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Bohr Y, Hankey J, Thomas A, Abdelmaseh M, Armour L, McCague H, Barnhardt J, Oskalns M, Garvey N, Singh Y, Danz C, Singoorie C, Qaunaq R, Oshoweetok I, Lucassen M, Merry S, Shepherd M, Bornstein MH, Ahmad F, Shulman S, Weiss J. A Nunavut community-directed Inuit youth mental wellness initiative: making I-SPARX fly. Int J Circumpolar Health 2024; 83:2401210. [PMID: 39388613 DOI: 10.1080/22423982.2024.2401210] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2024] [Revised: 09/02/2024] [Accepted: 09/02/2024] [Indexed: 10/12/2024] Open
Abstract
Inuit youth in Nunavut (NU) are resilient but face a protracted suicide crisis. The SPARX serious game and e-intervention, developed originally in New Zealand, teaches youth cognitive behavioural therapy (CBT) skills to ameliorate stress and depression. Inuit youth in NU reviewed and culturally adapted SPARX and an existing wellness outcome measure for Inuit. One hundred and twenty-one youth, aged 13 to 24, across NU then tested, played, and evaluated I(nuit)-SPARX, showing improvement in several areas of wellbeing post-play. Youth completed a CBT skills survey, engaged in sharing circles to assess CBT skill retention, and shared their thoughts about the usefulness and cultural fit of I-SPARX with Inuit Qaujimajatuqangit (IQ). Communication Skills, Listening Skills, and Problem Solving emerged as the most helpful learned CBT skills, and NU youth provided real-world examples of using I-SPARX skills to support their mental wellness. Several principles of IQ were exemplified and upheld in the content of the adapted SPARX tool and the process of the project as a whole. Empirically grounded, asynchronous e-tools, developed in collaboration with Inuit communities to ensure cultural specificity, may support psychological wellness in communities where mental health resources are scarce.
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Affiliation(s)
- Yvonne Bohr
- Department of Psychology, Faculty of Health, York University, Toronto, ON, Canada
- LaMarsh Centre for Child and Youth Research, Toronto, ON, Canada
| | - Jeffrey Hankey
- Department of Psychology, Faculty of Health, York University, Toronto, ON, Canada
- LaMarsh Centre for Child and Youth Research, Toronto, ON, Canada
| | - Alaina Thomas
- Department of Psychology, Faculty of Health, York University, Toronto, ON, Canada
- LaMarsh Centre for Child and Youth Research, Toronto, ON, Canada
| | - Marette Abdelmaseh
- Department of Psychology, Faculty of Health, York University, Toronto, ON, Canada
- LaMarsh Centre for Child and Youth Research, Toronto, ON, Canada
| | - Leigh Armour
- Department of Psychology, Faculty of Health, York University, Toronto, ON, Canada
- LaMarsh Centre for Child and Youth Research, Toronto, ON, Canada
| | - Hugh McCague
- Department of Psychology, Faculty of Health, York University, Toronto, ON, Canada
- LaMarsh Centre for Child and Youth Research, Toronto, ON, Canada
| | - Jenna Barnhardt
- Department of Psychology, Faculty of Health, York University, Toronto, ON, Canada
- LaMarsh Centre for Child and Youth Research, Toronto, ON, Canada
| | - Megis Oskalns
- Department of Psychology, Faculty of Health, York University, Toronto, ON, Canada
- LaMarsh Centre for Child and Youth Research, Toronto, ON, Canada
| | - Nichaela Garvey
- Department of Psychology, Faculty of Health, York University, Toronto, ON, Canada
- LaMarsh Centre for Child and Youth Research, Toronto, ON, Canada
| | - Yogita Singh
- Department of Psychology, Faculty of Health, York University, Toronto, ON, Canada
- LaMarsh Centre for Child and Youth Research, Toronto, ON, Canada
| | - Cassie Danz
- Department of Psychology, Faculty of Health, York University, Toronto, ON, Canada
- LaMarsh Centre for Child and Youth Research, Toronto, ON, Canada
| | | | - Reuben Qaunaq
- Ikpiarjuk/Δᒃᐱᐊᕐᔪᒃ/Arctic Bay, Arctic Bay, NU, Canada
| | | | - Mathijs Lucassen
- Nunabox, Iqaluit, NU, Canada
- School of Health and Medical Sciences, City, University of London, London, UK
- Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand
| | - Sally Merry
- School of Health and Medical Sciences, City, University of London, London, UK
| | | | - Marc H Bornstein
- Eunice Kennedy Shriver National Institute of Child Health and Human Development, Bethesda, MD, USA
- International Research Fellow, Institute for Fiscal Studies, London, UK
- Senior Advisor Research for ECD Parenting Programmes, UNICEF, New York city, NY, USA
| | - Farah Ahmad
- School of Health Policy & Management, Faculty of Health, York University, Toronto, ON, Canada
| | - Shmuel Shulman
- Department of Psychology, Bar-Ilan University, Ramat-Gan, Israel
| | - Jonathan Weiss
- Department of Psychology, Faculty of Health, York University, Toronto, ON, Canada
- LaMarsh Centre for Child and Youth Research, Toronto, ON, Canada
