Archives of Women's Mental Health

, Volume 13, Issue 3, pp 233–248 | Cite as

Screening for bipolar disorder during pregnancy and the postpartum period

  • Cheryl Ann Chessick
  • Sona Dimidjian
Review Article


Bipolar disorder is a significant mental health problem among perinatal women; however, little attention has been devoted to methods of screening for bipolar disorder during this phase of women’s life cycle. There is a need for reliable and valid screening instruments for perinatal women. This paper presents a review of 11 self-report measures used to screen bipolar disorder in the general population and discusses their applicability to screening among perinatal women. Published psychometric data, including reliability, sensitivity, specificity, and positive predictive value of each self-report instrument, is presented and critiqued. We make recommendations for screening in clinical practice and highlights priorities for future research. The need for more research in this area is emphasized.


Bipolar disorder Screening Women Perinatal Pregnancy Postpartum 


  1. Akiskal HS (1996) The prevalent clinical spectrum of bipolar disorders: beyond DSM-IV. J Clin Psychopharmacol 16(2 Suppl 1):4S–14SCrossRefPubMedGoogle Scholar
  2. Akiskal HS, Benazzi F (2005) Atypical depression: a variant of bipolar II or a bridge between unipolar and bipolar II? J Affect Disord 84(2–3):209–217CrossRefPubMedGoogle Scholar
  3. Akiskal HS, Walker P, Puzantian VR, King D, Rosenthal TL, Dranon M (1983) Bipolar outcome in the course of depressive illness. Phenomenologic, familial, and pharmacologic predictors. J Affect Disord 5(2):115–128CrossRefPubMedGoogle Scholar
  4. Akiskal HS, Bourgeois ML, Angst J, Post R, Moller H, Hirschfeld R (2000) Re-evaluating the prevalence of and diagnostic composition within the broad clinical spectrum of bipolar disorders. J Affect Disord 59(Suppl 1):S5–S30CrossRefPubMedGoogle Scholar
  5. Altman EG, Hedeker D, Peterson JL, Davis JM (1997) The Altman Self-Rating Mania Scale. Biol Psychiatry 15;42(10):948–955CrossRefGoogle Scholar
  6. Altman E, Hedeker D, Peterson JL, Davis JM (2001) A comparative evaluation of three self-rating scales for acute mania. Biol Psychiatry 15;50(6):468–471CrossRefGoogle Scholar
  7. American Psychiatric Association (2000) In: Diagnostic and Statistical Manual of Mental Disorders Fourth Edition, Text Revision ed. American Psychiatric Association, Washington, DCGoogle Scholar
  8. American Psychiatric Association (2002) Practice guideline for the treatment of patients with bipolar disorder (revision). Am J Psychiatry 159:1–50CrossRefGoogle Scholar
  9. Angst J, Adolfsson R, Benazzi F, Gamma A, Hantouche E, Meyer TD et al (2005) The HCL-32: towards a self-assessment tool for hypomanic symptoms in outpatients. J Affect Disord 88(2):217–233CrossRefPubMedGoogle Scholar
  10. Bauer MS, Crits-Christoph P, Ball WA, Dewees E, McAllister T, Alahi P et al (1991) Independent assessment of manic and depressive symptoms by self-rating. Scale characteristics and implications for the study of mania. Arch Gen Psychiatr 48(9):807–812PubMedGoogle Scholar
  11. Bauer MS, Vojta C, Kinosian B, Altshuler L, Glick H (2000) The Internal State Scale: replication of its discriminating abilities in a multisite, public sector sample. Bipolar Disord 2(4):340–346CrossRefPubMedGoogle Scholar
  12. Blacker D, Endicott J (2000) Psychometric properties. In: Rush A, First M, Blacker D (eds) Handbook of Psychiatric Measures. American Psychiatric Association, Washington DC, pp 7–14Google Scholar
