Mental Health

Current approaches to detecting depression and anxiety from speech primarily rely on machine learning techniques that utilize hand-engineered paralinguistic features and related acoustic descriptors derived from time- and frequency-domain representations of speech signals. Applying deep learning methods directly to raw speech signals has the potential to produce biomarker representations with substantially greater predictive power. However, these approaches typically require large volumes of carefully annotated data to learn robust and clinically meaningful representations of the underlying biomarkers. In this paper, we describe our efforts toward developing a deep learning model trained on a large-scale proprietary dataset comprising ~65,000 utterances collected from more than 23,000 subjects representative of relevant United States demographics. We present the techniques employed and analyze their impact on model performance. Our results demonstrate that the proposed models can extract content-agnostic biomarker information, which, when combined with lexical features extracted from audio, yields improved predictive performance in production settings. Our models are evaluated on ~5000 unique subjects and achieve performance of 71% in terms of sensitivity and specificity. To foster further research in mental health assessment from speech, we release the best-performing model described in this paper on HuggingFace.

Sentiment analysis has been of long-standing interest in psychotherapy research. Recently, the Transformer deep learning architecture has produced text-based sentiment analysis models that are highly accurate and context-aware. These models have been explored as proxies for emotion measurement instruments in psychotherapy, but not investigated as stand-alone psychometric tools. Using proposed utterance-level and session-level sentiment features derived from a fine-grained sentiment model on a large corpus of psychotherapy sessions (N = 751), we investigate the distribution of session aggregated sentiment scores. Further, we characterize the relationship of these features to individual components and the overall score of the OQ-45 instrument and find that this sentiment feature is most strongly correlated to components related to emotional valence in directionally intuitive ways. Finally, we report that there are statistically significant differences between the sentiment distributions for patients flagged as at risk of deterioration or dropping out of care via either the OQ Rational or Empirical outcome models. These correlations to a fully-validated psychometric instrument demonstrate that these proposed sentiment features are, at least, adjunctive measures of client distress and deterioration.

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.

The growing demand for cognitive remediation therapy, combined with limited speech therapist availability, has accelerated the adoption of remote rehabilitation tools. These systems generate large volumes of interaction data that are difficult for clinicians to review efficiently. This paper investigates automated clinical report generation for avatar-guided, home-based cognitive remediation sessions in a low-resource setting with no reference reports. We present and compare two approaches: (1) a rule-based template system encoding speech therapy domain knowledge as explicit decision rules and validated templates, ensuring clinical reliability and traceability; and (2) a zero-shot LLM-based approach (GPT-4) aimed at more fluent and concise output. Both systems use identical pre-extracted, expert-validated structured variables, enabling a controlled factual comparison. Outputs were evaluated by eight speech therapists and final-year students using a nine-criterion questionnaire. Results reveal a clear trade-off between clinical reliability and linguistic quality. The template-based system scored higher on fluidity, coherence, and results presentation, while GPT-4 produced more concise output. Directional differences are consistent across evaluation dimensions, though no comparison reached statistical significance after correction, reflecting the scale constraints of expert clinical evaluation. Based on evaluator feedback, we derive eight design recommendations for clinical reporting systems in remote rehabilitation settings. More broadly, this work contributes a replicable methodology combining expert elicitation, taxonomy-driven generation, and multi-dimensional human evaluation for clinical NLG in low-resource settings, and illustrates how controlled comparisons can inform the responsible adoption of generative AI in healthcare.

Automated mental health prediction using textual data has shown promising results with deep learning and large language models. However, deploying these models in high-stakes real-world settings remains challenging, as existing approaches largely rely on semantic representations and often produce overconfident predictions under ambiguous, noisy, or shifted data. Moreover, most methods lack reliable uncertainty estimation, undermining trust in risk-sensitive mental health applications. To address these limitations, we formulate the task as a multi-view learning problem that integrates semantic information from encoder-only models with higher-level reasoning information from decoder-only models, where reasoning-aware representations and uncertainty modeling are obtained in a trustworthy manner. To ensure reliable fusion, we adopt an evidential learning framework based on Subjective Logic to explicitly model uncertainty and introduce an evidential fusion strategy that balances complementary views while discounting unreliable evidence. Benchmarking on three real-world datasets, Dreaddit, SDCNL, and DepSeverity, reports accuracies of 0.835, 0.731, and 0.751, respectively, demonstrating its potential for reliable mental health prediction. Additional experiments on robustness to noise and case studies for interpretability confirm that our proposed framework not only improves predictive performance but also provides trustworthy uncertainty estimates and human-understandable reasoning signals, making it suitable for risk-sensitive applications in mental health assessment.

Large language models (LLMs) are increasingly used for decision support in healthcare, but clinical evidence is often incomplete or evolving. When the available information is insufficient to support a reliable answer, models should request clarification or abstain rather than provide unsupported responses. Existing medical benchmarks, however, typically assume that complete information is available upfront. We introduce Safe-Psych, a sequential benchmark for evaluating how LLMs handle evolving diagnostic uncertainty in clinical psychiatry. Safe-Psych contains over 1,000 real-world psychiatric clinical notes segmented to simulate incremental evidence disclosure, with psychiatrist-derived action labels at each stage: DIAGNOSE, CLARIFY, or ABSTAIN. We evaluate multiple state-of-the-art LLMs in full-information and sequential settings. Our findings show that capability does not ensure calibration: even strong models struggle under incomplete clinical information, with under-abstention exceeding 60% for most models and safety-aware prompting reducing premature commitment only by shifting errors toward excessive abstention. In sequential evaluation, models frequently diagnose before sufficient evidence is available and rarely seek clarification unless explicitly prompted; these premature diagnoses are less accurate than on-time diagnoses. Overall, Safe-Psych reveals a limitation across the evaluated models: recognizing when clinical evidence is incomplete and additional information is needed. We release Safe-Psych to support research on improving LLM safety in healthcare.

The scope of AI safety and alignment work in generative artificial intelligence (GenAI) has so far mostly been limited to harms related to: (a) discrimination and hate speech, (b) harmful/inappropriate (violent, sexual, illegal) content, (c) information hazards, and (d) use cases related to malicious actors, such as cybersecurity, child abuse, and chemical, biological, radiological, and nuclear threats. The public conversation around AI, on the other hand, has also been focusing on threats to our cognition, mental health, and welfare at large, related to over-relying on new technologies, most recently, those related to GenAI. Examples include deskilling associated with cognitive offloading and the atrophy of critical thinking as a result of over-reliance on GenAI systems, and addiction associated with attachment and dependence on GenAI systems. Such risks are rarely addressed, if at all, in the AI safety and alignment literature. In this paper, we highlight and quantify this discrepancy and discuss some initial thoughts on how safety and alignment work could address cognitive and mental health concerns. Finally, we discuss how information campaigns and regulation can be used to mitigate such prominent risks.

