The qualities of patients interested in using a game-based digital mental health intervention for depression : a sequential mixed methods study

Abstract

Background Digital interventions are typically evaluated by their effectiveness and engagement, while the characteristics of patients who perceive them to be attractive have remained poorly understood. This challenges user-centered intervention development but also presents an avenue to improve intervention efficacy and engagement. Our objective was to characterize people to whom game-based interventions appeal to with a focus on their mental health backgrounds and prior digital game experiences. Methods We performed a sequential mixed methods study with adults suffering from major depressive disorder (MDD) who participated in a randomized controlled clinical trial studying the effectiveness of a game-based digital intervention for depression. First, randomly chosen participants were interviewed (N = 22), and the transcribed data were analyzed inductively. Then, focusing on the themes established through the interview data, we triangulated the findings using complementary questionnaire data (N = 445). Results The interview data yielded four themes that we illuminated with quantified questionnaire data. (T1) The participants had enduring and diverse psychiatric symptomology: 73% had been diagnosed with a comorbid disorder in addition to depression. (T2) Participants had received at least some treatments that had not led to full remission of depression. 92% currently received therapeutic support, psychiatric medication, or both. (T3) Many participants had close relationships with digital gaming and played actively: on average, for 13 h a week on various gaming platforms and in various genres. (T4) Some participants used gaming to manage their psychiatric symptoms, and 76% found that playing helped them feel better. Conclusions Identifying and characterizing people attracted to game-based therapeutic interventions can catalyze intervention development and improve their efficacy. We found that game-based interventions have appealing potential across diverse psychiatric symptoms and for people with prior or existing treatments. Game-based interventions may appeal particularly to active players and offer a promising alternative to the self-treatment usage of entertainment games.