In a cross-sectional online survey, the prevalence of IGD and its psychiatric associations among gamers from three Arab countries (Jordan, Kuwait, and Syria) was assessed. The study used social media platforms (Facebook, Twitter, and LinkedIn) to distribute the online questionnaires described below. Any adult from 18 to 35 years from those three countries was eligible to participate in the study; social media platforms were used for data collection through invitations via private messages to participate in the survey. Ethical approval of the study was obtained from the internal review board (IRB) of the Faculty of Medicine, Aleppo University, Syria (number: 8197). The participants were asked to consent that they agree to answer the questionnaire for research purposes on the first page of the online form. At the beginning of the survey, participants were asked if they play Internet games (yes/no). By answering “yes,” they were directly linked to the survey. By answering “no,” they were directed to the questionnaire about psychiatric comorbidities only, which includes three tools to quantify depressiveness, anxiety as well as attention deficit, and hyperactivity (the inventories are described in the “Methods” section). Data were collected in June and July 2021.
The following demographic variables were obtained: age, gender, residence, parents’ education, profession, and country of residence.
Study questionnaires
The Internet Gaming Disorder-20 questionnaire (IGD-20)
The questionnaire consists of 20 questions to be answered on a 5-point Likert scale [never [1], rarely [2], sometimes [3], often [4], and very often [5]]. Thus the obtainable score ranges from 20 to 100, with scores above a cutoff point of 71 considered to indicate the presence of IGD. The questionnaire has a Cronbach’s alpha of 0.87 and 0.9, for the original and the Arabic version, respectively [10, 11].
The Patient Health Questionnaire (PHQ-9) for the assessment of depression
The questionnaire consists of nine questions to be answered on a 4-point Likert scale [not at all (0), on several days [1], on more than half of the days [2], nearly every day [3]]. Thus, the obtainable score ranges from 0 to 27, with higher scores meaning higher levels of depression. The Cronbach’s alpha for the questionnaire is 0.89 and 0.88, for the English and Arabic versions, respectively [12,13,14].
The Generalized Anxiety Disorder (GAD-7) questionnaire for the assessment of Anxiety
The questionnaire consists of 7 questions to be answered on a 4-point Likert scale [not at all (0), on several days [1] on more than half of the days [2], nearly every day [3]], with a score ranging from 0 to 21, and higher scores indicating higher anxiety levels. The Cronbach’s alpha for the questionnaire is 0.89 for the English and 0.88 for the Arabic version, respectively.
The Adult ADHD Self-Report Scale 26 (ASRS-26) (Arabic version)
The questionnaire consists of nine questions assessing attention deficit and nine questions assessing hyperactivity. The score for attention deficit and hyperactivity ranges from 0 to 36 each, with higher scores indicating higher levels of severity. The responses are scored depending on the question as zero or 1. On items, 1–3, 9, 12, 16, and 18 ratings of very often, often, or sometimes are assigned 1 point, while ratings of rarely or never are assigned 0 point. Regarding the remaining 11 items, ratings of very often or often are assigned 1 point (ratings of sometimes, rarely, and never are assigned 0 point) [15, 16].
Participants who reported not playing Internet games were not given the IGD-20 but rather the PHQ-9, GAD-7, and ADHD self-report scale only.
Sampling and sample size calculation
We used the following equation n = z2P[1-P]/d2 [17], with z denoting the statistic corresponding to confidence level, P being the prevalence that is expected, and d being the precision in correspondence to the effect size. Under the assumptions of a 95% CI, 50% response distribution, and 0.05 margin of error, a sample size of 384 participants was calculated as a minimal sample to represent the population of gamers. We continued to recruit responses (from both gamers and non-gamers) until the minimal sample size of gamers was reached. A team of data collectors (EA, MK, ZMH) was assigned to each country to distribute the online questionnaire on social media platforms, and the responses were collected from the social media platforms. As all three participating countries belong to the Arab region and therefore share the same language, values, and comparable Internet resources, data from the three participating countries were pooled for the analysis.
Statistical analysis
Descriptive statistics (frequency and percentage) were used to calculate the prevalence of IGD in the study sample. Furthermore, chi-square tests were used to compare the frequency of gaming disorders according to the participants’ demographics (p-value was set at 0.05).
To examine the association between IGD and psychiatric comorbidities, the scores of psychiatric disorders were compared between the disordered/non-disordered groups of gamers using the Mann-Whitney tests. Furthermore, the scores of psychiatric disorders were compared between gamers and non-gamers. Further correlation analyses were run between the gaming disorder score and scores in depression, anxiety, attention deficit, and hyperactivity.