Tong Alan C Y, Wong Kent T Y, Chung Wing W T, Mak Winnie W S
Department of Psychology, The Chinese University of Hong Kong, Hong Kong, China (Hong Kong).
J Med Internet Res. 2025 Apr 30;27:e70436. doi: 10.2196/70436.
The global surge in mental health challenges has placed unprecedented strain on health care systems, highlighting the need for scalable interventions to promote mental health self-care. Chatbots have emerged as promising tools by providing accessible, evidence-based support. While chatbots have shown promise in delivering mental health interventions, most studies have only focused on clinical populations and symptom reduction, leaving a critical gap in understanding their preventive potential for self-care and mental health literacy in the general population.
This study evaluated the effectiveness of a rule-based, topic-specific chatbot intervention in improving self-care efficacy, mental health literacy, self-care intention, self-care behaviors, and mental well-being immediately after 10 days and 1 month of its use.
A 2-arm, assessor-blinded randomized controlled trial was conducted. A total of 285 participants were randomly assigned to the chatbot intervention group (n=140) and a waitlist control group (n=145). The chatbot intervention consisted of 10 topic-specific sessions targeting stress management, emotion regulation, and value clarification, delivered over 10 days with a 7-day free-access period. Primary outcomes included self-care self-efficacy, behavioral intentions, self-care behaviors, and mental health literacy. Secondary outcomes included depressive symptoms, anxiety symptoms, and mental well-being. Assessments were self-administered on the web at baseline, 10 days after the intervention, and at a 1-month follow-up. All outcomes were analyzed using linear mixed models with an intention-to-treat approach, and effect sizes were calculated using Cohen d.
Participants in the chatbot group demonstrated significantly greater improvements in behavioral intentions (F=15.02; P<.001) and mental health literacy (F=4.27; P=.02) compared to the control group. The chatbots were also able to bring significant improvement in self-care behaviors (Cohen d=0.36, 95% CI 0.08-0.30; P<.001), mindfulness (Cohen d=0.37, 95% CI 0.14-0.38; P<.001), depressive symptoms (Cohen d=-0.26, 95% CI -1.77 to -0.26; P=.004), overall well-being (Cohen d=0.22, 95% CI 0.02-0.42; P=.02), and positive emotions (Cohen d=0.28, 95% CI 0.08-0.54; P=.004) after 10 days. However, these improvements did not differ significantly at 1 month when compared to the waitlist control group. Adherence was higher among participants who received push notifications (t=-4.91; P<.001).
This study highlights the potential of rule-based chatbots in promoting mental health literacy and fostering short-term self-care intentions. However, the lack of sustained effects points to the necessary improvements required in chatbot design, including greater personalization and interactive features to enhance self-efficacy and long-term mental health outcomes. Future research should explore hybrid approaches that combine rule-based and generative artificial intelligence systems to optimize intervention effectiveness.
ClinicalTrials.gov NCT05694507; https://clinicaltrials.gov/ct2/show/NCT05694507.
全球心理健康挑战的激增给医疗保健系统带来了前所未有的压力，凸显了需要可扩展的干预措施来促进心理健康自我护理。聊天机器人已成为有前景的工具，通过提供可获取的、基于证据的支持。虽然聊天机器人在提供心理健康干预方面已显示出前景，但大多数研究仅关注临床人群和症状减轻，在理解其对普通人群自我护理和心理健康素养的预防潜力方面存在关键差距。
本研究评估了基于规则的、特定主题的聊天机器人干预在使用10天和1个月后立即改善自我护理效能、心理健康素养、自我护理意图、自我护理行为和心理健康状况的有效性。
进行了一项双臂、评估者盲法的随机对照试验。总共285名参与者被随机分配到聊天机器人干预组（n = 140）和等待列表对照组（n = 145）。聊天机器人干预包括针对压力管理、情绪调节和价值观澄清的10个特定主题的会话，在10天内提供，有7天的免费访问期。主要结果包括自我护理自我效能、行为意图、自我护理行为和心理健康素养。次要结果包括抑郁症状、焦虑症状和心理健康状况。评估在基线、干预后10天和1个月随访时通过网络自行进行。所有结果均使用意向性分析方法的线性混合模型进行分析，并使用科恩d计算效应量。
与对照组相比，聊天机器人组的参与者在行为意图（F = 15.02；P <.001）和心理健康素养（F = 4.27；P =.02）方面有显著更大的改善。聊天机器人还能够在10天后使自我护理行为（科恩d = 0.36，95%置信区间0.08 - 0.30；P <.001）、正念（科恩d = 0.37，95%置信区间0.14 - 0.38；P <.001）、抑郁症状（科恩d = -0.26，95%置信区间 -1.77至 -0.26；P =.004）、总体幸福感（科恩d = 0.22，95%置信区间0.02 - 0.42；P =.02）和积极情绪（科恩d = 0.28，95%置信区间0.08 - 0.54；P =.004）有显著改善。然而，与等待列表对照组相比，这些改善在1个月时没有显著差异。收到推送通知的参与者的依从性更高（t = -4.91；P <.001）。
本研究强调了基于规则的聊天机器人在促进心理健康素养和培养短期自我护理意图方面的潜力。然而，缺乏持续效果表明聊天机器人设计需要必要的改进，包括更大程度的个性化和交互功能，以提高自我效能和长期心理健康结果。未来的研究应探索结合基于规则和生成式人工智能系统的混合方法，以优化干预效果。
ClinicalTrials.gov NCT05694507；https://clinicaltrials.gov/ct2/show/NCT05694507。
