The DOI matches its Crossref record; 57 of the 57 references it cites were found in a registry or an index; none of the 56 sources its claims cite is checked for support yet.
Game-Based Digital Interventions for Depression Therapy: A Systematic Review and Meta-Analysis
Open accessAbstract
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.
Overview
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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.
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Claims the paper makes
0 of 56 cited sources checked · 0 supported · 0 flagged
A result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“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.”
Tests✓ Asserted: passes✓ Checkable: passes✓ Load-bearing: passes✓ Based: passes- 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.
- Also stated in: § Results · plain
A result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“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.”
Strength:plain· not yet calibratedCausal:correlational· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes? Load-bearing: unclear✓ Based: passesA result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“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.”
Strength:plain· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes? Load-bearing: unclear✓ Based: passes- Also stated in: § Results · plain
A result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“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.”
Strength:plain· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes? Load-bearing: unclear✓ Based: passes- Rests on an assumption: The search of seven databases and the selected search terms identified all relevant studies.
- Also stated in: § Results · plain
A result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“Heterogeneity among the depression outcomes was moderate (I2=47%; Table 2).”
Strength:plain· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes? Load-bearing: unclear✓ Based: passesA result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“which was statistically significant (Z=−4.09, p<0.0001).”
Tests✓ Asserted: passes✓ Checkable: passes✓ Load-bearing: passes✓ Based: passes- 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.
A result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“inspection of the forest plot suggested that one comparison was a possible outlier.39”
Strength:hedged· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes? Load-bearing: unclear✓ Based: passesA result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“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.”
Strength:plain· not yet calibratedCausal:direct· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes? Load-bearing: unclear✓ Based: passesA result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“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]).”
- Also stated in: § Results · plain
“Across the 10 comparisons (eight studies) and a total of 387 game-based digital intervention groups and 388 control groups, there was a moderate effect size of d=−0.47 [95% CI −0.69 to −0.24]; Fig. 2) for self-reported depression posttest”
Tests✓ Asserted: passes✓ Checkable: passes✓ Load-bearing: passes✓ Based: passes- 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.
- Also stated in: § Results · plain
A result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“A higher effect was achieved when a waiting list was used as the control.”
Strength:plain· not yet calibratedCausal:direct· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes? Load-bearing: unclear✓ Based: passes
- It may state two separate claims as one. 22
- Probably not a substantial claim. 17
A result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“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%).”
Strength:plain· not yet calibratedCausal:correlational· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes? Load-bearing: unclear✓ Based: passesIt may state two separate claims as one.
A result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“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.”
Strength:plain· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes✗ Load-bearing: fails✓ Based: passesProbably not a substantial claim. The paper’s conclusions may not depend on it.
A result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“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.”
Strength:hedged· not yet calibratedCausal:conditional· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes? Load-bearing: unclear✓ Based: passesIt may state two separate claims as one.
The paper states this without a source or data behind it here, so there is nothing to check it against. The quote shows it is in the paper.
In the paper
“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.”
Strength:plain· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes✗ Load-bearing: fails✓ Based: passesProbably not a substantial claim. The paper’s conclusions may not depend on it.
None of the sources cited for this claim have been checked yet.
In the paper
“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”
What the sources say
- Not checked yetcites [41] Knox M, 2011, Mental Health in Family Medicine
- Not checked yetcites [39] source
Strength:plain· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes? Load-bearing: unclear✓ Based: passesIt may state two separate claims as one.
A result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“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]).”
Strength:hedged· not yet calibratedCausal:correlational· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes? Load-bearing: unclear✓ Based: passesIt may state two separate claims as one.
A result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“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).”
Strength:plain· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes✗ Load-bearing: fails✓ Based: passesProbably not a substantial claim. The paper’s conclusions may not depend on it. It may state two separate claims as one.
A result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“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).”
Strength:plain· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes✗ Load-bearing: fails✓ Based: passesProbably not a substantial claim. The paper’s conclusions may not depend on it. It may state two separate claims as one.
A result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“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.”
Strength:hedged· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes? Load-bearing: unclear✓ Based: passesIt may state two separate claims as one.
None of the sources cited for this claim have been checked yet.
In the paper
“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.”
Strength:plain· not yet calibratedCausal:direct· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes? Load-bearing: unclear✓ Based: passesIt may state two separate claims as one.
None of the sources cited for this claim have been checked yet.
