April 12, 2024 • 14 mins
Today we delve into the realm of gaming disorders, with a particular focus on the physically associated symptoms. We are thrilled to have Dr. Daniel Stjepanovic from the University of Queensland as our guest. Dr. Stjepanovic has recently published a paper titled 'Extended Hours of Video Gameplay and Negative Physical Symptoms and Pain' in Computers in Human and Behaviour.
This episode stands out as a Journal Club episode, as we shed light on the essentials of Dr. Stepanovic's paper. His research, part of the International Gaming Study 2022, looks at the implications of gaming disorder's recent classification as a diagnosable condition by WHO. The study focusses on the physical harm or discomfort associated with video gaming, a domain seldom touched upon in comparison to the social, emotional, and mental well-being.
The research methodology involved disseminating a comprehensive survey to regular video gamers, with the threshold for "regular" set as at least three hours a week. The concentration was on symptoms like eye fatigue, wrist or hand pain, back or neck pain, and general problems like headaches and muscle aches. Outcomes highlighted age or gender displaying no significant difference. However, a noticeable dose-response connection was observed where players who indulged in continuous gaming for at least three hours signposted significantly increased odds of physical discomfort.
As we continue discussing the evolving field of gaming disorder, we also touch upon the budding genre of esports and its potential translation into an actual career. With this in consideration, we further delve into the difference between aspiring professional players and those diagnosed with internet gaming disorder, in terms of the rate of physical injuries.
Lastly, we recount the chief physical injuries as reported in the survey, which include eye fatigue, wrist or hand pain, back or neck pain, and general physical problems like headaches and muscle aches. The episode ends on an open-ended note, awaiting more organized structure and research in the gaming disorder space, hinting at the probability of witnessing a future where generalized practicing encompasses sub-specialties like 'esports physicians'. Feel free to check out The National Center for Youth Substance Use Research at the University of Queensland's website for more information and findings on the subject.
https://www.sciencedirect.com/science/article/pii/S0747563224000499?via%3Dihub
Mark as Played
Transcript
Episode Transcript
Available transcripts are automatically generated. Complete accuracy is not guaranteed.
(00:00):
Hello and welcome to another episode of Be An Awesome GP.
Today we are going to be taking a deep dive into gaming disorders,
particularly physically associated symptoms in gaming disorders.
I am just stoked that we have Dr. Daniel Stepanovic here on the podcast with us today.
He is from the University of Queensland and he has just recently published a
(00:21):
paper, Extended Hours of Video Gameplay and Negative Physical Symptoms and Pain
in Computers in Human and behaviour.
Daniel, thank you for taking the time to be here with us. It's my pleasure, Chris.
Before I start, we are recording here on the traditional lands of the Dharawal
people. I pay my respects to elders past, present and emerging.
(00:44):
And this is going to be more of a journal club type episode.
And we're going to be looking at Dan's paper.
So Dan, do you want to just give us, I know I'm asking a lot,
but a very brief overview of what your paper was, and then we'll drill down into the specifics.
Sure, so this paper is one of several that we currently have in the pipeline,
as a result of the project that we've been calling the International Gaming Study 2022, or IGS 2022.
(01:10):
The impetus behind it was really the inclusion of gaming disorder as a diagnosable
condition within the WHO's International Classification of Diseases,
when that was updated a few years ago.
So we created a large survey that we disseminated to to individuals who play video games regularly.
So for our purpose, regularly really just meant three hours a week.
(01:34):
To my mind, that seemed like a low bar, because when I picture someone who's
an avid gamer, I think of them a lot more time than three hours,
but that gives us a bit of range in terms of how many hours individuals actually play.
For this particular paper, we were interested in symptoms of physical harm or
pain and discomfort. comfort.
So that's something that's not really focused on in this literature quite a lot.
(01:56):
There was a lot more focus on the social, emotional, and mental well-being,
but not as much on physical.
And for this particular paper, what we did was ask individuals if they had experienced
certain symptoms in the preceding 12 months.
Specifically, we looked at eye fatigue, wrist or hand pain, back or neck pain,
or physical problems more generally, so headaches, muscle aches, and so on.
