A randomised trial gave 148 adults on antidepressants nine weeks of a CBT smartphone game, optional online modules and therapist support on demand. Depressive symptoms favoured the intervention over a waitlist (d = 0.74), as did anxiety and self-reported adherence. Attrition was 40.8% in the intervention arm against 18.1% among controls, and the effect cannot be attributed to the game alone.
Why it is interesting: Medication adherence moved in a randomised design, though differential attrition and a waitlist comparator both bear on the size.
Abstract — the authors' own words, CC BY
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.
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