This paper is in the following e-collection/theme issue:

Chatbots and Conversational Agents (740) Artificial Intelligence (2129) Digital Mental Health Interventions, e-Mental Health and Cyberpsychology (2111) Safety and Error Prevention in Health (240) Anxiety and Stress Disorders (1330) Depression and Mood Disorders; Suicide Prevention (1691)

Published on in Vol 22, No 7 (2020): July

Preprints (earlier versions) of this paper are available at https://preprints.jmir.org/preprint/16021, first published .
Effectiveness and Safety of Using Chatbots to Improve Mental Health: Systematic Review and Meta-Analysis

Effectiveness and Safety of Using Chatbots to Improve Mental Health: Systematic Review and Meta-Analysis

Effectiveness and Safety of Using Chatbots to Improve Mental Health: Systematic Review and Meta-Analysis

Authors of this article:

Alaa Ali Abd-Alrazaq1 Author Orcid Image ;   Asma Rababeh2 Author Orcid Image ;   Mohannad Alajlani3 Author Orcid Image ;   Bridgette M Bewick4 Author Orcid Image ;   Mowafa Househ1 Author Orcid Image
Article Authors Cited by (268) Tweetations (22) Metrics

Journals

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  114. Kuhail M, Alturki N, Thomas J, Alkhalifa A, Alshardan A. Human-Human vs Human-AI Therapy: An Empirical Study. International Journal of Human–Computer Interaction 2025;41(11):6841 View
  115. Meadows R, Hine C. Entanglements of Technologies, Agency and Selfhood: Exploring the Complexity in Attitudes Toward Mental Health Chatbots. Culture, Medicine, and Psychiatry 2024;48(4):840 View
  116. Andreas S. As real as possible: Chancen und Herausforderungen von Online-Psychotherapie. PiD - Psychotherapie im Dialog 2024;25(03):41 View
  117. Akhtar A, de Graaff A, Habashneh R, Keyan D, Abualhaija A, Fanatseh S, Faroun M, Aqel I, Dardas L, Servili C, van Ommeren M, Bryant R, Carswell K. Scalable Technology for Adolescents and Youth to Reduce Stress in the Treatment of Common Mental Disorders in Jordan: Protocol for a Randomized Controlled Trial. JMIR Research Protocols 2024;13:e54585 View
  118. Lahutina S, Frankova I, Gruen M, Vermetten E, Zohar J, Spitschan M, Bajbouj M. A digital self-help tool to promote mental well-being for Ukrainians affected by war - Assessing predictors of stress. Neuroscience Applied 2024;3:104089 View
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  120. Nkabane-Nkholongo E, Mpata Mokgatle M, Bickmore T, Julce C, Thompson D, Jack B. Change in sexual and reproductive health knowledge among young women using the conversational agent “Nthabi” in Lesotho: a clinical trial. BMC Global and Public Health 2024;2(1) View
  121. MacNeill A, MacNeill L, Luke A, Doucet S. Health Professionals’ Views on the Use of Conversational Agents for Health Care: Qualitative Descriptive Study. Journal of Medical Internet Research 2024;26:e49387 View
  122. Brinsley J, O'Connor E, Singh B, McKeon G, Curtis R, Ferguson T, Gosse G, Willems I, Marent P, Szeto K, Firth J, Maher C. Effectiveness of Digital Lifestyle Interventions on Depression, Anxiety, Stress, and Well-Being: Systematic Review and Meta-Analysis. Journal of Medical Internet Research 2025;27:e56975 View
  123. Pendse S, Stapleton L, Kumar N, De Choudhury M, Chancellor S. Advancing a consent-forward paradigm for digital mental health data. Nature Mental Health 2024;2(11):1298 View
  124. Hunsrisakhun J, Naorungroj S, Tangkuptanon W, Wattanasit P, Pupong K, Pithpornchaiyakul S. Impact of Oral Health Chatbot With and Without Toothbrushing Training on Childhood Caries. International Dental Journal 2025;75(2):1348 View
  125. Yuan A, Garcia Colato E, Pescosolido B, Song H, Samtani S. Improving Workplace Well-being in Modern Organizations: A Review of Large Language Model-based Mental Health Chatbots. ACM Transactions on Management Information Systems 2025;16(1):1 View
  126. Yang Y, Tavares J, Oliveira T. A New Research Model for Artificial Intelligence–Based Well-Being Chatbot Engagement: Survey Study. JMIR Human Factors 2024;11:e59908 View
  127. Kuhail M, Alturki N, Thomas J, Alkhalifa A. Human vs. AI counseling: College students' perspectives. Computers in Human Behavior Reports 2024;16:100534 View
  128. Attridge M. Insomnia Prevalence and Mental Health Correlates Among 18,646 Users of an Internet-Based Cognitive-Behavioral Therapy Website: Archival Real-World Data from the United States, 2017-2019. Qeios 2024;6(11) View
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  144. Bramanti A, Corallo A, Clemente G, Greco L, Garofano M, Giordano M, Pascarelli C, Mitrano G, Di Palo M, Di Spirito F, Amato M, Bartolomeo M, Del Sorbo R, Ciccarelli M, Bramanti P, Ritrovato P. Exploring the Role of Voice Assistants in Managing Noncommunicable Diseases: A Systematic Review on Clinical, Behavioral Outcomes, Quality of Life, and User Experiences. Healthcare 2025;13(5):517 View
