Playing online games has become the most common leisure activity among adolescents worldwide. The prevalence of online game addiction or excessive gaming in adolescents varies across countries, at 3% in the Netherlands,1 8.2% in central Greece,2 and 9% in Singapore.3 Compared with these countries, Korea has reported an even higher rate of game addiction in adolescents, occurring at 14.6%.4
Online game-playing provides adolescents with opportunities to feel achievement from winning the games, to make friends and interact with them in virtual reality, to experience a sense of belonging, and to find relief from stress.5 However, excessive game use has been found to interfere with healthy growth and development of adolescents,6 thus leading to behavioral and social maladjustment.7 Emotional problems including depression, loneliness, anxiety, and aggression have also been identified as outcomes of online game overuse in adolescents.8,9
Emotions make significant contributions to our rational thoughts and behaviors.10 Emotional competence is the ability to be aware of and express one's emotions based on one's emotional intelligence (EI).11 Unlike negative emotion, positive emotion improves mental health and, furthermore, helps reduce the effects of negative emotions, resulting in psychological resilience.12 People with experiences of positive emotions are more likely to be socially integrated and healthy.13 Therefore, emotionally competent people can acknowledge and express their emotions in an appropriate manner by tapping their EI in order to adjust to the challenges of life. However, the literature on the topic of online game has been generally focusing on associations of negative emotions and excessive online game use,14 and little has been known about the relationship between online game use in adolescents and emotional competence, including positive emotion, emotional expression, and EI. Therefore, this study was carried out to investigate emotional competence of adolescents who play online games. The results of this study will provide insight on the role of emotional competence in adolescents playing online games and ultimately offer foundations for the establishment of strategies to enhance the emotional competence of those adolescents.
Objectives
This study examined the relations between emotional competence such as positive emotion, emotional expression, and EI and online game use in adolescents. The specific aims of this study were as follows:
* To examine the level of emotional competence and online game use
* To explore the relations between emotional competence and online game use
* To compare the difference in the emotional competence between general game users and excessive game users
* To identify the difference of emotional competence depending on the gender of general game users and excessive game users
METHODS
Study Design and Sample
This study used a cross-sectional descriptive survey with a convenience sample of 2199 adolescents. Before starting the study, 16 schools in Seoul and Kyunggi Province of South Korea were selected through a snowball sampling method. All the headmasters of the schools received letters from the research team explaining the purpose of the study and asking for participation. A total of 10 school headmasters agreed to participate in the study. The questionnaires and procedures of this study were examined by school officials and were approved by them before conducting the surveys, which indicates there were no contraindications relating to the proposed human subject procedures. The participants of this study were 2199 students attending elementary, middle, and high schools. We obtained written, informed consent from the participants. Parental consent may be omitted for anonymous surveys in Korea. The Ethical Committee of Dankook University Hospital approved the study.
Instruments
The questionnaire included the following components: (1) demographics, (2) online game use, and (3) emotional competence.
ONLINE GAME USE
The scale used in this study was the Korean version of the Internet game addiction self-test scale developed by the Korea Agency for Digital Opportunity & Promotion (KADO).15 The questionnaire is composed of 20 items and consists of four subscales: daily life (four items), withdrawal (seven items), tolerance and loss of self-control (five items), and pursuing virtual relationships (four items). A four-point Likert scale was used for the scoring system, with 1 representing "not at all" and 4 representing "always." The total score ranges from 20 to 80, with a higher score indicating a higher possibility of online game addiction. According to the guidelines presented by KADO, a person with a total score of 38 or above was classified as a high-risk user. In addition, a person with a total score of 20 to 37 was classified as a general user. Cronbach's [alpha] was used to establish the internal consistency of the instrument. Cronbach's [alpha] was .93 in the KADO study and .93 in this study.
EMOTIONAL COMPETENCE
Emotional competence was measured by assessing positive emotion, emotional expression, and EI of the participants in this study.
POSITIVE EMOTION
Positive emotion was measured using the Korean version of the Intensity and Time Affect Survey originally developed by Diener et al,16 which was translated and revised by Lee.17 This measure is composed of a total of eight different kinds of positive emotions (satisfaction, affection, pleasure, etc). A seven-point Likert scale, ranging from 0 (not at all) to 7 (always feel), was used. The total score was in the range of 8 to 56, where higher scores represented more positive emotions. Cronbach's [alpha] was .77 in original studies and .90 for the current study.
