{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,28]],"date-time":"2026-10-28T03:23:06Z","timestamp":1793157786047,"version":"4.5.0"},"reference-count":63,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2026,7,15]],"date-time":"2026-07-15T00:00:00Z","timestamp":1784073600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Psychiatry"],"abstract":"<jats:p>Mental health disorders represent a growing burden across the Middle East and North Africa (MENA) region, where depression and anxiety are highly prevalent amid conflict, displacement, and socioeconomic strain, affecting up to 40 percent of adults, yet treatment gaps remain at 80-95% due to provider shortages, financial strain, and cultural barriers. In this context, artificial intelligence (AI), in the form of large language models (LLMs) and specialized psychotherapy chatbots, may offer a scalable adjunct to help address these gaps through anonymous screening, predictive risk modeling, psychoeducation, and brief interventions. This narrative review examines current evidence of AI-driven conversational tools in mental health with a specific focus on their application, acceptance, and limitations within the MENA region. To do so, A structured search of MEDLINE and Embase (2000\u20132026) identified studies on conversational AI in mental health, prioritizing evidence from the MENA region and supplemented by relevant global literature. Overall, findings suggest that while these tools offer high accessibility and user engagement, particularly for low-intensity support, their effectiveness is limited by linguistic and cultural mismatches, including Arabic diglossia and poor alignment with locally grounded expressions of distress. At the same time, user acceptance reflects a paradox in which stigma and privacy concerns drive reliance on anonymous AI tools while simultaneously limiting trust in their clinical reliability, reinforcing a preference for hybrid models with human oversight. Taken together, these findings indicate that current systems remain insufficiently adapted to the MENA context, underscoring the need for culturally grounded, dialect-sensitive, and clinically supervised approaches to ensure safe and effective integration.<\/jats:p>","DOI":"10.3389\/fpsyt.2026.1878052","type":"journal-article","created":{"date-parts":[[2026,7,15]],"date-time":"2026-07-15T06:04:57Z","timestamp":1784095497000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":1,"title":["From promise to practice: artificial intelligence in mental health care in the MENA region"],"prefix":"10.3389","volume":"17","author":[{"given":"Sara","family":"El Hajj","sequence":"first","affiliation":[{"name":"Department of Psychiatry, American University of Beirut Medical Center","place":["Beirut, Lebanon"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ahmad","family":"Nsouli","sequence":"additional","affiliation":[{"name":"Department of Psychiatry, American University of Beirut Medical Center","place":["Beirut, Lebanon"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mohamad","family":"Wehbe","sequence":"additional","affiliation":[{"name":"Department of Psychiatry, American University of Beirut Medical Center","place":["Beirut, Lebanon"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"George","family":"Saad","sequence":"additional","affiliation":[{"name":"Faculty of Medicine, American University of Beirut","place":["Beirut, Lebanon"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Fadi T.","family":"Maalouf","sequence":"additional","affiliation":[{"name":"Department of Psychiatry, American University of Beirut Medical Center","place":["Beirut, Lebanon"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1965","published-online":{"date-parts":[[2026,7,15]]},"reference":[{"key":"B1","volume-title":"Over a billion people living with mental health conditions \u2013 services require urgent scale-up","year":"2025"},{"key":"B2","volume-title":"Mental health and COVID-19: early evidence of the pandemic\u2019s impact: scientific brief, 2 March 2022","year":"2022"},{"key":"B3","doi-asserted-by":"publisher","DOI":"10.1002\/mpr.1359","article-title":"Twelve-month and lifetime prevalence and lifetime morbid risk of anxiety and mood disorders in