Validation of the Hamilton Depression Rating Scale (HDRS) in the Tunisian dialect

Public Health. 2022 Jan;202:100-105. doi: 10.1016/j.puhe.2021.11.003. Epub 2021 Dec 20.


Objectives: The Hamilton Depression Rating Scale (HDRS) is one of the most frequently used depression assessment scales. In Tunisia, psychiatrists commonly use this scale in a Tunisian dialect. However, to the best of our knowledge, this scale has never been validated in Tunisia. This study aims to investigate the reliability and the validity of the HDRS among Tunisian patients who have been hospitalised for a suicide attempt. A secondary objective is to describe the sociodemographic characteristics of the study population.

Study design: This is a cross-sectional study performed in the emergency department.

Methods: Patients who were hospitalised for a suicide attempt were eligible for inclusion in this study. The Tunisian version of the HDRS was developed using a forward-backward translation procedure. Psychometric properties of the Tunisian version of the HDRS were tested, including (i) construct validity with a confirmatory one-factor analysis; (ii) internal validity with Pearson correlations and Cronbach alpha coefficients; and (iii) external validity by correlations with the Patient Health Quality-9 (PHQ-9) scale. We used the Receiver-Operating Characteristic (ROC) curve to analyse the correlation between the total HDRS score and the presence of depression according to the PHQ-9.

Results: In total, 101 participants were enrolled in this study. The principal component analysis (PCA) type factor analysis with varimax rotation found a high-grade correlation between HDRS individual items and the total score. The total variance, explained by five factors, was 64.4%. Cronbach's standardised alpha coefficient was 0.86 for the overall scale. Correlations between the total HDRS score and the PHQ-9 score, and its various items, were significant. The ROC curve analysis showed good sensitivity (80.8%) and specificity (91.1%).

Conclusion: The Tunisian version of the HDRS is an acceptable instrument to screen depression in individuals who have attempted suicide.

Keywords: Depression; HDRS scale; Suicide; Tunisia; Validation.

MeSH terms

  • Cross-Sectional Studies
  • Depression*
  • Humans
  • Language*
  • Psychiatric Status Rating Scales
  • Psychometrics
  • Reproducibility of Results