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ORIGINAL ARTICLE Table of Contents  
Ahead of print publication
A cross-sectional study to explore the association of peer pressure with Internet gaming

1 Associate Professor, Department of Psychiatry, Konaseema Institute of Medical Sciences and Research Foundation, Amalapuram, Andhra Pradesh, India
2 Professor and Head, Department of Psychiatry, Konaseema Institute of Medical Sciences and Research Foundation, Amalapuram, Andhra Pradesh, India
3 Postgraduate, Department of Psychiatry, Konaseema Institute of Medical Sciences and Research Foundation, Amalapuram, Andhra Pradesh, India

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Date of Submission02-Feb-2023
Date of Acceptance04-Apr-2023
Date of Web Publication04-May-2023


Background: Gaming is a new phenomenon and there are increasing concerns over its negative impact. After the official recognition by diagnostic and statistical manual-5 and International Classification of Disorder-11, much of the research is directed toward understanding the different constructs of the gambling disorder. Peer influence is an established factor in substance use but less researched in gaming.
Aims of the Study: The aim of this study is to explore and understand the influence of peer pressure on Internet gaming.
Materials and Methods: Individuals between 15 and 35 years were asked to participate after explaining the study objectives and assessed on the Peer Pressure Scale and Internet Gaming Disorder (IGD) Scale. Responses were analyzed using the R language with R studio as the integrated development environment. Generalized additive model was used to identify the best-fit model. The Akaike information criterion was used to select the best model.
Results: Battle Ground Mobile India is the most played game. Peer pressure alone accounts for 46.2% of the variability in Internet gaming and along with factors such as student; real friends; strategy games; online mode of playing, night time playing; and hours spent playing, increasing it to 56%. Peer pressure is positively correlated with IGD (P < 0.001, R = 0.65).
Conclusions: Peer pressure is directly associated and plays a role in developing Internet gaming along with factors such as being a student; playing with real friends; strategy game genre; online mode of playing games; and nightly playing. Substance use such as tobacco may influence peer pressure and Internet gaming, acting as a co-factor for both.

Keywords: Generalized additive model, Internet gaming disorder, peer pressure, predictive analysis

How to cite this URL:
Donthu RK, Mohammed AS, Pasam RS, Manchirevula S. A cross-sectional study to explore the association of peer pressure with Internet gaming. Arch Ment Health [Epub ahead of print] [cited 2023 Jun 5]. Available from: https://www.amhonline.org/preprintarticle.asp?id=375707

  Introduction Top

Gaming is an uprising phenomenon, especially among generation Z and generation alpha, described as technology naïve and technology savy, respectively, based on their exposure to technological advances.[1] In these technological advances, there has been a push toward developing more realistic and immersive games and it is gradually replacing a lot of normal daily activities and becoming a part of daily life. With the increase in gaming among adolescents, the prevalence of Internet gaming disorder (IGD) stands between 1.3% and 19.9% and is more prevalent among males as compared to females.[2]

Peer refers to the belongingness of a person to the same social group based on age or grade or status.[3] The exact definition of what peer pressure is vague, it could mean “pressure to conform” or “being part of a group.” In the study, peer pressure is defined as the insistence and encouragement of individuals in the same age group to make individual to do something. Becoming a member of a peer group is one of the primary developmental tasks of adolescence and peer groups influence adolescent socialization and identity by allowing young people to explore individual interests. Although a key aspect of normal adolescent development, there may be costs associated with becoming a member of a group of people. The relationship between peer pressure and substance abuse such as alcohol and smoking was observed in past studies.[4] One large survey based in South Korea suggested that substance abuse often precedes Internet addiction, specifically smoking and drug use. They also identified that addictions in peers are vital for early referral and improving outcomes.[5]

Major classification systems such as the diagnostic and statistical manual for mental disorders (DSM-5)[6] and the Internation Classification of Disorders-11[7] introduced the concept of IGD. In DSM 5, it has been included as “Conditions for further study” and more research is encouraged to improve our understanding. Currently, studies on IGD focus on exploring various factors such as prevalence, risk factors, impact on mental health, neurobiological constructs. According to our understanding, there is a dearth of research on peer influence over IGD. Peer influence is one of the established risk factors in various substance use disorders (SUDs), but evidence for the same is lacking with behavioral addiction. As behavioral addiction shares a lot of features with SUDs, we believe that exploring the influence of peer influence and its role as a risk factor for IGD might help further our understanding.

