Home | About IPJ | Editorial board | Ahead of print | Current Issue | Archives | Instructions | Contact us |   Login 
Industrial Psychiatry Journal
Search Articles   
    
Advanced search   
 


 
REVIEW ARTICLE
Year : 2022  |  Volume : 31  |  Issue : 2  |  Page : 197-206  Table of Contents     

Where, when, and to whom gaming motives may be harmful? A systematic review


1 Department of Epidemiology, National Institute of Mental Health and Neuro Sciences, Bengaluru, India
2 SHUT Clinic (Service for Healthy Use of Technology), Department of Clinical Psychology, National Institute of Mental Health and Neuro Sciences, Bengaluru, Karnataka, India
3 Department of Psychiatry, Armed Forces Medical College, Pune, Maharashtra, India
4 Department of Clinical Psychology, National Institute of Mental Health and Neuro Sciences, Bengaluru, Karnataka, India

Date of Submission06-Jul-2021
Date of Acceptance11-Oct-2021
Date of Web Publication02-Aug-2022

Correspondence Address:
Dr. Manoj Kumar Sharma
SHUT Clinic (Service for Healthy Use of Technology), Department of Clinical Psychology, National Institute of Mental Health and Neuro Sciences, Bengaluru, Karnataka
India
Login to access the Email id

Source of Support: None, Conflict of Interest: None


DOI: 10.4103/ipj.ipj_154_21

Rights and Permissions
   Abstract 


The alarming growth in online gaming activities in recent years calls for an understanding of the determinants of gaming behaviors among adolescents and young adults. A systematic review was conducted to collate and review all the research studies concerning the understanding of the gaming motives. Relevant published articles were identified through the electronic search from PubMed, Medline, PsycInfo, Sciencedirect, and APA databases. The review identified four major topics of gaming motives, namely gaming behavior, gaming usage pattern, gaming demographics, and associated psychopathology. The review highlighted the role of motives in gaming use and psychopathology. The age of the player was associated with the expression of these motives. Further insights were drawn into the role of motive in the recreational and problematic use of gaming. The study findings emphasize the need to develop adequate interventions to prevent the occurrence of psychological impairments that would result from potentially problematic video gaming.

Keywords: Gaming, interventions, motives, psychopathology


How to cite this article:
Amudhan S, Sharma MK, Srivastava K, Anand N, Vishwakarma A, Azhagannan K. Where, when, and to whom gaming motives may be harmful? A systematic review. Ind Psychiatry J 2022;31:197-206

How to cite this URL:
Amudhan S, Sharma MK, Srivastava K, Anand N, Vishwakarma A, Azhagannan K. Where, when, and to whom gaming motives may be harmful? A systematic review. Ind Psychiatry J [serial online] 2022 [cited 2022 Nov 30];31:197-206. Available from: https://www.industrialpsychiatry.org/text.asp?2022/31/2/197/352800



Ever since the introduction of the first video game called “Tennis for Two” in 1958, the video game industry has expanded exponentially, reaching a much broader and diverse population than that might have been expected. Today, the video game industry is one of the fastest-growing sectors of the global economy. The use and popularity of video games have seen a steady increase with the arrival of the Internet, and mobile devices. Now, video gaming has become a part of people's daily lives. It is estimated that there will be a total of 2.9 billion players across the globe by the end of 2021.[1] Despite the universal popularity, there exists a widespread negative concern regarding video games to promote violence, social isolation, gender stereotyping, and addiction.[2]

Gaming as a behavior can range from simple leisure activity to pathological patterns of excessive usage (called addictive) and is often associated with positive and negative effects. Though most research on video games has focused on the negative effects, particularly violence and addictive behaviors,[3],[4],[5] some recent studies have broadened their research to demonstrate the positive impact of video games and their implications on well-being.[6],[7],[8] Further, it was emphasized that the potential benefits and the adverse effects of video gaming could be best understood in the context of gamer's motivations for playing.[5],[9]

Gamers often have a variety of motives and preferences for playing.[10] This is because video games of different genres and developers have various choices for the players to interact in different ways. Even for the same video game, the motivations and the consequences for playing differed considerably for different players.[11] It has been found that gaming motives can play a crucial role in influencing the spectrum of gaming behaviors and their consequences.[11],[12] As far as game developers and players are concerned, measuring individual differences in-game motivations often have a vested interest and differing purposes. However, from the intervention point of view, a better understanding of the gaming motives and associated factors becomes crucial for promoting balanced and healthy gaming; identify and support gamers who are at risk for problematic game use.


