Mental Health

The rising global prevalence of mental health conditions, together with longstanding barriers in traditional healthcare, such as limited resources, high cost, stigma, and privacy concerns, has created an urgent need for accessible and scalable support. Large Language Models (LLMs) have emerged as a transformative technology with strong potential to democratize mental health support through advanced natural language understanding and generation. However, the rapidly expanding, fragmented body of work in this area lacks a coherent evolutionary narrative, making it difficult to contextualize current progress and identify future directions. This survey addresses this gap by organizing and analyzing the literature around a central thesis: the role of LLMs in mental health is evolving through three distinct, increasingly sophisticated phases. We trace this trajectory from Phase I, in which LLMs act primarily as passive Information Tools and Pattern Recognizers for assessment; through Phase II, where they function as Empathetic Conversationalists for in-the-moment, stateless interactions; to the current frontier, Phase III, which seeks Longitudinal, Personalized Companions implemented as stateful cognitive agents. To support this framework, we systematically review core technologies, agent architectures (Profile, Memory, Reasoning, and Planning), and the critical infrastructure of datasets and benchmarks, highlighting how their evolution underpins this developmental path. Viewing the field through this developmental lens, we provide a comprehensive synthesis of existing work, an insightful narrative of its trajectory, and a clear roadmap for future innovation in responsible, effective, and human-centered AI for mental healthcare. A curated collection of the resources reviewed in this survey is available at our project repository: https://github.com/Emo-gml/Awesome-Mental-Health-LLMs.

Recent advancements in large language models have revolutionized the field of psychological counseling, especially in the context of Cognitive Behavioral Therapy (CBT). While the success of CBT relies heavily on dynamic decision-making informed by the client's real-time mental state, this aspect has often been overlooked in current research, limiting both flexibility and therapeutic outcomes. In this paper, we introduce StratCBT, a dataset specifically designed for psychological counseling conversations with CBT Strategies, consisting of 9,688 sessions and around 256K utterances, with each counselor's response aligned with one of eight distinct strategies. The creation of StratCBT involves modeling clients based on their negative thoughts and generating high-quality counseling conversations through self-chat, incorporating realistic sessions as guidance, thereby significantly surpassing existing datasets in both general counseling and CBT-specific skills. We conduct extensive experiments to demonstrate the effectiveness of strategy-aligned generation and evaluate its efficacy in delivering professional and effective counseling with LLM-simulated clients to reflect real-world scenarios. The dataset can be obtained from https://github.com/zimuwangnlp/StratCBT.

Automated depression screening from clinical interviews requires attribution of utterances to the clinician or patient. We evaluate two datasets: DAIC-WOZ, where participant-only recordings require re-synthesizing both sides for controlled two-party evaluation, and PDCH-HAMD, comprising voice-converted real Chinese interviews for cross-lingual validation. Cascaded systems combine speaker diarization with role-assignment heuristics, so errors can propagate across stages. We propose an end-to-end model, which we named DiaWhisper, that fine-tunes Whisper-large-v3 with LoRA and an auxiliary frame-level role head for transcription and attribution, together with DiaWhisper-DPO, a failure-mined refinement that uses genuine decoding failures as DPO rejected completions without human preference annotation. On 29 DAIC-WOZ test sessions, DiaWhisper-DPO achieves 0.973 role accuracy and 0.119 DER, 72% below the strongest cascaded baseline, and reduces seed variation from σ = .205 to .002. Retrained on PDCH-HAMD, it achieves 0.757 role accuracy and improves all 78 session-seed pairs.

Rising societal and lifestyle complexity has been linked to a growing prevalence of mental distress worldwide. Educational institutions, workplaces, clinics, etc. collect large volumes of mental health survey data to understand and reduce this burden. Collaborative analysis of such data could yield effective generalizable predictive models. Privacy constraints and varied survey designs (i.e., different questions, scales, and formats) hinder direct integration. We propose a schema-aware split learning (SL) framework that preserves privacy, using a large language model (LLM) as a shared semantic encoder to harmonize heterogeneous survey schemas across institutions. We serialize each survey record into a natural-language description, unifying disparate survey schemas into a common format. The LLM is fine-tuned for mental distress assessment via Low-Rank Adaptation (LoRA) and partitioned across client and server. Clients retain the raw survey responses locally and run only a lightweight front-end, so original records never leave the institution that collected them. The resource-intensive backbone runs on the server, minimizing client-side computation. Using LLaMA-3.2-3B-Instruct, the framework attains an average ANLS of 0.708 with only 2,000 training samples, surpasses federated learning (FL) in eight of nine settings, and cuts per-client computation by three orders of magnitude, while generalizing to unseen datasets. Overall, it enables accurate, privacy-preserving, and resource-efficient collaborative learning from heterogeneous mental health survey data.

Stress is a pervasive determinant of mental health and a key target for mobile health interventions. On-device language models (ODLMs) offer privacy-preserving inference without cloud dependency, yet their feasibility for health prediction under mobile resource constraints remains underexplored. We evaluate ODLMs for multi-modal stress prediction using zero-shot prompting, measuring predictive accuracy alongside latency and throughput. Our results show that objective sensor features marginally outperform subjective self-reports on average, and that lightweight sub-2B models achieve low latency with predictable resource usage. Our findings highlight both the promise and the practical constraints of ODLMs for mobile mental health.

Online mental health communities thrive on peer support, yet those who volunteer to help often lack formal training and may struggle to articulate supportive responses. AI co-writing could lower this barrier; however, peer support derives much of its value from being perceived as personal, raising questions around authorship, ownership, and trust. We built PeerPen, a writing assistance tool embedded within a Reddit-like interface, supporting two main features: draft generation and revision of user-written responses. Through semi-structured interviews with 15 participants, we find that PeerPen reduced the burden of composing responses and increased confidence in offering support. Participants wanted AI to assist their writing without taking over authorship and anticipated tensions around authenticity and trust. Such assistance could make authorship uncertain even for responses written without it, weakening trust across the community. We contribute design implications for AI writing assistance that scaffolds supportive communication, preserves authorship, and accounts for community-level trust.

With the existing digital mental health tools specifically developed for Western settings, Pakistani students are exposed to a uniquely compounded stress situation in their university that includes academic, financial, familial, and relational stressors, which have become a serious concern for academic and psychological development of students in Pakistani universities. This paper introduces a new, AI-driven and culturally sensitive stress detection and wellness support system that is tailored to the context of Pakistani university students. The system is based on a machine learning model called Random Forest which is trained using a validated student stress data set of 1100 responses on 20 features from psychological, physiological, academic, environmental and social aspects, with an accuracy of 89.09% and a macro F1-score of 0.89, in three stress severity levels. The classification outputs are passed on to an open-source large language model through OpenRouter API, where an appropriately crafted system prompt, culturally aware, gives the model a conversation about wellness, in English, Urdu and Roman Urdu. The second most predictive stress factor in this population identified by feature importance analysis was teacher-student relationship, which is a culturally important stress factor highlighting the need for region-aware mental health systems. Future research will involve primary data collection from students at various academic levels of Pakistani Universities with the validated DASS-21 instrument focusing on the students who are moving from FSc to undergraduate studies, which is a time of being psychologically vulnerable which is under-researched.

