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Hamilton Depression Rating Scale
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About Hamilton Depression Rating Scale
Scale Name
Hamilton Depression Rating Scale also known as Hamilton Rating Scale for Depression
Author Details
Max Hamilton
Translation Availability
English
Background/Description
The Hamilton Depression Rating Scale (HDRS), developed by Max Hamilton in 1960, is a seminal clinician-rated tool designed to assess the severity of depression in adults. First published in the Journal of Neurology, Neurosurgery, and Psychiatry, the HDRS was created to standardize the evaluation of depressive symptoms in clinical settings, particularly for patients already diagnosed with depression. It has since become one of the most widely used depression scales in psychiatric research and practice, valued for its ability to measure symptom intensity and track treatment response.
The HDRS originally featured 17 items (HDRS-17), though versions range from 7 to 29 items, each scored variably (e.g., 0-2 or 0-4) based on symptom presence and severity over the past week. Total scores for the HDRS-17 range from 0 to 52, with thresholds like 7-17 indicating mild, 18-24 moderate, and 25+ severe depression. Items cover mood, guilt, suicidal ideation, insomnia, and somatic symptoms, assessed via a semi-structured interview. Taking about 20-30 minutes, the HDRS is administered by trained clinicians, with structured interview guides (e.g., Williams, 1988) enhancing reliability. Its extensive translations and adaptations, like the HDRS-7 for remission (McIntyre et al., 2003), ensure its global relevance.
Administration, Scoring and Interpretation
The following are some tips for administering the HAM-D:
- Obtain the copy: Access the HDRS from its original publication in Hamilton (1960) via Journal of Neurology, Neurosurgery, and Psychiatry or authorized clinical resources, often with a structured guide.
- Explain the purpose: Inform the clinician (and indirectly the patient) that the scale measures depression severity to guide diagnosis, treatment, or research outcomes.
- Provide instructions: Instruct the clinician to rate each item based on a semi-structured interview and observation, using the provided scales, and follow a standardized guide if available.
- Approximate time: Allow approximately 20-30 minutes for the interview and scoring, depending on the version and patient presentation.
- Administer the scale: Conduct the assessment in a clinical setting, observing the patient’s behavior and responses during the interview, and record scores systematically.
Reliability and Validity
The Hamilton Depression Rating Scale exhibits strong psychometric properties, as established in Hamilton (1960) and refined over decades. Inter-rater reliability is high with training, with intraclass correlation coefficients (ICC) ranging from 0.80 to 0.90, per Williams (1988), ensuring consistency across clinicians. Test-retest reliability yields coefficients around 0.81-0.89 over short intervals in stable patients, reflecting dependable measurement.
Validity is robustly supported. Concurrent validity is shown through strong correlations (r = 0.65-0.85) with the Beck Depression Inventory and Montgomery-Åsberg Depression Rating Scale. Content validity aligns with core depressive symptoms, though its somatic focus has been critiqued for overlap with physical illness. Discriminant validity distinguishes HDRS scores from mania scales, and its sensitivity to change, evidenced in antidepressant trials (McIntyre et al., 2002), makes it a gold standard for assessing remission and response, as with the HDRS-7 (McIntyre et al., 2003).
Available Versions
31-Items
21-Items
17-Items
7-Items
Reference
- Hamilton, M. (1960). A rating scale for depression. Journal of Neurology, Neurosurgery, and Psychiatry, 23(1), 56-62.
- Williams, J. B. (1988). A structured interview guide for the Hamilton Depression Rating Scale. Archives of General Psychiatry, 45(8), 742-747.
- McIntyre, R., Kennedy, S., Bagby, R. M., & Bakish, D. (2002). Assessing full remission. Journal of Psychiatry & Neuroscience, 27(4), 235-239.
- McIntyre, R. S., Fulton, K. A., Bakish, D., Jordan, J., & Kennedy, S. H. (2003). The HAM-D7: A brief depression scale to distinguish antidepressant response from symptomatic remission. Primary Psychiatry, 10(1), 39-42.
Important Link
Scale File:
Frequently Asked Questions
What is the HAM-D?
A 21-item clinician-rated scale used to measure the severity of depressive symptoms.
Who developed the HAM-D?
Max Hamilton, an English psychiatrist.
How is the HAM-D scored?
On a scale of 0 to 5, with 0 indicating no symptoms and 5 indicating the most severe symptoms.
What is the total score range for the HAM-D?
0 to 100, with higher scores indicating more severe depression.
What are the 7 categories of the HAM-D?
Depressed mood, feelings of guilt, suicide ideation, insomnia, agitation or retardation, anxiety, somatic symptoms, insight.
How long does it take to administer the HAM-D?
About 30 minutes.
Is the HAM-D reliable and valid?
Yes, it is a reliable and valid measure of depression.
What are some alternatives to the HAM-D?
The Beck Depression Inventory (BDI), the Patient Health Questionnaire-9 (PHQ-9), and the Montgomery-Åsberg Depression Rating Scale (MADRS).
What does the HDRS measure?
It measures the severity of depressive symptoms in adults.
How many items are in the HDRS?
The standard HDRS-17 has 17 items; versions vary from 7 to 29.
Who developed the HDRS?
It was developed by Max Hamilton in 1960.
How long does it take to complete the HDRS?
It takes about 20-30 minutes via clinical interview.
What is a severe depression score on the HDRS-17?
A score of 25 or higher indicates severe depression.
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