United States

Multilingual large language models (LLMs) are increasingly used to interpret mental health narratives in settings such as support chatbots, screening, and content moderation. A basic reliability question remains underexplored: when the same narrative is presented in different languages, does a model apply comparable evaluative standards? We study cross-linguistic variation in mental health evaluation between English and Chinese using two widely deployed LLMs (GPT-4o and Qwen3-32B). We separate (i) construct-level evaluative orientation from (ii) decision-level behavior on downstream tasks. At the construct level, we adapt validated psychometric stigma instruments spanning social, self, and health-professional stigma and quantify language-conditioned shifts in model responses. At the decision level, we evaluate models on binary stigma detection and four-way depression severity classification using semantically aligned English--Chinese datasets. Across instruments and models, Chinese prompts elicit systematically higher stigma scores than English prompts. These differences propagate to downstream decisions: Chinese prompts reduce sensitivity in stigma detection and induce a downward shift in predicted depression severity, producing substantially more under-estimation errors. Our findings show that prompt language can shift both evaluative orientation and effective decision thresholds, underscoring the need for multilingual evaluation and calibration before deploying LLMs in socially sensitive domains.

ACL 2026

Language Shapes Mental Health Evaluations in Large Language Models

language bias

stereotypes

mental health

large language models

multilingual

## Welcome to EMNLP 2022!
I am delighted to welcome you to EMNLP 2022! I believe this conference has been complicated beyond any precedent. Over the past year, it’s been thrilling to see the organization team approach each new puzzle with creativity and enthusiasm. We hope that those participating in Abu Dhabi as well as those joining remotely will leave the conference feeling newly inspired by the program and newly connected to our ever-growing community. Following EMNLP 2021 and major NLP conferences since, EMNLP 2022 is “hybrid,” serving both virtual and in-person participants.

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The evaluation of societal biases in NLP models is critically hindered by a geo-cultural gap. This leaves regions such as Latin America severely underserved, making it impossible to adequately assess or mitigate the perpetuation of harmful regional stereotypes in language technologies.

This paper presents LACES, a stereotype association dataset, for 15 Latin American countries. This dataset includes 4,789 stereotype associations\footnote{The de-identified dataset can be accessed via \href{https://github.com/fvialibre/LACES}{GitHub}}, manually created and annotated by 83 participants. The dataset was developed through targeted community partnerships across Latin America.

Additionally, in this paper, we propose a novel adaptive data collection methodology that uniquely integrates the sourcing of new stereotype entries and the validation of existing data within a single, unified workflow. This approach results in a resource with more unique stereotypes than previous static collection methods, enabling a more efficient stereotype collection. The paper further supports the quality of LACES by demonstrating reduced efficacy of debiasing methods on this dataset in comparison to existing popular stereotype benchmarks.

Adaptive Data Collection for Latin-American Community-sourced Evaluation of Stereotypes (LACES)

Stereotype repositories are critical to assess generative AI model safety, but currently lack adequate global coverage. It is imperative to prioritize targeted expansion, strategically addressing existing deficits, over merely increasing data volume. This work introduces a multilingual stereotype resource covering four sub-Saharan African countries that are severely underrepresented in NLP resources: Ghana, Kenya, Nigeria, and South Africa. By utilizing socioculturally-situated, community-engaged methods, including telephonic surveys moderated in native languages, we establish a reproducible methodology that is sensitive to the region's complex linguistic diversity and traditional orality. By deliberately balancing the sample across diverse ethnic and demographic backgrounds, we ensure broad coverage, resulting in a dataset of 3,534 stereotypes in English and 3,206 stereotypes across 15 native languages.

SAFARI: A Community-Engaged Approach and Dataset of Stereotype Resources in the Sub-Saharan African Context