the United States","volume":"21","author":"Kessler","year":"2012","journal-title":"Int J Methods Psychiatr Res"},{"key":"B4","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(18)31612-X","article-title":"The Lancet Commission on global mental health and sustainable development","volume":"392","author":"Patel","year":"2018","journal-title":"Lancet"},{"key":"B5","doi-asserted-by":"publisher","DOI":"10.1007\/s00127-021-02208-4","article-title":"Psychopathology in Children and Adolescents in Lebanon Study (PALS): a national household survey","volume":"57","author":"Maalouf","year":"2022","journal-title":"Soc Psychiatry Psychiatr Epidemiol"},{"key":"B6","doi-asserted-by":"publisher","DOI":"10.1007\/s00127-026-03071-x","article-title":"Youth mental health treatment gap in Lebanon: correlates of barriers to accessing child and adolescent mental health services (CAMHS)","volume":"61","author":"Bolhuis","year":"2026","journal-title":"Soc Psychiatry Psychiatr Epidemiol"},{"key":"B7","doi-asserted-by":"publisher","DOI":"10.1037\/cou0000382","article-title":"Machine learning and natural language processing in psychotherapy research: Alliance as example use case","volume":"67","author":"Goldberg","year":"2020","journal-title":"J Couns Psychol"},{"key":"B8","doi-asserted-by":"publisher","DOI":"10.2196\/57400","article-title":"Large language models for mental health applications: Systematic review","volume":"11","author":"Guo","year":"2024","journal-title":"JMIR Ment Health"},{"key":"B9","volume-title":"Exploring the Dangers of AI in Mental Health Care","year":"2025"},{"key":"B10","doi-asserted-by":"publisher","DOI":"10.1002\/hsr2.71595","article-title":"Use of artificial intelligence in mental healthcare, health psychology, and related research: A narrative review to address challenges and opportunities","volume":"8","author":"Rahman","year":"2025","journal-title":"Health Sci Rep"},{"key":"B11","volume-title":"AI regulation in the Middle East","year":"2024"},{"key":"B12","doi-asserted-by":"publisher","DOI":"10.2196\/78238","article-title":"Generative AI mental health chatbots as therapeutic tools: systematic review and meta-analysis of their role in reducing mental health issues","volume":"27","author":"Zhang","year":"2025","journal-title":"J Med Internet Res"},{"key":"B13","doi-asserted-by":"publisher","DOI":"10.2196\/mental.7785","article-title":"Delivering cognitive behavior therapy to young adults with symptoms of depression and anxiety using a fully automated conversational agent (Woebot): A randomized controlled trial","volume":"4","author":"Fitzpatrick","year":"2017","journal-title":"JMIR Ment Health"},{"key":"B14","article-title":"You\u2019re not crazy\u201d: A case of new-onset AI-associated psychosis","volume":"22","author":"Pierre","year":"2025","journal-title":"Innov Clin Neurosci"},{"key":"B15","article-title":"\u201cAI Psychosis\u201d: Emerging cases of delusion amplification associated with ChatGPT and LLM Chatbot Use \u2013 A psychiatric review","volume-title":"Psychiatry & Psychotherapy Podcast.","author":"Jutla","year":"2025"},{"key":"B16","doi-asserted-by":"publisher","DOI":"10.1016\/j.chb.2022.107273","article-title":"Attitudes and perspectives towards the preferences for artificial intelligence in psychotherapy","volume":"133","author":"Aktan","year":"2022","journal-title":"Comput Hum Behav"},{"key":"B17","doi-asserted-by":"publisher","DOI":"10.1177\/20552076241313401","article-title":"Chatbot-delivered mental health support: Attitudes and utilization in a sample of U.S. college students","volume":"11","author":"Rackoff","year":"2025","journal-title":"Digit Health"},{"key":"B18","doi-asserted-by":"publisher","first-page":"175","DOI":"10.1186\/s40359-025-02491-9","article-title":"The use of artificial intelligence in psychotherapy: development of intelligent therapeutic systems","volume":"13","author":"Spytska","year":"2025","journal-title":"BMC Psychol"},{"key":"B19","doi-asserted-by":"publisher","DOI":"10.7759\/cureus.49486","article-title":"AI-powered mental health virtual assistants\u2019 acceptance: An empirical study on influencing factors among generations X, Y, and