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  146. Escoredo M, Mostovoy K, Schickler R, Bechtel A, Shagan J, Bunge E. Enhancing parental skills through artificial intelligence‐based conversational agents: The PAT Initiative. Family Relations 2025;74(3):1250 View
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  148. Baek G, Cha C, Han J. AI Chatbots for Psychological Health for Health Professionals: Scoping Review. JMIR Human Factors 2025;12:e67682 View
  149. Hopman K, Richards D, Norberg M. A staged approach to the development of an embodied conversational agent to support wellbeing after injury. Behaviour & Information Technology 2025:1 View
  150. Kuhlmeier F, Bauch L, Gnewuch U, Lüttke S. Designing Chatbots to Treat Depression in Youth: Qualitative Study. JMIR Human Factors 2025;12:e66632 View
  151. Tong A, Wong K, Chung W, Mak W. Effectiveness of Topic-Based Chatbots on Mental Health Self-Care and Mental Well-Being: Randomized Controlled Trial. Journal of Medical Internet Research 2025;27:e70436 View
  152. Rony M, Das D, Khatun M, Ferdousi S, Akter M, Khatun M, Begum M, Khalil M, Parvin M, Alrazeeni D, Akter F. Artificial intelligence in psychiatry: A systematic review and meta-analysis of diagnostic and therapeutic efficacy. DIGITAL HEALTH 2025;11 View
  153. Zisquit ‪, Shoa A, Oliva R, Perry S, Spanlang B, Brunstein Klomek A, Slater M, Friedman D. AI-Enhanced Virtual Reality Self-Talk for Psychological Counseling: Formative Qualitative Study. JMIR Formative Research 2025;9:e67782 View
  154. Vowels L, Sweeney S, Vowels M. Evaluating the efficacy of Amanda: A voice-based large language model chatbot for relationship challenges. Computers in Human Behavior: Artificial Humans 2025;4:100141 View
  155. Hung J, Hartanto A, Goh A, Eun Z, Kasturiratna K, Lee Z, Majeed N. The efficacy of incorporating Artificial Intelligence (AI) chatbots in brief gratitude and self-affirmation interventions: Evidence from two exploratory experiments. Computers in Human Behavior: Artificial Humans 2025;4:100151 View
  156. M S, N V. Artificial Intelligence (AI) Generated Health Counseling For Mental Illness Patients. Current Psychiatry Research and Reviews 2025;21(3):269 View
  157. Albikawi Z, Abuadas M, Rayani A. Nursing Students’ Perceptions of AI-Driven Mental Health Support and Its Relationship with Anxiety, Depression, and Seeking Professional Psychological Help: Transitioning from Traditional Counseling to Digital Support. Healthcare 2025;13(9):1089 View
  158. Feng Y, Hang Y, Wu W, Song X, Xiao X, Dong F, Qiao Z. Effectiveness of AI-Driven Conversational Agents in Improving Mental Health Among Young People: Systematic Review and Meta-Analysis. Journal of Medical Internet Research 2025;27:e69639 View
  159. Scholich T, Barr M, Wiltsey Stirman S, Raj S. A Comparison of Responses from Human Therapists and Large Language Model–Based Chatbots to Assess Therapeutic Communication: Mixed Methods Study. JMIR Mental Health 2025;12:e69709 View
  160. Dechant M, Lash E, Shokr S, O'Driscoll C. Future Me, a Prospection-Based Chatbot to Promote Mental Well-Being in Youth: Two Exploratory User Experience Studies. JMIR Formative Research 2025;9:e74411 View
  161. Bal F. Artificial Intelligence and Psychotherapy. Psikiyatride Güncel Yaklaşımlar 2025;17(4):643 View
  162. Guglielmucci F, Di Basilio D. Predicting Engagement With Conversational Agents in Mental Health Therapy by Examining the Role of Epistemic Trust, Personality, and Fear of Intimacy: Cross-Sectional Web-Based Survey Study. JMIR Human Factors 2025;12:e70698 View
  163. Franke Föyen L, Zapel E, Lekander M, Hedman-Lagerlöf E, Lindsäter E. Artificial intelligence vs. human expert: Licensed mental health clinicians' blinded evaluation of AI-generated and expert psychological advice on quality, empathy, and perceived authorship. Internet Interventions 2025;41:100841 View
  164. Esmaeilzadeh P. Decoding the cry for help: AI's emerging role in suicide risk assessment. AI and Ethics 2025 View
  165. Fritz B, Eppelmann L, Edelmann A, Rohrmann S, Wessa M. How mental health status and attitudes toward mental health shape AI Acceptance in psychosocial care: a cross-sectional analysis. BMC Psychology 2025;13(1) View
  166. Olla P, Barnes A, Elliott L, Abumeeiz M, Olla V, Tan J. Deploying a Mental Health Chatbot in Higher Education: The Development and Evaluation of Luna, an AI-Based Mental Health Support System. Computers 2025;14(6):227 View
  167. Warren-Smith G, Laban G, Pacheco E, Cross E. Knowledge cues to human origins facilitate self-disclosure during interactions with chatbots. Computers in Human Behavior: Artificial Humans 2025;5:100174 View
