Video games get blamed for teen depression, but one may help prevent it

Video games get blamed for teen depression, but one may help prevent it

Can a video game help prevent teen depression? Students who played one mental health game reported fewer symptoms a year later.

Teenagers hear a lot about what video games do to their mental health, and little of it is good. A new clinical trial found something different: high school students who played one game at school reported fewer depression symptoms a year later.

The game, called PlaySmart, was built at Dartmouth College to teach teens how to recognize emotional distress, resist peer pressure, and ask for help. Researchers tested it against ordinary video games on 532 high school students.

Lynn Fiellin, the study’s senior author, is a professor of biomedical data science and medicine at Dartmouth’s Geisel School of Medicine. Her play2PREVENT Lab builds games for young people’s mental health.

“What surprised me most was that the effect on depressive symptoms actually became clearer over time,” Fiellin told Earth.com. “We often expect an intervention to have its biggest impact right after someone gets it, but here the groups really separated at the one-year follow-up.”

PlaySmart teaches teens to seek help

In PlaySmart, players steer a main character through scenarios built from experiences the lab gathered from real teenagers. One task asks them to spot the signs of depression in a friend’s room. Another asks whether to bring a hard situation to a trusted adult.

Better choices lead to better outcomes for the character and everyone around them. Students can also work backward through the story to see where a different decision would have led.

Sessions ran 40 to 60 minutes on iPads, once or twice a week, for up to six weeks. The game began as a project to prevent opioid misuse.

Control students played games like The Sims

Half the students, chosen at random, got PlaySmart. The other half picked from nine commercial games, including The Sims and Papers, Please.

“We also used a rigorous comparison group,” Fiellin said. “The control group played commercial games for the same amount of time, so we weren’t simply comparing PlaySmart to doing nothing. That gives us more confidence that the difference we saw was related to the content of PlaySmart rather than just the experience of playing a game or receiving attention.”

The students came from 15 school-based health programs in Connecticut, where Fiellin started her lab while at Yale University. They were 16 to 19 years old.

Each qualified by reporting recent use of alcohol, cannabis, vaping, or another non-opioid substance, or elevated symptoms of depression or anxiety. Anyone with prior opioid misuse was excluded, and enrollment ran from October 2021 to February 2024.

Depression scores were lower after one year

Students rated their depression symptoms on a standard questionnaire scored from 0 to 24 – higher means more severe. Both groups started just under 7, which counts as mild.

A year after the sessions ended, the PlaySmart group scored 1.12 points lower than the control group – about 5.3 on average, compared with 6.4. That gap is unlikely to be chance.

For any single student, 1.12 points is a small change. The effect is in the same range as those seen with school prevention programs districts already run, such as classroom lessons and group discussions.

“This was a prevention intervention, not a treatment for clinical depression, and participants on average had relatively mild symptoms to begin with,” Fiellin explained. “So while the effect is modest at the individual level, even small improvements could have meaningful public health impact if a serious game like this could be delivered at scale.”

The two groups’ scores diverged at the one-year mark, not sooner. The researchers suspect a sleeper effect.

Students absorb the game’s coping skills but treat them lightly at first, because a game taught them. Only when something hard happens later do the skills get real use.

PlaySmart did not reduce anxiety

The earliest change wasn’t in symptoms. After six weeks, PlaySmart players held slightly more positive views of counseling and psychological services than the control group did.

In an exploratory analysis, those early shifts partially explained the lower depression scores six months later. Recognizing distress and asking for help are exactly the skills the game was built to teach.

The trial found no effect on anxiety symptoms. Anxiety can require different tools – practice facing feared situations, worry management, and relaxation – which the game doesn’t teach.

About 45% of students identified as Black and 38% as Hispanic, groups that report some of the highest levels of sadness and hopelessness in national youth surveys. The effect did not differ by sex, grade level, food insecurity, peer substance use, or family history of substance misuse.

Caroline Barry, the study’s first author, is a postdoctoral research fellow in Fiellin’s lab.

“The benefit held across all subgroups, which matters for an intervention meant to be delivered schoolwide or in communities broadly,” Barry said.

Every score was self-reported, and the depression finding was a secondary outcome – the trial’s first question was about opioid harm awareness. The researchers want the finding replicated in future studies. Nobody measured how well students engaged with the game, only how long they played.

Schools can request PlaySmart now

Asked by Earth.com whether parents and schools can get PlaySmart today, Fiellin said yes. Schools, districts, community organizations, and health departments can request access through Playbl, the company that distributes the lab’s games. She founded Playbl and holds a financial stake in it.

Parents are the next audience. Fiellin’s team is building a short digital program for families to use alongside the game, meant to strengthen the depression effect and possibly help with anxiety too.

She added, “Supportive parent-adolescent communication buffers against both conditions, but parents often avoid the conversations that matter most – about distress and about seeking help.”

The team also wants to know why depression improved and anxiety didn’t. “What exactly within the game is driving the depression effect, and could we build on that by adding components that more directly target anxiety?” Fiellin said in her interview with Earth.com.

Fiellin is curious about one more thing: what a longer follow-up would show. Whether the gap keeps growing or fades, one year after the last session is as far as anyone has measured.

The full study was published in the journal JAMA Network Open.

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