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Hamilton Depression Rating Scale (HDRS)
Availability
The instrument is freely available here: Hamilton Depression Rating Scale
Classification
NeuroRehab Supplemental - Highly Recommended

Recommendations for Use: Indicated for studies requiring a measure of psychological status.
 
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.
Comments/Special Instructions
NeuroRehab Specific: Historical "gold standard" measure but does not correspond to current diagnostic nomenclature and may lack sensitivity to change especially in patients with comorbid medical or neurological conditions. Designed to be administered by trained clinician.
Scoring and Psychometric Properties
Scoring: Scores range from 0 - 54, with higher scores indicating increasing severity of depression. Scoring is completed by a trained interviewer.
 
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.
Scoring
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.
Rationale/Justification
Specific to Mitochondrial Disease:
 
Advantages: Fairly brief, reliable measure of depressive symptomatology. 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)
References
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.
 
Document last updated January 2022