Interactive Interpreter

Bipolar Test (MDQ)

The MDQ (Mood Disorder Questionnaire) is a 13-item yes/no self-report questionnaire that screens for a lifetime history of manic or hypomanic symptoms of bipolar spectrum disorder. A positive screen needs ≥7 symptoms, several in the same period, and at least moderate problems (sensitivity 0.73, specificity 0.90 in psychiatric outpatients in the original validation study).

For professional reference, research, and education only. Not for diagnosis or medical advice.

MDQ Part 1 Symptom Count

  • Enter a total score to see its range.

  • Part 1 has 13 yes/no symptom items. A positive MDQ screen requires ALL three parts: ≥7 Part 1 symptoms, several occurring in the same period (Part 2), and at least moderate problems (Part 3). The symptom count alone is not a positive screen.

    Part 1 symptoms endorsedInterpretation
    7+Meets Part 1 thresholdSeven or more symptoms endorsed. The screen is positive only if several occurred in the same period AND they caused at least moderate problems; a positive screen calls for a full clinical interview.
    0–6Below Part 1 thresholdFewer than seven symptoms endorsed. A negative screen does not rule out bipolar disorder; sensitivity in the validation study was 0.73.

    Hirschfeld RM et al. Am J Psychiatry. 2000;157(11):1873-5 (PMID 11058490): a score of 7 or more items gave sensitivity 0.73 and specificity 0.90 in psychiatric outpatients.

The MDQ (Mood Disorder Questionnaire) is a 13-item yes/no self-report screener for bipolar spectrum disorder, and it is the questionnaire behind this bipolar test. A positive screen needs ≥7 symptoms, several of them in the same period, and at least moderate problems [1]. The full scale page is the MDQ.

What does the MDQ measure?

The MDQ was developed by Hirschfeld and colleagues and first validated in psychiatric outpatients [1]. It screens for bipolar spectrum disorder, including Bipolar I, Bipolar II and cyclothymia, rather than unipolar depression. Its 13 yes/no items ask whether there has ever been a period of manic or hypomanic symptoms.

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 [4]. Accurate diagnosis is often delayed by 8 to 10 years, with bipolar disorder first diagnosed and treated as depression [3].

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 [2]. Early detection matters because treatment for bipolar disorder differs from treatment for depression.

How do you give the MDQ?

The MDQ is a brief self-report questionnaire completed by the client. It has three parts, answered in order.

Part 1, symptom history

Has there ever been a period when you were not your usual self and experienced the following? (Yes/No)

Part 2, 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?

Part 3, functional impairment

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 score and interpret the MDQ?

A positive MDQ screen needs all three of these [1]:

  1. ≥7 of the 13 symptoms endorsed as "yes".
  2. Several symptoms occurred during the same time period.
  3. The symptoms caused at least moderate problems.

Meeting only the symptom-count threshold, without the other two criteria, is not a positive screen. A positive screen means a clinician should conduct a full structured interview.

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), 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.

ScreenerItemsFormatPositive thresholdSensitivitySpecificity
MDQ (Mood Disorder Questionnaire)13 + 2Yes/No + 3-part screen≥7 symptoms + same period + moderate impairment0.73 [1]0.90 [1]
HCL-32 (Hypomania Checklist)32Yes/No lifetime≥14 affirmative responses [5]0.80 [3]; 0.85 [5]0.51 [3]; 0.79 [5]
BSDS (Bipolar Spectrum Diagnostic Scale)A descriptive storySentence-by-sentence assent + total scoreTotal score threshold0.76 [6]0.85 [6]

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 [3].
  • 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 [6].

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. 198 adults attending five outpatient clinics that mainly treat mood disorders completed the MDQ, and a research professional blind to the results gave a telephone diagnostic interview (the bipolar module of the Structured Clinical Interview for DSM-IV). A score of 7 or more items gave sensitivity 0.73 and specificity 0.90 [1].
  • US community survey. In 85,358 adults, the weighted positive screen rate was 3.4%, rising to 3.7% after adjustment for nonresponse bias [2].

