Hamilton Rating Scale for Depression

{{Short description|Psychometric outcome used to quantify symptoms of depression}}

{{Infobox diagnostic

| name = Hamilton Rating Scale for Depression

| image =

| alt =

| purpose = measures severity of depressive symptoms

| DiseasesDB =

| ICD10 =

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The Hamilton Rating Scale for Depression (HRSD),{{cite web|title=the ham-d scale|url=http://serene.me.uk/tests/ham-d.pdf|archive-url=https://web.archive.org/web/20140714173355/http://serene.me.uk/tests/ham-d.pdf |access-date=29 November 2012|archive-date=2014-07-14 }} also called the Hamilton Depression Rating Scale (HDRS), sometimes also abbreviated as HAM-D, is a multiple-item questionnaire used to provide an indication of depression, and as a guide to evaluate recovery.{{cite journal | author = Hedlund JL, Viewig BW | year = 1979 | title = The Hamilton rating scale for depression: a comprehensive review | journal = Journal of Operational Psychiatry | volume = 10 | pages = 149–165 }} Max Hamilton originally published the scale in 1960{{cite journal | author = Hamilton M | year = 1960 | title = A rating scale for depression | journal = Journal of Neurology, Neurosurgery, and Psychiatry | volume = 23 | issue = 1| pages = 56–62 | doi = 10.1136/jnnp.23.1.56 | pmid = 14399272 | pmc = 495331 }} and revised it in 1966,{{cite journal | author = Hamilton M | year = 1966 | title = Assessment of change in psychiatric state by means of rating scales | journal = Proceedings of the Royal Society of Medicine | volume = 59 | issue = Suppl 1 | pages = 10–13 | pmid = 5922401 | pmc = 1900655 }} 1967,{{cite journal | author = Hamilton M | year = 1967 | title = Development of a rating scale for primary depressive illness | journal = British Journal of Social and Clinical Psychology | volume = 6 | issue = 4| pages = 278–96 | pmid = 6080235 | doi = 10.1111/j.2044-8260.1967.tb00530.x }} 1969,{{cite journal | author = Hamilton M | year = 1969 | title = Standardised assessment and recording of depressive symptoms | journal = Psychiatria, Neurologia, Neurochirurgia | volume = 72 | issue = 2| pages = 201–5 | pmid = 5792061 }} and 1980.{{cite journal|last=Hamilton|first=M|year=1980|title=Rating depressive patients|journal=Journal of Clinical Psychiatry|volume=41|issue=12 Pt 2|pages=21–24|pmid=7440521}} The questionnaire is designed for adults and is used to rate the severity of their depression by probing mood, feelings of guilt, suicide ideation, insomnia, agitation or retardation, anxiety, weight loss, and somatic symptoms.

The HRSD has been criticized for use in clinical practice as it places more emphasis on insomnia than on feelings of hopelessness, self-destructive thoughts, suicidal cognitions and actions.Firestone, R.W., & Firestone, L.A. (1996). Firestone Assessment of Self-Destructive Thoughts Manual. San Antonio, TX: Psychological Corporation. An antidepressant may show statistical efficacy even when thoughts of suicide increase but sleep is improved, or for that matter, an antidepressant that as a side effect increases sexual and gastrointestinal symptom ratings may register as being less effective in treating the depression itself than it actually is.{{cite journal |vauthors=Bagby RM, Ryder AG, Schuller DR, Marshall MB |year=2004 |title=The Hamilton Depression Rating Scale: has the gold standard become a lead weight? |journal= American Journal of Psychiatry |volume=161 |issue=12 |pages=2163–77 |pmid=15569884 |doi= 10.1176/appi.ajp.161.12.2163}} Hamilton maintained that his scale should not be used as a diagnostic instrument.Berrios, G.E., & Bulbena, A. (1990). The Hamilton Depression Scale and the Numerical Description of the Symptoms of Depression. In Bech, P., & Coppen, A. (Eds.), The Hamilton Scales, Heidelberg: Springer, pp. 80–92

The original 1960 version contained 17 items (HDRS-17), but four other questions not added to the total score were used to provide additional clinical information. Each item on the questionnaire is scored on a 3 or 5 point scale, depending on the item, and the total score is compared to the corresponding descriptor. Assessment time is about 20 minutes.

