SUPPLEMENTARY MATERIALS. Appendix 1. Definition of Suicidal Behavior Using ICD-9 Diagnostic Codes.

Transcription

1 SUPPLEMENTARY MATERIALS Appendix 1. Definition of Suicidal Behavior Using ICD-9 Diagnostic Codes. For this study, suicidal behavior was defined using ICD-9 diagnostic codes and death certificates from the Commonwealth of Massachusetts. ICD-9 codes of E95* (injuries of intentional intent) are the most explicit diagnostic code for suicide attempts. In order to validate our case definition, we randomly selected 100 patients with an E95* code and reviewed all clinical notes within one week of the ICD-9 diagnosis. Three senior clinicians with expertise in the epidemiology and treatment of suicidal behavior (JWS, RHP, MKN) manually reviewed narrative notes. Each note was designated as one of six categories using consensus agreement by all three clinicians: (1) Self-harm, suicidal, (2) Self-harm, intentional, non-suicidal, (3) Self-harm, accidental, (4) Self-harm, not enough intent information, (5) Self-harm, contradictory intent information and (6) No evidence of selfharm. The positive predictive value (PPV) of each code was calculated as the proportion of notes classified in categories 1 or 2. To maximize sensitivity of the case definition we identified an additional set of 15 ICD-9 injury code categories as well as E98* (injury of questionable intent) as potential indicators of suicide attempts in the EHR (Table S-1). For each ICD-9 category, the clinicians reviewed a small sample of patients using the chart review method above. If the prevalence of true cases was > 20%, a larger sample of 50 randomly selected patients were subsequently reviewed. Code categories with a PPV > 0.70 were selected for our final case definition. These included E95* (PPV: 0.82), 965.* (Poisoning by analgesics, antipyretics, and anti-rheumatics, PPV: 0.80), 967.* (Poisoning by sedatives and hypnotics, PPV: 0.84), 969.* (Poisoning by psychotropic agents, PPV: 0.80) and 881.* (Open wound of elbow

2 forearm and wrist, PPV: 0.70). Detailed chart review results, including codes not included in the definition are available in Supplementary Table S-1. We searched death certificates for a primary or underlying cause of death of suicide as defined by the state (ie ICD-10 X60-X84, Y87.0, ICD-9 E950-E959). In Massachusetts, all deaths by suicide, homicide, deaths under suspicious or unusual circumstances and deaths due to poison or acute or chronic use of drugs or alcohol are referred to the medical examiner to establish the cause of death (MGL Ch. 38, Section 3) and 99.6% were reviewed by the medical examiner. While this may have resulted in our missing true cases, the effect would be expected to reduce the accuracy of our model (as these cases would have been included among controls). Thus our model accuracy metrics may be conservative and we now note this as a limitation of the study. Also, as noted in the main text, of the 852 death certificates with suicide as a cause of death, only 49 didn t have one of the ICD9 codes that comprise the case definition, supporting the assumption that our case definition of suicide attempt captures most individuals who completed suicide.

3 Appendix 2. Development of the Naïve Bayes Classifier Model To build the Naïve Bayes classifier we calculated the odds-ratio associated with each feature used in the model. We then calculated the log of the odds-ratio, converting ratios that are larger than one (more common among cases) into positive scores and ratios that are between zero and one (more common among controls) into negative scores. For example, Opioid abuse, unspecified use was recorded for 366 cases (out of a total of 627,121different ICD-9 codes recorded for the cases) and for 2,073 controls (out of a total of 53,596,375 ICD-9 codes recorded for the controls). Thus, the odds-ratio was: (366/627,121) / (2,073/53,596,375) = To calculate the Naïve Bayes score we took the natural log of the odds-ratio to get a score of: ln(15.09) = 2.71 The same process was repeated for all different variables. Once we had a Naïve Bayes score for each individual variable, we applied these scores for each subject over time and calculated the total cumulative score. Thus, if a subject X had a documentation of Opioid abuse, unspecified use at a specific time T, then their score from time T-1 will increase by 2.71 points.

