title: Psychometric analysis of the Melancholia Scale in trials with non-pharmacological augmentation of patients with therapy-resistant depression.
abstract: OBJECTIVE
  The Melancholia Scale (MES) consists of the psychic core items of the Hamilton Depression Scale (HAM-D6) (depressed mood, interests, psychic anxiety, general somatic, guilt feelings, and psychomotor retardation) and the neuropsychiatric items of the Cronholm-Ottossen Depression Scale. Patients resistant to anti-depressant medication (therapy-resistant depression) have participated in our trials with non-pharmacological augmentation. On the basis of these trials, we have evaluated to what extent the neuropsychiatric subscale of the MES (concentration difficulties, fatigability, emotional introversion, sleep problems, and decreased verbal communication) is a measure of severity of apathia when compared with the HAM-D6 subscale of the MES.
  
  
  METHODS
  We have focused on rating sessions at baseline (week 0) and after 2 and 4 weeks of therapy in four clinical trials on therapy-resistant depression with the following augmentations: electroconvulsive therapy, bright light therapy, transcranial magnetic stimulation or pulsed electromagnetic fields, and wake therapy. The item response theory model constructed by Mokken has been used as the psychometric validation of unidimensionality. For the numerical evaluation of transferability, we have tested item ranks across the rating weeks.
  
  
  RESULTS
  In the Mokken analysis, the coefficient of homogeneity was above 0.40 for both the HAM-D subscale and the apathia subscale at week 4. The numerical transferability across the weeks was statistically significant (p < 0.05) for both subscales.
  
  
  CONCLUSIONS
  The apathia subscale is a unidimensional scale with acceptable transferability for the measurement of treatment-resistant symptoms, analogue to the psychic core subscale (HAM-D6).
authors.affiliation: 1 Psychiatric Research Unit, Psychiatric Centre North Zealand, Copenhagen University Hospital, Hillerød, Denmark.
authors.forename: Per
authors.initials: P
authors.lastname: Bech
authors.affiliation: 1 Psychiatric Research Unit, Psychiatric Centre North Zealand, Copenhagen University Hospital, Hillerød, Denmark.
authors.forename: Lise
authors.initials: L
authors.lastname: Lauritzen
authors.affiliation: 1 Psychiatric Research Unit, Psychiatric Centre North Zealand, Copenhagen University Hospital, Hillerød, Denmark.
authors.forename: Marianne
authors.initials: M
authors.lastname: Lunde
authors.affiliation: 1 Psychiatric Research Unit, Psychiatric Centre North Zealand, Copenhagen University Hospital, Hillerød, Denmark.
authors.forename: Mogens
authors.initials: M
authors.lastname: Unden
authors.affiliation: 2 Psychiatric Research Unit, Psychiatric Centre Bispebjerg, Copenhagen University Hospital, Copenhagen, Denmark.
authors.forename: Lone Christina
authors.initials: LC
authors.lastname: Hellström
authors.affiliation: 1 Psychiatric Research Unit, Psychiatric Centre North Zealand, Copenhagen University Hospital, Hillerød, Denmark.
authors.forename: Claudio
authors.initials: C
authors.lastname: Csillag
authors.affiliation: 3 Psychiatric Department O, Psychiatric Centre Copenhagen, Copenhagen University Hospital, Copenhagen, Denmark.
authors.forename: Klaus
authors.initials: K
authors.lastname: Martiny
mesh_terms: D000328:Adult; D000368:Aged; D002986:Clinical Trials as Topic; D061218:Depressive Disorder, Treatment-Resistant / Q000175:diagnosis* / Q000628:therapy; D004565:Electroconvulsive Therapy; D005260:Female; D006801:Humans; D055909:Magnetic Field Therapy; D008297:Male; D008875:Middle Aged; D010789:Phototherapy; D011569:Psychiatric Status Rating Scales; D011594:Psychometrics; D012720:Severity of Illness Index; D050781:Transcranial Magnetic Stimulation; D016896:Treatment Outcome