Hamilton depression rating scale and montgomery-asberg depression rating scale in depressed and bipolar I patients: psychometric properties in a Brazilian sample

Background: The Hamilton Depression Rating Scale (HAM-D) and the Montgomery-Asberg Depression Scale (MADRS) are used worldwide and considered standard scales for evaluating depressive symptoms. This paper aims to investigate the psychometric proprieties (reliability and validity) of these scales in a Brazilian sample, and to compare responses in bipolar and unipolar patients. Methods: The sample comprised 91 patients with either bipolar I or major depressive disorder from a psychiatric institute at Sao Paulo, Brazil. Participants were recruited and treated by clinicians through the Structured Interview for DSM-IV criteria, and had previously been interviewed by a trained, blind tester. Results: Both scales indicated good reliability properties; however, the MADRS reliability statistics were higher than those of the HAM-D for detecting initial symptoms of unipolar depression. Correlation between the tests was moderate. Despite demonstrating adequate validity, neither test achieved the levels of sensitivity and specificity required for identification of a cutoff score to differentiate bipolar I and unipolar patients. Conclusions: Both scales demonstrate adequate reliability and validity for assessing depressive symptoms in the Brazilian sample, and are good options to complement psychiatric diagnosis, but are not appropriate for distinguishing between the two affective disorder types.