Lowering costs for large-scale screening in psychosis: a systematic review and meta-analysis of performance and value of information for speech-based psychiatric evaluation

Author(s)

Argolo, Felipe ; Magnavita, Guilherme ; Mota, Natalia Bezerra ; Ziebold, Carolina ; Mabunda, Dirceu ; Pan, Pedro M. ; Zugman, Andre ; Gadelha, Ary ; Corcoran, Cheryl ; Bressan, Rodrigo A.

• Document type: Journal article
• Source: Revista Brasileira de Psiquiatria; v. 42, n. 6, p. 14-pg., 2020-11-01.

Abstract

Objective: Obstacles for computational tools in psychiatry include gathering robust evidence and keeping implementation costs reasonable. We report a systematic review of automated speech evaluation for the psychosis spectrum and analyze the value of information for a screening program in a healthcare system with a limited number of psychiatrists (Maputo, Mozambique). Methods: Original studies on speech analysis for forecasting of conversion in individuals at clinical high risk (CHR) for psychosis, diagnosis of manifested psychotic disorder, and first-episode psychosis (FEP) were included in this review. Studies addressing non-verbal components of speech (e.g., pitch, tone) were excluded. Results: Of 168 works identified, 28 original studies were included. Valuable speech features included direct measures (e.g., relative word counting) and mathematical embeddings (e.g.: word-to-vector, graphs). Accuracy estimates reported for schizophrenia diagnosis and CHR conversion ranged from 71 to 100% across studies. Studies used structured interviews, directed tasks, or prompted free speech. Directed-task protocols were faster while seemingly maintaining performance. The expected value of perfect information is USD 9.34 million. Imperfect tests would nevertheless yield high value. Conclusion: Accuracy for screening and diagnosis was high. Larger studies are needed to enhance precision of classificatory estimates. Automated analysis presents itself as a feasible, low-cost method which should be especially useful for regions in which the physician pool is insufficient to meet demand. (AU)

• FAPESP's process: 18/05586-7 - Evaluation of the validity and reliability of the diagnostic categories of the primary care version of the eleventh revision of the international classification of diseases: ICD-11 PHC
• Grantee: Carolina Andrea Ziebold Jorquera
• Support Opportunities: Scholarships in Brazil - Doctorate