Combat veterans diagnosed with PTSD are substantially more likely to engage in a number of high risk activities including engaging in interpersonal violence, attempting suicide, committing suicide, binge drinking, and drug abuse BIBREF0. Despite improved diagnostic screening, outpatient mental health and inpatient treatment for PTSD, the syndrome remains treatment resistant, is typically chronic, and is associated with numerous negative health effects and higher treatment costs BIBREF1. As a result, the Veteran Administration's National Center for PTSD (NCPTSD) suggests to reconceptualize PTSD not just in terms of a psychiatric symptom cluster, but focusing instead on the specific high risk behaviors associated with it, as these may be directly addressed though behavioral change efforts BIBREF0. Consensus prevalence estimates suggest that PTSD impacts between 15-20% of the veteran population which is typically chronic and treatment resistant BIBREF0. The PTSD patients support programs organized by different veterans peer support organization use a set of surveys for local weekly assessment to detect the intensity of PTSD among the returning veterans. However, recent advanced evidence-based care for PTSD sufferers surveys have showed that veterans, suffered with chronic PTSD are reluctant in participating assessments to the professionals which is another significant symptom of war returning veterans with PTSD. Several existing researches showed that, twitter posts of war veterans could be a significant indicator of their mental health and could be utilized to predict PTSD sufferers in time before going out of control BIBREF2, BIBREF3, BIBREF4, BIBREF5, BIBREF6, BIBREF7, BIBREF8. However, all of the proposed methods relied on either blackbox machine learning methods or language models based sentiments extraction of posted texts which failed to obtain acceptability and trust of clinicians due to the lack of their explainability.In the context of the above research problem, we aim to answer the following research questionsGiven clinicians have trust on clinically validated PTSD assessment surveys, can we fill out PTSD assessment surveys using twitter posts analysis of war-veterans?If possible, what sort of analysis and approach are needed to develop such XAI model to detect the prevalence and intensity of PTSD among war-veterans only using the social media (twitter) analysis where users are free to share their everyday mental and social conditions?How much quantitative improvement do we observe in our model's ability to explain both detection and intensity estimation of PTSD?In this paper, we propose LAXARY, an explainable and trustworthy representation of PTSD classification and its intensity for clinicians.The key contributions of our work are summarized below,The novelty of LAXARY lies on the proposed clinical surveys-based PTSD Linguistic dictionary creation with words/aspects which represents the instantaneous perturbation of twitter-based sentiments as a specific pattern and help calculate the possible scores of each survey question.LAXARY includes a modified LIWC model to calculate the possible scores of each survey question using PTSD Linguistic Dictionary to fill out the PTSD assessment surveys which provides a practical way not only to determine fine-grained discrimination of physiological and psychological health markers of PTSD without incurring the expensive and laborious in-situ laboratory testing or surveys, but also obtain trusts of clinicians who are expected to see traditional survey results of the PTSD assessment.Finally, we evaluate the accuracy of LAXARY model performance and reliability-validity of generated PTSD Linguistic Dictionary using real twitter users' posts. Our results show that, given normal weekly messages posted in twitter, LAXARY can provide very high accuracy in filling up surveys towards identifying PTSD ($\approx 96\%$) and its intensity ($\approx 1.2$ mean squared error).Fig. FIGREF7 shows a schematic representation of our proposed model. It consists of the following logical steps: (i) Develop PTSD Detection System using twitter posts of war-veterans(ii) design real surveys from the popular symptoms based mental disease assessment surveys; (iii) define single category and create PTSD Linguistic Dictionary for each survey question and multiple aspect/words for each question; (iv) calculate $\alpha $-scores for each category and dimension based on linguistic inquiry and word count as well as the aspects/words based dictionary; (v) calculate scaling scores ($s$-scores) for each dimension based on the $\alpha $-scores and $s$-scores of each category based on the $s$-scores of its dimensions; (vi) rank features according to the contributions of achieving separation among categories associated with different $\alpha $-scores and $s$-scores; and select feature sets that minimize the overlap among categories as associated with the target classifier (SGD); and finally (vii) estimate the quality of selected features-based classification for filling up surveys based on classified categories i.e. PTSD assessment which