{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,7]],"date-time":"2026-10-07T10:25:48Z","timestamp":1791368748618,"version":"4.3.1"},"reference-count":83,"publisher":"JMIR Publications Inc.","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JMIR Ment Health"],"abstract":"\n Background<\/jats:title>\n 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.<\/jats:p>\n <\/jats:sec>\n \n Objective<\/jats:title>\n 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.<\/jats:p>\n <\/jats:sec>\n \n Methods<\/jats:title>\n 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\u20137, and Patient Health Questionnaire\u20138 were administered to all participants at baseline and every 7 days until completion.<\/jats:p>\n <\/jats:sec>\n \n Results<\/jats:title>\n A repeated measures\u2013ANOVA 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.<\/jats:p>\n <\/jats:sec>\n \n Conclusions<\/jats:title>\n 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.<\/jats:p>\n <\/jats:sec>\n \n Trial Registration<\/jats:title>\n German Clinical Trials Register (DRKS) DRKS00027638; https:\/\/drks.de\/search\/en\/trial\/DRKS00027638<\/jats:p>\n <\/jats:sec>","DOI":"10.2196\/47285","type":"journal-article","created":{"date-parts":[[2023,6,20]],"date-time":"2023-06-20T08:19:36Z","timestamp":1687249176000},"page":"e47285","source":"Crossref","is-referenced-by-count":41,"title":["The Impact of a Gamified Mobile Mental Health App (eQuoo) on Resilience and Mental Health in a Student Population: Large-Scale Randomized Controlled Trial"],"prefix":"10.2196","volume":"10","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-1987-7403","authenticated-orcid":false,"given":"Silja","family":"Litvin","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7077-8729","authenticated-orcid":false,"given":"Rob","family":"Saunders","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4477-9012","authenticated-orcid":false,"given":"Philip","family":"Jefferies","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8049-7923","authenticated-orcid":false,"given":"Hayley","family":"Seely","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5851-4253","authenticated-orcid":false,"given":"Patrick","family":"P\u00f6ssel","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9194-276X","authenticated-orcid":false,"given":"Stefan","family":"L\u00fcttke","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1010","published-online":{"date-parts":[[2023,7,21]]},"reference":[{"key":"ref1","doi-asserted-by":"publisher","DOI":"10.1371\/journal.pone.0119895"},{"key":"ref2","doi-asserted-by":"publisher","DOI":"10.1016\/j.brat.2015.01.009"},{"key":"ref3","doi-asserted-by":"publisher","DOI":"10.1111\/jcpp.13400"},{"key":"ref4","doi-asserted-by":"publisher","DOI":"10.1007\/s10567-018-0271-8"},{"key":"ref5","doi-asserted-by":"publisher","DOI":"10.1186\/1472-6963-14-313"},{"key":"ref6","doi-asserted-by":"publisher","DOI":"10.1016\/j.cpr.2016.09.005"},{"key":"ref7","doi-asserted-by":"publisher","DOI":"10.1037\/a0017391"},{"key":"ref8","doi-asserted-by":"publisher","DOI":"10.1007\/s00787-018-1195-z"},{"key":"ref9","doi-asserted-by":"publisher","DOI":"10.1002\/mpr.1782"},{"key":"ref10","doi-asserted-by":"publisher","DOI":"10.1097\/MLR.0b013e31803bb4c1"},{"key":"ref11","doi-asserted-by":"publisher","DOI":"10.1186\/1471-244X-10-113"},{"key":"ref12","unstructured":"Hidden waits force more than three quarters of mental health patients to seek help from emergency servicesRoyal College of Psychiatrists20222023-06-16https:\/\/www.rcpsych.ac.uk\/news-and-features\/latest-news\/detail\/2022\/10\/10\/hidden-waits-force- more-than-three-quarters-of-mental-health-patients-to-seek-help-from-emergency-services"},{"key":"ref13","unstructured":"Improving Access to Psychological Therapies (IAPT) waiting times guidance and FAQ\u2019sNational Health Service