Skip to main content
Headway

Compliance and documentation

How to use the Mood Disorder Questionnaire (MDQ)

A clinician's guide to the MDQ. See the full questionnaire, scoring criteria, sensitivity and specificity, and when to use it during intake and assessment.

August 28, 2026

By Ashley Abramson • Clinically reviewed by Ava Riedesel, LCSW

9 min read

By Ashley Abramson • Clinically reviewed by Ava Riedesel, LCSW

As a provider, you have the important responsibility of treating clients’ mental health symptoms. And as a part of this treatment, it’s important to understand the ways in which symptoms impact a client’s functioning. Evidence-based assessment tools can be useful to better understand the breadth of a client’s symptoms and their impact on that client’s functioning.

The Mood Disorder Questionnaire (MDQ) is one such tool. If you need a fast, reliable screening tool for bipolar disorder symptoms, you may consider using the MDQ. This self-report screening tool evaluates symptoms of hypomania and mania, along with functional impairment caused by these symptoms. While the MDQ doesn’t provide a definitive diagnosis on its own, it can be a helpful guide in prompting further evaluation and supporting effective treatment.

In this article, learn more about how the MDQ works, how to interpret results, and how the tools and support at Headway can help make it easier to assess and treat your clients.

Key insights

1

The Mood Disorder Questionnaire (MDQ) is a brief screening tool used to assess hypomania and mania, which are symptoms that can be present in bipolar disorder diagnoses.

2

A positive MDQ screen usually means someone endorsed enough symptoms, those symptoms happened around the same time, and they caused at least moderate problems in daily life. It flags people who might need a closer look — it doesn't diagnose bipolar disorder.

3

The MDQ performs less accurately in general population settings and is less sensitive for bipolar II disorder. A positive screen should always be followed by a comprehensive clinical evaluation.

What is the Mood Disorder Questionnaire (MDQ)?

The Mood Disorder Questionnaire (MDQ) is a brief self-report screening tool for bipolar disorder, including bipolar I, bipolar II, and related presentations sometimes described as the bipolar spectrum. Through 13 “yes” or “no” questions, the assessment evaluates for symptoms of hypomania or mania, symptom co-occurrence, and functional impairment from symptoms. While the MDQ can provide useful insight about whether an individual is experiencing symptoms of bipolar disorder, it’s not a diagnostic tool on its own; rather, results may suggest the need for further evaluation.

Practice in-network with confidence

Simplify insurance and save time on your entire workflow — from compliance and billing to credentialing and admin.

Talk to a practice consultant

The full Mood Disorder Questionnaire

The MDQ is made up of three sections, plus follow-up questions.

Section 1 asks whether someone has ever experienced 13 symptoms associated with mania or hypomania. Section 2 asks whether multiple endorsed symptoms occurred during the same period of time. Section 3 asks how much these symptoms affect a person’s functioning. Many published versions of the MDQ also include two unscored questions about family history or personal diagnosis of bipolar disorder.

The MDQ questions are as follows:


Section 1:

Has there ever been a period of time when you were not your usual self and…

  1. You felt so good or so hyper that other people thought you were not your normal self or you were so hyper that you got into trouble?
  2. You were so irritable that you shouted at people or started fights or arguments?
  3. You felt much more self-confident than usual?
  4. You got much less sleep than usual and found you didn’t really miss it?
  5. You were much more talkative or spoke faster than usual?
  6. Thoughts raced through your head or you couldn’t slow your mind down?
  7. You were so easily distracted by things around you that you had trouble concentrating or staying on track?
  8. You had much more energy than usual?
  9. You were much more active or did many more things than usual?
  10. You were much more social or outgoing than usual, for example, you telephoned friends in the middle of the night?
  11. You were much more interested in sex than usual?
  12. You did things that were unusual for you or that other people might have thought were excessive, foolish, or risky?
  13. Spending money got you or your family in trouble?

Section 2: If you checked YES to more than one of the above, have several of these ever happened during the same period of time?

Section 3: How much of a problem did any of these cause you — like being able to work; having family, money, or legal troubles; getting into arguments or fights?