Healthcare systems, mental health, and public well-being are increasingly affected by cyberbullying and harmful online interactions. This paper presents CareGuard, an early-warning framework designed to support healthcare-driven mental health protection and proactive online safety through the detection of cyberbullying-related content using advanced natural language processing techniques. CareGuard integrates zero-shot semantic labeling with fine-tuned transformer-based models, including BERT, DistilBERT, and RoBERTa, to enable robust and context-aware classification across sensitive cyberbullying categories. To improve efficiency and reduce unnecessary computation in healthcare-oriented monitoring settings, the framework incorporates an emotion-aware filtering mechanism alongside cosine similarity-based semantic screening, allowing the system to focus on semantically relevant and emotionally salient content. Experimental results on benchmark datasets demonstrate that CareGuard effectively balances detection accuracy and computational efficiency, highlighting its potential for scalable deployment in healthcare systems, mental health monitoring, and online safety applications.

We describe the Snugi-AI-v2 submission to eRisk 2026 Task 2, the second edition of contextualized early depression detection from Reddit discussions. Our central contribution is a learned MLP stopping policy trained to directly optimize ERDE50, replacing the fixed and tiered threshold strategies used in all prior eRisk Task 2 submissions. Combined with a sustained confidence gate that commits only after N=3 consecutive rounds of high policy confidence, the system reduces false positives caused by transient emotional posts without sacrificing recall. The pipeline encodes each discussion thread with a frozen MentalRoBERTa model, maps the accumulated representation to a depression probability via an MLP classifier, and delegates the timing decision to the learned policy. Our best run achieves F1 = 0.73 (Run 1) and F_latency = 0.70 (Runs 0 and 3), with a median alert round of 8 out of 500, completing the full evaluation in 1 hour 26 minutes, the fastest among all complete-submission teams. We report a systematic ablation across five runs spanning two encoder variants, four stopping strategies, and three gate values, along with negative results from GRPO policy training, BDI-II post filtering, MentalLongformer encoding, and DeBERTa ensembling. Code: https://github.com/chiuyuwen91/erisk-2026

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.

Retrieval-augmented generation (RAG) can improve the specificity and grounding of large language model responses, but its effect is not uniformly beneficial in single-turn mental-health question answering, where user queries often combine emotional distress, treatment concerns, and safety-sensitive needs. We study when retrieval helps or hurts mental-health QA, and whether a lightweight selective retrieval policy can better control this trade-off. We operationalize retrieval need using three draft-conditioned utility dimensions: psychoeducational need, coping need, and response specificity, together with a rule-based safety trigger. Following psychotherapy-grounded RAG systems such as coTherapist, we construct a compact and controllable guideline corpus comprising coping-strategy, psychoeducational, and safety resources. We fine-tune an instruction-tuned generator on MentalChat16K using QLoRA and compare Closed-book, Always Retrieval, and Selective Retrieval settings on CounselBench-Eval and CounselBench-Adv. Experiments show that retrieval is not uniformly beneficial in this domain. Always Retrieval improves specificity but lowers overall quality and introduces additional safety-sensitive failures. Selective Retrieval preserves closed-book behavior for low-need cases while avoiding the additional degradation caused by unconditional retrieval, supporting the view that retrieval activation is a safety-sensitive control decision.

Sentence-level recognition of depression symptoms is challenging because similar expressions can differ in symptom relevance, and language-model inference is insufficiently grounded in diagnostic definitions. This study proposes a two-stage framework separating symptom-candidate generation from definition-grounded verification. A contrastively fine-tuned sentence encoder generates a symptom candidate per sentence, and a fine-tuned language model verifies whether the candidate is present or absent using the sentence, its context, and a candidate-specific diagnostic definition, checking its judgment against that definition before answering. Evaluated against encoder, inference-based, medical, and general LLM baselines and a matched single-stage supervised classifier, the proposed pipeline attains the best accuracy and F1 scores of all methods, with rationales matching expert-authored annotations. A preliminary clinical audit indicates moderate alignment with diagnostic definitions, with explanation quality strongly dependent on prediction correctness. The results support decomposing symptom recognition into candidate generation and definition-grounded verification, though performance remains limited for rare categories.

Patients with depression present with diverse symptom profiles, yet clinical practice routinely reduces this variation to a single severity score. Large language models (LLMs) can potentially capture various symptoms and their severity from patient speech. However, how depressive symptoms are represented inside LLMs remains poorly understood, limiting clinical trust. To examine whether internal model activations match clinician judgment, we analyzed the residual stream of Gemma-3-27B-PT using mechanistic interpretability techniques. Recording activations across symptom descriptions drawn from validated clinical instruments, we found that symptom groups geometrically separated the most at layer 21 across multiple distance metrics. Using Semantic Projection, we then projected held-out naturalistic text onto Symptom Vectors constructed from these instruments. The resulting per-symptom coefficients preserved clinician-annotated rank ordering across mood, somatic, and suicidality axes. Furthermore, a single depression vector in Layer 21 separates held-out depressive from non-depressive text (AUC = 0.789), which can be used as an emotional valence gate that restricts symptom projection to depressive speech. These results reveal a decorrelated, clinician-aligned symptom signal readable directly from internal activations, offering a mechanistic foundation for interpretable depression-assessment tools.

Understanding how psychiatric patients subjectively experienced a clinical conversation is important for feedback and alliance-related process monitoring. While interviewers form post-session judgments about patient experience, these judgments do not always match patients' self-reports. Automatic approaches for predicting perceived interaction quality from conversation have been proposed, but it remains unclear whether such approaches can complement human judgment rather than simply replicate it. To address this gap, we evaluate a clinician-support framework in which post-session interviewer ratings are combined with automatic language-based predictions to estimate patient-reported interaction quality in free clinical interviews. We assess this integration across multiple standard model types, including Ridge, SVR, MLP, GRU, and BiLSTM, all trained on sentence embeddings extracted from dyadic transcripts of 107 free conversations between psychiatric patients and interviewers. Our results show that combining interviewer judgments with model predictions through simple averaging yields the strongest overall performance. The interviewer-only baseline reached a Pearson correlation of 0.365. Among fully automatic models, Ridge achieved the strongest Pearson correlation (r = 0.286), while BiLSTM achieved r = 0.270. The strongest result was obtained by BiLSTM interviewer integration (r = 0.403). Our findings suggest that automatic language analysis and interviewer judgment capture complementary aspects of patient experience and that their combination provides a more accurate approximation of the patient's own report than either source alone.

Depression and anxiety in older adults with Mild Cognitive Impairment (MCI) are frequently underdiagnosed due to limited access to care. Multimodal analysis of remote clinical interviews is a scalable screening approach, but existing methods have three limitations. First, they do not correct temporal misalignment across multimodal features extracted at different resolutions, inducing spurious cross-modal associations. Second, remote recordings exhibit uneven modality dropout, but missing values are often zero-filled, making them indistinguishable from valid near-zero measurements. Finally, they do not jointly attribute predictions to modalities, questions, and interview moments, limiting fine-grained clinical interpretation. We propose a Temporally-Aligned, Missingness-Aware, Interpretable (TAMI) multimodal fusion framework. TAMI aligns speech, language, facial, and physiological features within question-answer segments on a shared timeline, encodes modality-level missingness over time, and conditions fusion on question context. In interviews with 49 older adults with MCI, TAMI achieved area under the receiver operating characteristic curve (AUROC) scores of 0.68 (depression) and 0.69 (anxiety). Fine-grained temporal alignment of multimodal features produced the largest performance gain ($Δ{\geq}0.1$). Multi-level interpretability analysis revealed that depression classification relied on eyegaze and open-ended questions, while anxiety classification depended on eyegaze and head pose, with attribution uniformly distributed across questions. Using only responses to the open-ended questions (5.1min), the depression model achieved an AUROC score of 0.67, which was not significantly different from using the full interview (19min) ($p>0.05$). Our findings support designing interview protocols centered on open-ended questions for depression screening in older adults with MCI.

