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Can J Psychiatry. 2019 Jan;64(1):39-46. doi: 10.1177/0706743718772516. Epub 2018 May 2.

Cross-Cultural Psychometric Properties of the Hamilton Depression Rating Scale.

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1 Competence Centre for Transcultural Psychiatry, Mental Health Centre Ballerup, Copenhagen, Denmark.
2 Department of Psychology, University of Southern Denmark, Odense, Denmark.
3 Department of Public Health and Center for Healthy Aging, University of Copenhagen, Denmark.



The Hamilton Depression Rating Scale (HDRS) is considered the gold standard measure of depression. The factor structure of the HDRS is generally unstable, but 4 to 8 items appear to form a general depression factor. As transcultural studies of the HDRS have received little attention, and as most of the studies have taken a data-driven approach with a tendency to yield fragmented results, it is not clear if an HDRS general depression factor can also be found in non-Western populations. This is an important issue in deciding on the appropriateness of the scale as a gold standard in transcultural psychiatry.


A systematic review was carried out to compare previously reported factor structures of the HDRS in non-Western cultures. Overlapping clusters across studies were identified and subsequently tested with confirmatory factor analysis (CFA) of responses from an independent sample.


Fourteen relevant studies were identified, 12 of which were obtained. A general depression factor was identified, consisting of the following symptoms: depressed mood, guilt, loss of interests, retardation, suicide, and psychological anxiety. The subsequent CFA analysis supported the fit of this model.


This study indicates that a general depression cluster is manifest in responses to the HDRS across cultures. While psychometric properties of the full-length HDRS are still debated, the general depression cluster appears pertinent to the assessment of depression across cultures. We recommend that cross-cultural clinicians and researchers focus on the use of unidimensional depression scales, which are in agreement with this cluster.


Hamilton Depression Rating Scale; cross-cultural; depression; factor structure


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