The properties and utility of the CORE measure of melancholia

- Trained raters demonstrate high reliability in generating CORE scores.
- Those with CORE-assigned melancholia meet many of melancholia's ascriptions.
- The CORE has utility in advancing studies of causes and treatments of melancholia.

BackgroundThe CORE measure was designed to assess a central feature of melancholia - signs of psychomotor disturbance (PMD) - and so provide an alternate non-symptom based measure of melancholia or of its probability. This review evaluates development and application studies undertaken over the last 25 years to consider how well it has met its original objectives.MethodsAll studies published using the CORE measure as either the only or an adjunctive measure of melancholia were obtained and are considered in this review.ResultsFindings suggest high reliability in quantifying CORE scores can be achieved and that it has construct validity as a measure of PMD. A number of application studies assessing socio-demographic factors, cognitive and motor impairment, dexamethasone suppression and thyrotropin-releasing hormone, response to psychotherapy and to electroconvulsive therapy support its validity as a measure of melancholia, while functional brain imaging studies suggest that the measure identifies regions of decreased connectivity.LimitationsUse of the CORE benefits from rater training and for subjects to be assessed at or near nadir of their depressive episode. There have been insufficient studies evaluating genetic factors, and the treatment response of CORE-defined melancholic patients to antidepressant drugs of differing classes.ConclusionsThe CORE, either as a proxy or direct measure of melancholia, provides a strategy for assigning depressed subjects a diagnosis or melancholic or non-melancholic depression or for estimating the probability of melancholia.