The Hamilton Depression Inventory and Quick Inventory of Depressive Symptomatology - Research Paper Example

The Hamilton Depression Inventory (HDI) and Quick Inventory of Depressive Symptomatology (QIDS) – A Comparative Analysis Introduction The depression rating scale is the psychiatric measurement instrument that is used for indicating the severity of the depression symptoms experienced by the person. The scale consists of descriptive words and phrases and the person has to respond towards these according to his conditions (Sharp and Lipsky, 2002). The psychiatrists then judge the depression level of the people on the basis of the rating attained from the scale. The scale is not used for the diagnosis or identification of depression within a person but it basically helps allocating a score to the behavior of the person that helps in the process of his treatment of the depression (Maruish, 1999). There are different types of clinician reporting and self reporting depression rating scales. The clinician reporting scales are completed by the researchers or clinician while taking the interview of the patient under study and on the basis of the observations of the symptoms of patients. The self reporting scales are completed by the patients on the basis of their attitude and feelings over specific period of time ( Demyttenaere, 2003). Hamilton Depression inventory (HDI) and Quick Inventory of Depressive Symptomatology (QIDS) are two popular depression rating scales commonly used to evaluate the severity of the depression of the patients. The essay aims to compared and contract these two scales by analyzing their validity and reliability. The essay presents the background information about these scales and discusses the theoretical perspective of the development and usage of these scales. HDI and QIDS – A Theoretical Perspective The Hamilton Depression inventory (HDI) is originated from the Hamilton Rating scale for depression (HRSD) often called as Hamilton Depression rating scale. The scale comprises of a multiple choice questionnaire completed by the clinicians on the basis of the observations and information collected from the patients about their depression symptoms. The scale was developed by Max Hamilton and it was first published in 1960 (Hedlund and Viewig, 1979). However, there were several flaws identified in the test instrument as well as its conceptual base due to which it was revised numerous times to make it a reliable and credible scale for depression rating. There are several symptoms of depression included in this scale like moos, anxiety, weight loss etc using the questionnaire (Hamilton, 1960). The clinicians allot a rate to each of the symptom after interviewing the patients. Some of the questions are rated on the basis of the observation of the patient behaviors and body language. Originally HRSD comprised of 17 questions however after several revisions there are now total 29 questions embodied in the scale (Bagby et al, 2004). In the latest revised version of HRSD, Hamilton developed the Hamilton Depression Inventory (HDI) that is self reporting scale developed to assure the consistency with the theoretical formulation of depression. On the other hand, The Quick Inventory of Depression Symptomatology (QIDS) is a 16 item system that is designed for both the clinician and self reporting of depression symptoms known as QIDS-C and QIDS-SR. QIDS is based upon the criterion of symptom domain set by the American Psychiatry association Diagnostic and Statistical Manual of Mental Disorders (DSM- IV). Like HID, QIDS is also meant to access the severity of the symptoms of the depression diagnosis among the individuals. HDI is basically a self reporting system and for clinician reporting it would be imperative to use the complete HRSD however it is a distinguishing feature of QIDS that there are two different versions available for the clinicians and patients. HDI consists of 23 items and is often used to examine the severity of the depression symptoms among the individuals and not merely for the diagnosis of depression. The scale assesses the severity of depression among the patients that have already diagnosed depression but the level or severity is yet to identify. The scale could be used to assess the depression symptoms adults over 18 years of age must having the capability of reading 5th grade English. However, QIDS is basically used for the depression measurements of elderly and adolescent patients only. HDI is available both in short form and extensive professional version. In the HDI short form there are 9 items included in the scale that help measuring the depression level of the patient. This scale is used when there is shortage of time and there is no possibility of having in depth analysis of the symptom of depression experienced by the patients. The extensive professional manual of HDI comprises of detailed administration and scoring instruction. It allows the clinicians having deep analysis of patient depression severity using the normative information, conversion tables and reliability documentation etc. Significance and validity of HDI and QIDS HDI has been regarded as a comprehensive screening tool for the symptoms of depression diagnosed among the individuals. In this self reported system there are 23 items that help measuring the severity of depression. It has been regarded as a reliable tool of depression symptoms assessment because there are several multiple questions included in this scale and the patients become able to provide detailed and accurate information and responses about the depression that help the clinicians during the treatment process and assist them making several treatment decisions for the patient. The outcomes of the ratings using HDI usually help the clinicians in deciding the medications and treatment patterns for the patients. Hence, it is