arXiv subjects

Lili Chan

Publications and source records attributed to Lili Chan.

3 recordsLinked to original sources

arXiv2025

Bias Detection in Emergency Psychiatry: Linking Negative Language to Diagnostic Disparities

The emergency department (ED) is a high stress environment with increased risk of clinician bias exposure. In the United States, Black patients are more likely than other racial/ethnic groups to obtain their first schizophrenia (SCZ) diagnosis in the ED, a highly stigmatizing disorder. Therefore, understanding the link between clinician bias exposure and psychiatric outcomes is critical for promoting nondiscriminatory decision-making in the ED. This study examines the association between clinician bias exposure and psychiatric diagnosis using a sample of patients with anxiety, bipolar, depression, trauma, and SCZ diagnoses (N=29,005) from a diverse, large medical center. Clinician bias exposure was quantified as the ratio of negative to total number of sentences in psychiatric notes, labeled using a large language model (Mistral). We utilized logistic regression to predict SCZ diagnosis when controlling for patient demographics, risk factors, and negative sentence ratio (NSR). A high NSR significantly increased one's odds of obtaining a SCZ diagnosis and attenuated the effects of patient race. Black male patients with high NSR had the highest odds of being diagnosed with SCZ. Our findings suggest sentiment-based metrics can operationalize clinician bias exposure with real world data and reveal disparities beyond race or ethnicity.

q-bio.OT↗

arXiv2024

The Point of View of a Sentiment: Towards Clinician Bias Detection in Psychiatric Notes

Negative patient descriptions and stigmatizing language can contribute to generating healthcare disparities in two ways: (1) read by patients, they can harm their trust and engagement with the medical center; (2) read by physicians, they may negatively influence their perspective of a future patient. In psychiatry, the patient-clinician therapeutic alliance is a major determinant of clinical outcomes. Therefore, language usage in psychiatric clinical notes may not only create healthcare disparities, but also perpetuate them. Recent advances in NLP systems have facilitated the efforts to detect discriminatory language in healthcare. However, such attempts have only focused on the perspectives of the medical center and its physicians. Considering both physicians and non-physicians' point of view is a more translatable approach to identifying potentially harmful language in clinical notes. By leveraging pre-trained and large language models (PLMs and LLMs), this work aims to characterize potentially harmful language usage in psychiatric notes by identifying the sentiment expressed in sentences describing patients based on the reader's point of view. Extracting 39 sentences from the Mount Sinai Health System containing psychiatric lexicon, we fine-tuned three PLMs (RoBERTa, GatorTron, and GatorTron + Task Adaptation) and implemented zero-shot and few-shot ICL approaches for three LLMs (GPT-3.5, Llama-3.1, and Mistral) to classify the sentiment of the sentences according to the physician or non-physician point of view. Results showed that GPT-3.5 aligned best to physician point of view and Mistral aligned best to non-physician point of view. These results underline the importance of recognizing the reader's point of view, not only for improving the note writing process, but also for the quantification, identification, and reduction of bias in computational systems for downstream analyses.

cs.CL↗

arXiv2023

An AI-Guided Data Centric Strategy to Detect and Mitigate Biases in Healthcare Datasets

The adoption of diagnosis and prognostic algorithms in healthcare has led to concerns about the perpetuation of bias against disadvantaged groups of individuals. Deep learning methods to detect and mitigate bias have revolved around modifying models, optimization strategies, and threshold calibration with varying levels of success. Here, we generate a data-centric, model-agnostic, task-agnostic approach to evaluate dataset bias by investigating the relationship between how easily different groups are learned at small sample sizes (AEquity). We then apply a systematic analysis of AEq values across subpopulations to identify and mitigate manifestations of racial bias in two known cases in healthcare - Chest X-rays diagnosis with deep convolutional neural networks and healthcare utilization prediction with multivariate logistic regression. AEq is a novel and broadly applicable metric that can be applied to advance equity by diagnosing and remediating bias in healthcare datasets.

cs.LG↗