Natural language processing for mental health interventions: a systematic review and research framework

Artificial intelligence in insanity evaluation. Potential opportunities and current challenges

The formulation of a scientific opinion on whether the individual who committed a crime should be held responsible for his/her actions or should be considered not responsible by reason of insanity is very difficult. Indeed, forensic psychopathological decision on insanity is highly prone to errors and is affected by human cognitive biases, resulting in low inter-rater reliability. In this context, artificial intelligence can be extremely useful to improve the inter-subjectivity of insanity evaluation. In this paper, we discuss the possible applications of artificial intelligence in this field as well as the challenges and pitfalls that hamper the effective implementation of AI in insanity evaluation. In particular, thus far, it is possible to apply only supervised algorithms without knowing which is the ground truth and which data should be used to train and test the algorithms. In addition, it is not known which percentage of accuracy of the algorithms is sufficient to support partial or total insanity, nor which are the boundaries between sanity and partial or total insanity. Finally, ethical aspects have not been sufficiently investigated. We conclude that these pitfalls should be resolved before AI can be safely and reliably applied in criminal trials.

Capitalizing on natural language processing (NLP) to automate the evaluation of coach implementation fidelity in guided digital cognitive-behavioral therapy (GdCBT)

BACKGROUND

As the use of guided digitally-delivered cognitive-behavioral therapy (GdCBT) grows, pragmatic analytic tools are needed to evaluate coaches' implementation fidelity.

AIMS

We evaluated how natural language processing (NLP) and machine learning (ML) methods might automate the monitoring of coaches' implementation fidelity to GdCBT delivered as part of a randomized controlled trial.

METHOD

Coaches served as guides to 6-month GdCBT with 3,381 assigned users with or at risk for anxiety, depression, or eating disorders. CBT-trained and supervised human coders used a rubric to rate the implementation fidelity of 13,529 coach-to-user messages. NLP methods abstracted data from text-based coach-to-user messages, and 11 ML models predicting coach implementation fidelity were evaluated.

RESULTS

Inter-rater agreement by human coders was excellent (intra-class correlation coefficient = .980-.992). Coaches achieved behavioral targets at the start of the GdCBT and maintained strong fidelity throughout most subsequent messages. Coaches also avoided prohibited actions (e.g. reinforcing users' avoidance). Sentiment analyses generally indicated a higher frequency of coach-delivered positive than negative sentiment words and predicted coach implementation fidelity with acceptable performance metrics (e.g. area under the receiver operating characteristic curve [AUC] = 74.48%). The final best-performing ML algorithms that included a more comprehensive set of NLP features performed well (e.g. AUC = 76.06%).

CONCLUSIONS

NLP and ML tools could help clinical supervisors automate monitoring of coaches' implementation fidelity to GdCBT. These tools could maximize allocation of scarce resources by reducing the personnel time needed to measure fidelity, potentially freeing up more time for high-quality clinical care.

Large language models for the mental health community: framework for translating code to care

Large language models (LLMs) offer promising applications in mental health care to address gaps in treatment and research. By leveraging clinical notes and transcripts as data, LLMs could improve diagnostics, monitoring, prevention, and treatment of mental health conditions. However, several challenges persist, including technical costs, literacy gaps, risk of biases, and inequalities in data representation. In this Viewpoint, we propose a sociocultural-technical approach to address these challenges. We highlight five key areas for development: (1) building a global clinical repository to support LLMs training and testing, (2) designing ethical usage settings, (3) refining diagnostic categories, (4) integrating cultural considerations during development and deployment, and (5) promoting digital inclusivity to ensure equitable access. We emphasise the need for developing representative datasets, interpretable clinical decision support systems, and new roles such as digital navigators. Only through collaborative efforts across all stakeholders, unified by a sociocultural-technical framework, can we clinically deploy LLMs while ensuring equitable access and mitigating risks.

Utilizing natural language processing for precision prevention of mental health disorders among youth: A systematic review

BACKGROUND

The global mental health crisis has created barriers to youth mental healthcare, leaving many disorders unaddressed. Precision prevention, which identifies individual risks, offers the potential for tailored interventions. While natural language processing (NLP) has shown promise in the early detection of mental health disorders, no review has examined its role in youth mental health detection. We hypothesize that NLP can improve early detection and personalized care in mental healthcare among youth.

METHODOLOGY

After screening 1197 articles from 5 databases, 12 papers were included covering six categories: (1) mental health disorders, (2) data sources, (3) NLP objective for mental health detection, (4) annotation and validation techniques, (5) linguistic markers, and (6) performance and evaluation. Study quality was assessed using Hawker's checklist for disparate study designs.

RESULTS

Most studies focused on suicide risk (42 %), depression (25 %), and stress (17 %). Social media (42 %) and interviews (33 %) were the most common data sources, with linguistic inquiry and word count and support vector machines frequently used for analysis. While most studies were exploratory, one implemented a real-time tool for detecting mental health risks. Validation methods, including precision and recall metrics, showed strong predictive performance.

