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Oliva, VincenzoAuthorRodríguez Rey, Manuel ArturoAuthorAnmella GAuthorSanabra MAuthorCavero MAuthorMorilla IAuthorGrande IAuthorRuiz VAuthorMas AAuthorPiazza FAuthorSolanes AAuthorRadua JAuthorSans-Corrales MAuthorCaballeria EAuthorLópez-Pelayo HAuthorLópez CAuthorSolé BAuthorTorrent CAuthorMartinez-Arán AAuthorGuarch JAuthorNavines RAuthorMurru, AndreaAuthorFico, GiovannaAuthorDe Prisco, MicheleAuthorAmoretti, SilviaAuthorVieta Pascual, EduardAuthorHidalgo Mazzei, Diego AlbertoCorresponding Author

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Vickybot, a chatbot for anxiety-depressive symptoms and work-related burnout in primary care and healthcare professionals: development, feasibility, and potential effectiveness studies

Publicated to:Journal Of Medical Internet Research. 25 e43293- - 2023-04-03 25(), DOI: 10.2196/43293

Authors: Anmella, Gerard; Sanabra, Miriam; Prime-Tous, Mireia; Segu, Xavier; Cavero, Myriam; Morilla, Ivette; Grande, Iria; Ruiz, Victoria; Mas, Ariadna; Martin-Villalba, Ines; Caballo, Alejandro; Esteva, Julia-Parisad; Rodriguez-Rey, Arturo; Piazza, Flavia; Valdesoiro, Francisco Jose; Rodriguez-Torrella, Claudia; Espinosa, Marta; Virgili, Giulia; Sorroche, Carlota; Ruiz, Alicia; Solanes, Aleix; Radua, Joaquim; Also, Maria Antonieta; Murgui, Sandra; Sans-Corrales, Mireia; Young, Allan H; Vicens, Victor; Blanch, Jordi; Caballeria, Elsa; Lopez-Pelayo, Hugo; Lopez, Clara; Olive, Victoria; Pujol, Laura; Quesada, Sebastiana; Sole, Brisa; Torrent, Carla; Martinez-Aran, Anabel; Guarch, Joana; Navines, Ricard; Murru, Andrea; Fico, Giovanna; de Prisco, Michele; Oliva, Vicenzo; Amoretti, Silvia; Pio-Carrino, Casimiro; Fernandez-Canseco, Maria; Villegas, Marta; Vieta, Eduard; Hidalgo-Mazzei, Diego

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Abstract

A significant proportion of people attending Primary Care (PC) have anxiety-depressive symptoms and work-related burnout compounded by a lack of resources to meet their needs. The COVID-19 pandemic has exacerbated this problem and digital tools have been proposed as a solution.We present the development, feasibility, and potential effectiveness studies of Vickybot, a chatbot aimed at screening, monitoring, and reducing anxiety-depressive symptoms and work-related burnout in PC patients and healthcare workers.User-centered development strategies were adopted. Main functions included self-assessments, psychological modules, and emergency alerts. Healthy controls (HCs) tested Vickybot for reliability. (1) Simulation: HCs used Vickybot for 2 weeks to simulate different clinical situations. (2) Feasibility and effectiveness study: People consulting PC or healthcare workers with mental health problems were offered to use Vickybot for one month. Self-assessments for anxiety (GAD-7) and depression (PHQ-9) symptoms, and work-related burnout (based on the Maslach Burnout Inventory) were administered at baseline and every two weeks. Feasibility was determined from both subjective and objective user-engagement Indicators (UEIs). Potential effectiveness was measured using paired t-tests or the Wilcoxon signed-rank test for the change in self-assessment scores.40 HCs tested Vickybot simultaneously, and data was transmitted and registered reliably. (1) Simulation: 17 HCs (73% female; mean age=36.5±9.7) received 98.8% of the expected modules according to each simulation. Suicidal alerts were correctly received. (2) Feasibility and potential effectiveness study: 34 patients (15 from PC and 19 healthcare workers; 77% female; mean age=35.3±10.1) completed the first self-assessments, with 34 (100%) presenting anxiety symptoms, 32 (94%) depressive symptoms, and 22 (64.7%) work-related burnout. Nine (26.5%) patients completed the second self-assessments after two weeks of use. No significant differences were found between the scores of the first and second self-assessments for anxiety [t(8) = 1.000, P = .34] or depressive [t(8) = .40, P = .70] symptoms. However, work-related burnout scores were moderately reduced (Z = -2.07, P = 0.038, r = .32). There was a non-significant trend towards higher reduction in anxiety-depressive symptoms and work-related burnout with greater use of the chatbot. Three patients (8.8%) activated the suicide alert, and the research team intervened promptly with successful outcomes. Vickybot showed high subjective-UEIs, but low objective-UEIs (completion, adherence, compliance, and engagement). Feasibility was moderate.The chatbot was useful in screening for the presence and severity of anxiety and depressive symptoms, and detecting suicidal risk. Potential effectiveness was shown in reducing work-related burnout, but not anxiety or depressive symptoms. Subjective perceptions of use contrasted with low objective-use metrics. Our results are promising but suggest the need to adapt and enhance the smartphone-based solution in order to improve engagement. Consensus on how to report UEIs and validate digital solutions, especially for chatbots, are required.

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