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ORIGINAL ARTICLE
Year : 2020  |  Volume : 64  |  Issue : 6  |  Page : 172-176  

Impact of lockdown following COVID-19 on the gaming behavior of college students


1 Additional Professor, Behavioral Addictions Clinic, Department of Psychiatry, National Drug Dependence Treatment Centre, All India Institute of Medical Sciences, New Delhi, India
2 Senior Resident Doctor, Department of Psychiatry, National Drug Dependence Treatment Centre, All India Institute of Medical Sciences, New Delhi, India
3 Associate Professor, CHRIST (Deemed to be University), Ghaziabad, Uttar Pradesh, India
4 Additional Professor of Clinical Psychology, Department of Psychiatry, National Drug Dependence Treatment Center, All India Institute of Medical Sciences, New Delhi, India

Date of Submission29-Apr-2020
Date of Decision07-May-2020
Date of Acceptance10-May-2020
Date of Web Publication2-Jun-2020

Correspondence Address:
Yatan Pal Singh Balhara
Department of Psychiatry, National Drug Dependence Treatment Centre, Behavioral Addictions Clinic, All India Institute of Medical Sciences, New Delhi
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/ijph.IJPH_465_20

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   Abstract 


Background: The uncertainty about the impact of the lockdown in wake of COVID-19 on their future academic and carrier prospects, besides other concerns; makes college students, particularly vulnerable to stress during the COVID-19 pandemic. Gaming has been recognized as a coping mechanism against stress in the previously published literature. Objectives: The current study aimed to assess the gaming behavior of college students during the lockdown following COVID-19. Methods: Data were collected from a cohort of students that constituted the sampling frame of an ongoing project. A total of 393 college students were enrolled. All the eligible students were subsequently contacted through E-mail and WhatsApp messenger and invited to share the details. Results: About half (50.8%) of the participants reported that their gaming behavior had increased, whereas 14.6% reported a decrease in their gaming during the lockdown period. In binary logistic regression analysis, hours of gaming per day (odds ratio [OR] 1.75 [1.29–2.36]), increase in gaming due to examination related stress (OR 4.96 [1.12–21.98]), and belief that gaming helps managing stress (OR 4.27 [1.65–11.04]), were found to be independently associated with gaming behavior during lockdown period.Conclusion: In the lockdown period following COVID-19 pandemic, the increase in gaming behavior was associated with examination-related stress and the belief that gaming helps combat stress. These observations highlight the need to focus on the coping style of the students to ascertain the likelihood of them engaging in gaming behavior as a coping mechanism against stress.

Keywords: COVID-19, lockdown, gaming disorder, stress


How to cite this article:
Balhara YP, Kattula D, Singh S, Chukkali S, Bhargava R. Impact of lockdown following COVID-19 on the gaming behavior of college students. Indian J Public Health 2020;64, Suppl S2:172-6

How to cite this URL:
Balhara YP, Kattula D, Singh S, Chukkali S, Bhargava R. Impact of lockdown following COVID-19 on the gaming behavior of college students. Indian J Public Health [serial online] 2020 [cited 2020 Sep 26];64, Suppl S2:172-6. Available from: http://www.ijph.in/text.asp?2020/64/6/172/285596




   Introduction Top


Playing digital games have increasingly become a ubiquitous leisure activity among adolescents and young adults. The available literature suggests that a significant proportion of college students engage in gaming behavior excessively. This pattern of gaming could be detrimental to their physical and mental well-being.[1],[2] Gaming disorder has been included as a diagnosable mental disorder in the recent revision of International Classification of Diseases (ICD) 11 by the World Health Organization.

The prevalence of gaming disorder has been reported to vary from 0.7% to 27.5% across studies.[3] A pooled analysis of four large international surveys has estimated the prevalence in the general population to be between 0.3% and 1%.[4] While gaming disorder has been recognized as a public health problem, it is important to note that majority of people who engage in gaming do not fulfil the criteria for gaming disorder.

