- Strong and significant association between depressive symptoms and gaming addiction
There is a strong and significant association between depressive symptoms and gaming addiction among Sri Lankan youth.
This finding was made in an original paper on "Depressive symptoms as a predictor of addiction to tile-matching games: A cross-sectional study" which was authored by V Samaranada and S Perera, K Kanchana, H Thathsarani, and M Chandradasa.
Depressive disorder is a recognised mood disorder with significant morbidity. It contributes to a global point prevalence rate of self-reported depressive symptoms, which was 34 per cent from 2001 to 2020, a pooled one-year prevalence for major depressive disorder of 8% and a lifetime prevalence for major depressive disorder of 19%. In relation to young populations, the point prevalence of elevated depressive symptoms among adolescents was 37% between the years 2011 and 2020. Meanwhile, female adolescents were reported to have a higher prevalence of elevated depressive symptoms than males. Regarding Sri Lanka, the pooled prevalence of depression was found to be 19.4% and the highest prevalence, 39%, was reported among young people. Humans often seek relief and comfort during times of distress, and playing video games has become intensively popular among billions due to its easy accessibility. Video games include various genres such as role-playing games (RPGs), and puzzle games. Among these, tile-matching games which come under the genre of puzzle games have remained consistently popular even prior to the advent of smartphones. Tile-matching games, such as Bejewelled, Candy Crush, and Tetris, uniquely combine cognitive demands with immediate gratification, which underlie their broad appeal and compelling psychological engagement. These games capitalise on the human preference for order and completion by presenting disorganised tiles and offering the players the opportunity to restore order, which triggers dopamine release and reinforces continued participation in the play. Furthermore, in tile matching games, the players often enter a flow state, where players become deeply immersed, and lose time perception, as the game dynamically adjusts its difficulty to match the player’s skill level, providing a feeling of mastery and escapism. Accordingly, the widespread popularity of tile-matching games and appeal lies in their simplicity, straightforward mechanics, capacity for brief play sessions, visually appealing designs, engaging auditory effects, and frequent reward systems which together attract millions of players globally. These games also foster feelings of satisfaction, achievement, and victory to the player, making them feel self-satisfied.
Video games exert a dual-edged influence on youth development, providing both important cognitive benefits and significant psychological risks. Positively, certain gaming genres enhance problem-solving abilities, spatial cognition, resilience in the face of failure and challenges, and facilitate social interaction and communication, especially in multiplayer contexts. Conversely, excessive or problematic gaming often involving violent content, is linked to heightened aggressive thoughts and behaviours, the increased risk of gaming addiction, and adverse effects on sleep quality and academic performance. The overall influence of video gaming on mental health is largely determined by factors such as the type of game, the duration of game playing, and the context of play. While concerns about the potential harms of video game play have increased over the past decades, understanding its causal effect on mental health remains uncertain since video game exposure is complex and multifaceted, encompassing multiple factors such as the genre, duration, rewards, and social interaction that influence psychological outcomes differently. Moreover, abstaining from gaming is itself ambiguous, making it a complex issue to unpack. Although some individuals experience life problems linked to gaming, formalising a disorder like the World Health Organisation’s International Classification of Diseases - 11th Revision (ICD-11) Gaming Disorder requires stronger evidence, a careful study design, and the consideration of underlying issues such as depression or anxiety. Many have reported a co-occurrence between video game addiction and mental health disturbances, few studies have contextualised this relationship. For instance, it was found that video game addiction is related to depression, lower academic achievement, and conduct problems among adolescents, and it has been shown that one aspect of video game use is a way of coping with the presence of depression, anxiety and stress. Furthermore, heavily engaged young gamers with deteriorating mental health and maladaptive coping styles may be highly vulnerable to developing video game addiction, including tile-matching games. It was found that recurring structural characteristics influenced user behaviour after playing the games (two genres of the Facebook game included Tile Matching games and Simulation/RPGs), with simulation/RPGs causing more problems than tile-matching games. However, both genres tended to use similar features to promote player engagement.
