This series of articles explores the current clinical research that exists around the benefits that playing video games can have for wellbeing. Wherever we can, we have linked to a free full version of the publication, and otherwise refer to its abstract.
Today we’re looking at the how video games might be able to treat clinical depression.
Game-based digital interventions for depression therapy: a systematic review and meta-analysis.
Li J, Theng YL, Foo S. Cyberpsychol Behav Soc Netw. 2014;17(8):519-27. [Full article]
A meta-analysis is a study that doesn’t do any new investigating of its own – instead it gathers all of the other papers that have been published about a topic, and it adds all of their results together to see whether there is a pattern. Ultimately we can find out what the majority of studies have found and how likely it is to be true.
That’s exactly what this team did. They collected papers that used video games as an intervention for treatment of depression in a controlled and reliable way. They included psychoeducational games (providing information to people), virtual reality exposure therapy, exercise related games, and casual games used purely for entertainment.
The results showed a moderate effect size altogether, with educational games having a much smaller effect. Self-help games had a better outcomes than those that were “supported”, ie used with the help of a counsellor (which was a surprise to us!)
Collectively the improvements were significantly better than patients who received no intervention and were still on a waiting list.
Preventing Depression in Final Year Secondary Students: School-Based Randomized Controlled Trial.
Perry Y, Werner-Seidler A, Calear A, et al. Eysenbach G, ed. Journal of Medical Internet Research. 2017;19(11):e369. [Full text]
The effectiveness of SPARX, a computerised self help intervention for adolescents seeking help for depression: randomised controlled non-inferiority trial.
Merry SN, Stasiak K, Shepherd M, Frampton C, Fleming T, Lucassen MF. BMJ. 2012;344:e2598. [Full article]
SPARX might be my favourite project in the world. It’s an RPG being developed to treat mild to moderate depression in young people, straight out of New Zealand. They are backing up all of their progress with hard evidence using multiple studies across the world, with collaborations from global healthcare centres. The results are exceptionally exciting.
In 2012 they allocated SPARX to around 100 young people with an average age of 16. The matched control group received “treatment as usual” which means whatever they would get if they weren’t in the study. All participants were assessed before intervention, immediately after intervention and three months later.
The first important finding to note is that SPARX was not worse than treatment as usual. That doesn’t sound like much, but what it means is that those participants who played SPARX had as much of an improvement as those who had normal treatment. In fact, the improvement observed was better (depression scores reduced by 10 points in SPARX compared to 8 points for others). Also, remission rates – which means participants whose depression actually went away completely – were significantly higher for SPARX players. These effects were maintained at 3 month follow up.
More recently an international study looked at SPARX as a way of preventing depression in teenagers about to sit their final school exams. They were given a SPARX program or a control program, which was 20-30 minutes per week over 7 weeks.
The results are outstanding: SPARX showed significantly reduced symptoms of depression compared to the control not only straight after the program but also 6 months later. However it didn’t last to 18 months, which suggests to me we need to encourage these kids to play more!
You can read more about SPARX here, though note the full website is only available in NZ.
The Efficacy of Casual Videogame Play in Reducing Clinical Depression: A Randomized Controlled Study.
Russoniello CV, Fish M, O’brien K. Games Health J. 2013;2(6):341-6.
This study used casual video games, that are commercially available, as opposed to ones that have been designed for treating depression. They assigned half the participants to play games and half of them to surf NIMH’s website, for 30 minutes three times a week for a month. There were about 30 people in each group, so a relatively small size, but enough to get statistically significant results.
After a month they measured the difference in depression scores using an internationally validated questionnaire called the PHQ-9. The group who played video games scored significantly lower than the other group, showing a greater improvement in depressive symptoms.
All in all we’ve seen time and again that games are clearly useful in managing mild to moderate depression in a variety of age groups and demographics. Now the next challenge is convincing the world’s mental health professionals that this is the case, and starting to get people on game programs that could potentially change their life.