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Predicting prognosis for adults with depression using individual symptom data: a comparison of modelling approaches

Research output: Contribution to journalArticlepeer-review

J E J Buckman, Z D Cohen, C O'Driscoll, E I Fried, R Saunders, G Ambler, R J DeRubeis, S Gilbody, S D Hollon, T Kendrick, E Watkins, T C Eley, A J Peel, C Rayner, D Kessler, N Wiles, G Lewis, S Pilling

Original languageEnglish
Pages (from-to)1-11
Number of pages11
JournalPsychological Medicine
Early online date6 May 2021
Accepted/In press12 Apr 2021
E-pub ahead of print6 May 2021


King's Authors


BACKGROUND: This study aimed to develop, validate and compare the performance of models predicting post-treatment outcomes for depressed adults based on pre-treatment data.

METHODS: Individual patient data from all six eligible randomised controlled trials were used to develop (k = 3, n = 1722) and test (k = 3, n = 918) nine models. Predictors included depressive and anxiety symptoms, social support, life events and alcohol use. Weighted sum scores were developed using coefficient weights derived from network centrality statistics (models 1-3) and factor loadings from a confirmatory factor analysis (model 4). Unweighted sum score models were tested using elastic net regularised (ENR) and ordinary least squares (OLS) regression (models 5 and 6). Individual items were then included in ENR and OLS (models 7 and 8). All models were compared to one another and to a null model (mean post-baseline Beck Depression Inventory Second Edition (BDI-II) score in the training data: model 9). Primary outcome: BDI-II scores at 3-4 months.

RESULTS: Models 1-7 all outperformed the null model and model 8. Model performance was very similar across models 1-6, meaning that differential weights applied to the baseline sum scores had little impact.

CONCLUSIONS: Any of the modelling techniques (models 1-7) could be used to inform prognostic predictions for depressed adults with differences in the proportions of patients reaching remission based on the predicted severity of depressive symptoms post-treatment. However, the majority of variance in prognosis remained unexplained. It may be necessary to include a broader range of biopsychosocial variables to better adjudicate between competing models, and to derive models with greater clinical utility for treatment-seeking adults with depression.

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