Exploring Factors for Predicting Anxiety Disorders of the Elderly Living Alone in South Korea Using Interpretable Machine Learning: A Population-Based Study

Prospective prediction of anxiety onset in the Canadian longitudinal study on aging (CLSA): A machine learning study

BACKGROUND

Anxiety disorders are among the most common mental health disorders in the middle aged and older population. Because older individuals are more likely to have multiple comorbidities or increased frailty, the impact of anxiety disorders on their overall well-being is exacerbated. Early identification of anxiety disorders using machine learning (ML) can potentially mitigate the adverse consequences associated with these disorders.

METHODS

We applied ML to the data from the Canadian Longitudinal Study on Aging (CLSA) to predict the onset of anxiety disorders approximately three years in the future. We used Shapley value-based methods to determine the top factor for prediction. We also investigated whether anxiety onset can be predicted by baseline depression-related predictors alone.

RESULTS

Our model was able to predict anxiety onset accurately (Area under the Receiver Operating Characteristic Curve or AUC = 0.814 ± 0.016 (mean ± standard deviation), balanced accuracy = 0.741 ± 0.016, sensitivity = 0.743 ± 0.033, and specificity = 0.738 ± 0.010). The top predictive factors included prior depression or mood disorder diagnosis, high frailty, anxious personality, and low emotional stability. Depression and mood disorders are well known comorbidity of anxiety; however a prior depression or mood disorder diagnosis could not predict anxiety onset without other factors.

LIMITATION

While our findings underscore the importance of a prior depression diagnosis in predicting anxiety, they also highlight that it alone is inadequate, signifying the necessity to incorporate additional predictors for improved prediction accuracy.

CONCLUSION

Our study showcases promising prospects for using machine learning to develop personalized prediction models for anxiety onset in middle-aged and older adults using easy-to-access survey data.

Predicting medical waste generation and associated factors using machine learning in the Kingdom of Bahrain

Effective planning and managing medical waste necessitate a crucial focus on both the public and private healthcare sectors. This study uses machine learning techniques to estimate medical waste generation and identify associated factors in a representative private and a governmental hospital in Bahrain. Monthly data spanning from 2018 to 2022 for the private hospital and from 2019 to February 2023 for the governmental hospital was utilized. The ensemble voting regressor was determined as the best model for both datasets. The model of the governmental hospital is robust and successful in explaining 90.4% of the total variance.Similarly, for the private hospital, the model variables are able to explain 91.7% of the total variance. For the governmental hospital, the significant features in predicting medical waste generation were found to be the number of inpatients, population, surgeries, and outpatients, in descending order of importance. In the case of the private hospital, the order of feature importance was the number of inpatients, deliveries, personal income, surgeries, and outpatients. These findings provide insights into the factors influencing medical waste generation in the studied hospitals and highlight the effectiveness of the ensemble voting regressor model in predicting medical waste quantities.

Depressive Disorder Recognition Based on Frontal EEG Signals and Deep Learning

Depressive disorder (DD) has become one of the most common mental diseases, seriously endangering both the affected person's psychological and physical health. Nowadays, a DD diagnosis mainly relies on the experience of clinical psychiatrists and subjective scales, lacking objective, accurate, practical, and automatic diagnosis technologies. Recently, electroencephalogram (EEG) signals have been widely applied for DD diagnosis, but mainly with high-density EEG, which can severely limit the efficiency of the EEG data acquisition and reduce the practicability of diagnostic techniques. The current study attempts to achieve accurate and practical DD diagnoses based on combining frontal six-channel electroencephalogram (EEG) signals and deep learning models. To this end, 10 min clinical resting-state EEG signals were collected from 41 DD patients and 34 healthy controls (HCs). Two deep learning models, multi-resolution convolutional neural network (MRCNN) combined with long short-term memory (LSTM) (named MRCNN-LSTM) and MRCNN combined with residual squeeze and excitation (RSE) (named MRCNN-RSE), were proposed for DD recognition. The results of this study showed that the higher EEG frequency band obtained the better classification performance for DD diagnosis. The MRCNN-RSE model achieved the highest classification accuracy of 98.48 ± 0.22% with 8-30 Hz EEG signals. These findings indicated that the proposed analytical framework can provide an accurate and practical strategy for DD diagnosis, as well as essential theoretical and technical support for the treatment and efficacy evaluation of DD.

