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Cited by 219Digital Mental Health InterventionsEducational Games and GamificationAnxiety, Depression, Psychometrics, Treatment, Cognitive Processes

Game-based digital interventions for depression therapy: a systematic review and meta-analysis

Open access
Li, Jinhui, Theng, Yin-Leng, Foo, Schubert·2014·Cyberpsychology, Behavior, and Social Networking
DOI 10.1089/cyber.2013.0481PMC PMC4118698
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Abstract

The aim of this study was to review the existing literature on game-based digital interventions for depression systematically and examine their effectiveness through a meta-analysis of randomized controlled trials (RCTs). Database searching was conducted using specific search terms and inclusion criteria. A standard meta-analysis was also conducted of available RCT studies with a random effects model. The standard mean difference (Cohen's d) was used to calculate the effect size of each study. Nineteen studies were included in the review, and 10 RCTs (eight studies) were included in the meta-analysis. Four types of game interventions-psycho-education and training, virtual reality exposure therapy, exercising, and entertainment-were identified, with various types of support delivered and populations targeted. The meta-analysis revealed a moderate effect size of the game interventions for depression therapy at posttreatment (d=-0.47 [95% CI -0.69 to -0.24]). A subgroup analysis showed that interventions based on psycho-education and training had a smaller effect than those based on the other forms, and that self-help interventions yielded better outcomes than supported interventions. A higher effect was achieved when a waiting list was used as the control. The review and meta-analysis support the effectiveness of game-based digital interventions for depression. More large-scale, high-quality RCT studies with sufficient long-term data for treatment evaluation are needed.

AI snapshot

Written from the paper’s full text.

TL;DR

This systematic review and meta-analysis examined game-based digital interventions for depression, identifying 19 studies and meta-analyzing 10 RCTs from 8 studies. Game interventions showed a moderate posttreatment effect on depression (d=−0.47, 95% CI −0.69 to −0.24), with subgroup differences by game type, support type, and control condition.

Key findings

  • Nineteen studies were included in the review, covering four game types: psycho-education and training, virtual reality exposure therapy, exercising, and entertainment.
  • The meta-analysis of 10 RCTs (8 studies; 636 participants) found a moderate effect size for depression at posttreatment: d=−0.47 [95% CI −0.69 to −0.24], Z=−4.09, p<0.0001, with moderate heterogeneity (I²=47%). After removing one possible outlier, the effect was d=−0.35 [95% CI −0.53 to −0.16] and heterogeneity fell to I²=18%.
  • Subgroup analyses showed virtual reality exposure therapy had the largest effect (d=−0.67 [95% CI −1.19 to −0.14]), followed by entertainment (d=−0.42 [95% CI −1.23 to 0.39]), psycho-education and training (d=−0.41 [95% CI −0.67 to −0.14]), and exercising (d=−0.24 [95% CI −0.86 to 0.39]).
  • Nontherapist-involved interventions had a larger effect than therapist-involved interventions (d=−0.54 vs. d=−0.44), and waiting-list controls yielded a larger effect (d=−0.66 [95% CI −1.14 to −0.18]) than treatment as usual (d=−0.39 [95% CI −0.68 to −0.11]) or active treatment (d=−0.53 [95% CI −1.10 to 0.03]).

Methods

  • Systematic review searching seven health and technology databases for English-language studies published before May 2013, using terms for digital games and depression/mental health; eligible studies had to evaluate depression symptoms with a reliable and valid depression scale.
  • Meta-analysis included only RCTs with a controlled condition (e.g., waiting list, treatment as usual, or active treatment); non-RCTs, studies with uninterpretable/incomplete data, and studies with game-based control conditions were excluded.
  • Ten RCTs from 8 studies were analyzed in Review Manager 5.2 using a random-effects model and Cohen’s d; heterogeneity was assessed with I² and Q statistics, and a priori subgroup analyses used a mixed-effects model. Risk of bias was assessed by two reviewers using Cochrane domains.

