A risk calculator to predict suicide attempts among individuals with early-onset bipolar disorder.
A risk calculator to predict suicide attempts among individuals with early-onset bipolar disorder.
复制标题
用于预测早发性双相情感障碍患者自杀企图的风险计算器。
DOI：
10.1111/bdi.13250
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发表时间：
2022
影响因子：
5.4
通讯作者：
Birmaher,Boris
中科院分区：
文献类型：
--
作者：
Goldstein,TinaR;Merranko,John;Hafeman,Danella;Gill,MaryKay;Liao,Fangzi;Sewall,Craig;Hower,Heather;Weinstock,Lauren;Yen,Shirley;Goldstein,Benjamin;Keller,Martin;Strober,Michael;Ryan,Neal;Birmaher,Boris
ObjectivesTo build a one-year risk calculator（RC）to predict individualized risk for suicide attempt in early-onset bipolar disorder.MethodsYouth number 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 was included.通过A-LIFE自伤/自杀行为量表评估随访期间的自杀企图。从双相情感障碍自杀行为的文献中选择在临床实践中易于评估的预测因子，并酌情进行分类（过去6个月存在/仅终生病史/无终生病史）。RC通过提升的多项分类树进行训练;预测通过Platt缩放进行校准。一半样本用于训练，另一半样本用于独立测试RC。结果106人中有249人自杀未遂。10个预测因子占模型中交叉验证相对影响的90%以上（AUC = 0.82;按相对影响顺序）：（1）心境障碍发作年龄;（2）非自杀性自伤行为（切除）;（3）当前年龄;（4）精神病（切除）;（5）社会经济状况;（6）过去6个月内最严重的抑郁症状（无/阈下/阈下）;（7）自杀企图史（有）;（8）自杀行为家族史;（9）物质使用障碍（有）;（10）身体/性虐待终身史。对于所有的automomomized变量，在过去的6个月里可靠地预测更高的风险比lifetime history.ConclusionsThis RC持有承诺作为一个临床和研究工具，为前瞻性识别个性化的高风险期自杀企图在早发性双相情感障碍。
ObjectivesTo build a one‐year risk calculator (RC) to predict individualized risk for suicide attempt in early‐onset bipolar disorder.MethodsYouth 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.ResultsThere 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.ConclusionsThis 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.