Evaluation of chatbot-delivered interventions for self-management of depression: Content analysis

Conversational agents (CAs) or chatbots are increasingly used for depression, anxiety, and wellbeing management. CAs are considered acceptable and helpful. However, little is known about the adequacy of CA responses. This study assessed the structure, content, and user-customization of mental health CA dialogues with users with depression or at risk of suicide.

We used content analysis to examine the dialogues of CAs previously included in three assessments of mental health apps (depression education, self-guided cognitive behavioural therapy, and suicide prevention) performed between 2019 and 2020. Two standardized user personas with depression were developed to interact with the CA. All conversations were saved as screenshots, transcribed verbatim, and coded inductively.

Nine CAs were included. Seven CAs (78%) had Android and iOS versions; five CAs (56%) had at least 500,000 downloads. The analysis generated eight categories: self-introduction, personalization, appropriateness of CA responses, conveying empathy, guiding users through mood-boosting activities, mood monitoring, suicide risk management, and others. CAs could engage in empathic, non-judgemental conversations with users, offer support, and guide psychotherapeutic exercises.

CA evaluations were performed using standardized personas, not real-world users. CAs were included for evaluation only if retrieved in the search strategies associated with the previous assessment studies.

Assessed CAs offered anonymous, empathic, non-judgemental interactions that align with evidence for face-to-face psychotherapy. CAs from app stores are not suited to provide comprehensive suicide risk management. Further research should evaluate the effectiveness of CA-led interventions in mental health care and in enhancing suicide risk management strategies.