Background
Playing video games is now a major leisurely pursuit among children in many parts of the world [
1‐
12]. Over the past three decades, a number of studies have looked at the effects of video games on children and adolescents. These studies were conducted mostly in developed high-income countries. Several of these studies have shown that violent video game exposure increases aggressive thoughts, angry feelings, physiological arousal, aggressive behaviors, and physiological desensitization to violence in the real world [
1‐
11]. However, several other studies have found no connection between exposure to video game violence and youth violence [
12‐
18]. Conducting a meta-analytic review of studies that examines the impact of violent media on aggressive behavior, Ferguson and colleagues (2009) reported that the use of poor aggression measures in most studies have inflated the effect size. Once corrected for methodological bias, they found no support for this notion that media violence leads to aggressive behavior [
14]. Therefore, the evidence for the harmful effects of video game violence is, in fact, inconsistent.
Regardless, evidence suggests that the prevalence of video games, especially violent video games, among adolescents from low- and middle-income countries is increasing dramatically and requires additional investigation to evaluate the connection between violent video games and aggressive behaviors. Lack or insufficient reinforcement of copyright protections and the selling of rated video games to children in these countries have intensified public concerns on the possible negative impact of violent video games on aggressive cognitions, attitudes, behaviors, academic performance, and the psychological well-being of children. This study describes patterns and correlates of excessive video game use in a random sample of middle-school boys and girls in the Islamic Republic of Iran. Specifically, we examine the relationship between video game playing and psychological well-being, aggressive behaviors, and adolescents' perceived threat of video-computer game playing. To the best of our knowledge, no study has ever explored the prevalence and correlates of video games among children in Iran. The impact of violent video games on the attitudes, behaviors, and mental health of the youth in Middle-Eastern countries may be intensified or indeed suppressed by several ongoing violent conflicts in the region. Similar to the rest of Middle-Eastern countries, Iranians have constantly been exposed to well-publicized, broadcasted, excessive violence in the region, including an eight-year Iran-Iraq war, the first Persian Gulf war (Iraq vs. Kuwait and US-collection), the U.S. occupation of Afghanistan and Iraq following the tragedy of 9-11, almost 50 years of on-going Palestinian-Israeli conflict, as well as almost daily suicide and/or car bombings etc. by individuals in this region. Iran is the most populated country in the Middle East with a population of over 70 million. More than two-thirds of its population is under the age of 30 [
19,
20].
Results
Of 477 adolescents who were selected to participate in this study, 444 students (93%) completed the survey. Less than 7% of students refused to participate in the study or did not complete the survey. Since the survey was anonymous, we were unable to record and compare the non-responders (n = 31) with participants. Table
1 shows demographic and gaming characteristics, aggressive behaviors, and the mental heath status of our samples. About 47% and 53% of the participants were 12-13 and 14-15 years old, respectively. The sample was 51% female and 49% male. More than 93% of students who participated in this study reported that they have played video games. The initiation ages for video-game playing were 6%, 11%, 45%, and 40% for age groups ≤5; 6-7; 8-10; and 11-13 years of age, respectively. While computer games were used by 71%, home consoles by 16%, and internet games by 13%, no arcade video game machines were reported by our participants (the arcade video game machines currently are not offered in Hamadan).
Table 1
Characteristics of sample, comparing boys and girls.
Age | | | |
12-13 years old | 105 (48) | 105 (47) | 210 (47) |
14-15 years old | 115 (52) | 119 (53) | 234 (53) |
Fathers' age | 44 ± 6.73 | 45 ± 7.44 | 45 ± 7.35 |
Mothers' age | 38 ± 5.74 | 38 ± 5.76 | 38 ± 5.74 |
Parents' highest education (college degrees) | 53 (25) | 60 (27) | 113 (26) |
Length of time playing video games per setting* | 1.9 ± 1.19 | 1.8 ± 0.95 | 1.9 ± 1.07 |
Weekly hours playing video games* | 6.7 ± 3.45 | 6.5 ± 3.08 | 6.6 ± 3.26 |
Years of video game playing* | 2.9 ± 1.25 | 3.1 ± 1.20 | 3.0 ± 1.21 |
Initiation age for video gaming* |
10.2 ± 2.44
|
9.4 ± 2.46
|
9.8 ± 2.45
|
Own bedroom (yes) | 77 (35) | 69 (31) | 146 (33) |
Personal computers (yes) |
136 (62)
|
118 (53)
|
254 (57)
|
Severe arguments with parents (yes) | 132 (61) | 139 (62) | 271 (62) |
Self-reported aggressive behaviors | 8.8 ± 8.28 | 9.1 ± 9.36 | 8.9 ± 8.83 |
Perceived side-effects of games | 14.3 ± 4.01 | 14.0 ± 4.56 | 14.2 ± 4.29 |
General mental health status (GHQ-28) |
6.8 ± 6.20
|
4.6 ± 4.97
|
5.7 ± 5.72
|
≤8 |
143 (65)
|
182 (81)
|
325 (73)
|
> 8 |
77 (35)
|
42 (19)
|
119 (27)
|
Somatic |
1.5 ± 1.68
|
1.0 ± 1.53
|
1.2 ± 1.62
|
Anxiety/Insomnia |
1.8 ± 1.93
|
1.2 ± 1.56
|
1.5 ± 1.77
|
Social dysfunction |
1.7 ± 1.70
|
1.3 ± 1.48
|
1.5 ± 1.60
|
Severe depression |
1.9 ± 2.28
|
1.0 ± 1.53
|
1.4 ± 1.98
|
More than 57% of children reported that they had a computer or game console in their bedroom. Both girls and boys spent an average of 6.3, and 6.2 hours per week playing video gaming, respectively. Moreover, 47% of participants reported that they had played one or more intensely violent games including: Dead or Alive, Def Jam, Doom, Driver, Mortal Kombat, Grand Theft Auto, Resident Evil, and Prince of Persia.
