Psychiatrists’ Perceptions of World of Warcraft and Other MMORPGs
Video game use, particularly massively-multiplayer online games (MMOs) and massively-multiplayer online role-playing games (MMORPGs), has been a focus of considerable research in recent years. However, little is known regarding how mental health workers perceive patients and clients who report playing them. The present study examines whether psychiatrists play MMOs/MMORPGs and how they perceive those who play them. Psychiatrists (N = 48) at a tertiary care centre in Canada completed a questionnaire assessing history of playing video games as well as whether they associate such use with psychopathology. Only 36.7 % believed there was an association between psychopathology and MMO/MMORPG use. Implications for clinical practice and future research are discussed.
KeywordsWorld of Warcraft MMORPGs Role-playing games Video games Stereotypes Psychiatrists
Video game use has been a focus of considerable research in recent years. The growth of massively-multiplayer online games (MMOs), massively-multiplayer online role-playing games (MMORPGs), smart phone-based casual games, and other social online games has led to questions being asked regarding their effect on mental health and well-being , their potential for addiction , and their impact on social capital . In particular, the online role-playing game World of Warcraft (WoW) has attracted attention, with recent work examining such games’ addiction potential , sexism in the gaming community , and personality factors of players . WoW has also been studied as a teaching tool and method of disease modelling . While this research remains in its infancy, WoW and other MMOs/MMORPGs have forced mental health workers to reconsider how we assess social connectedness, pathological versus non-pathological gaming behaviour, and approach to addictive behaviours . MMOs/MMORPGs have also forced us to reconsider how they change communication, as evidenced by an entire scientific conference which was held via WoW . In popular culture, players of MMOs/MMORPGs are often depicted as socially isolated and socially inept, as well as obese and often suffering from one or more psychiatric disorder, which may or may not reflect an actual public perception. Whatever the real benefits or harms of such games, MMO/MMORPG players represent a population of millions of individuals , an unknown percentage of whom will eventually come into contact with mental health services for reasons both related and unrelated to gaming behaviour, and so there is clearly reason to investigate what preconceptions mental health practitioners may have about them.
MMOs/MMORPGs will be perceived by a majority of participants as being associated with at least one DSM-IV-TR diagnosis.
Age will predict psychiatrists’ perceptions of psychopathology associated with MMOs/MMORPGs.
Materials and Methods
Psychiatrists were recruited from six hospitals within the McGill University hospital network. All were currently employed English-speaking psychiatrists over the age of 18. Email contact information was obtained from the faculty listserv.
The online questionnaire was created by consensus between the authors and consisted of 63 questions, 12 of which specifically pertained to MMOs/MMORPGs. No demographic information was collected except for participants’ ages. Questions assessed recent use (“In the last 6 months, have you used a social networking site such as Facebook or Google Plus?”), knowledge (“How knowledgeable do you feel about blog or status update sites such as Twitter or Livejournal?”), perceived associations with specific psychiatric disorders (“Do you feel that there is a link or association (causative or not) between use of table-top RPGs and mental health problems (such as depression, social anxiety, etc.)?”; “How strongly associated are the following DSM IV diagnoses with massively multiplayer online games?”). All questions were either yes/no or rated on a five point Likert scale. The questionnaire was not validated prior to administration.
All statistical analyses were conducted with SPSS version 19 (IBM Corp. Released 2010. IBM SPSS Statistics for Windows, Version 19.0. Armonk, NY: IBM Corp.). Our specific hypotheses were tested in the following manner:
Mean scores were calculated for the association between psychopathology and MMOs/MMORPGs. Results of these were provided as descriptives.
Participants were stratified into different age groups (30–45, 45–60, 60+). A mean score of the association between psychopathology and MMOs/MMORPGs was calculated. The mean scores were compared using a one-way ANOVA.
Ethics approval was obtained from the McGill University Institutional Review Board. Each participant electronically signed a consent form prior to completing the questionnaire.
