Mood Disorder Questionnaire (MDQ)

Abstract

The Mood Disorder Questionnaire (MDQ) is a concise, self-administered measure developed by Hirschfeld and colleagues in 2000. Its core function is the rapid identification of individuals who may fall within the bipolar spectrum disorder. This tool was created specifically to combat the widespread clinical problem of under-recognition and misdiagnosis of Bipolar Disorder (BD). The scale items are clinically derived and directly align with the established diagnostic criteria for mania and hypomania found in the DSM-IV criteria. It is crucial to emphasize that the MDQ is strictly a screening instrument; a positive result mandates a subsequent, thorough diagnostic evaluation by a clinician.

Keywords

Mood Disorder Questionnaire, MDQ, Bipolar Disorder, screening instrument, mania, hypomania, psychometrics, self-report, sensitivity, specificity, clinical utility, affective disorders.

Authors

Robert M. Hirschfeld, Janet B. Williams, Robert L. Spitzer, Joseph R. Calabrese, Laurie Flynn, Paul E. Keck, Lydia Lewis, Susan L. McElroy, Robert M. Post, Daniel J. Rapport, James M. Russell, Gary S. Sachs, John Zajecka

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Purpose

The primary objective of the Mood Disorder Questionnaire (MDQ) is to enable the rapid and efficient screening of patients exhibiting symptoms that suggest a bipolar spectrum disorder. Timely and accurate identification of Bipolar Disorder is essential, as misdiagnosis—most commonly as major depressive disorder—leads to inappropriate treatment regimens and prolonged patient suffering.

The MDQ is designed as a brief, easily administered screening tool, typically taking less than five minutes to complete. It is explicitly not intended to replace formal diagnosis. Instead, its utility lies in its ability to effectively flag individuals in varied clinical settings (such as primary care or specialized psychiatric practices) who require immediate, comprehensive diagnostic interviews to confirm the presence of BD.

Construct

The MDQ is constructed to measure the lifetime presence, clustering, and functional impact of manic symptoms and hypomanic episodes. The scale is firmly rooted in the official diagnostic requirements for these episodes as outlined in the DSM-IV criteria, specifically targeting behaviors and experiences associated with elevated, expansive, or irritable mood states.

The instrument operationalizes this construct through a unique, sequential three-question format. Question 1 assesses the presence of 13 specific manic/hypomanic behaviors. Question 2 determines the crucial temporal aspect, asking if several of these symptoms occurred during the same time period. Finally, Question 3 evaluates the resulting functional impairment or severity caused by these symptoms. This structure ensures that the MDQ captures clinically significant symptom clusters that meet both duration and severity thresholds, moving beyond isolated symptoms.

Validity

The validity of the MDQ has been extensively studied, demonstrating strong utility, although its performance metrics—specifically its sensitivity and specificity—fluctuate significantly based on the population assessed. In specialized psychiatric clinical settings, the MDQ exhibits robust performance, often showing a sensitivity of 0.73 and a specificity of 0.90 when compared against gold-standard diagnostic interviews.

When applied to the general population, however, the MDQ shows a marked drop in sensitivity (to 0.28), while maintaining high specificity (0.97). This suggests that in the general public, the MDQ is excellent at ruling out Bipolar Disorder but may fail to identify many true positive cases. In primary care environments, performance is moderate, typically showing a sensitivity of 0.58 and a specificity of 0.93. Furthermore, studies indicate the MDQ is more sensitive in detecting Bipolar I disorder compared to Bipolar II or other spectrum disorders.

It is critical to note that the reliability of validity results is intrinsically linked to strict adherence to the standardized scoring parameters, particularly the standard cutoff point of seven positive items for the first question, and the specific diagnostic criteria used in the comparative validation studies.

Reliability

The Mood Disorder Questionnaire consistently demonstrates adequate internal consistency across multiple research investigations, confirming that its composite items reliably measure the intended construct of manic symptomatology. Initial validation efforts by Hirschfeld and colleagues (2000) and subsequent studies (e.g., Isometsä et al., 2003) reported high internal consistency levels.

