Kerstin Denecke ¹ Elia Gabarron ^2*

• ¹ Bern University of Applied Sciences, Bern, Switzerland
• ² Østfold University College, Halden, Østfold, Norway

Digital health interventions specifically those realized as chatbots are increasingly available for mental health. They include technologies based on artificial intelligence that assess user's sentiment and emotions for the purpose of responding in an empathetic way, or for treatment purposes, e.g. for analyzing the expressed emotions and suggesting interventions. In this paper, we study the ethical dimensions of integrating these technologies in chatbots for depression intervention using the digital ethics canvas and the DTx Risk Assessment Canvas. As result, we identified some specific risks associated with the integration of sentiment and emotion analysis methods into these systems related to the difficulty to recognize correctly the expressed sentiment or emotion from statements of individuals with depressive symptoms and the appropriate system reaction including risk detection. Depending on the realization of the sentiment or emotion analysis, which might be dictionary-based or machine-learning based, additional risks occur from biased training data or misinterpretations. While technology decisions during system development can be made carefully depending on the use case, other ethical risks cannot be prevented on a technical level, but by carefully integrating such chatbots into the care process allowing for supervision by health professionals. We conclude that a careful reflection is needed when integrating sentiment and emotion analysis into chatbots for depression intervention. Balancing risk factors is key to leveraging technology in mental health in a way that enhances, rather than diminishes, user autonomy and agency.