Development and validation of multivariable prediction models of remission, recovery, and quality of life outcomes in people with first episode psychosis: a machine learning approach

Leighton, S. P. et al. (2019) Development and validation of multivariable prediction models of remission, recovery, and quality of life outcomes in people with first episode psychosis: a machine learning approach. Lancet Digital Health, 1(6), e261-e270. (doi: 10.1016/S2589-7500(19)30121-9)

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Background: Outcomes for people with first-episode psychosis are highly heterogeneous. Few reliable validated methods are available to predict the outcome for individual patients in the first clinical contact. In this study, we aimed to build multivariable prediction models of 1-year remission and recovery outcomes using baseline clinical variables in people with first-episode psychosis. Methods: In this machine learning approach, we applied supervised machine learning, using regularised regression and nested leave-one-site-out cross-validation, to baseline clinical data from the English Evaluating the Development and Impact of Early Intervention Services (EDEN) study (n=1027), to develop and internally validate prediction models at 1-year follow-up. We assessed four binary outcomes that were recorded at 1 year: symptom remission, social recovery, vocational recovery, and quality of life (QoL). We externally validated the prediction models by selecting from the top predictor variables identified in the internal validation models the variables shared with the external validation datasets comprised of two Scottish longitudinal cohort studies (n=162) and the OPUS trial, a randomised controlled trial of specialised assertive intervention versus standard treatment (n=578). Findings: The performance of prediction models was robust for the four 1-year outcomes of symptom remission (area under the receiver operating characteristic curve [AUC] 0·703, 95% CI 0·664–0·742), social recovery (0·731, 0·697–0·765), vocational recovery (0·736, 0·702–0·771), and QoL (0·704, 0·667–0·742; p<0·0001 for all outcomes), on internal validation. We externally validated the outcomes of symptom remission (AUC 0·680, 95% CI 0·587–0·773), vocational recovery (0·867, 0·805–0·930), and QoL (0·679, 0·522–0·836) in the Scottish datasets, and symptom remission (0·616, 0·553–0·679), social recovery (0·573, 0·504–0·643), vocational recovery (0·660, 0·610–0·710), and QoL (0·556, 0·481–0·631) in the OPUS dataset. Interpretation: In our machine learning analysis, we showed that prediction models can reliably and prospectively identify poor remission and recovery outcomes at 1 year for patients with first-episode psychosis using baseline clinical variables at first clinical contact. Funding: Lundbeck Foundation.

Item Type:Articles
Glasgow Author(s) Enlighten ID:Krishnadas, Dr Rajeev and Cavanagh, Professor Jonathan and Leighton, Dr Samuel and Gumley, Professor Andrew
Authors: Leighton, S. P., Upthegrove, R., Krishnadas, R., Benros, M. E., Broome, M. R., Gkoutos, G. V., Liddle, P. F., Singh, S. P., Everard, L., Jones, P. B., Fowler, D., Sharma, V., Freemantle, N., Christensen, R. H.B., Albert, N., Nordentoft, M., Schwannauer, M., Cavanagh, J., Gumley, A. I., Birchwood, M., and Mallikarjun, P. K.
College/School:College of Medical Veterinary and Life Sciences > Institute of Health and Wellbeing > Mental Health and Wellbeing
College of Medical Veterinary and Life Sciences > School of Psychology & Neuroscience
Journal Name:Lancet Digital Health
Publisher:Lancet Publishing Group
ISSN (Online):2589-7500
Published Online:12 September 2019
Copyright Holders:Copyright © 2019 The Authors
First Published:First published in Lancet Digital Health 1(6): e261-e270
Publisher Policy:Reproduced under a Creative Commons License

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Project CodeAward NoProject NamePrincipal InvestigatorFunder's NameFunder RefLead Dept
410331Glasgow Edinburgh First Episode Study - how does engagement with services mediate symptomatic, emotional and quality of life outcomes.Andrew GumleyChief Scientist office (CSO)CZH/4/295IHW - MENTAL HEALTH & WELLBEING
552571Implementing improvement strategies based on an Integrated Care Pathway for Early Psychosis.Andrew GumleyChief Scientist office (CSO)CZH/3/5IHW - MENTAL HEALTH & WELLBEING
657471Consortium of Neuroimmunology of Mood Disorders and Alzheimer's DiseaseJonathan CavanaghWellcome Trust (WELLCOTR)104025/Z/14/ZIHW - MENTAL HEALTH & WELLBEING