2020 Articles

Personal Life Events—a Promising Dimension For Psychiatry In Electronic Health Records

Weissman, Myrna M.; Pathak, Jyotishman; Talati, Ardesheer

The adoption of electronic health records (EHRs) has empowered large-scale research in general medicine through providing clinically relevant data sources at relatively low cost. More recently, EHRs have begun to make substantial inroads in psychiatry, with some notable successes for genomics and for understanding polygenic risk and prediction of suicidal behavior. Their use is also critical to accelerate central nervous system innovation and new therapeutic strategies.

Beyond clinical variables related to diagnosis and treatment, there have been recent efforts to model the contributions of social determinants of health (SDOH) with EHRs, given their important roles in shaping health and well-being. Social determinants of health capture adverse social environments, such as poverty, crime, crowding, malnutrition, discrimination, and access to health care. These make engagement in psychiatric treatment or living with mental illness more difficult. However, there is another level of personal determinants of health, which predict risk and can occur even in individuals living in the most protected social environments. These events may be situations that threaten emotional and personal attachments or produce shame and humiliation. They can be proximal triggers to the onset of psychiatric symptoms, predict the likelihood of relapse from a disorder in remission, or be the result of a psychiatric disorder. We argue that such personal life events remain an underrecognized dimension in EHRs and that the addition of such information during routine care may further enhance the utility of EHRs for psychiatry.