# HiMA-MDD: A Hierarchical Multi-Agent Harness for Interpretable Multimodal Depression Detection in Clinical Interviews

arXiv: https://arxiv.org/abs/2608.21868 · HTML: https://mlsanity.com/paper/2608.21868/

## Key facts

- No citing papers in the map yet (data through 14 Oct 2026).
- Builds on 9 of its 34 references that are in the map.
- First posted on arXiv 22 Aug 2026.

## Builds on (most cited first, 9 of 9)

- [Efficient Memory Management for Large Language Model Serving with PagedAttention](https://mlsanity.com/paper/2309.06180/) (2023)
- [Robust Speech Recognition via Large-Scale Weak Supervision](https://mlsanity.com/paper/2212.04356/) (2022)
- [Are Large Language Model-based Evaluators the Solution to Scaling Up Multilingual Evaluation?](https://mlsanity.com/paper/2309.07462/) (2023)
- [DAIC-WOZ: On the Validity of Using the Therapist's prompts in Automatic Depression Detection from Clinical Interviews](https://mlsanity.com/paper/2404.14463/) (2024)
- [MAGI: Multi-Agent Guided Interview for Psychiatric Assessment](https://mlsanity.com/paper/2504.18260/) (2025)
- [LLM Questionnaire Completion for Automatic Psychiatric Assessment](https://mlsanity.com/paper/2406.06636/) (2024)
- [HiQuE: Hierarchical Question Embedding Network for Multimodal Depression Detection](https://mlsanity.com/paper/2408.03648/) (2024)
- [Enhancing Depression Detection via Question-wise Modality Fusion](https://mlsanity.com/paper/2503.20496/) (2025)
- [Dep-LLM: Training-Free Depression Diagnosis via Evidence-Guided Structured Multi-factor with Reliable LLM Reasoning](https://mlsanity.com/paper/2606.10796/) (2026)

## Abstract (arXiv)

Depression assessment from multimodal clinical interviews requires integrating dispersed evidence from multiple symptoms into a coherent PHQ-8 profile. This process is hierarchical: relevant evidence is often sparse and context-dependent within local question-answer exchanges, multiple exchanges jointly support symptom-level judgments, and the final assessment depends on the coherence of the complete symptom profile. Existing LLM systems either process interviews holistically or distribute work across generic agent roles; neither design necessarily provides an explicit orchestration mechanism that coordinates evidence access, item-score authority, bounded feedback, and state recording across these levels. To address this gap, we introduce HiMA-MDD, a hierarchical multi-agent harness that aligns this assessment hierarchy with three agent layers. After non-agentic preprocessing constructs context-preserving multimodal QA units, Layer 1 identifies candidate QA-to-item relations and supports bounded item-grounded evidence routing. Layer 2 assigns symptom groups to operational factor specialists, with one specialist responsible for each provisional item score. Layer 3 audits the complete provisional profile, requests at most one round of targeted revision, and reconstructs the verified PHQ-8 profile. This layered design naturally yields a Hierarchical Evidence Trace, preserves all intermediate evidence, judgments, and revisions for auditability. The final item scores then deterministically produce the total score and screening decision. Using Qwen2.5-72B-Instruct as the harness backbone, our experiments on E-DAIC demonstrate that HiMA-MDD outperforms the compared state-of-the-art methods.