Virtual reality therapy for adolescent depression: a prospective observational study

Adolescent depression represents a significant public health challenge, often characterized by emotional instability and poor adherence to conventional therapies. Virtual reality (VR) offers a novel, immersive tool designed to enhance engagement and emotional regulation. This study aimed to evaluate this approach and identify predictors of treatment remission. This prospective observational study was conducted at Shandong Daizhuang Hospital from December 2024 to February 2025, enrolling 100 adolescents (≤19 years). This study employed a VR platform to deliver a combined intervention of relaxation therapy and Cognitive Behavioral Therapy (CBT). The intervention consisted of 10 sessions of 15-minute VR therapy over two weeks. The change in the Self-Rating Depression Scale (SDS) score from baseline to post-treatment was assessed, with remission defined as a post-treatment SDS score of less than 53. At baseline, we collected demographic characteristics, clinical features, and inflammatory markers. Depression and anxiety symptoms were assessed using the SDS and Self-rating Anxiety Scale (SAS) at both baseline and the 2-week endpoint. Univariate and multivariate logistic regression analyses were employed to identify predictors of remission. Of the 100 participants recruited, 84 completed the study. The study cohort consisted of 68 females (81.95%) and 16 males (19.05%), with a median age of 15.00 years (interquartile range: 14.00–16.00). Following the VR intervention, a statistically significant reduction in SDS scores was observed (t = 10.61, p < 0.001). The overall remission rate was 36.90% (n = 31). In univariate analyses, the remission rate was significantly higher in males than in females (χ2 = 5.56, p = 0.018). Additionally, the remission group had lower baseline SAS (t = 3.17, p = 0.002) and SDS scores (t = 3.63, p < 0.001) compared to the non-remission group. Baseline inflammatory markers did not differ between groups. In the multivariate logistic regression model, none of the variables that were significant in the univariate analysis, such as gender, baseline SAS score, and baseline SDS score, emerged as independent predictors of remission. Our study found that VR-based relaxation therapy combined with CBT achieved a remission rate of 36.90% in adolescents with depression. Although baseline severity and gender showed potential associations with remission in univariate analysis, they were not independent predictors in the multivariate model. Given the absence of a control group in this study, subsequent randomized controlled trials are warranted to verify its efficacy and to identify biomarkers associated with treatment remission. The trial was registered prospectively in the Chinese Clinical Trial Registry (ChiCTR2400092919) on 26 November 2024.