Gynecology and Obstetrics Postgraduate Program, Medical School, Federal University of Rio Grande do Sul (UFRGS), Porto Alegre, RS, Brazil; Mood Disorders Research and Educational Program (PROPESTH), Hospital Psiquiátrico São Pedro (HPSP), Porto Alegre, RS, Brazil.
Instituto de Avaliação de Tecnologia em Saúde (AITS), Hospital de Clínicas de Porto Alegre (HCPA), Porto Alegre, RS, Brazil.
J Psychiatr Res. 2019 Jan;108:84-89. doi: 10.1016/j.jpsychires.2018.07.009. Epub 2018 Jul 21.
Assessing therapeutic response in depression requires scales that adequately measure the core symptoms of depressive symptomatology. The main goal of this study was to assess the psychometric properties of the 17-item Hamilton Depression Rating Scale (HAM-D17) and the 6-item Hamilton Depression Rating Scale (HAM-D6) in patients with Major Depressive Disorder (MDD), bipolar depression and bipolar depression with mixed features. We conducted a reanalysis of a pragmatic clinical trial in an outpatient clinic for mood disorders that included eight weeks of follow-up. A Mokken analysis was performed to evaluate the unidimensionality of the HAM-D17 and HAM-D6, and the Spearman correlation was used to assess concurrent validity between the HAM-D17, the HAM-D6 and quality of life scale (SF-36 and WHOQOL-BREF) scores. A total of 237 patients with a mean age of 40.2 years (±11.7) were included. According to the DSM-IV criteria, 58 (24.5%) were diagnosed with MDD and 73 (30.8%) were diagnosed with bipolar depression. Bipolar depression with mixed features was diagnosed in 106 (44.7%) patients according to the DSM-IV and supplemented by the Cincinnati criteria. Only the HAM-D6 scale proved to be unidimensional, showing strong homogeneity for evaluating MDD, moderate homogeneity for bipolar depression and weak homogeneity for bipolar depression with mixed features. Both the HAM-D17 and the HAM-D6 had inverse, significant correlations at baseline with SF-36 and WHOQOL-BREF scores. This is the first study to include bipolar depression patients with mixed features in an assessment of HAM-D6 unidimensionality.
评估抑郁症的治疗反应需要能够充分衡量抑郁症状核心的量表。本研究的主要目的是评估 17 项汉密尔顿抑郁量表（HAM-D17）和 6 项汉密尔顿抑郁量表（HAM-D6）在单相重性抑郁障碍（MDD）、双相抑郁和伴有混合特征的双相抑郁患者中的心理测量学特性。我们对心境障碍门诊的一项实用临床试验进行了重新分析，该研究包括 8 周的随访。采用 Mokken 分析评估 HAM-D17 和 HAM-D6 的单维性，采用 Spearman 相关评估 HAM-D17、HAM-D6 与生活质量量表（SF-36 和 WHOQOL-BREF）评分之间的同时效度。共纳入 237 名平均年龄为 40.2 岁（±11.7）的患者。根据 DSM-IV 标准，58 名（24.5%）患者被诊断为 MDD，73 名（30.8%）患者被诊断为双相抑郁。根据 DSM-IV 和辛辛那提标准，106 名（44.7%）患者被诊断为伴有混合特征的双相抑郁。只有 HAM-D6 量表被证明是单维的，在评估 MDD 时具有很强的同质性，在评估双相抑郁时具有中等同质性，在评估伴有混合特征的双相抑郁时具有较弱的同质性。HAM-D17 和 HAM-D6 在基线时与 SF-36 和 WHOQOL-BREF 评分均呈显著负相关。这是第一项评估 HAM-D6 单维性时纳入伴有混合特征的双相抑郁患者的研究。
