Effects of adolescent online gaming time and motives on depressive, musculoskeletal, and psychosomatic symptoms

Figures & data

Table I. Descriptive statistics for the sample of adolescents aged 13 to 18 years.

	Total n (%)	Boys n (%)	Girls n (%)	Chi-square	P
Age:
13–14	2,745 (35.4)	1,351 (34.9)	1,394 (35.9)
15–16	2,605 (33.6)	1,291 (33.3)	1,314 (33.8)
17–18	2,407 (31.0)	1,230 (31.8)	1,177 (30.3)	2.022	0.364
Ethnicity:
Scandinavian	6,345 (82.8)	3,152 (82.6)	3,193 (83.0)
Non-Scandinavian	1,319 (17.2)	664 (17.4)	655 (17.0)	0.193	0.661
Socio-economic status:
Low	1,150 (15.1)	537 (14.2)	613 (16.1)
Medium	5,637 (74.2)	2,766 (73.1)	2,871 (75.4)
High	805 (10.6)	482 (12.7)	323 (8.5)	38.320	<0.001
Body mass index:
Underweight	211 (2.9)	75 (2.1)	136 (3.8)
Normal weight	6,276 (87.3)	3,084 (85.0)	3,192 (89.6)
Overweight	566 (7.9)	375 (10.3)	191 (5.4)
Obese	138 (1.9)	93 (2.6)	45 (1.3)	95.461	<0.001
Physical activity:
At least once a week	5,944 (79.1)	2,975 (80.2)	2,969 (77.9)
Less than once a week	1,575 (20.9)	735 (19.8)	840 (22.1)	5.704	0.017
Depressive symptom:
No depression	5,883 (75.8)	3,256 (84.1)	2,627 (67.6)
Depression (DSM-IV, A-criterion)	1,874 (24.2)	616 (15.9)	1,258 (32.4)	287.169	<0.001
Musculoskeletal pain:
Few–medium symptoms	6,671 (86.7)	3,473 (90.8)	3,198 (82.7)
Many symptoms	1,022 (13.3)	351 (9.2)	671 (17.3)	111.273	<0.001
Psychosomatic symptoms:
Few–medium symptoms	6,303 (81.8)	3,486 (90.9)	2,817 (72.8)
Many symptoms	1,404 (18.2)	351 (9.1)	1,053 (27.2)	421.874	<0.001
Single player frequency:
Never	2,477 (33.7)	927 (25.3)	1,550 (42.2)
A few times a year	1,290 (17.6)	434 (11.8)	856 (23.3)
Occasionally every month	970 (13.2)	477 (13.0)	493 (13.4)
2–4 times a month	792 (10.8)	455 (12.4)	337 (9.2)
2–3 days a week	990 (13.5)	690 (18.8)	300 (8.2)
4–5 days a week	413 (5.6)	324 (8.8)	89 (2.4)
6–7 days a week	410 (5.6)	359 (9.8)	51 (1.4)	831.304	<0.001
Multiplayer online frequency:
Never	3,884 (52.9)	911 (24.8)	2,973 (80.9)
A few times a year	633 (8.6)	312 (8.5)	321 (8.7)
Occasionally every month	422 (5.7)	288 (7.8)	134 (3.6)
2–4 times a month	362 (4.9)	270 (7.3)	92 (2.5)
2–3 days a week	507 (6.9)	437 (11.9)	70 (1.9)
4–5 days a week	535 (7.3)	500 (13.6)	35 (1.0)
6–7 days a week	1,005 (13.7)	956 (26.0)	49 (1.3)	2726.933	<0.001
Online gaming time on weekdays:
Do not play	3,415 (47.9)	1,107 (31.0)	2,308 (65.0)
Less than one hour	1,306 (18.3)	649 (18.2)	657 (18.5)
1–2 hours	1,042 (14.6)	708 (19.8)	334 (9.4)
>2–5 hours	914 (12.8)	730 (20.4)	184 (5.2)
More than 5 hours	450 (6.3)	381 (10.7)	69 (1.9)	1099.083	<0.001
Online gaming time on weekends:
Do not play	2,438 (34.5)	638 (18.0)	1,800 (51.1)
Less than one hour	1,342 (19.0)	529 (14.9)	813 (23.1)
>2–5 hours	1,217 (17.2)	918 (25.9)	299 (8.5)
More than 5 hours	766 (10.8)	684 (19.3)	82 (2.3)	1451.883	<0.001
Fun/Social motives to play:
Medium–high Fun/Social	2,915 (68.2)	2,345 (81.5)	570 (40.9)
Low Fun/Social	1,357 (31.8)	534 (18.5)	823 (59.1)	711.579	0.240
Demand/Status motives to play:
Low–medium Demand/Status	3,282 (79.0)	2,107 (74.3)	1,175 (89.4)
High Demand/Status	870 (21.0)	730 (25.7)	140 (10.6)	123.446	<0.001
Escape motives to play:
Low–medium Escape	3,207 (77.2)	2,122 (74.9)	1,085 (82.3)
High Escape	945 (22.8)	712 (25.1)	233 (17.7)	28.366	<0.001