is trustworthy among the psychiatry community.Twitter activity based mental health assessment has been utmost importance to the Natural Language Processing (NLP) researchers and social media analysts for decades. Several studies have turned to social media data to study mental health, since it provides an unbiased collection of a person's language and behavior, which has been shown to be useful in diagnosing conditions. BIBREF9 used n-gram language model (CLM) based s-score measure setting up some user centric emotional word sets. BIBREF10 used positive and negative PTSD data to train three classifiers: (i) one unigram language model (ULM); (ii) one character n-gram language model (CLM); and 3) one from the LIWC categories $\alpha $-scores and found that last one gives more accuracy than other ones. BIBREF11 used two types of $s$-scores taking the ratio of negative and positive language models. Differences in language use have been observed in the personal writing of students who score highly on depression scales BIBREF2, forum posts for depression BIBREF3, self narratives for PTSD (BIBREF4, BIBREF5), and chat rooms for bipolar BIBREF6. Specifically in social media, differences have previously been observed between depressed and control groups (as assessed by internet-administered batteries) via LIWC: depressed users more frequently use first person pronouns (BIBREF7) and more frequently use negative emotion words and anger words on Twitter, but show no differences in positive emotion word usage (BIBREF8). Similarly, an increase in negative emotion and first person pronouns, and a decrease in third person pronouns, (via LIWC) is observed, as well as many manifestations of literature findings in the pattern of life of depressed users (e.g., social engagement, demographics) (BIBREF12). Differences in language use in social media via LIWC have also been observed between PTSD and control groups (BIBREF13).All of the prior works used some random dictionary related to the human sentiment (positive/negative) word sets as category words to estimate the mental health but very few of them addressed the problem of explainability of their solution to obtain trust of clinicians. Islam et. al proposed an explainable topic modeling framework to rank different mental health features using Local Interpretable Model-Agnostic Explanations and visualize them to understand the features involved in mental health status classification using the BIBREF14 which fails to provide trust of clinicians due to its lack of interpretability in clinical terms. In this paper, we develop LAXARY model where first we start investigating clinically validated survey tools which are trustworthy methods of PTSD assessment among clinicians, build our category sets based on the survey questions and use these as dictionary words in terms of first person singular number pronouns aspect for next level LIWC algorithm. Finally, we develop a modified LIWC algorithm to estimate survey scores (similar to sentiment category scores of naive LIWC) which is both explainable and trustworthy to clinicians.There are many clinically validated PTSD assessment tools that are being used both to detect the prevalence of PTSD and its intensity among sufferers. Among all of the tools, the most popular and well accepted one is Domain-Specific Risk-Taking (DOSPERT) Scale BIBREF15. This is a psychometric scale that assesses risk taking in five content domains: financial decisions (separately for investing versus gambling), health/safety, recreational, ethical, and social decisions. Respondents rate the likelihood that they would engage in domain-specific risky activities (Part I). An optional Part II assesses respondents' perceptions of the magnitude of the risks and expected benefits of the activities judged in Part I. There are more scales that are used in risky behavior analysis of individual's daily activities such as, The Berlin Social Support Scales (BSSS) BIBREF16 and Values In Action Scale (VIAS) BIBREF17. Dryhootch America BIBREF18, BIBREF19, a veteran peer support community organization, chooses 5, 6 and 5 questions respectively from the above mentioned survey systems to assess the PTSD among war veterans and consider rest of them as irrelevant to PTSD. The details of dryhootch chosen survey scale are stated in Table TABREF13. Table!TABREF14 shows a sample DOSPERT scale demographic chosen by dryhootch. The threshold (in Table TABREF13) is used to calculate the risky behavior limits. For example, if one individual's weekly DOSPERT score goes over 28, he is in critical situation in terms of risk taking symptoms of PTSD. Dryhootch defines the intensity of PTSD into four categories based on the weekly survey results of all three clinical survey tools (DOSPERT, BSSS and VIAS )High risk PTSD: If one individual veteran's weekly PTSD assessment scores go above the threshold for all three PTSD assessment tools i.e. DOSPERT, BSSS and VIAS, then he/she is in high risk situation which needs immediate mental support to avoid catastrophic effect of individual's health or surrounding people's life.Moderate risk