key: cord-301934-l0gfangp
authors: Amin, Kritika Premnath; Griffiths, Mark D.; Dsouza, Deena Dimple
title: Online Gaming During the COVID-19 Pandemic in India: Strategies for Work-Life Balance
date: 2020-07-10
journal: Int J Ment Health Addict
DOI: 10.1007/s11469-020-00358-1
sha: 
doc_id: 301934
cord_uid: l0gfangp

nan

platform, reported an almost 200% increase in the user base during the pandemic, with 75,000 new users (Ahaskar 2020) .

During the lockdown period, there was also an increase in user engagement in online gaming among those aged 25-35 years and a marginal increase in female users (Bora 2020) . Gaming has been reported throughout the day, with a peak gaming time from 8pm until midnight (Bora 2020) . The reason for the increased uptake in Indian gaming is because many people are now housebound and there are few leisure activities that individuals can participate in. To date, online gaming has played a supporting role in public health efforts to enforce effective spatial distancing during the pandemic and has been supported by the World Health Organization's collaborative campaign (#PlayApartTogether) with the online gaming industry encouraging individuals to stay at home and limit the spread of the virus (Maden 2020) .

Research evidence suggests that most engagement in gaming is of positive benefit (Griffiths 2019) and that the benefits can by educational, physical, and therapeutic (Griffiths et al. 2017) . Gaming can also help in developing cognitive skills such as reasoning, spatial awareness, and problem-solving (Bowen 2014; Nuyens et al. 2019 ). However, excessive gaming for protracted periods can be problematic for a minority of individuals. Research evidence suggests that problematic gaming is associated with psychosocial problems such as lack of sleep, low school well-being, concentration problems, impaired life skills, and poor selfcontrol (Männikkö et al. 2020) . Extreme engagement in online gaming is also strongly associated with poor academic performance among school-going children and adolescents (Terry and Malik 2018) .

The literature suggests that multiple factors are associated with problematic gaming such as personality traits (Şalvarlı and Griffiths 2019) , anxiety (Adams et al. 2019; Männikkö et al. 2020) , entertainment achievement and escapism (Männikkö et al. 2017) , game genre (Mihara and Higuchi 2017; Na et al. 2017) , and sensation-seeking behaviors (Hu et al. 2017 ). It has also been speculated that during the COVID-19 pandemic, some individuals may develop an increasing pattern of gaming to relieve psychological distress (King et al. 2020 ). According to a recent Indian study, gaming behavior increased among college students in the lockdown period (Balhara et al. 2020) . Also, due to the lockdown and subsequent occupational and/or educational disruption, individuals may have much more free time and/or may be easily distracted from working at home due to temptations such as online gaming. Subsequently, there is a need for well-balanced and effective strategies to support physical and psychological well-being (King et al. 2020) .

Individuals usually follow a structured routine or a set of routinized behaviors. These routines can provide life satisfaction and bring more significant meaning to one's life (Heintzelman and King 2019) . Given the apparent considerable increase in online gaming and the occupational and/or educational disruption it may cause for some individuals, it is important to maintain a healthy work/life balance during the COVID-19 crisis. The proposed model of lifestyle balance by Matuska and Christiansen (2008) suggests five aspects (i.e., health and physical safety; having rewarding and self-affirming relationships; feeling interested, engaged, challenged, and competent; creating meaning and positive personal identity; and organizing time and energy to meet personal goals). These and other aspects are briefly looked at in turn, in relation and gaming and occupational and/or educational balance.

Many factors, such as good nutrition, exercise, safety practices, adequate sleep, managing stress, and avoiding addictive substances, can have beneficial effects on health (Matuska and Christiansen 2008) . Given the significance of spatial distancing and nationwide lockdown in India at the time of writing, participation in a variety of activities across various mediums is needed to maintain psychological well-being. Engaging in gaming can be time-consuming and has been associated with increased consumption of sweet drinks (Turel et al. 2017 ), but maintaining a healthy diet is essential. Also, excessive online gaming is associated with physical inactivity, obesity, musculoskeletal problems (pain in hands, wrist, neck, and back), and visual problems (Ayenigbara 2018; Zirek et al. 2020) . At present, there is much uncertainty as to what will happen regarding the COVID-19 pandemic, due to the ever-changing characteristics of the virus (Lippi et al. 2020) . This is causing immense psychological distress and fear among some individuals all over the world (Ahorsu et al. 2020; Liu et al. 2020; Pakpour and Griffiths 2020; Xiang et al. 2020) . Such psychosocial effects can lead to emotional distress, anxiety, depression, substance use disorders, and behavioral addictions (Pfefferbaum and North 2020) . Subsequently, engagement in gaming can be a healthy way to relieve stress and modify mood , especially during times of crisis. However, excessive engagement in gaming and unhealthy coping strategies can prove challenging in developing a healthy daily routine. Here, we recommend the following strategies to maintain occupational and/or educational balance in times of challenge due to lockdown following the COVID-19 pandemic.

