A smartphone-based serious game to improve mental health and medication adherence in adults with depression: A randomised controlled trial.

BACKGROUND: Many adults treated with antidepressants experience residual depressive symptoms and low medication adherence. This randomised controlled trial investigated if access to a multicomponent digital intervention including a serious game can improve mental health and medication adherence. METHODS: 148 adults with ongoing antidepressant treatment and residual depressive symptoms were randomised to 9 weeks of access to an intervention with therapist guidance on demand, comprising the CBT-based smartphone serious game Fig: The Game for Depression and 25 optional internet-based CBT (ICBT) modules, or to a waitlisted control condition. The primary outcome was depressive symptoms (MADRS-S) at post-treatment. RESULTS: Regression models favoured the intervention group for depressive symptoms (d = 0.74), anxiety symptoms (d = 0.67) and medication adherence (d = 0.46) at post-treatment. Quality of life did not differ significantly. A larger proportion of intervention participants reached at least 30% improvement (51.11% vs. 18.64%), and the results were robust in missing-data sensitivity analyses. Most intervention participants (79%) installed Fig, completing a mean of 81 game sessions (SD 73); 31.6% contacted their therapist and 27.6% completed at least one ICBT worksheet. Attrition was 40.8% (intervention) and 18.1% (control). LIMITATIONS: Differential attrition, the open-label design, the waitlist comparator and self-reported outcomes limit the conclusions, and effects cannot be attributed to the game alone. CONCLUSIONS: Access to an intervention including Fig, optional ICBT modules and on-demand therapist support was associated with greater short-term improvements in depressive symptoms, anxiety and medication adherence than a waitlist condition.