Machine learning and Bayesian network analyses identifies associations with insomnia in a national sample of 31,285 treatment-seeking college students.

backgroundA better understanding of the relationships between insomnia and anxiety, mood, eating, and alcohol-use disorders is needed given its prevalence among young adults. Supervised machine learning provides the ability to evaluate which mental disorder is most associated with heightened insomnia among U.S. college students. Combined with Bayesian network analysis, probable directional relationships between insomnia and interacting symptoms may be illuminated.

methodsThe current exploratory analyses utilized a national sample of college students across 26 U.S. colleges and universities collected during population-level screening before entering a randomized controlled trial. We used a 4-step statistical approach: (1) at the disorder level, an elastic net regularization model examined the relative importance of the association between insomnia and 7 mental disorders (major depressive disorder, generalized anxiety disorder, social anxiety disorder, panic disorder, post-traumatic stress disorder, anorexia nervosa, and alcohol use disorder); (2) This model was evaluated within a hold-out sample. (3) at the symptom level, a completed partially directed acyclic graph (CPDAG) was computed via a Bayesian hill-climbing algorithm to estimate potential directionality among insomnia and its most associated disorder [based on SHAP (SHapley Additive exPlanations) values)]; (4) the CPDAG was then tested for generalizability by assessing (in)equality within a hold-out sample using structural hamming distance (SHD).

resultsOf 31,285 participants, 20,597 were women (65.8%); mean (standard deviation) age was 22.96 (4.52) years. The elastic net model demonstrated clinical significance in predicting insomnia severity in the training sample [R

conclusionThese findings provide insights into the associations between insomnia and mental disorders among college students and warrant further investigation into the potential direction of causality between insomnia and depression.

trial registrationTrial was registered on the National Institute of Health RePORTER website (R01MH115128 || 23/08/2018).