(02:21):
And what came out of it, some of it was surprising, so we didn't really see
any differences in terms of age or gender. What we did see is somewhat of a dose response.
Some individuals who played less than three hours did not report increased odds
of these symptoms, but those who did report at least three hours of continuous
play did report significantly increased odds of experiencing all of the physical symptoms,
(02:48):
and that stayed reasonably consistent for those who reported playing for six hours continuously.
I was actually really excited when I saw this paper because This whole area
of gaming disorder, screen disorder, it's an area where it's not traditional
work of the medical field, perhaps.
It's a new evolving field, both in the mental aspect as well as the physical aspect.
(03:12):
There are people now whose primary income comes from esports teams or gaming.
There's no such thing as an esports physician, but I do wonder if that's something
that's coming down the pipeline. But for the moment, general practice is there to help.
So i i enjoyed reading his study and it was basically gamers so it was it was targeted,
(03:32):
gamers only and we can get into the numbers on
gaming disorder later in the paper they're
slightly higher than the general population that's because it's a gaming catchment
rather than a general population catchment that's right so i guess the first
question we always ask is you know we we break down the journal article but
then we also ask what can we as clinicians take away from this to help our patients
and i think there is some good things there around around recommending healthy screen time,
(03:58):
around recommending ergonomics and how much time people should spend if they
want to avoid the common physical injuries.
Just recap those physical injuries for us if you'd be okay with that,
just the common ones that were found in the study.
Sure. So these were self-report. Being a survey, unfortunately,
we can't really measure anything directly.
(04:19):
So we asked very simply in the last 12 months, yes or no, So have you experienced these symptoms?
And they were eye fatigue, how well did the participant understand that wrist or hand pain?
So either of those, back or neck pain.
And then physical problems where we gave the specifiers of, for example,
(04:41):
headache, muscle aches, allowing the person to essentially read into that anything
else that they want that wasn't the previous categories.
And I have to look around, and although this was a cross-sectional survey,
and we appreciate taking it with a grain of salt because of that,
there's not a lot of higher-tier evidence, so this is actually a really interesting paper.
So we do take that with a grain of salt, but it's an interesting paper.
(05:05):
Now, are you a gamer yourself? Do you have a gaming interest, or are you not a gamer?
I keep thinking that I am, so I buy all the things and then don't really use them that much.
I have a Nintendo Switch that comes out very casually, But beyond that, really, no.
It seems to be something that's been relegated to my childhood.
(05:27):
And I think a lot of our audience would relate to that. I remember,
you know, I had to give up any form of gaming to get through med school.
There just wasn't time. I remember sitting in the study lab and watching someone
play League of Legends or Dota when they should have been studying in the med study labs.
And I just thought, that guy's been there for four hours.
It really is. and we're seeing more
(05:48):
and more the potential for addiction it really is an
interesting evolving field now your
study talked about people who intend to make their careers as gamers and this
is again something we we're encountering a little more as clinicians where you
know there's not a huge esports industry in its day there is some it's obviously
more focused around south korea the americas that said talk to me about that subset that had.
(06:13):
The intention to make a career as gamers because there was an interesting difference
between them versus the people who had internet gaming disorder and the rate of physical injury,
yeah that's right so i guess just
to take a step back the reason we're more interested in esports players i went
to two camps one was that we thought okay they may play more hours per week
(06:34):
or more intensely than your average gamer so if they're not negative symptoms
associated associated with video game play, they should be borne out in esports players.
The other is that aspiring to become a professional player shouldn't necessarily
be apologised any more than wanting to become a professional athlete.
And we know from people who are seeking to become professional athletes,
(06:58):
you do see more injuries and harm in those who are training to become an athlete
than the general population.
So we did want to know more about esports players for that reason,
to try and avoid over-pathologizing something that could be a valid career goal.
Although, as you say, not a lot of activity here in Australia compared to other
(07:20):
continents. continents.
So what we did see is a larger proportion of those who wanted to become professional
players experienced harm than those who did not want to become professional
players, so the percentage was higher.
