Screening for bipolar spectrum disorders: A comprehensive meta-analysis of accuracy studies

J Affect Disord. 2015 Feb 1;172:337-46. doi: 10.1016/j.jad.2014.10.024. Epub 2014 Oct 23.


Background: Bipolar spectrum disorders are frequently under-recognized and/or misdiagnosed in various settings. Several influential publications recommend the routine screening of bipolar disorder. A systematic review and meta-analysis of accuracy studies for the bipolar spectrum diagnostic scale (BSDS), the hypomania checklist (HCL-32) and the mood disorder questionnaire (MDQ) were performed.

Methods: The Pubmed, EMBASE, Cochrane, PsycINFO and SCOPUS databases were searched. Studies were included if the accuracy properties of the screening measures were determined against a DSM or ICD-10 structured diagnostic interview. The QUADAS-2 tool was used to rate bias.

Results: Fifty three original studies met inclusion criteria (N=21,542). At recommended cutoffs, summary sensitivities were 81%, 66% and 69%, while specificities were 67%, 79% and 86% for the HCL-32, MDQ, and BSDS in psychiatric services, respectively. The HCL-32 was more accurate than the MDQ for the detection of type II bipolar disorder in mental health care centers (P=0.018). At a cutoff of 7, the MDQ had a summary sensitivity of 43% and a summary specificity of 95% for detection of bipolar disorder in primary care or general population settings.

Limitations: Most studies were performed in mental health care settings. Several included studies had a high risk of bias.

Conclusions: Although accuracy properties of the three screening instruments did not consistently differ in mental health care services, the HCL-32 was more accurate than the MDQ for the detection of type II BD. More studies in other settings (for example, in primary care) are necessary.

Keywords: Accuracy studies; Bipolar disorder; Meta-analysis; Screening; Systematic review.

Publication types

  • Meta-Analysis
  • Research Support, Non-U.S. Gov't
  • Review
  • Systematic Review

MeSH terms

  • Adult
  • Bipolar Disorder / diagnosis*
  • Bipolar Disorder / epidemiology
  • Bipolar Disorder / psychology
  • Checklist / statistics & numerical data
  • Cyclothymic Disorder / diagnosis
  • Diagnosis, Differential
  • Female
  • Humans
  • International Classification of Diseases
  • Mass Screening / statistics & numerical data*
  • Mental Health Services / organization & administration*
  • Primary Health Care / organization & administration*
  • Surveys and Questionnaires