University students experience disproportionately high rates of common mental health conditions, such as depression, which can impair learning, social functioning, and overall well-being. Although lifestyle interventions such as mindfulness and physical activity can reduce the symptoms, many do not achieve symptomatic remission. Developing new approaches to identify students with poor outcomes could enable earlier and more targeted intervention. Machine learning (ML) methods have increasingly been used to predict remission in depressive patients. However, these ML models often suffer from class imbalance, where there may be an unequal proportion of people in the remitted group relative to the non-remitted group. This imbalance can reduce model accuracy and bias predictions. To address this, studies commonly employ the popular oversampling strategy SMOTE. However, SMOTE has a notable limitation: it may generate invalid synthetic minority samples. In a clinical context, these false positives can lead to incorrect risk stratification, potentially delaying necessary escalated care for patients unlikely to remit. In this paper, we introduce a novel and effective oversampling method that addresses this shortcoming. Our approach leverages the variance function of a Gaussian process to estimate the uncertainty of generated minority samples to reduce false positives. We validate our method on a depression dataset collected from university students and demonstrate that it is better than existing oversampling approaches in predicting remission (i.e., treatment outcome). By improving the reliable identification of non-responders, our method provides a robust computational tool to help clinicians rapidly pivot to adjunctive therapies, thereby personalizing and optimizing mental health care pathways.

Mental health disorders are a leading cause of disability worldwide, yet Natural Language Processing (NLP) research for mental healthcare has remained concentrated in high-income, English-language settings. North Africa, and Algeria in particular, is largely absent from this literature despite its unique linguistic, historical, and healthcare context. We present the first conceptual framework examining the potential role of NLP within Algeria's mental healthcare system. Drawing on narrative synthesis of global NLP mental health research, Algerian healthcare literature, and low-resource NLP methodologies, we identify four structural barriers to mental healthcare: the language-of-care gap, geographic inequities in access, stigma-related barriers to help-seeking, and the absence of research and digital infrastructure. We then map existing NLP capabilities to each barrier, outlining their potential applications, implementation constraints, and the technical, institutional, and governance requirements necessary for deployment. Based on this analysis, we propose a research and policy roadmap that prioritizes data resources, multilingual language technologies, evaluation frameworks, and regulatory capacity. Although grounded in the Algerian context, the framework addresses challenges common to many multilingual, low-resource, and post-colonial settings. This work provides a foundation for future research on culturally and linguistically appropriate NLP for mental healthcare and offers a practical roadmap for developing responsible AI-enabled mental health systems in underrepresented regions.

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.

Cognitive distortion detection is a key task in computational mental health, yet existing approaches often overlook the psychological structure of distorted thoughts. We propose MTI-GNN (Multi-Perspective Triad Interaction Graph Neural Network), which models Beck's cognitive triad---negative views of the self, world, and future---as complementary perspectives for classification. An LLM decomposes each utterance into the three perspectives, from which perspective-specific similarity graphs are constructed and encoded by a Multi-Perspective GNN. A Triad Interaction module models cross-perspective dependencies through sequential source-conditioned updates and feature-wise gating, while Prototype-Guided Perspective Fusion performs label-conditioned aggregation. Label-expanded supervision incorporates all available distortion annotations during training. We evaluate MTI-GNN on 9,764 samples from four Korean, English, and Chinese datasets spanning ten distortion categories. MTI-GNN significantly outperforms all supervised variants and exceeds eight prompted generative models under zero-shot and few-shot settings. Leave-one-perspective-out ablations show that all three perspectives contribute significantly, while human expert evaluation provides preliminary evidence of their alignment with the intended cognitive dimensions.

Synthetic generation of Cognitive Behavioral Therapy (CBT) sessions is challenged by two competing demands: adhering to strict therapeutic structure while modeling the resistant, unpredictable behavior of real patients. Existing script-based methods fail to capture dynamic therapeutic interactions, while multi-agent approaches struggle to adhere to CBT's sequential structure; both suffer from sycophancy, producing overly compliant patients that misrepresent real clinical settings. In this work we introduce ODRA, a novel framework for synthesizing therapy dialogues through a Chain-of-Thought (CoT) strategy grounded in foundational CBT guidelines (Beck, 2020). ODRA further incorporates a resistance orchestrator to solve patient sycophancy, which employs steering techniques to elicit behaviors aligned with their resistance level. Automated and expert evaluations show that ODRA significantly outperforms existing methods across therapeutic skills, CBT alignment, and patient behavioral fidelity, with licensed psychologists preferring ODRA sessions across 12 of 13 clinical metrics. Furthermore, models fine-tuned on our dataset demonstrate superior therapeutic performance against both cooperative and resistant patients, validating that explicit resistance modeling in synthetic training data directly translates to downstream clinical robustness.

In Motivational Interviewing (MI), a client's sustain talk (arguments for the status quo) calls for the counselor to roll with resistance, a move that can fail in two opposite ways: capitulation (abandoning the change agenda to preserve rapport) or confrontation (arguing or directing, overriding the client's autonomy). We introduce a two-axis evaluation of counselor responses, anchored in the Motivational Interviewing Treatment Integrity (MITI) code, Goal Persistence (GP) and Relational Attunement (RA), yielding a four-quadrant framing in which rolling with resistance is high on both, and we ask whether penalizing one failure through preference optimization teaches rolling with resistance or provokes its opposite. From the expert-annotated AnnoMI corpus we build topic-disjoint Direct Preference Optimization data whose preference sets differ only in which failure is rejected, using on-policy negatives. An automatic judge, validated against AnnoMI's expert labels and rechecked by trained human coders, scores blind pairwise win-rates against each base under a firewall in which disjoint model families generate, label, and judge. Across three aligned instruction models spanning the Qwen and Llama families, penalizing confrontation reliably lowers goal persistence below parity, on every base and in every seed run, a robust cost, whereas the attunement gain is base-dependent, present on two of the three bases but absent on the third. Penalizing capitulation is inert, because these models rarely capitulate on-policy, so the trade is gated by each base's failure profile. A prompt-only control raises attunement without the goal-persistence cost, locating the cost in the optimization rather than in attunement itself.

Early detection of mental health disorders is often limited by the lack of specialized resources in Spanish and the difficulty of analyzing long histories of social media posts. This paper addresses these challenges through three main contributions. First, we introduce three Spanish foundational models specifically adapted to the mental health domain through domain-specific pre-training. Second, we propose Incremental Context Expansion (ICE), an automatic relabeling methodology designed for early detection. ICE identifies the point at which cumulative messages provide enough evidence of a disorder, generating more informative training samples. Third, we provide a set of fine-tuned models using the samples generated with the ICE methodology for early risk detection tasks. Our results on three Spanish benchmarks show that combining these specialized models with ICE improves the state-of-the-art, reducing detection latency while maintaining high performance. All models are publicly available.

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.

Mental health understanding in long-form videos requires nuanced reasoning over observable behavior, interpersonal context, and latent psychological states. Existing benchmarks largely reduce this task to coarse-grained classification, providing limited insight into whether models truly understand psychological phenomena or rely on superficial correlations. To address this limitation, we introduce MMHBench, a comprehensive multimodal benchmark for multi-perspective mental health understanding, comprising 268 long-form videos and 2,184 carefully curated questions. MMHBench organizes the evaluation into two complementary settings: (1) third-person assessment, consisting of 605 questions that focus on the interpretation of observable behaviors and multimodal evidence, and (2) first-person perspective-taking, comprising 1,579 questions that require perspective-conditioned reasoning to identify the interpretation of the mental state supported by the available multimodal evidence. We propose a Multi-Agent Question Generation (MAQG) framework that simulates diverse social roles to synthesize questions from multiple perspectives. The generated questions are refined through multi-role feedback and iterative optimization, followed by expert-guided verification to ensure quality and validity. Extensive evaluation of 22 representative multimodal large language models (MLLMs), spanning both open-source and leading closed-source models, demonstrates that long-form video mental health understanding remains highly challenging.

