Identifying relapse predictors in individual participant data with decision trees

Lucas Böttcher, Josefien J. F. Breedvelt, Fiona C. Warren, Zindel Segal, Willem Kuyken, Claudi L. H. Bockting

Research output: Contribution to journalArticleAcademicpeer-review

Abstract

Background: Depression is a highly common and recurrent condition. Predicting who is at most risk of relapse or recurrence can inform clinical practice. Applying machine-learning methods to Individual Participant Data (IPD) can be promising to improve the accuracy of risk predictions. Methods: Individual data of four Randomized Controlled Trials (RCTs) evaluating antidepressant treatment compared to psychological interventions with tapering (N= 714) were used to identify predictors of relapse and/or recurrence. Ten baseline predictors were assessed. Decision trees with and without gradient boosting were applied. To study the robustness of decision-tree classifications, we also performed a complementary logistic regression analysis. Results: The combination of age, age of onset of depression, and depression severity significantly enhances the prediction of relapse risk when compared to classifiers solely based on depression severity. The studied decision trees can (i) identify relapse patients at intake with an accuracy, specificity, and sensitivity of about 55% (without gradient boosting) and 58% (with gradient boosting), and (ii) slightly outperform classifiers that are based on logistic regression. Conclusions: Decision tree classifiers based on multiple–rather than single–risk indicators may be useful for developing treatment stratification strategies. These classification models have the potential to contribute to the development of methods aimed at effectively prioritizing treatment for those individuals who require it the most. Our results also underline the existing gaps in understanding how to accurately predict depressive relapse.
Original languageEnglish
Article number835
JournalBMC psychiatry
Volume23
Issue number1
DOIs
Publication statusPublished - 1 Dec 2023

Keywords

  • Decision tree
  • Depression
  • Gradient boosting
  • Individual participant data
  • Logistic regression
  • Machine learning
  • Meta analysis
  • Relapse

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