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210]

MAMC Journal of Medical Sciences

Original article

Internet Gaming Disorder and Its Harmful Health Effects

among the Medical Students in a Tertiary Care Teaching
Hospital
Anshu Singh1, Tuhina Shree1, Prem Kumar2
1
Department of Community Medicine, School of Medical Sciences and Research, Sharda University, Gautam Buddh Nagar, Uttar Pradesh, 2Department of
Medicine, School of Medical Sciences and Research, Sharda University, Gautam Buddh Nagar, Uttar Pradesh, India

Abstract
Background: Online gaming has gained a lot of popularity due to easy accessibility of Internet-enabled devices. This has given rise to a new
phenomenon of gaming addiction. The Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5) published by American
Psychiatric Association, in 2013, included the term Internet gaming disorder (IGD). Impact of IGD on physical and psychologic health
warrants further exploration. Objectives and methods: A cross-sectional study was carried out among medical students to find out the
prevalence of IGD and the associated health effects. The study was conducted from July to September 2019. Data collection was carried out
using a semistructured self-administered questionnaire consisting of sociodemographic profile, Pittsburgh sleep quality index, DSM-5 criteria
for IGD and examination of participants. Data were entered and analyzed using frequency, percentage, and Chi-square test. Results: Almost
three-fourth participants (72.2%) engaged in the online games out of which 30.9% had IGD. A higher proportion of male students were found
to be suffering from IGD. Sleeping disorder was also found to be significantly more among those who had IGD. Conclusion: Prevalence of
IGD was found to be high among medical students. The majority of gamers also faced various health consequences of which sleeping disorder
was the major problem.

Keywords: Academic performance, DSM5, IGD, medical students, PSQI

INTRODUCTION Goldberg in 1995 introduced the term “Internet addiction”

for pathologic compulsive Internet use.[1] Internet gaming
Living in this 21st century, there is a rapid and extensive
addiction is the latest phenomenon in the world of the
proliferation of the Internet that has resulted in better
Internet.[2] Many adolescents spend time playing video
opportunities for research, communication, and
games on computer rather than using it for educational
information. When used appropriately and responsibly, it
activities.
has a vast application in the field of research,
communication, information, leisure activities, business
transactions, and learning. The benefits of Internet Address for correspondence: Dr Tuhina Shree, Department of Community
Medicine, School of Medical Sciences and Research, Sharda University,
outweigh the risks but still it can sometimes cause a
Gautam Buddh Nagar, Uttar Pradesh, India.
decline in physical and mental well-being owing to its E-mail: tuhinashree07@gmail.com
potential for causing addiction in the form of, excessive
gaming, pornography, chatting for long hours, gambling, Received: 9 June 2021 Revised: 23 June 2021
online shopping, and promoting sedentary lifestyle. Accepted: 28 January 2022 Published: 29 April 2022

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For reprints contact: reprints@medknow.com

DOI: How to cite this article: Singh A, Shree T, Kumar P. Internet Gaming
10.4103/mamcjms.mamcjms_63_21 Disorder and Its Harmful Health Effects among the Medical Students in a
Tertiary Care Teaching Hospital. MAMC J Med Sci 2022;8:33-9.

© 2022 MAMC Journal of Medical Sciences | Published by Wolters Kluwer - Medknow 33

