Depression Severity Estimation
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3 papers in the last four weeks, against 1 the four weeks before. 0.0% of all new papers.
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Depression has no diagnostic blood test. Language models promise tireless, consistent assessment, but can accurate raters disagree about individuals? We pre-registered 880 language-model raters, crossing 11 open models with prompting and scoring choices, and applied them to 189 interviews against the eight-item Patient Health Questionnaire. Model choice explained 30.0% of summed-symptom score variance, stable participant differences 10.5%. Two randomly drawn raters with area under the receiver operating characteristic curve (AUC) >= 0.70 disagreed on screening decisions for 40% of participants, on average. Average over-rating governed how many were flagged, yet equal-capacity raters chose differently for about one participant in five. A locked analysis of 86 new interviews reproduced the main pre-registered findings. Exploratory recalibration with 40 labelled participants raised accuracy from about 60% to 75% and halved disagreement, leaving one participant in five decided differently. Calibration repaired much of the rater dependence without securing agreement about individuals.
Structure vs. Chain-of-Thought: Evaluating LLM Criteria Extraction for Depression Severity
A large language model (LLM) can rate depression severity directly from a social media post or mark which clinical criteria the post shows and let code turn the count into a label. The latter is easier to audit because a clinician can check each marked criterion. We compare these approaches on two Reddit corpora using three LLMs (from 9B to frontier scale) and two questionnaires (PHQ-9, BDI-II), and measure agreement with quadratic weighted kappa. For the two frontier models, criteria extraction scores above chain-of-thought on one corpus only when its decision thresholds are fitted on labeled data. Neither model's gain is significant, with or without recalibrating chain-of-thought on the same labels. With thresholds fixed a priori from PHQ-9's criteria, extraction shows no gain on either corpus, even where models mark over two criteria per post. The 9B model behaves differently on a corpus from depression communities. It labels most posts severe, whether prompted directly or with chain-of-thought, while the a priori rule beats both without labels. After chain-of-thought is recalibrated on the same labels, no significant gap remains, consistent with a calibration effect. Yet higher ordinal agreement does not ensure better detection of severe cases. PHQ-9 criteria extraction misses most severe posts, and moving from direct prompting to chain-of-thought and then to extraction increases misses in nearly all comparisons. On the primary corpus, a relabeled stress dataset, a model using that dataset's own features, including word counts from the text, is not significantly different from frontier criteria extraction under the a priori rule.
MERID: Multimodal Exploration via Recursive Self-Improvement Agents for Major Depression Analysis
Major depressive disorder (MDD) severely impacts daily activities and quality of life. Detecting MDD involves multimodal data, such as interview recordings and sensor measurements. This is particularly challenging, as these heterogeneous modalities often demand distinct, customized prediction pipelines. Existing efforts to address this challenge have explored both manually engineered multimodal architectures and agent-assisted pipeline development. Despite their progress, it remains challenging to autonomously revise pipelines based on experimental feedback and carry verified improvements forward into subsequent designs. To this end, we propose Multimodal Exploration via Recursive Self-Improvement Agents for Major Depression Analysis (MERID). The framework develops depression pipelines through experience-based recursive self-improvement (RSI). Grounded State Construction (GSC) grounds experience by aligning multimodal records with subject-level depression targets. Coupled Pipeline Exploration (CPE) jointly modifies representations, fusion, and predictors to build successor pipelines for classification and severity estimation. Evidence-Guided Evolution (EGE) guides revisions through feedback and verifies gains under uncertainty in small depression cohorts before inheritance. Extensive experiments on depression benchmarks show that MERID achieves the best results on multiple tasks compared with multimodal and agent-based baselines. Further analysis highlights the value of acoustic and linguistic cues for depression detection. Our code is available at https://github.com/DiscoAILab/MERID
Cross-Scale Transfer Learning for Depression Severity Prediction: From PHQ-8 to HAMD-17 Across Languages and Clinical Paradigms
This work addresses continuous depression-severity score prediction from clinical interview transcripts under data scarcity. We propose a sequential low-rank adaptation (LoRA) protocol for cross-scale transfer: a Qwen3 backbone with a bounded regression head is first fine-tuned on the English DAIC-WOZ dataset (189 avatar-mediated sessions, PHQ-8), and the adapter then initializes fine-tuning on the Chinese PDCH dataset (100 real clinical consultations, HAMD-17), where a reinitialised, scale-specific head predicts the clinician-assigned score. All configurations use patient-level stratified 5-fold, 2-repeat cross-validation. On the data-scarce HAMD-17 target, the sequential protocol attains the best point-estimate MAE , RMSE, and macro- on both 0.6B and 1.7B backbones, outperforming target-only training and non-LLM baselines---4.96/6.59/0.36 with Qwen3-0.6B and 4.38/5.62/0.46 with Qwen3-1.7B. Ablations suggest that correctly aligned source supervision gives the best point estimates (unsupervised exposure and shuffled-label controls also show partial gains), that native-Chinese target input outperforms machine-translated English input, and that the reversed order yields no clear gain within run-to-run variance. The study is an exploratory, single-site internal evaluation: it does not establish screening or diagnostic utility, nor separately identify the contribution of the scale, language, or paradigm shifts. To our knowledge, no prior study evaluates this specific DAIC-WOZ-to-PDCH sequential transfer setting.
