Clinical Risk Prediction

Millions of people now use generative AI chatbots for psychological support. Despite their promise, the most pressing question in AI for mental health is whether these tools are safe. The field currently lacks a validated, automated benchmark for evaluating AI chatbot safety, particularly for users at risk of suicide. The Validation of Ethical and Responsible AI in Mental Health (VERA-MH) evaluation was recently proposed to address this need. This human validation study examined the alignment of VERA-MH safety ratings with expert clinician judgments. We simulated conversations between large language model (LLM)-based users spanning a range of suicide risk levels and disclosure styles and general-purpose AI chatbots. Licensed mental health clinicians from Spring Health independently rated chatbot safety using the VERA-MH scoring rubric. An LLM-based evaluator ("judge") applied the same rubric to the same conversations. We examined agreement among clinicians, between clinician consensus and the LLM judge, and across different judge LLMs. Clinicians also rated user-agent realism, suicide risk, and disclosure. Clinicians showed strong agreement in safety ratings (chance-corrected inter-rater reliability [IRR] = 0.77), establishing a reliable clinical consensus reference. The LLM judge was strongly aligned with this consensus (IRR = 0.81), and ratings were stable across judge models and repeated evaluations. Ratings of user-agent realism and fidelity to intended suicide risk and disclosure styles were mixed. These findings support the reliability of VERA-MH as an open-source, fully automated benchmark for evaluating AI chatbot suicide risk detection and response. Because these results reflect an earlier version of the benchmark, future work should validate updated versions, assess generalizability and robustness, and expand VERA-MH to additional domains of AI safety in mental health.

In high-stakes risk prediction, interval-valued predictions provide a natural way to represent predictive uncertainty. However, standard evaluation tools such as the receiver operating characteristic (ROC) curve and the area under the curve (AUC) are designed for point-valued predictions and do not capture how uncertainty affects discrimination performance. To address this gap, we develop an uncertainty-aware ROC framework and corresponding interval-based AUC (iAUC) metrics for evaluating the performance of interval-valued risk predictions. The framework constructs two ROC-style curves with associated areas $\mathrm{AUC}_L$ and $\mathrm{AUC}_U$, and shows that these quantities induce a three-region decomposition of positive-negative rankings into confidently correct, ambiguous, and confidently incorrect orderings. Under valid class-conditional coverage, $\mathrm{AUC}_L$ and $\mathrm{AUC}_U$, together with the pairwise miscoverage rate, provide theoretical bounds on the optimal AUC, linking interval coverage to achievable discrimination. The framework is compatible with a range of methods for quantifying epistemic uncertainty in risk prediction, including Bayesian, bootstrap, and ensemble-based procedures, and provides a practical way to compare predictive models and interval-generation methods. Experiments on clinical benchmark data and MIMIC-IV mortality prediction show that models with similar point AUC can have different uncertainty-aware ranking profiles, and that the proposed decomposition can support risk-aware model selection and threshold-based abstention.

Ecological Momentary Assessment (EMA) studies provide real-time data on suicidal thoughts and behaviors, but forecasting suicide attempts remains challenging: attempts are rare, and the pathways patients take to them are heterogeneous. Here, we investigate a cohort of patients from an EMA study with recorded suicide-related events. We show that a single model fit to all patients forecasts poorly, while idiographic (per-patient) models show improvement but overfit for those with little data. Based on this result, one may hypothesize that patients should be partitioned into subgroups---this way, similar patients' data can be pooled together to improve forecasts. However, we show that grouping patients at random already improves forecasts, with performance increasing monotonically with the number of groups. Moreover, we show that grouping patients by demographics yields worse forecasts than random groupings. From these results, we hypothesize that patient similarity is continuous, rather than discrete, and must be inferred from the data. This motivated us to use Latent Variable Multiple Output Gaussian Processes (LVMOGPs), adapted to our data. Preliminary results show that, even without careful kernel design, LVMOGPs already match the strongest baseline models on most metrics, and their latent spaces yield a similarity between patients that we can inspect directly. Because the cohort is conditioned on the outcome and the splits are not temporal, we read these results as evidence that idiographic structure exists and can be recovered, not as deployable forecasting performance---an area for future work.

