Type of the Paper (Article Int. J. Occup. Safety Health, Volume 13, No 1 (2023), 119-125 https://www.nepjol.info/index.php/IJOSH 119 Original Article Internet Gaming Disorder among Undergraduate Health Sciences Students in the Pokhara Valley: a Cross-Sectional Study Shahi S1, Baral YR1, Mishra DK1 1Manmohan Memorial Institute of Health Sciences, Department of Public Health Kathmandu, Nepal ABSTRACT Introduction: Internet Gaming Disorder (IGD) is an emerging public health impact of technological advancement and globalization. This study was conducted to assess the prevalence and factors associated with IGD among undergraduate health sciences students. Methods: A web-based cross-sectional study was conducted during a period of November 2019 to July 2020. A total of 412 college students from Undergraduate Health Sciences colleges of Pokhara Metropolitan city in Gandaki province, Nepal were enrolled. Online google forms were sent to all the eligible students through email and other social media sites like face book with the help of coordinator and class representative. Collected data were analyzed using SPSS IBM v.22 Results: The finding of the study shows that the prevalence of Internet Gaming Disorder among Undergraduate Health Sciences students was 7.1%. Sex (p=0.027), loneliness level at home (p=0.019), number of close friends (p<0.001), types of game (p<0.001), time spent on play game (p<0.001) and, type of gamer (p<0.001) were the factors associated with Internet Gaming Disorder among the participants. Conclusion: Sex of the participants, loneliness level at home, number of close friends, types of game, time spent on the game play, and type of gamer are the contributing factors for developing Internet Gaming Disorder. It is important to focus on these factors to address Internet Gaming Disorder and its psychological health effects. Keywords: Developing countries, Internet addiction, Internet Gaming Disorder, Problematic gaming, Video games Introduction Internet Gaming Disorder (IGD) refers to the problematic use of online or offline video games. It is defined as persistent and recurrent use of the internet to engage in games, often with other players, leading to clinically significant impairment or distress as indicated by five (or more) of the nine criteria in a 12-month period.1 World Health Organization (WHO) defined gaming disorder as “a pattern of gaming behavior (digital-gaming or video-gaming) characterized 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. Gaming disorder was incorporated as a mental health problem in the 11th revision of the International Classification of Disease (ICD-11) in 2018 and was recommended to the governments to formulate public health strategies and monitor IGD trends.2 The American Psychiatric Association (APA) included IGD in section III of the Diagnostic and Corresponding author: Dr. Yuba Raj Baral Associate Professor, Program Coordinator, Department of Public Health, Manmohan Memorial Institute of Health Sciences, Kathmandu, Nepal Email: baralyr3@gmail.com ORCID ID: https://orcid.org/0000-0002-0191- 6278 Date of submission: 16.01.2022 Date of acceptance: 18.08.2022 Date of publication: 01.01.2023 Conflicts of interest: None Supporting agencies: None DOI: https://doi.org/10.3126/ijosh.v13i 1.42038 Copyright: This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License ISSN: 2091-0878 (Online) ISSN: 2738-9707 (Print) https://orcid.org/0000-0002-0191-6278 https://orcid.org/0000-0002-0191-6278 https://doi.org/10.3126/ijosh.v13i1.42038 https://doi.org/10.3126/ijosh.v13i1.42038 http://creativecommons.org/licenses/by-nc/4.0/ http://creativecommons.org/licenses/by-nc/4.0/ http://creativecommons.org/licenses/by-nc/4.0/ Shahi et al. Internet Gaming Disorder among Undergraduate Health Sciences Students in the Pokhara Valley: a Cross-Sectional Study 120 Statistical Manual of Mental Disorers-5th edition (DSM-5) on the condition that it guaranteed more clinical research