IMPLEMENTATION OF SERIOUS GAME TECHNIQUES IN RAISING THE SOCIAL AWARENESS OF THE DEPRESSION DISEASE Plechawska-Wójcik Małgorzata1, Jakub Grzesiak1 1
Institute of Computer Science ,Lublin University of Poland, Lublin, Poland
[email protected]
Abstract The paper presents the model of the serious game designed to raise the awareness of the depression disease. The game is dedicated to wider audience of gamers, for people willing to empathize with the role of a patient suffering from the depression disease. The game aims to raise the level of knowledge about this disease and let a user to feel as a depressed person. The aim of the paper is to present the process of the game development including the conceptual model, development and implementation of the game and its deployment. What is more, the paper presents and discuses the results of examination of the game impact of on users emotional states. Keywords: Serious game, educational games, eHealth
1
INTRODUCTION
Serious games are gaining more and more popularity and they are applied in many areas such as education and training but also in health care, business and finance or engineering [1 2]. Serious games differ from entertainment games in such aspects as less important richness experience, focusing on learning and introducing therapeutic elements [3]. What is more, it was scientifically validated that playing chosen video and computer games not only de-stress, but also help patients to fight against depression and anxiety. Psychologists consider these games as a new way to reach and support people who need help. Considering that current therapeutic strategies do not suffice and depression is characterized by high recurrence rates as well as life-long disease course accompanied by disability and social exclusion there is a great need to seek more solutions that can help tackle this global health problem. Continuous stress, professional and personal problems, poor diet, conflicted environment, negative way of thinking are just some of possible causes of depression. The game models these features with the set of choices based on the graphical elements. The model is based on the decision tree considering user’s state, feeling and also choices he/she makes [4]. Depression is becoming an increasing problem in today's society. This more and more popular civilization disease requires long-term complex therapeutic strategies. Continuous stress, professional and personal problems or even negative way of thinking causes people to isolate from society, lose the will to live and even to suicide, especially if the disease is not diagnosed early and properly treated [5]. Currently no clinical studies are realized that could detect depression. The only way to diagnose depression are surveys and a detailed interview. People concerned about their or their relatives health can also perform a series of tests checking the threat of depression. Serious games is another method that can help in the initial diagnosis process. Serious game is a type of game that have been used for long to treat patients with phobias or trauma. In the psychological environment these games have opinion of modern complementary methods having positive feedback from many doctors. They are often treated as a tools to assist patients in the period between medical visits due to its versatility and positive opinions of people who have undergone treatment. Serious games might be also useful in education, among others to raise awareness and social sensitivity [6]. Depression disease is one of the suitable topics. Despite the fact that this disease occur more and more often, people know little about its symptoms and minimize threat that it brings. This results in a lack of sensitivity to the problem of people suffering from depression and inability to respond for it properly. The scope of the paper covers discussion of the serious games applications with an emphasis on medical and social issues. The game idea and its conceptual model is discussed and implementation
details are presented. The game was used to perform a set of user tests to find the influence of the game on their mood.