4 Table S-1 Sample sets and PPV by diagnostic codes reviewed for inclusion in the case definition. This table shows the number of patients in the Partners Electronic Medical Records who were assigned each code. A. ICD-9 Codes selected for inclusion in the case definition, based on clinician chart review that showed a PPV > 0.70 for suicide attempts and death by suicide. ICD-9 codes: E95* 965.* 967.* 969.* 881.* Case definition N in Partners EMR 6,364 3, ,906 9,517 20,246 (1) Self harm suicidal (2) Self harm - intentional, nonsuicidal (3) Self harm - accidental (4) Self harm - not enough intent information (5) Self harm - contradictory intent information (6) No evidence of self-harm Total PPV (Self harm (1) only) PPV (including (1) and (2)) B. ICD-9 Codes with suicide attempt PPV < 0.70 not included in the case definition ICD-9 codes: E98* E * 966.* 986.* 970.* E868.* 968. * N in Partners EMR 3, ,737 1, (1) Self harm - suicidal (2) Self harm - intentional, nonsuicidal (3) Self harm - accidental (4) Self harm - not enough intent information (5) Self harm - contradictory intent information (6) No evidence of self-harm Total PPV (Self harm (1) only) PPV (including (1) and (2))

5 Table S-2 - List of top 100 diagnoses, medications, and lab results associated with suicidal behavior, along with their incidence and associated risk-score. The incidence of each code and shown on a 1:100,000 codes ratio. The risk score for each code is calculated as the relative prevalence of the code among cases divided by the relative prevalence among controls. 95% Confidence Intervals (CI) are shown in brackets. A. Top 100 diagnostic and procedure codes associated with suicidal behavior. Diagnoses and Procedures Cases (1:100k) Controls (1:100k) TOTAL Women Men Risk Score [95% CI] Risk Score [95% CI] Risk Score [95% CI] Opioid abuse, continuous use [ ] [ ] 15.8 [ ] Other, mixed, or unspecified drug abuse, continuous use [ ] 17.9 [ ] 16.8 [ ] Combinations of opioid type drug with any other drug dependence, continuous use [ ] 16.7 [ ] [ ] Combinations of opioid type drug with any other drug dependence, unspecified use [ ] [ ] [ ] Poisoning by unspecified drug or medicinal substance [ ] [ ] [ ] Cocaine dependence, continuous use [ ] [ ] 14.5 [ ] Opioid abuse, unspecified use [ ] [ ] [ ] Barbiturate and similarly acting sedative or hypnotic abuse, unspecified use [ ] [ ] [ ] Cocaine abuse, continuous use [ ] 9.51 [ ] [9.2-15] Opioid type dependence, continuous use [ ] [8.1-13] [9.7-14] Drug withdrawal syndrome [ ] 10.7 [ ] 10.2 [ ] Other, mixed, or unspecified drug abuse, unspecified use [ ] [ ] 9.3 [ ] Combinations of drug dependence excluding opioid type drug, unspecified use [ ] [ ] 8.89 [ ] Acute alcoholic intoxication in alcoholism, unspecified drinking behavior [ ] [ ] 8.45 [7.1-10] Borderline personality [ ] [ ] 8.88 [ ] Unspecified neurotic disorder [8.9-11] [ ] 8.95 [ ] Acute alcoholic intoxication in alcoholism, continuous drinking behavior [ ] [ ] 7.47 [ ] Cocaine abuse, unspecified use [ ] [ ] 8 [7-9.2] Barbiturate and similarly acting sedative or hypnotic dependence, unspecified use [ ] 9.83 [7-13.8] 9.08 [ ] Cocaine dependence, unspecified use [ ] [ ] 8.45 [ ] Drug-induced organic affective [ ] 9.55 [ ] 8.78 [ ]

6 syndrome Opioid type dependence, unspecified use [8.2-10] 9.18 [ ] 8.33 [ ] Opioid abuse, in remission [ ] 8.46 [5-14.4] 8.55 [6-12.3] Lack of housing [ ] 8.23 [ ] 8.11 [ ] Depressive neuroses [ ] 8.26 [ ] 8.31 [ ] Alcohol/drug abuse or dependence w cc [ ] 9.76 [ ] 6.79 [5.1-9] Bipolar affective disorder, depressed, severe degree, specified as with psychotic behavior [ ] 6.68 [ ] 9.29 [ ] Unspecified drug dependence, unspecified use [ ] 7.86 [ ] 6.99 [6-8.1] Closed fracture of rib(s) [ ] 8.46 [ ] 6.08 [ ] Opioid type dependence, in remission [ ] 7.81 [ ] 6.35 [ ] Psychoses [ ] 7.1 [ ] 6.85 [ ] Open wound of hand except fingers alone, with tendon involvement [ ] [ ] 5.12 [ ] Cocaine abuse, episodic use [ ] [5.4-20] 5.01 [ ] Other, mixed, or unspecified drug abuse, in remission [ ] 7.32 [ ] 6.15 [ ] Other and unspecified alcohol dependence [ ] 7.83 [ ] 5.88 [ ] Unspecified personality disorder [ ] 8.28 [ ] 5.12 [ ] Assault by cutting and piercing instrument [ ] 5.12 [ ] 6.07 [ ] Bipolar affective disorder, mixed [ ] 7.34 [ ] 5.79 [3-11] Nontraumatic rupture of extensor tendons of hand and wrist [ ] [ ] 3.5 [ ] Unspecified schizophrenia, chronic state [ ] 8.24 [ ] 5.01 [ ] Schizo-affective type schizophrenia, chronic state with acute exacerbation [ ] 5.28 [2.3-12] 6.75 [ ] Observation following other inflicted injury [ ] 8.02 [ ] 4.72 [ ] Other and unspecified alcohol dependence, continuous drinking behavior [ ] 7.51 [ ] 5.22 [ ] Hepatitis C carrier [ ] 6.49 [ ] 5.39 [ ] Major depressive disorder, single episode, severe degree, specified as with psychotic behavior [ ] 5.95 [3.9-9] 6.13 [4-9.4] Unspecified drug-induced mental disorder [4-9.2] 6.48 [ ] 5.39 [ ]

