Original Article

Prevalence and Correlates of Internet Gaming Disorder Among an Advanced Level Student Population from Colombo, Sri Lanka

Minura Manjitha Manchanayake1, Thalpe Guruge Madara Malsirini1, Ashan Manelka Vithanage1, Dushyanthi Jayawardene2

doi: http://dx.doi.org/10.5195/ijms.2022.1193

Volume 10, Number 2: 165-174
Received 31 08 2021: Rev-request 01 10 2021: Rev-request 09 04 2022: Rev-recd 06 10 2021: Rev-recd 11 04 2022: Accepted 12 04 2022



Internet Gaming Disorder (IGD) is rising in many low and middle-income countries owing to the increasing popularity of electronic gaming and technology availability among adolescents. However, the epidemiology of IGD in South Asia remains largely unknown. We aimed to determine IGD's prevalence and associations, including motivations for gaming, among a Sri Lankan school-going population.


A cross-sectional study was conducted among Advanced Level students aged 16-18 attending four Colombo Educational Zone schools. Of the 412 randomly sampled recruits, 395 consenting participants filled a pretested questionnaire exploring gaming habits, motivations, and psychosocial factors. English and Sinhala versions of the Internet Gaming Disorder Scale Short-Form (IGDS9-SF) were used, and IGD was identified if ≥5 items in the scale were endorsed. The Sinhala IGDS9-SF demonstrated acceptable internal consistency reliability, and its factorial validity was affirmed via Confirmatory Factor Analysis.


Among the sample, 81.5% (n=322) were gamers. A majority of these gamers preferred mobile gaming (64.0%) and Multiplayer Battle Royale games (27.0%). The prevalence of IGD was 5.06% (95% CI = 2.90–7.22) and was significantly higher (p<0.05) among males, who constituted 52.4% of the sample. Daily weekday gaming for ≥6h, low involvement in student societies, poor relationship with parents, escape motive, and fantasy motive were positively associated with IGD, and the Competition motive was negatively associated with IGD in multivariable analyses.


The prevalence of IGD was considerably high in our student population and is associated with specific motives, poor parent-child relationships, and low extra-curricular involvement.

Keywords: Internet Gaming Disorder; Addictive Behavior; Motivation; Adolescent Psychiatry; Community Psychiatry (Source: MeSH-NLM).


Electronic gaming is a healthy recreational activity which confers several cognitive, motivational, emotional, and social benefits and is gaining popularity as a source of entertainment among adolescents.1 Pathological gaming, however, is a type of maladaptive behavior and is described as “Internet Gaming Disorder” (IGD) under Section III of the Diagnostic and Statistical Manual of Mental Disorders, 5th Edition (DSM-5), where it is defined as a pattern of persistent and recurrent participation in electronic gaming leading to significant impairment or distress as indicated by five or more of nine core symptoms exhibited over a year. The specified symptoms include pre-occupation with games, withdrawal, tolerance, lack of control, loss of interest in previous hobbies, continued excessive use despite knowledge of psychosocial problems, deception of family members and/or others, use of games to gain relief from negative emotions and jeopardizing important relationships or opportunities due to gaming behavior. The condition was also recognized by the World Health Organization and described as “Gaming Disorder” in the latest International Classification of Diseases (ICD-11).2 Despite its name, IGD applies to both online and offline gaming activity.3 It should be noted that Internet Addiction Disorder (Problematic Internet Use) and IGD are two distinct entities.4,5

IGD is a debilitating condition with consequences spanning the physical, mental, and social aspects of a person's wellbeing.6 Depressive symptoms, lower academic achievement,7 and increased physical aggression are consequences of pathological gaming.8 Other associated comorbid psychopathologies include attention deficit hyperactive disorder, obsessive-compulsive disorder, and anxiety.6,9 Psychosocial issues such as peer problems,10 poor relationship with parents and teachers,11 and low self-esteem12,13 are higher among gamers with IGD. Poor sleep quality and sleep-related problems,14 reduced interest in schoolwork,15,16 and extra-curricular activities are also linked to IGD.17 Gamers with IGD are more likely to prefer massively multiplayer online role-playing games (MMORPGs) and first-person shooter (FPS) games among other genres.18 Case reports suggest that problematic gaming may be associated with a preference for newer genres such as Battle Royale (BR) games as well.19 Increased gaming time15,20,21 and low involvement in sports and exercise22 adds to the risk of developing IGD. Furthermore, the possession of gaming consoles, a powerful internet connection,20 and an earlier age of first playing games are also implicated.23 Gaming motives are important predictors12,24 and mediators of psychopathology in gamers with IGD.25 Seven motives have been identified, namely: escape, fantasy, coping, skill development, recreation, competition and social.26

The global pooled prevalence of IGD is 3.05%,27 and the prevalence rates reported range from 0.21-57.5%.28 IGD is predominantly seen in males and is higher among adults than younger adolescents, although the prevalence decreases with increasing age among adults.29 The prevalence is lower among European populations compared to South-East Asian populations, with rates as low as 1.6% reported from representative European samples17 and as high as 10.1% in South-East Asia.30 The prevalence of IGD was 3.5% in a study done among a sample of 15-19-year-old school-going adolescents31 and 3.6% among a sample of medical students from India.32

The literature pertaining to the psychological aspects of electronic gaming is scarce in the South Asian region. Evidence from Sri Lanka has thus far been limited to case reports such as that done by Chandradasa and Rodrigo in 2017, where IGD was described in four adolescents aged 13-16 years presenting to a Sri Lankan tertiary care hospital.33 In this light, we aim to address this regional evidence gap by investigating the prevalence of IGD in a Sri Lankan school-going adolescent population, using a simple validated screening tool that can be used in native settings. We also aim to describe the role of interindividual and student-specific factors and the role of gaming motivations which have not been adequately explored in the extant literature.


