The impact of explicit mental health messages in video games on players’ motivation and affect

Effectiveness of applied and casual games for young people's mental health: A systematic review of randomised controlled studies

Many youth experience mental health problems and digital games hold potential as mental health interventions. This systematic review provides an overview of randomised controlled studies assessing the effectiveness of digital applied and casual games for improving mental health in youth aged 6-24 years. A systematic search of PsycINFO, Web of Science and Pubmed yielded 145 eligible studies. Studies on (sub)clinical participant samples (n = 75) most often focused on attention-deficit/hyperactivity disorder (ADHD), autism and anxiety. Applied games were found most effective for improving social skills, verbal memory and anxiety, whereas casual games were found most effective for improving depression, anxiety and ADHD. Studies involving healthy youth (n = 70) were grouped into papers examining anxiety in medical settings, momentary effects on positive and negative affect, and papers employing a longitudinal design measuring mental health trait outcomes. Promising results were found for the use of games as distraction tools in medical settings, and for applied and casual games for improving momentary affect. Overall, our findings demonstrate the potential of digital games for improving mental health. Implications and recommendations for future research are discussed, such as developing evaluation guidelines, clearly defining applied games, harmonising outcome measures, including positive outcomes, and examining nonspecific factors that may influence symptom improvement as well.

Assessing the Importance of Content Versus Design for Successful Crowdfunding of Health Education Games: Online Survey Study

Background

Health education games make health-related tasks enjoyable and interactive, thereby encouraging user participation. Entrepreneurs and health educators can leverage online crowdfunding platforms, such as Kickstarter, to transform their innovative ideas into funded projects.

Objective

This research focuses on health education game initiatives on Kickstarter. Through an online user survey, it aims to understand user perceptions and evaluate the significance of 8 distinct components that may influence the success of such crowdfunding initiatives.

Methods

A total of 75 participants evaluated games using 8 dimensions: game rules, learning objectives, narrative, content organization, motivation, interactivity, skill building, and assessment and feedback. The survey data were analyzed using descriptive statistical analysis, exploratory factor analysis, the Wilcoxon-Mann-Whitney test, and multivariate analysis.

Results

Exploratory data analysis showed that, among the 8 dimensions, skill building, content organization, and interactivity were the top-ranking dimensions most closely associated with crowdfunding health education game. The 8 dimensions can be grouped into 3 categories from the exploratory factor analysis: game content-, instruction-, and game design-related components. Further statistical analysis confirmed the correlation between these dimensions with the successful crowdfunding of health education games.

Conclusions

This empirical analysis identified critical factors for game proposal design that can increase the likelihood of securing crowdfunding support.

Does WeChat use intensity influence Chinese college students' mental health through social use of WeChat, entertainment use of WeChat, and bonding social capital?

Background

Previous research notes that the usage of WeChat is significantly related to individuals' mental health, but the underlying mechanism is still not completely discovered. The present study aimed to explore the sequential mediating roles of WeChat use motivations and bonding social capital on the effects of WeChat use intensity on mental health in Chinese college students.

Method

The present study adopted an online survey with a total of 487 Chinese college students. Correlation analysis and serial mediation analysis were measured by process regarding the hypothesis.

Results

The study presented findings indicating that WeChat use intensity had both direct and indirect impacts on the levels of life satisfaction and loneliness experienced by college students in China. Specifically, the utilization of WeChat for social motivation and entertainment motivation was found to have a suppressive effect on the relationship between the intensity of WeChat usage and individuals' life satisfaction. The association between the intensity of WeChat usage and mental health outcomes (life satisfaction and loneliness) was found to be mediated by bonding social capital. Furthermore, the association between the intensity of WeChat usage and mental health was found to be mediated by the sequential mediation effects of using WeChat for social motivation and bonding social capital, as well as the sequential mediation effects of using WeChat for entertainment motivation and bonding social capital.

Conclusion

Our findings provide implications for policymakers and social workers regarding renovating the perceptions of the relationships between WeChat use intensity and overall mental health. Specifically, practical online activities and services of SNSs are recommended to be designed for meeting social and recreational gratifications and boosting bonding social capital, which in turn promotes psychological wellbeing.

