Papst Lilia, Köllner Volker
Psychosomatic Rehabilitation Research Group, Department of Psychosomatic Medicine, Center for Internal Medicine and Dermatology, Charité University Medicine Berlin, Berlin, Germany.
Department of Psychosomatics and Behavioural Psychotherapy, Rehabilitation Centre Seehof, Teltow, Germany.
Front Psychiatry. 2022 Oct 20;13:1039914. doi: 10.3389/fpsyt.2022.1039914. eCollection 2022.
Psychiatric disorders increasingly contribute to disability and early retirement. This study was conducted to investigate whether machine learning can contribute to a better understanding and assessment of such a reduced earning capacity. It analyzed whether impaired earning capacity is reflected in missing treatment effects, and which interventions drive treatment effects during psychosomatic rehabilitation. Analyses were based on routine clinical data encompassing demographics, diagnoses, psychological questionnaires before, and after treatment, interventions, and an interdisciplinary assessment of earning capacity for = 1,054 patients undergoing psychosomatic rehabilitation in 2019. Classification of patients by changes in self-reported mental health and interventions predictive of changes were analyzed by gradient boosted model. Clustering results revealed three major groups, one of which was comprised almost exclusively of patients with full earning capacity, one of patients with reduced or lost earning capacity and a third group with mixed assessments. Classification results (Kappa = 0.22) indicated that patients experienced modestly divergent changes over the course of rehabilitation. Relative variable influence in the best model was highest for changes in psychological wellbeing (HEALTH-49). Regression analysis identified intervention A620 (physical exercise therapy with psychological goal setting) as most influential variable predicting changes in psychological wellbeing with a model fit of = 0.05 ( = 0.007). Results suggest that disability due to psychiatric disorders does associate with distinct demographic and clinical characteristics but may be less clear-cut in a subgroup of patients. Trajectories of treatment response show moderately divergent paths between patient groups. Moreover, results support both physical exercise therapy as efficient intervention in reducing disability-associated impairments and the complementarity of a multimodal treatment plan.
精神疾病对残疾和提前退休的影响日益增加。本研究旨在调查机器学习是否有助于更好地理解和评估这种收入能力下降的情况。它分析了收入能力受损是否反映在治疗效果不佳上,以及在身心康复过程中哪些干预措施推动了治疗效果。分析基于常规临床数据,包括人口统计学、诊断、治疗前后的心理问卷、干预措施以及对2019年接受身心康复治疗的1054名患者的收入能力进行的跨学科评估。通过梯度提升模型分析了根据自我报告的心理健康变化对患者进行的分类以及预测变化的干预措施。聚类结果显示出三个主要组,其中一组几乎完全由具有完全收入能力的患者组成,一组是收入能力降低或丧失的患者,第三组是评估结果混合的患者。分类结果(卡帕值=0.22)表明,患者在康复过程中经历了适度不同的变化。在最佳模型中,心理健康变化(HEALTH-49)的相对变量影响最大。回归分析确定干预措施A620(设定心理目标的体育锻炼疗法)是预测心理健康变化的最具影响力变量,模型拟合度为R² = 0.05(p = 0.007)。结果表明,精神疾病导致的残疾确实与不同的人口统计学和临床特征相关,但在一部分患者中可能不太明确。治疗反应轨迹显示患者组之间的路径有适度差异。此外,结果支持体育锻炼疗法作为减少与残疾相关损伤的有效干预措施,以及多模式治疗计划的互补性。