The most commonly used measure of depression is under increasing scrutiny as some antidepressant studies fail to distinguish active drug from placebo or ascertain greater benefit than risk. A recently published review of studies evaluating the Hamilton Rating Scale for Depression (HAM-D) posed the question, "Has the gold standard become a lead weight?" (Bagby et al., 2004).
Michael Bagby, Ph.D., and colleagues reviewed the studies evaluating the HAM-D that have been published since the last major review in 1979 (Hedlund and Vieweg, 1979). Bagby and colleagues (2004) concluded that the instrument, which is based on a 45-year-old construction, was "psychometrically and conceptually flawed" and, in their estimate, beyond repair.
"The breadth and severity of the problems militate against efforts to revise the current instrument," Bagby and colleagues wrote. "After more than 40 years, it is time to embrace a new gold standard for assessment of depression."
The HAM-D was also criticized during several presentations at the 2004 National Institute of Mental Health-sponsored New Clinical Drug Evaluation Unit (NCDEU) conference (see related story, p68 of the print edition--Ed.). Most of the criticism, however, has been directed at current versions of the HAM-D, rather than the scale Hamilton (1960) originally validated, according to Leon Rosenberg, M.D., who spoke at the NCDEU meeting. Scoring guidelines and anchors have been changed from the original, Rosenberg noted, and Hamilton's explicit direction that the instrument be applied by two raters has not been followed.
Bagby and colleagues (2004) did encounter at least 20 different published forms of the HAM-D, including both longer and shorter versions; but limited their review to studies of the 17-item version. The HAM-D-17 was the most studied, and the 17 items were contained in most other versions.