Gaming duration and psychological well-being among university students: implications for public health prevention using a cross-sectional study with a modelling approach

Online gaming has emerged as an important public health concern among university students due to potential association with adverse health outcomes. This study aimed to examine the association between PUBG gaming and depression, anxiety, stress, and post-traumatic stress symptoms among university students to inform public health prevention strategies. A cross-sectional survey was conducted with 542 participants who played PUBG, recruited through convenience sampling. Data were collected using self-administered questionnaires including, PHQ-9, PCL-5 (PTSD), and DASS-21 (depression, anxiety, stress). Associations were examined using Chi-square tests, Kendal tau correlations, and multinomial logistic regression. Additionally, SHAP-based explainable machine learning (XGBoost) was employed to evaluate the relative importance of demographic and gaming-related predictors. Among 542 participants (84.7% male), moderate psychological symptoms were the most frequently reported, including depression (50.6% on DASS-21), anxiety (62.9%), stress (47.0%). Probable PTSD was identified in 95 (17.5%) participants, compared with 447 (82.5%) classified as having no probable PTSD (χ²(1) = 228.61, p < 0.001). Years of PUBG experience was significantly associated with moderate stress (AOR = 0.810, 95% CI: 0.669–0.980, p = 0.031), For stress, playing 5–6 h/day was significantly associated with higher odds of mild stress (AOR = 2.213, 95% CI: 1.090–4.494, p = 0.028). However, greater PUBG playing experience was significantly associated with increased odds of probable PTSD, with each additional year of experience corresponding to a 25.3% increase in odds (AOR = 1.253, 95% CI: 1.019–1.542, p = 0.032). The study noted that Students reporting good academic performance had significantly decreased odds of probable PTSD (AOR = 0.300, 95% CI: 0.134–0.673, p = 0.003)Students who played PUBG for < 2 h/day had significantly decreased odds of probable PTSD (AOR = 0.225, 95% CI: 0.084–0.603, p = 0.003) SHAP-based explainable analysis further identified years of PUBG playing and average daily playing time as associated factors of symptom severity across the outcomes. The study concluded that PUBG gaming experience (years of play) and average daily playing time are important factors associated with the health of university students. These findings highlight the relevance of gaming behaviour as a potential public health concern and emphasize the need for preventive strategies promoting healthy digital habits, early identification of psychological distress, digital health literacy, and coordinated interventions involving families, schools, and healthcare systems. Longitudinal studies are warranted to establish the temporal relationship between gaming patterns and mental health outcomes and to guide evidence-based public health policies.