Abstract
During psychiatric assessment, clinicians observe not only what patients report, but important nonverbal signs such as tone, speech rate, fluency, responsiveness, and body language. Weighing and integrating these different information sources is a challenging task and a good candidate for support by intelligence-driven tools—however this is yet to be realized in the clinic. Here, we argue that several important barriers to adoption can be addressed using Bayesian network modelling. To demonstrate this, we evaluate a model for depression and anxiety symptom prediction from voice and speech features in large-scale datasets (30,135 unique speakers). Alongside performance for conditions and symptoms (for depression, anxiety ROC-AUC = 0.842, 0.831 ECE = 0.018, 0.015; core individual symptom ROC-AUC > 0.74), we assess demographic fairness and investigate integration across and redundancy between different input modality types. Clinical usefulness metrics and acceptability to mental health service users are explored. When provided with sufficiently rich and large-scale multimodal data streams and specified to represent common mental conditions at the symptom rather than disorder level, such models are a principled approach for building robust assessment support tools: providing clinically-relevant outputs in a transparent and explainable format that is directly amenable to expert clinical supervision. SUPPLEMENTARY INFORMATION: The online version contains supplementary material available at 10.1038/s41598-025-33331-w.