Toward Automatic Risk Assessment to Support Suicide Prevention.

Background: Suicide has been considered an important public health issue for years and is one of the main causes of death worldwide. Despite prevention strategies being applied, the rate of suicide has not changed substantially over the past decades. Suicide risk has proven extremely difficult to assess for medical specialists, and traditional methodologies deployed have been ineffective. Advances in machine learning make it possible to attempt to predict suicide with the analysis of relevant data aiming to inform clinical practice. Aims: We aimed to (a) test our artificial intelligence based, referral-centric methodology in the context of the National Health Service (NHS), (b) determine whether statistically relevant results can be derived from data related to previous suicides, and (c) develop ideas for various exploitation strategies. Method: The analysis used data of patients who died by suicide in the period 2013-2016 including both structured data and free-text medical notes, necessitating the deployment of state-of-the-art machine learning and text mining methods. Limitations: Sample size is a limiting factor for this study, along with the absence of non-suicide cases. Specific analytical solutions were adopted for addressing both issues. Results and Conclusion: The results of this pilot study indicate that machine learning shows promise for predicting within a specified period which people are most at risk of taking their own life at the time of referral to a mental health service.

Bootstrapping the out-of-sample predictions for efficient and accurate cross-validation.

Cross-Validation (CV), and out-of-sample performance-estimation protocols in general, are often employed both for (a) selecting the optimal combination of algorithms and values of hyper-parameters (called a configuration) for producing the final predictive model, and (b) estimating the predictive performance of the final model. However, the cross-validated performance of the best configuration is optimistically biased. We present an efficient bootstrap method that corrects for the bias, called Bootstrap Bias Corrected CV (BBC-CV). BBC-CV's main idea is to bootstrap the whole process of selecting the best-performing configuration on the out-of-sample predictions of each configuration, without additional training of models. In comparison to the alternatives, namely the nested cross-validation (Varma and Simon in BMC Bioinform 7(1):91, 2006) and a method by Tibshirani and Tibshirani (Ann Appl Stat 822-829, 2009), BBC-CV is computationally more efficient, has smaller variance and bias, and is applicable to any metric of performance (accuracy, AUC, concordance index, mean squared error). Subsequently, we employ again the idea of bootstrapping the out-of-sample predictions to speed up the CV process. Specifically, using a bootstrap-based statistical criterion we stop training of models on new folds of inferior (with high probability) configurations. We name the method Bootstrap Bias Corrected with Dropping CV (BBCD-CV) that is both efficient and provides accurate performance estimates.