Publication Summary
AimsTo develop, validate, and compare the performance of nine models predicting post-treatment outcomes for depressed adults based on pre-treatment data. MethodsIndividual patient data from all six eligible RCTs were used to develop (k=3, n=1722) and test (k=3, n=1136) nine models. Predictors included depressive and anxiety symptoms, social support, life events and alcohol use. Weighted sum-scores were developed using coefficient weights derived from network centrality statistics (Models 1-3) and factor loadings from a confirmatory factor analysis (Model 4). Unweighted sum-score models were tested using Elastic Net Regularized (ENR) and ordinary least squares (OLS) regression (Models 5-6). Individual items were then included in ENR and OLS (Models 7-8). All models were compared to one another and to a null model using the mean post-baseline BDI-II score in the training data (Model 9). Primary outcome: BDI-II scores at 3-4 months. ResultsModels 1-7 all outperformed the null model. Individual-item models (particularly Model 8) explained less variance. Model performance was very similar across models 1-6, meaning that differential weights applied to the baseline sum-scores had little impact. ConclusionsAny of the modelling techniques (1-7) could be used to inform prognostic predictions for depressed adults with differences in the proportions of patients reaching remission based on the predicted severity of depressive symptoms post-treatment. However, the majority of variance in prognosis remained unexplained. It may be necessary to include a broader range of biopsychosocial variables to better adjudicate between competing models, and to derive models with greater clinical utility for treatment-seeking adults with depression.
CAER Authors
Prof. Simon Gilbody
University of York - Director of the Mental Health and Addictions Research Group