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Reporting Mental Health Symptoms: Breaking Down Barriers to Care with Virtual Human Interviewers
Open accessAbstract
A common barrier to healthcare for psychiatric conditions is the stigma associated with these disorders. Perceived stigma prevents many from reporting their symptoms. Stigma is a particularly pervasive problem among military service members, preventing them from reporting symptoms of combat-related conditions like posttraumatic stress disorder (PTSD). However, research shows increased reporting by service members when anonymous assessments are used. For example, service members report more symptoms of PTSD when they anonymously answer the Post-Deployment Health Assessment (PDHA) symptom checklist compared to the official PDHA, which is identifiable and linked to their military records. To investigate the factors that influence reporting of psychological symptoms by service members, we used a transformative technology: automated virtual humans that interview people about their symptoms. Such virtual human interviewers allow simultaneous use of two techniques for eliciting disclosure that would otherwise be incompatible; they afford anonymity while also building rapport. We examined whether virtual human interviewers could increase disclosure of mental health symptoms among active-duty service members that just returned from a year-long deployment in Afghanistan. Service members reported more symptoms during a conversation with a virtual human interviewer than on the official PDHA. They also reported more to a virtual human interviewer than on an anonymized PDHA. A second, larger sample of active-duty and former service members found a similar effect that approached statistical significance. Because respondents in both studies shared more with virtual human interviewers than an anonymized PDHA -even though both conditions control for stigma and ramifications for service members’ military records- virtual human interviewers that build rapport may provide a superior option to encourage reporting.
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“Researchers further found that relational agents, which were built based on the theory of rapport, can induce users' openness (77, 78).”
From Digital Therapeutic Alliance With Fully Automated Mental Health Smartphone Apps: A Narrative Review (2022) · cites this paper as [78]
In the citing paper
“It is purported that embodiment makes conversations with chatbots more empathetic and facilitates effective rapport with users [19,42,43].”
From Effectiveness and safety of using chatbots to improve mental health: systematic review and meta-analysis (2020) · cites this paper as [42]
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“This may make artificial intelligence chatbots more effective in building rapport with users, thereby improving their mental health [42].”
From Effectiveness and safety of using chatbots to improve mental health: systematic review and meta-analysis (2020) · cites this paper as [42]
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“chatbots may encourage interaction by those who have traditionally been reluctant to seek mental health advice due to stigmatization [6, 12].”
From An overview of the features of chatbots in mental health: A scoping review (2019) · cites this paper as [12]
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“Most previous chatbot research relied on either finite-state (ie, dialog consisting of a sequence of predetermined steps or states) or frame-based systems (ie, dialog is not predetermined but dependent on the content of the user’s input and the information that the system has to elicit) [34-36].”
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Metadata
- Authors
- Lucas, G. M., Rizzo, A., Gratch, J., Scherer, S., Stratou, G., Boberg, J., & Morency, L.-P.
- Affiliations
- University of Southern California (US)
- Carnegie Mellon University (US)
- Corresponding author
- Lucas, Gale M.
- Venue
- Frontiers in Robotics and AI
- Publisher
- Frontiers Media SA
- Published
- 2017-10-12
- Volume
- 4
- ISSN
- 2296-9144 (ISSN-L)
- OpenAlex
- W2763552934
- Cited by
- 308
- References
- 53
- Citations by year
- 2026: 33 · 2025: 37 · 2024: 63 · 2023: 39 · 2022: 32 · 2021: 42 · 2020: 39 · 2019: 14 · 2018: 9
- FWCI
- 24.27
- Type
- journal article
- Language
- en
- Open access
- gold
- doi.org
- Licence
- cc-by
- Locations
- Frontiers in Robotics and AI (publishedVersion, cc-by)
- DOAJ (DOAJ: Directory of Open Access Journals) (submittedVersion, cc-by-sa)
- Funders
- Defense Sciences Office, DARPA
- Army Research Office
- Topics
- Social Sciences › Psychology › Social Psychology › Social Robot Interaction and HRI
- Social Sciences › Psychology › Applied Psychology › Digital Mental Health Interventions
- Health Sciences › Medicine › Psychiatry and Mental health › Mental Health Treatment and Access
- Keywords
- stigma, post-traumatic stress disorder, military personnel, anonymity, rapport building, disclosure, Afghanistan deployment
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