External validation of a prognostic model to improve prediction of psychosis: a retrospective cohort study in primary care

Sullivan, SA; Morris, R; Kounali, D; Kessler, D; Hamilton, W; Lewis, G; Lewis, G; Lilford, P; Nazareth, I

Journal article

External validation of a prognostic model to improve prediction of psychosis: a retrospective cohort study in primary care

Abstract:: Background: Early detection could reduce the duration of untreated psychosis. GPs are a vital part of the psychosis care pathway, but find it difficult to detect the early features. An accurate risk prediction tool, P Risk, was developed to detect these.

Aim: To externally validate P Risk.

Design and setting: This retrospective cohort study used a validation dataset of 1 647 934 UK Clinical Practice Research Datalink (CPRD) primary care records linked to secondary care records.

Method: The same predictors (age; sex; ethnicity; social deprivation; consultations for suicidal behaviour, depression/anxiety, and substance misuse; history of consultations for suicidal behaviour; smoking history; substance misuse; prescribed medications for depression/anxiety/post-traumatic stress disorder/obsessive compulsive disorder; and total number of consultations) were used as for the development of P Risk. Predictive risk, sensitivity, specificity, and likelihood ratios were calculated for various risk thresholds. Discrimination (Harrell’s C-index) and calibration were calculated. Results were compared between the development (CPRD GOLD) and validation (CPRD Aurum) datasets.

Results: Psychosis risk increased with values of the P Risk prognostic index. Incidence was highest in younger age groups and, in the main, higher in males. Harrell’s C was 0.79 (95% confidence interval = 0.78 to 0.79) in the validation dataset and 0.77 in the development dataset. A risk threshold of 1.0% gave sensitivity of 65.9% and specificity of 86.6%.

Conclusion: Further testing is required, but P Risk has the potential to be used in primary care to detect future risk of psychosis.

Publication status:: Published

Peer review status:: Peer reviewed

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APA Style

Sullivan, S. A., Morris, R., Kounali, D., Kessler, D., Hamilton, W., Lewis, G., Lewis, G., Lilford, P., & Nazareth, I. (2024). External validation of a prognostic model to improve prediction of psychosis: a retrospective cohort study in primary care. British Journal of General Practice, 74(749), e854–e860.

MLA Style

Sullivan, SA, et al. “External Validation of a Prognostic Model to Improve Prediction of Psychosis: a Retrospective Cohort Study in Primary Care.” British Journal of General Practice, vol. 74, no. 749, 2024, pp. e854–e860.

Chicago Style

Sullivan, SA, R Morris, D Kounali, et al. 2024. “External Validation of a Prognostic Model to Improve Prediction of Psychosis: a Retrospective Cohort Study in Primary Care.” British Journal of General Practice 74 (749): e854–e860.
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