Deep learning based prediction of depression and anxiety in patients with type 2 diabetes mellitus using regional electronic health records

Background: Depression and anxiety are prevalent mental health conditions among individuals with type 2 diabetes mellitus (T2DM), who exhibit unique vulnerabilities and etiologies. However, existing approaches fail to fully utilize regional heterogeneous electronic health record (EHR) data. Integrating this data can provide a more comprehensive understanding of depression and anxiety in T2DM patients, leading to more personalized treatment strategies. Objective: This study aims to develop and validate a deep learning model, the Regional EHR for Depression and Anxiety Prediction Model (REDAPM), using regional EHR data to predict depression and anxiety in patients with T2DM. Methods: A case-control development and validation study was conducted using regional EHR data from the Nanjing Health Information Center (NHIC). Two retrospective, matched (1:3) datasets were constructed from the full cohort for the model's internal and external validation. These two datasets were selected from the NHIC data of 2020 and 2022, respectively. The REDAPM incorporates both structured and unstructured EHR data, capturing the temporal dependency of clinical events. The performance of REDAPM was compared to a set of baseline models, evaluated using the area under the receiver operating characteristic curve (ROC-AUC) and the area under the precision-recall curve (PR-AUC). Subgroup, ablation, and interpretation analyses were conducted to identify relevant clinical features available from EHRs. Results: The internal and external validation datasets comprised 24,724 and 34,340 patients, respectively. The REDAPM outperformed baseline models in both datasets, achieving ROC-AUC scores of 0.9029 +/- 0.008 and 0.7360 +/- 0.005, and PR-AUC scores of 0.8124 +/- 0.011 and 0.5504 +/- 0.009. Ablation and subgroup experiments confirmed the significant contribution of patients' medical history text to the model's performance. Integrated gradient score analysis identified the predictive importance of other mental disorders. Conclusion: The REDAPM effectively leverages the heterogeneous characteristics of regional EHR data, demonstrating strong predictive performance for depression onset in diabetic patients. It also shows potential for discovering significant clinical features, indicating considerable promise for clinical utility.