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

Chatbots and Conversational Agents (623) Artificial Intelligence (1704) Digital Mental Health Interventions, e-Mental Health and Cyberpsychology (1795) Safety and Error Prevention in Health (225) Anxiety and Stress Disorders (1175) Depression and Mood Disorders; Suicide Prevention (1512)

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 (204) Tweetations (23) 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 2024:1 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
  119. Xu T, Weng H, Liu F, Yang L, Luo Y, Ding Z, Wang Q. Current Status of ChatGPT Use in Medical Education: Potentials, Challenges, and Strategies. Journal of Medical Internet Research 2024;26:e57896 View
  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
  129. Leung W, Lam S, Ng F, Yip C, Chan C. Effectiveness of chatbot-based interventions on mental well-being of the general population in Asia: protocol for a systematic review and meta-analysis of randomised controlled trials. BMJ Health & Care Informatics 2024;31(1):e101148 View
  130. Salmi S, Mérelle S, van Eijk N, Gilissen R, van der Mei R, Bhulai S. Real-time assistance in suicide prevention helplines using a deep learning-based recommender system: A randomized controlled trial. International Journal of Medical Informatics 2025;195:105760 View
  131. Li Y, Chung T, Lu W, Li M, Ho Y, He M, Mei X, Chen D, Bressington D. Chatbot-Based Mindfulness-Based Stress Reduction Program for University Students With Depressive Symptoms: Intervention Development and Pilot Evaluation. Journal of the American Psychiatric Nurses Association 2024 View
  132. Park J, Singh V, Wisniewski P. Current Landscape and Future Directions for Mental Health Conversational Agents for Youth: Scoping Review. JMIR Medical Informatics 2025;13:e62758 View
  133. Suazo Galdames I. Chatbots for Promoting Healthy Habits and Scientific Culture. International Journal of Medical and Surgical Sciences 2023:1 View
  134. Baird A, Xia Y. Applying analytics to sociodemographic disparities in mental health. Nature Mental Health 2025;3(1):124 View
  135. Van Meter A, Wheaton M, Cosgrove V, Andreadis K, Robertson R, Laroia G. The Goldilocks Zone: Finding the right balance of user and institutional risk for suicide-related generative AI queries. PLOS Digital Health 2025;4(1):e0000711 View
  136. Malouin-Lachance A, Capolupo J, Laplante C, Hudon A. Does the Digital Therapeutic Alliance Exist? Integrative Review. JMIR Mental Health 2025;12:e69294 View
  137. Sobowale K, Humphrey D. Evaluating the Quality of Psychotherapy Conversational Agents: Framework Development and Cross-Sectional Study (Preprint). JMIR Formative Research 2024 View
  138. Nieminen H, Vartiainen A, Bond R, Laukkanen E, Mulvenna M, Kuosmanen L. Recommendations for Mental Health Chatbot Conversations: An Integrative Review. Journal of Advanced Nursing 2025 View
  139. Boadu D, Boafo F, Owusu-Ansah L, Mensah S. AI and VR-Powered Interventions for Social Anxiety. International Journal of Virtual and Augmented Reality 2025;7(1):1 View
  140. Lee H, Wright C, Ferranto J, Buttimer J, Palmer C, Welchman A, Mazor K, Fisher K, Smelson D, O’Connor L, Fahey N, Soni A. Artificial intelligence conversational agents in mental health: Patients see potential, but prefer humans in the loop. Frontiers in Psychiatry 2025;15 View
  141. Han Q, Zhao C. Unleashing the potential of chatbots in mental health: bibliometric analysis. Frontiers in Psychiatry 2025;16 View
  142. Wu C, Chen C, Huang K, Chou Y. Determinants of Chatbot adoption among older adults: An extended TAM approach using PLS-SEM. Information Development 2025 View
  143. Rahsepar Meadi M, Sillekens T, Metselaar S, van Balkom A, Bernstein J, Batelaan N. Exploring the Ethical Challenges of Conversational AI in Mental Health Care: Scoping Review. JMIR Mental Health 2025;12:e60432 View
  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
  145. Chen C, Lam K, Yip K, So H, Lum T, Wong I, Yam J, Chui C, Ip P. Comparison of an AI Chatbot With a Nurse Hotline in Reducing Anxiety and Depression Levels in the General Population: Pilot Randomized Controlled Trial. JMIR Human Factors 2025;12:e65785 View
  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 View
  147. Shankar R, Bundele A, Mukhopadhyay A. Effectiveness of Chatbot interventions for reducing caregiver burden: Protocol for a systematic review and meta-analysis. MethodsX 2025;14:103272 View
  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. How to design a chatbot to treat depression among youth? Insights from a qualitative study. (Preprint). JMIR Human Factors 2024 View
  151. Tong A, Wong K, Chung W, Mak W. Effectiveness of topic-based chatbots on mental health self-care and mental well-being: A Randomized Controlled Trial (Preprint). Journal of Medical Internet Research 2024 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

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
  15. Meoli L, Nunes F, Félix B, Couto da Silva J, Ntinga X, Densmore M. ACM Conversational User Interfaces 2024. A Not So Chatty “Chatbot”: Co-designing to support First-Time Parents in South Africa and Portugal View
  16. Diaz A, Kwak D. 2023 International Conference on Computational Science and Computational Intelligence (CSCI). Leveraging Chatbots for Mental Health Enhancement View
  17. Nikolaeva D, Georgiev M, Bozhikova V, Petrova D, Stoeva M. 2024 XXXIII International Scientific Conference Electronics (ET). Using Digital Technologies in Mental Health Care View
  18. Manoharan G, Pant L, Tewari R, Vichare S, Sarkar P, Dhanraj J. 2024 7th International Conference on Contemporary Computing and Informatics (IC3I). AI-Powered Chatbots for Mental Health Support View
  19. Carchiolo V, Malgeri M. Global Congress on Emerging Technologies (GCET-2024). Quantitative Review of Conversational Agents in E-Health Using NLP and AI View
  20. Kollig F, Pater J, Nova F, Fiesler C. Proceedings of the 2025 CHI Conference on Human Factors in Computing Systems. Fictional Failures and Real-World Lessons: Ethical Speculation Through Design Fiction on Emotional Support Conversational AI View
  21. Wang Y, Wang Y, Crace K, Zhang Y. Proceedings of the 2025 CHI Conference on Human Factors in Computing Systems. Understanding Attitudes and Trust of Generative AI Chatbots for Social Anxiety Support View
  22. Viswanathan S, Ibrahim S, Shankar R, Binns R, Van Kleek M, Slovak P. Proceedings of the 2025 CHI Conference on Human Factors in Computing Systems. The Interaction Layer: An Exploration for Co-Designing User-LLM Interactions in Parental Wellbeing Support Systems View