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Association between violent video games and aggressive behaviour in a clinical sample of Hispanic adolescents.

Roberto Gutiérrez MD, Alexis González MD, Luz N. Colón- de Martí, MD.

Affiliation: Department of Psychiatry, University of Puerto Rico, Medical Science Campus, PR

Abstract

Background: Research studies have concluded that a complex interaction or combination of factors increase the likelihood that some children and adolescents become violent. In the 1980s there was a nationwide increase on the use of video games and computers for academic purposes. Concurrently as well, children began to have more access to play video games with violent content. The aim of this study was to assess the use of violent video games as a possible risk factor for developing aggressive behavior in a group of Hispanic adolescents using mental health services.
Method: A 44-items questionnaire was administered to Hispanic youngsters in order to examine their patterns of video use; while a 7-items questionnaire was administered to their corresponding parents to assess supervision. The Spanish version of the Buss-Perry Aggressive Scale and a question with a 1 to 10 self-rated violence scale where the participant was asked to choose the level of violence he/she liked in the video games was used to determine aggressiveness.
Results: 55 patients from the Child and Adolescent Psychiatric Outpatient Clinic completed the survey. The Buss-Perry Aggressive Scale showed that 31% of the subjects reported having difficulties to control their temper. More than thirty percent (32%) reported they have felt so upset that they have to break stuff. Interestingly, 45% reported using video games to decrease levels of anxiety or anger, while 40% of them reported that playing video games interfered with their school homework. In the question of how much violence they preferred in the games; in a range of 1 to 10 more than fifty percent (53%, n=39) chose the range of 7-10.
Discussion: A propensity between exposure to violent video games and children’s aggressive behavior was observed. We compared the top three most played video games’ ratings with three levels of violence according to the 1 to 10 self-rated violence question. We found that 68.2% (n=15) of the participants in the mature group (at least one M-rated video game) preferred the 7-10 category compared to 31.8% (n=7) in the Non-M group (E and T rated video games). This result was statistically significant (p=0.016) although expected; considering that M-rated video games can be more appealing to people who prefer violent video games.

Background

Numerous research studies have concluded that a complex interaction or combination of factors increase the likelihood that some children and adolescents become violent. There is a need to study the risk factors that are amenable to change (Loeber, 1987). The relationship between media violence and aggression has been the focus of several studies which document that media violence significantly contributes to youths’ aggressive behavior and their desensitization of violent acts as manifested in our daily lives (Willis & Stransburger, 1998). The American Academy of Pediatrics has expressed that playing violent video games accounts for a 13% to 22% increase in adolescent’s violent behavior compared to a 14% increase in lung cancer from smoking tobacco (O’Keefe, 2002). The non-limited, unsupervised use of violent video games in young children needs to be addressed not as the only factor but one that is potentially modifiable regarding violent/aggressive behavior in our youngsters (US Department of Health and Human Services, 2001).
The video game industry is now over 30 years old. In the 1980s there was a nationwide increase on the use of video games and computers for academic purposes. Concurrently as well, children began to have more access to play video games with violent content. Meanwhile, the quality of the video games improved in graphics’ techniques, making the characters and scenarios with violent content look more real and thus more appealing for the users. Nevertheless, during the last decade, there is more concern about the violent content of video games, particularly when it has been associated and described in the profile of troubled youngsters that perpetrated school shootings, such as the Columbine High School Massacre (1999) and the Virginia Tech Massacre (2007), among others (Anderson, 2004). This is why the Entertainment Software Rating Board (ESRB) was created. This rating system is designed to provide concise and impartial information about the content in computer and video games so consumers, especially parents, can make an informed purchase decision. ESRB ratings have two equal parts, the rating symbols that suggest age appropriateness for the game and the content descriptors which indicate elements in a game that may have triggered a particular rating and/or may be of interest or concern (www.esrb.com).
According to Robinson (2001) exposure to violent media seems to produce three effects in children. These are: 1) direct effects, in which they become more aggressive or develop attitudes and tendencies to resolve conflicts through violence; 2) desensitization to violence and victimization of others; and 3) the belief that the world around them is mean and scary (Robinson, Wiled, Navracruz, Haydel, Varady, 2001). The relationship between children’s exposure to aggression in electronic games and its impact on their behavior to manifest aggressiveness has been well documented as in the work done by Gentile and Anderson (2001, 2004), among others. No studies were found in the literature regarding the impact that violent video games may have in a clinical sample, furthermore with a sample of Hispanic Puerto Rican adolescents. This information is particularly critical to know because “violent entertainment is a public hazard” (Vastag, 2004) and, because in Puerto Rico the levels of violence, as evidenced by high rates of homicides, suicides and deaths caused by domestic violence, and/or children abuse or neglect are already a major public health concern (www.tendenciaspr.com). This is the first step for the public to reach a better understanding of the impact caused by this entertainment and to improve regulations in its usage. In addition, mental health professionals could use findings from studies like this one to identify possible risk factors that could lead to aggressive behavior or conduct disturbance in their patients.
The aim of this study was to assess the use of violent video games as a possible risk factor for developing aggressive behavior in a group of Hispanic adolescents using mental health services. Also, parental supervision for this particular activity – playing video games – was examined in the group of subjects’ parents.

