目的:心理社会康复(PSR)是精神病康复的核心。关于患者的需求和特征如何指导临床决策参考PSR干预措施的证据很少。这里,我们使用可解释的机器学习方法来确定社会人口统计学和临床特征如何影响严重精神疾病患者的PSR干预措施.
方法:数据来自法国康复中心网络,REHABase,在2016年至2022年之间收集,并在2022年2月至9月之间进行分析。参与者患有严重的精神疾病,包括精神分裂症谱系障碍,双相情感障碍,自闭症谱系障碍,抑郁症,焦虑症和人格障碍。在基线时从37个社会人口统计学和临床变量中提取信息,并将其用作潜在的预测因子。测试了几种机器学习模型,以预测对四种PSR干预的初始推荐:认知行为治疗(CBT),认知修复(CR),心理教育(PE)和职业培训(VT)。预测因子的解释能力是使用基于人工智能的SHAP(SHapley加法扩张)方法从最佳性能算法中确定的。
结果:纳入了总共1146例患者的数据(平均年龄,33.2年[范围,16-72岁];366名[39.2%]女性)。随机森林算法表现出最佳的预测性能,具有中等或平均预测精度[来自外部交叉验证的接收器工作曲线下的微平均面积:0.672]。SHAP依赖性图显示了社会人口统计学和临床预测因子与推荐PSR计划之间的深刻关联。例如,精神病患者更有可能被称为PE和CR,而那些非精神病性障碍患者更有可能被称为CBT和VT。同样,社会功能障碍和缺乏教育程度的患者更有可能被转诊至CR和VT,而那些功能和教育更好的人更有可能被称为CBT和体育。
结论:社会人口统计学和临床特征的组合不足以准确预测法国康复中心网络中四个PSR计划的初始转诊。对PSR干预的转介也可能涉及服务和临床医生水平的因素。考虑到社会人口统计学和临床预测因素,在转诊方面存在差异。目前的临床和心理问题,功能和教育。
OBJECTIVE: Psychosocial rehabilitation (PSR) is at the core of psychiatric recovery. There is a paucity of evidence regarding how the needs and characteristics of patients guide clinical decisions to refer to PSR interventions. Here, we used explainable machine learning methods to determine how socio-demographic and clinical characteristics contribute to initial
referrals to PSR interventions in patients with serious mental illness.
METHODS: Data were extracted from the French network of rehabilitation centres, REHABase, collected between years 2016 and 2022 and analysed between February and September 2022. Participants presented with serious mental illnesses, including schizophrenia spectrum disorders, bipolar disorders, autism spectrum disorders, depressive disorders, anxiety disorders and personality disorders. Information from 37 socio-demographic and clinical variables was extracted at baseline and used as potential predictors. Several machine learning models were tested to predict initial
referrals to four PSR interventions: cognitive behavioural therapy (CBT), cognitive remediation (CR), psychoeducation (PE) and vocational training (VT). Explanatory power of predictors was determined using the artificial intelligence-based SHAP (SHapley Additive exPlanations) method from the best performing algorithm.
RESULTS: Data from a total of 1146 patients were included (mean age, 33.2 years [range, 16-72 years]; 366 [39.2%] women). A random forest algorithm demonstrated the best predictive performance, with a moderate or average predictive accuracy [micro-averaged area under the receiver operating curve from \'external\' cross-validation: 0.672]. SHAP dependence plots demonstrated insightful associations between socio-demographic and clinical predictors and referrals to PSR programmes. For instance, patients with psychotic disorders were more likely to be referred to PE and CR, while those with non-psychotic disorders were more likely to be referred to CBT and VT. Likewise, patients with social dysfunctions and lack of educational attainment were more likely to be referred to CR and VT, while those with better functioning and education were more likely to be referred to CBT and PE.
CONCLUSIONS: A combination of socio-demographic and clinical features was not sufficient to accurately predict initial
referrals to four PSR programmes among a French network of rehabilitation centres.
Referrals to PSR interventions may also involve service- and clinician-level factors. Considering socio-demographic and clinical predictors revealed disparities in
referrals with respect to diagnoses, current clinical and psychological issues, functioning and education.