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Article History

Received: 27 April 2025

Accepted: 23 July 2025

First Online: 20 August 2025

Competing interests

: T.A.F. reports personal fees from Boehringer-Ingelheim, Daiichi Sankyo, D.T. Axis, Micron, Shionogi, SONY and UpToDate, and a grant from D.T. Axis and Shionogi, outside the submitted work; In addition, T.A.F. has a patent 7448125 (Toshi Furukawa, Masaru Horikoshi, Takashi Katayama for applying machine learning in internet CBT) and a pending patent 2024-521973 (Shionogi, Kyoto University, a machine learning algorithm to predict depression worsening), and has licensed intellectual properties for Kokoro-app to D.T. Axis. A.T. reports personal fees from Eisai and Shionogi outside the submitted work. M.S. is employed in the Department of Neurodevelopmental Disorders, Nagoya City University Graduate School of Medicine, which is an endowment department supported by the City of Nagoya and has received a personal fee from SONY outside the submitted work. M.H. has a patent 7448125, and has licensed intellectual properties for Kokoro-app to Mitsubishi-Tanabe. T.A. received lectures fees from AstraZeneca, Chugai, Daiichi-Sankyo, Eisai, Kowa, Kyowa Kirin, Lundbeck, M.S.D., Meiji-Seika Pharma, Mochida, Nipro, Otsuka, Pfizer, Shionogi, Sumitomo pharma, Takeda, Tsumura, and Viatris, and royalties from Igaku-Shoin. Akechi T. has patents pending (2020-135195, 2022-069057) (Institute) and the patents (7313617) (Institute), all outside the submitted work. N.K.a. is employed by the Junpukai Foundation and the Department of Digital Mental Health, The University of Tokyo, an endowment department that is supported by an unrestricted grant from 15 enterprises (). T.N. reports grants or contracts with I&H, Cocokarafine, Konica Minolta, N.T.T. DATA, consulting fees from Ohtsuka, Takeda, Johnson & Johnson, AstraZeneca, Nippon Zoki, payment or honoraria for lectures, manuscript writing or educational events from Pfizer, M.S.D., Chugai, Takeda, Janssen, Boehringer Ingelheim, Eli Lilly, Maruho, Mitsubishi Tanabe, Novartis, Allergan, Novo Nordisk, T.o.a. Eiyo, AbbVie, O.n.o., G.S.K., Alexion, Cannon Medical Systems, Kowa, Araya, Merck, Amicus, stock options in BonBon Inc., and donation from CancerScan and J.M.D.C., all outside the submitted work. S.F. received personal fees from Kyowa-Kirin, Boehringer-Ingelheim, Toray Medical, Health and Global Policy Institute, White Healthcare, and Health Insurance for Start-up Companies, and research grants from the Japan Health Insurance Association, National Health Insurance Association for Civil Engineering and Construction, Osaka Prefecture, and Cancer Scan, outside of this work. R.C.K. was a consultant for Cambridge Health Alliance, Canandaigua V.A. Medical Centre, Child Mind Institute, Holmusk, Massachusetts General Hospital, Partners HealtUMIN are, Inc., RallyPoint Networks, Inc., Sage Therapeutics and University of North Carolina. He has stock options in Cerebral Inc., Mirah, P.Y.M. (Prepare Your Mind), Roga Sciences and Verisense Health. All the other authors have no conflict of interest to declare.