   Methods Top


We followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines for this systematic review.

Data sources and search strategy

A comprehensive electronic search was conducted for the studies that provided information on various correlates and consequences of game motives. We searched PubMed, Medline, PsycInfo, Sciencedirect and APA databases for studies published from January 1, 2005 to May 31, 2020. We searched these databases using the combinations of Medical Subject Headings and free text words (e.g., Video game, video games, video Games psychology, video games play, video games player, video games motives, video games preferences) that were combined with other related search terms (reinforcement, correlates, dimension, addiction, disorder, pathology, adverse effects, consequences). We also searched the reference lists of eligible studies to identify other relevant studies [Figure 1].
Figure 1: Flowchart of study selection according to Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines

Click here to view


Study selection-Inclusion and exclusion criteria

Peer-reviewed articles with full-texts published in the English language were included in this systematic review. To have a piece of reasonably recent information on video game motives relevant to today's settings, we considered only studies published from the year 2000 and later. Further, the search for this systematic review was restricted to 8–30 years of age group. Studies were included irrespective of the study setting (online/offline), and there were no restrictions related to the study design. Preprints, case reports, case series, review articles, letters, editorials, articles without patient data, studies with sample size <50, studies published only as abstracts or posters, duplicate publications, and articles which did not have relevant information were excluded. Gray literature and unpublished data (dissertations, theses, policy papers, and institutional reports) were also excluded because the quality of such studies cannot be assessed adequately.

Two independent authors performed the literature search by screening the titles, abstracts, and keywords relevant to the review objective. This was followed by the retrieval of full-text articles for further screening. The retrieved full-text articles were assessed further for eligibility criteria for final inclusion in the review. Finally, the citations of the selected articles were exported to Zotero reference management software for de-duplication.

Data extraction and synthesis

Data from the selected studies were extracted and entered into the relevant data field of the review matrix using a customized data collection form. The data elements in the data collection form were predefined based on the research objectives. They included information about the study title, author's name, year of publication, measurement tools, study setting, study participants, sample size, study design, key findings including correlates, and consequences. The extracted data were cross-checked independently by another co-author to ensure consistency.

Risk of bias assessment in included studies

Two independent authors assessed the quality of the included studies using the National Institutes of Health quality assessment tool (https://www.nhlbi.nih.gov/health-topics/study-quality-assessment-tools). The assessment tool looked into objectives, eligibility criteria, sampling strategy, outcome measures, and outcome data under fourteen domains. Each of these domains was rated as “Yes” or “No” based on the quality of evidence and availability of information. After assessing all the domains, the overall rating was determined as per the tool's dictionary and guidelines. Based on the number of “yes” answers, a rating of good (7-9), fair (4–6), or poor (≤3) was assigned to each study. The final score was decided based on consensus among the reviewers. Any disagreements on study inclusion, data extraction, and quality assessment were resolved by discussion and consensus among reviewers or by consultation with a third investigator.

Assessment criteria

  1. Was the research question or objective in this paper clearly stated?
  2. Was the study population clearly specified and defined?
  3. Was the participation rate of eligible persons at least 50%?
  4. Were all the subjects selected or recruited from the same or similar populations (including the same time period)? Were inclusion and exclusion criteria for being in the study pre-specified and applied uniformly to all participants?
  5. Was a sample size justification, power description, or variance and effect estimates provided?
  6. For the analyses in this paper, were the exposure (s) of interest measured prior to the outcome (s) being measured?
  7. Was the timeframe sufficient so that one could reasonably expect to see an association between exposure and outcome if it existed?
  8. For exposures that can vary in amount or level, did the study examine different levels of the exposure as related to the outcome (e.g., categories of exposure, or exposure measured as a continuous variable)?
  9. Were the exposure measures (independent variables) clearly defined, valid, reliable, and implemented consistently across all study participants?
  10. Was the exposure (s) assessed more than once over time?
  11. Were the outcome measures (dependent variables) clearly defined, valid, reliable, and implemented consistently across all study participants?
  12. Were the outcome assessors blinded to the exposure status of participants?
  13. Was loss to follow-up after baseline 20% or less?
  14. Were key potential confounding variables measured and adjusted statistically for their impact on the relationship between exposure(s) and outcome(s)?



