Relative Importance of Symptoms, Cognition, and Other Multilevel Variables for Psychiatric Disease Classifications by Machine Learning

Abstract This study used machine-learning algorithms to make unbiased estimates of the relative importance of various multilevel data for classifying cases with schizophrenia (n=60), schizoaffective disorder (n=19), bipolar disorder (n=20), unipolar depression (n=14), and healthy controls (n=51) into psychiatric diagnostic categories. The Random Forest machine learning algorithm, which showed best efficacy (92.9% SD: 0.06), was used to generate variable importance ranking of positive, negative, and general psychopathology symptoms, cognitive indexes, global assessment of function (GAF), and parental ages at birth for sorting participants into diagnostic categories. Symptoms were ranked most influential for separating cases from healthy controls, followed by cognition and maternal age. To separate schizophrenia/schizoaffective disorder from bipolar/unipolar depression, GAF was most influential, followed by cognition and paternal age. For classifying schizophrenia from all other psychiatric disorders, low GAF and paternal age were similarly important, followed by cognition, psychopathology and maternal age. Controls misclassified as schizophrenia evidenced lower nonverbal abilities, mild negative and general psychopathology symptoms, and/or younger maternal/older paternal age. The importance of symptoms to classification of cases and lower GAF for diagnosing schizophrenia, notably more important and distinct from cognition and symptoms, concurs with current practices. The high importance of parental ages is noteworthy and merits further study.