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Evaluation of Risk of Bias in Neuroimaging-Based Artificial Intelligence Models for Psychiatric Diagnosis: A Systematic Review
Open accessAbstract
Importance: Neuroimaging-based artificial intelligence (AI) diagnostic models have proliferated in psychiatry. However, their clinical applicability and reporting quality (ie, feasibility) for clinical practice have not been systematically evaluated. Objective: To systematically assess the risk of bias (ROB) and reporting quality of neuroimaging-based AI models for psychiatric diagnosis. Evidence Review: PubMed was searched for peer-reviewed, full-length articles published between January 1, 1990, and March 16, 2022. Studies aimed at developing or validating neuroimaging-based AI models for clinical diagnosis of psychiatric disorders were included. Reference lists were further searched for suitable original studies. Data extraction followed the CHARMS (Checklist for Critical Appraisal and Data Extraction for Systematic Reviews of Prediction Modeling Studies) and PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-analyses) guidelines. A closed-loop cross-sequential design was used for quality control. The PROBAST (Prediction Model Risk of Bias Assessment Tool) and modified CLEAR (Checklist for Evaluation of Image-Based Artificial Intelligence Reports) benchmarks were used to systematically evaluate ROB and reporting quality. Findings: A total of 517 studies presenting 555 AI models were included and evaluated. Of these models, 461 (83.1%; 95% CI, 80.0%-86.2%) were rated as having a high overall ROB based on the PROBAST. The ROB was particular high in the analysis domain, including inadequate sample size (398 of 555 models [71.7%; 95% CI, 68.0%-75.6%]), poor model performance examination (with 100% of models lacking calibration examination), and lack of handling data complexity (550 of 555 models [99.1%; 95% CI, 98.3%-99.9%]). None of the AI models was perceived to be applicable to clinical practices. Overall reporting completeness (ie, number of reported items/number of total items) for the AI models was 61.2% (95% CI, 60.6%-61.8%), and the completeness was poorest for the technical assessment domain with 39.9% (95% CI, 38.8%-41.1%). Conclusions and Relevance: This systematic review found that the clinical applicability and feasibility of neuroimaging-based AI models for psychiatric diagnosis were challenged by a high ROB and poor reporting quality. Particularly in the analysis domain, ROB in AI diagnostic models should be addressed before clinical application.
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“identifying only 86 studies (15.5%) included external validation”
From Bias recognition and mitigation strategies in artificial intelligence healthcare applications (2025) · cites this paper as [18]
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“Overall, 83% of studies were rated at high ROB18.”
From Bias recognition and mitigation strategies in artificial intelligence healthcare applications (2025) · cites this paper as [18]
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“examined 555 published neuroimaging-based AI models for psychiatric diagnosis”
From Bias recognition and mitigation strategies in artificial intelligence healthcare applications (2025) · cites this paper as [18]
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“while 97.5% included only subjects from high-income regions.”
From Bias recognition and mitigation strategies in artificial intelligence healthcare applications (2025) · cites this paper as [18]
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Bias recognition and mitigation strategies in artificial intelligence healthcare applications
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Metadata
- Authors
- Chen, Z., Liu, X., Yang, Q., Wang, Y.-J., Miao, K., Gong, Z., Yu, Y., Leonov, A., Liu, C., Feng, Z., & Chuan-Peng, H.
- Affiliations
- Army Medical University (CN)
- Clark University (US)
- Qufu Normal University (CN)
- Nanjing Normal University (CN)
- Corresponding author
- Chen, Zhiyi
- Feng, Zhengzhi
- ORCID
- Venue
- JAMA Network Open
- Publisher
- American Medical Association (AMA)
- Published
- 2023-03-06
- Volume
- 6
- Issue
- 3
- Pages
- e231671
- ISSN
- 2574-3805 (ISSN-L)
- PMC
- PMC9989906
- OpenAlex
- W4323295479
- Cited by
- 43
- References
- 614
- Citations by year
- 2026: 20 · 2025: 10 · 2024: 10 · 2023: 3
- FWCI
- 0.51
- Type
- journal article
- Language
- en
- Open access
- gold
- doi.org
- Locations
- JAMA Network Open (publishedVersion)
- PubMed Central (publishedVersion, cc-by-nc-nd)
- PubMed (publishedVersion)
- Clark Digital Commons (Clark University) (submittedVersion, cc-by-nc-nd)
- Funders
- Chinese People’s Liberation Army
- Topics
- Health Sciences › Medicine › Health Informatics › Artificial Intelligence in Healthcare and Education
- Social Sciences › Decision Sciences › Statistics, Probability and Uncertainty › Meta-analysis and systematic reviews
- Physical Sciences › Computer Science › Artificial Intelligence › Ethics and Social Impacts of AI
- Keywords
- psychiatric diagnosis, reporting quality, PROBAST, clinical applicability, model validation, sample size adequacy, model calibration
- MeSH terms
- Artificial Intelligence, Calibration, Humans, Bias, Benchmarking, Neuroimaging
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