   Results Top


A total of 15 studies that satisfied the eligibility criteria were included for the final review [Table 1]. The risk of bias for the included studies ranged from good to fair [Table 2]. The majority of the studies were cross-sectional survey conducted in online platform. Few studies included samples from schools and universities. The study population covered by the included studies were either adolescents or adults. The synthesis of the review identified four major topics associated with gaming motives, namely gaming behavior, gaming usage pattern, gaming demographics, and gaming-related psychopathology.
Table 1: Details of the studies included in the systematic review

Click here to view
Table 2: Quality assessment of studies included in the systematic review

Click here to view


Gaming behavior

By behavior, nonproblematic gamers demonstrated higher offline social capital, less time spent on gaming, better psychological and cognitive functioning, and low impulsivity. In contrast, problematic gamers demonstrated lower social capital and low social efficacy, increased gaming time, poor academic performance, presence of psychological comorbidities and gaming disorder or addiction, and increased online engagement. The major motives behind playing included increased online interaction, coping modality to escape and manage mood states, need for autonomy, competence, relaxation, enhancement of imagination, socialization, team work and game mechanics.[15],[21],[23],[25],[26] The motives of problematic gamers tend to differ from nonproblematic gamers in certain areas. Escape motives (use of games to escape daily life, the use of games as a social outlet) and positive attitudes toward cumulative in-game rewards were positively associated with problematic game use.[18],[24]

Gaming usage pattern

Gaming platform, frequency of gaming, gaming during spare time, and self-description about gaming were used to understand motives associated with usage patterns. Gamers using dedicated platforms such as the PC had higher motives related to the story, violent reward, escapism, and social interaction, while those on incidental platforms like phones had higher motives related to loss-aversion and grinding. Further, increased frequency of gaming, increased spare time spent on gaming, and description of self as a “serious/hardcore” player were associated with higher violent reward, escapism, competition, gaming challenge, social interaction, and autonomy. While the decreased frequency of gaming, decreased spare time spending on gaming and description of self as an “informal/casual” player were associated with higher scores on loss-aversion and customization.[18] Further, lower Self-concept clarity and longer weekly gaming time were associated with problematic gaming.[10],[13],[15],[18],[19],[20],[24]

Gaming demographics

Age was significantly and negatively associated with catharsis, loss-aversion, social interaction, customization, competition, gaming challenge grinding, and positively with autonomy. However, age was not significantly associated with story, violent reward, or escapism. Further, achievement motivation, the importance of advancement, and role-playing were found to decrease with increased age.[10],[11],[13],[18],[19],[24] Male gamers had significantly higher gratification and achievement motives than female gamers, and the difference in motives was better explained by age than gender.[11],[19] Among adolescents, several contextual and developmental factors were found to mediate the development of addictive behavior.[22]

Gaming related psychopathology

Interlink between gaming motives and psychopathology are well documented. Internet gaming players indicated a significant presence of comorbid symptoms, i.e., impulsivity, executive functions disturbance, depression, anxiety, and stress. Players use escapism through fantasy immersion or role-play to avoid underlying problems (e.g., depression, social phobia). Players who are compelled to grind for hours and the complete full content of their video games have experienced greater problems that include pathological gaming and comorbid conditions. This suggests psychopathological mechanisms behind gaming motives, particularly for pathological gaming.[11],[14],[16],[17],[20],[24]


   Discussion Top


The present review empirically investigated the various dimensions, correlates, and consequences of game motives. The review indicated the role of motives, i.e., escapism, social interaction, autonomy, reward, in the frequent use of gaming. The findings suggested the association of these motives with age of the player, gaming behavior, associated psychopathology, and usage pattern. Different gamers had demonstrated different motives in a different context for gaming, and this implies that the same game may have very different meanings or consequences for different gamers. It was seen that the subjective experience of autonomy (a sense of control), competence (a sense that one is performing well), and relatedness (friends and relationships) were positively associated with games motives. Evidence synthesized on the gaming motives, and its associated factors in the current review will be crucial to inform interventions that promote healthy gaming and prevent pathological gaming.

The motives for gaming vary differently for different gaming behavior. Across, various studies the association between escapism and problematic gaming was found to be the most consistent.[24] Motives of achievement, mastering game mechanics, and socialization were other motives associated with problematic gaming. Gameplay within the virtual world is enhanced because players use this to explore new relationships, new places, and themselves.[15] However, specific features of the virtual worlds and poor self-concept were found to accentuate problematic gaming through the motive of satisfying social needs by virtual interactions.[24] The extent and mechanisms through which the motives (escapism, achievement, and others) mediate various gaming behavior (problematic/non-problematic) are very limited due to the paucity of longitudinal studies that hinder the determination of causal direction associations.[18],[24],[27] Further, an understanding of these mechanisms may be crucial for game developers, critics, and consumers to understand gaming preferences, behavior, and its effects. Future efforts may be able to broaden the scope of our understanding of the relationship between motivation and gaming behavior.

