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Structured Versions With Structured Interview
Many studies examined the inter-rater reliability of the different structured versions of the HAM-D. Whisman et al. showed that the inter-rater reliability of their structured version of the HAM-D, the DIS-HRSD, was satisfactory. Specifically, they found an ICC of 0.84, indicating a high level of agreement between raters . Akdemir et al. examined the inter-rater reliability of the SIGH-D, the structured interview guide published by Williams . They found Pearson correlation coefficients ranging from 0.87 to 0.98, indicating a high level of agreement between raters . Rohan et al. evaluated the inter-rater reliability of the SIGH-SAD, another structured interview developed by Williams and her research group . They found ICCs ranging from 0.92 to 0.96, indicating an excellent level of inter-rater reliability . As to the inter-rater reliabilities of individual items of the HAM-D structured versions, authors reported similar results . The inter-rater reliabilities of the individual items included in the structured versions of the HAM-D were significantly higher than those obtained in studies, in which anchor points and interview questions were not used .
Structured Versions With Anchor Points Only
The majority of studies examined the inter-rater reliability of the structured version of the HAM-D, which used the anchor points introduced by Bech et al. . Kørner et al. conducted one of the first studies in this regard. They found an ICC of 0.83, demonstrating a high level of agreement between raters . Koenig et al. and Fuglum et al. reported similar results. The former authors found inter-rater correlations between 0.93 and 0.98, while the latter researchers showed an ICC of 0.81, in both cases indicating a high level of inter-rater reliability. Bent-Hansen and Bech performed a similar study and found an ICC of 0.95, indicating a high level of inter-rater reliability.
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Transcultural Adaptation Of Grid Hamilton Rating Scale For Depression To Brazilian Portuguese And Evaluation Of The Impact Of Training Upon Inter
Dr. Henrique-Araújo is from the Institute of Health Sciences, Federal University of Bahia, Salvador, and Nova Esperança Medical School, João Pessoa, Brazil Dr. Osório is from the Department of Neuroscience and Behavior, State University of São Paulo, Ribeirão Preto, and the National Institute of Science and Technology for Translational Medicine, Brazil Dr. Ribeiro is from Sanatório São Paulo, Salvador, Brazil Dr. Monteiro is from Orasi Institute, Porto, Portugal Dr. Williams is from MedAvante Inc. and is a Professor Emerita at Columbia University, New York, New York, USA Dr. Kalali is from Quintiles Inc., and the University of California, San Diego, California, USA Dr. Crippa is from the Department of Neuroscience and Behavior, State University of São Paulo, Ribeirão Preto, Brazil, and the National Institute of Science and Technology for Translational Medicine, Brazil Dr. de Oliveira is from the Department of and Mental Health and the Institute of Health Sciences, Federal University of Bahia, Salvador, and Sanatório São Paulo, Salvador, Brazil.
Innov Clin Neurosci. 2014 11:1018
Funding: There was no funding for the development and writing of this article.
Financial Disclosures: None of the authors have a conflict of interest in the conduct and reporting of this study.
Key words: Depression, transcultural adaptation, GRID Hamilton rating scale for depression , reproducibility of results
Introduction
METHODS
RESULTS
DISCUSSION
Scalability Of The Different Versions Of The Ham
Bech and his research group conducted a number of studies in which they analyzed the scalability of the various versions of the HAM-D . In these studies, including a recent paper by da Silva et al. , the HAM-D6 was found to have an excellent level of scalability with Mokken coefficients ranging from 0.42 to 0.65 . Studies using the Rasch analysis further confirmed the scalability of the unstructured version of the HAM-D6 . The other HAM-D versions, which were found to have an acceptable level of scalability, were the unstructured HAM-D24 and the CID . Using the Rasch analysis, Bech et al. demonstrated that the CID contains valid subscales for the assessment of affective disorders such as depression, anxiety, and apathy.
Conflicting results were obtained for the scalability of the unstructured version of the HAM-D17. Mokken coefficients ranging from 0.24 to 0.35 were found, indicating that the HAM-D17 is a multidimensional rating scale. Similarly, Bobes et al. and Kyle et al. questioned the scalability of the unstructured version of the HAM-D21. They found Mokken coefficients ranging from 0.29 to 0.30 , indicating that the original version of the HAM-D, the HAM-D21, is a multidimensional rating scale.
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Hamilton Depression Rating Scale
The Hamilton Depression Rating Scale is a multiple item questionnaire used to provide an indication of depression, and as a guide to evaluating recovery. The scale consists of 17 items which each item being scoring on a 3 or 5 point scale. The higher the score, the more likely a person is depressed.