2
SERIOUS GAMES
Serious games is a kind of game where the aim is not only the entertainment, but also raising awareness of a player and gaining new knowledge. They are usually dedicate to solve the real problems in such fields as health, education, management or spatial planning. The reason why serious games gain popularity is the belief that the player involvement in the situation enable to gain better skills than during absorbing dry knowledge. Usually the gameplay of serious games is not very extensive, especially if the game is directed to a wide audience, also for people not used to computer games [7 8]. Such games typically cover only one issue or problem, and the game is constructed in order to solve it. There are also endless serious games presenting hard, insoluble situation. This method of presenting knowledge forces the player to feel the situation. The most important feature of any serious game is the interaction with the user, who needs to fully concentrate and participate mentally throughout the game [7]. It may seems that serious games were born with computers and Internet, but their history dates back to the nineteenth-century Prussian army, which practiced "dry" military maneuvers. However, the formal definition of serious games was proposed in 1971 in the "Serious Games" of Clark C. Abt [9]. The term serious game defined a game with a clear and well thought out educational purpose, and their primary function is not to provide entertainment [10 11]. In 2005, Mike Jew expanded the definition as computer game providing mental rivalry and based on certain principles, which uses entertainment to promote and achieve government or corporate objectives with training skills, education, health, public policy and communications strategic [12]. According to the theory of Nolan Bushnell [13] it is enough just to change the way of absorbing new knowledge to learn even 10-20 times faster and more efficiently. In his view, the world of education going through a revolution, which will change it completely in the next decade and serious games will play the basic role in modern education. Games for Entertainment and Learning Lab of University of Michigan [14] divided serious games into seven groups: 1. Persuasive Games 2. Games for Health 3. Corporate Games 4. Games for Learning 5. Military Games 6. Government – NGO Games 7. News Games Serious games can drive a wide range of problems. For example the game Killer flu presents to a player the risk of avian flu and how to protect against it. Another example is a game called BioChemFX depicting the consequences of the use of chemical or biological weapons in a metropolis. Recently serious games are developed by government organizations, for example well-known game Americas Army showing the current situation of the US Army. The initial premise was to create a game designed to cure veterans of the war in Iraq by showing the traumatic situations on the screen. According to research [9 11], people treated with this "virtual" methods achieved better results (no recurrences) than those treated in a traditional way. Currently the game is successfully used also to train future recruits of American army. Nowadays serious games dedicated to education and health problems are increasingly popular [15 16 17]. They might cover a wide range of healthy issues starting from eating problems ending with social disease [18 19]. Examples include such games as Time Out or Glucoboy presenting the problem of diabetes and showing how to deal with it in every moment of life [4] [6].
3
APPLICATION
The proposed application is dedicated to diagnose the player's mental state before the start of the game, which then plays a role of medieval king suffering from depression. He will undertake important decisions regarding his kingdom, and the path we choose will affect the fate, and yet the final result. The game was developed using technologies: Php, Html5, Bootstrap JavaScript library, Codeigniter PHP framework and MVC design pattern. An additional advantage of the application is its responsiveness, and thus the possibility of use the application on mobile devices even in clinics or on personal devices of specialists.
3.1
The gameplay
The first step of the game is to fill in the BDI questionnaire survey (Beck Depression scale) [1], which is dedicated to depression diagnosis. The original survey consists of 21 questions, while the game includes 10 selected questions. In the main game, the player empathizes with the role of a king and measure the problems of his medieval kingdom, which after many years of battles is in decline. The construction of the whole project has the form of a decision tree, which may lead to three different endings of the story. Each problem can be solved in two ways, one positive and one negative (typical for a person with depression). An additional effect is change of the saturation and brightness of images displayed on the screen, depending on whether the player selected positive or negative answer. Heading toward the negative decisions pictures getting darker and colors are faded. Apart from this, each decision will lead to the emergence of other problems. The end result will be the summary presenting the kingdom situation as well as information about player’s current mental state determined on the basis of accumulated points. Points are calculated in a similar way as in the Beck depression scale, however, with opposite scores for the answers: negative choices give less negative points than positive. An additional point of reference will be a short questionnaire consisting of three questions displayed together with the result and the score. The application’s role is to present problems which must face a person suffering from depression. It also examines the player psychological impact of game interface color changes. All data are collected for each user, what helps to distinguish the impact of games on respondent groups. Each user has access to his/her personal results of each game along with color describing mental state level. The system administrator has access to all collected data. Example decision tree of the game is shown in Fig. 1. Event 0
Positive decision
Negative decision
Event 1
Positive decision
Negative decision
Event 2
Positive decision
Fig.1. Pictorial diagram of a decision tree
Negative decision
3.2
Game implementation
Collected results are personalized according the specified user. Starting the game results in the preliminary survey view, the BDI. The player is asked to select answers about his/her current mood. Questions regards player’s:
state of being
concerns about the future
sence of guilt and negligence
favorite activities
the level of smugness
the feeling of being worse than others
pessimistic thoughts, suicide
irritability and nervousness
problems with decision-making
difficulty in performing daily activities and responsibilities
If a player plays for the first time during a day the first scenario of the game is displayed. The description of the first incident, along with a picture illustrating the current scenario is presented (Fig. 2).