Large language models (LLMs) are increasingly used as evaluative tools across languages, yet bias research remains overwhelmingly Anglocentric, with most studies conducted in English using Latin-script names. It remains unclear whether bias patterns generalize across linguistic contexts. We investigate this question and introduce the stereotype perceptual map, a framework for analyzing how ethnic groups are positioned along evaluative dimensions. 
Using 900,000 model responses over 45,000 names spanning 9 ethnicities, we evaluate model behavior across prompt languages (English, Chinese, Thai), writing scripts (Latin, Chinese, Thai), evaluative domains (competence, warmth), and models (GPT, DeepSeek). We find that ethnic bias hierarchies are jointly shaped by local linguistic context and model origin and differ substantially between Western-centric and Sinocentric models. DeepSeek exhibits highly stable rankings across conditions in math competence judgments, consistently placing Chinese at the top, followed by Russian, and White, Hispanic, and Black names at the bottom. GPT, by contrast, shows strong script-dependent reordering: Latin-script conditions form one stable cluster, while native-script conditions form another, with substantially lower cross-cluster correlations. We term this script-gated bias: transliterating the same names into a non-Latin script can activate a different evaluative frame and produce rankings that are sometimes inversely correlated with Latin-script results. Warmth evaluations are less stable than competence across both models.
Our findings demonstrate that multilingual bias cannot be characterized through single-language, single-script audits. For multilingual users, code-switching between languages can toggle between different bias regimes. Fairness evaluations for multilingual LLMs must therefore account for deployment language, writing system, and model origin to capture the full range of potentially harmful stereotypes these systems exhibit.

Through the Looking Glass of Multilingual AI: Contrasting Language- and Name Script-Dependent Ethnic Hierarchies in GPT and DeepSeek

Bias benchmarks for LLMs largely focus on English, overlooking language- and culture-specific stereotypes. We introduce CrowS-Pairs-NL, a Dutch stereotype benchmark built by filtering, translating, and adapting the English CrowS-Pairs dataset to address known conceptual pitfalls, and extending it with newly crowdsourced Dutch sentence pairs. We evaluate six multilingual and Dutch-trained models using both a pseudo-log-likelihood metric adapted for autoregressive models and a prompt-based metric with three template variants. Models explicitly trained on Dutch data consistently exhibit higher stereotyping scores, suggesting that language-specific fine-tuning introduces language-specific bias. The two metrics broadly agree on model rankings but differ in sensitivity, with the prompt metric showing a narrower range of scores. Our benchmark and findings underscore the need for culturally grounded bias evaluation beyond English.

CrowS-Pairs-NL: A Benchmark to Evaluate Dutch Stereotype Bias in LLMs

Large language models (LLMs) are increasingly used to convert patient language into clinical-style summaries, yet patient symptom descriptions may vary across linguistic, cultural, and cross-linguistic contexts. In this pilot study, we operationalize this variation using four expression styles: direct English, indirect English, culturally mediated English, and Chinese-original patient language. We propose a compact red-teaming framework for testing whether LLM-based symptom interpretation changes when the same underlying concern is expressed in different linguistic and cultural forms. Our pilot dataset contains eight symptom scenarios, each expressed in four styles, yielding 32 vignettes before prompt variation. We evaluate GPT-5 mini as a pilot case-study model under generic and culture-aware prompts, repeating the full evaluation three times to produce 192 model outputs. Reference labels and a stratified subset of model output annotations were reviewed for face validity by an independent reviewer with clinical training.The model usually preserves broad symptom categories, but subtle failure modes emerge. Culture-aware prompting reduces severity downgrades from 14.6% to 9.4% and ambiguity-flagging failures from 28.1% to 13.5%, but does not reduce interpretation inconsistency or clinical category shift, both of which remain at 6.2%. Indirect English shows the highest severity-downgrade and flagging-failure rates, while Chinese-original expressions are often interpreted with the correct broad category but are not consistently flagged as ambiguous. These findings suggest that medical LLM evaluation should assess cultural robustness, severity framing, ambiguity preservation, and human-review escalation in addition to factual accuracy.

Lost in Translation: Cross-Cultural Bias in LLM-Assisted Medical Symptom Interpretation

We ask whether stereotype-loaded queries about culturally marked people leak more personal information from a retrieval-augmented generation (RAG) system than otherwise equivalent neutral queries. We pre-register a four-culture audit covering en-Anglo, es-LATAM, Arabic, and Hindi probes on a synthetic English PII corpus, comparing five paired query arms via the Stereotype-Trigger Leakage Delta (STLD). The locked confirmatory estimator was not run, so all reported tests are exploratory or sensitivity analyses, with deviations documented. We also identify a prompt-echo confound in the name-leakage metric: the model often re-emits the queried name, inflating apparent leakage without retrieval extraction. On cleaner non-name channels—email, phone, SSN-like identifier, and address—we find no stereotype-driven amplification for any culture after multiple-comparison correction. One name-included es-LATAM cell is significant in the negative direction, but matched-arm decomposition and an expanded culture-neutral control sensitivity suggest a high-leak control-predicate sampling artifact rather than a stereotype-treatment effect. Because the study is powered only for mid-sized effects and the culturally marked probe bank mixes stereotype content with cultural markers and heritage practices, we interpret the results as no detection—not evidence of no effect—of culturally marked predicate-triggered PII amplification under this synthetic-English RAG setting. The paper contributes a preregistered stereotype-as-privacy-side-channel test, diagnoses prompt-echo and predicate-resource confounds, and outlines release of the synthetic corpus, predicate bank, query generator, audit scripts, and analysis code upon acceptance

