Prediction of suicidality in bipolar disorder using variability of intrinsic brain activity and machine learning

Bipolar disorder (BD) is associated with marked suicidal susceptibility, particularly during a major depressive episode. However, the evaluation of suicidal risk remains challenging since it relies mainly on self‐reported information from patients. Hence, it is necessary to complement neuroimaging features with advanced machine learning techniques in order to predict suicidal behavior in BD patients. In this study, a total of 288 participants, including 75 BD suicide attempters, 101 BD nonattempters and 112 healthy controls, underwent a resting‐state functional magnetic resonance imaging (rs‐fMRI). Intrinsic brain activity was measured by amplitude of low‐frequency fluctuation (ALFF). We trained and tested a two‐level k‐nearest neighbors (k‐NN) model based on resting‐state variability of ALFF with fivefold cross‐validation. BD suicide attempters had increased dynamic ALFF values in the right anterior cingulate cortex, left thalamus and right precuneus. Compared to other machine learning methods, our proposed framework had a promising performance with 83.52% accuracy, 78.75% sensitivity and 87.50% specificity. The trained models could also replicate and validate the results in an independent cohort with 72.72% accuracy. These findings based on a relatively large data set, provide a promising way of combining fMRI data with machine learning technique to reliably predict suicide attempt at an individual level in bipolar depression. Overall, this work might enhance our understanding of the neurobiology of suicidal behavior by detecting clinically defined disruptions in the dynamics of instinct brain activity.