Limitations

  • The paper states that only a small number of studies met inclusion criteria, leading to relatively few RCTs for meta-analysis; broad ranges of target groups, support types, and depression severity produced considerable heterogeneity, limiting generalizability.
  • The paper states that long-term data are lacking; only the RCTs by Emmelkamp et al. and Proudfoot et al. reported some remaining benefits at 6-month follow-up, and attrition rates were not presented in the meta-analysis.
  • Evident from the text: several subgroup estimates were based on only one trial (entertainment, exercising, elderly), and many risk-of-bias domains were rated unclear due to incomplete reporting; one study had high risk of bias in random sequence generation, and two had high risk due to incomplete outcome data.

Model-written summary. Check it against the paper before relying on it.

Integrity signals

Registry

Crossref · 10.1089/cyber.2013.0481

Cites

57 of 57 references verified0 citation errors · 0 not checkable

Statistics

Claims the paper makes

0 of 56 cited sources checked · 0 supported · 0 flagged

  • Findingown data
    § Abstract

    The meta-analysis included 10 RCTs from eight studies.

    “Nineteen studies were included in the review, and 10 RCTs (eight studies) were included in the meta-analysis.”
    • Also stated in: § Results · plain
      “Thus, eight studies involving a total of 636 participants in 10 RCTs were eligible for inclusion in the final meta-analysis.”
    Quote in the paperSubstantial claim
    • Rests on an assumption: The included game-based digital interventions are sufficiently similar to be pooled in a single meta-analysis.
    • Rests on an assumption: The different control conditions (waiting lists, treatment as usual, other active treatments) are sufficiently comparable to be combined in the overall meta-analysis.
    • Rests on an assumption: The depression scales used across studies measure the same underlying construct and can be pooled as self-reported depression outcomes.
  • Findingown data
    § Abstract

    Subgroup analysis showed interventions based on psycho-education and training had a smaller effect than those based on other forms.

    “A subgroup analysis showed that interventions based on psycho-education and training had a smaller effect than those based on the other forms, and that self-help interventions yielded better outcomes than supported interventions.”
    Quote in the paperNot a substantial claim
  • Findingown data
    § Abstract

    Four types of game interventions were identified: psycho-education and training, virtual reality exposure therapy, exercising, and entertainment.

    “Four types of game interventions—psycho-education and training, virtual reality exposure therapy, exercising, and entertainment—were identified, with various types of support delivered and populations targeted.”
    • Also stated in: § Results · plain
      “They were divided into four categories based on the game types they involved: (a) psycho-education and training, (b) virtual reality exposure therapy, (c) exercising, and (d) entertainment.”
    Quote in the paperNot a substantial claim
  • Findingown data
    § Abstract

    The systematic review included 19 studies.

    “Nineteen studies were included in the review, and 10 RCTs (eight studies) were included in the meta-analysis.”
    • Also stated in: § Results · plain
      “The search yielded a total of 1,179 articles, with 19 studies meeting the criteria for inclusion in the final review.”
    Quote in the paperNot a substantial claim
    • Rests on an assumption: The search of seven databases and the selected search terms identified all relevant studies.
  • Findingown data
    § Results

    Heterogeneity among depression outcomes was moderate (I2=47%).

    “Heterogeneity among the depression outcomes was moderate (I2=47%; Table 2).”
    Quote in the paperNot a substantial claim
  • May combine two claims. 22
  • Classified as probably not a substantial claim. 17

  • May combine two claims.

    Findingown data
    § Results

    After removing the outlier, the effect size changed to −0.35 (95% CI −0.53 to −0.16) and heterogeneity decreased to low (I2=18%).

    “After removing the outlier, the effect size changed to −0.35 [95% CI −0.53 to −0.16] and the heterogeneity decreased significantly to a low level (I2=18%).”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Findingown data
    § Results

    Some scales were applied for particular age groups, such as CDI and CDRS-R for adolescents, and GDS for elderly.