Study Design and Setting

A descriptive cross-sectional study with an analytical component was conducted among four conveniently selected national schools located in Colombo, the commercial capital of Sri Lanka. Being national schools, the students hail from around the country and therefore the population is diverse, and representative of the multi-ethnic demographic of Sri Lanka. Ethics approval was obtained from the Ethics Review Committee of the Faculty of Medicine, the University of Colombo, prior to the recruitment of participants (Reference No. MFC/AL/2016/911).

Sample Size

A sample size of 355 was deemed necessary at a confidence level of 95% and a 5% margin of error for a finite population of 4500 students. An estimated proportion of 50% was considered in the calculation to arrive at a maximum sample size.34


Sri Lankan school education is offered in four stages which are namely: Primary (Grades 1-5), Junior Secondary (Grades 6-9), Senior Secondary (Grades 10-11) and Collegiate or Advanced Level (A/L) (Grades 12-13). At the end of Grade 13, students face the General Certificate of Education (A/L) examination in their preferred stream (e.g., Biological Science, Physical Science, Commerce, Arts, etc.), which also serves as the entrance test to state universities. For our study, we recruited a total of 412 students aged 16-18 years studying in the A/L classes of the respective schools. Random cluster sampling was used in order to prevent selection bias, with a class of students constituting a cluster. The exclusion criteria included absence on the day of data collection, failure to provide informed written consent and assent, presence of known cognitive impairment/co-morbid psychopathology interfering with the reliability of responses and filling the questionnaire incompletely/incoherently. Based on these criteria, 17 participants were excluded due to absence (n=4), failure to return the consent and assent forms (n=2) and incompletely/incoherently filled questionnaires (n=11), with 395 students finally included in the study, resulting in a response rate of 95.87%.

Study Procedure

Data collection was done throughout September 2020. Permission was initially obtained from the Zonal Education Director and Principals of the selected schools before approaching the selected classes for data collection. The investigators approached the students during the free timeslots in their academic timetables. The study's objectives and procedure were described before distributing the consent forms, which were to be signed by the parents. Informed assent was obtained from participating students. Students who returned the completed consent and assent forms were given the questionnaire in their preferred language (English/Sinhala). Personal details such as name and residential address were not requested to ensure anonymity. The investigators were present at the time of data collection to answer any queries raised by the participants, although the participants were not allowed to discuss the contents of the questionnaire amongst themselves to prevent information bias.

Measures and Variables

The study employed a self-administered questionnaire, which was pre-tested among 32 A/L students from the Galle district. The questionnaire consisted of three sections.

Section A explored sociodemographic and academic characteristics, as well as the average hours of sleep obtained each night in the past week. Extra-curricular involvements, including sports, aesthetics and student societies, were assessed on a scale of 0-3, with higher values implying greater levels of involvement. Involvement in online learning activities, positive attitude regarding parent-child and teacher-student relationships, lack of satisfaction with one's physical appearance and the presence of few/no friends were assessed by single items graded on a five-point Likert scale, with higher values indicating greater levels of agreement. Self-esteem was assessed with a Single-Item Self-esteem Scale graded on a similar five-point scale.35 Gaming habits and preferences, including the preferred genre and device, were also explored in this section. The game that was played for the longest duration over the past year was used to identify the preferred gaming genre.

Section B consisted of the Internet Gaming Disorder Scale–Short Form (IGDS9-SF), which consists of nine items graded on a five-point Likert scale. Each item corresponds to one of nine DSM-5 diagnostic criteria.36 A forward-backward translation protocol was used to develop the Sinhala IGDS9-SF, and content validity was assessed by a panel of experts from the National Institute of Mental Health, Sri Lanka (Supplementary material). Positive cases of IGD were identified based on the endorsement of five or more items in the IGDS9-SF scale, with a score of 4/5 or 5/5 considered an item's endorsement.

Section C incorporated the Motives for Online Gaming Questionnaire (MOGQ). The items are divided into seven subscales which correspond to the seven gaming motives.26 Each item is graded on a five-point scale, and scores of the relevant items were tallied to provide a subscale score, with higher scores denoting greater degrees of motivation.

Statistical Analysis

The internal consistency of all scales was assessed using the Cronbach's alpha test and α ≥0.7 was considered acceptable. Factorial, validity of the Sinhala IGDS9-SF scale was assessed via factor analyses. Mean, standard deviation (SD), counts and proportions were used to describe the general characteristics of the sample.

Bivariate analyses were conducted using chi-square and fisher's exact tests to identify associations of IGD status. A p-value of <0.05 was considered statistically significant at a confidence level of 95%. The Shapiro-Wilk and Kolmogorov-Smirnov tests revealed a non-normal distribution of the IGDS9-SF scores, and so correlational analyses of the IGD score and MOGQ subscale scores were done using Spearman's Rank (rs) coefficients.

Multivariable analyses were then conducted using binary logistic regression with the IGD status as the dependent variable. All significant bivariate associations were initially entered into the initial model, and a forward method of entry was used to obtain the final model, which retained only significant variables. To verify the linearity assumption, the continuous variables were tested via the Box-Tidwell test. Multicollinearity was excluded by assessing the Variance Inflation Factors, which were <2.5. Exponentiated beta coefficients were presented as odds ratios with a 95% confidence interval (CI) for each variable. Statistical analyses were conducted using Version 26.0 of the Statistical Package for the Social Sciences and Version of jamovi.