  Materials and Methods Top

Aims of the study

To explore and understand the influence of peer pressure on Internet gaming and also the influence of sociodemographic factors on gaming.


Participants were selected randomly from those attending the psychiatry outpatient department who were between the age groups of 15 and 35 years without any psychiatric illness. They were briefed about the objectives of the study and once they were willing were asked to fill out the forms. A total of 195 responses were obtained, among them, 13 had inaccurate responses; hence, they were not included in the analysis, and a total of 182 responses were analyzed.


Sociodemographic details

Designed to capture the demographic details related to the participants. It did not include the identifying details of the participants.

Peer pressure scale

It is a five-point Likert scale with the goal of measuring peer pressure. The Cronbach alpha coefficient calculated for the reliability of Peer Pressure Scale (PPS) is 0.90 for the whole scale (34 items), 0.89 for the direct peer pressure subscale (19 items), and 0.82 for the indirect peer pressure subscale (15 items). High scores mean high peer pressure and vice versa. The permission to use in the study has been obtained from the original author.[8]

Internet gaming disorder scale-short form

It is a unidimensional tool comprising of a total 9 items reflecting all nine criteria for IGD as in DSM-5. The nine items of Internet gaming disorder scale-short form (IGDS-SF9) are valid, reliable, and proved to be highly suitable for measuring IGD.[9] The scale has been used in an Indian context by Balhara et al.[10]

Statistical analysis

The data were cleaned and wrangled in Microsoft Excel. Then, it was analyzed using the R language[11] with R studio as an integrated development environment. In R, packages such as “summartools,” “mgcv,” “akaike information criterion (AIC) cmodavg” and “ggpubr” were used for various tests. To find the association of sociodemographic details with PPS and IGD SF scroes, univariate analysis was done using Wilcoxon sign rank or Kruskal–Wallis. The qualitative data were represented in the median and inter-quartile range. For predicting the effect of different variables on Internet gaming (as dependent variable), generalized additive model (GAM)[12],[13] was used as all the assumptions for linear regression were not fulfilled. Models were constructed by adding each variable at a time based on univariate analysis. The best model was selected according to the AIC with the lowest value. It included the following variables: PPS; occupation; companion to games; games genere; mode of accessing games; time of playing; and money spent on games was the best fit with 56% variance in IGD-SF.

  Results Top

Sociodemographic details of the participants [Table 1]: The mean age of the participants was 22.2 years; males constitute 67.6% of the sample. Only 9.3% reported being in a relationship; 80% were students and 18.7% were employed. Almost three-four hail from an urban background. Almost half (47%) were staying with parents; 37.9% with roommates, and 11% are staying alone.
Table 1: Comparing demographic details with Internet gaming disorder short form and Peer Pressure Scale total scores

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Gaming details of the participants

Majority (81%) have reported playing games online; Battle Ground Mobile India followed by Player Unknown's Battle Ground were the single most commonly played games; role-playing games (RPGs) were the most played game genre (42%); more than half (51%) have reported using Wireless Fidelity for playing games and nearly half (51%) were playing games on a metered (a set limit exists for the usage of Internet use per day) data connection. The average hours spent playing games was 3 h per day with a minimum of 10 min to a maximum of 13 h. The most common time for playing was “After school or work” (47%) in the evening. Only one-third (35%) were playing with virtual friends (met on gaming platforms). Most have not reported (83%) spending money for or while playing games, the average money spent was 107 Indian National Rupee. The majority were introduced to games by their friends (48%) followed by the participant's own exploration (30%).

