Validation of the youth mood recurrences risk calculator in an adult sample with bipolar disorder.
Validation of the youth mood recurrences risk calculator in an adult sample with bipolar disorder.
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DOI：
10.1016/j.jad.2021.09.037
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发表时间：
2021-09
影响因子：
6.6
通讯作者：
J. Fiedorowicz;J. Merranko;S. Iyengar;H. Hower;M. Gill;S. Yen;T. Goldstein;Michael Strober;D. Haf
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文献类型：
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作者：
J. Fiedorowicz;J. Merranko;S. Iyengar;H. Hower;M. Gill;S. Yen;T. Goldstein;Michael Strober;D. Haf
背景预测个体情绪发作复发风险的能力可以促进双相情感障碍（BD）的个性化医疗。我们试图在成人样本中从外部验证一种在患有BD的青年/年轻成人中开发的情绪发作复发风险计算器，该风险计算器来自双相青年的过程和结果（COBY）研究。（CDS; N=258;平均（SD）年龄=35.5（12.0）年;平均随访时间=24.9年）被用作样本，以验证青年COBY风险计算器对抑郁、躁狂或任何情绪发作的发作。风险计算器预测在1年、2年、3年或5年随访间隔内任何发作的复发，曲线下面积（AUC）约为0.77。对于每个时间窗，预测抑郁发作的AUC约为0.81，高于躁狂或轻躁狂发作（AUC=0.72）。虽然风险计算器在风险评分范围内得到了很好的校准，但它系统性地低估了CDS样本中约20%的风险。主要自我报告的白色样本可能限制了普遍性;风险计算器不能评估更近端的风险（例如，1个月）。结论情绪发作复发的风险可以预测与良好的准确性在青年和成人BD缓解。风险计算器可能有助于识别治疗和研究的高风险BD亚组。
BackgroundThe ability to predict an individual's risk of mood episode recurrence can facilitate personalized medicine in bipolar disorder (BD). We sought to externally validate, in an adult sample, a risk calculator of mood episode recurrence developed in youth/young adults with BD from the Course and Outcome of Bipolar Youth (COBY) study.MethodsAdult participants from the National Institute of Mental Health Collaborative Depression Study (CDS; N=258; mean(SD) age=35.5(12.0) years; mean follow-up=24.9 years) were utilized as a sample to validate the youth COBY risk calculator for onset of depressive, manic, or any mood episodes.ResultsIn this older validation sample, the risk calculator predicted recurrence of any episode over 1, 2, 3, or 5-year follow-up intervals, with Area Under the Curves (AUCs) approximating 0.77. The AUC for prediction of depressive episodes was about 0.81 for each of the time windows, which was higher than for manic or hypomanic episodes (AUC=0.72). While the risk calculator was well-calibrated across the range of risk scores, it systematically underestimated risk in the CDS sample by about 20%. The length of current remission was a highly significant predictor of recurrence risk in the CDS sample.LimitationsPredominantly self-reported White samples may limit generalizability; the risk calculator does not assess more proximal risk (e.g., 1 month).ConclusionsRisk of mood episode recurrence can be predicted with good accuracy in youth and adults with BD in remission. The risk calculators may help identify higher risk BD subgroups for treatment and research.