Using a tele-behavioral health rapid intake model to address high demand for psychotherapy at an academic medical center during COVID-19

Can Artificial Intelligence Chatbots Improve Mental Health?: A Scoping Review

BACKGROUND AND OBJECTIVES

Mental health disorders, including anxiety and depression, are the leading causes of global health-related burden and have increased dramatically since the 1990s. Delivering mental healthcare using artificial intelligence chatbots may be one option for closing the gaps in mental healthcare access. The overall aim of this scoping review was to describe the use, efficacy, and advantages/disadvantages of using an artificial intelligence chatbot for mental healthcare (stress, anxiety, depression).

METHODS

PubMed, PsycINFO, CINAHL, and Web of Science databases were searched. When possible, Medical Subject Headings terms were searched in combination with keywords. Two independent reviewers reviewed a total of 5768 abstracts.

RESULTS

Fifty-four articles were chosen for further review, with 10 articles included in the final analysis. Regarding quality assessment, the overall quality of the evidence was lower than expected. Overall, most studies showed positive trends in improving anxiety, stress, and depression.

DISCUSSION

Overall, using an artificial intelligence chatbot for mental health has some promising effects. However, many studies were done using rudimentary versions of artificial intelligence chatbots. In addition, lack of guardrails and privacy issues were identified. More research is needed to determine the effectiveness of artificial intelligence chatbots and to describe undesirable effects.

Randomized Trial of the Effectiveness of Videoconferencing-Based Versus Message-Based Psychotherapy on Depression

OBJECTIVE

The authors compared the engagement, clinical outcomes, and adverse events of text or voice message-based psychotherapy (MBP) versus videoconferencing-based psychotherapy (VCP) among adults with depression.

METHODS

The study used a sequential multiple-assignment randomized trial design with data drawn from phase 1 of a two-phase small business innovation research study. In total, 215 adults (ages ≥18 years) with depression received care from Talkspace, a digital mental health care company. Participants were initially randomly assigned to receive either asynchronous MBP or weekly VCP. All therapists provided evidence-based treatments such as cognitive-behavioral therapy. After 6 weeks of treatment, participants whose condition did not show a response on the Patient Health Questionnaire-9 or was rated as having not improved on the Clinical Global Impressions scale were randomly reassigned to receive either weekly VCP plus MBP or monthly VCP plus MBP. Longitudinal mixed-effects models with piecewise linear time trends applied to multiple imputed data sets were used to address missingness of data.

RESULTS

Participants who were initially assigned to the MBP condition engaged with their therapists over more weeks than did participants in the VCP condition (7.8 weeks for MBP vs. 4.9 weeks for VCP; p<0.001). No meaningful differences were observed between the two groups in rates of change by 6 or 12 weeks for depression, anxiety, disability, or global ratings of improvement. Neither treatment resulted in any adverse events.

CONCLUSIONS

MBP appears to be a viable alternative to VCP for treating adults with depression.

Going Beyond Waitlists in Mental Healthcare

Managing waitlists for outpatient mental health services particularly in community health settings is difficult to standardize, poses an administrative burden, and are barriers rather than gateways to access to care particularly for low-income communities. While telehealth has initially expanded access to mental healthcare at the onset of the COVID-19 pandemic, it has not resolved the challenges associated with the increasing demand for services and the shortage of available providers. This commentary explores the intricate interconnections between wait times, readiness for and appropriateness of therapy, and engagement in treatment. Drawing on insights from waiting line theory to question the attachment to and utility of waitlists for non-emergency, outpatient mental healthcare, this commentary questions the utility and efficacy of waitlists. Alternative solutions that capitalize on community resources and collaboration and harness patients' agency for change are discussed.