Table II. Spearman’s rho correlations between study variables.

Factors	1	2^a	3^a	4	5	6	7	8	9	10	11	12	13	14	15	16
1. Age groups	1	–0.015 ns	0.033**	–0.083***	0.193***	0.055***	–0.095***	–0.056***	0.128***	–0.136***	0.032*	–0.041**	0.024ns	0.055***	0.041***	0.071***
2. Sex^a		1	0.005 ns	–0.065***	–0.115***	0.028*	–0.304***	–0.604***	–0.389***	–0.449***	–0.447***	–0.317***	–0.125***	0.238***	0.174***	0.345***
3. Parents’ country of birth^a			1	–0.062***	–0.008 ns	0.023*	–0.011 ns	–0.023 ns	–0.014 ns	0.001 ns	–0.028ns	–0.003ns	–0.035*	0.058***	0.027*	0.013ns
4. Socio-economic status				1	–0.066***	–0.120***	0.000 ns	0.050***	–0.005 ns	0.034**	0.045**	–0.003 ns	–0.113***	–0.159***	–0.096***	–0.170***
5. Body mass index					1	0.017 ns	0.048***	0.080***	0.116***	0.055***	0.049**	0.057***	0.072***	0.038***	0.026*	–0.001 ns
6. Physical activity						1	0.019 ns	0.016 ns	0.082***	0.043***	–0.011 ns	0.022 ns	0.121***	0.107***	0.010 ns	0.112***
7. Single player frequency							1	0.349***	0.257***	0.349***	0.171***	0.106***	0.121***	–0.059***	–0.028*	–0.103***
8. Multiplayer online frequency								1	0.598***	0.689***	0.565***	0.379***	0.248***	–0.101***	–0.085***	–0.170***
9. Online gaming time weekdays									1	0.713***	0.415***	0.339***	0.284***	0.053***	0.021 ns	–0.013 ns
10. Online gaming time weekends										1	0.501***	0.365***	0.273***	–0.034**	–0.049***	–0.096***
11. Fun/Social, gaming motive index											1	0.556***	0.410***	–0.048**	–0.052***	–0.120***
12. Demand/Status, gaming motive index												1	0.631***	0.144***	0.073***	0.043**
13. Escape, gaming motive index													1	0.293***	0.159***	0.210***
14. Depressive symptoms														1	0.365***	0.575***
15. Musculoskeletal symptoms index															1	0.466***
16. Psychosomatic symptoms index																1

^aCramer’s V was used for nominal data.

*P ≤ 0.05 level (2-tailed).

**P ≤ 0.01 level (2-tailed).

***P ≤ 0.001 level (2-tailed).

ns = Non-significant.