Limitations

  • Screening, not diagnosis. A positive MDQ calls for a full clinical interview; it cannot confirm bipolar disorder or distinguish Bipolar I from Bipolar II.
  • Setting-dependent accuracy. Sensitivity and specificity were established in psychiatric outpatients; performance varies in general-population and primary care settings.
  • Missed cases. With a sensitivity of 0.73, roughly a quarter of people with bipolar spectrum disorder in the validation sample screened negative [1].
  • Self-report and recall. Items ask about past periods of elevated mood, which depend on recall and insight; hypomania can feel productive and go unreported.
  • Adolescents. The adolescent version (MDQ-A) is not equivalent to the adult questionnaire. In adolescent outpatients, the parent-completed version at ≥5 symptoms gave sensitivity 0.72 and specificity 0.81, better than self-report [7].

For individuals: This page is a clinical reference, not a diagnostic tool. If you have concerns about your own symptoms, bring this information to a qualified mental health professional.

Related

FAQ

  • What score is considered a positive MDQ screen?

    A positive MDQ screen requires ALL three of the following: (1) seven or more of the 13 symptom items answered 'yes', (2) several of those symptoms occurred during the same time period, and (3) the symptoms caused at least moderate problems. Meeting only the symptom-count threshold without the other two criteria does not constitute a positive screen.

  • Can the MDQ diagnose bipolar disorder?

    No. The MDQ is a screening tool, not a diagnostic tool. A positive screen indicates a clinician should conduct a full structured interview. In the original validation study, a threshold of ≥7 symptoms yielded sensitivity of 0.73 and specificity of 0.90 in a psychiatric outpatient population; performance varies in general-population and primary care settings.

  • What is the difference between the MDQ and the HCL-32?

    The MDQ uses a 3-part positive screen and had high specificity (0.90) in its validation study. The HCL-32 is a 32-item checklist focused on hypomanic symptoms; in its first study it had higher sensitivity (80%) but lower specificity (51%) for separating bipolar disorder from unipolar depression, and it did not distinguish Bipolar I from Bipolar II. Neither score alone settles the subtype.

  • Is the MDQ validated for adolescents?

    An adolescent version (MDQ-A) exists. In a study of adolescent outpatients, the parent-completed version at a threshold of ≥5 symptoms showed sensitivity of 0.72 and specificity of 0.81, outperforming self-report. The MDQ-A is not equivalent to the adult questionnaire and requires separate clinical interpretation.

References

    1. 1.Hirschfeld RM, Williams JB, Spitzer RL, et al. Development and validation of a screening instrument for bipolar spectrum disorder: the Mood Disorder Questionnaire. Am J Psychiatry. 2000;157(11):1873–5.
    2. 2.Hirschfeld RM, Calabrese JR, Weissman MM, et al. Screening for bipolar disorder in the community. J Clin Psychiatry. 2003;64(1):53–9.
    3. 3.Angst J, Adolfsson R, Benazzi F, et al. The HCL-32: towards a self-assessment tool for hypomanic symptoms in outpatients. J Affect Disord. 2005;88(2):217–33.
    4. 4.Merikangas KR, Jin R, He JP, et al. Prevalence and correlates of bipolar spectrum disorder in the world mental health survey initiative. Arch Gen Psychiatry. 2011;68(3):241–51.
    5. 5.Vieta E, Sánchez-Moreno J, Bulbena A, et al. Cross validation with the mood disorder questionnaire (MDQ) of an instrument for the detection of hypomania in Spanish: the 32 item hypomania symptom check list (HCL-32). J Affect Disord. 2007;101(1-3):43–55.
    6. 6.Ghaemi SN, Miller CJ, Berv DA, et al. Sensitivity and specificity of a new bipolar spectrum diagnostic scale. J Affect Disord. 2005;84(2-3):273–7.
    7. 7.Wagner KD, Hirschfeld RM, Emslie GJ, et al. Validation of the Mood Disorder Questionnaire for bipolar disorders in adolescents. J Clin Psychiatry. 2006;67(5):827–30.

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