AI Chatbots for Anxiety Mental Health Literacy

The Anxiety Literacy Scale is a 22-item questionnaire designed to assess individuals' knowledge about anxiety. Each statement is answered using a binary response format (true or false). For each item, participants are also asked to rate their certainty in their response on a 5-point Likert scale. Correct responses are summed to produce a total knowledge score, with higher scores indicating greater anxiety-related mental health literacy. Certainty ratings are used to assess participants' confidence in their knowledge and to examine the calibration between knowledge accuracy and subjective certainty.

The Anxiety Stigma Scale is designed to measure stigma associated with Anxiety. It has two subscales which measure two different types of stigma: personal and perceived. The Personal Stigma Subscale measures stigma in the respondents own attitudes towards anxiety by asking them to indicate how strongly they personally agree with ten statements about anxiety.

The Perceived Stigma Subscale measures the respondent's perception about the attitudes of others towards anxiety by asking them to indicate what they think most other people believe about the same ten statements.

Responses to each item are measured on a five-point scale (ranging from zero 'strongly disagree' to four 'strongly agree'). Higher scores indicate higher levels of depression stigma.

The General Help-Seeking Questionnaire (GHSQ) in this study is an adapted 17-item version designed to fit Chinese cultural contexts. It assesses an individual's intentions to seek help for personal or emotional problems from both formal sources (e.g., mental health professionals, doctors) and informal sources (e.g., family, friends). Each item is rated on a 7-point Likert scale, ranging from 1 ("Extremely Unlikely") to 7 ("Extremely Likely"), with higher scores indicating a greater likelihood of seeking help.

The Confidence in Helping Others Scale is a self-developed, 13-item questionnaire designed to measure participants' confidence in providing support to individuals experiencing mental health issues. Each item is rated on a 5-point Likert scale, ranging from 1 ("Strongly Disagree") to 5 ("Strongly Agree"), with higher scores indicating greater confidence in recognizing symptoms, offering emotional support, and encouraging help-seeking.

The Mental Health Self-efficacy Scale is a 6-item questionnaire designed to measure participants' confidence in effectively manage stress, anxiety or depression about themself. Each item is rated on a 10-point Likert scale, ranging from 1 ("Not at all confident") to 10 ("Totally confident"), with higher scores indicating greater confidence in self-efficacy about mental health.

The Bot Usability Scale (BUS) in this study is an adapted 11-item version designed to assess the usability of AI-based chatbots. It evaluates participants' perceptions of the ease of use, effectiveness, efficiency, and overall user experience of the chatbots. The scale uses a 5-point Likert scale, ranging from 1 ("Strongly Disagree") to 5 ("Strongly Agree"), with higher scores indicating better perceived usability. Participants will complete the adapted BUS separately for both the AI Educator and the AI Anxiety Friend Simulators. The adapted BUS maintains the core usability assessment principles of the original scale while being tailored for AI-driven conversational agents.

The Generalized Anxiety Disorder-7 (GAD-7) is a 7-item self-report questionnaire used to assess the severity of generalized anxiety symptoms over the past two weeks. Each item corresponds to common symptoms of generalized anxiety disorder (GAD) and is rated on a 4-point Likert scale, ranging from 0 ("Not at all") to 3 ("Nearly every day"), with higher scores indicating greater symptom severity.

The Patient Health Questionnaire (PHQ-9) consists of 9 items designed to assess the severity of depressive symptoms over the past two weeks. Each item corresponds to one of the nine DSM-5 criteria for major depressive disorder and is rated on a 4-point Likert scale, ranging from 0 ("Not at all") to 3 ("Nearly every day"), with higher scores indicating greater symptom severity.

Intolerance of Uncertainty Scale is designed to measure participants' attidudes about uncertaunty. It is a self-developed, 12-item questionnaire, ranging from 1 ("not at all characteristic for me")) to 5 ("entirely characteristic of me"), with higher scores indicating greater intolerance.

Sometimes programs that aim to improve mental health can also have unwanted effects.The Negative Effects Scale (NES) is a 6-item self-report assessment tool designed to measure the participants' perceptions of unwanted experience. Each item is rated on a 5-point Likert scale, ranging from 1 (" Not at al") to 5 ("Extremely severe"), with higher scores indicating a greater negative Effects.

The Basic Empathy Scale in Adults (BES-A) is a 20-item self-report questionnaire designed to assess an individual's capacity for empathy, including both cognitive empathy (understanding others' emotions) and affective empathy (sharing others' emotions). Each item is rated on a 5-point Likert scale, ranging from 1 ("Strongly Disagree") to 5 ("Strongly Agree"), with higher scores indicating greater empathy.

This questionnaire is self-conducted and assesses the frequency of various mental health-related behaviors over the past month. Participants rate each behavior based on how often they engaged in it, using a 5-point scale (0 = Never, 4 = More than 4 times per week). The results provide insight into individuals' proactive engagement in mental well-being practices.

The Peking Alexithymia Scale (PAS) is a culturally adapted assessment tool designed to measure alexithymia-a personality construct characterized by difficulties in identifying and describing one's own emotions, coupled with an externally oriented thinking style-among Chinese populations. This subscale consists of 9 items divided into three distinct dimensions, each targeting a core feature of alexithymia.