The diagnosis of Bipolar II disorder (BD-II) is currently based on the patients' description of symptoms and clinical behavioral observations. This study explored the possibility of miRNA in peripheral blood (serum) as a specific biomarker for BD-II. We identified 6 candidate miRNAs to differentiate BD-II patients from controls using next-generation sequencing. We then examined these candidate miRNAs using real-time PCR in the first cohort (as training group) of 79 BD-II and 95 controls. A diagnostic model was built based on these candidate miRNAs and then tested on an individual testing group (BD-II: n = 20, controls: n = 20). We found that serum expression levels of miR-7-5p, miR-23b-3p, miR-142-3p, miR-221-5p, and miR-370-3p significantly increased in BD-II compared with controls in the first cohort, whereas that of miR-145-5p showed no significant difference. The diagnostic power of the identified miRNAs was further analyzed using receiver-operating characteristic (ROC). Support vector machine (SVM) measurements revealed that a combination of the significant miRNAs reached good diagnostic accuracy (AUC: 0.907). We further examined an independent testing group and the diagnostic power reached fair for BD-II (specificity = 90%, sensitivity = 85%). We constructed miRNA panels using SVM model, which may aid in the diagnosis for BD-II.Bipolar disorder (BD) has several subtypes. Bipolar I disorder (BD-I) and bipolar II disorder (BD-II) are two of the most commonly seen subtypes of BD. BD-I and BD-II differ in clinical presentation: BD-I involves one or more manic or mixed episodes in addition to one or more major depressive episodes. BD-II is characterised by at least one hypomanic episode with one or more major depressive episodes 1,2 . BD-II has become the focus of increasing attention and has been recognised as a unique disorder. Its prevalence rate ranges from 3% to 11% 3 . Nevertheless, because of the complex spectrum of symptoms, the diagnosis of BD remains subjective. Diagnosing BD is challenging because patients typically regard hypomanic episodes as a positive mood status or experience, and they only seek medical help during depressive episodes 4 . BD is initially misdiagnosed at a rate of approximately 40% and typically requires approximately 5-12 years to be correctly diagnosed and treated appropriately 5,6 . Delayed diagnosis and inefficacious treatment of BD-II may lead to a prolonged course, more affective episodes, and an increased suicide rate, adding further to its socioeconomic burden 5,7 .Accumulating evidence reveals that microribonucleic acids (miRNAs) are involved in many biological processes such as neurogenesis, neuroproliferation, and synaptic plasticity in the central nervous system 8,9 . Different expressions of peripheral miRNA have been reported in several mental disorders including schizophrenia, major depressive disorder, and Alzheimer disease [10][11][12] . Changes in peripheral miRNA may be correlated with changes in neuroendocrine or neuroimmune responses 13 . Because brain tissue ...