A Taxonomy of Mental Health and Technology Needs for Alzheimer's and Dementia Caregivers

Family members caring for individuals with Alzheimer's disease and related dementias (AD/ADRD) provide the foundation of long-term care worldwide. In 2023, more than 11 million U.S. family and friends contributed 18 billion hours of unpaid care, often at the cost of their own physical and mental health. These informal caregivers -- also referred as the "invisible second patients" -- experience elevated rates of mental health problems. Yet research commonly reduces their complex psychosocial experiences to a single construct of caregiver burden, obscuring which specific needs are unmet or effectively supported. At the same time, digital and AI-enabled technologies are rapidly expanding, from smartphone apps and videoconferencing to sensor platforms and AI chatbots. However, the absence of shared frameworks across medicine, psychology, and technology research limits cumulative progress. This study introduces a Caregiver Mental Health and Technology Taxonomy that systematically links AD/ADRD caregiver needs with corresponding classes of technology-based interventions. Drawing from an interdisciplinary literature review and two qualitative studies with caregivers, the taxonomy identifies mismatches between caregiver priorities and existing technological support, highlights under-served domains such as relational strain and compassion fatigue, and proposes design directions for adaptive, responsive systems. The framework offers a shared vocabulary to guide clinicians, researchers, and technology designers in developing more person-centered and clinically grounded innovation in dementia care.

When AI Says "I have been in similar situations": Synthetic Lived Experience in Peer-Like Caregiver Support

Caregivers often turn to online communities for informational and emotional support. In these spaces, peer supporters frequently draw on personal narratives to respond to emotionally complex caregiving situations. As LLMs are increasingly designed as peer-like sources of support, they introduce a critical tension: AI can provide immediate, private, and nonjudgmental support, but it cannot authentically possess the lived experiences that make human peer support meaningful. Yet, when prompted to sound peer-like, LLMs may generate language that implies lived experience. This creates a synthetic lived experience paradox: the same experiential language that may make AI support feel warm, relatable, and peer-like can also falsely position the system as someone with lived experience. We examine this paradox in the context of family caregivers of people living with Alzheimer's Disease and Related Dementias (ADRD). Drawing on caregiver support exchanges from online communities and prompted peer-like responses from three LLMs -- LLaMA, GPT-4o-mini, and MedGemma -- we analyze how human peers use personal narratives and how AI incorporates similar narrative forms. Psycholinguistic analysis shows that peer responses used significantly more first-person and past-focused language than peer-like AI responses. Qualitatively, we identify seven types of personal narratives in human peer support and show that AI often captures their emotional work, but can fabricate experiential grounding. These findings reveal a narrative authenticity gap: peer-like AI can generate synthetic lived experience without the real experience that makes peer support meaningful. We argue that caregiver-support AI systems need mechanisms to distinguish supportive peer-like framing from fabricated lived experience, ensuring that models can offer warmth and validation without falsely positioning themselves as experiential peers.

TUX: Measuring Human--AI Tacit Understanding

As large language models (LLMs) increasingly act as collaborative partners, human--AI alignment is often evaluated through explicit task success, accuracy, or reward optimization. Yet many collaborative settings depend on tacit understanding: whether an agent can align with a human's evaluative stance or representational priors without clear objectives, communication, or feedback. To study this capacity, we develop a spectrum-placement task inspired by the social party game Wavelength, in which humans and agents independently place concepts along subjective spectra. We operationalize the Tacit Understanding Index (TUX) as a pairwise measure of similarity between human and agent judgments, and evaluate it with 241 human participants and 200 profile-conditioned LLM agents across four models. We find that nearest human--agent pairs in trait space achieve significantly higher TUX, suggesting that tacit alignment is structured by person-level characteristics rather than random similarity. Regression analyses show that TUX becomes more explainable as predictor sets become richer, with individual traits, decision-making styles, and confidence improving over aggregate trait-distance baselines. These findings suggest that tacit understanding between humans and LLMs is measurable, while revealing the limits of profile-based conditioning for capturing deeper representational alignment.

