TY - JOUR
T1 - A multisite comparison using electronic health records and natural language processing to identify the association between suicidality and hospital readmission amongst patients with eating disorders
AU - Cliffe, Charlotte
AU - Cusick, Marika
AU - Vellupillai, Sumithra
AU - Shear, Matthew
AU - Downs, Johnny
AU - Epstein, Sophie
AU - Pathak, Jyotishman
AU - Dutta, Rina
N1 - Funding Information:
This study was funded in part by grants R01MH121922, R01MH121907, R01MH119177, and R01GM105688 from the US National Institutes of Health (NIH).
Funding Information:
This study was funded in part by grants R01MH121922, R01MH121907, R01MH119177, and R01GM105688 from the US National Institutes of Health (NIH). CC was funded by an National Institute for Health and Social Care Research (NIHR) Academic Clinical Fellowship and a NIHR Biomedical Research Centre at South London and Maudsley NHS Foundation Trust Preparatory Fellowship. JD was supported by an NIHR Clinician Science Fellowship award and has received support from a Medical Research Council (MRC) Clinical Research Training Fellowship and Psychiatry Research Trust Peggy Pollak Research Fellowship in Developmental Psychiatry. RD was funded by a Clinician Scientist Fellowship from the Health Foundation in partnership with the Academy of Medical Sciences and her work is supported by the NIHR Biomedical Research Centre at South London and Maudsley NHS Foundation Trust and King's College London. This paper represents independent research part-funded by the NIHR Maudsley Biomedical Research Centre at South London and Maudsley NHS Foundation Trust and King's College London. The views expressed are those of the author(s) and not necessarily those of the NIHR or the Department of Health and Social Care. For the purposes of open access, the author has applied a Creative Commons Attribution (CC BY) licence to any Accepted Author Manuscript version arising from this submission.
Publisher Copyright:
© 2023 The Authors. International Journal of Eating Disorders published by Wiley Periodicals LLC.
PY - 2023/8
Y1 - 2023/8
N2 - Objectives: To describe and compare the association between suicidality and subsequent readmission for patients hospitalized for eating disorder treatment, within 2 years of discharge, at two large academic medical centers in two different countries. Methods: Over an 8-year study window from January 2009 to March 2017, we identified all inpatient eating disorder admissions at Weill Cornell Medicine, New York, USA (WCM) and South London and Maudsley Foundation NHS Trust, London, UK (SLaM). To establish each patient's—suicidality profile, we applied two natural language processing (NLP) algorithms, independently developed at the two institutions, and detected suicidality in clinical notes documented in the first week of admission. We calculated the odds ratios (OR) for any subsequent readmission within 2 years postdischarge and determined whether this was to another eating disorder unit, other psychiatric unit, a general medical hospital admission or emergency room attendance. Results: We identified 1126 and 420 eating disorder inpatient admissions at WCM and SLaM, respectively. In the WCM cohort, evidence of above average suicidality during the first week of admission was significantly associated with an increased risk of noneating disorder-related psychiatric readmission (OR 3.48 95% CI = 2.03–5.99, p-value <.001), but a similar pattern was not observed in the SLaM cohort (OR 1.34, 95% CI = 0.75–2.37, p =.32), there was no significant increase in risk of admission. In both cohorts, personality disorder increased the risk of any psychiatric readmission within 2 years. Discussion: Patterns of increased risk of psychiatric readmission from above average suicidality detected via NLP during inpatient eating disorder admissions differed in our two patient cohorts. However, comorbid diagnoses such as personality disorder increased the risk of any psychiatric readmission across both cohorts. Public Significance: Suicidality amongst is eating disorders is an extremely common presentation and it is important we further our understanding of identifying those most at risk. This research also provides a novel study design, comparing two NLP algorithms on electronic health record data based in the United States and United Kingdom on eating disorder inpatients. Studies researching both UK and US mental health patients are sparse therefore this study provides novel data.
AB - Objectives: To describe and compare the association between suicidality and subsequent readmission for patients hospitalized for eating disorder treatment, within 2 years of discharge, at two large academic medical centers in two different countries. Methods: Over an 8-year study window from January 2009 to March 2017, we identified all inpatient eating disorder admissions at Weill Cornell Medicine, New York, USA (WCM) and South London and Maudsley Foundation NHS Trust, London, UK (SLaM). To establish each patient's—suicidality profile, we applied two natural language processing (NLP) algorithms, independently developed at the two institutions, and detected suicidality in clinical notes documented in the first week of admission. We calculated the odds ratios (OR) for any subsequent readmission within 2 years postdischarge and determined whether this was to another eating disorder unit, other psychiatric unit, a general medical hospital admission or emergency room attendance. Results: We identified 1126 and 420 eating disorder inpatient admissions at WCM and SLaM, respectively. In the WCM cohort, evidence of above average suicidality during the first week of admission was significantly associated with an increased risk of noneating disorder-related psychiatric readmission (OR 3.48 95% CI = 2.03–5.99, p-value <.001), but a similar pattern was not observed in the SLaM cohort (OR 1.34, 95% CI = 0.75–2.37, p =.32), there was no significant increase in risk of admission. In both cohorts, personality disorder increased the risk of any psychiatric readmission within 2 years. Discussion: Patterns of increased risk of psychiatric readmission from above average suicidality detected via NLP during inpatient eating disorder admissions differed in our two patient cohorts. However, comorbid diagnoses such as personality disorder increased the risk of any psychiatric readmission across both cohorts. Public Significance: Suicidality amongst is eating disorders is an extremely common presentation and it is important we further our understanding of identifying those most at risk. This research also provides a novel study design, comparing two NLP algorithms on electronic health record data based in the United States and United Kingdom on eating disorder inpatients. Studies researching both UK and US mental health patients are sparse therefore this study provides novel data.
KW - eating disorder
KW - electronic health records
KW - natural language processing
KW - suicidal ideation
KW - suicide
UR - http://www.scopus.com/inward/record.url?scp=85159412980&partnerID=8YFLogxK
U2 - 10.1002/eat.23980
DO - 10.1002/eat.23980
M3 - Article
C2 - 37194359
AN - SCOPUS:85159412980
SN - 0276-3478
VL - 56
SP - 1581
EP - 1592
JO - International Journal of Eating Disorders
JF - International Journal of Eating Disorders
IS - 8
ER -
