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- 30 - Jan - 2023
- by Ruma Choudhury
A review of the Hamilton Rating Scale for Depression and how it can be used effectively in clinical settings.
The Hamilton rating scale for depression is often abbreviated as HRSD, HDRS, or Ham-D. It was first proposed by Max Hamilton in late 1950 who was a psychiatrist at Leeds University. It was designed to analyze the performance level of ongoing antidepressant medications. This rating scale is still in use and its use is widespread in the examination of antidepressant medicines i.e. how much the particular antidepressant medication is effective in the ongoing clinical trial. From its initial use for around 40 years, It was considered to be the ‘gold standard’ but in the later 1990s, questions began to arise against its use.
For the administration of the Hamilton Rating Scale For Depression, the questionnaire is set for the patient who is in a state of depression after the clinical examination of the patient. As per Max Hamilton, "no specific questions needed to be asked during an unstructured interview in a health care setting. And the value of the questionnaire depends entirely on the skill of the interviewer." As described by Max Hamilton, this session takes about 15-20 minutes to complete. But if it is done practically, the time period may vary from person to person.
This scale is easily available and is used with two different versions of this scale. One is with 17 items and the other is with 21 items. The score is rated between 0 and 4. The 17 items on the first are used to measure the severe condition of depression and the level of depression in the patient i.e. how severe is the depression in the particular patient. The interviewer asks many pre-defined set of questionnaires from the patient and which are used to analyze the behavior of the patient, how he is affected by putting various circumstances, how much is the level of mood change or mood swings, how their mood swings are affecting their work performance at the job.
The remaining four items are used to measure factors affecting the depression level in the patient. They are not the measure of severity of depression, paranoia, or obsessional and compulsive symptoms. The final score is observed on 17 point rating scale where 0-7 is considered as normal, 8-16 depicts a mild depression state, 17-23 depicts moderate depression and a score arising above 24 depicts a state of severe depression. The maximum point on this scale is 52.
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Many studies are conducted to evaluate the performance of this rating scale and the studies suggested that the estimates of internal, inter-rater, and retest reliability are enough for the global score but when it comes to individual items, it is weaker. Studies further suggested that, "inter-rater reliability is affected by the level of training undertaken by the interviewer and whether a structured interview guide is provided". When it is compared to the Beck Depression Inventory, the meta-analysis suggested that "after therapeutic treatments, the HRSD was more ‘sensitive to change’ on retesting and this is probably why it has been so widely used in clinical trials."