Suicide remains a pressing global health crisis, with over 720,000 deaths annually and millions more affected by suicide ideation (SI) and suicide attempts (SA). Early identification of suicidality-related factors (SrFs), including SI, SA, exposure to suicide (ES), and non-suicidal self-injury (NSSI), is critical for timely intervention. While prior studies have applied AI to detect SrFs in clinical notes, most treat suicidality as a binary classification task, overlooking the complexity of cooccurring risk factors. This study explores the use of generative large language models (LLMs), specifically GPT-3.5 and GPT-4.5, for multi-label classification (MLC) of SrFs from psychiatric electronic health records (EHRs). We present a novel end to end generative MLC pipeline and introduce advanced evaluation methods, including label set level metrics and a multilabel confusion matrix for error analysis. Finetuned GPT-3.5 achieved top performance with 0.94 partial match accuracy and 0.91 F1 score, while GPT-4.5 with guided prompting showed superior performance across label sets, including rare or minority label sets, indicating a more balanced and robust performance. Our findings reveal systematic error patterns, such as the conflation of SI and SA, and highlight the models tendency toward cautious over labeling. This work not only demonstrates the feasibility of using generative AI for complex clinical classification tasks but also provides a blueprint for structuring unstructured EHR data to support large scale clinical research and evidence based medicine.

Identifying physiological and behavioral markers for mental health conditions is a longstanding challenge in psychiatry. Depression and suicidal ideation, in particular, lack objective biomarkers, with screening and diagnosis primarily relying on self-reports and clinical interviews. Here, we investigate eye tracking as a potential marker modality for screening purposes. Eye movements are directly modulated by neuronal networks and have been associated with attentional and mood-related patterns; however, their predictive value for depression and suicidality remains unclear. We recorded eye-tracking sequences from 126 young adults as they read and responded to affective sentences, and subsequently developed a deep learning framework to predict their clinical status. The proposed model included separate branches for trials of positive and negative sentiment, and used 2D time-series representations to account for both intra-trial and inter-trial variations. We were able to identify depression and suicidal ideation with an area under the receiver operating curve (AUC) of 0.793 (95% CI: 0.765-0.819) against healthy controls, and suicidality specifically with 0.826 AUC (95% CI: 0.797-0.852). The model also exhibited moderate, yet significant, accuracy in differentiating depressed from suicidal participants, with 0.609 AUC (95% CI 0.571-0.646). Discriminative patterns emerge more strongly when assessing the data relative to response generation than relative to the onset time of the final word of the sentences. The most pronounced effects were observed for negative-sentiment sentences, that are congruent to depressed and suicidal participants. Our findings highlight eye tracking as an objective tool for mental health assessment and underscore the modulatory impact of emotional stimuli on cognitive processes affecting oculomotor control.

Accurate identification and categorization of suicidal events can yield better suicide precautions, reducing operational burden, and improving care quality in high-acuity psychiatric settings. Pre-trained language models offer promise for identifying suicidality from unstructured clinical narratives. We evaluated the performance of four BERT-based models using two fine-tuning strategies (multiple single-label and single multi-label) for detecting coexisting suicidal events from 500 annotated psychiatric evaluation notes. The notes were labeled for suicidal ideation (SI), suicide attempts (SA), exposure to suicide (ES), and non-suicidal self-injury (NSSI). RoBERTa outperformed other models using multiple single-label classification strategy (acc=0.86, F1=0.78). MentalBERT (acc=0.83, F1=0.74) also exceeded BioClinicalBERT (acc=0.82, F1=0.72) which outperformed BERT (acc=0.80, F1=0.70). RoBERTa fine-tuned with single multi-label classification further improved the model performance (acc=0.88, F1=0.81). The findings highlight that the model optimization, pretraining with domain-relevant data, and the single multi-label classification strategy enhance the model performance of suicide phenotyping. Keywords: EHR-based Phenotyping; Natural Language Processing; Secondary Use of EHR Data; Suicide Classification; BERT-based Model; Psychiatry; Mental Health

In emergency medicine, timely intervention for patients at risk of suicide is often hindered by delayed access to specialised psychiatric care. To bridge this gap, we introduce a speech-based approach for automatic suicide risk assessment. Our study involves a novel dataset comprising speech recordings of 20 patients who read neutral texts. We extract four speech representations encompassing interpretable and deep features. Further, we explore the impact of gender-based modelling and phrase-level normalisation. By applying gender-exclusive modelling, features extracted from an emotion fine-tuned wav2vec2.0 model can be utilised to discriminate high- from low- suicide risk with a balanced accuracy of 81%. Finally, our analysis reveals a discrepancy in the relationship of speech characteristics and suicide risk between female and male subjects. For men in our dataset, suicide risk increases together with agitation while voice characteristics of female subjects point the other way.

