Hamilton Depression Rating Scale

Major Depressive Disorder involves a depressed mood, loss of pleasure, and changes in overall functioning (American Psychiatric Association, 2013).   Other symptoms associated with this diagnosis include weight loss, psychomotor changes, fatigue, feelings of worthlessness, and difficulty concentrating (American Psychiatric Association, 2013).   Hays, (2013), states that “the lifetime prevalence of major depressive disorder [is] estimated to be 17% in the general population” (p151).   Max Hamilton originally published The Hamilton Rating Scale in 1960 (Hamilton, 1960). This scale was initially intended as a tool to guide interview assessments for individuals diagnosed with either depression or affective disorders (Hamilton, 1960). Its main purpose is to assess the intensity and frequency of depressive symptoms (Hays, 2013). This assessment is “highly effective in differentiating individuals diagnosed with clinical depression from non-depressed individuals” (Hays, 2013, p153).   A free online version of this tool has been provided for this assignment and will be reviewed next. (Hamilton Rating Scale for Depression, n.d.).

My First Impression

In order to form a good overall impression of this tool’s usefulness, I utilized insights from the DSM-5 manual on Major Depressive Disorder (MDD).   The questions within this assessment appeared to correlate directly with diagnostic criterion for MDD (Hamilton Rating Scale for Depression, n.d.). Additionally, a resource titled “Structured Interview Guide for The Hamilton Depression Rating Scale”, showed me how these issues could be reviewed in a therapy session (Williams, 1988). Below, I discuss my impressions of this tool by referring to the criteria for MDD while utilizing insights from the interview guide mentioned above (American Psychiatric Association, 2013, p161; Williams, 1988).

  1. Criterion A1: Depressed Mood: The Hamilton Rating Scale uses two questions to assess mood. The first question asks respondents to rate the presence of a depressed mood (Hamilton Rating Scale for Depression, n.d.). Question eighteen indirectly addresses the issue of mood, by asking about symptomatic variations occurring throughout a day (Hamilton Rating Scale for Depression, n.d.). Williams (1988), suggests that the quality and variation of mood symptoms are key indicators of MDD.
  2. Criterion A2: Diminished Loss of Pleasure: The DSM-5 lists the loss of pleasure as a symptom of depression (American Psychiatric Association, 2013). Question seven, of the Hamilton Assessment asks respondents to rate changes in their level of participation and involvement (Hamilton Rating Scale for Depression, n.d.). This question manages to address criterion A2 only indirectly. Therefore, a therapist would need to assess for a loss of pleasure in activities previously experienced as enjoyable, in a follow-up interview (Williams, 1988).
  3. Criterion A3: Significant Weight Loss The DSM-5 describes significant changes in weight without dieting as another symptom of MDD (American Psychiatric Association, 2013). The Hamilton Inventory addresses this in question sixteen (Hamilton Rating Scale for Depression, n.d.).
  4. Criterion A4: Insomnia or Hypersomnia – A relatively significant portion of the Hamilton Depression Inventory addresses the issue of sleep problems associated with MDD (Hamilton Rating Scale for Depression, n.d.).   Three out of twenty-one questions in the Hamilton Rating Scale are devoted to assessing sleep patterns (Hamilton Rating Scale for Depression, n.d.). I find this fact perplexing.
  5. Criterion A5: Psychomotor Changes: The Hamilton Rating Scale addresses this criterion in questions eight and nine (Hamilton Rating Scale for Depression, n.d.).   Additionally, the questions appear to correlate very well with DSM-5 Criteria.
  6. Criterion A6: Loss of Energy – The DSM-5 manual addresses somatic symptoms associated with MDD briefly in Criterion A6 which refers to a loss of energy (American Psychiatric Association, 2013). Nonetheless, the Hamilton Rating Scale devotes questions twelve through sixteen to assessing a diversity somatic symptoms (Hamilton Rating Scale for Depression, n.d.). I surmise this can indicate potential medical causes underlying depressive episodes.
  7. Criterion A7: Guilt & Feeling of Worthlessness – The DSM-5 manual describes “feelings of worthlessness and excessive or inappropriate guilt” (American Psychiatric Association, 2013, p161) as a symptom of MDD. The Hamilton Depression Inventory assesses this issue briefly in question two, which asks respondents to rate feelings of guilt (Hamilton Rating Scale for Depression, n.d.). Williams (1988) suggests asking clients: “Have you been putting yourself down this past week, feeling you’ve done things wrong, or let others down” (p5). This may be a nice follow up question upon completion of the assessment.
  8. Criterion A8: Concentration & Decision Making – The DSM-5 lists deficiencies in concentration and decision making as key symptoms of MDD (American Psychiatric Association, 2013). Nonetheless the Hamilton Rating Scale, fails to address this issue altogether (Hamilton Rating Scale for Depression, n.d.). Williams (1988) suggests asking questions such as: “Were you able to focus on what you were doing?…Did you notice that minor decisions were more difficult to make than usual?” (p8). These questions might be helpful to assess for this factor in a post-assessment interview.
  9. Criterion A9: Suicidal ideation – The DSM-5 lists “recurrent thoughts of…suicidal ideation” (American Psychiatric Association, 2013, p161) as a symptom of MDD. Question three of the Hamilton Rating Scale briefly assesses the presence of suicidal thoughts (Hamilton Rating Scale for Depression, n.d.). In my opinion, a more thorough assessment of this issue should be included after completion of this assessment. For example, Williams (1988) suggests asking: “This past week, have you had thoughts that life is not worth living? What about thinking you’d be better off dead or wishing you were dead? Have you had thoughts of hurting or killing yourself?” (p4)
  10. Questions Related to Specifiers & Comorbidities: Several questions remain in the Hamilton Rating Scale, do not pertain to diagnostic criterion for MDD (Hamilton Rating Scale for Depression, n.d.). These questions assess for symptoms of anxiety, insight, paranoia, OCD, alongside Depersonalization and Derealization (Hamilton Rating Scale for Depression, n.d.). These symptoms correlate with MDD diagnostic specifiers and comorbid diagnoses (American Psychiatric Association, 2013).

References

American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). Washington, DC: Author.

Hamilton, M. (1960). A rating scale for depression. Journal of Neurology, Neurosurgery, and Psychiatry23(1), 56-62.
Hamilton Rating Scale for Depression (n.d.) Retrieved from: http://healthnet.umassmed.edu/mhealth/HAMD.pdf
Hays, D.G. (2013). Assessment in counseling a guide to the use of psychologicalassessment procedures (5th Ed.). Belmont, CA: Brooks/Cole, Sengage Learning.
Williams, J. B. (1988). A structured interview guide for the Hamilton Depression Rating Scale. Archives of General Psychiatry45(8), 742-747.

Share This: