Mental illnesses affect approximately 11% of the global population, posing a significant burden. Addressing the stigma and fostering mental health literacy are crucial for improving outcomes. Mental health literacy encompasses knowledge and awareness of mental illness, prevention, identification, and management. High mental health literacy enhances insight, promotes help-seeking, recovery, and psychosocial functioning. Empathy, the ability to understand another's experiences, also plays a crucial role in reducing stigma and fostering positive attitudes. Augmented reality (AR) combines real and digital information, while virtual reality (VR) excludes real-world stimuli. Both AR and VR technologies are increasingly used in healthcare education and therapy for various conditions. However, fewer studies examine their effectiveness as psychoeducational tools for improving understanding and reducing stigma related to mental illnesses. This scoping review addresses this gap by systematically examining the effectiveness of AR/VR-based interventions on knowledge, attitudes, empathy, and stigma towards people with mental illnesses.

The review examined existing literature on the use of AR/VR in mental healthcare, particularly focusing on their effectiveness as psychoeducational tools. While AR/VR have shown promise in treating conditions like anxiety disorders, phobias, and neurodevelopmental conditions, there is limited evidence on their effectiveness in improving mental health literacy and reducing stigma. This review aimed to synthesize existing studies to address this gap and inform future research in this area.

This scoping review followed the Joanna Briggs Institute methodology for scoping reviews, using a modified Arksey and O'Malley framework. The research question focused on the effectiveness of AR/VR interventions on knowledge, attitudes, empathy, and stigma related to mental illnesses. Seven databases (CINAHL, Cochrane Central Register of Controlled Trials, Embase, PsycINFO, PubMed, ScienceDirect, and Scopus) were searched from inception to April 2022, using keywords such as "virtual reality," "augmented reality," "knowledge," "attitude," "empathy," and terms related to specific mental illnesses. Inclusion criteria included primary research studies published in English examining AR/VR interventions with relevant outcomes. Two independent reviewers screened titles and abstracts, resolving discrepancies through discussion and a third reviewer. Data extraction included author, year, participant characteristics, interventions, and findings, summarized in a table and PRISMA flow chart (Figure 1).

Sixteen studies were included, involving diverse participants (undergraduates, high school students, patients, caregivers, and the public). Intervention types varied, including virtual interactions with characters, simulated environments, and sensory disturbances. The majority of studies (nine of 16) demonstrated increased knowledge of mental illnesses following VR interventions, with positive effects observed across a range of disorders (psychotic conditions, dementia). Eight studies examined attitudes, with over half showing improvement post-intervention. All seven studies examining empathy reported improvements. Seven studies assessed stigma, with five finding reductions in stigma. Two studies, however, reported increased stigma, potentially due to factors like discomfort with VR or the way schizophrenia was portrayed. Specific interventions such as Stigma-Stop (a VR game) and Virtual Dementia Tours demonstrated positive impacts on knowledge, attitudes, and stigma reduction.

The findings suggest AR/VR interventions are beneficial in improving knowledge, attitudes, empathy, and reducing stigma related to mental illnesses. The immersive nature of these technologies allows for realistic simulation of patient experiences (hallucinations, sensory disturbances), fostering deeper understanding and empathy. This aligns with findings from prior research highlighting the potential of AR/VR in health professions education and therapy. The effectiveness appears relatively consistent across intervention types, though the specific design features and the relationship between the participant and the virtual character may influence outcomes. The increase in stigma observed in some studies highlights the complexity of stigma reduction and suggests a need for nuanced approaches that go beyond mere simulation.

This scoping review indicates the potential of AR/VR interventions to enhance mental health literacy and reduce stigma. Further research is needed, particularly with larger, more diverse samples and standardized outcome measures. Future studies should compare different AR/VR modalities, investigate long-term effects, and explore optimal intervention designs to maximize effectiveness for various mental health conditions.

This review had several limitations. First, the limited number of studies and the predominantly Western, undergraduate sample size restrict the generalizability of the findings. Second, the heterogeneity of methodologies and outcome measures across studies hinders direct comparisons. Third, the small to modest sample sizes in some studies limit the power of the findings. Fourth, variations in AR/VR modalities limit conclusions on the relative effectiveness of each.