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SubscribeAssessing Risks of Large Language Models in Mental Health Support: A Framework for Automated Clinical AI Red Teaming
Large Language Models (LLMs) are increasingly utilized for mental health support; however, current safety benchmarks often fail to detect the complex, longitudinal risks inherent in therapeutic dialogue. We introduce an evaluation framework that pairs AI psychotherapists with simulated patient agents equipped with dynamic cognitive-affective models and assesses therapy session simulations against a comprehensive quality of care and risk ontology. We apply this framework to a high-impact test case, Alcohol Use Disorder, evaluating six AI agents (including ChatGPT, Gemini, and Character.AI) against a clinically-validated cohort of 15 patient personas representing diverse clinical phenotypes. Our large-scale simulation (N=369 sessions) reveals critical safety gaps in the use of AI for mental health support. We identify specific iatrogenic risks, including the validation of patient delusions ("AI Psychosis") and failure to de-escalate suicide risk. Finally, we validate an interactive data visualization dashboard with diverse stakeholders, including AI engineers and red teamers, mental health professionals, and policy experts (N=9), demonstrating that this framework effectively enables stakeholders to audit the "black box" of AI psychotherapy. These findings underscore the critical safety risks of AI-provided mental health support and the necessity of simulation-based clinical red teaming before deployment.
Reddit-Impacts: A Named Entity Recognition Dataset for Analyzing Clinical and Social Effects of Substance Use Derived from Social Media
Substance use disorders (SUDs) are a growing concern globally, necessitating enhanced understanding of the problem and its trends through data-driven research. Social media are unique and important sources of information about SUDs, particularly since the data in such sources are often generated by people with lived experiences. In this paper, we introduce Reddit-Impacts, a challenging Named Entity Recognition (NER) dataset curated from subreddits dedicated to discussions on prescription and illicit opioids, as well as medications for opioid use disorder. The dataset specifically concentrates on the lesser-studied, yet critically important, aspects of substance use--its clinical and social impacts. We collected data from chosen subreddits using the publicly available Application Programming Interface for Reddit. We manually annotated text spans representing clinical and social impacts reported by people who also reported personal nonmedical use of substances including but not limited to opioids, stimulants and benzodiazepines. Our objective is to create a resource that can enable the development of systems that can automatically detect clinical and social impacts of substance use from text-based social media data. The successful development of such systems may enable us to better understand how nonmedical use of substances affects individual health and societal dynamics, aiding the development of effective public health strategies. In addition to creating the annotated data set, we applied several machine learning models to establish baseline performances. Specifically, we experimented with transformer models like BERT, and RoBERTa, one few-shot learning model DANN by leveraging the full training dataset, and GPT-3.5 by using one-shot learning, for automatic NER of clinical and social impacts. The dataset has been made available through the 2024 SMM4H shared tasks.
Who's Asking? Simulating Role-Based Questions for Conversational AI Evaluation
Language model users often embed personal and social context in their questions. The asker's role -- implicit in how the question is framed -- creates specific needs for an appropriate response. However, most evaluations, while capturing the model's capability to respond, often ignore who is asking. This gap is especially critical in stigmatized domains such as opioid use disorder (OUD), where accounting for users' contexts is essential to provide accessible, stigma-free responses. We propose CoRUS (COmmunity-driven Roles for User-centric Question Simulation), a framework for simulating role-based questions. Drawing on role theory and posts from an online OUD recovery community (r/OpiatesRecovery), we first build a taxonomy of asker roles -- patients, caregivers, practitioners. Next, we use it to simulate 15,321 questions that embed each role's goals, behaviors, and experiences. Our evaluations show that these questions are both highly believable and comparable to real-world data. When used to evaluate five LLMs, for the same question but differing roles, we find systematic differences: vulnerable roles, such as patients and caregivers, elicit more supportive responses (+17%) and reduced knowledge content (-19%) in comparison to practitioners. Our work demonstrates how implicitly signaling a user's role shapes model responses, and provides a methodology for role-informed evaluation of conversational AI.
SMHD: A Large-Scale Resource for Exploring Online Language Usage for Multiple Mental Health Conditions
Mental health is a significant and growing public health concern. As language usage can be leveraged to obtain crucial insights into mental health conditions, there is a need for large-scale, labeled, mental health-related datasets of users who have been diagnosed with one or more of such conditions. In this paper, we investigate the creation of high-precision patterns to identify self-reported diagnoses of nine different mental health conditions, and obtain high-quality labeled data without the need for manual labelling. We introduce the SMHD (Self-reported Mental Health Diagnoses) dataset and make it available. SMHD is a novel large dataset of social media posts from users with one or multiple mental health conditions along with matched control users. We examine distinctions in users' language, as measured by linguistic and psychological variables. We further explore text classification methods to identify individuals with mental conditions through their language.
