JMIR Publications

ABSTRACT

Background:

Young people are particularly at risk of developing mental health problems, a challenge exacerbated by the COVID-19 pandemic. Digital tools such as apps and chatbots show promise in providing accessible, cost-effective, and less stigmatised ways of strengthening their mental health. However, while these interventions offer benefits, they extend mental health measures beyond traditional therapeutic settings and relationships, which raises ethical concerns due to the absence of established guidelines and regulations. This is particularly notable for technologies incorporating serious gaming elements. Additionally, adolescents are in a sensitive and at times vulnerable phase, which shows great potential for the effective use of preventive and sensitising mental health measures. Considering the lack of an integration into existing mental health structures among many young users, ethical considerations become crucial.

Objective:

This scoping review aims to build a knowledge base on ethical aspects of developing and implementing gamified digital mental health interventions for young people.

Methods:

We conducted a search on research articles and conference papers from 2015 to 2023 in English, German, and Spanish. We identified 1815 studies using a unique combination of keywords in the databases Scopus, Web of Science, Medline, PsycINFO. After removing duplicates (n=741), we included a total of 38 publications in this review following a double screening process.

Results:

This article finds that ethically relevant aspects were discussed with regards to (i) research ethics, (ii) ethical principles in design decisions (including privacy, accessibility, empowerment and autonomy, cultural and social sensitivity, co-design), (iii) vulnerable groups, and (iv) social implications (including implementation with facilitators in specific social contexts, relationship with other therapeutic options, economic aspects, social embeddedness of technologies).

Conclusions:

This scoping review identifies a limited interpretation of “ethics” as primarily research ethics across the publications included. It shows that co-design is frequently viewed in instrumental terms and that vulnerability is mostly addressed pragmatically. Moreover, discussions on the social embeddedness of technologies, beyond the practice of serious game design, were notably sparse. Through providing concrete examples of how mental health researchers and game designers have addressed and mitigated ethical challenges in specific interventions, this article maps the breadth of ethical discussions. It advocates for ethics to be integrated as an ongoing practice throughout all stages of developing and implementing serious games elements in mental health interventions for young people.