MDQ (Mood Disorder Questionnaire): Take It, Score It, Understand Your Results
The MDQ (Mood Disorder Questionnaire) is a brief self-report screening tool for bipolar spectrum disorders. Developed by Dr. Robert Hirschfeld and colleagues and published in 2000, it is the most widely used bipolar disorder screening instrument in primary care and psychiatry. The MDQ takes about 5 minutes to complete and asks about a lifetime history of manic or hypomanic episodes through 13 yes/no items plus 2 follow-up items on symptom co-occurrence and functional impact. A positive screen requires three criteria together: 7 or more 'yes' answers, symptoms that occurred during the same time period, AND moderate-to-serious functional impairment. The MDQ is a screening tool, not a diagnosis — a positive MDQ screen needs a clinician's evaluation before any treatment decisions, particularly because bipolar disorder treatment differs meaningfully from unipolar depression treatment.
What is the MDQ?
The MDQ (Mood Disorder Questionnaire) is a brief bipolar disorder screening questionnaire developed by Dr. Robert Hirschfeld, MD, and colleagues at the University of Texas Medical Branch and other institutions. It was first published in 2000 in the American Journal of Psychiatry. The MDQ was specifically designed to screen for bipolar spectrum disorders — a group of conditions characterized by alternating episodes of depression and mania or hypomania — in primary care and psychiatric settings. It has been widely adopted and translated into many languages because bipolar disorder is often initially misdiagnosed as unipolar depression, leading to treatment delays of 6 to 10 years on average. The MDQ helps surface possible bipolar episodes that a depression screen alone would miss.
What the MDQ measures
The MDQ measures lifetime history of symptoms that suggest manic or hypomanic episodes through 13 yes/no items covering elevated mood, increased energy, decreased need for sleep, racing thoughts, increased talking, increased activity, distractibility, increased sexual interest, increased risk-taking, irritability, increased self-confidence, increased socializing, and inappropriate behavior. Two follow-up items then ask whether several of those symptoms occurred during the same time period and how much functional impairment they caused. The recall window is lifetime — meaning the MDQ asks 'has there ever been a period of time when…' rather than focusing on current symptoms. This lifetime framing is essential because bipolar disorder is defined by episodes that may have occurred years before the person presents for help (often during depression).
How the MDQ is administered
The MDQ is a self-report questionnaire that takes about 5 minutes to complete. The first 13 items are answered Yes or No based on whether you have ever experienced the symptom. Item 14 asks whether several of those symptoms happened during the same period of time (Yes or No). Item 15 asks how much these symptoms caused problems — choosing No problem, Minor problem, Moderate problem, or Serious problem. The MDQ can be completed on paper, on a screen, or read aloud by a clinician. Honest answers about lifetime experience are what give the screen its meaning, particularly the 'same time period' item, which distinguishes mania from a collection of unrelated symptoms.
Who uses the MDQ
The MDQ is used routinely in primary care, psychiatry, integrated behavioral health, and bipolar disorder research worldwide. It is recommended in many clinical guidelines as an initial bipolar screening tool, particularly for patients presenting with depression because bipolar disorder is frequently misdiagnosed as unipolar major depression. Mental Health America and the Depression and Bipolar Support Alliance both offer the MDQ as an online self-screen with a clear handoff to clinical evaluation. The MDQ is in the public domain and has been translated into many languages. It is also used in clinical trials of bipolar treatments and in epidemiological research on bipolar spectrum prevalence.
MDQ is a screening tool, not a diagnosis
The MDQ is a screening instrument — a positive screen suggests bipolar spectrum symptoms that warrant clinical evaluation, but it cannot diagnose bipolar disorder I, bipolar II, cyclothymic disorder, or substance-induced mood disorder on its own. A formal diagnosis requires a clinician's comprehensive evaluation against DSM-5 criteria, including history of episodes, family history, and ruling out other causes such as substance use, thyroid disease, or medication effects. A positive MDQ screen is particularly important to discuss with a clinician before starting any antidepressant medication, because the National Institute of Mental Health notes that antidepressants used alone in people with bipolar disorder can trigger a manic episode or rapid cycling. A negative screen does not rule out bipolar disorder, particularly in primary care populations where the MDQ has lower sensitivity than in psychiatric settings. If you are in crisis, call or text 988 (U.S. Suicide & Crisis Lifeline).
How to score the MDQ: the 3-criteria positive screen
A positive Mood Disorder Questionnaire (MDQ) screen is not just a count of “yes” answers. It requires three separate criteria together, and all three must be met before the result counts as positive. Missing any one of them — even if the other two are clearly satisfied — pushes the result into the negative category. This is the most-misread aspect of the MDQ online, where many summaries treat the symptom count alone as the threshold.
