JMIR Publications

ABSTRACT

Background:

Depression is a common mental disorder characterized by disturbances in mood, thoughts, and/or behaviors. Serious games, which are games that have a purpose other than entertainment, have been used as a non-pharmacological therapeutic intervention for depression. Previous systematic reviews have summarized evidence of effectiveness of serious games in reducing depression symptoms, however, they are limited by design and methodological shortcomings.

Objective:

This study aims to assess the effectiveness of serious games in alleviating depression through summarizing and pooling the results of previous studies.

Methods:

A systematic review of randomized controlled trials (RCTs) was conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement. The search sources included 6 bibliographic databases (e.g., MEDLINE, PsycINFO, IEEE Xplore), the search engine “Google Scholar,” and backward and forward reference list checking of the included studies and relevant reviews. Two reviewers independently carried out the study selection, data extraction, risk of bias assessment, and quality of evidence appraisal. Results of the included studies were synthesized narratively and statistically, as appropriate, according to the type of serious games (i.e., exergames or computerized cognitive behavioral therapy (CBT) games).

Results:

From an initial 966 citations retrieved, 27 studies met the eligibility criteria. Fifteen were eventually included in meta-analyses. Very low quality evidence from 7 RCTs and 5 RCTs showed no statistically significant effect of exergames on the severity of depressive symptoms as compared to conventional exercises (P=0.12) and no intervention level (P=0.30), respectively. Very low quality evidence from 9 RCTs showed a statistically and clinically significant effect of computerized CBT games on the severity of depressive symptoms in comparison with no intervention (P=0.003).

Conclusions:

Serious games have the potential to alleviate depression as other active interventions do. However, we could not draw definitive conclusions regarding the effectiveness of serious games due to the high risk of bias in the individual studies examined and the low quality of meta-analyzed evidence. Therefore, we recommend that health care providers consider offering serious games as an adjunct to existing interventions until further, more robust, evidence is available. Future studies should assess the effectiveness of serious games that are designed specifically to alleviate depression and deliver other therapeutic modalities, recruit participants with depression, and avoid biases through following recommended guidelines for conducting and reporting RCTs.