Coupling of emotional prosody recognition and expression and their associations with psychiatric symptoms in schizophrenia

Emotional prosody is essential for social communication and is frequently disrupted in schizophrenia. However, the relationships among emotional prosody recognition, expressive acoustic characteristics, and psychiatric symptoms remain incompletely understood. This study examined speech emotion prosody (SER) recognition, acoustic features of emotional expression, and their associations with symptom dimensions in schizophrenia.

Ninety-six patients with schizophrenia and 54 healthy controls completed standardized emotional prosody recognition tasks and an emotional video-induced spontaneous speech task. Acoustic features were extracted using the eGeMAPS feature set. Psychiatric symptoms were assessed with the Positive and Negative Syndrome Scale (PANSS).

Patients exhibited significantly impaired recognition accuracy across emotions, accompanied by increased confusion rates, both of which were associated with greater symptom severity, particularly negative symptoms. Acoustic analyses revealed flatter and less dynamic vocal patterns in patients, characterized by reduced loudness variability, constrained fundamental frequency range, and altered spectral-formant features, which were most strongly related to negative symptoms. Stepwise regression analyses demonstrated that models combining SER performance and expressive acoustic features provided substantially better prediction of symptom severity than models based on either domain alone, explaining over one-third of the variance in negative symptoms.

Deficits in emotional prosody recognition and expression are closely coupled and jointly reflect core psychopathology in schizophrenia. The findings preliminarily support the utility of integrating perceptual and expressive prosodic markers as objective, quantitative indicators of symptom severity and highlight emotional prosody as a promising target for assessment and intervention in schizophrenia.