Rating depression severity in the elderly physically ill patient: reliability and factor structure of the Hamilton and the Montgomery–Asberg Depression Rating Scales

Objectives. To assess the appropriateness of the Hamilton Depression Rating Scale and the Montgomery–Asberg Depression Rating Scale in depressed elderly physically ill patients. Design. Depression scale scores from depressed medical inpatients were assessed for internal consistency using Cronbach's α, and subjected to exploratory principal components factor analyses. Subjects. 100 medical inpatients, aged 65 years and over (median age 80·5 years, range 66–99), 74 female, with Geriatric Mental State Schedule–AGECAT case level diagnoses of depression. Materials. The 17-item Hamilton Depression Rating Scale (HDS) and the Montgomery–Asberg Depression Rating Scale (MADRS). Results. Coefficient α for the HDS was 0·46; for the MADRS 0·61. Successive deletion of HDS items to maximize α resulted in a six-item scale (α=0·60); after deletion of five MADRS items, α was 0·77. Factor analysis of the HDS yielded a four-factor solution accounting for 57% of the variance, the majority due to anxiety and insomnia items; the MADRS yielded a two-factor solution explaining 60% of the variance. Conclusions. Coefficient α for both scales is well below the minimum necessary for the total score to be used to represent a single construct. The HDS appears to be an unreliable measure of depression severity in elderly people with physical illness, as the major variance in the scores is due to anxiety and insomnia. The MADRS performs better, and with modification may be an appropriate measurement of depression severity in this population. © 1998 John Wiley & Sons, Ltd.     

Confirmatory factor analysis of the revised version of the Thai multidimensional scale of perceived social support among the elderly with depression

ABSTRACT

Objective: Difficulties in modeling the Multidimensional Scale of Perceived Social Support (MSPSS) have occurred, and these were corrected in the revised version of the Thai MSPSS. However, the revised version has not been tested in elderly populations. The present study aimed at confirming the factor structure of the revised version of the MSPSS among the elderly with depressive disorders, in populations with or without depressive disorders.

Methods: Eight hundred and three elderly patients were recruited from four tertiary hospitals; 190 (23.7%) had depressive disorders. All completed the revised Thai MSPSS consisting of 12 items, using a 7-point Likert scale. Confirmatory factor analysis (CFA) of the MSPSS was conducted in both groups.

Results: The mean age was 69.24 years (SD 6.88), and 70% of the sample was female. There were no significant difference in demographic data between two groups. The revised version of the Thai MSPSS provided excellent internal consistency. The three-factor model was clearly superior to other alternative models in both depressed and non-depressed groups. CFA for the whole group revealed an acceptable model fit: χ² = 147.44, df = 45, p < 0.001; Tucker-Lewis Index 0.975; Comparative Fit Index 0.982; Good Fit Index 0.966; and root-mean-square error of approximation 0.056. The fit statistics in the depressed group was better than in the non-depressed group across all models.

Conclusions: Due to its robust factor structure, these data support the use of the revised MSPSS as a brief instrument for assessing perceived social support in the elderly with or without depressive disorders.     

Standardized clinical outcome rating scale for depression for use in clinical practice

The integration of research into clinical practice to conduct effectiveness studies faces multiple obstacles. One obstacle is the burden of completing research measures of outcome. A simple, reliable, and valid measure that could be rated at every visit, incorporated into a clinician's progress note, and reflect the DSM-IV definition of a major depressive episode (including partial and full remission from the episode) would enhance the ability to conduct effectiveness research. The goal of the present study was to examine the reliability and validity of such a measure. Three hundred and three psychiatric outpatients who were being treated for a DSM-IV major depressive episode were rated on the Standardized Clinical Outcome Rating for Depression (SCOR-D), 17-item Hamilton Rating Scale for Depression, Montgomery-Asberg Depression Rating Scale, and the Global Assessment of Functioning. We examined the correlation between the SCOR-D and the other measures, and conducted an analyses of variance to compare mean values on these measures for each rating point on the SCOR-D. The inter-rater reliability of the SCOR-D dimensional ratings and categorical determination of remission were high. The SCOR-D was highly correlated with the other scales, and there were significant differences on the other measures of depression severity between each adjacent rating level of the SCOR-D. The SCOR-D is a brief standardized outcome measure linked to the DSM-IV approach toward defining remission that can be incorporated into routine clinical practice without adding undue burden to the treating clinician with some evidence of reliability and validity. This measure could make it more feasible to conduct effectiveness studies in clinical practice.     

