Social Science & Medicine, volume 296, article 114721, March 2022 (online 12 January 2022)
- Open access
- 123,262 gamers
- 168 countries
- Online survey
- WHO vs APA frameworks
- Welch ANOVA
Free full text: the open access article (CC BY 4.0), re-typeset as a clean PDF with the same content as the published version. Please cite the published version.
- time spent gaming
- gaming disorder
- American Psychiatric Association
- World Health Organization
- internet gaming disorder
- disordered gaming
- gaming time
- screen time
- how much gaming is too much
- prevalence
- gender differences
- DSM-5
- ICD-11
- video games
- esports
- Gaming Disorder Test (GDT)
- Internet Gaming Disorder Scale–Short-Form (IGDS9-SF)
- large-scale online survey
- cross-sectional design
- Welch ANOVA
- Games-Howell test
- international sample
The more symptoms of gaming disorder gamers report, the more hours they play, but the 30 hours a week the American Psychiatric Association mentions underestimates the time disordered gamers spend. In 123,262 gamers from 168 countries, disordered gamers played about 35 to 40 hours a week, and prevalence was 1.96% under the WHO framework and 4.97% under the APA framework.
Key findings
- Gaming disorder is rarer under the WHO definition than the APA one. Among 123,262 gamers from 168 countries, 1.96% met the World Health Organization criteria for gaming disorder, compared with 4.97% under the American Psychiatric Association criteria for Internet gaming disorder (Pontes et al., 2022).
- More symptoms go with more gaming time. Weekly gaming time rose steadily with the number of criteria endorsed, from about 19 hours with none to about 40 hours at the highest levels, in both frameworks; the number of criteria explained about 9% of the variance in gaming time (ω² = 0.09) (Pontes et al., 2022).
- Disordered gamers play well over 30 hours a week. Gamers meeting the APA threshold of five criteria played 34.53 hours a week on average, and those meeting all four WHO criteria 40.13 hours, so the APA’s figure of at least 30 hours a week underestimates the time invested in disordered gaming (Pontes et al., 2022).
- Women with many symptoms play longer than men. Men played more than women at low symptom levels, but women endorsing six or more APA criteria, or all four WHO criteria, spent more time gaming than men with the same number of symptoms (Pontes et al., 2022).
At a glance
- Design
- Cross-sectional online survey, part of the ‘Smart Gaming’ campaign with ESL Gaming, promoted online and offline; May to December 2019 (before the COVID-19 pandemic)
- Participants
- 123,262 gamers aged 12 to 80 from 168 countries (92.7% men; mean age 24.4, SD 7.6), after cleaning an initial 182,586 responses
- Measures
- Gaming Disorder Test (GDT; WHO framework, four items) and Internet Gaming Disorder Scale–Short-Form (IGDS9-SF; APA framework, nine items); self-reported weekly time spent gaming
- Thresholds
- WHO: all four GDT items answered ‘often’ or ‘very often’. APA: at least five of the nine IGDS9-SF criteria
- Analysis
- Prevalence with 95% confidence intervals, data visualisation by gender, and Welch one-way ANOVAs with Games-Howell contrasts (Bonferroni-corrected), in R 4.0.0 and IBM SPSS
- Data quality
- Exclusions for missing parental consent, age, not gaming in the past year, a sham game item (‘Semeron Online’), implausible gaming hours and English proficiency; long-string screening for careless responding
- Ethics
- College Research Ethics Committee, Nottingham Trent University (2018/95)
Figure 1. Number of disordered gaming criteria and average weekly time spent gaming
Average weekly gaming time by number of WHO criteria endorsed
Tables
Table 1. Sociodemographic characteristics and related gaming behaviors
| Variable | Overall | Female | Male |
|---|---|---|---|
| Sample size (n) | 123,262 | 9,058 (7.34) | 114,204 (92.65) |
| Age (years) (mean, SD) | 24.35 (7.57) | 24.34 (7.64) | 24.35 (7.57) |