Toxic HallucinAItions: Perturbing Prompts and Tracing LLM Circuits

Large language models (LLMs) are increasingly deployed in conversational settings where user tone ranges from polite to adversarial or toxic, yet less is known about whether toxic language in otherwise semantically equivalent prompts can degrade factual reliability. We study how lexical and tone-based prompt perturbations affect the factual reliability of LLMs. Using controlled prompt variations across polite, random, and three toxicity levels, we evaluate five LLMs on ARC-Easy, GSM8K, and MMLU. We find that toxic lexical perturbations consistently reduce factual accuracy and increase uncertainty, while polite phrasing yields limited and inconsistent changes. To examine whether these answer inconsistencies correspond to internal changes, we conduct attribution-graph analyses of model activations and influences. We find that increasing toxicity selectively amplifies perturbation-sensitive variant nodes while relatively stable core reasoning nodes remain more invariant. These findings position prompt tone as a critical dimension of LLM reliability and provide behavioral and mechanistic evidence that surface-level lexical variation can alter factual outputs and internal computation.

Inform, Coach, Relate, Listen: Auditing LLM Caregiving Support Roles

Language models are increasingly being deployed for conversational support in informal caregiving contexts, where interactions often extend beyond information-seeking: caregivers seek emotional reassurance, guidance, and help, while navigating uncertain, relationally complex care decisions. Yet most safety evaluations assess model behavior under generic prompts, leaving a critical question unexamined: does a model's safety profile change with its support role? We study this by operationalizing four expert-reviewed support roles grounded in social support theory: Inform, Coach, Relate, and Listen, and comparing them against two baseline controls: a basic prompting condition and a retrieval-augmented generation (RAG) condition. We evaluate across three language models (GPT-4o-mini, Llama-3.1-8B-Instruct, and MedGemma-1.5-4b-it) on 5,000 real-world queries from online Alzheimer's Disease and Related Dementias (ADRD) communities. We find that the LLM's support role systematically shapes both the prevalence and composition of interactional risks. Furthermore, a human evaluation study reveals a perceived quality--safety tension: more directive, information-oriented roles are rated as more helpful and trustworthy despite exhibiting elevated interactional risk profiles. We release ~90,000 support role-conditioned model responses with risk annotations as an ecologically grounded resource for research on safer LLM-mediated conversational support.

LLUMI: Improving LLM Writing Assistance for Mental Health Support with Online Community Feedback

Large language models (LLMs) show promise in generating supportive responses for mental health queries, but improving their usefulness, empathy, and safety often requires substantial compute, expert input, and labeled data. At the same time, deploying proprietary, cloud-based models for mental health-related interactions raises important privacy and data-governance concerns, given the sensitivities. To address this challenge, we introduce LLUMI setup that can be hosted in-house within protected environments. LLUMI consists of two complementary components: a generation model (GM), which drafts supportive responses to mental health queries, and an improvement model (IM), which revises an initial human-crafted response. We leverage feedback signals from Reddit mental health communities, using community endorsement patterns such as upvotes and downvotes to construct chosen-rejected response pairs for Supervised Fine Tuning (SFT) and Direct Preference Optimization (DPO). We further align LLUMI using human evaluation across five dimensions: readability, empathy, connection, actionability, and safety. Our results show that, despite relying on smaller open-source models rather than proprietary cloud-based GPT models, LLUMI achieves comparable performance across linguistic analyses and human evaluations. These findings suggest that open-source models, when trained with community-derived preference signals, can support high-quality mental health support assistance while offering a more privacy-preserving alternative for sensitive support contexts.

AI Content Moderation in Therapy Conversations

Large language models (LLMs) are increasingly being used for emotional support. They are also being developed for formal therapy purposes. However, LLMs like ChaptGPT or Llama are often developed with content moderation guardrails that prevent them from discussing sensitive subjects with users for both liability and safety purposes, and this inability to broach these subjects may affect their capacity as therapists. In this study, we perform an algorithm audit on three state-of-the-art moderation systems (OpenAI's moderation endpoint, Meta's Llama Guard, and Google's Shield Gemma) to investigate the extent to which these systems flag the content of real-life therapy sessions as undesirable. Our results raise implications for the limitations that users and organizations may encounter when designing LLMs to play the part of a therapist.

