%0 Journal Article %@ 1929-0748 %I JMIR Publications %V 14 %N %P e64068 %T Escape Game to Promote Students’ Mental Health Outcomes in the Aftermaths of COVID-19 Pandemic: Protocol for a Mixed Methods Study Evaluating a Cocreated Intervention %A Labrosse,David %A Vié,Clara %A Harb,Mireille %A Montagni,Ilaria %+ Bordeaux Population Health U1219, Inserm, University of Bordeaux, 146 rue Léo Saignat, Bordeaux, 33000, France, 33 05 47 30 42 80, ilaria.montagni@u-bordeaux.fr %K Escape game %K pilot randomized controlled trial %K Covid-19 %K cocreation %K students %K mobile phone %D 2025 %7 2.4.2025 %9 Protocol %J JMIR Res Protoc %G English %X Background: The COVID-19 pandemic and the protracted lockdowns have heavily impacted university students’ mental health. Digital Escape Games represent a good means to reach students and propose them solutions for their psychological well-being. Objective: This study aimed to evaluate a cocreated digital Escape Game on students’ mental health in the aftermath of the COVID-19 pandemic, called EscapeCovid Game. The evaluation of the effectiveness of this stand-alone intervention concerns mental health outcomes (mental health literacy, appraisal and change of beliefs about mental health, management of emotions, and development of coping strategies) and the appreciation and relevance of the game. Methods: A randomized controlled trial with pre- and posttest data collection (online questionnaires with validated scales) is conducted among 500 students in Bordeaux, France, to evaluate the EscapeCovid Game cocreated with students, researchers, health professionals, and web developers. A subsample of students is randomly selected for responding to a semistructured interview following a mixed methods design. Recruitment is done through mail invitations from student associations and presentations in university classes. Half of the sample of the trial plays the Escape Game, while the other half receives an email with mental health–related information. Within the game, students discuss their personal experiences. The text is further used for the qualitative analyses. The whole study is carried out online. Results: The EscapeCovid Game has been developed, tested, and finalized by the end of March 2023. As of November 4, 2024, a total of 191 students have answered the baseline questionnaire (90 intervention vs 101 control). A total of 23 students have played the game and 53 are in the control arm. Among participants, by the end of September 20, 2023, twenty were interviewed (10 intervention and 10 control) reaching sample saturation. According to preliminary results, the EscapeCovid Game has had a positive impact on all defined outcomes, while the email has been effective in increasing knowledge on resources available and on coping strategies and meditation techniques. We expect the trial to be completed by the end of June 2025. Conclusions: The mixed methods findings of this study are due to demonstrate the effectiveness of the EscapeCovid Game in improving students’ mental health outcomes. Preliminary results from the qualitative substudy are promising: in the aftermath of the COVID-19 crisis, this intervention is intended to promote players’ mental health through gamification, knowledge transfer, and a learning-by-doing approach. Trial Registration: ClinicalTrials.gov NCT06720792; https://clinicaltrials.gov/study/NCT06720792 International Registered Report Identifier (IRRID): DERR1-10.2196/64068 %M 40173436 %R 10.2196/64068 %U https://www.researchprotocols.org/2025/1/e64068 %U https://doi.org/10.2196/64068 %U http://www.ncbi.nlm.nih.gov/pubmed/40173436 %0 Journal Article %@ 2291-9279 %I JMIR Publications %V 13 %N %P e67007 %T Comparative Efficacy of Video Games Versus Midazolam in Reducing Perioperative Anxiety in Pediatric Patients: Systematic Review and Meta-Analysis %A Luo,Ziyue %A Deng,Sisi %A Zhou,Ruihao %A Ye,Ling %A Zhu,Tao %A Chen,Guo %K video games %K midazolam %K perioperative period %K anxiety %K meta-analysis %K pediatric patients %D 2025 %7 10.3.2025 %9 %J JMIR Serious Games %G English %X Background: Pediatric patients undergoing surgery frequently experience significant anxiety, which can result in adverse effects such as prolonged sedation and behavioral changes associated with pharmacological interventions such as oral midazolam. Video games offer a nonpharmacological distraction method that shows promise in alleviating procedural anxiety without significant adverse effects. However, the effectiveness of video games compared to midazolam in managing perioperative anxiety remains uncertain. Objective: This study aimed to evaluate the effectiveness of video game interventions in reducing perioperative anxiety in pediatric patients undergoing general anesthesia. Methods: We conducted a comprehensive search across PubMed, Embase, Web of Science, and the Cochrane Library, supplemented by reference screening. Primary outcomes included anxiety levels assessed during parent separation and mask induction procedures, while secondary outcomes encompassed emergence delirium, postoperative behavior, and length of stay in the postanesthesia care unit (PACU). The risk of bias was assessed