Swedish study: FIGARO smartphone game lowered depression and anxiety scores in 148 adults on antidepressants

A Swedish study of 148 adults who still had depressive symptoms despite antidepressant therapy tested a smartphone serious game as an add-on, according to lomazoma.com. Over nine weeks, depression and anxiety scores fell more in the treatment group than in the waitlist group, and medication adherence also improved. Quality of life did not change substantially lomazoma.comlomazoma.comlomazoma.comOpen source ↗. The authors cite about 300 million people with depression worldwide.

FIGARO: game, modules and therapist contact

The package is called FIGARO. It combines the game "Fig", optional access to 25 modules of internet-based cognitive behavioural therapy (ICBT) and an interface for contacting a therapist on demand. In the study the game was used twice daily alongside usual treatment. Reward mechanics are meant to support routines: taking medication, sleeping, eating and physical activity. The interface includes dialogue-style learning sequences, mood monitoring and a diary for self-reflection.

Participants were recruited through social media and paid advertising. Their mean age was 40 years and 82% were women. Two thirds reported a prior psychiatric diagnosis, 66% had current major depression and 72% a recurrent pattern. Outcomes were measured with the self-reported Montgomery-Åsberg Depression Rating Scale, the GAD-7 for anxiety, the 8-item Morisky scale for adherence and the 12-item Brunnsviken Brief Quality of Life Scale. The waitlist group received the intervention two weeks after the nine-week phase ended.

Results and limitations

In the treatment group 79% installed the game, and these users completed 81 sessions on average. About 32% contacted the therapist and 28% completed at least one worksheet. Depression and anxiety fell moderately more than in the waitlist group. An improvement of at least 30% in depression was reached by 51% of the treatment group and 19% of the waitlist group, while 16% of the treatment group improved by at least 50% lomazoma.comlomazoma.comlomazoma.comOpen source ↗. The adherence benefit was small to moderate but lost statistical significance under the most conservative handling of dropouts. Actual use of the game and platform did not clearly correlate with the size of improvement. Of those who answered a satisfaction survey, 69% rated the treatment as fairly or very satisfactory.

The authors list several limitations. 41% of the treatment group and 18% of the control group did not complete follow-up, and 21% never installed the game. All participants knew their group, all outcomes were self-reported, and a waitlist comparison leaves room for expectation effects. The results reflect the whole FIGARO package rather than the game alone. The trial was registered after recruitment began; the authors state that the recorded outcomes did not change. The study is published in the Journal of Affective Disorders.