The comparison of demographic details, gaming parameters with IGD-SF and PPS scores [Table 1] and [Figure 1], [Figure 2]: A significant association is found in the participation report on tobacco use with both PPS (median: 34; P < 0.024) and IGD-SF total scores (median: 89; P < 0.001). There was a statistically significant association of variables with IGD-SF scores [Table 2]: Mode of accessing games (online: Median 19; P < 0.001); and whether money is spent playing (yes: Median 23; P < 0.002). There was also a significant association of variables with PPS scores: Mode of accessing games (online: Median 45; P = 0.001); game genre (RPG: Median 31; P = 0.003); type of Internet access (mobile data: Median 46.5; P = 0.004); type of Internet connection (unmetered: 49.5; P = 0.014); and money spent on playing games (yes: Median 65; P < 0.001). There is a positive correlation between variables: Amount of money spent (with PPS: P < 0.001; R = 0.57 and IGD-SF: P < 0.001; R 0.55), hours of play with IGD-SF scores (with PPS: P < 0.001; R = 0.35 and IGD-SF: P = 0.026; R = 0.16). In the case of money spent, the correlation is moderate (for both PPS and IGD-SF), and in case of hours of play, it is mild (for both PPS and IGD-SF).
Figure 1: Correlation between hours of playing games with IGD-SF score. IGD-SF: Internet gaming disorder short form, PPS: Peer Pressure Scale. Test used: Spearman correlation; P < 0.05 is significant

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Figure 2: Correlation between hours of playing games with PPS score. IGD SF: Internet gaming disorder short form, PPS: Peer Pressure Scale. Test used: Spearman correlation; P < 0.05 is significant

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Table 2: Association of gaming parameters with Internet gaming disorder and Peer Pressure Scale total scores

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Association between IGD-SF and PPS scores and predicting the influence of different variables on IGD-SF [Figure 3] and [Table 3]: There was a moderate positive correlation between peer pressure and Internet gaming scores (R = 0.65; P < 0.001). According to the GAM model to predict the influence of different variables on Internet gaming. Based on this, PPS alone accounts for approximately 46.2% of the total variance in IGD-SF and along with variables (included in model 5): occupation (student), games are played with (real friends), game genre (strategy), mode of accessing game (online), time of playing games (at night time during sleep), and hours spent playing account to approximately 56% of the variance in IGD-SF. In the study, model 5 had the lowest AIC score and hence the best fit.
Figure 3: Correlation between PPS and IGD-SF scores. IGD-SF: Internet gaming disorder short form, PPS: Peer Pressure Scale. Test used: Spearman correlation; P < 0.05 is significant

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Table 3: Generalized additive models for predicting the influence of different variables on internet gaming disorder short form scores

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  Discussion Top

Studies[14],[15] have shown that the prevalence of IGD is the highest among men as compared to females. The reasons cited in these studies were males spend most of their time in RPGs or violent games and often the reason is to make new friends and get excited, whereas in the case of females, the main reason is passing time by social networking, texting, or shopping. Therefore, the screen time due to playing games is shorter in women. This gender difference is in contrast to our finding, but this nil difference has also been reported by Festl et al.[16] and Dreier et al.[17] We believe that as Internet games are becoming popular, the gender gap might be slowly decreasing and there is a possibility that females are also exploring different game genre.

Peer pressure plays an important role in individuals' inclination toward using substances of abuse. Among collegegoers, as a part of affirming peer norms or as a part of securing support and intimacy, the individual may start to use addictive substances. These peer groups may also normalize substance use as a norm and hence the individual may never consider it as wrong.[18] A study by Studer et al.[19] found a strong association between different substances of abuse such as alcohol, smoking tobacco, and cannabis with peer pressure. In line with these findings, we also found tobacco use associated with peer pressure, not only that but also associated with Internet gaming. As the constructs which are relevant clinically in diagnosing SUDs also apply to gaming disorder, we believe that this could be a link between tobacco use and Internet gaming. There may be a bidirectional relationship between the individual's peer relationship that influences substance use and gaming that needs to be explored further.