The bivariate correlates of video gaming are reported in Table
2. Participants' mental health status, measured by GHQ-28, showed a significant relationship with initiation age and years of video game playing, indicating that those who initiated gaming at younger ages and have been playing for longer years were more likely to score poorer in mental health measures. No relationship between severe arguments with parents and gaming was detected. Quite interesting were those participants who reported longer years and hours playing games - they also reported a higher number of the negative side effects of video gaming.
Table 2
Bivariate correlates of video gaming (n = 444).
X1 - Initiation age | 1.00 | | | | | |
X2 - Length of time of playing video games | -.20** | 1.00 | | | | |
X3 - Years of video game playing | -.45** | 27** | 1.00 | | | |
X4 - Self reported aggression | -.07 | .12* | .02 | 1.00 | | |
X5 - Mental health status | .14** | .05 | -.10** | .36** | 1.00 | |
X6 - Perceived sides effect of video gaming | .08 | -.17** | -.17** | -.03 | .17** | 1.00 |
X7 - Severe arguments with parents | -.02 | .01 | .01 | .17** | .29** | .06 |
Participants' aggressive behaviors were associated with length of gaming; those who admitted playing longer, scored higher on the Orpinas' aggression scale (r = .15; p < .05). Further analysis shows that none of the 11 items of this scale were associated with length of time playing video games. However, boys who reported playing video games excessively - more than 7 hours per week - scored higher on: 1) fighting back; 2) name-calling; 3) teasing; and 4) threatening to hurt or hit items. None of the aggressive behaviors scale's items were associated with excessive playing among girls.
Table
3 compares the mean score for the General Mental Health Status scale (GHQ-28) and the sub-scales of this index for four groups (non-players to excessive players). Non-gamers and "excessive gamers" overall reported suffering poorer mental health compared to low or moderate players. Additionally, non-gamers and "excessive gamers" reported higher scores on three out of four sub-scales, indicating that they were more likely than low or moderate players to suffer from anxiety/insomnia, social dysfunction, and somatic symptoms.
Table 3
Mean score of total and sub-scale scores on the 28-item General Health Questionnaire for video gamers and non-gamers (N = 444).
Somatic symptoms | 1.96 ± 1.8 | 1.19 ± 1.6 | 1.04 ± 1.5 | 1.53 ± 1.7 | < .05 |
Anxiety and insomnia | 2.50 ± 2.4 | 1.41 ± 1.7 | 1.34 ± 1.7 | 1.82 ± 1.8 | < .01 |
Social dysfunction | 2.38 ± 2.0 | 1.42 ± 1.6 | 1.43 ± 1.3 | 1.53 ± 1.7 | < .05 |
Severe depression | 2.12 ±2 .5 | 1.40 ± 2.0 | 1.12 ± 1.6 | 1.73 ± 2.3 | 0.06 |
General mental health status | 8.96 ± 7.7 | 5.43 ± 5.6 | 4.97 ± 5.0 | 6.67 ± 6.0 | < .01 |
The multiple binary logistic regression technique was employed to examine independent correlates of excessive video game playing. Independent variables included in the equation are reported in Table
4. The estimated Nagelkerke R
2 indicates that this set of variables/subscales explain over 14% of the variance in the dependent variable. Age, personal computer ownership, and perceived side effects of playing video games each showed independent impact on the outcome variables. This finding indicates that, controlling for all other variables, older students [OR = 1.34 (95% CI = 1.04 - 1.74), p < .05], students who perceived less serious side effects for playing video games [OR = 3.5 (95% CI = 0.66 - 0.98), p < .01], and those who have personal computers [OR = 3.4 (95% CI = 2.13 - 5.41), p < .05] were more likely to report that they had played video games excessively. No significant independent relationship between parental demographic characteristics and excessive video gaming was detected.
Table 4
Multiple binary logistic regression between demographic characteristics, personal bedroom and computer ownership, and perceived side effect of gaming and excessive video game playing (n = 444).
