Balancing Act: A Qualitative Study on the Dual Nature of Video Game Addiction among medical college students in Chengalpattu district, Tamil Nadu

doi:10.21203/rs.3.rs-4812020/v1

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Research Article

Balancing Act: A Qualitative Study on the Dual Nature of Video Game Addiction among medical college students in Chengalpattu district, Tamil Nadu

https://doi.org/10.21203/rs.3.rs-4812020/v1

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Introduction:

Video games have recently become a significant field that has grown and transformed how people engage with themselves and others. This study aims to understand the motives, needs, and concerns of gamers addicted to video games and to explore the self-perceived impact of video games on college students' social, personal, and academic lives.

Materials and Methods

This was a comprehensive qualitative study conducted among medical students in the Chengalpattu district of South India. We used a semi-structured questionnaire guide to collect data from medical students identified as problem gamers according to the Internet Gaming Disorder Scale-Short Form (IGDS9-SF) questionnaire. Data was meticulously collected through in-depth interviews and transcribed verbatim. We ensured the reliability of our findings by reaching data saturation after interviewing 25 study participants. Qualitative data were analysed using deductive content analysis with the aid of Qualcoder Software.

Result

The primary themes that emerged from the study highlighted that individuals often use video games as a coping strategy to alleviate stress related to personal and academic pressures and to foster social connections. The benefits reported by participants included mood improvement and enhanced decision-making abilities. On the downside, the negative impacts identified were insufficient sleep, musculoskeletal problems, and impulsive gaming behaviour.

Conclusion

Video games serve as an efficient coping strategy for managing stress and social engagement, offering various benefits such as mood enhancement and improvement in the skills related to decision-making. However, these are overshadowed by drawbacks such as inadequate sleep, musculoskeletal problems and impulsive gaming behaviour.

online games

impulsive behaviour

videogame addiction

social life

violent video games

One of the people's most widely used pastime activities has recently been related to technology, which has developed rapidly over the past few decades. One of the significant fields that grew and transformed how people engage with themselves and others was video games [1]. It is one of the most popular leisure activities with positive and negative health implications [2].

There are various benefits of video games documented in the literature, depending on the genre of video games. An active video game can improve physical fitness [3, 4], whereas games with social components can improve social behaviour [5, 6]. Various studies documented that video games can positively impact cognition and the brain [7, 8]. It has improved reaction times, short-term and working memory, and cognitive components like visual attention [9–11].

World Health Organization (WHO) categorised and included gaming disorder under the International Classification of Diseases – 11 (ICD-11) as a pattern of persistent or recurrent gaming behaviour resulting in marked distress or significant impairment in personal, family, social, educational, occupational, or other important areas of functioning [12]. While problematic gaming behaviours can lead to various physical and mental health issues, it is essential to recognize that different factors and existing mental health problems can coexist, potentially leading to misinterpretation of video games as the cause [13, 14]. This may result in false positive diagnoses. There has been considerable debate about including gaming disorder in the ICD-11, with scholars from various fields emphasising the need to understand individuals with gaming disorder and the nature and severity of the problems they experience [15].

According to Self-Determination Theory (SDT), autonomy, competence, and relatedness are fundamental psychological needs for every individual. Autonomy involves the freedom to act independently, competence refers to feeling confident and skilful, and relatedness means feeling connected to others [16]. The current generation of video games, with their realistic graphics, beautifully designed open worlds, intricate storylines with character development, and competitive multiplayer modes, tend to satisfy an individual's need for autonomy, competence, and relatedness [17–19].

While video games can satisfy an individual's basic psychological needs, problems arise when an individual uses video games as a primary source for meeting them, which would have been due to various factors related to social, personal, academic, or professional life [20, 21].

In India, video games are often viewed negatively as one of the worst forms of entertainment. As a developing country with significant cultural diversity, India harbours many stereotypes and prejudices. Factors such as lack of awareness among parents, preconceived notions that video games are harmful, and the belief that playing video games is a waste of time that will ruin an individual's future contribute to conflicts between gamers and their family members, resulting in strained interpersonal relationships [22].

