Analyzing service descriptors and patients’ clinical characteristics may help understand heterogeneity in long-term trajectory of patients with schizophrenia, bipolar and major depressive disorder
Bibliographic record
Abstract
One major obstacle to advancing research and treatment for major psychiatric disorders is their substantial within-diagnosis heterogeneity in patient lifetime trajectories. Adapted research methods such as cluster analysis to define subgroups of patients are currently used. However few studies have included service delivery descriptors in cluster analysis to investigate the determinants of heterogeneity in long-term trajectories. The aim of this study was to test whether patterns of service delivery could help in defining subgroups in terms of trajectories and clinical profiles in schizophrenia, bipolar disorder or major depressive disorder patients. Hierarchical Agglomerative Clustering (HAC) algorithms were used on a sample extracted from a Quebec government (Canada) transactional database to group and classify patients according to their interactions with the service delivery system. The resulting clusters were analyzed using statistical tools to characterize service trajectories. We observed three distinct trajectories that were not specific to any one of the three lifetime psychiatric diagnoses. Clusters were particularly affected by varying rates of clinician changes across the trajectory and changes of diagnoses. Results suggest that incorporating service delivery characteristics in future longitudinal studies of heterogeneity might be useful as a complement to studies that solely examine patients' clinical features. The inclusion of service delivery elements may also be a useful tool for acquiring knowledge to adapt services to patients' needs in public mental health and mental health economics research.
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How this classification was reachedexpand
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 | 0.000 | 0.000 |
| 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 itClassification
machine, unvalidatedMachine predicted; a candidate call from one teacher head, not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".