Excessive gaming and internet use: Preliminary
results with anxiety and depression among highly
engaged Peruvian gamers
Jano Ramos-Diaz
Centre for Interdisciplinary Science and Society Studies (CIICS)
Universidad de Ciencias y Humanidades
Lima, Perú
januxko@gmail.com
Orsolya Király
Institute of Psychology
ELTE Eötvös Loránd University
Budapest, Hungary
orsolya.papay@gmail.com
Mark D. Griffiths
International Gaming Research Unit
Nottingham Trent University
Nottingham, United Kingdom
Abstract— According to the world internet statistics,
Peru reported 22 million of internet users in 2017 and the
penetration rate was 67% in the same year [1]. With the
rapid proliferation of internet and videogames, internet
addiction and addiction to videogames has become a topic
of interest among different professionals, scholars,
organizations and the media in Peru. Despite the fact that
previous research has found clear differences and
demographic profiles for internet addiction and internet
gaming disorder, to our knowledge, there have been no
further reports on these associations between these
variables in Peruvian gamers. In addition to this, the term
“internet addiction” has always been associated with
videogames in the Peruvian context. Therefore, the present
study aimed to examine the extent of association between
problematic internet use, gaming addiction, and time spent
playing, depression, and anxiety. Methods: To examine
these associations, Peruvian gamers completed the
problematic internet use questionnaire (PIUQ), and
problematic online gaming questionnaire (POGQ), as well
as anxiety and depression subscales of the Brief Symptom
Inventory (BSI). Results: As expected, results
demonstrated significant associations between PIUQ,
POGQ, anxiety, depression and amount of weekly gaming.
Implications and results are discussed for academics and
mental health professionals in Peru.
Keywords — gaming, internet gaming disorder, internet
addiction, problematic gaming use, Peruvian gaming
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Claudia Guevara-Cordero
Universidad Tecnológica del Perú
Lima, Peru
Zsolt Demetrovics
Institute of Psychology
ELTE Eötvös Loránd University
Budapest, Hungary
I. INTRODUCTION
According to different reports, half of the population
worldwide will have access to internet by 2020 [2]. The
internet has become part of our daily lives and it is used by
many organizations, educational institutions, and
entertainment among others. In line with this, in the mid-
1990s a couple of researchers introduced the concept of
internet addiction (IA) [3,4]. IA has been conceptualized as
the excessive use of different online applications that leads to
negative consequences in many areas of individuals’ lives [5].
Since then, many investigators in different disciplines have
started to research the topic [6]. Some researchers consider
videogame addiction as a psychopathology per se with its own
characteristics, while others have suggested that the internet is
the medium for different types of addictive behaviors [7]. In
line with this, the Diagnostic and Statistical Manual of Mental
Disorders included Internet Gaming Disorder (IGD) in
Section III as a condition for further research [8] and in the
International Classification of Diseases (ICD), Gaming
Disorder has been recognized in the beta draft of the 11th
revision [9]. Therefore, IGD refers to the repetitive use of
internet-based games with other players that leads to
significant impairment and distress with daily live functioning
[8]. In addition to this, Griffiths stated that internet addicts are
not addicted to the internet per se, but to specific activities
engaged in via the internet [10]. Moreover, Griffiths has
suggested that IGD is a subtype of IA. In the same way,
several authors contributed to the distinction between IA and
IGD [11, 12].
IGD has been associated with many different negative
outcomes such as low life satisfaction, low academic
performance, poor motivation to study, procrastination, stress,
attention deficit hyperactivy disorder, impulsivity, substance
use, poorer family environment, deficits in self-control,
decreased functional connectivity between the dorsolateral
pre-frontal cortex, social anxiety, depression, among other
negative psychosocial repercussions [13 -17]. In particular,
depression has been conceptualized as low mood state, lack of
interest and hope, suicidal thoughts and excessive guilt [8]. It
has been found that IA is associated with depression [18,19]
and that individuals with IGD experience depression when
they are prohibited from playing online games [8,20]. Along
the same lines, depression has been found to increase among
internet-addicted Taiwanese adolescents during a one-year
follow-up [19] and it has been considered the most important
predictor of IA [20]. Also, it has been found that IA has a
negative direct effect on psychological wellbeing which could
cause later worse depressive symptoms [21]. In the same way,
different anxiety disorders have been associated with IA and
IGD. For instance, Weinstein [22] argued that socially anxious
individuals prefer online interactions over face-to-face
communication due to the risks involved in social real life
communication. Furthermore, previous reports have shown
that individuals with generalized anxiety disorders are more
prone to addictive behaviors [23], and IGD [24], and have
impairments in their interpersonal relationships among other
things [25]. The same authors stated that excessive online
gaming could result in negative consequences and that these
issues will make individuals more worried about themselves,
thus, creating a vicious cycle.