7 Schizo-affective type schizophrenia, chronic state [3.6-10] 5.79 [ ] 6.02 [ ] Alcohol/drug abuse or depend w/o rehabilitation therapy w/o cc [ ] 5.95 [ ] 5.43 [ ] Bipolar affective disorder, depressed, moderate degree [ ] 7.45 [ ] 4.09 [2.1-8] Bipolar affective disorder, depressed, unspecified degree [ ] 6.26 [ ] 5.51 [ ] Other electroshock therapy [ ] 6.1 [4-9.4] 5.68 [ ] Alcohol withdrawal [ ] 8.15 [ ] 4.74 [ ] Alveolitis of jaw [ ] 4.91 [ ] 7.36 [ ] Bipolar affective disorder, unspecified [ ] 6.47 [ ] 4.87 [ ] Bipolar affective disorder, mixed, severe degree, without mention of psychotic behavior [ ] 7.64 [ ] 2.72 [1-7.4] Debridement of open fracture of radius and ulna [ ] 4.32 [ ] 6.34 [ ] Issue of repeat prescriptions [ ] 4.55 [ ] 6.01 [ ] Bipolar affective disorder, mixed, severe degree, specified as with psychotic behavior [ ] 4.94 [ ] 6.64 [3.7-12] Paranoid type schizophrenia, chronic state [ ] 6.05 [2.8-13] 4.73 [ ] Alcoholic gastritis, without mention of hemorrhage [ ] 6.43 [ ] 4.47 [ ] Acute adjustment reaction and psychosocial dysfunction [ ] 5.08 [3.2-8] 5.57 [ ] Major depressive disorder, recurrent episode [ ] 6.79 [ ] 2.54 [ ] Manic disorder, single episode, unspecified degree [ ] 5.96 [4.4-8] 4.44 [3-6.5] Other and unspecified alcohol dependence, unspecified drinking behavior [ ] 5.7 [ ] 4.56 [4.1-5] Bipolar affective disorder, mixed, unspecified degree [ ] 5.97 [ ] 4.37 [ ] Cannabis dependence, unspecified use [4-6.7] 4.69 [ ] 4.88 [ ] Bipolar affective disorder, depressed, severe degree, without mention of psychotic behavior [4-6.7] 5.83 [4.2-8] 4.44 [ ] Other and unspecified reactive psychosis [ ] 7.97 [ ] 2.85 [1.6-5] Alcohol abuse, unspecified drinking behavior [ ] 6.14 [ ] 4.2 [ ]

