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Reducing the Hypomania Checklist (HCL-32) to a 16-item version.
J Affect Disord. 2010 Aug; 124(3):351-6.JA

Abstract

BACKGROUND

The under-recognition of hypomanic symptoms by both clinicians and patients is a major clinical problem which contributes to misdiagnosis and diagnostic delay in patients with bipolar disorder. The recent development of validated screening instruments for hypomania, such as the Hypomania Checklist (HCL-32), may help to improve the detection of bipolar disorder. In this study, we assess whether it is possible to reduce the number of items on the HCL-32 without any loss in the screening tool's ability to reliably differentiate between bipolar disorder (BD) and major depressive disorder (MDD).

METHODS

Using our large samples of patients with DSM-IV defined bipolar I disorder (BD-I) (n=230) and recurrent MDD (n=322), we performed item correlations in order to identify potentially redundant items in the HCL-32. We then tested the performance of a shortened 16-item HCL questionnaire within a separate sample of patients with BD (including BD-I, BD-II and BD-NOS) (n=59) and MDD (n=76).

RESULTS

The structure of the 16-item HCL demonstrated two main factors similar to those identified for the HCL-32 (an 'active-elated' factor and a 'risk-taking/irritable' factor). A score of 8 or more on a shortened 16-item version of the HCL had excellent ability to distinguish between BD and MDD. The sensitivity (83%) and specificity (71%) of the 16-item version were very similar to those for the full 32-item HCL.

LIMITATIONS

The HCL-16 was derived after subjects had completed the full HCL-32. It will be important to test the validity of a 'stand-alone' 16-item HCL questionnaire.

CONCLUSIONS

A shortened 16-item HCL (the HCL-16) is potentially a useful screening tool for hypomania within busy clinical settings.

Authors+Show Affiliations

Department of Psychological Medicine, School of Medicine, Cardiff University, University Hospital of Wales, Cardiff, CF14 4XN, UK.No affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article
Research Support, Non-U.S. Gov't

Language

eng

PubMed ID

20129673

Citation

Forty, Liz, et al. "Reducing the Hypomania Checklist (HCL-32) to a 16-item Version." Journal of Affective Disorders, vol. 124, no. 3, 2010, pp. 351-6.
Forty L, Kelly M, Jones L, et al. Reducing the Hypomania Checklist (HCL-32) to a 16-item version. J Affect Disord. 2010;124(3):351-6.
Forty, L., Kelly, M., Jones, L., Jones, I., Barnes, E., Caesar, S., Fraser, C., Gordon-Smith, K., Griffiths, E., Craddock, N., & Smith, D. J. (2010). Reducing the Hypomania Checklist (HCL-32) to a 16-item version. Journal of Affective Disorders, 124(3), 351-6. https://doi.org/10.1016/j.jad.2010.01.004
Forty L, et al. Reducing the Hypomania Checklist (HCL-32) to a 16-item Version. J Affect Disord. 2010;124(3):351-6. PubMed PMID: 20129673.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Reducing the Hypomania Checklist (HCL-32) to a 16-item version. AU - Forty,Liz, AU - Kelly,Mark, AU - Jones,Lisa, AU - Jones,Ian, AU - Barnes,Emma, AU - Caesar,Sian, AU - Fraser,Christine, AU - Gordon-Smith,Katherine, AU - Griffiths,Emily, AU - Craddock,Nick, AU - Smith,Daniel J, Y1 - 2010/02/02/ PY - 2009/10/29/received PY - 2010/01/11/revised PY - 2010/01/11/accepted PY - 2010/2/5/entrez PY - 2010/2/5/pubmed PY - 2010/10/30/medline SP - 351 EP - 6 JF - Journal of affective disorders JO - J Affect Disord VL - 124 IS - 3 N2 - BACKGROUND: The under-recognition of hypomanic symptoms by both clinicians and patients is a major clinical problem which contributes to misdiagnosis and diagnostic delay in patients with bipolar disorder. The recent development of validated screening instruments for hypomania, such as the Hypomania Checklist (HCL-32), may help to improve the detection of bipolar disorder. In this study, we assess whether it is possible to reduce the number of items on the HCL-32 without any loss in the screening tool's ability to reliably differentiate between bipolar disorder (BD) and major depressive disorder (MDD). METHODS: Using our large samples of patients with DSM-IV defined bipolar I disorder (BD-I) (n=230) and recurrent MDD (n=322), we performed item correlations in order to identify potentially redundant items in the HCL-32. We then tested the performance of a shortened 16-item HCL questionnaire within a separate sample of patients with BD (including BD-I, BD-II and BD-NOS) (n=59) and MDD (n=76). RESULTS: The structure of the 16-item HCL demonstrated two main factors similar to those identified for the HCL-32 (an 'active-elated' factor and a 'risk-taking/irritable' factor). A score of 8 or more on a shortened 16-item version of the HCL had excellent ability to distinguish between BD and MDD. The sensitivity (83%) and specificity (71%) of the 16-item version were very similar to those for the full 32-item HCL. LIMITATIONS: The HCL-16 was derived after subjects had completed the full HCL-32. It will be important to test the validity of a 'stand-alone' 16-item HCL questionnaire. CONCLUSIONS: A shortened 16-item HCL (the HCL-16) is potentially a useful screening tool for hypomania within busy clinical settings. SN - 1573-2517 UR - https://www.unboundmedicine.com/medline/citation/20129673/Reducing_the_Hypomania_Checklist__HCL_32__to_a_16_item_version_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S0165-0327(10)00030-3 DB - PRIME DP - Unbound Medicine ER -