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Screening for bipolar disorder: does gender distort scores and case-finding estimates?

Gordon Parker1, Kathryn Fletcher1, Stacey McCraw1

  • 1School of Psychiatry, University of New South Wales, Sydney, Australia; Black Dog Institute, Prince of Wales Hospital, Randwick 2031, Sydney, Australia.

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|April 29, 2014
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Summary

This study found that the Mood Swings Questionnaire (MSQ) is not biased by gender, suggesting that observed gender differences in bipolar disorder prevalence may reflect true occurrence rather than screening tool artifacts.

Keywords:
BipolarGenderMeasureScreening

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Area of Science:

  • Psychiatry and Mental Health
  • Psychometric Evaluation
  • Bipolar Disorder Research

Background:

  • Existing research indicates gender disparities in bipolar disorder diagnoses, with males often diagnosed with bipolar I and females with bipolar II.
  • These observed differences may stem from true prevalence variations or measurement biases in screening tools.
  • This study investigates the potential for gender bias in the Mood Swings Questionnaire (MSQ).

Purpose of the Study:

  • To evaluate whether the Mood Swings Questionnaire (MSQ) exhibits gender bias in assessing bipolar disorder.
  • To determine if gender influences the scoring of the MSQ, potentially confounding prevalence estimates.

Main Methods:

  • Analysis of MSQ data from a large, age- and gender-matched sample of patients with bipolar I and bipolar II disorders.
  • Examination of gender differences in MSQ symptom prevalence, sub-scale scores, and total scores.
  • Application of univariate and differential item functioning (DIF) analyses to assess item-level gender effects.

Main Results:

  • Bipolar I patients, regardless of gender, reported higher overall MSQ scores and mysticism sub-scale scores compared to bipolar II patients.
  • No significant gender differences were found in total or sub-scale MSQ scores when analyzing bipolar I, bipolar II, and combined groups separately.
  • While some individual item differences emerged between genders within bipolar subtypes, these were inconsistent and likely due to chance, suggesting overall gender neutrality of the MSQ.

Conclusions:

  • The Mood Swings Questionnaire (MSQ) demonstrates no gender bias in total or sub-scale scores.
  • The findings suggest that the MSQ is a reliable screening tool for bipolar disorder across genders.
  • Differential prevalence rates of bipolar disorders observed in community studies are likely due to actual occurrence differences, not screening measure bias.