mostly administered in the beginning of the medication to decide the drug doses and therapies etc. In later stages, it is used again to make necessary changes in the treatment of the patients on the basis of the results attained from the scale. Likewise, the use of QIDS is also common for the medical research purpose because it allows deciding the treatment process in the early phase of medication and also guides throughout the process by indicating the need of making any change in the treatment. The scale is sensitive to change and thus the psychiatrists can evaluate the outcomes of the medication using this system. QIDS was basically developed to improve the available rating scales available to the clinicians and patients. It provides equivalent weighting (0-3) for each of the symptom item listed in the scale and also provide clear anchors to estimate the frequency of the symptoms. The scale has been developed on the theoretical foundations of DSM IV that affirms the credibility of the scale in assisting the clinicians measuring the severity of depression of their patients. The QIDS-C and QIDS-SR comprises of the items that are included to rate the nine item symptom domains used for defining the major depressive episode among the individuals. The outcomes of QIDS are found helpful in wide variety of research works and clinical setting like inpatient and outpatient psychiatric clinics as well as in the primary care settings. The significance of QIDS has been proved for rating the depression symptoms. At the same time it is also found that QIDS has also been converted to an interactive Voice Response system (IVR) through which it has become possible to directly collect the data from the patients under study. In this system the standard phone lines are used for getting the response of the patients while the prerecorded voice asks the specific questions to the patients. Sampling characteristics Both of these scales could be used for the measurement of the intensity of depression among people of different demographic and psychographic characteristics. There are some necessary characteristics must be considered during the sampling. It is imperative that the study participants must have already diagnosed depression because these scale measure the severity of depression and not merely the existence or non existence of depression. Secondly, the age group of the participant has to consider. HDI studies the depression symptoms of adults only whereas QIDZ could be used for sample comprises of both adults and adolescent. The education is also an important characteristic to consider during the sampling. Since HDI is a self reporting scale written at 5th grade reading level, it is imperative that the participants must be literate enough to read and understand this level of writing. QIDS on the other hand offers both clinician and self reporting scales so the participants not capable of reading or understanding the questions could be assisted by the clinicians in deciding the accurate answers of the questions. It implies that the required psychographic characteristics of the sample for both of these scales is supposed to be same i.e. patients diagnosed depression. Whereas the age and literacy characteristics for the samples of these two scales slightly differ from each others. Administration HDI is an easy system of measuring the depression level because the answering sheets designed under HDI are easy to administer. The scoring also becomes easy using the carbonized scoring sheets. The questionnaire is designed in easy understandable manner and has been written at 5th grade reading level. The administration of HDI is also easy because the short form questionnaire could be completed in just 10 minutes and ever in lesser time and the scoring could also done rapidly ( Demyttenaere, 2003).. Similarly, QIDS is also an easy administrable system either it is self reporting or clinician rated version. There is no requirement of getting specialized training for conducting this analysis but after having basic understanding of the scoring method the patients and clinicians could easily evaluate the depression using this inventory. The QIDS is administered in a way that the patients are asked to rate the severity as well as the frequency of the specific depression symptoms that they have experiences over the last seven days. Usually, it took 5-7 minutes to administer the clinician version of QIDS however the patient rated version needs little more time for administration and generally the patients become able to administer QIDS-SR in 10-15 minutes. The trained raters or the clinicians are supposed to complete the clinician version of QIDS that is referred as QIDS-C. They asked the patients specific questions to report on each of the items. The clinicians or trained raters are supposed to be well familiar with the symptoms so they easily rate the responses collected from the patients. Each of the items is interval scales from 0 to 3. If the patient expressed the absence of any depression symptom during the last seven days, then the rate for that item would be 0 whereas if the symptoms are observed frequently the clinicians rate them somewhere between 1 and 3 based on the frequency of their occurrence. The information is collected from the patients using semi structured interviews and several standardized introductory and follow up questions are asked from the patients to collect accurate data and information from them. The administration of QIDS-SR is bit different from that of QIDS-C. The patients are required to give more time to the questionnaire. Since they are not much familiar with the symptoms and items included in the form, they are required to carefully read all the questions and then select the item response from 0-3 that best described their experience of depression symptoms over last seven days. It is