Psychology RootsBech-Rafaelsen Melancholia Rating Scale (MES)
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About Bech-Rafaelsen Melancholia Rating Scale (MES)
Scale Name
Bech-Rafaelsen Melancholia Rating Scale (MES)
Author Details
Per Bech and Ole J. Rafaelsen
Translation Availability
English
Background/Description
The Bech-Rafaelsen Melancholia Rating Scale (MES), developed by Per Bech and Ole J. Rafaelsen in 1980, is a concise, observer-rated psychological tool designed to assess the severity of melancholic depression. Published in Acta Psychiatrica Scandinavica Supplementum, the MES was created to provide a streamlined alternative to broader depression scales like the Hamilton Depression Rating Scale (HDRS), focusing specifically on core melancholic features such as depressed mood, psychomotor retardation, and guilt.
This scale emerged from a need for a clinically sensitive measure that could capture the distinct phenomenology of melancholia—a subtype of depression characterized by profound sadness, anhedonia, and biological symptoms—making it particularly useful in psychiatric research and practice.
The MES comprises 11 items, each scored on a 5-point scale (0 = “not present” to 4 = “severe”), yielding a total score range of 0 to 44. Items include emotional symptoms (e.g., depressed mood, guilt) and physical signs (e.g., retardation, sleep disturbance), assessed through a structured clinical interview. Taking approximately 15-20 minutes to complete, the MES offers a focused evaluation of melancholic severity, aiding in diagnosis, treatment planning, and monitoring therapeutic outcomes, such as responses to antidepressants or electroconvulsive therapy. Its translations into multiple languages and its enduring relevance in studying melancholic depression highlight its utility across diverse clinical settings.
Administration, Scoring and Interpretation
- Obtain the copy: Access the MES from its original publication in Bech and Rafaelsen (1980) via Acta Psychiatrica Scandinavica Supplementum or authorized psychiatric resources, ensuring proper training for clinical use.
- Explain the purpose: Inform the clinician (and indirectly the patient) that the scale evaluates the severity of melancholic symptoms to guide diagnosis and treatment of depression.
- Provide instructions: Instruct the clinician to rate each of the 11 items based on observations and a semi-structured interview, using the 5-point scale and adhering to the provided descriptors.
- Approximate time: Allow approximately 15-20 minutes for the interview and scoring, depending on the patient’s condition and the clinician’s experience.
- Administer the scale: Conduct the assessment in a clinical environment, observing the patient’s behavior and responses during a structured interview, and document scores systematically.
Reliability and Validity
The Bech-Rafaelsen Melancholia Rating Scale exhibits robust psychometric properties, as established in its initial development and subsequent research. Inter-rater reliability is high, with correlation coefficients ranging from 0.85 to 0.92 among trained clinicians, reflecting consistent scoring across observers. Test-retest reliability, while not detailed extensively in the 1980 study, has been supported in later validations with coefficients around 0.80 over short intervals, indicating stability in untreated melancholic states.
Validity is well-documented through comparisons with established tools. Concurrent validity is evidenced by strong correlations (r = 0.75-0.85) with the HDRS melancholia subscale, while its focused item set ensures content validity for melancholic features. Discriminant validity distinguishes MES scores from mania or anxiety scales, confirming specificity to depression. Its sensitivity to change, demonstrated in clinical trials of antidepressants, supports its practical utility, with scores effectively tracking symptom reduction. These properties make the MES a reliable and valid measure for assessing melancholic depression.
Available Versions
11-Items
Reference
Bech, P., & Rafaelsen, O. J. (1980). The use of rating scales exemplified by a comparison of the Hamilton and the Bech‐Rafaelsen Melancholia Scale. Acta Psychiatrica Scandinavica, 62(S285), 128-132.
Important Link
Scale File:
Frequently Asked Questions
What does the Bech-Rafaelsen Melancholia Rating Scale measure?
It measures the severity of melancholic depression symptoms.
How many items are in the MES?
It includes 11 items scored from 0 to 4.
Who developed the MES?
It was developed by Per Bech and Ole Rafaelsen in 1980.
How long does it take to complete the MES?
It takes about 15-20 minutes via clinical interview.
What makes the MES different from other depression scales?
It focuses specifically on melancholic features, not general depression.
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