Machine Learning Models for the Prediction of Early-Onset Bipolar Using Electronic Health Records

Objective Early identification of bipolar disorder (BD) provides an important opportunity for timely intervention. In this study, we aimed to develop machine learning models using large-scale electronic health record (EHR) data including clinical notes for predicting early-onset BD. Method Structured and unstructured data were extracted from the longitudinal EHR of the Mass General Brigham health system. We defined three cohorts aged 10 – 25 years: (1) the full youth cohort (N=300,398); (2) a sub-cohort defined by having a mental health visit (N=105,461); (3) a sub-cohort defined by having a diagnosis of mood disorder or ADHD (N=35,213). By adopting a prospective landmark modeling approach that aligns with clinical practice, we developed and validated a range of machine learning models including neural network-based models, across different cohorts and prediction windows. Results We found the two tree-based models, Random forests (RF) and light gradient-boosting machine (LGBM), achieving good discriminative performance across different clinical settings (area under the receiver operating characteristic curve 0.76-0.88 for RF and 0.74-0.89 for LGBM). In addition, we showed comparable performance can be achieved with a greatly reduced set of features, demonstrating computational efficiency can be attained without significant compromise of model accuracy. Conclusion Good discriminative performance for early-onset BD is achieved utilizing large-scale EHR data. Our study offers a scalable and accurate method for identifying youth at risk for BD that could help inform clinical decision making and facilitate early intervention. Future work includes evaluating the portability of our approach to other healthcare systems and exploring considerations regarding possible implementation.