A Risk Calculator to Predict Suicide Attempts Among Individuals With Early-Onset Bipolar Disorder
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.
Reprinted from Bipolar Disord 2022; 24:749–757, with permission from John Wiley and Sons. Copyright © 2022
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Published in print: Fall 2023
Published online: 16 October 2023
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Competing Interests
Dr. T. Goldstein reports grants from NIMH, The American Foundation for Suicide Prevention (AFSP), University of Pittsburgh Clinical and Translational Science Institute (CTSI), and The Brain and Behavior Foundation and royalties from Guilford Press, outside the submitted work. Dr. Hafeman reports grants from NIMH and the Brain and Behavior Research Foundation. Dr. Weinstock reports research support from NIMH, NCCIH, the NIH Office of Behavioral Social Sciences Research (OBSSR), the Warren Alpert Foundation and the National Institute of Justice (NIJ). Dr. Yen reports research support from NIMH, the National Center for Complimentary and Integrative Health (NCCIH), and AFSP. Dr. B. Goldstein reports grant funding from Brain Canada, Canadian Institutes of Health Research, Heart & Stroke Foundation, NIMH, and the departments of psychiatry at the University of Toronto, and acknowledges salary support from the RBC Investments Chair, held at the Centre for Addiction and Mental Health and the University of Toronto department of psychiatry. Dr. Keller reports research support from NIMH and the John J. McDonnell and Margaret T. O'Brien Foundation. Dr. Strober reports research support from NIMH, and support from the Resnick Endowed Chair in Eating Disorders. Dr. Ryan reports grants from NIH and Axsome Therapeutics. Dr. Birmaher reports grants from NIMH, royalties from Random House, UpToDate and Lippincott, Williams & Wilkins. Mr. Merranko, Ms. Gill, Ms. Liao, Mr. Sewall and Ms. Hower report no financial relationships with commercial interests.
Funding Information
FUNDING INFORMATIONNational Institute of Mental Health, Grant/Award Number: MH059929, MH59691 and MH59977
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