Mental health chatbots can effectively engage people with depression, study shows

Clinical scientists at Nanyang Technological University, Singapore (NTU Singapore) have found that mental health chatbots are able to effectively engage people with depression in empathetic conversations and help treat their symptoms.

Chatbots or conversational agents are computer programs that simulate human conversations. They are increasingly used in healthcare, for example to help manage mental health conditions such as depression and anxiety and for general well-being.

A 2021 survey by Woebot Health, one of the leading therapeutic chatbot companies in the US, found that 22 percent of adults have used a mental health chatbot, with nearly half (47 percent) saying they would be interested in using one. if necessary .

This study by doctors from NTU’s Lee Kong Chian School of Medicine (LKCMedicine) is among the first to analyze user-Chatbot dialogue to assess their effectiveness.

Researchers analyzed nine mental health chatbots from leading app stores, five of which had at least 500,000 downloads, to see if they offered self-help for people with depression.

Nine mental health chatbots were included in the study, four of which, Marvin, Serenity, Woebot, 7 cupsare free to use while Happify, InnerHour, Wooper, Wysa and Tomorequired a subscription or one-time purchase to use.

The chatbots were evaluated by the NTU research team using custom users created to reflect different cultures, ages and genders. Individuals also exhibited behaviors that reflected varying degrees of depressive symptoms.

This study, published in December in the peer-reviewed Journal of Affective Disorders found that all chatbots engaged in empathic and nonjudgmental conversations with users and offered support and guidance through psychotherapeutic exercises commonly used by psychologists and counselors.

By examining the app’s interfaces and their privacy policy legal statements, the researchers observed that all chatbots keep the user’s personal information private and do not transfer or store any of it. This information includes chat history, names or addresses that they may reveal during chat sessions.

Depression affects 264 million people worldwide and is undiagnosed and untreated in half of all cases, according to the World Health Organization. In Singapore, the COVID-19 pandemic has led to an increase in mental health concerns, which include depression.

There is still a lot of stigma surrounding mental disorders and the COVID-19 pandemic has greatly increased the number of people affected by mental health issues. Globally, health systems are struggling to cope with increased demand for mental health services. Digital health tools, including chatbots, could help provide timely care to individuals who may be unwilling or unable to consult a health care provider. Through this study, we have shown how chatbots are used and how they engage in therapeutic conversations.”

Professor Josip Carr, director of the Center for Population Health Sciences at NTU’s LKCMedicine and leader of the study

Chat in chatbots to test their effectiveness

Although international research shows that chatbots can help people, previous studies have not evaluated the dialogue between chatbots and users.

The NTU team’s content analysis assessed the quality and effectiveness of the chatbots’ responses and looked at the level of personalization, relevance to support self-management for users with depression, and how they convey empathy to users.

The study also looked at how chatbots guide users to engage in or complete mood-enhancing activities, monitor moods and manage suicide risks.

The researchers said all the chatbots displayed a coach-like personality that was encouraging, nurturing and motivating. However, their analysis showed that while chatbots can engage in empathetic conversations with users, they are unable to provide personalized advice. This deep analysis of the conversation flow can be useful to help app developers design future chatbots.

First author Dr Laura Martinengo, research fellow at LKCMedicine said: “Chatbots are not yet able to provide personalized advice and do not ask enough personal questions – possibly to avoid breaching the user’s anonymity. However, these chatbots can still be a useful alternative for people in need, especially those who do not have access to medical care. Some people find it easier to talk to a machine than a human being.”

Although chatbots may support self-management of depression and other mental disorders, the researchers said more research is needed to improve chatbots for individuals at risk of suicide and to evaluate the long-term effectiveness of chatbot-led mental health interventions.

The researchers will conduct further studies to improve the scope, quality and safety of their research, looking at the effectiveness of other digital methods for mental wellbeing.


Nanyang Technological University, Singapore

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