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Bryant BR, Sisk MR, McGuire JF. Efficacy of Gamified Digital Mental Health Interventions for Pediatric Mental Health Conditions: A Systematic Review and Meta-Analysis. JAMA Pediatr 2024:2823863. [PMID: 39312259 PMCID: PMC11420825 DOI: 10.1001/jamapediatrics.2024.3139] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/04/2024] [Accepted: 06/26/2024] [Indexed: 09/26/2024]
Abstract
Importance Anxiety, depression, and attention-deficit/hyperactivity disorder (ADHD) affect up to 20% of children and adolescents. Despite demonstrated efficacy, evidence-based treatments for these conditions are often inaccessible; innovative solutions are essential to meet the demand for pediatric mental health care. Objective To examine the efficacy and moderators of gamified DMHIs for anxiety, depression, and ADHD in randomized clinical trials (RCTs) for children and adolescents. Data Sources A systematic search of PubMed, PsycInfo, and Web of Science was conducted for RCTs published before March 20, 2024. Study Selection RCTs that evaluated the efficacy of gamified DMHIs for treating pediatric ADHD, depression, or anxiety were included. Studies were excluded if they did not use a gamified DMHI, provide sufficient data for effect sizes, or were unavailable in English. Data Extraction and Synthesis Efficacy data were extracted from rating scales for ADHD, depression, and anxiety. Extracted moderator variables included participant characteristics (eg, age and sex), intervention characteristics (eg, delivery modality and time limit), and trial design characteristics (eg, outcome measure and risk of bias). Main Outcomes and Measures The primary outcome was change in ADHD, depression, or anxiety severity in the treatment group compared to the control group. Hedges g quantified treatment effects. Results The search strategy identified 27 RCTs that included 2911 participants across ADHD, depression, and anxiety disorders. There were modest significant effects of gamified DMHIs on ADHD (g, 0.28; 95% CI, 0.09 to 0.48) and depression (g, 0.28; 95% CI, 0.08 to 0.47) but small, nonsignificant effects for anxiety disorders (g, 0.07; 95% CI, -0.02 to 0.17). Moderator analyses revealed that DMHIs for ADHD delivered on a computer and those RCTs that had a greater preponderance of male participants produced larger treatment effects. DMHIs for depressive disorders that used preset time limits for gamified DMHIs also exhibited larger treatment effects. Conclusions and Relevance The findings suggest a benefit of gamified DMHIs for youth with ADHD or depressive disorder. Pediatricians and other health care professionals have new information about novel, accessible, and efficacious options for pediatric mental health care.
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Affiliation(s)
- Barry R. Bryant
- Division of Child & Adolescent Psychiatry, Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Morgan R. Sisk
- Department of Psychiatry, University of Alabama at Birmingham Heersink School of Medicine, Birmingham
| | - Joseph F. McGuire
- Division of Child & Adolescent Psychiatry, Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, Maryland
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Wols A, Pingel M, Lichtwarck-Aschoff A, Granic I. Effectiveness of applied and casual games for young people's mental health: A systematic review of randomised controlled studies. Clin Psychol Rev 2024; 108:102396. [PMID: 38320420 DOI: 10.1016/j.cpr.2024.102396] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2023] [Revised: 01/24/2024] [Accepted: 01/29/2024] [Indexed: 02/08/2024]
Abstract
Many youth experience mental health problems and digital games hold potential as mental health interventions. This systematic review provides an overview of randomised controlled studies assessing the effectiveness of digital applied and casual games for improving mental health in youth aged 6-24 years. A systematic search of PsycINFO, Web of Science and Pubmed yielded 145 eligible studies. Studies on (sub)clinical participant samples (n = 75) most often focused on attention-deficit/hyperactivity disorder (ADHD), autism and anxiety. Applied games were found most effective for improving social skills, verbal memory and anxiety, whereas casual games were found most effective for improving depression, anxiety and ADHD. Studies involving healthy youth (n = 70) were grouped into papers examining anxiety in medical settings, momentary effects on positive and negative affect, and papers employing a longitudinal design measuring mental health trait outcomes. Promising results were found for the use of games as distraction tools in medical settings, and for applied and casual games for improving momentary affect. Overall, our findings demonstrate the potential of digital games for improving mental health. Implications and recommendations for future research are discussed, such as developing evaluation guidelines, clearly defining applied games, harmonising outcome measures, including positive outcomes, and examining nonspecific factors that may influence symptom improvement as well.
