Juegos serios para el tratamiento o la prevención de la depresión: una revisión sistemática

Most included studies were carried out by the developers of the programs.

“Most studies were small and were carried out by the developers of the programs.”

One universal program had mixed results.

“Most reported promising results with some positive impact on depression although one universal program had mixed results.”

All included studies were tested with young people aged between 9 and 25 years.

“All were tested with young people (ages between 9 and 25 years).”

Most included studies were small.

“Most studies were small and were carried out by the developers of the programs.”

Nine studies relating to a total of six interventions met inclusion criteria.

“Nine studies relating to a total of six interventions met inclusion criteria.”

• Also stated in: § Results of the search · plain

  “Of the 43 studies interrogated for inclusion, 9 studies relating to six different interventions were eligible for inclusion.”

For the majority of possibly relevant studies that were excluded, the reason for exclusion was that the intervention was exclusively a Virtual Reality simulation that did not incorporate gaming as an integral or primary strategy or was an intervention aimed at other conditions.

“For the majority of possibly relevant studies that were excluded, the reason for exclusion was that the intervention was exclusively a Virtual Reality simulation that did not incorporate gaming as an integral or primary strategy or was an intervention that was aimed at other conditions.”

Five of the RCTs/CCTs had a sample size less than 34.

“The RCTs and CCTs were generally small; fi ve had a sample size less than 34; one RCT of SPARX (Merry et al., 2012) included a sample size of 187.”

The RCTs and CCTs were generally small.

“The RCTs and CCTs were generally small; fi ve had a sample size less than 34; one RCT of SPARX (Merry et al., 2012) included a sample size of 187.”

Eight included studies focused on children and/or adolescents aged 9 to 19 years.

“Eight studies focused on children and or adolescents (aged 9 to 19 years); while ReachOutCentral was tested with 18 to 25 year olds.”

In the open trial of Think Feel Do, participants demonstrated significant improvements in depression on the self-rated Adolescent Wellbeing Scale.

“In the open trial of Think Feel Do reported by Attwood et al. (2012), participants demonstrated signifi cant improvements in depression on the self-rated Adolescent Wellbeing Scale, the generalized anxiety subscale on the self-rated Spence Children's Anxiety Scale and in self-esteem on the Rosenberg Self Esteem Scale.”

One RCT of SPARX included a sample size of 187.

“The RCTs and CCTs were generally small; fi ve had a sample size less than 34; one RCT of SPARX (Merry et al., 2012) included a sample size of 187.”

Seven of the included studies reported programs tested with children or adolescents with depressive symptoms or emotional problems and recruited via schools, community organisations or health care providers.

“Seven of the studies reported programs tested with children or adolescents with depressive symptoms or emotional problems and recruited via schools, community organisations or health care providers.”

In the trial of ReachOutCentral, depression symptoms were only captured with the Kessler Psychological Distress Scale.

“In the trial of ReachOutCentral (Shandley et al., 2010), depression symptoms were only captured with the Kessler Psychological Distress Scale (which also includes items relevant to stress and anxiety) and there were no signifi cant improvements from pre-to post-intervention.”

In fully self-help interventions, between 60% and 90% of participants completed all 7 modules of SPARX.

“In terms of the fully self-help interventions (SPARX, SPARX-Rainbow, The Journey and ReachOutCentral); between 60% and 90% of participants completed all 7 modules of SPARX (Fleming et al., 2012, Lucassen et al., 2013, Merry et al., 2012) and 94% completed all modules of the Journey (Stasiak et al., 2012).”

In the trial of ReachOutCentral, there were no significant improvements in depression symptoms from pre- to post-intervention.

“In the trial of ReachOutCentral (Shandley et al., 2010), depression symptoms were only captured with the Kessler Psychological Distress Scale (which also includes items relevant to stress and anxiety) and there were no signifi cant improvements from pre-to post-intervention.”

In the CCT of Think Feel Do, those who received the intervention had significantly improved scores on social phobia and generalised anxiety subscales of the Spence Children's Anxiety Scale.

“Those who re-ceived the intervention had signifi cantly improved scores on the total anxiety score of the self-rated Spence Children's Anxiety Scale, as well as on social phobia and generalised anxiety subscales but no signifi cant improvements on parent-rated anxiety or on the parent-rated Strengths and Diffi culties Questionnaire (Attwood et al., 2012).”

