262 Chapter 6 While the first target population for serious games may be youth already in therapy, for whom serious games could supplement a therapistled intervention, serious games can also be aimed at youth not (currently) in therapy. Specifically, a particularly interesting target population for serious games are youth with mild mental health issues, because: (1) their symptoms may be mild enough to be alleviated through an intervention outside of a clinical setting and (2) prevention research has repeatedly shown larger effect sizes for prevention targeted at risk groups compared to universal prevention (Horowitz & Garber, 2006; Stockings et al., 2016). Moreover, people with acute mental health problems who nevertheless do not seek help is a third target population for serious games. A wide range of studies demonstrates that professional help-seeking is low in youth, with only about a quarter to a third of youth seeking help for diagnosable mood and anxiety disorders (Alonso et al., 2004; Merikangas et al., 2011). Perceived stigma is one important barrier that prevents youth from seeking help (Clement et al., 2015). Youth tend to feel self-conscious and embarrassed about seeking help from professionals and are concerned about confidentiality (Gulliver et al., 2010). Serious games may relieve the most pressing distress of these youth and/or aim to encourage youth to seek professional help. Thus, although serious games may target a range of populations, they may be most valuable when targeting youth with light mental health problems as well as those with severe mental health problems who are not inclined to seek professional help. Given the promise of serious games for mental health targeted at youth not (currently) in therapy, factors that increase motivation to engage with these games need to be addressed. It may be that promoting a serious game as a proven tool to enhance well-being could be effective. However, youth may not always be inclined to do something because it is ‘good for them’ and even if they do, their motivation may be lower than for a regular game. Another option may be a stealth approach which promotes mental health games as regular entertainment games. The value of each approach will depend on how youth value addressing mental health concerns. On the one hand, youth who are actually seeking interventions may be more attentive to games with explicit mental health aims than to games using a stealth entertainment promotion. Games that are explicitly promoted for their mental health aims may be easier to locate (e.g., online game stores or platforms have health and well-being sections). Also, youth who are not actively seeking interventions but have mild symptoms may still be more attentive to information about mental health improvement as it is personally relevant for them.
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