In the paper
“Ferguson and Rueda33 and Valadez and Ferguson34 suggested that players' depression decreased when playing offline violent games”
Strength:hedged· not yet calibratedCausal:direct· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes✗ Load-bearing: fails✓ Based: passesProbably not a substantial claim. The paper’s conclusions may not depend on it.
In the paper
“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.”
What the sources say
- Not checked yetcites [39] source
Tests✓ Asserted: passes✓ Checkable: passes✓ Load-bearing: passes✓ Based: passesIt may state two separate claims as one.
A result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“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.”
Strength:plain· not yet calibratedCausal:correlational· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes? Load-bearing: unclear✓ Based: passesIt may state two separate claims as one.
A result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“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.”
Strength:plain· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes? Load-bearing: unclear✓ Based: passesIt may state two separate claims as one.
The paper states this without a source or data behind it here, so there is nothing to check it against. The quote shows it is in the paper.
In the paper
“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).”
Tests✓ Asserted: passes✓ Checkable: passes✗ Load-bearing: fails✓ Based: passesProbably not a substantial claim. The paper’s conclusions may not depend on it.
The paper states this without a source or data behind it here, so there is nothing to check it against. The quote shows it is in the paper.
In the paper
“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.”
Tests✓ Asserted: passes✓ Checkable: passes✓ Load-bearing: passes✓ Based: passesIt may state two separate claims as one.
The paper states this without a source or data behind it here, so there is nothing to check it against. The quote shows it is in the paper.
In the paper
“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.”
Tests✓ Asserted: passes✓ Checkable: passes✓ Load-bearing: passes✓ Based: passesIt may state two separate claims as one.
The paper states this without a source or data behind it here, so there is nothing to check it against. The quote shows it is in the paper.
In the paper
“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.”
Strength:plain· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes? Load-bearing: unclear✓ Based: passesIt may state two separate claims as one.
None of the sources cited for this claim have been checked yet.
In the paper
“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”
What the sources say
Tests✓ Asserted: passes✓ Checkable: passes✓ Load-bearing: passes✓ Based: passesIt may state two separate claims as one.
In the paper
“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”
What the sources say
- Not checked yetcites [25] Higgins JPT, 2009
Load-bearingStrength:plain· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes✓ Load-bearing: passes✓ Based: passesProbably not a substantial claim.
In the paper
“The health benefits of digital videogames for older adults have been supported by a recent review,52”
What the sources say
- Not checked yetcites [52] source
Strength:plain· not yet calibratedCausal:direct· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes✗ Load-bearing: fails✓ Based: passesProbably not a substantial claim. The paper’s conclusions may not depend on it.
In the paper
“These games provoke sensations of pleasure,45 further resulting in behavioral or cognitive distraction in individuals toward external stressors.”
What the sources say
- Not checked yetcites [45] Caillois R, 2006
Strength:plain· not yet calibratedCausal:direct· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes? Load-bearing: unclear✓ Based: passesIt may state two separate claims as one.
In the paper
“As distraction is a significant way of managing negative emotions,46 exercising and entertainment interventions have the potential to reduce depression by suspending reality.”
What the sources say
- Not checked yetcites [46] source
Strength:hedged· not yet calibratedCausal:conditional· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes? Load-bearing: unclear✓ Based: passesIt may state two separate claims as one.
In the paper
“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”
What the sources say
- Not checked yetcites [53] source
Strength:plain· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes✗ Load-bearing: fails✓ Based: passesProbably not a substantial claim. The paper’s conclusions may not depend on it. It may state two separate claims as one.
A conclusion the paper draws from its own results — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“This may be because no treatment is worse than some treatment.”
Strength:hedged· not yet calibratedCausal:conditional· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes✗ Load-bearing: fails✓ Based: passesProbably not a substantial claim. The paper’s conclusions may not depend on it.
- Rests on an assumption: No treatment is worse than some treatment.
In the paper
“and Wilkinson et al.20 further suggested that the elderly population is an important group that merits attention from therapeutic game developers.”
What the sources say
- Not checked yetcites [20] source
Strength:hedged· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes✗ Load-bearing: fails✓ Based: passesProbably not a substantial claim. The paper’s conclusions may not depend on it.
A conclusion the paper draws from its own results — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“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).”
Strength:hedged· not yet calibratedCausal:conditional· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes✗ Load-bearing: fails✓ Based: passesProbably not a substantial claim. The paper’s conclusions may not depend on it.
In the paper
“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”
What the sources say
- Not checked yetcites [15] source
Strength:hedged· not yet calibratedCausal:conditional· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes✗ Load-bearing: fails✓ Based: passesProbably not a substantial claim. The paper’s conclusions may not depend on it. It may state two separate claims as one.
