Experimental Therapeutics & Pathophysiology Branch, Intramural Research Program, National Institute of Mental Health, National Institutes of Health, Bethesda, MD 20892, USA.
Experimental Therapeutics & Pathophysiology Branch, Intramural Research Program, National Institute of Mental Health, National Institutes of Health, Bethesda, MD 20892, USA.
J Affect Disord. 2018 Apr 15;231:51-57. doi: 10.1016/j.jad.2018.01.027. Epub 2018 Feb 5.
Due to the heterogeneity of depressive symptoms-which can include depressed mood, anhedonia, negative cognitive biases, and altered activity levels-researchers often use a combination of depression rating scales to assess symptoms. This study sought to identify unidimensional constructs measured across rating scales for depression and to evaluate these constructs across clinical trials of a rapid-acting antidepressant (ketamine).
Exploratory factor analysis (EFA) was conducted on baseline ratings from the Beck Depression Inventory (BDI), the Hamilton Depression Rating Scale (HAM-D), the Montgomery-Asberg Depression Rating Scale (MADRS), and the Snaith-Hamilton Pleasure Rating Scale (SHAPS). Inpatients with major depressive disorder (n = 76) or bipolar depression (n = 43) were participating in clinical ketamine trials. The trajectories of the resulting unidimensional scores were evaluated in 41 subjects with bipolar depression who participated in clinical ketamine trials.
The best solution, which exhibited excellent fit to the data, comprised eight factors: Depressed Mood, Tension, Negative Cognition, Impaired Sleep, Suicidal Thoughts, Reduced Appetite, Anhedonia, and Amotivation. Various response patterns were observed across the clinical trial data, both in treatment effect (ketamine versus placebo) and in degree of placebo response, suggesting that use of these unidimensional constructs may reveal patterns not observed with traditional scoring of individual instruments.
Limitations include: 1) small sample (and related inability to confirm measurement invariance); 2) absence of an independent sample for confirmation of factor structure; and 3) the treatment-resistant nature of the population, which may limit generalizability.
The empirical identification of unidimensional constructs creates more refined scores that may elucidate the connection between specific symptoms and underlying pathophysiology.
由于抑郁症状的异质性，包括情绪低落、快感缺失、负性认知偏差和活动水平改变，研究人员通常使用抑郁评定量表的组合来评估症状。本研究旨在确定跨抑郁评定量表测量的单维结构，并评估这些结构在快速作用抗抑郁药（氯胺酮）的临床试验中的表现。
对贝克抑郁量表（BDI）、汉密尔顿抑郁评定量表（HAM-D）、蒙哥马利-阿斯伯格抑郁评定量表（MADRS）和斯奈特-汉密尔顿快感评定量表（SHAPS）的基线评分进行探索性因子分析（EFA）。接受重大抑郁障碍（n=76）或双相抑郁（n=43）的住院患者正在参加氯胺酮临床试验。对参加氯胺酮临床试验的 41 名双相抑郁患者的单维评分轨迹进行了评估。
表现出与数据极好拟合的最佳解决方案由八个因素组成：情绪低落、紧张、负性认知、睡眠障碍、自杀念头、食欲减退、快感缺失和动机缺乏。在临床试验数据中观察到各种反应模式，包括治疗效果（氯胺酮与安慰剂）和安慰剂反应程度，这表明使用这些单维结构可能揭示传统个体仪器评分观察不到的模式。
局限性包括：1）样本量小（因此无法确认测量不变性）；2）缺乏独立样本验证因子结构；3）人群的治疗抵抗性，这可能限制了普遍性。
单维结构的实证识别创建了更精细的评分，这可能阐明特定症状与潜在病理生理学之间的联系。
