SCHIZOPHRENIA

RESEARCH

ELSEVIER Schizophrenia Research 19 (1996) 205-212

A psychometric comparison of the Calgary Depression Scale for

Schizophrenia and the Hamilton Depression Rating Scale
Donald Addington *, Jean Addington, Mark Atkinson
Department of Psychiatry, Foothills Hospital 1403 29 Street NV/, Calgary, Alberta T2N 2 T9, Canada
Received 3 January 1995; revision 21 June 1995; accepted 3 July 1995

Abstract

This study compared two measures of depression in a population with schizophrenia. Inpatients (n= 112) with
schizophrenia, were assessed on the Hamilton (HDRS), and Calgary (CDSS) depression scales and the Positive and
Negative Syndrome Scale (PANSS). Eighty-nine were reassessed 3 months later. A principal components factor
analysis was applied to each depression scale. The relationship between measures of depression and positive and
negative symptoms was explored using correlation, factor and regression analyses. There were no significant
correlations between the total CDSS and positive or negative symptoms at either time. In contrast, the HDRS total
score was correlated with both positive and negative syndromes at time 2. Moreover, a number of HDRS factors
correlated significantly with the PANSS positive scale at both times and with the negative subscale score at time 2.
Multiple regression analysis showed that the HDRS accounted for more of the variance in positive and negative
symptoms scores than did the CDSS. The CDSS has fewer factors and less overlap with positive and negative
symptoms than the HDRS. This suggests that it is a more specific measure of level of depression than the HDRS for
individuals with schizophrenia.

Keywords: Depression rating scale; (Schizophrenia)

1. Introduction when the scales are used in populations for which

Many depression scales have been used with
little consideration as to their content, or to how
they relate to accepted definitions of depressive
disorder (Snaith, 1993). The importance of meas-
uring symptoms has been reinforced by Costello
(1992), who has put forward a number of argu-
ments for allocating more time to the study of
symptoms. The concern about what depression
scales measure becomes of greater importance
* Corresponding author. Tel.: +1 (403) 670-1287; Fax: +1
(403) 283-7925.
they were not developed, such as a population
with schizophrenia.
In schizophrenia, the presence of depressive
symptoms has been reported since the disorder
was first described by Kraepelin (1971). More
recent support for a distinct dimension of depres-
sion in schizophrenia comes from a factor analytic
study of 240 people with schizophrenia ( K a y and
Sevy, 1990). Furthermore, the clinical concept of
secondary depression in schizophrenia received
substantial support from a comprehensive review
(Siris, 1991). Despite this strong support for the
concept of depression in schizophrenia, the diffi-

