• Stress and Anxiety
• Depression
• Premenstrual syndrome
• Diabetes
• Hypoglycemia
• Hyperthyroidism
• Bulimia
• Graves’ disease
• Medication
• Social factors

I. Hunger and Mental Disorders

1- Hunger, Stress, and Anxiety

The link between appetite, stress, and anxiety is associated with the “Fight-or-Flight” mechanism that involves hormonal communications between parts of the brain, including the hypothalamus and the pituitary gland, and the adrenal glands found on top of the kidneys.

Generally, in temporary stressful situations, the hypothalamus secretes CRH (corticotropin-releasing hormone) to stimulate the secretion of ACTH (Adrenocorticotropic hormone) by the pituitary gland leading to the secretion of the hormone noradrenaline (norepinephrine) by the adrenal glands which suppress appetite [1].

Epinephrine prevents appetite by inducing an increase in glucose blood level which signals to the brain that there is enough glucose available for the body cells to generate energy.

In the event of prolonged stress and anxiety, the hypothalamus secretes CRH to stimulate the secretion of ACTH by the pituitary gland leading to the secretion of a glucocorticoid known as cortisol by the adrenal glands that increase appetite, and therefore, hunger [2].

Cortisol indirectly increases appetite by stimulating appetite-promoting factors such as leptin, neuropeptide Y, or cytokines [3].

2- Hunger and Depression

Depression can either increase or decrease appetite depending on the activation or suppression of the activity of certain parts of the nervous system.

In case of increased appetite, there is a hyperactivation of the nervous system reward circuitry which contains pleasure centers.  This circuitry includes a pathway known as the dopamine reward pathway (mesolimbic pathway) responsible for the release of dopamine that promotes motivation and desire for reward stimulus such as an increase in appetite.

3- Hunger and Bulimia nervosa

Bulimia or bulimia nervosa is an eating disorder characterized by excessive eating followed by purging (vomiting) due to feelings of shame or guilt, associated with a potential weight gain. Bulimia is often associated with anxiety and depression.

Binge eating, purging, and the feeling of hunger appear to be associated with hedonic processes that involve motivation for pleasure, such as binge eating, and avoidance of pain such as potential weight gain. Therefore, purging is associated with preventing potential weight gain resulting in a vicious circle of binge eating, purging, and hunger [4].

II. Hunger and Pregnancy

During pregnancy, feeling hungry is natural and common, particularly during the second semester due to cravings, morning sickness, and the necessity to feed the growing baby. For this, a pregnant woman requires an additional supply of energy that triggers hunger and the need to consume more food.

II. Hunger and Premenstrual Syndrome

Physical and emotional changes take place before the start of the menstrual period and are known as premenstrual syndrome (PMS). During this period symptoms, such as stress, anxiety, sleeping difficulty, headache, mood swings, and increased hormonal levels, are common.

The level of hormones such as estrogens, serotonin, and cortisol are significantly increased resulting in metabolic surges and enhanced appetite.

III. Hunger and Chronic Diseases

1- Hunger and Diabetes

During diabetes, there is an increase in glucose levels in the blood known as hyperglycemia. However, the glucose is not being delivered to the cells to produce the energy necessary for their function.

Insulin resistance or lack of it results in a reduction of glucose absorption by the cells resulting in excessive hunger known as polyphagia.

2- Hunger and Hyperthyroidism

Hyperthyroidism is a disorder characterized by increased production by the thyroid of the thyroid hormones thyroxine (T4), and triiodothyronine (T3) that leads to an increase of the body metabolism and energy production.

This excessive metabolic demand is associated with increased glucose consumption by the cells which lowers the level of glucose in the blood causing hunger.

3- Hunger and Graves’ Disease

Graves’ disease is an autoimmune disease that affects the thyroid and causes hyperthyroidism. The increased metabolic demand for glucose and energy production results in hunger attacks.

4- Hunger and Hypoglycemia

Hypoglycemia is associated with a reduction in glucose level in the blood reaching a level of under 4 mmol/L due to several causes such as diabetic treatment using insulin and sulfonylureas, tumors, infections, organ failure, autoimmune diseases, and endocrine diseases [5]. This reduction reduces the level of glucose available for the cells’ function which triggers hunger.