PTSD: If one individual veteran's weekly PTSD assessment scores go above the threshold for any two of the three PTSD assessment tools, then he/she is in moderate risk situation which needs close observation and peer mentoring to avoid their risk progression.Low risk PTSD: If one individual veteran's weekly PTSD assessment scores go above the threshold for any one of the three PTSD assessment tools, then he/she has light symptoms of PTSD.No PTSD: If one individual veteran's weekly PTSD assessment scores go below the threshold for all three PTSD assessment tools, then he/she has no PTSD.To develop an explainable model, we first need to develop twitter-based PTSD detection algorithm. In this section, we describe the data collection and the development of our core LAXARY model.We use an automated regular expression based searching to find potential veterans with PTSD in twitter, and then refine the list manually. First, we select different keywords to search twitter users of different categories. For example, to search self-claimed diagnosed PTSD sufferers, we select keywords related to PTSD for example, post trauma, post traumatic disorder, PTSD etc. We use a regular expression to search for statements where the user self-identifies as being diagnosed with PTSD. For example, Table TABREF27 shows a self-identified tweet posts. To search veterans, we mostly visit to different twitter accounts of veterans organizations such as "MA Women Veterans @WomenVeterans", "Illinois Veterans @ILVetsAffairs", "Veterans Benefits @VAVetBenefits" etc. We define an inclusion criteria as follows: one twitter user will be part of this study if he/she describes himself/herself as a veteran in the introduction and have at least 25 tweets in last week. After choosing the initial twitter users, we search for self-identified PTSD sufferers who claim to be diagnosed with PTSD in their twitter posts. We find 685 matching tweets which are manually reviewed to determine if they indicate a genuine statement of a diagnosis for PTSD. Next, we select the username that authored each of these tweets and retrieve last week's tweets via the Twitter API. We then filtered out users with less than 25 tweets and those whose tweets were not at least 75% in English (measured using an automated language ID system.) This filtering left us with 305 users as positive examples. We repeated this process for a group of randomly selected users. We randomly selected 3,000 twitter users who are veterans as per their introduction and have at least 25 tweets in last one week. After filtering (as above) in total 2,423 users remain, whose tweets are used as negative examples developing a 2,728 user's entire weeks' twitter posts where 305 users are self-claimed PTSD sufferers. We distributed Dryhootch chosen surveys among 1,200 users (305 users are self claimed PTSD sufferers and rest of them are randomly chosen from previous 2,423 users) and received 210 successful responses. Among these responses, 92 users were diagnosed as PTSD by any of the three surveys and rest of the 118 users are diagnosed with NO PTSD. Among the clinically diagnosed PTSD sufferers, 17 of them were not self-identified before. However, 7 of the self-identified PTSD sufferers are assessed with no PTSD by PTSD assessment tools. The response rates of PTSD and NO PTSD users are 27% and 12%. In summary, we have collected one week of tweets from 2,728 veterans where 305 users claimed to have diagnosed with PTSD. After distributing Dryhootch surveys, we have a dataset of 210 veteran twitter users among them 92 users are assessed with PTSD and 118 users are diagnosed with no PTSD using clinically validated surveys. The severity of the PTSD are estimated as Non-existent, light, moderate and high PTSD based on how many surveys support the existence of PTSD among the participants according to dryhootch manual BIBREF18, BIBREF19.We download 210 users' all twitter posts who are war veterans and clinically diagnosed with PTSD sufferers as well which resulted a total 12,385 tweets. Fig FIGREF16 shows each of the 210 veteran twitter users' monthly average tweets. We categorize these Tweets into two groups: Tweets related to work and Tweets not related to work. That is, only the Tweets that use a form of the word “work*” (e.g. work,worked, working, worker, etc.) or “job*” (e.g. job, jobs, jobless, etc.) are identified as work-related Tweets, with the remaining categorized as non-work-related Tweets. This categorization method increases the likelihood that most Tweets in the work group are indeed talking about work or job; for instance, “Back to work. Projects are firing back up and moving ahead now that baseball is done.” This categorization results in 456 work-related Tweets, about 5.4% of all Tweets written in English (and 75 unique Twitter users). To conduct weekly-level analysis, we consider three categorizations of Tweets (i.e. overall Tweets, work-related Tweets, and non work-related Tweets) on a daily basis, and create a text file for each week for each group.We use Coppersmith proposed PTSD classification algorithm to develop our baseline