Mood Disorder Questionnaire (MDQ)

 

Background

The Mood Disorder Questionnaire (MDQ) was created by Hirschfeld and colleagues (2000) to address the need for accurately screening individuals with a bipolar spectrum disorder. Accurate identification of bipolar disorder (BD) is of concern as it’s often unrecognised or inaccurately diagnosed, which results in a delay of diagnosis and appropriate treatment (Lish, et al., 1994). Items on the MDQ are derived from the DSM-IV criteria and experience as a clinician (Hirschfeld, 2000).

Clinical Use

Self-report format, around five minutes to complete, not to be used for diagnostic purposes, only as a screening tool, and a comprehensive evaluation should follow a positive screen outcome.

Administration and Scoring

The MDQ consists of 3 questions. First, there are 13 items that examine manic symptoms. Second and third, enquires whether these symptoms identified have co-occurred, and the severity of the symptoms. To screen positive, the individual must have answered ‘yes’ to a minimum of 7 items on question 1, responded ‘yes’ to question 2, and answered ‘moderate problem’ or ‘serious problem’ to question 3.

Development and Psychometric Properties

The MDQ has achieved adequate internal consistency with a Cronbach’s alpha of 0.79 and 0.90 (Hirschfeld, 2000; Isometsä et al., 2003). The validation study administered the MDQ to patients at five psychiatric clinics in the United States (Hirschfeld, 2000). The results were used to determine cut off points for items, specificity, and sensitivity. Findings demonstrated that the MDQ had a 0.73 sensitivity and a 0.90 specificity when contrasted against other screening questionnaires in psychiatric settings. The researchers then conducted testing in a general population, which identified a 0.28 sensitivity and a 0.97 specificity (Hirschfeld, 2002). An additional study assessed the effectiveness of the MDQ in unipolar and bipolar depressive patients and found a 0.58 sensitivity (higher sensitivity for bipolar 1) and a 0.67 specificity (Miller, Klugman, Berv, Rosenquist, Ghaemi, 2004). Lastly, testing in a primary care setting revealed a 0.58 sensitivity and a 0.93 specificity (Hirschfeld, Cass, Holt, Carlson, 2005).

In sum, the MDQ is a useful screening tool for BD, demonstrating validity in clinical settings and across cultures. However, consideration should be given towards its higher sensitivity to detect BD type 1 compared to other BD on the spectrum, and its low sensitivity in general populations. Additionally, the use of differing cutoff points of items in scoring (e.g., standard or modified cutoff value of 7 for question 1), and the inclusion/exclusion criteria (e.g., more defined BD definition/criteria includes more severe cases, and increases sensitivity) has shown variability in sensitivity and specificity thus, limiting its overall effectiveness (Wang, et al., 2015).

References

Hirschfeld, R. M., Williams, J. B., Spitzer, R. L., Calabrese, J. R., Flynn, L., Keck Jr, P. E., … & Russell, J. M. (2000). Development and validation of a screening instrument for bipolar spectrum disorder: the Mood Disorder Questionnaire. American Journal of Psychiatry157, 1873-1875.

Hirschfeld, R. M. (2002). The Mood Disorder Questionnaire: a simple, patient-rated screening instrument for bipolar disorder. Primary care companion to the Journal of Clinical Psychiatry4, 9.

Miller, C. J., Klugman, J., Berv, D. A., Rosenquist, K. J., & Ghaemi, S. N. (2004). Sensitivity and specificity of the Mood Disorder Questionnaire for detecting bipolar disorder. Journal of Affective Disorders81, 167-171.

Hirschfeld, R. M., Cass, A. R., Holt, D. C., & Carlson, C. A. (2005). Screening for bipolar disorder in patients treated for depression in a family medicine clinic. The Journal of the American board of family practice18, 233-239.

Isometsä, E., Suominen, K., Mantere, O., Valtonen, H., Leppämäki, S., Pippingsköld, M., & Arvilommi, P. (2003). The mood disorder questionnaire improves recognition of bipolar disorder in psychiatric care. BMC psychiatry, 3, 8.

Lish, J. D., Dime-Meenan, S., Whybrow, P. C., Price, R. A., & Hirschfeld, R. M. (1994). The National Depressive and Manic-depressive Association (DMDA) survey of bipolar members. Journal of affective disorders31, 281-294.