Hamilton Depression Scale
Hamilton Depression Scale
The Hamilton Depression Scale (HDS or HAMD) is a test measuring the severity of depressive symptoms in individuals, often those who have already been diagnosed as having a depressive disorder. It is sometimes known as the Hamilton Rating Scale for Depression (HRSD) or the Hamilton Depression Rating Scale (HDRS).
The HDS is used to assess the severity of depressive symptoms present in both children and adults. It is often used as an outcome measure of depression in evaluations of antidepressant psychotropic medications and is a standard measure of depression used in research of the effectiveness of depression therapies and treatments. It can be administered prior to medication being started and then again during follow-up visits, so that medication dosage can be changed in part based on the patient’s test score. The HDS is often used as the standard against which other measures of depression are validated. There is a computerized version available intended for administration by telephone using a voice-recognition system and a computerized “interviewer.”
The HDS was developed by Max Hamilton in 1960 as a measure of depressive symptoms that could be used in conjunction with clinical interviews with depressed patients. It was later revised in 1967. Hamilton also designed the Hamilton Depression Inventory (HDI), a self-report measure for adults consistent with his theoretical formulation of depression in the HDS, and the Hamilton Anxiety Scale (HAS), an interviewer-rated test measuring the severity of anxiety symptoms.
Some symptoms related to depression, such as self-esteem and self-deprecation, are not explicitly included in the HDS items. Also, because anxiety is specifically asked about on the HDS, it is not always possible to separate symptoms related to anxiety from symptoms related to depression.
Because the HDS is administered and rated by the interviewer, there is some subjectivity when it comes to interpretation and scoring. Interviewer bias can affect the results. For this reason, some people prefer self-report measures where scores are completely based on the interviewee’s responses.
Depending on the version used, an interviewer can provide ratings for a test with 17 or 24 items. In addition to the items on the 17-item scale, the 24-item scale also addresses daytime-only symptoms, helplessness, hopelessness, worthlessness, obsessional symptoms, and paranoid feelings. A 21-item version has also been used for evaluations. Along with the patient interview answers, other information can be used in formulating ratings, such as information gathered from family, friends, and patient records. Hamilton stressed that the interview process be easygoing and informal and that there are no specific questions that must be asked.
Examples of items for which interviewers must give ratings include overall depression, guilt, suicide, insomnia , problems related to work, psychomotor retardation, agitation, anxiety, gastrointestinal and other physical symptoms, loss of libido, hypochondriasis , loss of insight, and loss of weight. For the overall rating of depression, for example, Hamilton believed one should look for feelings of hopelessness and gloominess, pessimism regarding the future, and a tendency to cry. For the rating of suicide, an interviewer should look for suicidal ideas and thoughts, as well as information regarding suicide attempts.
In the 17-item version, which is most commonly used, nine of the items are scored on a five-point scale, ranging from zero to four. A score of zero represents an absence of the depressive symptom being measured, a score of one indicates doubt concerning the presence of the symptom, a score of two indicates mild
Hypochondriasis —A mental condition in which the affected person perceives illness or symptoms of illness when none exist.
Psychomotor retardation —Slowdown in motor activity directly proceeding from mental activity.
Psychotropic medication —Medication that has an effect on the mind, brain, behavior, perceptions, or emotions. Psychotropic medications are used to treat mental illnesses because they affect a patient’s moods and perceptions.
Reliability —The ability of a test to yield consistent, repeatable results.
Validity —The ability of a test to measure accurately what it claims to measure.
to moderate symptoms, a score of three indicates moderate to severe symptoms, and a score of four represents the presence of extreme symptoms. The remaining eight items are scored on a three-point scale, from zero to two, with zero representing absence of symptom, one indicating that the symptom is present to a mild or moderate degree, and two representing clear presence of symptoms.
For the 17-item version, scores can range from zero to 54. One formulation suggests that scores between zero and six indicate a person who is typical and lacks morbidity with regard to depression; scores between seven and 17 indicate mild depression; scores between 18 and 24 indicate moderate depression; and scores over 24 indicate severe depression.
There has been evidence to support the reliability and validity of the HDS. The scale correlates highly with other clinician-rated and self-report measures of depression.
Edelstein, Barry. Comprehensive Clinical Psychology, Vol. 7: Clinical Geropsychology. Amsterdam: Elsevier, 1998.
Maruish, Mark R. The Use of Psychological Testing for Treatment Planning and Outcomes Assessment. Mahwah, NJ: Lawrence Erlbaum Associates, 1999.
Ollendick, Thomas. Comprehensive Clinical Psychology, Vol. 5: Children and Adolescents: Clinical Formulation and Treatment. Amsterdam: Elsevier, 1998.
Schutte, Nicola S., and John M. Malouff. Sourcebook of Adult Assessment Strategies. New York: Plenum Press, 1995.
Because the scale is in the public domain, it is available on numerous Web sites. One example is at <http://healthnet.umassmed.edu/mhealth/HAMD.pdf>. Note that this scale is intended to be administered and interpreted by a trained professional.
U.S. Food and Drug Administration. Description of the Hamilton Depression Rating Scale (HAMD) and the Montgomery-Asberg Depression Rating Scale (MADRS). (2007) Available online at: <http://www.fda.gov/ohrms/dockets/AC/07/briefing/2007-4273b1_04-DescriptionofMADRSHAMDDepressionR(1).pdf>.
Ali Fahmy, PhD
Emily Jane Willingham, PhD