using the Risk of Bias 2 scale. Data were synthesized descriptively and through meta-analysis, with the certainty of the evidence evaluated using the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) criteria. Results: Six randomized controlled trials involving 612 participants were included in the analysis. Children who participated in video game interventions reported significantly lower anxiety levels during parent separation (standardized mean difference, SMD −0.31, 95% CI −0.50 to −0.12; P=.001), with high certainty, and during mask induction (SMD −0.29, 95% CI −0.52 to −0.05; P=.02), with moderate certainty, compared to those receiving oral midazolam. Additionally, significant differences in postoperative behavior changes in children were observed compared to oral midazolam (SMD −0.35, 95% CI −0.62 to −0.09; P=.008). Children in the video game intervention groups also had a shorter length of stay in the PACU (mean difference, MD −19.43 min, 95% CI −31.71 to −7.16; P=.002). However, no significant differences were found in emergence delirium (MD −2.01, 95% CI −4.62 to 0.59; P=.13). Conclusions: Video game interventions were more effective than midazolam in reducing perioperative anxiety among pediatric patients, improving postoperative behavior, and shortening the length of stay in the PACU. However, video games alone did not outperform midazolam in managing emergence delirium. Further high-quality research is needed for more conclusive results. Trial Registration: PROSPERO CRD42023486085; https://tinyurl.com/yc3suavb %R 10.2196/67007 %U https://games.jmir.org/2025/1/e67007 %U https://doi.org/10.2196/67007 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 27 %N %P e69080 %T Digital Gaming and Subsequent Health and Well-Being Among Older Adults: Longitudinal Outcome-Wide Analysis %A Nakagomi,Atsushi %A Ide,Kazushige %A Kondo,Katsunori %A Shiba,Koichiro %+ Department of Social Preventive Medical Sciences, Center for Preventive Medical Sciences, Chiba University, 1-33 Yayoicho, Inage-ku, Chiba, 2638522, Japan, 81 432903177 ext 3177, anakagomi0211@gmail.com %K digital gaming %K older adults %K flourishing %K well-being %K physical activity %K social engagement %K mobile phone %D 2025 %7 27.1.2025 %9 Original Paper %J J Med Internet Res %G English %X Background: Digital gaming has become increasingly popular among older adults, potentially offering cognitive, social, and physical benefits. However, its broader impact on health and well-being, particularly in real-world settings, remains unclear. Objective: This study aimed to evaluate the multidimensional effects of digital gaming on health and well-being among older adults, using data from the Japan Gerontological Evaluation Study conducted in Matsudo City, Chiba, Japan. Methods: Data were drawn from 3 survey waves (2020 prebaseline, 2021 baseline, and 2022 follow-up) of the Japan Gerontological Evaluation Study, which targets functionally independent older adults. The exposure variable, digital gaming, was defined as regular video game play and was assessed in 2021. In total, 18 outcomes across 6 domains were evaluated in 2022; domain 1—happiness and life satisfaction, domain 2—physical and mental health, domain 3—meaning and purpose, domain 4—character and virtue, domain 5—close social relationships, and domain 6—health behavior. Furthermore, 10 items from the Human Flourishing Index were included in domains 1-5, with 2 items for each domain. Overall flourishing was defined as the average of the means across these 5 domains. In addition, 7 items related to domains 2, 5, and 6 were assessed. The final sample consisted of 2504 participants aged 65 years or older, with questionnaires containing the Human Flourishing Index randomly distributed to approximately half of the respondents (submodule: n=1243). Consequently, we used 2 datasets for analysis. We applied targeted maximum likelihood estimation to estimate the population average treatment effects, with Bonferroni correction used to adjust for multiple testing. Results: Digital gaming was not significantly associated with overall flourishing or with any of the 5 domains from the Human Flourishing Index. Although initial analyses indicated associations between digital gaming and participation in hobby groups (mean difference=0.12, P=.005) as well as meeting with friends (mean difference=0.076, P=.02), these associations did not remain significant after applying the Bonferroni correction for multiple testing. In addition, digital gaming was not associated with increased sedentary behavior or reduced outdoor activities. Conclusions: This study provides valuable insights into the impact of digital gaming on the health and well-being of older adults in a real-world context. Although digital gaming did not show a significant association with improvements in flourishing or in the individual items across the 5 domains, it was also not associated with increased sedentary behavior or reduced outdoor activities. These findings suggest that digital gaming can be part of a balanced lifestyle for older adults, offering opportunities for social engagement, particularly through hobby groups. Considering the