In an RCT, those who received The Journey had significantly greater reductions in clinician-rated depression on the CDRS-R compared with a psycho-educational computer program.

“The Journey was compared with a psycho-educational computer program in an RCT and those who received the intervention had signifi cantly greater reductions in clinician-rated depression on the CDRS-R but not on self-report depression symptoms measured on the RADS-II (Stasiak et al., 2012).”

94% completed all modules of The Journey.

“In terms of the fully self-help interventions (SPARX, SPARX-Rainbow, The Journey and ReachOutCentral); between 60% and 90% of participants completed all 7 modules of SPARX (Fleming et al., 2012, Lucassen et al., 2013, Merry et al., 2012) and 94% completed all modules of the Journey (Stasiak et al., 2012).”

In the open trial of Rainbow SPARX, there were significant reductions on the CDRS-R from pre- to post-intervention.

“In the open trial of Rainbow SPARX there were signif icant reductions on the CDRS-R, RADS-II and the MFQ, as well as anxiety on the self-rated Spence Children's Anxiety Scale from pre-to post-intervention (Lucassen et al., 2013).”

When compared with a waitlist control in students in alternative education settings, SPARX resulted in significantly greater reductions in depression on the CDRS-R.

“When compared with a waitlist control in students in alternative education settings, SPARX resulted in signifi cantly greater reductions in depression on the CDRS-R, and on RADS-II, as well as signifi cantly higher rates of remission.However, there were no signifi cant differences between groups on anxiety or other measures of psychological functioning (Fleming et al., 2012).”

In the largest RCT, there were significantly higher remission rates for those who received SPARX compared with those who received treatment as usual.

“In the largest RCT included in this review, SPARX was shown to be as effective as treatment as usual in reducing clinician-rated depression on the Children's Depression Rating Scale-Revised (CDRS-R), on self-report depression symptoms measured on the Reynolds Adolescent Depression Scale-Revised Edition (RADS-II) and on the Moods and Feelings Questionnaire (MFQ), with signifi cantly higher”

In the largest RCT, those who received SPARX also had significantly greater reductions on self-reported anxiety on the Spence Children's Anxiety Scale.

“Those who received the intervention also had significantly greater reductions on self-reported anxiety on the Spence Children's Anxiety Scale.”

In the largest RCT, SPARX was shown to be as effective as treatment as usual in reducing self-report depression symptoms measured on the Reynolds Adolescent Depression Scale-Revised Edition (RADS-II).

“In the largest RCT included in this review, SPARX was shown to be as effective as treatment as usual in reducing clinician-rated depression on the Children's Depression Rating Scale-Revised (CDRS-R), on self-report depression symptoms measured on the Reynolds Adolescent Depression Scale-Revised Edition (RADS-II) and on the Moods and Feelings Questionnaire (MFQ), with signifi cantly higher”

In the CCT of Think Feel Do as a universal intervention with boys, differences between intervention and attention placebo were not reported.

“In the CCT reported in this study, Think Feel Do was tested as a universal intervention with a group of boys.Differences between those who received the intervention and those who received an attention placebo were not reported.Depression was not measured.”

In the largest RCT, SPARX was shown to be as effective as treatment as usual in reducing self-report depression symptoms measured on the Moods and Feelings Questionnaire (MFQ).

“In the largest RCT included in this review, SPARX was shown to be as effective as treatment as usual in reducing clinician-rated depression on the Children's Depression Rating Scale-Revised (CDRS-R), on self-report depression symptoms measured on the Reynolds Adolescent Depression Scale-Revised Edition (RADS-II) and on the Moods and Feelings Questionnaire (MFQ), with signifi cantly higher”

In the open trial of Think Feel Do, participants demonstrated significant improvements in self-esteem on the Rosenberg Self Esteem Scale.

“In the open trial of Think Feel Do reported by Attwood et al. (2012), participants demonstrated signifi cant improvements in depression on the self-rated Adolescent Wellbeing Scale, the generalized anxiety subscale on the self-rated Spence Children's Anxiety Scale and in self-esteem on the Rosenberg Self Esteem Scale.”