Table III. Multivariate binary logistic regression analyses of gaming time and motives to play in relation to depressive, musculoskeletal, and psychosomatic symptoms.

	Depressive symptoms (DSM-IV)			Musculoskeletal symptoms			Psychosomatic symptoms
	OR^a	P	95% CI	OR^a	P	95% CI	OR^a	P	95% CI
Single player frequency	1.013	0.575	(0.967–1.060)	1.030	0.304	(0.974–1.089)	1.003	0.927	(0.950–1.058)
Multiplayer online frequency	0.960	0.164	(0.906–1.017)	0.987	0.707	(0.921–1.057)	0.951	0.134	(0.891–1.016)
Online gaming time on weekdays	1.217	<0.001	(1.106–1.339)	1.173	0.005	(1.048–1.313)	1.326	<0.001	(1.191–1.477)
Online gaming time on weekends	0.911	0.081	(0.821–1.011)	0.960	0.521	(0.847–1.087)	0.895	0.063	(0.797–1.006)
Low Fun/Social motive	1.261	0.040	(1.011–1.572)	0.940	0.650	(0.719–1.229)	1.129	0.331	(0.884–1.443)
High Demand/Status motive	1.758	<0.001	(1.396–2.213)	0.937	0.659	(0.702–1.250)	1.235	0.127	(0.942–1.619)
High Escape motive	3.382	<0.001	(2.723–4.200)	1.960	<0.001	(1.511–2.543)	2.460	<0.001	(1.920–3.152)
	R^2 = 0.212			R^2 = 0.067			R^2 = 0.185

^aOdds ratio; adjusted for sex, age, body mass index, physical activity, parents’ country of birth, and socio-economic status.

Table IV. Binary logistic regression analyses for the motives for playing combined with gaming time on weekdays in relation to depressive, musculoskeletal, and psychosomatic symptoms. The three different motives for playing models are presented in three separate analyses.