solitary nature of gaming, promoting social gaming opportunities may be a promising approach to enhance the positive effects of digital gaming on well-being. %M 39869904 %R 10.2196/69080 %U https://www.jmir.org/2025/1/e69080 %U https://doi.org/10.2196/69080 %U http://www.ncbi.nlm.nih.gov/pubmed/39869904 %0 Journal Article %@ 2291-9279 %I JMIR Publications %V 12 %N %P e58452 %T Game-Based Promotion of Assertiveness to Mitigate the Effects of Bullying in High School Students: Development and Evaluation Study %A Lepe-Salazar,Francisco %A Mejía-Romero,Fernando %A Benicio-Rodríguez,Dámaso %A Hernández-Reyes,Aylin %A Nakajima,Tatsuo %A Salgado-Torres,Sarita %+ Ludolab, Nigromante 89, Centro, Colima, 28030, Mexico, 52 3121100163, flepe@ludolab.org %K serious games %K bullying %K assertiveness %K multiple composite scenarios %K scenario %K cognitive behavioral therapy %K gaming %K design %K development %K bully %K assertive %K feasibility %D 2024 %7 24.12.2024 %9 Original Paper %J JMIR Serious Games %G English %X Background: For years, Mexico has reported the highest global incidence of school bullying, with approximately 19% of students going through some form of hostile peer interactions. Despite numerous interventions, these harmful conducts remain deeply entrenched in educational environments. Objective: To address this issue, we developed Bernstein, a serious game that promotes assertiveness—an essential protective factor that reduces the negative effects of bullying. Methods: Bernstein was designed using multiple composite scenarios, a methodology grounded in cognitive behavioral therapy. To evaluate the game’s effectiveness, we conducted an exploratory trial using the Rathus Assertiveness Schedule to assess assertiveness levels before and after the intervention. Participants were high school students who met the inclusion criteria of being open to playing a serious game (with no prior gaming experience required) and having access to a computer with internet connectivity for remote participation. A total of 100 students (65 boys and 35 girls) enrolled in the intervention; however, only 46 participants in the treatment group and 46 in the control group completed the study, resulting in a dropout rate of 8% (8/100). A paired 1-tailed t test was used to compare pre- and postintervention scores within each group, and a one-way ANOVA was conducted to compare the average score improvements between the 2 groups. Results: The treatment group showed a pretest mean Rathus Assertiveness Schedule score of –2.78 (SD 25.93) and a posttest mean of 1.69 (SD 29.48), with a paired 1-tailed t test yielding a P value of .01. The control group had a pretest mean of 2.07 (SD 25.69) and a posttest mean of –2.39 (SD 32.98), with a paired 1-tailed t test yielding a P value of .04. The one-way ANOVA (between groups) yielded a P value of .006, indicating a statistically significant difference, favoring Bernstein over the alternative protocol. Participant feedback highlighted the game’s engaging narrative and character design, although usability issues, such as navigation challenges, were noted as areas for improvement. Conclusions: The results suggest that Bernstein is a promising tool for promoting assertiveness in high school students, providing a potential strategy for addressing bullying-related issues. The study underscores the value of integrating Bernstein into educational programs, offering students a safe and interactive environment to develop resilience. As an exploratory trial, this study faced limitations affecting the generalizability of findings, including the remote format’s impact on facilitator guidance and a relatively small sample size. Further trials with larger, more diverse groups are recommended to validate these early results and enhance Bernstein’s scalability as part of a comprehensive antibullying strategy. %M 39718822 %R 10.2196/58452 %U https://games.jmir.org/2024/1/e58452 %U https://doi.org/10.2196/58452 %U http://www.ncbi.nlm.nih.gov/pubmed/39718822 %0 Journal Article %@ 2368-7959 %I JMIR Publications %V 7 %N 3 %P e12388 %T Reflective and Reflexive Stress Responses of Older Adults to Three Gaming Experiences In Relation to Their Cognitive Abilities: Mixed Methods Crossover Study %A Khalili-Mahani,Najmeh %A Assadi,Atousa %A Li,Kate %A Mirgholami,Mahsa %A Rivard,Marie-Eve %A Benali,Habib %A Sawchuk,Kim %A De Schutter,Bob %+ PERFORM Centre, Concordia University, , Montreal, QC, , Canada, 1 5148482424 ext 5370, najmeh.khalili-mahani@concordia.ca %K silver gaming %K serious games %K stress %K cognitive training %K brain training games %K exercise games %K ICT %D 2020 %7 26.3.2020 %9 Original Paper %J JMIR Ment Health %G English %X Background: The gamification of digital health provisions for older adults (eg, for rehabilitation) is a growing trend; however, many older adults are not familiar with digital games. This lack of experience could cause stress and thus impede participants’ motivations to adopt these technologies. Objective: This crossover longitudinal multifactorial study aimed to examine the interactions between game difficulty, appraisal, cognitive ability, and physiological and cognitive responses that