Improving the Health of Emerging Adult Gamers-A Scoping Review of Influences

Emerging adults (EAs), defined as adults aged 18 to 25, remain a difficult group to engage in healthy behaviours (including positive dieting and eating patterns). The environmental elements that influence the health behaviours of EAs have been studied. However, the literature is mixed on how online game environments, including eSports and game streaming, can be used to positively engage EAs. In this scoping review, we identified and analysed research on online games, EAs, and dietary patterns to create a behavioural ecological map of influences that intersect with EAs through online games. In total, 75 studies were found, identifying 23 influences that intersect with EAs through their online game use. ESports organisations, eSports athletes, and content creators may be areas of future research (and intervention) as these factors could positively influence the dietary behaviours of EAs (through online games).

Quality Social Connection as an Active Ingredient in Digital Interventions for Young People With Depression and Anxiety: Systematic Scoping Review and Meta-analysis

BACKGROUND

Disrupted social connections may negatively affect youth mental health. In contrast, sustained quality social connections (QSCs) can improve mental health outcomes. However, few studies have examined how these quality connections affect depression and anxiety outcomes within digital interventions, and conceptualization is limited.

OBJECTIVE

The aim of this study is to conceptualize, appraise, and synthesize evidence on QSC within digital interventions (D-QSC) and the impact on depression and anxiety outcomes for young people aged 14-24 years.

METHODS

A systematic scoping review and meta-analysis was conducted using the Joanna Briggs Institute methodological frameworks and guided by experts with lived experience. Reporting was guided by the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses). The MEDLINE, Embase, PsycINFO, and CINAHL databases were searched against a comprehensive combination of key concepts on June 24, 2020. The search concepts included young people, digital intervention, depression, anxiety, and social connection. Google was also searched. A reviewer independently screened abstracts and titles and full text, and 9.99% (388/3882) of these were screened by a second reviewer. A narrative synthesis was used to structure the findings on indicators of D-QSC and mechanisms that facilitate the connection. Indicators of D-QSC from the included studies were synthesized to produce a conceptual framework.

RESULTS

Of the 5715 publications identified, 42 (0.73%) were included. Among the included studies, there were 23,319 participants. Indicators that D-QSC was present varied and included relatedness, having a sense of belonging, and connecting to similar people. However, despite the variation, most of the indicators were associated with improved outcomes for depression and anxiety. Negative interactions, loneliness, and feeling ignored indicated that D-QSC was not present. In 24% (10/42) of the applicable studies, a meta-analysis showed a significant decrease in depression (-25.6%, 95% CI -0.352 to -0.160; P<.001) and anxiety (-15.1%, 95% CI -0.251 to -0.051; P=.003) after a D-QSC. Digital mechanisms that helped create a quality connection included anonymity, confidentiality, and peer support. In contrast, mechanisms that hindered the connection included disconnection from the real world and inability to see body language. Data synthesis also identified a 5-component conceptual framework of D-QSC that included rapport, identity and commonality, valued interpersonal dynamic, engagement, and responded to and accepted.

CONCLUSIONS

D-QSC is an important and underconsidered component for youth depression and anxiety outcomes. Researchers and developers should consider targeting improved QSC between clinicians and young people within digital interventions for depression. Future research should build on our framework to further examine relationships among individual attributes of QSC, various digital interventions, and different populations.

The Effect of Expectations on Experiences and Engagement with an Applied Game for Mental Health

Objective: Applied games are considered a promising approach to deliver mental health interventions. Nonspecific factors such as expectations and motivation may be crucial to optimize effectiveness yet have not been examined so far. The current study examined the effect of expectations for improvement on (1) experienced fun and positive affect, and (2) in-game play behaviors while playing MindLight, an applied game shown to reduce anxiety. The secondary aim was to examine the moderating role of symptom severity and motivation to change.

Materials and Methods: Fifty-seven participants (47 females; 17–21 years old) preselected on anxiety symptoms viewed a trailer in which MindLight was promoted as either a mental health or an entertainment game. These trailers were used to induce different expectations in participants. Participants subsequently played the game for 60 minutes. Before playing, participants filled out questionnaires about their general anxiety symptoms, motivation to change, state anxiety, affect, and arousal. While playing, in-game behaviors and galvanic skin response (GSR) were recorded continuously. After playing, state anxiety, affect, and arousal were measured again as well as experienced fun.

Results: Participants in both trailer conditions showed increases in state anxiety, arousal, and GSR. Expectations did not influence experienced fun and positive affect, nor in-game behaviors. In addition, no moderation effects of motivation to change and symptom severity were found.