汉密尔顿焦虑量表的因素结构研究

目的:探索汉密尔顿焦虑量表(HAMA)的因素结构.方法:对562名门诊抑郁症、焦虑症、强迫症患者进行HAMA测评.通过探索性因素分析和验证性因素分析的方法探索和评价HAMA的因素结构. 结果:探索性主成分分析结果显示,HAMA可分为7因子模型,验证性因素分析各拟合指标均达到测量标准(x2=1.184,RMAEA =0....     

Derivation of a definition of remission on the Montgomery-Asberg depression rating scale corresponding to the definition of remission on the Hamilton rating scale for depression

During the past decade the Montgomery–Asberg Depression Rating Scale (MADRS) has been used with increasing frequency to measure outcome in antidepressant efficacy trials (AETs). In characterizing treatment outcome in AETs it is common to define treatment remission as a score below a predetermined cutoff score on the scale. Various cutoffs have been used to define remission on the MADRS. The goal of the present paper is to determine the cutoff on the MADRS that most closely corresponds to the cutoff most frequently used on the Hamilton Rating Scale for Depression to define remission. Three hundred and three psychiatric outpatients who were being treated for a DSM-IV major depressive episode were rated on the HRSD and the MADRS. A linear regression equation was computed to estimate MADRS scores from HRSD scores. After deriving the regression equation, we computed the MADRS score corresponding to an HRSD score of 7. We also examined the sensitivity, specificity and overall classification rate of the MADRS for identifying remission on the HRSD. Based on the equation from a linear regression analysis for the entire sample, a MADRS score of 11 would correspond to a score of 7 on the HRSD. We repeated the analysis after excluding the more severely depressed patients who currently met criteria for MDD, and based on the equation from this regression analysis a MADRS score of 10 would correspond to a score of 7 on the HRSD. In a complementary analysis, we examined the sensitivity, specificity and overall classification rate of the MADRS at different cutoff points for identifying remission, and found that a cutoff of 10 maximized the level of agreement with the HRSD definition of remission. In conclusion, the regression equation relating HRSD and MADRS scores is dependent, in part, on the range and severity of scores in the sample. To facilitate comparisons of studies using the HRSD and MADRS our results suggest that a cutoff of 10 on the MADRS is equivalent to the HRSD cutoff of 7.     

Symptom reduction in depression after treatment with L-tryptophan or imipramine. Item analysis of Hamilton rating scale for depression.

Thirty-eight in-patients with endogenous- and 20 in-patients with non-endogenous depression, took part in a multi-centre 3-week double-blind trial where patients were randomly allocated to treatment with either 6 g L-tryptophan or 150 mg imipramine daily. Item analysis of Hamilton ratings, before the investigation and weekly during the trial period demonstrated few statistically different mean scores on individual items between the two treatment groups. After 3 weeks' treatment a statistically significant item mean reduction on the 0.1% level was found in the item Agitation in favour of imipramine-treated, and in the item Work and Activities in favour of L-tryptophan-treated endogenously depressed patients. After 3 weeks' treatment a statistically significant item mean reduction on the 5% level was found in the item Suicide in favour of imipramine-treated non-endogenously depressed patients. The present study has shown that, after 3 weeks' treatment, imipramine and L-tryptophan has decreased the mean score on individual items of HRS in about the same degree.     