    “Some scales were applied for particular age groups, such as the Children's Depression Inventory and Child Depression Rating Scale Revised (CDRS-R) for adolescents, and the Geriatric Depression Scale for elderly people.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Findingown data
    § Results

    Many of the studies used only a simple statement such as "we randomly allocated" or "using a randomized design" without indicating clearly the process of randomization, indicating that selection bias may have been a problem.

    “For example, many of the studies used only a simple statement such as “we randomly allocated” or “using a randomized design” without indicting clearly the process of randomization, indicating that selection bias may have been a problem.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Findingreasoning
    § Results

    Eleven of the studies were aimed at young people younger than 30 years if classification changed.

    “However, it is important to note that 11 of the studies were aimed at “young people” younger than 30 years if we change the classification of the target population.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Findingown data
    § Results

    One study had a high risk of bias in random sequence generation, and two had a high risk of bias due to incomplete outcome data.

    “One study had a high risk of bias in random sequence generation,41 and two had a high risk of bias due to incomplete outcome data.39,41”
    Quote in the paperNot a substantial claim0 of 2 sources checked
    • cites [41] Knox M, 2011, Mental Health in Family Medicine

      Not checked in the free run.

    • cites [39] source

      Not checked in the free run.

  • May combine two claims.

    Findingown data
    § Results

    Games in the virtual reality exposure therapy group seem to achieve the biggest effect size (d=-0.67), followed by the entertainment (d=-0.42) and psycho-education and training groups (d=-0.41).

    “Games in the virtual reality exposure therapy group (d=−0.67 [95% CI −1.19 to −0.14]) seem to achieve the biggest effect size, followed by the entertainment (d=−0.42 [95% CI −1.23 to 0.39]) and psycho-education and training groups (d=−0.41 [95% CI −0.67 to −0.14]).”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Findingown data
    § Results

    A wide range of self-reported scales was used; Beck Depression Inventory was most popular (7 out of 19).

    “A wide range of different self-reported scales was used to measure depression in the trials, among which the Beck Depression Inventory was the most popular (used in 7 out of the 19 studies).”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Findingown data
    § Results

    Majority of studies (11) focused on general adults, four on adolescents younger than 18, two on elderly older than 65, and two did not mention ages.

    “In terms of target groups, the majority of the studies (11) focused on general adults, four were aimed at adolescents younger than 18 years, and two targeted elderly people older than 65 years (two studies did not mention the participants' ages).”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Findingown data
    § Results

    The effect size was quite low for the elderly population (d=-0.24), but the estimate is probably not meaningful, as it was only based on one study.

    “Although the effect size was quite low for the elderly population (d=−0.24 [95% CI −0.86 to 0.39]), the estimate is probably not meaningful, as it was only based on one study.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Findingcitation
    § Results

    Two studies introduced therapeutic interventions using exercising video games to treat depression, both aimed at older adults and used Nintendo Wii.

    “Two studies introduced therapeutic interventions using exercising video games to treat depression.28,40 Both were aimed at older adults, and used the Nintendo Wii device to encourage body motions during game playing.”
    Quote in the paperNot a substantial claim0 of 2 sources checked
    • cites [28] source

      Not checked in the free run.

    • cites [40] source

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  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Findingcitation
    § Results

    Players' depression decreased when playing offline violent games.

    “Ferguson and Rueda33 and Valadez and Ferguson34 suggested that players' depression decreased when playing offline violent games”
    Quote in the paperNot a substantial claim0 of 2 sources checked
    • cites [33] source

      Not checked in the free run.

    • cites [34] source

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  • May combine two claims.

    Findingcitation
    § Discussion

    After removal of a possible outlier (Li, Chung, and Ho 2011), the effect size of the other nine trials did not change significantly, but heterogeneity decreased significantly to a low level.

