If we talk about depression, we are talking about one of the most prevalent and well-known mental disorders worldwide, causing a high level of suffering in those who suffer from it. Throughout history, a large number of tools and instruments have been developed to evaluate the existence and effect of this problem. One of them is the Hamilton Depression Scale .

The Hamilton Depression Scale: key features

The Hamilton Depression Scale is an assessment instrument designed by Max Hamilton and published in 1960, created to serve as a method of detecting the severity of depression symptoms in previously diagnosed patients , as well as the existence of changes in the patient’s condition over time. Thus, its main objectives are the assessment of said severity, the evaluation of the effects of possible treatments on each of the components it evaluates and the detection of relapses.

This means that the Hamilton Depression Scale is not intended for diagnosis, but for the assessment of the condition of patients who have previously been diagnosed with major depression. However, despite this being its original purpose, it has also been applied to assess the presence of depressive symptoms in other problems and conditions, such as dementia.

Structure and scoring

This instrument consists of a total of 22 items (although the initial one was 21 and later a reduced version of 17 was also developed), grouped into six main factors. These items consist of an element that the subject has to assess on a scale ranging from zero to four points. Among these items we find mainly different symptoms of depression, such as feelings of guilt, suicide, agitation, genital symptoms or hypochondria, which will end up being assessed in the six factors mentioned above.

Specifically, the factors in question are the assessment of somatic anxiety, weight (it should not be forgotten that in depression the presence of eating disorders is frequent), cognitive impairment, diurnal variation (if there is a worsening of the day for example), slowdown, and sleep disturbances. However not all these factors have the same importance , with the different aspects having a different weight and being weighted differently in the score (for example cognitive impairment and slowing down are valued more and agitation and insomnia less).

This is a scale initially designed to be applied externally by a professional, although it is also possible to fill in the scale by the subject being assessed. In addition to the scale itself, which is filled in during a clinical interview , external information can also be used, such as that from relatives or from the environment as a complement.

Interpretation

The interpretation of this test is relatively simple. The total score ranges from 0 to 52 points (this being the maximum score), with most of the items having five possible answers (from 0 to 4) with the exception of some items with a lower weighting (which range from 0 to 2).

This total score has different cut-off points, considering that 0-7 means that the subject does not present depression, that a score of 8-13 means that there is a slight depression, 14-18 means that there is moderate depression, 91-22 means that there is severe depression and over 23 means that there is a very severe depression and a risk of suicide.

When assessing not the severity of the depression but the existence of changes due to different aspects, among them a possible treatment , it must be taken into account that a response to it is considered to have occurred if there is a decrease of at least 50% of the initial score, and a remission with scores lower than 7.

Advantages and disadvantages

Compared to other tests that assess depressive symptoms, the Hamilton Depression Scale has the advantage of assessing non-cognitive elements that other scales do not usually take into account, in addition to illiterate or otherwise disturbed subjects.

However, it also has certain drawbacks: technically it does not allow for diagnosis as it is not designed for this purpose (although it does allow for the evaluation of altered aspects in depression) and it gives excessive weight to somatic aspects that can be confused with independent medical problems. Moreover, in its original version it does not include such relevant elements as anhedonia (since it was developed before the emergence of the DSM-III diagnostic criteria).

Bibliographic references

  • Hamilton, M. (1960). A rating scale for depression. J Neurol Neurosurg Psychiatry,23: 56-62.
  • NICE (2004). Depression: management of depression in primary and secondary care- NICE guidance.
  • Purriños, M.J. (n.d.) Hamilton Depression Rating Scale (HDDRS). I serve as an epidemiologist. Dirección Xeral de Saúde Pública. Galician Health Service.
  • Sanz, L.J. and Álvarez, C. (2012). Evaluation in Clinical Psychology. Manual CEDE de Preparación PIR. 05. CEDE: Madrid.