Individualized prediction of three- and six-year outcomes of psychosis in a longitudinal multicenter study: a machine learning approach

Jessica de Nijs, Thijs J. Burger, GROUP investigators, Ronald J. Janssen, Seyed Mostafa Kia, Daniël P.J. van Opstal, Mariken B. de Koning, Lieuwe de Haan, Wiepke Cahn, Hugo G. Schnack*

*Corresponding author for this work

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Schizophrenia and related disorders have heterogeneous outcomes. Individualized prediction of long-term outcomes may be helpful in improving treatment decisions. Utilizing extensive baseline data of 523 patients with a psychotic disorder and variable illness duration, we predicted symptomatic and global outcomes at 3-year and 6-year follow-ups. We classified outcomes as (1) symptomatic: in remission or not in remission, and (2) global outcome, using the Global Assessment of Functioning (GAF) scale, divided into good (GAF ≥ 65) and poor (GAF < 65). Aiming for a robust and interpretable prediction model, we employed a linear support vector machine and recursive feature elimination within a nested cross-validation design to obtain a lean set of predictors. Generalization to out-of-study samples was estimated using leave-one-site-out cross-validation. Prediction accuracies were above chance and ranged from 62.2% to 64.7% (symptomatic outcome), and 63.5–67.6% (global outcome). Leave-one-site-out cross-validation demonstrated the robustness of our models, with a minor drop in predictive accuracies of 2.3% on average. Important predictors included GAF scores, psychotic symptoms, quality of life, antipsychotics use, psychosocial needs, and depressive symptoms. These robust, albeit modestly accurate, long-term prognostic predictions based on lean predictor sets indicate the potential of machine learning models complementing clinical judgment and decision-making. Future model development may benefit from studies scoping patient’s and clinicians' needs in prognostication.

Original languageEnglish
Article number34
Journalnpj Schizophrenia
Issue number1
Publication statusPublished - 2 Jul 2021
Externally publishedYes

Bibliographical note

Funding Information:
We are grateful for the generosity of time and effort by the patients, their families and healthy subjects. Furthermore, we would like to thank all research personnel involved in the GROUP project, in particular: Joyce van Baaren, Erwin Veermans, Ger Driessen, Truda Driesen, Erna van’t Hag. The infrastructure for the GROUP study is funded through the Geestkracht program of the Dutch Health Research Council (Zon-Mw, grant number 10-000-1001), and matching funds from participating pharmaceutical companies (Lundbeck, AstraZeneca, Eli Lilly, Janssen Cilag) and universities and mental health care organizations (Amsterdam: Academic Psychiatric Centre of the Academic Medical Center and the mental health institutions: GGZ Ingeest, Arkin, Dijk en Duin, GGZ Rivierduinen, Erasmus Medical Centre, GGZ Noord Holland Noord. Groningen: University Medical Center Groningen and the mental health institutions: Lentis, GGZ Friesland, GGZ Drenthe, Dimence, Mediant, GGNet Warnsveld, Yulius Dordrecht and Parnassia psycho-medical center The Hague. Maastricht: Maastricht University Medical Centre and the mental health institutions: GGzE, GGZ Breburg, GGZ Oost-Brabant, Vincent van Gogh voor Geestelijke Gezondheid, Mondriaan, Virenze riagg, Zuyderland GGZ, MET ggz, Universitair Centrum Sint-Jozef Kortenberg, CAPRI University of Antwerp, PC Ziekeren Sint-Truiden, PZ Sancta Maria Sint-Truiden, GGZ Overpelt, OPZ Rekem. Utrecht: University Medical Center Utrecht and the mental health institutions Altrecht, GGZ Centraal and Delta.)

Funding Information:
L.H. has received research funding form Eli Lilly and honoraria for educational programs from Eli Lilly, Jansen Cilag, BMS, Astra Zeneca. R.K. is or has been a member of DSMB for Janssen, Otsuka, Sunovion. and Roche. W.C. is or has been an unrestricted research grant holder with, or has received financial compensation as an independent symposium speaker or as an consultant from, Eli Lilly, BMS, Lundbeck, Sanofi-Aventis, Janssen-Cilag, AstraZeneca and Schering-Plough. I.M.-G. is an unrestricted research grant holder with Janssen-Cilag and has received financial compensation as an independent symposium speaker from Eli Lilly, BMS, Lundbeck, and Janssen-Cilag. All other authors report no potential competing interests.

Publisher Copyright:
© 2021, The Author(s).


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