Reliability and validity of the Chinese Version of the Mood Disorder Questionnaire

Symptoms mediate the relationship between childhood trauma and non-suicidal self-injury: A hospital-based study of adolescents with mood disorder

BACKGROUND

Childhood trauma has a significant impact on the development of adolescents, which may lead to interpersonal and psychological problems. Determining the incidence and consequences of childhood trauma in psychiatric clinical practice is of great significance.

METHODS

A survey was conducted among adolescents with mood disorders. Childhood Trauma Questionnaire (CTQ), the Adolescent Non-Suicidal-Self-Injury Behavior Function Assessment Scale (ANBFAS) and a series of psychological scales were filled face to face. Path analysis was used to examine the causation structure of childhood trauma-related symptoms.

RESULTS

A total of 117 participants (74.5%) had experienced at least one type of trauma. Interpersonal and psychological features of adolescent patients with childhood trauma were detailed in this study. The path analysis model showed that the relationships between childhood trauma and NSSI were mediated by depressive symptoms and thinking disorders, respectively, whereas depressive symptoms individually mediated the correlation between childhood trauma and sleep disturbances in adolescent patients with psychiatric disorders (χ2 /df = 1.23).

CONCLUSION

For adolescent patients with childhood trauma, psychological counseling for interpersonal relationships should start with families and peers. It is important to treat their depressive symptoms and thinking disorders and alleviate NSSI behavior and sleep disorders.

Assessment of the diagnostic performance of various screening tools for bipolar disorder: a meta-analysis

Background

Various studies have shown that about 40–50% of patients with bipolar disorder (BD) are undiagnosed at the time of referral and are often treated as depression. The present meta-analysis was conducted to determine the diagnostic accuracy of psychometric properties of the bipolarity index (BI) in people with BD.

Methods

We systematically searched databases including, Scopus, ISI Web of Sciences (WOS), Pubmed/Medline, Embase, and PsycINFO using standard search terms.

Results

Two hundred and ninety-six records were found through the initial search. Of 679 articles, 25 duplicated studies were found and 70 were omitted due to the irrelevant titles and abstracts. The rest 450 were entered the full-text screening, of which 186 were excluded due to pre-defined inclusion criteria. Ultimately, 15 studies on 6525 patients were included. Our findings showed that the pooled sensitivity of BI in the diagnosis of BD was 0.82 (95%CI: 0.81–0.83, P < 0.0001, I2 = 99%), while the pooled specificity also was 0.73 (95%CI: 0.72–0.74, P = 0.000, I2 = 99%). The BI was significantly more accurate than the other tests with a pooled DOR of 47.2 (95%CI: 12.01–85.52, P = 0.0000, I2 = 99.2%).

Conclusion

BI appears to be a useful screening instrument with suitable psychometric properties to identify BD compared to both the MDQ and the HCL-32. Consequently, patients detected by the BI should be confirmed through diagnostic interviews. Thus, more studies are needed to explore the optimal cut-off values of BI among screened populations during long-term follow-up, since a considerable portion of individuals primarily diagnosed with major depressive disorders could have BD.

Assessment of the diagnostic performance of two new tools versus routine screening instruments for bipolar disorder: a meta-analysis

OBJECTIVE

The present meta-analysis was conducted to determine the diagnostic accuracy of the bipolarity index (BI) and Rapid Mode Screener (RMS) as compared with the Bipolar Spectrum Diagnostic Scale (BSDS), the Hypomania Checklist (HCL-32), and the Mood Disorder Questionnaire (MDQ) in people with bipolar disorder (BD).

METHODS

We systematically searched five databases using standard search terms, and relevant articles published between May 1990 and November 30, 2021 were collected and reviewed.

