Internet gaming disorder and violent video gameplay among higher secondary school-going adolescents in Karachi, Pakistan-A cross-sectional study.

Problematic video game use is giving rise to psychiatric illnesses amongst adolescents including Internet Gaming Disorder (IGD). Violent content of video games can influence IGD development in vulnerable youth, yet its knowledge among Pakistani adolescents is limited, necessitating its assessment. This study estimated IGD prevalence among higher secondary school-going adolescents and assessed its association with violent video game content. A cross-sectional study was conducted on 286 school-going adolescents. Violent video game content was assessed using game ratings by the International Age Rating Coalition, while IGD, anxiety and depression were evaluated using Internet Gaming Disorder Scale-Short-Form (IGDS9-SF), Generalized Anxiety Disorder-7 (GAD-7) and Patient Health Questionnaire-9 (PHQ-9), respectively. Multiple Cox proportional algorithm was used to report adjusted prevalence odds ratios (POR) and 95% CI considering p-value of <0.05 as significant. Participants were predominantly males and from middle socioeconomic backgrounds. IGD prevalence was 17.50% (95% CI: 13.30-22.40). IGD and violent video game content had no association. However, IGD was associated with 3-4 hours of gaming on weekdays: POR = 5.295 (95% CI: 1.957-14.332), less than 7 years' age of gaming onset: POR = 2.700 (95% CI: 1.035-7.046) and having a nuclear family: POR = 1.982 (95% CI: 1.021-3.844). Cronbach alpha for IGDS9-SF, GAD-7 and PHQ-9 was 0.742, 0.813 and 0.842 respectively. Findings suggest positive associations of IGD with prolonged gaming, early gaming onset and nuclear family. In conclusion, IGD is a growing concern for Pakistani adolescents. Findings suggest school-based awareness campaigns promoting healthier gaming practices and calls for government legislations for monitoring and control of age appropriate game usage.