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Table of Contents
Year : 2021  |  Volume : 4  |  Issue : 2  |  Page : 142-147

Cyberbullying among young Saudi online gamers and its relation to depression

1 Department of Psychiatry, College of Medicine, King Saud University, Riyadh, Saudi Arabia
2 College of Medicine, King Saud University, Riyadh, Saudi Arabia
3 King Saud University Medical City, Riyadh, Saudi Arabia

Date of Submission29-Jun-2020
Date of Decision23-Aug-2020
Date of Acceptance16-Sep-2020
Date of Web Publication21-Jan-2021

Correspondence Address:
Mohammed AlJaffer
Department of Psychiatry, King Saud University Medical City, P.O. BOX 11472, Riyadh 7805
Saudi Arabia
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Source of Support: None, Conflict of Interest: None

DOI: 10.4103/JNSM.JNSM_78_20

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Background: There is a worldwide interest that has been dedicated to discovering the impact of online video games on mental health among young gamers and its association with the risk of cyberbullying. Many studies have suggested that cyberbullying is associated with the development of depression. To our knowledge, there are no studies that have been carried out in Saudi Arabia that addressed such a topic. Objective: The objective of this study is to estimate the prevalence of cyberbullying among Saudi online video gamers, and it is associated risk to the development of depression. Methods: Using an anonymous online questionnaire posted on social media, a total of 143 caregivers of young Saudi gamers agreed to complete the questionnaire. The questionnaire examined multiple factors including addressing the act of cyberbullying for their association with developing depression. The Patient Health Questionnaire-9 was used to evaluate for depression. Results: Out of 143 gamers, 30 reported being cyberbullied as disclosed by their caregivers, half of which showed depressive symptoms. This had a statistical significance of P = 0.00001. Online chatting was associated with an increased risk of being cyberbullied. Conclusion: The trend of cyberbullying among young gamers is alarming. Depression and suicidality are strongly associated with such phenomena. The impact on emotional and behavioral changes among this group of individuals is encouraged to be further addressed and investigated.

Keywords: Cyberbullying, depression, online gaming, Saudi Arabia, youth

How to cite this article:
AlJaffer M, Alshehri K, Almutairi M, Aljumaiah A, Alfraiji A, Hakami M, Al-Dossary M, Irfan T. Cyberbullying among young Saudi online gamers and its relation to depression. J Nat Sci Med 2021;4:142-7

How to cite this URL:
AlJaffer M, Alshehri K, Almutairi M, Aljumaiah A, Alfraiji A, Hakami M, Al-Dossary M, Irfan T. Cyberbullying among young Saudi online gamers and its relation to depression. J Nat Sci Med [serial online] 2021 [cited 2021 Jun 13];4:142-7. Available from: https://www.jnsmonline.org/text.asp?2021/4/2/142/307565

  Introduction Top

There has been a profound proliferation in online video games in the last few decades, and these games are now an unavoidable part of many peoples' daily lives. Online gaming is one of the most popular leisure activities among adolescents in recent times.[1],[2] Although it provides youth with extraordinary prospects for education, entertainment, as well as coordination and connectivity with peers, there is a “dark side” to this new-age technology.[3],[4]

There are many negative consequences of online gaming on physical, mental, and psychological health.[5],[6],[7],[8],[9],[10],[11] The adverse effects of playing video games reported by studies include auditory hallucinations,[12] low self-esteem,[13],[14] poor academic achievement,[15] postural problems,[16],[17] joint pain,[16],[17],[18] tenosynovitis,[19],[20],[21],[22] hand-arm vibration syndrome,[23] straining injuries,[24] peripheral neuropathy,[25] and obesity.[26],[27],[28]

Many of the adverse effects reported are either infrequent or reversible after discontinuation of excessive playing.[29] Hellström et al. stated that the amount of time spent on gaming is directly related to low mood.[30] Furthermore, Messias et al. defined excessive video game playing by playing video games for more than 5 h a day which as a result leads to more depressive symptoms and suicidal risk in adolescents.[31]

Poor psychological functioning and potentially problematic gaming go along with each other.[32] However, the genre of games being played might independently influence behavior. The first comprehensive meta-analysis by Anderson and Bushman found that violent video games significantly increase aggression.[33],[34] While the online video game environment provides social networking opportunities, it also opens up the possibility to use this social networking to exercise aggression in the form of cyberbullying.[35]

