A three-factor analytic model of the MADRS in geriatric depression

Major depression is a heterogeneous disorder, perhaps comprising several clinical subtypes or subgroups of symptoms. This study examined whether items on the Montgomery-Asberg Depression Rating Scale (MADRS) form distinct symptom subgroups among geriatric depressive patients that might form the basis of new outcome measures for tracking treatment effects.

The study examined a sample of 225 adults age 59 and older diagnosed with major depression. Factor analysis with oblique rotation was used to analyze baseline MADRS item scores.

Three distinct interpretable factors were obtained; all ten items loaded <0.60 on a domain. The first factor, dysphoric apathy/retardation, comprised five items: apparent sadness, reported sadness, lassitude, reduced concentration, and inability to feel. Psychic anxiety, the second factor, included three items: inner tension, pessimistic thoughts, and suicidal thoughts. The third factor, vegetative symptoms, resulted from items involving sleep and appetite.

The study produced three interpretable MADRS factors reflecting geriatric depression dimensions that may be useable to monitor focused treatment outcomes.