Psychometric Tools Flashcards
How do the symptoms included on the MADRS and HAM-D compare?
HAM-D includes more items on physical symptoms of depression not included in MADRS (
How do the symptoms included on the MADRS and HAM-D compare?
HAM-D includes more items on physical symptoms of depression not included in MADRS (
Describe the HAM-D scores indicating remission, mild, moderate & severe depression?
Remission: 0-6 no depression
Mild: 7-17 depression
Moderate: 18-24
Severe: > 24
What scores on the MADRS indicate remission/severe depression
< 10: remission
> 30: severe
Using the BDI, HAM-D, MADRS, Zung, YMRS define whether they are self-report or clinician administered?
MADRS & HAM-D: clinician observer rated
BDI: self report
Zung (depression): self report
YMRS: clinician-administered
Outline the two main broad types of rating scales?
Clinician administered
- Clinical interview
- Individual clinician judgement
- Training
- Structured
Self-rated scales
- Less time consuming
- No training required
- Patient however needs to be able to read and understand the scale
- Rely upon a standardised administration and scoring process
Define
a) Validity
b) Internal consistency
c) Inter-rater reliability
d) Test-retest reliability
a) Does the scale measure what your meant to be measuring
b) Do all items measure the same thing - correlation between items
c) Amount of variation if different raters do the same scale on the same patient (depends upon training)
d) Variation in score if the same rater repeats the same test on the same patient - how consisting are rating scores
Can the suicide behaviour questionnaire-revised diagnose depression?
No this scale is a psychological self report questionnaire which identifies risk factors for suicide in children and adolescents between 13 & 18 years
- it can however provide an estimation of severity of symptoms at a point in time
Is the hamilton rating scale for depression valid for children?
Yes - it is valid for all ages
Takes 20-25 minutes to complete
Aim is to asses severity of depression
What are the cut off scores for the Hamilton-21 (4 items do not count - HRSD-17)
0 to 6 –> no depression
7 - 17 –> mild depression
18 - 24 –> moderate depression
> 24 –> severe depression
Name some positives &. negatives of the Hamilton rating scale for depression?
- Excellent validity
- Assess a range of clinical features
BUT
- Lack of atypical symptoms (over eating/over sleeping)
- Biases towards somatic symptoms (increased weight on these items) - which may be prone to effects of medication
- Total score not weighted but individual items are
- Some of the included symptoms may only be present in remission and not in depression
- Suboptimal sensitivity at identifying remission
- Items may measure different constructs –> irritability and anxiety
Is the BDI-II self-administered
Yes
Highly reliable questionnaire developed by Beck, Steer and Brown to assess key symptoms of depression
Outline the cutoff scores for the BDI-II
0-13 - minimal depression
14-19 - mild depression
20-28 - moderate depression
29-64 - severe depression
BDI-II includes both cognitive-affective and somatic items
Assess their presence in the last 14 days
The scale takes around 10 minutes to complete
Outline the internal consistency, the test-restest reliability and variable convergent validity of the BDI-II
V high internal consistency (0.9)
Good test-retest reliability (0.65-0.72)
Variable convergent validity (0.27 - 0.89)
Convergent validity is the degree that two theoretically related measures are actually related –> how closely the scale is related to other scales of the same construct
How do the MADRS and HRSD identify the information included?
Use clinical interviews (HRSD can also use informant report)
Both are clinician rated.
MDRS is observer rated too as included an “objective item”
How many items are included in the following scales
a) MADRS
b) BDI-II
c) HRSD
a) 10
b) 21 - 4 not scoring
c) 17
Does the MADRS include somatic items?
No - lacks these items which may be important for Geriatric populations (ones referring to are fatigue/pain, physical complaints, diurnal symptoms)
As a result the MADRS is not validated for this cohort
MDRS > HRSD - asks about concentration
What are the cut offs for the MADRS?
< 10 remission
> 30 severe depression
What is the internal consistency, inter rater reliability and convergent validity like with the MADRS?
- Good internal consistency > 0.95
- V high inter rater reliability even with minimal training (0.9)
- Convergent validity with other scales is high
Whats the highest possible score on the MADRS?
How much does each item range?
60 - highest score
Each item ranges from 0-6
Describe some training points for the MADRS
If unable to differentiate between two points despite questioning - rate up
Try to go with even anchor points if it is clinically appropriate
Outline the 10 items of the MADRS
- Reported sadness
- Apparent sadness
- Inner tension
- Reduced sleep
- Reduced appetite
- Concentration difficulties
- Lassitude
- Inability to feel
- Pessimistic thoughts
- Suicidal thoughts
Describe some issues with the Zung self-rating depression scale?
Uses graded answers - never, sometimes, always –> as such high false positive rates in non-depressed elderly individuals
Also high false positive rates if a patient has many somatic symptoms
- Zung self-rating depression scale is self assessed
Is the young mania scale self-report?
No it is clinician administered
Max score if 60
11 items range from 0-8, 0-4
Takes around 15 minutes
What is the internal consistency of the YMRS like?
Variable - 0.41 - 0.85
Inter-rater reliability is good 0.93
Good validity
What scale can be used for those with postnatal depression?
Edinburgh postnatal depression screen
Describe some pros and cons of the EPDS
- Good sensitivity
- Poor specificity (includes those who may be false positives)
- A preliminary score can be made to give to a clinician
How does the scoring of the EPDS vary?
Self-report assess symptoms over the last 7 days
10 items are scored 0-3 - over 13 indicates depressive episode of varying severity
0-9 - low depression concerns
10-12 modest concern
13-18 moderate concern
19 and above - likely to have depression/increased concern re suicide
How may the visual analogue scale help?
- Allows conveying of subjective experience
- Sensitive to monitoring changes due to continuous structure (answers marked on a 100mm line)
- Has been used a lot for assessment of mood/anxiety/pain in medical conditions (cancer, cardiovascular disease, HIV, palliative care)
- Validity and reliability now demonstrated but not commonly used in AD trials
What three options are included in the Maudsley VAS?
- Depressed mood
- Anhedonia
- Suicidality
Name some scales that assess depression in elderly cohorts?
Geriatric depression scale
Cornell scale for depression in dementia
What are the cutoffs for the PHQ-9?
Minimal depression 0-4
Mild depression 5-9
Moderate depression 10-14
Moderately severe depression 15-19
Severe depression 20-27
(Generally > 14 considered valid for depression)
What does the mood disorder questionnaire screen for?
Symptoms of mania/hypomania to indicate bipolar disorder
Threshold of > 9 set
It is self-report
