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Transcultural validity of the Hypomania Checklist-32 (HCL-32) in patients with major depressive episodes.
Bipolar Disord. 2013 Sep; 15(6):701-12.BD

Abstract

OBJECTIVES

There is mounting evidence that current diagnostic systems inadequately recognize clinically relevant levels of hypomania in depressed patients, thereby leading to an under-diagnosis of bipolar disorders and the associated risk of treatment that is inappropriate or may actually worsen illness course. The Hypomania Checklist-32 revised version 2 (HCL-32-R2) is a self-rating scale for hypomanic symptoms specifically developed to address this problem. The goal of this study was to assess the transcultural validity of the HCL-32-R2.

METHODS

Measurement invariance of HCL-32-R2 responses from the multinational Bipolar Disorders: Improving Diagnosis, Guidance, and Education (BRIDGE) Study of 5635 patients with major depressive episodes (MDEs) was assessed by exploratory and confirmatory factor analysis across five cultural regions.

RESULTS

Two previously identified factors were reproduced and explained 60% of the variance in test responses. Only three out of 32 items had cross-culturally variable factor loadings. Some moderate measurement invariance was also found with regard to age and gender. In discriminating unipolar from bipolar disorder, the HCL-32-R2 showed a sensitivity of 82% with a specificity of 57% when current DMS-IV criteria for bipolar disorder were used, and substantially higher specificity of 73% when evidence-based modified criteria were applied.

CONCLUSIONS

The psychometric properties of the HCL-32-R2 were largely culture-independent. This finding replicates that of our previous international study and is a step towards validating the HCL-32-R2 as a broadly applicable screening instrument for hypomanic features, facilitating the detection of hidden bipolarity in depressed patients.

Authors+Show Affiliations

Zürich University Psychiatric Hospital, Zurich, Switzerland. alex.gamma@uzh.chNo 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

23848428

Citation

Gamma, Alex, et al. "Transcultural Validity of the Hypomania Checklist-32 (HCL-32) in Patients With Major Depressive Episodes." Bipolar Disorders, vol. 15, no. 6, 2013, pp. 701-12.
Gamma A, Angst J, Azorin JM, et al. Transcultural validity of the Hypomania Checklist-32 (HCL-32) in patients with major depressive episodes. Bipolar Disord. 2013;15(6):701-12.
Gamma, A., Angst, J., Azorin, J. M., Bowden, C. L., Perugi, G., Vieta, E., & Young, A. H. (2013). Transcultural validity of the Hypomania Checklist-32 (HCL-32) in patients with major depressive episodes. Bipolar Disorders, 15(6), 701-12. https://doi.org/10.1111/bdi.12101
Gamma A, et al. Transcultural Validity of the Hypomania Checklist-32 (HCL-32) in Patients With Major Depressive Episodes. Bipolar Disord. 2013;15(6):701-12. PubMed PMID: 23848428.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Transcultural validity of the Hypomania Checklist-32 (HCL-32) in patients with major depressive episodes. AU - Gamma,Alex, AU - Angst,Jules, AU - Azorin,Jean-Michel, AU - Bowden,Charles L, AU - Perugi,Giulio, AU - Vieta,Eduard, AU - Young,Allan H, Y1 - 2013/07/12/ PY - 2012/04/16/received PY - 2013/05/18/accepted PY - 2013/7/16/entrez PY - 2013/7/16/pubmed PY - 2014/3/26/medline KW - bipolar disorder KW - confirmatory factor analysis KW - culture KW - hypomania KW - screening SP - 701 EP - 12 JF - Bipolar disorders JO - Bipolar Disord VL - 15 IS - 6 N2 - OBJECTIVES: There is mounting evidence that current diagnostic systems inadequately recognize clinically relevant levels of hypomania in depressed patients, thereby leading to an under-diagnosis of bipolar disorders and the associated risk of treatment that is inappropriate or may actually worsen illness course. The Hypomania Checklist-32 revised version 2 (HCL-32-R2) is a self-rating scale for hypomanic symptoms specifically developed to address this problem. The goal of this study was to assess the transcultural validity of the HCL-32-R2. METHODS: Measurement invariance of HCL-32-R2 responses from the multinational Bipolar Disorders: Improving Diagnosis, Guidance, and Education (BRIDGE) Study of 5635 patients with major depressive episodes (MDEs) was assessed by exploratory and confirmatory factor analysis across five cultural regions. RESULTS: Two previously identified factors were reproduced and explained 60% of the variance in test responses. Only three out of 32 items had cross-culturally variable factor loadings. Some moderate measurement invariance was also found with regard to age and gender. In discriminating unipolar from bipolar disorder, the HCL-32-R2 showed a sensitivity of 82% with a specificity of 57% when current DMS-IV criteria for bipolar disorder were used, and substantially higher specificity of 73% when evidence-based modified criteria were applied. CONCLUSIONS: The psychometric properties of the HCL-32-R2 were largely culture-independent. This finding replicates that of our previous international study and is a step towards validating the HCL-32-R2 as a broadly applicable screening instrument for hypomanic features, facilitating the detection of hidden bipolarity in depressed patients. SN - 1399-5618 UR - https://www.unboundmedicine.com/medline/citation/23848428/Transcultural_validity_of_the_Hypomania_Checklist_32__HCL_32__in_patients_with_major_depressive_episodes_ L2 - https://doi.org/10.1111/bdi.12101 DB - PRIME DP - Unbound Medicine ER -