It is possible for a single person to be aggressive toward multiple individuals and across age groups.[35] More common types of cyberbullying behaviors seem to be hurling insults or threats, mocking, and spreading rumors.[35] Just like those playing more than a certain number of hours per day, adolescents involved in cyberbullying are also more likely to experience negative mental health consequences such as depression, anxiety, and attempted suicide as compared to those not involved in cyberbullying.[36]

The extent of bullying and its digital form cyberbullying experienced by the young generation is worrisome. A global study on prevalence of bullying including adolescents aged 12–17 years from 83 countries, during 2003 and 2015, found that in the last 30 days, one-third of the world's adolescents had fallen victims to bullying.[37] Defined by Aboujaoude et al. as “any behavior performed through electronic or digital media by individuals or groups that repeatedly communicates hostile or aggressive messages intended to inflict harm or discomfort on others,” cyberbullying has been reported by 20%–40% of adolescents in the recent past.[38] An in-game survey of 2515 young individuals (12–25 years of age) carried out by a large charitable anti-bullying organization found that 1 in 2 of all online gamers had at some point been bullied in a game.[39]

The Global Advisor Cyberbullying Study carried out in 28 countries in 2018, by Ipsos, found an overall high level of cyberbullying awareness worldwide (75%). However, Saudi Arabia was reported to have the lowest level of awareness at 37%.[40] On the flip side, 1 in 3 parents in Saudi Arabia reported that a child in their community had experienced cyberbullying.[40] The only nationally representative study on adolescent health needs in Saudi Arabia published in 2012, named Jeeluna, reported the prevalence of depression as 14% and that of bullying in the past month as 25%.[41]

Attempting to gain a better understanding of the bullying experiences among Saudi adolescents, AlBuhairan et al. found cyberbullying to have taken place in the form of spreading rumors, social isolation, and blackmailing.[42] Available data shed some light on gaming behavior of students in international Saudi schools whose parents are in the country for work. A cross-sectional study of 276 non-Saudi (expatriate) secondary school students in the city of Buraydah, Saudi Arabia, found 16% to be addicted to video games with a significant correlation to psychological distress.[43]

To our knowledge, data on prevalence of cyberbullying among those who play video games in Saudi Arabia and its association with occurrence of depression in this group are not readily available. We hypothesized that cyberbullying is associated with the development of depression among young Saudis who play video games. This current study aims to establish the extent of video game use and exposure to in-game cyberbullying among local Saudi adolescents and its association, if any, with the occurrence of depression in this age group.

  Methods Top

Research design and setting

This was a cross-sectional study that has explored the impact of online video games on young Saudis gamers and its associated risk of developing depression following cyberbullying using an anonymous online questionnaire posted on social media between October and December 2019.

Subjects and sampling

A random snowballing sampling technique using a validated online questionnaire was carried out. Participants in this research (n = 143) were caregivers of young Saudis gamers who were invited to complete an assessment measure based on an informant report. The exclusion criteria included young individuals who are known to have previous psychiatric or neurological history.

Research instrument

The questionnaire was developed by the authors based on the study objectives and after a literature review of similar studies. The questionnaire consisted of 20 items in total and divided into three sections. There were five items in section 1 presented as demographics and clinical characteristics of young Saudi gamers that included age which was defined based on the World Health Organization with an age range of 10–24 years, as well as gender, parents' marital status, household income in Saudi Arabian Riyal (SAR), and finally, the presence of chronic illness with response choices of “Yes” and “No.”

The second section included six questions describing the participants' characteristics in terms of online video gaming habits and further explored daily time spent on online video games in hours that being played during weekdays and weekends, types of online video games being played, and two more subsequent questions followed up on wither being cyberbullied as well as for the usages of chatting properties during gaming with response choices of “Yes” and “No.”

To explore the association between online video games on young Saudi gamers and its relation to the risk of developing depression following cyberbullying, the Arabic version of the Patient Health Questionnaire-9 (PHQ-9) was used. The PHQ-9 consisted of nine items. Each item was rated on a scale of 0–3. A composite score, therefore, ranges between 0 and 27. The higher scores indicate a heightened depression state. For this study, a cutoff score of 5 or greater was used to define the presence of depression. A depression score of 0–4 was considered none – minimal; 5–9 was considered mild; 10–14 moderates; and 15 or more was considered moderately severe to severe in a range of 15–19 and 20–27, respectively.

A pilot study on a sample of 40 participants was conducted before initiating data collection in order to ensure for feasibility and validity of the scale used as well as to estimate the required time for data collection. The results of the piloted questionnaires were not included in the analysis. The final sample included in the study was 143 participants.

