StressSpeak: A Speech-Driven Framework for Real-Time Personalized Stress Detection and Adaptive Psychological Support

<b>Background:</b> Stress is a critical determinant of mental health, yet conventional monitoring approaches often rely on subjective self-reports or physiological signals that lack real-time responsiveness. Recent advances in large language models (LLMs) offer opportunities for speech-driven, adaptive stress detection, but existing systems are limited to retrospective text analysis, monolingual settings, or detection-only outputs. <b>Methods:</b> We developed a real-time, speech-driven stress detection framework that integrates audio recording, speech-to-text conversion, and linguistic analysis using transformer-based LLMs. The system provides multimodal outputs, delivering recommendations in both text and synthesized speech. Nine LLM variants were evaluated on five benchmark datasets under zero-shot and few-shot learning conditions. Performance was assessed using accuracy, precision, recall, F1-score, and misclassification trends (false-negatives and false-positives). Real-time feasibility was analyzed through latency modeling, and user-centered validation was conducted across cross-domains. <b>Results:</b> Few-shot fine-tuning improved model performance across all datasets, with Large Language Model Meta AI (LLaMA) and Robustly Optimized BERT Pretraining Approach (RoBERTa) achieving the highest F1-scores and reduced false-negatives, particularly for suicide risk detection. Latency analysis revealed a trade-off between responsiveness and accuracy, with delays ranging from ~2 s for smaller models to ~7.6 s for LLaMA-7B on 30 s audio inputs. Multilingual input support and multimodal output enhanced inclusivity. User feedback confirmed strong usability, accessibility, and adoption potential in real-world settings. <b>Conclusions:</b> This study demonstrates that real-time, LLM-powered stress detection is both technically robust and practically feasible. By combining speech-based input, multimodal feedback, and user-centered validation, the framework advances beyond traditional detection only models toward scalable, inclusive, and deployment-ready digital mental health solutions.