Brief report
Validation of the Mood Disorder Questionnaire for screening for bipolar disorder in a UK sample

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Abstract

Background

The Mood Disorder Questionnaire (MDQ) was designed as a screening questionnaire for bipolar disorder. Previous research has raised questions about the suitability of the MDQ structure for screening for bipolar II disorder. This study investigated the optimal sensitivity and specificity cut-off thresholds for the MDQ in bipolar I and bipolar II patients in a UK sample.

Methods

The MDQ was administered to patients before attending a tertiary mood disorders clinic. Diagnostic interviews were used to determine DSM-IV diagnoses and these were used as the gold standard against which to investigate the performance of the MDQ.

Results

54 patients with bipolar spectrum disorder and 73 patients with unipolar depressive disorder completed the MDQ. With the original scoring criteria (symptoms and supplementary questions) the sensitivity for bipolar disorder was 0.76 (bipolar I disorder 0.83, bipolar II disorder 0.67) with specificity 0.86. The optimal cut-off score in the current sample was a score of 9 or more endorsed symptoms without applying the supplementary questions (sensitivity of 0.90 and 0.88 for bipolar I and bipolar II groups respectively with a specificity of 0.90).

Limitations

The sample was drawn from a tertiary mood disorders clinic.

Conclusions

The MDQ appears to be a useful screening tool for bipolar spectrum disorder in UK psychiatric practice with sensitivity for bipolar II disorder improved by dropping the supplementary sections. Further investigation of the optimal cut-off scores of the MDQ is needed to determine its utility in non-specialist and community based samples.

Introduction

Bipolar disorder often goes unrecognised with delays of 8 years or more common before accurate diagnosis (Lish et al., 1994) which can result in a greater burden of illness, risk of suicide (Dunner, 2003) and inappropriate treatment (Altshuler et al., 1995). Bipolar spectrum disorders have been estimated to cost the UK around £2 billion per annum (Das Gupta and Guest, 2002) and unrecognised cases may have a greater cost for health services than recognised and treated cases (Li et al., 2002, McCombs et al., 2007).

A particular challenge is presented by ‘milder’ forms of bipolar disorder, such as bipolar II disorder and bipolar NOS. These are typically characterised by hypomania which may not be recognised as pathological by the individual or others (Akiskal et al., 2000). Treatment is likely to be sought for depressive episodes alone (Hirschfeld, 2001) often leading to a unipolar rather than bipolar diagnosis (Ghaemi et al., 2000).

The Mood Disorder Questionnaire (MDQ; Hirschfeld et al., 2000) was developed to aid diagnosis of bipolar spectrum disorders. It covers symptom endorsement (Section 1), symptom clustering (Section 2) and severity of problem caused (Section 3) (see Methods). The original validation study reported that the MDQ performed well against DSM-IV diagnosis (sensitivity 0.73, specificity 0.90) in a psychiatric outpatient population. Although questionnaires alone are not an alternative to clinical interview (Miller et al., 2004, Phelps and Ghaemi, 2006) the performance of the MDQ suggested promise for initial screening for bipolar disorder in primary care and busy psychiatric clinics.

MDQ validation studies in different US settings (Hirshfeld et al., 2003, Graves et al., 2007, Hirschfeld et al., 2005, Kemp et al., 2008, Miller et al., 2004) and in other countries (Hardoy et al., 2005, Isometsa et al., 2003, Konuk et al., 2007, Vieta et al., 2007, Weber Rouget et al., 2005) indicate that its psychometric properties vary somewhat according to the population studied. Its sensitivity, especially for bipolar II disorder, has been reported to be improved by exclusion or modification of Section 3 without markedly impairing its specificity (Benazzi, 2003, Isometsa et al., 2003, Kemp et al., 2008, Miller et al., 2004, Weber Rouget et al., 2005).

No validation studies of the MDQ have been reported for a UK sample. Given the importance of early detection of bipolar spectrum disorder, the aims of the present study were to validate the MDQ in a UK sample, to assess sensitivity and specificity scores of the MDQ for bipolar I and bipolar II groups using the original cut-off guidelines and to assess its performance without Sections 2 and 3.

Section snippets

Methods

Participants were sequential outpatient attendees of a tertiary NHS Specialist Service for Affective Disorders who completed the MDQ and then received a semi-structured clinical interview covering current and past mood disorder (DSM-IV-TR diagnosis; American Psychiatric Association, 2000) conducted by experienced psychiatrists who had access to the MDQ results.

The sample consisted of 127 patients; 54 had a bipolar spectrum disorder and 73 a unipolar diagnosis. Participants were English

Results

The bipolar group included 30 bipolar I, 21 bipolar II and 3 bipolar NOS participants; the later two were combined for analysis (called bipolar II). The unipolar group included 68 patients with major depression (18 single episode, 50 recurrent), 3 with depressive disorder NOS and 2 with dysthymic disorder.

Bipolar and unipolar groups did not differ with respect to age (means (sd): bipolar group 44.0 (11.8) years; unipolar group 42.1 (11.8) years) or gender (male 40.7% and 43.8% for bipolar and

Discussion

The MDQ showed good reliability and validity in identifying bipolar disorder in UK patients attending a tertiary clinic. Internal consistency was good (0.91) and comparable with that reported in the original validation study (0.90). Our finding of a higher sensitivity for bipolar I disorder (0.83) than bipolar II disorder (0.67) using the original scoring guidelines is similar to that reported in previous studies (Isometsa et al., 2003, Kemp et al., 2008, Miller et al., 2004, Weber Rouget et

Role of funding source

Nothing declared.

Conflict of interest

No conflict declared.

Acknowledgements

We thank Kirsten Bond for assisting with the collection of the data and Manchester Mental Health and Social Care trust for their facilitation in the study.

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