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Optimization of the Mood Disorder Questionnaire in identification of perinatal bipolar disorder

Published:October 21, 2022DOI:https://doi.org/10.1016/j.ajogmf.2022.100777

      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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      References

        • Clark C.T.
        • Wisner K.L.
        Treatment of peripartum bipolar disorder.
        Obstet Gynecol Clin North Am. 2018; 45: 403-417
        • Merikangas K.R.
        • He J.P.
        • Burstein M.
        • et al.
        Lifetime prevalence of mental disorders in U.S. adolescents: results from the National Comorbidity Survey Replication–Adolescent Supplement (NCS-A).
        J Am Acad Child Adolesc Psychiatry. 2010; 49: 980-989
        • Altshuler L.L.
        • Kupka R.W.
        • Hellemann G.
        • et al.
        Gender and depressive symptoms in 711 patients with bipolar disorder evaluated prospectively in the Stanley Foundation Bipolar Treatment Outcome Network.
        Am J Psychiatry. 2010; 167: 708-715
        • Sit D.K.
        • Wisner K.L.
        Identification of postpartum depression.
        Clin Obstet Gynecol. 2009; 52: 456-468
        • Terp I.M.
        • Mortensen P.B.
        Post-partum psychoses. Clinical diagnoses and relative risk of admission after parturition.
        Br J Psychiatry. 1998; 172: 521-526
        • Bowden C.L.
        A different depression: clinical distinctions between bipolar and unipolar depression.
        J Affect Disord. 2005; 84: 117-125
        • Carvalho A.F.
        • Takwoingi Y.
        • Sales P.M.
        • et al.
        Screening for bipolar spectrum disorders: a comprehensive meta-analysis of accuracy studies.
        J Affect Disord. 2015; 172: 337-346
        • Hirschfeld R.M.
        • Williams J.B.
        • Spitzer R.L.
        • et al.
        Development and validation of a screening instrument for bipolar spectrum disorder: the Mood Disorder Questionnaire.
        Am J Psychiatry. 2000; 157: 1873-1875
        • Wang H.R.
        • Woo Y.S.
        • Ahn H.S.
        • Ahn I.M.
        • Kim H.J.
        • Bahk W.M.
        The validity of the Mood Disorder Questionnaire for screening bipolar disorder: a meta-analysis.
        Depress Anxiety. 2015; 32: 527-538
        • Wang H.R.
        • Bahk W.M.
        • Yoon B.H.
        • et al.
        The influence of current mood states on screening accuracy of the Mood Disorder Questionnaire.
        Clin Psychopharmacol Neurosci. 2020; 18: 25-31
        • Harris P.A.
        • Taylor R.
        • Thielke R.
        • Payne J.
        • Gonzalez N.
        • Conde J.G.
        Research Electronic Data Capture (REDCap)–a metadata-driven methodology and workflow process for providing Translational Research Informatics Support.
        J Biomed Inform. 2009; 42: 377-381
      1. The Mood Disorder Questionnaire (MDQ) - overview. Available at: https://ibpf.org/wp-content/uploads/2016/11/MDQ.pdf. Accessed June 12, 2022.

        • Sharma V.
        • Xie B.
        Screening for postpartum bipolar disorder: validation of the Mood Disorder Questionnaire.
        J Affect Disord. 2011; 131: 408-411
        • Frey B.N.
        • Simpson W.
        • Wright L.
        • Steiner M.
        Sensitivity and specificity of the Mood Disorder Questionnaire as a screening tool for bipolar disorder during pregnancy and the postpartum period.
        J Clin Psychiatry. 2012; 73: 1456-1461
        • Dodd S.
        • Williams L.J.
        • Jacka F.N.
        • Pasco J.A.
        • Bjerkeset O.
        • Berk M.
        Reliability of the Mood Disorder Questionnaire: comparison with the structured clinical interview for the DSM-IV-TR in a population sample.
        Aust N Z J Psychiatry. 2009; 43: 526-530
        • Williams N.
        The Mood Disorder Questionnaire.
        Occup Med (Lond). 2017; 67: 165-166
        • Hirschfeld R.M.
        Screening for bipolar disorder.
        Am J Manag Care. 2007; 13: S164-S169
        • Singh T.
        • Rajput M.
        Misdiagnosis of bipolar disorder.
        Psychiatry (Edgmont). 2006; 3: 57-63
        • Merrill L.
        • Mittal L.
        • Nicoloro J.
        • Caiozzo C.
        • Maciejewski P.K.
        • Miller L.J.
        Screening for bipolar disorder during pregnancy.
        Arch Womens Ment Health. 2015; 18: 579-583
        • Clark C.T.
        • Sit D.K.
        • Driscoll K.
        • et al.
        Does screening with the MDQ and EPDS improve identification of bipolar disorder in an obstetrical sample?.
        Depress Anxiety. 2015; 32: 518-526
        • Trevethan R.
        Sensitivity, specificity, and predictive values: foundations, pliabilities, and pitfalls in research and practice.
        Front Public Health. 2017; 5: 307
        • Mahmoud D.R.
        • Yang A.
        • Ciolino J.D.
        • et al.
        Validity of the whiplashed as a tool to identify bipolar disorder in women.
        J Affect Disord. 2019; 246: 69-73
        • Kessler R.C.
        • Akiskal H.S.
        • Angst J.
        • et al.
        Validity of the assessment of bipolar spectrum disorders in the WHO CIDI 3.0.
        J Affect Disord. 2006; 96: 259-269