| Age category 12–19 (n, %) | 36,017 (29.21) | 2,404 (1.95) | 33,613 (27.26) |
| Age category 20–39 (n, %) | 82,181 (66.67) | 6,273 (5.08) | 75,908 (61.58) |
| Age category 40–59 (n, %) | 4,826 (3.91) | 343 (.27) | 4,483 (3.63) |
| Age category 60 and above (n, %) | 238 (.19) | 38 (.03) | 200 (.16) |
| Relationship status (not in a relationship, %) | 74,852 (60.72) | 4,333 (3.51) | 70,519 (57.21) |
| Employment (not working, %) | 59,150 (47.98) | 4,901 (3.97) | 54,249 (44.01) |
| Education (high school graduate diploma, %) | 45,192 (36.66) | 3,196 (2.59) | 41,996 (34.07) |
| Weekly time spent gaming (mean, SD) | 23.09 (16.59) | 21.18 (17.02) | 23.24 (16.55) |
| Percentage of time spent gaming on weekend (%) | 41.71 | 43.53 | 41.56 |
| Mostly played mode of video games (online, %) | 42,682 (34.62) | 2,506 (2.03) | 40,176 (32.59) |
| Membership to an in-game social group (yes, %) | 39,091 (31.71) | 2,953 (2.39) | 36,138 (29.31) |
| Gaming disorder prevalence–WHO (n, %, 95% CI) | 2,418 (1.96, 1.88–2.04) | 197 (.16, .14–.18) | 2,221 (1.80, 1.73–1.88) |
| Gaming disorder prevalence–APA (n, %, 95% CI) | 6,127 (4.97, 4.85–5.09) | 551 (.45, .41–.49) | 5,576 (4.52, 4.41–4.64) |
| Gaming disorder severity–WHO (GDT mean, SD) | 8.87 (3.19) | 8.92 (3.37) | 8.87 (3.18) |
| Gaming disorder severity–APA (IGDS9-SF mean, SD) | 17.86 (6.23) | 18.26 (6.57) | 17.83 (6.20) |
| Item-related descriptive statistics (mean, SD) | |||
| GDT item 1: Difficulties controlling gaming | 2.19 (1.01) | 2.21 (1.04) | 2.18 (1.01) |
| GDT item 2: Increased priority to gaming | 2.68 (1.07) | 2.72 (1.11) | 2.68 (1.07) |
| GDT item 3: Usage despite problems | 2.26 (1.19) | 2.25 (1.22) | 2.26 (1.19) |
| GDT item 4: Experience of significant problem | 1.75 (.91) | 1.73 (.94) | 1.76 (.91) |
| IGDS9-SF item 1: Preoccupation | 2.53 (1.19) | 2.40 (1.21) | 2.54 (1.19) |
| IGDS9-SF item 2: Withdrawal symptoms | 1.80 (.99) | 1.89 (1.07) | 1.79 (.98) |
| IGDS9-SF item 3: Tolerance | 2.12 (1.10) | 2.17 (1.15) | 2.11 (1.10) |
| IGDS9-SF item 4: Difficulties controlling gaming | 1.81 (.98) | 1.80 (1.00) | 1.81 (.98) |
| IGDS9-SF item 5: Loss of interest | 2.11 (1.14) | 2.18 (1.19) | 2.11 (1.13) |
| IGDS9-SF item 6: Usage despite problems | 1.89 (1.11) | 1.88 (1.15) | 1.89 (1.11) |
| IGDS9-SF item 7: Deception of others | 1.53 (.90) | 1.46 (.88) | 1.54 (.90) |
| IGDS9-SF item 8: Playing to escape negative moods | 2.70 (1.26) | 3.13 (1.26) | 2.66 (1.25) |
| IGDS9-SF item 9: Risking relationships and opportunities | 1.39 (.81) | 1.34 (.78) | 1.39 (.82) |
SD: Standard Deviation; GDT: Gaming Disorder Test; IGDS9-SF: Internet Gaming Disorder Scale–Short-Form. CI = Confidence Interval. As printed: the female and male percentages are shares of the whole sample, not of each gender.
Table 2. Summary of the descriptive statistics and one-way Analysis of Variance (ANOVA) results
| Number of criteria endorsed | n | Mean† | SD | df1/df2 | Welch’s F | p | ω² |
|---|---|---|---|---|---|---|---|
| World Health Organization framework | |||||||
| 0 | 82,379a | 19.77a | 14.28 | 4/10,609.14 | 2,441.29 | < .001 | 0.09 |
| 1 | 24,494b | 27.31b | 17.19 | ||||
| 2 | 9,687c | 31.28c | 19.02 | ||||
| 3 | 4,284d | 34.74d | 20.42 | ||||
| 4 | 2,418e | 40.13e | 23.42 | ||||
| American Psychiatric Association framework | |||||||
| 0 | 64,659a | 18.98abc | 13.87 | 9/5,338.64 | 1,140.26 | < .001 | 0.09 |
| 1 | 27,684b | 24.41abc | 16.20 | ||||
| 2 | 13,461c | 27.51abc | 17.41 | ||||
| 3 | 7,286d | 29.71abc | 18.45 | ||||
| 4 | 4,043e | 32.04abc | 19.11 | ||||
| 5 | 2,460fg | 34.53ab | 20.75 | ||||
| 6 | 1,553g | 36.67c | 21.27 | ||||
| 7 | 1,028gh | 38.31bc | 22.60 | ||||
| 8 | 607hi | 41.62a | 24.24 | ||||
| 9 | 479ig | 41.19abc | 24.78 |
Dependent variable = weekly time spent gaming (hours). †Rounded at the second decimal. Means with different superscript letters are described in the article as statistically different at p < .00009 (Games-Howell test with Bonferroni correction); letters as printed.
