Using relative utility curves to evaluate risk prediction

Summary.  Because many medical decisions are based on risk prediction models that are constructed from medical history and results of tests, the evaluation of these prediction models is important. This paper makes five contributions to this evaluation: the relative utility curve which gauges the potential for better prediction in terms of utilities, without the need for a reference level for one utility, while providing a sensitivity analysis for misspecification of utilities, the relevant region, which is the set of values of prediction performance that are consistent with the recommended treatment status in the absence of prediction, the test threshold, which is the minimum number of tests that would be traded for a true positive prediction in order for the expected utility to be non-negative, the evaluation of two-stage predictions that reduce test costs and connections between various measures of performance of prediction. An application involving the risk of cardiovascular disease is discussed.     

Child protection decision-making

The effects of interagency collaboration on risk assessment in child protection practice were analysed in respect of the decision-making processes in child death inquiries. Universal features in the assessment of risk as identified in psychological literature were applied; in particular, the concepts of ‘groupthink’, the ‘certainty effect’ and ‘group polarization’. It is suggested that case conference decisions are inherently more risky than those taken by professionals with individual responsibility because of the way in which cases are framed in terms of losses.     

Acknowledgement to editorial collaborators

Acknowledgments

Acknowledgement to editorial collaborators     

Issue Information

In 2017, the number of applications for care orders in England and Wales was the highest ever recorded at 14,207. This is a significant factor, contributing to the rise in the number of children who are looked after, which is at the highest level since 1985. The authors reflect on the recently published Care Crisis Review 2018, a sector‐led review, which examines the reasons for the rise in care proceedings and the number of children in care. The review sought to identify changes to policy and practice within local authorities and the family justice system, in an attempt to divert cases away from the family courts and to reduce the number of children in care, where it is safe to do so. Whilst the legislative framework is largely effective and the system generally works well, there is insufficient funding and resources to meet the needs of children and their families when they seek help, regardless of whether this is at an early stage or when they are in crisis and most in need of care and protection.     

Demographic differences in response rates for PHQ9 in a university student population

Objective: To examine differences in complete response rates for depression screening questions based on demographic characteristics. Methods: Cross-sectional study examining associations between demographic characteristics and completely responding depression-screening questions. Participants: “Healthy Minds Study” data, collected in a public University in February 2016, where 7,326 students participated. Results: women (AOR: 0.69; 95% CI =0.57–0.83) and gay/lesbian students (AOR: 0.24; 95% CI =0.10–0.60) had better complete response rates. Non-US (AOR: 1.46; 95% CI =1.03–2.07), black (AOR: 3.32; 95% CI =1.92–5.77), and Middle-Eastern students (AOR: 3.73; 95% CI =1.73–8.02) had lower complete response rates. Conclusions: Our study shows sex, gender, citizenship, and race categories have significant differences in complete response rates for the outcome. Our findings have several implications; including recognizing interventions for depression based on responders may not target those that tend to be “partial-responders”. Efforts in survey design, recruiting and completion of surveys should be maximized.     

Implementing a college mental health program – an overview of the first twelve months

Objective: To evaluate the demographics and clinical utilization patterns among college students during the initial 12 months of a novel, multi-disciplinary, collaborative, college mental health program (CMHP). Participants: Undergraduate and graduate students receiving treatment at the CMHP from Jan-Dec 2015. Methods: De-identified data was obtained via electronic health records for all students receiving care through the CMHP. Results: 1.2 FTE clinical providers treated 278 undergraduate and graduate students during the year (65.1% < age 26, 53.6% female, 49.6% caucasian). There were 1822 CMHP outpatient visits, 318 other medical visits and 103 total emergency room (ER)/inpatient visits. Ten students were identified as high utilizers of ER/inpatient services, while charges to the CMHP totaled $470,157 and total charges to the Health System were $2,378,315. Conclusions: Students with complex psychiatric/medical co-morbidities received cost effective, convenient and integrative treatment. Over time, we hope to intervene earlier and decrease ER/inpatient visits.     

Wanting To Be Remembered: Intrinsically Rewarding Work and Generativity in Early Midlife

Previous research on generativity, the desire to leave a legacy through establishing and guiding the next generation, has focused primarily on family life and civic engagement as pathways to midlife generativity. This paper proposes that intrinsically rewarding work can also be associated with a heightened sense of generativity in midlife. We test this hypothesis with data (n = 369 employed individuals, approximately 43 years old) from the 2010 wave of the Edmonton Transitions Study. Civic engagement was positively associated with midlife generativity, as predicted, but the hypothesized positive relationship between generativity and perceived parenting success was not found. Taking into account civic engagement and perceived parenting success, and controlling on a range of other variables, intrinsically rewarding work was positively associated with midlife feelings of generativity.