Artificial Intelligence Chatbot for Depression: Descriptive Study of Usage

Abstract

Background Chatbots could be a scalable solution that provides an interactive means of engaging users in behavioral health interventions driven by artificial intelligence. Although some chatbots have shown promising early efficacy results, there is limited information about how people use these chatbots. Understanding the usage patterns of chatbots for depression represents a crucial step toward improving chatbot design and providing information about the strengths and limitations of the chatbots. Objective This study aims to understand how users engage and are redirected through a chatbot for depression (Tess) to provide design recommendations. Methods Interactions of 354 users with the Tess depression modules were analyzed to understand chatbot usage across and within modules. Descriptive statistics were used to analyze participant flow through each depression module, including characters per message, completion rate, and time spent per module. Slide plots were also used to analyze the flow across and within modules. Results Users sent a total of 6220 messages, with a total of 86,298 characters, and, on average, they engaged with Tess depression modules for 46 days. There was large heterogeneity in user engagement across different modules, which appeared to be affected by the length, complexity, content, and style of questions within the modules and the routing between modules. Conclusions Overall, participants engaged with Tess; however, there was a heterogeneous usage pattern because of varying module designs. Major implications for future chatbot design and evaluation are discussed in the paper.

Bonding With Bot: User Feedback on a Chatbot for Social Isolation

“…Users can engage with Tess interventions through text message conversations or Facebook Messenger. Other studies provide more information on how Tess works ( 9 ). Recruitment advertisements were delivered via Facebook stating that the chatbot intended to reduce social isolation, loneliness, and depression.…”

“…There are several mental health and well-being chatbots that have been developed and are used commercially including Kokobot ( 7 ), Replika ( 6 ), Shim ( 8 ), Tess ( 9 , 10 ), Woebot ( 11 ), and Wysa ( 12 ). These chatbots have been shown to lead to improvements in mood and symptoms of mental disorders.…”

Psychometric Properties of a Chatbot Version of the PHQ-9 With Adults and Older Adults

“…Users can chat with Tess through text message conversations or Facebook Messenger. Other studies provide more information on how Tess works ( 21 ).…”

“…In recent years, there has been an increased interest in the integration of chatbots for assessment (20) and treatment of depression (21)(22)(23). While Fitzpatrick et al (22) and Fulmer et al (23) reported improvements in depressive symptoms using an interactive version of the PHQ-9 through a chatbot, the psychometrics properties have not been reported.…”

Digital Tools for Prevention and Treatment of Depression: Lessons from the Institute for International Internet Interventions for Health

“…Chatbots for mental health can be conceptualized as interactive self-help. Researchers at i4Health have studied how users engaged with a Chatbot's (Tess) conversations designed for management of depressive symptoms, finding that most U.S. adults users completed a mean of 2.18 conversations with Tess (Dosovitsky et al, 2020). While this number may seem low, it is higher than the mean number of modules completed in studies of most smartphone apps.…”