The studies that have explored the motives behind gaming, identified coping as an important motive for gaming behavior. The escape and achievement motives have also been consistently found to be associated with problematic gaming.[5] This association has also been observed among adolescents.[6] Gaming has been reported as a new way of satisfying basic human needs within the constraints of current modern society.[7]

The world is currently experiencing the COVID-19 pandemic. As part of the public health measures targeted at containing the spread of SARS-CoV-2 (virus causing COVID-19) in India, the educational institutions across the country were shut down in March, 2020. Subsequently, a nationwide lockdown was enforced for 21 days, which was extended first by 3 weeks and then by additional 2 weeks. The fear of acquiring the infection, idea of getting quarantined, restrictions placed on movements, and social distancing could have an adverse impact on the mental health during the times of epidemics and pandemics.[8] The same can be expected in the case of COVID-19-related lockdown in India, as this has been considered by public health experts as the worst public health disaster that humankind has experienced since the second world war.[9]

Most of the adolescents and young adults are likely to have experienced such a stressful situation for the first time in their lives. The uncertainty about the adverse impact of this situation on their future academic and carrier prospects, besides other concerns, makes college students particularly vulnerable to stress during the COVID-19 pandemic. In addition, most of the students at the time of closure of colleges (a few days before the nationwide lockdown) were expected to take their professional course examination. This examination also got postponed indefinitely. This could also be a potential factor impacting the mental health of college students. Thus, the college students were faced with a situation that is ridden with complexities and uncertainties about their future, at least in the short term.

Gaming has been recognized as a coping mechanism against stress in the previously published literature.[10],[11] However, there are no published reports on the impact of a pandemic of the scale of COVID-19 and the consequent restrictions as a result of public health response to such pandemic on the gaming behavior among college students.

We aimed to assess the gaming behavior of college students and its association with stress due to COVID-19 pandemic and the situation consequent to the public health measures instituted.


   Materials and Methods Top


Data were collected from a cohort of students that constituted the sampling frame of an ongoing project by the authors. This project started before the COVID-19 outbreak and participants were recruited following face-to-face interviews. The project is aimed at the development and validation of a scale to assess disordered gaming. A new scale has been developed by the authors to assess the gaming disorder and hazardous gaming. This scale has been validated through this project. The protocol was approved by the Institutional Ethics Committee (IEC 885/January 03, 2020). Consent was sought from the students for participation in the study.

A total of 393 college students were enrolled following face-to-face interview. All the eligible students were subsequently contacted through E-mail and WhatsApp messenger and invited to share the details. All these participants reported gaming and constituted the sample for the project. The data were collected online due to the restriction on movements. We aimed to study the gaming behavior of college students and its association with stress due to COVID-19 and the situation consequent to implementation of the public health measures. The survey was kept brief to achieve greater response rates.

The basic sociodemographic information was collected. A structured questionnaire was developed to enquire about the current gaming behavior and adverse mental health impact. Patient Health Questionnaire (PHQ)-9 and Generalized Anxiety Disorder (GAD)-7 scales were used for the measurement of depression and anxiety, respectively. The PHQ-9 is a self-report-based tool, which scores each of the nine Diagnostic and Statistical Manual of Mental Disorder (DSM)-IV major depression criteria on a four-point Likert scale from “0” (not at all) to “3” (nearly every day). The GAD-7 is a self-rated scale used as a screening tool and severity indicator for GAD. It consists of seven items also scored on a four-point Likert scale from of 0 (not at all) to 3 (nearly every day). PHQ-9 and GAD-7 have well established psychometric properties.[12],[13]

Internet Gaming Disorder Short Form-9 (IGDSF) scale was used to assess the severity of disordered gaming before the outbreak of COVID-19 pandemic. The IGDS9-SF is a unidimensional tool comprising of nine items, each reflecting one DSM-5 criteria for IGD. The psychometric properties of this instrument have been well-established.[14] Furthermore, the diagnosis of IGD was ascertained through the clinical interview by qualified psychiatrist using the DSM-5 criteria.

The concern about the academics in the form of end-semester examination and stress experienced due to COVID-19 were assessed using ten-point Visual Analog Scales (VAS) (where 1 was “not at all important” and 10 was “very important;” and 1 was “not at all stressed” and 10 was “very much stressed”, for the two questions, respectively).

Those who did not respond were sent up to three reminders. These reminders were sent at a gap of 3 days.

The data were compiled and analyzed using the Statistical Package for the Social Sciences software, version 23.0 (SPSS, Chicago, IL, USA). The data were checked for normality distribution using Q-Q distribution plots. The bivariate association between current gaming behavior and study variables was examined using the Chi-square test, and correlational analysis.

Multivariate analysis was performed using the binary logistic regression with “increase in gaming” as dependent variable. The demographic and clinical characteristics found significant following bivariate analysis were entered as independent variables in a backward stepwise logistic regression to determine the most parsimonious model.A p value of <.05 was considered statistically significant for all the tests.


   Results Top


Out of the 393 students who were invited, 134 students responded indicating a 34% response rate. Six students were excluded from the analysis due to the lack of consent. Data were analyzed for 128 students.