Mental-health dialogue models are increasingly evaluated by AI-based evaluators, yet these evaluators often treat surface empathy, supportiveness, or fluency as evidence of safety. In this paper, we study a hidden failure mode that we call implicit sycophancy: a response may appear empathetic while implicitly reinforcing catastrophizing, avoidance, hopeless prediction, or CBT-style labeling. To examine this problem, we introduce a diagnostic benchmark for implicit-sycophancy detection, built from three representative mental-health dialogue sources covering everyday peer support, counseling-style emotional support, and crisis-oriented interaction, and further construct a leakage-audited clean single-response matched benchmark with 500 contexts and 1,500 matched response windows. We then propose Dynamic Emotional Signature Graphs (DESG), a structured offline audit framework that separates LLM-based state extraction from final scoring and evaluates clinical direction through semantic, affective, and cognitive-distortion state transitions rather than free-form LLM judgment. Unlike metadata, surface-style, lexical, embedding, and rubric-LLM baselines, DESG scores the direction of clinical-state change induced by a response; on the leakage-audited clean matched benchmark, DESG-StateRisk improves over the strongest non-DESG baseline by 0.0488 macro-F1 and achieves the best harmful-risk detection result. These results suggest that evaluating implicit sycophancy requires explicit clinical-state modeling together with leakage checks, shortcut controls, and competitive baselines.

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 ($N=204$) with distinct interview structures. On high-discrepancy interviews, automated ratings approximated expert benchmarks ($\text{absolute error}=22$) more closely than original human ratings ($\text{absolute error}=26$). Implementing an ``extended'' protocol that incorporates qualitative clinical conventions significantly stabilized ratings, with absolute agreement reaching $\text{ICC(2,1)} = 0.877$. 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.

Predicting complex human traits from genetic data is challenging because different genetic, clinical, and molecular data sources often contain different parts of the signal. Here, we present EFGPP, a reproducible framework for generating, ranking, and combining multiple types of data for genotype-to-phenotype prediction. We applied EFGPP to migraine prediction using UK Biobank data from 733 individuals. The framework combined genotype-derived features, principal components, clinical and metabolomic covariates, and polygenic risk scores generated from migraine and depression GWAS using PLINK, PRSice-2, AnnoPred, and LDAK-GWAS. The best single data type achieved a test AUC of 0.644, while combining multiple data types improved performance to 0.688 using migraine-focused inputs and 0.663 using cross-trait depression-derived inputs. Genetic features alone did not outperform the covariates-only baseline, but genotype-derived features performed better than PRS alone, and depression-derived PRS showed useful predictive signal. Overall, EFGPP provides a practical proof-of-concept framework for prioritising and integrating heterogeneous genetic data sources for complex phenotype prediction.

How people narrate their experiences offers a window into how the mind organizes them. Computational approaches to therapeutic writing have evolved from lexical counting to neural methods, yet remain fragmented: dictionary tools miss discourse structure, while embeddings conflate local coherence with global organization. No existing framework maps these techniques onto the hierarchical processes through which narratives are constructed. Here we introduce a three-level framework - micro-level lexical features, meso-level semantic embeddings, and macro-level LLM narrative evaluation - and show, across 830 Chinese therapeutic texts spanning depression, anxiety, and trauma, that macro-level evaluation substantially outperforms lexical and embedding features for mental health prediction. This challenges the field's emphasis on word-counting: formal structural features (Labov's story grammar, RST coherence, propositional composition) demonstrate that narrative organization per se carries predictive signal, while clinically-grounded narrative dimensions capture how psychological states are expressed through discourse. Semantic embeddings add minimal independent value but yield incremental gains in multi-level classification. By grounding computational levels in discourse processing theory, this framework identifies macro-structural organization as the primary locus of clinical signal and generates testable hypotheses for intervention design and longitudinal research.

Effective mental health counseling is a complex, theory-driven process requiring the simultaneous integration of psychological frameworks, real-time distress signals, and strategic intervention planning. This level of clinical reasoning is critical for safety and therapeutic effectiveness but is often missing in general-purpose Large Language Models (LLMs). We introduce SAGE (Strategy-Aware Graph-Enhanced), a novel framework designed to bridge the gap between structured clinical knowledge and generative AI. SAGE constructs a heterogeneous graph that unifies conversational dynamics with a psychologically grounded layer, explicitly anchoring interactions in a theory-driven lexicon. Our architecture first employs a Next Strategy Classifier to identify the optimal therapeutic intervention. Subsequently, a Graph-Aware Attention mechanism projects graph-derived structural signals into soft prompts, conditioning the LLM to generate responses that maintain clinical depth. Validated through both automated metrics and expert human evaluation, SAGE outperforms baselines in strategy prediction and recommended response quality. By providing actionable intervention recommendations, SAGE serves as a cutting-edge decision-support tool designed to augment human expertise in high-stakes crisis counseling.

The scarcity of high-quality annotated medical data, particularly in mental health, poses a significant bottleneck for training robust machine learning models. Privacy regulations restrict data sharing, making synthetic data generation a promising alternative. The use of Large Language Models (LLMs) in a data augmentation pipeline could be leveraged as an alternative in this field. In the proposed methodology, DeepSeek-R1, OpenBioLLM-Llama3 and Qwen 3.5 are used to generate synthetic mental health evaluation reports conditioned on specific International Classification of Diseases, Tenth Revision (ICD-10) codes. Because naive text generation can lead to mode collapse or privacy breaches (memorization), a comprehensive evaluation framework is introduced. The generated diagnostic texts are assessed across three dimensions: semantic fidelity, lexical diversity, and privacy/plagiarism. The results demonstrate that all models can generate clinically coherent, diverse, and privacy-safe synthetic reports, significantly expanding the available training data for clinical natural language processing tasks without compromising patient confidentiality.

Digital biomarkers for depression have largely relied on static acoustic descriptors, pooled summary statistics, or conventional machine learning representations. Such approaches may miss nonlinear temporal organization embedded in conversational vocal dynamics. We hypothesized that depression is associated with altered recurrence structure in vocal state trajectories, reflecting changes in how the vocal system revisits acoustic states over time. Using the depression subset of the DAIC-WOZ corpus with 142 labeled participants, we modeled frame-level COVAREP trajectories as nonlinear dynamical systems and derived recurrence-based biomarkers from 74 vocal channels. Logistic regression with feature selection and stratified cross-validation evaluated classification performance. Recurrence-based biomarkers achieved a mean cross-validated AUC of 0.689, exceeding static acoustic baselines, entropy-dynamics features, Hurst exponent features, determinism features, and Lyapunov-like instability proxies. Permutation testing indicated statistical significance with $p=0.004$. Pooled cross-validated predictions yielded AUC 0.665 with a 95% bootstrap confidence interval of [0.568, 0.758]. These findings suggest that depression may be characterized by altered recurrence structure in conversational vocal dynamics and support nonlinear state-space analysis as a promising direction for digital psychiatric biomarkers.

