A Bayesian Approach to Modeling Risk of Hospital Admissions Associated With Schizophrenia Accounting for Underdiagnosis of the Disorder in Administrative Records
Schizophrenia is a debilitating serious mental illness characterized by a complex array of symptoms with varying severity and duration. Patients may seek treatment only intermittently, contributing to challenges diagnosing the disorder. A misdiagnosis may potentially bias and reduce study validity....
| Main Authors: | , , , , |
|---|---|
| Format: | Article |
| Language: | English |
| Published: |
Ubiquity Press
2018-02-01
|
| Series: | Computational Psychiatry |
| Subjects: | |
| Online Access: | https://cpsyjournal.org/articles/37 |
| _version_ | 1798031973038424064 |
|---|---|
| author | Eileen M. Stock James D. Stamey John E. Zeber Alexander W. Thompson Laurel A. Copeland |
| author_facet | Eileen M. Stock James D. Stamey John E. Zeber Alexander W. Thompson Laurel A. Copeland |
| author_sort | Eileen M. Stock |
| collection | DOAJ |
| description | Schizophrenia is a debilitating serious mental illness characterized by a complex array of symptoms with varying severity and duration. Patients may seek treatment only intermittently, contributing to challenges diagnosing the disorder. A misdiagnosis may potentially bias and reduce study validity. Thus we developed a statistical model to assess the risk of 1-year hospitalization for patients diagnosed with schizophrenia, accounting for when schizophrenia is underreported in administrative databases. A retrospective study design identified patients seeking care during 2010 within an integrated health care system from the Health Maintenance Organization Research Network located in the southwestern United States. Bayesian analysis addressed the problem of underdiagnosed schizophrenia with a statistical measurement error model assuming varying rates of underreporting. Results were then compared to classical multivariable logistic regression. Assuming no underreporting, there was an 87% greater relative odds of hospitalization associated with schizophrenia, OR = 1.87, CI [1.08, 3.23]. Effect sizes and interval estimates representing the association between hospitalization and schizophrenia were reduced with the Bayesian approach accounting for underdiagnosis, suggesting that less severe patients may be underrepresented in studies of schizophrenia. The analytical approach has useful applications in other contexts where the identification of patients with a given condition may be underreported in administrative records. |
| first_indexed | 2024-04-11T20:05:16Z |
| format | Article |
| id | doaj.art-e2dea9c5bb25488d962f65663dcc1d40 |
| institution | Directory Open Access Journal |
| issn | 2379-6227 |
| language | English |
| last_indexed | 2024-04-11T20:05:16Z |
| publishDate | 2018-02-01 |
| publisher | Ubiquity Press |
| record_format | Article |
| series | Computational Psychiatry |
| spelling | doaj.art-e2dea9c5bb25488d962f65663dcc1d402022-12-22T04:05:20ZengUbiquity PressComputational Psychiatry2379-62272018-02-01211010.1162/CPSY_a_0001035A Bayesian Approach to Modeling Risk of Hospital Admissions Associated With Schizophrenia Accounting for Underdiagnosis of the Disorder in Administrative RecordsEileen M. Stock0James D. Stamey1John E. Zeber2Alexander W. Thompson3Laurel A. Copeland4Cooperative Studies Program Coordinating Center, VA Maryland Health Care System, Department of Veterans Affairs, Perry Point, Maryland; Center for Applied Health Research, Central Texas Veterans Health Care System/Baylor Scott and White Health, Temple, Texas; Texas A&M Health Science Center, Bryan, TexasDepartment of Statistical Science, Baylor University, Waco, TexasCenter for Applied Health Research, Central Texas Veterans Health Care System/Baylor Scott and White Health, Temple, Texas; Texas A&M Health Science Center, Bryan, TexasDepartment of Psychiatry, University of Iowa Carver College of Medicine, Iowa City, IowaCenter for Applied Health Research, Central Texas Veterans Health Care System/Baylor Scott and White Health, Temple, Texas; Texas A&M Health Science Center, Bryan, TexasSchizophrenia is a debilitating serious mental illness characterized by a complex array of symptoms with varying severity and duration. Patients may seek treatment only intermittently, contributing to challenges diagnosing the disorder. A misdiagnosis may potentially bias and reduce study validity. Thus we developed a statistical