Against this backdrop, the study aimed to understand the motives, needs, and concerns of gamers classified as having video game addiction and to explore the impact of video games on college students' social, personal, and academic lives.

Study Design

Qualitative Study.

Study Area and Population

The present study is part of a more extensive study titled “Unveiling the Connection Between Video Games and Mental Health Among College Students in South India” conducted among medical students in the Chengalpattu district of South India [23]. Medical students who were found to be addicted to video games according to the Internet Gaming Disorder Scale–short-form (IGDS9-SF) [24, 25] and who met the following inclusion criteria were used as study participants.

Inclusion Criteria

Participants classified as having gaming disorder according to the IGDS9-SF scale [24, 25] and those who play for more than 2 hours per day for at least five days per week.

Exclusion Criteria

Persons diagnosed with psychiatric illnesses were excluded from the study.

Data Collection Tool

Based on the quantitative findings from the more extensive study [23], the significant predictors of gaming disorder, namely, hours of gaming, game genre, inadequacy of sleep, having an impact on academic life, along with questions regarding the benefits, drawbacks and motives for playing videogames were used as open-ended questions to develop the semi-structured questionnaire guide which was used for data collection in the present study.

Data Collection Method

A college student trained in qualitative research conducted in-depth interviews with the study participants in an informal setting on the college premises. Informed written consent was obtained, and the confidentiality of the interviews was explained. To avoid biased responses, the students' identities were kept anonymous from the investigator. The student would perform one interview per day and send the audio to the research team. The team would cross-validate among the members and guide the student in areas of improvement to be implemented in further interviews.

Data analysis

Data saturation was reached after interviewing 25 participants. The interviews were recorded, transcribed verbatim, and uploaded into the Qualcoder software. In the software, the interviews were assigned attributes, which included gender, genre of video game, online/offline play, platform used, and hours of gaming per day. Deductive content analysis using thematic coding to identify themes, subthemes, and codes.

Ethical Approval

and Informed Consent: The Institutional Human Ethical Committee of the tertiary medical college in Chengalpattu district obtained ethical approval (Approval number: SBMCH/IHEC/2023/110, Approval Date: 02.04.23). Informed consent was obtained from each study participant before enrollment.

[Table 1: Characteristics of study participants interviewed.]

Table 1

Characteristics of study participants interviewed.
S.No	Age	Gender	Genre	Online/Offline	Platform Used	Hours of play per day
Interview 1	19	Male	Action	Both	Console	3
Interview 2	20	Female	Casual	Offline	Mobile Phone	3
Interview 3	23	Male	Role Playing	Offline	Console / PC	5
Interview 4	22	Male	Role Playing	Offline	PC	6
Interview 5	21	Female	Adventure	Offline	Console	3
Interview 6	21	Male	Multiplayer	Online	Console	4
Interview 7	22	Male	Action	Online	Console / PC	6
Interview 8	23	Female	Action	Online	PC	4
Interview 9	21	Male	Racing	Offline/Online	PC	2
Interview 10	22	Female	Casual	Online	Mobile Phone	3
Interview 11	21	Male	Sports /Fitness	Offline	Console	2
Interview 12	22	Female	Action	Offline	Console	4
Interview 13	21	Male	Role Playing	Offline	PC	7
Interview 14	23	Male	Action	Online	PC	5
Interview 15	19	Male	Simulation	Offline	PC	4
Interview 16	20	Female	Sports	Both	Console	3
Interview 17	21	Male	Casual	Both	Mobile Phone	4
Interview 18	22	Male	Adventure	Offline	PC	4
Interview 19	21	Male	Action	Online	PC	3
Interview 20	22	Female	Sports	Both	PC	2
Interview 21	23	Female	Casual	Online	Mobile Phone	2
Interview 22	22	Male	Action	Online	Console	5
Interview 23	20	Male	Action	Online	PC	4
Interview 24	21	Female	Sports/Fitness	Online	Console	5
Interview 25	22	Male	Role Playing	Both	Console	4

Data saturation was achieved after conducting interviews with 15 male and 10 female participants; at this point, no new codes emerged. The genre with the highest daily hours of play was the role-playing genre, followed by the action genre. [Table 1]

[Table 2: Themes, subthemes, and codes obtained from qualitative interviews.]