EMOTIONAL EXPRESSION
Emotional expression is the expression of internal emotional experience, expression of positive emotions, and expression of negative emotions.18 Emotional expression was measured using the Korean version of the emotional expressiveness scale,19 originally developed by Kring et al.20 The scale measures each individual's tendency to express his/her emotions, one's perception of emotional expression, and other's perception of emotional expressions using 17 questions.
A five-point Likert scale ranging from "not at all" (0) to "always" (4) was used. The total score was in the range of 0 to 85, where higher scores represented more emotional expression. Cronbach's [alpha] was .90 at the time of the development of this instrument and .82 in the current study.
EMOTIONAL INTELLIGENCE
Emotional intelligence is the ability to perceive and express emotion accurately, as well as to assess the emotions of others correctly and regulate emotions in self and others.21 The present study based its foundation on the EI model in which Mayer and Salovey21 produced and used the Emotional Intelligence Questionnaire for adolescents and in Moon's22 study, adapted with permission. This scale includes 40 questions based on five different scales, namely, perception and appraisal of emotion, reflection of emotion, emotional facilitation of thinking, using emotional knowledge, and emotional regulation. A five-point Likert scale ranging from "not at all" (1) to "always" (5) was used. The total score was in the range of 40 to 200, and a higher score represented more EI. Cronbach's [alpha] was .81 at the time of the development of this instrument and .88 in the current study.
Data Collection
Data were collected from April 11 to June 17, 2011. After receiving approval for the study from the headmasters, the purpose of the study was explained to the students in the classroom by the researchers. Students were assured that their participation was voluntary and anonymous. The structured questionnaires were administered only to the students who verbally agreed to participate in the study, and completed questionnaires were then returned to the researcher. Completion of the questionnaire took approximately 20 minutes. The sample size is produced based on the following equation:
(where n is the sample size; d, sampling error; N, population) and can be calculated as 1536 considering 5 375 000 adolescent samples23 with a 95% confidence interval and 2.5% (sampling error). A total of 2199 questionnaires (94.6%) were collected, excluding invalid questionnaires among 2324 returned questionnaires.
Data Analysis
Data were analyzed using SPSS-PC (version 18.0 for Windows; SPSS, Chicago, IL). Descriptive analysis was used to describe students' demographic characteristics, the level of online game use, and all study variables. Pearson correlation coefficients were used to measure the correlation between variables. Independent t tests were used to compare differences in the mean scores among the two groups for positive emotion, emotional expression, and EI. Cronbach's [alpha] coefficient was used to determine the reliability of instruments. A significance level of .05 was considered acceptable.
RESULTS
General Characteristics and Online Game Use-Related Characteristics of Participants
Table 1 shows the demographic and online game use-related characteristics. Among the participants, there were 1293 male students (58.8%) and 906 female students (41.2%). The average age of the participants was 13.37 years. Most of the students were living with parents (86.5%), and the average number of siblings was 2.47. More than half of the participants (59.8%) had started playing online games after age 10, and the average age at first online game play was 9.11 years. Participants who play online games more than 3 days per week totaled 65.9%, and the average days playing online games was reported at 3.24 days per week. During the weekdays, 73.2% of participants responded that they played online games for more than 4 hours a day, and the mean hours of playing online games were 2.73 hours a day. During the weekends, 76.6% of participants reported playing online games more than 4 hours per day, and the average play time was 3.03 hours daily.
Mean and SD of Variables
The average mean (SD) score for positive emotion was 30.26 (10.75). The mean scores for emotional expression and EI were 47.52 (11.12) and 123.59 (32.56), respectively. According to the KADO, a person with a total score of 38 or above was classified as a high-risk user. The mean scores for online game use showed 26.87 (8.84).
Correlations Among the Research Variables
The correlation matrix is listed in Table 2. Positive emotion had positive correlation with emotional expression (r = 0.31, P < .001) and EI (r = 0.30, P < .001). Emotional expression had weak but positive correlation with EI (r = 0.10, P < .001). There were statistically significant negative correlations between online game use and positive emotion (r = -0.16, P < .001), emotional expression (r = -0.21, P < .001), and EI (r = -0.14, P < .001).
