Hamilton Rating Scale for Depression

Last updated
Hamilton Rating Scale for Depression
Purposemeasures severity of depressive symptoms

The Hamilton Rating Scale for Depression (HRSD), [1] 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. [2] Max Hamilton originally published the scale in 1960 [3] and revised it in 1966, [4] 1967, [5] 1969, [6] and 1980. [7] 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.

Contents

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. [8] 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. [9] Hamilton maintained that his scale should not be used as a diagnostic instrument. [10]

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. [11] 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. [12]

Although Hamilton's original scale had 17 items, other versions included up to 29 items (HRSD-29). [13] [14] [15] [16]

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. [17]

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. [18]

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, [19] the Raskin Depression Rating Scale, [20] the Inventory of Depressive Symptomatology (IDS), the Quick Inventory of Depressive Symptomatology (QIDS), [21] PHQ-9, [22] and other questionnaires. [23] [24]

See also

Notes

  1. ↑ "the ham-d scale" (PDF). Archived from the original (PDF) on 2014-07-14. Retrieved 29 November 2012.
  2. ↑ Hedlund JL, Viewig BW (1979). "The Hamilton rating scale for depression: a comprehensive review". Journal of Operational Psychiatry. 10: 149–165.
  3. ↑ Hamilton M (1960). "A rating scale for depression". Journal of Neurology, Neurosurgery, and Psychiatry. 23 (1): 56–62. doi:10.1136/jnnp.23.1.56. PMC   495331 . PMID   14399272.
  4. ↑ Hamilton M (1966). "Assessment of change in psychiatric state by means of rating scales". Proceedings of the Royal Society of Medicine. 59 (Suppl 1): 10–13. PMC   1900655 . PMID   5922401.
  5. ↑ Hamilton M (1967). "Development of a rating scale for primary depressive illness". British Journal of Social and Clinical Psychology. 6 (4): 278–96. doi:10.1111/j.2044-8260.1967.tb00530.x. PMID   6080235.
  6. ↑ Hamilton M (1969). "Standardised assessment and recording of depressive symptoms". Psychiatria, Neurologia, Neurochirurgia. 72 (2): 201–5. PMID   5792061.
  7. ↑ Hamilton, M (1980). "Rating depressive patients". Journal of Clinical Psychiatry. 41 (12 Pt 2): 21–24. PMID   7440521.
  8. ↑ Firestone, R.W., & Firestone, L.A. (1996). Firestone Assessment of Self-Destructive Thoughts Manual. San Antonio, TX: Psychological Corporation.
  9. ↑ Bagby RM, Ryder AG, Schuller DR, Marshall MB (2004). "The Hamilton Depression Rating Scale: has the gold standard become a lead weight?". American Journal of Psychiatry. 161 (12): 2163–77. doi:10.1176/appi.ajp.161.12.2163. PMID   15569884.
  10. ↑ 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
  11. ↑ HDRS-17: Hamilton Depression Rating Scale (HDRS) at University of Florida, College of Medicine.Additional Questions Retrieved December 12, 2011.
  12. ↑ Williams JB (1989). "A structured interview guide for the Hamilton Depression Rating Scale". Archives of General Psychiatry. 45 (8): 742–7. doi:10.1001/archpsyc.1988.01800320058007. PMID   3395203.
  13. ↑ HRSD-7: 7-ITEM HAMILTON RATING SCALE FOR DEPRESSION: HAMD-7 Archived 2007-07-05 at the Wayback Machine in Official website of CANMAT: Canadian Network for Mood and Anxiety Treatments Archived 2008-06-24 at the Wayback Machine Accessed June 30, 2008
    McIntyre R, Kennedy S, Bagby RM, Bakish D (July 2002). "Assessing full remission". J Psychiatry Neurosci. 27 (4): 235–9. PMC   161657 . PMID   12174732.
  14. ↑ HRSD-21: The Hamilton Rating Scale for Depression Archived 2007-11-20 at the Wayback Machine (to be administered by a health care professional) (presented as a service by GlaxoWellcome, February 1997) in UMass HealthNet: Consumer Health Resources for Massachusetts Residents: Official website of the Lamar Soutter Library, University of Massachusetts Medical School, Worcester, MA, 01655 USA Archived 2017-08-29 at the Wayback Machine . Retrieved June 27, 2008.
  15. ↑ HRSD-24: Hamilton Depression Rating Scale — 24 item (to be completed by a trained clinician) in 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.
  16. ↑ 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
  17. ↑ Carrozzino, Danilo; Patierno, Chiara; Fava, Giovanni A.; Guidi, Jenny (2020-04-14). "The Hamilton Rating Scales for Depression: A Critical Review of Clinimetric Properties of Different Versions". Psychotherapy and Psychosomatics. 89 (3): 133–150. doi: 10.1159/000506879 . hdl: 11585/762175 . ISSN   1423-0348. PMID   32289809.
  18. ↑ National Collaborating Centre for Mental Health (2010). Depression: The Treatment and Management of Depression in Adults. NICE Clinical Guidelines. Vol. 90. British Psychological Society. p. 638. ISBN   978-1-904671-85-5. PMID   22132433. NBK63748.
  19. ↑ Wechsler H, Grosser GH, Busfield BL (October 1963). "The depression rating scale: a quantitative approach to the assessment of depressive symptomatology". Archives of General Psychiatry. 9: 334–343. doi: 10.1001/archpsyc.1963.01720160024003 . PMID   14045262.
  20. ↑ Raskin A, Schulterbrandt J, Reatig N, McKeon JJ (1969). "Replication of factors of psychopathology in interview, ward behavior and self-report ratings of hospitalized depressives". Journal of Nervous and Mental Disease. 148 (1): 87–98. doi: 10.1097/00005053-196901000-00010 . PMID   5768895. S2CID   39730272.
  21. ↑ Inventory of Depressive Symptomatology (IDS) & Quick Inventory of Depressive Symptomatology (QIDS) Archived 2007-06-26 at the Wayback Machine in IDS/QIDS: Instruments in English and Multiple Translations by the University of Pittsburgh Epidemiology Data Center, 2008. Retrieved June 27, 2008.
  22. ↑ Kroenke K, Spitzer RL, Williams JB (September 2001). "The PHQ-9: validity of a brief depression severity measure". J Gen Intern Med. 16 (9): 606–13. doi:10.1046/j.1525-1497.2001.016009606.x. PMC   1495268 . PMID   11556941.
  23. ↑ Psychiatric Rating Scales for Depression in www.neurotransmitter.net website by Shawn M. Thomas. Retrieved June 30, 2008.
  24. ↑ Boyle GJ (1985). "Self report measures of depression: Some psychometric considerations". British Journal of Clinical Psychology. 24: 45–59. doi: 10.1111/j.2044-8260.1985.tb01312.x . PMID   3971068. S2CID   27521019.