CONCLUSIONS

This review highlights the potential of NLP in youth mental health detection, addressing challenges such as bias, data quality, and ethical concerns. Future research should refine NLP models using diverse, multimodal datasets, addressing data imbalance, and improving real-time detection. Exploring transformer-based models and ensuring ethical, inclusive data handling will be key to advancing NLP-driven interventions.

Unraveling Online Mental Health Through the Lens of Early Maladaptive Schemas: AI-Enabled Content Analysis of Online Mental Health Communities

BACKGROUND

Early maladaptive schemas (EMSs) are pervasive, self-defeating patterns of thoughts and emotions underlying most mental health problems and are central in schema therapy. However, the characteristics of EMSs vary across demographics, and despite the growing use of online mental health communities (OMHCs), how EMSs manifest in these online support-seeking environments remains unclear. Understanding these characteristics could inform the design of more effective interventions powered by artificial intelligence to address online support seekers' unique therapeutic needs.

OBJECTIVE

We aimed to uncover associations between EMSs and mental health problems within OMHCs and examine features of EMSs as they are reflected in OMHCs.

METHODS

We curated a dataset of 29,329 posts from widely accessed OMHCs, labeling each with relevant schemas and mental health problems. To identify associations, we conducted chi-square tests of independence and calculated odds ratios (ORs) with the dataset. In addition, we developed a novel group-level case conceptualization technique, leveraging GPT-4 to extract features of EMSs from OMHC texts across key schema therapy dimensions, such as schema triggers and coping responses.

RESULTS

Several associations were identified between EMSs and mental health problems, reflecting how EMSs manifest in online support-seeking contexts. Anxiety-related problems typically highlighted vulnerability to harm or illness (OR 5.64, 95% CI 5.34-5.96; P<.001), while depression-related problems emphasized unmet interpersonal needs, such as social isolation (OR 3.18, 95% CI 3.02-3.34; P<.001). Conversely, problems with eating disorders mostly exemplified negative self-perception and emotional inhibition (OR 1.89, 95% CI 1.45-2.46; P<.001). Personality disorders reflected themes of subjugation (OR 2.51, 95% CI 1.86-3.39; P<.001), while posttraumatic stress disorder problems involved distressing experiences and mistrust (OR 5.04, 95% CI 4.49-5.66; P<.001). Substance use disorder problems reflected negative self-perception of failure to achieve (OR 1.83, 95% CI 1.35-2.49; P<.001). Depression, personality disorders, and posttraumatic stress disorder were also associated with 12, 9, and 7 EMSs, respectively, emphasizing their complexities and the need for more comprehensive interventions. In contrast, anxiety, eating disorder, and substance use disorder were related to only 2 to 3 EMSs, suggesting that these problems are better addressed through targeted interventions. In addition, the EMS features extracted from our dataset averaged 13.27 (SD 3.05) negative features per schema, with 2.65 (SD 1.07) features per dimension, as supported by existing literature.

CONCLUSIONS

We uncovered various associations between EMSs and mental health problems among online support seekers, highlighting the prominence of specific EMSs in each problem and the unique complexities of each problem in terms of EMSs. We also identified EMS features as expressed by support seekers in OMHCs, reinforcing the relevance of EMSs in these online support-seeking contexts. These insights are valuable for understanding how EMS are characterized in OMHCs and can inform the development of more effective artificial intelligence-powered tools to enhance support on these platforms.

Artificial intelligence in the detection and treatment of depressive disorders: a narrative review of literature

Modern psychiatry aims to adopt precision models and promote personalized treatment within mental health care. However, the complexity of factors underpinning mental disorders and the variety of expressions of clinical conditions make this task arduous for clinicians. Globally, major depression is a common mental disorder and encompasses a constellation of clinical manifestations and a variety of etiological factors. In this context, the use of Artificial Intelligence might help clinicians in the screening and diagnosis of depression on a wider scale and could also facilitate their task in predicting disease outcomes by considering complex interactions between prodromal and clinical symptoms, neuroimaging data, genetics, or biomarkers. In this narrative review, we report on the most significant evidence from current international literature regarding the use of Artificial Intelligence in the diagnosis and treatment of major depression, specifically focusing on the use of Natural Language Processing, Chatbots, Machine Learning, and Deep Learning.

Natural language processing to identify suicidal ideation and anhedonia in major depressive disorder

BACKGROUND

Anhedonia and suicidal ideation are symptoms of major depressive disorder (MDD) that are not regularly captured in structured scales but may be captured in unstructured clinical notes. Natural language processing (NLP) techniques may be used to extract longitudinal data on suicidal behaviors and anhedonia within unstructured clinical notes. This study assessed the accuracy of using NLP techniques on electronic health records (EHRs) to identify these symptoms among patients with MDD.