	Depressive symptoms			Musculoskeletal symptoms			Psychosomatic symptoms
	%^a	P	OR (95% CI)^b	%^a	P	OR (95% CI)^b	%^a	P	OR (95% CI)^b
Fun/Social motive:
Non-gamers	22.2		1.0	12.3		1.0	17.7		1.0
High–medium Fun/Social, ≤2 h	20.7	<0.001	1.630 (1.338–1.986)	11.8	0.001	1.488 (1.171–1.891)	13.4	<0.001	1.504 (1.197–1.890)
High–medium Fun/Social, >2–5 h	20.1	<0.001	1.661 (1.306–2.112)	13.1	<0.001	1.814 (1.365–2.409)	12.1	0.002	1.582 (1.187–2.110)
High–medium Fun/Social, >5 h	25.1	<0.001	2.501 (1.851–3.399)	12.1	0.001	1.882 (1.280–2.765)	18.6	<0.001	3.075 (2.176–4.345)
Low Fun/Social, ≤2 h	28.7	<0.001	1.491 (1.192–1.865)	12.7	0.543	1.094 (0.819–1.462)	22.5	0.001	1.489 (1.167–1.900)
Low Fun/Social, >2–5 h	39.2	<0.001	2.746 (1.656–4.551)	18.9	0.034	1.927 (1.051–3.532)	29.7	0.001	2.618 (1.515–4.525)
Low Fun/Social, >5 h	44.2	<0.001	3.693 (1.926–7.081)	30.2	<0.001	4.266 (2.147–8.477)	30.2	<0.001	3.576 (1.757–7.277)
			R^2 = 0.123			R^2 = 0.054			R^2 = 0.143
Demand/Status motive:
Non-gamers	22.2		1.0	12.3		1.0	17.7		1.0
Low–medium Demand/Status, ≤ 2 h	21.2	<0.001	1.381 (1.159–1.646)	12.4	0.009	1.326 (1.074–1.637)	16.7	<0.001	1.512 (1.248–1.832)
Low–medium Demand/Status, >2–5 h	18.6	0.006	1.434 (1.106–1.859)	13.2	<0.001	1.693 (1.259–2.275)	12.6	0.007	1.510 (1.120–2.038)
Low–medium Demand/Status, >5 h	23.5	0.003	1.882 (1.246–2.843)	13.6	0.015	1.830 (1.126–2.976)	16.7	0.002	2.133 (1.334–3.412)
High Demand/Status, ≤2 h	32.6	<0.001	3.749 (2.724–5.158)	9.8	0.323	1.263 (0.795–2.006)	14.4	0.002	1.907 (1.263–2.880)
High Demand/Status, >2–5 h	32.1	<0.001	3.773 (2.639–5.396)	14.3	0.002	2.027 (1.288–3.191)	16.8	<0.001	2.569 (1.655–3.986)
High Demand/Status, >5 h	31.0	<0.001	3.930 (2.756–5.606)	14.2	<0.001	2.281 (1.460–3.564)	23.5	<0.001	4.617 (3.115–6.843)
			R^2 = 0.140			R^2 = 0.053			R^2 = 0.146
Escape motive:
Non-gamers	22.2		1.0	12.3		1.0	17.7		1.0
Low–medium Escape, ≤2 h	18.4	0.056	1.196 (0.995–1.437)	10.6	0.217	1.151 (0.921–1.440)	14.0	0.018	1.278 (1.043–1.566)
Low–medium Escape, >2–5 h	14.7	0.294	1.164 (0.887–1.544)	10.7	0.035	1.418 (1.025–1.961)	9.4	0.315	1.190 (0.848–1.669)
Low–medium Escape, >5 h	18.1	0.077	1.472 (0.958–2.262)	11.9	0.040	1.674 (1.025–2.734)	15.8	<0.001	2.340 (1.481–3.698)
High Escape, ≤2 h	42.9	<0.001	4.264 (3.224–5.641)	18.0	<0.001	2.079 (1.481–2.920)	27.1	<0.001	3.107 (2.269–4.254)
High Escape, >2–5 h	39.9	<0.001	4.165 (3.020–5.744)	20.2	<0.001	2.695 (1.851–3.923)	24.4	<0.001	3.266 (2.259–4.723)
High Escape, >5 h	37.3	<0.001	4.614 (3.230–6.590)	16.1	<0.001	2.494 (1.598–3.892)	25.0	<0.001	4.437 (2.966–6.637)
			R^2 = 0.156			R^2 = 0.058			R^2 = 0.156

^aPercentages within each subgroup within each model with depressive symptoms, many musculoskeletal symptoms, and many psychosomatic symptoms.

^bOdds ratio; adjusted for sex, age, body mass index, physical activity, parents’ country of birth, and socio-economic status.

Table V. Binary logistic regression analyses for the motives for playing combined with gaming time on weekends in relation to depressive, musculoskeletal, and psychosomatic symptoms. The three different motives for playing models are presented in three separate analyses.