Related Research Articles

Psychological testing refers to the administration of psychological tests. Psychological tests are administered or scored by trained evaluators. A person's responses are evaluated according to carefully prescribed guidelines. Scores are thought to reflect individual or group differences in the construct the test purports to measure. The science behind psychological testing is psychometrics.

The Beck Depression Inventory, 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 marked a shift among mental health professionals, who had until then, viewed depression from a psychodynamic perspective, instead of it being rooted in the patient's own thoughts.

The clinical global impression (CGI) rating scales are measures of symptom severity, treatment response and the efficacy of treatments in treatment studies of patients with mental disorders. It is a brief 3-item observer-rated scale that can be used in clinical practice as well as in researches to track symptom changes. It was developed by Early Clinical Drug Evaluation Program (ECDEU) team of researchers for use in NIMH-led clinical trials that could provide clinical judgment based assessment for determining the severity of symptoms and the treatment progress. This was meant to assess the patient's functioning prior to and after initiating medication in trials which is an important part of study process. Its 3 items assess, 1) Severity of Illness (CGI-S), 2) Global Improvement (CGI-I), and 3) Efficacy Index. Many researchers, while recognizing the validity of the scale, consider it to be subjective as it requires the user of the scale to compare the subjects to typical patients in the clinician experience.

<span class="mw-page-title-main">Beck Anxiety Inventory</span> Psychological assessment tool

The Beck Anxiety Inventory (BAI) is a formative assessment and rating scale of anxiety. This self-report inventory, or 21-item questionnaire uses a scale ; the BAI is an ordinal scale; more specifically, a Likert scale that measures the scale quality of magnitude of anxiety.