RESULTS

Ninety-three original studies were included (n=62,291). At the recommended cutoffs for the BI, HCL-32, BSDS, MDQ, and RMS, the pooled sensitivities were 0.82, 0.75, 0.71, 0.71, and 0.78, respectively, while the corresponding pooled specificities were 0.73, 0.63, 0.73, 0.77, and 0.72, respectively. However, there was evidence that the accuracy of the BI was superior to that of the other tests, with a relative diagnostic odds ratio (RDOR) of 1.22 (0.98-1.52, p < 0.0001). The RMS was significantly more accurate than the other tests, with an RDOR (95%CI) of 0.79 (0.67-0.92, p < 0.0001) for the detection of BD type I (BD-I). However, there was evidence that the accuracy of the MDQ was superior to that of the other tests, with an RDOR of 1.93 (0.89-2.79, p = 0.0019), for the detection of BD type II (BD-II).

CONCLUSION

The psychometric properties of two new instruments, the BI and RMS, in people with BD were consistent with considerably higher diagnostic accuracy than the HCL-32, BSDS, and MDQ. However, a positive screening should be confirmed by a clinical diagnostic evaluation for BD.

The Factor Structure of the Mood Disorder Questionnaire in Tunisian Patients

Background:

The Mood Disorder Questionnaire (MDQ) is a frequently used screening tool for the early detection of Bipolar Disorder (BD), which is often unrecognized or misdiagnosed at its onset. In this study, data from Tunisia has been used to evaluate the psychometric properties of the Arabic MDQ.

Methods:

The sample included 151 patients with a current major depressive episode. The Arabic adapted version of the Structured Clinical Interview for DSM-IV-TR was used to formulate a diagnosis, yielding 62 patients with BD and 89 with unipolar Major Depressive Disorder (MDD). Principal component analysis with parallel analysis was used to establish the spontaneous distribution of the 13 core items of the MDQ. Confirmatory Factor Analysis (CFA) was used to check the available factor models. Receiver Operating Characteristic (ROC) analysis was used to assess the capacity of the MDQ to distinguish patients with BD from those with MDD.

Results:

Cronbach’s α in the sample was 0.80 (95%CI: 0.75 to 0.85). Ordinal α was 0.88. Parallel analysis suggested two main components, which explained 59% of variance in the data. CFA found a good fit for the existing unidimensional, the two-factor, and the three-factor models. ROC analysis showed that at a threshold of 7, the MDQ was able to distinguish patients with BD from those with MDD with extraordinary negative predictive value (0.92) and a positive diagnostic likelihood ratio of 3.8.

Conclusion:

The Arabic version of the MDQ showed good measurement properties in terms of reliability, factorial validity and discriminative properties.

The Influence of Current Mood States on Screening Accuracy of the Mood Disorder Questionnaire

Objective

In this study we investigated whether current mood states of patients with bipolar disorder have an influence on the screening accuracy of the Mood Disorder Questionnaire (MDQ).

Methods

A total of 452 patients with mood disorder (including 192 with major depressive disorder and 260 with bipolar disorder completed the Korean version of the MDQ. Patients with bipolar disorder were subdivided into three groups (bipolar depressed only, bipolar euthymic only, bipolar manic/hypomanic only) according to current mood states. The screening accuracy of the MDQ including sensitivity, specificity and area under the curve (AUC) of receiver operating characteristic (ROC) curves were evaluated according to current mood states.

Results

The optimal cutoff of MDQ was 5 in this study sample. Sensitivity and specificity were not significantly different according to current mood states. Significant differences in AUCs of four independent ROC curves were not found (ROC 1st curve included all bipolar patients; ROC 2nd curve included only bipolar depressed patients; ROC 3rd curve included only bipolar manic/hypomanic patients; ROC 4th curve included only bipolar euthymic patients).

Conclusion

The study results showed that current mood states (either euthymic state, depressed or manic/hypomanic) did not significantly influence the screening accuracy of the MDQ suggesting that the MDQ could be a useful screening instrument for detecting bipolar disorder in clinical practice regardless of the current mood symptoms of subjects.