	Depressive symptoms			Musculoskeletal symptoms			Psychosomatic symptoms
	%^a	P	OR (95% CI)^b	%^a	P	OR (95% CI)^b	%^a	P	OR (95% CI)^b
Fun/Social motive:
Non-gamers	27.5		1.0	14.7		1.0	22.3		1.0
High–medium Fun/Social, ≤ 2 h	19.2	0.181	1.154 (0.935–1.425)	10.9	0.344	1.134 (0.874–1.470)	12.2	0.868	0.979 (0.767–1.251)
High–medium Fun/Social, >2–5 h	14.3	0.562	0.930 (0.728–1.188)	9.8	0.347	1.151 (0.858–1.544)	11.1	0.318	1.151 (0.874–1.517)
High–medium Fun/Social, > 5 h	24.9	<0.001	1.947 (1.520–2.494)	13.9	<0.001	1.832 (1.352–2.483)	15.2	<0.001	1.842 (1.372–2.473)
Low Fun/Social, ≤ 2 h	24.1	0.851	1.020 (0.829–1.255)	12.1	0.638	0.939 (0.721–1.222)	18.8	0.676	0.953 (0.759–1.196)
Low Fun/Social, >2–5 h	30.0	0.037	1.546 (1.027–2.328)	12.3	0.884	1.042 (0.602–1.803)	21.5	0.169	1.381 (0.872–2.189)
Low Fun/Social, > 5 h	37.8	0.016	2.245 (1.164–4.332)	20.0	0.054	2.119 (0.986–4.552)	24.4	0.069	1.998 (0.948–4.211)
			R^2 = 0.115			R^2 = 0.050			R^2 = 0.139
Demand/Status motive:
Non-gamers	27.5		1.0	14.7		1.0	22.3		1.0
Low–medium Demand/Status, ≤ 2 h	18.8	0.518	0.942 (0.788–1.128)	10.7	0.684	0.955 (0.765–1.192)	14.4	0.350	0.910 (0.747–1.109)
Low–medium Demand/Status, >2–5 h	16.0	0.949	1.008 (0.791–1.284)	10.4	0.356	1.145 (0.859–1.527)	12.0	0.475	1.104 (0.842–1.448)
Low–medium Demand/Status, > 5 h	19.1	0.076	1.327 (0.971–1.813)	14.2	0.002	1.765 (1.242–2.509)	13.4	0.040	1.457 (1.017–2.088)
High Demand/Status, ≤ 2 h	38.6	<0.001	3.695 (2.654–5.143)	15.1	0.014	1.701 (1.115–2.596)	18.4	0.005	1.795 (1.197–2.690)
High Demand/Status, >2–5 h	18.0	0.029	1.592 (1.049–2.417)	8.4	0.855	1.054 (0.597–1.861)	14.0	0.007	1.903 (1.191–3.042)
High Demand/Status, > 5 h	34.9	<0.001	3.734 (2.749–5.071)	14.1	0.001	1.907 (1.288–2.823)	19.1	<0.001	2.667 (1.853–3.839)
			R^2 = 0.139			R^2 = 0.053			R^2 = 0.144
Escape motive:
Non-gamers	27.8		1.0	14.7		1.0	22.3		1.0
Low–medium Escape, ≤ 2 h	16.9	0.070	0.843 (0.701–1.014)	9.7	0.273	0.880 (0.700–1.106)	12.6	0.039	0.806 (0.656–0.989)
Low–medium Escape, >2–5 h	11.9	0.029	0.743 (0.569–0.969)	8.4	0.668	0.934 (0.682–1.278)	9.8	0.658	0.936 (0.698–1.255)
Low–medium Escape, > 5 h	16.2	0.442	1.138 (0.818–1.583)	11.3	0.068	1.425 (0.974–2.085)	10.2	0.495	1.148 (0.772–1.706)
High Escape, ≤ 2 h	47.5	<0.001	3.955 (2.935–5.330)	19.9	<0.001	1.955 (1.369–2.791)	28.6	<0.001	2.364 (1.698–3.293)
High Escape, >2–5 h	31.7	<0.001	2.534 (1.804–3.559)	16.1	0.004	1.836 (1.211–2.786)	22.0	<0.001	2.315 (1.573–3.406)
High Escape, > 5 h	38.6	<0.001	3.827 (2.842–5.153)	17.9	<0.001	2.346 (1.633–3.371)	23.2	<0.001	2.997 (2.128–4.221)
			R^2 = 0.159			R^2 = 0.060			R^2 = 0.157

^aPercentages within each subgroup within each model with depressive symptoms, many musculoskeletal symptoms, and many psychosomatic symptoms.

^bOdds ratio; adjusted for sex, age, body mass index, physical activity, parents’ country of birth, and socio-economic status.