For instance, insulinoma, a small tumor of the pancreas, results in increased secretion of insulin which increases glucose intake by the body cells.

IV. Hunger and Medication

Appetite suppressants or diet pills are used to help individuals lose weight by reducing the brain urge to consume food. Withdrawing from using these medications can trigger hunger and the need to consume more food and energy.

As mentioned above, diabetic medications, such as insulin and sulfonylureas, also reduce the level of glucose in the blood which triggers the need for more energy, and therefore, hunger.

V. Hunger and Social Factors

Several societal factors can promote hunger and weight loss over a healthier diet that provides quality nutrients to our bodies. For instance, the need to lose weight in a short period of time can be dictated by certain cultures that are concerned with body aesthetics.

Another factor is associated with a type of food. A diet rich in carbohydrates increases appetite due to the fast release of glucose in the blood and its rapid use by the cells of the body which results in increased appetite and hunger.

Conclusion

In general, feeling hungry is normal and common in healthy individuals due to physical and mental activities. However, hunger can also be due to more mental disorders and chronic diseases that require treatment. In the case of mental disorders such as anxiety and depression, antidepressants, anxiolytics, and cognitive-behavioral therapies are required to reduce appetite and prevent weight.

For hunger related to chronic diseases, such as diabetes, hyperthyroidism, and Graves’ disease, a follow-up by professionals is essential to monitor both treatment and excessive hunger known to be associated with these diseases.

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Although video gaming is entertaining, its implications on mental health are beginning to emerge through studies that evaluated its benefits and disadvantages on anxiety, depression, and cognition.

1. Benefits of Video Gaming on Anxiety, Depression, and Cognition

A. Benefits of Video Gaming on Anxiety

Based on 2017 estimates, 284 million people live with anxiety disorder globally, and this number is likely to be higher now [1].  Interventions with digital technologies have been shown to improve the quality and accessibility of mental health care in high- and low-income countries [2].

Several studies demonstrated the positive effects of video gaming on reducing anxiety. Web-based video games were shown to lower anxiety levels and increase the feeling of belonging to a group in adolescent boys [3]. 

Another study included 59 participants diagnosed with depression and divided them into video game participants (30 participants) and non-video game participants (29 participants).

Using the STAI (State-Trait Anxiety Inventory) test which is designed to assess the anxiety of an individual from everyday situations, the researchers showed that the video gamer group had a significantly reduced severity of state and trait anxiety compared to the non-video game participants [4].

Other studies have shown that games such as MindLight (strategy game), Max and the Magic Marker (commercial video games (CVGs)), Rayman (CVG), Nintendo Wii Exergames, and RPGs, significantly prevented or reduced anxiety after or following continual play, while exergames, video games that require physical activity or movement of the body, have been shown to combat anxiety associated with COVID-19 lockdowns [5][6].

B. Benefits of Video Gaming on Depression

Based on 2017 estimates, 264 million people lived with depression globally, and this number is also likely to be higher now [1]. Several studies reported improvement in clinical cases of depression through playing games such as Candy Crush (CVG), Angry Birds (CVG), Limbo (CVG), and casual games.

These games have been shown to decrease depression by promoting enjoyment, motivation, and flow states in veterans who were treated for mental and/or behavioral health problems, and other individuals who were diagnosed with depression [7][8].

Another study assessed the effect of commercial video games (CVGs) on participants with depression. The participants were prescribed to play CVGs for one month, three times per week (with 24 hours between each session), and for 30 minutes.

The effects were measured using the PHQ-9 questionnaire which monitors the severity of depression and response to treatment. The results showed that participants who played CVGs had significantly reduced symptoms of clinical depression [9]. These observations confirm that CVGs can also alleviate clinical depression in patients.

C. Benefits of Video Gaming on Cognition

Anxiety and depression can have effects on multiple levels of cognition ranging from effects on perception to attention to learning and executive function [10][11]. Several studies have demonstrated the benefits of video gaming on cognition, and mental health [12]. The effect of video gaming on cognition is assessed using the Stroop test and the Trail-Making Test.

