A review of the explainability and safety of conversational agents for mental health to identify avenues for improvement.

Virtual Mental Health Assistants (VMHAs) continuously evolve to support the overloaded global healthcare system, which receives approximately 60 million primary care visits and 6 million emergency room visits annually. These systems, developed by clinical psychologists, psychiatrists, and AI researchers, are designed to aid in Cognitive Behavioral Therapy (CBT). The main focus of VMHAs is to provide relevant information to mental health professionals (MHPs) and engage in meaningful conversations to support individuals with mental health conditions. However, certain gaps prevent VMHAs from fully delivering on their promise during active communications. One of the gaps is their inability to explain their decisions to patients and MHPs, making conversations less trustworthy. Additionally, VMHAs can be vulnerable in providing unsafe responses to patient queries, further undermining their reliability. In this review, we assess the current state of VMHAs on the grounds of user-level explainability and safety, a set of desired properties for the broader adoption of VMHAs. This includes the examination of ChatGPT, a conversation agent developed on AI-driven models: GPT3.5 and GPT-4, that has been proposed for use in providing mental health services. By harnessing the collaborative and impactful contributions of AI, natural language processing, and the mental health professionals (MHPs) community, the review identifies opportunities for technological progress in VMHAs to ensure their capabilities include explainable and safe behaviors. It also emphasizes the importance of measures to guarantee that these advancements align with the promise of fostering trustworthy conversations.

LoST: A Mental Health Dataset of Low Self-esteem in Reddit Posts.

Low self-esteem and interpersonal needs (i.e., thwarted belongingness (TB) and perceived burden-someness (PB)) have a major impact on depression and suicide attempts. Individuals seek social connectedness on social media to boost and alleviate their loneliness. Social media platforms allow people to express their thoughts, experiences, beliefs, and emotions. Prior studies on mental health from social media have focused on symptoms, causes, and disorders. Whereas an initial screening of social media content for interpersonal risk factors and low self-esteem may raise early alerts and assign therapists to at-risk users of mental disturbance. Standardized scales measure self-esteem and interpersonal needs from questions created using psychological theories. In the current research, we introduce a psychology-grounded and expertly annotated dataset, LoST: Low Self esTeem, to study and detect low self-esteem on Reddit. Through an annotation approach involving checks on coherence, correctness, consistency, and reliability, we ensure gold standard for supervised learning. We present results from different deep language models tested using two data augmentation techniques. Our findings suggest developing a class of language models that infuses psychological and clinical knowledge.

Drug Abuse Ontology to Harness Web-Based Data for Substance Use Epidemiology Research: Ontology Development Study.

BACKGROUND: Web-based resources and social media platforms play an increasingly important role in health-related knowledge and experience sharing. There is a growing interest in the use of these novel data sources for epidemiological surveillance of substance use behaviors and trends. OBJECTIVE: The key aims were to describe the development and application of the drug abuse ontology (DAO) as a framework for analyzing web-based and social media data to inform public health and substance use research in the following areas: determining user knowledge, attitudes, and behaviors related to nonmedical use of buprenorphine and illicitly manufactured opioids through the analysis of web forum data Prescription Drug Abuse Online Surveillance; analyzing patterns and trends of cannabis product use in the context of evolving cannabis legalization policies in the United States through analysis of Twitter and web forum data (eDrugTrends); assessing trends in the availability of novel synthetic opioids through the analysis of cryptomarket data (eDarkTrends); and analyzing COVID-19 pandemic trends in social media data related to 13 states in the United States as per Mental Health America reports. METHODS: The domain and scope of the DAO were defined using competency questions from popular ontology methodology (101 ontology development). The 101 method includes determining the domain and scope of ontology, reusing existing knowledge, enumerating important terms in ontology, defining the classes, their properties and creating instances of the classes. The quality of the ontology was evaluated using a set of tools and best practices recognized by the semantic web community and the artificial intelligence community that engage in natural language processing. RESULTS: The current version of the DAO comprises 315 classes, 31 relationships, and 814 instances among the classes. The ontology is flexible and can easily accommodate new concepts. The integration of the ontology with machine learning algorithms dramatically decreased the false alarm rate by adding external knowledge to the machine learning process. The ontology is recurrently updated to capture evolving concepts in different contexts and applied to analyze data related to social media and dark web marketplaces. CONCLUSIONS: The DAO provides a powerful framework and a useful resource that can be expanded and adapted to a wide range of substance use and mental health domains to help advance big data analytics of web-based data for substance use epidemiology research.

Exo-SIR: an epidemiological model to analyze the impact of exogenous spread of infection.

