Beyond Static Screening: Depression Symptom Indicators Using Gaze Behavior and Gameplay Performance

This study investigates an active assessment approach for depressive symptom severity that combines eye-tracking with serious games to capture cognitive and attentional patterns during interactive tasks. Unlike traditional assessments based on self-report measures and passive viewing paradigms, this approach uses game-based cognitive challenges to examine symptom-related variations in attention and executive functioning. Fifty-three university students (25 female, 28 male; aged 20–30 years) completed the Beck Depression Inventory-II (BDI-II) and played six cognitive mini-games while gaze behavior was recorded with a Tobii 4C eye tracker. Results revealed significant associations between depressive symptom severity, gaze behavior, and game performance. Higher BDI-II scores were linked to increased fixation-to-saccade ratio, longer fixation durations, reduced saccadic amplitude, and poorer performance in cognitively demanding games. Eye-tracking measures showed strong correlations with depression severity (ρ = 0.702 for fixation-to-saccade ratio and ρ = −0.614 for saccade amplitude, p < 0.001), while gameplay performance also showed negative associations with symptom severity. An integrated model combining eye-tracking and gameplay features explained 81.9% of the variance in depression severity (R² = 0.819), with oculomotor measures emerging as the strongest predictors. These findings highlight the potential of serious games and eye-tracking metrics as objective indicators of depression-related cognitive and attentional processes.