indicate game stress using the Affective Game Planning for Health Applications framework. Methods: A total of 18 volunteers (mean age 71 years, SD 4.5; 12 women) completed a three-session study to evaluate different genres of games in increasing order of difficulty (S1-BrainGame, S2-CarRace, and S3-Exergame). Each session included an identical sequence of activities (t1-Baseline, t2-Picture encode, t3-Play, t4-Stroop test, t5-Play, and t6-Picture recall), a repeated sampling of salivary cortisol, and time-tagged ambulatory data from a wrist-worn device. Generalized estimating equations were used to investigate the effect of session×activity or session×activity×cognitive ability on physiology and cognitive performance. Scores derived from the Montreal Cognitive Assessment (MoCA) test were used to define cognitive ability (MoCA-high: MoCA>27, n=11/18). Kruskal-Wallis tests were used to test session or session×group effects on the scores of the postgame appraisal questionnaire. Results: Session×activity effects were significant on all ambulatory measures (χ210>20; P<.001) other than cortisol (P=.37). Compared with S1 and S2, S3 was associated with approximately 10 bpm higher heart rate (P<.001) and approximately 5 muS higher electrodermal activity (P<.001), which were both independent of the movement caused by the exergame. Compared with S1, we measured a moderate but statistically significant drop in the rate of hits in immediate recall and rate of delayed recall in S3. The low-MoCA group did not differ from the high-MoCA group in general characteristics (age, general self-efficacy, and perceived stress) but was more likely to agree with statements such as digital games are too hard to learn. In addition, the low-MoCA group was more likely to dislike the gaming experience and find it useless, uninteresting, and visually more intense (χ21>4; P<.04). Group differences in ambulatory signals did not reach statistical significance; however, the rate of cortisol decline with respect to the baseline was significantly larger in the low-MoCA group. Conclusions: Our results show that the experience of playing digital games was not stressful for our participants. Comparatively, the neurophysiological effects of exergame were more pronounced in the low-MoCA group, suggesting greater potential of this genre of games for cognitive and physical stimulation by gamified interventions; however, the need for enjoyment of this type of challenging game must be addressed. %M 32213474 %R 10.2196/12388 %U http://mental.jmir.org/2020/3/e12388/ %U https://doi.org/10.2196/12388 %U http://www.ncbi.nlm.nih.gov/pubmed/32213474 %0 Journal Article %@ 2368-7959 %I JMIR Publications %V 7 %N 3 %P e16066 %T Efficacy of a Virtual Reality Biofeedback Game (DEEP) to Reduce Anxiety and Disruptive Classroom Behavior: Single-Case Study %A Bossenbroek,Rineke %A Wols,Aniek %A Weerdmeester,Joanneke %A Lichtwarck-Aschoff,Anna %A Granic,Isabela %A van Rooij,Marieke M J W %+ Behavioural Science Institute, Radboud University, PO Box 9104, Nijmegen, 6500 HE, Netherlands, 31 243612638, r.bossenbroek@pwo.ru.nl %K anxiety %K disruptive behavior %K single-case study %K applied game %K serious games %K special education %K attention-deficit/hyperactivity disorder (ADHD) %K autism spectrum disorder (ASD) %K adolescents %D 2020 %7 24.3.2020 %9 Original Paper %J JMIR Ment Health %G English %X Background: Many adolescents in special education are affected by anxiety in addition to their behavioral problems. Anxiety leads to substantial long-term problems and may underlie disruptive behaviors in the classroom as a result of the individual’s inability to tolerate anxiety-provoking situations. Thus, interventions in special needs schools that help adolescents cope with anxiety and, in turn, diminish disruptive classroom behaviors are needed. Objective: This study aimed to evaluate the effect of a virtual reality biofeedback game, DEEP, on daily levels of state-anxiety and disruptive classroom behavior in a clinical sample. In addition, the study also aimed to examine the duration of the calm or relaxed state after playing DEEP. Methods: A total of 8 adolescents attending a special secondary school for students with behavioral and psychiatric problems participated in a single-case experimental ABAB study. Over a 4-week period, participants completed 6 DEEP sessions. In addition, momentary assessments (ie, 3 times a day) of self-reported state-anxiety and teacher-reported classroom behavior were collected throughout all A and B phases. Results: From analyzing the individual profiles, it was found that 6 participants showed reductions in anxiety, and 5 participants showed reductions in disruptive classroom behaviors after the introduction of DEEP. On a group level, results showed a small but significant reduction of anxiety (d=–0.29) and a small, nonsignificant reduction of disruptive classroom behavior (d=−0.16) on days when participants played DEEP. Moreover, it was found that the calm or relaxed state of participants after playing DEEP lasted for about 2 hours on average. Conclusions: This study demonstrates the potential of the game, DEEP, as an intervention for anxiety