Congning Ni

Weixin Liu, Congning Ni, Shelagh A. Mulvaney et al.

Large language models (LLMs) are increasingly used in the mental health domain, yet it remains unclear how well they capture related biomedical knowledge and how reliably they apply it to clinically salient structured judgments. Here, we present a knowledge-graph (KG)-grounded benchmark for assessing LLMs on mental-health entity recognition, relation judgment, and two-hop reasoning. The benchmark is derived from PrimeKG and comprises nine task families with KG-supported answers and controlled negative options. Experiments across 15 closed- and open-source LLMs reveal a persistent recognition-to-judgment gap: leading models achieve near-ceiling performance on entity typing and on the small relation-typing subset, yet they still struggle with relation prediction and two-hop reasoning. Additionally, short KG-derived snippets benefit some models but degrade performance for others. Moreover, output-format reliability can substantially influence measured performance under constrained multiple-choice settings, highlighting the critical role of response validity in benchmark-based evaluation. MHGraphBench should therefore be interpreted as evaluating agreement with a curated mental-health slice of PrimeKG under a constrained multiple-choice interface, rather than as a direct assessment of real-world clinical safety.

Weixin Liu, Bowen Qu, Juming Xiong et al.

Large language model (LLM) summarization systems may pass compact vector representations of private inputs to downstream retrieval, monitoring, audit, or analytic workflows. Even when source documents remain access-restricted, derived vectors may be handled under different access controls and still support sensitive-information inference, creating a residual information-disclosure risk. We study this issue in clinical discharge-summary generation as a high-stakes case study, using electronic health record (EHR)-recorded race as a controlled sensitive-label audit. We audit two artifacts that a system might retain or expose to downstream components: the final prompt-token hidden state and the mean-pooled prompt representation. Our results show that reducing recoverability of the case-study sensitive label from one exported artifact does not necessarily reduce recoverability from another. As a mitigation case study, we introduce SurfaceLoRA, an exported-vector-targeted parameter-efficient fine-tuning method that uses a gradient-reversal discriminator attached to a designated exported vector. Under a balanced five-way probing protocol, SurfaceLoRA reduces EHR-recorded race recoverability from the targeted final-token artifact toward chance while preserving summarization utility, yet recoverability remains substantially higher from untargeted pooled artifacts. These findings show that privacy auditing and mitigation should be performed on the exact vector artifact retained or exposed to downstream components.

Juming Xiong, Kevin Guo, Congning Ni et al.

Large language models (LLMs) achieve strong reasoning performance through chain-of-thought (CoT) reasoning, yet often generate unnecessarily long reasoning paths that incur high inference cost. Recent self-consistency-based approaches further improve accuracy but require sampling and aggregating multiple reasoning trajectories, leading to substantial additional computational overhead. This paper introduces a confidence-aware decision framework that analyzes a single completed reasoning trajectory to adaptively select between single-path and multi-path reasoning. The framework is trained using sentence-level numeric and linguistic features extracted from intermediate reasoning states in the MedQA dataset and generalizes effectively to MathQA, MedMCQA, and MMLU without additional fine-tuning. Experimental results show that the proposed method maintains accuracy comparable to multi-path baselines while using up to 80\% fewer tokens. These findings demonstrate that reasoning trajectories contain rich signals for uncertainty estimation, enabling a simple, transferable mechanism to balance accuracy and efficiency in LLM reasoning.

Weixin Liu, Congning Ni, Qingyuan Song et al.

Brief Hospital Course (BHC) narratives must be clinically useful yet faithful to fragmented EHR evidence. LLM-based clinical summarizers still introduce unsupported statements, and alignment can encourage omissions ("say-less" degeneration). We introduce VERI-DPO, which uses claim verification to mine preferences and distill them into the summarizer with Direct Preference Optimization (DPO). On MIMIC-III-Ext-VeriFact-BHC (100 ICU patients; patient-level splits), we train a retrieval-augmented verifier to label claim-evidence pairs as Supported, Not Supported, or Not Addressed via a single-token format. The verifier scores sentence-level claims from sampled BHC candidates and aggregates margins into a coverage-aware utility to mine length-controlled, contradiction-anchored preference pairs. On held-out patients, verifier-mined preferences separate candidates by contradiction density, and VERI-DPO reduces Not Supported claim rates from 10.7% to 1.9% (local verifier judge) and from 11.6% to 6.4% (GPT-4o judge), while improving validity from 76.7% to 82.5% and maintaining informative length.

Congning Ni, Sarvech Qadir, Bryan Steitz et al.

Mental health concerns are often expressed outside clinical settings, including in high-distress help seeking, where safety-critical guidance may be needed. Consumer health informatics systems increasingly incorporate large language models (LLMs) for mental health question answering, yet many evaluations underrepresent narrative, high-distress inquiries. We introduce UTCO (User, Topic, Context, Tone), a prompt construction framework that represents an inquiry as four controllable elements for systematic stress testing. Using 2,075 UTCO-generated prompts, we evaluated Llama 3.3 and annotated hallucinations (fabricated or incorrect clinical content) and omissions (missing clinically necessary or safety-critical guidance). Hallucinations occurred in 6.5% of responses and omissions in 13.2%, with omissions concentrated in crisis and suicidal ideation prompts. Across regression, element-specific matching, and similarity-matched comparisons, failures were most consistently associated with context and tone, while user-background indicators showed no systematic differences after balancing. These findings support evaluating omissions as a primary safety outcome and moving beyond static benchmark question sets.

Congning Ni, Qingxia Chen, Lijun Song et al.

Informal caregivers (e.g.,family members or friends) of people living with Alzheimers Disease and Related Dementias (ADRD) face substantial challenges and often seek informational or emotional support through online communities. Understanding the factors that drive engagement within these platforms is crucial, as it can enhance their long-term value for caregivers by ensuring that these communities effectively meet their needs. This study investigated the user interaction dynamics within two large, popular ADRD communities, TalkingPoint and ALZConnected, focusing on topic initiator engagement, initial post content, and the linguistic patterns of comments at the thread level. Using analytical methods such as propensity score matching, topic modeling, and predictive modeling, we found that active topic initiator engagement drives higher comment volumes, and reciprocal replies from topic initiators encourage further commentor engagement at the community level. Practical caregiving topics prompt more re-engagement of topic initiators, while emotional support topics attract more comments from other commentors. Additionally, the linguistic complexity and emotional tone of a comment influence its likelihood of receiving replies from topic initiators. These findings highlight the importance of fostering active and reciprocal engagement and providing effective strategies to enhance sustainability in ADRD caregiving and broader health-related online communities.