In clinician or facilitator supported interventions, 85% of participants in the RCT of Think Feel Do completed all modules.

“In terms of clinician or facilitator supported interventions, 85% of participants in the RCT of Think Feel Do completed all modules (Stallard).”

In the CCT of Think Feel Do as a universal intervention with boys, depression was not measured.

“In the CCT reported in this study, Think Feel Do was tested as a universal intervention with a group of boys.Differences between those who received the intervention and those who received an attention placebo were not reported.Depression was not measured.”

In the CCT of Journey to the Wild Divine and Freeze Framer, there were significant post-intervention differences between those who received the intervention and those in the waitlist control group on depression measured on the self-report Children's Depression Inventory.

“In the CCT of Journey to the Wild Divine and Freeze Framer, there were significant post-intervention differences between those who received the intervention and those who were in the waitlist control group on depression measured on the self-report Children's Depression Inventory as well as on anxiety measured by the self-report Multidimensional Anxiety Scale for Children (Knox et al., 2011).”

When compared with a waitlist control in students in alternative education settings, SPARX resulted in significantly greater reductions in depression on RADS-II.

“When compared with a waitlist control in students in alternative education settings, SPARX resulted in signifi cantly greater reductions in depression on the CDRS-R, and on RADS-II, as well as signifi cantly higher rates of remission.However, there were no signifi cant differences between groups on anxiety or other measures of psychological functioning (Fleming et al., 2012).”

On average males spent 69 minutes over 1.5 sessions on ReachOutCentral.

“On average females spent a total of 91 minutes over 1.6 sessions on ReachOutCentral and males spent 69 minutes over 1.5 sessions (Shandley et al., 2010).”

In the open trial of Rainbow SPARX, there were significant reductions on anxiety on the self-rated Spence Children's Anxiety Scale from pre- to post-intervention.

“In the open trial of Rainbow SPARX there were signif icant reductions on the CDRS-R, RADS-II and the MFQ, as well as anxiety on the self-rated Spence Children's Anxiety Scale from pre-to post-intervention (Lucassen et al., 2013).”

In the open trial of Rainbow SPARX, there were significant reductions on the RADS-II from pre- to post-intervention.

“In the open trial of Rainbow SPARX there were signif icant reductions on the CDRS-R, RADS-II and the MFQ, as well as anxiety on the self-rated Spence Children's Anxiety Scale from pre-to post-intervention (Lucassen et al., 2013).”

When compared with a waitlist control in students in alternative education settings, SPARX resulted in significantly higher rates of remission.

“When compared with a waitlist control in students in alternative education settings, SPARX resulted in signifi cantly greater reductions in depression on the CDRS-R, and on RADS-II, as well as signifi cantly higher rates of remission.However, there were no signifi cant differences between groups on anxiety or other measures of psychological functioning (Fleming et al., 2012).”

In the CCT of Think Feel Do, those who received the intervention had significantly improved scores on the total anxiety score of the self-rated Spence Children's Anxiety Scale.

“Those who re-ceived the intervention had signifi cantly improved scores on the total anxiety score of the self-rated Spence Children's Anxiety Scale, as well as on social phobia and generalised anxiety subscales but no signifi cant improvements on parent-rated anxiety or on the parent-rated Strengths and Diffi culties Questionnaire (Attwood et al., 2012).”

In the open trial of Rainbow SPARX, there were significant reductions on the MFQ from pre- to post-intervention.

“In the open trial of Rainbow SPARX there were signif icant reductions on the CDRS-R, RADS-II and the MFQ, as well as anxiety on the self-rated Spence Children's Anxiety Scale from pre-to post-intervention (Lucassen et al., 2013).”

In the largest RCT included in this review, SPARX was shown to be as effective as treatment as usual in reducing clinician-rated depression on the Children's Depression Rating Scale-Revised (CDRS-R).

“In the largest RCT included in this review, SPARX was shown to be as effective as treatment as usual in reducing clinician-rated depression on the Children's Depression Rating Scale-Revised (CDRS-R), on self-report depression symptoms measured on the Reynolds Adolescent Depression Scale-Revised Edition (RADS-II) and on the Moods and Feelings Questionnaire (MFQ), with signifi cantly higher”

In an RCT, those who received The Journey did not have significantly greater reductions in self-report depression symptoms measured on the RADS-II compared with a psycho-educational computer program.

