Hypomania-Checklist-33: risk stratification and factor structure in a mixed psychiatric adolescent sample

Area of Science:

• Child and Adolescent Psychiatry
• Psychometric Assessment
• Mental Health Screening

Background:

• The Hypomania Checklist (HCL-33) differentiates adolescent bipolar disorder (BD) from unipolar depression.
• Further examination of HCL-33 utility in routine diagnostics is needed.

Purpose of the Study:

• To assess the frequency and psychopathological characteristics of individuals identified by the HCL-33 in a mixed psychiatric sample.
• To investigate the HCL-33's effectiveness as a screening tool for bipolar disorder in adolescents.

Main Methods:

• 285 children and adolescents (12-18 years) completed the HCL-33, Children's Depression Inventory, Beck's Anxiety Inventory, and Strengths and Difficulties Questionnaire.
• A cut-off score of ≥18 on the HCL-33 identified individuals at-risk for BD among those with depressive symptoms.
• Factorial structure, correlations with psychopathology, and impact on daily functioning were analyzed.

Main Results:

• 20.6% of the sample met at-risk criteria for BD, presenting with older age, higher anxiety, and more conduct problems.
• Factor analysis supported two- and three-factor models, with 'active-elated' and 'risk-taking/irritable' as key factors.
• Higher scores on specific factors correlated with increased depression, anxiety, hyperactivity, and conduct problems; 51.7% reported functional impairment.

Conclusions:

• The HCL-33 demonstrates potential as a valuable screening tool for identifying adolescents at risk for bipolar disorder.
• It is particularly useful for adolescents with depressive symptoms who also exhibit anxiety and conduct problems.
• The findings support the HCL-33's role in improving diagnostic accuracy in clinical settings.