Tracking depression from multi-session counseling dialogues requires estimating both current symptom severity and how it changes across sessions. Yet progress on this task is constrained by the scarcity of longitudinal counseling data with standardized session-level depression labels. Existing resources typically provide either multi-session conversations without depression labels or labeled interviews in a single session. Building such a benchmark poses three challenges: maintaining longitudinal consistency and diversity, grounding symptom progression in empirical patterns, and expressing controlled depression states naturally without exposing target labels. To address these challenges, we introduce LongCounsel-8, a benchmark suite of three independently generated datasets totaling 7,749 five-session counseling trajectories, grounded in real-world client profiles, depression trajectories, symptom compositions, and counseling patterns. We combine profile-grounded simulation, empirically informed state construction, and indirect behavioral realization to address these challenges. Across the benchmark, simulated self-reports closely recover the controlled states, supporting label fidelity. Experiments on existing depression tracking methods reveal three key findings: (1) lower single-session score error does not guarantee accurate identification of trend, i.e., improvement or worsening; (2) existing methods are consistently less reliable on worsening trajectories; and (3) additional session history may reduce the accuracy of trend prediction. Together, these findings establish LongCounsel-8 as a foundation for advancing depression assessment from static, single-session prediction toward reliable longitudinal tracking of mental-health change.
Phuong Anh Nguyen, Jill Noorily, Matthew Flathers +7cs.CY cs.CL cs.IR
Online health information seeking is shifting from keyword search, where users consider a ranked list of links, to conversational systems that compose a single answer and curate its citations. Source evaluation therefore passes from user to platform, yet what these systems surface is poorly characterized. We audited three free consumer products (ChatGPT, Perplexity, Google AI Overview) on twenty English mental health questions under two prompt conditions, with a subset of three also translated into six further languages of varying resource tiers. We recorded 15,942 citations across 1,140 responses and 1,713 unique domains, then classified every citation with a nine-category organizational typology applied by a deterministic classifier validated against human coding. Citations were heavily concentrated: the ten most-cited domains accounted for 43.6% of English citations, and government, commercial health, and academic sources were closely matched at roughly 22% each. Platforms differed little in typical citation volume but sharply in consistency and in the source types they favored. Explicitly requesting sources shifted composition only modestly. Non-English queries surfaced fewer citations and were routed to language-appropriate resources at significantly lower rates. We release the typology, classifier, and annotated corpus as reusable instruments for auditing generative health search.
Merna Bibars, Bolaji Omofojoye, Allan I. Levey +3cs.CV cs.AI
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.
Judgments about psychological distress are socially situated: what counts as concerning hinges on community norms around emotional expression, vulnerability, and help-seeking. Yet large language models (LLMs) used for distress detection are typically aligned to a single, undifferentiated standard. How well do these models capture the perspectives of the communities whose language they assess? We address this question through a perspectivist annotation study in which 321 participants provided 9,587 judgments on 1,198 Reddit posts spanning six identity-based communities, yielding community-specific labels. Raters in the contextualized in-group condition show a modest tendency to agree more with their community than uncontextualized out-group raters (OR = 1.18), an effect varying significantly across communities. We then evaluate nine open-weight LLM configurations and four frontier configurations against these labels. Open-weight LLMs systematically over-estimate distress: when communities perceive none-to-mild distress, these models achieve only 31-44% accuracy, predominantly producing false positives. GPT-5 and Gemini 2.5 Pro show the same none-to-mild inflation even when their full-sample over/under rates are mixed, while Claude Opus 4 is more conservative. This pattern does not simply mirror an outsider reading position: uncontextualized out-group human aggregates were nearly symmetric, with 18% over-estimation versus 19% under-estimation. Instead, the models that inflate none-to-mild cases exhibit a distress prior that exceeds both contextualized in-group and uncontextualized out-group human judgments. These findings have implications for equitable AI deployment in mental health contexts, where miscalibrated distress detection may unevenly affect the communities being assessed.
