Mental Health

Cancer survivors face elevated rates of depression, anxiety, and general emotional distress, yet the precise moments they most need support are often the moments when self-report is sparse, a phenomenon we term the diary paradox. Passive smartphone sensing offers a continuous, unobtrusive alternative, but prior sensing-based affect prediction has been limited by an accuracy ceiling, suggesting a bottleneck not only in available data, but in how behavioral signals are interpreted. We present PULSE, a system that shifts from fixed feature pipelines to agentic sensing investigation: LLM agents equipped with eight purpose-built tools autonomously query smartphone sensing data, compare current behavior against personalized baselines, and calibrate inferences through retrieval-augmented population-level comparisons. Rather than receiving pre-formatted feature summaries, agents decide which modalities to inspect, how far back to look, and how deeply to investigate, mirroring hypothesis-driven clinical reasoning. We evaluate PULSE through a 2*2 factorial design crossing reasoning architecture (structured vs. agentic) with data modality (sensing-only vs. with diary) on 50 cancer survivors from a longitudinal study of cancer survivors. Agentic reasoning is the primary driver of performance: agentic multimodal agent achieves balanced accuracy of 0.743 for emotion regulation desire with diary and sensing data, while agentic agents predict intervention availability at 0.713 with passive sensing data only. These results suggest that agentic investigation may be a cornerstone for unlocking the clinical value of passive sensing, advancing the feasibility of proactive just-in-time mental health support.

Cognitive behavioural therapy is widely used to help patients understand and manage psychological distress. It is often delivered through spoken conversation, where therapists attend not only to what patients say, but also to how they say it, because these cues can help therapists decide how to respond and adapt treatment. Progress in building AI systems for CBT remains largely limited to text, partly because most available datasets are text based and shareable spoken CBT data are scarce under ethical and privacy constraints. This creates a blind spot because text based models and evaluations cannot capture the mismatch between the transcript and the patient's voice, even though therapists often rely on this mismatch to understand patient distress. We introduce CBT-Audio, a dataset for evaluating patient distress estimation from spoken CBT sessions with audio language models. CBT-Audio contains 1,802 patient turns from 96 publicly available CBT recordings, with turn-level distress labels validated on an experts-annotated subset. We evaluate 10 open source audio language models under three input conditions, where models receive only patient audio, only the transcript, or both audio and transcript. Our results show that audio can provide useful information beyond text, especially when combined with transcripts. Adding audio to transcript input improves distress estimation over using the transcript alone in 8 of 10 model families, with significant gains in 4, and case studies show the clearest benefit when verbal content and vocal delivery diverge. CBT-Audio makes spoken patient behaviour measurable for AI evaluation in CBT-related tasks and supports future work on audio language models for mental health interaction.

Large language models (LLMs) are increasingly used in the mental health domain, yet it remains unclear how well they capture related biomedical knowledge and how reliably they apply it to clinically salient structured judgments. Here, we present a knowledge-graph (KG)-grounded benchmark for assessing LLMs on mental-health entity recognition, relation judgment, and two-hop reasoning. The benchmark is derived from PrimeKG and comprises nine task families with KG-supported answers and controlled negative options. Experiments across 15 closed- and open-source LLMs reveal a persistent recognition-to-judgment gap: leading models achieve near-ceiling performance on entity typing and on the small relation-typing subset, yet they still struggle with relation prediction and two-hop reasoning. Additionally, short KG-derived snippets benefit some models but degrade performance for others. Moreover, output-format reliability can substantially influence measured performance under constrained multiple-choice settings, highlighting the critical role of response validity in benchmark-based evaluation. MHGraphBench should therefore be interpreted as evaluating agreement with a curated mental-health slice of PrimeKG under a constrained multiple-choice interface, rather than as a direct assessment of real-world clinical safety.

Post-Traumatic Stress Disorder (PTSD) is fundamentally a neuroplastic problem traumatic contact events encode over-reactive neural pathways through Hebbian long-term potentiation, producing hair-triggered amygdala-HPA stress cascades that fire before conscious awareness can intercept them. Existing therapeutic approaches, prolonged exposure, EMDR, cognitive behavioural therapy, operate predominantly downstream of the reactive cascade, teaching patients to tolerate or reframe distress after it has arisen. While clinically valuable, these suppression-based approaches do not produce the upstream pathway dissolution that constitutes lasting structural neural reorganisation. This paper proposes MindGap, a privacy-preserving on-device conversational AI framework that delivers structured neuroplastic rehabilitation for PTSD through the practice of dependent origination, a Buddhist psychological framework that identifies the precise moment between the pre-cognitive affective signal and the reactive elaboration that follows as the site of therapeutic intervention. MindGap guides patients through three progressive layers of observation at this feeling tone gap: noticing the bare affective signal before reactive elaboration, recognising it as self-arising rather than caused by the stimulus, and recognising the conditioned implicit belief beneath the feeling. Each layer corresponds to progressively deeper prefrontal regulatory engagement and progressively deeper long-term depression-mediated weakening of the reactive pathway, producing genuine upstream dissolution rather than downstream suppression. Running entirely on-device with no data egress, MindGap delivers daily calibrated exposure sessions through a fine-tuned lightweight large language model, making it deployable in sensitive clinical and military contexts where cloud-based solutions are not permitted.

