Validity of the 32-item Hypomania Checklist (HCL-32) in a clinical sample with mood disorders in China

Hai-chen Yang, Cheng-mei Yuan, Tie-bang Liu, Ling-jiang Li, Hong-jun Peng, Chun-ping Liao, Han Rong, Yi-ru Fang, Jules Angst, Hai-chen Yang, Cheng-mei Yuan, Tie-bang Liu, Ling-jiang Li, Hong-jun Peng, Chun-ping Liao, Han Rong, Yi-ru Fang, Jules Angst

Abstract

Background: The 32-item Hypomania Checklist (HCL-32), a questionnaire for screening bipolar disorders, has been utilised in several countries, but it unclear if the Chinese version of the HCL-32 is valid.

Methods: Consecutive patients with bipolar disorders (BP, N = 300) and unipolar major depression (UP, N = 156) completed the Chinese version of the HCL-32. The subjects underwent a structured clinical interview for DSM-IV Axis-I disorders (SCID).

Results: The eigenvalues for the first three factors in the HCL-32 were calculated as 5.16 (active/elated), 2.72 (risk-taking) and 2.48 (irritable) using factor analysis. Cronbach's alpha for the HCL-32 was calculated to be 0.88. Positive responses to twenty-eight items were significantly more frequent by patients with BP than those with UP, and the other four items (7th, 21st, 25th and 32nd) showed no such trend. Fourteen was the optimal cut-off for discriminating between BP and UP. The HCL-32 distinguished between BP-II and UP, with 13 being the optimal cut-off. A cut-off of 13 yielded a sensitivity of 0.77 and a specificity of 0.62 between BP and UP.

Conclusions: This study demonstrated that the simplified Chinese version of HCL-32 was valid for patients with mood disorders. The optimal cut-off of 13 for distinguishing between BP-II and UP was valid and could be used to improve the sensitivity of screening BP-II patients when the HCL-32 is used in psychiatric settings in China.

Figures

Figure 1
Figure 1
Frequency of positive responses between BP and UP patients. In BP patients, the frequency of positive responses to the thirty two items ranged from 11.6% (7th item, tend to drive faster) to 89.7% (3rd item, more self-confident). In UP patients, the frequency ranged from 6.4% (29th item, drink more coffee; 31th item, drink more alcohol) to 62.2% (3rd item).
Figure 2
Figure 2
Sensitivity and specificity at various cut-offs between BP and UP.
Figure 3
Figure 3
Sensitivity and specificity at various cut-offs between BP-I and UP.
Figure 4
Figure 4
Sensitivity and specificity at various cut-offs between BP-II and UP. A cut-off of thirteen had sensitivity of 0.73 and a specificity of 0.62 between BP-II and UP. A cut-off of fourteen had a sensitivity 0.67 and a specificity 0.66 between BP-II and UP.

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