Abd-Alrazaq, Alaa, Al-Jafar, Eiman, Alajlani, Mohannad, Toro, Carla, Alhuwail, Dari, Ahmed, Arfan, Reagu, Shuja Mohd, Al-Shorbaji, Najeeb and Househ, Mowafa (2022) The effectiveness of serious games for alleviating depression : systematic review and meta-analysis. JMIR Serious Games, 10 (1). e32331. doi:10.2196/32331 ISSN 2291-9279.

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Abstract

Background: Depression is a common mental disorder characterized by disturbances in mood, thoughts, or behaviors. Serious games, which are games that have a purpose other than entertainment, have been used as a nonpharmacological therapeutic intervention for depression. Previous systematic reviews have summarized evidence of effectiveness of serious games in reducing depression symptoms; however, they are limited by design and methodological shortcomings.

Objective: This study aimed to assess the effectiveness of serious games in alleviating depression by summarizing and pooling the results of previous studies.

Methods: A systematic review of randomized controlled trials (RCTs) was conducted in accordance with the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) statement. The search sources included 6 bibliographic databases (eg, MEDLINE, PsycINFO, IEEE Xplore), the search engine “Google Scholar,” and backward and forward reference list checking of the included studies and relevant reviews. Two reviewers independently carried out the study selection, data extraction, risk of bias assessment, and quality of evidence appraisal. Results of the included studies were synthesized narratively and statistically, as appropriate, according to the type of serious games (ie, exergames or computerized cognitive behavioral therapy [CBT] games).

Results: From an initial 966 citations retrieved, 27 studies met the eligibility criteria, and 16 studies were eventually included in meta-analyses. Very low-quality evidence from 7 RCTs showed no statistically significant effect of exergames on the severity of depressive symptoms as compared with conventional exercises (P=.12). Very low-quality evidence from 5 RCTs showed a statistically and clinically significant difference in the severity of depressive symptoms (P=.004) between exergame and control groups, favoring exergames over no intervention. Very low-quality evidence from 7 RCTs showed a statistically and clinically significant effect of computerized CBT games on the severity of depressive symptoms in comparison with no intervention (P=.003).

Conclusions: Serious games have the potential to alleviate depression as other active interventions do. However, we could not draw definitive conclusions regarding the effectiveness of serious games due to the high risk of bias in the individual studies examined and the low quality of meta-analyzed evidence. Therefore, we recommend that health care providers consider offering serious games as an adjunct to existing interventions until further, more robust evidence is available. Future studies should assess the effectiveness of serious games that are designed specifically to alleviate depression and deliver other therapeutic modalities, recruit participants with depression, and avoid biases by following recommended guidelines for conducting and reporting RCTs.

Trial Registration: PROSPERO International Prospective Register of Systematic Reviews CRD42021232969; https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=232969

Item Type:	Journal Article
Subjects:	G Geography. Anthropology. Recreation > GV Recreation Leisure R Medicine > RC Internal medicine
Divisions:	Faculty of Science, Engineering and Medicine > Engineering > WMG (Formerly the Warwick Manufacturing Group)
SWORD Depositor:	Library Publications Router
Library of Congress Subject Headings (LCSH):	Depression, Mental , Depression, Mental -- Treatment, Serious games , Cognitive therapy, Computer games
Journal or Publication Title:	JMIR Serious Games
Publisher:	JMIR Publications
ISSN:	2291-9279
Official Date:	14 January 2022
Dates:	Date Event 14 January 2022 Published
Volume:	10
Number:	1
Article Number:	e32331
DOI:	10.2196/32331
Status:	Peer Reviewed
Publication Status:	Published
Access rights to Published version:	Open Access (Creative Commons)
Date of first compliant deposit:	23 February 2022
Date of first compliant Open Access:	24 February 2022

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