Kim Poliniak
/ Released on September 26, 2024
After reviewing past studies, a team from the Johns Hopkins Children’s Center concluded that some video games created as mental health interventions could be a helpful (albeit modest) tool to improve the mental health of children and teens with anxiety, depression and attention-deficit hyperactivity disorder (ADHD).
The report, which reviewed studies in peer-reviewed journals from 2011 to March 20, 2024, was published Sept. 23 in JAMA Pediatrics.
“If you’re struggling to get pediatric patients to attend individualized mental health care, a gamified mental health intervention might be a good first step.”
Joseph McGuire
Associate Professor, Johns Hopkins University School of Medicine
In the United States, about 20% of children and teens ages 3 to 17 are estimated to have a mental, emotional, developmental, or behavioral disorder. Suicidal behavior among high school students also increased by more than 40% in the decade ending in 2019, according to a report by the Agency for Healthcare Research and Quality Assurance. Other studies provide evidence that disruptions from the COVID-19 pandemic have exacerbated these trends, and while studies suggest parents and other caregivers are seeking mental health care for their children, wait times for appointments are increasing.
“We found literature that suggests that even doubling the number of pediatric mental health workers would still not meet the need,” said Barry Bryant, a resident in the department of psychiatry and behavioral sciences at the Johns Hopkins University School of Medicine and lead author of the new study.
To determine whether so-called “gamified digital mental health interventions” — that is, video games aimed at treating mental illness — are effective for people with anxiety disorders, depression, and ADHD, the research team analyzed their use in a randomized clinical trial with children and adolescents.
Bryant and Joseph McGuire, an associate professor of psychiatry and behavioral sciences at the School of Medicine, identified 27 similar trials conducted in the United States and around the world. Collectively, the studies included 2,911 participants, half of whom were boys and half were girls, all between the ages of 6 and 17.
Digital mental health interventions vary in content, but all are designed to treat ADHD, depression, and anxiety. For example, for ADHD, some games involve competition or divided attention, requiring users to pay attention to multiple activities to be successful in gameplay. For depression and anxiety, some interventions teach psychotherapy-oriented concepts in a game format. All games were conducted on technology platforms such as computers, tablets, video game consoles, and smartphones. Video games are delivered to users in different ways; some are available online, while others must be accessed through the specific research team participating in the study.
Outcome measures vary across studies; however, the Johns Hopkins research team used a random-effects model to standardize effect sizes so that a positive result is indicated if the intervention is superior to the control condition. Hedges’ g, a statistic used to measure effect size, was used to quantify the overall treatment effect in the studies reviewed.
The research team’s analysis found that video games designed for people with ADHD and depression moderately reduced symptoms associated with ADHD and depression, such as improved ability to sustain attention and reduced sadness (effect size of both 0.28), based on feedback from study participants and families. The effect size of 0.28 is consistent with smaller effect sizes, while in-person interventions often produce medium (0.50) to large (0.80) effects. In contrast, video games designed for anxiety did not show a significant benefit (effect size of 0.07) in reducing participants’ anxiety symptoms, based on feedback from participants and families.
The researchers also investigated factors that could lead to better outcomes from digital mental health interventions. They found that certain factors related to the delivery of video games (e.g. computer-based interventions and interventions with time limits) and participants (e.g. studies with a higher proportion of boys) had a positive impact on treatment outcomes. The researchers said these findings suggest possible ways to improve the current modest symptom improvement effects.
“While the effects are still small, our study shows that there is a new tool that families can use relatively easily to help improve their children’s mental health, particularly for ADHD and depression,” Maguire says. “So if you’re a pediatrician who’s struggling to get your pediatric patients to individualized mental health care, there may be a gamified mental health intervention that could be a good first step for kids while you wait for individualized therapy to begin.”
The research team cautioned that the review does not show why certain video game interventions showed better results than others. They also noted that some of the trials included in the study used parent- or child-reported outcome measures rather than standardized clinician ratings, and that the studies did not uniformly examine the same factors and characteristics that may have influenced the effectiveness of treatments, such as participant engagement and social activity. They also found that some of the video games included in the studies were not easily accessible, as they were not available online or required a fee.
The researchers also noted that while video game addiction and lengthy screen time are concerns, children who played the games studied in a structured, time-limited format tended to perform best.
“When a child has a video gaming problem, a gamified digital mental health intervention might only require 20 to 45 minutes three times a week, whereas children are likely playing games for several hours a day,” Bryant said.
“I think having more tools in the toolbox will help us address the growing demand for child mental health care,” Maguire said.
Morgan Sisk of the University of Alabama at Birmingham is one of the authors of the study, which was funded by generous donors and Johns Hopkins Medicine.
