Misuse of the Mood Disorders Questionnaire as a case-finding measure and a critique of the concept of using a screening scale for bipolar disorder in psychiatric practice.

OBJECTIVES: Under-recognition of bipolar disorder (BD) is common and incurs significant costs for individuals and society. Clinicians are often encouraged to use screening instruments to help them identify patients with the disorder. The Mood Disorder Questionnaire (MDQ) is the most widely studied measure for this purpose. Some studies, however, have used the MDQ as a case-finding instrument rather than a screening scale. Such inappropriate use of screening scales risks distorting perceptions about many facets of BD, from its prevalence to its consequences.
METHODS: Studies using the MDQ were reviewed to identify those reports that have used the scale as a case-finding measure rather than a screening scale.
RESULTS: Multiple studies were identified in the BD literature that used the MDQ as a diagnostic proxy. The findings of these studies were misinterpreted because of the failure to make the distinction between screening and case-finding.
CONCLUSIONS: Inappropriate conclusions have been drawn regarding the prevalence, morbidity, and diagnostic under-recognition of BD in studies that rely on the MDQ as a diagnostic proxy. A conceptual critique is offered against the use of self-administered screening questionnaires for the detection of BD in psychiatric settings.