JMIR Publications

ABSTRACT

Background:

Positive self-esteem predicts happiness, well-being, and serves as a protective factor for favorable mental health. Scholarly gaming within the school setting may serve as a channel to deliver embedded mental health curriculum designed to improve self-esteem.

Objective:

To evaluate the impact of scholarly gaming curriculum with and without embedded preventive mental health curriculum, known as Mental Health Moments (MHM), upon the self-esteem of adolescents.

Methods:

Scholarly gaming curriculum and MHM were developed by 3 educators and a school-based mental health intervention expert. The scholarly gaming curriculum aligned with academic guidelines from the International Society for Technology Education (ISTE), teaching technology-based career skills along with video game business development. The curriculum consisted of 40 lessons, delivered over 14 weeks for a minimum of 120 minutes a week. 83 schools with previous gaming engagement were invited to participate and 34 agreed. Schools were allocated to +MHM or -MHM arms through a matched pairs experimental design. -MHM received the scholarly gaming curriculum alone. +MHM received the scholarly gaming curriculum plus MHM embedded into 27 of 40 lessons. MHM integrated concepts from the PERMA framework in positive psychology as well as the CASEL standards in education – emphasizing self-awareness, self-management, social awareness, relationship skills, and responsible decision-making. Participants in the study were students at schools offering scholarly gaming curriculum and enrolled as recruitment sites. Participants completed a baseline and post-intervention survey quantifying self-esteem with Rosenberg Self-esteem Scale (RSES) (range 0-30). A RSES <15 characterizes low self-esteem. Participants who completed both baseline and post-intervention surveys were included in analysis.

Results:

Of the 471 participants included in analysis, 235 received scholarly gaming without MHM (-MHM) and 236 received scholarly gaming curriculum with MHM (+MHM). Around 75% of participants were in high school and most (91%) reported this was their first year participating in scholarly gaming. Most participants were male (82%). Only 58% reported their race as White. The average self-esteem score at baseline was 17.9 (SD 5.1). Low self-esteem was reported in 22.1% (n=104). About 58 % (n=60) of participants with low-self-esteem at baseline rated themselves within the average level of self-esteem at post-intervention. When looking at the two groups, self-esteem scores improved by 8.3% among the +MHM group compared to no change among those who completed the standard curriculum alone (-MHM) (P=0.002). Subgroup analyses revealed that improvements in self-esteem attributed to the +MHM intervention differed by race, gender, and sexual orientation.

Conclusions:

Adolescents who engaged with scholarly gaming curriculum with +MHM improved self-esteem, shifting some participants from abnormally low self-esteem scores into normal ranges. Adolescent advocates, including healthcare providers, need to be aware of nontraditional educational instruction to improve the wellbeing of students.