This is the HCL screening tool for researchers trying to find people with bipolar disorder. Compr Psychiatry. Jan-Feb;48(1) Epub Sep 6. The Hypomania Checklist (HCL): its factorial structure and association to indices of. The item Hypomania Checklist (HCL), a questionnaire for screening bipolar disorders, has been utilised in several countries, but it.
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The item Hypomania Checklist HCLa questionnaire for screening bipolar disorders, has been utilised in several countries, but it unclear if the Chinese version of the HCL is valid.
The eigenvalues for the first three factors in the HCL were calculated as 5. Cronbach’s alpha for the HCL was calculated to be 0. Positive responses to twenty-eight items were significantly more frequent by patients with BP than those with UP, and the other four items 7th, 21st, 25th and 32nd showed no such trend. Fourteen was the optimal cut-off for discriminating between BP and UP. A cut-off of 13 yielded a sensitivity of 0. This study demonstrated that the simplified Chinese version of HCL was valid for patients with mood disorders.
It is important to differentiate bipolar disorders BP from other mood disorders; delayed diagnosis or misdiagnosis can prolong the suffering of patients [ 1 – 3 ] but accurate early diagnosis can be difficult [ 34 ].
Bipolar patients often present in the depressive phase [ 7 ] and many patients with BP particularly bipolar II are diagnosed as having unipolar depressive disorder [ 3 – 8 ]. Clinical guidelines published by the American Psychiatric Association indicate that bipolar II disorder BP-II is often initially misdiagnosed as a major depressive disorder, leading to patients receiving incorrect treatments [ 9 ].
Hypomania, an element of bipolar II disorder, is not usually perceived by patients to be pathological and is not reported to clinicians [ 1011 ].
The HCL towards a self-assessment tool for hypomanic symptoms in outpatients.
The retrospective detection of hypomania is crucial for a correct diagnosis of bipolar disorder, particularly for BP-II. An instrument to detect hypomania retrospectively would be useful in clinical settings. Recent studies have demonstrated that the item Hypomania Checklist HCL developed by Jules Angst is a good screening instrument for past hypomanic episodes [ 12 – 15 ].
The HCL was demonstrated to have good sensitivity 0. However, little is known about the usefulness of HCL for patients with mood disorders in China. In China, simplified Chinese characters are used, whereas in Taiwan complicated Chinese characters are used. Furthermore, in Taiwan different terms are used to express anxiety and emotion in patients.
The aim of this study was to evaluate the feasibility of using a simplified Chinese version of the HCL, to examine its psychometric properties and accuracy as a screening tool for bipolar disorders. The results were compared with those from previous studies concerning the use of the HCL in various countries. Subjects from the outpatient and inpatient departments at Shenzhen and Shanghai mental health centres were enrolled in the study from January to December The study was approved by the ethics committees of the two psychiatric hospitals.
Patients who satisfied the inclusion and exclusion criteria were evaluated. The inclusion criteria comprised patients diagnosed with major depressive disorder unipolar depressive disorder, UPbipolar I disorder BP-I or bipolar II disorder BP-IIaged between 18 and 60 years, educated for a minimum of five years, and who provided written informed consent.
The exclusion criteria comprised patients diagnosed with an unstable or severe clinical status, those who could not cooperate with the study procedures, patients who had received electroconvulsive therapy ECT or modified electroconvulsive therapy MECT during the previous four weeks, individuals who were illiterate, suffering from mental retardation, dementia or intellectual impairment.
Subjects did not have to have a certain clinical status as the aim was to elucidate the relationship between current state and HCL scores. Back translation was performed by a bilingual psychiatrist unaware of the original HCL A preliminary translated version was administered to individuals without psychiatric illness and patients with mood disorders.
The authors reviewed the results of this preliminary investigation before producing the final version. All interviewers were psychiatrists with a minimum of five years experience. The kappa coefficient for diagnosis of bipolar disorders was 0. There were contents concerning rating of current mental states much worse than usual, worse than usual, a little worse than usual, neither better nor worse than usual, a little better than usual, better than usual, much better than usual in the HCL in addition to the 32 items [ 12 ].
Subjects were asked to select one certain state. Principal component analysis with varimax rotation was used to determine the construct validity of the HCL The internal consistency of the HCL was determined using Cronbach’s alpha. Spearman correlation analysis was performed on the current mental state and the total score. Current mental states and the mean total HCL scores were compared between groups using the Kruskal-Wallis test.
