OToPS/Measures/Hypomania Checklist

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The Hypomania Checklist (HCL) is a self report questionnaire created by Jules Angst in 2005 designed to detect hypomanic symptoms in patients with Major Depressive Disorder to aid clinicians in determining a Bipolar II or Bipolar Spectrum Disorder diagnosis. [1] In the creation of the HCL, Angst and team used a population of adults ranging from 30-50 years of age, but since its creation it has been validated in adults ages 18 and older in both inpatient and outpatient settings, and has proven to have good psychometric properties for both reliability and validity. [1][2] It is a 32 item, multiple choice assessment that takes approximately 20 minutes to complete. The HCL is used in both clinical and research settings and has helped clinicians more accurately assess symptoms of hypomania, decreasing rates of misdiagnosis for Bipolar II and Bipolar Spectrum Disorders. [1][2]

Psychometrics[edit]

Reliability[edit]

Click here for instrument reliability table

Reliability[edit]

Not all of the different types of reliability apply to the way that questionnaires are typically used. Internal consistency (whether all of the items measure the same construct) is not usually reported in studies of questionnaires; nor is inter-rater reliability (which would measure how similar peoples' responses were if the interviews were repeated again, or different raters listened to the same interview). Therefore, make adjustments as needed.

Reliability refers to whether the scores are reproducible. Unless otherwise specified, the reliability scores and values come from studies done with a United States population sample. Here is the rubric for evaluating the reliability of scores on a measure for the purpose of evidence based assessment.

Evaluation for norms and reliability for the HCL (table from Youngstrom et al., extending Hunsley & Mash, 2008; *indicates new construct or category)
Criterion Rating (adequate, good, excellent, too good*) Explanation with references
Norms Excellent Multiple convenience samples and research studies, including both clinical and nonclinical samples. Large sample sizes. [2]
Internal consistency (Cronbach’s alpha, split half, etc.) Good Alpha reported in the creation of the HCL is 0.86 in the Swedish sample and .82 in the Italian sample. [1] In future studies with different samples, alpha is consistently over .80. [2]
Interrater reliability Not applicable The HCL is a self-report scale for adults. Thus, inter-rater reliability is not applicable.
Test-retest reliability (stability across multiple settings) Excellent A meta-analytic study of the HCL reported the HCL to have excellent test-retest reliability across a 4-week period. [2]
Repeatability Not published No published studies formally checking repeatability

Validity[edit]

Click here for instrument validity table

Validity[edit]

Validity describes the evidence that an assessment tool measures what it was supposed to measure. There are many different ways of checking validity. For screening measures, diagnostic accuracy and w:discriminative validity are probably the most useful ways of looking at validity. Unless otherwise specified, the validity scores and values come from studies done with a United States population sample. Here is a rubric for describing validity of test scores in the context of evidence-based assessment.

Evaluation of validity and utility for the HCL (table from Youngstrom et al., unpublished, extended from Hunsley & Mash, 2008; *indicates new construct or category)
Criterion Rating (adequate, good, excellent, too good*) Explanation with references
Content validity Excellent Covers both DSM diagnostic symptoms and a range of associated features[1]
Construct validity (e.g., predictive, concurrent, convergent, and discriminant validity) Adequate Studies have not been published comparing the HCL to other measures of bipolar disorder such as the Child Mania Rating Scale, Young Mania Rating Scale, or the General Behavior Inventory. However, the HCL shows good to excellent discriminative and convergent validity, which indicate good construct validity. [1][2]
Discriminative validity Good Many studies have demonstrated excellent discriminative validity of the HCL when trying to distinguish between non-bipolar patients, and patients with unipolar depression. Typically, these studies report Area Under the Curves (AUCs) of at least 0.80 under clinically realistic conditions, not using healthy controls. [1][2] However, despite having a an AUC of 0.80 when discriminating among bipolar, non-bipolar diagnoses, and other mood disorders, the ability of the HCL to discriminate between a bipolar I and a bipolar II diagnosis, is poor, with an AUC of 0.46. [1]
Validity generalization Good The HCL has been validated in a wide age group in mostly outpatient clinics, but also in a few inpatient clinics. [2]
Treatment sensitivity Not published No formal study has been published describing treatment sensitivity.
Clinical utility Good Free (public domain), strong psychometrics, extensive research base. Biggest concerns are length, reading level, and ability to discriminate between a bipolar I and bipolar II diagnosis.