Method

Fifty five Hispanic adolescents and their parents completed a 44 and 7-items questionnaire, respectively. Participants were drawn from an Outpatient Mental Health Clinic for Children and Adolescents at the Pediatric District Hospital in San Juan Puerto Rico. This clinic receives children that present a wide variety of mental illnesses (i.e. mood, anxiety, conduct and behavior disturbances) of both gender and younger than 18 years old. As the participants came to their follow-up appointment, they were asked to answer the questionnaires, other participants were invited as long as they were active patients to come by and fill out the questionnaires. More than 100 adolescents in an age range of 13 to 17 years and of both genders were contacted to participate. Two focal groups (one of each, parents and adolescents) were used to validate the questionnaires about video game use and parents supervision. A 44-items questionnaire was used in youngsters to evaluate the patterns of video game use; while a 7-items questionnaire evaluated parental supervision in this specific activity. A validated Spanish version of the Buss-Perry Aggressive Questionnaire (AQ) was used to assess levels of aggressive behavior in the youths. This questionnaire uses a 1 to 5 scale were 1 is non-significant/Never and 5 is very significant/Always.
Subjects’ parents received a consent form and were informed about the privacy rights. Questionnaires were anonymous for both parents and children; no identifying data other than gender and age was used. Researchers assigned a code in order to correlate parents’ questionnaires with those corresponding to their children and, also for methodological purposes. Finally, the Statistical Package for the Social Sciences program was used for analysis purpose.

Results

Fifty five subjects (n=55) completed the survey; 43.6 per cent were females and 56.4 were males. Eighty-four percent (84%) of the participants reported having a video game console at home, yet 26.5 per cent reported playing video games on a daily basis. In this sample, the youngest age at which adolescents reported to start playing video games was 3 years old.
Participants were asked to list their top three most played video games. Forty five participants (n=45) answered the question about their videogame classified as number one (i.e. most played). More than 50% (55.55%) reported a videogame category E (Everybody) as their #1 videogame, 20% reported a videogame category T (Teen); and 24.44% reported a videogame category M (Mature) as their number one videogame. Their number one video games was further analyzed: 22% reported fight games, 22% action games, and 23% adventure video games, which are games that can include from moderate to high content of violence. Adolescents were asked to classify, in a 1 to 10 range how much violence they preferred in the games they played. More than fifty percent (53%, n=39) chose the range of 7-10, 28.5% chose 4-6 and 18.5% the range of 1-3. For convenience and simplification of analysis a Chi-Square test was done to compare the games and the level of violence preferred. For analysis purposes, the three games most played were arranged in two categories: with at least one M-rated game (mature group) and without any M-rated game (Non-mature group: Everyone + Teen). In the group with at least one mature video game 68.2 per cent preferred high violent content (7to10) in their games; while in the group without mature games only 31.8 per cent preferred the same violent content. A Pearson Chi-Square of 0.016 was obtained in this analysis, with a continuity correction of 0.035 and a Fisher’s exact test of 0.015.
The Buss-Perry AQ showed that 31 per cent of the participants reported having difficulties to control their temper; 32 per cent reported that they have felt so upset that they have to break stuff; 45 per cent admitted using the video games to decrease anger or anxiety levels. Table 1 shows descriptive data of 3 items from the Buss- Perry AQ when compared with the category of the most played video games. Table 2 summarizes some of the variables that were compared to the Buss-Perry Aggressive Questionnaire.