  13. Boudreaux ED, Cagande C, Kilgannon JH, Clark S, Camargo CA (2006) Bipolar disorder screening among adult patients in an urban emergency department setting. Prim Care Companion J Clin Psychiatry 8(6):348–351CrossRefPubMedGoogle Scholar
  14. Boyd RC, Le HN, Somberg R (2005) Review of screening instruments for postpartum depression. Arch Womens Ment Health 8(3):141–153CrossRefPubMedGoogle Scholar
  15. Brand SR, Brennan MA, Brennan PA (2009) Impact of antenatal and postpartum maternal mental illness: how are the children? Clin Obstet Gynecol 52(3):441–455CrossRefPubMedGoogle Scholar
  16. Braunig P, Shugar G, Kruger S (1996) An investigation of the Self-Report Manic Inventory as a diagnostic and severity scale for mania. Compr Psychiatr 37(1):52–55CrossRefGoogle Scholar
  17. Brockington I (1996) Motherhood and mental health. Oxford University Press, Oxford, pp 200–284Google Scholar
  18. Brown ES, Bauer MS, Suppes T, Khan DA, Carmody T (2000) Comparison of the internal state scale to clinician-administered scales in asthma patients receiving corticosteroid therapy. Gen Hosp Psychiatr 22(3):180–183CrossRefGoogle Scholar
  19. Buist AE, Barnett BE, Milgrom J, Pope S, Condon JT, Ellwood DA et al (2002) To screen or not to screen—that is the question in perinatal depression. Med J Aust 177(Suppl):S101–S105PubMedGoogle Scholar
  20. Burt VK, Rasgon N (2004) Special considerations in treating bipolar disorder in women. Bipolar Disord 6:2–13CrossRefPubMedGoogle Scholar
  21. Carta MG, Hardoy MC, Cadeddu M, Murru A, Campus A, Morosini PL et al (2006) The accuracy of the Italian version of the Hypomania Checklist (HCL-32) for the screening of bipolar disorders and comparison with the Mood Disorder Questionnaire (MDQ) in a clinical sample. Clin Pract Epidemiol Ment Health 2:2CrossRefPubMedGoogle Scholar
  22. Cohen LS (2007) Treatment of bipolar disorder during pregnancy. J Clin Psychiatr 68(Suppl 9):4–9Google Scholar
  23. Cooke RG, Kruger S, Shugar G (1996) Comparative evaluation of two self-report Mania Rating Scales. Biol Psychiatr 40(4):279–283CrossRefGoogle Scholar
  24. Coryell W, Scheftner W, Keler M, Endicott J, Maser J, Klerman GL (1993) The enduring psychosocial consequences of mania and depression. Am J Psychiatr 150(5):720–727PubMedGoogle Scholar
  25. de Dios C, Ezquiaga E, Garcia A, Montes JM, Avedillo C, Soler B (2008) Usefulness of the Spanish version of the Mood Disorder Questionnaire for screening bipolar disorder in routine clinical practice in outpatients with major depression. Clin Pract Epidemiol Ment Health 4:14CrossRefPubMedGoogle Scholar
  26. Depue RA, Klein DN (1988) Identification of unipolar and bipolar affective conditions in nonclinical and clinical populations by the general behavior inventory. In: Dunner DL, Gershon ES, Barrett JE (eds) Relatives at Risk for Mental Disordes. Raven, New York, pp 179–204Google Scholar
  27. Depue RA, Slater JF, Wolfstetter-Kausch H, Klein D, Goplerud E, Farr D (1981) A behavioral paradigm for identifying persons at risk for bipolar depressive disorder: a conceptual framework and five validation studies. J Abnorm Psychol 90(5):381–437CrossRefPubMedGoogle Scholar
  28. Depue RA, Krauss S, Spoont MR, Arbisi P (1989) General behavior inventory identification of unipolar and bipolar affective conditions in a nonclinical university population. J Abnorm Psychol 98(2):117–126CrossRefPubMedGoogle Scholar
  29. Dew MA, Switzer GE, Myaskovsky L, DiMartini AF, Tovt-Korshynska MI (2006) Rating scales for mood disorders. In: Stein DJ, Kupfer DJ, Schatzberg AF (eds) The American Psychiatric Publishing Textbook of Mood Disorders. American Psychiatric Publishing, Arlington, pp 69–97Google Scholar