Differences of Variables by Online Game Use
The mean and SD scores for online game use by groups are presented in Table 3. Among the participants, 1947 students (88.54%) were identified as general users, and 252 students (11.46%) were high-risk users. The mean (SD) scores of positive emotion were 30.73 (10.83) for general users and 26.64 (9.35) for high-risk users. The mean (SD) scores for emotional expression and EI were 48.22 (11.01) and 124.24 (19.05), respectively, for general users, and 42.14 (10.54) and 118.52 (17.41), respectively, for high-risk users. There were significant differences in positive emotion (t = 6.40, P < .001), emotional expression (t = 8.57, P < .001), and EI (t = 4.85, P < .001) between the two groups.
Gender Differences in the Variables
In general users, there were statistically significant differences in the average scores for male adolescents' and female adolescents' positive emotion (t = -2.95, P = .004), emotional expression (t = -4.94, P < .001), and EI (t = -6.83, P < .001). In high-risk users, there were no statistically significant differences in the variables by gender (Table 4).
DISCUSSION
To the best of our knowledge, this is the first study to examine the relation of emotional competence and playing online game in adolescents. Our findings demonstrate that high-risk users of online games showed lower emotional competence, that is, lower positive emotion, emotional expression, and EI, than general users. This implies that adolescents who use online games excessively could be more negatively affected in terms of their emotional competence compared with those practicing moderate use of online games. The correlations between online game use and emotional competence were statistically significant but relatively low. Other studies also reported fairly low correlations between the use of Internet and emotion, such as anxiety14 and depression.24 Despite the weak correlation, emotional competence associated with online game use should not be disregarded because the relations were significant.
The high-risk users of online games in this study displayed lower levels of positive emotion than did the general users. This result was consistent with previous studies, which showed higher levels of negative emotions such as depression and loneliness, anger, hostility, phobic anxiety, paranoid ideation, and psychoticism in high-risk game users.25,26 Positive emotion does not merely reflect particular momentary happiness and satisfaction but functions to expand a person's attention and cognition. It includes confidence, optimism, and self-efficacy27; facilitates creative and flexible thinking; and derives effective problem solving and coping skills.28 In addition, positive emotions buffer the deleterious effects of negative emotions in order to allow for the attainment of psychological resilience.29 Therefore, healthcare providers should develop a strategy to enhance positive emotion of high-risk users and help them to be able to recognize and use their positive emotions to manage negative circumstances.
The results of this study also demonstrate that high-risk users express their emotions less than do general users. In this study, emotional expression was measured by assessing how the participants expressed their emotions to others through verbal or nonverbal channels. Meanwhile, gamers who felt socially awkward, isolated, and insecure in real life can transform themselves into someone who feels socially confident and connected to others within the game. As they immerse in the game, they feel themselves more accomplished and more accepted, which may not be the case in the real world. Inability to express emotions is associated with difficulties in interpersonal relations, hostility, social avoidance, depression, and somatization.30,31
Hence, adolescents who play online games excessively should be encouraged to engage in reality and express their emotions. Also, it should be emphasized that balance between the online world and real world needs to be sought, as they are no longer mutually exclusive, and building a positive online presence is becoming increasingly more important for adolescents. The results of a very recent study on the positive effects of video games stated that prosocial video games that promote positive social behaviors increased the accessibility of socially positive thoughts.32 This is because gamers help and support each other in nonviolent ways in prosocial games. The researchers reported that exposure to prosocial video games increased the accessibility of prosocial thoughts and promoted prosocial behaviors. "Chibi Robo," "Super Mario Sunshine," and the Zurich prosocial game are few examples of prosocial video games.33,34 Even though there are some criticisms about dichotomizing video games into prosocial and violent categories because prosocial themes are common in many violent games,35 guiding adolescents to play video games with positive effects on prosocial behavior rather than violent games is important. Therefore, utilization of online games designed for emotional expression could be useful in adolescents needing encouragement to express their emotions.