8 Multiple and unspecified open wound of upper limb, without mention of complication [4-6.4] 5.08 [ ] 4.67 [ ] Late effect of tendon injury [ ] 5.05 [ ] 4.65 [ ] Cannabis abuse, unspecified use [4.2-6] 6.76 [ ] 3.9 [ ] Counseling on substance use and abuse [ ] 4.86 [ ] 4.95 [ ] Poisoning and toxic effects of drugs age >17 w cc [ ] 3.44 [ ] 5.84 [3.8-9] Other and unspecified injury to head, face, and neck [ ] 5.87 [3-11.5] 4.19 [ ] Schizo-affective type schizophrenia, unspecified state [ ] 4.78 [ ] 4.96 [4-6.1] Alcohol detoxification [3.5-7] 3.31 [1.2-9] 4.7 [ ] Alcohol abuse, episodic drinking behavior [ ] 6.54 [ ] 3.91 [ ] Trauma To The Skin, Subcut Tiss and Breast Age >17 W CC [ ] 5.1 [ ] 4.49 [ ] Bipolar affective disorder, manic, unspecified degree [ ] 5.67 [ ] 4.03 [3.3-5] Osteomyelitis [2.9-8] 4.32 [ ] 4.73 [ ] Assault by other specified means [ ] 6.1 [ ] 3.63 [ ] Assault by striking by blunt or thrown object [ ] 6.25 [ ] 3.98 [3-5.3] Assault by unspecified means [4-5.8] 6.04 [ ] 3.96 [3.2-5] Unspecified affective psychosis [ ] 5.02 [ ] 4.4 [4-4.9] Residual schizophrenia, unspecified state [ ] 8.21 [ ] 2.41 [ ] Open wound of abdominal wall, lateral, without mention of complication [ ] 3.72 [ ] 4.63 [ ] Major depressive disorder, recurrent episode, severe degree, specified as with psychotic behavior [4-5.6] 5.39 [ ] 3.95 [ ] Contusion of back [ ] 5.72 [ ] 3.66 [ ] Prolonged posttraumatic stress disorder [ ] 4.96 [ ] 4.59 [ ] Alcohol abuse, continuous drinking behavior [4-5.5] 5.87 [ ] 3.9 [ ] Injury to unspecified blood vessel of head and neck [ ] 3.96 [ ] 4.73 [ ] Acute or unspecified hepatitis C without mention of hepatic coma [ ] 4.3 [ ] 4.5 [ ] Alcohol withdrawal delirium [3.6-6] 5.74 [ ] 3.89 [ ] Major depressive disorder, single episode, unspecified degree [4.3-5] 4.58 [ ] 4.82 [ ]

9 Chronic hepatitis C without mention of hepatic coma [ ] 4.72 [ ] 4.21 [ ] Cellulitis and abscess of hand, except fingers and thumb [ ] 5.42 [4.2-7] 3.76 [3-4.8] Cocaine abuse, in remission [ ] 4.34 [ ] 4.17 [ ] Other suture of other tendon of hand [ ] 4.92 [2.4-10] 3.93 [2.6-6] Other manic-depressive psychosis [ ] 5.15 [ ] 3.7 [ ] B. Top 100 medications associated with suicidal behavior. Medication Cases (1:100k) TOTAL Women Men Controls Risk Score [95% CI] Risk Score [95% CI] Risk Score [95% CI] (1:100k) Fluphenazine [ ] 5.05 [ ] 8.03 [ ] Buprenorphine- Naloxone [ ] 6.53 [ ] 5.35 [ ] Ziprasidone [ ] 5.16 [3.8-7] 7.18 [ ] Lithium [5-6.5] 6.61 [ ] 4.68 [ ] Disulfiram [ ] 3.27 [1-10.3] 5.12 [ ] Naltrexone [ ] 6.16 [ ] 3.07 [1.9-5] Chlordiazepoxide [ ] 3.88 [ ] 4.59 [ ] Methadone [4-5.1] 4.33 [ ] 4.5 [ ] Stavudine [ ] 4.87 [ ] 3.77 [ ] Nefazodone [ ] 3.79 [ ] 5.08 [ ] Benztropine [3.6-5] 4.55 [ ] 3.82 [3-4.9] Hydrocodone [ ] 6.15 [ ] 0.7 [0.1-5] Acamprosate [ ] 4.85 [ ] 3 [ ] Clonidine [ ] 3.61 [ ] 3.81 [ ] Risperidone [ ] 4.14 [ ] 3.26 [ ] Aripiprazole [ ] 4.23 [3.6-5] 3.05 [ ] Divalproex Sodium [ ] 3.81 [ ] 3.46 [3-4.1] Oxcarbazepine [ ] 3.75 [ ] 3.55 [ ] Clozapine [ ] 3.99 [ ] 3.2 [ ] Nelfinavir [2-6.3] 6.86 [3.4-14] 1.7 [ ] Mafenide Topical [ ] 5.51 [ ] 2.49 [ ] Quetiapine [ ] 3.89 [ ] 3.1 [ ] Fluvoxamine [ ] 3.91 [ ] 2.73 [ ] Clomipramine [2-5.5] 4.79 [ ] 1.94 [ ] Nicotine [ ] 3.46 [ ] 3.08 [ ] Zafirlukast [ ] 3.59 [ ] 2.84 [ ] Lamivudine [ ] 4.4 [ ] 2.54 [1.6-4] Trimethobenzami de [ ] 3.11 [ ] 3.75 [ ] Lindane Topical [ ] 0.73 [ ] 5.78 [ ]