Methodology

The patient is rated by a clinician on 17 to 29 items (depending on version) scored either on a 3-point or 5-point Likert-type scale. For the 17-item version, a score of 0–7 is considered to be normal while a score of 20 or higher (indicating at least moderate severity) is usually required for entry into a clinical trial.HDRS-17: [http://dcf.psychiatry.ufl.edu/files/2011/05/HAMILTON-DEPRESSION.pdf Hamilton Depression Rating Scale (HDRS)] at [http://dcf.psychiatry.ufl.edu University of Florida, College of Medicine].Additional Questions Retrieved December 12, 2011. Questions 18–20 may be recorded to give further information about the depression (such as whether diurnal variation or paranoid symptoms are present), but are not part of the scale. A structured interview guide for the questionnaire is available.{{cite journal | author = Williams JB | year = 1989 | title = A structured interview guide for the Hamilton Depression Rating Scale | journal = Archives of General Psychiatry | volume = 45 | issue = 8| pages = 742–7 | pmid = 3395203 | doi = 10.1001/archpsyc.1988.01800320058007 }}

Although Hamilton's original scale had 17 items, other versions included up to 29 items (HRSD-29).HRSD-7: [http://www.canmat.org/resources/PDF/HAMD-7%20rating%20scale.pdf 7-ITEM HAMILTON RATING SCALE FOR DEPRESSION: HAMD-7] {{webarchive|url=https://web.archive.org/web/20070705052003/http://www.canmat.org/resources/PDF/HAMD-7%20rating%20scale.pdf |date=2007-07-05 }} in [http://www.canmat.org/ Official website of CANMAT: Canadian Network for Mood and Anxiety Treatments] {{webarchive|url=https://web.archive.org/web/20080624113205/http://www.canmat.org/ |date=2008-06-24 }} Accessed June 30, 2008
{{cite journal | pmid = 12174732 | volume=27 | title=Assessing full remission | pmc=161657 | date=July 2002 | vauthors=McIntyre R, Kennedy S, Bagby RM, Bakish D | journal=J Psychiatry Neurosci | issue=4 | pages=235–9}}HRSD-21: [http://healthnet.umassmed.edu/mhealth/HAMD.pdf The Hamilton Rating Scale for Depression] {{Webarchive|url=https://web.archive.org/web/20071120002356/http://healthnet.umassmed.edu/mhealth/HAMD.pdf |date=2007-11-20 }} (to be administered by a health care professional) (presented as a service by GlaxoWellcome, February 1997) in [http://healthnet.umassmed.edu UMass HealthNet: Consumer Health Resources for Massachusetts Residents: Official website of the Lamar Soutter Library, University of Massachusetts Medical School, Worcester, MA, 01655 USA] . Retrieved June 27, 2008.HRSD-24: [http://www.medafile.com/cln/HDRS.html Hamilton Depression Rating Scale — 24 item] (to be completed by a trained clinician) in [http://www.medafile.com FOCUS ON ALZHEIMER'S DISEASE: MEDAFILE; Site constructed and maintained by J. Wesson Ashford, M.D., Ph.D., Stanford / VA Alzheimer's Center, Palo Alto VA Hospital, 3801 Miranda Way, Palo Alto, CA 94304 USA]. Retrieved June 27, 2008.HRSD-29: Williams JBW, Link MJ, Rosenthal NE, Terman M, Structured Interview Guide for the Hamilton Depression Rating Scale, Seasonal Affective Disorders Version (SIGHSAD). New York Psychiatric Institute, New York, 1988

Unstructured versions of the HDRS provide general instructions for rating items, while structured versions may provide definitions and/or specific interview questions for use. Structured versions of the HDRS show more reliability than unstructured versions with informed use.{{Cite journal|last1=Carrozzino|first1=Danilo|last2=Patierno|first2=Chiara|last3=Fava|first3=Giovanni A.|last4=Guidi|first4=Jenny|date=2020-04-14|title=The Hamilton Rating Scales for Depression: A Critical Review of Clinimetric Properties of Different Versions|journal=Psychotherapy and Psychosomatics|volume=89|issue=3|pages=133–150|doi=10.1159/000506879|issn=1423-0348|pmid=32289809|doi-access=free|hdl=11585/762175|hdl-access=free}}

Levels of depression

The UK National Institute for Health & Clinical Excellence has specified the following "levels of depression" based on the 17-item HRSD. It previously used the terms in parentheses, which are those of the American Psychiatric Association.{{cite book |author=((National Collaborating Centre for Mental Health)) |title=Depression: The Treatment and Management of Depression in Adults |publisher=British Psychological Society |date=2010 |isbn=978-1-904671-85-5 |url=https://www.ncbi.nlm.nih.gov/books/NBK63748/ |series=NICE Clinical Guidelines |volume=90 |id=NBK63748 |pmid=22132433 |page=638}}

Not depressed: 0–7
Mild (subthreshold): 8–13
Moderate (mild): 14–18
Severe (moderate): 19–22
Very severe (severe): >23

