The impact of a gamified Mobile mental health app (eQuoo) on resilience and mental health in a student population: large-scale randomized controlled trial
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Abstract
BACKGROUND: With many digital mental health interventions failing to engage clients for enough time to demonstrate substantive changes to their well-being and with only 2% of all digital solutions on app stores having undergone randomized controlled trials, the rising demand for mental health prevention and early intervention care is not being met. Young adults in particular struggle to find digital well-being apps that suit their needs. OBJECTIVE: This study explored the effects of eQuoo, an evidence-based mental health game that teaches psychological skills through gamification, on resilience, depression, anxiety, and attrition in a student population. METHODS: In total, 1165 students from 180 universities in the United Kingdom participated in a 5-week, 3-armed randomized controlled trial. Participants were randomly allocated into 1 of 3 groups: eQuoo users, users of a treatment-as-usual evidence-based cognitive behavioral health app called Sanvello, and a no-intervention waitlist. The Rugged Resilience Scale, Generalized Anxiety Disorder-7, and Patient Health Questionnaire-8 were administered to all participants at baseline and every 7 days until completion. RESULTS: A repeated measures-ANOVA revealed statistically significant increases in resilience scores in the test group (P<.001) compared with both control groups (Sanvello: P=.10 and waitlist: P=.82) over 5 weeks. The app also significantly decreased anxiety and depression scores (both P<.001). With 64.5% (251/389) adherence, the eQuoo group retained 42% more participants than the control groups. CONCLUSIONS: Digital health interventions such as eQuoo are effective, scalable, and low-cost solutions for supporting young adults and are available on all leading mobile platforms. Further investigation could clarify the extent to which specific elements of the eQuoo app (including gamification) led to better outcomes. TRIAL REGISTRATION: German Clinical Trials Register (DRKS) DRKS00027638; https://drks.de/search/en/trial/DRKS00027638.
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Previous research shows the importance of getting the client to engage in the treatment process.
“This also becomes clear as previous research shows the importance of getting the client to engage in the treatment process (49–51).”
From A systematic review on the efficacy of virtual reality and gamification interventions for managing anxiety and depression (2023) · cites this paper as [50]
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Flagged first, then by citations
Research works printed but not linked: 3
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- [58]Syafryadin S Nurkamto J Linggar DA Mujiyanto J Active, belief, and consequence (ABC) model technique in minimizing students’ speech anxiety Proceedings of the 5th International Seminar on English Language and Teaching 2017 ISELT-5 '17 August 17, 2017 Sumatra, Indonesia 320 4
- [63]Litvin S Gamification as an approach to improve mental well-being and reduce attrition in mobile mental health interventions: a randomized controlled trial Open Science Framework 2020 2023-06-06 https://dx.plos.org/10.1371/journal.pone.0237220 PMC7467300 32877425 · DOI · Paper page
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- Authors
- Litvin, S., Saunders, R., Jefferies, P., Seely, H., Pössel, P., & Lüttke, S.
- Affiliations
- Ludwig-Maximilians-Universität München (DE)
- University College London (GB)
- Dalhousie University (CA)
- University of Louisville (US)
- Universität Greifswald (DE)
- Corresponding author
- Litvin, Silja
- Venue
- JMIR Mental Health
- Publisher
- JMIR Publications Inc.
- Published
- 2023-07-21
- Volume
- 10
- Pages
- e47285
- ISSN
- 2368-7959 (ISSN-L)
- PMC
- PMC10403802
- OpenAlex
- W4381479860
- Cited by
- 43
- References
- 102
- Citations by year
- 2026: 15 · 2025: 20 · 2024: 7 · 2023: 1
- FWCI
- 11.10
- Type
- journal article
- Language
- en
- Open access
- gold
- doi.org
- Licence
- cc-by
- Locations
- JMIR Mental Health (publishedVersion, cc-by)
- PubMed Central (publishedVersion, cc-by)
- PubMed (publishedVersion)
- UCL Discovery (University College London) (submittedVersion, cc-by)
- DOAJ (DOAJ: Directory of Open Access Journals) (submittedVersion, cc-by-sa)
- Topics
- Social Sciences › Psychology › Applied Psychology › Digital Mental Health Interventions
- Social Sciences › Psychology › Developmental and Educational Psychology › Educational Games and Gamification
- Health Sciences › Health Professions › General Health Professions › Mobile Health and mHealth Applications
- Keywords
- gamification, mental health apps, resilience, depression, anxiety, young adults, university students, digital mental health interventions, app adherence, attrition, mental health prevention
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