The Bipolar-at-risk criteria may help screen for young individuals at risk of bipolar disorder

1. Compared to those who screened negative, individuals who screened positive via the Bipolar At-Risk Criteria were more likely to develop bipolar disorder at a 10-13-year follow-up. 

Evidence Rating Level: 2 (Good)

Study Rundown: Bipolar disorder (BD) is a mental illness affecting 2-3% of the global population. The bipolar at-risk (BAR) criteria is a screening tool used to identify those at risk of developing BD over 1-2 years. To screen positive via the BAR criteria, an individual must be between the ages 15 and 25, experienced subthreshold mania, depression, cyclothymic features, and have genetic susceptibility (a family history of BD). The ability of this tool to predict the development of BD over a more extended time period has not previously been studied. The authors recruited 60 participants aged 15-25 who were seeking mental health-related care. 28 of these participants met the BAR criteria, and 32 were in the comparison group. Over a 10-13 year follow-up period, the risk of developing BD I or II was significantly greater among the BAR group than the comparison group (8 individuals compared to 0). Overall, this study demonstrates that the BAR criteria are useful for identifying those at risk for developing BD over an approximately decade-long follow-up period. These criteria may be useful in clinical practice to identify individuals who would benefit from greater mental health support. 

Click to read the study in JAMA Network Open 

In-Depth [prospective cohort]: The authors recruited 69 individuals between the ages of 15 and 25 in Melbourne Australia. Participants were seeking help for non-psychotic mental health-related challenges, including mood, personality, and substance-use disorders. The mean age at follow-up was 32.9 years (SD 2.8), with 11.8% attrition. Participants were 81.7% female, 16.7% male, and 1.6% nonbinary. 28 participants met the BAR criteria, with 32 in the comparison group. 28.6% of participants in the BAR group had developed BD I or II over the 10-13 year follow-up period, compared to 0% of participants in the comparison group. The risk of developing BD was therefore significantly higher for those who screened positive via the BAR criteria (χ21 = 70.0; P < .001). The transition to BD was equally likely to occur during the first and second halves of the follow-up period. Of those who developed BD, 87.5% were diagnosed with BDII and 12.5% with BDI.  This study suggests that the BAR criteria are useful for identifying individuals at risk for developing BD over an approximately 10-year period. In clinical practice, the BAR criteria may be applied to adolescents and young adults seeking mental health care, to identify those who would benefit from greater support and monitoring for BD. A limitation of the study is that 11.8% of participants were not assessed at the time of follow-up. Given that those with more severe mental illness may be less likely to follow up, this attrition rate could skew the data. As well, the study sample size is relatively small. Future studies should aim to replicate this data among a larger cohort. 

Image: PD

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