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. 2022 Nov;24(7):749-757.
doi: 10.1111/bdi.13250. Epub 2022 Sep 9.

A risk calculator to predict suicide attempts among individuals with early-onset bipolar disorder

Tina R Goldstein  1 , John Merranko  1 , Danella Hafeman  1 , Mary Kay Gill  1 , Fangzi Liao  1 , Craig Sewall  1 , Heather Hower  2 , Lauren Weinstock  2 , Shirley Yen  2   3 , Benjamin Goldstein  4 , Martin Keller  2 , Michael Strober  5 , Neal Ryan  1 , Boris Birmaher  1
Affiliations

A risk calculator to predict suicide attempts among individuals with early-onset bipolar disorder

Tina R Goldstein et al. Bipolar Disord. 2022 Nov.

Abstract

Objectives: To build a one-year risk calculator (RC) to predict individualized risk for suicide attempt in early-onset bipolar disorder.

Methods: Youth numbering 394 with bipolar disorder who completed ≥2 follow-up assessments (median follow-up length = 13.1 years) in the longitudinal Course and Outcome of Bipolar Youth (COBY) study were included. Suicide attempt over follow-up was assessed via the A-LIFE Self-Injurious/Suicidal Behavior scale. Predictors from the literature on suicidal behavior in bipolar disorder that are readily assessed in clinical practice were selected and trichotomized as appropriate (presence past 6 months/lifetime history only/no lifetime history). The RC was trained via boosted multinomial classification trees; predictions were calibrated via Platt scaling. Half of the sample was used to train, and the other half to independently test the RC.

Results: There were 249 suicide attempts among 106 individuals. Ten predictors accounted for >90% of the cross-validated relative influence in the model (AUC = 0.82; in order of relative influence): (1) age of mood disorder onset; (2) non-suicidal self-injurious behavior (trichotomized); (3) current age; (4) psychosis (trichotomized); (5) socioeconomic status; (6) most severe depressive symptoms in past 6 months (trichotomized none/subthreshold/threshold); (7) history of suicide attempt (trichotomized); (8) family history of suicidal behavior; (9) substance use disorder (trichotomized); (10) lifetime history of physical/sexual abuse. For all trichotomized variables, presence in the past 6 months reliably predicted higher risk than lifetime history.

Conclusions: This RC holds promise as a clinical and research tool for prospective identification of individualized high-risk periods for suicide attempt in early-onset bipolar disorder.

Keywords: bipolar disorder; child and adolescent; risk calculator; suicide.

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Figures

Figure 1.
Figure 1.
Receiver Operating Characteristic Curve
See this image and copyright information in PMC

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