Predicting unplanned readmission due to cardiovascular disease in hospitalized patients with cancer: a machine learning approach

Cardiovascular disease (CVD) in cancer patients can affect the risk of unplanned readmissions, which have been reported to be costly and associated with worse mortality and prognosis. We aimed to demonstrate the feasibility of using machine learning techniques in predicting the risk of unplanned 180-day readmission attributable to CVD among hospitalized cancer patients using the 2017-2018 Nationwide Readmissions Database. We included hospitalized cancer patients, and the outcome was unplanned hospital readmission due to any CVD within 180 days after discharge. CVD included atrial fibrillation, coronary artery disease, heart failure, stroke, peripheral artery disease, cardiomegaly, and cardiomyopathy. Decision tree (DT), random forest, extreme gradient boost (XGBoost), and AdaBoost were implemented. Accuracy, precision, recall, F2 score, and receiver operating characteristic curve (AUC) were used to assess the model's performance. Among 358,629 hospitalized patients with cancer, 5.86% (n = 21,021) experienced unplanned readmission due to any CVD. The three ensemble algorithms outperformed the DT, with the XGBoost displaying the best performance. We found length of stay, age, and cancer surgery were important predictors of CVD-related unplanned hospitalization in cancer patients. Machine learning models can predict the risk of unplanned readmission due to CVD among hospitalized cancer patients.

Multi-omics data integration methods and their applications in psychiatric disorders

To study mental illness and health, in the past researchers have often broken down their complexity into individual subsystems (e.g., genomics, transcriptomics, proteomics, clinical data) and explored the components independently. Technological advancements and decreasing costs of high throughput sequencing has led to an unprecedented increase in data generation. Furthermore, over the years it has become increasingly clear that these subsystems do not act in isolation but instead interact with each other to drive mental illness and health. Consequently, individual subsystems are now analysed jointly to promote a holistic understanding of the underlying biological complexity of health and disease. Complementing the increasing data availability, current research is geared towards developing novel methods that can efficiently combine the information rich multi-omics data to discover biologically meaningful biomarkers for diagnosis, treatment, and prognosis. However, clinical translation of the research is still challenging. In this review, we summarise conventional and state-of-the-art statistical and machine learning approaches for discovery of biomarker, diagnosis, as well as outcome and treatment response prediction through integrating multi-omics and clinical data. In addition, we describe the role of biological model systems and in silico multi-omics model designs in clinical translation of psychiatric research from bench to bedside. Finally, we discuss the current challenges and explore the application of multi-omics integration in future psychiatric research. The review provides a structured overview and latest updates in the field of multi-omics in psychiatry.

Explainable artificial intelligence for mental health through transparency and interpretability for understandability

The literature on artificial intelligence (AI) or machine learning (ML) in mental health and psychiatry lacks consensus on what "explainability" means. In the more general XAI (eXplainable AI) literature, there has been some convergence on explainability meaning model-agnostic techniques that augment a complex model (with internal mechanics intractable for human understanding) with a simpler model argued to deliver results that humans can comprehend. Given the differing usage and intended meaning of the term "explainability" in AI and ML, we propose instead to approximate model/algorithm explainability by understandability defined as a function of transparency and interpretability. These concepts are easier to articulate, to "ground" in our understanding of how algorithms and models operate and are used more consistently in the literature. We describe the TIFU (Transparency and Interpretability For Understandability) framework and examine how this applies to the landscape of AI/ML in mental health research. We argue that the need for understandablity is heightened in psychiatry because data describing the syndromes, outcomes, disorders and signs/symptoms possess probabilistic relationships to each other-as do the tentative aetiologies and multifactorial social- and psychological-determinants of disorders. If we develop and deploy AI/ML models, ensuring human understandability of the inputs, processes and outputs of these models is essential to develop trustworthy systems fit for deployment.

LIME-based ensemble machine for predicting performance status of patients with liver cancer

Objective

The Eastern Cooperative Oncology Group performance status (ECOG PS) is a widely recognized measure used to assess the functional abilities of cancer patients and predict their prognosis. It plays a crucial role in guiding treatment decisions made by physicians. This study aimed to build a stacking ensemble-based prognosis predictor model for predicting the ECOG PS of a liver cancer patient undergoing treatment.

Methods

We used Light Gradient Boosting Machine (LightGBM) as the meta-model, and five base models, including Random Forest (RF), Extra Trees (ET), AdaBoost (Ada), Gradient Boosting Machine (GBM), and Extreme Gradient Boosting (XGBoost). After preprocessing the data and applying feature selection method, the stacking ensemble model was trained using 1622 liver cancer patients' data and 46 variables. We also integrated the stacking ensemble model with a LIME-based explainable model to obtain model prediction explainability.

