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 Table of Contents  
Year : 2019  |  Volume : 6  |  Issue : 4  |  Page : 237-241

Internet gaming disorder in undergraduate medical and dentistry students

Department of Neurology, Christian Medical College, Ludhiana, Punjab, India

Date of Submission30-Jul-2018
Date of Decision28-Oct-2018
Date of Acceptance25-Nov-2018
Date of Web Publication21-Nov-2019

Correspondence Address:
Aishwarya Aggarwal
Snow Hostel, Christian Medical College, Brown Road, Ludhiana, Punjab
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Source of Support: None, Conflict of Interest: None

DOI: 10.4103/cjhr.cjhr_117_18

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Introduction: The number of mobile game users has increased considerably over the last few years globally. Medical students are no exception to the increasing trend of gaming. Aim: The aim of this study was to find the prevalence of internet gaming disorder (IGD) and associated behavioral problems in medical and dentistry students. Materials and Methods: This cross-sectional study was conducted on undergraduate medical and dentistry students of Christian Medical College and Christian Dental College, Ludhiana, from July 2016 to October 2016. The self-administered questionnaire was based on the Diagnostic and Statistical Manual of Mental Disorders-5 (DSM-5) criteria for diagnosing IGD. Comparison was made between the individuals with IGD and without IGD for sleep, headache, and cognition-related problems. Chi-square and Student's t-tests were used. P < 0.05 was considered statistically significant. Results: Four hundred students participated in the study, of which 314 (78.5%) were medical and 86 (21.5%) dentistry students. Females 265 (66.2%) were a majority, and the mean age was 20.2 ± 9 years. Thirty-six students (9%) had IGD. Males were more commonly affected (males 22 [61.1%] vs. females 14 [38.9%], P < 0.001). The IGD group was more likely to play the games during classes (IGD group 24 [66.7%] vs. non-IGD group 176 [48.4%], P = 0.036) and tended to skip classes to continue gaming (IGD group 8 [22.5%] vs. non-IGD group 9 [2.5%], P < 0.001). The mean score for sleep and cognition-related problems was higher for the IGD group. Conclusion: IGD is prevalent among professional college students and is associated with sleep, headache, and cognition-related problems.

Keywords: Diagnostic and Statistical Manual of Mental Disorders-5, Internet gaming disorder, mobile gaming

How to cite this article:
Aggarwal A, Pandian JD. Internet gaming disorder in undergraduate medical and dentistry students. CHRISMED J Health Res 2019;6:237-41

How to cite this URL:
Aggarwal A, Pandian JD. Internet gaming disorder in undergraduate medical and dentistry students. CHRISMED J Health Res [serial online] 2019 [cited 2022 Aug 13];6:237-41. Available from: https://www.cjhr.org/text.asp?2019/6/4/237/271323

  Introduction Top

Internet gaming disorder (IGD) is the excessive and recurrent use of devices such as mobile phones, tablets, and computers for the purpose of online gaming, resulting in significant compromise of daily activities and distress.[1] IGD has been included as a condition for further study in Section III of the Diagnostic and Statistical Manual of Mental Disorders-5 (DSM-5).[1] The prevalence of IGD ranges from 1.4% to 16.9% as reported by various studies worldwide.[2],[3] Currently, there are limited data on the prevalence of IGD in India. Two brothers were diagnosed with IGD who developed severe symptoms leading to poor academic performance and negligence of self-care.[4] India ranked 5th globally in terms of a number of game downloads in the year 2016.[5]

Previous studies have shown that excessive mobile gaming adversely affects sleep by causing increased sleep-onset latency and sleep deficiency.[6] Video games stimulate the pleasure center of the brain and release a large amount of dopamine which is shown to maintain wakefulness by inhibiting melatonin.[7],[8] Excessive gaming has also been identified as a risk factor for the development of headaches.[9]

Players are much more likely to use navigation strategies that rely on the brain's reward system (the caudate nucleus) and not the brain's spatial memory system (the hippocampus).[10] Past research has shown that people who use caudate nucleus-dependent navigation strategies have decreased gray matter and lower functional brain activity in the hippocampus.[10] This means that people who spend a lot of time playing video games may have reduced hippocampal integrity, which is associated with an increased risk of neurological disorders such as Alzheimer's disease.[10]

Violent video games lead to the development of aggressive behaviors and reduced empathy in real life as evidenced by previous researches.[11],[12] A positive association has been found between IGD and adult attention deficit and hyperactivity disorder.[13] Hence, the aim of the prresent study was to find the prevalence of IGD in medical and dentistry students and its association with sleep, headache, and cognition-related problems.

  Materials and Methods Top

The study was conducted on medical and dentistry students of Christian Medical College and Christian Dental College, Ludhiana, from July 2016 to October 2016. Students from the 1st year till the final year were included in the study. A self-administered questionnaire based on the IGD scale (IGDS) was used to diagnose IGD.[1] The IGDS consisted of a set of nine criteria and each criterion had two responses (no = 0, yes = 1).[14] Individuals were diagnosed to have IGD if the total score was ≥5.[15],[16] The questionnaire for sleep was derived from the Global Sleep Assessment Questionnaire.[17] It consisted of five questions with four responses and a score (never = 0, sometimes = 1, usually = 2, always = 3) for each. Thus, the total score for sleep-related problems ranged from 0 to 15. The headache questionnaire consisted of six questions, the first four for the description of headache-related problem and the next two to assess the relationship of problem with gaming. The cognitive disorder questionnaire was derived from the adult attention-deficit/hyperactivity disorder (ADHD) Self-Report Scale-v1.1 and had seven questions with four responses and a score (never = 0, rarely = 1, sometimes = 2, often = 3) for each.[18] Thus, the total score for cognition-related problems ranged from 0 to 21. Written informed consent was obtained from the students. The study was approved by the Institutional Research Committee.

