Background: Reliable prediction models of treatment outcome in Major Depressive Disorder (MDD) are currently lacking in clinical practice. Data-driven outcome definitions, combining data from multiple modalities and incorporating clinician expertise might improve predictions.
Methods: We used unsupervised machine learning to identify treatment outcome classes in 1060 MDD inpatients. Subsequently, classification models were created on clinical and biological baseline information to predict treatment outcome classes and compared to the performance of two widely used classical outcome definitions. We also related the findings to results from an online survey that assessed which information clinicians use for outcome prognosis.
Results: Three and four outcome classes were identified by unsupervised learning. However, data-driven outcome classes did not result in more accurate prediction models. The best prediction model was targeting treatment response in its standard definition and reached accuracies of 63.9 % in the test sample, and 59.5 % and 56.9 % in the validation samples. Top predictors included sociodemographic and clinical characteristics, while biological parameters did not improve prediction accuracies. Treatment history, personality factors, prior course of the disorder, and patient attitude towards treatment were ranked as most important indicators by clinicians.
Limitations: Missing data limited the power to identify biological predictors of treatment outcome from certain modalities.
Conclusions: So far, the inclusion of available biological measures in addition to psychometric and clinical information did not improve predictive value of the models, which was overall low. Optimized biomarkers, stratified predictions and the inclusion of clinical expertise may improve future prediction models.
Keywords: Clinical expertise; Clustering; Major depressive disorder; Personalized psychiatry; Predictive modeling; Treatment outcome.
Copyright © 2023 Elsevier B.V. All rights reserved.