Research reportFactor structure and reliability of the Italian adaptation of the Hypomania Check List-32, second revision (HCL-32-R2)
Introduction
The onset of bipolar disorder (BD) involves a major depressive episode (MDE) in approximately half of type-I (BD-I) patients, and three-quarters of those diagnosed type-II (BD-II) (Baldessarini et al., 2013, Goodwin and Jamison, 2007, Koukopoulos et al., 2013, Tondo et al., 2014). Nonetheless, studies carried out in psychiatric and primary care settings have found that BD is sometimes under-recognized, particularly in patients presenting for treatment of depression (Ghaemi et al., 2000, Ghaemi et al., 2002, Hantouche et al., 1998, Zimmerman et al., 2008). Even for those patients diagnosed with BD, the time lag between initial treatment seeking and correct diagnosis often exceeds 10 years (Coryell et al., 1995, Hirschfeld et al., 2000, Lish et al., 1994). Yet, the treatment implications of the failure to promptly recognize BD in depressed patients include the under-prescription of mood-stabilizers, an increased risk of rapid cycling, increased cost of care due to ineffective treatment and increased risk for suicide (Baldessarini et al., 2013, Coryell et al., 1995, Dunner, 2003, Fiedorowicz et al., 2011, Ghaemi et al., 2001, Phillips and Kupfer, 2013). When symptomatic, patients with BD are much more likely to experience symptoms of depression and anxiety rather than symptoms of mania or hypomania (Judd et al., 2002). It is therefore often that, when presenting for treatment, patients with BD are not in the manic or hypomanic phases of the illness. This suggests that manic phases, especially when brief or not characterized by impulse dyscontrol, need to be elicited with retrospective assessment. This is done, despite the substantial risk for spontaneous recall bias, essentially due to the frequent lack of subjective suffering, enhanced productivity, ego-syntonicity and diurnal or seasonal rhythmicity associated with several manic/hypomanic symptoms (Cassano et al., 1999). To date, several factors have been proposed as possible predictors for the diagnosis of BD, essentially by comparing early clinical characteristics of patients eventually meeting diagnostic criteria for a bipolar vs. unipolar depressive disorder worldwide (Gilman et al., 2012, Takeshima and Oka, 2013, Tondo et al., 2014). Among other approaches, recommendations for improving the detection of BD include careful clinical evaluations inquiring about a history of mania and hypomania and the use of screening questionnaires (Rucci et al., 2013) aimed at identifying some of the most clinically sound predictive factors of eventual sub-threshold bipolarity (Nusslock and Frank, 2011). The Hypomania-Check-List 32-item (Angst et al., 2005), and its subsequent revisions/translations up to the latest (final 2008 module: CRF 05FEB08) 34-item second revision (HCL-32-R2) (Gamma et al., 2013) have been broadly adopted across different languages and cultural settings as part of the “Bipolar Disorders: Improving Diagnosis, Guidance, and Education” (BRIDGE) worldwide study (Angst et al., 2011). Yet no Italian adaptation of the HCL-32-R2 has been made available to date despite adaptations of the previous versions being available in Italian (Carta et al., 2006, Perugi et al., 2012, Sasdelli et al., 2013).
Therefore, the present study aims at testing the psychometric properties of the Italian adaptation of the HCL-32-R2 based in a representative outpatients׳ sample.
Section snippets
Design
The present observational study was conducted across 12 outpatient facilities through Italy (Catania, Pisa, Genoa, Novara, Naples, Foggia, Teramo, and Bressanone) between March 2013 and October 2014; participants were adult, treatment-seeking outpatients for current depression. After a full description of the study to potential subjects by the appointed investigators, (boarded psychiatrists and/or psychologists with at least five-year post-doctoral clinical and research experience) a written
Essential description of the sample
Four hundred and forty one outpatients accepted to participate to the study. According to literature guidelines, this is considered a representative sample size (Field, 2009). Substantially proportional number of subjects was screened at each participating center. Only two subjects declined the invite to participate to the study, due to privacy concerns. Essential demographic and clinical data of the sample have been outlined in Table 1.
