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Use of the 33-Item Hypomania Checklist (HCL-33) to Distinguish Bipolar Disorder From Major Depressive Disorder in
Xinqiao Zhang1, Wen Li2,3, Na Zhao2,3
1The National Clinical Research Center for Mental Disorders & Beijing Key Laboratory of Mental Disorders, Beijing Anding Hospital & the Advanced Innovation Center for Human Brain Protection, Capital Medical University, School of Mental Health, Beijing, China.
Insights
The Hypomania Checklist (HCL-33) accurately distinguishes bipolar disorder (BD) from major depressive disorder (MDD) in older adults. This validated tool demonstrates good reliability and can aid in diagnosing BD in geriatric populations.
Area of Science:
- Geriatric Psychiatry
- Psychometric Validation
- Mood Disorders
Background:
- Bipolar disorder (BD) is frequently misdiagnosed as major depressive disorder (MDD) in older adults.
- Accurate differentiation is crucial for appropriate treatment and management in this demographic.
Purpose of the Study:
- To evaluate the psychometric properties of the 33-item Hypomania Checklist (HCL-33).
- To assess the accuracy of the HCL-33 in differentiating BD from MDD among older patients.
Main Methods:
- Principal components analysis (PCA) for factor structure.
- Cronbach's alpha for internal consistency.
- Intra-class correlation coefficient (ICC) for test-retest reliability.
- Receiver operating characteristic (ROC) analysis for optimal cut-off determination.
Main Results:
- PCA identified two factors explaining 33.9% of variance.
- HCL-33 demonstrated high internal consistency (Cronbach's alpha = 0.912) and excellent test-retest reliability (ICC = 0.891).
- An optimal cut-off score of 14 yielded 88.8% sensitivity and 82.4% specificity for distinguishing BD from MDD.
Conclusions:
- The HCL-33 exhibits satisfactory reliability and validity in older adults.
- This checklist is a valuable tool for distinguishing bipolar disorder from major depressive disorder in geriatric patients.
Background:
Bipolar disorder (BD) is often misdiagnosed as major depressive disorder (MDD) in older patients. This study examined the psychometric properties of the 33-item Hypomania Checklist (HCL-33) and its accuracy to differentiate BD from MDD among older adults.
Method:
A total of 215 depressed older patients were recruited; 107 were diagnosed with BD (71 with BD-type I and 36 with BD-type II) and 108 with MDD. Principal components analysis (PCA) was used to explore the factor structure of the HCL-33. Cronbach's alpha was calculated to test the internal consistency. Intra-class correlation coefficient (ICC) was used to measure test-retest reliability. The receiver operating characteristic (ROC) analysis was used to generate the optimal cut-off value to differentiate between BD and MDD.
Results:
Two factors were identified in the PCA analysis accounting for 33.9% of the total variance. The Cronbach's alpha value for the HCL-33 was 0.912, with 0.922 for factor I and 0.664 for factor II. The test-retest reliability was excellent (ICC: 0.891). The optimal cut-off of the HCL-33 total score for discriminating between MDD and BD was 14, with a sensitivity of 88.8% and specificity of 82.4%.
Conclusion:
The HCL-33 had satisfactory reliability and validity and could be used to distinguish BD from MDD in older adults.
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