Validation and psychometric properties of the Arabic version of Hamilton Depression Rating Scale 7 items (HAMD-7) among non-clinical and clinical samples of Lebanese adults

Abstract

Background The Hamilton Depression Rating Scale (HDRS or HAMD) is widely used scale for depression assessment. A shortened version of the HDRS, composed of 7 items, was implemented. The latter is timesaving compared to the original version, while still providing similar precision. Our objective in this study was to assess the psychometric properties of the Arabic HAMD-7 scale among non-clinical and clinical samples of Lebanese adults. Methods In study 1, 443 Lebanese citizens enrolled in this cross-sectional study (June-September 2021). The total sample in study 1 was divided into two subsamples to conduct the exploratory-to-confirmatory factor analysis (EFA-to-CFA). Another cross-sectional study was conducted in September 2022 on another sample of Lebanese patients (independent from the sample of study 1) and included 150 patients attending two psychology clinics. The Montgomery–Asberg Depression Rating Scale (MADRS), Lebanese Depression Scale (LDS), Hamilton Anxiety Scale (HAM-A) and Lebanese Anxiety Scale (LAS) were used to assess the validity of the HAMD-7 scale. Results The results of the EFA (subsample 1; study 1) showed that the HAM-D-7 items converged into a one-factor solution (McDonald’s ω = .78). The CFA (subsample 2; study 1) confirmed the one-factor solution obtained in the EFA (ω = .79). CFA indicated that fit of the one-factor model of the HAM-D-7 was acceptable: χ2/df = 27.88/14 = 1.99, RMSEA = .066 (90% CI = .028, .102), SRMR = .043, CFI = .960, TLI = .939. All indices suggested that configural, metric, and scalar invariance was supported across gender. The HAMD-7 scale score positively correlated with the MADRS (r = 0.809; p<0.001), LDS (r = 0.872; p<0.001), HAM-A (r = 0.645; p<0.001) and LAS (r = 0.651; p<0.001) scales scores. The optimal cutoff score between healthy individuals and depressive patients for the HAMD-7 was at a value = 5.50 (Se = 82.8% and Sp = 62.4%). The positive and negative predicted values for the HAMD-7 were 25.1% and 96.0%, respectively. The positive and negative likelihood ratios were 2.20 and 0.28 respectively. No significant difference was found between the non-clinical total sample (study 1) and the clinical sample (study 2) in terms of HAM-D-7 scores (5.24 ± 4.43 vs 4.54 ± 5.06; t(589) = 1.609; p = .108). Conclusion Psychometric properties of the Arabic HAMD-7 scale are satisfactory, warranting its use clinically and in research. This scale seems highly efficient for ruling out depression; however, those with positive scores need a referral to a mental health professional for deeper evaluation. HAMD-7 might be self-administered by non-clinical subjects. Future studies are recommended to additionally confirm our results.