Other scales

Other scales include the Montgomery-Åsberg Depression Rating Scale (MADRS), the Beck Depression Inventory (BDI), the Zung Self-Rating Depression Scale, the Wechsler Depression Rating Scale,{{cite journal |vauthors = Wechsler H, Grosser GH, Busfield BL |title=The depression rating scale: a quantitative approach to the assessment of depressive symptomatology | journal = Archives of General Psychiatry | volume = 9 | pages = 334–343 | pmid = 14045262 | date = October 1963 | doi = 10.1001/archpsyc.1963.01720160024003 |doi-access=free }} the Raskin Depression Rating Scale,{{cite journal |vauthors = Raskin A, Schulterbrandt J, Reatig N, McKeon JJ | year = 1969 | title = Replication of factors of psychopathology in interview, ward behavior and self-report ratings of hospitalized depressives | journal = Journal of Nervous and Mental Disease | volume = 148 | issue = 1| pages = 87–98 | doi = 10.1097/00005053-196901000-00010 | pmid = 5768895 | s2cid = 39730272 |doi-access=free }} the Inventory of Depressive Symptomatology (IDS), the Quick Inventory of Depressive Symptomatology (QIDS),[http://www.ids-qids.org/index2.html Inventory of Depressive Symptomatology (IDS) & Quick Inventory of Depressive Symptomatology (QIDS)] {{Webarchive|url=https://web.archive.org/web/20070626130353/http://www.ids-qids.org/index2.html |date=2007-06-26 }} in [http://www.ids-qids.org/ IDS/QIDS: Instruments in English and Multiple Translations] by the University of Pittsburgh Epidemiology Data Center, 2008. Retrieved June 27, 2008. PHQ-9,{{cite journal |vauthors=Kroenke K, Spitzer RL, Williams JB |title=The PHQ-9: validity of a brief depression severity measure |journal=J Gen Intern Med |volume=16 |issue=9 |pages=606–13 |date=September 2001 |pmid=11556941 |pmc=1495268 |doi=10.1046/j.1525-1497.2001.016009606.x }} and other questionnaires.[http://www.neurotransmitter.net/depressionscales.html Psychiatric Rating Scales for Depression] in [http://www.neurotransmitter.net www.neurotransmitter.net website] by [http://www.neurotransmitter.net/bio.html Shawn M. Thomas]. Retrieved June 30, 2008.{{cite journal | author = Boyle GJ | year = 1985 | title = Self report measures of depression: Some psychometric considerations | journal = British Journal of Clinical Psychology | volume = 24 | pages = 45–59 | doi = 10.1111/j.2044-8260.1985.tb01312.x | pmid = 3971068 | s2cid = 27521019 | doi-access = free }}

Notes

External links

HRSD [http://farmacologiaclinica.info/scales/hamilton-depression/ online calculator] {{Webarchive|url=https://web.archive.org/web/20130824134514/http://farmacologiaclinica.info/scales/hamilton-depression/ |date=2013-08-24 }}
{{cite web |url= http://healthnet.umassmed.edu/mhealth/HAMD.pdf |title= The Hamilton Rating Scale for Depression |access-date= 2007-11-25 |archive-url= https://web.archive.org/web/20071120002356/http://healthnet.umassmed.edu/mhealth/HAMD.pdf |archive-date= 2007-11-20 |url-status= dead }} {{small|(49.0 KB)}}
[http://www.psychiatrictimes.com/clinical-scales/depression/ Clinically Useful Psychiatric Scales: HAM-D (Hamilton Depression Rating Scale)]. Accessed March 6, 2009.
[https://web.archive.org/web/20090728195932/http://geocities.com/psych_out_print_hamilton/ Hamilton Depression Rating Scale - Original scientific paper published in 1960] in [https://web.archive.org/web/20091027113835/http://geocities.com/psych_out_print Psychiatry out of Print website]. Accessed June 27, 2008.
[http://www.garfield.library.upenn.edu/classics1981/A1981MA25900001.pdf Commentary on the HRSD by Max Hamilton, July 10, 1981], in "This Week's Citation Classic", Current Contents 33: 325 (August 17, 1981), in [http://www.garfield.library.upenn.edu website of Eugene Garfield, Ph.D.] {{Webarchive|url=https://web.archive.org/web/20170426060025/http://www.garfield.library.upenn.edu/ |date=2017-04-26 }}. Accessed June 27, 2008.
Side-by-side comparison of the MADRS and the HDRS-24 in [https://web.archive.org/web/20091229012513/http://www.fda.gov/ohrms/dockets/AC/07/briefing/2007-4273b1_04-DescriptionofMADRSHAMDDepressionR(1).pdf "Description of the Hamilton Depression Rating Scale (HAMD) and the Montgomery-Asberg Depression Rating Scale (MADRS)] by the U.S. Food and Drug Administration, 2007. Accessed June 27, 2008.

Category:Depression screening and assessment tools