In Peru there are some studies concerning IA [28–33],
however, most of them only used Young´s criteria for internet
addiction and there is a lack of studies on videogame addiction
using the new DSM-5 criteria for IGD. In relation to internet-
related disorders, anxiety, and depression in the Peruvian
context, we found one retrospective study [31] were 30% of
individuals who were diagnosed as ‘internet addicts’ had
major depression. These results of previous studies may
indicate that emotional and behavioral issues are associated
with individuals who are addicted to internet and videogames.
However, since research in the Peruvian context is scarce, the
idea of finding associations between anxiety, depression,
gaming disorder, and problematic internet use in Peruvian
gamers, may provide a starting point for Peruvian clinicians to
make future evidence-based treatment taking into
consideration possible dual pathology, preventive strategies
and policies with the Peruvian gaming industry. Here, we
report basic demographic information, internet gaming
patterns, and associations between anxiety, depression,
problematic internet use, and problematic online gaming.
II. METHODS
A. Participants
The study was approved by the ethics committee at
Universidad de Ciencias y Humanidades (Lima, Peru) and was
part of a larger cross-cultural study on gaming motives [32].
The participants in the study comprised 825 Peruvian gamers.
Among them, 816 were males (98.9%) and nine females
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(1.1%), and their average age was 20 years (SD=3.695). Data
were collected during a gaming event in Lima, Peru. The link
of the questionnaire was posted in the main website of the
event and the sample was non probabilistic.
B. Measures
Basic socio-demographic information such as gender,
age, marital status, educational level, and current occupation
were collected. Internet gaming patterns such as weekly
playing hours, type of video game played, and gaming
frequency were also collected. To asses problematic internet
use, gamers completed the Problematic Internet Use
Questionnaire - Short Form (PIUQ-SF-6) (Cronbach´s α =
0.674) [33]. This scale assesses obsession, neglect and control.
To asses problematic internet game use, the Problematic
Online Gaming Questionnaire (POGQ) (Cronbach´s α =
0.938) was used for the present study [34]. This scale assesses
the extent of gaming-related problems experienced by the
players and is closely based on the Griffiths’ components
model for behavioral addictions. Therefore, it is closely
similar to the DSM-5 criteria for IGD. Finally, to assess
anxiety and depression, the depression and anxiety subscales
of the Brief Symptom Inventory (Cronbach´s α = 0.935). [35].
C. Procedure
The present study had a cross-sectional design. We
contacted the organizers of a big local gaming event in Lima,
Peru. After explaining the objectives of the study to
organizers, they agreed to host the study. This was principally
a Multiplayer Online Battle Arena (MOBA) gaming event.
However, many other types of games were also considered by
the organizers. All of the gamers were recruited by posting a
link of the questionnaire on the local gaming event website. A
raffle was made for gamers who decided to participate.
Confidentiality and anonymity were obtained before
participants started the survey. In the present study, data were
analyzed using SPSS.
III. RESULTS
The description and the sample characteristics can be
seen in Table I. In this sample, gamers were more likely to be
males, singles and in their twenties.
Table I. Basic demographics of Peruvian gamers.
N 825
Male (n, %) 816 (98.9%)
Female (n, %) 9 (1.1%)
Age, years; Mean (S.D.) 20 (3.69)
Marital Status (n, %)
Single 729 (88.4%)
In a relationship but living separately 67 (8.1%)
Living in partnership 19 (2.3%)
Married 10 (1.2%)
Educational level (n, %)
Completed elementary school 7 (0.8%)
Did not complete secondary school 61 (7.4%)
Completed secondary school 227 (27.5%)
Technical education from 1 to 2 years 34 (4.1%)
Technical education for 3 years 100 (12.1%)
Did not complete university 320 (38.8%)
Completed university 76 (9.2%)
 C. Discussion and conclusions
A. Gaming patterns and frequency, In the present study, frequencies of basic socio-
demographic information, internet-gaming usage patterns,
Gaming patterns of hours spent, type of videogames and
anxiety and depression among Peruvian gamers were
frequency can be seen in Figure 1 and Table II respectively.
