161, ( 2013 )

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• Marta Beranuy 1 ,
• Xavier Carbonell 1 , 3 &
• Mark D. Griffiths 2  

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Online gaming addiction is a relatively under-researched area and there have been few studies examining online gamers in treatment. This paper reports the findings from a qualitative interview study of nine players undergoing treatment for their addictive playing of Massively Multiplayer Online Role Playing Games (MMORPGs). A face-to-face interview study with nine online gaming addicts was carried out using Grounded Theory. The six most reported phenomena by the participants were: (i) entertainment search, (ii) virtual friendship, (iii) escapism and/or dissociation, (iv) game context, (v) control versus no control, and (vi) conflict. The findings suggest that players’ initial gaming motivation is because of three factors: (i) entertainment, (ii) escapism, and/or (iii) virtual friendship. MMORPG addiction appears once the playing time significantly increases, coupled with a loss of control and a narrow behavior focus. These factors lead to problems and result in psychological dependence and serious life conflicts. The consequences of MMORPG addiction are similar to the consequences of more established substance addictions including salience, mood modification, loss of control, craving, and serious adverse effects. Additionally, in some cases, tolerance and relapse may also be present.

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Acknowledgments

We thank Josep Cañete and Àngels González (Hospital of Mataró, Spain), Rosa Díaz (Hospital Clínic of Barcelona, Spain), Susanna Petri and Núria Aragay (Hospital of Terrassa, Spain) and Felix Cova and Maruzella Valdivia (Clínica de Atención Psicológica of University of Concepción, Chile).

Part of this study was carried out thanks to grant no. AP2005-2426 (Ministerio de Educación y Ciencia, Spanish Government) and FPCCE Blanquerna grant no. CER05/08-105C06.

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Beranuy, M., Carbonell, X. & Griffiths, M.D. A Qualitative Analysis of Online Gaming Addicts in Treatment. Int J Ment Health Addiction 11 , 149–161 (2013). https://doi.org/10.1007/s11469-012-9405-2

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ORIGINAL RESEARCH article

Positive effects of online games on the growth of college students: a qualitative study from china.

• 1 School of Nursing, Wenzhou Medical University, Wenzhou, China
• 2 School of Mental Health, Wenzhou Medical University, Wenzhou, China

Objectives: This study aimed to explore the positive effects of online games on college students’ psychological demands and individual growth.

Methods: A qualitative study design was carried out in September 2021. Semi-structured, in-depth, and individual interviews were conducted with a purposive sample of 20 undergraduates who played the online game “Glory of Kings” from six universities. Thematic analysis was employed to explore the positive features caused by “Glory of Kings”.

Results: College students reported three positive effects of online games, namely, satisfying the need for personal growth, meeting the requirement of social life and promoting academic performance.

Conclusion: College educators and families should take advantage of the positive effect of online games to guide college students to use online games reasonably.

1. Introduction

According to the survey data of the China Internet Network Information Center (CNNIC), by the end of December 2021, the number of netizens in China reached 1.032 billion, of which the number of online game users reached 554 million ( CNNIC, 2022 ). The number of game apps reached 709,000, accounting for 28.2% of all apps ( CNNIC, 2022 ). Online games include massive, multiplayer, online role-playing games (MMORPGs), first-person shooter (FPS), real-time strategy (RTS) games, and other games ( Park et al., 2016 ). MOBA (Multiplayer Online Battle Arena) game, a subgenre of RTS games where two teams of five players usually play against each other ( Mora-Cantallops and Sicilia, 2018b ), is one of the most popular online games in China because of its competitive, interactive, and simple operating characteristics. Specifically, “Glory of Kings,” as a MOBA game, is listed at the top of the Chinese mobile game charts for contemporary college students ( Huang, 2021 ).

