Dynamic Summary Generation for Interpretable Multimodal Depression Detection

Automatic Depression Detection (ADD) from clinical interviews is a pivotal task in computational mental health, yet it remains challenging due to two critical obstacles: 1) difficulty in modeling complex but sparsely distributed depression clues within lengthy, multi-topic clinical interviews, leading to superficial and unreliable reasoning; 2) scarcity of labeled data due to clinical privacy, together with high cost of training and fine-tuning, limiting the deployment of supervised ADD systems. To jointly address these challenges, we propose Dep-LLM, a training-free framework that mirrors the step-by-step reasoning of clinical psychiatrists and operates entirely on frozen off-the-shelf foundation LLMs. Dep-LLM comprises three stages. First, a Chain-of-Thought (CoT) Depression Multi-factor Analysis module structurally decomposes the long dialogue into five clinically aligned themes and produces evidence-grounded rationales, effectively handling long-context dependencies. Second, we introduce Confidence Analysis and Modulation module that quantifies the epistemic reliability from token-level entropy of each rationale and applies an intra-label and inter-theme modulation that amplifies trustworthy signals while suppressing uncertain ones without extra training. Third, a Collaborative Multi-factor Prediction module dynamically integrates multi-factor signals weighted by confidence into the final diagnosis. Extensive experiments on the DAIC-WOZ and E-DAIC datasets demonstrate the effectiveness and generalizability of Dep-LLM: it surpasses zero-shot baseline on nearly all 21 foundation LLMs across 9 metrics such as accuracy, macro F1 and weighted-average F1, and further outperforms state-of-the-art supervised domain-specific LLMs as well as the latest closed-source commercial LLMs, while requiring no extra training.

Automatic depression detection with deep learning has shown promise but often suffers from limited generalization due to domain shift arising from inter-speaker variability. To address this critical issue, we present the first patient-independent multimodal depression detection framework that incorporates domain generalization (DG), jointly leveraging both acoustic and textual modalities. The proposed model integrates bidirectional Long Short-Term Memory (BiLSTM) with intra- and cross-modal attention mechanisms, accompanied by segment-level fusion for decision-making. Generalization is further enhanced by applying a gradient reversal layer inspired by Domain-Adversarial Training of Neural Networks (DANN), which promotes domain-invariant representations by adversarially limiting the model's ability to identify individual speakers, effectively reducing patient-specific bias. Conducting experiments on the Androids-Corpus dataset with a 5-fold cross-validation (CV) protocol, various pairings of audio and text feature extractors were evaluated over different segment durations, determining MelSpec and ItalianBERT as the optimal baseline at a 30-second segment duration. The addition of DG to this baseline yields a 2.5% increase in accuracy and 3.3% in F1-score, achieving 93.2% accuracy, 93.2% precision, 96.2% recall, and 94.2% F1-score, surpassing all existing benchmarks. Extensive ablation studies assess the impact of multimodal fusion, deep architectural choices, and DG, highlighting their combined contribution to robust and generalizable depression detection.

Depression assessment from multimodal clinical interviews requires integrating dispersed evidence from multiple symptoms into a coherent PHQ-8 profile. This process is hierarchical: relevant evidence is often sparse and context-dependent within local question-answer exchanges, multiple exchanges jointly support symptom-level judgments, and the final assessment depends on the coherence of the complete symptom profile. Existing LLM systems either process interviews holistically or distribute work across generic agent roles; neither design necessarily provides an explicit orchestration mechanism that coordinates evidence access, item-score authority, bounded feedback, and state recording across these levels. To address this gap, we introduce HiMA-MDD, a hierarchical multi-agent harness that aligns this assessment hierarchy with three agent layers. After non-agentic preprocessing constructs context-preserving multimodal QA units, Layer 1 identifies candidate QA-to-item relations and supports bounded item-grounded evidence routing. Layer 2 assigns symptom groups to operational factor specialists, with one specialist responsible for each provisional item score. Layer 3 audits the complete provisional profile, requests at most one round of targeted revision, and reconstructs the verified PHQ-8 profile. This layered design naturally yields a Hierarchical Evidence Trace, preserves all intermediate evidence, judgments, and revisions for auditability. The final item scores then deterministically produce the total score and screening decision. Using Qwen2.5-72B-Instruct as the harness backbone, our experiments on E-DAIC demonstrate that HiMA-MDD outperforms the compared state-of-the-art methods.