Outcome Measure
Mood Disorder Questionnaire
What it measures?
- The Mood Disorder Questionnaire (MDQ) was developed as a screening measure for bipolar disorder, using 13 items to screen for a lifetime history of manic or hypomanic symptoms.
- MDQ items are derived from the bipolar disorder criteria outlined in the Diagnostic and Statistical Manual of Mental Disorders (DSM 4th edition) and the developers’ clinical experience.
- Items 1 - 13 inquire about experience of manic or hypomanic symptoms
- Item 14 inquires whether these symptoms co-occurred during the same period of time
- Item 15 inquires about the level of functional impairment due to these symptoms.
Who is it for?
Adults 18 and older (limited studies conducted using adolescent samples)
Instrument Quality
- The MDQ was reported to have high internal consistency. The questionnaire was found to have acceptable test re-test reliability with a 10 month interval.
Structure
- Items 1 to 13 are yes/no questions
- While item 14 is a yes/no question, respondents are instructed to answer item 14 only if more than one symptom was indicated as “yes”.
- Item 15 is a 4-point scale, ranging from “no problem” to “serious problem”.
Scoring instructions
For items 1-13, responses of “yes” are scored 1 point and responses of “no” are scored 0. The maximum score possible for the MDQ full-scale is 13. According to the developers, to screen positive for possible bipolar disorder, the following criteria must be met: 1) a score of seven or more on items 1-13, 2) indicating “yes” to item 14, and 3) indicating “moderate problem” or “serious problem” on item 15.
| Subscale | Item number |
|---|---|
Mood Disorder Questionnaire (MDQ) |
1,2,3,4,5,6,7,8,9,10,11,12,13,14,15,16,17 |
Score Interpretation
What higher scores mean?
- Higher total score on the 13 symptom items, combined with meeting the other two criteria, indicate greater likelihood of the individual meeting the diagnostic criteria for Bipolar Disorder.
Identifying risk
A patient may be at risk if they endorse any of the following ‘red flag’ items. Further risk assessment should be undertaken.
| Item number | Item content |
|---|---|
| 12 | …you did things that were unusual for you or that other people might have thought were excessive, foolish, or risky? |
How to assess symptom severity & change?
| Description | Score Range | |
|---|---|---|
| Below normative mean | 0 | |
| Normative mean | 7.38 | |
| Bipolar I Disorder | >= | Provisional Diagnosis |
| 1 SD above normative mean | 10.88 | |
| Maximum | 13 |
Instrument developers
- Hirschfeld, R. M., Williams, J. B., Spitzer, R. L., Calabrese, J. R., Flynn, L., Keck Jr, P. E., ... & Zajecka, J. (2000). Development and validation of a screening instrument for bipolar spectrum disorder: the Mood Disorder Questionnaire. American journal of psychiatry, 157(11), 1873-1875.
Refrences
* Jon, D. I., Hong, N., Yoon, B. H., Jung, H. Y., Ha, K., Shin, Y. C., & Bahk, W. M. (2009). Validity and reliability of the Korean version of the Mood Disorder Questionnaire. Comprehensive Psychiatry, 50(3), 286-291 * Miller, C. J., Klugman, J., Berv, D. A., Rosenquist, K. J., & Ghaemi, S. N. (2004). Sensitivity and specificity of the Mood Disorder Questionnaire for detecting bipolar disorder. Journal of affective disorders, 81(2), 167-171. * Zimmerman, M., & Galione, J. N. (2011). Screening for Bipolar Disorder with the Mood Disorders Questionnaire: A Review. Harvard Review of Psychiatry, 19(5), 219–228. https://doi.org/10.3109/10673229.2011.614101
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Severity ranges
The clinical mean was derived from a Spanish sample of 90 outpatients at general psychiatry mental health centres (de Dios et al., 2008). The normative mean was derived from research evaluating a sample of 167 undergraduate students (Female = 135, Male = 32), mean age = 19.3 (SD = 2.9; Udachina & Mansell, 2007).
Provisional diagnosis
* A positive screen on the MDQ is indicated by a score of 7 or higher on items 1 to 13 (“yes” = 1, “no” = 0), endorsement of question 2 (indicating that symptoms occurred during the same episode), and endorsement of question 3, demonstrating that symptoms caused “moderate” or “serious” psychosocial impairment. A positive screen suggest a high likelihood of Bipolar disorder and warrants further investigation. * The cutoff score of seven was selected by the developers to provide a balance between sensitivity and specificity (73% vs 90%). This approach also maximizes agreement with the standard diagnostic interview (Zimmerman & Galione, 2011). * The MDQ has demonstrated higher sensitivity in detecting Bipolar I (69%), whereas sensitivity for Bipolar II and NOS was 30% (Miller et al., 2004). Similarly, a study by Zimmerman and Galione (2011) found that the MDQ’s sensitivity was higher in detecting bipolar I disorder than bipolar II disorder (66.3% vs. 38.7%). * Although there is a debate regarding the optimal MDQ cutoff score, there is general consensus that the original cutoff supported by Hirschfield and colleagues may be too high. Several studies support a lower cutoff. Zimmerman and Galione (2011) suggest that if the questionnaire is intended for use as a screening measure, then the cutoff should be lower to increase sensitivity. Studies have also found that eliminating or lowering of the functional impairment threshold to ‘mild’ impairment improves the detection of bipolar II disorder (Zimmerman & Galione, 2011).
Reliable change and clinically significant improvement
Wampold et al (2001) conducted a meta-analysis of psychotherapy outcome studies and noted that the average improvement was reflected in an effect size (ES) of .80. Because a change of 1 SD corresponds to an ES of 1.0, and .80 is considered to be a large ES, Wise (2004) concludes that a change of 1 SD is a defensible indicator of clinically significant change.
Mean
Standard Deviation
Reliability