AI聊天机器人使用相关的妄想与伤害：来自185份真实世界报告的早期证据
Delusions and Harms Associated with AI Chatbot Use: Early Evidence from 185 Real-World Reports
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中文总结 AI 辅助
本研究分析185份真实报告，发现AI聊天机器人使用与妄想信念、感知验证及严重社会职业伤害相关，提示需前瞻性安全监测。
中文摘要 AI 辅助
重要性：有报告提出担忧，AI聊天机器人可能验证或详细阐述妄想信念，对自杀意念做出不恰当回应，并导致心理健康伤害，但关于所报告伤害的真实世界数据仍然有限。目的：描述与AI聊天机器人使用相关的心理健康伤害的第一手和第二手报告中，精神病理学特征、聊天机器人行为、时间及结果。设计：对2025年8月7日至2026年2月2日期间收集的去标识化在线调查回复进行横断面二次分析。主要结局与测量：主要定量结局为是否存在妄想信念，由具有相关临床经验的双人配对评分者进行编码。其他变量包括使用聊天机器人的原因、当前发作特征、妄想内容、聊天机器人对信念的验证、伤害、社会及职业后果、医疗保健使用和时间。结果：分析了95份第一手和90份第二手报告。中位年龄为35.0岁（四分位距27.0-45.0）。评分者在102份报告（55.1%）中编码了与妄想信念一致的描述，其中50/102（49.0%）报告了聊天机器人对信念的验证。常见结局包括孤立、关系破裂、住院、失业和经济损失。四份第二手报告描述了自杀死亡。结论：在这个自我选择的便利样本中，与AI聊天机器人相关的伤害经常被描述为与妄想信念、感知到的聊天机器人验证、高强度使用以及显著的社会、职业和临床后果相关。由于报告是回顾性的、未经核实的，且来自寻求报告伤害的个体，我们的发现应被解释为初步信号检测，而非暗示患病率或提供因果关系的证据。需要进行前瞻性监测和基于轨迹的安全性评估。
英文摘要
Importance: Reports have raised concerns that AI chatbots may validate or elaborate delusional beliefs, respond inappropriately to suicidal ideation, and contribute to mental health harms, but real-world data on reported harms remain limited. Objective: To characterize psychopathological features, chatbot behaviors, timing, and outcomes in first- and second-hand accounts of mental health harm linked with AI chatbot use. Design: Cross-sectional secondary analysis of deidentified online survey responses gathered between August 7, 2025, and February 2, 2026. Main Outcomes and Measures: The primary quantitative outcome was the presence of delusional beliefs, coded by paired raters with relevant clinical experience. Additional variables included reason for chatbot use, current episode features, delusional content, chatbot validation of beliefs, harms, social and occupational consequences, healthcare use, and timing. Results: 95 first-hand and 90 second-hand accounts were analyzed. Median age was 35.0 (IQR 27.0 - 45.0). Raters coded descriptions consistent with delusional beliefs in 102 reports (55.1%), with chatbot validation of beliefs in 50/102 (49.0%). Common outcomes included isolation, relationship breakdown, hospital admission, job loss, and financial loss. Four second-hand reports described death by suicide. Conclusions: In this self-selected convenience sample, AI-chatbot-associated harms were frequently described in relation to delusional beliefs, perceived chatbot validation, intensive use, and substantial social, occupational, and clinical consequences. Because reports were retrospective, unverified, and collected from individuals seeking to report harm, our findings should be interpreted as preliminary signal detection rather than as suggesting prevalence or providing evidence of causality. Prospective surveillance and trajectory-based safety evaluations are needed.
