A smartphone-based serious game to improve mental health and medication adherence in adults with depression: A randomised controlled trial
In brief
Over 50% using depression game achieved 30% symptom drop vs 19% waitlist
In 148 adults on antidepressants, a 9-week smartphone serious game plus optional CBT modules and on-demand therapist support cut depressive scores more than a waitlist, with 51% reaching at least a 30% improvement versus 19% controls; anxiety and medication adherence improved modestly. Higher dropout in the game arm and the open-label design temper confidence in the findings.
- Journal
- Journal of affective disorders (Q1)
- Published
- 18 September 2026
- Study design
- Randomized controlled trial
- Evidence level
- Level 1, High (CEBM 1b)
- Authors
- Josefin Brehmer, Matilda Berg, Gabriel Astudillo, Tomas Lindegaard, Amalie Englund Find, Per Carlbring, et al.
- PMID
- 42759616
- DOI
- 10.1016/j.jad.2026.122494
Why clinicians should know about it
- Picked for Psychiatry and Mental Health (paper of the day, 20 September 2026): RCT of serious game improves depression, anxiety, adherence
- Picked for Family Practice (top studies of the week, 20 September 2026): Serious game to improve depression and medication adherence
Abstract
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.
Abstract as published, via PubMed.
For healthcare professionals. The summary is generated by AI from the published abstract, and the evidence level is assigned automatically from the study design on the Oxford CEBM hierarchy. Neither is medical advice. Read the full paper before changing practice.