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Using Machine Learning Imputed Outcomes to Assess Drug-Dependent Risk of Self-Harm in Patients with Bipolar Disorder:
Anastasiya Nestsiarovich1, Praveen Kumar2, Nicolas Raymond Lauve2
1Center for Global Health, Department of Internal Medicine, University of New Mexico Health Sciences Center, Albuquerque, NM, United States.
JMIR Mental Health
|March 10, 2021
Summary
This study found that certain antidepressants, mood-stabilizing anticonvulsants (MSAs), and psychotherapy effectively prevent self-harm in bipolar disorder (BD). Some drug combinations increased self-harm risk compared to lithium.
Area of Science:
- Psychiatry
- Pharmacology
- Health Informatics
Background:
- Observational studies on self-harm prevention in bipolar disorder (BD) are hindered by incomplete suicidality coding in administrative claims data.
- Assessing pharmacotherapy and psychotherapy effectiveness for self-harm prevention in BD is challenging due to missing outcome data.
- Conflicting evidence exists regarding drug-dependent self-harm risk and the preventive effects of various treatment strategies in BD.
Purpose of the Study:
- To compare the risk of self-harm across commonly used BD pharmacotherapies and psychotherapy in a large insured population.
- To address underrecording of self-harm events in US electronic health records through imputation methods.
- To provide evidence-based insights into effective self-harm prevention strategies for bipolar disorder.
Main Methods:
- Utilized the IBM MarketScan administrative claims database to analyze self-harm risk in BD patients across 65 drug regimens and drug-free periods.
- Employed machine learning for imputing probable but uncoded self-harm events, with sensitivity analyses on probability thresholds.
- Applied Cox regression models to compare risks associated with various pharmacotherapies (lithium, MSAs, SGAs, FGAs, antidepressants) and psychotherapy.
Main Results:
- Among 529,359 patients, 1.66% experienced self-harm events. Adolescence was associated with higher self-harm risk.
- Six regimens showed increased self-harm risk versus lithium, including certain antidepressant + second-generation antipsychotic (SGA) combinations.
- Nine regimens demonstrated lower self-harm risk, including lamotrigine, valproate, risperidone, aripiprazole, and specific antidepressants (SNRI, SSRI, bupropion). Psychotherapy alone significantly reduced self-harm risk compared to no treatment.
Conclusions:
- Findings support the efficacy of antidepressants, mood-stabilizing anticonvulsants (MSAs), and psychotherapy in preventing self-harm among individuals with bipolar disorder (BD).
- Certain medication combinations are associated with a higher risk of self-harm compared to lithium, highlighting the importance of regimen selection.
- Machine learning imputation of self-harm events proved effective in overcoming data limitations for observational studies in BD.
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