Assessing Suicide Risk in Arabic Crisis Helpline Calls: A Comparison of Arabic and English Large Language Models
Authors: Linhai Ma, Rita El Hachem, Mahatab El Hajj, Lilian Ghandour, Samah Fodeh
Organizations: Department of Emergency Medicine, Yale University, New Haven, CT, USA. · Department of Epidemiology and Population Health, American University of Beirut, Beirut, Lebanon. · Embrace, Mental Health Center, Beirut, Lebanon.
Crisis helplines assess suicide risk through structured interviews, a process that is slow and dependent on operator training and workload. Natural language processing could support risk assessment and call prioritization, but almost no work addresses Arabic-language helpline calls or operates within the privacy constraints of real helpline data. We analysed de-identified transcripts from Lebanon's National Lifeline for Emotional Support and Suicide Prevention. Audio never left the helpline: calls were transcribed on site with a speech recognition model for Levantine Arabic, and an Arabic named-entity recognition model removed identifying information locally. Only the de-identified transcripts were shared with the research team. Operators recorded the five suicidal ideation items of the Columbia Suicide Severity Rating Scale, which we combined into two binary outcomes: at-risk and high-risk. We also machine-translated the transcripts into English, giving a paired Arabic/English comparison. On each corpus, we fine-tuned five instruction-tuned large language models alongside six transformer encoder baselines (four Arabic, two English) and evaluated all models on a held-out test set. We included 383 calls: 373 for the at-risk task (52.3% positive) and 297 for the high-risk task (30.0% positive). The best Arabic model reached a macro-F1 of 81.19 and a ROC-AUC of 90.61 on high-risk; the best English model reached 85.00 and 92.59, identifying 88.9% of high-risk calls. In both languages, high-risk calls separated more cleanly than at-risk calls, and translation to English did not reduce the best observed performance. Suicide risk can be classified from de-identified Arabic transcripts without sending audio outside the helpline. The high-risk results support further testing as an operator-facing tool; lower-severity ideation proved the harder case.
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.
Suicide is a critical global public health challenge, causing approximately 720,000 deaths each year and calling for timely, effective prevention strategies. Existing computational studies primarily focus on post-based social media platforms such as Twitter and Weibo, leaving instant messaging environments such as Telegram underexplored. Yet group chats pose distinct challenges: messages are short, fragmented, multi-party, and often rely on implicit or culturally specific expressions, making isolated post-level analysis insufficient. We introduce SuiChat-CN, a Chinese group-chat benchmark for contextual suicide risk assessment. We collect public Telegram group-chat data, construct coherent conversational segments through signal-word extraction and bidirectional context expansion, and annotate user risk levels with an expert-validated, LLM-assisted paradigm. SuiChat-CN contains 13,312 contextual segments from 1,406 users, covering 258,228 raw chat messages. Extensive experiments with PLMs and more than 40 LLMs demonstrate that contextual information is essential for reliable risk assessment, while fine-tuning and partial-context evaluation further reveal the challenges of early detection in multi-party conversations. Due to ethical and sensitivity concerns, the dataset is not publicly released but will be shared with accredited mental health and suicide-prevention research institutions upon reasonable request.
Assessing suicide risk from social media text is a small-data, high-stakes setting requiring not only severity prediction but also supporting evidence and clinically relevant risk and protective factors. Yet common NLP techniques, including model scaling, synthetic data, loss reweighting, ensembling, and threshold tuning, are often applied without testing whether their gains hold up under severe class imbalance, coupled outputs, and limited author-level data. We study 1,635 clinician-annotated posts and audit 31 pre-specified techniques from 7 methodological families through roughly 300 controlled experiments on author-disjoint partitions. We found no prior audit of this playbook in this regime. The findings guide a task-grounded system for three outputs: 4-level suicide risk, evidence spans, and 24 clinical risk and protective factors. Only 5 of 31 comparisons produced reliable gains. We reformulate factor prediction as entailment between each post and its codebook definitions, using an architecturally diverse ensemble with class-balanced training and score rescaling. Risk predictions condition a 7-model evidence tagger ensemble; evidence restricts symbolic risk rules; and a difficult risk class is routed separately. The factor predictor remains independent because risk evidence provides no additional factor signal. We also correct a mismatch between validation scores used for threshold fitting and test-time ensemble scores through deployment-consistent calibration, yielding the largest improvement to the factor system. The final system achieves 0.8203 for risk, 0.7953 for evidence, and 0.7045 macro-F1 for factors, with a 0.7781 composite, ranking third among 53 teams. We call the underlying principle task-conditioned technique selection: retain techniques only when task-specific knowledge, structure, or empirical evidence justifies them.