The Montgomery–Åsberg Depression Rating Scale (MADRS) is a ten-item diagnostic questionnaire which mental health professionals use to measure the severity of depressive episodes in patients with mood disorders. It was designed in 1979 by British and Swedish researchers as an adjunct to the Hamilton Rating Scale for Depression (HAMD) which would be more sensitive to the changes brought on by antidepressants and other forms of treatment than the Hamilton Scale was. There is, however, a high degree of statistical correlation between scores on the two measures.

A depression rating scale is a psychometric instrument (tool), usually a questionnaire whose wording has been validated with experimental evidence, having descriptive words and phrases that indicate the severity of depression for a time period. When used, an observer may make judgements and rate a person at a specified scale level with respect to identified characteristics. Rather than being used to diagnose depression, a depression rating scale may be used to assign a score to a person's behaviour where that score may be used to determine whether that person should be evaluated more thoroughly for a depressive disorder diagnosis. Several rating scales are used for this purpose.

The Comprehensive Psychopathological Rating Scale (CPRS) is a scale for rating the severity of psychiatric symptoms and observed behaviour. CPRS was developed by Swedish psychiatrists Marie Åsberg, Carlo Perris, Daisy Schalling, and Göran Sedvall in collaboration with the British psychiatrist, Stuart Montgomery.

The Edinburgh Postnatal Depression Scale (EPDS) is a 10-item questionnaire that was developed to identify women who have postpartum depression. Items of the scale correspond to various clinical depression symptoms, such as guilt feeling, sleep disturbance, low energy, anhedonia, and suicidal ideation. Overall assessment is done by total score, which is determined by adding together the scores for each of the 10 items. Higher scores indicate more depressive symptoms. The EPDS may be used within 8 weeks postpartum and it also can be applied for depression screening during pregnancy.

The Patient Health Questionnaire (PHQ) is a multiple-choice self-report inventory that is used as a screening and diagnostic tool for mental health disorders of depression, anxiety, alcohol, eating, and somatoform disorders. It is the self-report version of the Primary Care Evaluation of Mental Disorders (PRIME-MD), a diagnostic tool developed in the mid-1990s by Pfizer Inc. The length of the original assessment limited its feasibility; consequently, a shorter version, consisting of 11 multi-part questions - the Patient Health Questionnaire was developed and validated.

The Hamilton Anxiety Rating Scale (HAM-A) is a psychological questionnaire used by clinicians to rate the severity of a patient's anxiety. Anxiety can refer to things such as "a mental state...a drive...a response to a particular situation…a personality trait...and a psychiatric disorder." Though it was one of the first anxiety rating scales to be published, the HAM-A remains widely used by clinicians. It was originally published by Max Hamilton in 1959. For clinical purposes, and the purpose of this scale, only severe or improper anxiety is attended to. This scale is considered a "clinical rating" of the extensiveness of anxiety, and is intended for individuals that are "already diagnosed with anxiety neurosis."

The Children's Depression Inventory is a psychological assessment that rates the severity of symptoms related to depression or dysthymic disorder in children and adolescents. The CDI is a 27-item scale that is self-rated and symptom-oriented. The assessment is now in its second edition. The 27 items on the assessment are grouped into five major factor areas. Clients rate themselves based on how they feel and think, with each statement being identified with a rating from 0 to 2. The CDI was developed by American clinical psychologist Maria Kovacs, PhD, and was published in 1979. It was developed by using the Beck Depression Inventory (BDI) of 1967 for adults as a model. The CDI is a widely used and accepted assessment for the severity of depressive symptoms in children and youth, with high reliability. It also has a well-established validity using a variety of different techniques, and good psychometric properties. The CDI is a "Level B test," which means that the test is somewhat complex to administer and score, with the administrator requiring training.

The Somatic Symptom Scale - 8 (SSS-8) is a brief self-report questionnaire used to assess somatic symptom burden. It measures the perceived burden of common somatic symptoms. These symptoms were originally chosen to reflect common symptoms in primary care but they are relevant for a large number of diseases and mental disorders. The SSS-8 is a brief version of the popular Patient Health Questionnaire - 15 (PHQ-15).