    “It is important to note that after the removal of a possible outlier,39 the effect size of the other nine trials did not change significantly, but the heterogeneity decreased significantly to a low level.”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [39] source

      Not checked in the free run.

  • May combine two claims.

    Findingown data
    § Results

    Studies aimed at adults had the strongest effect size (d=-0.54) in the subgroup analyses of target population, with no heterogeneity in the three trials included in the subgroup.

    “Studies aimed at adults were recorded as having the strongest effect size (d=−0.54 [95% CI −0.86 to −0.21]) in the subgroup analyses of target population, with no heterogeneity in the three trials included in the subgroup.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Findingown data
    § Results

    Twelve out of 19 studies involved between-group experiments with at least a control condition, while seven applied other methodologies.

    “Twelve out of the 19 studies involved between-group experiments with at least a control condition, whereas the other seven applied other methodologies such as a single-group study or case study.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Findingreasoning
    § Discussion

    Sample size is another possible explanation, with Sally et al.'s trial involving nearly six times as many participants than Fleming et al.'s trial (187 vs 32 participants).

    “Sample size is another possible explanation, with Sally et al.'s trial involving nearly six times as many participants than Fleming et al.'s trial (187 vs. 32 participants).”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Findingreasoning
    § Discussion

    The review involved studies with a broad range of target groups, support types, and significance of depression symptoms, so there was considerable heterogeneity across the studies.

    “In addition, as the review involved studies with a broad range of target groups, support types, and significance of depression symptoms, there was considerable heterogeneity across the studies.”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Findingreasoning
    § Discussion

    Only a small number of studies met the inclusion criteria, which led to relatively few RCTs being identified for the meta-analysis.

    “As game-based digital applications for depression therapy is a rather new research area, only a small number of studies met the inclusion criteria, which also led to relatively few RCTs being identified for the meta-analysis.”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Findingnone given
    § Discussion

    In the 19 studies included in the review, four categories of game types were identified and described, of which psycho-education and training and virtual reality exposure therapy were identified as the most popular types of game application for depression.

    “In the 19 studies included in the review, four categories of game types were identified and described, of which psycho-education and training and virtual reality exposure therapy were identified as the most popular types of game application for depression.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Premisecitation
    § Introduction

    Preliminary results from early attempts showed effectiveness of individual games in reducing depression levels and enhancing social support.

    “Preliminary results from some early attempts to use this approach in the field have supported this claim by showing the effectiveness of individual games in reducing depression levels11,12 and enhancing social support.13”
    Quote in the paperSubstantial claim0 of 3 sources checked
    • cites [11] source

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    • cites [12] source

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    • cites [13] source

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  • Classified as probably not a substantial claim.

    Study design and conductcitation
    § Method

    Two reviewers assessed methodological quality of each study following Cochrane's risk of bias method.

    “Two reviewers were involved in the assessment of the methodological quality of each study, following Cochrane's method for assessing the risk of bias.25”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [25] Higgins JPT, 2009

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisecitation
    § Discussion

    The health benefits of digital videogames for older adults have been supported by a recent review.

    “The health benefits of digital videogames for older adults have been supported by a recent review,52”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [52] source

      Not checked in the free run.

  • May combine two claims.

    Premisecitation
    § Discussion

    These games provoke sensations of pleasure, further resulting in behavioral or cognitive distraction in individuals toward external stressors.

    “These games provoke sensations of pleasure,45 further resulting in behavioral or cognitive distraction in individuals toward external stressors.”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [45] Caillois R, 2006

      Not checked in the free run.

  • May combine two claims.

    Interpretationcitation
    § Discussion

    As distraction is a significant way of managing negative emotions, exercising and entertainment interventions have the potential to reduce depression by suspending reality.

    “As distraction is a significant way of managing negative emotions,46 exercising and entertainment interventions have the potential to reduce depression by suspending reality.”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [46] source

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Study design and conductnone given
    § Discussion

    We did not present data on attrition rates in the meta-analysis, which is a common concern for interventions that offer no support.

