Validation and extension of a risk calculator to predict mood recurrence in young people with bipolar disorder.

Ava Avolio, John Merranko, Mary Kay Gill, Jessica C Levenson, Tina R Goldstein, Danella Hafeman, Boris Birmaher

Abstract readValidation Study

In one paragraph

Article in Journal of affective disorders, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.

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4 · The record

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Validation and Extension of a Risk Calculator to Predict Mood Recurrence in Young People with Bipolar Disorder.2026

5 · Who and what money

Authors and funding

7 authors.

Ava AvolioDepartment of Psychiatry, Western Psychiatric Institute and Clinic, University of Pittsburgh School of Medicine, 3811 O'Hara St., Pittsburgh, PA, 15213, USA. Electronic address: avolioaj@upmc.edu.

John MerrankoDepartment of Psychiatry, Western Psychiatric Institute and Clinic, University of Pittsburgh School of Medicine, 3811 O'Hara St., Pittsburgh, PA, 15213, USA. Electronic address: merrankoja@upmc.edu.

Mary Kay GillDepartment of Psychiatry, Western Psychiatric Institute and Clinic, University of Pittsburgh School of Medicine, 3811 O'Hara St., Pittsburgh, PA, 15213, USA. Electronic address: gillmk@upmc.edu.

Jessica C LevensonDepartment of Psychiatry, Western Psychiatric Institute and Clinic, University of Pittsburgh School of Medicine, 3811 O'Hara St., Pittsburgh, PA, 15213, USA. Electronic address: levensonjc@upmc.edu.

Tina R GoldsteinDepartment of Psychiatry, Western Psychiatric Institute and Clinic, University of Pittsburgh School of Medicine, 3811 O'Hara St., Pittsburgh, PA, 15213, USA. Electronic address: goldtr@upmc.edu.

Danella HafemanDepartment of Psychiatry, Western Psychiatric Institute and Clinic, University of Pittsburgh School of Medicine, 3811 O'Hara St., Pittsburgh, PA, 15213, USA. Electronic address: hafemand@upmc.edu.

Boris BirmaherDepartment of Psychiatry, Western Psychiatric Institute and Clinic, University of Pittsburgh School of Medicine, 3811 O'Hara St., Pittsburgh, PA, 15213, USA. Electronic address: BirmaherB@upmc.edu.

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

objectiveThe episodic nature of bipolar disorder (BD) and the substantial variability in mood recurrences between individuals, emphasize the need for accurate prediction tools. The original Course and Outcome of Bipolar Youth (COBY) recurrence risk calculator (RC) estimates threshold recurrence risk, but its performance for subthreshold recurrences has not been established. This study extended the COBY RC to predict both threshold and subthreshold recurrences and evaluated its performance in an independent sample.

methodAdolescents and young adults with BD-I/II (N = 51; BD-I: 38, BD-II: 13; 14-24 years old) were assessed with standard instruments at intake and during follow-up on average every 6 months for a median of 54 weeks. Model performance for predicting threshold and subthreshold recurrence was evaluated using area under the receiver operating characteristic curves (AUC), with additional assessments of calibration and variable importance.

resultsThe model demonstrated good discrimination of any recurrence within the next six months (threshold AUC = 0.72; subthreshold or worse AUC = 0.77). Calibration analyses indicated systematic risk overestimation in the external sample, plausibly reflecting differences in ascertainment (prospective vs. retrospective) and prior remission length. Recalibration greatly improved calibration without reducing discrimination.

conclusionThe COBY RC showed good discrimination for both threshold and subthreshold recurrences in an independent young adult cohort, extending prior youth and adult validations. These findings support its potential utility for personalized monitoring and early intervention across developmental stages and symptom severity.

Indexed as

Bipolar DisorderAdolescentFemaleHumansMalePrediction AlgorithmsRecurrenceRisk AssessmentROC CurveYoung AdultAdolescentsBipolar disorderPersonalized medicineRisk calculatorYoung adults

Identifiers

PMID42628577

DOI10.1016/j.jad.2026.122402

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