Evidence in Action: Screening for Bipolar Disorder with the HCL-32 in N = 6 Adult Puerto Rican Female Outpatients with MDD

It takes ~10 years to reach an accurate bipolar disorder (BD) diagnosis in community clinics, increasing risk of mortality and morbidity. This study aimed to identify clinical correlates of possible BD in outpatients with Major Depressive Disorder (MDD) to improve diagnostic accuracy in non-psychiatric settings. Method: For this exploratory, cross-sectional study, n = 6 adult female outpatients diagnosed with MDD were recruited by availability from a primary health clinic. HCL-32, YMRS, BDI-II, PHQ-9, FAST were used to screen for hypomania, depression and functional impairment. Clinical correlates were identified from the evidence and analyzed in the sample with nonparametric tests. Results: An almost 3-fold increase in depression severity was found in subjects with possible BD (n = 2 BD family history, 1 MDD FHx). Patients with BD family history had earlier illness onset, positive HCL-32 total and irritability/risk-taking scores, histories of alcohol or substance abuse and severe functional impairment. 4/6 participants had MDD family history, but the one with possible BD (irritability/risk-taking only) also had early illness onset and history of postpartum depression, both associated with BD. All possible BD participants had prior hospitalizations. Conclusion: HCL-32 effectively screened for possible BD in a small clinical sample, pointing to the usefulness of this measure as a screening intervention in non-psychiatric settings. Findings from this study support evidence-based clinical correlates on a “micro” level, supporting the need for concise, evidence-based screening interventions to identify BD in MDD patients.