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Estimating Treatment Effect Heterogeneity in Psychiatry: A Review and Tutorial With Causal Forests

Erik Sverdrup, Maria Petukhova, Stefan Wager

2025International Journal of Methods in Psychiatric Research23 citationsDOIOpen Access PDF

Abstract

BACKGROUND: Flexible machine learning tools are increasingly used to estimate heterogeneous treatment effects. AIMS: This paper gives an accessible tutorial demonstrating the use of the causal forest algorithm, available in the R package grf. SUMMARY: We start with a brief non-technical overview of treatment effect estimation methods, focusing on estimation in observational studies; the same techniques can also be applied in experimental studies. We then discuss the logic of estimating heterogeneous effects using the extension of the random forest algorithm implemented in grf. Finally, we illustrate causal forest by conducting a secondary analysis on the extent to which individual differences in resilience to high combat stress can be measured among US Army soldiers deploying to Afghanistan based on information about these soldiers available prior to deployment. We illustrate simple and interpretable exercises for model selection and evaluation, including targeting operator characteristics curves, Qini curves, area-under-the-curve summaries, and best linear projections. RESULTS: A replication script with simulated data is available at https://github.com/grf-labs/grf/tree/master/experiments/ijmpr.

Topics & Concepts

Random forestComputer scienceReplication (statistics)Observational studyMachine learningEstimationTree (set theory)Artificial intelligenceSelection (genetic algorithm)EconometricsData sciencePsychologyStatisticsMathematicsEngineeringMathematical analysisSystems engineeringAdvanced Causal Inference TechniquesMental Health Research TopicsPosttraumatic Stress Disorder Research