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 Table of Contents  
Year : 2020  |  Volume : 36  |  Issue : 3  |  Page : 254-257

Anxiety as a predictor of gaming disorder among young adults

1 Department of Clinical Psychology, SHUT Clinic (Service for Healthy Use of Technology), National Institute of Mental Health and Neurosciences, Bengaluru, Karnataka, India
2 Department of Clinical Psychology, National Institute of Mental Health and Neurosciences, Bengaluru, Karnataka, India
3 Department of Biostatistics, National Institute of Mental Health and Neurosciences, Bengaluru, Karnataka, India
4 Department of Psychiatric Social Work, National Institute of Mental Health and Neurosciences, Bengaluru, Karnataka, India
5 Department of Clinical Psychology, SHUT Clinic, National Institute of Mental Health and Neurosciences, Bengaluru, Karnataka, India
6 Centre for Addiction Medicine, National Institute of Mental Health and Neurosciences, Bengaluru, Karnataka, India

Date of Submission25-Dec-2019
Date of Decision20-Mar-2020
Date of Acceptance10-Jun-2020
Date of Web Publication28-Sep-2020

Correspondence Address:
Manoj Kumar Sharma
Department of Clinical Psychology, SHUT Clinic (Service for Healthy Use of Technology), National Institute of Mental Health and Neurosciences, Bengaluru, Karnataka
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Source of Support: None, Conflict of Interest: None

DOI: 10.4103/ijsp.ijsp_129_19

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Background: Psychological morbidities have been found to be associated with gaming disorder. Objective: The aim of the current study was to examine the relationship of gaming disorder with affective states of depression, stress, and anxiety. Materials and Methods: The sample consisted of 403 males in the age range of 18–25 years. The mean age was 21 years. These young adults were approached for the administration of study tools from colleges and community of urban areas of Bengaluru. Inverse binomial sampling was used to collect the sample. The Internet Gaming Disorder Scale Short-Form and Depression Anxiety Stress Scales-21 were administered. Results: Stepwise regression analysis indicated that anxiety significantly contributed to gaming disorder. Depression and stress did not contribute significantly toward gaming disorder. Conclusions: This study implies the need for intervention of anxiety in the context of gaming disorder and the design of appropriate interventions.

Keywords: Anxiety, depression, gaming, stress

How to cite this article:
Sharma MK, Anand N, Marimuthu P, Suma N, Murthy KD, Thakur PC, Singh P, Ajith S J, John N, Mondal I, Biswas A, Archana R, Vishwakarma A, Tadpatrikar A, Ahuja S. Anxiety as a predictor of gaming disorder among young adults. Indian J Soc Psychiatry 2020;36:254-7

How to cite this URL:
Sharma MK, Anand N, Marimuthu P, Suma N, Murthy KD, Thakur PC, Singh P, Ajith S J, John N, Mondal I, Biswas A, Archana R, Vishwakarma A, Tadpatrikar A, Ahuja S. Anxiety as a predictor of gaming disorder among young adults. Indian J Soc Psychiatry [serial online] 2020 [cited 2023 Feb 7];36:254-7. Available from: https://www.indjsp.org/text.asp?2020/36/3/254/296259

  Introduction Top

The coexistence of psychological difficulties with the excessive use of internet is well established. Psychological distress, broadly speaking, has been found to be associated with the excessive or addictive use of internet in population of young adults in India.[1],[2],[3] In a similar manner, psychological morbidities are also seen among treatment seekers for gaming addiction. A study in the Indian context reported that 6.8% of gamers in the age group of 16–18 years had a life-time history of psychiatric symptoms, and depression, anxiety, and stress were shown to be associated with internet gaming disorder (IGD).[4] Another study reported elevated levels of state and trait anxiety and social phobia among problematic online gamers.[5] Meta-analytic research has also indicated an elevated prevalence of depression, anxiety, obsessive–compulsive disorder, and somatization in problematic gaming. Among those with problematic gaming, there was a medium effect size for depression and anxiety symptoms in young adults or adults and a small effect size among adolescents.[6] The review of IGD and comorbid psychological morbidity found that a large proportion of the studies on IGD reported significant relationships with psychological symptoms. Specifically, 92% of studies were associated with anxiety, 89% studies with depression, 87% with ADHD or hyperactivity symptoms, and 75% with social anxiety and obsessive–compulsive symptoms.[7] Among these symptom clusters, the effect sizes were strongest for anxiety.[7] Another National survey revealed elevated scores on measures of anxiety and depression among problematic online gamers.[8] The current study evaluated the role of affective states in predicting online gaming addiction in the Indian context.