The delayed access to specialized psychiatric assessments and care for patients at risk of suicidal tendencies in emergency departments creates a notable gap in timely intervention, hindering the provision of adequate mental health support during critical situations. To address this, we present a non-invasive, speech-based approach for automatic suicide risk assessment. For our study, we have collected a novel dataset of speech recordings from $20$ patients from which we extract three sets of features, including wav2vec, interpretable speech and acoustic features, and deep learning-based spectral representations. We proceed by conducting a binary classification to assess suicide risk in a leave-one-subject-out fashion. Our most effective speech model achieves a balanced accuracy of $66.2\,\%$. Moreover, we show that integrating our speech model with a series of patients' metadata, such as the history of suicide attempts or access to firearms, improves the overall result. The metadata integration yields a balanced accuracy of $94.4\,\%$, marking an absolute improvement of $28.2\,\%$, demonstrating the efficacy of our proposed approaches for automatic suicide risk assessment in emergency medicine.

Bipolar disorder (BD) is closely associated with an increased risk of suicide. However, while the prior work has revealed valuable insight into understanding the behavior of BD patients on social media, little attention has been paid to developing a model that can predict the future suicidality of a BD patient. Therefore, this study proposes a multi-task learning model for predicting the future suicidality of BD patients by jointly learning current symptoms. We build a novel BD dataset clinically validated by psychiatrists, including 14 years of posts on bipolar-related subreddits written by 818 BD patients, along with the annotations of future suicidality and BD symptoms. We also suggest a temporal symptom-aware attention mechanism to determine which symptoms are the most influential for predicting future suicidality over time through a sequence of BD posts. Our experiments demonstrate that the proposed model outperforms the state-of-the-art models in both BD symptom identification and future suicidality prediction tasks. In addition, the proposed temporal symptom-aware attention provides interpretable attention weights, helping clinicians to apprehend BD patients more comprehensively and to provide timely intervention by tracking mental state progression.

This paper presents a novel framework for quantitatively evaluating the interactive ChatGPT model in the context of suicidality assessment from social media posts, utilizing the University of Maryland Reddit suicidality dataset. We conduct a technical evaluation of ChatGPT's performance on this task using Zero-Shot and Few-Shot experiments and compare its results with those of two fine-tuned transformer-based models. Additionally, we investigate the impact of different temperature parameters on ChatGPT's response generation and discuss the optimal temperature based on the inconclusiveness rate of ChatGPT. Our results indicate that while ChatGPT attains considerable accuracy in this task, transformer-based models fine-tuned on human-annotated datasets exhibit superior performance. Moreover, our analysis sheds light on how adjusting the ChatGPT's hyperparameters can improve its ability to assist mental health professionals in this critical task.

Large generative AI models (GMs) like GPT and DALL-E are trained to generate content for general, wide-ranging purposes. GM content filters are generalized to filter out content which has a risk of harm in many cases, e.g., hate speech. However, prohibited content is not always harmful -- there are instances where generating prohibited content can be beneficial. So, when GMs filter out content, they preclude beneficial use cases along with harmful ones. Which use cases are precluded reflects the values embedded in GM content filtering. Recent work on red teaming proposes methods to bypass GM content filters to generate harmful content. We coin the term green teaming to describe methods of bypassing GM content filters to design for beneficial use cases. We showcase green teaming by: 1) Using ChatGPT as a virtual patient to simulate a person experiencing suicidal ideation, for suicide support training; 2) Using Codex to intentionally generate buggy solutions to train students on debugging; and 3) Examining an Instagram page using Midjourney to generate images of anti-LGBTQ+ politicians in drag. Finally, we discuss how our use cases demonstrate green teaming as both a practical design method and a mode of critique, which problematizes and subverts current understandings of harms and values in generative AI.

Abstract: dentifying suicidality including suicidal ideation, attempts, and risk factors in electronic health record data in clinical notes is difficult. A major difficulty is the lack of training samples given the small number of true positive instances among the increasingly large number of patients being screened. This paper describes a novel methodology that identifies suicidality in clinical notes by addressing this data sparsity issue through zero-shot learning. U.S. Veterans Affairs clinical notes served as data. The training dataset label was determined using diagnostic codes of suicide attempt and self-harm.

Identifying suicidality including suicidal ideation, attempts, and risk factors in electronic health record data in clinical notes is difficult. A major difficulty is the lack of training samples given the small number of true positive instances among the increasingly large number of patients being screened. This paper describes a novel methodology that identifies suicidality in clinical notes by addressing this data sparsity issue through zero-shot learning. U.S. Veterans Affairs clinical notes served as data. The training dataset label was determined using diagnostic codes of suicide attempt and self-harm. A base string associated with the target label of suicidality was used to provide auxiliary information by narrowing the positive training cases to those containing the base string. A deep neural network was trained by mapping the training documents contents to a semantic space. For comparison, we trained another deep neural network using the identical training dataset labels and bag-of-words features. The zero shot learning model outperformed the baseline model in terms of AUC, sensitivity, specificity, and positive predictive value at multiple probability thresholds. In applying a 0.90 probability threshold, the methodology identified notes not associated with a relevant ICD 10 CM code that documented suicidality, with 94 percent accuracy. This new method can effectively identify suicidality without requiring manual annotation.