Zeiler Michael, Vögl Sandra, Prinz Ursula, Werner Nino, Wagner Gudrun, Karwautz Andreas, Zeller Natalie, Ackermann Lorenz, Waldherr Karin
Medical University of Vienna, Department for Child and Adolescent Psychiatry, Vienna, Austria.
Ferdinand Porsche FERNFH - Distance Learning University of Applied Sciences, Wiener Neustadt, Austria.
JMIR Ment Health. 2025 May 5;12:e67418. doi: 10.2196/67418.
The effects of traditional health-promoting and preventive interventions in mental health and mental health literacy are often attenuated by low adherence and user engagement. Gamified approaches such as serious games (SGs) may be useful to reach and engage youth for mental health prevention and promotion.
This study aims to systematically review the literature on SGs designed to promote aspects of mental health literacy among adolescents aged 10 to 14 years, focusing on game design characteristics and the evaluation of user engagement, as well as efficacy, effectiveness, and implementation-related factors.
We searched PubMed, Scopus, and PsycINFO for original studies, intervention development studies, and study protocols that described the development, characteristics, and evaluation of SG interventions promoting aspects of mental health literacy among adolescents aged 10 to 14 years. We included SGs developed for both universal and selected prevention. Using the co.LAB framework, which considers aspects of learning design, game mechanics, and game design, we coded the design elements of the SGs described in the studies. We coded the characteristics of the evaluation studies; indicators of efficacy, effectiveness, and user engagement; and factors potentially fostering or hindering the reach, efficacy and effectiveness, organizational adoption, implementation, and maintenance of the SGs.
We retrieved 1454 records through database searches and other sources. Of these, 36 (2.48%) studies describing 17 distinct SGs were included in the review. Most of the SGs (14/17, 82%) were targeted to a universal population of youth, with learning objectives mainly focusing on how to obtain and maintain good mental health and on enhancing help-seeking efficacy. All SGs were single-player games, and many (7/17, 41%) were embedded within a wider pedagogical scenario. Diverse game mechanics and game elements (eg, minigames and quizzes) were used to foster user engagement. Most of the SGs (12/17, 71%) featured an overarching storyline resembling real-world scenarios, fictional scenarios, or a combination of both. The evaluation studies provided evidence for the short-term efficacy and effectiveness of SGs in improving aspects of mental health literacy as well as their feasibility. However, the evidence was mostly based on small samples, and user adherence was sometimes low.
The results of this review may inform the future development and implementation of SGs for adolescents. Intervention co-design, the involvement of facilitators (eg, teachers), and the use of diverse game mechanics and customization to meet the needs of diverse users are examples of elements that may promote intervention success. Although there is promising evidence for the efficacy and effectiveness of SGs for promoting mental health literacy in youth, there is a need for more rigorously planned studies, including randomized controlled trials and real-world evaluations, that involve follow-up measures and the assessment of in-game performance alongside self-reports.
传统的促进健康和预防干预措施对心理健康及心理健康素养的影响，常常因依从性低和用户参与度不高而减弱。诸如严肃游戏（SGs）等游戏化方法，可能有助于接触青少年并促使他们参与心理健康预防和促进活动。
本研究旨在系统回顾关于为10至14岁青少年设计的、旨在促进心理健康素养各个方面的严肃游戏的文献，重点关注游戏设计特征、用户参与度评估，以及有效性、成效和与实施相关的因素。
我们在PubMed、Scopus和PsycINFO中检索了原始研究、干预开发研究以及研究方案，这些研究描述了促进10至14岁青少年心理健康素养各个方面的严肃游戏干预措施的开发、特征和评估。我们纳入了为普遍预防和特定预防而开发的严肃游戏。使用共同实验室框架，该框架考虑学习设计、游戏机制和游戏设计等方面，我们对研究中描述的严肃游戏的设计元素进行了编码。我们对评估研究的特征、有效性、成效和用户参与度指标，以及可能促进或阻碍严肃游戏的覆盖范围、有效性和成效、组织采用、实施及维持的因素进行了编码。
我们通过数据库搜索和其他来源检索到1454条记录。其中，36项（2.48%）描述17种不同严肃游戏的研究被纳入综述。大多数严肃游戏（14/17，82%）针对的是青少年总体人群，学习目标主要集中在如何获得和保持良好的心理健康以及提高求助效能。所有严肃游戏均为单人游戏，许多（7/17，41%）被嵌入更广泛的教学情境中。采用了多种游戏机制和游戏元素（如小游戏和测验）来提高用户参与度。大多数严肃游戏（12/17，71%）具有类似于现实世界场景、虚构场景或两者结合的总体故事情节。评估研究为严肃游戏在改善心理健康素养方面的短期有效性和成效以及其可行性提供了证据。然而，证据大多基于小样本，且用户依从性有时较低。
本综述的结果可能为未来针对青少年的严肃游戏的开发和实施提供参考。干预共同设计、促进者（如教师）的参与，以及使用多种游戏机制和定制以满足不同用户的需求，都是可能促进干预成功的因素示例。尽管有证据表明严肃游戏在促进青少年心理健康素养方面具有有效性和成效，但仍需要更严格规划的研究，包括随机对照试验和现实世界评估，这些研究应包括随访措施以及除自我报告外对游戏内表现的评估。
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