The Positive Effect of Video-Game Play on College Students' Anxiety and Depression Symptoms During the COVID-19 Pandemic Shelter-in-Place Lockdowns: Mixed Methods Study

Abstract

Background: A growing body of research has examined the connection between video game play and relief from anxiety and depressive symptoms during the COVID-19 pandemic years. However, evidence has been limited in dissecting the role of video games in moderating personal health outcomes such as anxiety and depression. This research aimed to provide insights into this area by investigating Chinese college students living under difficult conditions during the COVID-19 pandemic shelter-in-place lockdowns.

Objective: This study investigated the effect of video games on mental disorders among Chinese college students during the COVID-19 pandemic shelter-in-place lockdown mandates.

Methods: A mixed methods approach was adopted. The quantitative portion included a cross-sectional survey of a national sample of 2818 (n=1396, 49.54% male vs n=1422, 50.46% female) college students from 8 provinces spanning 16 geographic regions during the extended COVID-19 pandemic lockdowns in late 2021 and early 2022. The qualitative portion encompassed 17 semistructured in-depth interviews of (9/17, 53% female vs 8/17, 47% male) students on their experiences, perceptions, and evaluations of playing video games during the lockdowns. Anxiety symptoms were measured using the 7-item self-administered Generalized Anxiety Disorder scale, while depression was assessed with the 9-item Patient Health Questionnaire scale. Multiple regression analyses were used to examine whether demographic variables (ie, sex and year in college), modality and content of play, and play time accounted for the outcomes of anxiety and depression. ANOVA tests were performed on overall playtime and the prelockdown-to-lockdown period change in game time on the severity of anxiety and depression symptoms. Thematic analysis of qualitative data provided additional perspectives on gaming dynamics in relation to anxiety and depression.

Results: No significant sex effect was detected in video game play outcomes for anxiety or depression. At the level of the study population, a significant difference between gamers and nongamers was observed to moderate anxiety (t₂₈₁₆=-0.42, P=.02) but not depression (t₂₈₁₆=-0.12, P=.60) symptoms, controlling for the effect of sex. Playing more online games, spending more time gaming, and an increase in play time were linked to heightened anxiety and depression symptoms. Conversely, playing with friends was connected to lowered anxiety (β=-0.05, P=.04) and depression (β=-0.08, P=.003) scores.

Conclusions: The buffer effects of video games may be strongest among routine players with moderate to low anxiety and depression symptoms, while excessive gaming, as shown in the overall amount of game time as well as the prelockdown-to-lockdown period increase in game time, may have detrimental consequences among those struggling with high anxiety and depression. Social play was an effective mechanism in mitigating anxiety and depressive tendencies. Future research should address game content and modality as well as the long-term impacts of video game engagement during crises.

Keywords: COVID-19; COVID-19 pandemic lockdowns; China; anxiety; college students; depression; mobile games; online games; video games.