Tomonari Irie

BACKGROUND Depressive symptoms are common across populations worldwide. In Japan, a nationwide survey of more than 8,000 adults reported that approximately one-fifth of respondents experienced clinically significant anxiety or depressive symptoms. Depressive symptoms are associated with impaired work functioning, reduced quality of life, and increased suicide risk, yet access to evidence-based psychological treatments remains limited. Mobile health (mHealth) interventions have the potential to increase access to psychological support by enabling self-guided use independent of time and location. Computerized cognitive behavioral therapy (cCBT) has been shown to reduce depressive symptoms in adolescents and adults; however, engagement and attrition remain key challenges in unguided digital interventions. SPARX is a game-based CBT program originally developed for adolescents, consisting of seven modules delivered through an interactive fantasy game. While previous randomized controlled trials have demonstrated benefits of SPARX under controlled conditions, less is known about its use and outcomes when delivered in real-world settings, particularly among adult users in Japan. OBJECTIVE This study aimed to examine changes in depressive symptoms associated with use of SPARX, a game-based cognitive behavioral therapy application, among Japanese adults in a real-world setting, and to explore whether symptom trajectories differed by age or baseline depressive symptom severity. METHODS This was a real-world repeated measures observational study of individuals who used SPARX in Japan between May 2016 and July 2021. In total, 5,374 individuals registered to use SPARX, and 3,367 users met the following eligibility criteria: (1) aged 20–69 years at the time of registration, and (2) having completed at least Module 1 of SPARX. Each user purchased the Japanese version of SPARX from the Apple App Store or Android Google Play Store. The primary outcome measure was the Japanese version of the Patient Health Questionnaire-9. Linear mixed model (LMM) analysis was used to examine changes in depressive symptom scores across program modules, comparing Module 4 and Module 7 with Module 1. RESULTS Overall, 3,367 individuals aged 20–69 years (2,925 men and 410 women; mean age = 34.28 years, SD = 9.28) completed Module 1. Linear mixed model analyses showed significant reductions in depressive symptom scores over program use among those who progressed through later modules. Reductions were observed at Module 4 (n = 1,356; estimate = −2.87, t = −15.40, p < .05, d = 0.69, 95% CI [0.53, 0.84]) and at Module 7 (n = 844; estimate = −4.57, t = −19.23, p < .05, d = 1.06, 95% CI [0.86, 1.27]). CONCLUSIONS In this large real-world repeated measures observational study without a control group, use of SPARX among Japanese adults was associated with improvements in self-reported depressive symptom scores among users who progressed through later modules. Although causal inferences regarding effectiveness cannot be made, these findings provide evidence on usage patterns and symptom trajectories of a game-based CBT program originally developed for adolescents when delivered to an adult population in a naturalistic setting.

Aims This study aimed to investigate the prevalence and psychosocial correlates of gaming disorder (GD) symptoms among Japanese adolescents. It also sought to distinguish subtypes of gamers based on gaming behavior, depressive symptoms, and social dysfunction using latent profile analysis (LPA).Design A large-scale cross-sectional survey was conducted via an online questionnaire.Setting Participants were recruited through a nationwide online panel in Japan between July and August 2022.Participants A total of 9,699 adolescents aged 12–18 years (3,113 males and 6,586 females) participated. Both gamers and non-gamers were included in the study. After excluding outliers based on financial variables, the final analytic sample was retained.Measurements Participants completed the Gaming Addiction Scale (GAS-7), Patient Health Questionnaire for Adolescents (PHQ-A), and five custom-developed items assessing game-related social dysfunction. Additional variables included gaming time, in-game purchases, and demographic factors.Findings Approximately 21.6% of adolescents met the criteria for probable GD. Correlation analyses showed that gaming time, depression, and social dysfunction were significantly associated with GD symptoms. LPA among 8,015 gamers revealed eight distinct profiles ranging from low-risk, psychosocially healthy gamers to high-risk groups with elevated GD symptoms, depressive symptoms, and functional impairment. Notably, some adolescents exhibited moderate gaming durations without adverse psychosocial consequences, suggesting adaptive gaming behaviors.Conclusions The findings provide essential normative data on adolescent gaming in Japan and highlight the heterogeneity of gaming behaviors and psychosocial outcomes. Identification of gamer subtypes may inform targeted interventions, including harm-reduction approaches that go beyond limiting gaming time. Preventive education and policy should consider the diverse motivations and mental health profiles underlying adolescent gaming behavior.

Depressive symptoms among university students have become an increasing public health concern, affecting academic performance and overall quality of life. This short communication evaluated whether a self-guided behavioral activation intervention delivered via a smartphone application (BEARS) could reduce depressive symptoms and improve behavioral engagement in Japanese university students. Sixteen students with moderate depressive symptoms (PHQ-9 scores 10–19) participated in a two-week intervention. The BEARS application provided psychoeducation, personal value clarification, goal-setting, daily activity scheduling, and mood monitoring. Assessments were conducted at baseline, one week, at the end of the intervention (two weeks), and at a four-week follow-up. A linear mixed model analysis revealed significant reductions in depressive symptoms, early decreases in avoidance behaviors, and a gradual increase in goal-directed activity. Usability feedback was generally positive despite occasional connectivity issues. These findings suggest that a smartphone-based behavioral activation intervention may offer an effective and accessible treatment alternative for reducing depression among university students.