Table 1: Descriptive Data of Buss-Perry AQ and Video Game Questionnaire

AQ question	Always/Yes and choose E rated game	Always/Yes and choose T/M rated game	Never/No and choose and E rated game	Never/No and choose and M rated game
If I have to resort to violence to protect my rights, I will.	50%	33.3%	66.6%	11.1%
I get into fights more than the average person.	40%	60%	66.6%	33.3%
Have you been involve in a physical fight in the last year?	52.1%	47.8%	59.0%	40.9%

Table 2: Buss-Perry Total AQ means score by Category of Most Played Video Games,Gender, Age group and participation in physical fights during the last year.

Variable	AQ mean score	Std. Deviation	Median	p value
Category of Most Played Games*
At least one Mature	2.98	0.70	2.91
No Mature**	2.70	0.70	2.57	0.223
Gender
Female	2.83	0.61	2.86
Male	2.86	0.79	2.57	0.972
Age Group (years)
13-14	2.79	0.82	2.53
15-17	2.90	0.59	2.97	0.350
Participation in physical fights during the last year
Yes	3.14	0.72	3.14
No	2.51	0.53	2.41	0.004

*= Top Three
**= Everyone + Teen

Discussion

In the 1980s there was a nationwide tendency in favor of the use of video games and computers in classrooms for academic purposes. Numerous video games with educational purposes have evolved throughout the last thirty years of the video game industry. However, concurrently with this development the industry has well designed video games for the youth with violent content, which rewarded the players every time they used violence during the game. While some may argue that not all adolescents exposed to violent video games are at risk to become more aggressive, it is known that exposure to violent video games may constitute a risk factor for some youngsters.
A literature review of the more recent studies in this topic done by Gentile (2004) argued that “a growing body of research is linking violent video game play to aggressive cognitions, attitudes, and behaviors.” Villani concluded that “the primary effects of media exposure are increased violent and aggressive behavior, increased high-risk behaviors, including alcohol and tobacco use, and accelerated onset of sexual activity” (Villani, 2001). The newer forms of media have not been adequately studied, but concern is warranted through the logical extension of earlier research on other media forms and the amount of time that average child spends with increasingly sophisticated media (Villani, 2001). Vastag found that “the most significant correlation between trait hostility and aggressive behavior came not from the amount of time spent playing violent video games, but rather from the level of parental involvement in purchasing and playing games”, and that “children of parents who set limits and monitored game purchases were much less likely to fight or argue with teachers” (Vastag, 2004). Robinson mention that exposure to violent media seems to produce significant effects in children such as increase in aggressiveness or develop attitudes and tendencies to resolve conflicts through violence (Robinson, Wiled, Navracruz, Haydel, Varady, 2001). We observed in our study that adolescents reported they have been more involved in physical fights during the last year and the Buss-Perry AQ results showed an increase in overall aggressive traits in this sample.
According to Gentile (2001) “many video games rated as suitable for all audiences (Everyone) have significant levels of violence” (Walds & Gentile, 2001). In our study, more than 40% (44.4%) of the adolescents reported as their most played (#1) video game, one rated Teen (T) or Mature (M). These categories have more violent content than those rated as Everyone (E) according to the ESRB (www.esrb.com). Fifty three percent (53.0%) reported they preferred violent video games, 22.0% preferred video games with fight content, 23.0 per cent with adventure content, and 22.0 per cent preferred action content. In addition, 47.8 per cent of the group of adolescents that reported been involved in physical fights during the last year, chose a video game rated as T or M as their most played video game. When examining the favorite video game ratings in each group, those involved in physical fights (59 per cent) and those not involved (52%), both groups pointed out as their favorite those videogames rated Everyone. A propensity between exposure to violent video games and children’s aggressive behavior was observed. We compared the top three most played games rating (Everyone, Teen and Mature) with the 1 to 10 (1-3 mild, 4-6 moderate and 7-10 high violence) self rated violence question. We found that 68.2% (n=15) of the participants in the Mature-group (at least one M-rated video game) preferred the high violence category compared to 31.8% (n=7) in the Non-M (Everyone + Teen) group. This result was statistically significant with a p=0.016 and expected, since people that like violence in their games will find M-rated games more appealing. It is interesting that only 64% of the parents that participated in this study reported to supervise the adolescent while playing video games. This issue needs to be explored with larger samples since parental involvement in video game habits may act as a protective factor for some children and adolescents who play violent video games. Mental health professionals could use these findings to understand the relevance of incorporating in their evaluations the exploration of video games habits as a potential risk factor for future aggressive/ maladaptive behavior in their patients.
This study has some limitations. First, the sample was a clinical one, so our findings cannot be generalized to other adolescent population. In addition, the size of the sample was not representative of the clinical population receiving clinical services at this Outpatient Psychiatric Clinic. Also, the design of the study do not allow for taking in consideration other pre-existing risk factors for aggressive/violent behaviour in this group of adolescents including the possibility of a Axis I diagnosis. In terms of parental supervision further analysis will be required to explore the point of view of the parents versus the adolescents. Further research in this area is needed to understand the relationship between exposure to violence in video games and aggressive behaviour.
Acknowledgement: We would like to acknowledge Josue De los Santos, Darice Rodríguez, Vanessa Padilla, and DorMarie Arroyo. Special thanks to Dr. Jose M. Andreu for all his support and collaboration and to Linnette Rodríguez Figueroa for contributing in the data analysis.

