Mood Disorder Questionnaire (MDQ)

About

The Mood Disorder Questionnaire (MDQ) is a self-administered screening instrument for bipolar spectrum disorders developed by Dr. Robert M.A. Hirschfeld and colleagues in 2000. The MDQ consists of three sections: (1) a 13-item yes/no symptom checklist covering DSM-IV-TR (and DSM-5-TR) criteria for manic or hypomanic episodes, asking whether the patient has ever experienced a period of time when they were not their usual self and felt unusually high, energetic, or irritable; (2) a single question asking whether multiple symptoms occurred during the same period of time; and (3) a question assessing the level of functional impairment caused by these symptoms (no problems, minor problems, moderate problems, or serious problems). For a positive screen, the MDQ requires 7 or more "yes" responses on the 13 symptom items, endorsement that symptoms occurred concurrently, and moderate or serious functional impairment. The MDQ has been validated in psychiatric outpatient settings (sensitivity 73%, specificity 90% for bipolar spectrum disorders) and in the general population (sensitivity 28-58%, specificity 97%). The MDQ is particularly useful for detecting bipolar I disorder, with moderate sensitivity for bipolar II disorder. The MDQ is recommended by the International Society for Bipolar Disorders (ISBD) as a screening tool and is widely used in primary care, psychiatric settings, and research. It should be noted that the MDQ is a screening tool, not a diagnostic instrument, and positive screens require comprehensive clinical evaluation.

Formula

Positive screen = ≥7 "yes" on 13 symptom items + concurrent symptoms + moderate/severe impairment

The MDQ is scored in three parts. Part 1: Sum the "yes" responses (1 point each) across the 13 symptom items. Part 2: The patient must confirm that multiple symptoms occurred during the same period of time (concurrent symptoms). Part 3: The patient must indicate at least moderate functional impairment (moderate or serious problems). A positive screen requires all three conditions: 7+ symptoms, concurrent occurrence, and moderate-to-severe impairment. The optimal cutoff of 7+ symptoms was established in the original validation study to maximize sensitivity and specificity for bipolar spectrum disorders.

Score Interpretation

Bipolar spectrum disorders affect approximately 2-5% of the global population, yet they are frequently misdiagnosed — particularly bipolar II disorder and cyclothymia. The average delay between symptom onset and correct diagnosis is 6-10 years, and up to 40% of patients with bipolar disorder are initially misdiagnosed with unipolar depression. This diagnostic delay has significant consequences including inappropriate antidepressant monotherapy (which may trigger manic switches or rapid cycling), increased suicide risk, greater functional impairment, and poorer long-term outcomes. The MDQ addresses this critical gap by providing a brief, validated screening tool that can be administered in routine clinical practice. The MDQ has been validated in multiple languages and populations worldwide, including psychiatric outpatient, primary care, and general population samples. The original validation study reported sensitivity of 73% and specificity of 90% for bipolar spectrum disorders in psychiatric outpatient settings, with lower sensitivity in general population samples. The MDQ is particularly valuable for distinguishing bipolar depression from unipolar depression — a critical clinical distinction with important treatment implications. The International Society for Bipolar Disorders (ISBD) recommends screening for bipolar disorder in patients presenting with depression, especially those with atypical features, early age of onset, or family history of bipolar disorder.

Reference Ranges