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Hypomania Checklist

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The Hypomania Checklist ( HCL-32 ) is a questionnaire developed by Dr. Jules Angst to identify hypomanic features in patients with major depressive disorder in order to help recognize bipolar II disorder and other bipolar spectrum disorders when people seek help in primary care and other general medical settings. It asks about 32 behaviors and mental states that are either aspects of hypomania or features associated with mood disorders. It uses short phrases and simple language, making it easy to read. The University of Zurich holds the copyright, and the HCL-32 is available for use at no charge. More recent work has focused on validating translations and testing whether shorter versions still perform well enough to be helpful clinically. Recent meta-analyses find that it is one of the most accurate assessments available for detecting hypomania, doing better than other options at recognizing bipolar II disorder.

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39-542: The Hypomania Checklist was built as a more efficient screening measure for hypomania, to be used both in epidemiological research and in clinical use. Existing measures for bipolar disorder focused on identifying personality factors and symptom severity instead of the episodic nature of hypomania or the possible negative consequences in behavioral, affective, or cognitive changes associated. These measures were mostly used in non-clinical populations to identify individuals at risk and were not used as screening instruments. The HCL-32

78-458: A Likert scale with ranked options , true-false, or forced choice, although other formats such as sentence completion or visual analog scales are possible. True-false involves questions that the individual denotes as either being true or false about themselves. Forced-choice is a set of statements that require the individual to choose one as being most representative of themselves. If the inventory includes items from different factors or constructs,

117-449: A 'better' response than the preceding value. (This may differ in cases where reverse ordering of the Likert scale is needed). The second, and possibly more important point, is whether the "distance" between each successive item category is equivalent, which is inferred traditionally. For example, in the above five-point Likert item, the inference is that the 'distance' between category 1 and 2

156-552: A different response compared to administration via a postal survey. Similar reliability scores were found when only using 16 item assessments versus the traditional 32-item format of the HCL-32. A score of at least 8 items was found valid and reliable for distinguishing Bipolar Disorder and Major Depressive Disorder. In a study, 73% of patients who completed the HCL-32 R1 were true bipolar cases identified as potential bipolar cases. However,

195-425: A positive outcome. On the other hand, even if a researcher presents what he or she believes are equidistant categories, it may not be interpreted as such by the respondent. A good Likert scale, as above, will present a symmetry of categories about a midpoint with clearly defined linguistic qualifiers. In such symmetric scaling, equidistant attributes will typically be more clearly observed or, at least, inferred. It

234-414: A scale proper, which emerges from collective responses to a set of items (usually eight or more), and the format in which responses are scored along a range. Technically speaking, a Likert scale refers only to the former. The difference between these two concepts has to do with the distinction Likert made between the underlying phenomenon being investigated and the means of capturing variation that points to

273-401: A set of such items that are highly correlated (that show high internal consistency ) but also that together will capture the full domain under study (which requires less-than perfect correlations). Others hold to a standard by which "All items are assumed to be replications of each other or in other words items are considered to be parallel instruments". By contrast, modern test theory treats

312-410: A statement. Sometimes an even-point scale is used, where the middle option of "neither agree nor disagree" is not available. This is sometimes called a "forced choice" method, since the neutral option is removed. The neutral option can be seen as an easy option to take when a respondent is unsure, and so whether it is a true neutral option is questionable. A 1987 study found negligible differences between

351-412: A theory of personality or a prototype of a construct. Factor analysis uses statistical methods to organize groups of related items into subscales. Criterion-keyed inventories include questions that have been shown to statistically discriminate between a comparison group and a criterion group, such as people with clinical diagnoses of depression versus a control group. Items may use any of several formats:

390-474: Is a psychometric scale named after its inventor, American social psychologist Rensis Likert , which is commonly used in research questionnaires . It is the most widely used approach to scaling responses in survey research, such that the term (or more fully the Likert-type scale ) is often used interchangeably with rating scale , although there are other types of rating scales. Likert distinguished between