Materials and methods
Design, setting, and participants
Samaranada et al. conducted a cross-sectional study among adolescents and young adults who engage in playing video games. Participants were selected only if they met the inclusion criteria (being a video game user; and being between the ages of 10 and 35 [inclusive], encompassing adolescence [10-18 years] and young adulthood [19-35 years]). Data were collected during June-August 2021 through an online survey using the snowball sampling technique. In reaching the potential participants, social media platforms and electronic mail were utilised. The study excluded individuals who were under treatment for any psychiatric condition other than depression.
Seven-item game addiction scale
The Game Addiction Scale (GAS) was used in the current study to screen for addictive gaming behaviour.
All essential criteria include those indicative of significant pathology such as conflict, withdrawal, and related problems, which are fulfilled by the addicted players/gaming addicts (pathological), and they provide a more accurate distinction between a habitual behaviour and a genuine addiction.
Results
Sample characteristics
The study included a sample of 401 individuals with a mean age of 23.71 years (plus/minus 4.69), and the vast majority (90.53%) were young adults (19-35 years). Females (55.4%) slightly outnumbered males (44.6%). The sample was predominantly composed of individuals identifying as Sinhalese (94.3%), with the majority residing in the Western Province (WP) (53.12%). In terms of education, over half of the participants were Undergraduates (56.9%), while a significant portion had completed their General Certificate of Education Advanced Level (22.9%). Economically, nearly half (47.4%) reported a monthly family income above Rs. 60,000, and a majority were unemployed (63.8%). Most were unmarried (91%). The sample was almost evenly split in their preference for tile-matching games (48.9%) versus other game types (51.1%). A substantial portion met the criteria for gaming addiction (42.4%) and a high prevalence of depressive symptoms (43.9%) was also observed among the respondents.
Prevalence of gaming addiction among tile-matching game players and other game players who do not play tile-matching games
Among tile-matching players (196), 45.9% were identified as having gaming addiction, while 49% met the criteria for depression. In contrast, among players of other types of games (205), 39% were categorised as addicted and 39% as depressed. Accordingly, players of tile-matching games exhibited a higher prevalence of both gaming addiction and depressive symptoms compared to players who exclusively play other types of games.
Bivariate associations with gaming addiction
Most demographic factors were not significantly associated with gaming addiction, and accordingly, no statistically significant associations were detected between addiction and the ethnicity, the Province, the education level, the income, the employment status, or the civil status. However, a significant association was observed between gender and addiction (401). Furthermore, the type of game did not exhibit a significant association with addiction (401). In contrast, the depression status demonstrated a significant association with addiction (401).
Bivariate associations with depressive symptoms
When the depression status was examined as the dependent variable, similar trends emerged, as demographic factors including the age group, gender, ethnicity, Province, education, income, and civil status did not show statistically significant relationships with depressive symptoms. The employment status showed a significant association with depressive symptoms (401). The game type was also significantly related to depressive symptoms (401).
Stratified analyses by game type indicated that the association between gaming addiction and depressive symptoms was statistically significant in both the groups (401).
A significant association was revealed between depressive symptoms and gaming addiction in the tile-matching game playing population (196). Furthermore, a significant association between depressive symptoms and addiction to other types of games was also found (205).
Comparison of gaming addiction and depressive symptoms between tile-matching and other game types
For tile-matching game players, 29.2% (31/106) of non-addicted participants and 72.2% (65/90) of addicted participants reported depressive symptoms. For other game players, among participants who were not addicted, 24.8% (31/125) reported depressive symptoms, whereas 61.3% (49/80) of the addicted participants were depressed.
The crude odds ratios indicated a stronger association between depressive symptoms and gaming addiction among tile-matching players compared with players of other game types. For tile-matching games, the odds of being addicted were 6.29 times higher among depressed individuals than among non-depressed individuals. In contrast, among players of other game types, depressed individuals had 4.79 times higher odds of addiction.