and experience.3 The essential feature of IGD is engaging in gaming for typically 8 to 10 hours or more per day, typically in internet- based group games.4 Gaming is considered as safe activity but in certain population adverse consequences of involving in this behavior is noticed.23 Engaging in gaming activities may promote negative behaviors such as smoking and aggression and could be harmful to physical and mental well-being.24,25 Increase in internet use and video-gaming contributes to public concern on pathological or obsessive play of video games among children and adolescents worldwide.22 Global Games Market (GGM) has shown that there were more than 2.5 billion gamers in the world in 2016, which is almost one-third of the total population globally.5 A systematic review on IGD has shown the prevalence of IGD ranged from 0.7 percent to 27.5 percent.6 In the context of Nepal, there has been very limited studies conducted on IGD to date. A cross-sectional study conducted during COVID-19 Pandemic Lockdown in 2020 showed that the prevalence of gaming disorder was 8.5% among 260 internet gaming users.20 A study conducted among university students of Ilam on internet addiction showed that 42.84% of students played online games, as a major purpose of internet using.7 Internet gaming disorder is a relatively new phenomenon, and all the studies on internet addiction that have been published in Nepal have pointed out that further research needs to be done in this area. A scoping review showed that 10-20% of children and adolescents have mental disorders and half of them started at age by 14 years 8. However, internet gaming as a cause of these conditions has not been ruled out. Hence, this study aimed to assess the status of IGD and factors associated with it. Data obtained from this study generates evidence and would guide to the development of appropriate interventions and policies to prevention of problematic gaming and its psychological health effects. Methods A web-based cross-sectional study was conducted among students of Undergraduate Health Sciences Colleges of the Pokhara Metropolitan City, Gandaki province of Nepal. The study was conducted during November-July 2020. The study participants were undergraduate health sciences students. Sample size was calculated using the formula {n= z2p (1-p)/d2} where z= level of confidence according to the standard normal distribution (for a level of confidence of 95%, z= 1.96), p= prevalence of IGD= 50%= 0.5, q= 0.5, d= margin of error=0.05 and the sample size (n) was 424 after adding 10% non-response rate. The main instrument to collect data was online self- administered questionnaires using Google forms. The survey instrument was distributed to faculty members to assess its validity and reliability before pretesting among 42 (10% of sample) undergraduate students for relevance, clarity, and acceptability. Changes such as shuffling the question patterns were made before the final questionnaire survey was distributed to the research participants. The study questionnaire consisted of the following two parts - Part A: General informative questionnaire to assess the socio-demographic profile, and Part B: The English version of the DSM-5 short (9-item) Dichotomous scale which compromises nine items, each reflecting one DSM- 5 criteria for IGD. The psychometric properties of this instrument have been well-established.1,26 For those who did not respond, the forms were sent at a gap of two days. The study included Undergraduate health sciences students of all semester and year studying in different medical colleges in Pokhara Metropolitan city. Interns and Post-graduate students were excluded from the study. Ethical clearance was obtained from Institutional Review Committee (IRC) of Manmohan Memorial Institute of Health Sciences (MMIHS) Kathmandu, Nepal (Ref no: 77/27) prior to the start of study. The study was conducted during a period of November 2019 to July 2020. Questionnaire