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Singh, et al.: Internet gaming disorder and associated effects
Online gaming revenue and customer base have steadily
increased in the recent years. China’s worth online gaming
market was **12 billion in 2013 as claimed by a market
survey. A review article reported prevalence estimates
ranging from 0.2% in Germany to 50% among Korean
teenagers.[3] Excessive Internet gaming has been described
as a specific subtype of the Internet addiction.[4] Online video
games are considered the most popular recreational activities
irrespective of age, gender, and culture. Few positive aspects
of online gaming include personal affiliation and gamer
couples strengthening their relationship. Gamers are also
proven to be faster at complex procedures than nongamers
and there is also an improvement in how their brain processes
visual information. However, there is always a flip side of any
new technology. Gaming disorder has been recently included
in the 11th Revision of the International Classification of
Diseases (ICD-11). Internet gaming disorder (IGD), defined
as “ersistent and recurrent use of the Internet to engage in
games, often with other players, leading to clinically
significant impairment or distress,” is a condition for
further study in the most recent version of the Diagnostic
and Statistical Manual of Mental Disorders, the DSM-5.[5]
Research work exploring online gaming and the Internet
addiction has increased in the last decade.[6,7] The
presentation of the IGD may range from a mild
sociopersonal distress to a gross disorganization in
behavior, self-care, health issues, and affected personal and
professional life too.
Medical curriculum covers an academic course duration of 5
and a half years and students have to continually study
around the clock. They use one or the other outdoor or
indoor recreational activities for relieving stress. Most of the
activities acts as a stress buster and has a beneficial effect;
however, a few activities result in detrimental effects such as
the IGD. The addicted students had playtime of 7 hours
compared to average time of 3 hours and lesser
concentration during classes, mood disturbance, anxiety,
and sleep disturbances. Due to all these conditions, they
can further develop conditions such as dry eyes, early
cataract, and worse can lead to neurodegenerative
diseases and personality disorder. Thus, online video
game addiction is a serious health issue which should not
be disregarded. Unfortunately, research on this addiction is
still in its infancy. With this background, our study examines
the prevalence of problematic online gaming among
undergraduate medical students and its association with
academic performance, and other health problems
encountered.
METHODOLOGY
A cross-sectional study was conducted among medical
college students of a tertiary care medical college of
Gautam Buddh Nagar district, Uttar Pradesh. The study
was conducted from July to September 2019 among
MBBS undergraduates and interns. Our aim was to
34 MAMC Journal of Medical Sciences ¦ Volume 8 ¦ Issue 1 ¦ January-April 2022
determine the prevalence of IGD among the medical
students of Gautam Buddh Nagar district and to assess
harmful health effects of IGD among the medical students.
Study tools: Consisted of a semistructured self-administered
questionnaire consisting of following sections:
Section 1: Sociodemographic profile
Section 2: Pittsburgh sleep quality index (PSQI)
Section 3: Epworth daytime sleepiness scale (EDSS)
Section 4: DSM5 criteria for IGD
Section 5: Examination of participants for height and weight
CRITERIA FOR INTERNET GAMING DISORDER IN DSM-5[8]
Pittsburgh sleep quality index: It is a self-reported instrument
to assess the quality of sleep. The questions are framed in a 4-
point Likert type and analyze factors such as sleep quality,
sleep latency, sleep duration, sleep efficiency, sleep
disturbance, and use of sleep medication.[9]
Epworth daytime sleepiness scale: It is a scale intended to
measure daytime sleepiness that is measured by use of a very
short questionnaire. This can be helpful in diagnosing sleep
disorders. It was introduced in 1991 by Dr Murray Johns of
Epworth Hospital in Melbourne, Australia. The
questionnaire asks the subject to rate his or her
probability of falling asleep on a scale of increasing
probability from 0 to 3 for eight different situations. The
scores for the eight questions are added together to obtain a
single number. A number in the 0 to 9 range is considered to
be normal, whereas the numbers 10 and 11 are border line
and 12 to 24 range indicates that expert medical advice
should be sought.
Sampling method: All the medical undergraduates from first
to final year and interns who gave their verbal consent to
participate in the study were included in the study.
Convenient sampling method was used.
Inclusion criteria: Students who gave consent and those who
were present at the time of study on that particular day.
Exclusion criteria: Students who refused to give consent to
fill the form.
Data collection: The aim of the study been explained to all the
study participants and their consent had been taken before the
study. Information thus collected was kept strictly
confidential. Questionnaire was distributed among all
medical students and interns enrolled in the college. After
the inclusion and exclusion criteria were met a total of 615
MBBS students and interns participated in the study.
Analysis of data: The information collected was converted
into computer-based spreadsheet using SPSS software.
Descriptive statistic such as mean standard deviation,
percentage was used to describe the data collected in the
present study.
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Singh, et al.: Internet gaming disorder and associated effects