People play a video game for many reasons, including “to relax, to experience competence and autonomy, and to escape from daily concerns.[10] Flow experience associated with gaming can decrease self-consciousness, false sense of time and low attention to surroundings and responsibilities besides rewarding intrinsically.[28] Gamers with lower self-concept clarity were found to spend more time playing video games. Previous researches suggests that the amount of time spent in playing is not an important predictor for problematic gaming when adjusted for other motives. However, the possible mechanism that links motives behind the amount of time spent in playing with other motives that lead to problematic gaming is relatively unexplored. This will be important to understand problematic gaming among adults who tend to spend more time in gaming.[26]

From the review, it is important to note that social learning did not emerge as a gaming motive. Unlike television and social media, available evidence suggests that gamers did not report using games to learn except for arousal transfer or priming. Though the review covered studies on adults and adolescents and highlighted differing and decreasing motives with age advancement, evidence suggests that adult spent more time in Massively Multiplayer Online Role-Playing Games (MMORPG) than adolescents with male domination.[26] The hours of playing online gaming were found to be associated with arousal, challenge, competition, diversion, fantasy, and social interactions.[29] Further, MMORPG was found to have highly socially interactive environment providing the opportunity to create strong friendships and emotional relationships.[15] The Maslow Hierarchy of need also mediates the indulgence in MMORPGs.[30] MMORPGs were found to encourage friendships and personal empowerment through group interactions.[15] At the same time, the risk of MMORPG fostering problematic use through escapism, grinding and social interaction is also well established. Research should explore all antecedents and effects of the games (different styles and genres) relative to the sets of motivation to understand their complex interactions. Notably, women proportion in the study sample was low and nonconsistent across most of the included studies. Future empirical attempts should focus on a balanced sample and qualitative investigations to better understand the gaming motives and time playing across different contexts.

The review highlighted the existing evidence relating gaming motives with psychopathology. Gaming fosters several negative effects, including increased tendencies towards violence, lower psychological and physical well-being, lower achievement and productivity, and more impoverished personal and familial relationships.[25],[28] This systematic review revealed that various motives mediate online gaming, but recurrent gaming can lead to pathological gaming and other comorbid condition. With gaming motives related to escapism and emotional regulation, psychological mechanisms similar to those compelling substance abuse behind gaming motives were also contemplated.[18] Although there are not many empirical intervention-based studies for the management of internet gaming disorder. The interventions module can integrate the assessment and management of motives in the module to improve the treatment outcome. Further, some of the common motivations behind game, gambling, and drug addictions suggest exploring the gaming motives through addiction mechanisms in general.[31] In contrast, gaming was also found to improve the outcome in psychological therapy, physical therapy, clinician skill outcome, disease self-skill management outcome.[32] Future studies should focus on understanding the motives that have the potential to promote improved health outcomes and reduce addictive behavior. Studies should also explore the potential possibility and benefits of incorporating certain features that enhance these positive motives in gaming.

Strengths and limitations

The unique contribution of this review is attributed to its scope and focus that extends beyond specific game genres, features, and behaviors. This allowed for an open broader perceptive and better understanding of the possible antecedents and effects of gaming motives. The knowledge of gaming motivations has also thrown light on the possible process that links the development of gaming disorder with the initial recreational engagement. Most of the studies included in the current review are cross-sectional in design. This will limit the understanding of the direction of the causal relation between motives and the associated factors, especially psychopathology. Future longitudinal researches are required to examine the development of gaming motives and their associated factors over time. It would also allow us to understand the changes in nature, pattern, and norms related to gaming motives over time. However, this review articulated the myriad of gaming motivations and the associated factors that can be explored further to understand problematic gaming.