Emotional intelligence is the ability to identify, understand, use, and regulate emotions in order to promote greater emotional and personal growth and to achieve one's goals using one's emotions. It has been found to be positively correlated with psychosocial well-being and life satisfaction,36 whereas it has negative relations with problematic behaviors, generalized anxiety disorder, depression, substance use, and cigarette smoking intensity.37-39 The levels of EI in the high-risk users of online games were lower than those in the general users in the present study. Emotional intelligence was found as a strong predictor of addiction-related behaviors such as gaming, Internet overuse, and online gambling.40 Siu's37 study reported that lower levels of EI were related to higher levels of internalizing behaviors such as depression, anxiety, and externalizing behaviors including aggression and delinquency. Therefore, the high-risk users of online games need to be supported to acknowledge and control their emotions through EI training. An EI training program was reported to be effective to enhance self-awareness, self-motivation, mood regulation, and getting along with peers.41 In addition, online game users could be aware of and manage their emotions and eventually regulate their game hours if schools or community organizations were to provide a simple, user-friendly self-screening tool for emotion and online game use regulation through personal e-mails or pop-up messages on school Web sites.
Our study results revealed gender differences in emotional competence among the general users of online games. Female adolescents had higher levels of positive emotion, emotional expression, and EI than male adolescents, which is consistent with the findings of previous studies.42,43 But the gender differences in emotional competence did not remain significant in high-risk users of online games, which may indicate that female adolescents lose their ability to control their emotions once they are involved in excessive use of online games. Hence, female high-risk game users should be included in the development of programs to improve emotional competence for online game users because they experience a decrease in emotional competence similar to male adolescents when they are addicted to online games.
We believe this study will help build awareness so that healthcare providers can monitor and plan to enhance emotional competence for adolescents playing online games. Early detection and intervention for adolescents at risk of online game overuse can be accomplished in schools by nurses. Screening services could be offered by school nurses along with an annual physical examination or nutritional assessment because poor nutrition is related to Internet overuse.44 School programs requiring students to receive instruction and learn potential health hazards from online game play may help students build emotional and social skills to prevent online game addiction.
Nursing interventions such as EI training for safe control of their own or others' emotions, self-understanding, and emotional regulation programs, refusal and resistance techniques against risky behaviors, peer counseling programs, and the Jump Up Internet Rescue School, a camp designed by the Korean government, would be beneficial.45-47 Education and counseling interventions could be offered not only to students who come for help, but also to at-risk students identified through screening, as a group or private service, based on students' preferences, and perhaps through online and offline services. School nurses must contact the parents, report online game overuse, and educate and involve the parents in monitoring and intervening with their children. Information on the prevalence of online game overuse and behaviors that might indicate the presence of a problem such as depression, anxiety, social phobias, and lower school performance48 can be disseminated through school newspapers or text messages. School nurses can also teach students how they might help in preventing and identifying problem behaviors among peers. Continuing education about online game addiction should be offered to school nurses who may be unprepared to deal with the phenomenon.
The relationship between emotional competence and online game use has not been investigated so there are currently no targeted interventions to improve emotional competence for online game users. The results of this study should build awareness of the need to monitor and develop emotional competence for adolescents playing online games.
Limitations
This study has several limitations. First, the data collection method used in this study, a self-report questionnaire, might result in a social desirability bias and limit interpretation of the average tendency. Second, the samples in this study were limited to adolescents residing in urban areas. This limits generalization of the results. Lastly, we did not measure the degree of characteristics of online games the participants were involved in. For example, violent games could affect the emotions of users more than other types of games. Future studies may need to include characteristics of games when assessing emotions of the users. Despite these limitations, this study is the first study investigating the relations of emotional competence and online game use among adolescents.
CONCLUSION
Our study results imply that adolescents' usage of online games and their emotional competence are closely correlated. High-risk game users have relatively low levels of positive emotion, emotional expression, and EI. Therefore, anticipatory guidance should be given to online game users and their parents to help them understand that excessive game use could have a negative impact on emotions. Furthermore, self-awareness in adolescents should be promoted to prevent excessive online game use and to allow for intervention at an earlier stage.
Additionally, there seems to be no difference in emotional competence between genders among excessive game users. Thus, female adolescents at high risk should not be overlooked for the possibility of game addiction. Healthcare providers should screen high-risk users of online games with low emotional competence in schools or in the community and support them to enhance their emotional competence.
REFERENCES