World J Psychiatry Ment Health Res | Volume 7, Issue 1 | Research Article | Open Access

Translating Research Findings into Clinical Decision- Making Thresholds for Young People at Risk of Bipolar Disorders

Macmillan I, Meyer T, Ryles F, Sharma A, McArdle P, Scott J*

1Alfred Psychiatry, Melbourne, Australia
2Department of Psychiatry & Behavioral Sciences, University of Texas Health Houston, USA
3Tees, Esk, and Wear NHS Trust, Middlesbrough, UK
4Institute of Neuroscience, Newcastle University, UK
5Cumbria, Northumberland, Tyne and Wear NHS Trust, Newcastle, UK

*Correspondance to: Jan Scott 

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Background: Although several screening methods can reliably detect Bipolar at Risk (BAR) criteria, researchers employ different statistics to report transition to Bipolar Disorders (BD). This hinders cross-study comparisons and translation of findings to clinical practice. This study highlights the potential utility of estimating Likelihood Ratios (LRs) and quantitative decision-making thresholds. Methods: Participants were individuals aged 16 to 25 who sought help for at least one clinically significant mood episode from secondary mental health services in Newcastle, England. Individuals who met one or more BAR criteria were followed up for one year. We used Likelihood Ratios (LRs) to quantify the change in the certainty (for early transition to BD) conferred by the presence or absence of different BAR criteria and identified those with the highest probability of BD onset. Results: The sample comprised 110 individuals with a mean age of 19.3; 26 individuals (23.6%) demonstrated early transition to hypo/mania. Positive LRs ranged from 1.08 (i.e., a small additional increase in probability of early transition) up to 5.38. Employing a treatment threshold of a positive probability of transition >50% would lead to three groups of individuals being offered immediate treatment (those with subthreshold mania; cyclothymia, depression and family history of BD; or anergia with/without hypersomnia). Conclusion: Proposals for developing early intervention services for youth at risk of developing BD will need to consider the economic cost versus clinical benefit. This short communication attempts to demonstrate the advantages of estimating LRs and probabilities of transition in moving BAR research forward and expanding its clinical relevance.


Bipolar disorder; At-risk; Likelihood ratios; Probabilistic reasoning; Clinical decision-making thresholds


Macmillan I, Meyer T, Ryles F, Sharma A, McArdle P, Scott J. Translating Research Findings into Clinical Decision-Making Thresholds for Young People at Risk of Bipolar Disorders. World J Psychiatry Ment Health Res. 2024; 7(1): 1038..

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