3 Common MADRS and HAM-D Rater Errors

Two of the most widely used instruments for assessing depression severity in clinical trials are the Montgomery Asberg Depression Rating Scale (MADRS) and the Hamilton Depression Rating Scale (HAM-D). Both scales have complexities in their administration, necessitating careful attention to rater training to reduce errors and capture high quality data for informed clinical trial decision making. 

Cogstate Clinician Network Associate Director, Kim Baldwin, shared information on MADRS and HAM-D rater training best practices and some of the common rater errors. Baldwin is a seasoned clinical research professional with years of experience with the MADRS and HAM-D and is known for her expertise in clinical assessment, training, and trial operations.

3 Common Rater Errors:  

• Halo Effect: Tendency to apply the rater’s impressions of one item or symptom’s severity to all the remaining symptoms. 
• Euthymic Baseline Challenges: Collecting and utilizing the participant’s last well period. Accurate and consistent assessment here requires training and calibration. 
• Follow-up and Scoring Variance:  When rating the MADRS, there are only anchor descriptors for even-numbered scores. That—along with variability in the level of questioning different raters may employ—can introduce a significant opportunity for rater variance. For the HAM-D, each item has anchor descriptors to distinguish between the scores, but the anchors provided have the key scoring criteria in parentheses. If raters are not trained on the proper use of the parenthetical anchors, it could lead to discrepancies in scoring across raters. 

Training Best Practices: 

Enhanced training is crucial when these scales are primary measures, while didactic training might suffice for secondary measures. Baldwin recommends comprehensive online modules, demonstration videos, and experienced trainer evaluations to ensure rater competency. At a minimum, a comprehensive online learning module should be provided to each MADRS/HAM-D rater. 

For more detailed insights and to learn about our training methodologies, feel free to contact our team or access our free webinar for more information.

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Kim Baldwin | Associate Director, Clinician Network 

Kim is a seasoned clinical research professional known for her extensive expertise in clinical assessment, central rating, quality oversight, training, and trial operations. She has a versatile therapeutic background spanning many populations and has worked in individual, family, group, and community mental health settings. 

Kim has an MA in Clinical Psychology from Pepperdine University and a BA in Psychology from The University of Texas at Austin.