This study identifies new depression biomarkers based on the dynamical properties of tract variables, which represent geometric features describing the configuration of the speech articulators. A key advantage of this approach lies in its ability to quantify aspects of the articulatory process that have not been previously explored in the context of depression, namely predictability, complexity, and randomness. These properties are respectively characterised using the Largest Lyapunov Exponent, the Correlation Dimension, and the Sample Entropy. Thorough experiments were conducted on the Androids Corpus, a publicly available dataset comprising 64 speakers diagnosed with depression by clinicians and 54 control speakers with no reported history of mental health conditions. The results indicate that the proposed biomarkers effectively discriminate between the depressed and control speakers, as evidenced by the high Cliffs delta values across both read and spontaneous speech.

Cognitive distortion amplifies negative emotions and contributes to mental health disorders. Cognitive Behavioral Therapy (CBT) is an effective way to address cognitive distortions, but its large-scale application is limited by the shortage of professional therapists. Although large language models (LLMs) have recently been explored for mental health applications, existing methods still suffer from limited domain specificity, overly flattering responses, and the absence of well-defined annotations for cognitive distortions. This paper proposes Cognivia, an evidence-based artificial intelligence therapist that integrates automatic cognitive distortion identification and rational response generation. Our framework is built on authoritative CBT texts widely regarded as core paradigms and standard references. It is further augmented with mental health question-answer (Q and A) data, and employs multi-stage prompting and structured generation strategies under the supervision of behavioral science experts. Then we fine-tune a lightweight LLM on this augmented CBT dataset to obtain Cognivia. In addition, we propose the first hierarchical quality evaluation framework for assessing LLM-generated rational responses, developed through collaboration between AI researchers and behavioral science experts. Cognivia is evaluated using lexical metrics, LLM-based Judges with two complementary criteria, and human evaluation by 10 behavioral science experts. It consistently outperforms the baseline methods in cognitive distortion recognition and rational response generation, demonstrating its effectiveness. Our code is available at https://github.com/SNOWTEAM2023/Cognivia.

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.

Psychotherapists need repeated training and supervision; however, scalability is problematic. We present MyMentorLLM, a multimodal voice- and text-based deliberate-practice environment with 2,100 complete Cognitive Behavioural Therapy (CBT) sessions. Each session links a DSM-5-TR-grounded LLM patient (with major depressive, generalised anxiety or borderline personality disorder), an LLM therapist-in-training and an LLM expert supervisor (powered by Gemma-4, Gemini-3.1-Flash-Live and Qwen-3.6). Sessions were analysed for emotional dynamics, therapeutic competence and diagnostic accuracy against human psychotherapy data. Simulated patients expressed disorder-congruent emotional profiles, which therapists mirrored as in human counselling. LLM trainee competence was rated above human levels in most conditions, while native speech-to-speech was closest to human scores. Supervisor feedback improved diagnostic accuracy in 5 of 7 LLM conditions, whereas symptom identification accuracy increased with model size. This work shows deliberate practice can be simulated for CBT training, although patient fidelity, supervisor calibration and harmful feedback require evaluation via a complex systems perspective.

Ethical governance of AI-driven systems is often expressed through high-level principles and static documentation, creating a gap between regulatory requirements and system-level verification. This challenge is particularly acute in digital phenotyping, where continuous behavioural data raises concerns around consent, privacy, and fairness. In this paper, we propose a computational ethical framework for AI-driven digital phenotyping system in which ethical requirements are formalised as deontic temporal logic constraints, alongside a conceptual ethical agent that oversees the system and ensures that any supervised system satisfies the specified constraints. Using a case study involving financial data and mental health, we model key ethical properties and verify them using the Z3 Satisfiability Modulo Theories (SMT) solver. Our evaluation shows that the framework is logically consistent and that violations of the specified ethical properties are ruled out within the formal model through counterexample-based verification. This presents early research enabling continuous, machine-verifiable ethical checking, moving beyond retrospective compliance based on static documentation. We discuss limitations, including the need for real-world verification with data, the challenge with subjectivity and contextual sensitivity, the need for human oversight, and outline how such approaches can support the development of digital phenotyping and AI systems with continuous and auditable ethical guarantees.

Using large language models (LLMs) to assist psychological counseling is an important task in the field of natural language processing. The construction of high-quality psychological support dialogue corpora serves as a critical foundation for training counseling-oriented conversational models. However, existing data generation approaches generally suffer from several limitations, including emotionally stable seekers, limited variation in emotional dynamics, and a high degree of compliance with counselors' guidance. These issues result in LLM that lack the capability to effectively respond to emotionally unstable scenarios. In addition, counselor responses are typically driven by problem-solving objectives, thereby overlooking the role of emotion-focused interaction, which are essential in psychological counseling. To address these gaps, we propose EmoTrace, a multi-turn dialogue corpus generation framework centered on modeling seekers' emotional trajectories. we construct seekers' cognitive profile and introduce a seeker module with emotional schemas and an associated activation mechanism, a counselor module, and an emotional trajectory control module, thereby enhancing the layering of the seeker's emotional expression and the counselor's targeted empathic expression. Experimental results demonstrate that the proposed method outperforms existing approaches in terms of emotional richness and empathy quality.

This paper presents GEMCo, a releasable, human-written proxy for inaccessible counselling data: 86 complete German e-mail counselling conversations (728 messages), expert-authored cases and counsellor sessions with trained role-players. It is validated against a held-out reference of 124 real counselling conversations. The proxy and the real conversations are measured against each other on counsellor strategies and client emotions. The gap is detectable but small. A generative validation supports the analysis. The corpus is the primary contribution. The validation method generalises to any domain where real data cannot be shared but a human-made proxy can. Privacy and ethics keep real counselling data closed. GEMCo carries none by design and can be released, a first step toward language research in this domain.

Automatic depression detection with deep learning has shown promise but often suffers from limited generalization due to domain shift arising from inter-speaker variability. To address this critical issue, we present the first patient-independent multimodal depression detection framework that incorporates domain generalization (DG), jointly leveraging both acoustic and textual modalities. The proposed model integrates bidirectional Long Short-Term Memory (BiLSTM) with intra- and cross-modal attention mechanisms, accompanied by segment-level fusion for decision-making. Generalization is further enhanced by applying a gradient reversal layer inspired by Domain-Adversarial Training of Neural Networks (DANN), which promotes domain-invariant representations by adversarially limiting the model's ability to identify individual speakers, effectively reducing patient-specific bias. Conducting experiments on the Androids-Corpus dataset with a 5-fold cross-validation (CV) protocol, various pairings of audio and text feature extractors were evaluated over different segment durations, determining MelSpec and ItalianBERT as the optimal baseline at a 30-second segment duration. The addition of DG to this baseline yields a 2.5% increase in accuracy and 3.3% in F1-score, achieving 93.2% accuracy, 93.2% precision, 96.2% recall, and 94.2% F1-score, surpassing all existing benchmarks. Extensive ablation studies assess the impact of multimodal fusion, deep architectural choices, and DG, highlighting their combined contribution to robust and generalizable depression detection.