Online games are criticized by educators because many students invest a lot of time, money, and energy into games, which seriously affects their academic studies, social interaction, and physical and mental health, and ultimately leads to the tragedy of online game addiction ( Freeman, 2008 ; Kuss and Griffiths, 2012 ; Blinka and Mikuška, 2014 ; Xu et al., 2017 ). Online game addiction, as one of the most serious behavioral addictions ( Lopez-Fernandez, 2018 ), could cause a series of physical and mental problems, such as poor sleep, depression, anxiety, or even death ( Ferguson et al., 2011 ; Kuss and Griffiths, 2012 ; Wei et al., 2012 ). Meanwhile, parents’ opposition to online games can also be observed in family education. Studies have shown that the more addicted adolescents are to online games, the worse their parents’ attitude toward online games ( Jeong and Kim, 2011 ). Many adolescents who love playing online games face restrictions or prohibitions from their parents over the time spent on the Internet or other ways. For example, in a study of 2,021 adolescents, parental restrictions were 1.9 times higher among adolescents who were overly addicted to online games than among other adolescents ( Wu et al., 2016 ). Parents who do not show enough attention to their children promptly can lead to children using online games to divert negative family-related emotions ( Xu et al., 2021 ).

However, it is worth noting that the majority of studies focus on the negative effects of online games ( Lo et al., 2005 ; Ng and Wiemer-Hastings, 2005 ; Yc, 2006 ; Smyth, 2007 ; Li and Wang, 2013 ), while positive effects are neglected. In fact, playing online games at a moderate level could be beneficial to players’ personal psychological growth and interpersonal relationships ( Ko et al., 2005 ; Yee, 2006b ; Granic et al., 2014 ). In terms of emotional experience, existing research on the emotional impact of online games suggests that they have the potential to reduce depression, stress and obtain happiness ( Wu and Liu, 2007 ; Ari et al., 2020 ; Pine et al., 2020 ). In the process of psychological development, college students’ cognitive, memory, and other mental skills are proved to be enhanced by online games ( Boot et al., 2008 ; Glass et al., 2013 ; Oei and Patterson, 2013 ). There is evidence that games have the potential to provoke thought about the player’s personal development and ideals and increase the sense of self-realization if the players have strong ability in online games ( Nuangjumnong, 2014 ; Bopp et al., 2016 ; Mora-Cantallops and Sicilia, 2018a ). In social life, online games also establish the value of social connectedness and enhance the sense of interaction ( McClelland et al., 2011 ; Snodgrass et al., 2011 ; Oliver et al., 2016 ). Sublette and Mullan (2010 , p. 20) argue that through online games “socialization may just shift in focus: while real-world relationships eroded for some players.” It is further proposed that intimacy in games will also extend to offline real life, and shared game experience will reinforce offline communication ( Kim and Kim, 2017 ; Lai and Fung, 2019 ). MOBA games focus on personality development and teamwork in battle ( Yang et al., 2014 ; Mora-Cantallops and Sicilia, 2018b ). In other words, electronic space expands social communication to the virtual field ( Yee, 2006a ) and increases the team cooperation consciousness, leading to diverse communication ways. Besides, in terms of learning, online games are proven to help students engage in learning activities ( Iaremenko, 2017 ; Schenk et al., 2017 ; Calvo-Ferrer and Belda-Medina, 2021 ).

Existing research confirms that the academic performance and satisfaction of Chinese college students positively impact on the continued use of the “Glory of Kings” and promote the reconstruction of the player’s social image ( Chen and Chang, 2020 ). As mentioned above, previous studies have examined various positive aspects of online games, but the studies are based on foreign cultural contexts. Research subjects from different cultural backgrounds may have different perceptions and influences on online games, so it is culturally significant to study the positive influence of online games on Chinese college students. In other words, whether they can apply to the Chinese culture and environment or whether similar conclusions can be drawn among the Chinese college gamer population, has not been verified. Moreover, although “Glory of Kings” is widely concerned and popular among college students, few scholars in China try to evaluate the positive impact of “Glory of Kings” on college students. The design and development of “Glory of Kings” have distinctive Chinese cultural characteristics, therefore, the choice of “Glory of Kings” as a carrier for the study has cultural significance. Secondly, the widespread usage of “Glory of Kings” among college students provides universality for the study. Third, since most of the existing studies are quantitative, qualitative research can enrich the existing research results, explore new experiences, and make relevant suggestions for higher education and family education. In conclusion, given the current popularity and influence of “Glory of Kings” in China, an in-depth study of Chinese college student players was conducted using it as a medium for qualitative research.

2. Materials and methods

2.1. participants.