    “Finally, we did not present data on attrition rates in the meta-analysis, which is a common concern for interventions that offer no support.53”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [53] source

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Interpretationnone given
    § Discussion

    The superiority of waiting list control effects over active treatment controls may be because no treatment is worse than some treatment.

    “This may be because no treatment is worse than some treatment.”
    Quote in the paperNot a substantial claim
    • Rests on an assumption: No treatment is worse than some treatment.

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisecitation
    § Discussion

    Wilkinson et al. suggested that the elderly population is an important group that merits attention from therapeutic game developers.

    “and Wilkinson et al.20 further suggested that the elderly population is an important group that merits attention from therapeutic game developers.”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [20] source

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  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Interpretationreasoning
    § Discussion

    The variance might reflect that game-based psycho-education intervention has higher effect on treating depression among adolescents excluded from mainstream education rather than typical young people.

    “The variance might reflect that game-based psycho-education intervention has higher effect on treating depression among adolescents excluded from mainstream education (Fleming et al.'s trial), rather than typical young people (Sally et al.'s trial).”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Interpretationcitation
    § Discussion

    Psycho-education and training interventions may have further advantages in activating patients' motivation in the learning process and increasing the efficacy of teaching instrumental actions to deal with stressful situations.

    “With the interactive platform and game elements involved, psycho-education and training interventions may have further advantages in activating patients' motivation in the learning process and increasing the efficacy of teaching instrumental actions to deal with stressful situations.15”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [15] source

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Interpretationcitation
    § Discussion

    Digital games are popular among young people, so they have a high potential to become valuable tools for mental therapy for teenagers and young adults.

    “Given that digital games are popular among young people,48,49 they have a high potential to become valuable tools for mental therapy for teenagers and young adults.”
    Quote in the paperNot a substantial claim0 of 2 sources checked
    • cites [48] source

      Not checked in the free run.

    • cites [49] Lenhart A, 2008, Pew Internet and American Life Project

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisecitation
    § Discussion

    Virtual reality exposure therapy is a typical "mimicry" game type according to Caillois' taxonomy.

    “According to Caillois' well-known taxonomy of games, virtual reality exposure therapy is a typical “mimicry” game type.45”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [45] Caillois R, 2006

      Not checked in the free run.

  • May combine two claims.

    Interpretationreasoning
    § Discussion

    The results are of limited generalizability and should be interpreted with caution.

    “This heterogeneity can be seen as an advantage because it allowed us to investigate the differences among the studies, but it does mean that the results are of limited generalizability and should be interpreted with caution.”
    Quote in the paperSubstantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisecitation
    § Discussion

    By simulating a real environment and contexts, virtual reality exposure therapy can lead to a sense of illusion and the delimitation of space and time.

    “By simulating a real environment and contexts, this type of intervention can lead to a sense of illusion and the delimitation of space and time.45”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [45] Caillois R, 2006

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Interpretationown data
    § Discussion

    As only 2 out of the 19 studies focused on the elderly, there is clearly a research demand for future studies on the development and evaluation of digital game-based interventions tailored specifically to address elderly depression.

    “As only 2 out of the 19 studies focused on the elderly, there is clearly a research demand for future studies on the development and evaluation of digital game-based interventions tailored specifically to address elderly depression.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Interpretationnone given
    § Discussion

    Most of the studies were conducted with a small number of participants, and thus suffer from the risk of bias.

    “It is important to note that most of the studies were conducted with a small number of participants, and thus suffer from the risk of bias.”
    Quote in the paperSubstantial claim
34 of 34

  • The paper relies on this without support.

    The included game-based digital interventions are sufficiently similar to be pooled in a single meta-analysis.

    “To estimate the effects of game-based digital interventions on depression, we applied the standard mean difference (Cohen's d) to calculate the effect size for each study in the posttreatment period, weighted by sample size, using a random effects model.”

