Hamilton Depression Rating Scale
Encyclopedia
The Hamilton Rating Scale for Depression (HRSD), also known as the Hamilton Depression Rating Scale (HDRS) or abbreviated to HAM-D, is a multiple choice questionnaire that clinicians may use to rate the severity of a patient's major depression. Max Hamilton
originally published the scale in 1960 and reviewed and evaluated it in 1966, 1967, 1969, and 1980. Initially considered the "Gold Standard
", there is increased criticism that it is flawed both as a test instrument and in its conceptual basis. It is also the case that users often disregard the constraints and instructions specified by Hamilton himself who was very clear about the fact that his scale could not be used as a diagnostic instrument.
The questionnaire rates the severity of symptoms observed in depression such as low mood
, insomnia
, agitation
, anxiety
and weight loss
. The questionnaire is presently one of the most commonly used scales for rating depression in medical research.
The clinician must choose the possible responses to each question by interviewing the patient and by observing the patient's symptoms. Each question has between 3-5 possible responses which increase in severity. In the original scale published in 1960, the first 17 questions contribute to the total score (HRSD-17). Questions 18-21 are 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.
Although Hamilton's original scale had 17 questions, others later developed HRSD scales with different numbers of questions, the greatest of which is 29 (HRSD-29). Clinicians can use the HRSD in place of, or in conjunction with, the Montgomery-Åsberg Depression Rating Scale
(MADRS), the Beck Depression Inventory
(BDI), the Zung Self-Rating Depression Scale
, 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.
Max Hamilton
Professor Max Hamilton was born on 9 February 1912 at Offenbach am Main, Germany. In 1915, his family emigrated to England. He was educated at the Foundation School in Cowper Street and went on to study medicine at University College Hospital, London. He served from 1939 to 1946 in the Royal Air...
originally published the scale in 1960 and reviewed and evaluated it in 1966, 1967, 1969, and 1980. Initially considered the "Gold Standard
Gold standard (test)
In medicine and statistics, gold standard test refers to a diagnostic test or benchmark that is the best available under reasonable conditions. It does not have to be necessarily the best possible test for the condition in absolute terms...
", there is increased criticism that it is flawed both as a test instrument and in its conceptual basis. It is also the case that users often disregard the constraints and instructions specified by Hamilton himself who was very clear about the fact that his scale could not be used as a diagnostic instrument.
The questionnaire rates the severity of symptoms observed in depression such as low mood
Mood (psychology)
A mood is a relatively long lasting emotional state. Moods differ from emotions in that they are less specific, less intense, and less likely to be triggered by a particular stimulus or event....
, insomnia
Insomnia
Insomnia is most often defined by an individual's report of sleeping difficulties. While the term is sometimes used in sleep literature to describe a disorder demonstrated by polysomnographic evidence of disturbed sleep, insomnia is often defined as a positive response to either of two questions:...
, agitation
Psychomotor agitation
Psychomotor agitation is a series of unintentional and purposeless motions that stem from mental tension and anxiety of an individual. This includes pacing around a room, wringing one's hands, pulling off clothing and putting it back on and other similar actions...
, anxiety
Anxiety
Anxiety is a psychological and physiological state characterized by somatic, emotional, cognitive, and behavioral components. The root meaning of the word anxiety is 'to vex or trouble'; in either presence or absence of psychological stress, anxiety can create feelings of fear, worry, uneasiness,...
and weight loss
Weight loss
Weight loss, in the context of medicine, health or physical fitness, is a reduction of the total body mass, due to a mean loss of fluid, body fat or adipose tissue and/or lean mass, namely bone mineral deposits, muscle, tendon and other connective tissue...
. The questionnaire is presently one of the most commonly used scales for rating depression in medical research.
The clinician must choose the possible responses to each question by interviewing the patient and by observing the patient's symptoms. Each question has between 3-5 possible responses which increase in severity. In the original scale published in 1960, the first 17 questions contribute to the total score (HRSD-17). Questions 18-21 are 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.
Although Hamilton's original scale had 17 questions, others later developed HRSD scales with different numbers of questions, the greatest of which is 29 (HRSD-29). Clinicians can use the HRSD in place of, or in conjunction with, the Montgomery-Åsberg Depression Rating Scale
Montgomery-Åsberg Depression Rating Scale
The Montgomery-Åsberg Depression Rating Scale is a ten-item diagnostic questionnaire which psychiatrists use to measure the severity of depressive episodes in patients with mood disorders...
(MADRS), the Beck Depression Inventory
Beck Depression Inventory
The Beck Depression Inventory , created by Dr. Aaron T. Beck, is a 21-question multiple-choice self-report inventory, one of the most widely used instruments for measuring the severity of depression...
(BDI), the Zung Self-Rating Depression Scale
Zung Self-Rating Depression Scale
The Zung Self-Rating Depression Scale was designed by Duke University psychiatrist Dr. William W.K. Zung to assess the level of depression for patients diagnosed with depressive disorder....
, 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 psychiatryDiagnostic classification and rating scales used in psychiatryThe following diagnostic systems and rating scales are used in psychiatry and clinical psychology.-Diagnostic Criteria:*Diagnostic and Statistical Manual of Mental Disorders *ICD-10 Chapter V: Mental and behavioural disorders...
- Diagnostic and Statistical Manual of Mental DisordersDiagnostic and Statistical Manual of Mental DisordersThe Diagnostic and Statistical Manual of Mental Disorders is published by the American Psychiatric Association and provides a common language and standard criteria for the classification of mental disorders...
- List of psychology topics
- Receiver operating characteristicReceiver operating characteristicIn signal detection theory, a receiver operating characteristic , or simply ROC curve, is a graphical plot of the sensitivity, or true positive rate, vs. false positive rate , for a binary classifier system as its discrimination threshold is varied...
External links
- 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 ContentsCurrent ContentsCurrent Contents is a rapid alerting service database from the Institute for Scientific Information, now part of Thomson Reuters, that is published online and in several different printed subject sections.-History:...
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, 2007. Accessed June 27, 2008.