Self-Evolving Human-Centered Framework for Explainable Depression Symptom Annotation

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.

Modeling latent clinical constructs from unconstrained clinical interactions is a unique challenge in affective computing. We present ADAPTS (Agentic Decomposition for Automated Protocol-agnostic Tracking of Symptoms), a framework for automated rating of depression and anxiety severity using a mixture-of-agents LLM architecture. This approach decomposes long-form clinical interviews into symptom-specific reasoning tasks, producing auditable justifications while preserving temporal and speaker alignment. Generalization was evaluated across two independent datasets ($N=204$) with distinct interview structures. On high-discrepancy interviews, automated ratings approximated expert benchmarks ($\text{absolute error}=22$) more closely than original human ratings ($\text{absolute error}=26$). Implementing an ``extended'' protocol that incorporates qualitative clinical conventions significantly stabilized ratings, with absolute agreement reaching $\text{ICC(2,1)} = 0.877$. These findings suggest that the ADAPTS framework enables promising evaluations of psychiatric severity. While the current implementation is purely text-based, the underlying architecture is readily extensible to multimodal inputs, including acoustic and visual features. By approximating expert-level precision in a protocol-agnostic manner, this framework provides a foundation for objective and scalable psychiatric assessment, especially in resource-limited settings.