In the digital era, playing games has become a common leisure activity for many individuals to relax. Engaging in online gaming can provide valuable life experiences, reduce stress, and enhance social interaction. However, excessive involvement in online gaming can pose risks for vulnerable groups, especially children and adolescents [1].

Teenagers and young adults are among the most active users of the internet and modern technology, having grown up in environments shaped by rapid internet development. Approximately two-thirds of global internet users are in the 15 to 24 age group. As a result, adolescents aged 12 to 17 represent a particularly vulnerable group due to their greater internet access compared to other age categories [2,3].

Internet gaming disorder (IGD) is recognized as a behavioral addiction and is classified within the substance-related disorders category. According to the Diagnostic and Statistical Manual of Mental Disorders, IGD can be diagnosed if an individual meets five or more out of nine specific criteria within a 12-month period. These criteria include obsession, withdrawal, increased tolerance, impaired control, loss of interest, continued use despite negative consequences, deceptive behavior, efforts to avoid negative feelings, and functional impairment [4].

In Asia, it is estimated that approximately 5% of adolescents experience internet gaming addiction, with prevalence rates reported to be seven times higher among boys than girls. Studies indicate that children and adolescents are particularly susceptible to a range of mental health disorders related to internet gaming, such as anxiety, depression, and loneliness [5]. The use of internet games among Indonesian teenagers is also substantial. Approximately 80% of Indonesian adolescents use the internet daily, and the prevalence of IGD among this population is estimated at 10.15% [6].

The physical, social, and psychological problems caused by IGD have significant implications not only for individuals but also for their families and communities. Evidence supports a link between IGD and physical health issues, including sleep disturbances, eating disorders, decreased physical activity, back pain, eye strain, and reduced visual acuity [1,6].

This research aimed to provide an overview of game addiction among secondary school students in Depok City, Indonesia. Furthermore, the study sought to evaluate the extent to which gaming dependency contributes to cognitive and social impairments in this population. By offering a detailed understanding of gaming addiction profiles, the study is expected to support the development of effective interventions to prevent gaming addiction from evolving into persistent cognitive disorders. The study's objectives were to assess the severity of online gaming addiction in adolescents and to explore the perceived impacts of gaming dependency on emotional, cognitive, behavioral, and social aspects through an item-level analysis of the Internet Addiction Test (IAT). By emphasizing cognitive and social dimensions, this research aims to make a meaningful contribution to the prevention and treatment of gaming addiction among secondary school students.

This study aimed to determine the level of online gaming addiction among secondary school students and its impacts; therefore, a descriptive and quantitative research design was employed. The study population consisted of junior high school and senior high school students in Depok City, Indonesia. Specifically, research samples were drawn from students attending SMPN 05 Depok (State Junior High School 05 Depok) and SMAN 14 Depok (State Senior High School 14 Depok). The study received ethical approval from the Health Research Ethics Committee of Universitas Indonesia (approval no. 826/UN2.F1/ETIK/PPM.00.02/2024). Informed consent to participate was obtained from either the student or their guardian.

Data collection was carried out by distributing questionnaires to all male and female students in both schools. The characteristics recorded for each subject included age and gender. To assess the degree of gaming addiction in adolescents, the researchers utilized the IAT questionnaire developed by Kimberly Young, which evaluates issues resulting from excessive internet use. The IAT is a self-report instrument utilizing a five-point Likert scale. This questionnaire has been validated in Indonesian, demonstrating a high correlation coefficient and strong reliability (Cronbach’s alpha of 0.895) [7]. The instrument consists of 20 items that assess psychological dependence, compulsive use, and withdrawal symptoms. The total IAT score is classified into four categories to indicate the severity of internet addiction: normal (0-30), mild internet addiction (31-49), moderate internet addiction (50-79), and severe internet addiction (80-100) [8,9]. Although initially developed to assess general internet addiction, the IAT captures critical behavioral domains, such as compulsive use, neglect of responsibilities, emotional regulation, and time management, that are frequently disrupted in individuals exhibiting problematic gaming patterns. The IAT has been widely used in adolescent populations and has shown robust validity and reliability in a range of cultural contexts, including Indonesia [10]. In this study, the researchers applied the 20-item IAT by Kimberly Young to evaluate the severity of gaming addiction. For exploratory purposes, the items were organized into four domains: emotional disturbances, learning impairments, sleep disturbances, and disruptions in daily activities.

Participants in this study were grouped into two age categories: 12-15 and ≥16 years. This classification was based on developmental stages commonly identified in adolescent psychology. The 12- to 15-year-old group generally represents early to mid-adolescence, which typically corresponds to junior high school students, while the ≥16-year-old group reflects late adolescence and comprises senior high school students. These groups differ in cognitive and emotional development, social environment, and academic demands, factors that may influence their vulnerability to problematic gaming behaviors and their associated psychological impacts.

Data analysis was conducted using SPSS ver. 23 (IBM Co.). The characteristics of the subjects are presented as proportions (%). For numerical data, normality was assessed initially. If the data were normally distributed, results are presented as means; otherwise, medians are reported. The analysis involved comparing the four domains of disturbances according to respondents’ gender and age. Additionally, associations between gender and age with the severity of gaming addiction were examined. Statistical significance was determined at a P value of <0.05.