  30. Eckblad M, Chapman LJ (1986) Development and validation of a scale for hypomanic personality. J Abnorm Psychol 95(3):214–222CrossRefPubMedGoogle Scholar
  31. Endicott J, Spitzer RL (1978) A diagnostic interview: the schedule for affective disorders and schizophrenia. Arch Gen Psychiatr 35(7):837–844PubMedGoogle Scholar
  32. First MB, Spitzer RL, Gibbon M, Williams JBW (1994) Structured clinical interview for axis I DSM-IV disorders, patient edition. SCID-I/P, Version 2.0. New York State Psychiatric Institute, Biometrics Research, New YorkGoogle Scholar
  33. Freeman MD, Gelenberg A (2005) Bipolar disorder in women: reproductive events and treatment considerations. Acta Psychiatr Scand 112:88–96CrossRefPubMedGoogle Scholar
  34. Freeman MP, Smith KW, Freeman SA, McElroy SL, Kmetz GE, Wright R et al (2002) The impact of reproductive events on the course of bipolar disorder in women. J Clin Psychiatr 63(4):284–287Google Scholar
  35. Frye MA, Salloum IM (2006) Bipolar disorder and comorbid alcoholism: prevalence rate and treatment considerations. Bipolar Disord 8(6):677–685CrossRefPubMedGoogle Scholar
  36. Gaynes BN, Gavin N, Meltzer-Brody S, Lohr KN, Swinson T, Gartlehner G et al (2005) Perinatal depression: prevalence, screening accuracy, and screening outcomes. Evid Rep Technol Assess (Summ) 119:1–8Google Scholar
  37. Gentile S (2006) Prophylactic treatment of bipolar disorder in pregnancy and breastfeeding: focus on emergin mood stabilizers. Bipolar Disord 8:207–220CrossRefPubMedGoogle Scholar
  38. Ghaemi SN, Sachs GS, Chiou AM, Pandurangi AK, Goodwin K (1999) Is bipolar disorder still underdiagnosed? Are antidepressants overutilized? J Affect Disord 52(1–3):135–144CrossRefPubMedGoogle Scholar
  39. Ghaemi SN, Boiman E, Goodwin FK (2000) Insight and outcome in bipolar, unipolar, and anxiety disorders. Compr Psychiatr 41(3):167–171CrossRefGoogle Scholar
  40. Ghaemi SN, Hsu DJ, Ko JY, Baldassano CF, Kontos NJ, Goodwin FK (2004) Bipolar spectrum disorder: a pilot study. Psychopathology 37(5):222–226CrossRefPubMedGoogle Scholar
  41. Glick HA, McBride L, Bauer MS (2000) A manic-depressive symptom self-report in optical scanable format. Bipolar Disord 5(5):366–369CrossRefGoogle Scholar
  42. Glover V, Liddle P, Taylor A, Adams D, Sandler M (1994) Mild hypomania (the highs) can be a feature of the first postpartum week. Association with later depression. Br J Psychiatr 164(4):517–521CrossRefGoogle Scholar
  43. Goldberg JF, Ernst CL (2002) Features associated with the delayed initiation of mood stabilizers at illness onset in bipolar disorder. J Clin Psychiatr 63(11):985–991Google Scholar
  44. Goodwin FK, Jamison KR (2007) Manic-Depressive Illness: Bipolar Disorders and Recurrent Depression, 2nd edn. Oxford University Press, New YorkGoogle Scholar
  45. Hardoy MC, Cadeddu M, Murru A, Dell'Osso B, Carpiniello B, Morosini PL et al (2005) Validation of the Italian version of the "Mood Disorder Questionnaire" for the screening of bipolar disorders. Clin Pract Epidemiol Ment Health 21:1–8Google Scholar
  46. Harvey AG (2008) Sleep and circadian rhythms in bipolar disorder: seeking synchrony, harmony, and regulation. Am J Psychiatr 165(7):820–829CrossRefPubMedGoogle Scholar
  47. Hasegawa M (2000) Mild hypomania phenomenon in Japanese puerperal women. Nurs Health Sci 2:231–235CrossRefGoogle Scholar
  48. Heron J, Haque S, Oyebode F, Craddock N, Jones I (2009) A longitudinal study of hypomania and depression symptoms in pregnancy and the postpartum period. Bipolar Disord 11:410–417CrossRefPubMedGoogle Scholar
