Mood Emot.  2019 Mar;17(1):12-20. 10.0000/me.2019.17.1.12.

Factor Structure of the Hamilton Depression Rating Scale for Patients with Major Depression with the Anxious Distress Specifier in DSM-5

  • 1Ilsang Psychiatric Clinic, Seoul, Korea.
  • 2Department of Psychiatry, College of Medicine, The Catholic University of Korea, Seoul, Korea.


The factor structure of the Hamilton Depression Rating Scale (HDRS) is well validated for patients with major depressive disorder (MDD). We examined whether HDRS factors can measure the anxious distress specifier in the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition, in patients with MDD.
A retrospective chart review of patients with MDD between March 2012 and June 2015 was conducted. We extracted data on anxious distress symptoms and detailed clinical information and examined how the 5 HDRS factors (anhedonia/retardation, guilt/agitation, bodily symptoms, insomnia, and appetite) were related to the anxious distress specifier using the receiver operating characteristic (ROC) curve analysis and the area under the ROC curve analysis.
We observed significant differences in the HDRS and Beck Depression Inventory scores between anxious distress and non-anxious distress groups at the index episode. The score for guilt/agitation factor was significantly higher than that for other factors in the anxious distress group and exhibited good predictive efficiency at baseline.
Further investigation of the anxious distress specifier as a diagnostic entity would be worthwhile. In addition, the scores for guilt/agitation factor on the HDRS might be a promising marker for distinguishing patients with anxious distress from those with other subtypes of major depression, especially for the index episode.


Diagnostic and Statistical Manual of Mental Disorders; Anxious distress; Hamilton Depression Rating Scale; Factor structure

MeSH Terms

Depressive Disorder, Major
Diagnostic and Statistical Manual of Mental Disorders
Retrospective Studies
ROC Curve
Sleep Initiation and Maintenance Disorders
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