The HCL-32: towards a self-assessment tool for hypomanic symptoms in outpatients

J Affect Disord. 2005 Oct;88(2):217-33. doi: 10.1016/j.jad.2005.05.011.


Background: Bipolar disorders (BP) are frequently diagnosed and treated as pure depression initially; accurate diagnosis often being delayed by 8 to 10 years. In prospective studies, the presence of hypomanic symptoms in adolescence is strongly predictive of later bipolar disorders. As such, an instrument for self-assessment of hypomanic symptoms might increase the detection of suspected and of manifest, but under-treated, cases of bipolar disorders.

Methods: The multi-lingual hypomania checklist (HCL-32) has been developed and is being tested internationally. This preliminary paper reports the performance of the scale in distinguishing individuals with BP (N=266) from those with major depressive disorder (MDD; N=160). The samples were adult psychiatry patients recruited in Italy (N=186) and Sweden (N=240).

Results: The samples reported similar clinical profiles and the structure for the HCL-32 demonstrated two main factors identified as "active/elated" hypomania and "risk-taking/irritable" hypomania. The HCL-32 distinguished between BP and MDD with a sensitivity of 80% and a specificity of 51%.

Limitations: Although the HCL-32 is a sensitive instrument for hypomanic symptoms, it does not distinguish between BP-I and BP-II disorders.

Conclusions: Future studies should test if different combinations of items, possibly recording the consequences of hypomania, can distinguish between these BP subtypes.

Publication types

  • Validation Study

MeSH terms

  • Ambulatory Care*
  • Bipolar Disorder / diagnosis*
  • Bipolar Disorder / ethnology
  • Bipolar Disorder / therapy
  • Cross-Cultural Comparison
  • Female
  • Humans
  • Italy
  • Language
  • Male
  • Middle Aged
  • Self-Assessment*
  • Sensitivity and Specificity
  • Surveys and Questionnaires*
  • Sweden