Severity classification on the Hamilton depression rating scale
Severity classification on the Hamilton depression rating scale
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DOI：
10.1016/j.jad.2013.04.028
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发表时间：
2013-09-05
影响因子：
6.6
通讯作者：
Dalrymple, Kristy
中科院分区：
文献类型：
--
作者：
Zimmerman, Mark;Martinez, Jennifer H.;Dalrymple, Kristy
在过去的20年里，症状严重程度作为治疗反应的调节因素一直是争论的主题。每一项检查抑郁严重程度治疗意义的Meta分析和大规模分析都使用了汉密尔顿抑郁评定量表（HAMD），全部或部分用于定义严重程度，尽管用于定义重度抑郁的截止值各不相同。有有限的实证研究，建立截断分数的严重程度的HAMD。本研究的目标是经验性地建立截止分数的HAMD在其分配的患者的严重groups.Methods六百二十七个门诊患者与当前的重性抑郁症进行了评估与半结构化诊断面试。根据恩迪科特et al.（1981）描述的转换方法，从评分中得出17项HAMD评分。患者还根据临床总体严重程度指数（CGI）进行了评分。结果轻度抑郁症患者HAMD评分显著低于中度抑郁症患者，中度抑郁症患者HAMD评分显著低于重度抑郁症患者。HAMD，最大限度地提高了敏感性和特异性的总和的截止分数为17轻度与中度抑郁症的比较和24中度与重度depression.Limitations-本研究进行了一个单一的门诊实践中，大多数患者是白色，女性，并有健康保险。尽管研究仅限于单个研究中心，但优势或招募程序是未选择样本参与治疗研究，排除和入选标准不会降低代表性或患者组。这些分析是基于从SADS评分中提取的HAMD评分。然而，我们使用了恩迪科特等人。结论：基于对精神科门诊重度抑郁症患者的大规模研究，我们推荐HAMD的严重程度范围为：无抑郁（0-7），轻度抑郁（8-16），轻度抑郁（10 - 15），重度抑郁（10 - 15中度抑郁（17-23）;重度抑郁（>= 24）。(C)2013爱思唯尔有限公司版权所有。
Background Symptom severity as a moderator of treatment response has been the subject of debate over the past 20 years. Each of the meta- and mega-analyses examining the treatment significance of depression severity used the Hamilton Depression Rating Scale (HAMD), wholly, or in part, to define severity, though the cutoff used to define severe depression varied. There is limited empirical research establishing cutoff scores for bands of severity on the HAMD. The goal of the study is to empirically establish cutoff scores on the HAMD in their allocation of patients to severity groups.Methods Six hundred twenty-seven outpatients with current major depressive disorder were evaluated with a semi structured diagnostic interview. Scores on the 17 item HAMD were derived from ratings according to the conversion method described by Endicott et al. (1981). The patients were also rated on the Clinical Global Index of Severity (CGI). Receiver operating curves were computed to identify the cutoff that optimally discriminated between patients with mild vs moderate and moderate vs. severe depression.Results HAMD scores were significantly lower in patients with mild depression than patients with moderate depression, and patients with moderate depression scored significantly lower than patients with severe depression. The cutoff score on the HAMD that maximized the sum of sensitivity and specificity was 17 for the comparison of mild vs moderate depression and 24 for the comparison of moderate vs. severe depression.Limitations The present study was conducted in a single outpatient practice in which the majority of patients were white, female, and had health insurance. Although the study was limited to a single site, a strength or the recruitment procedure was that the sample was not selected for participation in a treatment study, and exclusion and inclusion criteria did not reduce the representativeness or the patient groups. The analyses were based on HAMD scores extracted from ratings on the SADS. However, we used Endicott et al.'s (1981) empirically established formula for deriving a HAMD score from SADS ratings, and our results concurred with other small studies of the mean and median HAMD scores in severity groups.Conclusions Based on this large study of psychiatric outpatients with major depressive disorder we recommend the following severity ranges for the HAMD: no depression (0-7); mild depression (8-16); moderate depression (17-23); and severe depression (>= 24). (C) 2013 Elsevier B.V. All rights reserved.