Predicting therapy outcome in a digital mental health intervention for depression and anxiety: A machine learning approach

Abstract

Objective Predicting the outcomes of individual participants for treatment interventions appears central to making mental healthcare more tailored and effective. However, little work has been done to investigate the performance of machine learning-based predictions within digital mental health interventions. Therefore, this study evaluates the performance of machine learning in predicting treatment response in a digital mental health intervention designed for treating depression and anxiety. Methods Several algorithms were trained based on the data of 970 participants to predict a significant reduction in depression and anxiety symptoms using clinical and sociodemographic variables. As a random forest classifier performed best over cross-validation, it was used to predict the outcomes of 279 new participants. Results The random forest achieved an accuracy of 0.71 for the test set (base rate: 0.67, area under curve (AUC): 0.60, p = 0.001, balanced accuracy: 0.60). Additionally, predicted non-responders showed less average reduction of their Patient Health Questionnaire-9 (PHQ-9) (−2.7, p = 0.004) and General Anxiety Disorder Screener-7 values (−3.7, p < 0.001) compared to responders. Besides pre-treatment Patient Health Questionnaire-9 and General Anxiety Disorder Screener-7 values, the self-reported motivation, type of referral into the programme (self vs. healthcare provider) as well as Work Productivity and Activity Impairment Questionnaire items contributed most to the predictions. Conclusions This study provides evidence that social-demographic and clinical variables can be used for machine learning to predict therapy outcomes within the context of a therapist-supported digital mental health intervention. Despite the overall moderate performance, this appears promising as these predictions can potentially improve the outcomes of non-responders by monitoring their progress or by offering alternative or additional treatment.