  49. Hirschfeld RM, Williams JB, Spitzer RL, Calabrese JR, Flynn L, Keck PE Jr et al (2000) Development and validation of a screening instrument for bipolar spectrum disorder: the Mood Disorder Questionnaire. Am J Psychiatr 157(11):1873–1875CrossRefPubMedGoogle Scholar
  50. Hirschfeld RM, Calabrese JR, Weissman MM, Reed M, Davies MA, Frye MA et al (2003) Screening for bipolar disorder in the community. J Clin Psychiatr 64(1):53–59CrossRefGoogle Scholar
  51. Hirschfeld RM, Cass AR, Holt DC, Carlson CA (2005) Screening for bipolar disorder in patients treated for depression in a family medicine clinic. J Am Board Fam Pract 18(4):233–239CrossRefPubMedGoogle Scholar
  52. Huang CL, Yang YK, Chen M, Lee IH, Yeh TL, Yang MJ (2003) Patient- and family-rated scale for bipolar disorder symptoms: Internal State Scale. Kaohsiung J Med Sci 19(4):170–176CrossRefPubMedGoogle Scholar
  53. Isometsa E, Suominen K, Mantere O, Valtonen H, Leppamaki S, Pippingskold M et al (2003) The Mood Disorder Questionnaire improves recognition of bipolar disorder in psychiatric care. BMC Psychiatr 10:3–8Google Scholar
  54. Jones I, Craddock N (2001) Familiality of the puerperal trigger in bipolar disorder: results of family study. Am J Psychiatr 158:913–917PubMedGoogle Scholar
  55. Judd LL, Akiskal HS (2003) The prevalence and disability of bipolar spectrum disorders in the US population: re-analysis of the ECA database taking into account subthreshold cases. J Affect Disord 73(1–2):123–131CrossRefPubMedGoogle Scholar
  56. Judd LL, Akiskal HS, Schettler PJ, Endicott J, Maser J, Solomon DA et al (2002) The long-term natural history of the weekly symptomatic status of bipolar I disorder. Arch Gen Psychiatr 59(6):530–537CrossRefPubMedGoogle Scholar
  57. Judd LL, Akiskal HS, Schettler PJ, Coryell W, Endicott J, Maser JD et al (2003) A prospective investigation of the natural history of the long-term weekly symptomatic status of bipolar II disorder. Arch Gen Psychiatr 60(3):261–269CrossRefPubMedGoogle Scholar
  58. Kemp DE, Hirschfeld RM, Ganocy SJ, Elhaj O, Slembarski R, Bilali S et al (2008) Screening for bipolar disorder in a county jail at the time of criminal arrest. J Psychiatr Res 42(9):778–786CrossRefPubMedGoogle Scholar
  59. Kessler RC, Chiu WT, Demler O, Merikangas KR, Walters EE (2005) Prevalence, severity, and comorbidity of 12-month DSM-IV disorders in the National Comorbidity Survey Replication. Arch Gen Psychiatr 62(6):617–627CrossRefPubMedGoogle Scholar
  60. Kinsella MT, Monk C (2009) Impact of maternal stress, depression and anxiety on fetal neurobehavioral development. Clin Obstet Gynecol 52(3):425–440CrossRefPubMedGoogle Scholar
  61. Klein DN, Depue RA (1984) Continued impairment in persons at risk for bipolar affective disorder: results of a 19-month follow-up study. J Abnorm Psychol 93(3):345–347CrossRefPubMedGoogle Scholar
  62. Konuk N, Kiran S, Tamam L, Karaahmet E, Aydin H, Atik L (2007) Validation of the Turkish version of the Mood Disorder Questionnaire for screening bipolar disorders. Turk Psikiyatri Derg 18(2):147–154PubMedGoogle Scholar
  63. Kwapil TR, Miller MB, Zinser MC, Chapman LJ, Chapman J, Eckblad M (2000) A longitudinal study of high scorers on the hypomanic personality scale. J Abnorm Psychol 109(2):222–226CrossRefPubMedGoogle Scholar
  64. Lane A, Keville R, Morris M, Kinsella A, Turner M, Barry S (1997) Postnatal depression and elation among mothers and their partners: prevalence and predictors. Br J Psychiatr 171:550–555CrossRefGoogle Scholar
  65. Mallikarjun PK, Oyebode F (2005) Prevention of postnatal depression. J R Soc Promot Health 125(5):221–226CrossRefPubMedGoogle Scholar
