DSTRESS

Early screening of post traumatic disorder (PTSD) among active duty soldiers is essential to lead to a suitable support in order to, on the one hand, limit the occurence of the trouble and on the other hand to prevent it from becoming chronic (risk of addiction and suicide). Detection of PTSD is also a collective challenge with the maintaining of the operational capability in optimal condition of performance and safety (for ex: risk of decompensation on the field with impact on the group safety and the mission course). However, detection methods currently used (interview with a psychiatric or self-reported questionnaires) present several limits due to the fear of stigmatization increased in this professional context. There is a real need to develop screening tools of PTSD for soldiers 1) which have to be sensitive and specific (efficiency) 2) which have to be objective and don’t depend on responses of a self-reported questionnaire 3) which can be systematically used in large sample 4) which don’t depend on the spontaneous request of the soldier 5) which can be acceptable for the soldier PTSD can be considered as a conditioned fear response (“abnormal”) associated with the impairment of the physiological regulation system. In order to respond to the solution requirements to set up, we propose the D STRESS project whose goal is to develop a screening tool of PTSD based on the characterization of the fear response. MyReve (spin off of AP-HP) leads this project. This startup is developing virtual reality tools coupled with physiological measurements applied to fears. Our work program has several steps. First, to characterize the fear response, we have to inducing it using emotionally relevant stimuli. Virtual reality is an ideal tool to present them in scenario evoking the traumatism in a sensory flexible context . The specifications of the virtual world (stimuli to incorporate, sensory modality, script) will based on bibliography work realized under the supervision of Guillaume Levieux (MCU, CNAM, CEDRIC lab). Second, Emissive will produced the virtual reality application. Third, to characterize the fear response induced by the navigation in the virtual environment, several measures will be recorded: physiological measures (heart rate, skin conductance, respiratory rate) and behavioral measures (eye tracking and movement). Sonia Pellissier (MCU, LIP/PCS) will be on charged of this step. Fourth, in order to develop PTSD detection score, le fear response will be compared between subjects with and without PTSD. The enrollment of the population and regulatory approvals will be performed in collaboration with the Biomedical Research Institute of Army. `Firth, the detection score will be based on the measures recorded during the navigation in the virtual environment. The risk models developed by Prof. Mattheu Montès (CNAM, GBCM lab) will be used to identify the optimal threshold value of the score whose sensitivity and specificity will detect PTSD even if it’s subclinical. The economic impact of this project lies in the reduction of direct and indirect (work stoppage and professional retraining) costs of PTSD using an earlier detection and so a sooner support.