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预测青少年抑郁症患者非自杀性自伤的列线图:一项纵向分析

A nomogram for predicting non-suicide self-injury in youth depression patients: a longitudinal analysis.

作者信息

Li Yingwen, Ma Yarong, Sun Bin, Rosenheck Robert, Zhang Jie, He Hongbo

机构信息

The Affiliated Brain Hospital, Guangzhou Medical University, Guangzhou, China.

Department of Psychiatry, Yale School of Medicine, New Haven, CT, USA.

出版信息

Eur Child Adolesc Psychiatry. 2024 Nov 18. doi: 10.1007/s00787-024-02603-7.

Abstract

Non-suicidal self-injury (NSSI) behavior is a common issue in youth with depression while lacks a prognostic prediction model. This study aims to develop a nomogram for NSSI in youth with depression. A total of 701 patients were included in the analysis based a youth depression cohort. They were further divided into a training set and a validation set. The Lasso regression and binary logistic regression were used to select variables for the nomogram. The nomogram's discrimination, calibration, accuracy, clinical applicability, and generalization involved the use of metrics such as the area under the receiver operating characteristic curve (ROC), Hosmer-Lemeshow (HL) test, Brier score, calibration curve, decision curve analysis (DCA), and internal validation. The Delong test was employed to compare the ROC performance between the two models. These patients had an average age of 19.3+/-3.3 years, and 101 (20.6%) individuals reported NSSI. Five risk factors for NSSI were identified: age, age at first medication, previous instances of NSSI, academic stress score in the Adolescent Self-rating Life Events Check List (ASLEC), and somatic anxiety of the 14 item Hamilton Anxiety Rating Scale (HAMA-14). The training set and validation set of binary logistic regression-based model showed good discrimination (area under the curve (AUC) 0.781, 95% CI: 0.735 ~ 0.827; and 0.757, 95% CI: 0.682 ~ 0.831, respectively), calibration (P = 0.421 and 0.175, respectively), and accuracy (Brier score 0.119 to 0.155 and 0.109 to 0.168, respectively). A prognostic nomogram was developed and validated to assist clinicians in predicting NSSI of youth with depression.

摘要

非自杀性自伤(NSSI)行为是青少年抑郁症患者中的常见问题,但目前缺乏预后预测模型。本研究旨在为青少年抑郁症患者的NSSI行为建立列线图。基于一个青少年抑郁症队列,共纳入701例患者进行分析。他们被进一步分为训练集和验证集。使用Lasso回归和二元逻辑回归为列线图选择变量。列线图的区分度、校准度、准确性、临床适用性和泛化性涉及使用受试者操作特征曲线(ROC)下面积、Hosmer-Lemeshow(HL)检验、Brier评分、校准曲线、决策曲线分析(DCA)和内部验证等指标。采用Delong检验比较两个模型的ROC性能。这些患者的平均年龄为19.3±3.3岁,101例(20.6%)报告有NSSI行为。确定了NSSI的五个危险因素:年龄、首次用药年龄、既往NSSI行为史、青少年自评生活事件量表(ASLEC)中的学业压力得分以及14项汉密尔顿焦虑量表(HAMA-14)中的躯体焦虑得分。基于二元逻辑回归模型的训练集和验证集显示出良好的区分度(曲线下面积(AUC)分别为0.781,95%CI:0.735~0.827;和0.757,95%CI:0.682~0.831)、校准度(P值分别为0.421和0.175)和准确性(Brier评分分别为0.119至0.155和0.109至0.168)。开发并验证了一个预后列线图,以帮助临床医生预测青少年抑郁症患者的NSSI行为。

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