None of the sources cited for this claim have been checked yet.
In the paper
“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.”
What the sources say
- Not checked yetcites [48] source
- Not checked yetcites [49] Lenhart A, 2008, Pew Internet and American Life Project
Strength:hedged· not yet calibratedCausal:conditional· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes✗ Load-bearing: fails✓ Based: passesProbably not a substantial claim. The paper’s conclusions may not depend on it. It may state two separate claims as one.
In the paper
“According to Caillois' well-known taxonomy of games, virtual reality exposure therapy is a typical “mimicry” game type.45”
What the sources say
- Not checked yetcites [45] Caillois R, 2006
Strength:boosted· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes✗ Load-bearing: fails✓ Based: passesProbably not a substantial claim. The paper’s conclusions may not depend on it.
A conclusion the paper draws from its own results — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“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.”
Load-bearingStrength:plain· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes✓ Load-bearing: passes✓ Based: passesIt may state two separate claims as one.
In the paper
“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”
What the sources say
- Not checked yetcites [45] Caillois R, 2006
Strength:plain· not yet calibratedCausal:direct· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes✗ Load-bearing: fails✓ Based: passesProbably not a substantial claim. The paper’s conclusions may not depend on it.
A conclusion the paper draws from its own results — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“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.”
Strength:boosted· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes✗ Load-bearing: fails✓ Based: passesProbably not a substantial claim. The paper’s conclusions may not depend on it.
A conclusion the paper draws from its own results — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“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.”
Tests✓ Asserted: passes✓ Checkable: passes✓ Load-bearing: passes✓ Based: passesIt may state two separate claims as one.
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.”
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?
The source backs part of the claim, not all of it — or backs it for a different population, condition or comparison.
In the citing paper
“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]
Experimental — accuracy not yet measuredThe cited source says what the claim attributes to it.
In the citing paper
“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]
The cited source says what the claim attributes to it.
In the citing paper
“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]
In the citing paper
“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]
In the citing paper
“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]
In the citing paper
“Support for the effectiveness of game-based interventions for depression was found.”
From Serious Games for Mental Health: Are They Accessible, Feasible, and Effective? A Systematic Review and Meta-analysis (2017) · cites this paper as [36]
In the citing paper
“This finding is similar to that of a recently conducted meta-analysis of game-based interventions by Li et al. (36) for depression only.”
From Serious Games for Mental Health: Are They Accessible, Feasible, and Effective? A Systematic Review and Meta-analysis (2017) · cites this paper as [36]
In the citing paper
“However, Li and colleagues did not confine their meta-analysis to serious games—they included simulation studies as well.”
From Serious Games for Mental Health: Are They Accessible, Feasible, and Effective? A Systematic Review and Meta-analysis (2017) · cites this paper as [36]
In the citing paper
“The clinical impact for the youth group (≤18, g = 0.70, n = 5) is comparable to the adult group (g = 0.53), as in the Li et al.’s study (36).”
From Serious Games for Mental Health: Are They Accessible, Feasible, and Effective? A Systematic Review and Meta-analysis (2017) · cites this paper as [36]
In the citing paper
“Although much less work has been done with serious games for mental health as compared to other conditions, several game-based interventions have been developed [62-65].”
From Use of the Principles of Design Thinking to Address Limitations of Digital Mental Health Interventions for Youth: Viewpoint (2019) · cites this paper as [65]
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”
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
MinorThe 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.
“Active treatment 2 −0.53 [−1.10, 0.03] 1.85 *** 6%”
“***p<0.01; ****p<0.001.”
Nontherapist subgroup significance marking is too strong
MinorThe 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.
“Nontherapist involved (SA+PSH) 3 −0.54 [−0.86, −0.21] 3.27 **** 0%”
“***p<0.01; ****p<0.001.”
Two game-type comparisons have incorrect significance markings
MinorThe 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.
“Psycho-education and training 6 −0.41 [−0.67, −0.14] 3.00 **** 48% Virtual reality exposure therapy 2 −0.67 [−1.19, −0.14] 2.49 **** 49%”
“***p<0.01; ****p<0.001.”
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Metadata
- Authors
- Li, J., Theng, Y.-L., & Foo, S.
- Affiliations
- Nanyang Technological University (SG)
- 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
- 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
- FWCI
- 1.25
- Type
- journal article
- Language
- en
- Open access
- green
- www.ncbi.nlm.nih.gov
- 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
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