title: Factor structure and reliability of the Italian adaptation of the Hypomania Check List-32, second revision (HCL-32-R2).
abstract: OBJECTIVE
  To assess the psychometric properties of the Italian adaptation of the Hypomania-Check-List 32-item, second revision (HCL-32-R2) for the detection of bipolarity in major depressive disorder (MDD) treatment-seeking outpatients.
  
  
  METHODS
  A back-to-back Italian adaption of the "Bipolar Disorders: Improving Diagnosis, Guidance, and Education" English module of the HCL-32-R2 was administered between March 2013 and October 2014 across twelve collaborating sites in Italy. 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=441, of whom, BD-I=68; BD-II=117; MDD=256), using a cut-off of 14 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=89% and specificity=79%. Area under the curve was .888; positive and negative predictive values were 75.34% and 90.99% 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 factor analyses, whereas items n.33 ("I gamble more") and n.34 ("I eat more") introduced in the R2 version of the scale slightly loaded onto F2 and F1 respectively. Cronbach׳s α=.88 for F1 and .71 for F2.
  
  
  CONCLUSIONS
  No cross-validation with any additional validated screening tool; treatment-seeking outpatient sample; recall bias; no systematic evaluation of eventual medical/psychiatric comorbidities, current/lifetime pharmacological history, neither record of severity of current MDE.
  