Logistic regression analysis of factors predicting gaming addiction
A binary logistic regression was conducted to examine the predictors of gaming addiction in the population (401). The predictor variables included the age group, gender, ethnicity, Province, education level, monthly family income, employment status, civil status, game type, depression status, and the interaction between depressive symptoms and the game type.
Among all predictors, the depression status was the strongest and only consistently significant predictor of gaming addiction. Gender was also a significant predictor. Among other demographic variables, only the Province of residence was statistically significant. No significant associations were observed for the age group, ethnicity, educational qualifications, monthly family income, employment status, civil status, or game type.
The results of the depressive symptoms into game type interaction term, to assess whether the impact of depressive symptoms on gaming addiction differs between tile-matching and other game types, found that the finding was not statistically significant.
Discussion
Players of tile matching games exhibited a slightly higher prevalence of both gaming addiction (45.9%) and depressive symptoms (49.0%) compared to other types of game players (39% for each). Complementing these findings, the unadjusted odds of addiction were notably higher among depressed players of tile-matching games compared to their non-depressed counterparts, with a 6.29-fold increase. Conversely, depressed individuals playing other game types had 4.79 times greater odds of addiction than those without depressive symptoms. Moreover, the depressive symptoms into game type interaction term to assess whether the impact of depressive symptoms on gaming addiction differs between tile-matching and other game types showed an adjusted odds ratio above one. Based on the direction of the adjusted odds ratio, a tendency was found for depressed individuals to have higher odds of addiction when playing tile-matching games compared to other game types. The finding was however not statistically significant. The insignificance is inconclusive. Other strong predictors included depression.
Moreover, depressive symptoms may still contribute to heightened vulnerability to gaming addiction when engaging with tile-matching games. These findings may reflect structural features of tile matching games, such as the ease of access, the short session duration, the minimal cost, and frequent reward loops which can encourage habitual play. These features align with reinforcement mechanisms known to sustain repetitive behaviour without necessarily involving social competition or narrative immersion.
Depressive symptoms were the most consistent and significant predictor of being classified as addicted. Gender was also a significant predictor, with males being more likely to exhibit addictive behaviours than females, where males generally engage more intensively with digital games. The Provincial difference, where participants from the WP showed higher odds of addiction, may reflect greater urban access to devices, higher internet penetration, and increased exposure to competitive gaming environments rather than an inherent regional susceptibility. Meanwhile, the other socio-demographic variables including the education level and income did not reach statistical significance. Accordingly, the individual psychological factors appeared to have a stronger influence on excessive gaming patterns than demographic characteristics or the game type alone. Significant associations were demonstrated between depressive symptoms and gaming addiction within both game-type groups, and the presence of depressive symptoms is the most consistent and strongest predictor of gaming addiction, though this association does not necessarily imply causation.
The observed link between depression and gaming addiction can be understood through the compensatory internet use model, which suggests that depressed individuals, experiencing deficits in real-life fulfillment, social connection, and mood regulation, may turn to gaming as a coping mechanism to escape negative emotions or to compensate for unmet psychological needs. This is further illuminated by the lens of the self-determination theory, which posits that gaming addiction often develops when the virtual environment successfully satisfies the fundamental psychological needs for autonomy (feeling in control), competence (feeling effective), and relatedness (feeling connected to others), which are otherwise thwarted in the depressed person’s offline life.
Emotional distress is an important vulnerability factor for problematic gaming across different developmental stages. Adolescents with mobile game addiction had higher self-reported depression, social anxiety, and loneliness. Gaming addiction is a challenging problem among adolescents who also suffer from high levels of stress. Contrary to these, the present research found that age groups did not significantly predict gaming addiction, possibly due to the small proportion of adolescents (9.5%) compared to young adults. The widespread use of video games among adolescents has raised concerns about their impact on psychological and social development, and they revealed that balanced parental involvement and the development of adolescents’ social skills are necessary to mitigate the risks of problematic online gaming. However, in Sri Lanka, adolescents’ attitudes towards mobile phones and gaming addiction are both positive and negative. Some participants were aware of the negative impacts of addiction. In contrast, others perceived playing mobile games as a significant need in a person’s life. A study argued for its advantages, such as providing entertainment, reducing loneliness, helping to cope with feelings of sorrow, and enhancing self-identity. This duality in perception underscores the complexity of gaming addiction.
Gaming serves as a source of joy and social connection; on the other hand, it can lead to social isolation and mental health issues. Increased time spent gaming can correlate with feelings of loneliness and depression. Video game addicts reported more anxiety, depression, lower positive affect, and psychological well-being. In contrast, it has been showed that video games are psychologically nutritious but less nutritious than need-satisfying real-world experiences. For example, video games can provide a temporary escape and relief during stressful situations such as pandemics or academic pressures. They can serve as a source of entertainment and social interaction, helping individuals cope with feelings of loneliness and sadness.
With the emergence of Covid-19 in December 2019, unprecedented changes took place in people’s lives. Social distancing, quarantining, and stay-at-home orders impacted people’s daily lives, and resulted in increased physical inactivity, characterised by reduced exercise, increased sitting time, and heightened screen time among the Sri Lankan population. The physical mode of education and employment was converted to online. The average time per day of smartphone use among children and adolescents during the pandemic was higher (in four hours) than before. Moreover, problematic smartphone usage for different applications, including video games, has increased rapidly in recent decades, and it has become inseparable during the Covid-19 pandemic, especially among students.
In Sri Lanka, the pervasive social stigma surrounding mental health acts as a critical cultural factor, influencing how psychological distress is reported and managed. Cultural norms often lead to the denial of mental illness and a significant fear of social repercussions, resulting in delayed help-seeking behaviours. Consequently, individuals may channel their need for emotional regulation and escape into more socially acceptable or accessible activities. It has been consistently identified that escape and fantasy motives are strong correlates of Internet Gaming Disorder, suggesting that the gaming environment functions as a less-stigmatised compensatory space to flee from negative real-life experiences or internal depressive symptoms.
The question of whether video gaming addiction is a genuine clinical disorder has valid arguments on both sides. Proponents argue for its disorder status, pointing to its official inclusion as Gaming Disorder in the ICD-11, indicating recognised patterns of persistent, recurrent behaviour leading to significant impairment in personal, family, social, educational, or occupational functioning. Conversely, critics contend that pathologising this behaviour is premature, suggesting that excessive gaming may often be a symptom of underlying mental health issues like anxiety or depression, rather than a primary disorder, and that broad diagnostic criteria risk pathologising non-problematic intense engagement, especially since the stability and clinical necessity of the construct are still under debate.
However, the increased use of smartphones has highlighted the importance of categorising addiction to identify the severity of the addiction through pathological and excessive gaming behaviour. The main difference between excessive and pathological gaming is that excessive gaming reflects behaviour that is disproportionate but not necessarily problematic. In contrast, pathological gaming is defined as the persistent inability to control extreme gaming habits despite the associated social or emotional problems, such as preoccupation, withdrawal, loss of control, and interpersonal or intrapersonal conflicts.
A video game addiction is not a spontaneous occurrence. Four main features attract people to video games. First, the original game design: the soundtrack, frames, background story, and the complexity of the gaming elements. Secondly, the role-playing achievements. Thirdly, the online social interactions, and fourthly, the psychological needs and motivations. When comparatively considering these four attractions in games, it is evident that some games possess simplicity while some are complex, and on the other hand, different games provide different motives. Puzzle and action were both popular genres but weakly related to addiction, whereas RPGs were not very popular but strongly related to addiction. Thus, it is assumed that popularity and addiction are not two related factors. For tile-matching games, their popularity is attributed to their simplicity, frequent reward system, and other features.
Conclusion
Depression is the most powerful predictor, while being of the male gender also showed a notable association. The consistently elevated odds of addiction observed among players of tile-matching games points to a potential genre-specific vulnerability. The persistent trend indicates that the psychological interplay between depression and addiction to tile-matching games is likely more complex than a simple main effect.