MDQ: Mood Disorder Questionnaire

The MDQ (Mood Disorder Questionnaire) is a 13-item self-report screen for a lifetime history of manic or hypomanic symptoms. A positive screen needs 7 or more symptoms, clustering in the same period, and moderate or serious problems, and calls for a structured diagnostic interview ¹.

Why was the MDQ developed?

The Mood Disorder Questionnaire was developed by Robert Hirschfeld and colleagues because bipolar spectrum disorders (bipolar I, bipolar II and bipolar disorder not otherwise specified) frequently go unrecognized, undiagnosed and untreated ¹. A missed bipolar disorder is often treated as unipolar depression.

The MDQ maps onto DSM criteria for a manic or hypomanic episode and applies a three-criterion algorithm. It was validated against the bipolar module of the Structured Clinical Interview for DSM-IV (SCID) ¹. It takes about 5 minutes to complete.

In a survey of 61,392 adults in 11 countries, lifetime prevalence of bipolar spectrum disorder was 2.4%, and fewer than half of those with it had received mental health treatment ⁵. Accurate diagnosis is often delayed by 8 to 10 years, with bipolar disorder first diagnosed and treated as depression ⁴. In a US community survey, only 19.8% of adults who screened positive on the MDQ reported a previous bipolar diagnosis, while 31.2% reported a diagnosis of unipolar depression ³.

What does the MDQ measure?

The MDQ assesses manic and hypomanic symptom history across three criteria.

Criterion 1, Symptom checklist (13 items): Respondents indicate whether they have ever experienced each of the following:

• Feeling so good or hyper that others thought you were not your normal self, or were so hyper you got into trouble
• Being so irritable that you shouted at people or started fights
• Feeling much more self-confident than usual
• Getting much less sleep than usual but still feeling full of energy
• Being much more talkative or speaking faster than usual
• Thoughts racing through your head, unable to slow down
• Being easily distracted by things around you, trouble concentrating
• Having much more energy than usual
• Being much more active or doing many more things than usual
• Being much more social or outgoing than usual
• Being much more interested in sex than usual
• Doing things that are unusual or risky
• Spending money in ways that got you into trouble

Criterion 2, Symptom clustering: Whether several endorsed symptoms occurred during the same time period ("If you checked YES to more than one of the above, have several of these ever happened during the same period of time?").

Criterion 3, Functional impact: Whether the symptoms caused moderate or serious problems ("How much of a problem did any of these cause you, like being unable to work; having family, money, or legal troubles; getting into arguments or fights?").

How do you give the MDQ?

• Self-administered; takes about 5 minutes
• Available in multiple languages; widely used internationally
• Validated in adults; for youth, use measures built for them (e.g., Y-MRS, PGBI)
• Should be followed by structured diagnostic assessment when the screen is positive
• Most useful where bipolar disorder has a meaningful base rate (e.g., clients with treatment-resistant depression, recurrent mood episodes, or a family history of bipolar disorder)
• Check the copyright holder's terms before clinical or commercial use of the MDQ

Documenting MDQ results in clinical notes: MDQ screen status (positive/negative) and the criterion breakdown belong in the Objective section of a SOAP note.

How do you score and interpret the MDQ?

What is a positive screen on the MDQ?

A positive MDQ screen requires all three criteria to be met at once: 7 or more of the 13 symptoms endorsed, those symptoms clustered in the same time period, and moderate or serious functional impairment. Meeting only one or two criteria is a negative screen.

Interpretation notes:

• In the original study (198 adults attending mood-disorder outpatient clinics, SCID-IV reference), sensitivity for bipolar spectrum disorder was 73% and specificity 90% ¹.
• The MDQ is weaker for bipolar II disorder: in a meta-analysis the HCL-32 was more accurate than the MDQ for detecting it in mental health services ². A negative screen does not rule out bipolar II or cyclothymia.
• A positive MDQ indicates the need for a structured clinical interview, not a diagnosis.
• Comorbid conditions (e.g., ADHD, borderline personality disorder, substance use) can produce false-positive screens; clinical context is essential.
• Some researchers use a more relaxed Criterion 3 threshold (any problem vs. moderate/serious) to improve sensitivity.

How do bipolar I, bipolar II and cyclothymia differ?

The MDQ screens for the bipolar spectrum. The subtypes carry different treatment implications.

Bipolar I is defined by at least one manic episode lasting at least seven days (or less if hospitalization is required). Depressive episodes commonly occur but are not required for diagnosis. Manic episodes involve markedly elevated or irritable mood, increased energy, decreased need for sleep, grandiosity, racing thoughts, and behaviour with serious consequences.

Bipolar II requires at least one hypomanic episode and at least one major depressive episode, with no lifetime manic episodes. Hypomania resembles mania in quality but is shorter (4 days or more), less severe, and does not cause marked functional impairment or psychosis. Because hypomania can feel productive rather than distressing, bipolar II is especially prone to being misidentified as recurrent unipolar depression.

Cyclothymia involves at least two years of fluctuating hypomanic and depressive symptoms that do not meet full criteria for a hypomanic or major depressive episode. Symptoms are chronic and rarely absent for more than two months at a time. It is not a benign or "mild" variant.

Bipolar screening tools compared

Several self-report screeners are used in clinical and research settings. The table below gives each one's format and its reported performance in psychiatric outpatients.

Interpreting this table:

• MDQ. Moderate sensitivity with high specificity in clinical settings.
• HCL-32. Higher sensitivity at the cost of lower specificity in its first study, so it misses fewer hypomanic presentations but gives more false positives ⁴.
• BSDS. A narrative format that some clinicians find easier to discuss with clients; raising its threshold increased specificity from 0.85 to 0.93 without a significant loss of sensitivity ⁷.

None of these screeners reliably distinguishes bipolar I from bipolar II on score alone, and all need clinical follow-up for a diagnosis.

Psychometric properties

• Original validation. In 198 adults attending five outpatient clinics that mainly treat mood disorders, a score of 7 or more items gave sensitivity 73% and specificity 90% against a SCID telephone interview ¹.
• Meta-analysis. Across 53 accuracy studies (21,542 participants), the MDQ at recommended cutoffs had summary sensitivity 66% and specificity 79% in psychiatric services ².
• Primary care. At a cutoff of 7 in primary care or general population settings, summary sensitivity was 43% and specificity 95% ².
• US community survey. In 85,358 adults, the weighted positive screen rate was 3.4%, rising to 3.7% after adjustment for nonresponse bias ³.
• Adolescents. In adolescent outpatients, the parent-completed MDQ-A at 5 or more symptoms gave sensitivity 0.72 and specificity 0.81, better than self-report ⁸.
• Predictive value. Positive predictive value varies by setting and by the base rate of bipolar disorder in the sample.

Limitations

• Lower accuracy for bipolar II disorder than other screens, and low sensitivity outside psychiatric services ²
• Does not assess current severity or phase of illness, only lifetime manic/hypomanic symptom history
• False positives can arise from ADHD, borderline personality disorder, substance intoxication, or anxiety disorders
• Not designed for monitoring treatment response or tracking symptom change over time
• A negative screen should not be used to exclude bipolar disorder in clinically suspicious presentations