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The MDQ is the brief screen for bipolar-spectrum history. It’s the one to reach for when a client presents as depressed and you want to know whether there has ever been a hypomanic or manic period before you treat the depression as unipolar.

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What it measures

Lifetime manic and hypomanic experience, in three parts. Q1 — thirteen yes/no symptom items, all under the stem “Has there ever been a period of time when you were not your usual self and …”: elevated or hyper mood, irritability, inflated self-confidence, reduced need for sleep, pressured speech, racing thoughts, distractibility, increased energy, increased activity, increased sociability, increased sexual interest, risky or excessive behaviour, and spending that caused trouble. Q2 — one yes/no question about whether several of those symptoms ever happened during the same period of time. Q3 — one four-option question about how much of a problem the symptoms caused: work, family, money, legal trouble, arguments, fights. The frame is lifetime, not the last two weeks. That’s the point — the client sitting in front of you is depressed now; the question is what happened three years ago.

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When to use it

  • Before treating a depression as unipolar. Especially where an antidepressant is on the table or already prescribed by someone else.
  • When a depression hasn’t responded as expected. Treatment-resistant depression is one of the presentations where an unrecognized bipolar-spectrum history turns up.
  • Family history of bipolar disorder.
  • Alongside the PHQ-9 at intake when the history includes periods the client describes as unusually good, productive, or “not myself.”
  • Before a psychiatry referral, so the referral letter carries the screen rather than an impression.

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How clients fill it

Two to three minutes — most of it is yes/no. The thirteen Q1 items all carry the same two options:
  • No
  • Yes
Q2 reads: “If you checked YES to more than one of the above, have several of these ever happened during the same period of time?” — also No or Yes. Q3 reads: “How much of a problem did any of these cause you — like being unable to work; having family, money, or legal troubles; getting into arguments or fights?” — four options:
  • No problem
  • Minor problem
  • Moderate problem
  • Serious problem

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How Rivet scores it

Each Q1 item scores 1 for Yes and 0 for No, and the score Rivet shows you is the count of Yes answers across the thirteen symptom items. Range: 0–13. Q2 and Q3 carry no score. They’re captured with the response and shown with it, but they aren’t summed into anything.

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The positive screen

A positive MDQ screen requires all three of the following:
  1. Seven or more Yes answers among the thirteen Q1 symptom items
  2. Q2 answered Yes — several of the symptoms co-occurred
  3. Q3 answered “Moderate problem” or “Serious problem”
Rivet surfaces the first of those three automatically. The Q1 count and its band appear live in your scoring pill: Q2 and Q3 are yours to read. A Q1 of 9 with Q2 answered No, or with Q3 at “Minor problem,” is not a positive screen — the symptoms were scattered across the client’s life or didn’t cost them anything. Read all three before you call it. Hirschfeld 2000 reported sensitivity of 73% and specificity of 90% in a psychiatric outpatient sample.

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Clinical change

The MDQ isn’t a change measure. It asks about lifetime history, so re-administering it a month later measures nothing new. Administer it once, record the result, and track the depression with a depression measure.

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When NOT to use it

  • As a diagnostic instrument. A positive screen means the clinical interview needs to cover bipolar-spectrum history properly, and usually means a psychiatry consult. It is not a diagnosis.
  • To rule out bipolar disorder. A specificity of 90% is good; a sensitivity of 73% means roughly a quarter of true cases screen negative. A negative MDQ in a client with a strong family history and an odd treatment response doesn’t settle the question.
  • As a repeat outcome measure. See above — the frame is lifetime.
  • When the client can’t recall or report the period reliably. Collateral history often does more than the questionnaire here.

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MDQ vs YMRS

The MDQ is a self-report screen about the client’s history — has there ever been a period like this. The YMRS is rated by you about the client’s state right now, and it measures how severe a current manic episode is. That makes them sequential rather than alternative. The MDQ belongs at intake, particularly before treating what looks like unipolar depression, because a missed bipolar history changes the treatment plan. The YMRS belongs after, when there is a manic or hypomanic presentation to track. One caution about the MDQ specifically: it produces more false positives in clients with borderline features or co-occurring substance use. A positive screen is a reason for a clinical interview, never a diagnosis on its own.

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Is it free to use?

Yes. Hirschfeld’s 2000 publication grants free reproduction without permission.

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Citation

Hirschfeld, Williams, Spitzer, Calabrese, Flynn, Keck, Lewis, McElroy, Post, Rapport, Russell, Sachs & Zajecka (2000). American Journal of Psychiatry, 157: 1873–1875. The MDQ carries an explicit free-reproduction licence from that publication: “this material may be reproduced without permission.” Rivet preserves the canonical item wording verbatim.

PHQ-9

The depression measure the MDQ most often accompanies at intake.

YMRS

The clinician-rated mania severity scale, for when the question moves past screening.

Screening overview

When to screen and picking between overlapping measures.