Opioid-related variables did not improve suicide risk prediction models in samples with mental health diagnoses
Yarborough BJH, Stumbo SP, Rosales AG, Ahmedani BK, Boggs JM, Daida YG, Negriff S, Rossom RC, Simon G, and Perrin NA. Opioid-related variables did not improve suicide risk prediction models in samples with mental health diagnoses. J Affect Disord Rep 2022; 8
J Affect Disord Rep
BACKGROUND: Suicide risk prediction models derived from machine learning of electronic health records and insurance claims are an innovation in suicide prevention. Some models do not include opioid-related variables despite the relationship between opioids and suicide. This study evaluated whether inclusion of opioid-related variables improved suicide risk prediction models developed by the Mental Health Research Network.
METHODS: Approximately 630 opioid-related variables and interactions terms were introduced into existing suicide prediction models run in datasets of patient visits in mental health care (n = 27,755,401 visits) or primary care when a mental health diagnosis was given (n = 19,340,461 visits). Training and validation datasets were created. LASSO regression with 10-fold validation identified variables to be added to the models.
RESULTS: The new models predicting suicide attempts and suicide deaths in the mental health specialty visit sample performed as well as the existing models (new C-statistic for attempts model = 0.855, CI: 0.853-0.857 versus original C-statistic = 0.851, CI 0.848-0.853; death model = 0.868, CI: 0.856-0.879 versus 0.861, CI 0.848-0.875). The new model for suicide death in the primary care sample improved (0.855, CI: 0.837-0.874 versus 0.833, CI 0.813-0.853) while performance of the new model for suicide attempt in that sample degraded (0.843, CI: 0.839-0.847 versus 0.853, CI 0.849-0.857).
LIMITATIONS: Analyses did not include patients without recent care, data did not include illicit opioid use or unrecognized opioid use disorder.
CONCLUSIONS: Among patients with mental health diagnoses, inclusion of opioid-related variables did not improve prediction of suicide risk beyond mental health predictors.