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206 Donald A ddington et al./Schizophrenia Research 19 (1996) 205 212
culty of measuring depression in schizophrenia has
also been noted (Craig et al., 1985). The most
commonly used rating scale for assessing depres-
sion in schizophrenia has been the Hamilton
Depression Rating Scale (HDRS). However, the
validity of this scale for use in this population has
not been substantiated. Indeed, Goldman et al.
(1992), found that the HDRS contained a negative
symptom factor that correlated strongly with the
Scale for Assessment of Negative Symptoms
(SANS). This concern about overlap was in
agreement with an earlier study in which significant
correlations were found between the total scores
on the HDRS and SANS (Addington and
Addington, 1989). The problem of using scales in
populations for which they were not designed was
discussed by Hamilton, who specifically cautioned
that the HDRS was designed for use only in
populations which had been previously diagnosed
as depressed (Hamilton, 1967).
The Calgary Depression Scale for Schizophrenia
(CDSS) is a depression rating scale especially
developed for assessing depression in schizophre-
nia. It was originally developed by factor analysis
of items from both the Present State Examination
and the HDRS (Addington et al., 1990). Of note,
only 4 items were retained from the original
17-item Hamilton scale. A structured interview
and rating guide was developed to operationalize
the final CDSS instrument items. The interview
and rating scale were found to have good inter-
rater reliability and validity (Addington et al.,
1992). The construct and predictive validity of the
scale were supported by two findings. First, by
significant correlations between CDSS scores and
scores on other depression measures. Second, by
the finding that the scale as a whole predicted
the presence of a major depressive episode and
that each item contributed to that prediction.
Subsequently the scale was shown to measure
depression, rather than positive, negative or extra-
pyramidal symptoms (Addington et al., 1994).
The purpose of this study was to compare the
CDSS and HDRS as measures of depression in
schizophrenia. More specifically, to first examine
the underlying structure of the two instruments by
factor analysis and secondly, to compare the diver-
gent validity of the CDSS and HDRS with regard
to unrelated positive and negative symptomatol-
ogy. The overlap between measures of depression
and negative and positive symptoms of schizophre-
nia was examined using correlations and multiple
regression analyses.
2. Method
The sample consisted of 112 consecutive volun-
tary and consenting admissions to acute general
hospital psychiatric admission units in Calgary.
Diagnosis was based on information from a struc-
tured interview the Structured Clinical Interview
for DSM-III-R (SCID) (Williams et al., 1992;
Spitzer et al., 1992) and information from chart
review: inclusion criteria for the study were the
DSM-III-R criteria for schizophrenia. Exclusion
criteria were, substance abuse in the last year,
mental retardation, and major CNS disorder such
as epilepsy. A total of 112 subjects entered the
study and 89 were reassessed at the 3-month
follow-up. The sample at admission consisted of
67 males and 45 females. The mean age at admis-
sion was 35.3 (SD= 10.3) years. The mean age at
first hospitalization was 25.6 (SD = 7.9) years, with
an average of 5.6 (SD = 6.1) previous admissions.
Inter-rater reliability on all assessment instru-
ments was established between the PI and a
research assistant who administered the PANSS
and the two depression rating scales. Inter-rater
reliability on the depression scales was established
by jointly assessing patients in a room with each
rater taking turns to either interview or observe.
Ratings were conducted on 5 inpatients and 5
outpatients. The intraclass correlation coefficient
for the CDSS was 0.89, for the HDRS 0.93, and
for the PANSS 0.97. Reliability on the SCID was
established between two of the authors D.A. and
J.A. Joint interviews of 10 patients established the
agreement on the presence or absence of individual
items on the SCID to be 85%.
All subjects were assessed for level of depression
using both the CDSS and the HDRS. Positive and
negative symptoms were assessed using the Positive
and Negative Syndrome Scale (PANSS) (Kay
et al., 1987). This assessment procedure was con-
ducted twice, first at a time of relapse (time 1) and
 Donald Addington et al./Schizophrenia Research 19 (1996) 205-212 207

again 3 months later at a time of relative remission tions and at time 2 in 9 iterations. The results of
(time 2). the obliquely rotated CDSS time 1 factor analyses
The 89 subjects who were assessed both at times are presented in Table 1 and the factor analysis at
1 and 2 showed significant improvements on all time 2 in Table 4.
symptoms scales between the time of admission The factor analysis of the H D R S exhibited signs
and the 3-month follow-up. The mean scores at of psychometric instability. Following an initial
time 1 and time 2, respectively, were negative principal component analysis, examination of the
symptoms, 20.2 and 14.1 (t = 9.6, p < 0.0001 ), posi- scree plot did not reveal any clean break-point. As
tive symptoms, 21.4 and 19.4 (t=3.9, p < 0 . 0 0 0 1 ) a result, 7 factors were retained all with an eigen-
and depressive symptoms on the CDS, 6.49 to value of greater than 1. The oblique rotation
4.69, (t=3.31, p <0.001). eventually converged after 45 iterations, with the
A subgroup of 45 patients who also participated resulting solution explaining 65% of the variance
in a separate but overlapping study was assessed in scores (see Table 2).
on the Scale for Assessment of Negative Symptoms Examination of the correlations between total
(SANS) (Andreasen, 1981). CDSS score, total H D R S score and PANSS posi-
A principal components factor analysis using a tive and negative subscales at time 1 revealed no
correlation matrix and subsequent oblique rotation significant correlation (see Table 3).
was performed on both the CDSS and H D R S There were, however, significant correlations
using the admission (time 1) and follow-up (time among 3 of the H D R S (3, 6, 7) factors and the
2) data sets. The oblique rotation was performed PANSS positive symptom scale. Factor 3 is charac-
due to the assumption that meaningful correlations terized by its high loading on hypochondriasis and
exist between instrument factors. Subjects' factor negative loading on agitation. Factor 6 has signifi-
scores (weighted sum/regression method), derived cant positive loadings on agitation and loss of
from the principal components analysis were sub- weight. Factor 7 loads highly on psychic anxiety
sequently correlated with their positive and nega- and libido.
tive symptom scores derived from the PANSS. The The factor structure of the CDSS remained
utility of depression measures in this population is stable between times 1 and 2 (Table 4). Factor 1
dependent on their divergence with other symp-
toms of schizophrenia, such as the positive and Table 1
negative symptoms. Thus correlations between the Factor loadings - Calgary Depression Scalefor Schizophrenia:
PANSS and depression measures should ideally be time 1
low or absent. Next, the depression scale subscales Symptom Factor 1" Factor 2 Factor 3
of the CDSS were entered simultaneously into a
regression equation with the positive and negative 1. Depressed mood 0.74 0.61 0.24
symptoms scores of the PANSS as the dependent 2. Hopelessness 0.85 0.34 0.27
3. Self depreciation 0.74 0.12 -0.08
variables. The same procedure was repeated with
4. Guilty ideas of reference -0.01 0.78 0.12
the HDRS. 5. Pathological guilt 0.62 0.10 0.09
6. Morning depression 0.45 0.77 0.02
7. Early wakening 0.17 0.05 0.93
3. Results 8. Suicide 0.72 0.33 0.40
9. Observed depression 0.72 0.38 0.46
Factor analysis of the time 1 CDSS data and Eigenvalue 3.9 1.2 0.98
inspection of the scree plot revealed that factors 2 Variance accounted 43.1% 13.0% 10.9%
and 3 appeared to be on a plateau with similar Total percent of variance:
eigen values. As a result, an initial decision was 67%
Chronbach's ~ 0.84 0.68 0.63
made to examine the first 3 factors, which
Overall ~=0.82
accounted for 67% of the pooled variance. The
oblique rotation at time 1 converged in 12 itera- "Items loading above 0.40 are in bold.
208 DonaM Addington et al./Schizophrenia Research 19 (1996) 205-212