did not contain any identification detail such as email, name of the students and confidentiality was strictly maintained throughout the study. The participants had complete freedom to answer or decline the questionnaire. Shahi et al. Internet Gaming Disorder among Undergraduate Health Sciences Students in the Pokhara Valley: a Cross-Sectional Study 121 The data were transferred from Google form into a spreadsheet and again transferred it to micro- soft excel 2016, analysis was done using the Statistical Package for Social Sciences software (SPSS IBM v. 22). Data were presented in the form of frequency and percentage. Chi-square test (at 5% level of significance and 95% CI) was done to show the association between dependent and independent variables. A p value of <0.05 was considered statistically significant for all the tests. Results There were total of 424 students out of which 412 students participated in the study. Table 1 denotes the demographic characteristics of the respondents. The mean age of the participants was 21.45 ± 2.11 years with the majority (80.6%) of females. Most (94.2%) of them were unmarried and were (99.5%) above the poverty line. Average income less than 1.90$ (dollars) per day is defined as below poverty line and equal or more than 1.90$ (dollars) per day is defined as above poverty line.21 Table 1. Some of the demographic Criteria for Participation Variables Frequency Percentage Age (in years) Mean ± SD 21.45 ± 2.11 Sex Female 332 80.6 Male 80 19.4 Ethnicity Janajati 101 24.5 Brahmin 198 48.1 Chettri 88 21.4 Others 25 6.1 Marital status Unmarried 388 94.2 Married 24 5.8 Socio-economic status Below poverty 2 0.5 Above poverty 410 99.5 Table 2. IGD among the respondents was found to be (7.1%) Variables Frequency Percentage Prevalence of IGD No 273 92.9 Yes 21 7.1 Table 3 shows the analysis of factors significantly associated with IGD. Sex was significantly associated with IGD. The prevalence of IGD was higher in males than females. The study shows that males were 3 times more likely to have IGD than the female respondents (OR=2.906, 95% CI= 1.167- 7.240). Loneliness level at home was seen to be significantly associated with the IGD of the respondents. The respondents who felt much lonely at home were 7 times more likely to have IGD than the respondents who did not feel lonely at home (OR= 6.583, 95% CI= 1.143-37.917). Likewise, the respondents who felt a little lonely at home were 3 times more likely to have IGD than the respondents who did not feel lonely at home (OR= 3.199, 95% CI= 1.179-8.679). Number of close friends was also associated significantly with IGD. Respondents who had 1 to 2 close friends were 3 times more likely to have IGD than the respondents who had 7 or more close friends (OR= 3.205, 95% CI= 1.085-9.472). Likewise, respondents who had 3 to 6 close friends were less likely to have IGD than the respondents who had 7 or more close friends (OR= 0.393, 95% CI= 0.116- 1.329). Shahi et al. Internet Gaming Disorder among Undergraduate Health Sciences Students in the Pokhara Valley: a Cross-Sectional Study 122 Respondents who played action games were 13 times more likely to have IGD than the respondents who played strategic games (OR= 12.972, 95% CI= 3.600-46.746). Likewise, respondents who played adventure games were 5 times more likely to have IGD than the respondents who played strategic games (OR= 4.556, 95% CI= 0.883-23.495). Similarly, the respondents who played role-playing games were 4 times more likely to have IGD than the respondents who played strategic games (OR= 3.905, 95% CI= 0.381-40.054). Time spent on games was also found to be significantly associated with IGD. Respondents who played game for 8 and more than 8 hours were 7 times more likely to have IGD than the respondents who played games for 0 to 7 hours (OR= 6.951, 95% CI= 2.686-17.989). Respondents who were regular players were 8 times more likely to have IGD than the respondents who were irregular