  168. Xu S, Ma T. Depression intervention using AI chatbots with social cues: a randomized trial of effectiveness. Journal of Affective Disorders 2025;389:119760 View
  169. Mmbayi I, Gakii C, Musyoka F. Sentiment Analysis‐Based Model for Monitoring User Engagement With Mental Health Chatbots. Engineering Reports 2025;7(6) View
  170. Mayor E. Chatbots and mental health: a scoping review of reviews. Current Psychology 2025;44(15):13619 View
  171. Zhang Y. The effect of artificial intelligence applications GymBuddy & Elomia on the mental health and physical activities of teachers and learners exposed to e-learning platforms. Current Psychology 2025;44(14):13481 View
  172. Greaves J, Colucci E. Crisis-line workers’ perspectives on AI in suicide prevention: a qualitative exploration of risk and opportunity. BMC Public Health 2025;25(1) View
  173. Algumaei A, Yaacob N, Doheir M, Al-Andoli M, Algumaie M. Symmetric Therapeutic Frameworks and Ethical Dimensions in AI-Based Mental Health Chatbots (2020–2025): A Systematic Review of Design Patterns, Cultural Balance, and Structural Symmetry. Symmetry 2025;17(7):1082 View
  174. Fleming W, Coutts A, Pochard D, Trivedi D, Sanderson K. Human-Centered Design and Digital Transformation of Mental Health Services. JMIR Human Factors 2025;12:e66040 View
  175. Vowels L, Francois-Walcott R, Grandjean M, Darwiche J, Vowels M. Navigating relationships with GenAI chatbots: User attitudes, acceptability, and potential. Computers in Human Behavior: Artificial Humans 2025;5:100183 View
  176. Li J, Li Y, Hu Y, Ma D, Mei X, Chan E, Yorke J. Chatbot‐Delivered Interventions for Improving Mental Health Among Young People: A Systematic Review and Meta‐Analysis. Worldviews on Evidence-Based Nursing 2025;22(4) View
  177. Al-Shamaileh O, Mubin O, Nizamuddin N. Talking Tech in Education: A Systematic Review of Chatbot Evaluation, Methods, Communication Modalities, and Impact. International Journal of Human–Computer Interaction 2025:1 View
  178. Emile S, Horesh N, Garoufalia Z, Gefen R, Boutros M, Wexner S. Assessment of the Utility of Artificial Intelligence-Based Chatbots in Patient Education: A Systematic Review and Meta-Analysis. The American Surgeon™ 2025 View
  179. Klein S. The effects of human-like social cues on social responses towards text-based conversational agents—a meta-analysis. Humanities and Social Sciences Communications 2025;12(1) View
  180. Luxton D. AI-Powered Virtual Therapy: Toward a Responsible and Client-Centered Future. Journal of Health Service Psychology 2025 View
  181. Bendeck Soto J, Muñoz Guirales L, Muñoz Guirales C, García Uribe J. El uso de la tecnología para mejorar el cuidado de la salud mental en pacientes oncológicos: una revisión de alcance. RHS-Revista Humanismo y Sociedad 2025;13(2) View
  182. Alemi F, Wojtusiak J, Ursani A, Eklou K, Lybarger K. Artificial Intelligence for Management of Major Depression: Initial Design, Progress, and Research Plans. Alpha Psychiatry 2025;26(4) View
  183. You C, Ghosh R, Vilaro M, Venkatakrishnan R, Venkatakrishnan R, Maxim A, Peng X, Tamboli D, Lok B. Alter egos alter engagement: perspective-taking can improve disclosure quantity and depth to AI chatbots in promoting mental wellbeing. Frontiers in Digital Health 2025;7 View
  184. Hua Y, Siddals S, Ma Z, Galatzer‐Levy I, Xia W, Hau C, Na H, Flathers M, Linardon J, Ayubcha C, Torous J. Charting the evolution of artificial intelligence mental health chatbots from rule‐based systems to large language models: a systematic review. World Psychiatry 2025;24(3):383 View
  185. Hall A, Perrotta A, Shariati K, Patel A, Lee J. Artificial Intelligence Chatbots in Surgical Care: A Systematic Review of Clinical Applications. Journal of Artificial Intelligence for Medical Sciences 2025;00(00):1 View
  186. Aral A, Gerdan G, Usta M, Aral A. From promise to practice: insights into ChatGPT-4o use in child and adolescent mental health from professionals. Frontiers in Psychiatry 2025;16 View
  187. Ren W, Xue X, Liu L, Huang J. AI Applications in Depression Detection and Diagnosis: Bibliometric and Visual Analysis of Trends and Future Directions. JMIR Mental Health 2025;12:e79293 View
  188. Lack C, Haws J. Therapy Without a Therapist. Psychiatric Clinics of North America 2025 View
  189. Yang M, Yang Z, Ning Z, Shen H, Mao C, Ma C, Hu B. Echoes of Empathy: A Symbiotic IoT-Based Emotion Feedback Framework for Psychological Interventions via Large Language Model. IEEE Internet of Things Journal 2025;12(20):41297 View
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  191. Jones M, Schonewille M. Synthetic relationships and artificial intimacy: an ethical framework for evaluating the impact of generative-AI on community. Journal of Ethics in Entrepreneurship and Technology 2025 View
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Books/Policy Documents