The number of alcoholics worldwide has increased since the outbreak of the COVID-19 pandemic, and understanding and preventing alcohol addiction is of utmost importance. We investigated the relationships among odor cues of alcohol, autobiographical memory, and the mental health of individuals with and without problematic drinking behaviors. Overall, 711 and 332 Japanese participants with and without problematic drinking behaviors, respectively, were asked to recall autobiographical memory evoked by the odor of alcohol. Thereafter, the participants were asked to complete questionnaires to measure their autobiographical memory and mental health. The results revealed that participants without problematic drinking behaviors recalled more positive memories and exhibited better mental health than those with such behaviors. These results suggest that mental health may be enhanced by positive memory recall among problem drinkers. Clarifying how mental and physical health problems and well-being are specifically related to positive and negative memories among problem drinkers is important.

Studies have found that adolescents’ in-game purchases are related to psychosocial problems. In-game purchases, including loot boxes, are relatively new systems; therefore, the associated problems have not been fully examined. This study considered whether adolescents plan for in-game purchases and examined the issues related to the purchasing style. We surveyed 1,052 Japanese high school students (591 females, 443 males, and 18 unknowns, aged 15–18) on their online game-playing status, in-game purchases, gaming problems, and depression symptoms. The results revealed that adolescents who made unplanned purchases users had a greater degree of problems than those who planned their purchases. Among the non-planners, loot box users had poorer mental health than non-users of loot boxes. These results suggest that to prevent psychosocial problems associated with problematic gaming among adolescents, it is important to pay attention to unplanned purchases and loot boxes.

Through a randomized control design, this study examines whether tobacco consumption contributes to mood change and social enhancement in dyadic conversation. In addition, we would like to focus on the difference between smoking device and cigarette use. Specifically, we compare the intrapersonal and interpersonal communication in dyadic conversation among the cigarette group, the smoking device cigarette group, the water group, and the nothing consumption group. In the present study, 80 participants engaged in a dyadic, face-to-face, unstructured conversation with a stranger of the same gender. Regarding intrapersonal communication, no significant differences were found between the groups’ POMS 2 subscale scores (anger-hostility, confusion-bewilderment, depression-dejection, tension-anxiety, fatigue-inertia, vigour-activity, and friendliness). The smoking device and cigarette groups had greater rapport than the water group. Moreover, the smoking device group were more satisfied with dyadic conversation than the water group. Finally, there were no significant differences in verbal communication among the groups.

Background: Evidence shows that computerized self-help interventions are effective for reducing symptoms of depression. One such intervention, SPARX, is a gamified mobile computerized cognitive behavioral therapy (cCBT) developed for adolescents in New Zealand, which was shown to be as effective as usual care for young people with mild-to-moderate symptoms of depression. However, gamified cCBT has not yet been tested in Japan. Objective: This trial is designed to investigate whether a Japanese-adapted version of SPARX improves depressive symptoms in Japanese university students with mild-to-moderate depressive symptoms. Methods: In this 7-week, multicenter, stratified, parallel-group, superiority randomized trial, participants will be allocated to either a treatment condition (SPARX) or a wait-list control condition. SPARX is a fully automated program, which will be delivered to the mobile phone or tablet device of the participants. SPARX is designed as an interactive fantasy game to guide the user through seven modules that teach key CBT strategies. All participants will be recruited from universities via advertisements on online bulletin boards, the campus newspaper, and posters. Participants in the treatment condition will use the SPARX program weekly. The primary outcome is the reduction of depressive symptoms (using Patient Health Questionnaires-9) measured at baseline and weekly: once after the 7-week intervention and once at a 1-month follow-up. Secondary outcomes include satisfaction with the program and satisfaction with life, measured by the Satisfaction With Life Scale; positive and negative moods, measured by the Profile of Mood States Second Edition; social functioning, measured by the EuroQol Instrument; rumination, measured by the Ruminative Responses Scale; and coping, measured by the Brief Coping Orientation to Problem Experienced Inventory. Results: This study received funding from The Research Institute of Personalized Health Sciences, Health Sciences University of Hokkaido, and obtained institutional review board approval in September 2019. Data collection began in April 2019. Conclusions: Results of this trial may provide further evidence for the efficacy of gamified cCBT for the treatment of depression and, specifically, provide support for using SPARX with Japanese university students. Trial Registration: Japan Primary Registries Network UMIN000034354; https://tinyurl.com/uu7xd77 International Registered Report Identifier (IRRID): DERR1-10.2196/15164

Cognitive behavioral therapy is an effective treatment for improving mental health problems among university students. However, intervention components have different effects on mental health problems. This paper is a meta-analysis of the data concerning the relationship between cognitive behavioral variables and mental health status among university students. A total of five electronic databases were reviewed, and 876 articles met the initial selection criteria. Reviewers applied standardized coding schemes to extract the correlational relationship between cognitive behavioral variables and mental health status. A total of 55 articles were included in the meta-analysis. Correlations were found for three cognitive behavioral variables (attention, thought, and behavior) across nine mental health domains (negative affect, positive affect, happiness, social function, stress response, psychological symptom, quality of life, well-being, and general health). Across each cognitive behavioral process and all mental health domains, the estimated mean correlation was medium (r = .32 - .46), and varied by the domain of mental health.

Cognitive behavioral therapy is an effective treatment for improving mental health problems among university students. However, intervention components have different effects on mental health problems. This paper is a meta-analysis of the data concerning the relationship between cognitive behavioral variables and mental health status among university students. A total of 4 electronic databases were reviewed, and 1,227 articles met the initial selection criteria. Reviewers applied standardized coding schemes to extract the correlational relationship between cognitive behavioral variables and mental health status. A total of 54 articles were included in the meta-analysis. Correlations were found for three cognitive behavioral variables (attention, thought, and behavior) across nine mental health domains (negative affect, positive affect, happiness, social function, stress response, psychological symptom, quality of life, well-being, and general health). Across each cognitive behavioral process and all mental health domains, the estimated mean correlation is modest (.29 - .41), and the correlation depended on the domain of mental health.