Repetitive transcranial magnetic stimulation (rTMS) is a non invasive therapy for Major Depressive Disorder (MDD). In this study, we generate images using two time frequency methods to represent EEG signals: Fourier-Bessel Series Expansion with Euclidean Distance (FBSE-ED) and Discrete Wavelet Transform (DWT). We propose an efficient deep learning classifier to predict the outcome of rTMS depression therapy. In this study, we use a private rTMS databases to train a lightweight custom Convolutional Neural Network (CNN) using 10-fold cross validation strategy in order to avoid any bias in our results. The results show that the FBSE-ED representation achieves the highest classification accuracy of 93.60%, outperforming traditional time-frequency technique (DWT). In addition, the proposed architecture with FBSE-ED image representation technique outperforms more complex EEG-Specific deep learning models (EEGNet, DeepConvNet, SleepEEGNet) by 3.62-10.72% and pretrained models (Xception, DenseNet201, and MobileNetV2) by 23.03-27.35%. For more experiments, we utilize another private rTMS database as test database to show the robustness of the proposed model. Our results suggest that integrating advanced signal decomposition with deep learning can facilitate early prediction of rTMS treatment response and support more targeted clinical decision-making. The proposed framework is interpretable, computationally efficient, and well-suited for deployment in real-world local psychiatric clinics.

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.

Large language models (LLMs) are increasingly used for emotional support despite lacking mechanisms to safely govern evolving mental health risk. Existing safety approaches primarily detect risk but rarely shape how models respond as conversational risk unfolds. We developed a model-agnostic safety governance architecture that combines contextual risk detection, reasoning-based verification, and protocol-guided response generation for multi-turn mental health interactions. Synthetic conversations grounded in real-world mental health narratives were used to evaluate the architecture's performance, tested with GPT-5-chat and Qwen3.5-27B, achieving high risk detection performance (specificity: 0.85 (95%CI: 0.78;0.91), sensitivity: 0.92 (95%CI: 0.88;0.95)) and increasing clinician-preferred escalation responses by 25.6--59.2pp while preserving rapport and connection. Performance remained stable across conversation length and generalized across both proprietary and open-source models. These findings demonstrate that clinically-grounded safety governance can extend beyond risk detection to improve how LLMs manage evolving mental health risk, providing a scalable framework for safer deployment across models.

Digital mental health interventions (DMHIs) offer scalable support, but ensuring they accurately detect users' intent during volatile situations can be challenging. Pure parametric Large Language models (LLMs) do not contain specific safety critical architecture, and can miss critical cues, or hallucinate, undermining reliability. Retrieval Augmented Generation (RAG), which supplements an LLM with retrieved context, could enhance intent detection during volatile situations. Commercially available DMHIs typically combine multiple independent safety layers like rule-based filters, symbolic escalation protocols, and neural classification. The incremental contribution of any single layer, however, remains unquantified. This paper evaluates six LLM models within a DMHI called Wysa, via a controlled comparison of RAG-enabled versus RAG-disabled modes. Anonymized real and synthetic user-chatbot exchanges were annotated by a qualified clinical team against multi-class intent categories (e.g. self-harm, abuse, panic). The study computed classification accuracy, recall, precision and F1 scores against ground truth labels and tested differences for statistical significance. Performance was also examined by risk category and inter-model agreement. While RAG caused a rise in false alarms, the trade-off is consistent with safety-critical design principles that prioritize sensitivity, where flagged cases are routed to additional review rather than acted on directly. Overall, these findings support RAG as a promising approach to improve the accuracy, consistency and safety of LLM-driven DMHIs. Keywords: Digital Mental Health Intervention, Large Language Model, Retrieval Augmented Generation, Accuracy, Recall, Precision

Annotation quality is a major bottleneck in building reliable and explainable artificial intelligence (XAI) systems for mental health research. In depression-related datasets, labels are often assigned without structured evidence, symptom-level justification, or traceable alignment with the criteria of the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition, Text Revision (DSM-5-TR), limiting both transparency and downstream model interpretability. We propose a self-evolving, expert-in-the-loop annotation framework for Major Depressive Disorder (MDD) that combines large language model (LLM)-assisted labeling with expert verification. The framework is intended to support the construction of explainable, DSM-5-TR-aligned datasets rather than to perform clinical diagnosis. It operates in three stages: candidate evidence selection from textual records, criterion-level DSM-5-TR analysis, and case-level synthesis that produces label-level diagnostic and severity annotations. A dual-memory architecture, composed of Example Memory and Reflection Memory, is designed to internalize expert feedback and iteratively improve future annotations without retraining. We describe this mechanism and leave its evaluation across multiple feedback cycles to future work. In addition to final labels, the framework exports clinical evidence, reasoning traces, and edit histories, enabling comprehensive auditability. In a pilot study using expert-reviewed samples, the proposed approach improves annotation consistency and explainability while reducing manual revision effort.

Contemplative traditions have long guided ethical behavior and prosocial interaction, and recent work suggests that contemplative principles (e.g., mindfulness, compassion, non-dual reasoning) may offer a promising paradigm for aligning large language models (LLMs), improving cooperation and reducing ethical violations in LLM outputs. However, as new models, evaluation metrics, and benchmarks emerge rapidly, it remains challenging to systematically assess whether and how contemplative principles enhance LLM alignment across diverse and evolving scenarios, and existing approaches are often ad hoc and fail to generalize. We present a modular, extensible evaluation framework, initially targeted at the mental health domain, that enables seamless integration of new models, metrics, and benchmarks through a reusable pipeline. The framework currently reproduces existing state-of-the-art results and supports systematic cross-evaluation by flexibly mixing and matching models, metrics, and benchmarks, enabling fair comparison and deeper insight. Its plug-and-play prompting module offers a principled pathway for incorporating ethical perspectives such as contemplative principles, allowing domain experts to define alignment criteria without requiring technical expertise. Although initially focused on mental health, the framework is domain-agnostic and extends naturally to areas such as decision-making, moral reasoning, and human-AI collaboration. By bridging computational evaluation with human-centered ethical reasoning, this work lays the groundwork for interdisciplinary research spanning cognitive science, behavioral economics, philosophy, and system design, toward robust, trustworthy, and socially beneficial human-AI ecosystems.

Explainable machine learning (XML) pipelines applied to composite mental health outcomes can produce apparently-robust, cross-population-stable risk hierarchies that are largely artefacts of how the outcome was constructed. We demonstrate this using an ElasticNet pipeline applied to 886 medical students at the University of Lausanne (primary cohort, 2022), validated across 2,580 longitudinal observations at three time points and 701 non-medical students from eight faculties; all three datasets share identical instruments. The pipeline produces a hierarchy in which trait anxiety and health satisfaction dominate wherever the outcome is measured, with Kendall $τ= 1.0$ for the top-two positions across all five evaluation sets and consistent transfer performance ($R^2$: 0.41-0.49). Two residualization experiments, which isolate shared variance between correlated variables via regression, reveal the mechanism: when trait anxiety (STAI-T) is residualized against the co-included depression subscale (CES-D, $r = 0.72$), model $R^2$ drops from 0.41 to 0.16 and STAI-T falls from rank 1 to rank 6; when burnout subscales are residualized against CES-D, $R^2$ collapses to 0.016. Prediction intervals average 35.4 units on a 0-100 scale (2.4 outcome standard deviations), independently ruling out individual-level deployment. The residualization protocol is the paper's transferable contribution: any XAI study combining correlated predictor and outcome constructs should apply this check before interpreting apparent stability as a finding.