blackbox model BIBREF11. We utilize our positive and negative PTSD data (+92,-118) to train three classifiers: (i) unigram language model (ULM) examining individual whole words, (ii) character n-gram language model (CLM), and (iii) LIWC based categorical models above all of the prior ones. The LMs have been shown effective for Twitter classification tasks BIBREF9 and LIWC has been previously used for analysis of mental health in Twitter BIBREF10. The language models measure the probability that a word (ULM) or a string of characters (CLM) was generated by the same underlying process as the training data. We first train one of each language model ($clm^{+}$ and $ulm^{+}$) from the tweets of PTSD users, and another model ($clm^{-}$ and $ulm^{-}$) from the tweets from No PTSD users. Each test tweet $t$ is scored by comparing probabilities from each LM called $s-score$A threshold of 1 for $s-score$ divides scores into positive and negative classes. In a multi-class setting, the algorithm minimizes the cross entropy, selecting the model with the highest probability. For each user, we calculate the proportion of tweets scored positively by each LIWC category. These proportions are used as a feature vector in a loglinear regression model BIBREF20. Prior to training, we preprocess the text of each tweet: we replace all usernames with a single token (USER), lowercase all text, and remove extraneous whitespace. We also exclude any tweet that contained a URL, as these often pertain to events external to the user.We conduct a LIWC analysis of the PTSD and non-PTSD tweets to determine if there are differences in the language usage of PTSD users. We applied the LIWC battery and examined the distribution of words in their language. Each tweet was tokenized by separating on whitespace. For each user, for a subset of the LIWC categories, we measured the proportion of tweets that contained at least one word from that category. Specifically, we examined the following nine categories: first, second and third person pronouns, swear, anger, positive emotion, negative emotion, death, and anxiety words. Second person pronouns were used significantly less often by PTSD users, while third person pronouns and words about anxiety were used significantly more often.The heart of LAXARY framework is the construction of PTSD Linguistic Dictionary. Prior works show that linguistic dictionary based text analysis has been much effective in twitter based sentiment analysis BIBREF21, BIBREF22. Our work is the first of its kind that develops its own linguistic dictionary to explain automatic PTSD assessment to confirm trustworthiness to clinicians.We use LIWC developed WordStat dictionary format for our text analysis BIBREF23. The LIWC application relies on an internal default dictionary that defines which words should be counted in the target text files. To avoid confusion in the subsequent discussion, text words that are read and analyzed by WordStat are referred to as target words. Words in the WordStat dictionary file will be referred to as dictionary words. Groups of dictionary words that tap a particular domain (e.g., negative emotion words) are variously referred to as subdictionaries or word categories. Fig FIGREF8 is a sample WordStat dictionary. There are several steps to use this dictionary which are stated as follows:Pronoun selection: At first we have to define the pronouns of the target sentiment. Here we used first person singular number pronouns (i.e., I, me, mine etc.) that means we only count those sentences or segments which are only related to first person singular number i.e., related to the person himself.Category selection: We have to define the categories of each word set thus we can analyze the categories as well as dimensions' text analysis scores. We chose three categories based on the three different surveys: 1) DOSPERT scale; 2) BSSS scale; and 3) VIAS scale.Dimension selection: We have to define the word sets (also called dimension) for each category. We chose one dimension for each of the questions under each category to reflect real survey system evaluation. Our chosen categories are state in Fig FIGREF20.Score calculation $\alpha $-score: $\alpha $-scores refer to the Cronbach's alphas for the internal reliability of the specific words within each category. The binary alphas are computed on the ratio of occurrence and non-occurrence of each dictionary word whereas the raw or uncorrected alphas are based on the percentage of use of each of the category words within texts.After the PTSD Linguistic Dictionary has been created, we empirically evaluate its psychometric properties such as reliability and validity as per American Standards for educational and psychological testing guideline BIBREF24. In psychometrics, reliability is most commonly evaluated by Cronbach's alpha, which assesses internal consistency based on inter-correlations and the number of measured items. In the text analysis scenario, each word in our PTSD Linguistic dictionary is considered an item, and reliability is calculated based on each text file's response to each word