Development and history[edit]

There are multiple version of the HCL, and the most recent iteration of the HCL is the HCL-32, a more robust and developed version of the HCL-20. [1] The HCL was developed to fill the need for a clinical useful and timesaving assessment of hypomanic symptoms in an effort to aid in the diagnosis of bipolar II. [1] Further, other measures were not sensitive to the episodic nature of hypomania, and, or, were only sensitive to mania and not hypomania. [1] The HCL's main purpose was to screen for bipolar II and bipolar spectrum disorders in patients with major depressive disorder. [2]

Impact[edit]

The HCL can be used in clinical and research settings. It has good psychometric properties, and is shown to have good sensitivity to hypomania in patients diagnosed with unipolar or bipolar major depressive patients. [2][3]

Use in other populations[edit]

The HCL has been translated and validated in over 15 different languages. [4][5]

Scoring instructions and syntax[edit]

We have syntax in three major languages: R, SPSS, and SAS. All variable names are the same across all three, and all match the CSV shell that we provide as well as the Qualtrics export.

Hand scoring and general instructions[edit]

Scoring[edit]

The question breakdown of the HCL-32 is as follows:[6]

  • Question 1: is a screening question asking about the participant’s current emotional state
  • Question 2: is a question that asks about the person's typical temperament or personality -- constantly hyperthymic, depressed, or cyclothymic.
  • Question 3: This is the list of 32 yes or no questions that contribute to the participant’s overall score on the measure
  • Questions 4-7: These questions assess the “highs” of the participant over the last 12 months

Interpretation[edit]

The total score of the HCL-32 is mostly based on the answers to the 32 items in question 3:

  • Total scores of 14 or more positive (“yes”) answers indicates higher odds that the person has bipolar disorder.[6]
  • Other risk factors are also important, so if there is a family history of bipolar or mood disorders, the person is advised to see a clinician for a full assessment.[6] The total score has good internal consistency, a common indicator of reliability.

Sample items from the HCL-32 include:

  • "I need less sleep,"
  • "I feel more energetic and more active,"
  • "I spend more/too much money,"
  • "I have more ideas, I am more creative."[7]

CSV shell for sharing[edit]

Click here for CSV shell
  • <Paste link to CSV shell here>

Here is a shell data file that you could use in your own research. The variable names in the shell corresponds with the scoring code in the code for all three statistical programs.

Note that our CSV includes several demographic variables, which follow current conventions in most developmental and clinical psychology journals. You may want to modify them, depending on where you are working. Also pay attention to the possibility of "deductive identification" -- if we ask personal information in enough detail, then it may be possible to figure out the identity of a participant based on a combination of variables.

When different research projects and groups use the same variable names and syntax, it makes it easier to share the data and work together on integrative data analyses or "mega" analyses (which are different and better than meta-analysis in that they are combining the raw data, versus working with summary descriptive statistics).

R/SPSS/SAS syntax[edit]

Click here for R code

R code goes here

Click here for SPSS code

SPSS code goes here

Click here for SAS code

SAS code goes here

See also[edit]

External links[edit]

Screeners[edit]

References[edit]

Click here for references
  1. 1.00 1.01 1.02 1.03 1.04 1.05 1.06 1.07 1.08 1.09 1.10 Angst, Jules; Aldosson, Rolf; Benazzi, Franco; Gamma, Alex; Hantouche, Elie; Meyer, Thomas; Skeppar, Peter; Vieta, Eduard et al. (2005). "The HCL-32: Towards a self-assessment tool for hypomanic symptoms in outpatients". Journal of Affective Disorders 88: 217-233. doi:10.1016/j.jad.2005.05.011. 
  2. 2.0 2.1 2.2 2.3 2.4 2.5 2.6 2.7 2.8 2.9 Meyers, Thomas; Schrader, Julia; Ridley, Matthew; Lex, Claudia (2014). "The Hypomania Checklist (HCL) — Systematic review of its properties to screen for bipolar disorders". Comprehensive Psychiatry 55: 1310-1321. doi:http://dx.doi.org/10.1016/j.comppsych.2014.03.0020010-440X. 
  3. Perugi, Giulio; Fornaro, Michele; Maremmani, Icro; Canonico, Pier; Carbonatto, Paolo; Mencacci, Claudio; Muscettola, Giovanni; Pani, Luca (2012). ""Discriminative Hypomania Checklist-32 Factors in Unipolar and Bipolar Major Depressive Patients"". Psychopathology 45: 390-398. doi:10.1159/000338047. 
  4. Gamma, Alex; Angst, Jules; Azorin, Jean-Michel; Bowden, Charles; Perugi, Giulio; Vieta, Eduard; Young, Alan (2013). ""Transcultural validity of the Hypomania Checklist–32 (HCL-32) in patients with major depressive episodes"". Bipolar Disorders: and International Journal of Psychiatry and Neuroscience 15: 701-712. doi:10.1111/bdi.12101. 
  5. "Hypomania/Mania Symptom Checklist (HCL-32) | PsychEducation". psycheducation.org. Retrieved 2017-10-26.
  6. 6.0 6.1 6.2 Lakarhuset. "Hypomania Checklist Manual" (PDF). Retrieved 2 October 2015.
  7. Angst, Jules (2005). "The HCL-32: Towards a self-assessment tool for hypomanic symptoms in outpatients". Journal of Affective Disorders. doi:10.1016/j.jad.2005.05.011.