Social Games as Prevention Tools for Depression in Adolescents

Project Lead Category Project status
Anouk Tuijnman Anxiety | Depression Writing Dissertation

In my PhD project I study social games for the prevention of depression. In my project I take part in both the development and testing of games. I want to use video games to help youth become more emotionally resilient and to decrease the stigma that surrounds depression. I do this in close collaboration with other researchers and game designers. I am particularly interested in games that are played in a social context, because I believe that both social threat and social support are key factors in the development and maintenance of depression.

Project team


Rejection Sensitivity (ScrollQuest

People have evolved a tendency to reject certain groups of people and develop behaviour to avoid such rejection to occur [1]. Rejection and responses to rejection are part of human nature, but a problem occurs when people are overly sensitive to rejection (even when it's not there) and/or are continuously exposed to rejection. Prolonged stress that follows (perceived) social threat (like rejection) has severe physiological consequences [2], and can lead to sensitivity to rejection [3-6], which in turn has been linked to many mental health problems [5; 7-9]. Rejection sensitivity is “the disposition to anxiously expect, readily perceive, and overreact to rejection” [10, p. 1335]. In this PhD project we are developing games in which adolescents are exposed to rejection to help them overcome their sensitivity to it to prevent further problems to occur. One of these games is ScrollQuest, a multiplayer co-op game in which four players have to work together to defeat monsters and find gold. In a lab experiment we have compared ScrollQuest to the widely used research game Cyberball [11] and have shown that we can elicit feelings of rejection that are similar or stronger than in Cyberball. The results will soon be submitted for publication.

Mental Health Literacy (Moving Stories)

Between 66 and 82% of young people who are experiencing severe symptoms of depression or anxiety don’t seek professional help. The main reasons range from perceived stigma and embarrassment, to a preference for self-reliance and low mental health literacy [12-13]. The game Moving Stories aims to target mental health literacy to increase symptom recognition and improve help-seeking behaviour. At the same time, the game tries to decrease stigma by giving young people more information about mental health problems and bringing them into (digital and physical) contact with someone who has experienced a depression.

The game is based on the principles of the Australian Mental Health First Aid training, a programme that was developed to teach adults help-seeking strategies and supportive behaviours to use when they know someone who is suffering from mental health problems. A recent meta-analysis showed that the programme results in a decrease of negative attitudes and an increase of knowledge and supportive behaviours towards others with mental health problems [14]. Recently, the developers of Mental Health First Aid created a version specifically for adolescents (‘teen Mental Health First Aid). A first pilot showed promising results [15]. In Moving Stories the five-point action plan of the training for adolescents is incorporated in the gameplay and specific first aid messages [16] have been translated to actions in the game. Moving Stories has been developed by the game design company IJsfontein in close collaboration with the Trimbos Institute, 113online and the Radboud University Nijmegen. Data collection for the first Randomized Controlled Trial [17] ended in December 2018 and the results are currently analysed. 


One study showed that 21% of children overestimate or accurately perceive rejection by peers [16].


At least 66% of young people experiencing severe anxiety or depressive symptoms don't seek help [11]


About 30% of my gaming experiences consist of finding every little secret or nook in a game.


  • A Game-Based School Program for Mental Health Literacy and Stigma Regarding Depression (Moving Stories): Protocol for a Randomized Controlled Trial

    Tuijnman, A., Kleinjan, M., Hoogendoorn, E., Granic, I. & Engels, R.C. (2019). JMIR Research Protocols, 8(3):e11255, doi: 10.2196/11255

    Author: Anouk Tuijnman

    Upload date: 03-14-2019

  • Developing and Testing ScrollQuest: A Video Game Targeting Rejection Sensitivity in Adolescents

    Tuijnman, A., Granic, I., Whitkin, J., & Engels, R. C. M. E. (2017). In CHI PLAY'17 Extended Abstracts: Extended Abstracts Publication of the Annual Symposium on Computer-Human Interaction in Play (pp. 213-221). New York, NY: ACM.

    Author: Anouk Tuijnman

    Upload date: 10-15-2017

  • The Sims: A Social Improvement Mechanism for Adolescents

    Lobel, A., Engels, R., Tuijnman, A., de Valk, T., & Granic, I. (2013, April). Poster presented at the biennial meeting of the Society for Research in Child Development, Seattle, WA.

    Author: Adam Lobel

    Upload date: 04-15-2013

  • Use of the Principles of Design Thinking to Address Limitations of Digital Mental Health Interventions for Youth: Viewpoint

    Scholten, H., & Granic, I. (2019). Journal of Medial Internet Research, 21(1), e11528. doi: 10.2196/11528

    Author: Hanneke Scholten

    Upload date: 06-16-2020

Project team

Anouk Tuijnman title=
Anouk Tuijnman

I am a passionate researcher interested in improving the well-being of young people with the use of innovative interventions.




