Improving the Generalizability of Depression Detection by Leveraging Clinical Questionnaires

Automated methods have been widely used to identify and analyze mental healthconditions (e.g., depression) from various sources of information, includingsocial media. Yet, deployment of such models in real-world healthcareapplications faces challenges including poor out-of-domain generalization andlack of trust in black box models. In this work, we propose approaches fordepression detection that are constrained to different degrees by the presenceof symptoms described in PHQ9, a questionnaire used by clinicians in thedepression screening process. In dataset-transfer experiments on three socialmedia datasets, we find that grounding the model in PHQ9's symptomssubstantially improves its ability to generalize to out-of-distribution datacompared to a standard BERT-based approach. Furthermore, this approach canstill perform competitively on in-domain data. These results and ourqualitative analyses suggest that grounding model predictions inclinically-relevant symptoms can improve generalizability while producing amodel that is easier to inspect.<br

Improving the Generalizability of Depression Detection by Leveraging Clinical Questionnaires

Automated methods have been widely used to identify and analyze mental health conditions (e.g., depression) from various sources of information, including social media. Yet, deployment of such models in real-world healthcare applications faces challenges including poor out-of-domain generalization and lack of trust in black box models. In this work, we propose approaches for depression detection that are constrained to different degrees by the presence of symptoms described in PHQ9, a questionnaire used by clinicians in the depression screening process. In dataset-transfer experiments on three social media datasets, we find that grounding the model in PHQ9's symptoms substantially improves its ability to generalize to out-of-distribution data compared to a standard BERT-based approach. Furthermore, this approach can still perform competitively on in-domain data. These results and our qualitative analyses suggest that grounding model predictions in clinically-relevant symptoms can improve generalizability while producing a model that is easier to inspect

Embedding transfer for low-resource medical named entity recognition: a case study on patient mobility

Functioning is gaining recognition as an important indicator of global health, but remains under-studied in medical natural language processing research. We present the first analysis of automatically extracting descriptions of patient mobility, using a recently-developed dataset of free text electronic health records. We frame the task as a named entity recognition (NER) problem, and investigate the applicability of NER techniques to mobility extraction. As text corpora focused on patient functioning are scarce, we explore domain adaptation of word embeddings for use in a recurrent neural network NER system. We find that embeddings trained on a small in-domain corpus perform nearly as well as those learned from large out-of-domain corpora, and that domain adaptation techniques yield additional improvements in both precision and recall. Our analysis identifies several significant challenges in extracting descriptions of patient mobility, including the length and complexity of annotated entities and high linguistic variability in mobility descriptions

Classifying the reported ability in clinical mobility descriptions

Assessing how individuals perform different activities is key information for modeling health states of individuals and populations. Descriptions of activity performance in clinical free text are complex, including syntactic negation and similarities to textual entailment tasks. We explore a variety of methods for the novel task of classifying four types of assertions about activity performance: Able, Unable, Unclear, and None (no information). We find that ensembling an SVM trained with lexical features and a CNN achieves 77.9% macro F1 score on our task, and yields nearly 80% recall on the rare Unclear and Unable samples. Finally, we highlight several challenges in classifying performance assertions, including capturing information about sources of assistance, incorporating syntactic structure and negation scope, and handling new modalities at test time. Our findings establish a strong baseline for this novel task, and identify intriguing areas for further research

Development of natural language processing tools to support determination of federal disability benefits in the U.S.

The disability benefits programs administered by the US Social Security Administration (SSA) receive between 2 and 3 million new applications each year. Adjudicators manually review hundreds of evidence pages per case to determine eligibility based on financial, medical, and functional criteria. Natural Language Processing (NLP) technology is uniquely suited to support this adjudication work and is a critical component of an ongoing inter-agency collaboration between SSA and the National Institutes of Health. This NLP work provides resources and models for document ranking, named entity recognition, and terminology extraction in order to automatically identify documents and reports pertinent to a case, and to allow adjudicators to search for and locate desired information quickly. In this paper, we describe our vision for how NLP can impact SSA’s adjudication process, present the resources and models that have been developed, and discuss some of the benefits and challenges in working with large-scale government data, and its specific properties in the functional domain

Information extraction framework for disability determination using a mental functioning use-case

