MDQ
Mood Disorder Questionnaire
In this guide
Self-report screen for lifetime bipolar spectrum — used to surface possible hypomania missed in depression-focused assessments.
The MDQ (Mood Disorder Questionnaire) is a single-page self-report screen for bipolar spectrum disorder developed by Hirschfeld and colleagues (2000). It asks about lifetime symptoms of mania or hypomania.
When to use the MDQ
Use the MDQ before starting or recommending an antidepressant, and any time a depressed client reports periods of elevated mood, reduced need for sleep, or impulsivity. It screens for a bipolar-spectrum history that changes treatment entirely.
What the MDQ measures
Section 1: 13 yes/no items on lifetime hypomanic/manic symptoms. Section 2: whether several symptoms occurred together. Section 3: functional impairment from those episodes.
Use the MDQ when
- Any positive depression screen, before a medication referral
- Reported mood cycling, irritable highs, or reduced sleep need with high energy
- Antidepressant non-response, rapid response, or activation on an SSRI
- Family history of bipolar disorder
Why use the MDQ instead of another measure
Missing bipolarity is one of the highest-consequence errors in mental-health care because antidepressant monotherapy can precipitate mania. The MDQ is 13 yes/no items plus two qualifiers and takes under five minutes to rule the question in or out.
When not to use the MDQ
- You intend to treat the screen as a diagnosis — a positive MDQ requires a clinical interview
- The client has borderline personality features or ADHD; both inflate false positives
- Screening children or young adolescents
Scoring and bands
MDQ scores should be interpreted alongside the clinical interview, the client's context, and the measure's intended population. A cutoff suggests follow-up; it does not establish a diagnosis.
Cutoffs
All three sections must meet criteria for a positive screen. Sensitivity for bipolar I is good (~73%); sensitivity for bipolar II is weaker. Specificity around 90% in psychiatric samples.
What MDQ results mean — and what to do next
Fewer than 7 symptoms, or no co-occurrence, or no moderate impairment.
Next stepProceed with unipolar treatment; re-screen if a client activates on medication.
≥7 symptoms that co-occurred and caused at least moderate problems.
Next stepRefer for a diagnostic psychiatric evaluation before any antidepressant monotherapy; ask about family history and past episodes.
How often to re-administer
At intake and again whenever mood cycling or medication activation appears.
What to pair it with
PHQ-9 (current depressive severity) and AUDIT (substance-induced mood elevation is a common confound).
How to talk about the score
A positive MDQ is a prompt for a careful clinical interview about lifetime hypomania, not a diagnosis. Many clients with recurrent depression who screen positive turn out to be unipolar; misclassification of medications has consequences either direction.
Limitations
- Under-detects bipolar II
- Specificity drops in non-psychiatric samples
- Doesn't distinguish irritability from euphoria
- Past-episode reporting unreliable in active depression
Best used for
- Surfacing possible bipolar history when depression is the presenting concern
- Pre-medication consultation
- Adjunct to clinical interview
MDQ scoring — the three-part rule
A positive screen requires all three: (1) 'yes' to 7 or more of the 13 symptom items in Question 1, (2) 'yes' to Question 2 — several symptoms happened during the same period of time, and (3) a rating of 'moderate problem' or 'serious problem' on Question 3.
What a positive MDQ means
A positive MDQ means bipolar disorder should be explored in a full diagnostic interview — it is not a diagnosis. The screen is more sensitive to bipolar I than bipolar II, so a negative result does not rule out hypomania. Ask about family history and responses to antidepressants.
Frequently asked questions about the MDQ
Should every depressed client get an MDQ?
Many guidelines suggest yes — bipolar is frequently missed in depression presentations, and the cost of missing it is high (antidepressant monotherapy can destabilize mood).
What if a client screens positive but has never had a clear hypomanic episode?
Investigate further with structured questions about prior 'good periods' that included reduced sleep need, racing thoughts, etc. Collateral from family is often valuable.
References
Scoring bands and cutoffs on this page come from these published sources. This guide is educational and does not replace clinical judgment.
- Hirschfeld, R. M. A., Williams, J. B. W., Spitzer, R. L., et al. (2000). Development and validation of a screening instrument for bipolar spectrum disorder: The Mood Disorder Questionnaire. American Journal of Psychiatry, 157(11), 1873–1875.Supports: Instrument and the three-part positive-screen rule