Fig. 2. The view of event which the player must face.
Clicking the description replace the content window with the buttons with possible responses choice. After choosing one option next scenario is presented and the scheme is repeated until the game completion. During the game, if decisions are negative (depression) a player may notice a change of background colors and images of the page. They became darker and the color saturation is reduced (Fig. 3).
Fig. 3. The view showing the change of colors in depressive decision-making
After the game completion one of the possible ends appears with the detailed explanation. The application also displays the number of gathered points and the mental state of the player. In addition, the final survey is released, which is a benchmark for the initial survey and for the game itself. After the game the player answers questions about satisfaction with the taken decisions and about the level of his/her irritability and nervousness.
4
CASE STUDY RESULTS
Tests were performed on a random group of 37 people in different age. Most of testers fall within the range of 19-24 years. The number of performed tests is 89. Some of tested players performed study regularly once a day for several days, so a mood profile could be created. An example profile with points variations is presented in Fig. 4.
Fig. 4. Sample graph presenting mood swings for one of the players, calculated based game data at a certain time
Decisions in the game are guided towards one of the three endings of the story. Fig. 5 presents a chart with the number of times the player finished the game in each of the three ends divided by age groups. The blue color indicates users aged 13-19, green - aged 20-16 and red – above 27. The left part indicates the negative ending, the mean - neutral and the right - positive.
Fig. 5. The number of users for each of the endings divided by age groups
From Fig. 5 it can be concluded that the most common subjects have ended the game with negative finale. It means that changing colors of the game had a big impact on players decision-making. None of people aged 13-19 have completed the game with a negative final. The largest number for this range occurs in the completion of a neutral state or minor depression. On the contrary, however, it is for the other age categories:. 20-26 and 27-65 years old, where most trials ended negatively. These results may be caused by the fact that people in these categories pay more attention to the color of the environment and receive it emotionally as opposed to younger people who have not noticed much effect. The chart in Fig. 6. summarizes the average results collected in the game divided into age categories discussed previously (Fig. 5). Results confirm that the youngest people (13-19 years old) obtained results very similar to each other, despite a shorter period of study. In the other age groups results shows big variations of points gained by players.
Fig. 6. The average points gained in the game among players categorized by age group
Pearson correlation coefficient calculated for the data:
number of points from BDI survey (X axes)
number of points earned in the game (Y axes)
has the value: -0.75396157. This value represents a negative correlation with a fairly strong relationship. The increase of points from BDI survey goes with worse player outcome obtained in a game. This confirms the assumptions of the application. The correlation diagram is shown in Fig. 7. Additional confirmation of the research is a survey performed after the game completion. It shows that about 8/10 of players who received a negative result chose negative responses such as "I felt reluctance for my decisions". Fig. 8 presents a correlation diagram obtained for players who received low (less than 7 points) number of BDI survey, not indicating depression. The trend was not conferred among players of the group 13-19 years old. They undertook almost identical paths for the neutral and positive conclusion. Interesting dependency diagnosed among people aged 20-26 is the negative mental state declared at the very beginning. Most of them followed the similar decision paths and this compliance is as much as five to six cases. In the group of people 27-65 years the biggest spread of decision paths was noticed. it is impossible to designate any consistency in decision making.
Fig. 7. Correlation diagram for the points gained from the game and BDI survey
Fig. 8. Correlation diagram for the points gained from the game and BDI survey for the players without symptoms of depression
5
CONCLUSION
Building the application the emphasis has been put on simplicity and user-friendly interface, to make it easy to use even for who people who do not have contact with this type of application. The application was constructed in a way to ensure compatibility with all devices, including smartfones. The players did not report any problems with understanding the interface, what indicates that the application is intuitive. The game story was pleasant enough to encourage the player to replay and to discover other scenarios. E-healh serious games should be created in a way to encourage the user to participate in an interactive fun. Although the gameplay of serious games usually is simple, it is worth to offer users a gripping story to attract them. Obtained application helps players to understand the problem of depression and to aware players who do not know this disease. What is more, it shows how extensive might be mood swings.
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