Informatics Research on Mental Health Functioning: Decision Support for the Social Security Administration Disability Program.

The disability determination process of the Social Security Administration's (SSA's) disability program requires assessing work-related functioning for individual claimants alleging disability due to mental impairment. This task is particularly challenging because the determination process involves the review of a large file of information, including objective medical evidence and self-reports from claimants, families, and former employers. To improve this decision-making process, SSA entered an interagency agreement with the Rehabilitation Medicine Department, Epidemiology and Biostatistics Section, in the Clinical Center of the National Institutes of Health, intending to use data science and informatics to develop decision support tools. This collaborative effort over the past decade has led to the development of the Work Disability-Functional Assessment Battery and has initiated an approach to applying natural language processing to the review of claimants' files for information on mental health functioning. This informatics research collaboration holds promise for improving the process of disability determination for individuals with mental impairments who make claims at the SSA.

Information Extraction Framework for Disability Determination Using a Mental Functioning Use-Case.

Natural language processing (NLP) in health care enables transformation of complex narrative information into high value products such as clinical decision support and adverse event monitoring in real time via the electronic health record (EHR). However, information technologies for mental health have consistently lagged because of the complexity of measuring and modeling mental health and illness. The use of NLP to support management of mental health conditions is a viable topic that has not been explored in depth. This paper provides a framework for the advanced application of NLP methods to identify, extract, and organize information on mental health and functioning to inform the decision-making process applied to assessing mental health. We present a use-case related to work disability, guided by the disability determination process of the US Social Security Administration (SSA). From this perspective, the following questions must be addressed about each problem that leads to a disability benefits claim: When did the problem occur and how long has it existed? How severe is it? Does it affect the person's ability to work? and What is the source of the evidence about the problem? Our framework includes 4 dimensions of medical information that are central to assessing disability-temporal sequence and duration, severity, context, and information source. We describe key aspects of each dimension and promising approaches for application in mental functioning. For example, to address temporality, a complete functional timeline must be created with all relevant aspects of functioning such as intermittence, persistence, and recurrence. Severity of mental health symptoms can be successfully identified and extracted on a 4-level ordinal scale from absent to severe. Some NLP work has been reported on the extraction of context for specific cases of wheelchair use in clinical settings. We discuss the links between the task of information source assessment and work on source attribution, coreference resolution, event extraction, and rule-based methods. Gaps were identified in NLP applications that directly applied to the framework and in existing relevant annotated data sets. We highlighted NLP methods with the potential for advanced application in the field of mental functioning. Findings of this work will inform the development of instruments for supporting SSA adjudicators in their disability determination process. The 4 dimensions of medical information may have relevance for a broad array of individuals and organizations responsible for assessing mental health function and ability. Further, our framework with 4 specific dimensions presents significant opportunity for the application of NLP in the realm of mental health and functioning beyond the SSA setting, and it may support the development of robust tools and methods for decision-making related to clinical care, program implementation, and other outcomes.

Ambiguity in medical concept normalization: An analysis of types and coverage in electronic health record datasets.

OBJECTIVES: Normalizing mentions of medical concepts to standardized vocabularies is a fundamental component of clinical text analysis. Ambiguity-words or phrases that may refer to different concepts-has been extensively researched as part of information extraction from biomedical literature, but less is known about the types and frequency of ambiguity in clinical text. This study characterizes the distribution and distinct types of ambiguity exhibited by benchmark clinical concept normalization datasets, in order to identify directions for advancing medical concept normalization research. MATERIALS AND METHODS: We identified ambiguous strings in datasets derived from the 2 available clinical corpora for concept normalization and categorized the distinct types of ambiguity they exhibited. We then compared observed string ambiguity in the datasets with potential ambiguity in the Unified Medical Language System (UMLS) to assess how representative available datasets are of ambiguity in clinical language. RESULTS: We found that <15% of strings were ambiguous within the datasets, while over 50% were ambiguous in the UMLS, indicating only partial coverage of clinical ambiguity. The percentage of strings in common between any pair of datasets ranged from 2% to only 36%; of these, 40% were annotated with different sets of concepts, severely limiting generalization. Finally, we observed 12 distinct types of ambiguity, distributed unequally across the available datasets, reflecting diverse linguistic and medical phenomena. DISCUSSION: Existing datasets are not sufficient to cover the diversity of clinical concept ambiguity, limiting both training and evaluation of normalization methods for clinical text. Additionally, the UMLS offers important semantic information for building and evaluating normalization methods. CONCLUSIONS: Our findings identify 3 opportunities for concept normalization research, including a need for ambiguity-specific clinical datasets and leveraging the rich semantics of the UMLS in new methods and evaluation measures for normalization.

Automatic detection of cyberbullying in social media text.

While social media offer great communication opportunities, they also increase the vulnerability of young people to threatening situations online. Recent studies report that cyberbullying constitutes a growing problem among youngsters. Successful prevention depends on the adequate detection of potentially harmful messages and the information overload on the Web requires intelligent systems to identify potential risks automatically. The focus of this paper is on automatic cyberbullying detection in social media text by modelling posts written by bullies, victims, and bystanders of online bullying. We describe the collection and fine-grained annotation of a cyberbullying corpus for English and Dutch and perform a series of binary classification experiments to determine the feasibility of automatic cyberbullying detection. We make use of linear support vector machines exploiting a rich feature set and investigate which information sources contribute the most for the task. Experiments on a hold-out test set reveal promising results for the detection of cyberbullying-related posts. After optimisation of the hyperparameters, the classifier yields an F1 score of 64% and 61% for English and Dutch respectively, and considerably outperforms baseline systems.

Combining Lexico-semantic Features for Emotion Classification in Suicide Notes.

This paper describes a system for automatic emotion classification, developed for the 2011 i2b2 Natural Language Processing Challenge, Track 2. The objective of the shared task was to label suicide notes with 15 relevant emotions on the sentence level. Our system uses 15 SVM models (one for each emotion) using the combination of features that was found to perform best on a given emotion. Features included lemmas and trigram bag of words, and information from semantic resources such as WordNet, SentiWordNet and subjectivity clues. The best-performing system labeled 7 of the 15 emotions and achieved an F-score of 53.31% on the test data.