World Suicide Prevention Day: Gaming and suicide, an emerging connection

Kavita Mandhare
Thursday, 10 September 2020

On May 25, 2017, the World Health Organization (WHO) officially voted to include "gaming disorder" as a behavioural addiction in the 11th edition of the International Classification of Diseases (ICD).

Gaming. It's a word loved by all youth and hated by most parents. We all are aware of the struggle that parents are facing because their children just won't get away from the screen. The gaming world has evolved so much these days that gaining access to a game is only an installation away.

Even though we all are well informed about the fun-loving side of gaming, there is a darker side to it as well. Everything in excess leads to its adverse effects; likewise, gaming in excess may lead to gaming addiction. On May 25, 2017, the World Health Organization (WHO) officially voted to include "gaming disorder" as a behavioural addiction in the 11th edition of the International Classification of Diseases (ICD). WHO has defined gaming disorder in 2018 as "a pattern of gaming behaviour (digital or video) characterised by impaired control over gaming, increasing priority given to gaming over other activities to the extent that gaming takes precedence over other interests and daily activities, and continuation or escalation of gaming despite the occurrence of negative consequences."

Why is Gaming Addiction such a big deal, though? 

From the time gaming addiction came into focus, many connections between gaming and mental health issues have been made. One such connection is between gaming and suicide. The Youth Risk Behaviour Survey (YRBS) for 2007-2009 revealed that teenagers who reported five hours or more of a video game or daily internet use had significantly higher levels of sadness, suicide ideation, and suicide planning. This YRBS data were obtained by Messias et al., (2011) to study the association between excessive video game/internet use and teen suicidality.

Studies in specific populations also indicate a link between gaming and suicide. A nationwide survey in Germany carried out by the Criminological Research Institute of Lower Saxony (KFN, 2007-2008) collected data from juvenile males and females ninth-graders. The data indicated a clear dividing line between extensive gaming and video game dependency. Video game dependency was accompanied by increased levels of psychological and social stress in the form of lower school achievement, skipping responsibilities and duties, for example, schooling, reduced sleep time, limited hobbies, and increased suicidal thoughts.

What is known about this in India? 

There is very little scientific data from India on this connection between gaming addiction and suicide. Still, many media reports suggest that a link does exist. 

For example, Mumbai Mirror (July 2020), reported that a 13-year-old died by suicide after losing in an online game. He was apparently depressed after losing the combat game after which he took this step. 

There was another article by India TV (July 2020), which reported that smartphone gaming addiction led to the death of a teenager in India. A 13-year-old boy killed himself after his father asked him to eat food and stop playing the game on his father's smartphone. The two brothers argued over the mobile game, which led to the elder one killed himself.

There are many more such instances.

How can gaming addiction lead to suicide?

Gaming addiction can lead to various problems.

Psychological impact:  A study by Baum et al., (2015) on German-speaking expert gamers revealed that addicted gamers scored higher on depression, social anxiety and low on all dimensions of quality of life. They also reported gamers being less agreeable, thorough, and emotionally less stable and having severe anger, guilt, and envy. Another study by Wittek et al. (2015) revealed that video game addiction was also positively associated with neuroticism (negative or anxious emotional state). 

According to the Interpersonal-Psychological Theory of Suicide (Joiner, 2005), individuals become capable of withstanding the pain and fear associated with a suicide attempt through habituation to painful and/or frightening stimuli. This capability is referred to as 'acquired capability' and is composed of both pain tolerance and fearlessness about death. 

Gauthier et al. (2014) investigated the relationship between exposure to violent video games and both these components of acquired capability. The study revealed an association between violent video game exposure and fearlessness about death. Another research by Koga et al., 2019, studies acquired ability along with the unmet need for belongingness ('thwarted belongingness'), the belief that one is a burden on others ('perceived burdensomeness') and having suicide ideation without intention to act immediately (passive suicide ideation), was done on Japanese young adults and revealed that gaming addiction was associated with suicidality, perceived burdensomeness and thwarted belongingness. 

These psychopathologies are associated with suicide. 

Social engagement issues: Gordon Neufeld, a developmental psychologist, commented that digital intimacy ruins the appetite for genuine intimacy. People lose their need for significant attachment with their family, which can erode the relationship between them and their family. Kwon et al. (2011) found that Massive Multi-user Online Role-Playing Games (MMORPG) playing became compulsive for some adolescents and was significantly associated with interpersonal variables (negative mood, escape from self). It suggests that engaging in the immersive worlds of MMORPGs as a method of alleviating negative and stressful thoughts within oneself. Their results indicated that compulsive internet gaming was more highly correlated with parental rather than peer relationships and was significantly associated with parental hostility and parental supervision.

According to the American Addiction Centre, these games require engaging with others in computerised environments; they don't necessarily prepare children for the realities of socialising with their peers. Learning how to interact with others in a real-world setting is an essential social skill that may be neglected by individuals who spend too much time gaming. 

Changes to lifestyle: Hours spent sitting at a computer or in front of a device can take a toll on a younger person's body. The lack of physical exercise involved in gaming has led to weight gain, poor posture and increased risk of type 2 diabetes in American children and teens. In India, according to Dr Manoj Sharma (NIMHANS), who has studied excessive gamers by excessive gaming, has an adverse effect in the form of irregular dietary habits and other problems. It is also associated with insomnia, sleep apnea and nightmares. Among adults, it leads one to disregard for crucial daily responsibilities such as academic, work, family or social obligations.

Academic problems: As most of the time is spend on gaming, there is little to no time spent on studying. A study by Wright (2011), supports this statement. One hundred ninety-eight participants were included in this study which revealed that participants who played video game had significantly lower GPAs than participants who did not. The concern lies in the rapid movements and fast-paced action of video games that promote a loss of concentration in players. 

