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      Gamified Mobile Computerized Cognitive Behavioral Therapy for Japanese University Students With Depressive Symptoms: Protocol for a Randomized Controlled Trial

      , PhD , 1 , , MA 2 , , PhD 3 , , MA 4 , , PhD 5 , , MBChB, MD, FRANZCP, CCAP 6 , , PhD 6

      (Reviewer), (Reviewer)

      JMIR Research Protocols

      JMIR Publications

      SPARX, Japan, university students, depressive symptoms

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          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.


          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.


          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.


          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.


          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)


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          Most cited references 33

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          Psychological correlates of university students' academic performance: a systematic review and meta-analysis.

          A review of 13 years of research into antecedents of university students' grade point average (GPA) scores generated the following: a comprehensive, conceptual map of known correlates of tertiary GPA; assessment of the magnitude of average, weighted correlations with GPA; and tests of multivariate models of GPA correlates within and across research domains. A systematic search of PsycINFO and Web of Knowledge databases between 1997 and 2010 identified 7,167 English-language articles yielding 241 data sets, which reported on 50 conceptually distinct correlates of GPA, including 3 demographic factors and 5 traditional measures of cognitive capacity or prior academic performance. In addition, 42 non-intellective constructs were identified from 5 conceptually overlapping but distinct research domains: (a) personality traits, (b) motivational factors, (c) self-regulatory learning strategies, (d) students' approaches to learning, and (e) psychosocial contextual influences. We retrieved 1,105 independent correlations and analyzed data using hypothesis-driven, random-effects meta-analyses. Significant average, weighted correlations were found for 41 of 50 measures. Univariate analyses revealed that demographic and psychosocial contextual factors generated, at best, small correlations with GPA. Medium-sized correlations were observed for high school GPA, SAT, ACT, and A level scores. Three non-intellective constructs also showed medium-sized correlations with GPA: academic self-efficacy, grade goal, and effort regulation. A large correlation was observed for performance self-efficacy, which was the strongest correlate (of 50 measures) followed by high school GPA, ACT, and grade goal. Implications for future research, student assessment, and intervention design are discussed.
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            Advantages and limitations of Internet-based interventions for common mental disorders.

            Several Internet interventions have been developed and tested for common mental disorders, and the evidence to date shows that these treatments often result in similar outcomes as in face-to-face psychotherapy and that they are cost-effective. In this paper, we first review the pros and cons of how participants in Internet treatment trials have been recruited. We then comment on the assessment procedures often involved in Internet interventions and conclude that, while online questionnaires yield robust results, diagnoses cannot be determined without any contact with the patient. We then review the role of the therapist and conclude that, although treatments including guidance seem to lead to better outcomes than unguided treatments, this guidance can be mainly practical and supportive rather than explicitly therapeutic in orientation. Then we briefly describe the advantages and disadvantages of treatments for mood and anxiety disorders and comment on ways to handle comorbidity often associated with these disorders. Finally we discuss challenges when disseminating Internet interventions. In conclusion, there is now a large body of evidence suggesting that Internet interventions work. Several research questions remain open, including how Internet interventions can be blended with traditional forms of care. Copyright © 2014 World Psychiatric Association.
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              A systematic review of studies of depression prevalence in university students.

              Depression is a common health problem, ranking third after cardiac and respiratory diseases as a major cause of disability. There is evidence to suggest that university students are at higher risk of depression, despite being a socially advantaged population, but the reported rates have shown wide variability across settings. To explore the prevalence of depression in university students. PubMed, PsycINFO, BioMed Central and Medline were searched to identify studies published between 1990 and 2010 reporting on depression prevalence among university students. Searches used a combination of the terms depression, depressive symptoms, depressive disorders, prevalence, university students, college students, undergraduate students, adolescents and/or young adults. Studies were evaluated with a quality rating. Twenty-four articles were identified that met the inclusion and exclusion criteria. Reported prevalence rates ranged from 10% to 85% with a weighted mean prevalence of 30.6%. The results suggest that university students experience rates of depression that are substantially higher than those found in the general population. Study quality has not improved since 1990. Copyright © 2012 Elsevier Ltd. All rights reserved.

                Author and article information

                JMIR Res Protoc
                JMIR Res Protoc
                JMIR Research Protocols
                JMIR Publications (Toronto, Canada )
                April 2020
                7 April 2020
                : 9
                : 4
                [1 ] College of Comprehensive Psychology Ritsumeikan University Osaka Japan
                [2 ] School of Education and Culture Hokusho University Hokkaido Japan
                [3 ] School of Psychological Science Health Sciences University of Hokkaido Hokkaido Japan
                [4 ] HIKARI Lab, Inc Tokyo Japan
                [5 ] School of Dentistry Health Sciences University of Hokkaido Hokkaido Japan
                [6 ] Department of Psychological Medicine University of Auckland Auckland New Zealand
                Author notes
                Corresponding Author: Kengo Yokomitsu k-yoko@ 123456fc.ritsumei.ac.jp
                ©Kengo Yokomitsu, Tomonari Irie, Mayu Sekiguchi, Ayako Shimizu, Hirofumi Matsuoka, Sally Nicola Merry, Karolina Stasiak. Originally published in JMIR Research Protocols (http://www.researchprotocols.org), 07.04.2020.

                This is an open-access article distributed under the terms of the Creative Commons Attribution License ( https://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work, first published in JMIR Research Protocols, is properly cited. The complete bibliographic information, a link to the original publication on http://www.researchprotocols.org, as well as this copyright and license information must be included.


                sparx, japan, university students, depressive symptoms


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