A purposive sampling method was adopted to select college students who were “Glory of Kings” players from six universities or colleges in Zhejiang Province. Inclusion criteria: (1) college students; (2) playing the “Glory of Kings” game for more than 1 year; (3) have participated in the “Glory of Kings” game in the ranking tournament; and (4) informed consent and voluntary participation. Exclusion criteria: (1) college students suspended from school due to physical problems; (2) students who have a medical history of mental illness or psychiatric disorders and who were screened as having mental problems in the students’ general psychological test. The sample size was determined based on the principle of theoretical saturation. Interviews were conducted until reached theoretical saturation—that is, when the 18th participants did not provide new insights, and two more interviews were conducted to verify if new information would emerge. In the end, no new ideas were found to emerge making the sample size appropriate for this study. Among 23 students who were invited to participate, one student refused to participate due to lack of interest, and two persons were unable to participate due to time conflicts. Eventually, 20 college students (13 males and 7 females) were interviewed. Their ages ranged from 18 to 21 years, and their experience in playing the “Glory of Kings” game ranged from 2 to 6 years. The detailed information of participants is shown in Table 1 .

Table 1. The basic information of the “Glory of Kings” player interviewees.

2.2. Data collection

Participants were recruited in September 2021 with the assistance of the university’s gaming societies. The gaming societies presented the study recruitment information to members via social media. Participation was voluntary, and no incentive was offered for participation. The demographic information was collected before the interview, and the GPA information was collected at the beginning and end of the semester. The pilot-tested, semi-structured interviews were conducted using pre-determined, open-ended questions. The interviewers were conducted by two senior undergraduate students who had acquired knowledge of psychology, interpersonal communication, and qualitative research through relevant training prior to conducting this study. When conducting the interviews, they would follow a unified syllabus and agree on the follow-up questions. The interviews were conducted in a combination of online and offline formats. For participants located in Wenzhou City, interviews were conducted face-to-face in a meeting room at Wenzhou Medical University, where the environment was quiet and undisturbed. For participants located outside of Wenzhou City, online video interviews were conducted using social media. In addition to questions on demographic information, the interview syllabus was as follows:

1. Why do you play games?

2. How do you feel about being a player in the game of “Glory of Kings?”

3. What do you expect to gain from playing the game of “Glory of Kings?” And what do you actually gain from the game?

4. What is your experience with playing the game? And what experiences do you find enjoyable?

5. What are the best and worst things you think happen in the game?

6. What personal changes do you think have occurred after playing the game?

7. Is there anything else you would like to talk about on this topic?

All interviews were conducted at the time most convenient to the participants, and the interview schedule was determined 1 day in advance. Before the interview, participants were told about the procedures, such as how long the interview would last, the topics to be discussed, and permission to record the interview. Each interviewee lasted for approximately 30–40 min. All interviews were audiotaped and transcribed within 24 h after the interview. Two researchers independently completed and checked transcription to reduce personal biases.

2.3. Data analysis

Inductive thematic analysis was used to analyze the data ( Braun and Clarke, 2006 ) and data were analyzed using qualitative analysis software NVivo 10. The steps were as follows: (1) transcript reading, preliminary coding, and note-taking; (2) developing final codes by reading and rereading the transcripts to identify patterns and themes; (3) developing a thematic mind map; (4) defining and naming themes and sub-themes, and (5) preparing the final report with an analysis of the selected fragments. Data were analyzed by two researchers to ensure reliability, when other researchers examined and validated the data, codes, and analyses by holding regular research team meetings. Textual information was discussed by the researchers several times until a consensus was reached. In addition, the results of the preliminary analysis were shared with the participants for their reviews and comments. The analysis was done in Chinese and the quotes were then translated into English and checked by a native translator who was not involved with the data collection (see Table 2 for an example of the process).

Table 2. Thematic analysis of transcribed data from interviews with 20 people with the online game “Glory of Kings”.

2.4. Ethical considerations

The studies involving human participants were reviewed and approved by the Ethics Committee of Wenzhou Medical University (2022-028). This study complies with the Helsinki Declaration’s guidelines. After obtaining both verbal and written information about the study, the participants signed informed consent. Written informed consent was obtained from the individuals for the participation in this study and the publication of any potentially identifiable images or data included in this article, and the data was password-protected and encrypted. Each participant was assigned a coding reference, which referred to the participant’s number and gender (i.e., M3 refers to respondent 3, Male gender). During the interviews, the researchers treated the participants with respect, listened intently, and responded to their questions.

Three themes were identified from the data material, namely, meeting the college student’s personal growth, satisfying the social needs of college students, and promoting academic performance.

3.1. Meeting the need for personal growth

3.1.1. relieve stress and achieve happiness.

