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Authors’ Response to Peer Reviews of “Challenges in Implementing a Mobile AI Chatbot Intervention for Depression Among Youth on Psychiatric Waiting Lists: Randomized Controlled Study Termination Report”

Authors’ Response to Peer Reviews of “Challenges in Implementing a Mobile AI Chatbot Intervention for Depression Among Youth on Psychiatric Waiting Lists: Randomized Controlled Study Termination Report”

Response: A paragraph summarizing prior chatbot-led interventions in Japan has been added to the Introduction section, specifically in the fifth paragraph. This revision also incorporates cultural factors unique to Japan, providing a more comprehensive understanding of how chatbot interventions are perceived and utilized in this context.

Junichi Fujita, Yuichiro Yano, Satoru Shinoda, Noriko Sho, Masaki Otsuki, Akira Suda, Mizuho Takayama, Tomoko Moroga, Hiroyuki Yamaguchi, Mio Ishii, Tomoyuki Miyazaki

JMIRx Med 2025;6:e82083


Peer Review of “Challenges in Implementing a Mobile AI Chatbot Intervention for Depression Among Youth on Psychiatric Waiting Lists: Randomized Controlled Study Termination Report”

Peer Review of “Challenges in Implementing a Mobile AI Chatbot Intervention for Depression Among Youth on Psychiatric Waiting Lists: Randomized Controlled Study Termination Report”

The authors stated that the design they chose “reflects the real-world experience of many psychiatric waiting list patients in Japan,” but as they also declared, “the lack of timely intervention can exacerbate symptoms and increase the risk of severe outcomes.” Therefore, given such a risk, my question is: what is the rationale behind the authors’ decision to employ a passive control group?

Beatrice Tosti

JMIRx Med 2025;6:e82074


Peer Review of “Challenges in Implementing a Mobile AI Chatbot Intervention for Depression Among Youth on Psychiatric Waiting Lists: Randomized Controlled Study Termination Report”

Peer Review of “Challenges in Implementing a Mobile AI Chatbot Intervention for Depression Among Youth on Psychiatric Waiting Lists: Randomized Controlled Study Termination Report”

This paper [1] describes the results of a parallel group randomized controlled trial that examined the feasibility of an artificial intelligence (AI) chatbot-led mental health intervention to support pediatric patients on the psychiatry waitlists in Japan. The article is well-written and organized, and the objectives of the study are clearly stated. Methodology elements such as eligibility criteria, information sources, and data collection process are clear.

Maria da Graca Ambrosio

JMIRx Med 2025;6:e82073


Challenges in Implementing a Mobile AI Chatbot Intervention for Depression Among Youth on Psychiatric Waiting Lists: Randomized Controlled Study Termination Report

Challenges in Implementing a Mobile AI Chatbot Intervention for Depression Among Youth on Psychiatric Waiting Lists: Randomized Controlled Study Termination Report

Japan has a growing number of mental health technology apps, including various AI-driven chatbots, as outlined in recent market analyses. Several AI chatbots for mental health care have demonstrated reasonable feasibility, acceptability, and potential usefulness in Japan [15,16]. However, despite the high smartphone adoption rate among young people (96.9% among those aged 18‐29 years), actual usage of health management services remains notably low at only 21.6% [17].

Junichi Fujita, Yuichiro Yano, Satoru Shinoda, Noriko Sho, Masaki Otsuki, Akira Suda, Mizuho Takayama, Tomoko Moroga, Hiroyuki Yamaguchi, Mio Ishii, Tomoyuki Miyazaki

JMIRx Med 2025;6:e70960


Expressions of “Ikizurasa” in Posts on X (Formerly Twitter) in Japan in 2023: Descriptive Analysis

Expressions of “Ikizurasa” in Posts on X (Formerly Twitter) in Japan in 2023: Descriptive Analysis

In Japan, deaths from suicide declined during the early phase of the COVID-19 pandemic but later increased, especially among women and people younger than 40 years [1]. Depression and hopelessness are key predictors of suicidal ideation and behavior [2,3]. Recently, ikizurasa (“pain of living”) has drawn attention as a factor in adolescent mental health issues, including hikikomori (“being confined,” a term used to describe deep social isolation) and suicide [4].

Kanami Tsuno, Azusa Arimoto, Yuki Imamatsu, Yumiko Kobayashi, Miho Satoh, Tomoyuki Miyazaki

JMIR Form Res 2025;9:e70613


Assessing the Efficacy of the INTELLECT Cognitive Behavioral Therapy Mobile App for Anxiety and Depressive Symptoms Among At-Risk Japanese Employees: Randomized Controlled Trial

Assessing the Efficacy of the INTELLECT Cognitive Behavioral Therapy Mobile App for Anxiety and Depressive Symptoms Among At-Risk Japanese Employees: Randomized Controlled Trial

Similar figures were reported in Japan, where a previous study [3] conducted a nationwide survey of over 8000 Japanese citizens and found that approximately one-fifth of respondents experienced clinically severe anxiety and depressive symptoms. Numerous studies also found that significant changes in the economic and working conditions caused by the pandemic contributed to a marked increase in symptoms of anxiety and depression among Japanese employees [4-6].

Kengo Yokomitsu, Riki Oimatsu, Sean Han Yang Toh, Oliver Sündermann

JMIR Mhealth Uhealth 2025;13:e60871


Age-Specific Differences in Association Between Personality and Changes in Outing Behaviors During the COVID-19 Pandemic in Japan: Cross-Sectional Web-Based Questionnaire Survey

Age-Specific Differences in Association Between Personality and Changes in Outing Behaviors During the COVID-19 Pandemic in Japan: Cross-Sectional Web-Based Questionnaire Survey

For instance, Shinohara conducted a prospective six-month cohort study immediately after the first travel and public gathering restrictions in Japan, reporting an increase in frailty among older people [6]. Esquinas reported a decrease in physical activity and an increase in sedentary lifestyle for community-dwelling older people several weeks after a lockdown was implemented in Spain [7].

Kaori Yamaguchi, Takemi Akahane, Emi Yasuda, Manabu Akahane

Online J Public Health Inform 2025;17:e63120


Assessing the Reliability and Validity of Principles for Health-Related Information on Social Media (PRHISM) for Evaluating Breast Cancer Treatment Videos on YouTube: Instrument Validation Study

Assessing the Reliability and Validity of Principles for Health-Related Information on Social Media (PRHISM) for Evaluating Breast Cancer Treatment Videos on YouTube: Instrument Validation Study

In Japan, about 50% of people use the internet as a method for collecting medical information [3]. The sources of information include those officially provided by national cancer centers, as well as those from social media. On social media, anyone can post information regardless of their expertise or qualifications, making it very difficult for patients to judge the quality of that information, which is often a mix of reliable and unreliable sources [4].

Hiroki Kusama, Yoshimitsu Takahashi, Shunichiro Orihara, Kayo Adachi, Yumiko Ishizuka, Ryoko Semba, Hidetaka Shima, Yoshiya Horimoto, Hiroshi Kaise, Masataka Taguri, Sho Inoue, Takeo Nakayama, Takashi Ishikawa

JMIR Infodemiology 2025;5:e66416