Table 2

Themes, subthemes, and codes obtained from qualitative interviews.
Theme	Subtheme	Codes
Coping mechanism	Loneliness	To overcome loneliness due to working parents
	Domestic conflict between parents	To divert the mind from witnessing frequent quarrels in the family
	Stress relief	Diversion from any stress
	Introvert	Comfort having an introverted character
	Forget real-life troubles	Divert mind from current troubles happening in family/college.
Social Interaction	Friends in Online Games	As a means of social interaction with friends and family
	To have anonymous conversations with strangers	Use it to have anonymous conversations with strangers.
	Lack of friends in real life	As an alternative to lack of friends in real life
	Using social media for gaming broadcasts and chats	Using Apps like Discord / YouTube to broadcast games
Perceived Benefits of playing video games	Boosts mood	Feeling a sense of happiness after playing
	It helps to concentrate on academics.	Playing video games daily helps to focus on academics.
	Living in a fantasy world	Playing role-playing games helps them to live in a simulated fantasy world.
	Decision making	Helps in quick decision-making
	Fitness videogames	Using fitness videogames to boost physical health
Perceived drawbacks of playing video games	Conflict with parents	Frequent quarrels with parents as they ask them not to play videogames
	Affects academics	Decreased academic performance
	Impulsive to play	Impulsive to play videogames for long hours
	Ranked Matches	There is a constant need for validation in ranked matches.
	Lack of adequate sleep	Late-night gaming affects sleep.
	Neck pain / Myalgia	Developed neck/back pain due to long hours of play
	Weight gain	A sedentary lifestyle due to a pattern of play causes weight gain.

The identified themes, subthemes, and codes are presented in Table 2 and are discussed in detail below.

Theme 1: Coping Mechanism

Most of the study participants used video games to cope with deficiencies in their personal and professional lives. The subthemes identified under this theme were loneliness, conflict between parents, stress relief, introversion, and forgetting real-life troubles.

1a) Loneliness

The lack of friends or social support was cited as one of the main reasons for prolonged video game playing. “I play video games so that I feel like I have a companion with whom I can share things happening in my everyday life,” explained one interviewee (Interview 5).

1b) Conflict between parents:

Frequent quarrels among parents in nuclear families or relatives in joint/three-generation families led their children to play video games as a distraction. “Fights in the family had a huge impact on me since childhood. Video games are a godsend for me to divert myself so that my mind doesn’t get involved in those things” - (Interview 5)

1c) Stress Relief:

Video games help them overcome stressful situations in daily life. Some participants reported that, if not for video games, they might have ended up in psychiatric hospitals. “After a stressful day in college, a video game session helps me think clearly and focus on my studies” - (Interview 3).

1d) Introvert:

Most of the participants interviewed in the present study were introverts. They felt video games helped them overcome the lack of social interaction in their daily lives. “I always stay alone in my home rather than hanging out with friends/ family. Playing video games is my only pastime, boosting my mood and keeping me grounded” (Interview 1).

2. Social Interactions

2a) Forget real-world problems:

Participants shared that they become absorbed in video games' immersive worlds and engaging narratives, providing a temporary escape from everyday challenges. They also reported that playing video games allows them to take a mental break and gain perspective on their problems. “I always feel anxious and have panic attacks whenever I am faced with problems and challenges in my life. Video games help me stay centered and think clearly,” – Interview 4

2b) To have anonymous conversations with strangers:

Participants mentioned that they enjoyed conversing with random strangers because these interactions were unbiased, non-judgmental, and free of attachment fears. Some even noted that they didn’t know each other’s real names. One participant shared, “I met a random person while playing an online game. We discovered many common interests. I feel comfortable sharing all my feelings with him without revealing my real identity. He was my pillar of support during difficult times.”

2c) Lack of friends in real life:

Participants mentioned that, due to various disappointments in their daily lives, they could not form attachments and lacked real friends to confide in. For them, playing online video games provided solace, offering a way to meet new people and fill the void in their hearts. One participant shared, "All my friends have betrayed me, and I stopped trusting those around me. Social friendships in video games have been a lifesaver. Even though we may be in different countries or continents, sharing common interests and having someone to listen helps me keep going."

