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High dimensional predictions of suicide risk in 4.2 million US Veterans using ensemble transfer learning

  • Sayera Dhaubhadel,
  • Kumkum Ganguly,
  • Ruy M. Ribeiro,
  • Judith D. Cohn,
  • James M. Hyman,
  • Nicolas W. Hengartner,
  • Beauty Kolade,
  • Anna Singley,
  • Tanmoy Bhattacharya,
  • Patrick Finley,
  • Drew Levin,
  • Haedi Thelen,
  • Kelly Cho,
  • Lauren Costa,
  • Yuk-Lam Ho,
  • Amy C. Justice,
  • John Pestian,
  • Daniel Santel,
  • Rafael Zamora-Resendiz,
  • Silvia Crivelli,
  • Suzanne Tamang,
  • Susana Martins,
  • Jodie Trafton,
  • David W. Oslin,
  • Jean C. Beckham,
  • Nathan A. Kimbrel,
  • Khushbu Agarwal,
  • Allison E. Ashley-Koch,
  • Mihaela Aslan,
  • Edmond Begoli,
  • Ben Brown,
  • Patrick S. Calhoun,
  • Kei-Hoi Cheung,
  • Sutanay Choudhury,
  • Ashley M. Cliff,
  • Leticia Cuellar-Hengartner,
  • Haedi E. Deangelis,
  • Michelle F. Dennis,
  • Patrick D. Finley,
  • Michael R. Garvin,
  • Joel E. Gelernter,
  • Lauren P. Hair,
  • Colby Ham,
  • Phillip D. Harvey,
  • Elizabeth R. Hauser,
  • Michael A. Hauser,
  • Nick W. Hengartner,
  • Daniel A. Jacobson,
  • Jessica Jones,
  • Piet C. Jones,
  • David Kainer,
  • Alan D. Kaplan,
  • Ira R. Katz,
  • Rachel L. Kember,
  • Angela C. Kirby,
  • John C. Ko,
  • John Lagergren,
  • Matthew Lane,
  • Daniel F. Levey,
  • Jennifer H. Lindquist,
  • Xianlian Liu,
  • Ravi K. Madduri,
  • Carrie Manore,
  • Carianne Martinez,
  • John F. McCarthy,
  • Mikaela McDevitt Cashman,
  • J. Izaak Miller,
  • Destinee Morrow,
  • Mirko Pavicic-Venegas,
  • Saiju Pyarajan,
  • Xue J. Qin,
  • Nallakkandi Rajeevan,
  • Christine M. Ramsey,
  • Ruy Ribeiro,
  • Alex Rodriguez,
  • Jonathon Romero,
  • Yunling Shi,
  • Murray B. Stein,
  • Kyle A. Sullivan,
  • Ning Sun,
  • Suzanne R. Tamang,
  • Alice Townsend,
  • Jodie A. Trafton,
  • Angelica Walker,
  • Xiange Wang,
  • Victoria Wangia-Anderson,
  • Renji Yang,
  • Shinjae Yoo,
  • Hongyu Zhao,
  • Benjamin H. McMahon

摘要

We present an ensemble transfer learning method to predict suicide from Veterans Affairs (VA) electronic medical records (EMR). A diverse set of base models was trained to predict a binary outcome constructed from reported suicide, suicide attempt, and overdose diagnoses with varying choices of study design and prediction methodology. Each model used twenty cross-sectional and 190 longitudinal variables observed in eight time intervals covering 7.5 years prior to the time of prediction. Ensembles of seven base models were created and fine-tuned with ten variables expected to change with study design and outcome definition in order to predict suicide and combined outcome in a prospective cohort. The ensemble models achieved c-statistics of 0.73 on 2-year suicide risk and 0.83 on the combined outcome when predicting on a prospective cohort of \(\sim\)  4.2 M veterans. The ensembles rely on nonlinear base models trained using a matched retrospective nested case-control (Rcc) study cohort and show good calibration across a diversity of subgroups, including risk strata, age, sex, race, and level of healthcare utilization. In addition, a linear Rcc base model provided a rich set of biological predictors, including indicators of suicide, substance use disorder, mental health diagnoses and treatments, hypoxia and vascular damage, and demographics.