322 Chapter 7 and predominantly female. The current sample is therefore not representative of the Dutch young adult population that experiences mental health problems, which may have biased the results. In particular, university students may not have the same preferences and motivations regarding video games for mental health as the overall population might have. Secondly, the present study included participants with elevated mental health symptoms, but the current sample seemed to have restricted variability in motivation to change. When filling out the motivation to change questionnaire, participants were instructed that when the statements referred to “their problem”, they should answer in terms of the behaviours, feelings or situations they had identified in the previous questionnaire (i.e., the DASS-21 measuring depression, anxiety, and stress symptoms). It might be that participants did not experience “problems” that needed to be changed. As found in the current study, as well as in other studies (e.g., Dozois et al., 2004), more (severe) mental health symptoms are associated with more motivation to change. In addition, research has shown that more (severe) mental health symptoms are associated with more professional help-seeking (e.g., Merikangas et al., 2011; Oliver et al., 2005; Sawyer et al., 2012). Future research should examine how motivational factors influence engagement with a mental health game among a more representative sample experiencing more severe mental health symptoms. Future research should investigate the influence of motivational factors on prolonged engagement and ongoing use of mental health video games, for example through a daily diary study and/or ecological momentary assessments. On the other hand, it might also be interesting to examine how ongoing use and in-game experiences influence motivational factors. It might be that positive in-game experiences (e.g., increased positive mood) motivate participants to pursue activities that may improve their mental health symptoms (e.g., seeking help). Furthermore, as the current study only examined one specific game, future research should investigate whether other game-related motivational factors such as genre and visual aspects of the game, play a role in the willingness to select and play a mental health game. Insights into the influence of these game-related factors on game choice and engagement may guide game design and game promotion, potentially reaching a larger group of individuals with mental health symptoms. Finally, the current study found that participants became more neutral about the debilitating nature of stress. Future research should examine how changes in stress mindset are related to mental health outcomes over time, as well as whether changes in mindset persist over time.
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