Validity and Reliability of Scales

The English and Sinhala questionnaires were filled by 183 and 139 gamers, respectively. The internal consistency reliability of the Sinhala IGDS9-SF was good (α=0.854) and acceptable =0.77) in the English IGDS9-SF. The alpha estimates were not significantly increased by excluding any of the items, and inter-item correlations were acceptable (0.15-0.5). The Cronbach's Alpha values of the MOGQ subscales were acceptable (0.763-0.818 for the Sinhala version and 0.663–0.803 for the English version).

The Factorial Validity of the Sinhala IGDS9-SF scale was assessed using factor analyses. The adequacy of the sample size was initially verified with the Keiser-Meyer-Olkin measurement, which was acceptable at 0.886. The Bartlett's Test of Sphericity was significant (χ2=412, df=36, p<0.001). The Exploratory Factor Analysis done with a Varimax rotation on the nine items revealed a one-factor solution with an Eigenvalue threshold of one. This was further affirmed by examination of the Scree plot. The unidimensional structure was further assessed by Confirmatory Factor Analysis. The test for exact fit was significant (χ2=44.9, df=27, p<0.05) and other fit indices were acceptable (Comparative Fit Index = 0.954, Tucker-Lewis Index = 0.939 and Root Mean Square Error of Approximation = 0.069). All factor loadings were statistically significant (p<0.001) and ranged from 0.455-0.733.

These results affirm that the Sinhala IGDS9-SF scale measures a unidimensional construct, like its validated English counterpart.

Descriptive Analysis of Sample Characteristics

The general and gaming-related characteristics of the sample are described in Table 1. The mean age was 17.22 years (SD=0.54), and 52.4% of the participants were male. Most participants reported a monthly income of LKR 100,000–199,999 (31.6%, n=125) and had one sibling in the family (53.4%, n=211). Most of the students studied in the English medium (51.6%, n=204) and followed commerce subjects (32.9%, n=130). A majority reported high involvement in online learning activities (60.0%, n=237) and slept 6-7 hours every night (57.0%, n=225).

Table 1.

Frequency Distribution of Sample Characteristics.

Count %
Ethnicity (n=395)
 Sinhala 306 77.5
 Tamil 46 11.6
 Muslim 37 9.4
 Burgher 6 1.5
Monthly Income in LKR (n=395)
 <20,000 8 2.0
 20,000 – 49,999 41 10.4
 50,000 – 99,999 111 28.1
 100,000 – 199,999 125 31.6
 200,000 or more 110 27.8
Number of siblings (n=395)
 None 49 12.4
 One 211 53.4
 Two 104 26.3
 Three or more 31 7.8
Stream of study (n=395)
 Biological Science 88 22.3
 Physical Science 97 24.6
 Commerce 130 32.9
 Arts 70 17.7
 Other (Miscellaneous) 10 2.5
Hours of sleep per day (n=395)
 Less than four 14 3.5
 Four to five 118 29.9
 Six to seven 225 57.0
 Eight or more 38 9.6
Weekday gaming hours (n=322)
 One or less 172 53.4
 Two to three 91 28.3
 Four to five 39 12.1
 Six to seven 18 5.6
 Eight to ten 2 0.6
Weekend gaming hours (n=322)
 One or less 131 40.7
 Two to three 101 31.4
 Four to five 55 17.1
 Six to seven 23 7.1
 Eight to ten 9 2.8
 Eleven or more 3 0.9
Starting age of gaming (n=322)
 Less than five years old 26 8.1
 Five to seven years old 35 10.9
 Eight to ten years old 80 24.8
 11 to 13 years old 76 23.6
 14 to 16 years old 69 21.4
 Started recently 36 11.2
Preferred Device (n=322)
 Personal Computer 63 19.5
 Mobile Phone 206 64.0
 Tablet 24 7.5
 Gaming Console 29 9.0
Type of Games (n=322)
 Online Multiplayer 164 50.9
 Online Single Player 49 15.2
 Offline Single Player 109 33.9

Of the 395 participants, 322 identified themselves as “gamers” (81.5%). A gamer was defined as an individual who had intentionally played electronic games for any duration of time, offline/online, using any device during the past 12 months. A majority played games for ≤1h every day during the weekdays (53.4%, n=172) and weekends (40.7%, n=131). Most of the students started to play games when they were 8-10 years old (24.8%, n=80) and preferred online multiplayer games (50.9%, n=164) and gaming on mobile phones (64.0%, n=206). The favorite genre was Multiplayer Battle Royale (27.0%, n=87) among 11 identified gaming genres (Figure 1).

Figure 1

Distribution of gamers in the sample according to the preferred game genre (n=322).

Prevalence of IGD and Bivariate Analyses

The prevalence of IGD was 5.06% (95% CI = 2.90–7.22) among the total study population and 6.21% (95% CI = 3.58–8.85) among the gamers. Table 2 presents the cross-tabulated characteristics associated with IGD.

Table 2.

Bivariate Analysis of Factors Associated with Internet Gaming Disorder.