Gender | 0.89 | 0.58 - 1.37 |
Parents' education | 1.05 | 0.83 - 1.32 |
Mother's working status | 1.02 | 0.57 - 1.85 |
Personal bedroom | 0.88 | 0.54 - 1.46 |
Personal computer
|
3.40***
|
2.13 - 5.41
|
Perceived side-effects of video game playing
|
0.81*
|
0.66 - 0.98
|
Discussion
This cross-sectional study was performed to describe patterns and correlates of video game use in a random sample of middle-school students (aged 12 - 15) in the Islamic Republic of Iran. Similar to American teens [
26], our data show that nearly every teen (93%) plays video games, regardless of gender, age, or socioeconomic status. Overall, our participants spent an average of 6.3 hours per week playing video gaming.
Additionally, more than 15% of participants spend more than 10 hours per week playing video games. The stereotype that only boys play video games is far from true in Iran, as girls constitute a larger percentage of total video gamers: 92% of boys play video games, as do 96% of girls. While almost all girls and boys play video games, boys typically play games with greater duration than girls per setting; 11% and 6% of boys and girls spend more than 4 hours per setting, respectively. One out of two adolescents surveyed in this study reported that they had played one or more intensely violent games.
One aspect of the results that warrants further discussion is the impact of the non-gaming and excessive video game playing on mental health status. Importantly, non-gamers and excessive gamers overall reported suffering poorer mental health compared to moderate players. As indicated in Table
4, we have detected a curvilinear relationship between video game playing and mental health outcomes, with "moderate" gamers faring best. While "excessive" gamers showed mild increases in problematic behaviors (somatic symptoms; anxiety and insomnia; social dysfunction, and general mental health status), non-gamers showed the worst outcomes. Other researchers have documented the same effect. Kutner and Olson (2008), surveyed 1,254 children in grades 7 and 8, and 500 of their parents. They found that boys who did not play any video games during a typical week had a higher risk for problems [
27]. They also document many creative, social, and emotional benefits from video game play that were used by many children to relieve stress.
However, their surveys also documented statistically significant relationships between violent game play and some common childhood problems among boys but not girls. Boys who extensively played any Mature-rated game had twice the risk of certain aggressive behaviors and school problems compared to boys who played games with lower age ratings[
27]. Indeed, similar to our study, several other studies suggest that moderate video game use may be a positive experience, while excessive use may cause problems [
28]. While research suggests that that excessive use of video games may have a detrimental effect on students' GPA, moderate use of the video games and Internet has been linked with a more positive academic orientation when it is compared with nonuse or high levels users [
29]. Therefore, if parents set some limits on their children's daily video game use, then the worst of the documented problems associated with video games will be avoided [
28].
Another component of the results that requires further attention has to do with the detected impact of the perceived side-effects of video game playing on excessive game playing. The multiple binary logistic regression shows that controlling for all other variables, those who perceived less serious side effects for playing video games were more likely to report that they had played video games excessively. This important finding may have extensive policy implication. Educational motivational interventions should be designed to educate adolescents of the possible harmful impact of excessive video game playing on their health and psychosocial functioning.
Our findings suggest that playing video games may have different social implications for girls than for boys. Our data shows that boys, but not girls, who admitted playing video games excessively showed more aggressive behaviors. However, recent data show that moderate gaming among young men may provide a healthy source of socialization, relaxation, and coping [
30]. In addition, recent studies conducted among Singaporean, Japanese, and Americans provide robust evidence that adolescents and young adults who played more pro-social video games behaved more pro-socially [
31]. Therefore, strategies are needed to make pro-social video games more attractive and accessible to adolescents, particularly male adolescents. These results are not without their limitations that limit its generalizability. First, these data are cross-sectional and limit our ability to make causal inferences among the mental health status, aggressive behaviors, and video game playing. Second, we were unable to record and compare the non-responders of this study with participants and unable to document how this sample is a representative of Iranian adolescents. Third, it is important to notice that even though statistically a significant relationship between excessive gaming and mental health was detected, however, these bivariate correlations effect size fall below Ferguson's (2009) [
32] recommendations for "practical significance" (r ≥ .20) and should not be over interpreted as strong evidence of harm.
Conclusion
It is important to inform parents that while moderate video game use may be a positive experience, excessive use may cause problems. However, both children and parents of non-players should be updated about the positive impact of moderate video gaming. Similarly, comprehensive actions are needed in order to diminish excessive time spent playing video games, particularly mature-rated games, among adolescents in general and boys in particular. Finally, strategies are needed to encourage making pro-social video games more attractive and accessible to children, particularly male adolescents who play video games excessively.
Competing interests
The authors declare that they have no competing interests.
Authors' contributions
All authors read and approved the final manuscript. H.A. conceived of the study and participated in the design, data collection and analysis as well as MS preparation. M.B. participated in the data analysis and MS preparation. A.F. participated in the design and data collection. B.M. participated in the design data collection