Z","volume":"15","author":"Alanzi","year":"2023","journal-title":"Cureus"},{"key":"B20","doi-asserted-by":"publisher","first-page":"194","DOI":"10.1080\/13284207.2025.2515074","article-title":"Attitudes towards Artificial intelligence (AI) in psychotherapy: Artificial Intelligence in Psychotherapy Scale (AIPS)","volume":"29","author":"Bilge","year":"2025","journal-title":"Clin Psychol"},{"key":"B21","doi-asserted-by":"publisher","DOI":"10.2196\/16021","article-title":"Effectiveness and safety of using chatbots to improve mental health: Systematic review and meta-analysis","volume":"22","author":"Abd Alrazaq","year":"2020","journal-title":"J Med Internet Res"},{"key":"B22","doi-asserted-by":"publisher","first-page":"236","DOI":"10.1038\/s41746-023-00979-5","article-title":"Systematic review and meta-analysis of AI-based conversational agents for promoting mental health and well-being","volume":"6","author":"Li","year":"2023","journal-title":"NPJ Digit Med"},{"key":"B23","doi-asserted-by":"publisher","first-page":"1","DOI":"10.1002\/wps.21148","article-title":"Generative artificial intelligence in mental health care: Potential benefits and current challenges","volume":"23","author":"Torous","year":"2024","journal-title":"World Psychiatry"},{"key":"B24","doi-asserted-by":"publisher","DOI":"10.2196\/58462","article-title":"Patient perspectives on AI for mental health care: Cross-sectional survey study","volume":"11","author":"Benda","year":"2024","journal-title":"JMIR Ment Health"},{"key":"B25","doi-asserted-by":"publisher","DOI":"10.2196\/59479","article-title":"The opportunities and risks of large language models in mental health","volume":"11","author":"Lawrence","year":"2024","journal-title":"JMIR Ment Health"},{"key":"B26","doi-asserted-by":"publisher","DOI":"10.2196\/35668","article-title":"Evaluating user feedback for an artificial intelligence\u2013enabled, cognitive behavioral therapy\u2013based mental health app (Wysa): Qualitative thematic analysis","volume":"9","author":"Malik","year":"2022","journal-title":"JMIR Hum Factors"},{"key":"B27","doi-asserted-by":"publisher","DOI":"10.1145\/3442188.3445922","article-title":"On the dangers of stochastic parrots: Can language models be too big","author":"Bender","year":"2021","journal-title":"Proc ACM Conf Fairness Account Transpar"},{"key":"B28","doi-asserted-by":"publisher","DOI":"10.1038\/s44277-024-00016-7","article-title":"Hybrid care in mental health: A framework for understanding care, research, and future opportunities","volume":"2","author":"Chen","year":"2024","journal-title":"NPP Digit Psychiatry Neurosci"},{"key":"B29","doi-asserted-by":"publisher","first-page":"132","DOI":"10.1186\/s12888-025-06483-2","article-title":"The application of artificial intelligence in the field of mental health: a systematic review","volume":"25","author":"Dehbozorgi","year":"2025","journal-title":"BMC Psychiatry"},{"key":"B30","doi-asserted-by":"publisher","first-page":"332","DOI":"10.1007\/s44163-025-00569-2","article-title":"Applications of artificial intelligence in mental health: a systematic literature review","volume":"5","author":"Wajid","year":"2025","journal-title":"Discov Artif Intell"},{"key":"B31","doi-asserted-by":"publisher","first-page":"617","DOI":"10.1186\/s40359-025-02954-z","article-title":"How mental health status and attitudes toward mental health shape AI Acceptance in psychosocial care: a cross-sectional analysis","volume":"13","author":"Fritz","year":"2025","journal-title":"BMC Psychol"},{"key":"B32","doi-asserted-by":"publisher","DOI":"10.1177\/14614448221142007","article-title":"Too human and not human enough: A grounded theory analysis of mental health harms from emotional dependence on the social chatbot Replika","volume":"26","author":"Laestadius","year":"2024","journal-title":"New Media Soc"},{"key":"B33","doi-asserted-by":"crossref","DOI":"10.1007\/s11023-024-09694-w","article-title":"Mapping the ethics of generative AI: A comprehensive scoping review","volume-title":"arXiv","author":"Hagendorff","year":"2024"},{"key":"B34","doi-asserted-by":"publisher","first-page":"719","DOI":"10.1186\/s40359-025-03071-7","article-title":"Investigating psychotherapists\u2019 attitudes towards artificial intelligence in psychotherapy","volume":"13","author":"Wagner","year":"2025","journal-title":"BMC