Abstract
BackgroundThe hypomania checklist-32 (HCL-32) is a widely used questionnaire developed for identifying hypomanic components in patients with a depressive episode. Measuring and screening previous hypomanic symptoms in individuals without any definite history of depressive episode would also be needed for early detection of bipolar disorders (BDs). This study aimed at testing the clinical utility of the HCL-32 for screening of BDs in the non-clinical population.MethodsLifetime history of hypomanic symptoms was evaluated by using the HCL-32 in 220 patients with BDs and 313 non-clinical individuals. Sensitivity, specificity, and the area under the curve (AUC) of the Receiver Operating Characteristic (ROC) were evaluated for assessing the discriminatory power of the scale and its two sub-domains in screening BDs.ResultsThe mean HCL-32 total score was significantly higher in the Bipolar II disorder group compared to the non-clinical group (P < 0.001). Most of the items (10/12) of the irritable/risk-taking factor showed higher positive responses in patient groups. Items of active/elated factor showed mixed results. The HCL-32 total score and the active/elated factor score were not adequate for both BDs and its subgroups with AUC values of less than 0.7. The irritable/risk-taking factor score showed higher discrimination power, i.e. AUC for BDs, Bipolar I disorder, and Bipolar II disorder was 0.71, 0.67, and 0.75, respectively.ConclusionsThe HCL-32 could not adequately distinguish BD patients from the non-clinical adult population. However, the current study identified items of irritable/risk-taking factor of the scale that could be useful in screening BDs in the general population.
Highlights
The hypomania checklist-32 (HCL-32) is a widely used questionnaire developed for identifying hypomanic components in patients with a depressive episode
Written informed consent was obtained from all participants for the use of their test data in the bipolar disorder (BD) studies of our research group
Irritable/risk-taking score was highest in the bipolar II disorder (BD2) group and there was a significant difference among groups (P < 0.001, control < bipolar I disorder (BD1) < BD2)
Summary
The hypomania checklist-32 (HCL-32) is a widely used questionnaire developed for identifying hypomanic components in patients with a depressive episode. The HCL-32 is a self-report questionnaire developed to identify hypomanic components in patients with major depressive episodes [6]. It has been used as a screening instrument for BDs and bipolar spectrum disorders in various psychiatric clinical settings [7]. Compared to the MDQ, the HCL-32 showed higher sensitivity and lower specificity in screening hypomania, having high accuracy for the detection of ‘softer’ BD cases [10] Both questionnaires were developed for and have been applied to patients in a depressive episode
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