LongCounsel-8: A Benchmark Suite for Longitudinal Depression Tracking from Multi-Session Counseling Dialogues
Tracking depression from multi-session counseling dialogues requires estimating both current symptom severity and how it changes across sessions. Yet progress on this task is constrained by the scarcity of longitudinal counseling data with standardized session-level depression labels. Existing resources typically provide either multi-session conversations without depression labels or labeled interviews in a single session. Building such a benchmark poses three challenges: maintaining longitudinal consistency and diversity, grounding symptom progression in empirical patterns, and expressing controlled depression states naturally without exposing target labels. To address these challenges, we introduce LongCounsel-8, a benchmark suite of three independently generated datasets totaling 7,749 five-session counseling trajectories, grounded in real-world client profiles, depression trajectories, symptom compositions, and counseling patterns. We combine profile-grounded simulation, empirically informed state construction, and indirect behavioral realization to address these challenges. Across the benchmark, simulated self-reports closely recover the controlled states, supporting label fidelity. Experiments on existing depression tracking methods reveal three key findings: (1) lower single-session score error does not guarantee accurate identification of trend, i.e., improvement or worsening; (2) existing methods are consistently less reliable on worsening trajectories; and (3) additional session history may reduce the accuracy of trend prediction. Together, these findings establish LongCounsel-8 as a foundation for advancing depression assessment from static, single-session prediction toward reliable longitudinal tracking of mental-health change.
The MADRS Pipeline: Supporting Depression Assessment in Clinical Trials
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.
DynaBridge: Dynamic Summary-Guided Cross-Task Multimodal Fusion for DASS-Structured Mental Health Assessment
Multimodal behavioral analysis offers a scalable approach to assessing depression, anxiety, and stress, yet generic fusion models often ignore the psychometric structure of questionnaire labels. In DASS-21, risk labels are derived from ordered symptom items through fixed item-to-subscale mappings. We propose \textbf{DynaBridge}, a dynamic summary-guided cross-task multimodal framework for DASS-structured mental health assessment. DynaBridge encodes acoustic, visual, and textual cues across multiple sessions and augments them with frozen-LLM-generated DASS-aware summaries as participant-level semantic evidence. It predicts ordinal item distributions, reconstructs depression, anxiety, and stress risk evidence from item-level soft scores, and fuses this evidence with direct multimodal risk predictions. A confidence-aware refinement strategy further incorporates high-confidence semantic cues conservatively. On the official AdoDAS validation split, DynaBridge outperforms the official baseline and representative multimodal methods, achieving 0.5012 mean F1 for D/A/S risk prediction and 0.3216 mean QWK for DASS-21 item prediction. These results show the value of bridging multimodal cues, semantic summaries, and DASS-21 psychometric structure.
