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

Ruhé, Henricus G.; Dekker, Jack J.; Peen, Jaap; Holman, Rebecca; Jonghe, Frans de

doi:10.1016/j.comppsych.2005.03.001

« Previous Next »Comprehensive Psychiatry
Volume 46, Issue 6 , Pages 417-427, November 2005

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☆

Henricus G. Ruhé
- Mentrum, Depression Research Group, PO Box 75848, 1070 AV Amsterdam, The Netherlands
- Department of Psychiatry, Academic Medical Center, PO Box 22660, 1100 DD Amsterdam, The Netherlands
- Corresponding author. Department of Mood Disorders, MFO Psychiatrie AMC/De Meren, 1105 BC Amsterdam, The Netherlands. Tel.: +31 20 5662240; fax: +31 20 6919139.
Jack J. Dekker
- Mentrum, Depression Research Group, PO Box 75848, 1070 AV Amsterdam, The Netherlands
- Department of Clinical Psychology, Vrije Universiteit Amsterdam, 1081 BT Amsterdam, The Netherlands
Jaap Peen
- Mentrum, Depression Research Group, PO Box 75848, 1070 AV Amsterdam, The Netherlands
Rebecca Holman
- Department of Clinical Epidemiology and Biostatistics, Academic Medical Center, PO Box 22660, 1100 DD Amsterdam, The Netherlands
Frans de Jonghe
- Mentrum, Depression Research Group, PO Box 75848, 1070 AV Amsterdam, The Netherlands
- Department of Psychiatry, Academic Medical Center, PO Box 22660, 1100 DD Amsterdam, The Netherlands

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 α ≈ 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 ≤4 corresponded with an HDRS ≤7 criterion in both subscales.