Bipolar At-Risk Criteria may predict development of bipolar disorder among young patients in later life

Bipolar disorder, formerly called manic depression, is a mental health condition that causes extreme mood swings that include emotional highs and lows. Preventive and early interventions may help to improve outcomes for people at risk of bipolar disorder (BD), a recurrent condition prevalent in 2% to 3% of the population worldwide.

The findings in a new study suggest that help-seeking adolescents and young adults identified to be at risk using bipolar at-risk (BAR) criteria may benefit from longer-term monitoring and support. The study is published in JAMA Network.

The study was a prospective cohort study, completed between May 1, 2020, and November 7, 2022, included consenting people seeking help for nonpsychotic major mental health difficulties, including mood, personality, and substance use disorders, who were originally recruited at ages 15 to 25 years from a tertiary youth mental health setting in metropolitan Melbourne, Victoria, Australia, from May 1, 2008, to September 30, 2010. The primary outcome was expert consensus diagnosis of BD I or II based on the Mini International Neuropsychiatric Interview, self-reported information collected through online assessments, and linked data on mental health service utilization in Victoria over 10 to 13 years of follow-up.

The key findings of the study are

• Among 69 eligible participants, follow-up data were available for 60 (88.2%). The mean (SD) age at the end of follow-up was 32.9 (2.8) years, and 49 (81.7%) were women.

• A total of 28 participants met BAR criteria, and 32 were in the comparison group. In the BAR group, 8 patients (28.6%) developed BD over a mean (SD) of 11.1 (0.7) years of follow-up, and no patients in the comparison group developed BD.

• The risk of developing BD was higher in the BAR group than in the non-BAR group (χ21 = 70.0; P < .001). The proportions of transitions to BD were equal in the first and second halves of the follow-up period.

Researchers concluded that “ In this cohort study of participants seeking care for mental health difficulties, patients meeting the BAR criteria were significantly more likely to transition to BD over a decade after ascertainment compared with patients not meeting the BAR criteria. The findings suggest that those meeting BAR criteria may benefit from longer-term monitoring and support. Evaluation of predictive properties in longer-term studies using a risk measure will help with implementation of BAR criteria in clinical settings.”

Reference: Ratheesh A, Hammond D, Watson M, et al. Bipolar At-Risk Criteria and Risk of Bipolar Disorder Over 10 or More Years. JAMA Netw Open. 2023;6(9):e2334078. doi:10.1001/jamanetworkopen.2023.34078.