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Review of article written for Hornsby Hospital Psychiatry Department Journal Club Tuesday 15th September 2015

Please note: This post is more relevant for researchers and clinicians.

“Going to local area network (LAN) computer centers (which are popular in Singapore) more frequently was a risk factor.”

Research Paper Breakdown:

  • 2 year longitudinal panel study
  • Sampled 3034 elementary and secondary school students
  • Grades 3,4,7 and 8
  • Conducted in Singapore between 2007 and 2009
  • Three time points measured Time 1, Time 2 and Time 3.
  • Measured the following:
    -pathological video game use (PVG)
    -weekly amount gameplay (general media habits questionnaire)
    -impulsivity (Barratt impulsivity scale and ADHD screen)
    -social competence (personal strengths inventory)
    -depression (Asian adolescent depression scale)
    -social phobia
    -school performance
    -parent child relationship quality (parent family connectedness)
League of Legends (LoL) is a very popular competitve fantasy Internet strategy game played on Garena servers by Singaporean youths of today.


Weaknesses of the study:

This study surveyed 2179 boys and 819 girls. Increased gaming pathology was shown in boys. More boys surveyed could possibly lead to a gender bias.
It may also be difficult to generalise these findings to children’s use of screen, computer and Internet use of today. This study was conducted prior to the age of “social media” and Facebook. It also predates the rapid rise of smartphone use by youths of today. Youths may be using this technology in different ways and does not take into account the different ways children play these games let alone social media use (which could be argued as a preferred activity for girls as opposed to video gaming).

Strengths of Study:
Large sample, with high retention rate after 2 years.
Measures many different risk factors for PVG.

A video game store in Singapore.

What were their main findings?

Prevalence of PVG in Singaporean youths is approximately 9%.
Average weekly amount of time spent playing games at Time 1 =20.5 hours.
Average number of symptoms of pathological gaming at Time 1 = 2.28.
Boys more likely to spend more time and have more symptoms than girls.
9.9% of youths met criteria of pathological gaming at Time 1 (boys more likely to meet criteria at all time points).


84% who were pathological gamers at Time 1 were still pathological gamers at Time 3.

Grouped into latent groups. If met criteria at Time 1 and under threshold at Time 3 this was labelled “stops” group, below threshold at Time 1 but meet criteria at Time 3 labelled “starts” group and if met criteria at both Time 1 and Time 3 labelled “stays” group. One group that did not meet criteria at any stage was called the “never” group.

  • IMG_8467
    Arcade parlours with video game machines are enjoyed by not only youths but adults in Singapore where you can earn and achieve points to be redeemed for prizes.
  • Other Interesting aspects of the study:
    Risk factors for developing PVG were impulsivity, social competence, depression and anxiety. These factors worsen when  a youth develops PVG and improves once the PVG improves.
  • Youths who begin with more pathological symptoms at Time 1 have higher levels of depression, anxiety, and social phobia and lower grades at time 3.

    Greater identification with game characters predicted becoming a pathological gamer.

    Online gaming was not a predictor of becoming a pathological gamer, although online gaming increased over the 2 years.

    “Youths who became pathological gamers started with an average of 31 hours of play per week, compared with 19 hours per week for those who never became pathological gamers.”

    “Going to local area network (LAN) computer centers (which are popular in Singapore) more frequently was a risk factor.”

    “Once players became pathological gamers, they began to have poorer grades and poorer relationships with their parents and to be exposed to more violent games.”

    “children who began consuming more violent games also began to have more normative beliefs about aggression, hostile attribution biases, and aggressive fantasies and to engage in more physically and relationally aggressive behaviors”

    “Youths who became pathological gamers ended up with increased levels of depression, anxiety, and social phobia”

    “we did not find a systematic pattern of protective factors that helped some pathological gamers overcome their dysfunction”

    “children who began consuming more violent games also began to have more normative beliefs about aggression” (Gentile 2011).
  • What can we learn from this?
  • Videogames is a common form of play amongst youths. Many youths use video games as a way to cope with depression and anxiety. This study not only shows that PVG has co morbidity with depression and anxiety but depression and anxiety can be secondary to PVG.
  • IMG_8042
    Since this study, there are many different school based prevention programs such as Touch Cyberwellness for youths at risk of PVG.
  • Source:
    Gentile, Douglas A., et al. “Pathological video game use among youths: a two-year longitudinal study.” Pediatrics 127.2 (2011): e319-e329.