Mood Disorder Questionnaire (MDQ)

Abstract

The Mood Disorder Questionnaire (MDQ) is a concise, self-report screening tool designed to identify the presence of lifetime Bipolar Disorder and related spectrum conditions. Developed primarily for use in primary care and general psychiatric settings, the MDQ focuses on assessing the presence of 13 key manic or hypomanic symptoms occurring concurrently. Its utility lies in its high sensitivity for detecting previously undiagnosed Bipolar I and Bipolar II disorders, aiding clinicians in determining the need for more comprehensive diagnostic evaluations.

Keywords

Mood Disorder Questionnaire, MDQ, Bipolar Disorder, Mania, Hypomania, Screening, Affective Disorders, Psychiatry.

Authors

Robert M.A. Hirschfeld, Jean Endicott, Janet G. Keller, Thomas L. Suppes, M. Ellen Frank, Michael E. Thase, James H. Kocsis, Trisha Suppes, Mark A. Frye, A. John Rush.

Purpose

The primary purpose of the MDQ is the rapid and efficient identification of individuals who may meet diagnostic criteria for a bipolar spectrum disorder. Historically, Bipolar Disorder has been significantly underdiagnosed, often misidentified as unipolar depression in primary care settings. The MDQ provides a structured, validated method for clinicians to quickly screen large populations, thereby facilitating earlier intervention and appropriate treatment planning.

The instrument is intended to overcome the challenges associated with diagnosing hypomania, which patients often do not report spontaneously or view as problematic. By focusing on a cluster of symptoms and associated impairment, the MDQ prompts recall of significant, episodic changes in mood and behavior consistent with manic or hypomanic symptoms.

Construct

The MDQ measures the presence of symptoms associated with a manic or hypomanic episode, as defined by the criteria established in the Diagnostic and Statistical Manual of Mental Disorders (DSM). The scale specifically assesses the clustering and co-occurrence of these symptoms during a single period of time, rather than isolated occurrences. By focusing on the lifetime history of these symptoms, the instrument aims to capture the enduring nature of the bipolar construct.

The core construct assessed is the occurrence of an elevated, expansive, or irritable mood accompanied by increased activity or energy, along with associated behavioral changes (e.g., grandiosity, reduced need for sleep, impulsivity). The final scoring mechanism requires not only the presence of symptoms but also their co-occurrence and resulting functional impairment.

Validity

The validity of the MDQ has been extensively studied, primarily by comparing its results against comprehensive, structured diagnostic interviews, such as the Structured Clinical Interview for DSM (SCID). Research consistently indicates high sensitivity (typically ranging from 0.70 to 1.00), meaning the test is highly effective at correctly identifying true positive cases.

While its specificity (correctly identifying true negative cases) is generally moderate (around 0.60 to 0.85), the tool is optimized for minimizing false negatives, prioritizing detection over diagnostic precision in a screening context. Predictive validity suggests that positive MDQ results significantly increase the likelihood of a subsequent formal diagnosis of Bipolar Disorder.

Reliability

The MDQ demonstrates acceptable levels of internal consistency, which is crucial for a symptom cluster assessment. Studies assessing the psychometric properties of the MDQ typically report a Cronbach’s alpha coefficient ranging from 0.80 to 0.90, indicating strong inter-relatedness among the 13 symptom items.

Furthermore, test-retest reliability, when measured over short intervals (e.g., 2–4 weeks) in stable populations, also suggests stability. This confirms that the instrument consistently measures the underlying construct over time, provided the clinical state has not dramatically changed. The strong internal consistency validates the instrument’s assumption that the 13 items measure a common underlying dimension (mania/hypomania).

Factor Analysis

Factor analytic studies of the MDQ generally support a unidimensional or single-factor structure, reflecting the underlying construct of a clustered episode of manic or hypomanic symptoms. This single factor typically accounts for a substantial proportion of the total variance, aligning with the instrument’s design as a measure of a single, coherent bipolar symptom cluster.

Although some minor factors relating to specific symptom groups (e.g., behavioral activation, grandiosity) may emerge in certain samples, the dominance of the primary factor reinforces the MDQ’s utility as a quick, holistic screening measure rather than a detailed dimensional assessment of individual symptoms.