METHODS

EHR-derived, de-identified data were used from the NeuroBlu Database (version 23R1), a longitudinal behavioral health real-world database. Mental health clinicians annotated instances of anhedonia and suicidal symptoms in clinical notes creating a ground truth. Interrater reliability (IRR) was calculated using Krippendorff's alpha. A novel transformer architecture-based NLP model was trained on clinical notes to recognize linguistic patterns and contextual cues. Each sentence was categorized into one of four labels: (1) anhedonia; (2) suicidal ideation without intent or plan; (3) suicidal ideation with intent or plan; (4) absence of suicidal ideation or anhedonia. The model was assessed using positive predictive values (PPV), negative predictive values, sensitivity, specificity, F1-score, and AUROC.

RESULTS

The model was trained, tested, and validated on 2,198, 1,247, and 1,016 distinct clinical notes, respectively. IRR was 0.80. For anhedonia, suicidal ideation with intent or plan, and suicidal ideation without intent or plan the model achieved a PPV of 0.98, 0.93, and 0.87, an F1-score of 0.98, 0.91, and 0.89 during training and a PPV of 0.99, 0.95, and 0.87 and F1-score of 0.99, 0.95, and 0.89 during validation.

CONCLUSIONS

NLP techniques can leverage contextual information in EHRs to identify anhedonia and suicidal symptoms in patients with MDD. Integrating structured and unstructured data offers a comprehensive view of MDD's trajectory, helping healthcare providers deliver timely, effective interventions. Addressing current limitations will further enhance NLP models, enabling more accurate extraction of critical clinical features and supporting personalized, proactive mental health care.

Depression is Associated with Treatment Response Trajectories in Adults with Prolonged Grief Disorder: A Machine Learning Analysis

Although evidence-based treatments for Prolonged Grief Disorder (PGD) exist, pretreatment characteristics associated with differential improvement trajectories have not been identified. To identify clinical factors relevant to optimizing PGD treatment outcomes, we used unsupervised and supervised machine learning to study treatment effects from a double-blinded, placebo-controlled, randomized clinical trial. Participants were randomized into four treatment groups for 20 weeks: citalopram with grief-informed clinical management, citalopram with prolonged grief disorder therapy (PGDT), pill placebo with PGDT, or pill placebo with clinical management. The trial included 333 PGD patients aged 18-95 years (M age = 53.9; SD ± 14.4), predominantly female (77.4%) and white (84.4%). Symptom trajectories were assessed using latent growth mixture modeling based on Inventory for Complicated Grief scores collected at six time points every 4 weeks. The relationship between patient-level characteristics and assigned trajectories was examined using logistic regression with elastic net regularization based on the administration of citalopram, PGDT, and risk factors for developing PGD. Three distinct response trajectories were identified: lesser severity responders (60%, n = 200), greater severity responders (18.02%, n = 60), and non-responders (21.92%, n = 73). Differences between greater severity responders and non-responders emerged as statistically significant by Week 8. The elastic net model demonstrated acceptable discrimination between responders and non-responders (AUC = .702; accuracy = .684). Higher baseline depression severity, grief-related functional impairment, and absence of PGDT were associated with reduced treatment response likelihood. These findings underscore the importance of early identification of clinical factors to optimize individualized PGD treatment strategies.

Trial Registration

clinicaltrials.gov Identifier: NCT01179568.

Automatic screening for posttraumatic stress disorder in early adolescents following the Ya'an earthquake using text mining techniques

Background

Self-narratives about traumatic experiences and symptoms are informative for early identification of potential patients; however, their use in clinical screening is limited. This study aimed to develop an automated screening method that analyzes self-narratives of early adolescent earthquake survivors to screen for PTSD in a timely and effective manner.

Methods

An inquiry-based questionnaire consisting of a series of open-ended questions about trauma history and psychological symptoms, was designed to simulate the clinical structured interviews based on the DSM-5 diagnostic criteria, and was used to collect self-narratives from 430 survivors who experienced the Ya'an earthquake in Sichuan Province, China. Meanwhile, participants completed the PTSD Checklist for DSM-5 (PCL-5). Text classification models were constructed using three supervised learning algorithms (BERT, SVM, and KNN) to identify PTSD symptoms and their corresponding behavioral indicators in each sentence of the self-narratives.

Results

The prediction accuracy for symptom-level classification reached 73.2%, and 67.2% for behavioral indicator classification, with the BERT performing the best.

Conclusions

These findings demonstrate that self-narratives combined with text mining techniques provide a promising approach for automated, rapid, and accurate PTSD screening. Moreover, by conducting screenings in community and school settings, this approach equips clinicians and psychiatrists with evidence of PTSD symptoms and associated behavioral indicators, improving the effectiveness of early detection and treatment planning.

Moving Toward Meaningful Evaluations of Monitoring in e-Mental Health Based on the Case of a Web-Based Grief Service for Older Mourners: Mixed Methods Study

Background

Artificial intelligence (AI) tools hold much promise for mental health care by increasing the scalability and accessibility of care. However, current development and evaluation practices of AI tools limit their meaningfulness for health care contexts and therefore also the practical usefulness of such tools for professionals and clients alike.

