Journal of Psychopathology and Behavioral Assessment

, Volume 33, Issue 3, pp 368–374

Differentiating Bipolar Disorder from Major Depressive Disorder Using the MMPI-2-RF: A Receiver Operating Characteristics (ROC) Analysis

Article

Abstract

We examined the utility of the Minnesota Multiphasic Personality Inventory-2-Restructured Form (MMPI-2-RF) to differentiate patients with lifetime bipolar disorder (BD) from patients with lifetime major depressive disorder (MDD), and to differentiate patients with BD who are currently depressed from patients with current MDD. Sixty-one patients with BD (BD-I n = 51, BD-II n = 10) and 381 patients with MDD were administered the MMPI-2; MMPI-2-RF scale scores were derived from these MMPI-2 protocols. Receiver operating characteristics analysis revealed that the MMPI-2-RF Activation (ACT) scale had the largest Area Under the Curve (AUC), which was 0.74. Using a cut-off score of 4 on the ACT scale resulted in 71% of patients being correctly classified as having BD or MDD (sensitivity = 0.67, specificity = 0.71). An examination of currently depressed patients with BD (n = 29) and a randomly selected sample of MDD patients (n = 29) revealed that the ACT scale correctly classified 72% of patients (AUC = 0.75, sensitivity = 0.69, specificity = 0.76). Implications and limitations of these findings were discussed.

Keywords

Bipolar disorder Major depressive disorder MMPI-2-RF Activation scale ROC analysis 

