Sören Freerik Brähmer

Anxiety disorders are highly prevalent, driving the development of digital mental health technologies and raising important socio-anthropological questions. This study examines the representations and practices surrounding these tools among individuals experiencing anxiety, carers, and healthcare professionals across six European countries. Drawing on qualitative analysis of 100 focus group participants, this study explores lived experiences and perspectives on integrating digital technologies into mental health care. Participants valued the potential of digital tools to foster social connexion, reduce isolation, and empower users, viewing them as complementary to, rather than a substitute for, human interaction due to their limitations in addressing complex needs. Concerns about data security, intrusiveness, and the risk of dehumanising care were also prominent. Cross-country differences highlighted how healthcare policies, socioeconomic conditions, and cultural norms shape attitudes and usage patterns. Individuals experiencing anxiety expressed optimism, while professionals adopted a more cautious stance, emphasising personalisation and ethical oversight. These findings highlight the importance of designing digital mental health tools that are inclusive, equitable, and sensitive to users’ material conditions and needs. This study contributes to sociological debates on health digitalisation, by demonstrating how such technologies can both mitigate and reinforce existing inequalities.

Background: In the face of an increasing treatment need among people with dementia, effective and efficient interventions with a focus on quality of life need to be established. In this context, serious games have received increasing attention. However, there is a lack of apps specifically designed for people with dementia. Objective: In this prospective pilot study, we examined the usability of a newly developed serious game app (“Digimenz”). Methods: A total of 43 people with cognitive impairment and mild to severe dementia completed the repeated-measures study procedure. Participants were recruited from an inpatient geriatric psychiatric ward and a long-term care facility. Participants were asked to complete 4 conditions in randomized order, including playing 3 different serious games (experimental conditions) and reading a newspaper (control condition). Each condition was completed once, and the total duration was 60 to 90 minutes per participant. Data on app usability were collected through self-ratings and observation after each condition. We tested for differences in usability among the conditions and the recruitment sites, and analyzed the relation of usability to cognitive capacity. Results: The serious games were accepted in both settings (long-term care: 30/30, 100% interested; psychiatric ward: 31/41, 76% interested), although study completion was lower in the psychiatric subsample (15/41, 37%) than in the long-term care subsample (28/30, 93%). Global usability was rated good (System Usability Scale global mean score: 79). More severely impaired patients had more pronounced difficulties in learning how to play the games (ρ _{MMSE, Learnability} =−0.61, 95% CI −0.78 to −0.36; P <.001) and playing them alone (ρ _{MMSE, Support} =−0.49, 95% CI −0.69 to −0.19; P <.001). Nevertheless, playing the games was associated with a more positive mood (likelihood ratio χ ² ₃ = 25.09; P <.001), independent of the level of cognitive functioning (likelihood ratio χ ² ₁ = 0.64; P =.42). All games were played with a moderate error rate (0.19‐0.49). Conclusions: Our results indicated a positive association between serious game usage and well-being in patients with dementia, given adequate support. This is a valuable addition to the understanding of serious game usage in dementia care. Although challenging, user-centered development of serious games with people who are severely impaired by dementia is an important research target. Limitations like low data quality and a simplified design are inherent in this study population. Nevertheless, we demonstrated how usability testing in this target group is possible through careful definition and operationalization. The inclusion of different data sources, different recruitment sites, and different levels of cognitive impairment increased the generalizability of the findings. To accommodate severely impaired patients, future developments should incorporate a broader range of difficulties and adaptations to group settings.

BACKGROUND In face of an increasing treatment need of persons with dementia, effective and efficient interventions with a focus on quality of life need to be established. In this context, Serious Games have received increasing attention. However, there is a lack of applications specifically designed for people with dementia. OBJECTIVE In the current prospective pilot study, we examined the usability of a newly developed Serious Game app (“Digimenz”). METHODS 43 persons with cognitive impairment and mild to severe dementia completed the repeated-measures study procedure. Participants were recruited on an inpatient geriatric psychiatric ward and in a long-term-care facility. Each participant played three Serious Games (experimental conditions) and spent time reading a newspaper (control condition). Data on app-usability was collected through self-ratings and observation. We analyzed differences in usability regarding the conditions, the cognitive capacity and the recruitment sites. RESULTS The Serious Games were accepted in both settings (long-term-care: 100% interested, psychiatric ward: 76% interested), although study completion was lower in the psychiatric sample (37%) than in the long-term-care sample (93%). The global usability was rated good (System Usability Scale global mean: 79). More severely impaired patients had more pronounced difficulties in learning how to play the games (ρMMSE, Learnability=-0.61, P<.001) and playing them alone (ρMMSE, Support=-0.49, P<.001). Nevertheless, playing the games was associated with a more positive mood (LR ChiSq=25.08, DF=3, P<.001), independent of the level of cognitive functioning (LR ChiSq=0.65, DF=1, P=.42). All games could be played with a moderate error rate (0.19-0.49). CONCLUSIONS Our results indicate that the Serious Games have a positive impact on the well-being of dementia patients, given adequate support. Although challenging, participative development of Serious Games with people being severely impaired by dementia is an important research target. Limitations like low data quality and a simplified design are inherent in this study population. Still, we demonstrate how usability testing in this target group is possible through careful definition and operationalization. To accommodate severely impaired patients, future developments should incorporate a broader range of difficulty and adaptations to group settings. CLINICALTRIAL German Clinical Trials Register, DRKS00031363.