The Stroop test, which was first developed by Stroop in 1935 [13], assesses the response of subjects to stimuli based on characteristics other than those typical of the most relevant and more readily apparent ones. For example, naming the colors of displayed words instead of naming the words.

The Trail-Making Test (TMT) relies on drawing lines between circles that contain consecutive numbers (e.g., 1, 2, 3…etc.) to evaluate both the memory and executive function of the subjects.

The results of one of the studies investigated the effects of video gaming on cognition and showed that video gamers respond faster to the Stroop test, but make significantly more errors compared to non-video gamers.

In the Trail-Making test, video gamers had faster response times, but errors did not differ from those in non-video gamers. The study’s authors concluded that video gamers possess enhanced processing speed and task-switching ability; however, they favored speed over accuracy on the task that evaluated cognitive inhibition ability compared to non-video gamers [14]. 

2. Disadvantages of Video Gaming on Mental and Physical Health

Although many studies demonstrated the benefits of video gaming on anxiety, depression, and cognition, other studies also highlighted the negative effects. These effects were shown to be associated with increased violence, headaches, stress, obesity, and harm to vision (eyes).

In a study that tested the idea that violent video game exposure (VVE) influences not only the player but also the player’s social network, it was found that aggressive video games can increase aggressive behaviors and desensitization to violence which could spread among connected individuals who did not play violent video games [15].

A study included 87 participants who played a violent or nonviolent game for 20 minutes and were asked to read a stress-provoking story aloud while their voices were recorded. The researchers found that voice stress was higher among violent video game players than among nonviolent video game players [16]. 

The effect of video gaming on headaches was evaluated by a study that included 954 adolescents who answered a questionnaire about the use of video games, and the presence of headaches. The results showed an association between excessive use of video games and the presence of headaches, that could develop into a migraine-type [17].

Physically, the effect of video gaming can lead to obesity, especially, when playing for long hours video games that do not require physical activity or movement of the body such as exergames. Long hours of exposure to video game screens can also affect the eyes and harm the vision.

3. Frequently Asked Questions about Video Gaming Effects on Mental Health

Does playing video games make you violent?

Research shows no direct link between playing video games and increased violence. However, excessive gaming may desensitize individuals to violence in some cases.

Can video games cause addiction?

Yes, excessive gaming can lead to addiction, known as Gaming Disorder. It’s characterized by loss of control over gaming habits, prioritizing gaming over other activities, and continued gaming despite negative consequences.

Do video games contribute to anxiety and depression?

While gaming itself isn’t a direct cause, excessive gaming or using games to escape from real-life problems can exacerbate feelings of anxiety and depression. However, some games designed for relaxation or cognitive therapy can have positive mental health effects.

Are there age restrictions for video game content to protect mental health?

Many countries have age ratings systems (e.g., ESRB, PEGI) to guide parents and consumers about appropriate content for different age groups. However, individual tolerance to content varies, and parental guidance is crucial.

Can playing video games improve cognitive functions?

Some research suggests that certain types of video games, particularly those involving strategy, problem-solving, and memory, can enhance cognitive functions. However, moderation is key to avoiding negative effects on mental health.

How can I balance gaming and mental well-being?

Set limits on gaming time, prioritize real-life social interactions and activities, and be mindful of how gaming affects your mood and behavior. Taking regular breaks, engaging in physical activity, and seeking professional help if gaming interferes with daily life, are essential.

Do violent video games desensitize players to real-life violence?

There’s an ongoing debate, but some studies suggest that prolonged exposure to violent video games can desensitize individuals to violence. However, the effects vary among individuals, and other factors like upbringing and personality play a role.

Are there therapeutic benefits to playing video games?

Yes, certain games are designed for therapeutic purposes, such as reducing stress, improving mood, and enhancing cognitive skills. However, it’s essential to use them in conjunction with professional guidance for maximum benefit.

Can gaming help with social connections and loneliness?

Online gaming can facilitate social connections and provide a sense of belonging for some individuals. However, it’s important to balance virtual interactions with real-life socializing to maintain overall well-being.

How can parents support their children’s gaming habits while safeguarding their mental health?

Parents can set reasonable limits on screen time, encourage a balance of gaming with other activities, monitor content, and have open discussions about gaming habits and their impact on mental health. Additionally, being a positive role model for healthy screen use is crucial.

