Department of Psychosomatic Medicine and Psychotherapy, University Medical Center Hamburg-Eppendorf and Schön Klinik Hamburg Eilbek, Hamburg, Germany; Psychological Methods, Faculty for Psychology and Human Movement Science, University of Hamburg, Hamburg, Germany.
Department of Psychosomatic Medicine and Psychotherapy, University Medical Center Hamburg-Eppendorf and Schön Klinik Hamburg Eilbek, Hamburg, Germany.
Gen Hosp Psychiatry. 2018 Mar-Apr;51:106-111. doi: 10.1016/j.genhosppsych.2018.02.002. Epub 2018 Feb 2.
OBJECTIVE: To obtain predictors of suicidal ideation, which can also be used for an indirect assessment of suicidal ideation (SI). To create a classifier for SI based on variables of the Patient Health Questionnaire (PHQ) and sociodemographic variables, and to obtain an upper bound on the best possible performance of a predictor based on those variables. METHODS: From a consecutive sample of 9025 primary care patients, 6805 eligible patients (60% female; mean age = 51.5 years) participated. Advanced methods of machine learning were used to derive the prediction equation. Various classifiers were applied and the area under the curve (AUC) was computed as a performance measure. RESULTS: Classifiers based on methods of machine learning outperformed ordinary regression methods and achieved AUCs around 0.87. The key variables in the prediction equation comprised four items - namely feelings of depression/hopelessness, low self-esteem, worrying, and severe sleep disturbances. The generalized anxiety disorder scale (GAD-7) and the somatic symptom subscale (PHQ-15) did not enhance prediction substantially. CONCLUSIONS: In predicting suicidal ideation researchers should refrain from using ordinary regression tools. The relevant information is primarily captured by the depression subscale and should be incorporated in a nonlinear model. For clinical practice, a classification tree using only four items of the whole PHQ may be advocated.
目的:寻找自杀意念的预测指标,这些指标也可间接评估自杀意念(SI)。基于患者健康问卷(PHQ)的变量和社会人口学变量创建一个用于自杀意念的分类器,并获得基于这些变量的最佳预测性能的上限。
方法:从连续的 9025 名初级保健患者中抽取样本,6805 名符合条件的患者(60%为女性;平均年龄 51.5 岁)参与了研究。使用机器学习的高级方法推导出预测方程。应用了各种分类器,并计算了曲线下面积(AUC)作为性能指标。
结果:基于机器学习方法的分类器优于普通回归方法,达到了约 0.87 的 AUC。预测方程中的关键变量包括四个项目——即抑郁/绝望感、低自尊、担忧和严重的睡眠障碍。广泛性焦虑障碍量表(GAD-7)和躯体症状子量表(PHQ-15)并没有显著提高预测能力。
结论:在预测自杀意念方面,研究人员应避免使用普通回归工具。相关信息主要由抑郁子量表捕捉,应纳入非线性模型。对于临床实践,提倡仅使用 PHQ 的四个项目的分类树。
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