دورية أكاديمية
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External Validation and Updating of a Statistical Civilian-Based Suicide Risk Model in US Naval Primary Care.

التفاصيل البيبلوغرافية
العنوان: External Validation and Updating of a Statistical Civilian-Based Suicide Risk Model in US Naval Primary Care.
المؤلفون: Ripperger MA; Department of Biomedical Informatics, Vanderbilt University Medical Center, Nashville, Tennessee., Kolli J; Department of Biomedical Informatics, Vanderbilt University Medical Center, Nashville, Tennessee., Wilimitis D; Department of Biomedical Informatics, Vanderbilt University Medical Center, Nashville, Tennessee., Robinson K; Department of Biomedical Informatics, Vanderbilt University Medical Center, Nashville, Tennessee., Reale C; Department of Anesthesiology, Vanderbilt University Medical Center, Nashville, Tennessee., Novak LL; Department of Biomedical Informatics, Vanderbilt University Medical Center, Nashville, Tennessee., Cunningham CA; Retired, US Navy, Portsmouth, Virginia., Kasuske LM; Daniel K. Inouye Graduate School of Nursing, Uniformed Services University of the Health Sciences, Bethesda, Maryland., Grover SG; Naval Medical Center Portsmouth, US Navy, Portsmouth, Virginia., Ribeiro JD; Department of Psychology, Florida State University, Tallahassee., Walsh CG; Department of Biomedical Informatics, Vanderbilt University Medical Center, Nashville, Tennessee.; Department of Medicine, Vanderbilt University Medical Center, Nashville, Tennessee.; Department of Psychiatry, Vanderbilt University Medical Center, Nashville, Tennessee.
المصدر: JAMA network open [JAMA Netw Open] 2023 Nov 01; Vol. 6 (11), pp. e2342750. Date of Electronic Publication: 2023 Nov 01.
نوع المنشور: Journal Article
اللغة: English
بيانات الدورية: Publisher: American Medical Association Country of Publication: United States NLM ID: 101729235 Publication Model: Electronic Cited Medium: Internet ISSN: 2574-3805 (Electronic) Linking ISSN: 25743805 NLM ISO Abbreviation: JAMA Netw Open Subsets: MEDLINE
أسماء مطبوعة: Original Publication: Chicago, IL : American Medical Association, [2018]-
مواضيع طبية MeSH: Models, Statistical* , Suicide, Attempted*, Humans ; Male ; Female ; Cohort Studies ; Retrospective Studies ; Primary Health Care
مستخلص: Importance: Suicide remains an ongoing concern in the US military. Statistical models have not been broadly disseminated for US Navy service members.
Objective: To externally validate and update a statistical suicide risk model initially developed in a civilian setting with an emphasis on primary care.
Design, Setting, and Participants: This retrospective cohort study used data collected from 2007 through 2017 among active-duty US Navy service members. The external civilian model was applied to every visit at Naval Medical Center Portsmouth (NMCP), its NMCP Naval Branch Health Clinics (NBHCs), and TRICARE Prime Clinics (TPCs) that fall within the NMCP area. The model was retrained and recalibrated using visits to NBHCs and TPCs and updated using Department of Defense (DoD)-specific billing codes and demographic characteristics, including expanded race and ethnicity categories. Domain and temporal analyses were performed with bootstrap validation. Data analysis was performed from September 2020 to December 2022.
Exposure: Visit to US NMCP.
Main Outcomes and Measures: Recorded suicidal behavior on the day of or within 30 days of a visit. Performance was assessed using area under the receiver operating curve (AUROC), area under the precision recall curve (AUPRC), Brier score, and Spiegelhalter z-test statistic.
Results: Of the 260 583 service members, 6529 (2.5%) had a recorded suicidal behavior, 206 412 (79.2%) were male; 104 835 (40.2%) were aged 20 to 24 years; and 9458 (3.6%) were Asian, 56 715 (21.8%) were Black or African American, and 158 277 (60.7%) were White. Applying the civilian-trained model resulted in an AUROC of 0.77 (95% CI, 0.74-0.79) and an AUPRC of 0.004 (95% CI, 0.003-0.005) at NBHCs with poor calibration (Spiegelhalter P < .001). Retraining the algorithm improved AUROC to 0.92 (95% CI, 0.91-0.93) and AUPRC to 0.66 (95% CI, 0.63-0.68). Number needed to screen in the top risk tiers was 366 for the external model and 200 for the retrained model; the lower number indicates better performance. Domain validation showed AUROC of 0.90 (95% CI, 0.90-0.91) and AUPRC of 0.01 (95% CI, 0.01-0.01), and temporal validation showed AUROC of 0.75 (95% CI, 0.72-0.78) and AUPRC of 0.003 (95% CI, 0.003-0.005).
Conclusions and Relevance: In this cohort study of active-duty Navy service members, a civilian suicide attempt risk model was externally validated. Retraining and updating with DoD-specific variables improved performance. Domain and temporal validation results were similar to external validation, suggesting that implementing an external model in US Navy primary care clinics may bypass the need for costly internal development and expedite the automation of suicide prevention in these clinics.
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المشرفين على المادة: 78558-95-9 (N-methylchlorphentermine)
تواريخ الأحداث: Date Created: 20231108 Date Completed: 20231110 Latest Revision: 20231111
رمز التحديث: 20231111
مُعرف محوري في PubMed: PMC10632956
DOI: 10.1001/jamanetworkopen.2023.42750
PMID: 37938841
قاعدة البيانات: MEDLINE
الوصف
تدمد:2574-3805
DOI:10.1001/jamanetworkopen.2023.42750