{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,15]],"date-time":"2026-10-15T06:44:55Z","timestamp":1792046695580,"version":"4.4.0"},"reference-count":28,"publisher":"South American Publishing","license":[{"start":{"date-parts":[[2026,10,16]],"date-time":"2026-10-16T00:00:00Z","timestamp":1792108800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"},{"start":{"date-parts":[[2026,10,16]],"date-time":"2026-10-16T00:00:00Z","timestamp":1792108800000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["southam.pub","www.southam.pub"],"crossmark-restriction":false},"short-container-title":["SAP Social AI"],"accepted":{"date-parts":[[2026,10,15]]},"abstract":"<jats:p>Introduction: conversational agents based on generative artificial intelligence (AI) are increasingly used for emotional support, largely outside clinical frameworks. Objective: to synthesise the available evidence on the clinical efficacy, the clinical and psychosocial risks, and the governance of generative AI conversational agents in mental health, and to identify implications for clinical practice and health policy. Methods: narrative review based on a non-systematic search of randomised trials, systematic reviews, observational and experimental studies, technical evaluations and regulatory documents, with a qualitative synthesis organised in four areas. Development: in a national survey, 13.1% of US youths aged 12 to 21 reported using generative AI for mental health advice. A meta-analysis of AI-based conversational agents showed reductions in depressive symptoms and distress, and the first randomised trial of a purpose-built generative agent reported greater symptom reduction than a waitlist over four weeks, whereas a pilot trial in Argentina found no significant between-group differences. Documented risks include stigma and inappropriate responses, inconsistent handling of intermediate-risk suicide-related queries, sycophancy, reinforcement of delusional thinking and emotional dependence. Regulation is fragmented: at its November 2025 advisory meeting the US Food and Drug Administration noted that no authorised AI-enabled device used generative AI for mental health conditions, US states have adopted divergent laws, and the European Union AI Act imposes transparency obligations. Conclusions: evidence of benefit comes mainly from purpose-built agents tested in short trials, whereas real-world use relies on general-purpose and companion chatbots. These tools should be considered a complement to, not a substitute for, clinical care, with risk-based regulation, independent auditing, age-appropriate safeguards and trials in Spanish- and Portuguese-speaking populations.<\/jats:p>","DOI":"10.62486\/sai2026109","type":"journal-article","created":{"date-parts":[[2026,10,15]],"date-time":"2026-10-15T06:00:36Z","timestamp":1792044036000},"page":"109","update-policy":"https:\/\/doi.org\/10.62486\/crossmark","source":"Crossref","is-referenced-by-count":0,"title":["Generative artificial intelligence conversational agents in mental health care: clinical evidence, psychosocial risks and governance. A narrative review"],"prefix":"10.62486","volume":"2","author":[{"ORCID":"https:\/\/orcid.org\/0009-0000-6028-9377","authenticated-orcid":false,"given":"Maikro Osvaldo","family":"Ch\u00e1vez Moya","sequence":"first","affiliation":[{"name":"Universidad de Ciencias M\u00e9dicas de Villa Clara. Santa Clara, Cuba."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0007-9109-9585","authenticated-orcid":false,"given":"Leodanis Hern\u00e1ndez","family":"Cabrera","sequence":"additional","affiliation":[{"name":"Universidad de Ciencias M\u00e9dicas de Villa Clara. Santa Clara, Cuba."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0002-8489-2474","authenticated-orcid":false,"given":"Lauren Mart\u00ednez","family":"Ram\u00edrez","sequence":"additional","affiliation":[{"name":"Universidad de Ciencias M\u00e9dicas de Villa Clara. Santa Clara, Cuba."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0005-4952-9938","authenticated-orcid":false,"given":"Mariam Alejandra","family":"Gonz\u00e1lez Gonz\u00e1lez","sequence":"additional","affiliation":[{"name":"Universidad de Ciencias M\u00e9dicas de Villa Clara. Santa Clara, Cuba."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0001-8328-0938","authenticated-orcid":false,"given":"Andy Alonso","family":"Pazos","sequence":"additional","affiliation":[{"name":"Universidad de Ciencias M\u00e9dicas de Villa Clara. Santa Clara, Cuba."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0001-2924-2666","authenticated-orcid":false,"given":"Laura Beatriz","family":"Fern\u00e1ndez Feit\u00f3","sequence":"additional","affiliation":[{"name":"Universidad de Ciencias M\u00e9dicas de Villa Clara. Santa Clara, Cuba."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0006-5379-0052","authenticated-orcid":false,"given":"Gabriela Gonz\u00e1lez","family":"Pernas","sequence":"additional","affiliation":[{"name":"Universidad de Ciencias M\u00e9dicas de Villa Clara. Santa Clara, Cuba."}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"48931","published-online":{"date-parts":[[2026,10,16]]},"reference":[{"key":"ref1","unstructured":"1 Organizaci\u00f3n Mundial de la Salud. World mental health today: latest data. Ginebra: OMS; 2025."