Table 2
Factor loadings - Hamilton Depression Rating Scale: time 1

Symptom Factor I a Factor 2 Factor 3 Factor 4 Factor 5 Factor 6 Factor 7

1. Depression 0.80 0.28 - 0.29 0.03 0.30 0.13 0.28

2. Guilt 0.65 0.27 0.36 -0.12 0.47 -0.02 0.0l
3. Suicide 0.18 0.13 0.05 0.00 0.87 0.02 0.16
4. Insomnia I 0.28 0.80 - 0.14 0.04 0.23 0.16 0.02
5. Insomnia M 0.04 0.78 -0.05 -0.05 -0.02 0.02 0.04
6. Insomnia T 0.21 0.01 -0.29 -0.11 0.50 0.42 0.00
7. Work/interest 0.54 -0.21 -0.01 0.54 -0.23 0.25 0.12
8. Retardation 0.11 0.00 - 0.15 0.77 0.13 - 0.07 0.19
9. Agitation 0.24 0.33 -0.69 -0.16 0.16 0.42 0.11
10. Anxiety psychic 0.28 0.04 0.04 -0.04 -0.06 -0.23 0.74
11. Anxiety somatic 0.75 0.17 0.10 0.09 0.16 0.10 0.26
12. Somatic GI 0.17 0.17 -0.05 0.29 0.34 0.12 0.73
13. Somatic general 0.52 - 0.02 0.07 0.14 - 0.11 - 0.25 0.51
14. Libido 0.04 0.02 -0.29 -0.52 0.20 0.22 0.48
15. Hypochondriasis - 0.10 0.17 0.74 - 0.20 0.05 - 0.09 0.07
16. Loss of insight 0.20 0.25 0.07 -0.14 0.17 0.75 0.03
17. Loss of weight 0.46 0.05 0.25 0.15 0.34 -0.49 0.17
Eigenvalue 3.6 1.7 1.3 1.3 1. 1 1.] 1.0
Variance accounted 21.3% 10.2% 7.7% 7.5% 6.5% 6.3% 6.1%
Total percent of variance: 65.5%
Chronbach's ~ 0.72 0.56 0.46 0.05 0.50 0.23 0.54
Overall ~ = 0.73

altems loading above 0.40 are in bold.

