2 49 REVIEW OF APPLIED & CASUAL GAMES FOR MENTAL HEALTH the applied game. The two studies comparing an applied game to a passive condition found effect sizes of 1.31 and 0.25, respectively, with only Knox et al. (2011) finding a significant effect in favour of the applied game. Finally, the study of Khanna and Kendall (2010) showed a nonsignificant effect size of 0.22 when comparing the active condition to casual games. Depression and Self-Injury Six studies (described in seven papers) included participants at risk of developing a depressive disorder, seeking help for it, or experiencing (elevated) depressive or related symptoms. Participants’ mean age ranged from 12 to 17 years, and the proportion of male participants varied from 0% to 58.8%. All studies used a regular RCT design, with the exception of the study of Poppelaars and colleagues (reported in Poppelaars et al., 2014; and Poppelaars et al., 2016) in which cluster randomisation was used and the study of Bohr et al. (2023) using both cluster randomisation and a crossover design. See Table A.5 (Appendix) for the characteristics and findings of these studies. All studies measured self-reported depressive symptoms, hence this was taken as an outcome variable. Effect sizes were calculated on data from six papers. As two papers originated from the same study (Poppelaars et al., 2016), one of them was not included in the forest plot (Poppelaars et al., 2014 focused on player motivation). Four papers included two intervention arms, comparing the applied game to an active condition (Merry, Stasiak, et al., 2012; Stasiak et al., 2014), or to a passive condition (Bohr et al., 2023; Fleming et al., 2012). One paper included three intervention arms, namely two casual games and a passive condition (Poppelaars et al., 2021). As one of the casual games was hypothesised to include mechanisms that could reduce depressive symptoms, this game (i.e., Journey) was coded as applied game for the purpose of this review. This paper contributed two effect sizes to the plot. One paper included four intervention arms, namely an applied game, an active condition, a combined condition (applied game + active condition), and a passive condition (Poppelaars et al., 2016). For the purpose of this review, only the two effect sizes comparing the applied game to the active condition and to the passive condition were included in the plot. As seen in Figure A.8 (Appendix), the three effect sizes comparing an applied game to an active condition ranged from 0.00 to 0.23. Only the study of Merry, Stasiak, et al. (2012) reported a significant effect in favour of the applied game. The comparison between the ‘applied’ game Journey and a casual game revealed a nonsignificant effect size of 0.07 in the study of Poppelaars et al.
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