  
  CONCLUSIONS
  Our results seem to indicate fair accuracy of HCL-32 as a screening instrument for BD, though replication studies are warranted.
authors: Department of Education Science, University of Catania, Catania, Italy; Polyedra Research Group, Italy. Electronic address: dott.fornaro@gmail.com.
authors: Michele
authors: M
authors: Fornaro
authors: Polyedra Research Group, Italy; 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: Domenico
authors: D
authors: De Berardis
authors: Polyedra Research Group, Italy; Department of Life, Health and Environmental Sciences, University of L׳Aquila, L׳Aquila, Italy. Electronic address: monica.mazza@cc.univaq.it.
authors: Monica
authors: M
authors: Mazza
authors: Department of Life, Health and Environmental Sciences, University of L׳Aquila, L׳Aquila, Italy. Electronic address: mariachiara.pino@graduate.univaq.it.
authors: Mariachiara
authors: M
authors: Pino
authors: Department of Psychiatry of Bressanone (Brixen), Bolzano (Bozen), Italy. Electronic address: efavaretto@yahoo.com.
authors: Ettore
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authors: Favaretto
authors: Department of Psychiatry of Bressanone (Brixen), Bolzano (Bozen), Italy. Electronic address: fulviobedani@icloud.com.
authors: Fulvio
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authors: Bedani
authors: Department of Psychiatry of Bressanone (Brixen), Bolzano (Bozen), Italy. Electronic address: christian.wieser@sb-brixen.it.
authors: Christian
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authors: Wieser
authors: Department of Education Science, University of Catania, Catania, Italy. Electronic address: luisa.indelicato@hotmail.it.
authors: Luisa
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authors: Indelicato
authors: Centro siciliano per la cura di Depressione e Ansia (CESIDEA), Catania, Italy; Ospedale San Raffaele, Milano, Italy. Electronic address: info@cesidea.it.
authors: Vito Fabio
authors: VF
authors: Paternò
authors: Department of Education Science, University of Catania, Catania, Italy. Electronic address: francescalomonaco91@live.it.
authors: Francesca
authors: F
authors: Lo Monaco
authors: Department of Education Science, University of Catania, Catania, Italy. Electronic address: brunelladugo@alice.it.
authors: Febronia
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authors: Dugo
authors: Section of Psychiatry, University of Foggia, Department of Clinical and Experimental Medicine, Foggia, Italy. Electronic address: dr.ventriglio@gmail.com.
authors: Antonio
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authors: Department of Psychiatry, University of Genova, Genoa, Italy. Electronic address: sergiomungo@libero.it.
authors: Sergio
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authors: Clinica Viarnetto, Lugano, Switzerland. Electronic address: v.selle@clinicaviarnetto.ch.
authors: Valerio
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authors: Polyedra Research Group, Italy; Casa di Cura Villa San Giuseppe, Via dei Girasoli, n.6, 63100 Ascoli Piceno, Italy. Electronic address: alessandrovalchera@gmail.com.
authors: Alessandro
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authors: Valchera
authors: Department of Psychiatry, Mansoura Faculty of Medicine, Mansoura City, Egypt. Electronic address: elassym@gmail.com.
authors: Mai
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authors: Elassy
authors: Polyedra Research Group, Italy; Department of Neuroscience and Imaging, University "G. d׳Annunzio", Chieti, Italy. Electronic address: giovanni.martinotti@gmail.com.
authors: Giovanni
authors: G
authors: Martinotti
authors: Section of Psychiatry - Department of Neuroscience - University School of Naples "Federico II", Naples, Italy. Electronic address: adebarto@unina.it.
authors: Andrea
authors: A
authors: De Bartolomeis
authors: Polyedra Research Group, Italy; Section of Psychiatry - Department of Neuroscience - University School of Naples "Federico II", Naples, Italy. Electronic address: felix_ias@hotmail.com.
authors: Felice
authors: F
authors: Iasevoli
authors: Polyedra Research Group, Italy; Section of Psychiatry - Department of Neuroscience - University School of Naples "Federico II", Naples, Italy; National Health Service, Department of Mental Health, Unit of Psychiatry, Isernia, Italy. Electronic address: carmine.tomasetti@gmail.com.
authors: Carmine
authors: C
authors: Tomasetti
authors: Section of Psychiatry - Department of Neuroscience - University School of Naples "Federico II", Naples, Italy. Electronic address: livia.avvisati@gmail.com.
authors: Livia
authors: L
authors: Avvisati
authors: National Health Service, Department of Mental Health, Unit of Psychiatry, Isernia, Italy. Electronic address: sergio.tartaglione@asrem.org.
authors: Sergio
authors: S
authors: Tartaglione
authors: Polyedra Research Group, Italy; Department of Clinical Neuroscience, San Benedetto Hospital, Hermanas Hospitalarias, Albese con Cassano, Como, Italy. Electronic address: pernagp@gmail.com.
authors: Giampaolo
authors: G
authors: Perna
authors: National Health System, "ASL 13", Novara, Italy. Electronic address: dr.carloignaziocattaneo@gmail.com.
authors: Carlo Ignazio
authors: CI
authors: Cattaneo
authors: Department of Psychiatry, University of Pisa, Pisa, Italy. Electronic address: cogi77@gmail.com.
authors: Giorgio
authors: G
authors: Consoli
authors: Department of Psychiatry, University of Pisa, Pisa, Italy. Electronic address: annaromano21@libero.it.
authors: Anna
authors: A
authors: Romano
authors: Department of Psychiatry, University of Pisa, Pisa, Italy. Electronic address: adeldebbio@gmail.com.
authors: Alessandro
authors: A
authors: Del Debbio
authors: Department of Psychiatry, University of Genova, Genoa, Italy. Electronic address: matteomartino9@gmail.com.
authors: Matteo
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authors: Martino
authors: Department of Psychiatry, University of Genova, Genoa, Italy. Electronic address: dangelo1980@hotmail.com.
authors: Emanuela
authors: E
authors: D' Angelo
authors: Department of Education Science, University of Catania, Catania, Italy. Electronic address: depasqua@unict.it.
authors: Concetta
authors: C
authors: De Pasquale
authors: St. John׳s National Academy of Health Sciences, Bangalore, India. Electronic address: ann007sarah@gmail.com.
authors: Ann Sarah
authors: AS
authors: Koshy
authors: Department of Psychiatry, Psychotherapy and Psychosomatics, Psychiatric Hospital, University of Zurich, Zurich, Switzerland. Electronic address: jules.angst@uzh.ch.
authors: Jules
authors: J
authors: Angst
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001714:Bipolar Disorder / Q000453:epidemiology*; D015897:Comorbidity; D003865:Major Depressive Disorder / Q000453:epidemiology*; D039721:Diagnostic and Statistical Manual of Mental Disorders; D005260:Female; D006801:Humans; D007558:Italy / Q000453:epidemiology; D008297:Male; D008875:Middle Aged; D011237:Predictive Value of Tests; D011569:Psychiatric Status Rating Scales / Q000706:statistics & numerical data*; D011594:Psychometrics; D015203:Reproducibility of Results; D055815:Young Adult
keywords: 34-item; Bipolar disorder; Depression; Hypomania Check-List-32, second revision (HCL-32-R2); Italian