examined. In addition to this, relationships were found
between problematic internet use, problematic online gaming,
anxiety, depression, and hours spent gaming per week. Past
research has shown positive relationships between IA, IGD,
anxiety, and depressive symptoms [8,18–27]. Our data
revealed that most of the sample were male gamers which is
consistent with previous research [36-38]. Perhaps, the reason
of why a high percentage of males are found in this sample is
because of the nature of the event which was a gaming
tournament. Research suggest that males are likely to feel
more overconfident in tournaments than women. In addition to
this, our data showed that when gamers had more symptoms
Fig 1. Weekly playtime with online games of depression and anxiety, the more problematic internet and
gaming use patterns were found. Perhaps, the reason of why
Table II. Type of videogame and frequency this sample of Peruvian gamers with symptoms of anxiety
MOBA FPS MMORPG RTS Others showed more problematic internet use and problematic online
% % % % % gaming is that when gamers feel worried, nervous, tense
Never 3.4 33.3 54.3 30.8 34.4
and/or restless, they play videogames excessively to avoid
Less than a month 0.8 20.5 17.9 23.9 18.4
Once a month 0.7 20.1 10.8 20.5 17.0 these feelings. Moreover, gamers who are depressed may play
Weekly 15.9 18.4 12.4 18.4 21.3 more as a dysfunctional way to cope and alleviate their
Daily 79.2 7.6 4.6 6.4 8.8 depressive symptoms, feel better and improve their mood. The
combination of these symptoms in their real life and their
compensation in their competitive virtual world, status and
B. Problematic internet use, problematic online gaming, approval from others may increase addictive behaviors via
anxiety and depression. negative reinforcement. These findings support the growing
research linking addictive behaviors and psychopathology
Statistically significant correlations between
[25]. Further analyses of the relationship between weekly
problematic internet use, problematic online gaming, anxiety,
playtime and anxiety were not significant, nonetheless, a
depression, and hours played per week were found. Results
significant relationship between weekly playtime and
shown in Table III show a moderate positive correlation
depression was found. However this association is very weak
between problematic internet use and anxiety (r=.342**,
which is in line with previous findings [39].
p<.001). Similarly, a moderate positive correlation between
problematic internet use and depression (r=.336**, p<.001)
Nevertheless, there were some limitations with the
were found. Further analyses revealed positive moderate
present study. First, the sample was non-probabilistic, and this
correlationships between problematic online gaming and
means that results cannot be generalized. Second, research has
anxiety (r=.427**, p<.001) and depression (r=.433**, p<.001).
shown that there are differences in each type of games [40]
Another significant positive correlation was found between
and most of the sample in this study were MOBA (Dota 2)
hours per week and depression (r=.076*, p=033), however, the
players. Finally, it is impossible to provide definitive
strength of this association was very weak. Furthermore, hours
conclusions because of the correlational nature of the study.
per week was not related to anxiety (r=.035, p=320)
However, recent research has noted that psychiatric disorders
can result in addictive behaviors and that addictive behavior
Table III. Correlations between problematic internet use,
can lead to psychiatric disorders [25]. The present study
problematic online gaming, anxiety, depression, and weekly
assessed internet gaming patterns, basic socio-demographic
hours of gaming time.
Variables Anxiety Depression PIUQ POGQ Weekly gaming
information, problematic internet use, problematic online
Anxiety __ gaming, anxiety, and depression among Peruvian gamers.
Depressio .750** __ Future research with probabilistic samples, more diverse
n psychopathology measures, qualitative methods and more
PIUQ .342** .336** __ diverse types of videogames are needed to address and
POGQ .427** .433** .656* __
* develop specific treatments for disordered gamers in the
Weekly .035 .076* .123* .223* __ region. Such findings would help solve important issues
playtime * *
concerning health, academic, work and family variables
among Peruvian gamers. Also, such findings would be
valuable for game companies and organizations (i.e. The

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Peruvian Association of Electronic Sports and Videogames)
and game developers who may start evidenced- based
initiatives and strategies for responsible gaming and healthy
use of videogames. With highly involved gamers, the
possibility of previous or emerging psychopathology exist. In
addition to these, it seems plausible that if mental health
professional decrease unhealthy gaming and internet use and
not based only in time criteria as suggested by Kiràlys [39] ,
the benefits for the Peruvian gaming community including
children, teenagers and adults will be reflected in the society
as a whole.
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