Automated depression detection often relies on static aggregation of conversational signals, potentially obscuring clinically meaningful behavioral dynamics. We investigated whether entropy-driven temporal biomarkers improve depression detection beyond standard pooled features using the DAIC-WOZ corpus. Using 142 labeled participants, we reconstructed utterance-level acoustic trajectories and compared pooled temporal baselines, trajectory dynamics, Shannon entropy biomarkers, recurrence quantification, sample entropy, fractal complexity, and coupling biomarkers under leakage-aware validation. Static pooling achieved an AUC of 0.593, trajectory dynamics improved performance to 0.637, and entropy biomarkers produced the strongest statistically significant improvement over pooled baselines (AUC 0.646; nested cross-validated AUC 0.615; permutation p = 0.017). Entropy biomarkers outperformed recurrence, coupling, sample entropy, and fractalbased features, with several biomarkers stable across folds. These findings suggest depression-related signal may lie less in average acoustic levels than in entropy of conversational dynamics, supporting temporally informed digital phenotypes for mental-health assessment.

Patient simulators are gaining traction in mental health training by providing scalable exposure to complex and sensitive patient interactions. Simulating depressed patients is particularly challenging, as safety constraints and high patient variability complicate simulations and underscore the need for simulators that capture diverse and realistic patient behaviors. However, existing evaluations heavily rely on LLM-judges with poorly specified prompts and do not assess behavioral diversity. We introduce PSI-Bench, an automatic evaluation framework that provides interpretable, clinically grounded diagnostics of depression patient simulator behavior across turn-, dialogue-, and population-level dimensions. Using PSI-Bench, we benchmark seven LLMs across two simulator frameworks and find that simulators produce overly long, lexically diverse responses, show reduced variability, resolve emotions too quickly, and follow a uniform negative-to-positive trajectory. We also show that the simulation framework has a larger impact on fidelity than the model scale. Results from a human study demonstrate that our benchmark is strongly aligned with expert judgments. Our work reveals key limitations of current depression patient simulators and provides an interpretable, extensible benchmark to guide future simulator design and evaluation.

AI chatbots are increasingly used for health advice, but their performance in psychiatric triage remains undercharacterized. Psychiatric triage is particularly challenging because urgency must often be inferred from thoughts, behavior, and context rather than from objective findings. We evaluated the performance of 15 frontier AI chatbots on psychiatric triage from realistic single-message disclosures using 112 clinical vignettes, each paired with 1 of 4 original benchmark triage labels: A, routine; B, assessment within 1 week; C, assessment within 24 to 48 hours; and D, emergency care now. Vignettes covered 9 psychiatric presentation clusters and 9 focal risk dimensions, organized into 28 presentation-by-risk groups. Each group contributed 4 distinct vignettes, with 1 vignette at each triage level. Each vignette was rendered as a realistic human-authored conversational query, and the AI chatbots were tasked with assigning a triage label from that disclosure. Emergency under-triage occurred in 23 of 410 level D trials (5.6%), and all under-triaged emergencies were reassigned to level C urgency. Across target models, average accuracy ranged from 42.0% to 71.8%. Accuracy was highest for level D vignettes (94.3%) and lowest for level B vignettes (19.7%). Mean signed ordinal error was positive (+0.47 triage levels), indicating net over-triage. Dispersion was highest around the middle triage levels. All results were confirmed relative to clinician consensus labels from 50 medical doctors. When presented with user messages containing sufficient clinical information, frontier AI chatbots thus recognized psychiatric emergencies as requiring urgent medical assessment with near-zero error rates, yet showed marked over-triage for low and intermediate risk presentations.

The widespread adoption of social media has heightened interest in its psychological effects, particularly on mental health indicators such as anxiety, depression, loneliness, and sleep quality, as these platforms increasingly influence social interactions and well-being. Although previous research has examined correlations between social media use and mental health, few studies have utilized unsupervised machine learning to segment users based on behavioral and psychological patterns, leaving a gap in identifying distinct risk profiles across diverse groups. This study seeks to address this by segmenting individuals according to their social media usage and psychological well-being, employing clustering to reveal hidden patterns and evaluate their mental health implications. Data from 551 participants, collected via an online survey, were preprocessed using KNN imputation for missing values, one-hot encoding for categorical variables like Gender with 5 unique values, and outlier detection via IQR and Z-score methods. K-Means clustering, optimized at 6 clusters using the Elbow Method and a Silhouette Score of 0.32, was applied, with PCA reducing 22 dimensions for visualization and a correlation heatmap highlighting relationships, such as a 0.28 correlation between social media hours and anxiety.

Depression places substantial pressure on mental health services, and many people describe their experiences outside clinical settings in high-volume user-generated text (e.g., online forums and social media). Automatically identifying clinical symptom evidence in such text can therefore complement limited clinical capacity and scale to large populations. We address this need through sentence-level classification of 21 depression symptoms from the BDI-II questionnaire, using BDI-Sen, a dataset annotated for symptom relevance. This task is fine-grained and highly imbalanced, and we find that common LLM approaches (zero-shot, in-context learning, and fine-tuning) struggle to apply consistent relevance criteria for most symptoms. We propose Symptom Induction (SI), a novel approach which compresses labeled examples into short, interpretable guidelines that specify what counts as evidence for each symptom and uses these guidelines to condition classification. Across four LLM families and eight models, SI achieves the best overall weighted F1 on BDI-Sen, with especially large gains for infrequent symptoms. Cross-domain evaluation on an external dataset further shows that induced guidelines generalize across other diseases shared symptomatology (bipolar and eating disorders).

