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Getting What You Ask For: On the Selectivity of Depression Rating Scales
Abstract
A large number of rating scales has been developed to assess depression severity and change during antidepressant therapy. When reviewing the literature, the choice of the rating scales used in a particular study often seems arbitrary. The most frequently used observer rating scales, the Hamilton Depression Rating Scale (HDRS) and the Montgomery-Asberg Depression Rating Scale (MADRS), and the most frequently used self-rating scale (the Beck Depression Inventory, or BDI) were developed more than 20 years ago. Their historical background is too often forgotten and they are reflections of their origin: the HDRS and the MADRS reflect antidepressant activity while the BDI reflects psychotherapy. Moreover, the HDRS is at risk of putting 'all depressions in one basket', while the MADRS is at risk of putting 'all antidepressants in one basket'. Therefore, the question whether a particular antidepressant could be more effective in a particular subtype of depression cannot be answered. Observer rating scales are more frequently used than self-rating scales, and when scales are used that do exist in an observer rating and a self-rating version, interesting differences are found. The present paper does not suggest that one scale is better than another, but suggests that a better knowledge of their differential background can help the researcher choose the correct scale for his purposes.
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“Severity is determined by the number of symptoms, not by their intensity or quality”
From Clinical Pharmacopsychology: Conceptual Foundations and Emerging Tasks (2017) · cites this paper as [17]
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The Hamilton Depression Rating Scale: Has the Gold Standard Become a Lead Weight?
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“to assess depression severity, and to monitor patients already identified as depressed and receiving treatment.While theories and diagnostic criteria of depressive disorders have changed, diagnostic instruments for depression have remained relatively unaltered for the past 20 years [”
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“9,15 Third, some items refer to several heterogeneous symptoms, and the different grades for a certain item do not always represent differences in severity but qualitatively distinct phenomena; both these aspects may contribute to the poor inter-rater reliability marring this instrument.”
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Self-citation
Metadata
- Authors
- Demyttenaere, K., & De Fruyt, J.
- Affiliations
- Universitair Ziekenhuis Leuven (BE)
- ORCID
- Demyttenaere, Koen
- Venue
- Psychotherapy and Psychosomatics
- Publisher
- S. Karger AG
- Published
- 2003
- Volume
- 72
- Issue
- 2
- Pages
- 61-70
- ISSN
- 0033-3190 (ISSN-L)
- 1423-0348
- OpenAlex
- W2056648954
- Cited by
- 206
- References
- 66
- Citations by year
- 2026: 5 · 2025: 6 · 2024: 2 · 2023: 3 · 2022: 10 · 2021: 7 · 2020: 7 · 2019: 32 · 2018: 18 · 2017: 6 · 2016: 7 · 2015: 10 · 2014: 6 · 2013: 10 · 2012: 11
- FWCI
- 11.87
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- Psychotherapy and Psychosomatics (publishedVersion)
- PubMed (publishedVersion)
- Topics
- Social Sciences › Psychology › Experimental and Cognitive Psychology › Anxiety, Depression, Psychometrics, Treatment, Cognitive Processes
- Health Sciences › Medicine › Pharmacology (medical) › Treatment of Major Depression
- Social Sciences › Psychology › Applied Psychology › Psychological Testing and Assessment
- Keywords
- depression rating scales, Hamilton Depression Rating Scale, Montgomery-Asberg Depression Rating Scale, Beck Depression Inventory, observer rating scale, self-rating scale, antidepressant efficacy, depression subtypes, depression severity assessment
- MeSH terms
- Antidepressive Agents, Clinical Trials as Topic, Depressive Disorder, Humans, Psychological Tests, Sensitivity and Specificity, Reproducibility of Results, Bias
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