The Inventory of Depressive Symptomatology: German translation and psychometric validation

The Inventory of Depressive Symptomatology (IDS) is a rating scale for depression, widely used in international multicentre studies. There are two corresponding versions: a self-rated (IDS-SR) and a clinician-rated (IDS-C) scale. The aim of this study was to evaluate the reliability and validity of the German versions of the IDS-SR and IDS-C in comparison to the Hamilton Rating Scale for Depression (HRSD) and to the Beck Depression Inventory (BDI). The sample consisted of 59 inpatients and outpatients treated for unipolar or bipolar disorders. Internal consistency of the IDS-SR and IDS-C was found highly acceptable (alpha = 0.94 and alpha = 0.93). Item-total-correlations of the IDS-SR revealed that 68% of the items were strongly correlated with the sum score (> or =0.50). This was in the same range with the IDS-C (54%), the HRSD (53%) and the BDI (76%). Furthermore, there is a high concurrent validity (r > or = 0.88) of the IDS-SR with the IDS-C, the BDI and the HRSD. Substantial score-differences between inpatients and outpatients indicate a good discriminant validity. It is concluded that the German version of the IDS is a useful instrument for the assessment of depressive symptoms and that it has the same highly acceptable psychometric properties as the original English version.     

A comparison of alternative assessments of depressive symptom severity: a pilot study

This study compared the performance of an itemized symptom self-report (Inventory of Depressive Symptomatology - Self-Report; IDS-SR), patient global ratings, and clinician global ratings with an itemized clinician-rated symptom severity measure (Inventory of Depressive Symptomatology - Clinician-Rated; IDS-C) in detecting treatment effects in patients with major depressive disorder (MDD). A total of 28 inpatients (30.8% psychotic) and 34 outpatients (17.9% psychotic) with MDD began treatment that followed the Texas medication algorithm. The clinicians completed the IDS-C and a Physician Global Rating Scale (PhGRS) at each assessment visit, while the patients completed the IDS-SR and a Patient Global Rating Scale (PtGRS). Change scores from the baseline to subsequent weeks were computed for all subjects, utilizing all four measures. The IDS-SR was a significant independent predictor of the response to treatment as compared to the two global ratings. The IDS-SR was as sensitive to change as the IDS-C. While the clinician-rated itemized symptom severity rating scale remains the standard to assess the symptomatic outcome of the treatment of MDD, a self-report of identical symptomatology may be a reasonable alternative for many patients.     

A comparison of alternative assessments of depressive symptom severity: a pilot study

This study compared the performance of an itemized symptom self-report (Inventory of Depressive Symptomatology - Self-Report; IDS-SR), patient global ratings, and clinician global ratings with an itemized clinician-rated symptom severity measure (Inventory of Depressive Symptomatology - Clinician-Rated; IDS-C) in detecting treatment effects in patients with major depressive disorder (MDD). A total of 28 inpatients (30.8% psychotic) and 34 outpatients (17.9% psychotic) with MDD began treatment that followed the Texas medication algorithm. The clinicians completed the IDS-C and a Physician Global Rating Scale (PhGRS) at each assessment visit, while the patients completed the IDS-SR and a Patient Global Rating Scale (PtGRS). Change scores from the baseline to subsequent weeks were computed for all subjects, utilizing all four measures. The IDS-SR was a significant independent predictor of the response to treatment as compared to the two global ratings. The IDS-SR was as sensitive to change as the IDS-C. While the clinician-rated itemized symptom severity rating scale remains the standard to assess the symptomatic outcome of the treatment of MDD, a self-report of identical symptomatology may be a reasonable alternative for many patients.     

Assessing anxious features in depressed outpatients

Both the 17-item Hamilton Rating Scale for Depression (HRSD(17)) and 30-item Inventory of Depressive Symptomatology - Clinician-rated (IDS-C(30) ) contain a subscale that assesses anxious symptoms. We used classical test theory and item response theory methods to assess and compare the psychometric properties of the two anxiety subscales (HRSD(ANX) and IDS-C(ANX)) in a large sample (N = 3453) of outpatients with non-psychotic major depressive disorder in the Sequenced Treatment Alternatives to Relieve Depression (STAR*D) study. Approximately 48% of evaluable participants had at least one concurrent anxiety disorder by the self-report Psychiatric Diagnostic Screening Questionnaire (PDSQ). The HRSD(ANX) and IDS-C(ANX) were highly correlated (r = 0.75) and both had moderate internal consistency given their limited number of items (HRSD(ANX) Cronbach's alpha = 0.48; IDS-C(ANX) Cronbach's alpha = 0.58). The optimal threshold for ascribing the presence/absence of anxious features was found at a total score of eight or nine for the HRSD(ANX) and seven or eight for the IDS-C(ANX) . It would seem beneficial to delete item 17 (loss of insight) from the HRSD(ANX) as it negatively correlated with the scale's total score. Both the HRSD(ANX) and IDS-C(ANX) subscales have acceptable psychometric properties and can be used to identify anxious features for clinical or research purposes.     