The Mood Disorder Questionnaire (MDQ) is a self-report questionnaire designed to help detect bipolar disorder. It focuses on symptoms of hypomania and mania, which are the mood states that separate bipolar disorders from other types of depression and mood disorder. It has 5 main questions, and the first question has 13 parts, for a total of 17 questions. The MDQ was originally tested with adults, but it also has been studied in adolescents ages 11 years and above. It takes approximately 5–10 minutes to complete. In 2006, a parent-report version was created to allow for assessment of bipolar symptoms in children or adolescents from a caregiver perspective, with the research looking at youths as young as 5 years old. The MDQ has become one of the most widely studied and used questionnaires for bipolar disorder, and it has been translated into more than a dozen languages.

The Child Mania Rating Scales (CMRS) is a 21-item diagnostic screening measure designed to identify symptoms of mania in children and adolescents aged 9–17 using diagnostic criteria from the DSM-IV, developed by Pavuluri and colleagues. There is also a 10-item short form. The measure assesses the child's mood and behavior symptoms, asking parents or teachers to rate how often the symptoms have caused a problem for the youth in the past month. Clinical studies have found the CMRS to be reliable and valid when completed by parents in the assessment of children's bipolar symptoms. The CMRS also can differentiate cases of pediatric bipolar disorder from those with ADHD or no disorder, as well as delineating bipolar subtypes. A meta-analysis comparing the different rating scales available found that the CMRS was one of the best performing scales in terms of telling cases with bipolar disorder apart from other clinical diagnoses. The CMRS has also been found to provide a reliable and valid assessment of symptoms longitudinally over the course of treatment. The combination of showing good reliability and validity across multiple samples and clinical settings, along with being free and brief to score, make the CMRS a promising tool, especially since most other checklists available for youths do not assess manic symptoms.

The Mood and Feelings Questionnaire is a survey that measures depressive symptoms in children and young adults. It was developed by Adrian Angold and Elizabeth J. Costello in 1987, and validity data were gathered as part of the Great Smokey Mountain epidemiological study in Western North Carolina. The questionnaire consists of a variety of statements describing feelings or behaviors that may manifest as depressive symptoms in children between the ages of 6 and 17. The subject is asked to indicate how much each statement applies to their recent experiences. The Mood and Feelings Questionnaire has six versions, short and long forms of each of the following: a youth self-report, a version that a parent would complete, and a self-report version for adults. Several peer-reviewed studies have found the Mood and Feelings Questionnaire to be a reliable and valid measure of depression in children. Compared to many other depression scales for youth, it has more extensive coverage of symptoms and more age-appropriate wording and content.

The General Behavior Inventory (GBI) is a 73-question psychological self-report assessment tool designed by Richard Depue and colleagues to identify the presence and severity of manic and depressive moods in adults, as well as to assess for cyclothymia. It is one of the most widely used psychometric tests for measuring the severity of bipolar disorder and the fluctuation of symptoms over time. The GBI is intended to be administered for adult populations; however, it has been adapted into versions that allow for juvenile populations, as well as a short version that allows for it to be used as a screening test.

The Structured Inventory of Malingered Symptomatology (SIMS) is a 75-item true-false questionnaire intended to measure malingering; that is, intentionally exaggerating or feigning psychiatric symptoms, cognitive impairment, or neurological disorders.

The Kiddie Schedule for Affective Disorders and Schizophrenia (K-SADS) is a semi-structured interview aimed at early diagnosis of affective disorders such as depression, bipolar disorder, and anxiety disorder. There are different versions of the test that have use different versions of diagnostic criteria, cover somewhat different diagnoses and use different rating scales for the items. All versions are structured to include interviews with both the child and the parents or guardians, and all use a combination of screening questions and more comprehensive modules to balance interview length and thoroughness.

The nine-item Patient Health Questionnaire (PHQ-9) is a depressive symptom scale and diagnostic tool introduced in 2001 to screen adult patients in primary care settings. The instrument assesses for the presence and severity of depressive symptoms and a possible depressive disorder. The PHQ-9 is a component of the larger self-administered Patient Health Questionnaire (PHQ), but can be used as a stand-alone instrument. The PHQ is part of Pfizer's larger suite of trademarked products, called the Primary Care Evaluation of Mental Disorders (PRIME-MD). The PHQ-9 takes less than three minutes to complete. It is scored by simply adding up the individual items' scores. Each of the nine items reflects a DSM-5 symptom of depression. Primary care providers can use the PHQ-9 to screen for possible depression in patients.

This page is based on this Wikipedia article
Text is available under the CC BY-SA 4.0 license; additional terms may apply.
Images, videos and audio are available under their respective licenses.