Engagement Phenotypes for a Sample of 102,684 AI Mental Health Chatbot Users and Dose-Response Associations with Clinical Outcomes
Fuente:
arXiv
Salvato in:
| Autori principali: | , , , , , |
|---|---|
| Natura: | Preprint |
| Pubblicazione: |
2026
|
| Soggetti: | |
| Accesso online: | |
| Tags: |
Aggiungi Tag
Nessun Tag, puoi essere il primo ad aggiungerne!!
|
| _version_ | 1866909007175745536 |
|---|---|
| author | Wolfe, Emma C. Su, Ting Tieleman, Olivier Hull, Thomas D. Malgaroli, Matteo Stamatis, Caitlin A. |
| author_facet | Wolfe, Emma C. Su, Ting Tieleman, Olivier Hull, Thomas D. Malgaroli, Matteo Stamatis, Caitlin A. |
| contents | Background: Conversational AI chatbots are emerging as scalable mental health tools, but little is known about real world engagement or its relationship to clinical outcomes. Objective: To characterize engagement phenotypes among users of Ash, a purpose-built AI mental health chatbot, and examine associations with clinical change and working alliance. Methods: K-means clustering across eight behavioral features identified engagement phenotypes among 102,684 users. Subsamples completed the PHQ-9 (n=298), GAD-7 (n=298), and MSPSS (social support; n=194) baseline and 3 weeks; 11,437 users completed baseline Working Alliance Inventory (WAI). Results: Five engagement phenotypes emerged: Early Dropouts (52.2%), Power Users (1.6%), Intensive Users (4.1%), Weekly Users (25.3%), and a novel Concentrated User pattern (16.8%); across users, 66.9% had at least one overnight session (9pm-5am). Significant pre-post improvements occurred in depression (d = -0.51), anxiety (d = -0.57), and social support (d = 0.22). An observed dose-response gradient in self-reported depression improvement was replicated in a larger sample with model-predicted PHQ-9 (n = 23,813; Power Users d = -0.54; Early Dropouts d = -0.13). Higher working alliance predicted depression improvement and moderated the engagement-social support relationship. Conclusions: Engagement with AI mental health tools is multidimensional, and different clinical outcomes respond to different dimensions of use. Findings caution against treating session counts as a primary engagement metric and offer naturalistic evidence for the clinical value of purpose-built conversational AI. |
| format | Preprint |
| id |
arxiv_https___arxiv_org_abs_2605_00275 |
| institution | arXiv |
| publishDate | 2026 |
| record_format | arxiv |
| spellingShingle | Engagement Phenotypes for a Sample of 102,684 AI Mental Health Chatbot Users and Dose-Response Associations with Clinical Outcomes Wolfe, Emma C. Su, Ting Tieleman, Olivier Hull, Thomas D. Malgaroli, Matteo Stamatis, Caitlin A. Human-Computer Interaction Background: Conversational AI chatbots are emerging as scalable mental health tools, but little is known about real world engagement or its relationship to clinical outcomes. Objective: To characterize engagement phenotypes among users of Ash, a purpose-built AI mental health chatbot, and examine associations with clinical change and working alliance. Methods: K-means clustering across eight behavioral features identified engagement phenotypes among 102,684 users. Subsamples completed the PHQ-9 (n=298), GAD-7 (n=298), and MSPSS (social support; n=194) baseline and 3 weeks; 11,437 users completed baseline Working Alliance Inventory (WAI). Results: Five engagement phenotypes emerged: Early Dropouts (52.2%), Power Users (1.6%), Intensive Users (4.1%), Weekly Users (25.3%), and a novel Concentrated User pattern (16.8%); across users, 66.9% had at least one overnight session (9pm-5am). Significant pre-post improvements occurred in depression (d = -0.51), anxiety (d = -0.57), and social support (d = 0.22). An observed dose-response gradient in self-reported depression improvement was replicated in a larger sample with model-predicted PHQ-9 (n = 23,813; Power Users d = -0.54; Early Dropouts d = -0.13). Higher working alliance predicted depression improvement and moderated the engagement-social support relationship. Conclusions: Engagement with AI mental health tools is multidimensional, and different clinical outcomes respond to different dimensions of use. Findings caution against treating session counts as a primary engagement metric and offer naturalistic evidence for the clinical value of purpose-built conversational AI. |
| title | Engagement Phenotypes for a Sample of 102,684 AI Mental Health Chatbot Users and Dose-Response Associations with Clinical Outcomes |
| topic | Human-Computer Interaction |
| url | https://arxiv.org/abs/2605.00275 |