Publications and Research

Document Type


Publication Date

Summer 8-4-2014


Background: The American College Health Association found that over 30% of students reported difficulty in functioning due to feeling depressed, overwhelming anxiety (50%) and anger (36%). Suicide is the second leading cause of death among US adolescents and over half of mental illnesses emerge prior to adulthood. A similar study found that nearly half of student veterans met criteria for Post Traumatic Stress Disorder and 46% had suicidal ideation. Left untreated, mental illness can lead to increased absenteeism, lower academic performance, disrupted classroom behaviors and compromises school safety. Educators and students are well positioned to identify and refer students in psychological distress yet traditional gatekeeper programs increase knowledge with little impact on referral behaviors. The purpose of this study is to examine the effectiveness of newly developed game-based role-play training simulations designed to teach users how to identify, talk to and if necessary, refer students in psychological distress.

Methods: A total of 12,410 middle and high school educators, college faculty, staff and students completed one of five 45-minute training simulations where users practiced role-plays with emotionally responsive virtual humans that react like real students. Pre-, post and three month follow-up data was collected via the Gatekeeper Behavior Scale that measured preparedness, likelihood or behavioral intent and self efficacy. Gatekeeper behaviors included self-reported number of students identified, approached and referred from pre- to follow-up. All data was meta-analyzed.

Results: Composite effect size for pre- and post-training measures of preparedness, likelihood and self-efficacy to engage in gatekeeper behaviors was large at 0.72. Effect sizes comparing pre- to follow-up for preparedness was 0.70, likelihood 0.35 and self-efficacy 0.42. Changes in gatekeeper behaviors including increases in the number of distressed students identified, approached and referred to support services was 0.21.

Conclusions: Data supports the use of game-based role-play simulations that utilize virtual humans to train users to engage in gatekeeper behaviors to augment student mental health initiatives. This training modality, coupled with the benefits of online delivery, holds tremendous potential to reach large numbers of geographically dispersed populations. Additionally, this learning approach has potential to support a wide range of public health initiatives.