The Major Depressive Disorder Hierarchy: Rasch Analysis of 6 Items of the Hamilton Depression Scale Covering the Continuum of Depressive Syndrome

Abstract

ObjectivesMelancholic features of depression (MFD) seem to be a unidimensional group of signs and symptoms. However, little importance has been given to the evaluation of what features are related to a more severe disorder. That is, what are the MFD that appear only in the most depressed patients. We aim to demonstrate how each MFD is related to the severity of the major depressive disorder. MethodsWe evaluated both the Hamilton depression rating scale (HDRS-17) and its 6-item melancholic subscale (HAM-D6) in 291 depressed inpatients using Rasch analysis, which computes the severity of each MFD. Overall measures of model fit were mean (±SD) of items and persons residual = 0 (±1); low χ 2 value; p>0.01. ResultsFor ConclusionsDepressed mood is less severe, while guilt feelings and psychomotor retardation are more severe MFD in a psychiatric hospitalization. Understanding depression as a continuum of PLOS ONE |

Lower levels of brain‐derived neurotrophic factor are associated with melancholic psychomotor retardation among depressed inpatients

“…In a recent paper, we evaluated the severity of each melancholic feature of the HAM‐D 6 using modern psychometrics, including Rasch analysis . We showed that, similar to Bech's first findings, the item depressed mood is the least severe melancholic feature; work and activities , somatic symptoms and psychic anxiety are moderately severe; and feelings of guilt and psychomotor retardation are the most severe.…”

Different cytokine patterns associate with melancholia severity among inpatients with major depressive disorder

“…Previously, we have shown that the are a homogeneous group of signs and symptoms and that can be ordered by their severity. 35,36 In the present study, the main finding was that less severe melancholic symptoms (depressed mood, psychic anxiety, and guilt feelings) were associated with an anti-inflammatory response (higher levels of IL-4 and lower levels of IL-17 and IL-2). In contrast, the most severe melancholic feature, psychomotor retardation, was associated a proinflammatory profile, that is, higher levels of IL-6.…”

“…melancholic depression) and that these features could be ordered by their severity. 35 According to the item-response theory (a statistical model derived from educational sciences), signs and symptoms of a rating scale could be compared with a school test, where there are easier and more difficult questions. The most difficult questions (more severe symptoms) would discriminate better the ones with better performance (more depressed patients) than the others.…”

“…The most difficult questions (more severe symptoms) would discriminate better the ones with better performance (more depressed patients) than the others. 35 Hence, only the most severe patients would be the more likely to score higher in the most severe signs and symptoms. We showed that depressed mood and impaired work and activities are the least severe melancholic symptoms, followed by somatic symptoms and psychic anxiety in the middle, and guilt feelings and psychomotor retardation at the top.…”

“…For example, depressed mood was computed as the less severe symptom of MDD, probably because it is a 'filter symptom', since MDD patients have to present with depressed mood or anhedonia to fulfill the DSM-5 diagnostic criteria. 35,36 However, only the presence of depressed mood may not be representative of a biological substrate, since multiple presentations of MDD are possible even though all patients present with depressed mood. So, a homogeneous continuum of signs-and-symptoms severity may address this issue.…”