Ter Meulen Wendela G, Draisma Stasja, Beekman Aartjan T F, Penninx Brenda W J H, Kupka Ralph W
Amsterdam UMC, Vrije Universiteit, Psychiatry, Amsterdam Public Health research institute, The Netherlands; GGZ inGeest Specialized Mental Health Care, Amsterdam, The Netherlands.
Amsterdam UMC, Vrije Universiteit, Psychiatry, Amsterdam Public Health research institute, The Netherlands.
J Affect Disord. 2020 Feb 1;262:373-380. doi: 10.1016/j.jad.2019.10.055. Epub 2019 Oct 30.
No instrumnt exists that can predict the incidence of bipolar disorders (BD). The Bipolarity index (BI), originally developed to improve diagnostic confidence for a lifetime diagnosis of BD, may predict incident BD.
To assess the predictive performance of the BI for incident BD in persons with a lifetime depression.
The BI score was composed from different questionnaires and interviews in n = 1857 subjects without BD and with a lifetime unipolar depressive disorder from the Netherlands Study of Depression and Anxiety, a longitudinal cohortstudy. The incidence of DSM-IV defined BD I or II as a criterion diagnosis was established with the Composite International Diagnostic Interview after 2, 4, 6 and 9 years of follow-up. Cox regression analyses calculated whether the BI predicts incident BD during 9-years of follow-up. The area Under the Curve (AUC) was determined. At the optimal cut-off score, sensitivity, specificity, positive, and negative predictive values (PPV and NPV) were calculated.
Over the course of 9 years, bipolar conversion occurred in n = 46 subjects (2.5%). Each point increase in BI score significantly predicted incident BD (HR[95%CI]= 1.047[1.018-1.076], p = 0.001). The AUC was 0.61 (95%CI: 0.54-0.68). At the optimal cut-off of 30, sensitivity was 67%, specificity 52%, PPV 3% and NPV 98%.
Not all items of the BI were fully covered; mean age of the sample of 42.
The BI score predicts bipolar conversion over 9 years in those with a lifetime depression. However, given the modest performance metrics, the BI cannot guide clinical decision making yet.
目前尚无能够预测双相情感障碍（BD）发病率的工具。双相性指数（BI）最初是为提高BD终生诊断的诊断可信度而开发的，可能预测BD的发病情况。
评估BI对终生患有抑郁症的人群发生BD的预测性能。
在荷兰抑郁症和焦虑症研究（一项纵向队列研究）中，对n = 1857名无BD且患有终生单相抑郁症的受试者，通过不同问卷和访谈得出BI评分。在随访2、4、6和9年后，采用综合国际诊断访谈确定DSM-IV定义的BD I或II作为标准诊断的发病率。通过Cox回归分析计算BI是否能预测9年随访期间的BD发病情况。确定曲线下面积（AUC）。在最佳临界分数时，计算敏感性、特异性、阳性和阴性预测值（PPV和NPV）。
在9年期间，n = 46名受试者（2.5%）发生了双相转换。BI评分每增加1分显著预测BD发病（HR[95%CI]= 1.047[1.018 - 1.076]，p = 0.001）。AUC为0.61（95%CI：0.54 - 0.68）。在最佳临界值30时，敏感性为67%，特异性为52%，PPV为3%，NPV为98%。
BI的所有项目未完全涵盖；样本的平均年龄为42岁。
BI评分可预测终生患有抑郁症的人群在9年内的双相转换。然而，鉴于性能指标一般，BI尚不能指导临床决策。
