Patterns of Engagement With an AI Conversational Agent for Mental Health and Associations With Anxiety and Depression: Cross-Sectional Study.

Public hospitals in South Korea, operated by national and local governments and other public-sector institutions, serve as critical safety-net providers within the national healthcare system. These hospitals deliver essential and emergency medical services to vulnerable populations, support infection control and disaster preparedness, and promote community health equity through education, public health initiatives, and workforce training []. Despite these roles, the capacity of the public hospital sector remains limited. In 2020, public hospital bed availability was 1.2 per 1,000 population, substantially below the Organization for Economic Co-operation and Development (OECD) average of 2.8, and in 2021, public hospitals accounted for only 9.5% of all hospital beds—the lowest proportion among OECD member nations []. This structural imbalance places sustained pressure on public hospitals, contributing to high workloads amid ongoing resource constraints. These structural pressures are associated with heightened emotional, cognitive, and physical demands on nurses, who play a central role in sustaining essential services in public hospitals. Nurses are required to provide continuous patient monitoring, coordinate rapidly changing clinical situations, communicate with families, and meet administrative and regulatory expectations under strict time constraints. Chronic understaffing, limited financial resources, inadequate infrastructure, and rigid hierarchical cultures may further intensify these demands, increasing prolonged occupational stress and burnout []. Burnout—a multidimensional response to chronic work-related stress—has been consistently linked to poorer physical and psychological health, reduced work engagement, absenteeism, and higher turnover intentions among nurses, posing a substantial challenge to workforce sustainability []. Burnout is the inability to adequately cope with continuous job stress, manifested through emotional exhaustion, depersonalization, and a reduced sense of personal achievement []. As burnout among nurses intensifies, both physical health problems (e.g., cardiovascular symptoms, chronic pain, gastrointestinal disorders, and headaches) and emotional health problems (e.g., depression and insomnia) increase []. Consequently, job satisfaction decreases while turnover intention increases, exacerbating staffing shortages in clinical settings []. In particular, burnout increases the risk of patient safety incidents, such as falls and medication errors, leading to a decline in patient satisfaction and nursing care quality; thus, burnout reflects a critical issue that is directly linked to healthcare institution staffing and patient safety, extending beyond individual physical and emotional health problems [, ].