{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,17]],"date-time":"2026-08-17T16:28:50Z","timestamp":1786984130641,"version":"build-2736575974"},"reference-count":54,"publisher":"American Medical Association (AMA)","issue":"8","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JAMA Netw Open"],"abstract":"\n Importance<\/jats:title>\n Adolescent depression and anxiety are common and impairing conditions. Scalable, engaging digital interventions offer a low-burden strategy to support youth mental health.<\/jats:p>\n <\/jats:sec>\n \n Objective<\/jats:title>\n 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.<\/jats:p>\n <\/jats:sec>\n \n Design, Setting, and Participants<\/jats:title>\n 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.<\/jats:p>\n <\/jats:sec>\n \n Intervention<\/jats:title>\n Participants were randomized 1:1 to a digital game of approximately 300 minutes delivered during 6 weeks or to an attention-matched active control.<\/jats:p>\n <\/jats:sec>\n \n Main Outcomes and Measures<\/jats:title>\n 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.<\/jats:p>\n <\/jats:sec>\n \n Results<\/jats:title>\n \n 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 (\n F<\/jats:italic>\n 3,1308<\/jats:sub>\n \u2009=\u20092.93;\n P<\/jats:italic>\n \u2009=\u2009.03). 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, \u22121.12 [95% CI, \u22121.85 to \u22120.38] 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.\n <\/jats:p>\n <\/jats:sec>\n \n Conclusions and Relevance<\/jats:title>\n 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.<\/jats:p>\n <\/jats:sec>\n \n Trial Registration<\/jats:title>\n \n ClinicalTrials.gov Identifier:\n NCT04941950<\/jats:ext-link>\n <\/jats:p>\n <\/jats:sec>","DOI":"10.1001\/jamanetworkopen.2026.29173","type":"journal-article","created":{"date-parts":[[2026,8,17]],"date-time":"2026-08-17T15:30:28Z","timestamp":1786980628000},"page":"e2629173","source":"Crossref","is-referenced-by-count":0,"title":["A Digital Behavioral Health Game for Adolescent Mental Health"],"prefix":"10.1001","volume":"9","author":[{"given":"Caroline M.","family":"Barry","sequence":"first","affiliation":[{"name":"play2PREVENT Lab, Geisel School of Medicine, Dartmouth College, Hanover, New Hampshire"},{"name":"Center for Technology and Behavioral Health, Geisel School of Medicine at Dartmouth, Hanover, New Hampshire"},{"name":"Department of Biomedical Data Science, Geisel School of Medicine at Dartmouth, Hanover, New 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