Abstract
BACKGROUND
The recognition of bipolar disorder during the perinatal period is often challenging
because birthing people most commonly present in a depressive episode. The phenotypic
expression of episodes of bipolar depression is difficult to differentiate from major
depressive disorder and can lead to misdiagnosis and inappropriate treatment. The
Mood Disorder Questionnaire is a readily available screening tool for bipolar disorder
that has been validated in previous studies for use in the general and perinatal populations.
However, the discriminatory capacity of the Mood Disorder Questionnaire for perinatal
people who screen positive for depression in nonpsychiatric settings is still unclear.
OBJECTIVE
This study aimed to evaluate the discriminatory capacity of the Mood Disorder Questionnaire
to identify bipolar disorder in perinatal people who screen positive for depression
on the Patient Health Questionnaire-9.
STUDY DESIGN
This retrospective cohort study included individuals enrolled in the Collaborative
Care Model for Perinatal Depression Support Services, a collaborative care program
for perinatal mental health services implemented in a quaternary care setting, from
January 2017 to April 2021. All individuals completed the Mood Disorder Questionnaire
and psychiatric evaluation by a licensed clinical social worker. Clinical and sociodemographic
characteristics were compared between those with and without a clinical diagnosis
of bipolar disorder using bivariable analyses. The discriminatory capacity and test
characteristics of the Mood Disorder Questionnaire were assessed at each score cutoff
using the gold standard of a psychiatric clinical evaluation for comparison.
RESULTS
From January 2017 to April 2021, 1510 birthing people were enrolled in the Collaborative
Care Model for Perinatal Depression Support Services and included in this study. Among
this group, 62 (4.1%) were diagnosed with bipolar disorder by psychiatric clinical
evaluation using the Diagnostic and Statistical Manual of Mental Disorders, Fifth
Edition, diagnostic criteria. A score of ≥7 on question 1 is often used in the general
population to identify bipolar disorder, which has a 60% sensitivity and 88% specificity
in our perinatal sample with an area under the receiver operating characteristic curve
of 0.74 (95% confidence interval, 0.72–0.76). Lowering the threshold to ≥4 improves
sensitivity to 81% and the discriminatory capacity to an area under the receiver operating
characteristic curve of 0.75 (95% confidence interval, 0.70–0.80), at the expense
of a reduction in specificity to 69%.
CONCLUSION
The administration of the Mood Disorder Questionnaire in the perinatal period can
help to identify which individuals who have screened positive for depression on the
Patient Health Questionnaire-9 are at risk of a bipolar or unipolar disorder. In this
context, lowering the Mood Disorder Questionnaire score threshold from that used in
the nonperinatal population down to 4 improves test characteristics and reduces the
risk of a missed diagnosis of bipolar disorder.
Key words
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Article info
Publication history
Published online: October 21, 2022
Accepted:
October 17,
2022
Received in revised form:
October 13,
2022
Received:
August 12,
2022
Footnotes
C.T.C. provides advisory services for Seven Starling. The remaining authors report no conflict of interest.
This study received funding from the Friends of Prentice Special Projects Initiative (2017).
Cite this article as: Millan DM, Clark CT, Sakowicz A, et al. Optimization of the Mood Disorder Questionnaire in identification of perinatal bipolar disorder. Am J Obstet Gynecol MFM 2022;XX:x.ex–x.ex.
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