Predicting Outcomes of Antidepressant Treatment in Community Practice Settings

• Published in: Psychiatric services (Washington, D.C.) Vol. 75; no. 5; pp. 419 - 426
• Main Authors: Simon, Gregory E, Cruz, Maricela, Boggs, Jennifer M, Beck, Arne, Shortreed, Susan M, Coley, R Yates
• Format: Journal Article
• Language: English
• Published: United States American Psychiatric Publishing, Inc 01-05-2024
• Subjects: Adult; Aged; Antidepressants; Antidepressive Agents - therapeutic use; Clinical outcomes; Community Mental Health Services - statistics & numerical data; Depressive Disorder - drug therapy; Electronic health records; Electronic Health Records - statistics & numerical data; Female; Humans; Machine Learning; Male; Middle Aged; Outcome Assessment, Health Care - statistics & numerical data; Patient Health Questionnaire; Predictions; Washington; Young Adult; Washington; Depression; Antidepressants; Epidemiology; Statistics; Machine learning
• ISSN: 1075-2730; 1557-9700
• DOI: 10.1176/appi.ps.20230380

The authors examined whether machine-learning models could be used to analyze data from electronic health records (EHRs) to predict patients' responses to antidepressant medications.
EHR data from a Washington State health system identified patients ages ≥13 years who started an antidepressant medication in 2016 in a community practice setting and had a baseline Patient Health Questionnaire-9 (PHQ-9) score of ≥10 and at least one PHQ-9 score recorded 14-180 days later. Potential predictors of a response to antidepressants were extracted from the EHR and included demographic characteristics, psychiatric and substance use diagnoses, past psychiatric medication use, mental health service use, and past PHQ-9 scores. Random-forest and penalized regression analyses were used to build models predicting follow-up PHQ-9 score and a favorable treatment response (≥50% improvement in score).
Among 2,469 patients starting antidepressant medication treatment, the mean±SD baseline PHQ-9 score was 17.3±4.5, and the mean lowest follow-up score was 9.2±5.9. Outcome data were available for 72% of the patients. About 48% of the patients had a favorable treatment response. The best-fitting random-forest models yielded a correlation between predicted and observed follow-up scores of 0.38 (95% CI=0.32-0.45) and an area under the receiver operating characteristic curve for a favorable response of 0.57 (95% CI=0.52-0.61). Results were similar for penalized regression models and for models predicting last PHQ-9 score during follow-up.
Prediction models using EHR data were not accurate enough to inform recommendations for or against starting antidepressant medication. Personalization of depression treatment should instead rely on systematic assessment of early outcomes.