A Novel Casual Video Game With Simple Mental Health and Well-Being Concepts (Match Emoji): Mixed Methods Feasibility Study.

BACKGROUND: Adolescence is a crucial phase for early intervention and prevention of mental health problems. Casual video games are popular and have promise as a novel mechanism for reaching young people, but this potential has seldom been explored. OBJECTIVE: This study aimed to explore the acceptability, feasibility, and possible indicators of therapeutic changes after playing a purpose-built novel casual video game (Match Emoji) with simple mental health and well-being content among young adolescents. METHODS: We conducted a single-arm, nonrandomized trial of Match Emoji with 12- to 14-year-old school students (N=45; 26 [57%] New Zealand European, 12 [26%] Maori; 7 [15%] Asian or Pacific; 27 [60%] boys, 3 [6%] non-binary). Participants were invited to play Match Emoji for 15 minutes, 2-3 times a week over 2 weeks (a total of 60 minutes). Acceptability was assessed through the frequency and duration of use (analytics analyzed at the end of the 2-week intervention period and at weeks 4 and 6) and through participant reports. The Child and Adolescent Mindfulness Measure (CAMM), General Help-Seeking Questionnaire (GHSQ), Flourishing Scale (FS), and Revised Children's Anxiety and Depression Scale (RCADS) were assessed at baseline and week 2 to indicate possible effects. Focus groups were held in week 4. RESULTS: Most participants (n=39, 87%) used Match Emoji for at least 60 minutes over the 2-week intervention, with 80% (36/45) continuing to play the game after the intervention period. Mean change (from baseline to 2 weeks) on each measure was 1.38 (95% CI -0.03 to 2.79; P=.06) for CAMM; 0.8 (95% CI -2.71 to 4.31; P=.64) for GHSQ; -1.09 (95% CI -2.83 to 0.66; P=.21) for FS; and -3.42 (95% CI -6.84 to -0.001; P=0.49) for RCADS. Focus group feedback suggested that Match Emoji was enjoyable and helpful. CONCLUSIONS: The casual video game with mental health content appeared to be acceptable and provided a promising indication of possible therapeutic effects. This approach is worthy of further investigation. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID): RR2-10.2196/31588.

Herpes zoster vaccine effectiveness against herpes zoster and postherpetic neuralgia in New Zealand: a retrospective cohort study.

Background: Herpes zoster (HZ) and associated complications cause significant burden to older people. A HZ vaccination programme was introduced in Aotearoa New Zealand in April 2018 with a single dose vaccine for those aged 65 years and a four-year catch up for 66-80 year-olds. This study aimed to assess the 'real-world' effectiveness of the zoster vaccine live (ZVL) against HZ and postherpetic neuralgia (PHN). Methods: We conducted a nationwide retrospective matched cohort study from 1 April 2018 to 1 April 2021 using a linked de-identified patient level Ministry of Health data platform. A Cox proportional hazards model was used to estimate ZVL vaccine effectiveness (VE) against HZ and PHN adjusting for covariates. Multiple outcomes were assessed in the primary (hospitalised HZ and PHN - primary diagnosis) and secondary (hospitalised HZ and PHN: primary and secondary diagnosis, community HZ) analyses. A sub-group analysis was carried out in, adults ≥ 65 years old, immunocompromised adults, Maori, and Pacific populations. Findings: A total of 824,142 (274,272 vaccinated with ZVL matched with 549,870 unvaccinated) New Zealand residents were included in the study. The matched population was 93.4% immunocompetent, 52.2% female, 80.2% European (level 1 ethnic codes), and 64.5% were 65-74 years old (mean age = 71.1±5.0). Vaccinated versus unvaccinated incidence of hospitalised HZ was 0.16 vs. 0.31/1,000 person-years and 0.03 vs. 0.08/1000 person-years for PHN. In the primary analysis, the adjusted overall VE against hospitalised HZ and hospitalised PHN was 57.8% (95% CI: 41.1-69.8) and 73.7% (95% CI:14.0-92.0) respectively. In adults ≥ 65 years old, the VE against hospitalised HZ was 54.4% (95% CI: 36.0-67.5) and VE against hospitalised PHN was 75·5% (95% CI: 19.9-92.5). In the secondary analysis, the VE against community HZ was 30.0% (95% CI: 25.6-34.5). The ZVL VE against hospitalised HZ for immunocompromised adults was 51.1% (95% CI: 23.1-69.5), and PHN hospitalisation was 67.6% (95% CI: 9.3-88.4). The VE against HZ hospitalisation for Maori was 45.2% (95% CI: -23.2-75.6) and for Pacific Peoples was 52.2% (95% CI: -40.6 -83·7). Interpretation: ZVL was associated with a reduction in risk of hospitalisation from HZ and PHN in the New Zealand population. Funding: Wellington Doctoral Scholarship awarded to JFM.

Herpes zoster vaccine safety in the Aotearoa New Zealand population: a self-controlled case series study.

In Aotearoa New Zealand, zoster vaccine live is used for the prevention of zoster and associated complications in adults. This study assessed the risk of pre-specified serious adverse events following zoster vaccine live immunisation among adults in routine clinical practice. We conducted a self-controlled case series study using routinely collected national data. We compared the incidence of serious adverse events during the at-risk period with the control period. Rate ratios were estimated using Conditional Poisson regression models. Falsification outcomes analyses were used to evaluate biases in our study population. From April 2018 to July 2021, 278,375 received the vaccine. The rate ratio of serious adverse events following immunisation was 0·43 (95% confidence interval [CI]: 0·37-0·50). There was no significant increase in the risk of cerebrovascular accidents, acute myocardial infarction, acute pericarditis, acute myocarditis, and Ramsay-Hunt Syndrome. The herpes zoster vaccine is safe in adults in Aotearoa New Zealand.

