The Mood Disorder Questionnaire (MDQ) is a brief, 15-item self-report screening instrument used to identify patients who may have a bipolar spectrum disorder. Developed by Hirschfeld and colleagues in 2000, the MDQ screens for lifetime history of manic and hypomanic symptoms aligned with DSM criteria, asks whether those symptoms co-occurred, and rates the resulting functional impairment. It takes about five minutes to complete.
Improves Detection of Bipolar Disorder in Depressed Patients
Bipolar disorder is frequently misdiagnosed as unipolar depression because patients present in a depressive episode and do not spontaneously report past hypomania. The MDQ surfaces those missed manic episodes during routine screening.
Brief and Self-Administered
The MDQ can be completed by the patient in the waiting room or before a telehealth visit, requiring no clinician time to administer.
DSM-Aligned Item Content
Section 1 items map to the core manic and hypomanic symptoms used in DSM diagnostic criteria, making the screener clinically meaningful and easy to communicate to patients.
Three-Part Logic Reduces False Positives
A positive screen requires symptom endorsement, symptom co-occurrence, and functional impairment — a structure designed to separate true mood symptoms from isolated personality or substance-related features.
Widely Recognized and Validated
The MDQ is one of the most cited bipolar screeners in primary care and psychiatric literature and is used in research, quality improvement, and clinical workflows worldwide.
Primary Care
Used to screen patients presenting with depression, irritability, or sleep complaints, where bipolarity might otherwise be missed before an antidepressant is prescribed.
Outpatient Psychiatry and Behavioral Health
Administered at intake or before medication changes to inform differential diagnosis between unipolar and bipolar depression.
Integrated Behavioral Health
Embedded in collaborative care workflows alongside the PHQ-9 to flag patients whose depressive symptoms warrant a more detailed mood history.
Telehealth Psychiatry
Sent to patients before a video visit so the clinician can review responses and focus the encounter on positive symptom domains.
Emergency and Crisis Settings
Used as part of a structured mood assessment when patients present with acute mood symptoms and an unclear diagnostic history.
The first section asks the patient whether they have ever experienced a period when they were not their usual self and exhibited any of 13 symptoms of mania or hypomania. The items cover symptom domains such as:
A single question asks whether several of the symptoms endorsed in Section 1 occurred during the same period of time.
A single item asks how much of a problem the symptoms caused, with response options ranging from "no problem" to "serious problem."
| Criterion | Threshold |
|---|---|
| Section 1 — Symptom items endorsed | 7 or more "Yes" out of 13 |
| Section 2 — Symptom co-occurrence | "Yes" — several symptoms during the same time period |
| Section 3 — Functional impairment | "Moderate" or "Serious" problem |
| Positive screen | All three criteria met |
A positive MDQ screen indicates the need for a more detailed diagnostic evaluation for bipolar I or II disorder; it is not itself a diagnosis. In the original validation study by Hirschfeld and colleagues, the standard cutoff produced a sensitivity of 0.73 and a specificity of 0.90 in a psychiatric outpatient sample. Subsequent meta-analytic work has reported lower sensitivity in primary care populations, where prevalence is lower.
Digital administration of the MDQ improves on the paper form in several practical ways. Auto-scoring evaluates all three sections instantly and flags positive screens for clinician review without manual tallying. Longitudinal tracking stores serial MDQ scores so changes in symptom endorsement over time become visible at a glance. Conditional logic can suppress Sections 2 and 3 when fewer than seven symptoms are endorsed, shortening the patient experience while preserving scoring fidelity. All responses are stored in HIPAA-compliant infrastructure and route directly to the patient's chart through EHR integration.
Documenting structured bipolar screening supports HEDIS and CMS quality reporting for behavioral health, demonstrates appropriate diagnostic workup before initiating mood medications, and reduces the medico-legal risk associated with prescribing antidepressant monotherapy to patients with undiagnosed bipolarity. Electronic records of MDQ administration provide a defensible audit trail of clinical decision-making.
What does the MDQ screen for?
The MDQ screens for a lifetime history of manic or hypomanic symptoms that may indicate a bipolar spectrum disorder. It is designed to be used in patients presenting with depression or other mood complaints, where unrecognized bipolarity could change the treatment plan.
What is considered a positive MDQ score?
A positive screen requires endorsement of seven or more of the 13 symptom items, confirmation that several symptoms occurred during the same period, and at least moderate functional impairment from those symptoms. All three conditions must be met for the screen to be considered positive.
How accurate is the MDQ?
In the original psychiatric outpatient validation study, the MDQ showed 73% sensitivity and 90% specificity for bipolar disorder. Sensitivity tends to be lower in primary care, where bipolar disorder is less prevalent, so a negative screen does not rule out bipolarity in symptomatic patients.
Can the MDQ diagnose bipolar disorder?
No. The MDQ is a screening instrument, not a diagnostic tool. A positive screen indicates the need for a structured clinical interview that evaluates DSM criteria for bipolar I, bipolar II, or other specified bipolar and related disorder.
How often should the MDQ be administered?
Many practices administer the MDQ at psychiatric intake and re-administer it when patients present with a new or worsening depressive episode, when antidepressant therapy is being considered, or annually as part of behavioral health monitoring.
Is the MDQ free to use?
Yes. The MDQ is freely available for clinical and research use without licensing fees and has been translated into multiple languages, making it widely accessible across practice settings.
Last updated: May 2026.
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