Abstract
Background: Aim of the study was the validation of the Bipolar Disorder Rating Scale (BDRS) in an Italian population. Secondary aim was the evaluation of differences between unipolar and bipolar depression and between bipolar I and II depressed patients.Method: 125 Bipolar Disorder and 60 Major Depressive Disorder patients were administered an Italian translation of the BDRS (I-BDRS), Hamilton Depression Rating Scale (HDRS), Montgomery-Asberg Depression Rating Scale (MADRS), Young Mania Rating Scale (YMRS) and Temperament and Character Inventory-Revised (TCI-R).Results: I-BDRS showed considerable validity and reliability. Factor analysis found 3 subscales, two linked to depressive symptoms and one to mixed symptoms. Measures concerning depression (MADRS and HAM-D) were positively related to the I-BDRS's subscales, but mostly to the two subscales measuring depression. In mixed symptoms, the mean of the bipolar group was significantly higher than the unipolar group suggesting that the BDRS was able to distinguish between unipolar and bipolar depressed patients.Conclusion: I-BDRS is a valid scale for the measurement of depression in BD patients, with a notable internal consistency (Cronbach's α 0.82), a significant consistency between items/total (Cronbach's α from 0.80 to 0.82) and positive correlation with other scales (MADRS r = 0.67, p < 0.001; HDRS r = 0.81, p < 0.001; YMRS r = 0.46 p < 0.0001). The mixed state sub-scale shows usefulness in differentiating bipolar from unipolar patients. I-BDRS could be a sensitive tool, both in pure depression and in mixed states, and could be used in the everyday screening and treatment of Bipolar Disorder.
Highlights
Mania or hypomania are considered the pathognomonic characteristics of bipolar disorder (BD), depression is more common than manic symptoms during lifetime of bipolar patients (Judd et al, 2002)
To test the goodness of fit, we considered absolute fit indices as standardized root mean square residual (SRMR) and root mean square error adjustment (RMSEA) and incremental fit indices as comparative fit index (CFI), incremental fit index (IFI) and non-normed fit index (NNFI)
The results show that the I-Bipolar Depression Rating Scale (BDRS) is a valid scale for the measurement of depression in patients with Bipolar Disorder, with a considerable internal consistency (Cronbach’s α 0.82), a significant item-total correlations and strong positive correlation with the depressive symptom severity measured by the other administered scales (MADRS r = 0.67, p < 0.001; HAM-D r = 0.81, p < 0.001; Young Mania Rating Scale (YMRS) r = 0.46 p < 0.0001), including the YMRS (Berk et al, 2007)
Summary
Mania or hypomania are considered the pathognomonic characteristics of bipolar disorder (BD), depression is more common than manic symptoms during lifetime of bipolar patients (Judd et al, 2002). Apart from Bipolar Depression Rating Scale (Berk et al, 2007), other scales have been largely developed and validated on unipolar depressed patients and lack of sensitivity and accuracy to discriminate different psychopathological nuances of bipolar disorder. Bipolar depression has its own unique and distinct clinical profile that differs from unipolar depression. Rate of suicidality is higher, with a lifetime prevalence of 17% in bipolar I disorder and 24% in bipolar II disorder, compared to 12% in unipolar depression (Rihmer and Kiss, 2002; Kessler et al, 2005). Secondary aim was the evaluation of differences between unipolar and bipolar depression and between bipolar I and II depressed patients
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