Derivation and validation of a multivariable model to predict when primary care physicians prescribe antidepressants for indications other than depression
Why this work is in the frame
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Bibliographic record
Abstract
Objective: Physicians commonly prescribe antidepressants for indications other than depression that are not evidence-based and need further evaluation. However, lack of routinely documented treatment indications for medications in administrative and medical databases creates a major barrier to evaluating antidepressant use for indications besides depression. Thus, the aim of this study was to derive a model to predict when primary care physicians prescribe antidepressants for indications other than depression and to identify important determinants of this prescribing practice. Methods: Prediction study using antidepressant prescriptions from January 2003–December 2012 in an indication-based electronic prescribing system in Quebec, Canada. Patients were linked to demographic files, medical billings data, and hospital discharge summary data to create over 370 candidate predictors. The final prediction model was derived on a random 75% sample of the data using 3-fold cross-validation integrated within a score-based forward stepwise selection procedure. The performance of the final model was assessed in the remaining 25% of the data. Results: Among 73,576 antidepressant prescriptions, 32,405 (44.0%) were written for indications other than depression. Among 40 predictors in the final model, the most important covariates included the molecule name, the patient’s education level, the physician’s workload, the prescribed dose, and diagnostic codes for plausible indications recorded in the past year. The final model had good discrimination (concordance ( c ) statistic 0.815; 95% CI, 0.787–0.847) and good calibration (ratio of observed to expected events 0.986; 95% CI, 0.842–1.136). Conclusion: In the absence of documented treatment indications, researchers may be able to use health services data to accurately predict when primary care physicians prescribe antidepressants for indications other than depression. Our prediction model represents a valuable tool for enabling researchers to differentiate between antidepressant use for depression versus other indications, thus addressing a major barrier to performing pharmacovigilance research on antidepressants. Keywords: antidepressant; indications; predictive studies; predictors; primary care; pharmacovigilance
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Full frame distilled prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. Learned from the 10,348 direct Codex labels and 10,348 direct Gemma labels. Candidate is the union of thresholded teacher heads; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels or direct frontier model labels.
Codex and Gemma teacher scores by category
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.002 | 0.003 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.001 | 0.000 |
| Bibliometrics | 0.000 | 0.000 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.000 | 0.000 |
| Open science | 0.000 | 0.000 |
| Research integrity | 0.000 | 0.000 |
| Insufficient payload (model declined to judge) | 0.000 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from it