Predicting death by suicide following an emergency department visit for parasuicide with administrative health care system data and machine learning

BACKGROUND: Suicide is a leading cause of death worldwide and results in a large number of person years of life lost. There is an opportunity to evaluate whether administrative health care system data and machine learning can quantify suicide risk in a clinical setting. METHODS: The objective was to compare the performance of prediction models that quantify the risk of death by suicide within 90 days of an ED visit for parasuicide with predictors available in administrative health care system data. The modeling dataset was assembled from 5 administrative health care data systems. The data systems contained nearly all of the physician visits, ambulatory care visits, inpatient hospitalizations, and community pharmacy dispenses, of nearly the entire 4.07 million persons in Alberta, Canada. 101 predictors were selected, and these were assembled for each of the 8 quarters (2 years) prior to the quarter of death, resulting in 808 predictors in total for each person. Prediction model performance was validated with 10-fold cross-validation. FINDINGS: The optimal gradient boosted trees prediction model achieved promising discrimination (AUC: 0.88) and calibration that could lead to clinical applications. The 5 most important predictors in the optimal gradient boosted trees model each came from a different administrative health care data system. INTERPRETATION: The combination of predictors from multiple administrative data systems and the combination of personal and ecologic predictors resulted in promising prediction performance. Further research is needed to develop prediction models optimized for implementation in clinical settings. FUNDING: There was no funding for this study.