Psychol"},{"key":"B35","doi-asserted-by":"publisher","DOI":"10.3389\/fpsyt.2023.1277756","article-title":"ChatGPT is not ready yet for use in providing mental health assessment and interventions","volume":"14","author":"Dergaa","year":"2024","journal-title":"Front Psychiatry"},{"key":"B36","volume-title":"National Institute of Standards and Technology: Artificial Intelligence Risk Management Framework (AI RMF 1.0)","year":""},{"key":"B37","doi-asserted-by":"publisher","DOI":"10.3390\/healthcare13090963","article-title":"A scoping review of arabic natural language processing for mental health","volume":"13","author":"Alasmari","year":"2025","journal-title":"Healthcare"},{"key":"B38","doi-asserted-by":"crossref","DOI":"10.18653\/v1\/2021.eacl-main.135","article-title":"SpanEmo: Casting multi-label emotion classification as span-prediction","volume-title":"Proceedings for the 16th Conference of the European Chapter of the Association for Computational Linguistics (EACL 2021)","author":"Alhuzali","year":"2021"},{"key":"B39","doi-asserted-by":"crossref","DOI":"10.3390\/healthcare13090963","article-title":"A scoping review of Arabic natural language processing for mental health","volume-title":"Healthcare (Basel)","author":"Alasmari","year":"2025"},{"key":"B40","doi-asserted-by":"publisher","DOI":"10.1016\/j.chiabu.2026.107931","article-title":"Evaluating digital mental health interventions for Middle East and North Africa children and adolescents affected by armed conflict: A systematic review","volume":"173","author":"Iriqat","year":"2026","journal-title":"Child Abuse Negl"},{"key":"B41","doi-asserted-by":"publisher","DOI":"10.4103\/sjmms.sjmms_62_25","article-title":"Arabic mental health apps: A narrative review of therapeutic and engagement features","volume":"13","author":"Al Harrasi","year":"2025","journal-title":"Saudi J Med Med Sci"},{"key":"B42","volume-title":"Mental Health in the Gulf: Reforms and Challenges","author":"Al Yousef","year":""},{"key":"B43","doi-asserted-by":"publisher","DOI":"10.1097\/01.yco.0000179498.46182.8b","article-title":"Mental health practice in Arab countries","volume":"18","author":"Al-Krenawi","year":"2005","journal-title":"Curr Opin Psychiatry"},{"key":"B44","doi-asserted-by":"publisher","DOI":"10.1177\/0020764014537234","article-title":"Suggested avenues to reduce the stigma of mental illness in the Middle East","volume":"61","author":"Sewilam","year":"2015","journal-title":"Int J Soc Psychiatry"},{"key":"B45","doi-asserted-by":"publisher","DOI":"10.2196\/31727","article-title":"Egyptian students open to digital mental health care: cross-sectional survey","volume":"6","author":"Mamdouh","year":"2022","journal-title":"JMIR Form Res"},{"key":"B46","doi-asserted-by":"publisher","DOI":"10.1177\/00220221251406572","article-title":"A systematic review of mental health in the Arab Region","volume":"57","author":"Alshawwa","year":"2026","journal-title":"J Cross Cult Psychol"},{"key":"B47","doi-asserted-by":"publisher","first-page":"59","DOI":"10.1001\/jamapsychiatry.2025.3575","article-title":"Telemental health, hybrid, and in-person outpatient mental health care in the US","volume":"83","author":"Olfson","year":"2026","journal-title":"JAMA Psychiatry"},{"key":"B48","doi-asserted-by":"publisher","DOI":"10.1186\/s12889-025-25386-1","article-title":"AI chatbots as `pocket doctors': intimate health support for young women in Lebanon","volume":"25","author":"Mina","year":"2025","journal-title":"BMC Public Health"},{"key":"B49","doi-asserted-by":"publisher","first-page":"335","DOI":"10.1186\/s12913-025-13832-0","article-title":"Public attitudes and practices toward using AI chatbots for healthcare assistance: a multinational cross-sectional study","volume":"26","author":"Abdelwahed","year":"2025","journal-title":"BMC Health Serv Res"},{"key":"B50","doi-asserted-by":"publisher","DOI":"10.3389\/fpsyt.2025.1601456","article-title":"Perceptions of mental health professionals towards artificial intelligence in mental healthcare: a cross-sectional study","volume":"16","author":"Sharif","year":"2025","journal-title":"Front Psychiatry"},{"key":"B51","doi-asserted-by":"publisher","DOI":"10.2196\/preprints.38558","article-title":"Psychiatrists\u2019 attitudes toward