Screening for psychiatric disorders with self-administered questionnaires

Given the time demands of clinical practice it is not surprising that diagnoses are sometimes missed. To improve diagnostic recognition, self-administered screening scales have been recommended. A problem with much of the research effort on screening scales is the confusion between diagnostic testing and screening. It is important for a screening test to have high sensitivity because the more time intensive/expensive follow-up diagnostic inquiry will presumably only occur in patients who are positive on the initial screen. Investigators vary in how they analyze their data in determining the recommended cutoff score on a self-administered screening questionnaire. To illustrate this, in the present report we examined how often each of the different approaches towards determining a cutoff score on bipolar disorder screening scales were used. We reviewed 68 reports of the performance of the 3 most commonly researched bipolar disorder screening scales to determine how the recommended cutoff on the scale was derived. Most studies recommended a cutoff point on the screening scale that optimized the level of agreement with the diagnostic gold standard. Only 11 (16.2%) studies recommended a cutoff that prioritized the scale's sensitivity. It is important for clinicians to understand the difference between screening and diagnostic tests. The results of the present study indicate that most studies of the performance of the 3 most commonly studied bipolar disorder screening measures have taken the wrong approach in deriving the cutoff score on the scale for the purpose of screening.

Integrating Different Factorial Solutions of a Psychometric Tool Via Social Network Analysis

Abstract. Evaluating the factorial structure of a psychometric test is crucial to capture the complexity of a psychological phenomenon. Indeed, for the same test, several studies may find different factorial solutions which, in turn, may be explained by within and/or between sample variability. In this paper we introduce a novel quantitative approach to combine different factorial solutions of the same test. We propose to use a method based on Social Network Analysis to create and statistically evaluate an integrated factorial structure based on the information provided by previous researches. We present an application to the Mood Disorder Questionnaire by considering different factorial structures reported in the literature. The integrated factorial solution indicates the presence of three factors supporting the multidimensionality of the test. The role of single items in the composition of factors is also evaluated and discussed in terms of differences and similarities between the five original studies and the new integrated model. From an applied perspective, our approach may be useful to assist researchers in summarizing different factorial solutions for the same test efficiently. Furthermore, the resulting integrated factor solution could serve as baseline model to validate the structure of the test by applying confirmatory factor techniques to new data.

THE VALIDITY OF THE MOOD DISORDER QUESTIONNAIRE FOR SCREENING BIPOLAR DISORDER: A META-ANALYSIS

We conducted a meta-analysis to review the diagnostic accuracy of the Mood Disorder Questionnaire (MDQ) among patients with mood disorders. We used a bivariate random effects model to calculate summary sensitivity and specificity. Twenty-one studies were included. At the standard or modified cutoff value of 7, summary sensitivity was .62 and summary specificity was .85. When we pooled 11 studies including both patients with bipolar disorder (BD) and those with unipolar depression, the summary sensitivity was .76 and summary specificity was .81. However, among the six studies that excluded patients with known BD, the summary sensitivity was significantly reduced to .37 and summary specificity was .88. There were no significant differences on the diagnostic accuracy of the MDQ between studies from Eastern and Western countries after adjusting for various clinical correlates. The overall diagnostic accuracy of the MDQ was relatively good. However, when the MDQ is applied among patients with depression without previous diagnoses of BD, its sensitivity was significantly reduced. This suggests that when the MDQ is applied among this population, its optimal cutoff value should be adjusted to enhance its sensitivity.

