Nearly 60 subjects, half of whom served as controls, all meeting the criteria of clinical depression, participated in the study, which involved three family-friendly, non-violent puzzle games: Bejeweled 2, Peggle and Bookworm Adventures. (All of the games are made by PopCap Games, underwriter of the study.)
The hypothesis was tested using state-of-the-art technologies including psycho-physiological, biochemical and psychological measurements, and found an average reduction in depression symptoms of 57% in the experimental (“video game”) group. The study, the first such research ever to measure the efficacy of video games in reducing depression and anxiety, also found significant reduction in anxiety, as well as improvements in all aspects of mood, among study subjects who played the casual video games.
“The results of this study clearly demonstrate the intrinsic value of certain casual games in terms of significant, positive effects on the moods and anxiety levels of people suffering from any level of depression,” stated Dr. Carmen Russoniello, Director of the Psychophysiology Lab and Biofeedback Clinic at ECU and the professor who oversaw the study (as well as previous studies involving the same games' effects on stress levels). “In my opinion the findings support the possibility of using prescribed casual video games for treating depression and anxiety as an adjunct to, or perhaps even a replacement for, standard therapies including medication.”
Russoniello said that the games had both short term (after 30 minutes of game play) and long term (after one month) effects when compared to the control group. “Equally important, the data supports the hypothesis that casual video games contain intrinsic qualities that, when played, provoke physiological and biochemical changes consistent with positive changes in mood and anxiety.”
According to the National Institute of Mental Health in the United States an estimated 20.9 million American adults (9.5% of the U.S. population age 18 or older) suffers from a mood disorder, and more than two thirds of those (14.8 million U.S. adults) are cases of major depression. Depression is the leading cause of disability in the U.S. for people aged 15 to 44. Depressive disorders often co-occur with anxiety disorders, and approximately 40 million American adults (about 18 percent of all U.S. adults) have an anxiety disorder.
High-level findings of the study are provided below. Additional details, along with findings of previous studies, are available at the official website. Results indicate that there was a 57% average decrease in depression symptoms among participants in the experimental group and this was statistically significant when compared to the control group. Table 1 presents clinical results for PHQ-9 pre- and post-study for both the video game and control groups:
The video game group saw significant reductions in depression across the board, with all seven subjects previously classified as suffering from moderate to severe depression moving to the minor or minimal depression categories. At the same time, the number of subjects classified as having minor depression dropped from nine to four.
Graph 1 illustrates the decrease in depression symptoms in the casual video game group and shows how all participants in this group shifted into the mild symptom category:
Further analyses revealed differences in the effects of the games on male test subjects compared to female subjects, as well as differences between younger (less than 25 years) and older (equal to or greater than 25) study participants. Significant changes in overall mood (65% improvement on average) and anxiety level (20% reduction in anxiety on average) were also identified among subjects in the video game group. Even somatic, or overall physical, symptoms, improved in the experimental group, by 36% on average. Additional details on these and other initial findings of the study are available.
The study hypothesis, methodology and logistical plan were developed between July 2009 and August 2010, and the clinical state of the study was conducted between August 2010 and November 2010 and included a total of 59 subjects. Twenty-nine participants served as controls surfing the National Institutes of Mental Health’s Web page on depression. The experimental group consisted of 30 participants with 18 choosing to play Bejeweled 2; seven participants choosing to play Peggle and five participants choosing to play Bookworm Adventures (BWA). There were 30 females and 29 males in the study. Participants ranged in age from 18 to 74 with average age calculated at 30. Sixty-five percent of the participants were European-Americans; twenty three percent were African Americans, 3.3% Hispanic Americans, 1.6 % Asian Americans and 3.3% other. Sixty-three percent were gamers and 31% were not. Twenty-three percent were on anti-depressant medications and 73 % were not. Additional specifics of the study methodology can be found at the official website.
“Compliance was not an issue in this study with all participants meeting minimum playing time requirements and there were no side effects reported in the month long study,” Russoniello noted. “Given that only 25% of people who suffer from depression are receiving treatment, it seems prudent to make these low cost, readily accessible casual games video games available to those who need them. They should be made available at health clinics, community centers, online 'medical sites' and given out by therapists as a means of intervention.”