title: Screening for bipolar spectrum disorders: A comprehensive meta-analysis of accuracy studies.
abstract: BACKGROUND
  Bipolar spectrum disorders are frequently under-recognized and/or misdiagnosed in various settings. Several influential publications recommend the routine screening of bipolar disorder. A systematic review and meta-analysis of accuracy studies for the bipolar spectrum diagnostic scale (BSDS), the hypomania checklist (HCL-32) and the mood disorder questionnaire (MDQ) were performed.
  
  
  METHODS
  The Pubmed, EMBASE, Cochrane, PsycINFO and SCOPUS databases were searched. Studies were included if the accuracy properties of the screening measures were determined against a DSM or ICD-10 structured diagnostic interview. The QUADAS-2 tool was used to rate bias.
  
  
  RESULTS
  Fifty three original studies met inclusion criteria (N=21,542). At recommended cutoffs, summary sensitivities were 81%, 66% and 69%, while specificities were 67%, 79% and 86% for the HCL-32, MDQ, and BSDS in psychiatric services, respectively. The HCL-32 was more accurate than the MDQ for the detection of type II bipolar disorder in mental health care centers (P=0.018). At a cutoff of 7, the MDQ had a summary sensitivity of 43% and a summary specificity of 95% for detection of bipolar disorder in primary care or general population settings.
  
  
  CONCLUSIONS
  Most studies were performed in mental health care settings. Several included studies had a high risk of bias.
  
  
  CONCLUSIONS
  Although accuracy properties of the three screening instruments did not consistently differ in mental health care services, the HCL-32 was more accurate than the MDQ for the detection of type II BD. More studies in other settings (for example, in primary care) are necessary.
authors.affiliation: (a)Translational Psychiatry Research Group, Faculty of Medicine, Federal University of Ceara, Fortaleza, CE, Brazil. Electronic address: andrefc7@terra.com.br.
authors.forename: André F
authors.initials: AF
authors.lastname: Carvalho
authors.affiliation: Department of Public Health, Epidemiology and Biostatistics, University of Birmingham, Birmingham, UK.
authors.forename: Yemisi
authors.initials: Y
authors.lastname: Takwoingi
authors.affiliation: (a)Translational Psychiatry Research Group, Faculty of Medicine, Federal University of Ceara, Fortaleza, CE, Brazil.
authors.forename: Paulo Marcelo G
authors.initials: PM
authors.lastname: Sales
authors.affiliation: Mood Disorders Psychopharmacology Unit, University of Toronto, Toronto, ON, Canada.
authors.forename: Joanna K
authors.initials: JK
authors.lastname: Soczynska
authors.affiliation: Memory Research Laboratory, Brain Institute (ICe), Federal University of Rio Grande do Norte (UFRN), Natal, RN, Brazil.
authors.forename: Cristiano A
authors.initials: CA
authors.lastname: Köhler
authors.affiliation: (a)Translational Psychiatry Research Group, Faculty of Medicine, Federal University of Ceara, Fortaleza, CE, Brazil.
authors.forename: Thiago H
authors.initials: TH
authors.lastname: Freitas
authors.affiliation: Laboratory of Neurosciences, Graduate Program in Health Sciences, Health Sciences Unit, University of Southern Santa Catarina, Criciúma, SC, Brazil; Center for Experimental Models in Psychiatry, Department of Psychiatry and Behavioral Sciences, The University of Texas Medical School at Houston, Houston, TX, USA.
authors.forename: João
authors.initials: J
authors.lastname: Quevedo
authors.affiliation: Department of Psychiatry, University of Ioaninna, Ioaninna, Greece.
authors.forename: Thomas N
authors.initials: TN
authors.lastname: Hyphantis
authors.affiliation: Mood Disorders Psychopharmacology Unit, University of Toronto, Toronto, ON, Canada; Departments of Psychiatry and Pharmacology, University of Toronto, Toronto, ON, Canada.
authors.forename: Roger S
authors.initials: RS
authors.lastname: McIntyre
authors.affiliation: Bipolar Disorders Unit, Clinical Institute of Neurosciences, Hospital Clinic, IDIBAPS, University of Barcelona, CIBERSAM, Barcelona, Catalonia, Spain.
authors.forename: Eduard
authors.initials: E
authors.lastname: Vieta
mesh_terms: D000328:Adult; D001714:Bipolar Disorder / Q000175:diagnosis* / Q000453:epidemiology / Q000523:psychology; D057189:Checklist / Q000706:statistics & numerical data; D003527:Cyclothymic Disorder / Q000175:diagnosis; D003937:Diagnosis, Differential; D005260:Female; D006801:Humans; D038801:International Classification of Diseases; D008403:Mass Screening / Q000706:statistics & numerical data*; D008605:Mental Health Services / Q000458:organization & administration*; D011320:Primary Health Care / Q000458:organization & administration*; D011795:Surveys and Questionnaires
keywords: Accuracy studies; Bipolar disorder; Meta-analysis; Screening; Systematic review