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. 2019 Jul;36(7):607-616.
doi: 10.1002/da.22890. Epub 2019 Apr 22.

Speech-based markers for posttraumatic stress disorder in US veterans

Charles R Marmar  1   2 , Adam D Brown  1   2   3 , Meng Qian  1   2 , Eugene Laska  1   2 , Carole Siegel  1   2 , Meng Li  1   2 , Duna Abu-Amara  1   2 , Andreas Tsiartas  4 , Colleen Richey  4 , Jennifer Smith  4 , Bruce Knoth  4 , Dimitra Vergyri  4
Affiliations

Speech-based markers for posttraumatic stress disorder in US veterans

Charles R Marmar et al. Depress Anxiety. 2019 Jul.

Abstract

Background: The diagnosis of posttraumatic stress disorder (PTSD) is usually based on clinical interviews or self-report measures. Both approaches are subject to under- and over-reporting of symptoms. An objective test is lacking. We have developed a classifier of PTSD based on objective speech-marker features that discriminate PTSD cases from controls.

Methods: Speech samples were obtained from warzone-exposed veterans, 52 cases with PTSD and 77 controls, assessed with the Clinician-Administered PTSD Scale. Individuals with major depressive disorder (MDD) were excluded. Audio recordings of clinical interviews were used to obtain 40,526 speech features which were input to a random forest (RF) algorithm.

Results: The selected RF used 18 speech features and the receiver operating characteristic curve had an area under the curve (AUC) of 0.954. At a probability of PTSD cut point of 0.423, Youden's index was 0.787, and overall correct classification rate was 89.1%. The probability of PTSD was higher for markers that indicated slower, more monotonous speech, less change in tonality, and less activation. Depression symptoms, alcohol use disorder, and TBI did not meet statistical tests to be considered confounders.

Conclusions: This study demonstrates that a speech-based algorithm can objectively differentiate PTSD cases from controls. The RF classifier had a high AUC. Further validation in an independent sample and appraisal of the classifier to identify those with MDD only compared with those with PTSD comorbid with MDD is required.

Keywords: biomarkers; diagnostics; feature extraction; military; posttraumatic stress disorder; speech-based assessment; veterans.

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Conflict of interest statement

Dr. Marmar receives support from the NIAAA, Department of Defense, Steven and Alexandra Cohen Veterans Center, Cohen Veterans Bioscience, Cohen Veterans Network, the Steven & Alexandra Cohen Foundation, Robin Hood Foundation, McCormick Foundation, Home Depot Foundation, and the City of New York. Dr. Vergyri and Dr. Knoth have a patent, “Systems for Speech-Based Assessment of a Patient’s State-of-Mind, pending. All other authors have no financial relationships with commercial interests to declare.

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