“The Journey was compared with a psycho-educational computer program in an RCT and those who received the intervention had signifi cantly greater reductions in clinician-rated depression on the CDRS-R but not on self-report depression symptoms measured on the RADS-II (Stasiak et al., 2012).”

Study drop-outs but not adherence data were reported in the studies of gNats Island, Journey to the Wild Divine and Freeze Framer.

“Study drop-outs but not adherence data were reported in the studies of gNats Island Journey to the Wild Divine and Freeze Framer.”

In the open trial of Think Feel Do, participants demonstrated significant improvements in generalized anxiety on the self-rated Spence Children's Anxiety Scale.

“In the open trial of Think Feel Do reported by Attwood et al. (2012), participants demonstrated signifi cant improvements in depression on the self-rated Adolescent Wellbeing Scale, the generalized anxiety subscale on the self-rated Spence Children's Anxiety Scale and in self-esteem on the Rosenberg Self Esteem Scale.”

In the CCT of Journey to the Wild Divine and Freeze Framer, there were significant post-intervention differences between those who received the intervention and those in the waitlist control group on anxiety measured by the self-report Multidimensional Anxiety Scale for Children.

“In the CCT of Journey to the Wild Divine and Freeze Framer, there were significant post-intervention differences between those who received the intervention and those who were in the waitlist control group on depression measured on the self-report Children's Depression Inventory as well as on anxiety measured by the self-report Multidimensional Anxiety Scale for Children (Knox et al., 2011).”

When compared with a waitlist control in students in alternative education settings, there were no significant differences between groups on anxiety or other measures of psychological functioning.

“When compared with a waitlist control in students in alternative education settings, SPARX resulted in signifi cantly greater reductions in depression on the CDRS-R, and on RADS-II, as well as signifi cantly higher rates of remission.However, there were no signifi cant differences between groups on anxiety or other measures of psychological functioning (Fleming et al., 2012).”

Most studies did not include analysis of program content or detailed user feedback on program design.

“Most studies did not include analysis of program content or detailed user feedback on program design.”

There has been little investigation of important questions such as the effects of serious gaming interventions on existing consumer-therapist relationships, health service utilisation, equity of access to care and consumer perspectives.

“However the fi eld is relatively new, and there has been little investigation of important questions such as the effects of serious gaming interventions on existing consumer-therapist relationships, health service utilisation, equity of access to care and consumer perspectives (Murray et al., 2005;Stinson et al., 2009).”

• cites Murray et al., 2005Not checked yet

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• cites Stinson et al., 2009Not checked yet

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Eight of the included studies investigate a tool for children or adolescents with depression or current symptoms.

“Eight of the studies investigate the use of a tool for children or adolescents with depression or current symptoms.”

The literature regarding serious gaming is at an early stage.

“The literature regarding serious gaming is at an early stage.”

ReachOutCentral was tested with an unselected sample (participants did not need to have symptoms).

“ReachOutCentral was tested with an unselected sample (participants did not need to have symptoms)”

No included programs were smartphone-based.

“No programs were smartphone-based”

The review identified nine studies of six computerised interventions for depression that use gaming as a key component.

“In this systematic review, we have identifi ed nine studies of six computerised interventions for depression which utilise gaming as a key component.”

Many of the programs described (with the exception of ReachOutCentral, and, to those with New Zealand IP addresses, SPARX) are not available outside of research settings.

“Many of the programs described (with the exception of ReachOutCentral, and, to those with New Zealand IP addresses, SPARX) are not available outside of research settings.”

At present the literature on serious gaming for depression is very limited.

“however at present this literature is very limited.”

All included interventions focused on children, adolescents or young people (aged 9 to 25 years).

“All included interventions focused on children, adolescents or young people (aged 9 to 25 years).”

The average player used ReachOutCentral for one to two sessions.

“the average player used it for one to two sessions”

There were few notable changes in outcomes for ReachOutCentral.

“there were few notable changes in outcomes.”

The remaining included study is of ReachOutCentral (Shandley et al., 2010), an online program where users play the part of a new young person in town.

