Game-related behaviors among children and adolescents after school closure during the COVID-19 pandemic: A cross-sectional study

Abstract

Aim: Increased exposure to digital gaming content among youth in recent years has raised serious health concerns. Social restrictions such as school closures, imposed worldwide because of the ongoing COVID-19 pandemic, may increase exposure to gaming and lead to addictive gaming behavior in young people. In this study, we investigated gaming behaviors among Japanese students during COVID-19 school closures.

Methods: Students completed questionnaires regarding their living conditions, game-related behaviors, diagnosis of Internet addiction, psychological difficulties, and the impact of the COVID-19 pandemic. We compared differences between the responses of potentially at risk for gaming disorder (potentially at risk for gaming disorder; defined in this paper with reference to the ICD-11 MMS criteria for gaming disorder [PGD]) students who met the criteria for a diagnosis of gaming disorder in ICD-11 MMS and those of control students. Logistic regression analysis was performed to predict the extent of factors contributing to potential gaming disorder.

Results: Four thousand and forty-eight participants completed the survey. Compared with control students (93%), potentially at risk for gaming disorder (defined in this paper with reference to the ICD-11 MMS criteria for gaming disorder, PGD) students (7%) reported playing games for longer times, spending more money on in-game purchases, were of younger age at the start of game playing, showed a tendency toward Internet dependence, practised school avoidance or absenteeism, and demonstrated the need for psychological support. Moreover, participants in the PGD group reported more anxiety about COVID-19 than control participants, as well as an increase in game-playing time and amount of money spent on games during the COVID-19 pandemic.

Conclusion: These results indicate that young people classified as having a gaming disorder not only exhibit characteristic game-related behaviors but may be psychologically and socially vulnerable and need special support, especially during the ongoing COVID-19 pandemic.

Keywords: COVID‐19; ICD‐11; addictive behavior; anxiety; gaming disorder.

Figure 1

Graphical outline of this study. The study was conducted in four steps: Step (1) 5900 students were invited to participate in the study; Step (2) 5012 participants expressed their willingness to participate in the study; Step (3) 4048 participants completed the PGD survey, with 7% meeting the criteria for PGD, game‐related behaviors and psychosocial vulnerabilities of the PGD and control groups were compared; and Step (4) logistic regression analyses were conducted on data from 2686 participants, not including missing values. PGD, potential gaming disorder.

Figure 2

Questionnaire results on game‐related behaviors in elementary, junior high, and high school students during the COVID‐19 pandemic. (a) In total, 7.3% of elementary school students, 7.5% of junior high school students, 6.1% of high school students, and 7.0% of all participants met the criteria for PGD. (b) In total, 8.1% of male participants, 5.3% of female participants, and 7.7% of participants who chose not to indicate their sex met the criteria for PGD. The results for male and female students were significantly different. (c) In total, 60.9% of PGD participants and 37.5% of the control group reported school avoidance or absenteeism. Fisher's exact test showed that the difference between the two groups was significant. (d) Weekday game playing time for PGD and control groups. The number of participants who reported “2 h or less” of game playing time was lower in the PGD group than in the control group. Conversely, the number of participants who reported more than “3 h or less” of game playing time was higher in the PGD group than in the control group. (e) Holiday game playing time for PGD and control groups. The number of participants who reported “3 h or less” of game playing time was lower in the PGD group than in the control group. Conversely, the number of participants who reported more than “4 h or less” of game playing time was higher in the PGD group than in the control group. (f) Amount of money spent on games per month. (g) Starting age of gameplay. (h) YDQ score of PGD and control group participants: the difference between the means scores was significant. *p < 0.05, **p < 0.01. PGD, potential gaming disorder; YDG, Young's Diagnostic Questionnaire for Internet Addiction.

Figure 3

Impact of the COVID‐19 pandemic on game‐related behavior in children and adolescents. (a) In total, 33.8% of the PGD group reported increased anxiety (slightly increased = 24.6%, markedly increased = 9.2%) and 17.2% of the control group reported increased anxiety (slightly increased = 13.8%, markedly increased = 3.4%). (b) In total, 79.8% of the PGD group reported that their playing time increased (slightly increased = 41.9%, markedly increased = 37.9%) compared with 49.7% of the control group (slightly increased = 36.1%, markedly increased = 13.6%). (c) In total, 21.7% of the PGD group reported that the amount of money they spent on games increased (slightly increased = 14.7%, markedly increased = 7%) compared with 6.5% of the control group (slightly increased = 5.4%, markedly increased = 1.1%). PGD, potential gaming disorder.