Specific metrics, utilizing Cronbach’s alpha, generally range between 0.79 and 0.90. These strong correlations affirm that the 13 symptom items in the first section of the MDQ cohere well, providing a reliable, unidimensional measure of core manic and hypomanic features.

Factor Analysis

Although formal, detailed factor analysis reports may not be universally published in the source material, the MDQ’s structure inherently suggests a focus on a single, dominant factor: the lifetime experience of clinically relevant manic or hypomanic symptoms. The instrument’s design requires the clustering and co-occurrence of 13 specific behaviors to align with the single diagnostic dimension of the bipolar spectrum.

The consistently high internal consistency metrics (high Cronbach’s alpha values) lend robust empirical support to the interpretation that the items are largely unidimensional. They effectively assess the frequency and severity of the affective and behavioral features central to a manic or hypomanic episode.

Instrument

Test Type: Screening Questionnaire/Self-Report Inventory

Format: Paper-and-pencil or digital self-report, brief format (approx. 5 minutes)

Language Available: English (and widely translated into numerous other languages for international clinical and research use)

Population Group: Clinical populations (psychiatric and primary care) and general population samples

Age Group: Adults and adolescents (validated primarily in adults)

Population Details: Individuals suspected of having or being treated for mood disorders, particularly those diagnosed with depression where underlying bipolarity may be overlooked.

Test Methodology: The MDQ requires a positive screen result based on three criteria: 1) a positive response to a minimum of seven of the 13 symptom items (Question 1); 2) a positive response confirming the co-occurrence of these symptoms during the same time period (Question 2); and 3) a severity rating of ‘Moderate Problem’ or ‘Serious Problem’ (Question 3).

Keywords

Mood screening, Bipolar I, Bipolar II, DSM-IV, clinical utility, internal consistency, diagnostic delay, manic symptoms, self-report screening.

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Authors

Author ORCID Identifier: Not specified in source material.

Affiliation Email addresses: Not specified in source material.

Correspondence Address: Not specified in source material.

Permissions & Fee and Test Year

The Mood Disorder Questionnaire (MDQ) was developed and validated in 2000 by Hirschfeld and colleagues. It is frequently used in both clinical practice and research settings and is generally available without proprietary fees, although formal administrative permission may be required depending on the organizational context of its use. The original PDF of the instrument is available for download here: http://www.dbsalliance.org/pdfs/MDQ.pdf

Reference’s

• Hirschfeld, Robert M., Williams, Janet B., Spitzer, Robert L., Calabrese, Joseph R., Flynn, Laurie Keck, Paul E., Lewis, Lydia., McElroy, Susan L., Post, Robert M., Rapport, Daniel J., Russell, James M., Sachs, Gary S., Zajecka, John. (2000). “Development and Validation of a Screening Instrument for Bipolar Spectrum Disorder: The Mood Disorder Questionnaire.” American Journal of Psychiatry 157(11); 1873-1875.
• Hirschfeld RM. (2000). The mood disorder questionnaire: simple, patient- rated screening for bi- polar disorder. Journal of clinical Psychiatry primary care companion, 4; 9-11.
• Hirschfeld, R.M., Holzer, C., Calabrese, J.R., Weissman, M., Reed, M., Davies, M, et al. (2003). Validity of the mood disorder questionnaire: a general population study. American Journal of Psychiatry 160(1): 178-80.
• Hirschfeld, R.M., Calabrese, J.R., Weissman, M.M., Reed, M., Davies, M.A., Frye, M.A., et al. (2003). Screening for bipolar disorder in the community. Journal of clinical Psychiatry, 64(1): 53-9.
• Hirschfeld RMA, Vornik LA. (2004). Course and treatment of bipolar depression. In: Bowden CL, editor. Diagnosis and management of bipolar disorders. London (UK): Science Press; 2004. p. 28 – 40.
• Hirschfeld, R.M., et al. (2005). Screening for bipolar disorder in patient treated for depression in Family medicine clinic. Journal of the American Board of Family medicine, 18(4); 233-239.

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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.