Reporting Mental Health Symptoms: Breaking Down Barriers to Care with Virtual Human Interviewers

Abstract

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 yearlong 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.

Conversational agents in healthcare: a systematic review

“…Out of 14 conversational agents, 5 were embodied conversational agents 20 , 22–24 , 35 and 2 were chatbots; 21 , 27 the remaining were unspecific conversational agents. …”

“…Patient support was the focus of 7 studies, 19–21 , 24 , 26–28 mostly providing education and training for health-related aspects of their lives. Clinicians were the focus of 4 studies, 22 , 23 , 25 , 35 including 3 studies of conversational agents used to autonomously conduct clinical interviews with diagnostic purposes in mental health and sleep disorders, 22 , 23 , 35 and 1 study of a conversational agent used to assist with data collection and decision support in referral management 25 . A further 6 studies evaluated 3 different conversational agents used in applications supporting both clinicians and patients in telemonitoring and data collection 30–34 …”

Reducing the stigma on posttraumatic stress disorder in militaries through virtual reality

“…In the study of Lucas et al, US active service militaries are interviewed by virtual human interviewers about PTSD symptoms (13). The virtual human interviewers were created by the research group of Rizzo et al using the MultiSense system.…”

Virtual humans: transforming mHealth for veterans with post-traumatic stress disorder (PTSD)

“…As evidenced by Lucas and colleagues (6), one key advantage of using VHs is the simultaneous maximization of both rapport and anonymity. In addition to the applications mentioned by the authors, there may be several additional ways in which human resource management would benefit from this technology, although such uses merit rigorous empirical testing prior to widespread adoption.…”

“…In the present editorial, we review and expand upon the contributions of Lucas and colleagues (6) in furthering research on the use of VHs in clinical assessment, connecting their study to similar interventions on the market (i.e., those of Kognito). In addition, we recommend avenues for future research and potential broader applications of VHs in workplace settings.…”