2d) Using social media for gaming broadcasts and chats:

Approximately 30% of the participants owned a live YouTube or Discord channel where they broadcast their multiplayer or single-player gaming sessions and had over 1,000 followers. They feel a sense of achievement and confidence when someone compliments their play style. One participant said, "I excel at playing challenging games like Dark Souls. When I create tutorials on defeating the most difficult bosses, people applaud my skills, which gives me a sense of happiness and accomplishment" (Interview 19).

3) Perceived benefits of playing video games:

3a) Boosts mood:

Most participants reported that playing video games helps boost their mood and self-confidence. One participant stated, “Video games are my fuel. After a hard, depressing day in college, booting up a video game, completing in-game quests and sub-quests, and receiving compliments from non-playable characters helps me stay focused and reassures me that life, though challenging, can be rewarding.” (Interview 12)

3b) Helps to concentrate on academics:

Four study participants credited video games as the primary reason for their enhanced problem-solving skills in academics. They mentioned playing video games for an hour, even the day before exams, to de-stress and sharpen their focus and attention. One participant shared, "I play video games to stay focused on the tasks I tackle afterwards. It boosts my concentration, hand-eye coordination, and memory and gives me a feel-good sensation" (Interview 16).

3c) Living in a fantasy world:

Participants who play role-playing games reported being deeply immersed in the fantasy worlds of their games. One participant who plays the fantasy role-playing game stated, "The game's fantasy world captivates me, and for the first time in my life, I feel like my decisions have a meaningful impact on helping those around me." (Interview 4)

3d) Decision Making:

Participants played adventure role-playing games in which the decisions made by the player shaped the storyline to have either a good or bad ending. Those participants responded that they could apply those in real-life situations, too, as they saw the simulated outcome of their decisions in the video game.

3e) Fitness in videogames:

Participants engaged in gamified fitness games on their mobile phones or consoles, where tasks related to various fitness routines are displayed, and points are earned for completing each task. One participant mentioned, "I utilise the motion tracking capabilities of my video game controllers to perform guided workouts in the fitness game. It motivates me by awarding points, medals, and tokens, which I can use to purchase cosmetic accessories for my in-game character" (Interview 24).

4. Perceived drawbacks of playing videogames:

4a) Conflict with parents:

Nearly all the study participants reported that their parents view video games as detrimental to their academic performance. "Ever since school, I've argued with my parents about playing video games at home. They believe video games are as harmful as alcohol or smoking, potentially affecting my body and mind."

4b) Affects academics:

Almost half of the study participants indicated video games negatively impacted their academic performance. "When I play video games, I tend to procrastinate on important tasks like assignments and test preparation, which lowers my academic performance and leads to reduced self-esteem and confidence in college" (Interview 22).

4c) Impulsive to play:

Most participants who play adventure games reported that the extended gameplay duration often leads them to invest significant time progressing through the storylines, which can cause issues in their academic and personal lives. One participant noted, "Movies are over in two or three hours. But some of the role-playing games I play stretch over 150 hours, making me obsessed with seeing the story through to the end" (Interview 24).

4d) Ranked Matches:

Participants who play online competitive shooter games reported experiencing anger and frustration when they lose matches, negatively affecting their relationships with family and friends. One participant shared, "I get so angry and use cuss words while playing competitive online games. I used to rage quit games and throw things around me when things didn't go my way" (Interview 21)

4e) Lack of adequate sleep:

Five study participants reported that playing video games, especially at night, negatively impacted their sleep quality, reduced their sleep hours, and affected their mood the next morning. One participant stated, "Some days, I would play video games late into the night, after everyone else had gone to bed, until 2 or 3 AM. I would wake up tired and have low energy throughout the next day" (Interview 6).

4f) Neck and back pain:

Most participants reported experiencing numb fingers or pain in their arms, neck, or back due to poor posture while playing video games for extended periods. One participant mentioned, "I used to lie in bed and play video games. This caused severe neck pain, and I had to undergo a week of physiotherapy for the pain to subside" (Interview 12).

