title: Factor structure and reliability of the Arabic adaptation of the Hypomania Check List-32, second revision (HCL-32-R2).
abstract: OBJECTIVE
  To assess the psychometric properties of the Arabic adaptation of the Hypomania-Check-List 32-item, second revision (HCL-32-R2) for the detection of bipolarity in major depressive disorder (MDD) inpatients suffering a current major depressive episode (MDE).
  
  
  METHODS
  The "Bipolar Disorders: Improving Diagnosis, Guidance, and Education" Arabic module of the HCL-32-R2 was administered to mother-tongue Arabic MDE inpatients between March 2013 and October 2014. Diagnostic and Statistical Manual Fourth edition (DSM-IV) diagnoses were made adopting the mini-international neuropsychiatric interview, using bipolar disorder (BD) patients as controls.
  
  
  RESULTS
  In our sample (n=500, of whom, BD-I=329; BD-II=70; MDD=101), using a cut-off of 17 allowed the HCL-32-R2 to discriminate DSM-IV-defined MDD patients between "true unipolar" (HCL-32-R2(-)) and "sub-threshold bipolar depression" (HCL-32-R2(+)) with sensitivity=82% and specificity=77%. Area under the curve was .883; positive and negative predictive values were 93.44% and 73.23% respectively. Owing to clinical interpretability considerations and consistency with previous adaptations of the HCL-32, a two-factor solution (F1="hyperactive/elated" vs. F2="irritable/distractible/impulsive") was preferred using exploratory and confirmatory factors analyses. Item n.33 ("I gamble more") and n.34 ("I eat more") introduced in the R2 version of the HCL-32 loaded onto F1, though very slightly. Cronbach's alphas were F1=.86 and F2=.60.
  
  
  CONCLUSIONS
  No cross-validation with any additional validated screening tool. Inpatients only sample; recall bias; no systematic evaluation of eventual medical/psychiatric comorbidities, current/lifetime pharmacological history, or record of severity of current MDE.
  
  
  CONCLUSIONS
  In our sample, the HCL-32 fairly discriminated between MDD and BD-I but not BD-II, therefore soliciting for replication studies for use in Arabic-speaking depressed inpatients.
authors.affiliation: Department of Education Science, University of Catania, Catania, Italy. Electronic address: dott.fornaro@gmail.com.
authors.forename: Michele
authors.initials: M
authors.lastname: Fornaro
authors.affiliation: Department of Psychiatry, Mansoura University, Mansoura City, Egypt. Electronic address: elassym@gmail.com.
authors.forename: Mai
authors.initials: M
authors.lastname: Elassy
authors.affiliation: Department of Psychiatry, Mansoura University, Mansoura City, Egypt. Electronic address: marianne_123@hotmail.com.
authors.forename: Mina
authors.initials: M
authors.lastname: Mounir
authors.affiliation: Department of Psychiatry, Mansoura University, Mansoura City, Egypt. Electronic address: mohamed.samir33@yahoo.com.
authors.forename: Noran
authors.initials: N
authors.lastname: Abd-Elmoneim
authors.affiliation: Department of Psychiatry, Mansoura University, Mansoura City, Egypt. Electronic address: zeyadloay@yahoo.com.
authors.forename: Hala
authors.initials: H
authors.lastname: Ashour
authors.affiliation: Al-Azhar University, Cairo, Egypt. Electronic address: mohammed.ragab40@yahoo.com.
authors.forename: Rania
authors.initials: R
authors.lastname: Hamed
authors.affiliation: Abha general hospital, Abha, Saudi Arabia. Electronic address: al-shehri99@live.com.
authors.forename: Abdullah
authors.initials: A
authors.lastname: Al-Shehri
authors.affiliation: Department of Psychiatry, Mansoura University, Mansoura City, Egypt. Electronic address: samirelsayed112@yahoo.com.
authors.forename: Samir
authors.initials: S
authors.lastname: Bedir
authors.affiliation: Department of Psychiatry, Mansoura University, Mansoura City, Egypt. Electronic address: Ibrahem.hamdey@yahoo.com.
authors.forename: Ibrahem
authors.initials: I
authors.lastname: Rashed
authors.affiliation: Department of Psychiatry, Mansoura University, Mansoura City, Egypt. Electronic address: noha.amer87@gmail.com.
authors.forename: Noha
authors.initials: N
authors.lastname: Amer
authors.affiliation: South Valley University, Qenna, Egypt. Electronic address: Tolaetela@hotmail.com.
authors.forename: Talal A
authors.initials: TA
authors.lastname: Mohammed
authors.affiliation: National Health Service, Department of Mental Health, Psychiatric Service of Diagnosis and Treatment, Hospital "G. Mazzini", ASL 4, Teramo, Italy. Electronic address: dodebera@aliceposta.it.
authors.forename: Domenico
authors.initials: D
authors.lastname: De Berardis
authors.affiliation: Department of Life, Health and Environmental Sciences, University of L'Aquila, L'Aquila, Italy. Electronic address: monica.mazza@cc.univaq.it.
authors.forename: Monica
authors.initials: M
authors.lastname: Mazza
authors.affiliation: Department of Life, Health and Environmental Sciences, University of L'Aquila, L'Aquila, Italy. Electronic address: mariachiara.pino@graduate.univaq.it.
authors.forename: Mariachiara
authors.initials: M
authors.lastname: Pino
authors.affiliation: St. John's National Academy of Health Sciences, Bangalore, India. Electronic address: ann007sarah@gmail.com.
authors.forename: Ann Sarah
authors.initials: AS
authors.lastname: Koshy
authors.affiliation: Department of Education Science, University of Catania, Catania, Italy. Electronic address: depasqua@unict.it.
authors.forename: Concetta
authors.initials: C
authors.lastname: De Pasquale
authors.affiliation: Institute of Psychiatry, Ain Shams University, Cairo, Egypt. Electronic address: tokasha@internetegypt.com.
authors.forename: Tarek
authors.initials: T
authors.lastname: Okasha
authors.affiliation: Department of Psychiatry, Psychotherapy and Psychosomatics, Psychiatric Hospital, University of Zurich, Switzerland. Electronic address: jules.angst@uzh.ch.
authors.forename: Jules
authors.initials: J
authors.lastname: Angst
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D018912:Arabs / Q000523:psychology*; D001714:Bipolar Disorder / Q000150:complications / Q000175:diagnosis*; D003865:Major Depressive Disorder / Q000150:complications / Q000175:diagnosis*; D039721:Diagnostic and Statistical Manual of Mental Disorders; D005163:Factor Analysis, Statistical; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011594:Psychometrics; D015203:Reproducibility of Results; D055815:Young Adult