Ronald C Kessler1, Samantha A Chalker2, Alex R Luedtke3,4, Ekaterina Sadikova1, David A Jobes2. 1. Department of Health Care Policy, Harvard Medical School, Boston, MA, USA. 2. Department of Psychology, The Catholic University of America, Washington, DC, USA. 3. Department of Statistics, University of Washington, Seattle, WA, USA. 4. Vaccine and Infectious Disease Division, Fred Hutchinson Cancer Research Center, Seattle, WA, USA.
Abstract
OBJECTIVE: There is growing interest in the development of composite precision treatment rules (PTRs) to guide the selection of the treatments most likely to be helpful for individual patients. We present here the results of an effort to develop a preliminary PTR for Collaborative Assessment and Management of Suicidality (CAMS) relative to enhanced-care as usual based on secondary analysis of the Operation Worth Living (OWL) randomized controlled trial. The outcome of interest is eliminating suicide ideation (SI) within 3 months of initiating treatment. METHOD: A state-of-the-art ensemble machine learning method was used to develop the PTR among the n = 148 U.S. Soldiers (predominately male and White, age range 18-48) OWL patients. RESULTS: We estimated that CAMS was the better treatment for 77.8% of patients and that treatment assignment according to the PTR would result in a 13.6% (95% CI: 0.9%-26.3%) increase in 3-month SI remission compared to random treatment assignment. CONCLUSIONS: Although promising, results are limited by the small sample size, restrictive baseline assessment, and inability to evaluate effects on suicidal behaviors or disaggregate based on history of suicidal behaviors. Replication is needed in larger samples with comprehensive baseline assessments, longer-term follow-ups, and more extensive outcomes.
RCT Entities:
OBJECTIVE: There is growing interest in the development of composite precision treatment rules (PTRs) to guide the selection of the treatments most likely to be helpful for individual patients. We present here the results of an effort to develop a preliminary PTR for Collaborative Assessment and Management of Suicidality (CAMS) relative to enhanced-care as usual based on secondary analysis of the Operation Worth Living (OWL) randomized controlled trial. The outcome of interest is eliminating suicide ideation (SI) within 3 months of initiating treatment. METHOD: A state-of-the-art ensemble machine learning method was used to develop the PTR among the n = 148 U.S. Soldiers (predominately male and White, age range 18-48) OWL patients. RESULTS: We estimated that CAMS was the better treatment for 77.8% of patients and that treatment assignment according to the PTR would result in a 13.6% (95% CI: 0.9%-26.3%) increase in 3-month SI remission compared to random treatment assignment. CONCLUSIONS: Although promising, results are limited by the small sample size, restrictive baseline assessment, and inability to evaluate effects on suicidal behaviors or disaggregate based on history of suicidal behaviors. Replication is needed in larger samples with comprehensive baseline assessments, longer-term follow-ups, and more extensive outcomes.
Authors: Matthew K Nock; Evan M Kleiman; Melissa Abraham; Kate H Bentley; David A Brent; Ralph J Buonopane; Franckie Castro-Ramirez; Christine B Cha; Walter Dempsey; John Draper; Catherine R Glenn; Jill Harkavy-Friedman; Michael R Hollander; Jeffrey C Huffman; Hye In S Lee; Alexander J Millner; David Mou; Jukka-Pekka Onnela; Rosalind W Picard; Heather M Quay; Osiris Rankin; Shannon Sewards; John Torous; Joan Wheelis; Ursula Whiteside; Galia Siegel; Anna E Ordóñez; Jane L Pearson Journal: Psychiatr Res Clin Pract Date: 2020-12-21
Authors: Ronald C Kessler; Mark S Bauer; Todd M Bishop; Olga V Demler; Steven K Dobscha; Sarah M Gildea; Joseph L Goulet; Elizabeth Karras; Julie Kreyenbuhl; Sara J Landes; Howard Liu; Alex R Luedtke; Patrick Mair; William H B McAuliffe; Matthew Nock; Maria Petukhova; Wilfred R Pigeon; Nancy A Sampson; Jordan W Smoller; Lauren M Weinstock; Robert M Bossarte Journal: Front Psychiatry Date: 2020-05-06 Impact factor: 4.157