Department of Psychiatry and Psychology, Institute of Neuroscience, Hospital Clínic de Barcelona, Barcelona, Spain.
Bipolar and Depressive Disorders Unit, Digital Innovation Group, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain.
J Med Internet Res. 2023 Apr 3;25:e43293. doi: 10.2196/43293.
Many people attending primary care (PC) have anxiety-depressive symptoms and work-related burnout compounded by a lack of resources to meet their needs. The COVID-19 pandemic has exacerbated this problem, and digital tools have been proposed as a solution.
We aimed to present the development, feasibility, and potential effectiveness of Vickybot, a chatbot aimed at screening, monitoring, and reducing anxiety-depressive symptoms and work-related burnout, and detecting suicide risk in patients from PC and health care workers.
Healthy controls (HCs) tested Vickybot for reliability. For the simulation study, HCs used Vickybot for 2 weeks to simulate different clinical situations. For feasibility and effectiveness study, people consulting PC or health care workers with mental health problems used Vickybot for 1 month. Self-assessments for anxiety (Generalized Anxiety Disorder 7-item) and depression (Patient Health Questionnaire-9) symptoms and work-related burnout (based on the Maslach Burnout Inventory) were administered at baseline and every 2 weeks. Feasibility was determined from both subjective and objective user-engagement indicators (UEIs). Potential effectiveness was measured using paired 2-tailed t tests or Wilcoxon signed-rank test for changes in self-assessment scores.
Overall, 40 HCs tested Vickybot simultaneously, and the data were reliably transmitted and registered. For simulation, 17 HCs (n=13, 76% female; mean age 36.5, SD 9.7 years) received 98.8% of the expected modules. Suicidal alerts were received correctly. For the feasibility and potential effectiveness study, 34 patients (15 from PC and 19 health care workers; 76% [26/34] female; mean age 35.3, SD 10.1 years) completed the first self-assessments, with 100% (34/34) presenting anxiety symptoms, 94% (32/34) depressive symptoms, and 65% (22/34) work-related burnout. In addition, 27% (9/34) of patients completed the second self-assessment after 2 weeks of use. No significant differences were found between the first and second self-assessments for anxiety (t=1.000; P=.34) or depressive (t=0.40; P=.70) symptoms. However, work-related burnout scores were moderately reduced (z=-2.07, P=.04, r=0.32). There was a nonsignificant trend toward a greater reduction in anxiety-depressive symptoms and work-related burnout with greater use of the chatbot. Furthermore, 9% (3/34) of patients activated the suicide alert, and the research team promptly intervened with successful outcomes. Vickybot showed high subjective UEI (acceptability, usability, and satisfaction), but low objective UEI (completion, adherence, compliance, and engagement). Vickybot was moderately feasible.
The chatbot was useful in screening for the presence and severity of anxiety and depressive symptoms, and for detecting suicidal risk. Potential effectiveness was shown to reduce work-related burnout but not anxiety or depressive symptoms. Subjective perceptions of use contrasted with low objective-use metrics. Our results are promising but suggest the need to adapt and enhance the smartphone-based solution to improve engagement. A consensus on how to report UEIs and validate digital solutions, particularly for chatbots, is required.
许多接受初级保健（PC）的人都有焦虑抑郁症状和与工作相关的倦怠，加上缺乏满足需求的资源。COVID-19 大流行使这个问题更加严重，数字工具已被提议作为解决方案。
我们旨在展示 Vickybot 的开发、可行性和潜在有效性，Vickybot 是一种旨在筛查、监测和减少焦虑抑郁症状和与工作相关的倦怠，并检测 PC 患者和卫生保健工作者自杀风险的聊天机器人。
健康对照组（HCs）测试了 Vickybot 的可靠性。对于模拟研究，HCs 使用 Vickybot 进行了 2 周的模拟不同临床情况。对于可行性和有效性研究，有心理健康问题的咨询 PC 或卫生保健工作者的人使用 Vickybot 进行了 1 个月。在基线和每 2 周进行一次自我评估，评估焦虑（广义焦虑障碍 7 项）和抑郁（患者健康问卷-9）症状和与工作相关的倦怠（基于 Maslach 倦怠量表）。从主观和客观用户参与指标（UEIs）两个方面确定可行性。使用配对的双尾 t 检验或 Wilcoxon 符号秩检验测量潜在的有效性，以评估自我评估分数的变化。
总体而言，40 名 HCs 同时测试了 Vickybot，数据可靠地传输和注册。对于模拟，17 名 HCs（n=13，76%女性；平均年龄 36.5，SD 9.7 岁）收到了 98.8%的预期模块。自杀警报被正确接收。对于可行性和潜在有效性研究，34 名患者（15 名来自 PC，19 名卫生保健工作者；76%[26/34]女性；平均年龄 35.3，SD 10.1 岁）完成了第一次自我评估，100%（34/34）存在焦虑症状，94%（32/34）存在抑郁症状，65%（22/34）存在与工作相关的倦怠。此外，27%（9/34）的患者在使用 2 周后完成了第二次自我评估。在焦虑（t=1.000；P=.34）或抑郁（t=0.40；P=.70）症状方面，第一次和第二次自我评估之间没有显著差异。然而，与工作相关的倦怠评分中度降低（z=-2.07，P=.04，r=0.32）。随着聊天机器人的更多使用，焦虑抑郁症状和与工作相关的倦怠有更大的降低趋势，但没有统计学意义。此外，9%（3/34）的患者激活了自杀警报，研究小组迅速介入并取得了成功。Vickybot 显示出较高的主观 UEI（可接受性、可用性和满意度），但较低的客观 UEI（完成率、依从性、遵从性和参与度）。Vickybot 具有中等可行性。
该聊天机器人在筛查焦虑和抑郁症状的存在和严重程度以及检测自杀风险方面非常有用。潜在的有效性表明可以减少与工作相关的倦怠，但不能减轻焦虑或抑郁症状。使用的主观感知与低客观使用指标形成对比。我们的结果很有希望，但表明需要调整和增强基于智能手机的解决方案，以提高参与度。需要就如何报告 UEIs 和验证数字解决方案（特别是聊天机器人）达成共识。