Characteristic No IGD IGD Total n=322 Significance
n=302 % n=20 %
Age χ2 = 0.768
 16 - 17 214 93.0 16 7.0 230 p = 0.381
 18 88 95.7 4 4.3 92
Sex χ = 7.037
 Male 165 90.7 17 9.3 182 p = 0.008
 Female 137 97.9 3 2.1 140
 Sinhala 232 93.2 17 6.8 249 p = 0.582*
 Other 70 95.9 3 4.1 73
Income (LKR) χ2 = 0.20
 <100,000 116 93.5 8 6.5 124 p = 0.888
 ≥100,000 186 93.9 12 6.1 198
No. of Siblings X2 = 1.721 p = 0.19
 One or less 195 95.1 10 4.9 205 p = 0.19
 Two or more 107 91.5 10 8.5 117
Medium χ2 = 4.446
 Sinhala 138 89.8 14 9.2 152 p = 0.035
 English 164 96.4 6 3.5 170
Stream χ2 = 0.084
 Science 146 94.2 9 5.8 155 p = 0.772
 Non-science 156 93.4 11 6.6 167
Hours of sleep χ2 = 0.439
 Five or less 97 95.1 5 4.9 102 p = 0.507
 More than five 205 93.2 15 6.8 220
Sports χ2 = 0.02
 None/Minor 186 93.9 12 6.1 198 p = 0.888
 Moderate/Major 116 93.5 8 6.5 124
Unions χ2 = 5.455
 None/Minor 177 91.2 17 8.8 194 p = 0.02
 Moderate/Major 125 97.7 3 2.3 128
Aesthetics χ2 = 1.689
 None/Minor 151 92.1 13 7.9 164 p = 0.194
 Moderate/Major 151 95.6 7 4.4 158
Online Learning χ2 = 0.956
 Low 42 95.5 2 4.5 44 p = 0.620
 Moderate 77 91.7 7 8.3 84
 High 183 94.3 11 5.7 194
 Poor relationship 8 61.5 5 38.5 13 p = 0.001*
 Neutral 36 97.3 1 2.7 37
 Good relationship 258 94.9 14 5.1 272
 Poor relationship 12 75.0 6 33.3 18 p = 0.001*
 Neutral 67 97.0 2 2.9 69
 Good relationship 223 94.1 12 5.1 235
Self-appearance x2 = 12.66
 Satisfied 136 97.8 3 2.2 121 p = 0.002
 Neutral 109 94.0 7 6.0 105
 Not satisfied 57 85.1 10 14.9 61
Number of friends χ2 = 1.341
 Many 225 94.5 13 5.5 238 p = 0.512
 Moderate 42 93.3 3 6.7 45
 None/Few 35 89.7 4 10.3 39
Self-esteem χ2 = 3.501
 Low 27 100 0 0 27 df = 2
 Moderate 88 90.7 9 9.3 97 p = 0.174
 High 187 94.4 11 5.6 198
Weekday gaming hours
 Less than 6h per day 290 96.0 12 4.0 302 p < 0.001*
 6h or more per day 12 60.0 8 40.0 20
Weekend gaming hours
 Less than 6h per day 276 96.2 11 3.8 287 p < 0.001*
 6h or more per day 26 74.3 9 25.7 35
Preferred type χ2 = 0.819
 Online Multiplayer 152 93.1 12 7.3 164 p = 0.664
 Online Single Player 47 95.6 2 4.1 49
 Offline Single Player 103 93.8 6 5.5 109
Preferred genre χ2 = 11.76
 Battle Royale 75 86.2 12 13.8 87 p = 0.001
 Other 227 96.6 8 3.4 235
Preferred device χ2 = 0.745
 Mobile Phone 195 94.7 11 5.3 206 p = 0.388
 Other 107 92.2 9 7.8 116
Starting age of gaming χ2 = 0.013
 Starting age of gaming 10 years or less 132 93.6 9 6.4 141 p = 0.91
 Older than 10 years 170 93.9 11 6.1 181
*Fisher's exact test was conducted. Significant associations (p<0.05) are given in bold.

IGD was significantly higher (χ2=7.04, p<0.05) among males. The proportion of Sinhala medium students with IGD (9.2%, n=14) was significantly higher (χ2=4.45, p<0.05) than that among English medium students (3.5%, n=6). The only extra-curricular activity associated with IGD was involved in student societies. Students reporting no/minor involvement in such activities (8.8%, n=17) were significantly more likely to have IGD (χ2=5.46, p<0.05) than those reporting moderate/major involvements (2.3%, n=3). Poor quality of relationships with parents and teachers were also significantly linked to IGD (p<0.001). Furthermore, the proportion of IGD gamers who were dissatisfied with their physical appearances (14.9%, n=10) was found to be significantly higher (χ2=12.66, p<0.05) than those who were satisfied/neutral. Playing games for ≥6h during the weekdays and weekends was significantly associated with IGD (p<0.001). Furthermore, gamers who preferred BR games (13.8%, n=12) were more likely to have IGD (χ2=11.76, p<0.05) than those who preferred other genres (3.4%, n=8). Associations pertaining to the preferred type of games, gaming device, and starting age were not significant.

All correlations between the IGDS9-SF score and the MOGQ subscales were significant (p<0.001). The Escape motive correlated strongly with the IGD score (rs = 0.616). There were moderate positive correlations between IGD score and the social (rs = 0.514), coping (rs = 0.513) and fantasy (rs = 0.451) motives, while the correlations with the skill development (rs = 0.398), recreation (rs = 0.389) and competition motives (rs = 0.367), were positive but weak.

Multivariable analysis

The factors retained in the final binary logistic regression model are shown in Table 3. The Hosmer and Lemeshow test revealed an acceptable fit of the data (χ2=4.24; df=8; p=0.835). The model was found to be significant (χ2=63.64; df=7; p<.001) and explained 48.4% (Nagelkerke R2) of the variance in IGD status. Gaming daily for six hours or more during the weekdays was associated with almost seven-fold higher odds of having IGD (95% CI = 1.735 – 27.569). Furthermore, no/minor involvement in student-based societies and poor parent-child relationships positively predictive IGD status. While the escape and fantasy motives were positively predictive, every unit increase of the competition motive score was associated with 17.6% lesser odds of having IGD (95% CI = 0.703–0.967).

Table 3.

Multivariable Logistic Regression Model Retaining Significant Associations of Internet Gaming Disorder (n=322).

