MDQ: Mood Disorder Questionnaire

What this assessment is

The standard adult MDQ is positive only when a person endorses at least 7 of 13 lifetime symptoms, reports that several occurred together, and rates the resulting problems as moderate or serious. It is a screen, not a diagnosis or a 15-point severity scale.

Robert Hirschfeld and colleagues introduced the Mood Disorder Questionnaire as a self-report screen for a lifetime history of symptoms associated with bipolar spectrum disorders in a 2000 validation study.

Hirschfeld later described its intended primary care use in a clinical overview.

The result identifies a response pattern that may justify a fuller clinical assessment.

Who it was designed for

The original English-language U.S. validation involved adults receiving outpatient psychiatric care. A later study tested the instrument in the general U.S. population.

The current VA/DoD guideline supports case finding when history or examination creates clinical suspicion of mania or hypomania. It advises against routine screening of a general medical population.

It is not designed to decide the diagnosis alone. The adolescent MDQ-A and translated forms are different versions that need evidence appropriate to their population and use.

How it is administered

The reviewed standard MDQ is self-completed, asks about experiences across the person's lifetime, and takes about five minutes according to the author-permitted form.

It has three parts:

• 13 yes-or-no symptom responses
• one question about whether several endorsed experiences happened during the same period
• one rating of how much difficulty those experiences caused

The form records 15 responses, but only the 13 symptom responses are counted. The concurrence and impairment responses act as gates in the screening rule, not extra points. A later 2002 Eli Lilly-branded form adds two unscored history prompts, so records should identify the exact version used.

Use the complete form. Removing the concurrence or impairment question changes the screening rule.

What it measures

The symptom section covers broad domains such as mood elevation or irritability, activation, sleep or thinking changes, and behavior or functioning.

The concurrence question checks whether several experiences clustered in one period. The impairment question checks whether the cluster caused meaningful problems.

Those responses record clustering and impact. They cannot establish the episode's duration, cause, or diagnostic context.

How scoring works

The original positive-screen rule requires all three conditions:

• seven or more of the 13 symptom responses are endorsed
• several endorsed experiences occurred during the same period
• the reported problems were moderate or serious

If one condition is absent, the original algorithm is not positive.

Do not treat the 15 responses as a severity total or seven symptoms alone as a positive result. The concurrence and impairment responses are part of the rule.

The published algorithm gives no rule for replacing a missing response. Do not turn a blank into a “no” response.

How to interpret an MDQ result

The result is usually reported as positive or negative under a stated algorithm.

A positive screen means the response pattern resembles patterns seen in some people with bipolar disorder. A clinical interview should examine distinct mood episodes, their duration, change from usual behavior, and functional impact. It should also consider depression history, medication or substance effects, sleep, medical causes, and family history.

It does not prove bipolar I disorder, bipolar II disorder, or another bipolar spectrum condition.

A negative result does not rule them out. An independent review found that the standard rule was less likely to identify bipolar II disorder than bipolar I disorder, and performance varied by setting.

What the result cannot tell you

The MDQ cannot determine whether endorsed experiences happened during a manic or hypomanic episode.

Similar experiences can occur with attention problems, trauma, anxiety, substance use, medication effects, sleep loss, personality traits, physical illness, or ordinary periods of high activity.

The MDQ also cannot rate current symptom severity, choose treatment, or determine urgency by itself.

Evidence and limitations

In the original psychiatric outpatient validation, the standard rule identified 73% of participants who met the study's diagnostic standard and screened negative 90% of those who did not. These are the sensitivity and specificity for that sample.

In the general-population validation, the rule identified 28.1% of participants who met the study's diagnostic standard and screened negative 97.2% of those who did not. The proportion of positive screens that are true cases also depends on prevalence, which means how common bipolar disorder is in the screened population.

Those results show why setting matters. A negative screen cannot close the question when the history still suggests distinct periods of elevated or irritable mood and clear change in function.