Measuring the severity of depression and remission in primary care: validation of the HAMD-7 scale

Abstract

O ptimal management of major depressive disorders is enhanced by applying a chronic illnessmanagement model with precise and measurable therapeutic endpoints. 1 In contradistinction to several other chronic medical disorders, biological markers of illness activity in depression do not currently exist. In the interim, therapeutic progress is monitored by evaluating changes in the severity of depressive symptoms and in functional domains. This concatenation of findings is particularly disconcerting in view of the fact that most depressed patients in either primary care or psychiatric settings are not systematically evaluated with objective quantifiable measures -a modifiable deficiency in patient management. [2][3][4][5][6] The most frequently reported symptomatic outcome measure in clinical trials of antidepressants has been response to treatment, arbitrarily defined as a reduction of 50% or more in total symptom severity from a pretreatment assessment of the patient's depression. 7 A categorical response to therapy that fails to achieve a fully asympomatic remitted state furnishes an unsatisfactory outcome, in that it includes patients with ongoing disease activity that is clinically significant. Patients who show improvement in symptom severity but are not asymptomatic are at risk for developing chronic depression, and continue to be vulnerable to poor outcomes and comorbid medical disorders. [8][9][10] Remission is an objective outcome indicated by a quantifiable score with a depressive symptom measurement tool. In antidepressant clinical trials, the 17-item Hamilton Depression Rating Scale (HAMD-17) has been the "gold standard" for use. HAMD-17, however, has not been accepted by clinicians for many reasons, 11,12 notably psychometric deficiencies and the length of time needed to administer it.Although several brief rating scales for depression that attempt to improve upon the limitations of HAMD-17 have recently been validated and reviewed, [11][12][13][14][15][16][17][18] none that are brief, currently available and use a remission cut-off score that correlates with the most frequently cited definition of remission (a HAMD-17 score ≤ 7) 7 have been validated in both tertiary mental health and primary care settings.Our broad objective in using HAMD-7 was to improve upon the conceptual and pragmatic deficiencies ascribed to HAMD-17. HAMD-7 was originally derived from analyses of a natural practice database at a tertiary care centre composed of patients diagnosed with a major depressive disorder (n = 248). 14 The HAMD-17 items that were endorsed in a previous study 14 by 70% of depressed patients and were most sensi- Background: Symptomatic remission is the optimal outcome in depression. A brief, validated tool for symptom measurement that can indicate when remission has occurred in mental health and primary care settings is unavailable. We evaluated a 7-item abbreviated version (HAMD-7) of the 17-item Hamilton Depression Rating Scale (HAMD-17) in a randomized controlled clinical trial of patients with major de...

Predicting response to treatment and discriminating bipolar and depression symptoms using Hamilton Depression Rating Scale

“…Nonetheless, reliability results for short versions indicated that that scales has good sensitivity and specifity scores 23 and HAMD was not sensitive to specify depression symptoms as expected 12,13,17 . Addictionally, in contrast to the other subscales the McIntyre et al 8 subscale perform the best reliability and sensibility scores, and was the best version to predict results as HAMD 17, and showed the best correlation indices. So far, MADRS was the unique scale able to differentiate depressive symptoms between groups, showing that at entering time (V0) and after one month after medication (V4) the scale was able to detect and differentiate groups, indicating that MDD group has more symptoms than BD.…”

“…The psychometric properties of HAMD scale has been questioned, and considered as an imprecise scale. This way, tentatives to refine this scale was proposed, using versions based on core symptoms 8,12,13 . In the present study, HAMD 17 scores were reliable and satisfactory, and this could be comparable to Trajković et al 1 study, that related good properties in depression patients (primary diagnosis or with comorbidities) and with Bagby et al 12 revision, that found a Cronbach's Alpha (α > 0.70) and the internal reliability Referring to short versions, satisfactory; however, the 7 item version was the most adequate.…”

“…In order to compare psychometric properties, the items of HAMD 17 were transformed into the following subscales: Bech melancholia scale 14,15 , Gibbons global depression severity 13 and Toronto Scale 27 . Additionally, patients were assessed with the Montgomery-Åsberg Depression Rating Scale 18 (MADRS), to serve as a criteria for compare response.…”

“…Therefore, the need of tools to assess depressive symptoms was needed to establish a universal language of what could be understood by depression. Then, Max Hamilton developed a scale consisting of 17 descriptors initially 3 , which was subsequently validated in different countries 1,[4][5][6][7][8] , among them Brazil which confirm its ability to auxiliary in the diagnosis depressive disorder and severity detection [9][10][11] .…”

The American Psychiatric Association Practice Guidelines for the Psychiatric Evaluation of Adults

“…For example, a number of clinician-rated and/ or self-rated scales have been widely used in research and are increasingly used in ongoing clinical monitoring of depression (Chung et al 2013;Duffy et al 2008;Katzelnick et al 2011). These include the PHQ-9 (http://www.integration.samhsa.gov/images/res/PHQ%20-%20Questions.pdf; Kroenke et al 2001), the clinician-rated Hamilton Rating Scale for Depression (Ham-D; http://healthnet.umassmed.edu/mhealth/HAMD.pdf; Hamilton 1960;McIntyre et al 2005), and the Inventory of Depressive Symptomatology (IDS), which is available in clinician-rated and self-rated versions (http://www.ids-qids.org/; Rush et al 1996). Other symptom scales are described in Handbook of Psychiatric Measures, 2nd Edition, edited by Rush et al (2008).…”