  66. Meyer TD, Hammelstein P, Nilsson LG, Skeppar P, Adolfsson R, Angst J (2007) The Hypomania Checklist (HCL-32): its factorial structure and association to indices of impairment in German and Swedish nonclinical samples. Compr Psychiatr 48(1):79–87CrossRefGoogle Scholar
  67. Miklowitz DJ, Johnson SL (2006) The psychopathology and treatment of bipolar disorder. Annu Rev Clin Psychol 2:199–235CrossRefPubMedGoogle Scholar
  68. Miller CJ, Klugman J, Berv DA, Rosenquist KJ, Ghaemi SN (2004) Sensitivity and specificity of the Mood Disorder Questionnaire for detecting bipolar disorder. J Affect Disord 81(2):167–171CrossRefPubMedGoogle Scholar
  69. Miller L, Shade M, Vasireddy V (2009) Beyond screening: assessment of perinatal depression in a perinatal care setting. Arch Womens Ment Health 12(5):329–334 doi: 10.1007/s00737-009-0082-5 Google Scholar
  70. Munk-Olsen T, Munk Larsen T, Bocker Pedersen C (2006) New parents and mental disorders: a population-based registry study. JAMA 296(21):2582–2589CrossRefPubMedGoogle Scholar
  71. Nassir Ghaemi S, Miller CJ, Berv DA, Klugman J, Rosenquist KJ, Pies RW (2005) Sensitivity and specificity of a new bipolar spectrum diagnostic scale. J Affect Disord 84(2–3):273–277CrossRefPubMedGoogle Scholar
  72. Parker G, Hadzi-Pavlovic D, Tully L (2006) Distinguishing bipolar and unipolar disorders: an isomer model. J Affect Disord 96(1–2):67–73CrossRefPubMedGoogle Scholar
  73. Parker G, Fletcher K, Barrett M, Synnott H, Breakspear M, Hyett M et al (2008) Screening for bipolar disorder: the utility and comparative properties of the MSS and MDQ measures. J Affect Disord 109(1–2):83–89CrossRefPubMedGoogle Scholar
  74. Payne JL, MacKinnon DF, Mondimore FM, McInnis MG, Schweizer B, Zamoiski RB et al (2008) Familial aggregation of postpartum mood symptoms in bipolar disorder pedigrees. Bipolar Disord 10(1):38–44PubMedGoogle Scholar
  75. Perlis RH, Ostacher MJ, Patel JK, Marangell LB, Zhang H, Wisniewski SR et al (2006) Predictors of recurrence in bipolar disorder: primary outcomes from the Systematic Treatment Enhancement Program for Bipolar Disorder (STEP-BD). Am J Psychiatr 163(2):217–224CrossRefPubMedGoogle Scholar
  76. Phelps JR, Ghaemi SN (2006) Improving the diagnosis of bipolar disorder: predictive value of screening tests. J Affect Disord 92(2–3):141–148CrossRefPubMedGoogle Scholar
  77. Pignone MP, Gaynes BN, Rushton JL, Burchell CM, Orleans CT, Mulrow CD et al (2002) Screening for depression in adults: a summary of the evidence for the U.S. Preventive Services Task Force. Ann Intern Med 21;136(10):765–776Google Scholar
  78. Sanchez-Moreno J, Villagran JM, Gutierrez JR, Camacho M, Ocio S, Palao D et al (2008) Adaptation and validation of the Spanish version of the Mood Disorder Questionnaire for the detection of bipolar disorder. Bipolar Disord 10(3):400–412CrossRefPubMedGoogle Scholar
  79. Schneck CD, Miklowitz DJ, Calabrese JR, Allen MH, Thomas MR, Wisniewski SR et al (2004) Phenomenology of rapid-cycling bipolar disorder: data from the first 500 participants in the Systematic Treatment Enhancement Program. Am J Psychiatr 161(10):1902–1908CrossRefPubMedGoogle Scholar
  80. Schneck CD, Miklowitz DJ, Miyahara S, Araga M, Wisniewski S, Gyulai L et al (2008) The prospective course of rapid-cycling bipolar disorder: findings from the STEP-BD. Am J Psychiatr 165(3):370–377, quiz 410CrossRefPubMedGoogle Scholar
  81. Shabani A, Koohi-Habibi L, Nojomi M, Chimeh N, Ghaemi SN, Soleimani N (2009) The Persian Bipolar Spectrum Diagnostic Scale and Mood Disorder Questionnaire in screening the patients with bipolar disorder. Arch Iran Med 12(1):41–47PubMedGoogle Scholar
  82. Sharma V (2008) Management of bipolar II disorder during pregnancy and the postpartum period—Motherisk Update 2008. Can J Clin Pharmacol 16(1):e33–e41Google Scholar