People share mental health diagnoses on social media, yet how such language becomes visible around their self-disclosure, and whether community engagement tracks it, remain unexamined across conditions. We analyze 89,605 Reddit posts from 739 users across eight conditions, removing each user's diagnosis disclosure and aligning their surrounding posts to that anchor. Within the pre-disclosure year, language-visible burden was highest in the month before disclosure for six conditions, earlier for post-traumatic stress disorder and furthest from it for borderline personality disorder, and remained visible afterward rather than resolving. The theme Seeking Clinical Explanations showed the largest early-to-late difference before disclosure in five conditions, yet engagement rarely tracked what users wrote: only 9 of 360 language--engagement correlations survived correction. Disclosure is therefore a waypoint in an unevenly visible process, and we offer implications for community practice and platform design where engagement metrics do not reflect clinical need.
Mental health assessment relies on episodic self-report scales, which convert subjective states such as stress into numerical scores but provide only sparse snapshots of wellbeing. Wearable devices offer longitudinal behavioral and physiological signals for continuous, low-burden monitoring. Recent LLM-driven personal-health agents enable natural language queries over wearable signals, but mainly handle short-term, retrieval-based lookups (e.g., highest step count over a week). They do not evaluate whether agents can reason over long-term signals to predict wellbeing scores paired with evidence-grounded rationales. To address this gap, we introduce BALMS, the first systematic benchmark of LLM-based agentic systems for longitudinal mental health sensing. BALMS spans 3 real-world longitudinal datasets, 2 task families (closed-form wellbeing-score prediction and rationale generation auto-graded by an LLM-as-Judge), 3 agentic paradigms evaluated across 5 open- and closed-source LLM backbones. We find that zero-shot agents rarely outperform a simple mean baseline, except with stronger backbones or compact, semantically meaningful features. Chain-of-thought prompting improves reasoning-oriented backbones, but does not guarantee temporal grounding or numerical correctness. Together with more analysis on efficiency and temporal scaling, BALMS highlights the need for longitudinal mental health agents that selectively retrieve history, ground temporal evidence, and reason over interpretable behavioral features.
Matthew Flathers, Phuong Anh Nguyen, Jill Noorily +7cs.CL cs.AI cs.CY
General-purpose health benchmarks increasingly anchor claims about LLM medical performance, but they are not always resolved by clinical specialty, making domain-specific performance hard to isolate. Mental health is of acute public-health concern as millions of people turn to LLMs for psychological support, and most existing evaluations are bespoke academic benchmarks that are difficult to integrate into developer workflows. We introduce HealthBench-Psych and HealthBench-Psych-Hard. We screened HealthBench's 5,000 physician-rubric conversations for mental-health relevance with a transparent LLM-applied rubric, then validated the subset through two rounds of blinded clinician review with concealed known-exclude controls, yielding 610 conversations (12.2% of the corpus). Evaluating 20 frontier and open models under a cross-vendor panel of three LLM judges, we find a statistically tied frontier cluster, measurable refusal behavior in two models, and near-identical rankings across judges ($τ\ge 0.92$). We release the subset, pipeline, model responses, grades, and analysis code as a reusable resource.
Philipp Steigerwald, Nico Bienlein, Jennifer Burghardt +3cs.HC cs.CL
Rising global demand for mental health support creates significant service delivery challenges, with asynchronous email counselling serving as a crucial low-threshold channel for accessing care. This paper presents CAIA, a co-designed AI-based tool suite that demonstrates responsible AI integration into counselling practice through seven LLM-driven functions enhanced by retrieval-augmented generation. A field evaluation involved 34 professional counsellors conducting authentic sessions with trained student counsellees (36 threads, 321 messages, 1,257 AI outputs). User behaviour analysis confirms substantial adoption, revealing that professional autonomy and information accuracy are decisive for sustained acceptance, with counsellors particularly valuing interpretive functionalities that provide new perspectives and stimulate professional reflection.