players (OR= 8.227, 95% CI= 3.037-22.284). Table 3. Bivariate analysis of factors significantly associated with IGD Factors Prevalence of IGD p-value OR 95% CI (lower- upper limit) No Yes Sex Female 217 (94.8%) 12 (5.2%) Ref Male 56 (86.2%) 9 (13.8%) 0.022 2.906 1.167-7.240 Loneliness level at home None 158 (96.3%) 6 (3.7%) Ref Little 107 (89.2%) 13 (10.8%) 0.022 3.199 1.179-8.679 Much 8 (80.0%) 2 (20.0%) 0.035 6.583 1.143-37.917 No. of close friends 1 to 2 39 (79.6%) 10 (20.4%) 0.035 3.205 1.085-9.472 3 to 6 159 (97.0%) 5 (3.0%) 0.133 0.393 0.116-1.329 7 or more 75 (92.6%) 6 (7.4%) Ref Types of game Role-playing 14 (93.3%) 1 (6.7%) 0.251 3.905 0.381-40.054 Action 59 (80.8%) 14 (19.2%) 0.000 12.972 3.600-46.746 Adventure 36 (92.3%) 3 (7.7%) 0.070 4.556 0.883-23.495 Strategy 164 (98.2%) 3 (1.8%) Ref Time spend on game 0 to 7 hrs. 212 (98.8%) 7 (3.2%) Ref 8 and more hrs. 61 (81.3%) 14 (18.7%) 0.000 6.951 2.686-17.989 Type of gamer Irregular 254 (95.1%) 13 (4.9%) Ref Regular 19 (70.4%) 8 (29.6%) 0.000 8.227 3.037-22.284 Discussion This study found that the prevalence of IGD among Undergraduate Health Sciences students was 7.1% whereas among 92.9% of the respondents there was no IGD. In the context of Nepal, a comprehensive literature review showed a study on gaming disorder in Nepal. A recent study done in 2020 showed that the prevalence of gaming disorder was 8.5%.20 A study conducted in Kathmandu, Nepal among Health Sciences students in 2015 showed that 32.6% played online games on the internet.9 Few studies on internet addiction among adolescent students in Nepal showed gaming as a major purpose of internet use.7,9,10 Likewise, a study conducted in India showed that the prevalence of IGD was 3.50% which was similar to the study conducted in Thailand 5.4%.11,12 This study found sex as a strong predictor of IGD and prevalence was high among males than females among Undergraduate Health Science students. A study conducted in India showed that the prevalence of IGD was higher among male students than female students.11 Majority of the Shahi et al. Internet Gaming Disorder among Undergraduate Health Sciences Students in the Pokhara Valley: a Cross-Sectional Study 123 studies reported similar findings of high male prevalence like Lemmens et al (6.8%), Miller et al (3.1%).13,14 From this study, it is evident that sex acts as an important risk factor for IGD. This may be because video games are marketed more towards males than females, there are not many games that attract girls, interactive online games and contents mainly rely on power, dominance, control and/or violence, which, may explain males’ attraction on the internet use and games. Socio- demographic factors such as ethnicity, marital status, and family size were not associated with IGD in this study. Loneliness level at home was also significantly associated with IGD. A study conducted in Nepal showed that the respondents who felt much lonely at home were more addicted to the internet.10 Previous studies have consistently confirmed the connection between loneliness and game addiction.15,16 This may be because playing online games may temporarily provide an escape from the negative feelings associated with social deficiencies such as dysfunctional family, lack of friends, and may make them free from loneliness. Number of close friends was also significantly associated with IGD. This study did not find any association between tobacco, alcohol consumption, and IGD, this result was supported by a study done in Thailand.12 The study shows no association between socioeconomic status, internet access, and IGD. Pawan Taechoyotin et al support the findings.12 Time spent on games was significantly associated with IGD. A study done in Thailand supports the findings. If the games are played in controlled duration, it has a positive effect on learning process, motivation, memory formation and gives rise to happiness in those who play game. However, excessive internet