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

André F. Carvalho; Yemisi Takwoingi; Paulo Marcelo G. Sales; Joanna K. Soczynska; Cristiano A. Köhler; Thiago H. Freitas; João Quevedo; Thomas N. Hyphantis; Roger S. Mcintyre; Eduard Vieta

doi:10.1016/j.jad.2014.10.024

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

André F. Carvalho, Yemisi Takwoingi, Paulo Marcelo G. Sales, Joanna K. Soczynska, Cristiano A. Köhler, Thiago H. Freitas, João Quevedo, Thomas N. Hyphantis, Roger S. Mcintyre, Eduard Vieta

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Abstract

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.

Original language	English
Pages (from-to)	337-346
Number of pages	10
Journal	Journal of Affective Disorders
Volume	172
Early online date	23 Oct 2014
DOIs	https://doi.org/10.1016/j.jad.2014.10.024
Publication status	Published - 1 Feb 2015

Bibliographical note

Keywords

Bipolar disorder
Screening
Accuracy studies
Systematic review
Meta-analysis

UN SDGs

This output contributes to the following UN Sustainable Development Goals (SDGs)

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10.1016/j.jad.2014.10.024

Takwoingi_Screening_for_bipolar_spectrum_disorders_Journal_Affective_Disorders_2014
NOTICE: this is the author’s version of a work that was accepted for publication. Changes resulting from the publishing process, such as peer review, editing, corrections, structural formatting, and other quality control mechanisms may not be reflected in this document. Changes may have been made to this work since it was submitted for publication. A definitive version was subsequently published as André F. Carvalho, Yamisi Takwoingi, Paulo Marcelo G. Sales, Joanna K. Soczynska, Cristiano A. Köhler, Thiago H. Freitas, João Quevedo, Thomas N. Hyphantis, Roger S. McIntyre, Eduard Vieta, Screening for bipolar spectrum disorders: A comprehensive meta-analysis of accuracy studies, Journal of Affective Disorders, http://dx.doi.org/10.1016/j.jad.2014.10.024
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Cite this

Carvalho, A. F., Takwoingi, Y., Sales, P. M. G., Soczynska, J. K., Köhler, C. A., Freitas, T. H., Quevedo, J., Hyphantis, T. N., Mcintyre, R. S., & Vieta, E. (2015). Screening for bipolar spectrum disorders: a comprehensive meta-analysis of accuracy studies. Journal of Affective Disorders, 172, 337-346. Advance online publication. https://doi.org/10.1016/j.jad.2014.10.024

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abstract = "BackgroundBipolar 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.MethodsThe 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.ResultsFifty 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.LimitationsMost studies were performed in mental health care settings. Several included studies had a high risk of bias.ConclusionsAlthough 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 = "Bipolar disorder, Screening, Accuracy studies, Systematic review, Meta-analysis",

author = "Carvalho, {Andr{\'e} F.} and Yemisi Takwoingi and Sales, {Paulo Marcelo G.} and Soczynska, {Joanna K.} and K{\"o}hler, {Cristiano A.} and Freitas, {Thiago H.} and Jo{\~a}o Quevedo and Hyphantis, {Thomas N.} and Mcintyre, {Roger S.} and Eduard Vieta",

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doi = "10.1016/j.jad.2014.10.024",

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T2 - a comprehensive meta-analysis of accuracy studies

AU - Carvalho, André F.

AU - Takwoingi, Yemisi

AU - Sales, Paulo Marcelo G.

AU - Soczynska, Joanna K.

AU - Köhler, Cristiano A.

AU - Freitas, Thiago H.

AU - Quevedo, João

AU - Hyphantis, Thomas N.

AU - Mcintyre, Roger S.

AU - Vieta, Eduard

PY - 2015/2/1

Y1 - 2015/2/1

N2 - BackgroundBipolar 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.MethodsThe 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.ResultsFifty 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.LimitationsMost studies were performed in mental health care settings. Several included studies had a high risk of bias.ConclusionsAlthough 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.

AB - BackgroundBipolar 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.MethodsThe 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.ResultsFifty 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.LimitationsMost studies were performed in mental health care settings. Several included studies had a high risk of bias.ConclusionsAlthough 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.

KW - Bipolar disorder

KW - Screening

KW - Accuracy studies

KW - Systematic review

KW - Meta-analysis

U2 - 10.1016/j.jad.2014.10.024

DO - 10.1016/j.jad.2014.10.024

M3 - Article

C2 - 25451435

SN - 0165-0327

VL - 172

SP - 337

EP - 346

JO - Journal of Affective Disorders

JF - Journal of Affective Disorders

ER -

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

Abstract

Bibliographical note

Keywords

UN SDGs

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