Abstract
The 17-item Hamilton Depression Rating Scale (HDRS17) is used world-wide as an observer-rated measure of depression in randomised controlled trials (RCTs) despite continued uncertainty regarding its factor structure. This study investigated the dimensionality of HDRS17 for patients undergoing treatment in UK mental health settings with moderate to severe persistent major depressive disorder (PMDD). Exploratory Structural Equational Modelling (ESEM) was performed to examine the HDRS17 factor structure for adult PMDD patients with HDRS17 score ≥16. Participants (n = 187) were drawn from a multicentre RCT conducted in UK community mental health settings evaluating the outcomes of a depression service comprising CBT and psychopharmacology within a collaborative care model, against treatment as usual (TAU). The construct stability across a 12-month follow-up was examined through a measurement equivalence/invariance (ME/I) procedure via ESEM. ESEM showed HDRS17 had a bi-factor structure for PMDD patients (baseline mean (sd) HDRS17 22.6 (5.2); 87% PMDD >1 year) with an overall depression factor and two group factors: vegetative-worry and retardation-agitation, further complicated by negative item loading. This bi-factor structure was stable over 12 months follow up. Analysis of the HDRS6 showed it had a unidimensional structure, with positive item loading also stable over 12 months. In this cohort of moderate-severe PMDD the HDRS17 had a bi-factor structure stable across 12 months with negative item loading on domain specific factors, indicating that it may be more appropriate to multidimensional assessment of settled clinical states, with shorter unidimensional subscales such as the HDRS6 used as measures of change.
Highlights
This study investigated the dimensionality of HDRS17 for patients undergoing treatment in UK mental health settings with moderate to severe persistent major depressive disorder (PMDD)
The 17-item Hamilton Depression Rating Scale (HDRS17), which was developed in late 1950s has been the most frequently used observer-rated measure of depression for research including randomised controlled trials (RCTs) of treatments for depression [1,2,3]
There is an opportunity and need to re-assess the factor structure and measurement invariance of the HDRS17 in more severe PMDD, made more pressing by the fact that treatment guidelines, including those currently in preparation [30], continue to use the HDRS17 as a single total score across a range of depression severity and persistence. We address this issue here via Exploratory Structural Equational Modelling (ESEM) bi-factor modelling in a well-defined patient population with moderate to severe PMDD, recruited from UK mental health care settings in a previously published RCT [18], assessing construct stability across 12-month follow-up using a measurement equivalence/invariance (ME/I) procedure
Summary
The 17-item Hamilton Depression Rating Scale (HDRS17), which was developed in late 1950s has been the most frequently used observer-rated measure of depression for research including randomised controlled trials (RCTs) of treatments for depression [1,2,3]. Concerns persist about the widespread use of the of the HDRS17 as a unidimensional measure of depression severity, given indications that it has a more complex factor structure that is not fully captured by a single, total score [9,10,11,12,13]. The 17-item Hamilton Depression Rating Scale (HDRS17) is used world-wide as an observer-rated measure of depression in randomised controlled trials (RCTs) despite continued uncertainty regarding its factor structure. This study investigated the dimensionality of HDRS17 for patients undergoing treatment in UK mental health settings with moderate to severe persistent major depressive disorder (PMDD)
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