DS@GT ARC at eRisk 2026: Hybrid Multi-Agent LLM System with Structured Algorithmic Guidance for Conversational Depression Screening
We describe DS@GT's submission to the eRisk 2026 Task 1 challenge on conversational depression screening, in which systems interview LLM personas that simulate individuals with varying depression profiles and produce a Beck Depression Inventory II (BDI-II) score plus four key symptoms per persona, without directly asking sensitive mental health questions. Our pipeline evolved through three stages: a monolithic single-model prototype to start off, a baseline multi-agent architecture that separates conversational interviewing from BDI-II scoring under a coordinating orchestration layer, and a final hybrid configuration that replaces the paid GPT-5-nano interviewer with the open-source Gemma 27B. To offset the model's weaker reasoning and instruction-following, the hybrid adds three algorithmic components: a precomputed dialogue tree that standardizes interview openers and follow-ups, a reliability-weighted consensus aggregation inspired by the Weaver framework, and a cluster-based imputation step for unprobed symptoms. We submitted three fully automated runs across all 20 personas, with Run 1 from the paid baseline and Runs 2 and 3 from the hybrid. Hybrid Run 3 achieved an ADODL of 0.9063, ranking 3rd among all complete-submission runs and placing DS@GT 2nd among the 21 teams overall, while outperforming our paid baseline Run 1 (0.8841) at roughly one-quarter of the per-persona API cost. These results support our central hypothesis that with sufficient algorithmic supervision, a weaker open-source model can compete with a stronger proprietary model in the conversational interviewer role. Our source code is available at https://github.com/dsgt-arc/erisk-task1-2026.
Expresso-AI: Explainable Video-Based Deep Learning Models for Depression Diagnosis
Given the widespread prevalence of depression and its consequential impact on individuals and society, it is crucial to obtain objective measures for early diagnosis and intervention. As a multidisciplinary topic, these objective measures should be interpretable and accessible to health care professionals, ensuring effective collaboration and treatment planning in the realm of mental health care. Even though current automated depression diagnosis approaches improved over the last decade, a critical gap exists as they often lack affect-specificity and interpretability, limiting their practical application and potential impact on mental health care. In particular, interpretability from temporal activities from videos when deep models are used is not fully explored. In this study, we present a novel framework for analyzing Deep Neural Networks' decisions when trained on facial videos, specifically focusing on automatic depression severity diagnosis. By fine-tuning Deep Convolutional Neural Networks (DCNN) pre-trained on Action Recognition datasets on depression severity facial videos from AVEC depression dataset, our framework is able to interpret the model's saliency maps by examining face regions and temporal expression semantics. Our approach generates both visual and quantitative explanations for the model's decisions, providing greater insight into its reasoning. In addition to this interpretability, our video-based modeling has improved upon previous single-face benchmarks for visual depression diagnosis, resulting in enhanced predictive performance. Overall, our work demonstrates the successful development of a framework capable of generating hypotheses from a facial model's decisions while simultaneously improving depression's predictive capabilities.
A Multi-Agent Audit Framework for High-Stakes Reasoning: Evaluation and Interpretability in Clinical Mental Health Screening
High-stakes reasoning tasks necessitate transparent and verifiable workflows, yet conventional single-model large language models (LLMs) often struggle with hallucination and low interpretability under zero-shot paradigms. To address this general AI challenge, we propose a Multi-Agent Audit Framework that simulates a collaborative, multi-step verification process. We empirically validate this architecture in the sensitive domain of clinical mental health screening using a modular LangChain workflow. Our framework decomposes the reasoning process into a Perception Agent, Knowledge Retrieval-Augmented Generation (RAG), Chain-of-Thought (CoT) clinical inference, and a critical Audit verification stage. We evaluated this framework on the DAIC-WOZ dataset using locally deployed open-source models. Experimental results demonstrate that our multi-agent pipeline significantly outperforms single-agent baselines, reducing the Mean Absolute Error (MAE) for PHQ-8 depression severity prediction from 5.35 to 5.02. By exposing cross-agent validation traces, the framework mitigates reasoning drift and provides highly interpretable diagnostic rationales, offering a generalizable paradigm for reliable AI-assisted decision support beyond isolated model scaling. We make data and code open access on GitHub for replicability.
