title: Early identification of posttraumatic stress following military deployment: Application of machine learning methods to a prospective study of Danish soldiers.
abstract: BACKGROUND
  Pre-deployment identification of soldiers at risk for long-term posttraumatic stress psychopathology after home coming is important to guide decisions about deployment. Early post-deployment identification can direct early interventions to those in need and thereby prevents the development of chronic psychopathology. Both hold significant public health benefits given large numbers of deployed soldiers, but has so far not been achieved. Here, we aim to assess the potential for pre- and early post-deployment prediction of resilience or posttraumatic stress development in soldiers by application of machine learning (ML) methods.
  
  
  METHODS
  ML feature selection and prediction algorithms were applied to a prospective cohort of 561 Danish soldiers deployed to Afghanistan in 2009 to identify unique risk indicators and forecast long-term posttraumatic stress responses.
  
  
  RESULTS
  Robust pre- and early postdeployment risk indicators were identified, and included individual PTSD symptoms as well as total level of PTSD symptoms, previous trauma and treatment, negative emotions, and thought suppression. The predictive performance of these risk indicators combined was assessed by cross-validation. Together, these indicators forecasted long term posttraumatic stress responses with high accuracy (pre-deployment: AUC = 0.84 (95% CI = 0.81-0.87), post-deployment: AUC = 0.88 (95% CI = 0.85-0.91)).
  
  
  CONCLUSIONS
  This study utilized a previously collected data set and was therefore not designed to exhaust the potential of ML methods. Further, the study relied solely on self-reported measures.
  
  
  CONCLUSIONS
  Pre-deployment and early post-deployment identification of risk for long-term posttraumatic psychopathology are feasible and could greatly reduce the public health costs of war.
authors.affiliation: Research and Knowledge Centre, Danish Veteran Centre, Ringsted, Denmark. Electronic address: kareningekarstoft@gmail.com.
authors.forename: Karen-Inge
authors.initials: KI
authors.lastname: Karstoft
authors.affiliation: Center for Health Informatics and Bioinformatics, NYU School of Medicine, New York, NY, USA; Department of Medicine, NYU School of Medicine, New York, NY, USA.
authors.forename: Alexander
authors.initials: A
authors.lastname: Statnikov
authors.affiliation: Research and Knowledge Centre, Danish Veteran Centre, Ringsted, Denmark.
authors.forename: Søren B
authors.initials: SB
authors.lastname: Andersen
authors.affiliation: Research and Knowledge Centre, Danish Veteran Centre, Ringsted, Denmark; Mental Health Center Copenhagen, University of Copenhagen, Copenhagen, Denmark.
authors.forename: Trine
authors.initials: T
authors.lastname: Madsen
authors.affiliation: Department of Psychiatry, NYU School of Medicine, New York, NY, USA.
authors.forename: Isaac R
authors.initials: IR
authors.lastname: Galatzer-Levy
mesh_terms: D000328:Adult; D055826:Afghan Campaign 2001-; D000465:Algorithms; D015331:Cohort Studies; D003718:Denmark; D004644:Emotions; D005260:Female; D006801:Humans; D008137:Longitudinal Studies; D000069550:Machine Learning; D008297:Male; D008889:Military Personnel / Q000523:psychology*; D011237:Predictive Value of Tests; D011446:Prospective Studies; D055500:Resilience, Psychological; D018570:Risk Assessment; D013313:Stress Disorders, Post-Traumatic / Q000523:psychology*; D060388:Support Vector Machine
keywords: Machine learning; Military; Posttraumatic stress; Prediction; Prevention; Support vector machines