Not My Truce: Personality Differences in AI-Mediated Workplace Negotiation

AI-driven conversational coaching is increasingly used to support workplace negotiation, yet prior work assumes uniform effectiveness across users. We challenge this assumption by examining how individual differences, particularly personality traits, moderate coaching outcomes. We conducted a between-subjects experiment (N=267) comparing theory-driven AI (Trucey), general-purpose AI (Control-AI), and a traditional negotiation handbook (Control-NoAI). Participants were clustered into three profiles -- resilient, overcontrolled, and undercontrolled -- based on the Big-Five personality traits and ARC typology. Resilient workers achieved broad psychological gains primarily from the handbook, overcontrolled workers showed outcome-specific improvements with theory-driven AI, and undercontrolled workers exhibited minimal effects despite engaging with the frameworks. These patterns suggest personality as a predictor of readiness beyond stage-based tailoring: vulnerable users benefit from targeted rather than comprehensive interventions. The study advances understanding of personality-determined intervention prerequisites and highlights design implications for adaptive AI coaching systems that align support intensity with individual readiness, rather than assuming universal effectiveness.

Sima AIunty: Caste Audit in LLM-Driven Matchmaking

Social and personal decisions in relational domains such as matchmaking are deeply entwined with cultural norms and historical hierarchies, and can potentially be shaped by algorithmic and AI-mediated assessments of compatibility, acceptance, and stability. In South Asian contexts, caste remains a central aspect of marital decision-making, yet little is known about how contemporary large language models (LLMs) reproduce or disrupt caste-based stratification in such settings. In this work, we conduct a controlled audit of caste bias in LLM-mediated matchmaking evaluations using real-world matrimonial profiles. We vary caste identity across Brahmin, Kshatriya, Vaishya, Shudra, and Dalit, and income across five buckets, and evaluate five LLM families (GPT, Gemini, Llama, Qwen, and BharatGPT). Models are prompted to assess profiles along dimensions of social acceptance, marital stability, and cultural compatibility. Our analysis reveals consistent hierarchical patterns across models: same-caste matches are rated most favorably, with average ratings up to 25% higher (on a 10-point scale) than inter-caste matches, which are further ordered according to traditional caste hierarchy. These findings highlight how existing caste hierarchies are reproduced in LLM decision-making and underscore the need for culturally grounded evaluation and intervention strategies in AI systems deployed in socially sensitive domains, where such systems risk reinforcing historical forms of exclusion.

AI Psychosis: Does Conversational AI Amplify Delusion-Related Language?

Conversational AI systems are increasingly used for personal reflection and emotional disclosure, raising concerns about their effects on vulnerable users. Recent anecdotal reports suggest that prolonged interactions with AI may reinforce delusional thinking -- a phenomenon sometimes described as AI Psychosis. However, empirical evidence on this phenomenon remains limited. In this work, we examine how delusion-related language evolves during multi-turn interactions with conversational AI. We construct simulated users (SimUsers) from Reddit users' longitudinal posting histories and generate extended conversations with three model families (GPT, LLaMA, and Qwen). We develop DelusionScore, a linguistic measure that quantifies the intensity of delusion-related language across conversational turns. We find that SimUsers derived from users with prior delusion-related discourse (Treatment) exhibit progressively increasing DelusionScore trajectories, whereas those derived from users without such discourse (Control) remain stable or decline. We further find that this amplification varies across themes, with reality skepticism and compulsive reasoning showing the strongest increases. Finally, conditioning AI responses on current DelusionScore substantially reduces these trajectories. These findings provide empirical evidence that conversational AI interactions can amplify delusion-related language over extended use and highlight the importance of state-aware safety mechanisms for mitigating such risks.