Sensitivity and Specificity of the Mood Disorder Questionnaire as a Screening Tool for Bipolar Disorder During Pregnancy and the Postpartum Period
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BACKGROUND: Previous studies have shown that one-quarter of women with bipolar disorder relapse during pregnancy, and nearly half of bipolar women relapse during the postpartum period. The perinatal period is also associated with an elevated risk for new-onset mood disorder. Bipolar disorder is often unrecognized, and there is often a significant delay between illness onset and proper diagnosis and treatment. The objective of this cross-sectional psychometric study was to investigate the use of the Mood Disorder Questionnaire (MDQ) as a screening tool for bipolar disorder in a community-based population of pregnant and postpartum women. METHOD: 150 women with a mean age of 30.1 years (standard deviation = 5.5 years; range, 17-43 years) who had been referred to a women's mental health program for psychiatric assessment during pregnancy (n = 95) or the postpartum period (n = 55) were enrolled between June 2010 and December 2011. All women completed the MDQ on the day of their first assessment, and the sensitivity and specificity of the MDQ were calculated against DSM-IV-based clinical diagnoses provided by experienced psychiatrists. RESULTS: A total of 18 women (12% of the sample) were diagnosed with bipolar disorder (6 with bipolar I disorder, 10 with bipolar II disorder, and 2 with bipolar disorder not otherwise specified). The traditional scoring of the MDQ yielded poor sensitivity (39%) and excellent specificity (91%). The best-fitting model was a modified scoring algorithm using cutoff scores of 7 or more symptoms on the MDQ without the supplementary questions, yielding excellent sensitivity (89%) and specificity (84%). CONCLUSIONS: The MDQ is a useful instrument for screening for bipolar disorder during both pregnancy and the postpartum period. Considering that perinatal women have an elevated risk of both first-onset and relapse of bipolar disorder, particularly during the postpartum period, routine use of screening tools in perinatal programs is encouraged.