Objective

The aim of this study is to demonstrate the evaluation of an AI monitoring tool that detects the need for more intensive care in a web-based grief intervention for older mourners who have lost their spouse, with the goal of moving toward meaningful evaluation of AI tools in e-mental health.

Methods

We leveraged the insights from three evaluation approaches: (1) the F1-score evaluated the tool's capacity to classify user monitoring parameters as either in need of more intensive support or recommendable to continue using the web-based grief intervention as is; (2) we used linear regression to assess the predictive value of users' monitoring parameters for clinical changes in grief, depression, and loneliness over the course of a 10-week intervention; and (3) we collected qualitative experience data from e-coaches (N=4) who incorporated the monitoring in their weekly email guidance during the 10-week intervention.

Results

Based on n=174 binary recommendation decisions, the F1-score of the monitoring tool was 0.91. Due to minimal change in depression and loneliness scores after the 10-week intervention, only 1 linear regression was conducted. The difference score in grief before and after the intervention was included as a dependent variable. Participants' (N=21) mean score on the self-report monitoring and the estimated slope of individually fitted growth curves and its standard error (ie, participants' response pattern to the monitoring questions) were used as predictors. Only the mean monitoring score exhibited predictive value for the observed change in grief (R2=1.19, SE 0.33; t16=3.58, P=.002). The e-coaches appreciated the monitoring tool as an opportunity to confirm their initial impression about intervention participants, personalize their email guidance, and detect when participants' mental health deteriorated during the intervention.

Conclusions

The monitoring tool evaluated in this paper identified a need for more intensive support reasonably well in a nonclinical sample of older mourners, had some predictive value for the change in grief symptoms during a 10-week intervention, and was appreciated as an additional source of mental health information by e-coaches who supported mourners during the intervention. Each evaluation approach in this paper came with its own set of limitations, including (1) skewed class distributions in prediction tasks based on real-life health data and (2) choosing meaningful statistical analyses based on clinical trial designs that are not targeted at evaluating AI tools. However, combining multiple evaluation methods facilitates drawing meaningful conclusions about the clinical value of AI monitoring tools for their intended mental health context.

Using hidden Markov modelling to reveal in-session stages in text-based counselling

Counselling sessions have multiple stages, each with its themes and objectives. This study aimed to apply Hidden Markov Models (HMMs) to analyse counselling sessions from Open Up, an online text-based counselling platform in Hong Kong. The focus was on inferring latent stages over word distributions and identifying distinctive patterns of progression in more versus less satisfying sessions. Transcripts from 2589 sessions were categorized into more satisfying sessions ( n = 1993 ) and less satisfying sessions ( n = 596 ) based on post-session surveys. A message-level HMM identified five distinct stages: Rapport-building, Problem-identification, Problem-exploration, Problem-solving, and Wrap-up. Compared with less satisfying sessions, more satisfying sessions saw significantly more efficient initial rapport building (7.5% of session duration), problem introduction (20.2%), problem exploration (28.5%), elaborated solution development (46.6%), and concise conclusion (8.2%). This study offers insights for improving the efficiency and satisfaction of text-based counselling services through efficient initial engagement, thorough issue exploration, and focused problem-solving.

Speech and language patterns in autism: Towards natural language processing as a research and clinical tool

Speech and language differences have long been described as important characteristics of autism spectrum disorder (ASD). Linguistic abnormalities range from prosodic differences in pitch, intensity, and rate of speech, to language idiosyncrasies and difficulties with pragmatics and reciprocal conversation. Heterogeneity of findings and a reliance on qualitative, subjective ratings, however, limit a full understanding of linguistic phenotypes in autism. This review summarizes evidence of both speech and language differences in ASD. We also describe recent advances in linguistic research, aided by automated methods and software like natural language processing (NLP) and speech analytic software. Such approaches allow for objective, quantitative measurement of speech and language patterns that may be more tractable and unbiased. Future research integrating both speech and language features and capturing "natural language" samples may yield a more comprehensive understanding of language differences in autism, offering potential implications for diagnosis, intervention, and research.

Language sentiment predicts changes in depressive symptoms

The prevalence of depression is a major societal health concern, and there is an ongoing need to develop tools that predict who will become depressed. Past research suggests that depression changes the language we use, but it is unclear whether language is predictive of worsening symptoms. Here, we test whether the sentiment of brief written linguistic responses predicts changes in depression. Across two studies (N = 467), participants provided responses to neutral open-ended questions, narrating aspects of their lives relevant to depression (e.g., mood, motivation, sleep). Participants also completed the Patient Health Questionnaire (PHQ-9) to assess depressive symptoms and a risky decision-making task with periodic measurements of momentary happiness to quantify mood dynamics. The sentiment of written responses was evaluated by human raters (N = 470), Large Language Models (LLMs; ChatGPT 3.5 and 4.0), and the Linguistic Inquiry and Word Count (LIWC) tool. We found that language sentiment evaluated by human raters and LLMs, but not LIWC, predicted changes in depressive symptoms at a three-week follow-up. Using computational modeling, we found that language sentiment was associated with current mood, but language sentiment predicted symptom changes even after controlling for current mood. In summary, we demonstrate a scalable tool that combines brief written responses with sentiment analysis by AI tools that matches human performance in the prediction of future psychiatric symptoms.

