Relationship Between the Hamilton Depression Rating Scale and the Montgomery-Åsberg Depression Rating Scale in Depressed Elderly: A Meta-analysis

doi:10.1097/JGP.0b013e318098614e

The American Journal of Geriatric Psychiatry

Volume 15, Issue 10, October 2007, Pages 899-905

https://doi.org/10.1097/JGP.0b013e318098614e Get rights and content

Objective

To determine whether the sensitivity of the Hamilton Depression Rating Scale (HDRS) and Montgomery-Åsberg Depression Rating Scale (MADRS) to treatment effects are comparable in geriatric antidepressant randomized controlled trials by developing and validating an equation that links between the two instruments.

Methods

Literature search for this meta-analysis was based on three sources: MEDLINE, a recent related meta-analysis, and experts in geriatric antidepressant trials. The search resulted in 11 relevant geriatric antidepressant trial studies that administered both instruments for symptom ratings. The authors used baseline ratings as a model-building sample and postrandomization ratings as a validation sample. HDRS scores were prorated into HDRS17, a 17-item HDRS, for analysis. The development and validation was based on a total number of 1,874 subjects.

Results

The correlations were high between baseline mean HDRS17 and MADRS ratings (r = 0.80; Fisher's z = 1.09, N = 25, p <0.0001) and between postrandomization ratings (r = 0.88, Fisher's z = 1.39, N = 65, p <0.0001). The following equation was derived: HDRS17 = −1.58 + 0.86 × MADRS. The difference between observed and estimated HDRS17 in a validation sample consisting of postrandomization follow-up means did not depend on magnitudes of HDRS17.

Conclusion

Although generalizability of findings into a broader population could be limited, and the authors could not assess concordance of changes of particular item constructs between HDRS and MADRS ratings, both ratings are comparable in assessing changes in overall depressive symptom severity in response to antidepressants in depressed elderly at aggregated group mean levels.

Section snippets

Literature Search

The search was based on three sources: MEDLINE, a recent related meta-analysis conducted by the Cochrane group,⁵ and experts in geriatric antidepressant trials. The MEDLINE search resulted in 56 papers published by August 31, 2006 with the following key words: “geriatric depression” AND “clinical trial” AND “antidepressant.” The meta-analysis on studies of antidepressants in geriatric population⁴ listed more than 160 papers as references. The experts in geriatric antidepressants trials

Study Characteristics

The application of selection criteria resulted in 12 geriatric antidepressant trials published since 1992.6., 7., 8., 9., 10., 11., 12., 13., 14., 15., 16., 17. However, we excluded one study¹⁷ that used a scale of 0–3 for MADRS rating. Table 1 presents a summary of study characteristics over 11 studies. The total number of groups was 25 out of the remaining 11 studies, with 1,874 total subjects. Among these, 1,284 (68.5%) were females. Five studies6., 7., 11., 12., 13. used the 17 items for

DISCUSSION

The relatively high correlations between HDRS17 and MADRS in both the model building sample (r = 0.80) and the validation sample (r = 0.88) shows that they are highly comparable. This finding is notable given that the two instruments emphasize different symptoms. The correlation from the validation sample in particular is higher than those reported in a review by Bagby et al.,¹⁸ where the convergent validity of these was reported to range between 0.68 and 0.85 in mixed-aged adult samples. In

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: This work was supported in part by the National Institute of Mental Health (grants P30MH068638, U01MH62518, and K23MH67702).

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Regular Research ArticlesRelationship Between the Hamilton Depression Rating Scale and the Montgomery-Åsberg Depression Rating Scale in Depressed Elderly: A Meta-analysis

Objective

Methods

Results

Conclusion

Section snippets

Literature Search

Study Characteristics

DISCUSSION

Arch Gerontol Geriatr

J Affect Dis

Am J Psychiatry

J Psychiatric Res

A rating scale for depression

J Neurol Neurosurg Psychiatry

A new depression scale designed to be sensitive to change

Br J Psychiat

Treatment outcome in recurrent major depression: a post hoc comparison of elderly (“young old”) and midlife patients

Am J Psychiatry

Statistical methods for assessing agreement between two methods of clinical measurement

Lancet

Antidepressants for depressed elderly

Cochrane Database Syst Rev

A controlled mulitcenter clinical study of citalopram and placebo in elderly depressed patients with and without concomitant dementia

Acta Psychiatr Scand

Multicenter double blind study of paroxetine and amitriptyline in elderly depressed inpatients

Psychopharmacology

Regular Research Articles
Relationship Between the Hamilton Depression Rating Scale and the Montgomery-Åsberg Depression Rating Scale in Depressed Elderly: A Meta-analysis