Cross-cultural equivalence in depression assessment: Japan-Europe-North American study

Objective: Worldwide use of the Hamilton Rating Scale for Depression (HRSD) presupposes that depression symptomatology can be measured the same way across countries but no empirical study has yet examined this issue. We therefore examined cross-cultural consistency of factor structure of HRSD. Method: A 17-item HRSD data were sought for 5185 individuals diagnosed with major depression in Japan, Europe and North America. Candidate factor structures were obtained with simultaneous component analysis (SCA) across the three cultures. They were then submitted to multiple-group confirmatory factor analysis (CFA). Results: According to SCA, 3-, 4- or 5-factor solutions were found to optimally and adequately summarize the variables for all the three populations. When submitted to CFA, the 5-factor solution was the best fitting and the most parsimonious: they were 'anhedonia/retardation,' 'guilt/agitation,' 'bodily symptoms,' 'insomnia' and 'appetite.' Conclusion: Common underlying factors exist for HRSD among Japanese, European and American patients with major depression.