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Rating scales for depression in the elderly: external and internal validity.

Alex Kørner¹, Lise Lauritzen, Kirsten Abelskov

¹Psychogeriatric Department, Frederiksborg General Hospital, Hillerød, Denmark. alko@fa.dk

The Journal of Clinical Psychiatry

|March 29, 2007

Summary

The 6-item Hamilton Rating Scale for Depression (HAM-D(6)) demonstrated superior scalability and external validity in elderly individuals, outperforming longer versions and other depression scales. It is recommended for assessing depression in older adults, even alongside longer HAM-D scales.

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Area of Science:

Geriatric Psychiatry
Psychometric Validation
Neuropsychology

Background:

Accurate depression assessment in the elderly is crucial, complicated by cognitive impairment.
Existing depression scales, including various Hamilton Rating Scale for Depression (HAM-D) versions, require validation in diverse elderly populations.
Differentiating depression from dementia requires reliable and valid measurement tools.

Purpose of the Study:

To evaluate the internal and external validity of multiple depression scales in elderly Danes.
Specifically assessed were the HAM-D(6), HAM-D(17), Bech-Rafaelsen Melancholia Scale, Geriatric Depression Scale (15- and 30-item), and Cornell Scale for Depression in Dementia.
The study focused on populations with and without dementia.

Main Methods:

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Two independent, blinded clinicians assessed participants from psychogeriatric clinics and a control group.

Concurrent and convergent validity were analyzed using correlation coefficients.

Internal validity was assessed via item response theory (IRT) analysis, including Mokken and Rasch analyses; scalability required a coefficient of homogeneity ≥ 0.40.

Main Results:

145 elderly subjects (109 with depression, 36 controls) were included; 102 female, 43 male.
The HAM-D(6) was the only scale demonstrating total scalability in both cognitively intact and impaired elderly individuals.
The HAM-D(6) exhibited the strongest external validity when standardized against the Clinical Global Impressions-Severity of Illness (CGI-S) scale.

Conclusions:

The HAM-D(6) shows robust psychometric properties for assessing depression in the elderly.
Its scalability and external validity make it a reliable tool, even in the presence of cognitive impairment.
The HAM-D(6) warrants separate consideration for depression measurement in elderly populations, irrespective of longer HAM-D versions.