Conclusion

Besides exposure to violent video games that can lead to aggressive behaviors and the length of time playing video games that can damage the eyes, promote obesity, and increase headaches, video gaming appears to be beneficial in decreasing anxiety and depression, and in improving cognition in individuals.

Additionally, because of their wide availability and lower cost compared to medication-based therapies, video games can be used as an alternative therapy to traditional mental health care for some mental health issues such as anxiety and depression.

References

[1] Ritchie, H. and Roser, M., 2018. Mental health. Our world in data. Retrieved May, 19, p.2020.

[2] Naslund, J.A., Shidhaye, R. and Patel, V., 2019. Digital technology for building capacity of non-specialist health workers for task-sharing and scaling up mental health care globally. Harvard review of psychiatry, 27(3), p.181.

[3] Ohannessian, C.M., 2018. Video game play and anxiety during late adolescence: the moderating effects of gender and social context. Journal of affective disorders, 226, pp.216-219.

[4] Fish, M.T., Russoniello, C.V. and O’Brien, K., 2014. The efficacy of prescribed casual videogame play in reducing symptoms of anxiety: a randomized controlled study. GAMES FOR HEALTH: Research, Development, and Clinical Applications, 3(5), pp.291-295.

[5] Zayeni, D., Raynaud, J.P. and Revet, A., 2020. Therapeutic and preventive use of video games in child and adolescent psychiatry: a systematic review. Frontiers in psychiatry, 11, p.36.

[6] Viana, R.B. and de Lira, C.A.B., 2020. Exergames as coping strategies for anxiety disorders during the COVID-19 quarantine period. Games for health journal, 9(3), pp.147-149.

[7] Carras, M.C., Kalbarczyk, A., Wells, K., Banks, J., Kowert, R., Gillespie, C. and Latkin, C., 2018. Connection, meaning, and distraction: A qualitative study of video game play and mental health recovery in veterans treated for mental and/or behavioral health problems. Social Science & Medicine, 216, pp.124-132.

[8] Pine, R., Fleming, T., McCallum, S. and Sutcliffe, K., 2020. The effects of casual videogames on anxiety, depression, stress, and low mood: a systematic review. Games for health journal, 9(4), pp.255-264.

[9] Russoniello, C.V., Fish, M. and O’Brien, K., 2013. The efficacy of casual videogame play in reducing clinical depression: a randomized controlled study. GAMES FOR HEALTH: Research, Development, and Clinical Applications, 2(6), pp.341-346.

[10] Gotlib, I.H. and Joormann, J., 2010. Cognition and depression: current status and future directions. Annual review of clinical psychology, 6, pp.285-312.

[11] Robinson, O.J., Vytal, K., Cornwell, B.R. and Grillon, C., 2013. The impact of anxiety upon cognition: perspectives from human threat of shock studies. Frontiers in human neuroscience, 7, p.203.

[12] Kowal, M., Conroy, E., Ramsbottom, N., Smithies, T., Toth, A. and Campbell, M., 2021. Gaming Your Mental Health: A Narrative Review on Mitigating Symptoms of Depression and Anxiety Using Commercial Video Games. JMIR Serious Games, 9(2), p.e26575.

[13] Stroop, J.R., 1935. Studies of interference in serial verbal reactions. Journal of experimental psychology, 18(6), p.643.

[14] Kowal, M., Toth, A.J., Exton, C. and Campbell, M.J., 2018. Different cognitive abilities displayed by action video gamers and non-gamers. Computers in Human Behavior, 88, pp.255-262.

[15] Greitemeyer, T., 2018. The spreading impact of playing violent video games on aggression. Computers in human behavior, 80, pp.216-219.

[16] Hasan, Y., 2017. Violent video games increase voice stress: An experimental study. Psychology of Popular Media Culture, 6(1), p.74.

[17] Xavier, M.K.A., Pitangui, A.C.R., Silva, G.R.R., Oliveira, V.M.A.D., Beltrão, N.B. and Araújo, R.C.D., 2015. Prevalence of headache in adolescents and association with use of computer and videogames. Ciencia & saude coletiva, 20, pp.3477-3486.

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