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Hauptverfasser: Ni, Congning, Qadir, Sarvech, Steitz, Bryan, Vaidya, Mihir Sachin, Song, Qingyuan, Xia, Lantian, Mulvaney, Shelagh, Liu, Siru, Ryu, Hyeyoung, Hecht, Leah, Bucher, Amy, Symons, Christopher, Novak, Laurie, Rose, Susannah L., Kantarcioglu, Murat, Malin, Bradley, Yin, Zhijun
Format: Preprint
Veröffentlicht: 2026
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Online-Zugang:https://arxiv.org/abs/2604.00014
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author Ni, Congning
Qadir, Sarvech
Steitz, Bryan
Vaidya, Mihir Sachin
Song, Qingyuan
Xia, Lantian
Mulvaney, Shelagh
Liu, Siru
Ryu, Hyeyoung
Hecht, Leah
Bucher, Amy
Symons, Christopher
Novak, Laurie
Rose, Susannah L.
Kantarcioglu, Murat
Malin, Bradley
Yin, Zhijun
author_facet Ni, Congning
Qadir, Sarvech
Steitz, Bryan
Vaidya, Mihir Sachin
Song, Qingyuan
Xia, Lantian
Mulvaney, Shelagh
Liu, Siru
Ryu, Hyeyoung
Hecht, Leah
Bucher, Amy
Symons, Christopher
Novak, Laurie
Rose, Susannah L.
Kantarcioglu, Murat
Malin, Bradley
Yin, Zhijun
contents 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.
format Preprint
id arxiv_https___arxiv_org_abs_2604_00014
institution arXiv
publishDate 2026
record_format arxiv
spellingShingle Disentangling Prompt Element Level Risk Factors for Hallucinations and Omissions in Mental Health LLM Responses
Ni, Congning
Qadir, Sarvech
Steitz, Bryan
Vaidya, Mihir Sachin
Song, Qingyuan
Xia, Lantian
Mulvaney, Shelagh
Liu, Siru
Ryu, Hyeyoung
Hecht, Leah
Bucher, Amy
Symons, Christopher
Novak, Laurie
Rose, Susannah L.
Kantarcioglu, Murat
Malin, Bradley
Yin, Zhijun
Computation and Language
Human-Computer Interaction
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.
title Disentangling Prompt Element Level Risk Factors for Hallucinations and Omissions in Mental Health LLM Responses
topic Computation and Language
Human-Computer Interaction
url https://arxiv.org/abs/2604.00014