A Digital Behavioral Health Game for Adolescent Mental Health: A Prespecified Secondary Analysis of a Randomized Clinical Trial.

Authors

Caroline M Barry, Tyra Boomer, Katie Haile, Haiyi Xie, Lynn E Fiellin

Published in

JAMA network open. Volume 9. Issue 8. Pages e2629173. Aug 03, 2026. Epub Aug 03, 2026.

Abstract

Adolescent depression and anxiety are common and impairing conditions. Scalable, engaging digital interventions offer a low-burden strategy to support youth mental health.
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.
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.
Participants were randomized 1:1 to a digital game of approximately 300 minutes delivered during 6 weeks or to an attention-matched active control.
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.
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.
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.
ClinicalTrials.gov Identifier: NCT04941950.

PMID:
42606863
Bibliographic data and abstract were imported from PubMed on 18 Aug 2026.

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