Detecting the Clinical Features of Difficult-to-Treat Depression using Synthetic Data from Large Language Models

Difficult-to-treat depression (DTD) has been proposed as a broader and more clinically comprehensive perspective on a person's depressive disorder where despite treatment, they continue to experience significant burden. We sought to develop a Large Language Model (LLM)-based tool capable of interrogating routinely-collected, narrative (free-text) electronic health record (EHR) data to locate published prognostic factors that capture the clinical syndrome of DTD. In this work, we use LLM-generated synthetic data (GPT3.5) and a Non-Maximum Suppression (NMS) algorithm to train a BERT-based span extraction model. The resulting model is then able to extract and label spans related to a variety of relevant positive and negative factors in real clinical data (i.e. spans of text that increase or decrease the likelihood of a patient matching the DTD syndrome). We show it is possible to obtain good overall performance (0.70 F1 across polarity) on real clinical data on a set of as many as 20 different factors, and high performance (0.85 F1 with 0.95 precision) on a subset of important DTD factors such as history of abuse, family history of affective disorder, illness severity and suicidality by training the model exclusively on synthetic data. Our results show promise for future healthcare applications especially in applications where traditionally, highly confidential medical data and human-expert annotation would normally be required.