Improving Adherence to Psychotherapy and Clinical Outcome in Patients With Late-Life Depression Through Gamified...

We assessed the impact of implementing gamification via mHealth in psychotherapies treating late-life depression on promoting adherence to between-session homework and improving depressive symptoms. We also assessed the relationship between adherence and depressive symptoms.

We compared a gamified phase (Phase II) and a nongamified phase (Phase I) of three reward exposure-based psychotherapies treating late-life depression at the Weill Cornell ALACRITY Research Center. Each phase recruited its own cohort of participants.

Middle-aged to older adults (Mean [SD] age 69.4 [8.04]) with major depression (N = 102).

Adherence was indicated using daily self-reported homework completion, and depressive symptoms were measured four times over the 12-week study using the Montgomery Åsberg Depression Rating Scale (MADRS).

Participants who received gamified psychotherapy had higher odds (aOR = 8.20 [95% CI: 2.68-25.04]; p <0.001) of completing daily homework and greater reduction in MADRS (9.58 vs. 4.73, Δ=4.85 [95% CI: 2.23-7.47], p <0.001) compared to those who received a nongamified version. In the gamified version, a 20% increase in homework completion rate was associated with a 2.97-point reduction (95% CI: 1.31-4.63; p <0.001) in MADRS at the following assessment.

Using gamification in mHealth psychotherapies treating late-life depression was associated with higher homework adherence and reduced depressive symptoms. Higher adherence in gamified psychotherapies was associated with a greater reduction in depressive symptoms. This suggests that gamification could enhance the effectiveness of mHealth psychotherapies and promote the wider adoption among older adults, helping to address the growing demand for mental health care among this population.