Hamilton Depression Rating Scale HAM-D
Hamilton Depression Rating Scale HAM-D overview
Creator and Context
The Hamilton Depression Rating Scale (HAM-D, also HDRS) is the longest serving clinician rated measure of depression severity, published by Max Hamilton in 1960 and revised in 1967.
The 17 item version is the scoring standard. Longer 21 and 24 item versions also circulate. It remains the reference outcome measure in a large part of the antidepressant trial literature.
Presenting Conditions
The items cover depressed mood, guilt, suicide, insomnia across the night, work and activities, retardation, agitation, psychic and somatic anxiety, gastrointestinal and general somatic symptoms, genital symptoms, hypochondriasis, weight loss and insight.
There are no official subscales, although researchers have derived several.
Administration
Clinician administered as a semi structured interview, covering the past 7 days. Items use mixed scales: on the 17 item version nine items are rated 0 to 4 and eight are rated 0 to 2.
Structured administration guides such as the SIGH-D and GRID-HAMD exist precisely because unstructured administration produces poor inter rater reliability.
Desired Audience
Adults already diagnosed with depression. It is a severity measure, not a diagnostic screener.
Six decades of antidepressant trials are denominated in HAM-D points. If you need to place a patient or a service against that literature, this is the instrument that speaks its language.
Considerations
It is clinician rated. Deploying it as a client self report is a category error.
Version confusion is rampant. The 17, 21 and 24 item versions are not interchangeable. Always state which version is in use.
The scale is heavily weighted towards insomnia and somatic and anxiety items, and captures atypical depression poorly.
Inter rater reliability depends on structured administration and rater training.
Two competing sets of severity bands circulate. The empirically derived set (Zimmerman et al., 2013) is the more defensible.
How to score the Hamilton Depression Rating Scale HAM-D
Conducting the assessment
The clinician rates each item based on the interview, using the item specific 0 to 4 or 0 to 2 scale.
Interpretation
The 17 item version scores 0 to 52.
The empirically derived severity bands (Zimmerman et al., 2013), which were selected to maximise sensitivity and specificity:
0 to 7 no depression
8 to 16 mild
17 to 23 moderate
24 and above severe
A conventional legacy banding also circulates widely, but its provenance is not traceable to an authoritative primary source. Where a citable standard is needed, use the Zimmerman bands.
A reduction of 50 percent or more from baseline is the conventional definition of treatment response.
Clinical Considerations
Use a structured interview guide. Without one, inter rater reliability is poor and scores are not comparable.
Read the suicide item on its own, every time.
State the version and the banding scheme wherever the score is reported.
Hamilton Depression Rating Scale HAM-D use cases
Measuring depression severity in adults with a diagnosis
Tracking response to antidepressant treatment
Establishing remission
Clinical trials and comparison against the trial literature
Category
Depression
Research Summary
Hamilton, M. (1960). A rating scale for depression. Journal of Neurology, Neurosurgery, and Psychiatry, 23(1), 56 to 62.
Zimmerman, M., Martinez, J. H., Young, D., Chelminski, I., & Dalrymple, K. (2013). Severity classification on the Hamilton Depression Rating Scale. Journal of Affective Disorders, 150(2), 384 to 388.
Trajkovic, G., Starcevic, V., Latas, M., et al. (2011). Reliability of the Hamilton Rating Scale for Depression: A meta analysis over a period of 49 years. Psychiatry Research, 189(1), 1 to 9.
Other Assessment Guides
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Patient Health Questionnaire PHQ-9
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Note on Assessment licensing
Some assessments are copyright protected and require a licence or the copyright holder's permission for clinical, commercial or digital use. Where that applies, obtaining and maintaining that permission is the responsibility of the practice or organisation using the assessment. Tacklit provides the digital administration, scoring and reporting. We do not grant, transfer or supply rights to the underlying instrument.
