Ira H. Bernstein

An Evaluation of the Quick Inventory of Depressive Symptomatology and the Hamilton Rating Scale for Depression: A Sequenced Treatment Alternatives to Relieve Depression Trial Report

BACKGROUND Nine DSM-IV-TR criterion symptom domains are evaluated to diagnose major depressive disorder (MDD). The Quick Inventory of Depressive Symptomatology (QIDS) provides an efficient assessment of these domains and is available as a clinician rating (QIDS-C16), a self-report (QIDS-SR16), and in an automated, interactive voice response (IVR) (QIDS-IVR16) telephone system. This report compares the performance of these three versions of the QIDS and the 17-item Hamilton Rating Scale for Depression (HRSD17). METHODS Data were acquired at baseline and exit from the first treatment step (citalopram) in the Sequenced Treatment Alternatives to Relieve Depression (STAR*D) trial. Outpatients with nonpsychotic MDD who completed all four ratings within +/-2 days were identified from the first 1500 STAR*D subjects. Both item response theory and classical test theory analyses were conducted. RESULTS The three methods for obtaining QIDS data produced consistent findings regarding relationships between the nine symptom domains and overall depression, demonstrating interchangeability among the three methods. The HRSD17, while generally satisfactory, rarely utilized the full range of item scores, and evidence suggested multidimensional measurement properties. CONCLUSIONS In nonpsychotic MDD outpatients without overt cognitive impairment, clinician assessment of depression severity using either the QIDS-C16 or HRSD17 may be successfully replaced by either the self-report or IVR version of the QIDS.

The Montgomery Asberg and the Hamilton ratings of depression: a comparison of measures.

The 17-item Hamilton Rating Scale for Depression (HRSD(17)) and the Montgomery Asberg Depression Rating Scale (MADRS) are two widely used clinician-rated symptom scales. A 6-item version of the HRSD (HRSD(6)) was created by Bech to address the psychometric limitations of the HRSD(17). The psychometric properties of these measures were compared using classical test theory (CTT) and item response theory (IRT) methods. IRT methods were used to equate total scores on any two scales. Data from two distinctly different outpatient studies of nonpsychotic major depression: a 12-month study of highly treatment-resistant patients (n=233) and an 8-week acute phase drug treatment trial (n=985) were used for robustness of results. MADRS and HRSD(6) items generally contributed more to the measurement of depression than HRSD(17) items as shown by higher item-total correlations and higher IRT slope parameters. The MADRS and HRSD(6) were unifactorial while the HRSD(17) contained 2 factors. The MADRS showed about twice the precision in estimating depression as either the HRSD(17) or HRSD(6) for average severity of depression. An HRSD(17) of 7 corresponded to an 8 or 9 on the MADRS and 4 on the HRSD(6). The MADRS would be superior to the HRSD(17) in the conduct of clinical trials.

Cognitive biases and depression.

Compared symptomatically depressed, clinically remitted, and normal controls using cognitive measures designed to be traitlike and statelike in cross-sectional and longitudinal designs, respectively. Remitted depressives and normal subjects did not differ in their attributional biases, endorsement of dysfunctional attitudes, or interpretation of schema-relevant ambiguous events, but both groups differed from symptomatic depressives. Depressive episodes thus affect cognition, but cognitions measured by self-reports are more statelike than traitlike.

Cross- vs. within-racial judgments of attractiveness

Subjects from two pairs of ethnic groups (Chinese and White in Experiment 1, Black and White in Experiment 2) judged the attractiveness of faces in yearbook pictures of persons that belonged to their own or to the other ethnic group. This was to see whether: (1) a given group would perceive more variation in the attractiveness of faces belonging to its own vs. the other ethnic group, as suggested by the cross-racial literature, for example, Malpass and Kravitz (1969), and (2) the two groups would use the same or different rules to define attractiveness. There were essentially no differences in perceived variation for cross- vs. within-racial judgments, but there were differences in the criteria used to define attractiveness. As expected, Black and White aesthetic criteria were more like one another than were Chinese and White criteria. Discussion centered around reconciling these findings with the recognition literature.

On the dimensionality of the Buss/Perry Aggression Questionnaire

Buss and Perry (1992, Personality and Social Psychology, 63, 452-459) developed a 29-item test that presumably measures four aggression-related dimensions (physical aggression, verbal aggression, hostility, and anger). This study examined the factor structure of the items with particular concern towards seeing how much of the structure previously noted was an artifact of differences in item distributions. Although the scales are intercorrelated to the point that they may not span four dimensions, the scales are in fact multivariate in that the structure is not an artifact of differences in item distributions found with other presumed multifactor scales.