Results

According to the research, the best combination of the stacking ensemble model is ET + XGBoost + RF + GBM + Ada + LightGBM and achieved a ROC AUC of 0.9826 on the training set and 0.9675 on the test set.

Conclusions

This explainable stacking ensemble model can become a helpful tool for objectively predicting ECOG PS in liver cancer patients and aiding healthcare practitioners to adapt their treatment approach more effectively.

Clinical decision support system for quality of life among the elderly: an approach using artificial neural network

Background

Due to advancements in medicine and the elderly population’s growth with various disabilities, attention to QoL among this age group is crucial. Early prediction of the QoL among the elderly by multiple care providers leads to decreased physical and mental disorders and increased social and environmental participation among them by considering all factors affecting it. So far, it is not designed the prediction system for QoL in this regard. Therefore, this study aimed to develop the CDSS based on ANN as an ML technique by considering the physical, psychiatric, and social factors.

Methods

In this developmental and applied study, we investigated the 980 cases associated with pleasant and unpleasant elderlies QoL cases. We used the BLR and simple correlation coefficient methods to attain the essential factors affecting the QoL among the elderly. Then three BP configurations, including CF-BP, FF-BP, and E-BP, were compared to get the best model for predicting the QoL.

Results

Based on the BLR, the 13 factors were considered the best factors affecting the elderly’s QoL at P < 0.05. Comparing all ANN configurations showed that the CF-BP with the 13-16-1 structure with sensitivity = 0.95, specificity  =  0.97, accuracy = 0.96, F-Score = 0.96, PPV = 0.95, and NPV = 0.97 gained the best performance for QoL among the elderly.

Conclusion

The results of this study showed that the designed CDSS based on the CFBP could be considered an efficient tool for increasing the QoL among the elderly.

Prediction of successful aging using ensemble machine learning algorithms

Background

Aging is a chief risk factor for most chronic illnesses and infirmities. The growth in the aged population increases medical costs, thus imposing a heavy financial burden on families and communities. Successful aging (SA) is a positive and qualitative view of aging. From a biomedical perspective, SA is defined as the absence of diseases or disability disorders. This is distinct from normal aging, which is associated with age-related deterioration in physical and cognitive functions. From a social perspective, SA highlights life satisfaction and individual well-being, usually attained through socialization. It is an abstract and multidimensional concept surrounded by imprecision about its definition and measurement. Our study attempted to find the most effective features of SA as defined by Rowe and Kahn's theory. The determined features were used as input parameters of six machine learning (ML) algorithms to create and validate predictive models for SA.

Methods

In this retrospective study, the raw data set was first pre-processed; then, based on the data of a sample of 983, five basic ML techniques including artificial neural network, decision tree, support vector machine, Naïve Bayes, and k-nearest neighbors (K-NN) with one ensemble method (that gathers 30 K-NN algorithms as weak learners) were trained. Finally, the prediction result was yielded using the majority vote method based on the output of the generated base models.

Results

The experimental results revealed that the predictive system has been more successful in predicting SA with a 93% precision, 92.40% specificity, 87.80% sensitivity, 90.31% F-measure, 89.62% accuracy, and a ROC of 96.10%, using a five-fold cross-validation procedure.

Conclusions

Our results showed that ML techniques potentially have satisfactory performance in supporting the SA-related decisions of social and health policymakers. The KNN-based ensemble algorithm is superior to the other ML models in classifying people into SA and non-SA classes.

Aberrated Multidimensional EEG Characteristics in Patients with Generalized Anxiety Disorder: A Machine-Learning Based Analysis Framework

Although increasing evidences support the notion that psychiatric disorders are associated with abnormal communication between brain regions, scattered studies have investigated brain electrophysiological disconnectivity of patients with generalized anxiety disorder (GAD). To this end, this study intends to develop an analysis framework for automatic GAD detection through incorporating multidimensional EEG feature extraction and machine learning techniques. Specifically, resting-state EEG signals with a duration of 10 min were obtained from 45 patients with GAD and 36 healthy controls (HC). Then, an analysis framework of multidimensional EEG characteristics (including univariate power spectral density (PSD) and fuzzy entropy (FE), and multivariate functional connectivity (FC), which can decode the EEG information from three different dimensions) were introduced for extracting aberrated multidimensional EEG features via statistical inter-group comparisons. These aberrated features were subsequently fused and fed into three previously validated machine learning methods to evaluate classification performance for automatic patient detection. We showed that patients exhibited a significant increase in beta rhythm and decrease in alpha1 rhythm of PSD, together with the reduced long-range FC between frontal and other brain areas in all frequency bands. Moreover, these aberrated features contributed to a very good classification performance with 97.83 ± 0.40% of accuracy, 97.55 ± 0.31% of sensitivity, 97.78 ± 0.36% of specificity, and 97.95 ± 0.17% of F1. These findings corroborate previous hypothesis of disconnectivity in psychiatric disorders and further shed light on distribution patterns of aberrant spatio-spectral EEG characteristics, which may lead to potential application of automatic diagnosis of GAD.

