| Objective:Bipolar disorders (BP) are frequently diagnosed and treated as pure depression initially; accurate diagnosis often being delayed by 8 to 10 years. In prospective studies, the presence of hypomanic symptoms is strongly predictive of later bipolar disorders. As such, an instrument for self-assessment of hypomanic symptoms might increase the detection of suspected and of manifest, but under-treated, cases of bipolar disorders. The Hypomania Symptom Checklist-32 (HCL-32) is a self-applied questionnaire with 32 hypomania items and 8 severity and functional impact items which is being developed in several countries. Our objective was to evaluate the HCL-32 by the testing of sensitivity and specificity compared to Chinese classification and diagnostic criteria of mental disorders (CCMD-3) diagnosis obtained from a research diagnostic interview in outpatient population.Methods:This study enrolled outpatients being seen for treatment in department of psychiatry and psychological medicine of 3 centres in different regions (Shanghai, Hangzhou, Xi'an) in China. Inclusion criteria were as follows:(1) provision of written, informed consent; (2) mood disorder according to CCMD-3 criteria; (3) outpatients≥18 years of age; (4) able to understand and comply with the requirements of the study. Patients with mental retardation, organic mental disorder, drug abuse and poor education who have problem in understanding the HCL-32 were excluded. Eligible patients were asked to complete the HCL-32. An experienced psychiatrist, who was blind to the HCL-32 results, used the CCMD-3 to obtain a diagnosis of the eligible patients. All analyses were done in SPSS13.0. Factors with Eigenvalues greater than 1 were retained. A total score was obtained by summing all items of the HCL-32. Subscale scores for each factor were obtained by summing all items that loaded higher than 0.4 on the corresponding factor. The reliability of HCL-32 total and subscale scores was using Cronbach's alpha. Kruskal-Wallis tests were applied to continuous data. Results:1010 participants provided written consent to participate. There were 417 bipolar patients (236 BP-Ⅰand 181 BP-Ⅱ)and 593 with unipolar depressive disorder. After matrix rotation (using Kaiser's Varimax method), the HCL-32 proved to have a two-factor structure. The Eigenvalue of the two factors, labelled "active/elated" and "risk-taking/irritable" were 5.5 and 2.7 respectively. The two factors together accounted for 26.2% of the total variance. Subscale scores for each factor were obtained by summing all items that loaded higher than 0.4 on the corresponding factor. The first subscale consisted of 15 items and the second of 7 items. Both total and subscale scores were significantly lower in major depressive disorder (MDD) than in BP patients. None of the scales discriminated between BP-I and BP-II patients. The first subscale had a Cronbach's alpha of 0.84, the second subscale a Cronbach's alpha of 0.88, and the internal consistency of the HCL-32 total was 0.84. A HCL-32 screening score of 14 was chosen as the cut-off between BP and MDD. The sensitivity of HCL-32 was 69.30% and specificity was 0.66%. Analysis of the% of BP and MDD patients endorsing the individual items of the HCL-32 demonstrated statistically significant between-group differences on 19 item ratings.Conclusion:The study demonstrated the suitable validity and reliability of the HCL-32 in Chinese outpatients. It suggested that the HCL-32 is useful questionnaire for screening bipolar disorder in China. |
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