Automatic depression detection from conversational interactions holds significant promise for scalable screening but remains hindered by severe data scarcity and a lack of clinical interpretability. Existing approaches typically rely on black-box deep learning architectures that struggle to model the subtle, temporal evolution of depressive symptoms or account for participant-specific heterogeneity. In this work, we propose PsyGAT (Psychological Graph Attention Network), a psychologically grounded framework that models conversational sessions as dynamic temporal graphs. We introduce Psychological Expression Units (PEUs) to explicitly encode utterance-level clinical evidence, structuring the session graph to capture transitions in psychological states rather than mere semantic dependencies. To address the critical class imbalance in depression datasets, we employ clinically approved persona-based data augmentation, enable robust model learning. Additionally, we integrate session-level personality context directly into the graph structure to disentangle trait-based behavior from acute depressive symptoms. PsyGAT achieves state-of-the-art performance, surpassing both strong graph-based baselines and closed-source LLMs like GPT-5, achieving 89.99 and 71.37 Macro F1 scores in DAIC-WoZ and E-DAIC, respectively. We further introduce Causal-PsyGAT, an interpretability module that identifies symptom triggers. Experiments show a 20% improvement in MRR for identifying causal indicators, effectively bridging the gap between depression monitoring and clinical explainability. The full augmented dataset is publicly available at https://doi.org/10.6084/m9.figshare.31801921.

Early detection of mental health conditions, particularly stress and depression, from social media text remains a challenging open problem in computational psychiatry and natural language processing. Automated systems must contend with figurative language, implicit emotional expression, and the high noise inherent in user-generated content. Existing approaches either leverage external commonsense knowledge to model mental states explicitly, or apply self-augmentation and contrastive training to improve generalization, but seldom do both in a principled, unified framework. We propose K-SENSE (Knowledge-guided Self-augmented Encoder for Neuro-Semantic Evaluation of Mental Health), a framework that jointly exploits external psychological reasoning and internal representation robustness. K-SENSE adopts a three-stage encoding pipeline: (1) inferential commonsense knowledge is extracted from the COMET model across five mental state dimensions; (2) a semantic anchor is constructed by combining hidden representations from two parallel encoding streams, projected into a shared space before fusion; and (3) a supervised contrastive learning objective aligns same-class representations while encouraging the attention mechanism to suppress irrelevant knowledge noise. We evaluate K-SENSE on Dreaddit (stress detection) and Depression_Mixed (depression detection), achieving mean F1-scores of 86.1 (0.6%) and 94.3 (0.8%), respectively, over five independent runs. These represent improvements of approximately 2.6 and 1.5 percentage points over the strongest prior baselines. Ablation experiments confirm the contribution of each architectural component, including the temporal knowledge integration strategy and the choice to keep the knowledge encoder frozen during fine-tuning.

The growing availability of online support groups has opened up new windows to study mental health through natural language processing (NLP). However, it is hindered by a lack of high-quality, well-validated datasets. Existing studies have a tendency to build task-specific corpora without collecting them into widely available resources, and this makes reproducibility as well as cross-task comparison challenging. In this paper, we present a uniform benchmark set of four Reddit-based datasets for disjoint but complementary tasks: (i) detection of suicidal ideation, (ii) binary general mental disorder detection, (iii) bipolar disorder detection, and (iv) multi-class mental disorder classification. All datasets were established upon diligent linguistic inspection, well-defined annotation guidelines, and human-judgmental verification. Inter-annotator agreement metrics always exceeded the baseline agreement score of 0.8, ensuring the labels' trustworthiness. Previous work's evidence of performance on both transformer and contextualized recurrent models demonstrates that these models receive excellent performances on tasks (F1 ~ 93-99%), further validating the usefulness of the datasets. By combining these resources, we establish a unifying foundation for reproducible mental health NLP studies with the ability to carry out cross-task benchmarking, multi-task learning, and fair model comparison. The presented benchmark suite provides the research community with an easy-to-access and varied resource for advancing computational approaches toward mental health research.

Large language models are being deployed as mental health support agents at scale, yet only 16% of LLM-based chatbot interventions have undergone rigorous clinical efficacy testing, and simulations reveal psychological deterioration in over one-third of cases. We evaluate four generative models on 250 Prolonged Exposure (PE) therapy scenarios and 146 CBT cognitive restructuring exercises (plus 29 severity-escalated variants), scored by a three-judge LLM panel. All models scored near-perfectly on surface acknowledgment (~0.91-1.00) while therapeutic appropriateness collapsed to 0.22-0.33 at the highest severity for three of four models, with protocol fidelity reaching zero for two. Under CBT severity escalation, one model's task completeness dropped from 92% to 71% while the frontier model's safety-interference score fell from 0.99 to 0.61. We identify a systematic, modality-spanning failure: RLHF safety alignment disrupts the therapeutic mechanism of action by grounding patients during imaginal exposure, offering false reassurance, inserting crisis resources into controlled exercises, and refusing to challenge distorted cognitions mentioning self-harm in PE; and through task abandonment or safety-preamble insertion during CBT cognitive restructuring. These findings motivate a five-axis evaluation framework (protocol fidelity, hallucination risk, behavioral consistency, crisis safety, demographic robustness), mapped onto FDA SaMD and EU AI Act requirements. We argue that no AI mental health system should proceed to deployment without passing multi-axis evaluation across all five dimensions.

Psychiatric intake is a sequential, high-stakes information-gathering process in which clinicians must decide what to ask, in what order, and how to interpret incomplete or ambiguous responses under limited time. Despite growing interest in conversational AI for healthcare, there is still limited infrastructure for conversational AI in this application. Accordingly, we formulate this task as a question-selection problem with clinically grounded questions, known target information, and controllable patient difficulty. We also introduce a task-specific question-selection benchmark based on a bank of 655 clinician-authored intake questions and corresponding synthetic patient vignettes with 5 different behavioral conditions. In our evaluation, we compare random questioning, a clinical psychiatric intake form baseline, and an LLM-guided adaptive policy across 300 interview sessions spanning four patients and five behavioral conditions. Across the benchmark, the clinically ordered fixed form substantially outperforms random questioning, and the LLM-guided policy achieves the strongest overall recovery. The advantage of adaptation grows sharply under patient behavior that is less amenable to field recovery, especially under guarded-concise conditions. These findings suggest that performance in conversational clinical systems depends not only on language understanding after information is disclosed, but also on whether the system reaches the right topics within a limited interaction budget. More broadly, the benchmark provides a controlled framework for studying how clinical structure and adaptive follow-up contribute to information recovery in interactive clinical machine learning.