  Materials and Methods Top


The objective of the study was to examine the relationship of gaming disorder with affective states of depression, stress, and anxiety.


The sample size for the study was 403 males in the age group of 18–25 years. Inverse binomial sampling was used to collect the sample. The inclusion criteria consisted of recruiting those who were playing games for a minimum period of 1 year or above. Participants with an inability to read and write in English were excluded from the study. The Institute Ethics Committee approval was taken for the study.


Gaming screening sheet

This was developed by the investigators to collect information about demographic details as well as for screening participants regarding involvement in gaming for a minimum duration of 1 year or above. The participants who responded in affirmative to the screening question were included in the study for assessment of gaming, depression, stress, and anxiety.

The IGD Scale Short-Form (IGDS9-SF)[9] assesses the severity of IGD and its detrimental effects by examining both online and/or offline gaming activities occurring over a 12-month period. The scale comprises nine items corresponding to the nine core criteria defined by the DSM-5. These nine items are answered on a 5-point Likert scale ranging from 1 (never) to 5 (very often). Higher scores indicate higher severity of gaming disorder. Gaming disorder was classified based on the endorsement of at least five out of the nine criteria, i.e., when at least five of the answers were rated as “5” (very often). This scale has good reliability (internal consistency = 0.96) and adequate validity (Comparative fit index (CFI) = 0.964; Tucker–Lewis index (TLI) = 0.952; Root Mean Square Error of Approximation (RMSEA) = 0.054 [90% confidence interval]).

The Depression Anxiety Stress Scale (DASS-21)[10] is a 21-item self-report questionnaire designed to measure the frequency and severity of symptoms of depression, anxiety, and stress over the previous week. The ratings of severity are based on a 4-point Likert scale which has options ranging from 0 = did not apply to me at all to 3 = applies to me very much.


Informed consent was obtained from 509 participants at colleges before administration of the study tools. The survey included a screening question about their involvement in gaming for a minimum duration of 1 year or above. If they responded in affirmative to this question, they could complete the remaining survey. Thus, 106 females who did not acknowledge the involvement in gaming for the duration of 1 year or more were excluded from the study. Thus, the sample size for the study was 403. To achieve the sample of 403, the administration of the IGDS9-SF and DASS was carried out in groups of 20–30 participants.

Data analysis

Descriptive statistical analyses were carried out for ordinal data. Chi-square tests were used for categorical variables. Stepwise regression analysis was used to find the significant predictors among variables of depression, anxiety, and stress for gaming disorder.

  Results Top

The mean age of the sample was 20.9 years with standard deviation of 3.07 years. The mean and standard deviations of stress, anxiety, and depression were 7.33 ± 7.27, 6.24 ± 7.03, and 8.11 ± 8.72, respectively. The mean was 10.8 for IGDS9-SF and standard deviation for the same was 3.09.

[Table 1] shows the association of anxiety with gaming disorder. It showed that likelihood of presence of gaming disorder was found to be significant among users with anxiety. Stepwise regression analysis [Table 2]a indicated that anxiety significantly contributed to gaming disorder. Linearity was checked by ANOVA and the R2 was 0.46 indicating that the presence of anxiety explained 46% of the variance in gaming disorder by.
Table 1: Distribution of Depression, Anxiety, and Stress scores

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[Table 2]b showed that depression and stress have not contributed significantly toward gaming disorder.