1. Manage stress effectively-Stress management has a key impact on health and well-being, and it is important to incorporate healthy coping strategies such as regular exercise, deep breathing, yoga, or meditation in daily routines to decrease stress and elevate mood. It is vital to pay attention to the body signals, having personal time, space, and reflecting. Engagement in gaming reduces stress but it is imperative not to use this to the neglect of all other stress-relieving activities. 2. Get adequate sleep-Sleep hygiene is essential and can be helped by maintaining a sleep diary for duration and time of sleep. Individuals should (i) have a specific time they go to bed, (ii) avoid gaming before bedtime, (iii) ensure electronic gaming devices are not kept in the bedroom, and (iv) should make sure the bedroom is noise-free with dim light. Adequate sleep is important for psychological well-being and physical functioning.

Optimizing circadian rhythms and managing the sleep-wake cycle contributes to enhanced energy levels. 3. Engage in physical activity-Gaming can often displace physical activity, so it is very important to engage in physical activity to elevate mood and maintain health. Physical activity is an important outcome of health and well-being. Engaging in outdoor activities, walking, gardening, jogging, and any other activity that can be done in a safe and spatially distanced way. To avoid prolonging engagement in gaming, individuals need to set time restraints for gaming, incorporate frequent breaks, stretch, maintain good posture with a straight back, keep the head and neck upright, and consciously blink eyes. 4. Engage in good nutrition and eating habits-It is very common to snack while gaming.

Snacking healthy food is important, and gamers should eat meals at regular meal times (and not skip meals) and, like sleep, monitor their eating behavior. 5. Have rewarding and self-affirming relationships-Good social support and emotional support can be protective factors for maintaining an individual's good health (Reblin and Uchino 2008) . Furthermore, positive relationships and social support predict life satisfaction (Siedlecki et al. 2014 ). However, problematic online gaming is highly associated with cyberbullying and aggression (Mcinroy and Mishna 2017) , which can have a major impact on an individual's offline social relationships. Forming or renewing real social relationships is necessary. In the modern busy work schedule, individuals often find it hard to spend quality time with their family and socialize with friends. Capitalizing on the current situation, given that a significant proportion of the world's individuals are confined to their homes, for some it is an ideal time to reconnect with family and strengthen existing friendships. This can be done both in and outside of online gaming (Griffiths 2020) . Moreover, having a socially supportive environment has been associated with psychological well-being. Family time is important; having conversations, engaging in offline games, and participating in household chores can also help reduce stress and further strengthen relationships. For children and adolescents, parents need to monitor a child's game time and encourage more engagement in offline activities. 6. Engage in challenging activities-Work is an important way of interacting with the environment, fulfilling roles and responsibility, and developing mastery, which increases the sense of competence and self-efficacy. Participating in online gaming can also enhance positive emotions and bring about happier moods (Russoniello et al. 2009 ) by feeling entertained (Männikkö et al. 2017 ). However, problematic online gaming is associated with low social competence and self-esteem (Kuss and Griffiths 2012) . Therefore, it is important for individuals to invest in exploring new leisure activities and skills and/or restarting old ones to be engaged and productive. As mentioned earlier, participation in an array of physical activities, social activities, as well as cognitive-based activities with the component of challenge will be helpful. Exploration and participation in meaningful and gratifying activities such as painting, gardening, puzzles, and other activities should be encouraged. 7. Create meaning and positive personal identity-To create meaning and positive personal identity, individuals engage in a wide range of activities. During the pandemic, it is recommended that individuals be mindful when participating in gaming. Online gaming provides a platform to create a unique identity. For instance, in role-playing games, the player is free to choose gender, race, background, and physical appearance. The gaming industry has designed games and avatars, and some gamers form deep attachments to their game character (King et al. 2010) . However, for a minority, there is a risk of developing internet gaming disorder (IGD) where the individual can experience physical, emotional, and self-identity disturbances . Even though gaming provides an opportunity to escape the present reality, it is recommended that individuals find meaning and identity in their everyday events. The COVID-19 crisis has given many individuals sufficient time to reflect on their career, goals, inspiration, motivations, and drives. Consequently, participating in a variety of activities (including physical, creative, cognitive, and expressive activities) to maintain psychological well-being and overall health is highly recommended. 8. Organize time and energy to meet personal goals-Due to the current pandemic, millions of individuals are facing an occupational and/or educational imbalance. For some, this will cause stress associated with infringement on personal freedom, complete disruption of structured routines, and engagement in activities susceptible to behavioral addiction (Pfefferbaum and North 2020) . In addition, the allocation of time for day-to-day activities can become challenging and may cause occupational and/or educational disruption for individuals (Whiteford 2000) . Individuals who engage in excessive gaming will find the activity time-consuming, leading to less available time to engage in other activities. This could lead to delaying or completely avoiding necessary activities. When these routines are disrupted due to excessive engagement in online gaming, it may lead to occupational and/or educational imbalance inducing stress, anxiety, and various mental health issues (Brown and Hollis 2013) . This occupational imbalance or disruption can further lead to occupational and/or educational deprivation, paving the way to associated mental health issues. It is recommended that individuals make a more active choice of time use. Engagement in a variety of goal-directed healthy habits (which can include gaming) and maintaining positive relationships (which can be with others in and outside of gaming) is essential. It is important to plan a routine, use planners, keep a record of time spent on gaming, and using apps such as digital well-being and timers. Appropriate time use is highly related to individual well-being.