  • The paper relies on this without support.

    The different control conditions (waiting lists, treatment as usual, other active treatments) are sufficiently comparable to be combined in the overall meta-analysis.

    “The meta-analysis only included RCTs that encompassed a controlled condition (such as waiting lists, treatment as usual, or other active treatments).”

  • The paper relies on this without support.

    The depression scales used across studies measure the same underlying construct and can be pooled as self-reported depression outcomes.

    “Eligible studies had to contain an evaluation of the treatment's effects on participants' depression symptoms using a reliable and valid depression scale.”

  • The paper relies on this without support.

    The search of seven databases and the selected search terms identified all relevant studies.

    “A search of seven main health and technology databasesa was conducted to identify studies published in English before May 2013.”

  • The paper relies on this without support.

    No treatment is worse than some treatment.

    “This may be because no treatment is worse than some treatment.”

  • The paper relies on this without support.

    Virtual reality exposure therapy is more cost effective than exposure in vivo and allows therapists to control appropriate exposure stimuli for patients.

    “Compared with exposure in vivo, which requires going outside, virtual reality exposure therapy is more cost effective, and allows therapists to control the appropriate exposure stimuli for patients.”
6 of 6

Claims other papers make about this one

Each is checked against this paper’s own text: does it say what the citing paper says it does?

  • Mental health apps provide a potential way to reduce symptoms and increase adherence by dispensing psychoeducation and therapeutic skills through an accessible electronic format.

    “Mental health apps provide a potential way to reduce symptoms and increase adherence by dispensing psychoeducation and other therapeutic skills through an electronic, easily accessible format [26-34].”

    From Examining the effectiveness of gamification in mental health apps for depression: Systematic review and meta-analysis (2021) · cites this paper as [26]

    The Results describe game-based programs that deliver psychoeducation and therapeutic skills and report improvements in depression-related outcomes. The Introduction says these interventions can address barriers to access and engagement, but the paper focuses on game-based interventions rather than mental health apps generally and does not establish increased treatment adherence. The cited passages have section labels but no page numbers in our copy. (LLM, conf=0.83)

    Experimental — accuracy not yet measured

  • Mental health app interventions are moderately effective in reducing depressive symptoms compared to controls, consistent with prior meta-analyses.

    “Consistent with prior systematic reviews and meta-analyses on digital interventions for depression, we found that mental health app interventions are moderately effective in reducing depressive symptoms compared to controls [26,37,38,41,89].”

    From Examining the effectiveness of gamification in mental health apps for depression: Systematic review and meta-analysis (2021) · cites this paper as [26]

  • Previous systematic reviews and meta-analyses have shown significant reductions in symptoms for depression and other mental disorders while using mental health apps, some of which included CBT or gamification elements.

    “Additionally, previous systematic reviews and meta-analyses have shown significant reductions in symptoms for depression and other mental disorders while using mental health apps, some of which included cognitive behavioral therapy (CBT) or gamification elements [26,36,37,40,41].”

    From Examining the effectiveness of gamification in mental health apps for depression: Systematic review and meta-analysis (2021) · cites this paper as [26]

  • Because available reviews included studies that are not all RCTs, questions about effectiveness could not be answered optimally.

    “Also, since the available reviews (36, 37) included studies that are not all RCTs, questions about effectiveness could not be answered optimally.”

    From Serious Games for Mental Health: Are They Accessible, Feasible, and Effective? A Systematic Review and Meta-analysis (2017) · cites this paper as [36]

  • While a few reviews have been conducted on the potential impact of serious games for common mental disorders, none of these are robust.

    “Thus while a few reviews (36, 37) have been conducted on the potential impact of serious games for common mental disorders, none of these are robust.”

    From Serious Games for Mental Health: Are They Accessible, Feasible, and Effective? A Systematic Review and Meta-analysis (2017) · cites this paper as [36]

Statistics recomputed

Every reported test result, recomputed from its test statistic and degrees of freedom. A result shows as not adding up only once an independent check has confirmed it.

