Spontaneous head movements during virtual clinical interviews help predict 12-months clinical outcomes in youth at clinical high risk for psychosis

Identifying predictors of clinical and functioning outcomes in individuals at clinical high risk (CHR) for psychosis is essential to early intervention and symptom monitoring. While motor abnormalities have been established as core features of psychosis vulnerability, the prognostic value of social motor behavior, particularly head movements during social interactions, remains underexplored despite being readily accessible and measurable by clinicians. We analyzed 10-minute of video recordings from virtual clinical interviews involving 72 individuals at CHR using an open-access video-based head tracking tool to quantify spontaneous head movements. In a longitudinal study, we examined associations between head movements, symptom severity, and global functioning at baseline and 12-month follow-up. At baseline, results showed that total amount of head movements were positively correlated with positive symptoms (ρ = 0.37), negative symptoms (ρ = 0.28), particularly social anhedonia (ρ = 0.30) and avolition (ρ = 0.31), and social functioning (ρ = -0.33). Head movements at baseline also predicted worsening of avolition (R2 = 0.36, β = 0.0002, p = <0.05), and disorganized symptoms (trouble with focus and attention; R2 = 0.24, β = 0.0002, p = <0.05) at 12-months, controlling for baseline symptomatology. Taken together, the results suggested that spontaneous head movements captured during virtual clinical interviews represent a sensitive social behavioral marker of symptom severity and future clinical course in individuals at CHR. The automated and ecological nature of the assessment offers a promising avenue for scalable and objective risk prediction and monitoring.