Objective: There are many barriers to accessing mental health assessments including cost and stigma. Even when individuals receive professional care, assessments are intermittent and may be limited partly due to the episodic nature of psychiatric symptoms. Therefore, machine-learning technology using speech samples obtained in the clinic or remotely could one day be a biomarker to improve diagnosis and treatment. To date, reviews have only focused on using acoustic features from speech to detect depression and schizophrenia. Here, we present the first systematic review of studies using speech for automated assessments across a broader range of psychiatric disorders.
Methods: We followed the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) guidelines. We included studies from the last 10 years using speech to identify the presence or severity of disorders within the Diagnostic and Statistical Manual of Mental Disorders (DSM-5). For each study, we describe sample size, clinical evaluation method, speech-eliciting tasks, machine learning methodology, performance, and other relevant findings.
Results: 1395 studies were screened of which 127 studies met the inclusion criteria. The majority of studies were on depression, schizophrenia, and bipolar disorder, and the remaining on post-traumatic stress disorder, anxiety disorders, and eating disorders. 63% of studies built machine learning predictive models, and the remaining 37% performed null-hypothesis testing only. We provide an online database with our search results and synthesize how acoustic features appear in each disorder.
Conclusion: Speech processing technology could aid mental health assessments, but there are many obstacles to overcome, especially the need for comprehensive transdiagnostic and longitudinal studies. Given the diverse types of data sets, feature extraction, computational methodologies, and evaluation criteria, we provide guidelines for both acquiring data and building machine learning models with a focus on testing hypotheses, open science, reproducibility, and generalizability.
Level of evidence: 3a.
Keywords: machine learning; mental health; psychiatry; speech; voice.
© 2020 The Authors. Laryngoscope Investigative Otolaryngology published by Wiley Periodicals, Inc. on behalf of The Triological Society.