Gaming addiction refers to excessive online gaming that becomes problematic due to its adverse health effects, including physical and mental disorders, reduced social interaction, diminished work efficiency, and declines in academic performance. Based on the findings of this study, significant gender differences were identified in relation to gaming addiction. Male students were more likely to experience emotional disturbances, learning impairments, sleep disturbances, and disruptions in daily activities, whereas female students tended to report milder disturbances. Gender differences were also observed in the severity levels of gaming addiction, with the proportion of male students experiencing moderate addiction being the highest. Conversely, a greater proportion of female students were categorized as not experiencing gaming addiction.

These findings align with previous research by Samsidar et al. [11] and Kaur [12], both of which also reported significant gender differences in gaming addiction. Males appear to be more vulnerable to gaming addiction, potentially due to their tendency to engage in competitive and high-risk games, such as shooting and action genres. Additionally, many online games are designed with features that particularly appeal to males, especially adolescent boys [11,12]. In contrast, girls tend to use the internet more for social interaction. Studies also show that boys typically spend more time playing games each day than girls, making it unsurprising that males are more prone to gaming addiction across all age groups [1,13].

From a neural perspective, gaming-related stimuli trigger stronger desires to play in males and produce different neural responses. Competitive gaming structures may be particularly appealing to boys, who experience feelings of success and achievement through gaming. Social and cultural factors also play a role, as aggressive behavior may be more socially acceptable among boys, and some game developers specifically target boys as their primary users, given their enjoyment of challenging gameplay [13].

Neuroimaging studies in both men and women indicate that changes in resting-state brain activity are associated with internet gaming addiction in regions involved in attention, cognitive control, decision-making, and sensorimotor coordination, including the prefrontal cortex (PFC), parietal cortex, posterior cingulate cortex, and the cortical-ventral striatum circuit [14].

Activation of the ventral striatum influences motivation and goal-directed behavior, and the striatum can be activated when an individual encounters addiction-related stimuli. Notably, there is a positive correlation between male gender and striatal activation that may trigger addictive behavior. The orbitofrontal cortex also shows greater activation in males exposed to game-related cues, mediating seeking behavior and the risk of relapse, as seen in substance addiction. Following gameplay, several regions in the PFC demonstrate gender-specific activation patterns, with males displaying greater activity than females. Dysfunction in the PFC is considered a hallmark of addictive behaviors. Moreover, increased thalamic activation in males has been positively correlated with persistent gaming desire after playing [15].

In this study, the severity of gaming addiction also differed significantly between junior high school and senior high school students. The junior high school group exhibited more moderate to severe levels of gaming addiction. Adolescence is a critical period of identity exploration and decision-making, during which the search for or realization of life goals shapes identity development. It is presumed that senior high school students have more mature responsibilities and personalities, which may explain why their level of gaming addiction is generally milder [16].

Gaming addiction can negatively affect emotional well-being for several reasons. First, social isolation is a major consequence, as addicted individuals often spend extensive time in virtual environments, limiting real-life social interactions. This can lead to feelings of loneliness and disrupt emotional stability. Additionally, gaming addiction is associated with disturbed sleep patterns, as individuals may play late into the night, resulting in mood swings, fatigue, and emotional instability [17,18].

Psychological pressure also contributes to the relationship between gaming addiction and emotional disturbances. Addicted gamers may experience high levels of stress, especially when they feel overwhelmed by in-game tasks or compelled to achieve specific goals. This psychological pressure can significantly elevate stress and anxiety levels. Additionally, losing control over the amount of time and energy devoted to gaming can result in feelings of failure, regret, and frustration, further disrupting emotional balance [17,18].

Internet gaming addiction is often negatively associated with student learning and motivation. Gaming addiction adversely affects students’ behavioral, emotional, and cognitive engagement, leading to significant negative impacts across all dimensions of learning engagement. The results of research model validation indicate that behavioral, emotional, and cognitive engagement all contribute to reduced academic achievement motivation. Cognitive engagement was the most influential factor in students’ academic achievement, with emotional engagement also playing a crucial role [19].

Positive achievement motivation is a strong predictor of cognitive engagement within learning. Students who suffer from gaming addiction typically have lower academic achievement motivation due to insufficient academic planning and decreased motivation. Consequently, gaming addiction has a substantial impact on learning engagement, which in turn mediates the relationship between social network addiction and academic achievement [19].

The impacts of gaming addiction were more frequently observed in male students, consistent with the higher prevalence of gaming addiction among them [20]. However, this study found no significant differences in the impact of gaming addiction between junior high school and senior high school age groups. This suggests that the adverse effects of gaming addiction are experienced across all adolescent age groups.

In conclusion, the phenomenon of online gaming addiction has become a serious concern for children's mental health. This research demonstrates that gaming addiction is prevalent among middle school-aged children, especially males. Moreover, it was found that online gaming addiction can negatively affect cognitive abilities, emotional health, daily functioning, and academic performance. Therefore, integrated efforts by parents, schools, and communities are needed to enhance awareness of the risks of online gaming addiction and to develop effective prevention strategies. These strategies should aim to engage children in positive activities and foster a healthy balance between their online and offline lives.

Evidence-based interventions, such as school-based psychoeducational programs, cognitive-behavioral therapy for managing digital behavior, and parental involvement workshops, have been shown to be effective in reducing gaming-related problems. Additionally, community initiatives—including digital literacy campaigns and peer support groups—can help adolescents develop healthier gaming habits and improve self-regulation skills. Implementing these strategies in school curricula and community outreach may provide sustainable solutions for early intervention and prevention.