Towards Expectation Detection in Language: A Case Study on Treatment Expectations in Reddit

Treatment-resistant depression (TRD) is a severe form of major depressive disorder in which patients do not achieve remission despite multiple adequate treatment trials. Evidence across pharmacologic options for TRD remains limited, and trials often do not fully capture patient-reported tolerability. Large-scale online peer-support narratives therefore offer a complementary lens on how patients describe and evaluate medications in real-world use. In this study, we curated a corpus of 5,059 Reddit posts explicitly referencing TRD from 3,480 subscribers across 28 mental health-related subreddits from 2010 to 2025. Of these, 3,839 posts mentioned at least one medication, yielding 23,399 mentions of 81 generic-name medications after lexicon-based normalization of brand names, misspellings, and colloquialisms. We developed an aspect-based sentiment classifier by fine-tuning DeBERTa-v3 on the SMM4H 2023 therapy-sentiment Twitter corpus with large language model based data augmentation, achieving a micro-F1 score of 0.800 on the shared-task test set. Applying this classifier to Reddit, we quantified sentiment toward individual medications across three categories: positive, neutral, and negative, and tracked patterns by drug, subscriber, subreddit, and year. Overall, 72.1% of medication mentions were neutral, 14.8% negative, and 13.1% positive. Conventional antidepressants, especially SSRIs and SNRIs, showed consistently higher negative than positive proportions, whereas ketamine and esketamine showed comparatively more favorable sentiment profiles. These findings show that normalized medication extraction combined with aspect-based sentiment analysis can help characterize patient-perceived treatment experiences in TRD-related Reddit discourse, complementing clinical evidence with large-scale patient-generated perspectives.

Most prior work on predicting mental health help-seeking treats it as post-hoc classification of users already active in clinical communities, which cannot tell whether someone approaching a transition can be identified in advance. We instead frame help-seeking as a time-to-event problem and ask which Reddit users will eventually seek mental health support, and how imminent that transition is. We build a two-arm cohort: a control frame of 6,337 ordinary users with genuine right-censoring (12.1% transition rate) to answer who will transition, and a clinical frame of 5,023 eventual transitioners to answer how soon. Features come only from posts written before any clinical activity, and user-grouped five-fold cross-validation plus a four-year temporal holdout guard against leakage. We compare TF-IDF, MentalBERT embeddings and behavioural activity features using Cox proportional hazards models, Random Survival Forests and an LSTM sequential model. Behavioural features alone outperform text for predicting who will seek help (C-index 0.797 vs. 0.763), and combining both is best (0.823 under cross-validation, 0.856 on the holdout). The pattern reverses for predicting how soon a known transition will happen: text remains a stable predictor (C-index 0.698) while behavioural features become unstable. Structural engagement patterns therefore carry information about future help-seeking beyond linguistic content, and separating who from when yields a cleaner analysis.

Community-conditioned language model adaptation requires choices about data collection, community definition, and evaluation that are currently made independently in each study, making it hard to compare assumptions or reuse artifacts. We present RedditPersona, a modular framework that standardizes these choices: it collects Reddit posts and comments, profiles active users, partitions them under five grouping strategies (subreddit-based, graph-structural, semantic, hybrid, and interaction-based), trains a parameter-efficient adapter per strategy via QLoRA, and evaluates them under a shared metric suite spanning fluency, fidelity, distributional alignment, and community identifiability. Applied to 112 subreddits in the urban well-being domain (301,429 user profiles, 16M+ comments), we find that adapters' behavioral identifiability tracks each strategy's intrinsic agreement with the subreddit baseline, and that a consistent trade-off between identifiability and distributional similarity to real text holds across all five strategies. The code and configuration files are available at: https://github.com/Ahghaffari/redditpersona.