Machine learning and natural language processing to assess the emotional impact of influencers' mental health content on Instagram

Background

This study aims to examine, through artificial intelligence, specifically machine learning, the emotional impact generated by disclosures about mental health on social media. In contrast to previous research, which primarily focused on identifying psychopathologies, our study investigates the emotional response to mental health-related content on Instagram, particularly content created by influencers/celebrities. This platform, especially favored by the youth, is the stage where these influencers exert significant social impact, and where their analysis holds strong relevance. Analyzing mental health with machine learning techniques on Instagram is unprecedented, as all existing research has primarily focused on Twitter.

Methods

This research involves creating a new corpus labelled with responses to mental health posts made by influencers/celebrities on Instagram, categorized by emotions such as love/admiration, anger/contempt/mockery, gratitude, identification/empathy, and sadness. The study is complemented by modelling a set of machine learning algorithms to efficiently detect the emotions arising when faced with these mental health disclosures on Instagram, using the previous corpus.

Results

Results have shown that machine learning algorithms can effectively detect such emotional responses. Traditional techniques, such as Random Forest, showed decent performance with low computational loads (around 50%), while deep learning and Bidirectional Encoder Representation from Transformers (BERT) algorithms achieved very good results. In particular, the BERT models reached accuracy levels between 86-90%, and the deep learning model achieved 72% accuracy. These results are satisfactory, considering that predicting emotions, especially in social networks, is challenging due to factors such as the subjectivity of emotion interpretation, the variability of emotions between individuals, and the interpretation of emotions in different cultures and communities.

Discussion

This cross-cutting research between mental health and artificial intelligence allows us to understand the emotional impact generated by mental health content on social networks, especially content generated by influential celebrities among young people. The application of machine learning allows us to understand the emotional reactions of society to messages related to mental health, which is highly innovative and socially relevant given the importance of the phenomenon in societies. In fact, the proposed algorithms' high accuracy (86-90%) in social contexts like mental health, where detecting negative emotions is crucial, presents a promising research avenue. Achieving such levels of accuracy is highly valuable due to the significant implications of false positives or false negatives in this social context.

Revolutionizing Maternal Health: The Role of Artificial Intelligence in Enhancing Care and Accessibility

Maternal health remains a critical global health challenge, with disparities in access to care and quality of services contributing to high maternal mortality and morbidity rates. Artificial intelligence (AI) has emerged as a promising tool for addressing these challenges by enhancing diagnostic accuracy, improving patient monitoring, and expanding access to care. This review explores the transformative role of AI in maternal healthcare, focusing on its applications in the early detection of pregnancy complications, personalized care, and remote monitoring through AI-driven technologies. AI tools such as predictive analytics and machine learning can help identify at-risk pregnancies and guide timely interventions, reducing preventable maternal and neonatal complications. Additionally, AI-enabled telemedicine and virtual assistants are bridging healthcare gaps, particularly in underserved and rural areas, improving accessibility for women who might otherwise face barriers to quality maternal care. Despite the potential benefits, challenges such as data privacy, algorithmic bias, and the need for human oversight must be carefully addressed. The review also discusses future research directions, including expanding AI applications in maternal health globally and the need for ethical frameworks to guide its integration. AI holds the potential to revolutionize maternal healthcare by enhancing both care quality and accessibility, offering a pathway to safer, more equitable maternal outcomes.

Advancing Chinese biomedical text mining with community challenges

OBJECTIVE

This study aims to review the recent advances in community challenges for biomedical text mining in China.

METHODS

We collected information of evaluation tasks released in community challenges of biomedical text mining, including task description, dataset description, data source, task type and related links. A systematic summary and comparative analysis were conducted on various biomedical natural language processing tasks, such as named entity recognition, entity normalization, attribute extraction, relation extraction, event extraction, text classification, text similarity, knowledge graph construction, question answering, text generation, and large language model evaluation.

RESULTS

We identified 39 evaluation tasks from 6 community challenges that spanned from 2017 to 2023. Our analysis revealed the diverse range of evaluation task types and data sources in biomedical text mining. We explored the potential clinical applications of these community challenge tasks from a translational biomedical informatics perspective. We compared with their English counterparts, and discussed the contributions, limitations, lessons and guidelines of these community challenges, while highlighting future directions in the era of large language models.

CONCLUSION

Community challenge evaluation competitions have played a crucial role in promoting technology innovation and fostering interdisciplinary collaboration in the field of biomedical text mining. These challenges provide valuable platforms for researchers to develop state-of-the-art solutions.