Conceptualizing Suicidal Behavior: Utilizing Explanations of Predicted Outcomes to Analyze Longitudinal Social Media Data
The COVID-19 pandemic has escalated mental health crises worldwide, with social isolation and economic instability contributing to a rise in suicidal behavior. Suicide can result from social factors such as shame, abuse, abandonment, and mental health conditions like depression, Post-Traumatic Stress Disorder (PTSD), Attention-Deficit/Hyperactivity Disorder (ADHD), anxiety disorders, and bipolar disorders. As these conditions develop, signs of suicidal ideation may manifest in social media interactions. Analyzing social media data using artificial intelligence (AI) techniques can help identify patterns of suicidal behavior, providing invaluable insights for suicide prevention agencies, professionals, and broader community awareness initiatives. Machine learning algorithms for this purpose require large volumes of accurately labeled data. Previous research has not fully explored the potential of incorporating explanations in analyzing and labeling longitudinal social media data. In this study, we employed a model explanation method, Layer Integrated Gradients, on top of a fine-tuned state-of-the-art language model, to assign each token from Reddit users' posts an attribution score for predicting suicidal ideation. By extracting and analyzing attributions of tokens from the data, we propose a methodology for preliminary screening of social media posts for suicidal ideation without using large language models during inference.
Learning to Predict Fitness for Duty using Near Infrared Periocular Iris Images
This research proposes a new database and method to detect the reduction of alertness conditions due to alcohol, drug consumption and sleepiness deprivation from Near-Infra-Red (NIR) periocular eye images. The study focuses on determining the effect of external factors on the Central Nervous System (CNS). The goal is to analyse how this impacts iris and pupil movement behaviours and if it is possible to classify these changes with a standard iris NIR capture device. This paper proposes a modified MobileNetV2 to classify iris NIR images taken from subjects under alcohol/drugs/sleepiness influences. The results show that the MobileNetV2-based classifier can detect the Unfit alertness condition from iris samples captured after alcohol and drug consumption robustly with a detection accuracy of 91.3% and 99.1%, respectively. The sleepiness condition is the most challenging with 72.4%. For two-class grouped images belonging to the Fit/Unfit classes, the model obtained an accuracy of 94.0% and 84.0%, respectively, using a smaller number of parameters than the standard Deep learning Network algorithm. This work is a step forward in biometric applications for developing an automatic system to classify "Fitness for Duty" and prevent accidents due to alcohol/drug consumption and sleepiness.
Automated speech- and text-based classification of neuropsychiatric conditions in a multidiagnostic setting
Speech patterns have been identified as potential diagnostic markers for neuropsychiatric conditions. However, most studies only compare a single clinical group to healthy controls, whereas clinical practice often requires differentiating between multiple potential diagnoses (multiclass settings). To address this, we assembled a dataset of repeated recordings from 420 participants (67 with major depressive disorder, 106 with schizophrenia and 46 with autism, as well as matched controls), and tested the performance of a range of conventional machine learning models and advanced Transformer models on both binary and multiclass classification, based on voice and text features. While binary models performed comparably to previous research (F1 scores between 0.54-0.75 for autism spectrum disorder, ASD; 0.67-0.92 for major depressive disorder, MDD; and 0.71-0.83 for schizophrenia); when differentiating between multiple diagnostic groups performance decreased markedly (F1 scores between 0.35-0.44 for ASD, 0.57-0.75 for MDD, 0.15-0.66 for schizophrenia, and 0.38-0.52 macro F1). Combining voice and text-based models yielded increased performance, suggesting that they capture complementary diagnostic information. Our results indicate that models trained on binary classification may learn to rely on markers of generic differences between clinical and non-clinical populations, or markers of clinical features that overlap across conditions, rather than identifying markers specific to individual conditions. We provide recommendations for future research in the field, suggesting increased focus on developing larger transdiagnostic datasets that include more fine-grained clinical features, and that can support the development of models that better capture the complexity of neuropsychiatric conditions and naturalistic diagnostic assessment.
