Developing an Automated Depression

Assessment Tool in Bengali: Adhering to

WHO mhGAP Intervention Guidelines
Jannatul Ferdous Srabonee1, Umaima Afifa1, Antora Dev1, Md. Kafiul Islam2, Chiranjeeb Biswas3, Helal
Uddin Ahmed4, Farhana Sarker5 Khondaker A. Mamun1
1
AIMS Lab, Institute of Research, Innovation, Incubation and Commercialization (IRIIC), United
International University (UIU), Dhaka 1212, Bangladesh
2
Department of Electrical and Electronic Engineering, Independent University, Dhaka, Bangladesh
ORCID:0000-0001-7654-5726
3
Department of Psychiatry, Medical College for Women & Hospital (MCWH), Dhaka, Bangladesh (email:
drchiranjeeb@gmail.com)
4
Child Adolescent & Family Psychiatry, the National Institute of Mental Health (NIMH), Dhaka,
Bangladesh (email: soton73@gmail.com)
5
Department of Computer Science and Engineering, University of Liberal Arts Bangladesh, Bangladesh

Background: Mental health is a significant concern in low-income nations with substantial

populations, such as Bangladesh. The reluctance of individuals to seek professional support is
compounded by the social stigma surrounding visits to psychiatrists and the high costs associated
with mental health services. In light of these challenges, the implementation of a chatbot emerges
as a potential solution, offering privacy and discretion to users without facing societal scrutiny.
Chatbots are conversational agents that use artificial intelligence to help patients with mental
health concerns. They offer privacy and anonymity, and some use Cognitive Behavioral Therapy
(CBT). The World Health Organization (WHO) recognizes the need for action to reduce the burden
and to enhance the capacity of Member States to respond to this growing challenge. The Mental
Health Gap Action Programme (mhGAP) is WHO’s action plan to scale up services for mental,
neurological, and substance use disorders in countries, especially with low and lower middle
incomes [1]. The Patient Health Questionnaire-9 (PHQ-9) is a self-administered, validated survey
developed to assess and monitor depression severity in adults [2].
Mental health stigma refers to societal disapproval, or when society places shame on people who
live with a mental illness or seek help for emotional distress, such as anxiety, depression, bipolar
disorder, or PTSD. Financial problems adversely impact your mental health. The stress of debt or
other financial issues leaves you feeling depressed or anxious. Early intervention will help to
recognize the warning signs of a mental health or substance use challenge and act before it gets
worse. Personalized mental healthcare leverages the power of data to shorten the time to recovery.
Objective: The objective of this research is to design and deploy a depression assessment chatbot
in Bengali, catering to individuals in need of primary guidance to improve their mental well-being.
The chatbot is based on the guidelines outlined by the World Health Organization (WHO) in the
Mental Health Gap Action Programme (mhGAP) for assessing depression. Additionally, the
chatbot employs the Bengali version of the PHQ-9 questionnaire, with minor modifications, to
quantify the severity of depression. Through the implementation of this chatbot, the research
aspires to bridge the gap between mental health resources and individuals in need, particularly
those facing barriers such as stigma and financial constraints. By offering essential guidance and
facilitating early intervention, the chatbot can potentially contribute to the enhancement of mental
health support and overall well-being within society.
Methodology: The chatbot is based on the guidelines outlined by the World Health Organization
(WHO) in the Mental Health Gap Action Programme (mhGAP) for assessing depression. The
mhGAP is a comprehensive program that aims to bridge the gap between mental health resources
and individuals in need by providing evidence-based guidelines for the assessment and
management of mental health conditions. To quantify the severity of depression, we employed the
PHQ-2 and Bengali version of the PHQ-9 questionnaire, with minor modifications [3]. The PHQ-
9 consists of nine items that correspond to the diagnostic criteria for major depressive disorder as
outlined in the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV).
The chatbot was developed using the RASA platform, an open-source framework for building
conversational AI. RASA allows developers to create custom chatbots that can understand natural
language input and respond with relevant information. The chatbot seeks to fulfill its mission by
providing relevant guidelines to individuals experiencing depression and encouraging them to seek
professional assistance whenever necessary. It does so by asking users a series of questions based
on the PHQ-2 and the PHQ-9 questionnaire and providing tailored feedback based on their
responses.
Key Findings: The performance of the chatbot was evaluated with 7 individuals from the
Advanced Intelligent Multidisciplinary Systems Lab. Initially, the participants were administered
the standard PHQ-9 questionnaire and their scores were calculated accordingly. Subsequently, they
were advised to interact with the chatbot. A comparison of the outcomes from the chatbot-reported
score and the calculated score revealed that the chatbot performed with 57% accuracy. In the
future, we plan to further assess the chatbot’s performance in a clinical trial. In addition to
assessing depression, the chatbot adeptly collects supplementary mental health factors, in line with
the mhGAP guidelines. These factors include information about the user’s medical history,
substance use, and psychosocial stressors. When integrated within a mental support application,
this information will be able to furnish mental health specialists with a comprehensive background
of the patient, enabling better-informed decision-making and personalized care. Furthermore, our
research finds that users are receptive to using the chatbot to assess their mental well-being. Many
users report feeling more comfortable discussing their mental health concerns with the chatbot
than with a human healthcare provider, due to the anonymity and privacy afforded by the chatbot.
This enhanced comfort level encourages more users to engage with the chatbot, leading to a greater
understanding of their mental health status and potentially earlier interventions and support.
Conclusions: Through the implementation of this chatbot, we aspire to bridge the gap between
mental health resources and individuals in need, particularly those facing barriers such as stigma
and financial constraints. By offering essential guidance and facilitating early intervention, our
chatbot can potentially contribute to the enhancement of mental health support and overall well-
being within our society.
In conclusion, our research demonstrates the potential of chatbots to improve access to mental
health resources in low-income nations with substantial populations like Bangladesh. By
leveraging technology to provide accessible and convenient mental health support, we can help
individuals overcome barriers such as stigma and financial constraints and improve their overall
well-being.

References
[1] “mhGAP Mental Health Gap Action Programme.” https://www.who.int/publications-detail-
redirect/9789241596206 (accessed Jul. 28, 2023).
[2] R. Y. M. Cheung, “Patient Health Questionnaire-9 (PHQ-9),” in Handbook of Assessment in
Mindfulness Research, O. N. Medvedev, C. U. Krägeloh, R. J. Siegert, and N. N. Singh, Eds., Cham:
Springer International Publishing, 2022, pp. 1–11. doi: 10.1007/978-3-030-77644-2_63-1.
[3] “Screening for Common Mental Disorders,” MMHRC. https://multiculturalmentalhealth.ca/clinical-
tools/screening-for-common-mental-disorders/ (accessed Jul. 28, 2023).