Multidimensional Suicide Risk Assessment with Machine Learning using Electronic Health Records

Abstract

Suicide prevention remains a critical public health challenge, and electronic health records (EHRs) provide an opportunity to characterize suicide-related risk indicators using documented clinical, behavioral, medical, and social-contextual information. This paper presents a multidimensional machine learning framework to model and estimate suicide-related outcomes using MIMIC-IV EHR data. We construct clinically motivated diagnosis categories and define a composite outcome from documented codes corresponding to suicidal ideation, suicide attempt, prior suicidal behavior, and intentional self-harm. To address severe class imbalance and reduce age-related confounding, we apply age-matched resampling that retains all positive patients and samples comparison-cohort patients from the same age group. Logistic regression, random forest, and XGBoost classifiers are evaluated before and after resampling with isotonic calibration. The calibrated XGBoost model achieves the strongest matched-cohort performance, outperforming the other evaluated classifiers. SHAP-based interpretation shows that diagnostic burden, depression-related features, age, personality-disorder history, social determinants related to violence, and medical comorbidity contribute to elevated predicted probabilities. Our results demonstrate that combining broad EHR-derived features, age-matched cohort construction, calibration, and feature-level interpretation provides a practical framework for retrospective suicide-related risk modeling.