also imperative that the self reported version should be completed in one sitting so that the patients could not be confused regarding the assessment of their behavior over last seven days. The literacy and confidence level of the patients is also considered and if required the questions are read to them to assist in rating their depression symptoms. The responses collected from the 16 items of QIDS-C and the QIDS-SR is used for conducting the scoring. The total score ranged from 0-27. The score obtained for each item is added to get the total score and then the score for nine symptom domains in calculated. The sixteen items used in the scale donates nine major depression criterion including “sleep disturbance, psychomotor disturbance, appetite/weight disturbance, depressed mood, decreased interest, decreased energy, worthlessness/guilt, concentration/decision making, and suicidal ideation” (Rush et al, 2000) Likewise, the administration of HDI is also simple like that of QIDS. Usually it takes 10 minutes to complete the HDI form however, the elderly people and slow readers might take long time in completing the form. HDI measures the severity of the depression symptoms among the patients over the time period of last two weeks. There are total 38 questions included in HDI form to inquire patients about 23 items. There are several multiple questions included in the form for donating many symptoms of depression. These questions allow attaining comprehensive assessment of the depression symptoms experiences by the patients. The first 17 items included in the HDI form are taken from the HDRS whereas six additional items are added to HDI form in order to enhance the validity of its contents. These additional items represent the symptoms of major depressive disorders as described in Diagnostic and Statistical Manual of Mental Disorders (DSM-III-R and DSM-IV). The six additional items included in HDI are “hypersomnia, detachment, feelings of worthlessness, helplessness-pessimism, hopelessness and difficulty making decisions” (Reynolds, 1994). The response are rates using the 0-2 or 0-4 scale and the sum of the rate for each symptom is used for analyzing the severity of the depression being experienced by the patient. Summary The comparative analysis of Hamilton Depression Inventory (HDI) and Quick Inventory of Depressive Symptomatology (QIDS) allow identifying the similarities and differences among these two depression rating scales. It has been unveiled from the above discussion that both HDI and QIDS are effective and widely accepted rating scales that have been commonly used by the psychiatrists for assessing the severity of the depression symptoms of their patients. HDI and QIDS are similar with respect to their basic purpose and intentions as both of these are meant to assist the clinicians in the process of making treatment decisions for the depression patients. The purpose of the development of these scales is same and thus the implication of these scales is also similar. HDI differs from QIDS because it only provides the self reporting system based on HDRS whereas QIDS provides both the options for clinician and self rating of the depression symptoms. There are 16 items included in QIDS whereas basic HDI comprises of 23 item domains of depression that indicates that HDI explores the symptoms of depression among the patients more deeply as compared with that of QIDS. It is also unveiled that the administration of both of these scales is very easy and convenient because there is no need of specialized training and plenty of time to complete the rating forms. The clinician version of QIDS requires trained raters however, HDI could be conducted by the patients with little assistance and guidance provided by the clinicians. HDI collects the information about depression symptoms during the last two weeks whereas QIDS collect the data for last seven days. The entire discussion could be sum up with the conclusion that both of the above described scales possess their unique significance and implications to the psychiatric research and treatment. These scales are time saving and allow have accurate assessment of the depression symptoms of the patients in little time using basic analytical skills. Both of these scales are found helpful means to getting hold of detailed information and data about the depression symptoms and the psychiatric researchers are much benefited from both of these scales. References Bagby RM, Ryder AG, Schuller DR, Marshall MB (2004), ‘The Hamilton Depression Rating Scale: has the gold standard become a lead weight?’ American Journal of Psychiatry 161 (12): pp2163–77  Demyttenaere K, De Fruyt J (2003). ‘Getting what you ask for: on the selectivity of depression rating scales’, Psychotherapy and psychosomatics 72 (2): pp61–70 Hedlund JL, Viewig BW (1979), ‘The Hamilton rating scale for depression: a comprehensive review’, Journal of Operational Psychiatry 10: pp149-165 Hamilton, M (1960), ‘A rating scale for depression’, Journal of Neurology, Neurosurgery and Psychiatry, 23: pp56-62 Maruish, Mark R. (1999), the Use of Psychological Testing for Treatment Planning and Outcomes Assessment, Mahwah, NJ: Lawrence Erlbaum Associates Reynolds, W. M. (1994). ‘Assessment of depression in children and adolescents by self-report questionnaires’, In W. M. Reynolds and H. F. Johnston (Eds.), Handbook of depression in children and adolescents, New York: Plenum Rush, A.J., Carmody, T. and Reimitz, P.E. (2000),’ The Inventory of Depressive Symptomatology (IDS): Clinician (IDS-C) and self-report (IDS-SR) ratings of depressive symptoms’, International Journal of Methods in Psychiatric Research, 9:pp45-59 Sharp LK, Lipsky MS (September 2002), ‘screening for depression across the lifespan: a review of measures for use in primary care settings’. American Family Physician 66 (6): pp1001–1008   Read More