589 Identification of bipolar disorder in the perinatal context: the role of the mood disorder questionnaire

Abstract

Optimizing perinatal outcomes for women with bipolar disorder (BD) requires identification and effective treatment. However, recognition of BD during the perinatal period is challenging as the phenotypic expression most often overlaps with perinatal unipolar depression. Misdiagnosis of postpartum depressive symptoms can have detrimental consequences, yet the optimal approach to distinguish between unipolar and bipolar depression in the perinatal period is unclear. This retrospective cohort study included all women enrolled in a perinatal collaborative care program (COMPASS) between 1/2017 and 9/2020. During this time, the intended approach for all obstetric patients included universal screening for depression twice antenatally and once postpartum. Women with positive screening questionnaires for depression were referred to COMPASS for ongoing management. Once referred, women were asked to complete a series of additional screening questionnaires for other mental health conditions, including the Mood Disorder Questionnaire (MDQ) for BD. Women with any clinical concern for BD based on these evaluations or on clinical assessment by COMPASS social workers were then evaluated by a perinatal psychiatrist and a formal psychiatric diagnosis was made. We compared sociodemographic and clinical characteristics of all women who had enrolled in COMPASS with and without BD in bivariable analyses. We then evaluated test characteristics of the MDQ for identification of BD. During the study period, 1228 women were enrolled in COMPASS and 50 (4.1%) were diagnosed with BD by a psychiatrist. Compared to women without BD, women with BD were more likely to have public insurance and were less likely to be married (Table 1) with no other identified differences. The MDQ had a good discriminatory capacity for BD (AUC=0.82) with test characteristics at each score cut-off depicted in Table 2. The MDQ can be used in the setting of a positive perinatal depression screen to identify women with BD. A score of at least 8 provides reasonable discrimination with 90% of women being correctly classified.View Large Image Figure ViewerDownload Hi-res image Download (PPT)