Research report
The Brief-HAPPI: A questionnaire to assess cognitions that distinguish between individuals with a diagnosis of bipolar disorder and non-clinical controls

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Abstract

Background

Despite developments in cognitive behavioural therapy for bipolar disorder, little is known about the specific dysfunctional beliefs that may predispose individuals to mania. Therefore a measure was specifically designed for this purpose based on a cognitive approach. The measure is called the Hypomanic Attitudes and Positive Predictions Inventory (HAPPI).

Method

Fifty-six individuals with a diagnosis of bipolar disorder and 39 matched healthy controls completed a brief version of the HAPPI (Brief-HAPPI), the Internal State Scale, and the Hypomanic Interpretations Questionnaire (HIQ).

Results

The bipolar group scored higher on the overall Brief-HAPPI scale, higher on the forward items of the Brief-HAPPI, lower on the reverse items and no different on the filler items. The group differences in overall score remained when controlling for current self-reported symptoms of mania and depression, and recent history of hypomanic symptoms, yet within the bipolar group, Brief-HAPPI score was positively correlated with the level of symptoms. The Brief-HAPPI showed a sizeable correlation with the HIQ, yet each scale showed a significant and independent association with bipolar disorder.

Conclusion

The Brief-HAPPI assesses dysfunctional beliefs that are associated with a diagnosis of bipolar disorder.

Section snippets

Frontsheet

The first page of the questionnaire asked participants to answer ‘yes’ or ‘no’ to whether they had ever received a diagnosis of bipolar disorder (manic depression) and whether they had ever had clinical depression. They were asked to provide their age, gender and level of education.

Internal state scale

This is a self-report questionnaire intended to assess manic and depressive symptoms. It has 15 items which contribute to four subscales Activation (ISS-A), Well-Being (ISS-WB), Perceived Conflict (ISS-PC) and

Internal state scale (ISS)

Table 1 shows the group differences on the four subscales of the ISS. The bipolar group showed higher levels of Depression, and lower levels of Activation and Well-Being than the controls.

Brief-HAPPI and its subscales

The Cronbach alphas, means, standard deviations and t-values for the Brief-HAPPI subscales are displayed in Table 1. The mean total and the forward subscales of the Brief-HAPPI showed good internal validity as assessed by Cronbach's alpha. The reverse items were less internally consistent, possibly because

Discussion

This study has supported the validity of the HAPPI using a brief version of the scale that included reverse and filler items. As predicted the bipolar group scored higher on the total mean score and the mean of the forward items, lower on the reverse items, and no different from the controls on the filler items. This effect was maintained even when controlling for group differences in symptoms as assessed by the ISS. The bipolar group actually showed lower levels of Activation than the control

Acknowledgements

Thank you to Fiona Lobban, Jean Wit, and MDF The Bipolar Organization for their help with recruitment.

References (12)

There are more references available in the full text version of this article.

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