Comparing Screening Abilities of the 33-Item Hypomania Checklist (HCL-33) and the 33-Item Hypomania Checklist External Assessment (HCL-33-EA) for the Detection of Bipolar Disorder

Abstract

Background: Bipolar disorder (BD) is a severe psychiatric disorder that is often misdiagnosed and under-diagnosed in clinical settings. The 33-item Hypomania Checklist (HCL-33) is a newly developed self-administered scale for BD detection, while the 33-item Hypomania Checklist-external assessment (HCL-33-EA) is a version of the HCL-33 for external rating used by patient's carer (e.g., family member or friend). We aimed to compare the screening abilities between the HCL-33 and the HCL-33-EA, and evaluate the screening consistency between the two scales.Methods: The data were collected from 269 patients with diagnosed BD (n = 84) or major depressive disorder (MDD) (n = 185). The sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and area under the curve (AUC) between the HCL-33 and the HCL-33-EA for BD were compared against clinician diagnosis as the gold standard.Results: Using Youden's index, the optimal cut-off value of the HCL-33 is 20, while the corresponding figure for HCL-33-EA is 11. Using Youden's index, the HCL-33-EA showed a better performance than the HCL-33 (0.51 vs.0.41). The HCL-33-EA was more sensitive in correctly identifying BD patients from MDD patients than the HCL-33 (0.83 vs. 0.59), while the HCL-33 presented better specificity than the HCL-33-EA (0.82 vs. 0.68). There was significant screening consistency between the two scales (p < 0.001).Conclusions: Both scales have acceptable psychometric properties in detection BD from MDD. Use of the two scales should be considered based on the assessment purpose in clinical research or daily practice (i.e., prefer sensitivity or specificity). Noticeably, the current sample size is insufficient and future studies are recommended to further evaluate the scales.

A comparison of the 33-item Hypomania Checklist with the 33-item Hypomania Checklist-external assessment for the detection of bipolar disorder in adolescents

“…In addition, compared to the HCL-33 self-assessment, external assessment with the HCL-33-EA had a higher sensitivity and negative predictive value, and a lower specificity and positive predictive value. This finding was consistent with that of a study comparing the HCL-33 and HCL-33-EA in an adult sample (Wang et al 2021 ). Whilst the satisfactory sensitivity indicates that the HCL-33-EA may be an effective tool for differentiating BD from MDD, the lower specificity of HCL-33-EA may be the result of false positives.…”

Structure of Hypomanic Symptoms in Adolescents With Bipolar Disorders: A Network Approach

“…Total scores on these scales range from 0 to 33, with higher scores indicating more severe hypomanic symptoms. A previous comparative study found that the HCL-33-EA was more sensitive than the HCL-33 in distinguishing BD patients from MDD patients (0.83 vs. 0.59) while the HCL-33 presented better specificity than the HCL-33-EA did (0.82 vs. 0.68) ( 16 ).…”

“…Conversely, the 33-item Hypomania Checklist – external assessment (HCL-33-EA) is an observer-rated version of the HCL-33 that was designed to assess patients’ hypomanic symptoms based on ratings of their caregivers ( 14 ). The HCL-33 and HCL-33-EA are significantly and positively correlated with one another ( 15 ), though the HCL-33-EA is more sensitive in correctly distinguishing BD patients from MDD patients compared to the HCL-33 ( 16 ). To date, no study has examined the network structure of the HCL-33 or the HCL-33-EA.…”