Factor structure and reliability of the Arabic adaptation of the Hypomania Check List-32, second revision (HCL-32-R2)

Objective: To assess the psychometric properties of the Arabic adaptation of the Hypomania-Check-List 32-item, second revision (HCL-32- R2) for the detection of bipolarity in major depressive disorder (MDD) inpatients suffering a current major depressive episode (MDE). Method: The “Bipolar Disorders: Improving Diagnosis, Guidance, and Education” Arabic module of the HCL-32-R2 was administered to mother-tongue Arabic MDE inpatients between March 2013 and October 2014. Diagnostic and Statistical Manual Fourth edition (DSM-IV) diagnoses were made adopting the mini-international neuropsychiatric interview, using bipolar disorder (BD) patients as controls. Results: In our sample (n = 500, of whom, BD-I = 329; BD-II = 70; MDD = 101), using a cut-off of 17 allowed the HCL-32-R2 to discriminate DSM-IV-defined MDD patients between “true unipolar” (HCL-32-R2− ) and “sub-threshold bipolar depression” (HCL-32-R2+ ) with sensitivity = 82% and specificity = 77%. Area under the curve was .883; positive and negative predictive values were 93.44% and 73.23% respectively. Owing to clinical interpretability considerations and consistency with previous adaptations of the HCL-32, a two-factor solution (F1=”hyperactive/elated” vs. F2=”irritable/distractible/impulsive”) was preferred using exploratory and confirmatory factors analyses. Item n.33 (“I gamble more”) and n.34 (“I eat more”) introduced in the R2 version of the HCL-32 loaded onto F1, though very slightly. Cronbach’s alphas were F1 = .86 and F2 = .60. Limitations: No cross-validation with any additional validated screening tool. Inpatients only sample; recall bias; no systematic evaluation of eventual medical/psychiatric comorbidities, current/lifetime pharmacological history, or record of severity of current MDE. Conclusions: In our sample, the HCL-32 fairly discriminated between MDD and BD-I but not BD-II, therefore soliciting for replication studies for use in Arabic-speaking depressed inpatients.