4d) Weight gain:

Since playing video games is a passive activity, most study participants were either overweight or obese. Nearly half of the participants mentioned consuming junk food and drinks while gaming. One participant shared, "I played video games at least 3 to 4 hours daily. In the past three months, I've gained at least 3 kg, which I attribute to gaming, as I was physically active. The addictive nature of video games prevents me from focusing on my physical health."

Though video games are used for entertainment purposes and have many beneficial effects on individuals, they could cause some ill effects in some people. The present study explored these effects using in-depth interviews among individuals addicted to video games. The findings are discussed below in comparison with studies done elsewhere.

College students often encounter challenges that significantly impact their well-being and academic success. Family-related problems include broken family, loss of one or both parents and parental expectations and pressure. College-related problems include financial pressure, low academic performance and lack of friends [26–28]. Using video games as a coping mechanism or a diversion to overcome loneliness/issues in their life was one of the major themes identified in the present study. This is a cause of concern, as in a study done by Király O et al., having an escape motive to play video games was associated with problematic gaming behaviour [29]. In a study done by Hülya KÖ et al., it was concluded that video game addiction could potentially lead to loneliness [30]. An exciting finding was that most participants who played casual and sports genres of video games felt that video games helped reduce their stress levels due to various extrinsic factors. This is concurrent with findings from multiple other studies from the literature citing that video games could help reduce student anxiety and stress [31–33]. A study done by Desai V et al. found that playing a casual videogame was as effective as participating in a guided mindfulness meditation [34]. The present study found that introverts use video games to cope with the lack of social relationships in their daily life. This aligns with several studies indicating that online gaming environments can assist shy individuals in overcoming challenges related to forming friendships and meeting new people [35–37]. A study conducted by Perry R. et al. found that social interactions in online video games effectively build social capital and positively contribute to bonding, provided that gameplay aligns with other goals and values, mainly depending on the specific genre of the video games [38].

Perceived Benefits of Playing Videogames:

Regarding the perceived benefits of playing video games, the significant benefit shared was that they help improve mood and help students concentrate on their studies. A plethora of literature cites the beneficial effects of video games on one’s mood and psychological well-being [39–41]. A study by Przybylski, AK et al. found that video games improve emotional stability [42]. A study by Wack E et al. found that video games help reduce stress and improve mood [43]. A study done by Durkin K et al. found that depressed mood were found to be lower in moderate players of video games than among those who never play video games [44].

In the present study, participants played role-playing games (RPGs) for four or more hours daily. These players noted that the immersive fantasy worlds within the games helped them achieve virtual goals, boosting their self-confidence and motivation. Similar results were found in a study by Zagal JP et al. [45]. Additionally, research by Steadman J et al. indicated that psychotherapists could utilise RPGs to encourage healthy behaviours [46]. Granic I et al. further suggested that RPGs could aid in emotional regulation and overall improvement in mood for those experiencing depression [47]. These RPGs tend to have storylines in which the player makes decisions that will decide the outcome of the video game. Study participants reported that the decisions they make in games help them make quick decisions in real-world situations, boosting their mood and happiness. A study by Jordan T et al. found that those who play RPGs make more accurate and faster decisions compared to non-gamers [48].

Various fitness components are introduced into casual video games, providing motivation and tutorials to improve fitness [49, 50]. Some participants in the current study reported using fitness games to stay active, noting that the reward mechanisms in these games help them achieve their fitness goals. A study by Devereaux J found that active fitness games may be even more effective than traditional exercise regimes, as they tend to have higher adherence rates [51].

Perceived drawbacks of playing videogames:

Playing video games leads to conflict with parents, another finding identified in the present study. The current Indian society, having a negative attitude towards video games, condemns their children from video games as they believe that it will harm their children [22]. However, times are changing as the new Gen Y and Gen Z parents consider video games the best pastime and even prefer video games to social interactions [52]. Though video games tend to improve concentration and focus, [53, 54] excessive gaming can lead to a decline in academic performance, as evident from the present study's findings. Similar findings were obtained in studies done by Wahid NA et al. [55]. Contrary to popular belief, a study by Adžić S et al. found that video games could benefit students, serving as a self-reward mechanism. There was no significant difference between academic performance among gamers and non-gamers [56].

