Comparative analysis of the identification efficacy of the bipolarity index and diagnostic and statistical manual of mental disorders, 5th edition, for bipolar disorder screening among college students

Objective

This study aims to explore the differences in the identification efficacy of the Bipolarity Index (BPX) and the Diagnostic and Statistical Manual of Mental Disorders, 5th Edition (DSM-5), as screening approaches for bipolar disorder (BD).

Methods

A total of 150 college students with depressive episodes who underwent outpatient and inpatient treatment at Central China Normal University Hospital and the Renmin Hospital of Wuhan University between January 2021 and December 2022 were selected as research participants. We used a self-developed general data questionnaire to collect comprehensive demographic and clinical data from all participants. This questionnaire covered various aspects including gender, age, occupation, education level, drinking habits, age at onset, disease duration, frequency and duration of the current episode, comorbidities, family history of genetic conditions, diagnosis and prognosis. Participants were evaluated using the BPX, the DSM-5 and the International Classification of Diseases, 10th Revision (ICD-10). Clinical diagnosis based on the ICD-10 served as the standard against which the BPX and DSM-5 were compared for sensitivity, specificity, accuracy, positive predictive value (PPV) and negative predictive value (NPV). Additionally, we conducted a multivariate logistic regression analysis to evaluate risk factors associated with BD.

Results

The sensitivity, specificity, accuracy, PPV and NPV were 85.34%, 81.90%, 84.00%, 87.21% and 79.69% for the BPX screening, and 72.73%, 90.32%, 80.00%, 91.43% and 70.00% for the DSM-5 screening, respectively. The study also identified significant clinical characteristics that differentiated those who screened positive for BD using the BPX. These characteristics included a younger average age at onset, a higher prevalence of atypical depression and more frequent prior affective episodes compared with those who did not meet the BPX criteria for BD. Risk factors associated with BD included atypical depression, history of suicide attempts, four or more previous affective episodes, borderline personality disorder, mixed states and a family history of BD.

Conclusion

In conclusion, our findings suggest that the BPX exhibits superior sensitivity in screening for BD among college students compared with the DSM-5. Additionally, the study identifies significant risk factors (e.g., atypical depression, history of suicide attempts and multiple previous affective episodes), which are crucial for early detection and management.