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From items to syndromes in the Hypomania Checklist (HCL-32): psychometric validation and clinical validity analysis.
J Affect Disord. 2011 Jul; 132(1-2):48-54.JA

Abstract

BACKGROUND

The Hypomania Checklist (HCL-32) was developed to identify subthreshold bipolarity in patients with major depression. An HCL-32 version with fewer items has been suggested.

METHODS

Principal component analysis (PCA) without rotation was used to identify active/elevated mood versus risk-taking/irritable behaviour in the HCL-32. Using the Bech-Rafaelsen Mania Scale as index of clinical validity a shorter version was developed. Item response theory analysis was used to evaluate whether the total score of the HCL-32 was sufficient to measure subthreshold bipolarity. The short 13-item Mood Disorder Questionnaire (MDQ) was used for comparison.

RESULTS

In accordance with the SCID-II criteria, we included 59 bipolar I and 63 unipolar (depressed) outpatients who had recently been discharged from inpatient treatment. In the HCL-32, PCA identified the two contrasting factors: active/elevated mood versus risk-taking/irritable behaviour. The clinical validation analysis focussed on 20 HCL items as the most acceptable (HCL-20). Item response analysis accepted that the total scores of the HCL-32/HCL-20 were a sufficient statistic, as was the total score of the MDQ. Among the unipolar (depressed) patients not responding to their antidepressive medication, subtreshold bipolarity was identified in 55% of patients using the HCL-20, 36% using the HCL-32, but only 18% using the MDQ.

LIMITATIONS

Only outpatients recently discharged from inpatient treatment were studied. A further limitation is that 9.5% of the unipolar patients had only suffered from one episode, which, however had led to hospitalisation.

CONCLUSION

The HCL-20 was found to identify subthreshold bipolarity in up to 55% of inpatients with major depressive disorder not responding to antidepressive medication.

Authors+Show Affiliations

Psychiatric Research Unit, Frederiksborg General Hospital, Copenhagen University, Hillerød, Denmark. Per.bech@regionh.dkNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

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

Language

eng

PubMed ID

21349588

Citation

Bech, P, et al. "From Items to Syndromes in the Hypomania Checklist (HCL-32): Psychometric Validation and Clinical Validity Analysis." Journal of Affective Disorders, vol. 132, no. 1-2, 2011, pp. 48-54.
Bech P, Christensen EM, Vinberg M, et al. From items to syndromes in the Hypomania Checklist (HCL-32): psychometric validation and clinical validity analysis. J Affect Disord. 2011;132(1-2):48-54.
Bech, P., Christensen, E. M., Vinberg, M., Bech-Andersen, G., & Kessing, L. V. (2011). From items to syndromes in the Hypomania Checklist (HCL-32): psychometric validation and clinical validity analysis. Journal of Affective Disorders, 132(1-2), 48-54. https://doi.org/10.1016/j.jad.2011.01.017
Bech P, et al. From Items to Syndromes in the Hypomania Checklist (HCL-32): Psychometric Validation and Clinical Validity Analysis. J Affect Disord. 2011;132(1-2):48-54. PubMed PMID: 21349588.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - From items to syndromes in the Hypomania Checklist (HCL-32): psychometric validation and clinical validity analysis. AU - Bech,P, AU - Christensen,E M, AU - Vinberg,M, AU - Bech-Andersen,G, AU - Kessing,L V, Y1 - 2011/02/23/ PY - 2010/12/06/received PY - 2011/01/31/revised PY - 2011/01/31/accepted PY - 2011/2/26/entrez PY - 2011/2/26/pubmed PY - 2011/11/2/medline SP - 48 EP - 54 JF - Journal of affective disorders JO - J Affect Disord VL - 132 IS - 1-2 N2 - BACKGROUND: The Hypomania Checklist (HCL-32) was developed to identify subthreshold bipolarity in patients with major depression. An HCL-32 version with fewer items has been suggested. METHODS: Principal component analysis (PCA) without rotation was used to identify active/elevated mood versus risk-taking/irritable behaviour in the HCL-32. Using the Bech-Rafaelsen Mania Scale as index of clinical validity a shorter version was developed. Item response theory analysis was used to evaluate whether the total score of the HCL-32 was sufficient to measure subthreshold bipolarity. The short 13-item Mood Disorder Questionnaire (MDQ) was used for comparison. RESULTS: In accordance with the SCID-II criteria, we included 59 bipolar I and 63 unipolar (depressed) outpatients who had recently been discharged from inpatient treatment. In the HCL-32, PCA identified the two contrasting factors: active/elevated mood versus risk-taking/irritable behaviour. The clinical validation analysis focussed on 20 HCL items as the most acceptable (HCL-20). Item response analysis accepted that the total scores of the HCL-32/HCL-20 were a sufficient statistic, as was the total score of the MDQ. Among the unipolar (depressed) patients not responding to their antidepressive medication, subtreshold bipolarity was identified in 55% of patients using the HCL-20, 36% using the HCL-32, but only 18% using the MDQ. LIMITATIONS: Only outpatients recently discharged from inpatient treatment were studied. A further limitation is that 9.5% of the unipolar patients had only suffered from one episode, which, however had led to hospitalisation. CONCLUSION: The HCL-20 was found to identify subthreshold bipolarity in up to 55% of inpatients with major depressive disorder not responding to antidepressive medication. SN - 1573-2517 UR - https://www.unboundmedicine.com/medline/citation/21349588/From_items_to_syndromes_in_the_Hypomania_Checklist__HCL_32_:_psychometric_validation_and_clinical_validity_analysis_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S0165-0327(11)00050-4 DB - PRIME DP - Unbound Medicine ER -