arXiv:2506.18187cs.AIcs.LG2025-06

研究精神分裂症患者服药不依从如何提前1-4个月引发不良事件。

The Impact of Medication Non-adherence on Adverse Outcomes: Evidence from Schizophrenia Patients via Survival Analysis

  • 用生存分析结合因果推断,量化服药不依从对危机时间的影响。
  • 不依从使早亡、强制住院等事件提前1至4个月发生。
  • 适合精神卫生政策制定者和临床医生参考决策。

本研究通过生存分析评估精神分裂症患者抗精神病药物不依从与不良结局之间的关联。研究关注早期死亡、强制住院、被捕等事件的首次发生时间,将不依从视为治疗变量,扩展了T-learner、S-learner及最近邻匹配等因果推断方法以适配多种生存模型。分析使用宾夕法尼亚州阿勒格尼县的数据,分别基于3、6、9、12个月的纵向信息进行。结果表明,不依从使不良事件平均提前1至4个月发生;移除县级风险评分后效应增强,说明其有效控制混杂因素。按药物剂型(注射剂与口服剂)及药物类型分组分析均显示不依从与更早危机相关。研究强调依从性在延缓精神危机中的临床价值,并展示生存分析与因果推断融合可生成政策相关洞见。需注意,尽管采用因果方法,结论仅为关联性,且因果解释依赖特定假设。

原文摘要 · Abstract (English)

This study quantifies the association between non-adherence to antipsychotic medications and adverse outcomes in individuals with schizophrenia. We frame the problem using survival analysis, focusing on the time to the earliest of several adverse events (early death, involuntary hospitalization, jail booking). We extend standard causal inference methods (T-learner, S-learner, nearest neighbor matching) to utilize various survival models to estimate individual and average treatment effects, where treatment corresponds to medication non-adherence. Analyses are repeated using different amounts of longitudinal information (3, 6, 9, and 12 months). Using data from Allegheny County in western Pennsylvania, we find strong evidence that non-adherence advances adverse outcomes by approximately 1 to 4 months. Ablation studies confirm that county-provided risk scores adjust for key confounders, as their removal amplifies the estimated effects. Subgroup analyses by medication formulation (injectable vs. oral) and medication type consistently show that non-adherence is associated with earlier adverse events. These findings highlight the clinical importance of adherence in delaying psychiatric crises and show that integrating survival analysis with causal inference tools can yield policy-relevant insights. We caution that although we apply causal inference, we only make associative claims and discuss assumptions needed for causal interpretation.

精神分裂症生存分析依从性因果推断

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