AI-enabled digital mental health interventions for youth: A systematic review of AI readiness, user engagement, and wellbeing

AI-enabled digital mental health interventions (AI-DMHI) such as rule-based chatbots, NLP-driven agents, generative AI tools based intervention for mental health are increasingly emerging as an alternative to conventional mental health care for adolescents and young adults in Malaysia, yet the existing literature remains scattered across multiple disciplines without an integrated synthesis linking readiness to use, actual engagement, and user wellbeing outcomes, thereby creating a notable research gap. This Systematic Literature Review (SLR) aims to synthesise existing evidence on AI readiness, user engagement, and wellbeing outcomes within the context of AI-DMHI for this population. The study employed a transparent and replicable SLR design, reported in accordance with the PRISMA 2020 guidelines, encompassing a systematic search process, eligibility screening, and quality appraisal, yielding 57 final articles for thematic synthesis. All 57 articles scored 100% on the 6-item quality appraisal tool. The findings were synthesised into five main themes: AI readiness, user acceptance, and stigma reduction; user engagement dynamics and interactive design; digital therapeutic alliance and AI empathy; mental wellbeing outcomes and clinical effectiveness; and ethical safeguards, data privacy, risk safety, and blended care models. The findings show that AI-DMHI holds considerable potential as a complement to youth mental health care, but its effectiveness and safety depend on design, context, and responsible governance. This study proposes the development of an AI-DMHI-specific regulatory framework for Malaysia, along with priorities for future research on local-context RCTs, longitudinal studies, and the standardisation of outcome measurement tools to enable meta-analysis.