The MDQ (Mood Disorder Questionnaire): A Clinician Guide to Bipolar Screening

The Mood Disorder Questionnaire (MDQ) is a patient-completed screening instrument for a lifetime history of manic or hypomanic symptoms. Unlike most mood measures, which ask how someone has felt over the last week or two, the MDQ looks back across a person's whole life for periods of elevated, expansive, or irritable mood - the kind of episode that can point toward a bipolar spectrum condition rather than unipolar depression. It is completed by the patient in around five minutes and sits in the Depression & Mood assessment category.

What the MDQ is for

The MDQ exists to answer a specific clinical question: has this person ever had a distinct period of mood elevation, and if so, did it cause a real problem in their life? That question matters most when a patient is presenting with depression, because the first-line treatment approach for unipolar depression and bipolar depression is not the same. A depression screener on its own cannot distinguish the two, since both present with low mood - the MDQ is designed to surface an unrecognised manic or hypomanic history that a depression-focused conversation might otherwise miss.

The structure: a symptom checklist plus clustering

The MDQ is built from 13 core screening items, each asking whether the person has ever experienced a period of unusually elevated, expansive, or irritable mood together with a specific accompanying change - for example, being unusually talkative, needing far less sleep than usual, or being much more active or restless than normal. Each of these 13 items is answered yes or no. Beyond the 13-item checklist, the MDQ also includes additional questions that cluster the responses: they ask whether several of the endorsed symptoms tended to happen during the same period of time, and how much of a problem the symptoms caused in day-to-day functioning. This clustering step is what separates a coherent, functionally significant episode from a set of isolated, unrelated symptoms scattered across a person's life - which is why the instrument is described as "13 items plus clustering" rather than a simple 13-point sum.

How the MDQ is scored

The complete MDQ is administered as all three parts together - the 13-item symptom checklist, the co-occurrence question, and the impairment question - and all three are needed to interpret the result correctly. No score range or numeric cutoff for the MDQ is included in the verified reference material used for this guide, so none is stated here rather than risk repeating a threshold from memory. What can be said with confidence is the instrument's logic: the 13-item checklist on its own, without the clustering and impairment questions, is not the complete picture, because a scattering of individually endorsed symptoms across a lifetime is not the same as a cluster of symptoms that occurred together and caused a functional problem. Clinicians who need the precise published scoring threshold should consult the MDQ's original scoring guidance directly and confirm any positive screen with a full clinical interview before treating it as evidence of a bipolar spectrum condition.

MDQ compared with the PHQ-9

The MDQ complements a depression severity screener like the PHQ-9 rather than replacing it, because the two instruments ask fundamentally different questions. The PHQ-9 measures how severe a patient's depressive symptoms have been over the past two weeks; it says nothing about whether the patient has ever had a manic or hypomanic episode, because it was never designed to. The MDQ, in turn, does not measure current depression severity at all - it looks backward across a lifetime for evidence of mood elevation. In practice, many clinics use both together at intake: the PHQ-9 to gauge current depressive severity, and the MDQ to check whether an unrecognised bipolar spectrum history should change the treatment plan before an antidepressant is started.

Who it's for and its limitations

The MDQ is intended for adults and is self-completed, typically in about five minutes. Like any lifetime retrospective self-report measure, it depends on the patient's memory and willingness to recall and disclose past episodes, which may have happened years earlier and may not have been recognised as unusual at the time - people experiencing hypomania often feel good rather than distressed, so they may not spontaneously label the period as a problem. The MDQ is also a screening instrument, not a diagnostic one: a positive screen indicates that a bipolar spectrum condition should be considered and explored further with a full clinical interview, not that the diagnosis has been made. As with all screening tools discussed in this series, see our overview of validated psychological assessments for how screening instruments fit into a broader assessment process.

Using the MDQ digitally

Digital administration lets a patient work through the full MDQ - the 13-item checklist together with the clustering and impairment questions - privately and at their own pace, with responses recorded consistently and stored alongside other intake measures such as the PHQ-9. This keeps the complete instrument together as a single record rather than risking the checklist being reviewed in isolation from the clustering questions that give it clinical meaning, and it fits naturally into a broader digital intake workflow without adding to a busy clinic's paperwork.

Key takeaways

• The MDQ screens for a lifetime history of manic or hypomanic symptoms, not current depressive severity.
• It is built from 13 yes/no symptom items plus additional clustering and impairment questions that must be considered together.
• All three parts of the instrument are needed to interpret it correctly - the 13-item checklist alone is not the complete picture.
• It is commonly used alongside a depression screener like the PHQ-9, since neither instrument answers the other's question.
• A positive MDQ screen indicates further evaluation is warranted - it is not a bipolar disorder diagnosis on its own.