Clinical, cognitive, and demographic predictors of response to cognitive therapy for depression: a preliminary report

This preliminary study evaluated prognostic indicators or predictors of response to cognitive therapy. The sample included 37 unipolar outpatients with moderate to severe major nonpsychotic depressive disorder, according to Research Diagnostic Criteria. Demographic characteristics (sex, age, marital status, and education), pretreatment severity measures (Hamilton Rating Scale for Depression [HRSD] and Beck Depression Inventory [BDI]), pretreatment cognitive measures (Dysfunctional Attitudes Scale [DAS] and Attributional Style Questionnaire Failure Composite [ASQ-F]), and historical features (length of illness, length of current episode, number of episodes, and age of onset) were used in multiple regression models to predict response. In accord with previous findings, patients who had higher (rather than lower) pretreatment HRSD, BDI, or DAS scores and were single (rather than married) showed a poorer response to cognitive therapy, according to the HRSD. Furthermore, married outpatients with high DAS scores or single patients with low DAS scores showed an intermediate response to cognitive therapy, while single patients with high DAS scores responded the least. Generally, effects were stronger when response was assessed according to clinician-rated severity measures rather than patient self-reports.     

The 16-Item Quick Inventory of Depressive Symptomatology (QIDS), clinician rating (QIDS-C), and self-report (QIDS-SR): a psychometric evaluation in patients with chronic major depression.

The 16-item Quick Inventory of Depressive Symptomatology (QIDS), a new measure of depressive symptom severity derived from the 30-item Inventory of Depressive Symptomatology (IDS), is available in both self-report (QIDS-SR(16)) and clinician-rated (QIDS-C(16)) formats.This report evaluates and compares the psychometric properties of the QIDS-SR(16) in relation to the IDS-SR(30) and the 24-item Hamilton Rating Scale for Depression (HAM-D(24)) in 596 adult outpatients treated for chronic nonpsychotic, major depressive disorder.Internal consistency was high for the QIDS-SR(16) (Cronbach's alpha =.86), the IDS-SR(30) (Cronbach's alpha =.92), and the HAM-D(24) (Cronbach's alpha =.88). QIDS-SR(16) total scores were highly correlated with IDS-SR(30) (.96) and HAM-D(24) (.86) total scores. Item-total correlations revealed that several similar items were highly correlated with both QIDS-SR(16) and IDS-SR(30) total scores. Roughly 1.3 times the QIDS-SR(16) total score is predictive of the HAM-D(17) (17-item version of the HAM-D) total score.The QIDS-SR(16) was as sensitive to symptom change as the IDS-SR(30) and HAM-D(24), indicating high concurrent validity for all three scales. The QIDS-SR(16) has highly acceptable psychometric properties, which supports the usefulness of this brief rating of depressive symptom severity in both clinical and research settings.     

Item Response Analysis of the Inventory of Depressive Symptomatology

BACKGROUND: Both the clinician (IDS-C(30)) and self-report (IDS-SR(30)) versions of the 30-item Inventory of Depressive Symptomatology have acceptable psychiatric properties and have been used in various clinical studies. These two scales, however, have not been compared using item response theory (IRT) methods to determine whether the standard scoring methods are optimal. METHODS: Data were derived from 428 adult public sector outpatients with nonpsychotic major depressive disorder. The IDS-C(30) and IDS-SR(30) were compared using Samejima's graded response model. RESULTS: A model was constructed jointly fitting the IDS-C(30) and IDS-SR(30). An improvement in scale performance was obtained by grouping selected items into domains (specifically sleep, psychomotor, and appetite/weight domains) analogous to the standard scoring of the 16-item Quick Inventory of Depressive Symptomatology. CONCLUSIONS: For the IDS-C(30) and IDS-SR(30), standard scoring (ie, computing total score using all individual items) provides simplicity, comparability to published data, and a basis for clinical decision making. The revised scoring method, however, improves the utility of both scales when comparing groups as it provides explicit tests of item parameters.     

