Cohort Definition Name : Earliest Event of Depressive Disorder with Suicidal Ideation or Attempt Prevalent
Contributor name : Joel Swerdel’,‘Azza Shoaibi’ ,‘Pranav Bhimani’
Contributor OrcId :
Logic Description : Earliest occurrence of either 1) a depressive disorder diagnosis that is preceded by a suicidal ideation diagnosis or suicide observation in the prior year, or 2) a suicide ideation diagnosis that is preceded by a depressive disorder diagnosis in the prior year, or 3) a suicide attempt observation that is preceded by a depressive disorder diagnosis in the prior year cohort exit is the end of continuous observation.
Recommended study application : target
Assertion statement : This cohort definition was executed on at least one real person-level observational health data source and resulted in a cohort with at least 1 person.
Target Clinical Description : Major depressive disorder (MDD) with suicidal ideation and/or behavior can be defined as clinical depression with the thoughts of taking one’s own life/attempts to take one’s life. While suicide is a deadly act of ending one’s own life, the entire suicidal process is multifaceted[1]. Ideation prefaces the process, where, in the beginning, people may have occasional suicidal ideas that could lead to the creation of a suicidal plan. Suicidal plans may or may not be carried out, but regardless suicide is a largely preventable public health issue. According to the 2017 National Survey on Drug Use and Health, 4.3% of U.S. adults 18 and older had thoughts about suicide, and the highest prevalence was among adults ages 18 to 25. Those who suffer from MDD are disproportionally affected by suicidal ideation and/or suicidal behavior with reported prevalence estimated between 15%-17%[1].
"Evaluation conclusion : MDD with suicidal ideation and attempt using a concept set of 14 concepts which incorporated all those found from the literature review and from the analysis of PHOEBE and orphan concepts in cohort diagnostics. We performed the evaluation across a network of claim data sources and 1 EHR US data source. The data sources are: IBM® MarketScan® Commercial Database (CCAE), Optum’s longitudinal EHR repository (Optum EHR), Optum’s Clinformatics® Data Mart (DOD), IBM® MarketScan® Multi-State Medicaid Database (MDCD), IBM® MarketScan® Medicare Supplemental Database (MDCR), Japan Claims Database (JMDC), Clinical Practice Research Datalink (CPRD) , IQVIA® Australia Longitudinal Patient Data (LPD) database (Australia), IQVIA® Disease Analyzer (DA) France database (France), QVIA® Disease Analyzer (DA) Germany database (Germany), IQVIA® Adjudicated Health Plan Claims Data (formerly PharMetrics Plus) - US database (PharMetrics), IQVIA® Ambulatory EMR (EMR). The algorithm retrieves subjects from all databases tested. We developed a more specific cohort requiring a second diagnosis code for suicide idiation in the time period 31-365 days after index. This cohort may improve the specificity of the algorithm albeit at the expense of sensitivity from the PheValuator analysis. The significant loss in sensitivity, however, precludes its use in our analysis.
The performance characteristics for suicidal ideation were assessed with the inclusion of major depression disorder. PheValuator cannot assess two conditions simultaneously. In this analysis, however, we may view the differences in performance between a broad (single required code of suicide idiation) and a narrow (2 required codes of suicide idiation 31-365 days apart). We were able to assess the performance characteristics in 5 of the 8 databases; there were too few subjects in remaining database for an accurate assessment. We found that the broad definition had very good sensitivity ranging from 61% in Optum EHR to 90% in MDCR. PPV was also very good, ranging from 84% in MDCR to 95% in MDCD and Optum EHR. Adding the requirement of a second code raised the PPV in all databases (range: 87-97%) but at the expense of a large decrease in sensitivity (range: 9-18%).
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