Creating Multilingual Mental Health Dialogue Datasets: Limits of Persona-Based Localization via Nationality and Language
AI and large language models (LLMs) have emerged as promising tools to address global mental health challenges. Despite the global nature of these challenges, there remains a critical shortage of high-quality datasets for training and evaluating such systems. To mitigate this gap, researchers increasingly generate synthetic clinical personas to simulate user data and test digital mental health support systems. However, most validated personas rely on English-centric contexts. This paper investigates whether similar persona-based methods can be used to generate multilingual mental health datasets. We modified nationality and language parameters in personas to generate clinical dialogues in Mandarin, Bengali, and Hindi. We then examined how different LLMs perform when evaluating the depression severity of these generated multilingual datasets against the baseline in English. Our findings indicate that just adding nationality and language parameters in personas might not be adequate, as it can introduce clinical inconsistency across languages. LLM judge models often exhibit inaccuracies in assessing depression severity in non-English texts, with performance varying across different models. This exposes the systemic limitations of applying English-centric personas to multilingual contexts. Ultimately, our work highlights the urgent need for culturally responsive data generation to ensure equitable mental health systems globally.
Reading between the Lines: Leveraging Large Language Models for Global Dementia and Depression Assessment from Clinical Interviews
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.
Fine-tuning LLMs for Passive Depression Severity Estimation from AI Mental Health Dialogue
Depression is the leading cause of disability worldwide, and early detection of symptom change is essential for timely intervention. Validated instruments such as the Patient Health Questionnaire-9 (PHQ-9) support symptom monitoring at scale, but real-world completion rates are low, introducing response bias and systematic missingness. Passive approaches that infer severity from routinely generated data could close this gap. We address this by predicting PHQ-9 total scores directly from transcripts of conversations between users and an AI mental health application, requiring only conversation text and no additional clinical data. We fine-tune a Qwen3.5-27B backbone with a regression head, augment 3,111 ground-truth labels with pseudolabels generated by a reasoning model (Claude Opus) and iteratively trained intermediate models, for a combined dataset of 6,283 users. On a held-out test set of 842 users, our best model achieves MAE = 2.6, RMSE = 4.0, Pearson r = 0.80, and AUC = 0.91 at the PHQ-9 >= 10 clinical threshold. We also find AUC > 0.87 at every severity threshold from PHQ-9 >= 3 to PHQ-9 >= 24, demonstrating that the model captures depression severity across the full clinical spectrum. This work opens the door to passive, continuous symptom monitoring in AI mental health platforms, without requiring users to complete self-report measures.
Exploration of Perceptual Speech Features for Clinical Decision-Support in Mental Health Care
Speech and language technologies offer valuable opportunities for supporting mental health assessment through objective and interpretable cues. We present a systematic feature-based analysis framework leveraging perceptually grounded acoustic and linguistic characteristics, including prosody, vocal quality, semantic coherence, syntactic structure, and sarcasm. Using statistical analysis and interpretable machine learning (XGBoost with SHAP and LIME), we examine associations between speech features and validated symptom measures of depression, anxiety, and ADHD. Evaluated on both controlled benchmark datasets (StressID, DAIC-WOZ, Androids, EATD) and a real-world clinical dataset, the framework reveals stable and consistent relationships between symptom severity and vocal irregularities (e.g., shimmer, jitter), lexical-syntactic patterns, and affective tone. An ablation study conducted across all datasets further identifies the most informative feature groups. This work explores a transparent and clinically interpretable approach to speech-based mental health analysis.
EmoTrack: Clinical-Semantic Modeling for Text-Based Depression Severity Estimation
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.
Can We Trust LLMs for Mental Health Screening? Consistency, ASR Robustness, and Evidence Faithfulness
LLMs can estimate Hospital Anxiety and Depression Scale (HADS) scores from speech in a zero-shot manner, but clinical deployment requires reliability across three dimensions: intra-model consistency, ASR robustness, and evidence faithfulness. We evaluate three LLMs (Phi-4, Gemma-2-9B, and Llama-3.1-8B) on 111 English-speaking participants using ground-truth transcripts and three Whisper ASR variants (Large, Medium, Small), with three independent runs per model-condition pair. We find that (i) Phi-4 and Gemma-2-9B achieve excellent intra-model consistency (ICC > 0.89) with minimal degradation under ASR; (ii) Llama-3.1-8B shows ASR-fragile consistency, with ICC dropping from 0.82 to 0.36 at 10% WER; (iii) predictive validity is largely preserved under ASR for robust models; and (iv) keyword groundedness exceeds 93% for Phi-4 and Gemma-2-9B but falls to 77-81% for Llama-3.1-8B. Inter-model keyword agreement is far lower than score-level agreement, revealing a score-evidence dissociation with implications for clinical interpretability.