The scoring algorithm comes from Hirschfeld and colleagues’ original 2000 validation study. In that study, 7 or more “yes” items produced a sensitivity of 0.73 and a specificity of 0.90 in psychiatric outpatients. Mental Health America frames the rule in patient-facing language: a positive screen requires symptoms occurring “during the same period of time” plus acknowledgment that the symptoms caused problems, “from Minor Problem to Serious Problem”.
The three criteria, side by side
| Criterion | What the MDQ asks | Threshold for a positive screen |
|---|---|---|
| Symptom count | The first 13 yes/no items about lifetime manic or hypomanic symptoms | 7 or more “yes” answers out of 13 |
| Co-occurrence | Item 14: did several of these symptoms happen during the same time period? | Yes — the symptoms clustered into the same episode period |
| Functional impairment | Item 15: how much of a problem did these symptoms cause? | The symptoms caused a problem — patient screens accept Minor through Serious; the Hirschfeld cutoff pairs the ≥7 count with meaningful impairment |
A common scenario: someone marks 9 of the 13 items “yes” but answers “no” to item 14 or marks item 15 as “No problem.” That result is not a positive screen. Without same-period clustering or any acknowledged impairment, the pattern does not match the episodic, disruptive nature of mania the MDQ is designed to detect.
The reverse is also true. A score of 6 items with strong co-occurrence and serious impairment falls below the validated cutoff of 7. The MDQ is a screening tool, not a diagnosis. Borderline results are exactly the pattern a clinician should evaluate in person rather than dismiss based on a single number.
How accurate is the MDQ? Sensitivity, specificity, and the bipolar II blind spot
The MDQ’s accuracy depends heavily on where it is used and which type of bipolar disorder is being screened for. The original Hirschfeld validation enrolled 198 patients from five mood-disorder-focused outpatient clinics. A blinded clinician administered the DSM-IV bipolar module as the reference standard. In that psychiatric-outpatient sample, the ≥7/13 threshold yielded sensitivity of 0.73 and specificity of 0.90 — roughly three-quarters of people with bipolar disorder screened positive, and roughly 9 in 10 without it screened negative.
Setting changes the numbers
Meta-analytic work has found the MDQ is “one of the best self-report tools for assessing hypomania or mania in adults,” but its sensitivity “may be greater in inpatient versus community settings”. The more enriched the population for true bipolar disorder, the better the MDQ performs.
- Psychiatric inpatient or specialty outpatient samples: highest sensitivity, closest to Hirschfeld validation
- General community samples: lower sensitivity — bipolar screeners overall “tend to have lower sensitivity” in less-enriched populations
- Online self-screens: closer to clinical samples than to community populations, because the people electing to take the test already suspect something
The bipolar II blind spot
The MDQ shows “higher sensitivity when detecting bipolar I compared to other bipolar spectrum disorders.” It is also “much less sensitive to bipolar II, often missing more than half of the cases”. The mechanism is straightforward: the items emphasize the louder symptoms of full mania — risky behavior, inflated abilities, decreased need for sleep. These features are more attenuated in hypomania, where mood elevation can feel productive or even welcome rather than alarming.
A negative MDQ in a person with recurrent depressive episodes does not rule out bipolar II disorder. If the depressive episodes are recurrent or treatment-resistant, a clinician can probe for the briefer, milder hypomanic periods the MDQ frequently misses. Pairing the MDQ for mania history with a current-depression screen like the PHQ-9 gives a clinician more to work with than either tool alone.
What a positive MDQ does not tell you: BP-I vs BP-II vs cyclothymic, and the lifetime-recall caveat
A positive MDQ is a flag, not a label. The MDQ cannot distinguish bipolar I from bipolar II from cyclothymic disorder from substance-induced mood disorder on its own. This is not a flaw in the instrument; it is by design. A 5-minute self-report cannot replace the structured clinical interview and episode-duration mapping that diagnosis requires.
What the bipolar spectrum subtypes look like
| Subtype | Defining feature | Episode duration |
|---|---|---|
| Bipolar I | Manic episodes (full mania) | Manic ≥7 days or severe enough to require hospitalization; depressive typically ≥2 weeks |
| Bipolar II | Hypomania (milder than mania) alternating with major depressive episodes | Hypomanic episodes are shorter and less intense than full mania |
| Cyclothymic disorder | Hypomanic and depressive symptoms below full-episode thresholds | At least 2 years in adults or 1 year in children |
| Rapid cycling | A course specifier, not a separate subtype | 4 or more episodes within 12 months |
Each subtype has a different treatment trajectory. Bipolar I tends to present with the most acute episodes; bipolar II is more dominated by depression; cyclothymic disorder is chronic but milder. The MDQ flags the possibility of any of these — sorting them out is the clinician’s job.
