Can a Commercial Video Game Prevent Depression? Null Results and Whole Sample Action Mechanisms in a Randomized Controlled Trial.

Marlou Poppelaars,Roy Otten,Isabela Granic,Anna Lichtwarck-Aschoff

doi:10.3389/fpsyg.2020.575962

Abstract

Depressive symptoms and disorders are major public health concerns, affecting many adolescents and young adults. Despite extensive research, depression prevention programs for youth show limited effectiveness. Moreover, the maximal potential of youth psychotherapy — on which depression prevention programs are based — may have been reached. Commercial video games may offer an engaging alternative vehicle for youth to practice emotional and social skills vital to mental health. The current study investigated the potential for the commercial video game Journey to prevent the exacerbation of depressive symptoms. A pre-registered randomized controlled trial tested the effectiveness of Journey as an indicated depression prevention approach compared to a control game condition and a passive control condition (Dutch Trial Register: NL4873, https://www.trialregister.nl/trial/4873). Additionally, potential action mechanisms for depression prevention using video games were examined. Participants aged 15 to 20 years old with elevated depressive symptoms (n = 244, Mage = 17.11, SDage = 1.76, 66.4% female) were given 4 weeks to play Journey (Mduration = 3 h 20 min) or the control game, Flower (Mduration = 2 h 36 min). Results showed no beneficial effects of playing the commercial video game, Journey, on youth’s change in depressive symptoms above and beyond the active and passive control conditions up to 12-months after the intervention. Additionally, no action mechanisms were found specifically for Journey. Nevertheless, over the whole study, participants decreased in depressive symptoms, became less sensitive to rejection, and experienced more hope and optimism. Moreover, participants who during the study decreased in rejection sensitivity or rumination or who increased in hope and optimism or in distraction and problem solving showed the strongest decrease in depressive symptoms. Although results do not support the use of the studied commercial game as an effective indicated depression prevention strategy, our results do suggest that rejection sensitivity, hope, optimism, rumination, distraction, and problem solving are promising targets for future depression prevention efforts. We conclude with important lessons for future research on games to promote mental health. Particularly, encouraging careful consideration of research designs to explore for whom and how potential action mechanisms and associated game mechanics may be effective.

Highlights

Both depressive symptoms and depressive disorders are major public health concerns, negatively impacting individuals’ achievements, social interactions, and future mental health (Wesselhoeft et al, 2013; Hetrick et al, 2016; Carrellas et al, 2017)
Randomization was successful as there were no significant differences between conditions on the demographic variables, expectations of Journey, expectations of Flower, and on receiving other treatment during the study period
This study showed no beneficial effects of playing the commercial video game, Journey, on progression of depressive symptoms of adolescents and young adults with elevated depressive symptoms above and beyond an active and passive control

Summary

Introduction

Both depressive symptoms and depressive disorders are major public health concerns, negatively impacting individuals’ achievements, social interactions, and future mental health (Wesselhoeft et al, 2013; Hetrick et al, 2016; Carrellas et al, 2017). During adolescence and young adulthood individuals are most at risk for the emergence of depression (Merikangas et al, 2010; Avenevoli et al, 2015), with over 10% of youth experiencing depression in the past year (Weinberger et al, 2018). Research on depression prevention programs for youth is extensive (e.g., Horowitz and Garber, 2006; Merry et al, 2011; Hetrick et al, 2016). A recent meta-analysis shows that the maximal benefit of youth psychotherapy — on which depression prevention programs are based — has been reached (Jones et al, 2019), suggesting the need for genuine innovations in content and delivery of prevention approaches (Kazdin, 2019). In an attempt to explore alternatives to traditional depression prevention in youth, this study tested the effectiveness of a commercial video game hypothesized to affect a number of empirically supported action mechanisms

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