Ensemble Voting Regression Based on Machine Learning for Predicting Medical Waste: A Case from Turkey

Predicting medical waste (MW) properly is vital for an effective waste management system (WMS), but it is difficult because of inadequate data and various factors that impact MW. This study’s primary objective was to develop an ensemble voting regression algorithm based on machine learning (ML) algorithms such as random forests (RFs), gradient boosting machines (GBMs), and adaptive boosting (AdaBoost) to predict the MW for Istanbul, the largest city in Turkey. This was the first study to use ML algorithms to predict MW, to our knowledge. First, three ML algorithms were developed based on official data. To compare their performances, performance measures such as mean absolute deviation (MAE), root mean squared error (RMSE), mean absolute percentage error (MAPE), and coefficient of determination (R-squared) were calculated. Among the standalone ML models, RF achieved the best performance. Then, these base models were used to construct the proposed ensemble voting regression (VR) model utilizing weighted averages according to the base models’ performances. The proposed model outperformed three baseline models, with the lowest RMSE (843.70). This study gives an effective tool to practitioners and decision-makers for planning and constructing medical waste management systems by predicting the MW quantity.

Predicting High-Risk Groups for COVID-19 Anxiety Using AdaBoost and Nomogram: Findings from Nationwide Survey in South Korea

People living in local communities have become more worried about infection due to the extended pandemic situation and the global resurgence of COVID-19. In this study, the author (1) selected features to be included in the nomogram using AdaBoost, which had an advantage in increasing the classification accuracy of single learners and (2) developed a nomogram for predicting high-risk groups of coronavirus anxiety while considering both prediction performance and interpretability based on this. Among 210,606 adults (95,287 males and 115,319 females) in South Korea, 39,768 people (18.9%) experienced anxiety due to COVID-19. The AdaBoost model confirmed that education level, awareness of neighbors/colleagues’ COVID-19 response, age, gender, and subjective stress were five key variables with high weight in predicting anxiety induced by COVID-19 for adults living in South Korean communities. The developed logistic regression nomogram predicted that the risk of anxiety due to COVID-19 would be 63% for a female older adult who felt a lot of subjective stress, did not attend a middle school, was 70.6 years old, and thought that neighbors and colleagues responded to COVID-19 appropriately (classification accuracy = 0.812, precision = 0.761, recall = 0.812, AUC = 0.688, and F-1 score = 0.740). Prospective or retrospective cohort studies are required to causally identify the characteristics of anxiety disorders targeting high-risk COVID-19 anxiety groups identified in this study.

Developing a Predictive Model for Depressive Disorders Using Stacking Ensemble and Naive Bayesian Nomogram: Using Samples Representing South Korea

This study provided baseline data for preventing depression in female older adults living alone by understanding the degree of their depressive disorders and factors affecting these depressive disorders by analyzing epidemiological survey data representing South Koreans. To achieve the study objective, this study explored the main risk factors of depressive disorders using the stacking ensemble machine technique. Moreover, this study developed a nomogram that could help primary physicians easily interpret high-risk groups of depressive disorders in primary care settings based on the major predictors derived from machine learning. This study analyzed 582 female older adults (≥60 years old) living alone. The depressive disorder, a target variable, was measured using the Korean version of Patient Health Questionnaire-9. This study developed five single predictive models (GBM, Random Forest, Adaboost, SVM, XGBoost) and six stacking ensemble models (GBM + Bayesian regression, RandomForest + Bayesian regression, Adaboost + Bayesian regression, SVM + Bayesian regression, XGBoost + Bayesian regression, GBM + RandomForest + Adaboost + SVM + XGBoost + Bayesian regression) to predict depressive disorders. The naive Bayesian nomogram confirmed that stress perception, subjective health, n-6 fatty acid, n-3 fatty acid, mean hours of sitting per day, and mean daily sleep hours were six major variables related to the depressive disorders of female older adults living alone. Based on the results of this study, it is required to evaluate the multiple risk factors for depression including various measurable factors such as social support.