Forecasting military mental health in a complete sample of Danish military personnel deployed between 1992-2013

Publikation: Bidrag til tidsskriftTidsskriftartikelForskningfagfællebedømt

  • Lars R. Nissen
  • Ioannis Tsamardinos
  • Kasper Eskelund
  • Jaimie L. Gradus
  • Søren B. Andersen
  • Karstoft, Karen-Inge

Objective: Mental health problems (MHP) are a relatively common consequence of deployment to war zones. Early identification of those at risk of post-deployment MHP would improve prevention efforts. However, screening instruments based on linear models have not been successful. Machine learning (ML) has shown promise for providing the methodological frame for better prognostic models. Methods: The study population was all Danish military personnel deployed for the first time between January 1, 1992 and December 31, 2013. From extensive registry data, 21 pre- or at-deployment predictors comprising early adversity, social, clinical and demographic variables were used to predict psychiatric contacts (psychiatric diagnosis and/or use of psychotropic medicine) occurring within 6.5 years after homecoming. Four supervised ML methods (penalized logistic regression, random forests, support vector machines and gradient boosting machines) were compared in ability to classify those with high risk of post-deployment MHP and those without. Results: Of 27594 subjects, 2175 (8%) had a psychiatric contact. All four ML methods applied had performances well above chance (Area under the Receiver-operating Curve 0.62-0.68). Positive predictive value for the best model was 0.16. A range of pre-deployment factors were found to be predictive of post-deployment psychiatric contacts. Conclusions: ML methods can be useful in early identification of soldiers with high risk of MPH in the years following their first deployment. However, performances were modest and positive predictive values were low, limiting the applicability of the models for pre-deployment screening. Future studies should include neurobiological data and deployment experiences to increase accuracy of the models.

OriginalsprogEngelsk
TidsskriftJournal of Affective Disorders
Vol/bind288
Sider (fra-til)167-174
Antal sider8
ISSN0165-0327
DOI
StatusUdgivet - 1 jun. 2021

Bibliografisk note

Funding Information:
The authors would like to acknowledge colleagues from the Danish Veteran Centre for discussions on data management and analyses throughout the study. Funding for the study was provided by a grant from the Danish Foundation Trygfonden (grant number ID: 122623). The funding source played no role in the study design; collection, analysis, and interpretation of data; writing of the manuscript; or decision to submit the manuscript for publication. LN and KIK conceived the study, managed the data, and ran the analyses. SBA and KE was involved in study design. LN was responsible for drafting the paper and KIK, IT, KE, JG, and SBA took part in writing. IT provided modeling and statistical counselling throughout the process. All co-authors approved the final manuscript. Funding for the study was provided by a grant from the Danish Foundation Trygfonden (grant number ID: 122623). The funding source played no role in the study design; collection, analysis, and interpretation of data; writing of the manuscript; or decision to submit the manuscript for publication.

Funding Information:
Funding for the study was provided by a grant from the Danish Foundation Trygfonden (grant number ID: 122623). The funding source played no role in the study design; collection, analysis, and interpretation of data; writing of the manuscript; or decision to submit the manuscript for publication.

Publisher Copyright:
© 2021

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