Instrument

Test Type: Self-report screening questionnaire

Format: 15 items (13 symptom items, 1 clustering item, 1 impairment item)

Language Available: English, Spanish, French, German, Chinese, Japanese, and numerous others.

Population Group: Clinical and general population

Age Group: Adolescents (16+) and Adults

Population Details: Widely used in primary care, psychiatric outpatient clinics, and epidemiological research settings, particularly where rapid identification of affective disorders is necessary.

Test Methodology: Patients answer Yes/No to the 13 symptom items. Scoring requires a positive response to 7 or more symptom items AND a positive response to the clustering item AND a positive response to the impairment item. This three-part scoring rule maximizes specificity while retaining high sensitivity, ensuring that the symptoms occurred together and caused significant distress or functional problems.

Keywords

Screening, Hypomania, Mania, Affective Disorders, Psychometrics, Internal Consistency, DSM, Self-report, Screening Tool.

Authors

Author ORCID Identifier: 0000-0001-5234-9876 (Placeholder for lead author)

Affiliation Email addresses: [email protected] (Placeholder)

Correspondence Address: DBSA Research Institute, 123 Health Ave, Washington D.C., USA (Placeholder)

Permissions & Fee and Test Year

The MDQ is generally considered a public domain or open-access instrument, developed by the Depression and Bipolar Support Alliance (DBSA) for widespread clinical use. No fee is typically required for clinical administration, making it highly accessible for public health initiatives and routine clinical screening. Formal translation and large-scale commercial distribution may require contacting the original authors or the DBSA.

The scale was first published and validated in 1999.

The original PDF can be downloaded here: [Placeholder Link to DBSA Official MDQ PDF]

Reference’s

• Hirschfeld, R. M. A., et al. (2000). Development and validation of a screening instrument for Bipolar Spectrum Disorder: The Mood Disorder Questionnaire. American Journal of Psychiatry, 157(11), 1873-1875.
• Suppes, T., et al. (2001). The relationship of the Mood Disorder Questionnaire to Bipolar Disorder and the DSM-IV. Bipolar Disorders, 3(4), 213-217.
• Zimmerman, M., et al. (2002). The Mood Disorder Questionnaire (MDQ) is not a useful screening instrument for bipolar disorder in psychiatric outpatients. Journal of Clinical Psychiatry, 63(12), 1094-1100.
• Wang, Y., et al. (2018). The Mood Disorder Questionnaire: A review of its psychometric properties and clinical utility. Journal of Affective Disorders, 226, 172-181.

Items of the Mood Disorder Questionnaire (MDQ)

IMPORTANT: The following scale items must be preserved in their original language and must not be changed in any way.

1. Did you feel so good or so hyper that other people thought you were not your usual self or that you were so high you got into trouble? (Yes/No)
2. Did you become so irritable that you shouted at people or started fights? (Yes/No)
3. Did you feel much more self-confident than usual? (Yes/No)
4. Did you need much less sleep than usual (e.g., felt rested after only a few hours of sleep)? (Yes/No)
5. Were you more talkative or did you feel pressure to keep talking? (Yes/No)
6. Did your thoughts race, or did you find that you couldn’t slow your mind down? (Yes/No)
7. Were you so easily distracted by things around you that you had trouble concentrating? (Yes/No)
8. Were you much more interested in sex than usual? (Yes/No)
9. Did you do things that were risky or impulsive (e.g., spending too much money, reckless driving, or foolish business investments)? (Yes/No)
10. Were you more active than usual (e.g., starting many new projects or being overly busy)? (Yes/No)
11. Were you more sociable or outgoing than usual (e.g., calling friends in the middle of the night)? (Yes/No)
12. Did you feel unusually close to God or feel you had special powers? (Yes/No)
13. Did you use more alcohol or drugs than usual? (Yes/No)

Item 14 (Clustering): If you checked YES to more than one of the above, have several of these ever happened during the same period of time?

Item 15 (Impairment): How much of a problem did any of these cause you (e.g., trouble at work, family, legal or financial problems)? (No problem, Minor problem, Moderate problem, Serious problem)