A Machine Learning Approach to Predicting New‐onset Depression in a Military Population

Objective Depression is one of the most common mental disorders in the United States in both civilian and military populations, but few prospective studies assess a wide range of predictors across multiple domains for new‐onset (incident) depression in adulthood. Supervised machine learning methods can identify predictors of incident depression out of many different candidate variables, without some of the assumptions and constraints that underlie traditional regression analyses. The objectives of this study were to identify predictors of incident depression across 5 years of follow‐up using machine learning, and to assess prediction accuracy of the algorithms. Methods Data were from a cohort of Army National Guard members free of history of depression at baseline (n = 1951 men and 298 women), interviewed once per year for probable depression. Classification trees and random forests were constructed and cross‐validated, using 84 candidate predictors from the baseline interviews. Results Stressors and traumas such as emotional mistreatment and adverse childhood experiences, demographics such as being a parent or student, and military characteristics including paygrade and deployment location were predictive of probable depression. Cross‐validated random forest algorithms were moderately accurate (68% for women and 73% for men). Conclusions Events and characteristics throughout the life course, both in and outside of deployment, predict incident depression in adulthood among military personnel. Although replication studies are needed, these results may help inform potential intervention targets to reduce depression incidence among military personnel. Future research should further refine and explore interactions between identified variables.

[1]  S. Galea,et al.  Is wealth associated with depressive symptoms in the United States? , 2020, Annals of epidemiology.

[2]  S. Strother,et al.  Use of Machine Learning for Predicting Escitalopram Treatment Outcome From Electroencephalography Recordings in Adult Patients With Depression , 2020, JAMA network open.

[3]  A. J. Rosellini,et al.  Developing algorithms to predict adult onset internalizing disorders: An ensemble learning approach. , 2019, Journal of psychiatric research.

[4]  M. Helbich,et al.  Relative importance of perceived physical and social neighborhood characteristics for depression: a machine learning approach , 2019, Social Psychiatry and Psychiatric Epidemiology.

[5]  Brian K. Lee,et al.  Exploring Comorbidity Within Mental Disorders Among a Danish National Population , 2019, JAMA psychiatry.

[6]  C. Beevers,et al.  A machine learning ensemble to predict treatment outcomes following an Internet intervention for depression , 2018, Psychological Medicine.

[7]  Rupert Lanzenberger,et al.  Refining Prediction in Treatment-Resistant Depression: Results of Machine Learning Analyses in the TRD III Sample. , 2017, The Journal of clinical psychiatry.

[8]  Arkaprabha Sau,et al.  Predicting anxiety and depression in elderly patients using machine learning technology , 2017 .

[9]  S. Galea,et al.  Population Health Science and the Challenges of Prediction , 2017, Annals of Internal Medicine.

[10]  J. Gradus,et al.  Gender Differences in Machine Learning Models of Trauma and Suicidal Ideation in Veterans of the Iraq and Afghanistan Wars. , 2017, Journal of traumatic stress.

[11]  Ben Y. Reis,et al.  Predicting suicides after outpatient mental health visits in the Army Study to Assess Risk and Resilience in Servicemembers (Army STARRS) , 2016, Molecular Psychiatry.

[12]  P. Zandi,et al.  Heterogeneity in long-term trajectories of depressive symptoms: Patterns, predictors and outcomes. , 2016, Journal of affective disorders.

[13]  Shinyi Wu,et al.  Development of a Clinical Forecasting Model to Predict Comorbid Depression Among Diabetes Patients and an Application in Depression Screening Policy Making , 2015, Preventing chronic disease.

[14]  Marta R Prescott,et al.  Adverse Childhood Events and the Risk for New-Onset Depression and Post-Traumatic Stress Disorder Among U.S. National Guard Soldiers. , 2015, Military medicine.

[15]  Philip Spinhoven,et al.  Impact of childhood life events and childhood trauma on the onset and recurrence of depressive and anxiety disorders. , 2015, The Journal of clinical psychiatry.

[16]  A. Statnikov,et al.  Bridging a translational gap: using machine learning to improve the prediction of PTSD , 2015, BMC Psychiatry.

[17]  S. Stellman,et al.  Comorbidity of 9/11-related PTSD and depression in the World Trade Center Health Registry 10-11 years postdisaster. , 2014, Journal of traumatic stress.

