JMIR Publications

ABSTRACT

Background:

Conversational Agents (CAs, chatbots) are systems enabled with the ability to interact with the users using natural human dialogue. They are increasingly used to support interactive knowledge discovery of sensitive topics such as mental health topics. While much of the research on CAs for mental health has focused on adult populations, the insights from such research may not apply to CAs for youth.

Objective:

The aim of the study was to comprehensively evaluate the state-of-the-art research on mental health CAs for youth.

Methods:

Following Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, we synthesized 39 peer-reviewed studies specific to mental health CAs designed for youth. We conducted a scoping review of the literature to evaluate the characteristics of research on mental health CAs designed for youth, the design/computational considerations of mental health CAs for youth, and the evaluation outcomes reported in the research on mental health CAs for youth.

Results:

We found that most mental health CAs were designed as older peers to provide therapeutic and/or educational content to promote youth mental well-being. Most of the CAs were designed based on expert knowledge, with a few that incorporated inputs from youth. The technical maturity of CAs was in its infancy, focusing on building prototypes with rule-based models to deliver pre-written content, with limited safety features to respond to imminent risk. Research findings suggest that while youth appreciate the 24/7 availability of friendly/empathetic conversation on sensitive topics with CAs, they found the content provided by CAs to be limited. Finally, we found a concerning trend that most of the reviewed studies did not address the ethical aspects of mental health CAs while youth were concerned about the privacy and confidentiality of their sensitive conversation data.

Conclusions:

Our study highlights the need for researchers to continue to work together to align evidence-based research on mental health CAs for youth with lessons learned on how to best deliver these technologies to youth. Our review brings to light mental health CAs needing further development and evaluation. The new trend of large language models (LLMs) based CAs can make such technologies more feasible. Yet, the privacy and safety of the systems should be prioritized. Although preliminary evidence shows positive trends in mental health CAs, long-term evaluative research with larger sample sizes and robust research designs is needed to validate their efficacy. More importantly, collaborative efforts with youth and clinical experts are needed from early design phases to summative evaluation stages to build safe, effective, and youth-centered mental health CAs. Finally, best practices for risk mitigation and ethical development of CAs with and for youth are needed to promote their mental well-being. Clinical Trial: N/A