Depression following pegylated interferon-alpha: characteristics and vulnerability

OBJECTIVE: Interferon-alpha2 (IFN-alpha) injections may be capable of triggering depression in some individuals. The first objective was to further characterize this depression and, secondly, to examine whether pre-treatment temperament was correlated with subsequent vulnerability to IFN-alpha. METHODS: Twenty-three initially euthymic adults undergoing year-long PEG-IFN-alpha treatment for hepatitis C were evaluated at baseline and then prospectively monitored using both the Structured Clinical Interview for DSM-IV (SCID) and self-report questionnaires. RESULTS: A major depressive episode developed within 3 months in 39%. Principal component analysis of the change in self-report scores after 1 month of treatment demonstrated three orthogonal factors: (i) a specific increase in depression as manifested in the Beck Depression Inventory (BDI) and Hospital Anxiety and Depression Scale (HADS), (ii) an increase in hostility and anxiety, (iii) and a generalized combination of worse symptoms including somatic symptoms on the Symptom Check List (SCL-90). BDI at 1 month was predicted by baseline BDI (r=0.76, P=.004). Hostility at 1 month was predicted by low baseline agreeableness (r=0.75, P=.01). Controlling for baseline BDI scores, categorical major depression was predicted by combined high baseline neuroticism and low agreeableness (combined r=0.66, P=.03). CONCLUSION: These initial results (i) support the depressogenic nature of IFN-alpha treatment in a subset of vulnerable individuals, (ii) indicate that some individuals are also independently vulnerable to worsened hostility, and (iii) suggest that it may be possible to clinically predict these vulnerabilities in initially euthymic subjects.     

A comparison of self-reported versus clinician-related symptoms in depression

Self-reported and clinician-rated symptom-severity measures were administered to 19 patients with unipolar endogenous major depression, 24 patients with unipolar nonendogenous major depression, and 14 patients with dysthymic disorder. Both the dysthymic and the nonendogenous major depressive groups self-reported significantly (p less than .05) more symptoms than were recorded by clinicians, and the endogenously depressed group evidenced no significant (p = .83) discrepancy between self-rated and clinician-rated measures. The data are consistent with the idea that a negative thinking bias may in here particularly in the dysthymic and the nonendogenous depressed groups.     

Vagus nerve stimulation for treatment-resistant depression: a randomized, controlled acute phase trial.

BACKGROUND: Vagus nerve stimulation (VNS) alters both concentrations of neurotransmitters or their metabolites and functional activity of central nervous system regions dysregulated in mood disorders. An open trial has suggested efficacy. METHODS: This 10-week, acute, randomized, controlled, masked trial compared adjunctive VNS with sham treatment in 235 outpatients with nonpsychotic major depressive disorder (n = 210) or nonpsychotic, depressed phase, bipolar disorder (n = 25). In the current episode, participants had not responded adequately to between two and six research-qualified medication trials. A two-week, single-blind recovery period (no stimulation) and then 10 weeks of masked active or sham VNS followed implantation. Medications were kept stable. Primary efficacy outcome among 222 evaluable participants was based on response rates (>/=50% reduction from baseline on the 24-item Hamilton Rating Scale for Depression [HRSD(24)]). RESULTS: At 10-weeks, HRSD(24) response rates were 15.2% for the active (n = 112) and 10.0% for the sham (n = 110) groups (p = .251, last observation carried forward [LOCF]). Response rates with a secondary outcome, the Inventory of Depressive Symptomatology - Self-Report (IDS-SR(30)), were 17.0% (active) and 7.3% (sham) (p = .032, LOCF). VNS was well tolerated; 1% (3/235) left the study because of adverse events. CONCLUSIONS: This study did not yield definitive evidence of short-term efficacy for adjunctive VNS in treatment-resistant depression.     

Concordance between self-report and clinician's assessment of depression.

In order to assess differences between self-assessment and clinician's assessment of depression, 64 depressed in-patients were assessed for depressive symptomatology at admission (D0), 10 days (D10) and 28 days (D28) after the beginning of antidepressant treatment, using the Inventory for Depressive Symptomatology Clinician Rated (IDS-C) and the Inventory for Depressive Symptomatology Self-Rated (IDS-SR). Associated symptoms (SCL-90R) were assessed at D0 and personality dimensions (TCI) at D28. Although agreement was high between IDS-C and IDS-SR total scores, D0, D0-D10 and D0-D28 total scores were significantly different between IDS-C and IDS-SR, showing a higher sensitivity to change for IDS-C as compared to IDS-SR. Differences between IDS-C and IDS-SR were due mostly to mood items and not to somatic items. Discrepancies between self-assessment and clinician's assessment of depressive symptomatology were linked neither to age, sex, familial status, single/recurrent and length of episode, nor to depression severity, but to associated symptoms and, to a lesser extent, personality dimensions: patients over-estimating their depressive symptomatology change relative to the psychiatrist tended to score high on phobic anxiety, Cooperativeness (especially Social Acceptance) and Self-Transcendence (especially Self-forgetfulness) and vice-versa.     

