App review of anxiety and depression chatbots and their self-care features (Preprint)

BACKGROUND Anxiety and depression rates are at an all-time high along with other mental health disorders. Smartphone-based mental health chatbots or conversational agents can aid psychiatrists and replace some of the costly human based interaction and represent a unique opportunity to expand the availability and quality of mental health services and treatment. Regular up-to-date reviews will allow medics and individuals to recommend or use anxiety and depression related smartphone based chatbots with greater confidence. OBJECTIVE Assess the quality and characteristics of chatbots for anxiety and depression available on Android and iOS systems. METHODS A search was performed in the App Store and Google Play Store following the Preferred Reporting Items for Systematic reviews and Meta-Analysis (PRISMA) protocol to identify existing chatbots for anxiety and depression. Eligibility of the chatbots was assessed by two individuals based on predefined eligibility criteria. Meta-data of the included chatbots and their characteristics were extracted from their description and upon installation by 2 reviewers. Finally, chatbots quality information was assessed by following the mHONcode principles. RESULTS Although around 1000 anxiety and depression related chatbots exist, only a few (n=11) contained actual chatbots that could provide the user a real substitute for a human-human based interaction, even with today's Artificial Intelligence advancements, only one of these chatbots had voice as an input/output modality. Of the selected apps that contained chatbots all were clearly built with a therapeutic human substitute goal in mind. The majority had high user ratings and downloads highlighting the popularity of such chatbots and their promising future within the realm of anxiety and depression. CONCLUSIONS Anxiety and depression chatbot apps have the potential to increase the capacity of mental health self-care providing much needed assistance to professionals. In the current covid-19 pandemic, chatbots can also serve as a conversational companion with the potential of combating loneliness, especially in lockdowns where there is a lack of social interaction. Due to the ubiquitous nature of chatbots users can access them on-demand at the touch of a screen on ones’ smartphone. Self-care interventions are known to be effective and exist in various forms and some can be made available as chatbot features, such as assessment, mood tracking, medicine tracking, or simply providing conversation in times of loneliness.