Hamilton Depression Rating Scale

21 hours ago

Mercy Eke

Week 2 Discussion: Hamilton Depression Rating Scale


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Depression or Major Depressive Disorder is considered as a mental health disorder that negatively impacts how an individual feel, think and behave. Individuals who suffer from depression exhibit feelings of sadness and loss in interest in once enjoyed activities (Parekh. 2017). It can cause different kinds of emotional and physical problems and can minimize an individual’s ability to be functional in their daily routines. Annually, approximately 6.7% of adults are impacted by depression. It is estimated that 16.6% of individuals will experience depression at some time in their life (Parekh. 2017). Depression is said to manifest at any time, but on average, the first manifestation occurs during the late teens to mid-20s. The female population is susceptible to experience depression than the male population. Some research indicated that one-third of the female population would experience a major depressive episode in their lifetime (Parekh. 2017).

Among all the mental disorders, depression is one of the most treatable. It is estimated that between 80-90 % of individuals suffering from depression respond well to treatment and experienced remission of their symptoms (Parekh. 2017). As a mental health professional, prior to deciphering diagnosis and initiating diagnosis, it is paramount to conduct a complete diagnostic evaluation, which includes an interview and, if necessary, a physical examination (Parekh. 2017). Blood tests can be conducted to ascertain that depression is not precipitated by a medical condition like thyroid dysfunction. The evaluation is to identify specific symptoms, medical and family history, cultural factors, and environmental factors to derive a diagnosis and establish a treatment plan (Parekh. 2017). One of the assessment tools for depression is the Hamilton Depression Rating Scale. In this discussion, I will be discussing the psychometric properties of the Hamilton Depression Rating Scale and elaborate on when it is appropriate to utilize this assessment tool with clients, including whether the tool can be utilized to evaluate the efficacy of psychopharmacologic medications.

The Hamilton Depression Rating Scale (HDRS) was introduced in early 1960. It has been considered as a gold standard in depression studies and a preferred scale in the evaluation of depression treatment. It is the most vastly utilized observer-rated depression scale worldwide (Vindbjerg.et.al., 2019). The HDRS was initially created to measure symptoms severity in depressed inpatient; however, the 17-item HAM-D has advanced in over five decades into 11 modified versions that have been administered to various patient populations in an array of psychiatric, medical, and other research settings (Rohan.et.al., 2016). There are two most common versions with either 17 or 21 items and is scored between 0-4 points. Each item assists mental health professionals or clinicians to identify the one “cue,” which best characterizes the patient. Administration time is 20-30 minutes for the 17-item measure. The first 17 items assess the severity of depressive symptoms (Sharp. 2015). The remaining four items on the extended 21-point scale assess factors that might be related to depression but are not thought to be measures of severity, such as paranoia or obsessional and compulsive symptoms. The scoring is based on the 17-item scale, and scores of 0–7 indicate normal, 8–16 indicate mild depression, 17–23 moderate depression and counts over 24 are indicative of severe depression; the maximum score being 52 on the 17-point scale (Sharp. 2015). The study of the HDRS conducted by Bagby and colleagues, examined the psychometric properties of the 17-item version across 70 reviews, including reliability, item-response characteristics, and validity of the measure (Rohan.et.al., 2016). The results indicated sufficient reliability (internal, inter-rater, and retest safety) and efficacy (convergent, discriminant, and predictive validity) (Rohan.et.al., 2016).

Whenever clinicians are trying to select an assessment tool, it is paramount that they ask if it is appropriate to use with the client and what it actually measures (Bosley. 2017). It is essential to recognize that every assessment tool has associated positive and negative aspects. When deciding whether to utilize this assessment or another depression assessment tool, it is crucial to consider the cultural and diversity aspects of the client. As mentioned above, HDRS is the best or appropriate assessment tool that is utilized to measure depression severity in a patient; however, it is not supposed to be a diagnostic tool for depression. As clinicians, we will not be able to effectively help the client if we are not able to assess their severity level (Bosley. 2017). It is a great tool, and it is appropriate for clinicians to utilize during the therapeutic process (Bosley. 2017).

Since the introduction of antidepressants into psychopharmacology in the 1960s, the HDRS has been the most frequently utilized rating scale for depression in monitoring medication efficacy (Bech. 2006). It is also used as a scale for prediction of outcome with antidepressants. The HAM-D total score has obtained limited use analogous to the DSM-IV diagnosis of major depression (Bech. 2006).


Bech, P. (2006). Rating scales in depression: limitations and pitfalls. Dialogues in clinical neuroscience, 8(2), 207.

Bosley, D. (2017). Using the Hamilton Depression Rating Scale: A Case Study on Grief. Retrieved from: https://psychologydictionary.org/article/assessments/

Parekh, R (2017). What is depression? Retrieved from: https://www.psychiatry.org/patients-families/depression/what-is-depression

Rohan, K. J., Rough, J. N., Evans, M., Ho, S. Y., Meyerhoff, J., Roberts, L. M., & Vacek, P. M. (2016). A protocol for the Hamilton rating scale for depression: item scoring rules, rater training, and outcome accuracy with data on its application in a clinical trial. Journal of affective disorders, 200, 111-118.

Sharp, R. (2015). The Hamilton rating scale for depression. Occupational Medicine, 65(4), 340-340.

Vindbjerg, E., Makransky, G., Mortensen, E. L., & Carlsson, J. (2019). Cross-cultural psychometric properties of the Hamilton Depression Rating Scale. The Canadian Journal of Psychiatry, 64(1), 39-46.



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