Tabletop role playing games as a way forward with structurally marginalized youth: A narrative review

• TTRPGs are experiencing a cultural renaissance, surging in popularity. • TTRPGs have evolved into safe spaces embraced by structurally marginalized youth. • TTRPGs provide a less-intimidating, youth-driven approach to engagement. • TTRPGs are used to promote growth, prepare for therapy, and to deliver intervention. • Amid anti-trans discourse, TTRPGs provide safe spaces for growth and acceptance. Tabletop roleplaying games (TTRPGs) are experiencing a remarkable surge in popularity, with sales of Dungeons and Dragons™ more than tripling during the COVID-19 pandemic. Once a stigmatized pastime, TTRPGs have evolved into inclusive community spaces for structurally marginalized youth. Alongside this cultural transformation, there is growing recognition of TTRPGs not only as tools for healthy psychological development but also as promising vehicles for delivering psychosocial interventions. This review seeks to bridge the gap between the TTRPG community and mental health clinicians and researchers, demonstrating that gaming can serve as more than recreational activity. It can offer a powerful, youth-driven space for growth and engagement. For structurally marginalized youth, particularly those who have been harmed by systems and may be resistant to traditional interventions, TTRPGs provide a strengths-based, interest-driven approach that meets them where they are at. We begin by defining structural marginalization and its impact on adolescent development, then explore the evolution of TTRPGs into inclusive environments, review emerging evidence supporting their use as interventions, and conclude with practical recommendations and directions for future research. Special attention is given to the unique ways in which TTRPGs can support trans and gender non-conforming youth, particularly in the context of escalating anti-trans rhetoric and diminishing access to gender-affirming spaces and care.