Around 40% of study participants were male (n = 52), and the average age of the participants was 19.6 years (standard deviation [SD]: 1.9) (median - 19 [inter-quartile range (IQR) 18–20.75) years]. About half (50.8%) of the participants reported that their gaming behavior had increased, whereas 14.6% reported a decrease in their gaming during the lockdown period. Most participants were concerned about the end-semester examination, with more than 50% of them responding with a score of either 9 or 10 on the VAS. However, the concern about the examination did not change the gaming behavior in majority (69.5%) of the participants. Further, 12.5% participants reported an increase in their gaming due to examination-related stress and the remaining 18% reported cutting down upon the time they spent on gaming per day. The median duration of gaming per day was about 1 h (range 0–21 h).

The mean rating of stress related to COVID-19 was 6.6 (SD 2.3) on the VAS. Further, on enquiring about gaming as their preferred way of coping with stress due to COVID-19, an equal proportion of participants (34.6%) agreed and disagreed.

The PHQ-9 score distribution was skewed to the right. The median score was 6 (IQR: 3–10). The scores suggested 26.9% of the participants had moderate or severe depression. The GAD-7 score distribution was also skewed to the right. The median score was 4 (IQR: 2–8). The scores suggested 16.92% participants to have moderate or severe anxiety.

IGDSF9 scores were normally distributed, with a mean score of 18.0 (SD: 6.73). A diagnosis of IGD could be made for 14.84% participants using the DSM-5 criteria.

The participants (34.6%) who reported an increase in gaming behavior were compared with those who did not report an increase during the period of lockdown following COVID-19. It was found that the two groups did not differ significantly in their age and gender distribution. There was no significant difference in their perception about the importance of upcoming end-semester examination. The participants who reported increased gaming behavior due to examination-related stress had greater stress levels due to examination as compared to those who did not report increased gaming behavior due to examination-related stress (mean 4.19, SD 0.40 vs. mean 2.70, SD 0.64; t = −9.03, P < 0.01). They also believed that gaming helped them cope better with stress than those who did not increase gaming (mean 3.37, SD 1.00 vs. mean 2.52, SD 0.93; t = −4.92, P < 0.01). The anxiety related to COVID-19 was not significantly different between the two groups (mean 6.94, SD 2.17 vs. mean 6.25, SD 2.32; t = −1.72, P = 0.08).

There was no significant difference in preference for nongaming coping strategies and scores on PHQ-9 and GAD-7 between the two groups. However, those with moderate-or-severe anxiety had an association with the change in gaming behavior. Those with increased gaming had significantly greater chances of experiencing moderate-or-severe anxiety as compared to those who did not increase gaming. Similar association was not found for depression as measured by PHQ-9. The differences in both groups are described in [Table 1].
Table 1: Group differences between students who increased and did not increase their gaming behavior during COVID-19 lockdown

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In binary logistic regression analysis, hours of gaming per day (OR 1.75 [1.29–2.36]), increase in gaming due to examination-related stress (OR 4.96 [1.12–21.98]), and belief that gaming helped managing stress (OR 4.27 [1.65–11.04]), were found to be independently associated with gaming behavior during the lockdown period [Table 2]. The overall regression model was statistically significant (Chi-square = 50.29; P < 0.001) and explained 43.3% of the total variance observed in increased gaming behavior among study participants.
Table 2: Binary logistic regression analysis results (n=128)

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   Discussion Top


The current study explored the changes in gaming behavior among college students in the context of COVID-19. To the best of our knowledge, there are no published reports on the impact of pandemic of the scale of COVID-19 and the consequent restrictions because of public health response to such pandemic on the gaming behavior. The response rate of 34% in this online survey while seemingly low, is comparable with response rates reported in general mental health surveys for common mental disorders.[15] In addition, the ongoing stress consequent to the situation could have impacted the response rate.

A preexisting IGD was identified in 14.84% of the study population. This was higher as compared to other studies from the region.[1],[16] Interestingly, the prevalence of gaming disorder has been reported to vary widely from 0.7% to 27.5% across studies.[3]

About half of the participants reported increased gaming behavior during the lockdown period. They also endorsed the belief that gaming helped in managing stress related to COVID-19 pandemic and subsequent public health measures such as lock-down, quarantine, social distancing more strongly than those students who did not increase their gaming behavior. Interestingly, more than three-fourth of the students did not attribute change in the gaming behavior to the stress of examination. Understandably, the students who reported increased gaming behavior due to examination-related stress also reported greater stress levels due to examination when compared to those who did not report increased gaming behavior due to examination-related stress.