Modern mental healthcare faces a critical shortage of senior supervisory oversight, leading to a "supervision gap" where novice therapists manage high-stakes risks with delayed professional feedback. This paper proposes a new framework utilizing a fine-tuned Mistral-7B-instruct model as an automated "Supervisor-in-the-Loop" system. By leveraging 106 sessions from the DAIC-WOZ dataset, the model performs a tri-stream analysis: (1) Therapeutic Alliance tracking via semantic adherence, (2) Latent risk prediction using attention-weighted analytics, and (3) Supervisory Triage via a Dynamic Clinical Urgency Index (D-CUI). Our multi-modal VAL (Visual-Acoustic-Linguistic) framework achieves 95% technique identification accuracy [95% CI: 75.1%-99.9%], alliance assessment MAE of 0.105 on a 5-point scale [95% CI: 0.059-0.151], therapeutic fidelity alpha = 0.423, and mean D-CUI of 0.370 [95% CI: 0.322-0.419]. Training converged in 105 steps with 85.2% loss reduction on a single Tesla T4 GPU. The system reduces supervisory triage latency from 72 hours to real time (~10 seconds per session), enabling proactive intervention in high-risk cases. The system addresses the cold-start problem through Bayesian priors and implements timestamp-based modality synchronization for robust multi-modal fusion.
LLM-based simulated clients are increasingly used to train novice counselors, evaluate LLM therapists, and generate synthetic data. However, current simulators produce overly cooperative clients that disclose too readily, accept therapeutic reframes without resistance, and resolve core issues within a single session. We trace these issues to profiles that lack causal depth and behavioral mechanisms that treat all content as equally accessible. We present PatientAct, a framework for client simulation grounded in established clinical theories. Our profiles integrate the 5Ps clinical case formulation, providing causal depth without tying the design to any single therapeutic modality. During simulation, profiles include a dynamic memory layer in which items carry trust thresholds (e.g., symptoms are available early, whereas formative memories require a sustained therapeutic alliance). At each turn, the client's emotional reaction and behavior are modeled before generating a response. If the therapist approaches gated content, PatientAct expresses resistance in terms of quantity, content, and style rather than defaulting to cooperation or a single resistance pattern. We evaluate our framework on 40 clinical situations and demonstrate that it generates diverse profiles with high clinical plausibility. Moreover, PatientAct significantly outperforms the baselines, yielding substantial gains in resistance quality and behavioral realism. Our code and data will be publicly available via github.com/Sahandfer/PatientHub.
Samaneh Rezaeimanesh, Mohsen Behradfar, Mohammad Fili +1cs.LG
Body-focused repetitive behaviors, such as hair pulling and skin picking, are compulsive motor actions commonly associated with obsessive-compulsive and anxiety disorders. Their early, objective detection remains difficult because the movements are subtle and overlap with ordinary, non-pathological gestures. We developed and evaluated a multimodal deep learning framework to detect and classify these behaviors from wrist-worn sensor data. The data, collected by the Child Mind Institute using the Helios wrist-worn device, combine inertial measurement units, thermopile sensors, and time-of-flight sensors, capturing kinematic, thermal, and proximity information. The framework combined a convolutional neural network with a gated recurrent unit, alongside modality-specific autoencoders and a late-fusion classifier, to exploit temporal and spatial dynamics. It achieved an F1 score of 0.985 and an area under the receiver operating characteristic curve of 0.997 for binary detection, distinguishing these behaviors from other activities, and a macro-averaged F1 score of 0.700 with an area under the curve of 0.963 across a nine-class scheme that distinguished each individual behavior from a single grouped Non-Target class, improving over single-modality baselines. Post-hoc interpretability based on Shapley additive explanations showed that the time-of-flight and inertial modalities dominated discriminative power by capturing spatial proximity and dynamic movement, while hierarchical clustering indicated that misclassifications were driven primarily by the anatomical region of the gesture. These findings demonstrate that multimodal sensor fusion enables accurate, objective, and continuous behavioral monitoring. This work establishes a foundation for real-time, wearable-assisted mental health diagnostics and personalized interventions in biomedical research and clinical care.