and disruptive classroom behavior in a special school setting. Future research is needed to fully optimize and personalize DEEP as an intervention for the heterogeneous special school population. %M 32207697 %R 10.2196/16066 %U http://mental.jmir.org/2020/3/e16066/ %U https://doi.org/10.2196/16066 %U http://www.ncbi.nlm.nih.gov/pubmed/32207697 %0 Journal Article %@ 2368-7959 %I JMIR Publications %V 6 %N 7 %P e12853 %T Digital Games and Mindfulness Apps: Comparison of Effects on Post Work Recovery %A Collins,Emily %A Cox,Anna %A Wilcock,Caroline %A Sethu-Jones,Geraint %+ School of Management, University of Bath, Claverton Down, Bath, BA2 7AY, United Kingdom, 44 01225 388388, e.i.m.collins@bath.ac.uk %K play %K occupational health %K mindfulness %D 2019 %7 18.07.2019 %9 Original Paper %J JMIR Ment Health %G English %X Background: Engagement in activities that promote the dissipation of work stress is essential for post work recovery and consequently for well-being. Previous research suggests that activities that are immersive, active, and engaging are especially effective at promoting recovery. Therefore, digital games may be able to promote recovery, but little is known about how they compare with other popular mobile activities, such as mindfulness apps that are specifically designed to support well-being. Objective: The aim of this study was to investigate and compare the effectiveness of a digital game and mindfulness app in promoting post work recovery, first in a laboratory setting and then in a field study. Methods: Study 1 was a laboratory experiment (n=45) in which participants’ need for recovery was induced by a work task, before undertaking 1 of 3 interventions: a digital game (Block! Hexa Puzzle), a mindfulness app (Headspace), or a nonmedia control with a fidget spinner (a physical toy). Recovery in the form of how energized participants felt (energetic arousal) was compared before and after the intervention and how recovered participants felt (recovery experience) was compared across the conditions. Study 2 was a field study with working professionals (n=20), for which participants either played the digital game or used the mindfulness app once they arrived home after work for a period of 5 working days. Measures of energetic arousal were taken before and after the intervention, and the recovery experience was measured after the intervention along with measures of enjoyment and job strain. Results: A 3×2 mixed analysis of variance identified that, in study 1, the digital game condition increased energetic arousal (indicative of improved recovery) whereas the other 2 conditions decreased energetic arousal (F2,42=3.76; P=.03). However, there were no differences between the conditions in recovery experience (F2,42=.01; P=.99). In study 2, multilevel model comparisons identified that neither the intervention nor day of the week had a significant main effect on how energized participants felt. However, for those in the digital game condition, daily recovery experience increased during the course of the study, whereas for those in the mindfulness condition, it decreased (F1,18=9.97; P=.01). Follow-up interviews with participants identified 3 core themes: detachment and restoration, fluctuations and differences, and routine and scheduling. Conclusions: This study suggests that digital games may be effective in promoting post work recovery in laboratory contexts (study 1) and in the real world, although the effect in this case may be cumulative rather than instant (study 2). %M 31322125 %R 10.2196/12853 %U http://mental.jmir.org/2019/7/e12853/ %U https://doi.org/10.2196/12853 %U http://www.ncbi.nlm.nih.gov/pubmed/31322125 %0 Journal Article %@ 2368-7959 %I JMIR Publications %V 6 %N 6 %P e13717 %T Gamification in Apps and Technologies for Improving Mental Health and Well-Being: Systematic Review %A Cheng,Vanessa Wan Sze %A Davenport,Tracey %A Johnson,Daniel %A Vella,Kellie %A Hickie,Ian B %+ Brain and Mind Centre, The University of Sydney, 94 Mallett Street, Camperdown, Sydney,, Australia, 61 286276941, vanessa.cheng@sydney.edu.au %K well-being %K video games %K gamification %K mental health %K health behavior %K systematic review %K eHealth %K mHealth %K health informatics %D 2019 %7 26.06.2019 %9 Original Paper %J JMIR Ment Health %G English %X Background: There is little research on the application of gamification to mental health and well-being. Furthermore, usage of gamification-related terminology is inconsistent. Current applications of gamification for health and well-being have also been critiqued for adopting a behaviorist approach that relies on positive reinforcement and extrinsic motivators. Objective: This study aimed to analyze current applications of gamification for mental health and well-being by answering 3 research questions (RQs). RQ1: which gamification elements are most commonly applied to apps and technologies for improving mental health and well-being? RQ2: which mental health and well-being domains are most commonly targeted by these gamified apps and technologies? RQ3: what reasons do researchers give for applying gamification to these apps and technologies? A systematic review