Examining the Effectiveness of Gamification and Reward in Mental Health Applications for Depression: A Systematic Review and Meta-Analysis (Preprint)

BACKGROUND Previous research showed that computerized cognitive behavioral therapy can effectively reduce depressive symptoms. Some mental health applications incorporate gamification into their app design, yet it is unclear whether features differ in their effectiveness to reduce depressive symptoms over and above mental health applications without gamification. OBJECTIVE The objective of this study was to determine whether mental health applications with gamification elements differ in their effectiveness to reduce depressive symptoms when compared to those which lack these elements. METHODS A meta-analysis of studies that examined the effect of app-based therapy, including cognitive behavioral therapy; acceptance and commitment therapy; and mindfulness on depressive symptoms was performed. A total of 5,597 articles were identified via five databases. After screening, 39 studies (n= 8,713 participants) remained for data extraction. From these studies, 51 total comparisons between post-intervention mental health application interventions groups and control groups were included in the meta-analysis. RESULTS A random effects model was performed with gamification elements included as a moderator. This moderating variable compared mental health applications with gamification elements (n=25) to those without such elements (n=26). Results indicated a small to moderate effect size across all mental health applications in which the mental health applications intervention effectively reduced depressive symptoms compared to controls (Hedge’s g = -.28; (95% CI: -0.38; -0.18), P<.01). The gamification moderator was not a significant predictor of depressive symptoms (β= -.013, SE=.115, P=.909), demonstrating no significant difference in effectiveness between mental health applications with and without gamification features. CONCLUSIONS Results show that both mental health applications with and without gamification elements are effective in reducing depressive symptoms. There was no significant difference in the effectiveness of mental health applications with gamification elements on depressive symptoms. This research has important clinical implications for understanding how gamification elements influence the effectiveness of mental health applications on depressive symptoms.