Edoardo Sebastiano De Duro, Emma Franchino, Massimo Stellacs.CL cs.AI cs.SI
Natural Language Processing (NLP) models predicting mental health outcomes rarely specify what they measure: contextual knowledge, emotional content, or syntactic structure. NLP Psychometrics treats psychological prediction from text as a psychometric problem, linking scores to interpretable linguistic evidence and testing beyond the training text format. Nine LLMs, conditioned on controlled personas (cognitive digital shadows), completed psychometric questionnaires with textual explanations per item. We extracted emotional profiles and syntactic-semantic structure via textual forma mentis networks, combined with personality and sociodemographic variables in ablated random forest (RF) regressors, using SHAP to identify which features drove performance and in which direction. Full RF models explained up to 70.8% of variance in life satisfaction (SWLS), 55.7% in depression (PHQ-9), and, for DASS-21, 68.5% depression, 76.0% anxiety, 72.4% stress. Sociodemographics alone explained no meaningful variance in depression, anxiety, or stress, but did so for life satisfaction, where emotion features and income were the strongest predictors; neuroticism and network topology instead dominated depression and anxiety, reversing direction between them. Without retraining, RF models separated diaries from low- and high-score personas ($r$ up to 0.91) and, using only network/emotion features, classified clinical from control participants in real transcripts with up to 68% accuracy. These results show the promise and limits of synthetic data: LLM personas can expose model biases, recover patterns consistent with clinical rumination, and support psychometric prediction from human text without a matched questionnaire, but cannot substitute for human validation. NLP Psychometrics makes these distinctions explicit, measurable, and testable through interpretable AI and network/emotional features.
Cognitive distortion detection is a key task in computational mental health, yet existing approaches often overlook the psychological structure of distorted thoughts. We propose MTI-GNN (Multi-Perspective Triad Interaction Graph Neural Network), which models Beck's cognitive triad---negative views of the self, world, and future---as complementary perspectives for classification. An LLM decomposes each utterance into the three perspectives, from which perspective-specific similarity graphs are constructed and encoded by a Multi-Perspective GNN. A Triad Interaction module models cross-perspective dependencies through sequential source-conditioned updates and feature-wise gating, while Prototype-Guided Perspective Fusion performs label-conditioned aggregation. Label-expanded supervision incorporates all available distortion annotations during training. We evaluate MTI-GNN on 9,764 samples from four Korean, English, and Chinese datasets spanning ten distortion categories. MTI-GNN significantly outperforms all supervised variants and exceeds eight prompted generative models under zero-shot and few-shot settings. Leave-one-perspective-out ablations show that all three perspectives contribute significantly, while human expert evaluation provides preliminary evidence of their alignment with the intended cognitive dimensions.
Andreu Casamayor-Segarra, Vicent Ahuir, Antonio Molina-Marco +1cs.CL
Early detection of mental health disorders is often limited by the lack of specialized resources in Spanish and the difficulty of analyzing long histories of social media posts. This paper addresses these challenges through three main contributions. First, we introduce three Spanish foundational models specifically adapted to the mental health domain through domain-specific pre-training. Second, we propose Incremental Context Expansion (ICE), an automatic relabeling methodology designed for early detection. ICE identifies the point at which cumulative messages provide enough evidence of a disorder, generating more informative training samples. Third, we provide a set of fine-tuned models using the samples generated with the ICE methodology for early risk detection tasks. Our results on three Spanish benchmarks show that combining these specialized models with ICE improves the state-of-the-art, reducing detection latency while maintaining high performance. All models are publicly available.
Mental health understanding in long-form videos requires nuanced reasoning over observable behavior, interpersonal context, and latent psychological states. Existing benchmarks largely reduce this task to coarse-grained classification, providing limited insight into whether models truly understand psychological phenomena or rely on superficial correlations. To address this limitation, we introduce MMHBench, a comprehensive multimodal benchmark for multi-perspective mental health understanding, comprising 268 long-form videos and 2,184 carefully curated questions. MMHBench organizes the evaluation into two complementary settings: (1) third-person assessment, consisting of 605 questions that focus on the interpretation of observable behaviors and multimodal evidence, and (2) first-person perspective-taking, comprising 1,579 questions that require perspective-conditioned reasoning to identify the interpretation of the mental state supported by the available multimodal evidence. We propose a Multi-Agent Question Generation (MAQG) framework that simulates diverse social roles to synthesize questions from multiple perspectives. The generated questions are refined through multi-role feedback and iterative optimization, followed by expert-guided verification to ensure quality and validity. Extensive evaluation of 22 representative multimodal large language models (MLLMs), spanning both open-source and leading closed-source models, demonstrates that long-form video mental health understanding remains highly challenging.
