Depression Severity Estimation

Multilingual large language models (LLMs) are increasingly used in socially sensitive mental health contexts, including support chatbots, screening, and content moderation. This raises a reliability question: do semantically equivalent mental health inputs elicit comparable evaluations across languages, or systematic shifts consistent with language-associated social and cultural contexts? We examine this question in an English-Chinese setting with GPT-4o and Qwen3-32B using a two-level framework: construct-level evaluative orientation, measured by psychometric stigma instruments, and decision-level behavior, measured by binary stigma detection and four-class depression severity classification. Across instruments and models, Chinese prompts elicit higher stigma-related scores than English prompts. At the decision level, Chinese prompts reduce sensitivity to stigmatizing content and produce more conservative depression severity judgments, leading to more under-estimation errors. These findings show that prompt language can shift both evaluative orientation and downstream behavior in LLM-based mental health evaluation. They highlight the need to evaluate multilingual LLMs not only for aggregate performance, but also for whether they apply comparable evaluative standards across languages in socially sensitive domains.

Depression manifests through a diverse set of symptoms such as sleep disturbance, loss of interest, and concentration difficulties. However, most existing works treat depression prediction either as a binary label or an overall severity score without explicitly modeling symptom-specific information. This limits their ability to provide symptom-level analysis relevant to clinical screening. To address this, we propose a symptom-specific and clinically inspired framework for depression severity estimation from speech. Our approach uses a symptom-guided cross-attention mechanism that aligns PHQ-8 questionnaire items with emotion-aware speech representations to identify which segments of a participant's speech are more important to each symptom. To account for differences in how symptoms are expressed over time, we introduce a learnable symptom-specific parameter that adaptively controls the sharpness of attention distributions. Our results on EDAIC, a standard clinical-style dataset, demonstrate improved performance outperforming prior works. Further, analyzing the attention distributions showed that higher attention is assigned to utterances containing cues related to multiple depressive symptoms, highlighting the interpretability of our approach. These findings outline the importance of symptom-guided and emotion-aware modeling for speech-based depression screening.

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

Large language models (LLMs) are increasingly used in medical fields. In mental health support, the early identification of linguistic markers associated with mental health conditions can provide valuable support to mental health professionals, and reduce long waiting times for patients. Despite the benefits of LLMs for mental health support, there is limited research on their application in mental health systems for languages other than English. Our study addresses this gap by focusing on the detection of depression severity in Greek through user-generated posts which are automatically translated from English. Our results show that GPT3.5-turbo is not very successful in identifying the severity of depression in English, and it has a varying performance in Greek as well. Our study underscores the necessity for further research, especially in languages with less resources. Also, careful implementation is necessary to ensure that LLMs are used effectively in mental health platforms, and human supervision remains crucial to avoid misdiagnosis.

Large Language Models (LLMs) are increasingly being integrated into various medical fields, including mental health support systems. However, there is a gap in research regarding the effectiveness of LLMs in non-English mental health support applications. To address this problem, we present a novel multilingual adaptation of widely-used mental health datasets, translated from English into six languages (e.g., Greek, Turkish, French, Portuguese, German, and Finnish). This dataset enables a comprehensive evaluation of LLM performance in detecting mental health conditions and assessing their severity across multiple languages. By experimenting with GPT and Llama, we observe considerable variability in performance across languages, despite being evaluated on the same translated dataset. This inconsistency underscores the complexities inherent in multilingual mental health support, where language-specific nuances and mental health data coverage can affect the accuracy of the models. Through comprehensive error analysis, we emphasize the risks of relying exclusively on LLMs in medical settings (e.g., their potential to contribute to misdiagnoses). Moreover, our proposed approach offers significant cost savings for multilingual tasks, presenting a major advantage for broad-scale implementation.