Comparing the Self- and External Assessment Versions of the HCL-33 as Screening Instruments for Bipolar Disorder in Older Depressed Patients
Objectives: The misdiagnosis of bipolar disorder (BD) as major depressive disorder (MDD) is common in depressed older adults. The self-rated HCL-33 and its external assessment version (HCL-33-EA) have been developed to screen for hypomanic symptoms. This study compared the screening ability of these...
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Frontiers Media S.A.
2021
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oai:doaj.org-article:e7169ee6dae44216b18ea5276a3af0842021-11-15T04:53:07ZComparing the Self- and External Assessment Versions of the HCL-33 as Screening Instruments for Bipolar Disorder in Older Depressed Patients1664-064010.3389/fpsyt.2021.727992https://doaj.org/article/e7169ee6dae44216b18ea5276a3af0842021-11-01T00:00:00Zhttps://www.frontiersin.org/articles/10.3389/fpsyt.2021.727992/fullhttps://doaj.org/toc/1664-0640Objectives: The misdiagnosis of bipolar disorder (BD) as major depressive disorder (MDD) is common in depressed older adults. The self-rated HCL-33 and its external assessment version (HCL-33-EA) have been developed to screen for hypomanic symptoms. This study compared the screening ability of these two instruments to discriminate BD from MDD.Methods: A total of 215 patients (107 with BD and 108 with MDD) and their carers were recruited. Patients and their carers completed the HCL-33 and HCL-33-EA, respectively. The consistency of the total score and the positive response to each item between the two scales was calculated with the intraclass correlation coefficient (ICC) and Cohen's kappa coefficient separately. Receiver operating characteristics (ROC) curves were drawn for both instruments. The optimal cut-off points were determined according to the maximum Youden's Index. The areas under the ROC curve (AUC) of the HCL-33 and HCL-33-EA were calculated separately and compared. The sensitivity and specificity at the optimal cut-off values were also calculated separately for the HCL-33 and HCL-33-EA.Results: The intraclass correlation coefficient (ICC) between the total scores of the HCL-33 and HCL-33-EA was 0.823 (95% CI = 0.774–0.862). The positive response rate on all items showed high agreement between the two instruments. ROC curve analysis demonstrated that the total scores of both HCL-33 and HCL-33-EA differentiated well between MDD and BD, while there was no significant difference in the AUCs between the two scales (Z = 0.422, P = 0.673). The optimal cutoff values for the HCL-33 and HCL-33-EA were 14 and 12, respectively. With the optimal cutoff value, the sensitivities of the HCL-33 and HCL-33-EA were 88.8% and 93.5%, and their specificities were 82.4% and 79.6%.Conclusion: Both the HCL-33 and HCL-33-EA had good screening ability for discriminating BD from MDD in depressed older adults.Xinqiao ZhangWen LiNa ZhaoNa ZhaoNa ZhaoYu JinTeris CheungGabor S. UngvariGabor S. UngvariXi-Ling CuiGang WangYu-Tao XiangYu-Tao XiangYu-Tao XiangJules AngstFrontiers Media S.A.articlebipolar disorderHCL-33older adultsmajor depressive disorderpsychometric propertyPsychiatryRC435-571ENFrontiers in Psychiatry, Vol 12 (2021) |
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DOAJ |
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bipolar disorder HCL-33 older adults major depressive disorder psychometric property Psychiatry RC435-571 |
| spellingShingle |
bipolar disorder HCL-33 older adults major depressive disorder psychometric property Psychiatry RC435-571 Xinqiao Zhang Wen Li Na Zhao Na Zhao Na Zhao Yu Jin Teris Cheung Gabor S. Ungvari Gabor S. Ungvari Xi-Ling Cui Gang Wang Yu-Tao Xiang Yu-Tao Xiang Yu-Tao Xiang Jules Angst Comparing the Self- and External Assessment Versions of the HCL-33 as Screening Instruments for Bipolar Disorder in Older Depressed Patients |
| description |
Objectives: The misdiagnosis of bipolar disorder (BD) as major depressive disorder (MDD) is common in depressed older adults. The self-rated HCL-33 and its external assessment version (HCL-33-EA) have been developed to screen for hypomanic symptoms. This study compared the screening ability of these two instruments to discriminate BD from MDD.Methods: A total of 215 patients (107 with BD and 108 with MDD) and their carers were recruited. Patients and their carers completed the HCL-33 and HCL-33-EA, respectively. The consistency of the total score and the positive response to each item between the two scales was calculated with the intraclass correlation coefficient (ICC) and Cohen's kappa coefficient separately. Receiver operating characteristics (ROC) curves were drawn for both instruments. The optimal cut-off points were determined according to the maximum Youden's Index. The areas under the ROC curve (AUC) of the HCL-33 and HCL-33-EA were calculated separately and compared. The sensitivity and specificity at the optimal cut-off values were also calculated separately for the HCL-33 and HCL-33-EA.Results: The intraclass correlation coefficient (ICC) between the total scores of the HCL-33 and HCL-33-EA was 0.823 (95% CI = 0.774–0.862). The positive response rate on all items showed high agreement between the two instruments. ROC curve analysis demonstrated that the total scores of both HCL-33 and HCL-33-EA differentiated well between MDD and BD, while there was no significant difference in the AUCs between the two scales (Z = 0.422, P = 0.673). The optimal cutoff values for the HCL-33 and HCL-33-EA were 14 and 12, respectively. With the optimal cutoff value, the sensitivities of the HCL-33 and HCL-33-EA were 88.8% and 93.5%, and their specificities were 82.4% and 79.6%.Conclusion: Both the HCL-33 and HCL-33-EA had good screening ability for discriminating BD from MDD in depressed older adults. |
| format |
article |
| author |
Xinqiao Zhang Wen Li Na Zhao Na Zhao Na Zhao Yu Jin Teris Cheung Gabor S. Ungvari Gabor S. Ungvari Xi-Ling Cui Gang Wang Yu-Tao Xiang Yu-Tao Xiang Yu-Tao Xiang Jules Angst |
| author_facet |
Xinqiao Zhang Wen Li Na Zhao Na Zhao Na Zhao Yu Jin Teris Cheung Gabor S. Ungvari Gabor S. Ungvari Xi-Ling Cui Gang Wang Yu-Tao Xiang Yu-Tao Xiang Yu-Tao Xiang Jules Angst |
| author_sort |
Xinqiao Zhang |
| title |
Comparing the Self- and External Assessment Versions of the HCL-33 as Screening Instruments for Bipolar Disorder in Older Depressed Patients |
| title_short |
Comparing the Self- and External Assessment Versions of the HCL-33 as Screening Instruments for Bipolar Disorder in Older Depressed Patients |
| title_full |
Comparing the Self- and External Assessment Versions of the HCL-33 as Screening Instruments for Bipolar Disorder in Older Depressed Patients |
| title_fullStr |
Comparing the Self- and External Assessment Versions of the HCL-33 as Screening Instruments for Bipolar Disorder in Older Depressed Patients |
| title_full_unstemmed |
Comparing the Self- and External Assessment Versions of the HCL-33 as Screening Instruments for Bipolar Disorder in Older Depressed Patients |
| title_sort |
comparing the self- and external assessment versions of the hcl-33 as screening instruments for bipolar disorder in older depressed patients |
| publisher |
Frontiers Media S.A. |
| publishDate |
2021 |
| url |
https://doaj.org/article/e7169ee6dae44216b18ea5276a3af084 |
| work_keys_str_mv |
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