How-To Guides

In this nationwide outpatient survey, clinicians reported screening for bipolar disorder much less often than for depression. Overall, 82% of health care providers said they currently use a tool to screen for major depressive disorder, compared with 32% who said they use a tool to screen for bipolar disorder. Primary care clinicians were more likely than psychiatric clinicians to report depression screening (87% vs 71%; P = .008), while bipolar screening remained low in both groups (30% in primary care and 36% in psychiatric practice).

The Rapid Mood Screener (RMS) is a self-administered 6-item screening tool developed to help differentiate bipolar I disorder from major depressive disorder in patients with depressive symptoms. It assesses both hallmark manic symptoms and depressive features that are more likely to suggest bipolar disorder than unipolar depression, such as earlier age at depression onset, prior negative response to antidepressants, and multiple depressive episodes. A screen is considered positive for bipolar I disorder when 4 or more items are answered "yes."

In the validation study cited by the authors, the RMS showed 88% sensitivity and 80% specificity for bipolar I disorder when 4 or more items were endorsed. The article also notes that, in the same bipolar I analysis population, a positive Mood Disorder Questionnaire (MDQ) screen yielded 86% sensitivity and 78% specificity.

Clinicians in this survey preferred the Rapid Mood Screener over the MDQ. If both tools were available, 81% of respondents said they would be more likely to use the RMS, compared with 19% for the MDQ (P < .05). Respondents also rated the RMS more favorably than the MDQ across all valued screening-tool attributes, with especially large differences for brevity, practicality, easy scoring, and easy-to-answer questions.

The reasons clinicians most often gave for adopting the RMS were its practical features. The most commonly cited qualities were completion in less than 2 minutes (72%), small number of questions (66%), easy scoring (66%), and easily understood questions (60%). The article also notes that the RMS has fewer than half as many items as the MDQ and uses a simpler scoring algorithm.

Survey responses suggested clinicians saw a role for the RMS in both settings. The discussion states that three of four respondents said they were likely to use the RMS to screen new patients with depressive symptoms, and 68% said they were likely to use it to rescreen current patients with a depression diagnosis. Interest in rescreening was higher in primary care than psychiatry (74% vs 57%; P = .017).

Most clinicians thought the RMS would improve practice. Overall, 84% of health care providers said the RMS would have a positive impact on their practice, including likely screening of new patients with depressive symptoms or a depression diagnosis and more screening of patients suspected of having bipolar I disorder. The authors interpreted this as support for a meaningful clinical role for the RMS in routine outpatient care.

No, this article does not support using the RMS as a validated screener for bipolar II disorder. The authors state that the RMS has not been validated in patients with bipolar II disorder, so the survey did not include that group and the findings cannot be generalized to them. They add that if bipolar II is suspected, screening with the MDQ or another tool that screens for bipolar II may be prudent.

No. The authors state that a positive RMS result should prompt a more complete diagnostic assessment rather than serve as a stand-alone diagnosis. They also note that complete diagnostic evaluation for bipolar disorder is warranted not only after a positive RMS screen, but also after a subthreshold positive result or when other clinical suspicion remains.

The study was a self-reported survey of clinicians, so it measured reported awareness, preferences, and intended use rather than actual changes in diagnostic accuracy or patient outcomes in practice. The authors also caution that although the RMS compared favorably with the MDQ in survey responses and prior validation data, conclusions about the advantage of one screening tool over another would require further research in real-world settings. In addition, the RMS has not been validated in bipolar II disorder, so the findings cannot be generalized to that population.