Persistent and recurrent use of Internet to engage in games, often with other players, leading
to clinically significant impairment or distress as indicated by 5 (or more) of the following in
a 12-month period:
1. Preoccupation with Internet games. (The individual thinks about previous gaming activity
or anticipates playing the next game; Internet gaming becomes the dominant activity in daily
life.)
2. Withdrawal symptoms when Internet gaming is taken away. (These symptoms typically
are described as irritability, anxiety, or sadness, but there are no physical signs of
pharmacologic withdrawal.)
3. Tolerance – the need to spend increasing amounts of time engaged in Internet games.
4. Unsuccessful attempts to control the participation in Internet games.
5. Loss of interest in previous hobbies and entertainment as a result of, and with the
exception of, Internet games.
6. Continued excessive use of Internet games despite knowledge of psychosocial problems.
7. Has deceived family members, therapists, or others regarding the amount of Internet
gaming.
8. Use of Internet games to escape or relief or negative mood (e.g., feelings of helplessness,
guilty, anxiety).
9. Has jeopardized or lost a significant relation, job, or educational or career opportunity
because of participation in Internet games.

Informed consent: Informed consent was obtained from all

participants and they can terminate the survey anytime they Table 1: Year-wise distribution of gender profile of
desire. medical undergraduates (N = 615)
Semester Female, N (%) Male, N (%) Total, N (%)
Ethical concerns: This was a cross-sectional study without
intervention. Consent was obtained from participants. First year 77 (51.3) 73 (48.7) 150 (24.4)
Approval of the study protocol was obtained from Second year 66 (45.2) 80 (54.7) 146 (23.7)
institutional ethical committee and all research data were Third year 89 (61.8) 55 (38.2) 144 (23.4)
kept secure and participant confidentiality was maintained. Fourth year 46 (49.5) 47 (50.5) 93 (15.1)
Interns 41 (50) 41 (50) 82 (13.3)
Total 319 (51.8) 296 (48.2) 615 (100)
RESULTS
A total of 615 medical students consented to participate in the
study. All the students enrolled in the first professional of the students (30.9%) suffering from IGD according to
participated in the study forming the largest proportion DSM-5 criteria. Most preferred place of playing online games
(24.4%) of the total participants. The proportion of fourth was bed or couch (60.1%) followed by classroom (26.6%).
professional students (15.1%) and interns (13.3%)
Nearly one-third of the participants (32%) suffered from
participating in the study was the least. Nearly equal
various health problems due to indulging in online gaming.
proportion of male (48.2%) and female (51.2%) study
Out of those who faced problems, more than half had been
subjects were present in the study [Table 1].
playing online games for more than 12 months [Figure 1].
As shown in Table 2, almost three-fourth participants (72.2%) Based on PSQI and EDSS, abnormal sleeping quality was
engaged in the online games. At the time of the interview found among more than one-third of the participants (36.9%).
more than one-third of the participants (35.2%) had been Academic performance of more than one-third of the students
playing online games for greater than 6 months. Prevalence of (35.3%) had suffered with a calculated average score of less
IGD was found to be high in our study with almost one-third than 60% in last 1 year. More than one-third of the students

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Singh, et al.: Internet gaming disorder and associated effects

Table 2: Distribution of participants according to gaming Table 3: Distribution of participants according to the key
characteristics (N = 615) issues faced due to online gaming (N = 615)
Study variables Frequency (%) Health pproblems related to online gaming (N = 444)
Playing online games Yes 142 (32)
Yes 444 (72.2) No 302 (68)
No 171 (27.8) Health problems based on duration of playing online games (N = 142)
Duration of playing online games >12 months 89 (62.7)
>12 months 190 (30.8) <12 months 53 (37.3)
6–12 months 216 (35.2) Abnormal sleep quality (based on PSQI)
<6 months 38 (6.2) Present 227 (36.9)
Do not play online games 171 (27.8) Absent
Students suffering from Internet gaming disorder (based on DSM-5 and BMI 388 (63.1)
EDSS) Normal 378 (61.5)
Present 190 (30.9) Overweight/obese 237 (38.5)
Absent 425 (69.1) Academic performance (in the last 1year)
Preferred place of playing online games (multiple response) N = 444 <60% 217 (35.3)
Bed/couch 267 >60% 398 (64.7)
Classroom 118
PSQI, Pittsburgh sleep quality index; BMI, body mass index.
Travelling 87
Garden 65

performance was also not found to be statistically

significantly associated with the IGD (P = 0.14) [(Table 4].

