Zürich University Psychiatric Hospital, Zurich, Switzerland.
Bipolar Disord. 2013 Sep;15(6):701-12. doi: 10.1111/bdi.12101. Epub 2013 Jul 12.
There is mounting evidence that current diagnostic systems inadequately recognize clinically relevant levels of hypomania in depressed patients, thereby leading to an under-diagnosis of bipolar disorders and the associated risk of treatment that is inappropriate or may actually worsen illness course. The Hypomania Checklist-32 revised version 2 (HCL-32-R2) is a self-rating scale for hypomanic symptoms specifically developed to address this problem. The goal of this study was to assess the transcultural validity of the HCL-32-R2.
Measurement invariance of HCL-32-R2 responses from the multinational Bipolar Disorders: Improving Diagnosis, Guidance, and Education (BRIDGE) Study of 5635 patients with major depressive episodes (MDEs) was assessed by exploratory and confirmatory factor analysis across five cultural regions.
Two previously identified factors were reproduced and explained 60% of the variance in test responses. Only three out of 32 items had cross-culturally variable factor loadings. Some moderate measurement invariance was also found with regard to age and gender. In discriminating unipolar from bipolar disorder, the HCL-32-R2 showed a sensitivity of 82% with a specificity of 57% when current DMS-IV criteria for bipolar disorder were used, and substantially higher specificity of 73% when evidence-based modified criteria were applied.
The psychometric properties of the HCL-32-R2 were largely culture-independent. This finding replicates that of our previous international study and is a step towards validating the HCL-32-R2 as a broadly applicable screening instrument for hypomanic features, facilitating the detection of hidden bipolarity in depressed patients.
越来越多的证据表明，目前的诊断系统不能充分识别抑郁患者中临床相关程度的轻躁狂，从而导致双相障碍的诊断不足以及治疗不当或实际上可能使病情恶化的风险。经过修订的 32 项轻躁狂清单修订版 2 型（HCL-32-R2）是一种专门用于解决该问题的轻躁狂症状自评量表。本研究的目的是评估 HCL-32-R2 的跨文化效度。
通过探索性和验证性因子分析，对来自有 5635 例重性抑郁发作（MDE）患者的多国双相情感障碍：改善诊断、指导和教育（BRIDGE）研究的 HCL-32-R2 响应进行了跨文化不变性评估。
复制了之前确定的两个因素，并解释了测试反应的 60％的方差。在 32 项条目中有 3 项具有跨文化可变的因子负荷。关于年龄和性别，也发现了一些中等程度的测量不变性。在区分单相和双相障碍时，当使用当前的 DMS-IV 双相障碍标准时，HCL-32-R2 的灵敏度为 82％，特异性为 57％，而当应用基于证据的修改标准时，特异性则大大提高到 73％。
HCL-32-R2 的心理计量特性在很大程度上不受文化影响。这一发现复制了我们之前的国际研究结果，是朝着验证 HCL-32-R2 作为广泛适用的轻躁狂特征筛查工具迈出的一步，有助于在抑郁患者中发现隐藏的双相性。
