The Hamilton Rating Scale for Depression (HRSD), 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.
Max Hamilton
Max Hamilton (12 April 1912 – 9 September 1988) was born at Offenbach am Main, Germany. He migrated to England with his family (named Himmelschein) in 1914, aged years. He was educated at the Central Foundation Boys' School in Cowper Street a ...
originally published the scale in 1960 and revised it in 1966, 1967, 1969, and 1980. 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
Insomnia, also known as sleeplessness, is a sleep disorder in which people have trouble sleeping. They may have difficulty falling asleep, or staying asleep as long as desired. Insomnia is typically followed by daytime sleepiness, low energy, ...
,
agitation or retardation,
anxiety
Anxiety is an emotion which is characterized by an unpleasant state of inner turmoil and includes feelings of dread over anticipated events. Anxiety is different than fear in that the former is defined as the anticipation of a future threat wh ...
,
weight loss
Weight loss, in the context of medicine, health, or physical fitness, refers to a reduction of the total body mass, by a mean loss of fluid, body fat ( adipose tissue), or lean mass (namely bone mineral deposits, muscle, tendon, and other co ...
, 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. 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 increase sexual and gastrointestinal symptom ratings may register as being less effective in treating the depression itself than it actually is. Hamilton maintained that his scale should not be used as a diagnostic instrument.
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. Questions 18–20 may be recorded to give further information about the depression (such as whether
diurnal variation or
paranoid
Paranoia is an instinct or thought process that is believed to be heavily influenced by anxiety or fear, often to the point of delusion and irrationality. Paranoid thinking typically includes persecutory beliefs, or beliefs of conspiracy c ...
symptoms are present), but are not part of the scale. A structured interview guide for the questionnaire is available.
Although Hamilton's original scale had 17 items, other versions included up to 29 items (HRSD-29).
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.
Levels of depression
The
National Institute for Health & Clinical Excellence of the UK established the levels of depression in relation to the 17 item HRSD compared with those suggested by the APA.
APA 2000 (NIHCE 2019):
* 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
The Beck Depression Inventory (BDI, BDI-1A, BDI-II), created by Aaron T. Beck, is a 21-question multiple-choice self-report inventory, one of the most widely used psychometric tests for measuring the severity of depression. Its development mark ...
(BDI), the
Zung Self-Rating Depression Scale
The Zung Self-Rating Depression Scale was designed by Duke University psychiatrist William W.K. Zung MD (1929–1992) to assess the level of depression for patients diagnosed with depressive disorder.
* 20–44 Normal Range
* 45–59 Mildly Dep ...
, the Wechsler Depression Rating Scale, the Raskin Depression Rating Scale, the Inventory of Depressive Symptomatology (IDS), the Quick Inventory of Depressive Symptomatology (QIDS), and other questionnaires.
See also
*
Diagnostic classification and rating scales used in psychiatry
Diagnosis is the identification of the nature and cause of a certain phenomenon. Diagnosis is used in many different disciplines, with variations in the use of logic, analytics, and experience, to determine " cause and effect". In systems enginee ...
*
Diagnostic and Statistical Manual of Mental Disorders
The ''Diagnostic and Statistical Manual of Mental Disorders'' (DSM; latest edition: DSM-5-TR, published in March 2022) is a publication by the American Psychiatric Association (APA) for the classification of mental disorders using a common langua ...
*
List of psychology topics
The following outline is provided as an overview of and topical guide to psychology:
Psychology refers to the study of subconscious and conscious activities, such as emotions and thoughts. It is a field of study that bridges the scientific and ...
*
Receiver operating characteristic
A receiver operating characteristic curve, or ROC curve, is a graphical plot that illustrates the diagnostic ability of a binary classifier system as its discrimination threshold is varied. The method was originally developed for operators of ...
Notes
External links
* HRS
online calculator*
Clinically Useful Psychiatric Scales: HAM-D (Hamilton Depression Rating Scale) Accessed March 6, 2009.
Hamilton Depression Rating Scale - Original scientific paper published in 1960''in'
Psychiatry out of Print website Accessed June 27, 2008.
Commentary on the HRSD by Max Hamilton, July 10, 1981 ''in'' "This Week's Citation Classic",
Current Contents
''Current Contents'' is a rapid alerting service database from Clarivate Analytics, formerly the Institute for Scientific Information and Thomson Reuters. It is published online and in several different printed subject sections.
History
''Cur ...
33: 325 (August 17, 1981), ''in'
website of Eugene Garfield, Ph.D. Accessed June 27, 2008.
* Side-by-side comparison of the MADRS and the HDRS-24 ''in'
"Description of the Hamilton Depression Rating Scale (HAMD) and the Montgomery-Asberg Depression Rating Scale (MADRS)by the
U.S. Food and Drug Administration
The United States Food and Drug Administration (FDA or US FDA) is a federal agency of the Department of Health and Human Services. The FDA is responsible for protecting and promoting public health through the control and supervision of food ...
, 2007. Accessed June 27, 2008.
{{Depression rating scales
Depression screening and assessment tools