Machine learning-driven development of a stratified CES-D screening system: optimizing depression assessment through adaptive item selection.

IF 3.4 2区 医学 Q2 PSYCHIATRY
Ruo-Fei Xu, Zhen-Jing Liu, Shunan Ouyang, Qin Dong, Wen-Jing Yan, Dong-Wu Xu
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引用次数: 0

Abstract

Objective: To develop a stratified screening tool through machine learning approaches for the Center for Epidemiologic Studies Depression Scale (CES-D-20) while maintaining diagnostic accuracy, addressing the efficiency limitations in large-scale applications.

Methods: Data were derived from the Chinese Psychological Health Guard Project (primary sample: n = 179,877; age 9-18) and China Labor-force Dynamics Survey (validation samples across age spans). We employed a two-stage machine learning approach: first applying Recursive Feature Elimination with multiple linear regression to identify core predictive items for total depression scores, followed by logistic regression for optimizing depression classification (CES-D ≥ 16). Model performance was systematically evaluated through discrimination (ROC analysis), calibration (Brier score), and clinical utility analyses (decision curve analysis), with additional validation using random forest and support vector machine algorithms across independent samples.

Results: The resulting stratified screening system consists of an initial four-item rapid screening layer (encompassing emotional, cognitive, and interpersonal dimensions) for detecting probable depression (AUC = 0.982, sensitivity = 0.945, specificity = 0.926), followed by an enhanced assessment layer with five additional items. Together, these nine items enable accurate prediction of the full CES-D-20 total score (R2 = 0.957). This stratified approach demonstrated robust generalizability across age groups (R2 > 0.94, accuracy > 0.91) and time points. Calibration analyses and decision curve analyses confirmed optimal clinical utility, particularly in the critical risk threshold range (0.3-0.6).

Conclusions: This study contributes to the refinement of CES-D by developing a machine learning-derived stratified screening version, offering an efficient and reliable approach that optimizes assessment burden while maintaining excellent psychometric properties. The stratified design makes it particularly valuable for large-scale mental health screening programs, enabling efficient risk stratification and targeted assessment allocation.

分层CES-D筛选系统的机器学习驱动开发:通过自适应项目选择优化抑郁评估。
目的:通过机器学习方法为美国流行病学研究中心抑郁量表(CES-D-20)开发一种分层筛查工具,同时保持诊断准确性,解决大规模应用中的效率限制。方法:数据来源于中国心理健康卫士项目(主要样本:n = 179,877;9-18岁)和中国劳动力动态调查(跨年龄段验证样本)。我们采用了两阶段的机器学习方法:首先应用递归特征消除和多元线性回归来识别抑郁症总分的核心预测项目,然后使用逻辑回归来优化抑郁症分类(CES-D≥16)。通过区分(ROC分析)、校准(Brier评分)和临床效用分析(决策曲线分析)对模型性能进行系统评估,并在独立样本中使用随机森林和支持向量机算法进行额外验证。结果:分层筛选系统包括一个初始的四项快速筛选层(包括情绪、认知和人际维度),用于检测可能的抑郁(AUC = 0.982,灵敏度= 0.945,特异性= 0.926),然后是一个包含五个附加项目的增强评估层。这9个项目可以准确预测ce - d -20总分(R2 = 0.957)。这种分层方法在年龄组(R2 0.94,准确率> 0.91)和时间点上显示出强大的通用性。校准分析和决策曲线分析证实了最佳的临床效用,特别是在关键风险阈值范围内(0.3-0.6)。结论:本研究通过开发一种机器学习衍生的分层筛选版本,为改进CES-D做出了贡献,提供了一种高效可靠的方法,在优化评估负担的同时保持良好的心理测量特性。分层设计使其在大规模心理健康筛查项目中特别有价值,实现了有效的风险分层和有针对性的评估分配。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
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来源期刊
BMC Psychiatry
BMC Psychiatry 医学-精神病学
CiteScore
5.90
自引率
4.50%
发文量
716
审稿时长
3-6 weeks
期刊介绍: BMC Psychiatry is an open access, peer-reviewed journal that considers articles on all aspects of the prevention, diagnosis and management of psychiatric disorders, as well as related molecular genetics, pathophysiology, and epidemiology.
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