NINDS CDE Notice of Copyright
Hamilton Depression Rating Scale (HDRS)
The instrument is freely available here: Hamilton Depression Rating Scale.
Supplemental-Highly Recommended: Parkinson’s Disease (PD)
Supplemental: Mitochondrial Diseases (Mito)
Exploratory: Amyotrophic Lateral Sclerosis (ALS)
Short Description of Instrument
Background: This measure is considered the gold standard in depression research and is widely used. It is common in antidepressant drug trials.
Construct measured: This rater-administered instrument is the most widely used rating scale in depression research. There are semi-structured versions available. It is in the public domain and available in many languages.
Generic vs. disease specific: Generic.
Means of administration: Semi-structured interview completed by trained interviewer.
Intended respondent: Patient.
# of items: 21 items.
# of subscales and names of sub-scales: N/A.
# of items per sub-scale: N/A.
Administration time: 20-30 minutes.
Strengths: Widely used, items somewhat consistent with diagnostic criteria for Major Depressive Disorder, considered the gold standard in antidepressant trials for diagnosis of depression.
Weaknesses: There are no publications on use of this scale in ALS studies. Several items assess somatic symptoms (psychomotor retardation, anxiety: somatic, somatic: GI, somatic: general, genital symptoms, hypochondriasis, loss of weight) which may result in over-diagnosis of depression.
Specific to Mitochondrial Disease:
Advantages: Fairly brief, reliable measure of depressive symptomotology. Widely used and reliable
Limitations: The instrument has not been specifically used in studies with mitochondrial disorders. Several items tap somatic symptoms which may be elevated as a consequence of mitochondrial disorder rather than specific to depression, nad cut scores must therefore be used with caution in populations with co-occuring physical symptoms (Reijinders et al, 2010; Bech et al., 2014)
Scoring: Scores range from 0 – 54, with higher scores indicating increasing severity of depression. Scoring is completed by a trained interviewer.
Psychometric Properties
Feasibility: Low feasibility, requires trained interviewer and 20-30 minutes of interview.
Reliability: Less than optimal since completed by interviewer which may result in variability.
Validity: As sensitive to detecting effect size in clinical trials as Montgomery- Asberg Depression Rating Scale and Clinical Impressions Rating Scale.
Sensitivity to Change: Santen found that not all items of the Hamilton Depression (HAM-D) are equally sensitive to detect responding patients in a clinical trial.
Hamilton M. A rating scale for depression. J Neurol Neurosurg Psychiatry. 1960 Feb;23:56–62.
Hamilton M. Development of a rating scale for primary depressive illness. Br J Soc Clin Psychol. 1967;6(4):278–296.
Other References:
Bech P, Allerup P, Larsen ER, Csillag C, Licht RW. The Hamilton Depression Rating Scale (HAM-D) and the Montgomery-Asberg Depression Scale (MADRS). A psychometric re-analysis of the Europena Genome-Based Therapeutic Drugs for Depression Study using Rasch analysis. Psych Res. 2014;217:226–232.
Reijnders JSAM, Lousberg R, Leentjens AFG. Assessment of depression I Parkinson's disease: the contribution of somatic symptoms to the clinimetric performance of the Hamilton and Montgomery-Asberg rating scales. J Psychosomatic Res. 2010;68:561–565.
Santen G. Sensitivity of the individual items of the Hamilton depression rating scale to response and its consequences for the assessment of efficacy. J Psychiatr Res. 2008;42(12):1000–1009.
Williams JB. A structured interview guide for the Hamilton Depression Rating Scale. Arch Gen Psychiatry. 1988;45(8):742–747.
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