E-mail Anouk

Rutger Engels title=
Rutger Engels


CEO at Trimbos Institute / Professor Developmental Psychopathology Utrecht University


E-mail Rutger

Isabela Granic title=
Isabela Granic
Director of GEMH Lab

Professor and Chair of the Developmental Psychopathology department in the Behavioural Science Institute; writer; voracious podcast consumer; mother of two upstanding little gamers


Professor at McMaster's University & Co-founder of PlayNice Interactive


E-mail Isabela

Marloes Kleinjan title=
Marloes Kleinjan


Program Head Epidemiology & Research support at Trimbos Institute / Professor Youth Mental Health Promotion Utrecht University


E-mail Marloes

Ken Koontz title=
Ken Koontz
Creative Director of GEMH Lab

GEEK, Game designer, artist, producer, anime and video game enthusiast, American football player, and as of recently a newb gardener. I'm pretty much always down for new ventures and experiences - O' ley do it!


Founder of Koontz Interactive


E-mail Ken

Erik van den Berge title=
Erik van den Berge
GEMH Sessions Producer

Game developer, VR-guru, mocap artist, animator, video editor, and all-round problem solver. Avid gamer, movie lover and knowledge sponge.


Multimedia Designer at Radboud University


E-mail Erik


All sources
  1. Leary, M., & Cottrell, C. (2013). Evolutionary perspectives on interpersonal acceptance and rejection. In C. N. DeWall (Ed.), The Oxford handbook of social exclusion (pp. 9–19). New York: Oxford University Press.
  2. Slavich, G. M., & Irwin, M. R. (2014). From stress to inflammation and major depressive disorder: A social signal transduction theory of depression. Psychological bulletin, 140(3), 774-815.
  3. Butler, J. C., Doherty, M. S., & Potter, R. M. (2007). Social antecedents and consequences of interpersonal rejection sensitivity. Personality and Individual Differences, 43(6), 1376-1385.
  4. Feldman, S. I., & Downey, G. (1994). Rejection sensitivity as a mediator of the impact of childhood exposure to family violence on adult attachment behavior. Development and Psychopathology, 6(1), 231-247.
  5. London, B., Downey, G., Bonica, C., & Paltin, I. (2007). Social causes and consequences of rejection sensitivity. Journal of Research on Adolescence, 17(3), 481-506.
  6. Rowe, S. L., Zimmer-Gembeck, M. J., Rudolph, J., & Nesdale, D. (2015). A longitudinal study of rejecting and autonomy-restrictive parenting, rejection sensitivity, and socioemotional symptoms in early adolescents. Journal of Abnormal Child Psychology, 43(6), 1107-1118.
  7. Downey, G., Lebolt, A., Rincón, C., & Freitas, A. L. (1998). Rejection sensitivity and children's interpersonal difficulties. Child development, 69(4), 1074-1091.
  8. Marston, E. G., Hare, A., & Allen, J. P. (2010). Rejection sensitivity in late adolescence: Social and emotional sequelae. Journal of Research on Adolescence, 20(4), 959-982.
  9. Sandstrom, M. J., Cillessen, A. H., & Eisenhower, A. (2003). Children's appraisal of peer rejection experiences: Impact on social and emotional adjustment. Social Development, 12(4), 530-550.
  10. Downey, G., & Feldman, S. I. (1996). Implications of rejection sensitivity for intimate relationships. Journal of Personality and Social Psychology, 70(6), 1327-1343.
  11. Williams, K. D., Cheung, C. K. T., & Choi, W. (2000). Cyberostracism: effects of being ignored over the internet. Journal of Personality and Social Psychology, 79(5), 748-762. doi:10.1037//0022-3514.79.5.748
  12. Gulliver, A., Griffiths, K. M., & Christensen, H. (2010). Perceived barriers and facilitators to mental health help-seeking in young people: a systematic review. BMC psychiatry, 10(1), 1-9.
  13. Rickwood, D. J., Deane, F. P., & Wilson, C. J. (2007). When and how do young people seek professional help for mental health problems. Medical Journal of Australia, 187(7 Suppl), S35-S39.
  14. Hadlaczky, G., Hökby, S., Mkrtchian, A., Carli, V., & Wasserman, D. (2014). Mental Health First Aid is an effective public health intervention for improving knowledge, attitudes, and behaviour: A meta-analysis. International Review of Psychiatry, 26(4), 467-475.
  15. Hart, L. M., Mason, R. J., Kelly, C. M., Cvetkovski, S., & Jorm, A. F. (2016). ‘teen Mental Health First Aid’: a description of the program and an initial evaluation. International journal of mental health systems, 10(1), 1-18.
  16. Ross, A. M., Hart, L. M., Jorm, A. F., Kelly, C. M., & Kitchener, B. A. (2012). Development of key messages for adolescents on providing basic mental health first aid to peers: a Delphi consensus study. Early intervention in psychiatry, 6(3), 229-238
  17. Tuijnman, A., Kleinjan, M., Hoogendoorn, E., Granic, I., & Engels, R. C. (2019). A game-based school program for mental health literacy and stigma regarding depression (Moving Stories): Protocol for a randomized controlled trial. JMIR research protocols, 8(3), e11255.