Table 1.
Characteristics of studies included in the current review
| Authors | Year | Total, N | Mean age, years (range) | Experimental design | Primary outcome | Outcome measure | Location | Intervention group | Intervention description | Intervention delivery | Intervention group, n | Control group | Control group, n | Main findings |
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| David et al40 | 2019 | 96 | 13.02 (10−16) | RCT | Depression | EATQ-R | Romania | REThink | Progression through seven levels lasting maximum 50 min each | iOS application | 48 | Waiting list | 48 | Participants reported reduced depressive mood symptoms following REThink (d = 0.84) |
| Dennis and O'Toole41 | 2014 | 38 | 22.34 (17−50) | RCT | Anxiety | STAI | USA | ABMT | Points earned through successful completion of tasks consisting of 16 blocks of 40 trials | iOS application | 19 | Placebo training | 19 | Reduced subjective anxiety post-intervention in only the short ABMT condition |
| Dennis-Tiwary et al46 | 2016 | 42 | 20.60 (18−38) | Non-RCT | Anxiety | STAI | USA | ABMT | Points earned through successful completion of tasks consisting of 12 blocks of 40 trials | iOS application | 19 | Placebo training | 23 | STAI scores did not reach significance; women reported improved performance on anxiety stress-related task |
| Fleming et al43 | 2012 | 30 | 14.9 (13−16) | RCT | Depression | CDRS-R | New Zealand | SPARX | Learned skills to navigate fantasy game-world consisting of seven modules at 20 min each | Computer program | 19 | Waiting list | 11 | SPARX group reported significantly greater reduction in CDRS-R scores compared with waiting list |
| Knox et al47 | 2011 | 24 | 12.88 (9−17) | Non-RCT | Anxiety; depression | MASC; CDI | USA | Freeze-Framer 2.0 and Journey to the Wild Divine | Biofeedback programs where players interact with a fantasy world and face challenges to overcome when navigating | Biofeedback and computer program | 12 | Waiting list | 12 | Intervention group reported reduced MASC and CDI scores compared with comparison group |
| Kuosmanen et al42 | 2017 | 66 | 17.60 (15−20) | RCT | Anxiety; depression | GAD-7; SMFQ | Ireland | SPARX-R | Learned skills to navigate fantasy game-world consisting of seven modules at 20 min each (revised version of SPARX) | Computer program | 30 | No intervention | 36 | Non-significant treatment effect for both anxiety (P = 0.34) and depression (P = 0.88) |
| Lucassen et al48 | 2015 | 21 | 16.50 (13−19) | Non-RCT | Depression | CDRS-R | New Zealand | Rainbow SPARX | Learned skills to navigate fantasy game-world consisting of seven modules at 20 min each (revised version of SPARX to adapt program for sexual minority groups) | Computer program | 21 | − | − | Depressive symptoms decreased significantly post-intervention (d = 1.01), which was maintained at 3-month follow-up |
| Merry et al24 | 2012 | 374 | 15.60 (12−19) | RCT | Depression | CDRS-R | New Zealand | SPARX | Learned skills to navigate fantasy game-world consisting of seven modules at 20 min each | Computer program | 187 | Treatment as usual | 187 | Participants in intention-to-treat analysis reported mean reduction on CDRS-R scores with advantage to SPARX of 1.60 (P = 0.26) over comparison |
| Poppelaars et al44 | 2016 | 102 | 13.35 (11−16) | RCT | Depression | RADS-2 | The Netherlands | SPARX | Learned skills to navigate fantasy game-world consisting of seven modules at 20 min each | Computer program | 51 | No intervention | 51 | Depressive symptoms decreased across all conditions with all conditions being equally effective |
| Scholten et al45 | 2016 | 138 | 13.27 (11−15) | RCT | Anxiety | SCAS | The Netherlands | Dojo | Biofeedback game in a fantasy world where players interact with characters, and are challenged by them, with emotion states reflected in the game world | Biofeedback and computer program | 70 | Rayman 2: The Great Escape | 68 | Anxiety symptoms decreased in both conditions with equal improvement and no significant difference across the conditions |
| Shandley et al50 | 2010 | 266 | 20.50 (18−25) | Non-RCT | Anxiety/ depression | KPDS | Australia | Reach Out Central | Players roleplay as a character who must adjust to new a new environment and are encouraged to perform various ‘real-life’ actions in game to improve mood metre and progress | Online gaming program | 266 | − | − | Women reported higher mean scores on the KPDS |
| Shepherd et al49 | 2018 | 6 | 14.67 (14−16) | Non-RCT | Depression | CDRS-R | New Zealand | SPARX | Learned skills to navigate fantasy game-world consisting of seven modules at 20 min each | Computer program | 6 | − | − | SPARX led to significant reduction in CDRS-R scores post-intervention from baseline (P = 0.008) |
RCT, Randomised Controlled Trials; EATQ-R, Early Adolescent Temperament Questionnaire-Revised; STAI, State-Trait-Anxiety-Inventory; ABMT, Attention Bias Modification Training; CDRS-R, Children's Depression Rating Scale-Revised; SPARX, Smart, Positive, Active, Realistic, X-factor thoughts; MASC, Multidimensional Anxiety Scale for Children; CDI, Children's Depression Inventory; GAD-7, General Anxiety Disorder Assessment, 7-items; SMFQ, Short Mood and Feelings Questionnaire; SPARX-R, Smart, Positive, Active, Realistic, X-factor thoughts-Revised; RADS-2, Reynolds Adolescent Depression Scale, 2nd Edition; SCAS, The Spence Children's Anxiety Scale; KPDS, Kessler Psychological Distress Scale.