From immersion to burnout: anxiety mechanisms and pathways to motivational exhaustion in gamified health education

Gamified health education is increasingly used to sustain learners' 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 (<i>β</i> = -0.45, <i>p</i> < 0.001) but indirectly related to higher burnout through motivational depletion (indirect <i>β</i> = -0.14, <i>p</i> < 0.001). Anxiety mediated the pathway between immersion and depletion (<i>β</i> = 0.52, <i>p</i> < 0.001) and also directly predicted burnout (<i>β</i> = 0.25, <i>p</i> = 0.001). 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-resilient, stable, and high-risk-and moderation analysis showed that digital literacy buffered the association between depletion and burnout (<i>β</i> = -0.12, <i>p</i> = 0.006). 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.