Digital Health and Artificial Intelligence for PTSD: Improving Treatment Delivery Through Personalization

摘要

Exposure to potentially traumatic events (PTEs), including combat, accidents, or natural disasters, is intrinsic to the human condition. Over the course of a lifetime, 70% to 90% of people will experience one or more PTEs.~(1 ) Although multiple prospective studies have shown that psychological resilience is the norm after a PTE, a significant minority of survivors will suffer from poor adjustment and functioning difficulties, including post-traumatic stress disorder (PTSD).~(2 ) According to the Diagnostic and Statistical Manual of Mental Disorders, fifth edition ( DSM-5 ),~(3 ) hallmark features of PTSD include intrusions and/or flashbacks about the PTE, internal/external avoidance of PTE reminders, nightmares and other re-experiencing, and cognitive and hyperarousal symptoms. Although structured behavioral interventions for PTSD are available, clinical trials comparing their effectiveness are often characterized by high nonresponse and dropout rates, with marginal differences among conventional forms of treatment.~(4 ) A factor strongly contributing to such an outcome is the heterogeneity of PTSD; in an effort to encompass all different traumatic stress presentations, the DSM-5 diagnostic algorithm results in more than 636,120 possible diagnostic combinations meeting PTSD criteria.~(5 ) People presenting different symptoms may, therefore, be offered the same treatment, with varying results. All PTSD symptoms also uniquely interact and mutually reinforce one another in a way that is not fully captured by the PTSD diagnostic label.~(6 ) In addition, PTSD has unclear boundaries with commonly associated maladaptive responses including complicated grief,~(7 ) which may require additional targeted interventions.~(8 ) Outcomes to the same PTE can also be heterogenous~(9 ) and dependent on comorbid medical outcomes;~(10 ) therefore, differences in the trauma event could call for different therapeutic approaches. In sum, the small differences observed between conventional and PTE-focused therapy outcomes could be attributed to poor specificity of treatment given the wide variety of possible symptom clusters.