Using the Personalized Advantage Index to determine which veterans may benefit from more vs. less comprehensive intensive PTSD treatment programs

Background: Intensive PTSD treatment programs (ITPs) are highly effective but tend to differ greatly in length and the number of adjunctive services that are provided in conjunction with evidence-based PTSD treatments. Individuals’ treatment response to more or less comprehensive ITPs is poorly understood. Objective: To apply a machine learning-based decision-making model (the Personalized Advantage Index (PAI)), using clinical and demographic factors to predict response to more or less comprehensive ITPs. Methods: The PAI was developed and tested on a sample of 747 veterans with PTSD who completed a 3-week (more comprehensive; n = 360) or 2-week (less comprehensive; n = 387) ITP. Results: Approximately 12.32% of the sample had a PAI value that suggests that individuals would have experienced greater PTSD symptom change (5 points) on the PTSD Checklist for DSM-5 in either a more- or less comprehensive ITP. For individuals with the highest 25% of PAI values, effect sizes for the amount of PTSD symptom change between those in their optimal vs. non-optimal programs was d = 0.35. Conclusions: Although a minority was predicted to have benefited more from a program, there generally was not a substantial difference in predicted outcomes. Less comprehensive and thus more financially sustainable ITPs appear to work well for most individuals with PTSD. A Personalized Advantage Index (PAI) was developed for a 3-week (more comprehensive) and a 2-week (less comprehensive) intensive PTSD treatment program to predict treatment responses.Using the PAI, approximately 12% of the sample was predicted to have experienced meaningfully greater in another program than the one in which they participated.Findings suggest a less comprehensive and more financially sustainable 2-week intensive PTSD treatment program would work well for most veterans in the present study. A Personalized Advantage Index (PAI) was developed for a 3-week (more comprehensive) and a 2-week (less comprehensive) intensive PTSD treatment program to predict treatment responses. Using the PAI, approximately 12% of the sample was predicted to have experienced meaningfully greater in another program than the one in which they participated. Findings suggest a less comprehensive and more financially sustainable 2-week intensive PTSD treatment program would work well for most veterans in the present study.</p

S1 Protocol -

(DOC)</p

Fig 2 -

Model predicted means and 95% confidence intervals for PTSD symptom severity (Panel A), drinking days in the past 30 (Panel B), and heavy drinking days in the past 30 (Panel C) by treatment condition from pre-treatment to 12-month follow-up.</p

CONSORT diagram.

CONSORT diagram.</p

S1 File -

(DOCX)</p

Model estimates for final treatment assignment.

Model estimates for final treatment assignment.</p

Descriptive statistics for main outcomes stratified by condition.

Descriptive statistics for main outcomes stratified by condition.</p

Model estimates for initial assignment.

Model estimates for initial assignment.</p