Psychometric Properties of the Children's Depression Rating Scale–Revised in Adolescents

OBJECTIVE The aim of this study was to present the reliability and validity of the Childrens Depression Rating Scale-Revised (CDRS-R) in the adolescent age group. METHOD Adolescents with symptoms of depression were assessed using the CDRS-R and global severity and functioning scales at screening, baseline, and after 12 weeks of fluoxetine treatment. Global improvement was also assessed at week 12 (or exit). Reliability and validity were analyzed using Classical Test Theory (item-total correlations and internal consistency) and correlations between the CDRS-R and other outcomes. RESULTS Adolescents (n = 145) were evaluated at screening; 113 (77.9%) met criteria for major depressive disorder, 8 (5.5%) had subthreshold depressive symptoms, and 24 (16.6%) had minimal depressive symptoms. Ninety-four adolescents had a baseline visit after 1 week, and 88 were treated with fluoxetine. Internal consistency for the CDRS-R was good at all three visits (screening: 0.79; baseline: 0.74; exit: 0.92), and total score was highly correlated with global severity (r = 0.87, 0.80, and 0.93; p < 0.01). Only exit CDRS-R score was significantly correlated with global functioning (Childrens Global Assessment Scale; r = -0.77; p < 0.01). Reductions on the CDRS-R total score were highly correlated with improvement scores at exit (Clinical Global Impressions-Improvement; r = -0.83; p < 0.01). CONCLUSIONS The results demonstrate good reliability and validity in adolescents with depression.

A Confirmatory Factoring of the Self-Consciousness Scale

Fenigstein, Scheier, and Buss (1975) developed a three subscale inventory designed to measure self-consciousness. Burnkrant and Page (1984) used confirmatory factor analysis to evaluate the scale and concluded that five items did not belong to their assigned scales and that one of the original subscales really measured two separable traits. Burnkrant and Pages conclusions may simply reflect incidental properties of the item statistics and could weaken the scale if adopted. Fenigstein et al.s representation fits the data quite well in its original form. However, items on their social anxiety scale also tend to evoke relatively large variability over subjects and items on their public self-consciousness scale tend to evoke relatively little variability. In other words, items on their subscales differ nearly as much statistically as they do substantively.

Inflammation, obesity, and metabolic syndrome in depression: analysis of the 2009-2010 National Health and Nutrition Examination Survey (NHANES).

OBJECTIVE To describe the rates of elevated inflammation, obesity, and metabolic syndrome (MetS) within a large cohort of individuals with depression and to examine the interrelationships of inflammation and MetS in depressed individuals. METHOD Analyses were conducted on study participants from the 2009-2010 National Health and Nutrition Examination Survey (NHANES) with Patient Health Questionnaire (PHQ-9) depression scores ≥ 10 to (1) examine the relationship of inflammation (C-reactive protein; CRP) with demographic and clinical characteristics and (2) examine the prevalence of MetS criteria within CRP groups. RESULTS 5,579 participants provided PHQ-9 data; of those, 606 had PHQ-9 scores ≥ 10 and were included in further analysis. Of the 606 depressed participants, 585 participants had valid CRP data; 275 participants (47.01%) had CRP levels ≥ 3.0 mg/L, while 170 (29.06%) had CRP levels ≥ 5.0 mg/L. Elevated inflammation was significantly correlated with body weight, waist circumference, body mass index, insulin, 2-hour glucose tolerance, and self-report general health (P values < .05). 112 subjects (41.18%) met American Heart Association/National Heart, Lung, and Blood Institute criteria for MetS. Those with elevated CRP were more likely to meet criteria for MetS (odds ratios of 2.81 for those with CRP levels ≥ 3.0 mg/L and 1.94 for those with CRP levels ≥ 5.0 mg/L). CONCLUSIONS Over 29% of depressed individuals had elevated levels of CRP, and 41% met criteria for MetS. Individuals with elevated inflammation are more likely to be obese and meet criteria for MetS. These results highlight the significant inflammatory and metabolic burden of individuals with depression.

On the utility of the SCL-90-R with low-back pain patients

The SCL-90-R has become an increasingly popular measure of maladjustment. Its use beyond simply screening chronic low-back pain (CLBP) patients has been criticized, however, in part, because it appears to be a single-factor instrument. In fact, its nine major scales do share only one important common factor, i.e., general psychological discomfort. The scale most applicable to CLBP, however, somatization (SOM), has sufficient specific variance that it does not simply measure discomfort and predicts several other measures better than the SCL-90-Rs more reliable composite measure (GSI). Using SOM in conjunction with the GSI to separate psychological from physical discomfort is therefore both clinically and psychometrically appropriate. Other objections to the test are critically evaluated. The potential clinical relevance of the SCL-90-R is discussed.

Awareness, false recognition, and the Jacoby-Whitehouse effect.

Replication is made of Jacoby and Whitehouses (1989) findings that short duration context stimuli induced false recognition of test stimuli when the 2 events matched one another, but that the reserve was true of longer duration context stimuli (i.e., matching led to fewer false―as well as true―old responses). Although they claimed their results supported unconscious perception, short exposure in this article was clearly supraliminal, that is, subjects judged the relation between context and test stimuli far in excess of chance