10 Dicyclomine [ ] 2.29 [1.8-3] 4.44 [ ] Chlorpromazine [ ] 6.08 [ ] 1.94 [ ] Zidovudine [ ] 3.4 [ ] 2.58 [ ] Phenobarbital [ ] 2.92 [ ] 2.69 [ ] Olanzapine [ ] 3.12 [ ] 2.52 [ ] Paliperidone [ ] 1.96 [ ] 3.54 [ ] Bacitracin Topical [ ] 3.32 [ ] 2.35 [ ] Ribavirin [ ] 2.79 [ ] 2.6 [ ] Candida Albicans Extract [2-3.9] 3.83 [ ] 2.01 [ ] Thiamine [2.5-3] 2.62 [ ] 2.57 [ ] Mumps Skin Test Antigen [ ] 3.96 [ ] 1.78 [1-3.1] Prazosin [2-3.5] 4.13 [3-5.8] 1.47 [ ] Interferon Alfa-2a [ ] 3.13 [ ] 2.24 [ ] Efavirenz [ ] 2.67 [ ] 2.4 [1.5-4] Bupropion [ ] 2.77 [ ] 2.46 [ ] Lamotrigine [2.3-3] 3.03 [ ] 1.99 [ ] Hexachlorophene Topical [ ] 0.84 [0.1-6] 3.76 [ ] Clonazepam [ ] 2.61 [ ] 2.58 [ ] Urokinase [ ] 2.82 [ ] 2.26 [ ] Doxepin [2-3.1] 2.48 [ ] 2.64 [ ] Mirtazapine [ ] 2.42 [2-2.9] 2.56 [2.2-3] Methylnaltrexone [ ] 3.16 [ ] 1.91 [ ] Triethanolamine Polypeptide Oleate Otic [ ] 3.8 [ ] 0.82 [ ] Interferon Alfa-2a [ ] 2.61 [1-7] 2.2 [ ] Atazanavir [1.4-4] 2.6 [ ] 2.12 [1.1-4] Carisoprodol [ ] 2.55 [ ] 2.21 [ ] Iron Dextran [ ] 3.19 [ ] 1.39 [ ] Bretylium [1-5.6] 3.23 [1-10.2] 1.54 [ ] Quinine [ ] 2.61 [2-3.5] 1.92 [ ] Chlordiazepoxide- Clidinium [ ] 2.69 [ ] 1.46 [ ] Choline Salicylate- Magnesium Salicylate [ ] 2.21 [ ] 2.45 [ ] Abacavir [ ] 2.42 [ ] 1.98 [ ] Tiagabine [1-5] 1.9 [ ] 2.71 [ ] Lanolin Topical [1.2-4] 2.45 [ ] 1.95 [ ] Trazodone [ ] 2.26 [ ] 2.12 [ ] Paroxetine [2-2.4] 2.09 [ ] 2.44 [ ] Ritonavir [ ] 2.47 [ ] 1.92 [ ] Selegiline [ ] 3.3 [ ] 1.25 [ ] Ramelteon [ ] 3.21 [ ] 0.8 [ ] Desipramine [1.6-3] 2.61 [ ] 1.52 [ ]

