Precision stratification of risk for suicidal behavior in people with bipolar depression

Patients with bipolar depression are at the highest risk for suicidal behavior, comprising ~ 10% of all deaths. In the critical period preceding attempts, most are not in contact with mental health professionals to effect anti-suicidal strategies. There is an urgent need for decision support tools to help nonspecialist providers identify those at elevated risk to facilitate prevention.

However, we lack robust, performant predictive models to form the core of such tools. Here, we build a high-precision predictive model of 30-day risk for suicidal behavior using unique electronic health record data from > 220,000 patients with bipolar depression. We show that optimized machine learning approaches offer very strong clinical utility, delivering high Standardized Net Benefit in the context of near-perfect calibration and smooth, threshold-robust decision curves.

Our results break the longstanding performance ceiling in suicide risk prediction and highlight the importance of training models for clinical utility as well as discriminative skill. The authors received no specific funding for this work. Department of Psychiatry, University of Utah, 383 Colorow Drive, Salt Lake City, UT, 84108, USA Nina de Lacy, Wai-Yin Lam & Monika Baker Huntsman Mental Health Institute, Salt Lake City, USA Data Science Services, University of Utah, Salt Lake City, USA Matheson Center for Health Care Studies, University of Utah, Salt Lake City, USA Department of Sociology, Indiana University, Indianapolis, USA Department of Family and Consumer Studies, University of Utah, Salt Lake City, USA The authors declare no competing interests.

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The images or other third party material in this article are included in the article’s Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article’s Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by-nc-nd/4.0/. de Lacy, N., Lam, WY., Baker, M. et al.

Precision stratification of risk for suicidal behavior in people with bipolar depression. Sci Rep (2026). https://doi.org/10.1038/s41598-026-72870-8 DOI: https://doi.org/10.1038/s41598-026-72870-8