Ostergaard Søren D, Bech Per, Trivedi Madhukar H, Wisniewski Stephen R, Rush A John, Fava Maurizio
Research Unit Department P, Aarhus University Hospital, Risskov, Skovagervej 2, DK-8240 Risskov, Denmark; Unit For Psychiatric Research, Aalborg Psychiatric Hospital, Aalborg University Hospital, Aalborg, Denmark; Depression Clinical and Research Program, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA.
Psychiatric Research Unit, Psychiatric Center North Zealand, Copenhagen University Hospital, Hillerød, Denmark.
J Affect Disord. 2014 Jul;163:18-24. doi: 10.1016/j.jad.2014.03.049. Epub 2014 Apr 3.
Most depression rating scales are multidimensional and the resulting heterogeneity may impede identification of coherent biomarkers. The aim of this study was to compare the psychometric performance of the multidimensional 17-item Hamilton Depression Rating Scale (HAM-D17) and the 30-item Inventory of Depressive Symptomatology (IDS-C30) to that of their unidimensional six-item melancholia subscales (HAM-D6 and IDS-C6).
A total of 2242 subjects from level 1 (citalopram) of the Sequenced Treatment Alternatives to Relieve Depression (STAR* study were included in the analysis. Symptom change, response and remission rates were compared for HAM-D6 versus HAM-D17 and for IDS-C6 versus IDS-C30. The changes in total scores on these scales were compared to the change in Quality of Life Enjoyment and Satisfaction Questionnaire (QLES-Q) score using correlation analysis.
The response to treatment was significantly greater according to the HAM-D6 and IDS-C6. Furthermore, the correlation of changes in depression-ratings with changes in QLES-Q scores were comparable for the subscales and full scales.
STAR*D was not designed to answer the research questions addressed in this analysis.
Our findings indicate that the HAM-D6 and IDS-C6 melancholia scales capture a coherent construct in depression. The syndrome reflected in these scales is unidimensional, sensitive to specific pharmacological intervention, and therefore likely to have biological validity. We therefore believe that "melancholia" thus defined could be a valuable construct under the Research Domain Criteria (RDoC), which specifically aims at identifying the neurobiology underlying mental disorders and providing drugable targets.
大多数抑郁评定量表是多维的，由此产生的异质性可能会妨碍对连贯生物标志物的识别。本研究的目的是比较多维的17项汉密尔顿抑郁评定量表（HAM-D17）和30项抑郁症状量表（IDS-C30）与其单维的六项抑郁亚型量表（HAM-D6和IDS-C6）的心理测量性能。
共有2242名来自缓解抑郁的序贯治疗替代方案（STAR*D）研究一级（西酞普兰）的受试者纳入分析。比较了HAM-D6与HAM-D17以及IDS-C6与IDS-C30的症状变化、反应率和缓解率。使用相关分析将这些量表总分的变化与生活质量享受与满意度问卷（QLES-Q）得分的变化进行比较。
根据HAM-D6和IDS-C6，治疗反应显著更大。此外，抑郁评定变化与QLES-Q得分变化之间的相关性在亚型量表和完整量表中相当。
STAR*D并非设计用于回答本分析中提出的研究问题。
我们的研究结果表明，HAM-D6和IDS-C6抑郁亚型量表在抑郁中捕捉到了一个连贯的结构。这些量表所反映的综合征是单维的，对特定的药物干预敏感，因此可能具有生物学效度。因此，我们认为如此定义的“抑郁”可能是研究领域标准（RDoC）下一个有价值的结构，该标准专门旨在识别精神障碍背后的神经生物学并提供可用药靶点。