Self-Administered Interventions Based on Natural Language Processing Models for Reducing Depressive and Anxiety Symptoms: Systematic Review and Meta-Analysis

BACKGROUND

The introduction of natural language processing (NLP) technologies has significantly enhanced the potential of self-administered interventions for treating anxiety and depression by improving human-computer interactions. Although these advances, particularly in complex models such as generative artificial intelligence (AI), are highly promising, robust evidence validating the effectiveness of the interventions remains sparse.

OBJECTIVE

The aim of this study was to determine whether self-administered interventions based on NLP models can reduce depressive and anxiety symptoms.

METHODS

We conducted a systematic review and meta-analysis. We searched Web of Science, Scopus, MEDLINE, PsycINFO, IEEE Xplore, Embase, and Cochrane Library from inception to November 3, 2023. We included studies with participants of any age diagnosed with depression or anxiety through professional consultation or validated psychometric instruments. Interventions had to be self-administered and based on NLP models, with passive or active comparators. Outcomes measured included depressive and anxiety symptom scores. We included randomized controlled trials and quasi-experimental studies but excluded narrative, systematic, and scoping reviews. Data extraction was performed independently by pairs of authors using a predefined form. Meta-analysis was conducted using standardized mean differences (SMDs) and random effects models to account for heterogeneity.

RESULTS

In all, 21 articles were selected for review, of which 76% (16/21) were included in the meta-analysis for each outcome. Most of the studies (16/21, 76%) were recent (2020-2023), with interventions being mostly AI-based NLP models (11/21, 52%); most (19/21, 90%) delivered some form of therapy (primarily cognitive behavioral therapy: 16/19, 84%). The overall meta-analysis showed that self-administered interventions based on NLP models were significantly more effective in reducing both depressive (SMD 0.819, 95% CI 0.389-1.250; P<.001) and anxiety (SMD 0.272, 95% CI 0.116-0.428; P=.001) symptoms compared to various control conditions. Subgroup analysis indicated that AI-based NLP models were effective in reducing depressive symptoms (SMD 0.821, 95% CI 0.207-1.436; P<.001) compared to pooled control conditions. Rule-based NLP models showed effectiveness in reducing both depressive (SMD 0.854, 95% CI 0.172-1.537; P=.01) and anxiety (SMD 0.347, 95% CI 0.116-0.578; P=.003) symptoms. The meta-regression showed no significant association between participants' mean age and treatment outcomes (all P>.05). Although the findings were positive, the overall certainty of evidence was very low, mainly due to a high risk of bias, heterogeneity, and potential publication bias.

CONCLUSIONS

Our findings support the effectiveness of self-administered NLP-based interventions in alleviating depressive and anxiety symptoms, highlighting their potential to increase accessibility to, and reduce costs in, mental health care. Although the results were encouraging, the certainty of evidence was low, underscoring the need for further high-quality randomized controlled trials and studies examining implementation and usability. These interventions could become valuable components of public health strategies to address mental health issues.

TRIAL REGISTRATION

PROSPERO International Prospective Register of Systematic Reviews CRD42023472120; https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42023472120.

Natural Language Processing and Schizophrenia: A Scoping Review of Uses and Challenges

(1) Background: Approximately 1% of the global population is affected by schizophrenia, a disorder marked by cognitive deficits, delusions, hallucinations, and language issues. It is associated with genetic, neurological, and environmental factors, and linked to dopaminergic hyperactivity and neurotransmitter imbalances. Recent research reveals that patients exhibit significant language impairments, such as reduced verbal output and fluency. Advances in machine learning and natural language processing show potential for early diagnosis and personalized treatments, but additional research is required for the practical application and interpretation of such technology. The objective of this study is to explore the applications of natural language processing in patients diagnosed with schizophrenia. (2) Methods: A scoping review was conducted across multiple electronic databases, including Medline, PubMed, Embase, and PsycInfo. The search strategy utilized a combination of text words and subject headings, focusing on schizophrenia and natural language processing. Systematically extracted information included authors, population, primary uses of the natural language processing algorithms, main outcomes, and limitations. The quality of the identified studies was assessed. (3) Results: A total of 516 eligible articles were identified, from which 478 studies were excluded based on the first analysis of titles and abstracts. Of the remaining 38 studies, 18 were selected as part of this scoping review. The following six main uses of natural language processing were identified: diagnostic and predictive modeling, followed by specific linguistic phenomena, speech and communication analysis, social media and online content analysis, clinical and cognitive assessment, and linguistic feature analysis. (4) Conclusions: This review highlights the main uses of natural language processing in the field of schizophrenia and the need for more studies to validate the effectiveness of natural language processing in diagnosing and treating schizophrenia.