[18]  Marta R Prescott,et al.  Validation of lay‐administered mental health assessments in a large Army National Guard cohort , 2014, International journal of methods in psychiatric research.

[19]  M. Oquendo,et al.  Sex differences in clinical predictors of depression: a prospective study. , 2013, Journal of affective disorders.

[20]  Foreman,et al.  The state of US health, 1990-2010: burden of diseases, injuries, and risk factors. , 2013, JAMA.

[21]  Daniela M. Witten,et al.  An Introduction to Statistical Learning: with Applications in R , 2013 .

[22]  E. Youngstrom,et al.  The co-occurrence of major depressive disorder among individuals with posttraumatic stress disorder: a meta-analysis. , 2013, Journal of traumatic stress.

[23]  John Gathergood Debt and Depression: Causal Links and Social Norm Effects , 2012 .

[24]  Matthew K Nock,et al.  Prevalence of DSM-IV major depression among U.S. military personnel: meta-analysis and simulation. , 2012, Military medicine.

[25]  Marta R Prescott,et al.  PTSD comorbidity and suicidal ideation associated with PTSD within the Ohio Army National Guard. , 2011, The Journal of clinical psychiatry.

[26]  Galit Shmueli,et al.  To Explain or To Predict? , 2010, 1101.0891.

[27]  I. Gotlib,et al.  Stressful Life Events, Chronic Difficulties, and the Symptoms of Clinical Depression , 2009, The Journal of nervous and mental disease.

[28]  K. Kendler,et al.  Association of different adverse life events with distinct patterns of depressive symptoms. , 2007, The American journal of psychiatry.

[29]  F. Supek,et al.  Posttraumatic stress disorder: diagnostic data analysis by data mining methodology. , 2007, Croatian medical journal.

[30]  Jeffrey S. Simonoff,et al.  An Investigation of Missing Data Methods for Classification Trees , 2006, J. Mach. Learn. Res..

[31]  D. Ruppert The Elements of Statistical Learning: Data Mining, Inference, and Prediction , 2004 .

[32]  Eric R. Ziegel,et al.  The Elements of Statistical Learning , 2003, Technometrics.

[33]  Olga V. Demler,et al.  The epidemiology of major depressive disorder: results from the National Comorbidity Survey Replication (NCS-R). , 2003, JAMA.

[34]  Joan Kaufman,et al.  Effects of early adverse experiences on brain structure and function: clinical implications , 2000, Biological Psychiatry.

[35]  M. Marmot,et al.  Explaining social class differences in depression and well-being , 1997, Social Psychiatry and Psychiatric Epidemiology.

[36]  R. Kessler,et al.  Posttraumatic stress disorder in the National Comorbidity Survey. , 1995, Archives of general psychiatry.

[37]  Trevor Hastie,et al.  Tree-Based Methods , 2021, Springer Texts in Statistics.

[38]  E. Horváth-Puhó,et al.  Prediction of Sex-Specific Suicide Risk Using Machine Learning and Single-Payer Health Care Registry Data From Denmark. , 2019, JAMA psychiatry.

[39]  G. Tutz,et al.  An introduction to recursive partitioning: rationale, application, and characteristics of classification and regression trees, bagging, and random forests. , 2009, Psychological methods.

[40]  R. Kessler Women and Depression: The Epidemiology of Depression among Women , 2006 .

[41]  C. Keyes,et al.  Women and Depression: A Handbook for the Social, Behavioral, and Biomedical Sciences , 2006 .

[42]  C. Hammen Stress and depression. , 2005, Annual review of clinical psychology.

[43]  C. Sutton Classification and Regression Trees, Bagging, and Boosting , 2005 .

[44]  Chao Chen,et al.  Using Random Forest to Learn Imbalanced Data , 2004 .

[45]  R. Spitzer,et al.  The PHQ-9: validity of a brief depression severity measure. , 2001, Journal of general internal medicine.

[46]  Michael Stonebraker,et al.  The Morgan Kaufmann Series in Data Management Systems , 1999 .

[47]  R. Kessler,et al.  The effects of stressful life events on depression. , 1997, Annual review of psychology.

[48]  C. Eisdorfer,et al.  Stress and human health : analysis and implications of research : a study , 1982 .