Detecting bipolarity using the Lebanese Arabic hypomania checklist (HCL-32): validation of shortened HCL versions

Due to the under diagnosis of bipolar disorder, screening instruments such as the hypomania checklist 32 items (HCL-32) is used to differentiate between Bipolar Disorder (BD) and Major Depressive Disorder (MDD). However due to its lengthy format, efforts were done to validate a shorter alternative without compromising its ability to differentiate between BD and MDD. We aimed to shorten the HCL-32 and assess the screening performance of the three Lebanese Arabic abbreviated HCL versions (HCL-20, -16, and -8) relative to the full HCL-32 in a sample of clinically diagnosed patients with BD and MDD in Lebanon.

In a sample of 760 patients (BD-I=29, BD-II=142, MDD=589) clinically diagnosed with BD and MDD, the screening performance of the three Lebanese Arabic abbreviated HCL versions (HCL-20, -16, and -8) as well as the full HCL-32, was assessed, looking at the reliability, sensitivity, and specificity.

All the shortened HCL versions showed strong reliability (a=0.78-0.90.) They also demonstrated good screening ability (AUC=0.8520- 0.8835) in differentiating BD from MDD. For the sensitivities across the shortened versions, they were consistently higher in BD-II vs MDD compared to BD-I vs MDD across all scales showing that the shortened versions have the ability to detect BD-II cases much more effectively.

This study is the first to validate the shortened HCL versions in an Arabic speaking population. The HCL- 16 appears to be the most optimal shortened scale for distinguishing between BD versus MDD. However, these findings should be interpreted in light of the study's limitations including the use of retrospective data collection and item interdependence of the HCL-32.