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    <journal-meta />
    <article-meta>
      <title-group>
        <article-title>Combining Recommender Systems and Language Models in Early Detection of Signs of Anorexia</article-title>
      </title-group>
      <contrib-group>
        <contrib contrib-type="author">
          <string-name>Oskar Riewe-Perła</string-name>
          <xref ref-type="aff" rid="aff0">0</xref>
        </contrib>
        <contrib contrib-type="author">
          <string-name>Agata Filipowska</string-name>
          <xref ref-type="aff" rid="aff0">0</xref>
        </contrib>
        <aff id="aff0">
          <label>0</label>
          <institution>Poznan University of Economics and Business</institution>
          ,
          <addr-line>Al. Niepodleglosci 10, 61-875 Poznan</addr-line>
          ,
          <country country="PL">Poland</country>
        </aff>
      </contrib-group>
      <abstract>
        <p>The challenge of accurately classifying events in a stream, despite years of research, still demands attention, especially when it involves understanding complex events. An example of such complexity is identifying tweets written by individuals that may suggest the presence of a disease. This issue was addressed at the eRisk 2024 Lab during CLEF 2024, where the task focused on analyzing evidence to detect early signs of anorexia. The objective of the proposed solution is to determine, as early as possible from a sequence of events (messages), whether an individual is sufering from anorexia. To achieve this goal, we introduce a novel architecture that merges language models with recommender systems, facilitating the fast classification of new messages. Our model demonstrates good performance, with an average F1 score up to 0.68 and a recall rate of 0.97 on a real-life imbalanced dataset.</p>
      </abstract>
      <kwd-group>
        <kwd>eol&gt;Recommender systems</kwd>
        <kwd>Language models</kwd>
        <kwd>BERT</kwd>
      </kwd-group>
    </article-meta>
  </front>
  <body>
    <sec id="sec-1">
      <title>1. Introduction</title>
      <p>Social interactions and personal conversations have largely shifted to the digital world due to the
limitless availability of the Internet. While the mode of communication changes, the emotions involved
remain the same, making social media platforms an important source of information for mental health
studies. Text analysis ofers a plethora of use cases for detecting mental health issues such as depression,
anxiety or eating disorders. As these conditions become more prevalent and have a serious impact on
individuals’ health, there is a growing need for new detection methods.</p>
      <p>Constructing text classification models to analyze a stream of messages presents a significant
challenge, particularly when the objective is to identify specific phenomena, such as depression or anorexia,
early on, with both high precision and recall, thereby achieving a high F1 score. This task becomes
even more complex when the messages are composed by humans using unique online communication
language (lingo). Such content can contain crucial information about the user, potentially revealing
health issues or situations where intervention is necessary.</p>
      <p>
        In the eRisk 2024 Lab [
        <xref ref-type="bibr" rid="ref1 ref2">1, 2</xref>
        ], we tackle the challenge of developing a method for early risk detection
of anorexia (Task II). Our aim is to sequentially process textual evidence from social media and identify
early indicators of anorexia as promptly as possible. To monitor user interactions across blogs, social
networks, and other online platforms, texts are processed in the sequence they were posted.
      </p>
      <p>Our research leverages the latest advancements in Natural Language Processing (NLP) along with
a recommendation system architecture. By analyzing the behavior of models that suggest content
based on user similarities, we assess whether the recommended content originates from individuals
experiencing this condition. This approach enables us to issue early warnings for potential risks of
exhibiting eating disorder symptoms.</p>
    </sec>
    <sec id="sec-2">
      <title>2. Proposed Method</title>
      <sec id="sec-2-1">
        <title>2.1. Related work</title>
        <p>
          Throughout the evolution of natural language processing (NLP), studies have highlighted its efectiveness
in such areas as healthcare or psychology, i.e. in spotting symptoms and aiding in early detection,
which can shorten the time to diagnosis [
          <xref ref-type="bibr" rid="ref3 ref4 ref5">3, 4, 5</xref>
          ]. The advent of extensive datasets from social media
has been a game-changer for a field that previously sufered from a lack of measurable data on mental
disorders [
          <xref ref-type="bibr" rid="ref6">6</xref>
          ]. There’s been a noticeable change in the methodologies employed, paralleling NLP
advancements. Initially, statistical models were the state of the art for analyzing natural language,
often using Bag of Words (BoW) or Term Frequency-Inverse Document Frequency (TF-IDF) techniques
[
          <xref ref-type="bibr" rid="ref7 ref8">7, 8</xref>
          ]. The advent of vectorization methods like Word2Vec or GloVe significantly enhanced NLP task
outcomes by better capturing contextual nuances [
          <xref ref-type="bibr" rid="ref10 ref11 ref12 ref9">9, 10, 11, 12</xref>
          ]. More recently, the introduction of
transformer-based language models, has revolutionized the field, establishing new benchmarks. Fine
tuned models like BERT showcase state-of-the-art results on text classification tasks for mental health
studies, outperforming statistical models like SVM, but also other deep learning architectures like LSTM
or CNN [
          <xref ref-type="bibr" rid="ref13">13</xref>
          ].
