{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,21]],"date-time":"2026-08-21T12:46:47Z","timestamp":1787316407571,"version":"build-2736575974"},"reference-count":43,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2026,2,4]],"date-time":"2026-02-04T00:00:00Z","timestamp":1770163200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Public Health"],"abstract":"<jats:p>\n                    Gamified health education is increasingly used to sustain learners\u2019 motivation, yet its underlying psychological mechanisms remain insufficiently understood. Drawing on self-determination theory, flow theory, and resource-depletion perspectives, the present study employed a cross-sectional survey to examine how immersion, anxiety, and motivational depletion jointly shape learning burnout in gamified health education contexts. Data were collected from 350 university students who reported regular engagement with gamified health learning activities. Structural equation modeling revealed that immersion was negatively associated with anxiety (\n                    <jats:italic>\u03b2<\/jats:italic>\n                    \u202f=\u202f\u22120.45,\n                    <jats:italic>p<\/jats:italic>\n                    \u202f&amp;lt;\u202f0.001) but indirectly related to higher burnout through motivational depletion (indirect\n                    <jats:italic>\u03b2<\/jats:italic>\n                    \u202f=\u202f\u22120.14,\n                    <jats:italic>p<\/jats:italic>\n                    \u202f&amp;lt;\u202f0.001). Anxiety mediated the pathway between immersion and depletion (\n                    <jats:italic>\u03b2<\/jats:italic>\n                    \u202f=\u202f0.52,\n                    <jats:italic>p<\/jats:italic>\n                    \u202f&amp;lt;\u202f0.001) and also directly predicted burnout (\n                    <jats:italic>\u03b2<\/jats:italic>\n                    \u202f=\u202f0.25,\n                    <jats:italic>p<\/jats:italic>\n                    \u202f=\u202f0.001). Polynomial regression further identified an inverted-U relationship between immersion and anxiety, indicating that moderate engagement stabilizes emotional experience, whereas excessive immersion generates psychological tension. Latent profile analysis distinguished three learner groups\u2014resilient, stable, and high-risk\u2014and moderation analysis showed that digital literacy buffered the association between depletion and burnout (\n                    <jats:italic>\u03b2<\/jats:italic>\n                    \u202f=\u202f\u22120.12,\n                    <jats:italic>p<\/jats:italic>\n                    \u202f=\u202f0.006). Taken together, these findings suggest that engagement and exhaustion unfold within the same motivational system. Building on this pattern, the study advances the concept of psychological sustainability, emphasizing that effective gamified learning depends not only on motivational activation but also on opportunities for recovery. Accordingly, gamified health education should incorporate adaptive challenge, reflective pauses, and emotional regulation supports to sustain engagement without depleting psychological resources.\n                  <\/jats:p>","DOI":"10.3389\/fpubh.2026.1732924","type":"journal-article","created":{"date-parts":[[2026,2,4]],"date-time":"2026-02-04T06:47:36Z","timestamp":1770187656000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":1,"title":["From immersion to burnout: anxiety mechanisms and pathways to motivational exhaustion in gamified health education"],"prefix":"10.3389","volume":"14","author":[{"given":"Yangyang","family":"Lin","sequence":"first","affiliation":[{"name":"School of Smart Health Care, Zhejiang Dongfang Polytechnic","place":["Wenzhou, Zhejiang, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Chuyan","family":"Mo","sequence":"additional","affiliation":[{"name":"Faculty of Business, The University of Hong Kong","place":["Hong Kong, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Baojian","family":"Wei","sequence":"additional","affiliation":[{"name":"School of Nursing, Shandong First Medical University & Shandong Academy of Medical Sciences","place":["Tai'an, Shandong, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1965","published-online":{"date-parts":[[2026,2,4]]},"reference":[{"key":"ref1","doi-asserted-by":"publisher","first-page":"89","DOI":"10.1016\/j.invent.2016.10.002","article-title":"Gamification for health and wellbeing: a systematic review of the literature","volume":"6","author":"Johnson","year":"2016","journal-title":"Internet Interv"},{"key":"ref2","doi-asserted-by":"publisher","first-page":"69","DOI":"10.1186\/s12889-023-17517-3","article-title":"Effectiveness of gamified digital interventions in mental health prevention and health promotion among adults: a scoping review","volume":"24","author":"Aschentrup","year":"2024","journal-title":"BMC Public Health"},{"key":"ref3","doi-asserted-by":"publisher","first-page":"683","DOI":"10.1007\/s10459-020-10000-3","article-title":"Gamification of health professions education: a systematic review","volume":"26","author":"van Gaalen","year":"2021","journal-title":"Adv Health Sci Educ"},{"key":"ref4","doi-asserted-by":"publisher","first-page":"e68151","DOI":"10.2196\/68151","article-title":"Effectiveness of gamification interventions to improve physical activity and sedentary behavior in children and adolescents: systematic review and meta-analysis","volume":"13","author":"Wang","year":"2025","journal-title":"JMIR Serious Games"},{"key":"ref5","doi-asserted-by":"publisher","first-page":"e78686","DOI":"10.2196\/78686","article-title":"Effectiveness of mHealth-based gamified interventions on physical activity in older adults: systematic review","volume":"8","author":"Chen","year":"2025","journal-title":"JMIR Aging"},{"key":"ref6","doi-asserted-by":"crossref","DOI":"10.1007\/978-1-4899-2271-7","volume-title":"Intrinsic motivation and self-determination in human behavior","author":"Deci","year":"1985"},{"key":"ref7","volume-title":"Flow: The psychology of optimal experience","author":"Csikszentmihalyi","year":"1990"},{"key":"ref8","doi-asserted-by":"publisher","first-page":"603","DOI":"10.1162\/pres.1997.6.6.603","article-title":"A framework for immersive virtual environments (FIVE): speculations on the role of presence in virtual environments","volume":"6","author":"Slater","year":"1997","journal-title":"Presence Teleoperators Virtual Environ"},{"key":"ref9","doi-asserted-by":"crossref","first-page":"257","DOI":"10.1207\/s15516709cog1202_4","article-title":"Cognitive load during problem solving: effects on learning","volume":"12","author":"Sweller","year":"1988","journal-title":"Cogn Sci"},{"key":"ref10","doi-asserted-by":"publisher","first-page":"938","DOI":"10.1002\/asi.20801","article-title":"What is user engagement? 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