Michele Fornaro1, Domenico De Berardis2, Monica Mazza3, Mariachiara Pino4, Ettore Favaretto5, Fulvio Bedani6, Christian Wieser7, Luisa Indelicato8, Vito Fabio Paternò9, Francesca Lo Monaco10, Febronia Dugo11, Antonio Ventriglio12, Sergio Mungo13, Valerio Selle14, Alessandro Valchera15, Mai Elassy16, Giovanni Martinotti17, Andrea De Bartolomeis18, Felice Iasevoli19, Carmine Tomasetti20, Livia Avvisati21, Sergio Tartaglione22, Giampaolo Perna23, Carlo Ignazio Cattaneo24, Giorgio Consoli25, Anna Romano26, Alessandro Del Debbio27, Matteo Martino28, Emanuela D' Angelo29, Concetta De Pasquale30, Ann Sarah Koshy31, Jules Angst32. 1. Department of Education Science, University of Catania, Catania, Italy; Polyedra Research Group, Italy. Electronic address: dott.fornaro@gmail.com. 2. Polyedra Research Group, Italy; National Health Service, Department of Mental Health, Psychiatric Service of Diagnosis and Treatment, Hospital "G. Mazzini", ASL 4, Teramo, Italy. Electronic address: dodebera@aliceposta.it. 3. Polyedra Research Group, Italy; Department of Life, Health and Environmental Sciences, University of L׳Aquila, L׳Aquila, Italy. Electronic address: monica.mazza@cc.univaq.it. 4. Department of Life, Health and Environmental Sciences, University of L׳Aquila, L׳Aquila, Italy. Electronic address: mariachiara.pino@graduate.univaq.it. 5. Department of Psychiatry of Bressanone (Brixen), Bolzano (Bozen), Italy. Electronic address: efavaretto@yahoo.com. 6. Department of Psychiatry of Bressanone (Brixen), Bolzano (Bozen), Italy. Electronic address: fulviobedani@icloud.com. 7. Department of Psychiatry of Bressanone (Brixen), Bolzano (Bozen), Italy. Electronic address: christian.wieser@sb-brixen.it. 8. Department of Education Science, University of Catania, Catania, Italy. Electronic address: luisa.indelicato@hotmail.it. 9. Centro siciliano per la cura di Depressione e Ansia (CESIDEA), Catania, Italy; Ospedale San Raffaele, Milano, Italy. Electronic address: info@cesidea.it. 10. Department of Education Science, University of Catania, Catania, Italy. Electronic address: francescalomonaco91@live.it. 11. Department of Education Science, University of Catania, Catania, Italy. Electronic address: brunelladugo@alice.it. 12. Section of Psychiatry, University of Foggia, Department of Clinical and Experimental Medicine, Foggia, Italy. Electronic address: dr.ventriglio@gmail.com. 13. Department of Psychiatry, University of Genova, Genoa, Italy. Electronic address: sergiomungo@libero.it. 14. Clinica Viarnetto, Lugano, Switzerland. Electronic address: v.selle@clinicaviarnetto.ch. 15. Polyedra Research Group, Italy; Casa di Cura Villa San Giuseppe, Via dei Girasoli, n.6, 63100 Ascoli Piceno, Italy. Electronic address: alessandrovalchera@gmail.com. 16. Department of Psychiatry, Mansoura Faculty of Medicine, Mansoura City, Egypt. Electronic address: elassym@gmail.com. 17. Polyedra Research Group, Italy; Department of Neuroscience and Imaging, University "G. d׳Annunzio", Chieti, Italy. Electronic address: giovanni.martinotti@gmail.com. 18. Section of Psychiatry - Department of Neuroscience - University School of Naples "Federico II", Naples, Italy. Electronic address: adebarto@unina.it. 19. Polyedra Research Group, Italy; Section of Psychiatry - Department of Neuroscience - University School of Naples "Federico II", Naples, Italy. Electronic address: felix_ias@hotmail.com. 20. Polyedra Research Group, Italy; Section of Psychiatry - Department of Neuroscience - University School of Naples "Federico II", Naples, Italy; National Health Service, Department of Mental Health, Unit of Psychiatry, Isernia, Italy. Electronic address: carmine.tomasetti@gmail.com. 21. Section of Psychiatry - Department of Neuroscience - University School of Naples "Federico II", Naples, Italy. Electronic address: livia.avvisati@gmail.com. 22. National Health Service, Department of Mental Health, Unit of Psychiatry, Isernia, Italy. Electronic address: sergio.tartaglione@asrem.org. 23. Polyedra Research Group, Italy; Department of Clinical Neuroscience, San Benedetto Hospital, Hermanas Hospitalarias, Albese con Cassano, Como, Italy. Electronic address: pernagp@gmail.com. 24. National Health System, "ASL 13", Novara, Italy. Electronic address: dr.carloignaziocattaneo@gmail.com. 25. Department of Psychiatry, University of Pisa, Pisa, Italy. Electronic address: cogi77@gmail.com. 26. Department of Psychiatry, University of Pisa, Pisa, Italy. Electronic address: annaromano21@libero.it. 27. Department of Psychiatry, University of Pisa, Pisa, Italy. Electronic address: adeldebbio@gmail.com. 28. Department of Psychiatry, University of Genova, Genoa, Italy. Electronic address: matteomartino9@gmail.com. 29. Department of Psychiatry, University of Genova, Genoa, Italy. Electronic address: dangelo1980@hotmail.com. 30. Department of Education Science, University of Catania, Catania, Italy. Electronic address: depasqua@unict.it. 31. St. John׳s National Academy of Health Sciences, Bangalore, India. Electronic address: ann007sarah@gmail.com. 32. Department of Psychiatry, Psychotherapy and Psychosomatics, Psychiatric Hospital, University of Zurich, Zurich, Switzerland. Electronic address: jules.angst@uzh.ch.