Large language models (LLMs) have shown strong performance on isolated psychiatric tasks, including dialogue, diagnosis, and treatment planning, yet existing benchmarks rarely simulate complete psychiatric clinical encounters. We introduce $\textbf{MentalHospital}$, a virtual evaluation environment for LLM-based psychiatric clinical encounters. MentalHospital instantiates the Subjective Interviewing, Objective Examination, Diagnostic Assessment, and Treatment Planning (S.O.A.P.) workflow, using skill-augmented standardized patients constructed from 1,193 de-identified psychiatric electronic health record (EHR) cases spanning all major ICD-11 categories and 76 disorders. Each encounter is assessed through a dual-track protocol that combines objective comparison against EHR-derived references with subjective assessment of clinical process quality. To scale specialist judgment, we develop $\textbf{MentalEval}$, five domain-specific evaluators covering communication empathy, interviewing professionalism, clinical-note quality, diagnostic rigor, and treatment appropriateness, trained with rubric-grounded SFT and expert-guided DPO. Survey responses from 22 clinicians support MentalHospital's clinical fidelity (3.88/5), while MentalEval achieves strong expert alignment with an average QWK of 0.944. Benchmarking shows that even the strongest LLM trails clinicians by 37.28 percentage points in objective psychiatric competence, with mental status assessment as a key bottleneck.

Social robots offer a promising means of supporting cognitive therapies for dementia care by guiding structured conversation and therapeutic activities. However, little is known about the conversational dynamics that emerge during robot-delivered cognitive stimulation therapy (CST) sessions. This study analysed the interaction patterns from robot-delivered individual CST (iCST) sessions conducted with people living with dementia in home settings. Our Co-STAR (Cognitive Stimulation Therapy by an Autonomous Robot) system was deployed in the homes of eight PwDs for one week, who completed 30-minute sessions. Conversational metrics, including words per turn, speech production rate, response duration, response latency, and self-referential language, were analysed to examine how conversational engagement is shaped by prompt personalisation, interaction phase, and participant characteristics. The findings highlight three key interactional properties of robot-delivered iCST. First, personalised prompts significantly increase response duration, self-referential language, and overall engagement compared to generic prompts. Second, conversational behaviour changes within sessions, with a reduction in the verbal output and autobiographical engagement observed during later interaction phases, which suggests cognitive fatigue. Third, first-session conversational metrics were associated with long-term participation, while living situation influenced conversational engagement patterns. These findings provide empirical insights into the factors that shape conversational engagement in robot-delivered iCST. They inform the design of adaptive conversational robots for dementia therapy.

Large language models (LLMs) have become significant providers of mental health support, yet they remain products of an attention economy whose operational and commercial targets favour sustained engagement over the friction that effective psychological support often requires. Developers' safety responses have been largely reactive, addressing the most visible and acute harms while subtler, longer-term patterns of risk (e.g., dependency, boundary erosion, the amplification of distorted beliefs) receive less attention. We contend that making LLMs structurally safe requires alignment organised at three levels that mirror how society assures the safety of human clinical practice: 1) explicit value specification grounded in the codified normative commitments of clinical practice; 2) training that embeds those values in the model; and 3) oversight that detects drift and longer-term harm during deployment, much as clinical supervision does for human practice. Organising alignment in this way yields a construct we call alignment plausibility - a structured demonstration that a system's values, training regime, and oversight mechanisms are together consistent with safe and positive outcomes. We propose alignment plausibility as a regulatory construct (by drawing analogy to the established construct of biological plausibility) for AI in health: a principled way to argue for, or against, trust that systems are aligned to positive health outcomes, will cause no harm even where capable of doing so, and will ultimately lead to patient benefit.

Modelling psychological disorders in artificial agents offers both a testbed for computational psychiatry and a lens on the failure modes of affective control. Prior work induces one or two disorders in a reinforcement learning (RL) agent by hand-tuned reward shaping, labels the behaviour post hoc, and reports single runs. We recast disorder modelling as dose-controllable manipulation of cognitive appraisal signals in an appraisal-guided PPO agent, expressing seven disorders (anxiety, mania, obsessive-compulsive checking, depression, impulsivity, addiction, and post-traumatic stress) each as a single knob grounded in a computational psychiatry account, with each symptom measured by a preregistered assay mapped to a recognised paradigm. Across more than a thousand runs (10 seeds, four controls, 95% confidence intervals) every disorder shows a graded, monotone dose-response that no control reproduces. Beyond these induced effects, three findings emerge that were not written into the reward: the disorders self-organise into a two-dimensional affective space in which mania mirrors anxiety; removing a knob remits reward distortion disorders (mania, checking, addiction) but not avoidance disorders (anxiety, PTSD), which instead recover under a graded exposure curriculum; and two simultaneous knobs interact nonadditively, yielding testable comorbidity predictions. Appraisal weights thus parameterise a controllable space of affective phenotypes in which the same knobs that induce a disorder can model its treatment. We also show that three disorder knobs (depression, addiction, anxiety) transfer to a three-dimensional pixel environment (MiniWorld) with a standard convolutional agent and no appraisal critic, with cross-assay dissociation confirmed across both domains, indicating the framework is not specific to grid worlds or to PPO's appraisal critic.

Automatic depression detection using audio-visual data faces significant challenges, particularly in disentangling overlapping feature distributions and establishing robust decision boundaries. To address this, we propose a fine-grained multimodal framework featuring a temporal encoder and a mutual transformer to facilitate deep cross-modal fusion. Our core contribution is the Binary Advantage-weighting Ranking Loss, which optimizes the latent space distribution through two complementary mechanisms: Advantage-weighted Separation, which mines hard pairs by computing a pairwise prediction difference matrix and dynamically weighting them based on their difficulty; and Advantage-weighted Compactness, which minimizes intra-class variance to force features to cluster around their respective class centers. Extensive experiments on D-vlog and LMVD demonstrate that our model reconstructs the latent ordinal structure by prioritizing hard pairs, thereby achieving state-of-the-art performance.

Cognitive therapies have been shown to enhance the quality of life and well-being of people living with dementia (PwDs). However, their use remains limited due to a shortage of trained professionals and the significant time and training required of informal caregivers. To address this gap, we developed and deployed a social robot capable of autonomously delivering cognitive stimulation therapy (CST) in the home. Nine PwDs participated in a one-week ($7$ days) study that involved daily robot-led sessions. Participants engaged positively with the system, completing nearly half of the scheduled sessions, an adherence rate higher than typically observed in caregiver-led CST. Our findings also highlight the crucial role of family members, who often supported session initiation and occasionally joined the activities, enriching the interactions. This work demonstrates the feasibility and potential of socially assistive robots to deliver in-home cognitive therapy, offering a scalable approach to extend access to dementia care.

Large language models are increasingly used as private, always-available conversational systems, but little is known about how people with depressive symptoms use them. Building on CSCW work on disclosure and peer support, we examine ChatGPT as an emerging informal support infrastructure: private, persistent, responsive, and available outside ordinary hours. We analyze 187,093 ChatGPT conversations from 766 participants who completed the PHQ-8, comparing those below the moderate-symptom threshold (score of 10) with those at or above it. Higher-PHQ participants used ChatGPT more for mental-health, interpersonal, loneliness, self-focused, and support-seeking conversations, with pronounced late-night and recurring month-level patterns. Their language contained more first-person singular pronouns and absolutist terms. They more often engaged ChatGPT in high-disclosure contexts, but professional redirection was not higher. Language-based prediction was modest and insufficient for screening (AUROC 0.591). We argue these histories should not be treated as clinical screening data but as evidence LLMs are increasingly used as informal support infrastructure.

