JMIR Publications

ABSTRACT

Background:

Mental illness affects people worldwide and poses a significant burden to individuals and society. Digital mental health support has become an important strategy to address barriers in traditional mental health care. Advances in artificial intelligence (AI) have further expanded digital outreach. Particularly, people increasingly use large language model (LLM)-powered generative AI (GenAI) chatbots such as ChatGPT to process thoughts, emotions, and personal challenges. While most prior work focused on AI chatbots intentionally designed and clinically evaluated as digital therapeutics, less is known about general-purpose GenAI chatbots that people repurpose to support their routine mental health practices.

Objective:

This study aims to examine user-generated discussions shared on Reddit and investigate user experiences, positioning, and sentiment toward general-purpose GenAI chatbots through first-person narratives in naturalistic settings.

Methods:

We retrieved publicly available Reddit posts from four selected subreddits from 2023 to 2025, and cleaned the raw dataset using Python to remove duplicates, separate posts from comments, and convert the post file into a tabular format. The cleaned dataset was filtered using two predefined keyword dictionaries (i.e., GenAI terms and mental health terms) and further screened against inclusion and exclusion criteria. We followed the six phases of reflexive thematic analysis (RTA) to analyze sampled Reddit posts. Reddit users’ GenAI positioning and sentiment were coded and summarized descriptively.

Results:

A total of 169 Reddit posts across four subreddits met the inclusion criteria and were included for RTA. Three primary themes emerged: 1) GenAI chatbots as an emotional support system (39.6%), 2) a self-understanding tool (36.1%), and 3) limited or risky support (24.3%). Across 141 posts with sufficient contextual information for positioning coding, GenAI chatbots were primarily positioned as a supplementary tool (55.4%), although a notable portion of users relied on them as a primary (33.1%) or alternative source of support (11.5%), particularly during periods of distress or when traditional care was inaccessible. Overall, Reddit user sentiment toward using GenAI chatbots to support mental health leaned positive (38.5%) and mixed (32%).

Conclusions:

Our findings suggest that general-purpose GenAI chatbots are most often used as a supplementary tool, helping people work through thoughts, manage emotions, and support existing coping strategies. The positioning framework identification for understanding GenAI repurposing for mental health support highlights how users actively and dynamically define or redefine its role within their mental health support systems. As GenAI use continues to grow, this understanding will help inform future research, technology design, clinical care, and even health policy.