For depressed teenagers, a computer game may provide an alternative to in-person counseling, researchers found.
In a multicenter trial in New Zealand, playing the cognitive behavioral video game SPARX at home was noninferior to usual clinical counseling in terms of improvements in self-reported depression scores, Sally Merry, MD, of the University of Auckland, and colleagues reported online in BMJ.
“The results are more impressive when it is considered that SPARX was entirely a self-help resource,” they wrote. “The only contact with a clinician was at recruitment, and the only input from health professionals during the course of treatment was a brief phone call after a month.”
Less than a fifth of young people with depressive disorder are treated, the researchers said, partly because young people may be reluctant to seek traditional help.
Being able to have therapy on the computer, however, may offer a potential way to appeal to today’s “digital natives,” they wrote.
So to evaluate whether SPARX (Smart, Positive, Active, Realistic, X-factor thoughts) could reduce depressive symptoms in adolescents who sought help compared with usual treatment, the researchers conducted a randomized controlled trial at 24 primary healthcare sites in New Zealand, which included school-based counseling services, youth clinics, and general practices.
A total of 187 adolescents ages 12 to 19 who sought help for depressive symptoms but had no major risk of self-harm were enrolled, and 168 completed 3 months of follow-up.
The game is set up as an interactive fantasy in which the user chooses an avatar that is charged with restoring balance in a word dominated by “gloomy negative automatic thoughts.” Cognitive behavioral therapy is delivered during those challenges via a guide who puts the game into context, provides education, gauges mood, and sets and monitors real-life challenges.
Depression in children can, if untreated, affect school performance and learning, social interactions and development of normal peer relationships, self-esteem and life skill acquisition, parent-child relations and a child’s sense of bonding and trust, can lead to substance abuse, disruptive behaviors, violence and aggression, legal troubles, and even suicide. According to the American Academy of Pediatrics, suicide is the 3rd leading cause of death among children and adolescents, just behind accidents and violence. Moreover, depressive thinking can become part of a child’s developing personality, leaving long-term effects in place for the rest of a child’s life.
Childhood depression is a serious problem that demands a serious treatment approach. However, one obstacle to eliminating depression in children is first to recognize it for what it is. Often children’s behavioral problems are only brought to professional attention when they are obvious: they may cause classroom disruption, expulsion from school, school failure, or injury to themselves or others. These behaviors may be seen as symptoms of ADHD, Oppositional Defiant Disorder, “truancy,” “delinquency,” or other vague problems and never recognized to be manifestations of an underlying depressive disorder. It is important to determine if depression is a part of the overall behavioral picture, because many effective therapies and interventions are available today.
The player typically spends 20 to 40 minutes on each of seven modules, delivered over 4 to 7 weeks.
Usual care was in-person counseling delivered by trained counselors and clinical psychologists.
Overall, Merry and colleagues found that SPARX was noninferior to treatment as usual.
In a per-protocol analysis, SPARX reduced self-reported depressive symptoms by a mean of 10.32 points, compared with a mean reduction of 7.59 points for those who had treatment as usual (P=0.079).
How common is depression?
As stated above, in general about 5% of children and adolescents nationally could be diagnosed with depression at any given time. Further studies have shown that this number changes as children age: about 1% of preschoolers, 2% of school-age children, and 5% of adolescents are affected. About 25 to 50% of all children and adolescents in psychiatric treatment are seen for depression and its related problems. Childhood depression appears to be more common in boys than in girls (about a 5 to 1 ratio, boys to girls) until adolescence, when it becomes more common for girls than boys (2 to 1 ratio, girls to boys).
Children who have biologic relatives that suffer from depression, anxiety disorders, and substance abuse disorders have a biologic tendency towards depression, and are more likely to develop clinical depression than children that do not have biologic relatives with these disorders.
Noninferiority also was confirmed in the intention-to-treat analysis, with a mean reduction of 9.05 points on self-rated depression scales for SPARX compared with a mean 7.45- point reduction for usual care.