“The remaining study is of ReachOutCentral (Shandley et al., 2010), an online program where users play the part of a new young person in town.”

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Available data regarding adherence and impact is very limited.

“Available data regarding adherence and impact is very limited”

Attrition (non-completion) rates for computerised therapies have been shown to range from 2 to 83%.

“Attrition (non-completion) rates have been shown to range from 2 to 83% (Melville, Casey, & Kavanagh, 2010;Richards et al., 2012;So et al., 2013).”

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The evidence for serious gaming interventions for depression is currently very limited.

“Serious gaming interventions show promise for depression, however evidence is currently very limited.”

CCBT programs are acceptable to the adult population.

“and acceptable to the adult population (Gun, Titov, & Andrews, 2011).”

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Serious gaming interventions show promise for depression.

“Serious gaming interventions show promise for depression, however evidence is currently very limited.”

Growing evidence suggests that CCBT programs can be effective at reducing symptoms of depression and anxiety for young people.

“While less research has focused on children and adolescents, growing evidence suggests that CCBT programs can be effective at reducing symptoms of depression and anxiety for young people (Calear, & Christensen, 2010;Richardson, Stallard, & Velleman, 2010).”

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Rehearsal and feedback has been shown to enhance locus of control and self-efficacy.

“and has been shown to enhance locus of control and self-effi cacy (Goh, Ang, & Tan, 2008).”

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A therapeutic relationship appears to be a critical 'active ingredient' in face-to-face models of therapy.

“Firstly, a therapeutic relationship appears to be a critical 'active ingredient' in face-to-face models of therapy (Weisz, McCarty, & Valeri, 2006)”

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Increased human contact in conjunction with an online intervention has been the main change proposed to increase adherence.

“Secondly, increased human contact in conjunction with an online intervention has been the main change proposed to increase adherence (Christensen, Reynolds, & Griffi ths, 2011;Newman et al., 2011;Richards et al., 2012).”

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Participants who may be particularly sensitive to criticism or rejection are able to acquire and rehearse skills in a non-threatening context where choices are associated with clear outcomes.

“Participants who may be particularly sensitive to criticism or rejection are able to acquire and rehearse skills in a non-threatening context where choices are associated with clear outcomes (Read, & Shortell, 2011).”

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Rehearsal and feedback can be an effective tool for behaviour change.

“This rehearsal and feedback can be an effective tool for behaviour change (Read et al., 2011)”

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There is sufficient evidence to demonstrate that it is possible to develop game-based interventions to deal with depression.

“there is sufficient evidence to demonstrate that it is possible to develop game-based interventions to deal with the serious issue of depression”

The lack of definitive detail and the limited nature of the trials does not allow meta-analysis at this time.

“The lack of defi nitive detail and the limited nature of the trials does not allow meta-analysis at this time.”

Programs aimed at those with symptoms appear likely to reduce symptoms of depression.

“the programs aimed at those with symptoms appear to be likely to reduce symptoms of depression”

Existing literature has demonstrated that computerised interventions for depression can be effective.

“Existing literature has demonstrated that computerised interventions for depression can be effective”

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Users report favourably on game-based interventions for depression.

“users report favourably on them.”

Young people appear willing to try game-based interventions for depression.

“it appears that young people are willing to try these”

This review indicates that serious gaming might also be of use for depression.

“This review indicates that serious gaming might also be of use for depression”

Adherence to computerised interventions for depression is enhanced with therapist or paraprofessional support.

“and that adherence is enhanced with therapist or paraprofessional support (Spek et al., 2007;Richards et al., 2012).”

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Existing evidence shows that serious games can lead to improvements in diverse social, behavioural and clinical outcomes.

“Existing evidence shows that serious games can lead to improvements in diverse social, behavioural and clinical outcomes (Murray et al., 2005;Spek et al., 2007;Stinson et al., 2009).”

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These limitations preclude meaningful data synthesis at this time.

“These limitations preclude meaningful data synthesis at this time.”

The current data suggest that young people are willing to try serious games for depression.

“and that young people are willing to try them.”

Available data regarding adherence and impact is promising.

“but is promising.”

The current data suggest that it is possible to develop serious games for depression.

“The current data suggest that it is possible to develop serious games for depression”