Structured Versions With Semi
Paykel et al. examined the inter-rater reliability of the CID and found a Pearsons correlation coefficient of 0.81, indicating a satisfactory level of inter-rater agreement. The inter-rater reliability of the CID was evaluated in other studies, yielding similar results: the agreement between raters was high, with mean correlation coefficients ranging from 0.81 to 0.82 . Morriss et al. evaluated the inter-rater reliability of a structured version of the HAM-D17 and found ICCs ranging from 0.89 to 0.96, indicating excellent inter-rater reliability.
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Icipant Characteristics And Scores Of Scales
As shown in Table 1, the study population included 433 males and 1,308 females . Most of the depressed patients were 1826 years of age , unmarried , college students , and had an undergraduate education . The mean scores for the PHQ-9, HAMD-17, HAMD-6, GAD-7, PHQ-15 and ISI were 15.4, 18.2, 8.8, 10.2, 12.3, and 11.3 respectively.
Table 1. Socio-demographic characteristics of participants .
Discriminant Validity Of The Ham
Further, significantly slower improvement 2 weeks after admission was detected with the CID in depressed inpatients with comorbid personality disorders compared to those without, even though differences did not reach significance on the HAM-D17 . In another study , both the HAM-D17 and the CID sensitively discriminated between acutely and remitted depressed patients.
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From Psychometrics To Clinimetrics
It was Feinstein who coined the term clinimetrics to introduce an innovative approach, which has been defined as the science of clinical measurements . Such a clinically based evaluation method is particularly useful for testing a number of measurement properties , which do not find room in the traditional psychometric model . Homogeneity of components, as measured by statistical analyses such as Cronbachs alpha coefficients and factor analyses, has been considered the most important requirement for a psychometric rating scale . In the psychometric model, redundant items are needed for ensuring such homogeneity of components . However, the same properties that give a scale a high score for homogeneity may obscure its clinical utility, particularly its ability to detect change . In the clinimetric approach, homogeneity of components is not needed and what matters is the sensitivity of the rating scale, that is, its ability to discriminate between active therapy and placebo, to differentiate patients from healthy controls, to discriminate between different groups of patients, to differentiate the severity of symptoms , to detect clinically relevant changes in drug or psychotherapy trials . Such clinimetric properties are particularly important when treatment effects are small and in the evaluation of sub-clinical symptoms .
A Structured Interview Guide For The Hamilton Depression Rating Scale 1988 Aug 4: 742
The Hamilton Depression Rating Scale is the most widely used scale for patient selection and follow-up in research studies of treatments of depression. Despite extensive study of the reliability and validity of the total scale score, the psychometric characteristics of the individual items have not been well studied. In the only reliability study to report agreement on individual items using a test-retest interview method, most of the items had only fair or poor agreement. Because this is due in part to variability in the way the information is obtained to make the various rating distinctions, the Structured Interview Guide for the HDRS was developed to standardize the manner of administration of the scale. A test-retest reliability study conducted on a series of psychiatric inpatients demonstrated that the use of the SIGH-D results in a substantially improved level of agreement for most of the HDRS items.
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Comparison With The Cid
The HAM-D17 and the CID were used in a placebo-controlled trial of amitriptyline among depressed patients in GP . Several individual items of the CID showed the superiority of amitriptyline over placebo over 6 weeks of treatment, whereas only 4 items of the HAM-D17 displayed significant drug-placebo differences .
In a study on relapse prevention with cognitive therapy in residual depression , similar non-significant lower HAM-D17 and CID scores were found at 1-year follow-up in the CT + CM group compared to the CM only group. Differences between groups were most marked at the end of treatment and the next 6 months, and were not fully lost until 3 1/2 years after the end of CT . Significant time by group interactions were found at 1-year follow-up for the CID depression score and 2 individual items , but not for the HAM-D17 .
The Patient Health Questionnaire
- 1Department of Psychiatry, Renmin Hospital of Wuhan University, Wuhan, China
- 2School of Information Engineering, Wuhan University of Technology, Wuhan, China
- 3School of Health Sciences, Wuhan University, Wuhan, China
- 4Department of Psychiatry, Jingmen No. 2 People’s Hospital, Jingmen, China
Background: The Hamilton Rating Scale for Depression has been used for several decades to assess the severity of depression. Multiple studies have documented defects in this scale and deemed it unsuitable for clinical evaluation. The HAMD-6, which is the abbreviated version of HAMD-17, has been shown to be effective in assessing the core symptoms of depression with greater sensitivity than HAMD-17. And the Patient Health Questionnaire-9 is suggested as an effective alternative to the HAMD-17 because of its simplicity and ease-of-use.
Methods: Research was completed involving 1,741 participants having major depressive disorder. Cronbach’s alpha, intraclass correlation coefficient and weighted Kappa analysis was used to determine the reliability of the scales. Pearson correlation analysis and factor analysis were used to analyze validity. Item response theory was used to analyze psychological characteristics of items in both the HAMD-17 and PHQ-9.
