临床笔记 - - 提取的心理社会因素,用于预测ED患者自杀念头的自杀企图
Hyunjoon Lee1, Ketan Jadhav1,2, Michael Ripperger1
1Department of Biomedical Informatics, Vanderbilt University Medical Center, Nashville, Tennessee.
JAMA network open
|March 4, 2026
概括
将心理社会因素整合到自杀风险预测模型中,可显著提高急诊室患者的准确性. 这有助于识别需要针对性干预以预防自杀的个人.
科学领域:
- 紧急医疗 紧急医疗
- 精神病学是一个精神病学.
- 数据科学数据科学数据科学
背景情况:
- 联合委员会建议在急诊室 (ED) 进行普遍的自杀查.
- 目前使用临床数据的自杀风险预测模型的性能有限.
- 心理社会信息在提高预测准确性的作用还没有得到充分研究.
研究的目的:
- 为了确定是否将心理社会因素添加到临床数据中,可以改善自杀企图 (SA) 的预测.
- 用单独使用临床数据,单独使用心理社会因素以及两者的组合来评估模型的性能.
主要方法:
- 对4661名出现自杀念头 (SI) 的ED患者进行了回顾性分析.
- 电子健康记录数据被用来提取临床数据 (范德比尔特自杀企图和想法可能性[VSAIL]分数) 和心理社会因素 (无家可归,财务不安全,慢性压力,社会隔离,孤独,不良童年经历).
- 考克斯比例危险回归模型用于评估不同模型组合的预测性能 (AUROC,AUPRC,PPV).
主要成果:
- 与单独使用VSAIL相比,结合VSAIL和心理社会因素的模型显示出明显更高的预测性能 (AUROC,AUPRC,PPV).
- 心理社会因素显著提高了范德比尔特大学医院和区域卫生系统数据集的预测准确度.
- 慢性压力被确定为SA最重要的预测因素 (β = 0.643,P < .001).
结论:
- 通过从临床笔记中提取的心理社会因素来增加基于临床数据的自杀风险预测,可以显著提高预测性能.
- 这些发现支持使用心理社会因素来改善ED患者的风险分层.
- 有针对性的干预措施,特别是解决慢性压力的干预措施,可以在加强风险评估的基础上更有效地实施.
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