Correspondence to:
Roberto Gutiérrez, MD
Cond. Vista Verde 1200
Carr. 849 box 348 San Juan PR 00924
E-mail: rgutierrezmorales@yahoo.com

Note: The main authors confirm that they have full access to all the data in the study, and takes responsibility for the integrity of the data and the accuracy of the data analysis.

Study statistical expert: Linnette Rodríguez Figueroa, MSc, PhD

References

1. Anderson C. (2004). An Update of The Effects of Playing Violent Video Games. Journal of Adolescents 27 113-122.
2. Gentile D, Lynch P, Linder J, Walsh D (2004). The Effect of Violent Video Games Habits on Adolescent hostility, aggressive behaviors, and school performance. Journal of Adolescents 27 275-22.
3. Loeber R., Stouthamer-Loeber M. (1987). The prediction of delinquency. In Handbook of Juvenile Delinquency. Edited by Quay HC. New York, John Wiley & Sons, pp 325-382.
4. O’Keefe L. (2002). Media Exposure feeding children’s violent acts. AAP Policy states. AAP News. January.
5. Robinson T, Wilde M, Navracruz L, Haydel K, Varady A. (2001). Effects of Reducing Children’s Television and Video Game Use on Aggressive Behavior. Archive of Pediatric Adolescent Medicine, January, 155 (1): 17-23.
6. US Department of Health and Human Services (2001).Youth Violence: A Report of the Surgeon General. Rockville, MD: US Department of Health and Human Services, Centers for Disease Control and Prevention, National Center for Injury Prevention and Control; Substance Abuse and Mental Health Services Administration, Center for Mental Health Service; and National Institutes of Health, National Institute of Mental Health, pp 87.
7. Vastag, B (2004). Does video game violence show aggression? studies probe effects of virtual violence on children. JAMA 291:15 1822-1824.
8. Villani S. (2001). Impact of media on children and adolescents: A 10-year review of the research. Journal of the American Academy of Child and Adolescent Psychiatry 40:4 392-400.
9. Walds D, Gentile D, (2001). A validity test of movie/television /videogames rating. Pediatrics, 107: 1302-1308.
10. Willis E, Stransburger VC (1998). Media violence. Ped Clin North Am 45:2, 319.
11. www.esrb.com
12. www.tendenciaspr.com

First Published October 2009

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