429-499: Is a measure intended to have high sensitivity to direct clinicians from many countries to diagnosing individuals in a clinical population with bipolar disorder, specifically bipolar II disorder. Initially developed by Jules Angst and Thomas Meyer in German, the questionnaire was translated into English and translated back to German to ensure accuracy. The English version of the HCL has been used as

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468-584: Is advised for all self-report inventories. Items may differ in social desirability , which can cause different scores for people at the same level of a trait, but differing in their desire to appear to possess socially desirable behaviors. Likert scale 1800s: Martineau · Tocqueville  ·  Marx ·  Spencer · Le Bon · Ward · Pareto ·  Tönnies · Veblen ·  Simmel · Durkheim ·  Addams ·  Mead · Weber ·  Du Bois ·  Mannheim · Elias A Likert scale ( / ˈ l ɪ k ər t / LIK -ərt , )

507-615: Is itself sometimes erroneously referred to as being or having a scale, with this error creating pervasive confusion in the literature and parlance of the field. A Likert item is simply a statement that the respondent is asked to evaluate by giving it a quantitative value on any kind of subjective or objective dimension, with level of agreement/disagreement being the dimension most commonly used. Well-designed Likert items exhibit both "symmetry" and "balance". Symmetry means that they contain equal numbers of positive and negative positions whose respective distances apart are bilaterally symmetric about

546-703: Is no objectively correct answer; responses are based on opinions and subjective perceptions. Most self-report inventories are brief and can be taken or administered within five to 15 minutes, although some, such as the Minnesota Multiphasic Personality Inventory (MMPI), can take several hours to fully complete. They are popular because they can be inexpensive to give and to score, and their scores can often show good reliability . There are three major approaches to developing self-report inventories: theory-guided, factor analysis , and criterion-keyed. Theory-guided inventories are constructed around

585-450: Is recommended over the standard Wilcoxon signed-rank test . Responses to several Likert questions may be summed providing that all questions use the same Likert scale and that the scale is a defensible approximation to an interval scale, in which case the central limit theorem allows treatment of the data as interval data measuring a latent variable. If the summed responses fulfill these assumptions, parametric statistical tests such as

624-414: Is simply determined by the researcher designing the survey, who makes the decision based on a desired level of detail. However, by convention Likert items tend to be assigned progressive positive integer values. Likert scales typically range from 2 to 10 – with 3, 5, or, 7 being the most common. Further, this progressive structure of the scale is such that each successive Likert item is treated as indicating

663-508: Is that the appropriate type of analysis is dependent on how the Likert scale has been presented. The validity of such measures depends on the underlying interval nature of the scale. If interval nature is assumed for a comparison of two groups, the paired samples t -test is not inappropriate. If non-parametric tests are to be performed the Pratt (1959) modification to the Wilcoxon signed-rank test

702-449: Is the same as between category 3 and 4. In terms of good research practice, an equidistant presentation by the researcher is important; otherwise a bias in the analysis may result. For example, a four-point Likert item with categories "Poor", "Average", "Good", and "Very Good" is unlikely to have all equidistant categories since there is only one category that can receive a below-average rating. This would arguably bias any result in favor of

741-503: Is to summarize them via a latent variable model , for example using factor analysis or item response theory . Likert scale data can, in principle, be used as a basis for obtaining interval level estimates on a continuum by applying the polytomous Rasch model , when data can be obtained that fit this model. In addition, the polytomous Rasch model permits testing of the hypothesis that the statements reflect increasing levels of an attitude or trait, as intended. For example, application of

780-460: Is when a Likert scale is symmetric and equidistant that it will behave more like an interval-level measurement. So while a Likert scale is indeed ordinal , if well presented it may nevertheless approximate an interval-level measurement. This can be beneficial since, if it was treated just as an ordinal scale, then some valuable information could be lost if the 'distance' between Likert items were not available for consideration. The important idea here