The question
Gaming disorder is now recognised by the World Health Organization, while the American Psychiatric Association lists Internet gaming disorder as a condition for further study and suggests that affected gamers play at least 30 hours a week. Little is known about how much gaming is too much. We examined how weekly gaming time relates to the number of disordered gaming symptoms under both frameworks, how prevalence compares between them, and whether the pattern differs for men and women.
Implications
Practical implications
Clinicians should not rely on hours played alone: gaming time shares only about 10% of its variance with symptom levels, and the 30-hour figure risks both unnecessary concern and over-diagnosis. Functional impairment is a better guide. Screen-time guidance could distinguish gaming from other activities and take age into account, and the gaming industry could share anonymised play-time data with independent researchers.
Theoretical implications
The study shows that prevalence estimates depend on the diagnostic framework, with the APA framework yielding more than twice the WHO rate, and maps the link between symptom counts and gaming time across both frameworks and genders in the largest survey sample to date, informing the refinement of diagnostic criteria.
Limitations and future research
- Gaming time was self-reported and may not match actual play.
- The design is cross-sectional and the sample non-clinical, so causal and diagnostic conclusions are limited.
- Parents and guardians were not surveyed, and clinical studies of the WHO framework and the GDT are still scarce.
Questions this paper answers
How many hours of gaming a week is too much?
There is no single cut-off. In 123,262 gamers, those meeting gaming disorder criteria played on average 34.5 (APA) to 40.1 (WHO) hours a week, but gaming time explained only about 10% of the variation in symptoms, so impairment matters more than hours (Pontes et al., 2022).
How common is gaming disorder?
In this world-wide sample of gamers, 1.96% met the WHO criteria for gaming disorder and 4.97% met the APA criteria for Internet gaming disorder (Pontes et al., 2022).
What is the difference between gaming disorder and Internet gaming disorder?
Gaming disorder is the WHO’s ICD-11 diagnosis, based on four features including impaired control and continued gaming despite harm. Internet gaming disorder is the APA’s DSM-5 condition for further study, defined by five or more of nine criteria.
Do men and women differ in gaming time and disordered gaming?
Men played more at low symptom levels, but women with many symptoms played longer than men with the same number of symptoms (Pontes et al., 2022).
Key concepts
- Gaming disorder (WHO)
- An ICD-11 diagnosis (6C51) marked by impaired control over gaming, increasing priority given to gaming and continued gaming despite negative consequences, with significant impairment.
- Internet gaming disorder (APA)
- A DSM-5 condition for further study, defined by at least five of nine criteria within 12 months.
- Gaming Disorder Test (GDT)
- A four-item measure of gaming disorder based on the WHO framework (Pontes et al., 2021).
- IGDS9-SF
- The Internet Gaming Disorder Scale–Short-Form, a nine-item measure of the APA criteria (Pontes & Griffiths, 2015).
- Welch’s ANOVA
- A version of analysis of variance that does not assume equal variances across groups.
Open science and materials
- Full text (PDF) Open access article re-typeset as a clean PDF, including the tables and figures
- Published version Social Science & Medicine (open access), with the supplementary material
Study materials
- Sham item
- ‘Have you played the game Semeron Online in the last 12 months?’ (yes/no), a fictitious game used to detect mischievous responding.
- Supplementary material
- Games-Howell pairwise comparisons for all levels and further details of the data visualisation are in the article’s online supplementary data.
How to cite
Pontes, H. M., Schivinski, B., Kannen, C., & Montag, C. (2022). The interplay between time spent gaming and disordered gaming: A large-scale world-wide study. Social Science & Medicine, 296, Article 114721. https://doi.org/10.1016/j.socscimed.2022.114721
Open access under a Creative Commons CC BY 4.0 licence.