Online games, because of the characteristics of confrontation, entertainment and challenge, make it a way for college students to vent their emotions. Most interviewees believe that the fast pace of university brings them great study pressure. Also, college students of different grades report different sources of stress, such as pressure from parents, peers, academics, etc. However, no matter what kind of stress leads to negative emotions, they can be relieved through entertainment games. Following are typical quotes from gamers who said that the game can relieve negative emotions and bring positive feelings.

Game is not a necessity, but I would occasionally indulge in it. I like to live happily in virtual games (M5, 20-year-old).

When encounter troubles, I choose to play a few rounds of games. Although the pleasure brought by the game is temporary, it could fade away the troubles (M1, 20-year-old).

I went through a particularly bad period last semester… Later, I fell in love with “Glory of Kings,” and sometimes I even stayed up late to play games… However, when I was addicted to games temporarily, my pressure was released, which provides enough energy and enthusiasm to face difficulties (F7, 19-year-old).

3.1.2. Overcome the shortcomings and gain self-awareness

Due to the nature of “Glory of Kings,” it provides a platform for college students to fully enhance their consciousness. The characteristics of the five different roles in this game can also further prompt players to recognize their shortcomings and provide a reference for players to understand themselves. Players whose self-awareness is not clear enough get a clearer understanding through the game, and players whose self-perception is vague or even sometimes wrong get a chance to correct it. Following are typical quotes from gamers who have better self-awareness.

Gradually, I started to think about the reason, until I realized that I lacked a sense of the big picture and cooperation. Since then, I’ve made a conscious effort to work with my team on offense, which provides me with a better chance of victory. In life, I also recognized similar shortcomings and corrected them (F1, 19-year-old).

I prefer to play the role as an assassin, but I’m always not good at it. Later, my teammates suggested that I should be bolder and more adventurous. Under the guidance and practice, I gradually became proficient (M12, 18-year-old).

I am an untalkative person in life, but through playing games, I try to actively communicate with my teammates and gradually become more cheerful and good at communication (F4, 19-year-old).

3.1.3. Gain achievement and self-realization

Contrary to the harsh real society, the virtual game world demonstrates a new relatively equal social environment in its unique way and rich content. College students can explore multiple identities by experiencing multiple avatars or changing the appearance of avatars, thereby creating a virtual self-image that is sometimes compensatory and even restorative. Following are typical quotes from gamers who said that the game can bring them positive feelings.

I may be an ordinary person in life, but being a core character in games brings confidence (M1, 20-year-old).

In the virtual world of online games, college students can present themselves without the constraints of the single evaluation system of academic performance in real life. It provides the best arena for college students to gain achievement and fulfill their needs.

Sometimes I feel inferior because of my poor academic performance, and my classmates often treat me with colored glasses… Ranking as a king in the game, many players are willing to team up with me, which gives me a sense of accomplishment and brings back the confidence I lost in real life.

3.2. Satisfying the need for social life

3.2.1. broaden the social network.

College students can make friends around the world with common interests in the virtual world. The game’s forum provides the means to initiate a chat or team invitations to skilled players, as well as the option to team up with players in the same city. Through this avenue, strangers can converse with each other across geographical distances and blur cultural boundaries. Following are typical quotes from gamers who widened the breadth of interpersonal communication.

I spend most of my time playing games with my real friends, sometimes accepting game invitations from strangers and meeting skilled friends (F4, 19-year-old).

Because of the game, I met people of different ages and professions who taught me about game operations (M6, 19-year-old).

3.2.2. Increase social interaction

Online games offer everyone a convenient way to socialize and reduce social costs. The majority of participants reported that they would choose “Glory of Kings” as a common hobby to better integrate into the surrounding circle of friends. And some students will consciously take some compensatory actions against their friends who do not play games to maintain their friendship. Following are typical quotes from gamers who widened the breadth of interpersonal communication.

Playing games with unfamiliar individuals could quickly promote mutual understanding (F7, 19-year-old; M4, 21-year-old).

Playing games together can promote communication between roommates and increase common language (F2, 19-year-old).

I have a friend who does not play games and I tried to teach her to play but she refused. So I would study or eat with her after finishing the game time, and our relationship has always been tight (F5, 19-year-old).