Conclusion: Experiences and engagement with MindLight were not influenced by expectations, motivation to change, and symptom severity. For future research, it is recommended to examine individual differences in these effects, and long-term and more distal outcomes and processes.

Converging Evidence Supporting the Cognitive Link between Exercise and Esport Performance: A Dual Systematic Review

(1) Background: Research into action video games (AVG) has surged with the popularity of esports over the past three decades. Specifically, evidence is mounting regarding the importance of enhanced cognitive abilities for successful esports performance. However, due to the sedentary nature in which AVGs are played, concerns are growing with the increased engagement young adults have with AVGs. While evidence exists supporting the benefits of exercise for cognition generally in older adult, children and clinical populations, little to no work has synthesized the existing knowledge regarding the effect of exercise specifically on the cognitive abilities required for optimal esports performance in young adults. (2) Method: We conducted a dual-systematic review to identify the cognitive abilities integral to esports performance (Phase 1) and the efficacy of exercise to enhance said cognitive abilities (Phase 2). (3) Results: We demonstrate the importance of four specific cognitive abilities for AVG play (attention, task-switching, information processing, and memory abilities) and the effect that different types and durations of physical exercise has on each. (4) Conclusion: Together, these results highlight the role that exercise can have on not only combating the sedentary nature of gaming, but also its potential role in facilitating the cognitive aspects of gaming performance.

Trans and gender diverse young people's attitudes towards game-based digital mental health interventions: A qualitative investigation

BACKGROUND

Trans and gender diverse (TGD) young people are at high risk for mental health difficulties. Previous research has shown that three in four TGD young people have been diagnosed with an anxiety disorder and/or depression and almost one in two have attempted suicide. TGD young people experience barriers to traditional mental health services, commonly faced with inexperienced providers and discrimination. Video and computer games, as well as online spaces, are sources of resilience for TGD young people. Digital mental health interventions are a feasible, but understudied, approach to consider for this population.

METHODS

N = 14 TGD young people aged 11-18 years were recruited to take part in focus groups as part of a multistage project. The focus groups were transcribed verbatim and analysed using a general inductive thematic analysis approach. This paper reports on their attitudes towards digital games and game-based digital mental health interventions.

DISCUSSION

Aspects of game-based digital mental health interventions should be inclusive of diverse genders and sexuality, moderated appropriately and include content such as storylines and characters who are of diverse sexualities and/or gender. Participants were of the opinion that games should be preventative rather than treatment-focused; however, considering the high rate of mental health difficulties in this population, interventions should ideally address symptoms along the continuum from sub-clinical to clinical.

Explicit Mental Health Messaging Promotes Serious Video Game Selection in Youth With Elevated Mental Health Symptoms

Serious games aimed at promoting well-being in youth have promising effects and potential for far-reaching impact. Considering that most mental health disorders remain untreated in youth, therapeutic games may be most valuable when they are aimed at untreated youth with internalizing symptoms. However, when targeting youth outside of a clinical setting, the first impression of therapeutic video games may determine whether and how a game is played. Thus, understanding the influence of messaging used in the promotion of therapeutic games on game choice and experience is critical. The current study examined two alternatives in promoting mental health games: one included explicit mental health messaging (e.g., learn to manage stress) and the other was a stealth promotion that did not mention mental health but highlighted the entertainment value. Young adults with mild to severe internalizing mental health symptoms (i.e., depressive, anxiety, and stress symptoms) were shown two distinct trailer designs, with random assignment determining which design held which message. Participants (n = 129, M_age = 21.33, SD_age = 3.20), unaware that both trailers promoted the same commercial video game, were 3.71 times more likely to choose what they believed was the mental health game. Additionally, an unforeseen difference in the attractiveness of the two trailer designs resulted in participants being 5.65 times more likely to select the mental health game promoted in one trailer design over the other. Messaging did not influence game experience (i.e., gameplay duration, autonomy, competence, intrinsic motivation and affect). Exploratory analyses indicated that game experience, but not game choice, was influenced by symptom severity, symptom type and the interaction between symptom severity and messaging. The present study suggests that explicit mental health messages attract youth with mental health symptoms. Ultimately, youth may be empowered to seek out mental health games if they are promoted properly, allowing for far-reaching positive influences on well-being. Toward this aim, future research is needed on the game selection process, addressing underlying motivations, the balance between explicit health and entertainment messaging, and multiple interacting influences on game selection (e.g., promotion and peers).