LLM Use for Mental Health: Crowdsourcing Users' Sentiment-based Perspectives and Values from Social Discussions
Large language models (LLMs) chatbots like ChatGPT are increasingly used for mental health support. They offer accessible, therapeutic support but also raise concerns about misinformation, over-reliance, and risks in high-stakes contexts of mental health. We crowdsource large-scale users' posts from six major social media platforms to examine how people discuss their interactions with LLM chatbots across different mental health conditions. Through an LLM-assisted pipeline grounded in Value-Sensitive Design (VSD), we mapped the relationships across user-reported sentiments, mental health conditions, perspectives, and values. Our results reveal that the use of LLM chatbots is condition-specific. Users with neurodivergent conditions (e.g., ADHD, ASD) report strong positive sentiments and instrumental or appraisal support, whereas higher-risk disorders (e.g., schizophrenia, bipolar disorder) show more negative sentiments. We further uncover how user perspectives co-occur with underlying values, such as identity, autonomy, and privacy. Finally, we discuss shifting from "one-size-fits-all" chatbot design toward condition-specific, value-sensitive LLM design.
"When they say weed causes depression, but it's your fav antidepressant": Knowledge-aware Attention Framework for Relationship Extraction
With the increasing legalization of medical and recreational use of cannabis, more research is needed to understand the association between depression and consumer behavior related to cannabis consumption. Big social media data has potential to provide deeper insights about these associations to public health analysts. In this interdisciplinary study, we demonstrate the value of incorporating domain-specific knowledge in the learning process to identify the relationships between cannabis use and depression. We develop an end-to-end knowledge infused deep learning framework (Gated-K-BERT) that leverages the pre-trained BERT language representation model and domain-specific declarative knowledge source (Drug Abuse Ontology (DAO)) to jointly extract entities and their relationship using gated fusion sharing mechanism. Our model is further tailored to provide more focus to the entities mention in the sentence through entity-position aware attention layer, where ontology is used to locate the target entities position. Experimental results show that inclusion of the knowledge-aware attentive representation in association with BERT can extract the cannabis-depression relationship with better coverage in comparison to the state-of-the-art relation extractor.
Integrating Large Language Models into a Tri-Modal Architecture for Automated Depression Classification
Major Depressive Disorder (MDD) is a pervasive mental health condition that affects 300 million people worldwide. This work presents a novel, BiLSTM-based tri-modal model-level fusion architecture for the binary classification of depression from clinical interview recordings. The proposed architecture incorporates Mel Frequency Cepstral Coefficients, Facial Action Units, and uses a two-shot learning based GPT-4 model to process text data. This is the first work to incorporate large language models into a multi-modal architecture for this task. It achieves impressive results on the DAIC-WOZ AVEC 2016 Challenge cross-validation split and Leave-One-Subject-Out cross-validation split, surpassing all baseline models and multiple state-of-the-art models. In Leave-One-Subject-Out testing, it achieves an accuracy of 91.01%, an F1-Score of 85.95%, a precision of 80%, and a recall of 92.86%.
MythTriage: Scalable Detection of Opioid Use Disorder Myths on a Video-Sharing Platform
Understanding the prevalence of misinformation in health topics online can inform public health policies and interventions. However, measuring such misinformation at scale remains a challenge, particularly for high-stakes but understudied topics like opioid-use disorder (OUD)--a leading cause of death in the U.S. We present the first large-scale study of OUD-related myths on YouTube, a widely-used platform for health information. With clinical experts, we validate 8 pervasive myths and release an expert-labeled video dataset. To scale labeling, we introduce MythTriage, an efficient triage pipeline that uses a lightweight model for routine cases and defers harder ones to a high-performing, but costlier, large language model (LLM). MythTriage achieves up to 0.86 macro F1-score while estimated to reduce annotation time and financial cost by over 76% compared to experts and full LLM labeling. We analyze 2.9K search results and 343K recommendations, uncovering how myths persist on YouTube and offering actionable insights for public health and platform moderation.
M-HELP: Using Social Media Data to Detect Mental Health Help-Seeking Signals
Mental health disorders are a global crisis. While various datasets exist for detecting such disorders, there remains a critical gap in identifying individuals actively seeking help. This paper introduces a novel dataset, M-Help, specifically designed to detect help-seeking behavior on social media. The dataset goes beyond traditional labels by identifying not only help-seeking activity but also specific mental health disorders and their underlying causes, such as relationship challenges or financial stressors. AI models trained on M-Help can address three key tasks: identifying help-seekers, diagnosing mental health conditions, and uncovering the root causes of issues.
