Hamilton Depression Rating Scale HAM-D

Features Assessments Pricing Practitioner sign in Create account

Conduct psychological assessments remotely, get scores automatically, and maintain clinical records securely

What is HDRS

The Hamilton Depression Rating Scale (HDRS) is the most widely used clinician-administered depression assessment scale. The scale contains 17 variables. Some are defined in terms of a series of categories of increasing intensity, while others are defined by a number of equal-valued terms.

HDRS Printable PDF

You can create a free account on PsyPack to access fillable PDFs, manuals and educational resources for the HDRS

HDRS Scoring and Interpretation

PsyPack can automatically score the HDRS assessment and prepare corresponding tables and graphs.

Further, PsyPack automatically plots a graph to help you easily track progress over time.

Domain

Depression

What does HDRS measure

The purpose of the evaluation is to:

assess severity of depressive symptoms, and
assess change in depressive symptoms.

Administration

Clinician-administered

Type of outcome tool

Clinical

Assessment modes

Questionnaire

Age and eligibility

Adults

Estimated time

20 to 30 minutes

Notes

Clinician's administration may influence the subject by how they explain the question. Interpretation of the subjects response may also be hindered by the clinician even when methods are present to prevent interviewer biases.

Various problems are to be found with specific symptoms. Thus considerable difficulty is found with the depressive triad: depressive mood, guilt, and suicidal tendencies. These are so closely linked in description and judgment as to be very difficult to separate. It is very important to avoid the halo effect by automatically giving all of them high or low scores, as the case may be.

Depressed Mood - This tends to have a narrow range of scores, for no diagnosed patients will score zero and few will score 1 or 4. The most useful indicator for depressed mood is the tendency to weep, but it must always be considered against the cultural background, and patients may also "go beyond weeping".
Suicide - An attempt at suicide scores 4, but such an attempt may sometimes occur suddenly against a background of very little suicidal tendency; in such cases it should be scored as 3. There will be great difficulty sometimes in differentiating between a real attempt at suicide and a demonstrative attempt; the rater must use his judgment.
Work and Loss of Interest - Difficulties at work and loss of interest in hobbies and social activities are both included. The patient who has given up work solely because of his illness is rated 4.
Retardation - A grade 4 patient is completely mute, and is therefore unsuitable for rating on the scale. Grade 3 patients need much care and patience to rate, but it can be done.
Agitation - This is defined as restlessness associated with anxiety. Unfortunately, a five-point scale was found impracticable, and therefore this variable is rated on a three-point scale. The mildest degrees of agitation cause considerable difficulty.
Gastro-intestinal Symptoms - These occur in connexion with both anxiety and depression. Considerable clinical experience is required to evaluate them satisfactorily. The definitions given have been found very useful in practice.
General Somatic Symptoms - In depressions these are characteristically vague and ildefined, and it is extremely difficult to get a satisfactory description of them from the patient.
Hypochondriasis - This is easy to rate when it is obviously present, but difficulties arise with mild hypochondriacal preoccupations. Phobias of specific disease can cause difficulties. A phobia of venereal disease or of cancer will sometimes be rated under "guilt" by the nature of the symptom, but other cases may give rise to much doubt and judgment requires care. Fortunately, phobias are not common, but the whole subject of hypochondriasis could well repay clinical investigation.
Insight - This must always be considered in relation to the patient's thinking and background of knowledge. It is important to distinguish between a patient who has no insight and one who is reluctant to admit that he is "mental".

It is particularly useful to have two raters independently scoring a patient at the same interview, since this gives data for calculating the inter-physician reliability.

After recovery from depression, some patients sometimes show a brief hypomanic reaction, during which the exuberantly cheerful patient will deny that he has any symptoms whatever, though he is obviously not to be regarded as normal. In such cases, the rating scale is inapplicable and should be delayed until the patient has fully recovered.

The present scale has been devised for use only on patients already diagnosed as suffering from affective disorder of depressive type. It is used for quantifying the results of an interview, and its value depends entirely on the skill of the interviewer in eliciting the necessary information. The interviewer may, and should, use all information available to help him with his interview and in making the final assessment. The scale has undergone a number of changes since it was first tried out, and although there is room for further improvement, it will be found efficient and simple in use. It has been found to be of great practical value in assessing results of treatment.

Attribution and References

Hamilton M. A RATING SCALE FOR DEPRESSION. Journal of Neurology, Neurosurgery & Psychiatry 1960;23:56-62.

Archived link

Zimmerman, M., et al., Severity classification on the Hamilton depression rating scale. Journal of Affective Disorders, (2013), http://dx.doi.org/10.1016/j.jad.2013.04.028

Archived link

Williams JB. A structured interview guide for the Hamilton Depression Rating Scale. Arch Gen Psychiatry. 1988 Aug;45(8):742-7. doi: 10.1001/archpsyc.1988.01800320058007. PMID: 3395203.

Archived link