Data analysis

The participants included in the analysis comprised young Saudis with an age group ranging from 10 to 24 years who are engaged in online video games. To understand and describe the characteristics of the sample, descriptive statistics were used. Categorical variables were presented as frequency and percentage. Continuous variables were presented as a mean and a standard deviation.

To identify the association between sociodemographic factors and depression with cyberbullying, Chi-square testing was used. P ≤ 0.05 and 95% confidence intervals were used to report the statistical significance and precision of the results. The Statistical Package for the Social Sciences (SPSS) IBM version 22 (SPSS Inc., Chicago, IL, USA) software was used for data analysis and management.

Ethical considerations

The study was approved by the Institutional Review Board at King Saud University (Project No. E-18-3489). Signed informed consent was obtained from each participant which was clear and indicated the purpose of the study. Confidentiality was assured by assigning each participant with a code number for analysis only. No financial aid or awards were given, nor there was any conflict of interest. The study was conducted following the Declaration of Helsinki.

  Results Top

Participants' characteristics

Data presented in [Table 1] demonstrate the sociodemographic characteristics of young Saudis gamers who play online video games. A total of n = 143 participants were included in this study. The majority were females (59.44%). Age was categorized into 10–14, 15–19, and 20–24 years. Most of them were in the 20–24-year-old subgroup representing 51.05% of the total participants. A fraction of the total sample had a known chronic illness representing 11.19%.
Table 1: Distribution of young Saudi by sociodemographic and clinical characteristics (n=143)

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Participants of a married family were the majority representing 80.42% with the remaining (11.19% and 8.39%) representing the divorced and widowed, respectively. Moreover, less than half (39.86%) of the participants are having an overall monthly household income between 10,000 and 20,000 (Saudi Riyal).

Type and estimated time spent on online video games

The estimated hours spent on online video games were separated into weekdays and weekends. The weekdays estimated spent hours' mean was 5.68 ± 2.59; on the other hand, the weekends estimated spent hours' mean was 6.96 ± 3.43, as shown in [Table 2].
Table 2: Estimated hours spent on online video games (mean±standard deviation)

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Types of online video games that were played were categorized into action, real-time strategy, adventure, stealth shooter, combat, multiplayer online games, and unknown games. The majority of the participants reported playing stealth shooter games comprising 46.15%, whereas adventure, combat, and real-time strategy games constituted 33.57%, 32.87%, and 30.77%, respectively. The remaining online video game types were action, multiplayer online, and unknown yielding 25.87%, 12.59%, and 16.78%, respectively, as shown in [Graph 1].

Association between cyberbullying among youth and its associated risk factors

The results shown in [Table 3] explored the relation between cyberbullying among youth and its potential contributing factors. A higher percentage of cyberbullying was notable in the eldest age group of 20–24 years, showing 26.03% of which were being cyberbullied. In comparison, males had a slightly higher rate of cyberbullying than females showing 22.41% and the latter by 20%. Among those who reported having a chronic illness, 31.25% were cyberbullied; on the other hand, 19.69% were cyberbullied among those who did not have a chronic illness.
Table 3: Association between cyberbullying among youth and its potential contributing factors (n=143)

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Participants who had divorced parents reported higher rates of cyberbullying owning 37.50%. The highest rates of cyberbullying were seen among those with lower family monthly income (5000 SAR up to 10,000 SAR and <5000 SAR) (34.78% and 33.33%), respectively. The presence of chatting in online video games was found to be associated with cyberbullying (P = 0.00001). In contrast, however, age, gender, the presence of a chronic illness, parents' marital status, and families' monthly income were found not to be associated with cyberbullying.

The patterns of cyberbullying forms reported by individuals included cursing, sexual harassment, and threatening. The majority experienced cursing as a trending form of cyberbullying by 67%, while sexual harassment and threatening represented 18% and 15% of the pattern, as shown in [Graph 2].

Cyberbullying among youth and depression

Demonstrated in [Table 4] is the association between cyberbullying and depression, as measured according to the PHQ-9. A total number of 30 participants reported being cyberbullied, showing a prevalence of 20.97%, of which 15 showed depressive symptoms representing 50% of the total cyberbullied group. This had a statistical significance of P = 0.00001.
Table 4: Cyberbullying association to depression based on the Patient Health Questionnaire-9 (n=143)

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Depressive symptoms results were divided into 5 categories based on the score of PHQ-9 as follows: Nonminimal 0–4, mild 5–9, moderate 10–14, moderately severe 15–19, and severe 20–27. The majority of the participants had nonminimal symptoms showing 85%, whereas the remaining showed mild, moderate, moderately severe, and severe scores (7%, 3%, 3%, and 2%, respectively).