Health problems DISCUSSION

98
100
66 60
43
50
0 Gamers spend a considerable amount of time in online
Sleeping Dry Weight Others
Disorder Eyes Gain
Figure 1: Health problems related to gaming among the study subjects’
(N = 142) multiple responses.
fell under the category of overweight and obese of WHO
classification of body mass index (BMI) [Table 3].
Majority of gamers suffered negative consequences of online
gaming. Sleeping disorder was most often reported health
problem followed by dry eyes and weight gain. On
determining association of duration spent in playing online
games and its negative health impact, health problems were
found to be significantly more among participants playing
online games for more than 12 months (62.7%) when
compared with those who had been playing for less than
12 months (37.3%; P < 0.001) [Figure 1].
Table 4 depicts the association of IGD and associated
problems. When compared with female students, a higher
proportion of male students was found to be suffering from
IGD (P < 0.001). Sleeping disorder was found to be
significantly more in participants suffering from IGD (P <
0.001). The proportion of overweight/obese participants did
not differ by presence of IGD (P = 0.49). Academic
With the advancement of technology, we have entered the era
of Internet. The Internet is now available even in the far
reaches of our country and has become integral part of our
lives. With time, Internet gaming, both online and offline,
gained popularity, not only among youth but adults too.
gaming. With the easy accessibility of the Internet and an
increase in problematic Internet usage, there is a high
likelihood of potentially addictive behavior. The
occurrence of IGD can further lead to lifestyle disorders
and health problems among gamers. This study attempts to
expand our knowledge of IGD among medical students in
India.
In our study, among 615 medical students who participated,
nearly three-fourth students (72.2%) engaged in online
games. Similarly, a study conducted among undergraduate
medical and dental students in Ludhiana, Punjab reported a
high proportion of students (79.2%) playing online games.[10]
However, Gammal et al. in a study among university
students, observed that only 37% participants engaged
online games which is quite less than the prevalence we
found in our study.[11]
A high prevalence of IGD (30.9%) was observed in our study
among medical students. This was in accordance to a study
conducted by Severo et al. reporting a prevalence of 38.2% of
IGD among secondary students and undergraduates in
Southern Brazil.[12] Another study conducted in Lebanon
found prevalence of IGD as 9.2%; however, 35.7% were
reported to be at the risk of developing IGD.[13] By contrast,
Singh et al. in a study investigating the pattern of IGD in India