item, which forms an $N$(number of text files) $\times $ $J$(number of words or stems in a dictionary) data matrix. There are two ways to quantify such responses: using percentage data (uncorrected method), or using "present or not" data (binary method) BIBREF23. For the uncorrected method, the data matrix comprises percentage values of each word/stem are calculated from each text file. For the binary method, the data matrix quantifies whether or not a word was used in a text file where "1" represents yes and "0" represents no. Once the data matrix is created, it is used to calculate Cronbach's alpha based on its inter-correlation matrix among the word percentages. We assess reliability based on our selected 210 users' Tweets which further generated a 23,562 response matrix after running the PTSD Linguistic Dictionary for each user. The response matrix yields reliability of .89 based on the uncorrected method, and .96 based on the binary method, which confirm the high reliability of our PTSD Dictionary created PTSD survey based categories. After assessing the reliability of the PTSD Linguistic dictionary, we focus on the two most common forms of construct validity: convergent validity and discriminant validity BIBREF25. Convergent validity provides evidence that two measures designed to assess the same construct are indeed related; discriminate validity involves evidence that two measures designed to assess different constructs are not too strongly related. In theory, we expect that the PTSD Linguistic dictionary should be positively correlated with other negative PTSD constructs to show convergent validity, and not strongly correlated with positive PTSD constructs to show discriminant validity. To test these two types of validity, we use the same 210 users' tweets used for the reliability assessment. The results revealed that the PTSD Linguistic dictionary is indeed positively correlated with negative construct dictionaries, including the overall negative PTSD dictionary (r=3.664,p$<$.001). Table TABREF25 shows all 16 categorical dictionaries. These results provide strong support for the measurement validity for our newly created PTSD Linguistic dictionary.We use the exact similar method of LIWC to extract $\alpha $-scores for each dimension and categories except we use our generated PTSD Linguistic Dictionary for the task BIBREF23. Thus we have total 16 $\alpha $-scores in total. Meanwhile, we propose a new type of feature in this regard, which we called scaling-score ($s$-score). $s$-score is calculated from $\alpha $-scores. The purpose of using $s$-score is to put exact scores of each of the dimension and category thus we can apply the same method used in real weekly survey system. The idea is, we divide each category into their corresponding scale factor (i.e., for DOSPERT scale, BSSS scale and VIAS scales) and divide them into 8, 3 and 5 scaling factors which are used in real survey system. Then we set the $s$-score from the scaling factors from the $\alpha $-scores of the corresponding dimension of the questions. The algorithm is stated in Figure FIGREF23. Following Fig FIGREF23, we calculate the $s$-score for each dimension. Then we add up all the $s$-score of the dimensions to calculate cumulative $s$-score of particular categories which is displayed in Fig FIGREF22. Finally, we have total 32 features among them 16 are $\alpha $-scores and 16 are $s$-scores for each category (i.e. each question). We add both of $\alpha $ and $s$ scores together and scale according to their corresponding survey score scales using min-max standardization. Then, the final output is a 16 valued matrix which represent the score for each questions from three different Dryhootch surveys. We use the output to fill up each survey, estimate the prevalence of PTSD and its intensity based on each tool's respective evaluation metric.To validate the performance of LAXARY framework, we first divide the entire 210 users' twitter posts into training and test dataset. Then, we first developed PTSD Linguistic Dictionary from the twitter posts from training dataset and apply LAXARY framework on test dataset.To provide an initial results, we take 50% of users' last week's (the week they responded of having PTSD) data to develop PTSD Linguistic dictionary and apply LAXARY framework to fill up surveys on rest of 50% dataset. The distribution of this training-test dataset segmentation followed a 50% distribution of PTSD and No PTSD from the original dataset. Our final survey based classification results showed an accuracy of 96% in detecting PTSD and mean squared error of 1.2 in estimating its intensity given we have four intensity, No PTSD, Low Risk PTSD, Moderate Risk PTSD and High Risk PTSD with a score of 0, 1, 2 and 3 respectively. Table TABREF29 shows the classification details of our experiment which provide the very good accuracy of our classification. To compare the outperformance of our method, we also implemented Coppersmith et. al. proposed method and achieved an 86% overall accuracy of detecting PTSD users BIBREF11 following the same training-test dataset