Gaming parameters such as the online mode of playing games and spending money on games are associated with peer pressure. These factors might link individuals to the peer group and hence the association with peer pressure. Furthermore, probably due to the recent increase induced by COVID-19 in assess to online games or easy accessibility could have led to association with the online mode of games. As the individual starts playing with peers, when there is a rewarding gaming experience, they might spend money to enrich it. Asrese and Muche[20] found that online gaming among students is associated with problematic Internet use, which might explain the online mode of playing games. Rho et al.[21] found that having a membership in the game club membership; online playing of games; and spending money on games were some of the factors associated with IGD.

Gaming disorder and peer pressure are positively correlated; so as peer influence increases gaming also increases. A study by Gündoğdu and Kiran-Esan[22] explored the relationship between Internet addiction, peer pressure, and social support, they found that peer pressure was directly associated with Internet addiction and social support was inversely associated with Internet addiction. They felt that adolescents with Internet addiction have lower social skills, and hence, they may not have skills to resist peer pressure. In the past, much of the gaming was assessed through Internet cafes. However, with the advent of cheaper and easier assessment to mobile Internet data, gaming is at the fingertips. Physical peer pressure acted as a catalyst in the days of Internet cafés, but with the advent of massively multiplayer online RPGs real-time interaction with peers is much easier virtually. Another study by Liang et al.[23] found that peer victimization is positively associated with IGD, and this was stronger when parents' knowledge about the adolescents activities was less. Peer victimization is a negative aspect of peer relationships and is defined as any form of attack (physical or verbal or emotional) from a peer. A similar finding has been derived by Tian et al.[24] who found that peer affiliation mediated Internet gaming addiction. They reasoned out using the social development model[25] where adolescents follow the same behaviors as their peer to integrate into the peer group.

Gaming disorder can be predicted to some extent by peer pressure alone (46.2% variance) and others include (56% variance): Being a student; playing with real friends, strategy games; online mode of accessing games, night-time playing; and hours spent playing. Yamamoto et al.[26] found that among children and adolescents, the factors that increase the risk of gaming disorder were academic grades at school; absenteeism from school; spending money on gaming purchases; and the younger onset of playing. They also found that peer problems (measured by strengths and difficulties questionnaire) can affect gaming behavior. Rho et al.[21] predicted that factors such as spending money on gaming; offline community meetings; being a part of the gaming community; and gaming time on weekdays are more likely to lead to gaming disorder. Another study by Li et al.[27] found self-compensation; motivation; fear of missing opportunity; gaming experience; and time spent on gaming to be associated with gaming disorder. Study by Oka et al.[28] found that problematic Internet use plays an important role in IGD. Hence, we believe that peer influence has a role in influencing IGD along with other factors.

  Conclusions Top

Peer pressure is directly associated and also plays a role in developing Internet gaming along with the factors such as being a student; playing with real friends; strategy game genre; online mode of playing games; and hours spent playing. Substance use such as tobacco can influence peer pressure and Internet gaming, playing as a cofactor for both. We did not find any difference in gender for Internet gaming.


There may be other factors related to the development of Internet gaming, including self-control (internal) and parental influences (external), which were not assessed in the current study. Furthermore, owing to the study design, the directionality cannot be established between factors such as peer pressure and Internet gaming.

Ethical approval

The study has been approved by the Institutional Ethics Committee by letter: IEC/CD/2022 with serial number: 05/30.06.2022 dated: July 16, 2022.

Participant consent

Consent has been obtained from all the participants as per the ethics committee recommendations.


We would like to acknowledge the assistance provided by Dr. Krishna Varsha V in the data collection.

Financial support and sponsorship


Conflicts of interest

There are no conflicts of interest.

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Correspondence Address:
Raj Kiran Donthu,
Department of Psychiatry, Konaseema Institute of Medical Sciences and Research Foundation, Amalapuram - 533 201, Andhra Pradesh
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Source of Support: None, Conflict of Interest: None

DOI: 10.4103/amh.amh_32_23


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  [Table 1], [Table 2], [Table 3]


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