There seems to be a complex interaction between examination-related stress and engaging in gaming behavior as a coping mechanism. While the examination was reported to be a concern by a significant majority of the students, the rescheduled date for the same had not yet been declared. Consequently, it is likely that the examination was not perceived as an imminent stressor. Furthermore, it is likely that the stress related to the COVID-19 overwhelmed the other concerns. Previous research among students has suggested that the process models about stress and coping strategies differ across stress sources in several aspects. Academic stress has both the direct effects on negative feelings as well as indirect effects through negative problem-solving strategies. On the other hand, other stressors such as economic stress has only the indirect effects on negative feelings through negative problem-solving and support-seeking strategies.[15] Furthermore, it has been observed that in stressful environments various coping strategies function independently among the students and is dependent on the specific profile of each student's stress perception.[17] Perception of a stressful situation as controllable or uncontrollable can also impact the response among the students.[18] It is likely that while examination was perceived as a controllable stressor, COVID-19-related situation was perceived as uncontrollable by the study participants.

Coping has been reported as an important motive for gaming behavior in the published literature. The escape and achievement motives have been consistently found to be associated with problematic gaming.[5] Furthermore, gaming has been reported as a new way of satisfying basic human needs within the constraints of current modern society.[7] This was in line with our study finding that those who reported an increase in their gaming behavior during the lockdown were significantly more likely to endorse the belief that gaming helps managing stress as compared to the other group of students. This finding also suggested an increasing acceptance of gaming as a coping strategy among students in the present scenario. In a review of cognitive psychology of IGD, authors classified cognitions behind pathological gaming into the categories of game reward value and tangibility, maladaptive and inflexible rules about gaming behavior, over-reliance on gaming to meet self-esteem needs, and gaming as a method of gaining social acceptance.[19]

In the immediate aftermath of COVID-19 pandemic, a study from China reported more than 50% of the participants rated overall psychological impact of the epidemic as moderate or severe, with about 16.5% and 28.8% of them reporting moderate-to-severe depressive and severe anxiety symptoms on the Depression, Anxiety and Stress Scale, respectively.[20] This is comparable with our study findings of moderate-to-severe depression and generalized anxiety disorder among 26.9% and 16.92% participants, respectively. The association between psychopathology and gaming disorder, especially depression and anxiety has been widely reported in the literature.[21] However, we did not find a significant association between moderate or severe depression with increased gaming behavior during lockdown. The possible reasons behind this need to be explored in the light of complex interaction between different factors affecting the relationship between psychopathology and disordered gaming during the COVID-19 pandemic and the lockdown. It could be that high engagement with gaming behavior during the lockdown had a protective effect against depressive symptoms.

Another important finding of the present study was that increase in gaming behavior during the period of lockdown did not differ with the prior diagnosis of IGD status among the participants. The relationship between stress and increased gaming has been documented previously. In an Italian study, it was found that perceived stress was associated with higher gaming disorder severity scores, whereas psychological resilience was related to lower scores.[10] It is likely that with increased amount of time at disposal, coupled with restriction on movements outside of house, increase in gaming behavior was observed irrespective of ones' prior gaming disorder status in the current study. This observation has important implications as it highlights a need to focus on the gaming behavior of the students irrespective of their prior gaming disorder status. An increase in amount of time spent on gaming would likely reduce the time available for other life activities such as personal care, exercise, and communication with others. The advisories from public health agencies such as the World Health Organization, recommend keeping the right balance of gaming with off-line activities in daily routine during the current times. Online resource hub on behavioral addictions (BehavioR) that offers easily accessible resources on gaming disorders also list similar recommendations.[22]

This study adds to the nonexistent literature on change in gaming behavior in the context of COVID-19 pandemic. We had data for the diagnosis of Internet Gaming Disorder prior to beginning of the current lockdown. This helped avoid the bias due to recent changes in gaming behavior. However, there are certain limitations of the study as well. While the participants were recruited randomly out of the pool of the eligible participants, more than 60% of the eligible participants did not respond. In addition, data from six participants were excluded from the analysis. The baseline assessment of the study participants was carried out a few weeks before the current data collection. It is likely that the gaming behavior of the participants could have changed in the intervening period due to greater understanding about gaming disorder due to the ongoing study (Hawthorne effect). Since the data could be collected only online, the questionnaire was kept brief. Thus, certain correlates of recent gaming behavior could not be enquired.


   Conclusion Top


In the lockdown period following COVID-19 pandemic, majority of college students had increased their gaming behavior. This was associated with examination-related stress and the belief that gaming helps combat stress. These observations highlight the need to focus on the coping style of the students to ascertain their likelihood of gaming behavior as a coping mechanism against stress.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
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