        </p>
        <p>
          The method used to distinguish between various message types is known as document classification.
This traditional task involves, for example, assigning a tag or class to a document that appears within
a stream of messages or is part of a collection. From a diferent angle, a recommendation system
undertakes a similar task by attempting to predict whether a document aligns with user preferences,
efectively performing a type of classification on a set of messages. Traditionally, the recommendation
systems have been designed in two variants: content-based and collaborative recommendation systems.
The former relies on aligning the characteristics of user profiles with the attributes of items, aiming to
recommend content that is similar, and becomes more efective as it gathers more information about
the user [
          <xref ref-type="bibr" rid="ref14">14</xref>
          ]. However, it encounters dificulties with the user cold start problem. The collaborative
method, in contrast, seeks to identify similarities among users to introduce a variety of content, yet
it faces challenges with new items that lack initial ratings, known as the item cold start problem. To
leverage the strengths and overcome the limitations of both approaches, hybrid methodologies have
been developed and are proving to be an efective strategy for integrating both item and user features
to generate recommendations [
          <xref ref-type="bibr" rid="ref15 ref16 ref17">15, 16, 17</xref>
          ]. These systems have been successfully implemented across
various domains, leading to the idea of applying them to the classification of user-generated messages.
        </p>
        <p>The application of Deep Learning techniques has become increasingly evident in the field of
recommender systems, particularly those that process textual or visual inputs and where contextual details
are significant [ 18, 19]. Additionally, models originally designed for language processing, such as
BERT, have been adapted to improve recommendation generation, surpassing the performance of
existing top models [20]. Despite the widespread use of NLP techniques to enhance the efectiveness of
recommendation systems, there appears to be a lack of research on employing these systems directly
for the classification of mental health disorders.</p>
      </sec>
      <sec id="sec-2-2">
        <title>2.2. Architecture</title>
        <p>We propose a model designed for the early identification of potential mental health issues, utilizing
recommender systems enhanced by natural language processing (NLP) techniques. This model is built
upon three foundational elements: document embeddings, user embeddings, and a recommendation
engine. The initial two components employ language models to transform textual data into numerical
representations. Our approach incorporates the Sentence Transformer architecture, creating document
embeddings that are well-suited for similarity assessments. This process facilitates the generation of
user profiles based on the transformed data. By converting these textual and user representations into a
format analogous to the classic recommendation scenario involving items and users, we can interpret a
user’s posting history as a matrix of interactions. In the final stage, we deploy a hybrid recommendation
system that leverages both document and user embeddings to tailor recommendations to individual
user profiles. The system evaluates recommended posts in relation to their authors, where a higher
proportion of contributions from users experiencing mental health challenges is indicative of a positive
detection.</p>
      </sec>
      <sec id="sec-2-3">
        <title>2.3. Document embeddings</title>
        <p>A key component of the model is the representation of text, which influences both the final document
and the representation of the user. Among various NLP techniques suitable for this task, Sentence
Transformers have been shown to produce high-quality embeddings that are ideal for similarity comparisons
[21]. This approach not only eliminates the need for prior preprocessing but also accommodates raw
text and supports multi-lingual datasets. It generates a fixed-sized numerical vector as output, which is
applicable irrespective of the text’s length. We decided to use all-mpnet-base-v2 model, which is listed
on top of the ranking1 published by authors of the SBERT framework.</p>
        <p>The size of the document embeddings is determined by the chosen model; in our case, they are
768-dimensional vectors. The high dimensionality complicates comparison using conventional methods.
Although there are methods to handle sparse data, we recommend employing dimensionality reduction
techniques to decrease the time required for generating recommendations. This strategy is advocated
for e.g., Topic Modeling [22] and has been shown to efectively preserve the contextual information of
texts in a more generalized form. For this purpose, we have utilized the UMAP model [23], which can
be trained in a supervised manner. Providing binary labels for the training embeddings enhances the
model’s ability to distinguish between text representations from two distinct user groups.</p>
      </sec>
      <sec id="sec-2-4">
        <title>2.4. User embeddings</title>
        <p>To address the challenge of comparing authors and overcoming the issue of user cold start, we create
user embeddings. This process falls under the scope of Author Profiling in the field of NLP. While our
methodology primarily generates these embeddings from a history of documents authored by the users,
it is possible to enrich them with supplementary data such as age, geographical location, profession,
etc. For every user, we compute the average of their document embeddings, resulting in a fixed-size
vector that distinctly characterizes authors based on their written works.</p>
      </sec>
      <sec id="sec-2-5">
        <title>2.5. Recommender System</title>
        <p>
          Document and user embeddings, along with an interaction matrix, constitute the input for our
recommender system. To leverage the features of texts and their authors, and to accommodate profiles of new
users, we opted for a hybrid approach - LightFM [
          <xref ref-type="bibr" rid="ref17">17</xref>
          ], which integrates content-based methods with
collaborative filtering.