Large language models (LLMs) are increasingly utilized in clinical reasoning and risk assessment. However, their interpretive reliability in critical and indeterminate domains such as psychiatry remains unclear. Prior work has identified algorithmic biases and prompt sensitivity in these systems, raising concerns about how contextual information may influence model outputs, but there remains no systematic way to assess these, especially in the psychiatric domain. We propose an approach for reliability auditing downstream LLM tasks by structuring evaluation around the impact of prompt design and the inclusion of medically insignificant inputs on predicted hospitalization risk scores, which is often the first downstream AI clinical-decision-making task. In our audit, a cohort of synthetic patient profiles (n = 50) is generated, each consisting of 15 clinically relevant features and up to 50 clinically insignificant features, across four prompt reframings (neutral, logical, human impact, clinical judgment). We audit four LLMs (Gemini 2.5 Flash, LLaMa 3.3 70b, Claude Sonnet 4.6, GPT-4o mini), and our results show that including medically insignificant variables resulted in a statistically significant increase in the absolute mean predicted hospitalization risk and output variability across all models and prompts, indicating reduced predictive stability as contextual noise increased. Clinically insignificant features had an effect on instability across many model-prompt conditions, and prompt variations independently affected the trajectory of instability in a model-dependent manner. These findings quantify how LLM-based psychiatric risk assessments are sensitive to non-clinical information, highlighting the need for systematic evaluations of attributional stability and uncertainty behavior like this before clinical deployments.

Mental health challenges are increasing worldwide, straining emotional support services and leading to counselor overload. This can result in delayed responses during critical situations, such as suicidal ideation, where timely intervention is essential. While large language models (LLMs) have shown strong generative capabilities, their application in low-resource languages, especially in sensitive domains like mental health, remains underexplored. Furthermore, existing LLM-based agents often struggle to replicate the supportive language and intervention strategies used by professionals due to a lack of training on large-scale, real-world datasets. To address this, we propose CARE (Counselor-Aligned Response Engine), a GenAI framework that assists counselors by generating real-time, psychologically aligned response recommendations. CARE fine-tunes open-source LLMs separately for Hebrew and Arabic using curated subsets of real-world crisis conversations. The training data consists of sessions rated as highly effective by professional counselors, enabling the models to capture interaction patterns associated with successful de-escalation. By training on complete conversation histories, CARE maintains the evolving emotional context and dynamic structure of counselor-help-seeker dialogue. In experimental settings, CARE demonstrates stronger semantic and strategic alignment with gold-standard counselor responses compared to non-specialized LLMs. These findings suggest that domain-specific fine-tuning on expert-validated data can significantly support counselor workflows and improve care quality in low-resource language contexts.

Rising demand for mental health support has increased interest in using Large Language Models (LLMs) for counseling, but adapting them to this safety-critical domain is hindered by limited real-world data due to privacy constraints. Synthetic datasets provide a promising alternative, but existing approaches often rely on unstructured or semi-structured text inputs and overlook structural dependencies between a client's cognitive, emotional, and behavioral states, leading to psychologically inconsistent and less realistic interactions. We introduce Graph2Counsel, a framework for generating synthetic counseling sessions grounded in Client Psychological Graphs (CPGs) that encode relationships among clients' thoughts, emotions, and behaviors. Graph2Counsel uses a structured prompting pipeline guided by counselor strategies and CPG, and explores prompting strategies including CoT and Multi-Agent Feedback. It produces 760 sessions from 76 CPGs across diverse client profiles. In expert evaluation, our dataset outperforms prior datasets on specificity, counselor competence, authenticity, conversational flow, and safety (Krippendorff's $α$ = 0.70). Fine-tuning an open-source model on this dataset improves performance on several metrics on CounselingBench and CounselBench, while matching baselines on others. We further introduce Therapy-Eval, a multi-turn evaluation framework, and demonstrate the effectiveness of our fine-tuned model in realistic therapeutic conversations. We make our code, data and fine-tuned model public.

Building trustworthy AI systems for mental health support is a shared priority across stakeholders from multiple disciplines. However, "trustworthy" remains loosely defined and inconsistently operationalized. AI research often focuses on technical criteria (e.g., robustness, explainability, and safety), while therapeutic practitioners emphasize therapeutic fidelity (e.g., appropriateness, empathy, and long-term user outcomes). To bridge the fragmented landscape, we propose a three-layer trust framework, covering human-oriented, AI-oriented, and interaction-oriented trust, integrating the viewpoints of key stakeholders (e.g., practitioners, researchers, regulators). Using this framework, we systematically review existing AI-driven research in mental health domain and examine evaluation practices for ``trustworthy'' ranging from automatic metrics to clinically validated approaches. We highlight critical gaps between what NLP currently measures and what real-world mental health contexts require, and outline a research agenda for building socio-technically aligned and genuinely trustworthy AI for mental health support.

Depression is one of the most prevalent and debilitating mental health conditions worldwide, frequently underdiagnosed and undertreated. The proliferation of social media platforms provides a rich source of naturalistic linguistic signals for the automated monitoring of psychological well-being. In this work, we propose a system based on Large Language Models (LLMs) for depression risk assessment in Reddit posts, through multi-label classification of eight depression-associated emotions and the computation of a weighted severity index. The method is evaluated in a zero-shot setting on the annotated DepressionEmo dataset (~6,000 posts) and applied in-the-wild to 469,692 comments collected from four subreddits over the period 2024-2025. Our best model, gemma3:27b, achieves micro-F1 = 0.75 and macro-F1 = 0.70, results competitive with purpose-built fine-tuned models (BART: micro-F1 = 0.80, macro-F1 = 0.76). The in-the-wild analysis reveals consistent and temporally stable risk profiles across communities, with marked differences between r/depression and r/anxiety. Our findings demonstrate the feasibility of a cost-effective, scalable approach for large-scale psychological monitoring.

Physical activity (PA) is widely recognized as protective against mental distress, yet whether this benefit varies systematically across population subgroups remains poorly understood. Using pooled data from ten consecutive annual waves of the U.S. Behavioral Risk Factor Surveillance System (2015-2024; n = 3,242,218), we investigate heterogeneity in the association between leisure-time PA and frequent mental distress (FMD, >=14 days/month) across age groups. Survey-weighted logistic regression reveals a striking age gradient: the adjusted odds ratio for PA ranges from 0.89 among young adults (18-24) to 0.50 among adults aged 55-64, with the protective association strengthening monotonically with age. Temporal analysis across all ten years shows that the young-adult PA effect has been eroding over the past decade, with the 18-24 OR reaching 1.01 (null) in both 2018 and 2024 -- paralleling the deepening youth mental health crisis. Causal Forest via Double Machine Learning independently identifies age as the dominant driver of treatment effect heterogeneity (feature importance = 0.39, 2.5x the next predictor). E-value sensitivity analysis, propensity score overlap checks, placebo tests, and imputation comparisons confirm the robustness of the findings. These results suggest that the well-documented exercise--mental health link may not generalize to the youngest adult population, whose distress appears increasingly driven by stressors that PA alone cannot mitigate.

