Characterizing mental health diagnosis within Canadian primary care settings
Bibliographic record
Abstract
OBJECTIVE: To validate a primary care electronic medical record (EMR) case definition for mood and anxiety disorders (including depression, anxiety, and bipolar disorder) and schizophrenia that can be used to estimate prevalence and co-occurrence. DESIGN: Retrospective cross-sectional study. SETTING: Canada. PARTICIPANTS: De-identified EMR data was used from 1574 primary care providers participating in the Canadian Primary Care Sentinel Surveillance Network (CPCSSN) from 1,692,987 patients who had 1 or more visits with a primary care provider. The reference set included 2488 patients, with 434 positive and 2054 negative for 1 or more mental health conditions of interest. A second reference set for schizophrenia represented 760 patients (30 positive and 730 negative). MAIN OUTCOME MEASURES: The agreement of 29 case definitions was assessed against a reference set by reporting sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and accuracy. Prevalence was estimated and co-occurrence was assessed in the CPCSSN dataset (N=1,692,987). RESULTS: The strongest definition for mood disorders captured anxiety, depression, and bipolar disorder with a sensitivity of 80.7%, specificity of 88.7%, PPV of 59.9%, and NPV of 95.7%; and an estimated prevalence of 21.8% (95% CI 21.7 to 21.9). The inclusion of psychosis did not improve agreement (sensitivity 95.2%, specificity 80.7%, PPV 51.0%, NPV 98.8%), but schizophrenia alone had high agreement (sensitivity 93.3%, specificity 100%, PPV 100%, NPV 99.9%). CONCLUSION: High co-occurrence of anxiety, depression, and bipolar disorder was found. Algorithms validated to capture these conditions together produced stronger agreement compared with individual definitions. Schizophrenia was less likely to co-occur with other mental health conditions and produced higher agreement when validated separately. Application of validated algorithms to capture mental health conditions can inform disease surveillance and health system planning.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.005 | 0.031 |
| Meta-epidemiology (narrow) | 0.001 | 0.000 |
| Meta-epidemiology (broad) | 0.001 | 0.001 |
| Bibliometrics | 0.004 | 0.006 |
| Science and technology studies | 0.002 | 0.001 |
| Scholarly communication | 0.002 | 0.001 |
| Open science | 0.003 | 0.002 |
| Research integrity | 0.001 | 0.001 |
| Insufficient payload (model declined to judge) | 0.001 | 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 source (direct Gemma or distilled Codex), 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".