This paper audits benchmark evaluation in clinical-interview depression detection through four complementary probes across DAIC/E-DAIC, CMDC, ANDROIDS, MODMA, and PDCH. First, we re-evaluate E-DAIC under strict subject-disjoint leave-one-subject-out cross-validation. A lightweight hybrid text-plus-LLM-score model reaches macro-F1 = 0.723 - the highest reported under this protocol, to our knowledge - providing a conservative out-of-fold reference point that does not depend on the privileged official holdout. Second, we test whether the E-DAIC official split supports fine-grained leaderboard rankings by sweeping 96 model configurations across modality bundles, pooling strategies, and learners. Development-side cross-validation and official-test rankings align only moderately: the best cross-validation configuration ranks twentieth on the official test, the official-test winner ranks forty-first by cross-validation, top-3 overlap is zero, and the apparent winner is rank-1 in only 32.3% of subject bootstraps. Third, we externally validate strong public CMDC and ANDROIDS baselines that achieve near-ceiling in-domain performance. Zero-shot transfer to external corpora is substantially weaker. Finally, we stress-test E-DAIC text and audio models using paired symptom-dense versus symptom-light interview slices defined by an SRDS-based annotator. Text scores rise sharply on symptom-dense slices, whereas audio scores remain nearly flat; the text-minus-audio gap is positive across all five seeds.

Chatbot usage has increased, including in fields for which they were never developed for--notably mental health support. To that end, we introduce Validations of Ethical and Responsible AI in Mental Health (VERA-MH), a novel clinically-validated evaluation for safety of chatbots in the context of mental health support. The first iteration of VERA-MH focuses on Suicidal Ideation (SI) risks, by assessing how well chatbots can responds to users that might be in crisis. VERA-MH is comprised of three steps: conversation simulation, conversation judging and model rating. First, to simulate conversations with the chatbot under evaluation, another chatbot is tasked with role-playing users based on specific personas. Such user personas have been developed under clinical guidance, to make sure that, among others, multiple risk factors, demographic characteristics and disclosure factors were represented. In the judging step, a second support model is used as an LLM-as-a-Judge, together with a clinically-developed rubric. The rubric is structured as a flow, with a single Yes/No question asked each time, to improve answers' consistency and highlight models' failure modes. In the last stage, results of each conversation are aggregated to present the final evaluation of the chatbot. Together with the framework, we present the result of the evaluations for four leading LLM providers.

Large language model (LLM)-based simulations of clinical patients are increasingly used for research and training, yet their validity requires persona stability: coherent maintenance of an assigned psychological profile across and within conversations. We evaluate this prerequisite using eating disorder personas grounded in five published case vignettes, a dual-assessment framework (self-report + independent observer ratings), and validated psychometric instruments (EDE-Q) with known ground-truth scores. Across six LLMs and two experiments (between-conversation stability (Exp. I) and within-conversation stability (Exp. II)), we find that LLMs are paradoxically too stable and too inaccurate: variability is negligible, yet all models systematically overshoot ground-truth severity by 12-30% of the scale range (0.7-1.8 points on a 0-6 scale). The mechanism is selective stereotyping: models differentiate cases on behavioural items (dietary restraint) but maximise cognitive-affective items (body dissatisfaction, weight preoccupation) at ceiling regardless of case severity. Additional conversational context does not improve accuracy; it compounds the overshoot. LLMs can portray severe eating pathology but lack a representation of moderate clinical presentations, a "missing middle".

