What is the Hamilton Rating Scale for Depression?

Introduction

The Hamilton Rating Scale for Depression (HRSD), also called the Hamilton Depression Rating Scale (HDRS), abbreviated HAM-D, is a multiple item questionnaire used to provide an indication of depression, and as a guide to evaluate recovery.

Max Hamilton originally published the scale in 1960 and revised it in 1966, 1967, 1969, and 1980. 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.

The HRSD has been criticised for use in clinical practice as it places more emphasis on insomnia than on feelings of hopelessness, self-destructive thoughts, suicidal cognitions and actions. 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. Hamilton maintained that his scale should not be used as a diagnostic instrument.

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. 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.

Although Hamilton’s original scale had 17 items, other versions included up to 29 items (HRSD-29).

Unstructured versions of the HAM-D provide general instructions for rating items, while structured versions may provide definitions and/or specific interview questions for use. Structured versions of the HAM-D show more reliability than unstructured versions with informed use.

Levels of Depression

The UK National Institute for Health & Clinical Excellence (NICE) established the levels of depression in relation to the 17 item HRSD compared with those suggested by the American Psychiatrists Association (APA):

  • Not depressed: 0-7.
  • Mild (subthreshold): 8-13.
  • Moderate (mild): 14-18.
  • Severe (moderate): 19-22.
  • Very severe (severe): >23.

Other Scales

Other scales include:

What is the Zung Self-Rating Anxiety Scale?

Introduction

The Zung Self-Rating Anxiety Scale (SAS) was designed by William W. K. Zung M.D, (1929-1992) a professor of psychiatry from Duke University, to quantify a patient’s level of anxiety.

Background

The SAS is a 20-item self-report assessment device built to measure anxiety levels, based on scoring in 4 groups of manifestations: cognitive, autonomic, motor and central nervous system symptoms. Answering the statements a person should indicate how much each statement applies to him or her within a period of one or two weeks prior to taking the test. Each question is scored on a Likert-type scale of 1-4 (based on these replies: “a little of the time,” “some of the time,” “good part of the time,” “most of the time”). Some questions are negatively worded to avoid the problem of set response. Overall assessment is done by total score.

The Anxiety Index

The total raw scores range from 20-80. The raw score then needs to be converted to an “Anxiety Index” score using the chart on the paper version of the test that can be found on the link below. The “Anxiety Index” score can then be used on this scale below to determine the clinical interpretation of one’s level of anxiety:

  • 20-44: Normal Range.
  • 45-59: Mild to Moderate Anxiety Levels.
  • 60-74: Marked to Severe Anxiety Levels.
  • 75 and above: Extreme Anxiety Levels.

You can find an online version of the SAS here.

Refer to Zung Self-Rating Depression Scale and Taylor Manifest Anxiety Scale (TMAS).

PDF version of test with Raw Score-Index Score Conversion Table.

References

Zung, W.A.K. (1974). The Measurement of Affects: Depression and Anxiety. Modern Problems of Pharmacopsychiatry. 7(0), pp.170-188. doi: 10.1159/000395075.

Zung, W.A.K. (1971) A Rating Instrument for Anxiety Disorders. Psychosomatics. 12(6), pp.371-379. doi: 10.1016/S0033-3182(71)71479-0.

What is the Zung Self-Rating Depression Scale?

Introduction

The Zung Self-Rating Depression Scale (SDS) was designed by Duke University psychiatrist William W.K. Zung MD (1929-1992) to assess the level of depression for patients diagnosed with depressive disorder.

The Levels

  • 20-44: Normal Range.
  • 45-59: Mildly Depressed.
  • 60-69: Moderately Depressed.
  • 70 and above Severely Depressed.

The SDS has been translated into many languages, including Arabic, Azerbaijani, Dutch, German, Portuguese, and Spanish.

You can find an online version of the SDS here.

Refer to Zung Self-Rating Anxiety Scale.

Reference

Zung, W.A.K. (1965) A Self-Rating Depression Scale. Archives of General Psychiatry. 12(1), pp63-70.