Epidemics like Covid-19 and Ebola have impacted people's lives significantly. The impact of mobility of people across the countries or states in the spread of epidemics has been significant. The spread of disease due to factors local to the population under consideration is termed the endogenous spread. The spread due to external factors like migration, mobility, etc., is called the exogenous spread. In this paper, we introduce the Exo-SIR model, an extension of the popular SIR model and a few variants of the model. The novelty in our model is that it captures both the exogenous and endogenous spread of the virus. First, we present an analytical study. Second, we simulate the Exo-SIR model with and without assuming contact network for the population. Third, we implement the Exo-SIR model on real datasets regarding Covid-19 and Ebola. We found that endogenous infection is influenced by exogenous infection. Furthermore, we found that the Exo-SIR model predicts the peak time better than the SIR model. Hence, the Exo-SIR model would be helpful for governments to plan policy interventions at the time of a pandemic.

Knowledge-Driven Drug-Use NamedEntity Recognition with Distant Supervision.

As Named Entity Recognition (NER) has been essential in identifying critical elements of unstructured content, generic NER tools remain limited in recognizing entities specific to a domain, such as drug use and public health. For such high-impact areas, accurately capturing relevant entities at a more granular level is critical, as this information influences real-world processes. On the other hand, training NER models for a specific domain without handcrafted features requires an extensive amount of labeled data, which is expensive in human effort and time. In this study, we employ distant supervision utilizing a domain-specific ontology to reduce the need for human labor and train models incorporating domain-specific (e.g., drug use) external knowledge to recognize domain specific entities. We capture entities related the drug use and their trends in government epidemiology reports, with an improvement of 8% in F1-score.

ProKnow: Process knowledge for safety constrained and explainable question generation for mental health diagnostic assistance.

Virtual Mental Health Assistants (VMHAs) are utilized in health care to provide patient services such as counseling and suggestive care. They are not used for patient diagnostic assistance because they cannot adhere to safety constraints and specialized clinical process knowledge (ProKnow) used to obtain clinical diagnoses. In this work, we define ProKnow as an ordered set of information that maps to evidence-based guidelines or categories of conceptual understanding to experts in a domain. We also introduce a new dataset of diagnostic conversations guided by safety constraints and ProKnow that healthcare professionals use (ProKnow-data). We develop a method for natural language question generation (NLG) that collects diagnostic information from the patient interactively (ProKnow-algo). We demonstrate the limitations of using state-of-the-art large-scale language models (LMs) on this dataset. ProKnow-algo incorporates the process knowledge through explicitly modeling safety, knowledge capture, and explainability. As computational metrics for evaluation do not directly translate to clinical settings, we involve expert clinicians in designing evaluation metrics that test four properties: safety, logical coherence, and knowledge capture for explainability while minimizing the standard cross entropy loss to preserve distribution semantics-based similarity to the ground truth. LMs with ProKnow-algo generated 89% safer questions in the depression and anxiety domain (tested property: safety). Further, without ProKnow-algo generations question did not adhere to clinical process knowledge in ProKnow-data (tested property: knowledge capture). In comparison, ProKnow-algo-based generations yield a 96% reduction in our metrics to measure knowledge capture. The explainability of the generated question is assessed by computing similarity with concepts in depression and anxiety knowledge bases. Overall, irrespective of the type of LMs, ProKnow-algo achieved an averaged 82% improvement over simple pre-trained LMs on safety, explainability, and process-guided question generation. For reproducibility, we will make ProKnow-data and the code repository of ProKnow-algo publicly available upon acceptance.

Comparing Suicide Risk Insights derived from Clinical and Social Media data.

Suicide is the 10th leading cause of death in the US and the 2nd leading cause of death among teenagers. Clinical and psychosocial factors contribute to suicide risk (SRFs), although documentation and self-expression of such factors in EHRs and social networks vary. This study investigates the degree of variance across EHRs and social networks. We performed subjective analysis of SRFs, such as self-harm, bullying, impulsivity, family violence/discord, using >13.8 Million clinical notes on 123,703 patients with mental health conditions. We clustered clinical notes using semantic embeddings under a set of SRFs. Likewise, we clustered 2180 suicidal users on r/SuicideWatch (~30,000 posts) and performed comparative analysis. Top-3 SRFs documented in EHRs were depressive feelings (24.3%), psychological disorders (21.1%), drug abuse (18.2%). In r/SuicideWatch, gun-ownership (17.3%), self-harm (14.6%), bullying (13.2%) were Top-3 SRFs. Mentions of Family violence, racial discrimination, and other important SRFs contributing to suicide risk were missing from both platforms.

