Temerty Centre for Therapeutic Brain Intervention, Centre for Addiction and Mental Health, Toronto, Canada; Department of Psychiatry, University of Toronto, Toronto, Canada.
Department of Psychiatry, University of Toronto, Toronto, Canada; Institute of Health Policy Management and Evaluation, University of Toronto, Toronto, ON, Canada; Women's College Hospital, Toronto, Canada.
J Psychiatr Res. 2021 May;137:7-13. doi: 10.1016/j.jpsychires.2021.02.031. Epub 2021 Feb 16.
Mental illnesses are chronic conditions in which an individual will often experience recurrent outcomes such as hospitalization, symptomatic relapse or self-harm behaviours. Most clinical research in psychiatry considers only the first event, and does not analyze subsequent recurrent events. Methods exist to analyze recurrent events; however, these methods are underused in the psychiatric research literature. This review identifies that recurrent events can be analyzed using a time homogenous or time-to-recurrent-event (TTRE) framework. The TTRE framework is underutilized in psychiatric research; however, this framework allows for longitudinal observations that are more congruent with the chronic nature of psychiatric illness than typical first event analyses. There are several readily available statistical models using the TTRE framework extending the standard Cox proportional hazards model. Our decision tool outlines four aspects of a research question to consider when selecting a TTRE model: (1) importance of event timing, (2) explanatory vs predictive, (3) common vs event-specific hazard, and (4) correlation of events within an individual. Analyzing recurrent events in psychiatric research provides an opportunity to address research questions aimed at understanding the longitudinal course of a chronic condition. These approaches may provide novel insights into risk factors or interventions for psychiatric illness, and ultimately improved outcomes for these chronic conditions.
精神疾病是一种慢性疾病，个体通常会经历反复发作的情况，如住院、症状复发或自残行为。大多数精神病学的临床研究只考虑首次事件，而不分析随后的反复发作事件。虽然存在分析反复发作事件的方法，但这些方法在精神科研究文献中未得到充分应用。本综述确定可以使用时间同质或时间至复发事件（TTRE）框架来分析反复发作事件。TTRE 框架在精神科研究中未得到充分利用；然而，该框架允许进行更符合精神疾病慢性性质的纵向观察，而不是典型的首次事件分析。有几种现成的统计模型可使用 TTRE 框架扩展标准 Cox 比例风险模型。我们的决策工具概述了在选择 TTRE 模型时需要考虑的研究问题的四个方面：（1）事件时间的重要性，（2）解释性与预测性，（3）常见与特定于事件的风险，以及（4）个体内部事件的相关性。分析精神科研究中的反复发作事件为解决旨在了解慢性疾病纵向过程的研究问题提供了机会。这些方法可能为精神疾病的风险因素或干预措施提供新的见解，并最终改善这些慢性疾病的结果。