England20152023-06-28https:\/\/www.england.nhs.uk\/wp-content\/uploads\/2015\/02\/iapt-wait-times-guid.pdf"},{"key":"ref14","doi-asserted-by":"publisher","DOI":"10.3389\/fdgth.2021.763876"},{"key":"ref15","doi-asserted-by":"publisher","DOI":"10.2196\/18286"},{"key":"ref16","unstructured":"RichEMiahALuptonDLewisSCDigital health generation? Young people\u2019s use of \u2018healthy lifestyle\u2019 technologiesUniversity of Bath2023-03-07https:\/\/www.researchgate.net\/profile\/Andy-Miah\/publication\/343335783_Digital_Health_Genera tion_Young_People's_Use_of_'Healthy_Lifestyle'_Technologies\/links\/5f23e5ac458515b729f5ed49\/Digital-Health-Genera tion-Young-Peoples-Use-of-Healthy-Lifestyle-Technologies.pdf"},{"key":"ref17","unstructured":"The common sense census: media use by tweens and teens, 2021Common Sense Media20192023-03-07https:\/\/www.common sensemedia.org\/research\/the-common-sense-census-media-use-by-tweens-and-teens-2021"},{"key":"ref18","doi-asserted-by":"publisher","DOI":"10.2196\/13364"},{"key":"ref19","doi-asserted-by":"publisher","DOI":"10.1111\/jcpp.13010"},{"key":"ref20","doi-asserted-by":"publisher","DOI":"10.1016\/j.invent.2014.08.003"},{"key":"ref21","doi-asserted-by":"publisher","DOI":"10.1002\/wps.20472"},{"key":"ref22","doi-asserted-by":"publisher","DOI":"10.1002\/wps.20673"},{"key":"ref23","doi-asserted-by":"publisher","DOI":"10.1111\/jcpp.12663"},{"key":"ref24","doi-asserted-by":"publisher","DOI":"10.1016\/j.jad.2017.04.046"},{"key":"ref25","doi-asserted-by":"publisher","DOI":"10.1371\/journal.pdig.0000002"},{"key":"ref26","doi-asserted-by":"publisher","DOI":"10.1038\/nrn3475"},{"key":"ref27","doi-asserted-by":"publisher","DOI":"10.1097\/EDE.0b013e31818131e7"},{"key":"ref28","doi-asserted-by":"publisher","DOI":"10.2196\/jmir.7.1.e11"},{"key":"ref29","doi-asserted-by":"publisher","DOI":"10.1016\/j.jbtep.2014.08.005"},{"key":"ref30","doi-asserted-by":"publisher","DOI":"10.2196\/jmir.3261"},{"key":"ref31","doi-asserted-by":"publisher","DOI":"10.1145\/2181037.2181040"},{"key":"ref32","doi-asserted-by":"publisher","DOI":"10.1016\/j.ijinfomgt.2018.10.013"},{"key":"ref33","first-page":"2","author":"Fogg, BJ","year":"2002","journal-title":"Persuasive Technology: Using Computers to Change What We Think and Do"},{"issue":"2","key":"ref34","volume":"7","author":"Detoni, AM","year":"2022","journal-title":"ANALECTA-Centro Universit\u00e1rio Academia"},{"key":"ref35","doi-asserted-by":"publisher","DOI":"10.1093\/tbm\/ibz041"},{"key":"ref36","first-page":"1","author":"Nicholson, S","year":"2015","journal-title":"Gamification in Education and Business"},{"key":"ref37","unstructured":"Mental healthWorld Health Organization2022-06-17https:\/\/www.who.int\/news-room\/fact-sheets\/detail\/mental-health-strengthe ning-our-response"},{"key":"ref38","doi-asserted-by":"publisher","DOI":"10.1093\/jmp\/jhab032"},{"key":"ref39","doi-asserted-by":"publisher","DOI":"10.1177\/1524838013487805"},{"key":"ref40","doi-asserted-by":"publisher","DOI":"10.1017\/s0954579400006131"},{"key":"ref41","doi-asserted-by":"publisher","DOI":"10.1016\/S2215-0366(19)30434-1"},{"key":"ref42","doi-asserted-by":"publisher","DOI":"10.1186\/1741-7015-12-72"},{"key":"ref43","doi-asserted-by":"publisher","DOI":"10.1007\/s11482-021-09953-3"},{"key":"ref44","doi-asserted-by":"publisher","DOI":"10.1111\/j.1939-0025.2010.01067.x"},{"key":"ref45","doi-asserted-by":"publisher","DOI":"10.15270\/54-1-611"},{"key":"ref46","doi-asserted-by":"publisher","DOI":"10.1001\/archinte.166.10.1092"},{"key":"ref47","doi-asserted-by":"publisher","DOI":"10.1016\/j.jad.2008.06.026"},{"key":"ref48","unstructured":"Random.org: True Random Number ServiceRANDOM.ORG2023-06-28https:\/\/www.random.org\/"},{"key":"ref49","unstructured":"HaahrMIntroduction to randomness and random