The lifetime-recall caveat
The MDQ’s first 13 items “ask about any manic/hypomanic symptoms that may have occurred during one’s lifetime”. That recall window surfaces past episodes — a common scenario where someone arrives at care during a current depression but had hypomanic or manic episodes years earlier. It is also a limitation:
- Memory bias: people may underreport elevated mood states that felt good in the moment, or overreport energetic periods that were within normal range
- No severity grading: the yes/no format does not capture how intense, how long, or how many separate episodes occurred
- Social desirability: items carry “social desirability bias” and “demand characteristics” — responses can shift based on how the person wants to be perceived
This is again why a positive MDQ is a screening result, not a diagnosis. A clinician reconstructs the episode history with more nuance than yes/no items can capture.
Why a positive MDQ needs a clinician — the treatment-specificity reason
This is the most important reason to take an MDQ result to a clinician rather than self-interpret. Bipolar disorder is treated differently from unipolar depression, and a wrong assumption about which one is in play can make symptoms worse.
Antidepressant monotherapy is not the answer
The National Institute of Mental Health is explicit: antidepressants are “not used alone because they can trigger a manic episode or rapid cycling” in people with bipolar disorder. The clinical literature echoes this — “antidepressant monotherapy is not recommended in the treatment of bipolar disorder and does not provide any benefit over mood stabilizers”.
The risk is concrete. Antidepressants given without a mood stabilizer can cause affective switching — a shift from depression into manic or hypomanic phases — and may accelerate phase cycling. The highest switching risk is seen with tricyclic antidepressants and SNRIs; SSRIs and bupropion carry lower risk. This is why a person with depression who has a positive MDQ screen needs an evaluation before any antidepressant prescription, not after.
What bipolar treatment categories look like
A clinician’s plan typically draws from several treatment categories. These descriptions are educational — none of this is a recommendation to start, stop, or change any medication on your own.
- Mood stabilizers such as lithium or valproate are first-line; lithium “has the best overall evidence” and “reduces the risk of suicide, self-harm, and death”
- Atypical antipsychotics are commonly prescribed alongside mood stabilizers, particularly for bipolar depression
- Antidepressants in combination (never alone) may be added in selected cases, weighed against switching risk
- Psychotherapy including Interpersonal and Social Rhythm Therapy, Family-Focused Therapy, and Cognitive Behavioral Therapy — often combined with medication for better outcomes
Why the safety frame matters
Bipolar disorder carries elevated mortality risk: people with bipolar disorder have approximately 11.7 times higher risk of death by suicide than the general population, with around 34% reporting a lifetime suicide attempt. This figure is not meant to alarm. It is the reason a positive screen is a clinical priority rather than something to file away. A clinician evaluation lets the right treatment plan begin earlier, which is the single most effective response to that elevated risk. Bipolar disorder “usually requires lifelong treatment,” and the MDQ is the first step toward that ongoing care, not a substitute for it. The MDQ remains a screening tool, not a diagnosis.
When to talk to a clinician (and what to do if you screen positive)
A positive MDQ screen is a strong reason to schedule a clinical evaluation. Preferably this is with a psychiatrist or a primary care clinician familiar with mood disorders. Symptoms do not have to be at their worst for the appointment to be useful. The MDQ’s lifetime recall window means past episodes are often what triggers a positive screen, and a clinician can build a fuller picture from that history.
Consider scheduling an evaluation in any of these situations:
- You screened positive on the MDQ — 7 or more “yes” items plus same-period co-occurrence plus acknowledged impairment
- You screened negative but have recurrent or treatment-resistant depression — bipolar II is frequently missed by the MDQ
- You have a close family member with bipolar disorder — close-relative history is a recognized risk factor, “particularly when combined with trauma or significant stressful life events”
- Antidepressant treatment did not help, or seemed to trigger agitation, decreased sleep, or unusual energy — this pattern can suggest underlying bipolar disorder, where antidepressants alone may trigger a manic episode
- Symptoms interfere with work, school, relationships, or daily activities — impairment is what separates a mood quirk from a clinical episode
What to bring to the appointment
Bringing your completed MDQ — including the specific items you marked “yes” — gives the clinician a useful starting point. Mental Health America explicitly encourages this: “You are encouraged to share your results with a physician or healthcare provider”. A short written timeline of past mood episodes (when they started, how long they lasted, what changed in sleep, energy, and behavior) is also useful, because the yes/no format does not capture episode duration or severity.
