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Utility of AI-based decision support systems in mental health: Needs and challenges for shared decision-making
Halmstad University, School of Health and Welfare.ORCID iD: 0000-0002-5040-7242
2025 (English)Licentiate thesis, comprehensive summary (Other academic)
Abstract [en]

Mental healthcare services have been put under pressure from the demands of the increase in the prevalence of mental health problems. The rapid development of technologies, such as Artificial Intelligence (AI), in healthcare provides significant opportunities for the mental health services, including an improvement in clinical decision-making. However, the implementation and integration of AI-based decision support systems (DSSs) into mental healthcare present concerns regarding its sustainable use, which potentially may conflict with decision-making workflows, communication with the patient, and shared decision-making (SDM) processes.  The main objective of this thesis is to explore the role of AI-based DSSs in mental healthcare, with a specific focus on the requirements for integrating shared decision-making (SDM) principles into these systems. The thesis is based on a combination of two studies. The first is a scoping review with the aim of examining the empirical evidence regarding the use of AI-based DSSs in current research and how these systems have been researched, implemented, and evaluated in relation to the support of decision-making. This study included twelve studies that examined AI-based DSSs in healthcare, self-care, and simulation settings. The findings identified AI-based DSSs with a variation of utility, including the support for diagnosis and prediction of mental health state, treatment selection, and self-help for individuals seeking care. These AI-based systems had diverse data flows and a range of end-user interface interactions, which contributed to observable variations of decision-making processes. The evaluation of these AI-based systems revealed challenges, including their accuracy, workflow alteration, trustworthiness, and patient-healthcare professional communication when looking at the three factors of human, organization, and technology.  The second study is a qualitative study, with semi-structured interviews with the aim of exploring the requirements for using AI-based DSSs in mental healthcare from the healthcare professionals’ perspective and grounded in a shared decision-making framework. The findings showed that healthcare professionals emphasized the need for AI-based DSSs in relation to supporting early detection, holistic assessments, and a flexible healthcare approach in triage and personalized treatment recommendations. However, concerns were raised about inaccuracies in interpreting non-verbal cues, risks of overdiagnosis, reduced clinician autonomy, and missing human interaction with more use of AI that may lead to unseen problems such as a weakened trust in the therapeutic relationships. The key findings of this thesis are: (1) research on AI-based DSSs in mental health is in a pre-implementation stage, with no studies examining post-implementation adoption in clinical processes, (2) several potential implementation barriers and facilitators identified in relation to human, organization, and technology fit framework for the three AI types in the scoping review, with a significant gap of studies focusing on organization factor, (3) none of the literature in the scoping review explored SDM as a process when using or adopting AI-based DSSs in clinical workflows, (4) needs and concerns related to SDM elements were emphasized by healthcare professionals in all major categories of the SDM integrative model (essential, ideal, and general). However, SDM as a distinct and explicitly defined concept in healthcare practice was not illustrated by healthcare professionals.  In conclusion, the research on AI-based DSSs is still in its infancy stage, needing more empirical studies to evaluate the impact of these systems on the decision-making processes and closing the gap of missed SDM empirical investigation. When investigating SDM, it is crucial to consider both implicit and explicit representations of SDM to help derive meaningful research outcomes for the design and implementation of AI-based DSSs in future research.

Place, publisher, year, edition, pages
Halmstad: Halmstad University Press, 2025. , p. 68
Series
Halmstad University Dissertations ; 129
Keywords [en]
Artificial intelligence, mental health, shared decision-making, implementation, decision support systems, healthcare professionals, and young adults.
National Category
Public Health, Global Health and Social Medicine Health Care Service and Management, Health Policy and Services and Health Economy
Research subject
Health Innovation, IDC
Identifiers
URN: urn:nbn:se:hh:diva-55599ISBN: 978-91-89587-75-5 (print)ISBN: 978-91-89587-74-8 (electronic)OAI: oai:DiVA.org:hh-55599DiVA, id: diva2:1943116
Presentation
2025-04-04, S-huset Hörsal 1022, Högskolan i Halmstad, Kristian IV:s väg 3, Halmstad, 09:00 (English)
Opponent
Supervisors
Funder
Halmstad UniversityKnowledge Foundation, 20200208 01HAvailable from: 2025-03-12 Created: 2025-03-08 Last updated: 2025-03-18Bibliographically approved
List of papers
1. The Use of AI in Mental Health Services to Support Decision-Making: Scoping Review
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2025 (English)In: Journal of Medical Internet Research, E-ISSN 1438-8871, Vol. 27, article id e63548Article, review/survey (Refereed) Published
Abstract [en]

