Effect of a Cognitive Behavioral Therapy–Based AI Chatbot on Depression and Loneliness in Chinese University Students: Randomized Controlled Trial With Financial Stress Moderation
Abstract
Abstract Background Mental health concerns are prevalent among university students, with financial stress further compounding these issues. While cognitive behavioral therapy (CBT) is effective for these conditions, its delivery through artificial intelligence (AI) chatbots represents a promising approach, especially in non-Western contexts. Objective This study aims to investigate the efficacy of a culturally adapted, CBT-based AI chatbot for improving the well-being of Chinese university students and to examine whether financial stress moderates its effectiveness. Methods In this randomized controlled trial, 100 university students (mean age 20.8, SD 2.2 years; 62/100, 62% female) were allocated to either an intervention (n=50) or a waitlist control group (n=50). The intervention group interacted with a CBT-based AI chatbot for 7 consecutive days. Depression (Center for Epidemiologic Studies Depression Scale), anxiety (Generalized Anxiety Disorder-7 scale), and loneliness (UCLA Loneliness Scale) were assessed at baseline, day 3, and day 7. Financial stress was measured using the Psychological Inventory of Financial Scarcity. Results Significant group×time interactions were found for depression (F2,196=8.63; P<.001; η²p=.08) and loneliness (F2,196=5.57; P=.004; η²p=.05), but not for anxiety (F2,196=1.31; P=.27; η²p=.01). Post hoc comparisons showed significant reductions in both depression (t=3.85; P<.001) and loneliness (t=4.28; P<.001) from baseline to postintervention in…
How strong is the evidence?
Evidence Hub reads this as a randomized trial, done in people. Its evidence level is 2 of 5 (High · randomized trial). Randomized trials of a reasonable size are the strongest single-study design. Reported size: 50 participants or records.
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