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A Review of Indie Games for Serious Mental Health Game Design

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Serious Games (JCSG 2021)

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Abstract

Mental health disorders present a global challenge being the largest contributor to non-fatal burden of disease. In fact, those who are experiencing symptoms of mental illness often wait ten years before seeking help. This is frequently due to help-seeking barriers such as stigma and cost. One way to combat help-seeking barriers is through increasing the mental health literacy of the public. This has been achieved successfully through digital delivery of mental health information and services, including serious games. Early research suggests that serious games are an effective tool for improving mental health literacy. However, factors such as poor-quality game design and research studies mean that developers face challenges when designing, developing, and analyzing serious games. To address these challenges this paper will provide an analysis of indie games that feature topics of mental health, trauma, and grief. Indie games share similarities to research environments, often being created by small teams on a limited budget. Even with these limitations they can tell impactful and emotional stories, making them a valuable source of inspiration for developers of serious mental health games.

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References

  1. Vos, T., et al.: Global, regional, and national incidence, prevalence, and years lived with disability for 328 diseases and injuries for 195 countries, 1990–2016: a systematic analysis for the Global Burden of Disease Study 2016. The Lancet 390(10100), 1211–1259 (2017)

    Article  Google Scholar 

  2. Walker, E.R., McGee, R.E., Druss, B.G.: Mortality in mental disorders and global disease burden implications: a systematic review and meta-analysis. JAMA Psychiatry 72(4), 334–341 (2015)

    Article  Google Scholar 

  3. Depression and other common mental disorders: global health estimates. World Health Organization, Geneva (2017)

    Google Scholar 

  4. Kessler, R., et al.: Lifetime prevalence and age-of-onset distributions of mental disorders in the World Health Organization’s World Mental Health Survey Initiative. World Psychiatry 6(3), 168–176 (2007)

    Google Scholar 

  5. Andrade, L.H., et al.: Barriers to mental health treatment: results from the WHO World Mental Health surveys. Psychol. Med. 44(6), 1303–1317 (2014)

    Article  Google Scholar 

  6. Mechanic, D.: Removing barriers to care among persons with psychiatric symptoms. Health Aff. 21(3), 137–147 (2002)

    Article  Google Scholar 

  7. Dockery, L., et al.: Stigma- and non-stigma-related treatment barriers to mental healthcare reported by service users and caregivers. Psychiatry Res. 228(3), 612–619 (2015)

    Article  Google Scholar 

  8. Clement, S., et al.: What is the impact of mental health-related stigma on help-seeking? A systematic review of quantitative and qualitative studies. Psychol. Med. 45(1), 11–27 (2015)

    Article  Google Scholar 

  9. Kutcher, S., Wei, Y., Coniglio, C.: Mental health literacy: past, present, and future. Can. J. Psychiatry 61(3), 154–158 (2016)

    Article  Google Scholar 

  10. Ezell, J.M., Choi, C.-W., Wall, M.M., Link, B.G.: Measuring recurring stigma in the lives of individuals with mental illness. Community Ment. Health J. 54(1), 27–32 (2018). https://doi.org/10.1007/s10597-017-0156-1

  11. Fox, A.B., Smith, B.N., Vogt, D.: How and when does mental illness stigma impact treatment seeking? Longitudinal examination of relationships between anticipated and internalized stigma, symptom severity, and mental health service use. Psychiatry Res. 268, 15–20 (2018)

    Article  Google Scholar 

  12. Jorm, A.F., Korten, A.E., Jacomb, P.A., Christensen, H., Rodgers, B., Pollitt, P.: “Mental health literacy”: a survey of the public’s ability to recognise mental disorders and their beliefs about the effectiveness of treatment. Med. J. Aust. 166(4), 182–186 (1997)

    Article  Google Scholar 

  13. Jorm, A.F.: Mental health literacy: public knowledge and beliefs about mental disorders. Br. J. Psychiatry 177(5), 396–401 (2000)

