Aligning Large Language Models for Enhancing Psychiatric Interviews Through Symptom Delineation and Summarization: Pilot Study

Abstract

Background: Advancements in large language models (LLMs) have opened new possibilities in psychiatric interviews, an underexplored area where LLMs could be valuable. This study focuses on enhancing psychiatric interviews by analyzing counseling data from North Korean defectors who have experienced trauma and mental health issues. Objective: The study investigates whether LLMs can (1) identify parts of conversations that suggest psychiatric symptoms and recognize those symptoms, and (2) summarize stressors and symptoms based on interview transcripts. Methods: LLMs are tasked with (1) extracting stressors from transcripts, (2) identifying symptoms and their corresponding sections, and (3) generating interview summaries using the extracted data. The transcripts were labeled by mental health experts for training and evaluation. Results: In the zero-shot inference setting using GPT-4 Turbo, 73 out of 102 segments demonstrated a recall mid-token distance d < 20 in identifying symptom-related sections. For recognizing specific symptoms, fine-tuning outperformed zero-shot inference, achieving an accuracy, precision, recall, and F1-score of 0.82. For the generative summarization task, LLMs using symptom and stressor information scored highly on G-Eval metrics: coherence (4.66), consistency (4.73), fluency (2.16), and relevance (4.67). Retrieval-augmented generation showed no notable performance improvement. Conclusions: LLMs, with fine-tuning or appropriate prompting, demonstrated strong accuracy (over 0.8) for symptom delineation and achieved high coherence (4.6+) in summarization. This study highlights their potential to assist mental health practitioners in analyzing psychiatric interviews.