  1. Striegl J, Gotthardt M, Loitsch C, Weber G. Computers Helping People with Special Needs. View
  2. Välimäki M, Hipp K. Advanced Practice in Mental Health Nursing. View
  3. Ogilvie L, Prescott J, Hanley T, Carson J. Digital Innovations for Mental Health Support. View
  4. Thakur S, Rastogi D, Singh L. Sustainable Technology and Advanced Computing in Electrical Engineering. View
  5. Simões de Almeida R, da Silva T. Digital Therapies in Psychosocial Rehabilitation and Mental Health. View
  6. Viduani A, Cosenza V, Araújo R, Kieling C. Digital Mental Health. View
  7. Lira D, Martínez V. Prevention and Early Treatment of Depression Through the Life Course. View
  8. Simões de Almeida R, Silva T. Exploring the Convergence of Computer and Medical Science Through Cloud Healthcare. View
  9. Bickmore T, O'Leary T. Digital Therapeutics for Mental Health and Addiction. View
  10. Larsen M, Vo L, Pratap A, Peters D. Tasman’s Psychiatry. View
  11. Oladeji B, Oladele O, Gureje O. International Encyclopedia of Public Health. View
  12. Mehta U, Bagali K, Kommanapalli S. AI, Consciousness and The New Humanism. View
  13. Koukopoulos A, Danias N. Inclusivity and Accessibility in Digital Health. View
  14. Sohara Banu A, Nagaveni V, Gowda N, Yerriswamy T, Gururaj M, Varshitha N. Soft Computing and Signal Processing. View
  15. Tahvanainen L, Tetri B, Ahonen O. Digital Health and Wireless Solutions. View
  16. Sreeraj V, Parlikar R, Bagali K, Singh Shekhawat H, Venkatasubramanian G. Exploration of Artificial Intelligence and Blockchain Technology in Smart and Secure Healthcare. View
  17. Tuna A. Integrating Generative AI in Education to Achieve Sustainable Development Goals. View
  18. Larsen M, Vo L, Pratap A, Peters D. Tasman’s Psychiatry. View
  19. Gray S. Vertrauen in Künstliche Intelligenz. View
  20. Eisenstadt M. Integrated Science for Sustainable Development Goal 3. View
  21. Ghosh D, Ghatak S, Paul H. Biomedical Robots and Devices in Healthcare. View
  22. Wu L. Chatbots and Mental Healthcare in Psychology and Psychiatry. View
  23. de Bruijn G, Jabeen F, Bosse T. The Handbook of Mental Health Communication. View
  24. Shidara K, Kudo T. Multimodal Interaction Technologies for Training Affective Social Skills. View
  25. Lee K, Yeung J, Kurniawati A, Chou D. Information Systems for Intelligent Systems. View
  26. Osta A, Kokkinaki A, Chedrawi C. Territorial Landscapes Solutions for Sustainable Energy and Food Security. View
  27. Katoch H, Sandhu D. Harnessing Emotion AI for Customer Support and Employee Wellbeing. View
  28. Santa Cruz B, Vega C, Santangelo P, Satagopam V. AI for Clinical Applications. View
  29. Alqaidoom M, Ateeq A. Integrating Artificial Intelligence, Security for Environmental and Business Sustainability. View

