Predicting suicidality in people living with HIV in Uganda: a machine learning approach

People living with HIV (PLWH) are more likely to experience suicidal thoughts and exhibit suicidal behavior than the general population. However, there are currently no effective methods of predicting who is likely to experience suicidal thoughts and behavior. Machine learning (ML) approaches can be leveraged to develop models that evaluate the complex etiology of suicidal behavior, facilitating the timely identification of at-risk individuals and promoting individualized treatment allocation.

This retrospective case-control study used longitudinal sociodemographic, psychosocial, and clinical data of 1,126 PLWH from Uganda to evaluate the potential of ML in predicting suicidality. In addition, suicidality polygenic risk scores (PRS) were calculated for a subset of 282 study participants and incorporated as an additional feature in the model to determine if including genomic information improves overall model performance. The model's performance was evaluated using the area under the receiver operating characteristic curve (AUC), positive predictive value (PPV), sensitivity, specificity, and Mathew's correlation coefficient (MCC).

We trained and evaluated eight different ML algorithms, including logistic regression, support vector machines, Naïve Bayes, k-nearest neighbors, decision trees, random forests, AdaBoost, and gradient-boosting classifiers. Cost-sensitive AdaBoost emerged as the best model, achieving an AUC of 0.79 (95% CI: 0.72-0.87), a sensitivity of 0.63, a specificity of 0.74, a PPV of 0.36, and an NPV of 0.89 on unseen baseline data. The model demonstrated good generalizability, predicting prevalent and incident suicidality at 12-month follow-up with an AUC of 0.75 (95% CI: 0.69-0.81) and 0.69 (95% CI: 0.62-0.76), respectively. Incorporating PRS as an additional feature in the model resulted in a 6% improvement in model sensitivity and a 9% reduction in specificity. A positive MDD diagnosis and high stress contributed the most to predicting suicidality risk.

A cost-sensitive AdaBoost model developed using the sociodemographic, psychosocial, and clinical data of PLWH in Uganda can predict suicidality risk, albeit with modest PPV. Incorporating suicidality PRS improved the overall predictive performance of the model. However, larger studies involving more diverse participants are needed to evaluate the potential of PRS in enhancing risk stratification and the clinical utility of the prediction model.