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 the start of medication 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 often used as the standard against which other measures of depression are validated.
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 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 an interviewer-administered and rated measure, there is some subjectivity when it comes to interpretation and scoring. Interviewer bias can impact 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, there are either 17 or 21 items for which an interviewer provides ratings. Besides the interview with the depressed patient, other information can be utilized 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.
The 17-item version of the HDS is more commonly used than the 21-item version, which contains four additional items measuring symptoms related to depression, such as paranoia and obsession , rather than the severity of depressive symptoms themselves.
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 (sex drive), 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, 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 symptoms, a score of three indicates moderate symptoms, and a score of four represents the presence of severe symptoms. The remaining eight items are scored on a three-point scale, from zero to two, with zero representing absence of symptom, one indicating doubt that the symptom is present, and two representing clear presence of symptoms.
For the 17-item version, scores can range from 0 to 54. One formulation suggests that scores between 0 and 6 indicate a normal person with regard to depression, scores between 7 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.
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Ali Fahmy, Ph.D.