Scalable, context-sensitive psychiatric assessment with large language models and brief diaries
Abstract Background Accurate psychiatric assessment requires understanding a person’s unique experience within their psychosocial context. Clinical interviews have been the gold standard for assessment as the only methods capable of this complex task, but they are time and resource-intensive. Consequently, psychiatric assessment typically relies on patient report surveys that are decontextualized and narrow in scope. This comprehensiveness-scalability tradeoff is a major bottleneck in studying and treating psychopathology. We propose using large language models (LLMs) to score psychopathology from brief personal narratives as a low-burden, context-sensitive solution. Methods Participants (N = 108) completed brief (~1 minute), freeform audio diaries daily for 2 weeks. We used six LLMs to score wide-ranging psychopathology (Internalizing, Detachment, Disinhibition, Antagonism, Anankastia) from the diary transcripts. Leveraging an array of self-report and clinical interview measures, we tested the convergent, discriminant, concurrent, and clinical validity of LLM ratings for between-person differences and within-person fluctuations in psychopathology. Results Supporting convergent and discriminant validity, LLM ratings correlated most strongly with corresponding self-report domains at the between (average convergent r = .42) and within-person (r = .28) levels. LLM and self-report ratings had similar patterns of associations with external variables, except for Anankastia and Antagonism. Further, every LLM-rated domain related to psychopathology ascertained by clinical interview. Conclusions Across multiple forms of validity, we showed that LLMs can assess most major forms of psychopathology from mere minutes of audio. These results support scoring open-ended narratives with LLMs as a scalable, portable method to translate idiographic diagnostic data into standardized psychiatric assessments.