Variable β Odds Ratio (95% CI) p value
Involvement in student societies a: None/Minor 1.985 7.277 (1.420 - 37.288) * 0.017
Parent-Child Relationship b 0.003
 Poor 2.625 13.81 (2.571 - 74.174) ** 0.002
 Neutral −2.058 0.128 (0.009 - 1.85) 0.131
Escape 0.283 1.327 (1.108 - 1.588) ** 0.002
Competition −0.183 0.833 (0.713 - 0.973) * 0.021
Fantasy 0.190 1.209 (1.058 - 1.382) ** 0.005
Daily Weekday Gaming Hours c: 6 hours or more 1.934 6.917 (1.735 - 27.569) ** 0.006
*Significant at p<0.05. **Significant at p<0.01. aReference category is Moderate/Major involvement. bReference category is Good Relationship. cReference category is Less than 6 hours.


To our knowledge, this is the first study which describes the prevalence of IGD in a Sri Lankan adolescent population and is one of few conducted in the South Asian region. In addition to the disease burden, we have discussed IGD from the perspective of school-going students by focusing on interindividual factors such as the parent-child, teacher-child relationships, and the role of academic and extra-curricular activities, which are unique to this population and often overlooked by researchers. Understanding the interplay between motivation and addiction enables early identification of at-risk gamers at a community level. However, previous studies have described these motivations in relation to adult populations,12,24,25 and so, our study furthers the field by describing the specific motivations that drive gaming addiction among an adolescent population. Furthermore, the Sinhala IGDS9-SF, translated from the original English version, was found to be a potentially valid and reliable tool that can be used among native speakers in future studies.

The prevalence of IGD in our study was 5.06%, which is greater than the global pooled prevalence of 3.05%,27 but is lower than the pooled South-East Asian prevalence of 10.1%.30 It is also higher than the prevalence reported from India, i.e., 3.5-3.6%,31,32 although this may be explained by the strict diagnostic criteria adopted in these studies. Our prevalence resembles that among Thai high-school students, which is 5.4%.37

Male gamers were significantly more likely to have IGD than females, which is consistent with the existing research.29 This is partly explained by the fact that males spend more time gaming and prefer high-risk genres, whereas most female gamers favor low-risk casual games. Maladaptive cognitions such as the overvaluation of virtual rewards may also explain the higher prevalence of IGD among males.38

Of the academic characteristics explored, the only significant association was the language of study, with Sinhala medium students being more likely to have IGD. Poor sleep is a known association of IGD.20 In our study, however, reduced sleep hours was not linked to IGD. In fact, some studies report higher sleep hours among IGD gamers in high-school student populations.37 This could be explained by the regular sleep schedules students are compelled to adhere to, owing to early school commencement hours.

Although low exercise is cited as a risk factor,22 a low involvement in sports was not associated with IGD in our study, which may be explained by the lack of opportunities for sports activities owing to lockdowns amid the COVID-19 pandemic. A lack of interest in recreational activities is a known correlate,17 and our findings reflect this as IGD gamers were more likely to report low involvement in student societies.

Gamers with IGD also had poor interpersonal relationships with their parents and teachers. These interindividual factors, which are associated with internet addiction,11 appear to be linked to IGD. We did not find the number of friends to be a significant association with IGD, which supports the notion that despite real-life social exclusion, online gaming can facilitate social interactions,39 with IGD gamers reporting more friends than non-IGD counterparts in some studies.16

We also found that IGD gamers were significantly more likely to be dissatisfied with their self-appearance, which may explain the tendency to idolize in-game avatars with idealized physical forms.40 Although low self-esteem is commonly described among IGD gamers,12,13 this was not a significant association in our study, and so, it is conceivable that the feeling of virtual achievement may have a positive influence on a gamer's self-esteem.

Daily weekday gaming for ≥6h daily was retained as a significant association in multivariable analyses, highlighting the role of excessive gameplay in disordered gaming. Excessive gaming, however, is not tantamount to disordered gaming, with certain studies failing to show increased gameplay as a significant association.12 Although MMORPG and FPS games are traditionally implicated with disordered gaming,18 in our study, most of the gamers (27.0%) preferred Multiplayer Battle Royale games such as “PUBG” and “Fortnite,” which was also linked to IGD. Most gamers in our study (64.0%) preferred mobile phones to traditional gaming devices such as personal computers and consoles.20 The mobile phone is indeed an emerging gaming device in middle-income countries like Sri Lanka, with the number of mobile connections increasing by 2.2 million from January 2019 to January 2020,41 although a preference for mobile gaming was not associated with IGD.

Escape and fantasy were positively predictive of IGD, which echoes existing work on gaming motivations.12 However, competitiveness had a negative effect in our model, which is, described as a positive predictor among women in the cited study. Escape refers to “escaping from problems in the real world” and fantasy entails “stepping out of one's usual identity, trying new identities in a different fantasy world”, while competition represents the motive of “competing with and defeating others to feel a sense of achievement”.26


Our findings should be interpreted with caution. First, we acknowledge the limited generalizability of our results which may apply to the four selected national schools. The study's cross-sectional design does not allow temporal interpretation of associations as true predictors or consequences of disordered gaming. IGD was diagnosed using the IGDS9-SF scale, a validated psychometric tool. This is less accurate than the structured clinical interview, which is the gold standard of diagnosis. We also admit the possibility of recall bias and reduced answering accuracy as participants were expected to report gaming practices over a period of 12 months. Furthermore, the study was conducted amid the COVID-19 pandemic, so the data presented here may not reflect the “pre-COVID normal” where students were not compelled to follow online lessons owing to countrywide lockdowns. Despite these limitations, our study has set an important precedent for future studies both nationally and regionally.


