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A Preliminary Precision Treatment Rule for Remission of Suicide Ideation
Author(s) -
Kessler Ronald C.,
Chalker Samantha A.,
Luedtke Alex R.,
Sadikova Ekaterina,
Jobes David A.
Publication year - 2020
Publication title -
suicide and life‐threatening behavior
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.544
H-Index - 90
eISSN - 1943-278X
pISSN - 0363-0234
DOI - 10.1111/sltb.12609
Subject(s) - suicidal ideation , random assignment , randomized controlled trial , replication (statistics) , suicide attempt , psychology , medicine , clinical psychology , suicide prevention , poison control , medical emergency , pathology , virology
Objective There is growing interest in the development of composite precision treatment rules (PTRs) to guide the selection of the treatments most likely to be helpful for individual patients. We present here the results of an effort to develop a preliminary PTR for Collaborative Assessment and Management of Suicidality (CAMS) relative to enhanced‐care as usual based on secondary analysis of the Operation Worth Living (OWL) randomized controlled trial. The outcome of interest is eliminating suicide ideation (SI) within 3 months of initiating treatment. Method A state‐of‐the‐art ensemble machine learning method was used to develop the PTR among the n = 148 U.S. Soldiers (predominately male and White, age range 18–48) OWL patients. Results We estimated that CAMS was the better treatment for 77.8% of patients and that treatment assignment according to the PTR would result in a 13.6% (95% CI: 0.9%–26.3%) increase in 3‐month SI remission compared to random treatment assignment. Conclusions Although promising, results are limited by the small sample size, restrictive baseline assessment, and inability to evaluate effects on suicidal behaviors or disaggregate based on history of suicidal behaviors. Replication is needed in larger samples with comprehensive baseline assessments, longer‐term follow‐ups, and more extensive outcomes.