Can LLMs Understand the Impact of Trauma? Costs and Benefits of LLMs Coding the Interviews of Firearm Violence Survivors

This paper examines the opportunities, limitations, and practical considerations associated with the use of large language models (LLMs) in qualitative research. Drawing on a multidisciplinary perspective that combines expertise in qualitative methods and explainable AI, the paper argues that responsible integration of LLMs into qualitative workflows requires researchers to engage critically with a curated set of technical parameters, that is, context window constraints, temperature and top-p sampling settings, user and system prompt design, and model documentation in the form of system cards. The paper situates these considerations within the epistemological commitments of qualitative research, including reflexivity, positionality, and interpretive judgment, and discusses how the opacity of contemporary LLMs differs from earlier natural language processing tools such as topic models and lexicon-based sentiment analyzers.

Data from affected populations are crucial for informing humanitarian response, but their value depends on timely and consistent interpretation of nuanced accounts of need. Humanitarian organizations often lack the staff, time, and specialist expertise required to analyze this information at scale. Large language models (LLMs) may expand this capacity, but their reliability for coding qualitative humanitarian data has not been directly established. This benchmark study compares 46 LLMs to a human Gold Standard using 150 high-fidelity synthetic humanitarian transcripts. Evaluation combined inter-rater reliability testing with Krippendorff's alpha, discrepancy analysis distinguishing correct, near-correct, and incorrect codes, and qualitative assessment across humanitarian-specific criteria including discrimination, complex needs hierarchies, and non-standard communication styles. The authors find that multiple LLMs can perform deductive coding at reliability levels comparable to experienced human coders, especially when structured prompts and reasoning-enabled configurations are used. At the same time, aggregate reliability metrics alone are insufficient for deployment decisions. Models varied in recognizing needs expressed indirectly, needs outside predefined categories, and protection-relevant concerns such as physical safety and discrimination. These findings suggest that LLMs can materially expand humanitarian analytical capacity, but not as substitutes for human judgment. Appropriate use requires structured codebooks, reasoning-enabled models, attention to theme-specific performance, and tiered oversight focused on categories where miscoding would have the greatest programmatic consequences. For sensitive humanitarian data, open-weights models deployed on self-hosted infrastructure may offer a viable path for combining analytical scalability with stronger data governance.

The utility of AI in multi-coder qualitative coding has been widely discussed, yet little empirical evidence exists to delineate the contexts in which it performs reliably. We address this gap by quantifying the effectiveness of multi-agent LLM coding across varied qualitative datasets, revealing key contextual and structural factors that mediate coding outcomes. We developed a literature-informed baseline pipeline that enables AI agents to independently code, debate, and reconcile disagreements. Results revealed that coding accuracy depends on factors such as codebook length, qualitative data similarity, and agent disagreement. Notably, intense and unresolved debates between agents led to higher accuracy. Our analysis showed that while LLMs emulate many human discussion behaviors, they lack adaptive responsiveness to context. From these findings, we offer design recommendations for building automated coding systems. Our open-source AI discussion dataset and methodological framework lay the groundwork for advancing the design of AI-mediated automated thematic analysis.