Campus well-being underpins academic success, yet many universities lack effective methods for monitoring satisfaction and detecting mental health risks. This dissertation addresses these gaps through prevention (improving feedback collection) and intervention (advancing mental health detection), unified under an integrated framework. For prevention, we developed TigerGPT, a personalized survey chatbot leveraging LLMs to engage users in context-aware conversations grounded in conversational design and engagement theory, achieving 75% usability and 81% satisfaction. To address its limitations in repetitiveness and response depth, we introduced AURA, a reinforcement-learning framework that adapts follow-up question types (validate, specify, reflect, probe) within a session using an LSDE quality signal (Length, Self-disclosure, Emotion, Specificity), initialized from 96 prior conversations. AURA achieved +0.12 mean quality gain (p=0.044, d=0.66), with 63% fewer specification prompts and 10x more validation behavior. For intervention, we examine Expressive Narrative Stories (ENS) for mental health screening, showing BERT(128) captures nuanced linguistic features without keyword cues, while conventional classifiers depend heavily on explicit mental health terms. We then developed PsychoGPT, an LLM built on DSM-5 and PHQ-8 guidelines that performs initial distress classification, symptom-level scoring, and reconciliation with external ratings for explainable assessment. To reduce hallucinations, we proposed Stacked Multi-Model Reasoning (SMMR), layering expert models where early layers handle localized subtasks and later layers reconcile findings, outperforming single-model solutions on DAIC-WOZ in accuracy, F1, and PHQ-8 scoring. Finally, a cohesive framework unifies these tools, enabling adaptive survey insights to flow directly into specialized mental health detection models.

Psychological support hotlines provide critical support for individuals experiencing mental health emergencies, yet current assessments largely rely on human operators whose judgments may vary with professional experience and are constrained by limited staffing resources. This paper proposes a large language model (LLM)-based framework for automated crisis level classification, a key indicator that supports many downstream tasks and improves the overall quality of hotline services. To better capture emotional signals in spoken conversations, we introduce a paralinguistic injection method that inserts identified non-verbal emotional cues into speech transcripts, enabling LLM-based reasoning to incorporate critical acoustic nuances. In addition, we propose a reasoning-enhanced training strategy that trains the model to generate diagnostic reasoning chains as an auxiliary task, which serves as a regulariser to improve classification performance. Combined with data augmentation, our final system achieves a macro F1-score of 0.802 and an accuracy of 0.805 on the three-class classification task under 5-fold cross-validation.

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.

This paper describes our system for classifying psychological defense mechanisms in emotional support dialogues using the Defense Mechanism Rating Scales (DMRS), placing second (F1 0.406) among 64 teams. A central insight is that defense mechanisms are defined by what is absent: missing affect, blocked cognition, denied reality. We encode this as an affect-cognition integration spectrum in prompt-level clinical rules, which account for the largest single gain (+11.4pp F1). Our architecture is a multi-phase deliberative council of Gemini 2.5 agents where class-specific advocates rate evidence strength rather than voting, achieving F1 0.382 with no fine-tuning - a top-5 result on its own. We find, however, that the council is confidently wrong about minority classes: 59-80% of stable minority predictions are incorrect, driven by a systematic "L7 attractor" in which emotional content defaults to the majority class. A targeted override ensemble from three fine-tuned Qwen3.5 models applies 16 overrides (+2.4pp), selected by a structured multi-agent system (builder, critic, regression guard) that produced a larger F1 gain in one iteration than 8 prior attempts combined.

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 safety of mental health AI is often judged at the wrong temporal scale. Current evaluations typically score isolated responses, endpoint outcomes, or aggregate dialogue quality, while clinically consequential failures may arise from the order and accumulation of interactions themselves, including delayed escalation, repeated reinforcement, dependency formation, failed repair, and gradual deterioration across turns. This paper argues that this mismatch is not merely a limitation of evaluation coverage but a source of invalid safety conclusions. We introduce Temporal Safety Non-Identifiability, a formal account of why safety properties that depend on sequence, timing, accumulation, or recovery cannot be certified by protocols that discard those features. From this formalization, we develop SCOPE (Safety Claims Over Preserved Evidence) as a general principle for aligning safety claims with the evidence an evaluation actually retains, and instantiate it as SCOPE-MH, a mental-health instantiation of this reporting standard. We operationalize SCOPE-MH through a proof-of-concept on the AnnoMI dataset of expert-annotated motivational interviewing conversations, which reveals mechanisms of failure that per-turn behavior scoring does not represent. We propose SCOPE-MH as a diagnostic complement to existing evaluation infrastructure and argue that evaluation preserving temporal evidence is necessary, not optional, for safety-critical mental health AI deployment.