Cognitive distortion amplifies negative emotions and contributes to mental health disorders. Cognitive Behavioral Therapy (CBT) is an effective way to address cognitive distortions, but its large-scale application is limited by the shortage of professional therapists. Although large language models (LLMs) have recently been explored for mental health applications, existing methods still suffer from limited domain specificity, overly flattering responses, and the absence of well-defined annotations for cognitive distortions. This paper proposes Cognivia, an evidence-based artificial intelligence therapist that integrates automatic cognitive distortion identification and rational response generation. Our framework is built on authoritative CBT texts widely regarded as core paradigms and standard references. It is further augmented with mental health question-answer (Q and A) data, and employs multi-stage prompting and structured generation strategies under the supervision of behavioral science experts. Then we fine-tune a lightweight LLM on this augmented CBT dataset to obtain Cognivia. In addition, we propose the first hierarchical quality evaluation framework for assessing LLM-generated rational responses, developed through collaboration between AI researchers and behavioral science experts. Cognivia is evaluated using lexical metrics, LLM-based Judges with two complementary criteria, and human evaluation by 10 behavioral science experts. It consistently outperforms the baseline methods in cognitive distortion recognition and rational response generation, demonstrating its effectiveness. Our code is available at https://github.com/SNOWTEAM2023/Cognivia.
Quoc-Cuong Pham, Hoang-Thuy-Duong Vu, Thi-Thanh-Huong Ha +1cs.LG
Digital phenotyping (DP) using smartphones and wearable devices has shown considerable potential for mental health monitoring. However, progress remains difficult to evaluate due to heterogeneous datasets, inconsistent preprocessing pipelines. In this study, we present a reproducible benchmark built upon the Neurai-VN dataset, a high-resolution, multimodal dataset comprising passive sensing and active assessment from wearable and smartphone devices, collected from 100 Vietnamese adults over two weeks. The benchmark defines four clinically relevant binary classification tasks evaluated using standardized subject-wise cross-validation. Representative linear, tree-based, and neural baseline models are evaluated across predefined feature configurations. Mean subject-level F1 scores across five cross-validation folds reached 0.71 for Healthy Control vs. Depression and Healthy Control vs. Clinical, while Healthy Control vs. Anxiety and Depression vs. Anxiety achieved 0.69 and 0.56, respectively. These benchmark results provide reproducible baselines for future research on multimodal DP for mental health classification tasks.
Fatema Tuj Johora Faria, Mukaffi Bin Moin, Md. Mahfuzur Rahman +3cs.CL
Despite recent advances in large language models (LLMs), their ability to generate empathetic mental health counseling responses in low-resource languages remains largely unexplored. To address this gap, we curate 625 authentic mental health cases from three complementary sources: (1) publicly available Facebook posts discussing mental health concerns, (2) transcripts from the Bangladeshi television program "Ami Akhon Ki Korbo", and (3) anonymized student questionnaire responses covering diverse emotional and psychological challenges. Based on these cases, we build an evaluation corpus comprising advice written by licensed clinical psychologists and responses generated by three modern proprietary LLMs: GPT-4o Mini, Claude 4.5 Haiku, and Gemini 2.5 Pro. We further propose the Role-Playing Reflective Chain-of-Thought Advisory Framework (RP-RCAF), a task-specific prompting strategy that combines expert-authored few-shot examples with structured self-reflection to produce supportive, culturally aware, and ethically aligned counseling through a compassionate advisor persona. We also introduce the Grok 4-Based Response Evaluation and Scoring Framework (G-REFS), which integrates automated assessment with expert psychologist validation across emotional sensitivity, cultural appropriateness, linguistic clarity, and ethical soundness. Experimental results show that RP-RCAF consistently outperforms conventional prompting across all evaluated models and produces responses that more closely align with professional psychological counseling.
Anabela C. Areias, Catarina Botelho, António Farinhas +7cs.AI
Large language models (LLMs) are increasingly used for emotional support despite lacking mechanisms to safely govern evolving mental health risk. Existing safety approaches primarily detect risk but rarely shape how models respond as conversational risk unfolds. We developed a model-agnostic safety governance architecture that combines contextual risk detection, reasoning-based verification, and protocol-guided response generation for multi-turn mental health interactions. Synthetic conversations grounded in real-world mental health narratives were used to evaluate the architecture's performance, tested with GPT-5-chat and Qwen3.5-27B, achieving high risk detection performance (specificity: 0.85 (95\%CI: 0.78;0.91), sensitivity: 0.92 (95\%CI: 0.88;0.95)) and increasing clinician-preferred escalation responses by 25.6--59.2pp while preserving rapport and connection. Performance remained stable across conversation length and generalized across both proprietary and open-source models. These findings demonstrate that clinically-grounded safety governance can extend beyond risk detection to improve how LLMs manage evolving mental health risk, providing a scalable framework for safer deployment across models.