  Discussion Top

In our study, the prevalence of cyberbullying was 20.97% which is higher than a previous study that studied the prevalence of cyberbullying among adolescents which revealed a prevalence of 17.9%.[44] We have found that the prevalence of depression among those who were cyberbullied was 50% which was higher than expected. This is significantly higher than the prevalence of depression among the general population of the same age group which was 9.6%.[45]

Moreover, in other studies which investigated the prevalence of depression among cyberbullied population, the results were highly variable between 24.8%[3] and 68.1%,[1] and based on our findings, our prevalence was within this range. Possible causes of the variability in the results might be due to the differences in tools utilized in the assessment of depression, different ethnic groups, settings, and different forms of cyberbullying. As in our study, we have evaluated cyberbullying in the video gaming setting only.

Furthermore, video gaming itself increases depressive symptoms based on a previous study that investigated depression among gamers.[46] However, the aforementioned study did not investigate cyberbullying in online video games. A previous study estimated that the odds of developing depression increases three times in those who have experienced cyberbullying.[47] Hence, cyberbullying could be a risk factor of depression among gamers as cyberbullying significantly increases the risk of depression.

We have hypothesized that suicidal behavior among youth is significantly associated with cyberbullying in online video games setting by 35%, and based on our results, it was much lower, out of 30 participants who were cyberbullied, 10.4% fit the criteria of severe depression, and based on the literature, it is known that when depression's severity increases, the risk of suicidality increases subsequently.[48]

We have also studied the association between cyberbullying and other factors including age, gender, presence of a chronic illness, family income, and chatting. Chatting was the most important risk factor, as this falls in line with a previous study.[48] Most likely, this is due to the increased interaction between online gamers.

Other factors were not significantly associated with cyberbullying as no significant differences were notable. The eldest age group in our sample (20–24 years) showed an increased rate of cyberbullying compared to the other age groups. Our results have shown that this age group was the most age group associated with cyberbullying. This is also supported by another study which indicated that the highest prevalence of cyberbullying was in the same age group.[33] On the other hand, males were more likely to be associated with cyberbullying compared to females, which contradicts what was seen in earlier studies.[48],[49]

Gentile has defined pathological gamer as gamers who have spent more than 24 h a week playing.[50] In our study, the mean time spent on online gaming was 6 h/day which suggests that a part of our participants were excessive and pathological gamers. This might be a factor in the explanation of the prevalence of cyberbullying in our study.

Violent and aggressive behaviors are largely affected by what people encounter in their daily lives. In our study, the top 3 game genres that were reported are stealth shooter, combat, and then adventure. According to the general aggression model, which was proposed by Anderson and Bushman, indicate that “The enactment of aggression is largely based on the learning, activation, and application of aggression-related knowledge structures stored in memory.”[33] As such, those genres are associated with violence/cyberbullying, and it might lead to repetitive cycles of violence/cyberbullying among the gamer population.

Finally, our results have shown that the most form of cyberbullying was cursing (67%), followed by sexual harassment (18%). In compression to a study conducted in Taiwan,[51] sexual harassment was the most prevalent cyberbullying act comprising 27.5% and then rude comments by 12.8%; this might indicate that there is a variation between cyberbullying forms that yield to different trends in different communities depended on the sociodemographic factors and the social backgrounds of the bullies. This could raise the question about the popular act of cyberbullying among each gender and the factors leading to it. Male-to-female ratio could be one of the major factors affecting these studies, as in our study, it was 40.5:59.5 compared to Chang's study where it was 52:48.

  Conclusion and Recommendations Top

The prevalence of cyberbullying following online video gaming is increasing throughout the years, as well as the prevalence of suicide. Based on our results, video gaming is strongly associated with depression and suicidality as a result of cyberbullying; therefore, we recommend increasing the awareness regarding this phenomenon.

In addition, we recommend to further investigate the association between cyberbullying, depression, and suicidality as there were limited and only a few studies embarking this topic, especially in our Arabic region with emphasis on the adolescent age group.

Our study was limited by a moderate number of participants taking into consideration the large number of Saudi gamers. In addition, another limitation we have faced is the difficulty in investigating suicidality, due to the stigma behind it.

Financial support and sponsorship

This work was supported by King Saud University and College of Medicine Research Center, Deanship of Scientific Research, King Saud University, Riyadh, Saudi Arabia.

Conflicts of interest

There are no conflicts of interest.

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  [Table 1], [Table 2], [Table 3], [Table 4]


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