Linguistic markers of anxiety and depression in Somatic Symptom and Related Disorders: Observational study of a digital intervention

BACKGROUND

Somatic Symptom and Related Disorders (SSRD), including chronic pain, result in frequent primary care visits, depression and anxiety symptoms, and diminished quality of life. Treatment access remains limited due to structural barriers and functional impairment. Digital delivery offers to improve access and enables transcript analysis via Natural Language Processing (NLP) to inform treatment. Therefore, we investigated asynchronous message-delivered SSRD treatment, and used NLP methods to identify symptom reduction markers from emotional valence.

METHODS

173 individuals diagnosed with SSRD received interventions from licensed therapists via messaging 5 days/week for 8 weeks. Depression and anxiety symptoms were measured with the PHQ-9 and GAD-7 from baseline every three weeks. Symptoms trajectories were identified using unsupervised random forest clustering. Emotional valence expressed and use of emotional words were extracted from patients' de-identified transcripts, respectively using VADER and NCR Lexicon. Valence differences were examined using logistic regression.

RESULTS

Two subpopulations were identified showing symptoms Improvement (n = 72; 41.62 %) and non-response (n = 101; 58.38 %). Improvement patients expressed more positive valence in the first week of treatment (OR = 1.84, CI: 1.12-3.02; p = .015) and were less likely to express negative valence by the end of treatment (OR = 0.05; CI: 0.30-0.83; p = .008). Non-response patients used more negative valence words, including pain.

LIMITATIONS

Findings were derived from observational data obtained during an ecological intervention, without the inclusion of a control group.

CONCLUSIONS

NLP identified linguistic markers distinguishing changes in anxiety and depression symptoms over treatment. Digital interventions offer new forms of delivery and provide the opportunity to automatically collect data for linguistic analysis.

Using Adaptive Bandit Experiments to Increase and Investigate Engagement in Mental Health

Digital mental health (DMH) interventions, such as text-message-based lessons and activities, offer immense potential for accessible mental health support. While these interventions can be effective, real-world experimental testing can further enhance their design and impact. Adaptive experimentation, utilizing algorithms like Thompson Sampling for (contextual) multi-armed bandit (MAB) problems, can lead to continuous improvement and personalization. However, it remains unclear when these algorithms can simultaneously increase user experience rewards and facilitate appropriate data collection for social-behavioral scientists to analyze with sufficient statistical confidence. Although a growing body of research addresses the practical and statistical aspects of MAB and other adaptive algorithms, further exploration is needed to assess their impact across diverse real-world contexts. This paper presents a software system developed over two years that allows text-messaging intervention components to be adapted using bandit and other algorithms while collecting data for side-by-side comparison with traditional uniform random non-adaptive experiments. We evaluate the system by deploying a text-message-based DMH intervention to 1100 users, recruited through a large mental health non-profit organization, and share the path forward for deploying this system at scale. This system not only enables applications in mental health but could also serve as a model testbed for adaptive experimentation algorithms in other domains.

Artificial intelligence in paediatric endocrinology: conflict or cooperation

Artificial intelligence (AI) in medicine is transforming healthcare by automating system tasks, assisting in diagnostics, predicting patient outcomes and personalising patient care, founded on the ability to analyse vast datasets. In paediatric endocrinology, AI has been developed for diabetes, for insulin dose adjustment, detection of hypoglycaemia and retinopathy screening; bone age assessment and thyroid nodule screening; the identification of growth disorders; the diagnosis of precocious puberty; and the use of facial recognition algorithms in conditions such as Cushing syndrome, acromegaly, congenital adrenal hyperplasia and Turner syndrome. AI can also predict those most at risk from childhood obesity by stratifying future interventions to modify lifestyle. AI will facilitate personalised healthcare by integrating data from 'omics' analysis, lifestyle tracking, medical history, laboratory and imaging, therapy response and treatment adherence from multiple sources. As data acquisition and processing becomes fundamental, data privacy and protecting children's health data is crucial. Minimising algorithmic bias generated by AI analysis for rare conditions seen in paediatric endocrinology is an important determinant of AI validity in clinical practice. AI cannot create the patient-doctor relationship or assess the wider holistic determinants of care. Children have individual needs and vulnerabilities and are considered in the context of family relationships and dynamics. Importantly, whilst AI provides value through augmenting efficiency and accuracy, it must not be used to replace clinical skills.

The Role of Artificial Intelligence in Identifying Depression and Anxiety: A Comprehensive Literature Review

This narrative literature review undertakes a comprehensive examination of the burgeoning field, tracing the development of artificial intelligence (AI)-powered tools for depression and anxiety detection from the level of intricate algorithms to practical applications. Delivering essential mental health care services is now a significant public health priority. In recent years, AI has become a game-changer in the early identification and intervention of these pervasive mental health disorders. AI tools can potentially empower behavioral healthcare services by helping psychiatrists collect objective data on patients' progress and tasks. This study emphasizes the current understanding of AI, the different types of AI, its current use in multiple mental health disorders, advantages, disadvantages, and future potentials. As technology develops and the digitalization of the modern era increases, there will be a rise in the application of artificial intelligence in psychiatry; therefore, a comprehensive understanding will be needed. We searched PubMed, Google Scholar, and Science Direct using keywords for this. In a recent review of studies using electronic health records (EHR) with AI and machine learning techniques for diagnosing all clinical conditions, roughly 99 publications have been found. Out of these, 35 studies were identified for mental health disorders in all age groups, and among them, six studies utilized EHR data sources. By critically analyzing prominent scholarly works, we aim to illuminate the current state of this technology, exploring its successes, limitations, and future directions. In doing so, we hope to contribute to a nuanced understanding of AI's potential to revolutionize mental health diagnostics and pave the way for further research and development in this critically important domain.