Depression screening from large-scale behavioral data is challenged by fragmented circadian indicators, limited interpretability, and the lack of intervention-oriented analysis. Existing approaches typically analyze sleep, activity, and social behaviors in isolation, failing to capture their joint circadian structure. To address this limitation, we first propose the Circadian Rhythm Score (CRS), a composite index that compresses multi-domain daily behaviors into a unified representation of circadian rhythm. CRS is constructed to maximize discriminative power for depression screening while preserving behavioral semantics through non-negativity constraints. Empirical results demonstrate near-lossless compression, where a single CRS retains almost the full predictive capability compared with multiple raw behavioral indicators. Building upon CRS, we develop an interpretable depression screening framework based on gradient-boosted trees and SHAP analysis, revealing nonlinear and saturation-like associations between circadian rhythm and depression risk. Beyond risk prediction, we further integrate interaction modeling and counterfactual regression to estimate heterogeneous and dose-dependent behavioral effects, enabling intervention-oriented reasoning under different circadian contexts. Experiments on the China Health and Retirement Longitudinal Study (CHARLS, n=15,233), demonstrate robust screening performance (ROC-AUC=0.825) and identify actionable behavioral thresholds, including a minimum effective exercise dose of approximately 300 MET-min/week and an optimal restorative nap duration of approximately 65 minutes for sleep-deprived individuals. By bridging supervised representation learning and interpretable modeling, this work provides a scalable framework for depression screening and intervention-aware healthcare data mining.

Active mobility is widely promoted for sustainable and healthier living, but whether it translates into equitable mental health benefits across individuals and places over time remains unknown. Using causal machine learning and causal deep learning in 264168 UK adults, we find substantial inequalities in individualized effects of active mobility on anxiety, depression, and common mental disorders. These inequalities widen over time and are strongly structured by urban context. For example, anxiety risk at follow-up ranges from a 40.6% reduction to a 10.1% increase across individuals, versus a 10.4% reduction to a 0.1% increase at baseline. Benefits are greatest in greener, safer, less polluted, and less deprived neighborhood environments, with 81.8% of individuals experiencing above-average benefits and mean anxiety risk reduced by 26.4%, versus 10.4% of individuals and 7.4% reduction in the least supportive environments. Urban compact form further modifies these effects through nonlinear interactions with neighborhood environments, amplifying benefits only under supportive conditions. Despite these strong environmental gradients, genetic moderation is negligible. These findings suggest universal active mobility promotion could widen health inequalities if individual and contextual differences are not accounted for.

Online social media posts provide scalable signals for early depression screening, and recent studies mainly improve pre-classification evidence through risk-post selection, symptom grounding, and clinically informed feature construction. However, these screening-stage designs often leave final decisions to a single detector, overlooking how users heterogeneously express depressive risk after screening. A monolithic classifier must average across heterogeneous users, which may dilute localized evidence and cause misclassification, especially for non-self-disclosing users. To address this issue, we propose WPG-MoE, a weak-prior-guided dense mixture-of-experts framework built on a shared large language model (LLM) backbone. WPG-MoE derives user-level weak semantic priors to softly route users to experts matched to different evidence layouts. We formulate this process as learning using privileged information (LUPI): rich LLM-extracted structured evidence guides training-time routing, while inference retains only Patient Health Questionnaire-9 (PHQ-9) template screening and the deployable backbone. Experiments on Chinese and English datasets show that WPG-MoE outperforms strong baselines with interpretable routing behavior.

Bangladesh has an estimated 1.17 mental-health professionals per 100,000 population and only six child psychiatrists nationwide. No Bengali-language, culturally adapted tool exists for early screening of abuse-related psychological trauma in children. We present ShishuRaksha AI, a decision-support (not diagnostic) framework that fuses four screening modalities: validated questionnaires (SDQ, CPSS), Bengali narrative text, House-Tree-Person (HTP) drawing features, and facial affect. The fusion is training-free and clinically weighted, uses cross-modal attention, and includes a single-modality override rule. Every risk score is explained through clinically weighted, perturbation-based additive attribution and rendered as a bilingual (Bangla/English) report with referral routing to national child-protection services (OCC, DSS, NMHH) under the Children Act 2013. No clinical dataset of abused children can be collected ethically at this stage, so we introduce a noise-aware synthetic benchmark (500 cases, 116 positive [23.2%], four deliberate noise layers, literature-grounded HTP priors) and evaluate tree-ensemble surrogates of the fusion design (facial channel excluded) under 5-fold stratified cross-validation. The fused model reaches an AUC of 0.874 [0.834-0.908], against 0.756 [0.705-0.803] for an SDQ-only baseline, with ablation, operating-point, subgroup, and calibration analyses. We state all limitations openly, including synthetic-only data, no held-out set, text-feature circularity, and an urban-rural subgroup gap. This work is a feasibility study and a design contribution toward ethically deployable child-protection screening in low-resource settings.

Automatic depression detection from clinical interviews typically models the semantic content and acoustic characteristics of participant speech. However, the interactional timing between the clinician and participant remains comparatively under-modeled. We investigate conversational temporal dynamics, specifically dyadic turn-pair timing, as a primary modality fused with self-supervised encoders. Evaluated on the DAIC-WOZ dataset, we compare a compact 24-dimensional timing module against frozen WavLM-large and RoBERTa-large baseline detectors. This temporal module achieves the highest single-modality performance on the development set. Furthermore, a convex-weighted late fusion strategy improves overall performance to 0.804 and 0.669 macro-F1 on the development and test sets, respectively. The learned fusion effectively assigns zero weight to acoustics, demonstrating that conversational timing serves as a lightweight, interpretable complement for dyadic depression screening.

Detecting mental health disorders in a timely manner is an important societal challenge. NLP and machine learning (ML) methods used to assist with detection rely on data collected primarily from social media. However, such datasets often have sampling biases and inherent ethical and privacy issues. One avenue to overcome these limitations is non-social media data. We present the first comprehensive review of non-social media, free-text datasets for mental health research. We use the PRISMA methodology to conduct our survey and we review datasets available in multiple languages. We find that non-social media free-text based datasets are predominantly focused on English and on detecting depression. These datasets also vary in demographics, platforms, data types, annotation techniques, and methodologies. This systematic review also reveals key gaps and highlights opportunities to develop more diverse, reliable and clinically-relevant resources.

Social media posts are a rich and valuable source of data for analyzing mental health states and users' well-being using automated analysis tools. In this work, we demonstrate how we used a range of Natural Language Processing (NLP) methods, including Long Short-Term Memory (LSTM), BERT-based models, and Large Language Models (LLMs), for self-state and well-being analysis and summarization during the CLPsych Shared Task 2026. Our approach achieved one of the top Consistency and Contradiction scores for the summarization task and also middle-level results for the other tasks. By testing and developing such mental health-state estimation systems, we contributed to improving mental health support systems. We make our code available https://github.com/psytechlab/CLPsych2026/.

