Abstract

BackgroundCourse of illness in major depression (MD) is highly varied, which might lead to both under- and overtreatment if clinicians adhere to a 'one-size-fits-all' approach. Novel opportunities in data mining could lead to prediction models that can assist clinicians in treatment decisions tailored to the individual patient. This study assesses the performance of a previously developed data mining algorithm to predict future episodes of MD based on clinical information in new data. MethodsWe applied a prediction model utilizing baseline clinical characteristics in subjects who reported lifetime MD to two independent test samples (total n = 4226). We assessed the model's performance to predict future episodes of MD, anxiety disorders, and disability during follow-up (1–9 years after baseline). In addition, we compared its prediction performance with well-known risk factors for a severe course of illness. ResultsOur model consistently predicted future episodes of MD in both test samples (AUC 0.68–0.73, modest prediction). Equally accurately, it predicted episodes of generalized anxiety disorder, panic disorder and disability (AUC 0.65–0.78). Our model predicted these outcomes more accurately than risk factors for a severe course of illness such as family history of MD and lifetime traumas. LimitationsPrediction accuracy might be different for specific subgroups, such as hospitalized patients or patients with a different cultural background. ConclusionsOur prediction model consistently predicted a range of adverse outcomes in MD across two independent test samples derived from studies in different subpopulations, countries, using different measurement procedures. This replication study holds promise for application in clinical practice.

Highlights

  • The course of major depression (MD) can be highly varied (Eaton et al, 2008), which may lead to either over- or undertreatment in clinical practice if a generic treatment regimen is adopted

  • We previously developed a prediction model for recurrence of MD based on a large number of clinical characteristics at baseline, using training data from a longitudinal study of male-male and male-female twin pairs from the Virginia Adult Twin Study of Psychiatric and Substance Use Disorders (VATSPSUD)

  • Whereas VATSPSUD is based on birth records of twins in Virginia (Kendler and Prescott, 2006), Netherlands Study of Depression and Anxiety (NESDA) sampled from the general population, primary care, and specialized mental health care (Penninx et al, 2008)

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Summary

Introduction

The course of major depression (MD) can be highly varied (Eaton et al, 2008), which may lead to either over- or undertreatment in clinical practice if a generic treatment regimen is adopted. Results: Our model consistently predicted future episodes of MD in both test samples (AUC 0.68–0.73, modest prediction) Accurately, it predicted episodes of generalized anxiety disorder, panic disorder and disability (AUC 0.65–0.78). It predicted episodes of generalized anxiety disorder, panic disorder and disability (AUC 0.65–0.78) Our model predicted these outcomes more accurately than risk factors for a severe course of illness such as family history of MD and lifetime traumas. Conclusions: Our prediction model consistently predicted a range of adverse outcomes in MD across two independent test samples derived from studies in different subpopulations, countries, using different measurement procedures. This replication study holds promise for application in clinical practice

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