    Article  Google Scholar 

  14. Beyond Blue. https://www.beyondblue.org.au. Accessed 31 May 2021

  15. Twomey, C., et al.: A randomized controlled trial ofthe computerized CBT programme, MoodGYM, for public mental health service users waiting for interventions. Br. J. Clin. Psychol. 53(4), 433–450 (2014)

    Article  Google Scholar 

  16. moodgym. https://moodgym.com.au. Accessed 31 May 2021

  17. Qu, C.C., Sas, C., Roquet, C.D., Doherty, G.: Functionality of top-rated mobile apps for depression: systematic search and evaluation. JMIR Ment. Health 7(1), e15321 (2020)

    Article  Google Scholar 

  18. Michael, D., Chen, S.: Serious Games: Games That Educate, Train, and Inform, p. 17. Muska & Lipman/Premier-Trade, Boston (2005)

    Google Scholar 

  19. Marsh, T.: Serious games continuum: between games for purpose and experiential environments for purpose. Entertain. Comput. 2(2), 61–68 (2011)

    Article  Google Scholar 

  20. Boyle, E.A., et al.: An update to the systematic literature review of empirical evidence of the impacts and outcomes of computer games and serious games. Comput. Educ. 94, 178–192 (2016)

    Article  Google Scholar 

  21. Qian, M., Clark, K.R.: Game-based learning and 21st century skills: a review of recent research. Comput. Hum. Behav. 63, 50–58 (2016)

    Article  Google Scholar 

  22. Twomey, C., O’Reilly, G.: Effectiveness of a freely available computerised cognitive behavioural therapy programme (MoodGYM) for depression: meta-analysis. Aust. N. Z. J. Psychiatry 51(3), 260–269 (2017)

    Article  Google Scholar 

  23. Brijnath, B., Protheroe, J., Mahtani, K., Antoniades, J.: Do web-based mental health literacy interventions improve the mental health literacy of adult consumers? Results from a systematic review. J. Med. Internet Res. 18(6), e5463 (2016)

    Article  Google Scholar 

  24. Schneider, J., Foroushani, P.S., Grime, P., Thornicroft, G.: Acceptability of online self-help to people with depression: users’ views of MoodGYM versus informational websites. J. Med. Internet Res. 16, e90 (2014)

    Article  Google Scholar 

  25. Neary, M., Schueller, S.M.: State of the field of mental health apps. Cogn. Behav. Pract. 25(4), 531–537 (2018)

    Article  Google Scholar 

  26. Fitzgerald, M., Ratcliffe, G.: Serious games, gamification, and serious mental illness: a scoping review. Psychiatr. Serv. 71, 170–183 (2020)

    Article  Google Scholar 

  27. Fleming, T., et al.: Serious games and gamification for mental health: current status and promising directions. Front. Psychiatry 7, 215 (2017)

    Article  Google Scholar 

  28. SPARX. https://www.sparx.org.nz/home. Accessed 31 May 2021

  29. Merry, S.N., Stasiak, K., Shepherd, M., Frampton, C., Fleming, T., Lucassen, M.F.G.: The effectiveness of SPARX, a computerised self help intervention for adolescents seeking help for depression: randomised controlled non-inferiority trial. BMJ 344, e2598 (2012)

    Article  Google Scholar 

  30. Kuosmanen, T., Fleming, T.M., Newell, J., Barry, M.M.: A pilot evaluation of the SPARX-R gaming intervention for preventing depression and improving wellbeing among adolescents in alternative education. Internet Interv. 8, 40–47 (2017)

    Article  Google Scholar 

  31. Kitchener, B.A., Jorm A.F., Kelly, C.: Mental Health First Aid Manual. Mental Health First Aid, Melbourne (2017)

    Google Scholar 

  32. Ruberg, B.: Queering Indie: how LGBTQ experiences challenge dominant narratives of independent games. In: Ruffino, P. (ed.) Independent Videogames : Cultures, Networks, Techniques and Politics. Taylor & Francis Group, Milton (2020)

