Does Mood Disorder Questionnaire identify sub-threshold bipolarity? Evidence studying worsening of quality of life Mauro Giovanni Carta b,n,1 , Andrea Norcini-Pala b , Maria Francesca Moro b,a , Matteo Balestrieri d , Filippo Caraci c , Liliana Dell’Osso e,i , Guido Di Sciascio f , Carlo Faravelli g , Maria Carolina Hardoy a , Eugenio Aguglia c , Rita Roncone h , Antonio Egidio Nardi e , Filippo Drago c a Department of Public Health, Clinical and Molecular Medicine, University of Cagliari, Cagliari, Italy b Mailman School of Public Health, Columbia University, New York, NY, USA c Department of Clinical and Molecular Biomedicine, University of Catania, Catania, Italy d DISM, University of Udine, Udine, Italy e Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy f Department of Psychiatry, Policlinico Hospital, Bari, Italy g Department of Health Sciences, Psychology and Psychiatry Unit, University of Florence, Firenze, Italy h Department of Health, Life and Environmental Sciences, Unit of Psychiatry, University of L’Aquila, L’Aquila, Italy i Institute of Psychiatry, University of Rio de Janeiro, Rio de Janeiro, Brazil article info Article history: Received 28 February 2015 Received in revised form 29 April 2015 Accepted 30 April 2015 Available online 11 May 2015 Keywords: Mood Disorder Questionnaire Bipolar disorders Screening Quality of life Spectrum abstract Objective: It is debated whether the Mood Disorder Questionnaire (MDQ) can generate false positives by screening other disorders as bipolar, or identify sub-threshold bipolarity. The aim is to verify if Quality of Life (QoL) impairment in MQD positives in the community is due to MDQ positivity itself, or to psychiatric diagnosis associated with MDQ positivity (supporting the former hypothesis). Method: Community survey. Sample randomized after stratification of the adult population in the records of seven Italian regions. Tools: MDQ; Short Form Health Survey (SF-12); semi-structured clinical interview carried out by clinicians. Results: Positives at MDQ show worsening QoL with an attributable burden of 2.8 71.8 lower than in MDD (5.6 73.6, p o0.001) or Eating Disorders (4.4 76.6, p o0.03) and similar to Panic Disorder (2.9 70.9, p ¼0.44). The burden is lower in the middle-aged (25–59 years) than in the young (18–24) (4.65 74.5 vs 2.58 72.0, p ¼0.007) or in the elderly ( Z60) (4.12 73.2; p ¼0.024). In the elderly the burden is independent from comorbid psychiatric disorders. Limitations: This is a preliminary study based on one survey not designed to test this specific hypothesis, thus its results have a heuristic value only. Conclusions: The worsening of QoL due to positivity at MDQ is largely independent from comorbid conditions, supporting the hypothesis that MDQ positivity identifies a specific area of suffering that is “subthreshold“ to the psychiatric diagnosis, and relevant for public health. & 2015 Published by Elsevier B.V. 1. Introduction The introduction of screening questionnaires for Bipolar Dis- orders in epidemiology – like the Mood Disorder Questionnaire (MDQ) (Hirschfeld et al., 2000) and the Hypomania Check List 32 (HCL-32) (Angst et al., 2010) – has enhanced research in the field of epidemiology of bipolar disorders. Several community surveys were carried out under this method in different countries in the past two decades: a study in the USA using the Mood Disorder Questionnaire found a slightly lower than 4% prevalence of positivity at the screening (lifetime) (Hirschfeld et al., 2003); in Australia prevalence was 2.5% with the same instrument (Fisher et al., 2007); 3% in Italy (Carta et al., 2012a,b) and 3.6% in France (Carta et al., 2013). The publication of these data was followed by a heated debate; some researchers wrote that these instruments have low accuracy, because they generate false positives (Zimmerman et al., 2009) and consequently the high prevalence reported may be an artifact. Others defended the results on the basis that screening “positives” Contents lists available at ScienceDirect journal homepage: www.elsevier.com/locate/jad Journal of Affective Disorders http://dx.doi.org/10.1016/j.jad.2015.04.058 0165-0327/& 2015 Published by Elsevier B.V. n Corresponding author. Tel.: þ39 335 499994; fax: þ39 70 6093498. E-mail address: mgcarta@tiscali.it (M.G. Carta). 1 Postal address Department of Public Health, Clinical and Molecular Medicine, University of Cagliari, SS 554, Bivio Sestu, 09142 Monserrato, Cagliari, Italy. Journal of Affective Disorders 183 (2015) 173–178