Gaming addiction is an emerging public health challenge in our student population. The Sinhala IGDS9-SF was found to be a potentially valid and reliable tool. IGD was significantly higher among male gamers and was associated with a poor parent-child relationship, low extra-curricular involvement, increased daily weekday gaming and specific gaming motives. These associations should be considered when planning preventive interventions and awareness programs targeting high-risk groups. The inclusion of gaming motivations in the psychological assessment of at-risk gamers will facilitate screening efforts, as gaming time alone is insufficient in distinguishing disordered gaming from non-pathological high involvement. IGD should be considered a serious public health problem that is emergent in school-going adolescent populations and we recommend further studies exploring this condition in nationally/regionally representative samples.

Summary – Accelerating Translation

නව ෙයාවුනේ විෙයේ දරුවනේ අතර ඉෙලක්ෙට්‍රානික/විද්‍යුත් ක්‍රීඩා ජනප්‍රිය වීම සහ තාක්‍ෂණික ෙමවලම් වැඩිෙයනේ සතුව තිබීම ෙහ්තුෙවනේ ෙබාෙහෝ අඩු සහ මධ්‍යම ආදායම් ලබන රටවල විද්‍යුත් ක්‍රීඩා ආබාධය (Internet Gaming Disorder/IGD) වැඩිෙවමිනේ පවතී. IGD යනු ඇමරිකානු මෙනෝචිකිත්සක සංගමෙයේ (American Psychiatric Association) DSM-5 වරේගීකරණෙයේ සහ ෙලෝක ෙසෟඛ්ය සංවිධානෙයේ ICD-11 වරේගීකරණෙයේ (Gaming Disorder ෙලස) සඳහනේ වී ඇති මානසික ආබාධයකි. ෙමම තත්වය ෙහ්තුෙවනේ ෙබාෙහෝ දරුෙවෝ මානසික අවපීඩනය, කාංසාව හා නිනේද ආශ්‍රිත ගැටලු වලිනේ ෙපෙලති. තවද ඔවුනේෙගේ අධ්‍යාපනික කටයුතු ෙමම තත්වය නිසා අඩාල විය හැකියි. දකුණු ආසියාෙවේ IGD හි ව්‍යාප්තිය ෙනාදනේනා තරම් ය. එබැවිනේ, ශ්‍රී ලංකාෙවේ පාසලේ යන සිසුනේ අතර IGD හි ව්‍යාප්තිය සහ ඒ හා ආශ්‍රිත ෙපළඹවීම් (Motivations) ඇතුළු සාධක කිහිපයක් අපෙගේ පෙයර්‍්ශණය තුලිනේ නිරේණය කිරීම අපෙගේ අරමුණයි.

ෙකාළඹ අධ්‍යාපන කලාපෙයේ ජාතික පාසලේ හතරක ඉෙගනුම ලබන, වයස අවුරුදු 16-18 අතර උසස් ෙපළ සිසුනේ ෙමම පරේෙයේෂණය සිදු කිරීම සඳහා ෙතෝරාගනේනා ලදි. අහඹු ෙලස බඳවා ගත් සිසුනේ 412 ෙදෙනකුෙගනේ, සිසුනේ 395ක් පෙයර්‍්ශණයට සහභාගි වීමට කැමැත්ත පල කෙළ් ය. එෙස් කැමැත්ත පල කළ සිසුනේ විසිනේ විද්‍යුත් ක්‍රීඩා ක්‍රියාකාරකම් හා සබැඳි පුරුදු (ක්‍රීඩාවනේහි ෙයෙදන කාලය, කැමති ක්‍රීඩා වරේග, ආදිය), ෙපළඹවීම් සහ මෙනෝ සාධක රාශියක් ගෙවේෂණය වන ප්‍රශ්නාවලි පුරවන ලදි. විද්‍යුත් ක්‍රීඩා ආබාධය හඳුනා ගැනීම සඳහා Internet Gaming Disorder Scale – Short Form (IGDS9-SF) නැමැති ප්‍රශ්නාවලිය අප ෙයාදා ගත් අතර එම ප්‍රශ්නාවලිෙයේ වගනේති 9නේ වගනේති 5කට 4/5 ෙහෝ 5/5 ෙලස ප්‍රතිචාර දැක්වුවෙහාත් එම සිසුවාට විද්‍යුත් ක්‍රීඩා ආබාධය තිෙබනු යැයි අප විසිනේ තීරණය කරන ලදි.

සහභාගි වූ සිසුනේෙගනේ 81.5% ක් විද්‍යුත් ක්‍රීඩා වල ෙයදී තිබුෙනේය. ඉනේ බහුතරයක් ජංගම දුරකථනෙයනේ (64.0%) ක්‍රීඩා කළ අතර, PUBG® වැනි “Battle Royale” වරේගෙයේ ක්‍රීඩාවනේට (27.0%) වැඩිපුර කැමැත්තක් පල කරන ලදි. සහභාගි වූ වනේෙගනේ 5.06% කට අනේතරේජාල ක්‍රීඩා ආබාධය (IGD) තිෙබනු යැයි අප විසිනේ ෙසායාගනේනා ලදි. විද්‍යුත් ක්‍රීඩාවනේහි ෙයෙදන සිසුනේ අතර එහි ව්‍යාප්තිය 6.21% කි. ෙමම තත්වය පිරිමි සිසුනේ අතර වැඩිෙයනේ දැකගැනීමට හැකිවීම විෙශ්ෂත්වයකි. තවද දිනකට පැය 6කට වඩා ක්‍රීඩා කිරීම, ෙදමවේපියනේ හා සමග දුරේවල සම්බනේධතාවයක් තිබීම, ශිෂ්‍ය සංගම් ආශ්‍රිත කටයුතු වල අඩුෙවනේ නියැලීම යනාදිය IGD හා සබැඳි සාධක ෙලස අප විසිනේ ෙසායාගනේනා ලදි. ජීවිතෙයේ ගැටලු සහගත තත්වයනේෙගනේ මිදීමට ෙහෝ ෆැනේටසි ෙලෝකයකට පලායෑෙම් ෙචේතනාවනේෙගනේ ක්‍රීඩා කරන සිසුනේ අතර ෙමම තත්වය වැඩිෙයනේ දැකගැනීමට හැකි වූ අතර තරගකාරී මෙනෝභාවයකිනේ ක්‍රීඩා කරන සිසුනේ අතර ෙමම තත්වය අඩුෙවනේ දැකගැනීමට අපට හැකි විය.