artificial intelligence: Tasks, job security and benefits","author":"Al-Ansari","year":"2023","journal-title":"Bahrain Med Bull"},{"key":"B52","doi-asserted-by":"publisher","DOI":"10.3390\/bs15081119","article-title":"Communication errors in human-chatbot interactions: A case study of ChatGPT Arabic mental health support inquiries","volume":"15","author":"Al-Otaibi","year":"2025","journal-title":"Behav Sci"},{"key":"B53","doi-asserted-by":"publisher","DOI":"10.1037\/h0095015","article-title":"Culture, control, and family involvement: a comparison of psychosocial rehabilitation in India and the United States","volume":"25","author":"Stanhope","year":"2002","journal-title":"Psychiatr Rehabil J"},{"key":"B54","doi-asserted-by":"publisher","DOI":"10.1111\/ejn.15781","article-title":"Behavioural and electrophysiological analyses of written word processing in spoken and literary Arabic: New insights into the diglossia question","volume":"56","author":"Andria","year":"2022","journal-title":"Eur J Neurosci"},{"key":"B55","doi-asserted-by":"publisher","first-page":"5996","DOI":"10.1038\/s41598-026-36252-4","article-title":"Dialectal substitution as an adversarial approach for evaluating Arabic NLP robustness","volume":"16","author":"Alshemali","year":"2026","journal-title":"Sci Rep"},{"key":"B56","doi-asserted-by":"publisher","DOI":"10.1371\/journal.pone.0272991","article-title":"Semantic textual similarity for modern standard and dialectal Arabic using transfer learning","volume":"17","author":"Al Sulaiman","year":"2022","journal-title":"PLoS One"},{"key":"B57","doi-asserted-by":"publisher","DOI":"10.1016\/j.cmpbup.2022.100057","article-title":"Arabic chatbot technologies: A scoping review","volume":"2","author":"Ahmed","year":"2022","journal-title":"Comput Methods Programs BioMed Update"},{"key":"B58","doi-asserted-by":"publisher","DOI":"10.1016\/s0165-0327(97)00037-2","article-title":"Problems in validating endogenous depression in the Arab culture by contemporary diagnostic criteria","volume":"44","author":"Hamdi","year":"1997","journal-title":"J Affect Disord"},{"key":"B59","doi-asserted-by":"publisher","DOI":"10.3389\/fpsyt.2020.579057","article-title":"Exploring the representation of depressive symptoms and the influence of stigma in Arabic-speaking refugee outpatients","volume":"11","author":"Lindheimer","year":"2020","journal-title":"Front Psychiatry"},{"key":"B60","doi-asserted-by":"publisher","DOI":"10.4324\/9781315108322-5","article-title":"Culturally adapted digital mental health interventions for ethnic\/racial minorities: A systematic review and meta-analysis","volume":"90","author":"Ellis","year":"2022","journal-title":"J Consult Clin Psychol"},{"key":"B61","doi-asserted-by":"publisher","DOI":"10.1111\/jan.16762","article-title":"Recommendations for mental health chatbot conversations: An integrative review","volume":"81","author":"Nieminen","year":"2025","journal-title":"J Adv Nurs"},{"key":"B62","doi-asserted-by":"publisher","DOI":"10.2196\/51712","article-title":"The potential of chatbots for emotional support and promoting mental well-being in different cultures: Mixed methods study","volume":"25","author":"Chin","year":"2023","journal-title":"J Med Internet Res"},{"key":"B63","doi-asserted-by":"publisher","DOI":"10.1016\/j.psychres.2024.115724","article-title":"Psychiatrists\u2019 experiences and opinions of generative artificial intelligence in mental healthcare: An online mixed methods survey","volume":"333","author":"Blease","year":"2024","journal-title":"Psychiatry Res"}],"container-title":["Frontiers in Psychiatry"],"original-title":[],"link":[{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fpsyt.2026.1878052\/full","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,7,15]],"date-time":"2026-07-15T06:04:59Z","timestamp":1784095499000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fpsyt.2026.1878052\/full"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,7,15]]},"references-count":63,"alternative-id":["10.3389\/fpsyt.2026.1878052"],"URL":"https:\/\/doi.org\/10.3389\/fpsyt.2026.1878052","relation":{},"ISSN":["1664-0640"],"issn-type":[{"value":"1664-0640","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,7,15]]},"article-number":"1878052"}}