JMIR Publications

ABSTRACT

Background:

Chatbots based on large language models (LLM-CBs) are increasingly used as mental health support tools. Risks and harms are discussed especially for unsupervised use and for vulnerable groups. A naturalistic characterization of the use of LLM-CBs by patients affected by mental health disorders is currently lacking.

Objective:

The goal of this cross-sectional study is to investigate demographic and clinical characteristics of users of LLM-CB for mental health, and their associations with use behavior.

Methods:

Across 6 months, qualitative and quantitative data on LLM-CB use for mental health was collected in a consecutive sample of psychotherapy outpatients in routine treatment with at least one diagnosed mental health disorder. Results are reported descriptively.

Results:

Within a total of 812 outpatients, 245 (30.1%) reported having used LLM-CBs for mental health (32% once, 54% weekly, 14% daily). Users were more likely to be younger, female, better educated, students, or unemployed. 61% have used LLM-CBs in crisis situations of whom 68% found the experience unhelpful. LLM-CB use did not differ across number diagnosed mental health disorders but was higher for anxiety and eating disorder diagnoses and lower for somatoform disorders. Diagnosis of depression and anxiety diagnoses showed a positive association with use frequency and somatoform disorders a negative association. LLM-CBs were generally evaluated positively across various dimensions, especially when crisis situation use was experienced as helpful. Qualitative analysis of an open-ended question on use experience shows LLM-CB use across four domains: general psychological assistance, disorder-specific assistance, information assistance, and everyday assistance.

Conclusions:

This naturalistic characterization of LLM-CB use in mental health outpatients implies that while demographic factors gate initial use, clinical characteristics influence use behavior and experience, suggesting that harms and benefits of LLM-CB use depend on clinical profiles. The results underline the need for systematic clinical assessments of LLM-CB use for clinical practice and targeted research on diagnosis-specific human-LLM-interaction. Clinical practitioners need to be aware that their patients may use LLM-CBs for mental health which may need to be actively included in the treatment.