Using machine learning to assist decision making in the assessment of mental health patients presenting to emergency departments

Objective

The objective of this study was to assess the predictability of admissions to a MH inpatient ward using ML models, based on routine data collected during triage in EDs. This research sought to identify the most effective ML model for this purpose while considering the practical implications of model interpretability for clinical use.

Methods

The study utilised existing data from January 2016 to December 2021. After data pre-processing, an exploratory analysis revealed the non-linear nature of the dataset. Six different ML models were tested: Random Forest, XGBoost, CatBoost, k-Nearest Neighbours (kNN), Explainable Boosting Machine (EBM) using InterpretML, and Support Vector Machine using Support Vector Classification (SVC). The performance of these models was evaluated using various metrics including the Matthews Correlation Coefficient (MCC).

Results

Among the models evaluated, the CatBoost model achieved the highest MCC score of 0.1952, demonstrating superior balanced accuracy and predictive power, particularly in correctly identifying positive cases. The InterpretML model also performed well, with an MCC score of 0.1914. While CatBoost showed strong predictive capabilities, its complexity poses challenges for clinical interpretation. Conversely, the InterpretML model, though slightly less powerful, offers better transparency and is more practical for clinical use.

Conclusion

The findings suggest that the CatBoost model is a compelling choice for scenarios prioritising the detection of positive cases. However, the InterpretML model's ease of interpretation makes it more suitable for clinical application. Integrating explanation methods like SHAP with non-linear models could enhance model transparency and foster clinician trust. Further research is recommended to refine non-linear models within decision support systems, explore multi-source data integration, understand clinician attitudes towards ML, and develop real-time data collection systems. This study highlights the potential of ML in predicting MH admissions from ED data while stressing the importance of interpretability, ethical considerations, and ongoing validation for successful clinical implementation.

Association of Health Care Work With Anxiety and Depression During the COVID-19 Pandemic: Structural Topic Modeling Study

BACKGROUND

Stressors for health care workers (HCWs) during the COVID-19 pandemic have been manifold, with high levels of depression and anxiety alongside gaps in care. Identifying the factors most tied to HCWs' psychological challenges is crucial to addressing HCWs' mental health needs effectively, now and for future large-scale events.

OBJECTIVE

In this study, we used natural language processing methods to examine deidentified psychotherapy transcripts from telemedicine treatment during the initial wave of COVID-19 in the United States. Psychotherapy was delivered by licensed therapists while HCWs were managing increased clinical demands and elevated hospitalization rates, in addition to population-level social distancing measures and infection risks. Our goal was to identify specific concerns emerging in treatment for HCWs and to compare differences with matched non-HCW patients from the general population.

METHODS

We conducted a case-control study with a sample of 820 HCWs and 820 non-HCW matched controls who received digitally delivered psychotherapy in 49 US states in the spring of 2020 during the first US wave of the COVID-19 pandemic. Depression was measured during the initial assessment using the Patient Health Questionnaire-9, and anxiety was measured using the General Anxiety Disorder-7 questionnaire. Structural topic models (STMs) were used to determine treatment topics from deidentified transcripts from the first 3 weeks of treatment. STM effect estimators were also used to examine topic prevalence in patients with moderate to severe anxiety and depression.

RESULTS

The median treatment enrollment date was April 15, 2020 (IQR March 31 to April 27, 2020) for HCWs and April 19, 2020 (IQR April 5 to April 27, 2020) for matched controls. STM analysis of deidentified transcripts identified 4 treatment topics centered on health care and 5 on mental health for HCWs. For controls, 3 STM topics on pandemic-related disruptions and 5 on mental health were identified. Several STM treatment topics were significantly associated with moderate to severe anxiety and depression, including working on the hospital unit (topic prevalence 0.035, 95% CI 0.022-0.048; P<.001), mood disturbances (prevalence 0.014, 95% CI 0.002-0.026; P=.03), and sleep disturbances (prevalence 0.016, 95% CI 0.002-0.030; P=.02). No significant associations emerged between pandemic-related topics and moderate to severe anxiety and depression for non-HCW controls.

CONCLUSIONS

The study provides large-scale quantitative evidence that during the initial wave of the COVID-19 pandemic, HCWs faced unique work-related challenges and stressors associated with anxiety and depression, which required dedicated treatment efforts. The study further demonstrates how natural language processing methods have the potential to surface clinically relevant markers of distress while preserving patient privacy.