Article Summary
Clinical Summary: Screening for Bipolar I Disorder and the Rapid Mood Screener: Results of a Nationwide Health Care Provider Survey
Patients with bipolar I disorder often present during depression, and missed bipolarity can lead to delayed diagnosis and inappropriate antidepressant monotherapy. This survey addresses a practical gap in outpatient care: bipolar screening is used far less often than depression screening, and clinicians need tools they will actually use.
Design
A nationwide electronic survey of HCPs was conducted from June 1 to June 12, 2020
N
200 surveys were retained for analysis
Population
primary care = 130 [PCPs = 100; NPs/PAs = 30]; psychiatric = 70 [psychiatrists = 50, psychiatric NPs/PAs = 20]
Setting
outpatient settings
Key Findings
- Bipolar screening was much less common than depression screening: 82% of HCPs reported that they currently use a tool to screen for MDD, compared with only 32% of HCPs who reported using a tool to screen for bipolar disorder.
- Primary care HCPs were more likely than psychiatric HCPs to screen for MDD (87% vs 71%; P = .008), while bipolar screening remained low in both groups (primary care = 30%, psychiatric = 36%).
- The RMS was preferred over the MDQ when both were available, with significantly more HCPs indicating that they were more likely to use the RMS than the MDQ (81% vs 19%; P < .05).
- Most respondents viewed the RMS as practice-enhancing: 84% of HCPs indicated that the RMS would have a positive impact on their practice, and 68% reported that they were likely to use the RMS to rescreen current patients with a depression diagnosis (primary care = 74%, psychiatric = 57% [P = .017]).
- The largest perceived advantages of the RMS over the MDQ were pragmatic, including brevity (46-point differential), practicality (38 points), easy scoring (38 points), and easy-to-answer questions (37 points).
Clinical Bottom Line
In outpatient practice, bipolar screening remains underused, but clinicians strongly preferred the brief RMS over the MDQ and reported that it would increase screening and rescreening for bipolar I disorder. A short, easy-to-score screener appears more likely to be adopted in real-world care.
Practice Implications
- Consider adding a bipolar I screener for patients presenting with depressive symptoms, since only 32% of HCPs reported current bipolar screening despite 82% screening for MDD.
- If workflow is the main barrier, the RMS fits common outpatient practice needs: 72% cited ability to complete the tool in less than 2 minutes, 66% cited small number of questions, and 66% cited easy scoring.
- Use the RMS not only for new evaluations but also for patients already carrying a depression diagnosis, as 68% of HCPs reported they were likely to use it to rescreen current patients.
- Do not use the RMS as a substitute for full diagnostic assessment or for suspected bipolar II disorder; the article states that complete diagnostic evaluation is warranted after a positive or subthreshold positive RMS result and that the RMS has not been validated in patients with bipolar II disorder.