  Discussion and Conclusions Top

This study documents the association between anxiety and gaming disorder [Table 2]a and [Table 2]b. The scores for affective states were predominantly in the mild-to-moderate range on the depression, anxiety, and stress scale and association with anxiety [Table 1]. A study in the Indian context among adolescents found the association of anxiety with gaming disorder.[4] In an another study, social anxiety, expressions of true self, perceived in-game support, and face-to-face social support were examined as predictors of problematic internet use through the Generalized Problematic Internet Use Scale (GPIUS) scores and hours spent playing Massively Multiplayer Online Role-Playing Games (MMORPGs) per week in an online survey with 626 participants. These findings were further evaluated on a sample of 313 participants using structural equation modeling. The variables of expressing true self in game, higher levels of social anxiety, larger number of in-game social supports, and fewer supportive face-to-face relationships were found to be significant predictors of higher GPIUS scores, and the number of in-game supports was significantly associated with time spent playing online games.[11] Researchers also assessed the mediation role of anxiety for maladaptive coping and its role in video game addiction through two studies among undergraduate students.[12] Study 1 found that even after controlling for gaming frequency and other negative coping mechanisms, video games emerged as a means of coping with setbacks or stressors. The presence of stressors also predicted video game addiction symptoms. Serial mediation analysis also revealed that the presence of anxiety may prompt the greater use of video games as a coping mechanism.[12] Study 2 also corroborated these serial mediation model findings.[12]

In a similar study, 123 undergraduates were assessed for personality traits (sensation seeking, self-control, aggression, neuroticism, state anxiety, and trait anxiety) and online gaming addiction. The multiple linear regression analysis showed that personality traits of neuroticism, sensation seeking, trait anxiety, state anxiety, and aggression had high associations with online gaming addiction.[13] A study conducted within the Indian context also indicated that neuroticism was associated with the problematic use of online gaming.[14] The individuals with higher levels of neuroticism behave aggressively after exposure to violent games and this occurs more often when they also have low scores on traits of agreeableness and conscientiousness.[15],[16] In another study which assessed 429 young adult video gamers (mean age 20.7 years) using the Game Addiction Scale, the Toronto Alexithymia Scale-20, and the Hospital Anxiety and Depression scale, it was found that for male gamers, IGD was associated with being alexithymic, younger in age, and having high anxiety and depression scores.[17] Whereas in female gamers, IGD was associated with having less than a high school education and a high depression score.[17] In Multiplayer Online Battle Arena (MOBA) gamers, IGD was associated with difficulty in describing feelings, whereas in MMORPGs, IGD was associated with the presence of anxiety. The players may be using MOBA as a strategy to regulate emotions, whereas MMORPG is being used as maladaptive coping strategy to deal with negative emotional disturbances.[17] A similar trend was observed for a study with 987 volunteers who were administered Toronto Alexithymia Scale, the Buss-Perry Aggression Questionnaire, IGDS9-SF, and the depression and anxiety subscales of the 90-Item Symptom Checklist-Revised. It was found that both alexithymia and aggression (physical aggression) were associated with the intensity of IGD symptoms and severity of depressive symptom.[18]

The available research literature indicates that online gaming is associated with affective states and is used as a dysfunctional method of coping as well. The present study has limitations as it does not offer information for reciprocal relationships between other study variables such as types of games played, duration of play, female gamers' gaming preferences, and history of psychiatry morbidity. However, despite these limitations, this study demonstrated the role of anxiety in gaming disorder among young adults. The current study findings are timely, as the number of online gamers seeking help for problematic use of online games is likely to increase in the near future. Therefore, having an understanding about the underlying psychological variables will be beneficial in formulating early identification, assessment, and intervention strategies for both anxiety problems and problematic online gaming, as existence of either of these conditions can be a risk factor for the emergence of the other. Future studies could use an experimental design to explore the causal relationship between these affective states and online gaming, or a longitudinal design to examine the prospective relationship among these variables. In addition, studies can explore gaming from the perspective of offering benefits of introducing game formats in social communication, educational, and health delivery structure which may increase the productivity of engagement.[19] These studies may help us to develop a balanced perspective of the existence of addictive and promotive use of online gaming among young adults.


RGNIYD, Sripermubudur, Chennai, India, awarded the grant to Dr. Manoj Kumar Sharma.

Financial support and sponsorship


Conflicts of interest

There are no conflicts of interest.