  • Consistentz = -4.09reported p < .0001 · recomputed p < .001

    “(Z=−4.09, p < .0001”

1 of 1

Self-check

Percentages, sums and reported differences re-computed from the paper’s own numbers.

Each contradiction between two passages listed here was confirmed by an independent check.

  • Active-treatment result is marked significant despite a confidence interval crossing zero

    Minor

    The active-treatment comparison is marked *** (p<0.01), but its reported 95% confidence interval includes zero. Its reported Z of 1.85 also corresponds to a two-sided p-value of approximately 0.064.

  • Nontherapist subgroup significance marking is too strong

    Minor

    The reported Z of 3.27 corresponds to a two-sided p-value of approximately 0.0011, which does not meet the table's **** threshold of p<0.001.

  • Two game-type comparisons have incorrect significance markings

    Minor

    The reported Z values of 3.00 and 2.49 correspond to two-sided p-values of approximately 0.0027 and 0.013, respectively. Neither meets the table's stated **** threshold of p<0.001.

3 of 3

Cites

Flagged first, then by citations

Research works printed but not linked: 4

  1. The Cochrane Collaboration, 2012, Review Manager (RevMan)
  2. Lipsey MW, 2001, Applied Social Research Methods Series, 49
  3. Russoniello CV, 2009, Studies in Health Technology & Informatics, 144, 189
  4. Lenhart A, 2008, Pew Internet and American Life Project

Cited by

Sorted by citations

Related

Authors
Li, J., Theng, Y.-L., & Foo, S.
Affiliations
Nanyang Technological University (SG)
ORCID
Venue
Cyberpsychology, Behavior, and Social Networking
Publisher
SAGE Publications
Published
2014-08
Volume
17
Issue
8
Pages
519-527
ISSN
  • 2152-2715 (ISSN-L)
  • 2152-2723
DOI
10.1089/cyber.2013.0481
PMC
PMC4118698
OpenAlex
W2038850367
Semantic Scholar
cdab373a2cce9c19b13fd81580be783b474046c0
Cited by
219
References
57
Citations by year
2026: 6 · 2025: 21 · 2024: 24 · 2023: 28 · 2022: 28 · 2021: 25 · 2020: 26 · 2019: 16 · 2018: 12 · 2017: 13 · 2016: 11 · 2015: 5 · 2014: 2 · 2013: 1
FWCI
1.25
Type
journal article
Language
en
Open access
Licence
www.liebertpub.com/nv/resources-tools/text-and-data-mining-policy/121/ (tdm)
Locations
  • Cyberpsychology Behavior and Social Networking (publishedVersion)
  • PubMed Central (publishedVersion)
  • PubMed (publishedVersion)
  • DR-NTU (Nanyang Technological University) (submittedVersion)
Funders
  • National Research Foundation
  • National Research Foundation Singapore
Topics
  • Social Sciences › Psychology › Applied Psychology › Digital Mental Health Interventions
  • Social Sciences › Psychology › Developmental and Educational Psychology › Educational Games and Gamification
  • Social Sciences › Psychology › Experimental and Cognitive Psychology › Anxiety, Depression, Psychometrics, Treatment, Cognitive Processes
Keywords
depression treatment, serious games, virtual reality exposure therapy, psychoeducation, exercise intervention, self-help intervention, waitlist control, treatment effectiveness
MeSH terms
Depression, Female, Game Theory, Humans

About these checks

Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.

Claims read by deepseek-v4.1-flash under definition version 3 (extract-v3) on 2026-10-09.

Classified by jev-1.13-20260917 (gold-guideline-v0.2) on 2026-10-09.

Statistics and arithmetic are recomputed, not judged.

Confidence bands are shown only for fields calibrated on our annotated test set. None is calibrated yet, so no band is shown.

What counts as a claim ›How we measure confidence ›How we check this ›

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