Spahl W, Motta V, Woodcock K, Rubeis G. Gamified Digital Mental Health Interventions for Young People: Scoping Review of Ethical Aspects During Development and Implementation. JMIR Serious Games. 2024;12:e64488. doi:10.2196/64488
This scoping review provides an overview of the current literature on ethical considerations for gamified digital mental health interventions for young people. 1075 papers published between 2015 and 2023 were screened, 91 were reviews in full text, and 38 were included in the final analysis. In total 32 different interventions were discussed across the 38 papers. Nearly half of these interventions were designed as mobile apps (47%) and were based on cognitive behavioral therapy (30%) and socioemotional learning (13%). Most papers were published between 2021 and 2023 (53%), based in Europe (39%) or North America (24%), and focused on understanding user experiences (32%) and presenting intervention design (24%). Only 10 papers provided detailed discussions on research ethics. Across all studies, the most common ethical principles discussed in any level of detail were privacy (12/38, 32%), accessibility (9/38, 24%), empowerment and autonomy (4/38, 11%), cultural and social sensitivity, co-design, and psychological and educational value. Privacy was most addressed as a topic brought up by young people. In general, accessibility was related to game elements such as text size, storylines, and relatableness, not adaptations for vulnerable populations or specific minority or intersectional groups. Empowerment and autonomy were variable in definition across the four publications. Cultural and social sensitivity was addressed by the need to adapt interventions to cultural and social contexts for specific target audiences. Here, avatar and character diversity was a recurring theme. While co-design was discussed in a quarter of the papers, it was often used to increase user preferences. It was less frequently addressed as a collaborative process across multiple levels and relevant target contributors. Only 16% of papers addressed the implementation of the interventions, and 11% discussed the role of facilitators in this implementation. Overall, this review highlights a gap in the literature for ethical considerations for gamified digital mental health interventions for young people. Future research should expand beyond user experiences and work to address specific ethical considerations.