  83. Sharma V (2009) Management of bipolar II disorder during pregnancy and the postpartum period. Can J Clin Pharmacol 16(1):e33–e41PubMedGoogle Scholar
  84. Sharma V, Khan M, Corpse C, Sharma P (2008) Missed bipolarity and psychiatric comorbidity in women with postpartum depression. Bipolar Disord 10(6):742–747CrossRefPubMedGoogle Scholar
  85. Shugar G, Schertzer S, Toner BB, Di Gasbarro I (1992) Development, use, and factor analysis of a self-report inventory for mania. Compr Psychiatr 33(5):325–331CrossRefGoogle Scholar
  86. Smith S, Heron J, Haque S, Clarke P, Oyebode F, Jones I (2009) Measuring hypomania in the postpartum: a comparison of the Highs Scale and the Altman Mania Rating Scale. Arch Womens Ment Health 12:323–327CrossRefPubMedGoogle Scholar
  87. Solomon DA, Leon AC, Maser JD, Truman CJ, Coryell W, Endicott J et al (2006) Distinguishing bipolar major depression from unipolar major depression with the screening assessment of depression-polarity (SAD-P). J Clin Psychiatr 67(3):434–442CrossRefGoogle Scholar
  88. Spinelli MG (2009) Postpartum psychosis: detection of risk and management. Am J Psychiatr 166(4):405–408CrossRefPubMedGoogle Scholar
  89. Stang P, Frank C, Ulcickas Yood M, Wells K, Burch S (2007) Impact of bipolar disorder: results from a screening study. Prim Care Companion J Clin Psychiatr 9(1):42–47CrossRefGoogle Scholar
  90. Tafalla M, Sanchez-Moreno J, Diez T, Vieta E (2009) Screening for bipolar disorder in a Spanish sample of outpatients with current major depressive episode. J Affect Disord 114(1–3):299–304CrossRefPubMedGoogle Scholar
  91. Twiss J, Jones S, Anderson I (2008) Validation of the Mood Disorder Questionnaire for screening for bipolar disorder in a UK sample. J Affect Disord 110(1–2):180–184CrossRefPubMedGoogle Scholar
  92. Vieta E, Sanchez-Moreno J, Bulbena A, Chamorro L, Ramos JL, Artal J et al (2007) Cross validation with the mood disorder questionnaire (MDQ) of an instrument for the detection of hypomania in Spanish: the 32 item hypomania symptom check list (HCL-32). J Affect Disord 101(1–3):43–55CrossRefPubMedGoogle Scholar
  93. Viguera AC, Nonacs R, Cohen LS, Tondo L, Murray A, Baldessarini RJ (2000) Risk of recurrence of bipolar disorder in pregnant and nonpregnant women after discontinuing lithium maintenance. Am J Psychiatr 157:179–184CrossRefPubMedGoogle Scholar
  94. Viguera AC, Whitfield T, Baldessarini RJ, Newport DJ, Stowe Z, Reminick A et al (2007) Risk of recurrence in women with bipolar disorder during pregnancy: prospective study of mood stabilizer discontinuation. Am J Psychiatr 164(12):1817–1824, quiz 923CrossRefPubMedGoogle Scholar
  95. Weber Rouget B, Gervasoni N, Dubuis V, Gex-Fabry M, Bondolfi G, Aubry JM (2005) Screening for bipolar disorders using a French version of the Mood Disorder Questionnaire (MDQ). J Affect Disord 88(1):103–108CrossRefPubMedGoogle Scholar
  96. Webster J, Pritchard MA, Creedy D, East C (2003) A simplified predictive index for the detection of women at risk for postnatal depression. Birth 30(2):101–108CrossRefPubMedGoogle Scholar
  97. Yonkers KA, Wisner KL, Stowe Z, Leibenluft E, Cohen L, Miller L et al (2004) Management of bipolar disorder during pregnancy and the postpartum period. Am J Psychiatr 161(4):608–620CrossRefPubMedGoogle Scholar

Copyright information

© Springer-Verlag 2010

Authors and Affiliations

  1. 1.Department of Psychiatry, School of MedicineUniversity of Colorado DenverDenverUSA
  2. 2.Depression CenterUniversity of ColoradoDenverUSA
  3. 3.Department of PsychologyUniversity of Colorado at BoulderBoulderUSA

Personalised recommendations