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Depressed Patients Versus Healthy Controls
As to studies examining the ability of the HAM-D to differentiate patients from healthy subjects, Ganchrow et al. showed that the unstructured HAM-D17 sensitively discriminated patients with depression from controls. Fava et al. conducted a similar study, in which they demonstrated that only 17 items of the unstructured version of the HAM-D21 sensitively discriminated depressed patients from healthy controls. Rehm and OHara reported similar results. The total score of the unstructured version of the HAM-D17 sensitively differentiated depressed patients from healthy controls . However, they showed that 4 items failed to discriminate between depressed patients and controls .
Hamilton Rating Scale For Depression
| Hamilton Rating Scale for Depression | |
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| Purpose | indicates depression |
The Hamilton Rating Scale for Depression , also called the Hamilton Depression Rating Scale , sometimes also abbreviated as HAM-D, is a multiple-item questionnaire used to provide an indication of depression, and as a guide to evaluate recovery.Max Hamilton originally published the scale in 1960 and revised it in 1966, 1967, 1969, and 1980. The questionnaire is designed for adults and is used to rate the severity of their depression by probing mood, feelings of guilt, suicide ideation, insomnia, agitation or retardation, anxiety, weight loss, and somatic symptoms.
The HRSD has been criticized for use in clinical practice as it places more emphasis on insomnia than on feelings of hopelessness, self-destructive thoughts, suicidal cognitions and actions. An antidepressant may show statistical efficacy even when thoughts of suicide increase but sleep is improved, or for that matter, an antidepressant that as a side effect increase sexual and gastrointestinal symptom ratings may register as being less effective in treating the depression itself than it actually is. Hamilton maintained that his scale should not be used as a diagnostic instrument.
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| Alternative name |
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First used: 14 October 2021
Unstructured Versus Structured Versions
Compared to the unstructured HAM-D17, the inter-rater reliability of those versions including anchor points and interview guides was significantly higher independently if interviewers were experienced clinicians or novice raters . Potts et al. evaluated the inter-rater reliability of their structured version of the HAM-D17, the SI-HDRS, and found that the level of agreement between inexperienced raters was excellent: ICC of 0.92. Moberg et al. compared the unstructured HAM-D24 with their structured version of this rating scale. They found that the structured HAM-D24 produced significantly higher levels of inter-rater reliability than the unstructured one . Williams et al. conducted a similar study. They compared the inter-rater reliability of the GRID-HAM-D with that of the unstructured version of the HAM-D17 and found that the ICC for the unstructured HAM-D17 was significantly lower than the ICC for the structured GRID-HAM-D . Tabuse et al. provided further support to the inter-rater reliability of the GRID-HAM-D. They showed that this structured version of the HAM-D displayed excellent inter-rater reliability for both inexperienced and experienced raters before and after training .
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Differentiating Active Treatment From Placebo
Studies showed that the HAM-D6, but not the HAM-D17, sensitively discriminated between active drug and placebo . In Chouinard et al. , brofaromine was statistically superior to placebo on the HAM-D6, but did not significantly differ from placebo on the HAM-D17. Fabre et al. obtained similar results. Using the HAM-D6, they showed that sertraline was significantly superior to placebo at all 3 doses . This finding was not replicated when they used the HAM-D17 . In a subsequent study the HAM-D6, but not the HAM-D17, sensitively discriminated active treatment from placebo. More specifically, using the HAM-D6, Feiger et al. found that selegiline was statistically superior to placebo in decreasing symptoms of major depression.
Different Groups Of Patients
As to studies analyzing the ability of the various versions of the HAM-D to discriminate between different groups of patients, Rush et al. found that the total score of the unstructured version of the HAM-D17 sensitively differentiated patients with major depression from those with other psychiatric diagnoses .
Carneiro et al. showed that only 4 items of the unstructured HAM-D17 sensitively discriminated depressed patients from bipolar I patients.
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Unstructured And Structured Versions
Modalities of administration included unstructured versions with ratings only , devoid of interview guides and anchor points structured versions with at least anchor points , supplemented by semi-structured or structured interview questions .
The format of the original version of the HAM-D, the HAM-D21 , was unstructured: Max Hamilton provided only general instructions for rating the individual items of the HAM-D21. As he stated , the interview process depends entirely on the skill of the interviewer in eliciting the necessary information. In other terms, the unstructured versions of the HAM-D, particularly the HAM-D21 and the HAM-D17 , exclusively rely on expertise and clinical judgment of raters.
The version developed by Bech et al. , the HAM-D23, explicitly provided item definitions and operational criteria for rating each item of the HAM-D. Anchor points were introduced for detecting the presence and severity of depressive symptoms .
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