The frequency of each symptom item and the total HCL score were compared between groups using a t-test. The receiver operating characteristic ROC curve was used to distinguish between groups and to ascertain the sensitivity and specificity at various cut-offs.
ROC curves can be difficult to understand. Therefore, the change in sensitivity and specificity at various cut-offs are presented in figures, rather than the ROC curve. Probability values less than 0. All statistical analyses were carried out using SPSS Frequency of positive responses between BP and UP patients.
In BP patients, the frequency of positive responses to the thirty two items ranged from In UP patients, the frequency ranged from 6. The first three factors together explained If all items suppressed absolute factor loading less than 0. Other factors for which the eigenvalues were greater than one comprised few items and were difficult to describe for each factor.
A screening score of fourteen was the optimal cut-off sensitivity 0. A score of thirteen yielded a sensitivity of 0. The area under the curve was 0. A cut-off of thirteen had sensitivity of 0.
A cut-off of fourteen had a sensitivity 0. Bipolar disorder is very common and the lifetime prevalence of bipolar disorder spectrum is approximately 4.
Moreover, bipolar disorder is associated with substantial impairments in productive and social roles [ 1819 ]. The HCL is a convenient instrument for screening bipolar disorders, and psychiatrists in several countries use it in practice [ 12 – 152021 ]. China is the most populated country in the world. Therefore, a study concerning the use of the HCL in China is important.
The mean age of BP patients was significantly lower than that of UP patients in this study, and this is comparable with samples used for similar studies [ 121420 ]. The percentage of female UP patients was higher than the percentage of female BP patients.
This could reflect the fact that rates of major depression are higher in females than in males, and they are comparable for bipolar disorder [ 22 ]. Differences concerning the mean age and sex ratio between BP and UP patients could have resulted from enrolling individuals consecutively.
Therefore, there was a possible impact of current mental state on HCL scores of patients with mood disorders.
This result is similar to that of a Taiwanese study [ 14 ], but different from results obtained in Europe [ 1215 ]. The impact of current mental state on the HCL score is likely to be low and limited.
A three-factor solution using factor analysis in this study is different from the results obtained in the European and Taiwanese studies [ 1214 ].
Hypomania Checklist – Wikipedia
Cronbach’s alpha for the HCL was 0. This is comparable to the results from other studies 0. The internal consistency of the HCL was good for various ethnic samples. The percentage of people who own a car in China is low, and this could explain why the frequency of the 7th item drive faster was low in BP jcl-32 The reason for no significant difference for the three other items is unclear.
These results are comparable to those of the European study [ 12 ]. Subjects in the present study and that carried out in Taiwan were Chinese. In the European and Taiwanese studies, the duration criterion for hypomania was two days but in the present study it was a minimum of four days. This was similar to the results from other studies [ 1214 ]. The results from the current study suggest that the optimal cut-off between BP-II and UP should be used, particularly when considering the continuum of mood disorders.
High sensitivity is important for a screening instrument cut-off thirteen, sensitivity 0. From a clinical perspective, a screening questionnaire must have good sensitivity even if that increases false positives because of lower specificity [ 27 ].
There were limitations in the present study. The duration of the mood disorders were not evaluated in the current study as diagnoses were correlated to the duration of mood disorders. The psychometric properties of the simplified Chinese version of the HCL were demonstrated to be satisfactory using a clinical sample in China.
Furthermore, 13 can be used as the optimal screening cut-off between BP and UP in psychiatric settings in China. Authors LL and HY designed the study and developed the protocols.
LL is the tutor of HY. All authors were interviewers. All authors read and approved the final manuscript. National Center for Biotechnology InformationU. Published online May Author information Article notes Copyright and License information Disclaimer.
Received Nov 21; Accepted May This article has been cited by other articles in PMC. Abstract Background The item Hypomania Checklist HCLa questionnaire for screening bipolar disorders, has been utilised in several countries, but it unclear if the Chinese version of the HCL is valid.
Results The eigenvalues for the first three factors in the HCL were calculated as 5. Conclusions This study demonstrated that the simplified Chinese version of HCL was valid for patients with mood disorders. Background It is important to differentiate bipolar disorders BP from other mood disorders; delayed diagnosis or misdiagnosis can prolong the suffering of patients [ 1 – 3 ] but accurate early diagnosis can be difficult [ 34 ].
Methods Subjects Subjects from the outpatient and inpatient departments at Shenzhen and Shanghai mental health centres were enrolled in the study from January to December Statistical Analyses Principal component analysis with varimax rotation was used to determine the construct validity of the HCL Table 1 Description of samples.