Augmenting Interviewer Judgments of Patient Experience with Automatic Language Analysis

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

TAMI: Temporally Aligned, Missingness-Aware, and Interpretable Multimodal Fusion for Mental Health Assessment in Older Adults with Mild Cognitive Impairment

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

HiMA-MDD: A Hierarchical Multi-Agent Harness for Interpretable Multimodal Depression Detection in Clinical Interviews

Depression assessment from multimodal clinical interviews requires integrating dispersed evidence from multiple symptoms into a coherent PHQ-8 profile. This process is hierarchical: relevant evidence is often sparse and context-dependent within local question-answer exchanges, multiple exchanges jointly support symptom-level judgments, and the final assessment depends on the coherence of the complete symptom profile. Existing LLM systems either process interviews holistically or distribute work across generic agent roles; neither design necessarily provides an explicit orchestration mechanism that coordinates evidence access, item-score authority, bounded feedback, and state recording across these levels. To address this gap, we introduce HiMA-MDD, a hierarchical multi-agent harness that aligns this assessment hierarchy with three agent layers. After non-agentic preprocessing constructs context-preserving multimodal QA units, Layer 1 identifies candidate QA-to-item relations and supports bounded item-grounded evidence routing. Layer 2 assigns symptom groups to operational factor specialists, with one specialist responsible for each provisional item score. Layer 3 audits the complete provisional profile, requests at most one round of targeted revision, and reconstructs the verified PHQ-8 profile. This layered design naturally yields a Hierarchical Evidence Trace, preserves all intermediate evidence, judgments, and revisions for auditability. The final item scores then deterministically produce the total score and screening decision. Using Qwen2.5-72B-Instruct as the harness backbone, our experiments on E-DAIC demonstrate that HiMA-MDD outperforms the compared state-of-the-art methods.

Can Conversational Temporal Dynamics Improve Depression Detection in Dyads? A Preliminary Investigation in Multi-Modality Perspectives

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

Reading between the Lines: Leveraging Large Language Models for Global Dementia and Depression Assessment from Clinical Interviews

Dementia and depression are the most prevalent neuropsychiatric disorders in geriatric populations, and their overlapping symptoms pose major challenges for differential diagnosis. In this study, we investigate open-weights Large Language Models (LLMs) for predicting dementia and depression severity from speech samples collected during standardized history taking interviews with 154 German-speaking subjects. We introduce an observer-based Global Depression Scale (GDS-D) aligned with the established Global Deterioration Scale (GDS), enabling parallel global staging of affective and cognitive symptoms. We compare three LLMs (Mistral 3.1, DeepHermes, Qwen3) in two settings: (1) zero-shot prediction and (2) LLM-based feature extraction for Support Vector Regression, using human and pause-enriched transcripts. Results show that LLMs effectively predict depression severity in zero-shot settings (best MAE of 0.60), while dementia assessment benefits substantially from structured feature extraction (best MAE of 0.78), reducing errors by up to 35% over zero-shot baselines. Pause-enriched transcripts achieve competitive performance with human transcriptions, demonstrating the viability of fully automatic screening pipelines for differential neuropsychiatric assessment.

Dep-LLM: Training-Free Depression Diagnosis via Evidence-Guided Structured Multi-factor with Reliable LLM Reasoning

Automatic Depression Detection (ADD) from clinical interviews is a pivotal task in computational mental health, yet it remains challenging due to two critical obstacles: 1) difficulty in modeling complex but sparsely distributed depression clues within lengthy, multi-topic clinical interviews, leading to superficial and unreliable reasoning; 2) scarcity of labeled data due to clinical privacy, together with high cost of training and fine-tuning, limiting the deployment of supervised ADD systems. To jointly address these challenges, we propose Dep-LLM, a training-free framework that mirrors the step-by-step reasoning of clinical psychiatrists and operates entirely on frozen off-the-shelf foundation LLMs. Dep-LLM comprises three stages. First, a Chain-of-Thought (CoT) Depression Multi-factor Analysis module structurally decomposes the long dialogue into five clinically aligned themes and produces evidence-grounded rationales, effectively handling long-context dependencies. Second, we introduce Confidence Analysis and Modulation module that quantifies the epistemic reliability from token-level entropy of each rationale and applies an intra-label and inter-theme modulation that amplifies trustworthy signals while suppressing uncertain ones without extra training. Third, a Collaborative Multi-factor Prediction module dynamically integrates multi-factor signals weighted by confidence into the final diagnosis. Extensive experiments on the DAIC-WOZ and E-DAIC datasets demonstrate the effectiveness and generalizability of Dep-LLM: it surpasses zero-shot baseline on nearly all 21 foundation LLMs across 9 metrics such as accuracy, macro F1 and weighted-average F1, and further outperforms state-of-the-art supervised domain-specific LLMs as well as the latest closed-source commercial LLMs, while requiring no extra training.

AnchorSIPS: A Synthetic Dataset and Evaluation Resource for Evidence-Supported Psychosis-Risk Symptom Measurement

Progress on AI for psychosis-risk assessment is limited by a data-access bottleneck. Real clinical interviews are difficult to share because of privacy, governance, and consent constraints. We present AnchorSIPS, a synthetic dataset of 10K structured psychosis-risk interviews with transcript-grounded measurement targets. Each interview is modeled on Mini-SIPS, a clinician-administered psychosis-risk interview. It captures history, 24 symptom questions, follow-up evidence for items the patient affirms, decisions about delusion-like symptoms (unusual beliefs), hallucination-like symptoms (unusual perceptions), and disorganized communication, exclusion of clear psychotic-level symptoms ("frank psychosis"), and a final attenuated psychosis syndrome (APS) diagnosis, a high-risk state of milder or early psychotic symptoms. The APS diagnosis is not a standalone label. It depends on earlier endorsements, supporting follow-up details, symptom-class decisions, and the frank-psychosis check. Every intermediate decision is anchored to its supporting transcript turns. AnchorSIPS is generated by a plan-then-realize pipeline. A hidden case sheet specifies the patient's clinical state, a deterministic planner fixes the interview structure, and an LLM realizes only the patient utterances under validation and bounded repair. Fixing labels and structure before generation avoids the inter-turn inconsistencies typical of multi-turn LLM dialogue. Across seven LLM baselines, models recover coarse decisions but fail to extract follow-up details or cite supporting transcript turns, so final-label performance overstates interview competence. AnchorSIPS is intended for research on evidence extraction, transcript-grounded measurement, and uncertainty under partial disclosure.