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

Abstract

Background: The 17-item Hamilton Depression Rating Scale (HDRS) is used as a semi-gold standard in research. In treatment guidelines, the HDRS measurements serve to determine response and remission and guide clinical decision making for nonresponders. However, its use in clinical practice is limited, possibly because the HDRS is time consuming. In addition, the multidimensional HDRS is criticized for not measuring a unidimensional aspect as depression severity. The Maier and the Bech, two 6-item severity subscales extracted from the HDRS, are relatively unknown. This paper investigates whether the measurements obtained with these subscales are comparable with the original HDRS measurements. Methods: Data from 2 randomized controlled trials in 482 male and female patients, diagnosed with a major depression (with or without dysthymia) according to Diagnostic and Statistical Manual of Mental Disorders, Revised Third Edition, of whom 219 participated in the trials, were reanalyzed. A standardized stepwise psychopharmacological treatment was compared with a combination of pharmacotherapy with Short Psychodynamic Supportive Psychotherapy in a psychiatric outpatient department. Outcome measures were internal consistency and concurrent validity of HDRS, Maier, Bech, Clinical Global Impression scales, and Symptom Checklist depression subscale. Effect sizes of HDRS, Maier, and Bech were used to compare measured treatment effects for the randomized subjects participating in the trials. Item Response Theory was used to obtain conversion tables for the HDRS, Maier, Bech, and Symptom Checklist depression subscale. Results: We found moderate internal consistency (Cronbach a c 0.6-0.7) and high correlations of the Maier and Bech subscales with overall HDRS scores. Overall, there were no clinically relevant differences in effect sizes between Maier, Bech, and HDRS, although some differences were statistically significant. Receiver operating characteristic curves showed no difference between Maier and Bech to define remission but showed the Clinical Global Impression ratings to be unreliable. A cutoff V 4 corresponded with an HDRS V 7 criterion in both subscales. Conclusion: In clinical practice, both Maier and Bech scales can be used as equivalents of the HDRS, but will be more efficient. D

A Systematic Review of the Clinimetric Properties of the 6-Item Version of the Hamilton Depression Rating Scale (HAM-D₆)

“…Both Ruhe et al [20] and Kyle et al [21] found that a score <5 on the HAM-D 6 or <8 on the HAM-D 17 was obtained using CGI-S as reference for remission. These remission cut-off scores are important when using remission rates as outcome in treatment studies.…”

What Is the Best Sequential Treatment Strategy in the Treatment of Depression? Adding Pharmacotherapy to Psychotherapy or Vice Versa?

“…Secondary analyses indicated that, with the CGI-I, clinicians tended to overestimate the actual result of pharmacotherapy compared to patient reports. It may be advisable to use more specific instruments than the CGI, such as a short form of the HAM-D [74], which can be easily administered during pharmacotherapy consultations.…”

Assessment of depressive symptom severity among patients with co-occurring bipolar disorder and substance dependence

“…For example, items representing the reversed vegetative symptoms of depression (e.g., hyperphagia, hypersomnia, and weight gain), which recently have been considered to be especially pertinent among patients with bipolar disorder (Thase, 2005) were eliminated because of poor item characteristics. Several items associated with somatic and neurovegatative symptoms (e.g., appetite decrease, hypochondriasis, and weight loss) also performed poorly, which is somewhat inconsistent with the common criticism that the HDRS is overly sensitive to these symptoms (e.g., Bagby et al, 2004;Ruhe et al, 2005). It is possible that the participants in this sample tended to attribute any physiologically-based experiences to their post-acute withdrawal symptoms stemming from recent substance use and/or to medication side effects rather than to depression per se (e.g., Gao and Calabrese, 2005;Maremmani et al, 2006;Perugi et al, 2002).…”

“…Decades of research with the HDRS have resulted in many item modifications, and consequently have led to concerns about the scale's theoretical underpinnings, psychometric properties, and administration procedures. (e.g., Bagby et al, 2004;Ruhe et al, 2005;Santor and Coyne, 2001;Williams, 2001). Despite these concerns, various versions of the HDRS continue to be used in outcome-oriented investigations (e.g., Brown et al, 2006;Chengappa et al, 2000b;Gao and Calabrese, 2005;Nunes and Levin, 2004) that guide the development of pharmacotherapy and psychotherapy.…”