4 223 MENTAL HEALTH OUTCOMES OF APPLIED GAME MINDLIGHT Next to child factors, we also examined maternal mental health (i.e., maternal depressive, anxiety and stress symptoms) as possible outcome predictors. In line with our hypothesis, maternal mental health problems did not affect changes in children’s anxiety symptoms over time. It is important to note, however, that the prevalence of maternal mental health problems was relatively low in our sample. Considering the important role of maternal mental well-being in children’s development (Goodman et al., 2011; Powdthavee & Vignoles 2008) more research may be needed. For example, it may be interesting to select children for a prevention program based on whether their mother is highly stressed versus not and examine differential effects. Although anxiety symptoms at baseline, self-efficacy and maternal mental health did not predict the change in anxiety symptoms, there were some interesting associations between these mental health variables and initial levels of anxiety symptoms that warrant further discussion. First, as expected, children that rated themselves as more anxious at baseline also reported lower levels of social, emotional and academic self-efficacy. Second, initial levels of child-reported anxiety were predicted by mother-reported children’s anxiety at baseline. This result basically represents cross-informant agreement of baseline anxiety levels, which is generally significant but low (De Los Reyes et al., 2015). Last, higher initial levels of mother-reported children’s anxiety were predicted by higher maternal depression, anxiety and stress symptoms. This finding suggests that mothers with mental health problems might have a biased perception of their child’s emotional well-being (Briggs-Gowan et al., 1996). That is that mothers’ rating of their children’s anxiety is not so much a reflection of children’s actual anxiety level but reflects their own struggles with depression, anxiety and/or stress. In sum, these results suggest that MindLight and CBT can enhance mental health despite difficulties children or their parents may have. Strengths, Limitations and Future Research The current study used a non-inferiority randomised controlled design to assess the effectiveness of an applied game against the standard of anxiety prevention (i.e., CBT). More specifically, we extended previous work about the effectiveness of MindLight on anxiety symptoms by assessing effects on secondary outcomes and potential outcome predictors, factors that are often neglected in previous research. In addition to the broader range of outcomes, we extended previous studies on anxiety prevention programs by including children’s as well as maternal reports. The result that internalising and externalising problems decreased according to both children and mothers
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