Developing, Co-Designing and Testing a New Approach in Digital Mental Health for Young Adolescents: Match Emoji, a Casual Video Game Adapted for Mental Health and Well-Being

Although mental health and well-being treatments for adolescents exist, many who would benefit from these supports do not access them due to attitudinal and structural barriers, including stigma and cost. Digital mental health interventions address some of these barriers but have often had poor reach and retention in real-world settings. In this research, I explore a new mechanism that has received little attention to date. Specifically, I examined the potential of casual video games to enhance mental health and well-being among young adolescents. I undertook a stepwise series of studies exploring existing literature, establishing interest from young adolescents and adult stakeholders, and developing and testing Match Emoji, a casual video game adapted to enhance mental health and well-being. Methods 1. A systematic review of peer-reviewed literature published between 2009 to 2020 was carried out on the effects of casual video games on anxiety, depression, stress, and low mood. 2. An exploratory study using focus groups, workshops and brief presentations followed by open text forms was completed with young adolescents (13-to-15-years-olds) attending one of seven local primary or secondary schools.

3. Teachers and health professionals, including psychologists, social workers, and counsellors from across New Zealand, took part in an anonymous online survey to explore their opinions on adolescent mental health, digital mental health interventions and casual video games.

4. The development and design of Match Emoji, a casual video game adapted to enhance mental health and well-being, was documented. 5. A pilot study of Match Emoji was carried out with young adolescents (12-to-15-years-olds) from two New Zealand secondary schools and one intermediate school. Pre- and post-intervention mental health and well-being measures (Child and Adolescent Mindfulness Measure, General Help-Seeking Questionnaire, Flourishing Scale and Revised Children's Anxiety and Depression Scale) and semi-structured interviews were used to estimate the acceptability and therapeutic potential of Match Emoji.

From the 13 studies identified in the systematic literature review, 12 reported promising effects of casual video games on anxiety, depression, stress, and low mood (Study One). Among the 207 young adolescents who participated in the focus groups, workshops, and presentations, 91% reported playing casual video games at least once a week. Many participants reported playing these games to relieve stress, feel relaxed and become less bored. Overall, most participants were interested in the idea of casual video games adapted for mental health and well-being purposes and provided key recommendations, such as including brief mental health content, appealing colours and engaging game mechanisms (Study Two). In total, 98 teachers and health professionals took part in the online survey. Many participants shared similar views about the advantages of using digital mental health tools, including improving young people's access to mental health supports. A small number of participants were cautious about digital approaches, including using CVGs to deliver mental health and well-being content. However, given the importance of adolescent mental health, participants were open to novel ideas to address this challenge (Study Three). Among the 45 young adolescents who participated in a pilot study of Match Emoji, 71% (32/45) of participants reported playing the game after an 8-week follow-up, and participants reported some therapeutic benefits across the assessments after the completion of the study, with a significant difference found on the RCADS (P=.049) (Study Four).

A casual video game adapted to deliver mental health and well-being messaging represents a promising approach to support young adolescents' psychological well-being. It is important to explore the affordances of casual video games and exploit target-users current technology strategies.