819-680: The Young Mania Rating Scale and the General Behavior Inventory . The online version of the HCL has been shown to be as reliable as the paper version. Self-report inventories A self-report inventory is a type of psychological test in which a person fills out a survey or questionnaire with or without the help of an investigator. Self-report inventories often ask direct questions about personal interests, values, symptoms , behaviors , and traits or personality types . Inventories are different from tests in that there

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858-585: The analysis of variance can be applied. Typical cutoffs for thinking that this approximation will be acceptable is a minimum of four and preferably eight items in the sum. To model binary Likert responses directly, they may be represented in a binomial form by summing agree and disagree responses separately. The chi-squared , Cochran's Q test , or McNemar test are common statistical procedures used after this transformation. Non-parametric tests such as chi-squared test , Mann–Whitney test , Wilcoxon signed-rank test , or Kruskal–Wallis test . are often used in

897-451: The "neutral"/zero value (whether or not that value is presented as a candidate). Balance means that the distance between each candidate value is the same, allowing for quantitative comparisons such as averaging to be valid across items containing more than two candidate values. The format of a typical five-level Likert item, for example, could be: Likert scaling is a bipolar scaling method , measuring either positive or negative response to

936-427: The HCL-32 R1 does not accurately differentiate between Bipolar I and Bipolar II. However, the 16-item HCL has not been tested as a standalone section in a hospital setting. In addition, while the HCL-32 is a sensitive instrument for hypomanic symptoms, it does not distinguish between bipolar I and bipolar-II disorders. The HCL-32 has not been compared with other commonly used screening tools for bipolar disorder, such as

975-684: The analysis of Likert scale data. Alternatively, Likert scale responses can be analyzed with an ordered probit model, preserving the ordering of responses without the assumption of an interval scale. The use of an ordered probit model can prevent errors that arise when treating ordered ratings as interval-level measurements. Consensus-based assessment (CBA) can be used to create an objective standard for Likert scales in domains where no generally accepted or objective standard exists. Consensus-based assessment (CBA) can be used to refine or even validate generally accepted standards. A common practice for analyzing responses to collections of Likert scale items

1014-431: The basis for translation in other languages through the same process. The original study that used the HCL in an Italian and a Swiss sample noted the measure's high sensitivity and a lower sensitivity than other used measures. The scale includes a checklist of 32 possible symptoms of hypomania, each rated yes or no. The rating "yes" would mean the symptom is present or this trait is "typical of me," and "no" would mean that

1053-446: The difficulty of each item (the ICCs ) as information to be incorporated in scaling items. A Likert scale is the sum of responses on several Likert item s. Because many Likert scales pair each constituent Likert item with its own instance of a visual analogue scale (e.g., a horizontal line, on which the subject indicates a response by circling or checking tick-marks), an individual item

1092-596: The items can be mixed together or kept in groups. Sometimes the way people answer the item will change depending on the context offered by the neighboring items. Self-report personality inventories include questions dealing with behaviours, responses to situations, characteristic thoughts and beliefs, habits, symptoms, and feelings. Test-takers-are usually asked to indicate how well each item describes themselves or how much they agree with each item. Formats are varied, from adjectives such as "warm", to sentences such as "I like parties", or reports of behaviour "I have driven past

1131-506: The model often indicates that the neutral category does not represent a level of attitude or trait between the disagree and agree categories. Not every set of Likert scaled items can be used for Rasch measurement. The data has to be thoroughly checked to fulfill the strict formal axioms of the model. However, the raw scores are the sufficient statistics for the Rasch measures, a deliberate choice by Georg Rasch , so, if you are prepared to accept

1170-464: The most applicable methods. This disagreement can be traced back, in many respects, to the extent to which Likert items are interpreted as being ordinal data. There are two primary considerations in this discussion. First, Likert scales are arbitrary. The value assigned to a Likert item has no objective numerical basis, either in terms of measure theory or scale (from which a distance metric can be determined). The value assigned to each Likert item

