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

• Published in: PloS one Vol. 12; no. 1; p. e0170000
• Main Authors: Primo de Carvalho Alves, Lucas, Pio de Almeida Fleck, Marcelo, Boni, Aline, Sica da Rocha, Neusa
• Format: Journal Article
• Language: English
• Published: United States Public Library of Science 23.01.2017; Public Library of Science (PLoS)
• Subjects: Adult; Analysis; Anxiety; Biology and Life Sciences; Care and treatment; Cross-Sectional Studies; Depression (Mood disorder); Depressive Disorder, Major - diagnosis; Female; Hospital patients; Humans; Intellectual disabilities; Internet; Laboratories; Major depressive disorder; Male; Medicine and Health Sciences; Mental depression; Middle Aged; Mood; Neurobiology; Neurosciences; People and Places; Principal components analysis; Psychiatric Status Rating Scales; Psychiatry; Psychological aspects; Quantitative psychology; Rasch model; Risk factors; Signs and symptoms; Social Sciences; Studies
• ISSN: 1932-6203; 1932-6203
• DOI: 10.1371/journal.pone.0170000

Melancholic 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. We 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. For 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. Depressed 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.