Development of a casual video game (Match Emoji) with psychological well-being concepts for young adolescents.

Digital interventions for mental health and well-being have been shown to be effective in trials, yet uptake and retention in real-world settings are often disappointing. A more significant impact may be achieved by building interventions that are closer to how target groups use technology to support their own psychological well-being. Casual video games may be poised to offer an opportunity in this area as they are a highly popular activity among young people. We propose that mental health content can be integrated into the explicit content and the implicit processes used in casual video games. In this paper, we describe the design and core processes of Match Emoji, a casual video game designed to support the development of psychological well-being via gameplay and micro-messages. The iterative development of Match Emoji involved various phases, including a systematic review of the literature, consultation with target users, clinicians, game developers, and close reading of the literature. Expert collaboration was sought throughout the process to ensure gameplay and messages matched behaviour change and learning theories. An acceptability and feasibility study of Match Emoji will inform a randomised controlled trial in the future.

A Casual Video Game With Psychological Well-being Concepts for Young Adolescents: Protocol for an Acceptability and Feasibility Study.

BACKGROUND: Many face-to-face and digital therapeutic supports are designed for adolescents experiencing high levels of psychological distress. However, promoting psychological well-being among adolescents is often neglected despite significant short-term and long-term benefits. OBJECTIVE: This research has 3 main objectives: (1) to assess the acceptability of Match Emoji, a casual video game with psychological well-being concepts among 13-15-year-old students in a New Zealand secondary school; (2) to identify the feasibility of the research process; and (3) to explore the preliminary well-being and therapeutic potential of Match Emoji. METHODS: Approximately 40 participants aged 13-15 years from a local secondary college in Wellington, New Zealand, will be invited to download and play Match Emoji 3-4 times a week for 5-15 minutes over a 2-week period. Participants will complete 4 assessments at baseline, postintervention, and 3 weeks later to assess psychological well-being and therapeutic changes. Statistical analysis will be used to synthesize data from interviews and triangulated with assessment changes and game analytics. This synthesis will help to assess the acceptability and feasibility of the Match Emoji. RESULTS: The key outputs from the project will include the acceptability, feasibility, and therapeutic potential of Match Emoji. It is anticipated that participants will have finished playing the recommended game play regimen by August 2021 with analysis of results completed by October 2021. CONCLUSIONS: Data from the study are expected to inform future research on Match Emoji including a randomized controlled trial and further adjustments to the design and development of the game. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID): PRR1-10.2196/31588.

Young adolescents' interest in a mental health casual video game.

BACKGROUND: Mental distress and disorders among adolescents are well documented. Despite the array of treatments available, many mental health issues remain untreated and often undiagnosed. In an attempt to narrow the treatment gap, researchers have adapted existing mental health interventions into digital formats. Despite their efficacy in trial settings, however, real-world uptake of digital mental health interventions is typically low. Casual video games (CVGs) are popular among adolescents and may be a promising tool to reduce stress, anxiety and depression. AIM: We set out to explore young adolescents' views of CVGs and their opinions of mental health CVG prototypes, to help determine whether this idea warrants further investigation. METHODS: Pen and paper feedback forms following a brief presentation to 13-15-year-old adolescents in seven high schools (n = 207) followed by more detailed focus groups (n = 42) and workshops (n = 21) with interested students. FINDINGS: Across all three methods, participants reported playing CVGs several times a week or day to help relieve stress, feel more relaxed and relieve boredom. Most were also interested in the idea of a mental health CVG. Participants in focus groups and workshops confirmed that playing CVGs was common among themselves and their peers, and that the idea of a CVG with subtle and brief mental health content such as game-linked 'micro messages' was appealing. Participants recommended that the game should have an engaging interface and subtle mental health skills and information. CONCLUSIONS: Findings from this exploratory study suggest that the concept of a mental health CVG appears to be appealing to adolescents. This novel approach should be tested.

The Effects of Casual Videogames on Anxiety, Depression, Stress, and Low Mood: A Systematic Review.

Background: Despite the variety of available treatments for mental health symptoms, many individuals do not engage with treatment and among those who do, dropout rates are often high. Therefore, providing alternative opportunities to access treatment is imperative. Research interest in the therapeutic effects of digital mental health initiatives and serious games has grown in recent years, but the potential of simple, easy-to-use casual videogames (CVGs) that can be played in short bursts of time has seldom been considered. Objective: The objective of the present study is to provide a systematic review of the literature examining the effects of CVGs on treating anxiety, depression, stress, and low mood. Method: A systematic search was conducted, using the terms (casual gam* or casual videogam* or mini gam* or minigam* or mini-gam* or gamif*) and (mental health or anx* or depress* or stress or mood) and (study or trial or treatment or prescribed or prevention) as "Title," "Abstracts," "Keywords," or "Topic" words across all years. A Google search was also completed to check for articles that may have been missed. Results: N = 13 studies met inclusion criteria (no studies were added via the Google search). These studies reported findings for nine different CVGs, with six studies aimed at reducing anxiety, two examining effects for depression, and four investigating the effects of CVGs on treating stress or low mood. Promising effects were identified. Conclusion: CVGs may have promise for treating anxiety, depression, stress, and low mood.