of the literature was conducted to answer these questions. Methods: We searched ACM Digital Library, CINAHL, Cochrane Library, EMBASE, IEEE Explore, JMIR, MEDLINE, PsycINFO, PubMed, ScienceDirect, Scopus, and Web of Science for qualifying papers published between the years 2013 and 2018. To answer RQ1 and RQ2, papers were coded for gamification elements and mental health and well-being domains according to existing taxonomies in the game studies and medical literature. During the coding process, it was necessary to adapt our coding frame and revise these taxonomies. Thematic analysis was conducted to answer RQ3. Results: The search and screening process identified 70 qualifying papers that collectively reported on 50 apps and technologies. The most commonly observed gamification elements were levels or progress feedback, points or scoring, rewards or prizes, narrative or theme, personalization, and customization; the least commonly observed elements were artificial assistance, unlockable content, social cooperation, exploratory or open-world approach, artificial challenge, and randomness. The most commonly observed mental health and well-being domains were anxiety disorders and well-being, whereas the least commonly observed domains were conduct disorder and bipolar disorders. Researchers’ justification for applying gamification to improving mental health and well-being was coded in 59% (41/70) of the papers and was broadly divided into 2 themes: (1) promoting engagement and (2) enhancing an intervention’s intended effects. Conclusions: Our findings suggest that the current application of gamification to apps and technologies for improving mental health and well-being does not align with the trend of positive reinforcement critiqued in the greater health and well-being literature. We also observed overlap between the most commonly used gamification techniques and existing behavior change frameworks. Results also suggest that the application of gamification is not driven by health behavior change theory, and that many researchers may treat gamification as a black box without consideration for its underlying mechanisms. We call for the inclusion of more comprehensive and explicit descriptions of how gamification is applied and the standardization of applied games terminology within and across fields. %M 31244479 %R 10.2196/13717 %U http://mental.jmir.org/2019/6/e13717/ %U https://doi.org/10.2196/13717 %U http://www.ncbi.nlm.nih.gov/pubmed/31244479 %0 Journal Article %@ 2368-7959 %I JMIR Publications %V 6 %N 5 %P e12430 %T Using Computer Games to Support Mental Health Interventions: Naturalistic Deployment Study %A van der Meulen,Hidde %A McCashin,Darragh %A O'Reilly,Gary %A Coyle,David %+ University College Dublin, School of Computer Science, Belfield, Dublin, 4, Ireland, 353 17162818, d.coyle@ucd.ie %K mental health %K eHealth %K mHealth %K adolescents %K children %K computer game %K treatment %K cognitive behavioral therapy %D 2019 %7 09.05.2019 %9 Original Paper %J JMIR Ment Health %G English %X Background: Recent research has highlighted naturalistic uptake as a key barrier to maximizing the impact of mental health technologies. Although there is increasing evidence regarding the efficacy of digital interventions for mental health, as demonstrated through randomized controlled trials, there is also evidence that technologies do not succeed as expected when deployed in real-world settings. Objective: This paper describes the naturalistic deployment of Pesky gNATs, a computer game designed to support cognitive behavioral therapy (CBT) for children experiencing anxiety or low mood. The objective of this deployment study was to identify how therapists use Pesky gNATs in real-world settings and to discover positive and negative factors. On the basis of this, we aimed to derive generalizable recommendations for the development of mental health technologies that can have greater impact in real-world settings. Methods: Pesky gNATs has been made available through a not-for-profit organization. After 18 months of use, we collected usage and user experience data from therapists who used the game. Data were collected through an online survey and semistructured interviews addressing the expectations and experiences of both therapists and young people. Thematic analysis was used to identify key themes in the interview and survey data. Results: A total of 21 therapists, who used Pesky gNATs with 95 young people, completed the online survey. Furthermore, 5 therapists participated in the follow-up interview. Confirming previous assessments, data suggest that the game can be helpful in delivering therapy and that young people generally liked the approach. Therapists shared diverse opinions regarding the young people for whom they deemed the game appropriate. The following 3 themes were identified: (1) stages of use, (2) impact on the delivery of therapy, and (3) customization. We discuss therapists’ reflections on the game with regard to their work practices and consider the question of customization, including the delicate balance of adaptable interaction versus the need for fidelity to a therapeutic model. Conclusions: This