No Transformer Beats Six Covariates: Long-Horizon Prediction of Depressive Symptoms from Childhood Essays

Natural Language Processing (NLP) models predicting mental health outcomes rarely specify what they measure: contextual knowledge, emotional content, or syntactic structure. NLP Psychometrics treats psychological prediction from text as a psychometric problem, linking scores to interpretable linguistic evidence and testing beyond the training text format. Nine LLMs, conditioned on controlled personas (cognitive digital shadows), completed psychometric questionnaires with textual explanations per item. We extracted emotional profiles and syntactic-semantic structure via textual forma mentis networks, combined with personality and sociodemographic variables in ablated random forest (RF) regressors, using SHAP to identify which features drove performance and in which direction. Full RF models explained up to 70.8% of variance in life satisfaction (SWLS), 55.7% in depression (PHQ-9), and, for DASS-21, 68.5% depression, 76.0% anxiety, 72.4% stress. Sociodemographics alone explained no meaningful variance in depression, anxiety, or stress, but did so for life satisfaction, where emotion features and income were the strongest predictors; neuroticism and network topology instead dominated depression and anxiety, reversing direction between them. Without retraining, RF models separated diaries from low- and high-score personas ($r$ up to 0.91) and, using only network/emotion features, classified clinical from control participants in real transcripts with up to 68% accuracy. These results show the promise and limits of synthetic data: LLM personas can expose model biases, recover patterns consistent with clinical rumination, and support psychometric prediction from human text without a matched questionnaire, but cannot substitute for human validation. NLP Psychometrics makes these distinctions explicit, measurable, and testable through interpretable AI and network/emotional features.

Text-based counseling provides a valuable source of information for assessing depression severity. We study prediction of the total score on the eight-item Patient Health Questionnaire (PHQ-8), a self-report measure of depression severity, from counseling transcripts. Clinical-based methods rely mainly on large language model (LLM) inference to obtain structured session-level assessments, but these assessments provide limited information about which utterances support each score. Training-based methods train predictors directly on sentences or their semantic embeddings and preserve local conversational detail, but must learn clinical structure from limited labeled transcripts. Integrating a small set of clinical feature scores with a long sequence of high-dimensional utterance representations is challenging, as simple fusion can overemphasize dialogue evidence and fail to link clinical features to supporting utterances. Combining structured clinical assessments with sentence-level semantics, we propose EmoTrack, which jointly encodes clinical feature scores and utterance representations to predict the total PHQ-8 score. For longitudinal assessment across successive sessions, the model can also incorporate a compressed representation of the preceding session as optional memory. On the real-world DAIC-WOZ benchmark, EmoTrack reduces mean absolute error from 2.8234 to 2.4708 relative to the strongest evaluated baseline. Across five settings covering single-session estimation, cross-dataset transfer without adaptation, and longitudinal assessment, it reduces normalized aggregate error by approximately 6.1% relative to the strongest baseline.

Dementia and depression are the most prevalent neuropsychiatric disorders in geriatric populations, and their overlapping symptoms pose major challenges for differential diagnosis. In this study, we investigate open-weights Large Language Models (LLMs) for predicting dementia and depression severity from speech samples collected during standardized history taking interviews with 154 German-speaking subjects. We introduce an observer-based Global Depression Scale (GDS-D) aligned with the established Global Deterioration Scale (GDS), enabling parallel global staging of affective and cognitive symptoms. We compare three LLMs (Mistral 3.1, DeepHermes, Qwen3) in two settings: (1) zero-shot prediction and (2) LLM-based feature extraction for Support Vector Regression, using human and pause-enriched transcripts. Results show that LLMs effectively predict depression severity in zero-shot settings (best MAE of 0.60), while dementia assessment benefits substantially from structured feature extraction (best MAE of 0.78), reducing errors by up to 35% over zero-shot baselines. Pause-enriched transcripts achieve competitive performance with human transcriptions, demonstrating the viability of fully automatic screening pipelines for differential neuropsychiatric assessment.