This paper studies how empirical dialogue-flow statistics can be incorporated into Next Dialogue Act Prediction (NDAP). A KL regularization term is proposed that aligns predicted act distributions with corpus-derived transition patterns. Evaluated on a 60-class German counselling taxonomy using 5-fold cross-validation, this improves macro-F1 by 9--42% relative depending on encoder and substantially improves dialogue-flow alignment. Cross-dataset validation on HOPE suggests that improvements transfer across languages and counselling domains. In systematic ablations across pretrained encoders and architectures, the findings indicate that transition regularization provides consistent gains and disproportionately benefits weaker baseline models. The results suggest that lightweight discourse-flow priors complement pretrained encoders, especially in fine-grained, data-sparse dialogue tasks.

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.

Large language models (LLMs) are increasingly explored as scalable tools for mental health counseling, yet evaluating their safety remains challenging due to the interactional and context-dependent nature of clinical harm. Existing evaluation frameworks predominantly assess isolated responses using coarse-grained taxonomies or static datasets, limiting their ability to diagnose how harms emerge and accumulate over multi-turn counseling interactions. In this work, we introduce R-MHSafe, a role-aware mental health safety taxonomy that characterizes clinically significant harm in terms of the interactional roles an AI counselor adopts, including perpetrator, instigator, facilitator, or enabler, combined with clinically grounded harm categories. Then, we propose MHSafeEval, a closed-loop, agent-based evaluation framework that formulates safety assessment as trajectory-level discovery of harm through adversarial multi-turn interactions, guided by role-aware modeling. Using R-MHSafe and MHSafeEval, we conduct a large-scale evaluation across state-of-the-art LLMs. Our results reveal substantial role-dependent and cumulative safety failures that are systematically missed by existing static benchmarks, and show that our framework significantly improves failure-mode coverage and diagnostic granularity.

Emotional Support Conversation (ESC) plays a critical role in mental health assistance by providing accessible psychological support in real-world applications. Large Language Models (LLMs) have shown strong empathetic abilities in ESC tasks. Yet, existing methods overlook the issue of cognitive distortions in help-seekers' expressions. As a result, current models can only provide basic emotional comfort, rather than helping help-seekers address their psychological distress at a deeper cognitive level. To address this challenge, we construct the CogBiasESC dataset, the first dataset that expands existing ESC datasets by adding labels for cognitive distortions, includes their type, intensity, and safe risk level. Furthermore, we propose the Cognitive Policy-driven Large Language Model framework (CoPoLLM) to enhance LLMs' ability to diagnose and intervene cognitive distortions in help-seekers. We also analyze the safety advantages of CoPoLLM from a theoretical perspective. Experimental results show that CoPoLLM significantly outperforms 15 state-of-the-art baselines in terms of distortion diagnosis accuracy, intervention strategy effectiveness, and safety risk control.

Large language models (LLMs) can generate fluent dialogue, but prior works lack situational grounding, dynamic strategy control, and evaluation aligned with clinical standards in motivational interviewing (MI). We introduce StoryMI, a multi-LLM agent framework for controllable MI dialogue generation, where questionnaire-based client profiles are expanded into situational stories that provide narrative context for the dialogue. Therapist and client agents generate MI-coded utterances guided by MI codes selected by the interaction agent, while an interaction agent dynamically coordinates exchanges to control MI strategies during a multi-turn conversation. We propose a two-level evaluation protocol: lexical metrics and MI-specific measures of macro-level counseling strategies, alongside LLM-as-judge and human expert assessments. We construct a dataset of 6K simulated MI dialogues grounded in 1K questionnaire-story pairs, covering 12 MI codes and 13 symptom domains, and benchmark six open- and closed-source LLMs. Our results show that situational grounding and macro-level control can improve MI adherence and clinical plausibility, demonstrating the effectiveness of a structured multi-agent workflow for psychotherapy dialogue generation. We provide code and data for reproducibility.

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.

Continuous glucose monitoring (CGM) is central to diabetes care, but explaining CGM patterns clearly and empathetically remains time-intensive. Evidence for retrieval-grounded large language model (LLM) systems in CGM-informed counseling remains limited. To evaluate whether a retrieval-grounded LLM-based conversational agent (CA) could support patient understanding of CGM data and preparation for routine diabetes consultations. We developed a retrieval-grounded LLM-based CA for CGM interpretation and diabetes counseling support. The system generated plain-language responses while avoiding individualized therapeutic advice. Twelve CGM-informed cases were constructed from publicly available datasets. Between Oct 2025 and Feb 2026, 6 senior UK diabetes clinicians each reviewed 2 assigned cases and answered 24 questions. In a blinded multi-rater evaluation, each CA-generated and clinician-authored response was independently rated by 3 clinicians on 6 quality dimensions. Safety flags and perceived source labels were also recorded. Primary analyses used linear mixed-effects models. A total of 288 unique responses (144 CA and 144 clinician) generated 864 ratings. The CA received higher quality scores than clinician responses (mean 4.37 vs 3.58), with an estimated mean difference of 0.782 points (95% CI 0.692-0.872; P<.001). The largest differences were for empathy (1.062, 95% CI 0.948-1.177) and actionability (0.992, 95% CI 0.877-1.106). Safety flag distributions were similar, with major concerns rare in both groups (3/432, 0.7% each). Retrieval-grounded LLM systems may have value as adjunct tools for CGM review, patient education, and preconsultation preparation. However, these findings do not support autonomous therapeutic decision-making or unsupervised real-world use.

Large language models (LLMs) show promise in generating supportive responses for mental health and counseling applications. However, their responses often lack cultural sensitivity, contextual grounding, and clinically appropriate guidance. This work addresses the gap of how to systematically incorporate domain-specific, clinically validated knowledge into LLMs to improve counseling quality. We utilize and compare two approaches, retrieval-augmented generation (RAG) and a knowledge graph (KG)-based method, designed to support para-counselors. Our KG is constructed manually and clinically validated, capturing causal relationships between stressors, interventions, and outcomes, with contributions from multidisciplinary people. We evaluated multiple LLMs in both settings using BERTScore F1 and SBERT cosine similarity, as well as human evaluation across five metrics, which is designed to directly measure the effectiveness of counseling beyond similarity at the surface level. The results show that KG-based approaches consistently improve contextual relevance, clinical appropriateness, and practical usability compared to RAG alone, demonstrating that structured, expert-validated knowledge plays a critical role in addressing LLMs limitations in counseling tasks.

