Yaling Shen

Yaling Shen, Stephanie Fong, Yiwen Jiang et al.

The increasing integration of large language models (LLMs) into mental health applications necessitates robust frameworks for evaluating professional safety alignment. Current evaluative approaches primarily rely on refusal-based safety signals, which offer limited insight into the nuanced behaviors required in clinical practice. In mental health, clinically inadequate refusals can be perceived as unempathetic and discourage help-seeking. To address this gap, we move beyond refusal-centric metrics and introduce \texttt{PsychEthicsBench}, the first principle-grounded benchmark based on Australian psychology and psychiatry guidelines, designed to evaluate LLMs' ethical knowledge and behavioral responses through multiple-choice and open-ended tasks with fine-grained ethicality annotations. Empirical results across 14 models reveal that refusal rates are poor indicators of ethical behavior, revealing a significant divergence between safety triggers and clinical appropriateness. Notably, we find that domain-specific fine-tuning can degrade ethical robustness, as several specialized models underperform their base backbones in ethical alignment. PsychEthicsBench provides a foundation for systematic, jurisdiction-aware evaluation of LLMs in mental health, encouraging more responsible development in this domain.

Qingyang Xu, Yaling Shen, Stephanie Fong et al.

The increasing use of large language models (LLMs) in mental healthcare raises safety concerns in high-stakes therapeutic interactions. A key challenge is distinguishing therapeutic empathy from maladaptive validation, where supportive responses may inadvertently reinforce harmful beliefs or behaviors in multi-turn conversations. This risk is largely overlooked by existing red-teaming frameworks, which focus mainly on generic harms or optimization-based attacks. To address this gap, we introduce Personality-based Client Simulation Attack (PCSA), the first red-teaming framework that simulates clients in psychological counseling through coherent, persona-driven client dialogues to expose vulnerabilities in psychological safety alignment. Experiments on seven general and mental health-specialized LLMs show that PCSA substantially outperforms four competitive baselines. Perplexity analysis and human inspection further indicate that PCSA generates more natural and realistic dialogues. Our results reveal that current LLMs remain vulnerable to domain-specific adversarial tactics, providing unauthorized medical advice, reinforcing delusions, and implicitly encouraging risky actions.

Ming Hu, Kun Yuan, Yaling Shen et al.

Surgical practice involves complex visual interpretation, procedural skills, and advanced medical knowledge, making surgical vision-language pretraining (VLP) particularly challenging due to this complexity and the limited availability of annotated data. To address the gap, we propose OphCLIP, a hierarchical retrieval-augmented vision-language pretraining framework specifically designed for ophthalmic surgical workflow understanding. OphCLIP leverages the OphVL dataset we constructed, a large-scale and comprehensive collection of over 375K hierarchically structured video-text pairs with tens of thousands of different combinations of attributes (surgeries, phases/operations/actions, instruments, medications, as well as more advanced aspects like the causes of eye diseases, surgical objectives, and postoperative recovery recommendations, etc). These hierarchical video-text correspondences enable OphCLIP to learn both fine-grained and long-term visual representations by aligning short video clips with detailed narrative descriptions and full videos with structured titles, capturing intricate surgical details and high-level procedural insights, respectively. Our OphCLIP also designs a retrieval-augmented pretraining framework to leverage the underexplored large-scale silent surgical procedure videos, automatically retrieving semantically relevant content to enhance the representation learning of narrative videos. Evaluation across 11 datasets for phase recognition and multi-instrument identification shows OphCLIP's robust generalization and superior performance.

Yaling Shen, Zhixiong Zhuang, Kun Yuan et al.

Medical multimodal large language models (MLLMs) are becoming an instrumental part of healthcare systems, assisting medical personnel with decision making and results analysis. Models for radiology report generation are able to interpret medical imagery, thus reducing the workload of radiologists. As medical data is scarce and protected by privacy regulations, medical MLLMs represent valuable intellectual property. However, these assets are potentially vulnerable to model stealing, where attackers aim to replicate their functionality via black-box access. So far, model stealing for the medical domain has focused on classification; however, existing attacks are not effective against MLLMs. In this paper, we introduce Adversarial Domain Alignment (ADA-STEAL), the first stealing attack against medical MLLMs. ADA-STEAL relies on natural images, which are public and widely available, as opposed to their medical counterparts. We show that data augmentation with adversarial noise is sufficient to overcome the data distribution gap between natural images and the domain-specific distribution of the victim MLLM. Experiments on the IU X-RAY and MIMIC-CXR radiology datasets demonstrate that Adversarial Domain Alignment enables attackers to steal the medical MLLM without any access to medical data.

Yiwen Jiang, Deval Mehta, Siyuan Yan et al.

Multimodal Large Language Models (MLLMs) have shown promise in visual-textual reasoning, with Multimodal Chain-of-Thought (MCoT) prompting significantly enhancing interpretability. However, existing MCoT methods rely on rationale-rich datasets and largely focus on inter-object reasoning, overlooking the intra-object understanding crucial for image classification. To address this gap, we propose WISE, a Weak-supervision-guided Step-by-step Explanation method that augments any image classification dataset with MCoTs by reformulating the concept-based representations from Concept Bottleneck Models (CBMs) into concise, interpretable reasoning chains under weak supervision. Experiments across ten datasets show that our generated MCoTs not only improve interpretability by 37% but also lead to gains in classification accuracy when used to fine-tune MLLMs. Our work bridges concept-based interpretability and generative MCoT reasoning, providing a generalizable framework for enhancing MLLMs in fine-grained visual understanding.

Xiangyu Zhao, Yaling Shen, Yiwen Jiang et al.

Depression is one of the most prevalent mental health disorders globally. In recent years, multi-modal data, such as speech, video, and transcripts, has been increasingly used to develop AI-assisted depression assessment systems. Large language models have further advanced this field due to their strong language understanding and generalization capabilities. However, conventional LLMs remain text-centric and cannot process the rich non-verbal cues found in audio and visual modalities, which are critical components in mental health evaluation. While multi-modal LLMs offer a promising direction, few are tailored for psychological applications. In this study, we propose a novel multi-modal LLM framework for depression detection. Our approach augments an audio language model with visual understanding and aligns audio-visual features at the timestamp level. This fine-grained alignment improves modeling of temporal dynamics across modalities while reducing the need for extensive training data and computational resources. Experiments on the DAIC-WoZ dataset demonstrate that our model outperforms both single-modality approaches and previous multi-modal methods. Moreover, the proposed framework can be extended to incorporate additional physiological signals, paving the way for broader clinical applications beyond mental health.

Jinpeng Hu, Jianling Li, Zhihong Chen et al.

Radiology reports play a critical role in communicating medical findings to physicians. In each report, the impression section summarizes essential radiology findings. In clinical practice, writing impression is highly demanded yet time-consuming and prone to errors for radiologists. Therefore, automatic impression generation has emerged as an attractive research direction to facilitate such clinical practice. Existing studies mainly focused on introducing salient word information to the general text summarization framework to guide the selection of the key content in radiology findings. However, for this task, a model needs not only capture the important words in findings but also accurately describe their relations so as to generate high-quality impressions. In this paper, we propose a novel method for automatic impression generation, where a word graph is constructed from the findings to record the critical words and their relations, then a Word Graph guided Summarization model (WGSum) is designed to generate impressions with the help of the word graph. Experimental results on two datasets, OpenI and MIMIC-CXR, confirm the validity and effectiveness of our proposed approach, where the state-of-the-art results are achieved on both datasets. Further experiments are also conducted to analyze the impact of different graph designs to the performance of our method.