Statistical analysis

Based on an assumed prevalence of 20% and an allowable error of 20% using the formula N = 4pq/ d2, the sample size was calculated as 400. The group with IGD was compared with the group without the disorder. Chi-square and Student's t-tests were used. P < 0.05 was considered statistically significant. The data were analyzed using IBM SPSS Statistics version 21.0 Software.

Ethical approval

The permission was taken from Institutional Ethics Committee prior to starting the project. All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

  Results Top

Description of the study population

A total of 400 students participated in the study. There were 135 (33.7%) males and 265 (66.2%) females. The mean age was 20.2 ± 9 years. Three hundred and fourteen (78.5%) students belonged to the undergraduate medical (MBBS) course and 86 (21.5%) belonged to the undergraduate dentistry (BDS) course. A total of 317 (79.2%) students played online games. Many individuals played multiple games. The most commonly played games are shown in [Figure 1].
Figure 1: Most commonly played mobile games

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Prevalence of Internet gaming disorder and its characteristics

As per the IGDS, 36 (9%) students were diagnosed to have IGD. The most prevalent criteria within the IGD group were continuing gaming despite problems 32 (88.9%), playing to escape adverse moods 29 (80.6%), and giving up other activities to continue gaming 26 (72.2%). The differences in the characteristics of the IGD and the non-IGD group are shown in [Table 1].
Table 1: Comparison of characteristics of Internet gaming disorder group with the non-Internet gaming disorder group

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Behavioral problems related to Internet gaming disorder

The comparison between IGD and non-IGD group for problems related to sleep, cognition, and headache is depicted by [Table 2], [Table 3], [Table 4], respectively.
Table 2: Comparison of sleep-related problems between Internet gaming disorder and non-Internet gaming disorder group

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Table 3: Comparison of cognition-related problems between Internet gaming disorder and non-Internet gaming disorder group

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Table 4: Comparison of headache-related problems between Internet gaming disorder and non-Internet gaming disorder group

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  Discussion Top

Females were a majority in our study, which reflects the general gender distribution in the medical and dentistry colleges of India. The prevalence of IGD in this study was found to be 9% and was higher than the prevalence of 5.9% reported in Korean adolescents and 5.7% in 12–25 years old in Germany.[18],[19] The prevalence was considerably higher than that of 2.5% as recorded in Slovenian primary school children.[20] It was lesser than the prevalence of 16.9% and 13.8% as reported in two other studies.[3],[21] Male gender was more commonly affected in this report, which is similar to previous studies.[2],[3],[14] The average time spent for playing by individuals with IGD was 2 h in this study, whereas it was reported to be 3 h in another study.[22] IGD group was more likely to play games during classes and even missed classes to continue their gaming.

The most commonly played games were Candy Rush, Temple Run or Subway Surfer, and Mini Militia. Candy Crush is one of the most popular games worldwide and is played by individuals of all age groups. It is easy and can be played with one hand, allowing the users to multitask.[23] It targets the reward system of the brain to release dopamine and is highly addictive.[24] A man was reported to have ruptured his left extensor pollicis longus tendon due to weeks of constant play of Candy Crush.[25] Temple Run and Subway Surfer are other games which are based on individuals achieving certain targets and giving them a sense of accomplishment. Mini Militia is a multiplayer online role-playing game and involves firing at and killing other players. The most prevalent IGDS criteria among the IGD group in this study were continuing gaming despite problems, playing to escape adverse moods, and giving up other activities to continue gaming.

Individuals with gaming habit have a poorer quality of sleep and increased daytime sleepiness.[26] In our study not only did the individuals with IGD had increased daytime sleepiness but they were also more prone to have nightmares. An association was found between IGD and ADHD with individuals being more hostile and impulsive.[13] Our study supports this relation as individuals with IGD were more likely to be distracted during a conversation, avoided starting tasks requiring organization, and were compelled to do things as if driven by a motor.

Individuals with IGD were more likely to develop headaches after prolonged gaming, and the duration of gaming required to produce a headache was more in the IGD group suggesting tolerance. Refraining from gaming prevented headaches.


The sample population has a limited representation. The prevalence might vary depending on the age, region, and educational status of individuals.

  Conclusion Top

This study has given an estimate of the prevalence of IGD in India and its association with sleep, cognition, and headache-related problems. The rate of indulgence of students in gaming is increasing at an alarming rate, and this may adversely affect the health of the individuals and their commitment to studies in the long run. There is a need to spread awareness regarding the disorder, and individuals with severe addiction should be counseled.

Declaration of patient consent

The authors certify that they have obtained all appropriate patient consent forms. In the form the patient(s) has/have given his/her/their consent for his/her/their images and other clinical information to be reported in the journal. The patients understand that their names and initials will not be published and due efforts will be made to conceal their identity, but anonymity cannot be guaranteed.

Financial support and sponsorship


Conflicts of interest

There are no conflicts of interest.

  References Top

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  [Figure 1]

  [Table 1], [Table 2], [Table 3], [Table 4]

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