   Conclusion Top


Although the study findings may not be amalgamated into a simple one, we believe this as a distinct systematic effort to understand the important concern of where, when, and to whom gaming motivations may lead to harmful consequences. Without oversimplifying, the study suggests gaming behavior, gaming usage pattern, gaming demographics, and associated psychopathology as potentially relevant factors that influence gaming motives and its effects. Practically, the review brought out the crucial role of gaming motives in problematic gaming, the understanding of which would suggest effective prevention and intervention program that include psycho-education interventions and tools for developing healthier gaming motives and coping strategies.[33] This also will help to develop adequate interventions that are applied to prevent psychological impairments that may go along with potentially problematic video gaming.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
   References Top

1.
Wijman T. Global Games Market to Generate $175.8 Billion in 2021; Despite a Slight Decline, the Market is on Track to Surpass $200 Billion in 2023. Newzoo. Available from: https://newzoo.com/insights/articles/global-games-market-to-generate-175-8-billion-in-2021-despite-a-slight-decline-the-market-is-on-track-to-surpass-200-billion-in-2023/. [Last accessed on 2021 Sep 03].  Back to cited text no. 1
    
2.
Rosas R, Nussbaum M, Cumsille P, Marianov V, Correa M, Flores P, et al. Beyond Nintendo: Design and assessment of educational video games for first and second grade students. Comput Educ 2003;40:71-94.  Back to cited text no. 2
    
3.
Schou Andreassen C, Billieux J, Griffiths MD, Kuss DJ, Demetrovics Z, Mazzoni E, et al. The relationship between addictive use of social media and video games and symptoms of psychiatric disorders: A large-scale cross-sectional study. Psychol Addict Behav 2016;30:252-62.  Back to cited text no. 3
    
4.
Prescott AT, Sargent JD, Hull JG. Metaanalysis of the relationship between violent video game play and physical aggression over time. Proc Natl Acad Sci U S A 2018;115:9882-8.  Back to cited text no. 4
    
5.
Reid G. Motivation in video games: A literature review. Comput Games J 2012;1:70-81.  Back to cited text no. 5
    
6.
Greitemeyer T, Traut-Mattausch E, Osswald S. How to ameliorate negative effects of violent video games on cooperation: Play it cooperatively in a team. Comput Human Behav 2012;28:1465-70.  Back to cited text no. 6
    
7.
Halbrook YJ, O'Donnell AT, Msetfi RM. When and how video games can be good: A review of the positive effects of video games on well-being. Perspect Psychol Sci 2019;14:1096-104.  Back to cited text no. 7
    
8.
Taylor LM, Maddison R, Pfaeffli LA, Rawstorn JC, Gant N, Kerse NM. Activity and energy expenditure in older people playing active video games. Arch Phys Med Rehabil 2012;93:2281-6.  Back to cited text no. 8
    
9.
Olson CK. Children's motivations for video game play in the context of normal development. Rev Gen Psychol 2010;14:180-7.  Back to cited text no. 9
    
10.
Ryan R, Rigby C, Przybylski A. The motivational pull of video games: a self-determination theory approach. Motiv Emot 2006;30:344-60.  Back to cited text no. 10
    
11.
Yee N. Motivations for play in online games. Cyberpsychol Behav 2006;9:772-5.  Back to cited text no. 11
    
12.
Hellström C, Nilsson KW, Leppert J, Åslund C. Effects of adolescent online gaming time and motives on depressive, musculoskeletal, and psychosomatic symptoms. Ups J Med Sci 2015;120:263-75.  Back to cited text no. 12
    
13.
Blinka L, Mikuška J. The role of social motivation and sociability of gamers in online game addiction. Cyberpsychol J Psychosoc Res Cyberspace 2014;8:6. Available from: https://cyberpsychology.eu/article/view/4309. [Last accessed on 2021 Sep 03].  Back to cited text no. 13
    
14.
Blinka L, Smahel D. Predictors of adolescents' excessive Internet use: A comparison across European countries. In: Proceedings of the 15th European Conference on Developmental Psychology. Bologna, Italy: Mediamond; 2012. p. 337-42.  Back to cited text no. 14
    
15.
Cole H, Griffiths MD. Social interactions in massively multiplayer online role-playing gamers. Cyberpsychol Behav 2007;10:575-83.  Back to cited text no. 15
    
16.
Gentile D. Pathological video-game use among youth ages 8 to 18: A national study. Psychol Sci 2009;20:594-602.  Back to cited text no. 16
    
17.
Gentile DA, Choo H, Liau A, Sim T, Li D, Fung D, et al. Pathological video game use among youths: A two-year longitudinal study. Pediatrics 2011;127:e319-29.  Back to cited text no. 17
    
