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. 2017 Jan 23;12(1):e0170000.
doi: 10.1371/journal.pone.0170000. eCollection 2017.

The Major Depressive Disorder Hierarchy: Rasch Analysis of 6 items of the Hamilton Depression Scale Covering the Continuum of Depressive Syndrome

Lucas Primo de Carvalho Alves  1   2   3 , Marcelo Pio de Almeida Fleck  1   2   3 , Aline Boni  1 , Neusa Sica da Rocha  1   2   3
Affiliations

The Major Depressive Disorder Hierarchy: Rasch Analysis of 6 items of the Hamilton Depression Scale Covering the Continuum of Depressive Syndrome

Lucas Primo de Carvalho Alves et al. PLoS One. .

Abstract

Objectives: Melancholic features of depression (MFD) seem to be a unidimensional group of signs and symptoms. However, little importance has been given to the evaluation of what features are related to a more severe disorder. That is, what are the MFD that appear only in the most depressed patients. We aim to demonstrate how each MFD is related to the severity of the major depressive disorder.

Methods: We evaluated both the Hamilton depression rating scale (HDRS-17) and its 6-item melancholic subscale (HAM-D6) in 291 depressed inpatients using Rasch analysis, which computes the severity of each MFD. Overall measures of model fit were mean (±SD) of items and persons residual = 0 (±1); low χ2 value; p>0.01.

Results: For the HDRS-17 model fit, mean (±SD) of item residuals = 0.35 (±1.4); mean (±SD) of person residuals = -0.15 (±1.09); χ2 = 309.74; p<0.00001. For the HAM-D6 model fit, mean (±SD) of item residuals = 0.5 (±0.86); mean (±SD) of person residuals = 0.15 (±0.91); χ2 = 56.13; p = 0.196. MFD ordered by crescent severity were depressed mood, work and activities, somatic symptoms, psychic anxiety, guilt feelings, and psychomotor retardation.

Conclusions: Depressed mood is less severe, while guilt feelings and psychomotor retardation are more severe MFD in a psychiatric hospitalization. Understanding depression as a continuum of symptoms can improve the understanding of the disorder and may improve its perspective of treatment.

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Conflict of interest statement

The authors have declared that no competing interests exist.

Figures

Fig 1
Fig 1. Major Depressive Disorder Signs and Symptoms Hierarchy.
The person-Item map shows the severity scores for both the persons (top chart) and the items (bottom chart). The location (logits) is the measurement of the severity score (i.e., the higher is the logit, the more severe are the persons and the items). When any sign/symptom has the same Rash score of any person, it means that this person has a 50% probability to present that sign or symptom. So, any person that has a lower score of any item is less probable to present that sign or symptom; in contrast, any person that has a higher score of any item is more probable to present that sign or symptom.
See this image and copyright information in PMC

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