Development and validation of a machine learning model to predict cognitive behavioral therapy outcome in obsessive-compulsive disorder using clinical and neuroimaging data

Journal of Affective Disorders, vol. 389, pp. 119729

Abstract

BACKGROUND: Cognitive behavioral therapy (CBT) is a first-line treatment for obsessive-compulsive disorder (OCD), but clinical response is difficult to predict. In this study, we aimed to develop predictive models using clinical and neuroimaging data from the multicenter Enhancing Neuro-Imaging and Genetics through Meta-Analysis (ENIGMA)-OCD consortium. METHODS: Baseline clinical and resting-state functional magnetic imaging (rs-fMRI) data from 159 adult patients aged 18-60 years (88 female) with OCD who received CBT at four treatment/neuroimaging sites were included. Fractional amplitude of low frequency fluctuations, regional homogeneity and atlas-based functional connectivity were computed. Clinical CBT response and remission were predicted using support vector machine and random forest classifiers on clinical data only, rs-fMRI data only, and the combination of both clinical and rs-fMRI data. RESULTS: The use of only clinical data yielded an area under the ROC curve (AUC) of 0.69 for predicting remission (p = 0.001). Lower baseline symptom severity, younger age, an absence of cleaning obsessions, unmedicated status, and higher education had the highest model impact in predicting remission. The best predictive performance using only rs-fMRI was obtained with regional homogeneity for remission (AUC = 0.59). Predicting response with rs-fMRI generally did not exceed chance level. CONCLUSIONS: Machine learning models based on clinical data may thus hold promise in predicting remission after CBT for OCD, but the predictive power of multicenter rs-fMRI data is limited.

Authors 22

1. Laurens A. van de Mortel corresponding

   Amsterdam UMC Location University of Amsterdam · Amsterdam Neuroscience

   Affiliation as printed

   Amsterdam UMC location University of Amsterdam, Department of Psychiatry, Meibergdreef 9, Amsterdam, the Netherlands; Amsterdam Neuroscience, Amsterdam, the Netherlands. Electronic address: l.a.vandemortel@amsterdamumc.nl

2. Willem B. Bruin Aachen

   Leiden University · Amsterdam UMC Location University of Amsterdam · Amsterdam Neuroscience

   Affiliation as printed

   Amsterdam UMC location University of Amsterdam, Department of Psychiatry, Meibergdreef 9, Amsterdam, the Netherlands; Amsterdam Neuroscience, Amsterdam, the Netherlands; Leiden University, Institute of Education & Child Studies, Section Forensic Family & Youth Care, the Netherlands

3. Pino Alonso

   Bellvitge University Hospital · Institut d'Investigació Biomédica de Bellvitge · Centro de Investigación Biomédica en Red de Salud Mental · Universitat de Barcelona

   Affiliation as printed

   Bellvitge Biomedical Research Insitute-IDIBELL, Bellvitge University Hospital, Barcelona, Spain; CIBERSAM, Barcelona, Spain; Department of Clinical Sciences, University of Barcelona, Barcelona, Spain

4. Sara Bertolín

   Bellvitge University Hospital · Institut d'Investigació Biomédica de Bellvitge · Centro de Investigación Biomédica en Red de Salud Mental · Universitat de Barcelona

   Affiliation as printed

   Bellvitge Biomedical Research Insitute-IDIBELL, Bellvitge University Hospital, Barcelona, Spain; CIBERSAM, Barcelona, Spain; Department of Clinical Sciences, University of Barcelona, Barcelona, Spain

5. Jamie D. Feusner

   Centre for Addiction and Mental Health · University of Toronto · Karolinska Institutet

   Affiliation as printed

   Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada; Centre for Addiction and Mental Health, Toronto, Ontario, Canada; Department of Women's and Children's Health, Karolinska Institutet, Stockholm, Sweden

6. Joyce Y. Guo

   University of California San Diego · University of California, Davis

   Affiliation as printed

   Department of Radiology, University of California, San Diego, CA, USA; Imaging Research Center, the University of California at Davis, Sacramento, CA, USA; Center for Neuroscience, the University of California at Davis, CA, USA

7. Kristen Hagen

   Haukeland University Hospital · Molde Hospital

   Affiliation as printed

   Bergen Center for Brain Plasticity, Haukeland University Hospital, Bergen, Norway; Psychiatric Department, Hospital of Molde, Molde, Norway

8. Bjarne K. A. Hansen

   Haukeland University Hospital · Senter for Krisepsykologi · University of Bergen

   Affiliation as printed

   Bergen Center for Brain Plasticity, Haukeland University Hospital, Bergen, Norway; Centre for Crisis Psychology, University of Bergen, Bergen, Norway

