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. 2024 Feb 15:347:278-284.
doi: 10.1016/j.jad.2023.11.066. Epub 2023 Nov 23.

Validation of a youth suicide risk calculator in an adult sample with bipolar disorder

Jess G Fiedorowicz  1 , John A Merranko  2 , Tina R Goldstein  2 , Heather Hower  3 , Satish Iyengar  4 , Danella M Hafeman  2 , Jeffrey I Hunt  5 , Michael Strober  6 , Martin B Keller  7 , Benjamin I Goldstein  8 , Rasim S Diler  2 , Sara Siddiqi  9 , Boris Birmaher  2
Affiliations

Validation of a youth suicide risk calculator in an adult sample with bipolar disorder

Jess G Fiedorowicz et al. J Affect Disord. .

Abstract

Background: Bipolar disorder (BD) conveys the highest risk of suicide of all mental disorders. We sought to externally validate a risk calculator (RC) of suicide attempts developed in youth with BD from the Course and Outcome of Bipolar Youth (COBY) study in an adult sample.

Methods: A prospective cohort of adults with BD from the National Institute of Mental Health Collaborative Depression Study (CDS; N = 427; mean (+/- SD) age at intake (36 +/- 13 years)) was secondarily analyzed to validate the COBY RC for one-year risk of suicide attempts/deaths. Nine of the ten predictor variables from the COBY RC were available in the CDS and used: age, age of mood disorder onset, first and second (partial) degree family history of suicide, history of psychotic symptoms, substance use disorder, prior suicide attempt, socioeconomic status, and non-suicidal self-injury (prospectively, incompletely at baseline).

Results: Over a mean (SD) follow-up of 19 (10) years, 29 % of the CDS sample attempted suicide. The RC predicted suicide attempts/deaths over one-year follow-up with an area under the receiver operating characteristic curve (AUC) of 0.78 (95 % CI 0.75-0.80). The RC performed slightly better in those with a younger age of mood disorder onset.

Limitations: Clinical samples may limit generalizability; the RC does not assess more acute suicide risk.

Conclusions: One-year risk of suicide attempts/deaths can be predicted with acceptable accuracy in youth and adults with BD, comparable to commonly used RCs to predict cardiovascular risk. This RC may help identify higher-risk individuals with BD for personalized treatment and research. https://cobysuicideattemptsrc.shinyapps.io/Shiny.

Keywords: Bipolar disorder; Personalized medicine; Prospective cohort study; Risk calculator; Suicide attempts.

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Conflict of interest statement

Declaration of competing interest Dr. Fiedorowicz has received research support from the National Institute of Mental Health (NIMH) and National Center for Advancing Translational Sciences (NCATS). He receives support from Elsevier for duties as an Editor-in-Chief, and from the United States Food and Drug Administration (USFDA) for service on the Psychopharmacologic Drugs Advisory Committee. Dr. T. Goldstein has received research support from NIMH, the American Foundation for Suicide Prevention (AFSP), and The Brain and Behavior Foundation, and royalties from Guilford Press. Dr. Strober has received research support from NIMH, and support from the Resnick Endowed Chair in Eating Disorders. Dr. Hafeman has received research support from NIHM and the Klingenstein Third Generation Foundation. Dr. Keller has received research support from NIMH and the John J. McDonnell and Margaret T. O’Brien Foundation. Dr. Iyengar has received research support from NIMH. Dr. Diler has received research support from NIMH. Ms. Hower has received honoraria from the Department of Defense (DOD) and from the Department of Psychiatry, University of California at San Diego (UCSD) School of Medicine. Dr. Hunt has received honorarium from Wiley Publishers and has received support from the NIMH. Dr. B. Goldstein has received research support from the Brain and Behavior Research Foundation (NARSAD), Brain Canada, the Canadian Institutes of Health Research, the Heart & Stroke Foundation, NIMH, and the Ontario Ministry of Research and Innovation. Dr. Birmaher has received research support from the National Institute of Mental Health (NIMH), and royalties for publications from Random House, Inc., UpToDate, and Lippincott Williams and Wilkins. Mr. Merranko, Ms. Siddiqi report no financial relationships with commercial interests.

Figures

Figure 1
Figure 1. Receiver operating characteristic (ROC) curves for one-year predication of suicidal behavior.
The ROC curves compare the classification ability of the risk calculator in the CDS external validation sample (AUC=0.78) compared to the prior COBY holdout sample (AUC=0.82). AUC = Area Under the Curve, CDS = Collaborative Depression Study, COBY = Course and Outcome of Bipolar Youth study.
Figure 2
Figure 2. Calibration plot for five-year test predictions.
Predicted versus observed one-year suicide risk are displayed for the CDS external validation and the COBY holdout sample. The risk calculator underestimated risk in the higher risk portion of the sample in the CDS external validation cohort. CDS = Collaborative Depression Study, COBY = Course and Outcome of Bipolar Youth study.
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