study provides further evidence that therapeutic games can support the delivery of CBT for young people in real-world settings. It also shows that deployment studies can provide a valuable means of understanding how technologies integrate with the overall mental health ecosystem and become a part of therapists' toolbox. Variability in use should be expected in real-world settings. Effective training, support for therapist autonomy, careful consideration of different approaches to customization, the reporting of deployment data, and support for communities of practice can play an important role in supporting variable, but effective, use. %M 31094346 %R 10.2196/12430 %U https://mental.jmir.org/2019/5/e12430/ %U https://doi.org/10.2196/12430 %U http://www.ncbi.nlm.nih.gov/pubmed/31094346 %0 Journal Article %@ 2368-7959 %I JMIR Publications %V 6 %N 5 %P e12418 %T Gaming With Stigma: Analysis of Messages About Mental Illnesses in Video Games %A Ferrari,Manuela %A McIlwaine,Sarah V %A Jordan,Gerald %A Shah,Jai L %A Lal,Shalini %A Iyer,Srividya N %+ Prevention and Early Intervention Program for Psychosis, Douglas Mental Health University Institute, Pavillon Burland, 6875 Blvd LaSalle, Montreal, QC, H4H 1R3, Canada, 1 5147616131 ext 2087, manuela.ferrari@douglas.mcgill.ca %K mental disorders %K social stigma %K video games %D 2019 %7 08.05.2019 %9 Original Paper %J JMIR Ment Health %G English %X Background: Video game playing is a daily activity for many youths that replaces other media forms (eg, television); it serves as an important source of knowledge and can potentially impact their attitudes and behaviors. Researchers are, thus, concerned with the impact of video gaming on youth (eg, for promoting prosocial or antisocial behavior). Studies have also begun to explore players’ experience of gameplay and video game messages about violence, sexism, and racism; however, little is known about the impact of commercial video games in the sharing and shaping of knowledge, and messages about mental illness. Objective: The aim of this review was to identify how mental illness, especially psychosis, is portrayed in commercial video games. Methods: We performed keyword searches on games made available between January 2016 and June 2017 on Steam (a popular personal computer gaming platform). A total of 789 games were identified and reviewed to assess whether their game content was related to mental illness. At the end of the screening phase, a total of 100 games were retained. Results: We used a game elements framework (characters, game environment/atmosphere, goals, etc) to describe and unpack messages about mental health and illness in video games. The majority of the games we reviewed (97%, 97/100) portrayed mental illness in negative, misleading, and problematic ways (associating it with violence, fear, insanity, hopelessness, etc). Furthermore, some games portrayed mental illness as manifestations or consequences of supernatural phenomena or paranormal experiences. Mental illness was associated with mystery, the unpredictable, and as an obscure illness; its treatment was also associated with uncertainties, as game characters with mental illness had to undergo experimental treatment to get better. Unfortunately, little or no hope for recovery was present in the identified video games, where mental illness was often presented as an ongoing struggle and an endless battle with the mind and oneself. Conclusions: The game elements of the identified commercial video games included mental illness, about which many perpetuated well-known stereotypes and prejudices. We discuss the key findings in relation to current evidence on the impact of media portrayals of mental illness and stigma. Furthermore, we reflect on the ability of serious video games to promote alternative messages about mental illness and clinical practices. Future research is needed to investigate the impact that such messages have on players and to explore the role that video games can play in fostering alternative messages to reduce the stigma associated with mental illness. %M 31066703 %R 10.2196/12418 %U https://mental.jmir.org/2019/5/e12418/ %U https://doi.org/10.2196/12418 %U http://www.ncbi.nlm.nih.gov/pubmed/31066703 %0 Journal Article %@ 2368-7959 %I JMIR Publications %V 6 %N 4 %P e13485 %T The Potential of Game-Based Digital Biomarkers for Modeling Mental Health %A Mandryk,Regan Lee %A Birk,Max Valentin %+ Department of Computer Science, University of Saskatchewan, 176 Thorvaldson Bldg, 110 Science Place, Saskatoon, SK, S7N5C9, Canada, 1 3069664888, regan.mandryk@gmail.com %K digital games %K digital phenotyping %K mental health %K computational modeling %K big data %K video games %K biomarkers %D 2019 %7 23.04.2019 %9 Viewpoint %J JMIR Ment Health %G English %X Background: Assessment for mental health is performed by experts using interview techniques, questionnaires, and test batteries and following standardized manuals; however, there would be myriad benefits if behavioral correlates could predict mental health and be used for population screening or prevalence estimations. A variety of digital sources of data (eg, online search data and social