Screening for Bipolar Disorder with the Mood Disorders Questionnaire: A Review

BACKGROUND: Several research reports have suggested that bipolar disorder is underrecognized. Recommendations for improving the detection of bipolar disorder include the use of screening questionnaires. The Mood Disorders Questionnaire (MDQ) has been the most widely studied screening instrument for bipolar disorder, with nearly two dozen published reports on its performance. We reviewed the literature on the MDQ's performance to assess its utility as a screening instrument. METHODS: We conducted a Medline search on the terms Mood Disorders Questionnaire, MDQ, screening AND bipolar disorder, and recognition AND bipolar disorder. Only studies of adults were included. RESULTS: Across all studies the sensitivity of the MDQ was 61.3%; specificity, 87.5%; positive predictive value, 58.0%; and negative predictive value, 88.9%. Compared to the studies using the MDQ for psychiatric outpatients, studies using it in the general population found it to have much lower sensitivity and positive predictive value, and higher specificity and negative predictive value. The MDQ's sensitivity was higher in detecting bipolar I disorder than bipolar II disorder (66.3% vs. 38.6%). Lowering the threshold to identify cases markedly improved the MDQ's sensitivity, with only a modest reduction in specificity. Studies of the best symptom cutoff to identify cases have produced inconsistent findings. CONCLUSIONS: The MDQ's performance depends upon the setting in which it is used, the threshold to identify caseness, and the subtype of bipolar disorder examined. Conceptual issues in the use of a bipolar disorder screening questionnaire are discussed, and questions are raised about the clinical value of a self-report screening scale for bipolar disorder. Based on current available evidence, routine clinical use of the MDQ cannot be recommended because of the absence of studies simultaneously examining both the potential benefits (e.g., improved detection) and costs (e.g., overdiagnosis) of screening.