Table 3
Intercorrelations a m o n g depression factors and positive and
negative syndromes: time 1

Factor Positive syndrome Negative syndrome Table 4

Factor loadings - Calgary Depression Scale for schizophrenia:
CDSS total -0.09 -0.03 time 2
CDSS 1 -0.18 -0.05
CDSS 2 0.17 -0.14 Symptom Factor I a Factor 2 Factor 3
CDSS 3 -0.08 0.02
H D R S total 0.01 0.08 1. Depressed m o o d 0.86 0.02 0.00
HDRS 1 0.02 0.13 2. Hopelessness 0.74 0.10 0.13
HDRS 2 - 0.11 0.01 3. Self depreciation 0.80 0.05 - 0.16
HDRS 3 0.35 ° 0.17 4. Guilty ideas of reference -0.03 0.88 0.15
HDRS 4 0.02 - 0.13 5. Pathological guilt 0.42 - 0.09 0.47
HDRS 5 -0.02 0.12 6. Morning depression 0.81 -0.22 0.06
HDRS 6 - 0.25 b 0.18 7. Early wakening 0.06 0.15 0.89
HDRS 7 0.25 b -0.16 8. Suicide 0.50 0.50 -0.10
9. Observed depression 0.78 0.14 0.11
"p < 0.05.
bp<O.O1. Eigenvalue 4.3 1.1 0.81
Cp<O.O01. Total variance accounted 47.7% 12.0% 9.0%
Total percent of variance:
r e t a i n e d i t s o r i g i n a l s t r u c t u r e a t t i m e 2, w h i l e t h e r e 68.7%
Chronbach's ~ 0.87 0.47 0.34
were some changes of items between factors 2 and
Overall ~ = 0 . 8 6
3 across the two times. In contrast, the changes in
the factor structure of the HDRS between the two altems loading above 0.40 are in bold.
 Donald Addington et al./Schizophrenia Research 19 (1996) 205-212 209

assessments were pronounced. Less than half of Table 6

Intercorrelations a m o n g depression factors and positive and
the items loaded on the same factors at both times,
negative syndromes: time 2
making interpretation of the factors uncertain
(Table 5). Factor Positive syndrome Negative syndrome
The intercorrelations between depression mea-
CDSS total 0.02 - 0.2
sures and positive and negative symptoms at time
CDSS 1 -0.12 -0.09
2 are outlined in Table 6. Similar to time 1, there CDSS 2 0.31 b 0.18
are no correlations between the global CDSS score CDSS 3 0.01 0.04
and either positive or negative symptoms. There
is, however, one significant correlation between HDRS total 0.24 a 0.32 b
HDRS 1 0.24 a 0.37 b
factor 2 and the positive syndrome scale. Again
HDRS 2 0.05 0.05
by contrast, the total HDRS score is significantly HDRS 3 0.16 0.08
correlated with both positive and negative sub- HDRS 4 0.14 0.17
scales at time 2. These correlations are accounted HDRS 5 0.13 0.22 a
for by 4 HDRS factors. HDRS 6 0.37 b 0.00
HDRS 7 -0.20 u 0.03
In order to determine the overall percentage of
variance in positive and negative symptom scale ap < 0.05.
scores that might be explained by the depression bp < 0.01.
scales, both the HDRS factors and the CDSS
factors were each entered into two multiple regres-
sion analyses with the positive and negative sub- (Table 7 and Table 8). The CDSS factors together
scales as the dependent variables. These regressions accounted for only 9% of the variance of positive
were done separately both at time 1 and time 2 symptoms at both times 1 and 2. The HDRS, on

