The Rapid Mood Screener: A Novel and Pragmatic Screener Tool for Bipolar I Disorder

Introduction: Depressive episodes/symptoms of bipolar I disorder (BPD-I) are commonly misdiagnosed as major depressive disorder (MDD). We developed the novel and pragmatic Rapid Mood Screener (RMS) to screen for manic symptoms and BPD-I risk factors (eg, age of onset) to improve misdiagnosis of BPD-I as MDD.

Methods: Existing questionnaires and risk factors were identified through a targeted literature search to select concepts thought to differentiate BPD-I from MDD. Individuals with self-reported BPD-I or MDD (N=12) participated in cognitive debriefing interviews to test and refine item wording. An observational study was conducted to evaluate the tool’s predictive validity. Participants with clinical interview-confirmed diagnoses of BPD-I or MDD completed a 10-item draft screening tool and other questionnaires. Data were analyzed to identify the smallest possible subset of items with optimized sensitivity and specificity.

Results: A total of 139 patients with confirmed BPD-I (n=67) or MDD (n=72) participated in the observational study. The draft screening tool was reduced from 10 to 6 items based on item-level analysis. When 4 or more items were endorsed ("yes") in this analysis sample, sensitivity was 0.88 and specificity was 0.80; positive and negative predictive values were 0.80 and 0.88, respectively. These properties represent an improvement over the Mood Disorder Questionnaire while using >50% fewer items.

Conclusion: The novel 6-item RMS differentiates BPD-I from MDD in patients with depressive symptoms. Using the RMS can provide real-world guidance to primary care practitioners on whether more comprehensive assessment for BPD-I is warranted, helping to reduce misdiagnosis and improve treatment selection.