John W Williams1, Christina Perez Stellato, John Cornell, James E Barrett. 1. Center for Health Services Research in Primary Care, Department of Veterans Affairs Medical Center, Duke University Medical Center, Durham, North Carolina 27705, USA. jw.williams@duke.edu
Abstract
OBJECTIVE: Depression scales that are responsive to changes in clinical symptoms are important for clinical monitoring and outcomes assessment in longitudinal studies. We evaluated the psychometric properties and responsiveness to clinical change of the 13- and 20-item versions of the Hopkins Symptom Checklist Depression Scale (HSCL-D). METHODS: A secondary data analysis from a large 11-week, multicenter clinical trial, comparing three treatments was performed. Adult patients with minor depression or dysthymia and a score of > or = 10 on the Hamilton Depression Rating Scale (HDRS) were recruited from primary care clinics. Item-total correlations and Cronbach alphas were computed for HSCL-D-13 and HSCL-D-20. Clinical response at 11 weeks was defined by a Hamilton Depression Rating Scale (HDRS) < 10, clinical remission by a HDRS < 7, and criterion symptom remission by < or = 1 DSM-III-R criterion symptoms. Standardized effect sizes and Guyatt's responsiveness statistic were determined for the 13- and 20-item HSCL-D. RESULTS: Of the 656 subjects enrolled, 511 (77.9%) had complete data and were included in the analysis. Patients were 61.1 +/- 15.0 years old; minor depression was diagnosed in 238, dysthymia in 273. Both scales had good internal consistency; Cronbach's alpha = 0.835 and 0.859 for the 13- and 20-items questionnaires respectively. Standardized effect sizes for clinical response (0.62 for the HSCL-D-13; 0.66 for the HSCL-D-20), clinical remission (0.69 and 0.70), and criterion symptom remission (0.65 and 0.67) showed moderate to large effects and did not differ significantly for the two versions. Responsiveness was virtually identical for patients with minor depression and dysthymia but responsiveness was substantially lower for ethnic minorities. CONCLUSION: The HSCL-D-13 and 20-item versions have similar responsiveness to change. For use in European Americans, we recommend the HSCL-D-13 if response burden is the preeminent consideration. To more fully capture DSM criterion symptoms, we recommend the HSCL-D-20.
OBJECTIVE:Depression scales that are responsive to changes in clinical symptoms are important for clinical monitoring and outcomes assessment in longitudinal studies. We evaluated the psychometric properties and responsiveness to clinical change of the 13- and 20-item versions of the Hopkins Symptom Checklist Depression Scale (HSCL-D). METHODS: A secondary data analysis from a large 11-week, multicenter clinical trial, comparing three treatments was performed. Adult patients with minor depression or dysthymia and a score of > or = 10 on the Hamilton Depression Rating Scale (HDRS) were recruited from primary care clinics. Item-total correlations and Cronbach alphas were computed for HSCL-D-13 and HSCL-D-20. Clinical response at 11 weeks was defined by a Hamilton Depression Rating Scale (HDRS) < 10, clinical remission by a HDRS < 7, and criterion symptom remission by < or = 1 DSM-III-R criterion symptoms. Standardized effect sizes and Guyatt's responsiveness statistic were determined for the 13- and 20-item HSCL-D. RESULTS: Of the 656 subjects enrolled, 511 (77.9%) had complete data and were included in the analysis. Patients were 61.1 +/- 15.0 years old; minor depression was diagnosed in 238, dysthymia in 273. Both scales had good internal consistency; Cronbach's alpha = 0.835 and 0.859 for the 13- and 20-items questionnaires respectively. Standardized effect sizes for clinical response (0.62 for the HSCL-D-13; 0.66 for the HSCL-D-20), clinical remission (0.69 and 0.70), and criterion symptom remission (0.65 and 0.67) showed moderate to large effects and did not differ significantly for the two versions. Responsiveness was virtually identical for patients with minor depression and dysthymia but responsiveness was substantially lower for ethnic minorities. CONCLUSION: The HSCL-D-13 and 20-item versions have similar responsiveness to change. For use in European Americans, we recommend the HSCL-D-13 if response burden is the preeminent consideration. To more fully capture DSM criterion symptoms, we recommend the HSCL-D-20.
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