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Measuring depression: comparison and integration of three scales in the GENDEP study

  • R. Uher (a1), A. Farmer (a1), W. Maier (a2), M. Rietschel (a3), J. Hauser (a4), A. Marusic (a5), O. Mors (a6), A. Elkin (a1), R. J. Williamson (a1), C. Schmael (a3), N. Henigsberg (a7), J. Perez (a8), J. Mendlewicz (a9), J. G. E. Janzing (a10), A. Zobel (a2), M. Skibinska (a4), D. Kozel (a5), A. S. Stamp (a6), M. Bajs (a7), A. Placentino (a8), M. Barreto (a9), P. McGuffin (a1) and K. J. Aitchison (a1) (a11)...
Abstract
Background

A number of scales are used to estimate the severity of depression. However, differences between self-report and clinician rating, multi-dimensionality and different weighting of individual symptoms in summed scores may affect the validity of measurement. In this study we examined and integrated the psychometric properties of three commonly used rating scales.

Method

The 17-item Hamilton Depression Rating Scale (HAMD-17), the Montgomery–Asberg Depression Rating Scale (MADRS) and the Beck Depression Inventory (BDI) were administered to 660 adult patients with unipolar depression in a multi-centre pharmacogenetic study. Item response theory (IRT) and factor analysis were used to evaluate their psychometric properties and estimate true depression severity, as well as to group items and derive factor scores.

Results

The MADRS and the BDI provide internally consistent but mutually distinct estimates of depression severity. The HAMD-17 is not internally consistent and contains several items less suitable for out-patients. Factor analyses indicated a dominant depression factor. A model comprising three dimensions, namely ‘observed mood and anxiety’, ‘cognitive’ and ‘neurovegetative’, provided a more detailed description of depression severity.

Conclusions

The MADRS and the BDI can be recommended as complementary measures of depression severity. The three factor scores are proposed for external validation.