media posts) have been previously proposed as candidates for digital biomarkers in the context of mental health. Playing games on computers, gaming consoles, or mobile devices (ie, digital gaming) has become a leading leisure activity of choice and yields rich data from a variety of sources. Objective: In this paper, we argue that game-based data from commercial off-the-shelf games have the potential to be used as a digital biomarker to assess and model mental health and health decline. Although there is great potential in games developed specifically for mental health assessment (eg, Sea Hero Quest), we focus on data gathered “in-the-wild” from playing commercial off-the-shelf games designed primarily for entertainment. Methods: We argue that the activity traces left behind by natural interactions with digital games can be modeled using computational approaches for big data. To support our argument, we present an investigation of existing data sources, a categorization of observable traits from game data, and examples of potentially useful game-based digital biomarkers derived from activity traces. Results: Our investigation reveals different types of data that are generated from play and the sources from which these data can be accessed. Based on these insights, we describe five categories of digital biomarkers that can be derived from game-based data, including behavior, cognitive performance, motor performance, social behavior, and affect. For each type of biomarker, we describe the data type, the game-based sources from which it can be derived, its importance for mental health modeling, and any existing statistical associations with mental health that have been demonstrated in prior work. We end with a discussion on the limitations and potential of data from commercial off-the-shelf games for use as a digital biomarker of mental health. Conclusions: When people play commercial digital games, they produce significant volumes of high-resolution data that are not only related to play frequency, but also include performance data reflecting low-level cognitive and motor processing; text-based data that are indicative of the affective state; social data that reveal networks of relationships; content choice data that imply preferred genres; and contextual data that divulge where, when, and with whom the players are playing. These data provide a source for digital biomarkers that may indicate mental health. Produced by engaged human behavior, game data have the potential to be leveraged for population screening or prevalence estimations, leading to at-scale, nonintrusive assessment of mental health. %M 31012857 %R 10.2196/13485 %U http://mental.jmir.org/2019/4/e13485/ %U https://doi.org/10.2196/13485 %U http://www.ncbi.nlm.nih.gov/pubmed/31012857 %0 Journal Article %@ 2368-7959 %I JMIR Publications %V 6 %N 4 %P e12432 %T Framing Mental Health Within Digital Games: An Exploratory Case Study of Hellblade %A Fordham,Joseph %A Ball,Christopher %+ Department of Media and Information, Michigan State University, 404 Wilson Road, Michigan State University, East Lansing, MI, 48824, United States, 1 517 618 1235, fordham4@msu.edu %K video games %K electronic gaming %K psychosis %K stigma %D 2019 %7 18.04.2019 %9 Original Paper %J JMIR Ment Health %G English %X Background: Researchers and therapists have increasingly turned to digital games for new forms of treatments and interventions for people suffering from a variety of mental health issues. Yet, the depiction of mental illness within digital games typically promotes stigmatized versions of those with mental health concerns. Recently, more games have attempted to implement more realistic and respectful depictions of mental health conditions. Objective: This paper presents an exploratory analysis of a contemporary game that has the potential to change the way researchers, practitioners, and game designers approach topics of mental health within the context of gaming. Methods: A case study of Hellblade: Senua's Sacrifice was conducted using frame analysis to show how key design choices for this game present the potential for new ways of approaching games and mental health. Results: A case study of Hellblade’s development shows how research-informed collaborative design with mental health practitioners, scientists, and individuals with mental health problems can lead to a realistic depiction of mental illness in games. Furthermore, the use of frame analysis demonstrates how to harness narrative, mechanics, and technology to create embodied experiences of mental health, which has the potential to promote empathetic understanding. Conclusions: This paper highlights an exemplary case of collaborative commercial game design for entertainment purposes in relation to mental health. Understanding the success of Hellblade's depiction of psychosis can improve serious games research and design. Further research must continue to provide deeper analysis of not only games that depict mental illness, but also the design process behind them. %M 30998224 %R 10.2196/12432 %U http://mental.jmir.org/2019/4/e12432/ %U https://doi.org/10.2196/12432 %U http://www.ncbi.nlm.nih.gov/pubmed/30998224