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)
|
Text
193892.pdf - Published Version Available under License Creative Commons Attribution Non-commercial No Derivatives. 1MB |
Abstract
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 |
|---|---|
| Status: | Published |
| Refereed: | Yes |
| Glasgow Author(s) Enlighten ID: | Cavanagh, Professor Jonathan and Leighton, Dr Samuel and Gumley, Professor Andrew and Krishnadas, Dr Rajeev |
| 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 > School of Health & Wellbeing > Mental Health and Wellbeing College of Medical Veterinary and Life Sciences > School of Psychology & Neuroscience |
| Research Centre: | College of Medical Veterinary and Life Sciences > School of Infection & Immunity > Centre for Immunobiology |
| Journal Name: | Lancet Digital Health |
| Publisher: | Lancet Publishing Group |
| ISSN: | 2589-7500 |
| 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 |
University Staff: Request a correction | Enlighten Editors: Update this record
Funder and Project Information
Funder and Project Information