Copyright
Corresponding author
*Address for correspondence: R. Uher, PO80 SGDP, Institute of Psychiatry, 16 De Crespigny Park, London SE5 8AF, UK. (Email: r.uher@iop.kcl.ac.uk)
References
Hide All
Bagby RM, Ryder AG, Schuller DR, Marshall MB (2004). The Hamilton Depression Rating Scale: has the gold standard become a lead weight? American Journal of Psychiatry 161, 21632177.
Baker F (2001). The Basics of Item Response Theory. ERIC Clearing house on Assessment and Evaluation: University of Maryland College Park, MD.
Bech P, Cialdella P, Haugh MC, Birkett MA, Hours A, Boissel JP, Tollefson GD (2000). Meta-analysis of randomised controlled trials of fluoxetine v. placebo and tricyclic antidepressants in the short-term treatment of major depression. British Journal of Psychiatry 176, 421428.
Bech P, Gram LF, Dein E, Jacobsen O, Vitger J, Bolwig TG (1975). Quantitative rating of depressive states. Acta Psychiatrica Scandinavica 51, 161170.
Beck AT, Ward CH, Mendelson M, Mock J, Erbaugh J (1961). An inventory for measuring depression. Archives of General Psychiatry 4, 561571.
Brown TA (2006). Confirmatory Factor Analysis for Applied Research. Guilford Press: New York.
Browne C, Schulberg HC, Madonia MJ (1995). Assessing depression in primary care practice with the Beck Depression Inventory and Hamilton Rating Scale for Depression. Psychological Assessment 7, 5965.
Carmody TJ, Rush AJ, Bernstein I, Warden D, Brannan S, Burnham D, Woo A, Trivedi MH (2006). The Montgomery Asberg and the Hamilton ratings of depression: a comparison of measures. European Neuropsychopharmacology 16, 601611.
Edwards BC, Lambert MJ, Moran PW, McCully T, Smith KC, Ellingson AG (1984). A meta-analytic comparison of the Beck Depression Inventory and the Hamilton Rating Scale for Depression as measures of treatment outcome. British Journal of Clinical Psychology 23, 9399.
Elkin I, Shea MT, Watkins JT, Imber SD, Sotsky SM, Collins JF, Glass DR, Pilkonis PA, Leber WR, Docherty JP (1989). National Institute of Mental Health Treatment of Depression Collaborative Research Program. General effectiveness of treatments. Archives of General Psychiatry 46, 971982.
Embretson SE, Reise S (2000). Item Response Theory for Psychologists. Lawrence Erlbaum Associates: Mahwah, NJ.
Evans KR, Sills T, DeBrota DJ, Gelwicks S, Engelhardt N, Santor D (2004). An item response analysis of the Hamilton Depression Rating Scale using shared data from two pharmaceutical companies. Journal of Psychiatric Research 38, 275284.
Faries D, Herrera J, Rayamajhi J, DeBrota D, Demitrac M, Potter WZ (2000). The responsiveness of the Hamilton Depression Rating Scale. Journal of Psychiatric Research 34, 310.
Feinberg M, Carroll BJ, Smouse PE, Rawson SG (1981). The Carroll rating scale for depression. III. Comparison with other rating instruments. British Journal of Psychiatry 138, 205209.
Flora DB, Curran PJ (2004). An empirical evaluation of alternative methods of estimation for confirmatory factor analysis with ordinal data. Psychological Methods 9, 466491.
Flora DB, Thissen D (2002). User's Guide for RTScore. L. L. Thurstone Psychometric Laboratory University of North Carolina: Chapel Hill, NC.
Floyd FJ, Widaman KF (1995). Factor analysis in the development and refinement of clinical assessment instruments. Psychological Assessment 7, 286299.
Gibbons RD, Clark DC, Kupfer DJ (1993). Exactly what does the Hamilton Depression Rating Scale measure? Journal of Psychiatric Research 27, 259273.
Grayson D, Bridges K, Cook D, Goldberg D (1990). The validity of diagnostic systems for common mental disorders: a comparison between the ID-CATEGO and the DSM-III systems. Psychological Medicine 20, 209218.
Greenberg RP, Bernstein RF, Greenberg MD, Fisher S (1992). A meta-analysis of antidepressant outcome under ‘blinder’ conditions. Journal of Consulting and Clinical Psychology 60, 664669.
Gullion CM, Rush AJ (1998). Toward a generalizable model of symptoms in major depressive disorder. Biological Psychiatry 44, 959972.
Hamilton M (1960). A rating scale for depression. Journal of Neurology, Neurosurgery and Psychiatry 23, 5662.
Hamilton M (1967). Development of a rating scale for primary depressive illness. British Journal of Clinical Psychology 6, 278296.
Humphreys LG, Montanelli RG (1975). An investigation of the parallel analysis criterion for determining the number of common factors. Multivariate Behavioral Research 10, 193206.
Korszun A, Moskvina V, Brewster S, Craddock N, Ferrero F, Gill M, Jones IR, Jones LA, Maier W, Mors O, Owen MJ, Preisig M, Reich T, Rietschel M, Farmer A, McGuffin P (2004). Familiality of symptom dimensions in depression. Archives of General Psychiatry 61, 468474.
Moller HJ (2001). Methodological aspects in the assessment of severity of depression by the Hamilton Depression Scale. European Archives of Psychiatry and Clinical Neuroscience 251 (Suppl. 2), II13II20.
Montgomery SA, Asberg M (1979). A new depression scale designed to be sensitive to change. British Journal of Psychiatry 134, 382389.
Muthen LK, Muthen BO (2006). Mplus User's Guide: Statistical Analysis with Latent Variables, 4th edn.Muthen & Muthen: Los Angeles.
Orlando M, Sherbourne CD, Thissen D (2000). Summed-score linking using item response theory: application to depression measurement. Psychological Assessment 12, 354359.
Prusoff BA, Klerman GL, Paykel ES (1972). Concordance between clinical assessments and patients' self-report in depression. Archives of General Psychiatry 26, 546552.
Rehm LP, O'Hara MW (1985). Item characteristics of the Hamilton Rating Scale for Depression. Journal of Psychiatric Research 19, 3141.
Ruhe HG, Dekker JJ, Peen J, Holman R, de Jonghe F (2005). Clinical use of the Hamilton Depression Rating Scale: is increased efficiency possible? A post hoc comparison of Hamilton Depression Rating Scale, Maier and Bech subscales, Clinical Global Impression, and Symptom Checklist-90 scores. Comprehensive Psychiatry 46, 417427.
Rush AJ, Trivedi MH, Carmody TJ, Ibrahim HM, Markowitz JC, Keitner GI, Kornstein SG, Arnow B, Klein DN, Manber R, Dunner DL, Gelenberg AJ, Kocsis JH, Nemeroff CB, Fawcett J, Thase ME, Russell JM, Jody DN, Borian FE, Keller MB (2005). Self-reported depressive symptom measures: sensitivity to detecting change in a randomized, controlled trial of chronically depressed, nonpsychotic outpatients. Neuropsychopharmacology 30, 405416.
Samejima F (1969). Estimation of latent ability using a response pattern of graded responses. Psychometrika Monograph Supplement, No. 17.
Santor DA, Coyne JC (2001). Examining symptom expression as a function of symptom severity: item performance on the Hamilton Rating Scale for Depression. Psychological Assessment 13, 127139.
Shafer AB (2006). Meta-analysis of the factor structures of four depression questionnaires: Beck, CES-D, Hamilton, and Zung. Journal of Clinical Psychology 62, 123146.
Thissen D, Chen WH, Bock D (2003). MULTILOG 7. SSI Scientific Software International: Lincolnwood, USA.
Williams JB (1988). A structured interview guide for the Hamilton Depression Rating Scale. Archives of General Psychiatry 45, 742747.
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Psychological Medicine
  • ISSN: 0033-2917
  • EISSN: 1469-8978
  • URL: /core/journals/psychological-medicine
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