title: Assessment of depressive symptom severity among patients with co-occurring bipolar disorder and substance dependence.
abstract: BACKGROUND
  We examined a modified version of the Hamilton Depression Rating Scale (HDRS) among treatment-seeking patients with co-occurring bipolar disorder and substance dependence in order to elucidate key features of depression in this specific population of patients.
  
  
  METHODS
  Patients with current bipolar disorder and substance dependence who were prescribed mood stabilizers (n=105) completed a 27-item version of the HDRS that was subjected to item and principal components analyses. Preliminary validity analysis consisted of comparing the derived total and component scores to the depressed mood indicators from the Addiction Severity Index (ASI).
  
  
  RESULTS
  Eleven items representing two related components labeled "melancholia" and "anxiety" were retained. The 11-item HDRS total and component scores were higher for those who reported serious depression, serious anxiety, cognitive problems, and suicidal ideation on the ASI than for those who did not report these problems.
  
  
  CONCLUSIONS
  We conducted the analyses with a relatively small sample of patients who were primarily white and were diagnosed with bipolar I disorder, thus limiting the generalizability of findings. Moreover, we obtained limited data regarding construct validity of the 11-item scale.
  
  
  CONCLUSIONS
  Our psychometric evaluation of the HDRS led us to retain 11 items representing primarily melancholic and neurovegetative symptoms of depression. These findings suggest that sample-specific item characteristics of the HDRS need to be evaluated prior to using this scale to assess depressive symptom severity among patients with complex diagnostic and treatment characteristics.
authors.affiliation: The Alcohol and Drug Abuse Treatment Program, McLean Hospital, 115 Mill Street, Belmont, MA 02478, United States. mkolodziej@mclean.harvard.edu
authors.forename: Monika E
authors.initials: ME
authors.lastname: Kolodziej
authors.forename: Margaret L
authors.initials: ML
authors.lastname: Griffin
authors.forename: Rachel
authors.initials: R
authors.lastname: Bender
authors.forename: Roger D
authors.initials: RD
authors.lastname: Weiss
mesh_terms: D000328:Adult; D000553:Ambulatory Care; D001007:Anxiety / Q000175:diagnosis / Q000453:epidemiology / Q000523:psychology; D001714:Bipolar Disorder / Q000175:diagnosis / Q000453:epidemiology / Q000523:psychology*; D015897:Comorbidity; D003863:Depression / Q000175:diagnosis / Q000453:epidemiology / Q000523:psychology*; D017831:Diagnosis, Dual (Psychiatry); D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010555:Personality Inventory / Q000706:statistics & numerical data; D011594:Psychometrics / Q000706:statistics & numerical data; D011615:Psychotherapy, Group; D015203:Reproducibility of Results; D019966:Substance-Related Disorders / Q000175:diagnosis / Q000453:epidemiology / Q000523:psychology*