Video games and violence among children and adolescents in the Arab world: a systematic review

The paper defines video games and outlines their genre diversity and global popularity, noting approximately 3 billion players worldwide with 15% in the Middle East and Africa, and average weekly playtime over six hours. It describes WHO’s definition of violence and highlights that violent games are often favored by youth. Prior research suggests links between violent video games and aggressive cognition, affect, behavior, reduced prosocial behavior and empathy, though some meta-analyses report minimal effects. Evidence indicates both violent and nonviolent gaming may be implicated in adolescent aggression, with longer play duration associated with higher aggression and media violence linked to desensitization and decreased empathy. Such aggression can have short- and long-term adverse outcomes. The authors identify a gap: no prior systematic review has focused on the association between video games and violence among children and adolescents in the Arab world. The objective is to systematically examine this association, considering duration of play, game genres, and other potential moderating factors.

Systematic searches were conducted in PubMed and Web of Science. The initial search took place on 11/02/2021 with an updated search on 06/25/2022. Search strings combined terms for violence/aggression, video/computer games, and Arab countries. Two researchers independently screened titles, abstracts, and full texts; discrepancies were resolved by a third reviewer. Duplicates were removed manually. Inclusion criteria: studies in English assessing associations between video games and any measure of violence among children and adolescents in Arab world countries (Saudi Arabia, Qatar, Algeria, Syria, Bahrain, Comoros, Somalia, Djibouti, Sudan, Egypt, Yemen, Iraq, Jordan, Tunisia, Kuwait, Libya, Morocco, Mauritania, Lebanon, Palestine, UAE, Oman). Non-English studies were excluded; an unpublished dissertation on university students (mean age 22.42) was excluded for age. A standardized data extraction form captured study characteristics (authors, year, setting), design, tools, population (age, sex), and outcomes (aggression, associations with games, genre, duration, risk factors, behaviors). Nine cross-sectional questionnaire-based studies met criteria, representing five Arab countries, with a total of 2,875 participants. A PRISMA flow diagram summarized selection.

- Nine studies (all cross-sectional, questionnaire-based) with 2,875 participants from five Arab countries were included. - Association with aggression: Six studies examined aggression; five reported a significant positive association between video game play and aggression (Saudi Arabia and Egypt). One study (Lebanon) found no significant association when broader community violence exposures were considered. - Moderators/demographics: Aggression was more prevalent among males and early adolescents (10–14 years). Significant associations were observed between aggression and both age and sex. - Duration of play: Longer playtime was consistently linked to higher aggression. Heavy gaming (≥4 h/day) was reported in 20.1% of participants, 75.4% of whom were male. Median daily gaming time was 2 h/day in one study. Verbal aggression was associated with intense/heavy gaming. - Prevalence and patterns: Gaming prevalence ranged from ~80% to 99% in Saudi cohorts; median age of onset ~10 years; daily play was common. Devices varied by study (PlayStation frequently used; in another sample iPad 38.7%, smartphones 32.3%, PlayStation 19%). - Game genres: Preference for violent, stirring/adventure, or risk-taking/racing games was associated with higher aggression, risky behaviors, traffic rule violations, firearm-related violence, physical violence, and sexual harassment. One study (Lebanon) did not find a significant association between violent games and pro-violence attitudes. - Contextual/social factors: Playing with family members, especially brothers, was associated with higher aggression; gaming in cybercafes correlated with traffic violations and physical violence. - Behavioral observations: Frustration when interrupted or after losing; fights with siblings/friends; shouting; interest in copying game actions in real life; mood affected by game outcomes; some participants reported pleasure when viewing game violence.

Findings indicate a generally positive association between video game exposure and aggression among children and adolescents in the Arab world, aligning with several international studies. However, inconsistencies exist: one included study found no significant association, echoing other international work reporting null effects. Variability likely reflects differences in measurement (lack of standardized exposure and outcome tools), context (e.g., community violence potentially overshadowing game effects), and moderating factors such as age, sex, play duration, and game genre. Early adolescence appears to be a sensitive period with stronger associations, and male sex is consistently linked to higher aggression risk. Longer durations and certain genres (violent, adventure, racing/risk-taking) are associated with elevated aggressive and risky behaviors. These results underscore the need for standardized assessments and longitudinal/experimental designs to clarify causal pathways and moderators in the Arab context.

Evidence from the Arab world is limited and yields mixed results regarding the association between video games and violence in children and adolescents. While most included studies suggest a positive association moderated by age, sex, duration of play, and game genre, definitive conclusions cannot be drawn due to methodological heterogeneity. Given the growing prevalence of gaming, there is a pressing need for high-quality, standardized, and preferably longitudinal or experimental research to conclusively determine associations and mechanisms.

- Geographic coverage: Studies originated from only five of 22 Arab countries, limiting generalizability. - Study design: All included studies were observational, cross-sectional, and questionnaire-based, increasing susceptibility to confounding, self-report, and social desirability biases. - Measurement issues: Lack of standardized measures for gaming exposure (duration, frequency) and specific game content; some studies assessed media use broadly (TV, internet, video games), reducing specificity to video games. - Exposure detail: No study specifically isolated the effect of longer durations of violent (vs. nonviolent) game play. - Potential confounders: Uncontrolled contextual factors (e.g., exposure to community violence) may influence outcomes and attenuate associations.