But when we put this into a regression model to try and predict harm,
(07:41):
this didn't meet our strict statistical cutoff, so
wanting to be a professional player was not
predictive of experiencing harm there's a
few reasons that may have happened one is
we don't we didn't have a large proportion of individuals who wanted to become
professional players the way that the question was worded also meant that those
(08:05):
who are currently professional players so they've been in a league they've competed
they would answer no to that question because they're not aspiring to, they are.
And then the third one that jumps out is of course that if you are serious about
this, you will buy the ergonomic chair, you will have the ergonomic mouth.
You will have the wrist support to try and potentially minimize any of these symptoms.
(08:28):
Or you are playing and training in ways that reduce this, similar to an athlete.
I hadn't considered that aspect. That would be protected.
Perspective so i refer a
couple of like if someone comes in and they're intending to
become an esports gamer and i don't see that many
it's still relatively one of the things that happens when they get referred
(08:52):
to a psychologist is they just tell them look look up the statistics yourself
on what the success rate is for esports gamers because yes there is the person
who makes a million dollars playing esports but the actual you know conversion rate is very slim.
It's very slim and that's something my patients come back and tell me sometimes.
I was talking to a few people. There's no actual e-sports guidelines.
(09:18):
I did find a paper about e-sports that was written by an orthopedic doctor from
America, but there's no special interest group in the sports medicine college
and no special interest group in the RACGP.
And I think there actually would be a space for gaming disorder and internet
gaming disorder and e-sports in the RACGP's special interest group. room.
(09:41):
Are there particular groups that you get involved with with researchers and
particular bodies that you're commonly working with in terms of this space?
Not in particular when it comes to work on gaming disorder.
So we have a few colleagues who have advised WHO in the development of the gaming
(10:01):
disorder diagnostic definition.
But in terms of groups, there is, at least in australia there is a lack of existing
structures so there aren't societies dedicated to,
video gaming or gaming disorder research there aren't dedicated treatment centers,
(10:22):
so these are still i think in the early days which could be because it wasn't
that it was difficult to diagnose without a proper um diagnostic definition as there is one now in icd.
But i think the the strongest interest
we've seen has been for our parents of younger kids
(10:43):
the parents are driving it there is
a lot of community concern around video gaming but it just doesn't got formal
structure yet interesting because a lot of the i guess a lot of the treatment
would not be something that is is too novel to us here in general practice you
know treating Carpal Tunnel Syndrome or repetitive stress injuries is not that
(11:05):
different to our regular day,
our regular consulting in our rooms.
And it is also interesting you mentioned the parents because from the addiction
side of things, the thing that really helps the kids with internet gaming disorder,
it seems to be the parental involvement
in the relatively extensive psychotherapy they have to undertake.
(11:26):
So watch this space, I guess, is a good thing to say let's
talk about let's talk about the um study
participants because in the study there's about 17.9 percent of the study met
the threshold for internet gaming disorder based on the questionnaire in the
population we see about three to four percent in the last study i saw obviously
this was a subset of gamers so that that skews it but it was a higher percentage
(11:49):
than than I had expected.
Yeah. Over 20% pretending to be a professional player. Yeah.
So, I mean, the 20% jumps out as very high because, as you say,
it's a very low percentage,
very low percentage of those who actually have a good crack at it will be able
(12:12):
to support themselves let alone make it really big.
That said, the intention to do something is quite divorced from behaviour.
I've been intending to exercise more regularly for the last four months and
that hasn't translated into behaviour quite as well as I would have hoped.
(12:32):
So it's difficult difficult to know just with the way that this question was
worded what that actually means to the participants who completed this study.
We are about to roll out the next version of the survey and there we intend
to ask a little bit more specific questions.
We focus eSports specifically on those who want to become gamers.
(12:55):
But as you noted, there are other ways to make a living from video gaming where
you don't have to be particularly good at playing a game.
You can be engaging Twitch streamer. You can have a YouTube channel.
You can be involved in gaming without the actual play being the necessary focus of it.
And those could all be career aspirations for someone who does game.
(13:17):
So I think it would be important to tease that 21.7% apart.
Some of those could be people who do have aspirations, but being professional
could just be playing in a tournament. They're not going to make a league.
Or it could be that kind of lumping in other forms of income that aren't necessarily
gaming itself, but are related to it.
