Leveraging Contextual Relatedness to Identify Suicide Documentation in Clinical Notes through Zero Shot Learning

 Abstract — Objectives: Identifying suicidality including suicidal ideation, attempts, and risk factors in electronic health record data in clinical notes is difficult. A major difficulty is the lack of training samples given the small number of true positive instances among the increasingly large number of patients being screened. This paper describes a novel methodology that identifies suicidality in clinical notes by addressing this data sparsity issue through zero-shot learning. Materials and Methods: U.S. Veterans Affairs clinical notes served as data. The training dataset label was determined using diagnostic codes of suicide attempt and self-harm. A base string associated with the target label of suicidality was used to provide auxiliary information by narrowing the positive training cases to those containing the base string. A deep neural network was trained by mapping the training documents’ contents to a semantic space. For comparison, we trained another deep neural network using the identical training dataset labels and bag-of-words features. Results: The zero shot learning model outperformed the baseline model in terms of AUC, sensitivity, specificity, and positive predictive value at multiple probability thresholds. In applying a 0.90 probability threshold, the methodology identified notes not associated with a relevant ICD-10-CM code that documented suicidality, with 94% accuracy. Conclusion: This new method can effectively identify suicidality without requiring manual annotation.