Dysfunctional cognitions of depressive inpatients and their relationship with treatment outcome

BackgroundDysfunctional cognitions can contribute to depression and its maintenance. They may be related to a higher relapse rate and a longer duration of the depressive episode. The relevance of dysfunctional cognitions for acute inpatient treatment of unipolar depression is examined in this study and its variability by cognitive behavioural therapy (CBT).Methods222 patients suffering from Major Depressive Disorder (MDD) were evaluated during their inpatient treatment by assessing admission and discharge depression scores and their relationship to dysfunctional cognitions, using the Dysfunctional Attitude Scale (DAS). The relationship between dysfunctional cognitions and treatment outcome was examined. Primary outcome measures were the Hamilton-Rating-Scale (HRSD) and the Beck Depression Inventory (BDI).ResultsHigher age, depression severity at admission, comorbid personality disorders and recurrent depressive disorders are related with higher DAS-scores at admission. DAS-Scores declined during treatment but to a lower extend than depressive symptom scales (effect size d_{DAS-G t1-t2} = .31; d_{HRSD t1-t2} = 2.88; d_{BDI t1-t2} = 1.38). Higher DAS-scores at admission correlated negatively with the improvement of depressive symptoms during treatment (HRSD: r = −.62; p < .01; BDI: r = −.54; p < .01) and remission rates (HRSD: r = −.65; p < .01; BDI: r = −.48; p < .01). CBT did not additionally reduce DAS-scores compared to pharmacotherapy only.ConclusionDysfunctional cognitions are relatively stable compared to other depressive symptoms and are associated with poorer treatment outcome even in combined treatment of antidepressant medication and CBT during inpatient treatment. Changes of dysfunctional cognitions seem to be a long-term treatment goal, especially because of their association with comorbid personality disorders and recurrent depressive disorders.     

Generalized anxiety disorder in older adults: examining the relation between clinician severity ratings and patient self-report measures

Generalized anxiety disorder (GAD) is the most prevalent of the chronic anxiety disorders for older adults. Although a variety of self-report measures are beginning to be utilized to assess anxiety and related symptoms in older adults, there is a paucity of data regarding the convergence of self-report measures with clinician ratings of symptom severity. This situation is problematic in that interpretability of assessment data is limited, as is our broader understanding of the construct of GAD in an older adult population. To address these issues, we examined convergence across assessment modalities among 64 older adults who met diagnostic criteria for GAD. In addition to two Anxiety Disorders Interview Schedule for DSM-IV (ADIS-IV) interviews conducted by independent raters, participants completed four self-report measures (Penn State Worry Questionnaire [PSWQ], Worry Scale [WS], State-Trait Anxiety Inventory [STAI], Beck Depression Inventory [BDI]) as part of a more extensive pretreatment assessment battery. Results revealed significant correlations between clinician-rated GAD severity and the BDI, STAI, and PSWQ. Regression analyses indicated that the BDI (r2 = .15) and the PSWQ (r2 = .07) were particularly useful predictors of clinician-rated GAD severity. A comorbid mood disorder, however, was identified as an important mediator of these relations. Specifically, presence of coexistent depression accounted for 17% of the variance in clinician severity ratings (CSR; P < .01), with individuals diagnosed with a comorbid mood disorder receiving higher clinician severity ratings. The only self-report measure that accounted for additional significant variance was the PSWQ (7%). The study highlights the need to address coexistent psychological conditions when examining convergence between assessment modalities, and expands upon the relatively neglected area of anxiety assessment in older individuals. Specifically, the BDI and the PSWQ are identified as particularly useful screening instruments that may be helpful in conceptualizing GAD severity within an older adult population.     

