False Positives in Mood Disorders Questionnaire Screening for Bipolar Disorder

When compared with diagnoses made using the Structured Clinical Interview for DSM-IV-TR (SCID), the Mood Disorders Questionnaire had a sensitivity of 75%, a specificity of 74%, a positive predictive value of 55%, and a negative predictive value of 88%, according to a study published in the Journal of Affective Disorders. Furthermore, the self-rated measuring of bipolar symptoms in the Mood Disorders Questionnaire appears to measure a dimension shared by other conditions characterized by impulsivity and affective instability.

For this study, researchers administered the SCID Mood Disorder and Post-Traumatic Stress Disorder modules to each of the 759 participants (501 women and 258 men) to assess the accuracy of their diagnoses. Whenever SCID screening indicated the presence of another mental health disorder, the modules for that specific disorder were also administered. After these results were compared with the Mood Disorders Questionnaire screening, the Mood Disorders Questionnaire was found to have a positive predictive value ranging from 50% to 55%, with the sensitivity value being higher in bipolar type I (85.7%), than in bipolar type II (72.4%), or cyclothymia/not otherwise specified bipolar disorder (59.3%).

False negatives were highest in patients with not otherwise specified bipolar disorder (42.3%) and lower in those with bipolar II (27.6%) and bipolar I (14.3%). False positives were more likely among patients with current post-traumatic stress disorder (55.6%), substance use disorder (55.6%), or borderline personality disorder (62.3%). These patients were also more likely to be younger with lower education levels.

Considering the overlap of symptoms between bipolar disorder and other disorders, study investigators conclude that it is important for clinicians to inform patients that positive screenings using self-rated instruments (particularly those found online) are not necessarily synonymous with bipolar disorder. Nevertheless, study investigators still see the Mood Disorders Questionnaire as a useful clinical tool, seeing as a positive screening will indicate the presence of a condition in need of further assessment and treatment. They also state that “the [Mood Disorders Questionnaire] can also be an indicator of severity, quality of life, or predicting response to treatment.”

Reference

Paterniti S, Bisserbe JC. Factors associated with false positives in MDQ screening for bipolar disorder: Insight into the construct validity of the scale. J Affect Disord. 2018; 238:79-86.