Background:Recent advancements in artificial intelligence (AI) have changed the care processes in mental health, particularly in decision-making support for health care professionals and individuals with mental health problems. AI systems provide support in several domains of mental health, including early detection, diagnostics, treatment, and self-care. The use of AI systems in care flows faces several challenges in relation to decision-making support, stemming from technology, end-user, and organizational perspectives with the AI disruption of care processes.

Objective:This study aims to explore the use of AI systems in mental health to support decision-making, focusing on 3 key areas: the characteristics of research on AI systems in mental health; the current applications, decisions, end users, and user flow of AI systems to support decision-making; and the evaluation of AI systems for the implementation of decision-making support, including elements influencing the long-term use.

Methods:A scoping review of empirical evidence was conducted across 5 databases: PubMed, Scopus, PsycINFO, Web of Science, and CINAHL. The searches were restricted to peer-reviewed articles published in English after 2011. The initial screening at the title and abstract level was conducted by 2 reviewers, followed by full-text screening based on the inclusion criteria. Data were then charted and prepared for data analysis.

Results:Of a total of 1217 articles, 12 (0.99%) met the inclusion criteria. These studies predominantly originated from high-income countries. The AI systems were used in health care, self-care, and hybrid care contexts, addressing a variety of mental health problems. Three types of AI systems were identified in terms of decision-making support: diagnostic and predictive AI, treatment selection AI, and self-help AI. The dynamics of the type of end-user interaction and system design were diverse in complexity for the integration and use of the AI systems to support decision-making in care processes. The evaluation of the use of AI systems highlighted several challenges impacting the implementation and functionality of the AI systems in care processes, including factors affecting accuracy, increase of demand, trustworthiness, patient-physician communication, and engagement with the AI systems.

Conclusions:The design, development, and implementation of AI systems to support decision-making present substantial challenges for the sustainable use of this technology in care processes. The empirical evidence shows that the evaluation of the use of AI systems in mental health is still in its early stages, with need for more empirically focused research on real-world use. The key aspects requiring further investigation include the evaluation of the use of AI-supported decision-making from human-AI interaction and human-computer interaction perspectives, longitudinal implementation studies of AI systems in mental health to assess the use, and the integration of shared decision-making in AI systems.

©Hassan Auf, Petra Svedberg, Jens Nygren, Monika Nair, Lina E. Lundgren.

Place, publisher, year, edition, pages
Toronto: JMIR Publications, 2025
Keywords
AI, artificial intelligence, decision-making, human-computer interaction, implementation, mental health, shared decision-making
National Category
Health Care Service and Management, Health Policy and Services and Health Economy
Research subject
Health Innovation; Health Innovation, IDC
Identifiers
urn:nbn:se:hh:diva-55429 (URN)10.2196/63548 (DOI)001411227400001 ()39854710 (PubMedID)2-s2.0-85216280035 (Scopus ID)
Available from: 2025-02-14 Created: 2025-02-14 Last updated: 2025-03-08Bibliographically approved
2. Healthcare professionals’ perspectives on AI-driven decision support in young adult mental health: An analysis through the lens of a shared decision-making framework
Open this publication in new window or tab >>Healthcare professionals’ perspectives on AI-driven decision support in young adult mental health: An analysis through the lens of a shared decision-making framework
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(English)In: Frontiers in Digital Health, E-ISSN 2673-253XArticle in journal (Other academic) Submitted
Keywords
artificial intelligence, shared decision-making, decision support systems, healthcare professionals, and young adults
National Category
Health Care Service and Management, Health Policy and Services and Health Economy Public Health, Global Health and Social Medicine
Identifiers
urn:nbn:se:hh:diva-55596 (URN)
Funder
Halmstad UniversityKnowledge Foundation, 20200208 01H
Available from: 2025-03-08 Created: 2025-03-08 Last updated: 2025-03-12Bibliographically approved

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