numbersRandom20232023-06-16https:\/\/www.random.org\/randomness\/"},{"key":"ref50","doi-asserted-by":"publisher","DOI":"10.15761\/nns.1000119"},{"key":"ref51","doi-asserted-by":"publisher","DOI":"10.1371\/journal.pone.0237220"},{"key":"ref52","doi-asserted-by":"publisher","DOI":"10.1145\/3012430.3012578"},{"key":"ref53","doi-asserted-by":"publisher","DOI":"10.1007\/s10608-020-10136-x"},{"key":"ref54","doi-asserted-by":"publisher","DOI":"10.2196\/13717"},{"key":"ref55","doi-asserted-by":"publisher","DOI":"10.1080\/15332691.2019.1567174"},{"key":"ref56","doi-asserted-by":"publisher","DOI":"10.1016\/j.cub.2016.01.023"},{"key":"ref57","doi-asserted-by":"publisher","DOI":"10.1037\/\/0021-843x.99.3.260"},{"key":"ref58","unstructured":"SyafryadinSNurkamtoJLinggarDAMujiyantoJActive, belief, and consequence (ABC) model technique in minimizing students\u2019 speech anxietyProceedings of the 5th International Seminar on English Language and Teaching2017ISELT-5 '17August 17, 2017Sumatra, Indonesia3204"},{"key":"ref59","doi-asserted-by":"publisher","DOI":"10.4037\/ajcc2021962"},{"key":"ref60","doi-asserted-by":"publisher","DOI":"10.1192\/bjp.bp.106.025981"},{"key":"ref61","doi-asserted-by":"publisher","DOI":"10.2196\/jmir.1776"},{"key":"ref62","doi-asserted-by":"publisher","DOI":"10.4103\/2229-3485.83221"},{"key":"ref63","unstructured":"LitvinSGamification as an approach to improve mental well-being and reduce attrition in mobile mental health interventions: a randomized controlled trialOpen Science Framework20202023-06-06https:\/\/dx.plos.org\/10.1371\/journal.pone.0237220"},{"key":"ref64","doi-asserted-by":"publisher","DOI":"10.1001\/archpsyc.65.12.1429"},{"key":"ref65","doi-asserted-by":"publisher","DOI":"10.1016\/j.jad.2020.10.060"},{"issue":"11","key":"ref66","first-page":"858","volume":"82","author":"Kohn, R","year":"2004","journal-title":"Bull World Health Organ"},{"key":"ref67","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(21)02143-7"},{"key":"ref68","doi-asserted-by":"publisher","DOI":"10.1136\/eb-2018-102891"},{"key":"ref69","doi-asserted-by":"publisher","DOI":"10.1186\/s13063-018-3023-7"},{"key":"ref70","doi-asserted-by":"publisher","DOI":"10.2196\/31274"},{"key":"ref71","doi-asserted-by":"publisher","DOI":"10.1016\/j.invent.2020.100327"},{"key":"ref72","doi-asserted-by":"publisher","DOI":"10.1145\/3449190"},{"key":"ref73","doi-asserted-by":"publisher","DOI":"10.1109\/ssci.2018.8628621"},{"key":"ref74","doi-asserted-by":"publisher","DOI":"10.1108\/ijilt-02-2017-0009"},{"key":"ref75","doi-asserted-by":"publisher","DOI":"10.1089\/tmj.2020.0068"},{"key":"ref76","doi-asserted-by":"publisher","DOI":"10.1016\/j.cpr.2010.03.003"},{"key":"ref77","doi-asserted-by":"crossref","first-page":"227","DOI":"10.4324\/9781315648033-14","author":"Sarkar, M","year":"2017","journal-title":"Managing for Resilience: A Practical Guide for Employee Wellbeing and Organizational Performance"},{"key":"ref78","doi-asserted-by":"publisher","DOI":"10.1016\/S2215-0366(14)00080-7"},{"key":"ref79","doi-asserted-by":"publisher","DOI":"10.1037\/0022-006X.71.6.973"},{"key":"ref80","doi-asserted-by":"publisher","DOI":"10.1016\/0191-8869(86)90014-0"},{"key":"ref81","doi-asserted-by":"publisher","DOI":"10.1016\/j.jenvp.2014.09.003"},{"key":"ref82","doi-asserted-by":"publisher","DOI":"10.1037\/pro0000278"},{"key":"ref83","doi-asserted-by":"publisher","DOI":"10.3389\/fpsyt.2022.900615"}],"container-title":["JMIR Mental Health"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/mental.jmir.org\/2023\/1\/e47285","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,6,30]],"date-time":"2026-06-30T17:54:57Z","timestamp":1782842097000},"score":1,"resource":{"primary":{"URL":"https:\/\/mental.jmir.org\/2023\/1\/e47285"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2023,7,21]]},"references-count":83,"URL":"https:\/\/doi.org\/10.2196\/47285","relation":{"has-preprint":[{"id-type":"doi","id":"10.2196\/preprints.47285","asserted-by":"object"}]},"ISSN":["2368-7959"],"issn-type":[{"value":"2368-7959","type":"electronic"}],"subject":[],"published":{"date-parts":[[2023,7,21]]}}}