Additional questions:

  • Have any of your blood relatives (ie, children, siblings, parents, grandparents, aunts, uncles) had manic-depressive illness or bipolar disorder?
  • Has a health professional ever told you that you have manic-depressive illness or bipolar disorder?

How to score the Mood Disorder Questionnaire

A positive MDQ screen requires all three scoring criteria to be met together, following the standard scoring method established in the questionnaire's original validation study. Meeting only one or two criteria is not considered a positive result.

  • Criterion: At least 7 "yes" responses to the 13 symptom items in Question 1.
  • Criterion: A "yes" response indicating that multiple endorsed symptoms occurred during the same period of time (Question 2).
  • Criterion: A rating that the symptoms caused a moderate or serious problem in functioning (Question 3).

If all three criteria are met, the screen is considered positive and should be followed by a comprehensive clinical evaluation to determine whether bipolar disorder or another condition best explains the client’s symptoms.

Remember: The MDQ isn’t meant to provide a diagnosis on its own, and your clinical judgment still plays an important role. A positive screen signals further assessment, and a negative screen doesn’t rule out bipolar disorder altogether.

What are the limitations of the MDQ?

While the MDQ can be a valuable screening tool, it still has limitations clinicians should consider. First, the MDQ is not a diagnostic instrument on its own, and it can’t distinguish bipolar disorder from other conditions that may cause similar symptoms.

The MDQ is also less sensitive for bipolar II disorder, which means some clients who present with symptoms of bipolar II disorder may screen negative. Because it’s a self-report measure, a person’s responses may be affected by their memory or current mood state. It’s best to follow a positive MDQ result with a comprehensive clinical interview and consider differential diagnoses when appropriate.

When to use the MDQ in clinical practice

Not sure when the MDQ is best used in clinical practice? While it isn't necessary for every client, the MDQ can be a valuable screening tool in specific clinical situations where bipolar disorder is a possibility. Keep the following best practices in mind:

  • Intake screening: The MDQ is most useful during the initial intake or diagnostic assessment, particularly when a client presents with depression. Because bipolar disorder often first comes to clinical attention during a depressive episode, screening can help identify individuals who may require a more comprehensive bipolar evaluation before treatment begins.
  • Treatment-resistant depression: The MDQ can also be appropriate when depression has not improved with one or more adequate antidepressant trials, especially if antidepressants have caused agitation, mood elevation, or rapid mood shifts. (Any change to a client's medication should come from the prescribing clinician, and clients should never stop or adjust a psychiatric medication on their own.)
  • Other triggers: Other situations that warrant screening include a history of episodic mood changes, decreased need for sleep, impulsive or high-risk behaviors, unusually increased energy, or a first-degree family history of bipolar disorder.
  • Limitation: The MDQ is not designed to monitor symptom severity or treatment response over time, as it assesses lifetime symptoms rather than a person’s current status. For ongoing measurement, pair the MDQ with symptom-specific outcome measures such as the PHQ-9 for depressive symptoms, the Altman Self-Rating Mania Scale (ASRM), or clinician-rated mania scales when appropriate.

How to discuss MDQ results with clients

Any potential mental health diagnosis can contribute to anxiety for clients. A collaborative approach and open communication can help limit anxiety and maintain a supportive environment as you work toward a diagnosis. Here’s what to consider in the process.

  • Framing a positive screen: A positive screen that indicates the possibility of bipolar disorder can be overwhelming for clients. It can help to frame the results as a starting point. Remind your client that the MDQ isn’t a diagnostic instrument on its own, and that additional assessments can help you understand symptoms and functional impairment.
  • Framing a negative screen: If a client does not screen positive on the MDQ, explain to them that the negative result doesn’t completely rule out bipolar disorder, and that continued monitoring is necessary when suspicion remains.
  • Documentation: Whether your client screened positive or negative on the MDQ, documenting the result can help support medical necessity and continuity of care. Record the client’s score, whether screening criteria were met, and any follow-up assessment or clinical decision-making prompted by the findings.
  • Collaborative review: Your clinical judgment is an essential aspect of clarifying diagnosis. Walk through the items your client endorsed together, so you can better understand why they selected the answer they did.

