Can a Commercial Video Game Prevent Depression? Null Results and Whole Sample Action Mechanisms in a Randomized Controlled Trial

Abstract

Depressive symptoms and disorders are major public health concerns, affecting many adolescents and young adults. Despite extensive research, depression prevention programs for youth show limited effectiveness. Moreover, the maximal potential of youth psychotherapy — on which depression prevention programs are based — may have been reached. Commercial video games may offer an engaging alternative vehicle for youth to practice emotional and social skills vital to mental health. The current study investigated the potential for the commercial video game Journey to prevent the exacerbation of depressive symptoms. A pre-registered randomized controlled trial tested the effectiveness of Journey as an indicated depression prevention approach compared to a control game condition and a passive control condition (Dutch Trial Register: NL4873, https://www.trialregister.nl/trial/4873). Additionally, potential action mechanisms for depression prevention using video games were examined. Participants aged 15 to 20 years old with elevated depressive symptoms (n = 244, Mage = 17.11, SDage = 1.76, 66.4% female) were given 4 weeks to play Journey (Mduration = 3 h 20 min) or the control game, Flower (Mduration = 2 h 36 min). Results showed no beneficial effects of playing the commercial video game, Journey, on youth’s change in depressive symptoms above and beyond the active and passive control conditions up to 12-months after the intervention. Additionally, no action mechanisms were found specifically for Journey. Nevertheless, over the whole study, participants decreased in depressive symptoms, became less sensitive to rejection, and experienced more hope and optimism. Moreover, participants who during the study decreased in rejection sensitivity or rumination or who increased in hope and optimism or in distraction and problem solving showed the strongest decrease in depressive symptoms. Although results do not support the use of the studied commercial game as an effective indicated depression prevention strategy, our results do suggest that rejection sensitivity, hope, optimism, rumination, distraction, and problem solving are promising targets for future depression prevention efforts. We conclude with important lessons for future research on games to promote mental health. Particularly, encouraging careful consideration of research designs to explore for whom and how potential action mechanisms and associated game mechanics may be effective.

Gaming My Way to Recovery: A Systematic Scoping Review of Digital Game Interventions for Young People's Mental Health Treatment and Promotion

“…The eight games for young adults included six therapeutic games: On Track>The Game ( 105 ) for first episode psychosis, PlayMancer ( 116 ) for bulimia nervosa, RAW HAND ( 117 ) for OCD, Walk in My Shoes ( 119 ) for PTSD, e-SMART-MH ( 106 ) for depression and OCfree ( 110 ) for OCD. One treatment facilitation game, the Cockroach Game ( 114 ), addressed specific phobia and a commercial game, Journey ( 109 ), depressive symptomatology.…”

“…Processes (RQ1) used in these eight studies included two RCTs ( 106 , 109 ), one clinical trial ( 110 ), two pre-post game assessments ( 117 , 119 ), one mixed method study ( 105 ) and two single case studies ( 114 , 116 ). The one barrier to study implementation involved a study design/research issue around burdensome travel requirements to the study site that affected recruitment and study feasibility ( 106 ).…”

“…Outcomes on young adult games for mild-moderate conditions (RQ2) included Impact , with five interventions showing significant improvement on their main variables: attitudes toward recovery in On Track>The Game ( 105 ), game feasibility (vs. controls) in e-SMART-MH ( 106 ), less binge eating in PlayMancer ( 116 ), on reaction scores and video game self-efficacy and attitudes toward the game for Walk in My Shoes ( 119 ) and on fear/avoidance in the Cockroach Game ( 114 ) for which Effectiveness was also demonstrated. The mobile CBT intervention, OCfree ( 110 ), demonstrated equal effectiveness as offline CBT for treating OCD, whereas the commercial game, Journey ( 109 ), had no effect on depressive symptoms, which persisted for 50.2% of players at follow-up. No results on secondary variables were reported.…”

“…Regarding Engagement (see Table 2 ), no young adult studies at Steps 2-3 reported on stakeholder involvement in game development (RQ3), whereas four studies reported on in-study user satisfaction, acceptability or other game assessments (RQ 4): On Track>The Game ( 105 ), e-SMART-MH ( 106 ), OCfree ( 110 ), and Journey ( 109 ). There was no participation in the other four young adult studies, but gameplay was recorded for the Cockroach Game ( 114 ), PlayMancer ( 116 ), RAW HAND ( 117 ), and Walk in My Shoes ( 119 ).…”

“…All studies in the review were primary studies, representing substantial methodological variation (e.g., RCTs and clinical trials, pre-post game assessments, mixed methods, qualitative studies, and a number of single studies using other methods). The quality assessment was limited to RCTs, of which five were rated as “fair” ( 77 , 78 , 108 , 109 , 111 ) and the remainder “poor.” Methodological issues included lack of blinding of participants and outcome assessors, lack of treatment allocation concealment, small sample sizes, low adherence, loss to follow-up and lack of avoidance of other treatments. For most studies, the randomization methods used, power calculations, reasons for loss to follow-up and low adherence were underreported (see Quality Rating Table, Appendix 4 in Supplementary Material ).…”