(13:37):
In terms of the 17.9% for IGD-10 cutoff, when we look at enriched samples,
that number isn't too different.
It varies a fair amount from population to population.
But when you focus on gamers, the numbers are around 17, 20, 15%. Interesting.
So I guess if people were wanting to
(14:00):
keep an eye out for what's coming out from you guys review i'm not sure
if you want people to be driven to this study recruitment and
the participant recruitment is there anything people should keep an eye
out for or i'm not sure
how you recruit participants for this upcoming studies but is there anything
you wanted to mention i mean if anyone's interested in the work we're doing
in this space they could have a look at the website of the national center for
(14:22):
youth substance use research at the university of queensland we have our projects
listed there The main focus is substance use in young people,
but we also have, as you've seen here, branched into behavioural addictions,
and we do update findings as they come out on there, as well as the university's news.
(14:42):
Alright, well, I do love a good Journal Club article.
We don't get to do it as much as we'd like, but you have a great day.
Thank you for your time, and I'm going to go get some lunch.
My pleasure. Have a good lunch.
Hello and welcome to another episode of Be An Awesome GP.
Today we are going to be taking a deep dive into gaming disorders,
particularly physically associated symptoms in gaming disorders.
I am just stoked that we have Dr. Daniel Stepanovic here on the podcast with us today.
He is from the University of Queensland and he has just recently published a
(00:21):
paper, Extended Hours of Video Gameplay and Negative Physical Symptoms and Pain
in Computers in Human and behaviour.
Daniel, thank you for taking the time to be here with us. It's my pleasure, Chris.
Before I start, we are recording here on the traditional lands of the Dharawal
people. I pay my respects to elders past, present and emerging.
(00:44):
And this is going to be more of a journal club type episode.
And we're going to be looking at Dan's paper.
So Dan, do you want to just give us, I know I'm asking a lot,
but a very brief overview of what your paper was, and then we'll drill down into the specifics.
Sure, so this paper is one of several that we currently have in the pipeline,
as a result of the project that we've been calling the International Gaming Study 2022, or IGS 2022.
(01:10):
The impetus behind it was really the inclusion of gaming disorder as a diagnosable
condition within the WHO's International Classification of Diseases,
when that was updated a few years ago.
So we created a large survey that we disseminated to to individuals who play video games regularly.
So for our purpose, regularly really just meant three hours a week.
(01:34):
To my mind, that seemed like a low bar, because when I picture someone who's
an avid gamer, I think of them a lot more time than three hours,
but that gives us a bit of range in terms of how many hours individuals actually play.
For this particular paper, we were interested in symptoms of physical harm or
pain and discomfort. comfort.
So that's something that's not really focused on in this literature quite a lot.
(01:56):
There was a lot more focus on the social, emotional, and mental well-being,
but not as much on physical.
And for this particular paper, what we did was ask individuals if they had experienced
certain symptoms in the preceding 12 months.
Specifically, we looked at eye fatigue, wrist or hand pain, back or neck pain,
or physical problems more generally, so headaches, muscle aches, and so on.
(02:21):
And what came out of it, some of it was surprising, so we didn't really see
any differences in terms of age or gender. What we did see is somewhat of a dose response.
Some individuals who played less than three hours did not report increased odds
of these symptoms, but those who did report at least three hours of continuous
play did report significantly increased odds of experiencing all of the physical symptoms,
(02:48):
and that stayed reasonably consistent for those who reported playing for six hours continuously.
I was actually really excited when I saw this paper because This whole area
of gaming disorder, screen disorder, it's an area where it's not traditional
work of the medical field, perhaps.
It's a new evolving field, both in the mental aspect as well as the physical aspect.
(03:12):
There are people now whose primary income comes from esports teams or gaming.
There's no such thing as an esports physician, but I do wonder if that's something
that's coming down the pipeline. But for the moment, general practice is there to help.
So i i enjoyed reading his study and it was basically gamers so it was it was targeted,
(03:32):
gamers only and we can get into the numbers on
gaming disorder later in the paper they're
slightly higher than the general population that's because it's a gaming catchment
rather than a general population catchment that's right so i guess the first
question we always ask is you know we we break down the journal article but
then we also ask what can we as clinicians take away from this to help our patients
and i think there is some good things there around around recommending healthy screen time,
(03:58):
around recommending ergonomics and how much time people should spend if they
want to avoid the common physical injuries.