MDQ vs. other bipolar screening tools

Several screening tools can help identify potential symptoms of bipolar disorder, but each tool serves a different purpose. The MDQ is a widely studied and commonly used tool for routine screening in outpatient mental health settings, because it is brief and easy to administer. Additional screening tools include:

  • HCL-32: The Hypomania Checklist-32 (HCL-32) focuses on hypomanic symptoms and is more sensitive than the MDQ, making it useful when evaluating clients with recurrent depression or when hypomania is suspected despite a negative MDQ.
  • BSDS: The Bipolar Spectrum Diagnostic Scale (BSDS) uses a narrative format rather than a symptom checklist and may better identify individuals with subtle or atypical bipolar spectrum presentations.
  • SCID: For diagnostic confirmation, the Structured Clinical Interview for DSM-5 (SCID-5) remains the gold standard because it involves a comprehensive clinician-led interview. However, its length and training requirements make it impractical for routine screening, so it is typically reserved for diagnostic assessments or research settings.
  • Setting-based choice: In outpatient mental health settings, the MDQ offers a good balance of speed and accuracy, while the HCL-32 and BSDS may be useful in specialty mental health settings or diagnostically complex cases. In primary care and general population settings — where the MDQ's sensitivity is lower — a negative screen is more likely to be a false negative, so let your clinical judgment guide whether to assess further. The SCID-5 is most appropriate when a formal diagnostic evaluation is needed.

Frequently asked questions about the Mood Disorder Questionnaire

Is the MDQ a diagnostic tool?

Rather than a diagnostic tool, the Mood Disorder Questionnaire is a screening instrument that can provide helpful insight about potential bipolar disorder symptoms and how they affect an individual’s functioning. A positive result on the MDQ signals the need for further evaluation for bipolar disorder.

Can clients take the MDQ on their own?

The MDQ is a self-report measure, which means clients can complete it on their own in or out of a therapy session. MDQ results should always be interpreted by a qualified professional — a therapist, psychiatric nurse practitioner, or psychiatrist — who can explain the results and guide the client on potential next steps.

How accurate is the MDQ?

The MDQ performs best in psychiatric settings, where a meta-analysis of 19 studies reports approximately 66% sensitivity and 79% specificity using the standard cutoff of seven or more symptoms. Accuracy may drop in primary care and general population settings, with sensitivity falling to about 43% and specificity around 95%, making false negatives more likely, especially for bipolar II disorder.

Does a negative MDQ result rule out bipolar disorder?

No. A negative MDQ result does not rule out bipolar disorder. The MDQ is not a diagnostic tool, and it can miss cases, especially with bipolar II disorder. Persistent symptoms of bipolar disorder warrant additional assessment.

Can the MDQ be used with adolescents?

The standard version of the MDQ is validated for use among adults. The Mood Disorder Questionnaire-Adolescent Version (MDQ-A) is a 15-item screening instrument developed in 2006 to identify bipolar spectrum disorders in adolescents ages 13 to 17.

Is the MDQ available in other languages?

Yes. The MDQ has been translated into many languages and used as a screening instrument in other countries. Validated versions include Spanish, French, Italian, Chinese, Turkish, Portuguese, and Thai.

How Headway supports providers

Headway makes it easier for behavioral health providers to focus on client care by providing administrative support, documentation templates, and EHR tools.

  • Documentation and notes: Through its integrated, free EHR, Headway offers insurer-ready templates and AI-assisted progress notes to save providers time and streamline workflows while supporting compliant documentation.
  • Billing and payments: With Headway’s billing support, providers can rely on consistent, biweekly payments.
  • Caseload and credentialing: Headway streamlines the insurance credentialing process and provides referrals, making it easier for providers to grow their caseload and business without stress and time-consuming admin.
Talk to a practice consultant

This content is for general informational and educational purposes only and does not constitute clinical, legal, financial, or professional advice. All decisions should be made at the discretion of the individual or organization, in consultation with qualified clinical, legal, or other appropriate professionals.

© 2026 Therapymatch, Inc. dba Headway. All rights reserved. No part of this publication may be reproduced without permission.

Compliance and documentation

How to write progress notes

Progress notes are the core piece of documentation a provider should write after each client session, but it’s more than just a record of what happened.