Are artificial intelligence chatbots safe for suicide risk assessment? A narratively synthesized review of current...

Suicide is a significant global public health concern, and conventional clinical risk assessment is constrained by workforce availability, scalability, and clinician variability. The classic suicidality risk evaluation is largely dependent on clinical judgment, which, although helpful, can demonstrate a ceiling effect in its predictive validity. AI-driven chatbots, conversational systems that engage users in real-time natural language dialog, have emerged as candidate tools for augmenting suicide risk detection and prevention. This narrative review aimed to: evaluate the performance of AI-driven chatbots in detecting and assessing suicidal ideation relative to clinical benchmarks; examine the effectiveness of chatbot-based interventions for suicide prevention; and identify ethical, cultural, and implementation challenges limiting clinical translation. Six electronic databases were searched, with the initial search conducted in 2024 and updated in 2026 through targeted monitoring, with no upper cutoff date applied. A thematic narrative synthesis approach was applied across five domains. Eleven primary studies met eligibility criteria and were included in the synthesis. Chatbot-based risk assessment showed adequate response alignment with expert judgment at the extremes of suicide risk, but consistently failed to distinguish intermediate risk levels across multiple model families. Across 29 tested commercial chatbot agents, none met the criteria for an adequate suicidal crisis response. A clinically designed, framework-anchored chatbot achieved high efficacy across six outcome domains. Three percent of social chatbot users reported halted suicidal ideation, and a purpose-built clinical chatbot in emergency department settings significantly improved evidence-based care delivery. Systematic risk severity underestimation and the absence of cross-cultural evaluation were identified across all studies. AI-driven chatbots show potential as adjunctive tools across the suicide care continuum. Clinically designed, evidence-anchored chatbots demonstrate feasibility and meaningful benefit; commercially deployed chatbots without clinical validation demonstrate near-universal crisis response inadequacy. Mandatory clinical validation prior to public release, clinician oversight, and crisis system integration are prerequisites for responsible deployment.