A Digital Behavioral Health Game for Adolescent Mental Health: A Prespecified Secondary Analysis of a Randomized Clinical Trial
In brief
Digital game lowers teen depression scores by about one point after 12 months
In a randomized trial of 532 high-school adolescents, a 6-week, 300-minute behavioral health game produced an average PHQ-8 reduction of 1.1 points compared with an active control at one year, while anxiety scores were unchanged. Early gains in attitudes toward counseling appeared to mediate the mood benefit, suggesting scalable support but modest effect size.
- Journal
- JAMA network open (Q1)
- Published
- 3 August 2026
- Study design
- Randomized controlled trial
- Evidence level
- Level 1, High (CEBM 1b)
- Authors
- Caroline M Barry, Tyra Boomer, Katie Haile, Haiyi Xie, Lynn E Fiellin
- PMID
- 42606863
- DOI
- 10.1001/jamanetworkopen.2026.29173
Why clinicians should know about it
- Picked for Psychiatry and Mental Health (paper of the day, 18 August 2026): Digital game for adolescent depression/anxiety, RCT secondary analysis
Abstract
IMPORTANCE: Adolescent depression and anxiety are common and impairing conditions. Scalable, engaging digital interventions offer a low-burden strategy to support youth mental health. OBJECTIVE: To evaluate the association of a codesigned digital behavioral health game for adolescents with depressive and anxiety symptoms during 12 months of follow-up and to explore the association with psychosocial outcomes. DESIGN, SETTING, AND PARTICIPANTS: This prespecified secondary analysis of a randomized clinical trial included assessments from baseline through 12 months. Eligible adolescents from 15 school-based health programs in Connecticut were 16 to 19 years of age and reported past 30-day use of alcohol, cannabis, vaping, or other nonopioid substances or elevated depression and/or anxiety symptoms. Participants were enrolled between October 21, 2021, and February 27, 2024; data analyses were completed on November 12, 2025. INTERVENTION: Participants were randomized 1:1 to a digital game of approximately 300 minutes delivered during 6 weeks or to an attention-matched active control. MAIN OUTCOMES AND MEASURES: Prespecified secondary outcomes included depressive (8-item Patient Health Questionnaire [PHQ-8]) and anxiety (7-item Generalized Anxiety Disorder [GAD-7]) symptoms. Psychosocial outcomes included beliefs about psychological services (BAPS), help-seeking intentions, and emotion regulation. Linear mixed models with participant-level random intercepts tested group, time, and group-by-time effects. Moderation by baseline characteristics and exploratory mediation of PHQ-8 scores via BAPS were examined. RESULTS: Among 532 participants, 269 were randomized to the intervention and 263 to the control condition; 284 (53.4%) were male, with a mean (SD) age of 16.6 (0.7) years. A group-by-time interaction was observed for PHQ-8 scores (F3,1308 = 2.93; P = .03). At 12 months, adjusted mean PHQ-8 scores were 5.30 (95% CI, 4.74-5.86) in the intervention group and 6.42 (95% CI, 5.86-6.98) in the control group (adjusted difference, -1.12 [95% CI, -1.85 to -0.38] points), with no association detected for GAD-7. At 6 weeks, intervention participants reported higher BAPS scores (adjusted difference, 0.03 [95% CI, 0.01-0.05]). Exploratory mediation showed that early BAPS improvements were associated with PHQ-8 score reductions at 6 months. No associations with remaining outcomes or moderation were observed. CONCLUSIONS AND RELEVANCE: In this prespecified secondary analysis of a randomized clinical trial, the intervention was associated with modest, sustained reductions in depressive symptoms during 12 months of follow-up. Early improvements in BAPS showed associations consistent with mediation of short-term depressive symptom reductions. Digital games may support adolescent mental health at scale. TRIAL REGISTRATION: ClinicalTrials.gov Identifier: NCT04941950.
Abstract as published, via PubMed.
For healthcare professionals. The summary is generated by AI from the published abstract, and the evidence level is assigned automatically from the study design on the Oxford CEBM hierarchy. Neither is medical advice. Read the full paper before changing practice.