The study participants reported having difficulty controlling their impulsiveness to play video games for extended periods because they became absorbed in the overarching narratives of the games. Although video games promote fast-paced decision-making, they can reduce a person's ability to control impulsive behaviour. This condition, known as proactive executive control, can even lead to aggressive behaviour [57]. A study by Bailey K et al. and Anderson CA et al. found that playing action video games can lead to impulsive behaviour [58, 59]. Based on these findings, there is a possibility of a causal relationship between playing action video games for long periods and reduced cognitive control and increased impulsivity, warranting further research into the subject [60].

The participants in the present study reported that playing video games late at night affects their sleep duration and quality. Peracchia S et al. found that playing video games late at night and evening can lead to poor sleep quality and impaired cognition in the following days [61]. Similar results were observed in various studies conducted with different genres of video games [62–65].

Participants in the present study reported experiencing musculoskeletal pain in the neck due to long hours of gaming. Similar findings were observed in a study by Kang J-W et al., which found that excessive gaming, defined as more than three hours per day, led to musculoskeletal problems in the upper limbs, particularly the neck, among college students [66]. Another study by Sekiguchi T et al. found that excessive computer gaming could cause shoulder and elbow pain [67]. Additionally, a study by Tholl C et al. concluded that playing video games for more than three hours per day is a significant predictor of musculoskeletal problems [68].

By recognising the individual experiences and perspectives of those struggling with video game addiction, family medicine practitioners can tailor their interventions and treatment plans to meet their patients' specific needs better. These findings can serve as a valuable educational resource for enhancing their professional development and improving their ability to educate patients and their families about the complexities of video game addiction.

Limitations:

Since this study is qualitative, external validity is limited as the results may not be generalizable to the whole population. Participants who had difficulty controlling their impulsiveness to play video games may have other factors that could have influenced the same, including social, psychiatric or factors related to academic life. These factors could be better addressed by adopting longitudinal studies.

The motivations for playing video games varied, including achievements, social interaction, immersion, and fulfilling psychological needs. It was observed that video games can serve as both a source of stress relief and a cause of stress and distress, depending on game genre, player skill level, and social context. Further research is needed to explore these themes in greater depth and address emerging gaming industry trends.

Author Contributions: Dr Sushmitha G (Conception of design, acquisition of data, analysis, interpretation of data, drafting the manuscript), Dr V.M.Anantha Eashwar (Conception of design, acquisition of data, analysis, and interpretation of data, Manuscript drafting, revision and approval), Dr R.J. Charulatha (drafting and revision of the manuscript), Dr Surya N.B ((drafting and revision of the manuscript).

Source of Funding: Nil

Conflicts of interest/Competing interests: Nil

Data availability: Data is currently not openly available. The research team will consider data-sharing requests.

Code Availability: Not applicable

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No competing interests reported.

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Balancing Act: A Qualitative Study on the Dual Nature of Video Game Addiction among medical college students in Chengalpattu district, Tamil Nadu

Status:

Version 1

Abstract

Introduction:

Materials and Methods

Result

Conclusion

Introduction

Methodology

Results

[Table 1: Characteristics of study participants interviewed.]

[Table 2: Themes, subthemes, and codes obtained from qualitative interviews.]

Theme 1: Coping Mechanism

1b) Conflict between parents:

1c) Stress Relief:

1d) Introvert:

2. Social Interactions

2a) Forget real-world problems:

2b) To have anonymous conversations with strangers:

2c) Lack of friends in real life:

2d) Using social media for gaming broadcasts and chats:

3) Perceived benefits of playing video games:

3a) Boosts mood:

3b) Helps to concentrate on academics:

3c) Living in a fantasy world:

3d) Decision Making:

3e) Fitness in videogames:

4. Perceived drawbacks of playing videogames:

4a) Conflict with parents:

4b) Affects academics:

4c) Impulsive to play:

4d) Ranked Matches:

4e) Lack of adequate sleep:

4f) Neck and back pain:

4d) Weight gain:

Discussion

Perceived Benefits of Playing Videogames:

Perceived drawbacks of playing videogames:

Limitations:

Conclusion

Declarations

References

Additional Declarations

Status:

Version 1