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. 2022 Jan 6:27:100495.
doi: 10.1016/j.invent.2022.100495. eCollection 2022 Mar.

Using AI chatbots to provide self-help depression interventions for university students: A randomized trial of effectiveness

Hao Liu  1 , Huaming Peng  1 , Xingyu Song  2 , Chenzi Xu  3 , Meng Zhang  3
Affiliations

Using AI chatbots to provide self-help depression interventions for university students: A randomized trial of effectiveness

Hao Liu et al. Internet Interv. .

Abstract

Background: Depression impacts the lives of a large number of university students. Mobile-based therapy chatbots are increasingly being used to help young adults who suffer from depression. However, previous trials have short follow-up periods. Evidence of effectiveness in pragmatic conditions are still in lack.

Objective: This study aimed to compare chatbot therapy to bibliotherapy, which is a widely accepted and proven-useful self-help psychological intervention. The main objective of this study is to add to the evidence of effectiveness for chatbot therapy as a convenient, affordable, interactive self-help intervention for depression.

Methods: An unblinded randomized controlled trial with 83 university students was conducted. The participants were randomly assigned to either a chatbot test group (n = 41) to receive a newly developed chatbot-delivered intervention, or a bibliotherapy control group (n = 42) to receive a minimal level of bibliotherapy. A set of questionnaires was implemented as measurements of clinical variables at baseline and every 4 weeks for a period of 16 weeks, which included the Patient Health Questionnaire-9 (PHQ-9), the Generalized Anxiety Disorder scale (GAD-7), the Positive and Negative Affect Scale (PANAS). The Client Satisfaction Questionnaire-8 (CSQ-8) and the Working Alliance Inventory-Short Revised (WAI-SR) were used to measure satisfaction and therapeutic alliance after the intervention. Participants' self-reported adherence and feedback on the therapy chatbot were also collected.

Results: Participants were all university students (undergraduate students (n = 31), postgraduate students (n = 52)). They were between 19 and 28 years old (mean = 23.08, standard deviation (SD) = 1.76) and 55.42% (46/83) female. 24.07% (20/83) participants were lost to follow-up. No significant group difference was found at baseline. In the intention-to-treat analysis, individuals in the chatbot test group showed a significant reduction in the PHQ-9 scores (F = 22.89; P < 0.01) and the GAD-7 scores (F = 5.37; P = 0.02). Follow-up analysis of completers suggested that the reduction of anxiety was significant only in the first 4 weeks. The WAI-SR scores in the chatbot group were higher compared to the bibliotherapy group (t = 7.29; P < 0.01). User feedback showed that process factors were more influential than the content factors.

Conclusions: The chatbot-delivered self-help depression intervention was proven to be superior to the minimal level of bibliotherapy in terms of reduction on depression, anxiety, and therapeutic alliance achieved with participants.

Keywords: AI Artificial Intelligence; AI, Artificial Intelligence; ANCONA, Analysis of Covariance; ANOVA, Analysis of Variance; CBT, Cognitive Behavioral Therapy; CSQ-8, the Client Satisfaction Questionnaires-8; DPO, Dialogue Policy Optimization; DST, Dialogue Status Tracking; GAD-7, the Generalized Anxiety Disorder Scale-7 (GAD-7); IPI, Internet-based Psychological Interventions; ITT, Intent-to-Treat; PANAS, the Positive and Negative Affect Schedule (PANAS) (Watson et al., 19s88); PHQ-9, the Patient Health Questionnaires-9; Public health informatics; SD, Standard Deviation; WAI-SR, the Working Alliance Inventory-Short Revised; mHealth.

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Conflict of interest statement

The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper.

Figures

Fig. 1
Fig. 1
(A) The workflow of the chatbot XiaoNan. (B) The structure of the chatbot XiaoNan.
Fig. 2
Fig. 2
Examples of using the chatbot. (A) Both text and voice messages are supported. There will be instructions when using the chatbot for the first time. Users can select the options in the choice list by clicking the text or replying with relevant number or contents. (B) An example of CBT treatment. The chatbot will try to recognize, evaluate, and deal with negative emotions from the input text. (C) “Exploring depression” provides a question answering system on the topic of depression disorder.
Fig. 3
Fig. 3
The flow of participants.
Fig. 4
Fig. 4
Clinical variables during the period. aNumbers are mean (SD).
Fig. 5
Fig. 5
Self-reported adherence rate. aNumbers are mean (SD).
See this image and copyright information in PMC

References

    1. Abd-alrazaq A.A., Alajlani M., Alalwan A.A., Bewick B.M., Gardner P., Househ M. An overview of the features of chatbots in mental health: a scoping review. Int. J. Med. Inform. 2019;132 doi: 10.1016/j.ijmedinf.2019.103978. - DOI - PubMed
    1. Abd-Alrazaq A.A., Rababeh A., Alajlani M., Bewick B.M., Househ M. Effectiveness and safety of using chatbots to improve mental health: systematic review and meta-analysis. J. Med. Internet Res. 2020;22:1–17. doi: 10.2196/16021. - DOI - PMC - PubMed
    1. Andersson G. Internet-delivered psychological treatments. Annu. Rev. Clin. Psychol. 2016 doi: 10.1146/annurev-clinpsy-021815-093006. - DOI - PubMed
    1. Andrade L.H., Alonso J., Mneimneh Z., Wells J.E., Al-Hamzawi A., Borges G., Bromet E., Bruffaerts R., De Girolamo G., De Graaf R., Xavier M., Kessler R.C. Barriers to mental health treatment: results from the WHO world mental health surveys. Psychol. Med. 2014;44:1303–1317. doi: 10.1017/S0033291713001943. - DOI - PMC - PubMed
    1. Andrews B., Wilding J.M. The relation of depression and anxiety to life-stress and achievement in students. Br. J. Psychol. 2004;95:509–521. doi: 10.1348/0007126042369802. - DOI - PubMed