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 visual environment is a fundamental yet unquantified determinant of mental health. While the concept of the environmental exposome is well established, current methods rely on coarse geospatial proxies or biased self reports, failing to capture the first person visual context of daily life. We addressed this gap by coupling ecological momentary assessment with vision language models (VLMs) to quantify the semantic richness of human visual experience. Across 2674 participant generated photographs, VLM derived estimates of greenness robustly predicted momentary affect and chronic stress, consistent with established benchmarks. We then developed a semi autonomous large language model (LLM) based pipeline that mined over seven million scientific publications to extract nearly 1000 environmental features empirically linked to mental health. When applied to real world imagery, up to 33 percent of VLM extracted context ratings significantly correlated with affect and stress. These findings establish a scalable objective paradigm for visual exposomics, enabling high throughput decoding of how the visible world is associated with mental health.

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.

Romantic breakups are among the most common and intense sources of psychological distress. We evaluated overit, a single-session AI chatbot that uses cognitive reappraisal to address breakup distress, informed by memory reconsolidation theory. In a pre-registered randomized controlled trial, 254 adults in the United States and United Kingdom who had experienced a romantic breakup were assigned to either an initial survey assessment followed by an AI chat session or to a survey-only control. Breakup distress was measured at baseline, 7 days, and again at an exploratory 1-month follow-up using the Breakup Distress Scale. Participants assigned to overit showed a significantly greater reduction in breakup distress than controls at 7 days (time-by-condition interaction B = -5.36, SE = 1.19, p < .001; completer-based d = -0.70). A smaller but still significant treatment advantage remained detectable at the exploratory 1-month follow-up among post-session completers (B = -2.92, SE = 1.22, p = .017). Exploratory post hoc moderation suggested a larger effect among male participants (B = 7.78, p = .003). These results suggest that a brief AI chatbot conversation can meaningfully reduce breakup distress, with exploratory evidence that a smaller advantage persists over the following month. Future work should test the intervention against active controls, evaluate repeated-session use, and recruit more diverse samples.

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.

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.

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.

People increasingly turn to general-purpose AI chatbots for advice about emotional and mental health problems, but the ability of these systems to recognize and appropriately triage psychiatric emergencies remains under-characterized. We evaluated psychiatric triage performance in 15 frontier AI chatbots using 112 clinical vignettes spanning four urgency levels, from routine care to immediate emergency assessment. In each trial (1680 total), a chatbot received a single user message conveying all triage-relevant information from one vignette and recommended a timeframe for care. The primary outcome was emergency under-triage; secondary outcomes included triage accuracy and the direction of errors. Vignettes and user messages were generated using a clinician-verified LLM pipeline. Across 415 emergency trials, 23 were under-triaged (5.5%; 95% CI 1.8-15.9). Overall accuracy, averaged across urgency levels, ranged from 42.0% to 71.8% across chatbots and was lowest for intermediate cases (19.6%; 95% CI 11.7-28.1). Every chatbot showed a net over-triage bias; overall, 763 of 786 incorrect assignments (97.1%) were more urgent than the prespecified triage level. The error pattern was similar when predictions were assessed against clinician ratings: 35 of 430 trials involving vignettes rated as emergencies by at least 75% of clinicians were under-triaged (8.1%). AI chatbots recognized most psychiatric emergencies but still missed clinically important cases and frequently over-triaged less urgent presentations. Further evaluations should examine how triage performance changes when clinically relevant information must be elicited through conversation.

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).

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.

Emerging AI systems in behavioral health and psychiatry use multi-step or multi-agent LLM pipelines for tasks like assessing self-harm risk and screening for depression. However, common evaluation approaches, like LLM-as-a-judge, do not indicate when a decision is reliable or how errors may accumulate across multiple LLM judgements, limiting their suitability for safety-critical settings. We present a statistical framework for multi-agent pipelines structured as directed acyclic graphs (DAGs) that provides an alternative to heuristic voting with principled, adaptive decision-making. We model each agent as a stochastic categorical decision and introduce (1) tighter agent-level performance confidence bounds, (2) a bandit-based adaptive sampling strategy based on input difficulty, and (3) regret guarantees over the multi-agent system that shows logarithmic error growth when deployed. We evaluate our system on two labeled datasets in behavioral health : the AEGIS 2.0 behavioral health subset (N=161) and a stratified sample of SWMH Reddit posts (N=250). Empirically, our adaptive sampling strategy achieves the lowest false positive rate of any condition across both datasets, 0.095 on AEGIS 2.0 compared to 0.159 for single-agent models, reducing incorrect flagging of safe content by 40% and still having similar false negative rates across all conditions. These results suggest that principled adaptive sampling offers a meaningful improvement in precision without reducing recall in this setting.

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.

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.