18.
Hilgard J, Engelhardt CR, Bartholow BD. Individual differences in motives, preferences, and pathology in video games: The gaming attitudes, motives, and experiences scales (GAMES). Front Psychol 2013;4:608.  Back to cited text no. 18
    
19.
Sherry JL, Lucas K, Greenberg BS, Lachlan K. Video game uses and gratifications as predictors of use and game preference. In: Vorderer P, Bryant J, editors. Playing Video Games: Motives, Responses, and Consequences. Mahwah: Lawrence Erlbaum Associates Publishers; 2006. p. 248-62.  Back to cited text no. 19
    
20.
Thomas NJ, Martin FH. Video-arcade game, computer game and Internet activities of Australian students: Participation habits and prevalence of addiction. Aust J Psychol 2010;62:59-66.  Back to cited text no. 20
    
21.
Collins E, Freeman J. Do problematic and non-problematic video game players differ in extraversion, trait empathy, social capital and prosocial tendencies? Comput Human Behav 2013;29:1933-40.  Back to cited text no. 21
    
22.
Dreier M, Tzavela E, Wölfling K, Mavromati F, Duven E, Karakitsou C, et al. The developemnt of adaptive and maladaptive patterns of Internet use among European adolescents at risk for Internet addictive behaviors: A grounded theory inquiry. Eur Psychiatry 2013;28:1-1.  Back to cited text no. 22
    
23.
Hussain Z, Griffiths MD. Excessive use of massively multi-player online role-playing games: A pilot study. Int J Ment Health Addict 2009;7:563.  Back to cited text no. 23
    
24.
Šporčić B, Glavak-Tkalić R. The relationship between online gaming motivation, self-concept clarity and tendency toward problematic gaming. Cyberpsychol J Psychosoc Res Cyberspace 2018;12:4. Available from: https://cyberpsychology.eu/article/view/9534. [Last accessed on 2021 Sep 03].  Back to cited text no. 24
    
25.
von der Heiden JM, Braun B, Müller KW, Egloff B. The association between video gaming and psychological functioning. Front Psychol 2019;10:1731.  Back to cited text no. 25
    
26.
Dindar M, Akbulut Y. Motivational characteristics of Turkish MMORPG players. Comput Human Behav 2014;33:119-25.  Back to cited text no. 26
    
27.
Melodia F,Canale N,Griffiths MD. The Role of Avoidance Coping and Escape Motives in Problematic Online Gaming: A Systematic Literature Review. Int J Ment Health Addiction 2020. doi: 10.1007/s11469-020-00422-w.  Back to cited text no. 27
    
28.
Sanjamsai S, Phukao D. Flow experience in computer game playing among Thai university students. Kasetsart J Soc Sci 2018;39:175-82.  Back to cited text no. 28
    
29.
Vorderer P, Bryant J. Playing Video Games: Motives, Responses, and Consequences. Mahwah: Lawrence Erlbaum Associates Publishers; 2006. p. 1-583.  Back to cited text no. 29
    
30.
Sharma MK, Narasimha S, Singh P. Battle of royale game: Perspective from Maslow's hierarchy of needs. Int J Soc Psychiatry 2021;20764021991574. DOI: 10.1177/0020764021991574.W  Back to cited text no. 30
    
31.
Shaffer HJ, LaPlante DA, LaBrie RA, Kidman RC, Donato AN, Stanton MV. Toward a syndrome model of addiction: Multiple expressions, common etiology. Harv Rev Psychiatry 2004;12:367-74.  Back to cited text no. 31
    
32.
Primack BA, Carroll MV, McNamara M, Klem ML, King B, Rich M, et al. Role of video games in improving health-related outcomes: A systematic review. Am J Prev Med 2012;42:630-8.  Back to cited text no. 32
    
33.
Kuss DJ, Louws J, Wiers RW. Online gaming addiction? Motives predict addictive play behavior in massively multiplayer online role-playing games. Cyberpsychol Behav Soc Netw 2012;15:480-5.  Back to cited text no. 33
    


    Figures

  [Figure 1]
 
 
    Tables

  [Table 1], [Table 2]



 

Top
  
 
  Search
 
  
    Access Statistics
    Email Alert *
    Add to My List *
* Registration required (free)  

 
  In this article
    Abstract
   Methods
   Results
   Discussion
   Conclusion
    References
    Article Figures
    Article Tables

 Article Access Statistics
    Viewed981    
    Printed51    
    Emailed0    
    PDF Downloaded64    
    Comments [Add]    

Recommend this journal