Ecological Momentary Assessment (EMA) studies enable the collection of high-frequency self-reports of suicidal thoughts and behaviors (STBs) via smartphones. Latent stochastic differential equations (SDEs) are a promising model class for EMA data, as it is irregularly sampled, noisy, and partially observed. But SDE-based models suffer from two key limitations. (a) These models often violate domain constraints, undermining scientific validity and clinical trust of the model. (b) Training is numerically unstable without ad hoc fixes (e.g. oversimplified dynamics) that are ill-suited for high-stakes applications. Here, we develop a novel class of expressive SDEs whose solutions are provably confined to a prescribed compact polyhedral state space, matching the domains of EMA data. In this work, (1) we show why chain-rule based constructions of SDEs on compact domains fail, theoretically and empirically; (2) we derive constraints on drift and diffusion for general and stationary SDEs so their solutions remain in the desired state space; and (3), we introduce a parameterization that maps arbitrary (neural or expert-given) dynamics into constraint-satisfying SDEs. On several real EMA datasets, including a large suicide-risk study, our parameterization improves forecasts and optimization dynamics over standard latent neural SDE baselines. These contributions pave the way for principled, trustworthy continuous-time models of suicide risk and other clinical time series and extend applications of SDE-based methods (e.g. diffusion models) to domains with hard state constraints.

Early and accurate glaucoma detection is critical to prevent irreversible vision loss, yet existing AI methods often rely on unimodal inputs and lack interpretability. We present GlaBoost, a multimodal gradient boosting framework that unifies three complementary signals for glaucoma risk prediction: fundus image embeddings from a pretrained convolutional encoder,free-text neuroretinal rim assessments encoded by a transformer-based language model, and structured ophthalmic biomarkers. These modalities are fused into a single representation and classified by an enhanced XGBoost model.On two real-world annotated datasets, GlaBoost consistently outperforms unimodal and generic multimodal baselines. Feature importance analysis highlights the cup-to-disc ratio, rim thinning, and the ISNT rule as the dominant predictors, yielding clinically consistent and interpretable decisions. GlaBoost offers a transparent and scalable foundation for multimodal decision support in ophthalmology.

Every year in the United States, 800,000 individuals suffer a stroke - one person every 40 seconds, with a death occurring every four minutes. While individual factors vary, certain predictors are more prevalent in determining stroke risk. As strokes are the second leading cause of death and disability worldwide, predicting stroke likelihood based on lifestyle factors is crucial. Showing individuals their stroke risk could motivate lifestyle changes, and machine learning offers solutions to this prediction challenge. Neural networks excel at predicting outcomes based on training features like lifestyle factors, however, they're not the only option. Logistic regression models can also effectively compute the likelihood of binary outcomes based on independent variables, making them well-suited for stroke prediction. This analysis will compare both neural networks (dense and convolutional) and logistic regression models for stroke prediction, examining their pros, cons, and differences to develop the most effective predictor that minimizes false negatives.

Cancer treatments are known to introduce cardiotoxicity, negatively impacting outcomes and survivorship. Identifying cancer patients at risk of heart failure (HF) is critical to improving cancer treatment outcomes and safety. This study examined machine learning (ML) models to identify cancer patients at risk of HF using electronic health records (EHRs), including traditional ML, Time-Aware long short-term memory (T-LSTM), and large language models (LLMs) using novel narrative features derived from the structured medical codes. We identified a cancer cohort of 12,806 patients from the University of Florida Health, diagnosed with lung, breast, and colorectal cancers, among which 1,602 individuals developed HF after cancer. The LLM, GatorTron-3.9B, achieved the best F1 scores, outperforming the traditional support vector machines by 39%, the T-LSTM deep learning model by 7%, and a widely used transformer model, BERT, by 5.6%. The analysis shows that the proposed narrative features remarkably increased feature density and improved performance.

Obesity is a major health problem, increasing the risk of various major chronic diseases, such as diabetes, cancer, and stroke. While the role of obesity identified by cross-sectional BMI recordings has been heavily studied, the role of BMI trajectories is much less explored. In this study, we use a machine-learning approach to subtype individuals' risk of developing 18 major chronic diseases by using their BMI trajectories extracted from a large and geographically diverse EHR dataset capturing the health status of around two million individuals for a period of six years. We define nine new interpretable and evidence-based variables based on the BMI trajectories to cluster the patients into subgroups using the k-means clustering method. We thoroughly review each cluster's characteristics in terms of demographic, socioeconomic, and physiological measurement variables to specify the distinct properties of the patients in the clusters. In our experiments, the direct relationship of obesity with diabetes, hypertension, Alzheimer's, and dementia has been re-established and distinct clusters with specific characteristics for several of the chronic diseases have been found to be conforming or complementary to the existing body of knowledge.