9. Anders Lillevik Thorsen

   Haukeland University Hospital · Senter for Krisepsykologi · University of Bergen

   Affiliation as printed

   Bergen Center for Brain Plasticity, Haukeland University Hospital, Bergen, Norway; Centre for Crisis Psychology, University of Bergen, Bergen, Norway

10. Ignacio Martínez‐Zalacaín

    Bellvitge University Hospital · Institut d'Investigació Biomédica de Bellvitge

    Affiliation as printed

    Bellvitge Biomedical Research Insitute-IDIBELL, Bellvitge University Hospital, Barcelona, Spain; Radiology Department, Hospital Universitari de Bellvitge, L'Hospitalet de Llobregat, Barcelona, Spain

11. José Manuel Menchón

    Bellvitge University Hospital · Institut d'Investigació Biomédica de Bellvitge · Centro de Investigación Biomédica en Red de Salud Mental · Universitat de Barcelona

    Affiliation as printed

    Bellvitge Biomedical Research Insitute-IDIBELL, Bellvitge University Hospital, Barcelona, Spain; CIBERSAM, Barcelona, Spain; Department of Clinical Sciences, University of Barcelona, Barcelona, Spain

12. Erika L. Nurmi

    University of California, Los Angeles

    Affiliation as printed

    Division of Child and Adolescent Psychiatry, Jane & Terry Semel Institute For Neurosciences, University of California, Los Angeles, CA, USA

13. Joseph O’Neill

    University of California, Los Angeles

    Affiliation as printed

    Division of Child and Adolescent Psychiatry, Jane & Terry Semel Institute For Neurosciences, University of California, Los Angeles, CA, USA; UCLA Brain Research Institute, University of California, Los Angeles, CA, USA

14. John C. Piacentini

    University of California, Los Angeles

    Affiliation as printed

    Division of Child and Adolescent Psychiatry, Jane & Terry Semel Institute For Neurosciences, University of California, Los Angeles, CA, USA

15. Eva Real

    Bellvitge University Hospital · Institut d'Investigació Biomédica de Bellvitge

    Affiliation as printed

    Bellvitge Biomedical Research Insitute-IDIBELL, Bellvitge University Hospital, Barcelona, Spain; CIBERSAM, Barcelona, Spain

16. Cinto Segalàs

    Bellvitge University Hospital · Institut d'Investigació Biomédica de Bellvitge

    Affiliation as printed

    Bellvitge Biomedical Research Insitute-IDIBELL, Bellvitge University Hospital, Barcelona, Spain; CIBERSAM, Barcelona, Spain

17. Carles Soriano‐Mas

    Bellvitge University Hospital · Institut d'Investigació Biomédica de Bellvitge · Centro de Investigación Biomédica en Red de Salud Mental · Universitat de Barcelona

    Affiliation as printed

    Bellvitge Biomedical Research Insitute-IDIBELL, Bellvitge University Hospital, Barcelona, Spain; CIBERSAM, Barcelona, Spain; Department of Social Psychology and Quantitative Psychology, Institute of Neurosciences, University of Barcelona, Barcelona, Spain

18. Sophia I. Thomopoulos

    University of Southern California

    Affiliation as printed

    Imaging Genetics Center, Stevens Neuroimaging & Informatics Institute, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA

19. Dan Joseph Stein

    South African Medical Research Council · University of Cape Town

    Affiliation as printed

    SA MRC Unit on Risk and Resilience in Mental Disorders, Department of Psychiatry, Neuroscience Institute, University of Cape Town, Cape Town, South Africa

20. Paul M. Thompson

    University of Southern California

    Affiliation as printed

    Imaging Genetics Center, Stevens Neuroimaging & Informatics Institute, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA

21. Odile A. van den Heuvel

    Amsterdam UMC Location Vrije Universiteit Amsterdam

    Affiliation as printed

    Amsterdam UMC location Vrije Universiteit Amsterdam, Department of Psychiatry, De Boelelaan 1117, Amsterdam, the Netherlands; Amsterdam UMC location Vrije Universiteit Amsterdam, Department of Anatomy and Neurosciences, De Boelelaan 1117, Amsterdam, the Netherlands

22. Guido Alexander van Wingen

    Amsterdam UMC Location University of Amsterdam · Amsterdam Neuroscience

    Affiliation as printed

    Amsterdam UMC location University of Amsterdam, Department of Psychiatry, Meibergdreef 9, Amsterdam, the Netherlands; Amsterdam Neuroscience, Amsterdam, the Netherlands