A protocol for the Hamilton Rating Scale for Depression: Item scoring rules, Rater training, and outcome accuracy with data on its application in a clinical trial

Abstract

Background We present a fully articulated protocol for the Hamilton Rating Scale for Depression (HAM-D), including item scoring rules, rater training procedures, and a data management algorithm to increase accuracy of scores prior to outcome analyses. The latter involves identifying potentially inaccurate scores as interviews with discrepancies between two independent raters on the basis of either scores (≥ 5-point difference) or meeting threshold for depression recurrence status, a long-term treatment outcome with public health significance. Discrepancies are resolved by assigning two new raters, identifying items with disagreement per an algorithm, and reaching consensus on the most accurate scores for those items. Methods These methods were applied in a clinical trial where the primary outcome was the Structured Interview Guide for the Hamilton Rating Scale for Depression—Seasonal Affective Disorder version (SIGH-SAD), which includes the 21-item HAM-D and 8 items assessing atypical symptoms. 177 seasonally depressed adult patients were enrolled and interviewed at 10 time points across treatment and the 2-year followup interval for a total of 1,589 completed interviews with 1,535 (96.6%) archived. Results Inter-rater reliability ranged from ICCs of .923 to .967. Only 86 (5.6%) interviews met criteria for a between-rater discrepancy. HAM-D items “Depressed Mood,” “Work and Activities,” “Middle Insomnia,” and “Hypochondriasis” and Atypical items “Fatigability” and “Hypersomnia” contributed most to discrepancies. Limitations Generalizability beyond well-trained, experienced raters in a clinical trial is unknown. Conclusions Researchers might want to consider adopting this protocol in part or full. Clinicians might want to tailor it to their needs.

Patterns of depressive symptom remission during the treatment of seasonal affective disorder with cognitive-behavioral therapy or light therapy

“…Symptom severity was assessed via blind interviewer at pre-treatment, weekly during treatment (treatment weeks 1–5) and upon completing treatment (post-treatment). Rater’s made scoring decisions based on clearly defined item scoring rules (Rohan, Rough et al, 2016). In the parent trial, episode remission was defined as a pre- to post-treatment total SIGH-SAD score reduction of at least 50% in addition to a 21-item HAM-D score ≤ 7 and an 8-item atypical score ≤ 7.…”

“…All SIGH-SAD interviews were audio recorded and independently rated by a second blinded rater. Discrepancies between raters were resolved using the procedures outlined in Rohan, Rough et al (2016). Intraclass correlations for inter-rater reliability ranged between 0.92 and 0.97 for pre-treatment, treatment weeks 1–5, and post-treatment (see Rohan, Rough et al, 2016).…”

Seasonal affective disorder, winter type: current insights and treatment options

“…These two aspects were combined in the Structured Interview Guide for the Hamilton Depression Rating Scale – Seasonal Affective Disorder version (SIGH-SAD) 49. Rohan et al50 have recently presented a protocol and rules for the scoring of the HRSD and have reported high interrater reliability scores. A self-rating version of the SIGH-SAD rating scale is also available.…”

An Evaluation of Melanopsin Function and Light Exposure in Depressive Disorders

“…A score of at least 19 on HDRS and a score of 4 or more on the 8 ATYP symptom score was indicative of SAD (Terman, Terman, & Rafferty, 1990). The inter-rater reliability trial of HDRS-SAD shows relatively low inter-rater discrepancy (5.6%), specially with items-""depressed mood", "work and activities", "middle insomnia", and "hypochondriasis" and atypical (SAD) items-"fatigability" and "Hypersomnia" (Rohan, Rough, Evans, Ho, Meyerhoff, Roberts, & Vacek, 2016). Given, some degree of discrepancy recorded with HDRS-SAD, the diagnosis of MDD and SAD will be made in conjunction with MINI, BDI-II and SPAQ that are shown to have high internal consistencies (Lecrubier et al, 1997;Magnusson, Friis, & Opjordsmoen, 1997;Storch et al, 2004).…”

“…Although these patients scored higher than cutoff on the atypical HDRS-SAD scale, a diagnosis of winter SAD could not be made as the peak depressive symptoms during winter with remission during the summer was not confirmed. Studies suggest inconsistencies with the HDRS scale (Uher, Farmer, Maier, Rietschel, Hauser, Marusic, Mors, Elkin, Williamson, Schmael, Henigsberg, Perez, Mendlewicz, Janzing, Zobel, Skibinska, Kozel, Stamp, Bajs, Placentino, Barreto, McGuffin, & Aitchison, 2008) and inter-rater discrepancies with HDRS-SAD with respect to the atypical SAD mood symptoms like "fatigability" and 'hypersomnia" (Rohan et al, 2016). It is unlikely that SAD participants have been included in this study as none of the participants had a self-reported history of SAD with worst mood during winter and complete remission during summer.…”