A paper published by Swing et al., (2012) has found that games can hurt and help children's attention issues. It impacts the ability to concentrate in short bursts but damaging long-term concentration. Children who spend a lot of time playing may become less interested in reading books, which requires more focused, prolonged attention. 

Increased aggression or violence: It's observed that children who devote a lot of time to playing games that focus on combat, fighting or violence may display more signs of aggression than the ones who don't play these games.

A longitudinal study confirms that playing violent video games is a significant risk factor for later physically aggressive behaviour and that this violent video game effect on youth generalised across very different cultures (Anderson et al.,2008).

However, there is a lot we do not know, and the connections which link gaming to suicide need to be established through further research.  

Does this mean that all the gamers are at risk for suicide?

No, vulnerability to suicide differs from person to person. 

Factors related to suicide: Some gamers may be more prone to suicide because of other unknown and some known factors in their lives. The known factors include a family history of suicide, previous suicide attempts, history of mental disorders like depression, alcohol use, feelings of hopelessness, social withdrawal, impulsive or aggressive tendencies, loss of loved ones, physical illness, easy access to lethal methods of suicide, etc.

Nature of the game: There are several studies, which show that action games that include violence and crime can increase the risk of suicide. One research study conducted with college students who played video games weekly (Mitchell et al., 2015) tried to examine the relationship between video gameplay and the acquired capability for suicide (i.e. pain tolerance and fearlessness about death) found that individuals who play many hours of action video games may be more capable of lethal self-harm if they experience suicide ideation. According to Texas Tech University (2016), hours of video gameplay is associated with increased acquired capability only when people report playing action games.

Gender: Generally, males are at more risk for suicide than females, and males tend to also more prone to gaming addiction. One study (Wittek et al. 2015) randomly selected gamers from the National Population Registry of Norway, and the results showed that being male was positively associated with addicted and problematic gaming. Another significant correlation between violent gameplay and suicidality, depression was only for males (Koga et al., 2019).

However, there is a lot we still do not know about factors that result in increased risk for suicide in gamers, and these need to be investigated further before conclusions can be made. 

Treatment for gaming addiction 

The following techniques can reduce addiction to gaming - 

  • Cognitive Behaviour Therapy (CBT): This is one of the most effective methods to deal with online addiction. CBT can help dismiss false beliefs and insecurities that lead to excessive gaming, provide self-help tools to improve their moods and teach effective communication skills. It can help recognise what triggers addiction and facilitate avoiding those trigger situations.
  • Motivational Interviewing (MI): This is a useful technique to evaluate, establish, and increase motivation for abstinence as well as a therapeutic relationship for treatment of gaming addiction. Patients seeking assistance for this are most frequently pressured into treatment by a family member. Many patients do not arrive for treatment at the highest level of motivation, so attempts must be made to enhance treatment readiness and motivation, and potentially strengthen them in the early course of treatment. This technique is mostly used with CBT to make the treatment more effective. 
  • Support groups or online support forums: There are a variety of online forums, designed by and for the use of those affected by excessive game playing. Some of these are parent-run groups, whereas professional organisations run others. These forums commonly provide practical advice to reduce gaming and/or experiential stories to motivate other people. This is a valuable source of motivation and moral support, especially for individuals who have lost contact with friends or peers as a result of their gaming addiction.  

For more information about these treatments, visit the following links:

https://www.verywellmind.com/what-is-motivational-interviewing-22378

https://www.addictioncenter.com/treatment/cognitive-behavioral-therapy/

https://americanaddictioncenters.org/video-gaming-addiction

The good side to gaming 

Gaming is not all bad! There are several benefits to gaming when played within limits.

Economical: According to Financial Express, India has the largest youth population and second-largest internet population, which makes the country one of the most attractive markets in the gaming sector. The report by Indian Gaming Industry indicates that the gaming sector is expected to grow 41 per cent annually due to the growth of digital infrastructure and a substantial rise in quality and engaging gaming content.

Job opportunities: The market value of the gaming industry in India is estimated to go up to over Rs 250 billion by 2024 (Financial express). The number of new job opportunities in the country's gaming industry is a clear indicator of the constant evolution of this sector. By 2022, the estimated number of employees within the market would be over 40,000 (Statista, 15 July 2020).

Therapeutic: iThrive Games Foundation designs game-based learning tools to equip teens with the social and emotional skills they need to be healthy and resilient. Here gaming is considered as a therapeutic technique. Connecting people to others who can provide mental health support and assistance with coping skills can help prevent suicide, and video games can play an important role by fostering connections and support.

So, gaming has its positives, but gaming addiction is a rising problem in young people today. There is evidence to show that gaming addiction can lead to suicide, but more rigorous data are needed from India regarding this topic. 

Please reach out to these helplines if you are experiencing problems because of gaming:

Alpha Healing Centre (De-addiction and Rehab Centre): +91- 9136783804

Cadabams: +91 9611194949

NIMHANS Centre for Well-Being: 080-26685948/ 9480829670

If you're having suicidal thoughts or any of your acquaintance needs help, the following numbers can be reached out:

91-9152987821/ 022 25521111

Sneha: 04424640050

Connecting NGO: 9922004305 

Aasra: 9820466726/ 022 27546669

Inputs from Madhumita Balaji

(Kavita Mandhare is a Master's degree holder in Clinical Psychology and a research assistant working for the Young Lives Matter project in Pune. This project aims to assess the reasons for suicide attempts in young people between 15-29 years of age in India.)

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