AI is increasingly used for mental health and well-being support, creating an urgent need for safer engagement, while design, evaluation, and governance take time to develop. We explore a complementary approach: helping users critically reflect on their own AI conversations. We introduce CounselReflect, a tool that translates literature-grounded counseling quality metrics into a user-facing reflection framework. Using CounselReflect as a study probe, we interviewed 21 users of AI for mental health and well-being support. Although most participants did not routinely reflect on their conversations, they articulated concrete questions they would want reflection to address. Tool-assisted reflection also revealed challenges: participants selectively sought evidence confirming existing perceptions of AI and prioritized dimensions they already valued. We argue that reflection tools should surface blind spots and scaffold more holistic examination of AI interactions. Finally, overcoming emotional barriers to revisiting tense conversations remains a major design challenge and warrants input from future work.

Automatic depression detection from doctor-patient conversations has gained momentum thanks to the availability of public corpora and advances in language modeling. However, interpretability remains limited: strong performance is often reported without revealing what drives predictions. We analyze three datasets: ANDROIDS, DAIC-WOZ, E-DAIC and identify a systematic bias from interviewer prompts in semi-structured interviews. Models trained on interviewer turns exploit fixed prompts and positions to distinguish depressed from control subjects, often achieving high classification scores without using participant language. Restricting models to participant utterances distributes decision evidence more broadly and reflects genuine linguistic cues. While semi-structured protocols ensure consistency, including interviewer prompts inflates performance by leveraging script artifacts. Our results highlight a cross-dataset, architecture-agnostic bias and emphasize the need for analyses that localize decision evidence by time and speaker to ensure models learn from participants' language.

Psychiatric consultation requires agents to elicit discriminative evidence, map uncertain narratives to diagnostic criteria, and decide when evidence suffices. Existing dialogue and retrieval-augmented systems condition policies on raw histories or appended passages, leaving observed evidence, missing checks, differentials, and support reliability entangled. We introduce MIND, a criteria-grounded evidence-state decision interface. At each turn, MIND constructs a typed state containing observed evidence, unresolved criterion checks, active differentials, criterion-linked supports, and reliability metadata. A training-split Psychiatric Reasoning Bank supplies gated supports, turning retrieval into state construction rather than prompt injection. The same state conditions action selection, process rewards, information-gain scoring, and trajectory rectification. Under EMR-grounded simulator protocols, MIND improves accuracy by 8.8 and 7.3 points over strong inference-only, RAG, and RL baselines, with gains transferring to public MDD-5k dialogues. Matched interventions attribute these gains to the shared state rather than prompt length, retrieval text, or formatting. MIND targets screening-level decision support, not autonomous diagnosis. Code is available at https://github.com/Lingxi-mental-health/MIND.Å

Privacy and computational constraints limit the use of large language models in psychiatry, while adapting small language models (SLMs) often requires substantial data and expert annotation. We developed ClinMPO, an evidence-guided reinforcement-learning framework guided by the psychiatrist-defined Clinical Psychiatry Thinking Strategy (CPTS). ClinMPO uses ClinRM, a reward model trained on 18,569 question--answer pairs from 4,474 psychiatry articles. We evaluated four Qwen3 sizes on 1,737 model-screened questions. ClinMPO outperformed Base, supervised fine-tuning and standard group relative policy optimization across scales. From responses by 300 senior pre-licensure medical students, we established the human baseline, a medical-student reference. The 4B model approached this baseline, whereas the 8B model surpassed it and ranked first among 31 models and post-training variants. ClinMPO improved performance across two complementary schemes covering ICD-11 diagnostic categories and psychiatric practice competencies. Blinded assessment by three clinicians showed improved rationale quality across CPTS criteria. These findings highlight how existing clinical evidence and specialist knowledge can be incorporated into the development of medical AI systems through evidence-guided learning.

We present Tell Me, a mental well-being system that leverages advances in large language models to provide accessible, context-aware support for users and researchers. The system integrates three components: (i) a retrieval-augmented generation (RAG) assistant for personalized, knowledge-grounded dialogue; (ii) a synthetic client-therapist dialogue generator conditioned on client profiles to facilitate research on therapeutic language and data augmentation; and (iii) a Well-being AI crew, implemented with CrewAI, that produces weekly self-care plans and guided meditation audio. The system is designed as a reflective space for emotional processing rather than a substitute for professional therapy. It illustrates how conversational assistants can lower barriers to support, complement existing care, and broaden access to mental health resources. To address the shortage of confidential therapeutic data, we introduce synthetic client-therapist dialogue generation conditioned on client profiles. Finally, the planner demonstrates an innovative agentic workflow for dynamically adaptive, personalized self-care, bridging the limitations of static well-being tools. We describe the architecture, demonstrate its functionalities, and report evaluation of the RAG assistant in curated well-being scenarios using both automatic LLM-based judgments and a human-user study. This work highlights opportunities for interdisciplinary collaboration between NLP researchers and mental health professionals to advance responsible innovation in human-AI interaction for well-being.

The growing demand for scalable psychological counseling highlights the need for high-quality, privacy-compliant data, yet such data remains scarce. Here we introduce MAGneT, a novel multi-agent framework for synthetic psychological counseling session generation that decomposes counselor response generation into coordinated sub-tasks handled by specialized LLM agents, each modeling a key psychological technique. Unlike prior single-agent approaches, MAGneT better captures the structure and nuance of real counseling. We further propose a unified evaluation framework that consolidates diverse automatic metrics and expands expert assessment from four to nine counseling aspects, thus addressing inconsistencies in prior evaluation protocols. Empirically, MAGneT substantially outperforms existing methods: experts prefer MAGneT-generated sessions in 77.2% of cases on average across the nine aspects over the strongest baseline, and sessions generated by MAGneT using Llama3-8B-Instruct backbone yield 3.2% higher general counseling skills and 4.3% higher CBT-specific skills on cognitive therapy rating scale (CTRS). An open source Llama3-8B-Instruct model fine-tuned on MAGneT-generated data also outperforms models fine-tuned using baseline synthetic datasets by 6.9% on average on CTRS. We make our code, data and fine-tuned model public.

Prior clinical psychology research shows that Western individuals with depression tend to report psychological symptoms, while Eastern individuals report somatic ones. We test whether Large Language Models (LLMs), which are increasingly used in mental health, reproduce these cultural patterns by prompting them with Western or Eastern personas. Results show that LLMs largely fail to replicate the patterns when prompted in English, though prompting in major Eastern languages (i.e., Chinese, Japanese, and Hindi) improves alignment in several configurations. Our analysis pinpoints two key reasons for this failure: the models' low sensitivity to cultural personas and a strong, culturally invariant symptom hierarchy that overrides cultural cues. These findings reveal that while prompt language is important, current general-purpose LLMs lack the robust, culture-aware capabilities essential for safe and effective mental health applications.