Cognitive Behavioral Therapy (CBT) provides a structured framework for understanding a user's mental state by examining the interaction between cognitive and behavioral factors. However, out-of-the-box LLMs respond fluently and empathetically, yet collapse into validation & reflection, regardless of what the user actually needs. They know theoretical CBT (scoring up to 96% accuracy on licensing exam questions) but fail to apply it effectively. We explore this gap with a knowledge-guided framework that treats CBT dialogue as controlled affective reasoning: user narratives are decomposed into Beck's Cognitive Conceptualization structure, grounded in clinical SNOMED CT concepts validated via Natural Language Inference, and a Multiple Chain-of-Thought (MCoT) strategy selection between Validation & Reflection, Socratic Questioning, or Alternative Perspectives. To measure whether such guidance actually changes behavior, we introduce the Protocol Leverage Force (F), a behavior-level metric that captures how far an intervention shifts a model away from its default response. Across three open-weight LLMs and 14 RealCBT-derived case studies, evaluated with human experts, valence-arousal trajectories, and linguistic entrainment, F shows that simply introducing protocol definitions via single chain-of-thought prompting fails to change LLM behavior, while MCoT on these definitions guides strategy selection better. Still, the effect stays within 1% (approx. 1.2-1.3%), and all models remain biased toward Validation & Reflection. These results show CBT knowledge alone does not ensure effective application, giving the affective-computing community instrumentation to measure where LLMs fall short.

Electroencephalography (EEG) offers a noninvasive approach for examining neurophysiological correlates of dimensional psychopathology, yet systematic evidence across EEG paradigms and feature granularities remains limited. Here, we develop a granularity-aware EEG feature pipeline that organizes multi-scale descriptors into global, regional, and channel levels. Using the Healthy Brain Network (HBN) cohort, we evaluate the prediction of four psychopathology dimensions: p-factor, internalizing, externalizing, and attention problems, across four EEG paradigms. Given the heterogeneity of pediatric psychopathology and the moderate reliability of questionnaire-derived scores, this setting represents a challenging feasibility test rather than a clinical screening scenario. Tree-based models and granularity-balanced feature selection showed promising improvements over conventional approaches in selected conditions, although effect sizes remained modest. Visualization of selected markers revealed dimension-specific spatial and spectral patterns that were broadly aligned with existing neurophysiological knowledge. An exploratory cross-dataset sanity check on the independent PEARL cohort suggested that the proposed selection principle remains technically feasible under protocol shifts, without claiming cross-dataset generalizability. Overall, multi-scale EEG features contain weak but detectable signals related to dimensional psychopathology, and granularity-aware selection may serve as a useful feature-reduction strategy for future EEG-based phenotyping studies.

Mental health disorders affect nearly one billion people globally, yet 75% of individuals in low- and middle-income countries receive no treatment due to workforce shortages, cost barriers, and stigma. Current AI-powered wellness solutions predominantly rely on single-mode conversational interfaces that suffer high abandonment rates and fail to provide measurable, immediate relief calibrated to users' dynamic emotional states. This paper presents Copewell, a novel multi-agent swarm system designed to expand access to mental wellness support through human-centered AI principles. Our architecture introduces three technical innovations: (1) a multi-source assessment framework integrating self-reported, physiological, and contextual data to mitigate algorithmic bias; (2) valence-arousal emotion mapping using Russell's Circumplex Model of Affect to route users to specialized AI agents; and (3) dual-mode intervention delivery combining conversational support with evidence-based sensory wellness protocols. We examine the sociotechnical design considerations underlying Copewell's development, including a privacy-first architecture, embedded ethical oversight through a dedicated Ethics Supervisor agent, and participatory design informed by mental health practitioners. Early practitioner engagement and beta deployment inform design decisions and identify directions for future empirical evaluation. This work contributes to responsible AI discourse by demonstrating how technical architecture can operationalize equity and safety principles from inception.

Graph Neural Networks (GNNs) have been widely used to capture spatial functional connectivity patterns to improve electroencephalography (EEG)-based depression recognition performance. However, the functional connectivity of brain networks in patients with depression exhibits an inherent hierarchical structure, making it difficult to capture accurate connection patterns. To address these issues, this paper proposes a novel model named Sample-Adaptive Hyperbolic Graph Neural Network (SA-HGNN), which aims to accurately extract the authentic hierarchical structure of depression-affected brain networks. Specifically, the proposed model comprises three core modules. First, a Sample-Adaptive Graph Construction module dynamically constructs personalized brain network topologies to capture more complex spatial relationships within the brain network. Second, hyperbolic graph convolution is employed to overcome the representation bottlenecks of Euclidean space, leveraging hyperbolic geometry to precisely capture latent hierarchical relationships within the brain network. Finally, an Attention Pooling module adaptively filters out highly redundant noise channels in EEG signals, effectively mitigating the interference of inherent noise on the authentic hierarchical topology. Extensive experiments on public EEG datasets demonstrate the superior performance of our method across resting-state and task-related paradigms, validating its robustness to noise and efficacy in capturing abnormal functional connectivity patterns in brain networks of patients with depression.

Recent advances in Large Language Models (LLMs) have motivated their adoption across a wide range of domains, including Artificial Intelligence (AI) for mental health. Given the growing prevalence of mental health disorders worldwide and the limited accessibility of professional care, there is an increasing demand for scalable computational approaches that can assist in early detection and continuous monitoring of psychological well-being. In this area, ongoing efforts have focused on curating domain-specific datasets and leveraging them to develop LLMs capable of supporting holistic mental health analysis. In line with this direction, we propose an LLM-based pipeline for comprehensive mental health analysis over sequentially ordered user posts, as part of the CLPsych shared task. Our pipeline offers a unified framework that jointly enables post-level assessment and user-level temporal modeling.

Large language models show promise for mental health support, yet therapeutic quality improves only when evaluation functions as an actionable control signal rather than a passive metric. We introduce a framework that formulates therapeutic response generation as a decision-refinement problem driven by multi-dimensional, human-aligned evaluation. In Stage I, we introduce TheraJudge, an open-source therapeutic evaluator trained via preference-based optimization on human-annotated data to produce reliable judgments across 7 psychological dimensions. In Stage II, we introduce TheraAgent, which operationalizes TheraJudge's evaluations through a coordinated refinement process with specialized Critic, Coach, and Therapist roles that translate evaluative signals into targeted response revisions. Empirically, TheraJudge achieves strong agreement with clinician ratings, with intraclass correlation coefficients (ICC = 0.87-0.95), surpassing supervised baselines and strong closed-source judges, particularly on critical dimensions such as Safety, Relevance, and Empathy. Acting on these evaluations, TheraAgent yields a +0.43 improvement in human-rated therapeutic quality (on a 5-point scale) under blind evaluation, with 96% clinician inter-rater reliability. Low-quality responses ($\leq 3$) improve by +2.45 points with a 94% recovery rate, demonstrating targeted correction of unsafe outputs. Overall, our results indicate that effective alignment of mental-health LLMs stems from acting on human-aligned evaluation, rather than relying solely on stronger generation. We release code at https://github.com/vis-nlp/TheraAlign.

Reasoning large language models (LLMs) have recently made much progress in complex problem-solving, leveraging internal reasoning (or thought) to guide their solution generation. However, existing LLM-based counseling agents, including those using Motivational Interviewing (MI), generate responses without explicitly aligning thoughts with counseling techniques, limiting their effectiveness. We propose MIThinker, a lightweight thinking model that generates therapeutic thoughts to guide MI counseling agents in strategy selection and response generation. To overcome the lack of annotated thought data, we introduce AugR1-MI, an automated pipeline that reverse-engineers counselor's thoughts from observed responses. Through two-stage training combining supervised fine-tuning and reinforcement learning, MIThinker demonstrates improved theory-of-mind assessment and strategy alignment. Comprehensive evaluations show that MindfulMI, our agent leveraging MIThinker, achieves MI competency comparable to state-of-the-art systems with an order of magnitude less computation.