Using self-report surveys at the beginning of service to develop multi-outcome risk models for new soldiers in the US Army
Using self-report surveys at the beginning of service to develop multi-outcome risk models for new soldiers in the US Army
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DOI：
10.1017/s003329171700071x
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发表时间：
2017-10-01
影响因子：
6.9
通讯作者：
Kessler, R. C.
中科院分区：
文献类型：
--
作者：
Rosellini, A. J.;Stein, M. B.;Kessler, R. C.
背景。美国陆军使用普遍的预防性干预措施来应对服役初期特别高风险的负面结果（如自杀、暴力、性侵犯）。目前存在更密集的干预措施，但只有针对高风险士兵才具有成本效益。我们报告了在军队服役初期进行的自我报告调查中为这种目标制定模型的努力结果。2011-2012年，21,832名新兵完成了自我管理问卷（SAQ），并同意将行政数据与SAQ回答联系起来。针对2013年12月之前发生的12种行政记录结果开发了惩罚回归模型：自杀未遂、精神住院、药物测试呈阳性、创伤性脑损伤（TBI）、其他严重伤害、几种类型的暴力犯罪和受害、降职和减员。表现最好的模型是TBI （AUC = 0.80）、重大身体暴力犯罪（AUC = 0.78）、性侵犯犯罪（AUC = 0.78）和自杀未遂（AUC = 0.74）。虽然预测的风险评分在各结果之间显著相关，但在模型中包括其他结果的风险评分并不能改善预测。特别值得注意的是，在预测风险最高的10%的新兵中，有40.5%的人自杀未遂；在预测风险最高的15%的新兵中，有57.2%的人遭受过性侵犯；在预测风险最高的10%的新兵中，有35.5%的人遭受过性侵犯。在服役初期自我报告调查中收集的数据可用于开发风险模型，以确定在服役的头几年里，一小部分新兵占了很大比例的负面结果。
Background. The U.S. Army uses universal preventives interventions for several negative outcomes (e.g. suicide, violence, sexual assault) with especially high risks in the early years of service. More intensive interventions exist, but would be cost-effective only if targeted at high-risk soldiers. We report results of efforts to develop models for such targeting from self-report surveys administered at the beginning of Army service.Methods. 21 832 new soldiers completed a self-administered questionnaire (SAQ) in 2011-2012 and consented to link administrative data to SAQ responses. Penalized regression models were developed for 12 administratively-recorded outcomes occurring by December 2013: suicide attempt, mental hospitalization, positive drug test, traumatic brain injury (TBI), other severe injury, several types of violence perpetration and victimization, demotion, and attrition.Results. The best-performing models were for TBI (AUC = 0.80), major physical violence perpetration (AUC = 0.78), sexual assault perpetration (AUC = 0.78), and suicide attempt (AUC = 0.74). Although predicted risk scores were significantly correlated across outcomes, prediction was not improved by including risk scores for other outcomes in models. Of particular note: 40.5% of suicide attempts occurred among the 10% of new soldiers with highest predicted risk, 57.2% of male sexual assault perpetrations among the 15% with highest predicted risk, and 35.5% of female sexual assault victimizations among the 10% with highest predicted risk.Conclusions. Data collected at the beginning of service in self-report surveys could be used to develop risk models that define small proportions of new soldiers accounting for high proportions of negative outcomes over the first few years of service.