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The Rapid Mood Screener: A Novel and Pragmatic Screener Tool for Bipolar I Disorder

Published online by Cambridge University Press:  10 May 2021

C. Brendan Montano
Montano Wellness LLC, Cromwell, CT, USA
Mehul Patel
AbbVie Inc., Madison, NJ, USA
Rakesh Jain
Texas Tech University, School of Medicine at Permian Basin, Midland, TX, USA
Prakash S. Masand
Global Medical Education, New York, NY, USA
Amanda Harrington
AbbVie Inc., Irvine, CA, USA
Patrick Gillard
AbbVie Inc., Irvine, CA, USA
Kate Sullivan
Knoxville Behavioral & Mental Health Services, Knoxville, TN, USA
Susan L. McElroy
Lindner Center of HOPE, Mason, OH, USA
T. Michelle Brown
RTI Health Solutions, Triangle Park, NC, USA
Lauren Nelson
RTI Health Solutions, Triangle Park, NC, USA
Roger S. McIntyre
University Health Network, Toronto, Ontario, Canada
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Approximately 70% of patients with bipolar disorder (BPD) are initially misdiagnosed, resulting in significantly delayed diagnosis of 7–10 years on average. Misdiagnosis and diagnostic delay adversely affect health outcomes and lead to the use of inappropriate treatments. As depressive episodes and symptoms are the predominant symptom presentation in BPD, misdiagnosis as major depressive disorder (MDD) is common. Self-rated screening instruments for BPD exist but their length and reliance on past manic symptoms are barriers to implementation, especially in primary care settings where many of these patients initially present. We developed a brief, pragmatic bipolar I disorder (BPD-I) screening tool that not only screens for manic symptoms but also includes risk factors for BPD-I (eg, age of depression onset) to help clinicians reduce the misdiagnosis of BPD-I as MDD.


Existing questionnaires and risk factors were identified through a targeted literature search; a multidisciplinary panel of experts participated in 2 modified Delphi panels to select concepts thought to differentiate BPD-I from MDD. Individuals with self-reported BPD-I or MDD participated in cognitive debriefing interviews (N=12) to test and refine item wording. A multisite, cross-sectional, observational study was conducted to evaluate the screening tool’s predictive validity. Participants with clinical interview-confirmed diagnoses of BPD-I or MDD completed a draft 10-item screening tool and additional questionnaires/questions. Different combinations of item sets with various item permutations (eg, number of depressive episodes, age of onset) were simultaneously tested. The final combination of items and thresholds was selected based on multiple considerations including clinical validity, optimization of sensitivity and specificity, and pragmatism.


A total of 160 clinical interviews were conducted; 139 patients had clinical interview-confirmed BPD-I (n=67) or MDD (n=72). The screening tool was reduced from 10 to 6 items based on item-level analysis. When 4 items or more were endorsed (yes) in this analysis sample, the sensitivity of this tool for identifying patients with BPD-I was 0.88 and specificity was 0.80; positive and negative predictive values were 0.80 and 0.88, respectively. These properties represent an improvement over the Mood Disorder Questionnaire, while using >50% fewer items.


This new 6-item BPD-I screening tool serves to differentiate BPD-I from MDD in patients with depressive symptoms. Use of this tool can provide real-world guidance to primary care practitioners on whether more comprehensive assessment for BPD-I is warranted. Use of a brief and valid tool provides an opportunity to reduce misdiagnosis, improve treatment selection, and enhance health outcomes in busy clinical practices.


AbbVie Inc.

© The Author(s), 2021. Published by Cambridge University Press


Presenting Author: Roger S. McIntyre