3.2.3. Value teamwork

In the game “Glory of Kings,” college students work as a team to promote friendship and learn from each other’s strengths. Cooperation is necessary for the progress of this game, and there is also a respondent who says he has transformed from a solitary player to a competent collaborator. Every interviewee agreed that they preferred to work with the team and were willing to do their best to cooperate with their teammates when playing the game and even sacrifice for teammates when necessary. Following are typical quotes from gamers who enjoyed teamwork.

Sometimes I could not figure it out on my own, but a team could succeed (M1, 20-year-old).

I used to fight alone when I think that just be happy with myself. But gradually I fell in love with playing in team battles and was happy to cooperate with the team. Meanwhile, if I do not focus on team cooperation, there will be no communication in the game, and the road to promotion will be bumpy (M3, 19-year-old).

3.3. Promoting academic performance

3.3.1. improve learning ability.

The topic of academics was constantly mentioned and excavated in the interviews. The interviewees mentioned that online games helped them to master some transferable skills, such as problem-solving ability, quick thinking ability, etc. These abilities are usually trained unconsciously in games, and the player is able to experience the corresponding ability improvements in the real world when the match is over. Following are typical quotes from gamers who improved their ability to learn.

By studying the characters’ skill matching and line-ups in the game, my mind seemed to be more flexible and my problem-solving efficiency improved (M8, 18-year-old).

In order to improve my game skills, I watched the live video of the game host and learned their skills. As time passed, I found it easier to follow the teacher’s explanation in class while I could not keep up with the teacher’s quick thinking before (F2, 19-year-old).

3.3.2. Increase interest in learning

The combination of abstract and complex knowledge with online games can change the current passive input education model and make students more interested and effective in learning. Following are typical quotes from gamers who said that they could accept the teaching content more effectively in the process of playing games.

The teacher introduced the historical relationships between different characters using the heroic characters from “Glory of Kings,” which suddenly made a sleepy history lesson come to life (F2, 19-year-old).

Some interviewees also proposed that combining the virtual currency obtained in the game with the correct rate of answering questions in the virtual classroom of college students can improve students’ classroom performance. Following are typical quotes from gamers who proposed that the mechanics of the game can be realized in the real world.

Using this way of learning can motivate me to arrange my online game time rationally, reduce my dependence on online games and enjoy studying more (F6, 20-year-old).

4. Discussion

This study examines whether “Glory of Kings” has a positive impact on college students. The qualitative nature of this study allows players to fully articulate specific aspects of their perspectives and allows researchers to analyze their views and attitudes in depth.

4.1. The impact on personal growth

Most participants in our study believe that the pressure in their university life can be relieved through online games which are consistent with the findings of Ari et al. (2020) . The pressure from various aspects, such as academics, family, and social lives, as well as the confusion about the future, bring contemporary college students under more psychological pressure. Online games make it a way for college students to escape from reality and vent their suppressed emotions, and some students also accompany the relief method of verbal catharsis in the process. These findings are similar to those of Pine et al. (2020) that college students enjoy the happiness that accompanies the release of stress when gaming.

College students are in an important period of strengthening their self-consciousness system. As a medium, “Glory of Kings” provides players with a competitive platform whose ultimate goal is victory. In order to continue to win, players need to constantly reflect and summarize ( Kow, 2017 ). Larsen (2020) proposed seven aspects of the skill theory framework to guide players to improve their skill level in the game. Therefore, players can correspond to the theoretical framework and reflect on their shortcomings and deficiencies. By having the opportunity to overcome shortcomings and reflect on themselves in the game world, ultimately a clearer self-awareness can be projected and benefit the player in the real world.

According to Maslow’s hierarchy of needs theory, the ultimate human need is self-actualization. Likewise, college students need to be respected and expect to gain achievement ( Zhong and Yao, 2013 ). Liao et al. (2017) proposed that people will form virtual personalities on the Internet through self-remodeling, while virtual personalities are often different from the real world. In real life, the differences in economic conditions, living areas, material conditions, status, and the increasingly fierce competition environment often limit college students’ achievement experience. In online games, the boundary between physical reality and virtual reality will be blurred by more personalized and immersive environments ( Young, 2009 ; Soutter and Hitchens, 2016 ; Kuo et al., 2017 ), resulting in a convenient way for college students to get achievements. Like the ordinary student M8, he was appreciated by others for his superb gaming skills. In conclusion, achieving self-worth and reaching potential are the goals to meet the need for self-actualization ( Liao et al., 2017 ).