        </p>
      </sec>
      <sec id="sec-2-6">
        <title>2.6. Classification</title>
        <p>For every new user, we apply our model to generate recommendations of posts written by authors from
the training dataset. From the top 20 documents, we measure the share of those coming from authors
with anorexia. The positive classification is given for the users with scores higher than the predefined
threshold of 50%. Additionally, to prevent too early classification based on limited information, we have
set our threshold to 100% for the first five iterations. Meaning that the model delays triggering the alert,
unless all recommended posts come from authors struggling with anorexia. According to the eRisk 2024
task constraints, positive classification also stops further processing of the user’s stream of writings.</p>
      </sec>
    </sec>
    <sec id="sec-3">
      <title>3. Experimentation and results</title>
      <p>Our research involved analyzing a dataset aimed at the Early Detection of Mental Health Disorders [24].
This dataset comprises 823,850 social media posts along with their titles from 1,287 participants. Each
1https://www.sbert.net/docs/pretrained_models.html
entry is timestamped, which facilitates sequential analysis, a point elaborated upon in discussions about
the online learning component of our study. A notable aspect of this dataset is the uneven distribution
between users dealing with anorexia (134) and the rest of the participants (1153). In our model, we
leveraged language models for text representation, which allowed us to bypass traditional preprocessing
steps. We combined the title and body of each post into a single text string for analysis.</p>
      <p>In the experiment we perform, our model receives continuous updates with new posts from each
user, mimicking the natural pattern of social media activity. The model is not retrained; instead, it
updates the user profile for more precise recommendations. Once an alert for a user is activated, the
model ceases to analyze subsequent posts from that individual.</p>
      <p>Our findings indicate that posts from users with an eating disorder are more likely "to be
recommended" to others facing similar challenges, aiding in early detection. We evaluated the efectiveness of
our model by the proportion of recommendations that come from users with eating disorders, using a
numerical score to determine when a positive classification is warranted.</p>
      <p>The model was evaluated by us on a test dataset, as well as by eRisk Lab authors using a separate
evaluation dataset, that was not accessible to us before the evaluation process. The model exhibits similar
results on both datasets, as presented in Table 1, demonstrating its strong generalization capability. It
has achieved very low ERDE loss (ranging between 0.02 and 0.07), indicating its ability of triggering an
alert with minimal delay and proving that small number of social media posts is enough to perform
accurate classification. The model’s high recall score (0.85-0.97) indicates its proficiency in correctly
identifying most positive cases. However, the lower precision (0.45-0.56) suggests that the model
mistakenly identifies some negative samples as positive, an issue that could potentially be mitigated by
increasing the classification threshold.</p>
    </sec>
    <sec id="sec-4">
      <title>4. Discussion and future work</title>
      <p>We have implemented a mental health disorder detection model that achieves robust F1 score of 0.68,
high recall rate of 0.97, while maintaining a low ERDE loss ranging between 0.02 and 0.07. This model
leverages advancements in the Natural Language Processing and combines them with recommender
system architecture to detect similarities between users with and without anorexia.</p>
      <p>This research contributes to the broader domain of tasks focused on early detection and intervention
for mental health disorders through digital platforms. We suggest expanding already existing use cases
for recommender systems with NLP methods for proactive health management, addressing the urgent
need for early identification of eating disorders. The overall good results prove the feasibility of
employing recommender systems in the task of mental health issues detection. Its simplicity and flexibility
shows a potential in applying it in real-life application and enhancing the social impact of recommender
systems. Its modular design ensures ongoing development in parallel with the advancements of NLP
and emergence of more powerful language models. The promising results indicate the importance
of continuous improvement and adaptation of these models to keep pace with the evolving nature of
online communication and mental health challenges.</p>
      <p>Future work should focus on improving the model’s precision score, to eliminate false negative
predictions. We propose investigating the optimal delay before triggering an alert, as too short posts
might initially mislead the model. A similar approach to detect an adequate amount of data enough
for prediction was previously suggested [25], by calculating the combined size of the text taken into
analysis, instead of only relying on number of posts. Moreover, our suggested technique for creating
user embeddings rely solely on the averaged document embeddings. More time-aware methods could
be considered to reflect the transition of mental state between the posts, especially as post creation
timestamps are available in the dataset.
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