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 χ2 value; p>0.01.ResultsFor the HDRS-17 model fit, mean (±SD) of item residuals = 0.35 (±1.4); mean (±SD) of person residuals = -0.15 (±1.09); χ2 = 309.74; p<0.00001. For the HAM-D6 model fit, mean (±SD) of item residuals = 0.5 (±0.86); mean (±SD) of person residuals = 0.15 (±0.91); χ2 = 56.13; p = 0.196. MFD ordered by crescent severity were depressed mood, work and activities, somatic symptoms, psychic anxiety, guilt feelings, and psychomotor retardation.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 symptoms can improve the understanding of the disorder and may improve its perspective of treatment.

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

“…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.…”

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

“…Several studies, including a recent systematic review, support that view, showing that the HAM-D 6 is clinically more meaningful, more psychometrically robust, and capable of measuring greater effect size than the HDRS-17 for biological treatments, such as second-generation antidepressants. [24][25][26][27][28][29] Furthermore, the HAM-D 6 fulfills the criteria of unidimensionality, whereas the HDRS-17 does not. 25,29 In a recent paper, we evaluated the severity of each melancholic feature of the HAM-D 6 using modern psychometrics, including Rasch analysis.…”

“…[24][25][26][27][28][29] Furthermore, the HAM-D 6 fulfills the criteria of unidimensionality, whereas the HDRS-17 does not. 25,29 In a recent paper, we evaluated the severity of each melancholic feature of the HAM-D 6 using modern psychometrics, including Rasch analysis. 29 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.…”

Reduced Recovery of Depression in Female T Allele Carriers of TNF-RII rs1061622 at Earlier Stage after Wenchuan Earthquake

“…Depression is one of the most common psychiatric disorders in adolescents all over the world [ 1 , 2 ], which appears after experiencing severe traumatic situations, such as earthquakes, violence, and other man-made or natural disasters. Depression affects the personal lives of the patients and results negatively in disruptions in community and society.…”