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Acoustic analysis of vocal expression offers a potentially inexpensive, unobtrusive, and highly sensitive biobehavioral measure of serious mental illness (SMI)-related issues. Despite literature documenting its use for understanding SMI, prior studies have largely ignored that vocal expression is highly dynamic within individuals over time. We employed ambulatory vocal assessment from SMI outpatients to understand links between vocal expression, SMI symptoms, and affective states. Vocal samples were analyzed using a validated acoustic analysis protocol.Overall, vocal expression was not directly related to SMI symptoms but changed as a function of state and state by symptom interactions. The results suggest that a) vocal expression fails to modulate across changing affective states in individuals with active SMI symptoms, b) this lack of modulation may be commonly associated with many SMI symptoms, and c) vocal analysis can accommodate temporal dynamics.General Scientific Summary: Acoustic analysis of vocal expression offers a potentially inexpensive, unobtrusive, and highly sensitive biobehavioral measure of serious mental illness (SMI)-related issues. Despite literature documenting its use for understanding SMI, prior studies have largely ignored that vocal expression is highly dynamic within individuals over time. This manuscript attempts to close this gap by employing ambulatory vocal assessment from SMI outpatients to understand links between vocal expression, SMI symptoms, and affective states.

Poor social connection or loneliness is a prominent feature of schizotypy and may exacerbate psychosis risk. Previous studies have examined the interrelationships between loneliness and psychosis risk, but critically, they have largely been conducted in non-clinical samples or exclusively used laboratory questionnaires with limited consideration of the heterogeneity within schizotypy (i.e., positive, negative, disorganized factors). The present study examined links between loneliness and psychotic-like symptoms across the dimensions of schizotypy through cross-sectional, laboratory-based questionnaires (Study 1; N = 78), ambulatory assessment (Study 2; N = 118) in undergraduates, and ambulatory assessment in inpatients in a substance abuse treatment program (Study 3; N=48). Trait positive schizotypy consistently predicted crosssectional and state psychotic-like symptoms. Loneliness, assessed via cross-sectional and ambulatory means, was largely linked with psychotic-like symptoms. Importantly, psychotic-like symptoms were dynamic: psychotic-like symptoms largely increased with loneliness in individuals with elevated positive and disorganized schizotypal traits, though there were some inconsistency related to disorganized schizotypy and state psychotic-like symptoms. Negative schizotypy and loneliness did not significantly interact to predict psychotic-like symptoms, suggesting specificity to positive schizotypy. Ambulatory approaches provide the opportunity for ecologically valid identification of risk states across psychopathology, thus informing early intervention.