Just recap those physical injuries for us if you'd be okay with that,
just the common ones that were found in the study.
Sure. So these were self-report. Being a survey, unfortunately,
we can't really measure anything directly.
(04:19):
So we asked very simply in the last 12 months, yes or no, So have you experienced these symptoms?
And they were eye fatigue, how well did the participant understand that wrist or hand pain?
So either of those, back or neck pain.
And then physical problems where we gave the specifiers of, for example,
(04:41):
headache, muscle aches, allowing the person to essentially read into that anything
else that they want that wasn't the previous categories.
And I have to look around, and although this was a cross-sectional survey,
and we appreciate taking it with a grain of salt because of that,
there's not a lot of higher-tier evidence, so this is actually a really interesting paper.
So we do take that with a grain of salt, but it's an interesting paper.
(05:05):
Now, are you a gamer yourself? Do you have a gaming interest, or are you not a gamer?
I keep thinking that I am, so I buy all the things and then don't really use them that much.
I have a Nintendo Switch that comes out very casually, But beyond that, really, no.
It seems to be something that's been relegated to my childhood.
(05:27):
And I think a lot of our audience would relate to that. I remember,
you know, I had to give up any form of gaming to get through med school.
There just wasn't time. I remember sitting in the study lab and watching someone
play League of Legends or Dota when they should have been studying in the med study labs.
And I just thought, that guy's been there for four hours.
It really is. and we're seeing more
(05:48):
and more the potential for addiction it really is an
interesting evolving field now your
study talked about people who intend to make their careers as gamers and this
is again something we we're encountering a little more as clinicians where you
know there's not a huge esports industry in its day there is some it's obviously
more focused around south korea the americas that said talk to me about that subset that had.
(06:13):
The intention to make a career as gamers because there was an interesting difference
between them versus the people who had internet gaming disorder and the rate of physical injury,
yeah that's right so i guess just
to take a step back the reason we're more interested in esports players i went
to two camps one was that we thought okay they may play more hours per week
(06:34):
or more intensely than your average gamer so if they're not negative symptoms
associated associated with video game play, they should be borne out in esports players.
The other is that aspiring to become a professional player shouldn't necessarily
be apologised any more than wanting to become a professional athlete.
And we know from people who are seeking to become professional athletes,
(06:58):
you do see more injuries and harm in those who are training to become an athlete
than the general population.
So we did want to know more about esports players for that reason,
to try and avoid over-pathologizing something that could be a valid career goal.
Although, as you say, not a lot of activity here in Australia compared to other
(07:20):
continents. continents.
So what we did see is a larger proportion of those who wanted to become professional
players experienced harm than those who did not want to become professional
players, so the percentage was higher.
But when we put this into a regression model to try and predict harm,
(07:41):
this didn't meet our strict statistical cutoff, so
wanting to be a professional player was not
predictive of experiencing harm there's a
few reasons that may have happened one is
we don't we didn't have a large proportion of individuals who wanted to become
professional players the way that the question was worded also meant that those
(08:05):
who are currently professional players so they've been in a league they've competed
they would answer no to that question because they're not aspiring to, they are.
And then the third one that jumps out is of course that if you are serious about
this, you will buy the ergonomic chair, you will have the ergonomic mouth.
You will have the wrist support to try and potentially minimize any of these symptoms.
(08:28):
Or you are playing and training in ways that reduce this, similar to an athlete.
I hadn't considered that aspect. That would be protected.
Perspective so i refer a
couple of like if someone comes in and they're intending to
become an esports gamer and i don't see that many
it's still relatively one of the things that happens when they get referred
(08:52):
to a psychologist is they just tell them look look up the statistics yourself
on what the success rate is for esports gamers because yes there is the person
who makes a million dollars playing esports but the actual you know conversion rate is very slim.
It's very slim and that's something my patients come back and tell me sometimes.
I was talking to a few people. There's no actual e-sports guidelines.