Psychotherapy versus the combination of psychotherapy and pharmacotherapy in the treatment of depression: a meta‐analysis

Background: A large number of studies have shown that psychological treatments have significant effects on depression. Although several studies have examined the relative effects of psychological and combined treatments, this has not been studied satisfactorily in recent statistical meta‐analyses. Method: We conducted a meta‐analysis of randomized studies in which a psychological treatment was compared to a combined treatment consisting of the same psychological treatment with a pharmacological therapy. For each of these studies we calculated the effect size indicating the difference between the psychological and the combined treatment. Results: All inclusion criteria were met by 18 studies, with a total of 1,838 subjects. The mean effect size indicating the difference between psychological and combined treatment was 0.35 (95% CI: 0.24～0.45; P<0.001), with low heterogeneity. Subgroup analyses indicated that the difference between psychological and combined treatments was significantly smaller in studies in which cognitive behavior therapy was examined. We also found a trend (P<0.1) indicating that the difference between psychological and combined treatment was somewhat larger in studies aimed at specific populations (older adults, chronic depression, HIV patients) than in studies with adults, and in studies in which Trycyclic antidepressants or SSRIs were examined, compared to studies in which a medication protocol or another antidepressant was used. At follow‐up, no difference between psychological and combined treatments was found. Conclusion: We conclude that combined treatment is more effective than psychological treatment alone. However, it is not clear whether this difference is relevant from a clinical perspective. Depression and Anxiety, 2009. © 2008 Wiley‐Liss, Inc.     

Alterations in prefrontal cortical activity in the course of treatment for late-life depression as assessed on near-infrared spectroscopy

Aim:  To evaluate the severity of depression by measuring alterations in prefrontal cortical activity associated with mood disorders, as assessed on near-infrared spectroscopy.
Methods:  Ten of 27 subjects hospitalized for late-life depression from May 2006 to June 2007, were examined. In these 10 subjects changes in hemoglobin concentration were measured on near-infrared spectroscopy during two types of the rock, paper, scissors game as the cognitive tasks affecting prefrontal cortical activity on 2 days, including 1 day on which depressive symptoms had slightly improved due to treatment, and then on another day >4 weeks later. Severity of depression and cognitive impairment were also simultaneously assessed.
Results:  The change in oxygenated hemoglobin concentration during a difficult task (intentional loss task) was significantly larger than that during an easy task (try to win task) on the left side (left, P  = 0.010; right, P  = 0.059). On the left side there was a significant negative correlation between the ratio of oxygenated hemoglobin measurements on the second day to those on the first day, and the severity of depression on the second day (left, P  = 0.012; right, P  = 0.090). Thus, the more left prefrontal cortical activity tended to increase, the fewer depressive symptoms tended to be present on the second day of testing.
Conclusions:  Measuring of alterations in prefrontal cortical activity associated with mood disorders, as assessed on near-infrared spectroscopy, is feasible in subjects with depression.     

Psychometric characteristics of the Beck Depression Inventory-II with college students of diverse ethnicity

Introduction To evaluate the psychometric characteristics of the Beck Depression Inventory – Second Edition (BDI-II) with an ethnically diverse sample of college students. Methods The BDI-II was completed by a group of 502 college students (54% women) with an ethnic distribution of African-American (n=49, 10%), Asian-American (n=33, 7%), Hispanic (n=113, 22%), Native-American (n=10, 2%), and White (n=297, 59%). Psychometric characteristics of the inventory with the ethnically diverse group were compared to the results published in the test manual for nonclinical samples composed predominantly of European and White participants. Results Using confirmatory factor analyses, a three-factor model that identified negative attitude, performance difficulty, and somatic dimensions, provides a better fit of the data than does the two-factor model. Similar psychometric characteristics were found between the ethnically diverse student sample and the standardization sample. Based on multivariate analysis of variance, White students had higher scores on the item of agitation compared to Asian-American students and on the items of worthlessness and irritability compared to Hispanic students. Conclusion The results of the psychometric analyses suggest that the BDI-II is suitable as a screening instrument for depression in college populations of diverse ethnicity.     