References

  1. Altshuler, L. L., Post, R. M., Leverich, G. S., Mikalauskas, K., Rosoff, A., & Ackerman, L. (1995). Antidepressant-induced mania and cycle acceleration: a controversy revisited. American Journal of Psychiatry, 152, 1130–1138.PubMedGoogle Scholar
  2. Angst, J., Gamma, A., Benazzi, F., Ajdacic, V., Eich, D., & Rossler, W. (2003). Toward a re-definition of subthreshold bipolarity: epidemiology and proposed criteria for bipolar-II, minor bipolar disorders and hypomania. Journal of Affective Disorders, 73, 133–146.PubMedCrossRefGoogle Scholar
  3. Angst, J. A., Adolfsson, R., Benazzi, F., Gamma, A., Hantouche, E., Meyer, T. D., et al. (2005). The HCL-32: towards a self-assessment tool for hypomanic symptoms in outpatients. Journal of Affective Disorders, 88, 217–233.PubMedCrossRefGoogle Scholar
  4. Baldessarini, R. J., Finklestein, S., & Arana, G. W. (1983). The predictive power of diagnostic tests and the effect of prevalence of illness. Archives of General Psychiatry, 40, 569–573.PubMedGoogle Scholar
  5. Ben-Porath, Y. S., & Tellegen, A. (2008). Minnesota multiphasic personality inventory – 2 restructured form (MMPI-2-RF). Manual for administration, scoring, and interpretation. Minneapolis: University of Minnesota Press.Google Scholar
  6. Ben-Porath, Y. S., Butcher, J. N., & Graham, J. R. (2001). Contribution of the MMPI-2 content scales to the differential diagnosis of psychopathology. Psychological Assessment: A Journal of Consulting and Clinical Psychology, 3, 634–640.Google Scholar
  7. Berk, M., Malhi, G. S., Cahill, C., Carman, A. C., Hadzi-Pavlovic, D., Hawkins, M. T., et al. (2007). The Bipolar Depression Rating Scale (BDRS): its development, validation and utility. Bipolar Disorders, 9, 571–579.PubMedCrossRefGoogle Scholar
  8. Butcher, J. N., & Rouse, S. V. (1996). Personality: individual differences and clinical assessment. Annual Review of Psychology, 47, 87–111.PubMedCrossRefGoogle Scholar
  9. Butcher, J. N., Dahlstrom, W. G., Graham, J. R., Tellegen, A., & Kaemmer, B. (1989). Minnesota multiphasic personality inventory (MMPI-2). Manual for administration and scoring. Minneapolis: University of Minnesota Press.Google Scholar
  10. Camara, W. J., Nathan, J. S., & Puente, A. E. (2000). Psychological test usage: implications in professional psychology. Professional Psychology: Research and Practice, 31, 141–154.CrossRefGoogle Scholar
  11. Cohen, J. (1973). Eta-squared and partial eta-squared in communication science. Human Communication Research, 28, 473–490.Google Scholar
  12. Cohen, J. (1988). Statistical power analysis for the behavioral sciences (2nd ed.). Hillsdale: Erlbaum.Google Scholar
  13. Cuellar, A. K., Johnson, S. L., & Winters, R. (2005). Distinctions between bipolar and unipolar depression. Clinical Psychology Review, 25, 307–339.PubMedCrossRefGoogle Scholar
  14. Engström, C., Brändström, S., Sigvardsson, S., Cloninger, R., & Nylander, P. O. (2004). Bipolar disorder I. Temperament and character. Journal of Affective Disorders, 82, 131–134.PubMedCrossRefGoogle Scholar
  15. First, M. B., Spitzer, R. L., Gibbon, M., & Williams, J. B. W. (1995). Structured clinical interview for DSM-IV axis I disorders – patient edition, version 2.0. New York: Biometrics Research Department.Google Scholar
  16. Ghaemi, S. N., Lenox, M. S., & Baldessarini, R. J. (2001). Effectiveness and safety of long-term antidepressant treatment in bipolar disorder. Journal of Clinical Psychiatry, 62, 565–569.PubMedCrossRefGoogle Scholar
  17. Goldberg, J. F., & Ernst, C. L. (2002). Features associated with the delayed initiation of mood stabilizers at illness onset in bipolar disorder. Journal of Clinical Psychiatry, 63, 985–991.PubMedCrossRefGoogle Scholar
  18. Hamilton, M. (1960). A rating scale for depression. Journal of Neurology, Neurosurgery, and Psychiatry, 23, 56–73.PubMedCrossRefGoogle Scholar
  19. Hirschfeld, R. M. A., Williams, J. B. W., Spitzer, R. L., Calabrese, J. R., Flynn, L., Keck, P. E., Jr., et al. (2000). Development and validation of a screening instrument for bipolar spectrum disorder: the mood disorder questionnaire. American Journal of Psychiatry, 157, 1873–1875.PubMedCrossRefGoogle Scholar
  20. Hirschfeld, R. M. A., Lewis, L., & Vornik, L. A. (2003). Perceptions and impact of bipolar disorder: how far have we really come? Results of the National Depressive and Manic-Depressive Association 2000 survey of individuals with bipolar disorder. Journal of Clinical Psychiatry, 64, 161–174.PubMedCrossRefGoogle Scholar
  21. Kessler, R. C., Wittchen, H. U., Abelson, J. M., & Zhou, S. (2000). Methodological issues in assessing psychiatric disorder with self-reports. In A. A. Stone, J. S. Turrkan, C. A. Bachrach, J. B. Jobe, H. S. Kurtzman, & V. S. Cain (Eds.), The science of self-report: Implications for research and practice (pp. 229–255). Mahwah: Erlbaum.Google Scholar
  22. Mitchell, P. B., Goodwin, G. M., Johnson, G. F., & Hirschfeld, R. M. A. (2008). Diagnostic guidelines for bipolar depression: a probabilistic approach. Bipolar Disorders, 10, 144–152.PubMedCrossRefGoogle Scholar
  23. Montgomery, S. A., & Åsberg, M. (1979). A new depression scale designed to be sensitive to change. British Journal of Psychiatry, 134, 382–389.PubMedCrossRefGoogle Scholar
  24. Nichols, D. S. (2006). The trials of separating bath water from baby: a review and critique of the MMPI-2 Restructured Clinical Scales. Journal of Personality Assessment, 87, 121–138.PubMedCrossRefGoogle Scholar
  25. Parker, G., Hadzi-Pavlovic, D., & Tully, L. (2006). Distinguishing bipolar and unipolar disorders: an isomer model. Journal of Affective Disorders, 96, 67–73.PubMedCrossRefGoogle Scholar
  26. Parker, G., Fletcher, K., Barrett, M., Synott, H., Breakspear, M., Hyett, M., et al. (2008). Screening for bipolar disorder: the utility and comparative properties of the MSS and MDQ measures. Journal of Affective Disorders, 109, 83–89.PubMedCrossRefGoogle Scholar
  27. Rom, D. M. (1990). A sequentially rejective test procedure based on a modified Bonferroni inequality. Biometrika, 77, 663–665.CrossRefGoogle Scholar
  28. Shear, M. K., Greeno, C., Kang, J., Ludewig, D., Frank, E., Swartz, H. A., et al. (2000). Diagnosis of nonpsychotic patients in community clinics. American Journal of Psychiatry, 157, 581–587.PubMedCrossRefGoogle Scholar
  29. Solomon, D. A., Leon, A. C., Maser, J. D., Truman, C. J., Coryell, W., Endicott, J., et al. (2006). Distinguishing bipolar major depression from unipolar major depression with the screening assessment of depression-polarity (SAD-P). Journal of Clinical Psychiatry, 67, 434–442.PubMedCrossRefGoogle Scholar
  30. Streiner, D. L., & Cairney, J. (2007). What’s under the ROC? An introduction to receiver operating characteristics curves. Canadian Journal of Psychiatry, 52, 121–128.Google Scholar
  31. Swets, J. A. (1988). Measuring the accuracy of diagnostic systems. Science, 240, 1285–1293.PubMedCrossRefGoogle Scholar
  32. Tellegen, A., Ben-Porath, Y. S., Sellbom, M., Arbisi, P. A., McNulty, J. L., & Graham, J. R. (2006). Further evidence on the validity of the MMPI-2 restructured clinical scales: addressing questions raised by Rogers, Sewell, Harrison, and Jordan, and Nichols. Journal of Personality Assessment, 87, 148–171.PubMedCrossRefGoogle Scholar
  33. Wehr, T. A., & Goodwin, F. K. (1987). Can antidepressants cause mania and worsen the course of affective illness? American Journal of Psychiatry, 144, 1403–1411.PubMedGoogle Scholar
  34. Weinstock, L. M., Strong, D., Uebelacker, L. A., & Miller, I. W. (2009). Differential item functioning of DSM-IV depressive symptoms in individuals with a history of mania versus those without: An item response theory analysis. Bipolar Disorders, 11, 289–297.PubMedCrossRefGoogle Scholar
  35. Youden, W. J. (1950). Index for rating diagnostic tests. Cancer, 3, 32–35.PubMedCrossRefGoogle Scholar
  36. Zimmerman, M., Galione, J. N., Ruggero, C. J., Chelminski, I., Young, D., Dalrymple, K., et al. (2010). Screening for bipolar disorder and finding borderline personality disorder. Journal of Clinical Psychiatry, 71, 1212–1217.PubMedCrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media, LLC 2010

Authors and Affiliations

  • Chris Watson
    • 1
  • Lena C. Quilty
    • 1
  • R. Michael Bagby
    • 1
    • 2
  1. 1.Clinical Research DepartmentCentre for Addiction and Mental HealthTorontoCanada
  2. 2.Department of PsychiatryUniversity of TorontoTorontoCanada

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