Background: Children and teenagers frequently use video games as a form of entertainment. Although the middle east has one of the fastest-growing video game user populations, most studies need more national data to demonstrate the prevalence of playing video games and its effects on aggressive and mental health behaviours. Therefore, this study aimed to assess the prevalence of video game use and its association with aggressive behaviours among adolescents in Saudi Arabia.Methods: This was a community-based cross-sectional study involving males and females, aged 15-18 years, in both private and public secondary schools in the five main regions of Saudi Arabia. A modified aggression questionnaire comprised 29 items and scored on a 5-point Likert scale was electronically self-administered for each participant. This survey measured hostility, verbal aggression, physical aggression, and anger.Results: A total of 4,840 students participated in the study with an average age of 16.15±3.98 years. Males frequently played video games compared with females (p<0.0001). The average playing time per day was significant across males (p<0.0001). Females were more likely to show anger and hostility (p<0.0001 for both). However, males were more likely to show physical aggression (p<0.0001).Conclusions: Our study suggests that playing video games might associate with violent behaviours among adolescents in Saudi Arabia. This conclusion is supported by previous international studies. Increasing families’ awareness about video games and their impact on mental health and behaviours would help them identify their benefits and drawbacks.