CMAJ • November 22, 2005; 173 (11). doi:10.1503/cmaj.050786.
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Right arrow Mood disorders (including depression)

Research

Measuring the severity of depression and remission in primary care: validation of the HAMD-7 scale

Roger S. McIntyre, Jakub Z. Konarski, Deborah A. Mancini, Kari A. Fulton, Sagar V. Parikh, Sophie Grigoriadis, Larry A. Grupp, David Bakish, Marie-Josee Filteau, Chris Gorman, Charles B. Nemeroff and Sidney H. Kennedy

From the University Health Network, Toronto, Ont. (McIntyre, Parikh, Grigoriadis, Kennedy); Department of Psychiatry, University of Toronto, Toronto, Ont. (McIntyre, Konarski, Mancini, Fulton, Parikh, Grigoriadis, Grupp, Kennedy); Institute of Medical Science,University of Toronto, Toronto, Ont. (Konarski, Kennedy); Department of Pharmacology, University of Toronto, Toronto, Ont. (Grupp); Ottawa Psychopharmacology Clinic, Ottawa, Ont. (Bakish); Centre de Recherche Laval–Robert Giffard, Beauport, Que. (Filteau); Department of Psychiatry, University of Calgary, Calgary, Alta. (Gorman); and School of Medicine, Emory University, Atlanta, Ga. (Nemeroff).

Correspondence to: Dr. Roger S. McIntyre, Mood Disorders Psychopharmacology Unit, University Health Network, 399 Bathurst St., Toronto ON M5T 2S8; fax 416 603 5368; roger.mcintyre{at}uhn.on.ca

Background: Symptomatic remission is the optimal outcome in depression. A brief, validated tool for symptom measurement that can indicate when remission has occurred in mental health and primary care settings is unavailable. We evaluated a 7-item abbreviated version (HAMD-7) of the 17-item Hamilton Depression Rating Scale (HAMD-17) in a randomized controlled clinical trial of patients with major depressive disorder being cared for in primary care settings.

Methods: We enrolled 454 patients across 47 primary care settings who met DSM-IV-TR criteria for a major depressive disorder. Of these, 410 patients requiring antidepressant medication were randomized to have their symptoms rated with either HAMD-7 (n = 205) or HAMD-17 (n = 205) as the primary measurement tool. The primary outcome was the proportion of patients who achieved a-priori defined responses to 8 weeks of therapy using each instrument.

Results: Of the 205 participants per group, 67% of those evaluated with HAMD-7 were classified as having responded to therapy (defined as a ≥ 50% reduction from the pretreatment score), compared with 74% of those evaluated with HAMD-17 (p = 0.43). The difference between the groups' changes in scores from baseline (pretreatment) to endpoint was significant (p < 0.001), without a main effect of group (p = 0.84) or group-by-time (p = 0.83) interaction. The HAMD-7 test was brief to administer (e.g., 3–4 min for 85% of the primary care physicians evaluated), which facilitated the efficient and structured evaluation of salient depressive symptoms.

Interpretation: The abbreviated HAMD-7 depression scale is equivalent to the HAMD-17 in assessing remission in patients with a major depressive disorder undergoing drug therapy.




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Response to HAMD-7 article
J. Ellen Anderson
CMAJ, 8 Dec 2005 [Full text]
HAMD-7 is too long for routine use
Michelle Greiver
CMAJ, 12 Dec 2005 [Full text]
The Importance of the HAMD-7 Scale to Primary Care Practice
Sol Stern
CMAJ, 6 Feb 2006 [Full text]