Screening the risk of bipolar spectrum disorders: Validity evidence of the Mood Disorder Questionnaire in adolescents and young adults

The aim of this study was to gather sources of validity evidence of the Mood Disorder Questionnaire (MDQ) in young adults for its use as a screening tool for bipolar spectrum disorders. The sample was composed of 1,002 participants, 268 men (26.7%). The mean age of participants was 21.1 years (SD=3.9). The results showed that between 3 and 59% of the sample reported some hypomanic experience. Gender differences were found in the total score of the MDQ. The analysis of the internal structure by exploratory factor analysis yielded 2 factors, called Energy-Activity and Disinhibition-Attention. This dimensional structure was replicated in the exploratory structural equation modeling (ESEM), and also had factorial equivalence by gender. Participants who met the cut-off points of the MDQ reported a worse perceived mental health status and more consummatory and anticipatory pleasure, compared to the low scores group. These findings indicate that the MDQ has adequate psychometric properties in non-clinical samples, and could be useful as a screening tool in psychopathology, with the possibility of optimizing strategies for early identification and prevention in individuals at high risk for bipolar disorders. Future studies should further explore the role of subclinical bipolar phenotype and conduct longitudinal studies in samples of the general population.

Comparing factor structure of the Mood Disorder Questionnaire (MDQ): In Italy sexual behavior is euphoric but in Asia mysterious and forbidden

BACKGROUND

The introduction of screening questionnaires, such as the Mood Disorder Questionnaire (MDQ), has stimulated clinical and epidemiological studies on bipolar disorders. In this work, we studied the item response pattern of the MDQ in the Italian population and compared the results with those of the validation of the MDQ in Asian studies (Chinese and Korean), analyzing similarities and differences among the populations studied.

METHODS

The sample was made up of 2278 participants, distributed as follows: 56.6% females, 50.8% living in the north-central Italy, and 33.7% living in rural areas. The factor analysis was run on the matrix of tetrachoric correlations. The psychometric properties of the MDQ were also studied using the Rasch logistic model.

RESULTS

The parallel analysis found two significant components. The first includes symptoms referring to acceleration, danger and irritability as risky behaviors, social interaction problems and mental flow. The second includes symptoms referring to self-confidence and energy. With respect to the Korean/Chinese results, the Italian sample, item 11 ("much more sex"), appears related to self-confidence and energy, while in Asia it is connected with items expressing risky behaviors and irritability.

LIMITATIONS

Differences in the frequency of comorbid disorders in Asian and Italian populations should be considered. The results should be confirmed and compared with those of other populations.

CONCLUSIONS

Cultural differences appear to be associated with a different symptomatic expression of bipolar spectrum disorders. Future research will investigate the role of gene-environment interaction in the genesis of these differences.

Development and validation of a screening instrument for bipolar spectrum disorder: The Mood Disorder Questionnaire Thai version

BACKGROUND

The Mood Disorder Questionnaire (MDQ) has been translated to many languages and has been used in many countries as a screening instrument for bipolar disorder. The main objective of this study was to evaluate validity of the Thai version of the MDQ as a screening instrument for bipolar disorder in a psychiatric outpatient sample, and to determine its optimum question #1 item threshold value for bipolar disorder.

METHODS

The English language Mood Disorder Questionnaire (MDQ) was translated into Thai. The process involved back-translation, cross-cultural adaptation, field testing of the prefinal version, as well as final adjustments. Two hundred and fifty major depressive disorder outpatients were further assessed by the Thai version of the MDQ and the Thai version of the Mini International Neuropsychiatric Interview (MINI). During the assessment, reliability and validity analyses, and receiver operating characteristic curve (ROC) analysis were performed.

RESULTS

The Thai version of the MDQ screening had adequate internal consistency (Cronbach's alpha =0.791, omega total =0.68, and omega hierarchical =0.69). The optimal question #1 item threshold value was at least five positive items, which yielded adequate sensitivity (76.5%), specificity (72.7%), positive predictive value (74.3%), and negative predictive value (75.0%). The ROC area under the curve (AUC) for this study was 0.82 (95% confidence interval: 0.70 to 0.90).

CONCLUSION

The Thai version of the MDQ had some useful psychometric properties for screening for bipolar disorder in a mood disorder clinic setting, with a recommended question #1 item threshold value of at least five positive items.