Comparison of the 32-item Hypomania Checklist, the 33-item Hypomania Checklist, and the Mood Disorders Questionnaire for bipolar disorder

Aim: Bipolar disorder (BD) is frequently misdiagnosed as major depressive disorder (MDD) and hence reliable and culturally appropriate screening tools are needed. This study compared the 32-item Hypomania Checklist (HCL-32), the 33-item Hypomania Checklist (HCL-33), and the Mood Disorders Questionnaire (MDQ) for BD.

Methods: Altogether, 350 depressed patients were included. The HCL-32, HCL-33, and MDQ were completed by patients to identify manic and/or hypomanic symptoms. The sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and area under the curve among the HCL-32, HCL-33, and MDQ for BD and MDD were calculated and compared, using cut-offs suggested by respective validation studies.

Results: Of the three scales, the MDQ had the highest sensitivity and NPV (sensitivity = 0.90, 0.81, and 0.90 for BD vs MDD, BD-I vs MDD, and BD-II vs MDD, respectively; NPV = 0.78, 0.86, and 0.86 for BD vs MDD, BD-I vs MDD, and BD-II vs MDD, respectively), while the HCL-33 had the highest specificity and PPV (specificity = 0.74, 0.69, and 0.66 for BD vs MDD, BD-I vs MDD, and BD-II vs MDD, respectively; PPV = 0.74, 0.55, and 0.56 for BD vs MDD, BD-I vs MDD, and BD-II vs MDD, respectively).

Conclusion: Compared to both HCL scales, the MDQ had higher sensitivity and lower specificity in screening for BD. These results contradict previous findings in Western populations. As a screening instrument for BD in Chinese clinical settings, the MDQ appears to be appropriate.