A Multi-Probe Audit of Clinical-Interview Depression Detection Benchmarks
Authors: Takehiro Ishikawa, Jon Duke
Organizations: College of Computing, Georgia Institute of Technology, Atlanta, GA, USA · Georgia Tech Research Institute, Georgia Institute of Technology, Atlanta, GA, USA
This paper audits benchmark evaluation in clinical-interview depression detection through four complementary probes across DAIC/E-DAIC, CMDC, ANDROIDS, MODMA, and PDCH. First, we re-evaluate E-DAIC under strict subject-disjoint leave-one-subject-out cross-validation. A lightweight hybrid text-plus-LLM-score model reaches macro-F1 = 0.723 - the highest reported under this protocol, to our knowledge - providing a conservative out-of-fold reference point that does not depend on the privileged official holdout. Second, we test whether the E-DAIC official split supports fine-grained leaderboard rankings by sweeping 96 model configurations across modality bundles, pooling strategies, and learners. Development-side cross-validation and official-test rankings align only moderately: the best cross-validation configuration ranks twentieth on the official test, the official-test winner ranks forty-first by cross-validation, top-3 overlap is zero, and the apparent winner is rank-1 in only 32.3% of subject bootstraps. Third, we externally validate strong public CMDC and ANDROIDS baselines that achieve near-ceiling in-domain performance. Zero-shot transfer to external corpora is substantially weaker. Finally, we stress-test E-DAIC text and audio models using paired symptom-dense versus symptom-light interview slices defined by an SRDS-based annotator. Text scores rise sharply on symptom-dense slices, whereas audio scores remain nearly flat; the text-minus-audio gap is positive across all five seeds.
Automatic depression detection from doctor-patient conversations has gained momentum thanks to the availability of public corpora and advances in language modeling. However, interpretability remains limited: strong performance is often reported without revealing what drives predictions. We analyze three datasets: ANDROIDS, DAIC-WOZ, E-DAIC and identify a systematic bias from interviewer prompts in semi-structured interviews. Models trained on interviewer turns exploit fixed prompts and positions to distinguish depressed from control subjects, often achieving high classification scores without using participant language. Restricting models to participant utterances distributes decision evidence more broadly and reflects genuine linguistic cues. While semi-structured protocols ensure consistency, including interviewer prompts inflates performance by leveraging script artifacts. Our results highlight a cross-dataset, architecture-agnostic bias and emphasize the need for analyses that localize decision evidence by time and speaker to ensure models learn from participants' language.
Hasindri Watawana, Sergio Burdisso, Diego A. Moreno-Galván +4
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.
Depression is a major mental disorder for which diagnosis relies primarily on clinical assessments. Automated methods to support its detection via the psychiatric MADRS scale are getting more and more attention. While existing solutions primarily focus on detecting the disorder from different text sources (e.g., online text, social media), there is still limited support for clinical trials, where clinical assessments are conducted through structured interviews based on standard guidelines such as SIGMA. In this work, we develop a LLM pipeline specifically designed to support clinicians in supporting the assessment of depression in patients enrolled in clinical trials. Our pipeline converts audio interviews into transcripts, maps them into the ten MADRS symptom items, estimates their severity, and identify problematic clinical ratings associated with them. Evaluation on real clinical interviews shows a strong overall correlation of 0.867 with expert ratings, providing interpretable support for future assessments in clinical trials.