A comparison of the 33-item Hypomania Checklist with the 33-item Hypomania Checklist-external assessment for the detection of bipolar disorder in adolescents

Xu Chen, Wei Bai, Na Zhao, Sha Sha, Teris Cheung, Gabor S. Ungvari, Yuan Feng, Yu Tao Xiang, Jules Angst

Research output: Journal article publicationJournal articleAcademic researchpeer-review


Background: Adolescents with bipolar disorder (BD) are often misdiagnosed as having major depressive disorder (MDD), which delays appropriate treatment and leads to adverse outcomes. The aim of this study was to compare the performance of the 33-item Hypomania Checklist (HCL-33) with the 33-item Hypomania Checklist- external assessment (HCL-33-EA) in adolescents with BD or MDD. Methods: 147 adolescents with BD and 113 adolescents with MDD were consecutively recruited. The HCL-33 and HCL-33-EA were completed by patients and their carers, respectively. The sensitivity, positive predictive value (PPV), specificity, negative predictive value (NPV), and area under the curve (AUC) were calculated and compared between the two instruments, using cut-off values based on the Youden’s index. Results: The total scores of the HCL-33 and HCL-33-EA were positively and significantly correlated (rs = 0.309, P < 0.001). Compared to the HCL-33, the HCL-33-EA had higher sensitivity and NPV (HCL-33: sensitivity = 0.58, NPV = 0.53; HCL-33-EA: sensitivity = 0.81, NPV = 0.60), while the HCL-33 had higher specificity and PPV (HCL-33: specificity = 0.61, PPV = 0.66; HCL-33-EA: specificity = 0.37, PPV = 0.63). Conclusion: Both the HCL-33 and HCL-33-EA seem to be useful for screening depressed adolescents for BD. The HCL-33-EA would be more appropriate for distinguishing BD from MDD in adolescents due to its high sensitivity in Chinese clinical settings.

Original languageEnglish
Article number41
JournalInternational Journal of Bipolar Disorders
Issue number1
Publication statusPublished - Dec 2021


  • Adolescents
  • Bipolar disorder
  • External assessment
  • HCL-33
  • Self-assessment

ASJC Scopus subject areas

  • Psychiatry and Mental health
  • Biological Psychiatry

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