Biological 'markers' for endogenous depression. Effect of age, severity of illness, weight loss, and polarity

The dexamethasone suppression test (DST) can differentiate between endogenous and nonendogenous depression. Similarly, EEG sleep patterns can differentiate primary from secondary depression, and this technique has also been used to make the endogenous-nonendogenous discrimination. However, a number of physiological variables associated with this diagnostic distinction may also affect the DST results and sleep architecture. With the use of multivariate statistical procedures, we found that although age and weight loss affect the results of both tests, both the DST and sleep EEG differentiate endogenous from nonendogenous depression when these variables are taken into account. Severity of illness affected both proposed diagnostic markers, but did not account for the differences between diagnostic groups, alone or when added to the physiological variables. The DST was more sensitive in unipolar than in bipolar endogenous depression, but there were no significant differences in the sleep of unipolar and bipolar patients.     

Clinical results for patients with major depressive disorder in the Texas Medication Algorithm Project

CONTEXT: The Texas Medication Algorithm Project is an evaluation of an algorithm-based disease management program for the treatment of the self-declared persistently and seriously mentally ill in the public mental health sector. OBJECTIVE: To present clinical outcomes for patients with major depressive disorder (MDD) during 12-month algorithm-guided treatment (ALGO) compared with treatment as usual (TAU). DESIGN: Effectiveness, intent-to-treat, prospective trial comparing patient outcomes in clinics offering ALGO with matched clinics offering TAU. SETTING: Four ALGO clinics, 6 TAU clinics, and 4 clinics that offer TAU to patients with MDD but provide ALGO for schizophrenia or bipolar disorder.Patients Male and female outpatients with a clinical diagnosis of MDD (psychotic or nonpsychotic) were divided into ALGO and TAU groups. The ALGO group included patients who required an antidepressant medication change or were starting antidepressant therapy. The TAU group initially met the same criteria, but because medication changes were made less frequently in the TAU group, patients were also recruited if their Brief Psychiatric Rating Scale total score was higher than the median for that clinic's routine quarterly evaluation of each patient. MAIN OUTCOME MEASURES: Primary outcomes included (1) symptoms measured by the 30-item Inventory of Depressive Symptomatology-Clinician-Rated scale (IDS-C(30)) and (2) function measured by the Mental Health Summary score of the Medical Outcomes Study 12-item Short-Form Health Survey (SF-12) obtained every 3 months. A secondary outcome was the 30-item Inventory of Depressive Symptomatology-Self-Report scale (IDS-SR(30)). RESULTS: All patients improved during the study (P<.001), but ALGO patients had significantly greater symptom reduction on both the IDS-C(30) and IDS-SR(30) compared with TAU. ALGO was also associated with significantly greater improvement in the SF-12 mental health score (P =.046) than TAU. CONCLUSION: The ALGO intervention package during 1 year was superior to TAU for patients with MDD based on clinician-rated and self-reported symptoms and overall mental functioning.     

Quality of life in unipolar and bipolar depression: are there significant differences?

In the present investigation, we compared the impact of illness on quality of life (QOL) in adult outpatients with unipolar (N = 89) and bipolar (N = 25) depression. While attending a university hospital in southern Brazil, patients completed the WHO's QOL Instrument-Short Version and the Beck Depression Inventory. After analyses, patients with bipolar depression reported significantly lower scores on the psychological QOL domain (p = .013) than patients with unipolar depression. There were no significant differences between the study groups in terms of social and demographic variables, in the other QOL domains assessed (i.e., physical health, social relationships, and environmental), and in the severity of depressive symptoms. In conclusion, our findings suggest that patients with bipolar and unipolar depressions have different QOL profiles, and that this difference is probably independent of the severity of the mood disturbance and might be related to the higher rates of suicide observed in the bipolar population.     

Factor analysis of the Montgomery Asberg Depression Rating Scale in 251 bipolar II and 306 unipolar depressed outpatients

Symptomatological differences between bipolar II (n = 251) and unipolar (n = 306) depressed outpatients, interviewed with the Structured Clinical Interview for DSM-IV, were studied by Montgomery Asberg Depression Rating Scale factor analysis. Different factors were found in bipolar II [factor 1 (apparent sadness, reported sadness), factor 2 (reduced sleep, reduced appetite), factor 3 (concentration difficulties, lassitude, inability to feel, pessimistic thoughts, and suicidal thoughts)], and in unipolar [factor 1 (apparent sadness, reported sadness, inability to feel, suicidal thoughts), factor 2 (concentration difficulties, lassitude, inability to feel, pessimistic thoughts), factor 3 (inner tension, reduced sleep)]. Different factor structure (between bipolar II and unipolar depression) supports previous findings that response to antidepressants and biology may be different in bipolar II and unipolar depression.