We want to determine if we can use digital virtual characters in virtual reality (VR) to improve the detection and diagnosis of depressed children and adolescents in real life.
For this purpose, we will develop a game-based virtual reality application that uses emotionally believable virtual characters to learn how to recognize complex mental illnesses. The application will simulate a diagnostic situation where one can experience an anamnesis with a mentally ill person. 
The initial target groups are medical students, therapists in training, and other persons involved in diagnosis and therapy. Later, a simplified learning module will be made available to youth trainers and recreational sports coaches to improve awareness of the first symptoms of depression or other mental illnesses.

Teaching in medicine has evolved into competency-based teaching. The National Competence-Based Learning Objectives Catalogue for Medicine (NKLM) includes clinical-practical skills and medical interviewing as concrete learning objectives. At the University of Duisburg-Essen, this content is taught as a longitudinal curriculum (ECKO). Communication and interaction are also essential to all child and adolescent psychiatry courses. A significant challenge is practical teaching, which requires actual or simulated patients. There are no corresponding simulation patients for children and adolescents up to 16 years of age, so young adults have to be used, which is, at best, an approximation. Video material is not a good alternative due to patients' personal protection needs and the medium's limitations. Here, virtual reality can be a possible solution precisely because of the intense presence experience.
Together with our partners PD Dr. Gertraud Gradl-Dietsch from the LVR-Klinikum, we design the application and emphasize the credible design of the virtual agents and motivating (playful) interaction possibilities to offer students the best possible experience.

Conveying emotions with digital characters is challenging because humans have a fine sense of other people's appearance, language, facial expressions, and gestures. An uneasiness towards non-real but human-like characters is known in psychology as the "Uncanny Valley Effect." This makes it challenging to portray convincing virtual characters, but recent technical possibilities from computer games show promise (Mavrogiorgou et al., 2021). Such virtual characters, also called agents, are computer-controlled beings that can be virtual humans. They are not avatars representing an actual human in a virtual world. Studies show that people treat virtual characters equally and perceive them as social entities if they are designed to be believable (Harth, 2017; Emmerich et al., 2018). In particular, believability can be enhanced by representing different affective communication channels (Clavel et al., 2009; Ennis et al., 2013; Demeure et al., 2011), which can also lead to virtual characters triggering empathy in their counterparts (Rativa et al., 2020). Thus, emotional virtual characters bring excellent prerequisites for using them to model the complex emotional world of a mentally ill child or adolescent. The development of a youthful character initially for the diagnosis of depression takes into account the high lifetime prevalence of depressive illnesses in adolescence of up to 10% (Avenevoli et al., 2015). Each agent would be the same for each student, which ensures that the content is conveyed in a standardized manner. In addition to the realization and embedding of virtual patients, VR offers the students the feeling of actually interacting with living characters due to the high degree of immersion (Nowak & Biocca, 2003). An application that is available to all students and includes a range of different mentally ill characters can also offer a motivational aspect to encourage regular use by students. Here, playful aspects (e.g., prepared dialogues similar to computer games) could be used, which makes learning with the application an instructive and exciting experience for the students. Game mechanics, such as collecting achievements, can motivate gamers to want to play the game again. Therefore, students would be motivated to learn in addition to the advantages of such a VR application. As additional motivation and for better integration into the curriculum, the VR training could be provided with a certificate that the students can acquire.

Our goal for this project is to conduct a comparative study in the winter semester of 2024/25 to test the effectiveness of our application. For this purpose, a group of 10th-semester medical students will practice with the VR application concurrently with their preparation for the "Psychiatry and Psychotherapy" exam. In contrast, a control group will receive no additional preparation. The students are to get to know eight different virtual patients in several sessions spread over the semester and practice the procedure of a diagnostic interview with them. They are to be accompanied by the investigators. In this course, we can also collect measures for assessing the emotional virtual characters.

If you are interested in our project or would like to support us, don't hesitate to contact us directly!