Table 5
Factor loadings Hamilton Depression Rating Scale: time 2

Symptom Factor I a Factor 2 Factor 3 Factor 4 Factor 5 Factor 6 Factor 7

1. Depression 0.62 -0.41 -0.44 0.43 -0.18 0.20 0.41

2. Guilt 0.37 -0.42 -0.51 -0.36 -0.10 0.10 0.44
3. Suicide 0.02 0.15 -0.04 0.10 -0.04 0.02 0.88
4. Insomnia I 0.32 -0.17 -0.76 0.05 0.10 0.15 0.37
5. Insomnia M 0.06 0.00 -0.78 -0.14 0.16 0.15 -0.07
6. Insomnia T 0.22 -0.31 -0.42 -0.09 0.81 0.16 0.11
7. Work/interest 0.22 -0.78 --0.19 -0.02 0.11 0.17 -0.11
8. Retardation 0.20 -0.76 0.21 0.21 0.17 0.17 -0.00
9. Agitation 0.40 -0.51 -0.54 -0.17 0.22 0.27 0.37
10. Anxiety psychic 0.54 -0.45 -0.18 -0.21 0.29 0.18 0.08
11. Anxiety somatic 0.78 -0.15 -0.17 -0.27 0.24 0.31 0.28
12. Somatic GI 0.74 0.39 -0.03 -0.07 0.19 0.24 -0.01
13. Somatic general 0.30 -0.21 -0.15 -0.15 -0.15 0.79 0.24
14. Libido 0.01 -0.12 -0.12 0.24 0.36 0.75 -0.12
15. Hypochondriasis 0.06 0.04 0.05 0.87 - 0.06 0.08 0.11
16. Loss of insight 0.78 -0.14 -0.30 0.18 -0.22 -0.02 -0.02
17. Loss of weight 0.42 -0.19 0.18 -0.47 0.56 0.46 0.06
Eigenvalue 4.5 1.8 1.5 1.4 1.1 1.0 0.90
Variance 26.5% 10.7% 8.7% 8.0% 6.6% 6.0% 5.3%
Total percent of variance: 71.8%
C h r o n b a c h ' s ct 0.76 0.73 0.71 0.44 0.46 0.42 0.58
Overall ~ = 0 . 7 9

altems loading above 0.40 are in bold.

210 Donald Addington et al./Schizophrenia Research 19 (1996) 205-212

Table 7
Results of multiple regression analyses on positive and negative symptoms: time 1

Predictor variable Dependent variable Multiple r r2 df Significant F

CDSS factors PANSS positive 0.30 0.09 4 0.04 a

PANSS negative 0.15 0.02 4 0.67
HDRS factors PANSS positive 0.41 0.17 8 0.01 b
PANSS negative 0.53 0.28 8 0.00 ¢

ap<0.05.
bp<0.01.
Cp <0.001.

Table 8
Results of multiple regression analyses on positive and negative symptoms: time 2

Predictor variable Dependent variable Multiple r r2 df Significant F

CDSS factors PANSS positive 0.31 0.09 3 0.03 a

PANSS negative 0.25 0.06 3 0.14
HDRS factors PANSS positive 0.57 0.32 7 0.00 c
PANSS negative 0.48 0.23 7 0.00 b

ap<0.05.
bp<0.01.
Cp<0.001.