Books/Policy Documents

  1. Saiz Manzanares M, Martínez Martín M, Escolar Llamazares M, Ortiz Huerta J, Santamaría Vázquez M, Mercado Val E, Marticorena Sánchez R, Arnáiz González Á, Díez Pastor J, Rodríguez Arribas S. Formación y especialización en atención temprana: uso de recursos tecnológicos y de inteligencia artificial. View
  2. Saiz Manzanares M, Martínez Martín M, Escolar Llamazares M, Ortiz Huerta J, Santamaría Vázquez M, Mercado Val E, Marticorena Sánchez R, Arnáiz González Á, Díez Pastor J, Rodríguez Arribas S. Training and specialisation in early intervention: use of technological resources and artificial intelligence. View

Conference Proceedings

  1. Kim J, Muhic J, Robert L, Park S. CHI Conference on Human Factors in Computing Systems. Designing Chatbots with Black Americans with Chronic Conditions: Overcoming Challenges against COVID-19 View
  2. van Cuylenburg H, Ginige T. 2021 International Conference on UK-China Emerging Technologies (UCET). Emotion Guru: A Smart Emotion Tracking Application with AI Conversational Agent for Exploring and Preventing Depression View
  3. Driss M, Almomani I, Alahmadi L, Alhajjam L, Alharbi R, Alanazi S. 2022 2nd International Conference of Smart Systems and Emerging Technologies (SMARTTECH). COVIBOT: A Smart Chatbot for Assistance and E-Awareness during COVID-19 Pandemic View
  4. Aarts T, Markopoulos P, Giling L, Vacaretu T, Pillen S. Interaction Design and Children. Snoozy: A Chatbot-Based Sleep Diary for Children Aged Eight to Twelve View
  5. Xygkou A, Siriaraya P, Covaci A, Prigerson H, Neimeyer R, Ang C, She W. Proceedings of the 2023 CHI Conference on Human Factors in Computing Systems. The "Conversation" about Loss: Understanding How Chatbot Technology was Used in Supporting People in Grief. View
  6. Paul S, Ray L. 2022 International Conference on Computational Science and Computational Intelligence (CSCI). Service Chatbots and International Students: A Systematic Review View
  7. Punugoti R, Duggar R, Dhargalkar R, Bhati N. 2023 International Conference on IoT, Communication and Automation Technology (ICICAT). Intelligent Healthcare: Using NLP and ML to Power Chatbots for Improved Assistance View
  8. Peltola J, Kaipainen K, Keinonen K, Kiuru N, Turunen M. Proceedings of the 5th International Conference on Conversational User Interfaces. Developing A Conversational Interface for an ACT-based Online Program: Understanding Adolescents’ Expectations of Conversational Style View
  9. Rajani G, Ruparel K. 2023 International Conference on Advanced Computing Technologies and Applications (ICACTA). Deep Learning based Chatbot Architecture for Medical Diagnosis and Treatment Recommendation View
  10. Serrano G, Kwak D. 2023 Congress in Computer Science, Computer Engineering, & Applied Computing (CSCE). ESAI: An AI-Based Emotional Support System to Assist Mental Health Disorders View
  11. Ma Z, Mei Y, Long Y, Su Z, Gajos K. Proceedings of the CHI Conference on Human Factors in Computing Systems. Evaluating the Experience of LGBTQ+ People Using Large Language Model Based Chatbots for Mental Health Support View
  12. Li B. Extended Abstracts of the CHI Conference on Human Factors in Computing Systems. Designing Conversational Agents to Facilitate Patient-Physician Communication and Clinical Consultation View
  13. Al-Remawi M, Aburub F. 2024 2nd International Conference on Cyber Resilience (ICCR). Clinical Applications of AI in Post-Cancer Rehabilitation View
  14. He L, Braggaar A, Basar E, Krahmer E, Antheunis M, Wiers R. ACM Conversational User Interfaces 2024. Exploring User Engagement Through an Interaction Lens: What Textual Cues Can Tell Us about Human-Chatbot Interactions View
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