ADAPTS: Agentic Decomposition for Automated Protocol-agnostic Tracking of Symptoms
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 () with distinct interview structures. On high-discrepancy interviews, automated ratings approximated expert benchmarks () more closely than original human ratings (). Implementing an ``extended'' protocol that incorporates qualitative clinical conventions significantly stabilized ratings, with absolute agreement reaching . 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.
MA-DLE: Speech-based Automatic Depression Level Estimation via Memory Augmentation
Speech-based automatic estimation of depression levels is essential for enabling early detection and timely intervention, particularly in resource-constrained mental health settings. In recent years, deep learning has demonstrated impressive success across various domains, including affective computing and mental health assessment. Most existing approaches rely on RNN-based architectures (such as LSTM and GRU) to model temporal information for depression estimation. However, the extracted features often emphasize only a few adjacent speech segments, limiting their ability to capture long-range dependencies. To overcome this limitation, we introduce a memory-based feature augmentation method that enhances the representational capacity of GRU-extracted features. Rather than indiscriminately incorporating historical data, our memory bank is designed to selectively integrate two types of components in order to reduce redundancy and irrelevance: (1) historical temporal features that closely resemble the current GRU output, offering complementary contextual information; and (2) dynamic memory features identified based on feature variability, which capture behavioral and emotional fluctuations indicative of depressive symptoms. To effectively fuse the memory-augmented features with GRU outputs, we further design a Hierarchical Attention Fusion (HAF) module. Our method is evaluated on the widely used DAIC-WOZ and E-DAIC datasets, achieving state-of-the-art performance.
EviDep: Uncertainty-Aware Multimodal Depression Estimation via Disentangled Evidential Learning
Audio--visual recordings provide complementary cues for estimating depression severity, but their informativeness varies across time and modalities. Point predictions alone do not express the uncertainty associated with these estimates. We present EviDep, a multimodal evidential regression framework that integrates multi-scale temporal modeling and shared--private representation learning for uncertainty-aware depression estimation. Frequency-aware Feature Extraction decomposes behavioral feature sequences into multiple frequency bands and refines them with scale-specific experts. Disentangled Evidential Learning encourages the disentanglement of cross-modal shared and modality-specific information in the refined features. Multi-branch Evidential Regression maps the resulting shared and private representations to three Normal-Inverse-Gamma (NIG) outputs and uses evidence-weighted aggregation to estimate depression severity and quantify aleatoric and epistemic uncertainty. Experiments on AVEC 2013, AVEC 2014, DAIC-WOZ, and E-DAIC show competitive prediction accuracy, with ablation studies supporting the contributions of frequency-aware refinement and shared--private disentanglement. Further analyses show that estimated epistemic uncertainty helps identify higher-error predictions, while both uncertainty estimates generally increase under controlled feature degradation.
"Mirror" Large Language Model Evaluations of Depression are Criterion Contaminated
Large Language Model (LLM) studies that use language responses elicited from depression assessments to predict scores on those same assessments often report near-perfect prediction of depression. We refer to these as "Mirror" evaluations and demonstrate an applied case of criterion contamination. N = 110 participants completed both structured diagnostic depression interviews (Mirror condition) and life history interviews ("Non-Mirror" condition). LLMs were prompted to predict depression scores in each condition. As expected, Mirror evaluations were near-perfect. However, Non-Mirror evaluations also displayed prediction sizes considered outstanding in psychology. Further, both Mirror and Non-Mirror predictions correlated with Patient Health Questionnaire-9 scores at similar sizes, suggesting the Mirror condition's advantage collapses when predicting an independent depression measurement. Topic modeling revealed differing depression-related themes across interview types. Mirror evaluations are better considered as reliability evaluations than as validity evaluations. Incorporating Non-Mirror approaches in LLM depression assessment may support more valid and clinically-relevant applications. Keywords: large language models, psychological assessment, psychopathology, depression, reliability, validity, criterion contamination