The Frankfurt Complaint Questionnaire for self‐assessment of basic symptoms in the early detection of psychosis—Factor structure,reliability, and predictive validity

Objectives

Patients with schizophrenia often experience subtle disturbances in several domains of information processing—so‐called basic symptoms (BS). BS are already present before onset of frank psychosis and can be assessed by interviews but also by the self‐administered Frankfurt Complaint Questionnaire (FCQ). We investigated the factor structure, reliability, and predictive validity for transition to psychosis of the FCQ, comparing previously proposed factor solutions containing 1, 2, 4, and 10 factors.

Methods

Confirmatory factor analysis was used in a sample of 117 at‐risk mental state and 92 first‐episode psychosis participants of the Basel FePsy (early detection of psychosis) study.

Results

Although all factor models fitted to the data, the 2‐ or 4‐factor solutions performed best among the models that used at least half of the FCQ items, suggesting the covariance between FCQ items is best explained by 2 to 4 underlying factors. No FCQ‐scale predicted transition to psychosis.

Conclusion

We could confirm a 2‐ to 4‐factor structure of the FCQ in a sample of at‐risk mental state and first‐episode psychosis patients using confirmatory factor analysis. Contrary to interview‐assessed cognitive–perceptive BS, self‐assessed BS do not seem to improve prediction of psychosis. This result reinforces reports of poor correspondence between interview‐ and questionnaire‐assessed BS.

     

精神分裂症患者应对方式的结构

背景 精神分裂症患者面临着许多压力,但他们不恰当的应对方式往往影响着疾病的预后.国外的应对方式问卷由于文化背景差异不完全适用于我国人群;而国内的应对方式量表是在精神病人以外的人群中建立的,是否适合精神病人仍不清楚.本研究旨在探索精神分裂症患者和正常人的应对方式结构是否相同,如存在差异,则应另编制适合患者的问卷.方法 通过文献复习收集了91个应对方式项目.7例精神分裂症患者完成模拟测查,根据反馈意见修改部分项目并补充了1个项目.经专家评阅后修改编辑成92个项目的应对方式问卷初稿.分别在符合入选条件的315名正常人和208例精神分裂症患者中测试.患者的入选条件①≥16岁;②符合中国精神障碍分类与诊断标准第3版(CCMD-3)精神分裂症诊断标准;③住院接受药物治疗1个月或以上;④临床总体印象评定的病情严重程度为"中度有病"或更轻,且阳性和阴性症状量表(PANSS)中"注意障碍"项目得分不超过3分;⑤能够理解题意独立完成问卷并知情同意.正常组入选条件①≥16岁;②无精神病史;③能理解题意独立完成问卷并知情同意.对测试结果采用探索性因子分析比较两组的应对方式结构.经过因子分析删除了共通性或载荷量低的项目,两组总共保留了73个项目.根据研究对象的反馈意见再次修改及合并有关项目,编辑成65个项目的应对方式问卷修改稿.而后在符合同样入选条件的另外287名正常人和219例精神分裂症患者中进行验证,采用验证性因子分析分别确定各自的应对方式结构.同时收集患者的病程、诊断亚型资料,并由3名经过一致性培训的主治医师以上的精神科医师对其中205名患者进行了PANSS评定,分析患者的临床特点与应对方式因子得分之间的关系.结果 正常组的应对方式包括"问题解决指向"、"回避"、"认知调整"、"情绪调节"、"寻找专业支持"和"否认"6个因子;而患者组只有前四个因子,后两个因子的相应项目分散到这四个因子中,没有形成独立的因子.验证性因子分析的结果验证了上述结构.研究对象的年龄、性别以及受教育程度对因子结构均无明显的影响.模型比较的结果说明4因子结构对分裂症患者优于6因子结构.偏执型患者"回避"因子分高于未分型患者;偏执型及未分型患者的"问题解决"和"认知调整"因子分高于其他患者.总病程与"情绪调节"因子分呈正相关;PANSS阳性症状分与"回避"因子分呈正相关.结论 精神分裂症患者应对方式的结构与正常人不同,患者的应对方式缺乏必要的选择性.在此基础上编制适合精神分裂症患者特点的应对方式问卷是必要的.     