Digital mental health interventions (DMHIs) offer scalable support, but ensuring they accurately detect users' intent during volatile situations can be challenging. Pure parametric Large Language models (LLMs) do not contain specific safety critical architecture, and can miss critical cues, or hallucinate, undermining reliability. Retrieval Augmented Generation (RAG), which supplements an LLM with retrieved context, could enhance intent detection during volatile situations. Commercially available DMHIs typically combine multiple independent safety layers like rule-based filters, symbolic escalation protocols, and neural classification. The incremental contribution of any single layer, however, remains unquantified. This paper evaluates six LLM models within a DMHI called Wysa, via a controlled comparison of RAG-enabled versus RAG-disabled modes. Anonymized real and synthetic user-chatbot exchanges were annotated by a qualified clinical team against multi-class intent categories (e.g. self-harm, abuse, panic). The study computed classification accuracy, recall, precision and F1 scores against ground truth labels and tested differences for statistical significance. Performance was also examined by risk category and inter-model agreement. While RAG caused a rise in false alarms, the trade-off is consistent with safety-critical design principles that prioritize sensitivity, where flagged cases are routed to additional review rather than acted on directly. Overall, these findings support RAG as a promising approach to improve the accuracy, consistency and safety of LLM-driven DMHIs. Keywords: Digital Mental Health Intervention, Large Language Model, Retrieval Augmented Generation, Accuracy, Recall, Precision
Mobile and wearable sensing enables longitudinal observation of behavior, yet translating these signals into meaningful mental health constructs remains difficult. We introduce a clinician-in-the-loop benchmark for evaluating whether large language models (LLMs) can generate evidence-grounded Brief Hierarchical Taxonomy of Psychopathology (B-HiTOP) item profiles from passive sensing, ecological momentary assessment (EMA), and questionnaire evidence. Using the Generalization of Longitudinal Behavior Modeling (GLOBEM) dataset, we construct 14,592 participant-day instances and align multimodal evidence to 29 B-HiTOP items across five spectra. Since GLOBEM lacks B-HiTOP responses, we evaluate evidence compatibility (C) rather than diagnostic accuracy, separating substantive predictions from abstentions when evidence is insufficient for item-level scoring. Two-stage prediction improves C for EMA and questionnaire evidence, but reduces C under passive sensing and combined evidence and produces more conservative score distributions across models, spectra, and evidence settings. Overall, semantic abstraction helps organize heterogeneous self-report evidence while becoming an information bottleneck for indirect behavioral sensing signals.
Asher Sprigler, Yang-Yang Feng, Iftach Amir +5cs.AI cs.HC
Contemplative traditions have long guided ethical behavior and prosocial interaction, and recent work suggests that contemplative principles (e.g., mindfulness, compassion, non-dual reasoning) may offer a promising paradigm for aligning large language models (LLMs), improving cooperation and reducing ethical violations in LLM outputs. However, as new models, evaluation metrics, and benchmarks emerge rapidly, it remains challenging to systematically assess whether and how contemplative principles enhance LLM alignment across diverse and evolving scenarios, and existing approaches are often ad hoc and fail to generalize. We present a modular, extensible evaluation framework, initially targeted at the mental health domain, that enables seamless integration of new models, metrics, and benchmarks through a reusable pipeline. The framework currently reproduces existing state-of-the-art results and supports systematic cross-evaluation by flexibly mixing and matching models, metrics, and benchmarks, enabling fair comparison and deeper insight. Its plug-and-play prompting module offers a principled pathway for incorporating ethical perspectives such as contemplative principles, allowing domain experts to define alignment criteria without requiring technical expertise. Although initially focused on mental health, the framework is domain-agnostic and extends naturally to areas such as decision-making, moral reasoning, and human-AI collaboration. By bridging computational evaluation with human-centered ethical reasoning, this work lays the groundwork for interdisciplinary research spanning cognitive science, behavioral economics, philosophy, and system design, toward robust, trustworthy, and socially beneficial human-AI ecosystems.
