Validation of the Bech–Rafaelsen Melancholia Scale and the Hamilton Depression Scale in patients with major depression; is the total score a valid measure of illness severity?

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Abstract
Objective:  Evaluation of antidepressant drug efficacy requires adequate rating scales for measuring the severity of depression. However, to measure the illness severity by such a total score, the scale needs to fulfil criteria of unidimensionality. On this background, we aimed at comparing the unidimensionality of the Bech–Rafaelsen Melancholia Scale (MES) and the 17‐item Hamilton Depression Rating Scale (HAM‐D17).Method:  A total of 1629 patients aged between 18 and 65 years with a major depressive episode were treated openly with sertraline at a fixed oral dose of 50 mg daily during 4 weeks. The HAM‐D17 and the MES were applied at baseline and at weeks 2 and 4. Unidimensionality was tested with Mokken and Rasch analysis.Results:  Unidimensionality of the HAM‐D17 could not be confirmed. However, the 6‐item Hamilton Depression Subscale (HAM‐D6), was accepted by the Rasch analysis both at baseline and after 2 and 4 weeks of therapy. For the MES (as well as for the HAM‐D6), a Loevinger coefficient of homogeneity above 0.40 (suggesting acceptance) was found at week 4.Conclusion:  The HAM‐D6 and the MES did fulfil criteria for unidimensionality while the HAM‐D17 did not. Therefore, the extended use of the HAM‐D17 in drug trials may be questioned.