Characterization of time-variant and time-invariant assessment of suicidality on Reddit using C-SSRS.

Suicide is the 10th leading cause of death in the U.S (1999-2019). However, predicting when someone will attempt suicide has been nearly impossible. In the modern world, many individuals suffering from mental illness seek emotional support and advice on well-known and easily-accessible social media platforms such as Reddit. While prior artificial intelligence research has demonstrated the ability to extract valuable information from social media on suicidal thoughts and behaviors, these efforts have not considered both severity and temporality of risk. The insights made possible by access to such data have enormous clinical potential-most dramatically envisioned as a trigger to employ timely and targeted interventions (i.e., voluntary and involuntary psychiatric hospitalization) to save lives. In this work, we address this knowledge gap by developing deep learning algorithms to assess suicide risk in terms of severity and temporality from Reddit data based on the Columbia Suicide Severity Rating Scale (C-SSRS). In particular, we employ two deep learning approaches: time-variant and time-invariant modeling, for user-level suicide risk assessment, and evaluate their performance against a clinician-adjudicated gold standard Reddit corpus annotated based on the C-SSRS. Our results suggest that the time-variant approach outperforms the time-invariant method in the assessment of suicide-related ideations and supportive behaviors (AUC:0.78), while the time-invariant model performed better in predicting suicide-related behaviors and suicide attempt (AUC:0.64). The proposed approach can be integrated with clinical diagnostic interviews for improving suicide risk assessments.

Impact of reproduction number on the multiwave spreading dynamics of COVID-19 with temporary immunity: A mathematical model.

OBJECTIVES: The recent discoveries of phylogenetically confirmed COVID-19 reinfection cases worldwide, together with studies suggesting that antibody titres decrease over time, raise the question of what course the epidemic trajectories may take if immunity were really to be temporary in a significant fraction of the population. The objective of this study is to obtain an answer for this important question. METHODS: We construct a ground-up delay differential equation model tailored to incorporate different types of immune response. We considered two immune responses: (a) short-lived immunity of all types, and (b) short-lived sterilizing immunity with durable severity-reducing immunity. RESULTS: Multiple wave solutions to the model are manifest for intermediate values of the reproduction number R; interestingly, for sufficiently low as well as sufficiently high R, we find conventional single-wave solutions despite temporary immunity. CONCLUSIONS: The versatility of our model, and its very modest demands on computational resources, ensure that a set of disease trajectories can be computed virtually on the same day that a new and relevant immune response study is released. Our work can also be used to analyse the disease dynamics after a vaccine is certified for use and information regarding its immune response becomes available.

Personalized Health Knowledge Graph.

Our current health applications do not adequately take into account contextual and personalized knowledge about patients. In order to design "Personalized Coach for Healthcare" applications to manage chronic diseases, there is a need to create a Personalized Healthcare Knowledge Graph (PHKG) that takes into consideration a patient's health condition (personalized knowledge) and enriches that with contextualized knowledge from environmental sensors and Web of Data (e.g., symptoms and treatments for diseases). To develop PHKG, aggregating knowledge from various heterogeneous sources such as the Internet of Things (IoT) devices, clinical notes, and Electronic Medical Records (EMRs) is necessary. In this paper, we explain the challenges of collecting, managing, analyzing, and integrating patients' health data from various sources in order to synthesize and deduce meaningful information embodying the vision of the Data, Information, Knowledge, and Wisdom (DIKW) pyramid. Furthermore, we sketch a solution that combines: 1) IoT data analytics, and 2) explicit knowledge and illustrate it using three chronic disease use cases - asthma, obesity, and Parkinson's.

Fish Ontology framework for taxonomy-based fish recognition.

Life science ontologies play an important role in Semantic Web. Given the diversity in fish species and the associated wealth of information, it is imperative to develop an ontology capable of linking and integrating this information in an automated fashion. As such, we introduce the Fish Ontology (FO), an automated classification architecture of existing fish taxa which provides taxonomic information on unknown fish based on metadata restrictions. It is designed to support knowledge discovery, provide semantic annotation of fish and fisheries resources, data integration, and information retrieval. Automated classification for unknown specimens is a unique feature that currently does not appear to exist in other known ontologies. Examples of automated classification for major groups of fish are demonstrated, showing the inferred information by introducing several restrictions at the species or specimen level. The current version of FO has 1,830 classes, includes widely used fisheries terminology, and models major aspects of fish taxonomy, grouping, and character. With more than 30,000 known fish species globally, the FO will be an indispensable tool for fish scientists and other interested users.