Screening for major depression in persons with HIV infection: the concurrent predictive validity of the Profile of Mood States Depression‐Dejection Scale

Major Depressive Disorder (MDD) is among the most prevalent but underdiagnosed psychiatric disorders in persons with HIV infection. Given the known adverse impact of comorbid MDD on HIV disease progression and health‐related quality of life, it is important both for research and for efficient, effective clinical care, to validate existing screening measures that may discriminate between MDD and the somatic symptoms of HIV (such as fatigue). In the current study, we evaluated the concurrent predictive validity of the Profile of Mood States (POMS) Depression‐Dejection scale in detecting current MDD in 310 persons with HIV infection. The Structured Clinical Interview for DSM‐IV (SCID) diagnosis of MDD and the Cognitive‐Affective scale from the Beck Depression Inventory (BDI‐CA) served as comparative diagnostic and severity measures of depression, respectively. Results demonstrated that the POMS Depression‐Dejection scale accurately classified persons with and without MDD SCID diagnoses, with an overall hit rate of 80%, sensitivity of 55%, specificity of 84%, and negative predictive power of 91% using a recommended cutpoint of 1.5 standard deviations above the normative mean. Moreover, the POMS performed comparably to the BDI‐CA in classifying MDD. Findings support the predictive validity of the POMS Depression‐Dejection scale as a screening instrument for MDD in persons with HIV disease. Copyright © 2006 John Wiley & Sons, Ltd.     

Factorial Structure and Invariance of the Academic Expectations Stress Inventory Across Hispanic and Chinese Adolescent Samples

Using confirmatory factor analysis, the current study provided further evidence for the two-factor structure of the Academic Expectations Stress Inventory [AESI; Ang RP, Huan VS (2006) Educ Psych Meas 66:522–539] using a sample of 191 US Hispanic adolescents and a sample of 211 Singapore Chinese adolescents. This study also examined the cross-cultural validity of the AESI using multigroup confirmatory factor analysis to investigate the invariance of the factor structure of the AESI across both samples. Results from multigroup confirmatory factor analysis suggested that while partial invariance was observed across the samples, the consistency of fit indices indicating either no change or a minimal loss of fit between the unconstrained basic model and the partially constrained models, provided support that partial invariance was acceptable. Analyses of covariance results indicated that perceived overall academic stress and academic stress arising from self-expectations were significantly higher among Singapore Chinese adolescents compared with US Hispanic adolescents.     

Confirmatory factor analysis of the familism scale in a sample of dementia caregivers

Familism is considered to be a cultural value shared by different Hispanic groups. The familism scale (FS) was developed by Sabogal, Marín, Otero-Sabogal, Marín, and Perez-Stable (1987, Hispanic familism and acculturation: What changes and what doesn't? Hispanic Journal of Behavioral Sciences, vol. 9, pp. 397–412) as a self-report measure of this construct, and three dimensions were obtained through exploratory factor analysis: familial obligations, perceived support from the family, and family as referents.

Objectives and method: The purpose of the present study was to assess the underlying factor structure of the FS using confirmatory factor analysis (CFA) in a sample of 135 Spanish caregivers.

Results: The original model did not fit the data well, and five items with factor loadings below 0.40 were trimmed. The fit indexes for the remaining items suggest a good fit of this model and an acceptable internal consistency index.

Conclusion: The results suggest that the modified factor model for the FS has acceptable psychometric properties in a sample of dementia caregivers.