Title

Machine Learning Prediction of Posttraumatic Stress Disorder Trajectories Following Traumatic Injury: Identification and Validation in Two Independent Samples

Document Type

Article

Language

Eng

Publication Date

12-2022

Publisher

Wiley

Source Publication

Journal of Traumatic Stress

Source ISSN

0894-9867

Original Item ID

doi.org/10.1002/jts.22868

Abstract

Due to its heterogeneity, the prediction of posttraumatic stress disorder (PTSD) development after traumtic injury is difficult. Recent machine learning approaches have yielded insight into predicting PTSD symptom trajectories. Using data collected within 1 month of traumatic injury, we applied eXtreme Gradient Boosting (XGB) to classify admitted and discharged patients (hospitalized, n = 192; nonhospitalized, n = 214), recruited from a Level 1 trauma center, according to PTSD symptom trajectories. Trajectories were identified using latent class mixed models on PCL-5 scores collected at baseline, 1–3 months posttrauma, and 6 months posttrauma. In both samples, nonremitting, remitting, and resilient PTSD symptom trajectories were identified. In the admitted patient sample, a unique delayed trajectory emerged. Machine learning classifiers (i.e., XGB) were developed and tested on the admitted patient sample and externally validated on the discharged sample with biological and clinical self-report baseline variables as predictors. For external validation sets, prediction was fair for nonremitting versus other trajectories, areas under the curve (AUC = .70); good for nonremitting versus resilient trajectories, AUCs = .73–.76; and prediction failed for nonremitting versus remitting trajectories, AUCs = .46–.48. However, poor precision (< .57) across all models suggests limited generalizability of nonremitting symptom trajectory prediction from admitted to discharged patient samples. Consistency in symptom trajectory identification across samples supports prior studies on the stability of PTSD symptom trajectories following trauma exposure; however, continued work and replication with larger samples are warranted to understand overlapping and unique predictive features of PTSD in different traumatic injury populations.

Comments

Accepted Version. Journal of Traumatic Stress, Vol. 35, No. 6 (December 2022): 1656-1671. DOI © 2022Wiley. Used with Permission.

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