    Google Scholar 

  33. Iuppa, N., Borst, T.: End-To-End Game Development : Creating Independent Serious Games and Simulations from Start to Finish. Focal Press, Waltham (2010)

    Google Scholar 

  34. The Last of Us. Sony Computer Entertainment, Naughty Dog, PlayStation (2013)

    Google Scholar 

  35. Hellblade: Senua’s Sacrifice. Ninja Theory, PlayStation 4 (2017)

    Google Scholar 

  36. Case, N.: Coming Out Simulator. Online (2014)

    Google Scholar 

  37. Assassin’s Creed Origins. Ubisoft, PlayStation 4 (2017)

    Google Scholar 

  38. Florence. Mountains, Annapuma Interactive, Steam (2018)

    Google Scholar 

  39. Quinn, Z., Lindsey, P., Schankler, I.: Depression Quest. Online (2013)

    Google Scholar 

  40. That Dragon, Cancer. Numinous Games, Steam (2016)

    Google Scholar 

  41. Melinn, I., Lima, C.: Keep in Mind: Remastered. Little Moth Games, Akupara Games, Steam (2018)

    Google Scholar 

  42. O’Neill, W.: Actual Sunlight. WZO Games Inc., Steam (2014)

    Google Scholar 

  43. Rock Paper Shotgun. https://www.rockpapershotgun.com/2013/02/11/thoughts-on-actual-sunlight. Accessed 21 June 2019

  44. Martínez, M.A.C.: Depression. itch.io

    Google Scholar 

  45. https://manuacruz.itch.io/depression. Accessed 27 June 2021

  46. Figueroa, N., Martinsson, I.: Fran Bow. Killmonday Games, Steam (2015)

    Google Scholar 

  47. Ferrari, M., McIlwaine, S.V., Jordan, G., Shah, J.L., Lal, S., Iyer, S.N.: Gaming with stigma: analysis of messages about mental illnesses in video games. JMIR Ment. Health 6(5), e12418 (2019)

    Article  Google Scholar 

  48. CheckPoint. https://checkpointorg.com/mental-health-representation. Accessed 31 Mar 2020

  49. Figueroa, N.: Interview: Killmonday on fran bow, mental health, beauty. In: Walker, J. (ed.). Rock Paper Shotgun Online (2013)

    Google Scholar 

  50. The Suicide of Rachel Foster. One-On-One Games, Daedalic Entertainment, Steam (2020)

    Google Scholar 

  51. Watts, R.: The Suicide of Rachel Foster. PC Gamer (2020). https://www.pcgamer.com/the-suicide-of-rachel-foster-review

  52. Evans-Thirlwell, E.: The Suicide of Rachel Foster review - a Shining-esque riff on Gone Home that doesn't quite dazzle. Eurogamer (2020). https://www.eurogamer.net/articles/2020-02-16-the-suicide-of-rachel-foster-review-shining-esque-hotel-adventure-doesnt-quite-dazzle

  53. Gardner, M.: Review: ‘The Suicide Of Rachel Foster’ Is A Rollercoaster Ride That Plummets At The End. Forbes. https://www.forbes.com/sites/mattgardner1/2020/02/26/review-the-suicide-of-rachel-foster-is-a-rollercoaster-ride-that-plummets-at-the-end

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King, M., Marsh, T., Akcay, Z. (2021). A Review of Indie Games for Serious Mental Health Game Design. In: Fletcher, B., Ma, M., Göbel, S., Baalsrud Hauge, J., Marsh, T. (eds) Serious Games. JCSG 2021. Lecture Notes in Computer Science(), vol 12945. Springer, Cham. https://doi.org/10.1007/978-3-030-88272-3_11

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  • DOI: https://doi.org/10.1007/978-3-030-88272-3_11

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