gaming activity may develop into IGD.17 Types of gamers were also significantly associated with IGD. A similar study conducted in 2016 by Gaetan et al showed that compared to irregular gamers, regular gamers have IGD and express their emotions less, and have difficulty being emotionally reactive.18 Types of games were also significantly associated with IGD. This study shows that respondent who play action games were more likely to have a prevalence of IGD, this might be because action games content rely on power, fights, control that will attract the gamers towards the action genre. A study conducted by Bonaire et al in 2019 supports this finding.19 Video games act as a medium for projecting and experiencing one’s emotional life by staging the emotional self and thus giving priority to gaming than other activities.18 Conclusion The present study revealed 7.1% prevalence of IGD among Undergraduate Health sciences students of Pokhara Metropolitan city. We found respondent’s sex, loneliness level at home, number of close friends, types of game played, time spent on a game per day, and type of gamer to be the contributing factors for developing IGD. Therefore, it is very important to focus on these factors to address IGD and its psychological health effects on undergraduate heath sciences students. Acknowledgments We'd like to express our gratitude to the participants in the study for their involvement and all the Undergraduate Health Sciences colleges of Pokhara Metropolitan City, for their support during study. We are grateful to all the faculties of the Department of Public Health, Manmohan Memorial Institute of Health Sciences, Kathmandu, Nepal. References 1. American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders, 5th Ed. Arlington,VA: American Psychiatric Association;2013. Available from: https://doi.org/10.1176/appi.books.9780890425596 2. WHO. Addictive behaviours: Gaming disorder [Internet]. 2020 [cited 2020 Nov 9]. Available from: https://www.who.int/news-room/questions-and- answers/item/addictive-behaviours-gaming-disorder 3. Jo YS, Bhang SY, Choi JS, Lee HK, Lee SY, Kweon YS. Clinical Characteristics of Diagnosis for Internet Gaming Disorder: Comparison of DSM-5 IGD and ICD-11 GD Diagnosis. Journal of clinical medicine.2019;8(7):945. Available from: https://doi.org/10.3390/jcm8070945 https://doi.org/10.1176/appi.books.9780890425596 https://www.who.int/news-room/questions-and-answers/item/addictive-behaviours-gaming-disorder https://www.who.int/news-room/questions-and-answers/item/addictive-behaviours-gaming-disorder https://doi.org/10.3390/jcm8070945 Shahi et al. Internet Gaming Disorder among Undergraduate Health Sciences Students in the Pokhara Valley: a Cross-Sectional Study 124 4. American Psychiatric Association. Update to DSM-5 Criteria, Text, and ICD-10 Codes [Internet]. [cited 2020 Aug 10]. Available from: https://www.psychiatry.org/psychiatrists/practice/ds m/updates-to-dsm-5 5. Newzoo. The Global Games Market 2016 | Per Region & Segment [Internet]. Newzoo. 2016 Apr 21 [cited 2020 Aug 10]. Available from: https://newzoo.com/insights/articles/global-games- market-reaches-99-6-billion-2016-mobile-generating- 37/ 6. Mihara S, Higuchi S. Cross-sectional and longitudinal epidemiological studies of Internet gaming disorder: A systematic review of the literature. Psychiatry Clin Neurosci. 2017 Jul;71(7):425–44. Available from: https://doi.org/10.1111/pcn.12532 7. Hashemian A, Direkvand-Moghadam A, Delpisheh A, Direkvand-Moghadam A. Prevalence of internet addiction among university students in Ilam: a cross- sectional study. International Journal of Epidemiologic Research [Internet]. 