Associations of presenting symptoms and subsequent adverse clinical outcomes in people with unipolar depression: a prospective natural language processing (NLP), transdiagnostic, network analysis of electronic health record (EHR) data

TY - JOUR

T1 - Associations of presenting symptoms and subsequent adverse clinical outcomes in people with unipolar depression

T2 - a prospective natural language processing (NLP), transdiagnostic, network analysis of electronic health record (EHR) data

AU - Patel, Rashmi

AU - Irving, Jessica

AU - Brinn, Aimee

AU - Taylor, Matthew

AU - Shetty, Hitesh

AU - Pritchard, Megan

AU - Stewart, Robert

AU - Fusar-Poli, Paolo

AU - McGuire, Philip

N1 - Funding Information: Competing interests All authors have completed the ICMJE uniform disclosure form at www.icmje.org/coi_disclosure.pdf and declare: RS has received funding from Janssen, GSK and Takeda outside the submitted work. RP has received funding from Janssen, Induction Healthcare and Holmusk outside the submitted work. Funding Information: Funding HS, MP, RS and PM have received funding from the National Institute for Health Research (NIHR) Biomedical Research Centre at South London and Maudsley NHS Foundation Trust and King’s College London, which also supports the development and maintenance of the BRC Case Register RP has received funding from an NIHR Advanced Fellowship (NIHR301690), a Medical Research Council (MRC) Health Data Research UK Fellowship (MR/S003118/1) and a Starter Grant for Clinical Lecturers (SGL015/1020) supported by the Academy of Medical Sciences, The Wellcome Trust, MRC, British Heart Foundation, Arthritis Research UK, the Royal College of Physicians and Diabetes UK. RS has received funding from a Medical Research Council (MRC) Mental Health Data Pathfinder Award to King’s College London, an NIHR Senior Investigator Award and the National Institute for Health Research (NIHR) Applied Research Collaboration South London (NIHR ARC South London) at King’s College Hospital NHS Foundation Trust. Publisher Copyright: ©

PY - 2022/4/29

Y1 - 2022/4/29

N2 - OBJECTIVE: To investigate the associations of symptoms of mania and depression with clinical outcomes in people with unipolar depression. DESIGN: A natural language processing electronic health record study. We used network analysis to determine symptom network structure and multivariable Cox regression to investigate associations with clinical outcomes. SETTING: The South London and Maudsley Clinical Record Interactive Search database. PARTICIPANTS: All patients presenting with unipolar depression between 1 April 2006 and 31 March 2018. EXPOSURE: (1) Symptoms of mania: Elation; Grandiosity; Flight of ideas; Irritability; Pressured speech. (2) Symptoms of depression: Disturbed mood; Anhedonia; Guilt; Hopelessness; Helplessness; Worthlessness; Tearfulness; Low energy; Reduced appetite; Weight loss. (3) Symptoms of mania or depression (overlapping symptoms): Poor concentration; Insomnia; Disturbed sleep; Agitation; Mood instability. MAIN OUTCOMES: (1) Bipolar or psychotic disorder diagnosis. (2) Psychiatric hospital admission. RESULTS: Out of 19 707 patients, at least 1 depression, overlapping or mania symptom was present in 18 998 (96.4%), 15 954 (81.0%) and 4671 (23.7%) patients, respectively. 2772 (14.1%) patients subsequently developed bipolar or psychotic disorder during the follow-up period. The presence of at least one mania (HR 2.00, 95% CI 1.85 to 2.16), overlapping symptom (HR 1.71, 95% CI 1.52 to 1.92) or symptom of depression (HR 1.31, 95% CI 1.07 to 1.61) were associated with significantly increased risk of onset of a bipolar or psychotic disorder. Mania (HR 1.95, 95% CI 1.77 to 2.15) and overlapping symptoms (HR 1.76, 95% CI 1.52 to 2.04) were associated with greater risk for psychiatric hospital admission than symptoms of depression (HR 1.41, 95% CI 1.06 to 1.88). CONCLUSIONS: The presence of mania or overlapping symptoms in people with unipolar depression is associated with worse clinical outcomes. Symptom-based approaches to defining clinical phenotype may facilitate a more personalised treatment approach and better predict subsequent clinical outcomes than psychiatric diagnosis alone.

AB - OBJECTIVE: To investigate the associations of symptoms of mania and depression with clinical outcomes in people with unipolar depression. DESIGN: A natural language processing electronic health record study. We used network analysis to determine symptom network structure and multivariable Cox regression to investigate associations with clinical outcomes. SETTING: The South London and Maudsley Clinical Record Interactive Search database. PARTICIPANTS: All patients presenting with unipolar depression between 1 April 2006 and 31 March 2018. EXPOSURE: (1) Symptoms of mania: Elation; Grandiosity; Flight of ideas; Irritability; Pressured speech. (2) Symptoms of depression: Disturbed mood; Anhedonia; Guilt; Hopelessness; Helplessness; Worthlessness; Tearfulness; Low energy; Reduced appetite; Weight loss. (3) Symptoms of mania or depression (overlapping symptoms): Poor concentration; Insomnia; Disturbed sleep; Agitation; Mood instability. MAIN OUTCOMES: (1) Bipolar or psychotic disorder diagnosis. (2) Psychiatric hospital admission. RESULTS: Out of 19 707 patients, at least 1 depression, overlapping or mania symptom was present in 18 998 (96.4%), 15 954 (81.0%) and 4671 (23.7%) patients, respectively. 2772 (14.1%) patients subsequently developed bipolar or psychotic disorder during the follow-up period. The presence of at least one mania (HR 2.00, 95% CI 1.85 to 2.16), overlapping symptom (HR 1.71, 95% CI 1.52 to 1.92) or symptom of depression (HR 1.31, 95% CI 1.07 to 1.61) were associated with significantly increased risk of onset of a bipolar or psychotic disorder. Mania (HR 1.95, 95% CI 1.77 to 2.15) and overlapping symptoms (HR 1.76, 95% CI 1.52 to 2.04) were associated with greater risk for psychiatric hospital admission than symptoms of depression (HR 1.41, 95% CI 1.06 to 1.88). CONCLUSIONS: The presence of mania or overlapping symptoms in people with unipolar depression is associated with worse clinical outcomes. Symptom-based approaches to defining clinical phenotype may facilitate a more personalised treatment approach and better predict subsequent clinical outcomes than psychiatric diagnosis alone.

UR - http://www.scopus.com/inward/record.url?scp=85129157917&partnerID=8YFLogxK

U2 - 10.1136/bmjopen-2021-056541

DO - 10.1136/bmjopen-2021-056541

M3 - Article

SN - 2044-6055

VL - 12

SP - e056541

JO - BMJ Open

JF - BMJ Open

IS - 4

M1 - e056541

ER -