Abstract

Objective: An implicit assumption in the use of depressive severity measures to assess change during treatment, such as the Hamilton Rating Scale for Depression (HRSD), is that reductions from pre- to post-treatment that are equal to each other are of equal value. However, stakeholders' valuations of changes might depart substantially from this assumption. Method: Vignettes were constructed that reflected the six possible 1, 2, and 3-point reductions on five cognitive and four somatic symptoms derived from the HRSD. Former or currently depressed patients provided judgments of the importance of the symptom reductions. Mean importance ratings were modeled using symptom category and the pre/post-treatment combination. Differences were explored using the Tukey method. Results: Results indicated that mean ratings, from most to least important, were: Anxiety, Suicide, Depressed Mood, Work, and Guilt (the cognitive symptoms) followed by Somatic, Sleep, Appetite & Weight, and Retardation (the somatic symptoms). Participants valued reductions that resulted in posttreatment scores of zero more than expected, given the magnitude of the reductions. Conclusions: The value of reductions in symptoms captured by the HRSD, as judged by patients, appears to differ as a function of symptom category and the post-treatment score. Similar patterns might characterize other measures of depression severity.

摘要

目的：使用抑郁严重程度测量来评估治疗期间的变化，如抑郁症汉密尔顿评定量表 (HRSD) 的一个隐含假设是，从治疗前到治疗后的减少量是相等的. 然而，利益相关者对变化的估值可能与这一假设大相径庭。方法：构建的小插曲反映了源自 HRSD 的五种认知和四种躯体症状的六种可能的 1、2 和 3 分降低。以前或现在的抑郁症患者提供了对症状减轻重要性的判断。使用症状类别和治疗前/治疗后组合对平均重要性评级进行建模。使用 Tukey 方法探索差异。结果：结果表明，从最重要到最不重要的平均评分是：焦虑、自杀、抑郁情绪、工作和内疚（认知症状），其次是躯体、睡眠、食欲和体重以及迟缓（躯体症状）。考虑到减少的幅度，参与者对导致治疗后得分为零的减少的重视程度高于预期。结论：根据患者判断，HRSD 捕获的症状减轻值似乎因症状类别和治疗后评分而异。类似的模式可能表征抑郁严重程度的其他措施。