Out of a total population of 160, 48 (30 %) completed the questionnaire. Ages ranged from 32 to 77 (mean = 53.8, SD = 10.8). Three (6.3 %) have ever played MMOs/MMORPGs and only one had played one in the last 6 months. 32 (67 %) have ever played any video game, 19 in the past 6 months.
36.7 % perceive a link between mental illness and MMOs/MMORPGs. This was similar to the percentage who associate Facebook and social networking sites (37 %) or Twitter and social update sites (33 %) with psychopathology  but notably higher than the percentage who perceive an association between psychopathology and RPGs (22 %) . There were no significant differences by age group for perceptions of psychopathology in people who play MMOs/MMORPGs (F = 1.22, df = 2, p > 0.05).
Our data did not support our hypotheses. None the less, interesting findings emerge.
Approximately one-third of this sample perceived an association between MMOs/MMORPGs and psychopathology. This has never previously been demonstrated and is important because such games are commonly played. Among our sample, stereotypes regarding those who play MMOs/MMORPGs were not widespread.
Fewer than one in ten psychiatrists in this sample have ever played MMOs/MMORPGs, although close to half of participants had played some form of video game in the past 6 months. We wonder whether this reflects a lack of interest in MMOs/MMORPGs in this population or whether it reflects that it is difficult to become involved in such games with physicians’ busy schedules.
There was no apparent effect of psychiatrists’ ages and their belief that MMOs/MMORPGs are associated with psychopathology.
Our study has a number of important limitations. Our participants are a convenience sample from hospitals at a single university centre; our results may not be generalizable to psychiatrists in the community or other centers. In total, 48 out 160 eligible psychiatrists completed questionnaires, and there was probably response bias. Our online questionnaire was distributed by email, so more computer-literate psychiatrists were more able to participate. We know that a number of individuals in our population do not use computers and were therefore functionally excluded; our results may not generalize to less computer-literate psychiatrists. However, 16 % of respondents were at least age 65 and our mean age was 54.3 years, suggesting that we did not entirely exclude older staff.
Our study was powered to detect moderate effect sizes. We could have been underpowered to detect smaller effects.
We did not collect extensive demographic information due to concerns about length and to minimize questions that could identify participants. Our sample included both adult and child and adolescent psychiatrists, but our questionnaire did not ask what age group(s) participants work with; we cannot comment on whether general psychiatrists and child psychiatrists have a different perception of video games. Our population included specialists in addiction medicine but we did not examine their responses separately from other psychiatrists; we cannot comment on whether addiction specialists perceive these games differently.
These findings suggest directions for future research. While the majority of psychiatrists in our study do not hold stereotypes about patients who use MMOs/MMORPGs, approximately one-third do. This potentially represents a large number of health care practitioners and could have implications for large numbers of patients. It could therefore be useful to further explore the beliefs which mental health workers hold regarding such new media technologies and more closely examine whether or not there is truth to the stereotypes they hold. Similarly, this pilot study was limited to psychiatrists, but much of the research on new media technologies appears in the social science literature. It could be valuable to distribute our questionnaire or one like it to allied mental health professionals (psychologists, social workers, nurses) as well as to other physicians in front-line mental health care.
This study represents some of the first data collected on psychiatrists’ perceptions of MMOs/MMORPGs. Our results suggest that psychiatrists do not assume that players of online games are at higher risk of psychopathology. This is a potentially understudied area and future research could potentially add significantly to our understanding.
Compliance with Ethical Standards
Conflict of Interest
All authors declare that they have no conflict of interest.
No funding was provided for this research.
All procedures followed were in accordance with the ethical standards of the responsible committee on human experimentation (institutional and national) and with the Helsinki Declaration of 1975, as revised in 2000 (5). Informed consent was obtained from all patients for being included in the study.
- 10.Blizzard Entertainment: World Of Warcraft®: Cataclysm™ One-Month Sales Top 4.7 Million. California: Blizzard Entertainment, 2011. http://us.blizzard.com/en-us/company/press/pressreleases.html?id=2847887. Accessed 2 April 2015.