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Singh, et al.: Internet gaming disorder and associated effects
Table 4: Association between IGD and study variables
Study variables IGD
Yes (N = 190) No (N = 425)
Gender
Male 112 (37.8) 184 (62.2)
Female 78 (24.5) 241 (75.5)
Sleep disorder
Present 98 (43.2) 129 (56.8)
Absent 92 (23.7) 296 (76.3)
BMI
Normal 113 (29.9) 265 (70.1)
Overweight/obese 77 (32.5) 160 (67.5)
Academic performance
<60% 75 (34.6) 142 (65.4)
>60% 115 (28.9) 283 (71.1)
IGD, Internet gaming disorder; BMI, body mass index.
observed a prevalence of 3.6% among medical
undergraduates.[14] Mihara and Higuchi in a systematic
review estimated global prevalence of IGD ranging from
0.70% to 27.50%.[15] Another systematic review of IGD
among children and adolescents between the period of
1991 and 2016 found the prevalence in the range of
0.60–50%.[16] Darvesh et al. in a scoping review found
that the prevalence of IGD ranging from 0.21% to 57.50%
in general populations and 3.20% to 91.00% in clinical
populations.[17] The prevalence of IGD observed in our
study was higher when compared with the prevalence
observed in various other international and national
studies.[10,18,19] This high prevalence of IGD observed in
our study can be attributed to the higher socioeconomic status
of all the study participants with readily available Internet and
smartphones which provide them an easier access to Internet
games that too with the latest technologic advancements. In
addition, the criteria and definition employed to diagnose
IGD varied across different studies which can be the reason
for difference of prevalence observed between present study
and above-mentioned studies. The geographical and cultural
diverseness could also be the contributing factors in the
variation of prevalence.
The gender distribution of male and female students was
almost equal in our study (48.2% and 51.8%, respectively)
which was in line to a study conducted by Singh et al. among
medical undergraduates.[14] Moreover, occurrence IGD was
found to be significantly more in male participants when
compared with female participant in our study which was
consistent with study carried out by Wartberg et al., Salam
et al., and Taechoyotin et al.[18,20,21] Another study carried
out among undergraduate medical and dental students also
found male gender to be a risk factor for IGD.[10] In contrast,
Przybylski et al. found no association of IGD with
gender.[11,22]
In the current study, one-third of the students (32%) suffered
health problems due to playing online games. Sleeping
MAMC Journal of Medical Sciences ¦ Volume 8 ¦ Issue 1 ¦ January-April 2022
x2 value P-value
Total (N = 615)
296 12.88 0.0003
319
227
388 25.4 <0.001
378 0.45 0.49
237
217 2.11 0.14
398
problems, dry eyes, and weight gain were the most
commonly reported health problems. A wide range of
health problems were identified in previously conducted
studies. Israel Ayenigbara in his literature review carried
out to understand the impact of gaming on health, reported
that the eye problems, musculoskeletal problems, and weight
gain were the most frequently encountered health issues.[23] A
study among Swedish adolescents reported symptoms of
depression, musculoskeletal problems, and psychosomatic
issues.[24] Headache was found to be the most commonly
reported problem due to online gaming in studies conducted
in Punjab and Kerala.[10]
The present study used PQSI scale to assess sleep quality of
the participants and more than one-third of the students
(36.9%) were found to have poor sleep quality. Gammal
et al. and Severo et al. reported a very high proportion of
participants (52% and 60%, respectively) suffering from a
poor sleep quality which are in concordance with our
study.[11,12] Abnormal sleep quality was found to be
significantly associated with IGD in our study which was
supported by findings from other global studies.[12,13,25,26]
Findings in our study was also comparable to other studies
carried out in various regions of India.[10,27]
In our study, more than one-third of the participants (38.5%)
were found to be overweight/obese, although IGD was not
found to be significantly associated with BMI. Similarly,
inconclusive evidence of association of obesity with video
gaming was found in a scoping review which examined
research papers published between 2013 and 2018.[28]
Contrary to our study fourth Thai National Health
Examination Survey, found increased risk of overweight
with online games.[29] A study conducted among
adolescents also found a positive correlation between
videogame addiction and abdominal obesity.[30] Melchior
et al. in study conducted among young adults also reported
that those who were engaged in video games were more likely
to be overweight.[31]
37
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Singh, et al.: Internet gaming disorder and associated effects
In our study, more than one-third of the students (35.3%) had
a score of less than 60% in last 1 year and no significant
association of academic performance was found with IGD.
Similarly, Gammal et al. and Taechoyotin et al. also
reported no significant association among them.[11,21] On
the contrary, a study conducted among Lebanese
adolescents found a low academic performance among
IGD group.[13]
Limitations
Our study reflected the findings in medical students which
limits the generalizability of the findings. In addition, we only
measured height and weight of the participants; other
parameters such as diet and other behavioral factors were
not evaluated. BMI is a flawed indicator of fitness, as it does
not take into account sex, age, or body fat. Moreover, impact
of behavioral risk factors such as smoking and alcohol
consumption was not taken into consideration. Effect of
other recreational interests involving outdoor activities also
was not taken into account.
CONCLUSION
Based on the findings of the current study, there is a high
prevalence of IGD among medical students. Online gaming
affects all aspects of life, whether it is academic progress or
lifestyle disorders. Quality of sleep was also found to be poor
among gamers. Compared to girls, boys were found to be
more at risk of IGD. Its time that IGD gets the attention it
deserves, as online gaming is becoming increasingly
prevalent among the different strata of the society.
Recommendations
Limiting Internet usage can also be practiced. Family
members should be promoted to get more involved and
create a positive environment to prevent the occurrence of
IGD. Children should be made aware right from the school
days regarding the addicting potential of Internet. Parents as
well as students in their initial classes should be sensitized
regarding IGD by conducting awareness sessions in schools
and colleges. Parents can be taught to monitor the Internet
usage timing. Service for Healthy Use of Technology clinic, a
first of its kind initiative by National Institute of Mental
Health and Neurosciences is helping people in deaddiction
from technology. It uses a digital detox mobile-based
application. Awareness regarding such applications and
clinics can be raised among the multitude and also the
individuals affected with IGD.
Financial support and sponsorship
Nil.
Conflicts of interest
There are no conflicts of interest.
38 MAMC Journal of Medical Sciences ¦ Volume 8 ¦ Issue 1 ¦ January-April 2022
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