model to assess the risk of 1-year hospitalization for patients diagnosed with schizophrenia, accounting for when schizophrenia is underreported in administrative databases. A retrospective study design identified patients seeking care during 2010 within an integrated health care system from the Health Maintenance Organization Research Network located in the southwestern United States. Bayesian analysis addressed the problem of underdiagnosed schizophrenia with a statistical measurement error model assuming varying rates of underreporting. Results were then compared to classical multivariable logistic regression. Assuming no underreporting, there was an 87% greater relative odds of hospitalization associated with schizophrenia, OR = 1.87, CI [1.08, 3.23]. Effect sizes and interval estimates representing the association between hospitalization and schizophrenia were reduced with the Bayesian approach accounting for underdiagnosis, suggesting that less severe patients may be underrepresented in studies of schizophrenia. The analytical approach has useful applications in other contexts where the identification of patients with a given condition may be underreported in administrative records.https://cpsyjournal.org/articles/37schizophreniaunderdiagnosisbayesian analysismeasurement error |
| spellingShingle | Eileen M. Stock James D. Stamey John E. Zeber Alexander W. Thompson Laurel A. Copeland A Bayesian Approach to Modeling Risk of Hospital Admissions Associated With Schizophrenia Accounting for Underdiagnosis of the Disorder in Administrative Records Computational Psychiatry schizophrenia underdiagnosis bayesian analysis measurement error |
| title | A Bayesian Approach to Modeling Risk of Hospital Admissions Associated With Schizophrenia Accounting for Underdiagnosis of the Disorder in Administrative Records |
| title_full | A Bayesian Approach to Modeling Risk of Hospital Admissions Associated With Schizophrenia Accounting for Underdiagnosis of the Disorder in Administrative Records |
| title_fullStr | A Bayesian Approach to Modeling Risk of Hospital Admissions Associated With Schizophrenia Accounting for Underdiagnosis of the Disorder in Administrative Records |
| title_full_unstemmed | A Bayesian Approach to Modeling Risk of Hospital Admissions Associated With Schizophrenia Accounting for Underdiagnosis of the Disorder in Administrative Records |
| title_short | A Bayesian Approach to Modeling Risk of Hospital Admissions Associated With Schizophrenia Accounting for Underdiagnosis of the Disorder in Administrative Records |
| title_sort | bayesian approach to modeling risk of hospital admissions associated with schizophrenia accounting for underdiagnosis of the disorder in administrative records |
| topic | schizophrenia underdiagnosis bayesian analysis measurement error |
| url | https://cpsyjournal.org/articles/37 |
| work_keys_str_mv | AT eileenmstock abayesianapproachtomodelingriskofhospitaladmissionsassociatedwithschizophreniaaccountingforunderdiagnosisofthedisorderinadministrativerecords AT jamesdstamey abayesianapproachtomodelingriskofhospitaladmissionsassociatedwithschizophreniaaccountingforunderdiagnosisofthedisorderinadministrativerecords AT johnezeber abayesianapproachtomodelingriskofhospitaladmissionsassociatedwithschizophreniaaccountingforunderdiagnosisofthedisorderinadministrativerecords AT alexanderwthompson abayesianapproachtomodelingriskofhospitaladmissionsassociatedwithschizophreniaaccountingforunderdiagnosisofthedisorderinadministrativerecords AT laurelacopeland abayesianapproachtomodelingriskofhospitaladmissionsassociatedwithschizophreniaaccountingforunderdiagnosisofthedisorderinadministrativerecords AT eileenmstock bayesianapproachtomodelingriskofhospitaladmissionsassociatedwithschizophreniaaccountingforunderdiagnosisofthedisorderinadministrativerecords AT jamesdstamey bayesianapproachtomodelingriskofhospitaladmissionsassociatedwithschizophreniaaccountingforunderdiagnosisofthedisorderinadministrativerecords AT johnezeber bayesianapproachtomodelingriskofhospitaladmissionsassociatedwithschizophreniaaccountingforunderdiagnosisofthedisorderinadministrativerecords AT alexanderwthompson bayesianapproachtomodelingriskofhospitaladmissionsassociatedwithschizophreniaaccountingforunderdiagnosisofthedisorderinadministrativerecords AT laurelacopeland bayesianapproachtomodelingriskofhospitaladmissionsassociatedwithschizophreniaaccountingforunderdiagnosisofthedisorderinadministrativerecords |