distribution. Fig FIGREF28 illustrates the comparisons between LAXARY and Coppersmith et. al. proposed method. Here we can see, the outperformance of our proposed method as well as the importance of $s-score$ estimation. We also illustrates the importance of $\alpha -score$ and $S-score$ in Fig FIGREF30. Fig FIGREF30 illustrates that if we change the number of training samples (%), LAXARY models outperforms Coppersmith et. al. proposed model under any condition. In terms of intensity, Coppersmith et. al. totally fails to provide any idea however LAXARY provides extremely accurate measures of intensity estimation for PTSD sufferers (as shown in Fig FIGREF31) which can be explained simply providing LAXARY model filled out survey details. Table TABREF29 shows the details of accuracies of both PTSD detection and intensity estimation. Fig FIGREF32 shows the classification accuracy changes over the training sample sizes for each survey which shows that DOSPERT scale outperform other surveys. Fig FIGREF33 shows that if we take previous weeks (instead of only the week diagnosis of PTSD was taken), there are no significant patterns of PTSD detection.LAXARY is a highly ambitious model that targets to fill up clinically validated survey tools using only twitter posts. Unlike the previous twitter based mental health assessment tools, LAXARY provides a clinically interpretable model which can provide better classification accuracy and intensity of PTSD assessment and can easily obtain the trust of clinicians. The central challenge of LAXARY is to search twitter users from twitter search engine and manually label them for analysis. While developing PTSD Linguistic Dictionary, although we followed exactly same development idea of LIWC WordStat dictionary and tested reliability and validity, our dictionary was not still validated by domain experts as PTSD detection is highly sensitive issue than stress/depression detection. Moreover, given the extreme challenges of searching veterans in twitter using our selection and inclusion criteria, it was extremely difficult to manually find the evidence of the self-claimed PTSD sufferers. Although, we have shown extremely promising initial findings about the representation of a blackbox model into clinically trusted tools, using only 210 users' data is not enough to come up with a trustworthy model. Moreover, more clinical validation must be done in future with real clinicians to firmly validate LAXARY model provided PTSD assessment outcomes. In future, we aim to collect more data and run not only nationwide but also international-wide data collection to establish our innovation into a real tool. Apart from that, as we achieved promising results in detecting PTSD and its intensity using only twitter data, we aim to develop Linguistic Dictionary for other mental health issues too. Moreover, we will apply our proposed method in other types of mental illness such as depression, bipolar disorder, suicidal ideation and seasonal affective disorder (SAD) etc. As we know, accuracy of particular social media analysis depends on the dataset mostly. We aim to collect more data engaging more researchers to establish a set of mental illness specific Linguistic Database and evaluation technique to solidify the genralizability of our proposed method.To promote better comfort to the trauma patients, it is really important to detect Post Traumatic Stress Disorder (PTSD) sufferers in time before going out of control that may result catastrophic impacts on society, people around or even sufferers themselves. Although, psychiatrists invented several clinical diagnosis tools (i.e., surveys) by assessing symptoms, signs and impairment associated with PTSD, most of the times, the process of diagnosis happens at the severe stage of illness which may have already caused some irreversible damages of mental health of the sufferers. On the other hand, due to lack of explainability, existing twitter based methods are not trusted by the clinicians. In this paper, we proposed, LAXARY, a novel method of filling up PTSD assessment surveys using weekly twitter posts. As the clinical surveys are trusted and understandable method, we believe that this method will be able to gain trust of clinicians towards early detection of PTSD. Moreover, our proposed LAXARY model, which is first of its kind, can be used to develop any type of mental disorder Linguistic Dictionary providing a generalized and trustworthy mental health assessment framework of any kind.

Q: Do they evaluate only on English datasets?

Q: Do the authors mention any possible confounds in this study?

Q: How is the intensity of the PTSD established?
A: Given we have four intensity, No PTSD, Low Risk PTSD, Moderate Risk PTSD and High Risk PTSD with a score of 0, 1, 2 and 3 respectively, the estimated intensity  is established as mean  squared error.
defined into four categories from high risk, moderate risk, to low risk

Q: How is LIWC incorporated into this system?

Q: How many twitter users are surveyed using the clinically validated survey?

Q: Which clinically validated survey tools are used?