2014 Dec 1 [cited 2020 Sep 28];1(1):9–15. Available from: http://ijer.skums.ac.ir/article_8671.html 8. Chaulagain A, Kunwar A, Watts S, Guerrero APS, Skokauskas N. Child and adolescent mental health problems in Nepal: a scoping review. Int J Ment Health Syst. 2019;13:53. Available from: https://ijmhs.biomedcentral.com/articles/10.1186/s130 33-019-0310-y 9. Marahatta S, Adhikari B, Aryal N, Regmi R.. Internet addiction and associated factors among health sciences students in Nepal. J Community Med Health Educ. 2015;5(4):6-10. Available from: https://doi.org/10.4172/2161-0711.1000362 10. Karmacharya I, Bhujel K, Yadav DK, Subedi K. Prevalence of Internet Addiction among Higher Secondary Level Students in Kathmandu District. Journal of Health and Allied Sciences [Internet]. 2018 [cited 2020 Aug 9];7(1):40-6. Available from: https://www.jhas.org.np/jhas/index.php/jhas/article/v iew/21 11. Undavalli VK, Rani GS, Kumar JR. Prevalence of internet gaming disorder in India: a technological hazard among adolescents. 2020. 2020;7(2):6. International Journal Of Community Medicine And Public Health. 2020 Feb;7(2):688-93. Available from: https://dx.doi.org/10.18203/2394-6040.ijcmph20200450 12. Taechoyotin P, Tongrod P, Thaweerungruangkul T, Towattananon N, Teekapakvisit P, Aksornpusitpong C, et al. Prevalence and associated factors of internet gaming disorder among secondary school students in rural community, Thailand: a cross-sectional study. BMC Res Notes [Internet]. 2020 [cited 2020 Sep 22];13(1):11. Available from: https://doi.org/10.1186/s13104-019-4862-3 13. Majumdar A. Japan plans “fasting camps” for Web- addicted children- Technology News, Firstpost [Internet]. 2013 Aug 27 [cited 2020 Aug 9]. Available from: https://www.firstpost.com/tech/news- analysis/japan-plans-fasting-camps-for-web- addicted-children-3635073.html 14. Lemmens JS, Valkenburg PM, Peter J. Development and Validation of a Game Addiction Scale for Adolescents. Media Psychology [Internet]. 2009 Feb 26 [cited 2020 Aug 11];12(1):77-95. Available from: https://doi.org/10.1080/15213260802669458 15. Spilkova J, Chomynova P, Csemy L. Predictors of excessive use of social media and excessive online gaming in Czech teenagers. J Behav Addict. 2017 Dec 1;6(4):611-9. Available from: https://doi.org/10.1556/2006.6.2017.064 16. VAN Rooij AJ, Kuss DJ, Griffiths MD, Shorter GW, Schoenmakers MT, D VDM. The (co-)occurrence of problematic video gaming, substance use, and psychosocial problems in adolescents. J Behav Addict. 2014;3(3):157-65. Available from: https://doi.org/10.1556/jba.3.2014.013 17. Blum K, Thanos PK, Oscar-Berman M, Febo M, Baron D, Badgaiyan RD, et al. Dopamine in the Brain: Hypothesizing Surfeit or Deficit Links to Reward and Addiction. J Reward Defic Syndr [Internet]. 2015 [cited 2021 Mar 22];1(3):95–104. Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4936 401/ 18. Gaetan S, Bréjard V, Bonnet A. Video Games in Adolescence and Emotional Functioning: Emotion Regulation, Emotion Intensity, Emotion Expression, and Alexithymia. Computers in Human Behavior. 2016 Aug 1;61:344-9. Available from: https://doi.org/10.1016/j.chb.2016.03.027 https://www.psychiatry.org/psychiatrists/practice/dsm/updates-to-dsm-5 https://www.psychiatry.org/psychiatrists/practice/dsm/updates-to-dsm-5 https://newzoo.com/insights/articles/global-games-market-reaches-99-6-billion-2016-mobile-generating-37/ https://newzoo.com/insights/articles/global-games-market-reaches-99-6-billion-2016-mobile-generating-37/ https://newzoo.com/insights/articles/global-games-market-reaches-99-6-billion-2016-mobile-generating-37/ https://doi.org/10.1111/pcn.12532 http://ijer.skums.ac.ir/article_8671.html https://ijmhs.biomedcentral.com/articles/10.1186/s13033-019-0310-y https://ijmhs.biomedcentral.com/articles/10.1186/s13033-019-0310-y https://doi.org/10.4172/2161-0711.1000362 https://www.jhas.org.np/jhas/index.php/jhas/article/view/21 https://www.jhas.org.np/jhas/index.php/jhas/article/view/21 https://dx.doi.org/10.18203/2394-6040.ijcmph20200450 https://doi.org/10.1186/s13104-019-4862-3 https://www.firstpost.com/tech/news-analysis/japan-plans-fasting-camps-for-web-addicted-children-3635073.html https://www.firstpost.com/tech/news-analysis/japan-plans-fasting-camps-for-web-addicted-children-3635073.html