If you are in crisis
If you are having thoughts of suicide or self-harm, or are in immediate danger, call or text the 988 Suicide & Crisis Lifeline at 988. In a life-threatening situation, call 911. The Depression and Bipolar Support Alliance also offers peer support groups, and any screening tool’s disclaimer is unambiguous: “if you have any concerns, see your doctor or mental health professional”.
MDQ vs other depression and bipolar screeners (PHQ-9, bipolar II screens, child variants)
The MDQ is not the only mood screening tool, and it works best when its limitations are understood alongside its complements. A common pattern: someone presents with depression, gets screened with a depression questionnaire like the PHQ-9, is treated for unipolar depression, and only years later — sometimes after a treatment-induced manic episode — is reassessed for bipolar disorder. Pairing the MDQ with a depression screener short-circuits that delay by surfacing the mania history a depression-only screen cannot detect.
How the MDQ compares to its closest neighbors
| Tool | What it screens for | Recall window | Format |
|---|---|---|---|
| MDQ | Bipolar spectrum (mania/hypomania history) | Lifetime | 13 yes/no items + 2 follow-up |
| PHQ-9 | Major depressive disorder severity | Past 2 weeks | 9 items, severity-rated |
| DBSA brief mania screen | Mania symptoms, brief patient-facing format | Brief screening format | Short self-report |
| Parent-report MDQ (P-MDQ) | Mood symptoms in children ages 5+ | Lifetime | Parent-rated |
Why pairing matters
The MDQ was developed because bipolar spectrum conditions are frequently underdiagnosed in routine care. Depressive episodes are typically what bring people to care, and a depression-only screen will grade depression but will not surface a manic history — the gap the MDQ is designed to fill. Symptomatik’s mood screens, including the depression-focused PHQ-9, are written to be used together for this reason.
Child and adolescent considerations
The MDQ as originally validated is an adult screening tool. A parent-report version (P-MDQ) was created in 2006 for children ages 5 and older, and that is the appropriate MDQ-family instrument for younger ages. Clinicians evaluating mood symptoms in children typically combine parent-report tools with direct interview rather than screening alone.
Screening, not diagnosis
No bipolar screener — MDQ, DBSA’s brief mania screen, the parent-report MDQ, or any other — is a substitute for a clinician’s evaluation. The screeners systematize symptom recollection so a clinician has a structured starting point. The diagnosis itself comes from clinical interview, history, and DSM-5 criteria.
Frequently asked questions
Where can I get the official MDQ PDF?
The MDQ is in the public domain and is freely available through patient-facing organizations like Mental Health America, which hosts an online version based on the Hirschfeld 2000 instrument. The Depression and Bipolar Support Alliance also provides mood screening tools, though DBSA’s own brief mania screen is distinct from the full MDQ.
What does a score of 7 mean on the MDQ?
A count of 7 or more “yes” answers on the first 13 items is one of three criteria for a positive screen. The other two — same-period co-occurrence and acknowledged functional impairment — must also be present. A 7 alone, without the other two, is not a positive screen.
What if I score 7 yes answers but no co-occurrence or no impairment?
That result is not a positive screen. The MDQ’s validated algorithm requires all three criteria together: symptom count, same-period clustering, and acknowledged impairment. A high count without clustering or impairment falls outside the validated positive range, though it can still be worth discussing with a clinician.
Is there a child version of the MDQ?
A parent-report MDQ was created in 2006 for children ages 5 and older. The original adult MDQ was not validated in children. Clinicians evaluating mood symptoms in younger children typically use parent-report tools alongside direct interview rather than relying on screening alone.
What age range is the MDQ for?
The MDQ as validated by Hirschfeld and colleagues is an adult screening tool, validated in psychiatric outpatient adults. The parent-report variant covers children ages 5 and older. For adolescents who can self-report, clinicians typically combine MDQ items with structured interview rather than the adult MDQ alone.
Can I take the MDQ online?
Yes. Mental Health America offers the MDQ as an online self-screen with an explicit disclaimer that “online screening tools are not diagnostic instruments” and a recommendation to share results with a clinician. The Depression and Bipolar Support Alliance also offers online mood screening with a similar handoff to clinical evaluation.
Does the MDQ detect bipolar II?
Often, no. The MDQ is “much less sensitive to bipolar II, often missing more than half of the cases,” because hypomanic symptoms are milder than full mania and easier to underreport. A negative MDQ in a person with recurrent or treatment-resistant depression should not be treated as ruling out bipolar II.
How is the MDQ different from the PHQ-9?
The Mood Disorder Questionnaire (MDQ) screens for lifetime manic or hypomanic symptoms; the PHQ-9 screens for current depressive symptom severity. They are complementary, not substitutes. Bipolar spectrum conditions are frequently underdiagnosed in routine care, so using both screens together helps a clinician see the full mood picture rather than just the depressive half.