Beyond Baseline Severity: Temporal and Disease-Specific Predictors of Depression Outcomes Following Mindfulness Interventions

Abstract

Depression severity among patients with chronic or acute medical conditions is influenced by a complex interaction of baseline psychological state, demographic characteristics, clinical context, and engagement with behavioral interventions. This paper presents an interpretable machine-learning analysis of a multi-center longitudinal clinical cohort to predict Beck Depression Inventory-II (BDI-II) scores at 12 and 24 weeks following mindfulness-based intervention participation. The study uses demographic variables, clinical condition information, hospital-center identifiers, baseline BDI-II scores, and therapy engagement measures to model short-term and long-term depression outcomes. Missing follow-up outcomes were addressed using a model-based stochastic imputation procedure to preserve the modest sample size while maintaining outcome variability. Five regression models were evaluated, spanning regularized linear regression and tree-based ensemble methods. Ridge Regression achieved the best 12-week performance with an RMSE of 5.186 and R^2 of 0.474, while LightGBM achieved the best 24-week performance with an RMSE of 5.038 and R^2 of 0.525. Beyond prediction accuracy, the analysis reveals three clinically relevant patterns: baseline severity remains the strongest overall predictor, short-term outcomes are more strongly associated with clinical and hospital context, and long-term outcomes show greater dependence on behavioral adherence and demographic factors. Disease-specific and hierarchical subgroup analyses further indicate that predictors differ substantially across and within clinical categories. These findings support the use of interpretable, context-aware modeling to inform personalized mental-health support following mindfulness-based interventions.