ROC curve analysis and predictive values
Receiver operating characteristics (ROC) curve analysis
Limitations of the study
A number of limitations should be acknowledged in the interpretation of the results from the present study. Specifically, no cross-validation was made with any alternative screening instrument, as the classification of positive vs. negative cases relied just on the DSM-IV diagnoses, no within-groups or healthy-control group comparison was performed distinguishing cases based on their geographical origin or other demographic or clinical features, including severity of current MDE and/or the
Role of founding source
Nothing declared.
Conflict of interest
No conflict declared.
Acknowledgment
None to state.
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Clinical features associated with early drop-out among outpatients with unipolar and bipolar depression
2021, Journal of Psychiatric ResearchGenetic risk for bipolar disorder and psychopathology from childhood to early adulthood
2019, Journal of Affective DisordersCitation Excerpt :We therefore also examined, as sensitivity analyses, binary measures of hypomania defined by HCL scores of ≥16/28, ≥18/28, ≥20/28, ≥22/28 and ≥24/28 to explore whether results are consistent irrespective of how we define the outcome, and if not, how they change as we alter the cut-off threshold Hypomania factors: Other secondary outcomes were latent factors relating to a) ‘energy/mood’ and b) ‘risk-taking/irritability’ that have previously been derived (An et al., 2011; Fornaro et al., 2015; Hantouche et al., 2003; Meyer et al., 2007), and confirmed in this sample (Mistry et al., 2017). We used the Strengths and Difficulties Questionnaire (SDQ) that was completed by parents when their children were aged 9 years as a measure of emotional and behavioural difficulties (Goodman, 1997).
Exploration of the psychometric properties of the 33-item Hypomania Checklist - external assessment (HCL-33-EA)
2019, Journal of Affective DisordersCitation Excerpt :The factor structure of the HCL-33-EA is similar to findings on the HCL-32 (Angst et al., 2005) and the HCL-33 (Feng et al., 2016; Lojko et al., 2016). Previous studies on the HCL scales found different factor loadings, which could possibly be due to socio-cultural influences on the expression of mood symptoms (Gamma et al., 2013; Fornaro et al., 2015a; Fornaro et al., 2015b). Hence, the performance and factor loadings of the HCL-33-EA may have been modified according to the Chinese socio-cultural context.
The development and validation of a short version of the 33-item Hypomania Checklist (HCL-33)
2018, Journal of Affective DisordersCitation Excerpt :As the HCL-16 was developed in the United Kingdom, while the HCL-23 in China, the performance and factor loadings of different short versions of the HCL could be influenced by the given socio-cultural context. The discrepancy in factor loadings between studies could be due to socio-cultural influences on the expression of the mood symptoms (Fornaro et al., 2015a; Fornaro et al., 2015b; Gamma et al., 2013). There are several limitations of this study.
The role of comorbidities in duration of untreated illness for bipolar spectrum disorders
2015, Journal of Affective DisordersCitation Excerpt :In order to improve the diagnosis of BD and thus shortening the DUI, special attention must be paid to some elements such as presence of suicidal acts or substance abuse, cyclothymic temperament, family history of BD, younger onset age (<25 years), and male sex (Tondo et al., 2014). The use of screening tools specifically designed to detect hypomanic symptoms, such as the HCL-32, represent a valid aid also (Angst et al., 2005; Fornaro et al., 2015; Hidalgo-Mazzei et al., 2015). Unlike the Drancourt and cols’ study (2013), no statistically significant differences in DUI according to bipolar subtype were found in this sample.
Factor structure and reliability of the Arabic adaptation of the Hypomania Check List-32, second revision (HCL-32-R2)
2015, Comprehensive PsychiatryCitation Excerpt :Also, no “broader definition of bipolarity”, otherwise assessed by the BRIDGE study, was adopted herein [24]. In our sample, the HCL-32-R2 was in agreement with the two-factor solution already reported by most of previous studies carried either on R0 or R1 adaptations [48] and on the Italian adaptation of the R2 scale as well [64]. Nonetheless, the cumulative explained variance was low compared to the overall one explained by the two-factorial solution reported by the BRIDGE [24] group or the “GAMIAN” European collaborative study [32].