(09:18):
I did find a paper about e-sports that was written by an orthopedic doctor from
America, but there's no special interest group in the sports medicine college
and no special interest group in the RACGP.
And I think there actually would be a space for gaming disorder and internet
gaming disorder and e-sports in the RACGP's special interest group. room.
(09:41):
Are there particular groups that you get involved with with researchers and
particular bodies that you're commonly working with in terms of this space?
Not in particular when it comes to work on gaming disorder.
So we have a few colleagues who have advised WHO in the development of the gaming
(10:01):
disorder diagnostic definition.
But in terms of groups, there is, at least in australia there is a lack of existing
structures so there aren't societies dedicated to,
video gaming or gaming disorder research there aren't dedicated treatment centers,
(10:22):
so these are still i think in the early days which could be because it wasn't
that it was difficult to diagnose without a proper um diagnostic definition as there is one now in icd.
But i think the the strongest interest
we've seen has been for our parents of younger kids
(10:43):
the parents are driving it there is
a lot of community concern around video gaming but it just doesn't got formal
structure yet interesting because a lot of the i guess a lot of the treatment
would not be something that is is too novel to us here in general practice you
know treating Carpal Tunnel Syndrome or repetitive stress injuries is not that
(11:05):
different to our regular day,
our regular consulting in our rooms.
And it is also interesting you mentioned the parents because from the addiction
side of things, the thing that really helps the kids with internet gaming disorder,
it seems to be the parental involvement
in the relatively extensive psychotherapy they have to undertake.
(11:26):
So watch this space, I guess, is a good thing to say let's
talk about let's talk about the um study
participants because in the study there's about 17.9 percent of the study met
the threshold for internet gaming disorder based on the questionnaire in the
population we see about three to four percent in the last study i saw obviously
this was a subset of gamers so that that skews it but it was a higher percentage
(11:49):
than than I had expected.
Yeah. Over 20% pretending to be a professional player. Yeah.
So, I mean, the 20% jumps out as very high because, as you say,
it's a very low percentage,
very low percentage of those who actually have a good crack at it will be able
(12:12):
to support themselves let alone make it really big.
That said, the intention to do something is quite divorced from behaviour.
I've been intending to exercise more regularly for the last four months and
that hasn't translated into behaviour quite as well as I would have hoped.
(12:32):
So it's difficult difficult to know just with the way that this question was
worded what that actually means to the participants who completed this study.
We are about to roll out the next version of the survey and there we intend
to ask a little bit more specific questions.
We focus eSports specifically on those who want to become gamers.
(12:55):
But as you noted, there are other ways to make a living from video gaming where
you don't have to be particularly good at playing a game.
You can be engaging Twitch streamer. You can have a YouTube channel.
You can be involved in gaming without the actual play being the necessary focus of it.
And those could all be career aspirations for someone who does game.
(13:17):
So I think it would be important to tease that 21.7% apart.
Some of those could be people who do have aspirations, but being professional
could just be playing in a tournament. They're not going to make a league.
Or it could be that kind of lumping in other forms of income that aren't necessarily
gaming itself, but are related to it.
(13:37):
In terms of the 17.9% for IGD-10 cutoff, when we look at enriched samples,
that number isn't too different.
It varies a fair amount from population to population.
But when you focus on gamers, the numbers are around 17, 20, 15%. Interesting.
So I guess if people were wanting to
(14:00):
keep an eye out for what's coming out from you guys review i'm not sure
if you want people to be driven to this study recruitment and
the participant recruitment is there anything people should keep an eye
out for or i'm not sure
how you recruit participants for this upcoming studies but is there anything
you wanted to mention i mean if anyone's interested in the work we're doing
in this space they could have a look at the website of the national center for
(14:22):
youth substance use research at the university of queensland we have our projects
listed there The main focus is substance use in young people,
but we also have, as you've seen here, branched into behavioural addictions,
and we do update findings as they come out on there, as well as the university's news.
(14:42):
Alright, well, I do love a good Journal Club article.
We don't get to do it as much as we'd like, but you have a great day.
Thank you for your time, and I'm going to go get some lunch.
My pleasure. Have a good lunch.
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