Abstract
BackgroundPrevious research showed that computerized cognitive behavioral therapy can effectively reduce depressive symptoms. Some mental health apps incorporate gamification into their app design, yet it is unclear whether features differ in their effectiveness to reduce depressive symptoms over and above mental health apps without gamification.ObjectiveThe aim of this study was to determine whether mental health apps with gamification elements differ in their effectiveness to reduce depressive symptoms when compared to those that lack these elements.MethodsA meta-analysis of studies that examined the effect of app-based therapy, including cognitive behavioral therapy, acceptance and commitment therapy, and mindfulness, on depressive symptoms was performed. A total of 5597 articles were identified via five databases. After screening, 38 studies (n=8110 participants) remained for data extraction. From these studies, 50 total comparisons between postintervention mental health app intervention groups and control groups were included in the meta-analysis.ResultsA random effects model was performed to examine the effect of mental health apps on depressive symptoms compared to controls. The number of gamification elements within the apps was included as a moderator. Results indicated a small to moderate effect size across all mental health apps in which the mental health app intervention effectively reduced depressive symptoms compared to controls (Hedges g=–0.27, 95% CI –0.36 to –0.17; P<.001). The gamification moderator was not a significant predictor of depressive symptoms (β=–0.03, SE=0.03; P=.38), demonstrating no significant difference in effectiveness between mental health apps with and without gamification features. A separate meta-regression also did not show an effect of gamification elements on intervention adherence (β=–1.93, SE=2.28; P=.40).ConclusionsThe results show that both mental health apps with and without gamification elements were effective in reducing depressive symptoms. There was no significant difference in the effectiveness of mental health apps with gamification elements on depressive symptoms or adherence. This research has important clinical implications for understanding how gamification elements influence the effectiveness of mental health apps on depressive symptoms.
Highlights
Depression is a highly prevalent mental disorder in the United States that affects 17.3 million people [1]
The results show that both mental health apps with and without gamification elements were effective in reducing depressive symptoms
There was no significant difference in the effectiveness of mental health apps with gamification elements on depressive symptoms or adherence
Summary
Depression is a highly prevalent mental disorder in the United States that affects 17.3 million people [1]. Of all adult Americans who experienced a major depressive episode in 2017, 35% did not receive treatment [1] To mitigate these challenges, companies have created technology-based mental health apps, with the goal of alleviating symptoms of various mental disorders [8,9]. As of 2019, 81% of all Americans owned a smartphone, which highlights the potential impact of technology-based mental health apps: providing a platform, consuming less time, requiring less commitment, and allowing users to move at their own pace [10] This ubiquity suggests that app technology could make treatment more accessible by providing individuals with cost-efficient tools and apps to aid them between sessions. Some mental health apps incorporate gamification into their app design, yet it is unclear whether features differ in their effectiveness to reduce depressive symptoms over and above mental health apps without gamification
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