11 Ticlopidine [ ] 1.61 [ ] 2.23 [ ] Haloperidol [2-2.4] 2.51 [ ] 1.81 [ ] Lamivudine- Zidovudine [ ] 2.82 [ ] 1.61 [ ] Al Hydroxide/Mg Hydroxide/Simethi cone [ ] 2.11 [ ] 2.11 [ ] Amphotericin B Topical [ ] 3.13 [ ] 1.42 [ ] Carbamazepine [ ] 2.35 [1.8-3] 1.85 [ ] Fluoxetine [ ] 2.13 [ ] 2.24 [2-2.6] Salsalate [ ] 2.6 [1.7-4] 1.38 [ ] Theophylline [ ] 2.54 [ ] 1.59 [1-2.6] Perphenazine [ ] 2.71 [ ] 1.34 [0.9-2] Venlafaxine [ ] 2.12 [ ] 2.19 [ ] Emtricitabine- Tenofovir [ ] 2.39 [ ] 1.75 [ ] Trihexyphenidyl [ ] 1.92 [ ] 2.02 [1-4.3] Salmeterol [ ] 2.14 [ ] 1.86 [ ] Cisapride [ ] 2.12 [ ] 1.84 [1-3.4] Hydrocodone- Ibuprofen [ ] 1.03 [ ] 3.26 [ ] Multivitamin With Minerals [ ] 2.31 [ ] 1.57 [ ] Valdecoxib [ ] 1.87 [ ] 2.27 [ ] Hepatitis B Immune Globulin [1-3.6] 2.8 [ ] 0.88 [ ] Valproic Acid [ ] 1.56 [1-2.5] 2.12 [1.5-3] Tuberculin Purified Protein Derivative [ ] 1.86 [ ] 1.96 [ ] Nafcillin [ ] 1.9 [ ] 1.79 [ ] Mexiletine [1-3.5] 3.36 [ ] 1.21 [ ] Tetracaine Ophthalmic [ ] 1.45 [ ] 2.41 [ ] Acetaminophen- Tramadol [ ] 2.19 [ ] 1.54 [0.8-3] Bupropion [1.7-2] 1.89 [ ] 1.89 [ ] Flunisolide [ ] 2.38 [ ] 1.28 [ ] Ticarcillin- Clavulanate [ ] 3.75 [ ] 0.87 [ ] Rofecoxib [ ] 2.02 [ ] 1.68 [ ] Coal Tar Topical [0.7-5] 2 [ ] 1.67 [ ] Citric Acid- Potassium Citrate [ ] 3.2 [ ] 0.84 [ ]

12 C. Top 100 lab-tests associated with suicidal behavior. Each test is shown with its associated result in brackets encoded as: N=negative, H=high, L=low, A=abnormal, and U=un-interpretable. Lab Test (result) Cases (1:100k) Controls (1:100k) TOTAL Women Men Risk Score [95% CI] Risk Score [95% CI] Risk Score [95% CI] Norchlordiazepoxide [Presence] in Serum or Plasma (N) [ ] [ ] 15.4 [ ] Chlordiazepoxide Plasma by Screen method (N) [ ] [ ] [ ] Demoxepam [Mass/volume] in Serum or Plasma (N) [ ] [ ] [ ] Cocaethylene [Presence] in Serum or Plasma (N) [ ] [ ] [ ] Methadone [Mass/volume] in Serum or Plasma by Screen method (N) [ ] [ ] [ ] Alprazolam [Mass/volume] in Serum or Plasma (N) [ ] [ ] [ ] Cocaine [Presence] in Serum or Plasma (N) [ ] [ ] 12.8 [ ] Nordiazepam Plasma by Screen method (N) [ ] [ ] [ ] Oxazepam [Mass/volume] in method (N) [ ] [ ] [ ] Clonazepam [Mass/volume] in Serum or Plasma by Screen method (N) [ ] [ ] [ ] Diazepam [Mass/volume] in method (N) [ ] 14.1 [ ] [ ] Norpropoxyphene Plasma by Screen method (N) [ ] [ ] [6.9-20] M-chlorophenylpiperazine [Presence] in Serum or Plasma (N) [ ] [ ] 9.89 [7-13.9] Diphenhydramine Plasma by Screen method (N) [ ] [ ] [ ] Fluoxetine [Mass/volume] in method (N) [ ] [ ] 9.47 [ ] Norfluoxetine Plasma by Screen method (N) [ ] [ ] 8.77 [ ]