Explainable machine learning (XML) pipelines applied to composite mental health outcomes can produce apparently-robust, cross-population-stable risk hierarchies that are largely artefacts of how the outcome was constructed. We demonstrate this using an ElasticNet pipeline applied to 886 medical students at the University of Lausanne (primary cohort, 2022), validated across 2,580 longitudinal observations at three time points and 701 non-medical students from eight faculties; all three datasets share identical instruments. The pipeline produces a hierarchy in which trait anxiety and health satisfaction dominate wherever the outcome is measured, with Kendall $τ= 1.0$ for the top-two positions across all five evaluation sets and consistent transfer performance ($R^2$: 0.41-0.49). Two residualization experiments, which isolate shared variance between correlated variables via regression, reveal the mechanism: when trait anxiety (STAI-T) is residualized against the co-included depression subscale (CES-D, $r = 0.72$), model $R^2$ drops from 0.41 to 0.16 and STAI-T falls from rank 1 to rank 6; when burnout subscales are residualized against CES-D, $R^2$ collapses to 0.016. Prediction intervals average 35.4 units on a 0-100 scale (2.4 outcome standard deviations), independently ruling out individual-level deployment. The residualization protocol is the paper's transferable contribution: any XAI study combining correlated predictor and outcome constructs should apply this check before interpreting apparent stability as a finding.
Safety-critical mental-health support systems must distinguish when supportive conversation is appropriate from when free-form generation should be blocked. This paper presents Anian, a safety-gated multimodal AI backend for perinatal mental-health support and mindfulness-intervention routing. Anian is not intended to diagnose psychiatric conditions or replace clinical care or crisis intervention. Its modular pipeline places generative AI downstream of structured state representation, conservative risk fusion, and response gating. User text or voice-derived ASR transcripts are mapped into four linked layers: L1 emotion states, L2 psychosocial constructs, L3 safety risk, and L4 intervention routes. Local text- and rule-based safety evidence is fused with external voice-derived evidence using a highest-risk-priority rule, S_fusion = max(S_local, S_external). At moderate or high fused risk, ordinary AI-generated responses and text-to-speech delivery are blocked and replaced by fixed safety content and prompts for human support. An internal prototype evaluation used approximately 858,295 normalized records from public emotion, dialogue, mental-health-related, and Chinese dialogue corpora within a weak-label and rule-derived framework. Micro-F1 scores were 0.9604 for L1 emotion classification, 0.9144 for L2 psychosocial constructs, and 0.9742 for L4 routing. In a controlled safety stress test of 233 samples, the L3 rule engine achieved high-risk recall of 1.0000 within predefined scenarios. These findings support the internal feasibility of the label framework and gating logic but do not establish clinical validity, diagnostic accuracy, real-world safety, or effectiveness. We report the architecture, ontology, safety-fusion mechanism, prototype evaluation, error-analysis plan, and roadmap for expert-reviewed and real-world validation.
Gwydion Williams, Sara Zannone, Bilal A Mateencs.AI
Large language models (LLMs) have become significant providers of mental health support, yet they remain products of an attention economy whose operational and commercial targets favour sustained engagement over the friction that effective psychological support often requires. Developers' safety responses have been largely reactive, addressing the most visible and acute harms while subtler, longer-term patterns of risk (e.g., dependency, boundary erosion, the amplification of distorted beliefs) receive less attention. We contend that making LLMs structurally safe requires alignment organised at three levels that mirror how society assures the safety of human clinical practice: 1) explicit value specification grounded in the codified normative commitments of clinical practice; 2) training that embeds those values in the model; and 3) oversight that detects drift and longer-term harm during deployment, much as clinical supervision does for human practice. Organising alignment in this way yields a construct we call alignment plausibility - a structured demonstration that a system's values, training regime, and oversight mechanisms are together consistent with safe and positive outcomes. We propose alignment plausibility as a regulatory construct (by drawing analogy to the established construct of biological plausibility) for AI in health: a principled way to argue for, or against, trust that systems are aligned to positive health outcomes, will cause no harm even where capable of doing so, and will ultimately lead to patient benefit.
