What is the Mood Disorder Questionnaire (MDQ) and how does it work

Bipolar disorder is actually a spectrum of disorders characterized by cycling between two or more mood states, such as mania, hypomania, and depression. Because depression is a common symptom, bipolar is often misdiagnosed, despite requiring a different treatment path. Because of this need for earlier and more frequent identification of potential cases, Robert M. A. Hirschfeld and colleagues created the MDQ in 2000 based on the criteria for bipolar disorder identified in the fourth version of the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV).

The MDQ is self-administered, and can be completed in about 5 minutes. It contains 13 yes/no items assessing a history of manic or hypomanic symptoms and behaviors, such as “thoughts raced through your head or you couldn’t slow your mind down.” Two additional questions about symptom co-occurrence (more than one symptom at the same time) and impaired functioning (symptoms causing real-world problems) are also included to measure the severity of the symptoms. A total score is calculated based on the 13 main items.

In its original validation study (Hirschfeld et al., 2000), a cutoff score of 7 provided good sensitivity and specificity for independent diagnosis of bipolar spectrum disorder (including bipolar I, bipolar II, and bipolar disorder not otherwise specified). Subsequent research has confirmed the accuracy of using the MDQ to screen for bipolar disorder (Wang et al., 2019). In Creyos Health, if a patient scores 7 or higher, answers “yes” to co-occurrence of multiple symptoms during the same time period, and “moderate” or “severe” to the problems caused by symptoms, then a positive screen is indicated, and the patient is recommended to continue with comprehensive evaluation for bipolar spectrum disorder.

The MDQ does have some limitations to be aware of. Although the instrument’s sensitivity is quite good—about 80% across studies (Wang et al., 2019)—widespread use of the MDQ would still lead to a large number of false positives. Therefore, whenever the MDQ indicates possible bipolar symptoms, it is always recommended to follow up with a confirmatory diagnostic interview from a qualified expert (Carvalho et al., 2015). As with most self-report questionnaires, it is best used for screening, diagnostic aid, and tracking of symptoms rather than as a standalone diagnostic tool.