},{"key":"ref2","unstructured":"2 Organizaci\u00f3n Mundial de la Salud. Over a billion people living with mental health conditions \u2013 services require urgent scale-up [Internet]. Ginebra: OMS; 2 de septiembre de 2025 [citado 4 de octubre de 2026]. Disponible en: https:\/\/www.who.int\/news\/item\/02-09-2025-over-a-billion-people-living-with-mental-health-conditions-services-require-urgent-scale-up"},{"key":"ref3","doi-asserted-by":"crossref","unstructured":"3 McBain RK, et al. Use of generative AI for mental health advice among US adolescents and young adults. 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Npj Ment Health Res. 2 de abril de 2024;3:12. doi:10.1038\/s44184-024-00056-z","DOI":"10.1038\/s44184-024-00056-z"},{"key":"ref21","unstructured":"21 Contribuciones de autores"},{"key":"ref22","unstructured":"22 Conceptualizaci\u00f3n: Maikro Osvaldo Ch\u00e1vez Moya, Leodanis Hern\u00e1ndez Cabrera, Gabriela Gonz\u00e1lez Pernas."},{"key":"ref23","unstructured":"23 Metodolog\u00eda: Laura Beatriz Fern\u00e1ndez Feit\u00f3, Lauren Mart\u00ednez Ram\u00edrez."},{"key":"ref24","unstructured":"24 Investigaci\u00f3n: Mariam Alejandra Gonz\u00e1lez Gonz\u00e1lez, Andy Alonso Pazos, Leodanis Hern\u00e1ndez Cabrera."},{"key":"ref25","unstructured":"25 An\u00e1lisis formal: Gabriela Gonz\u00e1lez Pernas, Maikro Osvaldo Ch\u00e1vez Moya."},{"key":"ref26","unstructured":"26 Redacci\u00f3n - borrador inicial: Lauren Mart\u00ednez Ram\u00edrez, Andy Alonso Pazos."},{"key":"ref27","unstructured":"27 Redacci\u00f3n - revisi\u00f3n y edici\u00f3n: Laura Beatriz Fern\u00e1ndez Feit\u00f3, Mariam Alejandra Gonz\u00e1lez Gonz\u00e1lez, Leodanis Hern\u00e1ndez Cabrera."},{"key":"ref28","unstructured":"28 Supervisi\u00f3n: Maikro Osvaldo Ch\u00e1vez Moya."}],"container-title":["SAP Social AI"],"original-title":[],"link":[{"URL":"https:\/\/southam.pub\/journals\/files\/sai\/sai2026109en.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/southam.pub\/journals\/files\/sai\/sai2026109en.pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,10,15]],"date-time":"2026-10-15T06:00:46Z","timestamp":1792044046000},"score":1,"resource":{"primary":{"URL":"https:\/\/southam.pub\/journals\/article\/sai2026109"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,10,16]]},"references-count":28,"URL":"https:\/\/doi.org\/10.62486\/sai2026109","relation":{},"ISSN":["3121-2131"],"issn-type":[{"value":"3121-2131","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,10,16]]},"assertion":[{"value":"Yes","name":"peer_reviewed","label":"Peer Reviewed"},{"value":"2026-10-16","name":"published","label":"Published"},{"value":"Creative Commons Attribution 4.0","name":"license","label":"License","explanation":{"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"}},{"value":"South American Publishing","name":"maintained_by","label":"This article is maintained by"},{"value":"Generative artificial intelligence conversational agents in mental health care: clinical evidence, psychosocial risks and governance. A narrative review","name":"article_title","label":"Article Title"},{"value":"SAP Social AI","name":"journal_title","label":"Journal Title"},{"value":"https:\/\/doi.org\/10.62486\/sai2026109","name":"publisher_version","label":"CrossRef DOI link to publisher maintained version"},{"value":"review-article","name":"content_type","label":"Content Type"},{"value":"\u00a9 2026 The Authors","name":"copyright","label":"Copyright"},{"value":"2026-07-02","name":"received","label":"Received","group":{"name":"article_history","label":"Article History"}},{"value":"2026-10-15","name":"accepted","label":"Accepted","group":{"name":"article_history","label":"Article History"}},{"value":"2026-10-16","name":"first_online","label":"First Online","group":{"name":"article_history","label":"Article History"}},{"value":"Ch\u00e1vez Moya, Maikro Osvaldo https:\/\/orcid.org\/0009-0000-6028-9377","order":1,"name":"author_1","label":"Author 1","group":{"name":"authors","label":"Authors"}},{"value":"Cabrera, Leodanis Hern\u00e1ndez https:\/\/orcid.org\/0009-0007-9109-9585","order":2,"name":"author_2","label":"Author 2","group":{"name":"authors","label":"Authors"}},{"value":"Ram\u00edrez, Lauren Mart\u00ednez https:\/\/orcid.org\/0009-0002-8489-2474","order":3,"name":"author_3","label":"Author 3","group":{"name":"authors","label":"Authors"}},{"value":"Gonz\u00e1lez Gonz\u00e1lez, Mariam Alejandra https:\/\/orcid.org\/0009-0005-4952-9938","order":4,"name":"author_4","label":"Author 4","group":{"name":"authors","label":"Authors"}},{"value":"Pazos, Andy Alonso https:\/\/orcid.org\/0009-0001-8328-0938","order":5,"name":"author_5","label":"Author 5","group":{"name":"authors","label":"Authors"}},{"value":"Fern\u00e1ndez Feit\u00f3, Laura Beatriz https:\/\/orcid.org\/0009-0001-2924-2666","order":6,"name":"author_6","label":"Author 6","group":{"name":"authors","label":"Authors"}},{"value":"Pernas, Gabriela Gonz\u00e1lez https:\/\/orcid.org\/0009-0006-5379-0052","order":7,"name":"author_7","label":"Author 7","group":{"name":"authors","label":"Authors"}}]}}