IGD යනු සමාජෙයේ අලුතිනේ පැන නැගී ඇති මෙනෝෙසෟඛ්‍ය ගැටලුවකි. විද්‍යුත් ක්‍රීඩාවනේහි නියැෙලන සුලුතරයකට පමණක් IGD ඇති විය හැකි වුවද, ශීඝ්‍රෙයනේ වැඩිෙවන විද්‍යුත් ක්‍රීඩක ප්‍රජාව හමුෙවේ ෙමය සැලකිය යුතු කාරණාවකි. එබැවිනේ, ෙමම පෙයර්‍්ශණය තුලිනේ ෙසායාෙගන ඇති සාධක ඉලක්ක වන ෙලස ප්‍රජා ෙසෟඛ්ය වැඩපිළිෙවත් නිරේමාණය විය යුතු යැයි අෙප් නිරේෙදේශය යි.

Conflict of Interest Statement & Funding

The Authors have no funding, financial relationships or conflicts of interest to disclose.

Author Contributions

Conceptualization; Formal Analysis; Software: MMM. Project Administration; Supervision: MMM, DJ. Resources: TGMM, AMV. Validation: DJ. Data Curation; Investigation; Visualization; Writing – Original Draft Preparation: MMM, TGMM, AMV. Methodology; Writing – Review & Editing: MMM, TGMM, AMV, DJ.


The authors would like to thank the Department of Community Medicine of the Faculty of Medicine, University of Colombo, Sri Lanka for their role in coordinating the undergraduate research program.


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Minura Manjitha Manchanayake, 1 4th year MBBS undergraduate – Faculty of Medicine, University of Colombo, Sri Lanka.

Thalpe Guruge Madara Malsirini, 1 4th year MBBS undergraduate – Faculty of Medicine, University of Colombo, Sri Lanka.

Ashan Manelka Vithanage, 1 4th year MBBS undergraduate – Faculty of Medicine, University of Colombo, Sri Lanka.

Dushyanthi Jayawardene, 2 MBBS, MSc (Community Medicine) – Lecturer, Department of Community Medicine, Faculty of Medicine, University of Colombo, Sri Lanka.

About the Author: Minura Manjitha Manchanayake is a 4th year undergraduate of a 5-year MBBS program offered by the Faculty of Medicine, University of Colombo. He is a recipient of the Prof. K.N. Seneviratne Prize in Physiology and is a Student Editor of the Research Promotion and Facilitation Centre of the same faculty.

Correspondence: Minura Manjitha Manchanayake, Address: College House, 94 Kumaratunga Munidasa Mawatha, Colombo, Sri Lanka. Email: medmbbs160912@stu.cmb.ac.lk

Editor: Paul Morgan Student Editors: Andrew Thomas & Mohammad Amin Khazeei Tabari Copyeditor: Adam Urback Proofreader: Adam Urback Layout Editor: Francisco J. Bonilla-Escobar Process: Peer-reviewed

Cite as: Manchanayake MM, Malsirini TGM, Vithanage AM, Jayawardene D. Prevalence and Correlates of Internet Gaming Disorder Among an Advanced Level Student Population from Colombo, Sri Lanka. Int J Med Stud. 2022 Apr-Jun;10(2):165-74.

Supplementary Material The English Internet Gaming Disorder Scale – Short Form (IGDS9-SF)

These questions will ask about your gaming activity during the past year (i.e., the last 12 months). By gaming activity, we understand any gaming-related activity played either from a computer/laptop or a gaming console or any other kind of device (e.g., mobile phone, tablet, etc.), both online and/or offline. There are no right or wrong answers.

Read each of the given statements and put an “X” on the appropriate number.1 = Never, 2 = Rarely, 3 = Sometimes, 4 = Often, 5 = Very Often

1. Do you feel preoccupied with your gaming behavior? (Some examples: Do you think about previous gaming activity or anticipate the next gaming session? Do you think gaming has become the dominant activity in your daily life?) 1 2 3 4 5
2. Do you feel more irritability, anxiety or even sadness trying to either reduce or stop your gaming activity? 1 2 3 4 5
3. Do you feel the need to spend increasing amounts of time engaged in gaming in order to achieve satisfaction or pleasure? 1 2 3 4 5
4. Do you systematically fail when trying to control or stop your gaming activity? 1 2 3 4 5
5. Have you lost interest in previous hobbies and other entertainment activities due to your engagement with the game? 1 2 3 4 5
6. Have you continued your gaming activity despite knowing it was causing problems between you and others? 1 2 3 4 5
7. Have you deceived any of your family members or others because of the amount of your gaming activity? 1 2 3 4 5
8. Do you play in order to temporarily escape or relieve a negative mood (e.g., helplessness, guilt, anxiety)? 1 2 3 4 5
9. Have you jeopardized or lost an important relationship, job or an educational opportunity because of your gaming activity? 1 2 3 4 5
The Sinhala Internet Gaming Disorder Scale – Short Form (IGDS9-SF)