Natural language processing (NLP) in health care enables transformation of complex narrative information into high value products such as clinical decision support and adverse event monitoring in real time via the electronic health record (EHR). However, information technologies for mental health have consistently lagged because of the complexity of measuring and modeling mental health and illness. The use of NLP to support management of mental health conditions is a viable topic that has not been explored in depth. This paper provides a framework for the advanced application of NLP methods to identify, extract, and organize information on mental health and functioning to inform the decision-making process applied to assessing mental health. We present a use-case related to work disability, guided by the disability determination process of the US Social Security Administration (SSA). From this perspective, the following questions must be addressed about each problem that leads to a disability benefits claim: When did the problem occur and how long has it existed? How severe is it? Does it affect the person’s ability to work? and What is the source of the evidence about the problem? Our framework includes 4 dimensions of medical information that are central to assessing disability—temporal sequence and duration, severity, context, and information source. We describe key aspects of each dimension and promising approaches for application in mental functioning. For example, to address temporality, a complete functional timeline must be created with all relevant aspects of functioning such as intermittence, persistence, and recurrence. Severity of mental health symptoms can be successfully identified and extracted on a 4-level ordinal scale from absent to severe. Some NLP work has been reported on the extraction of context for specific cases of wheelchair use in clinical settings. We discuss the links between the task of information source assessment and work on source attribution, coreference resolution, event extraction, and rule-based methods. Gaps were identified in NLP applications that directly applied to the framework and in existing relevant annotated data sets. We highlighted NLP methods with the potential for advanced application in the field of mental functioning. Findings of this work will inform the development of instruments for supporting SSA adjudicators in their disability determination process. The 4 dimensions of medical information may have relevance for a broad array of individuals and organizations responsible for assessing mental health function and ability. Further, our framework with 4 specific dimensions presents significant opportunity for the application of NLP in the realm of mental health and functioning beyond the SSA setting, and it may support the development of robust tools and methods for decision-making related to clinical care, program implementation, and other outcomes

A comprehensive study of mobility functioning information in clinical notes: Entity hierarchy, corpus annotation, and sequence labeling

Background Secondary use of Electronic Health Records (EHRs) has mostly focused on health conditions (diseases and drugs). Function is an important health indicator in addition to morbidity and mortality. Nevertheless, function has been overlooked in accessing patients’ health status. The World Health Organization (WHO)’s International Classification of Functioning, Disability and Health (ICF) is considered the international standard for describing and coding function and health states. We pioneer the first comprehensive analysis and identification of functioning concepts in the Mobility domain of the ICF. Results Using physical therapy notes at the National Institutes of Health’s Clinical Center, we induced a hierarchical order of mobility-related entities including 5 entities types, 3 relations, 8 attributes, and 33 attribute values. Two domain experts manually curated a gold standard corpus of 14,281 nested entity mentions from 400 clinical notes. Inter-annotator agreement (IAA) of exact matching averaged 92.3 % F1-score on mention text spans, and 96.6 % Cohen’s kappa on attributes assignments. A high-performance Ensemble machine learning model for named entity recognition (NER) was trained and evaluated using the gold standard corpus. Average F1-score on exact entity matching of our Ensemble method (84.90 %) outperformed popular NER methods: Conditional Random Field (80.4 %), Recurrent Neural Network (81.82 %), and Bidirectional Encoder Representations from Transformers (82.33 %). Conclusions The results of this study show that mobility functioning information can be reliably captured from clinical notes once adequate resources are provided for sequence labeling methods. We expect that functioning concepts in other domains of the ICF can be identified in similar fashion

Broadening horizons: the case for capturing function and the role of health informatics in its use

Background Human activity and the interaction between health conditions and activity is a critical part of understanding the overall function of individuals. The World Health Organization’s International Classification of Functioning, Disability and Health (ICF) models function as all aspects of an individual’s interaction with the world, including organismal concepts such as individual body structures, functions, and pathologies, as well as the outcomes of the individual’s interaction with their environment, referred to as activity and participation. Function, particularly activity and participation outcomes, is an important indicator of health at both the level of an individual and the population level, as it is highly correlated with quality of life and a critical component of identifying resource needs. Since it reflects the cumulative impact of health conditions on individuals and is not disease specific, its use as a health indicator helps to address major barriers to holistic, patient-centered care that result from multiple, and often competing, disease specific interventions. While the need for better information on function has been widely endorsed, this has not translated into its routine incorporation into modern health systems. Purpose We present the importance of capturing information on activity as a core component of modern health systems and identify specific steps and analytic methods that can be used to make it more available to utilize in improving patient care. We identify challenges in the use of activity and participation information, such as a lack of consistent documentation and diversity of data specificity and representation across providers, health systems, and national surveys. We describe how activity and participation information can be more effectively captured, and how health informatics methodologies, including natural language processing (NLP), can enable automatically locating, extracting, and organizing this information on a large scale, supporting standardization and utilization with minimal additional provider burden. We examine the analytic requirements and potential challenges of capturing this information with informatics, and describe how data-driven techniques can combine with common standards and documentation practices to make activity and participation information standardized and accessible for improving patient care. Recommendations We recommend four specific actions to improve the capture and analysis of activity and participation information throughout the continuum of care: (1) make activity and participation annotation standards and datasets available to the broader research community; (2) define common research problems in automatically processing activity and participation information; (3) develop robust, machine-readable ontologies for function that describe the components of activity and participation information and their relationships; and (4) establish standards for how and when to document activity and participation status during clinical encounters. We further provide specific short-term goals to make significant progress in each of these areas within a reasonable time frame