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Background Depression and anxiety in children and adolescents are major health problems worldwide. In recent years, serious games research has advanced in the development of tools to address these mental health conditions. However, there has not been an extensive analysis of these games, their tendencies, and capacities. Objective This review aims to gather the most current serious games, published from 2015 to 2020, with a new approach focusing on their applications: awareness, prevention, detection, and therapy. The purpose is also to analyze the implementation, development, and evaluation of these tools to obtain trends, strengths, and weaknesses for future research lines. Methods The identification of the serious games through a literature search was conducted on the databases PubMed, Scopus, Wiley, Taylor and Francis, Springer, PsycINFO, PsycArticles, Web of Science, and Science Direct. The identified records were screened to include only the manuscripts meeting these criteria: a serious game for PC, smartphone, or virtual reality; developed by research teams; targeting only depression or anxiety or both; aiming specifically at children or adolescents. Results A total of 34 studies have been found that developed serious games for PC, smartphone, and virtual reality devices and tested them in children and adolescents. Most of the games address both conditions and are applied in prevention and therapy. Nevertheless, there is a trend that anxiety is targeted more in childhood and depression targeted more in adolescence. Regarding design, the game genres arcade minigames, adventure worlds, and social simulations are used, in this order. For implementation, these serious games usually require sessions of 1 hour and are most often played using a PC. Moreover, the common evaluation tools are normalized questionnaires that measure acquisition of skills or reduction of symptoms. Most studies collect and compare these data before and after the participants play. Conclusions The results show that more awareness and detection games are needed, as well as games that mix the awareness, prevention, detection, and therapy applications. In addition, games for depression and anxiety should equally target all age ranges. For future research, the development and evaluation of serious games should be standardized, so the implementation of serious games as tools would advance. The games should always offer support while playing, in addition to collecting data on participant behavior during the game to better analyze their learning. Furthermore, there is an open line regarding the use of virtual reality for these games due to the capabilities offered by this technology.

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Serious games have to meet certain characteristics relating to gameplay and educational content to be effective as educational tools. There are some models that evaluate these aspects, but they usually lack a good balance between both ludic and learning requirements, and provide no guide for the design of new games. This study develops the Gaming Educational Balanced (GEB) Model which addresses these two limitations. GEB is based on the Mechanics, Dynamics and Aesthetics framework and the Four Pillars of Educational Games theory. This model defines a metric to evaluate serious games, which can also be followed to guide their subsequent development. This rubric is tested with three indie serious games developed using different genres to raise awareness of mental illnesses. This evaluation revealed two main issues: the three games returned good results for gameplay, but the application of educational content was deficient, due in all likelihood to the lack of expert educators participating in their development. A statistical and machine learning validation of the results is also performed to ensure that the GEB metric features are clearly explained and the players are able to evaluate them correctly. These results underline the usefulness of the new metric tool for identifying game design strengths and weaknesses. Future works will apply this metric to more serious games to further test its effectiveness and to guide the design of new serious games.