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

• Published in: Journal of affective disorders Vol. 172; pp. 337 - 346
• Main Authors: Carvalho, André F, Takwoingi, Yemisi, Sales, Paulo Marcelo G, Soczynska, Joanna K, Köhler, Cristiano A, Freitas, Thiago H, Quevedo, João, Hyphantis, Thomas N, McIntyre, Roger S, Vieta, Eduard
• Format: Journal Article
• Language: English
• Published: Netherlands Elsevier B.V 01.02.2015
• Subjects: Accuracy studies; Adult; Bipolar disorder; 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; Meta-analysis; Primary Health Care - organization & administration; Psychiatry; Screening; Surveys and Questionnaires; Systematic review; Screening; Accuracy studies; Bipolar disorder; Systematic review; Meta-analysis
• ISSN: 0165-0327; 1573-2517
• DOI: 10.1016/j.jad.2014.10.024

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.