Expert perspectives on AI-based counseling for anxiety and depression in Iran: cultural, ethical, and clinical insights

This study examined how Iranian experts in mental health, information technology, and public health perceive the potential role of artificial intelligence (AI) in counseling for anxiety and depression. Particular attention was given to perceived effectiveness, requirements for cultural adaptation, and ethical considerations surrounding the integration of AI into clinical practice. A qualitative design was employed using semi-structured interviews with 25 experts from seven regions of Iran (Ardabil, Tehran, Mashhad, Sanandaj, Zahedan, Tabriz, and Ahvaz). Interviews were conducted between May and August 2024 and analyzed through reflexive thematic analysis following Braun and Clarke’s framework. Data collection and analysis proceeded iteratively, and thematic saturation was reached after the twenty-third interview. Five overarching themes captured expert perspectives: (1) perceived usefulness of AI for individuals with mild to moderate symptoms (reported by 21 of 25 experts); (2) opportunities for improving accessibility in underserved regions (noted by 23 experts); (3) the central importance of cultural and religious alignment in system design (highlighted by 18 experts); (4) ethical and relational concerns, including privacy, data governance, and the absence of genuine empathy (raised by 20–22 experts across subthemes); and (5) recommendations for responsible implementation, such as regulatory oversight, clinician training, and the use of culturally representative datasets (noted by 17–19 experts). Experts viewed AI-assisted counseling as a potentially helpful complementary resource rather than a substitute for human-delivered care. Successful integration requires culturally sensitive design, transparent data governance, and national guidelines for safe implementation. The findings provide actionable insights for policymakers, developers, and mental-health authorities planning to incorporate AI-driven tools within Iran and other culturally comparable settings.