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A total of 121 patients with BD, 21 UR and 38 HC were included. A total of 107.033 voice data entries were collected [BD (n\u2009 =\u200978.733), UR (n\u2009 =\u20098004), and HC (n\u2009 = \u200920.296)]. Daily, patients evaluated symptoms using a smartphone-based system. Affective states were defined according to these evaluations. Data were analyzed using random forest machine learning algorithms.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>Compared to HC, BD was classified with a sensitivity of 0.79 (SD 0.11)\/AUC\u2009 =\u20090.76 (SD 0.11) and UR with a sensitivity of 0.53 (SD 0.21)\/AUC of 0.72 (SD 0.12). Within BD, compared to euthymia, mania was classified with a specificity of 0.75 (SD 0.16)\/AUC\u2009 =\u2009 0.66 (SD 0.11). Compared to euthymia, depression was classified with a specificity of 0.70 (SD 0.16)\/AUC\u2009 =\u2009 0.66 (SD 0.12). In all models the user dependent models outperformed the user independent models. Models combining increased mood, increased activity and insomnia compared to periods without performed best with a specificity of 0.78 (SD 0.16)\/AUC\u2009 = \u20090.67 (SD 0.11).<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>Voice features from naturalistic phone calls may represent a supplementary objective marker discriminating BD from HC and a state marker within BD.<\/jats:p><\/jats:sec>","DOI":"10.1186\/s40345-021-00243-3","type":"journal-article","created":{"date-parts":[[2021,12,1]],"date-time":"2021-12-01T02:03:18Z","timestamp":1638324198000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":33,"title":["Voice analyses using smartphone-based data in patients with bipolar disorder, unaffected relatives and healthy control individuals, and during different affective states"],"prefix":"10.1186","volume":"9","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-0462-6444","authenticated-orcid":false,"given":"Maria","family":"Faurholt-Jepsen","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Darius Adam","family":"Rohani","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jonas","family":"Busk","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Maj","family":"Vinberg","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jakob Eyvind","family":"Bardram","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lars Vedel","family":"Kessing","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2021,12,1]]},"reference":[{"key":"243_CR1","doi-asserted-by":"crossref","first-page":"20","DOI":"10.1038\/532020a","volume":"532","author":"E Anthes","year":"2016","unstructured":"Anthes E. 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Analysis on speech signal features of manic patients. 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The BIO study: the study protocol was approved by the Committee on Health Research Ethics of the Capital region of Denmark (protocol No. H-7-2014-007) and the Danish Data Protection Agency, Capital Region of Copenhagen (RHP-2015-023). Both studies complied with the Declaration of Helsinki (Seoul, October 2008). All participants provided written informed consent. Data from smartphones were stored by Monsenso subject to a data management agreement between Monsenso and The Capital Region of Denmark.","order":2,"name":"Ethics","group":{"name":"EthicsHeading","label":"Ethics approval and consent to participate"}},{"value":"All authors consent for publication of the present study.","order":3,"name":"Ethics","group":{"name":"EthicsHeading","label":"Consent for publication"}},{"value":"MFJ, DR, and JoB have no competing interests. MV has within the last 3\u00a0years been a consultant for Lundbeck, Sunovion and Janssen-Cilag. LVK has been a consultant for Lundbeck within the past 3\u00a0years. JB is a co-founder and shareholder in Monsenso.","order":4,"name":"Ethics","group":{"name":"EthicsHeading","label":"Competing interests"}}],"article-number":"38"}}