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Affiliation(s)
- Aniek Wols
- Radboud University, Behavioural Science Institute, Nijmegen, the Netherlands.
| | - Michelle Pingel
- Radboud University, Behavioural Science Institute, Nijmegen, the Netherlands
| | - Anna Lichtwarck-Aschoff
- Rijksuniversiteit Groningen, Department of Pedagogical & Educational Sciences, Groningen, the Netherlands
| | - Isabela Granic
- McMaster University, Health, Aging & Society, Hamilton, Ontario, Canada
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Povey J, Raphiphatthana B, Torok M, Nagel T, Mills PPJR, Sells JRH, Shand F, Sweet M, Lowell A, Dingwall K. An emerging framework for digital mental health design with Indigenous young people: a scoping review of the involvement of Indigenous young people in the design and evaluation of digital mental health interventions. Syst Rev 2023; 12:108. [PMID: 37393283 PMCID: PMC10314399 DOI: 10.1186/s13643-023-02262-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/22/2022] [Accepted: 05/30/2023] [Indexed: 07/03/2023] Open
Abstract
BACKGROUND Indigenous young people worldwide possess unique protective factors that support wellbeing. However, they experience mental illness at higher rates than their non-indigenous counterparts. Digital mental health (dMH) resources can increase access to structured, timely, and culturally tailored mental health interventions by reducing structural and attitudinal barriers to accessing treatment. The involvement of Indigenous young people in dMH resource development is recommended, however, no guidelines exist on how this can best be facilitated. METHODS A scoping review examining processes to involve Indigenous young people in developing or evaluating dMH interventions was conducted. Studies reported between 1990 and 2023 involving Indigenous young people aged 12-24 years, originating from Canada, the USA, New Zealand, and Australia, in the development or evaluation of dMH interventions were eligible for inclusion. Following a three-step search process, four electronic databases were searched. Data were extracted, synthesized, and described under three categories: dMH intervention attributes, study design, and alignment with research best practice. Best practice recommendations for Indigenous research and participatory design principles derived from the literature were identified and synthesised. Included studies were assessed against these recommendations. Consultation with two Senior Indigenous Research Officers ensured Indigenous worldviews informed analysis. RESULTS Twenty-four studies describing eleven dMH interventions met inclusion criteria. Studies included formative, design, pilot, and efficacy studies. Overall, most included studies demonstrated a high degree of Indigenous governance, capacity building, and community benefit. All studies adapted their research processes to ensure that local community protocols were followed and most aligned these within an Indigenous research paradigm. Formal agreements regarding existing and created intellectual property and implementation evaluations were rare. Outcomes were the primary focus of reporting, with limited detailed descriptions of governance and decision-making processes or strategies for managing predictable tensions between co-design stakeholders. CONCLUSIONS This study identified recommendations for undertaking participatory design with Indigenous young people and evaluated the current literature against these criteria. Common gaps were evident in the reporting of study processes. Consistent, in-depth reporting is needed to allow assessment of approaches for this hard-to-reach population. An emergent framework, informed by our findings, for guiding the involvement of Indigenous young people in the design and evaluation of dMH tools is presented. TRIAL REGISTRATION Available via osf.io/2nkc6.
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Affiliation(s)
- Josie Povey
- Menzies School of Health Research, Charles Darwin University, Casuarina Campus, Ellengowan Drive, Casuarina, NT 0810 Australia
| | - Buaphrao Raphiphatthana
- Menzies School of Health Research, Charles Darwin University, Casuarina Campus, Ellengowan Drive, Casuarina, NT 0810 Australia
| | - Michelle Torok
- Black Dog Institute, University of New South Wales, Sydney, NSW 2052 Australia
| | - Tricia Nagel
- Menzies School of Health Research, Charles Darwin University, Casuarina Campus, Ellengowan Drive, Casuarina, NT 0810 Australia
| | - Patj Patj Janama Robert Mills
- Menzies School of Health Research, Charles Darwin University, Casuarina Campus, Ellengowan Drive, Casuarina, NT 0810 Australia
| | - Joshua Russell Howard Sells
- Menzies School of Health Research, Charles Darwin University, Casuarina Campus, Ellengowan Drive, Casuarina, NT 0810 Australia
| | - Fiona Shand
- Black Dog Institute, University of New South Wales, Sydney, NSW 2052 Australia
| | - Michelle Sweet
- Menzies School of Health Research, Charles Darwin University, Casuarina Campus, Ellengowan Drive, Casuarina, NT 0810 Australia
| | - Anne Lowell
- Northern Institute, Charles Darwin University, Casuarina Campus, Casuarina, NT 0810 Australia
| | - Kylie Dingwall
- Northern Institute, Charles Darwin University, Casuarina Campus, Casuarina, NT 0810 Australia
- Menzies School of Health Research, Charles Darwin University, 10 Grevillia Drive, Alice Springs Campus, NT Australia
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