Automated Detection and Classification of Delusion-related Content in Naturalistic Audio Diaries Using Multi-Agent Language Models
Authors: Feng Chen, Justin Tauscher, Changye Li, Meliha Yetisgen, Alex Cohen, Adam Kuczynski, Angelina Pei-Tzu Tsai, Benjamin Buck, +2 more
Organizations: Department of Biomedical Informatics and Medical Education, University of Washington, Seattle, WA, USA · Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle, WA, USA · Department of Psychology, Louisiana State University, Baton Rouge, LA, USA · Department of Psychiatry, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
Speech monologues recorded in naturalistic settings provide opportunities to characterize mental illness phenomenology and detect symptom exacerbation. Large language models (LLMs) offer new possibilities for automating this process, as they require annotated data primarily for evaluation rather than training. In this paper, we present a novel automated, multi-agent LLM pipeline for the fine-grained, multi-label extraction of language suggestive of delusional beliefs, associated affective responses, and behavioral responses from transcripts of naturalistic audio diaries collected from people with moderate persecutory ideation. Evaluating an ensemble of three foundation models, we demonstrate that detailed diagnostic prompt instructions successfully reduce false positives for delusional theme classification, but also constrain the interpretation of affective or behavioral responses. Furthermore, comparing multi-agent adjudication frameworks shows that complex conversational debate between agents diminishes accuracy on clinically ambiguous text by inducing premature consensus. Instead, majority voting establishes robust performance (Micro F1 of 0.872 and 0.779 for delusion detection and classification respectively). This work provides a validated and scalable pipeline for the automated detection and characterization of content suggesting delusional beliefs in naturalistic speech.
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.
Psychological support hotlines provide critical support for individuals experiencing mental health emergencies, yet current assessments largely rely on human operators whose judgments may vary with professional experience and are constrained by limited staffing resources. This paper proposes a large language model (LLM)-based framework for automated crisis level classification, a key indicator that supports many downstream tasks and improves the overall quality of hotline services. To better capture emotional signals in spoken conversations, we introduce a paralinguistic injection method that inserts identified non-verbal emotional cues into speech transcripts, enabling LLM-based reasoning to incorporate critical acoustic nuances. In addition, we propose a reasoning-enhanced training strategy that trains the model to generate diagnostic reasoning chains as an auxiliary task, which serves as a regulariser to improve classification performance. Combined with data augmentation, our final system achieves a macro F1-score of 0.802 and an accuracy of 0.805 on the three-class classification task under 5-fold cross-validation.
Early detection of dementia enables timely intervention, and reflecting cognitive impairment, spontaneous speech offers a non-invasive screening modality. Conventional approaches often focus on a single representational dimension -- such as acoustic descriptors, pause modeling, automatic speech recognition (ASR) transcripts, or multimodal fusion -- limiting integrative reasoning across heterogeneous cognitive symptoms. We propose a low-rank adaptation (LoRA)-tuned large language model (LLM) that performs structured multi-view reasoning over four complementary speech-derived signals: ASR transcripts with pause markers, discourse-level topic cues, temporal fluency statistics, and phonological sequences. These cues are encoded within a unified prompt, enabling a single LLM to learn a coherent decision function without modality-specific encoders or late-stage fusion. On ADReSSo, our best model achieves an F1-score of 90.14%, and ablation confirms the complementary contribution of each view.