https://www.firstpost.com/tech/news-analysis/japan-plans-fasting-camps-for-web-addicted-children-3635073.html https://doi.org/10.1080/15213260802669458 https://doi.org/10.1556/2006.6.2017.064 https://doi.org/10.1556/jba.3.2014.013 https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4936401/ https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4936401/ https://doi.org/10.1016/j.chb.2016.03.027 Shahi et al. Internet Gaming Disorder among Undergraduate Health Sciences Students in the Pokhara Valley: a Cross-Sectional Study 125 19. Bonnaire C, Baptista D. Internet gaming disorder in male and female young adults: The role of alexithymia, depression, anxiety and gaming type. Psychiatry Res. 2019;272:521-30. Available from: https://doi.org/10.1016/j.psychres.2018.12.158 - 20. Shrestha MV, Shrestha N, Sharma SC, Joshi SK. Gaming Disorder among Medical College Students during COVID-19 Pandemic Lockdown. Kathmandu University medical journal (KUMJ). 2020;18(70):48-52. Available from: https://doi.org/10.3126/kumj.v18i2.32956 21. Ferreira F, Jolliffe DM, Prydz EB. The international poverty line has just been raised to $1.90 a day, but global poverty is basically unchanged. How is that even possible? [Internet]. Let’s Talk Development, World Bank Blogs. 2015 Oct 4 [Cited 2022 Mar 3]. Available from: https://blogs.worldbank.org/developmenttalk/interna tional-poverty-line-has-just-been-raised-190-day- global-poverty-basically-unchanged-how-even 22. Choo H, Gentile DA, Sim T, Li D, Khoo A, Liau AK. Pathological video-gaming among Singaporean youth. Annals of the Academy of Medicine, Singapore. 2010;39(11):822-9. Available from: http://hdl.handle.net/10497/16240 23. Saunders JB, Hao W, Long J, King DL, Mann K, Fauth- Bühler M, et al. Gaming disorder: Its delineation as an important condition for diagnosis, management, and prevention. J Behav Addict. 2017;6(3):271-9. Available from: https://doi.org/10.1556/2006.6.2017.039 24. Dejan S, Ana D, Pal Singh BY, et al. Assessing the symptoms of Internet Gaming Disorder among college/university students: An international validation study of a self-report. Psihologija. 2020;53:43-63. Available from: https://doi.org/10.2298/PSI190421015S 25. Anderson CA, Shibuya A, Ihori N, Swing EL, Bushman BJ, Sakamoto A, et al. Violent video game effects on aggression, empathy, and prosocial behavior in eastern and western countries: a meta- analytic review. Psychological bulletin. 2010;136(2):151-73. Available from: https://doi.org/10.1037/a0018251 26. Petry NM, Rehbein F, Gentile DA, Lemmens JS, Rumpf HJ, Mößle T, et al. An international consensus for assessing internet gaming disorder using the new DSM-5 approach. Addiction (Abingdon, England). 2014;109(9):1399-406. Available from: https://doi.org/10.1111/add.12457 https://doi.org/10.1016/j.psychres.2018.12.158 https://www.google.com/search?q=Bonnaire+C%2C+Baptista+D.+Internet+gaming+disorder+in+male+and+female+young+adults%3A+The+role+of+alexithymia%2C+depression%2C+anxiety+and+gaming+type.+Psychiatry+Res.+2019%3B272%3A521-30.&rlz=1C1CHBD_enNP890NP890&oq=Bonnaire+C%2C+Baptista+D.+Internet+gaming+disorder+in+male+and+female+young+adults%3A+The+role+of+alexithymia%2C+depression%2C+anxiety+and+gaming+type.+Psychiatry+Res.+2019%3B272%3A521-30.&aqs=chrome..69i57.1609j0j7&sourceid=chrome&ie=UTF-8 https://doi.org/10.3126/kumj.v18i2.32956 https://blogs.worldbank.org/developmenttalk/international-poverty-line-has-just-been-raised-190-day-global-poverty-basically-unchanged-how-even https://blogs.worldbank.org/developmenttalk/international-poverty-line-has-just-been-raised-190-day-global-poverty-basically-unchanged-how-even https://blogs.worldbank.org/developmenttalk/international-poverty-line-has-just-been-raised-190-day-global-poverty-basically-unchanged-how-even http://hdl.handle.net/10497/16240 https://doi.org/10.1556/2006.6.2017.039 https://doi.org/10.2298/PSI190421015S https://doi.org/10.1037/a0018251 https://doi.org/10.1111/add.12457