Conversational artificial intelligence (AI), particularly AI-based conversational agents (CAs), is gaining traction in mental health care. Despite their growing usage, there is a scarcity of comprehensive evaluations of their impact on mental health and well-being. This systematic review and meta-analysis aims to fill this gap by synthesizing evidence on the effectiveness of AI-based CAs in improving mental health and factors influencing their effectiveness and user experience. Twelve databases were searched for experimental studies of AI-based CAs’ effects on mental illnesses and psychological well-being published before May 26, 2023. Out of 7834 records, 35 eligible studies were identified for systematic review, out of which 15 randomized controlled trials were included for meta-analysis. The meta-analysis revealed that AI-based CAs significantly reduce symptoms of depression (Hedge’s g 0.64 [95% CI 0.17–1.12]) and distress (Hedge’s g 0.7 [95% CI 0.18–1.22]). These effects were more pronounced in CAs that are multimodal, generative AI-based, integrated with mobile/instant messaging apps, and targeting clinical/subclinical and elderly populations. However, CA-based interventions showed no significant improvement in overall psychological well-being (Hedge’s g 0.32 [95% CI –0.13 to 0.78]). User experience with AI-based CAs was largely shaped by the quality of human-AI therapeutic relationships, content engagement, and effective communication. These findings underscore the potential of AI-based CAs in addressing mental health issues. Future research should investigate the underlying mechanisms of their effectiveness, assess long-term effects across various mental health outcomes, and evaluate the safe integration of large language models (LLMs) in mental health care.

中文翻譯：

基于 AI 的對話代理促進(jìn)心理健康和福祉的系統(tǒng)評價和薈萃分析

對話式人工智能 （AI），尤其是基于 AI 的對話式代理 （CA），在心理健康護(hù)理領(lǐng)域越來越受歡迎。盡管它們的使用越來越多，但缺乏對其對心理健康和福祉影響的全面評估。本系統(tǒng)評價和薈萃分析旨在通過綜合有關(guān)基于 AI 的 CA 在改善心理健康方面的有效性以及影響其有效性和用戶體驗的因素的證據(jù)來填補這一空白。搜索了 12 個數(shù)據(jù)庫，以查找 2023 年 5 月 26 日之前發(fā)表的基于 AI 的 CA 對精神疾病和心理健康影響的實驗研究。在 7834 條記錄中，確定了 35 項符合條件的研究進(jìn)行系統(tǒng)評價，其中 15 項隨機對照試驗被納入進(jìn)行薈萃分析。薈萃分析顯示，基于 AI 的 CA 顯著減輕了抑郁 （Hedge's g 0.64 [95% CI 0.17–1.12]）和痛苦 （Hedge's g 0.7 [95% CI 0.18–1.22]）的癥狀。這些影響在多模式、基于生成式 AI、與移動/即時消息應(yīng)用程序集成并針對臨床/亞臨床和老年人群的 CA 中更為明顯。然而，基于 CA 的干預(yù)措施顯示整體心理健康沒有顯著改善 （Hedge's g 0.32 [95% CI -0.13 至 0.78]）?；?AI 的 CA 的用戶體驗在很大程度上取決于人機 AI 治療關(guān)系的質(zhì)量、內(nèi)容參與和有效溝通。這些發(fā)現(xiàn)強調(diào)了基于 AI 的 CA 在解決心理健康問題方面的潛力。未來的研究應(yīng)調(diào)查其有效性的潛在機制，評估各種心理健康結(jié)果的長期影響，并評估大型語言模型 （LLMs） 在心理健康護(hù)理中的安全整合。

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