A machine learning approach using migration-related cultural stress to classify depression and post-traumatic stress disorder among hurricane survivors

• Published in: Journal of affective disorders 2024-02, Vol.347, p.77-84
• Main Authors: Dell, Nathaniel A., Salas-Wright, Christopher P., Vaughn, Michael G., Maldonado-Molina, Mildred M., Oh, Sehun, Bates, Melissa, Schwartz, Seth J.
• Format: Article
• Language: English
• Subjects: Adult; Cyclonic Storms; Data science; Depression; Depression - diagnosis; Ethnic discrimination; Humans; Machine Learning; Post-traumatic stress disorder; Stress Disorders, Post-Traumatic - diagnosis; Survivors
• ISSN: 0165-0327; 1573-2517
• DOI: 10.1016/j.jad.2023.11.055

Data science approaches have increasingly been used in behavioral health research and may be useful for addressing social factors contributing to disparities in health status. This study evaluated the importance of cultural stress-related factors in classifying depression and post-traumatic stress disorder (PTSD) among adult survivors (N = 319) of Hurricane Maria who migrated from Puerto Rico to the United States mainland. We evaluated the performance of random forests (RF) and logistic regression (LR) for classifying PTSD and depression. Models included demographic, hurricane exposure, and migration-related cultural stress variables. We inspected area under the receiver operating characteristic curve (AUC), accuracy, balanced accuracy, F1 score, precision, recall, and specificity. Negative context of reception and language-related stressors were moderately important for accurately classifying depression and PTSD. For classifying depression, RF showed higher accuracy, balanced accuracy, specificity, precision, and F1. For classifying PTSD, RF showed higher accuracy, specificity, precision, and F1. A more thorough classification model would also include biomarkers (e.g., of allostatic load), family, community, or neighborhood-level attributes. Findings may not generalize to other groups who have experienced crisis-related migration. Findings underscore the importance of culturally and linguistically appropriate and trauma-informed clinical services for recent migrants. Use of assessments to identify pre-migration and post-migration stressors could inform clinical practice with migrants presenting with behavioral health-related difficulties. •Random Forest and Logistic Regression models performed acceptably in classifying depression and PTSD.•Random Forest models had lower AUC but higher precision, specificity, and F1 than logistic regression models.•Language-related stress and negative context of reception were useful for distinguishing migrants with probable mental health conditions.