Neil K. R. Sehgal, Dunigan Folk, Lyle Ungar +1cs.HC cs.AI
Large language models are increasingly used as private, always-available conversational systems, but little is known about how people with depressive symptoms use them. Building on CSCW work on disclosure and peer support, we examine ChatGPT as an emerging informal support infrastructure: private, persistent, responsive, and available outside ordinary hours. We analyze 187,093 ChatGPT conversations from 766 participants who completed the PHQ-8, comparing those below the moderate-symptom threshold (score of 10) with those at or above it. Higher-PHQ participants used ChatGPT more for mental-health, interpersonal, loneliness, self-focused, and support-seeking conversations, with pronounced late-night and recurring month-level patterns. Their language contained more first-person singular pronouns and absolutist terms. They more often engaged ChatGPT in high-disclosure contexts, but professional redirection was not higher. Language-based prediction was modest and insufficient for screening (AUROC 0.591). We argue these histories should not be treated as clinical screening data but as evidence LLMs are increasingly used as informal support infrastructure.
Active mobility is widely promoted for sustainable and healthier living, but whether it translates into equitable mental health benefits across individuals and places over time remains unknown. Using causal machine learning and causal deep learning in 264168 UK adults, we find substantial inequalities in individualized effects of active mobility on anxiety, depression, and common mental disorders. These inequalities widen over time and are strongly structured by urban context. For example, anxiety risk at follow-up ranges from a 40.6% reduction to a 10.1% increase across individuals, versus a 10.4% reduction to a 0.1% increase at baseline. Benefits are greatest in greener, safer, less polluted, and less deprived neighborhood environments, with 81.8% of individuals experiencing above-average benefits and mean anxiety risk reduced by 26.4%, versus 10.4% of individuals and 7.4% reduction in the least supportive environments. Urban compact form further modifies these effects through nonlinear interactions with neighborhood environments, amplifying benefits only under supportive conditions. Despite these strong environmental gradients, genetic moderation is negligible.
Online social media posts provide scalable signals for early depression screening, and recent studies mainly improve pre-classification evidence through risk-post selection, symptom grounding, and clinically informed feature construction. However, these screening-stage designs often leave final decisions to a single detector, overlooking how users heterogeneously express depressive risk after screening. A monolithic classifier must average across heterogeneous users, which may dilute localized evidence and cause misclassification, especially for non-self-disclosing users. To address this issue, we propose WPG-MoE, a weak-prior-guided dense mixture-of-experts framework built on a shared large language model (LLM) backbone. WPG-MoE derives user-level weak semantic priors to softly route users to experts matched to different evidence layouts. We formulate this process as learning using privileged information (LUPI): rich LLM-extracted structured evidence guides training-time routing, while inference retains only Patient Health Questionnaire-9 (PHQ-9) template screening and the deployable backbone. Experiments on Chinese and English datasets show that WPG-MoE outperforms strong baselines with interpretable routing behavior.
Detecting mental health disorders in a timely manner is an important societal challenge. NLP and machine learning (ML) methods used to assist with detection rely on data collected primarily from social media. However, such datasets often have sampling biases and inherent ethical and privacy issues. One avenue to overcome these limitations is non-social media data. We present the first comprehensive review of non-social media, free-text datasets for mental health research. We use the PRISMA methodology to conduct our survey and we review datasets available in multiple languages. We find that non-social media free-text based datasets are predominantly focused on English and on detecting depression. These datasets also vary in demographics, platforms, data types, annotation techniques, and methodologies. This systematic review also reveals key gaps and highlights opportunities to develop more diverse, reliable and clinically-relevant resources.
Igor Buyanov, Nafisa Valieva, Ekaterina Mazurinacs.CL
Social media posts are a rich and valuable source of data for analyzing mental health states and users' well-being using automated analysis tools. In this work, we demonstrate how we used a range of Natural Language Processing (NLP) methods, including Long Short-Term Memory (LSTM), BERT-based models, and Large Language Models (LLMs), for self-state and well-being analysis and summarization during the CLPsych Shared Task 2026. Our approach achieved one of the top Consistency and Contradiction scores for the summarization task and also middle-level results for the other tasks. By testing and developing such mental health-state estimation systems, we contributed to improving mental health support systems. We make our code available https://github.com/psytechlab/CLPsych2026/.