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Digital mental health interventions (DMHIs) with game-like elements -- also known as gamification -- appeared to provide limited benefit for some mental health conditions in young people, according to a systematic review and meta-analysis.

Among more than 2,900 youth in 27 randomized controlled trials (RCTs), gamified DMHIs had small but significant effects on attention-deficit/hyperactivity disorder (ADHD, Hedges' g=0.28, P<0.001) and depressive disorder (Hedges' g=0.28, P<0.005), according to Joseph McGuire, PhD, of Johns Hopkins University School of Medicine in Baltimore, and colleagues.

Gamified interventions also had small, nonsignificant effects for anxiety disorders (Hedges' g=0.07, P<0.14), they reported in .

"It was heartening to see that DMHIs have the potential to improve symptoms of ADHD and depression in children and adolescents," McGuire told MedPage Today in an email. "While the benefits are still modest based on the current data, findings from this meta-analysis of [RCTs] highlight potential ways to further enhance these modest effects."

Larger treatment effects were seen in studies that looked into preset time limits for gamified digital interventions for depressive disorders.

The authors also found that treatment effects were larger in studies of computer-delivered ADHD interventions and when most of the trial participants were male. With the recent increase in mental health apps for mobile devices, McGuire's group suggested that the larger treatment effect from computer-based interventions should be further investigated.

These findings also highlight the need for establishing reporting guidelines for RCTs of these interventions, as the researchers noted the lack of consistency in measures across trials.

"While the overall effects are modest and further research is needed, it highlights the potential of DMHIs to be scalable solutions -- 'one tool in a tool box' of solutions -- that help address the growing need for mental healthcare among children and adolescents," McGuire said.

James Sherer, MD, medical director of addiction psychiatry at Overlook Medical Center in Summit, New Jersey, told MedPage Today in an email that he hopes this research can pave the way for more investment in the development of DMHIs for young people.

"There are many at-risk populations and communities that don't have access to traditional, brick-and-mortar mental health services," said Sherer, who was not involved in the study. "Gamified interventions could allow more people to access mental health treatment."

"As a life-long gamer myself, I don't find the results surprising," Sherer added. "Game systems that allow for steady progression have engaged gamers for decades. It makes sense that these types of interventions could be repurposed for mental health treatment."

He added that the FDA has already for the treatment of ADHD, and various apps incorporate gamified mindfulness therapy as well.

For the systematic review and meta-analysis, the authors conducted searches on PubMed, PsycInfo, and Web of Science for RCTs published before March 20, 2024, using several key terms, including "videogame," "computer game," and "game-based."

McGuire and colleagues identified 27 studies with 2,911 participants, including 771 with ADHD, 1,332 with depression, and 1,719 with anxiety. The studies included 32 treatment comparisons.

While there was a significant association between biological sex and treatment effects, the researchers did not find significant associations between average participant age and treatment effects.

The study had several limitations, including that most of the studies relied on reporting from parents or children, making them more at risk of bias than using assessment from independent evaluators. There were also limited characteristics available across all studies, meaning unexamined factors could influence treatment effects. The authors also excluded studies that did not use gamified DMHIs, lacked sufficient data for effect sizes, and were published in languages other than English.

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