Abstract
OBJECTIVE: To assess the psychometric properties of the Italian adaptation of the Hypomania-Check-List 32-item, second revision (HCL-32-R2) for the detection of bipolarity in major depressive disorder (MDD) treatment-seeking outpatients. METHODS: A back-to-back Italian adaption of the "Bipolar Disorders: Improving Diagnosis, Guidance, and Education" English module of the HCL-32-R2 was administered between March 2013 and October 2014 across twelve collaborating sites in Italy. Diagnostic and Statistical Manual Fourth edition (DSM-IV) diagnoses were made adopting the mini-international neuropsychiatric interview, using bipolar disorder (BD) patients as controls. RESULTS: In our sample (n=441, of whom, BD-I=68; BD-II=117; MDD=256), using a cut-off of 14 allowed the HCL-32-R2 to discriminate DSM-IV-defined MDD patients between "true unipolar" (HCL-32-R2(-)) and "sub-threshold bipolar depression" (HCL-32-R2(+)) with sensitivity=89% and specificity=79%. Area under the curve was .888; positive and negative predictive values were 75.34% and 90.99% respectively. Owing to clinical interpretability considerations and consistency with previous adaptations of the HCL-32, a two-factor solution (F1="hyperactive/elated" vs. F2="irritable/distractible/impulsive") was preferred using exploratory and confirmatory factor analyses, whereas items n.33 ("I gamble more") and n.34 ("I eat more") introduced in the R2 version of the scale slightly loaded onto F2 and F1 respectively. Cronbach׳s α=.88 for F1 and .71 for F2. LIMITATIONS: No cross-validation with any additional validated screening tool; treatment-seeking outpatient sample; recall bias; no systematic evaluation of eventual medical/psychiatric comorbidities, current/lifetime pharmacological history, neither record of severity of current MDE. CONCLUSIONS: Our results seem to indicate fair accuracy of HCL-32 as a screening instrument for BD, though replication studies are warranted.
OBJECTIVE: To assess the psychometric properties of the Italian adaptation of the Hypomania-Check-List 32-item, second revision (HCL-32-R2) for the detection of bipolarity in major depressive disorder (MDD) treatment-seeking outpatients. METHODS: A back-to-back Italian adaption of the "Bipolar Disorders: Improving Diagnosis, Guidance, and Education" English module of the HCL-32-R2 was administered between March 2013 and October 2014 across twelve collaborating sites in Italy. Diagnostic and Statistical Manual Fourth edition (DSM-IV) diagnoses were made adopting the mini-international neuropsychiatric interview, using bipolar disorder (BD) patients as controls. RESULTS: In our sample (n=441, of whom, BD-I=68; BD-II=117; MDD=256), using a cut-off of 14 allowed the HCL-32-R2 to discriminate DSM-IV-defined MDDpatients between "true unipolar" (HCL-32-R2(-)) and "sub-threshold bipolar depression" (HCL-32-R2(+)) with sensitivity=89% and specificity=79%. Area under the curve was .888; positive and negative predictive values were 75.34% and 90.99% respectively. Owing to clinical interpretability considerations and consistency with previous adaptations of the HCL-32, a two-factor solution (F1="hyperactive/elated" vs. F2="irritable/distractible/impulsive") was preferred using exploratory and confirmatory factor analyses, whereas items n.33 ("I gamble more") and n.34 ("I eat more") introduced in the R2 version of the scale slightly loaded onto F2 and F1 respectively. Cronbach׳s α=.88 for F1 and .71 for F2. LIMITATIONS: No cross-validation with any additional validated screening tool; treatment-seeking outpatient sample; recall bias; no systematic evaluation of eventual medical/psychiatric comorbidities, current/lifetime pharmacological history, neither record of severity of current MDE. CONCLUSIONS: Our results seem to indicate fair accuracy of HCL-32 as a screening instrument for BD, though replication studies are warranted.