the other hand, accounted for more of the variance
in positive and negative symptoms at both assess-
ment periods.
A subgroup of 45 patients participated in a
separate, but overlapping, study in which they
were assessed on the Scale for Assessment of
Negative Symptoms (SANS). All of these patients
were assessed at both times. Results were similar
to the results with the PANSS negative symptom
score. There were no significant correlations
between SANS negative score and either the total
CDSS score or CDSS factors at either time 1 or
time 2. There was a statistically significant correla-
tion between the HDRS factor 5 and the SANS
at time 1 and with the SANS total score and
HDRS factors 1 and 7 at time 2.
4. Discussion
The results of the factor analyses of the CDSS
reveal a fairly stable underlying structure across
time, in that the factor loadings of factors 1 and
2 are similar at times of relapse and remission. An
exception is factor 3 which appears at time 1
(although weakly, eigen 0.98) and even more
weakly at time 2 (eigen value 0.81). In addition,
the c~coefficient of factor 3 was lower than for the
other factors especially at time 2. This third factor
was retained for both statistical and clinical
reasons. First, inspection of the scree plot showed
a plateau with factors 2 and 3. Second, because of
the clinical significance of the item early morning
wakening. Early morning wakening, the main item
loading on factor 3 is a symptom of melancholia,
which is a specifier for a major depressive episode.
The results of the correlation between both total
CDSS score and the CDSS factors with negative
symptoms suggest that the CDSS measures depres-
sion distinct from negative symptoms. This finding
is in keeping with a prior study (Addington
et al., 1994).
The small, but statistically significant correlation
between CDSS factor 2 and positive symptoms
(0.31), occurred at time 2 only. Factor 2 at time
2 carries loadings on item 4, guilty ideas of refer-
ence and item 8 suicide. Guilty ideas of reference
is a symptom similar to, but not identical with,
 Donald Addington et al./Schizophren& Research 19 (1996) 205-212
the symptom of delusions of guilt. The relationship
between these two symptoms may account for the
correlation between factor 2 and positive symp-
toms, but this idea is speculative. Alternatively,
the correlation may arise spuriously as a result of
the simultaneous increase in depression and posi-
tive symptoms. Such a hypothesis is congruent
with the concept of revealed depression (Hirsch,
1982) which suggests that depression is present
and at its highest at a time of relapse. Such an
explanation is also congruent with earlier findings
that a significant relationship exists between suici-
dal thinking and levels of positive symptoms
(Addington and Addington, 1992) as well as the
finding that the onset of depressive episodes occurs
concurrently with increases in positive symptoms
(Green et al., 1990).
The clinical significance of the 3 CDSS factors
requires speculation. Factor 1 appears to a general
depression factor and factor 2, with its highest
rating on guilty ideas of reference, could be inter-
preted as a cognitive factor. The potential clinical
significance of the CDSS factor 3 has been dis-
cussed above as part of the justification for its
retention. The lack of stability of factor 3 may
reflect the significant reduction in levels of depres-
sion noted between times 1 and 2. Since the scale
is to be used at both times of relapse and remission
it would be important to maintain a factor in the
scale which accounted for 10% of the variance at
time 1, even if this factor was not so stable at
time 2.
The results of the HDRS factor analysis are
difficult to interpret. The first problem hindering
interpretation is the poor convergence on a final
rotated solution. The statistical routine required
45 iterations to converge at time 1 and 72 at time
2, suggesting that there was no readily apparent
underlying factor structure. A second problem is
the massive changes in factor loading which
occurred between time 1 and time 2. Third, there
is evidence of poor divergent validity with respect
to schizophrenic symptomatology, indicated by the
significant correlations between the HDRS factors
and the positive and negative syndromes. The
multiple regression analyses confirm the poor dis-
criminant validity of the HDRS depression factors
and the positive and negative subscales of the
211
PANSS. Poor internal consistency is a final area
of concern. The HDRS produced lower ~ estimates
at both times 1 and 2 than the CDSS, despite the
greater number of items in the HDRS.
The results of the present study are consistent
with the only prior study which has examined the
factor structure of the HDRS in schizophrenia
(Goldman et al., 1992). Both studies examined a
group of patients at two points in time and the
number of HDRS factors found in both studies is
similar (6 and 7). In addition, Goldman and
colleagues reported that only 6 of 17 items loaded
on the same factors at both assessment times.
Similarly, both studies reported no correlation
between the total HDRS and negative symptoms
at initial assessment, but did find a significant
correlation at follow-up. The studies differ in that
Goldman et al. (1992) did not examine the issue
of overlap with positive symptoms. Extending this
work, the present study reports significant correla-
tions between HDRS factors and positive symp-
toms at both times. The degree of variance in
positive or negative symptoms that is explained by
the HDRS appears to vary between 17 and 32%.
This level of overlap between the measures is large
enough to warrant concern, particularly in clin-
ical trials.
The two studies also differ in the choice of the
main negative symptom measures. Goldman used
the Scale for Assessment of Negative Symptoms
(SANS) Andreasen (1981 ) a stand alone measure
of negative symptoms. In this study we used the
PANSS (Kay et al., 1987), a multidimensional
assessment instrument. The PANSS was selected
because the negative symptom measure was
designed to tap a different dimension of psycho-
pathology from positive and general symptoms of
psychopathology. The PANSS was selected in the
hope that it would produce a negative symptom
score that did not show the problems of overlap
previously demonstrated between the SANS and
HDRS (Addington and Addington, 1989).
In the current study, no attempt has been made
to interpret the factors produced in this analysis
of the HDRS because they appear so unstable. It
is not apparent why at time 2 suicidality and
insomnia should be the items which most load on
a factor with a significant correlation with negative
212 Donald A ddington et al. ~Schizophrenia Research 19 (1996) 205-212
symptoms. Hamilton (1967) and others (Rehm
and O'Hara, 1985) have also found several factors
in studies of the HDRS in depressed populations.
However, these dimensions have been replicated
across studies and have some face validity with
concepts such as core depression, anxiety, somati-
zation and insomnia.
In summary, this study supports the recommen-
dation of Goldman et al. (1992) that the HDRS,
when used in a population with schizophrenia,
should not be interpreted in the same manner as
in a population with depression. Global depression
scores measured by an instrument such as the
HDRS may represent several components of affect,
only a portion of which are consistent with
common notions of depression. The results of the
present study suggest that the CDSS is less con-
founded by positive and negative symptoms than
the HDRS. This difference should be of value in
studies of outcome in which depression in schizo-
phrenia is a variable of interest, and in studies
which seek to distinguish between depression, posi-
tive, negative and extrapyramidal symptoms.
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