1209-636: The ordinal scale level in Likert scales. For example, in a set of items A ,  B ,  C rated with a Likert scale circular relations like A  >  B , B  >  C and C  >  A can appear. This violates the axiom of transitivity for the ordinal scale. Research by Labovitz and Traylor provide evidence that, even with rather large distortions of perceived distances between scale points, Likert-type items perform closely to scales that are perceived as equal intervals. So these items and other equal-appearing scales in questionnaires are robust to violations of

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1248-449: The questionnaire is completed, each item may be analyzed separately or in some cases item responses may be summed to create a score for a group of items. Hence, Likert scales are often called summative scales. Whether individual Likert items can be considered as interval-level data, or whether they should be treated as ordered-categorical data is the subject of considerable disagreement in the literature, with strong convictions on what are

1287-450: The raw scores as valid, then you can also accept the Rasch measures as valid. An important part of data analysis and presentation is the visualization (or plotting) of data. The subject of plotting Likert (and other) rating data is discussed at length in two papers by Robbins and Heiberger. In the first they recommend the use of what they call diverging stacked bar charts and compare them to other plotting styles. The second paper describes

1326-600: The severity or frequency of symptoms in order to minimize their problems. For this reason, self-report inventories are not used in isolation to diagnose a mental disorder, often used as screeners for verification by other assessment data. Many personality tests, such as the MMPI or the MBTI add questions that are designed to make it difficult for a person to exaggerate traits and symptoms. They are in common use for measuring levels of traits, or for symptom severity and change. Clinical discretion

1365-932: The speed limit" and response formats from yes/no to Likert scales, to continuous "slider" responses. Some inventories are global, such as the NEO , others focus on particular domains, such as anger or aggression. Unlike IQ tests where there are correct answers that have to be worked out by test takers, for personality, attempts by test-takers to gain particular scores are an issue in applied testing. Test items are often transparent, and people may "figure out" how to respond to make themselves appear to possess whatever qualities they think an organization wants. In addition, people may falsify good responses, be biased towards their positive characteristics, or falsify bad, stressing negative characteristics, in order to obtain their preferred outcome. In clinical settings patients may exaggerate symptoms in order to make their situation seem worse, or under-report

1404-456: The symptom is not present or "not typical" for the person. The HCL suffers from the same problems as other self-report inventories , in that scores can be easily exaggerated or minimized by the person completing them. Like all questionnaires, the way the instrument is administered can influence the final score. If a patient is asked to fill out the form in front of other people in a clinical environment, for instance, social expectations may elicit

1443-508: The underlying phenomenon. When responding to a Likert item, respondents specify their level of agreement or disagreement on a symmetric agree-disagree scale for a series of statements. Thus, the range captures the intensity of their feelings for a given item. A scale can be created as the simple sum or average of questionnaire responses over the set of individual items (questions). In so doing, Likert scaling assumes distances between each choice (answer option) are equal. Many researchers employ

1482-628: The use of "undecided" and "neutral" as the middle option in a five-point Likert scale. Likert scales may be subject to distortion from several causes. Respondents may: Designing a scale with balanced keying (an equal number of positive and negative statements and, especially, an equal number of positive and negative statements regarding each position or issue in question) can obviate the problem of acquiescence bias, since acquiescence on positively keyed items will balance acquiescence on negatively keyed items, but defensive, central tendency, and social desirability biases are somewhat more problematic. After

1521-527: The use of the Likert function in the HH package for R, and gives many examples of its use. The five response categories are often believed to represent an interval level of measurement . However, this can only be the case if the intervals between the scale points correspond to empirical observations in a metric sense. Reips and Funke (2008) show that this criterion is much better met by a visual analogue scale . In fact, there may also appear phenomena which even question

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