AI Representations of Mental Health Stigma: Quantifying the Gap Between AI Estimations and Human Perceptions Across Gender Groups Using GPT-Based LLMs
Authors: Soojong Kim, Hye Min Kim, Kwanho Kim, Dongdong Zhu
Organizations: Department of Communication, University of California Davis, United States · Department of Communication, University of Massachusetts Boston, United States · Department of Media, College of Politics and Economics, Kyung Hee University, South Korea
The increasing use of artificial intelligence (AI) in mental health applications raises concerns about its potential to internalize and perpetuate societal biases. This research evaluates both disparities and misalignment in how large language models (LLMs), GPT-4 and GPT-5, represent perceptions of mental health across gender groups. The research comprises two studies. Study 1 applied widely adopted measures of Social Distance, Stereotypes, and Attitudes Toward Seeking Help to assess whether the AI models depict systematic gender differences. Study 2 compared AI estimations of Personal, Self, and Perceived Stigma with large-scale real-world human data from the Healthy Minds Study (N = 76,406) to evaluate alignment between AI estimations and human perceptions. Results from Study 1 showed the AI models consistently portrayed men as having the greatest desire for social distance from someone with mental health problems, relatively higher Stereotypes scores, and the least favorable attitudes toward help-seeking, compared with women and nonbinary individuals. Study 2 confirmed that this ordinal pattern partially aligned with human-reported data for Personal and Self Stigma. However, the AI models systematically underestimated Personal Stigma and Perceived Stigma while substantially overestimating Self Stigma for all gender groups. These findings reveal that, although the AI models have learned relative gender-based patterns reflecting human experiences to a certain extent, they function as distorted portrayals, highlighting the need for rigorous, context-specific validation against real-world data to ensure AI's safe and equitable deployment.
While large language models (LLMs) are increasingly being explored for mental health applications, recent studies reveal that they can exhibit stigma toward individuals with psychological conditions. Existing evaluations of this stigma primarily rely on multiple-choice questions (MCQs), which fail to capture the biases embedded within the models' underlying logic. In this paper, we analyze the intermediate reasoning steps of LLMs to uncover hidden stigmatizing language and the internal rationales driving it. We leverage clinical expertise to categorize common patterns of stigmatizing language directed at individuals with psychological conditions and use this framework to identify and tag problematic statements in LLM reasoning. Furthermore, we rate the severity of these statements, distinguishing between overt prejudice and more subtle, less immediately harmful biases. To broaden the reasoning domain and capture a wider array of patterns, we also extend an existing mental health stigma benchmark by incorporating additional psychological conditions. Our findings demonstrate that evaluating model reasoning not only exposes substantially more stigma than traditional MCQ-based methods but also helps identify the flaws in the LLMs' logic and their understanding of mental health conditions.
Mental health stigma has profoundly harmful impacts but its complexity makes it difficult to evaluate. Stigma may involve explicit derogation, but also subtler forms of blame, fear, paternalistic pity, social distancing, structural exclusion, and discrimination. We introduce a theory-grounded benchmark for automatic evaluation of mental health stigma in online communication, consisting of naturally occurring online news and social media text annotated with a fine-grained taxonomy of stigma across multiple mental health conditions. Our annotation framework comprises a binary stigma-detection task and a multi-level taxonomy covering (i) stigma mode, (ii) domain, and (iii) specific components of certain forms of stigma. We apply this framework to texts mentioning six mental health conditions and evaluate large language models alongside stigma-related classifiers for detecting sentiment, toxicity, and hate speech. Results show that mental health stigma is not well captured by models trained to detect these neighboring constructs, and that LLMs often overpredict stigma unless given explicit operational rules - mirroring the importance of decision rules in human annotation. We release the publicly available part of benchmark, annotations, prototypical exemplars of stigma and code at: https://github.com/jemimakang/mh_stigma.
Naomi Baes, Jemima Kang, Nick Haslam +4
Melbourne School of Psychological Sciences, The University of Melbourne · Department of General and Computational Linguistics, University of Tübingen · School of Computing and Information Systems, The University of Melbourne
Understanding gender biases in large language models (LLMs) is increasingly important as these systems become embedded in decision-support tools with real consequences. Prior research has focused only on a small set of models, leaving open the extent to which gender biases are common and heterogeneous across LLMs. We address this gap across ten models released between April 2025 and June 2026, spanning nine vendors, using two paradigms: gender attribution to stereotyped phrases (Study 1) and moral judgment of abuse or torture against a woman or a man to prevent a catastrophic outcome (Study 2). In Study 1, two of ten models attributed masculine-stereotyped phrases to female writers more often than the reverse, while three models showed the opposite pattern. In Study 2, several models converged on a male-disadvantaging asymmetry that was directionally consistent with a documented human tendency to protect female targets from harm, though the specific conditions under which this asymmetry emerged varied by model; three other models, by contrast, showed no variation across conditions. These results indicate that gender-related biases are common in LLMs. Their direction and magnitude, however, are highly heterogeneous, to the point that some models behave in diametrically opposite ways to others. Bias auditing should therefore be treated as an ongoing, multi-vendor process, rather than a one-time assessment.