13 Trazodone [Mass/volume] in method (N) [ ] [9.5-15] 8.73 [6.9-11] Paroxetine [Presence] in Serum or Plasma (N) [ ] [ ] 7.45 [ ] Ibuprofen [Mass/volume] in method (N) [ ] 12.5 [ ] 7.31 [5-10.7] Opiates [Presence] in Urine (H) [ ] 8.36 [ ] 9.12 [6.9-12] Cocaine [Presence] in Serum or Plasma by Screen method (H) [ ] [ ] 7.45 [ ] Sertraline [Presence] in Serum or Plasma (N) [ ] [8-14.8] 7.67 [ ] Norsertraline [Presence] in Serum or Plasma (N) [ ] [7.9-14] 7.17 [ ] Amitriptyline [Mass/volume] in Serum or Plasma by Screen method (N) [ ] 8.12 [4.7-14] 8.98 [ ] Acetaminophen Plasma by Screen method (L) [7-10.8] [ ] 7.25 [ ] Nortriptyline [Mass/volume] in Serum or Plasma by Screen method (N) [ ] 7.95 [5-12.5] 9.1 [6-13.8] Salicylates [Mass/volume] in method (N) [ ] 9.28 [ ] 7.37 [ ] Oxycodone [Presence] in Serum or Plasma (N) [6.3-11] 8.9 [ ] 7.31 [ ] Venlafaxine [Presence] in Serum or Plasma (N) [ ] 9.54 [6.5-14] 6.01 [ ] Benzodiazepines [Presence] in Serum or Plasma (A) [ ] 6.68 [ ] 8.06 [ ] Lorazepam [Mass/volume] in Serum or Plasma by Screen method (N) [6-9.7] 9.65 [ ] 6.01 [ ] Carbamazepine Plasma by Screen method (N) [ ] 8.85 [5.2-15] 5.98 [ ] Salicylates [Mass/volume] in Serum or Plasma (N) [ ] 7.47 [5.1-11] 6.6 [ ] Benzoylecgonine [Presence] in Urine (A) [ ] 8.51 [ ] 5.46 [ ] Ethanol [Presence] in Urine (N) [ ] 5.9 [4.4-8] 8.12 [6-11] Benzodiazepines [Presence] in Urine (A) [5.7-8] 6.85 [ ] 6.53 [ ] Acetaminophen Plasma (N) [ ] 7.44 [ ] 5.78 [4.2-8] Ethanol [Mass/volume] in Blood (N) [ ] 7.81 [ ] 5.43 [4.9-6]

14 Deprecated Tetrahydrocannabinol [Presence] in Urine by Screen method (H) [5-8.6] 6.85 [ ] 5.8 [ ] Hepatitis C virus Ab [Presence] in Serum (A) [ ] 6.37 [ ] 6.01 [ ] Benzodiazepines [Presence] in Urine (H) [ ] 5.85 [ ] 5.88 [ ] Deprecated Tetrahydrocannabinol [Presence] in Urine by Screen method (N) [ ] 6.18 [ ] 5.66 [ ] Tricyclic antidepressants [Presence] in Serum or Plasma (A) [ ] 7.25 [4.4-12] 4.9 [3-8.1] Amphetamines [Presence] in method (N) [ ] 6.2 [ ] 5.5 [ ] Lithium [Mass/volume] in Serum or Plasma (L) [ ] 6.98 [ ] 4.83 [ ] Amitriptyline [Mass/volume] in Serum or Plasma (N) [ ] 4.69 [2.7-8] 8.39 [ ] Opiates [Presence] in Urine (A) [ ] 6.42 [ ] 4.96 [ ] Lithium [Mass/volume] in Serum or Plasma (N) [ ] 7.03 [ ] 4.32 [ ] Cocaine [Presence] in Serum or Plasma by Screen method (N) [5-6.3] 5.57 [ ] 5.34 [ ] Cannabinoids [Presence] in Urine by Screen method (N) [ ] 4.85 [ ] 6 [ ] Amitriptyline+Nortriptyline Plasma (N) [ ] 5.33 [ ] 5.44 [ ] Salicylates [Presence] in Serum or Plasma (L) [ ] 5.06 [ ] 5.03 [ ] Ethanol [Mass/volume] in Blood (H) [ ] 5.16 [ ] 4.63 [ ] Methanol [Mass/volume] in Serum or Plasma (N) [4-6.4] 5.32 [ ] 4.41 [ ] Lithium [Moles/volume] in Serum or Plasma (L) [ ] 3.91 [ ] 5.78 [ ] Lamotrigine [Mass/volume] in Serum or Plasma by Screen method (N) [ ] 6.39 [ ] 3.68 [1.5-9] Isopropanol [Mass/volume] in Serum or Plasma (N) [4-6.3] 5.51 [ ] 4.31 [ ] Ethanol [Mass/volume] in Serum or Plasma (U) [ ] 6.96 [4.8-10] 3.62 [2.6-5] Cannabinoids [Units/volume] in Urine (A) [ ] 5.17 [ ] 4.42 [ ] Gabapentin [Mass/volume] in Serum or Plasma (N) [ ] 5.45 [3.3-9] 4.37 [ ] Acetaminophen [Presence] in Urine (N) [ ] 5.35 [ ] 4.29 [ ]