Exploratory As-Analyzed No-Detection of Culturally-Marked Predicate-Triggered PII Amplification in a Synthetic-English RAG Probe: A Predicate-Resource-Confounded Audit

Multilingual large language models exhibit systematic differences in their outputs across languages, even when representing the same underlying knowledge. Prior work has primarily focused on evaluating or reducing such inconsistencies. In this work, we instead study whether cross-lingual behavior can be controlled: specifically, whether answer distributions associated with other languages can be expressed under English prompting. To this end, we construct a human-annotated factual dataset and a cultural scenarios dataset, and compare intervention methods including persona prompting, activation steering, and preference-based fine-tuning. We evaluate how these methods affect answer distributions and their generalization to culturally grounded settings. Our results show that answer distributions can be systematically shifted toward those observed in other languages, with persona prompting consistently outperforming more complex intervention methods.

Controlling Cross-Lingual Answer Distributions in Language Models: Enabling Transfer of Factual Preferences

Large language models (LLMs) are increasingly explored for patient-facing medical advice and symptom triage, yet their responses may shift when identical clinical evidence is paired with culturally marked patient descriptors. 
We present a counterfactual audit framework for evaluating cross-cultural variation in LLM-generated medical advice by isolating identity-related cues while holding clinical evidence constant.
Our evaluation uses matched clinical vignettes, cross-regional and culturally marked prompt variants, repeated sampling, and structured comparison of urgency framing, safety recommendations, empathy, and escalation advice.
Across multiple commercial and open-weight LLMs, we observe measurable identity-conditioned variation in both triage decisions and interactional framing. In several cases, culturally marked descriptors shift urgency assessments or escalation recommendations despite unchanged clinical evidence. While the magnitude and direction of these effects differ across models, the results suggest that LLM-generated medical advice remains sensitive to culturally linked identity cues in ways that may affect safety-critical guidance.
Our results demonstrate how culturally grounded counterfactual auditing can help identify clinically unsupported variation while distinguishing potentially harmful shifts from appropriate communication adaptation in patient-facing medical advice.

Counterfactual Auditing of Cross-Cultural Variation in LLM-Generated Medical Advice

Large language models (LLMs) perpetuate cultural stereotypes not only through biased associations but through systematic omission and orthographic erasure of underrepresented languages. We present empirical evidence of two compounding failure modes affecting Northeast Indian languages: (1) entity-level invisibility, where state-of-the-art NER systems score F1=0.000 on culturally critical named entities such as Khasi surnames, Garo festivals, and tribal names; and (2) orthographic corruption, where LLM tokenizers corrupt semantically meaningful diacritics (ï, ñ) and the Garo morpheme boundary marker (U+00B7) at rates of 18.8–50% across four of five evaluated models. Drawing on NortheastNER (F1=0.964, six entity categories, XLM-RoBERTa-base) and a systematic tokenization study across Khasi and Garo, we argue that stereotype-by-omission constitutes a distinct and measurable harm to indigenous language communities. We further show that a custom multilingual tokenizer achieves 26–50% token reduction over five baseline LLMs, demonstrating that culturally grounded infrastructure can partially remediate these failures. Our findings call for cultural representation audits as a standard component of multilingual NLP evaluation.

Stereotyped by Silence: How LLMs Erase Northeast Indian Languages Through Omission and Orthographic Corruption

Stereotypes associate a group (G) with an attribute (A), often through broad generalizations like "Gs are A". In the age of large language models, many existing datasets and methods measure bias by considering changes in $P(A|G)$ between different social groups ($G_{alt}$). Motivated by literature on generics, we argue that constructing minimal pairs along the group dimension is not enough: explicitly considering the alternate attribute ($A_{alt}$) is necessary for a robust score. We first show how to adapt existing log-probability metrics to this setup, but we find that aggregating them across different stereotypes is inherently flawed. We propose a new metric representing the mutual information (MI) between the social groups and attributes. We argue that it is better suited for aggregation across individual points, allowing for robust comparison of stereotype strength across different languages and models. We demonstrate this on a set of paired English and Russian stereotypes from the BiasShades dataset.

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