The Effectiveness of Serious Games for Alleviating Depression: Systematic Review and Meta-analysis

Abstract

Background Depression is a common mental disorder characterized by disturbances in mood, thoughts, or behaviors. Serious games, which are games that have a purpose other than entertainment, have been used as a nonpharmacological therapeutic intervention for depression. Previous systematic reviews have summarized evidence of effectiveness of serious games in reducing depression symptoms; however, they are limited by design and methodological shortcomings. Objective This study aimed to assess the effectiveness of serious games in alleviating depression by summarizing and pooling the results of previous studies. Methods A systematic review of randomized controlled trials (RCTs) was conducted in accordance with the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) statement. The search sources included 6 bibliographic databases (eg, MEDLINE, PsycINFO, IEEE Xplore), the search engine “Google Scholar,” and backward and forward reference list checking of the included studies and relevant reviews. Two reviewers independently carried out the study selection, data extraction, risk of bias assessment, and quality of evidence appraisal. Results of the included studies were synthesized narratively and statistically, as appropriate, according to the type of serious games (ie, exergames or computerized cognitive behavioral therapy [CBT] games). Results From an initial 966 citations retrieved, 27 studies met the eligibility criteria, and 16 studies were eventually included in meta-analyses. Very low-quality evidence from 7 RCTs showed no statistically significant effect of exergames on the severity of depressive symptoms as compared with conventional exercises (P=.12). Very low-quality evidence from 5 RCTs showed a statistically and clinically significant difference in the severity of depressive symptoms (P=.004) between exergame and control groups, favoring exergames over no intervention. Very low-quality evidence from 7 RCTs showed a statistically and clinically significant effect of computerized CBT games on the severity of depressive symptoms in comparison with no intervention (P=.003). Conclusions Serious games have the potential to alleviate depression as other active interventions do. However, we could not draw definitive conclusions regarding the effectiveness of serious games due to the high risk of bias in the individual studies examined and the low quality of meta-analyzed evidence. Therefore, we recommend that health care providers consider offering serious games as an adjunct to existing interventions until further, more robust evidence is available. Future studies should assess the effectiveness of serious games that are designed specifically to alleviate depression and deliver other therapeutic modalities, recruit participants with depression, and avoid biases by following recommended guidelines for conducting and reporting RCTs. Trial Registration PROSPERO International Prospective Register of Systematic Reviews CRD42021232969; https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=232969

The Effectiveness of Serious Games in Alleviating Anxiety: Systematic Review and Meta-analysis

“…This finding is consistent with that of a previous review [ 16 , 62 ]. Specifically, a meta-analysis of 8 studies showed a statistically significant difference ( P =.004) in depression levels between the exergames group and the control group.…”

“…This indicates that conventional exercises are at least as effective as conventional exercises. Our findings are similar to those of previous reviews [ 16 , 62 ]. Specifically, a meta-analysis of 5 RCTs showed no statistically significant difference ( P =.81) in anxiety levels between the exergames group and the usual care group (ie, conventional exercises) [ 16 ].…”

“…Specifically, a meta-analysis of 5 RCTs showed no statistically significant difference ( P =.81) in anxiety levels between the exergames group and the usual care group (ie, conventional exercises) [ 16 ]. Similarly, no statistically significant difference ( P =.12) in depression levels between the exergames group and conventional exercises was found in another meta-analysis of 7 RCTs [ 62 ].…”

“…Specifically, a meta-analysis of 8 studies showed a statistically significant difference ( P =.004) in depression levels between the exergames group and the control group. In contrast, exergames have a statistically and clinically significant effect on depression levels when compared with no intervention, according to a meta-analysis of 8 studies [ 62 ].…”

The Effectiveness and Safety of Serious Games for Improving Cognitive Abilities Among Elderly People With Cognitive Impairment: Systematic Review and Meta-Analysis

“…Serious games exist in a variety of formats based on the therapeutic modality, including (1) cognitive training games that aim to maintain or improve users’ cognitive functions, such as working memory and attention; (2) exergames, or video games that entail physical exercises (eg, balance exercises) as part of the intended gameplay; (3) computerized cognitive behavioral therapy (CBT) games, which are video games that provide CBT for the users; and (4) biofeedback games, which are video games that utilize electrical sensors attached to the participant to receive information about the participant’s body state (eg, electrocardiogram sensors) and seek to influence some of the player body’s functions (eg, heart rate). Previous systematic reviews have shown that serious games have the potential to prevent or alleviate mental disorders such as depression [ 14 ] and anxiety [ 15 ]. Further, the literature suggests that serious games can be a good mental stimulant and improve brain health through the use of memory, visualization, and motor skills [ 16 ].…”