As lockdowns are eased in India and elsewhere, the minority who have used gaming as an unhealthy coping mechanism (where there is an over-dependence on gaming as a means of escapism from reality) may suffer from mental health issues. For some, the impact of the pandemic may lead to the persistence of excessive gaming and result in negative consequences. Mental health experts such as psychiatrists, psychologists, occupational therapists, and social workers must continue to monitor the psychosocial needs of individuals and deliver the needed psychosocial support wherever and whenever they can (Pfefferbaum and North 2020) . The general population, especially vulnerable groups, requires the utmost mental health care during this pandemic. Early identification of the vulnerable population should begin as early as possible to help overcome the mental health issues caused by the COVID-19 pandemic.

Conflict of Interest The authors declare that they have no conflict of interest.

Ethical Approval Not applicable.

Informed Consent Not applicable.

Internet gaming disorder behaviors in emergent adulthood: A pilot study examining the interplay between anxiety and family cohesion

How gaming industry is fighting the battle against Covid-19. Live Mint

The fear of COVID-19 scale: Development and initial validation

Gaming disorder and effects of gaming on health: An overview

Impact of lockdown following COVID-19 on the gaming behavior of college students

For Indian gaming startups, Covid-19 lockdown is a boon for business. The Economic Times

Video game play may provide learning, health, social benefits, review finds. Monitor on

The meaning or occupation, occupational needs and occupational therapy in a military context

The therapeutic and health benefits of playing videogames

Coronavirus: Making friends through online gaming. The Conversation

Videogames as therapy

Routines and meaning in life

Sensation seeking and online gaming addiction in adolescents: A moderated mediation model of positive affective associations and impulsivity

eSports and gaming industry thriving as video games provide escape from reality during coronavirus pandemic

Video game structural characteristics: A new psychological taxonomy

Problematic online gaming and the COVID-19 pandemic

Online gaming addiction in children and adolescents: A review of empirical research

Typology of Internet gaming disorder and its clinical implications

Health risks and potential remedies during prolonged lockdowns for coronavirus disease

Online mental health services in China during the COVID-19 outbreak

World Health Organization encourages people to game during coronavirus outbreak. Windows Central

Problematic gaming behaviour in Finnish adolescents and young adults: Relation to game genres, gaming motives and self-awareness of problematic use

Problematic gaming behaviour and health-related outcomes: A systematic review and meta-analysis

A proposed model of lifestyle balance

Cyberbullying on online gaming platforms for children and youth

Cross-sectional and longitudinal epidemiological studies of Internet gaming disorder: A systematic review of the literature

The influence of game genre on Internet gaming disorder

Quarantine alone or in combination with other public health measures to control COVID-19: A rapid review

The experimental analysis of nonproblematic video gaming and cognitive skills: A systematic review

The fear of COVID-19 and its role in preventive behaviors

Mental health and the Covid-19 pandemic

Social and emotional support and its implication for health

The effectiveness of casual video games in improving mood and decreasing stress

Internet gaming disorder and its associated personality traits: A systematic review using PRISMA guidelines

The relationship between social support and subjective well-being across age

The physical, emotional, and identity user-avatar association with disordered gaming: A pilot study

Video gaming as a factor that affects academic performance in grade nine

A model linking video gaming, sleep quality, sweet drinks consumption and obesity among children and youth

Occupational deprivation: Global challenge in the new millennium

Coronavirus disease (Covid-19) pandemic

Timely mental health care for the 2019 novel coronavirus outbreak is urgently needed

A systematic review of musculoskeletal disorders related to mobile phone usage