4.2. The impact on interpersonal communication

In the case of “Glory of Kings,” which is a confrontation that unfolds by grouping, the system offers both the opportunity to form teams on one’s own and the option of random matching. Online games try to expand player interactivity and social friendships in the setting of game rules to attract more players, which coincides with the needs of college students to interact with people ( Ducheneaut and Moore, 2004 ). Linked to the trait of awakened autonomy among college students, they will establish emotional communication with like-minded friends they meet in “Glory of Kings,” and will also subjectively choose whom to team up with, which may be teammates they meet through the game or friends in the real world. The game provides a more comfortable communication platform for strangers in real life, thus widening the breadth of interpersonal communication.

Most of the participants in this research also tend to play “Glory of Kings” with their friends. According to the study by Croes and Antheunis (2021) , people’s intimacy is directly proportional to the frequency of interaction. Consistent with the conclusion of Lai and Fung (2019) , college students will not alienate their friends and feel lonely because of excessive investment in playing games. On the contrary, the emotions and experiences shared in the virtual game world can strengthen the bond between them ( Granic et al., 2014 ). College students can fight side by side with their friends in the gaming world, and discuss gaming skills together offline. The game does not destroy or isolate their relationships. On the contrary, the tacit cooperation and communication between players in the game make the relationship closer.

Most of our participants recognize that they liked the teamwork model of “Glory of Kings.” Consist to the study by Chen and Chang (2020) , a MOBA mobile game, it simulates a real-world situation in which temporary teams of strangers complete complex tasks in a short period. It can provide players with a unique platform for teamwork in such scenarios where social relationships need to be established quickly. It is further suggested in the study of Ewoldsen et al. (2012) that this can increase pro-social behaviors outside of the game environment, such as social and civic activities. It follows that teams derive satisfaction from existence, which is part of the meaning of collective effort. Choosing the group and cooperating to reach the same goals is precisely what is essential in real life as well.

4.3. The impact on academic performance

Contrary to conventional beliefs that playing games is intellectually lazy and sedating, playing games is shown to promote a wide range of cognitive skills ( Granic et al., 2014 ). Compared with non-gamers, gamers show faster and more accurate attention allocation, and higher spatial resolution enhanced mental rotation in visual processing, these skills are transferred to other spatial tasks outside the game context ( Green and Bavelier, 2012 ). In addition, scholars speculate that problem-solving skills can also be developed. On the whole, there are many good principles of learning built into good online games ( Adachi and Willoughby, 2013 ), which could be applied to school learning tomorrow.

For this generation that grows up with the Internet, online games are an integral medium of communication and learning and have great potential for schools and workplaces to increase engagement, creativity and lifelong learning skills ( Gee, 2003 ; Turkay and Adinolf, 2012 ; Granic et al., 2014 ). From the existing overall analysis results, the condition of the online games has more positive learning effect than traditional teaching condition. In addition to improving learning and memory ( Sitzmann, 2011 ; Wouters et al., 2013 ), online gameplay has the potential to motivate individuals to participate in educational settings to improve students’ interest in learning ( Clark et al., 2016 ).

4.4. Suggestions for parents and college management

By considering both the negative effects and potential benefits of the existence of games, many scholars proposed some balanced perspectives on the use of games for real-world personal growth with the intervention and supervision of a third party. The influence of the family is a pivotal factor, as it contributes significantly to the socialization of adolescents ( Liu et al., 2015 ). Parental regulation through restrictive mediation or conversational mediation in adolescents’ gaming is one important factor that may limit adolescents’ gaming behavior ( Colasante et al., 2022 ).

On the other hand, it is unscientific for parents to blindly prohibit their children from online games ( Chen et al., 2020 ). More and more parents accept the Internet and games as valuable learning tools ( Willoughby, 2008 ). Those parents help children become consumers to judge the advantages of games, plan a variety of leisure activities, mediate violent temptation games, and help children find the meaning of online games through positive communication ( Chiu et al., 2004 ). Indeed, co-playing games with parents are associated with heightened prosocial behavior for girls ( Coyne et al., 2011 ). In addition, researchers suggest that adolescents who receive the correct family education for the online game may learn ways to meet basic needs and self-control ( Griffiths and Meredith, 2009 ; Liu et al., 2015 ; Chen et al., 2020 ). Parents should create a harmonious family atmosphere by continuously improving their parenting skills and building close relationships with their children, which is in line with the suggestions of Chiu et al. (2004) . Meanwhile, parents should keep in touch with teachers to understand their children’s confusion as well as their use of the Internet at school to actively cooperate with the school’s policies.