  References Top

Anand N, Thomas C, Jain PA, Bhat A, Thomas C, Prathyusha PV, et al. Internet use behaviors, internet addiction and psychological distress among medical college students: A multi centre study from South India. Asian J Psychiatr 2018;37:71-7.  Back to cited text no. 1
Anand N, Jain PA, Prabhu S, Thomas C, Bhat A, Prathyusha PV, et al. Prevalence of excessive internet use and its association with psychological distress among university students in South India. Ind Psychiatry J 2018;27:131-40.  Back to cited text no. 2
[PUBMED]  [Full text]  
Anand N, Jain PA, Prabhu S, Thomas C, Bhat A, Vasuki PV, et al. Internet use patterns, internet addiction and psychological distress among engineering university students: A study from South India. Indian J Psychol Med 2018;40:458-67.  Back to cited text no. 3
[PUBMED]  [Full text]  
Archana R, Sharma MK, Kumar KJ, Marimuthu P. Internet gaming disorder and psychiatric symptoms in Bengaluru, India: Treatment implication for promotion of user mental health. Indian J Soc Psychiatr 2019;35:135-6.  Back to cited text no. 4
Cole SH Hooley JM. Clinical and personality correlates of MMO gaming: Anxiety and absorption in problematic internet use. Soc Sci Comput Rev 2013;31:424-36.  Back to cited text no. 5
Mannikko N, Ruotsalainen H, Miettunen J, Pontes HM, Kaariainen M. Problematic gaming behaviour and health-related outcomes: A systematic review and meta-analysis. J Health Psychol 2020;25:67-81.  Back to cited text no. 6
González-Bueso V, Santamaría JJ, Fernández D, Merino L, Montero E, Ribas J. Association between internet gaming disorder or pathological video-game use and comorbid psychopathology: A comprehensive review. Int J Environ Res Public Health 2018;15:668.  Back to cited text no. 7
Mentzoni RA, Brunborg GS, Molde H, Myrseth H, Skouveroe KJ, Hetland J, et al. Problematic video game use: estimated prevalence and associations with mental and physical health. Cyberpsychol Behav Soc Netw 2011;14:591-6.  Back to cited text no. 8
Pontes HM, Griffiths MD. Measuring DSM-5 Internet gaming disorder: Development and validation of a short psychometric scale. Comput Hum Behav 2015;45:137-43.  Back to cited text no. 9
Lovibond SH, Lovibond PF. Manual for the Depression, Anxiety, Stress Scales. 2nd ed. Sydney: Psychology Foundation; 1995.  Back to cited text no. 10
Lee BW, Leeson PR. Online gaming in the context of social anxiety. Psychol Addict Behav 2015;29:473-82.  Back to cited text no. 11
Plante CN, Gentile DA, Groves CL, Modlin A, Blanco-Herrera J. Video games as coping mechanisms in the etiology of video game addiction. Psychol Pop Med Cult 2019;8:385-94.  Back to cited text no. 12
Mehroof M, Griffiths MD. Online gaming addiction: the role of sensation seeking, self-control, neuroticism, aggression, state anxiety, and trait anxiety. Cyberpsychol Behav Soc Netw 2010;13:313-6.  Back to cited text no. 13
Sharma MK, Anand N, Murthy KD. Personality characteristics of online gamers. Indian J Psychiatry 2020. [In Press]. Available from: https://doi.org/10.4103/psychiatry. IndianJPsychiatry_422_19. [Last accessed on 2020 May 10].  Back to cited text no. 14
Markey PM, Markey CN. Vulnerability to violent video games: A review and integration of personality research. Rev Gen Psychol 2010;14:82-91.  Back to cited text no. 15
Porter G, Starcevic V, Berle D, Fenech P. Recognizing problem video game use. Aust N Z J Psychiatry 2010;44:120-8.  Back to cited text no. 16
Céline B, Baptista D. Internet gaming disorder in male and female young adults: The role of alexithymia, depression, anxiety and gaming type. Psychiatry Res 2019;272:521-30.  Back to cited text no. 17
Evren C, Evren B, Dalbudak E, Topcu M, Kutlu N. Relationship of internet gaming disorder severity with symptoms of anxiety, depression, alexithymia, and aggression among university students. Atten Defic Hyperact Disord 2019;11:413-21.  Back to cited text no. 18
John N, Sharma MK, Kapanee AR. Gaming- a bane or a boon – A systematic review. Asian J. Psychiatry 2019;42:12-7.  Back to cited text no. 19


  [Table 1], [Table 2]

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