Research report
The sensitivity and specificity of the Major Depression Inventory, using the Present State Examination as the index of diagnostic validity

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Abstract

Background: A self-rating inventory has been developed to measure DSM-IV and ICD-10 diagnoses of major (moderate to severe) depression by the patients’ self-reported symptoms. This Major Depression Inventory (MDI) can be scored both according to the DSM-IV and the ICD-10 algorithms for depressive symptomatology and according to severity scales by the simple total sum of the items. Methods: The Schedule for Clinical Assessment in Neuropsychiatry (SCAN) was used as index of validity for the clinician’s DSM-IV and ICD-10 diagnosis of major (moderate to severe) depression. The sensitivity and specificity of MDI was assessed in a sample of 43 subjects covering a spectrum of depressive symptoms. Results: The sensitivity of the MDI algorithms for major depression varied between 0.86 and 0.92. The specificity varied between 0.82 and 0.86. When using the total score of MDI the optimal cut-off score was estimated 26 and the total score was shown to be a sufficient statistic. Limitations: The sample of subjects was limited. Patients with psychotic depression were not included. Conclusion: The MDI was found to have a sensitivity and specificity which is acceptable. The questionnaire is brief and can be scored diagnostically by the DSM-IV and ICD-10 algorithms as well as by its simple total score.

Introduction

Most rating scales measuring severity and frequency of depressive symptoms have been developed before 1980, i.e., before the release of the evidence-based diagnostic system DSM-III (APA, 1980). Thus, the most widely used interview scale, the Hamilton Depression Scale (HAM-D) was developed 40 years ago (Hamilton, 1960). The most widely used self-rating scales, the Beck Depression Inventory (BDI) and the Zung Self-Rating Depression Scale (Zung-SDS) were also developed in the 1960s (Beck et al., 1961, Zung, 1965).

Recently, the HAM-D has been modified to cover DSM-IV (APA, 1994) and ICD-10 (WHO, 1993) symptoms of major (moderate to severe) depression (Bech, 1996, Bech et al., 1997) and the BDI has been modified to have a closer coverage of DSM-IV major depression (Beck et al., 1996).

We have developed the Major Depression Inventory (MDI), based on the universe of symptoms in DSM-IV major depression and ICD-10 moderate to severe depression (Bech, 1997, Bech and Wermuth, 1998). The MDI items are measured in frequency, using the past 2 weeks as the time frame identical to both DSM-IV major depression and ICD-10 moderate to severe depression. In the first study we evaluated the applicability and internal validity of MDI when measuring severity of depressive states, using the total scale score as a sufficient statistic. In this respect the MDI was found superior to the Zung-SDS (Bech and Wermuth, 1998). In the study to be reported here we have evaluated the sensitivity and the specificity of MDI, using the Schedules for Clinical Assessment in Neuropsychiatry (SCAN) as index of validity, i.e., the DSM-IV and ICD-10 diagnosis of major (moderate to severe) depression. MDI has been evaluated both by the algorithms for diagnosing major depression and by its total score.

Section snippets

Major depression inventory

The scale contains the items that cover the ICD-10 symptoms of depression. These symptoms include the DSM-IV major depression symptoms as well, although DSM-IV only contains nine symptoms, as low self-esteem in DSM-IV is incorporated in the item of guilt. The MDI contains, in principle, 12 items, as item 8 and item 10 each have two subitems, a and b. In total, thus, the MDI contains 12 items. Functionally, though, the MDI has only 10 items as it is only the highest score of either a or b that

Results

In total, 43 subjects were included, with a mean age of 48.9 years (9 males and 34 females).

According to SCAN, 21 of the 43 subjects fulfilled the diagnosis of major depression after DSM-IV as well as the diagnosis moderate to severe depression after ICD-10. Of the remaining 22 subjects, four fulfilled the ICD-10 criteria of mild depression. However, within this group no subject fulfilled the DSM-IV criteria of major depression. Five subjects fulfilled the ICD-10 criteria of anxiety disorders.

Discussion

Over the last decades, many self-rating instruments have been developed to screen subjects for depressive disorders in the various clinical settings (e.g., the medical patient, the psychiatric patient, the general practice patient) as well as in the community. One of the most frequently used screening instruments is the General Health Questionnaire (GHQ) which was developed to detect cases of affective disorders in clinical settings (Goldberg, 1972, Goldberg and Huxley, 1980, Goldberg and

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