15 Amphetamines [Presence] in Urine (A) [ ] 7.6 [ ] 2.76 [ ] Methamphetamine [Presence] in Urine (N) [ ] 5.21 [ ] 4.26 [ ] Metoprolol [Presence] in method (N) [2.8-8] 4.83 [2.1-11] 4.43 [ ] Clozapine [Mass/volume] in Serum or Plasma (N) [ ] 6.09 [ ] 3.63 [ ] Benzodiazepines [Presence] in Urine by Screen method (N) [3.1-7] 3.86 [2-7.5] 5.12 [ ] Tricyclic antidepressants [Presence] in Urine (N) [ ] 5.01 [ ] 4.15 [ ] Phenytoin [Mass/volume] in method (N) [ ] 4.48 [ ] 4.3 [3-6.2] Barbiturates [Presence] in Urine by Screen method (N) [ ] 4.3 [ ] 4.66 [ ] Phencyclidine [Mass/volume] in Urine (N) [ ] 4.06 [ ] 4.63 [ ] Imipramine+Desipramine Plasma (N) [2.5-8] 3.72 [ ] 5.15 [ ] Tetrahydrocannabinol [Presence] in Urine (A) [ ] 4.27 [ ] 4.31 [ ] Lithium [Moles/volume] in Serum or Plasma (N) [3.2-6] 5.11 [ ] 3.64 [ ] Hepatitis C virus RNA [Units/volume] (viral load) in Serum or Plasma by Probe and target amplification method (H) [3-6.4] 6.21 [ ] 3.18 [ ] Salicylates [Mass/volume] in Serum or Plasma (L) [ ] 4.81 [ ] 3.8 [ ] Benzoylecgonine [Presence] in Urine (N) [ ] 4.48 [ ] 3.99 [ ] Barbiturates [Presence] in Urine (A) [ ] 6.72 [ ] 2.16 [1-4.9] Ethanol [Presence] in Blood (U) [ ] 4.58 [ ] 3.52 [ ] Phencyclidine [Presence] in Urine (N) [ ] 4.32 [4-4.6] 3.72 [3.5-4] Ethanol [Mass/volume] in Serum or Plasma (N) [ ] 4.37 [3.8-5] 3.72 [ ] Amphetamine [Presence] in Urine by Screen method (N) [ ] 4.23 [ ] 3.94 [ ] Oxycodone [Presence] in Urine (H) [2.3-7] 8.12 [4.1-16] 1.74 [ ] Benzodiazepines [Presence] in Serum or Plasma (N) [ ] 4.4 [4-4.9] 3.54 [ ] Hepatitis C virus RNA [Units/volume] (viral load) in Serum or Plasma by Probe and target amplification method (N) [ ] 3.85 [ ] 3.82 [ ]

16 Hepatitis C virus genotype [Identifier] in Serum or Plasma by Probe and target amplification method (N) [ ] 3.37 [ ] 3.92 [ ] Cannabinoids [Units/volume] in Urine (N) [ ] 3.81 [ ] 4.24 [ ] Valproate [Mass/volume] in Serum or Plasma (L) [ ] 4.41 [ ] 3.41 [ ] Lidocaine [Mass/volume] in method (N) [ ] 5.34 [ ] 2.96 [ ] Tetrahydrocannabinol [Presence] in Urine (N) [3.7-4] 4.01 [ ] 3.54 [ ] Cocaine [Presence] in Urine (N) [ ] 4.25 [ ] 3.44 [ ] Acetaminophen Plasma (L) [ ] 4.16 [ ] 3.44 [3-3.9] Amphetamines [Presence] in Urine (N) [3.7-4] 3.89 [ ] 3.58 [ ] Barbiturates [Presence] in Serum, Plasma or Blood (N) [ ] 4.07 [ ] 3.38 [3-3.8] Barbiturates [Presence] in Urine (N) [ ] 3.85 [ ] 3.55 [ ] Theophylline [Mass/volume] in Blood (L) [ ] 5.98 [3.3-11] 1.94 [ ] Opiates [Presence] in Urine (N) [ ] 3.78 [3.5-4] 3.39 [ ] Tricyclic antidepressants [Presence] in Serum or Plasma (N) [ ] 3.86 [ ] 3.3 [3-3.6] Salicylates [Mass/volume] in method (L) [ ] 4.18 [ ] 3.08 [ ] Benzodiazepines [Presence] in Urine (N) [ ] 3.69 [3.5-4] 3.38 [ ] Valproate [Mass/volume] in Serum or Plasma (N) [ ] 3.94 [ ] 3.13 [ ]

17 Table S-3 - Overall model performance by age and gender (based on testing-cohort). Accuracy: the percentage of correct predictions made out of all predictions; PPV: Positive Predictive Value; NPV: Negative Predictive Value. Age Accuracy Sensitivity Specificity PPV NPV MEN (AUC=0.76) WOMEN (AUC=0.77)