A randomised controlled trial published in npj Digital Medicine evaluated the World Health Organization’s STARS (Sustainable Technology for Adolescents and Youth to Reduce Stress) chatbot intervention among psychologically distressed older adolescents and young adults in Jordan.
The study enrolled 344 participants aged 18–21 and compared the 10-session STARS chatbot, supported by five brief weekly calls from trained non-specialist “e-helpers,” to enhanced usual care. Outcomes were assessed at baseline, one week post-treatment and three months post-treatment.
At three months, participants receiving STARS showed significantly greater reductions in anxiety and depression compared to enhanced usual care, with moderate to large effect sizes (0.70 for anxiety and 0.61 for depression). Improvements were also observed across secondary outcomes, including psychological distress, functional impairment, personally identified problems, wellbeing and sense of agency. Notably, benefits were retained even among participants with more severe baseline symptoms.
Engagement levels were relatively high for a digital intervention, with two-thirds of participants completing at least seven of the ten chatbot lessons. Sensitivity analyses indicated that findings were robust despite expected attrition.
The results suggest that a rule-based, guided chatbot intervention can offer a scalable, evidence-based option for addressing anxiety and depression in low- and middle-income countries, where access to specialist mental health services remains limited. By combining automated digital delivery with brief human support, STARS represents a promising model for expanding access while maintaining clinical impact.