පසුගිය වසර තුළ (එනම් පසුගිය මාස 12 තුළ) ඔබෙගේ විද්‍යුත් ක්‍රීඩා ක්‍රියාකාරකම් (Electronic Gaming Habits) පිළිබඳව ෙමම ප්‍රශ්න මාලාෙවනේ අසනු ලැෙබේ. ෙමහිදී විද්‍යුත් ක්‍රීඩා ක්‍රියාකාරකම් ෙලස පරිගණක/ලැප්ෙටාප් ෙහෝ PlayStation®, X-box® වැනි ෙකානේෙසෝලයකිනේ ෙහෝ ඕනෑම උපකරණයකිනේ (උදා: ජංගම දුරකථන, ටැබේලේට් ආදිය මගිනේ) සිදු කරන ක්‍රීඩා සැලකිලේලට ගනිමු. ෙමහිදී අනේතරේජාලයට සම්බනේධ වී ෙහෝ ෙනාවී සිදු කරන ක්‍රීඩා ෙදවරේගයම සැලකිලේලට ගනිමු. ෙමම ප්‍රශ්න වලට නිවැරදි ෙහෝ වැරදි පිළිතුරු ෙනාමැත.

ලබා දී ඇති සෑම ප්‍රකාශයක්ම කියවා සුදුසු අංකයට “X” ලකුණ ෙයාදනේන. 1 = කිසිවිටක නැත, 2 = කලාතුරකිනේ, 3 = සමහර අවස්ථා වලදී, 4 = ෙබාෙහෝ අවස්ථා වලදී, 5 = සැමවිටම පාෙහ්

1 ඔබ විද්‍යුත් ක්‍රීඩා (පරිගණක/ලැප්ෙටාප් ෙහෝ ෙකානේෙසෝලයකිනේ ෙහෝ ජංගම දුරකථන, ටැබේලට් ආදිය මගිනේ සිදු කරන ක්‍රීඩා) වලට වුවමනාවට වඩා අවධානය ෙයාමු කරනේෙනේද? (උදාහරණ කිහිපයක්: ඔබ ෙපර ෙයාමු වුනු ක්‍රීඩා වාර ගැන සිතනේෙනේද? නැතෙහාත් ඊළඟ ක්‍රීඩා වාරය අෙප්ක්ෂාෙවනේ සිටිනේෙනේද? ඔෙබේ ෛදනික ජීවිතෙයේ ඉෙලක්ෙට්‍රානික ක්‍රීඩා වල ෙයදීම ප්‍රමුකඛතම ක්‍රියාකාරකම බවට පත්ව ඇතැයි ඔබ සිතනවාද?) 1 2 3 4 5
2 ඔබෙගේ විද්‍යුත් ක්‍රීඩා ක්‍රියාකාරකම් අඩු කිරීමට ෙහෝ නැවත්වීමට උත්සාහ කරන විට වැඩි ෙකෝපයක්, කාංසාවක් ෙහෝ දුකක් දැෙනනවාද? 1 2 3 4 5
3 තෘප්තියක් ෙහෝ සතුටක් ලබා ගැනීම සඳහා විද්‍යුත් ක්‍රීඩාවනේහි වැඩි වැඩිෙයනේ කාලය ගත කිරීෙම් අවශ්‍යතාවය ඔබට දැෙනනවාද? 1 2 3 4 5
4 ඔබෙගේ විද්‍යුත් ක්‍රීඩා ක්‍රියාකාරකම් පාලනය කිරීමට ෙහෝ නැවැත්වීමට උත්සාහ කිරීෙම්දී ඔබ අසමත් ෙවනවාද? 1 2 3 4 5
5 විද්‍යුත් ක්‍රීඩාවනේහි ෙයදීෙම් ප්‍රතිඵලයක් ෙලස ෙපර විෙනෝදාංශ සහ ෙවනත් විෙනෝදාත්මක ක්‍රියාකාරකම් ෙකෙරහි ඇති උනනේදුව ඔබට අහිමි වී තිෙබේද? 1 2 3 4 5
6 ඔබ විද්‍යුත් ක්‍රීඩාවේනේහි ෙයෙදන නිසා ඔබ සහා අෙනක් පුදේගලයිනේ අතර ගැටලු ඇති වන බව ඔබ දැන සිටියද ඔබ විද්‍යුත් ක්‍රීඩාවනේහි දිගටම නියැලී සිටිෙයේද? 1 2 3 4 5
7 ඔබ විද්‍යුත් ක්‍රීඩාවනේහි ෙයෙදන කාලය පිළිබඳව ඔබෙගේ පවුෙලේ සාමාජිකයනේ ෙහෝ ෙවනත් අය ඔබ රවටා තිෙබේද? 1 2 3 4 5
8 ඔබ විද්‍යුත් ක්‍රීඩාවනේහි ෙයෙදනේෙනේ ඍණාත්මක මෙනෝභාවයකිනේ (උදා: අසරණභාවය, වරදකාරී හැඟීම්, කාංසාව ආදිෙයනේ) තාවකාලීව පැන යාමට ෙහෝ සහනයක් ලබා ගැනීමටද? 1 2 3 4 5
9 ඔබ විද්‍යුත් ක්‍රීඩා ෙහ්තුෙවනේ වැදගත් පුදේගල සම්බනේධතාවයනේ ෙහෝ අධ්‍යාපනික අවස්ථා ෙහෝ රැකියා අවස්ථා අහිමි කරෙගන ෙහෝ අවදානමට ලක් කරෙගන තිෙබේද? 1 2 3 4 5

Copyright © 2022 Minura Manjitha Manchanayake, Thalpe Guruge Madara Malsirini, Ashan Manelka Vithanage, Dushyanthi Jayawardene

This work is licensed under a Creative Commons Attribution 4.0 International License.

International Journal of Medical Students, VOLUME 10, NUMBER 2, April 2022