title: Testing a machine-learning algorithm to predict the persistence and severity of major depressive disorder from baseline self-reports.
abstract: Heterogeneity of major depressive disorder (MDD) illness course complicates clinical decision-making. Although efforts to use symptom profiles or biomarkers to develop clinically useful prognostic subtypes have had limited success, a recent report showed that machine-learning (ML) models developed from self-reports about incident episode characteristics and comorbidities among respondents with lifetime MDD in the World Health Organization World Mental Health (WMH) Surveys predicted MDD persistence, chronicity and severity with good accuracy. We report results of model validation in an independent prospective national household sample of 1056 respondents with lifetime MDD at baseline. The WMH ML models were applied to these baseline data to generate predicted outcome scores that were compared with observed scores assessed 10-12 years after baseline. ML model prediction accuracy was also compared with that of conventional logistic regression models. Area under the receiver operating characteristic curve based on ML (0.63 for high chronicity and 0.71-0.76 for the other prospective outcomes) was consistently higher than for the logistic models (0.62-0.70) despite the latter models including more predictors. A total of 34.6-38.1% of respondents with subsequent high persistence chronicity and 40.8-55.8% with the severity indicators were in the top 20% of the baseline ML-predicted risk distribution, while only 0.9% of respondents with subsequent hospitalizations and 1.5% with suicide attempts were in the lowest 20% of the ML-predicted risk distribution. These results confirm that clinically useful MDD risk-stratification models can be generated from baseline patient self-reports and that ML methods improve on conventional methods in developing such models.
authors.affiliation: Department of Health Care Policy, Harvard Medical School, Boston, MA, USA.
authors.forename: R C
authors.initials: RC
authors.lastname: Kessler
authors.affiliation: Interdisciplinary Center Psychopathology and Emotion Regulation, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands.
authors.forename: H M
authors.initials: HM
authors.lastname: van Loo
authors.affiliation: Interdisciplinary Center Psychopathology and Emotion Regulation, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands.
authors.forename: K J
authors.initials: KJ
authors.lastname: Wardenaar
authors.affiliation: Office of Public Health, Department of Veterans Affairs, Washington, DC, USA.
authors.forename: R M
authors.initials: RM
authors.lastname: Bossarte
authors.affiliation: Departments of Physical Medicine and Rehabilitation, Psychiatry, and Neurology, University of Colorado, Anschutz Medical Campus, Aurora, Colorado; Rocky Mountain Mental Illness Research Education and Clinical Center, Denver, CO, USA.
authors.forename: L A
authors.initials: LA
authors.lastname: Brenner
authors.affiliation: Department of Biostatistics, Harvard School of Public Health, Boston, MA, USA.
authors.forename: T
authors.initials: T
authors.lastname: Cai
authors.affiliation: Department of Health Care Policy, Harvard Medical School, Boston, MA, USA.|Department of Psychology, Clinical Psychology and Psychotherapy, Friedrich-Alexander University Nuremberg-Erlangen, Erlangen, Germany.
authors.forename: D D
authors.initials: DD
authors.lastname: Ebert
authors.affiliation: Department of Health Care Policy, Harvard Medical School, Boston, MA, USA.
authors.forename: I
authors.initials: I
authors.lastname: Hwang
authors.affiliation: Department of Biostatistics, Harvard School of Public Health, Boston, MA, USA.
authors.forename: J
authors.initials: J
authors.lastname: Li
authors.affiliation: Interdisciplinary Center Psychopathology and Emotion Regulation, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands.
authors.forename: P
authors.initials: P
authors.lastname: de Jonge
authors.affiliation: Department of Psychiatry and Depression Clinical and Research Program, Harvard Medical School and Massachusetts General Hospital, Boston, MA, USA.
authors.forename: A A
authors.initials: AA
authors.lastname: Nierenberg
authors.affiliation: Department of Health Care Policy, Harvard Medical School, Boston, MA, USA.
authors.forename: M V
authors.initials: MV
authors.lastname: Petukhova
authors.affiliation: Department of Health Care Policy, Harvard Medical School, Boston, MA, USA.
authors.forename: A J
authors.initials: AJ
authors.lastname: Rosellini
authors.affiliation: Department of Health Care Policy, Harvard Medical School, Boston, MA, USA.
authors.forename: N A
authors.initials: NA
authors.lastname: Sampson
authors.affiliation: Interdisciplinary Center Psychopathology and Emotion Regulation, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands.
authors.forename: R A
authors.initials: RA
authors.lastname: Schoevers
authors.affiliation: Epidemiology, Janssen Research & Development, LLC, Titusville, NJ, USA.
authors.forename: M A
authors.initials: MA
authors.lastname: Wilcox
authors.affiliation: Department of Health Care Policy, Harvard Medical School, Boston, MA, USA.
authors.forename: A M
authors.initials: AM
authors.lastname: Zaslavsky
mesh_terms: D000293:Adolescent; D000328:Adult; D000465:Algorithms; D015897:Comorbidity; D003865:Major Depressive Disorder / Q000175:diagnosis*; D039721:Diagnostic and Statistical Manual of Mental Disorders; D018450:Disease Progression; D005260:Female; D005544:Forecasting / Q000379:methods*; D006801:Humans; D016015:Logistic Models; D008137:Longitudinal Studies; D000069550:Machine Learning; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D011446:Prospective Studies; D057566:Self Report; D012720:Severity of Illness Index; D011795:Surveys and Questionnaires