Large language models (LLMs) may support counseling training, yet evidence from Japanese-language interactions and automated quality ratings remains limited. We examined 18 fixed Japanese-language counseling transcripts generated through artificial intelligence (AI)-to-AI interactions under three counselor conditions: GPT-minimal (GPT-4-turbo with a minimal role instruction), GPT-SMDP (GPT-4-turbo with the Structured Multi-step Dialogue Prompt [SMDP]), and Claude-SMDP (Claude-3-Opus with SMDP). Fifteen counseling experts rated transcripts on four adapted global scales from the Motivational Interviewing Treatment Integrity coding manual and an overall-quality item; three newer LLMs independently rated the same transcripts in three iterations. In this fixed stimulus set, SMDP-condition dialogues received higher expert ratings for cultivating change talk, partnership, empathy, and overall quality than GPT-minimal dialogues; the two SMDP counselor models did not differ. LLM ratings were reproducible but generally more lenient than expert-reference ratings, particularly for softening sustain talk and overall quality. Simulated-client naturalness was below the scale midpoint. These findings provide an expert-referenced benchmark for Japanese-language AI counseling simulations and show that reproducible LLM ratings should not be treated as calibrated counseling-quality evidence without expert validation. This study does not test clinical effectiveness or human-client outcomes.

Peer support plays a vital role in expanding access to mental health care by providing empathetic, community-based support outside formal clinical systems. As digital platforms increasingly mediate such support, the design and impact of these technologies remain under-examined, particularly in Asian contexts. This paper presents findings from an interview study with 20 peer supporters in Singapore, who operate across diverse online, offline, and hybrid environments. Through a thematic analysis, we unpack how participants start, conduct, and sustain peer support, highlighting their motivations, emotional labour, and the sociocultural dimensions shaping their practices. Building on this grounded understanding, we surface design directions for culturally responsive digital tools that scaffold rather than supplant relational care. Drawing insights from qualitative accounts, we offer a situated perspective on how AI might responsibly augment peer support. This research contributes to human-centred computing by articulating the lived realities of peer supporters and proposing design implications for trustworthy and context-sensitive AI in mental health.

Mental health is a growing global concern, prompting interest in AI-driven solutions to expand access to psychosocial support. \emph{Peer support}, grounded in lived experience, offers a valuable complement to professional care. However, variability in training, effectiveness, and definitions raises concerns about quality, consistency, and safety. Large Language Models (LLMs) present new opportunities to enhance peer support interactions, particularly in real-time, text-based interactions. We present and evaluate an AI-supported system with an LLM-simulated distressed client (\client{}), context-sensitive LLM-generated suggestions (\suggestions{}), and real-time emotion visualisations. 2 mixed-methods studies with 12 peer supporters and 6 mental health professionals (i.e., experts) examined the system's effectiveness and implications for practice. Both groups recognised its potential to enhance training and improve interaction quality. However, we found a key tension emerged: while peer supporters engaged meaningfully, experts consistently flagged critical issues in peer supporter responses, such as missed distress cues and premature advice-giving. This misalignment highlights potential limitations in current peer support training, especially in emotionally charged contexts where safety and fidelity to best practices are essential. Our findings underscore the need for standardised, psychologically grounded training, especially as peer support scales globally. They also demonstrate how LLM-supported systems can scaffold this development--if designed with care and guided by expert oversight. This work contributes to emerging conversations on responsible AI integration in mental health and the evolving role of LLMs in augmenting peer-delivered care.

Mental health problems such as stress, anxiety, and depression affect millions of people worldwide. These conditions are usually assessed using questionnaires, which rely on how people describe their own feelings. In this study, we explore whether a wearable device can help measure mental health using physical signals from the body. The device records small changes in blood flow and tissue activity from the fingertip. We collected data from 132 adults across 19 countries and compared these signals with mental health questionnaire results. We found that patterns in blood flow and tissue activity are linked to stress-related symptoms. This approach may help develop new tools for simple, non-invasive mental health monitoring in everyday life. Code and datasets are publicly available: https://github.com/leduckhai/Wearable_LDF-FS

Large language models (LLMs) are increasingly being used as ad hoc therapists. While prior research has found that LLMs outperform human counselors in generating single-turn empathetic responses, fewer studies have compared their behaviors across multi-turn sessions. In this study, we compare the session-level behaviors of human peer counselors with those of an LLM, both trained on the same manual to deliver multi-turn, single-session Cognitive Behavioral Therapy (CBT). Our three-phase, mixed-methods study involved: (a) an 18-month ethnography of a peer support platform, where seven counselors iteratively refined CBT prompts through 110 self-counseling sessions and 60 weekly focus groups; (b) a novel session generation method that allows direct, controlled comparison of human and LLM counselors under matched conditions---client responses were drawn from publicly available human-led CBT sessions while counselor responses were generated by a CBT-prompted LLM; and (c) expert evaluations conducted by three licensed clinical psychologists. Through data triangulation, our results show a trade-off. Human peer counselors use relational techniques to interpret subtle cues, adapt CBT to users' values and cultural contexts, and use strategies such as small talk and contextually relevant self-disclosure to build rapport and guide the session, but often at the expense of session structure and therapeutic focus. LLM counselors, on the other hand, demonstrate greater methodological adherence to CBT techniques, but struggle to sustain turn-taking, frequently fail to distinguish between clinically important and trivial content, and are more prone to lecturing and imposing solutions. LLM counselors also tend to produce ``deceptive empathy'', excessively anthropomorphic responses that can inflate user expectations of genuine human care.

Psychiatry research seeks to understand the manifestations of psychopathology in behavior, as measured in questionnaire data, by identifying a small number of latent factors that explain them. While factor analysis is the canonical tool for this purpose, the resulting factors may not be interpretable, and may also be subject to confounding variables. Moreover, missing data are common, and explicit imputation is often required. To overcome these limitations, we introduce Interpretability Constrained Questionnaire Factorization (ICQF), a non-negative matrix factorization method with regularization tailored for questionnaire data. Our method aims to promote factor interpretability and solution stability. We provide an optimization procedure with theoretical convergence guarantees, and an automated procedure to determine latent dimensionality accurately. We validate these procedures using realistic synthetic data. We demonstrate the effectiveness of our method in a widely used general-purpose questionnaire, in two independent datasets (the Healthy Brain Network and Adolescent Brain Cognitive Development studies). Specifically, we show that ICQF preserves diagnostic information across a range of disorders, outperforming competing methods for smaller dataset sizes, and improves interpretability, as assessed by our clinical research collaborators and co-authors. This suggests that the regularization in our method matches domain characteristics, in addition to satisfying qualitative desiderata.

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