Data-based Decision Rules to Personalize Depression Follow-up

Sci Rep. 2018 Mar 22;8(1):5064. doi: 10.1038/s41598-018-23326-1.

Abstract

Depression is a common mental illness with complex and heterogeneous progression dynamics. Risk grouping of depression treatment population based on their longitudinal patterns has the potential to enable cost-effective monitoring policy design. This paper establishes a rule-based method to identify a set of risk predictive patterns from person-level longitudinal disease measurements by integrating the data transformation, rule discovery and rule evaluation. We further extend the identified rules to create rule-based monitoring strategies to adaptively monitor individuals with different disease severities. We applied the rule-based method on an electronic health record (EHR) dataset of depression treatment population containing person-level longitudinal Patient Health Questionnaire (PHQ)-9 scores for assessing depression severity. 12 risk predictive rules are identified, and the rule-based prognostic model based on identified rules enables more accurate prediction of disease severity than other prognostic models including RuleFit, logistic regression and Support Vector Machine. Two rule-based monitoring strategies outperform the latest PHQ-9 based monitoring strategy by providing higher sensitivity and specificity. The rule-based method can lead to a better understanding of disease dynamics, achieving more accurate prognostics of disease progressions, personalizing follow-up intervals, and designing cost-effective monitoring of patients in clinical practice.

MeSH terms

  • Adult
  • Aged
  • Cost-Benefit Analysis
  • Databases, Factual
  • Decision Support Systems, Clinical
  • Depression / diagnosis*
  • Depression / drug therapy
  • Depression / epidemiology*
  • Depression / physiopathology
  • Disease Progression
  • Electronic Health Records
  • Evaluation Studies as Topic
  • Female
  • Follow-Up Studies
  • Humans
  • Logistic Models
  • Longitudinal Studies
  • Male
  • Middle Aged
  • Monitoring, Physiologic
  • Precision Medicine*
  • Prognosis*
  • Risk Factors