Schools are digital education providers and prevention centers. Our results suggested that educators can take advantage of game-based education to facilitate problem-solving ability and to increase the study interests of college students ( Whitton and MacLure, 2017 ). Moreover, universities or colleges can use online games as a potentially useful and beneficial educational tool to promote students’ positive emotions. For example, a school in Seoul, South Korea, set up an online game course that covers the humanities of games, game terminology, game manipulation, Q&A with professional players, and game science to positively impact students at different grades and schools in public education sites ( Choi and Bang, 2021 ).

Many colleges and universities in China nowadays create electronic competitive social organizations and used network games in their daily teaching, not only to enrich students’ extracurricular life, but also to provide a platform for college students to find like-minded friends to play online games reasonably. Furthermore, some universities or colleges combine health education of online games with ideological and political work and try to establish college students’ mental profiles to understand their overall psychological conditions when they are playing online games. More strategies are needed to maximize the positive impact of online games on college students and help them grow healthily.

5. Implication

Despite the negative perception of online games in the Chinese cultural context, our study re-examines the impact of online games from the gamer’s perspective. To a certain extent, online games meet the personalized requirements of college students’ personal growth in Chinese collectivist culture, realize the need for the social interaction satisfaction, and enhance creativity in learning ( Chen and Chang, 2020 ). The higher education nowadays should more scientifically guide teachers and parents to change their attitudes toward online games and recognize the benefits of online games ( Whitton and MacLure, 2017 ). Meanwhile, the advantages of online games can be exploited to benefit more students by promoting their problem-solving ability through game-based education, contributing to more productive physical and mental health and learning ( Granic et al., 2014 ).

6. Limitation

Although this study shows that “Glory of Kings” has a positive impact on contemporary college students, it should be noted that the data are cross-sectional and longitudinal studies are still needed to confirm the long-term impact of “Glory of Kings” on college students. Secondly, the data is only derived from the feedback that respondents actively self-reported, which means that there may be some hidden part of the self-reflection content of respondents. Thirdly, relevant quantitative studies can be carried out to further verify and analyze the results of this study.

7. Conclusion

In this study, it is found that meeting the need for personal growth, satisfying the need for social life and promoting academic performance are the main positive effects of playing online games. Some suggestions that enhance the supportive role of online games are structured for family and college education.

Data availability statement

The original contributions presented in this study are included in the article/supplementary material, further inquiries can be directed to the corresponding authors.

Ethics statement

The studies involving human participants were reviewed and approved by the Ethics Committee of Wenzhou Medical University (2022-028). Written informed consent was obtained from the individual for the publication of any potentially identifiable images or data included in this article.

Author contributions

FL and DZ contributed to the conceptualization and writing—original draft. SW was in charge of the data collection and analysis. RZ assisted in data collation and analysis as well as literature search. CD and JZ contributed to the writing, reviewing, and editing. All authors contributed to manuscript revision, read, and approved the submitted version.

This research was supported by the Wenzhou Science and Technology Bureau Project (R20220086) and Zhejiang Province Curriculum Ideological and Political Education Research Project.

Acknowledgments

We would like to express gratitude to the colleagues who offered constructive and illuminating feedback, and to Guohua Zhang and Bingling Xia, who helped shape earlier versions of this article with their comments.

Conflict of interest

The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

Publisher’s note

All claims expressed in this article are solely those of the authors and do not necessarily represent those of their affiliated organizations, or those of the publisher, the editors and the reviewers. Any product that may be evaluated in this article, or claim that may be made by its manufacturer, is not guaranteed or endorsed by the publisher.

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Keywords : college students, online games, Glory of Kings, personal growth, social life, academic performance, qualitative study

Citation: Li F, Zhang D, Wu S, Zhou R, Dong C and Zhang J (2023) Positive effects of online games on the growth of college students: A qualitative study from China. Front. Psychol. 14:1008211. doi: 10.3389/fpsyg.2023.1008211

Received: 31 July 2022; Accepted: 13 February 2023; Published: 24 February 2023.

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† These authors have contributed equally to this work and share first authorship

‡ These authors have contributed equally to this work and share last authorship

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