title: DOES SCREENING WITH THE MDQ AND EPDS IMPROVE IDENTIFICATION OF BIPOLAR DISORDER IN AN OBSTETRICAL SAMPLE?
abstract: BACKGROUND
  Women with bipolar disorder (BD) are at high risk for postpartum affective episodes and psychosis. Although validated screening tools are available for postpartum unipolar depression, few screening tools for hypomania/mania exist. Screening tools for BD in the postpartum period are essential for improving detection and planning appropriate treatment. We evaluated whether adding the Mood Disorders Questionnaire (MDQ) to the Edinburgh Postnatal Depression Scale (EPDS) increased the identification of BD in the early postpartum period.
  
  
  METHODS
  Women (N = 1,279) who delivered a live infant and screened positive on the EPDS and/or MDQ at 4-6 weeks postbirth were invited to undergo an in-home Structured Clinical Interview for DSM-IV (SCID).
  
  
  RESULTS
  Positive EPDS and/or MDQ screens occurred in 12% of the sample (n = 155). In home SCID diagnostic interviews were completed in 93 (60%) of the mothers with positive screens. BD was the primary diagnosis in 37% (n = 34). Women with BD screened positive on the EPDS and/or MDQ as follows: EPDS+/MDQ+ (n = 14), EPDS+/MDQ- (n = 17), and EPDS-/MDQ+ (n = 3). The MDQ identified 50% (17/34) of the women with BD and 6 additional cases of BD when the MDQ question regarding how impaired the mother perceived herself was excluded from the screen criterion.
  
  
  CONCLUSIONS
  Addition of the MDQ to the EPDS improved the distinction of unipolar depression from bipolar depression at the level of screening in 50% of women with traditional MDQ scoring and by nearly 70% when the MDQ was scored without the impairment criterion.
authors.affiliation: Asher Center for the Study and Treatment of Depressive Disorders, Department of Psychiatry, Northwestern University Feinberg School of Medicine, Chicago, Illinois.
authors.forename: Crystal T
authors.initials: CT
authors.lastname: Clark
authors.affiliation: Department of Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania.
authors.forename: Dorothy K Y
authors.initials: DK
authors.lastname: Sit
authors.affiliation: Asher Center for the Study and Treatment of Depressive Disorders, Department of Psychiatry, Northwestern University Feinberg School of Medicine, Chicago, Illinois.
authors.forename: Kara
authors.initials: K
authors.lastname: Driscoll
authors.affiliation: Department of Epidemiology, Graduate School of Public Health, Epidemiology Data Center, University of Pittsburgh, Pittsburgh, Pennsylvania.
authors.forename: Heather F
authors.initials: HF
authors.lastname: Eng
authors.affiliation: Center for Health Equity Research and Promotion, VA Pittsburgh Healthcare System, Pittsburgh, Pennsylvania.
authors.forename: Andrea L
authors.initials: AL
authors.lastname: Confer
authors.affiliation: Department of Epidemiology, Graduate School of Public Health, Epidemiology Data Center, University of Pittsburgh, Pittsburgh, Pennsylvania.
authors.forename: James F
authors.initials: JF
authors.lastname: Luther
authors.affiliation: Department of Epidemiology, Graduate School of Public Health, Epidemiology Data Center, University of Pittsburgh, Pittsburgh, Pennsylvania.
authors.forename: Stephen R
authors.initials: SR
authors.lastname: Wisniewski
authors.affiliation: Asher Center for the Study and Treatment of Depressive Disorders, Department of Psychiatry, Northwestern University Feinberg School of Medicine, Chicago, Illinois.
authors.forename: Katherine L
authors.initials: KL
authors.lastname: Wisner
mesh_terms: D000328:Adult; D001008:Anxiety Disorders / Q000175:diagnosis; D001714:Bipolar Disorder / Q000175:diagnosis*; D003866:Depressive Disorder / Q000175:diagnosis; D005260:Female; D006801:Humans; D049590:Postpartum Period; D011569:Psychiatric Status Rating Scales / Q000592:standards*; D019966:Substance-Related Disorders / Q000175:diagnosis; D055815:Young Adult
keywords: bipolar; depression; manic-depressive; postnatal; postpartum; screening